Recently there have been increased acceptance of complementary and alternative medicine (including traditional medicines) not only among laypersons but also various medical specialities. Ayurveda is one such, that originated at least in 3000 BC in the Indian subcontinent. Ayurveda aims at not only treating diseases but also maintaining optimum health. Psychiatry branch of Ayurveda recommends the use of both medicines and psychotherapy. Past papers on Ayurvedic psychotherapy have limitations in terms of semantics, conveying relevance and practical implementation. To tide over such limitations, we review concepts of psychotherapy in the Ayurveda texts Charaka Samhita (CS), Sushruta Samhita (SS), Ashtanga Hridaya (AH) and their commentaries from the original Sanskrit texts, in light of RDoC framework. The approaches derived can be used not just for therapy but also as mental health promotion.

1. 1. To delineate approaches to psychotherapy from Ayurveda classics and their commentaries, which are useful for both mental health promotion and therapy.

2. 2. To view the components of Ayurvedic psychotherapy approaches in terms of RDoC constructs/subconstructs.

Relevant chapters were scanned in the texts CS, SS, AH and their commentaries for descriptions of psychotherapy. Consequently, its components were compared with the definitions of constructs and subconstructs of RDoC to identify similarities.

Only CS and AH had descriptions on psychotherapy, among which, one out of the four described in CS and the only one in AH was suitable for our purpose. The components of these models with relevant counterparts (single or combined) are tabulated in Table 1.Table 1

Thus, CS and AH provide a 5-dimensional and a 3-dimensional approach to psychotherapy respectively (with its components having correlates with few RDoC constructs or subconstructs) which can be explored clinically and evaluated, for therapy and mental health promotion purposes.

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There has been growing evidence to support the hypothesis that inflammation is involved in the pathogenesis of schizophrenia.

The aim of the present literature review was to assess the efficacy of acetylsalicylic acid (ASA) as an adjuvant agent in the treatment of an acute exacerbation of schizophrenia.

We searched randomized clinical trials based on regular searches of MEDLINE, Embase, PubMed.

We included four studies. The results were in favor of the efficacy of ASA in the study where authors targeted early psychosis. Illness duration seems to predict response to anti-inflammatory agents.

Further studies of early stages of schizophrenia are helpful.

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Heavy academic loads imposed on medical students explain why it is so important for a university to pay more attention to the issues of maintaining their students’ mental health.

To compare the level of mental health and the need for mental health services in domestic and international medical students

The survey covered 305 domestic and 241 international university students of the Faculty of Medicine. Their mental health level was measured with the SCL-90R questionnaire, their interest to mental health services - by means of a 5-point questionnaire.

The data achieved by measuring the level of mental health with the SCL-90R revealed that in both groups this level is within standard limits. However, the international students showed a higher level of psychopathological distress reflected by GSI index (χ2=2.14; р=.03). Both groups have experienced a visit to a psychiatrist or psychotherapist (12.13% and 8.3% correspondingly). Some of them have undergone treatment in connection with their emotional and behavioral problems (3.28% и 3.73%). Currently, they claim, with the same frequency, that they are in need of a psychiatrist’s or psychotherapist’s help (14.43% и 13.28%). Domestic students, as compared with international students show higher need (χ2=24.55; р=.001) for a psychologist’s help (34.75% and 16.18%).With different frequency, 65.15% of the international students and 89.5% of the domestic students consider mental health services as necessary.

When providing medical support to medical students, it is important to take into account their need for mental health services and to keep in mind their different cultural backgrounds.

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Comorbidity between psychiatric disorders and disorders linked to psychoactive substance use is common and represent a real public health problem.

The association of a psychiatric disorder can, in certain cases, modify the treatment methods and also the evolution of the addictive behavior.

Determining the prevalence of psychiatric comorbidities in patients with substance use disorder Identify the sociodemographic and clinical characteristics of patients hospitalized in the addictology department.

We conducted a cross-sectional study with descriptive and analytical aims, in order to study psychiatric comorbidities in 150 patients with substance use disorder hospitalized in the addictology department of Ar Razi hospital in Salé over a period from June 1, 2022 to August 30, 2023.

Data collection was done using a questionnaire including clinical and socio-demographic characteristics, the prevalence of problematic use of psychoactive substances and the comorbidity of psychiatric disorders (diagnoses assessed by DSM 5 criteria).

A male predominance was noted (80%). The main substances consumed in the last 12 months were tobacco (98%), cannabis (74%), alcohol and benzodiazepines.

The majority of patients presented at least one psychiatric comorbidity (80%), with a predominance of depressive disorder and anxiety disorders.

Personal history of suicide attempts was found in 30% of the sample Substance dependency that prompted initially the consultation was higher in patients with psychiatric comorbidity (p < 0.05)

Post-traumatic stress disorder was significantly associated with the presence of problematic cocaine and alcohol use. Social phobia is associated with the absence of a criminal record.

Addictive behaviors are often associated with psychiatric disorders. The most common psychiatric comorbidities are depression, anxiety and personality disorders, hence the need for simultaneous treatment of psychiatric pathologies and addictive behavior

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Microdosing psychedelics has garnered considerable attention within both nonprofessional circles and the scientific community in recent years. This method involves taking small, non-hallucinogenic doses of substances like LSD or psilocybin over weeks or months, purportedly to enhance specific behaviors, emotions, or address psychiatric conditions.

Exploring these assertions is crucial given the potential therapeutic value of microdosing, especially in conditions that respond positively to full psychedelic doses, such as depression. The full psychedelic experience might not always be suitable due to various factors like age, capacity to consent or comprehend the experience (e.g., dementia), or individual personality traits that might hinder surrendering to the experience. Microdosing could potentially serve as a maintenance therapy post-full dose administration, aiding specific psychological or biological processes during therapy or therapeutic exercises.

Recent studies in healthy individuals highlight that small psychedelic doses have nuanced effects on pain perception, mood, neuroplasticity, sleep duration, brain connectivity, and default mode network synchronicity. However, some parameters show null effects after both single and repeated administration.

Our survey research uncovered that individuals with ADHD reported symptom relief through microdosing, deeming it more effective than their conventional treatments. Subsequently, we conducted a naturalistic study following individuals with ADHD across a 4-week microdosing period. Our findings indicated a reduction in symptoms over time, an increase in trait mindfulness, and a decrease in neuroticism compared to baseline. While these results are intriguing, they necessitate validation in a clinical trial. We have recently concluded such a trial and are currently analyzing the data to further explore these effects.

K. Kuypers Grant / Research support from: The author is a principal investigator on a research project that is sponsored by Mindmed, a company that is developing psychedelic medicines.

Sexuality, although an essential component of human health, remains a controversial topic shrouded in stigma, particularly in the context of neurodiversity, which includes autism spectrum disorder (ASD), where the expression of sexuality presents unique challenges. Autism and sexuality is a complex and multifaceted topic that involves understanding the unique ways in which individuals on the autism spectrum experience and express their sexuality.

The purpose of this work is to address the complexity of the biopsychosocial sexuality components of people with autism, promoting a shift in the medical perspective, societal attitudes, and supporting greater inclusion of these individuals in current discussions regarding this area of human behavior and experience.

Evidence-based review, through research conducted on PubMed and selection of the most relevant studies on this topic, published in the last decade.

Sexuality in autism is now recognized as a normative and integral aspect of development and functioning. Existing research suggests that most individuals with ASD display a clear interest in sexuality and relationships, with a study reviling that 96% of the ASD sample expressed an interest in sexuality. Individuals with high autistic traits tended to identify themselves more times as bisexual or presented a sexuality not definable within the categories of heterosexual. The relationship between autism and gender dysphoria is an area of ongoing research and discussion. Studies have suggested a higher prevalence of gender diverse identities and experiences within the autism community compared to the general population. Various hypotheses have been proposed to explain the increased gender and sexual diversity among individuals with autism. People with ASD may face unique challenges when it comes to their sexuality. The impairments in social skills and communication central to ASD potentially impact an autistic individual’s expression and experience of sexuality by affecting their abilities to understand and interpret social cues, emotions, and nonverbal behaviors of others. Importantly, such individuals may be more vulnerable, as they may have different or even limited understanding of boundaries and consent. To address these challenges, it is important to acknowledge and respect the diversity of sexual experiences and desires among individuals with neuro(bio)logical differences. This can be done by providing accurate and inclusive sex education, creating safe spaces for such individuals to explore and express their sexuality, and working to address discrimination and abuse in intimate contexts.

Recognizing and respecting this diversity and fostering inclusive and accepting environments, we can help individuals with neurological differences to fully express and explore their sexuality and have satisfying sexual lives.

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According to data, choking is one of the principal causes of death in mental health units. Specifically, research reveals that psychiatric patients -compared to the general population- are 43 times more likely to die due to choking. Nevertheless, only a limited number of studies has been focused on the risk factors of choking among this category of patients. Interestingly, dysphagia and choking on food are underdiagnosed and underreported in the UK psychiatry departments while there is an important insufficiency of provided information in national guidance archives as well as in regional clinical settings for adults with mental health diseases.

To explore the risk factors of choking among psychiatric patients and to highlight interventions of preventing choking-related incidents.

A review of 36 articles -from 2010 to 2023- on PubMed and Google Scholar regarding choking-related incidents among inpatients of mental health units.Articles exploring choking suicide-related incidents or choking as cause of neurological illness, were excluded from the research. Keywords: choking, psychiatric patients, death.

Numerous risk factors of choking have been identified, such as:

Antipsychotics,

Anxiolytics,

Bradykinetic dysphagia (extra-pyramidal syndrome),

Intellectual disabilities,

Dementia,

Anxiety,

Coughing while eating,

Fast paced eating and cramming food,

Mealtime-related stressors such as willingness of avoiding peers.

There is an absolute need for a specialized training of nurses, caregivers, mental health clinicians to prevent incidents and injuries of inpatients due to choking. Close supervision, routine screening during the mealtime, and detailed information from relatives about the patient’s eating habits are essential for the safety and the ameliorated quality of hospitalization for the mentally ill.

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Women experiencing severe perinatal mental health problems require specialized services and care. Perinatal mental disorders are common and can contribute to maternal mortality, affecting neonatal, infant, and child outcomes. Home treatment can prevent hospital admissions and promote strategies within the patient’s support network.

Our aim is to describe a clinical case in perinatal psychiatry managed by a Psychiatric Home Treatment Unit.

We present a case of perinatal psychotic depression in a 26-year-old pregnant woman.

We describe the case of a patient with no prior history of mental health issues. She was 25 weeks pregnant when she first sought psychiatric help in July 2023 and was diagnosed with depressive disorder with psychotic symptoms. She reported symptoms such as low mood, psychomotor inhibition, delusional guilt thoughts, and auditory hallucinations beginning three weeks before her initial visit. Due to her clinical presentation, the patient was admitted to the hospital, where pharmacological treatment was initiated with Olanzapine 5 mg, Sertraline 50 mg, and Lorazepam 1.5 mg. She remained in the hospital for four days, during which she showed gradual improvement but did not achieve full recovery.

Considering the improvement observed, home treatment was proposed and accepted by the patient and her relatives. During home treatment, she continued to exhibit persistent depressive and psychotic symptoms, including low mood, inhibition, and delusional thoughts of ruin and catastrophe. Therefore, her treatment was adjusted, with Olanzapine increased to 10 mg, Sertraline raised to 100 mg, and Lorazepam reduced to 0.75 mg. Over time, significant improvement in her clinical symptoms was noted. Throughout the follow-up period, she reported no significant side effects from the pharmacological treatment. After a month of follow-up in our department, she was discharged with outpatient care provided by a specialized community perinatal psychiatric unit.

We illustrate the possibility of home treatment for perinatal psychiatric disorders. The potential benefits of remaining close to one’s support network and developing coping strategies can be advantageous during the course of illness. Further studies should be conducted to explore these potential benefits.

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Duration of untreated psychosis (DUP) is defined as the time between the onset of psychotic symptoms and the initiation of appropriate treatment. DUP has been the subject of intensive research to understand how it is associated with a poorer prognosis in patients with first-episode psychosis (FEP). Involuntary treatment is often necessary in the context of FEP.

To characterize the relationship between the duration of untreated psychosis (DUP) and the type of hospitalization (voluntary versus involuntary) in patients admitted for FEP.

We conducted a retrospective observational study, collecting data from patients admitted between January 2019 and December 2022, in the psychiatric unit at our hospital in Bragança, Portugal. We used the information recorded in the clinical records and statistical analysis of the data was performed using the SPSS program.

Over the 4-year study period, 81 patients with first-episode psychotic symptoms at admission were selected. The average age was 46.98 years, with a slight male predominance. 46.9% (n=38) were admitted involuntarily, and 53.1% (n=43) were admitted voluntarily. The average DUP was 73 days. DUP was 95.92 days for patients admitted involuntarily and 54.72 days for voluntary admission. This difference was not statistically significant.

There was a longer DUP in patients admitted involuntarily, although this association was not statistically significant. However, it is important to emphasize that involuntary hospitalization is frequently linked to more severe cases and poorer prognosis. Therefore, recognizing psychotic symptoms as early as possible is essential to facilitate prompt identification and effective treatment for patients experiencing their first episode of psychosis, ultimately leading to an improved prognosis.

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Psychotic patients are a vulnerable population from a social and health point of view. The SARS Cov-2 pandemic affected millions of people around the world, however, its effects on psychotic patients in Avilés Spain, have not been analized.

The objective of this study was to determine and compare the mortality of patients with psychosis due to SARS Cov-2 in Avilés, Spain with others regions and countries in the European Union. Determine the influence of social condition and antipsychotic treatment on the condition of these patients.

This is a descriptive, observational study, in which patients diagnosed with psychosis in the period 2020-2021 who contracted SARS Cov-2 infection in Avilés, Spain, were studied to determine those who died from this cause. The influence of social status and antipsychotic medication, as well as sociodemographic factors (age, sex, marital status) were analyzed and compared with other regions and countries of the European Union.

Despite the high mortality rate in patients with psychosis, during the years of the pandemic SARS Cov-2 played an important role given the vulnerability of these patients.

The negative effects and deaths during the COVID-19 pandemic were at the time a major problem for public health worldwide. This study concluded that the morbidity and mortality of psychotic patients who contracted COVID-19 was lower than the rest of the population.

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In the last 30 years, Switzerland has been established as a destination country for psychiatric trainees. The needed competences for the work as a trainee deviate regarding colleagues from foreign countries though, hindering a viable solid development professional without specific on-boarding program. A similar approach to the figure of tutor anchored in the Spanish postgraduate medical training is still missing in the Swiss medical System. Hereby we performed a survey in the new colleagues who are part from the medical team in an observer status before beginning with the responsibilities as a trainee.

Recognizing competences and needs of the onboarding in current trainees that are still allocating because of the work conditions as stated in the following paper, (Bischof et al. Swiss Arch Neurol Psychiatr Psychother. 2021;172:w03198)

Survey with open questions collecting needs and competences expected to fulfil in Switzerland were distributed in 5 different medical colleagues in an observer status between August 2022 and September 2023.

Response rate was 62,5 %. Main reasons for the migration were considering better perspectives in education and professional development in the goal country, coming push factors as the current work situation in the original country to the fore. Support regarding the local language and an overview of the interprofessional communication were outlined as the advantage of the internship prior to the duties as a psychiatric trainee.

An structured on-boarding program is a demand for the newcomers - majority of trainees from foreign countries - to step in better in the Swiss health system. Elements of the Spanish trainee system could be adapted for a suitable allocation and integration process in the goal country.

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Czech health care workers recently experienced serious challenges to their mental health. After the COVID-19 pandemic that was extremely stressful, a war in Ukraine caused a flood of refugees that needed health care. Although the Czech Republic does not have borders with Ukraine, it welcomed more than 400,000 refugees in 2022.

The aim of this study was to investigate the association between depression and working with Ukrainian refugees among health care workers and the nature of emotional burden connected with this situation.

We use data from an online survey of the Czech COVID-19 HEalth caRe wOrkErS (HEROES) Study collected in September - November 2022 (n=1,076). We combined quantitative binary logistic regression and qualitative content analysis of answers to an open-ended question (“How does the current situation of war in Ukraine affect your mental well-being and working conditions?”). Logistic regression estimated odds ratio (OR) of at least moderate depression, defined as => 10 points on the Patient Health Questionnaire.

Among our participants (75.1% women, mean age 46 (SD 11.0)), 62.1% had experience of working with Ukrainian refugees, and 13.8% reported moderate to severe depression. Logistic regression model (adjusted for potential confounders) indicated that health care workers who worked with Ukrainian refugees had slightly greater chance of having depression, but the association was not statistically reliable (OR 1.05; 95% CI 0.59-1.86). Out of all survey respondents, 867 replied to an open-ended question. As follows from qualitative analysis, three categories of psychological strain were described by the health care workers: 1) specificity of work with the refugee patients (e.g. language barrier, increased workload, opinion conflicts), 2) insecurity, threat of war and fears about future (regarding global and nuclear war, security, future of kids, economic burden, etc.), 3) grief and compassion for the suffering of refugees. It was also frequently mentioned in the responses that war is a greater threat to health care workers than the COVID-19 pandemic.

There is a slight association between working with refugees and depression. However, health care workers are also endangered by general fears of war and insecurity in a nearby country. In this changing world, it is of the greatest importance to pay attention to resilience building and stress prevention programs. Further, health care workers should be offered psychological support and practical resources to deal with the varying workload.

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Attention-Deficit/Hyperactivity Disorder (ADHD), once considered a predominantly childhood condition, has increasingly gained recognition as a prevalent and clinically significant concern among adult women. They often display a distinctive symptom profile characterized by high levels of inattention, emotional dysregulation, and difficulties in executive functioning. Diagnosis of female adult ADHD is frequently complicated by gender bias in traditional diagnostic criteria, which may fail to account for the unique ways in which women manifest the disorder.

This comprehensive literature review aims to characterize the unique symptomatology of female adult ADHD, including variations in inattention, hyperactivity, and impulsivity, as well as the presence of emotional dysregulation. It also seeks to explore the diagnostic challenges stemming from gender bias in diagnostic criteria and the role of comorbidity in diagnostic complexity. Additionally, the review assesses the broad spectrum of functional impairments experienced by adult women with ADHD, spanning academic, occupational, interpersonal, and emotional domains.

This literature review comprises a systematic examination of published research articles, clinical studies, and relevant academic literature addressing female adult ADHD. A comprehensive search strategy involving electronic databases, including PubMed, PsycINFO, and Google Scholar, was employed to identify peer-reviewed articles published between 2000 and 2023. The selected studies underwent critical appraisal for quality and relevance to the review’s objectives.

The synthesis of existing literature reveals that female adult ADHD presents a distinctive clinical picture characterized by a higher prevalence of inattention, emotional dysregulation, and comorbid conditions such as mood and anxiety disorders. Diagnostic challenges arise from gender bias in diagnostic criteria and the absence of overt hyperactivity, often leading to delayed diagnosis or misdiagnosis. Functional impairments extend to academic, occupational, interpersonal, and emotional domains, affecting the overall quality of life for affected individuals. Gender-specific factors, including societal expectations and biases in healthcare evaluation, contribute to diagnostic disparities and hinder timely access to appropriate interventions.

The literature review underscores the critical need for enhanced recognition, understanding, and tailored support for female adults with ADHD. The distinct symptomatology, diagnostic complexities, functional impairments, and gender-specific factors contribute to a multifaceted clinical landscape. Advancing gender-sensitive diagnostic criteria, increasing awareness among healthcare professionals, and developing interventions that address the unique needs of this population are essential steps toward improving the quality of life and outcomes for female adults with ADHD.

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Recovery in Schizophrenia: The Role of Psychosocial interventions Recovery is individual and so needs individual responses from the mental health services. Different interventions are useful at different stages and of course they only “work” for some people. The paper will describe some psychosocial interventions and the role they might pay in the patient’s journey to their expected recovery. Three main strategies are often referred to – reducing symptoms, reducing barriers to recovery, and extending and maintaining recovery to achieve some stable and acceptable (to the patient) optimal level of functioning. Psychosocial intervention strategies are beneficial for each of these often thought of as independent, but they are inter-related with one type of therapy leading to reductions in the need for other therapies. The process of considering which one to start with is a choice and this paper will describe some decision making to ensure that patients have the best options.

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Depression is a complex and highly heterogeneous disorder with an omnigenic and multifactorial background. This diversity is obvious not only in its symptomatic manifestation but also in its neurobiological underpinnings which is one potential factor contributing to the high observed rate of treatment resistance. Thus, subtyping depressions, understanding their distinct neurobiological and genetic background, and potentially developing biomarkers aiding their differential diagnosis may bring us one step closer to more effective treatment. The present talk will overview the different etiological factors contributing to the emergence of depression along an endogenous-reactive continuum, the contributory roles of different types of stress, different genes involved in distinct processes, and the potential consequences of conceptualising, diagnosing and treating depressions developing in the context or independently of current stress.

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Being a doctor is a profession with special medical requirements. Therefore, the assessment of medical fitness for work among physicians remains a complex decision, particularly for those with psychiatric disorders.

To assess the fitness for work decisions among physicians with psychiatric disorders.

Descriptive and retrospective study including physicians with psychiatric disorders referred to the occupational department of the Charles Nicolle Hospital in Tunis for a medical fitness for work from January 1, 2018 to August 30, 2023.

The study included 28 patients with a female predominance (sex ratio M/F at 0.3) and a mean age of 44.1 ± 12 years. Participants were general practitioners (N=12), junior doctors (N=10), specialists (N=5) and one dentist. They worked in the public health sector in 93% of cases, and had a mean professional seniority of 12.4 ± 9.3 years. A psychiatric history was found in 20 patients. Current psychiatric disorders recorded were: depression (N=15), bipolar disorder (N=7), anxiety-depressive disorder (N=4), personality disorders (N=1) and addiction (N=1). Concerning the fitness for work, six patients were fit for work and 11 were temporarily unfit. Job adjustments were proposed for 11 physicians, mainly night shift exemption.

Physicians are exposed to several occupational hazards and require strict medical qualifications. The impact of psychiatric disorders on medical fitness for work is considerable, and could be avoided by appropriate prevention by occupational health practionnairers, starting from professional orientation.

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Although there is an increasing interest in making mental health services (MHS) accessible to youths, there is limited ground-up involvement of youths while designing MHS in Asian settings.

This qualitative study sought to understand what youths considered as important elements of youth centric MHS and how these could be designed to improve access by youths in Singapore.

We conducted seven focus group discussions, and four semi-structured interviews with 50 multiracial youths aged 15-35 years in Singapore - a high-income Southeast Asian country. Purposive sampling allowed adequate representation of age, gender, and race (mainly Chinese, Malay, and Indian) groups. Participants reflected on the features of an ideal MHS for youths and how these could improve youths’ attitude and access to services. Participants also shared their preferences and additional opinions for culturally tailored and age appropriate MHS. Framework analysis using the ‘Conceptual Framework of Access to Healthcare’ (Levesque et al. Int J Equity Health 2013, 12:18) was used to code transcripts and identify the key themes (Ritchie & Spencer. In Analyzing qualitative data, 1994).

The average age of the participants was 24 years. About one third of the participants had accessed MHS in the past. Three key themes were identified – making facilities ‘approachable’, ‘available and appropriate’ and ‘affordable’. (i) Making facilities approachable related to having non-stigmatizing, non-threatening and welcoming aesthetics, organizational culture, and personnel. The participants also recommended a range of professional services, digital tools, and online features to enhance the approachability of MHS designed for youths. (ii) Flexible operating hours, easy appointment management, accessible location, and easy availability to youths with unique needs (e.g., employed youths) or socio-cultural backgrounds were necessary for making facilities available and accessible to youths. (iii) While sharing challenges of family involvement in the help-seeking process, most of the participants, particularly those in the lower ages, talked about tailoring MHS to the ability of youths to pay for the services. Preferences such as having cheaper services for teenagers and initial contacts, offering more non-medical but trained professionals, and considering shorter in-person counselling sessions, followed by free online options were brought up by the participants.

The study provided insights into multiple aspects of MHS and how these could be designed to cater to the needs of youths in Singapore from their perspective. MHS that incorporate non-stigmatizing, flexible, non-threatening and affordable design approaches could improve help-seeking and early interventions in youths.

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Melancholia is a concept deeply intertwined with the history of mood disorders in psychiatry. Isháq Ibn Imrân, a prominent Arab-Muslim physician of the 12th century, contributed significantly to the understanding of melancholia in his era, its. His treatise is the oldest surviving work entirely dedicated to melancholia, making it a pivotal milestone in the history of psychiatry. It is noteworthy that Ibn Imrân’s work has often been overlooked in Western psychiatry. This oversight highlights the enduring relevance of his insights within the context of modern psychiatry.

The objective of this study is to assess the clinical and therapeutic aspects delineated by Ibn Imrân in his treatise on melancholia for their contemporary accuracy and relevance within the field of modern psychiatry.

The review method for the Isháq Ibn Imrân treatise involves a detailed analysis of the original Arabic text and its French translation by Adel Omrani and Radhi Jazi from the Tunisian Academy of Sciences, Letters, and Arts Beit el Hekma. This includes studying the content, structure, and historical context, as well as comparing the Arabic and French versions for accuracy.

The treatise is divided into two parts to clinical examination and treatment. While some of the terminology may differ from contemporary classifications, the core observations resonate with modern psychiatric knowledge. The clinical form is described as sadness, loss of pleasure, social withdrawal, dark thoughts, and loss of interest, along with somatic manifestations: sleep disturbances such as onset insomnia or hypersomnia, as well as weight loss. Additionally, perceptual disturbances, including elementary visual hallucinations (black silhouettes), are mentioned. Regarding etiologies, perinatal factors are mentioned in the treatise (“mood of the uterus”), along with six postnatal acquired causes that must be balanced in an individual: movement and rest, sleep and wakefulness, food and drink, depletion and retention, ambient air and location and psychological torment. A seasonal pattern is described, with an association between melancholia and autumn. Several clinical forms are described, with the most prominent being catatonia compared to epilepsy, in its two agitated and inhibited forms. The second part of his treatise is dedicated to treatment, focusing on individualized approaches such as talk therapy, music therapy, and dietary interventions. Ibn Imrân also describes mental strategies to correct false beliefs. For the pharmacological treatment, specific herbs has been used via oral, nasal, or intra-rectal.

In conclusion, Isháq Ibn Imrân’s treatise on melancholia represents a timeless cornerstone in the history of psychiatry. This historical treasure serves as a reminder of the enduring quest to understand and alleviate the complexities of mental health.

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Patients with difficult-to-treat depression (DTD) need multimodal treatment with combination of psychotherapy, pharmacotherapy and neuromodulation. In severe cases, combination of neuromodulatory techniques may be considered to achieve symptom relief.

To describe a novel treatment approach, which combines VNS in synchronization with accelerated intermittent Theta-Burst-Stimulation (aiTBS) over three weeks in two cases with difficult-to-treat depression.

In this presentation we describe two cases of DTD, which have been implanted with VNS and did not respond to aiTBS previously. Patients then were offered a synchronized treatment regimen, where each stimulus train of aiTBS was synchronized with ON-time of VNS. To start each train simultaneously with VNS ON-time, we set treatment cycle of each aiTBS and VNS to 19 sec. Patients received 2400-3000 TBS pulses daily for 3 weeks over left dorsolateral prefrontal cortex (DLPFC) at 100% of resting motor threshold.

In the first patient the MADRS score decreased from 37 to 26 (-30%) and in the other patient there was a decrease of MADRS score from 20 to 9 (-55%), which corresponded to remission after 3 weeks of treatment. The synchronized treatment procedure was well-tolerated in both cases. As both patients experienced significant improvement, we planned maintenance treatment in both cases.

Synchronization of aiTBS with VNS is a novel treatment approach in patients with DTD, which can lead to improvement even if patients previously did not respond to aiTBS without synchronization with VNS.

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