COVID19 pandemic had a significant psychological impact on the population worldwide. However, health care workers have been the most exposed to psychological effects.

To determine the psychological impact of the covid19 pandemic on health care professionals (HCPs) who were working in the covid19 setting.

Descriptive cross-sectional study carried out in May 2020, having interested the HCPs of the Charles Nicolle hospital who were working in the COVID19 settings .The data collection was carried out with a pre-established questionnaire .The visual analog scale of B. Chini was used to assess the level of work stress. This assessment was undertaken at three points in time: during the work, during the confinement period and post confinement .

Seventy five nurses participated to the study. The average age was 39.7±9.6 years. The sex ratio was 0.74. The average professional seniority was 11.6±8.14 years. During the confinement, a feeling of anxiety and apprehension of danger to others were reported by 96% of the participants. In addition, sleep disorders and irritability were noticed in 65% and 92% of cases respectively. At the end of the confinement period, 77% of the cases reported neuropsychological complaints: feelings of anxiety (57%), mood disorders (49%), a sleep disorders (32%) and concentration disorders (20%). The average level of stress was evaluated at 7.54 during the work, 7.36 during confinement and 5.28 after confinement. Faced with this psychological suffering, 88% of the cases noted the absence of psychological support or assistance.

Psychological support and early screening in psychiatry and occupational medicine are necessary to prevent any deterioration in their mental health.

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During the COVID-19 pandemic, health care workers found themselves threatened by developing psychological effects.

The objective of this study is to evaluate the impact of exposure to COVID-19 on the mental health of medical and paramedical staff at Farhat Hached Hospital in Sousse and to identify potential risk factors.

This is a descriptive cross-sectional study that included 166 health care workers of Farhat Hached Hospital of Sousse throughout 3 months. The patient health questionnaire (PHQ-9), the generalized anxiety disorder (GAD-7), and the revised event impact scale (IES- R) were used to assess depression, anxiety, and stress respectively.

The mean age of the participants was 37.06 ±11.07 years with a female predominance (80.1%). The median professional seniority was 7.5 years with extremes ranging from 1 to 39 years. Nurses were the most represented (34.3%) followed by medical residents (24.7%). PHQ-9, GAD-7, and IES- R scores revealed that 51.8%, 40.4%, and 28.3% of participants had moderate or severe levels of depression, anxiety, and stress, respectively. Personal history of psychiatric disorders was significantly associated with depression (p<10-3) and anxiety (p=0.004). On the other hand, paramedical staff had a significantly higher risk of experiencing symptoms of depression (OR = 2.40 ; 95% CI [1.28-4.48] ; p= 0.006) and stress (OR = 2.03 ; 95% CI [1.01-4.11] ; p= 0.04) than medical personnel.

This study reported a high prevalence of symptoms of anxiety, depression and stress among health care workers. Improving mental well-being and providing psychological support to health care workers is recommended.

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Developing or presenting with a serious mental illness whilst working offshore may result in substantial barriers to treatment, rehabilitation and repatriation to one’s home country, especially amid changes in border control practices over the COVID-19 pandemic. Further difficulties arise arise in relation to language and cultural barriers.

Our aim was to explore the experience of providing safe and effective treatment for a psychiatric patient from another country, culture and language using a non-medical interpreter.

In this report, we describe the case of a 26-year-old Chinese citizen, a cargo ship crew member, who docked at the Port of Santos-Brazil in june 2021 with severe psychiatric disturbance.

Following the hospital assessment, the patient was admitted in the psychiatric ward and started the diagnostic research and treatment. After stabilization of the psychopathological condition, he was repatriated to his country of origin uneventfully. This case shows that treating and communicating with people who do not share the same language is challenging, in particular in a psychiatric context. The use of an interpreter is essential in the assessment process, but there are challenges in accessing and using these services.

With a detailed multi-disciplinary rehabilitation plan a patient with serious mental illness can be rehabilitated in order to facilitate the repatriation in humanized ways and respecting all health protocols of COVID-19 pandemic.

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For over fifty years, minorities in Burma have faced severe persecution and violence, forcing them to flee their homeland. In the past ten years there has been an influx in the number of refugees resettled in Denver, Colorado. Refugees often struggle to navigate the complexities of the American health care system and adapt to life in a foreign culture. The development of programs and partnerships to assist refugees in their pursuit of health and integration is essential to building stronger communities.

This community based participatory research (CBPR) project was developed in collaboration with the refugee community from Burma living in the Denver area. After regular meetings with a group of motivated teenagers and young adults from this community to form our Youth Advisory Board (YAB), they identified alcohol use and misuse as a health concern within their community. With this identified issue, the project aimed to gather data from community members that could be leveraged to create, implement, and evaluate a culturally competent intervention to effectively address risky alcohol use in this community.

Data collection involved formal one-on-one, semi-structured, audio-recorded interviews with community members. Participants were recruited voluntarily at health information nights held by the student researchers at their local apartment complex. The interviews were conducted by one medical student researcher with one translator present and were transcribed afterward. The interview data was analyzed using Immersion Crystallization methodology.

Initial results from the community meetings with the YAB, local organizations, formative community surveys, and key informant interviews highlighted the vulnerability of the refugee population, scarcity of culturally appropriate resources for alcohol abuse, and urgency of addressing problematic alcohol use. The analysis of the ten audio-recorded surveys showed several themes including negative consequences of alcohol use, specifically negative impacts on familial relationships, employment, and financial resources, and a perceived personal responsibility for managing one’s own alcohol consumption.

This project corroborates current literature regarding the scope and breadth of hazardous alcohol use within the community of refugees from Burma. Our data has expanded our understanding of the values of community members including the influence of religion and family on behaviors, and the negative impact on employment as the most impactful negative consequence. These findings need to be shared with the community to move forward in mapping the most effective and appropriate interventions.

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For a very long time, anthropologists and psychiatrists have studied how the symptomatology of mental diseases varies among cultures. Different social environments approach depression in different ways, and cultural practices and meanings influence how it develops. Culture also affects how symptoms are felt and described, how treatments are chosen, how patients and doctors interact, how likely it is that certain events, like suicide, will occur, and how professionals behave. As a result, all of these circumstances must be taken into consideration when approaching the diagnosis and management of depressive disorders. To illustrate the above, we present the case of a 31-year-old man, originally from Nigeria, who was admitted to the hospital after a suicide attempt by precipitation onto the subway tracks.

(1) To describe the clinical particularities of this case, focusing on the diagnostic difficulties we faced derived from intercultural contrasts (2) To review cross-cultural differences in the symptomatology and its implication on severity of depressive disorders.

A review of the patient’s clinical history and complementary tests performed was carried out. Likewise, a bibliographic review of the available scientific literature was also performed in relation to transcultural depressive experiences and its severity.

There is little evidence in favor of a direct link between sociocultural factors and severe depression, but we reviewed the arguments that look significant for further research. Depressive illnesses are found in all societies and their symptomatic expression varies culturally, particularly in terms of somatization and delusional ideas. Similarly, the social and individual representations of the disease depend on the culture, and some conceptual models can increase the effects of stigmatization. These cross-cultural variations could influence the care-seeking process and therefore modulate the evolution of the disease in the sense of greater severity.

All societies experience depressive disorders, which exhibit symptoms that vary culturally, especially in terms of somatization and delusional beliefs.

The care-seeking process is affected by cross-cultural differences, and as a result, the disease’s progression may also be modulated in terms of increased severity.

When we ignore cultural factors in understanding, assessing, and treating depression, we are contributing to misdiagnosis and errors in patient management.

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If children are taught early on to control their emotions, that can prevent problems that cause disturbing emotions: violence, suicide, drug abuse, etc. The artistic experience, just like the religious one, is an essential experience of the human being. Art ,occupational, play therapy concerns itself with the information that the images have to offer regarding their author.

Our goal is to discover new perspectives and sources of inspiration to establish new prevention and recovery methods and techniques to advance in defining the importance of resilience in personal development. The development and maintenance of social skills will thus be the necessary conditions for improving adaptability and the capacity for personal transformation, without forgetting at the same time the effectiveness of the process of resocialization and recovery of juvenile delinquents.

The child is stimulated in the problem-solving and the decision-makings strategies, in order to achieve formal diversifications. In the preventive activities we include all activities involving nonverbal communication and holistic engagement of people in creative activities, specific to visual arts (plastic, decorative design and multimedia), facilitating school reintegration or optimizing the school situation, completing the general and specialized culture.

The individual skills are traced by the specific means of the visual arts; moreover, we care about the individual capacities, the freedom to follow his own destiny, encouraging the joy to manifest creatively on several levels of difficulty in any activity. These activities lead to changes in the attitudes towards the work or the discovery of recreational activities and the use of leisure time.

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Considering the diversity of the child`s non-verbal communication, art therapy, occupational and play therapy are not a mere accessory method within the therapeutic process of the emotional disorders of children, but a mandatory condition of it. The development and the maintenance of social abilities will thus be the necessary conditions of an improved adaptability and of the capacity of personal transformation, “Social Cohesion” is a Common Goal for Psychiatry, and art, occupational , play therapies.

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The new type of postmodern art can be interpreted from the point of view of self expression polarized between: art - art-therapy, ludic, occupational therapy - religion. The computer becomes the new medium after the impact of television, and by integrating computers into the network, their communication function has become more prevalent than that of data processing. Contemporary visual arts bring together, in different degrees of relationship and fusion, fields of art that until now were understood and practiced more individually. Multimedia and mixed media technology, which has evolved into meaningful visual representations, incorporates the science behind human perception and knowledge.

The purpose of art in art-therapy, in this context, is not an exercise of the already acquired knowledge upon the artistic material, but a discovery of the yet unknown. Art-based therapies, as nondirective methods, attempt to visualize past traumatic experiences and harmonize the individual with himself and with others.

In the preventive activities, we include all activities involving nonverbal communication and holistic engagement of people in creative activities, specific to visual arts (plastic, decorative design, and multimedia).”Beneficiaries can create their own images with which they want to interact, to arrange their environment…We experiment with art-specific ways to make interdisciplinary exchanges and cultural interferences using the universal language of visual arts along with intercultural elements and religious ecumenism” . The child expresses various issues related to his feelings, like the search of his identity, the generated anxieties, the family and professional environment, the situations of neglect and abuse. For the same purpose, as a complement to activities in nature camps, where education/art therapy takes place in the artist’s studio, special care must be taken to create an evocative and stimulating work environment.

We detect hidden capacities through the specific means of the visual arts with the aim of providing the freedom to follow one’s own destiny, encouraging the joy of creatively manifesting at multiple levels of difficulty in any activity. Harmonizing cultural differences develop self-esteem, tolerance, resilience, and necessary adaptation to the conditions of a multiethnic society.

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There is an equidistant trialogue and circular relations between art, religion, and science, without any specific supremacy. This can offer up from the start the possibility of a lasting harmonization, of information transfers and professional enhancements to support new developments, uplifting the human being through positive reorientations and beneficial recoveries.

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Considering the development of this study, we selected cases where art therapy played a central role in the educational/therapeutic process. Studied 130-150 cases per year on average, for 25 years (1996-2021), including children and adolescents aged between 2 and 18 years of both sexes, different social backgrounds in terms of housing, culture, and education: education/ clinical art therapy ( Mental Health Center for Children and Adolescents ward of the Cluj-Napoca Children’s Emergency Hospital) and non-clinical education/art-therapy.

The activities also have components of artistic creation, research, and teaching with students, within the disciplines “Art therapy in institutional contexts” and “Artistic play and experiment in group dynamics”, within the University of Art and Design section Pedagogy of Plastic and Decorative Arts from Cluj-Napoca Romania. The results are published at the international and world congresses to which we were invited together with the practitioners under supervision.

The aims of occupational therapy, which include art therapy and play therapy, are to facilitate the use of creative process and symbolic communication, associated with narrative and imitation, to develop new ways of communication, self-expression and seeing things.

We use materials and techniques that are specific to visual arts (painting, sculpture, graphic, multimedia, photography, film, animation, and digital media), but also traditional ones, specific to tridimensional arts, such as pottery wheels and sculptural modeling. Activities are structured according to the following dimensions:

• • The making of art or the production of other crafts resembles a situation test

• • The analysis of the products allows the beneficiaries to attain a certain level of introspection and to “work through” their problems in constructive manner

• • The execution of an operation requires sensory, cognitive, and affective intervention;

• • Psychological dimensions, which include the individual’s intrinsic need for self-improvement, for obtaining competence and self-knowledge;

• • The socio-cultural and symbolic dimension of the act;

• • The spiritual dimension, related to the meaning of the occupation for the individual;

• • The temporal dimensions of the occupation (referring to the time or period of time required for recovery).

By interacting with these factors, the individual gets to know his own potential and limits, but also those of the environment in which he lives.

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An equidistant trialogue and circular relations between art, religion and science, without any specific supremacy, is created, which can offer from the start the possibility of lasting harmonizations, of informational transfers and professional enhancements that support developments, ennobling the human being through positive reorientations and beneficial recoveries.

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A growing amount of evidence indicates that South Asians in the UK are experiencing high rates of mental health disorders. Despite this, data from the National Health Service reveals that these communities utilise mental health services less than any other ethnic group residing in the UK. For these communities, mental illness stigma has been cited as a major barrier to accessing mental healthcare.

By situating stigma within a specific socio-cultural context, this study aimed to explore how stigma may affect the utilisation of mental healthcare by South Asian communities within the UK. Acknowledging that the experiences of stigma can be influenced by an intersection of multiple social categorisations, it aimed to disaggregate the data further. This study examined how the experiences of stigma and the subsequent utilisation of mental healthcare may differ across generational statuses.

This qualitative study utilised document analysis as its approach to data collection and interpretation. Both, academic and grey literature were used. A literature search was performed using Google Scholar and PubMed. Google search engine was also used to identify grey literature such as blogs and reports. The search terms “mental health services”, “stigma”, “utilisation”, “South Asian”, “culture” and “generation” were used. Articles were organised into matrices relating to cultural stigma and intersections relating to culture and generational status.

This study revealed that the values and beliefs instilled within South Asian cultures may perpetuate the effects of stigma, thus contributing to the under-utilisation of mental health services within the UK. This study also observed that second-generation South Asians may be more likely to utilise mental health services in comparison to the first-generation. This is ascribed to the fact that second-generation individuals, as a result of processes related to acculturation, are more likely to disengage with their heritage culture, which may, in turn, mitigate the levels of stigma experienced and reduce barriers to care.

This research argues that stigma is socially constructed within cultural groups, and heterogeneously across generations. Such findings can have wider relevance for healthcare professionals, who wish to become more culturally competent and policymakers, who wish to tailor anti-stigma interventions. Primary qualitative research, using questionnaires and interviews, should be employed to further understand mental illness stigma within cultural groups, such as South Asians, and could prove useful in acknowledging discrete beliefs between first- and second-generation cultural groups.

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One of the most significant changes to society came with the advent of social media, and with it a cultural shift in whom people consider their actual friends. The cultural influence of entertainment figures is not a new phenomenon; however, there has a revolution in the way celebrities interact with their fans, specifically in the Korean Pop (Kpop) industry. In contrast with musicians who release an album and then disappear into mysterious obscurity, Kpop stars constantly interact with fans through meet and greets, live streams, variety tv shows, and most importantly, through social media. With a concomitant rise in parasocial interactions and relationships, Kpop blurs the line between what constitutes pathological delusions and healthy fan activity.

• • To learn the assessment and management of patients with anorexia nervosa

• • To understand changes in management to address suicidality in patients with anorexia nervosa

• • To understand influences by media in perpetrating certain body types in impressionable adolescents

Patient is a 19 year-old Hispanic female with a Past Psychiatric History of Bipolar Disorder, who was brought in by EMS due for agitation and disorganized behavior. Patient presented manic, labile, and her delusions extended to beliefs that the Kpop group EXO has been communicating with her through morse code in their videos, and that certain members would wink at her through the computer screen in real time. The patient’s BMI at the time of admission was 15.4, and she continued to compare her own body to Kpop idols.

Patient shared a lifetime mix of both shame and trauma concerning her eating habits, with multiple incidents that may have contributed to her fear of eating, and simultaneously into her becoming obsessed with the Kpop group (“2018 and COVID were a miracle for me. I got closer to EXO”). Patient denies looking ugly or fat and seems mostly satisfied with her current appearance.

With social isolation growing due to the pandemic, online parasocial relationships are becoming an increasingly normal part of people’s lives. We discuss a case where an unhealthy obsession with Kpop contributed to body dissatisfaction, and the precipitating factors that lead to these circumstances, as well as the challenges that are present in helping these adolescents and young adults in coping with social media use. As such, it is important to discuss the challenges faced by psychiatrists who must be sufficiently aware of the ever-changing face of contemporary cultural landscape when forming an accurate diagnosis.

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Schizophrenia affects people worldwide. In Europe, the advantages of second-generation and long-acting injectable antipsychotics (SG-LAIs) are known and used, supported by scientific evidence. However, somewhere there is limited evidence on this topic.

Highlight the improvements in antipsychotic treatment and raise awareness of the scar between Europe and Africa, showing the results of the evidence with a case of cooperation with Cameroon.

About a case of a 42-year-old Cameroonian woman with 25 years of schizophrenia, treated with first-generation antipsychotic polypharmacy (APP) oral and depot, with several psychotic relapses, disorganized behaviors, motor and cognitive impairment and isolation (telemedicine consultation received through a NGO platform).

A search on PubMed was performed, selecting two systematic reviews including “antipsychotic” AND “Africa”, one systematic review for SGAs and four reviews for LAIs.

Seven articles were reviewed, finding that APP use is highly prevalent in Africa with a lack of research on this, SGAs show an improved safety and tolerability profile and LAIs are among the most effective treatments in psychiatry improving adherence and overall patient outcomes.

In our case, we recommend progressively adjusting treatment to SG-LAI monotherapy, visiting the patient six months later in Cameroon, observing sustained stability of positive symptoms with an improvement of negative symptoms and good adherence and tolerability to treatment without extrapyramidal effects.

Our case is an example of the evidence that supports the improvement that SG-LAIs represent in psychiatric treatment and how international cooperation can help bridge the gap between Africa and Europe. Nevertheless, more research is needed to build bridges.

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The accumulated experience, both with typical and atypical children, led to the desire for an easier integration into the collective.Detecting and encouraging the skills of the atypical child, with the help of combined arts techniques and environmental stimulation, supports their’s integration into the comunity.

Beneficiaries-Centered Art therapy, with the aim of identifying and developing outstanding skills, trough environmental manipulation and combined arts techniques

The environmental manipulation method is used in the art therapy session trough artistic installations and colorful fabrics. Trough chromatics and textures are generated different contexts and atmospheres sense, through which the atypical child comes to accept and discover that environment. Through the manipulation of artistic installations, gross motor skills are also required, having to produce large movements with the whole body, in order to shape the elements in the environment.

Costume making as a transitional phase in the adaptation of the beneficiary to the previously created environment independently or together with the art therapist, consists in harmonizing the beneficiary with the environment. These stages are achieved through mixed techniques of artistic work, painting, decorating, modeling, collage, weaving and binding techniques.

By practicing these methods during the art therapy sessions, the beneficiaries increased their self-esteem through the achievements they had and discovered and improved their outstanding skills: fine and gross motor skills, color sense, visual thinking, hand-eye coordination; improved and developed both verbal and non-verbal communication between beneficiary - art therapist and beneficiary - beneficiary, in the case of group sessions

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The role of the artist/Art-therapist can be to identify and encourage the creative potential of the beneficiaries by making both individual and team artworks; to support social integration through art and to value the outstanding skills of the beneficiaries.

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We all live in a global world where all cultures have their own unique identity, a sense of belonging, and pride. In the same way I am proud to be part Sindhi culture which is originated from Indus Valley civilization. It’s a 5 thousand years old civilisation.It gave me food for thought and an opportunity to take a lead in to do a project which will not only help my college but to more than 50 million of SINDHI speaking people living across the world. As most of Siddhis live in Pakistan, India, UAE, some of them have migrated and settled in USA, Canada, UK, Australia and Ireland.

It gave me food for thought and an opportunity to take a lead in to do a project which will not only help my college but to more than 50 million of SINDHI speaking people living across the world. As most of Siddhis live in Pakistan, India, UAE, some of them have migrated and settled in USA, Canada, UK, Australia and Ireland

I contacted someone in the mental health information office at Royal College of Psychiatrist and expressed my interest to help the college by contributing one more language to the college website which will be my native language SINDHI. As I wanted to translate leaflets of Royal College about various common mental health disorders in SINDHI language which would benefit more than 50 million people across the world. As they would be able to read about common mental health disorders in their own language which will help them to understand that conditions in a better way and will reduce the stigma and will encourage them to get the right help which they need and deserve.

We started working together on the project and agreed that I will do writing and he will do proof reading for it. We completed the project and handed back it over to the college representatives dealing with leaflets in other languages. After about one month’s hard work, we were lucky enough to get out a leaflet translation published by Royal College of Psychiatrist. It was a proud moment for me being a psychiatrist to help me patients and being a SINDHI to be able get my mother tongue published on Royal College website. I couldn’t have asked for more. Its not the end of this story, as we will continue to work with our college to translate more leaflets and contribute to society and to the college being a proud member of Royal College of Psychiatrist UK.

It was published on RCPSYCH website in translation section

I contributed one more language to RCPSYCH webiste through my work

MY TRANSLATION WORK WAS PUBLISHED ON OFFICIAL WEBSITE OF ROYAL COLLEGE OF PSYHCIATRIST UK

IT WAS WIDLEY APPRECIATED BY WIDER COMMUNITY AND CURRENT AND EX DEAN OF ROYAL COLLEGE OF PSYCHIATRIST https://www.rcpsych.ac.uk/mental-health/translations/sindhi/depression-sindhi

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Culture and ethnicity are crucial to our identity and responsible for our health, values and thereby to our satisfaction from work.

To this end, this study focused on the minority groups of ultra-orthodox women in their work sphere and examined differences between women who work within the enclave, women who work both with ultra-Orthodox and other sectors of the Israel society and women who work mainly outside the ultra-Orthodox enclave on the different study variables. Moreover, a model which include main resources [family, community, diversity climate perceptions (in the job environment) and inclusive leadership] as potential explanatory factors of employees’ satisfaction from work and mental health.

Data were gathered from 304 ultra-Orthodox women who belong to various streams in this society, who were recruited by the Midgam research panel. The participants filled out self-reported questionnaires among which family quality of life, community sense of coherence, diversity climate, inclusive leadership, job satisfaction and mental health. The participants’ age ranged between 19-64 years (M=30.86 SD=8.71).

The explanation of the full model for jobs satisfaction was: 46% of the variance among women within the enclave, 60% among women who work in mixed environment, and 53% among women who work outside the enclave. As for mental health: 22% of the variance among women within the enclave, 17% among women in mixed environment, and 41% among women outside the enclave.

The results are analyzed through the lens of Bronfenbrenner’s ecological theory and show that in traditional societies such as the ultra-Orthodox one, the most important factors for job satisfaction and mental health are family and communal resources.

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Mental health awareness campaigns in the past few years have vastly improved how medical professionals treat mental health patients. However, prejudices and ignorance still interfere in medical practice. In this context, with the case presented we can see that even in presumed mental health diagnoses along with cultural factors (race, language…), the best medical assistance is not ensured.

Review how different intersectional factors can determine the treatment patients receive at hospitals.

Presentation of a patient’s case and review of existing literature, in regards to the influence of race, language barriers and mental health diagnoses when attending patients.

The patient is presumed to suffer from a mental health condition after a battery of initial tests with inconclusive results do not demonstrate an organic origin. Instead of continuing with the medical study, the patient is disregarded as psychiatric even though his profile doesn´t fit beforehand of a fictitious or conversion disorder. The fact that there are also cultural factors in play (race and language) probably unconsciously influence how the medical team treats this patient’s case. Cultural social factors persistently present as barriers in clinical practice.

Race, language barriers and mental health diagnoses as well as other intersectional factors do have a great impact in the treatment patients receive. There is yet a lot to do when it comes to educating health professionals if we want to offer the best medical assistance.

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Existing as an emerging topic in the field and undergoing constant evolution, Transcultural Psychiatry addresses how social and cultural factors influence mental illness. During the second half of the twentieth century, phenomena such as globalization, massive migrations and immigration, occurring in ever increasing frequency, continue to bring this topic to the forefront of discussion as challenges in the treatment of patients from varying cultural backgrounds emerge. Viewed from the biopsychosocial perspective, culture delineates a framework for the evaluation of various expressions of emotion and behaviour as well as defining the limits of what counts as disorder. As border restrictions are lifted, cases which present with these particularities are bound to increase, necessitating an increased attention to the influence that cultural and social factors play in the psychopathological clinical pictures which may present to the practitioner.

The authors aim to briefly explore the concept of transcultural psychiatry and its importance in clinical presentation and practice with recourse to various clinical cases of international patients hospitalized in a Portuguese Psychiatry ward during a two-year period.

A brief non-systematized literature review was performed based on works most pertinent to the topic discussed. As compliment to the topic, a discussion of various clinical cases of hospitalized international patients is presented.

Culture has been demonstrated to contribute to psychopathological presentations in a variety of forms, solidifying the old adage that ‘no man is an island’ and giving reason to the biopsychosocial approach applied in clinical practice. The impact of sociocultural factors is such that the DSM-5-TR includes in its classification culture-specific syndromes. The cases discussed demonstrate the various nuances necessary not only in exploring psychopathology, but also in implementing appropriate standards of care.

Transcultural psychiatry rises as a relatively recent topic as well as raising important philosophical, theoretical and technical challenges for mental health practitioners. Although existing as a subspecialty, each mental health practitioner should strive to be transcultural, taking into consideration the influence that these factors exert on mental illness. The patient should be evaluated with consideration to their cultural background, as well as not neglecting how the culture of the practitioner may influence the interpretation of psychopathological presentation.

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Mental illness is characterized by a major emotional, cognitive, and or behavioral impairment of an individual. It is usually accompanied by distress or functional impairments in important areas.

Mental illness affects 48.9% of the Moroccan population. This makes it a major public health issue but one that is still unrecognized and underestimated in the general population. Because of certain cultural aspects considering mental illness as a taboo or privileging traditional healing.

to evaluate the time between the initial symptomatology and the first psychiatric consultation Identify the course of action to be taken in the face of the first symptoms of the illness; Determine the factors responsible for the diagnostic delay;

We conducted a cross-sectional study to assess the duration between initial symptoms and diagnosis and to identify the responsible factors of diagnostic delay. This study included 200 patients followed at the psychiatry department of the University Hospital Arrazi of Salé, and evaluated by an hetero questionnaire.

The average age of our patients was 29 years, male gender was predominant (84%). The mean diagnostic delay was 46 months. Data analysis showed some significant results: - The Diagnostic delay was longer in male patients. - The diagnsotic delay conditioned response to treatment and therefore the prognosis.

In conclusion, public awareness of psychiatric problems, treatment availability, and educational efforts to overcome the social stigma are essential to reduce diagnostic delay and improve the prognosis of schizophrenia.

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Migration is a rapidly growing phenomenon in European countries and its association with psychotic disorders is a public health concern. Psychosis is more prevalent among migrants, which suggests that adverse social experiences play an important role in its pathogenesis. Throughout the migration process, migrants are exposed to several social disadvantages, including in the post-immigration context, where perceived discrimination appears to be an important stressor. In fact, the highest incidence rates of psychosis occur in the most discriminated populations, namely migrants with darker skin complexion, particularly when living in low-ethnic-density neighborhoods, where both discrimination and social isolation are more prominent.

To conduct an updated review about the association between migration, perceived discrimination and psychosis, aiming to better understand the mechanisms involved.

Narrative literature review using the keywords “migration”; “psychosis”; “discrimination”; “racism” on PubMed database, in conjunction with presentation of a clinical case concerning a patient from Guinea-Bissau, admitted to our hospital in the context of first-episode psychosis (FEP), with onset months after completing the Mediterranean migration route to Europe.

Literature suggests that experiences of racism and social exclusion contribute to feelings of imminent danger, fear and general anxiety, which may develop into paranoid ideas of ubiquitous persecution. Furthermore, intense social defeat experiences, common in migrants, are associated with more distressing forms of delusional content, with delusions of psychological persecution being more common. However, there is also evidence that migrants with FEP have better occupational and social functioning profiles compared to natives, suggesting that, in these patients, there is a higher burden of social-environmental risk factors, with the onset of psychosis occurring only when this burden overcomes a higher threshold. Our patient fits this description. After completing his migratory route and while living in an Italian refugee camp, he described suffering experiences of severe discrimination. Real or not, these experiences escalated to become delusional ideas of persecution involving European governments, thought to seek for his humiliation. Despite the presence of psychotic symptoms, this patient was able to maintain a reasonable level of functioning during years, up to his psychiatric admission.

Given the notorious effect of perceived discrimination and racism on the increased risk of psychosis in immigrants, it is urgent to adopt policies that promote the social protection of these vulnerable groups, namely through enhancing their integration in the host countries.

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Major depressive disorder (MDD) is a mental health disorder characterised by persistently low mood; anhedonia; feelings of worthlessness and guilt; altered appetite, weight and sleep and suicidal ideation. About one-third of patients do not respond to available antidepressants (AD). Treatment-resistant depression (TRD) is a clinical term used to define a lack of response to two or more AD in patients with MDD that do not respond to other lines of treatment either. TRD is associated with an increased risk of relapse, hospitalisation and suicide. Esketamine is a non-competitive NMDAR antagonist that acts as an antidepressant by modulating glutamatergic neurotransmission, disturbed in MDD patients. It has recently been approved by the European Commission as a fast-acting nasal spray therapy for depression and suicidal ideation after showing effectiveness in TRD patients (Papakostas et al. JCP 2020; 81 4).

The aim of this study is to determine the effectiveness, safety and tolerability of intranasal esketamine in two TRD-diagnosed patients and to assess their clinical evolution.

A prospective study was conducted describing the evolution of two TRD patients treated with intranasal esketamine. We used The Hamilton Depression Rating Scale (HDRS) to quantify the severity of their symptoms and assess their recovery over time, analyzing the score change from baseline to endpoint as a primary outcome of the study. We also applied the Addensbrooke Cognitive Examination (ACE-III) as a tool to establish their cognitive condition before therapy and its evolution. Changes in dosage during treatment, adverse effects, time required for onset of action, clinical outcomes and other variables were also measured.

Intranasal esketamine was administered twice a week during the first 4-week induction phase and weekly during the following 6-month maintenance phase. Dosage of antidepressant was determined depending on each patient’s age and clinical evolution, being 56 mg the initial dose for case 1 (57 years old) and 28 mg for case 2 (71 years old). This antidepressant was effective in both patients in a fast-acting way, with the onset of action occuring within the first two weeks. During the course of treatment, the HDRS score significantly decreased, associated with improvement and remission of depressive symptoms. Cognitive performance got better in both cases. None of the patients discontinued treatment due to adverse effects or lack of efficacy.

Our data suggest that intranasal esketamine therapy is a good alternative in TRD patients, being effective, fast-acting and well-tolerated, with a manageable safety profile. Clinical stability was also observed in the medium-term follow-up after the end of treatment. This presents esketamine as a promising therapeutic and effective strategy in MDD patients who are either treatment-resistant or acutely suicidal.

None Declared

Perry syndrome is a rare neurological disorder, characterized by atypical parkinsonian symptoms, sleep disturbances, central hypoventilation, weight loss, and psychiatric symptoms, especially apathy or depression. This syndrome is due to a TDP-43 proteinopathy as a result of a mutation in the DCTN-1 gene.

To present the case of a patient with a mutation in the DCTN1 gene, related to Perry syndrome, who debuted with several depressive episodes, with apathy and weight loss.

A non-systematic literature review was conducted on PubMed database on depressive episodes related to Perry´s syndrome. The clinical case report was prepared through the review of the clinical record of the patient.

The authors present the case of a 49-year-old man, who contacted psychiatry for the first time 10 years earlier due to depressive symptoms, suffering multiple episodes. These episodes consisted of hypothymic mood, apathy, anhedonia and marked irritability, together with suicidal ideation, leading to several drug overdoses. He also presented disruptive behaviors, such as abusive drinking and aggressiveness. These episodes responded to antidepressants at medium doses, although maintaining several relapses. Given this, it was decided to introduce valproic acid as a mood stabilizer, with good tolerance.

In parallel, the patient’s mother, who had also suffered from depressive episodes, began with dementia symptoms, after which it was decided to request a genetic study. In this context, a mutation, similar in both patients, was observed in the DCTN1 gene, related to Perry syndrome.

In the case of the patient presented, no other associated alterations were found, neither in the neurological examination or in the rest of the tests performed (polysomnography without notable alterations, functional imaging tests without pathological findings).

Neurological diseases as Perry syndrome can show depressive symptoms and other behavioral changes at the beginning, developing the rest of the symptoms (parkinsonism, weight loss or central hypoventilation) several years after the onset of the symptoms. It must be taken into account in patients with a family history of mutations or atypical depressive symptoms. It should also be assessed in terms of genetic counseling.

None Declared