Communicating bad news is common in the health care sector, especially in emergency services. The importance of formal training in giving bad news in health care and the differences in the services provided by health care units in urban and rural contexts are well-documented in the literature. However, opportunities for clinicians to develop bad news communication skills provided by the distinct contexts of the health care unit in which they are included have rarely been studied. We assume that the communication of bad news is part of the service provided in emergency departments. Therefore, it can vary across rural and urban health care units.

This comparative cross-sectional study aims to test whether the location of the health care unit (rural vs. urban) has a significant impact on the communication of bad news by clinicians in emergency services.

Data will be collected through an online questionnaire based on the literature in two purposive samples of emergency health care professionals in rural and urban contexts. Qualitative and quantitative methods will be applied to analyze data regarding work features, situational context, experience, perceived knowledge and skills in providing bad news, and training needs and preferences.

Rural health care units serve populations with more health disparities and poorer outcomes than non-rural, and classically have shortage of emergency medicine trained physicians. In urban areas health units have larger and more differentiated teams. The results will be discussed in the light of the literature on discrepancies between rural and urban health care units, describing professional characteristics and experience in delivering bad news of the study participants. We expect to identify specific contextual factors associated with geographic location, institutional settings, and health professionals’ training in delivering bad news in emergency medicine.

The results of this study can aid to differentiate bad news communication trainers and health care unit managers in rural and urban areas (a) justifying the implementation of training programs, (b) adapting training programs to the audience, and (c) improving institutional facilities, practices, and policies to support adequate communication of bad news in emergency settings.

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Hostility is defined as an enduring tendency in individuals to perceive the opinions and actions of others as negative or to anticipate aggression. This study examines how the Intensive Care Unit (ICU) admission of a critically ill family member influences the hostility levels of their relatives.

This study aims to assess the hostility levels of family members of ICU patients, focusing on their sociodemographic characteristics and the closeness of their relationship to the patient.

The study included first-degree relatives, close relatives, and intimate friends of ICU patients. Data were collected via written questionnaires completed by relatives during the first week of the patient’s ICU stay. Instruments used were a sociodemographic questionnaire and the Hostility and Direction of Hostility Questionnaire (HDHQ).

A total of 223 family members (mean age: 41.5 ± 11.9 years), representing 147 critically ill patients, participated. Among the participants, 81 (36.3%) were male and 142 (63.7%) were female. The majority were the patients’ children (40.8%), siblings (19.3%), or companions (16.1%). The mean hostility scores for male and female relatives were 20.54 ± 8.16 and 19.36 ± 7.43, respectively, with no statistically significant difference (P = 0.271). However, a statistically significant difference (P = 0.030) was found between relatives living in the same household as the patient (21.38 ± 8.47) and those living separately (18.92 ± 7.13).

This study highlights elevated hostility levels among relatives of ICU patients, suggesting that hostility may fluctuate in response to external stressors such as the critical illness of a loved one. The findings support the notion that hostility, while a personality trait, may also function as an adaptive behavior influenced by situational challenges, such as those faced when a family member is admitted to intensive care.

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The challenge of loneliness underlines the need for studies that allow us to analyse and understand this phenomenon, particularly in vulnerable groups. Although loneliness can occur at any stage of life, it seems to be more prevalent during phases of transition, where changes in social relationships are frequent (Mund et al., 2020). In the younger population, a significant restructuring of social life is observed, with peer relationships becoming more central while family ties become less prominent. This often coincides with key life transitions such as change of residence, first romantic relationships, work experiences, etc. (von Soest et al., 2020). This is especially noticeable during the university stage, a period often accompanied by academic pressure due to personal, familial or societal expectations and/or needs. Furthermore, this stage is especially critical from a mental health perspective, as most mental health problems appear for the first time before the age of 25.

1) To analyse the impact that loneliness has on the student community at the Complutense University of Madrid (UCM). 2) To find out the prevalence and types of loneliness as well as its association with different problems of mental health.

This study follows a two-phase mixed-methods approach. In the first phase, two focus groups were conducted to explore the definition and characteristics of loneliness in-depth. The convenience sample consisted of 8 to 10 students per focus group from different educational levels and academic disciplines. A pre-designed guide with open-ended questions facilitated the session (e.g., “Reflecting on your university experience, what situations or experiences have made you feel lonely?”). In the second phase, a cross-sectional observational study was conducted. While we estimated a sample size of 246 participants to explore the prevalence of loneliness, we aim to obtain a representative sample of students from the UCM. The following measures were included: loneliness (frequency, type), mental health (depression, anxiety, psychotic experiences, suicidal behaviour), well-being and social relationships, academic performance, non-behavioural addictions and lifestyle. Data is being processed and analysed using appropriate statistical and qualitative analysis software. This study has received ethical approval from the participating institution.

Data from the focus groups and the online survey were compared from different educational levels and academic disciplines to explore characteristics of loneliness and mental health problems.

This study seeks to gain a deeper understanding of loneliness among university students. These findings aim to promote changes that integrate a new form of care and promotion of mental health in this group (i.e., identification, prevention and management of loneliness) as well as to encourage further research in this area.

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Burnout is characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment. Medical students are particularly susceptible to academic burnout compared to students in other disciplines, due to the demanding nature of their training, which offers limited time and resources.

Our study aimed to assess academic burnout in a sample of students from the Faculty of Medicine of Sfax, Tunisia, as well as the link between these two entities.

This was a cross-sectional and descriptive study, conducted using GOOGLE FORMS in February and March 2024, with a sample of students from the Faculty of Medicine in Sfax, Tunisia.

Data collection was carried out based on a questionnaire including an information sheet and the Maslach Burnout Inventory-Student Survey (MBI-SS) assessing academic burnout according to a three-dimensional structure : Emotional Exhaustion (EE) due to the study requirements; Cynicism (CY), which refers to a detached attitude towards one’s studies and Academic Effectiveness (AE) linked to a sense of achievement as a student.

Our study included 154 students. They were predominantly females (64.9%). Their median age was 22 years (IQR = [20 – 23 years]).

According to the MBI-SS, the prevalence of academic burnout was 98.1%.

The distribution of scores showed that academic burnout was mild in 15.9% of cases, moderate in 43.7% of cases and severe in 40.4% of cases.

The median scores on the EE, CY and AE dimensions were 17 (IQR = [13 – 20]) ; 11.5 (IQR= [7 – 16]) and19 (IQR = [15 – 23]), respectively.

The distribution of medical students according to the level of academic burnout is illustrated in Figure 1.

Our results showed that medical students experience high levels of educational burnout. To mitigate this high prevalence, it essentiel to raise awareness about its symptoms and to implement educational programs focused on mindfulness and well-being. Higher education institutions play a vital role in supporting students’ professional development and resilience by fostering a healthy learning environment and providing psychological and pedagogical support.

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In Italy, in 2000, the estimated annual economic burden of schizophrenia was 25.000 € per patient, of which 30% were direct costs and 70% indirect costs (Tarricone et al., 2000). Yet, a steep growth has been observed throughout the years: a study showed a yearly expenditure of 41.290 € per patient in 2020 (Latorre et al., 2022).

The aim of this study was to better characterize the association between direct costs and clinical and psychosocial variables in schizophrenia spectrum disorders (SSD).

A total of 276 individuals with schizophrenia spectrum disorders receiving treatment from the Community Mental Health Centers of Brescia (Italy) were included in the study: for each participant socio-demographic, clinical and functional characteristics were assessed, and data related to the use of services in 2022 (then converted to costs) were collected. Clinical and functional characteristics were assessed using the Clinical Global Impression-Severity (CGI-S) scale, the Personal and Social Performance Scale (PSP) scale and the Positive and Negative Syndrome Scale (PANSS). Correlations between the included variables were performed using SPSS v28; values of p <0.05 were considered statistically significant.

Our analyses identified a direct healthcare expenditure of 16477.23 € per patient per year. A positive correlation was observed between higher costs and higher scores at the CGI-S (p<0.001), the PANSS total (p<0.001) and all the PANSS subscales (all p<0.001). Moreover, a negative correlation between higher costs and age of onset (p=0.010) and PSP total score (p<0.001), were observed.

An earlier age of onset, a more severe clinical presentation and a worse psychosocial functioning are associated to a higher expenditure in terms of direct costs associated to use of services in SSD. These results prompt to the implementation of interventions that aim at improving not only clinical aspects, but also functional ones: a full functional recovery would not only benefit patients, but also lead to a lower impact of SSD on healthcare systems. One limitation of the present study is that the estimation of the costs was based on a direct analysis of costs related to the use of services, therefore excluding indirect costs. Future studies should include data on pharmacological treatments, comorbidities and other clinical variables central to the disorder, such as cognition.

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Attention Deficit and Hyperactivity Disorder (ADHD) affects both males and females, however, sex differences can be found in presentation, epidemiology and even influence clinical management. Male-to-female ratio is different in childhood from adulthood, meaning girls with ADHD are probably less referred to medical care and underdiagnosed. Women with ADHD have more prevalence of depression and anxiety than men. Also, fluctuating levels of estrogen and progesterone interferes in symptoms and medication response

To study sex differences regarding sociodemographic, mental health care access, and psychiatric comorbidity in a sample of patients from our ADHD outpatient clinic

We collected data from all patients who attended the Adult ADHD Outpatient Clinic of our hospital from 2017-2022 (N = 262), excluding those without written information or an ICD-11 diagnosis of 6A05 - attention deficit hyperactivity disorder (n=209). We performed a descriptive statistical analysis comparing male (n=132) and female (n=76) on sociodemographic factors, educational achievement, age of diagnosis, treatment and comorbidities

Average of age was 39,4 for females (F) and 34,3 for males(M). Levels of primary education were 5% for both, secondary education 41% F and 53% M, and tertiary education 41% F vs 37% M. 30% F and 37% M had failed at least once during their academic path. 26% F vs 25% M were students, 45% F vs 48% M were working actively and 8% F vs 15% M were unemployed. Only 8% F had an ADHD diagnosis during childhood and adolescence whether 41% of M had a history of early diagnosis and/or treatment. At least once psychiatric comorbidity was found in 75% F and 67% M, and medical comorbidities were present in 36%F and 44% M. Comorbid psychiatric diagnosis were anxiety disorders (36% F vs 26% M), depressive disorders (29% F vs 18% M), intellectual developmental disorders (5% F vs 13% M), substance abuse disorders (5% F vs 9% M), bipolar disorder (11% F vs 5% M), and autism spectrum disorders (3% F vs 5% M). In F, 75% were treated with stimulants and 11% with non-stimulants as in M 80% were treated with stimulants and 8% with non-stimulants. 37% F vs 24% M maintain follow-up, while 50% F vs 61% M abandoned it

In our study, women were less diagnosed in childhood and adolescence than men, regardless of failing in school in a similar percentage, which reflects underdiagnose in girls. Women had more percentage of psychiatric comorbidities, including anxiety, depressive, and bipolar disorders, whereas men had more prevalence of substance abuse and intellectual developmental disorders, meaning that women with ADHD are more prone to develop mood-related comorbidities than men. The percentage of follow-up abandon is also lower on women which indicates that, in spite of being less referred to medical care for ADHD, they are probably more likely to adhere to treatment

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Iimpaired cognitive functions are an urgent problem of modern neurology and psychiatry. Cognitive failure appears to be as etiologically heterogeneous syndrome, characterized by a decrease in memory indicators below the age norm, with unimpaired intellectual functioning and well-preserved activity. The wide prevalence of affective disorders and the leading role of the cognitive component in the process of personal self-development determine the undoubted relevance of studying the frequency and severity of cognitive impairment in affective disorders.

The purpose of this work was to study the cognitive impairment frequency and features in patients with generalized anxiety disorder (GAD) or panic disorder with agoraphobia (PDA).

The study included 25 patients with an established diagnosis of GAD and 20 patients PDA. The control group consisted of 20 conditionally healthy volunteers. Cognitive function was assessed based on complaints, a study of visual-constructive skills, naming, memory, attention, praxis, speech, abstraction, orientation, using the Mini-mental State Examination scale and the Montreal Cognitive Function Rating Scale. The severity of anxiety disorders symptoms was determined during a clinical interview by a psychiatrist, as well as using the Hamilton Anxiety Scale (HDRS), Beck Anxiety Scale (BAI).

All patients in contrast to the healthy participants showed signs of cognitive impairment of varying severity. When studying cognitive function, the following was found:

1. patients with PDA were characterized by mild non-dementia cognitive impairment and showed signs of rumination - a tendency to think through the same stressful event over and over again. No memory or attention impairments were identified;

2. in patients with GAD moderate cognitive impairment was observed, the severity of which was obvious to both patients and their relatives in the form of impaired attention and memory, also in the absence of signs of dementia. The spectrum of cognitive impairment manifestations included impaired attention, executive functions and memory disorders. These patients were characterized by perfectionism, decreased confidence in their own memory, anxious doubts and double-checks.

Our data indicate that in all patients with affective disorders impaired cognitive functions are detected. GAD is characterized by a greater severity of cognitive deficits compared to those in PDA.

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Borderline Personality Disorder (BPD) remains a challenging and complex disorder but it can be successfully treated.

In 2013, the first portuguese BPD specialized treatment programme was created in the Psychiatry Department at Local Health Unit of São João, becoming a very useful tool in the patients’ management.

We aim to study the influence of clinical characteristics on the duration of intervention and discharge from this BPD treatment programme.

Retrospective observational study of patients admitted to this programme until August 31st 2024. Descriptive analysis of the results was performed using the SPSS software, version 29.

A total of 157 BPD patients were admitted to this programme, 154 (98%) of which are female. These patients had a mean age of 24,6 years old, when they engaged in the programme. During the follow‑up 39% have abandoned the programme, and 27% have been discharged due psychotherapeutic stabilization.

We will also present results related to association between clinical factors (namely previous diagnoses and history of use of substances) and the duration of the intervention/discharge plan, in order to know if our results are consistente with the ones from another centers where comorbidity with eating disorders and cocaine use disorder were clinical variables predictors of shorter duration of the intervention.

Understanding the influence of clinical factors and their impact on intervention is essential to enhance this challenging programme to improve the treatment of BPD patients.

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Depression is a major concern in patients with chronic heart failure (CHF), with a prevalence of approximately 20-40%. It has been linked to worsened outcomes, including mortality and significant declines in physical and social functioning. Understanding the relationship between depression and hemodynamic as well as lipid metabolism parameters in CHF patients can provide insights into the underlying mechanisms of these worsened outcomes.

This study aims to evaluate the correlation between depression and central hemodynamic and lipid metabolism parameters in patients with chronic heart failure (CHF).

The study involved 80 patients with CHF II-III NYHA classes caused by chronic coronary artery disease. They were divided into two groups: 20 without signs of depression and 60 with depression, as diagnosed using the Zung Self-Rating Depression Scale, Beck Depression Inventory, and Hamilton’s Depression Scale. Hemodynamic parameters were assessed using echocardiography (EchoCG), and lipid levels were measured in blood plasma. Statistical analyses were performed using t-tests, Mann–Whitney U tests, and correlation coefficients to determine relationships between variables.

Depressive symptoms were prevalent in 71.6% of the CHF patients, with severe depression observed in 3.3%. Significant correlations were found between depression severity and blood pressure, triglyceride levels (r = 0.7, p < 0.05), and key echocardiographic measures such as left atrium diameter (r = 0.57, p < 0.05), end-diastolic size (r = 0.53, p < 0.05), and ejection fraction (r = -0.29, p < 0.05). Additionally, situational anxiety was significantly correlated with serum urea levels (r = 0.42, p < 0.05), triglycerides (r = 0.91, p < 0.05), and echocardiographic parameters.

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Patients with CHF and depression exhibit more severe central hemodynamic and lipid metabolism disorders than those without depression. These findings suggest that addressing depression in CHF management may mitigate some of the adverse effects on cardiovascular health.

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Patient-Initiated Brief Admission (PIBA) is an intervention designed to provide constructive crisis management for patients. The purpose of this study was to evaluate outcomes in healthcare utilisation and self-inflicted injuries at one Swedish Hospital where PIBA was implemented in late 2017.

Patients who signed a PIBA-contract between 2017 and 2023 were included in the study. Data on inpatient care, contacts with the psychiatric emergency department and self-inflicted injuries that resulted in contact with medical care were collected from patients’ medical records. Effects of PIBA were assessed using paired t-tests, comparing pre-post changes 0.5, 1 and 2 years, from initiation of PIBA-contract, respectively.

Data from a total of 38 patients were analysed. There was a marked decrease in inpatient care from voluntary admissions in the first six months after initiation of PIBA. There was also a significant decrease in number of contacts with the psychiatric emergency department (for all patients) in the 1-year pre-post comparison, but not for the 0.5- and 2-year pre-post comparisons. There were no significant reductions in compulsory inpatient care or self-inflicted injuries in our cohort. Patients with contracts extending over several years appeared stable, on average, in their use of care and prevalence of intoxications.

The main effect on inpatient care after initiation of PIBA was a reduction in voluntary admissions, coinciding with a shift from voluntary admissions in favour of PIBA. The results support a more widespread utilisation of PIBA from a health-economic perspective.

Treatment-resistant schizophrenia (TRS) develops in ˜30% of patients, resulting in higher hospitalization rates, morbidity, mortality, and suicidality, and increased costs (Pompili et al CNS NDDT 2017; 16 870-884). Despite inconsistent findings of its efficacy, antipsychotic polypharmacy (APP) is frequently prescribed in an attempt to treat refractory symptoms (Correll ClinNorthAm 2012; 35 661-681). While marketed APs all act through the modulation of 5HT/DA transmission, clozapine, the only drug approved for TRS, seems to act on multiple receptor systems (Brunello et al NPP 1995; 13 177-213). The need to modulate non-monoaminergic targets is supported by findings of excessive glutamatergic activity, rather than increased dopamine synthesis, in patients with TRS (Demjaha et al BioPsy 2014; 75 11-3). Evenamide, devoid of biological activity at >150 CNS targets, is able to normalize excessive glutamate release without affecting basal levels. Evenamide has demonstrated benefits in several animal models of psychosis (monotherapy and add-on to AP). Benefit of evenamide as add-on was demonstrated in a phase 2, open-label trial (Anand et al IJNPP 2023; 174 216-229) and in a phase 2/3 randomized, double-blind study in patients not responding adequately to SGAs.

Evaluate the efficacy, safety, and tolerability of evenamide 30 mg bid as add-on treatment in patients with documented TRS receiving AP treatment but not adequately benefitting from a stable therapeutic dose.

This is a prospective, potentially pivotal, phase 3, randomized, double-blind, placebo-controlled, 1-year international study, with a primary efficacy endpoint at 12 weeks and long-term efficacy endpoints at 26 and 52 weeks. Eligible patients must have a diagnosis of TRS according to the TRRIP consensus guidelines (Howes et al AmJPsy 2017; 174 216-229). During the 6-week screening period and throughout the study, adherence to background AP(s) and evenamide will be confirmed through measurements of plasma levels. Selection criteria include CGI-S of mildly to severely ill (3-6); BPRS total score ≥45, with a score ≥18 on core symptoms of psychosis, and PANSS total score ≥70. An Independent Eligibility Committee will determine patients’ eligibility. Patients improving ≥20% on the BPRS or ≥1 category on the CGI-S during the screening period will be excluded. Efficacy (PANSS, CGI-S/C, Q-LES-Q-SF, PSP scales) and safety (vital signs, ECG, lab tests, physical/neurological/eye exams, ESRS-A, CDSS, C-SSRS) will be evaluated at regular intervals.

Results from this study will determine whether addition of evenamide 30 mg bid to APs is associated with clinically important benefit in TRS patients.

Positive results would support the role of glutamate modulators for the optimal treatment of TRS.

R. Anand Consultant of: AbbVie, Acadia, BiolineRx, Domain, Enkam,Erydel, Forest, Janssen, Hoffman La Roche, Lundbeck, Noema, Ono, Pfizer, UCB, Shire, Sigma-Tau, Takeda, Teva, A. Turolla Employee of: Newron Pharmaceuticals SpA, G. Chinellato Employee of: Newron Pharmaceuticals SpA, R. Giuliani Employee of: Newron Pharmaceuticals SpA, F. Sansi Employee of: Newron Pharmaceuticals SpA, R. Hartman Employee of: Newron Pharmaceuticals SpA

The electronic cigarette (EC), invented in 2006, represents a recent phenomenon that is increasingly discussed especially in healthcare environment. Beliefs regarding this form of consumption are very diverse.

This study aims to assess the perception of young doctors towards EC consumption.

An online survey had been conducted inspired from the French health barometer (2017). Data were collected through an anonymous questionnaire using Google Forms. The recruitment of participants was based on social media platforms combining young doctors.

A total of 203 young doctors had responded to the questionnaire. Most of participants were female (71%) with a mean age of 25.64 ± 2.64 years. More than half (60%) were resident doctors. Non-smokers represent 79.3% of our population. At the time of the survey, only 14 subjects (6.9%) had used EC or experienced vaping. The evaluation of perceptions with regard to vaping had showed that 30% of participants disagreed with the fact that EC consumption represents a measure to promote the cessation of tobacco use and 82% hadn’t recommended it to their patients. A proportion of 47.3% thought that vaping is as harmful as smoking and 60% agreed that e-cigarettes may contain toxic chemicals. More than half (51.6%) almost agreed that vaping may encourage ex-smokers to become nicotine addicts.

We may conclude that EC represents for young doctors an emerging form of consumption that is not a safe or healthy alternative to smoking.

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Work-related hand injuries can lead to significant physical impairments. However, their psychological impact is often underestimated. Mental distress, including anxiety, depression, and post-traumatic stress, may arise following such injuries, potentially hindering recovery and affecting both professional and personal life. Given the critical importance of hand function in daily tasks and occupational roles and the prevalence of hand injuries, addressing their psychological dimension is crucial.

This study aims to evaluate mental distress among individuals with work-related hand injuries (WRHI) and to identify the associated factors.

We conducted a cross-sectional study, between January 2021 to December 2022, involving private sector workers, victims of WRHI. Data were collected using a pre-established questionnaire that covered sociodemographic and professional characteristics, details of the occupational accident, and medical information. Psychological distress was assessed using the Kessler Psychological Distress Scale (K6), and functional disability of the hand was evaluated using the Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) score.

Our study included 136 workers, with a male-to-female ratio of 7.5. The average age was 41.2 ± 10.9 years, and the average body mass index (BMI) was 26.48 ± 4.4. Blue-collar workers made up 77.9% of the sample (n = 106). In 61.8% of cases, the injury involved the dominant hand. The median of time to return to work was 101.5 days (interquartile range (IQR) [67; 182.5]). Twenty-five participants (18.4%) reported discrimination at the workplace. The median of the Quick DASH score was 34.1 (IQR [13.6; 52.3]). The median K6 score was 8 (IQR [4; 15]), with 42 participants (30.9%) experiencing moderate psychological distress and 45 (33.1%) reporting severe psychological distress. The K6 score showed a significant correlation with the Quick DASH score (p < 0.001, r = 0.297), BMI (p = 0.031, r = 0.185), and time to return to work (p = 0.005, r = 0.241). Those with injuries to the dominant hand had higher K6 scores compared to those with non-dominant hand injuries (p = 0.043). Furthermore, the K6 score was associated with reports of workplace discrimination following the accident.

Work-related hand injuries not only lead to physical impairments but also have a considerable psychological impact. These findings highlight the importance of comprehensive rehabilitation programs that address both the physical and psychological aspects of recovery to improve outcomes and support reintegration into the workforce.

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Major Depressive Disorder (MDD) represents a significant challenge for global public health, profoundly affecting social and economic well-being. It is estimated that around 30% of patients do not respond to standard therapies, being classified as Treatment-Resistant Depression (TRD) patients. Intranasal ketamine emerges as a promising therapeutic option for these patients.

The objective of this study is to analyze the actual clinical use of intranasal esketamine in a sample of patients with treatment-resistant depression (TRD).

A descriptive study of different socio-demographic and clinical variables was conducted to analyze the profile of TRD patients treated with intranasal ketamine in the Vigo Health Area.

A study was conducted on 33 TRD patients (48% women), with an average age of 52.77 years. In the current episode, it was observed that 24.2% had received electroconvulsive therapy and 41.7% had experienced at least one psychiatric admission. Additionally, 66.7% had visited the emergency room for psychiatric reasons, while 50% presented with comorbid anxiety, 15% with obsessive-compulsive personality disorder, and 21% with fibromyalgia.

The analysis showed that 88% of the participants had failed at least six lines of treatment, with an average of 4.18 concomitant treatments at baseline. The response to intranasal ketamine was evidenced, for the most part, in the second week of treatment, with a notable increase in the use of the 84 mg dose. In 60% of patients, the induction period was set at 4 weeks and a decrease in MADRS scale scores was observed at weeks 4, 8, and 12. No adverse effects were reported that had not been previously recognized in clinical trials. Adverse effects were rare and mild.

The study indicates that patients presented with highly complex depression, which explains the prolonged induction periods. The good tolerability of ketamine has facilitated a rapid increase to 84 mg dosage in most cases. Although this sample does not align completely with the typical profile of patients who respond well, intranasal ketamine was effective in 70% of cases, similar to the findings of clinical trials. It is suggested that the accumulated knowledge about the drug has contributed to these clinical improvements. Additionally, a more flexible approach has helped patients with low expectations of response.

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Rates of mental health disorders in resettled refugees surpass those of the host population (Hameed et al, KJM 2018;11 20-23). However, most studies suggest heterogenicity between populations, suggesting a need for a non-generalized approach to resettled-refugee mental health (Silove et al, World Psychiatry 2017;16 130-139). Since the Taliban assumed control in August 2021, the United States has taken in about 90,000 Afghan refugees (Green, Wilson Center 2023), 15,000 have settled in Houston, Texas (Schneider, Texas Standard 2023).

This study investigates factors that may predict higher rates of distress and symptoms of PTSD and depression within an Afghan refugee community resettled in Houston, Texas.

Seventy-four Afghan refugees located in Houston, Texas were surveyed for demographic information and physical or emotional symptoms as directed by the Refugee Health Screener-15 (RHS-15). An average score of ≥ 12 on the RHS-15 or a self-reported distress score ≥5 indicated a positive result on the screening tool. Mann-Whitney and Fisher’s exact tests were used to compare differences in patient baseline characteristics and responses stratified by a positive RHS-15 or distress screen. Spearman’s Rank Correlation Coefficient was used to assess the correlation between selected response variables and outcomes as well as between the RHS-15 and distress scores.

40% of subjects scored ≥12 on the RHS-15 and 35% indicated a distress score ≥ 5. Income differed significantly between the RHS <12 group and the RHS ≥12 group (p=.02). The RHS <12 group had a higher proportion of individuals in the lowest income bracket, < $10,000, and a greater proportion in the $20,000-$30,000 bracket. Meanwhile, the RHS ≥12 group had a higher proportion in the $10,000-20,000 income bracket. There was a negative correlation between self-reported health scores with both RHS-15 score (ρ=-.508, p<.001) and distress score (ρ=-.423, p=.001) as well as between neighborhood support levels and distress scores(ρ=-.314, p=.018).

This Afghan refugee cohort shows theoretical rates of PTSD and MDD higher than the average American (40.3% RHS-15 score vs. 3.6% PTSD and 8.3% MDD) (NIH 2023). The increased risk of mental disorder may be attributed to lower perceived community support, poor physical health, and low socioeconomic status. If income growth is a function of increased time spent in the United States, the unique pattern in income between the two RHS groups may reflect a “honeymoon period” that has previously been demonstrated in studies on migrants and culture shock (Maillet et al, APMH 2023; 50 563–575). Following this honeymoon period, however, lower income may predict worsened mental health in resettled refugees. These results support multi-factorial initiatives to support resettled refugees especially in areas of community interconnectedness, health and economic support.

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Drug resistance is a major clinical challenge in psychiatry, with limited understanding of influencing factors. Personality traits and psychopathological symptoms may contribute to drug resistance, affecting treatment response to standard interventions.

This study aims to assess whether personality traits, mainly neuroticism and extraversion, and psychopathological symptoms correlate with drug resistance profiles in clinically stable patients with severe mental disorders.

The study included 36 outpatients (17 males, 19 females) consecutively treated at the Mental Health Centre of Rieti, Italy. Patients were diagnosed with Major Depressive Disorder (39%), Bipolar Disorder (25%), Schizophrenia (28%), and other diagnoses, including Obsessive-Compulsive Disorder (8%). Drug resistance was defined as a lack of response to previous antidepressant treatments, requiring either dual antidepressant therapy, add-on therapy with a tricyclic or lithium, or a lack of response to atypical antipsychotic treatments, necessitating either dual atypical antipsychotic therapy, the addition of a typical antipsychotic, or the prescription of clozapine. Mann-Whitney U tests were used to compare 11 patients with a drug resistance profile to the remaining 25, and stepwise logistic regression was conducted to assess the association between drug resistance (dependent variable) and study variables, including the Brief Psychiatric Rating Scale (BPRS), Eysenck Personality Questionnaire factors (e.g., extraversion, neuroticism), and Global Assessment of Functioning (GAF) scores. The local ethics committee approved this study (Protocol No. 0948/2023).

Mann-Whitney U tests revealed significant differences between groups in total BPRS scores (p = 0.032) and the BPRS Negative Symptoms subscale (p = 0.001), with higher scores in the drug-resistant group. GAF scores also differed significantly (p = 0.022), with lower scores in resistant patients. Logistic regression showed that extraversion had a significant negative association with drug resistance (β = -0.803, p = 0.033), suggesting higher extraversion is linked to reduced resistance. The BPRS Negative Symptoms factor had a significant positive association (β = 0.467, p = 0.026), while Positive Symptoms showed a trend toward a positive relationship (β = 0.508, p = 0.059). The final model explained a substantial proportion of variance (McFadden’s R² = 0.543) and improved over previous models (ΔΧ², p = 0.042).

Extraversion negatively correlates with drug resistance profiles in clinically stable patients with severe mental disorders. BPRS negative symptoms are positively correlated with resistance, and positive symptoms show a similar trend. This study highlights the importance of personality and psychopathological aspects in treatment response and the need for personalized interventions for patients with drug resistance.

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