Bulimic behavior has been increasingly recognized in patients with bipolar disorder (BD). Even during euthymic phases, individuals with BD may remain vulnerable to disordered eating patterns such as bulimia and binge eating.

This study aims to examine the occurrence of bulimic behavior in euthymic patients with BD and identify associated clinical and sociodemographic factors.

We conducted a cross-sectional, descriptive, and analytical study of 93 patients followed for bipolar disorder at the psychiatry outpatient unit at the Hedi Chaker University Hospital in Sfax. The questionnaire included sociodemographic data, medical and psychiatric history, and anthropometric characteristics. Bulimic behavior was assessed using the Bulimic Investigatory Test Edinburgh (BITE).

The mean age of the participants was 41.49±12.33 years, with a M/F sex ratio of 2.58. Among the patients, 58.1% were married, 45.2% had secondary education, and 47.3% were unemployed. Personal somatic history was reported by 35.5%, while 11.8% had psychiatric comorbidities in addition to bipolar disorder.

The mean body mass index (BMI) was 27.4 kg/m² (SD=5.96), with 29% of patients being overweight and 31.2% classified as obese.

Eight patients (8.6%) had BITE scores above the threshold of 20, indicating bulimic behavior.

Significant associations were found between elevated BITE scores and female gender (p=0.012), comorbid medical conditions (p=0.005), family history of schizophrenia (p=0.024), weight (p<10⁻³), BMI (p<10⁻³), hypomanic residual symptoms (p<10⁻³), irregular follow-up (p=0.027), and delayed management of BD (p=0.04).

Our results highlight the importance of early identification and comprehensive management of disordered eating in bipolar patients, even during periods of mood stability, to optimize overall health and psychiatric outcomes.

None Declared

Many beneficiaries are stuck and find it difficult to act creatively because they are used to being in a different place than where they are at that moment:

they lose their balance and the ability to move in harmony with the forces of the environment which, in the end, will support the expression.

They expect something different from what they are doing at that moment or they think that what they are doing is inadequate; they get stuck, they get caught in negative and confused thoughts.

Even if a finished object or image is obtained, the research pursues, first of all, the way and the extent to which the creative process and execution of the artifact contributes to the improvement or healing of the studied beneficiaries. Correlative objective being the increase of their quality of life and their socio-professional integration. In assessing the motor functions of the beneficiaries, it is essential that the emphasis is placed on the outstanding and hidden motor abilities of each individual. The aim is to improve: coordination disorders, spatialization disorders, fine motor skills, sensoriality, creativity, socialization.

ORGANIZATION OF ACTIVITIES is done in three types of workshops, with different objectives and interventions,

• - Occupational therapy workshop in the category that includes art therapy.

• - Occupational therapy

• - Relaxation, play therapy

CASE STUDY: Placement center Jucu PA, sex M, 16 years old.

Diagnosis: Secular infantile encephalopathy, behavioral disorders

• - heteroaggressiveness, severe mental retardation, alalia.

• - Uses modeling for self-expression and self-fulfillment. During work, he is not aggressive and relates to people who appreciate his work.

An advanced level is observed in modeling, even compared to normal people. Spatial abstract compositions from plasticine, expressive and balanced, are made at the beginning, the evolution is observed in the modeling of the figures (he starts to model personalized human figures), which he pairs chromatically, groups them into dancing figures, or groups them affectively and vertically. He also showed changes in his behavior: he smiled while working, clapped and recognized us when we entered the workshop, wanted to be photographed and petted (although normally he can’t stand being touched). He showed interest in the camera and in the modeling works of other children from Placement center.

Work in visual arts and design therapies aims to create a product. The benefits arise from experiences based on artistic creativity: materializing ideas and solving unexpected results.

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The artistic image becomes significant in strengthening the verbal exchange between the beneficiary and the art therapist, solving problems and formulating new perceptions that in turn lead to positive changes, growth and healing.

None Declared

Attention-Deficit/Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder and accurate diagnosis is essential but remains challenging due to the potential for malingering. Additionally, the increasing demands of a fast-paced society place, prompting quick solutions, may lead to simulated presentations or feigning. This paper examines the complexities of distinguishing genuine ADHD cases from malingering, emphasizing the need for refined diagnostic protocols. Malingering, in fact, involves deliberately fabricating symptoms to achieve a desired result, such as:

• - Academic Advantages

• - Access to Medications

• - Avoiding Responsibilities

Given all these challenges, we explored how current scientific literature addresses this issue. Inspired by the work of many colleagues, we aimed to summarize their efforts in this systematic review to propose a possible solution for collaborative improvement.

We analyzed over 296 papers from major scientific databases focusing on “malingering and ADHD” to create a comprehensive overview of this increasingly widespread problem.

The main results, after a thorough analysis of all parameters, emphasize the need for:

1. Advanced Assessment and Objective Measures: dynamic assessment techniques, combined with psychophysiological measures and parental input.

2. Enhanced Diagnostic Protocols and Tools Integration: ADHD rating scales and Symptom Validity Tests (SVTs) like TOMM (Test of Memory Malingering) and WMT (Word Memory Test) to minimize diagnostic errors, make the criteria more robust.

The following table summarizes the criteria analyzed in the 37 articles selected after a thorough review.

Traditional ADHD assessments, based heavily on self-reported symptoms, are becoming less reliable, especially with the growing trend of self-diagnosis and malingering. To address this, adding performance-based tests like TOMM and WMT is key for spotting malingering and improving diagnosis accuracy. Our study aims to elucidate this issue, which has subtle but profound implications for the quality of life of thousands of patients, who may receive a superficial diagnosis that could affect them for a lifetime, even pharmacologically.

None Declared

A heightened susceptibility to mood disorders among women at specific junctures throughout their reproductive lifetime has been reported. Previous studies have suggested that the probability of developing Major Depressive Disorder (MDD) during the menopausal transition is amplified from 2 to 4 times when contrasted with both premenopausal and postmenopausal periods and also increased mood symptom severity in the menopausal transition in bipolar disorder (BD) has been cited (Chen et al. Arch Womens Ment Health 2017; 20 463-8). A considerable body of evidence suggests that mitochondrial dysfunction plays a crucial role in the pathophysiology of various psychiatric disorders, including MDD and BD. Researchers have proposed that the mitochondrial DNA copy number (mtDNAcn) may serve as an essential marker of mitochondrial health, which is the ratio of mitochondrial and nuclear DNA (Malik et al. Mitochondrion 2013; 13 481-92).

In this review, we aimed to compile and present existing data regarding mtDNAcn alterations in women during the menopausal transition by comparing the mtDNAcn numbers of the women in premenopausal, perimenopausal and postmenopausal periods thereby establishing a foundation for future research on the origins of these conditions.

A literature search was conducted on the electronic databases PubMed, Cochrane Library, Medline (OVID), Scopus, Web of Science and CINAHL to identify the relevant studies published until 14 October 2024. The search was performed using the following keywords (Menopause OR Premenopause OR Pre-Menopause OR Premenopaus* OR Perimenopause OR Postmenopause OR Post-Menopause OR Postmenopaus*) AND (mitochondrial DNA copy number OR mtDNA copy number) and limited to English language.

According to the search results, 66 publications were reached in total. After detecting and removing duplicate publications, there were 21 publications left. After screening, any of the studies met inclusion criteria for the systematic review, because most of them were conducted in different patient groups and healthy controls in the menopausal transition periods, but the main findings of these studies can be summarized as; mtDNAcn varies between the patients groups and healthy controls in the menopausal transition periods with the conflicting results. Some of the studies found higher mtDNAcn in patient groups such as breast cancer and pelvic organ prolapsus, whereas some of them found lower mtDNAcn numbers in patient groups such as osteopenia and osteoporosis.

Considering above findings, there is mtDNAcn alterations in women during the menopausal transition. These findings may highlight the need for future studies to elucidate the link with mtDNAcn and mood disorders in the menopausal transition period by comparing the women in different menopausal periods.

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 prior hypomanic episodes.

The phase-III, randomized, multi-centric, assessor-blind, parallel-group, active-controlled, comparative, non-inferiority study included Indian 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 number of prior hypomanic episodes in lifetime: Subgroup 1 [S1]: 1 episode and Subgroup 2 [S2]: >1 episode. 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 251 in S1[Test=129; Comparator=122] and 211 in S2[Test=102; Comparator=109]. 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=37.2% and Comparator=35.2%; S2: Test=31.4% and Comparator=35.8%] and no serious adverse events were reported.

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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 number of previous hypomanic episodes and both treatments were found to be well tolerated.

A. Dharmadhikari: None Declared, P. Chaurasia: None Declared, Y. Patel: None Declared, D. Choudhary: None Declared, P. Dasud: None Declared, M. Bhirud: None Declared, P. Meena: None Declared, F. Shah: None Declared, G. Ganesan: None Declared, B. P. Rathour: None Declared, K. Mistry: None Declared, M. Dutta: None Declared, A. Ramaraju: None Declared, S. Mangalwedhe: None Declared, S. G. Goyal: None Declared, G. Kulkarni: None Declared, A. Mukhopadhyay: None Declared, P. Chaudhary: None Declared, G. T. Harsha: None Declared, M. Parikh: None Declared, S. Dey: None Declared, S. Sarkhel: None Declared, N. Jyothi: None Declared, A. Kumar: None Declared, N. Sooch: None Declared, A. Shetty Employee of: Sun Pharma, S. Saha Employee of: Sun Pharma, P. Devkare Employee of: Sun Pharma, A. Shetty Employee of: Sun Pharma, D. Patil Employee of: Sun Pharma, P. Ghadge Employee of: Sun Pharma, A. Mane Employee of: Sun Pharma, S. Mehta Employee of: Sun Pharma.

In this study, the scale’s psychometric properties are estimated among South African high school learners during a period of the coronavirus-19 crisis. The study was a cross-sectional design. The data were collected from 1603 high school learners in four South African districts. The PHQ-4 was administered for data collection, and was anchored from 0 (not at all) to 3 (nearly every day) over a two-week period, with higher scores indicating the extent of symptom severity (Kroenke et al., 2009).

The study sought to validate the PHQ-4 among South African school learners in various South African districts, and tested a model that included the PHQ-4 to investigate the obtaned factor structure’s usefulness.

Useful questionnaires were collected from 1562 high school learners within a cross-sectional design. Grades 10 to 12 learners completed the PHQ-4 from March to May 2022.

Confirmatory Factor Analysis (CFA) was conducted to validate the factor structure of the scale. CFA results show that all PHQ-4 items load onto a single factor. The factor structure reported in this study is unique. Whilst the PHQ-4 is commonly considered to measure anxiety and depression, the results suggest that the scale measures a unidimensional, psychological distress factor among the learners. The total score of the PHQ-4, characterized as psychological distress, could be predicated by associated factors, although the coefficients obtained were statistically significant but weak. The PHQ-4 was predicted by the Perceived Vulnerability and the Germ Aversion subscales but not the Fear of COVID-19 scale in girls. But the PHQ-4 was predicted by the Fear of COVID-19 scale and not the Perceived Vulnerability and the Germ Aversion subscales among boys.

Contrary to existing studies, the PHQ-4 did not consist of 2 factors. Evidence from the current study suggests that it should be used as a unidimensional, single factor scale. The PHQ-4 total scores of girls and boys were predicted by different factors, suggesting that gender should be considered an important factor when using the PHQ-4 in reseaerch.

None Declared

The World Health Organization (WHO) defines adolescence as the developmental stage between childhood and adulthood, spanning ages 10 to 19. This period is characterized by significant physical, cognitive, and psychosocial growth.

This study aims to understand the clinical profile of adolescents hospitalized for the first time in the psychiatric department.

• - It’s a retrospective and descriptive study covering the files of patients who consulted the Avicenna Psychiatry department of Razi hospital aged under 18, during the year 2023.

• - The collection of anamnestic and clinical data was established using a pre-established form

Our study included 24 patients aged between 16 and 18 years, with a mean age of 17 years, comprising 13 males and 11 females.

Patients presented voluntarily in 42% of cases, were brought in by law enforcement in 25%, and were referred by a private psychiatrist in 17% of cases. The reasons for consultation were as follows: behavioral disturbances in 63% of cases, a suicide attempt in 21%, and incoherent statements in 8% of cases. 60% of cases used medication ingestion as the method during the suicide attempt. A family history of psychiatric disorders was found in 50% of cases, as well as a family history of suicide attempts in 13% of cases. Additionally, 71% of cases had prior follow-up with a private psychiatrist, 21%of cases had previously attempted suicide, and 33%of cases had personal somatic histories.

The onset of disturbances was progressive in 71% of patients. Upon hospitalization, anxious symptoms were noted in 25% of cases, while depressive symptoms with suicidal ideation were recorded in 29% of patients. hallucinations and delusions were noted in 50% of cases, and behavioral eccentricity was observed in 25% of cases.Instinctual disorders were present in 75% of cases, with sleep disturbances observed in 71%of cases, sexual disorders in 25%of cases, and appetite disorders in 13 %of cases.

Verbal hetero-aggression was identified in 83% of cases, while physical hetero-aggression was noted in 67%of cases. Self-harming behaviors were recorded in 48% of patients.

The diagnoses made according to DSM-5 criteria were distributed as follows: bipolar disorder in 29% of cases, schizophrenia in 17%of cases, and 13%of cases related to a life stage.

Adolescent psychiatric hospitalizations are rising, emphasizing the need to understand clinical characteristics of this population. This study analyzes clinical aspects of adolescents admitted to a psychiatric unit over one year. The findings aim to enhance treatment strategies and patient outcomes.

None Declared

Methamphetamine use disorder (MUD) and associated conditions impose a significant burden not only on affected individuals and their families but also on communities. Neurotransmitter system imbalances, mitochondrial dysfunction, oxidative stress, and activation of the inflammasome have all been implicated in methamphetamine-induced neurotoxicity. However, whether MUD is associated with peripheral mtDNA alterations remains uncertain.

This study aimed to investigate the relationship between mtDNA copy number and clinical parameters in individuals diagnosed with MUD, comparing them with healthy controls.

Our study is a case-control research involving 52 patients diagnosed with MUD based on DSM-5 criteria and 52 healthy controls. Peripheral blood samples were collected, and leukocytes were isolated using the ELK Biotech Genomic DNA Extraction Kit for genomic DNA extraction. DNA samples were diluted to a concentration of 0.5-2 ng/μl for mtDNA copy number analysis, which was performed using the ScienCell qPCR Assay Kit. Two qPCR reactions were carried out for each sample using mtDNA and SCR primer sets. Known mtDNA copy number samples were used as references, and mtDNA copy numbers for each sample were calculated using the comparative ∆∆Cq method.

When comparing the mtDNA copy numbers between patients diagnosed with MUD and the control group, the mtDNA copy number in individuals with MUD was found to be significantly lower than that of the control group (p=.001). After controlling for age and gender, clinical parameters (suicide attempt, non-suicidal self-injury, duration of disorder, withdrawal symptoms, psychosis) and scale scores were compared based on mtDNA copy numbers. Among these, only substance use duration showed a statistically significant difference between the groups (p=.045). Additionally, in this study, a significant negative correlation was found between mtDNA copy numbers and the duration of disorder in MUD patients (r=-.369, p=.008).

This is the first study examining the relationship between peripheral mtDNA alterations and clinical parameters in individuals diagnosed with MUD. A previous study showed that individuals with MUD exhibited decreased mtDNA copy numbers and increased mtDNA damage compared to healthy individuals in the Chinese population. Consistent with these findings, it was suggested that methamphetamine could lead to mitochondrial dysfunction and a reduction in mtDNA copy numbers in cell lines and animal models. In conclusion, individuals with MUD show decreased mtDNA copy numbers in peripheral blood samples, potentially related to increased autophagy. In this context, the reduction in mtDNA copy numbers could be used as a biomarker for MUD, and preventing this reduction may be beneficial in the clinical treatment of addiction.

None Declared

Suicide Crisis Syndrome (SCS) is an acute suicidal state characterized by feelings of entrapment, affective disturbances, loss of cognitive control, hyperarousal, and social withdrawal. It has been demonstrated that SCS predicted suicidal behavior post discharge and that could help identifying high risk patients (Galynker I. Oxford University Press 2023; Yaseen ZS et al. Suicide Life Threat Behav Aug 2019;49(4):1124-1135). Until today, there is no valid consensus on which medication class is more effective in reducing the acute symptoms of SCS, which often accompany suicidal patients.

The present study aims to evaluate medication response to SCS along hospitalization into a psychiatric unit and to determine if certain drug classes can alleviate SCS symptoms.

The sample consisted of 133 participants, aged 18 to 85, recruited across four Mount Sinai Health System hospitals in New York City, USA and admitted to the psychiatric units for suicidal behavior in the past week. Patients were assessed at intake and discharge with the Suicide Crisis Syndrome -Checklist (SCS-C) to evaluate the presence of SCS symptoms. Administered medication were divided into 5 classes: antipsychotics, antidepressants, mood stabilizers, benzodiazepines and opioids.

Looking at administered medications, descriptive analysis showed an overall decrease in mean SCS-C scores from intake to discharge with antipsychotics and opioids being associated with greater SCS symptoms reduction throughout hospitalization. On the other hand, participants taking antidepressants, mood stabilizers or benzodiazepines did not show different SCS-C results than participants who were not administered these medications.

Our results are preliminary and to gain a clearer perspective a larger sample size would be needed. Nonetheless, antipsychotics drugs given their broad psychopharmacological properties might be able to address the difficult and heterogeneous symptomatology of suicidal patients, especially loss of cognitive control aspect of the SCS. Given that opioids are used to treat emotional pain, they may be an effective treatment for symptoms of SCS as well. These results highlight the need for further studies and randomized clinical trials to adequately assess the effectiveness and safety of these medications in treating SCS.

None Declared

Although heightened anxiety associated with social interaction or evaluation is the core diagnostic criterion for social anxiety disorder (SAD), there is growing evidence that SAD is characterized by more pervasive reactivity beyond social situations. We employed Ecological Momentary Assessment (EMA) to describe the affective dynamics and emotional reactivity to daily events in a community-based sample of adults with SAD compared with other anxiety disorders, and controls without anxiety or mood disorders.

A sample of 236 adults with a lifetime diagnosis of SAD (n = 53), other anxiety disorders (n = 120), and no mood or anxiety disorder (n = 63) based on comprehensive diagnostic interviews answered brief electronic interviews that assessed daily life events and mood and anxiety symptoms four times a day for two weeks. Linear mixed models were used to quantify reactivity to daily life events.

Persons with SAD had higher average levels of sad and anxious mood than those with other anxiety disorders or controls. Irrespective of comorbid mood disorders, people with SAD also demonstrated significantly greater decreases in both sad and anxious mood following positive events, and a greater increase in anxious mood following negative, particularly non-social events.

Our findings regarding pervasive reactivity beyond the social context in people with SAD confirm the need for broader conceptualization of this disorder as well as expansion of interventions beyond the social context. This work also demonstrates the utility of EMA as a powerful tool to track individual variability and reactivity in daily life that can inform etiology, treatment and prevention.

Functional Neurological Disorder (FND) is a well-recognised disorder that is seen by both neurology and psychiatry services. It is an unconscious disorder that may involve motor or sensory neurological symptoms, classically ascribed to underlying psychological distress, the aetiology of which can sometimes be difficult to ascertain.

This case presented highlights several key features of FND.

Presentations can involve pain and may evolve to involve multiple locations that may not follow a neuroanatomical distribution.

There may be initial reluctance of the patient or family to accept the diagnosis.

These can be difficult cases but there is potential for improvement with multidisciplinary support.

Inclusion of the patients’ perspective of going through the diagnostic process, in this case, gives a unique perspective of being a patient with this disorder,

.

A young female presented to the emergency department with acute onset severe right facial pain, subjective facial swelling, minor ptosis of the right eyelid and headache. Symptoms evolved over the next week to include speech disturbance, right shoulder pain, and reduced sensation in her right arm. After initial extensive negative work, it was felt that the patient most likely had a functional neurological disorder and underwent multidisciplinary treatment. The patient represented four months later after a minor fall at work with re-emergence of the right arm and facial pain associated with speech disturbance. Relapsed functional neurological disorder (FND) was diagnosed. A multidisciplinary team (MDT) approach with neurology, liaison psychiatry, speech and language therapy (SALT), physiotherapy and psychotherapy was instituted resulting in the resolution of symptoms. FND is a common disorder in which clinicians receive limited training. This case highlights a complex presentation of FND including “pseudoptosis”, a rarely seen functional symptom, and how MDT input led to symptomatic improvement. Relapse of FND is not uncommon, sometimes after minor physical or psychological stress or trauma. There is hope to improve symptoms when this happens. Our review also includes the patient’s perspective of going through the FND diagnosis.

Functional Neurological Disorders are common and greater training in and understanding of these disorders is important.

Symptoms that are rarely functional such as ptosis, do not exclude FND.

FND can be a difficult diagnosis for patients and families to accept, but accepting the diagnosis is key to appropriate treatment and recovery

An MDT approach incorporating neurology, psychiatry, physiotherapy, psychology, speech and language therapy and occupational therapy provides the best opportunity for recovery.

Early diagnosis and multi-disciplinary treatment can aid recovery, reduce the development of further disability and reduce healthcare utilisation and costs.

None Declared

Major Depressive Disorder (MDD) is a neuropsychiatric condition whose neurobiological characteristics include alterations in brain plasticity, modulated by Brain Derived Neurotrophic Factor (BDNF). In animal models, Environmental Enrichment promotes neuroplasticity and reduces depressive-like behaviors. It has been proposed to measure the level of Enriched Environment (EE) as a protective or risk factor for the development and severity of MDD using the EE Indicator (EEI).

Determine the relationship between the level of EE and serum levels of BDNF in participants with MDD and healthy controls.

Treatment-free MDD patients and controls were recruited, who underwent an analysis of their LES, clinical factors, and serum BDNF levels.

25 participants were recruited, of which 6 participants with MDD and the same number of controls were selected in a paired manner, who were divided into two groups:

medium and low EE. Although no differences were found between the concentration of BDNF between the groups, positive correlations were observed between social EE and BDNF, as well as negative correlations between this same domain with the Hamilton scale score for depression and the presence of this condition. No differences were found in the EE groups classified by total score between the cognitive, social and physical domains; But when breaking them down, it was observed that the sum between cognitive and social EE has a positive correlation with the serum concentration of BDNF (p=0.0451).

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The level of EE is potentially modulating the presence and severity of MDD at a clinical level, but it can also influence at a neuroplastic level through promoting or limiting the concentration of BDNF.

None Declared

The month of Ramadan, a sacred period in the Islamic calendar, is a time of fasting, prayer, and reflection for millions of Muslims worldwide. While the effects of fasting on physical and mental health have been extensively studied, there has been little focus on its specific impact on sexual life, particularly in the Tunisian context.

The aim of our research was to study the opinions of Tunisians regarding their sexual behavior during the month of Ramadan.

This was a retrospective, descriptive, and comparative study conducted through an online survey among Tunisian adults. Data collection was carried out via a self-administered online questionnaire during Ramadan 2024, from March 21 to April 4, 2024. Two reminders were sent and the anonymity of the responses was guaranteed.

Our study included 130 Tunisian adults with a mean age of 28.69 years. The majority of our population resided in urban areas (98.5%), 43.8% were single where 29.2% were in a relationship and both genders were equally represented (53.1% female, 46.9% male). The majority of participants identified as heterosexual (89.2%). During Ramadan, 78.5% of participants fasted, and 77.7% believed sexual activity was permissible during this period. Overall, 44.6% of participants felt that fasting had a negative impact on sexual behavior, 30.7% on sexual desire, and 26% on sexual performance. More than 70% reported that fasting influenced their sexual behavior, primarily in a negative way (44.6%). Among those who perceived an impact (n=93), changes were mostly noted in the timing (77.7%) and frequency of sexual activities (75.5%). Furthermore, 72.3% of participants reported that fasting influenced their sexual desire, with 40.9% perceiving this influence positively. Behavioral factors were identified as the most common cause of these changes (52.1%), followed by religious reasons (27.7%) and societal factors (11.7%). Significant gender differences were observed, with women being more affected by religious factors (p=0.02), while men were more influenced by behavioral factors (p=0.03). Women also reported a significantly greater impact on the frequency of sexual activity compared to men (p=0.012) and perceived a more significant negative impact of fasting on sexual performance compared to men (p=0.06).

Our study indicates that Ramadan fasting significantly affects the sexual lives of Tunisians, driven by sociocultural, religious, and physiological factors. This highlights the need for culturally sensitive sexual education and targeted health policies to ensure accessible and inclusive care during Ramadan.

None Declared

In certain cultures psychological suffering is expressed with more somatic symptoms. Besides, they tend to describe more often hallucinations and other forms of perception problems.

To describe and warn about the risks of misdiagnose when culture is not an element considered in the diagnosis.

Descriptive methodology based on practice and observation.

In the last year MSF has been working in more than 40 countries such as South Sudan and Chad with local and refugee populations. The teams have provided treatment to people with anxiety, trauma related and depressive disorders. However, we have also treated many people with hallucinations in the context of trauma, forced displacement. Several patients presented sudden, abrupt symptoms such as fear, insomnia, anxiety, and hallucinations. These hallucinations are often related to the potential traumatic event, to the witness of violence or displacement. When it appears accompanied by flashbacks, hypervigilance, and other PTSD symptoms it may be considered as PTSD with psychotic like symptoms. But other times these hallucinations seem to be more linked to a depressive episode or adjustment disorder. We have witness several cultures where hallucinations are very common during grief processes. The main risks of a misdiagnose of psychosis is the mistreatment.

On another note, it is known that migrant and refugee status are associated with a higher prevalence of psychosis. Using the cultural lenses, should we question these findings? Is there maybe a bias or misdiagnosis in some of these research?

Not all people with sensory perceptual alterations can be diagnosed with psychosis. A proper diagnose that is adapted to the culture of the person is essential for a good quality treatment.

None Declared

Galonal increases gamma-aminobutyric acid (GABA) neurotransmission in the brain by having a modulatory effect on neuronal GABAA-receptors (GABAA-R). The presence of functional GABAA-R on the surface of immune cells, in particular T-lymphocytes, which mediate modulation of the cell’s functional activity has also been described. Chronic alcohol use is associated with significant T-lymphocytes dysregulation within the adaptive immune system. It suggests that synthetic GABAA-R ligand Galonal, similar to its effects on neuronal cells, may cause modulation of the functional activity of the lymphocytes, thereby influencing the intensity of the immune response.

Considering the fact that GABAA-R proved to be the molecular targets of ethanol on the immune and nervous cells, we investigated behavior and immunomodulatory effects of the artificial GABA receptor ligand Galonal during long-term alcohol exposure to find new perspective pharmacological substances in the treatment of alcoholism.

Galonal (100 mg/kg) was administered in mice with 6-month 10% ethanol exposure (suspension of 1% starch mucus intragastrically) for 10 days, after which animal’s alcohol consumption, behavior and immune parameters were estimated.

After the course of Galonal administration a decrease in alcohol motivation and stimulation of exploratory behavior have been established in long-term alcoholized mice. An increase in the humoral immune response was also recorded, assessed by the absolute and relative numbers of AFC, to a level characteristic of healthy animals of the corresponding age. Significant stimulation of the cellular immune response, estimated by the DTH reaction and lymphocytes proliferative activity was also registered.

Galonal demonstrated positive neuroimmunomodulation effect during long-term alcohol exposure, therefore, its promising for clinical use in the treatment of alcoholism.

None Declared

Depression significantly affects patients with chronic kidney disease (CKD), with prevalence rates reaching up to 39% among those on hemodialysis, and is often overlooked in screening. This study aims to assess the PHQ-9’s effectiveness in Omani dialysis patients, potentially improving early detection and mental health care integration.

The objectives of this study are as follows: 1) To assess the sensitivity, specificity, positive predictive value and negative predictive value of the PHQ-9 in detecting depression among Omani renal dialysis patients at Al Seeb and Bausher dialysis units from October 2023 to January 2024. 2) To evaluate the psychometric properties of the PHQ-9, including the optimal cut-off score, internal consistency, and criterion validity, in Omani renal dialysis patients by January 2024

This cross-sectional study was conducted from October 1, 2023, to January 31, 2024, at two renal dialysis centers in Muscat, focusing on adults aged 18 and older who had undergone dialysis for at least three months. Data collection included a sociodemographic questionnaire, the Patient Health Questionnaire (PHQ-9) for depression symptoms, and the Structured Clinical Interview for DSM-5 (SCID-5) for psychiatric evaluation, with all ethical standards adhered to and Institutional Review Board approval obtained. Data analysis utilized MedCalc® software, with statistical significance set at p < 0.05, and the diagnostic accuracy of the PHQ-9 evaluated through ROC curve analysis.

The study included 209 patients with Chronic Kidney Disease (CKD), averaging 48.43 years, with demographics summarized in Table 1. The Patient Health Questionnaire-9 (PHQ-9) effectively screened for Major Depressive Disorder (MDD), achieving an AUC of 0.87, as illustrated in Figure 1, with an optimal cutoff score of 9, sensitivity of nearly 78%, and specificity of about 85%. Additional metrics are detailed in Table 2, confirming the PHQ-9’s overall accuracy of 83.25% in identifying depression, highlighting the importance of clinical evaluation for diagnosis.

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This study provides strong evidence for the validity and reliability of the PHQ-9 as a depression screening tool for Omani dialysis patients, emphasizing the need for culturally sensitive approaches in screening. It suggests adjusting cutoff scores to enhance diagnostic accuracy, with significant implications for clinical practice in Oman and similar regions. Healthcare professionals are urged to consider cultural factors when implementing screening protocols to improve patient care. Future research should broaden the validation of the PHQ-9 across other regions in Oman and the Middle East, examining how linguistic and educational differences may affect its effectiveness.

None Declared

Previous studies have indicated a potential increase in risks of mental disorders among the offspring of mothers with depressive disorders. However, the association between maternal exposure at different developmental periods, including the period around pregnancy, and the offspring’s risk for adverse mental health outcomes remain unclear. Additionally, there is a lack of studies controlling for potential confounding by familial factors.

To determine the association between the timing of maternal depression around pregnancy and the risk of mental disorders among the offspring.

Population-based cohort study using linkage from Swedish national registers including 4,051,192 live singleton births in 1973-2010. Individuals were followed from age 3 until the first date of mental disorders diagnosis, emigration, death or 31 December 2013. We included the following diagnoses: depression, postpartum depression, neurotic disorders, stress-related disorders, alcohol use disorders, drug use disorders, attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), intellectual disability, behavioural disorders (child-/adolescent-onset), schizophrenia, other psychotic disorders, bipolar disorders, eating disorders, personality disorders, and others. Timing of maternal depression was defined as the earliest date of diagnosis or antidepressant dispensation around pregnancy, categorised into ‘1 year before conception’, ‘during pregnancy’, and ‘1 year after childbirth.’ Hazard ratios (HR) were estimated using Cox regression, adjusting for potential confounders. We also stratified the associations by age at follow up and birth year. To account for familial confounding, comparison was also made within full siblings.

In the population-based analysis, maternal depression was associated with a higher risk of overall mental disorder diagnosis in offspring in all three time periods, although the association tends to be stronger during the first year before conception (HR 1.90, 95% CI 1.78-2.03) and somewhat attenuated afterwards (HR during pregnancy 1.77, 95% CI 1.69-1.84; HR 1 year after childbirth 1.68, 95% CI 1.57-1.79; Figure 1). However, the associations were attenuated to null in the sibling analysis (HR overall mental disorders 1 year before conception 0.94, 95% CI 0.83-1.07; during pregnancy 1.08, 95% CI 0.98-1.17; 1 year after childbirth 1.00, 95% CI 0.88-1.13). Similar patterns were observed in most mental disorder diagnoses (Figure 1), across age at diagnosis (Figure 2), and birth year (Figure 3).

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While maternal depression before, during, and after pregnancy is predictive for the offspring’s mental health development, the link is likely driven by shared familial genetic and environmental factors.

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This research explores the intricate relationship between coping strategies, perceived stress levels, and life satisfaction among female medical professionals. The medical field is known for its rigorous demands, and understanding how lady doctors manage stress and its impact on their overall life satisfaction is crucial. While previous studies have shed light on stress-related issues in medical undergraduates, there is a significant gap in research focused on the well-being of practicing female doctors.

The objectives of this study are to investigate the relationship between coping behaviors and stress levels among lady doctors, assess the role of coping behaviors in shaping life satisfaction, explore the connections between coping behaviors, life satisfaction, and stress, and analyze the influence of demographic factors such as age and marital status on coping life satisfaction, and stress perception.

This study utilizes a quantitative research design and a purposive sample of lady doctors from government hospitals in Pakistan. Key measures include the COPE Inventory to assess coping behaviors, the Satisfaction with Life Scale to gauge life satisfaction, and the Perceived Stress Scale to measure stress levels. These tools allow for a comprehensive examination of the intricate interplay between these variables. SPSS 21 was used to analyze the data.

Results indicated that Coping is negatively correlated with Stress (r = -.29, n = 100, p = 0.05) meaning that higher coping strategies are associated with lower stress levels. Similarly, Coping is positively correlated with Life Satisfaction (r = .36, n = 100, p = 0.05) indicating that higher coping strategies are associated with higher life satisfaction. Likewise, Stress is negatively correlated with Life Satisfaction (r = -.22, n = 100, p = 0.05), suggesting that higher stress levels are associated with lower life satisfaction. Also, there is a statistically significant difference in coping between Single and Married individuals (t = 2.2, df = 36.6, p = 0.03), with Single individuals showing higher coping scores.

The findings of this study provide valuable insights into the psychological well-being of female medical professionals in Pakistan. This research contributes to the broader discourse on the well-being of healthcare professionals, shedding light on the unique experiences of female doctors in a challenging healthcare environment. Ultimately, it aims to inform policies and practices that support the psychological resilience and job satisfaction of female doctors, ensuring they can continue providing high-quality healthcare services to their communities.

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The COVID-19 pandemic has placed immense psychological pressure on healthcare workers (HCWs) worldwide. In addition to the physical risks of infection, HCWs have faced high levels of anxiety due to their proximity to the virus, overwork, and the challenges of providing care in an ever-evolving environment. These psychological effects are expected to persist well beyond the initial phase of the pandemic.

This study explores the long-term impact of COVID-19 on both anxiety and depression among HCWs and identifies the main contributing factors.

This cross-sectional study was conducted among HCWs infected with SARS Cov-2 between January and August 2022. Sociodemographic and professional data were extracted from participants’ medical records. Anxiety and depression were evaluated using the GAD-7 (Generalized Anxiety Disorder) and PHQ-9 (Patient Health Questionnaire) scales, respectively, through phone interviews conducted at least one year after their last COVID-19 infection

This study included a total of 184 healthcare workers (HCWs). The mean age of the participants was 41.93 years (± 8.6), with 95.1% being over 30 years old. Women comprised 81.4% of the cohort, and the majority of participants were nurses (45.7%), followed by administrative staff (20.1%). The median occupational seniority was 16 years. Notably, 28.3% of HCWs were employed in COVID-19 wards. Anxiety symptoms were reported by 92.9% of participants, with 17.3% experiencing mild anxiety, and 38.5% severe anxiety. Depression was prevalent in 69.1% of HCWs, with 27.2% presenting mild symptoms, and 24.5% experiencing moderate to severe depression. Female HCWs and those aged over 40 were significantly more likely to report symptoms of anxiety and depression (p < 0.001). Furthermore, HCWs with pre-existing conditions, such as diabetes, as well as those directly exposed to COVID-19 patients, exhibited significantly higher anxiety and depression scores. Nurses demonstrated particularly elevated levels of psychological distress, especially those working in COVID-19 wards.

The COVID-19 pandemic has had a profound and lasting psychological impact on healthcare workers, with anxiety and depression levels remaining elevated long after the acute phase of the crisis. This study emphasizes the need for targeted psychological support interventions. Addressing the mental health needs of HCWs is crucial not only for their well-being but also for ensuring the ongoing efficacy and resilience of the healthcare workforce in times of crisis. Further research is warranted to explore long-term impacts and effective strategies for mental health support in this population.

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