Lithium associated with hypercalcemia may mimic a psychiatric condition and be confused for a relapse of bipolar disorder. The etiology seems to be due to a reduced sensitivity of the parathyroid cells to calcium, altering the parathyroid hormone (PTH) response. Lithium as an essential monovalent cation has some structural similarity to calcium (Ca) and can interact with protein receptors. This leads to changes in the inhibitory configuration of PTH and increased serum calcium concentrations, rising the threshold necessary to suppress hormone secretion.

Lithium-induced hyperparathyroidism (HIL) is the main cause of hypercalcemia in these patients.

Based on a clinical case of lithium-associated hypercalcemia in a patient with bipolar disorder, review the existing literature and state the needs for periodic monitoring protocols.

Case report and bibliographical review.

A 38-year-old woman, diagnosed with bipolar affective disorder at the age of 18, has been treated with lithium during which she developed secondary tubulointerstitial nephropathy as an adverse effect. Recently, she requested medical evaluation for constitutional syndrome associated with deterioration of general condition with loss of strength and difficulty in walking. Analytically, mild hypercalcemia was detected, and the study was extended to include Ca and PTH.

Chronic lithium therapy often develops mild hypercalcemia (approximately 10 to 20 percent of patients taking lithium), most likely due to increased secretion of PTH. Lithium can also unmask previously unrecognized mild hyperparathyroidism in patients with adenomas within a few years of starting therapy or induce parathyroid hyperplasia with a chronic use.

The hypercalcemia usually, but not always, subsides when the lithium is stopped. Normalization of serum calcium is more likely to occur one to four weeks post-lithium withdrawal in patients with a relatively short duration of lithium use. It is less likely in patients receiving lithium for more than 10 years.

Regarding the case to be presented, a review of the literature is carried out and the need to propose periodic calcium monitoring protocols is exposed.

Recommendations include determination of serum calcium every 6 months, urinary calcium and creatinine every 12 months, and bone mineral density monitoring every 1 to 3 years. Regular analytical monitoring including total calcium, PTH and vitamin D, would identify patients with a tendency to hypercalcemia so that appropriate measures could be taken. So as chronic treatment with lithium can develop mild hypercalcemia, I consider it necessary to develop periodic monitoring protocols for this adverse effect.

None Declared

Conventional Bayesian network meta-analysis (NMA) of multiple outcomes are performed using non-informative prior distribution, independently for each outcome.

This study aimed to estimate pharmacological intervention effects against placebo within a multivariate Bayesian framework using an informative lognormal prior distribution.

13,188 participants were evaluated for two dichotomous study outcomes, namely, treatment response and all-cause dropouts, in 57 double-blinded randomized controlled trials (RCTs) for the treatment of acute bipolar mania (ABM) in adults. Both the study outcomes were measured from baseline to week 3. 10 pharmacological drugs or interventions consisted of mood stabilizers, anti-psychotics, antidepressants, combinations of the above and other agents, and were compared against each other as well as with placebo either as monotherapy or add on agents. These treatments include placebo, aripiprazole, haloperidol, quetiapine, ziprasidone, olanzapine, divalproex, paliperidone, carbamazepine, lithium; and lamotrigine. Aggregated arm-based data on both the study outcomes were considered. We used the logit scale to model the probability of event occurrence and adopted multivariate modelling approach; wherein both the study outcomes were included in a single NMA model. Further, the between-study variance-covariance matrix was decomposed using the Cholesky and spherical decomposition techniques and the results were compared. The deviance information criterion (DIC) indices were used to assess the model fit. Analyses included 16,00,000 Markov Chain Monte Carlo (MCMC) iterations with 6,00,000 burn-in period and thinning of 100; tested by running three chains with different starting values. All the analyses were carried out in WinBUGS software.

Under Cholesky and spherical decompositions, the correlation between the study outcomes were estimated as -0.51 (-0.68, -0.29) and -0.56 (-0.68, -0.50), respectively. DIC model fit index values for Cholesky and spherical decompositions were 667.74 and 667.53, respectively; indicating both decomposition techniques were equally good. Further, the Gelman-Rubin convergence statistics were stable and all Monte Carlo errors were around 0.005. Overall, olanzapine, paliperidone and quetiapine were both significantly more effective and acceptable than placebo; whereas aripiprazole, haloperidol ziprasidone, divalproex, and carbamazepine were not. In addition, both lithium and lamotrigine failed to be effective and acceptable.

Our findings exhibit an excellent concordance with the one used in clinical practice. Moreover, the Canadian Network for mood and Anxiety Treatments, and Royal Australian and New Zealand College of Psychiatrists guidelines also recommended these drugs as first-line medications for treating bipolar disorder.

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Manic and depressive mood states in bipolar disorder (BD) may emerge from the non-linear relations between constantly changing mood symptoms exhibited as a complex dynamic system. Dynamic Time Warp (DTW) is an algorithm that may capture symptom interactions from panel data with sparse observations over time.

The current study is the first to analyze a time series of depression and manic symptoms using DTW analyses in patients with BD. We studied interactions and relative changes in symptom severity within and between participants.

The Young Mania Rating Scale and Quick Inventory of Depressive Symptomatology were repeatedly assessed in 141 patients with BD, with on average 5.5 assessments per patient every 3 to 6 months. DTW calculated the distance between each of the 27*27 pairs of standardized symptom scores. The changing profile of standardized symptom scores of BD patients was analyzed in individual patients, yielding symptom dimensions in aggregated group-level analyses. Using an asymmetric time-window, symptom changes that preceded other symptom changes (i.e., Granger causality) yielded a directed network.

The mean age of the patients was 40.1 (SD 13.5) years old, and 60% were female. Idiographic symptom networks were highly variable between patients. Yet, nomothetic analyses showed five symptom dimensions: core (hypo)mania (6 items), dysphoric mania (5 items), lethargy (7 items), somatic/suicidality (6 items), and sleep (3 items). Symptoms of the ‘Lethargy’ dimension showed the highest out-strength, and its changes preceded those of ‘somatic/suicidality’, while changes in ‘core (hypo)mania’ preceded those of ‘dysphoric mania’.

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DTW may help to capture meaningful BD symptom interactions from panel data with sparse observations. It may increase insight into the temporal dynamics of symptoms, as those with high out-strength (rather than high in-strength) could be promising targets for intervention.

None Declared

Mixed states, the co-occurrence of manic and depressive symptoms, were recognized and described from the time of antiquity. DSM-5 first, and DSM-5-TR after, introduced the ‘’mixed features’’ specifier, defined by the presence of at least three non-overlapping opposite-pole symptoms during a syndromic depressive, hypomanic, or manic episode. Various manifestations, including irritability, distractibility, anxiety, psychomotor agitation, were excluded from the specifier, since they can occur during both depressive and hypo/manic episodes and other mental illnesses.

The objective of this study was to evaluate the phenomenology and prevalence of mixed states among bipolar disorder (BD) patients. We first assessed the frequency of specific features during different mood states. Then, we estimated the prevalence of mixed states by applying DSM-5 criteria, comparing it qualitatively with the one detected from psychometric questionnaires.

In a naturalistic study, 903 adult outpatients with BD participating in the Stanley Foundation Bipolar Network were followed longitudinally across 14,213 visits for 7 years. The scores at the Inventory of Depressive Symptomatology–Clinician-Rated Version (IDS-C) and at the Young Mania Rating Scale (YMRS), administered at each visit, were used to define the mood episode and to assess the frequency of specific symptoms. In addition, we applied DSM-5 criteria for “with mixed features” to our sample, to examine a DSM-5-based construct.

Specific symptomatic profiles differentiate mixed states from pure ones (Figure 1 and 2). Mainly, a higher prevalence of irritability was found during mixed episodes, both depressive and hypo/manic, compared to pure depression (0.60 vs. 1.20, p < 0,001) and hypo/mania (0.82 vs. 1.54, p < 0,001), as reported at the 6th item of IDS-C.

Figure 1. Individual YMRS items scores in visits with pure depression, mixed depression, pure hypo/mania and mixed hypo/mania.

Figure 2. Individual IDS-C items scores in visits with pure depression, mixed depression, pure hypo/mania and mixed hypo/mania.

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Preliminary results of the present study showed that symptoms like irritability are strongly prevalent during mixed states. Moreover, the DSM-5 diagnostic criteria for “with mixed features” specifier for any of the mood episodes detected lower rates of mixed states, hence this criteria may yield inadequate sensitivity in recognizing patients suffering from such conditions.

None Declared

This program project arises from the consternation of psychotherapists at the increase in self-injurious behaviors in the child and adolescent population.

Currently, in consultation, we are seeing many cases that do not match the conditions (anxiety disorders, depression, attention deficit disorder and hyperactivity…) described by current classifications. These cases have a common feature: emotional dysregulation.

- Reduce the discomfort and emotional pain of the patient.- Increase the patient’s skills.

- Improve patient motivation.

- Generalize to the natural environment.

- Structure the environment.

The program is directed to peoople between the ages of 12 and 18. They are divided into two groups: one from 12 to 15 years old and another from 16 to 18 years old.

The groups are a maximum of 8 adolescents. Parents also participate.

These are closed groups.

The duration of each session is one hour or one hour and a half.

A therapeutic contract is signed.

We will use different scales to measure the evolution of the patients. The following scales will be passed at the beginning and at the end: DERS, EGD, DASS 21, GHQ-12.

Dialectical dilemmas in families will be worked on. These results will be collected and compared with those at the end of the program.

People with emotional dysregulation sometimes do not have the necessary skills to regulate emotions. With this program, we intend to carry out training in skills (mindfulness; middle path; tolerance to discomfort; emotional regulation), structured in modules, in addition to relying on individual therapy.

Given this increase in deregulated children and young people, we see ourselves in the need to train ourselves and address these cases from a different point of view.

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Forensic psychiatry is a specific field of practice in child psychiatry where skills are applied for legal purposes and the expert is faced with certain difficulties.

Our objective was to determine the characteristics of the forensic procedure and the clinical profile of the consultants.

Cross-sectional and retrospective descriptive study concerning patients consulting the child psychiatry department of Mongi Slim Hospital between January 2018 and December 2019 in the context of a forensic expertise, excluding administrative expertise. Telephone interviews were carried out for the medicolegal follow-up.

The average age was 9 [+/- 3.1] years and the sex ratio was 0.97. The majority of the requests for expertise came from the specialised unit for violence against women and children (40%). The expert’s task was to carry out a child psychiatric examination in 44% of cases and to establish credibility in 6.8% of cases. Apart from 3 cases of perpetrators, the requests concerned victims of physical (40.1%), sexual (38.6%) and psychological (21.3%) aggression. The assault had taken place within the family in 52% of cases and the alleged aggressor was the father in 36%. The average time between the incident and the request for an expert opinion was significantly longer in cases of sexual assault (p =0.01). The physical assaults concerned more boys (p = 0.05) while those of a sexual nature concerned female children (p=0.005). Victims of sexual aggression showed more sexualised behaviour (p<0.05). No significant differences were found in psychiatric diagnoses according to the type of assault, but an examination without abnormalities was prevalent in cases of psychological assault (p=0.009). Claims were significantly more difficult to interpret in preschool children (p=0.05). Child victims of sexual abuse had more subsequent requests for further investigations (p=0.05) and a judgment, pronounced in 34% of cases, was most often related to psychological abuse (p=0.05).

The practice of forensics requires a specific competence that requires extensive training. Better coordination between the professionals involved is needed as well as the creation of specialised forensic units.

None Declared

Adolescence is considered as a particularly vulnerable period for body image disturbance. Body esteem is defined as the self-evaluation of one’s own body or appearance.

Validate the Body Esteem Scale for Adolescents and Adults (BESAA) in Tunisian adolescents.

We conducted a cross-sectional study among adolescents who attend Tunisian high school from 11 October 2021 to 11 November 2021.

We translated the BESAA into dialectal Tunisian Arabic based on the translation back-translation method. The validity of the scale was evaluated through content validity, reliability and construct validity. We used the Arabic version of Rosenberg Self Esteem Scale as an external validator.

We recruited 340 adolescents aged between 12 and 19 years’ old. The translated version was considered satisfactory. The internal consistency showed a good result with a Cronbach Alpha of 0,830. The correlation between items and subscales demonstrated statistically significant and logical results. Statistically significant correlations were found between the BESAA and its external validator the Rosenberg Self Esteem Scale (r= 0,422; p< 0,01). The exploratory analysis related three factors similarly to the original version of the questionnaire and in confirmatory analysis. The scale demonstrated good model fit statistics as follow: Comparative fit index= 0,87; goodness of fit index=0,81; adjusted goodness of fit index=0,77; Root Mean Square Error of Approximation=0,1 and Standardized Root Mean Square Residual=0,09.

Our BESAA version can be reliably used to conduct further studies and researches on body esteem in the Tunisian population.

None Declared

Self-esteem is a valuable personal asset and it has shown to be related to well-being across cultures and nations.

Explore the level of self-esteem among Tunisian adolescents and the different factors that modulate it.

We conducted a cross sectional study among adolescents who attend Tunisian high school from 11 October 2021 to 11 November 2021. Adolescents filled the Tunisian version of Body Esteem Scale of Adolescents and Adults, the Arabic version of the Rosenberg Self Esteem Scale and a questionnaire containing socio- demographic and clinical variables.

The population was made of 60.3% of girls and 39.7% of boys. Their age varied from 12 to 19 years’ old. The adolescents were attending the high school from seventh to third year of secondary school. Their body mass index (BMI) was normal in 58.2%, <18.5 in 31.5% and ≥ 25 in 10.3%. the score of the Rosenberg Self Esteem Scale ranged from 13 to 40 with an average of 31.02.

Female adolescents had a low self-esteem (Rosenberg Self Esteem Score <31) in 59.51%, while only 39.25% of male adolescents had a low self-esteem.

We did not find significant correlation between self-esteem and age. We found positive correlation between self-esteem and body esteem (r= 0,422; p <0.01) and a negative correlation between self-esteem and body mass index (r= -0,131; p <0,05). We found that adolescents with high self-esteem were more satisfied with their weight, their appearance and that they perceived a good external evaluation. We found also that when body mass index increased, self-esteem decreased.

It’s widely important to study self-esteem among adolescents because it’s modulated by several factors and a low self-esteem may have a negative impact on the mental health.

None Declared

Children exposed to trauma present particular clinical features, therefore this population requires specific care and support.

Study the clinical features and care modalities of children consulting Trauma & Resilience Unit.

It is a retrospective descriptive study of children consulting Trauma & Resilience unit at the child psychiatry department of Mongi Slim Hospital in Tunis (Tunisia) between January and April 2022. We collected data concerning the course of clinical features and care modalities with help of an exploitation form. Statistical analyses were performed by SPSS26.

Our study included 66 patients. The sex ratio was 1. The mean age was 10.46 ± 3.24 years. The main symptoms initially presented were hypervigilance in preschoolers (p=0.02), avoidance behaviors in school-age children (p<0.05) and flashbacks in adolescents (p<0.05).

The diagnosis of adjustment disorders was made in 38.4% of the cases of which 32% were victims of physical assault. Post-traumatic stress disorder was diagnosed in 25.7% of cases, 35.2% of which were victims of sexual assault. A normal psychiatric examination was significantly frequent in cases of psychological assault (p=0.04). The Child Protection Officer was alerted in 46.2% of cases. The school was notified of the repercussions on children health in 38.4 % of cases. Psychotherapy was provided in 86.2% of cases. We prescribed pharmacological treatment for 14% of patients with 59% antidepressants in 59% and sleep medication in 41%.

Management of children in psychotraumatology units turns out to be challenging. Therefore, working on the links between the various partners involved, while respecting the differences and specificities of each, is an essential prognostic element for the children and adolescents concerned.

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Mental health problems are common in children and young people (CYP) in England, yet evidence suggests high levels of unmet need in this group. Understanding of the determinants of mental health-related service contact is needed to identify gaps in service provision and areas for targeted intervention to improve access.

To determine the relationship between CYP characteristics and mental health-related support and service contact in England.

A secondary analysis of the 2017 NHS Digital Mental Health of Children and Young People (MHCYP-2017) cross-sectional survey dataset was performed. MHCYP-2017 was a national survey investigating the mental health of CYP using a stratified multistage random probability sampling approach, providing the official national statistics for England. Multi-informant data were collected through a combination of questionnaires and interviews. Expert clinical rating took place to formally identify the presence of mental disorders, according to established diagnostic criteria. This secondary analysis describes mental health-related support and service contact amongst 6681 participants aged 5-16 recruited to the MHCYP-2017 study. A range of socio-demographic and clinical characteristics were analysed as explanatory variables and their relationships with different types of support/service contact were examined through multivariable multinomial logistic regression. Analyses were stratified by age group: 5-10- and 11-16-year-olds.

Overall, around 25% of parents reported CYP mental health-related contact with one or more types of support/service in the past 12 months due to concerns regarding CYP “emotions, behaviour, concentration or difficulties in getting along with people”. Age stratified multivariable analyses revealed several statistically significant associations between participant socio-demographic/clinical characteristics and mental health-related support and service contact, independent of CYP mental health status and parental perception of difficulties. These associations were not necessarily consistent across mental health support categories, suggesting that several of the measured characteristics have differential relationships with different types of support and service contact. Whilst there were some differences between the 5-10 and 11-16 age groups, similar associations were seen for many of the explanatory variables. Socioeconomically disadvantaged and black and minority ethnic CYP were less likely to have had professional contact for mental health problems.

There may be higher levels of unmet need in socioeconomically disadvantaged and black and minority ethnic CYP, warranting further investigation and efforts to address inequalities. Further longitudinal studies are needed to elucidate causal associations and mechanisms underlying these observations.

None Declared

Researches has shown that a subset of the autism spectrum disorder (ASD) population presents with immune dysregulation. Based upon the immunological abnormalities, various treatment modalities have been applied to children with ASD. One immunomodulatory treatment that has been studied in ASD is intravenous immunoglobulins (IVIG).

This report is based upon two hypotheses: autism etiology may be closely related to neuroinflammation; and, an effective treatment should restore the individual’s comminication skills. In this report, we present two cases who were diagnosed with ASD and received IVIG treatment.

Case A is a 5-year-old female patient who was diagnosed with ASD at the age of 3. The second case, B is a 9 -year-old male patient who is a 7th grade student and was also diagnosed with ASD at the age of 3. The first patient’s autism symptoms was noticed by her family at the age of 2. Although she had the ability to coordinate eye contact, understood simple commands, she was observed to lose all her acquired developmental skills one by one at around 18-24 months. Towards the age of 3, stereotypical movements such as turning around and flapping wings, started. Similarly, the second patient’s acquired skills were lost around at the age of 2-3, after having recurrent infections. Based on deficits in social‐emotional reciprocity, deficits in nonverbal communicative behaviors used for social interaction and restricted/repetitive patterns of behavior, both patients were diagnosed with ASD. Considering that autoimmune mechanisms may have been affected in ASD, IVIG treatment was initiated at 1 g/kg/month. Case A received IVIG once in a month, total 5 infusions had been applied. Case B received total 12 infusions with the same protocol. Treatment response was assessed with the Childhood Autism Rating Scale (CARS).

In these two ASD cases which were treated with IVIG ,a subjective partial reduction in autism symptoms and an objective decrease in CARS scores were detected. Current evidence suggests that there are various factors contributing to the development of autism and different combinations of these aspects give rise to different variations of some ASD subtypes. Recent studies in this field indicate a possible connection between the immune system impairments and ASD. This report, therefore, provide support for the notion that at least a subset of children with ASD might have immune abnormalities and may respond to the immune modulating effect of IVIG therapy.

Although, autoimmune or inflammatory etiologies may not explain the majority of cases of autism, it might at least be useful to understand some. Further studies with larger number of patients should be conducted about the use of IVIG in selected patients with ASD.

None Declared

Use of lumateperone in reduction of aggression in patients with both autism spectrum disorder and intermittent explosive disorder has not heretofore been described.

Explore the impact of lumateperone treatment for intermittent explosive disorder in autism spectrum disorder.

Case A: An illiterate non-verbal 18-year-old male, presented with history of behavior problems, developmental and intellectual delays. He attended special education programs at school where he had difficulty interacting with peers and teachers. For three weeks prior to presentation, he has displayed more anger and aggression, biting his hands, pounding on the walls and furniture, and screaming.

Case B: This 18-year-old male, presented with a history of hypsarrhythmia, Lennox-Gastaut syndrome, severe developmental delay, deficit in socializing with lack of interaction with others and autism, presented with aggression, agitation, and hostility, banging on walls and furniture and throwing objects. Coincident with this was an increase in frequency of myoclonic seizures occurring up to twenty-five seizures per day followed by a postictal period of shouting and screaming.

Case A: Psychiatric examination: Nonverbal, intermittently grunting and screaming, eyes darting, not responding to verbal commands. Posturing of arms in the air, in a hostile stance. Ten days post starting nightly lumateperone 42 mg, patient was no longer banging furniture nor biting. He remained non-verbal but without screaming and hostile behavior.

Case B: Psychiatric examination: Non-verbal screaming, throwing furniture, hitting walls and uncooperative to verbal commands. One month post starting lumateperone 42 mg nightly, while the seizures persisted, patient’s violent attacks were not severe. Two months later, the aggression was much less severe, that he could attend school. Behavioral problems with aggression would recur an hour before the next evening’s lumateperone dose.

Lumateperone modulates a variety of neurotransmitters including glutamate, functions as a presynaptic partial dopamine agonist and postsynaptic dopamine antagonist, and enhances N-methyl-d-aspartate, an inhibitor of serotonin reuptake (Reddy, 2020), input, on any of these, may be its mechanism of action (Vyas, 2020). Perchance, its action as a 5HT-2A receptor antagonist may be its method of reducing aggression, as has been posited for its anti aggression effect in schizophrenia (Vyas, 2020). Lumateperone impacts on neurotransmitters, including substance P, which modulate aggression (Gretchen, 2020). Alternativity ASD correlated with dysfunction of Area VIIIA of the right posterior cerebellum and its connection with the left frontal cortex (Heemkerk, 2021). Lumateperone may act to stabilize these areas and thus inhibit aggression (Heemkerk, 2021). In those with aggression associated with ASD and IED, a trial of lumateperone may be worthwhile.

None Declared

Since the COVID-19 pandemic outbreak, children and adolescents mental health has been severely impacted. During the first lockdown measures in the spring of 2020, we observed a decrease in access to care, principally due to the “stay home” policy. From the beginning of the year 2021, we observed a massive increase in admission to the Child and Adolescent Psychiatry (CAP) Emergency Departments (ED) (Beaudry et al. Ann. Gen. Psychiatry 2022; 21(1), 17; Hernández-Calle et al. SJCAPP 2022; 10(1), 53–57).

First, this study aimed to quantify the increase in patients’ admissions to the CAP ED of the paediatric university hospital in the urban area of Brussels. Second, we described the reasons for admission.

We conducted an observational retrospective study in the French-speaking Belgium paediatric university hospital in Brussels. Through the ED register, we selected all the admissions for psychiatric reasons from 1st December 2020 to 1st December 2021. Data were collected from patients’ electronic medical records and compared to data from 1st January 2013 to 29th February 2016, already collected in 2016 from the same ED. To compare the variables between 2013-2016 and 2020-2021, we performed a Student’s t-test for the number of admissions to CAP EP, a chi-squared test for sex rate, suicide attempts and urgent hospitalizations, and a Wilcoxon test for the median age. The study protocol was approved by the Queen Fabiola Children’s University Hospital IRB (reference 99/21).

Female patients were more represented in 2020-2021 than in 2013-2016 (48% compared to 66.1%, p<0.001), and the median age increased from 12 to 14 y.o. (p<0.05). Compared to a few years before, we registered a 280.79% increase in the admissions to the CAP ED, resulting in 252 admissions in 38 months (2013-2016) compared to 303 in 12 months (2020-2021) (p<0.001). Admissions for suicidal attempts were twice higher than 2013-2016 (from 6.8% to 12.5%; p<0.001) and urgent hospitalizations increased eight times (from 0.8% to 6.7%; p<0.001). Admissions to the CAP ED started to decrease progressively during the whole year 2021, with the lowest peak during summer holidays (Fig.1). In 2013-2016, the 3 main reasons for admissions to the CAP ED were disruptive behaviors (15.1%), psychomotor agitation (14.2%) and somatic manifestations (12.3%); whereas in 2020-2021, these were suicidal ideations (14%), suicide attempts (12.5%) and somatic manifestations (10.4%).

Figure 1 – Admissions to the CAP ED during 2020-2021, rates per month.

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According to our comparative study and the literature, admissions to the CAP ED increased significantly during the second wave of the COVID-19 pandemic, especially for suicidal ideations and suicide attempts. The urgent hospitalisations are eight times higher during the period 2020-2021.

None Declared

Suicide among children, adolescents and young adults is a major health problem, as it represents the fourth leading cause of death among people aged 15-29 (WHO, 2022). A recent study showed that the years of potential life lost (YPLL) due to suicide in 2018 were 1,344,552, which is very close to the 1,591,487 YPLL caused by COVID-19 in the year 2020 (Porras-Segovia et al, 2021). In the recent years, there is a growing interest in suicide prevention research in differentiating attempter profiles in terms of lifetime suicide attempts. Specifically, studies suggest that there may be meaningful differences concerning risk factors between patients with a history of one versus multiple suicide attempts. Multiple attempters (MA) show more suicidal ideation, depressive symptoms and hopelessness than single attempters (SA) (Esposito et al, 2003; Goldston et al, 1998).

We aimed to answer the question ‘What are the factors associated with attempting suicide for the first time and are they different from the factors associated with re-attempting suicide in children and adolescents?’

We conducted a systematic literature search in four databases. Article selection and data extraction according to a predefined protocol, including bias risk assessment, were performed by independent peer reviewers. Due to the different way to present data in the studies effect sizes were pre-calculated to standard mean differences (SMD). Random effects model was used to calculate the pooled effect size for all meta-analysis. Publication bias was assessed using funnel plots.

14 studies were included in the systematic review, and 13 in the meta-analysis. Original articles used in the meta-analysis included a total of 4286 participants of whom 1579 were multiple suicide-attempters and 2707 single suicide attempters.

MAs showed significantly higher proportion of anxiety disorders (SMD = 0.387, 95%CI [0.09, 0.68], p < 0.022), alcohol abuse disorder (SMD = 0.382, 95%CI [0.07, 0.70], p < 0.036) and substance abuse disorder (SMD = 0.526, 95%CI [0.21, 0.84], p <0.013) than SAs. Mean depression severity was higher among MAs than SAs (SMD = 0.515, 95%CI [0.17, 0.86], p < 0.011). MAs showed higher impulsivity (SMD = 0.28, 95%CI [-0.03, 0.60], p < 0.068) and aggressiveness (SMD = 0.688, 95%CI [0.42, 0.96], p < 0.00) than SAs. Hopelessness (SMD = 0.482, 95%CI [0.06, 0.91], p < 0.03) and suicidal ideation (SMD = 0.399, 95%CI [0.34, 0.46], p < 0.007) was significantly higher in MA.

On the basis of the current results, multiple attempters may represent a distinct patient population in terms of being a more severe clinical profile. This can provide the basis of stronger suicide prevention and vigilance programs focused in this suicidal phenotype.

None Declared

In schizoaffective disorder, treatment with atypical antipsychotics is a first-line treatment option associated with treatment with mood stabilizers. One of the associated adverse effects is weight gain, which is sometimes associated with a deterioration of self-image and greater psychosocial impact.

1. To assess the personal perception and psychosocial adjustment in patients with affective psichotic disorder onset of symptoms in adolescence in current treatment with oral or IM aripiprazole. 2. To determine if there is variation in self-perception in patients with oral treatment compared to patients with long-term injectable treatment

Patients with affective psichotic disorder onset in adolescence come to consultation. Retrospective data collection: 9 months. Cross-sectional assessment with E-PICA scale. SPSS21.0.

33 patients, 60% women (mean 38.6 years) and 40% men (40.46 years). Men consulted for psychiatric symptoms earlier and their diagnosis is earlier than in women (men: onset 16.8 years, ASD diagnosis 27.15; women: symptoms onset 20.5 years, diagnosis 37.1 years).

The use of ILD aripiprazole is observed in 54%, with a similar proportion in both sexes (men 53%, women 55%). In patients with oral aripiprazole, scores were obtained: mild psychosocial impact in 18%, all of them women; moderate impact 18% and severe impact in 9% of cases. While the results with ILD treatment: mild impact in 30% and moderate impact in 24% of cases, not observing severity scores in aripiprazole ILD.

We observed a better body perception and self-esteem in women diagnosed with schizoaffective disorder and with long-term injectable aripiprazole treatment, assessing the psychosocial impact as mild. In men, the impact is greater, being observed more frequently in men with oral treatment. Continuity of follow-up and future studies will be necessary to determine other associated factors, as well as comparison with the use of other treatments.

None Declared

Extremely preterm birth (defined as birth before 28 weeks’ gestational age) has been associated with risk of developing autism spectrum disorder (ASD) in infancy. The underlying physiopathological pathways that condition the emergence of ASD on these kids remains unknown, although there is increasing evidence that oxidative stress and inflammation play an important role.

We investigated the association and the predictive value of marker levels with the primary outcome (risk for ASD at age 6 months, defined as presence of two or more clinical ASD “red flags” at this age), and with other demographic and clinical variables.

In a sample of N= 68 extremely preterm newborns, we collected urine samples from birth up to first week of life (T1= birth, T2=24-72 hours, T3=day 7), and analysed levels of biomarkers of oxidative stress and inflammation, and assessed risk for ASD at age 6-months. Through liquid chromatography mass spectrometry, we obtained levels of lipid peroxidation, DNA and protein oxidation metabolites, alongside levels of inflammation markers.

Compared to those with no risk for ASD, patients at risk for ASD showed significantly higher levels of 14(RS)-14-F4t-NeuroP at 24-72 hours of life (d=1.296, p=.018) and significantly lower levels of total isoprostanes at 24 hours of life (d=1.161, p=.048). In patients at risk for ASD, levels of 14(RS)-14-F4t-NeuroP decreased significantly over time from 24-72 hours (T2) to day 7 of life (T3), p=.032.

In summary, we obtained a panel of urine biomarkers potentially predictive of early risk for ASD in extremely preterm newborns.

None Declared

There is a complex relationship between smoking, mental health and diabetes. On one side, there is a bidirectional relationship between tobacco and depression: smokers are more at risk to suffer from depression compared with non-smokers and smoking cessation is associated with mood improvement. Moreover, persons with depressive disorders may be particularly vulnerable to nicotine addiction and are less likely to quit smoking. On the other side, a strong association is observed between depression and diabetes. Gender and sex have also been described as influencing the associations between these different pathologies.

Our aim was to determine if and how this relationship exist in a population with diabetes and to assess the impact of smoking reduction on depressive, anxiety symptoms and a health assessment score. We tried also to highlight the potential differences that we find between men and women.

Data were collected from a randomized controlled trial evaluating the 1-year efficacy of smoking cessation interventions in a population of smokers with type 2 diabetes. PHQ-9, GAD-7 and SF12 scores were used to assess depressive, anxiety symptoms and health assessment. We used STATA to perform data analysis.

48 participants were recruited in this study. Women represent 60,4% of the population and men 39,6%. The mean age was 61,9 years old (SD 9.93). The mean depression, anxiety and health assessment scores were 4.1 (SD 4.55), 3.4 (SD 4.83) and 3.0 (SD 0.69) respectively. There were no significant differences between women and men scores. Women tended to have higher depression and anxiety scores, whether they reduced their consumption or not. Men who decreased their smoking consumption (reducers) tended to have better mental health scores than women at baseline. In both genders, we found a trend toward improvement in depressive, anxiety and health assessment scores of participants that reduced their tobacco consumption. We assessed a loss of 1.8 (SD 2.58, p-value= 0.424 ) and 1.7 (SD 3.20, p-value=0.448 ) points to their depressive and anxiety scores respectively while non-reducers only lost 0.6 (SD 4.03*) and 0.7 (SD 2.88**) points respectively.

Our study suggests that differences between genders exist and that there are improvement differences in scores of people who reduced their tobacco consumption compared to people who didn’t reduce their consumption. However, none of our results were significant. A study with a greater number of participants and with more strength should be done to confirm our hypotheses.

None Declared

As much as one fifth of hospitalized patients with dementia may have sleep disturbance which may impair daily functioning, cause lower quality of life, chronic stress and consequently even deterioration of physical health. We hypothesized that multimorbidity may be one of many causes of higher incidence of sleep disturbances in hospitalized patients with dementia. Multimorbidity may be defined as having two or more chronic medical conditions. In 2018, the U.S. Academy of Medical Sciences declared studies on multimorbidity a global priority, noting the lack of research and the clinical importance and complexity of the problem.

To assess the association of chronic physical multimorbidity (CPM) with the quality of sleep, in population of hospitalized patients with dementia.

We performed a cross-sectional study at University Psychiatric Hospital “Sveti Ivan”, Zagreb, Croatia. We selected a consecutive sample of patients diagnosed with mild or moderate dementia. The outcome was quality of sleep assessed by the Pittsburgh Sleep Quality Index. We recoded the number of chronic medical conditions from the hospital electronic health records, and defined multimorbidity as ≥ 2.

After the adjustment for possible confounders: age, gender, duration of hospitalization, dementia severity and treatment, patients having a CPM had 2.5 times higher odds for sleep disturbance than patients with no, or with only one chronic medical condition (OR=2.51; 95% CI 0.60-4.41; p=0.011). This association between CPM and sleep disturbance was markedly stronger in women (OR=3.42; 95% CI 0.40-6.45; p=0.029) than in men (OR=1.73; 95% CI -0.66-4.14; p=0.145). In patients with three, and four chronic medical conditions the odds for sleep disturbance growth rapidly (OR=3.65; 95% CI 0.53-6.77; p=0.023; OR=4.71; 95% CI 1.40-8.03; p=0.007, respectively).

Chronic multimorbidity is associated with sleep disturbance in patients with mild or moderate dementia.

None Declared

Schizoaffective disorder (SAD) is a nosographic entity characterized by an association of schizophrenic symptoms with thymic episodes. Addictive substance abuse behaviours precede or appear concomitantly with thymic and/or schizophrenic symptoms for the majority of patients.

The objective of our work was to specify the sociodemographic ,clinical and therapeutic characteristics of this population and to compare them to a group of schizophrenic patients who do not use cannabis.

This is a retrospective descriptive study of patients with Schizoaffective Disorder (SAD) meeting the criteria of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, 5th Version (DSM-5), hospitalized between January 2015 and December 2021 in the psychiatry department of the EPS Tahar Sfar Mahdia.

Our sample was composed of two groups: A first group formed by patients with a positive toxicological assessment to tetra-hydro-cannabinol (n=14) and a second group witha negative toxicological assessment (n=36). In SAD subjects using cannabis, the average age at first hospitalization was younger (27.5 years) than in the other groups, hospitalization was earlier (27.27 vs 33.58; p=0.04), the duration in number of days of hospitalization was greater (29.33 vs. 24.67; p=0.02) and they had required during their hospital stay a higher dosage of antipsychotics in equivalent doses of chlorpromazine (723 vs 603; p=0.04). There was a significant difference (p ≤ 0.04) in the psychometric scales (BPRS, SAPS and SANS) in favour of patients who did not use cannabis.

The deleterious psychic effects of chronic cannabis use have long been suspected for a long time. Patients followed for SAD present more frequently than the reference population addictive behaviours towards cannabis which is associated with many negative events affecting clinical symptomatology, evolution, prognosis and therapeutic response.

None Declared

Severe mental disorders (i.e., schizophrenia spectrum disorders and bipolar disorders) have been associated with a high incidence of metabolic dysfunctions, diabetes mellitus (DM) included. There are multiple factors converging to this phenomenon, and not all of them are yet known (i.e., a specific genetic vulnerability, lifestyle factors, adverse events of antipsychotics and antidepressants, etc.). Glucagon-like peptide 1 receptor agonists (GLP1RAs), dipeptidyl-peptidase-4-inhibitors (DPP4Is), and sodium-glucose cotransporter 2 inhibitors (SGLT2Is) are new hypoglycemic drugs which are generally well tolerated and associate good glycemic control in clinical trials (usually in combination with classical antidiabetics).

To explore the available evidence supporting the use of new-generation hypoglycemic drugs (NGHD) in patients with severe mental disorders with comorbid DM.

A literature review was performed through the main electronic databases (PubMed, CINAHL, Clarivate/Web of Science, and EMBASE) using the search paradigm “schizophrenia spectrum disorders” OR “bipolar disorders” OR “major depression” AND “diabetes mellitus” AND “new-generation hypoglycemic agents” OR “glucagon-like peptide 1 receptor agonists” OR „dipeptidyl-peptidase-4-inhibitors” OR „sodium-glucose cotransporter 2 inhibitors”. All papers published between January 2000 and September 2022 were included.

Based on the reviewed papers, GLP1RAs may be useful (n=20 sources identified) in order to obtain glycemic control in patients with severe mental disorders receiving antipsychotics; SGLT2Is added to metformin could be beneficial to the same population, but data that support their use is extremely limited (n=4 sources); extremely limited data (n=2) about DPP-4Is do not allow to formulate any recommendation about this class in patients with severe mental disorders and associated DM. A number of ongoing trials have also been identified during this search (n=5), especially focused on GLP1RAs, which are expected to bring more information regarding the efficacy and safety of these drugs in this specific population. Most of the collected data in this review were of low and moderate quality.

Based on the currently available evidence, GLP1RAs and SGLT2As may be useful in the management of DM in patients with severe mental disorders, but more data about their long-term efficacy and safety is required before making any categorical recommendation.

None Declared