Announcing a diagnosis of leukemia is a difficult process, especially for a vulnerable population of children.

Determine the attitude of caregivers in the announcement of diagnosis of leukemia among children.

A cross-sectional study was conducted at Aziza Othmana hospital department of haematology in Tunisia between June and July 2021.

We have questioned the mothers about the announcement of the diagnosis of leukemia to their children.

We included 31 children with leukemia, 71% of these children were male. Their average age was 10 years ±4.5 with extremes from 4 to 17 years of age.

The majority of the children (80.6%) were of school age. The three children who were six years old were not able to integrate into a school and fifteen children stopped their studies because of their disease.

Acute lymphoblastic leukemia was the most frequent type of cancer (94%).

Fifty five per cent (55%) of these children were not informed of their disease according to their mothers.

The provision of adapted information, through individualized assessments of each child’s needs, can contribute to the improvement of the child’s experience of the disease.

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Bladder cancer, which is primarily a non-muscle invasive bladder cancer (NMIBC), is prevalent worldwide and its incidence is increasing. NMIBC shows a high recurrence rate of 50-70%, and in 25% of cases, progresses to muscle-invasive disease (Saginala K et al. Med Sci 2020; 15) (Fernandez-Gomez, J et al. J Urol 2009; 182(5) 2195-2203). Frequent recurrence and consecutive medical interventions in patients with NMIBC lead to psychological problems such as anxiety, fear of recurrence, depression, and stress, resulting in reduced quality of life (Chung et al. Support Care Cancer 2019; 27(10), 3877-3885). It is expected that the increased accessibility and convenience of mobile health (mHealth) will be effective in providing a mobile-based psychological intervention program to promote the mental health of patients with NMIBC.

This study aims to develop a mobile-based mental health improvement program for NMIBC patients, design a protocol for evaluating feasibility, and provide preliminary evidence of the efficacy of the developed program.

The program content was developed based on the results of a needs assessment conducted among patients with NMIBC through a cross-sectional study. The draft program was prepared by referring to the guidelines of the National Comprehensive Cancer Network and publications of the International Continence Society. Based on the developed draft, two professors of nursing, a professor of counseling psychology, a registered nurse, and a counseling practitioner verified the validity of the content before finalizing the program. The final version of the developed program consisted of one session on NMIBC knowledge and symptom management and five sessions on mental health improvement. Researchers sent an online link to the YouTube video comprising lecture materials and voice recordings of health professionals weekly using a mobile messenger (Kakao Talk) (Image 1). The topics of each session were as follows: Session 1 (Understanding of bladder cancer and treatment), Session 2 (Understanding and respecting myself), Session 3 (Maintaining reasonable thoughts and positive emotions), Session 4 (Benefits of positive emotions and healthy communication), Session 5 (Living in a healthy way through stress management), and Session 6 (Finding happiness and meanings in daily life).

The protocol for evaluating the feasibility of the developed program is outlined in Image 2.

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The feasibility of the mental health improvement program for patients with NMIBC based on mobile messenger (KakaoTalk) will be evaluated through the developed protocol. Moreover, by introducing a program that reflects the feasibility of test results into practice, the results of this study can contribute to improving the quality of life of patients with NMIBC.

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Though the evidence regarding the psychotherapeutic and drug treatment of borderline personality disorder (BPD) is rapidly accumulating, with more then 120 randomised controlled trial on the clinical treatment being availabe currently, no evidence-based guidelines existed as yet in Germany. This talk will present the first German evidence-based clinical guidelines for BPD.

In this talk the German evidence-based clinical guidelines for borderline personality disorder will be presented, and focuses and important recommendations highlighted.

A diverse, multidisciplinary panel, including members with research and clinical expertise in the treatment and care of individuals with BPD as well as representatives of persons with lived experience and their relatives, has developed the first evidence-based German treatment guidelines for BPD. The Australian NHMRC and the British NICE guidelines were used as source guidelines and adapted, based on the findings of updated literature searches. All recommendations were consented in an independently moderated, formalised consensus process. Special attention was paid to the management of financial and non-financial conflicts of interest.

The guidelines support the early detection and treatment of BPD and recommend that the diagnosis be made in adolescents from the age of twelve years on. Disorder-specific psychotherapies, i.e. structured psychological therapies that are specifically designed for people with BPD, are recommended as the first-line treatment for BPD. If the primary focus is the treatment of self-harm, Dialectical Behaviour Therapy or Mentalisation-Based Treatment are recommended. Drug treatment should only be considered if in crisis psychological interventions do not suffice and should be withdrawn as early as possible. Besides, drug treatment may only have a role if required for the treatment of comorbid psychic disorders. The guidelines also recommend educating significant others of the person concerned about the disorder and including them in the development of crisis plans. It is also recommended to offer support to relatives, especially if they are children or adolescents. Also, the role of individuals with BPD who are parents is considered, and early support to foster parenting skills and attachment relationships is recommended.

The first evidence-based German guidelines on BPD are now available and will help to ameliorate the health care of persons with a diagnosis of BPD. The publication of an English version is impending.

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borderline personality disorder, which is characterized by major impulsivity and marked instability of emotions, interpersonal relationships and self-image, may be associated with traits such as grandiosity, sense of entitlement, exploitation of others, over-reliance on the admiration of others to regulate self-esteem arrogant and haughty behaviors, exhibitionism and lack of empathy, traits belonging to the narcissistic personality disorder, thus modifying the clinical expression, influencing the occurrence of possible additional comorbidities and complicating both the diagnostic approach, the therapeutic strategy, the possible complications and the prognosis.

to shed light on this combination, its characteristics, its manifestations and clinical implications and its therapeutic approaches

We have performed a systematic review of litterature using the following keywords on the GoogleScholar and PUBMED database: borderline personality disorder subtypes, borderline personality disorder comorbidities; borderline and narcissic comorbidity; borderline treatment

The authors have noted that patients meeting both borderline and narcissistic personality disorder criteria are significantly less likely to be hospitalized in psychiatric facilities and have fewer psychiatric comorbidities than those with borderline personality disorder alone, particularly anxiety disorders.

In contrast to the rarity of psychiatric complications, the authors noted that patients with both borderline and narcissistic personality criteria were more likely to exhibit other pathological personality traits, including schizotypal, histrionic and paranoid.

The authors have noted that patients meeting both borderline and narcissistic personality disorder criteria are significantly less likely to be hospitalized in psychiatric facilities and have fewer psychiatric comorbidities than those with borderline personality disorder alone, particularly anxiety disorders.In contrast to the rarity of psychiatric complications, the authors noted that patients with both borderline and narcissistic personality criteria were more likely to exhibit other pathological personality traits, including schizotypal, histrionic and paranoid.

The combination of narcissistic personality traits and borderline personality disorder has a significant impact on clinical manifestations, complications and prognosis, which is seen positively with a decrease in psychiatric complications, self-harm and suicide attempts, hence the rarity of hospitalization compared to subjects with borderline personality disorder, thus classifying narcissistic personality traits as a protective factor for subjects with borderline personality disorder.

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Official classification of personality disorders (PDs) has witnessed a significant shift from traditional categorical to more dimensional diagnostic perspective in the recently published International Classification of Diseases - 11th Revision (ICD-11).

The goal of this preliminary study was to explore the clinical use (i.e., diagnostic validity) of the newly constructed, as well as recently adapted to Croatian language, self-report measures of the ICD-11 PD severity and personality trait domains.

This study was carried out in a sample of 363 psychiatric patients (54% female, mean age 46 years) who were being treated at Department of Psychiatry and Psychological Medicine of the University Hospital Center Zagreb and the University Psychiatric Clinic Sveti Ivan, Zagreb, Croatia. Patients were divided into two groups: 98 patients with the diagnosis of PD (‘’PD group”) based on the ICD-10 criteria and 265 patients with other psychiatric disorders (‘’non-PD group”) (43% anxiety disorders, 31% affective disorders, 16% psychotic disorders, and 10% substance use disorders). They filled out the following scales that were developed according to the ICD-11 PD guidelines: the Personality Disorder Severity ICD-11 (PDS-ICD-11) scale and the Personality Assessment Questionnaire for ICD-11 (PAQ-11).

Statistical comparison of the two clinical groups revealed that the ‘’PD group” was significantly younger, had relatively more female patients and showed a trend towards higher number of psychiatric hospitalizations, whereas there were no group difference in terms of education level, relationship status and treatment length. More importantly, the ‘’PD group” exhibited a significantly higher total score (mean 16.30 vs. 12.39) on the PDS-ICD-11, indicating greater global personality dysfunction (i.e., more severe PD). Also, of the five PD trait domains measured by the PAQ-11, the ‘’PD group” had significantly more pronounced Negative Affectivity, Dissociality, Disinhibition and Detachment, whereas Anankastia was similar across the two groups.

Given the radical changes in ICD-11 related to PD diagnosis, there is an urgent need to culturally adapt and evaluate psychometric properties of the scales developed to measure PD severity and personality trait domains. Our preliminary findings support diagnostic validity of two such instruments among Croatian psychiatric patients: the PDS-ICD-11 and PAQ-11.

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With increased consensus regarding the validity and reliability of diagnosing Borderline Personality

Disorder (BPD) in adolescents, clinicians express concern over the distinction between BPD and Attention-Deficit/Hyperactivity Disorder (ADHD), and its co-morbidity in clinical settings.

The goal of this study was to evaluate differences between BPD, ADHD and BPD + ADHD in terms of co-morbid psychiatric disorders and a range of selfreported behavioral problems in adolescents.

Our sample consisted of N = 550 inpatient adolescents with behavioral and emotional disorders that have not responded to prior intervention. We took a person-centered approach (for increase clinical relevance) and compared adolescents with ADHD, BPD and ADHD+BPD in terms of co-occurring psychiatric disorders and behavioral problems. We performed a regression analysis to test whether BPD symptoms make an incremental contribution to the prediction of psychiatric symptoms over ADHD symptoms.

The severity of almost all co-occurring disorders, aggression, self-harm, suicidal thoughts, and substance use, were higher in the ADHD+BPD group. Borderline symptoms made an incremental contribution to the prediction of psychiatric symptoms beyond the contribution of ADHD.

The findings of this study demonstrated that ADHD and BPD have different psychiatric symptomatology. In addition, subjects who meet criteria for both the BPD and ADHD diagnoses may have more severe psychiatric and behavioral problems compared to individuals with only ADHD or BPD.

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Attention Deficit/Hyperactivity Disorder (ADHD) and Borderline Personality Disorder (BPD) have several similarities and it is difficult to distinguish these disorders in adolescents.

We aimed to identify the unique correlates of mentalization abilities that may distinguish these two disorders, and to investigate the mentalization abilities of adolescents with ADHD, BPD and ADHD+BPD in an inpatient sample (n=550) to determine the effect of co-morbidity on mentalization abilities.

We have explored the relationship between Child Eye Test (CET) scores, Movie for the Assessment of Social Cognition (MASC) subscales, and ADHD and BPD symptoms in adolescent inpatients. In addition, we compared ADHD, BPD and ADHD+BPD groups in terms of their mentalization abilities.

Correct MASC scores were negatively associated with both ADHD and BPD symptoms in girls, and negatively associated with ADHD symptoms in boys. In addition, hypermentalization scores were associated with BPD symptoms in girls, and hypomentalization and no mentalization scores were associated with ADHD symptoms in girls. CET scores were negatively associated with ADHD symptoms in girls, but no relations with BPD were found. Group comparisons revealed no significant difference among groups.

We found that while ADHD symptoms are related to hypomentalization, BPD symptoms are rather related to hypermentalization. We believe that these findings make significant contributions to literature aimed at understanding the differences between two disorders which have great commonalities in terms of clinical appearance and developmental course.

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Body dysmorphic disorder (BDD) is defined in DSM5 as a preoccupation with one or more perceived defects or flaws in physical appearance causing significant distress or impairment in social and occupational functioning. Despite many studies on mental health disorders related to BDD, the diagnosis is still frequently overlooked.

Previous studies have examined the general personality characteristics of BDD. The objective of this study is to find out how socially aversive personality traits are related.

Total of 86 mentally and physically healthy adults participated. BDD was assessed by BDDE-SR, and aversive personality was assessed by Short Dark Triad (SD3: Machiavellianism, narcissism, psychopathy), Assessment of Sadistic Personality (ASP), and paranoid (PAR), borderline (BOR), and antisocial (ANT) features of the clinical subscales of Personality Assessment Inventory(PAI). Correlations between the reported scores were investigated using Pearson’s and regression was performed on relevant scales.

Thirty seven males and 49 females (mean age 23.8 years) showed no statistically significant difference in total BDDE-SR was reported based on sex(p=0.18) or BMI(underweight, normal, overweight, p=0.236). BDDE-SR, SD3 and ASP were not statistically correlated, but all of the subscales of PAR(PAR-H, PAR-P, PAR-R), BOR(BOR-A, BOR-I, BOR-N, BOR-S) and ANT(ANT-A, ANT-E, ANT-S) were associated with BDDE-SR. Regression results demonstrated in Table 1 show that BOR-I and PAR-R predict BDDE-SR. Correlation of BOR-I and PAR-R with BDDE-SR factors was shown in Table 2.Table 1.Hierarchical multiple linear regression analysis for BOR-I, PAR-R in predicting BDD symptoms

This study shows that BDD symptoms are associated with borderline-identity problems and paranoia-resentment and suggests that we should consider the diagnosis of BDD for individuals with high BOR and PAR scores.

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The present time is characterized by the instability of society, the authoritarian state, social insecurity, and the events of the global pandemic. One of the main properties of modernity is the continuous nature of the social changes taking place in it. Social uncertainty, instability and social insecurity complicate the usual strategy for constructing ideas about the world around us. In connection with certain factors, events in a person’s life can be defined as significant.

The purpose of this study was to ckeck the fact that important life events are something associated with stress and have a negative emotional connotation.

The methodological basis of the research was the qualitative study: semi-structured interviews, including projective techniques (case and content analysis) were carried out. N = 50 residents of Russia and Austria, age 16-65.

The hypothesis about important life events was completely confirmed. It turned out that important life events were described by the respondents mainly as negative, that is, in most cases (more than 70% of the total number of answers), important events were associated as something associated with stress, having a negative emotional connotation. It is interesting that mentions of joyful and happy events were much less frequent than negative ones, while there were practically no descriptions of the experience of vivid emotions accompanying any long-awaited events. At the same time, important events are quite extensively associated with stress and critical emotional experiences, often with mental problems: “shock”, “crisis”, “debts”, “severe depression”, “complete collapse”, “everything goes to hell”.

Important life events for a person are rather negatively assessed events, as well as events associated with stress, rather than positively assessed events.

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ADHD has been studied less extensively in adults than in children over the years, even though the indications of it clearly affect academic attitudes and closely linked to depression and substance abuse.

Exploratory cross-sectional research was conducted to examine the prevalence of subclinical ADHD is among medical students and its correlations with substance abuse. Furthermore, our goal was to find psychological and academic mediating variables, that might be risk or protective factors of its occurrence.

A total of 239 (69 male) medical students were screened by an online questionnaire using Adult Self-Report Scale (ASRS), Depression, Anxiety and Stress Scale-21 (DASS-21), Maslach Burnout Inventory-Student Version (MBI-SS), Utrecht Work Engagement Scale for Students (UWES-S) and CAGE Questionnaire, which included smoking, alcohol, stimulant and sedative use.

Problematic substance use was reported by 48% of medical students for alcohol use, 43% for smoking, 25% for stimulant use and 21% for sedative use. The prevalence of ADHD symptoms is relatively high among medical students (m=36.13). Correlation and linear regression analysis showed a strong association between ADHD symptoms, depression, and substance abuse. The prevalence of subclinical ADHD symptoms mediates the relationship between depression and substance use, such as alcohol and stimulant use, but there is no significant relationship between academic attitudes (engagement and burnout) and ADHD symptoms, except for depersonalization, which was found to be a risk factor for the development of alcohol and stimulant use.

The increased exposure of medical students to stress makes it particularly important to identify and address factors that can lead to more serious mental illness.

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Estimating the current likelihood of transitioning from a clinical high risk for psychosis (CHR-P) to psychosis holds paramount importance for preventive care and applied research.

Our aim was to quantitatively examine the consistency and magnitude of transition risk to psychosis in individuals at CHR-P.

This meta-analysis is compliant with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines. PubMed and Web of Science databases were searched for longitudinal studies reporting transition risks in individuals at CHR-P.

Primary effect size was cumulative risk of transition to psychosis at 0.5, 1, 1.5, 2, 2.5, 3, 4, and more than 4 years’ follow-up, estimated using the numbers of individuals at CHR-P transitioning to psychosis at each time point. Random-effects meta-analysis were conducted.

A total of 130 studies and 9222 individuals at CHR-P were included. The mean (SD) age was 20.3 (4.4) years, and 5100 individuals (55.3%) were male.

The cumulative transition risk was 9% (95% CI = 7-10% k = 37; n = 6485) at 0.5 years, 15% (95% CI = 13-16%; k = 53; n = 7907) at 1 year, 20% (95% CI = 17%-22%; k = 30; n = 5488) at 1.5 years, 19% (95% CI = 17-22%; k = 44; n = 7351) at 2 years, 25% (95% CI, 21-29%) at 2.5 years, 25% (95% CI = 22-29%; k = 29; n = 4029) at 3 years, 27% (95% CI = 23-30%; k = 16; n = 2926) at 4 years, and 28% (95% CI = 20-37%; k = 14; n = 2301) at more than 4 years.

Meta-regressions showed that a lower proportion of female individuals (β = -0.02; 95% CI, -0.04 to -0.01) and a higher proportion of brief limited intermittent psychotic symptoms (β = 0.02; 95% CI, 0.01-0.03) were associated with an increase in transition risk. Other predictors were not statistically significant (p > 0.05).

Heterogeneity across the studies was high (I2 range, 77.91% to 95.73%).

In this meta-analysis, 25% of individuals at CHR-P developed psychosis within 3 years. Transition risk continued increasing in the long term. Extended clinical monitoring and preventive care may be beneficial in this patient population.

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Many countries are currently expanding their paternity leave policies, which have positive effects on parental mental health.

We examined whether two weeks of paid paternity leave are associated with post-partum depression (PPD) in mothers and fathers at two months after the birth of their child.

Data originated from The Etude Longitudinale Française depuis l’Enfance (ELFE) cohort study. A total of 10 975 fathers and 13 075 mothers with reported information on paternity leave and PPD at two months were included in the statistical analyses. Logistic regression models, using survey-weighted data and adjusted for confounders using Inverse Probability Weights (IPW), yielded Odds Ratios.

Fathers had a median age of 32∙6 (inter-quartile range (IQR) 36∙9 – 22∙6 years), and mothers had a median age of 30∙5 years (IQR 34∙0 – 27∙1 years) at the time of the ELFE child’s birth. Fathers who took paternity leave had reduced odds of PPD [0∙74 (95% CI: 0∙70 -0∙78)] as well as fathers who intended to take paternity leave [0∙76 (95 CI%: 0∙70 – 0∙82)] compared to fathers who did not take paternity leave. Mothers had an increased likelihood of PPD at two months if their partners took paternity leave [1∙13 (95 CI%: 1∙05 – 1∙20)]. Fathers’ educational level, work contract type nor the number of children in the family were found to be interactions (p>0.25).

Taking and intending to take a two-week paid paternity leave is associated with lower odds of PPD in fathers. Mothers whose partners take paternity leave experience borderline higher odds of PPD at two months. Offering only a two-week paternity leave may protect fathers against PPD but does not significantly protect may increase mothers’ risk of against PPD onset.

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The suicide rate in the elderly population is the highest of all ages in Korea. Suicide prevention programs specialized in the elderly are scarce.

We evaluated the effect of the suicidal prevention program named “Nae-an-ae” (means to love oneself), which was specifically designed for the conditions of the community dwelling elderly.

The subjects were those who agreed to participate in the Nae-an-ae program among those evaluated as suicide high-risk groups according to the 2021 Jeollanam-do Mental Health Survey. The program consisted of five sessions of simple activities that could be practiced in daily life along with knowledge transfer through education on emotion recognition, stress management, sleep and relaxation, pain and exercise, and depression. This program was conducted by social workers or nurses working at each local community mental health and welfare center. We evaluated the Geriatric Depression Scale-Short Form Korean Version (GDS-SF), suicidal ideation, satisfaction with life scale (SWLS) and brief resilience scale (BRS) which were measured before and after the program and compared them with the control group.

A total of 276 participated in the program, 226 were in the control group. In the program participating group, the frequency of suicidal ideation was significantly decreased from 36.2% to 11.6% after the program. GDS-SF, SWLS and BRS were significantly decreased in active group than control group.

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These findings showed that “Nae-an-ae” program was found to affect not only the control of suicide risk factors such as depression but also positive factors such as life satisfaction and resilience.

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Psy-Flex is a brief instrument that assesses psychological flexibility defined, according to the theoretical model of Acceptance and Commitment Therapy, by the set of competencies capable of leading the individual to change behavior, facilitating behaviors that are more adaptive and valued by the individual. This set of psychological skills involved in psychological flexibility is associated with psychological well-being and mental health.

The present research sought to translate and adapt Psy-Flex to the Portuguese language and, consequently, to conduct the factor analysis, reliability, and validity studies of this instrument in the Portuguese population (in non-clinical and clinical samples)

The non-clinical sample consisted of 566 individuals (372 female and 192 male) ranging in age from 18 to 74 (M = 36.64; SD = 15.11). The clinical sample included 30 participants aged between 20 and 69 years (M=43.13 and SD= 13.85). The minimum number of years of education is 4, and the maximum is 19 (M=11.80 and SD=3.32). The non-clinical sample was filled out on an online platform the protocol that assessed psychological flexibility (Psy-Flex), Psychological Inflexibility and Flexibility (MPFI-24), anxiety and depression symptoms (PHQ-4), and perceived mental health (MHC-SF). In the clinical sample, the protocol was applied individually and face-to-face.

Psy-Flex evidenced a unifactorial structure attested to by EFA and CFA. Invariance tests revealed the Psy-Flex model to be invariant in configural, metric, and scalar terms for male and female gender and non-clinical and clinical samples. The Psy-Flex revealed adequate reliability as assessed by Cronbach’s alpha and Composite Reliability in non-clinical and clinic samples. In non-clinical sample, the Psy-Flex showed a positive, moderate to strong, association with flexibility (measured by the MPFI-24-FP) and mental health. It also showed a negative, moderate to strong, association with MPFI-24-IP assessed inflexibility and with depression and anxiety symptoms. Age and years of schooling showed a weak positive association with Psy-Flex. Men and women differed significantly, with men showing higher values of psychological flexibility. Psy-Plex showed discriminant validity, differentiating between non-clinical and clinical groups. The non-clinical group showed significantly higher values of psychological flexibility.

The present study was innovative in making available a new instrument in the Portuguese language that revealed excellent psychometric characteristics that could be used in community and clinical samples. It also allows the evaluation of efficacy studies of interventions that aim to promote psychological flexibility.

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Relationships in various forms are an important source of meaning in people’s lives that can benefit their health, wellbeing and happiness. Relationship distress is associated with public health problems such as alcohol misuse, obesity, poor mental health, and child poverty, whilst safe, stable, and nurturing relationships are potential protective factors. Despite increased emphasis on relationship education (RE) in schools, little is known about the views of relationship professionals on relationship education specifically, and how this contrasts with the views of young people (YP).

This Wellcome Centre for the Cultures and Environments of Health funded Beacon project seeks to fill this gap by exploring their perspectives and inform the future development of relationship education.

We conducted focus groups with YP (n=4) and interviews with relationship professionals (n=10). The data was then thematically analysed.

Themes from YP focus groups included: ‘Good and bad relationships’; ‘Learning about relationships’; ‘the role of schools’ and ‘Beyond Relationship Education’. Themes from interviews with relationship professionals included: ‘essential qualities of healthy relationships’; ‘how YP learn to relate’ and ‘the role of RE in schools’.

YP and relationship professionals recognised the importance of building YP’s relational capability in schools with a healthy relationship with oneself at its foundation. Relationship professionals emphasised the need for a developmental approach, stressing the need for flexibility, adaptability, commitment and resilience to maintain relationships over the life course. YP often presented dichotomous views, such as relationships being either good or bad relationships, and perceived a link between relationships and mental health. Although not the focus of current curriculum guidance, managing relationship breakdowns and relationship transitions through the life course were viewed as important with an emphasis on building relational skills. This research suggests that schools need improved RE support, including specialist expertise and resources, and guidance on signposting YP to external sources of help. There is also potential for positive relationship behaviours being modelled and integrated throughout curriculums and reflected in a school’s ethos. Future research should explore co-development, evaluation and implementation of RE programmes with a range of stakeholders.

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Many studies demonstrate that monitoring of the therapeutic alliance can assist therapists to identify changes in patient-therapist relations and accommodate their interventions to prevent early termination. Nonetheless, therapists in public mental health institutes are only required to provide a textual description of patient’s visit, and are usually overloaded to complete empirical measures after each session.

The aim of this study is to develop a novel empirical tool to assess therapists’ perception of the therapeutic alliance through therapists’ clinical reports completed in public mental health.

Patients (N=56) and their therapists (N=32) recruited to participate in a randomized controlled trial completed the Session Alliance Inventory- 6 items (SAI-6) after each session. In this measure, the working alliance included three components: an emotional bond, the agreement on goals, and the agreement on tasks. Afterwards, medical records were extracted and ranked using the SAI-6 by two independent researchers. Inter-rater reliability was .94, indicative of excellent reliability.

Overall, 163 sessions were extracted and evaluated, and were compared with 32 therapist evaluations and 56 patient evaluations. The factor structure of both coders demonstrated a two-factor solution explaining 89.38% of the variance for coder 1, and 71.50% of the variance for coder 2. For patients and therapists, a one-factor solution emerged, explaining 73.00% of the variance for patients, and 62.29% of the variance of the therapists. Both coders demonstrated higher factor loadings of the goals and tasks (0.75-0.81 for coder 1, 0.75-0.78 for coder 2) compared with the bond index (0.57-0.62 for coder 1, 0.52-0.56 for coder 2), indicating higher consistency across these subscales. Internal consistency was alpha Cronbach .87 for coder 1, 0.77 for coder 2, 0.92 for patients and 0.87 for therapists. The scale was partially associated with the therapists’ reports, with coder 2 having a stronger association with therapists ratings in all indexes (r= 0.04 -0.25) than coder 1 (r= 0.03- 0.15). Both coders did not correlate with therapists’ ratings on the bond component. As known in the scientific literature, patients rated the alliance higher than therapists (M=5.74, SD=1.36 for patients, and M=4.67, SD=0.84 for therapists, SE=0.10, p<0.001).

The results of the current study demonstrate the feasibility of assessing therapists’ perceptions of the working alliance via therapists’ routine reports. The differences emerging in the factor structure suggests that coding the clinical reports in primarily beneficial for the evaluation of the agreement on the treatment goals and tasks, and less for the evaluation of patient-therapist emotional bond.

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In recent years, mental health professionals have faced a lot of difficulties and challenges in their work and often need the help of colleagues themselves.

To study the specifics of self-reflection of mental health professionals in different years (January 2020 - October 2022)

Since 2002, Institute of Integrative Family Therapy has been using an approved registration card, which is filled in and handed over after completion of work by all specialists working with families. The maps contain sections describing the progress of work, hypotheses, system parameters of the family, features of the state of the specialist and clients, and so on. We conducted a content analysis of the cards: in 2020, 531 cards were considered, in 2021 - 390, in 2022 - 464 cards.

There are differences in the subjective assessment by specialists of their condition over the years. In the description for the section “Themes and questions in family work that elicited strong emotional reactions from the therapist(s”), professionals began to mention their reactions of fear and confusion more often than before. So, in 2020, fear was mentioned by 4 and confusion by 17 specialists, in 2021 - by 5 and 16, in 2022 - by 36 and 121, respectively. In the section related to the reasons for changing the working (systemic) hypothesis, specialists changed the hypothesis more often (in 2020 - in 53 cases, in 2021 - 40, in 2022 - 98). “The degree of satisfaction of the specialist (-s) with the results of working with the family (in points from 1 to 10, where 1 - absolutely not satisfied, 10 - satisfaction exceeded all expectations" was assessed in 2022 by specialists lower than in previous years: the average value in 2020 - 8.8; in 2021 - 8.9; in 2022 - 6.2.

Supervision, as a form of professional growth and support from a more experienced colleague, is becoming an indispensable component of the work of a specialist helping families in 2022. Assistance in overcoming “dead end” and advising difficult cases due to the experience of the supervisor, on the one hand, allows specialists to understand the situation, offer alternative hypotheses, teach new interventions, on the other hand, it helps the supervised colleague to reflect on the case, analyze its “blind” zones, understand mistakes and summarize the unique experience gained in the psychotherapy of a “difficult” patient.

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Psychoses represent serious psychiatric disorders in which an individual perceptions, thoughts, mood and behavior are significantly altered. Each person who develops a psychosis lives a unique set of symptoms and experiences that may widely vary depending on life circumstances. Although cognitive behavioral psychotherapy (CBT) for psychosis is recommended by main international guidelines, its effectiveness in real-world is still a subject of controversy.

The aim of this study was to evaluate, in an Italian outpatient clinical setting, eventual improvements induced by a 6 months intensive CBT specific programme focused on metacognition and emotional regulation and its consequences on psychosocial functioning and subjective well-being in pharmacologically stabilized psychotic patients.

Eight patients with schizophrenia spectrum disorders (DSM-V), clinically and pharmacologically stabilized, were included in a 6-month program of weekly CBT sessions with focus on metacognition, emotional dysregulation, social functioning and subjective well-being. Patients were assessed with the Metacognitions Questionnaire-30, Difficulties in Emotion Regulation Scale, Heinrichs Quality of Life Scale, The Psychological General Well-Being Index, Brief Psychiatric Rating Scale, Hamilton Depression Rating Scale at baseline and at 3 and 6 months, to verify any improvement on these specific domains and, possibly, on general psychopathology.

In this study CBT showed to be effective on all domains evaluated, most notably for younger patients with a short history of disease (<5 years). Metacognitive capacity was the dimension with most evident improvements, followed by the ability to modulate emotions and the consequent improvement in psychosocial functioning and perceived subjective well-being. During the 6 months follow-up none of the enrolled patients experienced symptoms exacerbation or psychotic relapses.

In conclusion, the 6-month CBT treatment showed to be effective for stabilized psychotic patients, improving metacognitive functions, emotional regulation, psychosocial functioning, and subjective well-being. In addition, insight, adherence and the therapeutic alliance improved. The absence of psychotic relapses is not attributable with certainty to the effect of CBT since, for this purpose, longer duration studies on larger case series and with RCT methods are required. However, it is plausible that the improvement obtained in disease awareness and adherence may be a facilitating factor in relapse reduction.

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Cognitive Analytic therapy (CAT) is a brief focal therapy consisting of 16 - 24 sessions in the context of complex cases. It involves three stages: reformulation, recognition and revision (Taylor et al, 2017 Dec;90(4):511-529). CAT was shown to have an effect within a 24-session format and has been found to be particularly helpful by those who work with these ‘hard to help’ patients, including abuse survivors, the elderly and offenders.

To introduce CAT to Malta as a Creative Service Initiative with outcome measures in part-fulfillment of the Malta Postgraduate Training Programme in Psychiatry. To perform a qualitative study to see the attitudes of course participants towards other modalities of therapy besides Cognitive Behavioral Therapy and Psychodynamic Psychotherapy.

A CAT Skills Training Course was organised for the first time in Malta in collaboration with Richmond Foundation, the Malta Association of Psychiatrists and the International Cognitive Analytic Therapy Association. The course was delivered over 6 days. This was divided into 35 hours of theory and 8 hours of skills based sharing and learning with a particular emphasis on contextual mapping including team dynamics, systemic and structural role positioning within health services and orgnaistaions.

A qualitative questionnaire was disseminated to participants at the end of the 6-month programme which included supervision via skype and completion of a reflective essay. A follow-up training course in 2022 was organised and the introduction of CAT Malta to psychiatric trainees planned for March 2023.

A total of 20 participants participated in the original CAT Training in March 2020 of which 1 was a psychiatrist, 2 were psychiatric trainees, 6 were social workers, 3 were counsellors and the remainder were psychologists. From this group of participants 4 members (1 psychiatrist, 1 psychiatric trainee, one psychologist and one social worker) continued to level 2 of training with the aim of continuing to CAT practitioner training. The remaining 16 participants dropped out in view of personal commitments and pressures presented during the COVID-19 pandemic. A new cohort of 14 participants were recruited in September 2022 of which all plan to continue to level 2 of training with the hopes of becoming CAT practitioners. A qualitative study into their reflective essays is being undertaken.

CAT Malta was established in 2022 with the 4 members who continued CAT training level 2. These members are in the process of becoming CAT practitioners and pioneering this new treatment into mental health services amongst the Maltese islands.

In conclusion the above proves that the implementation of CAT Training is feasible and acceptable. It will be introduced to Maltese psychiatric trainees in March 2023.

None Declared

Pandemic caused by the virus COVID-19 had a significant impact on mental health of the population, not only by increasing the levels of stress and anxiety, but by affecting the most vulnerable ones, aggravating the symptoms of mental illnesses in people suffering from one of the mental health conditions [1], including the people suffering from schizophrenia. Pandemic made the increased need of that particular patient population for various psychotherapeutic and sociotherapeutic interventions even more evident. Art therapy is a form of psychotherapy that in itself integrates expressive characteristics of art with explorative characteristic of psychotherapy using the visual language of arts as the main media of communication and expression. Art therapy has been used from its beginnings with people suffering from one of the psychotic disorders [2] and it is enlisted today in NICE guidelines as one of the psychological therapies of schizophrenia [3].

To understand and to activate the potential of artistic expression in patients suffering from psychotic disorders during the pandemic of virus COVID-19.

During the period of lockdown in pandemic of virus COVID-19, a young male patient suffering from schizophrenia was admitted to the Acute ward of the University psychiatric hospital Sveti Ivan in Zagreb. As the patient was keen on visually expressing himself, five individual psychodynamically oriented art therapy sessions were carried out on a weekly basis with professionally trained art therapist during the period of patient’s hospitalization. The patient was offered various art materials allowing him to visually express himself in a free manner and the artistic artefact created during the process served as a catalyst for later therapeutic work.

During the therapeutic process, single image was being gradually made and developed session by session. As new layers of color and form were added to the painting, each session revealed new layers of meaning and symbolism to both patient and therapist. First sessions pertained to the anxiety caused by the experience of pandemic, but as the process moved forward, deeper subject matters were brought to the surface, such as the nature of the therapeutic relationship, patient’s splitting, hidden aggressive potentials and, in the end, the nature of father-son relationship connecting the image of coronavirus causing fear and discomfort with the image of the oppressive father.

Circumstances caused by the pandemic of virus COVID-19 aggravated the patient’s symptoms and his internal conflicts. The art therapeutic process, with its possibility of projections and its multilayered interpretations, enabled the patient to express the true conflict and disturbing content hiding underneath the anxiety related to the pandemic of coronavirus which the patient was primarily complaining about.

None Declared