Prior studies have shown contradicting results regarding adrenal gland volume (AGV) in depressed patients, with some reporting significant enlargement and others not.

The aim of this study was to retrospectively compare CT image segmentations of the adrenal glands in patients with depression to a control group with stringent exclusion criteria to minimize confounding factors.

We included patients diagnosed with depression (ICD-10: F32/33) who underwent abdominal CT imaging between 2012 and 2022 and did not have any other psychiatric disorders. Diagnoses that could potentially influence AGV were excluded. The resulting 31 depressed patients were compared to a matching control group of 31 patients without depression. The AGV was manually segmented in thin-sliced reconstructions (≤1 mm).

Total AGV in the depressed group was 6.78 (5.19-7.56) cm3 compared to 6.90 (5.54-10.05) cm3 in the control group. There was no significant difference in AGV between the two groups after adjusting for age, height, and weight. A positive correlation was observed between AGV and height (r=0.41, p<0.001) and weight (r=0.52, p<0.001). Males showed significantly larger AGV than females (p≤0.001), and left AGV was significantly larger than right AGV (p<0.001). Patients within the depressed group who underwent imaging after a suicide attempt showed larger total AGV compared to the control group, though not statistically significant.

AGV is not increased in the well-selected cohort of depressed patients in this study, which contrasts with some previous reports in literature. Further multi-centric studies are required to identify potentially influencing factors such as attempted suicide.

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International Medical Graduates add up to nearly one-third (23-28%) of the total physician workforce in the US, the UK, Australia, and Canada, of which around 40%-75% are from low-income countries. Pakistan is one of the three leading source countries following India and the Philippines. As per 2002 statistics by the Bureau of Emigration and Foreign Employment, only 10-15% of emigrated Pakistani physicians repatriate. No official data on the exact number of repatriated Pakistani physicians are available. This is the first original study that assessed satisfaction with life in physicians repatriating to a lower-middle-income country.

To assess satisfaction with life (SWL) and its correlation with psychological well-being in foreign-trained, repatriated Pakistani physicians.

We conducted this cross-sectional study from April’22 to Nov’23, through purposive sampling among foreign-trained Pakistani physicians who repatriated at least three months before participating. We used the Scale of Positive and Negative Emotions (SPANE), Flourishing Scale, and Satisfaction with Life (SWL) scale. After transforming data to normality in SPSS 25 through the Distribution Fraction method, the independent sample t-test, and one-way ANOVA were applied. We assessed the correlation between affect balance, flourishing, and SWL through Pearson’s correlation and ascertained the predictors of SWL through binary logistic regression (α=0.05).

Of 109 respondents, the majority (70.6%) were males, from Punjab (83.5%), trained in USA/Canada (68.8%), and from the private sector (69.7%), with a Mean±SD age of 47.31±7.9. The total Mean ± SD SWL scores were 27.48± 5.03. 99 (90.8%) were satisfied with life while only 9.2% weren’t. The currently married respondents (27.8±4.9 vs 24.6±5.4, p=0.04) while those from Sindh and KPK provinces had lower scores. We found a positive moderate correlation between SWL and flourishing (r=0.488), positive emotions (r=0.391), and affect balance (r=0.327) all at p=<0.001. We found good fitness of the final model with SWL as the outcome variable and Flourishing and Overall Affect Balance as predictors: Omnibus Tests of Model Coefficients (p=0.001) and Hosmer and Lemeshow tests (p=0.322). Only flourishing predicted SWL and with higher perceived flourishing, there were 1.3x higher odds of SWL.

This is the pioneer study to have addressed SWL and its correlation with psychological well-being in repatriated physicians, who using their skill sets and expertise, may help strengthen the healthcare system of the lower-middle income countries of origin, hence it’s imperative to identify factors linked to their psychological well-being. We recommend further research on this particularly qualitative exploration.

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Although there is good empirical data on factors that predict harmful outcomes, and standardised approaches to risk assessment have been developed, there remains a disconnect between the academic study of risk and routine clinical practice. This is exemplified by (i) the outstanding uncertainty about how to use predictive models for everyday clinical decision-making, and (ii) the use of predictive methodology to test tools that eschew prediction. The disconnect is, in part, a consequence of the varied use of the notion of ‘risk’ within and between academia and clinical practice.

To derive a more nuanced understanding of the meaning of ‘risk’ in clinical practice.

After reading clinical vignettes, participants (all practising clinicians, n=18) took part in semi-structured interviews regarding clinical decision-making. The interview transcripts were subject to thematic analysis using a novel approach to the analysis of ideas in expressed language (in this case the idea of ‘risk’) which draws on philosophical and intellectual history methodologies (derived from the work of Wittgenstein, and Skinner respectively).

The use of risk by participants varied according to the extent and type of its spatial location (figure 1).

In many cases, ‘risk’ was used in a disembodied (i.e., dislocated) way (e.g., ‘what is the risk,’ ‘risk will increase’).

When locatable, it was evident that participants located risk in:

1. a) the patient (e.g., ‘the patient’s risk’) which was sometimes qualified by the type of harm envisaged (e.g., ‘his risk involved hurting staff’);

2. b) clinical activity (e.g., risk assessment, positive risk-taking, risk management);

3. c) the clinician (e.g., risk tolerances and thresholds); and

4. d) the system (e.g., ‘our system is… quite risk averse,’ ‘who holds the risk’).

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This study demonstrates the varied use of ‘risk’ in practice. By empirically delineating the different expressed forms ‘risk’ takes in clinicians’ language (and thinking), the findings of this study can inform (i) the development of risk study methodologies that are more applicable to practice, and (ii) improvements in clinical practice by clarifying how risk can be understood and spoken about.

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Stigmatization has been associated with unfavorable outcomes for individuals with mental illnesses, as it acts as a barrier to seeking help and achieving age-appropriate functional goals. Among mental disorders, people with schizophrenia are most frequently stigmatized, followed by those with alcohol-related disorders, substance use disorders, and depressive disorders.

Substance use disorders have often been viewed as stigmatizing conditions

To assess perceived stigmatization and its consequences among patients followed and hospitalized for the management of opioid use disorder in the addiction service at Arrazi Psychiatric Hospital in Salé.

This is a descriptive cross-sectional study using a questionnaire that includes sociodemographic and clinical criteria, as well as an assessment of perceived stigmatization among patients followed and hospitalized for the management of opioid use disorders in the addiction service at Arrazi Psychiatric Hospital in Salé.

Perceived stigmatization was measured using the Perceived Stigma of Addiction Scale (PSAS). This scale consists of 8 items measuring perceived stigma among substance users.

patients of both sexes, aged 18 to 65, diagnosed with opioid use disorder.

A total of 72 responses were retained. Approximately 60% were male, the majority lived with their families, and about 85% were unemployed. Codeine and tramadol were the most commonly used substances, while heroin was less prevalent. Psychiatric comorbidity was present in about the majority of participants (anxiety disorder, depressive disorder, personality disorder, and 2% with psychosis).

The mean (standard deviation) score of the perceived stigma scale for the study population was 21.23. The mean perceived stigma score was significantly associated with the place of residence, with significantly higher perceived stigma found in participants living alone. Stigmatization was also higher depending on the route of opioid administration and was correlated with the participants‘ socio-economic status.

The study suggests that stigma is a major concern among patients with opioid use disorders. Further research is needed to assess the relationship between stigma and the extent of substance use, personality factors, treatment-seeking behaviors, and its impact on quality of life. Studies could evaluate the evolution and trajectory of stigma throughout treatment in order to develop interventions that could help address the issue of stigma in mental health.

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Delirium is a severe neurocognitive condition marked by acute, fluctuating disruptions in attention, awareness, and cognition, leading to significant morbidity and mortality. Despite its impact, there is currently no definitive pharmacological or non-pharmacological treatment for delirium (cf. American Psychiatric Association, 2013). Recognizing and managing delirium early is crucial to prevent long-term consequences. However, there is an international lack of consensus regarding the division of responsibilities in delirium care among physicians and advanced practice nurses (APNs).

Distribution of tasks between physicians and nurses in delirium management: „where everyone is responsible, no one is responsible

An international systematic literature review investigated the task distribution between advanced practice nurses (APNs) and physicians. The review focused on publications retrieved from PubMed and CINAHL databases.

From the initial systematic literature search, 395 articles were identified. Following the PRISMA statement (cf. Page et al., 2021) criteria, 30 articles were selected for analysis. Utilizing MAXQDA® (Release 2022.6) and qualitative content analysis, the literature was examined across categories such as physical examination, delirium screening, ordering pharmacological tests, treatment, psychoeducation on delirium. or procedures, diagnosis, non pharmacological treatment, and

Our systematic review revealed the absence of international guidelines for defining task distribution between physicians and nurses, particularly advanced practice nurses (APNs), in delirium care. We propose that research defining the roles among these experts will create synergies in delirium management which result in better recognition and management of delirium. Future research will test this hypothesis

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Depression among older adults is a significant public health issue that often goes underrecognized, despite its profound impact on their quality of life and mental well-being. With advancing age, many individuals encounter challenges such as loneliness, chronic illness, and bereavement, which heighten their vulnerability to depressive symptoms. These symptoms are not only detrimental to overall health but are also strongly associated with an increased risk of suicidal behaviours. Although these suicidal behaviours are preventable, much research should be done to disentangle development pathways in older adults.

The aim of this research is to identify the symptomatic profiles of depression in the elderly population and to relate this profile to suicidal outcomes.

We utilized data from the “Edad con Salud” cohort study, a longitudinal household survey conducted on a nationally representative sample in Spain (aged 18+ years). Participants who could not be personally interviewed and those under 50 years old were excluded, resulting in a final sample of 3,533 participants (54.31% female, age = 66.42(10.27)). Suicidal behaviours and depressive symptoms were assessed using the Composite International Diagnostic Interview (CIDI 3.0). A Latent Class Analysis (LCA) was performed at base level to identify participant profiles based on 8 depressive symptoms. We followed this with a survival analysis to assess differences between profiles in the progression of suicidal ideation and attempts in the different waves. Finally, Cox regression was used to examine the impact of sociodemographic and clinical covariates on suicidal behaviours.

The three-cluster model provided the best fit. The first class (72.52%) included most participants without depressive symptoms; the second class (13.67%) included participants with three symptoms (depressive mood, diminished interest or pleasure and fatigue); and the third class (13.81%) included participants with all eight symptoms (see Image 1). Survival analysis revealed significant differences between the groups over time for both suicidal ideation (χ2=1332, p < .01) and suicide attempts (χ2=215, p < .01), with the third group having the highest number of cases. Cox regression indicated that suicidal ideation was associated with the second (HR = 5.38) and third classes (HR = 59.8), age (HR = 0.97), and loneliness (HR = 0.91), among other variables. Suicide attempts were associated with the second (HR = 6.08) and third classes (HR = 25.3), age (HR = 0.92), and loneliness (HR = 1.02).

Image 1:

Participants with depressive symptoms, even at a subclinical level, have an increased risk of suicidal behaviours, especially when other risk factors such as loneliness are present.

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The Flemish Association of Psychiatry developed due care guidelines for medical assisted dying in cases of severe and unbearable psychiatric suffering, which were adopted by the Order of Physicians. In principle, there are therefore more than enough well-known recommendations on how to handle a request for termination of life from a patient with psychiatric issues.

Nevertheless, occasionally something goes wrong due to misinterpretation of the legal criteria or due to careless actions by the consulting or performing physician.

In 2010, a female patient died by euthanasia because of unbearable mental suffering, which was unacceptable for her family. The family decided to initiate a court case to have the inaccuracies in the decision-making process and the execution of the euthanasia evaluated by a judge. In 2020, three involved doctors, including a psychiatrist, were prosecuted for this euthanasia. An analysis of the court case and the media coverage of this case will be discussed.

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BEHAVIORAL ADDICTIONS AS A REPETITIVE PATTERN OF BEHAVIOR WITH DECREASE IN SELF-CONTROL AND A POWERFUL DESIRE TO CARRY OUT IT, DESPITE THE NEGATIVE CONSEQUENCES; WITH ACCOMPANYING SYMPTOMATOLOGY OF IRRITABILITY, CONCERN AND ANXIETY.

ANALYZE THE RESULTS ON REPORTS OF BEHAVIORAL ADICTIONS

IN THE REPORTS ON BEHAVIORAL ADDICTIONS, ESTUDES (SURVEY ON THE DRUG USE IN SECONDARY EDUCATION IN SPAIN, 14-18 YEARS OLD) AND EDADES (SURVEY ON ALCOHOL AND DRUGS IN SPAIN) WE FOUND THE FOLLOWING:

• - MANY MINORS PARTICIPATE IN GAMBLING GAMES.

• - THE USE OF THE INTERNET, GAMBLING WITH MONEY AND VIDEO GAMES ARE VERY COMMON PRACTICES.

• - ONLINE BETTING GAMES ARE MORE PREVALENT IN YOUNG PEOPLE.

• - WITHIN THE PATHOLOGICAL GAME, A GREATER PREVALENCE OF BEHAVIOR IS OBSERVED RISK.

• - WITHIN THE ABUSIVE USE OF THE INTERNET, GREATER CONSUMPTION OF CANNABIS AND ALCOHOL.

REGARDING THE TREATMENT, THE USEFULNESS OF COGNITIVE PSYCHOTHERAPY IS RECOGNIZED. BEHAVIORAL AND THE USE OF PSYCHODRUGS SUCH AS NALMEFENE AND NALTREXONE.

ADDICTION TO THE INTERNET AND VIDEO GAMES COULD BE RECOGNIZED AS PSYCHIATRIC DIAGNOSES WHEN THEY LEAD MORE COMPLEX CHARACTERISTICS. SOME STUDIES PROPOSED TO TAKE INTO ACCOUNT THE EMOTIONAL NEEDS AND THE IMPULSIVITY, WHILE OTHERS, TALK ABOUT THE NEURO-BIOLOGICAL-GENETIC COMPONENT OF ADDICTIONS.

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Although Autism Spectrum Disorder (ASD) is frequently reported as a comorbidity in adults with Attention Deficit Hyperactivity Disorder (ADHD), diagnosing this additional condition in clinical practice remains challenging. Missing this diagnosis can significantly impact treatment and reduce the quality of life for these adults. In child and adolescent psychiatry, attention is also given to the source(s) that influence the symptoms and complaints of ASD and ADHD, both in diagnosis and treatment.

This lecture highlights the importance of identifying the source(s) of symptoms and complaints in adult patients, with or without ADHD, in an outpatient urban setting. Better mapping of these source(s) helps distinguish the symptoms of ASD from those of ADHD, refining both diagnosis and treatment. Unsurprisingly, ASD is often not even considered a potential comorbid condition in adults. In this lecture, we share practical experiences with adult outpatients and discuss the source(s) that frequently emerge, which aid in differentiating ASD symptoms from those of ADHD.

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Emotional dysregulation is an unhealthy emotional response to stimuli and a common reason for adolescent hospitalization. Linked to disorders like depression, borderline personality disorder, childhood trauma, and eating disorders, understanding its underlying causes may improve outcomes and prevent relapse.

The aim of this study is to characterize emotional dysregulation among adolescent impatient.

Our study involves inpatients (16-24 years) hospitalized at our Transitional Psychiatric ward in Ancona (Università Politecnica delle Marche, Italy). The used rating scale were: Temperament Evaluation in Memphis, Pisa and San Diego (TEMPS-M), Difficulties in Emotion Regulation Scale (DERS), Barratt Impulsiveness Scale-11 (BIS-11), Toronto Alexithymia Scale-20 (TAS-20), Aggression Questionnaire (AQ). Descriptive analysis, simple and multivariate linear regression analysis were conducted.

97 adolescent patients were admitted from February 2022 to March 2023. The mean age of the sample is 17.3±1.9. The mean score to the BPRS is 43.9±10.3. The 70.7% (n=70) of the sample are females and the 79.8% (n=79) lives with their parents. Disruptive, impulse-control, and conduct disorders are the prevalent disorders in the sample (32.3%, n=32). The 21.1% (n=21) was diagnosed with depression, the 13.2% (n=13) with bipolar disorder and the 9.1% (n=9) with psychosis. According to the DERS, patients with emotional dysregulation are the 82,2% (n=37) of the sample. The 25.3% (n=24) of the sample could be classified as alexithymic. The most represented temperaments in the sample are the dysthymic 24.4% (n=11) and cyclothymic 22.2% (n=10). The mean score of the DERS is 122.33±29.5, the mean score of the TAS-20 is 58.9±166 and the mean score of the AQ is 78.7±30.1, the mean score of the BIS-11 is 65.2±19.1. A simple linear regression between DERS and AQ (R=0.536, R2=0.287, F(1)=15.284, p<0.001), TAS-20 (R=0.502, R2=0.252, F(1)=12.819, p=0.001) and BIS-11 (R=0.534, R2=0.285, F(1)=15.128, p<0.001) was observed. A multivariate linear regression was observed between the DERS (R=0.917, R2=0.842, F(1)=25.708, p<0.001) and the subscale about physical aggressivity of the AQ (β=2.065, p=0.008), the dysthymic subscale of the TEMPS (β=1.87, p<0.001), the hostility subscale of the AQ (β=-3.321, p<0.001), the subscale about difficulty identifying feelings of the TAS-20 (β=1.598, p=0.001), the total score of the AQ (β=0.5, p=0.006) and the subscale about cognitive impulsivity of the BIS-11 (β=1.024, p=0.047).

The results suggest a link between emotional dysregulation, impulsivity, aggression, and alexithymia. Notably, emotional dysregulation appears in those with a dysthymic temperament, marked by high aggression, difficulty identifying feelings, cognitive impulsivity and low hostility. Further research is needed to explore these findings and develop treatment strategies.

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Successful implementation of patient engagement (PE) and mHealth could reduce inappropriate catheter use and Catheter-associated urinary tract infections (CAUTIs). Insight into patient acceptance, impact on PE and quality of care, potential barriers and facilitators to the implementation of an mHealth intervention could improve the impact of both current and future infection prevention programs.

Implementation of the smartphone app “Participatient” was evaluated in four Dutch hospitals. Patient questionnaires assessed the acceptability of the app and its impact. Healthcare professionals (HCPs) were interviewed to evaluate the implementation process.

Acceptability constructs were evaluated positively. PE and quality of care were rated high before and after implementation. All 22 HCPs perceived barriers, eg incomplete training for HCPs and unclear communication on roles; and lack of promotion by ward professionals. The principal facilitator was the HCPs’ positive attitude toward PE.

App users perceived the Participatient app as acceptable, which fulfills a precondition for implementation. The implementation strategy evaluated in the present study was designed to fulfill all the conditions considered crucial for implementation. Nevertheless, the level of adoption remained low, and HCPs still imputed their failure to promote the use of the app to insufficiencies in training and communication and to a misfit between the app and their existing workflow. These findings underscore the need to verify whether there may be additional, less evident barriers to the adoption of mHealth tools that support PE in general, and more specifically, to the adoption of Participatient to engage patients in preventing CAUTIs.

As part of our comprehensive early intervention program for psychotic disorders (RIPEPP), we have been conducting psychodynamic group psychotherapy for family members since 2005. This type of therapy intended for family members of patients that are motivated for psychological work and the correction of maladaptive forms of family interactions. The 90-minute sessions are held every two weeks under the guidance of a psychiatrist – group analyst.

At the beginning of this new experience, we applied group analytical principles in the group. Due to the large drop out and specific dynamics, we gradually changed the therapeutic technique and became more flexible and supportive.

During the years of therapy, with the strengthening of group cohesion, it was gradually possible to switch again from a more flexible and supportive method to the classic group analytical technique.

In this presentation, we will show vignettes from the therapeutic process.

An overview of the need to modify the group-analytic technique in the treatment of family members of individuals with psychotic disorders.

Following the protocol of group sessions.

Over the course of the therapeutic process, the group members become more ready for group analytical work, which is adapted and applied in sessions in which they openly talk about themselves, their feelings and partner relationships. The modification of the group analytic technique is still at work with a continuously present psychodynamic understanding.

A group-analytic approach is applied in the treatment of family members of individuals with psychotic disorders. The frequent occurrence of dropouts among group members highlighted the need to modify the group-analytic technique, with the potential to revert to the classical method by strengthening group cohesion and improving family dynamics.

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Neuropsychiatric symptoms (NPS), prevalent in individuals with mild cognitive impairment (MCI), are linked to functional decline, accelerated dementia progression, and reduced quality of life. In clinical practice, molecular imaging plays a key role in diagnosing cognitive and behavioral issues with high accuracy.

This study aims to analyze the correlation between NPS and molecular imaging findings in MCI-diagnosed patients.

A retrospective, descriptive study was conducted with MCI patients who had undergone Amyloid PET scans (APscan) between January 2019 and October 2024 at Infanta Leonor Hospital in Madrid. Data included demographics, neurological diagnoses, Global Deterioration Scale (GDS) scores, NPS (e.g., depression, psychosis, behavioral and sleep disturbances, anxiety, suicidal thoughts), and PET-FDG/APscan results. Statistical analysis was performed using Dataset and SPSS 22.0.

A total of 72 patients were included. The main characteristics of the sample are shown in table 1. Among these patients, 65.28% exhibited NPS; notably, 49.3% had depression, 23.61% behavioral disturbances, 19.44% sleep disorders, 16.67% anxiety, 4.17% psychosis, and 2.82% suicidal ideation. In patients with a positive APscan, 29.79% had NPS, including 34.29% with depression and 66.67% with psychosis. Patients with abnormal FDG-PET scans showed higher NPS prevalence (65.96%), particularly behavioral disturbances (64.71%), sleep disorders (57.14%), and depression (62.86%).

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This study underscores the high incidence of NPS in MCI patients, noting that NPS may exacerbate patient distress, contribute to autonomy loss, and increase institutionalization risk. Furthermore, molecular imaging patterns can help predict MCI progression to dementia and highlight NPS as potential predictors and outcomes of these biological changes.

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Prementrual disorders (PMD) affect millions of women in reproductive age worldwide. Understanding the potential link between PMD and its comorbidities, including autoimmune disease (AD), is crucial for ultimately improving women’s health. Although hormonal fluctuations seem involved in the development of PMD and some AD, the relationship between PMD and AD remains unclear.

Hence, we aimed to investigate the bidirectional association between PMD and AD.

Leveraging Swedish nationwide and regional registers, we conducted a nested-case control study and a matched-cohort study. Among 3,630,028 eligible women of reproductive ages during 2001-2022, we identified 104,972 incident PMD, their unaffected full sisters, and 10 unaffected matched women per case. We extracted 41 types of AD diagnosis recorded in the registers. Using conditional logistic regression and Cox regression models, we estimated the odds ratio (OR) and hazard ratio (HR) with 95% confidence interval (CI).

Women with AD had a 12% increased risk of subsequent PMD (95% CI 1.10-1.15) compared to unaffected women, and a 6% increased risk compared to their unaffected full sisters (95% CI 1.01-1.11). Women with PMD had 23% (95% CI 1.20-1.26) and 17% (95% CI 1.10-1.24) elevated risks of subsequent AD compared to unaffected women and full sisters, respectively. Among parous women, a stronger bidirectional association was observed for those both exposed to PMD and perinatal depression (nested case-control OR:1.46, 95%CI 1.38-1.54; matched cohort HR:1.49, 95%CI 1.34-1.66) compared to only PMD (nested case-control OR:1.04, 95%CI 1.00-1.07; matched-cohort HR:1.14, 95%CI 1.07-1.21). The strongest bidirectional association with PMD was found for autoimmune thyroid disease and celiac disease.

Our findings illustrate a bidirectional association between PMD and AD, in particular among parous women with a history of perinatal depression. If confirmed in future studies, healthcare professionals need to be vigilant about the risk of AD in women with PMD and vice versa.

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War is the most powerful psychosocial stressor affecting all segments of modern Ukrainian society.

It was conducted a comprehensive examination of 176 patients of both sexes: Group I consisted of 101 military personnel; Group II - 97 volunteers; Group III - 95 IDPs in order to develop a system of personality-oriented treatment of stress-related disorders in persons affected by war.

Clinical and psychopathological examination, which included a structured interview and patient’s observation aimed at studying influence of socio-psychological and biological factors on development of post-stress disorders. Psychodiagnostic method include use: M-PTSD; HADS; HAM-A, HAM-D; Questionnaire of neuropsychological stress by T.A. Nemchin; State-Trait Anxiety Invertory; Methods of diagnosing coping behaviour in stressful situations; Impact of Event Scale-Revised; Clinical Administered PTSD Scale-CAPS; Traumatic Stress Questionnaire; Colombian Suicide Intentions Severity Scale; Methods for determining suicide risk and assessing self-awareness of death in patients with depressive disorder (Kozhyna H.M., Zelenska K.O., 2015); Methods for ‘Diagnosing the level of social frustration (Wasserman L.I., modified by Boyko V.V., 2002).

Clinical structure of stress-related disorders was presented by PTSD and adjustment disorders. Clinical structure of PTSD was represented by anxious, dysphoric, asthenic and somatoform syndromes. System of personality-oriented treatment was developed, including differentiated use of psychopharmacotherapy, psychotherapy and psychoeducation; creation of re-adaptive atmosphere; formation of health-centered lifestyle and based on a salutogenic approach. Pharmacotherapeutic component of developed program included differentiated, targeted use of SSRIs, SNRIs, antipsychotics, tranquilizers and anxiolytics. Psychotherapeutic program was based on identification of dominant resource channels for overcoming stress and finding inner stability using integrative model of psychological survival after severe stress, Basic Ph. Psychotherapeutic support included trauma-focused CBT for all patients, EMDR therapy with additional use of Pucelik Consulting Group’s PTSD Self-Management Program for servicemen patients in Group I; individual crisis therapy for patients in Group II; and interpersonal therapy for patients in Group III. For anxious depressive reactions, CBT and art therapy were used for all patients; with the additional use of problem-solving therapy for patients of Group I; Group II - individual crisis therapy; Group III - mindfulness techniques, relaxation training.

Effectiveness of developed system of personality-oriented treatment of stress-related disorders was proved, and positive dynamics of mental state, reduction of psychopathological symptoms, increased resistance, reduced levels of social and psychological frustration were established.

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Sibutramine is an anorexigenic drug that has been used to treat obesity. After its commercialization, FDA ordered the suspension of its prescription in USA because of the adverse effects. It has structural similarities to amphetamine and is a serotonin-noradrenaline reuptake inhibitor. The primary metabolites are responsible for the activity and inhibit the reuptake of noradrenalin and serotonin from the synaptic cleft. This substance can interfere with one of the known mechanisms of psychosis increasing dopaminergic transmission and leading to potential psychomimetic effects.

The main objective in this paper is to obtain a critical evaluation of the literature regarding psychosis and sibutramine. There has been done a bibliographic review in databases such us SCOPUS, Web of Science, UptoDate and PubMed. This review was realized under certain criteria and keywords. The motivations behind this research were generated after an unusual clinical case (in symptomatology’s presentation). Sibutramine is a compound, which is not commercialized in the UE, so the diagnosis of the toxic psychosis was more complicated than the average psychedelics drugs.

To develop this review, numerous databases were chosen: PubMed, Scopus, UpToDate and Web of Science. However, only in PubMed we have obtain relevant results. For descriptors we have used two terms: “psychosis” and “sibutramine”. In this database, 27 results were obtained. With the criteria previously designed, which were free text access and works published in the last 20 years, only ten of them met all the criteria. With these ten articles, a systematic and qualitative analysis has been done, focusing on the ones which described similar cases.

The sibutramine psychosis is difficult to identify. Frequently is mixed up with other substances in dietary supplements, which can appear as harmless. So, as clinics, we need to be careful, always considering this information in the clinical records. This case was peculiar; a 24 years old woman was consuming sibutramine as a compound in one supplement she was taken for losing weight. Three weeks prior to the consult the symptons started with an erotomaniac delusions, accompanied by disruptive behaviour, mood swings (dysphoria) and irritability. She was hospitalized and treated with antipsychotic medication (aripiprazole) showing a full recovery in five days.

Sibutramine can cause severe mental health disorders. As a compound of dietary supplements, can be easily acquired through online stores. Our work as clinics is to be vigilant of this kind of substances because of the danger that can generate. More studies should be done, to acquire knowledge of the psychobiological mechanisms involved in these cases. The prognosis seems to be positive, but there are certain risks in patients with unknown vulnerability factors.

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Adult patients with Autism Spectrum Disorder (ASD) exhibit a range of behaviours that can be disruptive to the medical care of themselves and other patients and as a result, are at higher risk of being sedated. Symptom severity is heterogenous. Some patients are completely non-verbal, some require assistance with basic activities of daily living, and others function independently with only mild difficulties. Roughly two thirds of patients with ASD have a comorbid psychiatric diagnosis, with the most frequent comorbidities being ADHD, anxiety and depressive disorders or intellectual disability. These comorbidities complicate the management of these patients, and may further increase their agitation and distress.

The present study aims to determine whether adult patients with ASD who present with acute psychiatric illnesses receive more sedatives in the emergency department.

43 adult patients with a previous diagnosis of ASD who were referred to the mental health team at a single, large emergency department in metropolitan Victoria over the year of 2021 were identified and matched with an equal number of controls within the same cohort. Sedative medications were converted to diazepam and chlorpromazine equivalent doses.

There were 41.9% female participants among cases and controls. The mean age of patients with ASD was 26.7 (SD = 7.9), which was similar to the mean age of controls of 27.4 (SD = 7.6). The mean hospital length of stay was 13.4 hours (SD 8.6) among cases and 14.0 (SD 7.0) among controls. A higher proportion of patients with ASD received benzodiazepines at 60.5% compared to 46.5% among controls, with a difference that was not statistically significant. A lower proportion of 30.2% of patients with ASD received antipsychotics compared to 44.1% among controls, with a difference that was not statistically significant.

This study shows evidence that patients with ASD are more heavily sedated in the emergency department compared to patients who present similarly but do not have a prior diagnosis of ASD. While the observed increased dose of benzodiazepines was modest, it does represent a potentially increased degree of harm to patients with ASD. We strongly recommends that every attempt should always be made to reduce the use of sedative medications in favour of other techniques for behavioural management. These include verbal de-escalation, reducing sensory stimuli, one-to-one nursing, prompt security presence and the involvement of family or friends. Since patients with ASD are at a higher risk of receiving sedatives, efforts should be made to recognise their patterns of behaviour and difficulty, to understand them and formulate constructive and safe ways to manage their behaviour.

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New antidepressant treatments are needed that not only demonstrate strong efficacy but also act quickly, are safe for long-term use, and are well-tolerated by patients. Accelerated intermittent Theta-Burst Stimulation (aiTBS) is a promising form of noninvasive brain stimulation in the treatment of depression (1). iTBS stimulation is a time saving and cost-effective technique, and could provide long-lasting improvement of treatment-resistant depression (TRD) (2). Currently, there is limited evidence regarding the role of aiTBS within treatment algorithms for TRD compared to placebo.

This is a single-center, double-blind, randomized, placebo-controlled pilot intervention study, designed to evaluate the efficacy and safety of aiTBS for TRD.

Stimulation will be administered in 10 daily sessions, one session every 50 minutes, over 5 days, for a total of 50 sessions. Each session will consist of 3 minutes of stimulation at a frequency of 50 Hz, delivering 600 stimuli per session, with an intensity of 120% of the motor threshold targeted at the left dorsolateral prefrontal cortex.

Participants must be adults aged 18 to 75 years (inclusive), and meet the criteria for TRD, unresponsive to two antidepressants at an adequate dose and for an adequate duration with a stable dose for at least 4 weeks. Assessments, including HDRS, PHQ-9, EQ-5D-5L, SDS, CGI-S, and MGH-ATRQ, will be conducted at the baseline visit, at the end of the treatment, one and three months after the treatment.

Accelerated protocols are an emerging area of interest in the treatment of TDR, but several issues remain to be clarified, including the durability of their effects, safety, and feasibility of implementing these protocols in outpatient settings in routine clinical practice.

None Declared