Esketamine has been linked to dissociation, which was claimed to predict or not to predict antidepressant response. Speculations regarding predictivity were based on results obtained with the CADSS, a scale investigating dissociative symptoms, with higher scores indicating more symptoms.

To investigate the effect of intranasal esketamine on dissociation and its subsequent influence on clinical response, we administered the CADSS 40 minutes after inhalation at the first esketamine administration and 40 minutes after the ninth inhalation and measured clinical response through the Clinical Global Impressions-Severity (CGI-S), the Young Mania Rating Scale (YMRS), the Montgomery-Åsberg Depression Rating Scale (MADRS), and the 24-item Brief Psychiatric Rating Scale (BPRS).

We included 61 adults (33 women and 28 men; age, mean, 52.69±11.80, range 20-73 years) with Thase & Rush (J Clin Psychiatry 1997;58 [Suppl 13]:23-29) treatment-resistant depression. All patients received intranasal esketamine spray and were assessed at the first and ninth administrations (one month after the first administration, i.e., the end of the induction period and the beginning of maintenance), at the day of the spray after 40 min with the CADSS and 1 month later with the CGI-S, the BPRS, the MADRS, and the YMRS.

CADSS scores dropped from 6.59±7.42 40 min after the first administration to 3.12±4.41 40 minutes 1 month later (dropped by 3.48 points, 47.27% of baseline); t=3.15; p=0.0021. CGI-S scores dropped from 5.12±0.61 at baseline to 3.95±0.76 1 month later (t=9.32; p<0.00001). BPRS scores dropped from 51.85±11.55 at baseline to 41.21±10.64 after 1 month (t=5.29; p<0.00001). MADRS scores dropped from 34.29±7.89 at baseline to 22.61±9.07 after 1 month (t=7.59; p<0.00001). Responders (≥50% drop of MADRS from baseline) were 12 patients (19.67%), while remitters (MADRS score≤10) were 2 (3.28%). YMRS scores moved from 2.18±2.59 at baseline to 1.72±2.37 1 month later (t=1.02; p=0.309, n.s.), always in the normal range. Blood pressure 40 minutes after spray at the first administration was unchanged in 35 patients, increased in 16 (maximum by 20 mmHg), and decreased in 10 (maximum drop 20 mmHg). Contrary to previous claims, CADSS scores did not correlate at any time with scores on clinical scales or therapeutic response (Pearson’s r from 0.232 with p=0.072 to 0.013 with p=0.918). As for side effects, 15 patients reported dissociation, 15 sedation, 8 vertigo, 8 dizziness, 6 confusion, 5 headache, 4 nausea/vomiting, and 0 hypertension.

Patients in our sample scored very low on the CADSS. At the end of the induction period, esketamine was associated with significant decreases in the severity of psychopathology.

None Declared

Tobacco and alcohol use are two of the main risk factors for most of the non-communicable diseases and causes of death worldwide. Healthcare professionals can play an important role in helping patients to quit smoking and alcohol consumption, but this role is undermined if they themselves have the same addictions.

The aim of this study was to study the effect of smoking and alcohol use on healthcare professionals’ quality of life. In addition we aimed to identify any demographic and occupational factors that affect quality of life.

The research sample of the present cross-sectional study consisted of 200 health professionals. The Demographic Questionnaire, the Smoking Addiction Inventory (Fagerstrom), the Alcohol Addiction Inventory, and the Quality of Life Inventory (EQ-5D) were used. The statistical analysis was performed using the statistical package IBM Spss v.27

Among the sample, the 46.5% stated that were smokers. The mean score of alcohol dependence was found to be 3.61 (±3.29), while the corresponding mean value of Fagerstrom was calculated to be 3.96 (±2.27). The EQ-5D quality of life score was found to be 0.93. Finally, the EQ-Vas score was found to be 7.95 (± 1.57).

A particularly high prevalence of smoking was found among the healthcare professionals in the study, while alcohol consumption was moderate. The results showed that tobacco and alcohol consumption negatively affects the quality of life of healthcare professionals.

None Declared

Lumateperone, an atypical antipsychotic drug approved for Bipolar II depression in 2021, has a dual mechanism of action by combination of activity at central serotonin (5-HT2A) and dopamine (D2) receptors.

This subgroup analysis of an Indian Phase 3 study was conducted to evaluate the efficacy and safety of Lumateperone 42mg compared to Quetiapine 300mg in treatment of Bipolar II depression when stratified based on mixed symptoms assessed via Young Mania Rating Scale (YMRS).

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. The patients were stratified based on YMRS: Subgroup 1 [S1]: ≤6 and Subgroup 2 [S2]: >6 to 12. For efficacy outcomes MADRS score, CGI-BP-S (total score, depression subscore and overall bipolar illness subscore), and Quality of life enjoyment and satisfaction-short form questionnaire (Q-LES-Q-SF) score were evaluated and for safety outcomes treatment emergent adverse events (TEAEs) were assessed. [Clinical trial registration: CTRI/2023/10/058583]

This subgroup analysis included 235 patients in S1[Test=109; Comparator=126] and 227 in S2[Test=122; Comparator=105]. The baseline demographic characteristics were comparable in between treatment arms across subgroups. The primary endpoint of reduction in MADRS score from baseline to Day 42 in Test arm was non-inferior to Comparator arm in both subgroups [Figure 1] as the upper 95% CI was below the pre-defined margin of 3.0. The reduction of CGI-BP-S (total score, depression subscore and overall bipolar illness subscore) from Day 14 to Day 42 were comparable in both Test and Comparator arms in both subgroups. The improvement in Q-LES-Q-SF score from baseline to Day 42 were comparable in both Test and Comparator arms in both subgroups. The incidence of TEAEs were similar in both treatment arms [S1: Test=28.4% and Comparator=28.6%; S2: Test=40.2% and Comparator=43.8%] and no serious adverse events were reported.

Image 1:

This subgroup analysis demonstrated that Lumateperone 42mg is non-inferior to Quetiapine 300mg in treatment of Bipolar II depression as assessed via MADRS score from baseline to Day 42, irrespective of presence of mixed symptoms and both treatments were found to be well tolerated.

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.

Alcohol use remains a significant public health issue across Europe, contributing to approximately 5% of premature deaths and 25% of all fatal road accidents. The effects of excessive alcohol consumption are widespread, impacting both physical and mental health. In Moldova, as in many other regions, alcohol use is a contributing factor to a range of health issues, including alcohol dependence and alcohol-induced psychoses. This underscores the importance of comprehensive strategies to address these challenges and promote better mental health outcomes.

This study aims to analyze the epidemiological trends of alcohol use in Europe, particularly Moldova, and its associated mental health consequences. It explores the role of alcohol in the development of psychiatric comorbidities, including depression and anxiety, and discusses strategies for prevention and treatment.

Data from WHO and local health authorities were used to assess the incidence and prevalence of alcohol dependence and alcohol-induced psychoses. The study tracked trends from 2019 to 2023 across different regions in Moldova, comparing them with European data. Furthermore, the study examined the links between alcohol use and mental health disorders like depression and bipolar disorder, highlighting the complexities of managing these co-occurring conditions.

The analysis of alcohol use patterns in Moldova revealed significant regional variations in both alcohol dependence and alcohol-induced psychoses. For instance, the Northern region experienced an increase in alcohol dependence rates from 79,2 cases per 100,000 in 2019 to 99,2 in 2023. Similarly, the prevalence of alcohol-induced psychoses in the Central region rose from 26,4 cases per 100,000 in 2019 to 35,2 in 2023. These patterns are consistent with trends observed across Europe, where alcohol consumption is frequently linked to heightened risks of developing mental health disorders, particularly depression and anxiety. Furthermore, alcohol-related psychiatric conditions pose challenges for effective treatment, often requiring integrated care that addresses both substance use and mental health.

The evolving patterns of alcohol use and its associated mental health consequences highlight the need for integrated, non-stigmatizing public health interventions. Prevention strategies that combine public health education, policy reform, and improved access to mental health services can help reduce the burden of alcohol use on individuals and communities. Early intervention and personalized care approaches are essential for mitigating the dual impact of alcohol and mental health issues.

None Declared

Melanopsin-expressing intrinsically photosensitive retinal ganglion cells (ipRGCs) are critical regulators of circadian rhythms and various non-image-forming visual functions, such as the pupillary light reflex (PLR), which adjusts the amount of light entering the eye. ipRGCs, through their direct responsiveness to circadian light, influence both circadian entrainment and neurophysiological processes that affect mood regulation. Emerging evidence suggests that melanopsin-mediated PLR may be disrupted in mood disorders, including bipolar disorder (BD) and even patients with increased bipolar disorder-traits. Given the well-documented association between circadian dysregulation and BD pathophysiology, it is hypothesized that changes in ipRGC function may contribute to the neurobiological mechanisms underlying BD.

The primary aim of this review is to synthesize and evaluate the existing body of literature on melanopsin-mediated pupillary responses in individuals with bipolar disorder. Specifically, this review seeks to assess the extent to which these responses are altered in BD and to explore the potential utility of melanopsin-driven PLR as a biomarker for mood dysregulation and circadian disruption in this patient population.

A non-systematic review of the literature on the melanopsin-mediated pupillary light reflex in patients with bipolar disorder, through a targeted search of databases.

The reviewed studies demonstrate consistent alterations in melanopsin-mediated pupillary responses in individuals with BD. Several investigations report reduced PLR amplitude and delayed latency in BD patients, with variability depending on mood state. Manic and depressive episodes appear to be associated with distinct patterns of dysregulation, suggesting that melanopsin signaling may be differentially affected by the phase of illness. One study also shows a variation in ipRGCs responses in remitted BD patients, suggesting an alteration of this system throughout the disease. (Madsen et al. Int J Bipolar Disord 2021;9,7) These findings align with circadian disruptions commonly observed in BD, further supporting a mechanistic link between ipRGC dysfunction and mood regulation.

Melanopsin-mediated pupillary responses have emerged as a promising avenue of investigation for identifying biomarkers of bipolar disorder, particularly concerning circadian rhythm and mood dysregulation. Despite encouraging preliminary findings, the current literature is limited by methodological heterogeneity and small sample sizes. Future research should standardize assessment protocols and investigate how ipRGC dysfunction contributes to BD pathophysiology, potentially leading to novel treatments targeting circadian regulation and improving clinical outcomes.

None Declared

Suicide is one of the leading causes of preventable death.

The PRISURE program is developed with a series of objectives and actions aligned with the Mental Health Strategy of the National Health System - (Spain), Strategic Plan for Mental Health and Addictions of the Community of Madrid 2022-2024 and the Prevention Plan suicide in the community of Madrid 2022-2026, based on the experience of the suicide risk prevention program developed between 2014 and 2023 at the Retiro Mental Health Center (CSM) of the Institute of Psychiatry and Mental Health of the General University Hospital Gregorio Marañón.

Presentation of a secondary suicide prevention program in the Community of Madrid with 10 years of implementation and reinforcement of the therapeutic team in the last year.

Treatment outcomes, assessment of patients’ suicide risk progression during follow-up, referral to patient discharge, and outcome indicators in the past year are measured.

Description of the functioning of the PRISURE program and descriptive study of sociodemographic and clinical characteristics, suicidal crises, evolution and discharge referrals, of all patients treated in PRISURE. The program’s performance indicators, as well as its results, are evaluated over one year from its implementation.

Sociodemographic and clinical characteristics are analyzed, including psychometric evaluation at baseline, 3, 6, 9, and 12 months after referral to PRISURE from August/2023 to August/2024. The suicide risk profile, treatment adherence, program implementation indicators and initial results are evaluated.

PRISURE is a comprehensive care process that includes the prevention, intervention and postvention of suicidal behavior.

It includes interventions indicated for the prevention of suicidal behavior aimed at people in whom relevant signs or symptoms that anticipate the development of a mental disorder, or biological or psychological markers that indicate a high suicidal risk, have been identified.

PRISURE encompasses a set of activities aimed at early detection and indicated prevention, support and care of suicidal behavior, as well as research and promotion of mental health.

None Declared

Children and adolescents with chronic cutaneous conditions are at risk of experiencing adverse psychosocial effects such as anxiety, depression, and loneliness. Children with psoriasis had significantly higher rates of any psychiatric disorder, but these are often unrecognised or under-recognised and not referred to mental health services. It is also clear that the well-being of these children’s families may also be impacted by their child’s condition.

The aim of this study was to review current knowledge of the comorbidity of psoriasis and psychiatric disorders in the paediatric population, which are often underdiagnosed and undertreated.

A narrative literature review was carried out in the PubMed, Cochrane and Embase databases, selecting only the articles published in the last 10 years, using the following keywords: psoriasis, psychiatric disorders, paedriatic population.

There is no doubt that psoriasis is one of the most debilitating chronic dermatological conditions affecting children from a quality-of-life perspective. Indeed, numerous studies have demonstrated that its impact is on par with that of other chronic conditions such as diabetes, asthma or epilepsy. Current research generally supports a positive association between paediatric psoriasis and the onset of anxiety and depression. However, it is difficult to establish a causal relationship as there is some evidence that psoriasis and psychiatric illness can exacerbate each other. Children with psoriasis had significantly higher rates of any psychiatric condition, particularly depression and suicidal ideation. Patients with higher disease severity (Psoriasis Area and Severity Index (PASI) and Body Surface Area (BSA) scores) and longer disease duration, are undoubtedly more likely to experience worse anxiety and depression. They may have other psychiatric comorbidities, such as excoriation (skin picking) disorder or obsessive-compulsive disorder (OCD), resulting in body-focused repetitive behaviours that exacerbate psoriatic plaques.

Paediatric patients with psoriasis appear to be more vulnerable to the psychosocial effects of their disease than adults, especially those diagnosed at a younger age, who had poorer lifetime outcomes due to less robust coping skills compared to other children. Young children may also not be able to understand or express their emotions associated with psoriasis, which is a significant barrier to conducting research. There is little research on supportive treatment, but psychological support (group or individual) during appointments has been reported positively by patients.

It is essential to consider the psychosocial impact of this particular pathology on children and their families, in order to improve their quality of life through a better understanding of their conditions and the implementation of interventions that help to mitigate these effects.

None Declared

Major depression not only impairs individual health and labour market performance but also imposes significant economic burdens on society. It is linked to substantial costs through healthcare use, lost productivity and absenteeism. Recent genome-wide association studies have identified genetic markers associated with major depression, offering new insights into its genetic risk factors. However, the potential association of these genetic risks with educational attainment and career outcomes remains underexplored. Understanding this connection is crucial for addressing the broader public health and socio-economic implications of depression risk beyond clinical populations.

This study aims to investigate the relationship between genetic risk for depression and individual career performance in the general population of Finland from 1992 to 2017.

We utilised pooled data from the Finnish Finrisk (1992-2012) and FinHealth (2017) studies, which together include a population representative sample of individuals aged 25-64 (N=20,121). Genetic, survey and socio-economic registry data were integrated for this analysis. Using probit and semi-structural regression models, we examined various career performance indicators, with polygenic scores for depression (Howard et al. Nat Neurosci 2019; 22 343-352) as the main explanatory variable. Socio-demographic characteristics and genetic principal components were included as controls.

Our study revealed a negative association between higher genetic risk for depression and the likelihood of attaining higher education—an essential predictor of career success. Additionally, our study provides novel insights into how elevated polygenic risk for depression was linked to employment and self-employment rates, both directly and via educational pathways.

These findings highlight that genetic predispositions for depression can adversely affect career prospects in the general population, suggesting that the economic burden of depression extends beyond those clinically diagnosed. As effect sizes are modest, our results imply that supportive measures and compensatory behaviours could mitigate some of the educational and career disadvantages associated with higher genetic risk for depression.

A. Hazak: None Declared, J. Liuhanen: None Declared, K. Kantojärvi: None Declared, S. Sulkava: None Declared, T. Jääskeläinen: None Declared, V. Salomaa: None Declared, S. Koskinen: None Declared, M. Perola: None Declared, T. Paunio Consultant of: Idorsia Pharmaceuticals and Biogen (unrelated to the present work)

Given the specific characteristics of their work positions, sewing machine operators (SMOs) represent a vulnerable population to musculoskeletal symptoms such as wrist pain in the leather and footwear sector.

This study aims to assess the association between wrist pain and occupational stress among SMOs.

A cross-sectional study was conducted among SMOs working in a shoe and leather factory. Data collection was carried out using Computer-Assisted Personal Interviews through a pre-established questionnaire. This questionnaire consisted of sociodemographic and professional data. We also assessed occupational stress using the validated French version of Job Content Questionnaire of Karasek.

The average age of SMOs (n = 145) was 35.2 ± 9.9 years, with extremes ranging from 18 to 59 years. A female predominance was noted (sex ratio of 0.25). The average seniority in the current position was 14.4 ± 9.9 years. More than half of the population had high psychological demand, low decision latitude and low social in respectively 53.2%, 97.1% and 67.6%. Among SMOs, 76.3% had wrist pain. In bivariate analysis, wrist pain was positively associated to low decision latitude (p=0.033, OR=2.49, 95%IC [1.11-5.59]. Moreover, it was positively associated to professional seniority (p=0.014).

This study highlights a significant prevalence of wrist pain among SMOs in the leather and footwear sector. It can be exacerbated by various factors, including occupational stress. Addressing these factors is essential for enhancing both the health and productivity of this vulnerable workforce.

None Declared

Developmental Coordination Disorder (DCD) is a motor skills disorder characterized by delayed motor development. It affects approximately 6% of school-aged children, limiting their ability to perform everyday tasks. DCD is often associated with Attention Deficit/Hyperactivity Disorder (ADHD) and executive functions prejudices, making it essential to conduct more detailed investigations.

To explore potential correlations and trends between suspected DCD and behaviors related to inattention, hyperactivity, and impulsivity, as well as performance on tasks that involve attention, cognitive flexibility, and working memory.

The study utilized data from a protocol for ADHD assessment conducted at Mackenzie Center for Research in Childhood and Adolescence in São Paulo, Brazil, with approval from the Ethics Committee. The protocol consists of neuropsychological, behavioral and psychiatric assessments. For this study, the following tests were considered: Rey Complex Figure Test and the Five-Digit Test (FDT) to assess cognitive flexibility and memory, Psychological Battery for Attention (BPA) to assess attention, Total index of the ADHD questionnaire based on DSM-5 criteria (total items of greatest severity), and DCD Questionnaire for DCD assessment. Twelve children aged between 6 and 15 years, who were referred for evaluation due to complaints of inattention and hyperactivity, participated in this study. Pearson correlation analyses were performed between the DCDQ and the other collected data.

The results revealed a significant positive correlation between the DCDQ and the Rey Complex Figure Test (r=0.840, p=0.009), suggesting that better motor performance is associated with improved planning and memory functions. There was also a marginally significant correlation between the DCDQ and the BPA divided attention test (r=0.646, p=0.083), which engages working memory abilities. A marginally significant negative correlation was found between the DCDQ and the FDT cognitive flexibility test (r=-0.637, p=0.065), indicating that higher DCDQ scores were associated with shorter times to complete the test. A negative correlation was also observed for the most severe items of the ADHD questionnaire related to hyperactivity and impulsivity. However, inattention complaints did not correlate with the DCDQ scores.

Developmental coordination disorders should not be overlooked in studies and assessment protocols for children with suspected ADHD. Further investigations are needed to identify the domains and characteristics most closely associated with DCD. This will provide evidence to support the development of care programs and intervention strategies for these children.

None Declared

Research underlay various results concerning the differences focusing on gender in smartphone use and mental issues. Some find no difference, but assessing mental factors reveals the influence of social interactivity, low emotional understanding, and perceived social support variations according to problematic smartphone use.

Our research aims to investigate problematic smartphone use, mental well-being, emotional regulation, and social anxiety as a function of gender to explore specific ways of functioning in the addiction process.

The study participants were 400 young adults, of whom 104 were men (26%), 293 were women (73.2%), and three individuals (0.8%) were of another gender. The mean age of the participants was 25.9 years (SD 10.9). Registered answers refer to demographic data (gender, age, smartphone usage habits) as well as psychological measures: a Smartphone Application-Based Addiction Scale (SABAS), a Mental Health Continuum Scale (MHC), an Assessing Emotions Scale (AES), and Fear of Negative Perception Questionnaire (FNPQ).

The results showed that gender showed significant differences in the mediating factors that affect problematic smartphone use. In the mediation model, gender relates significantly related to time spent with smartphones (p=.001) and fear of negative perception (p=.001). The statistical mediation model highlighted the gender-depending significant role of the mediating factors (time of use per day, MHC, AES, FNPQ) in problematic smartphone use.

Our research highlights gender differences in excessive smartphone use, such as higher social anxiety, which is a higher predisposing factor in women than in men. Gender is a significant indirect determinant of problematic smartphone use.

None Declared

Huntington’s Disease (HD) is a serious inherited neurodegenerative disorder characterized by a progressive decline in motor and cognitive functions, along with neuropsychiatric symptoms. The pathophysiology involves extended CAG repeats in the huntingtin (HTT) gene, leading to the toxic accumulation of protein aggregates and subsequent neurodegeneration. Current treatments for HD solely provide symptomatic relief and are merely adjunctive, with no effect on disease progression. Novel gene editing technologies, such as CRISPR on the other hand, directly target mutant huntingtin at either the DNA or RNA level, and may potentially delay or halt the progression of HD through their disease-modifying effects.

This review is aimed at critically evaluating the recent advances in gene therapy and symptomatic treatment approaches, focussing on both current treatments as well as first-generation human and preclinical studies targeting HD. The review also seeks to assess the rationale for these studies, the mechanisms of action involved, and their broader implications for clinical practice and patient care.

A systematic review of the recent literature on drug-based and non-drug-based HD treatment approaches, including symptomatic and advanced gene-editing strategies, was conducted. Data pooling was carried out with random-effects models to provide calculated standardized mean differences (SMDs) and 95% confidence intervals (CIs). The review included a comprehensive investigation of strategies such as CRISPR-Cas9, prime editing, antisense oligonucleotides, and RNA interference, yielding promising data with prudent clinical utility.

Eighteen studies with a total of 2,152 participants were analyzed. A significant reduction in motor manifestations compared to controls was recorded with Tetrabenazine and Deutetrabenazine use, with an SMD of -0.65 (p < 0.001). Antidepressant supplementation showed promising effects on psychiatric symptoms, achieving an SMD of -0.70 (p < 0.001). Non-drug-related treatments moderately improved participants’ quality of life, as illustrated by an SMD of 0.58 (p < 0.001). In gene therapy-related interventions, CRISPR-Cas9 and prime editing approaches showcased a significant reduction in the levels of mutant huntingtin protein, with a mean of -1.25 (p < 0.001). Additionally, antisense oligonucleotides provided encouraging results, eliciting a dose-dependent reduction in RNA levels, with a mean of -0.85 (p < 0.001).

Combining innovative symptomatic treatments with novel gene-editing technology marks a potential paradigm shift in managing Huntington’s Disease. While symptomatic therapies are paramount to ensure optimal patient comfort, recent advances in gene therapy research hold tremendous potential in modifying and curbing disease progression.

None Declared

This study examines the frequency and underlying mechanisms of antidepressant discontinuation syndrome (ADS) in patients receiving SSRI therapy who subsequently experience viral infections such as influenza or COVID-19. Clinical observations suggest that viral infections may diminish the efficacy of SSRIs, potentially triggering ADS even without changes in dosage.

To assess the prevalence of ADS symptoms among patients undergoing SSRI treatment during viral infections and to explore potential biological mechanisms behind this interaction.

A sample of 84 individuals was recruited from a large Russian-language forum for users of antidepressants. Data on ADS symptoms onset and exacerbation during viral infections were collected using a survey based on the DESS scale. Inclusion criteria for ADS were the new appearance or worsening of withdrawal symptoms specifically during the viral illness.

A significant portion of the cohort reported ADS symptoms. Key findings included dizziness (62%), increased anxiety (40%), mood instability (57%), sleep disturbances (65%), and memory impairment (40%). Notably, brain zaps were observed in 63% of patients, identifying this symptom as distinct to ADS rather than typical viral symptomatology.

The study indicates a high prevalence of ADS symptoms in patients continuing SSRI therapy during viral infections, likely influenced by neuroinflammatory responses and cytokine release, along with tryptophan depletion driven by interferon activity. These insights underscore the importance of vigilance and potentially adapting SSRI management strategies during periods of viral illness to mitigate ADS effects.

None Declared

Cognitive behaviour therapy is the main evidence-based psychological treatment for paranoid ideations in patients with psychotic disorders. Virtual reality may improve psychological treatment, because it facilitates behaviour interventions aimed at reducing avoidance and dropping safety behaviours. We investigated the effects of virtual-reality-based cognitive behaviour therapy for paranoid ideations (VR-CBTp) compared to standard CBTp.

We performed a pragmatic single-blind, randomised clinical trial in seven mental health centres in the Netherlands and Belgium. Eligible patients had a psychotic spectrum disorder and experienced paranoid ideations. Both interventions consisted of 16 sessions maximum. Treatment could be completed early when all goals had been achieved. The primary outcome was momentary paranoia, measured with the experience sampling method (ESM). Secondary outcomes included other measures of paranoid ideations, safety behaviour, social anxiety, depression, worry and self-esteem.

103 participants were enrolled and 98 randomised to VR-CBTp (n=48) or CBTp (n=50). At post-treatment, VR-CBTp had significantly stronger effects than standard CBTp at post-treatment on momentary paranoia (interaction effect b=-0·3, 95% CI -8·4 to 7·8, n=81, p=0·04, effect size 0·62), safety behaviour, depressive symptoms and self-esteem, of which the difference in effects on self-esteem and social interaction anxiety remained at follow-up. Completers on average received 12·4 (VR-CBTp) and 15·0 (CBTp) sessions. Limited ESM compliance resulted in 43% data loss at post-treatment and 49% at follow-up.

CBTp and VR-CBTp are both efficacious treatments for paranoid ideations, but VR-CBTp may be somewhat more effective and more efficient than CBTp.

None Declared

Hashimoto’s encephalopathy (HE) is a rare, steroid-responsive neuropsychiatric disorder associated with Hashimoto’s thyroiditis. The pathophysiology of HE remains unclear, but it is hypothesized to involve an autoimmune mechanism, distinct from thyroid hormone levels. The condition often presents with a variety of neurological and psychiatric symptoms, including cognitive decline, seizures, mood disorders, and movement abnormalities. Timely diagnosis and treatment are crucial to prevent further neurological impairment.

This report highlights a case of HE in a patient with bipolar disorder and hypothyroidism.

A 42-year-old male patient, followed in psychiatry for bipolar disorder type I and in endocrinology for hypothyroidism secondary to Hashimoto’s thyroiditis, was admitted to the endocrinology department of Farhat Hached hospital, Sousse, due to fatigue, psychomotor retardation, and an enlarged goiter, in the context of discontinuation of his replacement therapy. Laboratory tests revealed a significantly elevated TSH level of 17.5mUI/L, indicating profound hypothyroidism. Hospitalization was therefore prompted by this endocrine decompensation to reinitiate treatment and to monitor him to prevent complications.

During the hospital stay, thyroid hormone replacement therapy was resumed. However, despite adequate treatment, the patient quickly became unstable, exhibiting vague persecutory delusions, marked irritability, changes in behavior, distractibility, attention problems, insomnia and confusion. This clinical picture raised the possibility of either a manic relapse with psychotic features, potentially triggered by the resumption of thyroid treatment, or Hashimoto’s encephalopathy.

Further investigations, including brain imaging and anti-thyroid peroxidase antibodies (ATPO) measurement, were performed. Brain imaging was normal, and ATPO were elevated. Given the clinical history and elevated thyroid antibodies, the diagnosis of Hashimoto’s encephalopathy was considered. The patient was started on corticosteroid therapy (prednisone), leading to a significant improvement in both psychiatric and cognitive symptoms within weeks.

This case illustrates the importance of considering HE in patients with neuropsychiatric symptoms and underlying thyroid disease. The combination of elevated ATPO levels and progressive psychiatric deterioration, with normal neuroimaging, and significant improvement with immunomodulatory treatment supports the diagnosis of HE. It is a rare condition with a reported prevalence of 2.1/100000. It presents with a wide range of neurological and psychiatric symptoms and the presentation varies among patients.

This case underscores the need for increased awareness of HE as a differential diagnosis in patients with thyroid disorders and neuropsychiatric manifestations.

None Declared

Introduction. Previous evidence showed significant discrepancies in psychiatric services utilization between migrants and reference populations in Europe. An important barrier for migrants to Europe is the lack of adequate legal entitlements. Sometimes these barriers are mistakenly attributed to cultural differences and misunderstandings because the term ‘culture’ may be used as a putative politically correct expression reifying social differences and neglecting discrimination. Our study aims were to evaluate incidence and characteristics of psychiatric hospitalizations of migrant patients compared with reference populations and to assess how the COVID-19 pandemic affected admissions. Methods. All patients admitted to the psychiatric ward “SPDC-Malpighi” of the Bologna Mental Health Department, Italy, from 01/01/2018 to 31/12/2020 were included. Differences in sociodemographic and clinical characteristics were tested by migrant status. Incidence rate ratios of hospital admissions by migrant status were estimated via Poisson regression considering population-at-risk, gender, and age-group. Results. Migrants had higher hospitalization rates due to any psychiatric disorder (IRR=1.16). The risk was especially pronounced among women (IRR=1.25) and within the youngest age-group (IRR=3.24). Young migrants had also a greater risk of compulsory admission (IRR=3.77). Regarding admissions due to a specific diagnosis, we found relevant differences in hospitalization rates for psychosis, mood disorders, and personality disorders. Finally, migrants were more likely to be admitted via the Emergency Department and less likely to be referred from a specialist. Discussion. During the year of pandemic (2020) we observed an increase in the proportion of migrants admitted voluntarily or compulsorily. Migrants, especially those from the youngest age-group, had higher hospitalization rates for any disorder. Younger migrants were also at higher risk of compulsory treatment. The distribution of psychiatric admissions during the pandemic period seemed to have further increased discrepancies in mental healthcare needs and provision between migrants and the reference population. Tailored interventions and policies are urgently needed to address this issue. Keywords Psychiatric admissions · Migrants · Pandemic · Compulsory treatments References: Tarricone I, D’Andrea G, Galatolo M, Carloni AL, Descovich C, Muratori R; Bo-East Psychiatric Admissions Study Group. Psychiatric Admission Among Migrants Before and During Pandemic: a Retrospective Study in Acute Psychiatric Ward in Bologna, Italy. J Immigr Minor Health. 2023 Jun;25(3):507-521. doi: 10.1007/s10903-023-01464-7. Epub 2023 Mar 23. PMID: 36952152; PMCID: PMC10034892.

None Declared

The rise in cannabis consumption in Morocco, paralleling global patterns, has heightened concerns over its potential repercussions on mental and physical health, as well as its broader societal implications.

This study aims to delineate the demographic and clinical characteristics of individuals affected by cannabis toxicity and elucidate the details of their exposure scenarios in Morocco.

We conducted a retrospective analysis of cannabis poisoning incidents from 2008 to 2017, encompassing both occasional and habitual users. Data were sourced from the Moroccan Poison Control Center (MPCC), providing a comprehensive national perspective.

During the study period, 553 cases of cannabis poisoning were reported, with a gender distribution of 19.3% female and 80.7% male. Notably, 245 individuals were identified as regular users. The mean age of those affected was 18.3 years. Findings indicate that children are particularly vulnerable to accidental poisoning from psychoactive substances, predominantly due to the ingestion of delta-9-tetrahydrocannabinol (THC), the principal psychoactive compound. The clinical manifestations vary depending on the dosage and pattern of use. Out of 438 cases with documented outcomes, six resulted in fatalities, while the remainder showed improvement following appropriate medical interventions, including gastrointestinal decontamination.

The escalating use of cannabis necessitates immediate and strategic public health interventions, particularly targeting the youth, to mitigate its adverse health effects and societal impact. It is crucial to develop targeted strategies to enhance preventive efforts and curb cannabis misuse among vulnerable populations.

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The level of functioning, in patients with schizophrenia, is an essential aspect in assesing and improving their quality of life. Schizophrenia is a major contributor to severe disability in adults, as it impacts patients’ capacity to live independently, engage in social activities and pursue work or education. It is important to focus not only on reducing patients’ symptoms, but also on improving their overall functioning. There are some factors, that can improve the functional capacity of these patients, such as: family support, level of education, being employed, treatment adherence.

A 64 years old man, was diagnosed with Schizophrenia at the age of 20 years old ( 44 years ago) and he has had several hospitalizations in the Psychiatry Clinic. He is living with his 90 years old mother, has never been married and doesn’t have any children. The patient finished high school, but he doesn’t have additional studies and he has never had a job. Outside the hospitalization periods, the patient has never been compliant to the amtipsychotic treatment. The mental state exam is dominated by: complex visual and auditory hallucinations; delusional ideas of interpretation and persecution; soliloquy, stereotyped speech; bizarre, desorganized behavior; diminished self-care and self-management abilities; recent and long-term memory loss.

A 65 years old man, was diagnosed with Schizophrenia at the age of 31 years old ( 34 years ago) and has had several hospitalizations in the Psychiatry Clinic. He lives with his wife, he has 3 children and 2 grandchildren. The patient finished high school and has post-secondary studies. He worked as an electrician until the age of 53 years old and then he retired due to his medical condition. The patient was compliant to the treatment for the majority of the time. The mental state exam of the patient, was dominated by: complex imperative auditory pseudohallucinations, complex visual pseudohallucinations and hallucinations, cenesthetic hallucinations; delusional ideas of persecution and interpretation, tangentiality and circumstantiality; emotional blunting, with an improvement of the symptoms over time.

The GAF scale was applied for both patients ( in 2024), and the difference between the two of them was significant, with the first patient scoring only 27 points, indicating a notable deterioration in his functionality. The second patient scored 58 points, indicating a much better level of functionality. The SQLS scale was also applied for both patients, the first one achieved a higher score, meaning a poor quality of life, whereas the second one obtained a lower score, meaning a better quality of life.

The socio-educational factors play a significant importance in the quality of life, in patients with schizophrenia Mental health professionals should be aware of this factors for helping their patients to improve their functionality.

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Since the start of the pandemic, healthcare workers (HCWs) have faced a range of infectious and psychosocial risks. Contracting SARS-CoV-2 has impacted their physical, mental, and emotional well-being, with sleep also likely being affected.

Our study aims to assess the impact of SARS-CoV2 infection on sleep quality in HCWs.

We conducted a descriptive cross-sectional study among staff at Sfax University Hospital who were infected with SARS-CoV-2 between October 2020 and June 2021, during post-COVID follow-up consultations. A questionnaire was utilized, with the medical section completed by a physician to assess sociodemographic, professional, and clinical characteristics of the infection. A self-administered section evaluated the impact of the infection on sleep quality using the Insomnia Severity Index (ISI).

Our study included 200 healthcare workers with an average age of 42.97 years. Nurses comprised 53.5% of the sample, and 41% of the participants were involved in the care of patients with SARS-CoV-2. Workplace infections accounted for 39% of the cases. At the post-COVID follow-up consultation, 83% reported persistent symptoms. According to the Insomnia Severity Index (ISI), 47.5% had no sleep disturbances, 3.5% had mild insomnia, 26% had moderate insomnia, and 8% had severe insomnia. Additionally, 38% of the staff were dissatisfied with their sleep quality following their SARS-CoV-2 infection.

SARS-CoV-2 infection impacts the sleep of healthcare workers, highlighting the need for strategies to improve sleep quality. Addressing these issues is crucial for maintaining staff well-being and ensuring the quality of care provided.

None Declared