Benzodiazepines (BZDs) have a broad spectrum of therapeutic effects, with undeniable efficacy and low toxicity/lethality. The high prevalence of anxiety and sleep disorders makes them one of the most prescribed drugs in the world.

We have chosen to focus on these drugs because of the interest they arouse nowadays due to the potential danger linked to their prolonged or abusive use, which can have major consequences on the state of health of populations.

The objective of this study is to evaluate the knowledge and attitudes of general practitioners in relation to the prescription of benzodiazepines, with a view to possibly proposing recommendations aimed at rationalizing the use of these drugs in Morocco.

The method used is therefore the semi-structured interview, lasting on average 40 minutes, a fairly free method which allows the collection of valuable information.

This method is relevant for analysing the meaning that prescribers give to their practices, to highlight the knowledge and reference points from which they orient themselves and determine their practices. It allows for a “continuous process of verification and reformulation of hypotheses”. As the survey progresses, new questions can be addressed.

A questionnaire was therefore developed and used as the basis for the interview. It included practical questions relating to the activity of the doctors, their practice in consultation, their training, their management of psychiatric pathologies, their knowledge of benzodiazepines, and finally, their opinion on the overprescription of this molecule.

The survey was conducted among 10 general practitioners, 8 of whom prescribed benzodiazepines for the treatment of anxiety, insomnia and depression.

The first molecule prescribed was alprazolam, for an average duration of more than three months.

To this end, several measures have been taken in some developed countries to regulate prescribing in order to improve proper use, control consumption and avoid misuse of these drugs.

None Declared

Panic disorder is a widespread mental illness associated with the use of high levels of emergency care. However, the clinical characteristics of patients with panic disorder in the emergency department are not known.

This study was designed to investigate datas related to panic attack and treatment in emergency room of panic disorder patients who visited emergency room for panic attack.

A retrospective analysis of medical records was conducted on 92 patients with panic disorder who visited Chungju Konkuk university hospital emergency department due to panic attack and had bodily symptoms from 1st January 2010 to 31th December 2019. In addition to demographic characteristics and comorbid disorders, triggering stressors and alcohol consumption were corrected as pre-panic attack datas, bodily symptoms at the time of panic attack were corrected as datas during attack, electrocardiogram trial, consultation with psychiatrist, admission and information of used psychotropic drugs were corrected as post-attack data. Depending on size of data, Chi-square test or Fisher’s exact test was used. Collected data was analyzed using R 4.03.

Cardiovascular disease was accompanied by 5.4% and depressive disorder was the most common coexisting mental disorder. Among triggering stressors, economic problem/work-related stress was significantly higher in men than women (x2=4.322, p<0.005). The most common physical symptom during attack was circulatory (65.2%), followed by respiratory (57.6%), numbness-paralysis (33.7%), dizziness (19.6%), gastro-intestinal (14.1%) and autonomic symptom (12.0%). Electrocardiogram was taken at higher rate when patients complained circulatory symptom (x2=8.46, p<0.005). The psychotropic drug most commonly used in emergency room was lorazepam, used in 92.1%.

The most common bodily symptom during panic attack was circulatory symptom and the most common triggering stressor in men was economic problem/work-related stress. The most commonly used psychotropic for panic attack was lorazepam.

None Declared

Medical-technical advances are contributing to the increased life expectancy of children with congenital heart disease (CHD) (Ladouceur et al., 2021). As they grow up into adulthood, they face many challenges (eg. surgeries, hospitalizations, separations from family, cardiac symptoms, anxiety symptoms). It is known that some parenting practices like parental overprotection during childhood are associated with anxiety in the general population, but little is known in this population.

We aim to measure the contribution of parental practices (global; positive: warm care, consistent structure, autonomy support; and negative: overprotection) to explain variance in anxiety symptoms in adults with CHD, beyond sociodemographic and antecedents of pediatric hospitalisations.

An observational cross-sectional study was conducted on 223 adults with CHD followed at the Montreal Heart Institute. We evaluated anxiety symptoms and retrospective parental practices using validated self-reported questionnaires, namely the Hospital Anxiety and Depression Scale, the Parental Bonding Inventory, the Perceived Parental Autonomy Support and the Multidimensional Parental Structure Scale. Sociodemographic and antecedents of pediatric hospitalisations information was collected from medical records and pediatric archives. Hierarchical multiple linear regression analyses were conducted.

The average age of our participants is 46 years and the majority (59 %) were female at birth. The median number of hospitalisation before 18 years old was two. 15 % presented severe anxiety symptoms (HADS-A ≥ 11), 17 % had moderate symptoms (HADS-A = 8-10), and 68 % had mild or no symptoms (HADS-A ≤ 7).

The inclusion of parenting practices significantly increased the proportion of variance explaining anxiety symptoms. They explained more variance (13%) than sociodemographic and pediatric hospitalisations combined (10%).

In this model, only positive parenting practices were significantly associated with anxiety, in contrast to parental overprotection.

When the parental practices were analyzed separately, positive practices (autonomy, care, and structure) were negatively associated with anxiety symptoms, while overprotection was positively associated with anxiety symptoms.

Our results suggest that although our participants’ physical health may be limited by their CHD, the majority report a low anxiety scores. Further, parenting practices appear to be malleable predictors of anxiety. Beyond avoiding overprotective parenting style, positive and supportive parenting practices are potential targets for future initiatives to prevent anxiety symptoms in adults with CHD.

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T1D is the most common chronic endocrine pathology in children. The management of type 1 diabetes requires strong diet, physical activity, lifelong insulin therapy, and proper self-monitoring of blood glucose and is usually complicated and, therefore may result in a psychosocial problems for the whole family. Metabolic control of the disease is determined by glycated haemoglobin (HbA1c), the main criterion for diabetes compensation. It is assumed that anxiety and depression symptoms negatively affect glycaemic control. Parental psychological distress was associated with higher child self-report of stress and depressive symptoms, and it had negative effects on diabetes management.

Type 1 diabetes mellitus (T1D) is the most common chronic endocrine pathology in children. The management of type 1 diabetes requires strong diet, physical activity, lifelong insulin therapy, and proper self-monitoring of blood glucose and is usually complicated and, therefore may result in a variety of psychosocial problems for children, adolescents, and their families. Metabolic control of the disease is determined by glycated haemoglobin (HbA1c), the main criterion for diabetes compensation. A correlation is observed between anxiety and depression level and glycaemic control in many previous studies. It is assumed that anxiety and depression symptoms negatively affect glycaemic control. Parental psychological distress was associated with higher child self-report of stress and depressive symptoms, and it had negative effects on diabetes management.

To evaluate the relationship between parental depression and anxiety and metabolic control of their adolescents with T1DM.

Cross-sectional study recruited adolescents with T1D (N=251) and their parents (N=251). Anxiety level was measured by 7-item Generalized Anxiety Disorder (GAD-7) scale. Depressive symptms wasdetected using The Patient Health Questionnaire – 9 (PHQ-9). Glycaemic control of patients was assessed using the last HbA1c values. GLM mediation analysis was performed to determine the potential mediating effect of parental depression and anxiety on the relationship between depression and anxiety of the child on the level of glycated hemoglobin.

502 respondents were eligible for screening. Mediation analysis was performed to assess the mediating role of parent GAD-7 on the linkage between HbA1c, child GAD-7 and child PHQ-9. The total effect of child GAD-7 on HbA1c was significant but the total effect of child PHQ-9 was not. With the inclusion of the mediating variable (parent GAD-7) (Figure 1), the indirect effect of child GAD-7 and the child PHQ-9 on HbA1c though parent GAD-7 was found significant (Table 1).

Image:

Image 2:

Parental anxiety is a significant risk factor for child depression and anxiety, which determines poorer T1D metabolic compensation ard worse HbA1C scores.

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The process of integrating technology into mental health pathways represents a social transformation that we are gradually getting used to. But does it represent a valid alternative to face-to-face care processes? In this paper we will consider telesychology as a tool for treating anxiety and depression and its validity. Anxiety and depression are harmful to individuals, suffering from these disorders, their caregivers, and the economy. Remote delivery of psychotherapy has been established as a viable alternative to traditional in-person psychotherapy for treating anxiety and depression. However, literature comparing and evaluating the variety of remote delivery modalities of psychotherapy has not yet been integrated.

This review examines the efficiency – to - practice and the limits of e-therapy and its mediums: telephone, video, and online-administered psychotherapy, for treatment of anxiety and depression.

A comprehensive literature search, conducted using PubMed and PsycINFO included systematic reviews, randomized controlled trials, and cost-analysis studies focused on a remote delivery method of e-psychotherapy for anxiety and depression

Overall, interventions delivered through telephone, video, and online modalities, have generally demonstrated good efficiency in treating anxiety and depression; also comorbid with other disorders. The literature also suggested that telehealth psychotherapy is accessible, convenient, and cost-effective.

In evaluating the reviews on the databases, it also emerged that among the many psychological therapies for anxiety disorders, delivered digitally (CBT, Attention bias modification, Exposure therapy, Applied relaxation, Bibliotherapy, Psychodynamic therapy, Mindfulness, Behavioral stress management, Counseling), the best digital therapy is internet-based cognitive behavioral therapy (iCBT), in particular for Social Anxiety Disorder (SAD).

Despite this, overall, the efficiency and practical benefits of remote psychotherapy interventions in treating anxiety and depression across a diverse range of patient groups suggested that it is an appropriate alternative for those who cannot access in-person psychotherapy.

Further research evaluating the efficiency and practical benefits of e-psychotherapy for anxiety and depression is much needed for patients with limited access to in-person psychological care. Moreover, it remains to evaluate the maintenance of therapeutic gains after the end of the treatments.

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After the introduction of proposal regarding cannabidiol for the treatment of some psychiatric disorders including anxiety, there is confusion if cannabidiol use is associated with the provocation of anxiety symptoms or it can be safely used for the treatment. In nonmedical terms, (Cannabidiol) Cannabis is referred to as Marijuana and has been considered a potential substance of abuse for ages, that raises few questions for its use as a treating agent. It is an interesting area to be explored.

Our aim is to find out the implications of Cannabidiol use. We look forward to knowing the mechanism behind cannabidiol being a potential treatment strategy for anxiety.

A literature search was conducted using the search terms [anxiety] OR [cannabis] OR[ Marijuana] OR [cannabidiol] OR [tetrahydrocannabinol] OR [phytocannabinoids] OR [panic] OR [generalized anxiety] OR [social anxiety] OR [psycholgic distress] OR[psychosis] OR [depression]. The overall search produced 230 results. We included 30 studies relevant to the subject in this review.

Results revealed that anxiety is highly prevalent in individuals with a history of cannabidiol use in comparison to non-users. Symptoms of stress are more pronounced with more frequent cannabidiol use. Chronic users present with more severe symptoms like palpitations and the constant restlessness that are difficult to be managed. The potential role of Cannabinoids in reducing the conditioning of fear can be considered one of the reasons for investigations being done on it. Cannabidiol (Cb1) receptor plays a potential role in producing anxiolytic effects. The side effects of first-line drugs like distorted body shape due to weight gain, sexual health concerns and resistance along with frequent relapses, available for managing anxiety disorders are one of the reasons to consider alternative substances. Though, human testings are still underway, animal models are used currently for experimentation purposes and show positive anxiolytic effects of cannabidiol.

There is increased need to investigate necessary chemical and physiologic changes that are produced within the body in response to cannabidiol use. More investigations should be done on human subjects along with animal studies. Proper guidelines should be shared with practicing physicians so that new and pretested ways are open for the treatment of resistant cases with proper implications of knowledge in clinical settings so that there is minimal chance of abuse of potentially addictive chemicals.

Keywords: Cannabis, Cannabidiol, anxiety, treatment, provocation.

None Declared

Although dysfunctional breathing is a common symptom in general population and affects qualities of life, it is still underdiagnosed. There are some studies of prevalence of it in asthma, but few studies in mental illness.

The purposes of this study were to explore the prevalence of it in anxiety related disorders, and to investigate whether anxiety influence it.

150 patients diagnosed with anxiety or depressive disorders, and 135 controls were recruited. Nijmegen questionnaire was used to assess dysfunctional breathing, and Hospital anxiety depression scale was used.

The prevalence of dysfunctional breathing in anxiety related disorders was higher than that in control.

In the linear regression model, anxiety accounted for 61.2 % of dysfunctional breathing, but depressed mood. With covariate adjusted for anxiety, scores of dysfunctional breathing in anxiety or depressive disorders were higher than in controls.

Dysfunctional breathing in anxiety related disorders is higher than that in control. Adjusting anxiety, its difference is still. Anxiety affects dysfunctional breathing, but depressed mood does not.

None Declared

Within the theories that explain tooth grinding are dental factors, skeletal malocclusions, occlusal anomalies and defective reconstructions, however, there would be psychological factors that explain this phenomenon.

The aim of the study is to evaluate anxiety, depression and coping responses in university students who self-report clenching or grinding teeth.

Design: Non-experimental, cross-sectional, and quantitative.

Sample: University students (n=25) aged between 18-25 years (mean: 25.3; SD: 2.39), purposive sampling. Participants completed a self-reported questionnaire reporting teeth clenching/grinding habits.

Instruments: Standardized instruments were used, such as the State Trait Anxiety Inventory (STAI), Beck’s Depression Inventory (BDI) and Coping Strategies Scale Modified (CSS-M).

Procedure: First, the study was disclosed, the participants were informed and signed informed consent. They were asked to complete an instrument on teeth grinding/clenching habits and if it was fulfilled, it was included in the study and the psychological evaluation instruments were administered.

Data analysis: An analysis was made using descriptive statistics.

The STAI results showed a high Anxiety-State in all the participants and the Anxiety-Trait had a prevalence of 92.3%. Regarding the levels of depression, it was evidenced that 7.7% presented moderate depression and 31.6% showed mild symptoms.

The most used coping strategies were problem solving (87.2%), positive reappraisal (74.4%) and religious support (71.8%), while the least used were seeking professional help (92.3%), waiting (76.9%), aggressive reaction (74.4%) and expression of coping difficulty (71.8%).

University students must cope with an academic load that exceeds their capacity to face academic challenges (Wikes et al., 2019). This demand causes significant discomfort that increases emotions with a high negative charge and favors the appearance or intensification of mental health problems, such as chronic stress, anxiety, depression, nervousness and behavioral disorders.

None Declared

A heterogeneity in prevalence rates of functional and/or dissociative disorders is evidenced in primary care settings. At least one medically unexplained symptom is diagnosed in 40–49% of all primary care patients and 91% of all patients with a functional diagnosis are managed exclusively by general practitioners (GP) and nonpsychiatric specialists. It is therefore important that GPs identify these disorders so that individualized, multimodal treatment, with psychiatric collaboration, can be initiated promptly.

Our objective is to demonstrate the role of consultation-liaison (CL) psychiatrists in the management of patients with a functional diagnosis in primary care, as well as the potential impact of non-collaboration between GPs and psychiatrists.

Case report of Mrs. P., a 32-year-old patient, married for one year. Following a burnout that occurred two years ago, associated with anxiety-depressive symptoms, she developed gradually persistent dizziness, with balance disorders and asthenia. Mrs. P. consulted a psychiatrist for these symptoms and was treated first with an SSRI and then with an SNRI, which increased her symptoms of dizziness and vertigo. She stopped the psychiatric treatment, being disappointed by the proposed care, and asked her GP for help. No pathology was revealed by the neurological and ENT assessment requested by her GP. He referred her for a second opinion at the university center for general medicine.

After an initial GP assessment, a CL-psychiatric evaluation was performed (a first joint GP-psychiatrist session, 3 psychiatric sessions, and a feedback joint GP-psychiatrist session), during which a feeling of loss of control was noted in a patient with obsessive personality traits and controlling tendencies. A bidirectional relationship between anxieties, underlying uncontrolled internal conflicts, and dizziness was demonstrated. A dynamic work around the underlying conflicts according to the bio-psycho-social model allowed to identify the presence of a dissociative neurological symptom disorder, with vertigo or dizziness (6B60.2) of which the patient could become aware. This brief CL-psychiatric and psychotherapeutic intervention, proposed and accompanied by the GP, made it possible to explore and elaborate on the patient’s modes of functioning in her relationship to her body, to herself, and to others. At the same time, vestibular rehabilitation was performed by a ENT, with a favorable clinical and postural evolution. Thanks to this multidisciplinary treatment led by the GP, Ms P. was able to resume her professional and social activities after 3 months.

GPs have a central role in the detection of dissociative neurological symptom disorder, with vertigo or dizziness, and in the rapid organization of an adapted care network. Collaboration with CL-psychiatrist can offer optimal management of such disorders in primary care settings.

None Declared

Celiac disease (CD), triggered by gluten ingestion, occurs in people genetically predisposed to develop this chronic autoimmune condition. The triggering environmental factor, gluten, is known as a protein present in wheat, rye and barley. In recent decades, specialists have found more knowledge about the disease mechanisms, how it develops and other disturbances which accompany it. The CD was considered a pediatric main gastrointestinal disorder, associated with symptoms of abdominal pain, diarrhea, constipation and bloating, and characterized by damage to the villi of the small intestine. People with CD may experience anemia, fatigue, osteopenia or osteoporosis, bone fracture, neurological and psychiatric problems beside anxiety as depression, ataxia, neuropathy. However, the results of several studies conducted on the fact that people with CD have an increased level of anxiety are mixed.

The present work is highlighting the importance of observing the anxiety levels in people diagnosed with CD beside the suitable interventions in reducing it.

For our study scientific databases were screened using certain keywords and combinations of it as: ”celiac disease”, ”gluten”, ”gastrointestinal disorder”, ”treatment”, ”neurological problems”, ”anxiety”. Inclusion criteria were studies that (1) investigated anxiety levels in CD people, (2) reported gender results, (3) were written in English, and (4) were published within the last 20 years.

In some cases, as main intervention in CD, gluten removal from the people’s diet usually reported improvements of the present symptoms. In addition, data from literature are describing a higher level of anxiety in females compared to males diagnosed with CD. This can be a consequence of females concerns about how they can manage the CD issues and, especially, what this is bringing in their lifestyle. On the opposite, there are reports which showed that demographic parameters (gender, age, education) are not associated with CD presence.

The balance between CD and anxiety needs to be more investigated in order to identify and fully understand what is the background mechanism and how this can be regulated through specific interventions.

M. Robea Grant / Research support from: ,Platformă multidisciplinară de cercetare-dezvoltare medicală în regiunea N-E,,, acronim: CENEMED, cod mySMIS: 127606, proiect cofinanțat prin Programul Operațional Competitivitate, Axa Prioritară: Cercetare, Dezvoltare tehnologică și Inovare (CDI)., A. Ciobica: None Declared, C. Stanciu: None Declared, A. Trifan: None Declared

Conversive disorder is characterised by the presence of one or more involuntary neurological symptoms that are not due to a clear medical pathology. On the other hand, consciously simulated illnesses fall into two diagnostic categories: factitious disorders and malingering, which are differentiated by both the motivation for the behaviour and the awareness of that motivation. Factitious disorder behaviours are motivated by an unconscious need to assume the sick role, whereas malingering behaviours are consciously driven to achieve external secondary gains.

Study of the differences between conversion disorder and factitious disorder and their repercussions from a case of difficult diagnosis.

Bibliographic review of scientific literature based on a relevant clinical case.

We present the case of a 14-year-old male patient. Adoptive parents. Studying in high school. Social difficulties since childhood. He comes to the emergency department on several occasions referring stereotyped movements and motor tics in the four extremities with left cervical lateralization. Increase of these symptoms in the last month, so it was decided to admit him to the pediatric hospital. After observation and study of the patient’s movements with normal complementary tests he should return home. The following day he returned to the emergency department after an episode of dizziness, mutism and emotional block. It was decided to admit him to Psychiatry for behavioral observation and differential diagnosis.

In the assessment of patients it is essential to make an appropriate diagnosis taking into account the patient’s symptomatology and the patient’s background and life context. Conversion disorder is the unintentional production of neurological symptom, whereas malingering and factitious disorder represent the voluntary production of symptoms with internal or external incentives. They have a close history and this has been frequently confounded. Practitioners are often confronted to medically unexplained symptoms; they represent almost 30% of neurologist’s consultation. The first challenge is to detect them, and recent studies have confirmed the importance of “positive” clinical bedside signs based on incoherence and discordance. Multidisciplinary therapy is recommended with behavioral cognitive therapy, antidepressant to treat frequent comorbid anxiety or depression, and physiotherapy. Factitious disorder and malingering should be clearly delineated from conversion disorder. Factitious disorder should be considered as a mental illness and more research on its physiopathology and treatment is needed, when malingering is a non-medical condition encountered in medico-legal cases.

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The Roma population constitutes the largest ethnic minority in Spain (more than 2% of the population), with our country having the third largest total population of Roma in the world. The concept of health and disease varies with the sociocultural context. It is important to know the cultural characteristics to exercise good clinical practice. The stigma surrounding mental illness is widely known, and is even stronger in the Roma community, leading to marginalization and shame.

We present a case of a gypsy woman misdiagnosed from the age of 8 with hebephrenic schizophrenia.

Patient frequents the emergency department with symptoms of predominantly anxiety, including episodes of psychomotor agitation, self-harm, verbalization of visual hallucinations of a mystical-religious nature. In treatment with antipsychotics since diagnosis, with no therapeutic adherence. It is observed during all the episodes how the anxiolytic treatment, even, sometimes, the verbal restraint, make the symptoms subside. Psychotic symptoms over the years are ruled out.

Due to the diagnosis, this patient has been relegated from the gypsy community, she has not married or had children (an important milestone in gypsy culture), this has generated an exponential increase in anxiety symptoms and home problems.

It is important to know the cultural traits to which the patients we treat in consultation belong, and how the disease can affect their lives, and a simple diagnosis can be a source of greater anxiety.

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Functional Neurological Disorder (FND) is associated with altered social-emotional cognition. Social isolation is a recognized complication of FND and is a perpetuating factor for this condition. Limited data is available on the severity and determinants of social isolation and detachment in FND.

To assess the prevalence, severity and determinants of social detachment in patients with FND.

This is a study of 32 consecutive referrals to a specialist FND service for adults.

We analyzed the study subjects’ scores on the Social Detachment PAI trait subscale. High social detachment scores on this subscale are recognized to occur in socially isolated people and those with difficulty interpreting the normal emotional nuances of interpersonal behaviour.

We evaluated the correlation between scores on the Social Detachment subscale and the symptomatological pattern of FND. Subsequently, patients were classified into two groups: those who subjectively evaluated their symptoms as visible (primarily those with Functional motor FND and Non-epileptic Attack Disorder) and those who subjectively evaluate their symptoms as not significantly visible (predominantly sensory FND).

We evaluated the correlation between subjective sense of symptom visibility, demographic and comorbidity variables on one hand and social detachment on the other hand.

We examined the correlation between the social detachment scores and difficulties interpreting emotional expressions as detected on the Perception of Emotions Test (POET).

In a normative standardization population sample the 90th percentile T score of the PAI Social Detachment Subscale was 54. In the study sample of patients with FND the mean score was high, exceeding the 90th percentile at 59 ( p< 0.05).

In terms of comorbidity, we identified a high-risk ratio of social detachment in patients with FND who also have a concurrent diagnosis of Somatization Disorder (Risk ratio = 4.1; 95% CI, 1.6 to 10).

There was no statistically significant correlation between patients’ demographic variables and Social Detachment score, nor was there a statistically significant correlation between the phenomenology and the visibility of Functional Neurological Disorder (motor, sensory, cogniform, non-epileptic attack disorder or mixed) and social detachment.

We found no correlation between subjects’ scores on the Perception of Emotions Test and their scores on Social Detachment.

Social detachment is a significant feature of FND, particularly in those with a concurrent diagnosis of somatization disorder. Rehabilitation focused on restoring social function may be an essential intervention. Social detachment in this population may not be related to understanding nuances of emotional expression, nor is it related to the visibility of FND symptoms. Further research is needed to understand social cognitive processes in FND, specially when associated with somatization disorder.

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Alzheimer’s Disesase is the most frequent cause of dementia, accounting for approximately 60% of cases. It is characterized by an accumulation of beta amyloid and tau protein in the brain, resulting in the loss of normal brain tissue and cognitive decline, including loss of memory and language. Prior studies have found that this is one of the most feared disorders, possibly because of the associated cognitive decline, our poor ability to prevent and treat the disorder, and its poor prognosis. Prior studies have found different results regarding the importance of age and gender on level of fear.

We wanted to study the fear of obtaining Alzheimer’s disorder in a Norwegian sample and to examine the importance of age and gender.

The Fear of Alzhemer’s Disease Scale (FADS, French et al, Geriatr Psych 2011;27:521-8) was translated into Norwegian for this study, following standard procedures. The questionnaire has 30 items, each responded to on a 5-point likert scale with responses ranging from ‘never’ to ‘always’. The total maximum score was 120 points. Links to the questionnaire were posted on Facebook. Respondents were directed to a site for anonymous and untracable participation. SPSS version 24 was used for statistical analyses. Non-parametrical tests, including the Mann-Whitney U-test, were used to study between-group differences (age below 50/others, male/female).

The FADS score was significantly higher (U=5113, Z=-2.236, p=0.025) in the respondents below 50 years (60.00) than in the others (54.93). The FADS score was not significantly different (U=7513, Z=1.673, p=0.094) between men (56.12) and women (59.67).

We found that the level of fear, on average, was quite high. Those below 50 years were significantly more fearful of the disorder than the older respondents. This might seem counterintuitive, as the disorder is much more common in older people. However, emotional regulation and fear of illness may improve with age (Carstensen et al. Psychol Aging 2011;26:21-33), which might explain our finding. There was no significant gender-related difference in fear of getting Alzheimer’s Disease, which is interesting given that 2/3 of those suffering from the disorder are women. The study was based on a questionnaire posted online, which might have resulted in a bias in participation. Further studies are needed to confirm our findings.

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The global toll of chronic kidney disease (CKD) is significantly rising and unevenly distributed. In Indonesia, CKD is primarily managed by hemodialysis (HD) because limited resources rule out the possibility of renal transplantation. HD patients are commonly accompanied by caregivers but most studies show neglected the physical and mental health of caregivers.

This work aims to know the relationship between anxiety and depression with systolic blood pressure (SBP) in HD caregivers at Soehadi Prijonegoro Regional Public Hospital.

A cross-sectional study design was conducted to assess the population. This research took place in Soehadi Prijonegoro Regional Public Hospital Sragen Indonesia, at the Hemodialysis department in November 2022, with 31 participants. We assessed their SBP using a sphygmomanometer, and then we interviewed the caregivers using Hamilton Depression Rating Scale (HAM-D or HDRS) and Hamilton Anxiety Rating Scale (HAM-A).

We found that 38,8% of caregivers have hypertension with SBP above 140 mmHg. Around 93.5% and 6.5% of caregivers were found to be mild and mild-moderate anxious. Also, 22.6% were found to have mild depression, while the rest showed the normal result. There is a relationship between SBP and anxiety (p=0.037), while depression is not (p=0.302). However, there is a strong relationship between anxiety and depression (p<0.05), with a correlation coefficient of 0.69.

One-third of the caregivers were found to have hypertension, which is significantly related to anxiety. Furthermore, depression could occur in a patient with anxiety. Thus, caregivers need to maintain their physical and mental health.

None Declared

Obligate autoscopic mirror hallucinations of senescence have not heretofore been described.

To reveal that perception of looking older in the mirror may be the manifestation of Mirror Autoprosopometamorphopsia.

A 37 year old right handed female, with schizoaffective disorder, bipolar subtype She described that when she would gaze at herself in the mirror, she would not see her current face, but rather the visage of an “old person”. This would recur whenever she would directly look at herself in the mirror, and would avoid glancing at any mirrors because she was fearful of looking at her transform senescent countenance. She realised it was not another person but rather herself in the future, having become her geriartric self.

Abnormalities in Physical Examination: Mental Status Examination: Hyperverbal, grandiose with expansive affect, poor insight and judgment. Recalls 3 out of 4 objects in 3 minutes and all 4 with reinforcement. Proverb testing: correct abstraction. Neuropsychiatric Testing: The Patient Health Questionnaire 9:7 (mild depression). Other: Magnetic Resonance Imaging/ Magnetic Resonance Angiography of Brain with Infusion: Normal.

Autoscopic mirror hallucinations appearing only when embedded in a mirror are obligate autoscopic mirror hallucinations and suggest occipital and parietal lobe dysfunction (Virk, 2018). The inability to recognize the perception of another image or another person replacing the individual looking in the mirror, while defined as a mirror sign, may also be viewed as “a capgras syndrome for the mirror image” (Feinberg, 2005). Distortion of one’s own face only when viewed in a mirror is autoprosopometamorphopsia. With such distortion, this may be a misidentification of one’s own image. This phenomenon is classified as a form of delusional misidentification syndrome with inability to recognise one’s image in the mirror (Postal, 2005). Autoprosopometamorphopsia, obligate to mirror reflection, but metamorphosized to enhance perceived senescence, has not been specifically localized. Possibly a single lesion in the non dominant inferior parietal lobe may have caused this phenomenon. Somatoparaphrenia with somatosensory illusions involving body image are seen with parietal lobe dysfunction (Nightingale, 1982). In the general population, an individual’s focus on a mild facial imperfection often is associated with a negative view of their image. Exaggeration of this to involve the entire face, with projection of imperfection of aging, may be a somatic manifestation of such negative self image. It is possible that such senescent autoprospometamorphopsia may be prevalent, to a lesser degree, in the general population and may be a nidus for younger people seeking cosmetic and plastic surgical intervention of the face.

None Declared

Subjective hyperosmia, as a manifestation of belief of exposure to Bluetooth transmission, with testing demonstrating the absence of true hyperosmia, has not heretofore been described.

Correlation of Bluetooth transmission with subjective hyperosmia.

This 53-year-old right-handed single woman presented with a 10-year history of increase in sensitivity to aroma and enhanced perception of smells upon exposure to Wi-Fi electromagnetic radiation. She noted an intensity-duration effect: with higher intensity and duration of Wi-Fi exposure, her sense of smell would escalate and persist: after a few hours of exposure, her smell would jump to a 190% of normal and last for two weeks. When she drives toward a metropolitan area, she can feel that the Wi-Fi is more intense and gets an electrical sensation like “I am an antenna”. Because of this, she refuses to use a cell phone or have Wi-Fi in her home.

Mental Status Examination: Able to recall 3 out of 4 objects in 3 minutes without reinforcement. Chemosensory Testing: Olfaction: Brief Smell Identification Test: 9 (normosmia). Alcohol Sniff Test: 8 (hyposmia). Gustation: Waterless Emperical Taste Test: brothy: 4/8 (hypogeusia), total: 46 (normogeusia).

Nidus for such hyperosmic delusions may be a primary olfactory system disorder, with induction of ephaptic transmissions, causing intermittent phantosmia or otherwise misperceived odor, misattributed to the ambient environment. Paradoxically, such perceived hyperosmia may be due to a specific or isolated hyposmia or anosmia, the olfactory equivalent to monochromatic color blindness. The assignment of the source of the hyperosmia to that of Bluetooth is consistent with the zeitgeist of mistrust and paranoia of higher technology. Thus, the subjective hyperosmia would only occur when the patient perceives there was a kippage of radiation/ Bluetooth/ electromagnetic waves present, independent of these actually being present. This may be a form of expectation effect due to visual evidence (high tower wires); suggestion combined with subcultural group dynamics with belief in harm of such electromagnetic/Bluetooth waves, with distorted information recall and misattribution. Such group dynamics and shared misperceptions may act to fuel such a delusion as in the Mandela effect (French, 2018). This may represent the chemosensory equivalent of somatosensory amplification due to external intensification (Brascher, 2017). Perchance, this case represents not delusional hyperosmia, due to a functional psychiatric disorder, but rather has a neuroanatomic basis. Those with subjective hyperosmia and hypersensitivity to aromas have demonstrated hypertrophied gray matter volume in the posterior subregion of the right hippocampus, left precuneus, left superior frontal gyrus, and right hypothalamus (Han, 2020). In those with subjective hyperosmia, neurological investigation is warranted.

None Declared

Stress is an integral part of the profession of health care personnel (HCP) and manifests in higher rates of depressive and anxiety disorders (ADD).

Screening of anxiety and depressive disorders factors among HCPs

A descriptive cross-sectional study in two university hospitals in Ariana was carried out ont september 2022. It included HCP who were examined for medical periodic visit. Data was collect from medical records, anxiety and depression Scale (HAD) and somnolence questionnaire (Epworth).

One hundred and nine HCP were included in the study. Women represented 87.2% of cases. The average age was 38 ±10.7 years. The average occupational seniority varied between one to 38 years. Nurses represented 38.5%, technicians 24% and doctors 7%. They had night work in 12% of cases. Depression and anxiety were found for 20% and 31% of cases respectively. Successive daytime sleepiness was found in 7% of cases. A statistically significant relationship was found between excessive daytime sleepiness and anxiety (p=0.005) and between depression (p=0.002).

Anxiety and depressive disorders in HCP were considerable. they were assiciated with sleepiness disorder. Night or day time shift wasn’t statistically correlated with ADD. Referral to psychiatric consultations after psychological opinion was done in order garantee therapeutic support and decide fitness to work.

None Declared

The somatoform disorders are a group of psychiatric disorders that present with unexplained physical symptoms.

This study aimed at assessing the prevalence and risk factors of somatoform disorders (SD) and their types among patients attending a major psychiatric clinic in Duhok Governorate/Kurdistan Region of Iraq. Our secondary aim was to assess the common presenting symptoms of conversion disorder (CD).

637 subjects were randomly selected from the outpatient psychiatric clinic at Azadi Teaching Hospital in Duhok Governorate/Kurdistan Region of Iraq. Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Edition (Version 2.0) was applied to diagnose patients with SDs.

In our sample the prevalence of SD was 24%. CD comprised the vast majority of SD at 75.8%, followed by somatization disorder at 7.8% and undifferentiated SD at 5.2%. SD was most common (60.1%) in adolescents and young adults (ages 15-25 y.o.); (p <0.05), and female gender comprised most of the SD in our sample (75.8%; p <0.001)

Although, more than two-third of the cases were from lower educational levels (illiterate and primary educational level) (67.3%), more than fifty percent were married (52.3%), majority were housewives (39.2%) and more than half of the cases were from urban areas (52.3%), but no significant association were found between SD and educational level, marital status, occupation, and residence (p-values were 0.218, 0.659, 0.072, 0.090 respectively). Regarding the symptomatic presentation of CD, vast majority of the cases presented with pseudo-seizures which comprised (81%), followed by motor symptoms which comprised (17.2%), and sensory symptoms which constituted (1.7%) only.

SD was highly prevalent among patients attending a major outpatient psychiatric clinic in Duhok Governorate/Kurdistan Region of Iraq, and CD was the most common presenting form of SD. Younger age (adolescents and young adults) and female gender comprised the majority of cases. Interestingly, the most common presenting symptom of CD in our sample was pseudo-seizures.

None Declared

The elderly represents the fastest growing group of the population. It is fair to assume that the portion of old age patients suffering from bipolar disorder will grow in a similar manner. Elderly patients represent approximately 25% of the bipolar population. Summarizing, 5–10% of patients were 50 years of age when they experienced their first manic episode, constituting the subgroup of late onset bipolar disorder (LOBD).

The purpose of this case report and literature review is to emphasise the importance of LOBD in old population and to highlight its still sparse-knowledge.

Descriptive case study and review of literature (Arnold,I. et al. Old Age Bipolar Disorder—Epidemiology, Aetiology and Treatment. Medicina 2021,57,587; Baldessarini et al. Onset-age of bipolar disorders at six international sites. J Affect Disord 2010;121(1-2):143-6).

A 60-year-old woman is brought to the emergency department for evaluation by her family. Over the past 7 days, the patient has become increasingly irritable and argumentative, is sleeping less, is talking faster than usual and has begun to express paranoid concerns about her students “stealing my exam”. The patient is a university professor.

In the assessment interview she is hyperverbal, expansive, and grandiose. The family has also just recently discovered that she has spent a large sum of money on the Internet.

She has no history of psychiatric contact or substance use disorders; however, she has a family history of severe depression.

In the absence of any plausible non-psychiatric condition that could mimic or induce mania, the working diagnosis is bipolar I disorder, most recent episode (MRE) manic with psychotic features.

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The share of older age bipolar disorder will grow constantly in the next decades and further research on this neglected patient group is urgently required.

None Declared