Substance use is an onging public health burden. As a result all psychiatrists encounter patients with substance use and addictive disorders, either as primary mental health issue, or as co-occurring with other mental health issues. In this presentation, first trends in substance use across Europe will be presented, based on findings from the European Union Drugs Agency (EUDA). Next, findings on co-occurring other mental health issues will be discussed, with a focus on co-occurring Attention Deficit Hyperactivy Disorder (ADHD). Recent findings from the International Colaboration on ADHD and Substance Abuse (ICASA) will be shared. ICASA’s most recent work was the longitudinal International Naturalistic Cohort Study of ADHD and Substance Use Disorders (SUD). Nearly 600 patients with both ADHD and SUD in treatment were followed for nine months. About two thirds of participants received some kind of ADHD treatment, with half receiving pharmacologic treatment, one third receiving psychological treatment, and only one-fifth receiving combined pharmacologic and psychological treatment. Higher ADHD symptom severity and sobriety at intake were associated with receiving ADHD treatment. These findings suggest that treatment of SUD and ADHD is suboptimal. The implementation of ICASA’s consensus statements on diagnosis and treatment of co-occurring ADHD and SUD could help improve quality of care for these individuals.

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Perinatal depression (PND) is a debilitating mood disorder that occurs during or following pregnancy. Information regarding characteristics associated with PND can aid in better understanding the disease.

Examine patient characteristics and comorbidities of PND patients and matched non-PND controls in a UK electronic health record (EHR) database.

Women aged 12-55y with a delivery record (livebirth, stillbirth, mixed birth) during Jan 2017-Dec 2021 were selected from the Clinical Practice Research Datalink (CPRD) GOLD primary care database via a pregnancy algorithm. PND was ascertained using read codes during pregnancy or one year after the end of pregnancy date (EPD). Two ways to define PND were explored: 1) restricted definition (PND-r) where only PND codes were included; 2) broad definition (PND-b) including both PND and 34 other depression codes. For each PND case, two controls were matched on key patient variables such as age, depression history, and pregnancy outcome. Patients were required to have at least 12 months (mo) of continuous enrollment prior to and post EPD. Patient characteristics and select psychiatric and pregnancy-related comorbidities were compared, and prevalence rate ratios (PRR) and 95% Wald confidence intervals (CI) were calculated comparing cases and controls.

The study included 2,214 cases of PND-r and 4,718 cases of PND-b, and their respective non-PND matched controls. PND-r and PND-b cases differed in timing of diagnosis. Of the PND-r cases, 6% were diagnosed during pregnancy and 47% in the first 3mo following delivery; whereas the distribution in the PND-b was, respectively, 18% and 30%. The mean age of the PND-r and PND-b cohorts was consistent (29y, SD=6). A prior recorded history of depression was present in 36% of PND-r cases and 43% of PND-b cases. Approximately 55% of PND-r cases and 65% of PND-b cases had a history of antidepressant use prior to last menstrual period.

During the 12mo pre-EPD, PND-r cases had higher prevalence of hyperemesis gravidarum (PRR=1.5, 95% CI 1.3-1.8), gestational diabetes (PRR=1.4, 95% CI 1.1-1.7), and anxiety/panic disorders (PRR=1.8, 95% CI 1.3-2.3) compared to controls. During the 12mo post-EPD, PND-r cases had higher prevalence of comorbid anxiety/panic disorders (PRR=3.8, 95% CI 3.0-4.9) as well as post-traumatic stress disorder (PRR=3.1, 95% CI 1.5-6.1) compared to controls. Results were similar in the PPD-b analyses, but with higher PRR of anxiety/panic disorders (post-EPD PRR: 11.2, 95% CI 9.7-12.9).

80% of PND-r and 71% of PND-b cases were diagnosed during pregnancy or in the first 6mo following EPD. Cases had higher prevalence of certain pregnancy and psychiatric conditions compared to controls, with comorbid anxiety/panic disorder estimates higher using the PND-b definition. Future research should consider comparing results using both broad and restricted definitions of PND in EHRs.

C. Gillis Shareolder of: Biogen, Employee of: Biogen, S. Chen Shareolder of: Biogen, Employee of: Biogen, C. Mak Shareolder of: Biogen, Employee of: Biogen, E. Tworkoski Shareolder of: Biogen, Employee of: Biogen, L. Li Shareolder of: Biogen, Employee of: Biogen, S. Eaton Shareolder of: Biogen, Employee of: Biogen, C. Green Shareolder of: Biogen, Employee of: Biogen, N. Maserejian Shareolder of: Biogen, Employee of: Biogen, M. Koch Shareolder of: Biogen, Employee of: Biogen.

The Autonomous Region of the Azores faced considerable challenges in providing comprehensive, efficient, and integrated mental health care services, exacerbated by geographical isolation, resource constraints, and the absence of a cohesive system for referrals and quality assessment in mental health care.

Despite the recognized need, the integration of mental health services into primary health care (PHC) and the broader health system in the Azores was fragmented. Key issues included lengthy waiting lists, inadequate referral systems between primary care and specialized psychiatric services, and a lack of standardized quality assessment and performance indicators for mental health care. Additionally, there was a significant need for community mental health teams, emergency management of agitated patients, and comprehensive training for health professionals in psychiatric care.

Through collaborative efforts, the region achieved notable advancements, including the creation of referral criteria from PHC to psychiatry services, structuring inter-service referrals, reactivation of Community Mental Health Teams, and establishment of a “Physician’s Bank.” Noteworthy was the elimination of a waiting list of over 1,000 patients and the development of quality assessment and performance indicators. The construction of a courtyard for involuntarily hospitalized patients and the creation of an emergency room on Faial Island further exemplified the tangible improvements in patient care and system efficiency. Training programs were extensively implemented across various professional groups, enhancing the capacity for mental health care delivery at all levels.

The integration efforts underscored the value of cross-sector collaboration, stakeholder engagement, and the adaptation of models like the SURE framework and COM-B theory to address the multifaceted barriers to mental health care integration. Key facilitators included the development of guidelines, training, and clinical supervision, alongside innovative approaches to public health interventions.

The transformative work in the Azores exemplifies how integrated care models, supported by strategic collaborations and policy reforms, can significantly enhance mental health service delivery in geographically isolated regions. It underscores the importance of systemic approaches to training, infrastructure development, and stakeholder engagement in achieving sustainable improvements in mental health care.

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The prevalence of depressive symptoms and cognitive decline increases with age. Understanding the temporal dynamics of these symptoms could provide valuable insights into the early stages of cognitive decline, allowing for more timely and effective treatment and management.

Our objective was to explore how depressive symptoms, apathy, limitations in daily life activities, and cognitive impairment evolve and interact over time in older individuals. Specifically, we aimed to determine whether changes in these symptoms could help identify subsequent cognitive decline. We used Dynamic Time Warping analysis to model and characterize the progression of these symptoms, examining their relationships both at individual and group levels.

Participants from the Prevention of Dementia by Intensive Vascular Care (preDIVA) trial cohort with baseline and ≥3 follow-up measurements were included, with a median of 6.7 years of follow-up. Dynamic Time Warping analysis was used to model temporal dynamics of individual constituents of the Mini Mental State Exam (MMSE), activities of daily living (ADL) using the Amsterdam Linear Disability Scale (ALDS) and depressive symptoms using the 15-item Geriatric Depression Scale (GDS-15).

The 1537 participants had an average age of 74 years at baseline, 56.5% were female, and 19.9% had finished a higher education. The directed analyses revealed a nuanced temporal pattern, wherein certain depressive symptoms preceded cognitive decline indicators, and vice versa. The GDS-15 symptoms with the strongest outstrength, meaning changes in these symptoms preceded subsequent changes in other items, were the apathy symptoms ‘dropped activities/interests’, ‘energetic’ and ‘not doing new things’ (all p’s<.001). The MMSE constituents with the strongest instrength, meaning changes in these symptoms were preceded by changes in other items, were ‘immediate memory’, ‘verbal comprehension’ and ‘naming objects’. Decline in ADL function was a consistent predictor of worsening of depressive symptoms and cognitive decline (p<.001).

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An increase in apathy and a decline in ADL preceded mood-related symptoms and cognitive impairment in older people aged 70-78 years.

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Addiction treatments are complex, and their goals have changed over time. In the past, abstinence was the main objective. Nowadays, treatments focus on people and their recovery. They are developed to act in many areas of life, therefore appropriate measures are needed that really show the results achieved. One of the variables that has been shown to be appropriate for measuring the results of interventions is quality of life.

Our main objective was to evaluate the results of the intervention carried out on people who have been discharged, with an instrument that includes data on quality of life. Another objective was to standardize the measurement of results, establishing reliable criteria that include the diversity of people in treatment for addictions.

A computer-assisted telephone survey was conducted, with 575 people, between May 2023 and June 2024. They had been for 3 or 6 months on therapeutic or voluntary discharge.

Criteria for therapeutic discharge, voluntary discharge, and abandonment were established. They included results in different areas: substance use, health and self-care, mental health, social/family integration and educational/work.

The World Health Organization Quality of Life BREF (WHOQOL BREF) questionnaire was used. Psychosocial and drug use questions were added to the evaluation.

At discharge, around 75% of people considered that they were in better health than before starting treatment, 60% believed that their quality of life was good or very good, 72% considered that their life had a lot or some meaning and 75% maintained abstinence from the substance for which they were in treatment.

Regarding quality of life (WHOQOL BREF) in people with discharge from treatment, the domain with the lowest score was the one of personal relationships.

Opiate patients were the ones with the lowest scores, with physical health values being highlighted. In terms of gender, women scored worse than men, especially in psychological health.

The results obtained indicate that the biopsychosocial and interdisciplinary treatment of addictions at the Addictions Institute of Madrid City Council improves the overall quality of life and the perception of health. These changes are largely maintained over time, including abstinence.

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In 2002, the euthanasia law was voted in Belgian parliament, depenalising physician-assisted dying under certain conditions for irremediable physical or mental suffering caused by an incurable condition for which all therapeutic options have been exhausted. The euthanasia request needs to be repeated, well-considered and voluntary and the patient should be competent. If the patient is not in a terminal condition, there should be at least one month between the written request and the euthanasia and three independent physicians have to be involved in the evaluation.

Psychiatric suffering was not excluded in the law, but there is discussion whether the possibility of psychiatric euthanasia was intended by the legislator. In the first years after the euthanasia law, psychiatric euthanasia was limited to a few cases, but then rose to a mean of 25 cases per year. There was a peak in 2013 of 54 cases, but after 2013 there was no more increasing trend.

In 2017, the Flemish Association for Psychiatry issued an advice regarding due diligence in psychiatric euthanasia. Controversy regarding psychiatric euthanasia kept stirring the public debate, especially after one court case in which a psychiatrist and general physician were accused and acquitted after a psychiatric euthanasia.

Another prominent topic in the public debate in Belgium is broadening the euthanasia law for advanced dementia based on an advance directive. Now euthanasia is only possible in the earlier stages of neurodegenerative disease, when competence is still sufficiently intact.

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Perinatal psychopathology, encompassing a spectrum of psychiatric disorders such as perinatal depression, generalized anxiety disorder, post-stress traumatic disorder (PTSD), bipolar disorder, and postpartum psychosis, has been increasingly recognized for its potential to disrupt early mother-infant interactions. These disruptions may have profound consequences on the formation of secure attachment, which is crucial for healthy infant neurodevelopment. Attachment theory posits that early relational experiences shape the foundation of emotional regulation and social functioning, making it essential to understand how maternal psychopathology influences this critical developmental period.

This study aims to explore the impact of perinatal psychopathology on the development of attachment between mothers and their infants. Specifically, it seeks to identify how various mental health disorders affect maternal sensitivity and responsiveness, and how these alterations contribute to insecure or disorganized attachment styles in children.

A comprehensive review of the literature was conducted by searching major medical databases (e.g. PubMed and Google Scholar), giving preference to studies published between 2000 and 2024. Articles were selected based on relevance to perinatal psychopathology and attachment theory. This narrative review includes both quantitative and qualitative studies, clinical trials, and observational research that examine how maternal mental health conditions during pregnancy and the postpartum period affect attachment processes. Key themes and findings were extracted to provide a holistic view of the current state of knowledge on this subject.

The findings align with existing research on the impact of maternal mental health on early attachment, reinforcing the role of maternal sensitivity as a mediator between psychopathology and attachment security. Psychiatric conditions impair the mother’s ability to engage in synchronous interactions with her infant, disrupting the child’s ability to develop a secure base. Moreover, the presence of comorbid psychiatric conditions and chronicity of symptoms were identified as risk factors for more severe attachment disruptions. Pharmacological treatment and psychotherapy were shown to mitigate these effects, highlighting the need for integrated perinatal mental health services.

Perinatal depression, PTSD, and psychosis significantly compromise maternal-infant attachment, increasing the risk of insecure or disorganized attachment styles. Timely psychiatric interventions can enhance maternal mental health and promote healthier attachment outcomes. This review underscores the importance of integrating maternal mental health treatment into perinatal care to prevent long-term developmental issues in children and foster secure attachment relationships.

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Autism is a neurodevelopmental condition affecting 1 in 36 people worldwide. Approximately one third of autistic individuals report a diagnosed mental health condition. Autistic people constitute 20% of referrals to outpatient psychiatry clinics. Limited knowledge and awareness of autism is the main barrier to receiving appropriate diagnostic and therapeutic support. Autistic individuals’ increased mental health needs coupled with greater barriers to accessing healthcare necessitate that both primary care physicians as well as specialised services are well versed in working with these patients.

This study aimed to evaluate knowledge of autism and self-reported confidence in caring for autistic patients amongst psychiatrists and general practitioners (GPs) in Malta. This will facilitate identification of lacunae in doctors’ knowledge and advocating for greater training and awareness.

A online, anonymous questionnaire was distributed amongst psychiatrists and general practitioners in Malta as well as psychiatry and GP trainees. The questionnaire consisted of demographic questions, a 22-item modified Knowledge of Autism Scale as well as a 14-item Self-efficacy Scale targeting confidence in working with autistic patients. Data was analysed using SPSS and scores were adjusted for chance responses. Scores of the psychiatry group and the GP group were compared.

The questionnaire was answered by 98 participants of which 60% (n=59) were female. The mean score on the knowledge of autism scale was 89.2% (SD=7.7) for psychiatry and 83.1% (SD=8.5) for GP. Mann Whitney U test revealed that psychiatrists fared better than GPs with an effect size of 0.35 (p=0.0003). The mean self-efficacy score was 6.7 (SD=0.4) for psychiatry and 5.7 (SD=0.8) for GP. Independent sample t-test revealed that psychiatrists scored better than GP (p=0.0003, 95% CI [0.509,1.49]). In both groups, there was no significant correlation between knowledge of autism scales and self-efficacy scales (psychiatry p = 0.26; GP p = 0.14).

General practitioners, psychiatrists and their trainees overall have good knowledge about autism, and feel moderately confident in working with autistic patients. As expected, psychiatrists scored better than GPs for both knowledge and self-reported efficacy. The scores obtained are comparable to studies done on a similar population in the United Kingdom. Unfortunately, Malta stilll lacks autism diagnostic services in the public sector. Nonetheless, undergraduate medical education and postgraduate training must strive to prepare doctors for working with this common cohort of patients. This will ensure a high standard of care and avoidance of adverse health outcomes or iatrogenic harm.

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The relationship between psychosis and ayahuasca use is a topic of considerable interest and debate in the scientific and medical community. Ayahuasca is traditionally used in shamanic ceremonies in the Amazon, composed mainly of the Banisteriopsis caapi vine and the leaves of Psychotria viridis, which contain DMT (dimethyltryptamine), a powerful hallucinogen.

Ayahuasca induces altered states of consciousness, with experiences that can include visions, deep introspection, and changes in the perception of reality. The experience can be intense and emotionally overwhelming. In individuals with a history of psychosis or psychiatric disorders, ayahuasca may more easily trigger a psychotic episode. The interaction with neurotransmitters and the serotonergic system can influence their appearance.

We report a case of a patient who, after consuming ayahuasca, presented a psychotic episode that required hospitalization. After the initiation of treatment with antipsychotics, the condition had a favorable evolution towards the complete resolution of the symptoms.

Given the increasingly frequent use of ayahuasca in developed societies, the current case highlights the needs to understand, regulate and research the use of ayahuasca. Additionally, raising awareness of the potential risks of ayahuasca use through psychoeducation should be implemented.

Describe the case of a psychotic episode induced by ayahuasca: Clinical debut, symptoms and evolution after initiation of treatment.

Description of a clinical case as well as bibliographic review.

The relationship between hallucinogens and psychosis is a critical area of study due to the intense and potentially destabilizing effects that hallucinogens can have on people with this condition. Hallucinogens can trigger or aggravate psychotic symptoms, which may include hallucinations and delusions. We must keep in mind that hallucinogens can interact negatively with antipsychotics or other medications used to treat psychosis. These interactions may reduce the effectiveness of treatment or cause adverse side effects, as well as affect adherence to treatment, as it may lead to an alteration in the perception of the need for medication or the ability to follow the treatment regimen.

Ayahuasca use can have profound and potentially destabilizing effects, especially in people with a history of psychotic disorders. Although there is therapeutic potential, it is crucial to proceed with caution and under the supervision of trained professionals. Proper preparation and risk assessment are essential to minimize potential adverse effects.

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This presentation explores the intersection of psychotherapy interventions and AI, focusing on how AI can be leveraged to augment traditional therapeutic methods. AI-powered tools such as chatbots, virtual therapists, and predictive analytics will be covered. Additionally, the talk will address the ethical implications, challenges, and opportunities posed by the use of AI in mental health care, emphasizing the importance of maintaining the human element in therapy. Drawing on current research and case studies, possible opportunities of AI assisted therapists in identifying patterns in patient behavior, improving treatment efficacy, and reducing barriers to mental health care, especially in underserved populations will be explored. The presentation will conclude with a forward-looking perspective on how AI and psychotherapy can collaboratively evolve to shape the future of mental health care.

Artificial Intelligence, Psychotherapy, Mental Health, Chatbots, Virtual Therapy, Ethical Considerations, Personalized Treatment.

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Cyberaddiction, characterized by excessive and uncontrollable internet use, has been linked to various psychological and behavioral issues. Adolescents are particularly vulnerable to these risks, as they are heavy users of digital platforms, often spending long hours online for social interaction, entertainment, and gaming. While research on this issue is expanding, our study seeks to contribute further insights into the factors associated with problematic internet use and its implications for adolescent well-being.

The objective of our study was to determine the prevalence of cyberaddiction among adolescents in Sousse, Tunisia and to investigate its relationship to self-esteem.

We conducted a descriptive cross-sectional study with analytical objectives among adolescents aged 12 to 18 from schools in Sousse Medina, Tunisia during February, March, and April 2024. We used a demographic information form, the Young Internet Addiction Test and the Rosenberg Self-Esteem Scale for data collection.

Our population consisted of 416 adolescents. The most represented age group was 14 years old (22.1%), with a mean age of 15.05 ± 1.7 years. The sample comprised 236 females (56.7%) and 180 males (43.3%). Our findings indicate that 83.2% of participants exhibited problematic internet use with potential life consequences, 11.3% showed occasional excessive use but maintained control, and 5.5% experienced severe repercussions from their internet use. Additionally, 43% of participants spent more than 2 hours per day online. A statistically significant relationship was observed between the amount of time spent online and cyberaddiction (p = 0.009, with higher levels of cyberaddiction associated with increased internet usage. According to the Rosenberg Scale, 51.9% of adolescents had low self-esteem, however, no statistically significant relationship was observed between self-esteem and cyberaddiction.

Our findings highlight a concerning prevalence of problematic internet use among adolescents, with no significant correlation identified between self-esteem and cyberaddiction. This suggests that other underlying factors may contribute to the challenges faced by this population. It is crucial for healthcare professionals and policymakers to prioritize preventive measures and awareness campaigns, promoting healthier online habits and ultimately fostering the well-being of young people in an increasingly digital world.

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Mental disorders, such as Bipolar Disorder (BD), Schizophrenia (SZ), and Schizoaffective Disorder (SA), are prevalent and often debilitating conditions that significantly impact individuals’ lives (Scangos et al. Nat Med 2023; 29(2): 317-33). Recent findings have identified blood RNA editing gene modifications that may aid in distinguishing between healthy controls, depressed patients, and those with BD and unipolar depression, improving diagnostic accuracy and treatment strategies (Salvetat et al. Transl Psychiatry 2022; 12(1):182).

This study demonstrates that RNA editing biomarkers can accurately differentiate individuals with SZ, SA, BD, and healthy controls, highlighting the potential of artificial intelligence (AI)-based predictions for diagnosis.

A comparative analysis was performed with 85 healthy controls subjects, 39 BD, 31 SZ, and 14 SA patients. Patient samples were collected from two cohorts. Diagnostic assessments were conducted using SCID-1, HDRS, YMRS, and M.I.N.I., while healthy controls had no history of mental disorders or psychotropic medication use.

Significant biomarkers were combined using a multiclass Random Forest algorithm. The algorithm was trained on 70% of the population. Then, the test was performed on the 30% of the population who never saw the algorithm. The analysis shows clear differentiation between the control group and individuals with BD, SZ, and SA with high sensitivities and specificities for ROC area under the curve (AUC).

This proof-of-concept analysis provides strong evidence for using RNA editing signature in diagnosis, and potentially in prognosis and treatment prediction. Further validation will be performed using a larger cohort.

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Chronic oral health issues, particularly periodontal disease, are significant contributors to systemic inflammation. Emerging evidence indicates that this inflammation can influence neurophysiological processes and contribute to psychiatric disorders, including depression and anxiety. Recent literature review has revealed that periodontal disease and depression share common biomarkers, such as lipopolysaccharide (LPS), C-reactive protein (CRP), interleukin-6 (IL-6), and cortisol.

To elucidate the connection between poor oral health and psychiatric disorders through the lens of systemic inflammation and its neurophysiological impacts.

A comprehensive literature review was conducted using PubMed, PsycINFO, and Google Scholar, focusing on studies from the past decade that examine the relationship between periodontal disease, systemic inflammation, and psychiatric disorders. Key findings regarding the involvement of pro-inflammatory cytokines and their neurophysiological effects were synthesized.

The review highlighted that periodontal disease leads to elevated levels of pro-inflammatory cytokines. Such cytokines as CRP, IL-6, and tumor necrosis factor-alpha (TNF-α) can cross the blood-brain barrier, contributing to neuroinflammation and dysregulation of neurotransmitter systems. One significant effect is on serotonin metabolism, which is critical in the pathophysiology of depression. Pro-inflammatory cytokines can lead to reduced serotonin availability by upregulating genetic expression of serotonin transporters and increased serotonin metabolism. Given the interplay between inflammatory cytokines and neurotransmitter metabolism, the studies indicate that individuals with periodontal disease are more likely to exhibit depressive and anxiety symptoms, with neuroinflammation serving as a mediating factor.

Table 1: Impact of Pro-inflammatory Cytokines on Neurophysiological Processes

Systemic inflammation resulting from poor oral health significantly impacts neurophysiological processes associated with psychiatric disorders. These findings underscore the need for integrated healthcare approaches that consider both oral and mental health to mitigate the adverse effects of neuroinflammation on psychiatric well-being.

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Interpersonal Psychotherapy (IPT) has been recognized as an effective treatment for various eating disorders, particularly Binge Eating Disorder (BED) and Bulimia Nervosa (BN). IPT focuses on addressing interpersonal difficulties, such as role transitions, interpersonal disputes, and social deficits, which are common in individuals with eating disorders. While evidence supports its use for BED and BN, its effectiveness for Anorexia Nervosa (AN) remains limited. Group-based IPT has also shown promise by targeting interpersonal deficits that perpetuate disordered eating behaviors.

This literature review aims to evaluate the efficacy of IPT in treating eating disorders, with a focus on BED and BN. Additionally, it explores the role of interpersonal deficits as a central focus of IPT and compares the outcomes of individual and group-based IPT formats.

A review of peer-reviewed studies, clinical trials, and meta-analyses published between 2000 and 2024 was conducted. The review assessed the effectiveness of IPT in reducing disordered eating behaviors, improving interpersonal functioning, and maintaining long-term treatment gains. Studies on both individual and group IPT formats were included, with a focus on binge eating reduction, interpersonal relationship improvements, and relapse prevention.

The literature consistently shows that IPT is effective in reducing binge eating behaviors and improving interpersonal relationships in individuals with BED. Group IPT, in particular, has been shown to effectively address interpersonal deficits, providing social support and improving interpersonal skills, which contributes to sustained treatment outcomes. IPT has demonstrated comparable short-term efficacy to Cognitive Behavioral Therapy (CBT), with studies indicating superior long-term maintenance of treatment effects. However, evidence for IPT’s use in AN remains sparse.

IPT is a promising treatment for eating disorders, particularly for individuals with BED and BN who exhibit significant interpersonal deficits. Group IPT appears to be especially effective in addressing these interpersonal issues, providing long-term benefits. While CBT remains the most widely used therapy, IPT offers a valuable alternative, particularly for individuals who do not respond to CBT. Future research should focus on exploring IPT’s mechanisms and expanding its application to other eating disorders, including AN, where evidence is currently lacking.

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A number of medicinal plants have produced noticeable results in depression treatment including, Rhodiola rosea and Crocus Sativus (saffron).

To evaluate the efficacy and safety of a combination of rhodiola and saffron in patients with moderate depression.

Adults with moderate depression (International Classification of Diseases [ICD-10]) of moderate intensity (Hamilton Depression Score [HAM-D] ≥ 17 and ≤ 23) were recruited (n=126; 64 students, 62 non students). Patients took 2 tablets of the supplement (i.e. 308 mg rhodiola and 30 mg saffron) or a placebo daily for 6 weeks. Main criterion was the evolution of HAM-D score between Day (D) 0 and D42. Other criteria were evolution of HAM-D, Hospital Anxiety and Depression Scale (HADS)-anxiety and HADS-depression, Patient’s Global Impression of Change (PGIC), Clinical Global Impression of severity and improvement (CGI-S and -I) at D0, D21 and D42, tolerability and compliance.

A significant 10-point decrease in HAM-D score was observed only in the supplemented non-student population between D0 and D21 (from 18.9±1.7 to 8.6±3.4 in Supplement group versus 18.5±1.8 to 11.2±4.2 in Placebo group, p=0.005). At D42, a 12-point decrease was observed in the Supplement group; the difference between the two groups being marginally significant (from 18.9±1.7 to 7.1±5.0 in Supplement group versus from 18.5±1.8 to 8.8±4.2 in Placebo group, p=0.087). The percentage of patients with a HAM-D score reduction >75% was higher in the Supplement group (p<0.05). The HAM-D score decrease was particularly marked in patients with HADS-anxiety ≥11 at D21. The distribution of patients by severity HAM-D classes (no, mild, moderate depression) was significantly different between the two groups (p<0.05 at D21 and D42), with a greater number of patients with no or mild symptoms in the Supplement group. The remission rate (HAM-D ≤ 7) was higher in this group (p<0.05 at D21 and D42). These results by classes were also found with HADS-depression scale. Results for CGI-S and CGI-I were in favor of the Supplement group (p<0.05 at D21). These results were not observed in students. Compliance and tolerability were good.

As expected, the rhodiola plus saffron combination improved psychological well-being of non-student patients with moderate depression. The poor results observed in students suggest that health professionals should ascertain the real depressive state of students confronted with stressful and/or anxiety-provoking situations linked to exams, professional future or precarity. When prescribing, clinicians should not only rely on quantitative scales, but above all on their clinical feelings.

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Clozapine has the strongest evidence for efficacy for schizophrenia that has proved refractory to adequate trials of standard antipsychotic medication. Its use is limited to these cases due to the uncommon but severe adverse effect agranulocytosis or severe neutropenia, defined as a neutrophil count under 500/microL. It is seen in 0,4 % of clozapine patients and it usually occurs in the first three months. Risk is managed with close blood count (BC) monitoring protocol.

This work aims to improve the understanding and management of this condition.

With this purpose, we present a clinical report and rewiew its management in literature.

We present the case of a 60-year-old man with the diagnosis of resistant schizophrenia who is hospitalized in the acute Psychiatry Unit due to decompensation, where clozapine is initiated with gradual dose augmentation and weekly BC. After improvement of psychotic symptoms, the patient is transferred to a subacute care facility. Two months later, BC revealed mild neutropenia (1000/microL; defined as 1000-1500/microL) becoming severe (100/microL) on the next test one week later. Clozapine is then interrupted and replaced with olanzapine. Neutrophils descend to zero within one day and three days later, with all granulocytes in low levels, the patient presents fever and diarrhea, being finally hospitalized in Internal Medicine. Empirical intravenous antibiotic therapy is prescribed as well as filgastrim, a granulocite-colony stimulating factor (G-CSF). Antibiotic is adjusted after Enterococo Faecalis is isolated in blood cultives. Despite eleven days without clozapine and eight days with G-CSF, agranulocytosis persisted. Taking in consideration the severity of the case and the non existence of acute psychotic symptoms, olanzapine is interrupted and benzodiacepine medication is increased, with BC normalization within three days and remission of digestive symptoms and fever. G-CSF is interrupted and the patient is re-transferred to the subacute unit, with initiation of aripiprazol in the following days.

Upon the appereance of mild neutropenia, closer blood monitorization is recommended (three times a week); with interruption of clozapine and daily monitoring in case of moderate or severe neutropenia. In relation to when to reintroduce antipsychotic treatment, clinical guidelines are cautious, emphasizing the need of close hematological monitoring and careful evaluation of risks and benefits. However, most recommend waiting for complete neutrophil recovery, taking into account the severity of the psychotic symptoms. Olanzapine, with similar mechanism of action but much lower risk, is usually the election.

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Although clozapine-induced agranulocytosis is rare, its complexity and severity requires a fine review of its management, considering that this probably has an impact on the patient’s clinical evolution.

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In the high-stress world of healthcare, the intertwined relationship mental health and the life quality is pivotal.

Prioritizing healthcare professionals’ mental health and nurturing a positive safety climate are essential to enhancing overall job satisfaction.

Evaluate the mental health status of the physiotherapists.

his is a cross-sectional study among Physiotherapists (PTs) working in the city of Sousse. A self-administrated questionnaire was distributed either manually or via e-mail to collect information about the personal and occupational history of participants. The mentel health was assesed by the the mental component score (MCS-12) of the the Short Form Survey SF-12.

A total of 93 questionnaires were collected. The PTs were 35±8 years old on average. Women made up 65.6% of the PTs. Sixty-six (71.7%) and sixty-two (67.4%) did not provide any medical or surgical history respectively and the majority of the population (54.5%) had a normal BMI. Among all respondents, nineteen (20.4%) PTs were regular smokers and an alcoholic beverage was consumed by 14 (15.7%) PTs. The sport was the common hobby of PTs (53.8%). In this group of PTs, 37 (40.2%) worked in the public sector, and 55 (59.8%) worked in the private sector. The mean seniority was 11.9±7.8 years and the average workweek for the population was 42.42 hours. The mean MCS-12 score was 43.94 (9.05 SD). The findings showed that 35 PTs (37.6%) had MCS-12 scores below the standard value. Male PTs showed slightly higher MCS-12 means than female PTs with a modest difference between PTs working in the public and private sectors. PTs who had more than 15 years of work experience scored the lowest MCS-12 mean 41.40 (SD 9.94) which is a score underneath the reference value indicating in this case low mental health functioning among PTs.

This study showed that Tunisian PTs had low mental health statuts highlighting the need for approaches to improve interventions that effectively enhance well-being, retention, and sustainability of practitioners, and thus the care delivered, in the healthcare system

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Autism spectrum disorder (ASD) presents specific characteristics in child development. Behavioral and, mainly, communicative aspects are the most frequent for diagnostic closure (APA Artmed 2014; Asperger Archiv F. Psychiatrie 1944; 117 76-136). The absence, delay or difficulties in establishing expressive language are important social markers in early childhood, being one of the main reasons that lead families to seek therapeutic guidance (Amato USP 2006; Andrade UFPB 2017; Andrade Pró-Fono 2023). One of the aspects related to the communication of children with ASD is the interest in foreign languages, which manifests itself from early childhood (Avelar Universidade Presbiteriana Mackenzie 2018). The use of a foreign language for interpersonal communication presented spontaneously, by children with ASD, is something that needs to be evaluated within the functional aspects of social communication, since the major communicative difficulties faced are related to pragmatic aspects (Andrade Pró-Fono 2023; Balestro et al. Rev Soc Bras Fonoaudiol 2012; 17 279-86). The form and means of communication, length of permanence and communicative quality are fundamental elements to be analyzed when comparing expected child development to chronological age. In a research process involving humans, it makes perfect sense to anticipate and understand linguistic, cultural and educational differences, in order to avoid contextual and communicative variables that conflict with the proposed aims.

The objective of this study is to evaluate the functional communication of children with ASD in Portuguese and English language contexts.

16 children were selected, aged 42 to 72 months, without relatives and/or living with multilingual people. Samples were collected by recording spontaneous communication between patient and therapist in a natural intervention environment. 5-minute clips of greater interaction were made and, from these, the analyzes were carried out. This research has an opinion approved by the Ethics Committee, under number 6,890,786.

Parents’ perception of their children’s communication difficulties were unanimously reported. Greater communicative ability was demonstrated in the Portuguese language, however, communicative ability and functionality was verified in the English language, without significant statistical differences when comparing the two languages. In the production of grammatical classes, there was greater production in the Portuguese language, with greater lexical production.

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The children under observation and evaluation in this study showed satisfactory correlation and performance in the proposed tests. There was communicative performance, with results without significant statistical differences in the Functional Communication Profile in both languages. More studies will be needed to support these results.

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