Depressive disorders in adolescence and young adulthood have always been and remain an urgent problem due to their fairly high prevalence among the population, serious difficulties in diagnosis and untimely treatment. Timely diagnosis and adequate treatment can have a powerful impact on the future life of a person in a positive context. This process requires both standardized mechanisms, and an individual detailed study of each case, as the future of the individual depends on it.

A young adult M., 20 years old, a university student, from a socially prosperous family, approached us.

Main complaints: headaches that have been going on for almost 4 years. Pains did not depend on loads, both physical and mental, were of various characteristic and different localization. Non-steroidal anti-inflammatory drugs, as well as anti-migraine drugs, have little effect on the pathological experiences.

Our main method of examination was clinical interview. In the complex assessment detailed neurological and ophtalmological examination included.

The parents referred patient for a medical examination about a year ago, because they noticed persistent mydriasis in him. During the year, the patient underwent a detailed examination (consultations of a therapist, endocrinologist, neurologist, ophthalmologist, MRI, EEG, dopplerography). Doctors expressed various assumptions about the diagnosis, because all the studies did not reveal any pathology that could explain the indicated complaints and mydriasis.

During the initial interview, a high level of intelligence and knowledge was revealed, as well as a sufficient ability to learn. Examining the emotional-volitional sphere, a slight level of emotional instability, mild irritability, anhedonia and a slight degree of hypobulia (which can be explained by long-lasting and persistent pathological somatic experiences in the form of headaches) were found. Incomplete Protopopov’s triad was revealed.

The patient was referred for repeated neurological and ophthalmological examination. Specialists with a high qualification level discovered the A. Athanassio symptom in him.

He was diagnosed with recurrent depressive disorder, a current episode of severe depression with somatic symptoms, and appropriate treatment was prescribed.

1. 1. Depressive disorders in adolescence and young adulthood require special attention from specialists of all medical specialties.

2. 2. The need for a detailed medical examination and modern neuroimaging methods is beyond doubt.

3. 3. Psychiatric examination cannot be limited to assessment of mental status only, and assessment of Protopopov’s triad should be part of psychiatric examination.

4. 4. Neurological and ophthalmological examination must necessarily include an assessment of neuro-ophthalmological symptoms.

5. 5. Individual selection of treatment should be carried out by a psychiatrist.

Sorry to say, Professor Mykola Pityk died 27.12.2020

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Knowledge about muscular dystrophies and in particular X-linked inherited disorders such as Duchenne and Becker Muscular Dystrophy has been gradually acquired as more research studies have been conducted to better understand the pathogenesis, management and prognosis of these conditions. However, little is known about a probable correlation between muscular dystrophies and neuropsychiatric disorders. We present the case of a 41-year-old male with history of a mild rare form of muscular dystrophy and elevated CPK level, who presents with psychotic symptoms that resolve with proper management of the underlying medical condition.

The purpose of this case report is to emphasize the importance of being mindful when diagnosing patients with a psychiatric illness as psychotic symptoms could also result from underlying rare muscular dystrophies.

A comprehensive review of literature using databases, such as PubMed and Google Scholar was conducted to gain a better understanding of this specific disorder and to rule out conditions that present in a similar way. Keywords used were Muscular Dystrophy, Elevated CPK, Psychosis, Becker, Duchenne.

Data shows that patients with these muscular dystrophies have mutations that affect Dp71 expression. Moreover, Dp71 is expressed in postsynaptic membranes in the glutaminergic pathway whose alteration might contribute to neuropsychiatric disorders. As there is growing body of evidence of rhabdomyolysis encountered in patients treated with antipsychotics, there is less data available about a possible causal relationship between rhabdomyolysis and subsequently elevated CPK inducing psychosis.

Further studies could be helpful to explore a possible correlation between an elevated CPK level and psychotic symptoms as demonstrated by this case report. A thorough history taking, psychiatric and medical evaluations would prevent misdiagnosis of psychiatric disorders and would lead to proper management of these rare cases.

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Among the cases usually referred to Pain Clinics, the existence of cases of medically unexplained symptoms (MUS) is frequent, which are defined as those physical symptoms that present little or no basis that they respond to an underlying organic disease or that even when organic disease exists the symptoms are inconsistent or disproportionate to it.

The main objective of this study is to know the proportion of patients who present MUS among those referred to a Pain Clinic. Secondarily, an attempt will be made to classify those patients with MUS in different diagnostic categories.

Observational study. All those patients referred to the Pain Unit of the Complejo Asistencial Universitario de León for 18 months were included in the study. All patients are evaluated in real clinical conditions, without any experimental control of variables, initially by a multidisciplinary team made up of Anesthesiologist, Psychiatrist and Rehabilitator and, in those who suspect a MUS condition, individually by part of psychiatry in order to confirm and characterize the syndrome.

462 patients were evaluated in a multidisciplinary way. 174 (37.7%) were male and 288 (62.3%) females. The mean age was 59.06 + 16.30 years. After the multidisciplinary assessment, two groups of patients were formed, one of 313 patients (67.75%) in whom there was no suspicion of MUS and the other of 149 patients (32.25%) in whom the existence of a MUS condition was suspected and who were referred for evaluation by psychiatric interview. After the psychiatric interview, it is observed that psychopathological and social factors explain the painful condition in 23.7% of the cases. The diagnoses found were Somatoform Disorders and Central Sensitization (N = 49, 10.6%), Malingering (N = 23, 5%), Factitious Disorders (N =21, 4.5%) and Other Diagnoses (N = 38, 8.2%).

The psychological and social factors are relevant to explain the condition of up to

23.7% of the patients referred to the pain unit.

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Serotonin syndrome is a potentially life-threatening condition due to increased serotonergic activity in the CNS. Its most well-known causes are the ingestion of large amounts of serotonergic drugs or the inappropriate combination of two or more serotonergic antidepressants. Rarer causes of serotonin syndrome have been reported in the literature.

The aim of this paper is to highlight, through case presentation, rarer causes of serotonin syndrome.

Case presentation (woman, 39 years old) who was hospitalized with clinical presentation of Serotonin syndrome, after pharmaceutical self-poisoning with a large amount of quetiapine (>20g). The search of the case data (clinical and paraclinical examination findings) was performed from the medical records and files of the 3rd Internal Medicine Clinic and the Liaison Psychiatry Department of our hospital. A literature search of similar cases (through PubMed) was performed.

A patient with a history of mood disorders, under treatment with venlafaxine, lamotrigine, quetiapine and aripiprazole, was admitted to the hospital ICU due to a decreased level of consciousness (GCS 11/15). Ingestion of approximately 100 tablets of Quetiapine 200mg was reported. The patient developed upper and lower limb myoclonus, supraventricular tachycardia (130bpm), nystagmus, bilateral mydriasis with normal photomotor reflexes, increased tendon reflexes, excessive sweating, upper limb muscle rigidity and abdominal flatulence with the presence of loud bowel sounds. Gastric lavage was performed and admission to the Internal Medicine department followed. Intravenous diazepam was administered, 30mg on the 1st 24 hour period and 20mg on the 2nd, with gradual tapering. From the very 2nd 24 hour period of hospitalization, her clinical condition showed significant improvement, with complete remission of symptoms and recovery of a satisfactory level of consciousness.

Serotonin syndrome can be effectively treated if early recognition of symptoms is made. Clinicians should be particularly alert and suspect the possibility of serotonin syndrome in a patient with compatible symptoms by clinical examination, especially in case of overdose of a drug, with or without a serotonergic mechanism of action.

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Diabetes-related distress (DD) is one of the psychological disorders affecting patients with diabetes.

The aim of this study was to assess the prevalence and level of DD and its associated factors among patients with type 2 diabetes.

This was descriptive and analytical cross-sectional study, carried out with patients followed for type 2 diabetes at the endocrinology consultation.

The participant’s sociodemographic and clinical information was obtained through face-to-face interviews and medical records.

DD was assessed using the Arabic version of diabetes distress scale (DDS-17). The DDS contains 17 items, each rated on a 6-point Likert scale. The scale yields a total diabetes distress score, and scores for four subscales: emotional burden, regimen distress, physician distress and interpersonal distress.

There were 103 subjects. The mean age was 59.31 ±10.83 years with a sex ratio (M/F) = 1.19.

Median duration of diabetes was 7 years (IQR 3 ; 12 years). Among our patients, 31.1% of patients had properly controlled diabetes (HbA1c < 7%) and 41% had at least one diabetes complication.

The prevalence of diabetes related distress was 70.90% in which emotional distress was the most prevalent (78.60%) domain.

Low socio-economic level (p=0.001), married status (p=0.034) having diabetes complications (p=0.008) younger age at onset of diabetes (p=0.001) were associated with diabetes related distress. Poor HbA1c control (HbA1c≥7%) was significantly correlated with DD (p≤0,001).

Our study suggests that diabetes related distress was highly prevalent in type 2 diabetes patients in Tunisia. Active screening for DD should be an integral part of diabetes care.

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Stroke survivors frequently deal with neuropsychiatric sequelae - depression, anxiety and apathy being the most common ones. Pathological laughing and crying (PLC) is a post stroke condition characterized by brief, intense uncontrollable crying and/or laughing due to a neurological disorder. Prevalence of PLC post stroke has been reported to be 15-20%. Pathological laughter (PL) is commonly associated with bilateral or diffuse cerebral lesions. Ischemic injury involving the internal capsule and basal ganglia seems to be associated with emotional disorders.

To discuss an uncommon case of pathological laughter developing after recurrent infarct.

A 32-year-old male patient presented to the medical emergency for complaints of slurring of speech since 7 hours. On examination, patient was alert, oriented, with blood pressure 150/90 mmHg. He had a history of similar stroke 2 years prior to current complaints and was on treatment for hypertension since then.

Baseline investigations were done. MRI brain revealed acute lacunar infarcts in bilateral ganglio-capsular region, chronic small vessel ischaemic changes in B/L periventricular white matter (Fazeka grade 2) and micro-haemorrhages in various brain regions. Patient was managed conservatively (antiplatelets, statins, antihypertensives).

Patient was then referred to Psychiatry department for uncontrollable laughing spells, which started few hours after onset of above complaints. These occurred without any provocation, every 1-2 hours, lasting for several seconds to a minute, and relieved spontaneously. Patient was aware of episodes and found them embarrassing socially. Mental status examination revealed no mood features or other abnormalities.

Patient was prescribed Escitalopram, but shifted to homeopathic medicine and was lost to follow up. Telephonic interview one year later revealed that while other complaints have remitted, patient still has laughing spells of similar quality and frequency.

Discussion: In post stroke PLC, pathological crying represents about 80% cases, while Pure Pathological Laughing, as in the present case, is uncommon. It is generally seen in diffuse CNS pathologies (eg. multiple sclerosis) or bilateral – ischaemic or degenerative.

In case of strokes, PL may herald symptom onset, or may immediately follow focal deficits. The aetiology of PLC is unknown; monoaminergic neurotransmission may be altered in post stroke PLC. SSRIs are regarded as first choice treatment agents, given their greater tolerability overall.

Pathological laughter is a comparatively uncommon but recognisable and treatable post stroke sequela, more commonly seen in bilateral lesions. Patients often describe PL as distressing and socially disabling, but awareness about this condition and available treatments is lacking.

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The clinical features of juvenile fibromyalgia were first described by Yunus & Masi in 1985. In the US, it is estimated that about 6% of adolescents between 15 and 19 years of age suffer from juvenile fibromyalgia. However, this entity remains “a poorly defined disorder”, being excluded from the main diagnostic classification systems.

The goal of our work is to present and discuss a case-based review of juvenile fibromyalgia.

We present a case of chronic pain in pediatric age, referred to a multidisciplinary chronic pain consultation. Through the analysis of this case, we review the concept of juvenile fibromyalgia and its pathophysiology, the risk factors, the diagnostic criteria, the recent evidence for the treatment of these cases and the prognosis of this disorder.

We describe the case of an 11-year-old female, who presented with widespread musculoskeletal pain, headaches, and sleep disturbances for a period over 3 months. At physical examination no significant alterations were found except for pain at palpation of the referred pain locations and at palpation of 11 typical fibromyalgia tender points. Complementary diagnostic exams were normal. The patient was referred to a multidisciplinary chronic pain consultation and was prescribed pharmacological therapy with antidepressants and a gabapentinoid and non-pharmacological therapy with a plan of physical exercises and psychotherapy.

This case report demonstrates the importance of considering juvenile fibromyalgia in the differential diagnosis of pain in pediatric age, showing also the complexity involved in the assessment and treatment of these cases. This case also highlights the importance of multidisciplinary collaboration in the management of chronic pain.

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Among patients with heart disease, such as coronary artery disease or heart failure, depression and anxiety disorders are extremely common. In these populations, 20% to 40% have elevated depressive symptoms, and 15% to 20% suffer from MDD. Anxiety may be even more common than depression. A recent meta-analysis suggests that over 50% of patients with heart failure have elevated rates of anxiety, and 13% meet criteria for an anxiety disorder. These prevalence rates are significantly higher than those in the general population and highlight the high-risk status of cardiac patients for these disorders.

The aim of this study is to highlight the frequency of anxiety and depression in patients with cardiac health problems and to explain the mechanism by which anxiety and depression influence the manifestation of cardiac diseases.

Α bibliographical review was performed using the PubMED platform. All relevant articles were found using the keywords: depression, anxiety, cardiac disease.

The links between depression, anxiety, and cardiovascular disease are complex and involve psychological, biological, and behavioral mechanisms. Depression, arrhythmias, and coronary artery disease frequently co-occur because they share common behavioral and pathophysiological drivers-unhealthy lifestyle, autonomic dysregulation, hypothalamic-pituitary-adrenal (HPA) axis dysregulation, endothelial dysfunction, and inflammation-that are intricately related to one another.

In patients with cardiovascular disease, depression and anxiety disorders are common, persistent, and associated with poor functional and cardiac outcomes. As such, making a timely and accurate clinical diagnosis using DSM-5 criteria is critical. Safe and effective treatments are available for the management of these disorders in patients with cardiac disease, and it is hoped that such treatment can improve psychiatric health, quality of life, and medical outcomes.

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A broad spectrum of medical conditions manifest with both neurological and psychiatric symptoms. One of them is encephalitis- an inflammatory brain disease, caused by diverse etiological factors. Due to the pronounced psychopathological findings these patients frequently encounter primarily the mental health services or may appear as a part of the consultation-liaison psychiatry practice.

We present the case of a 31-year-old male firstly consulted by a psychiatrist and consequently admitted to neurological ICU. His condition developed over two-year period, developing transient psychiatric symptoms, such as anxiety, auditory hallucinations, persecutory delusions and auto-aggressive behavior; non-specific neurological findings, including pseudobulbar syndrome, oral and manual automatisms; as well as EEG paroxysmal activity. The most notable manifestations were fluctuating orientation and awareness, progressive executive function decline and cognitive impairment. In the course of the illness many psychotropic medicines had been used. The patient had shown either no improvement or low tolerance to adverse effects.

To demonstrate a challenging and provocative case of our liaison psychiatry practice, where an interdisciplinary approach was mandatory.

For the needs of the psychiatric assessment a clinical interview was conducted. A neurocognitive examination via MMSE was performed. Some of the tests that took place in the neurology ward included: virological testing of blood and CSF, immunological screening for paraneoplastic syndrome and autoimmune encephalitis, MRI and EEG. The diagnosis was based on the ICD-10 criteria.

The mental status of the patient during the hospitalization showed no remarkable changes. The MMSE score was 22/30, correlating with a mild cognitive impairment. The neurological status fluctuated slightly over the period. Most of the tests showed none or only borderline deviations, considered nonsignificant. Some of the results were not ready prior the discharge of the patient from the hospital. After an immunomodulatory therapy there was a slight improvement in the condition of the patient.

Based on the course of the disorder, the presence of neurological aberrations, including in the higher cortical functions, the therapeutic resistance and low adverse effects threshold, a primary psychiatric disorder was excluded. Virological, paraneoplastic and autoimmune genesis of the disorder were also ruled out. More result are expected and more examinations are needed. Postinfectious encephalitis was accepted as the most probable diagnosis.

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The current SARS cov 2 virus disease pandemic presents a threatening physical danger as well as its impact on mental health. It seems important to screen any patient who has experienced covid 19 for its psychological impact.

Therefore the aim of our study was to highlight the impact of COVID-19 infection on mental health by screening them for depression

This is a cross-sectional, single-center study, conducted at the Sahloul Emergency Department, over a period of 5 months (January to May 2021). Patients are collected from a database of ouremergencydepartment COVID-19 unit.We included patients whose age is greater than or equal to 18 years old; who has been infected with SARS-COV-2 according to the results of the PCR test. All patients lost to follow-up, refusing to participate in this study, having a psychiatric illness or having taken a psychotropic medication before randomization or non-cooperating (unable to respond to the evaluation test) were excluded.A telephone follow-up was done after 30 days from admission to calculate the HAMILTON score after a positif HAD D scale.

200 patients were included. For the 20 patients (10%) with depressive symptomatology (doubtful and certain) according to the HAD D scale, their responses to the Hamilton scale were analysed in order to determine the severity of the depressive symptomatology. Note that 30% of patients had mild to moderate signs of depression and 70% had severe depression.The majority of patients in whom the presence of depressive symptoms was noted had an average age of 40 years; those who presented with severe depression had an average age of 51.3 years with a female majority of 72%. No difference was noted in relation to pathological history, half had been hospitalized for treatment of COVID-19(57%). Patients with severe depression symptom resolution lasted an average of 14 days.

According to the results of this study, interventions may be carried out to minimize the pandemic’s negative psychological consequences.

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The actual pandemic of COVID 19 is a very unusual yet real situation we are facing. It has affected people in both physical and psychological way. In fact,in such particular circumstances, so many people experience stress, anxiety and depression.Objective

The goal of our study is to emphasize theanxiety among patients who were tested positive with COVID 19 , using the HAD scale.

It is a retrospective study single-centerstudyPatients are collected from a database of the Sahloul emergency COVID unit. We include patients whose age is greater than or equal to 18 years old who has been infected with SARS-COV-2 according to the results of the PCR test. All patients lost to follow-up, refusing to participate in this study, having a psychiatric illness or having taken a psychotropic medication before randomization or non-cooperating (unable to respond to the evaluation test) were excluded. At 30 days follow up, anxiety was evaluated by HAD scale.

200 patients were included in this study.In our study, 98 patients had symptoms of anxiety (49%) after one month of their consultation in the emergency room; i.e. 39% have a doubtful symptomatology of anxiety and 10% have a certain symptomatology. Half (51%) of the patients had no signs of anxiety depression. The average age of the patients in whom the presence of definite anxiety symptoms was noted was 56.2 years; 63.7% of these patients were female. No difference was noted in relation to the pathological history. Patients in whom the symptoms of anxiety were certain presented a persistence of clinical signs for 10.7 days in average as opposed to 7.1 days in patients without anxious symptoms (p<0.001).

Anxiety is so common among COVID 19 patients and it has a huge influence on the evolution of their health state . This is why all health workers have to fight against COVID and its effects on both physical and mental health . Highlighting the fact that a psychological assistance is highly recommended in the management ofCOVID19 patients in order to improve their prognosis

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The outbreak of COVID-19 has long-term negative effects on mental health. This study shows the negative mental health effects of studying under pandemic limits involving distance learning and social isolation.

The specialized studies carried out after the emergence of the Coronavirus revealed the impact of the measures implemented during the period of restrictions and after the outbreak of the pandemic, as well as the way in which these measures were felt by the general population.

Qualitative analysis of students’ answers regarding the stress felt after the outbreak of the pandemic.

Social and individual anxiety remains a subject of investigation among female students, who are in the process of emotional maturation and professional training.

Students remain a vulnerable population category, in the conditions in which society is in full post-pandemic adaptation process.

None Declared

Since the declaration of the first Covid-19 case on December 08th ,2019, and to curb the spread of this pandemic, each country and notably Tunisia, has implemented a preventive strategy dominated by general lockdowns in accordance with social distancing and basic hygiene measures. These measures were not applicable in the health care sector as health care workers are at the forefront in the fight against COVID-19. This condition affects not only their physical health caused by elevated workload, but also their mental health causing anxiety, fear, and depression. Previous studies have reported that health care professionals feel stigmatized, experience high levels of anxiety and symptoms of depression, and have sleep problems. Impaired Quality of Sleep (QoS) can affect their efficiency in providing medical services and adequate psychological support for patients suffering from COVID-19.

To evaluate the QoS among health care professionals treating patients with COVID-19 and quantifying the symptoms of depression and levels of anxiety.

A cross-sectional study was conducted in 75 health care professionals matched by age and sex working in public hospital Taher Sfar Mahdia. The study was based in a self administred, French language questionnaire containing three validated questionnaires: 7-item Generalized Anxiety Disorder (GAD-7) Scale, 9-items Patient Health Questionnaire (PHQ-9) Scale, Pittsburgh Sleep Quality Index (PSQI) and additional survey constructed for the purpose of the study.

Healthcare professional treating COVID-19 patients (Group I) group was predominately females mean aged of 32.67±7.04. The health professionals treating COVID-19 patients had poorer Quality of Sleep; Pittsburgh score 10.6 ± 742 vs 7.89 ± 6.14 in the group not treating COVID-19 patients ( p=0.001). Levels of anxiety and depression were significantly higher in the group I (respectively p=0.005 and 0.03). Multiple linear regression analysis revealed that higher scores on GAD (beta = .809, p < .01) and the lower one was the number of persons in charge (beta = –0.632; p < .01) were independent predictors of a poorer quality of sleep

This study has revealed the heavy mental health burden health care professionals treating infected patients in Tunisia during the COVID-19 pandemic are exposed to. Providing early psychological support and a psychologically safe environment for these healthcare workers may alleviate their stress and, consequently, ameliorate their QoS. More attention should be devoted to their quality of sleep and work schedules. In many countries, online training, telehealth supports, behavioral group therapy, cognitive behavioral therapy, and mindfulness-based therapy have been deployed for frontier Healthcare workers and have proven effective in such circumstances.

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Coronavirus infection is accompanied by the development of a wide range of neuropsychiatric and somatic complications.

The aim of the study is to assess the severity of somatic disorders and to identify their EEG correlates in depressive patients who had and did not have COVID-19.

The study involved 30 female depressive patients (F31.3-4, F21.3-4 + F34.0, according to ICD-10), aged 16-25 years, who previously had a mild or asymptomatic coronavirus infection (group "COVID”), and 40 depressive patients matched in gender, age and syndrome structure to patients of the “COVID” group, but who did not have COVID-19 (“non-COVID” group). The pre-treatment severity of depressive symptoms was assessed by the total sum, and by sums of clusters: depression (items 1, 2, 3, 7, 8), anxiety (items 9, 10, 11), sleep disorders (items 4, 5 , 6) and somatic disorders (items 12, 13, 14) of HDRS-17 scale. All patients underwent pre-treatment multichannel (16 leads) recordings of the background EEG followed by analysis of the absolute EEG spectral power (SP) in 8 narrow frequency sub-bands. Statistical analysis of the data was carried out using the methods of descriptive statistics and correlation analysis of the IBM SPSS Statistics, v.22 software package.

The values of the total sums of scores of individual clusters (depression, anxiety, sleep disorders) of the HDRS-17 scale in the “COVID” and “non-COVID” groups did not differ statistically. The exception was a significantly higher (p>0.01) number of complaints of somatic disorders (weakness, heaviness and pain in the muscles, a feeling of loss of energy, loss of strength, decreased libido) in patients who had COVID compared to those who did not (2.4±1.0 and 1.4±1.1 points, respectively). In the “non-COVID” group, the HDRS-17 somatic disorder cluster scores positively correlated with SP values of beta2 EEG (20–30 Hz) in leads F3, F8, and P3. which reflects the increased activation of brain stem structures, characteristic for depressive conditions. In the “COVID” group, these scores correlated with the SP values of alpha3 (11-13 Hz, in leads F4, F8, C4 and T4) and beta2 (20-30 Hz, in C4) not positively, but negatively. Thus, the severity of somatic complaints in patients of this group is associated not with greater, but with less activation of the brain (in particular, of the right hemisphere), which, presumably, may be associated with the “exhaustion” of the central mechanisms of regulation of autonomic functions after suffering COVID disease.

COVID (in a mild or asymptomatic form) did not show a significant effect on the overall severity of depression of the studied group of patients who recovered from COVID, with the exception of a significantly greater severity of their somatic complaints compared to the group of patients who had not been ill with COVID. The study supported by the RSF grant No. 21-18-00129.

None Declared

The COVID-19 pandemic has affected millions of people worldwide. Among a large number of deaths, COVID-19 has caused significant health-related sequelae involving many systems of the body. Some results include increased anxiety, depression, insomnia, and other distress symptoms. Additionally, there are reports of sudden onset of psychosis in patients with no psychiatric history following COVID-19.

Emphasizing the importance of Covid 19 causing many psychiatric diseases, although its etiology is not yet known.

Report of a clinical case

We report a 68-year-old previously healthy woman with no personal or family history of mental illness who was hospitalized due to COVID-19 and then started to have psychiatric complaints. She had complaints such as refusal to speak, eat and drink, fear of death which started after her discharge from the hospital due to COVID-19.

On 14.07.2021, she applied to the psychiatry outpatient clinic of our hospital for the first time. In addition to the existing complaints, we have considered the preliminary diagnoses of dementia and psychotic depression due to the increasing fear of being alone, going out alone, confusion in the interim periods, and thoughts that someone will harm her and her family. We consulted the neurology clinic and she was admitted to the neurology service with a preliminary diagnosis of encephalitis. During her hospitalization, the patient’s EEG and MRI were taken, LP was performed, and no pathology was detected in the examinations. Her current psychiatric treatment (escitalopram 10mg/d, medazepam 2mg/d, and olanzapine 2,5mg/d) continued throughout her hospitalization in the neurology service, but her complaints did not change. She was fed formula with an NG tube, IV hydration was provided, and a urinary catheter was inserted.

After ruling out neurological disease on 12.08.2021, the patient was admitted to our psychiatry service with a prediagnosis of catatonic-psychotic depression. Electroconvulsive therapy was planned because the visual hallucinations and persecutory delusions persisted. Total of 7 sessions of ECT were received. The patient’s oral intake started with the current treatment, and her fluent speech began. Olanzapine dose was increased to 7.5mg/d, and escitalopram dose was increased to 20mg/d due to persistent depressive and psychotic symptoms. The patient was discharged on 02.09.2021 with the current treatment. Her complaints had improved before she was discharged.

COVID-19 remains an emerging disease with unknown psychological sequelae. Caution should be exercised regarding psychiatric symptoms and associated risks in patients with a recent diagnosis of COVID-19. Cytokine storm may also be involved in the etiology, in addition to many psychological factors such as fear of illness, uncertainty, and isolation. Potential risk factors and underlying biological mechanisms should be investigated.

None Declared

The “Post-COVID Syndrome” affects approximately 10% of people who have been infected with Covid-19. These people have a physical and mental impact.

The objective of this study is to analyze factors related to poorer mental health in these patients from primary health care.

Cross-sectional study. The study population was post-COVID-19 patients aged 18 years or older and treated by Primary Health Care (PHC). The main variable was Affective state through the Hospital Anxiety and Depression Scale (HADS) questionnaire. The rest of the variables were: Socio-demographic variables, number of residual symptoms, cognitive using the Montreal Cognitive Assessment (MoCA), physical functioning variable will be measured by Sit to Stand Test and Sleep quality through the Insomnia Severity Index (ISI). A bivariate analysis and also a lineal multivariate model were developed. Ethics approval was granted by the Clinical Research Ethics Committee of Aragón (PI21/139 and PI21/454).

A total of 100 individuals participated, of whom, 80 were women and 20 were men. The median scores in HADS was 16 and the interquartile range was 12. Multilevel analysis shows that better physical functioning (sit to stand test) and worse sleep quality (Insomnia severity index) are predictors of worse affective state. The models explain 36.5% of the HADS variance.

It is relevant to take account these variables in the treatment of the affective state of patients with long covid.

None Declared

Long COVID patients have experienced a decline in their quality of life caused, in part but not wholly, by its negative emotional impact. Some of the most prevalent mental symptoms presented by Long COVID patients are anxiety, depression and sleep disorders.

The objective of this study is to increase understanding of the affective state of people diagnosed with Long COVID, the evolution and associated factors.

Longitudinal study of three months of duration. The study population was 100 post-COVID-19 patients aged 18 years or older (80 women and 20 men). The main variable was the affective state through the Hospital Anxiety and Depression Scale (HADS) questionnaire. The rest of the collected variables were: Socio-demographic variables, number of residual symptoms, cognitive functioning using the Montreal Cognitive Assessment (MoCA), physical functioning variable measured by Sit to Stand Test and Sleep quality through the Insomnia Severity Index (ISI). A statistical analysis comparing baseline and 3months follow up measures were performed, using a Student T for related samples statistical. A lineal regression analysing associated factors to a reduction in HADS score was also performed. Ethics approval was granted by the Clinical Research Ethics Committee of Aragón (PI21/139 and PI21/454).

At baseline the score in anxiety, depression and total score were 9,10 (SD: 4,67), 8,25 (SD: 4,51) and 17,35 (SD: 8,43) respectively, and 74% of the participants were considered cases. At three months, there is a slightly decrease but not significative in the score of HADS, both in anxiety, depression and total score (pvalue 0,465; 0,236; and 0,216 respectively). 64,4% of the participants had a positive diagnosis of depression/anxiety. About the rest of the variables there were also a slight decrease but without being significant There was not a predictive model that explained the decrease in the HADS score.

The evolution of the people suffering long covid is very slow along the time, and also the affective state.

None Declared

Since its emergence at the end of 2019, the COVID-19 virus has spread worldwide. In Spain, mandatory home confinement was established on March 15, 2020, and lasted 99 days. Previous studies on events that required isolation situations suggest a worsening in the mental health of general population, and in particular, of especially vulnerable groups such as individuals with severe mental disorder (SMD).

The aim of this study is to evaluate the psychological effect (anxiety and depression) of confinement in patients with SMD and to study the dissimilarities among the different diagnostic groups.

In this study, assessments were performed using the IDER and STAI questionnaires, in order to evaluate symptoms of depression and anxiety, respectively. The evaluations were carried out in patients who had required at least one admission to the Psychiatric Hospitalization Unit of the University Hospital of Basurto. The Shapiro-Wilk test was used to verify the normality of the sample. ANOVA test was used to study differences among diagnostic groups. Posteriorly, Bonferroni correction was performed.

95 participants completed the IDER questionnaire, obtaining a mean score of 24.56 (SD=8.18) for the state and 23.57 (SD=8.14) for the trait. In the STAI questionnaire, a mean score of 27.86 (SD=15.19) was obtained for the state and 30.49 (SD=14.71) for the trait. ANOVA test indicated presence of differences among groups. However, differences did not persist after Bonferroni correction.

Increased levels of anxiety and depression were found in the sample studied with respect to the general population.No statistically significant differences were found among different disgnostic groups. Further studies should be performed in order to increase the knowledge around this research area.

None Declared

Following the protracted duration of the coronavirus pandemic, the Serbian health system now faces a period of mid- and long-term health consequences in patients that have recovered from the acute phases of infection.

A 57-year-old woman presented at a psychiatric examination complaining of forgetfulness, listlessness, fatigue, insomnia, low mood, and decreased efficacy in daily activities, two months after infection with the SARS-CoV-2 virus. The clinical picture of acute COVID-19 infection was accompanied by an elevated body temperature, a cough, an increases of CRP, and X-ray verified bilateral pneumonia with band-like speckled shadows of milk glass density. Before infection, she was vaccinated with 3 doses of the Sinopharm Covid-19 vaccine.

The following examinations were made: MRI of endocranium, HDRS, laboratory examination, and neuropsychological testing.

MRI of endocranium (figure 1): extensively cortico-subcortical lesions extensively within both cerebral hemispheres, dominantly in the temporo-insular regions, in association with partial parenchymal defects and a high degree of atrophy - the overall morphology corresponds to chronic encephalopathy, which is of non-specific morphology; HDRS score of 24; elevated serum levels of IgM, IgG, albumin in serum 7.05 (35-55), albumin in cerebrospinal fluid 812.0 (0-35), albumin index 115.8 (<9.0); IEF: oligoclonal bands in CSF and serum; neuropsychological testing: decrease in general mental activity and visuoperceptive and visuospatial ability. Due to the temporal connection between infection with the SARS-CoV-2 virus and presented symptoms, the patient was diagnosed with post-acute COVID-19 encephalopathy.

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A meticulous follow-up post-acute SARS-CoV-2 infection monitoring and care could decrease mortality and prevent debilitating neurological and other burdens, especially in risk groups.

None Declared

With the closure of higher education institutions during the COVID-19 sanitary crisis, students have experienced problems such as interruptions to their education, loss of peer support networks, and mental health issues.

This study aimed to explore adjustment patterns used by students to overcome the impact of the COVID-19 pandemic.

A qualitative descriptive study was developed by carrying out Focus Group Discussions (FGDs). Portuguese students enrolled in education levels above high school, including undergraduate and graduate programs, were considered eligible. Participants were recruited using convenience sampling. Each FGD took approximately 60–90 min.

Twelve students were participated in 2 FGDs, each one with 6 participants. Mostly were undergraduate students (Bachelor’s degree), in the field of health area. The thematic analysis revealed three main themes. The first theme was related to the personal sphere and included most of adjustment strategies used, namely: pandemic as a “window of opportunity” to be involved in new academic and professional projects; work-life balance by organizing and separating work from private life; self-care through the adoption of healthy lifestyles; being compassionate with others and compliance with sanitary measures. In the social sphere, students evoked new ways of communicating via digital networking to compensate for the lack of physical proximity and stay in safe contact with friends and relatives. In the contextual sphere, students talked about the importance of adapting the “teaching/learning” environment. Tailored teaching support was a significant strategy, especially in maintaining their motivation.

Several strategies were pointed by students to stay mentally healthy and mitigate delayed-onset post-traumatic stress disorder during the COVID-19 pandemic. Besides, positive coping and hope should be integrated into the standard training of students across all study areas.

None Declared