Domestic violence is a scourge that continues to spread, destroying family ties and increasing the prevalence of divorce in our Arab-Muslim societies. In our culture, women often find it hard to disclose domestic violence in general, but what about sexual violence? It’s the most under-reported form of violence in Tunisia. However, few studies have focused on sexual violence in the Tunisian context, or on the psychological repercussions of this form of violence.

To determine the prevalence and describe the different forms of sexual violence perpetrated by husbands against their wives and to evaluate marital satisfaction and its relation with sexual violence.

This is a descriptive and analytical cross-sectional study of 122 married women who consulted for medical expertise following domestic violence.

An anonymous survey was asked to these ladies. It included a section for collecting socio-demographic and clinical data on the woman and her partner, and a section for assessing the various forms of sexual violence.

We used the Azrin scale to evaluate marital satisfaction.

One hundred and twenty-two women victims of domestic violence were included in our study. Their average age was 35.66 years, it oscillates between 18 and 64 years. A family history of domestic violence was found in 32.8% of women (N=40). The battered family member was the mother in 41.5% of cases.

A history of childhood sexual abuse was found in 14.8% of women (N=18).

Half of the women (53.3%; n=65) were victims of sexual violence. Different types of sexual violence were reported with decreasing prevalence: forced intercourse (36.1%), unwanted intercourse (15.6%), unusual type of intercourse (31.1%) and pain during intercourse (4.9%).

Seventy-one percent (N=87) had poor marital satisfaction. On multivariate analysis using binary logistic regression, we found that sexual violence: an unusual type of relationship (p=0.04; OR=4.62) and the presence of psychological distress (p=0.04; OR=2.63) were independent factors associated with poor marital satisfaction.

Our study suggests that more attention should be provided to women victims of domestic violence in order to detect any form of sexual violence and provide them with the necessary psychological support.

None Declared

Thyroid and sex hormones play pivotal roles in the regulation of various physiological processes, including brain function. Dysregulation of these hormones has been increasingly associated with a range of neuropsychiatric disorders, including depression, anxiety, cognitive impairment, and mood disorders.

This review aims to systematically examine the correlation between thyroid and sex hormones disorders and the spectrum of emerging neuropsychiatric manifestations, enlightening the pathophysiological mechanisms.

A literature search was performed in many databases including PubMed, Web of Science, and Google Scholar for studies published in recent years. Eligible randomized controlled trials, observational studies, and systematic reviews examining neuropsychiatric outcomes in patients with thyroid or sex hormone disorders were included. Findings were synthesized both quantitatively, with meta-analyses where possible, and qualitatively, with thematic analysis for heterogeneous data.

The review identified a strong association between thyroid dysfunctions and neuropsychiatric disorders such as depression, anxiety, and cognitive decline. Hypothyroidism was consistently linked with depressive symptoms likely due to impaired serotonergic and dopaminergic neurotransmission, along with decreased hippocampal neurogenesis. Conversely, hyperthyroidism, characterized by elevated thyroid hormone levels, was associated with heightened anxiety, irritability, and emotional lability, possibly through dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and increased sympathetic nervous system activity.

In the context of sex hormone disorders, estrogen deficiency during menopause was correlated with a significant increase in behavioral and cognitive impairments, potentially mediated by reduced modulation of serotonin receptors, diminished synaptic plasticity, and increased neuroinflammatory responses. Similarly, testosterone decline in aging men was linked to mood and cognitive disorders, with evidence pointing to disruptions in androgen receptor signaling and alterations in γ-aminobutyric acid (GABA)ergic and glutamatergic pathways.

This review underscores the significant link between thyroid dysfunctions, particularly hypothyroidism and hyperthyroidism and mood disorders such as depression and anxiety, while also indicates that estrogen deficiency and testosterone decline contribute to cognitive impairments and emotional disturbances. These findings help the healthcare providers to recognize neuropsychiatric symptoms as potential indicators of underlying endocrine disorders.

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Chronic pain is a prevalent issue among breast cancer survivors, often causing significant distress, disability, and interference with daily activities. Affecting around 18% of the global population, chronic pain is the leading cause of years lived with disability. Among breast cancer survivors, it has become a key focus due to its high prevalence and impact on quality of life.

To assess the prevalence and characteristics of chronic pain in breast cancer survivors and examine its correlation with anxiety, depression, and interference with daily life activities.

This is a cross-sectional descriptive and analytic study conducted on 100 women treated for breast cancer at the medical oncology department of Fattouma Bourguiba University Hospital. The study spanned eight months (June 2021–February 2022). Pain characteristics were assessed, and anxiety and depression levels were measured using the Hospital Anxiety and Depression Scale (HADS). Pain-related catastrophic thinking was evaluated with the Pain Catastrophizing Scale (PCS), and family functionality was measured using the Family APGAR score.

The study involved 100 breast cancer survivors, with a mean age of 53.6 ± 10.1 years.

Our entire population confirmed having chronic pain for more than 3 months, most of them (53%) had it from 2 to 5 years

The median duration of chronic pain was 3 years [IQR: 2-5], with the most common pain locations being the breast area (72%) and upper limb (27%). Pain intensity was predominantly mild (62%), followed by moderate (34%), and severe (4%).

Chronic pain significantly interfered with daily activities, especially in patients with moderate to high pain intensity (p < 0.001), affecting both affective and activity clusters. The mean Pain Catastrophizing Scale score was 7.79 ± 5.25, indicating mild catastrophic thinking, which was most likely due to the low pain intensity experienced by the majority.

Anxiety levels were significantly correlated with higher pain intensity (p = 0.013), whereas depression, though elevated in patients with more severe pain, did not demonstrate a statistically significant association (p = 0.135).

The majority of participants were from highly functional families, with 88% reporting strong family support

Despite the prevalence of chronic pain, fatigue was not significantly related to pain intensity.

Chronic pain in breast cancer survivors significantly interferes with daily activities, particularly among those with moderate to high pain intensity. Anxiety is notably more prevalent in patients experiencing more severe pain. These findings underline the importance of comprehensive pain management strategies and psychological support for breast cancer survivors.

None Declared

A case report on the use of Brexpiprazole for the treatment of behavioral disturbance in dementia is presented.

A brief review of the benefit of Brexpiprazole treatment in the treatment of dementia is presented in a case report.

This is an 84-year-old female patient with newly diagnosed multifactorial cognitive impairment. The patient was brought to Mental Health because of the behavioral alteration presented. She reported delusions of harm, theft and a suspicious attitude in relation to moderate cognitive impairment, as well as the recent transfer to a nursing home. In addition, the nursing home had observed that he presented erratic wandering that affected the functioning of the residential environment. In response to this symptomatology, the patient was aggressive and physically heteroagressive towards the caregivers.

The patient, due to the clinical presentation, had been treated with benzodiazepines, which had worsened the episodes of agitation and confusion, interspersed with episodes of somnolence. Therefore, her treatment was modified by adding quetiapine and haloperidol, worsening her psychomotor restlessness and alertness.

When the patient was seen in the psychiatry department, she presented a high level of restlessness that corresponded to akathisia due to the haloperidol, as well as a fluctuating level of alertness that oscillated between wakefulness and somnolence. Despite the overmedication, according to the residency report, the patient maintained episodes of agitation and heteragresivity during wakefulness.

For this reason, it was decided to replace the antipsychotic treatment of quetiapine and haloperidol, progressively with brexpiprazole at 4mg DMD divided in two.

After two weeks of monotherapy with brexpiprazole, the side effects of the previous treatment disappeared, and the patient’s daily functioning improved. She remained alert, the suspicious attitude and the delusions of harm disappeared. The episodes of behavioral disturbances had also ceased.

For the treatment of behavioral symptoms in dementia, it is important to have an effective approach to the clinical management without causing adverse effects that can be severe in elderly people. Brexpiprazole is an atypical antipsychotic, being a 5HT1A and D2 partial agonist and a 5HT2A antagonist, and is an appropriate treatment in this age group.

None Declared

Violence is a major global health concern among patients with schizophrenia. However, the triggers of violent behavior remain unclear. In previous studies, familial risk factors are believed to be associated with mental disorders and violence. The relationship between parental bonding or childhood adversity and psychopathologic behavior (such as violence) has rarely been evaluated.

The study aimed to explore the relationship between violent behavior and childhood experience and to determine the role of the early child-parent bond in violence risk in patients with schizophrenia.

The study enrolled 287 patients with schizophrenia and 100 healthy controls. Patients were divided into 3 groups: patients with homicidal history (Group A), patients with violent behavior and without homicidal history (Group B) and patients without violent behavior (Group C). Childhood trauma questionnaire (CTQ), parental bonding instrument (PBI) and modified overt aggression scale (MOAS) were used to explore the violent behavior and childhood experience. All individuals participated voluntarily and provided informed consent. This study was approved by the ethics committee of the Academy of Forensic Science.

The findings indicated the proportion of males to be higher in the patient groups than in the healthy controls, especially in the group with homicidal history. Patients had a significantly higher prevalence of sexual abuse, emotional abuse and emotional neglect than the healthy controls. The emotional abuse and emotional neglect were found to be positively and negatively related to MOAS scores. Maternal over protection was found to be negatively related to the MOAS scores. On the CTQ subscales, emotional neglect was significantly associated with violence risk (OR=1.13, 95% CI=1.04–1.22). On the PBI subscales, maternal and paternal care (0.84, 0.74–0.94 and 1.30, 1.13–1.49) and over protection (1.18, 1.07–1.29 and 0.87, 0.81-0.95) were found to be significantly associated with violence risk. Maternal and paternal over protection were significantly associated with homicide risk (0.87, 0.78-0.97 and 1.10, 1.01-1.20).

The schizophrenia patients with violence might suffer lower paternal care and emotional abuse during the childhood. In terms of violence in schizophrenia patients, paternal over protection and maternal care might be a protective factor and emotional neglect, maternal over protection and paternal care might be a risk factor. In terms of homicide in schizophrenia patients, paternal over protection might be a risk factor and maternal over protection might be a protective factor. Therefore, childhood trauma and parental care and over protection could be a potential reference indicator for assessing violence risk in patients with schizophrenia.

X. Ling: None Declared, S. Wang: None Declared, N. Li: None Declared, Q. Zhang: None Declared, H. Li Grant / Research support from: This study was supported by National Key R & D Program of China [grant number 2022YFC3302001], National Natural Science Foundation of China [grant number 81801881], Science and Technology Committee of Shanghai Municipality [grant numbers 20DZ1200300, 21DZ2270800, 19DZ2292700].

Sexual functioning is an essential aspect of human existence. Sexual dysfunctions are prevalent and negatively affect the quality of life in the general population. Little attention has been paid to the sexual function of health workers.

The aim of our work was to evaluate sexual dysfunction among Tunisian doctors and to determine associated underlying factors.

A cross-sectional study was conducted online, from January to March 2024, via a pre-established questionnaire. Tunisian doctors, who had finished their medical studies, working in the public or private sector and who agreed to anonymously respond to the questionnaire were included. Sociodemographic, economic, clinical data and those related to the medical profession were collected. Sexual function was evaluated with the Arizona Sexual Experience Scale (ASEX).

A total of 80 individuals had fully responded to the questionnaire. The mean age of participants was 36.81 ± 7.49 years and 68,7 % (n=55) of them were male. Ninety five percent (n=76) were married and 77.5 % (n=62) had children. The mean working hours per week was 34.32 ± 5.32. A regular physical activity was practiced by 35 % (n=28) of individuals. The mean monthly income was 3592.5 ± 596 Tunisian Dinars. The results of the ASEX showed that 23,8 % (n=19) of participants, 23,6 % (n=13) of male participants and 24 % of female (n=6) participants had sexual dysfunction. Ten per cent of individuals (n=8) have previously consulted a sexologist. Longer working hours, lower monthly income, less physical exercise were significantly associated with increased risk for sexual dysfunction.

Sexual dysfunctions seem to be common among Tunisian doctors. Knowledge about their sexual functioning is important to promote their physical and mental health and to improve the care delivered.

None Declared

Blended therapy (BT) is defined as the use of digital tools combined with traditional face-to-face therapy. Despite growing evidence concerning BT in outpatient settings, there is not much data on BT in inpatient care. To our knowledge, this is one of the first studies to investigate the implementation of BT in the routine care of psychiatric inpatients.

Our objective was to identify factors potential barriers and facilitating factors influencing the implementation of BT in psychiatric inpatient settings.

We used a retrospective, exploratory qualitative research design and developed a semi-structured interview to collect our data. This enabled us to gain insights into the experiences of healthcare staff and patients. Participants were asked to reflect on the following themes we had pre-defined: resources, support, integration and sequential BT.

Therapists cited work overload with inadequate time adjustments and lack of ongoing training to sustain the use of BT in the long term as common barriers. A key finding of this study from the therapists’ perspective was also the importance of a clearly defined concept and setting for successful implementation. Patients valued the availability of satisfactory instructions for use, integration by therapists and a flexible setting. There were mixed opinions on sequential BT, with therapists mentioning in particular a lack of resources for patient care after discharge.

In summary, the results show that therapists reported more barriers in contrast to patients’ perceptions. This highlights that while understanding the patient’s perspective is important, healthcare professionals play the central role in implementing and maintaining BT.

None Declared

Søren Kierkegaard’s philosophy, particularly his exploration of anxiety, serves as a cornerstone in existential thought. His concepts of “authenticity,” “choice,” and the confrontation with the self underlie much of the contemporary understanding of anxiety as both a psychological and philosophical experience. Kierkegaard’s works, especially Either/Or, offer a profound analysis of human freedom, responsibility, and the resulting anxiety. The objective of this analysis is to bridge the philosophical with the practical and artistic, providing a multidimensional understanding of anxiety.

This study seeks to explore Kierkegaard’s conceptualization of anxiety, its application in psychotherapy, and its resonance in contemporary culture. Specifically, it investigates how these ideas can aid individuals in confronting existential anxiety in therapeutic settings.

A philosophical and qualitative approach is used, analyzing Kierkegaard’s Either/Or. The study incorporates interpretations from existential thinkers, psychotherapists and artists. Theoretical analysis is coupled with psychological insights, exploring anxiety as a pathway to self-awareness.

Kierkegaard presents anxiety as inherent to human freedom and choice. His stages of life—the aesthetic, ethical, and religious—represent different ways of engaging with anxiety. In the aesthetic stage, individuals pursue pleasure but encounter despair when they confront their limitations. The ethical stage offers structure but introduces existential guilt. The religious stage, requiring a leap of faith, is seen as the highest form of existence, where anxiety leads to transcendence. Kierkegaard’s ideas are reflected in existential psychotherapy, where anxiety is viewed not only as a symptom but as a catalyst for personal growth. Elliott Smith’s Either/Or album mirrors these themes, portraying modern struggles with freedom, despair, and self-doubt. Songs like “Between the Bars” and “Ballad of Big Nothing” articulate the tension between aesthetic escape and ethical responsibility, offering a visceral interpretation of Kierkegaard’s philosophical concerns.

Kierkegaard’s exploration of anxiety offers profound insights into human existence, emphasizing the need to confront, rather than avoid, existential dilemmas. His framework of life stages provides a guide for understanding the progression toward authenticity, where anxiety is a key driver. The study shows that Kierkegaard’s ideas remain relevant in psychotherapy, helping individuals navigate anxiety to achieve self-realization. Ultimately, this research affirms that embracing anxiety is crucial for personal freedom, growth, and authenticity, aligning with Kierkegaard’s vision of a life well-lived.

None Declared

The benefits of breastfeeding for mothers, infants, and society as a whole are well documented. These benefits appear to be linked to the duration of breastfeeding for both mother and child. Despite this knowledge, the rates of exclusive breastfeeding and continued breastfeeding at 6 and 12 months in Greece are exceptionally low.

To explore Greek parents’ attitudes towards breastfeeding according to their sociodemographic characteristics.

A cross-sectional study was conducted using self-administered questionnaires completed by 862 parents—both mothers and fathers—who had received support from a private maternity and breastfeeding support center in Athens.

The choice of breastfeeding was positively correlated with parents’ higher educational level (p<0.001), normal delivery (p<0.001), residence in Athens or another urban area ((p=0.017), positive attitude towards breastfeeding during pregnancy (p<0.001) and for breastfeeding after 12 months (p<0.001), previous breastfeeding experience (p<0.001), not using a pacifier (p<0.001), introducing whole foods at 6 months ( p<0.001), co-sleeping with their baby (p<0.001) and not implementing sleep training (p<0.001). Accordingly, the duration of breastfeeding was positively associated with living in another urban area (p<0.001), and unemployment (p=0.009). Longer duration of breastfeeding showed children who were exclusively breastfed (p<0.001), who weaned naturally (p<0.001), who were born naturally (p<0.001), who did not take a pacifier (p<0.001), who started with whole foods ( p<0.001), who stayed longer in their parents’ room (p<0.001), who did not receive sleep training (p<0.001) and those whose parents were informed about breastfeeding (p<0.001).

This study could serve as a foundation for more extensive research on breastfeeding. Findings can be utilized by health professionals to enhance their awareness, empathy, and effectiveness regarding issues related to breastfeeding.

None Declared

In the dynamic setting of psychiatric care, patient satisfaction and shared decision-making are crucial for optimal, personalized treatment. This approach is particularly vital in the context of a psychiatric ward, where engaging patients in treatment decisions could enhance their satisfaction and the overall therapeutic outcomes.

This study evaluated the impact of shared decision-making on patient satisfaction from services among patients treated in a psychiatric ward. Additionally, it examined whether there are differences in satisfaction between psychotic and non-psychotic patients.

53 patients (30 women and 23 men) who were hospitalized in the 4th Inpatient Department of the Psychiatric Hospital of Attica were assessed using the Client Satisfaction Questionnaire (CSQ-8) and the 9-Item Shared Decision-Making Questionnaire (SDM-Q-9). Diagnoses were based on the Mini International Neuropsychiatric Interview (M.I.N.I.). A multiple linear regression analysis was conducted to evaluate the effect of the SDM-Q-9 total score and of the presence of psychotic symptoms on the CSQ-8 total score. The relationship of separate SDM-Q-9 and CSQ-8 items, controlling for the presence of psychosis was further analyzed through partial correlation analyses. The Bonferroni method was employed in order to adjust for multiple comparisons.

The mean age of the participants was 47.49 years (SD=13,65), and the mean duration of the disease was 15 years (SD=12,36). Thirty-two patients were diagnosed with psychotic disorders (psychotic disorder=28, bipolar disorder=1, mood disorder with psychotic features=3), while twenty-one were diagnosed with non-psychotic disorders (including Major Depressive Disorder, Obsessive Compulsive Disorder, Bipolar Disorder and Substance Use disorders). Increasing SDM-Q-9 total score significantly correlated with increasing CSQ-8 total score (B=0,276, 95% CI=,177, 0.374, t=5,627, p<0.001). Partial correlation analyses showed that separate SDM-Q-9 items significantly correlated with separate CSQ-8 items, while many correlations survived the stringent bonferonni correction. The presence of psychotic symptoms was not associated with client satisfaction.

Our findings suggest that shared decision-making correlates positively with patient’s satisfaction from services during their hospitalization in a psychiatric ward and this was independent of the presence of psychosis. In the ongoing effort to find real-world solutions in mental health, integrating shared decision-making practices into psychiatric care can be a fundamental strategy to empower and satisfy patients suffering from mental disorders.

None Declared

Borderline Personality Disorder (BPD) was historically an underdiagnosed condition in Kyrgyzstan, often identified only in extreme cases, such as when individuals engaged in self-harm or displayed severe emotional instability. Traditionally, psychiatric consultations for BPD were initiated not by the individuals themselves but by concerned family members, typically parents. As mental health was heavily stigmatized in Kyrgyz society, especially personality disorders, many individuals likely went undiagnosed or untreated.

From 2020 to 2022, the Institute of Behavioral Health at the American University of Central Asia (AUCA) identified only 15 cases of BPD, However, since 2022, there has been a significant rise in BPD diagnoses, with over 70 cases recorded in just two years.

This study aims to examine the factors contributing to the increase in BPD diagnoses in the Kyrgyz Republic over the past two years.

The study’s methodology includes the analysis of secondary data provided by mental health organizations, including the AUCA Institute of Behavioral Health, which has tracked BPD cases in recent years. Additionally, anecdotal reports from practicing clinicians offer insights into the evolving nature of mental health diagnoses and treatments in Kyrgyzstan.

Several key factors have contributed to the rise in BPD diagnoses in Kyrgyzstan over the past two years. First, socio-economic stressors have intensified, particularly following the political and economic challenges of 2022. Financial instability and high unemployment rates have exacerbated psychological stress for many individuals. These conditions often worsen emotional dysregulation, a core feature of BPD, particularly for those already predisposed to the disorder. Second, the proliferation of social media has played a notable role in shaping mental health patterns, especially among young people. Increased social media exposure has been linked to feelings of inadequacy, identity confusion, and emotional instability—all key components of BPD. Third, domestic violence and trauma remain significant public health concerns in Kyrgyzstan. BPD has long been associated with adverse childhood experiences, including emotional neglect, sexual abuse, and physical violence, making trauma a significant factor in the development of the disorder. As trauma rates rise, so too does the likelihood of developing BPD, especially in those with preexisting vulnerabilities. Moreover, the reduction in stigma surrounding mental health in recent years has also contributed to the rise in diagnoses. Consequently, mental health professionals are now diagnosing BPD earlier and more frequently than in previous years.

The sharp increase in BPD cases in Kyrgyzstan can be attributed to a combination of socio-economic, psychological, and cultural shifts. Addressing underlying socio-economic and trauma-related factors remains crucial.

None Declared

Effective suicide risk assessment remains a significant challenge in psychiatric care, particularly when dealing with patients undergoing acute crises. This case study highlights the limitations of current assessment practices and underscores the need for a more nuanced understanding of suicide risk, particularly through the lens of personal narrative crisis and Suicide Crisis Syndrome (SCS).

The objective of this study is to describe a clinical case involving a patient with Suicide Crisis Syndrome (SCS), which emerged from a fundamental alteration in his personal life narrative. Additionally, this study reflects on the existing clinical gap due to the lack of consensual or homogeneous approaches for detecting suicide risk in psychiatric patients experiencing a crisis.

Methodology: A detailed review of the clinical process and hetero-anamnesis was conducted. The case explores the concept of SCS—an acute mental state that precedes a genuine suicide attempt.

The patient, a 45-year-old single male with no children, had a biographical history marked by traumatic events during military service and the loss of a child in combat at age 30. For years, he exhibited symptoms consistent with Post-Traumatic Stress Disorder (PTSD), which he managed effectively through meditation and martial arts, resulting in total symptom remission for over a decade. However, following complex cardiac surgery two years ago, he experienced a significant loss of functionality and autonomy, leading to the abandonment of his martial arts practice and lifelong profession as a rehabilitation therapist. This change had profound emotional, behavioral, and socio-economic impacts, resulting in depressive symptoms. During psychiatric evaluation, the patient exhibited affective dysregulation, marked hopelessness, a sense of loss of meaning, feelings of non-belonging, social defeat, and difficulty adjusting unrealistic goals to his current situation. Although he denied active suicidal ideation, he reported intrusive thoughts of death.

Conclusion and Implications: The assessment of self-reported suicidal ideation is often unreliable. There is an urgent need to adopt more comprehensive approaches that focus on the personal narrative crisis and SCS, as current evidence suggests that SCS is a strong predictor of actual suicidal behavior within 1-2 months after discharge.

None Declared

Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are two common neurodevelopmental conditions, whose prevalence in the general population has significantly increased in the last decade (2.2% and 2.5%, respectively). The co-occurring prevalence of ASD and ADHD is estimated at approximately 28% (Lai et al. 2019), and the differential diagnosis between these two conditions has become increasingly challenging, especially in adulthood. For instance, both individuals diagnosed with either ASD or ADHD might present social difficulties, despite the underlying causes are notably different: individuals with ASD struggle with social approach and communication, while individuals with ADHD might show distractibility and rapid loss of interest in social activities, or even exhibit behaviors perceived as annoying or rude, such as interrupting and intruding conversations (Antshel & Russo, 2019). Most importantly, in both ASD and ADHD (and especially in women) copying strategies such as the well-known “camouflaging” were observed, to mask autistic- or ADHD-related traits, to try to fit into a society mainly structured by and for neurotypical individuals (Lai & Baron-Cohen, 2015), but ultimately affecting their physical and mental health.

Aim of this study was to estimate the prevalence of ADHD traits and diagnosis in a sample of adult individuals with ASD without intellectual disabilities, examine sex differences in ADHD features, and explore the association between impulsivity and autistic traits.

146 adults with ASD completed assessments for autistic-, ADHD-traits, and impulsivity. Those above the ADHD-traits cut-off underwent the Diagnostic Interview for ADHD in adults (DIVA-5).

42 subjects (28.8%) were diagnosed with ADHD comorbid with ASD (26 combined type, 16 inattentive, 0 impulsive). Most diagnosed subjects (71.4%) were females, but males scored higher on inattentive and hyperactive-impulsive symptoms. Autistic traits were positively correlated with attentive impulsiveness.

Adults with ASD without intellectual disabilities show a significant prevalence of comorbid ADHD, particularly with inattentive symptoms. Attention difficulties are common in both disorders. Further studies and tailored diagnostic processes are needed to assess sub-threshold symptoms in ASD, ADHD, and other neurodevelopmental conditions.

None Declared

Distinguishing between bipolar and unipolar disorder is essential for effective treatment, yet accurate diagnosis remains challenging despite extensive research. The MDQ (Mood Disorder Questionnaire) and BSDS (Bipolar Spectrum Diagnostic Scale) are widely used self-assessment tools, each offering unique advantages. However, these tools are typically used based on total scores, potentially overlooking valuable information within individual items.

This study aims to employ clustering analysis on the MDQ and BSDS, utilizing subscales derived from factor analysis, to better differentiate patients with bipolar and unipolar disorders.

The study included patients diagnosed with bipolar and bipolar depression, with diagnoses confirmed by a psychiatrist according to DSM-IV-TR criteria. A total of 299 patients with bipolar depression and 142 with unipolar depression completed the MDQ and BSDS. Based on prior factor analysis, the MDQ was divided into two subscales: the positive activation subscale (items 3, 4, 8, 9) and the negative activation subscale (items 1, 2, 6, 7, 12, 13). K-means clustering was performed twice: once using the total scores from the MDQ and BSDS (two scores), and using the positive activation subscale, negative activation subscale from the MDQ, and the total score from the BSDS (three scores). The analysis was iterated 1000 times to avoid overfitting.

The analysis identified an optimal solution with K=2. Cluster 1, characterized by high scores on both questionnaires, predominantly comprised bipolar patients. In contrast, Cluster 2, with lower scores, was primarily composed of unipolar patients. Using the total scores from both the MDQ and BSDS for clustering yielded an accuracy of 67.88%. In the second analysis using the MDQ subscales and the BSDS total score, the accuracy improved to 77.55%.

Clustering based on the MDQ and BSDS achieved a 77.55% accuracy in distinguishing bipolarity when using MDQ subscales alongside the BSDS score, demonstrating a promising level of precision with self-report questionnaires. Importantly, segmenting the MDQ into positive and negative activation subscales resulted in a nearly 10% increase in accuracy compared to using total scores alone. This suggests that increasing the dimensionality of the data by incorporating disorder-specific subscales can improve clustering accuracy. These findings highlight the potential of using high-dimensional psychiatric data to develop more effective classification models.

None Declared

Trans women can encounter various struggles throughout their gender-affirmation. There is a need for further understanding of trans women’s experiences to gain deeper insights into how they cope throughout this process. The development of psychosocial support services that are adapted to their personal needs is crucial to enhancing their coping strategies.

The current study aimed to examine the coping experiences of trans women throughout their gender-affirmation.

This qualitative descriptive study utilized in-person, semi-structured interviews with 12 trans women to gather in-depth data on their coping experiences. Content analysis was employed to analyze the data.

The experiences of trans women emerged in five themes. Four themes correspond to four distinct phases: “self-discovery,” “self-acceptance,” “coming out to others,” and “after coming out to others,” each characterized by its own coping mechanisms. The fifth theme was labeled “to facilitate coping…”. Trans women have a heightened need for support during the periods “when they confront the possibility that their situation will not change,” “when they accept themselves but attempt to decide how they can move forward in life,” and “when they first come out to people around them.” The study indicates the critical role of addressing family and social stigma in trans women’s coping throughout their gender-affirmation. Furthermore, the study unveils a striking finding that efforts to facilitate trans women’s coping throughout their gender-affirmation extend beyond the purview of mental health professionals. It reveals that these efforts have dimensions that concern the entire healthcare system, the legal system, social security, labor, and working conditions.

The study highlights the importance of psychosocial support and improved access to these services to bolster trans women’s coping mechanisms throughout their gender-affirmation, with particular emphasis on the specific periods identified above. The psychosocial support for trans women should encompass not only them but also extend to their families, significant others, and the community in which they live, adopting a holistic approach.

None Declared

Perinatal disorders occur in 25% of childbearing women. Postnatal depressive symptoms (PDS) have been widely studied, whilst PDS usually overshadows bonding disorder (BD) in clinical practice and research. BD includes mild disorders, such as delay, ambivalence or loss of maternal emotional response, and severe disorders, such as pathological anger or rejection of the child (Brockington et al., Arch Womens Ment Health 2006; 9(5) 243-251).

To estimate the prevalences of PDS and BD in mothers during the six months after birth.

Women and their male partners aged ≥ 18, without delivery and neonatal complications, were recruited at the Maternity Ward in a public hospital in Madrid, during 2021-2022. Data was collected at immediate puerperium (T0), sixth week (T1), fourth month (T2), and sixth month (T3). The last observation carried forward (LOCF) was used. An Ad hoc Socio-Demographic questionnaire was used. To determine the presence of PDS and BD, respectively, there were used the Edinburgh Postnatal Depression Scale (EPDS), cut off ≥ 11 (Ascaso-Terrén et al., Med Clin (Barc) 2003; 120(9) 326-329) and Postpartum Bonding Questionnaire (PBQ), cut off ≥ 13 for BD, and ≥ 18 for severe BD (Torres-Giménez et al., Span J Psychol. 2021; 24, e47, 1-9).

1502 couples were recruited at T0. The main characteristics of female participants were: mean age 34.1 years, 53.9% married, 54.1% primiparous, 27.8% migrants, 67.3% university degree or higher, 83.2% employed, 14.8% financial difficulties, 4.9% smoking during pregnancy and, 21.7% c-section. At T0, the prevalences of PDS were 13.0% of mothers, 10.5% of fathers, and 3.5% of both parents. Applying LOCF, 874 women responded to the questionnaires at some timing during the follow-up. The results were divided into two groups (see Table 1 and Table 2) depending on whether they presented PDS at T0. In mothers with PDS at T0, PDS and BD rates eventually decrease at T3. In the other group, while BD rates decrease at T3, a slight increase in PDS presentation at T3 is observed.Table 1.

LOCF of mothers with PDS at T0

Depressive symptoms and impaired bonding could have different severity and timing during the postnatal period. More research on bonding disorder is needed to clarify more accurately the psychopathological features that distinguish it from postnatal depression to provide more targeted treatment that will also reduce the associated stigma of childbearing difficulties.

None Declared

Research into early interventions following a first episode of psychosis (FEP) has enabled a focused approach on prognostic-modifying factors. Among these, poor medication adherence contributes to relapse, as well as cognitive and functional deterioration. Several studies report discontinuation rates of oral antipsychotics (OAPs) after FEP at 70%, regardless of the prescribed OAP. The early introduction of long-acting injectable antipsychotics (LAIAs) could present an alternative.

This study aims to review the efficacy of LAIAs in the early stages of psychosis and compare the most relevant international guidelines on this topic.

Methodology: A non-systematic literature review using the keywords “long-acting injectable” and “first episode psychosis,” limited to articles published in English and Portuguese in the last 10 years from the PubMed®/MEDLINE® database, and clinical practice guidelines on psychosis, schizophrenia, and FEP from NICE, APA, and RANZCP.

Despite frequent selection biases (such as reserving LAIAs for patients with worse prognostic factors), significant benefits of LAIAs over OAPs in preventing hospitalization and relapse during the early phases of psychosis are consistently reported. LAIAs reduce non-adherence due to forgetfulness or reduced insight, while their different pharmacokinetics minimize withdrawal symptoms, drug interactions, and fluctuations in plasma concentration, enhancing tolerability. No second-generation LAIA was found to be clearly superior in terms of efficacy. Various guidelines recommend offering this treatment option early, favoring an informed and collaborative decision-making process. However, despite documented benefits in robust studies, they do not consider LAIAs as a first-line treatment.

Discussion/Conclusions: Significant variations in the proportion of patients on LAIAs across countries suggest that factors other than efficacy may influence its use. Greater understanding of these factors could help identify potential barriers to optimal implementation. New evidence may prompt a review of the guidelines.

None Declared

Breast cancer is one of the most common cancers in women. Depression and anxiety affect not only health behaviors and treatment adherence but also cancer recurrence. Several studies have demonstrated that psychosocial interventions improve both mood symptoms and survival in breast cancer patients.

Psychodynamics plays a significant role in psychological distress and maladaptive behaviors. Therefore, psychoeducation focusing on patient dynamics can offer more individualized and tailored intervention. This study investigated the impact of psychodynamic-oriented psychoeducation for early-stage breast cancer patients on both psychological distress and disease trajectory, compared to those receiving standard cancer treatment only.

Psychodynamic-oriented psychoeducation aims to provide guidance on managing psychological distress during cancer treatment, based on clinical and psychodynamic assessments of patients. A trained psychiatrist delivered this 60-minute intervention at least once within one-week post-mastectomy. The study included early-stage breast cancer patients (AJCC stages 0-IIIA) who underwent mastectomy at Kyungpook National University Hospital (KNUH) and Kyungpook National University Chilgok Hospital (KNUCH) between 2008 and 2015, excluding those with prior cancer history. Participants were divided into two groups: control (standard treatment) and treatment (standard treatment plus psychodynamic-oriented psychoeducation). Outcomes measured included breast cancer recurrence, disease-free survival, and psychological assessments using the Hospital Anxiety and Depression Scale (HADS) and Experiences in Close Relationships-Modified 36 (ECR-M36) at baseline and 12 months post-intervention in the treatment group. Propensity score matching was used to control for recurrence-related factors.

The median follow-up was 72.6 months. Recurrence rates were comparable between control and treatment groups (control vs. treatment: 9.0% vs. 8.3%, p=0.763). In a subanalysis of recurrent cases, the treatment group showed longer disease-free survival (51.3 vs. 32.5 months, p=0.038). (Table 1 and Figure 1) HADS scores showed no significant difference at 12 months, while ECR-M36 showed significant decreases in total and anxiety subscale scores at 12 months (p<0.05). (Table 2)

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This study, unique in integrating psychodynamic principles into psychoeducation, showed improvements in attachment-related anxiety and longer disease-free survival, specifically among recurrent cases, suggesting the potential benefits of this approach for certain breast cancer patients. Further research is needed to identify which patients might benefit most from this intervention.

None Declared

Nonadherence in transplantology stands for a not cooperating patient in terms of taking medication, having the laboratory, and imaging tests taken, missing appointments, not following dietary and lifestyle recommendations related to smoking tobacco, drinking alcohol, and other high-risk behaviours. Factors of not following therapeutic recommendations in patient after liver transplantation are high costs, psychiatric disorders, convictions regarding harmfulness of the immunosuppressive medicine and its side effects as well as rejection episodes, infections, stress related to suffering from a chronic disease and inadequate social support.

The aim of this study was to assess the adherence to therapeutic recommendations in patients after liver transplantation including the level of depression, anxiety, degree of acceptance of the disease and social support.

Study was carried out among 112 respondents after liver transplantation. The Delphi method was used and the following standardised tools were used: ISSB, AIS, BDI, STAI X-1 and X-2 as well as a questionnaire form regarding sociodemographic data.

An average level of adherence to therapeutic recommendations was on an average level (6.8±1.85). A statistically significant positive correlation between disease acceptance and following therapeutic recommendations was observed (r = –0.20, t = –2.040; p = 0.044). The adherence to recommendations increased with growing disease acceptance. Six factors were distinguished from the analysed predictors which in a relevant way influenced the level of adherence to therapeutic recommendations in the group of patients after liver transplantation. Regression model consisting of six independent variables explains 55% of variation of the dependent variable (r2corrected= 0,55, F(6, 98) = 22.127; p<0.001). Such positive factors include always following recommendations (β = –0.23; p = 0.002) and seeking various sources of information (β = –0.34; p<0.001), while negative ones constituted of illness duration (β = 0.18; p = 0.008), experiencing side effects (β = 0.40; p<0.001), suffering from concomitant diseases (β = 0,40; p<0,001).

Patients who have accepted their disease constitute a group that adheres to therapeutic recommendations to a lesser extent.

The main factors affecting adherence to therapeutic recommendations are the search for other sources of information and declarative adherence to therapeutic recommendations. Negative predictors- duration of disease, experiencing adverse effects of treatment, and comorbidities.

The way in which a physician communicates to the patients after liver transplantation the information about the results indicating that the medications were taken irregularly significantly more often influenced not following therapeutic recommendations which might suggest an unintended non-adherence.

None Declared

Tardive dyskinesia (TD) is an iatrogenic disorder characterized by a range of movement abnormalities, described as irregular, stereotyped, and choreiform caused by exposure to antipsychotics. This condition can lead to significant or disabling symptoms that affect quality of life. However, the exact mechanism underlying TD remains unclear. Pharmacotherapy of TD includes cholinergic drugs, benzodiazepines, antioxidants, amantadine, propanolol, botulinum toxin, whereas the non-pharmacotherapy approach includes modified electroconvulsive therapy and deep brain stimulation. We successfully treated a chronic schizophrenia patient with comorbid TD using Aripiprazole and botulinum toxin after trying calcium channel blockers in association with Aripiprazole and vitamin E.

To determine the effects of calcium channel blocker drugs (Amlodipine) for treatment of neuroleptic-induced tardive dyskinesia in people with schizophrenia, and the efficiency of botulinum toxin in treating induced tardive dyskinesia.

Through a case report and a literature review, our work aims to study antipsychotics induced tardive dyskinesia and its pharmacotherapy especially the use of calcium channel blocker and botulinum toxin in association with Aripiprazole.

A 22 years male, diagnosed with schizophrenia since the age of 16 years, with one hospitalization. The evolution of his disease was marked by the development of a tardive dyskinesia, cervical and brachial movements disorders with rapid worsening in few months, the patient was treated with olanzapine oral administration. During his follows-up, his tardive dyskinesia disn’t resolve despite switching the incriminated antipsychotic to Aripiprazole, lowering the dose since he was on complete remission. we added benzodiazepines and vitamin E to his treatment, before trying the calcium channel blocker for two months, with no improvement, on the contrary a worsening was noted using the Unified Dyskinesia Rating Scale. The aggravation of the movements was a reason for the patient attempted suicide, after this late incident we chose to try the botulinum toxin injections. His tardive dyskinesia was spectacularly improved within the fisrt injections.

Antipsychotic drugs are known to cause a variety of adverse effects, including tardive dyskinesia. Hence the importance of knowing the pharmacotherapy and non-pharmaco- therapy to manage this effect, through this case report where it tardive dyskinesia got treated after using botilinum toxin injections with a spectacular improvement in its Unified Dyskinesia Rating Scale. In our case, we had no response after adding calcium channel blocker .The effects of calcium channel blockers for antipsychotic-induced tardive dyskinesia are unknown, and it use is still limited.

None Declared