Cleft lip and palate are birth defects that occur when a baby’s lip or mouth do not form properly during pregnancy. Individuals with a cleft of the lip and/or palate (CL/P) differ from their peers due to their facial appearance, hearing and speech problems, in addition, it causes psychosocial impacts among affected children. However, among untreated adults, it seems that psychological sequelae can be major and life limiting.

The purpose of this study is to assess Algerian untreated young CL/P patients psychological and lifestyle issues.

This is a survey-based cross-sectional study conducted during August- October 2022 in Algeria through an online survey which is a self-administered questionnaire ( SAQ). The study target population were young individuals ( age between 17 and 30) with untreated or partially treated clef lip and palate confitions. The questionnaire consisted of 10 multiple questions including a demographic section, evaluating patients satisfaction, lifestyle, psychological problems related to their conditions and limitations due to it. All participants provided their informed consent prior to their participation. The Statistical Package for the Social Sciences (SPSS) version 22.0 was used to analyse the collected data.

Final sample size consisted in 207 responses. The mean age of the participants was 24.3± 3 years. Findings showed that slightly more that three fourths (75,9%) of participants reported that they are unsatisfied of their life because of their CL/P condition. Among 120 uneducated participants, (67%) of them reported thay they abandoned school because of their appearance. For P <0.001, suicide thoughts were higher among female participants (38%) than male participants (9%). Almost half of respondents (49.4%) presented strong immigration desires due to their education, relationships and psychosocial health issues.

The psychological impact of cleft lip and palate in adults appears to be disturbing, chronic and life-limiting. Urgent approaches to ensure the early management of cleft lip and palate in Algeria remain mandatory. Increasing the number of specialized maxillofacial services seems to be a good first step.

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The area of Sensory Integration has its origin in the 1960s, developed by the neuroscientist and occupational therapist Jean Ayres. Although the first studies focused on the relationship between learning problems and atypical sensory processing, today there are new applications in clinical practice.

Sensory integration is defined as the neurological process responsible for organizing the sensations that one receives from one’s own body and from the environment, in order to respond and function adequately in relation to environmental demands.

This work has several objectives. On the one hand, review the concept of sensory integration, the definition and theoretical basis as well as the scientific evidence of this theory. On the other hand, review the use of sensory integration in psychiatric practice from the 1960s to the present day. Also, explain the experience of a child and adolescent psychiatry unit with the use of sensory integration as part of the treatment. Finally, new challenges, approaches and needs of psychiatry services will be considered for the implementation or improvement of this new work tool in a multidisciplinary team.

A bibliographic search has been carried out in the main sources of medical information such as pubmed, uptodate as well as in national and international journals. Likewise, the knowledge and clinical experience of the team has been reviewed.

In our clinical experience, the child and adolescent psychiatry device for intensive outpatient treatment where patients between 12 and 17 years of age with severe mental disorders attend, initially passed the sensory profile by occupational therapy to patients who presented behavioral or emotional symptoms. not consistent with the psychopathological examination. In view of the results and magnificent progress, this intervention began to be carried out systematically to the boys who joined the device.We present the case of a 15-year-old patient who attended the device due to emotional dysregulation and suicidal risk. During evolution, possible difficulties were seen in sensory integration that made it difficult for the patient to improve with psychiatric or psychological therapy alone. The patient was evaluated and treated by the team’s occupational therapist, specifically trained in sensory integration. It was evaluated with the sensory profile, with the results having a sensory sensitivity profile and auditory and tactile avoidance. The specific measures that were carried out were: sensory diet and environmental modifications.

Sensory integration is a therapy with sufficient clinical evidence to implement it in child and adolescent psychiatry services. Therapy should be performed by suitably trained and validated occupational therapists. This therapy must be included in a multidisciplinary approach to the patient and specific modifications that can be developed at home and at school are provided.

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Cri du Chat syndrome (CdCS) is a genetic disorder resulting from a variable size deletion of the end of the short arm of chromosome 5 (5p), including a critical region located at p15.2. It represents one of the most frequent chromosomal deletions, with an incidence in the general population of 1/20,000 to 1/50,000.

Through this observation we update the scientific news of this rare syndrome and present an observation of a Cri du Chat syndrome confirmed by metaphasic karyotype (46,XY,del(5)(p13) de novo) with autism spectrum disorder.

Description a case with cat cry syndrome seen in child psychiatry consultation in our institution

Discussion through articles published on pubmed, googlescholar and science direct

Typical features of CoCs present in the subject include intellectual disability, psychomotor acquisition delays, language delay, and dysmorphic features (e.g., wide and high nasal root, hypertelorism, and coarseness of features). Expected features of CoCs that are not present are: growth retardation, microcephaly, round facies, micrognathia, epicanthal folds and characteristic high-pitched cry. Behavioral features in this subject include symptoms of autism spectrum disorder.

The deletion of the short arm of chromosome 5, when it includes a critical region located at p15.2, is responsible for a well-characterized syndrome, Cri-du-Chat disease, including a characteristic craniofacial dysmorphia that evolves with age, the mental handicap in the characteristic form is very severe. Visceral malformations are relatively rare and not very specific.

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Screening instruments can be crucial in child and adolescent mental healthcare practice by allowing to triage the patient flow in a limited resource setting and help in clinical decision making. However, for a screening procedure to work, we must be sure that the screening tools used have reasonable validity and clinical utility in the population they are used in.

Our study aimed to examine the psychometric and predictive properties of the parent-report version of the Strengths and Difficulties Questionnaire (SDQ), with the application of the original UK-based scoring algorithm, in a clinical psychiatric population sample of Latvian children and adolescents.

363 outpatients aged 2 to 17 years from two outpatient child psychiatry centres in Latvia were screened with the parent-report version of the SDQ and assigned clinical psychiatric diagnoses. The basic psychometric properties, and ability of the SDQ to predict the clinical diagnosis in major diagnostic groups (emotional, conduct, hyperactivity, and developmental disorders) was assessed.

Most of the study participants were male (n=230, 63%). The mean age was 9,28 (SD=3,82) years for males and 10,93 (SD=4,11) years for females.

Emotional problems, hyperactivity, and prosocial subscales of the SDQ, as well as the externalising and total difficulties scales, demonstrated acceptable internal consistency (Cronbach’s alfa > 0,7). The results for the conduct problems and internalising difficulties scales were also close to being on the acceptable level (0,68 and 0,69 respectively). The peer problems subscale was the only SDQ scale with poor internal consistency (0,57).

The subscales of the parent-report SDQ showed significant correlation with the corresponding clinical diagnoses. The sensitivity and specificity of appropriate subscales of the parent-report SDQ were 67% CI [0,57,0,77] and 57% CI [0,50, 0,64] for any emotional disorder, 78% CI [0,67, 0,89] and 57% CI [0,50, 0,64] for any conduct disorder, 65% CI [0,55, 0,75] and 78% CI [0,73, 0,83] for the hyperkinetic disorder, 72% CI [0,63, 0,81] and 44% CI [0,36, 0,52] for developmental disability.

Overall, none of the subscales of the SDQ has reached the interval of potential usefulness for clinical decision-making in specialized psychiatric settings, based on the positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio estimates.

We suggest the SDQ rather be used in primary healthcare settings, where it can be an essential tool to help family physicians recognise children needing further specialised psychiatric evaluation. There is a need to assess the psychometric properties and validate the SDQ in a larger populational sample in Latvia, determine the population-specific cut-off scores, and reassess the performance of the scale in primary healthcare practice.

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Growing evidence supports a possible link between gut microbiota and attention-deficit/hyperactivity disorder (ADHD) via the gut-brain axis. Short-chain fatty acids (SCFAs), the major metabolites produced by gut microbiota through anaerobic fermentation, may influence gut-brain communication.

To determine the alterations of gut microbiota and fecal SCFAs in children diagnosed with ADHD compared to healthy subjects.

Fecal samples were collected from children with ADHD (n=10), and age- and sex-matched healthy controls (n=10) for gut microbiota and SCFAs analysis.

There were no significant differences in the abundance of any bacterial phyla in feces between groups. However, fecal concentrations of acetic acid, propionic acid, and butyric acid were significantly lower in children with ADHD compared to those of controls (Figure1). Interestingly, acetic acid and propionic acid levels were negatively correlated with ADHD symptoms (Table 1). Macronutrient and fiber intake, determined from food frequency questionnaires, did not differ between groups.Table 1.The regression analyses predicting ADHD symptoms scores from fecal short-chain fatty acids level.

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Our findings suggested that gut dysbiosis was possibly developed in children with ADHD, as indicated by a significant decrease in fecal SCFAs. In fact, fecal acetic acid, propionic acid, and butyric acid may potentially be the early detector for ADHD. In addition, fecal acetic acid and propionic acid could be potential biomarkers for the severity of ADHD.

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Career self-exploration activities can be defined as orienting oneself in one’s own vocational interests, skills, job, and organizational characteristics and as an important career pre-decision stage (Stumpf et al., 1983). Effective career exploratory behaviors are associated with less anxiety regarding uncertainty and difficulties during first career decision-making (Storme, Celik, 2017; Xu et al., 2014). In Study 1, we showed that productive career self-exploration in adolescence is associated with a high level of tolerance for uncertainty (TU) (Chesnokova, Churbanova et al., 2022).

The aim of Study 2 was to compare the social intelligence (SI) and creativity (Cr) of students with high and low level career adapt-abilities applied to present and prospective future career decisions.

Participants were 67 students (15-17 years old). SI was assessed by O’Sullivan & Guilford’s Tests (1966), Cr was measured by CAP consisted of Test of Divergent Thinking and Test of Divergent Feeling (Williams, 1980). Career adapt-abilities were estimated by CAAS (Savickas & Porfeli, 2012; Pryazhnikov, 2016).

Two contrast clusters based on SI and Cr mediated by TU level were analysed. One cluster included students with high pragmatic motivation concerning career path choice. There were students with high TU, high SI and cognitive Cr and low level of Divergent Feeling who focusing on nearest obstacles like entrance exams and distant professional future (professional revenues, social status and on task-oriented content). They are open to new career experiences and flexible in career choice (at r .56, p .001), but they lack social intelligence’s diplomatic techniques and cognitively complicated interpersonal situational awareness. They mostly rely on academic aptitude and self-efficacy. The second cluster of students was made up of those with low TU, average to low SI, and high levels of divergent feelings. They exhibited less pragmatist motivation and active career exploratory behaviors regarding both immediate and long-term professional paths, professional values, the human aspects of potential careers, the social structure of professional society, and the need to use emotional intelligence when interacting with clients and working in teams. They rely on social support from professional representatives and teachers during their career decision making.

In sum, SI and Divergent feelings may be significant mediators in the development of career adaptability and realistic self-perceived confidence in task-oriented content as well as interpersonal specificity of professional social environments. To reduce stress and anxiety of prospective students, the development of self-efficacy and motivation should be given priority over just academic readiness for exams and narrow professional skills.

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Prader-Willi syndrome (PWS) is a genetic disorder with an estimated prevalence of 1:25,000. PWS results from defective gene expression on the paternal copy of chromosome 15. In 70% of the cases it is a deletion that means that part of the paternal chromosome 15 is missing. Maternal uniparental disomy (mUPD) is present in 25% of cases. Typical clinical features of PWS are dysmorphism, hypotonia, hyperphagia, hypogonadism and developmental delay. In addition, the syndrome is accompanied by various psychiatric symptoms that are often insufficiently known within the psychiatric field. Regarding the relationship between PWS and schizophrenia spectrum disorders (SSDs), individuals with mUPD appear to have a 3 to 4 times higher risk of psychotic symptoms than those with the deletion subtype. Psychotic episodes have an atypical presentation with recurrent episodes of confusion and rapidly fluctuating psychotic and mood symptoms.

To describe an unusual clinical case in order to determine the management regarding clinical approach, and provide an overview of psychotic episodes in patients with PWS for the general practitioner with the most up-to-date information on workup and management.

We report a case involving a 13-year-old woman with PWS (mUPD of chromosome 15) and mild intellectual disability (IQs 59), who presented psychotic symptomatology in the form of disorganized behavior, delusional ideation, auditory hallucinations, self-referentiality and suspicion. Parents reported that these symptoms started two days prior the day of consultation. No environmentals stressors were identified and no recent treatment changes were made. Patient’s medication consists in 150 mg sertraline per day due to anxiety control and aid in emotional and behavioral regulation.

Given the diagnostic approach of a psychotic episode (PE) in a patient with PWS, it was decided to offer 0.5mg risperidone per day, in an increasing pattern until reaching a final dose of 1.25 mg per day, presenting a global remission of the psychotic symptomatology.

Recommendations for patients with PWS presenting PE are based upon systematic reviews. Patients with PWS, especially mUPD subjects, are at risk for SSDs and mood disorders. Antipsychotics (APs) are the gold standard in the treatment of SSDs, and some authors have suggested that APs protect patients with previous psychotic symptoms from relapse. It is unknown whether there is a protective effect of APs in mUPD patients who have not previously exhibited psychotic signs.

PWS represents a good example of a genetic disease with behavioral and psychiatric symptoms that may be challenging to treat with psychotropic medications. For a better understanding of psychiatric problems in adults with PWS, longitudinal studies with careful and standardized follow-up of psychiatric symptoms in PWS are necessary.

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Although mastectomy is a treatment for the cleaning of cancer cells in the breast, it can also cause psychological changes in women.

This research was carried out to investigate the cognitive distortions, mental symptoms, and marital adjustment relationships in women with mastectomy.

The descriptive and comparatice study was conducted in a public hospital with 90 mastectomies and 90 healthy female samples. The data were collected using The Cognitive Distortions Scale (CDS), The Brief Symptom Inventory (BSI), and Marriage Adjustment Scale (MAS) and were evaluated by descriptive statistical analyzes, t test, Mann-Whitney U test and Spearman Correlation Analysis.

Women with mastectomy scored high in the healthy control group in all sub-dimensions of CDS and BSI and this difference is highly significant (p<0,5). Women with mastectomy scored higher in total agreement sub-dimensions than the healthy control group and the difference between them was statistically significant (p<0,5). There ara positive, very strong and statistically significant relationships between all sub-dimensions of the CDS and the total sub-dimension scores of the BSI (r=,769and, 919). There are positive, strong and statistically significant relationships between the sub-dimensions of the CDS and the sub-dimension of the agreement and the total score of MAS (r=681 and 734). There are strong and statistically significant relationships between the total and sub-dimension scores of the BSI and the sub-dimension and total score of the MAS’s agreement (r=,672 and 778).

Cognitive distortions and mental symptoms are significantly higher in women with mastectomy, and cognitive distortions are associated with mental symptoms. Cognitive distortions and psychological symptoms scores, marriage adjustment scores and agreement sub-dimension scores increase in women.

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International guidelines recommend that prospective organ transplant patients receive a psychosocial assessment to optimise outcomes. There is limited consensus regarding the criteria for psychosocial evaluation. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) tool was developed to enhance the pre-transplant psychosocial workup. The Mater Hospital is the National Centre for heart and lung transplantation in Ireland. The consultation-liaison psychiatry (CLP) service provides screening of pre-transplant candidates using a biopsychosocial assessment, SIPAT and cognitive screening tools. Post-transplant patients are reviewed on a referral basis.

To identify the psychosocial needs of heart and lung transplant recipients and CLP service input over a one year period.

A review of all heart and lung transplant recipients between January 1st and December 31st 2021 was conducted. The following data were recorded: demographics, pre-existing mental illness, SIPAT scores, and referral to the CLP service within six months of transplantation.

Twenty-eight individuals received a heart/lung transplant in 2021 (7 heart, 19 lung, 1 heart &liver, 1 heart & lung). Prior to transplant 50% (14/28) had a pre-existing mental health diagnosis, 7% (2/28) had attended a psychiatrist, and 28.6% (8/28) were on psychotropic medication. SIPAT scores were available for 20 patients. The overall mean SIPAT score was 10.8 (SD 6.1). The subscales were as follows: Patient Readiness, mean 3.2 (SD 1.7); Social Support System, mean 2.1 (SD: 1.8); Psychological Stability & Psychopathology, mean 1.6 (SD 2.7); and Lifestyle & Substance Misuse, mean 3 (SD 1.5). Based on SIPAT scores, 20% (4/20) were excellent candidates, 75% (15/20) were good candidates and 1 (1/20) was minimally acceptable. Pre-existing mental illness was associated with higher total SIPAT scores (p=0.013) and higher scores on the psychological stability subscale (p=0.032). Post-transplant, 50% (14/28) were referred for psychological support and 21.4% (6/28) were referred to the CLP service. A further 10.7% (n=3) were attending CLP prior to transplant. Referrals to CLP occurred (median) 13 days (range 1-275) post-transplant surgery. The reasons for attending CLP were anxiety (5/9), delirium (3/9) and mood (1/9).

SIPAT can be a valuable tool for use in the pre-transplant workup to help identify those that will require intensive psychosocial support post- transplant.

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Diabetes is one of the diseases in which treatment adherence is most fragile. Several factors seem to contribute to the lack of treatment compliance of the disease, from longer duration of diabetes to mental health issues. In this study, we try to identify the main factors affecting insight for diabetes (clinical, demographic, and narcissistic traits).

The main objective is to find clinical, demographic and narcisistic characteristics that differenciate good insight from poor insight diabetic patients.

A cross-sectional study was developed with inclusion of 100 patients with diabetes, aged over 18 years, carried out at the Associação Protetora dos Diabéticos de Portugal (APDP). All the participants gave their informed consent. Patients were submitted to DAS (Diabetes Awareness Scale), and NPI-13 (Narcissistic Personality Inventory-13), the two most used evaluations for insight in diabetes and narcisic personality traits. The clinical and demographic factors were obtained by the records from APDP whose Ethic Comittee gave permission for this study.

The clinical and demographic characteristics of the sample of 100 patients with diabetes, are described in Table 4.1.

Positive and statistically significant correlations were found between HbA1c and total DAS (r = 0.420, p < 0.001), Symptom Attribution (r = 0.362, p < 0.001), Awareness of Negative Consequences (r = 0.229, p = 0.025), and Awareness of Need for Treatment (r = 0.210, p = 0.040) - Table 5. In other words, patients who were metabolically poorly controlled and had higher levels of serum HbA1c, showed higher levels of insight into the disease.

There was a statistically significant negative low-moderate affect correlation between Symptom Attribution of the DAS and the E/E (Empowerment/Explorativeness) sub score of the NPI-13 (r= -0.243, p=0.05)-Table 8.

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Our results allowed us to conclude that the capacity for insight may sometimes arise in the context of already existing consequences of diabetes, in patients with poor metabolic control.Some studies had already highlighted the dubious role of increased individual perception of illness with diabetes regulation, while others were consistent with our observations, regarding the role of gender and family history in insight.

Despite these results, we propose that the knowledge of the profile of patients with insight and the anticipation of a low insight to the disease at the time of diagnosis or during follow-up allows the individualization of medical practice and the use of insight as a tool for better metabolic control of patients, ideally should arise before the development of vascular complications.

However, further studies are needed, ideally with a larger and more diverse, to understand if there are other factors that may be related to insight in the disease, as well as the development of techniques for acquisition of insight in patients with diabetes.

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The majority of people with cardiovascular disorder meets the criteria of type D personality. Its prevalence, however, favours experiencing negative emotions and avoiding social connections [Kupper et al. Int J Cardiol. 2013;166(2) 327-33]. Cardiovascular disorders’ steady morbidity growth entitles to search for the factors, which have an impact on functioning, acceptance of the disorder and obeying doctor’s orders among patients with this diagnosis [Leu et al. J Formos Med Assoc. 2019;118(3) 721-729]. One of the factors, which largely determines mental efficiency, except for anxiety and depression symptoms, is cognitive functioning [Burkauskas et al. Cogn Behav Neurol.2016;29(2)91-9, Schiffer et al. Eur J Heart Fail. 2008;10(8) 802-10].

Evaluation of cognitive functioning, acceptance of the disorder, intensifying of anxiety and depression symptoms among people who suffer from cardiovascular diseases with type D personality and seeking for relationships between those parameters.

102 people took part in the study, including 63 men and 39 women, the average age amounting to 65,471 (SD±10,567). Patients were divided according to the presence of type D personality, gender and cardiological diagnoses. The DS-14 scale was used to assess the type D personality, the HADS scale to assess the symptoms of anxiety and depression, and also the AIS scale to assess the acceptance of the disease and MoCA 7.2 scale for cognitive functions. The original questionnaire was used to collect the necessary sociodemographic data, data on the type and course of the main disease, comorbidities and medications taken.

About 37% of respondents meet the criteria of type D personality. The AIS scores correlate negatively with age, disease duration, and with both components of the DS-14 scale (negative emotions-Ne and social inhibition-Hs). Both DS-14 subscales correlate positively with HADS-A and HADS-D, and the DS-14 (Ne) subscale is also positively associated with age. The results of the MoCA scale negatively correlate with age and duration of the disease. People without personality traits of type D have higher AIS scores, lower HADS-A (fig.1) and HADS-D scores (fig.2), and higher MoCA scores (fig.3) than those with type D personality. There were no differences between patients with ischemic heart disease and patients with ischemic heart disease and heart failure. In the subscale of social inhibition DS-14 (Hs), women obtained a higher result.

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1. People with D personality are more difficult to accept their illness, they are characterized by a higher level of depression and anxiety, and weaker cognitive functions.

2. Women are characterized by stronger social inhibition.

3. Younger people with a shorter medical history accept the disease more easily.

4. Heart failure is not a factor differentiating the studied group of patients.

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Population recent studies have shown that most patients with endocrine pathology suffer from at least one of the three DCPR syndromes: irritable mood, demoralization (despair), persistent somatization. The thyroid gland is a unique organ among the glands of internal secretion, in the pathology of which non-psychotic mental disorders are extremely common. Therefore, the use of a complex, integrative, systemic approach in the examination of patients with thyroid pathology should be the basis of planning the strategy and tactics of the treatment program for such patients.

We examined 132 patients with primary hypothyroidism.

We used psychopathological method and an adapted methodology for assessing typologies of psychological defence. It was the method of Robert Plutchik adapted by L.I.Wasserman, O.F.Eryshev, E.B.Klubova for assessment of the next mechanisms of defense: negation, projection, regression, displacement, repression, intellectualization, reactive formation, compensation.

In 108 patients, who made up 81.12% of the total number of investigated, various forms of non-psychotic mental disorders were detected, among which 23 patients (12.04%) had an anxiety-depressive syndrome, and astheno-depressive syndrome (32.41%).

It was established that excessive compensation, projection, reactive formation formed a tendency to increased self-control, to analysis and introspection, self-justification, isolation, which in general influenced the structure of the astheno-depressive syndrome. Insufficient reactive formation, displacement, and excessive intellectualization in a complex contributed to the formation of subjective feelings of anxiety and fear in patients, led to the avoidance of problematic situations, unnatural slowness with behavioral manifestations of anxiety, therefore influenced the structuring of anxiety and depressive disorders at the same time. Thus, significant connections have been established between the intrapsychic level of functioning and the formation of astheno-depressive and anxiety-depressive disorders, which should be used in the planning of psychotherapeutic and psychocorrective measures.

This approach ensures that endocrinologists and general practitioners master the simplest skills for providing psychocorrective care to patients with depressive disorders. It includes the application of elements of rational psychotherapy, in order to form a sense of control over their own condition and the ability to master negative influences, which contributes to stabilization their general condition and improvement of the quality of life. So medical care to such patients should focus on early diagnosis and correction of nonpsychotic mental disorders. Both medications and psychological influences should be used in the treatment of such patients.

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Delirium is common and is associated with many adverse short-term consequences as increased hospital costs, health care complications, and increased mortality. Long-term cognition consequences on delirium have not been well synthesized and quantified.

Our study aims to determine the relationship between an episode of delirium and subsequent dementia and death over five years.

Postoperative delirium, previous psychiatric disorders, mental health service use, and death data collected from a cohort of inpatients diagnosed with delirium that requires psychiatric attendance in a general hospital were analyzed. Between 2009 and 2011, we started a follow-up of 91 patients aged 65 years or older at baseline for 60 months.

Five patients (5.4%) were diagnosed with dementia previously. During the first year, 35 patients without previous dementia (40.6%) died. More than half of the one-year survivors (27; 52.9%) were diagnosed with dementia at the follow-up. Differences in age (79,5 vs 80.3; Z=-0.07; p=0.93), survival time (54.8 vs 48.8;Z=1.30;p=0.19), postoperative delirium rates (74%vs66.6%; χ2=0.33, DF=1, p=0.56) and mental disorder antecedents were not found. Patients with dementia after delirium were more likely to be attentive in mental health services (48.1vs16.6%; χ2=5.666, DF=1, p=0.017).

In our study, delirium is an important risk marker for dementia and death and is significantly associated with the long-term cognitive decline in surgical and non-surgical patients. Subsequent follow-up in mental health service could help detect dementia after episodes of delirium and lead to fewer potentially harmful interventions such as hospitalization or antipsychotic medication. An important question to determine is whether delirium is simply a risk marker for dementia or whether the delirium could cause neuronal damage leading to dementia.

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HIV-associated neurocognitive disorder has been less frequent in recent years due to the availability of anti-retrovials. However, in the Philippines, persons with HIV are diagnosed late resulting to cases of HIV-associated neurocognitive disorder. With higher incidence of depression and anxiety in this population, difficulty sleeping becomes a prominent symptom and diphenhydramine is a common non-prescription nighttime sleep aid being given.

To present a case of diphenhydramine-induced delirium after a patient with HIV-associated neurocognitive disorder.

This a case report.

Mr. JR., a 38-year-old person living with HIV and no past psychiatric history, presents with acute onset altered mental status, suicidal attempt, and jerking movements of the neck and extremities. He has been having bouts of diarrhea, fatigue, weight loss, and forgetfulness for a year before he was diagnosed with HIV-AIDS with CD4 count of 59 cells/mm3. At this time, he already had blurring of vision, poor sleep, weakness, poor concentration, and increasing severity of forgetfulness. He also started to have depressed mood and anhedonia but no suicidal ideations. He was eventually started on antiretroviral (ARVs) which are lamivudine, tenofovir, dolutegravir and antibiotics targeting opportunistic bacteria – Isoniazid, Moxifloxacin and Clindamycin. A few days after, he started to have jerking movements of the neck and extremities contributing further to poor sleep. Upon consult with a local clinic to address his sleep, he was prescribed with Diphenhydramine and after taking 50mg dose that evening, he started to have disorientation, paranoia, command auditory hallucinations resulting to a suicidal attempt, on top of the jerking movements, which prompted consult to the emergency room and subsequent admission. Initially assessed as central nervous system infection and focal seizure, CSF fluids studies and EEG were done showing normal findings. Started on Sodium Valproate + Valproic acid 500mg IV twice daily and Olanzapine 2.5mg twice a day, on top of his previously mentioned ARVs and antibiotics, the disorientation, auditory hallucinations, and myoclonic jerks mood resolved after five days. Five months on ARVs, he has no recurrence of myoclonic jerks, disorientation or psychosis, with memory and concentration improved, euthymic mood, and was able to resume work as an engineer.

Diphenhydramine is a common nighttime sleep aid. Due to its anticholinergic effect, cases of delirium were reported for doses 300mg to 1,000mg per day. For Mr. JR, the mere 50mg dose of diphenhydramine caused disorientation and psychosis as his co-occurring HIV-associated neurocognitive disorder made his brain “delirium-ready”. Diphenhydramine is a relatively safe drug however not getting a thorough medical history may inadvertently cause harm to patients who are medically ill and frail.

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Acute clinical deterioration in hospital inpatients can be caused by a range of factors including dementia, delirium, substance withdrawal and psychiatric disturbance, creating challenges in diagnosis, often requiring a management plan with input from multiple disciplines. Staff forums and broader literature have confirmed that healthcare staff working in non-mental health settings, may not be as skilled in recognising and managing early signs of emerging and/or escalating clinical agitation. The BoC RRT is a consultation service within the Division of Medicine and CL Psychiatry. Staffed by Medical Registrars and Mental Health Nurses, the collaboration provides a unique healthcare response to acute general wards. The BoC RRT has been implemented to address the rising number of incidences whereby staff and patient safety are compromised. Using evidence-based skills the team aimed to: respond to episodes of clinical agitation that require an internal security response, assist ward referrals by exploring biopsychosocial contributants to behaviour, develop individual patient support plans and review and reduce restrictive intervention practices.

To determine if the rapid response model has influenced:

- The impact on staff/patient safety

- Frequency of emergency responses for aggression

- Frequency of restrictive intervention use

This project was approved as a quality assurance project (QA2022018). The patients within scope of the BoC RRT include inpatients in medical and surgical wards. It excludes patients in Emergency Departments, mental health units, outpatient clinics, and visitors. The evaluation of the pilot has used a PDSA (Plan, Do, Study, Act) cycle when implementing new improvements. A mixed methods approach explored the impact of the BoC RRT. Staff consultation will identify challenges in responding to scenarios whereby there is risk of harm to staff and patients. Staff feedback and the emergency response data was monitored.

In 2021, there was approx. 720 code greys per month, requiring a security response. Since the implementation of BoC RRT, these numbers have reduced to 527. Reviewing restrictive intrvention practices has identified areas for policy review and need for education. Staff consultation found that nurses were confident caring for those patients exhibiting clinical agitation associated with delirium and dementia. However, caring for people with mental health or substance use disorders were more challenging.

These interim results indicate that BoC RRT has been generally well received by clinical staff. The decline in code grey responses indicates that it is likely having a positive impact in early identification and management of clinical agitation for hospital inpatients. There is support for this response model to continue beyond the pilot phase and further area for research.

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In recent years, there has been an increase in the number of candidates for bariatric surgery and a decrease in psychiatric contraindications.

We aim to make an descriptive evaluation of unfavorable feedback concerning mental health of the candidates for bariatric surgery of the Local Health Unit of Matosinhos (Porto, Portugal).

Descriptive analysis of unfavorable feedback of mental health of candidates for surgical treatment of obesity.

From March 2017 to August 2022, the Mental Health Service of the Local Health Unit of Matosinhos issued 347 pre-surgical feedback. In 63 cases the initial opinion issued was unfavorable: 11 cases due to a psychiatric contraindication (not meeting conditions for intervention) and 52 cases had a conditional opinion (requiring pre-surgical interventions in order to become eligible for the intervention). Regarding contraindications, these were due to alcohol use disorder (n=3), binge eating (n=3), intellectual development disorder (n=2), purgative behavior (n=1), psychotic disorder (n=1) and mood disturbance (n=1). In terms of conditional opinions, the issues mencioned were lack of motivation for surgery (n=22), psychopathology (n=20), doubts about informed consent (n=8) and need for multidisciplinary discussion/coordination (n= 7).

There was an increase in eligibility of candidates for surgical treatment as most of the initial unfavorable opinions were conditional. This could be explained by the decline of complications associated with bariatric surgery, but also because psychiatric disorders are now being viewed as treatable. Notably people with eating disorders are now fit for surgery after a medical or psychotherapeutic intervention.

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Delirium is an acute, transient, global organic disorder of CNS functioning resulting in impaired consciousness, attention, and other cognitive functions. Causes of delirium are multifactorial and can be unrecognized in 2/3 of cases. It is recommended to use as few psychotropic medications as possible because many of them can worsen delirium. Antipsychotics are not recommended as a drug of first choice.

To present rate of delirium regarding to treatment and outcome.

A retrospective observational study was conducted in the department of consultative psychiatry of the University Clinical Center Tuzla during the one-year period of the COVID-19 pandemic.

761 calls from different clinics of the University Clinical Center Tuzla were received in one year period. Delirium was diagnosed in 213 patients (28%). The total number of deaths was 147 (19.3%), the number of deaths in patients with delirium was 88 (41.3%). Antipsychotics were used in 137 (64%) patients with delirium. Death as an outcome was more common in patients treated with antipsychotics (64%) p˂ 0.05. The most used antipsychotic was Promazine 94 (44.1%). Number of deaths in patients with delirium treated with Promazine was 42 (44.7%) p ˂ 0.05.

In patients with delirium mortality is significantly higher in those treated with antipsychotics, especially when treated with Promazine. The choice of antipsychotic medications should be made according to pharmacological properties and the clinical context.

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Recently, orthognathic surgeries have gained popularity in orthodontics settings. The perception of body image is a driving force in individuals who seek orthodontic treatments. Therefore, the clinician should be suspicious of underlying psychological conditions, namely body dysmorphic disorder (BDD). Indices like the “index of complexity, outcome, and need” (ICON) in orthodontics not only objectively determine malocclusion traits but also consider the influence of subjective beauty perspectives.

This study aimed to assess if dentists can use an objective orthodontics index in order to screen for and detect BDD among their patients.

This case-control study was conducted in the Faculty of Dentistry at Mashhad University of Medical Sciences, Mashhad, Iran. In total, 414 women were recruited between January 2019 and April 2020. After determining the ICON index, applicants filled out a demographic questionnaire, the Beck depression inventory (BDI II), Beck anxiety inventory (BAI), and Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder (BDD-YBOCS).

In total, 31 (15%) cases in the orthodontics group and 21 (10.1%) subjects in the control group had a score of 20 or higher on the BDD-YBOCS (p=0.182). Moreover, there was no significant difference between groups in the mean BDD-YBOCS (p=0.184), BAI (p=0.163), and BDI-II (p=0.147). However, a statistically significant difference was found between the orthodontics patients and controls in the mean ICON index score (p<0.001). No correlation was found between the severity of ICON and BDD-YBOCS scores in all participants (p=0.804), cases (p=0.655), nor controls (p=0.403).

Objective indices such as ICON were not able to screen for BDD. Furthermore, BDD has an increased prevalence in patients seeking orthodontic treatments. Orthodontists should look for BDD features in patients during the first visit by careful history taking and can benefit from utilizing the BDD-YBOCS survey as a screening tool in patients who are suspected of having BDD while referring the individuals who have higher scores to psychiatrists for further clinical evaluations.

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According to the psychodynamic hypothesis in FGIDs, as well, UGIDs such as functional heartburn (FH) and functional dyspepsia (FD) are often a consequence of receiving inadequate nutrition from one’s mother during childhood, which leads to a failure to adapt to eating. Meanwhile, lower GI disorders such as IBS and functional constipation are generally accompanied by avoidant defense mechanisms and obsessive compulsive disorder.

This study aimed to identify the differences in the psychological characteristics of the anatomical location of functional gastrointestinal disorders (FGIDs) and the factors that influence the quality of life (QOL).

Altogether, 233 patients who were diagnosed with FGIDs were classified into the upper gastrointestinal disorder (UGID; n=175) group and the lower gastrointestinal disorder group (LGID; n=58). Psychological characteristics were identified using the Korean version of the Beck Depression Inventory 2nd ed.; Korean version of the Beck Anxiety Inventory; Korean version of Childhood Trauma Questionnaire; Multi-dimensional Scale of Perceived Social Support; Korean version of Type-D Personality Scale-14; and Korean version of the Connor–Davidson Resilience Scale. QOL was evaluated using the World Health Organization Quality of Life - Brief Version.

The UGID group demonstrated higher scores in ‘emotional’ than the LGID group. (t=-3.031, p<.01) A significant difference was observed between groups in ‘significant others’. (t=2.254, p<.05) Significant differences were observed between the groups in hardiness (t=2.259, p<.05) and persistence (t=2.526, p<.05), while the LGID group demonstrated significantly lower scores than the UGID group in ‘negative affectivity’. (t=-1.997, p<.05) Additionally, the LGID group demonstrated lower QOL than the UGID group. (t=2.615, p<.05) The stepwise regression analysis on OQL involved depression, resilience, social support, and childhood trauma, which accounted for 48.4% of the total quality of life explanatory variance

Psychological characteristics and QOL significantly differed when FGIDs were classified according to anatomical location. Thus, psychological interventions customized for each type of FGIDs may be necessary for effective treatment.

None Declared

From the beginning of the pandemic in Georgia, Covid clinics and Covid hotels were not ready to receive and manage people confirmed Covid 19 with pre-existing mental disorders, because of stigma. As a result of this, the Ministry of Health created special Covid-Psychiatric clinics.

Study the impact of stigma on people with pre-existing mental disorders during Covid 19 pandemic. Also clinical, and dynamic characteristics of Covid 19 infection in people with severe mental illness.

A retrospective statistical analysis of medical records of all hospitalized patients (total 301) at the specialized Rustavi Covid –Psychiatric clinic from November 23, 2020, to March 15, 2022, according to the following parameters: age, gender, mental disorder diagnosis, comorbid chronic illness, vaccination rates, degree of covid infections ongoing, and outcome.

57% of patients were men. Average age-44 years. 67% were asymptomatic or mild with covid symptoms, 25% with moderate severity and 8% were referred to the intensive care unit. 56% of referred patients were hospitalized already in serious conditions. 46% of patients had schizophrenia spectrum disorders. Among referred patients, 60% were women, and 25% had comorbid diabetes mellitus. 44% of patients transferred to the intensive care unit died. Most of the hospitalized patients with pre-existing mental disorders were in remission, and only 7% were referred to other psychiatric clinics for continuing their inpatient treatment.

The study showed that only due to the lack of readiness of the relevant structures, individuals with Covid 19 infection were hospitalized in psychiatric clinics because of their past mental history. Vaccination rates were extremely low than in the general population. The aforementioned indicates a high degree of stigma in the country that makes obstacles for people with mental disorders from receiving adequate and timely medical care. Comorbidities played a big role in degree of COVID infections ongoing, especially diabetes. Statistics also showed that the majority of hospitalized patients did not require inpatient treatment and covid infection did not aggravate the course of most severe mental disorders.

None Declared