Schizophrenia is a severe, chronic mental disorder, with about one-third of patients failing to achieve remission. Its multifactorial etiology includes a strong genetic component that remains insufficiently understood. Dysregulation of dopaminergic and glutamatergic neurotransmitter pathways has been implicated in the development of schizophrenia, as revealed through neuromorphological, molecular, pharmacological, and pharmacogenetic studies. Recent research has expanded this focus to include neuroinflammatory mechanisms and metabolic pathways, emphasizing the fine regulation of these neurotransmitter systems. Among these, adenosine has gained attention for its potential role in the pathophysiology of schizophrenia.

This literature review aims to explore the role of adenosine in schizophrenia, its connection to dopaminergic and glutamatergic hypotheses, and broader implications for the development of symptoms and complications.

A comprehensive review of studies investigating adenosine’s neuroregulatory, inflammatory, and neuromodulatory functions.

The adenosine hypothesis suggests that reduced adenosine activity plays a critical role in the development of schizophrenia symptoms. Adenosine regulates dopaminergic and glutamatergic neurotransmission via ADORA A1 and ADORA A2 receptors. Studies have shown changes in adenosine receptors, transporters, and enzymes involved in adenosine metabolism in individuals with schizophrenia. Moreover, adenosine’s neuroprotective role, particularly in stress and inflammation, connects it to the dopaminergic/glutamatergic systems and the broader neurodevelopmental “two-hit” hypothesis, suggesting that schizophrenia develops through a combination of genetic vulnerability and environmental factors. A study by Ary Gadelha and colleagues proposed a link between hypo-adenosine states and the increased risk of sudden cardiac death in schizophrenia patients, indicating the broader systemic importance of adenosine dysregulation in these individuals.

Adenosine appears to be a potential modulator in the pathophysiology of schizophrenia, connecting various neurotransmitter pathways and influencing genetic vulnerabilities, neuroinflammation, and cardiovascular risks. Further research into adenosine-related mechanisms could offer valuable insights into early interventions, improving treatment outcomes and potentially reducing complications such as treatment resistance and sudden cardiac death in schizophrenia patients.

References

Lara DR, Souza DO. Schizophrenia: a purinergic hypothesis. Med Hypotheses. 2000;54(2):157-166. doi:10.1054/mehy.1999.0003

Boison D. Adenosine as a neuromodulator in neurological diseases. Curr Opin Pharmacol. 2008;8(1):2-7. doi:10.1016/j.coph.2007.09.002

Fredholm BB, Chen JF, Cunha RA, Svenningsson P, Vaugeois JM. Adenosine and brain function. Int Rev Neurobiol. 2005;63:191-270. doi:10.1016/S0074-7742(05)63007-3. PMID: 15797469

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The EPA acknowledges both the therapeutic potential of psychedelic substances and the challenges for both research and clinical implementation. Steps need to be taken towards a well-balanced policy based upon sound scientific evidence and research, aiming at safe, ethical responsible integration of psychedelic therapy available for all patients who can potentially benefit. In the EPA policy paper the importance of the psychosocial components of the treatment as well as the ethical and professional aspects playing a role in real-world implementation, are highlighted. Four recommendations are formulated for further research and clinical implementation.

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While various fields and work areas have been impacted due to COVID-19, undergraduate students appear to have compounded stress. We sought to investigate the variables that predict meaning in life for Omani college students during the COVID-19 pandemic.

This study investigated the personal and academic factors associated with the presence and search for meaning in life among college students in Oman.

A cross-sectional study was conducted in April 2021. A self-reported survey comprising the Meaning in Life Questionnaire (MLQ) and a sociodemographic questionnaire was completed by 970 students at the National University of Science and Technology in Oman. We used multiple linear regression to explore the independent predictors.

Compared with engineering students, medical students were found to have a higher degree of both the presence of meaning in life as well as the search for meaning in life (p-value 0.001), and with each advancing academic year, the presence of meaning in life was found to be lower (p-value = 0.002). Students with chronic physical disease had a lower degree of presence of meaning in life and a lower degree of search for meaning in life (p = 0.001) compared with those without chronic disease. In addition, mental illness was associated with a lower degree of presence of meaning in life (p-value 0.001) and financial strain was associated with a lower degree of presence of meaning in life (p-value = 0.001).

In conclusion, no prior research demonstrated higher levels of meaning in life among medicine major students compared to those in engineering or pharmacy majors. Moreover, other academic, socio-economic, and health-related factors correlated with individuals’ sense of meaning & search in life. Therefore, psychologists and psychiatrists should consider these diverse factors when designing interventions to support individuals in exploring and enhancing their meaning in life, considering their unique needs and contexts.

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Social media has become a powerful influence on adolescent body image. Platforms like Instagram and TikTok, which focus on appearance, often promote idealized body standards, leading young users to internalize unrealistic beauty ideals. This has resulted in increasing body dissatisfaction and negative mental health outcomes, as adolescents seek validation through likes and comments.

This review examines how social media exposure affects body image and emotional wellbeing in adolescents, particularly whether it contributes to negative outcomes like low self-esteem, body dissatisfaction, and mental health issues.

A review of international studies published in the last five years was conducted using PubMed and Google Scholar. Search terms included “social media,” “body image dissatisfaction,” “mental health,” and “adolescents.” A total of 26 studies that met the criteria were analyzed.

social media, body image dissatisfaction, adolescents, mental health, eating disorders, self-esteem, COVID-19

The studies consistently revealed a strong link between frequent social media use and negative body image. Both male and female adolescents reported increased body dissatisfaction, though most studies focused on females. Social media exposure was also linked to higher risks of eating disorders and a drive for thinness.

Frequent users of appearance-focused platforms experienced reduced self-esteem and heightened levels of anxiety and depression, with social comparison behavior worsening these effects. Adolescents’ body image was further influenced by peer and parental validation, with peer approval playing a critical role in shaping their self-perception. The negative impacts of social media were particularly exacerbated during the COVID-19 lockdown due to increased isolation.

Social media platforms centered on appearance have a significant negative impact on adolescents’ body image and mental health. These findings highlight the need for interventions promoting media literacy, critical social media engagement, and support from parents and educators to mitigate these effects.

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Obsessive-compulsive disorder (OCD) is a chronic condition that frequently co-occurs with mood disorders such as major depressive disorder (MDD) and bipolar disorder (BD), complicating both prognosis and treatment. The presence of MDD or BD in OCD patients is associated with more complex clinical presentations and worse outcomes.

Despite the high prevalence of these comorbidities, few studies have thoroughly compared the traits and states of OCD patients with comorbid mood disorders. This study aims to explore the differences in traits and states among OCD patients with comorbid mood disorders, including MDD, bipolar disorder I (BD1), and bipolar disorder II (BD2).

The study included 114 OCD patients: 21 without mood disorders, 32 with MDD, 47 with BD2, and 14 with BD1. Demographic variables such as family history of psychiatric disorders and history of pharmacological treatment for OCD were analyzed. Participants were evaluated using standardized tools such as the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A), Obsessive-Compulsive Inventory (OCI), Depressive Symptom Inventory Suicidality Subscale (DSI-SS). Statistical analyses including one-way analysis of variance (ANOVA) and chi-squared tests were conducted to identify significant differences between groups.

Patients with comorbid bipolar disorder (BD), particularly those with BD1, had a significantly higher prevalence of psychiatric family history (85.7%, p = .031). Pharmacological treatment for OCD was less frequent in patients with BD, with the lowest rate in the BD2 group (61.7%, p = .008). Compared to patients without mood disorders or those with MDD, OCD patients with BD showed higher scores in several temperament dimensions, including cyclothymic temperament (p < .001), depressive temperament (p = .007), hyperthymic temperament (p = .006), anxious temperament (p < .001), and irritable temperament (p < .001). These patients also exhibited more severe depressive symptoms (p < .001), higher anxiety levels (p < .001), and greater suicidality (p = .002). Obsessive-compulsive symptoms, particularly neutralizing behaviors (p = .010), ordering behaviors (p < .001), and hoarding behaviors (p < .001), were more pronounced in the BD groups.

OCD patients with comorbid BD show distinct clinical profiles compared to those with MDD. They have a stronger genetic predisposition to psychiatric disorders and are less likely to receive pharmacological treatment for OCD. These patients also experience more severe depressive symptoms, anxiety, and obsessive-compulsive traits, complicating treatment. The findings highlight the need for comprehensive evaluations and personalized treatment plans for OCD patients with mood disorder comorbidities.

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Major depressive disorder (MDD) is a very common and debilitating disorder. MDD accounts for 4.3% of the global burden of disease, is among the largest single causes of disability worldwide, and is an important cause of premature death. Depression expands its negative influence in all aspects of life, being estimate that 12 billion productive workdays are lost every year to depression and anxiety.

On top of that, non-response to first line pharmacological and psychotherapeutic treatments are substantial, with treatment-resistant depression (TRD) affecting approximately one third of these patients. These patients are thus candidates for non-invasive neuromodulation procedures such as repetitive transcranial magnetic stimulation (TMS), included in all major treatment guidelines.

With this work we intend to present a descriptive analysis of the efficacy of the intermittent theta burst TMS (iTBS) protocol in patients with TRD who underwent this treatment at Hospital de Magalhães Lemos, Porto, since July 2022.

We conducted an analysis of sociodemographic characteristics of patients who underwent treatment with iTBS. The primary outcome was the Beck’s Depression Inventory (BDI) score difference between the first and last sessions. Secondary outcome included the Montgomery-Asberg Depression Rating Scale (MADRS) applied to a smaller cluster of patients.

Since July 2022, more than 50 cycles of iTBS treatment have been performed.

More than 60% of the TRD patients enrolled scored positive changes with the treatment, on BDI. Improvements exceeded non-response in both sexes, irrespective of disease duration, and in nearly all age groups – except for the single patient under 25 years old. Positive changes were also observed with the MADRS, with more than 70% of this cluster of TRD patients scoring positive changes, including the patient under 25 years old who score non-response with BDI.

iTBS was also applied to a small number of patients diagnosed with treatment-resistant bipolar major depression, in whom positive changes outweighed non-response.

All iTBS cycles were performed without major adverse effects being reported.

TMs, represented here by the iTBS protocol, is safe and effective in improving depressive symptoms when first line treatments are not. The positive effects extend to patients diagnosed with BD, despite the small number of patients present in our patient pool.

Combined with the logistical ease of its use, not requiring general anaesthesia or induction of seizures like electroconvulsive therapy, TMS presents itself as an important alternative in the treatment of TRD.

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Acute confusional state is usually the main diagnosis we encounter in hospitalized older adults. Its incidence increases in parallel with age. Often underdiagnosed. The main characteristics are alteration in the level of consciousness and/or attention, cognitive impairment (disorientation or reduction in memory), relatively rapid onset and fluctuations. As clinical manifestations there is usually disorganization of thought, perceptual disorders, hyper or hypoactivity, alteration of sleep rhythm and alteration of mood.

Behavioral and psychological symptoms of dementia (BPSD) describes a heterogeneous group of behavioral or mood disturbances, such as agitation, anxiety, depression, psychosis, or sleep disorders. They are universal and are present in dementia of any etiology and can be observed in any phase of the disease. They are considered multifactorial and are characterized by a recurrent or sporadic course.

68-year-old female patient who went to the hospital due to the presentation of symptoms that had been going on for 3 months (memory lapses, insomnia and irritability) that had intensified in recent days, leading to the appearance of visual hallucinations, episodes of disconnection from the environment, their language becomes impoverished and a disintegrated and incoherent speech appears with difficulty in naming.

Propose differential diagnosis between confusional syndrome and psychological and behavioral symptoms of dementia.

Analytical: elevation of acute phase reactants.

Cranial CT: no findings that justify the diagnostic suspicion.

Neurology: despite the sudden onset of the symptoms, they rule out performing LP, given the unremarkable nature of the rest of the complementary tests.

It was decided to admit him to mental health to study the condition. The evolution is characterized by a fluctuating picture while the acute phase reactants begin to gradually increase, D-Dimer: 5500 and an ECG with an S1Q3T3 pattern. CT angiography is requested (ruling out PET)

Finally, after evaluation by neurology in which new analysis is requested along with urine and culture (+ for C.Glabrata) due to fever peak, lumbar puncture and cranial MRI (small acute ischemic lesions). Finally, it was decided to admit him to neurology with targeted treatment, resulting in resolution of the condition.

Confusional syndrome with a subacute course of etiology under study.

BPSD of dementia are multifactorial and include different neurobiological factors, as well as environmental, social and psychological factors. They generally have a recurrent or sporadic character and can appear in all phases of any type of dementia, although they do not usually occur acutely. Therefore, it is important not to lose sight of carrying out complementary tests and a multidisciplinary approach, given that psychopathology of acute-subacute onset should not make us forget to rule out an acute confusional state.

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Charles Bonnet syndrome, first described by Charles Bonnet in 1760, is characterized by visual hallucinations in cognitively normal patients who are typically elderly and often visually impaired.

This case has been evaluated as a typical Charles Bonnet syndrome characterized by multisensory hallucinations (visual, auditory, olfactory hallucinations) observed in a patient with NF-2 diagnosis. In this respect, this case analysis might make an important contribution to the literature, as it might expand the understanding of CBS in the context of complex neurological disorders. Consideration must be put into the possibility of associating the patients’ multisensory hallucinations with organic pathology due to the presence of occipital and temporal meningiomas.

In this section, data obtained from our own case will be included. Additionally, a literature review was conducted using PubMed, restricting the search to studies published between 2014 and 2024. The search term “Charles Bonnet Syndrome” was used to identify relevant articles. Furthermore, a detailed anamnesis of the disease process was obtained from the patient’s mother.

A 31-year-old female first presented to our psychiatry outpatient clinic in July 2024, with her relative reporting a diagnosis of neurofibromatosis type 2. It was documented that the patient underwent surgery in November for diffuse meningiomas (both supra- and infratentorial, involving the temporal and occipital regions). Also, the patient experienced total hearing loss due to vestibular schwannomas in the right region and suffered from visual loss during the pre-operating period. She reported a distressing increase in the acute perception of the smell and taste of food and beverages. Her first psychiatric examination was conducted postoperatively. Olanzapine 2.5mg/day was commenced as a treatment for relative auditory and olfactory hallucinations, and the dose of the drug was gradually increased to 10mg/day. The final examination was conducted on August 26, 2024. According to reports from the patient’s relatives, there was a noted decrease in the frequency and intensity of the hallucinations. Throughout the medical examinations, communication with the patient was partially facilitated using tactile cues.

A typical Charles Bonnet syndrome is a disorder characterized by visual loss accompanied by visual hallucinations. In this case, olfactory, auditory and alpha-factor hallucinations that developed after visual and hearing loss were detected and resulted in the involvement of more than one sensory organ, shedding light on the current literature. In this case, the fact that the person already had neurofibromatosis type 2 disease further complicates the etiology of these symptoms and requires detailed follow-up and treatment.

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It is well established that user behavior does not align with clinical recommendations regarding using medication in psychotic disorders, particularly bipolar disorder (BD). Nonadherence to treatment carries a high risk of relapse due to the recurrent nature of the illness and is influenced by multiple factors

The aim of this study is to investigate the prevalence of medication adherence among BD patients and to explore the various factors contributing to poor adherence.

This cross-sectional, descriptive, and analytical study was conducted with patient diagnosed with bipolar disorder at the Psychiatry “A” Department of Hedi Chaker University Hospital. Data on clinical and sociodemographic variables were collected between March and September 2023 using a questionnaire, alongside the Medication Adherence Rating Scale (MARS) to evaluate treatment adherence.

A total of 37 patients with BD completed the questionnaire. The mean age was 45.4 ± 13.9 years, with a sex ratio (M/F) of 1.46.

In this study, 73 % of patients had BD type I and 27% had BD type II.

The mean MARS score was 7.14 ± 2.13 and 62.2% were adherent to their treatment.

Only 16.2% of bipolar patients discontinued their medication due to side effects, while 51.4% present unintentional poor adherence.

A significant association was found between treatment adherence and socio-economic status (p = 0.05).

The MARS score was negatively correlated with the number of hospitalizations (p = 0.05, r = -0.315)

This study highlights that treatment adherence in bipolar disorder is influenced by various factors, with socio-economic status being a significant determinant. The negative correlation between MARS scores and the number of hospitalizations suggests that better adherence is associated with fewer hospitalizations. Improving treatment compliance is crucial to reducing the risk of recurrence and hospitalization in BD.

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Unaccompanied Migrant Minors (UMMs) who travel alone and live apart from their families are particularly vulnerable to mental health issues and social exclusion in Spain. Risk factors related to the migratory cycle, including travelling alone, living away from family, and experiencing discrimination, can negatively impact their mental health and increase the risk of social exclusion.

This study aims to describe the profile of newly arrived UMM and identify the relevant health risk factors among them, considering factors before, during, and after migration and their impact on psychological distress.

The study involved face-to-face interviews with 230 minors in foster care placements. The interviews covered sociodemographic information, education and employment situations, factors related to the migratory process (before, during, and after migration), health status, and psychological distress. They were conducted in Arabic or French and translated into Spanish.

The findings revealed that UMMs generally perceived themselves as having good health before migration. However, they often held unrealistic expectations about their new life. Upon arrival, they had to cope with post-migration stressors such as stress (β = 0.468, SE = 0.142, p = 0.001) and discrimination (β = 0.357, SE = 0.121, p = 0.003), which adversely affected their mental health.

The study highlights the impact of post-migration factors on psychological distress among newly arrived UMM. It underscores the need for comprehensive mental health care that considers the different stages of the migratory cycle. Additionally, it advocates for promoting cross-cultural mental health care models and developing policies and services to address and mitigate the effects of post-migration factors, including discrimination against UMMs in Spain.

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Selenium seems to have the ability to alleviate inflammatory signaling path-ways. Obesity is associated with chronic low-grade inflammation. Depression is also defined as an inflammatory disorder. PPAR-γ has been shown to have antidepressant-like effects The levels of inflammatory cytokines that are parameters associated with obesity―are also related to the severity of depression. Studies confirm an increased risk of depressive symptoms in middle-aged women. Therefore, it seems reasonable to consider the influence of selenium, PPAR-γ, and selected proinflammatory cytokines in the context of obesity and depression among middle-aged women.

The aim of this study was to evaluate the effect of serum selenium on PPAR-γ and selected proinflammatory cytokines (IL-1β, IL-6, TNF-α) in relation to depressive symptoms and obesity in middle-aged women.

The study sample included 443 middle-aged women living in north-western Poland. The research procedure: a survey performed using the authors’ questionnaire and the BDI, anthropometric measurements, and analysis of blood for the levels of selenium, cytokines, and genetic analysis of the PPAR-γ polymorphism.

It has been found that BMI increases along with the concentration of IL-6. No moderating effect of selenium was observed, although cut-off values for “p” were established for IL-β*Se (p=0.068) and IL-6*Se (p=0.068), so there is a potential association with these two markers. At high selenium levels, the effect of higher IL-β levels on a decrease in BMI was stronger. So was the effect of an increase in IL-6 levels on an increase in BMI.

No effect of selenium on PPAR-γ has been found in relation to depressive symptoms and obesity. 2. Higher selenium levels may have a beneficial effect on BMI even at high IL-β concentrations, however, at high IL-6 concentrations, this effect was not observed. 3. Selenium levels had no impact on depressive symptoms.

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Sexual violence is considered to be one of the most traumatic, pervasive, and common human rights violations. In Tunisia, there is limited research about this issue.

The present study aims to explore the relationship between sexual violence and mental health in Tunisia, with a focus on understanding the prevalence and types of mental health problems experienced by victims, as well as different factors related to it.

This is a descriptive cross-sectional study that took place over six months from September 2022 to March 2023. Data collection was carried out using an online self-administered questionnaire distributed online. It is composed of 24 questions with “restricted” answers in the form of propositions. Each participant was invited to fill out the sociodemographic and clinical data form, the Harvard trauma questionnaire and the Hopkins symptoms questionnaire.

86.1% of our participants reported that they were subjected to a form of sexual aggression. Including 95.5% female, 4% male, and 0.5% non-binary. The median reported age of the first sexual aggression was 14 years. Our study found no significant correlation between age and trauma outcomes. Participants who reported sexual aggression were more likely to have scores above the cutoff for both the Harvard PTSD score and the Hopkins Symptoms Checklist scores. No statistically significant difference was found in the comparison of scores across genders. Participants with a past medical psychiatric history had a significantly higher average Harvard PTSD score as well as Hopkins symptoms checklist scores compared to those without this history. 35.5% of our participants chose not to disclose their traumatic experience to anyone. Notably, 34% of disclosures were made to friends and 22% to family members. The study found no statistically significant difference in the scores for post-traumatic stress disorder (PTSD), anxiety, or depression between participants who disclosed the assault and those who kept it a secret. The aggressor’s identity is mostly unknown (34.7%). Higher scores were reported by those who identified their partner as the aggressor. Our participants reported that they were victims of more than one episode of sexual assault in 67.3% of cases, with a mean age of revictimization of 19 years. A lower age of first sexual aggression was a significant risk factor for subsequent revictimization. 3.8% of our participants took legal action against their aggressor, and they had significantly higher average scores on all measured items and total scores. 30.8% of our participants seek psychiatric help. And the main reason for that would be a lack of awareness and knowledge.

The cultural context of Tunisia, intricately woven into the fabric of our study, emphasizes the need for targeted and culturally sensitive approaches to addressing the aftermath of sexual violence.

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Several factors can threaten the mental health of engineers and seem to lead to anxiety and depressive disorders. Workaholism is an emerging phenomenon that has been the topic of much debate on its impact on workers’ mental health.

Determining the prevalence of workaholism among women and men engineers and screening for psychological distress among the workaholic engineers with a focus on gender differences.

This study is a descriptive-cross sectional analysis conducted on active engineers for one month. Data were collected through an online questionnaire, including socio-professional data, the WART (Work Addiction Risk Test) and the Hospital Anxiety and Depression scale.

Our population consisted of 45 women and 62 men engineers with an average age of 28.62± 4.3 years and 29.61± 4.5 years respectively. A high risk of workaholism was present among 42.2% and 41.9% of women and men respectively.

Among workaholic engineers, anxiety and depression were present in 73.1% and 46.2% of cases respectively among men and in 78.9% and 42.1% of cases respectively among women.

Workaholic engineers women were likely to have anxiety (p=0.000) and reproach from their families for excessive professional commitment (p=0.007).

Among engineers men, associations were found between workaholism and anxiety (p=0.000), depression (p=0.024), the use of psychotropic medication (p=0.013), a job satisfaction less than 4/10 (p=0.024) and facing reproach from their families for excessive professional commitment (p=0.032).

Workaholism among both women and men engineers was negatively correlated with sports activities (p=0.006, p=0.042).

Workaholism is a significant phenomenon among engineers that can lead to anxiety and depression disorders. Therefore, the detection of early signs of workaholism and its associated symptoms seems essential among this vulnerable population in order to prevent its psychological impact.

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Comorbidities in addiction: It is a rule rather than an exception. The story starts in childhood; even before, in infancy, and may be in prenatal life. The dimensional traits have already been there, existing obviously far before any DSM-5 diagnosis. Among these traits, the developmental features named as stress sensitivity, impulsivity and emotion dysregulation are the leading ones. Comorbidity research addressed childhood abuse, neglect or other childhood adverse experiences as a definite risk factor for adolescence and adult mental disorders, particularly substance use disorders. Developmental and environmental adversities in a mutually amplifying pattern make a vicious cycle in which the individual finally finds an illusionary exit, a pathway to addiction.

This presentation aims to discuss the complexities and challenges for the diagnosis and treatment of cases presenting with ASUD (alcohol and substance use disorders) and comorbid neurodevelopmental and affective or psychotic disorders . The history as well as the life and the management charts of the patients are reviewed in the light of information collected during the follow-up years revealing significant alterations with regard to diagnoses and therapeutic approaches. A specific focus of the case studies will be the missed or mis-diagnoses, and the impact of them on the treatment courses and the outcomes. One of the case studies with an eight year follow-up period, shows ADHD traits, alcohol use disorder, affective disorder and a later emerging severe stimulant use disorder. The second case with a similar ADHD history, presents with a stimulant use disorder, co-occuring with a severe psychotic disorder, that has been mis-diagnosed as schizophrenia. The life and management charts of the studied cases convey the drawbacks of the diagnostic difficulties, the treatment failures and the implication of efficient therapeutic strategies.

The challenges faced by clinicians due to co-occuring disorders that have become a common practice for addiction professionals. should be managed by transdiagnostic and integrative modalities. While big data or empirical large datasets can have their own limitations to help the practitioner for overcoming such complexities of real world situations, as stated in Stein’s article (2022, Psychiatric diagnosis and treatment in the 21st century: paradigm

shifts versus incremental integration) “the age-old single-case studies, may sometimes provide clinical insights that outweigh those from big data analyses.”

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Clozapine, the first atypical antipsychotic agent, serves as the gold standard treatment for treatment-resistant schizophrenia (TRS), being the most effective choice. Despite the fact that early commencement of clozapine is related to a higher response rate of patients, many psychiatrists remain reluctant towards its initiation. Identifying sociodemographic and clinical features correlating to clozapine response could facilitate the prompt clozapine initiation and ameliorate clinical outcomes.

Our department presents the preliminary results of a prospective cohort study on patients diagnosed with TRS, as defined by the Treatment Response and Resistance in Psychosis (TRRIP) Working Group criteria, before clozapine initiation prospectively for 6 months. The study aims to evaluate the potential association of several sociodemographic and clinical factors with clozapine response.

The patients included in our study were required to have a history of treatment-resistant schizophrenia, as specified by the TRRIP criteria and no history of treatment with clozapine. The TRS patients were submitted to clinical assessments in baseline and 6 months after clozapine initiation included the following: the Positive and Negative Syndrome Scale (PANSS), the Perrsonal and Social Performance Scale (PSP), past medical history, sociodemographic data, blood tests, and monitoring of clozapine blood levels.

30 patients have been screened until now, of which, 26 met the inclusion criteria. 4 patients withdrew from the study before the 6-month follow-up, 4 patients discontinued clozapine due to serious adverse events. 18 patients successfully completed the follow-up. 50% of the TRS patients showed significant clinical response to clozapine, as described by >20% increase in PANSS score. Clozapine responders also showed a significant increase in functionality, as assessed by the elevation of the PSP score (p <0,001), as expected. However, neither PSP score nor PANSS positive, negative or total score at baseline were predictive of clozapine response. Regarding the patients’ sociodemographic data, no statistically significant differences were identified between clozapine responders and non-responders.This study is also in accordance with the existing literature suggesting a significant delay in clozapine prescription by physicians. In our study, 80% of patients were prescribed more than three different antipsychotics before clozapine was initiated.

Clozapine is an effective treatment for TRS, as supported by the preliminary results of our study. 50% of the TRS patients showed significant clinical response to clozapine, as shown by reduction in PANSS score, and increase in PSP score, as a measure of functionality. However, larger clinical samples are needed to showcase further, more delicate differences among the two groups, to highlight potential predictive factors of clozapine response.

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Eating disorders comprise various conditions yet do not cover chronic overeating that may result in extreme obesity. Binge eating disorder with chronic somatic effects is not included in DSM-V; behavioural addictions do not comprise chronic overeating either. Neither do impulse control disorders. There are no actual screening tools for chronic overeating, and research is scarce on its chronic psychological effects

This research aims to find the distinctive psychometric characteristics of addiction using MMPI-2 data taken from patients who underwent gastric surgery due to high-risk obesity or moderate-risk obesity with alarming comorbidities.

This study employed a consecutive patient cohort to evaluate complication rates and the efficacy of Single-Anastomosis duodeno-ileal bypass with Gastric plication (SADI-GP). Patient recruitment commenced in October 2018 and ceased in June 2019. The process involved preoperative assessment, surgery, and several postoperative follow-up appointments at 1, 3, 6, and 12 months. The Minnesota Multiphasic Personality Inventory (MMPI-2) was administered during the 12-month follow-up. Participants aged between 18 and 65 years were included in the study, with body mass indexes (BMIs) exceeding 40 for individuals without comorbidities related to morbid obesity, and exceeding 35 for those with comorbidities related to morbid obesity, particularly related to glucose metabolism.

MMPI-2 scales previously confirmed to be related to SUD were analyzed, and common psychological comorbidities of SUD were searched for using these scales

High scores on MAC-R, AAS, and APS scales are well-represented in the sample (Table 1).

The sample includes a high number of high scorers on Rc4 and a moderately high number of high scorers on Rc9 (Table 2).

Elevated individual scale scores form dual or triplet peak settings in the MMPI-2 results and may describe certain conditions, like SUD. The majority of the subjects showed SUD-like personality settings (Figure 1). This study is constrained by limitations about sample size, a dropout rate exceeding expectations, stringent exclusion criteria, male-to-female ratio, short-term results, and the absence of longitudinal data on psychological characteristics.

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We found the MacAndrews Revised (MAC-R) scale strong, with AAS and APS as intermediate indicators for non-substance-based behavioural addiction in our sample (Table 1). RC4 also seems to be a strong indicator (Table 2), along with Pd-D and Pd-Pa peaks (Figure 1).

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Subutex abuse in Tunisia is a phenomenon that is becoming more and more frequent and the management of which is not obvious due to the development of this substance in parallel markets.

Our objective was to assess the patient’s Subutex use and initially assist with withdrawal, followed by achieving abstinence.

We followed the case of a patient in the psychiatric unit B at the Razi hospital, for depressive symptoms and having a problem of misuse of Subutex for 4 years, in a difficult family and social context.

Patient follow-up was done over a one-year period with weekly consultation sessions at the beginning to assess the situation. Although withdrawal was done after a few weeks, it was essential to maintain this abstinence, using psychotherapy based on CBT done over 7 sessions.

During the study period, the patient violated abstinence only once in a family conflict.

The patient’s response to our management has reinforced the hope of being able to treat addiction to Subutex despite the severity of his condition and family and social instability.

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Bipolar disorder is a chronic mental health condition characterized by alternating periods of mania, depression, and mixed states. The timing and recurrence of these mood episodes may be influenced by external factors, including seasonal variations. Previous research has highlighted potential seasonal patterns in the onset of manic episodes, with environmental factors such as changes in light exposure, temperature, and circadian rhythms playing a role. Comprehending these temporal patterns is paramount, as they provide critical insights into the underlying mechanisms of mood dysregulation and can inform the development of more targeted and effective clinical interventions for individuals with bipolar disorder.

The primary objective of this study is to determine whether manic and mixed episodes in bipolar disorder show a seasonal pattern. Specifically, this study aims to investigate whether specific times of the year are associated with a heightened incidence of hospitalizations for manic or mixed episodes.

A retrospective analysis was conducted on patient records from an inpatient psychiatric unit over four years. Inclusion criteria were a primary diagnosis of bipolar disorder and admission due to a manic or mixed episode. Data were categorized by month and season of hospitalization, and statistical analyses were performed to assess for significant seasonal variations.

Our study revealed a significant increase in hospitalizations for manic episodes during the spring and summer months, with 58% of manic episodes occurring during this period, and a secondary peak in autumn. Mixed episodes demonstrated less pronounced but still observable seasonal variation. Statistical analysis confirmed the presence of seasonality, with manic episodes more likely to occur during periods of increased daylight, while mixed episodes appeared more distributed across the year.

The findings indicate that manic episodes in bipolar disorder follow a distinct seasonal pattern, peaking in spring and summer. Although mixed episodes are less strongly correlated with seasonality, some seasonal trends were observed. These results highlight the significance of considering environmental and seasonal factors in the management of bipolar disorder. Further investigation into the underlying mechanisms of these patterns could improve preventative care and inform the development of personalized treatment strategies.

None Declared

Cognitive deficits in schizophrenia are associated with impaired predictive processes, however, the neural mechanisms of these impairments at the early stages of the disease are poorly understood. A modified memory-guided saccade task can be informative for studies in this field. The contingent negative variation (CNV) slow negative potentials (SNP1, 2, 3 waves) in 1000-ms interval before a memory-guided response are considered to be neural correlates of attention, memory, motor, and inhibitory predictive processes.

We aimed to assess the CNV-type slow negative event-related potentials (ERP) during the latent period before the signal to perform remembered saccades in patients with clinical high risk (CHR) for schizophrenia.

An electroencephalogram (EEG) from 24 electrodes and electrooculogram of horizontal eye movements were recorded in 16 patients with CHR and 18 healthy controls. The participants had to remember the location of a peripheral stimulus (PS, 150ms) and perform a saccade or antisaccade (50% probability) when the central fixation stimulus (CFS) was turned off after a delay period of 2800–3000 ms. The СFS shape (cross or circle) defined a motor response type: saccade or antisaccade.

The task performance (assessed based on response latency and errors) was worse in CHR patients compared to controls. In the antisaccade condition, SNP1 was faster in CHR patients compared to controls possibly reflecting attention deficits in CHR patients. The SNP1 amplitude peaks were equally distributed across the EEG leads in CHR patients but were located predominantly in frontal and central leads in controls. Diffuse representation of the amplitude peaks may reflect a compensatory involvement of posterior temporal and parietal-occipital cognitive control networks at the early stages of schizophrenia. At the last 300 ms of the delay period, the late SNP3 wave was shorter before memory-guided antisaccades compared to saccades only in patients. This may reflect the violation of predictive attention processes as well as proactive inhibition deficits, that are well-known in schizophrenia, in CHR patients.

Based on our data we consider the SNP1 and SNP3 components in the memory-guided saccade task to be potentially significant neurobiological markers of cognitive control at the early stages of schizophrenia.

The research was carried out within the state assignment of Ministry of Science and Higher Education of the Russian Federation (theme No.121032500081-5 and No.AAAA-A19-11904049098-9).

None Declared

Lumateperone, an atypical antipsychotic drug, has a dual mechanism of action by combination of activity at central serotonin (5-HT2A) and dopamine (D2) receptors.

This post-hoc analysis of an Indian Phase 3 study was conducted to evaluate the impact of Lumateperone 42mg compared to Quetiapine 300mg on severity of depression assessed via MADRS in patients with Bipolar II depression.

The phase-III, randomized, multi-centric, assessor-blind, parallel-group, active-controlled, comparative, non-inferiority study included patients with Bipolar II depression with moderate severity having a Montgomery-Asberg depression rating scale (MADRS) score ≥20 and Clinical global impression–bipolar version–severity (CGI-BP-S) score ≥4. The study was conducted after receiving regulatory and ethics committee approvals. The patients were randomized (1:1) to either receive Lumateperone 42mg [Test] or Quetiapine 300mg [Comparator] for 6 weeks. This post-hoc analysis evaluated MADRS total score and individual items from Question 1 to Question 10 i.e. (Q1) Apparent sadness; (Q2) Reported sadness; (Q3) Inner tension; (Q4) Reduced sleep; (Q5) Reduced appetite; (Q6) Concentration difficulties; (Q7) Lassitude; (Q8) Inability to feel; (Q9) Pessimistic thoughts; and (Q10) Suicidal thoughts respectively and for safety outcomes treatment emergent adverse events (TEAEs) were assessed. [Clinical trial registration: CTRI/2023/10/058583]

This subgroup analysis included 462 patients, out of which 231 were in the Test group and 231 in the comparator group. The baseline demographic characteristics were comparable in between treatment arms. The reduction in MADRS score (total and individual items) from baseline to Day 42 in Test arm was comparable to Comparator arm [Figure 1 & 2]. The incidence of TEAEs were similar in both treatment arms [Test: 34.6%; Comparator: 35.5%] and no serious adverse events were reported.

Image 1:

Image 2:

This post-hoc analysis demonstrated that Lumateperone 42mg is comparable to Quetiapine 300mg in treatment of Bipolar II depression as assessed via MADRS score from baseline to Day 42, and both treatments were found to be well tolerated. Hence, Lumateperone can be considered as valuable treatment option in management of Bipolar II depression.

A. Dharmadhikari: None Declared, P. Chaurasia: None Declared, Y. Patel: None Declared, D. Choudhary: None Declared, P. Dasud: None Declared, M. Bhirud: None Declared, P. Meena: None Declared, F. Shah: None Declared, G. Ganesan: None Declared, B. P. Rathour: None Declared, K. Mistry: None Declared, M. Dutta: None Declared, A. Ramaraju: None Declared, S. Mangalwedhe: None Declared, S. G. Goyal: None Declared, G. Kulkarni: None Declared, A. Mukhopadhyay: None Declared, P. Chaudhary: None Declared, G. T. Harsha: None Declared, M. Parikh: None Declared, S. Dey: None Declared, S. Sarkhel: None Declared, N. Jyothi: None Declared, A. Kumar: None Declared, N. Sooch: None Declared, A. Shetty Employee of: Sun Pharma, S. Saha Employee of: Sun Pharma, P. Devkare Employee of: Sun Pharma, A. Shetty Employee of: Sun Pharma, D. Patil Employee of: Sun Pharma, P. Ghadge Employee of: Sun Pharma, A. Mane Employee of: Sun Pharma, S. Mehta Employee of: Sun Pharma.