Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that attracts interest, fascination, and controversy. Due to their developmental characteristics that hinder autonomy and socialization, children with ASD appear to be vulnerable and prone to victimization. Indeed, victimization has severe consequences for these children, who face risks of rejection and stigmatization. However, research on this phenomenon in Tunisia is still limited, highlighting a significant gap in the current knowledge base.

Our study aimed to determine the prevalence of victimization among children and adolescents with ASD consulting at the Regional Rehabilitation Unit of Monastir- Tunisia and identify the associated factors.

This is a cross-sectional analytical study. It included children and adolescents with ASD aged between 5 and 18 years consulting at the Regional Rehabilitation Unit in Monastir during the year 2023. Sociodemographic and clinical data of the children were collected using a pre-established form created by the working group. We used the Juvenile Victimization Questionnaire ScreenerSumVersion (JVQ-SSV) to assesse childhood victimization and major forms of aggression against youth.

Our study included 74 participants, demonstrating a male predominance with a sex ratio of 6.4. The average age of the patients was 9 years, ranging from 6 to 14 years.The main results of our study showed that participants with ASD are particularly vulnerable to victimization, with 77% having experienced at least one victimizing event in their lifetime and nearly 69% in the past year. The most commonly reported victimization events included bullying (56.7%), peer or sibling aggression (50%)… Our results revealed that 56.2% of these incidents occurred at school. Additionally, nearly 46% of children with ASD were reported by their parents to be perpetrators of victimization towards other. Univariate analysis identified significant factors associated with victimization, including the parent’s age, attendance at specialized education centers, and being a perpetrator of victimization.

The social inclusion of children with ASD, though crucial, remains fragile amid widespread victimization in both school and family environments. The concerning repercussions of these experiences necessitate focused efforts to develop and implement strategies that safeguard and support these children. Addressing the multifaceted nature of victimization and promoting protective measures are essential for improving their well-being and fostering a more inclusive environment.

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In high-income countries, Coordinated Specialized Care for First Psychotic Episode (FEP) programs have been shown to be effective in reducing symptoms and disability. Chile guarantees universal access to these services through a national policy, but previous research indicates that evidence-based approaches are not used. Our team adapted the OnTrackNY (OTNY) program to the Chilean context, called OnTrackChile (OTCH), to evaluate its effectiveness and implementation. This summary presents preliminary results on model fidelity, one of the primary outcomes of the study.

To evaluate the fidelity of the implementation of the OTCH program in comparison with usual care services for FEP, analyzing its compliance in 18 key domains of care and its alignment with the National Mental Health Plan.

A fidelity scale was designed to guide data collection on OTCH implementation. The scale included the name and definition of each domain, along with a set of expectations. The scale assessed 18 key domains, such as staffing, team integration, communication, burden of care, service flexibility, crisis, treatment planning, prescribing, care management, working with families, and education and employment support, among others. The scale was applied in the 5 OTCH intervention sites and 8 control sites that maintained usual care included in the cluster-randomized controlled clinical trial.

OTCH sites met more than 80% of the criteria for the domains assessed in the fidelity scale, which is more than twice the compliance observed in the control sites. In domains related to the usual functioning of the centers coincident with those established in the National Mental Health Plan, OTCH intervention sites exceeded compliance standards to control sites (p<0.001). In situations where the frequency of problems was similar between both types of centers, such as suicidal risk and risky substance use, OTCH centers showed significantly better performance (p<0.001) compared to control centers.

The implementation of the OTCH model has not only allowed the introduction of specific aspects of the program, but has also improved the overall performance of the centers in key areas defined by the National Mental Health Plan. This suggests that the implementation of OTCH in the Chilean context is not only feasible, but can also improve the quality of community mental health care.

OnTrack Chile is funded by the U.S. National Institute of Mental Health (R01MH115502).

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Adoption is a process which aspires to protect the children and provide them a secure home. Nevertheless these minors present very often in their new environment a wide range of different difficulties, that enhances them to adapt in their personal and academic spaces. ADHD is one of the most prevalent neurodevelopment diseases among adopted children (Mulas et al., 2016; Doom et al., 2016).

The objective of this review is to shed light on the association between ADHD and adoption.

A literature review has been carried out of scientific studies on the prevalence and risk factors for developing ADHD among adopted children from different countries of origin. Systematic reviews of papers and studies on new developments in the etiology of ADHD were also consulted.

The prevalence of ADHD in adopted children is estimated to be around 25-50% (Mulas et al., 2013; Enriquezet. al., 2017). However, this percentage varies considerably depending on the origin of the children (Eastern Europe (de Maat et al., 2018), versus China (van Ginkel et al. 2016)). However, adopted children are more easily referred to a mental health specialist, as a consequence of the fact that adoptive parents are often particularly focused on the adaptation of these children (Sánchez et al., 2012).

The postnatal environment of adopted and institutionalized childrenchildren is often marked physical, emotional, sexual or other types of abuse (Doom et al., 2016). The quality of these orphanages and foster homes contributes to the lack of stimuli that children should receive in the first 2 to 3 years of life (Mullas et al., 2015). Consequently, this social and emotional deprivation among adopted children has been related to attachment disorders and ADHD (Elovainio et al., 2015).

On the other hand, other pre- and perinatal risk factors that influence the etiology of this disorder are especially prevalent in adopted children: premature birth, low birth weight and exposure to alcohol during pregnancy (Macke et al., 2020).

The role of culture as a possible protective factor is supported by research, with immigrants showing lower rates of ADD than adopted children of the same age range (Tan et al., 2016).

Finally, early foster care in adoptive families and the promotion of family bonding and appropriate parenting strategies can help adopted children improve their regulatory skills and other typical ADHD symptoms (Barca et al.,2017).

The deprivation of affective care and the lacking opportunity to establish a relationship with a main caregiver experienced by institutionalized children can lead to the expression of this disease in genetically predisposed individuals. These fenomenon reveals the importance of connection to family and culture to promote better mental health.

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Substance abuse among adolescents has risen significantly in recent years, with serious implications for mental health and development. Factors such as peer pressure, socio-economic stress, and mental health issues contribute to this trend. Early substance use is linked to long-term risks, including substance use disorders and co-occurring psychiatric conditions. This study examines data from CHC Rijeka, highlighting trends in adolescent substance use over recent years, emphasizing the need for targeted prevention and treatment strategies.

This study aims to analyze the number of adolescent patients having issues with drug abuse, who were hospitalized at the Adolescent Psychiatry ward in order to identify trends, assess associated risk factors.

We compared the numbers of hospitalized patients who were dignosed with substance abuse, as well as the percentages of those patients per year, from 2019 until 2024.

From 2019 to 2024, the number of adolescents hospitalized for substance abuse at the Adolescent Psychiatry ward increased. In 2019, substance abuse was diagnosed in approximately 20% of all adolescent admissions, whereas by 2024, this figure had risen to 28%. This rise in the percentage of substance abuse diagnoses, relative to the total number of admissions, indicates a growing prevalence of substance use disorders among hospitalized adolescents. This trend mirrors broader national patterns of increasing adolescent substance use and underscores the urgent need for targeted prevention and intervention strategies, both in clinical settings and within the community.

The rising percentage of adolescents hospitalized for substance abuse highlights a critical public health issue. To address this, efforts should focus on early intervention, increasing access to mental health and substance use services, and implementing school-based prevention programs. Additionally, enhancing community support networks and reducing the stigma around substance abuse treatment are key to preventing further escalation of this growing trend.

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Internet gaming addiction (IGA) can have a significant impact on the characteristics of individual gamers, and may even be a contributing factor to the development of social anxiety symptoms. This study of adolescent Saudi Arabian Internet gamers examined the influences of Internet gaming time and probable Internet Gaming Disorders (IGDs). It investigated the association between Internet game addiction and social anxiety symptoms among them.

The aim of this study was to investigate the association between internet game addiction and social anxiety symptoms among Saudi adolescents. Since very few researches examined the association between internet game addiction and psychiatric illnesses among Saudi youth, Our study focused on social anxiety symptoms which has not been done so far.

A cross-sectional, survey was conducted from March to June of 2023 among adolescents in the Saudi population. Probable Internet Game Addiction was measured by using the DSM-5 checklist and the Arabic version of the Social Phobia Inventory (SPIN) was used to evaluate social phobia or anxiety.

A total of 764 participants were enrolled in the current study, majority of gaming addiction participants were 15-16 years old. There was a significant association between gender and gaming addiction (p-value ≤ 0.05). 86.6% of Saudis have been significantly associated with gaming addiction. The majority of the participants have moderate social phobia compared to severe social phobia. There was a significant association between social phobia and age (p-value ≤ 0.05). 34.9% of male participants have moderate social phobia and 24.6% of females have moderate social phobia. There was an insignificant association between social phobia and nationality. The participants with gaming addiction showed 37.2% had mild, 60.5% had moderate, 68.1% had severe and 79.5% had very severe social phobia. There was a significant association between Social Phobia and gaming Addiction (p-value≤0.05).

This study examines the association between video game addiction and social anxiety amongadolescents in Saudi Arabia. Despite its limitations of less sample size and small setting, the findings imply a significant correlation between IGA and these psychological concerns, particularly among male adolescents. Excessive video gaming use leads to higher levels of social anxiety. Future research should adopt experimental or longitudinal designs to establish causal relationships and consider the potential reciprocal nature of the association. Mental health educators and practitioners should be mindful of the adverse impacts of excessive video gaming, with a specific focus on male adolescents who might be more susceptible to heightened social anxiety.

B. Alsubaie Employee of: General physician in psychiatry department. Declare no conflict of interest, N. Alhujaili Consultant of: Psychiatry. Declare no conflict of Interest, S. Alzahrani Employee of: General physician. Declare no conflict of interest, F. Aljahdali Employee of: Medical Intern. Declare no conflict of interest, W. Alghamdi Consultant of: Associate professor of psychiatry. Declare no conflict of interest, M. Almatrafi Consultant of: Psychiatry. Declare no conflict of Interest, A. Alghamdi Consultant of: Psychiatry. Declare no conflict of interest

Bipolar disorder is a chronic disorder characterized by intense fluctuations in mood, which seriously affects the mental health and quality of life of the individual (APA, 2022). The most prominent features of this disorder include episodes of mania, hypomania and depression. In between these episodes, individuals may generally experience periods of emotional stability; however, the severity and frequency of emotional fluctuations may show individual differences. Bipolar disorder affects not only individuals’ mood, but also their cognitive functioning, social relationships, and overall mental health. In this context, the strategies these individuals use to cope with emotional difficulties play an important role in mental health. Especially in manic episodes, individuals often struggle with an uncontrolled increase in excessive positive emotions, while in depressive episodes they have to cope with intense negative emotions (Gruber, 2011). Research shows that individuals with bipolar disorder often resort to dysfunctional emotion regulation strategies, which may have a negative impact on the frequency and severity of episodes. However, studies on the effectiveness of emotion regulation strategies in individuals with bipolar disorder are limited. In particular, more research is needed on how these strategies play a role in different stages of the illness and to what extent the effects of these strategies on individuals’ overall functioning differ.

This study aims to examine the effects of emotion regulation strategies used by individuals with bipolar disorder on functioning.

The aim of this study is to examine the effect of emotion regulation strategies used by individuals with bipolar disorder on their functioning. In particular, it is aimed to analyze the differences between functional and non-functional strategies on functioning.

This study was planned according to a descriptive correlational design. Data will be collected from individuals diagnosed with bipolar disorder using the Cognitive Emotion Regulation Scale, Difficulty in Emotion Regulation Scale-Short Form (DERS-16), Young Mania Rating Scale, Brief Psychiatric Functioning Rating Scale and Sociodemographic Data Form. Participants will fill in these scales and the effect of emotion regulation strategies on functioning will be evaluated. The data will be subjected to appropriate methods for statistical analysis.

Data extraction is still on going in detailed style by principal authors. Description of studies and the key findings will be presented.

The results of this study aim to determine the different effects of functional and dysfunctional strategies on functioning in individuals struggling with bipolar disorder and to provide recommendations for interventions that can improve the mental health of these individuals.

bipolar disorder, emotion regulation, functioning, coping.

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Women with bipolar disorder (BD) face a high risk of adverse mental health outcomes during the perinatal period, including a high prevalence of affective episodes and postpartum psychosis. The challenge of management BD in this period includes balancing maternal stability while securing fetal safety, given the teratogenic risks of mood-stabilizing medications.

To evaluate the course of BD during the perinatal period, assess the impact of risk factors, and examine the effectiveness of therapeutic interventions.

This prospective cohort study included 23 patients with various sociodemographic characteristics, diagnosed with BD (ICD-10 criteria). They were monitored over the course of 6 months utilizing EPDS (Edinburgh Postnatal Depression Scale), and the Young Mania Rating Scale at baseline, 3 – months and 6-months follow up, in addition to a clinically guided interview, non-standardized sociodemographic and risk factors questionnaire. The patients were treated with a combined approach in a specialized unit for mothers, including individual and group therapy, along with pharmacological treatment. Nearly all patients were switched to atypical antipsychotics with stabilizing effects while valproate was excluded due to teratogenic risks.

The cohort comprised mostly of women over 30 (69.6%, p = 0.006), married (78.3%, p = 0.000), with stable socioeconomic status (69.6%, p = 0.008). Combined treatment (inpatient and outpatient) was predominant (82.6%, p = 0.000), with antipsychotics either alone (21.7%) or in combination with other medications as the most common treatment (91.3%, p = 0.000). All participants reported risk factors, including history of affective episodes (95.6%), traumatic events, intimate-partner violence (34.8%), substance abuse (26.1%), and unplanned pregnancy (21.7%).The EPDS scores showed a low likelihood of depression at baseline, 3, and 6 months (56.5%, 69.6%, 69.6%; p < 0.05), with mean scores decreasing from baseline to three months and slightly increasing at six months (p = 0.81). The YMRS scale indicated a significant reduction in mania from baseline to six months (p = 0.038). There was no significant correlation between risk factors and postnatal depression (p > 0.05).

The study confirms that BD women are at high risk for affective destabilization during the perinatal period. While continuous treatment mitigates severe mood deterioration, BD women remain vulnerable, necessitating long-term monitoring. One or more risk factors were registered in all of the participants. Although no direct significant correlation was observed in this study, existing literature suggests that risk factors such as unplanned pregnancy, abrupt medication changes, and intimate-partner violence are associated with adverse outcomes in BD women during the perinatal period. Understanding and managing these risks is essential for comprehensive BD care.

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Wisdom is a capacity which is needed to cope with difficult situations in life. Wisdom can be trained like other capacities. Wisdom psychotherapy has been developed as a method of cognitive behavior therapy to help patients who are stuck in negative life experiences, or confronted with unsolvabale dilemmas.

Test the efficacy of wisdom psychotherapy in patients with adjustment disorders.

patients with adjustment disorders (>18 on the ADNM8 scale) were randomly assigned to group wisdom therapy (WT: N=114), or group behavioral activation therapy (BA: N=109). Additionally a matched group of patients was build, which were not included in any study procedures but underwent routine treatment only (RT: N=114). Wisdom was measured with the Multidimensional Wisdom Competency Scale (MWC15).

There was an increase on the MWC15 of 5.3 in the wisdom group as compared to 0.4 in the activation group and 0,2 in the routine group. This is statically sigificant in the pre-post comparison and in the time/goup interaction (F4,42, p=0,13). The ADNM8 score, the SCL90 GSI, the BDI score decreased, with a trend for more side effects in the wisdom than the activity group.

The results confirm that wisdom psychotherapy can make a difference in the improvement of wisdom capacities. Wisdom therapy, different from other psychotherapies, does not aim at increasing hedonic or symptom free wellbeing but rather eudaimonic wellbeing in order to teach patients to live a decent and successful life.

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The COVID_19 pandemic has affected all facets of living, notably our sleep-wake cycle. In fact, sleep disturbances have been reported, not only during the acute phase, but also after the episode. Previous studies have shown that some socio-demographic characteristics are associated with sleep problems.

To assess the relationship between sleep disturbances and the sociodemographic profile of the COVID-19 survivors.

We conducted a prospective cohort study including 121 Tunisian COVID-19 inpatients who had been discharged alive from hospital. Each enrolled patient was asked about the period before the hospital stay, and the 6-9 month-period after hospital discharge, using the Arabic validated version of Pittsburgh sleep quality index “PSQI” scale to assess sleep problems.

The median age of our participants was 59 years old. Among them, 62 (51.2 %) were females. One hundred and eleven patients were married (91.7%), 102 patients (84.2%) had at least a primary educational level, while 19 (15.7%) patients were illiterate. Among the participants 86 (71.07%) had a job at the time of the infection, among them, 9 (7.4%) were Heath care providers. Ninety-five (78.5%) participants were non-smokers. As for alcohol use, 11 patients (9.1%) consumed alcohol. According to PSQI, the incidence of sleep disturbances after COVID was 48.8%. Sleep duration, sleep quality as well as sleep onset latency, sleep disturbances and sleep efficiency were the most affected domains in the PSQI. Females showed significantly higher PSQI after the COVID-19 infection (p<0.001). Non-married participants reported significantly higher scores of hypnotic drug use and daytime dysfunction (p=0.006, p=0.02 respectively). Quality of sleep was significantly poorer in illiterate patients (p=0.036). Health care providers had worse daytime dysfunction in comparison to other occupations (p=0.035). Non-smokers showed a deteriorated sleep efficiency as well as daytime dysfunction (p=0.03, p=0.021 respectively). No statistical association was found between sleep problems and age nor alcohol consumption.

Our study highlighted several associations between sleep problems and sociodemographic characteristics of COVID-19 survivors. This helps clinicians to pinpoint the at-risk people, in order to intervene when needed.

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Culture fundamentally influences human thinking, feeling and behaviour. The integration of cultural contexts into psychotherapeutic treatment is therefore essential, especially in light of the increasing diversity of our society. In addition, psychological stress following experiences of migration or flight requires special treatment expertise. Thus, intercultural psychotherapy is an essential approach in addressing mental health issues across diverse populations.

Life-threatening events, to which we feel helpless and at the mercy of, can inflict severe psychological trauma on us. If the event is too aversive, too horrific, and therefore cannot be autobiographically interwoven, fragments of memory are created that are not modified over time - like ordinary memories - but remain rigid, as if ‘frozen’. They are activated by triggers reminiscent of the original situation and then reappear, e.g. in the form of flashbacks. The high number of people with migration and refugee backgrounds with trauma-induced secondary disorders calls for culturally sensitive, trauma-focussed psychotherapies to close the enormous gap in care. Numerous psychotherapies are available for the treatment of trauma-related disorders, some of them have yet to be evaluated - or modified for the treatment of traumatised persons in the context of migration and flight in the case of those that have already been well evaluated. This presentation will give an overview on cultural and migration-related aspects of trauma-related disorders.

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Cognitive impairments are present from the first manifestations of the disorder, including social cognition in individuals at ultra-high risk for psychosis (UHR). While advances in psychopharmacology in recent decades have significantly altered the course of the illness, antipsychotic therapy is more effective in treating positive symptoms than negative symptoms, comorbid depression, and cognitive and social cognitive dysfunction. Again, cognitive impairment has a significant impact on functional outcome, more so than symptom severity.

Due to the particular significance of cognitive deficits, it is very important to identify them accurately at an early stage. Strategies for identifying cognitive deficits are presented in an EPA guidance paper.

To improve cognition in patients with schizophrenia, it has been suggested to combine pharmacotherapy with neuropsychological training. A meta-analysis showed the positive effect of cognitive remediation programmes in schizophrenia. While the strategies available today for the treatment of cognitive dysfunction are useful and should be implemented, it is hoped that pharmacological add-on strategies will come onto the market to have a greater effect on cognitive impairments.

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Adults with intellectual and developmental disabilities (IDD) often struggle to access suitable psychiatric care due to cognitive and communication challenges. Traditional mental health services are not always well-equipped for these needs, highlighting a critical need for evidence-based, IDD-specific guidelines. Expanding research, especially randomized controlled trials (RCTs), is essential to develop personalized, effective treatments for this population.

This poster aims to outline current gaps in psychiatric care for adults with IDD, propose strategies for treatment adaptation, and emphasize research priorities to advance evidence-based care for this underserved group.

A literature review assessed studies on treatment adaptations for IDD, focusing on the effectiveness of current interventions and limitations in existing research. Priority was given to innovative care approaches and adaptations in standard mental health treatments.

Psychiatric care for adults with IDD often involves adapting treatments like cognitive-behavioral therapy (CBT) and pharmacotherapy with simplified, patient-centered methods. For example, CBT adaptations may include breaking techniques into smaller steps, using visual aids, and shorter sessions, which accommodate cognitive limitations. Personalized care is essential due to varying abilities within this population. Pharmacological treatments also require careful titration and close monitoring, as the risk of side effects is higher among those with IDD. However, few RCTs assess the efficacy and safety of treatments for severe psychiatric disorders in the IDD population, underscoring the need for more rigorous research to support clinical guidelines. To overcome recruitment and follow-up barriers in RCTs, studies suggest alternative methods such as targeted outreach through day centers, provider organizations, and one-on-one approaches, which have been effective in reducing dropout rates. Furthermore, bipolar disorder treatment in IDD is particularly under-researched, despite its significant impact on quality of life, highlighting a need for focused studies in this area.

Enhancing psychiatric care for adults with IDD will require systemic changes, including increased research funding, IDD-specific clinical guidelines, and improved provider training. RCTs focused on adapted therapies and pharmacological interventions are crucial to build a strong evidence base. By promoting individualized, evidence-based approaches, the field can better meet the unique needs of adults with IDD, ultimately improving mental health outcomes and quality of life.

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Hemodialysis, although crucial for maintaining the survival of patients suffering from end-stage renal disease, can have severe repercussions on patients’ overall quality of life and sexuality.

To determine the prevalence and factors associated with sexual dysfunction in hemodialysis patients.

This is a multicenter, descriptive, cross-sectional study with analytical aims, conducted at 3 hemodialysis units (the Mahmoud El Matri Hospital in Ariana, the El Manzah private hemodialysis center and the El Omrane polyclinic) over a 5-month period (August-December 2023). Patients’ sexual dysfunction was assessed using the IIEF5 scale.

Our study population comprised 73 patients. Patient ages ranged from 25 to 86 years, with a median age of 56.87 years. Twenty-eight subjects (38.4%) were between 56 and 70 years of age. Sixty patients (82.2%) were married, with 68 living with relatives. Regarding anamnestic data, organic comorbidity was found in all patients with diabetes in 67.1% and arterial hypertension in 50.7% of cases. The median duration of hemodialysis was 48 months. The frequency of hemodialysis sessions was 3 per week in 69 patients (94.5%).

Erectile dysfunction was diagnosed in 64 patients, corresponding to a prevalence of 87.7%. The dysfunction was mild in 24.7% of cases, moderate in 45.2% and severe in 17.8%.

Erectile dysfunction was significantly correlated with age over 55 with an adjusted OR = 2.43 and the presence of diabetes with an adjusted OR = 1.5.

The prevalence of erectile dysfunction is high in hemodialysis patients. A systematic sexological approach is needed to ensure early and appropriate management.

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Persistent sexual arousal syndrome (PSAS) is characterized by unwanted and distressing genital sensations that persist for long time periods without concurrent sexual desire or fantasies. The aetiology of this remains largely enigmatic although it is likely that the condition has a diverse set of neurological, vascular, pharmacological, and psychological precipitants.

To analyze the case of a woman with schizoaffective disorder (severe depressive decompensation) and a comorbid PSAS.

We study the clinical case of a 47-year-old patient who was admitted to the acute care unit due to a major depressive condition with psychotic symptoms in the context of a schizoaffective disorder after partial abandonment and erratic taking of the medication she was previously taking.

Before the admission, the patient was hypomimic, perplexed, with psychomotor inhibition, bradypsychia, thought blockages, sadness, emotional lability, apathy, anhedonia, paranoidism, phenomena of reading and thought control, self-referentiality, delusional ideas of harm and auditory pseudohallucinations in the form of voices that urge her to harm herself. In addition, the patient presented several “sexual” crises that appeared paroxysmal throughout the day, consisting of episodes of sexual hyperarousal in the absence of desire, experienced with intense guilt. Initially, a differential diagnosis was made through an extensive history and organic screening, and she was finally diagnosed with a comorbid PSAS.

Complementary tests (complete blood, urine and imaging tests) were normal.

At the pharmacological level, several strategies were used that were ineffective: paliperidone up to 18mg/day that had to be withdrawn due to intolerable extrapyramidal effects, olanzapine up to 15mg/day with high sleepiness and finally caripracin up to 12mg/day with good tolerance and efficacy. Stabilizing treatment (valproic acid 1000mg/day with optimal blood levels (99.3 microgr/mL)) were added. However, after a month and a half of admission and given the little improvement of the depressive symptoms, even having added an SSRI for 2 weeks at full doses, it was decided together with the patient and her family to start Electroconvulsive Therapy (ECT)sessions. The patient received 12 sessions of bitemporal ECT with onset of response from the 6th session, with a complete remission of the sexual crisis and depressive symptoms.

To our knowledge, Yero et al., reported the first two cases of patients with concomitant PSAS and bipolar disorder treated with ECT. It is important to understand how sexual symptoms differ in PSAS and bipolar disorder. Remission of the mood episode could have been accompanied by resolution of the sexual symptoms. Although ECT was successful, the mechanism of action in treating PSAS is unknown, and it is premature to suggest that it should be recommended as a first line treatment of PSAS.

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Gambling disorder was previously classified as an impulse control disorder in the DSM-IV, but with the introduction of DSM-5, it has been redefined as a behavioural addiction. This reclassification reflects a growing understanding of how gambling shares many characteristics with substance use disorders, including the compulsive nature of the behaviour, its neurological underpinnings, and the significant consequences it has on an individual’s life. The shift from an impulse disorder to an addiction framework highlights the chronic, relapsing nature of the condition and underscores the need for more comprehensive treatment approaches. Gambling disorder is now recognized as one of the major public health issue due to its association with significant psychological, social, and financial harm. Furthermore, it frequently co-occurs with other psychiatric conditions, particularly mood disorders and substance use disorders, making treatment and recovery more complex. This dual diagnosis often results in overlapping symptoms that reinforce each other, complicating the course of treatment and decreasing the likelihood of sustained abstinence. Addressing the multifaceted nature of gambling disorder is critical to improving therapeutic outcomes, particularly in individuals with comorbid conditions.

This case report aims to examine the challenges in maintaining abstinence in individuals with co-occurring substance use and gambling disorders, focusing on the role of impulsivity and motivational instability. It also seeks to explore effective treatment strategies to improve long-term recovery outcomes.

A case report approach was employed, following a 23-year-old male patient with a history of multiple psychiatric hospitalizations due to substance use and gambling disorders. The patient’s treatment journey was analysed, with particular attention to his motivation, therapeutic engagement, and relapse patterns.

The patient struggled with maintaining long-term abstinence due to impulsivity, frustration intolerance, and repeated relapses, exacerbated by non-compliance with treatment. Although initial motivation for recovery was present, it deteriorated over time, resulting in premature termination of treatment programs. Persistent gambling and substance use led to significant personal and financial consequences.

Effective treatment for co-occurring gambling and substance use disorders must prioritize enhancing frustration tolerance, impulse control, and stable motivation. Comprehensive therapeutic interventions, continuous support, and realistic goal-setting are crucial for improving abstinence and preventing relapse. Understanding the interconnectedness of gambling and substance use is key to tailoring effective treatments.

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Major depressive disorder is a global mental health challenge imposing a serious burden on individuals and society. Treatment resistant depression (TRD) is most commonly defined as inadequate treatment response following at least two consecutive antidepressant trials of adequate dose, duration and treatment adherence. TRD is associated with high personal suffering, considerable functional impairment and significant mental health costs.

This study investigated the rate of TRD in treatment-seeking outpatients with major depressive disorder and clinically-related variables. We hypothesized that patients with TRD would have more severe symptoms, chronic course and more hospitalization than patients without TRD.

The files of patients diagnosed with Major Depressive Disorder who had applied to the Outpatient Psychiatry within the last 3 months and had a follow-up history of at least 1 year were reviewed (n=204). Demographic and clinical data of the patients were recorded using a structured data form. Dutch Measure for quantification of Treatment Resistance in depression (DM-TRD) scores were calculated. The study was approved by the Akdeniz University Ethics Committee (approval date:22/8/2024).

Regarding the index episode, the majority of patients had received selective-serotonin reuptake inhibitor (SSRI) treatment (22% escitalopram, 14.2% sertraline). 30.9% of the patients had received augmentation. After the first treatment trial, 21.1% of the patients had treatment-response, and 30.7% achieved remission. After the second treatment trial, 10.5% showed treatment-response, and 16.3% achieved remission. The proportion of patients meeting the criteria for TRD was 29.9%.

When comparing patients with TRD, the total number of depressive episodes was significantly lower (p=0.01), the duration from the onset of the index episode to treatment and recovery was longer (p<0.001, p=0.02; respectively) in those with TRD. The number of ECT episodes and rTMS sessions was higher (p<0.001, p=0.004; respectively), the DM-TRD score, the frequency of benzodiazepine use and the rate of inpatient treatment were also higher (p<0.001, p<0.001, p=0.01; respectively). The rate of non-adherence to treatment, the rate of chronic episodes and symptom severity were higher, functional impairment was more severe, and the frequency of comorbid personality disorders was higher (p<0.001, all).

To the best of our knowledge, this is the first study reporting TRD data from Türkiye. Our results showed that patients with TRD had more chronic and less repetitive illness course, duration of untreated depressive symptoms were longer, use of benzodiazepine, ECT and rTMS treatments were more frequent and longer than patients without TRD. These results should alert clinicians about subprofiles of patients with TRD to predict course and develop preventive effective strategies.

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Obsessive-compulsive disorder (OCD) is a significantly disabling and difficult-to-treat psychiatric disorder. Non-invasive neuromodulation techniques like repetitive transcranial magnetic stimulation (rTMS) have been increasingly used in the management of OCD. This study aimed to compare the efficacy of early augmentation with low-frequency rTMS (LF-rTMS) and continuous theta burst stimulation (cTBS) in improving psychopathology in OCD patients.

The study design was a parallel-group, double-blind, randomized clinical trial. The study recruited 46 OCD patients who were randomly allocated to receive either LF-rTMS or cTBS (23 patients in each group) following the computer-generated random table method. All participants were rated on YBOCS, HAM-A, and HAM-D at baseline and third week and sixth weeks. These patients received a total of 15 sessions of LF-rTMS or cTBS stimulation once daily for 5 consecutive days in a week for 3 consecutive weeks over the right dorso-lateral pre-frontal cortex (DLPFC) area.

There was a statistically significant improvement in the total YBOCS score for both the LF-rTMS group and the cTBS group at the end of the third and sixth week when compared with their baseline scores. However, there was no statistically significant difference between the 2 groups in terms of the improvement in the total YBOCS score, as well as the total scores for the HAM-A and HAM-D during the follow-up periods.

The study results suggest that both LF-rTMS and cTBS were equally effective in managing OCD patients as an early augmentation strategy.