The so called “silver tsunami” i.e. the unprecedented increase in the number of older patients often affected by multimorbidity is a serious health and socioeconomic concern for modern societies and the interconnected challenges of huge workload, premature burnout, and the shortage of primary care personnel represent a pressing issue for the near future. Addressing the complexity of this issue requires a comprehensive approach due to the scarcity of healthcare professionals in European primary care. The health and well-being of both the primary care workforce and the communities they serve are intrinsically intertwined. Enhancing working conditions is a priority: addressing issues like long hours, heavy workloads, bureaucratic demands, and burnout can enhance the appeal of rural primary care practice, attracting and retaining more professionals. Wonca Europe is actively involved in addressing this issue: in June 2023 at the WONCA Europe 2023 Conference in Brussels with the statement Shortage of European Primary Health Care Workforce and in October 2023 at the 73rd Session of the WHO Regional Committee for Europe, Astana, Kazakhstan. Policymakers, healthcare organizations and professional associations need to collaborate to develop tailored solutions that address the unique challenges faced in each region. By addressing the workload of primary care doctors and other professionals, we can enhance their professional satisfaction, improve patient outcomes, and strengthen primary care as a whole.

None Declared

The increasing prevalence of metabolic syndrome in persons with schizophrenia has driven research into the underlying mechanisms of its pathophysiology. Overlapping neurobiological profiles of metabolic risk factors and psychiatric symptoms, particularly shared genetic liabilities, suggest that oxytocin system dysfunction may be a common mechanism underlying both schizophrenia and metabolic syndrome. Given its prosocial and anorexigenic effects, intranasal oxytocin has been studied for its therapeutic potential in schizophrenia and obesity. However, the pathophysiology and mechanisms of oxytocin in schizophrenia are complex and it is too early to draw definitive conclusions.

This study aims to investigate the correlation between plasma oxytocin levels and metabolic syndrome and to test whether oxytocin system dysfunction could serve as a putative endophenotypic marker of schizophrenia.

This prospective cohort study involved 90 persons with schizophrenia, all of whom were responsive and maintained on stable monotherapy with either olanzapine, risperidone, or aripiprazole, without any alterations to their antipsychotic regimen, alongside 60 healthy controls. All participants were followed for 24 months. Anthropometric measurements, metabolic parameters, and the presence of metabolic syndrome were assessed. Plasma oxytocin levels were measured. The psychopathology of persons with schizophrenia was evaluated using the Positive and Negative Syndrome Scale (PANSS), and quality of life was assessed using the World Health Organization Quality of Life (WHOQOL-BREF) scale. Other potential confounding factors, including dietary habits, caffeine and nicotine use, and menstrual cycle, were considered in the analysis.

Plasma oxytocin levels were inversely associated with the presence of metabolic syndrome in persons with schizophrenia, regardless of antipsychotic treatment. Persons with schizophrenia who had metabolic syndrome at baseline showed lower baseline plasma oxytocin levels. Among those with metabolic syndrome at baseline, higher plasma oxytocin levels were associated with better metabolic parameters at the end of the follow-up period. Conversely, for those without metabolic syndrome at baseline, lower plasma oxytocin levels were predictive of a higher risk of developing metabolic syndrome over time.

This study highlights the potential role of oxytocin in the pathophysiology of metabolic syndrome in schizophrenia. Lower plasma oxytocin levels were associated with both the presence and risk of developing metabolic syndrome, suggesting that oxytocin system dysfunction may contribute to metabolic dysregulation in schizophrenia. These findings support the hypothesis that oxytocin could be a putative endophenotypic marker for metabolic vulnerability in schizophrenia, while future studies should further investigate the therapeutic implications of targeting the oxytocin system.

None Declared

One of the great challenges for Mental Health Services is dealing with users who repeatedly use the facilities. This phenomenon, beyond representing an increase in the economic cost and in terms of human resources, generates high levels of frustration and dissatisfaction, both in professionals and in the consultants themselves. These users have been called “hyperfrequent users”. Users can frequent different services, including the Emergency service. The phenomenon of hyperfrequent use can lead to an inappropriate use of the Emergency services and gives rise to substantial costs for the health system, as well as a decrease in the efficiency of the service.

The objective of our work is to describe those factors associated with the hyper-frequent use of Mental Health Hospital Emergency Services by users who engage in suicidal behavior.

A descriptive, observational study was carried out. The population included all users of the Hospital Emergency Department treated by the Mental Health Service in one year who consulted for suicidal behaviour (self-harming ideas, suicidal attempts or self-harm). Patients who consulted on 4 or more occasions in the hospital psychiatric emergency departments for consultations related to suicidal behaviour were considered as frequent users.

860 consultations were attended to, corresponding to 546 users who consulted in the psychiatric hospital emergency departments for suicidal behaviour (self-harming ideas, suicidal attempts or self-harm). Of these users, 314 consulted on more than one occasion. Taking as a frequent user >=4 consultations, we have 14 users in one year. Regarding sex, the female sex stands out 86% over the male sex 14%. One user is considered a great frequent user, attending on 17 occasions. The most frequent reasons for suicidal consultation among frequent users are consultations for self-harm ideation (33%) and self-harm attempts (60%) and self-harm (7%). Anxiety and alcohol consumption are the most frequent comorbid diagnoses among frequent users. By sex, self-harm behavior stands out in both women and men and self-harm is more frequent in women. Regarding discharge after assessment, referrals to a community mental health specialist stand out in 45% after consultation and 28% of frequent users required hospital admission after care for suicidal behavior.

In our work, it is observed that the profile of frequent users with suicidal behavior is adult women who consult for self-harm attempts in their majority. These hyper-frequent users continue to demand attention from the health network devices, so knowing their needs would help to improve health care and use resources more efficiently and effectively for these users who engage in suicidal behavior.

None Declared

The 2020 Aegean Sea earthquake occurred on October 30, 2020, 23 km from the Seferihisar district of Izmir, with a magnitude of 6.9. It caused the death of a total of 119 people and the injury of 1053 people in Turkey and Greece. After this earthquake, many people were observed to have symptoms of post-traumatic stress disorder and received treatment. The two major earthquakes centered in Kahramanmaraş on February 6, 2023 also caused great destruction in Turkey. After this earthquake, an increase in the mental complaints of people who had previously experienced the earthquake in Izmir Seferihisar was observed and these people applied to the psychiatry outpatient clinic.

Revealing how much former earthquake victims are affected by similar events through the media.

Determining the situations that cause people to be re-traumatized.

Observing the effects of the media on mental health.

This study investigated the effects of former earthquake victims who applied to Izmir Seferihisar State Hospital after these new earthquakes, and who were not in the earthquake region at the time of the earthquake and who did not have any losses or injuries to relatives or acquaintances, through the media. For this purpose, after the earthquake centered in Kahramanmaraş, the Adult Resilience Scale and the Post-Traumatic Stress Disorder Checklist for DSM-5 were applied to these individuals at their first application, and it was questioned whether the individuals had received pharmacotherapy and psychotherapy after the previous Aegean Sea earthquake. It was also investigated how the individuals followed the news about the new earthquake. Afterwards, whether the individuals received treatment and the duration of this treatment were recorded, and the Post-Traumatic Stress Disorder Checklist for DSM-5 was applied to the individuals at the 1st, 3rd, 6th, 9th and 12th months.

People who have received psychotherapy are 1.9 times less likely to need treatment afterwards.

Women are 4.1 times more likely to be affected by the media and use SSRIs.

People who have lost their homes need treatment as often as those whose close relatives have died.

The risk of people who do not receive treatment after a disaster being affected by the media and receiving treatment is 3.4 times higher than those who received treatment during the first disaster.

After disasters, when another disaster occurs, PTSD symptoms can be observed again in former disaster victims. Post-traumatic psychotherapy can also be protective in terms of future situations. Watching traumatic events in the media can cause PTSD symptoms to be seen even if no relatives have been harmed.

None Declared

The advent of the Coronavirus Disease 2019 (Covid-19) pandemic in late 2019 precipitated a profound transformation in the daily lives of individuals across the world, with notable implications for global mental health. The fear of the virus became a significant source of anxiety and stress, compounded by the rapid dissemination of information, both accurate and inaccurate, through digital media. The growing reliance on digital platforms for health information during the pandemic underscored the significance of eHealth literacy, which pertains to the capacity to locate, comprehend, and utilize health data from digital sources. As reliance on digital platforms for health information increased, it became imperative to examine the potential impact of digital health literacy on fear and anxiety levels related to the novel coronavirus disease (2019-nCoV), also known as Coronavirus Disease 2019 (Covid-19).

The objective of this study is to examine the relationship between fear of the Coronavirus disease 2019 (Covid-19) pandemic and mental health, while investigating the influence of eHealth literacy on these fears.

The study was conducted on a sample of 158 individuals from the general population, representing a diverse range of demographic characteristics. The data were collected using a structured questionnaire comprising three sections: demographic information, the Fear of Coronavirus Scale (FCV-19S), and the eHealth Literacy Scale (eHeals). A statistical analysis was conducted to investigate the relationships between demographic factors, levels of fear, and eHealth literacy. Additionally, a comparative analysis was performed to assess the differences between individuals who had and had not contracted the virus.

The analysis revealed no statistically significant differences in the levels of fear regarding the novel coronavirus disease (Covid-19) or eHealth literacy between different demographic groups, including gender, age, education, and health status. Nevertheless, a statistically significant discrepancy was observed in the level of fear between individuals who had contracted the virus and those who had not. Specifically, those who had not been infected exhibited higher levels of fear compared to those who had previously contracted the virus. No significant differences were identified in eHealth literacy based on infection status.

In conclusion, the findings of this study indicate that while demographic factors do not appear to influence the level of fear or digital health literacy, personal experience with a confirmed case of infection does. Those who have not contracted the virus tend to experience greater fear, suggesting that familiarity with the disease may reduce anxiety. These findings underscore the necessity for interventions.

None Declared

Two high security Forensic Psychiatric Centers (FPC) were implemented in the last decade in Flanders (FPC Ghent and FPC Antwerp). FPCs provide court[1]ordered treatment for forensic psychiatric patients (called “internees”) that have committed a criminal offense related to their psychiatric disorder and who are at a high risk for recidivating.

Treatment is often mandatory and lengthy, and per[1]sonal rights are highly restricted, which has an impact on treatment motivation and overall patient wellbeing (Lutz et al., 2022). While the Risk Need Responsivity (RNR) model - which focuses on risk reduction – was and still is the prominent model for offender rehabili[1]tation, other aspects are currently given more atten[1]tion. This includes the Good Lives Model (GLM) and the recovery movement, that aim at improving the achievement of skills necessary to maintain a good live and give meaning and value in one’s existence (Lutz et al., 2022).

Data collection and statistical analyses The descriptive analyses of categorical and continuous variables was done using SPSS version 28. Valid per[1]centages were given. Assumption testing was per[1]formed and found that the data were not eligible for parametric examination. The significance level was set at .05.

Weight and BMI At the initial measurement, the mean weight was 89.3 kg (SD ¼ 21.64, range ¼ 46–222 kg). The mean weight at second measurement was 92.6 kg, with a standard deviation of 21.90 and a range of 46.6–185.6. The second weight measurement occurred 812.2 days or 2.2 years (SD ¼ 552.39, range ¼ 7–3084 days) after the initial measurement. The weight difference between the two measurements ranged from a weight loss of 53.8 kg to a weight gain of 51.6 kg and showed a mean weight increase of 2.2 kg (SD ¼ 10.41)1

The overall conclusion of the study is that obesity, MetS, smoking, as well as substance misuse are highly prevalent among our high security population. These are all risk factors associated with somatic morbidity and mortality. Our study showed that obesity and MetS were found across psychiatric diagnoses and the presence of metabolic syndrome was not limited to the use of SGA.

None Declared

Remote interaction offers new opportunities for medical-psychological rehabilitation, providing access when in-person consultations are limited. The proactive model of psychosomatic medicine, focusing on prevention and can to enable continuous monitoring and active patient engagement, crucial for those affected by post-COVID syndrome and war.

Analyze the effectiveness of a medical-psychological rehabilitation program for anxiety and depressive post-COVID disorders, as well as post-traumatic symptoms resulting from war, in the context of remote interaction.

The study sample consisted of 240 individuals with anxiety and depressive post-COVID disorders. The tools used in the study included the PHQ-9, GAD-7, and PCL-5.

By day 63, according to the PHQ-9, depression in the study group decreased to 6.942±5.073, while in the control group it remained at 15.567±6.540 (p < 0.001; t = 11.437). According to the GAD-7, anxiety reduced to 3.991±3.589 in the study group, whereas in the control group it remained higher at 12.966±3.980 (p < 0.001; t = 18.355). According to the PCL-5, PTSD symptoms decreased to 13.295±8.727 in the study group, while in the control group they remained high at 29.177±13.541 (p < 0.001; t = 10.836).

The study results indicate that the medical-psychological rehabilitation program, delivered through remote interaction, effectively reduces symptoms of depression, anxiety, and post-traumatic stress in individuals with post-COVID disorders amid wartime conditions.

None Declared

Borderline personality disorder (BPD) is characterized by instability in the area of one’s own self and affective reactions, instability in relationships, and impulsive behavior. BPD patients experience dissociative or quasi-psychotic symptoms much more often than the general population. These symptoms directly affect the daily functioning of patients, often preventing them from taking up professional work or having a stable family life. The etiology of dissociative experiences in BPD patients is still unknown. One of the biological models suggests that biological changes in the brain occur on the basis of a traumatic experience, which can produce symptoms. The arcuate fasciculus (AF) is a structure of white matter that interconnects Broca’s area and Wernicke’s area in the brain. AF is often considered in the context of research on psychotic symptoms. For this reason, we hypothesize that AF may be related to dissociative symptoms in BPD patients.

The aim of our study was to investigate a relationship between the integrity of AF and symptomatology of dissociation in patients with borderline personality disorder.

45 BPD subjects and 43 healthy controls (HC) participated in the study. A DTI analysis was performed on all study participants. The psychopathology of BPD was assessed using the Dissociative Experiences Scale - Taxon (DES-T). The AF analysis was then conducted using fractional anisotropy (FA) parameter.

BPD significantly more often than the control group experienced dissociative experiences. We could not identify differences in the integrity of the AF between the two groups. Nevertheless, we examined the correlation between the quality of the AF structure and the severity of dissociative symptoms (r=-0.0299, p=0.039).

The attenuation of the structure of AF may be involved in symptomatology of dissociation in patients with BPD. Further structural brain studies are needed in the BPD population.

None Declared

Extreme preterm birth (<28 weeks) is a significant risk factor for adverse neurodevelopmental outcomes in infants but also for heightened psychological stress in parents, both of these impacting on parent-child bonding style. Abnormal parent-child bonding may impact, in turn, on child’s emotional development. Longer stays at NICUs, with their stressful environment and caregiving demands, alongside psychosocial factors and perinatal complications can exacerbate parental emotional stress.

(i) To compare, around birthtime, levels of anxiety and depressive symptoms in parents of extremely preterm newborns (EPTN) compared to parents of born-at-term healthy control (HC) newborns; (ii) to assess, in parents of EPTN, longitudinal changes in levels of anxiety and depressive symptoms from birth up to 40 postmenstrual weeks (40PMW), and their association with demographic, clinical and environmental risk factors; (iii) to assess, in parents of EPTN, the impact of NICU-related stress and psychosocial / family context on levels of symptoms; and (iv) to examine, in parents of EPTN, the association between levels of anxiety and depressive symptoms and parent-child bonding quality around hospital discharge.

Observational, longitudinal, prospective, 24-month follow-up study. We recruited a cohort of n=150 EPTN and n=50 HC (the PeriStress-PremTEA cohort) in two tertiary hospitals in Spain. Of those, parents of n=70 EPTN and n=42 HC successfully completed, around birthtime (and at 40 PMW in EPTN) the STAI state & trait, BDI, PBQ, MSPSS and PPS at NICU questionnaires. We also gathered demographic, clinical and obstetric data from all patient & HC families. We compared, in EPTN vs HC, parental symptom levels around birth. Using logistic regression, we assessed, in EPTN, the association between demographic/perinatal variables, parental symptom levels around birth time and parent-child bonding quality at discharge.

Both fathers and mothers of EPTN showed higher anxiety and depressive symptom levels than those of HC (all p<.01). In EPTN, parental symptom levels around birth time were highly correlated with PSS NICU scores (p<.01). Levels of anxiety and depressive symptoms in mothers of EPTN predicted parent-child bonding quality at discharge, above and beyond other potential risk factors, as did level of depressive symptoms in fathers of EPTN (p<.01).

Our findings support the need to establish screening and longitudinal monitoring programs of psychopathology in parents of EPTN, both for mothers and fathers of these children, and even more so in higher-risk subgroups, such as those with higher perception of NICU-related stress.

None Declared

Childhood sexual abuse (CSA) is a major public health concern and is closely associated with dissociative symptoms. According to the betrayal trauma theory, dissociation can be interpreted as a response towards betrayal trauma (i.e., trauma perpetrated by a close person, such as a family member). No previous study has validated this theory with a focus on CSA in the Chinese context.

We hypothesized that people with betrayal CSA, but not non-betrayal CSA, would report significantly more dissociative symptoms than people without CSA. We also hypothesized that betrayal CSA, but not non-betrayal CSA, would be significantly associated with the severity of dissociative symptoms. We tested the hypotheses in two independent Chinese-speaking samples.

Sample 1 (N = 91) consisted of participants seeking treatment in an evaluation study; while Sample 2 (N = 376) included community health service users in a survey study. In both Chinese-speaking samples, participants completed the two CSA items on the Brief Betrayal Trauma Survey and the 16-item Dissociative Features Section of the Self-report Dissociative Disorders Interview Schedule (SR-DDIS). ANOVA and regression analyses were used to test our hypotheses.

Across both samples, participants with betrayal CSA reported significantly more dissociative symptoms than those without any CSA (Sample 1: M = 5.60, SD = 3.14 vs M = 3.67, SD = 3.06; F = 3.301, p = .041, Sample 2: M = 2.06, SD = 2.49 vs M = 0.93, SD = 1.32; F = 8.428, p < .001). As hypothesized, no significant differences in dissociative symptoms were observed between participants with and without non-betrayal CSA (Sample 1: M = 4.00, SD = 3.71 vs M = 3.67, SD = 3.06; Sample 2: M = 1.14, SD = 1.83 vs M = .93, SD = 1.32). Across both samples, betrayal CSA, but not non-betrayal CSA, was significantly associated with dissociative symptoms (Sample 1: β = .250, p = .024, Sample 2: β = .189, p < .001), after controlling for age and gender.

This study provides cross-cultural evidence for the betrayal trauma theory. We suggest that proactive family-centered child protection is needed to prevent CSA, and screening for dissociative symptoms is also necessary in CSA survivors.

None Declared

The rigid maintenance of an acquired response in participants with obsessive-compulsive (OC) traits has been widely reported in the literature (e.g., Hassoulas et al., 2014; 2017; 2024). As such, demonstrating flexibility in responding to concurrently presenting stimuli with differing rates of reinforcement has also been shown to be difficult for those diagnosed with OCD (e.g., Clayton et al, 1999). Matching Law proposes a quantifiable description of behaviour when consequences to responding under two concurrently presented schedules of reinforcement differ. The application of a matching procedure, whereby participants exhibiting OC traits are presented with concurrent schedules of reinforcement, would highlight this difficulty in distinguishing between stimuli that provide different rates of reinforcement. That is, the competing sources of reinforcement would relate to the concurrent stimuli that individuals with OCD have been shown to have trouble attending to separately.

Sensitivity to concurrent schedules has not been previously investigated in the context of OCD. As such, two experiments were designed to measure matching behaviour between groups of participants with and without OC traits.

A total of 60 participants (33 females, 27 male) were recruited to take part in the two studies. The Maudsley Obsessive-Compulsive Inventory (MOCI) was used to screen for the presence of OC traits. Concurrent variable intervals (VI) were presented over ten trials, with an aversive auditory stimulus serving as a punisher superimposed during every second trial. During the first experiment, VI 20-second schedules were concurrently presented with VI 40-second and VI 60-second schedules. The ratio between concurrent schedules was widened during the second experiment; with VI 20-second schedules presented alongside VI 100-second and VI 180-second schedules.

A significant interaction of trial with OC traits was revealed when the punisher was presented in experiment 1, F(4,68)=2.68, p < 0.05, but not in experiment 2 (p>0.05). The findings suggest that the presence of an auditory punisher facilitates schedule-sensitive responding in participants with OC traits, but that schedule-sensitivity is lost when intervals between concurrent schedules are widened. Figures 1 and 2 display response ratios for both high and low scoring groups during experiments 1 and 2 respectively.

Image 1:

Image 2:

The widening of the schedule ratios in the second experiment disrupted sensitivity to the schedule contingencies for the OC group. Greater flexibility in responding within this group can therefore be facilitated by considering specific parameters and rates of reinforcement.

None Declared

Over the last decade, there has been a growing recognition of the importance of identifying and treating cognitive impairment associated with bipolar disorder, as it persists during remission periods. Evidence suggests that neurocognitive dysfunction may significantly influence patients’ psychosocial outcomes. An increasing body of research aims to improve understanding of potential moderators contributing to cognitive impairment in bipolar disorder in order to develop prevention strategies and effective treatments

The aim of this study is to explore the prevalence of cognitive impairment among bipolar disorder patients and identify related factors.

It was a cross-sectional, descriptive, and analytical study conducted on bipolar disorder patients from the Psychiatry “A” Department, Hedi Chaker University Hospital. Clinical and sociodemographic data were collected from March to September 2023 through a questionnaire along with The Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA) for evaluation of subjective cognitive impairment

A total of 37 patients with BD completed the questionnaire. The mean age was 45.4 ± 13.9 years, with a sex ratio (M/F) of 1.46.

Our results showed that 73 % of patients were with BD type I and 27% were with BD type II.

The mean score of COBRA was 12.54 ± 7.62 and 32.4% of participants presented subjective cognitive disorder.

Subjective cognitive disorder was significantly associated with the number of relapses, hospitalizations and suicide attempts, with respectively p< 0.001, p= 0.02 and p= 0.05

Female patients and patients with poor income presented significantly more subjective cognitive disorders (p = 0.01 and p = 0.02, respectively).

The COBRA score was positively correlated with the number of relapses (p<0.001, r = 0.67).

Our findings indicate that a significant proportion of individuals with bipolar disorder report cognitive difficulties, which may impact their daily functioning and quality of life. Key factors such as poor income, female sex, and the number of relapses and suicide attempts were associated with higher levels of perceived cognitive dysfunction. These results highlight the need for greater attention to cognitive symptoms in the clinical management of bipolar disorder.

None Declared

The Lancet Commission noted severe mental health service disparities in low- and middle-income countries facing crises. Regarding this, the World Health Organization (WHO) developed the early adolescent skills for emotions (EASE), an experimental group-based intervention delivered by non-specialists, to offer evidence-based psychological support for adolescents with mental distress.

This systematic review and meta-analysis assesses EASE’s effectiveness in alleviating post-traumatic stress disorder (PTSD) compared with enhanced treatment as usual (ETAU).

We systematically searched PubMed, Cochrane, and Scopus for randomized controlled trials (RCTs) comparing EASE with ETAU. Our outcomes included the overall improvement in post-traumatic and depressive symptoms, measured by the Children’s Revised Impact of Event Scale (CRIES-13) and the Patient Health Questionnaire-Adolescent version (PHQ-A) scores respectively. We pooled mean differences (MD) with 95% confidence intervals (CI) in RStudio using a random-effects model. Heterogeneity was assessed with I² statistics.

Six RCTs were included with 1,417 patients, of whom 642 (45.3%) received EASE treatment. In 67% of the studies, Syria was the main location of RCT’s. A total of 688(49%) were female. CRIES-13 (MD = -0.18, 95% CI [-1.88, 1.52], p = 0.84, I² = 0%; Figure 1) and PHQ-A (MD = -0.69, 95% CI [-1.47, 0.09], p = 0.08, I² = 15%; Figure 2) scores in the EASE intervention group compared to the ETAU group showed no significant difference. In both outcomes the heterogeneity was low.

Image 1:

Image 2:

The benefit of EASE in improving mental distress in adolescents is uncertain. Additional trials will provide new evidence for EASE potential therapeutic benefits.

None Declared

Lumateperone, an atypical antipsychotic drug, 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 baseline body mass index (BMI).

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 baseline BMI: Subgroup 1 [S1]: <25Kg/m2 and Subgroup 2 [S2]: ≥25Kg/m2. 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 462 patients, out of which 276 in S1[Test=139; Comparator=137] and 186 in S2[Test=92; Comparator=94]. 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=38.1% and Comparator=36.5%; S2: Test=29.3% and Comparator=34.0%] 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 baseline BMI and both treatments were found to be well tolerated. Hence, Lumateperone can be considered as valuable treatment option in management of Bipolar II depression.

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

Shared psychotic disorder (folie à deux) is a rare mental health condition where delusions are transmitted from one person to another within a close relationship. Understanding these complex dynamics is crucial for effective diagnosis and treatment.

To present two cases of shared psychosis involving close relatives diagnosed with schizophrenia, aiming to open discussion on the complex dynamics of familial relationships and their impact on mental illness.

2 case reports.

We present two cases of shared psychosis involving close family members. The first case involves two sisters, aged 43 and 48, both diagnosed with paranoid schizophrenia. The 43-year-old sister was admitted following a suicide attempt and exhibited active psychosis with paranoid delusions. During her hospitalization, the older sister displayed identical delusions and refused her sibling’s treatment, leading to her own admission. Both sisters, previously untreated and highly educated, were managed with antipsychotic medications. While the delusions were encapsulated during treatment, concerns remain about their shared living environment and its potential influence on their ongoing recovery.

The second case involves a 33-year-old woman with a decade-long history of schizophrenia who was brought to the emergency room malnourished and uncommunicative, having not eaten for over a week. She was fed via a nasogastric tube during her lengthy hospitalization and placed on a regimen of Clozapine. The patient exhibited severe negative symptoms and behaviors suggestive of auditory hallucinations. Her mother, also of low educational and socioeconomic status, was present throughout her stay but displayed delusional beliefs that interfered with her daughter’s treatment. Following restrictions on the mother’s access to the patient, the daughter showed slight improvement and began eating independently.

These cases highlight the significant impact that familial relationships and shared psychosis can have on the progression and management of schizophrenia. The challenge in treating shared delusions lies not only in addressing the symptoms but also in mitigating the interpersonal dynamics that may perpetuate them. Further investigation into family-based psychosis and its treatment is warranted.

None Declared

Social anxiety disorder (SAD) and body dysmorphic disorder (BDD) share a unique and intricate relationship, often presenting with overlapping yet distinct anxieties about social evaluation. In patients who have undergone repeated surgical interventions, the added dimension of neuropathic pain further complicates the clinical picture, as seen in this 48-year-old male. His preoccupation with his perceived nasal and upper lip deformities, coupled with neuropathic pain from multiple reconstructive surgeries, underscored a profound interplay of psychological and somatic symptoms, warranting a multidimensional therapeutic approach.

To elucidate the diagnostic overlap between SAD and BDD in a patient with neuropathic pain post-surgery, to explore the off-label use of pregabalin in addressing both anxiety and neuropathic pain symptoms, and to highlight the subtle clinical distinctions between social phobia related to perceived physical flaws (BDD) versus the broader fear of negative evaluation in social contexts (SAD).

The patient’s history includes five reconstructive surgeries to correct perceived nasal and upper lip deformities, which resulted in significant spastic neuropathic pain. This pain was exacerbated by the patient’s intense anxiety regarding his physical appearance, manifesting as avoidance behaviors, fear of negative social evaluation, and repetitive self-evaluative behaviors typical of BDD. Initial treatment involved clonazepam and mirtazapine combined with psychotherapy. Despite partial relief of anxiety symptoms, neuropathic pain persisted, exacerbating his body image concerns. Pregabalin was introduced under the assumption that neuropathic pain was worsening his BDD-related distress and social anxiety symptoms.

Following the introduction of pregabalin, the patient demonstrated marked clinical improvements. The dual efficacy of pregabalin, particularly in its off-label role for social anxiety, contributed to a reduction in the fear of social situations, previously fueled by BDD-related preoccupations. The remission of neuropathic pain, in conjunction with improved social functioning, underscores the utility of pregabalin in addressing the complex somatopsychic interactions in patients with comorbid psychiatric and neuropathic conditions.

This case highlights the intricate diagnostic and therapeutic complexities in managing co-occurring social anxiety and body dysmorphic disorder, where psychosomatic pain further distorts the clinical picture. The addition of pregabalin, despite its off-label status for SAD, proved to be a pivotal intervention, addressing both the patient’s physical and psychological distress, incorporating psychopharmacology, pain management, and psychosocial interventions to effectively restore function and quality of life.

None Declared

Specific Learning Disorder (SLD) is a significant comorbidity in children with Attention Deficit Hyperactivity Disorder (ADHD). Both ADHD and SLD are neurodevelopmental conditions that share common characteristics, such as deficits in executive functions. Identifying SLD in patients with ADHD is crucial because targeted educational interventions are the primary treatment for SLD.

This study aimed to evaluate the utility of the Stroop Test (ST) in differentiating SLD from ADHD.

79 patients (42 with ADHD and 37 with both ADHD and SLD) participated in the study. Sociodemographic information and ST performance metrics (completion time, omission errors, and commission errors) were collected by a child and adolescent psychiatrist. Additionally, parents completed the Turgay DSM-IV ADHD Rating Scale to assess the severity of ADHD symptoms.

There were no significant differences between the ADHD and ADHD+SLD groups regarding age, gender, or ADHD symptom severity. The ADHD+SLD group exhibited longer completion times across all sections of the ST. Omission errors in the fourth and fifth sections were significantly higher in the ADHD+SLD group. After adjusting for age, gender, and ADHD symptom severity, the completion time in the fifth section and omission errors in the fourth and fifth sections remained significant. Receiver Operating Characteristic (ROC) analysis identified cut-off scores for the fifth section’s completion time (42 seconds; Sensitivity: 0.62, Specificity: 0.66) and omission errors (1 error; Sensitivity: 0.64, Specificity: 0.61). Moreover, omission errors in the fifth section predicted being in the ADHD+SLD group (p= .006, Odds Ratio [OR]= 1.527, 95% CI= 1.127–2.068).

The findings suggest that the ST may be a valuable tool for diagnosing SLD in patients with ADHD. In particular, the completion time and omission errors in the fifth section of the ST may serve as practical diagnostic indicators. Further research with larger sample sizes is necessary to confirm these results.

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Empathy, a key component of an effective physician-patient relationship, is understood as a multifaceted socio-cognitive ability influenced by various cognitive, emotional, social factors. While it has been extensively studied in medical students and healthcare professionals overall, there is limited research on empathy skills among psychiatrists, whose profession especially demands a strong capacity for empathy in their practice.

This study aimed to explore the different facets of empathy among Tunisian psychiatry trainees and assess their connections with demographic, occupational, emotional, and social variables.

Across-sectional study was conducted. An online survey was proposed to 120 Tunisian psychiatry trainees. In addition to sociodemographic and work-related variables, it comprised the Davis’s Interpersonal Reactivity Index, a 28-item tool used for a multidimensional assessment of empathy with four distinct subscales: Perspective taking(PT), Empathic concern(EC), Personal distress(PD) and Fantasy scale(FS). The survey also included the Difficulties in Emotion Regulation Scale(DERS), the Perceived Stress Scale(PSS), the Social Support Questionnaire(SSQ) and the General Self-Efficacy Scale(SE). Factors associated with empathy were evaluated using t test/ANOVA for categorical variables and correlation for continuous predictors.

The total participation rate was 71% and the mean empathy subscores were as follows: 19.04 ± 3.95 for PT, 20.41 ± 3.71 for EC, 12.67 ± 4.41 for PD and 16.40 ± 4.91 for FS. Empathy dimensions’ scores were significantly associated with the rank in the siblings, mother’s level of education, satisfactory relationship with the mother, extra-professional activities and personal psychiatric history. They also were associated with work-related factors such as the year of residency, the desired choice of specialty, the training in a general hospital with a consultation-liaison psychiatry and the perceived verbal aggression from colleagues.

Empathy dimensions’ scores, mainly those of PT and PD, were correlated with emotion regulation difficulties. In fact, PT scores were negatively correlated with five of the six emotion regulation difficulties and PD scores were positively correlated with all the six emotion regulation difficulties of the DERS. EC scores were positively correlated with PSS total score and the number of social supports. PT scores were positively correlated with SE total score and PD scores were negatively correlated with SE total score.

Our findings underscore empathy’s complexity, revealing that in psychiatry trainees, it is shaped by contextual, emotional, and social factors. Without assessing these dimensions and mediators, empathy remains a theoretical concept rather than a teachable and improvable skill.

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Sciatica pain represents a typical symptom of spinal radicular syndromes. Disability due to this pain can affect mental health of patients.

Our study aims to assess the relationship between mental health and disability among patients with chronic sciatica.

We conducted a descriptive, analytical and cross-sectional survey among patients suffering from documented common sciatic pain evolving for more than 3 months. We collected socio-professional data. We used the Hospital Anxiety and Depression Scale (HADS) and the Oswestry Disability Index (ODI).

Our study population was exclusively female, including 69 patients. The mean age of participants was 56.2 ±12.6 years. The most frequent etiology of sciatica pain was a herniated disc, followed by lumbar spinal stenosis and spondylolisthesis. The root path was L5 in 49 cases and S1 in 20 cases. The mean Oswestry score was 25 ± 4.1. The disability was moderate, severe and crippled respectively in 10.1%, 82.6% and 7.2% of patients. Regarding the patients’ anxiety levels, it was found that 76.8%, 20.3%, and 2.9% appeared to have mild, moderate, and severe anxiety, respectively. As for the depression levels of patients, 13 were mildly depressed (18.8%), 20 were moderately depressed (29%), and 36 were severely depressed (52.2%). We found that anxiety and depression were correlated with disability (p = <0.05, r = 0.2).

Our findings highlight a correlation between altered mental health and disability among patients with chronic sciatica. It is crucial to screen psychiatric disorders among these patients in order to improve their well-being.

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