Nonsuicidal self-injury (NSSI) is a self-damaging behavior with typical onset in early adolescence, and shows greater prevalence in females. NSSI is defined by recurrent episodes of intentional self-inflicted damage to body tissue, without suicidal intent. These recurring self-inflicted injuries are done by the indivuduel to relief oneself from negative feelings, to resolve interpersonal difficulties, or to induce positive feelings.

NSSI in DSM-5. has been included among the conditions in need of further study.

NSSI can be interpreted as a maladaptive coping mechanism that can be regarded as an emotional dysregulation. Adverse childhood experiences including physical abuse, neglect or sexual abuse are the strongest predictors of the NSSI. Research has repetitively found strong associations between NSSI and identity diffusion and/or distorted personality traits.

The aim of our study was to assess the association between childhood traumatization, personality characteristics including stages of identity development, and self-injurious behavior among female adolescents that experience difficulties with emotional regulation.

We compared our results to a Hungarian normative sample. The sample consisted of inpatients adolescents, age between 14 and 18, with a diagnosis consisting of „Emotional disorders with onset specific for childhood” or „Mixed disorders of conduct and emotions” with chronic nonsuicidal self-injurious behavior.

Childhood traumatization was measured with the short version of Childhood Trauma Questionnaire (H-CTQ-SF). Identity development and identity diffusion were measured with the Assessment of Identity Development in Adolescence Questionnaire (AIDA). Temperament and character factors were measured with the Junior Temperament and Character Inventory (JTCI).

Adolescent patients with NSSI reported severe and multiplex childhood traumatization. These patients scored higher on novelty seeking and harm avoidance and scored lower on the persistence, self-directedness, and cooperativeness factors in the JTCI. These results were compared with the Hungarien normative sample. Adolescents scored higher on the Discontinuity and Incoherence scales of the AIDA.

Our preliminary results suggest that childhood traumatization predicts self-injurious behavior in adolescent females. Additionally, we have found associations between signs indicative of personality disorder, including lower level of self-cohesion, self-integration and self-directedness.

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The multifamily group that has been underway since April 2019 in Alcobendas, Madrid is described. A group that serves people diagnosed with mental disorder and their families, with the aim of improving their health and quality of life. It is about facilitating and improving the basic communication of relational aspects and healthy bonds. It is intended to offer a space where you can think together about the experiences lived in your own family with the rest of the group

Assess the evolution and improvement of the patient and family members with the Score 15 questionnaire, The Score is a way of giving users a voice about the therapy process, not about the contents of their problems, but about their perception of the effectiveness of therapeutic work and for professionals it is an opportunity to obtain important feedback from their work.

Using the Score !5 questionnaire on all participants in the group at time zero and after 12 sessions

Improvement in the family description items, and in the quantitative improvement in scoring of the following questions: What degree of severity would indicate? Do you think therapy will be helpful/has it been helpful to you?

Family therapy in the modality of Multifamily Groups provides an improvement in intrafamily communication, its links and therefore in the rest of social communication, facilitating the exit from loneliness and misunderstanding and in turn broadens the understanding and understanding by therapists

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Prolonged grief disorder has recently been added to the Diagnostic and Statistical Manual of Mental Disorders 5, Text Revision. To understand the health burden and then allocate economic and professional resources, it is necessary to provide epidemiological data for this new disorder. More information on the characteristics of people suffering from PGD is also beneficial to better identify individuals at risk.

This study, therefore, aimed to estimate the prevalence of the PGD criteria in a special period such as the Covid-19 pandemic and in a representative population-based sample, evaluate the sociodemographic, and loss-related correlates of PGD caseness and explore possible predictors.

The study included 126 people (97 females/29 males) who lost a relative for any reason during the Covid-19 pandemic period (March 2019-January 2022) in Turkey.We used self-reported data from articipants who all completed questions on socio-demographic and loss-related characteristics plus Hospital Anxiety and Depression Scale (HADS), Prolonged Grief Disorder Scale (PG-13), Multidimensional Scale of Perceived Social Support (MSPSS), Adult Separation Anxiety Questionnaire (ASA-27).

Median age was 34 years, range (18-63); 12 participants were diagnosed with PGD (9.5%). No difference was detected between deaths due to COVID-19 and its complications and deaths due to other causes in terms of PGD diagnosis and PGD symptom severity. When we divide the participants into two groups according to PGD diagnosis (PGD and nonPGD):The average age of the PGD group was higher (Z=-2.068; p=0,31) and they had more additional medical conditions (χ²=7.21; p=0,007). Thoughts of guilt were more common in the PGD group (χ²=7.92; p=0,005). Additionally, HADS-total, HADS -depression, HADS -anxiety and ASA-27 were higher in the PGD group (respectively: Z=-4.047; P=0,00, Z=-4.209; P=0,00, Z=-3.437; P=0,001, Z=-1.975; P=0,048). PGD occurred most frequently after first-degree losses (χ²=13.67; p=0,00) and was inversely proportional to the age of the loss (Z=-1.979; P=0,04). In the nonPGD group, the rate of believing in any religion (χ²=5.807; p=0,016). and the level of fulfilling the requirements of the religion were higher ( χ²=10.584; p=0,05). In the linear regression analysis examining the predictors associated with the severity of prolonged grief; the deceased person was a first-degree relative (t= 6.23; p<0,001) and younger in age (t=-3.71; p<0,001), the presence of guilt (t= 3.28; p=0,001), and increased separation anxiety (t= 4.13; p<0,001) and depression scores (t= 4.29; p<0,001) were significant boost of prolonged grief severity.

Although higher PGD rates were expected in deaths due to Covid-19 compared to deaths due to other causes, we did not detect any significant difference in this study. However, this study identified some possible predictors associated with PGD.

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Lack of adherence to pharmacological treatment is considered a multifactorial phenomenon, remarkably frequent in clinical practice. Non-adherence is associated with increased number of relapses, poor clinical and functional outcomes, and worsening of patient health status, with a resulting increase in healthcare costs, particularly in people with severe mental disorders (SMD). Treatment adherence rates remain extremely low, highlighting the need to develop innovative and integrated strategies; one of these is represented by the promotion of healthy lifestyle behaviours, including regular physical activity.

The aim of this study is to assess how the rates of treatment adherence vary in patients with SMD after receiving a psychosocial intervention, focusing on the positive relationship between treatment adherence and physical activity.

LIFESTYLE is a randomized controlled trial comparing the efficacy of a structured psychosocial lifestyle intervention involving moderate physical activity exercises over a brief psychoeducational intervention. Levels of physical activity was assessed thorough the IPAQ scale, while treatment adherence was evaluated by the Morisky Medication Adherence Scale (MMAS).

The sample includes 401 patients, with a mean duration of illness was 16.3 (±17.8) years. All patients were receiving a pharmacological drug treatment; in particular, 59.6% (N=239) were treated with a second-generation antipsychotic and 54.9% (N=220) with a mood stabilizer. Our results show that moderate physical activity improves rates of treatment adherence. After 6 months, adherence to treatment increased from 35.8% at baseline to 47.6% at baseline in the experimental group, along with improvement in clinical health parameters (reduction in BMI, weight, and metabolic parameters). Another significant inverse correlation was found between adherence and quality of life (Rho di Person: -.140, p<.005). Furthermore, this study indicates that having a diagnosis of major depression, a better cognitive functioning, a shorter duration of illness and contact time with the local mental health centre are factors that positively influence treatment adherence. Remarkably, treatment adherence was not influenced by symptom severity and type of pharmacological treatment.

Moderate physical activity can represent a valid strategy to increase treatment adherence in patients with SMD. Therefore, promoting physical activity exercises in our clinical practice may be associated with better outcomes. However, further studies that evaluate patients with acute mental disorders are needed.

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Many foster children experience traumatic events that result in a wide range of disruptive behaviours, such as temper tantrums, superficially charming, no sincere remorse, and so forth. These problematic behaviours are challenging to the implementation of holistic therapeutic interventions.

The purpose of the current study is to explore the effectiveness of employing Child-Parent Relationship Therapy (CPRT) on externalised behaviours of a traumatised child at home and in social interactions.

This study used a case study to explore the influence of CPRT on externalised behaviours of traumatised foster children. The case study focused on the externalised problematic behaviours of an Australian Aboriginal child fostered under long-term care at 18 months by a Caucasian family. The foster parent and the foster child received a 10-session structured CPRT across ten weeks. The child’s externalised behaviours were evaluated through the Child Behaviour Checklist (CBCL) form.

The findings describe the process of a 10-session structured CPRT with a foster child who exhibits externalised disruptive behaviours because of abandonment and complex trauma. The themes in the foster parent’s role and the play therapy approach relate to traumatic events and attachment issues. The results indicated a slight reduction in these behaviours. According to the follow-up interview, the child still showed aggressive behaviours in social interactions but not at home. Interviews with the foster parent indicated both the parent and child require additional support and further sessions of CPRT.

This case study identified an improvement in externalised behaviours for foster children with experience of complex trauma and abandonment after a 10-session CPRT. Further research is required to explore the effectiveness of a longer-term session of CPRT alongside additional support services for foster parents.

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Treatment-resistant schizophrenia (TRS) is one of the most pressing issues in the field of treatment and research of psychotic disorders. The pronounced decline in social and professional functioning in this group of patients as well as high costs of therapy determine high interest in TRS. This is a part of an ongoing study on the clinical and biological features of TRS.

The aim of this study is to identify the leading symptoms in patients with TRS.

Using the Personal and Social Performance Scale (PSP), Positive and Negative Syndrome Scale (PANSS) and Calgary Depression Scale for schizophrenia (CDSS), 30 male patients (age 28.99 ± 8.08 years) diagnosed with paranoid schizophrenia (F20.0) were examined. All patients had persistent productive symptoms and met the criteria for TRS. The average daily doses of antipsychotics in chlorpromazine equivalent were 1382.07 ± 897.15 mg/day. The average age of onset of the disease was 19.52 ± 5.97 years, the average disease was 9.47 ± 7.61 years.

The average scores were: on the PSP scale: 46.05 ± 9.17, on the CDSS scale 8.10 ± 4.53, on the PANSS positive symptoms subscale - 21.52 ± 4.24, on the PANSS negative symptoms subscale - 24.67 ± 4.42, on the general psychopathology subscale PANSS – 45.62 ± 6.11 . Positive symptoms were represented mainly by delusions (P1, 4.14 ± 0.85 points) and hallucinations (P3, 4.10 ± 1.76 points). Blunted affect (N1, 4.29 ± 0.56 points) and emotional withdrawal (N2, 3.67 ± 0.73 points) predominated among negative symptoms, while the least prominent negative symptom was poor rapport (N3, 3.24 ± 0.94). The most pronounced general psychopathology symptoms were depression (G6, 4.00 ± 1.10 ) and lack of judgment and insight (G12, 4.05 ± 0.92). The total score on the PANSS was 91.81 ± 12.40.

The CDSS score indicates a high incidence of depressive symptoms in patients with TRS. A low PSP score reflects poor social functioning. The most common symptoms according to the PANSS are delusions, hallucinations, blunted affect, emotional withdrawal, depression and lack of judgment and insight.

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Individuals with co-occurring mental and physical health issues have worse health outcomes in both domains. Integration improves outcomes and aligns with patient preference, but health services tend to be siloed. The Mental Health in Medicine Clinic (MHiM) supports patients receiving inpatient or outpatient medical or surgical care at a tertiary academic hospital in Toronto, Canada. The predominantly virtual clinic has an interdisciplinary team offering services via stepped care, matching patient need with service intensity. Measurement-based care (MBC), the systematic evaluation of patient reported outcomes, was not initially used routinely in the clinic, but its implementation may improve treatment decision-making and may be useful in allocating patients within a stepped care model.

1) To describe the stepped care model, referral patterns, diagnoses, and level of care provided since implementation of stepped care. 2) To conduct a quality improvement initiative to implement MBC in the clinic, with a goal of 50% of patients completing at the time of first assessment and prior to discharge from the clinic.

We reviewed the electronic medical record for referral source, diagnoses, and level of stepped care within the clinic. We conducted semi-structured interviews with stakeholders (clinicians, administrative staff, patients) to explore barriers to implementation of MBC. Interviews were analyzed for themes around barriers and facilitators to MBC. Plan, Do, Study, Act cycles were carried out around change concepts informed by stakeholder interviews and relevant literature.

The MHiM clinic began operations in August 2020. The clinic operated on a physician-only model until March 2022 and then shifted to a stepped care model with an interdisciplinary team. The most frequent referral sources were internal medicine, COVID19 clinics, consultation-liaison psychiatry, red blood cell disorders clinic and cardiology. Since the implementation of stepped care, 250 referrals were assessed. 58% of new referrals were assessed by the psychiatrist, 42% were managed by the NP, and 25% consulted with the social worker. Referrals consisted of trauma and stress-related disorders (32%), depression (21%) or anxiety disorders (20%). Personality, substance use, and psychotic disorders accounted for less than 10% of referrals combined. Some patients did not have any diagnosis (6%). Results from the quality improvement initiative to implement MBC will also be presented.

The MHiM clinic provides an integrated care pathway addressing comorbid mental and physical health conditions. We describe a novel stepped care model and the implementation of MBC. Future directions include ongoing quality improvement of MBC and its integration within the clinic to assess and re-assess service intensity.

None Declared

According to World Health Organisation (WHO), Extremely Low Frequency Electro-Magnetic Fields (ELF-EMF) include frequencies ranging from 0 to 300 Hz. They are widespread in our daily life and in the workplace. These fields have an impact on physical and mental health including depression and anxiety.

To assess the impact of chronic occupational exposure to ELF-EMF on Depression, Anxiety and Stress among workers in the Tunisian Electricity and GasCompany of Sousse, Tunisia.

In this cross-sectionalstudy, participants were enrolled into two groups: an “exposed group” including workers in a power plant and an “unexposed group” including administrative workers belonging to the same company. The Exposure to ELF EMFs was assessed by spot measurements using a portable magnetometer. Depression,Anxiety and Stress were assessed by the the Depression,Anxiety and Stress Scale(DASS-21).

This study included 77 exposed subjects and 88 unexposed subjects. The median age was 37 years for the exposed group and 43,5 years for the unexposed ones. Almost half of the exposed group were technicians and had a work experience of 9 years. The median value of EMF was 5,86 uT in the power plant[Min 0,1 Max 40,34 ut].The interpretation of DASS-21 showed that 24.7% of the exposed group and 3.4% of the unexposed group had depression (p<10-3). Anxiety was reported by, 23.4% of the exposed group and by none of the unexposed group. Stress was observed among 46.8% of the exposed group and by none of the unexposed group. After multivariate analysis, ELF-EMF exposure was significantly associated only with depression (p<10-3 ; OR=1,45 [1,17-1,81]) ).

Chronic occupational exposure to ELF-EMF increases the risk ofDepression, anxiety and Stress. Underlying mechanisms are not established yet suggesting the need of further studies.

None Declared

Emergency psychiatric care, unplanned hospital admissions, and inpatient health care are the costliest forms of mental health care. According to Statistics Canada (2018), almost 18% (5.3 million) of Canadians reported needing mental health support. However, just above half of this figure (56.2%) have reported their needs were fully met. To further expand capacity and access to mental health care in the province, Nova Scotia Health has launched a novel mental health initiative, the Rapid Access, and Stabilization Program (RASP).

This study evaluates the effectiveness and impact of the RASP on high-cost health services utilization (e.g. ED visits, mobile crisis visits, and inpatient treatments) and related costs. It also assesses healthcare partners’ (e.g. healthcare providers, policymakers, community leaders) perceptions and patient experiences and satisfaction with the program and identifies sociodemographic characteristics, psychological conditions, recovery, well-being, and risk measures in the assisted population.

This is a hypothesis-driven program evaluation study that employs a mixed methods approach. A within-subject comparison will examine health services utilization data from patients attending RASP, one year before and one year after their psychiatry assessment at the program. A controlled between-subject comparison will use historical data from a control population will examine whether possible changes in high-cost health services utilization are associated with the intervention (RASP). The primary analysis involves extracting secondary data from provincial information systems, electronic medical records, and regular self-reported clinical assessments. Additionally, a qualitative sub-study will examine patient experience and satisfaction, and examine health care partners’ impressions.

The results for the primary, secondary, and qualitative outcome measures to be available within 6 months of study completion. We expect that RASP evaluation findings will demonstrate a minimum 10% reduction in high-cost health services utilization and corresponding 10% cost savings, and also a reduction in the wait times for patient consultations with psychiatrists to less than 30 calendar days. In addition, we anticipate that patients, healthcare providers, and healthcare partners would express high levels of satisfaction with the new service.

This study will demonstrate the results of the Mental Health and Addictions Program (MHAP) efforts to provide stepped-care, particularly community-based support, to individuals with mental illnesses. Results will provide new insights into a novel community-based approach to mental health service delivery and contribute to knowledge on how to implement mental health programs across varying contexts.

None Declared

Cannabinoid Hyperemesis Syndrome (CHS) is distinguished by a pathognomonic cyclic pattern of hyperemesis characterized by recurring episodes of severe vomiting every few weeks to months, as well as obsessive thoughts and compulsive behavior, such as a proclivity to take frequent hot baths or showers. It is largely accepted as the most commonly used illicit drug in the United States, with estimates ranging from 42% to 46% lifetime consumption. Despite greater awareness of CHS, practitioners continue to lack comprehension, resulting in an unfortunate delay in patient identification and treatment.

The aim of this article is to bring attention to CHS in order to enable clinicians, and more specifically, addiction medicine specialists and psychiatrists, to diagnose it as quickly as possible and thus avoid unnecessary additional invasive examinations and investigations. This will save the patient’s time, prevent financial burdens and mental health stresses, and increase their overall quality of life.

A thorough screening and data extraction of the relevant articles was conducted using PubMed, Cochrane, and Embase. Databases were used to search for articles on CHS published between January 2021 and September 2023, yielding relevant articles. Keywords used were “hyperemesis”, “cyclical vomiting,” “cannabis” and “cannabinoid”.

We present a case of 20-year-old teens who came to emergency with severe dehydration and vomiting of more than 40 episodes at home. He had multiple admissions for abdominal pain, nausea, and vomiting in the past and was evaluated and diagnosed with gastritis, PUD, and H. pylori infection. A more detailed medical history revealed a frequent use of cannabis over the past few years and symptoms manifestation and worsening is associated with the use of cannabis. After the complete cessation of cannabis, there have been no new symptomatic episodes reported in the patient and the patient is stable clinically.

Cannabinoid Hyperemesis Syndrome (CHS) is a serious health hazard that requires immediate discovery and treatment. Despite the widespread use of cannabis, CHS is often misdiagnosed, resulting in unnecessary medical treatments and complications for patients. Given their special knowledge of linking chronic cannabis use to this syndrome, this case report and literature review highlight the critical role of addiction medicine experts and psychiatrists in quickly detecting and treating CHS. Early detection and treatment, particularly complete cannabis abstinence, are critical in alleviating symptoms, minimizing recurrent hospitalizations, and ultimately improving patients’ overall quality of life.

None Declared

Empathy is an essential skill in the doctor-patient relationship since it contributes to improve aspects of health care and patient satisfaction. Nevertheless, burnout research projects have been developed in recent years.

To examine the predictive capacity that empathy has on burnout syndrome in health professionals.

A non-experimental, cross-sectional design was proposed. The type of study was correlational-descriptive since it was sought out to explore a functional relation through the prognosis of a criterion variable. Sample: 200 (100 female and 100 male).

First, the variance of cognitive and Affective Empathy was dug out in the emotional exhaustation criterion scale. Results accounted for 15% of variability in emotional exhaustation. (Corrected R 2 = .15, F = 17,56, p = 0,00). The best predictor of emotional exhaustation refers to Cognitive Empathy. (B = -.27, p = 0.00). It does not seem that Affective Empathy acts as a predictor variable of Emotional Exhaustation. (Table 1).Table 1

Multiple linear regression analysis considering Emotional Exhaustation as a criterion.

The predictive capacity of Empathy in relation to Depersonalization was estimated (Corrected R 2 = .20, F = 25,4, p = 0.00). Cognitive and affective empathy were included as predictor variables and MBI as a criterion variable (Table 2). On one hand, the best predictor of Depersonalization is the Cognitive Empathy. On the other hand, regarding Affective Empathy, it does not act as a predictor of Depersonalization.Table 2

Multiple linear regression analysis considering Depersonalization as a criterion.

Lastly, the predictive capacity of Empathy in relation to Personal Achievement was figured out. (Corrected R 2 = .19, F = 23,4, p = 0.00). Cognitive Empathy is the best predictor for Personal Fulfillment (Table 3).Table 3

Multiple linear regression analysis considering Personal Fullfilment as a criterion.

It was noticed that through a linear multiple regression analysis, the variable that best explains Emotional Exhaustation is Cognitive Empathy. Those results are replicated for Depersonalization and Personal Fullfilment.

None Declared

• - Introduce the topic of the continuity of psychoses and its relevance in contemporary psychiatry.

• - Present authors as Henry EY, Jim van Os and Germán Berrios as key figures in the discussion on this topic, highlighting Ey, Dr. Jim van Os’s significant contributions to the understanding of the continuum of psychosis, Germán Berrios’s historical and cultural perspectives, and the importance of Bartolomé Llopis’s critical viewpoint. We also review the evolutionary approach about mental disorders as a keypoint in this discussion.

Analyzing and comparing the theses of Jim van Os, Ey, Germán Berrios, and Bartolomé Llopis’s critical perspective. about the continuum of the psychosis and the importance of this neverending question for its use in the clinical practice.

I will present a detailed literature review and a textual analysis of their writings.

• - Provide a brief description of Jim van Os’s theses highlighting his key ideas:

• - Dimensional Approach: promotes a dimensional approach to understanding psychosis, viewing psychotic experiences as continuous variables rather than categorical entities. This challenges the traditional diagnostic system.

• - Psychotic-Like Experiences: His research focuses on “psychotic-like experiences” (PLEs) in non-clinical populations, including mild hallucinations or paranoid thoughts.

• - Transdiagnostic Perspective: His work contributes to a transdiagnostic perspective, suggesting flexibility in diagnostic boundaries in psychiatry.

• - Next, introduce Germán Berrios’s theses on the same topic, emphasizing his historical and cultural perspectives and recognition of individual variability.

• - Finally, introduce Bartolomé Llopis’s critical perspective:

• - Llopis criticizes simplistic models of psychosis, arguing that they fail to capture the complexity of individual experiences.

• - He advocates for comprehensive assessments that consider not only symptomatology but also the unique contexts and histories of individuals.

• - While Ramón y Cajal is best known for his contributions to neuroscience and neuroanatomy, he did not directly apply Darwinian principles to his work in those fields. However He believed that an understanding of the evolutionary history of the brain and nervous system could provide valuable insights into their structure and function.

• - Highlight the potential for a more comprehensive and holistic approach to understanding and addressing psychotic experiences within an evolutionary context.

• - The relationship between the continuum of psychosis and evolutionism is a complex and multifaceted topic. It involves exploring how the concept of the continuum of psychosis, which suggests that psychotic experiences exist on a spectrum in the general population, may relate to evolutionary theories and perspectives on mental health. We will explain some key points to consider about this and the main psychiatrists whicha dealt with this question.

None Declared

In Colombia the traditional treatment model implies the needing of a total cessation of consume to be able to acces an impatientand long stance rehabilitation program. However, literature in other countries expériences had sugested and used a harm reduction program with an otpatien rehabilitation program.

As this programs are more cost-effective and enables the patient to continue his daily life, perpetuate his life style, keep and enhance the psychosocial network, an outpatient comprehensive multimodular program was designed to adapt to a health promotion company (EPS for its spanish acronym) and has been used since 2017.

• - share the expérience aquired in an undeveloped country of latin America

• - The tipification in the main substance consumption in the development group as well as it’s differentiation in gender and age group

Expérience and results

• - The majority of patients are men over women

• - the predominant age group is between 29-59 years old

• - there is a difference between the age group depending on the substance of impact

The experience have shown that up to 30% of the population treated have gotten to a controlled consumption or the total suspension without the needing of an impatient program In général thé patient have shown motivation and adherence to an outpatient program

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Clozapine is a second-generation atypical antipsychotic medication used in patients with treatment-refractory schizophrenia. Its use is limited due to its associated adverse effects, including myocarditis. These adverse effects may have variable presentations, such as myocarditis transient or persistent, and a generalized inflammatory process. Thus, clinical monitoring to inform accurate diagnosis is essential to avoid unnecessary discontinuation of clozapine, leading to psychiatric decompensation.

To review clinical features of clozapine induced Myocarditis and accurately identify signs and symptoms attributed to be most specific for myocarditis and determine at what stage clozapine should be discontinued.

We conducted a literature review on PubMed, MeSH, google scholar and Mount Sinai’s Levy Library using keywords, clozapine, drug related side effects, adverse reaction, myocarditis, treatment resistant schizophrenia. Review of two cases series was done.

A review of 15 articles that addressed the cardiac complications of clozapine was performed. This review provides a base on variable clinical characteristics and outcomes of clozapine –induced Myocarditis. It showed patients who had myocarditis ruled out, demonstrated high prevalence of systemic signs of inflammation such as fever, malaise, tachycardia and elevated c-reactive protein. However, despite clozapine maintenance in most, this systemic response subsided without any intervention. A nonspecific inflammatory response is common when initiating clozapine, this inflammatory “clozapine storm’ occurs within the first month of initiation and is not necessarily predictive of myocarditis. These patients were monitored closely. Those confirmed with clozapine- induced myocarditis using echocardiography and cardiac magnetic resonance imaging were managed with dose reduction, laboratory monitoring, vital signs check, with early initiation of beta-blockers without discontinuation of clozapine, with improvement in their laboratory results and vital signs. Those with progressive clinical signs of myocarditis required immediate cessation of clozapine.

We are proposing a critical need for a multidisciplinary team of psychiatrists, cardiologists and pharmacists collaborating to prevent premature termination of clozapine in cases of treatment-refractory schizophrenia. Our cases showed middle aged patients with treatment - refractory schizophrenia, presenting with symptoms suggestive of clozapine induced- myocarditis, few weeks after initiation. Clozapine was continued with close monitoring, as symptoms resolved. Though clozapine is associated with myocarditis, with proper knowledge on guidelines for monitoring patients, it can mitigate unnecessary discontinuation of clozapine in those patients.

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Ecological studies have suggested the protective effect of micro-dose lithium in drinking water against suicide, however, the association between body lithium level and suicide is unknown.

We aimed to compare body lithium levels between suicide and non-suicide fatalities.

This cross-sectional study included 12 suicides and 16 non-suicides who were examined or dissected at the Tokyo Medical Examiner’s Office from March 2018 to June 2021. The aqueous humor lithium concentration was measured twice using inductively coupled plasma mass spectrometry. Analysis of covariance (ANCOVA) was used to compare the lithium concentration between suicides and non-suicides. Mixed-effects model was conducted to account for all lithium concentration data.

The aqueous humor lithium concentration did not change after death (t(7)=-0.70, SE=0.03, 95% CI=[-0.09, 0.05], P=0.51, Cohen’s d=0.01). The aqueous humor lithium concentration was lower in suicides (mean 0.50 μg/L (variance s2 0.04)) than in non-suicides (mean 0.92 μg/L (s2 0.07)) (t(26)=4.47, SE=0.09, 95% CI=[0.22 to 0.61], P<0.001, Cohen’s d=1.71). The ANCOVA showed that death by suicide was significantly associated with lower lithium concentration (F(1, 24)=8.57, P=0.007), and the effect size was large (ηp2=0.26). The random intercept model showed a significant effect of suicide on aqueous humor lithium concentration (b=-0.261, SE=0.102, 95% CI=[-0.471 to -0.051], t(24)=-2.568, P=0.017).

The results of this study demonstrate that even micro-dose lithium is associated with suicide death. Clinical studies are warranted to examine the effects of micro-dose lithium on suicide prevention.

None Declared

Eating disorders (ED) negatively affect physical, mental, and social well-being. The exact psychopathology of ED is still unknown, with research suggesting the interplay of a combination of factors.

The aim of our study was to estimate the prevalence of ED in the Tunisian general population, and to identify associated risk factors.

We conducted a cross-sectional, descriptive and analytical study among Facebook group members, using an online questionnaire, over the period from February 17, 2023 to May 26, 2023. All respondents over the age of 18 were included in the study. All participants filled a socio-demographic questionnaire. The Eating Attitudes Test (EAT-26) was used to screen for those at risk of eating disorders.

A total of 528 responses were included in the study.33.3±11.95 years. The subjects were unmarried in 63.4% of cases, of low socio-economic level in 19.5%, with a university education in 75.2% and with a regular occupation in 56.1% of cases.

The mean EAT-26 score was 12.36±10.34. according to this scale, 12.3% of our population were at high risk of developing an ED.

In a multivariate analysis, the female gender (p = 0.006), the low economic status (p = 0.012), a psychiatric comorbidity (p < 0.001), and physical activity (p= 0,037) were strongly associated with ED.

This study highlighted the magnitude of the risk of disordered eating attitudes in the Tunisian population and the need for programs to prevent and control these disorders.

None Declared

Complementary and alternative therapy, especially yoga, is emerging as an important treatment modality for various complex disorders. Yoga therapy has reportedly been demonstrated to exhibit clinical benefits in schizophrenia. However, the modulatory effects of yoga therapy on the pathobiological pathways of schizophrenia are inadequately explored. Immune dysregulation is a widely recognized etiopathological construct of schizophrenia. It is not precisely known whether yoga therapy can modulate the expression of immune molecules by regulating gene expression and epigenetic processes in schizophrenia.

To understand the impact of 12-weeks add-on yoga therapy on the immune-inflammatory pathway in schizophrenia by examining plasma levels and gene expression levels of cytokines and complement proteins as well as by profiling promoter DNA methylation pattern of genes coding for cytokines and complement proteins.

Fifty-seven schizophrenia patients fulfilling DSM-V criteria were recruited into the study and randomized into Yoga therapy (n=28) and waitlist control (n=29) groups. Plasma levels of IL-1β, IL-6, IL-10, IL-17, C1q, C2, C3, C4, C5, C5a, Factor B and Factor H by Multiplex Suspension Assay, quantification of gene expression of Il1b, Il6, Il10, IL17, C3, C4 and C5 genes by quantitative PCR and promoter DNA methylation of Il1b, Il6, Il10, Il17, C3, C4 and C5 genes by pyrosequencing were carried out in all the study participants.

Plasma levels of IL-1β (Z score= 2.42, p=0.02) dropped significantly and C2 (Z score= 2.24, p=0.03) levels increased after 12-weeks of yoga therapy. The expression of Il1b (Z score=2.45, p=0.01) and Il6 (Z score=2.07, p=0.04) genes were significantly downregulated, while the levels of C4 (Z score=2.23, p=0.03) gene was upregulated in schizophrenia patients of yoga therapy group. Two CpG sites in the promoter region of Il1b (all p≤0.05) and Il6 (all p≤0.05) genes and three CpG sites in the promoter region of C4 (all p<0.05) gene were hypermethylated, while two CpG sites in the gene body of Il6 (all p≤0.05) gene and two CpG sites in the promoter region of Il10 (all p ≤0.05) gene were hypomethylated after 12-weeks of yoga therapy in schizophrenia patients.

Our findings provide important insights into the mode of action of yoga therapy in schizophrenia. This study for the first time reports the epigenetic effects of yoga therapy on immune-inflammatory pathway in schizophrenia.

None Declared

Traumatic life events (TLEs) have been associated with the entire spectrum of psychosis outcomes, including risk and severity of psychotic disorders and psychotic-like experiences (PLEs). In a non-clinical setting, understanding the relationship could help improve prevention services.

The aim of this study is to establish the relationship between TLEs and PLEs.

A cross-sectional study was conducted in a Tunisan business and engineering school from March 2022 to June 2022. Participants completed the Tunisian dialect version of the Prodromal Questionnaire-Brief (PQ-B), a validated self-report instrument designed to evaluate prodromal symptoms. TLEs such as physical, sexual, and emotional abuse, as well as neglect experiences, lived or witnessed have been assessed along with bullying experiences.

The final sample size consisted of 358 participants, with a median age of 22 ± 2.22 years, with a sex ratio (M/F) of 1.41. More than half of the participants (58.6%) reported having experienced TLEs (49% in the preceding 6 months) while 31% had experienced bullying or abuse in school (27.9% in the preceding 6 months). The mean total score of the PQ-B for the study population was 7.27 ± 4.387, 36.3% reached the threshold and were defined as PQ-B-positive subjects. Those with a lifetime history of major life events were more likely to screen positive on the total score PQ-B (p = 0.000), as were those with a lifetime history of bullying or abuse (p = 0.000).

Understanding the factors that interact in the significant association between PLEs and TLEs may provide useful information for prevention programs and the improvement of mental health.

None Declared

The COVID-19 pandemic was originally of a magnitude exceeding that of previous epidemics, placing a heavy burden on healthcare systems in general and healthcare professionals in particular.

To assess the prevalence of depressive and anxiety symptoms among healthcare professionals at Farhat Hached Hospital in Sousse during the COVID-19 pandemic and to identify associated risk factors.

This is a descriptive cross-sectional study conducted among healthcare professionals practicing in the Farhat Hached Hospital of Sousse, which took place during the period extending between August and November 2021. The 9-item Patient Health Questionnaire (PHQ-9), the 7-item Generalized Anxiety Disorder (GAD-7), were used to assess depression and anxiety respectively.

Our study included 326 healthcare professionals from the Farhat Hached University Hospital. The mean age of our population was 36.38 ±10.19 years, with a clear female predominance of 81.3%. The prevalences of depression and anxiety were 46% and 35.3% respectively. Female gender and being a paramedical staff were risk factors for depressive and anxiety symptoms. On the other hand, professional seniority of over 5 years was statistically significantly associated with anxiety. Sporting activity was inversely associated with depressive and anxiety symptoms.

The multi-variate analytical study revealed that the practice of leisure activities other than sport was a protective factor against the occurrence of depressive symptomatology in healthcare professionals, while current smoking and the practice of a sporting activity were inversely associated with the occurrence of anxious symptomatology.

These findings underline the need for specific prevention strategies to reduce these symptoms and help healthcare professionals maintain their mental health. This will help to guarantee the quality and efficiency of work in the medical environment, to better control the pandemic.

None Declared