Rehospitalization is common in psychosis, often due to poor adherence to antipsychotic treatments. Long-acting injectable antipsychotics (LAIs), particularly paliperidone palmitate 6-month (PP6M), have shown promise in improving adherence and reducing relapses compared to monthly or quarterly formulations . Rapid initiation of PP6M during hospitalization may further optimize post-discharge outcomes and enhance the therapeutic adherence, minimizing the risk of a new outbreak, reducing the impact of rehospitalization and improving patients’ quality of life.

To evaluate clinical outcomes and treatment adherence in schizophrenia and other psychotic disorders after rapid PP6M initiation during psychiatric hospitalization.

A retrospective analysis of 24 hospitalized patients diagnosded with schizophrenia and other psychotic disorders treated with PP6M within 7–10 days was conducted. Treatment adherence, follow-up attendance, and adverse effects were evaluated using McNemar’s test for statistical analysis.

Patients had a mean age of 36.8 years (SD=10.85), 64% were male, with an average of 2 prior hospitalizations (SD=3.16) in the past two years. Previously, 57% were on monthly LAIs. Post-discharge, 83% attended follow-ups. Antipsychotic monotherapy increased by 27% (p = .10) to 59%, while attendance at over 80% of appointments improved by 47% (p ≤ .001). Akathisia was reported in 25% of patients.

PP6M significantly improves adherence by simplifying treatment regimens. Increased follow-up attendance (47%) and greater use of monotherapy reflect better patient outcomes. These findings align with prior evidence on the efficacy of LAIs in preventing relapses. Rapid initiation of PP6M can reduce rehospitalizations and optimize hospital resources. The low incidence of akathisia (25%) supports its safety and tolerability for long-term use.

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Treatment-resistant Depression (TRD) nowadays it is consider a public health problem. Studies had demonstrate that TRD has higher prevalence of psychiatric comorbid conditions, twice the utilization of outpatient health care resources, 3 times the number of inpatient bed-days, and 23% higher all-cause mortality. Esketamine, the S-enantiomer of ketamine, has been recently approved for depression that has failed to respond to two or more antidepressants 2. Nevertheless, considering its steep cost, accessibility in Ecuador becomes a crucial factor. Comprehensive studies are essential to substantiate its efficacy

Evaluate the effectiveness and safety of esketamine nasal spray in a clinical sample of patients with TRD

This is an observational, retrospective and multicentric study comprising a total of 16 TRD patients treated with esketamine nasal pray, the sample was collected over a period of 2 years. Anamnestic data and psychometric assessment (MADRS and Columbia scale for suicidal ideation) were collected from medical records at baseline (T0), one month (T1) and two month (T2) follow-ups.

Clinical response was achieved in 68% at T1 and 81% by T2. Remission rates of 50% was detected by T2. Few side effects were seen in this study, 25% (4) present disossiacion 13% (3) hypertension and anxiety 12% (2) all of them were autolimited and no treatment was required. Based on the Columbia scale to assess suicidal ideation, the disappearance of suicidal risk was observed before T1 in all cases. It is important to emphasize that 2 of the patients taken into account for the study abandoned treatment before the time established. The first patient abandoned it in the second application for economic reasons and the second patient because he observed total remission of the symptoms by T1

Taking into account the results, it can be concluded that esketamine is a safe medication, given the low percentage of observed adverse effects, all of which were mild and self-limiting. Moreover, the high rates of clinical response and remission allow us to conclude its effectiveness. However, the restriced accessibility should be taken into acount due to the elevated cost of esketamine which also limits this study due to the small sample size

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The CLUMP (CLinical Utility of early intervention including the 5-Step Precision Medicine (5SPM) Method) project is a translational research initiative that aims to improve adherence to antipsychotic (AP) medications and therapeutic outcomes in patients with first-episode psychosis (FEP). CLUMP seeks to apply an early intervention model of Personalised Precision Psychiatry, based on pharmacogenetics, to this clinical group. In this specific analysis, we examine time to discontinuation of the first prescribed oral AP treatments before the implementation of the CLUMP project in Salamanca, Spain, in order to determine the impact the new Personalised Precision Psychiatry model might have on it. Indeed, given the high AP treatment discontinuation rates already identified in pragmatic, randomised controlled trials including FEP patients, these data would offer additional information about such rates in real-world clinical scenarios.

1. 1. To assess time to discontinuation for the first prescribed oral AP treatments in FEP.

2. 2. To identify specific AP with higher retention rates, which might reflect better tolerability and/or effectiveness.

This study includes a consecutive, retrospective cohort of 42 patients with FEP treated immediately before the CLUMP project implementation, who were followed for at least one year. Kaplan-Meier survival analysis was used to assess AP time to discontinuation during the first year post-treatment initiation.

Table 1 (Image 1) summarises median times to discontinuation and confidence intervals (CIs) for each AP. Survival curves (Image 2 and 3) depict treatment retention trends. The overall median time to discontinuation was 36 days (95% CI: 25-153 days), suggesting an overall high early AP treatment discontinuation. Results also showed very high variability across AP, with Paliperidone (264 days) and Risperidone (72 days) having longer retention times. However, most of the sample was initiated on Risperidone (71.2%), which affects the generalisability of these results.

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Concurring with previous randomised controlled trials, we identified a high rate of early AP treatment discontinuation in FEP treated in routine clinical practice. For most patients, the first prescribed AP was discontinued within the first month post-treatment initiation. These results emphasise the need for a more personalised AP treatment choice for patients with FEP.

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People living with severe mental illness (SMI) face a life expectancy reduction of 10 to 20 years, often due to physical comorbidities. In addition to medication side effects, unhealthy lifestyle choices may contribute to this disparity.

Understanding the experiences and views of people living with SMI regarding diet is essential in addressing these challenges.

To explore the role of nutrition and its determinants within a biopsychosocial framework, 28 semi-structured interviews were conducted with service users living in Germany, Austria, and Australia. A generic thematic analysis was applied to uncover key themes around implications of dietary behavior and its determinants.

Both positive and negative effects of diet were reported. A prominent theme was the mental strain related to body weight, which contributed to feelings of guilt and experiences of stigma. Numerous biological, psychological, and social factors were identified as influencing dietary choices and behaviors. Many participants expressed a desire for greater support in achieving dietary balance and breaking the vicious cycle between diet and mental health.

From the viewpoint of people living with SMI, dietary interventions should be more integrated into mental health care. Psychosocial aspects, such as the emotional impact of eating, are as important as biological factors like nutrient intake, emphasizing the need for a holistic approach to addressing diet in mental health care.

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This case series examines five adolescents with both gender dysphoria and pervasive developmental conditions, highlighting the social, familial, and psychological challenges involved. The cases reveal how these conditions intersect, shaping identity, social interactions, and family dynamics. Findings suggest a trend toward isolation and virtual spaces for acceptance, with limited family support often exacerbating isolation. Integrated therapeutic approaches addressing both gender dysphoria and developmental conditions are recommended to improve mental health and self-acceptance.

To explore the diversity of gender dysphoria manifestations within pervasive developmental disorders.

We analysed five cases of adolescents from Professor Doctor Alexandru Obregia Clinical Hospital of Psychiatry in Bucharest, each diagnosed with both gender dysphoria and a pervasive developmental disorder. Each case highlights unique psychological and social factors influencing the adolescents’ identities and interactions. Patients were monitored over an average period of one year to observe developments and responses to therapeutic interventions.

The cases illustrate diverse expressions of gender dysphoria among adolescents with pervasive developmental disorders:

Case 1: 12-year-old with Asperger’s syndrome and gender dysphoria, with interests and social withdrawal shaped by online interactions, further isolating her.

Case 2: 15-year-old with severe depression and Asperger’s syndrome, marked by social withdrawal, a strong attachment to solitary pursuits, and an identity struggle.

Case 3: 16-year-old with significant gender dysphoria and past suicide attempts, feeling alienated with a strong focus on transitioning.

Case 4: 17-year-old facing gender dysphoria complicated by family resistance, social anxiety, and unresolved grief, destabilizing family acceptance.

Case 5: 15-year-old with major depression, social anxiety, and emergent gender dysphoria, poor medication response, and preference for solitude, indicating an uncertain prognosis.

This study explores whether pervasive developmental disorders and gender dysphoria coexist by chance, influence each other, or share a common cause. It examines whether atypical gender identity might lie dormant and what may trigger its expression. These cases highlight the complexity of treating gender dysphoria in adolescents with developmental disorders, suggesting that tailored support and therapy can improve psychosocial outcomes and self-acceptance.

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The reproduction of the structure of the NEO-FFI has been stable across different Arabic cultures. The NEO Five-Factor Inventory-3 (NEO-FFI-3) is the revised version of the NEO-FFI-R, which describes personality in terms of the Five Factor Model, namely Neuroticism, Extraversion, Openness to Experience, Agreeableness, and Conscientiousness. The psychometric properties of the NEO-FFI-3 present a robust verification base in diverse cultures. Although there is an Arabic version of the NEO-FFI, the psychometric properties of the Arabic NEO-FFI-3 are yet unknown.

The study aims to investigate the psychometric properties of the Arabic adaptation of the NEO-FFI-3.

The Arabic version of the NEO-FFI-3 is a 60-item questionnaire, and the NEO-FFI-R 60-item questionnaire was administered to1373 Kuwait university undergraduates (559 males mean age = 20.41±1.43 and 814 females; mean age = 20.60±1.18). The internal consistency reliability, factor structure, and convergent validity of the NEO-FFI-3 with NEO–FFI-R were assessed.

Cronbach’s alpha was satisfactory for N (0.72), E (0.82), O (0.79), A (0.82) and C (0.74). Results revealed significant gender differences in N, O & C with a favor for females. PCA showed that NEO-FFI-3 five factors explains 53.98% of the total variance. However, the high mean correlations between the NEO-FFI-3 and NEO–FFI-R scales, with coefficients of (0.87) for the N, (0.85) for the E, (0.84) for the C, (0.78) for the O, and (0.77) for the A.

The findings support the psychometric properties of the Arabic adaptations of the NEO-FFI-3 as useful instruments for assessing the Big Five.

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Suicide attempt is a person’s suicidal behavior that does not result in death and may or may not result in injury. Understanding the factors associated with suicide attempts in patients with major depressive disorder is important to predicting future suicide attempts.

To identify the associated factors with suicide attempts in patients with MDD at the University Medicine Center in Vietnam.

This cross-sectional analytical study was conducted in the psychiatry clinic of the University Medical Center of Ho Chi Minh City, Vietnam, from March to October 2023. Individuals aged 18 and more diagnosed with major depressive disorder as per DSM-5 TR were included. Exclusion criteria were current psychosis, severe intellectual disabilities, and acute medical illnesses.

Participants were interviewed using a questionnaire including sociodemographic criteria, clinical information, and the Hamilton Depression Rating Scale (HDRS).

We collected 151 participants. The average age of participants was 41.3±15.5 years, and they were predominantly female (78.8%) and living in urban areas (62.9%). Nearly four fifths (79.5%) of patients are currently in severe depression. The prevalence of suicide attempts in the lifetime and past 3-months were 7.9% and 5.3% respectively.

In univariate logistic regression analysis of sociodemographic factors and clinical features of depression associated with suicidal attempt among individuals with major depressive disorder, we found that young age (OR=0,91; p=0,004), single status (OR=0,09; p=0,002), early onset of illness (OR=0,91; 95% CI 0,85-0,97), and severe depression as measured by the total HDRS score (OR= 1,19; 95% CI 1,06-1,34). In particular, the risk of a suicide attempt was 72 times higher in patients with a history of self-harm (OR=72,22; 95% CI 13,71-380,49). There was no association between gender, area, education level, cohabitation status and employment status with lifetime prevalence of suicide attempts. After adjusting for covariates using a multivariable logistic regression model, only the severity of depressive episode and history of self-harm remained significantly associated with suicide attempts.

Suicide attempts were significantly high among patients of major depressive disorder in Vietnam. The severity of depression and previous self-harm was significantly associated with it. There is a need for more research and a better understanding of the associated factor with suicide attempts in this population which in turn could lead to the development and implementation of effective preventive interventions.

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Depressive disorders with psychotic symptoms in elderly individuals are serious conditions whose diagnosis may be complicated by confusion with neurocognitive disorders. Electroconvulsive therapy (ECT) is an effective intervention for these patients when pharmacological treatments are either ineffective or not feasible due to medical comorbidities.

To describe three clinical cases of women over 69 years of age with an initial diagnosis of depression with psychotic symptoms versus neurocognitive disorder.

To assess the clinical response to ECT during their hospitalization.

A retrospective observational case series was conducted. Three female patients over 69 years old, admitted with a diagnosis of major depression with psychotic symptoms and signs of cognitive impairment, and who received ECT as part of their treatment, were included. The patients’ medical records were reviewed to gather information on their diagnosis, evolution, and response to treatment.

Case 1: Patient A (80 years old): psychomotor slowing, delayed response latency, nihilistic delusions with major affective symptoms. She received 10 sessions of ECT, with significant improvement in psychotic, depressive, and cognitive symptoms. She was discharged for outpatient follow-up.

Case 2: Patient B (70 years old): delusions of guilt, impersonation, and persecution, with concomitant major affective symptoms. She received 11 sessions of ECT, with significant improvement in affective, psychotic, and cognitive symptoms. Upon discharge, she continued follow-up with her Mental Health team.

Case 3: Patient C (72 years old): perplexed gaze, hypomimic facies, psychomotor slowing, thought blocking, no delusional symptoms, and major affective symptoms. She received 10 sessions of ECT, with little response in the affective and cognitive spheres. Care continued in the Convalescence Unit (subacute), and she was later institutionalized in a senior residence.

ECT was effective in two of the three patients in terms of psychotic, affective, and cognitive symptom response. In the third patient, where symptoms were more indicative of a neurocognitive disorder, ECT was ineffective, requiring long-term follow-up coordinated between Psychiatry and Neurology.

ECT is effective in treating major depression with psychotic symptoms in elderly patients, although it may have limited response in cases of cognitive impairment. Therefore, a comprehensive approach and multidisciplinary follow-up are required to manage these cases.

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Bipolar disorder (BD) is a chronic and often severe mental illness. Yet despite the well-documented complexities in its diagnosis and treatment, little research has been dedicated to understanding the complex inner landscape experienced by those living with BD. Even as qualitative research has explored the lived experience of BD across a variety of perspectives, i.e., what BD looks like, there is a lack of research exploring what BD means to those living with the condition.

We aimed to understand how people with BD perceive their condition, construct the meaning of their illness, and view BD in relation to their sense of self.

We conducted individual, semi-structured interviews with 20 adults with clinically stable BD. We coded the transcripts according to the principles of thematic analysis and analyzed the data using an interpretative phenomenological analysis approach.

We identified three overarching domains: (1) Benefit or burden: a dialectic through which participants weighed the valence of their illness over time; (2) Self or other: the internal or external locus through which they experienced BD; and (3) From ineffability to meaning making: the process of naming, understanding, and incorporating BD into their life’s whole. Within each domain, themes and subthemes outline nuanced and often conflicting perspectives of participants’ illness experiences.

Our work provides a framework of three domains central to the inner reality of lived bipolar experience. Thoughtful understanding of patients’ experiences, perspectives, and desires within these three domains may aid clinicians and loved ones alike in more sensitively and effectively addressing the unique individual needs of those living with BD. By exploring patients’ perspectives in each of the three domains we identified, those caring for people with BD may be better positioned to help identify the inner work and practical interventions needed to achieve a rich, meaningful life with BD.

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Negative symptoms pose a significant challenge for the treatment and management of schizophrenia. They refer to the loss or diminishment of normal emotional and behavioural functions, which profoundly impact one’s quality of life and socio-occupational outcomes. They are often persistent and difficult to treat.

To explore and assess different treatment strategies for addressing negative symptoms of schizophrenia, including pharmacological, psychosocial, and non-invasive neurostimulation interventions. The goal is to provide an overview of current evidence and recommendations for enhancing the quality of life and functional outcomes in individuals with schizophrenia.

We conducted a review of the extant literature to determine treatment strategies for negative symptoms in schizophrenia. We incorporated findings from randomised controlled studies, meta-analyses and systematic reviews.

We have identified several treatment strategies for negative symptoms in schizophrenia. The literature indicates that second generation antipsychotics such as Cariprazine and Amisulpride are associated with better functional outcomes with lower cognitive impairment. Adding on an anti-depressant, particularly to first-generation antipsychotics, has demonstrated positive effects. Psychosocial interventions including Cognitive Remediation (CR), Social Skills Training (SST) and exercise programs also alleviate negative symptoms. Additionally, non-invasive neurostimulation intervention such as rTMS applied to the left dorsolateral prefrontal cortex (DLPFC) has shown encouraging results in reducing negative symptoms.

The findings highlight the important of comprehensive and holistic treatment approach integrating both pharmacotherapy and non-pharmacotherapy strategies to address the heterogeneity of negative symptoms. There is a need for further research into personalised treatments that address individual symptom profiles.

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Lyme borreliosis is one of the most common vector diseases transmitted by tick bites; it is caused by Borrelia burgdorferi. Mostly it manifests on the skin, in the nervous system or joints. It involves the nervous system in 10-15% of cases, of which 2-4 % affect the central nervous system. The most common manifestation is encephalitis, which has a diverse clinical picture.

We aim to describe a rare case and discuss the diagnostic challenges of a rapidly progressive disease.

A detailed description of the patient based on our interview and clinical findings, including blood work, imaging, microbiological testing, lumbar puncture, and treatment.

A 67-year old female patient came to the psychiatric emergency room in March 2024, because of persistent anxiety and unexplained somatic disorders, including weight loss, tremor and unstable gait, which began a few months ago. She had some somatic diagnostic procedures done, with no abnormal findings. 2 weeks before being admitted she was sent to the emergency neurological unit because of fatigue and tremor. They excluded focal neurological signs and concluded that she had an adjustment disorder and suggested psychiatric treatment. In March 2024 she was admitted to the geriatric psychiatry ward, where at first our main differential diagnosis was pseudodementia. In the next few days her condition worsened. She appeared psychotic, with ideas of persecution and reference. On the psychological exam she had moderate cognitive decline with a focus on impaired attention, memory and executive systems, misinterpretations of past and current events, misidentifications of people and possible complex visual hallucinations. At that time we suspected she might have prolonged delirium. Because of an uncommon clinical picture, we pursued further diagnostics. The lumbar puncture showed cerebral spinal fluid (CSF) pleocytosis, which confirmed the diagnosis of encephalitis. Blood tested for multiple infectious causes was positive for Lyme borreliosis. The brain CT scan showed an inflammatory or infiltrative process in both cerebral hemispheres. We then transferred her to the infectious disease clinic where she had a brain MRI with contrast and her CSF was tested for Borrelia and other possible causes. On the MRI they suspected she had rhombencephalitis with leptomeningitis. After the diagnosis of neuroborreliosis was confirmed, she received a 4-week parenteral treatment with ceftriaxone. Two months after completing the treatment she has fully recovered.

When faced with a patient with rapidly progressive dementia a wider range of possible diagnoses has to be considered. We have to be aware of the importance of recognising the cause of the disease sooner, as the patient may have a treatable condition.

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Bipolar disorder (BD) is a mental health disorder characterized by episodes of mania or hypomania alternating with depression, and it is known that seasonal changes can have an impact on the risk of relapse. Circadian rhythm - which works as an internal biological clock that regulates sleep-wake cycles, hormone production and mood stability -, plays a crucial role in the course of the disease, and it is likely that it influences relapse during seasonal changes, through mechanisms not entirely understood.

Review the relationship between seasonal changes and bipolar disorder relapse, focusing on circadian rhythm disruption, including possible pathophysiological pathways and treatment options.

Narrative review of articles published on Pubmed’s database using the following keywords and their combinations: bipolar disorder, circadian rhythms, seasonal and sleep disturbances, screening for relevance.

Several studies show us that manic episodes are associated with transition into spring and summer and depressive ones with transition into autumn and winter. Seasonal changes result in alterations in daylight exposure, which in turn, through the cardinal role of the suprachiasmatic nuclei in the hypothalamus, lead to disruptions in sleep-wake cycles, impacting melatonin and cortisol levels, which can contribute to mood instability. These hormones are also subjected to changes by other shifts in biological rhythms such as body temperature regulation, that come with seasonal transitions. On the other hand, light exposure also influences neurotransmission, particularly of serotonin and dopamine, with consequences on energy, mood and reward processing and arousal. There might also be a role for genetic polymorphisms like CLOCK, BMAL1 and PER, that influence sleep patterns and hormonal regulation, and therefore can predispose some people to mood disorders. Furthermore, there are important social factors related to seasonal changes, such as increases or decreases in social activities, that can impact mood. Therapeutic approaches that target circadian rhythm, such as light therapy and chronotherapy (including options like sleep deprivation and phase advance therapies), can be useful in decreasing relapse episodes. Additionally, simple psychoeducation on the matter, regarding maintenance of regular sleep schedules and social activities, might be helpful in preventing or, at the very least, decreasing relapses.

Seasonal changes play a relevant role in both manic and depressive relapses in BD through their role in circadian rhythm disruption, by way of a myriad of mechanisms. Future investigation should focus on these mechanisms and others that might possibly be involved, allowing us to reach more targeted treatment and even preventative measures to diminish relapse episodes in BD.

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Psychiatry has historically underserved Indigenous people. Earlier, cross-cultural psychiatry assumed that psychiatric disorders were universal and varied little across cultures. This approach has not worked well for Indigenous people who may have different views of mind and mental health. For example, Indigenous philosophy tend to explain the world and states of mental health from a storied approach encompassing relations to land, spiritual beings, ancestors, and the community which can result in different conclusions from conventional psychiatry.

We wanted to explore what modifications in their approach practicing psychiatrists have made to be successful in Indigenous communities and to determine what was common among how communities in which they worked conceptualized mind and mental health.

We interviewed psychiatrists working in Indigenous communities regarding what was effective and how they had changed their practice to work in those communities and how those communities had changed them. We used the iterative processing of constructivist grounded theory to find commonalities in their responses. We present from rural and remote Indigenous settings in Canada (Saskatchewan and Northern Ontario), New Zealand, and Maine (USA).

We found a modified approach to psychiatric services that emphasized Indigenous values and that determined positive aspects of the client’s history as well as problem areas and engaged the client in therapy from the beginning of the evaluation. Some key concepts that emerged from qualitative analysis of interviews and case histories using constructivist grounded theory as a method of analysis included (1) reframing the person’s self-story within a threat-power-meaning network, (2) working with stories about the spirit of the suffering, (3) exploring right relationships and meaningful conduct, (4)acknowledging the intergenerational transmission of suffering. Physicians came to understand that the client sets their goals and defines what recovery means for them in discussion with their family and important community members including elders. This led to a different understanding of what privacy meant to clients. Indigenous cultures encountered were different but appeared to share some similarities including a highly relational approach to defining the self, a collectivist mindset in which the needs of the group can supersede the needs of the individual, a reliance upon stories for transmission of knowledge and culture, and a commitment to a biopsychosocial and spiritual approach.

Psychiatry can form effective collaborative relationships with Indigenous communities requring modifications in the usual worldview and orientation to how psychiatry is practiced.

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Patients with End-Stage Renal Disease (ESRD) undergoing hemodialysis (HD) are particularly susceptible to psychological disorders, such as anxiety and depression, which can significantly affect their quality of life and clinical outcomes. However, in spite of its prevalence, psychiatric comorbidity in this population remains under-recognized, contributing to worse health outcomes and increased mortality.

The primary aim of this study is to explore the prevalence of psychiatric comorbidities, particularly depression and anxiety, among HD and PD patients. Insights into the different psychological effects of different dialysis treatments are offered, emphasizing the importance of integrated mental and physical healthcare in improving patient outcomes.

A narrative review was carried out using PubMed and Google Scholar to identify relevant articles with the keywords “dialysis,” “psychiatry,” and “comorbidities.”

The review underscores the important burden of psychiatric disorders among dialysis patients. Studies suggest that depression may affect up to 50% of these individuals. Both HD and PD patients exhibit varying degrees of psychological distress, exacerbated by factors such as the invasiveness of dialysis, comorbid medical conditions (e.g., diabetes), and socioeconomic challenges. The evidence suggests that HD patients may experience an even more heightened psychiatric burden due to the more invasive nature of HD compared to PD, which imposes greater restrictions on daily activities. Psychiatric disorders in these patients are often underdiagnosed, leading to treatment non-compliance, increased hospital admissions, and elevated mortality rates. The findings stress the necessity of regular mental health screenings and the integration of psychiatric care into routine dialysis practice.

Psychiatric comorbidities are prevalent among dialysis patients, with HD patients exhibiting a greater psychological burden. This review highlights the urgent need for routine mental health screening and intervention within the dialysis care framework. The integration of mental health support into dialysis treatment protocols could lead to improved patient outcomes, fewer hospitalizations, and better treatment adherence. Future research should focus on developing customized mental health interventions that address the specific challenges faced by dialysis patients, thereby enhancing their quality of life and clinical outcomes.

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Workplace violence, particularly in the healthcare sector, is on the rise and severely affects the quality of life and performance of healthcare workers. The psychological repercussions of such violence are particularly concerning, making it imperative to develop appropriate prevention strategies.

To evaluate the prevalence of assaults against healthcare staff at the Farhat Hached University Hospital in Sousse over a 20-year period, describing the characteristics of the victims, the circumstances of the assaults, and the psychological impacts observed.

This retrospective descriptive study, covering the years 2004 to 2023, analyzes workplace injury reports related to violence at the Farhat Hached University Hospital. The sample includes healthcare workers who were victims of reported assaults, with data collected on a synoptic sheet detailing sociodemographic aspects, the circumstances of the assaults, and their consequences.

Out of a total of 5695 workplace accidents, 110 were recorded as assaults, representing a prevalence of 1.9%. The victims had an average age of 46.8 ± 6.72 years, with a strong female predominance (69.1%). The most affected professions were nurses (50%) and workers (25.5%), with the most impacted departments being maternity (15.5%), emergency (13.6%), and psychiatry (11.8%). The majority of assaults (68.2%) occurred in the morning, and the perpetrators were primarily patients themselves (38.2%) or their relatives (33.6%).

Regarding the psychological aspects of the assaults, 42.7% of incidents involved psychological violence, such as verbal abuse, intimidation, or threats. The psychological consequences were significant: 26.4% of the victims developed disorders such as post-traumatic stress disorder (PTSD) and sleep disturbances.

The high prevalence of assaults and their psychological repercussions highlight the urgent need to strengthen preventive measures. Specific training on conflict management and psychological support strategies should be implemented to improve the safety and well-being of healthcare staff.

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Case management is a model of community intervention in people with severe mental illness.

To explore the treatment adherence and effectiveness of patients with severe schizophrenia undergoing treatment in a community-based, case management program (CMP) with an integrated pharmacological and psychosocial approach compared to the standard treatment.

An observational, longitudinal study was conducted with a ten-year follow-up of patients with severe schizophrenia (CGI-S ≥ 5) treated in mental health units (MHUs) or on a CMP (N = 688). All causes of treatment discontinuation, psychiatric hospital admissions, suicide attempts, and antipsychotic (AP) medications were recorded. Clinical severity was assessed with the CGI-S.

Adherence to the CMP was higher than to the standard treatment (p < 0.001). There were fewer hospital admissions and suicide attempts on the CMP than in standard care (p < 0.001). Clinical severity decreased more in the CMP than in MHUs (p < 0.005). Long-acting injectable (LAI) AP medication was more closely related to these outcomes than oral APs (p < 0.001) in both settings, but especially on the CMP.

Treatment clinical outcomes after 10-year follow-up

N: number of patients %: percentage of patients Av: average SD: standard deviation

*: basal (at beginning of program) **: standard treatment ***: Program treatment

The treatment of patients with severe schizophrenia in a multicomponent, case-managed program recorded higher compliance and effectiveness compared to standard care. Treatment with LAI antipsychotics was linked to these outcomes. A combination of case management, psychosocial approach, and LAI AP medication contributed more to the achievement of clinical goals in these patients than the standard treatment and oral APs.

None Declared

Tattooing is a mode of bodily expression that belongs to both tradition and modernity. This form of expression is rich in variant and variable meanings for women in general, and women with psychiatric disorders in particular. Their popularity and prevalence are increasing rapidly, particularly among young people. However, despite this expansion, the social perception of tattoos, particularly among women, remains a complex and often stigmatized subject. Hence the interest in knowing the characteristics of tattoos among women in Morocco, the different perceptions of the latter as well as the correlation of tattooing with psychiatric disorders.

To study the characteristics, meaning and perception of tattoos among Moroccan women, past and present. In an attempt to better understand the potential health implications of this mode of expression and its correlation with mental health.

A descriptive cross-sectional study was carried out among women of different profiles. Data were collected using a form sent online and distributed in paper form. The form collected socio-demographic data, descriptive characteristics of the tattoos and the women’s mental health status. Statistical analysis was performed using Jamovi 2.3.

Our results focused on the socio-demographic characteristics of our population, it was carried out on 52 women, 57.7% of whom were aged between 25 and 40, 62% of our sample were single and the majority(92%) had a level of education higher than the baccalaureate. Also, almost 30% were unemployed. ours study results focused essentially on the tattoo characteristics, summarized in Image 1. Image 2 shows the results concerning the psychiatric history of our population.

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Tattooing is a means of expression and a form of body modification, rich in cultural and personal significance, with a dual affiliation to tradition and modernity. It is highly prevalent among women, and has implications for both mental and physical health.

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Schizophrenia is one of the most disabling mental disorders, affecting around 1% of the population. Although most patients respond to antipsychotic treatment, one third have a limited response to antipsychotic medication, being considered treatment resistant schizophrenia (TRS). Clozapine is the only effective medication for TRS, but 30-40% of TRS patients do not respond to it. Patients with schizophrenia who do not respond to clozapine experience more severe disability, persistent symptoms, a lower quality of life and incur higher economic costs compared to those who respond to treatment.

The aim of the present study is to review evidence for therapeutic strategies for patients with treatment-resistant schizophrenia not responding to clozapine.

Review of the literature regarding treatment-resistant schizophrenia not responding to clozapine. The research was carried out through the PubMed® database, using the terms “treatment resistant schizophrenia”, “schizophrenia resistant to clozapine” and “clozapine augmentation”.

For patients with treatment-resistant schizophrenia who do not respond to clozapine, several therapeutic strategies have been explored. These include pharmacological approaches, non-pharmacological interventions and brain stimulation procedures [Electroconvulsive Therapy (ECT) and Transcranial Magnetic Stimulation (TMS)]. However, the evidence is weak and the reported benefits were modest.

The current evidence is weak for efficacy of pharmacological augmentation strategies to clozapine. There are contradictory data regarding ECT and clozapine augmentation. More studies are necessary to clarify the potential of these strategies in order to manage these complex patients.

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