Introduction:

Mental illness-related stigma creates serious barriers to access employment, education, housing, health and social care. There are different types of stigma, one of them is self or internalized stigma. Drug addiction is one of the most discriminated diseases in psychiatry, in many levels – structural, interpersonal and intrapersonal.

Objectives:

With this work we aim to study the internalized stigma and quality of life in the context of Methadone Maintenance Therapy (MMT) in a Portuguese sample.

Methods:

We conduct a survey at Centro de Resposta Integrada Porto Ocidental (Porto, Portugal); it consisted in three parts: 1) sociodemographics; 2) the Interalized Stigma of Mental Illness scale (ISMI); 3) the World Health Organization Quality of Life Instruments – Bref. We ask all the patients on MMT (low and high-risk programmes) to answer the questionnaire. For statistical analysis we use the Excel software and use a regression analysis.

Results:

53 patients participated in our study; the average age was 43 years old and 92% were male. The majority was in a weekly MMT, 74% for more than five years. All the dimensions of the ISMI (social withdrawal, stereotype endorsement, alienation, discrimination experience, stigma resistance) scored low self-stigma (< 2.5 points). The quality of life was on average bad and it was associated with unemployment, without association with internalized stigma.

Conclusions:

In contrast to earlier findings, we found that MMT patients show low self-stigma. There are several possible explanations for these results, such as the Self-Selection bias. Our data thus need to be interpreted with caution.

Introduction:

In recent years, studies have been demonstrating that oxidative stress, neuroinflammation and dysregulation of glutamatergic neurotransmission play an important role in psychoactive substance use disorders (PSUD). Prefrontal - hippocampal - striated cortical circuits, interconnected by glutamatergic signaling, are dysfunctional in mental illnesses that involve vulnerability to substance dependence. Currently, pharmacological treatment options approved for most PSUDs are limited. This is especially true for cocaine and cannabis-related disorders for which there are no drugs approved by the Food and Drug Administration. N-acetylcysteine (NAC), an antioxidant molecule with glutamatergic properties, has been investigated as a therapeutic agent in the treatment of PSUD.

Objectives:

This work aims to bring together a set of theoretical conceptions about the usefulness of NAC in PSUD (cocaine, methamphetamine, alcohol, cannabis and tobacco).

Methods:

Brief literature review, based on research of scientific articles published in PubMed, using as keywords the terms “n-acetylcysteine” and “psychiatry”.

Results:

Studies indicate that chronic exposure to psychoactive substances disrupts glutamate homeostasis, which is the basis of the mechanism of dependence and compulsive use characteristic of PSUD. In recent years, the scientific community has attempted to explore the potential of NAC to treat PSUD. NAC positively regulates the glutamate transporter (GLT-1) that removes excess glutamate from nucleus accumbens and may therefore be effective in promoting abstinence or preventing relapse.

Conclusions:

NAC is a low-cost, multi-target molecule with a favorable adverse effect profile, making it a promising drug in psychiatry. However, large-scale studies are needed to prove the therapeutic benefit of NAC in the treatment of addiction and compulsiveness/impulsivity.

Introduction:

Alcohol use is common among university students. For some, might be part of the “college experience”, for others, a way to cut loose from the daily pressure to have good academic results. Regardless of the motive, those studying in health courses are expected to be more aware of the consequences of alcohol consumption.

Objectives:

We aim to understand if university students, namely those in health-related studies have significant alcoholic habits.

Methods:

Narrative Review of the literature, based on Pubmed search of related papers published from 2009 to 2019.

Results:

Most studies showed the same pattern still visible in the general population: a male prevalence in drinking habits. Perhaps for that reason, the prevalence of smoking and significant alcohol use is low among medical students, which might be due to the high female number of students. More than half of the questioned students had a binge-drinking episode in the 2 previous weeks. The numbers for high-risk consumption (including alcohol dependence) ranged from 5% to 32.4%. The percentage is lower for more modest use: 74.5% for low-risk alcohol consumption and 21% for moderate-risk. The protective factors against alcohol use were catholic religion and living with the family. On the other hand, risk factors for alcohol abuse/dependence are burnout, educational debt, being unmarried, and being younger.

Conclusions:

Even accounting for the discrepancies among studies, the reported rates of alcohol misuse are alarming. These results are of extreme concern, as medical professionals are supposedly more educated on the harmful effects of excessive alcohol consumption.

Introduction:

Montenegro is country with population of 622.471. There are 23 municipalities. Mental health care units are organized as CMHC on the primary level in 18 units call Dom Zdravlja, two psychiatryc hospital, one psychiatryc ward in the hospital and in Psychiatry Clinic in Podgorica. Buprenorphine substitution treatment started in 16 CMHC, and in Psychiatry Cčinic in Podgorica. In the mentioed work the autorsdeal with the result achieved in the sense of the number of patient in the program with the special focus in Podgorica wich as the capital city has the most number of patients involved. We followed the patients who were included in the buprenorphine substitution treatment for a period of 12 months . We suggested to the patients to do a screening test for Hepatitis Cvirus, we also followed the change in dose.

Objectives:

The objectives were to detect and involve in the treatment patients with viral C hepatitis. By working with family members we want to reduce stigma they feel about their member and whole family.

Methods:

We followed pationts durung the period of one year.

Results:

For example in Podgorica 51% of total number of patients who work anlysis are HCV+., 25% are HCV-, but 24% refused to be tested.

Conclusions:

For most adults with opoide use disorder, maintenance therapy with Buprenorphine is effective treatment approach. this sort of treatment is most effective in combination with counseling services , which can include different form of behavioural therapy and self -help program.

Introduction:

Ketamine is a dissociative anesthetic drug which acts on the central nervous system chiefly through antagonism of NMDA receptor. Ketamine is primarily used in clinical settings for analgesia and sedation. The indications include pain and asthma. The delirium and dissociation caused by the use of ketamine has led to recreational abuse and its use in nonconsensual sexual intercourse. Despite these considerations, ketamine has attracted attention as a rapid-acting anti-depressant and as a potential strategy to treat substance addictions.

Objectives:

Evaluate the safety and relevance of using ketamine to treat substance addictions.

Methods:

PubMed database was searched using combinations of the term “ketamine” and the terms “alcoholism”, “cocaine” and “addiction”. Original research articles were included.

Results:

As a candidate drug for psychedelic psychotherapy, ketamine was used for treating alcoholism. In a 10-years research, a prolonged abstinence period and favorable changes on mood and lifestyles were verified on the follow-up. In a two-year follow-up study of heroin addiction, a reduced rate of relapse and marginal anti-craving effects were achieved in patients receiving an intramuscular injection of high-dose ketamine. In patients with cocaine addiction, a single infusion of a sub-anesthetic dose of ketamine enabled the reduction in cue-induced craving.

Conclusions:

Despite the ethical issues, ketamine may have a potential role to treat alcohol use and other drug dependences. However ketamine addictive properties recommend precaution in its use and well-controlled research is needed to evaluate not only its efficacy but also to define proper therapeutic protocols for its use in addictive conditions.

Introduction:

Nowadays, the consequences of alcoholism are usually minimized or devalued because it is a progressive disease and in the early stages it is socially acceptable. In general, society and health professionals deposit in alcoholics’wives task of care and providing emotional support for the alcoholic, especially at the time of his recovery. However, being married to or living with an alcoholic or a problem drinker increases the likelihood of developing substance abuse, emotional, behavioral and psychiatric disorders such as depression, anxiety and somatic complaints.

Objectives:

To present a non-systematic review of the literature on the relationship between alcohol consumption and mental health of alcoholics’wives.

Methods:

A literature search was conducted using the search engine Pubmed® and the keywords alcoholics’wives and mental health.

Results:

Major depressive disorder, dysthymia and anxiety disorders were the most common psychiatry diagnosis, among the female partners of men who drink heavily. In association with these diagnosis, loss of libido, irritant reactions and suicidal ideation were also present in alcoholics’wives. The use of alcohol can be considered a risk factor for the occurrence of domestic violence and consequently the emergence of depression in wives.

Conclusions:

Treatment includes not only appropriate psychotropic drugs but also behavioural couples therapy. Group therapy that provide couples’treatment or counseling to female partners of alcohol dependent men have reported to alleviate the mood, anxiety, stress, general health, and quality‑of‑life problems. Thus, clinicians should recognize these women as a risk group, and their access to medical care should be facilitated.

Introduction:

Craving has been linked to situational and emotional psychological processes (DiFranza et al., 2012) in substance use disorders. Few studies have evaluated the influence of emotional dimensions through affectivity (Watson D, & Clark LA., 1984) on craving (Zuo et al., 2016) and the impact of alexithymia which represents the major disorder of emotional regulation in addiction (Thorberg et al., 2009).

Objectives:

The main objective of this review is to bring together studies on the emotional dynamic of craving by simultaneously considering affects (negative and positive) and alexithymia.

Methods:

A systematic review complying with the PRISMA protocol was conducted, and identified 23 studies targetting craving for addictions with substances.

Results:

As much as 20 of the 23 studies selected show a correlation between affectivity, alexithymia and craving; highlighting 55% of direct links and 48% of partial links. Studies on negative affects (78%) put forth their causal link in the triggering of craving, while studies on positive affectivity (26%) present it as a moderating element in the intensity of craving. Finally, studies on alexithymia (17%) show its effects on emotional reactivity in negative affectivity situations.

Conclusions:

The results confirm the impact of emotional processes on craving by highlighting the distinct and interdependent roles of negative affectivity, positive affectivity and alexithymia. These aspects of the psychological functioning will therefore have to be target elements in the care.

Introduction:

The term Chemsex stands for the intentional use of certain psychoactive drugs to enhance sexual relations between gay, bisexual and other men who have sex with men (MSM), usually for long periods of time. Slamming or slamsex defines when drugs are injected intravenously in this context. It has been described psychopathological symptoms in chemsex context, like depression, anxiety or psychosis. “Sex, drugs and You” was created in the ONG Apoyo Positivo in Madrid, in order to offer a multidisciplinary approach to people who practice chemsex.

Objectives:

To describe the program and the profile and psychopathology of patients attended in the program “Sex, Drugs and You” from 2017 to 2018.

Methods:

Description of program and the profile and psychopathology of patients attended in the program “Sex, Drugs and You”.

Results:

138 patients were attended. Median age was 37,46 years. 40% engaged on slamsex and 79,2% were HIV positive. 62 (46,26%) were derived to psychiatric assesment. From these, 100% had a drug-abuse disorder, being the main drugs abused: mephedrone(69,3%), GHB(48,3%), Crystal Meth (32,2%), cocaine(19,3%) and ketamine (4.8%). 54,8% also abused poppers and 35,4% abused erectile disfunction drugs. From this subsample, 82,25% also had a comorbid psychopathological disorder: 30,6% depression, 22,5 % psychosis, 8% anxiety, 8% personality disorders, 4,8% ADHD and 1,6% OCD.

Conclusions:

The program “Sex, Drugs and You” offers a multidisciplinary approach for people that engage in chemsex. Our sample shows a high prevalence of drug-abuse disorders and other comorbid psychopathology. The role of the psychiatrist to treat disorders related to chemsex is essential.

Introduction:

Although ketamine use is an established preclinical model of schizophrenia and kynurenine pathway has been shown to be strongly associated with schizophrenia, it was not known whether the metabolites of the kynurenine pathway plays a role in the pathophysiology of ketamine associated psychosis. We hypothesized that the chronic use of ketamine, the exogenouse NMDAR antagonist, will alter the level of the metabolites of kynurenine pathway.

Objectives:

We examined the serum levels of the kynurenine pathway metabolites tryptophan (TRP), KYN and kynurenic acid (KYNA) in chronic ketamine users. The correlations between serum levels of these metabolites with the demographic, drug use and clinical characteristics were analyzed.

Methods:

Serum TRP, KYN, KYNA levels were determined by high-performance liquid chromatograph (HPLC) followed by tandem mass spectrometry (MS/MS). The psychopathological symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS), the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI).

Results:

Serum TRP, KYNA and KYN levels were significantly lower in ketamine users than those in controls. Serum KYNA levels were positively correlated with the current frequency of ketamine use in ketamine users.

Conclusions:

TRP, KYNA, KYN were decreased in chronic ketamine users compare to healthy control. The alterations in the metabolites of the kynurenine pathway may play a role in the pathophysiology associated with ketamine abuse.

Introduction:

Online gaming is potentially harmful to a group, but not for the entire population, of online gamers. The prevalence varies by geographical areas, however, there are few Italian studies about risk factors for Internet Gaming Disorder (IGD) and its presence among non-occasional gamers.

Objectives:

This study aimed to describe the presence of IGD in internet gamers who participate in online communities, and how well-established risk-factors can predict it.

Methods:

Participants were surveyed about their playing habits and other relevant characteristics. IGDS-SF9 diagnosed IGD. TAS-20 measured alexithymia scores, i.e. Difficult in Identifying (DIF) and Describing Feelings (DDF), and Externally Oriented Thinking (EOT). Selected order of variables (via linear regression) and interactions were set in a logistic regression (outcome: IGD≥21).

Results:

The sample included 5,979 responders (88.7% males; 44% 14-18 years-hold). Alexithymia explained the 11.3% of the variance. IGD was present in the 43% of the subjects, the risk (70% prediction-rate) was increased by male gender (OR=1.2, 95% C.I.=1, 1.5, p=0.019), higher DIF z-scores (OR=1.5, 95% C.I.=1.1, 2.1, p=0.003), boredom/loneliness feelings (OR=1.8, 95% C.I.=1.5, 2, p<0.001), recent negative events (OR=1.1, 95% C.I.=1, 1.3, p=0.026), a behavioural dependency (OR=2.1, 95% C.I.=1.2, 3.9, p=0.009). Time spent playing exponentially increased the risk, up to eight times if six hours/per day were spent playing (OR=7.6, 95% C.I.=5.5, 10.6, p<0.001) and it did not interact with DIF scores (Figure-1). Figure-1

Conclusions:

Players who participate in forum and communities are particularly at-risk of IGD. DIF and time spent playing were the most important and independent predictors of a pathological approach to videogames.

Introduction:

The intentional use of drugs before or during sexual intercourse (chemsex) is a phenomenon of special importance in the MSM (men who have sex with men) population due to its impact on mental, physical and sexual health. Mental health disorders such as psychosis, delirium and serotonine syndrome has been described associated with chemsex practices. Other sexual health issues such as difficulties in achieving sober sex or erectile dysfunction has been described. To date, no specific sexual health intervention has been described.

Objectives:

To describe a sexual health intervention program for patients with chemsex practices. We describe the profile of users according to socio-demographic, medical, psychopathological and drug-related characteristics. On the other hand, we analyze a survey of satisfaction made by users.

Methods:

Description of the program. Demographics, consumption patterns, other accompanying substances, use of geo-social applications and comorbid medical and psychiatric disease and perceived satisfaction data were described through a online survey.

Results:

12 sexual health workshops were done based on behavioral-cognitive theory, biopsychosocial and Sex Positive Model. The most common profile was a male of Spanish nationality, 35-45 years old, living with HIV and drug use perceived as problematic. 35% presented a reduction in frequency or amount of drug use. 10% stopped practicing chemsex. 45% presented a reduction in sexual risk behaviour. 60% perceived an improvement in perceived social support and increased awareness of presenting a drug addiction.

Conclusions:

Interventions in sexual health were perceived as satisfactory and useful by users to improve their sexual health and self-efficacy to change substance use patterns.

Introduction:

The intentional use of drugs before or during sexual intercourse (chemsex) is a phenomenon of special importance in the MSM (men who have sex with men) population due to its impact on mental, physical and sexual health. A 12 workshop sexual health program was made in two Drug Dependence Clinics in Madrid. Shame, stigma, homophobia or ignorance of drug services assistance have been describe as barriers by chemsex drug users to accessing services. Facilitators such as creating a safe environment are necessary.

Objectives:

The objective of this study was to identify barriers and facilitators to the implementation of a sexual health program for chemsex users in two Drug Dependence Clinics in Madrid.

Methods:

The study is based on a qualitative research approach. We analyze an anonymous on-line survey with chemsex users with open answer questions about barriers and facilitators for implementing the sexual health program. Data analysis was based on thematic analysis of content.

Results:

Facilitators included: motivated stuff with LGBT cultural competence, close interaction between stuff and the patients, a nonjudgemental and multidisciplinary approach which includes sexual health and mental health. Barriers included: stigma related to attending drug dependence clinics, psychopathology in acute state (psychosis, anxiety), lack of perceived support from public institutions facing the mental and sexual health problems associated with chemsex.

Conclusions:

Chemsex, a public health problem in some Spanish communities, is a phenomenon that needs a collaborative approach between users and mental and sexual health professionals and other medical stuff. The described program is a pioneering initiative in Spain.

Introduction:

Intentional use of psychoactive substances before or during sexual intercourse (chemsex) to increase both sexual pleasure and arousal is a phenomenon of special importance in the GBMSM (gay, bissexual and other men who have sex with men) population due to its impact on mental and physical health.

Objectives:

We report the case of a patient with a suicide attempt diagnosed with a mephedrone and GHB use disorder and a depressive disorder in chemsex context. To review the evidence on associations between chemsex and mental disorders.

Methods:

A case reported is presented. A narrative review was performed to analyze the association between chemsex practice and mental health disorders.

Results:

In qualitative research conducted in Europe with participants with chemsex practices, psychiatric symptoms in the context of acute consumption such as irritability, anxiety, aggressive behaviours where described. Memory loss and changes in personality and dependence substance disorders were described as longer-term psychiatric harms. Drug-induced psychosis, encephalopaty, serotonin syndrome and delirium were described in case reports. In quantitative research analyzing data from a 2014 survey of people attending HIV clinics, chemsex was associated with depression/anxiety, and use of other recreational drugs.

Conclusions:

There is a lack of robust evidence in the association of chemsex with mental health disorders. Research on the impact of chemsex on mental health is essential. Due to the high prevalence of mental disorders in MSM population and the possible harms from drug use, a collaborative approach (including mental and sexual health professionals) could be beneficial with the problems associated with chemsex.

Introduction:

Alcohol consumption affects the way a person interacts with society. When ethanol addiction is associated with compulsive rituals, the alcohol-related disorder changes its dynamics. Even though alcohol can exacerbate the OCD (obsessive-compulsive disorder) of an individual, the combination of fighting and drinking a significant amount of alcohol, is quite common.

Objectives:

Dynamic evaluation of a pathology related to alcohol consumption superimposed on compulsive behaviors. Disorders related to alcohol consumption cause a change in the treatment of obsessive rituals; but rituals also the consumption of alcohol through the complexities of thought.

Methods:

The case presentation refers to a patient with multiple hospitalizations, over the years, in the Elisabeta Doamna Psychiatric Hospital, Galati, Romania. For the diagnosis, were used the criteria ICD-10 (Classification of mental and behavioral disorders), diagnostic criteria DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), for the evaluation of alcohol consumption and compulsive rituals were used, AUDIT psychometric tests.

Results:

A 38-year-old male patient has multiple admissions to the Psychiatric Hospital against a compulsive disorder (F42.1) and is being treated with antidepressants. Diagnostic code F42.1 is a diagnosis of compulsive or obsessiveness, consisting of regular checks on cleaning status or a potentially hazardous order-related circumstance. Ritual acts are marked by indecision and slowness, which involves checking the cleanliness of the glasses and the content of the alcohol bottle.

Conclusions:

OCD is a common form of mental illness, and alcohol is the drug with the highest incidence of addiction and abuse. The association between compulsive rituals and alcohol consumption is an unlikely dual diagnosis.

Introduction:

Substance abuse among medical professionals is common and can lead to malpractice. The study of identity conflicts developed by the Psychology of Personal Constructs could explain part of this problem.

Objectives:

This study aims to describe the medical professionals who abuse substances in terms of their personal construing process and other associated psychological measures.

Methods:

Thirty medical professionals suffering from a substance use disorder hospitalized in a clinic specialized in their treatment were recruited for this study. The Repertory Grid, Beck’s Depression Inventory, State-Trait Anxiety Inventory, and Maslach Burnout Inventory were used for assessment.

Results:

More than half of the participants presented cognitive conflicts (implicative dilemmas) and this group scored higher on trait anxiety and burnout than medical professionals without such conflicts. No statistically significant differences were found between those with implicative dilemmas and those without in terms of depression symptoms or state of anxiety. Logistic regression analysis showed that the presence of cognitive conflicts was best predicted by burnout. Distance between the "ideal self" and "actual self " elements, and cognitive complexity were the best predictors of belonging to the clinical sample or to a randomly matched community sample. Content analysis of the constructs revealed an overrepresentation of constructs referring to values and interests in the clinical sample.

Conclusions:

Overall, our findings support previous research with regards to psychological factors associated with the development of substance abuse and identity problems among medical professionals. The presence of implicative dilemmas and self-esteem problems can help us better understand these problems.

Introduction:

The history of social networking sites (SNSs) dates back to 1997, when the first SNS SixDegrees emerged (Boyd D et al, 2008). In 2004, Facebookwas launched. In SNSs individuals connect with others who share similar interests. The perceived need to be online may result in compulsive use of SNSs, which in extreme cases may result in symptoms and consequences traditionally associated with substance-related addictions.

Objectives:

To present a non systematic review on the subject of social networking sites addiction; to draw attention to its clinical features and therapeutic approach.

Methods:

Brief review of the english literature published using the Pubmed® database. Key-words: “social media addiction”; "social networking sites and addiction”; “psychiatric symptoms o and social networking sites addiction”. Articles were selected based on the content of the abstract and its relevance.

Results:

SNS use may lead to symptoms traditionally associated with substance-related addictions (Kuss D.J et al, 2011; Andreassen C.S, 2015). These symptoms are salience, mood modification, tolerance, withdrawal, relapse, and conflict with regards to behavioral addictions (Griffiths M. D et al, 2005). High engagement in social networking is partially due to the ‘fear of missing out’ (FOMO), a pervasive apprehension that others might be having rewarding experiences from which one is absent” (Przybyloki A. K et al, 2013).

Conclusions:

When SNS use is discontinued, addicted individuals will experience negative psychological and sometimes physiological symptoms (withdrawal), often leading to a reinstatement of the problematic behavior (relapse). SNSs addiction is a genuine mental health problem that needs attention from professionals, affecting person's social-biological development (Barker Vet al, 2009).

Introduction:

Substance use disorders (SUD) are a global problem with many health and economic consequences, impacting the user, the mental health system and society at large. Over half of SUD problems begin during adolescence. Treatment approaches and effective management frequently involve psychotherapeutic interventions, which prevents long term morbidity and mortality. Recognizing this public health concern and the need for more empirical based knowledge, the European Cooperation in Science and Technology (COST) funded the ‘European Network of Individualized Psychotherapy Treatment of Young People with Mental Disorders’ (TREATme).

Objectives:

As part of the aims of TREATme, in this particular study a systematic review of the published literature was conducted to determine the effectiveness of specific psychotherapeutic interventions (PI) in young people (YP) with SUDs.

Methods:

A systematic review on psychotherapeutic treatment outcomes for specific SUDs in YP was performed. Systematic literature searches were conducted in PubMed and PsycINFO following the PRISMA guidelines, and inclusion and exclusion criteria were created following PICOS model. Two independent raters carried out the ratings of the papers and final selection was made based on the inclusion criteria after reading the full texts and reaching consensus between two autonomous raters.

Results:

The systemic search generated 2135 papers, of which 577 were included for full-text review following exclusion by title and abstract. A consensus was reached that 212 papers met the inclusion criteria.

Conclusions:

The findings from this systematic literature review advise which PI may be most effective for each SUD in YP based on research evidence.

Introduction:

Delay discounting describes the tendency to want things now rather than later. This inability to wait is considered an aspect of impulsivity and is strongly expressed in Cocaine Use Disorder (CUD). It is generally measured using the monetary choice questionnaire (Kirby & Maraković, 1996), in which participants are presented with a fixed set of monetary choices between small immediate and larger delayed rewards.

Objectives:

We sought to investigate whether high levels of delay discounting in CUD are confounded by impairments in time perception. We changed the presentation of time delays in the Kirby questionnaire from time periods in days to concrete dates. We hypothesised that CUD patients show less delay discounting when presented with concrete dates, rather than time periods.

Methods:

We recruited 43 men with CUD and 32 healthy male control volunteers, aged between 18-65 years. Participants completed the original Kirby questionnaire and a modified version that depicted the same temporal delays by concrete dates, counterbalanced. Participants also completed two questionnaires about the subjective perception and evaluation of time.

Results:

The two groups were well-matched for age but differed on verbal intelligence, which was statistically controlled for in the analysis. CUD patients scored significantly higher on both versions of the Kirby (F_1,68=11.96, p=0.001) but showed significantly lower scores when dates were presented (F_1,68=4.23,p=0.044). Subjective measures confirmed distorted time perception.

Conclusions:

Our findings suggest that high delay discounting scores on the Kirby questionnaire are partly inflated by impairments in time perception. Clarification of the nature of the deficits in time perception is warranted.

Introduction:

Treatment seeking practices among patients with Alcohol Dependence Syndrome (ADS) may influence the overall treatment, risk assessment, public awareness, and psychoeducation to patient and family.

Objectives:

To explore the treatment-seeking practices in paients with alcohol dependence syndrome.

Methods:

In this descriptive cross-sectional study, we studied all the patients presenting with ADS at tertiary care teaching hospital in Nepal from June 2016 to May 2017.We diagnosed ADS according to the International Classification of Mental and Behavioural Disorders 10. We collected data on demographic characteristics,alcohol use history and treatment-seeking practices. We summarized the numerical variables with median and inter-quartile range (IQR) and the categorical variables with proportions.

Results:

A total of 105 patients with ADS admitted during the study period were studied. The median age was 42 years (IQR 34-50) and four were female (3.8%). Half of them (53, 50.47%) had received treatment with hospitalization. Many of them (46, 82%) were brought by the family members for the treatment – more than half (25, 54.3%) of these families had a history of psychiatric and substance-related problems. Only five patients had sought treatment on their own and all had medical comorbidities.

Conclusions:

Treatment seeking by patients with ADS was sub-optimum. Further exploration of the barriers to treatment-seeking and understanding of alcohol dependence as an illness is needed to develop appropriate treatment approaches.

Introduction:

Cannabinoid Hyperemesis Syndrome (CHS) is characterized by gastrointestinal symptoms, usually refractory to standard therapy, which occurs in chronic cannabis users. Since 2004, when it was first described, an increasing number of studies have been conducted in order to better understand this syndrome, whose presentation may seem paradoxical and can be easily missed in the emergency department (ED).

Objectives:

Report a case of CHS and brief literature review of the topic.

Methods:

Clinical case presentation through retrospective review of clinical notes and non-systematic literature review on this topic.

Results:

Recent evidence shows that CHS can affect up to 6% of patients consulting ED for hyperemesis. Patients are often misdiagnosed and undergo potential deleterious diagnostic and treatment procedures before a correct diagnosis is made. A prominent feature of this condition appears to be clinical improvement with prolonged hot baths. Our patient is a 24 years-old man, chronic user of THC with recent consumption increase, who presented multiple times in the emergency department with nausea, vomiting and abdominal pain associated with anxiety and akathisia-like movements. He was hospitalized in the psychiatry ward for better assessment of his complaints, that quickly ceased with anxiety treatment and no need of antiemetic medication. Since discharge, he remains THC abstinent with no symptoms recurrence.

Conclusions:

With this case report we want to raise awareness about this syndrome that still has limited evidence. The increasing use of THC should alert us to the likely increase in prevalence of this syndrome in order to be correct and promptly diagnosed and treated.

Introduction:

Zolpidem is a nonbenzodiazepine hypnotic commonly used worldwide for insomnia treatment. It belongs to a class of drugs developed in the 1980s with the intention of overcoming the detrimental effects of benzodiazepines (BZD). Despite the proposed lower dependence and abstinence symptoms and better side-effects profile, their occurrence is not negligible and has been more frequently described.

Objectives:

Report a case of a patient with memory and behavioral complaints related with zolpidem abuse

Methods:

Clinical case presentation through retrospective review of clinical notes and non -systematic literature review on this topic.

Results:

Our patient is a 66-year-old man, until recently independent and working as a restaurant manager who was sent to Psychiatry consultation for depressive complaints. For insomnia he was medicated 1.5 years earlier with zolpidem. At the first visit, he reported taking an average 15 tablets/day for anxiety control, which was nevertheless ineffective. The patient and his family reported disorientation, night wandering, difficulties in engaging with daily life activities and memory impairment – he only recognized his psychiatrist at the 4th appointment! A withdrawal scheme was prescribed, and anxiety and insomnia treated. The patient was admitted to an assisted care residence to medication intake and behavioral surveillance, progressively regaining autonomy.

Conclusions:

Although initially considered safer, recent evidence shows that there is a similarity in the adverse effect profile with benzodiazepines, potentially aggravated in case of abuse. Awareness should be made to this problem so it can be early detected and dealt with.

Introduction:

Alcohol-related Cognitive Impairment (ARCI) is highly prevalent among patients with alcohol dependence, with 50-70% of these patients presenting some degree of impairment. Although it negatively influences treatment outcome, this condition is underdiagnosed and undertreated.

Objectives:

The aim of this systematic review is to investigate the existing evidence regarding both cognitive and pharmacological interventions for ARCI.

Methods:

We systematically reviewed PubMed, Scopus and Science direct databases up to May 2019 and followed the PRISMA guidelines. The quality of the studies was assessed using the Jadad Scale.

Results:

26 studies were eligible for inclusion (14 referring to neuropsychological interventions and 12 to pharmacological treatments). Among neuropsychological interventions, computerised treatments, errorless learning and component method showed positive effects on working memory, memory measures and general cognitive function. On the other hand, thiamine, memantine and metilphenidate improved working memory, long term memory and general cognitive function. Nevertheless, these studies have several limitations, such as small sample size, lack of replication of the results or low specificity of the interventions.

Conclusions:

Cognitive functions can be improved by using specific neuropsychological and pharmacological interventions, and these improvements can have a positive effect on the reduction of alcohol use. However, methodological weaknesses of studies in this field prevent from having a gold standard treatment for Alcohol-related Cognitive Impairment. and further research based on promising strategies (e.g. digital interventions, thiamine) is required. Also, ecological interventions are needed in order to enhance the transferring and generalisation of the acquired abilities into the natural environment.

Introduction:

Although quantities seem to influence cannabis-related outcomes, until now its use has been mainly assessed by frequency. On 2017 the Standard Joint Unit (SJU) was set based on quantity of 9-Tetrahydrocannabidol (9-Δ-THC) found in cannabis: 1 SJU=1 joint=0.25 g of cannabis=7mg of 9-Δ-THC.

Objectives:

We evaluated if cannabis dose (SJU) consumed before admission influenced psychiatric inpatient’s symptom severity and outcomes.

Methods:

Cross-sectional study in an acute psychiatric inpatient unit between March and August 2018 including 106 individuals. Quantity of 9-Δ-THC consumption measured as SJU, symptoms severity measured through the Brief Psychiatric Rating Scale (BPRS) and secondary outcomes (e.g. length of stay) were assessed. Bivariate analyses and multivariate analyses were performed.

Results:

Point prevalence of cannabis use before admission was 25.5%, mean quantity consumed the week before admission was 17.6 SJU (SD=17.4). Mean BPRS score was 55.8 (SD=16.1); and 62.9 (SD=11.1) among cannabis users. A positive correlation between SJU consumed the week before admission and BPRS score (r=0.19,p<0.04) was found. Statistically significant difference (F(2,1)=23.46, p<0.0005) was observed in BPRS scores between patients in the three main diagnostic groups.

Conclusions:

Although no relationship between SJU and length of stay or BPRS was found, both the diagnostic group (schizophrenia and other psychotic disorders vs. others) and need of PRN measures predicted a higher BPRS score, possibly meaning a more severe clinical presentation. Differences in cannabis use among acute inpatients with mental health disorders points to the need for the development of tailored interventions for high-risk groups. We show the SJU is a useful quantification tool suitable for further clinical research.

Introduction:

Addictions among physicians and nurses are a cause of serious concern due to their negative impact both on their wellbeing and on their practice safety. Easy access and increased knowledge of legal drugs increases their risk of developing some substance related disorders such as opioid dependence. In the last decades, Physicians Health Programs (PHPs) have accumulated experience on how to prevent and treat those conditions.

Objectives:

To describe the clinical characteristics of physicians and nurses with opioid dependence (OD) in treatment at the Galatea PHP.

Methods:

Data from medical records of physicians and nurses consecutively admitted to the Galatea PHP from 2008 to 2018 will be presented. Records form patients meeting DSM-IV-TR criteria for OD will be selected and compared to those with other addictions. A specific analysis of the clinical relationship between drug prescription and physical pain in the OD subsample will be performed.

Results:

Physicians and nurses with opioid dependence are expected to be different than other addicted health professionals with regards to specialty (OD more frequent among those with access to intravenous drugs), type of referral (OD less likely to be self-referred for treatment), and risk for self or others (higher among OD patients). Some of them may have developed an OD as a strategy to deal with physical complaints without adequate medical supervision.

Conclusions:

Acknowledging the factors associated with OD among physicians and nurses may help develop more effective preventive and treatment interventions for them.

Introduction:

Hormonal effects on psychiatric symptoms in dual-diagnosis patients on methadone maintenance therapy (MMT) have not been completely elucidated. MMT is increasingly common in the United States and identifying long-term sequelae may influence patient adherence. Endocrinopathies, including hypogonadism and hypercortisolism, secondary to chronic opioid therapy have been well-documented in the pain literature. Patients receiving MMT often report poor libido, sexual dysfunction, fatigue, depressed mood, and sleep disturbance. It can be difficult to determine if these symptoms are due to a psychiatric disorder or secondarily due to a methadone-induced endocrinopathy. This case series examines the relationship of opioid-induced endocrinopathy and psychiatric symptoms in a psychiatry-based academic MMT program.

Objectives:

To review presentations of opioid-induced endocrinopathy in dual-diagnosis patients receiving MMT with the aim of improving psychiatric diagnosis and treatment adherence.

Methods:

Three patients were selected from a psychiatry-based academic MMT program. A literature review was conducted using the keywords "opioids," "methadone," "endocrine," "hypogonadism," "hypocortisolism," and "sexual dysfunction."

Results:

All patients were abusing intravenous and prescription opioids, initiated on MMT with doses titrated up to as high as 340mg daily. Patients endorsed a variety of systemic symptoms including poor sleep, depressed mood, and sexual dysfunction. The female patient endorsed changes in her menstrual cycle and fertility. Treatment adherence improved with concurrent treatment of endocrine dysfunction.

Conclusions:

Dual-diagnosis patients receiving MMT may benefit from concurrent treatment of endocrine dysfunction to help alleviate psychiatric symptoms. Sexual dysfunction in particular may be underreported and a driver for nonadherence.

Introduction:

Over the past ten years, a large number of New Psychoactive Substances (NPS) have entered the recreational drug scenario. NPS intake has been associated with health-related risks, and especially so for vulnerable populations such as the youngsters. Currently, most knowledge on the NPS health effects is learnt from both a range of users' reports, made available through the psychonauts’ web fora, and from the few published, related toxicity, clinical observations.

Objectives:

This paper aims at providing an overview of NPS effects on youngsters’mental health, performing a systematic review of the current related knowledge.

Methods:

A systematic electronic search including original papers up to August 2019 was carried out by using the Pubmed/Medline database.

Results:

NPS consumption poses serious health risks, due to both a range of unpredictable clinical pharmacological properties and the typical concomitant use of other psychoactive molecules, which can lead to near misses and fatalities.In comparison with adults, the central nervous system of children/adolescents may be more vulnerable to the activity of these molecules, hence raising even further the levels of health-related concerns.Further research is needed, to provide evidence of both short- and long-term effects of NPS, related health risks, and their addiction potential.

Conclusions:

NPS constitute a challenging public health issue. Within the current drug scenario, where ‘traditional’ drugs of abuse are both controlled and easily identified, NPS may be seen as attractive, and especially so for young people.

Introduction:

N-Ethyl-Hexedrone (NEH) is the third most seized synthetic cathinone in powder form in Europe. A Pub Med and Google Scholar search in June 2019 revealed only two studies in which NEH was ingested by humans. It is coherent to think that the effects and risks could be similar to those of other psychostimulants. However, the lack of scientific studies on humans left this assumption in only theoretical.

Objectives:

To provide evidence that NEH can induce psychotic symptoms on its own in humans.

Methods:

The case of a young man experience psychotic symptoms after the use of NEH is reported. The patient provided a sample of the substance that he had used the night prior to the hospitalization. The analysis was performed by Energy Control by gas chromatography associated with mass spectrometry (GC/MS) at the IMIM (Institut de Recerca Hospital del Mar – Parc de Salut Mar, Barcelona).

Results:

A 29 years-old male was hospitalized in the context of a psychotic episode and diagnosed of substance-induced psychotic disorder with onset during intoxication FI 5.259 (ICD-10-CM). He reported a higher-than-usual dose of NEH the day before the hospitalization. He described no regular use of psychoactive substances. Urine tests, blood tests, EKG and cranial MRI did not show any clinically significant results. Substance analysis revealed the presence of pure unadulterated NEH.

Conclusions:

In the absence of other plausible explanations, NEH is the most probable cause of the psychotic episode in this case. Researchers should continue to provide scientific evidence about the effects, risks, and treatment of NPS.

Introduction:

Alcohol-related seizures are usually attributed to alcohol-withdrawal. However, previous studies have documented an association between alcoholism and epilepsy. Several mechanisms underlying alcoholic epilepsy have been proposed (neurochemical and electrophysiologic “kindling”, cortical atrophy) leading to a gradual decrease in convulsive threshold, through at least one decade, eventually culminating in spontaneous seizures.

Objectives:

Characterization of alcoholic epilepsy regarding epidemiologic, clinical, neuroimagiologic and electroencephalografic (EEG) data, in comparison to alcohol-withdrawal seizures.

Methods:

Retrospective analysis of alcohol-dependent patients with seizures admitted in our ward, from January to December 2018. Exclusion criteria: previous diagnosis of idiopathic or secondary epilepsy. Patients were divided into two groups: 1) alcohol-withdrawal seizures; 2) alcoholic epilepsy, whose diagnosis was made upon clinical grounds (seizures unrelated to alcohol-withdrawal, ruling out metabolic/ionic disturbances).

Results:

From a total of 178 patients, 7 were excluded. Five out of the 171 patients (2.9%) had alcohol-withdrawal seizures and 2/171 patients (1.2%) had alcoholic epilepsy. Both groups presented tonic-clonic seizures and did not significantly differed in age-of-onset, consumption duration or EEG. Nonetheless, we found a more pronounced brain atrophy pattern in group 2; and in group 1 the two patients with longer consumption (24 and 37 years) also displayed a generalized cortical atrophy.

Conclusions:

These preliminary results show a consistent finding of brain atrophy in correlation with consumption duration. Nevertheless, we must consider that it does not reflect the precise cumulative burden of alcohol consumption. Beside this dose-relationship factor, neurobiological factors underlying an interindividual vulnerability to epileptogenesis in alcoholism are so far not fully understood.

Introduction:

Ayahuasca is a psychoactive brew prepared from the Amazonian vine Banisteriopsis caapi, which contains b-carboline type alkaloids, such as harmine and tetrahydroharmine, and leaves of the bush Psychotria viridis, which offers the psychoactive alkaloid N,N-Dimethyltryptamine (DMT). Ayahuasca has been used by indigenous populations of Amazonia as a central component of religious, curative, and other tribal rituals for over 4000 years. When ingested induces several hours of a dream-like altered state of consciousness characterized by visual and auditory hallucinations.

Objectives:

Brief review of Ayahuasca brew and its potential therapeutic effects in drug use disorders.

Methods:

Bibliographic search conducted through PubMed with key-words: “Ayahuasca”; “Ayahuasca assisted therapy”; “N,N-Dimethyltryptamine”; “drug use disorder”.

Results:

The anti-drug addiction mechanisms of ayahuasca and its alkaloids are not yet known. Physiological, biological, psychological and spiritual factors could play a synergetic role. Considering the studies reviewed, it seems that ayahuasca has a positive impact in drug use disorders, it leads to a decrease in drug use and withdrawal symptoms as well as improvements in quality of life. Those results were relevant concerning alcohol and cocaine use.

Conclusions:

Due to limited success of currently available medical treatments for drug use disorders these results seem promising. Controlled studies are still needed to replicate these observational findings in greater populations and attest the safety of ayahuasca as a medical treatment.

Introduction:

Studying the variability in biomarkers for Alcohol Dependence(AD) can substantiate the clinical suspicion of alcohol use.

Objectives:

1) To study biomarkers for screening and assessing severity of AD and in relation to withdrawal syndrome. 2) To correlate biomarkers to psychosocial factors-craving in AD patients.

Methods:

90 patients(>18 years) of Mental/ behavioural disorder due to alcohol use within 24 hours of alcohol intake were assessed for amount of alcohol intake, severity of AD, withdrawal symptoms and craving using The British Heart foundation and The Royal college criterion, Clinical Institute of withdrawal Assessment (CIWA-Ar), Penns Alcohol Craving Scale(PACS) scales respectively and biomarkers- serum uric Acid(UA), Mean corpuscular Volume(MCV), Alanine Transaminase(ALT), Aspartate transaminase(AST), Gamma glutamyl tranferase(GGT) were sent. Biomarkers and scales were reassessed on day 7 and 14. Level and variability of biomarkers was studied in mild, moderate and severe AD patients.

Results:

Significant decrease in mean PACS, mean CIWA in all groups on day 7 and 14 as compared to day 1(p<0.0001)was observed. Mean PACS level, CIWA level was significantly higher in severe AD as compared to other groups(p< 0.0001). Decrease in mean ALT, AST with slight decrease in mean MCV, UA is seen in all groups at day 7 and 14 as compared to day 1. With correlation analysis, positive good correlation was observed between GGT and PACS(0.514 ); GGT and CIWA(0.501); ALT and PACS(0.519).

Conclusions:

Significant craving and withdrawal is observed in severe AD as compared to other groups. GGT can be used as biomarker for craving and withdrawal in AD patients.

Introduction:

Digitalization of everyday life raises the question of the relationship of online activity with the psychological well-being of adolescents.

Objectives:

The aim was to study Internet addiction and anxiety as indicators of psychological well-being in Russian adolescents with different digital activity.

Methods:

Study was based on EU Kids Online methodology (Livingstone, Haddon, 2009) and included 1085 adolescents 14-17 years old. Cronbach's alpha for composite scores on Internet addiction items were 0.78 and on anxiety – 0.836.

Results:

The adolescents were divided by digital activity into 4 groups: low (<2.4 hours a day), medium (2.4-8.1 h.), high (8.1-10.9 h.), hyper-connectivity (>11 h.). Median scores on Internet addiction and anxiety were following: low usage group – 8 and 13.59, medium group – 9.13 and 14.81, high group – 10.14 and 16.31, hyper-connectivity group – 10.88 and 15.33. Than were assessed the significance of differences between groups (Mann–Whitney U-test). Low usage group differs in the level of Internet addiction from medium (p=0.002), high (p=0.001) and hyper-connectivity (p=0.001) groups. Medium usage group differs in the level of Internet addiction from high (p=0.015) and hyper-connectivity (p=0.004) groups. Low group differs in the level of anxiety from medium (p=0.012) and high (p=0.001) groups, and medium group differs from high group (p=0.015).

Conclusions:

The manifestation of Internet addiction and anxiety differs in adolescents with different levels of digital activity. The more time an adolescent spends on the Internet, the higher the level of anxiety and Internet addiction is. Research is supported by the Russian Science Foundation, project No. 18-18-00365.

Disclosure:

Research is supported by the Russian Science Foundation, project No. 18-18-00365.

Introduction:

The emergency states caused by periodic forms of compulsive craving for alcohol (the so called " dipsomania alcohol abuse", " heavy drinking bouts"), while which patients completely lose their conscious ability for determined will efforts over quantitative and situational self-control use of alcohol toxic megadoses, are considered one of the urgent issues of clinical addictology. It is a risk factor for severe mental, behavioral, somatoneurological disorders, disability and mortality. Since the pathogenesis and clinical manifestations of dipsomania are complex, addictology uses comprehensive pharmacological and other treatments, mostly insufficiently effective.

Objectives:

Innovative improvement of relieving method for heavy drinking states in alcohol abusers aiming at rise of efficiency, reduction of side effects and complications.

Methods:

Valid clinical-diagnostic, laboratory, biochemical, electrophysiological, psychological (scaling, testing) methods of dipsomaniac alcohol dependence statistical identification.

Results:

A new way of relieving alcohol intoxication (patent, 41156, UA) using pharmacological therapy (detoxifying, general tonic, thymolytic, tranquilizing, neuroleptic) has been proposed, characterized by intramuscular 1 ml Galapril (Ukrainian analogue of international Haloperidol) 3-7 days, once-twice daily, carried out against the background of: а) intravascular/transdermal laser therapy (0.63 μm wavelength, 2 mW radiation intensity, 30-40 min exposure, once daily for 3-5 procedure course), b) oral administration of sorbent Enterosgel (15 g single dose, three times daily 1.5-2 hours before or 2 hours after meals and taking medications, a course of 7-14 days). Membrane plasmapheresis is also pathogenetically grounded (patent 41156, UA).

Conclusions:

The treatment method was statistically significantly more effective compared to the conventional therapeutic approach.

Introduction:

Availability and further positive evolution of treatment modalities for relieving pain syndrome (PS) is the most urgent addictological clinical therapeutic issue. Clinical picture of opioid dependence specific PS is pathogenically caused by exogenous and endogenous intoxication syndromes, that prevents narcotization discontinuation. International addictological analgesic relieving programs are mostly ineffective enough.

Objectives:

To develop and propose new addictology treatment modality based on scientific analysis of international and own scientific and clinical experience concerning differential diagnostic clinical and pathogenic features of PS in opioid addicts, targeted improvement of conventional, search for new therapeutic analgesic programs.

Methods:

Pain intensity was determined by most widely used, valid one-dimensional scales: Numerical Rating Scale (NRS), Verbal Rating Scale (VRS), Visual Analogue Scale (VAS) (Breivik H., Borchgrevink R., Allen S., et al.).

Results:

Our method for relieving recurrent pain syndrome in opioid dependence (Patent 53586, UA) technology: membrane plasmapheresis performed at minimized conventional therapy. Heparin 10,000 U; sodium chloride 0.9% 1400.0 ml; blood preservative Glugicir (sodium citrate) 200.0 ml are used; 600.0-900.0 ml plasma is removed while a session. Blood intravascular laser irradiation with red spectrum (wavelength 0.63 μm), power 1.5-2.0 mW, exposure 20-30 minutes) is carried out 12-14 hours after membrane plasmapheresis. Laser therapy is combined with 1.0 ml Ketanov solution intramuscular injection.

Conclusions:

Representative clinical observations and approbation of the proposed method of relieving recurrent PS in opioid dependence with complex membrane plasmapheresis, intravascular laser therapy, Ketanov intramuscular injection demonstrated effective detoxification and analgesic effects, reduced period, increased quality of relieving therapy.

Introduction:

Contemporary international addictology, as a neuroscience, concentrated a large array of theoretical and applied knowledge about alcohol dependence pathogenetic mechanisms, exogenous and endogenous intoxication leading role, urgent states of alcohol genesis, decompensated detoxification mechanisms. This fact is of key importance in the development, testing and accumulation of numerous treatment modalities for alcohol dependence conditions and urgent relief in addictology practice. Unfortunately, not all proposed therapeutic programs stand the test of time for effectiveness.

Objectives:

Based on the analytical review of the principles of intensive elimination of post-alcohol disorders, to develop an innovative method of complex detoxification therapy for emergency conditions of alcohol genesis (withdrawal syndrome, dipsomania, pre-delirious and delirious conditions, etc.).

Methods:

International tests and scales for identification of alcohol dependence and its complications as emergency conditions. Follow-up control of laboratory, biochemical, electrophysiological and other studies.

Results:

An innovative method of complex detoxification therapy in emergency states of alcohol genesis (patent 20470, UA) by plasmapheresis method is developed, which is specific for membrane plasmapheresis with a dosed blood plasma removal volume of 600.0-1000.0 ml, and directly pre-treatment drip-feed intravenous administration of 200.0-400.0 ml Rheosorbilact or Sorbilact (by new prescription), 2.0-3.0 ml nicotinic acid intramuscularly, and medical oxygen inhalation for 5-10 minutes, every other 3 days procedure, 2-3 procedures tolally per treatment.

Conclusions:

The proposed detoxification method quickly and effectively reduces emergency clinical manifestations (eg., alcohol withdrawal syndrome with predilirious condition after prolonged binge drinking) and normalizes laboratory, electrophysiological and other parameters (middle weight molecules content, malondialdehyde level).

Introduction:

Intensive elimination of intoxication factors is an essential component of therapeutic programs for emergency states common enough among the drug addicts. However, most of the known detoxification methods are insufficiently effective.

Objectives:

The creative task was to develop considerably and improve intensive detoxification treatment modality in emergency states of narcotic genesis.

Methods:

International scales and tests for identification of drug dependence and relieving emergency states of narcotic genesis. The study monitored the dynamics of the main biochemical, major clinical laboratory and electrophysiological parameters.

Results:

Aiming to increase significantly detoxification efficiency, our utility model “Method of intensive detoxification therapy in emergency states of narcotic genesis” (patent 24574, UA) provides membrane plasmapheresis (MPP) at minimized conventional pharmacotherapy with dosed 600.0-1000.0 ml blood exfusion, and hyperbaric oxygen therapy (HBO) 12-14 hours after the procedure, with 1.2-1.3 atm oxygen pressure in the chamber, and 45-60 minutes exposure; every 3 days MPP procedure re-treatment (2-3 courses totally for a course), and a 3-5 session course of daily HBO. It has been proved that MPP pathogenetically provides intensive extracorporeal exfusion of toxic substances from circulating blood plasma. Hyperbaric oxygen promotes generalized detoxification, improves metabolic, detoxification processes, promotes elimination of hypoxic factor, positively influences (stimulates functional activity of the cardiovascular system, including capillary), adding synergistic preconditions for plasmapheretic exfusion of toxins and harmful metabolites excreted in circulation.

Conclusions:

The phenomenon of synergistically combined two best methods of detoxification (MPP + HBO) statistically significantly increases the treatment effectiveness for emergency conditions of narcotic genesis.

Introduction:

Hepatobiliary disorders in alcohol dependent patients is the prevalent dual morbidity with steady upward trend of 15-30% annual increase. Therefore, development of new, more effective, integrated approaches to dual morbidity (alcohol dependence + alcoholic liver disease) treatment is quite relevant.

Objectives:

Research for creative task of innovative metamorphosis of integrated therapy for alcohol dependence, complicated by liver comorbidity, using essential synergistic anti-alcohol methods and differentiated choice of modern pharmacological hepatoprotective drugs.

Methods:

Modern complex of clinical and psychopathological pathopsychological, laboratory, electrophysiological, biochemical examination to identify dual comorbidity.

Results:

A new method of integrated therapy for alcohol dependence complicated by liver comorbidity (patent 96702, UA) using conventional anti-alcohol and hepatoprotective pharmacotherapy has been proposed. Novelty of the utility model is provided by therapeutically combined anti-alcohol, hepatoprotective and psychotherapeutic agents: a) synchronous administration of intravenous and oral new-generation hepatoprotectors, adjuvantly affecting various pathogenic mechanisms of liver function alcoholic impairment: Lesfal 5.0 ml intravenously (7-10 per course), Antral 1 tablet (0.2 g) 3 times a day (14-21 day per course); b) treatment against the background of nanotechnological membrane plasmapheresis (“Hemofenix” unit, 2-3 sessions of 750-850 ml blood plasma exfusion per session; c) psychotherapeutic mediating of the present visual signs caused by chronic alcohol intoxication with metabolic toxic (xenobiotic) contamination at plasma membrane plasmapheresis exfusion.

Conclusions:

Catamnesis of representative group of patients statistically objectified the increased treatment efficiency of dual comorbidity, primarily due to the quality of remissions, persistent anti-alcohol motivations, reduction of impaired liver functions and shortening of treatment period.

Introduction:

Individuals with opioid dependence, even after entering opioid substitution treatment (OST), are at increased risk of lifestyle-related disease. Barriers hinder seeking medical help through the conventional healthcare system which results in unmet healthcare needs. As part of a larger study on unmet healthcare needs, the objective of this study was to explore these barriers, which, to this point, have been sparsely studied in this population.

Objectives:

To examine barriers towards healthcare seeking among patients in OST

Methods:

Mixed methods were used, where the quantitative part of the study, data had been collected from 218 patients in OST, by questionnaires. The qualitative part of the study was conducted by the use of semi-structured interviews with eleven OST patients, in Malmö, Sweden, between February 2018 and March 2018. Interviews were taped and transcribed

Results:

Three central themes were distinguished as barriers towards healthcare seeking consisting of procrastination/deprioritization, prior experience of stigma and internalization thereof, and inability/health illiteracy, supporting the initial findings of the quantitative part of the study.

Conclusions:

Patients in OST carry a heavy burden of physical symptoms and a high degree of unmet healthcare needs. Internal and societal systematic level of barriers seem to lead to inequalities in healthcare utilization. Further investigations into this subject need to be conducted.

Introduction:

Alcohol is one of the most widely-used addictive substances (WHO, 2017). Alcohol Use Disorder (AUD) has well-established effects on mental and physical health. AUD has also been linked with compromised emotional regulation (Brevers et al. 2013), potentially mediated by increased impulsivity in alcohol users. Many highly-functioning individuals regularly consume harmful levels of alcohol, but it is still unclear whether these effects are also seen in harmful drinkers who are sub-threshold for AUD.

Objectives:

We investigated social decision-making in individuals with regular harmful drinking and healthy volunteers, hypothesizing that if negative emotions are problematic for harmful drinkers, we would predict lower tolerance to unfairness and higher proportions of rejected offers compared to controls.

Methods:

We recruited 45 volunteers in the community: 28 reported regular harmful alcohol consumption (as measured by AUDIT scores >15) and 17 reported rare alcohol consumption. All participants performed the Ultimatum Game, making a number of guesses to earn money; however, to capitalise on their gains, they must cooperate with another player and share their earnings.

Results:

The groups were matched in age, gender, socioeconomic status and education. Although the groups did not differ with respect to sensitivity to monetary value (F_1,50=1.3;p=0.251); there were significant differences in responses to unfairness. Overall, alcohol users accepted fewer unfair offers than their opponents (F_1,98=3.7;p=0.04), which was inversely correlated with their AUDIT scores (r=-.32,p=0.020).

Conclusions:

In socially-frustrating situations, such as unfair offers, alcohol users may experience difficulty in regulating emotional impulses and likely to respond retributively. These difficulties should be addressed by early intervention programs.

Disclosure:

The authors thank all the participants who agreed to participate in our study, which was partly funded by the Cambridge Biomedical Research Centre and the University of Cambridge School of Clinical Medicine. The authors declare no conflict of interest.

Introduction:

Alcohol addiction is a leading risk factor for personal death and disability. In 2016, alcohol use caused 2.2% of female deaths and 6.8% of male deaths, and disability-adjusted life years (DALYs) were 2.3% in female and 8.9% in male. Alcoholics are at high risk of mental illnesses and are comorbid with liver disease.

Objectives:

Psychological interventions and medical treatments are used for alcohol addiction in Europe and/or the United States. However, the effect is limited, and the need of additional interventions is substantial.

Methods:

We planned to conduct a literature review related to the etiologies of alcohol addiction such as genetic inheritance and the physiological mechanisms of alcohol addiction, and current medical treatments for alcohol addiction, such as Naltrexone, Disulfiram, Acamprosate. We focused on the mechanisms that alcohol use impairs the intestinal barrier and cause the change of the intestinal permeability, as well as the gut microbiota composition.

Results:

The findings from our review suggested that probiotics, through either administrations or faecal microbiota transplantation, increased intestinal levels of potentially beneficial bacteria such as bifidobacterial and lactobacilli, improving in levels of liver-associated enzymes in patients with mild alcoholic hepatitis and demonstrating beneficial psychotropic effects on anxiety and depression.

Conclusions:

Previous studies try to reveal the role of the gut–brain axis among the alcoholics. Bacterial product penetrates the impaired intestinal barrier and causes central inflammation; the change of gut microbiota impairs enterohepatic circulation of bile acids; alcohol abuse causes shortage of vital nutrition such as thiamine. The association between gut–liver–brain axis and alcohol dependence is unclear and future studies are needed.

Introduction:

Dental anxiety impairs the individual's oral health, psychosocial well-being and quality of life. Dental Fear Survey (Kleinknecht et al. 1973) presents good psychometric properties in diverse cultures and languages, including in Portuguese (Lopes 2009). However, the Portuguese validation was exclusively based on a sample of university students.

Objectives:

To analyze the psychometric properties of the DFS Portuguese version in a general population sample, namely factor structure using confirmatory factor analysis (CFA), internal consistency and concurrent validity.

Methods:

A community sample of 437 adults (68.2% women; mean age= 35.15±15.790; range:18-88 years) completed the Portuguese versions of: DFS, Modified Dental Anxiety Scale (Lopes 2009) and State-Trait Anxiety Inventory (STAI-X2; Silva et al. 2006).

Results:

The model with the best fit was composed of five-factors (with eight errors correlated) (X2/df=3.233; CFI=.950; GFI=.880; TLI=.937; p[RMSEA≤.01]=.080). DFS Cronbach’s alpha was of α=.964; for the factors were: Avoidance of dental care, α=.922; Physiologic arousal during dental treatment, α=.892; Anticipatory anxiety while waiting for dental treatment, α=.924; Fear of the injection needle, α=.892; Fear of the drill, α=.760. DFS total and dimensional scores significantly and highly correlated (r=.70) with all MDAS measures and moderately with trait-anxiety (r=.25).

Conclusions:

This further validation with a more representative sample of the Portuguese population ensures that DFS is a valid and reliable instrument that can be used to continue understanding this important dental related psychological construct. In the near future we will determine the DFS cut-off to screen for dental anxiety disorders.

Introduction:

Research linking chronic pain with anxiety and traumatic reactions as proposed several pain-related anxiety constructs. Sensitivity to Pain Traumatization/SPT is defined as the propensity to develop anxiety-related somatic, cognitive, emotional, and behavioral responses to pain that resemble features of a traumatic stress reaction. Recently, Katz et al. (2017) develop the Sensitivity to Pain Traumatization Scale (SPTS-12) to measure this construct.

Objectives:

To analyze the psychometric properties of the SPTS-12 Portuguese version, namely construct validity, internal consistency and convergent validity.

Methods:

A community sample of 227 adults (55.7% women; mean age= 43.65±15.952; range:18-88) completed the Portuguese versions of SPTS-12 and other validated questionnaires to evaluate trait anxiety (STAI), dental anxiety (MDAS and DFS) and repetitive negative thinking (PTQ-15). The total sample was randomly divided in two sub-samples: sample A (n=113) was used to exploratory factor analysis/EFA; sample B (n=114) to confirmatory factor analysis/CFA.

Results:

EFA resulted in two components. CFAs revealed that the unifactorial model, found by Katz presented a poor fit. The bifactorial model presented good fit indexes (X2/df=2.167; CFI=.940; GFI=.916; TLI=.924; p[RMSEA≤.01]=.076). Cronbach alphas were α=.902 for F1 Sensations and α=.810 for F2 Thoughts and avoidance. F1 and F2 scores significantly and moderately correlated with measures of trait-anxiety, dental anxiety and repetitive negative thinking (all coefficients r≥.30, p<.001).

Conclusions:

This study provides preliminary evidence for the validity and reliability of the Portuguese version of SPTS-12, which dimensions will be used in an ongoing research project on the relationship between dental pain, trauma and anxiety.

Introduction:

According to the understanding of the term «vulnerability» as it is given in the APA dictionary (2006) as «susceptibility to developing a condition, disorder, or disease when exposed to specific agents or conditions» we have evaluated the parental representations of child mental health and factual health vulnerability. Our research was based on Green & Solnit ’s concept of «Vulnerable child syndrome» (1964) and was enlarged by using the principles of the «L’enquette québécoise sur le développement des enfants à la maternelle 2012» (2013).

Objectives:

We studied how parental emotional state and characteristics (anxiety and stress) could moderate parental subjective assessment of child mental and factual health vulnerability.

Methods:

The study was conducted among 46 women and the following questionnaires were used: State-Trait Anxiety Inventory (STAI) (1983), Parental Stress Index (PSI-IV) (2012), The Appraisal of child vulnerability.

Results:

Linear regression showed statistically significant relations between mother’s personal anxiety (STAI) and mother’s Emotional Appraisal of general child vulnerability (Rsq=11,5%, P=0,001). Also the following relation was found: The higher rate of Total parental Stress and the higher rate of stress by Child Domain (PSI-IV) relate to the higher rate of child mental health vulnerability assessment (R²=.34, p<.0001; R²=.51, p<.0001).

Conclusions:

The parental representation of child vulnerability is a phenomenon that has its own structure and determinations. For practice it means that parental anxiety and stress may be a factor of dramatization in diagnostics.

Introduction:

Aberrant emotional processing is increasingly recognized as a vascular risk factor. The same time, multiple theories of emotion link emotion with interoception. Thus, it is feasible to investigate the mechanisms of cerebrovascular disorders from a broad psychosomatic perspective that includes the role of interrelated emotional and interoceptive processing in body regulation.

Objectives:

To identify a pattern of emotional and interoceptive processing that is associated with cerebrovascular risk.

Methods:

The pilot study included 30 females aged 40–65 years with no history of cardiovascular events. The participant underwent ambulatory blood pressure monitoring, classified in accordance with the ESC criteria for hypertension, structural brain MRI, rated by the Fasekas criteria for vascular lesions, functional MRI with the heartbeat detection task and psychological examination. A cluster analysis was performed on the variables describing the emotional and interoceptive processing: Mayer-Salovey-Caruso Emotional Intelligence Test (MSEIT), Toronto Alexithymia Scale (TAS), Beck Depression Inventory, Short Health Anxiety Inventory, Screening for Somatoform Symptoms (SOMS), Interoceptive Accuracy and right insular activation during the heartbeat detection task.

Results:

The cluster analysis identified three subgroups. Subgroup including participants with lower emotional intelligence (MSEIT 92±8), higher alexythimia (TAS 57±11), higher rate of somatization (SOMS 21±5), lower interoceptive accuracy and insular activation showed higher rate of cerebral small vascular disease (modified Fasekas score 1 or more) — 73% vs. 31% in other participants (p=.05), along with higher rate of arterial hypertension — 82% vs. 38% in other participants (p=.004).

Conclusions:

In a pilot study we identified a psychosomatic pattern associated with higher cerebrovascular risk.

Introduction:

The Mayo Clinic Behavioral Medicine Practice (BMP) is a sub-specialty practice well integrated with other medical specialty practices and collaboratively evaluates individuals with somatic symptom and related disorders. We managed patients who encountered challenges overcoming their fear of the unknown and engaged in behavior of avoidance, that slowed recovery and limited their quality of life.

Objectives:

Through case presentations and literature review, we want to highlight agnostophobia as a probable impediment.

Methods:

Cases: 57-year-old married male with 18-month duration of multiple somatosensory symptoms unexplainable by known pathophysiological mechanisms after evaluation by multiple clinicians. 47-year old married male with functional neurological symptoms for 5 years leading to decreased quality of life from inability to work as a carpenter. 31-year old single female with somatic symptom disorder with predominant pain limiting her ability to engage in meaningful relationship and maintain employment. 20-year single male with spells and extensive evaluation negative for seizures who is on work accommodation. 21-year-old single female, previously a gymnast, with inability to move lower extremities and wheel chair bound. Extensive neurological and musculoskeletal work-up negative.

Results:

The fear-avoidance model attempted to explain the process of pain perception.¹ Lee-Jones et al. proposed cognitive behavioral model for fear of cancer recurrence and emphasized the role of cognitions, individual perception, knowledge, beliefs, and maladaptive behaviors². Morris et al. examined effect of negative conditioning on cognition and amygdala reactivity³.

Conclusions:

Understanding probable cognitive formulations of fear and avoidance may offer opportunities to facilitate restoration of function through adapted CBT.

Introduction:

Prevalence of functional constipation (FC) among adults worldwide is about 24%. The disease affects female more than male. Сomorbid psycho-emotional disorders, i.e. anxiety and depression might be associated with FC but the role of somatization and distress in such patients is still unclear. Actual schemes of symptomatic treatment of FC have low efficiency. At the same time only 50% of patients with FC follow the doctor’s recommendations. Difficulty of identification of non-compliant patients can have impact on the treatment outcome.

Objectives:

To assess the signs, which impact adherence to laхative treatment in females with FC.

Methods:

40 females with FC (ROME IV) were examined for somatic symptoms and tested by Latent Dysphoric Scale (LDS) and the Four-Dimensional Symptom Questionnaire (4DSQ) for emotional disorders.

Results:

All patients were prescribed laxatives. Somatization and dysphoria, but not depression and anxiety were presented at the beginning. Two weeks later patients were examined on their compliance. 14 patients stopped treatment (noncompliant group - NCP) and 26 patients continued treatment (compliant group - CP). No difference in age, years of disease duration and somatic symptoms severity between NCP and CP groups was observed. All NCP and CP patients showed equal positive response to treatment. The difference concerned only emotional status: latent dysphoria and all symptoms of 4DSQ: distress, somatization, depression and anxiety were more severe in the NCP group (p<0,05 for each index).

Conclusions:

Emotional disturbances, including latent dysphoria, distress, somatization, anxiety and depression, but not severity of somatic symptoms, predispose to non-compliance in female patients with FC.

Introduction:

At the present stage of a society development in Ukraine among based medical care problems the special priority has been provided the problem of somatoform vegetative disorders. A prevalence somatization clinical disturbances at patients with frustration various nosologic accessories and necessity of development of clinical criteria of differential diagnostics with somatic diseases were the precondition for studying this area.

At the same time, in Ukraine the diagnosis “Vegetative-vascular dystonia” which is ciphered G 90.8, according to ICD-10 instead of “Somatoform disoders” F40.0-F48 is used. It leads unreasonable treatment significant contingents of neurotic patients in neurological departments.

Objectives:

Create a comprehensive treatment program for patients with Somatoform disoders

Methods:

On the basis of complex study 727 patients of city policlinic and hospital are conducted determination of structure and prevalence of somatoform disorders in ambulatory-policlinic practice in the conditions of Kharkiv-city.

Clinic-epidemiological and clinic-statistical research allowed to define the structure of somatoform disorders in ambulatory-policlinic practice

Results:

Organ neuroses with cardiorespiratory functional violations make 10%, organ neuroses with functional violations of gastrointestinal system − 5,7%, organ neuroses with functional violations of the urinal system − 12,2%. Set personality psychological, social-psychological and social constituents of somatoform disorders.

Conclusions:

On that ground has been developed complex level differentiated system of medical- psychological and psychotherapy correction of somatoform disorders with the 75% higt efficasy.

Introduction:

Important reasons for the development of child anxiety are the factor of parental anxiety and the experience of the children's illness. There are differences between the level of anxiety in frequently and rarely ill children, as well as these indicators in their parents.

Objectives:

To assess the relationship between parental anxiety and anxiety among frequently and rarely ill children.

Methods:

Sample: 145 people: 46 frequently ill children (mean age – 16.3±0.3), 41 rarely ill children (mean age – 16.1±0.1), 28 parents of frequently ill children (mean age – 44.9±0.8), 30 parents of rarely ill children (mean age –44.5±1.5). Methods: State-Trait Anxiety Inventory (Spielberger, 1983), Short Health Anxiety Inventory (Salkovskis, 2002).

Results:

Frequently ill children significantly differ from rarely ill children by personal anxiety parameter (p= 1.386, p≤0.01) and have no significant differences with this indicator in their parents (p=12.825, p>0.05). For rarely ill children and their parents, this indicator has significant differences (p=2.382, p≤0.01). Frequently ill children, like their parents, have a high level of personal anxiety, which may not always be correlated with the severity of the disease of children, but has an impact on their personal development. Health anxiety among frequently and rarely ill children has no significant differences (p= 9.265, p>0.05). Illness experience doesn’t affect health anxiety in these groups.

Conclusions:

Parental anxiety is defined as one of the significant components of adverse effects on children’s development. The psychological impact on the frequently ill anxious child will be more effective if the parental attitude to him is optimized.

Introduction:

Interpersonal communication is a sphere where somatic complaints appear and acquire their psychological meaning that could be related to their further perpetuation.

Objectives:

The aim was to study psychological factors of somatic complaints and relationship to such complaints in interpersonal communication in patients with non-delirious hypochondria.

Methods:

45 patients with non-delirious hypochondriac syndrome in affective disorders and hypochondria disorder (28 males, 20-63 years old) and 45 participants without mental disorders replied to modification of Rosenzweig test including 40 cards with frustrating situations of interpersonal communication (Migunova, Rasskazova, 2014) provoking somatic complaints to resolve some problem (“Have you been home all day? I asked you to ... What happened?”), health anxiety (“Are you dizzy again? Listen, I think it's time to see a doctor - can this be very dangerous?”) or describing situation when somebody report somatic complaints to resolve some communication problem (“My head ached terribly from you! I need rest”). Then they filled Cognitions About Body and Health Questionnaire (Rief et al., 1998) and Screening for somatoform symptoms (Rief, Hiller, 2003).

Results:

Comparing to controls, patients more frequently reported somatic complaints to resolve interpersonal problems (p<.05), higher subjective stress if other person expressed distrust to their complaints (p<.01) with readiness to prove that symptom exists (p<.05) but also more trusted others’ complaints (p<.05). Cognitive beliefs and somatoform symptoms were unrelated to these patterns.

Conclusions:

Patients with hypochondria demonstrate specific communication style regarding somatic complaints. Research is supported by the Russian Foundation for Basic Research, project No. 20-013-00799.

Disclosure: Research is supported by the Russian Foundation for Basic Research, project No. 20-013-00799

Introduction:

Despite the growing interest to the “cyberchondria” as an excessive online search for health-related information (Starcevic, Berle, 2013, Lutwak, 2017; Wangler, Jansky, 2018), little is known about whether it is specific phenomenon or should be considered as a component of excessive Internet use or hypochondriac beliefs and behavior.

Objectives:

The aim was to study relationships between cyberchondria, cognitive beliefs typical for patients with hypochondriac disorder and Internet addiction in those who actively search for health-related information online.

Methods:

33 active participants of medical online societies and forums (10 males, 18-63 years old, M=27.5; SD=11.7) and 54 people who replied that rarely or never search for health-related information online (31 males, 18-63 years old, M=31.7; SD=8.8) filled The Cyberchondria Severity Scale (CSS, McElroy, Shevlin, 2014), Chen Internet Addiction Scale (Chen et al., 2003), Scale for Assessing Illness Behavior (Rief et al., 2001), Cognitions About Body and Health Questionnaire (Rief et al., 1998).

Results:

In people actively searching online for health-related information scored higher on Compulsion, Distress, Excessiveness, Reassuarance Seeking scales of CSS (p<.05) than controls. Comparing to controls, in these people cyberchondria related to any aspects of hyperchondriac behavior (r=.19-.23, p<.05) and unrelated to excessive Internet use.

Conclusions:

Results suggest that while in the general population cyberchondria could manifest both in the structure of hypochondriac beliefs and Internet addiction, in people who actively search online for health-related information, cyberchondria is related to hypochondriac beliefs and behavior only. Research is supported by the Russian Foundation for Basic Research, project No. 20-013-00799.

Disclosure: Research is supported by the Russian Foundation for Basic Research, project No. 20-013-00799.

Introduction:

Posttraumatic stress disorder symptoms(PTSS) is a problematic morbidity related to disaster consequences. PTSD impairment has been described as one of the most impairing mental disorders. However, most of the studies evaluating post-disaster psychiatric morbidity have not included measures of functional impairment. Shedding light into this field by studying impairment related to health disaster outcomes would head to gain a comprehensive understanding to assist this population.

Objectives:

The aim of this study is to describe the prevalence of PTSS and physical illness in South Korean disaster victims sample 1 year post-disaster and compare social adjustment between individuals with PTSS and individuals with physical illness.

Methods:

A total of 1659 individuals were surveyed in 2017. Patients aged between 19-69yo, who did not present physical/psychiatric illness history pre-disaster were selected, leading to a total n=988. Three groups were constructed based on the incidence of PTSS and Physical Illness in 1 year post-disaster. Cross-sectional descriptive analysis was performed using ANOVA with Bonferroni correction.

Results:

From a total of 988 individuals surveyed, 59.10% presented post-disaster new onset physical illness and 35.12% presented partial or full criteria for PTSD. After covariate adjustment work and social maladjustment presented association with PTSS(+)Physical illness (-) group=(OR:1.19, IC:1.12-1.26, p<.001), and PTSS(+)Physical Illness(+) group=(OR:1.16, IC:1.08-1.23, p<.001). No association was found with PTSS(-)Physical Illness(+) group.

Conclusions:

According to our results, individuals who present PTSS criteria after a disaster have worse work and social adjustment than those who present physical illness. Therefore, it should be borne in mind to include PTSS assessment program for this population; hence, minimise morbidity.

Introduction:

Cognitive impairment (CI) is currently investigated as a possible factor of a significant functional and economic burden in affective disorders.

Objectives:

To assess CI in patients with bipolar disorder I and II types(BD) and major depressive disorder(MDD) in remission.

Methods:

The sample included 85 outpatients with BD (with BDI – 64; BDII – 21) and 45 outpatients with MDD in remission (DSM-V criteria), who received treatment in 2017-2019. We provided a single examination of a patient including clinical interview, HDRS and YMRS to assess affective symptoms (the results were in the normal range), and screening for CI with The Brief Neuropsychological Cognitive Examination (BNCE).

Results:

CI (mild cognitive deficit) according to the BNCE was identified in 37 patients with BD (43.5%) and 12 with MDD (26.7%; p=0.059). Patients with CI were characterized by low scores on the subtests «set of sequences» (patients with BD – 2.44±0.57; MDD – 2.73±0.5; p=0.035) and «finding similarities» (2.46±0.5; 2.69±0.51; p=0.025) which indicate a decrease in working memory, operative memory and executive functions in patients with BD in comparison with MDD. CI was linked with the impaired professional functioning in patients with BD (r=0.495; p<0.001). CI in patients of both groups was associated with a deterioration of family relationships (BD: r=0.33; p=0.002; MDD: r=0.45; p=0.002). The association between CI and treatment has not been established.

Conclusions:

CI was found in 26-43% of patients with mood disorders in remission. Our results suggest that patients with BD may have higher levels of cognitive and functional (professional) impairment than those with MDD.

Introduction:

Bipolar disorder (BD) implies sexual dysfunctions (SD) during euthymia that affect quality of life and treatment compliance. Treatment, comorbidities, and subsyndromic symptomatology; are among the causes that explain SD in BD stable patients. However, there are no studies that investigate the influence of personality. Affective temperaments, as endophenotypes of BD are associated with different expressions of psychopathology and course in BD, so they are likely to have an effect on SF in euthymic patients.

Objectives:

To explore the relationship between SF and temperament in euthymic patients treated with mood-stabilizers +/- benzodiazepines; minimizing effects of polytherapy.

Methods:

This is a cross-sectional study in 100 euthymic bipolar outpatients from four hospitals in Spain: La Fe Hospital(Valencia), Oviedo Hospital (Oviedo), Sant Joan de Deu Hospital (Barcelona), and Mutua de Terrassa Hospital (Barcelona). Temperament was evaluated with TEMPS-A and SF with CSFQ-14. The effect of temperaments on CSFQ-14 was analyzed with Bayesian ordinal-regression considering age, gender, BD type, polarity of episodes, metabolic syndrome, marital status, and HDRS/YMRS scores as covariables. Statistical analyses were performed using R (version3.5.3).

Results:

Hyperthymic scores predicted better SF in all domains of CFSQ-14. We didn’t find an influence of the rest of temperaments. As secondary-outcomes, age and female sex predicted worse SF; and treatment with valproate was related with better global SF and arousal.

Conclusions:

Hyperthymic traits predict better SF in BD patients independently of the type of treatment. It is important to systematically assess SF and temperament in BD patients so as to improve patients’ quality of life and adapt clinical decision-making.

Disclosure: Yolanda Canada has had support for conference from Janssen and Lundbeck. Pablo Navalon has received support from Lundbeck and Janssen. Seetal Dodd has received grant support from the Stanley Medical Research Institute, NHMRC, Beyond Blue, ARHRF, Simons Fo

Introduction:

Several pharmacological agents are recommended as first-line treatment options for acute mania in bipolar disorder according to most recent guidelines with comparable efficacy among them. However, there are no specific decision algorithms on treatment choice and guidelines establish individual criteria based on specific characteristics of the patient’s clinical history or syndromic characteristics. In order to fill this gap, we propose an algorithm on “how to treat mania” based on clinical guidelines and tested on a series of cases.

Objectives:

To propose a treatment algorithm in acute manic episodes according to clinical guidelines and patient characteristics.

Methods:

All patients with acute manic episodes admitted to the psychiatric ward were grouped according to the presence of congruent or incongruent psychotic symptoms during acute mania. Patients with congruent psychotic symptoms were all treated with combination of aripiprazole plus lithium/valproate and those ones with incongruent psychotic symptoms received a combination of risperidone plus lithium/valproate.

Results:

Seven patients with acute manic episodes (4/3 women/men aged 20-59 years-old) were included. All patients presented remission of manic and psychotic symptoms during hospitalization. No major adverse effects due to treatment were reported. Before discharge, patients with poor treatment adherence predictors or personal preference were started on long-acting injectable (LAI) aripiprazole or LAI paliperidone palmitate.

Conclusions:

The congruence of psychotic symptoms in acute manic episodes can be used to determine the antipsychotic strategies (serotonin-dopamine antagonist vs partial dopamine agonist) in combination with mood stabilizers (lithium/valproate). The combination of aripiprazole/risperidone plus lithium/valproate are effective in treating acute manic episodes.

Introduction:

Childhood trauma (CT) is consistently associated with suicidality across various psychiatric conditions, including bipolar disorder (BD). Impulsivity has been suggested as a potential mediator of the effect of CT on suicidality. However, relevant literature is scarce and inconsistent in BD (Etain et al., 2013, 2017; Richard-Lepouriel 2019; Watkins & Meyer, 2013).

Objectives:

To explore potential mediatory effects of impulsivity in the pathway from CT to suicidality in BD.

Methods:

We included 78 BD patients (60.3% females, 68% BD-I), aged 23-78 (mean 47) years. CT was assessed with the Early Trauma Inventory Self Report-Short Form (ETISR-SF), impulsivity with the Barratt Impulsivity Scale-11 (BIS) while lifetime suicidality was investigated with the Suicidal Behaviors Questionnaire-Revised (SBQ-R). Path analysis was performed in structural equation models including gender, age and diagnosis (BD-I, BD-II) as covariates.

Results:

38.5% reported lifetime suicide attempts. In the model without BIS, CT significantly predicted SBQ-R (p=0.004). After being included in the model, BIS significantly predicted SBQ-R (p=0.011) while the effect of CT was no longer significant (p=0.077). BIS was significantly predicted by CT (p<0.001). Therefore, the effect of CT on SBQ-R was completely mediated by BIS. In an alternative model including CT and BIS dimensions, only ETISR-SF physical abuse (p=0.013) and BIS attentional (p<0.001) subscales significantly predicted SBQ-R. The effect of ETISR-SF physical abuse on SBQ-R was partially mediated by BIS attentional subscale.

Conclusions:

CT exerts its effect on suicidality in BD via impulsivity. In specific, attentional impulsivity mediates the effect of physical abuse on suicidality in BD patients.

Introduction:

Anxiety disorders and obsessive-compulsive disorder (OCD) are highly prevalent in bipolar disorder (BD), complicating its clinical presentation, prognosis and therapeutic outcomes. Personality characteristics have generally been associated with the emergence of anxiety spectrum disorders. However, literature is scarce and inconsistent regarding the personality profile of anxiety disorder comorbidity in BD.

Objectives:

To explore the personality profile of BD patients with comorbid anxiety disorders (including OCD) using Cloninger's Temperament and Character Inventory (TCI).

Methods:

We included 149 BD patients (63.8% females, 63.1% BD-I), aged 20-78 (mean 47.6) years and 99 healthy controls (62.6% females), aged 18-73 (mean 40.8) years. Main diagnosis (BD-I, BD-II) and comorbidity of anxiety disorders was established with MINI-5.

Results:

Adjusting for gender and age, patients scored higher on novelty seeking, harm avoidance (HA), self-transcendence (ST) and lower on self-directedness and cooperativeness than controls (all p<0.001). 22.8% of patients suffered from at least one anxiety disorder. Adjusting for gender, age and main diagnosis, patients with comorbid anxiety disorders scored higher on HA (p=0.008) and ST (p=0.044). Anxiety disorder comorbidity was predicted only by BD-II diagnosis (OR=6.1, p<0.001) and HA (OR=1.05, p=0.008) in a stepwise logistic regression adjusting for gender and age.

Conclusions:

Apart from BD-II diagnosis, HA is an additional though weak, independent predictor of anxiety disorder comorbidity in BD.

Introduction:

The rTMS of the dorsolateral prefrontal cortex (CPFDL) is a cerebral stimulation therapy that is giving rise to a revival of interest in the treatment of mood disorders.

Objectives:

To identify the various factors influencing the effectiveness of transcranial magnetic stimulation in the treatment of mood disorders.

Methods:

We conducted research studies exploring predictors of a good response to rTMS in the treatment of mood disorders. Publications were compiled from the Pubmed, Google Scholar and Direct Science electronic data bases.

Results:

It seems that antidepressant effects of rTMS depend on clinical considerations, stimulation characteristics and on the profile of the cerebral metabolism which differs between the right and the left side of the stimulation. A possible association of rTMS with pharmacological treatment, a history of a good response to antidepressants, ECT or rTMS, and the characteristics of the depressive disorder, are also involved in this response. Not to mention the impact of antecedents of previous psychiatric hospitalizations, treatments implemented, and the overall duration of evolution of the current depressive episode. The characteristics of stimulation depend on the uni or bipolar type of depression. In case of mania, these characteristics are the reverse of those of depression. Bipolar depressions seem to respond to rTMS faster than unipolar depressions.

Conclusions:

It turns out that rTMS could be an interesting alternative to antidepressants in the treatment of uni and bipoal depression. However, the literature is poorer in terms of mania. Nowadays, the theta burst stimulation would have more robust effects with a shorter application time.

Introduction:

Bipolar disorder is a chronic severe mental illness that has among the highest rates of comorbidities, including substance use disorder. Despite the increasing number of scientific research investigating comorbidity between bipolar disorder and frequent substance use disorder such as alcoholism, there has been less considering the association of bipolar disorder and opioid use.

Objectives:

The aim of this study was to compare the social and clinical profile and the manic episode features of bipolar patients with and without opioid addiction comorbidity.

Methods:

We conducted a descriptive, retrospective study including all cases of patients admitted for acute bipolar manic episodes from October 2018 to March 219 in "F" psychiatric Department of Razi Hospital. Social and clinical information was collected from medical records and case notes. Data were analyzed using SPSS.

Results:

The prevalence of opioid dependence among bipolar patients was 12%. All patients reported non-medical use of high doses of buprenorphine (Subutex). Opioid-dependent patients had significantly more criminal history and exhibited more behavioural strangeness during their manic episode (manic episode with psychotic characteristics) than patients without opioid dependence. In addition, there was a longer hospital stay and a lower score in the Global Assessment of Functioning scale for opioid users, but these differences were not significant.

Conclusions:

Despite the few differences in the social, clinical and prognostic indices examined between the two groups, it appears that bipolar patients with opioid addiction seem to have more severe manic episodes, which encourages special attention to be given to addictive disorder in bipolar patients.

Introduction:

Bipolar disorder is a severe and chronic disease that can be life threatening. Treatment adherence is a key to remission and a way to recover a good social functionning. Long acting antipsychotics can be used in maintenance treatment of bipolar disorder.

Objectives:

We aimed to describe the clinical characteristics of bipolar patients on long acting injections of antipsychotics.

Methods:

Cross sectional study among hospitalized patients with a manic or depressive episod of bipolar disorder, in the period from october 2018 to september 2019. Clinical assessments were performed using clinical global impression scale (CGI) and the global assessement of functionning scale (GAF).

Results:

We included 39 patients, with a mean age of 42+ 13 years, 80% were male, 43% were single and 26% unemployed. The mean number of hospitalizations was 5. Long acting antipsychotics were prescribed in 34% of cases. The use of depot treatment was significantly associated with the age of onset (p=0.005), suicide attempts (p=0.04) and cannabis use (p=0.005).

Conclusions:

The use of long acting antipsychotics is not a commonly recommended tretment in BD, but it can be used in order to deal with non adherence or in severe cases. More research is required to assess the effectiveness of this approach.

Introduction:

The evidences of comparative efficacy and tolerability of anticonvulsants in longterm therapy for bipolar disorder (BD) are sparse.

Objectives:

to compare the longterm efficaсy and tolerability of valproate (SV), lamotrigine (LAM), topiramate (TPM) in BD.

Methods:

90 BD patients (34 men, 56 women, mean age - 40.8±12.7, disease duration at least 2 years (mean - 14.1±9.4), with at least 2 episodes during the past year, were randomized into 3 therapeutic groups (SV, LAM, TPM). Efficacy was separately assessed by the changes in the relapse rate and duration of both depressive and manic episodes.

Results:

The mean relapse duration decreased for SV by 81.84%, LAM-71.4%, TPM-73.5% (p<0.0001), the frequency - 67.7%, 63.3% and 63.6%, respectively (p<0.0001) (SV vs LAM vs TPM – NS). The TPM group had the highest dropout rate and the shortest period of time for therapy discontinuation. Manic symptoms duration decreased (p<0.0001) in the SV group by 79.0%, LAM – 69.3%, TPM - 63.8%, depressive – 64.4%, 80.2%, 73.9%, respectively. Manic episodes frequency (p<0.0001) - by 60.0%, 41.7%, 54.5%, depressive – 50.0% (p<0.0001), 55.0% (p<0.0001) and 43.8% (p<0.05), respectively. Differences between drugs (Mann-Whitney test) in pairwise comparison to reduce the duration of manic symptoms for SV and TPM (p=0.008), depressive - for VN and LAM (p=0.002), frequency of manic episodes for SV and LAM (p=0.003), depressive – NS. The incidence of side effects: TPM (26.7% of patients) >SV(20.7%) > LAM(12.9%).

Conclusions:

SV, TPM, LAM have equal efficacy. VN, TPM were better of LAM in controlling manic, LAM - in depressive symptoms.

Introduction:

Current researches suggest that 0.3-1.5% of world's population suffer from bipolar affective disorder. Modern researches emphasize that main medical and social consequences of bipolar affective disorder are due to high level of comorbidity and suicidal behavior associated with this form of pathology.

Objectives:

Purpose of the study is to develop a pathogenetically justified system of psychoprophylaxis of autoaggressive behavior in patients with bipolar affective disorder on basis of studying features of its formation.

Methods:

We conducted comprehensive examination of 117 patients of both sexes with bipolar affective disorder with signs of autoaggressive behavior with clinical psychopathological method.

Results:

It has been established that autoaggressive behavior in case of manic episode of bipolar affective disorder is associated with angry mania; in case of depressive episode it is associated with sad depression, when mixed episode - with a combination of angry mania and anxious depression. We have developed pathogenetically justified system for the prevention of autoaggressive behavior in patients with bipolar affective disorder, which included pharmacotherapy, psychotherapy and psychosocial therapy. Pharmacotherapy of manic episode of bipolar affective disorder included the use of valproic acid salts, olanzapine; when depressive episode - lamotrigine or valproic acid salts, quetiapine; when mixed episode - valproic acid salts, aripiprazole. The psychotherapeutic component was represented by the integrated use of rational psychotherapy, personality-oriented psychotherapy, and cognitive therapy. Psychosocial therapy was implemented through conducting psychoeducational trainings and training of solving interpersonal problems.

Conclusions:

1.5 year follow-up study showed high efficiency of developed prevention system of suicidal behavior in patients with bipolar affective disorder.

Introduction:

Patients with bipolar disorder frequently have cognitive deficits even when euthymic. These deficits are considered one of the main drivers of functional disability in bipolar disorder. Cognitive remediation programs have been proposed to address this issue.

Objectives:

This study investigated whether computerized working memory training using the COGMED® program in patients with bipolar disorder can improve global functioning, therapeutic compliance, and subjective quality of life.

Methods:

For this naturalistic prospective study, 40 patients with bipolar disorder and cognitive complaints were recruited. Sociodemographic, clinical, neurocognitive and functional data were collected before starting the remediation intervention (baseline). At home, patients used the web-based working memory training program COGMED® that included a battery of interactive games (daily sessions, five days per week for five weeks), supported by weekly phone-based feedback. The clinical, neurocognitive and functional assessment was repeated four weeks after the intervention end and compared with the baseline data.

Results:

Thirty-two patients completed the study. Compared with baseline, general functioning was significantly improved after the WM training program, as indicated by a mean reduction of 6.78 (SD 4.65) points in the Functioning Assessment Short Test (FAST) (p<0.001). This result remained significant after controlling for depressive symptomatology improvement. Similarly, the scores of neuropsychological tests for cognitive complaints, depressive symptomatology, and worming memory verbal and visuospatial components were significantly different before and after the intervention (p<0.05). Conversely, the subjective quality of life and therapeutic compliance did not change.

Conclusions:

In patients with bipolar disorder, global functioning is improved by computerized WM remediation.

Introduction:

New onset mania in older adults could be a late-onset Bipolar Disorder, but most commonly will be related to an organic disease. An association between thyroid dysfunction and psychiatric phenomena is well known.

Objectives:

We describe a case of a 64 years-old patient with manic syndrome secondary to iatrogenic hyperthyroidism, focusing on clinical presentation, differential diagnosis and management.

Methods:

Clinical case report and review of relevant literature.

Results:

Mrs. M, 64 years, was brought to the psychiatry emergency department by her husband, who described behavioral changes characterized by leaving home during the night, decreased need for sleep, excessive talkativeness and mood elation. He reported that these symptoms started after his wife was discharged from a three-day admission in an Internal Medicine department, twenty days earlier, due to hyponatremia, hypokalemia and iatrogenic hyperthyroidism (TSH<0.004uUl/mL; T4L 2.1ng/dL, normal= 0.4-4.0uUl/mL; 0.8-1.6ng/dL). M. had a background of depressive episodes, hypertension and hypothyroidism, and was medicated with paroxetine 20mg ½ cp id; diazepam 10mg id; trazodone 100mg id; quetiapine 50mg id; AAS 100mg id; levothyroxine 0.1mg id and lisinopril 5mg id. In the emergency department her mental state examination identified expansive posture, overfamiliarity, disinhibition, distractibility, pressure of speech with flight of ideas, auditory hallucinations and persecutory delusion. She was admitted to the Psychiatry department, and after a battery of exams we discovered that her thyroid function wasn’t yet normalized (TSH 0.012uUl/mL; T4L 1.0ng/dL). Management included pharmacological adjustments and close monitorization of thyroid function.

Conclusions:

Thyroid function should be closely checked in patients presenting with mania, especially in older adults.

Introduction:

Most patients diagnosed with bipolar disorder remain symptomatic with depression more prominent than mania. Saturation of enzymatic cofactors has been a successful strategy for improving a number of genetic disorders. We wondered if a high-dose, high-potency micronutrient formula with fish oil could reduce the symptom burden among patients without increasing side effects.

Objectives:

We aimed to conduct a randomized, double-blinded, controlled trial of micronutrient+fish oil versus placebo vitamins and oil with an aim of enrolling 127 patients with 97 receiving at least 4 months of treatment in a 3-2 design stratified on age. We excluded only those people who were unable to complete questionnaires or come for follow-up.

Methods:

A 36-ingredient micronutrient supplement was used (Empower Plus; True Hope) with high doses of all 36 ingredients but nevertheless remaining under the recommended maximum daily allowance. A fish oil preparation (Wylie’s Finest) was also used in doses that would provide 2100 mg of eicosapentaneoic acid daily. Each company prepared an equivalent placebo for us that resembled the active substances in every way. Subjects received baseline evaluations and were seen monthly for 12 months. An additional open label trial of one year is now underway.

Results:

We saw statistically significant improvements in a composite z-score of compromised of individual z-scores of overall symptomatology, dose of medications, and side effects among the group receiving micronutrients compared to placebo.

Conclusions:

Micronutrient augmentation of patients with bipolar can improve symptoms without the need to increase conventional medications and without an increase in side effects.

Introduction:

Hormonal fluctuations are associated with an increased risk of affective dysregulation and mood episodes in women with bipolar disorder. Examples of this are the high rate of depression during the postpartum period and the increase in mood instability during the menopausal transition, particularly an increase in depression.

Objectives:

The aims of this work are to review the published studies concerning the use of hormone replacement therapy (HRT) on BD, specifically, possible indications for its use, the potential adverse effects and the role of HRT in the prevention of mood episodes.

Methods:

A search was made on databases Pubmed and Cochrane Library with the mesh terms: bipolar disorder or mania or bipolar depression and hormone replacement therapy, selecting the articles published between 1994 and 2019. A total of 39 articles were found and of these 15 selected for this work.

Results:

Evidence for the role of HRT per se in the treatment of women with BD is limited. Exogenous estrogen has been linked with the induction of mania and rapid cycling, and conversely an estrogen–progesterone combination showed success for treatment-refractory post-partum mania. The use of HRT in perimenopausal and postmenopausal women with BD shows controversial results in the prevention of depression. On the other hand, the diagnosis of BD is not a contraindication to the use of HRT for the relief of menopause symptoms.

Conclusions:

Throughout the reproductive cycle of bipolar women, HRT can be considered for the prevention or treatment of mood episodes, although there is a lack of systematic reviews in this area.

Introduction:

Bipolar disorder is associated with a lifetime risk of completed suicide between 3–6%, which is 20-fold greater than population rates. Suicide accounts, indeed, for 15% to 20% of deaths among bipolar disorder patients. Clozapine's anti-suicidal properties in schizophrenia are well documented and could extend to bipolar disorder.

Objectives:

Presenting a short review of literature about clozapine’s effect on suicidal bipolar disorder patients.

Methods:

We performed a research on Pubmed database, using the following query: "clozapine"[MeSH Terms] AND "suicide"[MeSH Terms] AND "bipolar disorder"[MeSH Terms]. We focused on data from systematic reviews and case series published on last 5 years, either in English or Portuguese.

Results:

Bipolar disorder patients treated with clozapine demonstrated improvement in suicidal ideation and aggressive behavior. Interestingly, psychotic symptoms do not predict a better response to clozapine in bipolar patients, compared with those in schizophrenic patients, and the doses required for optimal effect in BD may be less than those used for treatment-resistant schizophrenia (100-200 mg, in a case series). Clozapine seems to be effective, safe, and well tolerated. Nevertheless, it is used with only 1.5% of bipolar patients, suggesting a substantial underutilization of this valuable drug.

Conclusions:

Clozapine, with its unique pharmacology, anti-aggressive and anti-impulsive properties, is potentially an effective strategy for suicidality in bipolar disorder. An obvious concern is the scarcity of evidence from randomised controlled trials, but it might be worthwhile to re-examine the role of this drug in future revisions of international guidelines.

Introduction:

Cognitive impairment is a well-known feature in bipolar disorder (BD), however most of the evidence comes from studies led by research groups in tertiary services. Cognitive performance assessment is not a common practice in most outpatient clinics yet, and screening instruments may help to fill this knowledge gap. The Screening test for Cognitive Impairment in Psychiatry - Spanish version (SCIP-S) is a validated test to assess suspected cognitive impairment in patients with BD in real-world clinical practice and ISBD cognition impairment task group has recommended it.

Objectives:

To determine neurocognitive function in a representative sample of euthymic outpatients with BD from real-world clinical practice.

Methods:

Neuropsychological performance of 118 euthymic outpatients with DSM-5 BD was assessed by the SCIP-S and two measures for positive cognitive impairment screening were obtained: SCIP-S total score and transformed scores by age and educational level (percentiles ≤15 meaning a positive screening).

Results:

For the total sample, 67% and 52% of the patients screened positive for cognitive impairment when measured by SCIP-S total score and transformed scores, respectively. When the sample was split by age and transformed scores (percentiles) used, cognitive impairment was suspected for 46 % of the patients under 56 years, and 61% of the patients over 55 years

Conclusions:

In a real world sample, results showed a lower percentage of patients with suspected cognitive impairment when compared with specialized centers samples. SCIP-S should be used carefully in patients older than 55 years old, where transformed scores should be recommended.

Introduction:

The omnipresence of social media (SoMe) and online dating sites (ODS) has spurred research investigating how these new possibilities for interaction affect the users’ mental health. However, information is lacking when it comes to patients with mental disorders.In this context, those with bipolar disorder (BD) could be particularly vulnerable due to the occasional transgressive behaviour associated with manic episodes, which is subsequently regretted.

Objectives:

We aimed to investigate whether patients with BD are at increased risk of behaving in a regrettable manner on SoMe and ODS.

Methods:

Individuals aged 18-75 were invited to participate in a survey on the use of SoMe and ODS. Participants were recruited from the outpatient clinic for affective disorders at Aarhus Hospital (AUH-P) and two general practices chosen to roughly match the urban-rural composition of the catchment area of AUH-P. The association between BD and self-reported regretted behaviour on SoMe and ODS was investigated by means of logistic regression with adjustment for age and sex.

Results:

A total of 130 patients with BD and 198 individuals without BD and unipolar depression from the general practices (controls) formed the study sample. BD was associated with a significantly increased risk of regretted behaviour on both SoMe (adjusted odds ratio: 3.54, 95% CI: 2.15- 5.82) and ODS (adjusted odds ratio: 4.31, 95% CI: 2.23- 8.33).

Conclusions:

Our results suggest that individuals with BD are at elevated risk of behaving in a regrettable manner on SoMe and ODS. Guiding patients with BD on cautious use of SoMe and ODS may be warranted.

Introduction:

Differences between BD-I and BD-II patients with regard to specific illness characteristics are poorly understood.

Objectives:

This study is mainly aimed to compare socio-demographic and clinical characteristics between BD-I and BD-II patients with the goal of clarifying possible predictors of clinical course.

Methods:

The sample of this cohort study is composed of 387 currently euthymic bipolar patients. Participants were all receiving only maintenance treatment; their psychopharmacological regimens and psychopathological conditions were stable at assessment.

Results:

BD-II patients were more likely to be female, had more frequently a recent depressive episode and substance abuse/dependence relative to BD-I. BD-II patients were also less likely to have a positive history of psychiatric conditions in family, psychotic symptoms at first episode, and first depressive illness episode. Moreover, BD-II were older at their illness onset and first treatment than BD-I patients. Furthermore, BD-I were more likely to have higher depressive, manic, anxiety, and symptoms severity than BD-I patients. Being female (OR=.289), having psychiatric conditions in family (OR=.273), and higher severity of illness at CGI (OR=.604) were all significantly associated with BD-II.

Conclusions:

Additional studies are required to replicate these results, and facilitate the prediction of BD outcomes according to the specified profile.

Introduction:

Hearing loss is the sixth most common disability in the US. Sign language alike with spoken language is not universal. Knowledge of deaf culture and American Sign Language (ASL) is crucial to accurate diagnosis of psychosis in this population. Psychosis can contribute to sign language dysfluency. Deaf individuals are more likely to be misdiagnosed with psychosis, in part due to differences in the language development of deaf individuals compared with hearing individuals.

Objectives:

To identify, assess and diagnose Psychosis in a deaf patient. Shine Light on Treatment Challenges and Pitfalls in Deaf patient.

Methods:

a case report

Results:

Some of Ms. K’s disorganized communications might have derived from misunderstandings related to language and social deficits. Auditorially based hallucinations are not present in prelingually deaf people. Deaf people’s written communication can be misconstrued as thought disorder and should not be used or interpreted as evidence of a thought disorder but only to judge fluency in English. Lack of consistent exposure to sign language has been shown to result in impairment in language development, understanding emotions and understanding cause and effect sequences. Information about the etiology of deafness is valuable to rule out language deficits due to brain injury.

Conclusions:

In assessment of deaf, language dysfluent patients is complex and requires specialized cultural and linguistic knowledge. Misinterpretation of Psychiatric Illness in Deaf Patients isn’t uncommon; patient’s frustrations and rapid signing mightseen as manic behavior, thought actually a norm with Deaf individuals. Clinicians need to be cautious when diagnosing and treating deaf patients with communication difficulties and suspected psychosis.

Introduction:

Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive and focal form of brain stimulation. rTMS is an evidence-based treatment option accepted by the US Food and Drug Administration, the American Psychiatric Association, the Canadian Network for Mood and Anxiety Treatment, the World Federation of Societies of Biological Psychiatry. There are strong evidences for the efficacy of rTMS in treatment of depressive patients.

Objectives:

To use rTMS in patient with bipolar depression in order not to add new medication in the drug therapy.

Methods:

We used left dorsolateral rTMS in patient with bipolar depression. Current depressive episode was moderate MADRS=27, YMRS=3. The rTMS parameters were 10 Hz, 120% RMT. We reduced the dosage of Quetiapine from 200 mg daily to 150 mg/daily. No changes were made in the dosages of the moodstabilizers: Lamotrigine 300 mg/daily and Carbamazepine 600 mg/daily.

Results:

After the fourth rTMS procedure the patient switched into hypomanic episode, MADRS=5, YMRS=14. We were forced to stop rTMS and to increase the dosage of Quetiapine. It took a week before patient was euthymic and stable again.

Conclusions:

It is difficult to explain the observed hypomanic episode. The hypomanic episode could be a result of the conducted rTMS procedures. It could be a sequence of the reduced dosage of quetiapine or could be just a sequence of the natural course of the bipolar disorder. More accurate data is needed to reach a true conclusion.

Introduction:

Cortisol has been repeatedly associated with neurocognitive functioning in healthy and clinical populations. However, only few studies have assessed the effect of cortisol on cognition in Bipolar Disorder (BD) despite its clinical relevance.

Objectives:

The aim of our study was to examine the effect of cortisol on two cognitive tasks targeting visual memory and executive function (planning) in BD as well as potential moderators. Moreover, we investigated whether cortisol exerts mediatory effects between clinicodemographic or treatment-related factors and cognition, which is as yet unexplored.

Methods:

Cognitive performance of 60 bipolar-I patients and 30 healthy controls was evaluated with CANTAB tasks targeting paired associative learning (PAL) and planning (SOC). Moreover, basal serum cortisol levels were measured.

Results:

Bipolar patients showed significantly poorer performance in PAL and SOC than controls. Higher cortisol was associated with worse performance in PAL (p=0.022). This association was stronger for males (p=0.071). Moreover, current treatment with mood stabilizers had a negative indirect effect on PAL performance through cortisol which was opposite but less strong than the direct association of mood stabilizers with better PAL performance. SOC was not significantly associated with cortisol.

Conclusions:

The present study is one of few studies to examine the effect of cortisol on neurocognitive function in BD and the first to address mediation and moderation effects. Cortisol levels were associated with worse performance in PAL, especially in bipolar men (trend level). Moreover, current use of mood stabilizers showed a significant positive effect on PAL performance despite an opposite indirect effect through cortisol, which necessitates further investigation

Introduction:

Primary healthcare (PHC) physicians play an important role in early diagnosis of Autism Spectrum Disorder (ASD) in children as they are the first line of contact. There have been no studies evaluating the knowledge level of ASD early symptoms and signs in PHC physicians in Saudi Arabia (KSA).

Objectives:

This study aims to assess the awareness of the PHC physicians of ASD early signs in children, by determining the level of knowledge possessed by PHC physicians, identifying the limiting factors affecting their awareness, and discussing the preferred methods required to fill in the knowledge gap.

Methods:

This cross-sectional study was conducted among 147 PHC physicians working in PHC centres and hospitals in the period from January to February 2019 in Riyadh, KSA. The physicians were recruited through convenient sampling technique. A written questionnaire was used for data collection.

Results:

The study findings revealed poor level of knowledge of ASD early signs in children among PHC physicians in Riyadh. A significant positive association was appreciated between the total mean knowledge score with both job title and experience years. Physicians who received prior psychiatric training were noted to have higher level of knowledge about ASD early signs.

Conclusions:

Having a suboptimal awareness of identifying early signs and symptoms of ASD can lead to delayed diagnosis and intervention which adversely affects the health needs and quality of life for autistic children. Thus, it is recommended to provide better specific training of ASD, its presentation and tools of screening.

Introduction:

Today, studies on pediatric acute-onset neuropsychiatric syndrome (PANS), including pediatric infection-triggered neuropsychitric disorder (PITAND) and pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS), are scarce (Calaprice et al., 2017). These disorders represent true clinical entities where is still debated because the data available to describe a characteristic phenotype are still controversial (Gamucci et al., 2019).

Objectives:

The aim of this study is to describe the clinical, neuropsychological and biochemical aspects of patients with symptoms suggestive of PANS.

Methods:

Description of three clinical cases of children diagnosed with PANDAS and PITAND treated in child and adolescent psychiatric unit (Infantil Mental Health Unit) between 2011 to 2019.

Results:

All of patients presented, abruptly, ritualized behaviors, egodistonic obsessive thinking, irritability, emotional lability and separation anxiety. Also, motor tics were observed in one of the patients and another child had night terrors. They were ages between 8 and 10 years. One of the patients was previously diagnosed of autism. All of children had pharyngotonsillitis weeks prior to diagnosis, as well as elevated anti-streptolysin O antibody (ASLOs) titers and pharyngeal smears positive for SBHGA or Haemophilus influenzae. They were treated with beta-lactam antibiotics, SSRIs and low doses of risperidone.

Conclusions:

The PANDAS or PITAND diagnosis is currently controversial. However, series of cases with onset or exacerbation of characteristic symptoms in the context of a high tract infection support the existence of this neuropsychiatric syndrome and that it is necessary to continue investigating.

Introduction:

The three vital parenting practices stressed upon by Self-determination theory (Ryan & Deci, 2000) i.e. parental autonomy-support, parental involvement and parental warmth are suggested to have significant psychological repercussions for adolescents.

Objectives:

The present study aimed to investigate the predictive association of maternal parenting practices (i.e. perceived autonomy support, perceived involvement, and perceived warmth) with positive affect and negative affect in adolescents within Pakistani cultural context.

Methods:

A purposive sample of 531 adolescents (275 males & 256 females) with an age range of 17.18 (±SD 1.41) was recruited form public and private sector schools and colleges of Karachi, Pakistan. Along with Demographic Form, they were administered Perceptions of Parents Scales: The College-Student Scale (Robbins, 1994) and Positive Affect & Negative Affect subscales of ICP-Subjective Well-Being Scale (ICP-SWBS; Moghal, 2012).

Results:

The results of Multiple Regression demonstrate that three dimensions of maternal parenting practices (i.e. perceived autonomy support, perceived involvement, and perceived warmth) explained 24% variation in the scores of positive affect. However, only perceived maternal autonomy support and perceived maternal involvement were found to be significant predictors of positive affect. Likewise, three dimensions of maternal parenting practices explained 18% variation in the scores of negative affect. However, only perceived maternal autonomy support and perceived maternal involvement predicted negative affect.

Conclusions:

Thus, findings highlight the significance of specific maternal parenting dimensions for positive affect and negative affect in adolescents. The findings have important implications and pave the pathways for future studies.

Introduction:

Mental health of the adolescents is a significant universal community health concern because it is the main cause of disease and disability for the adolescents as well as their families and the community. A growing body of evidence has confirmed that adolescents not only experience the whole spectrum of depressive disorders but also suffer from the significant morbidity and mortality associated with them. Consequently, understanding the risk and protective factors influential to mental health problems are considered very important for the prevention of such disorders.

Objectives:

The objective of the present study was to examine the relative contribution of psychosocial factors like, Age, gender, socioeconomic status, birth order, and acedemic achievement in relation to adolescents' depressive symptomatology in Karachi, Pakistan.

Methods:

The sample of 508 adolescents was selected randomly from different public and private educational schools and colleges situated in Karachi-Pakistan. The participant’s age range was between 15-19 years. The Reynolds Adolescents Depression Scale, 2^nd Edition (RADS-2; Reynolds, 2002) was used to measure the depressive symptomatology in adolescents. A demographic form was designed to measure the demographic information of the sample.

Results:

The results of Multiple Regression Analysis suggest that all the variables under investigation i.e. age, gender, birth order, socioeconomic status and academic achievement significantly predicted depressive symptomatology in adolescents.

Conclusions:

The findings of this study contribute to our growing understanding of the connections between psychosocial variable and suggest that in relation to adolescents’ depressive symptomatology, the dimensions of Age, Gender, birth order, socioeconomic status and academic achievement are of vital significance.

Introduction:

attachment troubles are considered relevant co-factors in the pathogenesis of many mental disorders. In particular, their role is a consistent pathogenic factor for eating disorders.

Objectives:

the present contribution describes the possible path linking family and parenting troubles and attachment dynamics with the child and adolescent neurodevelopment, and with the pathogenesis of eating disorders.

Methods:

the report presents literature data focused on the family dynamics’ and the attachment troubles related to the pathogenesis of the EDs which were evidenced worldwide in clinical groups of subjects affected with anorexia nervosa, bulimia nervosa and binge-eating or obesity disorders. The report links these data to the evolutionary steps of child and adolescent development, and evidences the relevance of attachment according to a neurobiological perspective.

Results:

parenting and attachment troubles are relevant in constituting the neurobiological and psychological bases of the self-identity. A weak self-identity is a specific risk factor for the development of an eating disorder during adolescence. Moreover, the troubles of early attachment represent a risk factor for the subsequent difficulties in building the relational-self and managing relationships in adolescence.

Conclusions:

the path linking early parenting and attachment dynamics to the outburst of an eating disorder is a dual carriageway. Each problematic area is interwoven with the other, and it may influence the complex symptoms which are typical of the EDs. The therapeutic approaches which address attachment troubles may produce more rapid effects on both. Future research may explore new therapeutic approaches, also technologically supported, to address attachment troubles during childhood.

Introduction:

Attachment styles is thought to predict the individual's future relationships.

Objectives:

Determine attachment patterns of maltreating mothers with their own fathers during childhood.

Methods:

We conducted a study on mothers whose child was consulting in the unit of child psychiatry of Mongi Slim Hospital (Marsa, Tunisia) between the 1^st of April and the 30^th of June 2018. These children were divided into 2 groups: children of abusive (G1) and non-abusive mothers (G2). Abuse experienced by mothers during their childhood was assessed by the Childhood Trauma Questionnaire (CTQ). We used The Parental Bonding Instrument (PBI) to assess parental behaviours and attitudes.

Results:

The sample was composed of 167 mothers: 108 of them were placed in the G1 and 59 in the G2. The mean age of mothers was 40 years and 3 months. Maltreating mothers had more frequently a history of physical abuse, or emotional abuse or emotional neglect during their childhood (p values were respectively 0.002, 0.05 and 0.007). Three of the mothers in our study had never known their father. Thus, we were only able to complete the PBI questionnaire in 164 cases. There was no significant difference between the “care” and “overprotection” dimensions scores of the participating mothers (p was 0.104 and 0.151). No significant difference was found between the 2 groups concerning the different patterns of attachment.

Conclusions:

More research is necessary to determine the degree to which these results about the role of father attachment in the emergence of child maltreatment are borne out.

Introduction:

Child maltreatment by mothers is a special sub-type of child abuse wich is poorly analysed in the literature.

Objectives:

Identify Sociodemographic and clinical factors associated to children who were abused by their mothers.

Methods:

We conducted a study on mothers whose child was consulting in the unit of child psychiatry of the Mongi Slim Hospital (Marsa, Tunisia) between the 1^st of April and the 30^th of June 2018. These children were divided into 2 groups: children of abusive (G1) and non-abusive mothers (G2). We collected socio demographic and clinical data and information concerning maltreatment using a questionnaire.

Results:

Among the 167 children, 108 (64.7%) were maltreated by their mothers. Physical abuse and emotional abuse were the most frequent (93.1% and 78.7%). These maltreatments began at the mean age of 5 years and 4 months and were lasting for an average of 3 years and 9 months at the time of the study. There was no link between gender and child maltreatment (p=0.709). Children between 6 and 12 years old were more frequently maltreated by their mothers (p=0.004). Some risk factors related to the child were identified: youngest children were more frequently maltreated (p=0.039) as well as those perceived by their mothers as turbulent (p=0.007). In contrast, pre-mature children and children with autism spectrum disorders were less frequently maltreated (p respectively 0.038 and 0.002).

Conclusions:

Child maltreatment is the outcome of the interaction of multiple risk and protection factors. All these factors must be taken into considerations when elaborating a prevention strategy.

Introduction:

A maternal history of child maltreatment is thougt to be an important risk factor in several etiological theories of child maltreatment

Objectives:

Compare traumas experienced during childhood in maltreating and non-maltreating mothers.

Methods:

We conducted a study on mothers whose child was consulting in the unit of child psychiatry of the Mongi Slim Hospital (Marsa, Tunisia) between the 1^st of April and the 30^th of June 2018. These children were divided into 2 groups: children of abusive (G1) and non-abusive mothers (G2). We collected information concerning maltreatment using a questionnaire. Abuse experienced by mothers during their childhood was assessed by the Childhood Trauma Questionnaire (CTQ).

Results:

The G1 was composed of 108 maltreating mothers (64.7%) and the G2 was composed of 59 non-maltreating mothers (35.3%). The mean age of the children sample was 8 years and 11 months. The 2 groups were comparable concerning age, socio-economic level. 83.2% of the mothers experienced different types of abuse and neglect during their childhood. This rate was significantly higher in G1 (87%) than in G2 (76.3%) (p=0.005). Concerning type of maltreatments experienced, significant difference were found for physical abuse (p=0.002), emotional abuse (p=0.05) and emotional neglect (p=0.007). There was no significant difference between the 2 groups concerning the occurrence of physical neglect and sexual abuse during mother’s childhood (p respectively at 0.210 and 0.097).

Conclusions:

We found that maltreatment is transmitted through the generations. Early screening of mothers is essential to break the cycle of perpetuation and stem the intergenerational cascade of maltreatment.

Introduction:

Psychogenic nonepileptic seizures (PNES) are paroxysmal, time-limited impairment of motor-sensory control with alterations in behaviour and consciousness. The estimated prevalence of PNES is 2 to 33 per 100,000 but the epidemiology is less studied in children and adolescents. PNES have been conceptualised as; dissociative phenomena or defensive mechanism to insulate against emotional difficulties; a “hardwired” motor or defensive reflex; a learned and modelled behaviour which is further maintained by reinforcement; a disruption of cognitive control and functions. However, PNES are etiologically and experientially heterogeneous.

Objectives:

This study aims to examine the clinical and psychosocial profile of paediatric PNES patients, gender-related differences, subtype of somatic symptoms and healthcare utilisation rates.

Methods:

This was a retrospective case series in a national specialist paediatric liaison psychiatry department over 3 years. Clinical notes were assessed along with application of CAPA Life Events Scale subscale of the Child and Adolescent Psychiatric Assessment and Child & Adolescent Self-harm in Europe (CASE) Study questionnaire comprising categories of lifetime experience.

Results:

36 patients were included. Mean age of onset was earlier for males (10.3 vs. 13.6 years, p>0.05). Self-harm were only observed in females, and they were more likely to report bullying (p=0.036). Parental separation was the most common life stressor (24.0%)Comorbid epilepsy predicted psychiatric co-morbidity (p=0.035). 39% were diagnosed more than 12 months after PNES onset, 61% had a psychiatric comorbidity and 58.2% had other medically unexplained symptoms. (52.8% chronic pain). 94% patients developed illness in autumn/spring school term.

Conclusions:

Children with PNES have long delays to diagnosis, significant psychiatric morbidity and psychosocial stress. Better understanding by clinicians may improve treatment and prognosis.

Introduction:

Sexual assault is a public health problem worldwide that can be seen both in adult and in child.

Objectives:

This study aims to determinate the sociodemographic profile of child victims of sexual abuse

Methods:

A retrospective study was conducted at the Child and Adolescent Psychiatry Department of Mongi Slim Hospital (Tunisia). We included all cases of patients followed for sexual abuse from January 2013 until June 2019. Data was collected from patients’ records.

Results:

A total of 150 cases was collected with a sex ratio of 0.66. The age ranged from 2 to 18 years old with a mean age of 9.4 years. Concerning the order among their siblings: 31% of our patients were the first, 17% the second, 33% were the youngest and 12% were the only child in their families. Twenty percent of victims lives with parents having conflictual relationship Only 6% of the victims had a mental disability. We find that 28% had scholar difficulties and 17% had excellent results. Concerning familiar characteristics, parents were married in 76%, separated in 12%, and divorced in 12%. 37% of their parents suffer of chronic disease. The familial socio-economic level was low in 24,66 %.

Conclusions:

A better knowledge of the sociodemographic profile of the sexual abused children will allow us to have a better psychiatric care in the future.

Introduction:

Technological advances in psychiatric treatment is relatively recent. Previous studies have shown an improvement, in the access to treatment, for patients with first-episode psychosis (FEP).

Objectives:

The aim of this study is to develop and test the effectiveness of a mobile app–based intervention to improve community functioning in adolescents with FEP.

Methods:

We designed a randomized clinical trial to study the effectiveness of a mobile app–based intervention for adolescents with FEP aged 14-19 years recruited from Gregorio Marañón Hospital, Madrid, Spain. Patients were randomly assigned to an intervention group, which received treatment as usual plus five modules of a psychological intervention through the mobile app (psychoeducation, recognition of symptoms and prevention of relapses, problem solving, mindfulness, and contact wall), or to a control group (standard care).

Results:

The effectiveness of the intervention were assessed by means of an extensive battery of clinical tests at baseline and at 3 months of follow-up. The primary outcome was reduction in psychotic and depressive symptoms; secondary outcomes comprise adherence, awareness, use of drugs, and quality of life. Also, will report the usefulness, user experience (UX) and security perceived by adolescents with a PEP: frequency of application use, average time of use, quantitative use, etc.

Conclusions:

To our knowledge, this is the first randomized online treatment for adolescent with early psychosis comparison with treatment as usual. The main novelty of our approach is the integration of new technologies with traditional psychoeducation, cognitive behavioral therapy techniques, mindfulness and social skills development.

Introduction:

Adolescence is a critical period characterized by deep alterations in one’s identity, conditioned by the experiences and life adversities such as childhood sexual assault (CSA).

Objectives:

Describe the impacts of CSA and study its correlations with PTSD, bipolar disorder (BD) and gender dysphoria (GD).

Methods:

The case of a 17-year-old adolescent, followed-up at the adolescent and child psychiatry department (Mongi Slim Hospital, Tunisia), is reported. A literature review using the following key words was done on Pubmed and Google Scholar: PTSD, avoidance, homosexuality, BD, sexual identity, CSA.

Results:

Case description: GR is a 17-year-old female who’s been followed-up since 2018 for PTSD and depression following a sexual assault. The treatment was based on psychotherapy and medication. The antidepressant was substituted with mood stabilizers following an induced hypomania. During follow-up, considerable changes in physical appearance were noted. GR had her hair cut short and she began to dress like a boy. She also admitted a recent attraction to females, and that she entertained an intimate relationship with a girl, with whom she had a sexual intercourse. This event caused great distress, guilt, perpetual questioning about her sexual identity, and additional PTSD symptoms regarding the homosexual experience.

Conclusions:

CSA is a deleterious type of trauma with severe effects on developmental processes, psychopathology and identity, especially during adolescence. Correlations between CSA, sexual orientation, gender identity and mood disorders remain blurred and require further investigations.

Introduction:

The research was conducted in the tradition of Moscow experimental pathopsychological school and was aimed at development of traditional pathopsychological methods in the direction of new psycholodiagnostical trends oriented at acquisition of both objective data and data about self-awareness of the patient.

Objectives:

Differentiative diagnostical potential of the modified completion test (MCT) (Burlakova, 2016) for adolescents with self-destructive behavior was researched.

Methods:

The study included 128 adolescents aged between 13 and 17 (average age 15±1). 30 of them were the clinical group with self-destructive behavior who received treatment in the psychiatric facility. Control group consisted of 98 adolescents who never sought psychiatric help, were not diagnosed with mental disorders and studied in regular schools. The following methods were used: 1) clinical conversation, 2) psychological anamnesis, 3) MCT, 4) cognitive assessment methods.

Results:

The analysis of test administration and received data was conducted. The specific features of the MCT were defined that intensified emotional involvement of the patient — which expands diagnostic potential of the method. The results of the MCT possessed statistically significant difference in the clinical and control groups. On the stage of completion — number of mistakes and their types; on the stage of continuation — number of emotionally involved and psychologically complex variants and their types. The qualitative differences in the results were discovered in both groups.

Conclusions:

The differentiative diagnostic potential of the MCT was confirmed. The typical markers of test performance were distinguished. Gained results may be useful for the development of pathopsychological diagnostics for adolescents.

Introduction:

Cardiometabolic risks of second-generation antipsychotics (SGAs) are concerning.

Objectives:

To study cardiometabolic risks of SGAs in antipsychotic-naïve youth in a large cohort treated under real-world conditions.

Methods:

Three-month, clinician’s choice Second-Generation Antipsychotic Treatment Indications, Effectiveness and Tolerability in Youth (SATIETY) cohort study in youth (4-18 years). Monthly assessments of height, weight, fasting blood work and illness severity. Analyses stratified by antipsychotic exposures status. Non-adherent subjects served as psychiatric controls.

Results:

599 participants were 15.0 (12.2, 16.9) years old, predominantly post-pubertal (74.5%), male (55.5%), and of normal body weight status (59.8%). In 398 trials of antipsychotic-naive subjects (12 weeks; IQR: 7; 12.7), weight increased significantly +5.2 kg (95% CI=4.8-5.6), differing by SGA (p<0.0001): Olanzapine (N=45) +8.1kg (7.2, 9.0), quetiapine (N=63) +5.4kg (4.6, 6.3), risperidone (N=166) +5.2kg (4.7, 5.), aripiprazole (N=97) +4.2 kg (3.6, 4.9). Controls (N=27) remained stable: 0.5 kg (-0.8, 1.8). In 328 trials of antipsychotic-exposed subjects (12 weeks; IQR: 9; 12.9), weight increased significantly by 3.7kg (95% CI=3.2-4.1) differing by SGA (p<0.0001): Olanzapine (N=44) +7.3kg (6.1, 9.0), quetiapine (N=89) +2.5kg (1.7, 3.5), risperidone (N=72) +5.5kg (4.6, 6.4), ziprasidone (N=41) +3.5 kg (1.9, 5.1), aripiprazole +1.4kg (0.6, 2.5). In antipsychotic-naïve subjects on olanzapine, glucose and all lipid parameters increased significantly (p>0.05); increases in non-HDL differed from aripiprazole, risperidone and controls (p_HSDcorrected<0.05). With quetiapine, insulin, HOMA, total cholesterol, non-HDL cholesterol, triglycerides and the triglyceride/HDL-cholesterol-ratio increased significantly (p>0.05).

Conclusions:

First time SGA use more than repeated SGA use was associated with early clinically significant weight gain with each SGA. Metabolic changes varied more among the SGAs.

Disclosure:

As a family member I share conflicts of interests with Dr. Correll. Dr. Correll has been a consultant to or has received honoraria from AstraZeneca, Bristol-Myers Squibb, Cephalon, Eli Lilly, Intra-Cellular Therapeutics, Medicure, OrthoMcNeill-Janssen, Ot

Introduction:

This presentation attempts to bring awareness into the extent to which learning disabilities and more specifically reading disabilities impact children and adolescent's mental health.

Objectives:

Increase awareness in mental health providers about specific learning disabilities to be able to provide appropriate referrals for the assessment and treatment of these conditions. Provide tools that will help clinicians and families advocate for school related services for children with specific learning disabilities Improve identification of depression and anxiety co-morbid with learning disabilities

Methods:

We reviewed the literature including Pub-med, Google scholar and other available databases relevant for the educational system and found articles pertinent to our topic. We also reviewed data from psychiatric hospitalizations to the child and adolescent psychiatric inpatient unit at Rush University Medical Center from 2014 to 2018 looking for the variability in the number of admissions depending on the school calendar and whether or not the school was in session.

Results:

The majority of students with specific learning disabilities are improperly diagnosed by schools. In addition to school refusal, research confirms that students who have been impacted by learning disabilities tend to exhibit a series of mental health concerns such as low self-esteem, anxiety and depression.

Conclusions:

Identifying and addressing specific learning disabilities in children and adolescent is necessary when evaluating a child that is struggling at school and has academic underachievement. An assessment for co-morbid emotional difficulties should be part of these patients evaluation. There is treatment for specific learning disabilities and when appropriately addressed patients will have improved overall mental health.

Introduction:

Despite the pivotal role that religion plays in the lives of many human beings, it continues to be overlooked in the realm of modern medicine. Efforts to quantify the impact of spirituality on mental health have been scientifically vague, leading to a lack of consensus on the strength of this association. Many depressed adolescent fail to respond to current treatment modalities and demands acute attention.

Objectives:

This literature review aims to extract relevance from studies done in the recent past as they pertain to the question of whether adding a spiritual content to traditional CBT is an area worth looking into, for increased efficacy of psychotherapeutic intervention in adolescents with depression and self-harming behaviors.

Methods:

We used “PubMed”, “Google Scholar” and “PsycINFO” to review study abstracts between 1998-2019 relevant to the keywords, “Adolescent Depression”, “NSSI”, “Religion” and “CBT” and separated 22 articles for deeper analysis. We used Microsoft Excel to stratify study by type, year, study size and findings. We finally inferred one out of three possible answers, “Yes”, “No” and “Neutral” from each study.

Results:

In response to the question: Is there need to expand research in RCBT as a treatment option for adolescents with depression and self-harming behaviors; •19/22 studies were inferred as “Yes”, •2/22 studies were inferred as “Neutral”, •1/22 studies was inferred as “No”

Conclusions:

Depression and NSSI is an escalating problem among adolescents and is not being addressed completely with the current validated standard of care. Incorporating spirituality and faith in CBT could potentially strengthen its efficacy, particularly in adolescents with baseline religiosity.

Introduction:

Sexual minorities show a higher risk of suicide and attempted suicide, but, to our knowledge, a systematic evaluation has not been performed yet.

Objectives:

We aim at evaluating the risk of attempted suicide among LGBTQ youths compared to heterosexual peers, differentiating for each sexual minority group.

Methods:

Using Electronic databases (PubMed, Embase, and PsycINFO) we searched for the terms heterosexual, homosexual, bisexual, transgender, adolescents, teens, and attempted suicide. We identified 764 articles through April 30, 2017. We included studies reporting attempted suicide in sexual minority adolescents compared with heterosexual peers. Thirty-five studies satisfied criteria for inclusion. Pooled analyses were based on odds ratios (ORs), with relevant 95% CIs, weighting each study with inverse variance models with random effects. Risk of publication bias and analysis of heterogeneity through univariable and multivariable meta-regressions were also rated.

Results:

We included 35 studies reported in 22 articles that involved a total of 2.378.987 heterosexual and 113.468 sexual minority adolescents (age range 12-20 years) . Sexual minority adolescents showed higher risk of attempted suicide (OR, 3.50; 95%CI, 2.98-4.12; c2=3074.01; P<.001; I2=99%). Specific OR was 3.71 in the homosexual group (95%CI, 3.15-4.37; c2=825.20; P<.001; I2=97%) and 4.87 in the bisexual group (95%CI, 4.76-4.98; c2=980.02; P<.001; I2=98%); transgender youths were differentiated from the other groups in one study, with an OR of 5.87 (95% CI, 3.51-9.82).

Conclusions:

LGBTQ adolescents have a significantly higher risk of life-threatening behaviors compared to their heterosexual peers, especially transgender. Public awareness and supportive strategies should be implemented in public health plannings.

Introduction:

Adolescents and young adults are at risk for the emergence of mental disorders; 50% of mental health problems show-up by the age of 16 and 75% by 24. This vulnerable population needs an organized transition between child and adolescent mental health services (CAMHS) and adult mental health services (AMHS). Many times this transition struggles due to ideological, structural and functional differences between CAMHS and AMHS. There is a lack of consensus and high-quality evidence regarding which transition-model is the most appropriate for these emerging adults.

Objectives:

To describe the transition model from a sample recruited at CAMHS in Barcelona (CSMIJ-Sant-Martí).

Methods:

Cross-sectional descriptive analysis of a sample of adolescents referred from CAMHS to AMHS, regarding active follow-up, waiting days and psychiatric characteristics.

Results:

Between January 2018 and June 2019, 51 CAMHS patients (58.8% males) were referred to 3 different AMHS; 34 of them (66.6%) have an active follow-up at the moment of the study. 23 patients (45.1%) meet criteria for severe mental disorder, and 34 (66.6%) have neuropsychiatric-treatment prescriptions. Sequential model was used in 45 (88.2%), whereas 6 patients (11.7%) needed parallel transition. Average waiting days until transfer was 49.9 days. One CAMHS-AMHS coordination-meeting takes place every 6 months to assure optimal transition.

Conclusions:

Our results suggest both sequential and parallel models can be effective for a successful CAMHS-AMHS transition. An individualized and flexible approach will always be needed, as well as good coordination between services. Improving transitional care is essential for the prevention, treatment and prognosis of young people. More studies must be conducted in this regard.

Introduction:

Psychiatric inpatient treatment (PIT) indicates a severe disability in need of intensive and expensive therapy. Patients who require PIT early in life are a population particularly at risk. Factors such as adverse childhood experiences (ACEs) are, however, understudied in those with reoccurring PIT in young adulthood.

Objectives:

To investigate risk factors of former inpatients at child and adolescence psychiatry (CAP) in young adulthood.

Methods:

An explorative population-based systematic chart investigation of 390 psychiatric inpatients (51.8% female) aged 18-25 was conducted at the University Hospital Tulln. Data evaluation was done with descriptive methods. Pearson’s chi-squared or Mann-Whitney-U tests and predictive logistic regression models were applied.

Results:

Inpatients with a former CAP admission (10.3%) were predominantly female (77.5%) and heavy PIT users (87.5% vs 28.3%). Their frequency (75.0/61.1) and cumulative number (2 vs 1.1) of documented ACEs were compared to those without a former CAP inpatient treatment increased, having experienced any form of family dysfunction (70.0/43.1), neglect (50.0/24.9) or abuse (40.0/21.1) up to twice as often. Having been an adoptive or foster child (OR:4.5) and sexual abuse (OR:3.0) were next to gender (OR:3.0) identified as main risk factors in the logistic ACE regression model (χ²:44.24, p=<.001, Nagelkerke-R²:22.2%).

Conclusions:

Inpatients with a former CAP admission suffer from significantly higher rates of severe ACEs and require PIT in young adulthood a great deal more often. Special focus should be laid on identifying ACEs, evaluating needs for psychosocial support and therapy, and providing these also after discharge.

Introduction:

Early identification and follow-up of young people with ultra-high-risk for psychosis (UHR) has become one of the main targets of early intervention programmes.

Objectives:

We aimed to explore the presence of dissociative symptoms and self-reported trauma exposure in a population of adolescents (<18 years) referred to a UHR Early Intervention Programme.

Methods:

We studied 77 adolescents (mean age 15.2 year old, 60% males) attending the Child and Adolescent Mental Health Department from Parc Taulí Hospital (Sabadell, Spain) who were referred to the UHR Early Intervention Programme. The Comprehensive Assessment of At Risk Mental States (CAARMS) interview was administered to obtain a UHR diagnosis. Dissociative symptoms were defined by the presence of at least one of the following CAARMS items: depersonalization, derealization and/or perceptual abnormalities. Self-reported exposure to traumatic events was assessed by clinical interview. Fisher’s exact test was used to compare categorical variables between diagnostic groups (UHR vs non-UHR). Significance was set at p<0.05 (two-tailed).

Results:

27 out of 77 (35%) screened adolescents met UHR criteria. UHR individuals reported more dissociative symptoms than non-UHR subjects (100% vs 57%, p<0.001). UHR individuals also reported a greater exposure to traumatic events than non-UHR individuals (63% vs 36%, p= 0.03). However, there was a significant prevalence of dissociative symptoms not related to perceived trauma in both groups.

Conclusions:

Among adolescents who are referred to a UHR programme, those meeting UHR criteria show a greater prevalence of dissociation and exposure to traumatic events. Dissociative symptoms are not necessarily associated with trauma exposure.

Introduction:

The fact of adopting ASD in a child is a difficult task for most families, without which, however, comprehensive rehabilitation and treatment of the child is impossible.

Objectives:

a study of the relationship between the characteristics of the parental perception of a child’s disease and various parameters of the family system, as well as a study of the dynamics of changes in these characteristics at different stages of the adoption of a child’s disease

Methods:

FACES-3, DOBR, essay “My child”, expert evaluation of the adoption of the illness of the child by the parent

Results:

57% of families have a hypognosis type of attitudes toward the illness of the child, i28% - hypergnosis and in 14% - adequate type. Families with a hypognosis type are mainly at the stage of denying the fact of the child's illness. They are characterized by rigid internal and blurred external family boundaries. Families with a hypergnosis type are more likely to be at the bargaining or depression stage; the internal borders are blurred, and the external ones are rigid. Families with an adequately formed picture of the child’s disease have passed the stages of adoption. They are characterized by flexible internal and external boundaries of the family system, take part in the correctional and rehabilitation process.

Conclusions:

Work with families should facilitate family acceptance of the child’s disease and should be aimed at creating an adequate picture of the child’s disease, which will lead to increased adherence to treatment and increased functionality of families.

Introduction:

While atypical antipsychotics are promising as effective treatment strategies for psychiatric disorders in children, they are associated with an increase in cardiometabolic side effects.With this in mind, cardiometabolic monitoring is at the forefront of research with atypical antipsychotics and the APA has guidelines for screening

Objectives:

We aimed to evaluate the effectiveness of an electronic medical record "hard stop" that is dedicated to cardiometabolic screening. Our hope is that since its implementation we would see an improvement in cardiometabolic monitoring for all children and adolescents prescribed atypical antipsychotics

Methods:

A retrospective cross-sectional study was conducted in our Child and Adolescent outpatient clinic and identified those that were prescribed atypical antipsychotics. Of the 1088 patients, 212 were prescribed AAAs. We compare cardiometabolic monitoring in these patients post intervention in our resident run performance improvement project. The intervention included stops and questions in the electronic medical record. We compare the rate of cardiometabolic monitoring from these two periods and review fasting blood glucose, HgA1c, BMI, weight and cholesterol/LDL.

Results:

The 212 patients who were prescribed AAAs found to have the following distinguished characteristics which collaborating with National-Based studies; mean age 14 yo Male 129(61), Female 83 (39%), Hispanic 97(46%), Black77(36%), Other 38(18%). The intervention in the electronic medical record improved cardiometabolic monitoring in the child and adolescent population.

Conclusions:

While interventions in the electronic medical record have been shown to be effective, there continues to be a need for continued education for clinicians, patients and guardians alike

Introduction:

Currently, Atypical Antipsychotic Agents(AAAs) are FDA approved for the management of several child psychiatric disorders. The most notable rise in prescribing trends has been reported in the off-label use of AAAsStudies show that groups including parents, healthcare providers, and payers, are motivated to find effective strategies to combat disruptive behaviors in children in an effort to prevent the development of chronic, disabling conditions adn to help decrease the amount of hospitalizations.

Objectives:

To highlight the importance of treatment early on DMDD, to identify Challenges in Prescribing Practice of AAAs aiming to reduce hospitalization rates and address what would be good practice in managing DMDD

Methods:

This is a retrospective case controlled review of 212 selected patients on AAAs studied for rates of hospitalization due to illness exacerbation, compared with a random sample of patients matched in Age window, Ethnicity, gender, diagnosis spectrum, but characteristically not prescribed AAAs during the calendar year and managed by non-pharmacological approach instead

Results:

We hypothesize that there will be a difference in hospitalization rates for patients on AAAs as compared to those patients not on AAAs

Conclusions:

Although the use of AAAs in children is mostly used for off label reasons we aim to add to this research and highlight the importance of treatment early on in the disease to reduce hospitalization rates and maintain functionality for patients. Based on our study, having a patient-centered prescribing practice featured with a case-by-case review of risks and benefits would be a good practice to consider

Introduction:

Major depression is a significant global health problem with the highest risk emerging during adolescence. Data from world and U.S epidemiological studies show rising levels of depression and suicidality, including suicidal ideation and plans. Early onset of depression is associated with a higher likelihood of recurrence and left untreated, significant sequelae including interpersonal issues, poor educational performance, comorbidity, and suicide.

Objectives:

The objective of this presentation is to present the state of the science of the psychopharmacological treatment of depression in adolescents.

Methods:

Review of the literature on antidepressants in adolescents.

Results:

Despite recent advances, SSRIs remain the mainstay of psychopharmacological treatment in youth and there is limited data on the efficacy of other antidepressants, including newer SSRIs, SNRIs, and bupropion. Of the SSRIs, there is the most data on fluoxetine, either alone or in combination with psychotherapy. However, youth also exhibit high rates of placebo response, further complicating our understanding of their effectiveness. Debate continues on their risks, including suicide. The selection of an antidepressant for adolescents depends on clinical need including severity of depression, comorbidity, and youth/family choice, balanced with the risk of side effects, including potential for suicidality. Careful monitoring is necessary, especially early, for worsening of symptoms, lack of effect, and suicide risk.

Conclusions:

Overall, the data suggest that some antidepressants are effective for the treatment of adolescent depression, and the combination of both medication and psychotherapy appears to be the most effective. Treatment is necessary to intervene early and prevent recurrence.

Introduction:

Referral rates to Child and Adolescent Psychiatric (CAP) services in Denmark have increased by more than 75% in the past 15 years, resulting in 15% of all children being in contact with CAP services before the age of 18. This has led to major concerns in the public regarding the increasing rates of children and adolescent with psychiatric disorders and overdiagnosis due to lower thresholds for referral. However, data does not support that an increase in prevalence is driving the steep increase in referral rates and referral rates do not exceed the known prevalence of psychiatric disorders in children and adolescents. There is a need to investigate changes in referral patterns to improve our understanding of what is driving the increase in referral rates.

Objectives:

The study objectives: 1. Investigate changes in referral patterns from 2005-2018. 2. Describe characteristics of children and adolescent referred to CAP services in 2018.

Methods:

Comparison of referral data from 2018 with referral data from 2005 and 2010 from the Danish Child and Adolescent Psychiatry Database. Systematic review of all referral letters (N=2200) to CAP services in the North Denmark Region from 2018.

Results:

This study will show changes in distribution of demographic and referral variables over time and provide knowledge on the characteristics of children and adolescents referred to CAP services, regarding symptomology, functioning and help acquired prior to referral.

Conclusions:

Conclusion: Results from this study will provide valuable new knowledge on referral patterns that can inform the future organisation of CAP services.

Introduction:

Self-injurious behavior appears among people who harm themselves to induce pain. This behavior is increasingly common among adolescents. Researchers investigate psychosocial factors, such as emotion dysregulation, associated with self-injurious behavior. It is supposed that this link is not direct and can be mediated by body image (Muehlenkamp, Brausch, 2012).

Objectives:

In present study we investigated links between health anxiety, body image and self-injurious behavior among adolescents.

Methods:

One hundred twenty-five adolescents took part in the study (age range = 13-17 y.o., M_age = 14.81, SD = 0.93, 62 males). The Short Health Anxiety Inventory (Salkovskis et al., 2002) was used to measure health anxiety. Body investment scale assessed the degree of dissatisfaction with one’s body (Skugarevsky et al., 2007). Self-injurious behaviors were measured by self-report (Polskaya, 2010).

Results:

Regression analysis showed that health anxiety was significantly and positively related to body dissatisfaction (β = .322, t = 3.769, p = .0001, R² = .096). Body dissatisfaction was significantly and positively related to self-injurious behavior (β = .284, t = 3.289, p = .001, R² = .073). There was no significant relation between health anxiety and self-injurious behavior (β = .055, t = .612, p = .542, R² =-.005).

Conclusions:

Higher levels of health anxiety are associated with body dissatisfaction. In its turn, body dissatisfaction is related to self-injurious behavior. The absence of direct link between health anxiety and self-injurious behavior suggests that body dissatisfaction fully mediates that link. These findings are in line with previous research (Muehlenkamp, Brausch, 2012).

Introduction:

Prediction of the antipsychotic’s effectiveness in patients with acute psychotic episode is a relevant topic in the field of personalized medicine. Adolescents are an under-explored cohorton this aspect.

Objectives:

To evaluate associations of DRD2 and HTR2A polymorphisms with effectiveness of psychopharmacotherapy in adolescents with acute psychotic episode

Methods:

53 adolescents were included in the study, with 14 days of observation. Average age: 15,08±1,7 years. All patients were prescribed antipsychotics as the main drug. We evaluated the effectiveness of psychopharmacotherapy using the Positive and Negative Symptoms Scale (PANSS). Every patient had a buccal epithelium scrape taken from them. Identification of DRD2 (rs1800497, T allele) and HTR2A (rs6313, C allele) were performed by the RT-PCR. Statistical processing was carried out in SPSS Statistics 21.0, non-parametric methods of analysis were used.

Results:

The distribution of genotypes of all polymorphisms corresponded to the Hardy-Weinberg equilibrium (p>0.05).The carriers of the DRD2 rs1800497 (CT+TT genotypes) had a higher value of the delta score of PANSS subscale “Positive Symptoms” between 1 and 14 day of observation (Mediana=(-4,00) [-12,00; 9,00] vs Mediana=(-7,50)[-14,00; -2,00]; p=0,005). Significant associations were found between the HTR2A rs6313 and the delta score of PANSS subscale “Negative Symptoms”: the improvement of the state of C-allele carriers was significantly lower compared to the TT homozygotes (Mediana=(-3,00) [-9,00; 4,00] vs Mediana=(-1,00) [-17,00; 11,00]; p=0,037).

Conclusions:

Carriers of the DRD2 rs1800497 (CT+TT) had significant improvement in positive symptoms compared to CC homozygotes. HTR2A rs6313 polymorphism carriers (TC+CC) had a lack of reduction of negative symptoms compared to TT homozygotes.

Introduction:

Various digital technologies are increasingly being introduced into the everyday life of children. What kind of specific effect does this new “digital environment” have for cognitive and brain development in children?

Objectives:

The goal of this research is to reveal the impact of computer game addiction on visuospatial abilities in 7-year-old children.

Methods:

We used questionnaire for parents to reveal children with computer game addiction. Experimental group consisted of 23 7-year-old children with computer game addiction. Control group consisted of 23 children without computer game addiction. The children from experimental and control group were matched for IQ, gender and age. To assess the visuospatial abilities in children we used subtests from NEPSY (Block Construction, Design Copying, Route Finding) as well as the Rey-Osterrieth Complex Figure test.

Results:

One-way ANOVAs by group revealed significant differences (p≤0,05) between the groups for scores in two visuospatial subtests from NEPSY (Block Construction, Design Copying). We also revealed significant differences (p≤0,05) between the groups for number of spatial errors in the Rey-Osterieth Complex Figure test.

Conclusions:

This research has shown that 7-year-old children with computer game addiction have weakness in visuospatial abilities. It can be assumed that computer game addiction is one of the risk factors for emerging deficit in visuospatial abilities in children. We are going to check this hypothesis using longitudinal approach.

Introduction:

It is known that children with attention deficit disorder have deficit in cognitive abilities, specifically in executive abilities. It is important to develop the trainings to overcome this deficit in children with ADD.

Objectives:

The goal of this study was to reveal effect of body-oriented therapy on executive abilities in ADD children. We compared the efficacy of two methods of treatment (body-oriented therapy for children vs. conventional motor exercises) in a randomized controlled pilot study.

Methods:

15 children with ADD between 6 to 7 years of age were included and randomly assigned to treatment conditions according to a 2×2 cross-over design. The body-oriented therapy included the exercises from yoga and breathing techniques. To assess the executive functions and attention in children we used 4 subtests from NEPSY (Tower, Auditory Attention and Response Set, Visual Attention, Statue). Effects of treatment were analyzed by means of an ANOVA for repeated measurements.

Results:

The ANOVA has revealed (p<.05) that for all 4 subtests on executive functions and attention the body-oriented therapy was superior to the conventional motor training, with effect sizes in the medium-to-high range (0.44-0.83).

Conclusions:

The findings from this pilot study suggest that body-oriented therapy can effectively influence the executive abilities in children with attention deficit disorder. However, it is necessary to do further research for revealing the impact of body-oriented therapies on the prevention and treatment of ADD in children. The research was supported by Act 211 Government of the Russian Federation, agreement 02.A03.21.0006.

Introduction:

Children with specific language impairment have difficulties with producing and understanding language (Bishop, 1997). It is necessary to search for the risk factors, which can provoke the development of this deficit in children.

Objectives:

The goal of this research was to examine the hypothesis that children at the age of 5 with deficit in executive abilities have a risk for emerging weakness in grammar understanding at the age of 8.

Methods:

119 children at the age of 5 were assessed using 5 subtests from NEPSY, which are designed to assess executive abilities in children. We have revealed 28 children with deficit in executive abilities. These children were included in the experimental group. The control group included 28 children with no deficit in executive abilities. In the framework of longitudinal research children at the age of 8 from both groups were assessed by Grammar Understanding Test from Luria's neuropsychological assessment technique.

Results:

One-way ANOVA has revealed significant differences [p≤0,05] between groups for scores in Grammar Understanding Test. Children from experimental group had low level of grammar understanding.

Conclusions:

This research has shown that deficit in executive abilities can predict the delay in development of grammar understanding in children. The received results provided insight into cognitive mechanisms in typically developing and the underlying nature of specific language impairments. It can be assumed that deficit in executive abilities is one of the risk factors for emerging weakness in grammar understanding in children. The research was supported by Act 211 Government of the Russian Federation, agreement no. 02.A03.21.0006.

Introduction:

It was shown that children with attention deficit disorder (ADD) have cognitive deficit, particularly deficit in working memory (Martinussen et al., 2012). In our previous research we have revealed that ADHD children have deficit in visual memory in delayed recall condition in comparison to immediate condition (Kiselev, 2018).

Objectives:

The goal of this research was to examine the hypothesis that 7-8 years old children with attention deficit disorder have a deficit in verbal memory in delayed recall condition.

Methods:

The experimental group included 15 children with ADD at the age of 7-8 years. The control group included 15 typically developing children. The children from groups were matched for IQ, gender and age. Children from both groups were assessed with verbal memory test from Luria’s neuropsychological battery. This test is designed to assess reproducing the 6 words in immediate and delayed recall conditions. ANOVA with repeated measures was used to reveal group differences in reproducing the words in two conditions.

Results:

We have not revealed significant differences between children from experimental and control group in reproducing the words in immediate condition. However, the interaction of condition type and group was significant [p≤0,05]. Children with ADD had weakness in reproducing the words in delayed recall condition.

Conclusions:

In view of our previously received results in children with ADD, we can propose that deficit in memory in delayed recall condition can be one of the key symptoms in this disorder. The research was supported by Act 211 Government of the Russian Federation, agreement 02.A03.21.0006.

Introduction:

The need arises to investigate the origin of graphic productions, so particular for the victims of CSA, as mental representations of early traumatic experiences, during the development of the nervous system and its imprints in the cerebral cortex (Brodmann and Broca areas), associated with other interconnected nuclei, that deal with regulatory functions of emotions as well as those related to cognition.

Objectives:

We can show that these graphs are motor expression of the evocation of the sensory stimuli which were experienced during and / or the traumatic episodes, and that are perceived through all the senses, predominantly tactile one (somatosensory areas).

Methods:

The drawings of 38 victims of CSA (22 girls, 16 boys) were studied, whose ages oscillated, at the time of the first consultation, between 3 and 38 years old, with or without prior disclosure of the facts. They were evaluated with HTP, DFH and Free Drawing, whose findings coincided with CSA indicators in other projective tests (Patté Noire, Desiderative) and with clinical signs (enuresis, sleep disorders, learning and eating, anxiety, somatization, etc.).

Results:

The graphs showed shading of genital areas, marks on trunks, hidden hands, absent body parts; asymmetrical, unstable and small figures, etc.

Conclusions:

It can be concluded that the observed relationship between graphic signs and the descriptions and / or the suspicion of CSA, can be based on the imprints that such trauma causes in the cortical regions of the naturally immature Central Nervous System, in each age group studied.

Introduction:

Abusive conduct, mistreatment, neglect and domestic violence are rarely considered among likely or differential diagnoses, unless they indicate sexual abuse or when sexually transmitted diseases are confirmed. The recognition of physical and psychological abuse, however, should be done by child care agencies, through a multidisciplinary approach, seeking to minimize or eliminate the suffering of the child, promoting and ensuring its well-being and even survival. Violence against children tends to be an uncomfortable topic for many doctors, in part by the lack of training to recognize and deal with the problem.

Objectives:

To introduce the hospitalization of children from 0 to 19 years old due to mistreatment syndrome registered by the SUS (Unique System of Health) from july 2009 to july 2019 in Brazil. This is a way to alert and prevent an early diagnostic from Mistreatment Syndrome.

Methods:

The data concerning hospitalization due to Mistreatment Syndrome were collected from Ministry of Health - Hospital Information System (SIH/SUS) and analysed.

Results:

5.763 people were hospitalized due to mistreatment syndrome in Brazil registered by the SUS (Unique System of Health) from july 2009 to july 2019. From this amount, 2.867 (49,7%) children from 0 to 19 years old were treated for the mistreatment, 1.872 (65,3%) of those children were female. Most cases of those children (24,9%) occurred at the age of 5 to 9 years.

Conclusions:

Mistreatment Syndrome demonstrate the urgent need of resources for preventive medicine, withouth forgetting curative medicine. This requires an action plan that must bring together health professionals, educators and the media.

Introduction:

The generalized structure of voluntary activity (VA) includes goal-setting, modeling, planning, self-control, and self-correction. Diagnosis of violations of VA in CSN should be based on the characteristics of a concrete disorder to form an adequate development strategy.

Objectives:

We assume that in preschool-age CSN, the specific profile of primary neurocognitive deficit is combined with the features disorder of VA revealed for different groups of CSN differing from the normatively developing children (NDC). The study involved 27 children, and two groups were formed. The 1^st group included 14 CSN (ADHD, ASD, SSD, and MD). 13 NDC formed the 2^nd group.

Methods:

A complex of neuropsychological tests, a technique for diagnosing the development of systemic components of activity self-regulation 'Build your house', a questionnaire for evaluating the components of VA for parents and educators, adapted technique for the inhibition of the dominant response 'Simon Task'.

Results:

All CSN demonstrated less developed strategies for goal-setting, planning, modeling, self-control and self-reflection (CSN-33%, NDC-78%). Temporal and qualitative differences in tests performance were found within groups CSN. Better scores for the 'Selection reaction' test correlated with the higher development of the basic components of VA. The better CSN managed the 'Selection reaction' test, the better they performed the attention tests (Simon task (R_both=,72) and test 'Faces' (R=,60)), the spatial test (R=,57), and the constructive praxis test (R=,65).

Conclusions:

Preschool children of CSN have common and specific features of voluntary activity that distinguish them from NDC.

Introduction:

Perfectionism is a personality trait leading individuals to develop unrealistically high standards for performance accompanied by tendencies for overly critical self-evaluations. Onset of perfectionism may begin early in life, sometimes in young children. The Child-Adolescent Perfectionism Scale - Parents Report (CAPS–PR) is a 9-item scale to be answered by parents (mother and/or father) to assess Perfectionism in their children.

Objectives:

To examine the construct validity of the CAPS-PR (using Confirmatory Factor Analysis/CFA) to evaluate children perfectionism as perceived by their parents.

Methods:

Parents (mother or father) of 150 children (6-10 years) answered the Portuguese versions of the CAPS-PR and some questions about anxiety symptoms. To study the temporal stability, 66 respondents answered the questionnaires again after six weeks.

Results:

CAPS–PR’s CFA indicated a good fit (X²/df = 2.495; CFI = 0.945; GFI = 0.922, RMSEA = 0.100; p[rmsea≤0.06]), supporting the two-factor structure previously found in an Exploratory Factor Analysis carried with a different sample: Social Prescribed Perfectionism/SPP and Self-Oriented Perfectionism/SOP. Both dimensions presented Cronbach’s alpha coefficients (α) <.80 and test-retest correlation was r=.78 for SOP-PR and r=.61 for SPP-PR. The SPP-PR score significantly and moderately correlated with anxiety symptoms (p<.05). Mean scores did not differ by gender.

Conclusions:

CAPS–PR presents adequate construct validity, as well as reliability and convergent validity. This innovative instrument has the potential to be a useful in understanding the transgenerational aspects of perfectionism in young children.

Introduction:

Parents have a significant impact on the formation of their children's health-saving behavior. A detailed study of this effect allows us to determine strategies of interaction and directions of psych correction of maladaptive behaviors in health issues. Deformation of family relationships can lead to violations of adaptation and dependent behavior in children.

Objectives:

To access the parental influence on the formation of health-saving behavior in primary school-age children.

Methods:

The study has involved 69 people (33 frequently and rarely ill children (mean age – 9±1.8) and 36 parents (mean age – 43±11). We used “Unfinished sentences about health” (Yakovleva, 2014) for both children and parents and the questionnaire “The Analysis of family relationships” (Eidemiller, Justickis, 1990).

Results:

Parents of frequently and rarely ill children in families with hyper- and hypoprotection transmitted their health attitudes to primary school-age children in such components as: Diseases (75% vs 75%, p>0.05), Health promotion factors (causes) (75% vs 83.3%, p>0.05). Families with hyperprotection significantly differ from hypoprotection families by the following components: Assessment of healthy people (81.2% vs 58.3%, p≤0.01), Health promotion actions (62.5% vs 83.3%, p≤0.01). Awareness of the value of health is transmitted in families with hyperprotection in 100% of cases and is not transmitted in families with hypoprotection at all.

Conclusions:

The obtained results prove the importance of family education style and parents' health attitudes to the process of the health-saving behavior formation in children. We have identified health attitude components that are the most significant for children at this age.

Introduction:

Chronic somatic pathology, detected in early childhood and compensated by adolescence, often referred to as psychosomatic disorders. It traditionally include atopic dermatitis (AD), bronchial asthma (BA), gastroesophageal reflux disease (GERD) and a number of other disorders. The indicated diseases are often accompanied by mild neuropsychiatric disorders. In children with AD developmental deficiency is observed; in children with GERD neuropsychiatric disorders of cerebral organic origin are detected; in children with BA impaired attention, memory and self-control skills are observed.

Objectives:

to study the clinical neuropsychiatric and neuropsychological features of children suffering from psychosomatic disorders

Methods:

the study involved children from 5 to 12 years old with an established diagnosis of bronchial asthma - 108 children; atopic dermatitis - 105 children; gastroesophageal reflux disease - 112 children; the control group consisted of 60 same age healthy children. All children underwent clinical-anamnestic, neurological, psychopathological and neuropsychological research.

Results:

The children with psychosomatic disorders have a significantly high incidence of pathogenic factors of central nervous system damage in early stages of ontogenesis (pathology of pregnancy and childbirth). Early sensory and motor deprivation due to somatic suffering aggravates neuropsychiatric deficiency. Neuropsychological disorders were predominantly represented by a violation of the perception of their body, lack of kinesthetic and motor functions, spatial and quasi-spatial representations.

Conclusions:

the clinical dynamics of neuropsychiatric disorders in children with psychosomatic disorders corresponds to the dynamics of residual cerebral organic impairment with a stage-age changes of syndromes. The revealed neuropsychological disorders correspond to preferential damage to the first (energy) functional block of the brain.

Introduction:

Mental development of a physically disabled adolescent who makes no goal-directed efforts can result in a certain impairment of his social adjustment.

Objectives:

The goal of the research is to determine the specifics of the psychosocial adjustment in physically disabled adolescents.

Methods:

We used Rogers and Dymond’s questionnaire to evaluate the psychosocial adjustment in 51 physically disabled adolescents and in the control group of 52 adolescents who have no health disorders.

Results:

The integral level of psychosocial adjustment among physically disabled adolescents is statistically lower than in the control group (p<0.05). A significant decline in the indicators of psychosocial adjustment in physically disabled adolescents has been marked at such levels as evaluation of others (p<0.05), emotional comfort (p<0.05) and integrity (p<0.05). The received findings explain why disabled adolescents feel less inclined to communicate and interact with other people, or work with them in a team, as well as why they feel uncertain in their emotional response to the actual reality, which manifests in lack of confidence, depression and inertia. We did not find any veritable statistic differences between these two groups of adolescents at the levels of self-esteem and domination as the components of psychosocial adjustment (p>0.05).

Conclusions:

The specificity of psychosocial adjustment of physically disabled adolescents lies in the reduced adjustment to the conditions of interaction with the real world against the background of their adequate perception of their own strengths and weaknesses, declined tolerance towards other people, inclination for keeping distance in communication and lack of evident desire to influence other people.