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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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

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.

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.

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

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.

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.

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.

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.

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.

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 (r_S = 0.760) and the propensity to excessive seizure of computer games (r_S = 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.

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.

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.

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.

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 (F_1,41=6.0,p=0.019) and sensation-seeking traits (F_1,42=36.7,p<0.001) and demonstrated normal sensitivity to monetary value (F_1,41=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 (F_1,41=2.6,p=0.112) but showed less motivation to work towards financial reward (F_1,41=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.

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

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(1^st 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.

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.

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.

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

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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).

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.

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.

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.

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.

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.

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

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

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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

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.