The quantification of suicidal risk in specific populations is important for the adoption of prevention and risk reduction measures. This risk remains very high in patients with eating disorders compared to the general population.

The present study evaluates the prevalence of suicide among patients with eating disorders all seeking different suicidal risk factors in these patients.

A retrospective study of medical records of all patients with eating disorders, diagnosed according to DSM 5 criteria, at Arrazi hospital of Salé for the past 14 years, by assessing the prevalence of suicide attempts and care.

In our work, all patients are female, 17 years old on average, 18 patients out of 20 have anorexia nervosa, 4 of them have had bouts of bulimia, and only one patient was admitted for management of bulimia nervosa alone. The mean age of onset was 15 years with addictive comorbidity in 5 patients.

Thirteen patients had comorbid depressive disorder, one patient was schizophrenic and six patients had borderline personality disorder.

12 patients have made suicide attempts, planned especially in a depressive environment.

Preventive management of suicidal risk must be taken in order to improve the prognosis in this category of patients.

No significant relationships.

Body image dissatisfaction as negative evaluation of personal physical characteristics is often associated with low self-esteem, eating and affective disorders. What body regulation practices can people resort to when they are dissatisfied with their body image?

The goal is to determine body image practices that help people to reduce tension caused by dissatisfaction with their body image.

We obtained the data by using a focus group technique. The group comprised 43 healthy undergraduate university students of both genders. Afterwards, the data were subject to analysis and systematization.

The findings revealed 11 variants that represent the spectrum of body regulation practices, which semantically can form three groups. The first group combines adaptive regulation practices that help people successfully adapt to actual life situation, develop their capabilities concerning their physiology, personality, intellectual interests, and image making. The second group combines compensatory regulation practices that mainly focus on one of the sides of body regulation, which bear a certain threat to their health (weight control, building up muscle bulk, medical cosmetology procedures, body modification). The third group includes non-adaptive body regulation practices associated with high risk to their health and personal wellbeing (auto-aggressive, hetero-aggressive, and psychopathological).

Information about preferable body regulation practices used by people who are dissatisfied with their body image can help predict health hazards and disorders, as well as work out targeted prevention programs.

No significant relationships.

A distorted body image appears to be a significant factor predisposing an individual to developing anorexia nervosa and its maintaining. Anorexia nervosa presents with the highest mortality rate among all mental disorders.

The aim of the research work was to assess the distorted body image in women diagnosed with anorexia nervosa, as well as to analyse the impact of the severity of the symptomatology of eating disorders, level of depression and anxiety on the distorted body image.

A total of 105 people participated in the study. The clinical group consisted of 36 women diagnosed with anorexia nervosa, while the group of healthy women consisted of 69 participants. Patients completed several psychological and clinical measures such as: EAT-26, BSQ-34, BIDQ, BDD-YBOCS, CDRS, CESDR, and STAI.

Between group comparisons were performed using nonparametric the Mann-Whitney U test. Results revealed statistically significantly greater distorted body image perception in anorexia group. Women diagnosed with anorexia nervosa showed significantly higher levels both depression and anxiety compared to the healthy controls. Based on correlation analyses, it was shown that there are statistically significant relationships between the body image variable and eating disorders, depression, and anxiety (state and trait).

To deepen the problem of distorted body image, further research is required on etiopathogenesis and dynamics of body image in relation to body mass index and illness chronicity.

No significant relationships.

Despite the huge effect eating disorders (Eds) have on the lives of sufferers and their families there has been little research on the effect an ED has on siblings even though their lives are repeatedly significantly affected by the situation. It is important to gain more insight into the experiences and needs of siblings as the nature and magnitude of the effect of patients EDs on non-affected siblings is mixed in the current research.

To conduct a systematic review allowing an extensive search of the current literature to identify where the current research is lacking. Also, to highlight the need for a greater focus on the effect of EDs on siblings both in research and clinical practice.

A systematic review is being conducted to gain an understanding of the gaps in the literature.

It is expected that the systematic review will reveal a lack of literature regarding siblings’ experiences of having a brother or sister with an ED. As well as showing the conflicting emotions felt by the siblings, both positive due to the love they feel for their sibling and negative due to the burden they feel.

By raising awareness of the needs of non-affected siblings this research should have a notable impact on their experiences by highlighting the need for specific interventions and support services as well as education about their siblings’ ED.

No significant relationships.

There is a well-established body of investigations showing that the experience of shame is associated with eating disorders symptoms. Meta-analytical data indicate that body shame is one type of shame that seems to be especially relevant in case of eating disorders. While there are many studies which investigated the association between the predisposition to feel ashamed about one’s body and eating disturbance, there are virtually no inquires on how momentary body shame is related to disturbed eating behaviors.

In this study we aimed to investigate the relationship between momentary body shame and disturbed eating behaviors using an intensive longitudinal design.

Females with high levels of eating disorders symptoms completed five, randomly-initiated surveys per day delivered via a smartphone application for a total of two weeks. The survey evaluated the level of body shame and disturbed eating behaviors (i.e., binge eating, purging, excessive exercises, body checking).

Preliminary results indicate that higher levels of body shame are associated with higher levels of disturbed eating behaviors. The level of body shame was higher in binge eating days compared with non-binge eating days.

Fluctuations in body shame seem to contribute to the maintenance of disturbed eating behaviors. Implications and limitations of these findings are discussed.

No significant relationships.

Anorexia nervosa is an eating behavior disorder that is often related to various personality factors. The relationship between obsessive compulsive disorder and eating Disorders has been highlighted.

To present a clinical case of a patient with eating disorder and gastric bezoar, secondary to compulsive hair ingestion.

Bibliographic review of articles published in relation to the comorbidity of these disorders, based on articles published in the last 5 years in Pubmed.

26-year-old female. Diagnosis of restrictive anorexia nervosa. She was admitted to the hospital on two occasions for nutritional disorders. In the last admission, she reported greater anxiety and significant weight loss. She reports that she has limited her food intake, but she does feel thin and is unable to eat for fear of gaining weight. Ruminative thoughts about her body image. During admission, the patient expressed a sensation of fullness, nausea and vomiting, later observing in abdominal X-ray and gastroscopy, the presence of a gastric trichobezoar, which was finally resolved conservatively.

Trichotillomania is observerd in 1 in 2000 people, trichophagia is even less frequent. According to DSM- V, these disorders are grouped within obsessive-compulsive spectrum disorders. A Trichobezoar is a conglomerate that can be found in the stomach or intestine, composed mainly of hair, previously ingested. Trichotillomania can be associated with anorexia nervosa, especially in patients with obsessive personality traits, which occurs frequently. The gastric slowing that patients with anorexia often present is a factor that favors the formation of the bezoar

No significant relationships.

Anorexia nervosa (AN) is an eating behavior disorder characterized by intense fear of gaining weight or persistent behavior that interferes with weight gain, with caloric intake restriction and secondary loss of body weight. It can affect up to 4% of women during their lifetime and is responsible for one of the highest mortality rates from psychiatric disorders.

Review of the literature and exposure of a case report of AN in a woman with high level of stress at work.

Case report and nonsystematic review using databases such as PubMed and UpToDate.

Caucasian woman, 31-year-old, PhD in biology, who works in a multinational company. No personal or family history of psychiatric disorder. She was observed in the psychiatry emergency department, due to low weight, caloric restriction and intense physical exercise, maladaptive personality traits related to perfectionism and control were found. She began follow-up with a multidisciplinary team, but there was a need for hospitalization due to clinical deterioration with BMI of 11. After 6 months, she continued to follow up at the consultations and, despite refusing psychotropic drugs, she maintains psychotherapy and presents clinical improvement (BMI - 17).

Eating behavior disorders are chronic and difficult to treat diseases that are more frequent among people subject to high levels of stress. This case represents a restrictive AN in a woman with multiple risk factors: athlete, perfectionist, with stressful work and life events and restricted interpersonal and affective relationships.

No significant relationships.

Eating disorders (ED) and gender dysphoria (GD) are associated with a change in body perception. Therefore, body dissatisfaction plays a common and central role in these disorders. In GD, body image concerns are related to the features of the biological sex. In ED, body dissatisfaction comes from a distorted perception of weight and body shape and plays an important role in the development and maintenance of the psychopathology.

To present and discuss the clinical case of a patient with a previous diagnosis of GD who presented with a clinical condition suggesting a restrictive anorexia nervosa (AN).

Patient´s clinical files consultation and literature review using Pubmed and the keywords: eating disorders and gender dysphoria.

We present the case of a 25-year-old patient who was living in a shelter for victims of domestic violence and was admitted for severe restrictive AN. The patient was discharged after 40 days and medicated with sertraline, diazepam and olanzapine, as well as her previous medication (hormonal therapy): cyproterone, finasteride, estradiol, oxybutynin.

Although studies on this subject are still scarce, there has been some progress and the literature recognizes the coexistence of these conditions. However ED symptoms in patients with GD could have a different meaning: they may represent a dysfunctional coping strategy adopted to block features of the biological sex. Therefore health professionals may take a more holistic approach to body image. Additional studies will be necessary, allowing the establishment of cause-consequence interactions between weight loss and psychopathology related to GD.

No significant relationships.

Concerns about health and fitness during lockdown may serve as a trigger for eating disorders in vulnerable individuals. Other risk factors may also include increased use of social networks and comparison with beauty ideals. Isolation, loneliness and problems with emotional regulation may lead people to reduce food intake by giving them a greater sense of control.

Emphasise the relevance of the increase in the incidence of Eating Disorders (ED) cases during the pandemic.

Review of the scientific literature based on a relevant clinical case.

14-year-old female, residing with her mother. She reports that from the beginning of COVID-19 confinement she became obsessed with leading a healthier life, starting to restrict food, limiting fats and carbohydrates, and having also started compulsive physical activity (approximately 4 hours of aerobic exercise per day), without associated purging behaviours. She also acknowledges eating small amounts (although she minimises this aspect) and controlling all calories, stating that food and practices aimed at “staying healthy” now dominate her life. Her previous BMI was 18, with a current BMI of 11.7.

Patients suffering from ED, who often have poor knowledge of their illness and find social-emotional communication difficult, may delay seeking help. Studies suggest the relevance of identifying specific vulnerability factors among ED patients in confinement in order to develop preventive strategies and personalised treatment approaches.

No significant relationships.

Eating disorders and borderline personality disorder can coexist with high frequency in people with alexithymia. At the same time, it has been described that alexithymia can be present in patients suffering from depression, anxiety, obsessive-compulsive disorders, PTSD and eating disorders, among others. In this sense, it has been described that alexithymia could help maintain eating disorder.

To review the existing literature on the relationship between alexithymia, emotional instability and a family history of autism spectrum traits with the development of eating disorders. To expose, through the clinical case of a patient with eating disorders, the diagnostic complexity and evolution after the beginning of a comprehensive and multidisciplinary therapeutic plan with different mental health devices.

To review the personal and family psychopathological aspects and the clinical evolution of a patient with a diagnosis of restrictive subtype anorexia nervosa since its inclusion in a therapeutic program.

This is a longitudinal study through personal biographical reconstruction and family history and subsequent follow-up of a clinical case based on the implementation of an individualized therapeutic program and the results obtained.

Currently there is evidence in the literature that finds a high correlation between alexithymia and eating disorders. However, these findings are believed to be influenced by other comorbid symptoms such as depression or anxiety. Furthermore, the diagnosis of ASD in people with AN is a complex process that requires a thorough clinical evaluation over time. Detailed studies are needed to determine the importance of these factors in the development of an eating disorder.

No significant relationships.

The extent to which social media contributes to body image dissatisfaction and lower self-esteem is currently under debate

This research seeks to study the relationship between the use of Instagram (one of the main platforms used by young people nowadays) and the degree of dissatisfaction with body image and the level of self-esteem among their younger users

A sample of 585 Spanish adults between 18 and 40 years old was used, to whom the Body Shape Questionnaire (BSQ), the Rosenberg Self-esteem Scale and the Social Comparison of Appearance Scale (PACS) were applied.

A positive correlation was observed between the frequency of use of the social network and dissatisfaction with body image and low self-esteem. In addition, it was found that content observation time significantly predicts body dissatisfaction and low self-esteem. On the other hand, the type of content both published and observed, showed no effect on any of these variables, although it has been found that the relationship between the use of the platform and the study variables seems to be mediated by the tendency of their users to compare their appearance with others.

These results invite us to reflect on the use of social networks and their impact on constructs as relevant to the person as self-esteem and body image and on how different policies should be taken into account to prevent a negative impact on the mental health of their users

No significant relationships.

Obesity is a multiorgan disorder that is caused by eating a much larger overeating that the body needs to live. Obese people tend to eat a lot and after hours, and it is hypothetised that it exists a relationship between increased impulsivity and obesity. In addition these patients tend to have more psychopathology,

The aim of the study is to observe if obese people ingest impulsively and if there are differences between the sexes regarding impulsivity. Also it will be studied the relationship between impulsivity in these patients and other psychosocial factors, anxiety and depression symptoms and personality traits.

It was carried out an assessment of impulsivity in 30 obese population followed at the outpatient Endocrinology that attended pre-bariatric surgery groups.Patients were handed the Plutchik impulsivity questionnaire, Hospital Anxiety and Depression Scale (HADS) and The Temperament and Character Inventory (TCI).

In our sample, 43.4% of the obese patients did not show high levels of impulsivity, while 56.6% did show markedly impulsive traits. No differences in impulsivity between sexes were found. No other significant relationships with addititional psychological factors were found.

A larger sample is needed to reach a conclusion and to extrapolate the results to the general population. People with morbid obesity have higher impulsivity and a binge eating;in addition they have more psychopathology, mainly affective, greater impulsivity and greater severity on scales that assess the core symptoms of disordered eating behavior and body dissatisfaction.

No significant relationships.

The psychopathological causes that advise against a bariatric surgical procedure include any state that puts at risk the modification of habits and beliefs regarding eating behavior, wich condition weight loss and health improvement.

To Study the psychiatric profile of patients rejected for bariatric surgery at the Complejo Hospitalario Asistencial de León (León, Spain).

Retrospective observational study. All patients for whom bariatric surgery procedure has been contraindicated for psychopathological reasons are included. 145 patients were evaluated in the context of the protocol for bariatric surgery. The following diagnostic scales were used as support: Salamanca Questionnaire, Plutchik Impulsivity Scale, Attitudes towards change in patients with eating disorders (ACTA), Bulimia Investigatory Test Edinburgh e, and European Quality of Life-5 Dimensions.

41 Patients were rejected for psychiatric reasons (28.28%). The most frequent diagnoses are impulse control disorder (39%), followed by eating disorder (27%). Other diagnoses found are: depressive disorder (10%), adjustment disorder (5%), personality disorders, intellectual disability and generalized anxiety disorder (3%) 78% of them are women.

Uncontrolled psychiatric pathology is a contraindication to bariatric surgery. Impulse control disorder and eating disorder are related to overweight and obesity, so a diagnosis and treatment are necessary prior planning surgical procedure. Psychopathological variables determine the success of bariatric surgery procedures and it is mandatory to consider them in the process.

No significant relationships.

General Lockdown was first declared in Tunisia from March 20th to May 4th 2020 to contain the spread of COVID19 pandemic, the last sanitary lockdown period was declared from July 12th to august 1st in 2021. Psychiatric emergency access and consultation has been affected by the confinement. RAZI Hospital Emergency Department (RHED) is the only emergency department in Tunisia specialized in psychiatry. Thus making it the most representative psychiatric emergency health care service in Tunisia.

To assess changes in patients flow and admission rates in RHED in the context of the COVID-19 lockdown

We examined emergency room records and the hospital’s computer admission database during the first and the last COVID19 lockdowns and compared it to the same period of the previous year.

The number of consultations was significantly lower in 2020 lockdown (N = 577) compared the same period in 2019 (N = 1525) (p<10−3). We observed a drop in RHED emergency hospitalization rate from 45.57% to 29.81% during this study period. The number of consultations per day was significantly lower during the first lockdown (N= 12.44) compared to the last lockdown (N=26.61) (p<10−3), the hospitalization rate rose from 29.81% during the first lockdown to 44.36% during the last.

Fear of COVID19 contamination and lockdown limitation had a huge impact on RHED visits and admissions. Medical team had to adjust in order to prevent further delay in acute psychiatric care.

No significant relationships.

Aggressive behavior is frequently associated with acute psychiatric admission. Several studies highlight the increased risk of aggression in certain psychiatric disorders.

The aim of the study was to explore the extent of aggressive behavior, its various manifestations, and its association with gender, age, and diagnosis among patients admitted to an acute psychiatric ward.

Patients admitted to our acute psychiatric ward in a three months period were included and the Dynamic Appraisal of Situational Aggression - Inpatient Version (DASA-IV) questionnaire was administered in the first seven days after admission for all patients.

A total of 290 patients, 153 men and 137 women, with a mean age of 46.9 years (SD=17.5) participated in the study. Men were overrepresented among patients who showed aggressive behavior (p=.008). There was no correlation between age and DASA-IV score (p=.259). 40% of patients (N=116) did not show aggression, while 60% (N=174) experienced some form of aggression. Of those who exhibited some form of aggressive behavior, 94% had only low, 4% had high, and 2% had extremely high levels of aggression. Aggression was most common in patients with intellectual disabilities, dementia, and bipolar disorder.

According to our findings the majority of the acutely admitted psychiatric patients shows no or only low level of aggression. There were also differences in the forms and extent of aggressive behavior between the diagnostic groups. Risk assessment is important because it provides an opportunity for early detection and prevention, and the development of personalized treatment plans.

No significant relationships.

Only three population-based observational human studies provided evidence that benzodiazepines (BZD) are associated with clinically adverse respiratory outcome. Striking was the finding that BZD drug exposure was associated with a 32% significantly increased adjusted risk of all-cause mortality, including, of note, the subgroup of individuals with no comorbidities. Causation, however, cannot be inferred in observational study design and, highly likely, recipients received BZD’s in these studies to help treating anxiety related to inter alia pre-existing respiratory symptoms.

Based on one fatal particular case, authors of current rapport explain what can go wrong when BZD’s are given in patient with respiratory impairment.

Authors provide a model on how an increase in carbon dioxide can lead to impaired cerebral autoregulation in a person with pre-existing respiratory decompensation. Discussion of integrative metabolic and vascular physiology.

Case rapport of a 18 y.o. otherwise healthy man, who was hospitalized with a novel episode of diabetic ketoacidosis accompanied by profound hypocapnia and anxiety, and who deteriorated and died shortly after airway management because of a clinically important acid-base balance disturbance caused by increased carbon dioxide. All the blood tests and results of respiratory monitoring were collected and carefully assessed.

Current case suggests that the P(CO(2))--HCO(3) hypothesis is consistent with known data on impaired cerebral autoregulation in diabetic ketoacidosis, driven mainly by increased levels of pCO2. In our opinion, it indicates the recommendation not to administrate BZD’s in patients with pre-existing compensatory hyperventilation as it may counter to the logic of adaptive physiology.

No significant relationships.

Psychiatry emergencies in India is major challenge for emergency service providers due to rapid growth of various behavioural, higher morbidity and mortality rate. Despite, psychiatry conditions are neglected area related to stigma, share, lack of awareness, and superstitious beliefs. There is an urgent need for specialist psychiatric emergency services, which can fill the huge gap between policymakers and health service providers joined together.

Present feasibility study has been undertaken to evaluate the safety and efficacy of combined emergency and Ayurveda medicine management of psychiatric emergencies in community-based settings.

Ayu-Emergency Care project was developed in partnership with policy makers, researchers and health care providers, a collaborative platform of emergency medicine and Ayurveda medicine (Indian Traditional Medicine) for developing whole-system perspective, where providers work in a coordinated and joined-up way. Twenty trained care providers in psychiatry emergency and Ayurveda management worked in partnership with community-based organisation.

Patients with major clinical difficulties, in the acute phase were treated and managed by Ayu-Emergencypractitioners. Severe Agitation and violence relating to substance abuse, anxiety disorder and psychosis were the most common admission diagnoses. 2-weeks results indicate that Ayurveda intervention can reduce anxiety(p<0.01), aggression (p< 0.001) and agitation (p<0.01) significantly with no side effects reported. Intervention found to be clinically beneficial and cost-efficient alternative to out-of-home placements (i.e., Incarceration, psychiatric hospitalisation).

The study’s findings highlight safety, efficacy and feasibility of intervention. Patients both prefer and seem to benefit from community-based ayu-psychiatric care, and early-intervention community program could be a good model for such care.

No significant relationships.

Neuroleptic malignant syndrome (NMS) may be a life-threatening neurologic crisis primarily emerging as an idiosyncratic reaction to antipsychotic agent use, and characterized by a particular clinical syndrome of mental status alter, rigidity, fever and dysautonomia. Mortality results straightforwardly from the dysautonomic manifestations of the disease and from systemic complications.

To describe an unusual clinical case in order to determine the management regarding medication and electroconvulsive therapy (ECT), and provide an overview of NMS for the general practitioner with the most up-to-date information on etiology, workup, and management.

We report a case involving a 55-year-old man with paranoid schizophrenia disorder who presented with hyperthermia, hemodynamic instability, miosis, muscular rigidity, urinary incontinence, catatonic signs and mutism after combining several antipsychotics at the same time: long-acting injectable form of paliperidone, aripiprazol and haloperidol.

Guidelines for specific medical treatments in NMS are based upon case reports and clinical experience. Generally used agents are dantrolene, bromocriptine, and amantadine. A conceivable approach is to start with benzodiazepines along with dantrolene in moderate or severe cases, followed by the addition of bromocriptine or amantadine. ECT is generally reserved for patients not responding to other treatments.

NMS is an uncommon adverse drug reaction, with a multifactor pathophysiology and manifestation. Early diagnosis and interruption of antipsychotic therapy is the first-line treatment, followed by supportive care and pharmacotherapy. ECT is an effective treatment when supportive treatment together with pharmacotherapy fails. It could be considered first line in severe life-threatening situations. It is advisable to consider maintenance ECT due to the high risk of relapse.

No significant relationships.

Mutism is the inability or unwillingness to speak, resulting in an absence or marked paucity of verbal output. Mutism is a common manifestation of psychiatric, neurological, and drug-related illnesses. Psychiatric disorders associated with mutism include schizophrenia, affective disorders, conversion reactions, dissociative states, and dementias. Neurological disorders causing mutism affect the basal ganglia, frontal lobes, or the limbic system.

Outline the importance of setting a differential diagnosis of mutism in the Emergency Room.

Review of scientific literature based on a relevant clinical case.

Male, 58 years old. He has lived in a residence for 3 months due to voluntary refusal to ingest. Diagnosed with paranoid personality disorder. He is refered to the Emergency Service due to sudden mutism. During this day, he has been stable and suitable with a good functionality. For 3 hours he is mutist, oppositional attitude and stiff limbs, refusing to obey simple orders. Hyperalert and hyperproxia. Not staring. After ruling out organic pathology: normal blood tests, negative urine toxins and cranial CT without alterations, he was admitted to Psychiatry for observation and, finally, he was diagnosed with Psychotic Disorder NOS.

Mutism most often occurs in association with other disturbances in behavior, thought processes, affect, or level of consciousness. The most common disorder of behavior occurring with mutism is catatonia. The differential diagnosis of mutism is complex. In some cases the diagnosis will be clarified only by careful observation and after a neurological evaluation. Published studies show neurological disorders presenting with mutism can be misdiagnosed as psychiatric.

No significant relationships.

Haloperidol is a first generation, high potency, low cost and widely used antipsychotic. There are inconsistencies in the literature about comparison of effectiveness between long-acting injectable haloperidol (HDLAI) with oral haloperidol (OH), as well as the combined use of both formulations (HDLAI+OH).

To verify whether HDLAI reduces the number of emergency visits and hospitalizations when compared to oral OH, or in combination therapy HDLAI+OH.

Retrospective observational study on a Psychiatric Emergency department, including patients aged 18 to 60 years, both genders, under continuous treatment for at least 5 months with Haloperidol for any psychiatric illness, divided into 3 groups of patients (HDLAI, OH, HDLAI+OH). Dependent variables: visits and admissions. Independent variables: sex and age. Data were checked for normality (Kolmogorov-Smirnov test) and homoscedasticity (Bartlett test). For comparison of average number of visits and hospitalizations of patients Kruskal-Wallis test followed by Dunn’s multiple comparison test was used. It was considered statistically significant if p < 0.05. This study was approved by the Ethics Committee of Maringá State University.

No statistical difference between groups HDLAI and OH was found. The HDLAI+OH group presented higher means of emergency visits and hospitalizations with statistical significance.

It suggests the use of HDLAI can be considered an alternative as effective as oral intake. Prolonged use of associated HDLAI and oral supplementation leads to worst outcomes.

No significant relationships.