Mothers of preterm babies that were hospitalized in Neonatal Intensive Care Unit (NICU), might react with anxiety due to the extremely challenging circumstances. From maternal point of view, after a sudden, high-risk and traumatic birth that has recently occurred, their fragile preterm babies are in an intimidating medical environment, separated from them and are at high-risk of morbidity and mortality. Those circumstances, accompanied by great uncertainty, provoke perceptions of control such as locus of control and maternal self-efficacy, which are both known as central in evoking anxiety.

The proposed presentation examines the mediating effect of maternal self-efficacy in the association between locus of control and anxiety, among mothers of hospitalized babies in the NICU, above and beyond gestational age and mothers’ socio-economic status.

The participants in the present study were 128 Israeli mothers of 208 NICU hospitalized preterm babies. They completed self-report questionnaires regarding their background variables, internal locus of control, maternal self-efficacy, and anxiety.

The analysis showed that while gestational age and mothers’ socio-economic status were controlled, internal locus of control had a significant and positive effect on maternal self-efficacy, and that maternal self-efficacy had a significant and negative effect on mothers’ anxiety. Finally, the direct negative effect of internal locus of control on anxiety decreased with the inclusion of maternal self-efficacy. Altogether, the model explains 26.2% of the variance in maternal anxiety.

The results demonstrate the central role of senses of control in reducing the levels of anxiety experienced by mothers while their preterm babies are NICU hospitalized. fessionals’ interventions with preterm mothers should focus on supporting and encouraging perceptions of internal control as well as promote positive self-perception regarding their ability to succeed in mothers’ tasks. Higher internal perception of control will lead to higher maternal confidence in their ability to perform as mother, which in turn will reduce their anxiety levels. These outcomes may potentially benefit not only the preterm mothers themselves, but also their babies through higher levels of maternal engagement and responsibility as well as through better maternal functioning and subjective well-being. These will impact infants in the short and long run, in terms of physical, cognitive and emotional development.

None Declared

Pregnancy-specific anxiety is defined as a mental state of a pregnant woman whose concerns are specific to the pregnancy itself, such as fears regarding the pregnancy, delivery, and health of the child. In the perinatal period, anxiety disorders are relatively common and are more common than depressive disorders. These psychiatric concerns can lead to long-term negative effects on pregnancy outcome. On the other hand, when the pregnancy is complicated by the diagnosis of fetal malformations, these concerns are more detrimental to maternal health.

This study aimed to determine the association between pregnancy-specific anxiety in pregnant women and the diagnosis of prenatal fetal malformations, through our database of genetic counseling and prenatal diagnoses.

We conducted a retrospective study on 20 pregnant women who were referred to our genetic counselling. The consultation was piloted during a prenatal genetic exploration and counselling after the second trimester ultrasound diagnosis of syndromic and non-syndromic fetal malformations. Collection and characterization of the psychiatric concerns of the cohort were conducted using the self-reported feelings during the consultation. A conversion of these data using the Perinatal Anxiety Screening Scale was possible to assess the pregnancy-specific anxiety level of our patients.

Results of our study showed that pregnancy-specific anxiety is significantly associated with the discovery of fetal malformations during pregnancies. Depression, generalized anxiety, and post-traumatic stress disorder as well as a specific phobia from the malformed baby were constants as psychiatric concerns.

Health care providers should pay special attention to pregnancy-specific anxiety. The Arabic translated version of the PASS that has been shown to have adequate validity and reliability must be used in our institutions to screen for the new concept of pregnancy-specific anxiety among all pregnant women in the perinatal phase. Women who experienced the discovery of a malformed fetus and who are facing pregnancy termination due to fetal abnormalities need to have a particular psychological support. A specific scale may be crucial in pregnant women with a malformed fetus before and after termination of the pregnancy.

None Declared

Post-traumatic stress disorder, following stress of a particular intensity, is often related to the perception of childbirth as a traumatic event requiring the optimization of follow-up and the interest of early detection.

To determine the factors associated with post-traumatic stress disorder related to childbirth.

This is a longitudinal prospective analytical study carried out in the obstetrics gynecology department of the Tahar Sfar Mahdia hospital. The study population was women who gave birth during the study period from March 15, 2020 to September 15, 2020. We used a pre-established questionnaire including sociodemographic and clinical characteristics as well as a psychometric part containing the psychiatric scale for screening for post-traumatic stress disorder.

Our sample included 120 women. The average age was 28.2±5.3.Five participants (4.2%) had a psychiatric history .

Thirty-five patients (29.1%) had a pathological obstetric history. However, fifteen patients (12.5%) were hospitalized during their pregnancies. Psychometric assessment revealed a prevalence of PTSD at 5.8% with PTSD symptomatology in 18.4% of women.

Twenty-two patients (18.3%) described the childbirth as painful and traumatic.

The frequency of PTSD was higher in women with a history of abortion (6.9%)

Postpartum PTSD was statistically associated with a low level of education (p=0.02), postpartum complications (p=0.05) and sex of the newborn (p=0.01)

The detection of factors associated with postpartum posttraumatic stress disorder seems to be essential for comprehensive and multidisciplinary management of women at risk.

None Declared

Peak incidence for many psychiatric disorders occurs in reproductive years. We don’t have FDA-approved drugs or clinical guidelines. The main cause of pharmacological suspension in pregnancy is the lack of knowledge of their effects on the product. Gathering information on this regard becomes crucial so we can avoid relapses or exacerbation

Describe neurodevelopmental effects in children ≥ 6 months exposed to antipsychotics prenatally.

PROSPERO-CRD42020170314. Using MeSH terms in 5 databases, without language and time restriction, obtaining n=3932. After review and exclusion n=24 were obtained for qualitative review. (Figure 1).

Of 20 case reports 4 had more ambivalence results (Table 1). In the cohort studies, exposure may cause short-term delay at 6 months but no significant difference at 12 months (Table 2).Table 2

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Most are case reports, hence the importance of collecting this information, not ignoring it due to lack of methodological rigor. The intent is not to conclude that prenatal exposure to antipsychotics doesn’t have long-term neurodevelopmental effects, rather documenting the available evidence contributing to an informed clinical decision.

None Declared

Violence against women is a violation of human rights and is part of one of the sustainable development goals. Thus, it is very important to be able to guarantee healthcare spaces from a differential approach, in which they will be developed that promote equality and will help to prevent violence. Therefore, it is necessary to analyse the social representation that future professionals will have in health, and that can affect the approach given to this phenomenon.

To analyse the social representations of violence against women in psychology students at a university in the Colombian Caribbean.

The study was qualitative, exploratory and for convenience, with the application by web platform. The sample consisted of 110 psychology students from a university in the Colombian Caribbean, aged between 18 and 32 years (M=21; SD=3). The technique of free association of words and the application of semi-structured interviews were produced to identify the central and peripheral nucleus of social representation. For data analysis, the Atlas.ti version 22 software was obtained.

It was found that the social representation of violence against women, in its strongest association, deals with the types of physical violence, highlighting among these physical beatings, rapes, assaults and femicides. Likewise, the effects that this phenomenon generates on the mental health of the victims and its relationship with stereotypes about gender roles, in turn, the presence of problems in the judicial system, which end up causing many cases to go unpunished or re-victimize women.

Violence against women constitutes a health problem, having professionals in this area who can understand the psychological impact, generates advantages in the development of strategies aimed at guaranteeing better care, which contributes not only to prevent this phenomenon but also to avoiding revictimization from mental health services.

None Declared

Several studies have reported on the feasibility and impact of e-monitoring using computers, or smartphones, in patients with mental disorders, including Bipolar Disorder (BD). Despite some promising early results, concerns have been raised about the motivation and ability of patients with BD to adhere to e-monitoring, in particular when they are depressed or manic. While studies on e-monitoring have examined the role of demographic factors, such as age, gender, or socioeconomic status and use of health apps, to our knowledge, no study has examined clinical characteristics that might impact adherence with e-monitoring of patients with BD.

We analyzed adherence to e-monitoring in patients with BD who participated in an ongoing e-monitoring study and evaluated whether demographic and clinical factors would predict adherence.

Eighty-seven participants with BD in different phases of the illness were included. Patterns of adherence for wearable use, daily and weekly self-rating scales over 15 months were analyzed to identify adherence trajectories using growth mixture models (GMM). Multinomial logistic regression models and Multiple Component Analyses were fitted to compute the effects of predictors on GMM classes.

Adherence rates were 79.5% for the wearable; 78.5% for weekly self-ratings; and 74.6% for daily self-ratings. GMM identified three latent class subgroups: (i) participants with good adherence with the protocol; (ii) participants with partial adherence; (iii) participants with poor adherence. Women, participants with a history of suicide attempt, and those with a history of inpatient admission were more likely to belong to the group with good adherence.

Participants with higher illness burden (e.g., history of admission to hospital, history of suicide attempts) have higher adherence rates to e-monitoring. This is important because our findings debunk myths around illness burden as an obstacle to adhere to e-monitoring studies. Participants might have seen e-monitoring as a tool for better documenting symptom change and better managing their illness, thus motivating their engagement.

None Declared

Although the effect of lithium treatment on kidney and endocrine systems has been extensively investigated, this literature, however, suffers from substantial heterogeneity and many prior studies are limited by short follow-up on just one marker of interest.

We aimed to determine the impact of long-term lithium therapy on renal, thyroid and parathyroid function within a large real-world cohort.

We performed a cohort study within the Central Region of Denmark (approximately 1.3 million inhabitants). Using the Electronic Patient Record system, we identified all patients with at least one serum-lithium (se-Li) measurement in the period from January 1, 2013 to July 20, 2022, and a reference group of patients diagnosed with bipolar disorder (ICD-10: F30, F31) was matched on age, sex and creatinine level. The outcomes were renal, thyroid, and parathyroid function as indicated by all blood tests taken during follow-up measuring creatinine, estimated glomerular filtration rate (eGFR), thyroid-stimulating hormone (TSH), parathyroid hormone (PTH) and calcium. Multilevel regression analyses adjusted for age, sex, severity of the mental disorder (as indicated by the number of hospitalizations), and somatic comorbidity calculated the association between lithium treatment and development in renal, thyroid, and parathyroid function over time.

A total of 4,709 lithium users (61.5% females, median age 46 years [IQR: 32-60]) and 4,027 control individuals were identified with a total follow-up period of 14,686 person-years (median = 1.7 years, range: 1-9.5). Out of the 4,709 lithium users, a total of 3,157 were incident lithium users. The final results will be shown at the 2023 EPA Congress.

The conclusions will be presented at the congress.

None Declared

Bipolar Disorder (BD) is a frequent psychiatric disorder, which can be associated with high disability. Psychotic symptoms occur in more than half of bipolar patients and are associated with an unfavorable course of the disorder (Chakrabarti et al. World J Psychiatry 2022; 12(9) 1204-1232).

The aim of this study is therefore to identify clinical and biological markers able to discriminate between BD patients with (BD-PS) and without lifetime psychotic symptoms (BD-NPS) to facilitate early diagnosis and to implement a target clinical management of these patients.

We recruited 665 patients consecutively hospitalized for BD at Fondazione IRCCS Policlinico (Milan) and at San Gerardo Hospital (Monza). Data were obtained through a screening of the clinical charts and blood analyses conducted during the hospitalization. Patients were assessed by psychometric scales. The two groups (BD-PS and BD-NPS) were compared by t tests for quantitative variables and χ2 tests for qualitative ones. Variables that resulted to be significant in univariate analyses were inserted in binary logistic models with the presence of psychotic symptoms as dependent variable.

Among the total sample, 64.5% of patients were affected by BD-PS while 35.5% by BD-NPS. The final binary logistic regression model showed that, compared to patients with BD-NPS, those with BD-PS had a longer duration of hospitalization (p=0.007) and were more frequently hospitalized for a manic episode (p=0.001). In addition, subjects with BD-PS had a lower score on the current Global Assessment of Functioning (GAF) (t = 3.157; p = 0.002) and were more frequently males (χ² = 4.061; p = 0.044; OR = 1.399). With regard to biological variables, patients with BD-PS, compared to the counterpart, had a higher Neutrophile to Lymphocyte Ratio (NLR) (t = 2.776; p = 0.006), lower levels of Gamma-Glutamyl Transferase (γGT) (t = 2.249; p = 0.026), higher total bilirubin (t = 2.348; p = 0.019) and creatine phosphokinase (CPK) (t=2.807; p = 0.005), lower total cholesterol (t = 2.369; p = 0.018) and triglycerides (t = 2.554; p = 0.013).

Our data appear to be in line with the literature, especially with respect to the occurrence of psychotic symptoms mainly in manic episodes and their association with greater clinical severity, longer hospitalization and worse outcome (Altamura et al. Aust N Z J Psychiatry 2019; 53(8) 772-781). From a biological point of view, it seems important to emphasize that patients with lifetime psychotic symptoms presented a higher NLR, revealing more prominent low-grade inflammation in these patients than the counterpart. These data confirm the possibility of using NLR as biomarker of severity in bipolar patients, as proposed previously by other authors (Kulacaoglu et al. Nord J Psychiatry 2022). Future multi-center study have to confirm the results of the present study.

None Declared

The existence of a clinical entity on the spectrum of mood disorders characterized by the occurrence of manic episodes without major depressive episodes (Unipolar Mania, UM) is largely debated. Although not classified nosologically, the studies exploring this topic have suggested that UM might differ from bipolar disorder with a manic-depressive course (md-BD), in terms of several clinical characteristics. Individuals with UM might represent a subpopulation with specific clinical profiles and unmet care needs, requiring personalized treatments, as compared with those suffering from md-BD.

To identify clinical factors associated with UM, as compared with md-BD.

We performed a systematic review and meta-analysis of observational studies according to the MOOSE guidelines. We searched for articles indexed up to July 2022 in the main electronic databases. We conducted random-effects meta-analyses of the association between UM and relevant correlates, using odds ratio for categorical variables and standardized mean difference for continuous variables.

Based on data from 21 studies meeting the eligibility criteria, we found that individuals with UM, as compared with md-BD, were more likely to be males (p = 0.007) and to have an earlier age at onset (p = 0.020). Moreover, UM was significantly associated with a higher number of hospitalizations (p < 0.001), the occurrence of psychotic features (p < 0.001), as well as hyperthymic temperament (p = 0.012). Finally, subjects with UM were less likely to report a family history of depression (p = 0.006) and a personal history of suicide attempts (p < 0.001).

Our work supports the hypothesis that UM might represent a distinctive diagnostic construct, with peculiar clinical correlates. Additional research is needed to better differentiate UM in the context of affective disorders.

None Declared

Recent research on Schizophrenia (SCZ) suggests that reduced sleep spindle and slow wave density could be particularly informative of underlying thalamocortical and cortical synchronization mechanisms and dysfunctions. Although sleep disturbances are also highly prevalent across all stages of Bipolar Disorder (BD), the objective evaluation of sleep macrostructure and microstructural oscillatory activity remains understudied in this population.

We aimed to investigate sleep EEG activity in BD, with a focus on sleep architecture, sleep spindles and slow waves.

We recorded high-density EEG (64–channel BrainAmp, Brain Products GmbH, Germany) during sleep in 18 euthymic patients with BD and 18 age/gender-matched healthy control (HC) subjects. After sleep scoring and EEG artifact rejection, several parameters of sleep spindles (12-16 Hz), including density and amplitude, and slow waves (0.1-4 Hz) were identified for the first cycle of sleep using automated algorithms and compared between groups using non-parametric statistics.

BD subjects showed significantly higher Wake After Sleep Onset and lower Sleep Efficiency (Table 1). Total (12 - 16 Hz), slow (12 - 14 Hz) and fast (14 - 16 Hz) sleep spindle parameters of density (Image 1) and amplitude did not differ significantly between groups. On the other hand, slow wave density was reduced in a large frontal cluster of electrodes in the BD group (Image 2).Table 1

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Image 2:

The absence of sleep spindle deficits in the BD group suggests that the systems involved in generating and maintaining these thalamocortical oscillations are presevered during periods of clinical stability in Bipolar Disorder. Conversely, reduced sleep slow wave density points to an altered cortical synchronization, which might represent a common neurophysiological feature shared with Schizophrenia. Further research is needed to confirm these preliminary observations in all–night recordings and with a direct comparison of larger cohorts of patients with both diagnoses.

None Declared

The definition of mixed states has been changed over the years, leading to substantial heterogeneity and inconsistencies across studies, and thus limiting the understanding of this phenomenon. Given the limited data available after the introduction of the DSM-5 mixed features specifier (MFs), we conducted a cross-sectional study evaluating MFs in individuals suffering from affective disorders, i.e., major depressive disorder (MDD) or bipolar disorder (BD).

The aim of this study is to evaluate rates and correlates of MFs in a consecutive sample of inpatients with mood episodes.

We included adults consecutively admitted to our inpatient mental health unit with a current manic episode (ME) or major depressive episode (MDE). DSM-5 criteria were used to assess the occurrence of MFs. Young Mania Rating Scale (YMRS) and Montgomery-Åsberg Depression Rating Scale (MADRS) were used to assess the severity of the mood episodes. We used the Kemp Compliance Rating Scale to assess medication adherence.

A total of 285 individuals were included (mean age ± SD: 48.3 ± 17.9; M/F ratio: 2/3). Among them, 94 (33.0%) were in a ME and 191 (67.0%) in a MDE. Forty individuals (14.0%) exhibited MFs. We found that MFs were significantly more frequent in participants with a diagnosis of BD (p<0.001) and during a ME (p=0.006). In addition, study participants with MFs had lower medication adherence at hospital admission (p=0.008). Finally, individuals with ME and MFs had lower YMRS scores than those without MFs (p<0.001), and, similarly, those with MDE and MFs had lower MADRS scores than those without MFs (p<0.001).

Considering DSM-5 classification, we found that MFs are a phenomenon strongly linked to BD. While the symptom severity of the prevalent polarity tends to be lower in episodes with MFs, the reduced adherence may be suggestive of a more complex clinical management requiring specific treatment approaches.

None Declared

Bipolar disorder (BD) is characterized by significant inter-individual variation in terms of course and outcome. The most important factors associated with the outcome are subsyndromal depression and cognitive disability. Predominant polarity (PP), which is a proposed course specifier for BD, can be associated with various clinical differences such as psychotic feature, suicidality, hospitalization, while it is thought to be associated with the severity of cognitive impairment.

To elucidate the role of the predominant polarity on cognitive dysfunction in patients with BD.

Patients with BD in remission (n=84) and healthy control volunteers (HC, n=27) participated in the study. Patients were divided into 3 subgroups according to their PP characteristics: manic (MPP, n=31), depressive (DPP, n=25), and undetermined (UPP, n=28). Structured Clinical Interview for DSM-5 Disorders-Clinician Version (SCID-5/CV), WAIS-R-Vocabulary Subtest, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Young Mania Rating Scale, Rey’s Auditory Verbal Learning Test (RAVLT), Trail Making Test (TMT), Stroop Test (ST), WMS-R Visual Reproduction Subtest, Controlled Oral Word Association Test (COWAT), Auditory Consonant Trigrams Test (ACT), Reading the Mind in the Eyes Test (RMET), Hinting Test (HT), Wisconsin Card Sorting Test (WCST), and Conners Continuous Performance Test (CCPT) were administered. Scores that do not show normal distribution were transformed using the two-step normalization method. Principal component analysis (PCA) with direct oblimin rotation was applied as a dimension reduction technique to identify different neurocognitive domains. Single-factorial PCA was also applied to calculate global cognition scores.

In MPP group compared to HC, worse performance was observed in ACT (d=1.24), COWAT (d=1.16), RMET (d=1.03), HT (d=1.78), WCST correct answers (d=0.99), CCPT correct target section (d=0.99) and a prolongation in TMT-A (d=1.00). Compared to DPP, MPP had a weak performance in COWAT (d=0.89), RMET (d=0.86) and HT (d=1.00). MPP (d=1.18) and UPP (d=1.03) groups showed deterioration in processing speed compared to HC. MPP group showed impairment in working memory (d=1.17) and attention (d=0.70) compared to HC. In problem-solving and reasoning, deterioration was found in MPP compared to HC (d=1.16) and UPP (d=0.67), also in DPP compared to HC (d=0.74).

The MPP group yielded more severe cognitive impairment in verbal fluency and social cognition tests compared to DPP. Predominant polarity may also be related to cognitive impairment patterns seen in BD.

None Declared

Postpartum psychosis is a rare psychiatric emergency, occurring days to weeks after 1-2 per 1000 deliveries. Its low prevalence makes it difficult to recruit enough participants to investigate the underlying pathophysiology. It is epidemiologically linked to bipolar disorder, which one study also found it to resemble in genetic susceptibility for psychiatric disorders (Di Florio et al. Lancet Psych 2021; 8: 1045–52).

In this study we aim to investigate polygenic liability for psychiatric disorders in two new Swedish postpartum psychosis cohorts.

Cases with postpartum psychosis, defined as a psychiatric hospitalization within 6 weeks after delivery, and/or receiving a diagnosis of F53.1 (ICD 10) or 294.40 (ICD 8.), parous women with severe mental illness without postpartum psychosis, and healthy parous controls were identified in two Swedish genetic studies: the Swedish bipolar collection (SWEBIC) and Predictors for ECT (PREFECT). Polygenic risk scores (PRS) were calculated from summary statistics from genome wide studies on bipolar disorder (Mullins et al. Nat Genet 2021; 53 817-829), schizophrenia (Trubetskoy et al. Nature 2022; 604 502-508) and major depression (Wray et al. Nat Genet. 2018; 50 668-681). The p-value thresholds best predicting their respective phenotype were used in logistic regression analyses with the first six principal components and genotyping platform as confounders.

We identified 176 patients with postpartum psychosis and genetic information (N(SWEBIC)=126, N(PREFECT)=50). Compared with healthy parous women, patients with postpartum psychosis had significantly higher PRS for bipolar disorder (SWEBIC: odds ratio [OR] 2.6 (95% confidence interval [CI] 1.9-3.5), PREFECT: OR 2.4 (95% CI 1.8-3.2), Figure 1.) and schizophrenia (SWEBIC: OR 1.6 (95% CI 1.2-2.2), PREFECT: OR 1.8 (95%; CI 1.3-2.5)). Patients with postpartum psychosis had significantly higher PRS for bipolar disorder (SWEBIC: OR 1.4 (95% CI 1.2-1.8), PREFECT: OR 1.5 (95% CI 1.1-2)) compared with parous women with severe mental illness without postpartum psychosis. We found no associations with major depression PRS in either cohort.

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We replicated previous findings of significantly higher PRS for bipolar disorder and schizophrenia in postpartum psychosis compared with healthy controls. In contrast to previous research, we find postpartum psychosis cases to have higher PRS for bipolar disorder than bipolar disorder cases. Our findings highlight the genetic influence in postpartum psychosis and support previous genetic and epidemiological evidence that postpartum psychosis lies on the bipolar spectrum.

None Declared

Antipsychotics have shown their interest in several pathologies of children and adolescents. However, in this vulnerable population, they are not exempt from adverse effects. Hyperprolactinemia is a frequent and underestimated consequence of treatment with these drugs.

Risperidone has a marked tendency to elevate prolactin and induce the impact of hyperprolactinemia, comparable to haloperidol, and higher than most atypical antipsychotics. Reported prevalences range from 43.2% to over 64% [4].

Aripiprazole is more neutral, even decreasing prolactin levels. Several studies have affirmed this nature, hence its usefulness and effectiveness in the management of antipsychotic-induced hyperprolactinemia.

To highlight the importance of monitoring prolactinemia in children on antipsychotic drugs. evoke the different therapeutic alternatives for the management of this adverse effect. show the effectiveness of aripiprazole in the management of antipsychotic-induced hyperprolactinemia.

We report the case of a 14-year-old girl, followed since the age of 5 for an intellectual development disorder, who was put on risperidone to manage her aggressiveness and insomnia. the appearance of mild hirsutism (Ferriman and Gallwey score = 15) with amenorrhea for 3 months. Thus, we decreased the dose of risperidone to 1 mg/d and requested a prolactinemia, which came back very high at 1637 mUI/l (N=63.6 - 305.28). The diagnosis of antipsychotic-induced hyperprolactinemia was retained after elimination of a prolactinoma and the patient was put on aripiprazole according to the modalities of the antipsychotic switch. We report the case of a 14-year-old girl, followed since the age of 5 for an intellectual development disorder, who was put on risperidone to manage her aggressiveness and insomnia.the appearance of mild hirsutism (Ferriman and Gallwey score = 15) with amenorrhea for 3 months. Thus, we decreased the dose of risperidone to 1 mg/d and requested a prolactinemia, which came back very high at 1637 mUI/l (N=63.6 - 305.28). The diagnosis of antipsychotic-induced hyperprolactinemia was retained after elimination of a prolactinoma and the patient was put on aripiprazole according to the modalities of the antipsychotic switch.

We observed a rapid decrease in serum prolactin as soon as 10 mg of aripiprazole was reached with a change from 1276 to 461 mIU/l after one month before its normalization the following month (237 mIU/l).

The prescriber must therefore make a choice that is adjusted to the patient’s pathology, but also to the slightest sign of adverse effects. He will have to re-evaluate regularly the efficacy of the treatment and confront it with the possible adverse effects of the patient.

None Declared

Many metabolic diseases influence brain function and are associated with psychiatric symptoms and neuropsychiatric disorders (including autism-spectrum disorders, ADHD and psychotic disorders). Attention-deficit-/hyperactivity disorder (ADHD) is among the most common neurodevelopmental disorders in children, with a worldwide prevalence of about 5% in childhood. Tyrosinemia is caused by a genetic mutation in the fumarylacetoacetase gene that leads to a deficiency in the encoded enzyme, which catalyzes the cleavage of tyrosine metabolites to acetoacetic acid and fumaric acid. In recent studies of children with tyrosinemia type 1, a strong correlation was observed between symptoms of ADHD and blood levels of tyrosine, supporting a direct role of this amino acid in the pathogenesis.

we report this case of tyrosinemia type 1 associated to ADHD symptoms to contribute in literature to provide more insights into possible shared pathophysiological mechanisms and how these affect their treatment.

We report the case of an 8-year-old child, followed since the age of 3 months for a tyrosinemia type 1 who presented symptoms of ADHD.

scales and questionnaires were used to detect ADHD symptoms, the SNAP IV - Swanson, Nolan and Pelham Teacher and Parent Rating Scale was used with the mother, the items concerning inattention (items 1 to 10) and Hyperactivity-Impulsivity (items 11 to 20) were revealing; The Conners Evaluation Questionnaire was delivered, confirming the same result, a neuropsychological evaluation of the child with IQ evaluation by WISC-IV - Wechsler Intelligence Scale for Children and Adolescents revealed limited intellectual performance with an IQ of 65.

NMDs, such as HT-1, constitute a large group of conditions that are often containable with early clinical intervention, but still present lifelong difficulties and high societal costs. many studies suggest that there may be similar biological mechanisms behind the cognitive difficulties seen in ADHD and HT-1. In clinical settings, the impaired dopamine synthesis due to substrate inhibition in treated HT-1 may be compensated for by standard ADHD medication, such as methylphenidate or amphetamine. Similarly, the reduced serotonin synthesis may be counteracted by tryptophan supplementation.

None Declared

Tuberculosis (TB) is a bacterial infection caused by Mycobacterium tuberculosis and is a major public health problem in Morocco. The World Health Organization (WHO) recommends a four-drug combination therapy for two months (isoniazid (INH), rifampicin, pyrazinamide and ethambutol), followed by two drugs (INH and rifampicin) for 4 months, as first-line treatment for newly diagnosed pulmonary TB in children and adults. This regimen is generally considered effective, safe, and cost-effective. However, adverse effects and drug interactions often complicate the treatment of TB. Isoniazid is associated with 32% of adverse events, of which 1.9% are psychiatric.

focus on drug-induced etiologies of acute psychotic symptoms make the diagnosis of isoniazid-induced psychosis report the literature on the management of this condition. focus on drug-induced etiologies of acute psychotic symptomsmake the diagnosis of isoniazid-induced psychosis report the literature on the management of this condition.

The patient and guardians were interviewed to obtain information after their consent. Data from the patient profile forms and laboratory test reports were evaluated. Causality assessment was done by the WHO scale and the Naranjo scale. Oral informed consent was obtained from the patient and parents.

We report a case of acute psychosis in a child with a temporal sequence strongly in favor of INH-induced psychosis. Treatment with risperidone at an appropriate dose improved the symptomatology while waiting for the end of the antituberculosis protocol. As soon as the isoniazid was stopped, there was a clear return to the child’s premorbid state.

The acute onset of psychotic symptoms in a patient taking isoniazid should lead to suspicion of this psychiatric side effect and prompt intervention, involving discontinuation of isoniazid and/or a trial of an antipsychotic.

As protective measures, the authors suggest adjusting the dose of isoniazid to weight, possibly performing a genetic test if slow acetylation is suspected, and closely monitoring patients with a favourable background.

The acute onset of psychotic symptoms in a patient taking isoniazid should lead to suspicion of this psychiatric side effect and prompt intervention, involving discontinuation of isoniazid and/or a trial of an antipsychotic.As protective measures, the authors suggest adjusting the dose of isoniazid to weight, possibly performing a genetic test if slow acetylation is suspected, and closely monitoring patients with a favourable background.

None Declared

Autism Spectrum Disorder is a chronic medical condition usually diagnosed during childhood. With psychosocial advancements in managing autistic children, the situation seems less debilitating compared to what it used to be in the past years. Adding neuroimaging advancements in the management can further improve the management of Autism Spectrum Disorder.

Our objective is to investigate structural changes in the insular cortex through our review of the available literature in the area of interest.

Detailed literature search conducted using Pubmed, OVID, Google scholar with the search terms [insula] OR [autism] OR [brain changes] OR [ autism spectrum disorder] OR [insular cortex] OR [ insular changes] OR [neuroimaging] OR [neurology] OR [right insula] OR [left insula] OR [precentral cortex] OR[ amygdala] Or [emotion] Or[ memory] that produced around 300 results which were later narrowed down to be centered around search terms [autism] OR [insula] OR [structural changes] OR [brain]. 20 articles were made part of this review.

Results revealed that there are significant changes that are seen in neuroimaging of patients with Autism Spectrum Disorder. Their anterior cortex undergoes changes more than the posterior cortex with changes being more pronounced on the right side. Neuroimaging can be used to follow up with the prognosis of a chronic condition. Insula is a multifunctional region of the brain that is responsible for connecting cognitive, emotional, and movement functions in the brain. It is a highly functional area responsible for important neural connections. Insula is a highly emotion-sensitive area responsible for pain perception and emotion regulation. Insular changes can also help to diagnose the chronicity of the condition and age of patients with Autism.

Cortical changes are visible on neuroimaging in several psychiatric conditions including schizophrenia, depression, anxiety, substance abuse, and alcoholism. Autism spectrum disorder is one of the diseases where neuroimaging can play an important role in planning further management. But unfortunately, this area is still under underresearched and needs to be given due importance to facilitate management of the chronic condition.

Keywords: cortex, insula, neuroimaging, autism spectrum disorder

None Declared

For several years, strong theoretical and clinical links have been established between intra-family relationships and eating disorders.

To study intra-family relationships in adolescent with food addictive behaviour.

This was a cross-sectional, descriptive and analytical study conducted among a sample of adolescents randomly collected in 6 schools in the region of Sfax-Tunisia, during the month of February 2022. The food addiction symptomatology was assessed by the “Dimensional Yale Food Addiction Scale version 2.0 For Children” (dYFAS-C 2.0) and the family attitude was studied by the “Brief Family Relationship Scale” (BFRS) which evaluates three dimensions: cohesion, expressiveness and conflict, each having a separate score. Both scales are validated in Arabic.

The study involved 360 high school students, with a mean age of 16.62 +/- 0.822 years. The sex ratio was 1.09.

The total score for food addiction symptomatology in our sample ranged from 0 to 56 with an average of 16.37 +/- 12.380.

Of the three dimensions of the quality of intra-family relationships studied, conflict had the highest mean score: 25.29+/-9.027.

A high food dependence score was significantly related to these three dimensions of the intrafamily relationship: lack of conflict (p=0.044), cohesion (p=0.011) and expressiveness (p=0.005) presence.

The present study shows that the symptomatology of food addiction is influenced by the quality of the intra-family relationship.

Enhanced perception of the family environment and involvement of the family in possible care can help to prevent the onset of eating disorders and to plan an appropriate intervention.

None Declared

The relationship between cyber video game addiction and impulsivity is controversial. Some studies have shown a significant link, others have found no association between the two behaviours.

To study impulsivity in adolescents with problematic use of internet video games.

This was a cross-sectional, descriptive and analytical study, conducted among a sample of adolescents randomly collected in 6 schools in the region of Sfax-Tunisia, during the month of February 2022. The rate of addiction to video games was assessed by the 20-item “Internet Gaming Disorder-20” (IGD-20) scale and impulsivity by the 30-item “Barratt Impulsivity Scale” (BIS-11). Both scales are validated in Arabic.

The study involved 360 secondary school students, with a mean age of 16.62 +/- 0.822 years. The sex ratio was 1.09.

A gaming addiction was found in 4.7% of cases.

Similarly, impulse control disorder was noted in 23.6% of adolescents.

Problematic internet game use was significantly related to motor impulsivity (p=0.025).

There was no significant association between cyber video game addiction and cognitive or non-planning impulsivity.

According to the results, impulsiveness is a factor to consider for understanding the development of addiction to internet video games. Thus, impulsiveness should be taken into account to explain problematic gaming behaviour as well as to design preventive and treatment interventions.

None Declared

The course of adolescence is marked by feelings of insecurity, vulnerability and can be accompanied by the emergence of several mental health problems.

Having a good self-esteem brings many benefits such as security, well-being and a strong sense of confidence. Low self-esteem is often accompanied by psychological distress such as stress.

To assess the level of stress and self-esteem in young high school students and to identify the risk factors associated with low self-esteem in these adolescents.

This was a cross-sectional, descriptive and analytical study conducted among a sample of adolescents randomly collected in 6 schools in the region of Sfax-Tunisia, during the month of February 2022. The level of stress was assessed using the Lovibond Depression Anxiety Stress Scale (DASS-21) and self-esteem by the Rosenberg Self-Esteem Scale, both scales are validated in Arabic.

We collected 396 adolescents. The mean age was 16.65+/-0.897 years and the sex ratio was 0.82.

Of these adolescents, 102 had stress symptoms according to the DASS-21 scale, i.e. 26% of the sample. Stress was severe to extremely severe in 37.2% of cases.

Low to very low self-esteem was found in 65.7% of cases compared to 14.7% with high self-esteem.

In addition to the association with high levels of stress in these adolescents (p=0.002), low self-esteem was associated with other psycho-social factors such as intra-family relationship problems (p=0.014), a history of repeating a year (p=0.026), low to average school performance (p=0.027) and behavioural problems in the school environment (p=0.032).

These results suggest that the association of stress with certain psycho-social factors helps the deterioration of self-esteem in adolescents and vice versa.

Having high self-esteem may protect the individual from psychological vulnerabilities such as stress and help him/her to cope with them.

None Declared