Affective disorders exhibit diverse clinical manifestations, and one distinctive subtype is delirious mania. Despite its exclusion from formal diagnostic manuals, delirious mania frequently emerges in everyday clinical practice. Recognizing it within the realm of differential diagnosis is crucial. Delirious mania is characterized by acute onset of excitement, grandiosity, emotional lability, delusions, and insomnia typical of mania, combined with disorientation and altered consciousness characteristic of delirium. Some authors consider delirious mania as a variant of classic bipolar disorder, while others associate it with catatonia. Additionally, some link it to underlying medical or neuropsychiatric causes.

To describe the clinical case of a patient with delirious mania and emphasize the importance of recognizing this as a potencial diagnosis in patients with abrupt alterations in mental state.

Clinical case report and literature review.

A 61-year-old female patient with a history of a unique depressive episode over 20 years ago, treated with Carbamazepine up to 750 mg, is admitted to the Emergency Room with acute symptoms consistent in global disorientation, agressive behavior, mutism, bradyphrenic and repetitive incoherent speech, along with visual hallucinations, all of which had developed over a few days. The gradual withdrawal of Tegretol over an 8-month period preceded her admission to the ER.

Relevant medical tests, including cranial CT, EEG, blood tests, and urine analysis, were conducted during her ER stay, all of which yielded normal results. Neurological evaluation ruled out acute neurological pathology, leading to her subsequent admission to the Psychiatry department. Throughout her admission, the patient exhibited irritability and expressed derogatory comments filled with offensive language. She gradually became more expansive, with her thought content becoming megalomaniac in a delirious range. Her speech was incoherent, verbose and had loose associations.

Treatment was reintroduced with Carbamazepine up to 600 mg/day and Olanzapine up to 20 mg/day, resulting in a rapid and comprehensive improvement of her symptoms, ultimately leading to the complete resolution of her condition.

This case highlights the concept of delirious mania, characterized by alterations in attention, orientation, memory, confusion, behavioral and thought fluctuations, and psychomotor disturbances which can manifest abruptly, as observed in this patient. This clinical case underscores the significance of considering delirious mania in the differential diagnosis of patients with abrupt alterations in mental state, particularly those of advanced age with a history of affective episodes. A global understanding of this condition is essential for its timely recognition and appropriate management.

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Post-Traumatic Stress Disorder (PTSD) is a psychiatric disorder that can occur after a traumatic event. It results in mental suffering and physical complications that profoundly alter personal, social, and professional life.

One can develop PTSD after experiencing a frightening event, for example: rape, the death of a loved one, war veterans, or following a car accident. In Morocco, traffic accidents cause, on average, nearly 3,500 deaths and 12,000 serious injuries per year.

Our main purpose is to evaluate the incidence of post-traumatic stress disorder in patients who are victims of traffic accidents and to identify key risk factors in the general population.

This is a descriptive cross-sectional study through a questionnaire shared on social networks including a socio-demographic description, a clinical description, and the “Peri-traumatic Distress Inventory (PDI)” Scale to evaluate the risk of developing PTSD.

This study is based on 48 participants with 82.8% of females and 17.2% of men. The average age was 27.6. Most of the participants lived in urban areas (93%), a majority had higher education (93.1%), and 41.4% of the candidates had a physical impact of the accident.

According to PDI scale, 65% showed PTSD and the average score was 20.3. A score of 15 and above indicates significant distress.

Our results confirm the presence of PTSD in victims of accidents. We propose a clinical reflection on the possible improvement of the care of people suffering from PTSD following a public road accident.

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he present study investigates irritable bowel syndrome in mental health professionals and the characteristics of psychosocial factors that affect this.

The present study selected an irritable bowel syndrome group among 291 mental health professionals based on the Rome III criteria, and investigated demographic variables. The Hospital Anxiety Depression Scale (HADS), Psychosocial Well-being Index (PWI), and Korean Occupational Stress Scale (KOSS) were used to evaluate psychosocial factors. An independent t-test and chi-square test were used to determine differences between the groups, and a logistic regression analysis was used to determine the odds ratio (OR) of IBS based on occupational stress. SPSS 21.0 (IBM Statistical Package for the Social Sciences 21.0) was utilized for all statistics.

Differences in demographic variables based on IBS group were not statistically significant. Depressive symptoms (t = -4.767, p<0.001) and anxiety (t = -4.068, p<0.001) were higher in the IBS group, and psychosocial well-being was lower (t = 2.288, p<0.05). The OR of IBS based on depressive symptoms was 5.737 (95% CI = 2.24–14.69). There were significant differences in occupational stress based on IBS within the subordinate domains of physical environment (t = -3.160, p<0.01), job demand (t = -3.273, p<0.01), interpersonal conflict (t = -2.295, p<0.05), job security (t = -3.005, p<0.01), and lack of reward (t = -2.046, p<0.05). The OR of IBS based on the subordinate domains of occupational stress was 3.708 (95% CI = 1.20-11.41) in physical environment, and 3.759 (95% CI = 1.33-10.56) in job demand.

The results of the present study verify that psychosocial factors in mental health professionals have a close correlation with IBS. Accordingly, improvements in both IBS symptoms and quality of life should occur through proactive intervention in these variables.

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Becoming a psychiatrist, clinical psychologist or psychotherapist involves a complex set of skills that require extensive training. Clinical practice development and professional and personal identity formation are closely intertwined and continue throughout one’s career. Individual and environmental factors influence dropout. The beginning stages of training are incredibly challenging for trainees and can be a time of vulnerability as they face early professional hurdles. We propose that certain educational factors, such as inadequate practical training and insufficient emotional support during professional dilemmas, play a crucial role in manifesting burnout or other symptoms, potentially leading to stagnation in one’s career.

The main objective of our study is to identify causes of disruption and/or discontinuation of the training/residency programs in psychiatry, clinical psychology, and psychotherapy. Our study also aims to highlight the causes of chronic exhaustion among trainees in mental health professions.

The research team has developed a comprehensive questionnaire including two validated psychometric scales, the Effort-Reward Imbalance Questionnaire (ERI, Siegrist et al. Soc Sci Med 2004; 58 1483-99, Salavecz et al. J Men Psychosom 2006; 7 231–246) and the Mental Health Test (MHT, Vargha et al. J Men Psychosom 2020; 21 281–322). A quantitative analysis (Braun et al. Qual. Res. Psychol. 2006; 3 77–101) will be performed on the responses, following which interviews will be conducted with previous volunteers who participated in the study. The interviews will be evaluated through content analysis. Our survey is prepared with the involvement of all significant training centers in Hungary. The study was approved by the United Ethical Review Committee for Research in Psychology (EPKEB, approval numbers: 2021-109, 2023-101).

The participants’ main characteristics and the questionnaires’ results will be summarized with standard statistical methods, while the interviews will be analyzed with the help of qualitative methods.

Based on the results of the described study, we aim to investigate the educational system’s impact on the career development and commitment of psychiatrists, psychologists, and psychotherapists in Hungary. Additionally, the research will yield valuable perspectives on how these factors affect the mental well-being of these professionals. Ultimately, the results could help address areas of concern and improve mental health professionals’ training.

* Presenting author

** The two authors contributed equally.

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While the acoustic environment in the cities correlates with various health-related problems, health benefits of natural sounds are proven. These positive effects of the sounds of nature should probably be taken seriously in urban design and urban renewal projects.

The aim of this study was to review the paradigm of natural soundscapes in the cities, psychological effects of natural soundscapes and the potential urban recommendations for such architecture design.

We conducted a comprehensive review of the scientific literature using Web databases with the following keywords: natural soundscapes, natural sound, urban design, and mental health.

Our research found that improving the urban environment soundscape for the well-being of city dwellers has become one of the most pressing challenges of modern times. In a growing number of published studies, positive psychological effects of natural soundscapes are explored using various methods such as questionnaires, biofeedback sensors coupled with virtual reality experiences in laboratories, and quantification of the prevalence of restorative acoustic environments in parks. In a recent study (2023), Jian Kang from the United Kingdome, reported that “by taking psycho-acoustical, neural and physiological, and contextual factors into account, the European Research Council Soundscape Indices project will adequately reflect levels of human comfort, to integrate side-by-side with (and eventually replace) decibel-based metrics into existing (international) regulations”. The same paper highlighted how the transition from fighting noise pollution to creating soundscapes is key.

Architects should develop mandatory guidelines regarding the spatial planning focusing on managing natural soundscapes in cities. Various sites such as green urban public spaces that offers exposure to natural sounds should be an integral part of the urban environment. These areas must be with a high abundance of natural sound (geophony and bio phony) and a low anthropogenic sound to enhance human physical and psychological health.

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Several authors have demonstrated the relevance of the therapist sensitivity to the affective expression of his client (Merten & Schwab, 2005; 150-158), as well as to his own emotional experience (Haynal-Raymond et al., 2005;142-148) in order to build a more effective therapeutic relationship, and results. An important source of information to decode the emotional expression hints is the face, and its expression (Ekman & Friesen, 1975; Russel & Fernández-Dolls, 1997;275-294). Despite common sense saying that context is relevant to understand the meaning of the emotional facial expression, the literature review shows inconsistent results.

The main goal of this study was to evaluate the impact of clinical context over the perception of the emotional facial expression.

This study followed a within-subjects design, and its sample consisted of 60 clinical psychologists. 21 combinations of prototypical expression images with mixed emotional signals, and clinical information texts were presented to the participants. Then their judgement on the type of emotion displayed was requested. The presentation of the text-image pairs was randomized between three conditions: consistent, and non-consistent, and neutral.

The results suggest that emotions are more easily recognized in the presence of a concordant context than a non-concordant or neutral one, and that the greater the similarity between the facial expression of the image presented and the face prototypically associated with the context, the greater the influence of the context.

However, In the recognition of mixed emotional signs, there was greater recognition of signs of anger in the facial expression, as a non-dominant emotion, when in the presence of the neutral story than of the story that agreed with the dominant emotion (sadness). There was also greater recognition of sadness, as a non-dominant emotion, in the presence of a story in agreement with fear than in the presence of a neutral story. There was also a statistically significant increase in the attribution of anger to images in which it is not present and whose dominant emotion is fear, when associated with a context of aggression vs. a neutral context.

It was also found that there was a significant decrease in the attribution of fear to the sadness-anger image (25%-75%) in the presence of the aggression context compared to the neutral and panic contexts.There was also a statistically significant decrease in the attribution of sadness to an image of fear in the neutral context compared to the other contexts (panic and aggression).

In conclusion, our study have shown an impact of context over overvaluation or the undervaluation of the emotional facial expression as well as either with prototypical expressions or the mixed emotional signals when referring to sadness, fear, and anger. Thus, mental health clinicians should consider the influence of these contexts.

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Stupor is a state of numbness of almost all personality functions, accompanied by stiffness, lethargy and abulia (lethargy). A person in a state of stupor is recognized by the fact that he is constantly silent, does not respond to stimuli at all, refuses food, has a motionless body posture, a face immobile like a mask, a gloomy and absent look. We can call a person who is in a stupor only by calling loudly, shaking hard and similar charms. Catatonic stupor is a state of complete loss of spontaneous and active movement, the patient stands stiffly for hours, sits, does not take food, does not speak but registers everything that is happening around him because his consciousness is not clouded.

Here, we report on the case of a 32 year-old man. He was brought in the Emergency Center by his mother with the eyes shut and unresponsive to all sorts of verbal and gestural attempts to elicit any kind of response, with extreme complete body rigidity. He was sweating.

Over several weaks, he developed gradually social withdrowal, motoric stereotypies, loss of apetite, body stiffness. Three days before he was admited to the hospital he stopped eating, drinking water, he was developed body rigidity.

Case report

He was admitted to a Psychiatric Clinic and first days he was treated with 7,5 mg of lorazepam daily, kariprazin tbl. a 3mg in the morning and olanzapine 10 mg in the evening. Over several days symptoms has diminished.

The patient was reacted very well on the therapy and after several days syptoms diminished. After a month he was released from the hospital. He is in good remission for over a year. He comes regularly for outpatient check-ups

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Cannabinoid hyperemesis syndrome (CHS) is an underrecognized condition characterized by acute episodes of intractable nausea and vomiting, colic abdominal pain and restlessness related to chronic cannabis use. Antiemetics commonly fail to alleviate the severe nausea and vomiting. A very particular finding is the symptomatic relief with hot water. Antipsychotics (such as haloperidol), benzodiazepines and/or capsaicin cream appear to be the most efficacious in the treatment of this unique disorder. Precisely, it has been studied that transient relief of symptoms with topic capsaicin or hot water share the same pathophysiology. Nevertheless, abstinence from cannabis remains the most effective way of mitigating morbidity associated with CHS.

The objective is to study this phenomenom in our hospital and to alert of its existence in order to avoid a suspected misdiagnosis and overdiagnosis.

We report a case series of seven patients who attended the Emergency Room (ER) of a third level hospital located in Cantabria (Spain) where a psychiatric evaluation was demanded.

The reasons for consultation were agitation and/or compulsive vomit provocation and showers. They were all women, with a median age of 29 years (range 21 to 38), who all smoked cannabis and in probable high doses (seven to up to twenty joints per day, information was missing in three of the patients) and probable long duration of consumption (more than nine years up to twenty-three, information was missing in three of the patients).

One of the most striking findings is the time to diagnosis, being the median of years of more than eight (range from two to twenty-one). In all of the cases there is a hyperfrequentation to the ER for this reason (not counting other emergency centres we have in Cantabria which we don´t have access to), being the average of almost twenty-two times (thirteen up to thirty times), not diagnosing it until last visits. Another interesting fact is that Psychiatric evaluation is done approximately in a third of the visits, being the department that makes all of the diagnosis except in one case. In all of the cases there are a lot of diagnostic orientation doubts from different medical departments, being the two most common psychiatric misdiagnosis: Other Specified Anxiety Disorder and Other Specified Feeding or Eating Disorder. Two of the patients were hospitalized in an acute psychiatric unit for this reason, one of them nine times and the other patient, twice.

CHS has a very particular presentation which makes its recognition very simple. From our experience, it is an unknown entity for most of the doctors, something that needs to change in order to make a correct therapeutic management. Larger studies need to be done to make this findings more solid and for further information.

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Beaumont Hospital is the National Neurosurgical Centre in Ireland. Due to the high numbers of referrals from Neurology and Neurosurgery, The Department of Psychiatry established a specialist Neuropsychiatry inpatient Liaison service and a weekly Neuropsychiatry outpatient clinic. Many of the referrals that the service receive involve the management of delirium. Delirium is a common medical complication, particularly in neurosurgical settings. Delirium causes significant symptom burden which can lead to distress to all involved and impacts quality of life.

The aim was to improve the rates of referrals for delirium presentations and referral rates overall from Neurology and Neurosurgery. The neuropsychiatry service have implemented a delirium protocol for all medical and surgical teams in Beaumont Hospital. This protocol can be accessed through the Beaumont hospital phone app, or on site on each ward. For this reason, delirium can be managed by medical teams in the first instance. If this is not successful, neuropsychiatry can be contacted for further advice or review of patients with more complicated presentations.

The neuropsychiatry service receives referrals through the Patient Information Profile Explorer system which is accessed through the Beaumont Hospital online portal. In the event of an urgent referral, neurology or neurosurgery teams can contact the neuropsychiatry service directly by phone. Referrals are logged on the team referral log book, and details of the referral are recorded along with diagnosis and management. Data was collected retrospectively from the PIPE and log book to measure the rates and reasons for referrals over a one year period. Rates and details of referrals were initially recorded between July-December 2022. An educational intervention was provided where psychoeducation was provided to junior hospital doctors during protected teaching times and further education was provided over the phone when referrals were discussed between team members. Rates and details of referrals were then recorded between January-July 2023.

There was a reduction in referrals when comparing the two six month periods. There were 115 neuropsychiatry referrals from July to December 2022 and 78 referrals from January to July 2023. Rates of delirium referrals also reduced from 31% to 25% after psychoeducation was provided to junior doctors.

This audit highlights the importance of communication and education for medical and surgical trainees in the management of delirium. There is a high rate of turnover of junior doctors throughout the year in Beaumont Hospital. For this reason, it is imperative that continued education is provided to allow them to follow the delirium protocol independently before seeking tertiary service assistance. Ultimately, early and rapid intervention of delirium can have a positive impact on patient care and prognosis

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Depression is a widespread problem that affects individuals of all ages. This study looks at the use of omega-3 polyunsaturated fatty acids (PUFAs) as an additional therapy for depression in people of different ages. Depression has an impact on everyone, from youth to the elderly, causing therapeutic concerns such as treatment resistance and recurrence. Omega-3 PUFAs, which may be found in fish and flaxseed, are important because of their impact on neurochemistry, inflammation, and neuroprotection. While pharmacotherapy, including antidepressants, has proven beneficial for many, the likelihood of remission and recurrence remains substantial. In recent years, there has been a growing interest in the potential role of omega-3 polyunsaturated fatty acids (n-3 PUFAs) in mitigating depressive symptoms. The primary constituents of n-3 PUFAs are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Understanding the potential of omega-3 PUFAs across the lifespan can help address the multifaceted challenges posed by depression and improve mental health outcomes for diverse age groups.

This review aims to assess the role of omega-3 fatty acids in depression treatment across different age groups: children and adolescents, adults (18–60), and the elderly (60+). It investigates the effectiveness and potential differences in omega-3 supplementation among these age cohorts.

A comprehensive literature search was conducted from 2003 to 2023 using PubMed, Google Scholar, and EMBASE, using specific keywords. Studies with inadequate age group information or Omega-3 intervention were excluded.

In children and adolescents, several studies indicate a positive association between omega-3 supplementation and improved depressive symptoms. In adults, results are mixed, with some studies showing benefits while others do not. In the elderly, omega-3 PUFAs appear to have a more consistent positive effect on depression. In contrast, a consistent positive association was observed in the geriatric population, suggesting that Omega-3 PUFAs may hold particular promise in the treatment of depression among older adults. However, variations in methodology, dosage, and study populations contribute to these mixed findings.

Omega-3 PUFAs show promise as an adjunct therapy for depression across different age groups. Further research with standardized methodologies and larger sample sizes is needed to clarify their role and establish optimal dosage guidelines. Omega-3 PUFAs should be considered as a potential complement to conventional depression treatments, emphasizing the need for personalized approaches in depression management.

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Predicting acute affective episodes in individuals with Bipolar Disorder (BD) remains a clinical challenge. Specific environmental stressors, including air pollution, noise, and temperature variations might worsen affective symptoms or sleep in the general population, but their role in BD relapses is often overlooked. Indeed, they might exacerbate BD by perturbing circadian rhythms – fundamental aspects of BD.

We thereby present the protocol of this pilot study and future preliminary data. We aim to longitudinally assess sleep alterations, mood fluctuations, and environmental exposure to several factors (air pollutants, climate, noise, artificial light-at-night, green space access) in patients with BD and to check the association of these variables with BD relapses.

In this pilot study, we will recruit 40 patients with BD in a 6-month prospective study. Patients were assessed during baseline, at 3 and 6 months. Data recollected will consist of a subjective (questionnaires) and objective (through meteorological stations) evaluation of physical environmental factors around the home residence; clinical assessment of mood and circadian rhythms, and continuous tracking of sleep-wake patterns, energy, and movement using actigraphy.

Expected results will show that exposure to a worse environment (higher pollution, noise, light exposure, climate) will be associated with worse BD outcomes (i.e., relapse, mood symptoms, sleep alterations).

We will be sharing preliminary data from our ongoing study, offering insights into early patterns and findings that shed light on our objectives.

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Crisis resolution teams (CRTs) are a crucial component of mental health care, providing timely support to individuals experiencing acute mental health crises. This abstract delves into the concept of crisis and seeks to identify the patients who stand to benefit from these specialized services.

Defining crisis within the context of CRTs can be complex. It encompasses not only immediate emergencies but also broader mental health distress.

Research suggests that suitable candidates for CRT interventions are those facing acute mental health crises : This includes individuals experiencing suicidal ideation, severe agitation, or severe emotional distress.

La “Escala de Evaluación de Resolución de Crisis” (Crisis Resolution Team Assessment Tool, CRTAT) de Sonia Johnson es una herramienta diseñada para para medir la efectividad de los CRT y la duración de la intervención en crisis. Establece un límite de seis semanas como el período máximo durante el cual se debe ofrecer la atención en crisis.

Existen otras escalas de evaluación para medir la eficacia de la resolución de crisis:

1. 1. Escala de Intensidad de Crisis (CIS): se utiliza para medir la gravedad de la crisis y la necesidad de intervención inmediata.

2. 2. Escala de Evaluación de Crisis de Brage Hansen (BCES): se enfoca en la evaluación de crisis suicidas y evalúa la intensidad de la ideación suicida y la urgencia de la intervención.

3. 3. Escala de Evaluación de Crisis de Eriksson (ECAS): Diseñada para evaluar la intensidad de la crisis en pacientes psiquiátricos, la ECAS se centra en la agitación, la ansiedad y la angustia emocional.

- Studies have explored the effectiveness of CRTs and the perspectives of service users. Understanding how patients perceive crisis and CRT services is crucial for tailoring interventions effectively.

- CRTs play a vital role in mental health care, offering timely support to individuals experiencing crises. While defining crisis is complex, suitable candidates often include those in acute distress requiring immediate intervention. Understanding the perspectives of service users and the diverse nature of crisis experiences informs effective crisis resolution strategies.

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Children, who are particularly vulnerable in emergency situations, need tailored mental health strategies.

We investigated the impact of the COVID-19 pandemic on anger and life satisfaction in children.

September 2021, we conducted a cross-sectional study in Preveza, Greece, interviewing 91 students aged 10-12 years from four elementary schools. The survey included socio-demographic questions, the Anger Expression Scale for Children (AESC), and the Satisfaction with Life Scale (SWLS). AESC scores range from 6 to 30 indicating anger severity, while SWLS scores between 5-9 signify extreme dissatisfaction and 31-35 extreme satisfaction.

Significant correlations were found between the number of siblings (p 0.004), duration of electronic play (p 0.005), and duration of sleep (p 0.014) with life satisfaction. Children without siblings, with limited play consumption, and early bedtimes had lower life satisfaction. The presence of a television in their room (p 0.027) and daily use of television and social media (p 0.007) correlated with anger management and behavior. Social media/TV use was associated with better anger management.

Despite the pandemic lasting almost two years, children’s anger levels in Preveza remained stable, possibly due to outdoor activities and online interactions. These findings provide insights for policy makers, healthcare professionals, and parents seeking to improve anger management of children.

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The shortage of medical professionals is becoming a nearly unsurmountable burden worldwide. Increasing uncertainties in the external environment require enhanced capacity for predicting future outcomes from the young adult population of medical students.

To find the level of resilience, the domains of psychological well-being and the symptoms of distress; and to identify associations between them in a cohort of medical students.

Data were collected in the 2022-23 academic year among Hungarian and English medical students at Semmelweis University. An online questionnaire was circulated via the official academic administration system (Neptun) with the incentive to provide personal results with available resources for those who requested it. Besides age and gender, we applied the short form of the Nicholson McBride Resilience Questionnaire (NMRQ), Ryff’s Psychological Well-being Scales (PWB), and the Depression, Anxiety and Stress Scale (DASS). Additional to descriptive statistics, univariate analyses as well as multiple regression analyses (SPSS v.24) were used. (Ethics permission No: BM/5326-2/2023).

Altogether 318 students (132 Hungarians) filled the questionnaire, and 251 students requested personal answers. 114 males participated with a mean age slightly higher than that of females (24 (SD:4) ys vs 23 (SD:3) ys). Hungarians (H) demonstrated lower resilience (Mdn:37, IQR:32, 42) then international (I) students (Mdn: 41, IQR: 36, 47), U=15287, p<0.001. Both H and I students showed similar patterns on PWB, scoring highest on personal growth, purpose in life and positive relations with others; while reaching lowest scores on environmental mastery, and lower scores on autonomy and self-acceptance. However, they demonstrated differences in each of the domains (see table).

Higher prevalence of symptoms of depression, anxiety and stress were found in I students. Multiple regression analyses resulted in statistically significant models for both H (F(11, 121)=19.6; p<0.001; R2=0.641) and I students (F(12, 143)=8.98; p<0.001; R2=0.430) indicating that EM (t=4.7; p<0.001), PL (t=--3.2; p=0.002), SA (t=4.2; p<0.001), A (t=2.9; p=0.005), and anxiety (t-4.06; p<0.001) significantly predicted the strength of resilience in H, while autonomy (t=4.9; p<0.001) proved to be significant predictor in case of I students.

These single-centre results need to be further clarified on national and international level to stimulate interventions for strengthening resilience through establishing a caring network by universities for the fragile population of medical students.

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Suicide is a global public health issue. According to the latest available data from the National Institute of Statistics, 4,003 people died by suicide in 2021, reaching a new historical high. Approximately 90% of suicide victims suffer from one or more severe psychiatric disorders, and there is a documented 20-fold higher risk of suicide in individuals with affective disorders compared to healthy subjects (Abdelnaim et al., 2020). Repetitive transcranial magnetic stimulation (rTMS) has been established as an effective alternative or complementary treatment option for patients with depressive disorders, but little is known about its effects on suicide risk.

To assess the efficacy of rTMS in reducing depressive symptoms in patients with suicidal ideation and behaviors.

Population and Methods: A retrospective analysis was conducted on a sample of 28 psychiatric patients (23 females; mean age 49.36 ± 16.23) with suicidal ideation identified by item 3 (suicidality) of the Hamilton Depression Rating Scale (HDRS), who were treated with rTMS. All patients received a minimum of 30 sessions, consisting of the application of a high-frequency (>10Hz) or intermittent theta burst stimulation (TBS) over the left dorsolateral prefrontal cortex (DLPFC) at an intensity of 120% of the resting motor threshold (RMT), and repeated low-frequency pulses (1Hz) or continuous TBS over the right DLPFC with an intensity of 110% of the RMT.

Results: The results show a statistically significant improvement in depressive symptoms following rTMS intervention (p < 0.001). Furthermore, remission was observed in 46% of the sample (HDRS < 8).

Discussion: In line with recent studies (Abdelnaim et al., 2020; Hines et al., 2022) and systematic reviews (Cui et al., 2022; Bozzay et al., 2020) on suicidal ideation in the context of psychiatric disorders, the findings of this study demonstrated that rTMS achieved satisfactory results in reducing depressive symptoms and suicidal ideation.

Conclusions: This clinical study indicates preliminary promise for the prevention of suicidal acts and underscores the need for more detailed and specific research on rTMS in the field of suicide.

Keywords: rTMS, neuromodulation, depression, suicide.

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To our knowledge there is no study exploring the interrelationship between nomophobia, phubbing and social phobia in Portuguese young adults and adults.

To explore the nomophobia, phubbing and social phobia levels, the interrelationship between these three constructs, in a sample of Portuguese young adults and adults.

316 subjects, with a mean age of 25.71 years old (SD = 8.231; range 18 - 59) fulfilled a sociodemographic questionnaire, and the Portuguese validations of the Nomophobia Questionnaire, the Phubbing Scale and the Social Interaction and Performance Anxiety and Avoidance Scale.

All the subjects presented nomophobia (100%, n = 316), with 62% (n = 196) presenting a moderate risk level and 22% (n = 69) an higher risk level. The mean of the ‘total phubbing score’ was of 21.50 (DP = 5.50) and ‘smartphone obsession’ was the phubbing subscale with an higher score (X = 12.81, DP = 3.50). The mean of the total nomophobia was of 80.0 (DP = 22.83) and ‘not being able to communicate’ was the nomophobia subescale with an higher score (X = 24.75, DP = 9.95).Considering social phobia scale, the mean of the ‘anxiety/distress’ subscale was of 95.36 (DP = 25.14) and of the ‘avoidance subscale’ was of 89.56 (DP = 25.53). Almost 22% (n = 69) of the subjects presented ‘social anxiety’ and 24% (n = 76) presented ‘social avoidance’, suggesting probable social phobia cases (higher than the proposed cut-off scores). Positive and significant correlations were found between all the nomophobia and phubbing subscales (ranging from .30** to .61**). Positive and significantly correlations, mostly with low magnitude, were found between nomophobia and social phobia subscales (ranging from .03** to .22**), except for ‘social avoidance’ subescale, which correlation was negative (-.021*). Females presented higher levels of nomophobia (Md = 176.28) and phubbing (Md = 167.22) than males (Md =124.73, U = 7301.500, p <.001;Md = 141.93), U = 9475.500, p= .019, respectively). Total social phobia scores and nomophobia (not being able to access information and giving up convenience subescales) were significantly higher in young adults.

Nomophobia, phubbing and social phobia are significantly intercorrelated. Future longitudinal studies are needed to clarify nomophobia and phubbing etiology. The level of nomophobia (100%) found in this sample is specially worrying.

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Children with non-syndromic orofacial clefts are at higher risk for developmental difficulties. Speech and language as commonly affected developmental domains in these children.

The aim of the current study was to explore the effects of early interventions for speech and language on later cognitive outcomes in this patient population.

A combined retrospective/prospective-comparative study was carried out at the Department of Pediatrics of the University of Pécs in Hungary. The participants were children between 6 and 16 years of age. The study consisted of a self-designed demographic questionnaire and an IQ test (WISC-IV).

A total of 41 children with non-syndromic orofacial clefts and 44 age-matched controls participated in the study. Children of the cleft group were examined by pedagogical professional services and required special education plans significantly more often than controls (p<0.001 and p=0.02, respectively). Participants of the cleft group who received early speech and language therapy score higher on the Verbal Comprehension Index (p=.005). Full-Scale IQ score was also higher for cleft participants who received therapy, however not significant but borderline (p=0.08).

Early language and speech interventions for children with non-syndromic orofacial clefts may have a positive effect on verbal skills and overall cognitive development. Future longitudinal studies examining baseline cognitive functioning of infants are needed to provide more conclusive evidence on the effects of interventional programs on speech and language development in cleft patients.

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Simulation-based training (Sim) is an established method of teaching in medical education and can help bridge the gap between medical theory and clinical practice. While sim is well-established in medical and surgical specialties, it is less well developed in psychiatry. Psychiatric emergencies often occur out of hours when there are fewer senior staff available on-site. Sim offers a safe setting for development of essential clinical skills with carefully delivered feedback.

Sim can be high-cost involving specialized simulation facilities, especially when utilising high-fidelity equipment. Even lower-fidelity techniques requiring standardized patients (SPs) require funding for actors and this can be a barrier to utilising Sim.

We piloted a Sim course to NCHDs working in psychiatry in a tertiary university hospital with the aim of improving trainee skills and confidence in managing psychiatric emergencies on-call including risk assessment, involuntary admission and acute behavioural disturbance. A low-fidelity approach was taken with minimal use of SPs.

A sim handbook developed by Irish Centre for Applied Patient Safety and Simulation (ICAPSS) was used for reference in developing the simulation modules. Three modules were delivered in a structured manner over three hours; involuntary admission, risk assessment and management of acute behavioural disturbance. Each module involved the simulation exercise (20 minutes) followed by debrief (20 minutes). The facilitated debrief involved open discussion and prompted reflective learning. Anonymous, paper-based questionnaires were used to collect feedback on participants’ experience of the training.

There were 12 attendees and ten participants completed the feedback. All participants (100%, n=10) agreed or strongly agreed that sim helped them to learn and all agreed that the topics covered were relevant to their clinical role. All participants (100%, n=10), indicated that they enjoyed the workshop. Eighty percent (n=8) agreed or strongly agreed that they would like to do more sim-based workshops. The supportive environment and debrief sessions were reported as the most enjoyable aspects of the workshop.

Participants unanimously agreed that the training was useful to them in their clinical roles and helped them to learn. Sim was effective in teaching high risk complex psychiatric cases to psychiatry NCHDs and consideration should be given to expand this teaching method within postgraduate psychiatry training in Ireland.

None Declared

Depressive disorder is a common public health problem that significantly impairs quality of life and has a high risk of mortality and morbidity.

The aim of this study was to investigate circadian rhythm differences, stressful life events and coping styles in patients with depression.

The study involved 100 participants, including 50 patients with depression and 50 healthy controls, recruited from the psychiatric clinic of one-university hospital. The participants completed a sociodemographic information form, Beck Depression Inventory (BDI), Life Events Checklist (LEC-5), Coping Inventory for Stressful Situations-Short Form (CISS-21) and Morningness-Eveningness Questionnaire (MEQ).

The mean age of the patients with depression was 31.88±10.6 years, and the control group was 29.84±8.02 years. There were no significant relationships between the variables including gender and some other sociodemographic characteristics except education level. There were significant differences between the depression and control groups in terms of coping styles for stressful life events. Emotional coping was significantly higher in patients with depression compared to the control group, whereas task-oriented coping was significantly lower than the control group (p<0.05). The majority of both depression and the control group consisted of intermediate type. Natural disasters, severe suffering, and other stressful events or experiences were more frequent stressful life events in the depression group. Task-oriented coping scores and emotional coping scores showed significant discrimination with sensitivity and specificity values.

Recognizing stressful life events and the coping strategies used to deal with them is important for identifying future mental problems such as depression and developing treatment and follow-up plans. Longitudinal studies are needed to fully understand how the reporting of mature and dissociative coping methods interacts with depression in recovery from traumatic events.

None Declared