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E-Poster Viewing

Published online by Cambridge University Press:  04 September 2020

Abstract

Type
Abstracts
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s) 2020
RANZCP position: e-cigarettes and vaporisers
J. Allan
Royal Australian and New Zealand College of Psychiatrists, President, , Australia

Introduction:

People living with mental illness are more likely to smoke and tend to smoke more heavily than the general population. They are less likely to succeed during a smoking cessation attempt. People with mental illness experience significantly poorer physical health outcomes too; smoking is the leading cause of this. Tobacco harm reduction is an essential component of any policy framework that aims to improve health outcomes for people who smoke.

In 2018, the Royal Australian and New Zealand College of Psychiatrists (RANZCP) published a position statement on e-cigarettes which supports the legalisation and regulation of nicotine containing e-cigarettes to facilitate their use as harm reduction tools.

Objectives:

To provide an overview of the RANZCP position on e-cigarettes and vaporisers.

Methods:

Relevant studies were sourced from the published literature and reviewed by members of the RANZCP Faculty of Addiction Psychiatry. The position statement was subject to rigorous consultation and review within the RANZCP.

Results:

The statement provides an overview of the RANZCP position on e-cigarettes. The position statement recognises the potential harm which use of such products may entail and therefore encourages further research to clarify the nature and extent of harm associated with e-cigarettes given recent safety concerns, as well as the role they may play in smoking cessation.

Conclusions:

In recognition of the disproportionately high smoking prevalence, and low quit rates, among people living with mental illness, the RANZCP supports the legalisation and regulation of nicotine containing e-cigarettes to facilitate their use as harm reduction tools.

Keywords:

e-cigarettes

vaporisers

Conflict of interest:

No

The relationship between alexithymia and suicide among moroccan patients with substance use disorders
K. Karjouh 1
F.-Z. Azzaoui 2 *
A.O.T. Ahami 3
H. Hami 4
S. Boulbaroud 5
1Unit of Cognitive and Behavioral Neuroscience and Applied Nutrition, Faculty of Science, Department of Biology, KENITRA, Morocco
2Unit of Cognitive and Behavioral Neuroscience and Applied Nutrition, Faculty of Science, Department of Biology, , Morocco
3Unit of Cognitive and Behavioral Neuroscience and Applied Nutrition, Faculty of Science, Department of Biology, , Morocco
4Laboratory of Genetics and Biometry, Faculty of Science, Ibn Tofail University, Department of Biology, , Morocco
5Polydisciplinary Faculty- Sultan Moulay Slimane University, Polydisciplinary Faculty, , Morocco
*Corresponding author.

Introduction:

The substance use disorders (SUD) are a major public health problem around the world. Different neuropsychological impairments can appear during this disorder, such as the alexithymia syndrome and suicidal ideations and behaviors, that both constitute risks that threat these patients.

Objectives:

To estimate the prevalence of alexithymia among drug addicted patients and to determine the relation between alexithymia and suicidal ideation and factors associated with suicidal ideation among drug addicted patients.

Methods:

A sample of 152 drug addicted patients (77% Male and 23% F), whom respond to socio-demographic questionnaire are recruited to this study. Alexithymia is measured by Toronto Alexithymia Scale-20 (TAS-20), suicidal ideation and behaviours are measured by Columbia-Suicide Severity Rating Scale (C-SSRS).

Results:

Among substance-dependent patients 46.7% was considered as a group with alexithymia. Rates of being single and unemployed were higher in the alexithymic group, but current age, age at first substance use and educational status were lower. A significant correlation was found between TAS 20, its factors and C-SSRS. Almost more than two thirds of alexithymic drug addicted patients have suicidal ideation and behaviours. It was found also, that TAS 20 total scores predicted C-SSRS scores.

Conclusions:

SUD patients with intensive suicidal ideation and behaviours accompanied with alexithymia are characterized by the inability to communicate feelings. Therefore, suicidal ideation and behaviours may occur in those patients without expressed suicide message. Based upon the finding’s, alexithymia may be a good predictor of suicidal ideation and behaviours for preventing suicidal attempts in patients with drug addiction.

Keywords:

Suicide

Addiction

Morocco

Alexithymia

Conflict of interest:

No

Suicidality in a sample of patients with gambling disorder
C. Carmassi 1
F.M. Barberi 1 *
V. Dell'Oste 1
C.A. Bertelloni 1
I.M. Cremone 1
V. Pedrinelli 1
A. Cordone 1
P. Mannari 2
E. Pioli 2
A. Maglio 1
L. Dell'Osso 1
1University of Pisa, Department of Clinical and Experimental Medicine, , Italy
2Asl Toscana Nord Ovest, Serd, , Italy
*Corresponding author.

Introduction:

Emerging evidence suggests how individuals with Gambling Disorder (GD) may show an increased risk for suicide and suicidal ideation compared with the general population.

Objectives:

The aim of this study was to first explore the relationship between GD and suicidality in a sample of patients attending a specific program for GD in the Center for pathological addictions (SerD).

Methods:

A sample of 36 patients with GD attending the SerD in Lucca (Italy) completed the Columbia-Suicide Severity Rating Scale (C-SSRS) to assess suicidal ideation and behavior.

Results:

Most of the patients were males (33, 89,2%), with a mean age (±SD) of 50,6 ± years. A 40.5% of the total sample met at least one C-SSRS item of suicidal ideation at admission and 13.5% of suicidal behavior. Those who had at least one C-SSRS suicidal ideation item had an intensity of ideation mean score of 11.5 / 25 points.

Conclusions:

This study corroborates the need for careful investigation and specific prevention of suicidal ideation and attempts in patients with a behavioural addiction, such as GD.

Keywords:

Suicide

Gambling

behavioral addictions

Suicidality

Conflict of interest:

No

Problematic use of the internet (PUI) and post-traumatic stress spectrum symptoms in patients with bipolar disorder
C. Carmassi
C.A. Bertelloni
F.M. Barberi *
V. Dell'Oste
A. Maglio
A. Cordone
V. Pedrinelli
I.M. Cremone
L. Dell’Osso
University of Pisa, Department of Clinical and Experimental Medicine, , Italy
*Corresponding author.

Introduction:

Recent data showed a high risk for Problematic Use of the Internet (PUI) in patients with mood disorders, especially Bipolar Disorder (BD). Despite traumatic exposure and Post-Traumatic Stress Disorder (PTSD) have been shown to be associated with alcohol and substance use disorder, as well as behavioral addictions such as gambling disorder among patients with BD, little is known about the possible correlations with PUI.

Objectives:

The aim of this study was to examine the relationships between PUI and lifetime trauma exposure, besides Post-Traumatic Stress Spectrum symptoms, in a sample of inpatients with BD consecutively hospitalized at the Psychiatric Clinic of the University of Pisa.

Methods:

113 inpatients with BD completed the Adult Autism Spectrum (AdAS Spectrum), that includes item 66 to assess putative PUI, and the Trauma and Loss Spectrum Self-Report (TALS-SR), to explore lifetime Post-Traumatic Stress Spectrum symptoms.

Results:

21.2% of the sample reported a putative PUI with significantly higher TALS-SR total scores with respect to patients with BD without PUI. The former also reported significantly high scores in some of the TALS-SR domains: Potentially Traumatic Events, Re-experiencing, Maladaptive Coping and Arousal. Furthermore, a positive association emerged between Potentially Traumatic Events and Arousal TALS-SR domains scores and putative PUI.

Conclusions:

This study reveals a significant association between PUI and lifetime trauma exposure as well as Post-Traumatic Stress Spectrum symptoms in patients with BD, suggesting the need for accurate evaluation of these subjects and possible targeted treatment.

Keywords:

PTSD

Bipolar disorder

internet addiction

Conflict of interest:

No

The effect of psychotherapeutic treatment in co-dependent relatives of drug-dependent patients on the efficiency of the treatment-rehabilitation process.
Z. Bereza 1 *
E. Isaeva 2
1Bechterev Medical Centre, Psychiatry, , Russian Federation
2Medical State University n.a Pavlov, Psychology, Saint-Peterburg , Russian Federation
*Corresponding author.

Introduction:

Due to the lack of methadone maintenance treatment for opioid addicts in Russia, an integrated medical and social rehabilitation is the principal method of medical care of such patients, co- dependence is a number of changes and violations in relations and interactions in families with one or more members suffer substance abuse.

Objectives:

The study is devoted to the study of the phenomenon of codependence in the families of drug addicts and the influence of psychotherapeutic correction of co-dependence in mothers on the stability of participation of drug addicts in the complex medical rehabilitation program.

Methods:

We examined 61 drug-addicted patients and 61 their mothers, admitted for hospital treatment and agreed to participate in the study. We studied the socio-demographic, Clinical and psychological characteristics of participants and also we collected annual follow-up data.

Results:

Drug addicts whose mothers underwent a psychotherapeutic support program, were much more likely to remain in the inpatient rehabilitation program. Kaplan-Mayer survival analysis showed significant differences between the groups in the duration of patients’ participation in the rehabilitation program and the average duration of remission.

Conclusions:

The positive effect of the correction of co-dependent behavior patterns in the mothers on the progress of drug addiction rehabilitation programs was revealed. Thus, the duration of participation of a drug addicted family member in the program of treatment and rehabilitation measures was significantly longer in the group of patients whose mothers actively participated in the program of psychotherapeutic support for relatives.

Keywords:

in-patient rehabilitation

co-dependent psychotherapy

co-dependence

complex medical rehabilitation of drug addicts

Conflict of interest:

No

Age, gender and personality: factors linked with binge-watching
C. Jolly
C. Bristuile *
L. Romo
Université Paris Nanterre, Psychology, , France
*Corresponding author.

Introduction:

Binge-watching is measured by the time spend weekly to watch series and the number of episodes watched during one viewing session.

Objectives:

This study’s main goal is to evaluate the weight of personality dimensions, age and genre on Binge-Watching’s behaviours.

Methods:

Numerous tools were used. The BFI-10 to evaluate the personality, the EPG to evaluate passions, the PIUQ to evaluate the problematic use of series, the QPI to evaluate immersion, and finally the PTQ for rumination. The sample (n = 199) is composed of people watching series ranging from 18 to 30 years old.

Results:

Regressions revealed that time spent weekly is predicted by extraversion and gender, whereas the number of episodes watched is predicted by agreeableness, conscientiousness and gender. Other results are not significant and do not allow to make links between variables such as age, neuroticism with Binge-Watching. However, this study shows that gender plays an important role in series related behaviours, and more precisely, that being a woman would predict a consumption of more episodes and a more problematic use of series.

Conclusions:

We supposed that Binge-Watching behaviours could be explained and predicted by personality dimensions and more particularly by neuroticism, and by age and gender. Our results do not allow us to confirm or reject our hypothesis because of the lack of significance.

Keywords:

Binge-Watching

Personality

Series

BFI-10

Conflict of interest:

No

Cannabinoid hyperemesis syndrome: two cases managed for 10 years in ramón y cajal hospital´s psychiatry department
I. Caballero 1 *
A. Correa 2
S. Guillen 1
E. Ochoa Mangado 1
1University Hospital Ramon y Cajal, Psychiatry Department, , Spain
2Ramon y Cajal Hospital, Psychiatry, , Spain
*Corresponding author.

Introduction:

Cannabinoid hyperemesis syndrome is a clinical entity characterized by recurrent vomiting associated with chronic cannabis consumption.

Objectives:

To expose the causal relation between cannabis intake and the syndrome’s symptoms by analyzing the evolution of two cases over the course of more than ten years.

Methods:

25 and 29-year-old males admitted into the Drug Abuse Unit of the Psychiatry Department of Ramon y Cajal Hospital. In both cases, the presenting symptom was projectile vomiting, cyclic, without a clear triggering cause, and that alleviated with hot baths. They also associated muscle spasms, tremor and profuse sweating. Admission to hospital care was necessary in both cases due to dehydration and weight loss (15 and 17 kg in each case). A complete work-up lead by the Internal Medicine and the Gastroenterology Departments came up negative, classifying both cases as psychosomatic.

Results:

It is deemed necessary a complete cannabis abstinence, enforced by means of urine drug tests and patient drug-intake diaries. Cannabis cessation lead to an immediate recovery in both patients. However, one of the patients relapsed sporadically, with symptoms reappearing each time a few days after cannabis consumption. The other patient has successfully continued abstinent and has therefore stayed asymptomatic until the present day.

Conclusions:

Being cannabis used as an antiemetic treatment, there is a paradoxical effect in susceptible chronic consumers in which nausea and vomiting become recurrent. It has been noticed a causal relationship between cannabis intake and symptoms; abandoning consumption constitutes an effective treatment, but symptoms return with every relapse, even after long periods of abstinence.

Keywords:

chronic users

cannabis

cyclical hyperemesis

vomiting

Conflict of interest:

No

Could the cloninger’s personality characteristics distinguish addiction problems in korea?
S.J. Lee 1
H. Chae 2 *
1Kyungsung University, Department of Psychology, , Korea, Republic of
2Pusan National University, School of Korean Medicine, , Korea, Republic of
*Corresponding author.

Introduction:

According to the biopsychosocial model of Cloninger, temperament is stable throughout life and basically forms the biological vulnerability of psychopathology, and character is shaped through interactions with environment and pivotal for manifestation of mental disorders.

Objectives:

The aim of current study was to investigate the personality characteristics of addiction using Temperament and Character Inventory (TCI), and to explore the personality dimensions which might explain the psychopathological features of addiction.

Methods:

Ninety-six participants (74 males and 22 females) consisting of 3 groups (alcohol problem, gambling problem, and healthy control) were recruited from the Greater Busan area, and completed the TCI. Analysis of Covariance (ANCOVA) considering age and sex as covariates and post hoc analysis were conducted to explore the personality difference among groups.

Results:

There were significant differences of Novelty Seeking (NS) and Harm Avoidance (HA) temperaments and Self-Directedness (SD) and Cooperativeness (CO) characters. That is, scores of NS and HA in both addiction groups were higher than those in control group, and scores of SD and CO in both addiction groups were lower than those in control group.

Conclusions:

This study suggested that the Cloninger’s personality dimensions, both temperament and character in combination were significant for distinguishing those with addiction problems from healthy control. The implication for clinical application was discussed.

Keywords:

Alcohol problem

temperament

gambling problem

Character

Conflict of interest:

No

A case series of inpatient treatment of GHB/GBL addiction
M. Delic
University Psychiatric Clinic Ljubljana, Center for Treatment Of Drug Addiction, , Slovenia

Introduction:

Gamma-hydroxybutyrate (GHB) and its precursor gamma-butyrolactone (GBL) are popular drugs of abuse used for their euphoric, (potential) anabolic, sedative, and amnestic properties. Daily use of GHB/GBL can lead to addiction and the possibility of withdrawal syndrome on cessation which results in tremor, tachycardia, insomnia, anxiety, hypertension, delirium, coma.

Objectives:

To describe the baseline characteristics, treatment and retention in patients admitted for GHB/GBL withdrawal management.

Methods:

A retrospective review of 4 consecutive cases of patients reporting GHB/GBL addiction who were admitted for inpatient management of withdrawal syndrome.

Results:

All patients were using GHB/GBL daily, 1-1.5 ml per hour. One of them was using cannabis additionally, others were using alcohol, cocaine and amphetamine type stimulants. Psychiatric comorbidities as personality disorders, depression, anxiety and bigorexia were recognized. Patients were treated with benzodiazepines and/or clomethiazole, atypical and typical antipsychotics and beta-blockers. Delirium was developed in two patients. One patient completed detoxification and finished the treatment program. One patient completed detoxification but stopped his treatment earlier, two patients did not completed detoxification and left the program.

Conclusions:

Conclusion: GHB/GBL withdrawal can be severe and retention in program is poor. Polysubstance use, psychiatric co-morbidities and heavier GHB/GBL use as possible predictors of poor treatment outcome need consideration in treatment planning.

Keywords:

treatment

GHB/GBL

inpatient

withdrawal

Conflict of interest:

No

Polysomnographic features of opiate use disorder
A. Elsheshai 1 *
J. Mekky 2
A. Rady 2
O. Elkholy 2
T. Molokhia 2
1Maamoura Psychiatric Hospital, Psychiatry, , Egypt
2Alexandria Faculty of Medicine, , , Egypt
*Corresponding author.

Introduction:

There exists four distinct phases of opioid dependence and withdrawal: drug induction, drug maintenance, acute abstinence and protracted abstinence. There are different Sleep architecture changes for each of the 4 phases. Limited evidence is available regarding sleep during acute withdrawal from chronic opioid use.

Objectives:

This work aims to determine presence and presentation pattern of polysomnographic features in opiate users as compared to non-opiate substance users.

Methods:

The study was conducted on 90 subjects divided into 3 groups Group 1A: 30 patients who were using only opiate agonists

Group 1B: 30 patients who were polysubstance users

Group 2: 30 controls matched for gender and age Patients will undergo: 1. Physical and mental state examinations.

2. Demographic data and characteristic of the illness including severity using Addiction Severity Index.

3. Urine drug screen test.

4. polysomnographic tracing

Results:

Total sleep time was reduced in Multi-drug users. There was a reduction in Sleep efficiency and stage 1 NREM sleep in both patient groups. There was an increase in slow wave sleep in the opiate-only users. REM percentage was reduced in cases as compared to controls with a more pronounced reduction in Multi-drug users than opiate-only users. Respiratory disturbance index was higher in both subject groups than in controls with no difference between the opiate-only and polysubstance users. Sleep latency was reduced in polysubstance users. REM latency was increased in opiate-only users.

Conclusions:

Analyzing PSG data found that total sleep time, sleep efficiency and NREM stages 1 and 2 were significantly reduced in sample group compared to controls

Keywords:

Addiction

polysomnography

sleep architecture

substance use

Conflict of interest:

No

Protracted abstinence syndrome in recovering opiate addicts
A. Elsheshai 1 *
J. Mekky 2
A. Rady 2
O. Elkholy 2
T. Molokhia 2
1Maamoura Psychiatric Hospital, Psychiatry, , Egypt
2Alexandria Faculty of Medicine, , , Egypt
*Corresponding author.

Introduction:

Addiction is a long lasting recurring disorder that consists of compulsive drug seeking and use. 80% of sufferers relapse to drug seeking and use after a period of withdrawal and abstinence during what is known as the protracted withdrawal phase. The chronic nature of this compulsion and the high rates of recidivism present a challenge for effective treatment.

Objectives:

To describe symptoms associated with protracted abstinence from opiates in recovering addicts

Methods:

The was a longtudinal study that was conducted on 60 subjects divided into 2 groups: 30 oiate-only users and 30 polysubstance users.

Baseline visit included assessment for psychiatric morbidity and addiction severity using Addiction Sseverity Index (ASI)

6 monthly visits were made to assess 3 characters of protracted abstinence syndrome, namely:

1. Hamilton Depression Rating Scale (HDRS) to assess depressed mood and anxiety

2. Obcessive Compulsive Drug use Scale (OCDUS): to assess craving

3. Somatic Symtom Scale-8: The SSS-8 is used to assess somatic complaints

Results:

HDRS scores were higher in opiate-only users. There was a higher score of OCDUS in polysubstance drug users that showed a slow decline that was still significantly higher in this group than in the opiate only users in most follow-up visits. SSS-8 showed a hgiher score in protracted withdrawal syndrome in polysubstance users.

Conclusions:

As regard HDRS Results show a higher score In group A Initially that rapidly dissipates after 3 months of followup. Group B shows high OCDUS scores over the entire period of follow-up while somatization scale is mostly significantly increased in group B as well.

Keywords:

substance use

opiate

Relapse prevention

Addiction

Conflict of interest:

No

Addictive behavior and free will: from philosophy to neurobiology
V. Froes *
H. Afonso
S. Esteves
M. Carneiro
S. Torres
J. Vilas Boas
Z. Gameiro
Centro Hospitalar Barreiro Montijo, Psiquiatria E Saúde Mental, , Portugal
*Corresponding author.

Introduction:

Addictive behavior is characterized by impaired control, social impairment and risky use of a substance. Instead of achieving reward system activation through adaptive behaviors, drugs of abuse directly activate the reward pathways. The individual continues using the substance despite significant substance-related problems. The question behind is, if when you are addicted to something are you free to stop?

Objectives:

Our aim is to look for changes in addictive brain that can lead to a lost of free will.

Methods:

From philosophy to neurobiology the authors did a non systematic review in pubmed with the words: “addiction”, “free will”, “ reward system”.

Results:

In history of psychiatry some authors like Freud with psychodynamic and Watson with behaviorism deny the existence of free will. Others think in fact, although there are some conditionings, free will is a separated category. Aristotle defines ‘free will’ as ‘the strongest control condition - whatever that turns out to be—necessary for moral responsibility’. In addictive behavior, what was at first time a free choice, became, a habit, that change neuroplasticy of the brain. In PET-scan studies it was found, that in the beginning there is an activation of nucleo accumbens, ventral striatum and ventromedial pre frontal cortex. Then there is a migration of activation to dorsal striatum and orbitofrontal cortex. There is a disruption of dopaminergic areas in the prefrontal cortex, reason why the patients can’t inhibit their behavior.

Conclusions:

Better understanding of neurobiology of addiction can help us to underline that is a disease of free will.

Keywords:

free will

reward system

Addiction

Conflict of interest:

No

The feeling of guilt experienced by adults whose parents were alcohol addicts (case-study research)
A. Lutsenko 1 *
A. Spivakovskaya 2
1Moscow State University, Psychology, , Russian Federation
2Lomonosov Moscow State University, Psychology, , Russian Federation
*Corresponding author.

Introduction:

The feeling of guilt has been studied less than primary emotions because it cannot be directly observed. A lot of research shows that adults whose parents were alcohol addicts usually feel guilty, but these investigations were conducted on individuals who suffered from alcohol addiction.

Objectives:

The purpose of our research was to investigate the feeling of guilt experienced by adult people whose parents were alcohol addicts.

Methods:

Abstract is printed with the permission of the study participants. The study was conducted in the period from October 2018 to March 2019. We used a lot of qualitative methods (analysis of TAT, a phenomenological analysis of the transcripts of the public meetings 12-step recovery program, phenomenological analysis of interviews). The participant was 27years woman A.K. whose mother was alcohol addict.

Results:

The feeling of guilt is manifested both in the conversation and in the description of TAT tables. The girl feels guilty of responsibility for the fact that she could not cope with her duties (to save the family, to save the mother from alcoholism). Feelings of guilt is associated with the fear of the death of close relatives. Feelings of guilt is manifested by the girl in the behavioral (the girl often asks for forgiveness from her mother) and emotional components (the girl experiences depression, suffering and regret when she speaks about mother’s alcoholism).

Conclusions:

Based on our research results, we suggest that the feeling of guilt may be one of the factors that prevent a person from building trusting relationships in his own family.

Keywords:

guilt

12-step recovery program

Alcohol addiction

dysfunctional family

Conflict of interest:

No

The negative emotions experienced by adults whose parents were alcohol addicts
A. Lutsenko 1 *
A. Spivakovskaya 2
1Moscow State University, Psychology, , Russian Federation
2Lomonosov Moscow State University, Psychology, , Russian Federation
*Corresponding author.

Introduction:

A lot of research shows that adults whose parents were alcohol addicts usually feel guilty, but these investigations were conducted either on mentally ill people, or on individuals who suffered from alcohol or other addictions. In cognitive psychology, the guilt is investigated as a result of attributing to oneself the causality of events.

Objectives:

The purpose of our research was to investigate the feeling of guilt experienced by adult people whose parents were alcohol addicts.

Methods:

The sample consisted of 52 subjects, they were participants in a 12-step program for adult people whose parents were alcohol addicts, and 50 controls. We investigated that there are significant differences between the feelings of guilt experienced by adult people from healthy families versus adult people whose parents were alcohol addicts. We used the two groups of methods: 1) guilt questionnaires ("The Interpersonal Guilt Questionnaire", "The Guilt Inventory Questionnaire ", 2) qualitative methods (analysis of TAT).

Results:

The feelings of guilt experienced by adults whose parents had alcohol addiction scored significantly higher than the feelings of guilt in people from control group (p=0,038). The feelings of guilt were connected with the sense of responsibility. People whose parents had alcohol addiction felt guilty in situations when they took care of somebody and did not know how to do this because their parents did not take care of them.

Conclusions:

Based on our research results, we suggest that the feeling of guilt may be one of the factors that prevent a person from building trusting relationships in his own family.

Keywords:

guilt

Alcohol addiction

shame

negative emotions

Conflict of interest:

No

The bridge between classical and ‘synthetic’/chemical psychoses: towards a clinical, psychopathological and therapeutic perspective
L. Orsolini
University of Hertfordshire, Psychopharmacology Drug Misuse and Novel Psychoactive Substances Research Unit, , Italy

Introduction:

The critical spread and dissemination of novel psychoactive substances (NPS), particularly amongst the most vulnerable youngsters, may pose a further concern about the psychotic trajectories related to the intake of new synthetic drugs. The psychopathological pattern of the ‘new psychoses’ appear to be extremely different from the classical presentation. Therefore, clinicians need more data on these new synthetic psychoses and recommendations on how to manage them.

Objectives:

The present mini-review aims at deepening both the clinical, psychopathological features of synthetic/chemical NPS-induced psychoses and their therapeutic strategies, according to the different NPS classes implicated, by underlining the main differences with the ‘classical’ psychoses.

Methods:

A comprehensive review was carried using the PubMed/Medline database, by combining the search strategy of free text terms and exploding a range of MESH headings relating to the topics of Novel Psychoactive Substances and Synthetic/Chemical Psychoses as follows: ((Novel Psychoactive Substances[Title/Abstract]) AND Psychosis[Title/Abstract])) and for each NPS categories as well, focussing on synthetic cannabinoids and cathinones, without time and/or language restrictions.

Results:

An overview of the main Clinical and psychopathological features between classical versus NPS-induced chemical/synthetic psychoses is provided for clinicians working with Dual Disorders and Addiction Psychiatry. A proposal of psychopathological and clinicalclassification of NPS-induced psychoses has been here provided.

Conclusions:

Further insight is given here on therapeutic strategies and practical guidelines for managing patients affected with synthetic/chemical NPS-induced psychoses.

Keywords:

Synthetic psychosis

psychosis

Novel Psychoactive Substances

Conflict of interest:

No

The role of day hospital in the treatment of dual pathology
Á.J. Palma Conesa *
Á. Represa Martinez
J. Moreno Bustos
C. Merino Del Villar
Àrea de Salut Eivissai Formentera, Psychiatry, , Spain
*Corresponding author.

Introduction:

The World Psychiatric Association (WPA) refers by Dual Pathology (DP) to people "with both an addictive disorder and another mental illness.” The World Health Organisation (WHO) advocates for community treatment in mental health.

Objectives:

To present the innovative program of partial hospitalization for DP designed in the Àrea de Salut Eivissa Formentera (ASEF) meeting WPA and WHO recommendations.

Methods:

The intervention is structured in individual and group sessions from a medical, psychological and social approach. Fours hours per day of intensive therapy are designed for each user in a modular structure based on the principles of motivational interviewing (MI), dialectical behavioral therapy (DBT), mindfulness-based relapse prevention (MBRP), metacognitive training (MCT) and rehabilitation programs. Individual consultations are also scheduled regularly. Sociodemographic and clinical data are evaluated. Results from the intervention in terms of symptoms, functional recovery and agreed individual objectives are evaluated for each user after three months.

Results:

Since its opening in June 2019, a total of 8 users have benefited from admission to the program. The outcomes measured so far show a positive impact of the intervention in functional recovery.

Conclusions:

The partial hospitalization program combines an intensive medical and psychological treatment with the possibility of testing and adapting the new treatments and skills to the real milieu of the users. It is still soon to evaluate the wider impact of this pioneering intervention, but the initial implementation indicates positive consequences in the global recovery of the users and their ability to adapt both to their environment and their personal life goals.

Keywords:

dual pathology

partial hospitalization

hospital day clinic

Conflict of interest:

No

Life-meaningful orientations and coping styles in women from dysfunctional families
E. Pervichko *
S. Kshniankina
J. Koniukhovskaia
Lomonosov Moscow State University, Faculty of Psychology, , Russian Federation
*Corresponding author.

Introduction:

The severity of psychological disturbances and mental disorders in adults who grew up in alcoholic families make it extremely urgent to develop effective psychotherapeutic programs for them. Besides, the topic of maintaining women’s health is one of the priorities of modern Medicine and psychology.

Objectives:

This study aims to assess the psychological effects of the program «Adult children of alcoholics» (Twelve-step program) for Russian women who grew up in alcoholic families.

Methods:

The study involved 80 women who grew up in alcoholic families aged 18 to 44. Participants performed the following assessment: “Purpose-in-Life Test” (Leontiev, 2000), “The Coping Strategy Indicator” (Amirkhan, 1990), The Reflexivity Test (Karpov, 2003), The Test of the Personal Self-conception (Stolin, Panteleev, 1998), State-Trait Anxiety Inventory (Spielberger, et al., 1983), Beck Depression Inventory.

Results:

Women attend the twelve-step program for more than 2.5 years differ from women attended less than 6 sessions of the program as well as women grew up in prosperous families by higher rates of «Problem Solving» coping strategy (23,91±3,28 vs 19,34±5,67 vs 19,26±6,48; P=0,001); coping strategy «Seeking Social Support» (24,64±3,44 vs 19,41±5,76 vs 20,70±8,09; P=0,006); meaningfulness of life (Purpose-in-Life Test) (27,83±5,17 vs 21,24±7,53 vs 24,04±7,22; P=0,009). They are less likely to use such coping strategy as «Avoidance» (16,55±3,53 vs 21,86±5,29 vs 19,04±6,24; P=0.001). They have low anxiety (48,42±5,65 vs 54,07±7,12 vs 52,81±9,01; p=0,006) and low depression (10,92±5,52 vs 25,90±16,70 vs 16,33±12,35; P=0,003).

Conclusions:

The results convincingly prove the effectiveness of f twelve-step program in Russia

Keywords:

adult children of alcoholics

Twelve-step program

coping behaviour

life-meaningful orientations

Conflict of interest:

No

Inhibitory control in patients with alcohol-use disorder: an EEG study
A. Peshkovskaya *
S. Galkin
Tomsk National Research Medical Center, Russian Academy of Sciences, Mental Health Research Institute, , Russian Federation
*Corresponding author.

Introduction:

Impaired inhibitory control is considered to contribute to the development, maintenance, and relapse of addictive disorders. Researchers associate inability to maintain a long-term remission in alcohol-use disorder (AUD) with weakened inhibitory control.

Objectives:

The aim of the study was to investigate inhibitory control and its neural correlates in patients with AUD.

Methods:

Cognitive and neural measures were obtained in 30 detoxified AUD patients with Go-NoGo Task and EEG, and then matched with data of 30 healthy subjects. For the analysis, the data of 16 EEG channels were selected. To study cognitive and neural correlates of inhibition ANOVA analysis was performed.

Results:

Analysis of inhibitory control indicated a greater number of inhibition errors in AUD patients versus controls: 7.34 vs. 3.25 (p = 0.039). Inhibitory control performance was accompanied by a significant increase in the beta power in motor brain areas among patients versus healthy subjects (λ = 0.906, F (2, 115) = 5.961, p = 0.003). This finding corresponds to the Go-NoGo Task performance — AUD patients made more “motor” errors than healthy subjects, i.e. patients failed to hold on the response to the irrelevant stimulus (wrongly respond to the NoGo signal).

Conclusions:

Impaired inhibitory control in AUD patients were associated with an automatic motor response to a stimulus and accompanied with the increase in beta power in the motor areas of the cerebral cortex. Since the power of beta band correlated with metabolism and trophic changes in certain brain area, we suggested that changes in motor cortex were significant features of AUD.

Disclosure: The study was funded by RFBR and Tomsk Region Administration according to the research project No. 19-413-703007. Examination of healthy subjects was carried out as part of the research project No. 20-013-00766 funded by RFBR.

Keywords:

alcohol-use disorder

EEG

inhibitory control

Cognition

Internet gaming disorder: case report
P. Ponizovskiy *
V. Khanykov
A. Gofman
Research Institute of Psychiatry – branch of V.Serbsky National Medical Research Center for Psychiatry and Addiction, Department For Treatment Of Mental Disorders, Complicated By Addictions, Moscow, Russian Federation
*Corresponding author.

Introduction:

Internet Gaming Disorder (IGD) will be classified in ICD-11. Cross-sectional studies report the high co-morbidity of internet addiction with psychiatric disorders such as depression, anxiety disorders, and substance use disorder. The case report is of a 23-year-old male student seeking in-patient treatment for severe internet gaming problems.

Objectives:

To explore co-existing psychiatric disorders and potential treatment for Internet Gaming Disorder.

Methods:

Patient clinical data that includes the Mini-International Neuropsychiatric Interview (M.I.N.I.), Chen Internet Addiction Scale (CIAS), Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI), The Liebowitz Social Anxiety Scale (LSAS), and the Prodromal Questionnaire (PQ-16).

Results:

The clinical signs of IGD that the patient reported included a preoccupation with internet games and excessive periods spent gaming, withdrawal symptoms of irritability, a reduction in time spent on previous hobbies, persistent gaming in spite of interpersonal and educational problems. The patient scored 78 points on CIAS indicating a substantial pattern of internet addiction. No psychiatric disorder was detected using the psychometric scales. The patient undertook a course of psychotherapeutic treatment including motivational interviewing and cognitive behavioral therapy.

Conclusions:

In the absence of associated psychiatric disorders, IGD itself becomes a focus for psychosocial interventions. In order to avoid possible medicalization of normal behavior, it is important to elaborate the precise diagnostic criteria of IGD including the assessment of degree of functional impairment that is not included in the DSM-5 classification.

Keywords:

internet addiction

internet gaming disorder

case report

Problematic Internet Use

Conflict of interest:

No

Predictive ability of addictive beliefs
C. Suarez Pérez *
J. Ballesteros López
V. Álvarez González
Hospital Universitario Infanta Cristina, Psychiatry, , Spain
*Corresponding author.

Introduction:

Beliefs are defined as relatively rigid and lasting cognitive structures, which are not easy to modify by experience.

Objectives:

The objective of this study is to investigate the relationship between nuclear beliefs about drug use and craving and different sociodemographic and clinical variables.

Methods:

Observational, descriptive, cross-sectional study in the Mental Health area of Parla and Getafe, Madrid, Spain. A questionnaire is used to determine the degree to which patients are identified with nuclear beliefs related to drug use and craving. This questionary has 26 items.

Results:

We analysed the sample and we extracted the most significant variables. The nuclear beliefs are organised around 4 factors: idea of general operation without substance, intention to consume again, conditions to consume again (controlled, non-addictive consumption) and expectations positive consequences of consumption. An also beliefs related to craving.

Conclusions:

Beliefs significantly influence in the patient consumption. Recognizing the diversity of beliefs about substance abuse allows the development of specific intervention programs

Keywords:

dual disorders

nuclear beliefs

substances

craving

Conflict of interest:

No

Addiction treatment services in belarus.
A. Yarmalinskaya
health care facilicy city clinical drug dispensary, , , Belarus

Introduction:

The City Clinical Drug Dispensary medical institution is located in Minsk and provides narcological assistance to the population of Minsk with various types of dependence.

Objectives:

to present the structure of drug treatment services in the city of Minsk.

Methods:

data of statistical reports.

Results:

The population of Minsk in 2018 is determined to 1 982 444 people. The number of patients with narcological disorders registered for the first time in the life of the City Clinical Narcological Dispensary health care institution amounted to 12 742 people (64.3 per 100 thousand). Dependence structure: 1.8% - psychotic disorders associated with alcohol consumption (1.3% - amnesic syndrome and residual psychotic disorder), 20.8% - alcohol dependence syndrome, 1% - drug dependence syndrome. 72.1% - alcohol consumption with harmful consequences and 4.1% - drug use with harmful consequences. 11 people were first recognized as disabled due to amnesia and dementia due to alcohol consumption. Drug treatment: inpatient unit - 6 (325 round-the-clock beds, 60 of which are rehabilitation beds) and 6 intensive care units. Full-time departments: 6 (250 beds), of which 5 are for helping adults and 1 cabinet is for helping adolescents. Outpatient rooms: 20 drug treatment rooms for adults, 4 rooms for the treatment and prevention of drug addiction, 2 rooms for methadone replacement therapy and 9 drug treatment rooms for adolescents. 68 specialist work with doctors, psychiatrists-narcologists.

Conclusions:

the structure and staffing of the health care facility "City clinical drug dispensary" allows to provide quite effective assistance in providing assistance to the population of Minsk.

Keywords:

Addiction

treatment service

health care

alcohol

Addiction

treatment service

health care

Conflict of interest:

No

Childhood trauma, emotion regulation and pain in alcohol-dependent individuals
J. Zaorska 1 *
M. Kopera 1
M. Nowakowska 1
P. Kobyliński 2
M. Wojnar 3
A. Jakubczyk 1
1Medical University of Warsaw, Psychiatry, , Poland
2National Information Processing Institute, Laboratory of Interactive Technologies, , Poland
3Medical University of Warsaw, Psychiatry Clinic, , Poland
*Corresponding author.

Introduction:

Several studies have confirmed that the experience of childhood trauma, poor emotion regulation as well as experience of physical pain may contribute to development and poor treatment outcomes in alcohol dependence (AD). However, little is known about mutual relationships between all these factors in individuals with AD.

Objectives:

to analyze associations between childhood trauma, emotion regulation and pain tolerance in alcohol-dependent individuals.

Methods:

The study group comprised 165 individuals diagnosed with AD. The Childhood Trauma Questionnaire was used to investigate different types of trauma during childhood; the Brief Symptom Inventory - to assess anxiety symptoms; the Difficulties in Emotion Regulation Scale (DERS) – to assess emotional dysregulation and Pain Resilience Scale - to measure self-reported pain tolerance.

Results:

Childhood emotional abuse (CTQ subscale score), anxiety, emotional dysregulation (DERS total score), and the covariates (sex and age) explained almost 16% of the variance in pain tolerance (R2 = 0.156; F[5, 138] = 5.094; p < 0.001). Childhood emotional abuse was positively associated with anxiety, anxiety was positively associated with emotional dysregulation, and emotional dysregulation was negatively associated with pain resilience, adding up to the indirect negative association between childhood emotional abuse and pain tolerance. All of the correlations were significant. The statistical procedure proved anxiety and emotional dysregulation, operating in serial, mediated the effect of childhood emotional abuse on pain resilience in the study group.

Conclusions:

Addressing the issue of emotional dysregulation and physical pain in relation to childhood trauma, may be an important part of alcohol dependence therapeutic treatment programs.

Keywords:

childhood trauma

pain

emotion regulation

Conflict of interest:

No

Cannabis use and risk perception: a review.
E. Arribas Pinero *
L. León-Quismondo
RAMON YCAJAL UNIVERSITY HOSPITAL, Psychiatry, , Spain
*Corresponding author.

Introduction:

Cannabis is the most widely used illegal drug in the world, with an increase in use over the past two decades. One of the main factors that would explain this phenomenon would be a decreased risk perception on its use.

Objectives:

To study false beliefs that may lead to a low risk perception of cannabis use in the population.

Methods:

A review of the available literature on false beliefs that exist behind a decreased risk perception was performed.

Results:

A lower risk perception about cannabis use is associated with a higher frequency of cannabis use. Consumers have a greater number of positive beliefs related to cannabis use, such as that it does not produce addiction, that it has no negative effects on health, that it is good for some diseases, and that it is not related to intellectual or behavioral disturbances. Consumers hold fewer negative beliefs about the mental and physical health consequences of cannabis use, as opposed to those of those who have never used cannabis in their lifetime, who do consider it to be a real risk.

Conclusions:

The relationship between perceived risk of cannabis use and cannabis use has been evident for years. There is a reciprocal relationship between the presence of false beliefs about the consequences of cannabis use and the present and future evolution of cannabis use among young people. In this context, early intervention programs are particularly relevant.

Keywords:

cannabis

risk perception

risk factor

false believes

Conflict of interest:

No

Peculiarities of alcohol dependence formation in combatants as a basis for their rehabilitation
H. Kozhyna *
V. Lytvynenko
K. Zelenska
V. Koshchii
T. Radchenko
KHARKIV NATIONAL MEDICAL UNIVERSITY, Psychiatry, Narcology And Medical Psychology, Kharkiv, Ukraine
*Corresponding author.

Introduction:

The problem of treatment of alcohol dependence in Ukraine remains rather acute currently, as the results of the research show a significant increase in the number of alcohol consumers among the population.

Objectives:

In order to study the peculiarities of alcohol dependence formation in combatants as basis for their rehabilitation.

Methods:

56 combatants with alcohol dependence syndrome (F 10.2x) were examined by Clinical and psycopathological method.

Results:

of the study indicated that clinical picture of alcohol dependence was characterized by loss of situational control (85.3 ± 3.8% of the examined), palimpsests (25.2 ± 2.4%), dysphoria (38.1 ± 1.8%), affective reactions (27.3 ± 1.6%), anxious-depressive disorders (34.6 ± 1.8%) and asthenic manifestations (29.1 ± 1.6%). Pathological psychological predictors of formation of alcohol dependence in men are affective behavior, proneness to conflict, and prevalence of non-constructive forms of coping strategies. 31.4 ± 1.7% of examined have full manifestation of stress disorder, 39.5 ± 1.4% of examined persons have partial manifestation, and 29.1 ± 1.3% of patients have complete manifestation of stress disorder.

Conclusions:

The purpose of psychocorrection and psychoeducation of the patients with alcohol dependence is making the patient aware of the disease; learning the skills to cope with alcohol cravings; analysis of one’s personal characteristics and peculiarities of self-perception in society; formation in the patient of motivation for treatment; restoring the old and building new public relations with full integration into society; development of skills of adequate behavior in psycho-traumatic situations; correction of “alcoholic” patterns of behavior.

Keywords:

Alcohol dependence

combatants

rehabilitation

psychocorrection

Conflict of interest:

No

Specificity of psychopathological symptoms, associated with disorders related to alcohol consumption, in combatants, forcibly displaced persons and ordinary residents
A. Markov 1 *
K. Gaponov 2
M. Markova 3
V. Koshchii 4
M. Chernyaev 1
1Kharkiv Medical Academy of Postgraduate Education, Sexology, Medical Psychology Medical And Psychological Rehabilitation, Kharkiv, Ukraine
2Kharkiv Medical Academy of Postgraduate Education, Narcology, , Ukraine
3Kharkiv Medical Academy of Postgraduate Education, Sexology, Medical Psychology, Medical Abd Psychological Rehabilitation, Kharkiv, Ukraine
4Kharkiv National Medical University, Psychiatry,narcology And Medical Psychology, Kharkiv, Ukraine
*Corresponding author.

Introduction:

Ukraine ranks 2nd in the world in terms of the number of years lost due to disability or premature death due to the alcohol consumption (DALY).This is due to a significant increase in the long-term stress load, which the population of Ukraine now has, which generates an increase in the level of alcohol consumption.

Objectives:

To study the peculiarities of the clinical variability of psychopathological symptoms, associated withalcohol addiction (AA) in persons with different levels of psychosocial stress (PS).

Methods:

312 men with AA were examined: 107 combatants; 89 forcibly displaced persons; 116 residents of the city of Kharkiv region. The study included the use of clinical-psychopathological, psychodiagnostic and statistical methods.

Results:

In combatants, a significant increase in the severity of psychopathological symptoms with an increase in the level of PS, and, accordingly, the severity of AA, is observed on the basis of depression and obsessive-compulsive response, somatization, interpersonal sensitivity and psychoticism. In displaced persons, there is a tendency to increasing the expressiveness of manifestations of depression, interpersonal sensitivity and paranoyality with an increase in the level of stress. For the local inhabitants, the regularity of increase of expressiveness of all psychopathological manifestations combining with increase of severity of PS is characteristic. The severity of obsessive-compulsive, interpersonal sensitivity and phobic anxiety symptoms is greater among combatants and displaced persons; hostility and paranoyality – in combatants; depression – in displaced persons.

Conclusions:

The level of PS is an important factor determining the peculiarities of the variety of psychopathological symptoms in persons with AA.

Keywords:

Alcohol addiction

Psychosocial Stress

combatants

forcibly displaced persons

Conflict of interest:

No

Characteristics of addictive status in patients with alcohol dependence and different levels of macrosocial stress
M. Markova 1 *
K. Gaponov 2
A. Markov 3
H. Kozhyna 4
V. Koshchii 5
1Kharkiv Medical Academy of Postgraduate Education, Sexology, Medical Psychology, Medical Abd Psychological Rehabilitation, Kharkiv, Ukraine
2Kharkiv Medical Academy of Postgraduate Education, Narcology, , Ukraine
3Kharkiv Medical Academy of Postgraduate Education, Sexology, Medical Psychology Medical And Psychological Rehabilitation, Kharkiv, Ukraine
4KHARKIV NATIONAL MEDICAL UNIVERSITY, Psychiatry, Narcology And Medical Psychology, Kharkiv, Ukraine
5Kharkiv National Medical University, Psychiatry,narcology And Medical Psychology, Kharkiv, Ukraine
*Corresponding author.

Introduction:

4.2% of Ukrainians have alcohol-related problems, which is significantly higher than in most developed European countries. This is due to a significant increase in the long-term stress load, which the population of Ukraine now has, which generates an increase in the level of alcohol consumption.

Objectives:

To study the peculiarities of severity and manifestations of addictive states associated with alcohol-related disorders in patients with different levels of macrosocial stress (MS).

Methods:

Upon condition of informed consent 312 men with alcohol dependence (AD) were examined: 107 combatants ; 89 forcibly displaced persons; and 116 residents of the city of Kharkiv and Kharkiv region. The study included the use of clinical-psychopathological, psychodiagnostic, statistical methods.

Results:

The clinical variability of AD is associated with the severity of MS: with an increase in the maladaptive stress load, there is a decline of the clinical symptoms of AD. The addictive status of patients with AD demonstrates the tension of a number of addictive objects of chemical and non-chemical origin, the severity of which is directly or inversely associated with the AD and MS. The severity of tobacco smoking (rS = 0.760) and the propensity to excessive seizure of computer games (rS = 0.703) is most closely related to the severity of AD and MS, as well as the addictive tension for other addictive objects.

Conclusions:

The prospect of further research is the creation of a system of target-personified treatment and rehabilitation, differentiated depending on the level of MS by the patients, and its introduction into the existing integrated system of medical care to AD patients.

Keywords:

ADDICTIVE STATUS

MACROSOCIAL STRESS

ALCOHOL DEPENDENCE

Conflict of interest:

No

Novel link between poor impulse control and high caffeine intake and expectancies
J. Cebrián 1 *
G. Gonzalez-Cuevas 1 2
1European University of Madrid, Department of Psychology, , Spain
2Idaho State University, Department of Biomedical And Pharmaceutical Sciences, , United States of America
*Corresponding author.

Introduction:

Caffeine, one of the most commonly used and socially acceptable drugs in the world, has been shown to produce neurobehavioral effects similar to other drugs of abuse. Although impulsive behaviors are closely related to drug use and abuse, little is still known about the relationship between impulsivity and caffeine.

Objectives:

For this reason, an investigation was carried out to examine the possible link between caffeine and response inhibition.

Methods:

Our sample consisted of forty psychology undergraduate students who completed (1) the CaffEQ, a questionnaire that evaluates people beliefs about caffeine effects, (2) the caffeine consumption questionnaire, which assesses the average amount of caffeine consumed within a week, and (3) the Stop-Signal Reaction-Time (SSRT) task, a measure of response inhibition or impulse control.

Results:

Our results demonstrated statistically significant associations between high caffeine expectations and intake and poor response inhibition. More specifically, impulsive behaviors were associated with greater expectancies for withdrawal/dependence and physical performance enhancement as well as greater consumption of coffee and energy drinks.

Conclusions:

To the best of our knowledge, this work is the first to find a novel link between caffeine and the specific dimension of impulsivity known as response inhibition. Further studies are therefore warranted to explore the direction of causal connections between impulse control and caffeine.

Keywords:

Caffeine

impulsivity

intake

expectancies

Conflict of interest:

No

Alcohol related dementia: a distinct or multifactorial nosological entity?
P. Costa 1 *
M. Melo 1
P. Branco 1
J. Teixeira 2
1Centro Hospitalar Psiquiatrico de Lisboa - CHPL, Psicogeriatria, , Portugal
2Centro Hospitalar Psiquiátrico de Lisboa, Serviço Alcoologia E Novas Dependências, , Portugal
*Corresponding author.

Introduction:

The nosological status of Alcohol Relatred Dementia (ArD) as a distinct mental disorder remains under debate as to its neuropathophysiology. It is a chronic and heterogeneous cognitive problem, secondary to alcohol abuse. Wernicke-korsakoff syndrome (SWK) is also characterized by cognitive deficits whose presentation has characteristics similar to ArD, thus adding challenges to the diagnosis.

Objectives:

This work aims to discuss alcohol-related dementia etiology, its diagnosis and treatment.

Methods:

The authors used the search engine PubMed, selecting articles from 2013 to 2019, using the words “alcohol related dementia”, “Wernicke-Korsakoff syndrome” and “thiamine”.

Results:

ArD appears to result from direct ethanolic neurotoxicity on brain cells. Clinically, language impairment is infrequent, there is a lower impact on semantic tasks and verbal memory, with worse performance in visuospatial tasks. Unlike other dementias, it has recovery potential with abstinence. It often overlaps with other entities, notably SWK, secondary to the thiamine deficit. In this syndrome, Wernicke encephalopathy corresponds to the acute phase, presenting by a characteristic triad (gait ataxia, confusional state, and ophthalmoplegia). This may evolve to a more chronic condition, the Korsakoff syndrome, characterized by persistent anterograde amnesia, deficits in executive function, may also coexist with confabulation.

Conclusions:

ArD is a serious complication of alcohol abuse. Given the heterogeneity of the condition, is essential to have a high index of suspicion and a low diagnostic threshold, with an early onset of IV/IM thiamine replacement. It seems to be also advantageous to start routine neuropsychological screening for earlier diagnosis.

Keywords:

alcohol related dementia

Wernicke-Korsakoff syndrome

thiamine

Conflict of interest:

No

Psychosocial factors involved in substance use behavior in young medical undergraduate
A. Mihailescu 1 2
A. Ciobanu 3 4
B. Iorga 2
A. Damian 3 *
C. Mihailescu 5
O. Popa-Velea 2
1Clinical Hospital of Psychiatry „Prof dr Al. Obregia”, Psychiatry 1, , Romania
2University of Medicine and Pharmacy „Carol Davila”, Medical Psychology, , Romania
3”Prof. Alexandru Obregia” Clinical Hospital of Psychiatry, Psychiatry 1, , Romania
4”Prof. Alexandru Obregia” Clinical Hospital of Psychiatry, 1st, , Romania
5CMI MIhailescu S. Cristian, General Practice, , Romania
*Corresponding author.

Introduction:

Increasing prevalence of cannabis use in young adults is an important health issue as substance use contributes to increased risk of poor mental health.

Objectives:

We have analysed psychosocial risk factors for cannabis disorder in young adults.

Methods:

In this study we have analysed associations between emotional distress, personality factors and socioeconomical status and cannabis use disorder using a case-control design. 35 inpatient patients with cannabis use disorder diagnosed by a psychiatrist and 30 outpatient individuals with cannabis use disorder were compared to 112 individuals within the same age range, gender and level of education. We have used the following instruments: Big-Five personality markers (NEO-PI), WHOQOL BREF, DSM 5- Level 1 and 2 self-rated instruments, CUDIT-R for cannabis use disorder and a socio-demographical interview.

Results:

Specific personality factors were present in association with substance use, thus, inpatient young adults with cannabis use had low Emotional Stability, by contrast with outpatient young adults with cannabis use that had high levels of Openness (F(2,92)=3,613, p<0,05), Agreeableness (F(2,92)=8,424, p<0,0001) and Consciousness (F(2,92)=3,405, p<0,05). Negative affect was associated with cannabis use disorder compared to control ((F(2,92)=72,277, p<0,05). Quality of life was lower in all cannabis users, however quality of life domains were more affected in cannabis inpatient users (p<0.05).

Conclusions:

We have found significant differences between young adults with cannabis use disorder and controls in view of personality big-five markers, emotional distress and quality of life domains. This directs the intervention towards identifying personality factors and early emotional health issues in young adults with the scope of preventing substance use disorder.

Keywords:

cannabis

mental health

medical undergraduates

substance use

Conflict of interest:

No

Regular alcohol use in young adults is associated with reduced motivation to work for financial reward
C. David 1 2 *
K. Ersche 3
T.V. Lim 3
1Brunel University London, Psychology, , United Kingdom
2Cambridge University, Psychiatry, , United Kingdom
3University of Cambridge, Department of Psychiatry, , United Kingdom
*Corresponding author.

Introduction:

How we behave is shaped by past experiences. Regular use of alcohol may change our ability to adjust to behaviour in response to feedback.

Objectives:

We investigated changes in reinforcement sensitivity in young adults, who regularly consume alcohol, using a monetary incentive reinforcement (MIR) task. We hypothesized that regular alcohol use is associated with altered responses in anticipation of monetary gain and loss.

Methods:

We recruited 46 volunteers from the local community, half of whom reported consuming alcohol at harmful levels. Participants completed a number of personality questionnaires and performed the MIR task, which measures participants’ efforts in gaining money and avoiding monetary loss. Analysis of co-variance was used to explore group differences; age and gender were included as co-variates.

Results:

Alcohol users reported significantly higher levels of impulsivity (F1,41=6.0,p=0.019) and sensation-seeking traits (F1,42=36.7,p<0.001) and demonstrated normal sensitivity to monetary value (F1,41=1.07,p=0.307). When challenged to gain reward or avoid punishment, alcohol users were equally motivated as control volunteers to take action to avoid financial loss (F1,41=2.6,p=0.112) but showed less motivation to work towards financial reward (F1,41=4.7,p=0.036). The lack of motivation to work for reward was negatively associated with the severity of alcohol use (r=-.48,p<0-05).

Conclusions:

In a community sample we observed reduced motivation to obtain financial reward, but intact loss avoidance in heavy drinkers. This effect was directly related to alcohol use severity, suggesting that changes in reinforcement sensitivity occur at an early stage of chronic alcohol use.

Keywords:

Motivation

monetary

reinforcement sensitivity

Alcohol

Conflict of interest:

No

Pramipexole differentially modulates fronto-striatal circuits in addictive and compulsive disorders
K. Dionelis 1 *
C. Meng 1
K. Craig 1
S. Shabbir 2
N. Fineberg 3
B. Sahakian 4
J. Suckling 1
E. Bullmore 4
T. Robbins 4
K. Ersche 4
1University of Cambridge, Department of Psychiatry, , United Kingdom
2GlaxoSmithKline, Clinical Unit Cambridge, , United Kingdom
3Hertfordshire Partnership University NHS Foundation Trust, Psychiatry, , United Kingdom
4Cambridge university, Department of Psychiatry And Behavioural And Clinical Neuroscience Institute, , United Kingdom
*Corresponding author.

Introduction:

Stimulant use disorder (SUD) and obsessive-compulsive disorder (OCD) are both characterised by compulsive behaviours, previously conceptualised as dysfunctional habits. Thus, imbalanced regulatory control between fronto-striatal and cortico-striatal loops subserving goal-directed and habitual behaviour respectively, possibly involving midbrain dopaminergic input, could be involved in compulsive behaviour.

Objectives:

We used resting-state fMRI to investigate neural networks of compulsivity in SUD and OCD. We hypothesised that SUD and OCD would differ from healthy volunteers in fronto-striatal and cortico-striatal connectivity, and that dopaminergic drug challenges would differentially affect these networks in both disorders.

Methods:

In a randomised, double-blind, placebo-controlled, crossover design, patients with SUD (n=18), OCD (n=18), and healthy volunteers (n=18) received one dose of placebo, pramipexole, or amisulpride, before undergoing resting-state fMRI. Regions of interest included ventromedial prefrontal cortex (vmPFC), premotor cortex (pMOT) and posterior putamen (pPUT), regions involved in goal-directed and habitual control. We compared functional connectivity within these networks and related connectivity to disorder-specific compulsivity measures.

Results:

Disorder-specific compulsivity predicted functional connectivity between vmPFC and pPUT on placebo in SUD (r=0.51, p<0.05), but not OCD. Pramipexole reversed this relationship in both disorders, so that the correlation was negative in SUD (r=-0.54, p<0.05), but positive in OCD (r=0.49, p<0.05). Pramipexole equally increased connectivity between vmPFC and pMOT in SUD, and decreased connectivity between pPUT and pMOT in OCD.

Conclusions:

Our findings suggest that imbalanced fronto-striatal loops are involved in compulsive behaviour in SUD and OCD. Dopaminergic modulation of these circuits putatively contributes to compulsivity, with possible ramifications for novel treatments.

Disclosure: Dr Meng is supported by the Wellcome Trust (105602/Z/14/Z) and the NIHR Cambridge Biomedical Research Centre. Dr Bullmore is employed part-time by GSK and part-time by University of Cambridge. He holds stock in GSK. Dr Craig was employed by the University

Keyword:

compulsivity addiction OCD dopamine

“Correlation of urine ethyl glucuronide (ETG) and ethyl sulfate (ETS) with other markers of recent alcohol use and factors affecting its levels”.
S. Huddar *
P. Murthy
P. Sharma
P. Chand
L. Shukla
National Institute of Mental Health and Neurosciences(NIMHANS), Psychiatry, , India
*Corresponding author.

Introduction:

Alcohol use disorders are recognized world over as a major public health issue. The role of biomarkers has proved to be important in the identification of problem drinking and in monitoring relapse. Urine EtG and EtS are direct biomarkers of alcohol helpful in the detection of recent alcohol use. This study focuses on understanding the correlation of urine EtG and EtS with other markers of alcohol use and factors affecting its levels.

Objectives:

To study the correlation between urinary EtG and EtS and other markers of alcohol use among patients of alcohol dependence syndrome. To study the factors affecting the levels of Urine EtG and EtS

Methods:

Urine EtG and EtS was monitored serially in each subject sixth hourly for 72 hours. Breath alcohol concentration (BrAC), Serum EtG & EtS levels were measured at T0(1st sample).

Results:

Urine EtG and EtS shows positive correlation with Breath alcohol concentration(p-0.015) and Serum EtG and EtS(p-0.001). Amount of alcohol consumption and time elapsed since last alcohol use are the only two factors which determine levels of Urine EtG and EtS irrespective of age.

Conclusions:

Longer detection window, positive correlation with other markers of recent alcohol use and minimal patient related factors determining its level makes Urine EtG and EtS an ideal marker of recent alcohol use.

Keywords:

Ethyl Glucuronide

Ethyl Sulfate

Alcohol

biomarker

Conflict of interest:

No

The relationship between family history and early onset alcoholism: more rapid transition to dependence or denial of their addiction?
M.R. Patrascu *
T.C. Ionescu
M.R. Dumitrescu
M. Ladea
Alexandru Obregia Clinical Hospital, Department 3, , Romania
*Corresponding author.

Introduction:

The harmful use of alcohol can lead to destructive mental disorders, therefore it is critical to address factors contributing to their development and maintenance.

Objectives:

We aimed to identify whether family history is predictive of earlier initiation of drinking or more rapid transition to dependence. Moreover, we examined the time span between at-risk behaviour and onset of alcoholism, the main reason alcohol consumption became a pattern, as well as the patients’ awareness of their addiction.

Methods:

Using cross-sectional data from a male patient-based cohort of 110 alcoholics admitted in a Department of “Prof. Dr. Al. Obregia” Psychiatry Clinical Hospital in 2019, we evaluated the chronology of addiction development using our own assisted survey questionnaire. Social-demographic data, age at first alcohol use, age at onset of alcoholism, family history and perceived reason for alcohol consumption pattern were collected. Patients were also asked whether they consider themselves addicted.

Results:

As predicted, family history was linked with early initiation of drinking, although transition to alcohol dependence was similar across patients without a family history. The approximate time frame between at-risk behaviour and onset of alcoholism was 15 years, whereas the main reason for addiction was coping with stress. A significantly amount of patients did not consider they had an addiction problem. Frequently, patients described symptoms of depression/anxiety prior to addiction development.

Conclusions:

Family history of alcoholism can be used when predicting earlier initiation of drinking. An at-risk group could be identified by evaluating comorbid symptomatology and environmental factors such as stress.

Keywords:

family history

alcoholism

denial

Early Onset

Conflict of interest:

No

The relationship between family history and early onset alcoholism: more rapid transition to dependence or denial of their addiction?
M.R. Patrascu 1 *
T.C. Ionescu 1
M.R. Dumitrescu 1
M. Ladea 2
1Alexandru Obregia Clinical Hospital, Department 3, , Romania
2University of Medicine and Pharmacy “Carol Davila”, Psychiatry, , Romania
*Corresponding author.

Introduction:

The harmful use of alcohol can lead to destructive mental disorders, therefore it is critical to address factors contributing to their development and maintenance.

Objectives:

We aimed to identify whether family history is predictive of earlier initiation of drinking or more rapid transition to dependence. Moreover, we examined the time span between at-risk behaviour and onset of alcoholism, the main reason alcohol consumption became a pattern, as well as the patients’ awareness of their addiction.

Methods:

Using cross-sectional data from a male patient-based cohort of 110 alcoholics admitted in a Department of “Prof. Dr. Al. Obregia” Psychiatry Clinical Hospital in 2019, we evaluated the chronology of addiction development using our own assisted survey questionnaire. Social-demographic data, age at first alcohol use, age at onset of alcoholism, family history and perceived reason for alcohol consumption pattern were collected. Patients were also asked whether they consider themselves addicted.

Results:

As predicted, family history was linked with early initiation of drinking, although transition to alcohol dependence was similar across patients without a family history. The approximate time frame between at-risk behaviour and onset of alcoholism was 15 years, whereas the main reason for addiction was coping with stress. A significantly amount of patients did not consider they had an addiction problem. Frequently, patients described symptoms of depression/anxiety prior to addiction development.

Conclusions:

Family history of alcoholism can be used when predicting earlier initiation of drinking. An at-risk group could be identified by evaluating comorbid symptomatology and environmental factors such as stress.

Keywords:

Early Onset

denial

Addiction

family history

Conflict of interest:

No

Psychometric properties of the transaddiction craving triggers questionnaire in alcohol use disorder
C. Von Hammerstein 1 2 *
A. Cornil 3
S. Rothen 4
L. Romo 5 6
Y. Khazaal 7
A. Benyamina 2
J. Billieux 8 9
A. Luquiens 2 10
1Université parisnanterre, Ea Clipsyd, nanterre, France
2Hôpital Paul brousse APHP, Department of Psychiatry And Addictologyuniversity Paris-sud , Uvsq, , Inserm U 1178, villejuif, France
3Université Catholique de Louvain, Laboratory For Experimental Psychopathology (lep), Psychological Science Research Institute,, , Belgium
4University of geneva, Research Center for Statistics, Geneva School of Economics And Management,, , Switzerland
5Saint Anne Hospital, Inserm, , Center for Psychiatry And Neuroscience,, Paris, France
6Université Paris Nanterre, Clipsyd Ea4430, , France
7University hospital Lausanne, Addiction Medecine, , Switzerland
8University of Lausanne, Institut Of Psychology, , Switzerland
9University of luxembourg, Addictive And Compulsive Behaviorslab. Institute For Health And Behaviour,, luxembourg, Luxembourg
10CHU Nîmes - Inserm, Addiction, , France
*Corresponding author.

Introduction:

Given the robust association between craving and relapse, most psychological interventions tend to focus on the identification of hig-hrisk situations; situations that are supposed to trigger craving. A crucial aspect of psychological intervention is to help individuals learn skills to efficiently cope with them. To date, no appropriate instrument exists to assess craving triggers

Objectives:

We aimed to develop the Transaddiction Craving Triggers Questionnaire (TCTQ), which assesses the propensity of specific situations and contexts to trigger craving, and to test its psychometric properties in alcohol use disorder (AUD).

Methods:

This study included a sample of 111 AUD outpatients. We performed exploratory factor analysis (EFA) and calculated item-dimension correlations. Internal consistency was measured with Cronbach’s alpha coefficient. Construct validity was assessed through Spearman correlations with craving, psychological functioning and drinking characteristics.

Results:

The EFA suggested a 3-factor solution: unpleasant affect, pleasant affect, cues and related thoughts. Cronbach’s coefficient alpha ranged from 0.80 to 0.95 for the 3 factors and the total score. Weak positive correlations were identified between the TCTQ and drinking outcomes, and moderate correlation were found between the TCTQ and craving strength, impulsivity, anxiety, depression and impact of alcohol on quality of life.

Conclusions:

The 3-factor structure is congruent with the well-established propensity of emotions and cues to trigger craving. Construct validity is supported by close relations between the TCTQ and psychological well-being rather than between the TCTQ and drinking behaviors. Longitudinal validation is warranted to assess sensitivity to change of the TCTQ and to explore its psychometric properties in other Addictive disorders

Disclosure: o CvH declares that there is no conflict of interest o AC declares that there is no conflict of interest o SR declares that there is no conflict of interest o LR has received sponsorship to participate in scientific research funded by FRA through a conven

Keywords:

psychometrics

triggers

alcohol use disorder

craving

Two faces of exercise addiction - self-esteem, narcissism and sport addiction in women
E. Wojtyna 1 *
T. Król 2
M. Hyla 1
1University of Silesia in Katowice, Institute of Psychology, Katowice, Poland
2Medical University of Silesia, School of Public Health, , Poland
*Corresponding author.

Introduction:

CrossFit is among the sports that involve high-intensity exercises. It often takes a form of group training and is considered as a sport likely to cause injury. Exercise addiction, which may lead to more frequent injuries, is often connected to low self-esteem and narcissism.

Objectives:

The study aimed at establishing the links between different aspects of self-esteem and narcissism, and exercise addiction in women training CrossFit. Another goal was establishing the profile of traits connected with self-esteem and narcissism in women displaying different levels of exercise addiction.

Methods:

The study included 110 women who have been training CrossFit for at least 6 months. Questionnaires used were as follows: Exercise Addiction Inventory, Self-Liking/Self-Competence Scale, Self-Compassion Short Scale, Appearance Schemas Inventory, Satisfaction with Life Scale as well as Narcissistic Admiration and Rivalry Questionnaire.

Results:

24.5% of subjects were at high risk of exercise addiction. No rectilinear correlations between self-esteem - narcissismand exercise addiction were shown. Strong addiction to physical exercises in women training CrossFit is connected to two profiles of self-esteem and narcissism. One is characterised by high self-esteem and high narcissism connected with admiration; second is characterised by low self-esteem and high rivalry narcissism.

Conclusions:

Knowledge of these two profiles of self-esteem and narcissism in women with high profile of exercise addiction may translate into creating psychoeducational and psychoprophylactic programs on risky training which is adequately fitted to the needs of women.

Keywords:

exercise addiction

narcissism

self-esteem

Conflict of interest:

No

The role of different game-genres in predicting internet gaming disorder (IGD)
L. Ferraro 1 *
C. Avanzato 1
G. Maniaci 1
C. Sartorio 1
F. Seminerio 1
G. Tripoli 2
D. Quattrone 3
M. Daino 1
D. La Barbera 1
C. La Cascia 1
1University of Palermo, Psychiatry section, , Neuroscience And Advanced Diagnostic (bind), , Italy
2King’s College London, Psychosis Studies, , United Kingdom
3King’s College London, , , And Developmental Psychiatry Centre Institute of Psychiatry, Psychology, And Neuroscience, London, United Kingdom
*Corresponding author.

Introduction:

Internet gaming disorder (IGD) is a new diagnosis in DSM 5 worth of research. New potentially addictive features are emerging in pay- and free-to-play videogames, involving different at-risk populations of gamers. However, few studies have examined whether and how different game-genres can contribute to the risk of IGD.

Objectives:

This study aimed to investigate how game-genres can predict IGD, accounting for alexithymia scores, time-related playing habits, and other predictors.

Methods:

Participants were gamers joining online communities, surveyed about which games they played more than 20 hours in their lifetime, time-variables, other stressors and alexithymia scores. A six-steps linear regression with IGD scores and a post hoc logistic regression (outcome: IGD>=21) were performed.

Results:

5,979 subjects (88.7% males, 14-18 years), playing at different games (Figure-1). The game-genre explained the 1% of variation only. WoW and similar MMORPGs confirmed their potentiality in promoting IGD, regardless of alexithymia features (B=0.50, p=0.005). However, time-variables completely absorbed the WoW effect (B=0.01, p=0.951). LoL resulted addictive, even if considering time-variables and alexithymia (B=0.88, p<0.001). Minecraft emerged when time-variables were inserted (B=0.359, p=0.041) and stayed significant if removing alexithymia scores (B=0.48, p=0.010). Playing at Diablo3 and similar RPG did not increase IGD (B=-0.99, p>0.001). None of the different game-genres was able to push the subject over the threshold of IGD, because other characteristics interacted as additive risk-factors.

Conclusions:

Alexithymia traits and time-related playing habits mostly moderated the effect of different games in increasing IGD risk. A videogame could engage people with specific characteristics that may, in turn, differentially predispose to IGD.

Keywords:

MMORPG

MINECRAFT

playing time

Alexithymia

Conflict of interest:

No

Differences between female and male gamers and gender-specific risk-factors for internet gaming disorder (IGD)
L. Ferraro 1 *
C. Avanzato 1
G. Maniaci 1
C. Sartorio 1
F. Seminerio 1
G. Tripoli 1 2
D. Quattrone 3
M. Daino 1
D. La Barbera 1
C. La Cascia 1
1University of Palermo, Psychiatry section, , Neuroscience And Advanced Diagnostic (bind), , Italy
2King’s College London, Psychosis Studies, , United Kingdom
3King’s College London, , , And Developmental Psychiatry Centre Institute of Psychiatry, Psychology, And Neuroscience, London, United Kingdom
*Corresponding author.

Introduction:

Videogames have become more popular across females, although their widespread diffusion among males. However, few studies have examined differences between female and male gamers and gender-specific risk factors for Internet Gaming Disorder (IGD).

Objectives:

The study aimed to describe males and females’ differences in a sample of gamers, and to identify gender-specific risk-factors for IGD, accounting for alexithymia, playing habits, and other perceived stressors.

Methods:

Participants were gamers joining online communities, tested by IGDS-SF9 and TAS-20 for alexithymia. To explore risk-factors for IGD (outcome: IGD>=21), we set a binary logistic regression stratified by gender.

Results:

5,305 males and 674 females differed in most of the descriptive characteristics (Figure-1) and game-genres preferences (Figure-2). Higher DIF scores increased the risk of IGD in both males (OR=1.8 95% C.I. 1.6, 2) and females (OR=1.3 95% C.I. 1.1, 1.7) while higher EOT in males only (OR=1.2 95% C.I. 1.1, 1.3). Having another hobby apart from gaming was protective for males (OR=0.5, 95% C.I. 0.4, 0.6). Having started playing before their ten-years was a risk factor for females (OR=2.3 95% C.I. 1.2, 4.6). Loneliness and boredom feelings predicted IGD in males (OR=1.7 95% C.I. 1.5, 2) and, even more, in females (OR=2.7 95% C.I. 1.8, 4.2). Playing more than six hours/per day increased IGD-risk up to seven times in males (OR=7.3 95% C.I. 5.1, 10.3) and of almost sixteen times in females (OR=15.9 95% C.I. 5.4, 46.7) (Figure-3).

Conclusions:

Female gamers presented specific characteristics and a greater vulnerability to the increased time spent playing as a risk-factor for IGD.

Keywords:

gender psychiatry

DSM 5

videogames

time spent playing

Conflict of interest:

No

Service evaluation of child safeguarding referral process from the drug and alcohol service in SWLSTG mental health trust
P. Nagasinghe
SOUTHWEST LONDON & ST GEORGE’S MENTAL HEALTH NHS TRUST, Neurodevelopment Services, TOOTING, United Kingdom

Introduction:

A child is considered abused if he or she is treated in a way that is unacceptable in a given culture at a given time. Safeguarding refers to the process of protecting children to provide safe and effective care. This includes all procedures designed to prevent harm to a child. Strengthening the approach to prevention we aimed to look at our referral process to promote safeguarding practices within professionals.

Objectives:

To assess the current referrals process of child safeguarding in Engage Merton (Drugs and Alcohol Service)

Methods:

Patients who were referred for new assessment during the period of September-November 2017 were identified using electronic record system. A questionnaire identified the following information: age, gender, whether the patient has children, referral to social services, was the referral followed up, reason for not referring to social services if patient had children.

Results:

43 patients were identified in this period (Mean age 42.3). Of these, 17 were identified as having children. 16 were identified as not having children. This information was not recorded for 10 cases. Of the 17 patients with children, 2 were referred for child safeguarding. Of the cases where patients had children that were not referred for safeguarding, 8 were already known to social services.

Conclusions:

Professionals carrying out initial assessment in Drugs and Alcohol service need to ensure that presence or absence of children is properly documented for each service user. A safe guarding referral has been considered for each service user with children but none of the referrals were followed up.

Keywords:

Child safeguarding

Drugs and Alcohol Service

Social Service

Parental responsibility

Conflict of interest:

No

Treatment of social anxiety disorder in a public context. About a case.
D. Carracedo Sanchidrián
Hospital Universitario la Paz, Mental Health, , Spain

Introduction:

Social Anxiety Disorder (SAD) has considerable impact on health, especially in adolescence or young adulthood.

Objectives:

To illustrate the treatment of SAD with cognitive-behavioral techniques in a public context.

Methods:

Descriptive case study.

Results:

A 20-year-old female referred to Mental Health in relation to anxiety with history of generalized anxiety. No relevant somatic history. She was in treatment by Clinical Psychology and Psychiatry with 12 years with diagnosis of Anxiety reactive to bullying. She refers history of night terrors and nightmares. Exploration: Coherent speech, no formal alterations, in low tone. High anxiety, facial flushing, tremor and avoidant behavior. Low mood and tendency to isolation. Frequent nightmares, insomnia, hypnagogic and hypnopompic phenomena. Denies toxic consumption. Death thoughts in context of high anxiety, there have never been attempts or structured suicidal plans. Fifty-minute sessions every 2 weeks. A total of 10 sessions in 5 months were conducted. Therapeutic objectives: reduction of anxiety symptoms, establishment of at least 2 significant interpersonal relationships and maintenance or improvement of academic performance. Relaxation techniques were trained, patient’s negative automatic thoughts were worked ("nobody likes me," "I am weird"), progressive social exposures were held, validated and reinforced as attending the faculty. The patient began to attend more to her classes and being involved in social tasks (e.g. group work). Anxiety was markedly reduced, although nightmares persisted. Finally, the patient found a job compatible with her studies that made it easy to go on Erasmus trip.

Conclusions:

Cognitive-behavioral techniques are viable and effective for addressing SAD in public context

Keywords:

Social Anxiety Disorder

cognitive behavioral therapy

public health

Conflict of interest:

No

Comparative efficacy and tolerability of 14 benzodiazepines in the treatment of patients with anxiety: a network meta-analysis
H. Fernandes 1 *
C. Novais 2
R. Moreira 3
1BIAL - Portela & C.ª, S.A., Department of Research And Development, Coronado (S. Romão e S. Mamede), Portugal
2BIAL - Portela & C.ª, S.A, Department of Research And Development, Coronado (S. Romão e S. Mamede), Portugal
3São João University Hospital Centre, Psychiatry And Mental Health Clinic, , Portugal
*Corresponding author.

Introduction:

Some publications refer that benzodiazepines are the most frequently prescribed class of drugs in the treatment of anxiety disorders worldwide.

Objectives:

The aim of this preliminary network meta-analysis was to evaluate the efficacy and tolerability of 14 benzodiazepines used in clinical practice for anxiety treatment.

Methods:

In this network meta-analysis, we searched on pubmed different possible combinations of comparative studies between several benzodiazepines frequently used in the treatment of anxiety. Only randomised double blind head-to-head clinical trials in which the study population had anxiety were included. A network meta-analysis of random effects was performed to synthesize all the evidence for each possible pairing and to obtain a ranking for all treatments. All languages were allowed. Our primary outcome was efficacy (mean reduction in severity of anxiety based on Hamilton Anxiety Rating Scale, during treatment). Tolerability (number of adverse events) was a secondary outcome.

Results:

We included 79 double-blind clinical comparative trials, with a total population of 9454 patients. Regarding efficacy, all drugs were superior to placebo, except prazepam and cloxazolam that had no significant result versus placebo. The range of mean effect size was -3,8 to -11. Mexazolam showed a statistically significant superior effect than lorazepam, diazepam, clobazam and prazepam. Regarding tolerability, only diazepam showed a worse statistically significant difference compared with placebo.

Conclusions:

In this preliminary network meta-analysis, we found some interesting differences between benzodiazepines, that might be important for clinical practice. Several limitations should be acknowledged. More robust head-to-head clinical trials are needed.

Disclosure:

Hélder Fernandes and Catarina Novais are employees of BIAL - Portela & C.ª, S.A.

Keywords:

benzodiazepines

Anxiety

network meta-analysis

efficacy and tolerability

Adherence to treatment among patients with chronic rhinosinusitis and anxiety disorders
E. Pervichko 1
I. Kim 2
V. Vinogradov 2
A. Grishanina 1 *
1Lomonosov Moscow State University, Faculty of Psychology, , Russian Federation
2Federal State Budgetary Institution " Scientific and Clinical Center of Otorhinolaryngology of the Federal Medico-Biological Agency of the Russian Federation, Head And Neck Cancer, , Russian Federation
*Corresponding author.

Introduction:

Recent data has demonstrated that chronic rhinosinusitis (CRS) with nasal obstruction affects approximately 5–15% of the general population both in Europe and the USA (WHO, 2012). CRS patients are often diagnosed with Anxiety Disorders (AD).

Objectives:

The aim of the research was to study the relationships between adherence to treatment of patients with CRS and AD with their emotional, personal and cognitive characteristics.

Methods:

We used an author’s psychodiagnostic interview and two questionnaires: Cognitive Emotion Regulation Questionnaire (Garnefski, Kraaij, Spinhoven, 2002; Pisareva, Gritsenko, 2011), Illness Perception Questionnaire – Revised (Moss-Morris, et al, 2002); and The modified version of the Rosenzweig Picture Frustration Test (Rosenzweig, 1976; Pervichko, 2015, 2018; Zinchenko, Pervichko, 2016). The study involved 37 patients with CRS aged 32 to 54 (40,3±7,5).

Results:

High level of treatment adherence is more typical for patients who associate the occurrence of the disease with psychological causes (p=0,042). The low level of treatment adherence is associated with ideas about the predominant influence of "diffuse risk factors" (p=0,552). High level of treatment adherence is associated with ego-protective reactions to frustration (p=0.007).

Conclusions:

CRS patients with moderate level of adherence are the most adaptive to treatment of chronic disease.

Keywords:

Anxiety

adherence to treatment

emotion regulation

Reactions to frustration

Conflict of interest:

No

Efficacy of acceptance and commitment therapy in the treatment of anxiety disorders
L. León-Quismondo 1 *
F. López Ríos 2
A. Fernández Liria 3
G. Lahera 4
1Ramon y Cajal University Hospital, Psychiatry, , Spain
2University of Almería, Psychology, , Spain
3Hospital Universitario Príncipe de Asturias, Psychiatry, , Spain
4University of Alcala, School of Medicine, , Spain
*Corresponding author.

Introduction:

Acceptance and Commitment Therapy (ACT) is part of third-generation or contextual therapies. This therapy has a recent development but is increasingly applied to more mental health problems.

Objectives:

To evaluate the efficacy of ACT in the treatment of anxiety disorders, compared to established treatments.

Methods:

A systematic review of the literature was conducted to examine the evidence of efficacy of ACT. PubMed and PsycInfo were searched.

Results:

Evidence available from randomized clinical trials shows that ACT is more effective than control conditions and’ as usual’ treatments. Comparing ACT with Cognitive Behavioral Therapy (CBT), evidence of equivalent improvements in severity of the disorder, sensitivity to anxiety, worry, fear, quality of life, life satisfaction, avoidance and functioning is obtained, although with different mechanisms of action. At 12-month follow-up, ACT appears to outperform CBT, showing more pronounced improvements in the severity of the disorder and level of avoidance, while CBT achieves better quality of life indices.

Conclusions:

There is growing evidence on the efficacy of ACT in the treatment of anxiety disorders. ACT is at least as effective as empirically validated Cognitive Behavioral Therapies. However, more evidence is needed to conclude whether it is more effective than established treatments.

Keywords:

anxiety disorders

Acceptance and Commitment Therapy

Efficacy

Conflict of interest:

No

Predictors of efficacy of cognitive behavioral therapy in patients with panic disorder
L. León-Quismondo 1 *
E. Rodríguez Pedraza 2
A. Fernández Liria 3
G. Lahera 4
1Ramon y Cajal University Hospital, Psychiatry, , Spain
2Príncipe deAsturias University Hospital, Psychiatry, Alcalá de Henares, , Spain
3Hospital Universitario Príncipe de Asturias, Psychiatry, , Spain
4University of Alcala, School of Medicine, , Spain
*Corresponding author.

Introduction:

The National Institutes of Health (NIH) is committed to personalized medicine in the field of mental health. This involves selecting treatments based on certain individual characteristics that have predictive value on the results of the same.

Objectives:

To know the patient profile and the characteristics that predict a favorable response to treatment with Cognitive Behavioral Therapy (CBT) in patients with panic disorder.

Methods:

A systematic review of the literature was conducted to examine the available evidence on predictors of the efficacy of CBT in panic disorder. PubMed and PsycInfo were searched.

Results:

The available evidence indicates that variables such as agoraphobic avoidance, low expectation of change, high level of functional impairment, comorbid C cluster personality disorders, comorbid depression and high neuroticism predict worse psychotherapeutic outcomes. Non-hostile family support and high severity of the disorder are identified as predictors of better outcomes. Other variables obtain a less clear result, such as the duration of the disorder, the age of onset of the disorder or sensitivity to anxiety. Finally, other variables have not been shown to predict outcome, such as the presence of comorbid disorders of Axis I or the number of comorbid disorders, the use of concurrent medication, sociodemographic variables (sex, age, socioeconomic status) or motivation.

Conclusions:

The knowledge of predictors of response to psychotherapy makes it possible to personalize treatments, thus facilitating the professional’s decision making on which therapy to apply and increasing the possibilities of obtaining effective results.

Keywords:

cognitive behavioral therapy

panic disorder

predictors

Conflict of interest:

No

Supporting anxiety management through mHealth: methods and first contributions considering the academic campus
D. Ferreira 1
D. Melo 2
P. Silva 2
A. Santo 2
N. Madeira 3 *
S. Soares 4
S. Silva 1
1University of Aveiro, Department of Electronics, Telecommunication And Informatics (deti)/Institute of Electronics And Informatics Engineering (ieeta), , Portugal
2University of Aveiro, Department of Education And Psychology, , Portugal
3University of Coimbra, Faculty of Medicine, Department of Psychological Medicine, , Portugal
4William James Center for Research, University of Aveiro, Department of Education And Psychology, , Portugal
*Corresponding author.

Introduction:

Although adaptive, anxiety may become dysfunctional and severely impact cognitive abilities, such as attention and memory. Importantly, high levels of distress and anxiety are dramatically growing in higher education contexts, given the presence of a wide range of stressors (time demands, increased workload, among others). Mobile technologies for health (mHealth) represent a promising tool to tackle anxiety and promote well-being to a wider academic community. However, most efforts disregard the multidisciplinary nature of the required effort (gathering mental health providers and engineers) and do not account for the user’s motivations and expectations, a paramount condition for both acceptance and efficacy.

Objectives:

Materialize a multidisciplinary user-centered effort to propose mHealth-based support to address anxiety in the academic campus.

Methods:

A team including Psychologists, HCI and Software Engineers, adopted human-centred methodologies (e.g., Personas, scenarios, focus groups) to identify and characterize the profile and anxiety triggering contexts for the academic community, proposing specific therapeutic techniques that might be applicable, in those contexts.

Results:

Three stakeholders were identified and characterized: first-year students, students in evaluation periods, and early-stage teachers. The diverse nature of the anxiety inducing contexts and the need to support users throughout the campus motivated the proposal of a first mHealth tool prototype delivering several evidence-based techniques for managing anxiety.

Conclusions:

This approach enabled a clear characterization and understanding of the user and anxiety triggering scenarios to support the proposal of a custom mHealth approach. The implemented techniques are now being assessed in a laboratory setting before the first pilot trials.

Keywords:

higher education

mHealth

Anxiety

mobile health

Conflict of interest:

No

Anxiety during pregnancy, about 62 cases
D. Mnif *
R. Sellami
HEDI CHAKER hospital, Psychiatric Service, SFAX, Tunisia
*Corresponding author.

Introduction:

Pregnancy challenges the identity of the future woman and disrupts her psychic balance. Several authors associate the gestational period with a moment of emotional and relational disorganization. Many anxious symptoms testify to the intensity of this period of vulnerability.

Objectives:

Evaluate anxiety as a trait and state during the terms of the pregnancy.

Methods:

A cross-sectional descriptive study conducted during the month of February 2018 at the consultation of the gynecology and obstetrics department on a population of 62 pregnant women. We used an information sheet on participants’ socio-demographic and clinical data and the State-Trait Anxiety Inventory (STAI-Y) to assess anxiety in 2 forms: anxiety-state and anxiety-trait.

Results:

The average age of the participants was 29.7 years old. Of the women surveyed, 35.5% had exaggerated sympathetic signs. According to a dimensional approach, the mean anxiety-state score was 46.72 with a standard deviation of 9.67 and the mean anxiety-trait score was 43.24 with a standard deviation of 8, 25.According to a categorical approach, most women were anxious with a prevalence of anxiety-state of 71% and anxiety-trait of 50%. The results of the sociodemographic parameters analyzed did not show any significant difference in terms of anxiety-state and trait anxiety. Anxiety-state was significantly more common in the 3rd trimester of pregnancy (p = 0.049). We found a significant correlation between exaggeration of sympathetic signs and anxiety-trait (p = 0.02).

Conclusions:

Anxiety is common in pregnant women. It plays an unfavorable role on the woman’s health during pregnancy and postpartum and that of her newborn.

Keywords:

Anxiety

anxiety trait

anxiety state

Pregnancy

Conflict of interest:

No

Phantom phone signals in undergraduate university students of different faculties
E. Nikolaev
Ulianov Chuvash State University, Department of Social And Clinical Pscyhology, , Russian Federation

Introduction:

Most of the research on effects of mobile phone use has been based on medical students. Not less interesting is to compare manifestations of phantom phone signals (PPS) in the students of different faculties.

Objectives:

The goal is to determine the peculiarities of manifestation of PPS in undergraduate university students of different faculties.

Methods:

The research is based on the survey of 406 university students of four faculties – future dentists, engineers, economists, and psychologists. Survey questions concerned the specificity of a student’s interaction with personal smartphone.

Results:

Phantom ringing syndrome was more often in students of the economic faculty (р=0.03) than in students of the engineering faculty (74.0% vs 55.9%), and it insignificantly bothers future dentists (1.2%) and engineers (1.7%). We found no significant differences in prevalence of phantom vibration syndrome in different faculties (54.2% - 66.0%). Smartphone relocation helps more often (р=0.011) future dentists (15.3%) than future engineers (1.7%) to cope with the problem. PPS manifestation with the telephone switched off was more often (р=0.05) revealed in dental students (36.2%) as compared to psychology students (17.9%). With no access to their smartphone during a day, future dentists (18.4%) experienced severe emotional anxiety more often (р=0.016) than future economists (7.0%). At this, future engineers (28.8%) twice as often (р=0.039) as future economists (14.0%) dismissed this fact.

Conclusions:

We have revealed valid differences in the manifestation of PPS in future professionals, which may be determined by the specificity of the professional university education and the students’ personal traits.

Keywords:

Anxiety

phantom phone signals

University students

smartphone use

Conflict of interest:

No

Mechanisms of anxiety – a reappraisal on GABAA receptor subunits and role of benzodiazepines
C. Novais 1 *
H. Fernandes 2
M. Vieira-Coelho 3
1BIAL - Portela & C.ª, S.A, Department of Research And Development, Coronado (S. Romão e S. Mamede), Portugal
2BIAL - Portela & C.ª, S.A., Department of Research And Development, Coronado (S. Romão e S. Mamede), Portugal
3Centro Hospitalar Universitário de São João, Psychiatry, , Portugal
*Corresponding author.

Introduction:

γ-aminobutyric acid type A receptors (GABAA-Rs) are the major mediators of synaptic inhibition in the human brain. Advances about the pharmacological properties of GABAA-Rs have contributed to our understanding about its function.

Objectives:

In this study, we review the GABAA-Rs subunit’s composition research with emphasis on their impact on benzodiazepine´s choice for anxiety.

Methods:

Relevant literature was identified by searching the PubMed, using the keywords “benzodiazepine”, “GABAA receptor” and “anxiety”. Forty-two papers were included for qualitative analysis.

Results:

The benzodiazepine receptor (BZD-R) is an intrinsic positive allosteric modulatory site of the GABAA-R-chloride channel complex that can be opened by the inhibitory neurotransmitter GABA. Years after the discovery of the BZD-R, studies revealed heterogeneity in the subunit composition of GABAA-Rs, which comprises five subunits, and is classified into three major groups (α, β and γ) and several minor ones. The α subunit is the main determinant of the variability of the benzodiazepine site’s affinity and efficacy. Receptors containing the α1 subunit mediate sedation and serve as targets for sedative hypnotics. Selective agonists for α2 and/or α3 containing GABAA-R have been shown to provide anxiolysis without sedation. Inverse selective agonists for α5 subunit provide memory enhancement. Currently there are no total selective benzodiazepines targeting the different GABAA-Rs. For anxiety treatment, the suitable benzodiazepine should have α2 and/or α3 selectivity.

Conclusions:

More recent research has been trying to identify more selective GABAA-R-subtype compounds. Furthermore, we must also consider a tailored benzodiazepine choice regarding treatment of anxiety.

Disclosure:

Dr. Novais and Dr. Fernandes are employees of Bial, Portela & C.ª, S.A.

Keywords:

benzodiazepine

GABAA receptor

Anxiety

Role of hope, personality, dissociation, and self-stigma in the treatment of the resistant anxiety disorders
M. Ociskova 1
J. Prasko 1 *
M. Slepecky 2
A. Kotianova 2
1Faculty of Medicine and Dentistry, University Palacky Olomouc, Department of Psychiatry, , Czech Republic
2Faculty of Social Science and Health Care - Constantine the Philosopher University in Nitra- Slovak Republic,, Department of Psychology Sciences, , Slovak Republic
*Corresponding author.

Introduction:

Hope has a direct effect on the effectiveness of psychotherapy. Dissociation proved to be one of the important factors influencing treatment efficacy in anxiety disorders. Self-stigma complicated adherence of the patients to the treatment.

Objectives:

The hypothesis is that the increase of self-stigma is connected with the level of dissociation and both lead to a decrease in self-esteem and could also decrease treatment effectiveness in patients with anxiety disorders.

Methods:

A total of 109 patients were evaluated the start and end of therapy by the following scales: Mini International Neuropsychiatric Interview; The Internalized Stigma of Mental Illness Scale; Adult Dispositional Hope Scale; Temperament and Character Inventory – Revised Version; Clinical Global Impression (CGI; objective and subjective); Beck Anxiety Inventory; Beck Depression Inventory – Second Edition; Dissociative Experiences Scale. The therapeutic program included 25 group sessions and 5 individual therapy sessions of cognitive behavioral therapy or psychodynamic therapy in combination with pharmacotherapy.

Results:

Greater improvement in psychopathology, assessed by the relative change of the objective CGI, was associated with lower initial levels of dissociation, pathological dissociation, harm-avoidance, and self-stigma, and higher levels of hope and self-directedness. There were differences in the relative changes in objective CGI between the subgroups with and without a comorbid personality disorder. The patients without comorbid personality disorder improved significantly more than those with that disorder.

Conclusions:

Treatment effectiveness in anxiety disorders is related to self-stigma, hope, harm-avoidance, self-directedness, and dissociation. Supported by the research grant VEGA no. APVV-15-0502

Keywords:

anxiety disorders

dissociation

self-stigma

hope

Conflict of interest:

No

Relationship between self-stigma and personality in mixed neurotic spectrum and depressive disorders
M. Ociskova
J. Prasko *
Faculty of Medicine and Dentistry, University Palacky Olomouc, Department of Psychiatry, , Czech Republic
*Corresponding author.

Introduction:

A number of patients suffering from psychiatric disorders experience a stigma associated to prejudices about psychiatric diseases. It has been publicized that stigma is most detrimental when it is internalized.

Objectives:

The objectives of this research were to identify factors, which are significantly related to self-stigma in patients with anxiety disorders.

Methods:

109 patients with anxiety disorders and some of them with comorbidity with depressive or personality disorders, who were admitted to the psychotherapeutic department, participated in the study. All patients completed several psychodiagnostic methods – Internalized Stigma of Mental Illness Scale, Temperament and Character Inventory, Adult Dispositional Hope Scale, Dissociative Experiences Scale, Beck Anxiety Inventory, Beck Depression Inventory, and Clinical Global Impression (also completed by the senior psychiatrist).

Results:

The overall level of self-stigma was positively connected to a comorbidity with a personality disorder, more severe symptomatology, more intense symptoms of anxiety and depression, and higher levels of dissociation and harm avoidance. Self-stigma was negatively related to hope, reward dependence, persistence, self-directedness, and cooperativeness. A multiple regression analysis showed that the most significant factors connected to self-stigma are harm avoidance, the intensity of the depressive symptoms, and self-directedness.

Conclusions:

Patients with anxiety disorders with and without comorbidity with depressive and personality disorders may suffer from self-stigma. Individuals with greater sensitivity to rejection and other social aversive stimuli are prone to the development of self-stigma. Other personality factors, such as hopeful thinking and self-acceptance, serve as factors of resilience about self-stigma.

Keywords:

self-stigma

/ hope /

anxiety disorders

Dépression

Conflict of interest:

No

Dissociation and therapy of depressive and anxiety disorders with or without personality disorders
J. Prasko 1 *
M. Ociskova 1
M. Slepecky 2
A. Kotianova 2
1Faculty of Medicine and Dentistry, University Palacky Olomouc, Department of Psychiatry, , Czech Republic
2Faculty of Social Science and Health Care - Constantine the Philosopher University in Nitra- Slovak Republic,, Department of Psychology Sciences, , Slovak Republic
*Corresponding author.

Introduction:

Dissociation is imporant feature of the patients wiht anxiety disorders and depressive disorders.

Objectives:

Goal of the study was to analyze the impact of dissociation on the treatment of the patients with anxiety/neurotic spectrum and depressive disorders, and with or without personality disorders.

Methods:

The sample consisted of inpatients with neurotic spectrum disorders and depressive disorder. The participants completed Beck Depression Inventory, Beck Anxiety Inventory, subjective version of Clinical Global Impression-Severity, Sheehan Patient-Related Anxiety Scale, and Dissociative Experience Scale, at the start and the end of the therapeutic program

Results:

The total of 840 patients with anxiety or depressive spectrum disorders, who were resistant to pharmacological treatment were referred for hospitalization for the six-week complex therapeutic program, were enrolled in this study. 606 of them were statistically analyzed. The patients’ ratings significantly reduced during the treatment. Patients without comorbid personality disorder improved significantly more than patients with comorbid personality disorder in the reduction of depressive symptoms. However, there were no significant differences in change of anxiety and severity of disorder between the patients with and without personality disorders. The higher degree of dissociation at the beginning of the treatment predicted minor improvement.

Conclusions:

Dissociation presents an important factor influencing treatment effectiveness in the treatmentresistant patients with anxiety/depression with or without personality disorders. Supported by the research grant VEGA no. APVV-15-0502

Keywords:

Dépression

dissociation

cognitive behavioral therapy

anxiety disorders

Conflict of interest:

No

I know i will die, but when?
K. Puljic 1 *
M. Herceg 2
D. Herceg 3
1University Psychiatric Hospital Vrapče, Department For Psychotic Disorders, , Croatia
21School of Medicine, University of Zagreb, Croatia 2 University Psychiatric Hospital Vrapče, Zagreb, Croatia, Department For Psychotic Disorders, Zagreb, Croatia
3School of Medicine, University of Zagreb, School Pf Medicine, , Croatia
*Corresponding author.

Introduction:

Brugada syndrome is a genetic disorder which is characterized by the abnormal electrical activity and increased risk of sudden cardiac death.

Objectives:

The aim of this case is to present a patient with Brugada syndrome, which develop anxiety symptoms and discuss about treatment options if connected to anxiety disorder.

Methods:

A 45 years old female patient, married, mother of two, employed, without psychiatric treatment so far. She attends the first psychiatric examination for support and initially refuses psychopharmacotherapy. Three months ago, she was diagnosed with Brugada syndrome, which was also diagnosed to her son and daughter a few years back. The patient has been overwhelmed with a sense of fear and worry, becoming less functional in all spheres of life. She presents anxious with negative anticipation of future, occasional lack of air, dysphoricsubdepressed mood, without psychotic production and suicidal thoughts, but has overprotective behaviour towards her children.

Results:

The patient rejected psychopharmacological treatment which requires special caution of drug selection. She began individual psychotherapy to learn more coping strategies, but the group psychotherapy is also recommended.

Conclusions:

We emphasize the importance of timely diagnosis of Brugada syndrome, but also of recognizing symptoms of the anxiety spectrum if they occur because the physical symptoms of anxiety disorder could be mistaken and interweave with presenting symptoms of Brugada syndrome.

Keywords:

Brugada syndrome

Psychiatry

Anxiety

womwn

Conflict of interest:

No

Psychosomatic diseases as a result of stress caused by robberies
T. Sabo 1 *
M. Vranko 2
D. Bosnjak Kuharic 3
T. Cervenjak 4
P. Brečić 5
T. Jendričko 6
1University Psychiatric Hospital Vrapce, Department of Affective Disorders, , Croatia
2University Psychiatric Hospital Vrapče, Department of Psychotherapy, Department of Social Pedagogy, , Croatia
3University Psychiatric Hospital Vrapce, Department For Diagnostics And Intesive Care, , Croatia
4General Hospital Vinkovci, Department For General Psychiatry, , Croatia
5University Psychiatric Hospital Vrapče, Department of Affective Disorders, , Croatia
6University Psychiatric Hospital Vrapče, Department of Psychotherapy, , Croatia
*Corresponding author.

Introduction:

Response to traumatic event is the result of a complex interaction of many variables: type of stressful event, individual characteristics, subjective response and social support.

Objectives:

To show effects of different internal and external factors on the development of psychosomatic diseases.

Methods:

We will present a case of a female patient who developed a series of psychosomatic diseases after she was the victim of five armed robberies. The patient has been in psychiatric outpatient treatment since 2015 under the diagnosis of Post-traumatic stress disorder (PTSD).

Results:

Not being able to defend herself and her colleagues from the robbers lead to intense feelings of guilt and humiliation that impacted her daily functioning and became a part of her nightmares. After the robbery, patient developed arterial hypertension, diabetes mellitus, psoriasis vulgaris and inversa. Risk factor for developing psychiatric and psychosomatic symptoms was her cultural background with ideas that women must not reach out for help, have to act as support for others and suppress their own feelings. After the fourth robbery, helplessness, a feeling previously unknown to her, finally led to her first contact with psychiatrist. In her case, strong social support from family members was a protective factor.

Conclusions:

As a traumatic event, robbery may have consequences on both psychological and physical integrity of the victims leading to different clinical presentations including PTSD and different psychosomatic diseases. Integrative approach comprising of psychotherapy, sociotherapy and pharmacotherapy is essential in complicated cases like this.

Keywords:

Psychosomatic disease

Traumatic event

psychotherapy,Posttraumatic Stress Disorder

Conflict of interest:

No

The rise of severe anxiety when exposed to food – a specific phobia case report
N. Santos *
A. Alho
R. Gasparinho
L. Ferreira
M. Martins
N. Fernandes
E. Sêco
Hospital Distrital de Santarém, Psychiatry And Mental Health, , Portugal
*Corresponding author.

Introduction:

Specific phobias are characterized by excessive and persisting fear of a certain object or circumstance. The diagnosis of specific phobia requires active avoidance of the feared object or the development of extreme anxiety when exposed to the phobic situation.

Objectives:

To present a case-report illustrating the diagnosis and management challenges in patients with specific phobias.

Methods:

Literature research using “PubMed” database with MeSH term "Phobic Disorders"[Mesh]. Restricted to review articles written in English, published over the last 10 years. Total of 233 results; 10 articles selected. Information regarding the clinical case was obtained by consulting the patient’s file.

Results:

Woman, 37 years old. Complained of a feeling of obstruction in her throat after an episode of choking while eating, 3 months ago. Recalled serious dyspnoea and anxiety during the incident. The felling of obstruction worsened so she started eating only doughty food and fluids, losing 9kg of weight. Underwent an upper digestive endoscopy, which showed no significant findings. Was then referenced to a psychiatry appointment during which the patient reported being afraid to suffocate while swallowing saliva. On mental state examination, was identified severe anxious humour. The diagnosis of phagophobia was suspected. Psychoeducation and treatment with a selective serotonin reuptake inhibitor were started. Symptoms markedly improved and the patient was completely asymptomatic after 4 months.

Conclusions:

This case emphasizes that specific phobias can masquerade as organic disorders. A clinical evaluation by a physician combined with a prompt psychiatric evaluation may reduce the duration of the diagnostic period and lessen iatrogenic damage.

Keywords:

Anxiety

Specific phobias

phagophobia

Conflict of interest:

No

Life-threatening somatic symptom disorder: a case report
N. Santos *
A. Alho
M. Martins
N. Fernandes
L. Ferreira
R. Gasparinho
E. Sêco
Hospital Distrital de Santarém, Psychiatry And Mental Health, , Portugal
*Corresponding author.

Introduction:

Somatic symptom disorder (SSD) is characterized by the idea that one has a serious disease based on misinterpretation of physical symptoms, causing significant impairment in one’s life.

Objectives:

To present a case-report of severe SSD.

Methods:

Research using “PubMed” database with MeSH term "Hypochondriasis". Restricted to articles written in English, published in the last 5 years. Total: 114 results; 12 articles selected. Information regarding the clinical case obtained by consulting patient’s file.

Results:

Man, 42 years old. Past medical history: abdominal trauma requiring surgical management; heroin use disorder. Pharmacological regimen: methadone 40mg/day. Went to the emergency department 12 times over the previous 6 months complaining of constipation. Bowel obstruction due to adhesions was suspected versus constipation due to opiates. Admitted to general surgery ward. Work-up showed no findings. Constipation remained despite therapeutic measures. Returned a month after discharge with the same complaint. Felt his pylorus was “obstructed” thus had only ingested fluids for the previous 22 days. Lost 15kg. Was referenced for psychiatric evaluation. Mental state examination identified: speech centred in somatic complains; severely anxious mood; lack of insight. Diagnosis of severe SSD was suspected. Admitted to psychiatry ward. Psychoeducation was done and started treatment with selective serotonin reuptake inhibitor. Completely asymptomatic 15 days after admission.

Conclusions:

This case reiterates the importance of considering SSD as a differential diagnosis of clinical symptoms with no objectifiable organic findings, evaluating the clinical scenario as a whole and not focusing on a single symptom. This is crucial to guide precise therapeutic management, avoiding iatrogenesis and life-threatening situations.

Keywords:

somatic symptom disorder

Hypochondriasis

Conflict of interest:

No

Therapeutic management of anxiety disorders due to multiple sclerosis
O. Vasiliu
University Emergency Central Military Hospital Dr. Carol Davila, Psychiatry, , Romania

Introduction:

Multiple sclerosis (MS) is a severe neurological disorder and the white matter abnormalities as well as the involvement of corpus callosum may represent the links between MS and psychiatric disorders. The onset of anxiety disorders in MS patients may further worsen their daily functionality and quality of life.

Objectives:

To report a case series of patients diagnosed with MS who also presented anxiety disorders after the onset of their neurological disease.

Methods:

Three patients, 2 male and one female, mean age 45.3 years, diagnosed with MS, were evaluated in an out-patient setting for anxiety disorders. The diagnoses of panic disorder (n=2) or generalized anxiety disorder (n=1) were confirmed according to the DSM-5 criteria, and treatment was initiated with either escitalopram (15 mg daily dose, n=2) or sertraline (100 mg daily dose, n=1). These patients were monitored for 6 months using Hamilton Anxiety Rating Scale–17 items (HAMA), Clinical Global Impressions–Severity (CGI-S), and Global Assessment of Functioning (GAF) every 4 weeks.

Results:

The mean decrease of the HAMA score was 15.6 points at endpoint compared to baseline, and two patients reached the level of remission. GAF and CGI-S scores reflected this favourable evolution in all three cases, with a mean improvement of 43.6% and 52.2%, respectively. No significant adverse events were reported during the 6-month monitoring period.

Conclusions:

The case manager should be aware of the high risk for anxiety disorders in MS patients. Escitalopram and sertraline are good therapeutic options because they are both efficient and well tolerated.

Disclosure:

The author was speaker for Servier, Eli Lilly and Bristol-Myers, and participated in clinical trials funded by JanssenCilag, Astra Zeneca, Otsuka Pharmaceuticals, Sanofi-Aventis, Sunovion Pharmaceuticals.

Keywords:

generalized anxiety disorder

multiple sclerosis

anxiety disorders

panic disorder

Virtual/augmented reality and neurofeedback in the treatment of agoraphobia and social phobia - a comparative and randomized study
F. Canais 1 *
R. Maçorano 1
H.A. Ferreira 1
A. Charraz 2
Y. Martins 2
A. Matos Pires 2
M. Suárez-Gómez 2
1Faculty of Sciences of Lisbon University, Biophysics And Biomedical Engineering Institute, , Portugal
2Unidade Local de Saúde do Baixo Alentejo, Psychiatry, , Portugal
*Corresponding author.

Introduction:

The efficacy of virtual/augmented reality (VR/AR) games in phobia treatment, as a complement to the conventional methods, is already broadly studied. However, this method lacks objective metrics, since the exposure level does not suit the state of the patient. Thus, the hypothesis to add neurofeedback to objectify and personalize the treatment, arose.

Objectives:

In this work, a study with six already-diagnosed patients (three agoraphobia - AP, three social phobia - SP), undergoing psychotherapy, was performed. The study had a five-month duration, with a mean interval of two weeks between sessions. The aim was to evaluate the efficacy and tolerance of using serious games directly controlled by neurofeedback.

Methods:

For that, the patients wore a headband that measured Electroencephalography (EEG) and Photoplethysmography (PPG), which were then translated into brain signals and heart-rate, as they watched the virtual scenarios. In this phase of the work, the different levels of the games were played without direct control from the physiological data acquired. Afterwards, the goal is to test the game control already integrated, directly from the physiological data readings. Before each session, the patients completed two scales: Beck Anxiety Inventory (BAI), and Severity Measure for Agoraphobia (SMA) or Liebowitz Social Anxiety Scale (LSAS).

Results:

Outcomes show a positive effect: AP patients had a mean decrease on phobic symptoms of 13.43%; and SP patients had a mean decrease of 3.45%.

Conclusions:

The study shows that the addition of VR/AR in psychotherapy is positive. Future work will be conducted to assess the effect of the neurofeedback control.

Keywords:

Virtual/Augmented Reality

Digital therapeutics

neurofeedback

digital health

Conflict of interest:

No

Specifics of emotional regulation and cognitive processing in acute myocardial infarction
O. Nikolaeva 1
E. Nikolaev 2 *
A. Bogdanov 2
A. Zakharova 3
N. Maksimova 3
1Chuvash Republic Cardiology Clinic, Cardiosurgery Unit, , Russian Federation
2Ulianov Chuvash State University, Faculty of Medicine, , Russian Federation
3Ulianov Chuvash State University, Social And Clinical Psychology Department, , Russian Federation
*Corresponding author.

Introduction:

Alexithymia as a personality construct reflecting deficit of emotional regulation and cognitive processing is considered a universal trait that transcends cultural differences (Taylor et al.). In acute myocardial infarction (AMI) it is associated with delayed treatment seeking (Carta et al.).

Objectives:

The aim of the study was to explore the specifics of emotional regulation and cognitive processing in AMI patients through measuring the three-factor structure of alexithymia.

Methods:

The instrument that we used was the Russian version of Toronto Alexithymia Scale (TAS-20-R) (Starostina et al.) which was administered to 48 AMI patients during their in-patient treatment in Cardiology Clinic.

Results:

The prevalence of alexithymia among AMI patients was 68.8% (31.25% - moderate level, 37.5% - high level). The integral index of alexithymia in the examined patients as compared to the scientific data was surely higher (p=0.039). The concept characteristic of the identified differences was a higher level of the difficulty identifying feelings factor (p=0.0063). We have also revealed significant interrelations of alexithymia with the lipid status of the AMI patients. We identified positive correlations between the level of high-density lipoproteins (HDL) and the general index of alexithymia (r=0.37) and the factors that constitute its structure - difficulty identifying feelings (r=0.27), difficulty describing feelings (r=0.40), externally oriented thinking (r=0.33).

Conclusions:

Deficit of emotional regulation and cognitive processing as manifestations of alexithymia have been monitored in two thirds of AMI patients. Its higher level is characterized by patients’ difficulty describing their own feelings. Positive interrelations of alexithymia with the HDL level need further studying.

Keywords:

emotional regulation

cognitive processing

Alexithymia

acute myocardial infarction

Conflict of interest:

No

Bipolar disorder misdiagnose: a case report of cushing’s disease psychiatric manifestations.
R. De Hita Santillana 1 *
Á. Cerame Del Campo 2
M.L. Costa Ferrera Da Silva 3
1Instituto psiquiatrico Jose Germain, Psyhciatric Trainee, , Spain
2Instituto Psiquiatrico José Germain, Psiquiatría, , Spain
3Instituto psiquiatrico Jose Germain, Psyhciatrist, , Spain
*Corresponding author.

Introduction:

Diagnostic manuals agree on the need to rule out organic causes before making the diagnosis of bipolar disorder.

Objectives:

To highlight the importance of carrying out a comprehensive study to rule out possible treatable causes which could be producing psychiatric symptoms.

Methods:

We present a case report of a 60-year-old woman with no prior psychiatric history who, in the course of 4 months, developed symptoms of irritability, loss of social distance, behavioural disorganization, impulsive shopping, magical delusions and nocturnal hyperactivity. Episodes of mutism and self-limited language alterations were similarly observed. The patient was referred by her family doctor to our out-patient department due to a suicide attempt by ingesting soap after which she did not seek medical assistance. At her request, she was admitted into a private psychiatric institution for a month where she was diagnosed with bipolar disorder. After discharge and despite the established pharmacological treatment, no symptomatic improvement was observed. She was then admitted into our hospital where after screening test she was diagnosed with ACTH-producing pituitary macroadenoma.

Results:

The patient was intervened by the Neurosurgery department through trans-sphenoidal resection and the symptoms progressively disappeared.

Conclusions:

It is of vital importance to rule out organic causes prior to the diagnosis of bipolar disorder.

Keywords:

Bipolar

cushing

ORGANIC

Conflict of interest:

No

When there is no other option: ECT in bipolar disorder
R. De Hita Santillana 1 *
C. Aguilar Romero 2
A. Suárez Velázquez 3
Á. Cerame Del Campo 4
1Instituto psiquiatrico Jose Germain, Psyhciatric Trainee, , Spain
2Hospital Universitario Severo Ochoa, Uhb, , Spain
3Instituto Psiquiátrico Montreal, Hospital De Día-cet, , Spain
4Instituto Psiquiatrico José Germain, Psiquiatría, , Spain
*Corresponding author.

Introduction:

Electroconvulsive therapy (ECT) is indicated for the treatment of both manic and depressive phases of bipolar disorder in some cases: the severity of the symptoms, the necessity of an urgent response or the impossibility of using drugs for the treatment.

Objectives:

To show the benefits of the application of ECT in patients with comorbidities with a case communication.

Methods:

We present a 60-year old male patient with a bipolar disorder diagnosis with 41 years of treatment history. Due to a depressive episode, he was admitted to the psychiatric ward. Symptoms consisted of mutism, psychomotor retardation, and refusal of oral intake of food (BMI 14.5) and hydration, attributing the latter with autolytic intentionality. His vital risk was aggravated because of chronic renal failure and nephrogenic diabetes insipidus, both related to the treatment with lithium he had followed for years, requiring an adequate water intake. During his admission symptoms hadn’t responded to therapeutical dosages of venlafaxine that hadn’t been able to be increased over 150 mg/day due to adverse effects. Analysis ordered by the Nephrology department indicated that he presented SIADH (syndrome of inappropriate anti-diuretic hormone) related to treatment with valproate, as it remitted after stopping the drug. Together with the family judicial authorization for treatment with ECT was requested and granted.

Results:

We administered up to 12 ECT sessions, with clinical improvement after the 5th-6th session.

Conclusions:

ECT is a therapeutical option to consider in cases of severe psychiatric disorders in which a pharmacological approach is not enough or is not well tolerated.

Keywords:

electroconvulsive

comorbidities

Bipolar

Conflict of interest:

No

Residual symptoms and specific functional impairments in euthymic patients with bipolar disorder
R. Felhi 1 *
S. Chebli 1
A. Bouallagui 2
M. Karoui 3
F. Ellouze 3
1Razi hospital, Forensic Psychiatry, , Tunisia
2Razi hospital, Psychiatry Ward B, , Tunisia
3Razi hospital, Psychiatry Ward G, , Tunisia
*Corresponding author.

Introduction:

Functional disability in bipolar disorder, despite optimal treatment, has been associated with residual symptoms. Nevertheless, the impact and relevance of each of them remain unclear in clinical practice.

Objectives:

The aims of the present study were to evaluate the impact of residual symptoms on overall functioning in euthymic patients with bipolar disorder and to explore the relationship between residual symptoms and specific areas of functional impairment.

Methods:

This was a cross-sectional, non-interventional study of adult bipolar outpatients. All patients were euthymic at the time of assessment (YMRS score <8 and BDRS ≤8). The Functioning Assessment Short Test was used to assess overall and specific domains of functioning (autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships, and leisure time). Various residual symptoms were assessed (residual mood symptoms, sleep and sexual disorders). Logistic correlation was used to determine the best model of association between functional domains and residual symptoms.

Results:

Almost quarter of 40 patients included (22,5%) had poor overall functioning. Residual depressive symptoms were associated with poor overall functioning and occupational functioning outcome (r=0,405, p=0,009; r=0,343, p=0,003 respectively). In addition, sleep quality appeared to have an impact on global functioning and autonomy (r=0,402, p=0,01; r=0,46, p=0,003 respectively). Residual manic symptoms and sexual function weren’t correlated with functioning impairment.

Conclusions:

ln this study, residual depressive symptoms and sleep quality impairments were the most prominent factors associated with the level of functioning. Thereby, these residual symptoms need to be targeted in order to optimize bipolar patients functioning and quality of life.

Keywords:

Bipolar disorder

residual symptoms

functioning

Conflict of interest:

No

Hetero-aggressive behavior in bipolar disorders: along the thread of affective temperaments and predominant polarity
G. Fico 1 *
N. Verdolini 1
G. Anmella 1
I. Pacchiarotti 2
A. Murru 2
1Bipolar and Depressive Disorders Unit, IDIBAPS, ,, Institute of Neuroscience, Hospital Clinic, University Of Barcelona,, , Spain
2Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona, Psychiatry, , Spain
*Corresponding author.

Introduction:

Aggressive behaviors represent a public health concern and although most psychiatric patients are not aggressive, bipolar disorders (BDs) are associated with increased risk of these behaviors. Previous research focused on self-aggression identifying different predictors including affective temperaments and predominant polarity (PP), but little is known about hetero-aggressive behavior (HAB).

Objectives:

To explore the association between affective temperaments, PP and HAB and clinical predictors of HAB in BDs.

Methods:

A total of 371 subjects with BDI o BDII were recruited from the Barcelona Bipolar Disorder Program. Data on HAB were obtained from structured interviews with the patients or electronic clinical records. Affective temperaments were assessed with the TEMPS-A. Patients with and without HAB were compared regarding Clinical and sociodemographic variables and a logistic regression was performed.

Results:

81 patients reported HAB which was associated positively with substance use (SU) (p=0.004), manic polarity (p=0.024) and treatment with atypical antipsychotics (p=0.030) and negatively with depressive polarity (DP) (p=0.032) and hyperthymic temperament (p=0.025). After logistic regression, SU was positively associated with HAB (OR 2.05 [95% CI 1.18-3.57] p = 0.001) and DP negatively (OR 0.44 [95% CI, 0.20-0.97] p=0.042).

Conclusions:

Current evidence on prevention strategies for HAB in BDs is limited. It is possible that high levels of impulsivity in BDs, as linked to behavioral dyscontrol and SU, can lead to HAB. The evaluation of PP and SU should direct in the prevention of HAB, but the assessment of self-aggressive behaviors remain the main focus for a clinician.

Keywords:

aggressive behaviour

predominant polarity

affective temperaments

Bipolar Disorders

Conflict of interest:

No

Gender differences in hospitalized patients with bipolar disorder in spain.
A. García 1 *
D. Hernández-Calle 2
G. Kollias 3
A. Suárez Lorenzo 3
J. Curto Ramos 3
Í.I. Louzao 1
M.F. Bravo-Ortiz 3
1Hospital Universitario La Paz, Psychiatry, Clinical Psychology And Mental Health, , Spain
2Hospital Universitario La Paz, Psychiatry, , Spain
3La Paz University Hospital, Psychiatry, Clinical Psychology And Mental Health, , Spain
*Corresponding author.

Introduction:

Previous studies have analyzed the influence of gender on demographical and clinical patterns of patients with bipolar disorder. It remains unclear the association between gender and inpatient characteristics in bipolar patients.

Objectives:

The aim of this study is to investigate the association between gender and demographical and clinical features of patients hospitalized for bipolar disorder.

Methods:

Admission data were extracted from national database of 2013 (CMBD-H). Patients with primary diagnosis of bipolar disorder were included using International Clasification of Diseases, 9th revision, Clinical Modification (ICD-9 CM). To study the association between gender and qualitative and quantitative variables, Chi-square and T-student tests were applied. Admission rates by gender per 10.000 people were calculated by age-standarized rates obtained by National Statistic database 2013 (INE).

Results:

The database included 8.384 admissions by 6.846 patients. The number of readmission was higher in men (p<0,05). The mean age in women was higher than men (48 years vs 44 years, respectively; 95% CI p<0,05). Most patients were diagnosed with bipolar disorder type I. Up to 63 % of patients were admitted for manic episodes, the number of episodes was significantly higher (p<0,05) in men than women. It was followed by mix and depressive episodes which were higher in women (p<0,05).

Conclusions:

This study reveals gender differences in demographical and clinical variables of patients hospitalized for bipolar disorder. It is necessary further research on this topic to understand the causes of this findings.

Keywords:

Bipolar disorder

Gender

inpatient

Conflict of interest:

No

Comorbidities and gender differences in hospitalized patients with bipolar disorder
A. García 1 *
D. Hernández-Calle 1
G. Kollias 1
A. Suárez Lorenzo 2
J. Curto Ramos 2
Í.I. Louzao 1
M.F. Bravo-Ortiz 3
1Hospital Universitario La Paz, Psychiatry, Clinical Psychology And Mental Health, , Spain
2La Paz University Hospital, Psychiatry, Clinical Psychology And Mental Health, , Spain
3La Paz University Hospital Research Health Institute (IdiPAZ), Psychiatry, Clinical Psychology And Mental Health, , Spain
*Corresponding author.

Introduction:

Past studies have investigate the influence of gender in medical and psychiatric disorders in patients with bipolar disorder. The association of gender and comorbidities remains unclear.

Objectives:

The aim is to identify physical and mental comorbidities of patients hospitalized for bipolar disorder and to analyse them by gender.

Methods:

Admission data were extracted from national database from 2013(CMBD-H). All patients hospitalized for bipolar disorder as primary diagnosis were included using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). Chi-quare and logistic regresion models were applied to identify the association in comorbidities by gender.

Results:

The most frequent physical comorbidities found in bipolar inpatients were hypertension, hypothyroidism, diabetes, obesity and asthma. Hypothyroidism was more than 4 times higher in women (OR=4,78), followed by asthma and obesity. Tobacco use disorder, alcohol use disorder and drug use disorder were the top three psychiatric comorbidities followed by personality disorder and suicidability. Women had less odds in all sustance use disorders like tobacco(OR=0.8), drugs(OR=0.3) and alcohol(OR=0.33); higher odds were found in personality disorder and suicidability in women.

Conclusions:

This study reveals important differences in medical and psychiatric comorbidities in bipolar inpatients. Women had more medical comorbidities than men. Sustance use disorder had higher rates in men. Further research needs to be done in order to investigate de causes and offer and comprehensive treatment.

Keywords:

Gender

inpatient

Bipolar disorder

comorbidities

Conflict of interest:

No

From personality disorder to affective one: case report.
C. Martín Villarroel *
L. Carpio Garcia
J. Dominguez Cutanda
G. Belmonte Garcia
M. Sánchez Revuelta
J. Matsuura
E. Garcia
HOSPITAL PROVINCIAL DE LA MISERICORDIA, PsiquiatrÍa (consultas Externas), TOLEDO, Spain
*Corresponding author.

Introduction:

Affective instability is a present feature not only of affective disorders but also of personality ones, particularly on borderline disorder, where is often a difficult diagnosis because of their symptomatic overlap.

Objectives:

The objective of this paper is to evaluate whether bipolar disorder and borderline personality disorder are independent or represent different manifestations of the same disorder.

Methods:

A bibliographic search was performed from different databases (Pubmed, ScienceDirect) about both entities, from a case series report, showing throw aspects related to differential diagnosis and transition between both.

Results:

On many occasions has being proposed to talk about “bipolar spectrum” more than separated diagnostic categories. It would be relevant to propose a paradigm change to allow both entities to be more flexible, with the intention of improving diagnostic boarding and treatment. However there is no agreement between the distinction or the inclusion of Borderline in the Bipolar spectrum. Although mood symptoms are a prominent feature for both of them, the pattern is different. Borderline personality disorder is characterized by transient mood shifts that occur in response to interpersonal stressors, whereas bipolar disorder is associated with sustained mood changes. Studies have proved these disorders can be further distinguished by comparing their phenomenology, etiology and management.

Conclusions:

More studies are required to find a correct differentiation between both disorders, allowing a different initial boarding, because there will always be the question if we could modify the course with an early detection and attention. Guidelines for differential diagnosis are suggested and priorities for further research are recommended.

Keywords:

mood symptoms

affective disorders

borderline disorder

differential diagnosis

Conflict of interest:

No

The combination of pharmacotherapy and a software system at the remission stage for patients with affective disorders
S. Moroz 1 *
V. Semenikhina 2
I. Makarova 2
R. Khaitov 2
N. Turishcheva 2
1Dneproptrosk Regional Clinic Hospital named after I.I.Mechnikov, Psychosomatic Center, , Ukraine
2Dnipropetrovsk Regional Clinic Hospital named after I.I. Mechnikov, Psychosomatic Center, , Ukraine
*Corresponding author.

Introduction:

The goal of maintenance treatment is the stable social functioning of patients who have achieved stable remission. Affective pathology always remains dangerous in relation to suicides, relapses, antisocial actions and other complications. Pharmacotherapy during this period consists in continuing effective therapy with mood stabilizers, taking into account its tolerance and safety.

Objectives:

Non-pharmacological treatment includes the psychotherapy and software package for the analysis of physiological, psycho-emotional and social data of the patient, collected using smart bracelets and smartphones. The importance in this period belongs to compliance with the treatment regimen. It was noted that with the abolition of part of the treatment, the likelihood of maintaining remission decreases sharply and relapse is observed.

Methods:

The treatment of affective disorders is aimed at preventing relapse, developing suicidal behavior and other complications, as well as improving the patient’s quality of life. The essence of the pharmacological effect at this stage is to continue the therapy with mood stabilizers.

Results:

The software package collects patient data using smart bracelets and smartphones. The system processes this data using an analytical model and machine learning and notifies patient and the attending physician when determining anomalies in the indicators. It becomes possible to adjust psychopharmacotherapy at an early stage of exacerbation.

Conclusions:

Comprehensive strategies, including IT technologies used in combination with pharmacotherapy, improve compliance, reduce the risk of relapse and help restore patients’ social functioning.

Conflict of interest:

No

Impulsivity, decision-making and risk behavior in bipolar disorder and major depression in bipolar multiplex families.
A. Ramírez-Martín 1 *
J. Guzmán-Parra 1
F. Streit 2
S. Witt 2
J. Frank 2
L. Sirignano 2
T. Andlauer 3
M. Nöthen 4
A. Forstner 5
Y. De Diego-Otero 1
F. Mayoral 6
M. Rietschell 2
B. Moreno-Küstner 7
1University Regional Hospital of Málaga, Department of Mental Health, , Spain
2Central Institute of Mental Health, Department of Genetic Epidemiology In Psychiatry, , Germany
3University Hospital of the Technical University of Munich, Department of Neurology, , Germany
4University of Bonn, Institute of Human Genetics, , Germany
5University of Bonn School of Medicine & University Hospital Boon, Department of Genomics, , Germany
6University Regional Hospital of Málaga, Psychiatry Section, , Spain
7University of Málaga, Department of Personality, Assessment And Psychological Treatment, , Spain
*Corresponding author.

Introduction:

It is not clear whether in families with a marked genetic risk for bipolar disorder (BD) there are impairments in impulsivity, risk behavior and decision making in BD and major depressive disorder (MDD).

Objectives:

To analyze differences in impulsivity, decision making and risk behavior in bipolar multiplex family members diagnosed with BD, MDD and a healthy control group (HC).

Methods:

A sample of 8 bipolar multiplex families of an ongoing study (ABIF) was used. A group with a diagnosis of BD (N =31), another with a diagnosis of MDD (N = 26) and finally a HC group (N = 31) from the families and the community were compared. The Stop Signal Task and the Cambridge Gambling Task from the CANTAB battery were used. Mixed logistic regression adjusted by age and gender was carried out. Family structure was included as a random effect using a genetic relationship matrix. The analysis was carried out in R using the function relmatLmer of the package lme4qtl4.

Results:

There were significant differences between BD and HC, with higher delay aversion (p = 0.032) in BD and marginally significant results with worse response inhibition (p = 0.057) and decision making (p = 0.057) in BD. No differences were found in risk behavior (p = 0.181). There were no significant differences between BD and MDD and between MDD and HC in any variable.

Conclusions:

In bipolar multiplex families specific deficits were found in impulsivity in individuals with BD. Larger studies are needed to detect smaller effects.

Keywords:

major depression

Bipolar disorder

Impulsivity

decision-making and risk behavior

bipolar multiplex families

Conflict of interest:

No

Influence of the combined consumption of tobacco and cannabis on the clinical/funtional and cognitive evolution of patients with first manic episodes
L. Rementeria *
S. García
J. Fernandez
I. González-Ortega
S. Alberich
P. López
I. Zorrilla
A. González-Pinto
University Hospital of Alava-Santiago , Department of Psychiatry, , Spain
*Corresponding author.

Introduction:

Numerous studies demonstrate that patients with bipolar disorder present high rates of cannabis (C) and tobacco (T) consumption.The use of these substances has been associated with the progression and increase severity of the disorder, as well as with a greater likelihood of suffering more episodes (manic and depressive), more hospitalizations, suicidal attempts and greater cognitive impairment.

Objectives:

The general objective of this study is to analyze the influence of the combined consumption of T and C on the Clinical and functional evolution of patients with first manic episodes and also the cognition.

Methods:

The sample consists of 46 patients diagnosed with a first manic episode, according to defined criteria of the DSM IV-TR. The analyses were performed with SPSS v.23 statistical program, applying Kolgorovo-Smirnov, Student’s T test to examine the clinic. Besides, univariate general linear models (post-hoc analysis) were carried out to study the cognition.

Results:

Although the results are not significant at a functional level among the three groups, they all show improvement after six months. In terms of cognition, there are significant differences in attention and processing speed, being the group that consumes tobacco the one that obtains the best cognitive results.

Conclusions:

In conclusion, the combined use of cannabis and tobacco influence notably the Clinical and functional outcome of patients with first manic episodes, being global attention and processing speed being the most affected domains.

Keywords:

First manic episode

Bipolar disorder

Tobacco

cannabis

Conflict of interest:

No

Treatment and response in a spanish sample of children and adolescents with bipolar disorder
M. Ribeiro-Fernández 1 *
A. Diez-Suarez 2 3
1Complejo Hospitalario de Navarra, Psiquiatría, , Spain
2Clínica Universidad de Navarra, Psychiatry, , Spain
3The University of Texas, Psychiatry And Behavioral Sciences, , United States of America
*Corresponding author.

Introduction:

The treatment of bipolar disorder (BD) in children and adolescents is a challenge for psychiatrists. The delay in diagnosis, difficulty in the prescription and the increased likelihood of side effects can difficult to start it.

Objectives:

To analyze the treatment received in a sample of 72 patients under 18 with bipolar disorder, as well as their response.

Methods:

We analyze the treatment received in a sample of children and adolescents with BD. We evaluate the specific treatment, its dose and its response according to Clinical Global Impression (CGI).

Results:

93% of patients required some type of psychotropic drug. 77.8% of patients needed more than one drug. 68% of patients required some antipsychotic, and out of these, more than 11% received clozapine. More than 8% needed lithium and almost 70% were treated with some other stabilizer. The percentage of response to treatment according to CGI was: 20.8% good (CGI 1-2); 45.8% moderate (CGI 3-4); 33.3% insufficient (CGI 5-7).

Conclusions:

The results of this study show the need for treatment and the difficulty in controlling symptoms despite such treatment. It is necessary to continue to deepen the treatment of children and adolescents with BD

Keywords:

Bipolar disorder

Children

adolescent

treatment

Conflict of interest:

No

Treatment and response in a spanish sample of children and adolescents with bipolar disorder
M. Ribeiro-Fernández 1 *
A. Diez-Suarez 2 3
1Complejo Hospitalario de Navarra, Psiquiatría, , Spain
2Clínica Universidad de Navarra, Psychiatry, , Spain
3The University of Texas, Psychiatry And Behavioral Sciences, , United States of America
*Corresponding author.

Introduction:

The treatment of bipolar disorder (BD) in children and adolescents is a challenge for psychiatrists.The delay in diagnosis, difficulty in the prescription and the increased likelihood of side effects can difficult to start it.

Objectives:

To analyze the treatment received in a sample of 72 patients under 18 with bipolar disorder, as well as their response

Methods:

We analyze the treatment received in a sample of children and adolescents with BD. We evaluate the concrete treatment, its dose and its response according to Clinical Global Impression (CGI).

Results:

93% of patients required some type of psychotropic drug. 77.8% of patients needed more than one drug. 68% of patients required some antipsychotic, and of these, more than 11% received clozapine. More than 8% needed lithium and almost 70% were with some other stabilizer. The percentage of response to treatment according to CGI was: 20.8% good (CGI 1-2); 45.8% moderate (CGI 3-4); 33.3% insufficient (CGI 5-7)

Conclusions:

The results of this study show the need for treatment and the difficulty in controlling symptoms despite such treatment. It is necessary to continue to deepen the treatment of children and adolescents with BD

Keywords:

treatment

Children

adolescent

Bipolar

Conflict of interest:

No

Switching from carbolithium to lithium sulphate prolonged-release: differences in subjective experience of psychosocial functioning and quality of life
M. Tortorelli *
L. Tatini
G. D’Anna
M. Santella
F. Piumelli
E. Cassioli
A. Ballerini
University of Florence, Psychiatry, , Italy
*Corresponding author.

Introduction:

Bipolar disorder (BD) is one of the most disabling psychiatric disorders. Carbolithium is the first-line therapy in BD, but has important adverse effects and a narrow therapeutic range, affecting patients’ compliance and quality of life.

Objectives:

investigate effects of switching from Carbolithium to corresponding Sulphate formulation in a group of bipolar patients in order to evaluate any difference in psychosocial functioning and quality of life.

Methods:

15 patients diagnosed with BD were enrolled. All patients were stabilized with Carbolithium and then treated by the corresponding Lithium Sulphate formulation dosage. Subjects were evaluated before therapy switch (T0) and 3 months later (T1) and subjected to blood analyses. MADRS, MRS, PANSS, HAM-A, AMDP were used to evaluate psychopathology; to assess subjective experience of psychosocial functioning and quality of life WHODAS 2.0, DAI-10 and SF-36 were submitted. Repeated measures ANOVA was conducted using SPSS.

Results:

Statistically significant improvements emerged in the following scores: TSH (p=.000), SF-36 (AFT p=.004, SMT p=.009); MRS (p=.002); HAM-A (p=.000); WHODAS self-administered (p=.000), WHODAS proxy administered (p=.002). Lithium blood levels remained stable. An improvement of thyroid indexes and no worsening of renal function emerged. Only DAI-10 shows a decrease (p=.021): this data can be related to study limitations and to Lithium Sulphate price that may affect negatively patients’ drug attitude.

Conclusions:

Lithium Sulphate does not affect negatively renal and thyroid function and seems to improve patients’ psychosocial functioning and quality of life, even though this study is limited to a small sample of patients and for a short observational period.

Keywords:

Bipolar disorder

carbolithium

Lithium Solphate

subjective experience

Conflict of interest:

No

Efficacy of functional remediation on cognitive and psychosocial functioning in patients with bipolar disorder: study protocol for a randomized controlled study
V. Accardo 1 2 *
S. Barlati 2 3
A. Vita 2 3
1University of Brescia, Viale Europa 11, , Brescia, Italy, Department of Molecular And Translational Medicine, Brescia, Italy
2University of Brescia School of Medicine, Department of Mental Health And Addiction Services, Asst Spedali Civili, Brescia, Italy., Brescia, Italy
3University of Brescia, , ., Department of Clinical and Experimental Sciences, University Of Brescia, Brescia, Italy, Brescia, Italy
*Corresponding author.

Introduction:

Cognitive dysfunction is a major feature of bipolar disorder (BD), strongly associated with patients’ functional outcome.

Objectives:

The main objective is to assess functional remediation (FR)1 efficacy in improving cognitive deficits (measured by BAC-A) and psychosocial functioning (measured by FAST) in a sample of euthymic patients with BD, compared to standard treatment (TAU). Other secondary endpoints are to identify biomarkers for FR response, through serum BDNF levels and functional neuroimaging techniques.

Methods:

Two arms (1:1) randomized, rater-blinded, controlled study of 72 out-patients with BD-I and BD-II, according to DSM-5 criteria. Patients between 18 and 55 years in euthymic phase for at least two months prior to study entry will be enrolled. All patients will be assessed at baseline, at the end of treatment and after a 6-months follow-up with clinical (Y-MRS and HAM-D), neurocognitive (BAC-A) and psychosocial functioning (FAST) measures. At the same times, serum assessment of BDNF levels and functional neuroimaging techniques will be performed.

Results:

The main result expected is that, after treatment, patients receiving FR show better cognitive and psychosocial performance than those receiving TAU. Other expected findings are associated with any differences in serum BDNF levels and functional brain changes related to cognitive and functional improvement after FR.

Conclusions:

There is the need of new non-pharmacological interventions in BD in order to improve not only affective symptoms, but also cognitive dysfunctions, with the final goal to achieve full functional recovery. If FR will confirm its effectiveness, it should be implemented in the standard care of BD.

Keywords:

Bipolar disorder

Cognition

biomarkers

Functional remediation

Conflict of interest:

No

Association between borderline personality symptoms and psychiatric pregnancy outcomes in women with bipolar disorder
M. Casanova Dias 1 *
A. Di Florio 1
M. Kelson 2
L. Jones 3
I. Jones 1
1National Centre for Mental Health School of Medicine Cardiff University, Psychological Medicine and Clinical Neurosciences, , United Kingdom
2Exeter University, College Of Engineering, Mathematics And Physical Sciences, , United Kingdom
3Worcester University, Institute of Health & Society, , United Kingdom
*Corresponding author.

Introduction:

Bipolar disorder affects 3-5% of the population. Women with bipolar disorder have approximately 40% chance of having an illness episode related to childbirth and 20% will have a severe episode of illness. Knowing the factors associated with the outcomes might be beneficial for the prediction and prevention of episodes.

Objectives:

To establish if borderline personality disorder symptoms as measured by the BEST (Borderline Evaluation of Severity over Time) scale are associated with psychiatric pregnancy outcomes.

Methods:

We recruited women with bipolar disorder as part of BDRN (Bipolar Disorder Research Network) study. Women were interviewed and we collected their demographic, reproductive and clinical information.

Participants were subsequently asked to complete the BEST questionnaire in 2013 via mail-out.

We analysed the association of BEST scores with the following pregnancy outcomes: developing puerperal mania ever; developing postnatal depression as the worst episode of illness ever.

Results:

In our sample of 1369 women who completed the interview and BEST questionnaire, 924 women became pregnant.

Having puerperal mania ever (within 6 weeks of childbirth) was associated with BEST scores (aOR 0.958 p<0.0001 CI 95%[0.941; 0.976]). The higher the BEST score, the less likely to have puerperal mania ever.

Having depression within 6 months of childbirth as the worst episode of illness ever was also associated with BEST scores (aOR=1.025 p=0.001 CI 95%[1.010; 1.040]). Highest quintile, more likely to have postnatal depression.

Conclusions:

In women with bipolar disorder, the presence of borderline personality disorder symptoms is correlated with pregnancy outcomes.

Keywords:

Bipolar disorder

Pregnancy

Borderline Personality Disorder

Conflict of interest:

No

Association between borderline personality traits and becoming pregnant in women with bipolar disorder
M. Casanova Dias 1 *
A. Di Florio 2
M. Kelson 3
L. Jones 4
I. Jones 2
1National Centre for Mental Health School of Medicine Cardiff University, Psychological Medicine, , United Kingdom
2National Centre for Mental Health School of Medicine Cardiff University, Psychological Medicine and Clinical Neurosciences, , United Kingdom
3Exeter University, College Of Engineering, Mathematics And Physical Sciences, , United Kingdom
4Worcester University, Institute of Health & Society, , United Kingdom
*Corresponding author.

Introduction:

Bipolar disorder affects 3-5% of the population. Approximately 40% are likely to have an episode related to childbirth. Individualised predictions are difficult to make and the decision to become pregnant is challenging.

Objectives:

To establish if becoming pregnant is associated with borderline personality disorder symptoms as measured by the BEST (Borderline Evaluation of Severity over Time) scale in women with bipolar.

Methods:

We recruited and interviewed women with bipolar disorder as part of BDRN (Bipolar Disorder Research Network) study.

Participants were subsequently asked to complete the BEST questionnaire in 2013 via mail-out.

We analysed the association of BEST scores with becoming pregnant.

Results:

In our sample of 1369 women who completed the interview and BEST questionnaire, 924 women became pregnant and 380 did not. Women scored between 12 and 60 on the BEST scale.

The total score of BEST and the total scores of its subscale A (thoughts and feelings) and subscale B (measures negative behaviours) were not associated with being parous.

We used quantiles to better allow for understanding relationships between variables outside of the mean of the data.

When BEST scores were analysed in quintiles as categorical variable, we found a significant association with being parous. That association remained when we accounted for the pre-specified potential confounders.

Conclusions:

In women with bipolar disorder, those with the lowest or highest number of borderline personality disorder symptoms as measured by the BEST scale were more likely to have become pregnant.

Keywords:

Bipolar disorder

Pregnancy

Conflict of interest:

No

Seasonality in bipolar disorder: a specifier that needs being specified?
M. De Toffol 1 *
G. Fico 2
M. Sagué 3
N. Verdolini 2
I. Pacchiarotti 4
M. Solmi 5
E. Vieta 6
A. Murru 4
1University of Padua, Department of Neuroscience, , Italy
2Bipolar and Depressive Disorders Unit, IDIBAPS, , Institute of Neuroscience, Hospital Clinic, University Of Barcelona, , Spain
3Hospital Clínic de Barcelona, Addictions Unit. Psychiatry And Psychology Service, , Spain
4Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona, Psychiatry, , Spain
5Padova Neuroscience Center, University of Padova, Department of Neurosciences, , Italy
6University of Barcelona, Department of Psychiatry And Psychology, , Spain
*Corresponding author.

Introduction:

Among the course specifier of Bipolar Disorder (BD), seasonal pattern specifier (SPS) outlines a clinical course characterizad by a tendency towards relapses according to specific moments of the year. This course affects 15-25% of BD patients. In the past, SPS just considered depressive episodes, intrinsically biasing clinical correlates outlined. Seasonality in DSM-5 may be applied to both polarities of relapse.

Objectives:

To assess SPS and its clinical correlates, in a sample of BD I and II patients.

Methods:

BD-I and BD-II patients enrolled from a prospective cohort follow-up. Data on seasonality were obtained from electronic clinical records, and assessed with respect to season of relapse and type of episode per season. SPS and non-SPS patients were compared according to sociodemographic and clinical correlates variables. A binary logistic regression was performed on the likelihood of association with SPS.

Results:

Among the 889 BD patients enrolled, 168 presented SPS. Significant variables at bivariate comparisons were included in a binary logistic regression. Total variance explained by the model was statistically significant (p<0.0001), between 7.2-11.0%, and included significant contribution of BD- II (p<0001, OR=2.655), treatment less treated with quetiapine (p<0.008 OR=1.8), undetermined predominant polarity (p<0.003, OR=1.8).

Conclusions:

Our results outline a known association with BD-II, an unknown association with undetermined predominant polarity. Differences among SPS BD patient might possibly underpin a need for a more precise definition which implements type of the affective relapse as well as season of relapse, in order to stratify among SPS patients more homogenous subpopulations.

Keywords:

seasonality

Bipolar disorder

Conflict of interest:

No

Characteristics of the early onset bipolar disorder
A. Guermazi *
S. Omri
N. Smaoui
R. Feki
L. Zouari
N. Charfi
J. Ben Thabet
M. Maalej Bouali
M. Maalej
Hedi Chaker University Hospital, Psychiatry C Department, , Tunisia
*Corresponding author.

Introduction:

Bipolar disorder (BD) is a multifactorial disorder with heterogeneous clinical presentation, in particular according to age at onset (AAO). AAO has been discussed as a potential specifier in future classification and may be included in future algorithms of treatment decisions.

Objectives:

To specify the clinical, progressive and therapeutic characteristics in early onset BD (EOBD).

Methods:

A retrospective descriptive study, involving 30 male patients suffering from early onset BD, who were hospitalized in in the psychiatry Department of Hedi Chaker University Hospital in Sfax (Tunisia), between January 2009 and December 2018. General, Clinical and therapeutic data were collected from medical records.

Results:

The mean AAO was 18.1 years, and the mean age at first hospitalization was 20 years. Familial history of mental disorders and suicide attempts were found respectively in 26.7% and 16.7% of them. Ninety-seven percent of the patients were diagnosed as having bipolar I disorder. The first experienced mood episode was maniac in 63.3% of cases and depressive in 36.7% of cases. Psychotic features were present in 60% of cases. During the acute phase of mood episodes, treatment involved the combination of antipsychotics and mood stabilizers for all patients.

Conclusions:

Youths with a family history of BD are at high risk for the disorder. Early psychosocial intervention to delay or even prevent its onset should be developed.

Keywords:

early onset BD

Bipolar disorder

age at onset

Conflict of interest:

No

Impact of antipsychotics on the sexuality of women with bipolar disorder type I
Z. Boudali 1
Y. Zgueb 2
U. Ouali 2
Y. Harrabi 3 *
R. Jomli 3
F. Nacef 3
1Razi Hospital, Departement "a", , Tunisia
2razi hospital, Psychiatry A, manouba, Tunisia
3Razi Hospital, A "avicenna" Department, , Tunisia
*Corresponding author.

Introduction:

In addition to the clinical characteristics of bipolar disorder type I (BD I), several other factors can disrupt female sexual behaviour, including factors related to side effects of treatment.

Objectives:

The aim of our work was to determine the impact of antipsychotics (AP) on the sexuality of women with BD I.

Methods:

This was a descriptive study that took place over a year (March 2018-March 2019). We recruited 80 patients with BD I from the A psychiatry departments at Razi Hospital. The assessment of sexual function was done using the Arabic Female Sexual Function Index scale (ArFSFI).

Results:

The average age of patients was 43.8 years (±11). Eighty-four % of the patients (n=67) were on AP, 22% were on conventional AP alone, 67% were on atypical AP alone, 8% were on a combination of conventional and atypical AP and 3% were on two conventional AP. Among patients on conventional AP (n=24), 42% were on long-acting neuroleptics (seven on haloperidol decanoas and three on fluphenazine). Among patients on atypical AP (n=50), 56% were on olanzapine. AP were statistically associated with the excitation domain (p=0.022; r=-0.256) and the sexual pain domain (p=0.023; r=-0.253). The class of conventional AP had a statistically significant influence on the excitation domain (p=0.022; r= -0.256).

Conclusions:

The altered sexuality of these patients appears to be multifactorial, linked to both the clinical characteristics of the disease and the effects of treatments. Several recommendations are to be developed for better sexual management of these patients.

Keywords:

antipsychotics

sexuality

women

bipolar disorder

Conflict of interest:

No

Arab-muslim society’s relationship with female sexuality
Z. Boudali 1
Y. Zgueb 1
U. Ouali 1
Y. Harrabi 2 *
R. Jomli 2
F. Nacef 2
1razi hospital, Psychiatry A, manouba, Tunisia
2Razi Hospital, A "avicenna" Department, , Tunisia
*Corresponding author.

Introduction:

The idea of the taboo around sexuality is found in all societies of the world, but it is particularly present in Muslim societies, where modesty and chastity still retain an important place.

Objectives:

Exploring the vision of female sexuality in Arab-Muslim societies.

Methods:

This is a review of the literature. We searched the ScienceDirect, Medline and Google Scholar databases using the following keyword combinations: "woman and sexuality," "Arab-Muslim sexuality" and "woman in Arab-Muslim countries."

Results:

In the Arab-Muslim countries, women’s emancipation remains an unresolved problem and a struggle that risks bringing for many to sexual decadence. Despite the advances made in favor of women, there is still a deep patriarchal tendency reinforced by Muslim conservatives since the 1970s, which helps to keep women in what many people consider, wrongly, as the role attributed to them by religion. This idea would support the findings of a recent study where the majority of respondents believed, not only that sexuality in women was a religious duty, but also that women had no right to refuse to her husband. According to Bouhdiba, the study of sexuality in Arab societies reveals that the derealization of female status has practically ended, with a few exceptions, by locking the woman either into a role of object of enjoyment or in that of sire.

Conclusions:

Thus, despite progress in equal rights between men and women, attitudes on female sexuality still suffer from certain taboos.

Keywords:

society

Women

sexuality

arab-muslil countries

Conflict of interest:

No

Effects of benzodiazepines on sexuality of women with bipolar disorder type I
Z. Boudali 1
Y. Zgueb 1
U. Ouali 1
Y. Harrabi 2 *
R. Jomli 2
F. Nacef 2
1razi hospital, Psychiatry A, manouba, Tunisia
2Razi Hospital, A "avicenna" Department, , Tunisia
*Corresponding author.

Introduction:

While some authors consider that certain antipsychotic treatments have a protective role on sexuality of women suffering from bipolar disorder type I (BD I) then what about benzodiazepines (BDZ)?

Objectives:

Determine the impact of BDZ on the sexuality of women followed for BD I.

Methods:

This was a one-year descriptive study (March 2018-March 2019) done at the "A" psychiatry Department of Razi Hospital, La Manouba. We recruited 80 women followed for BD I. The feminine sexuality evaluation was done using the Arabic Female Sexual Function Index (ArFSFI) scale.

Results:

The average age of patients was 43.8 years (±11). Forty-two patients (53%) were on BDZ, most (60%) were on Lorazepam, 30% were on Diazepam. No patient was under a combination of two BDZs. The average prescribing dose was 3.94 (± 1.8) mg / d. In our study, the use of BDZ significantly impacted the overall mean score of ArFSFI (p = 0.016, r = -0.269), the field of excitation (p = 0.023, r = -0.254) and that of orgasm. (p = 0.038, r = -0.233). There was no statistically significant association with the interpretation of sexual activity according to the ArFSFI (p = 0.064).

Conclusions:

Providing a clear answer to the question of the impact of BDZ on the sexuality of women with TB I seems so delicate because it would require a comparative study between a group of untreated patients and a group of treated patients which raises problems of ethics and methodology.

Keywords:

benzodiazepines

sexuality

women

bipolar disorder

Conflict of interest:

No

Evaluation of the sexual function of women with bipolar disorder type I on the psychotropic-related sexual dysfunction questionnaire scale
Z. Boudali 1
Y. Zgueb 1
U. Ouali 1
Y. Harrabi 2 *
R. Jomli 2
F. Nacef 2
1razi hospital, Psychiatry A, manouba, Tunisia
2Razi Hospital, A "avicenna" Department, , Tunisia
*Corresponding author.

Introduction:

In addition to its influence on social and emotional life, bipolar disorder type I (BD I) also seems to have consequences on sexuality. Sexual dysfunction is classically described in depression, however, few studies have described the sexual behavior of stabilized bipolar patients.

Objectives:

The aim of this work was to evaluate the sexual function of women followed for BD I whose aim is to stimulate interest and debate in this little known area.

Methods:

This is a one-year descriptive study (March 2019-March 2019) that took place in the "A" psychiatry department at Razi Hospital. Eighty women followed for BD I were recruited. The assessment of sexual function was made using the Psychotropic-Related Sexual Dysfunction scale (PRSexDQ-SALSEX).

Results:

According to the PRSexDQ-SALSEX scale, 81% of patients (n = 65) had sexual dysfunction. Forty-one (51%) patients reported having sexual dysfunction since the beginning of treatment. No patient had spontaneously reported sexual dysfunction to her doctor. Forty-three patients (54%) had impaired sexual pleasure, 46 patients (58%) had dysorgasmia, 48 (60%) reported having anorgasmia and 39 (49%) had vaginal lubrication dysfunction. Forty-five percent of patients (n=36) reported that although they experienced a change in their sexuality and an impact on their relationship, they never considered discontinuing their treatment on their own.

Conclusions:

Our results suggest the importance of assessing the sexual dysfunction of patients with BD I including euthymic phase. The therapist must therefore be less reluctant and ashamed to discuss the subject of sexuality during consultations.

Keywords:

Sexual Function

Women

Bipolar disorder;

Conflict of interest:

No

Affective temperament and suicide in bipolar disorder: a comparative study
Y. Zgueb
M. Chakroun
D. Ben Khaled
S. Hechmi *
U. Ouali
F. Nacef
Razi University Hospital, Department of Psychiatry A, , Tunisia
*Corresponding author.

Introduction:

Suicide is a major social and clinical problem. Clinical characteristics associated with suicidal risk in bipolar disorder, include affective temperament types.

Objectives:

The aims of our study were to compare the temperament traits of two patients groups with a type I bipolar disorder, those who have attempted suicide and those who have not attempted suicide.

Methods:

A cross-sectional, comparative and retrospective study of 150 patients in remission. Realized over a period of six months, from October 2018 to May 2019. Demographic data, duration and the course of the disease were extracted from patients’ medical files. Affective temperaments were evaluated by the validated Tunisian version of the TEMPS-A scale.

Results:

The average age was 42, 25±10 years. The gender ratio (M / F) was 1,67. Thirty-five patients (23%) did at least one suicide attempt. The average age at the first suicide attempt was 32.06 ± 9.3 years. Hyperthymic temperament was the most common temperament found in our population (32%).The suicidal attempt was significantly associated with higher depressive temperament scores (P= 0,048).

Conclusions:

This study identified the independent contribution of temperament traits to suicidal behavior. Assessing the temperament of patients with bipolar disorder may result in deep insight into suicidal behavior and facilitate intervention for those at risk.

Keywords:

temperament

Bipolar disorder

Suicide

mood

Conflict of interest:

No

Suicidal behavior in bipolar disorder type 1
Y. Zgueb
M. Chakroun
D. Ben Khaled
S. Hechmi *
U. Ouali
F. Nacef
Razi University Hospital, Department of Psychiatry A, , Tunisia
*Corresponding author.

Introduction:

Suicidal behavior is a major public health problem, and its prevention is a challenge. This behavior is more common in association with mood disorders and especially with bipolar disorder.

Objectives:

The aims of our study were to determine the prevalence and peculiarities of suicidal behavior in a population of bipolar patients.

Methods:

A cross-sectional, descriptive and retrospective study included 150 patients with a type 1 bipolar disorder diagnosed according to DSM 5 criteria. Demographic data and the course of the disease were extracted from patients’ medical files.

Results:

A family history of bipolar disorder was noted in 51.4% of suicidal patients. Eighteen patients had a personality disorder. A history of suicidal ideation was found in 62.7% of cases. The prevalence of suicide attempts was 23.3%. The mean age at the first suicide attempt was 32.06 ± 9.3 years. The average number of suicide attempts was 2.66 ± 2.83. In 88.6% of the cases, the suicide attempt was concomitant with a thymic relapse (It was a depressive episode in 83.9% of cases, and a mixed episode in 12.9% of cases).The attempt was made by a drug ingestion in 57% of cases. Suicide attempt was significantly associated with age(p=0.005), family history of suicide (p=0.008), family history of bipolar disorder(p=0.002), duration of disease(p=0.008),and personality disorder(p=0.014).

Conclusions:

The prevention of suicidal behavior in bipolar disorder need more assessment of vulnerability factors. A close and sustained clinical supervision can improve the management of suicidal risk in these patients.

Keywords:

Suicide

Bipolar disorder

suicidal behavior

Conflict of interest:

No

The cannabis use as a predictor of suicide attempts in bipolar disorder
Y. Zgueb
M. Chakroun
D. Ben Khaled
S. Hechmi *
U. Ouali
F. Nacef
Razi University Hospital, Department of Psychiatry A, , Tunisia
*Corresponding author.

Introduction:

Bipolar disorder is a severe mental disorder that implies a high risk of suicide. Cannabis is the most commonly abused drug among patients with bipolar disorder and has been found to increase the duration and the intensity of symptoms.

Objectives:

The aims of this study was to establish the prevalence of cannabis use and suicide attempts in patients with a type 1 bipolar disorder and to study the association between them.

Methods:

A cross-sectional and retrospective study of 150 patients. Demographic data and the course of the disease were extracted from patients’ medical files.

Results:

The average age was 35.97±11.55 years. A psychiatric family history was noted in 79 patients (52.7%). Twenty-five patients had psychiatric comorbidities. Eighteen patients had a personality disorder. Thymic episodes was of manic type in 48% of cases and of depressive type in 36 % of cases. The average duration of the disease was 15.95 ± 9.6 years. Therapeutic adherence was good in 44.7% of cases. A history of suicidal ideation was found in 94 patients and suicide attempts was found in 35 patients. Thirteen patients were cannabis users. Suicidal attempts was significantly associated with cannabis use (p=0.013), especially in male patients (p=0.025).

Conclusions:

Despite some limitations, this study estimate a strong association between cannabis use disorder and suicidal attempts in patients with bipolar disorder. Further studies are needed to clarify the nature of this relationship and that mechanism.

Keywords:

cannabis

Bipolar disorder

Suicide

Conflict of interest:

No

The clinical aspect of bipolar disorder type 1: about a mediterranean population
Y. Zgueb
M. Chakroun
D. Ben Khaled
S. Hechmi *
U. Ouali
F. Nacef
Razi University Hospital, Department of Psychiatry A, , Tunisia
*Corresponding author.

Introduction:

Bipolar disorders are one of the most severe psychiatric disorders, implying a high degree of morbidity and incapacity for patients. Some factors contribute to modifying the clinical profile and the course of the disease.

Objectives:

The aims of our study were to determine the Clinical and evolutionary aspect of bipolar disorder type 1 in a Mediterranean population.

Methods:

A cross-sectional and retrospective study included 150 Tunisian patients. Demographic data and the course of the disease were extracted from patients’ medical files.

Results:

Forty-six patients had a family history of bipolar disorder.Sixty-nine patients (46%) were smokers. Twenty-six patients (17.3%) were alcohol users. Aggressive behavior was found in 26.7% of cases. A criminal record was found in 18 patients (12%).The average age of onset of the disease was 26.23 ± 7.88 years old. The time between onset of disorders and follow-up in psychiatry was more than one year in 50 patients (33.3%).The first thymic episode was predominantly manic (48%), and severe with psychotic features (57,3%).The average number of years of disease progression was 15.95 ± 9.6 years. the average number of relapses was 7.28±5.38. Therapeutic compliance was good in 44.7% of cases. The average number of treatment discontinuations per year was 2.17±1.32 because of side effects in 15.7% of cases.

Conclusions:

Numerous other studies have confirmed this clinical aspect, especially in the tropical and Mediterranean regions. European and American studies do not find the same results. Other comparative studies are desirable.

Keywords:

Bipolar disorder

Mediterranean

Type 1

Clinical aspect

Conflict of interest:

No

Thymoregulators and suicide prevention in bipolar disorder
Y. Zgueb
M. Chakroun
D. Ben Khaled
S. Hechmi *
U. Ouali
F. Nacef
Razi University Hospital, Department of Psychiatry A, , Tunisia
*Corresponding author.

Introduction:

Bipolar disorder is a severe and recurrent psychiatric disorder with a high rate of suicide. The anti-suicidal benefit of lithium on suicidal behavior in bipolar disorder is well established. Data are mixed on the effects of other mood stabilizers.

Objectives:

The aims of our study were to highlight the preventive action of other mood stabilizers on suicide in bipolar disorder population.

Methods:

A cross-sectional retrospective and comparative study included 150 patients with bipolar type I disorder, diagnosed according to the DSM-5.Demographic data and the course of the disease were extracted from patients’ medical files.

Results:

The average age was 35.97±11.55 years. The average age of onset of the disease was 26.23 ± 7.88 years. The first thymic episode was of manic type in 48% of cases. The average duration of the disease was 15.95 ± 9.6 years. Valproic acid was the most used tymoregulator (80%) and carbamazepine was prescribed in 17 patients (11.3%). A history of suicidal ideation was found in 94 patients (62.7%). The prevalence of suicide attempts was 23.3% (n = 35). Suicidal attempts, were significantly less common in patients who were treated with a valproic acid (p=0.016).

Conclusions:

Our results suggest that the prescription of the valproic acid in bipolar patients may be associated with a reduced risk of suicidal acts and may be a good alternative to lithium use. Other specific studies on the effects of valproic acid on suicide risk are recommended.

Keywords:

Bipolar disorder

Suicide prevention

Thymoregulators

Conflict of interest:

No

Hyperthyroidism after levothyroxine overdose may induce delayed mixed states in bipolar disorder: a case report and review of recent work
E. Izquierdo Vendrell 1 *
A. González-Rodríguez 2
N. Sanz 2
J. Cobo 2
N. Salvat 3
C. Feijoo 4
A. Guàrdia Delgado 5
A. Álvarez Pedrero 2
J.A. Monreal 6
D. Palao Vidal 7
J. Labad 7
1Corporació Sanitària Parc Taulí, Mental Health, , Spain
2Parc Taulí University Hospital. Autonomous University of Barcelona (UAB). I3PT, Mental Health, , Spain
3Corporació Sanitària Parc Taulí. Hospital Universitari de Bellvitge. IDIBELL, Mental Health, , Spain
4Corporació Sanitària Parc Taulí, Internal Medicine, , Spain
5Parc Taulí University Hospital, Mental Health, , Spain
6Parc Taulí University Hospital. Autonomous University of Barcelona (UAB). , CIBERSAM, Mental Health, , Spain
7Parc Taulí University Hospital. Autonomous University of Barcelona (UAB). I3PT. CIBERSAM, Mental Health, , Spain
*Corresponding author.

Introduction:

Current literature report the occurrence of manic states in hypothyroid subjects after hormone supplementation. However, after drug overdose of levothyroxine, little research have described the induction of delayed mixed states.

Objectives:

Our aim is to present a case of overdose of levothyroxine with suicidal intention in a women diagnosed with bipolar II disorder.

Methods:

A case report and narrative review of recent work.

Results:

A 40-year old female patient with bipolar II disorder and ankylosing spondylitis was brought to the Emergency Service after committing a suicidal overdose of paracetamol (>7gr), methotrexate (>40 mg) and levothyroxine (>1250 mcg). Antidote and four days of clinical observation was needed. Psychopathological assessment revealed the occurrence of depressive symptoms, so patient was admitted to our inpatient unit. Olanzapine 5 mg/day and citalopram 10mg/day were initiated in the first 24-48 hours. After 4 days, the patient presented tachycardia (130-150 beats/min), irritability, suicidal ideation, tremor and worsening of depressive symptoms. Electrocardiography did not reveal any arrhythmia. Laboratory (4th day): thyroid stimulating hormone (TSH) < 0.01 μU/mL (0.40 -4.00), free T4 (fT4) >7.77 ng/dL (0.80- 1.80) and free T3 (fT3): 22.50 pg/mL (2.00-4.40). Diagnoses: Severe hyperthyroidism due to exogenous thyroid hormone and mixed state in bipolar disorder. Thyrotoxicosis remitted and mixed symptoms improved. Olanzapine was increased to 10 mg/day. Normalization of fT3 and fT4 was achieved. TSH normalized within several days later.

Conclusions:

Levothyroxine is a lipophilic molecule that can be accumulated for several days. Continuous monitoring is mandatory. Affective symptoms should be also monitored as psychotropic medications after normalization.

Keywords:

Bipolar disorder

Hyperthyroidism

levothyroxine

mixed states

Conflict of interest:

No

Family illness perception of bipolar disorders: why we have to take into account family in mental health?
K. M’Bailara 1 2 *
C. Munuera 3
I. Minois 2
L. Zanouy 2
J. Sportich 2
F. Josse 2
S. Gard 2
1University of Bordeaux, Ea4139, Laboratory Ofpsychology, , France
2Hospital Charles Perrens, Bipolar Expert Center, , France
3University of Bordeaux, Laboratory of Psychology, , France
*Corresponding author.

Introduction:

Based on a self-regulation theory, illness perception is a process by which individuals respond to a perceived health threat (Leventhal, et al., 1984). It’s central to interpret patients’ reactions in different stages of care (Weinman, 1997). In view of the impact of bipolar disorder on psychosocial functioning, to cope with to the illness is not only the patient’s affair but also that of his or her family members. But, perception of illness by family caregivers is an untreated thematic of research in bipolar disorders.

Objectives:

The objective is to describe the perception of bipolar disorder in family caregivers. The second objective is to compare the perception of illness between family caregivers and patients.

Methods:

The sample is composed about 241 persons, 80 family caregivers and 161 have a bipolar disorder. An adapted version for bipolar disorder of the brief Illness Perception Questionnaire (IPQ, Broadbent et al., 2006) was used to assess patients’ cognitive and emotional representations of their illness.

Results:

For caregivers, chronicity is the most threatening followed by emotional distress and stress, followed by the impact of illness. Lack of personal control, severity of symptoms and misunderstanding are perceived as moderately threatening. There is no significant difference between caregivers and patients in the illness perception.

Conclusions:

Like patients, caregivers have a negative perception of bipolar disorder. So, these results encourage to help family to elaborate their own ideas of the illness, which is essential for successful interventions. For example, Therapeutic Education could be relevant to improve family adjustment to bipolar disorder (M’bailara, 2019).

Keywords:

illness perception

Bipolar disorder

family

Conflict of interest:

No

Bipolar disorder, implications of dimensional perspective
L. Muntean 1 *
A. Nirestean 1 2
E. Lukacs 2
A. Comaniciu 1
1Mures County Hospital, Psychiatric Clinic No. 2, , Romania
2George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Psychiatry, , Romania
*Corresponding author.

Introduction:

In the present, it is being discussed about the interference between psychiatric pathology and personality, a large part of the factors involved in the development of personality disorders constitute risk factors for psychiatric disorders. It is well known that there is an association between bipolar disorder and personality disorder approached from a categorical point of view such as borderline, narcissistic and obsessive compulsive personality disorder but also the fact that premorbid personality always conditions their prognosis.

Objectives:

Our study aims to highlight some associations between the personality structure approached from a dimensional point of view, the awareness of the disease, the compliance at the treatment and the functioning in the professional and family role of the patients with bipolar disorder.

Methods:

In this study, were included patients diagnosed with bipolar disorder who were admitted to the Psychiatry Clinic II from Tg. Mureș, between the ages of 30 and 55. Patients were in the phase of complete clinical remission at the time of evaluation. We evaluated their personality from a dimensional point of view using the DECAS scale, based on the “Big Five” dimensional model and applied the Birchwood Insight Scale for insight assessment. The diagnosis of bipolar disorder was made according to DSM-5 criteria.

Results:

There is an association between the personality dimensions and the clinico-evolutionary particularities of the bipolar disorder in the studied patients.

Conclusions:

Increased values of conscientiousness and agreeableness are a favorable prognostic factor. Low conscientiousness and increased neuroticism are aggravating prognostic factors.

Keywords:

Bipolar disorder

dimensional perspective

personality disorder

insight

Conflict of interest:

No

The efficacy of the interpersonal and social rhythm therapy (IPSRT) for patients with bipolar disorder
C. Palummo *
V. Caivano
F. Zinno
A. Vece
L. Marone
V. Giallonardo
A. Di Cerbo
G. Sampogna
M. Luciano
A. Fiorillo
University of Campania "Luigi Vanvitelli", Department of Psychiatry, , Italy
*Corresponding author.

Introduction:

The Interpersonal and Social Rhythm Therapy (IPSRT) has shown to be effective in reducing symptoms’ severity and regularizing circadian rhythms of patients with bipolar disorder (BD). Few studies assessed the efficacy of this approach in a group format.

Objectives:

The aims of this study are to assess the efficacy of a group IPSRT (IPSRT-G) in terms of improvement of symptoms, quality of life and adherence to treatments and reduction of levels of stigma.

Methods:

Patients with BD were recruited according to the following inclusion criteria: 1) age between 18 and 65 years; 2) diagnosis of BD type I or II; 3) absence of psychiatric comorbidities and of serious physical diseases. The IPSRT-G consisted of eight 90-minute sessions (two individual and six group sessions). Patients have been assessed at baseline (T0), at the end of the intervention (T1) and after 3 months (T2).

Results:

16 patients have been recruited; 62.5% of them were females, with a mean age of 48.19±11.3 years and with a mean age at onset of 25.47±7.07 years. Patients reported a significant reduction at the Beck Depression Inventory (BDI) (p<0.05) and Internalized Stigma of Mental Illness Inventory (ISMI) total scores (p<0.01). In particular, a significant reduction was reported at the "Social Retreat" subscale (p<0.02), and an improvement at the “Stigma Resistance” subscale (p<0.05).

Conclusions:

Our data show that the IPRST-G can be effective in reducing depressive symptoms and stigma, in particular by increasing coping strategies to stigma and reducing social withdrawal, also when provided in the group format.

Keywords:

Bipolar disorder

outcome

Interpersonal and Social Rhythm Therapy

group interventions

Conflict of interest:

No

Aggressive behaviours and clinical course of bipolar disorder
V. Caivano
F. Zinno
G. Tarantino *
M. Carfagno
C. Palummo
M. Raia
G. Cristilli
A. Di Cerbo
G. Sampogna
M. Luciano
A. Fiorillo
University of Campania "Luigi Vanvitelli", Department of Psychiatry, , Italy
*Corresponding author.

Introduction:

Aggressive behaviours are frequent during the acute phases of bipolar disorders and are often associated to the need for hospitalization, prolonged hospital stays and to a worse long-term outcome of the disorder.

Objectives:

To analyze the socio-demographic and clinical characteristics, as well as the affective temperaments of patients with bipolar I and II disorders (BD) with a positive history of aggressive behaviours.

Methods:

All patients with a diagnosis of BD I or II according to the DSM-5 criteria have been recruited. Socio-demographic and clinical characteristics have been collected with an ad-hoc schedule. All patients filled in the short version of the TEMPS-M. According to the history of aggressive behaviours, patients were then divided in two groups.

Results:

84 patients with BD I or II have been recruited. 63% of them were female, with a mean age of 49.6±12 years. The most common diagnosis was BD II (48.8%). Patients with a history of aggressive behaviours had a greater number of affective episodes (p=0.013), mostly episodes of mania (p=0.002) and mixed states (p=0.01). Aggressive behaviours were correlated to a history of substance (p=0.007) and alcohol abuse (p=0.015) and with an irritable temperament (p=0.05).

Conclusions:

Our study confirms the relationship between alcohol abuse, aggressive behaviours, affective temperaments and BD. It is crucial to identify patients who are at risk of developing aggressive behaviour in order to provide adequate interventions.

Keywords:

Aggressive behaviours

Bipolar disorder

alcohol abuse

affective temperaments

Conflict of interest:

No

Minor physical anomalies in bipolar disorders: a meta-analysis and systematic review
E. Varga *
A. Hajnal
T. Tenyi
R. Herold
University of Pécs, Department of Psychiatry, , Hungary
*Corresponding author.

Introduction:

Minor physical anomalies (MPAs) are insignificant errors of morphogenesis, which may reflect basic neurobiological features underlying the disease. Despite several studies about the presence of MPAs in bipolar disorders, the evidence in favor of a neurodevelopmental basis for the disease is still controversial.

Objectives:

The aim of this meta-analysis was to assess the standardized weighted mean effect sizes of MPAs in bipolar disorders, and to investigate if MPAs may be found predominantly in the head and facial regions in patients with bipolar affective disorder compared to healthy controls (HC).

Methods:

Four studies, involving 155 patients with bipolar disorders (BPD), as well as 187 HC, were involved in the analysis after literature search. For the investigation of MPAs in the periferial (MPA-P) and in the head and facial regions (MPA-FC) two studies involving 121 BPD patients, as well as 133 HC passed the inclusion criteria.

Results:

The MPAs of BPD were significantly higher compared to HC (SMD = 0.62, p = 0.003). Another important finding of the present study is that BPD patients’ MPA-P scores do not significantly differ from those of healthy controls. In contrast, BPD patients’ MPA-CF scores were found to be significantly higher compared to HC subjects (SMD = 0.84, p < 0.001).

Conclusions:

The findings of the present study suggest an early insult during the development of the brain in bipolar affective disorder.

Keywords:

Méhes scale

Waldrop scale

Bipolar disorder

minor phisical anomalies

Conflict of interest:

No

Affective temperaments in patients with bipolar and cyclothymic disorder: a clinical characterization
F. Zinno 1 *
G. Sampogna 1
V. Del Vecchio 1
V. Giallonardo 1
M. Luciano 1
L. Steardo 2
G. Perugi 3
M. Pompili 4
A. Tortorella 5
U. Volpe 6
A. Fiorillo 1
1University of Campania "L. Vanvitelli", Department of Psychiatry, , Italy
2University "Magna Graecia" of Catanzaro, Psychiatry Unit, , Italy
3University of Pisa, Azienda Ospedaliera Universitaria Pisana (AOUP), Department of Clinical and Experimental Medicine, Psychiatric Section, , Italy
4S. Andrea Hospital, Sapienza University, Department of Neurosciences, Mental Health And Sensory Organs, Suicide Prevention Center, , Italy
5University of Perugia, Department of Medicine, Division Of Psychiatry, , Italy
6School of Medicine Università Politecnica delle Marche, Department of Neurosciences/dimsc, , Italy
*Corresponding author.

Introduction:

Affective temperaments (ATs) play a significant role in the clinical presentation of bipolar (BD) or cyclothymic disorder (CYC) and can have an impact on long-term outcome and symptoms’ severity. Despite this, ATs are understudied in these patients.

Objectives:

To evaluate socio-demographic and clinical characteristics associated with ATs in a sample of outpatients with BD or CYC.

Methods:

Patients have been recruited in two Italian University sites. Inclusion criteria were: 1) age above 18 years; 2) diagnosis of BD type I (BDI) or II (BDII), or CYC according to the DSM-5; 3) being in a stable phase of the disorder. Recruited patients were asked to fill in the Italian version of the short TEMPS-M.

Results:

815 patients were recruited, mainly female (61.1%) with a mean age of 44.4±14.6 years. 52.8% of them had a diagnosis of BDI, 19.4 of BDII and 27.9 of CYC. In female, the most represented AT were the depressive (p<.01), cyclothymic (p<.01) and anxious (p<.0001) ones, while the irritable temperament was most represented in men (p<.01). All temperaments were more represented in CYC than in BDI (p<.005); depressive, cyclothymic and irritable temperaments were more represented in CYC, depressive and anxious temperaments in BDII (p<.005); only the hyperthymic temperament was more represented in BDI (p<.005).

Conclusions:

Our results confirm the link between AT and Clinical and socio-demographic characteristics of BD and CYC. Given the predictive role of the AT for the outcome of bipolar disorders, their assessment should be part of the routine care of these patients.

Keywords:

affective temperaments

Bipolar disorder

cyclothymic disorder

Conflict of interest:

No

Awareness of attention deficit hyperactivity disorder among special education students in riyadh and qassim regions of saudi arabia 2019-2020
S. Alotaibi 1
N. Alsoqih 2
S. Aljhani 3 *
A. Alshubrmi 1
A. Alshawi 1
H. Abdullah 1
R. Almushaity 1
S. Alkuraidess 1
1Qassim university, Medical College, , Saudi Arabia
2Qassim university, Pediatric Neurology, , Saudi Arabia
3Qassim university, Psychiatry, , Saudi Arabia
*Corresponding author.

Introduction:

ADHD is a chronic genetic neurodevelopmental disorder. Which is represented by either inattention symptoms or hyperactivity symptoms or both of them. Subsequently, the peak of symptoms appears during childhood and decreases with growing older. Plenty of researches showed various factors could contribute to increasing symptoms’ severity. ADHD is considered as one of the most common neurodevelopmental disorders. Yet, Saudi society’s awareness towards it appears to be relatively lacking. Apart from that, Researches showed that teachers and parents misconception about the disorder affects children’s improvement as a result of decreased support and not providing a healthy suitable environment for children’s case.

Objectives:

The general objective is to measure awareness levels of ADHD among college students majored in special education. Besides, other specific objectives such as assessing their knowledge about dealing with ADHD child, assessing their thoughts about having an ADHD course and its importance in their career, and evaluating ADHD involvement within special education curriculums.

Methods:

Data will be collected through a demographic questionnaire along with the Knowledge of Attention Deficit Disorders Scale (KADDS). Then, processed by the SPSS Statistics program.

Results:

Expected Results (ongoing) Average to low levels of awareness among the students. Especially in medical knowledge about the disorder.

Conclusions:

no conclusion yet will be posted as soon as possible

Keywords:

Autism

awarness

Neurodevelopmental

Conflict of interest:

No

Separation anxiety - how to help to child and to a parent case report
Z. Barac-Otasevic *
I. Ljutica
Medical Clinical Centre Montenegro, , Psychiatry Clinic, , Montenegro
*Corresponding author.

Introduction:

Child separation fear is a completely normal stage in a child’s development, but what can further aggravate the situation is the parent’s fear of separation. Namely, parents very often inadvertently encourage the separation problem with their own anxiety, which is very difficult to hide from the child. If there is any parenting issue regarding the child’s departure to kindergarten, he or she will probably come to light, even if they do not say it - voice communication is not the only way the child "reads" our messages. In the work, the author discusses the help of a boy of 7.5 years, who was in the first grade, and who refuses to go to school without his mother. On the other side mum says that she is tired .... What’s best for both?

Objectives:

Best solution for adaptation in new circumstances - school

Methods:

Case report

Results:

The child may have a marked need to be with the parents and may seem to be regressing. But that’s also the way a child goes through separation after feeling safe again. If he is allowed to "hang" with you at first, when he is ready for it, the child will stop doing so. If he pushes himself away or expects to grow up very quickly (for example, he cares for a younger child more than is appropriate for his age), then the child’s insecurity will deepen and he will continue to express it through behavior.

Conclusions:

working separately with child and mother

Keywords:

Anxiety

child

separation

parents

Conflict of interest:

No

Construction and analysis of psychological anamnesis as basis for diagnostics of children and adolescents in psychiatric clinic
N. Burlakova 1 *
V. Oleshkevich 2
1Lomonosov Moscow State University, Faculty of Psychology, Department of Neuro- And Pathopsychology, , Russian Federation
2Scientific Practical Children’s Mental Health Centre n. a. G. Sukhareva of Moscow City Department of Healthcare, -, , Russian Federation
*Corresponding author.

Introduction:

The contemporary psychodiagnostics often is oriented only at objective data. This trend is supported by the requirements of the evidence-based medicine, and it transforms the results of studies to partial, objectified and therapeutically insignificant.

Objectives:

The objective was to explore systematically the methods used for diagnostics of children and adolescents in psychiatric clinic.

Methods:

Analytic-empirical method was used.

Results:

1) The multidirectionality and unsystematization of the methods shaped in the different historical situation were demonstrated; 2) the methods aimed at exploration of the patient’s inner world and at phenomenological understanding of inner mechanisms of psychological development are poorly developed. 3) psychiatry needs the systematic cultural-historical methodology aimed at construction and analysis of psychological anamnesis as well as ways to describe and analyze the child’s development and developmental disorders in the social environment. 4) As the research showed, elaboration of methodology aimed at construction and analysis of psychological anamnesis is necessary. Main structures of the psychological anamnesis include description of early ontogenesis, main psycho-physiological features of the child, personality type, social interactions between the child and environment, chronological analysis of changes and their structure within the context of social environment, etc.

Conclusions:

Analysis of the psychological anamnesis constructed in such a way allows to explore the structure of object relations between child and environment, reconstruct transformation of social relations in the intrapsychic relations, characterize the inner dialogues of self-awareness and reconstruct the developmental mechanisms both under normal and pathological conditions. Such an approach allows to develop new opportunities integral clinical psychological diagnostics for children and adolescents.

Keywords:

psychological diagnostics

psychological anamnesis

Conflict of interest:

No

Adhd and emotional dysregulation
N. Chinchurreta 1 *
J.J. De Frutos Guijarro 2
R. Martín Aragón 3
C. Moreno Menguiano 2
1HOSPITAL PUERTA DE HIERRO, Psychiatry, , Spain
2Centro de Salud Doctor Luengo Rodriguez, Servicio De Psiquiatría, , Spain
3Complejo Hospitalario Mancha Centro., Unidad De Salud Mental Infanto-juvenil ., ., Spain
*Corresponding author.

Introduction:

El trastorno por déficit de atención con hiperactividad (TDAH) es un ejemplo común de psicopatología del desarrollo que podría entenderse mejor tomando una perspectiva de regulación emocional. Como se ha visto que la desregulación emocional se está convirtiendo en un problema más frecuente en la población infantil-juvenil, una psicopatología del desarrollo común como el TDAH podría entenderse mejor tomando una perspectiva de la emoción

Objectives:

To describe the magnitude of emotional dysregulation in ADHD

Methods:

To presente a bibliographic review about clinical, prevalence, etiology, treatmente efficacy ; the magnitude of emotional desregulation in ADHD.

Results:

The prevalence found in different studies ranges from 24-50%. Functional neuroimaging have discovered neuronal networks related to cognition (Cold) that are involved in the allocation of attention resources to stimuli that arouses emotion and other networks related to emotion (hot) that are responsible for orientation early to emotional stimuli and their perception. Therapeutic strategies used in the treatment of ADHD have shown efficacy in the management of emotional symptoms in parallel to the remission of the main symptoms of ADHD.

Conclusions:

Emotional deregulation is a dimensional entity, NOT a categorical diagnosis. The majority of epidemiological research, focusing on children, has found a strong association between ADHD and emotional dysregulation; moderate association between difficult early temperament, with high negative emotionality, and ADHD combined with emotional deregulation. ADHD patients have a primary dysfunction in the recognition of emotional stimuli and a difficulty in modulating emotions when they are negative.

Keywords:

ADHD

emotional regulation

Conflict of interest:

No

Function of self-harm in adolescents. about a case
N. Chinchurreta 1 *
J.J. De Frutos Guijarro 2
R. Martín Aragón 3
C. Moreno Menguiano 2
A. De Cós Milas 4
1HOSPITAL PUERTA DE HIERRO, Psychiatry, , Spain
2Centro de Salud Doctor Luengo Rodriguez, Servicio De Psiquiatría, , Spain
3Complejo Hospitalario Mancha Centro., Unidad De Salud Mental Infanto-juvenil ., Alcázar de San Juan., Spain
4HOSPITAL UNIVERSITARIO DE MÓSTOLES, Psychiatry, , Spain
*Corresponding author.

Introduction:

La creciente prevalencia de conductas suicidas y autolesiones en adolescentes se ha convertido en un problema de salud pública, y alcanza valores de fenómeno viral. Las autolesiones no suicidas son conductas deliberadas afectadas a producir daño físico, sin objetivo de provocar la muerte, que afecta a los adolescentes con una prevalencia, en esta etapa, del 10% en población general y del 35% en población psiquiátrica.

Objectives:

Investigar la relación entre rasgos de personalidad, eventos de la vida y autolesiones (a través de cortes de piel) en la adolescencia.

Methods:

Se lleva a cabo, a través de la presentación de un caso clínico y una revisión de la literatura de los artículos actuales en relación con la autolesión en la adolescencia, en la que se analiza la prevalencia, las causas, los factores de riesgo, los síntomas, las consecuencias, el diagnóstico, el tratamiento y la prevención.

Results:

Se describen tres tipos de conductas autolesivas (catártica, reintegrativa, manipuladora) que están asociados con diferentes formas de regulación emocional y rasgos de personalidad.

Observa una serie de factores de riesgo: sexo femenino, impulsividad, ira, conflicto familiar, trastornos psicopatológicos, baja expresión de afectividad, desesperanza, etc.

Conclusions:

La identificación rápida y oportuna de los adolescentes que se autolesionan es de suma importancia para evitar suicidios.

El uso de la escala SHQ-E puede ayudar a identificar a estos pacientes con precisión. La primera línea de tratamiento se basa en terapias que ayudan a controlar las emociones, el entrenamiento en habilidades sociales y la resolución de conflictos.

Conflict of interest:

No

Mood disorder and hypothyroidism in adolescents. a case report
N. Chinchurreta 1 *
R. Martín Aragón 2
J.J. De Frutos Guijarro 3
J. Martin Carballeda 4
A. De Cós Milas 5
1HOSPITAL PUERTA DE HIERRO, Psychiatry, , Spain
2Complejo Hospitalario Mancha Centro., Unidad De Salud Mental Infanto-juvenil., Alcázar de San Juan., Spain
3Centro de Salud Doctor Luengo Rodriguez, Servicio De Psiquiatría, , Spain
4Centro salud mental Alcorcon, Unidad De Salud Mental Infanto-juvenil., , Spain
5HOSPITAL UNIVERSITARIO DE MÓSTOLES, Psychiatry, , Spain
*Corresponding author.

Introduction:

El hipotiroidismo subclínico se define como la elevación de TSH en presencia de concentraciones normales de hormonas tiroideas circulantes. La prevalencia en adolescentes es <2%. Una deficiencia en el metabolismo de las hormonas tiroideas puede conducir a trastornos mentales porque juegan un papel esencial en el desarrollo y la función del sistema nervioso central.

Objectives:

Describir la relación entre el trastorno del estado de ánimo y el hipotiroidismo en adolescentes.

Methods:

Se lleva a cabo, a través de una presentación de caso clínico y una revisión de la literatura de artículos actuales en relación con el trastorno del estado de ánimo y el hipotiroidismo en adolescentes.

Results:

Según los datos en la literatura, los niños y adolescentes con problemas de tiroides pueden tener problemas de comportamiento, ansiedad o bajo estado de ánimo. Y, a menos que se realice un examen analítico específico, no se detecta, ya que no es frecuente a una edad temprana. En adolescentes (entre 13 y 16 años) se ha visto que la función cognitiva con la prueba de Wechsler, así como el cociente intelectual, no varía en los jóvenes eutiroideos y en aquellos con hipotiroidismo.

Conclusions:

It's important to be clear that the symptoms of hypothyroidism can be confusing and can produce symptoms attributable to a psychiatric illness. Early identification and treatment of thyroid disease in adolescents and children is essential to optimize neurocognitive growth and development. The appearance of complex symptoms abruptly, which affect the mood, should indicate the need to start a study to rule out organic pathology.

Keywords:

hypothyroidism

mood

disorder

Conflict of interest:

No

A case of 16p11.2 duplications and deletions as a risk factor to autism
M. De La Mata Hidalgo 1 *
R. De La Mata 2
R. Tenorio 1
M. Pacheco 1
M. Mota 1
G. Anmella 3
M. Suárez 1
1Hospital Juan Ramón Jiménez, Psiquiatría, , Spain
2Centro Salud Mental Infanto Juvenil, Psychiatry, , Spain
3Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Schizophrenia Unit, Institute of Neuroscience, , Spain
*Corresponding author.

Introduction:

Chromosome 16p11.2 duplication is characterized by austism spectrum disorder, development delay, schizophrenia, and idiophatic generalised epilepsy, as well as dismorphic feature. In the recent years, it has been developed some tools to facilitate the diagnosis of this delections and dupplicantions like array CGH. The earliy diagnosis of this syndrome, the identification and correct treatment of his psychiatricts disorders is primary in the beggining of the chilhood to decreased the suffering of the patients and their families.

Objectives:

This case aim to make a review of this syndrom and show some of the psychiatric cormobilities that are able to appear. It also pretends to discuss the possible treatments that are avaliable in children. It is important to know and identified the neuropsychiatric and neurobehavioral disorders, including cognitive impairment, attention de cit-hyperactivity disorder that are asociated with.

Methods:

We present a clinical report and literatura review of a 16p11.2 syndrom in a five years old boy.

Results:

The use of typical antipsychotics as haloperidol could help to decrease the aggressiveness and motor stereotypies. There are also available the addition of other drugs as risperidona, to manage the behavioral disorders.

Conclusions:

Treatment is multidisciplinary and will vary according to the age, cormobilities and experience of the clinician.

Keywords:

16p11.2

microdelection

arrayCGH

Autism

Conflict of interest:

No

Anxiety/depression has a strong impact on attention to eye region in adolescents with autism spectrum disorder
T. Fujioka 1 *
K. Tsuchiya 2
T. Katayama 3
H. Kosaka 4
1University of Fukui, Department of Science Of Human Development, Humanities And Social Science, Faculty of Education,, fukui, Japan
2Hamamatsu University School of Medicine, Research Center for Child Mental Development, , Japan
3Osaka Univrersity, Department of Child Development, , Japan
4University of Fukui, Department of Neuropsychiatry, , Japan
*Corresponding author.

Introduction:

Individuals with Autism Spectrum Disorder (ASD) gaze less at eye in the face, which is one component of sociality. Previous researches also reported that anxiety and depression diminished gaze time on eye region (Horley et al., 2003;Noiret et al., 2014). However, there is no report clarifying the effects of anxiety and depression in attention to eye in individuals with ASD.

Objectives:

This study aimed to clarify the effects of anxiety/depression in attention to eye in adolescents with ASD.

Methods:

We recruited 30 individuals with ASD (21 males, 13.1+/-1.9 years, FSIQ 90.8+/-14.1; 9 females, 13.1+/-2.1 years, FSIQ 101.7+/-23.2). We used the Gazefinder (JVC KENWOOD Corporation, Japan), an all-in-one eye-tracking system. The Gazefinder included two types of face movie: A) face without mouth motion, B) face with mouth motion. We conducted correlation analyses among T score of Anxious/Depressed scale of the Child Behavior Checklist, Prosocial behavior subscale of the Strengths and Difficulties Questionnaire, and the percentages of fixation time to eye region.

Results:

For male group, there was a significant correlation between the percentages of fixation time to eye and Anxious/Depressed scale in B) (r=.65, p=.001, figure2). The correlations between them were marginally significant in A) for both male group (r=.39, p=.082, figure1) and female group (r=-.66, p=.054, figure1). There were significant group differences in slopes in both A) and B) (ps<.05). There were no other significant correlations.

Conclusions:

In adolescents with ASD, anxiety/depression have a stronger impact on attention to eye, and the effects of anxiety/depression for attention to eye may have sex difference.

Keywords:

Autism Spectrum Disorder

eye-tracking

Dépression

Anxiety

Conflict of interest:

No

"My mother was very sad when i was born." psychopathology in sons of patients with severe mental disorder. Case report
P. Del Sol Calderón *
Á. Izquierdo De La Puente
M. Garcia Moreno
HOSPITAL UNIVERSITARIO PUERTA DE HIERRO MAJADAHONDA, Psychiatry, , Spain
*Corresponding author.

Introduction:

This is a 9-year-old male who begins follow-up in mental health derived from pediatrics due to behavioral problems.

Objectives:

The aim of this case is to show how presenting a serious mental disorder implies a greater risk of psychopathology in the children of these patients.

Methods:

The medical history includes digestive colic and 3 admissions for bronchiolitis in childhood. The patient is in third grade (repeated second grade once). He is an only child. The mother has two children from a previous marriage, divorced from her ex-partner 5 years before the patient's birth. Highlights very low tolerance to frustration with intense tantrums. In addition, both at school and at home, the patient is very restless, with difficult handling and often maintaining a challenging attitude. He never respects the turn of speech both in class and in games. Also for about 2 months he complains of nonspecific abdominal pain that the pediatrician has considered as functional

Results:

As a family history, severe postpartum depression stands out consisted of high nervousness, low mood with marked apathy and anhedonia. She had severe thoughts of disability rejecting his son. She had intense suicide ideas with fear of harming her son. She was admitted responding to 11 sessions of electroconvulsive therapy. During her follow-up she has been diagnosed with bipolar disorder

Conclusions:

Mental pathology in parents can affect the development of a secure attachment, giving more frequent health problems and a decrease in weight and height; with more risk of anxiety and depression and ADHD

Keywords:

ADHD

attachment disorder

child and adolescent

parent´s psychopathology

Conflict of interest:

No

Group therapy experiences in adolescents with autism spectrum disorder
L. Garcia Murillo *
A. Forti Buratti
M. Díaz De Neira
I. Palanca Maresca
Hospital Universitario Puerta de Hierro, Child And Adolescent Psychiatry, Majadahonda, , Spain
*Corresponding author.

Introduction:

Deficits in social interaction are a key component of Autism Spectrum Disorder (ASD). To treat these deficits in social interaction, group therapy focusing on social skills has been reported to be an effective tool, improving social competence and friendship quality for children and adolescents with ASD and average or above average cognitive skills (Cochrane 2012).

Objectives:

To offer a comprehensive and holistic intervention for ASD patients in a Spanish tertiary care university hospital in the Northwestern area of Madrid.

Methods:

Since 2014 our team has been performing group therapy for adolescents (between 12 and 18 years old) with ASD and average or above average intelligence. We performed two annual groups of between seven to eight participants per group, being the mean duration of the treatment an academic year (nine months). One-hour sessions were performed once every three weeks with the participants. Our approach was focus on structured instructions with role playing situations and coaching during training sessions.

Results:

All participants engaged during the sessions, being all the qualitative reviews at the end of the group very positive. The most frequent complaints were the limitation of the number and duration of the sessions.

Conclusions:

Group therapy is an important tool for treatment of ASD. Social Skills groups can improve social competence for some children and adolescents with ASD, improving their quality of life.

Keywords:

group therapy

adolescents

Autism

social skills

Conflict of interest:

No

Subjective experiences and quality of life in siblings of children with intellectual disabilities: a review of literature
S. Gnanavel
Health Education North East England, Child And Adolescent Psychiatry, Newcastle upon Tyne, United Kingdom

Introduction:

Compared to siblings of normally developing children, siblings of children with intellectual difficulties experience more burden and undergo unique subjective experiences that determines their quality of life.

Objectives:

To systematically summarise available evidence in this important but less researched field.

Methods:

PubMed, PsycINFO and Cochrane Library databases were searched manually for relevant studies. Both qualitative and quantitative studies were considered. However, non English and grey literature were not considered. In total, fifteen studies were selected.

Results:

Subjective wellbeing (SWB) is defined as a positive state of mind involving the whole life experience encompassing satisfaction and happiness while Quality of life (QoL) describes overall well-being resulting from a complex interaction of health, standards and relationships. Some of the predictors for SWB included affiliate stigma, self esteem, social support and positive aspects of care-giving. The psychosocial moderating factors for QoL included caregiver burden, stigma, self esteem, social support and positive meaning in care giving.

Early evidence focused on the negative outcomes including reduced parental attention, emotions like worry and social embarrassment. However, recent research has highlighted positive aspects including growing more empathetic towards those with disabilities.

Targeted intervention in groups and developing social support networks has shown early promise. The major challenges in sibling research include lack of control group, confounding factors such as age, number of siblings and other environmental differences.

Conclusions:

More research on the moderating variables determining the SWB and QOL as well as possible interventions that can provide hope and inspiration in this unique but less researched group holds plenty of promise.

Keywords:

siblings

QOL

learning disability

Conflict of interest:

No

Spatial representation in children with mild mental retardation
T. Goryacheva *
O. Makarova
Pirogov Russian National Research Medical University, Psychological-social Faculty, , Russian Federation
*Corresponding author.

Introduction:

Spatial representations as one of the core structures of mental development underlie the algorithms for all types’ coordination, cognitive and learning activity. More than that, they make a contribution to quasi-spatial functions like abstract thinking. That is why a weakness of visual-spatial representations leads to writing, counting and grammar disorders.

Objectives:

We aimed to study the level of development of spatial representation in children with mild mental retardation (MR) compared with normally developing children.

Methods:

67 children (7-8 years old) with mild MR (E group) were compared to 67 (7-8 year old) normally develop children (C group). All children studied in primary school. All subjects were assessed with the battery of neuropsychological tests and Raven’s Matrices. Also, we examined children by specific tests to study such kinds of spatial representations as coordinate, structural, projective, metric, body schema and visual-spatial memory.

Results:

Significant differences for all indicators of the developmental level of spatial representations were observed between the groups of subjects. The weakest spatial functions in children with mild MR (EG) compared with the Control group are body schema, coordinate and structural representations. There were found a strong correlation between academic performance and the development of all types of spatial representations, with the exception of metric and projection ones.

Conclusions:

Having intact elementary components of spatial functions children with mild MR have difficulties to join these components into integral spatial representations, therefore, their learning skills such as writing, reading, and counting require additional correction and tuition.

Keywords:

mental retardation

spatial representations

Conflict of interest:

No

The characteristics of visual attention of the students of the elementary school with ADHD
T. Goryacheva *
A. Belousov
Pirogov Russian National Research Medical University, Psychological-social Faculty, , Russian Federation
*Corresponding author.

Introduction:

The current study considers attention as a multi-component process with several characteristics. The analysis of each characteristic helps to understand the special features of attention development of children with ADHD.

Objectives:

The research aim is analyzing the characteristics of voluntary visual attention of children in the age from nine to eleven years with hyperactive disorder with attention deficit.

Methods:

The experimental group consists of 25 children of 9-11 years with the diagnosis F90.0 Attention deficit hyperactivity disorder. The control group includes 25 children of the same age and gender meeting the requirements of homogeneous indexes with the experimental group. The research methods include six consequent techniques, given in the following order: Bourdon test, Comparison of characteristics (Cohen’s Test), Schulte table test; Ray’s twisted lines test; Pieron-Rouser test; shortened five-minute Toulouse-Pieron attention test.

Results:

The research shows that the children with ADHD demonstrate derangements in concentration degree, stableness, distribution, volume and shift of attention comparing with the children of the control group. For instance, by the end of the Bourdon Test the latter decrease their speed but the concentration remains relatively high, whereas the ADHD children show the deterioration of concentration along with the practically the same speed of performance.

Conclusions:

The fatigue as a result of a series of several consequent tasks reflecting various attention characteristics comes sooner to the children with ADHD whereas the children of the control group just slow down the activity and change the strategy, still keeping concentration at the same level.

Keywords:

visual attention

ADHD

Conflict of interest:

No

Agression and impulsivity in play therapy: therapeutic challenges and limits
M. Gungor 1 *
S. Calli 2
S. Arslandogdu 2
M. Yavuz 3
1ISTANBUL AYDIN UNİVERSİTY, FRENCH LAPE HOSPİTAL, Psychology, Child And Adolescent Psychiatry, , Turkey
2Istanbul Aydin University, Psychology Department, , Turkey
3Istanbul Aydin University, French Lape Hospital, Psychology, Child And Adolescent Psychiatry, , Turkey
*Corresponding author.

Introduction:

The play therapy is an effective therapy technique in younger ages. Because the verbal capacity of litte children is limited. Previous studies reported that play therapy may improve both internalizing and externalizing disorders such as eating problems, sleep disorders, emotional problems, somatoform disorders, hyperactivity and conduct problems.

Objectives:

The aim of this study is to evaluate the management of the agressive behaviors. Probable positive or negative consequences of setting limits in play therapy sessions.

Methods:

Four children (three males and one female) between the ages of three and seven were followed for 20 weeks with play therapy. The common symptoms of the children were hyperactivity, agressive behaviors towards parents and peers. The fifty minute sessions were planned as one in a week. The authors will present the clinical features of the children, and the progression of the therapeutic sessions.

Results:

The therapists allowed children to reflect their agressive impulses to a certain degree during play. However, their agressive attitudes towards toys and therapists were not allowed. After 20 sessions, the clinical interview revealed that the externalizing problems of the children are decreased in school and family enviroment.

Conclusions:

Play therapy is an effective therapeutic technique, especially for younger children presenting with externalizing problems. Therapists should be flexible when dealing with agressive behaviors of the children. Optimum rules and limits should not prevent expressing agressive fantasies of the children in sessions, but should direct such agressive fantasies towards creative games in therapy.

Keywords:

Play therapy

agression

limits

Children

Conflict of interest:

No

The zone of proximal development in children with specific developmental disorders
M. Ivanov
Moscow Institute of Psychoanalysis, Department of Child And Adolescent Clinical Psychology, , Russian Federation

Introduction:

The concept of the zone of proximal development (ZPD), was first introduced by Lev S. Vygotsky. This concept is used to reveal the internal connections between the learning process and the mental development of the child. The research of the ZPD is relevant for children with various intellectual disabilities.

Objectives:

Explore the zone of proximal development in children of preschool age with specific developmental disorders.

Methods:

50 children aged 5-6 years were examined (27 children with the of specific developmental disorders (ICD-10, F80-F83); 23 children with the normative development). Subtests WPPSI (Russian version): Block Design; Similarities; Picture Concepts.

Results:

If the task performance was done incorrectly or if there were difficulties, the child was helped. The help of the specialist was carried out in the form of individual hints. In the experiment were introduced "leading questions", "lessons-tips", "auxiliary tasks". Three criteria for assessing the child's intellectual development were used: susceptibility to the help of the experimenter, the ability to transfer the learned principles to other tasks and the orientation activity of the child. Another important factor influencing the efficiency of determining the ZPD is the emotional and motivational involvement of the child in joint activities with adults.

Conclusions:

Diagnosis and determination of ZPD makes it possible to directly determine the level of mental development when using psychometric tools and the ability (prospects) to learn. Funding. – The research was supported by the Grants of the President of the Russian Federation for state support of young Russian scientists – МК-3619.2019.6.

Keywords:

Children

specific developmental disorders

zone of proximal development

Lev S. Vygotsky

Conflict of interest:

No

Deprivation factors and mental health in early childhood
M. Ivanov *
I. Margolina
N. Platonova
Federal State Budgetary Scientific Institution "Mental Health Research Centre", Department of Child Psychiatry, , Russian Federation
*Corresponding author.

Introduction:

The impact of stress factors on mental and physical development of children is very important due to their prevalence and psychosocial consequences.

Objectives:

The aim is to examine the impact on the child mental development of the following deprivation factors: parental deprivation (orphans), family physical abuse, family sexual abuse.

Methods:

Clinical (pediatric, neurological, psychopathological) and psychological. Follow-up study. The children (age from 1 to 15 years) exposed to parental deprivation (98 persons), physical (72 persons) and sexual abuse (60 persons).

Results:

In all groups, specific mental disorders are represented by both: - positive psychopathological symptoms include affective disorders and psychopathic disorders; - negative psychopathological symptoms are manifested by the deficiency of a number of mental functions (mental retardation, emotional deficiency, lack of communicative functions and, as a consequence, lack of social competence in the future). It is common that, with prolonged exposure, all three types of mental deprivation contribute to the likelihood of personality disorder in the future, manifested in the form of sequentially occurring emotional disorders, attachment disorder, communicative disorders and behavioral problems.

Conclusions:

Parental deprivation, physical and sexual abuse are stress factors that cause mental development disorders, including both non-specific psychiatric disorders observed in all three cases, and other types of psychogenic inherent in childhood, and specific disorders to the traumatic factor. The fact of a significant psychosocial importance that stresses the urgency of this problem is the tendency to repetition by persons exposed to these deprivation factors, experienced as a child in relation to their own children and others during adulthood.

Keywords:

orphans

deprivation

physical abuse

sexual abuse

Conflict of interest:

No

Suicide attempts in adolescents: a case report
Á. Izquierdo De La Puente 1 *
P. Del Sol Calderón 1
M. Garcia Moreno 1
M. Vizcaíno Da Silva 1
R. Fernández Fernández 2
O. Mendez Gonzalez 1
A. Rodríguez Rodríguez 1
R. Blanco 1
M. Martín García 3
I. González-Villalobos Rincón 1
1HOSPITAL UNIVERSITARIO PUERTA DE HIERRO MAJADAHONDA, Psychiatry, , Spain
2Hospital Universitario HM Puerta del Sur, Psychiatry, , Spain
3Hospital Universitario Puerta de Hierro, Majadahonda, , Spain
*Corresponding author.

Introduction:

We presented a case of a 16-year-old patient who is brought to the Emergency Department after autolytic attempt is raised.

Objectives:

The objetive is to review the incidence of suicide in adolescents

Methods:

A 16-year-old female patient who is brought by the SUMMA by autolytic attempt. After having a family discussion, the patient throws herself on the road with the intention of being hit by a car. The patient refers to a chronic situation of intense family conflict motivated by the parents' rejection of their daughter's romantic relationships.

Results:

Upon psychopathological examination, the patient does not present major mood alterations or anxious semiology or alteration of the chronobiological rhythms that could indicate the existence of an associated mood disorder. Given the absence of insight and criticism of the self-injurious gesture, she was hospitalized.

Conclusions:

The suicide attempt is one of the most important risk factors for the consummation of suicide. It is estimated that among the adolescent population, between 2 and 12% have made some self-injurious gesture with autolytic purpose. The most frequent stage is between 15 and 19 years, increasing the risk with age. In recent years, the suicide rate among adolescents has increased, becoming the third leading cause of death in this age group. The most commonly used method is the superinstate of psychotropic drugs. As in the adult stage, autolytic attempts are more common in females while consummated ones are more frequent in males. Family conflicts, bullying, harmful use of social networks and background in the suicide family are risk factors.

Conflict of interest:

No

Kleine lein syndrome: a case report
Á. Izquierdo De La Puente *
R. Perteguer
P. Del Sol Calderón
M. Garcia Moreno
HOSPITAL UNIVERSITARIO PUERTA DE HIERRO MAJADAHONDA, Psychiatry, , Spain
*Corresponding author.

Introduction:

Klein Leine syndrome is relatively rare. He has hyperphagia, hypersomnia and hypersexuality. The case of a patient who after alcohol intake begins with hypersomnia is presented.

Objectives:

The objective is to make a brief review about this syndrome.

Methods:

A 13-year-old female patient who, after consuming alcohol for the first time, begins to progressively develop hypersomnia, getting to sleep more than 24 hours. Also associated with this picture, begins to present hyperphagia, with a feeling of lack of control over food. Her parents said they found her apathetic, with difficulty performing tasks and more clueless. Denies toxic consumption, apart from alcohol. No psychotic symptoms or other symptoms that suggest infectious origin.

Results:

After performing complementary tests among which blood and urine tests were found, the diagnosis was confirmed by the Electroencephalogram (EEG).

Conclusions:

Kleine Lein syndrome occurs in outbreaks, with the typical triad of hyperphagia, hypersomnia and hypersexuality. Hypersomnia is the most frequent symptom and hypersexuality is more frequent in men. Also, during outbreaks, they present apathy, confusion and slowing down. It is of unknown origin and usually appears around 15 years of age. It is relatively common for episodes to be triggered with alcohol intake. The characteristic pattern in the EEG is generalized slowness without epilepsy data. The treatment includes regularization of the rhythms of sleep and lithium.

Keywords:

teenagers

Kleine Lein Syndrome

Conflict of interest:

No

PTSD symptoms in adolescents from low- and middle-income countries: international child mental health - study group
D. Stupar 1
D. Stevanovic 1
A. Doric 2
R. Knez 3 *
1Clinic for Neurology and Psychiatry for Children and Youth, Department of Child Psychiatry, , Serbia
2Faculty of Humanities and Social Sciences, Department of Psychology, , Croatia
3University of Gothenburg, Department of Psychiatry And Neurochemistry, , Sweden
*Corresponding author.

Introduction:

Exposure to traumatic events in childhood and adolescence is associated with the development and maintenance of various psychopathologies, such as anxiety, depression, somatic, but most frequently with posttraumatic stress disorder (PTSD). Adolescent PTSD is unresearched in low- and middle-income countries (LMICs).

Objectives:

To evaluate the presence of PTSD symptoms in trauma-exposed adolescents from LMICs.

Methods:

The study included 3370 adolescents (1465 (43.5%) males; age mean 15.41 (1.65) years), experiencing at least one traumatic event, from Brazil, Bulgaria, Croatia, Indonesia, Montenegro, Nigeria, Palestinian Territories, the Philippines, Romania, Serbia, and Portugal, a high-income country, as a reference point. The UCLA PTSD Reaction Index for DSM-5 (PTSD-RI) was used.

Results:

960 (28.5%) adolescents had two to three PTSD symptoms. The percentages of adolescents with symptoms from all four DSM-5 criteria for PTSD were 6.2-8.1% in Indonesia, Serbia, Bulgaria, and Montenegro; and 9.2-10.5% in Philippines, Croatia and Brazil. From Portugal, 10.7% adolescents fall into this criterion, while 13.2% and 15.3% for Palestine and Nigeria, respectively. Younger age, experiencing war, being forced to have sex, and greater symptom severity (i.e., persistent avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity) appeared as the predictors of PTSD symptoms present.

Conclusions:

Every third adolescent in LMICs might have some PTSD symptoms after experiencing a traumatic event, while one in ten might have enough symptoms to be diagnosed with PTSD. Younger adolescents, exposed to war or forced to sex, and those with more severe PTSD symptoms are at the greatest risk.

Keywords:

UCLA PTSD index

Culture

traumatic events

prevalence

Conflict of interest:

No

Disorders of adaptation in children from forcibly displaced families
H. Kozhyna *
O. Samoylova
K. Zelenska
T. Radchenko
V. Koshchii
KHARKIV NATIONAL MEDICAL UNIVERSITY, Psychiatry, Narcology And Medical Psychology, , Ukraine
*Corresponding author.

Introduction:

Children are too vulnerable to psycho-traumatic factors. Their unformed psyche cause a more severe response to the action of a traumatic situation, as well as the low level of control of emotional reactions.

Objectives:

Clinical-psychopathological and pathopsychological features of children from forcibly displaced families with adaptation disorders were investigated with separation of targets of psychotherapy.

Methods:

We have used the following research methods to achieve our goal: clinical psychopathology, psychometric, psychodiagnosis and medical statistics.

Results:

The prevalence of the expressed manifestations of distress in the structure of clinical manifestations in the examined children was found: discomfort, somatic equivalents of anxiety; involuntarily intolerable repetitive ideas and images about stressful experiences, compulsive actions with anxiety and mental stress; the presence of cognitive and somatic correlates of depression. It was determined that in psychological mechanisms of formation of adaptation disorders in children from forcibly displaced families, there are character traits (incredulity, excessive vulnerability, negativity, stubbornness, self-centeredness, coldness and formality in contacts, irresponsibility, capriciousness, emotional imbalance), as well as trait anxiety.

Conclusions:

The age-sex and demographic features of the formation of anxiety and depression level were established among children from forcibly displaced families, with the establishment of correlation-regression interconnections with the forming factors. The presence and severity of the main protective psychophysiological mechanisms were identified in children from forcibly displaced families; and the targets of psychotherapy were detected.

Keywords:

children from forcibly displaced families

adaptation disorders

psycho-traumatic factor

post-traumatic stress disorder

Conflict of interest:

No

A brief paradigm to evaluate mentalization and theory of mind, in preschool children
S. Lascarez Martínez *
J. Flores Lázaro
Universidad Nacional Autónoma de México, Neurociencias, , Mexico
*Corresponding author.

Introduction:

Reliable instruments that evaluate core developmental capacities for mentalization/theory of mind, based on normative developmental characteristic, in preschool children divided by sex, are word wide scarce.

Objectives:

Develop a brief paradigm for mentalization and theory of the mind that allows the analysis of these dimensions separately and in groups.

Methods:

We developed a brief paradigm to evaluate Mentalization (face emotion recognition), and Theory of mind (agency: cause-effect actions). a) Face coupling: face-draws cards with six basic emotions are presented to be coupled-paired (coupling the same emotions). Avoiding naming (language effect), or confrontation (identification by explicit knowledge). Focusing on perceptual features of recognition and coupling. b) Agency: six histories presented in three separated cards (beginning-history setting, history action, and final effect), in each history a children is the agent, and other children is the recipient of the agency. Children must order the cards in sequence. c) Psycholinguistic performance: audio-recording was performed of the spontaneous oral-language production for each history elaboration. No specific instruction is given. For all three dimensions several parameters were registered and numerically qualified; 100 normative children from 3 to 6 years old (balanced by sex) were studied; a clinical behavioral scale for autistic traits, and performance in a computerized attention-detection test, was included as co-variables.

Results:

show different developmental trends (age in months), for girls versus boys. Specific results for each dimension (correlation, anova and linear regression) are presented.

Conclusions:

The differences presented suggest that the mentalization and theory of the mind may be different dimensions that require independent analysis.

Keywords:

preschool children

paradigm

mentalization

theory of mind

Conflict of interest:

No

Child sexual abuse and revictimization at law courts: neuroendocrine effects.
A.M. Martorella
Hospital Materno Mar del Plata, Mental Health, Mar del Plata, Argentina

Introduction:

Currently, cases of intrafamily CSA require the intervention of the Family and Penal Law Courts. In all cases, the actors at law courts show a marked lack of knowledge about the characteristics of the evolving child psyche and its implications in cases of intrafamily CSA, which leads them to revictimize the child when exposed to the re-evocation of traumatic episodes in environments devoid of emotional reliability and therapeutic support. The situation further worsens if one considers that the testimony of the minor involves a member of their family as an aggressor figure, hence the cover court refers to Cars as "aggravated sexual abuse by the link". This means that we are faced with a representation of incest with all that this entails in structuring the psyche during early growth and development.

Objectives:

Test differences in evolution and prognosis in the short and médium term.

Methods:

Several child victims (3 boys, 5 girls) who have or not given testimony have been selected in this sample.

Results:

From my professional experience in adolescence and child psychiatry, I can infer that children, who have been victims of intrafamily sexual abuse and who, in turn, have been exposed to testimonial situations in the different judicial stages, are more likely to show neuroendocrine symptomatology (eg cushing syndrome).

Conclusions:

Court staff should be trained to interview child victims according to the age of each one. Likewise, the victims can be heard through their representative: their therapist, who can be punishable in case of false testimony.

Keywords:

child sexual abuse

revictimization

post traumatic disorder

neuroendocrine effects

Conflict of interest:

No

Psychopathology in fragile X syndrome. Experience in a genetic disorders unit from a children and adolescent mental health center.
M. Oscoz Irurozqui 1 *
L. Urraca Camps 2
S. Pujol Serra 2
C. Colomina Llobell 2
M. Pàmias Massana 2
D. Palao Vidal 2
1Benito Menni CASM, Psychiatry, Sant Boi de Llobregat, Spain
2Parc Tauli-University Hospital, Mental Health, Sabadell (), Spain
*Corresponding author.

Introduction:

Fragile X syndrome (FXS) is a X-linked disorder which has been associated with a high risk of psychopathology, particularly neurodevelopment disorders like attention-deficit/hyperactivity disorder (ADHD) and Autism Spectrum Disorder (ASD), and those are of interest to the psychiatrist.

Objectives:

The aim of the study is to describe and analyze demographic and clinical features of comorbid psychopathology in patients diagnosed of Fragile X syndrome.

Methods:

A retrospective analysis of patients with genetically confirmed XFS who were referred to Genetic Disorders Unit and treated by children and adolescent mental health professionals from January 2018 to August 2019 were included. Data was obtained from the clinical evaluations, and previous clinical information recorded in our unit database. Statistical analysis was performed with SPSS.

Results:

A total of 18 patients under 21 years old were analyzed. The 55.5 % were men and mean age was 11.6 ± 4.2. Origin referring department was Neurology (83.3%) and main reasons for consultation were behavioral disturbance (55.5%) and anxiety (27.7%). Higher incidence diagnosis were ASD (38.8%), ADHD (61.1%) and anxiety (16.6%). 77.7% of patients had intellectual disability or borderline intellectual functioning. 100% had psychological intervention, 72.2% pharmacological treatment and 72.2% had nursery and social work follow-up.

Conclusions:

High prevalence of psychiatric disorders in our sample were observed. An intensive treatment by child and adolescent mental health professionals to all comorbid disorders is determinant to improve mental outcomes treating FXS patients.

Keywords:

fragile x syndrome

psycopathology

GENETIC DISORDERS

Children

Conflict of interest:

No

“How long does it take for antipsychotic to get out of my child system?”- Discontinuation of antipsychotic in children.
R. Patel
County of San bernadino, Mental Health, , United States of America

Introduction:

According to the most recently data, there is significant increase in prescription of psychotropic medication and particularly antipsychotic medication in children and adolescent. Antipsychotic medication can have long-lasting consequences particularly due to the side effects for children and adolescent. It should be prescribed appropriately and patient should be evaluated for ongoing necessity for antipsychotic medication.

Objectives:

The purpose of this presentation to discuss slowly tapering and discontinuing antipsychotic medication. We will also discuss importance of being cautious while switching patient high potency antipsychotic medication to low potency antipsychotic medication, as well effects of polypharmacy and cocurrent use of stimulant medication.

Methods:

We discuss about different case presentations, collection of data from clincal cases, and how we discontinued their antipsychotic medication

Results:

There is no particular guideline available how to discontinue antipsychotic medication and children and an abrupt or quick discontinuation can lead to withdrawal dyskinesia.

Conclusions:

At the conclusion of presentation, participant will have knowledge about importance of slowly tapering antipsychotic medication particularly in children and need for continuous assessment particularly for withdrawal dyskinesia. during the switching or tapering or adding medication

Keywords:

Antipsychotic medication

Discontinuation of Antipsychotic medication

Withdrawal dyskinesia

switching of medication

Conflict of interest:

No

Parental practices implemented in adolescents in the city of santa marta, colombia
L.F. Miranda 1
K. Pérez Correa 2 *
L. Pedraza Álvarez 3
W. Salas Picón 2
1Universidad del Magdalena, Facultad De Educación, Santa Marta, Colombia
2Universidad Cooperativa de Colombia, Facultad De Psicología, Santa Marta, Colombia
3Universidad del Magdalena, Facultad De Ciencias De La Salud, Santa Marta, Colombia
*Corresponding author.

Introduction:

Parental practices become a key factor in the generation of prosocial or aggressive behaviors in adolescents and, consequently, have incidences in the way they behave and live together in social groups.

Objectives:

In this sense, the present work aims to identify the parental practices applied by the caregivers of adolescents in the city of Santa Marta, Colombia.

Methods:

It was developed as a quantitative cross-sectional research where the Parental Practice Scale was applied in a sample of 51 adolescents with an average age of 12.35 years.

Results:

The parental practices that were reflected were permissive, authoritarian and democratic practices. On permissive practices, the Parental Practice Scale found that 78.4% of adolescents responded that their parents were permissive, while 21.6% responded otherwise. On authoritarian parental practice, 82.4% of adolescents responded that their parents are not authoritarian, however, 17.6% said they were. Regarding democratic parental practice, 94.1% of adolescents expressed that their parents did not apply this type of practice, and only 5.9% answered the question in the affirmative.

Conclusions:

There is a need to implement parental practices that promote prosocial behaviours in adolescents in the perspective of ensuring the construction of favourable behaviors for peaceful coexistence in society.

Keywords:

Parental practices

prosocial behavior

aggressive behavior

Conflict of interest:

No

Prosocial and aggressive behaviors in adolescents in the city of santa marta, colombia
L.F. Miranda 1
K. Pérez Correa 2 *
J. Viloria Escobar 3
F. Rodríguez Pacheco 3
1Universidad del Magdalena, Facultad De Educación, Santa Marta, Colombia
2Universidad Cooperativa de Colombia, Facultad De Psicología, Santa Marta, Colombia
3Universidad del Magdalena, Facultad De Ciencias De La Educación, Santa Marta, Colombia
*Corresponding author.

Introduction:

According to the theory of social learning, the behaviors and behaviors developed by children and adolescents are learned from the contexts where they live and are mediated by the parental practices of their caregivers.

Objectives:

In this sense, the objective of the present work is to identify the prosocial and aggressive behaviors of adolescents in the city of Santa Marta, Colombia.

Methods:

We developed a quantitative cross-sectional research where the CESC instrument was applied in a sample of 51 adolescents with an average age of 12.35 years.

Results:

15.7% of adolescents reflected aggressive behaviors, however 84.3% of these do not have this behavior. On the other hand, related to prosocial behaviour, only 5.9% of the sample demonstrate this type of behaviour, on the other hand that 94.1% of these do not have prosociality within their interpersonal relationships and in social settings.

Conclusions:

There is a need to promote greater prosocial behaviour in adolescents based on the intervention of social scenarios such as family and school, in order to ensure the promotion of values and standards that allow them to be set up as adults comprehensive and peaceful in society that contribute positively to the development of communities.

Keywords:

Parental practices

prosocial behavior

aggressive behavior

Conflict of interest:

No

Approach through stories of emotional regulation to anxiety in a sample of primary school students.
S. Pérez Sánchez 1 *
I. Martín Herrero 1
A. Crespo Portero 2
D. Güimil Raya 1
1Morales Meseguer Public University Hospital, Psychiatry, , Spain
2Lorca Mental health Center, Psychiatry, , Spain
*Corresponding author.

Introduction:

Anxiety disorders are the most diagnosed psychological problems in children. Its natural evolution without treatment can lead to serious negative repercussions on academic, social and family functioning. The group storytelling work in the classroom means that through the exposure of emotions and identification with classmates, the student can acquire the ability to internalize them.

Objectives:

1 Determine the frequency and characteristics of childhood anxiety symptoms in a community-based school population. 2 With group therapy techniques through stories you can improve the expression of emotions.

Methods:

Interventions (4 monthly sessions) in the classroom through storytelling and group reflection. Prospective collection: 9 months. Transversal assessment with SCAST scale before and after intervention. SPSS16.0

Results:

107 primary students participated: 37.38% men, 62.6% women. According to age: 42.7% 7 years, 57.3% 8 years. Average pre-intervention score: 25.2% high anxiety, most often these scores in the group of women (66%), showing greater separation anxiety and physical fears (2.3%) and social phobia (1.7% ). Post intervention: observed decrease of the average global score of 21.2 (SD = 9.8). Finding a greater decrease in global scores associated with female sex without being statistically significant.

Conclusions:

We believe that at the community level it is necessary to explore anxieties and fears in children in order to provide tools for managing emotional regulation. We believe that stories can be an effective tool in addressing these emotions and easily applied in the school environment to favor the growth and integral learning of children and adolescents. With group therapy techniques through stories you can improve the expression of emotions.

Keywords:

stories

emotional regulation

anxiety

primary school students.

Conflict of interest:

No

“Why do i have this pain? What if it is a serious disease?” – A reflection about somatic symptoms in children and adolescents
M. Pinto *
M.J. Lobato De Sousa
M.G. Almeida
C. Maia
Centro Hospitalar do Tâmega e Sousa, Child And Adolescent Psychiatry, , Portugal
*Corresponding author.

Introduction:

Somatization is common in children and adolescents. When it is impairing, persistent and meets specific criteria, it becomes a disorder called Somatic Symptom Disorder (SSD). SSD may result in disproportionate healthcare utilization, school absenteeism and even unnecessary diagnostic and treatment intervention.

Objectives:

Highlight some of the themes seen in pediatric somatization through a case presentation; review the literature and summarise the risk factors, evaluation and management of such cases.

Methods:

Case presentation of a 17-year-old male with emergency room visits and several appointments in different medical specialties for management of his chest pain and other somatic symptoms. Extensive work up has been negative and he has a history of anxiety symptomatology. Based on this clinical case, we carried out a narrative literature review.

Results:

There are multiple risk factors for SSD. While their existence does not necessarily imply a diagnosis of SSD, it should increase suspicion. Diagnostic evaluation should be multimodal with a work up of physical health causes appropriate for the complaints, while avoiding invasive testing or intervention, and an early and close collaboration with mental health services. Proven treatments include cognitive behavioural therapy, mindfulness-based therapy, and pharmacotherapy.

Conclusions:

Somatic symptomatology may adversely affect the academic and social functioning of children and adolescents and there is a higher risk for developing anxiety and depressive disorders in young adulthood. Therefore, after ruling out organic causes, anxiety and other emotional factors should be identified and managed at the earliest with the involvement of the children and their families.

Keywords:

somatization

somatic symptom disorder

Anxiety

Children and adolescents

Conflict of interest:

No

Antipsychotic and mood stabilizer treatments complete slow removal in a severe mental illness young adult diagnosed in adolescence.
T. Ponte-López 1 *
J. Herranz-Herrer 1
L. Caballero Martínez 2
E. Gil-Benito 1
B. Estevez-Peña 1
A. Pérez-Balaguer 3
M.J. Lobato 1
M. Martín García 1
1Hospital Universitario Puerta de Hierro, Majadahonda, , Spain
2Hospital Puerta de Hierro, Psychiatry, , Spain
3Hospital Puerta de Hierro de Majadahonda, Majadahonda, , Spain
*Corresponding author.

Introduction:

Adolescents developing severe disruptive behaviors and psychotic symptoms are ocasionally admited and diagnosed as severe mental ilness.

Objectives:

The purpose is to show a successful high dose treatment withdrawal in a young woman who was admitted to the Psychiatric Day Hospital with a previous history of 9 adolescent psychiatric unit’s admissions, multidiagnosed, with bipolar and psychotic disorders among others. At the arrival her treatment was: haloperidol 4.5mg/d, quetiapine 1200mg/d, lamotrigine 125mg/d, valproic acid, 1750mg/d, melatonine 5mg/d, zolpidem 5mg/d.

Methods:

Stabilizer and antipsychotic drugs where gradually removed. She initially showed an illness role and a regressive attitude, with disproportionate reactions, frequent mood fluctuations, disrupting behavior and dissociative symptoms which included short self-limited hallucinatory phenomena that had complete remission with benzodiazepines. She started referring hallucinations on his first admission by copying another patient. Parent interviews reflect a rigid family system built around the daughter's illness, reacting aversively to the patients recovery and when feeling challenged during psychoeducation. We conducted a narrative approach that fosters hope, healthy aspects, and encouraged an autonomous self separated from the illness.

Results:

It was shown a growth in self-regulation, social interaction, life functionality with optimistic projection of the future, and disruptive behaviors ceased completely. Besides, she had a 18kg weight loss that took her from 34.3 BMI to a healthy appearance.

Conclusions:

During the 10 months of follow-up, no psychotic symptoms or major affective symptom were observed. Diagnosis when discharged was “previous diagnoses, currently in remission”. Treatment was: fluoxetine 20 mg/d, topiramate 200 mg/d and clonazepam 0.5mg/d.

Keywords:

Bipolar disorder

borderline personality

psychosis

dissociative

Conflict of interest:

No

Current situation of chilean education and a way to prevent desertion and delinquency based on mental health
J. Rojas
Hospital de Niños Dr. Luis Calvo Mackenna, Psychiatry, , Chile

Introduction:

Primary education in Chile is provided primarily by public funds and regulated by the Ministry of Education. There is also a minority percentage of the population, corresponding to 7% and coming from more affluent sectors, that access a private education, this being of a higher quality, creating, in this way, a great inequality between these two worlds.

Objectives:

To carry out an integrating educational system integrating prevention on mental health, where the individual capacities and personal motivations of each child are managed, to achieve a possible, practical and applicable education in all the realities of our heterogeneous country.

Methods:

The intervention has begun, with 36 children in permanent threat of failure in the traditional school system but still with the possibility of an emotionally adaptive rescue, in a multi-level educational system, It is carried out through activities in an integrating classroom with children from 7 to 12 years old, with activities that develop thought, level and homogenize knowledge. Its objective is to achieve reading, writing and calculation as the main axis, complementing it with the use of technology, bilingualism, art and sport. Short educational sessions (of 20 minutes) are carried out in related subgroups of approximately 6 children, as well as experiential therapeutic activities coordinated by psychologist, social worker and always integrating families in this process of integral growth.

Results:

There is still no results from the intervention, since it has started recently in 2018. We hope to have results by march 2020

Conclusions:

To be seen

Keywords:

child

education

Motivation

delinquency

Conflict of interest:

No

Dietary and psychological characteristics of obese japanese children.
M. Saito 1 *
A. Lefor 2
S. Saito 2
Y. Kikuchi 1
1Haga Red Cross Hospital, , , Japan
2Jichi Medical University, Surgery, , Japan
*Corresponding author.

Introduction:

Due to nutritious school lunches and a culture of walking to school, Japan’s childhood obesity rate is lower than in other countries. However, Japan’s childhood obesity rate between 1977 and 2015 grew from 2.6% to 3.8% at the age of 6 years and 6.5%to 8.9% at the age of 11 years. An effective intervention for obese Japanese children is considered.

Objectives:

The aim of this study was to clarify the dietary and psychological characteristics of obese Japanese children.

Methods:

Nine obese Japanese children who applied for a 3-day program which offered workshops on nutrition, mental health and exercise as well as a detailed examination for obesity were interviewed about their diet by a nutritionist. Their mental health was evaluated using the Japanese Questionnaire for Triage and Assessment– a 30 item instrument that measures depression, self-esteem, anxiety and psychological symptoms. Participants were followed for one year.

Results:

More than half of the children thought that they had healthy eating habits, however they tended to eat more rice and snacks than their peers. Their self-esteem tended to be lower than children with other chronic diseases (p=0.0031). Children with poor family function showed poor improvement in obesity after participating in the program (p=0.0479).

Conclusions:

Obese Japanese children may be overweight because of eating more rice, a Japanese staple food, and snacks. Parental encouragement may strengthen their self-esteem resulting in their children achieving a healthy weight.

Keywords:

obesity

Japanese

self-esteem

Children

Conflict of interest:

No

Pharmacogenetics of short-term antipsychotics safety in adolescents with acute psychotic episode: CYP2D6 and ABCB1 polymorphisms do matter
M. Tazagulova 1 *
D. Ivashchenko 2
N. Buromskaya 3
P. Shimanov 4
R. Deitch 5
K. Akmalova 6
E. Grishina 6
Y. Shevchenko 2
D. Sychev 7
1Russian Medical Academy of Continuous Professional Education, Moscow, Russia, Child And Adolescent Psychiatry And Psychotherapy, , Russian Federation
2Russian Medical Academy of Continuous Professional Education, Child Psychiatry And Psychotherapy, , Russian Federation
3G.E. Sukhareva Research Practical Centre of Children and Adolescents Mental Health, No 1, , Russian Federation
4G.E. Sukhareva Research Practical Centre of Children and Adolescents Mental Health, No 7, , Russian Federation
5G.E. Sukhareva Research Practical Centre of Children and Adolescents Mental Health, No 3, , Russian Federation
6Russian Medical Academy of Continuous Professional Education, Molecular Medicine, , Russian Federation
7Russian Medical Academy of Continuous Professional Education, Clinical Pharmacology And Therapeutics, , Russian Federation
*Corresponding author.

Introduction:

The concept of personalized medicine is based on patients' unique genetic profiles which can predict treatment options. For instance, polymorphisms of CYP3A4, CYP3A5, CYP2D6, and ABCB1 genes may be associated with adverse effects of psycopharmacotherapy.

Objectives:

To establish association of CYP3A4, CYP3A5, CYP2D6, and ABCB1 genetic polymorphisms with safety profile of antipsychotics after one month of treatment in adolescents with acute psychotic episode.

Methods:

Thirty six adolescents with acute psychotic episode were included in the study, mean age was 14.83±1.84 years. Follow-up was 30 days. All patients received an antipsychotic as the main treatment. We evaluated frequency of adverse events by UKU Side-Effect Rating Scale. Buccal epithelium sample was retrieved from each patient. Using real-time PCR we detected the following polymorphisms: CYP3A4*22 (rs35599367), CYP3A5*3, CYP2D6*4, *10, ABCB1 1236C/T (rs1128503), 2677G/T/A (rs2032582), and 3435T/C (rs1045642).

Results:

The polymorphism ABCB1 2677G>T/A was associated with increased duration of sleep (50% vs 5.6% vs 0%, p=0.004), polyuria/polydipsia (33.3% vs 0% vs 0%, p=0.005); ABCB1 3435C>T was associated with reduced salivation (55.6% vs 10% vs 14.3%, p=0.021). CYP2D6*10 polymorphism was associated with reduced salivation (50% vs 14.3% p=0.032) and orthostatic dizziness (37.5% vs 7.1% p=0.029). CYP2D6*4 polymorphism was also associated with reduced salivation (60.0% vs 16.1%, p=0.029).

Conclusions:

We have established that genetic polymorphisms CYP2D6*4, *10, ABCB1 2677G>T/A and 3435C>T were associated with certain adverse effects of antipsychotics in adolescents with acute psychotic episode during the first month on treatment.

Disclosure:

Research was supported by the grant of Russian Science Foundation, project №18-75-00046

Keywords:

antipsychotics

adolescents

acute psychotic episode

pharmacogenetics

Prevalence of attention deficit and hyperactivity disorder in adolescents attending school
S. Morel
N. Tejada *
N. Martinez
A. Valdez
Pontificia Universidad Catolica Madre y Maestra, Escuela De Medicina, , Dominican Republic
*Corresponding author.

Introduction:

Attention Deficit and Hyperactivity Disorder (ADHD) is one of the most common neuropsychiatric conditions that interfere in the normal process of teenage development, adaptation and learning, affecting the fulfillment of norms and in their behavior within family, interpersonal and academic environments.

Objectives:

Determine the prevalence of Attention Deficit and Hyperactivity Disorder (ADHD) in adolescents attending school in Santiago de los Caballeros, Dominican Republic.

Methods:

The investigators conducted a descriptive, cross-sectional study of primary source during the months of March-April 2018. The population was adolescents from 13 to 17 that were attending school in Santiago de los Caballeros. This investigation was performed through a survey that was filled in by the parents or tutors of the adolescents. The sample used was of 615 students, divided into 12 schools.

Results:

The results showed a prevalence of ADHD of 25.7%. The type of ADHD that predominated was hyperactivity and impulsivity (47.5%). The relation between sex and the disease demonstrated a ratio of 1:1. The 27.4% and 22.3% of individuals within the age ranges of 15 to 17 and 13 to 14, respectively, presented symptomatology of ADHD. The analysis presented statistical association between failing subjects and grades and showing symptoms of the disease (p < 0.05).

Conclusions:

One quarter of the population studied obtained positive result of ADHD. Hyperactivity and impulsivity predominated over the other types of the disorder. Public schools showed more cases than private schools, although no statistical significance was observed. Relation between ADHD and failing grades and subjects at school was found.

Keywords:

adolescent

attention-deficit hyperactivity disorder

prevalence

Conflict of interest:

No

Treatment-resistant schizophrenia in adolescence: a case report.
F.J. Torres Varona 1 *
N. Rodríguez Criado 2
1Hospital Central de la Defensa Gómez Ulla, Psychiatry And Mental Health Department, , Spain
2Hospital Infantil Universitario Niño Jesús, Child And Adolescent Psychiatry And Psychology Department, , Spain
*Corresponding author.

Introduction:

The concept of treatment-resistant schizophrenia includes partial response, absence of remission and inability of antipsychotic treatment to prevent relapse. 34-50% of cases of early onset schizophrenia have an insufficient response to antipsychotic treatment. Clozapine is the treatment of choice in these cases. However, a delay in the initiation of clozapine is common.

Objectives:

Describing the case of a 15-year-old male diagnosed with treatment-resistant schizophrenia.

Methods:

We present the case of a 15-year-old male who manifests auditory, visual and cenesthetic hallucinations and delusional ideation for over a year. History of developmental delay between age 2 and 6. Schooling in the ordinary education system since age 7, with good adaptation and academic performance. Psychomotor development without other alterations. He lives with his parents and his younger brother. Risperidone was started (up to 6 mg/day), with partial improvement and significant side effects (drowsiness, bradypsychia and hyperprolactinemia), so aripiprazole was added (up to 10 mg/day), with insufficient response. The patient enters the child and adolescent psychiatry service due to a clinical worsening in the last 2 weeks despite the pharmacological treatment.

Results:

The patient initiated treatment with clozapine up to 200mg/24h, with adequate tolerance. A significant improvement in positive symptoms and mood was observed. After discharge, he continued outpatient treatment in a child and adolescent psychiatry day hospital.

Conclusions:

Early onset schizophrenia is a prevalent and severe pathology with a poor prognosis. Early diagnosis is essential. The goal of treatment should be clinical remission.

Keywords:

early-onset schizophrenia

treatment-resistant schizophrenia

clozapine

adolescent

Conflict of interest:

No

Comparison of attitudinal aspects of body image in adolescents with self-reported nssi and body modifications
A. Ryzhov 1 *
K. Mamedova 2
E. Sokolova 1
L. Pechnikova 1
E. Zhuykova 3
1Lomonosov MSU, Faculty of Psychology, , Russian Federation
2Lomonosov MSU, Baku Branch, , Azerbaijan
3Psychological Institute of the Russian Academy of Education, Adolescent Psychology Laboratory, , Russian Federation
*Corresponding author.

Introduction:

Body image attitudes play an important role in both culturally sanctioned (tatoo and piercing) and deviant (self-cutting) body-mutilations. To what extend theyshare the same features in both cases, and whether extreme body modifications can be regarded as mild forms of nonsuicidal self-injurious behaviour remains unclear.

Objectives:

The goal of the study was to compare attitudes towards body in adolescents with non-suicidal self-injury (NSSI) and body modifications (BM).

Methods:

Participants were 28 adolescents (15-20 years) with self-reported NSSI, and 28 adolescents with extreme forms of BM (age ranged 15-20 years). Body attitudes were assessed with Russian versions of MBSRQ and BIQLI questionnaires (Brown et al, 1990, Cash, 2000, Cash & Fleming, 2002, Baranskaya, 2010). Beck Hopelessness scale was used as a measure related to suicidality and depression. Presence of NSSI was assessed with Reasons for Self-injury survey (Polskaya, 2013).

Results:

(1) NSSI group scored significantly lower than BM on Appearance Evaluation (Mann-Whitney’s U, p<0.001) and Fitness Evaluation (U, p<0.01) scales only. Both groups scored significantly lower than a normative sample on all evaluative scales, and Body areas self-satisfaction scale (Kruskal-Wallis H, p<0.001, p<0.005 for different scales). (2) Groups showed no significant differences on Hopelessness scale, but both scored higher than normative sample (H, p<0.001). (3) In NSSI group only a significant correlation between Hopelessness scale and both Appearance Evaluation and Orientation scales was found (r=-0.43 and r=-0.44, p<0.05).

Conclusions:

There are signs of negative body attitudes in both groups, but NSSI group is more affected and shows relationships between appearance worries and depressive preoccupations.

Keywords:

hopelessness

NSSI

body modifications

body image

Conflict of interest:

No

Variability in the final subtype of bipolar disorder in children and adolescents in a spanish sample
M. Ribeiro-Fernández 1 *
A. Diez-Suarez 2 3
1Complejo Hospitalario de Navarra, Psiquiatría, , Spain
2Clínica Universidad de Navarra, Psychiatry, , Spain
3The University of Texas, Psychiatry And Behavioral Sciences, , United States of America
*Corresponding author.

Introduction:

Although the diagnosis of Bipolar Disorder (BD) in adults does not present controversies, more than 60% of patients report onset of symptoms before the age of 20. These symptoms can be non-specific, which can lead to a delay in diagnosis.

Objectives:

To analyze the variability over time of a sample of 72 patients under 18 years of age diagnosed with BD according to the DSM criteria.

Methods:

A sample (n = 72) of children and adolescents with DSM BD is evaluated according to subtype (I, II and NOS). This sample is evaluated over a 15-year period. We assessed the most frequently present symptoms prior and at time of diagnosis and its subtypes (I, II and NOS)

Results:

Patients [75% boys, median age at diagnosis 12.6years] went follow up for a median period of 3.86 years. At the time of diagnosis, 37.5% had BD-I, 8.3% BD-II, and 54.2% BD-NOS. At follow-up, 62.5% had BD-I, 8.3% had BD-II, and 23.6% had BD-NOS, whereas 4.2% no longer met the DSM criteria for BD.

Conclusions:

After a median follow-up period of 3.86 years half of all patients with baseline BD-NOS maintained their BD subtype, but most of the other half showed conversion to BP-I at follow up. Only 4.2% of the sample (all with BD-NOS at baseline) did not meet criteria for BD at follow up, and these patients were stable.

Keywords:

Subtype

Bipolar disorder

Children

adolescent

Conflict of interest:

No

Depressive disorder in children and adolescents: comorbidities and therapeutic management: about 40 cases
W. Bamaarouf
Hospital ARAZZI SALE, Psychiatry, , Morocco

Introduction:

Adolescent depression is a real diagnostic and therapeutic issue for the child psychiatrist on a daily basis. The international recommendations that have developed since 2005 are fairly consensual and emphasize the need for identifying and diagnosing depression in children and adolescents. Management is essentially psychotherapeutic and the place of therapeutic drugs (mainly fluoxetine) must be modest. Medications should be introduced with caution.

Objectives:

To shed light on the socio-demographic and psychopathological characteristics of patients with depressive disorder and to identify the main comorbidities and antidepressants used in the management of these young patients.

Methods:

Retrospective study on 40 consultation files carried out at the child psychiatry service of the Arrazi University Psychiatric Hospital.

Results:

Sociodemographic and Psycho-pathological characteristics:

Conclusions:

The recommendations of good practice on the diagnosis and the management of the depressive manifestations of adolescents have developed since 2005 on the international level. The recommendations are fairly consensual and emphasize the need for identification and diagnosis of depression in children and adolescents. Management is essentially psychotherapeutic and the place of therapeutic drugs (mainly fluoxetine) should be modest and should be introduced with caution. Treatment must be carefully monitored. New therapeutic modalities (Transcranial magnetic stimulation) are being studied for resistant depressions. Their interest would be to be able to do without antidepressant drugs whose benefit / risk ratio is lower in young people at other times of life.

Keywords:

médication

Dépression

Children

adolescent

Conflict of interest:

No

Parent screening during child assessment: exploring child and parent psychopathology in child/adolescent clinic.
M. Bani 1 *
B. Allkoja 2
E. Petrela 3
1University Hospital Center “Mother Teresa”, Tirana, ., Department of Neuroscience,, , Albania
2HEALTH COMMUNITY CENTER NR.1, Child/adolescent Psychiatry, TIRANA, Albania
3University Hospital Center “Mother Teresa”, Tirana, ., Department of Statistics, , Albania
*Corresponding author.

Introduction:

Children of depressed and/or anxious parents are at increased risk of developing psychiatric disorders. An observational cross-sectional study was done to identify this relationship.

Objectives:

1) to identify the current rates of parental symptoms in families coming to the UHC, CHILD AND ADOLESCENT PSYCHIATRIC CLINIC; 2) to determine whether there is a relationship between parental symptoms and parent reports of their children’s symptoms

Methods:

The sample includes youth 4 through 17 years of age (n=98) from 345 ,who were evaluated between February 2019, and September 2019 CHILD AND ADOLESCENT CLINIC in Mother Tereza Hospital.Were excluded children with a life-threatening medical illness, active psychosis, active suicidality, mental retardation, pervasive developmental disorder, or physical/sexual abuse (n=245).

Results:

Parental reports on the SDQ internalizing scales were highly correlated with scores of depression in PHQ-9,higher in mothers, (for mothers: y=9.78+1.48 depresi_prind ; For fathers: y=10.91+0.04 depresi_prind)The same was found for the relationships between parental reports on the SDQ internalizing scale with scores on parental reports on GAD-7.

Conclusions:

Both parents’ symptoms were significantly associated with their reports of children’s internalizing and externalizing problems. This may be due to parents’ symptoms influencing their interpretation of their children’s problems.

Keywords:

child psychiatric evaluation

parent screening

Conflict of interest:

No

Outcome predictors in a low-intensity early start denver model implemented in the taiwanese public health system
C.-H. Chiang *
T.L. Lin
National Chengchi University, Psychology, , Taiwan
*Corresponding author.

Introduction:

Early Start Denver Model (ESDM) is an evidence-validated program for young children with autism spectrum disorder (ASD). In the past nearly 10 years, most of the ESDM studies were reported in the west, what predictors of outcome implementing ESDM in Taiwanese public health system is an open issue.

Objectives:

The purposes of this study was to examine the predictors of outcome implementing low-intensity ESDM for young children with ASD in Taiwanese public health service system.

Methods:

A total of 25 children with ASD aged between 25 and 46 months were recruited. Children in ESDM intervention group received 9 hours per week of one on one ESDM intervention in clinical settings for 24 weeks. Children outcome measures were administered pre and post intervention, comprising the cognitive ability, language, adaptive behaviors and symptom severity assessed by the MSEL, ABAS-II and ADOS, respectively. Outcome predictors measures were administered at pre intervention, comprising temperament, sensory process, imitation, play and social orientation.

Results:

The results revealed that children in ESDM intervention having better imitation and play performances at pre-intervention can predict better improvements in cognitive ability, and having more initiating joint attention and lower object exploring can predict more decrease in symptom severity.

Conclusions:

The study showed that social communicative abilities such as imitation, play and joint attention are important indicators to predict the outcomes in cognitive function and autism severity in low-intensity ESDM program for young children with ASD.

Keywords:

Autism

Early Start Denver Model

Outcome Predictors

Comprehensive Early Intervention

Conflict of interest:

No

Dating violence in adolescents
D.S. Cohen 1 *
A. Muñoz Domenjó 2
P. Muñoz-Calero 3
S. Gadea Del Castillo 1
D. Herrero Escudero 1
E.M. Rybak Koite 1
N. Rodríguez Criado 4
I. Mesián Pérez 4
1Complejo Asistencial de Segovia, Servicio De Psiquiatría, , Spain
2Hospital Universitario de Móstoles, Psiquiatría, Móstoles, , Spain
3Hospital Universitario de Móstoles, Psychiatry, , Spain
4Hospital Infantil Universitario Niño Jesús, Servicio De Psiquiatría Y Psicología Del Niño Y El Adolescente, , Spain
*Corresponding author.

Introduction:

Dating Violence in Adolescence is defined as the psychological, physical or sexual aggression that occurs in sentimental relationships between adolescents aged 10-19. Dating violence is a matter of public health, as it has a prevalence of 5-10%.

Objectives:

Through this presentation we will expose a case report and present the different resources available in our area.

Methods:

We present the case of a 13-year-old girl involved in a relationship who suffers dating violence. She experiences a significant change of attitude with important disturbance in different areas (scholarship, family and friends), requiring hospitalization in psychiatry over suicidal ideation. We have carried a bibliographic review of dating violence in adolescence through Pubmed and MeshDatabase using the terms “Intimate Partner Violence” and “adolescent”.

Results:

Adolescence is a crucial period in which the brain suffers many structural and functional changes, especially in the prefrontal cortex. These changes involve the development of executive functions and play a very important role in impulsivity control and emotional regulation in adolescence. The short-term effects of dating violence include depression, anxiety, substance abuse and suicidal ideation, while the long-term effects are low self-esteem, lower academic performance, substance dependence and eating disorders.

Conclusions:

Investing in mental health in adolescents will guarantee healthy adults in the future. Due to its high prevalence, it is mandatory to ask about dating violence when interviewing adolescents at risk. Some useful methods to manage these situations include school-based interventions and follow-up with mental health professionals.

Keywords:

dating violence

Intimate partner violence

adolescent

Conflict of interest:

No

Updating ASD and comorbid eating disorders: strategies for treatment and management.
E. Dominguez Ballesteros 1 *
E. Santamaría Rubio 1
M. Sanchez Vicente 2
1Clinica Lopez Ibor, Child Psychiatry, , Spain
2Quirón Salud, Accident And Emergency Department, , Spain
*Corresponding author.

Introduction:

Prevalence of comorbid eating disorders in ASD patients represent around 15% of ASD population. Symptoms of eating difficulties in ASD range from restrictive patterns of feeding to binging or purging behaviours. It is also suggested that there could be an overlap in pathophysiological mechanisms between ASD and anorexia-bulimia nervosa given some similarities such as deficits in abstract thinking or impulse-control issues. However, there are not well-defined strategies to manage these comorbid disorders. Therefore, clinicians are not sufficient aware of the importance of an accurate diagnosis and specific therapeutic approaches for those patients

Objectives:

Based on the need to formulate protocols,we aim to conduct a systematic review on the recent literature research on this topic.

Methods:

Review authors set PubMed as data source and agreed on exclusion and inclusion criteria of the reviewed articles.

Results:

Following a preliminary search on PubMed a total number of 133 peer reviewed articles were considered. Filters were applied for language, date of publication and text availability with a provisional result of 63 publications. We selected those articles focused on etiology, clinical outcomes or treatment of comorbid ASD and ED with a final result of 21 articles

Conclusions:

Our systematic review suggest that despite the evidence of a link between ASD and eating disorders, there is a lack of research on the topic. As a result, mental health professionals tend to use systematic approaches to treat those patients. There could be shared mechanisms between ASD and eating disorders. However, further research is needed to better understand this relationship.

Keywords:

ASD

eating disorders

comorbidity

Child Psychiatry

Conflict of interest:

No

Improving mental health care service in children and adolescents with e-poster viewing: intellectual disability
I. Insa Pineda *
M. Chamorro Fernández
A. Huguet Miguel
C.L. Gómez González
E. Ventura Mallofré
Hospital Sant Joan de Déu of Barcelona, Child And Adolescent Psychiatry And Psychology Department, Esplugues de Llobregat, , Spain
*Corresponding author.

Introduction:

There is limited research data published on the emotional state of caregiver (parents and teachers) of children with ID and mental illness.

Objectives:

The objective of our study was to assess the parents and teachers' distress in order to propose intervention strategies to reduce it

Methods:

A descriptive, cross-sectional study was carried out. The study sample was composed of 39 children, their respective parents and the 23 teachers who assist these students/patients. The assessment included: 1. Parents' cariables: Parental Stress Index-Short form scale (PSI-SF) and Beck Depression Inventory scale (BDI-II). 2. Teachers' variables: Malasch Burnout Inventory (MBI).

Results:

26.1% of students in this special education school had a comorbid mental disorder. 79.4% presented a diagnosis of ASD with or without comorbidity. The average total score of PSI in fathers was 81±36.35 and 85.18±23.07 in mothers. 26% of teachers showed medium-high levels of emotional exhaustion, 26% report depersonalization sensation and only 4.3% showed low personal achievement.

Conclusions:

The parents ‘average BDI scores showed the presence of mild depression. Mothers have clinically significant parental stress levels. Some of the teachers showed important levels of emotional exhaustion. Since September 2018, students of a special education school with psychiatric comorbidity are attended by the mental health professionals (Psychiatrists) in the educational center. Treating the patients within the school environment aims to increase patient information, ensure continuity of care and increases the perception of teacher support.

Keywords:

special education school

Intellectual disability

Caregivers

Burnout

Conflict of interest:

No

Effects of dance movement therapy on social engagement in young children with autism spectrum disorder
T.-C. Lee 1 *
Y.-C. Su 2
C.-H. Chiang 2
1National Chengchi University, Education, , Taiwan
2National Chengchi University, Psychology, , Taiwan
*Corresponding author.

Introduction:

Joint engagement (JE) is one of the core deficits in young children with autism spectrum disorder (ASD). In typical development of joint engagement, person-person game or dyadic interaction occurs first when caregiver interacts with baby before 6 months. Affect connection between infant and caregiver is developed mainly through body interaction and synchronization. Then, JE occurs when the toys are added to the games during caregiver-infant interaction after 6 months. However, the literature has few articles to address the issue in early intervention for young children with ASD.

Objectives:

The purpose of this study was to explore if Dongshi movement intervention, a kind of dance movement therapy, can facilitate body synchronization and affect attunement in young children with ASD.

Methods:

Three young children aged 2-4 years with middle-to-low functioning ASD were recruited. The study used a single case design with multiple baseline design across cases and multiple probe design, including baseline, intervention and follow-up phases. In intervention phase, Dongshi movement intervention consisted of 17-19 sessions with 40 minutes per session and twice a week. The primary outcome measures included the total time of engaging in interaction with person and coordinated joint engagement.

Results:

showed that effects of joint engagement were observed in the three participants, however, two participants showed stable improving trends and generalization during the intervention and kept maintenance at follow-up sessions.

Conclusions:

The findings revealed that Dongshi movement intervention, a kind of dance movement therapy can facilitate social engagement in young children with ASD. Limitations and further studies were discussed.

Keywords:

dance movement therapy

Autism

joint engagement

affect attunement

Conflict of interest:

No

Improving policy and practice in the interface between child and adolescence psychiatry and adult psychiatry services: a portuguese articulation project
A. Maia 1 2 3 *
D. Couto 3
J. Gago 1 3
G. Maia 1 3
L. Sardinha 1 3
1Universidade Nova de Lisboa, Portugal, Nova Medical School | Faculdade De Ciências Médicas, , Portugal
2Champalimaud Centre for the Unknown, Champalimaud Clinical Centre, , Portugal
3Centro Hospitalar de Lisboa Ocidental, Psychiatry And Mental Health, , Portugal
*Corresponding author.

Introduction:

Mental illnesses frequently start in childhood, requiring not only an early intervention in Child and Adolescence Psychiatry (CAP), but also its maintenance in Adult Psychiatry (AP) Services. Given the importance of continuity of care and the co-occurrence of psychopathology in different members of the same family, a close articulation between CAP and AP Services is fundamental to ensure a good quality of care.

Objectives:

To review the existing evidence supporting the need of a collaborative articulation between CAP and AP Services, and to describe a Portuguese Articulation Project between CAP and AP services at our Hospital Centre, in Lisbon.

Methods:

Literature review and Project description.

Results:

Transition into adulthood is a vulnerable period, increasing the risk of non-adhesion and disruption of care. However, less than one-third of young adults referred from CAP to AP Services perform an effective transition. Additionally, not only Children of Parents with a Mental Illness (COPMI) have an increased risk of developing mental illness in the future (RR 2.52; 95%CI 2.08-3.06), but parents of children evaluated in CAP Services also have an increased risk of psychiatric symptoms. We developed an Articulation Project between CAP and AP Services at our Hospital Centre, comprising articulation meetings for joint discussion/referring of cases, and formative meetings in areas of interest for both services.

Conclusions:

A close interaction between CAP and AP Services is crucial to ensure a gradual and coherent transition between the two services, with the additional advantage of allowing joint discussion and referring of family members at risk of developing mental illness.

Keywords:

Transition into adulthood

COPMI

Articulation project

quality of care

Conflict of interest:

No

Sleep disturbances in unmedicated children recently diagnosed with attention-deficit/hyperactivity disorder assessed by actigraphy and parent-report questionnaires
C.F. Marta *
I.P. Imma
G.G. Cristina
A.D. Ja
Sant Joan de Deu Hospital, Child/youth Mental Health Centre, , Spain
*Corresponding author.

Introduction:

Children with ADHD frequently have sleep disturbances. Results from subjective and objective sleep studies in ADHD have been inconsistent. The most often cited issues about the heterogeneity of result are the different methods of sleep measurement, the use of stimulant medication and the presence of psychiatric comorbidity.

Objectives:

The objectives of this study were to assess sleep disturbances in unmedicated children recently diagnosed with attention-deficit/hyperactivity disorder (ADHD), compared with healthy peers, using actigraphy and parental questionnaires, and examine the potentially moderating role of severity of symptoms, ADHD subtype and comorbidity.

Methods:

120 children of age group between 6-16 years (60 children diagnosed with ADHD and 60 controls), recruited from a hospital’s Child Psychiatry Outpatient services. Sleep disturbances were assessed using actigraphy during 7 consecutive days. The parents of these children were interviewed using Sleep Disturbance Scale for Children (SDSC). The severity of ADHD and comorbidity were evaluated via the Conner’s Parents Rating Scale and K-SADS-PL.

Results:

The SDSC scale showed a significantly greater incidence of sleep disorders in children with ADHD as compared to controls. Children with ADHD had a higher score on Problems Initiating and Maintaining Sleep, Night Awakenings, Sleep-Disordered Breathing, Sleep-Awakening and Excess Daytime Sleepiness. Sleep disturbances were not finding by actigraphy. The presence of psychiatric comorbidity and combined ADHD subtype were associated with more severe sleep disturbances, but not severity of symptoms.

Conclusions:

Sleep disturbances are more prevalent in children with combined ADHD subtype and psychiatric comorbidity; however, it is necessary objective assessment tools to verify these sleep disturbances.

Keywords:

Newly diagnosed ADHD

comorbidity

Children

sleep disorders

Conflict of interest:

No

Clinical phenotype of autism spectrum disorders in children of preschool and school age, burdened epileptic seizures.
I. Martsenkovsky *
T. Skrypnyk
Research Institute of Psychiatry of the Ministry of Health of Ukraine, Department of Mental Disorders Of Children And Adolescents, , Ukraine
*Corresponding author.

Introduction:

Clinical comorbidity ASD, tics disorders and epilepsy can be determined by different variants of genetic polymorphism, as an option different variants of gene expression, determined by different environmental influences.

Objectives:

The purpose of the study was to study the features of the clinical phenotype of ASD in preschool and school-age children with tics, epileptic seizures and specific epileptic activity on EEG.

Methods:

116 children aged 2-10 years with ASD were examined. For diagnostics, ADI-R, ADOS techniques and DSM-V diagnostic criteria were used. DAWBA was used to screen for comorbid disorders. The study group was divided into three subgroups: subgroup A - 23 children with a history of epileptic seizures, subgroup B - 35 children with specific forms of epileptic activity on EEG without epileptic seizures, subgroup C - 19 children with ASD having specific epileptic activity for EEG repetitive involuntary movements (motor and vocal tics). The control group consisted of 39 children with ASD none a history of seizures and specific epileptic activity on the EEG. The follow-up of children with ASD in the comparison groups was performed for 3-5 years.

Results:

Clinical phenotypes of ASD with epileptic seizures or specific epileptic activity on the EEG are characterized by differing clinical symptoms and their change during follow-up. Motor and vocal tics were present in subgroup C (P < 0,001); no differences were found in subgroups A and B.

Conclusions:

Further research is needed on the clinical phenotypes of ASD polymorbid disorders.

Keywords:

autism

epileptic seizures

motor and vocal tics

Conflict of interest:

No

Efficacy and safety of levetiracetam and risperidone for aggression irritability, and hyperactivity in adolescent with autism spectrum disorder
I. Martsenkovsky *
G. Makarenko
I. Martsenkovska
Research Institute of Psychiatry of the Ministry of Health of Ukraine, Department of Mental Disorders Of Children And Adolescents, , Ukraine
*Corresponding author.

Introduction:

Efficacy and safety of Levetiracetam and Risperidone for aggression irritability, and hyperactivity in adolescent with autism spectrum disorder (ASD) are controversial

Objectives:

The sudy of Levetiracetam and Risperidone efficacy and safety for aggression and mood instability in ASD adolescents.

Methods:

66 adolescents with ASD (MD = 14,6) were randomized into three groups : Lvetiracetam + Risperidone (A), Placebo + Risperidone(B) and Placebo +Levetiracetam (C) for an 8-week, placebo-controlled study with the use of flexible doses of Risperidone (1.0-3.0 mg; MD = 2,3) and LCT(1000.0 – 2000.0 mg; MD = 1580 mg). Patients were assessed at baseline and after 2, 4, 6 and 8 weeks of therapy. We used : DAYS, MASC, LSAS-CA, YBOCS, ADHD-IV, SCQ, ASDS, RAASI, SSRS, GAF. Groups were considered the independent variable, and five measurements during treatment were considered as the dependent variable for themultiple regression analysis.

Results:

Compared with the group B, patients of group C demonstrated improved symptoms of hyperactivity, impulsivity and mood instability. No treatment difference was observed between A and B groups for the SCQ, ASDS, RAASI and SSRS. Changes in group A were greater than in C and B. The GAF score in the patients improved significantly from 39.00 ± 7.36 before therapy to 58.00 ± 9.12 after risperidone (F = 30.16, df = 1, p < 0.001) and to 64.00 ± 8.21 after Levetiracetam + Risperidone (F = 33.89, df = 1, p < 0.001).

Conclusions:

Risperidone is useful in treating behavioral problems; adding Levetiracetam to Risperidone was more effective for irritability and stereotyped behavior.

Keywords:

Efficacy

safety

levetiracetam

risperidone

Conflict of interest:

No

Quality improvement project in ADHD treatment pathway under merton child and adolescent mental health service (CAMHS)
P. Nagasinghe
SOUTHWEST LONDON & ST GEORGE'S MENTAL HEALTH NHS TRUST, Neurodevelopment Services, , United Kingdom

Introduction:

Diagnosis of ADHD for children residing in the Borough if Merton is currently being carried out by CAMHS Neurodevelopment Service located at Springfield Hospital. Due to centralised nature of assessments young people tends to stay in a waiting list for nearly 6-8 months. Following diagnosis they get redirected to Merton CAMHS as a new referral to consider initiation of medication. This two-stage process adds a considerable delay into starting medication.

Objectives:

Reduce the waiting time for young people waiting on medication treatment pathway under Merton CAMHS.

Methods:

We are hoping to collect following data on patients who were on waiting list in September and October 2019; number of patients, age range, duration of being on waiting list, total number of medication initiation appointments offered, average duration of these appointments We will be handing over an information pack on ADHD medication from November to December 2019 to get patient feedback on what needs to be included in such a pack. Finalised information packs will be sent to young people prior to each medication initiation appointment from January to February 2020 while reducing the appointment time to 45 minutes.

Results:

We have collected the data and currently distributing the information packs to young patients and families.

Conclusions:

Our hypothesis could be that the introduction of information pack on medication would help to bring down appointment time by half. This would help us to bring the waiting time by half for the current cohort.

Keywords:

ADHD Medication

Treatment pathway

Conflict of interest:

No

Functional NIRS evaluation of prefrontal cortex activity during emotional processing in children with ADHD
M. Maddalena 1
S. Grazioli 2
A. Crippa 2
A. Bacchetta 2
E. Maggioni 3
P. Brambilla 4
V. Diwadkar 5
E. Gatti 2
S. Bertella 2
M. Molteni 2
M. Nobile 2 *
1University of Milano-Bicocca , Phd Program In Neuroscience, School of Medicine and Surgery, , Italy
2Scientific Institute 'Medea', Child Psychopathology Unit, Bosisio Parini, Italy
3Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Neurosciences And Mental Health, , Italy
4University of Milan, Department of Pathophysiology And Transplantation, , Italy
5Wayne State University School of Medicine, Departments Of Psychiatry Andbehavioral Neurosciences,, DETROIT, United States of America
*Corresponding author.

Introduction:

Attention deficit hyperactivity disorder (ADHD) is characterized by a lack in self-regulation of behaviour, cognition and emotional response. Children with ADHD often experience emotional dysregulation (ED) defined as the inability to regulate emotions and to organize behaviours in response to emotional stimuli.

Objectives:

The present exploratory study aimed to evaluate possible peculiar sensitivity to emotional stimuli in children with ADHD and ED, revealed by behavioural performances and cortical hemodynamic characteristics measured with functional Near Infrared Spectroscopy (fNIRS). The relationship between haemodynamic activation during task and ADHD and ED symptoms was also investigated.

Methods:

Eighteen children with ADHD and ED, all drug naïve, and 25 typically developing (TD) peers, aged 6-16 years, underwent fNIRS while performing a visual emotional continuous performance task in which faces with relevant positive, negative and neutral content were presented. ADHD and ED symptoms were evaluated with Conners’ parents rating scales (CPRS). Selected fNIRS sources and detectors see figure1

Results:

Between groups comparisons revealed worse performances of ADHD children, with a statistically significant difference for positive blocks and total errors. fNIRS analysis showed higher activation in TD group, as measured by higher oxygenated-haemoglobin concentration changes, localized in right prefrontal cortex, regardless from the valence of the emotional stimuli. Correlations conducted between fNIRS activation and CPRS revealed several associations between hemodynamic changes in right prefrontal regions and inattention and hyperactivity, but not ED symptoms.

Conclusions:

Lack of self-regulation and ED impact on ADHD children ability to process emotional stimuli, as revealed by worse performances and haemodynamic peculiarities in right prefrontal cortex.

Keywords:

emotional regulation

ADHD

Prefrontal Cortex

fNIRS

Conflict of interest:

No

Features of the interrelations of existential characteristics and depressive symptoms of adolescents with autoaggressive behavior
A. Grigorieva 1
B. Osipova 2 *
D. Nedelko 2
L. Usova 3
A. Gavrichenkova 3
1National Medical Research Center of Psychiatry and Addiction, Ministry of Health Care, Russia, Department of Organization Of The Prevention Aid In Addiction, , Russian Federation
2Moscow state University of Psychology and Education, Legal And Forensic Psychology, , Russian Federation
3National Medical Research Center of Psychiatry and Addiction, Department of Organization Of The Prevention Aid In Addiction, , Russian Federation
*Corresponding author.

Introduction:

Autoaggressive behavior is one of the most important social and medical problems. Adolescents suffering from autoaggressive behavior are at increased risk of suicide (Olfson, Wall, Wang, Crystal, Bridge, Blanco, 2018). Currently, suicide is the second leading cause of mortality among adolescent. (World Health Organization, 2014). Depression is the most frequently diagnosed mental disorder among adolescents with self-injurious behavior (Tilton-Weaver, Marshall, Svensson, 2019).

Objectives:

Depression is accompanied by a decline in the quality of life, and therefore it is necessary to study the relationship of existential experiences and depressive symptoms in adolescents with autoaggression

Methods:

«The Children's Depression Inventory» (CDI) (M. Kovacs, 1997); «Test existential motivations» (TEM) (A. Lange, P. Eckhard, 2000); Spearman's rank correlation coefficient. The study include 75 adolescents with autoaggressive behavior.

Results:

Average total depth indicator symptoms of depression in adolescents with autoaggressive behavior indicates an excess of the critical level in the severity of depressive symptoms. The largest number of significant correlations were found between depressive symptoms and the components of the first “confrontation with the world” (r = -0.659, p <0.001), the third “authenticity” (r = -0.529, p <0.01) and the fourth “confrontation with meaning” (r = -0.509, p <0.01) of existential fundamental motivations

Conclusions:

In adolescents with autoaggressive behavior, there is a significant relation between the symptoms of depression (negative mood, interpersonal problems, anhedonia, negative self-esteem, the total level of depression) and the experience of existential fulfillment, characterized as an experience of quality of life.

Keywords:

Self-harm

adolescence

Dépression

autoagressive

Conflict of interest:

No

Support program for the carieer of attention deficit hyperactivity disorder: a university extension project
C.J. Paiva Wagner *
A.C. Kurmann
V. Viapiana
M. Santos De Morais
C. Rebechi
D. Glimm
Universidade de Passo Fundo, Faculdade De Medicina, Passo Fundo, Brazil
*Corresponding author.

Introduction:

Attention Deficit Hyperactivity Disorder (ADHD) is the main neurobehavioral disorder affecting children and adolescents between six and seventeen years of age; It is a neurodevelopmental disorder of chronic and hereditary characteristics, with behavioral patterns of inattention, impulsivity, and hyperactivity1,4. ADHD affects 5% of school-age children and 2.5% of adults.² In addition, 60-80% of patients remain with symptoms in adulthood.¹ Among the etiologies involved in ADHD, the main one is heritability, which may reach 75%2,3. Regarding the prognosis, there is a relationship between ADHD and substance abuse and other psychiatric disorders, academic and professional failure, difficulty in interpersonal relationships3. It is recommended that the treatment be multimodal, involving drug therapy, psychological and psychoeducation5. The drugs of choice are methylphenidate and dexamphetamine4.

Objectives:

To present a multidisciplinary university extension project that works in the diagnosis and treatment of children with ADHD.

Methods:

The project operates in a multidisciplinary way, involving the medical, psychological and psycho-pedagogical areas. Patients undergo initial medical evaluation, followed by neuropsychological evaluation to confirm or exclude the diagnosis. When associated with learning disorders, psychopedagogic intervention is performed.

Results:

In 2019, the project provided over 130 consultations, covering more than 60 patients.

Conclusions:

The project performance is justified, being ADHD a prevalent disease in the population and with developmental damage; thus, it is of utmost importance to correctly diagnose and treat patients with a specialized and multidisciplinary team.

Keywords:

child and adolescent psychiatry

Attention Deficit Hyperactivity Disorder

University extension project

Conflict of interest:

No

Nutrition in neurodevelopmental disorders: to supplement or not to supplement, that is the question!
F. Sa-Carneiro 1 *
R. Coelho 1
C. Calhau 2
M. Figueiredo-Braga 3
1Centro Hospitalar Universitário de São João, Psychiatry, , Portugal
2Faculty of Medicine University of Porto, Center for Health Technology And Services Research (cintesis), , Portugal
3Faculty of Medicine University of Porto, Department of Neurosciences And Mental Health, , Portugal
*Corresponding author.

Introduction:

Neurodevelopmental disorders such as Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) are lifelong conditions which have undergone huge diagnostic and therapeutic evolutions in the past decades. Although there seems to be consensus regarding therapeutic interventions in ADHD targeting dopaminergic and noradrenergic deficits in this disorder, the aetiology of the disorder seems far more complex, and in the case of ASD specific therapeutic target are still elusive to date. Concerns about adverse effects and interactions of multiple pharmacotherapy have boosted research on treatment strategies as nutritional supplements, but their advantages remain controversial.

Objectives:

The present study aimed to investigate nutritional status in Portuguese children diagnosed with ASD and ADHD (n=91).

Methods:

Clinical evaluation included the Autism Diagnostic Observation Schedule (ADOS-2) and Autism Diagnostic Interview-Revised (ADI-R) and formal cognitive evaluation scales was performed in all the children, and patients on special diets, with metabolic disorders or with known vitamin deficiencies were excluded.

Results:

An association between subclinical nutritional deficits and both Autism Spectrum Disorders and Attention Deficit Hyperactivity Disorder was detected.

Conclusions:

With the present work, the authors aim to enlighten the role for PUFA’s, iodine, zinc, selenium, iron and magnesium in neurodevelopment as distinct factors in the clinical presentation of both disorders. The relationship between nutritional status and ROS in the pathophysiology of ASD and ADHD is explored.

Keywords:

Autism Spectrum Disorder

Attention Deficit Hyperactivity Disorder

nutritional deficits

supplementation

Conflict of interest:

No

Perspectives of latin version of ICD-11. Tradition and modern trends in the newest diagnostic categories of mental disorders
W. Kosmowski 1 *
K. Jóskowska 2
1Nicolaus Copernicus University, Department of Psychiatry, , Poland
2Nicolaus Copernicus University, Collegium Medicum, Department of Applied Linguistics, , Poland
*Corresponding author.

Introduction:

Implementation of ICD-11 in different countries needs reflection on medical nomenclature. For many ages Latin and Greek were the main languages to express medical diagnose. In recent years they have been replaced with modern languages. Medical terms in different languages have in most cases Greek and Latin roots, therefore knowledge of Latin names of diseases enables international communication. The official dictionary of ICD-10 with Polish and Latin terms was released in 1997. Even in the newest medical textbooks e.g. ‘Internal Disorders’ by A. Szczeklik (red.) medical diagnoses are presented in Polish, Latin and English. The use of only living languages can cause misunderstanding. This is due to the different connotations of many words and terms used in medicine. Especially semantics is a key to understand the meaning of different terms and how to use them in best possible way.

Objectives:

The aim of this study is a presentation of Latin-English dictionary of ICD-11 and the rules of translation and understanding medical terminology in different languages.

Methods:

In translation process medical textbooks as well as medical (e.g. Index Medicorum) and glossary (e.g. Lexicon Recentis Latinitatis) dictionaries were used to ensure that proposition is correct from both medical and semantic point of view.

Results:

The results are contained in tables consistent with a different group of mental disorders e.g. mood disorders. Additionally special list of Greek prefixes and suffixes applicable in translation of ICD-11 categories were prepared.

Conclusions:

Translation process requires knowledge of psychopathology as well as semantics to prepare short, informative and easy to use expressions.

Keywords:

Latin

ICD-11

classification

Conflict of interest:

No

Misophonia: considering a new mental disorder.
B. Ezquerra *
M. Esteban
A. Carpintero
C. Lopez
M. Sanchez
R. Del Hoyo Mitjans
Hospital Universitario Guadalajara, Psychiatry, , Spain
*Corresponding author.

Introduction:

Misophonia is a term firstly defined in the year 2000 by the ENT specialist Jastreboff as an abnormal emotional reaction to specific sounds, generally produced by human beings, such as chewing gum or coughing. It has also been described associated to movements as hair twirling or leg swinging. Different authors have considered misophonia as a mental disorder which should be classified by DSM-V or ICD-10.

Objectives:

Our aim is to discuss if misophonia should be considered and classified as a mental disorder, as well as to describe frequent comorbid psychiatric illnesses.

Methods:

A case of a 28 year old man whose first contact with psychiatry occurs in the emergency room because of anxiety produced by referred misophonias is presented. A first psychotic episode is suspected during this first contact in the ER. He is transferred to a specialized unit where he initiates a psychopharmacological intervention. In addition, a bibliographical search is conducted in order to deepen in this disorder.

Results:

Misophonia has been described by numerous authors in relation to mental disorders such as OCPD, eating disorders and Tourette syndrome, among others. No audiological cause has been found.

Conclusions:

Misophonia meets many criteria for a mental disorder, however, further investigation is needed as cases described are relatively low. Comorbidity with other mental disorders is, nonetheless, remarkable, further reason for additional study.

Keywords:

Misophonia

Conflict of interest:

No

Diagnostic conversion of schizoaffective disorder: a retrospective study
T. Ferreira *
S. Dehanov
I. Figueiredo
M. Dias
N. Borja Santos
T. Maia
Hospital Prof. Doutor Fernando Fonseca, Psychiatry Department, , Portugal
*Corresponding author.

Introduction:

Schizoafective disorder (SZA) is considered one of the most unstable nosological categories in Psychiatry and is often characterized by having “low reliability and questionable validity”. A recent meta-analysis (Santelmann H et al., 2016) reported diagnostic conversion in 36% of the patients initially diagnosed with SZA when reassessed.

Objectives:

Analyze the diagnostic conversion of a sample of patients diagnosed with SZA.

Methods:

Retrospective study with a sample of patients with a registered diagnosis of SZA and follow-up in Psychiatry from January 2013 to June 2017. Data were retrieved from their clinical files in order to calculate the percentage of diagnostic conversion at 12 and 24 months and at the time of data collection (November 2019).

Results:

We obtained a sample consisting of 67 patients (females 43.3%; age M±SD 45.3±11.63 years). There was diagnostic conversion at the 12-month point in 8 (11.9%) and at 24-month in 13 (19.4%) patients. At the moment of data collection, there was diagnostic conversion in 20 patients (29.9%) (bipolar disorder n=9, 13.4%; schizophrenia n=7, 10.4%; non-specified psychosis n=3, 4.5%; recurrent depressive disorder n=1, 1.5%).

Conclusions:

We found a percentage of diagnostic conversion ranging from 12 to 30%, increasing with follow-up time, with conversion to bipolar disorder predominating, followed by schizophrenia. To eliminate certain bias (e.g. sample size, sample from a single department), the authors consider that expanding to a multicenter study may be appropriate.

Keywords:

Schizoaffective disorder

psychosis

Mood disorders

Diagnostic Conversion

Conflict of interest:

No

Relationship between cannabis use and affective disorders: a review of the evidence.
E. Arribas Pinero *
L. León-Quismondo
RAMON Y CAJAL UNIVERSITY HOSPITAL, Psychiatry, , Spain
*Corresponding author.

Introduction:

In recent decades, cannabis use has grown steadily, despite the risks to mental health. Many researches have been conducted to determine the risk that this consumption has for the development of different mental disorders, especially in the area of psychosis. On the other hand, research has been much more limited in the domain of affective disorders.

Objectives:

To study the use of cannabis as a possible risk factor for the development of affective disorders.

Methods:

A review of the available literature on the possible association between cannabis use and affective disorders was conducted.

Results:

Different results can be found in the available literature. On the one hand, there are studies that conclude that the association between cannabis use and depressive symptomatology, although significant, is poor. On the other hand, several longitudinal studies, after controlling several contaminant variables, do not find significant relationships. Finally, there are studies that find a significant association between cannabis use and the emergence of depressive symptoms, as well as an increase in the probability of experiencing suicidal ideation and attempts among users. Some studies have also suggested that cannabis may be associated with a earlier age of onset for bipolar disorder, increased suicide attempts, and a more severe course of the disease in initial stages.

Conclusions:

Compared to research in psychosis, in the field of affective disorders the number of investigations is lower and with less conclusive results that should be interpreted with caution. More research is required in this area.

Keywords:

cannabis

Depressive disorder

risk factor

affective disorders

Conflict of interest:

No

Cannabis use as a risk factor for psychosis: a review.
E. Arribas Pinero *
L. León-Quismondo
RAMON Y CAJAL UNIVERSITY HOSPITAL, Psychiatry, , Spain
*Corresponding author.

Introduction:

Many studies have identified cannabis use as an additional risk factor for the development of psychotic spectrum disorders.

Objectives:

To study the available evidence about cannabis as a risk factor for the development of psychosis.

Methods:

A review of the available literature on the relationship between cannabis use and the risk of psychotic disorders was performed.

Results:

Cannabis use increases the risk of psychosis, showing a dose-response effect. Although a causal relationship between these two variables has not been established and the mechanisms of this association are not yet clear, the results suggest that this association is especially present in a population with a previous vulnerability to suffering psychotic spectrum disorders, accelerating its development and significantly altering the onset, course, phenomenology, results and relapse in schizophrenia. Another direct effect of cannabis use is the presentation of transient psychotic reactions derived from intoxication, something that some authors consider as an early expression of schizophrenia in vulnerable individuals, being able to evolve later towards the development of the disease.

Conclusions:

There is numerous evidences about cannabis use as a risk factor for the development of psychosis. This risk is especially present in the young population and with a previous vulnerability. Preventive measures are necessary in high-risk groups, mainly consumers of large quantities and those who initiate consumption in adolescence.

Keywords:

schizophrenia

cannabis

risk factor

psychosis

Conflict of interest:

No

Psychosomatic aspects of gastric ulcer disease and hypothyroidism combination
M. Artemieva *
V. Kuznetsov
E. Basova
I. Manyakin
I. Danilin
Peoples' Friendship University of Russia (RUDN University), Department of Psychiatry And Medical Psychology, , Russian Federation
*Corresponding author.

Introduction:

The relevance of the study was determined by the high incidence of mental disorders and decrease of the quality of life (QL) in patients with combination of gastrointestinal tract (GIT) diseases and hypothyroidism (the frequency of this combination of diseases-about 30%).

Objectives:

The aim was to evaluate the quality of life of patients with combined pathology.

Methods:

Questionnaire SF 36 and Hamilton's scale of Depression and anxiety were used.

Results:

Patients are divided in two groups: the first group – patients with ulcer disease (20 persons); the second group – patients with ulcer disease and hypothyroidism (20 persons). The quality of life of patients from the second group is low. The physical component of health is 51,36% in the first group and 40,8 in the second group (p≤ 0,05). Such indications are associated with the symptoms of hypothyroidism: metabolic disorders of protein, lipids, decelerate of carbohydrates utilization, weight gain, tendency to bradycardia, pain caused by biliary dyskinesia. The mental component in the first group is 41.22%, in the second – 30.75% (p ≤ 0.05). The score on the Hamilton Anxiety Rating Scale (HAM-A) is also high for both groups. High score indicates the course of the pathological process affects the personality of the patient and his emotional experiences. The mental component of QOL is various for somatic patients.

Conclusions:

Patients with combined pathology of peptic ulcer and thyroid dysfunction should be examined by psychotherapist as well because of pronounced somatogenic mental disorders. The publication was prepared with the support of the “RUDN University Program 5-100”

Keywords:

Gastric Ulcer Disease

psychosomatics

Conflict of interest:

No

The quality of life of patients with gastroesophageal reflux disease
M. Artemieva *
V. Kuznetsov
I. Manyakin
E. Basova
A. Lazukova
Peoples' Friendship University of Russia (RUDN University), Department of Psychiatry And Medical Psychology, , Russian Federation
*Corresponding author.

Introduction:

Comorbidity of patients with GERD and thyroid diseases degrades the course of the disease, increases the cost of diagnosis and treatment.

Objectives:

The aim was to evaluate the quality of life in patients with comorbidity with GERD and thyroid diseases.

Methods:

Questionnaire SF 36 and Hamilton's scale of Depression and anxiety were used.

Results:

Patients are divided in two groups: the first group – patients with GERD (15 persons); the second group – patients with GERD and hypothyroidism (15 persons). The quality of life of patients from the second group is low for such indications as “physical and mental components of health”, “social functioning”. The intensity of pain in two groups significantly limits daily activities of patients. The physical component of health in patients with GERD is 48.82%, and in patients with comorbidity – 39.21% (p ≤ 0.05). A significant difference in the mental health component is observed: in the first group – 39.7%, and in the second group – 30.18% (p ≤ 0.05).

Conclusions:

Patients with GERD suffer not only symptoms associated with erosive-ulcerative, catarrhal and/or functional disorders of the distal esophagus, but also neurotic disorders. Depression, memory impairment, attention disorders are more common. Thyroid dysfunction manifests with psychoendocrine syndrome (depressive and anxiety-phobic disorders), therefore the mental health component of the quality of life of patients with GERD and hypothyroidism decreases. The publication was prepared with the support of the “RUDN University Program 5-100”

Keywords:

eating disorders

GERD

Conflict of interest:

No

Multiple sclerosis and the impact of the association of psychiatric pathology
C. Darie 1 *
M. Mutica 2
I. Peterson 3
A. Ciubara 4
1Resident Psychiatrist at Psychiatric Hospital ''Elisabeta Doamna'', Psychiatry, , Romania
2PhD "Dunarea de Jos" University of Galați, Psychiatry, , Romania
3PhD Student, Psychiatric Clinic Ryhov, Psychiatry, , Sweden
4Professor at "Dunarea de Jos" University, Senior Psychiatrist at ''Elena Doamna'' Psychiatric Hospital, Psychiatry, , Romania
*Corresponding author.

Introduction:

Multiple sclerosis (MS) is a chronic progressive disorder of the Central Nervous System, which can cause a change in the patient’s psyche. Sadly, psychiatric comorbidities can affect up to 95% of MS patients during their lifetime.

Objectives:

Following the evolution of a patient diagnosed with multiple sclerosis, during the period 2012-2019, under antidepressant and anxiolytic treatment.

Methods:

Patient presenting with multiple hospitalizations during the period 2012-2019 at the 'Elisabeta Doamna' Psychiatric Hospital, Galati, Romania. We used the Psychiatry Hospital Database 'Elisabeta Doamna' from Galati, Romania, where patient information were accessed and admitted to the Psychiatry Clinic Section II, searching for different bibliographical references, diagnostic criteria ICD-10 (Mental and Behavioral Disease Classification), diagnostic criteria DSM-5 (Diagnostic and Statistical Disorders), and the psychometric tests such as HAM-D (Hamilton Depression Rating Scale) and HAM-A (Hamilton Anxiety Rating Scale).

Results:

The patient’s evolution during 2012-2019 fluctuated, with the predominance of an anxiety pathology associated with depressive pathology (F41.0 in 2012, F32.0 in 2013, F41.2 in 2016, F41.3 in 2019). Even under drug treatment with anxiolytic antidepressants, the patient’s condition shows a gradual deterioration with the acceleration of the anxiety symptoms, in the last year.

Conclusions:

Multiple sclerosis has a major impact on the patient’s psyche, as the symptoms of the disease increase. Given the high incidence of psychiatric symptoms in patients with MS and taking into account previous reports of "psychiatric relapses," it may be wise to consider MS as a differential diagnosis of patients presenting to psychiatric clinics.

Keywords:

multiple sclerosis

Psychiatry

Dépression

Anxiety

Conflict of interest:

No

Impact of psoriasis, depression and alcohol related disorder on quality of life
C. Darie 1 *
G. Stoleriu 2
M. Terpan 3
R.-C. Oltenacu 3
A. Ciubara 4
1Resident Psychiatrist at Psychiatric Hospital ''Elisabeta Doamna'', Psychiatry, , Romania
2PhD, Assos. Professor "Dunarea de Jos" University, Psychiatry, , Romania
3PhD Student "Dunarea de Jos" University, Psychiatry, , Romania
4Professor at "Dunarea de Jos" University, Senior Psychiatrist at ''Elena Doamna'' Psychiatric Hospital, Psychiatry, , Romania
*Corresponding author.

Introduction:

In our society, where high standards of perfection are sets, the one with psoriasis is commonly considered as an outsider, a marginalized person unable to be in line with standards. If a pathology related to acool consumption is associated with psoriasis, the marginalization of the person increases.

Objectives:

We present a case of a 43-year-old patient diagnosed with psoriasis, alcohol disorder and depression, to examine the impact of psoriasis and depression on the patient’s quality of life.

Methods:

The 43-year-old patient is a policeman and has been diagnosed with severe psoriasis, alcohol disorders and depression. At the first multidisciplinary evaluation, the patient had: PASI: 18, HAM-D: 19 and DLQI: 27. The psychiatric evaluation uses the ICD-10 criteria (Classification of mental and behavioral disorders), for depression and alcohol-related disorders.

We find out that the patient was discriminated at workplace, because of skin diseases, then gradually lost family and friends, and at one point, started thinking about the idea of suicide. The patient begins to compensate for the depressive illness by consuming alcohol.

The dermatologist decided to initiate biological therapy for psoriasis.

Results:

After 3 months of biological therapy for psoriasis, at multidisciplinary evaluation, patient had: PASI: 0 HAM-D: 3 and DLQI: 0, with normal lifestyle.

Conclusions:

In this case, quality of life was significantly influenced by psoriasis, alcohol disorder and depresion. Social exclusion, discrimination and stigma was psychologically devastating for the patient. Skin disease remission helped him to reintegrate at work and to restore relationships with friends and family, starting a normal life.

Keywords:

Psychiatry

dermatology

Dépression

psoriasis

Conflict of interest:

No

Eating disorders and disorders due to substance use comorbidity etiopathogenesis.
J.J. De Frutos Guijarro 1 *
R. Martín Aragón 2
N. Chinchurreta 3
M.E. Saez Roche 1
P. Calleja Alonso 4
D. Garcia-Consuegra Colado 4
C. Moreno Menguiano 1
1Centro de Salud Doctor Luengo Rodriguez, Servicio De Psiquiatría, , Spain
2Complejo Hospitalario Mancha Centro., Unidad De Salud Mental Infanto-juvenil., Alcázar de San Juan., Spain
3HOSPITAL PUERTA DE HIERRO, Psychiatry, , Spain
4Centro de Salud Coronel de Palma, Unidad De Trastornos De Conducta Alimentaria, , Spain
*Corresponding author.

Introduction:

With the emergence and dissemination of the categorical approach to psychiatric diagnosis, the concept of comorbidity has become very controversial on certain areas. Patients with eating disorders (ED) frequently associate disorders due to substance use (SUD). Clinical and prognosis implications make important to clarify the etiopathogenesis of this association.

Objectives:

To study the etiopathological relation linking ED and SUD.

Methods:

We conducted a bibliographical research of the available literature on clinical models of association of ED and SUD.

Results:

There are several clinical models of comorbidity that attempt to clarify the relationships between ED and SUD. The addictive model hypothesizes that ED is a specific form of addition. Another model defies that SUD is a risk factor for the development of ED. Some argue, the other way around, that ED is a risk factor for the development of SUD. At the intermediate point is placed the model that explains the existence of common etiopathogenic mechanisms for SUD and ED. The more complex model understands that both pathologies would influence and modify each other from a pathoplastic point of view, modulating its morphology and development.

Conclusions:

ED and SUD are complex clinical phenomena, so complex models are needed to aproach them. There are clinical data supporting each one of these models, and it is therefore unlikely that only one of them can explain the complex interaction between ED and SUD. It is important to transmit to clinicians and patients the complexity of the etiopathogenesis of these diagnoses, in order to achieve a correct conceptualization.

Keywords:

eating disorders

substance use

comorbidity

etiopathogenesis

Conflict of interest:

No

Myristica fragrans abuse and mania, a case report
N. Fernandez Gomez 1 *
M.F. Bravo-Ortiz 2
B. Bardón Rivera 2
J. Marín Lozano 2
E.M. Román Mazuecos 2
1Hospital Universitario La Paz, Psiquiatría Y Salud Mental, , Spain
2La Paz University Hospital Research Health Institute (IdiPAZ), Psychiatry, Clinical Psychology And Mental Health, , Spain
*Corresponding author.

Introduction:

Myristica fragans seed, commonly known as nutmeg, is a kitchen spice which has been used for centuries worldwide. In folkloric medicine, it has been used as a remedy for gastrointestinal disorders mainly. Nutmeg effects on Central Nervous System (CNS) have also been studied, but reports about its impact on anxiety, depression, and hallucinatory experiences are contradictory.

Objectives:

Our aim is to describe the clinical case of a 25 years old male who suffered a manic episode, after have been doing an abusive use of nutmeg.

Methods:

We describe and analyse the clinical case of a 25 years old male who suffered a manic episode after nutmeg abuse. We also conduct a literature rewiew about nutmeg effects on CNS.

Results:

The patient was admitted to psychiatric unit. He was concious, and globally oriented. Inattentive.Desnhibited.Expansive mood.Speech showed tachylalia and derailment.Structured mystical and megalomaniac delusions with auditory hallucinations were present. He suffered mixed insomnia.Psychopharmacological treatment with 20 mg oral aripiprazole was administered with partial remission of the manic episode. Two weeks before manic episode, he had been using a high amount of nutmeg as stimulant agent.

Conclusions:

Nutmeg has not well defined effects on CNS.Its psychoactive and hallucinogenic properties have been described but the hypothesis of psychoactivity is due to amphetamine-like metabolites has not been experimentally supported.Anxiogenic activity has been reported, as well as an antidepressant effect because of nutmeg´s involvement on adrenergic, serotonergic and dopaminergic systems. We sustain the clinical hypothesis that manic episode was associated to nutmeg abuse, but further investigation about nutmeg´s psychotropism is needed.

Keywords:

mania

myristicafragans

substanceabuse

stimulant

Conflict of interest:

No

The importance of screening for bipolar disorder in patients treated for substance use disorders
S. Jonovska *
V. Sendula Jengic
Psychiatric Hospital Rab, Department of Addictions, , Croatia
*Corresponding author.

Introduction:

Affective disorders are common in people with substance use disorders. If not recognized and appropriately treated, co-morbid affective disorders can hinder therapeutic plans, harming clinical outcomes of patients' substance use disorders. Bipolar depression is frequently underdiagnosed or misdiagnosed as unipolar depression. Its pharmacologic mismanagement can lead to worsening of affective symptoms leading to relapse early in recovery.

Objectives:

We are going to present our experiences by analyzing around 100 patients treated for addictions during a 5-month period, who were also screened for BD. An additional case report will be presented, involving a patient with co-morbid bipolar disorder, substance use disorder and antisocial personality disorder.

Methods:

We will be addressing the importance of current screening tools for bipolar disorder (BD), such as Hypomania Checklist 32 (HCL-32) and Young Mania Rating Scale (YMRS), with focus on their importance in addiction medicine.

Results:

Preliminary results show a great percentage of bipolar affective disorder in screened population of patients treated of different addictions, eather diagnosed before or not.

Conclusions:

In our opinion, screening for BD should be routinely performed in patients with substance use disorder, in order to improve the clinical outcome of patients.

Keywords:

Screening

Addiction

treatment

Bipolar disorder

Conflict of interest:

No

Dysfunctional breathing as interdisciplinary phenomenon
J. Koniukhovskaia *
E. Pervichko
Lomonosov Moscow State University, Faculty of Psychology, , Russian Federation
*Corresponding author.

Introduction:

The dysfunctional breathing (DB) are pathological and stable breathing patterns, in which the pulmonary ventilation is inadequate to the functional needs of the body. As a result, breathing pattern disorder provokes respiratory, cardiovascular, gastrointestinal, muscular, neurologic and psychological dysfunctions. DB may aggravate the underlying cause of the disease, mimics a serious illness or creates medically unexplained symptoms because of the psychological factor.

Objectives:

To exam of etiological reasons, classification, comorbidity of dysfunctional breathing in different study fields (psychiatry, pulmonology, psychology).

Methods:

There were conducted literature reviews searching the terms "dysfunctional breathing" in PubMed and Web of Science at study fields of psychiatry, pulmonology, and psychology. The research strategy was limited to articles written in English and included only adult human samples.

Results:

The etiologic reasons for BD may be pathological, biomechanical, biochemical, environmental, habitual, psychological, or their combination. DB includes the next types: hyperventilation syndrome, unregular breathing, thoracoabdominal asynchrony, upper-chest breathing, periodic deep sighing or breath holdings. Dysfunctional breathing can aggravate asthma, COPD and occur because of nasal breathing disorders. Dysfunctional breathing accompanies to generalized anxiety disorder, panic disorder, phobias, PTSD, somatoform and dissociative disorders. From a psychological point of view, respiratory pattern disorders occur in response to stress, attachment disorders, as well as a distorted interpretation of internal sensations.

Conclusions:

The study, diagnosis, and treatment of dysfunctional breathing require a holistic consideration of human functioning, taking into account physiological and psychological factors. Therefore, it is necessary to create an interdisciplinary approach to research various causes of dysfunctional breathing and provide personalized care.

Keywords:

dysfunctional breathing

panic disorder

PTSD

anxiety disorder

Conflict of interest:

No

Subjective anxiety according to comorbidity in dual pathology
F.J. Pino Calderon 1 *
V. Lozano Gomez 2
J. Zoido Ramos 3
J.R. Gutierrez Casares 4
1Servicio Extremeño de Salud, Equipo De Salud Mental De Montijo, , Spain
2Servicio Extremeño de Salud, Psychiatry Unit - Hospital Universitario De Badajoz, , Spain
3Servico Extremeño de Salud, Cedex Los Pinos, , Spain
4Servicio Extremeño de Salud, Esm Psiquiatría Infantil - Hospital Perpetuo Socorro, , Spain
*Corresponding author.

Introduction:

The presence of comorbidity in substance users is common as for example ADHD and Depression, suggesting that dual pathology should be understood as trial pathology, as Gutierrez et al propose. In addition, the presence of accompanying anxious symptoms is not negligible.

Objectives:

Our purpose is to assess in a sample of substance users if the subjective anxiety was different according to the comorbidity (No Comorbidity, ADHD, Depression, and ADHD+Depression)

Methods:

This is a sample of 177 substance users (alcohol n=64, cannabis n=49, cocaine=44 and opiates=20). We measure subjective anxiety through a numerically transformable visual analog scale from 0 to 10. We divide the sample into four groups as they exceed or not the cut-off points of BDI-1A and ADHD-RS scales. A comparative test is carried out using a one-way ANOVA and then a post hoc analysis to determine which groups differ.

Results:

The mean age was 36,51 ± 10,83 with a 13,56% females. The group with the highest subjective anxiety was ADHD + Depression (7,03), the least, the group without added comorbidity (5,16). The means comparison between groups showed a statistically significant result according to the ANOVA (p = 0.001). The post hoc analysis indicated that the groups that differentiate each other were ADHD + Depression and Non-Comorbidity, finding two homogeneous subsets that do not differ from each other as can be seen in the figures

Conclusions:

Subjective anxiety was different according to the comorbidity in our sample, with the ADHD + Depression and Non-Comorbidity groups differing.

Keywords:

Anxiety

Dépression

dual pathology

ADHD

Conflict of interest:

No

Confusion in children after moderate-severe and severe traumatic brain injury
A. Tyutyukina 1
Y. Sidneva 2 *
V. Bykova 3
1Clinical and Research Institute of Emergency Pediatric Surgery and Trauma, Neurosurgery; Rehabilitation, , Russian Federation
2Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST), Department of Recovery Treatment And Rehabilitation, , Russian Federation
3Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST), Neurosurgery; Rehabilitation, , Russian Federation
*Corresponding author.

Introduction:

After moderate-severe and severe traumatic brain injury (MSTBI and STBI) in the process of recovery of consciousness patients go through the stage of confusion, described in the literature in adults. Post-traumatic confusion in childhood has not been studied. Purpose: to study the stage of confusion in children during the recovery of consciousness after MSTBI and STBI.

Objectives:

28 children after MSTBI and STBI (4-17 years old, median 12), who entered the CRIEPST (2016-2018).

Methods:

neuropsychological (clinical interview, methods by A.R. Luria); data of psychopathological, neurological and neuroimaging methods. Scales: assessment of the level of consciousness - by T. Dobrokhotova, RLAS-LCF-R, SCABL; confusion diagnostics - COAT

Results:

Confusion was detected in 16 children (57%), 8-17 years old (median 15.5), most of them were adolescents (10-17 years old). Symptoms were noted: 1) disorientation in time, space, personal data; 2) memory impairment of current events and modally-nonspecific type; 3) impairments of executive functions and neurodynamic parameters; 4) agitation; 5) impairments of emotional and personal spheres. The duration of confusion was an average of 2-3 weeks. Among the factors affecting the features of characteristics, severity and dynamic of confusion may be the degree of evolution of brain structures and the level of formation of mental functions, the relationships of parents and children, accompanied by neurosurgical, surgical and somatic disorders and other factors.

Conclusions:

The stage of confusion was detected in 57% of children (over adolescence) after MSTBI and STBI in the symptoms: disorientation, amnesia, impairments of executive functions and neurodynamics, emotional and personal spheres; agitation.

Keywords:

Post-traumatic confusion

Children

traumatic brain injury

Conflict of interest:

No

Start-up and first results of the dual pathology outpatient program in salamanca.
B. Vicente Hernandez 1 *
P.R. Gutierrez Álvarez 1
R. Martinez 1
S. Herranz Rodríguez 1
L. Recio Martín 1
R. García Sanchez 1
C. Roncero 2
A. Álvarez 1
1University of Salamanca Health Care Complex, Psychiatry, , Spain
2University of Salamanca Health Care Complex,, Psychiatry, , Spain
*Corresponding author.

Introduction:

At present in the province of Salamanca, there is no outpatient program focused on dual pathology. There is a perceived need of attention to those patients who present a serious mental disorder and a substance use disorder.

Objectives:

In accordance with the recommendations of the scientific evidence of recent years, we propose the creation of a specific healthcare resource within the framework of the University of Salamanca Health Complex.

Methods:

The dual pathology outpatient program sits (image 1) on the second level of the assistance system and follows the indications of the IV Mental Health Plan of the Regional Ministry of Health. It is intended to be a bridge between the two usual lines of assistance (image 2): mental health network and drug dependence network. It will offer a multidisciplinary and integrated approach from a biopsychosocial perspective. It will focus on diagnosis, differential diagnosis, psychopharmacological and psychotherapeutic approach, nursing care and psychometry. In addition, the dual pathology outpatient program aims to be a training area for service professionals and the basis for promoting research activity focused on dual pathology. A previous training and coordination program has been carried out with the different resources of both networks. A pilot project is proposed, building a therapeutic team consisting of a psychiatrist, two clinical psychologists, two nurses, a social worker and two social educators.

Results:

The first clinical results are presented.

Conclusions:

This new program results from the effort to improve care for patients with dual pathology.More experience in this area is necessary.

Keywords:

dual pathology

dual disorders

outpatient program

Conflict of interest:

No

Personality features, dissociation, self-stigma, hope, and the complex treatment of depressive disorder
J. Prasko 1 *
M. Ociskova 1
M. Slepecky 2
A. Kotianova 2
1Faculty of Medicine and Dentistry, University Palacky Olomouc, Department of Psychiatry, , Czech Republic
2Faculty of Social Science and Health Care - Constantine the Philosopher University in Nitra- Slovak Republic,, Department of Psychology Sciences, , Slovak Republic
*Corresponding author.

Introduction:

Identifying the predictors of response to psychiatric and psychotherapeutic treatment may be useful for increasing treatment efficacy in pharmacoresistant depressive patients.

Objectives:

The goal of this study was to examine the influence of dissociation, hope, personality trait and selected demographic factors in treatment response of this group of patients.

Methods:

Pharmacoresistant depressive inpatients were enrolled in the study. All patients completed Clinical Global Impression – both objective and subjective form (CGI), Beck Depression Inventory (BDI-II), and Beck Anxiety Inventory (BAI) at baseline and after six weeks of combined pharmacotherapy and psychotherapy treatment as outcome measures. Internalized Stigma Of Mental Illness Scale (ISMI), Dissociative Experience Scale (DES), Adult Dispositional Hope Scale (ADHS), and Temperament and Character Inventory (TCI-R) were completed at start of treatment with intention to find predictors of treatment efficacy.

Results:

The study included 72 patients hospitalized for the pharmacoresistant major depression, 63 of them finished the study. Mean scores of BDI-II, BAI, subjCGI, and objCGI significantly decreased during the treatment. BDI-II relative change statistically significantly correlated with the total ISMI score, Discrimination Experience, and Harm Avoidance. Strongest factors connected to BDI-II relative change were duration of disorder and Discrimination Experience. The strongest factor connected to objCGI relative change was Discrimination Experience. The existence of comorbid personality disorder did not influence the treatment response

Conclusions:

According to our results, the patients with pharmacoresistant depressive disorders, who have had more experience with discrimination because of their mental struggles, showed a poorer response to treatment. Supported by the research grant VEGA no. APVV-15-0502

Keywords:

dissociation

Depressive disorder

personality features

Psychotherapy

Conflict of interest:

No

Psychiatric comorbidity and use of psychopharmacology treatments in adults with autism spectrum disorder (ASD).
A. Álvarez Pedrero *
A. Palacin
I. Parra
R. Muñoz
S. Membrives
M. Llorens
L. Santos
J.A. Monreal
D. Palao Vidal
Parc Taulí University Hospital. Autonomous University of Barcelona (UAB). I3PT, Mental Health, , Spain
*Corresponding author.

Introduction:

Prevalence of autism spectrum disorders (ASD) has increased in recent years. The literature shows a high psychiatric comorbidity and use of psychopharmaceuticals although they tend to tolerate them worse than the rest of the population.

Objectives:

The main aim of this study is to investigate comorbidity and prescription of psychoactive drugs in outpatient adults with ASD.

Methods: