Manifestations of phantom ringing syndrome are widely seen in healthy population. Are there any interrelations between this phenomenon and personal psychological characteristics that are connected with the level of their mental health?

To determine the specificity of interrelations of phantom ringing syndrome related anxiety and personal self-esteem in university students

The anonymous survey covered 546 undergraduate university students. The questions were centered on the students’ patterns of their personal smartphone use.

The research showed that manifestations of phantom ringing syndrome is available in 189 students, or in every third student (34.6%), who use mobile phones. It is equally represented in males (49.7%) and females (50.2). Clinically, it is characterized by a higher level of anxiety, which reliably correlates (p<0.01) with the level of stress (r=.17), level of nervousness caused by absence of a mobile phone (r=.18), the frequency of headache (r=.15), the frequency of medication consumption related to chronic somatic disease (r=.15). We also established valid negative interrelations between the level of phantom ringing syndrome related anxiety and the personal self-esteem based on the parameters of religious belief (r=-.15), personal attractiveness (r=-.16), mind (r=-.17), happiness (r=-.24), liveliness (r=-.25) and well-being (r=-.15). We have not found any proof of valid interrelations with self-assessment of health.

The received results prove that phantom ringing syndrome related anxiety is connected with the personal self-esteem, the level of the perceived stress and some other clinical manifestations

None Declared

Recent clinical and preclinical evidences suggested that neuroinflammation is a key factor which interacts with the neurobiological correlates of major depressive disorder, which are the (i) dysregulation of the hypothalamic-pituitary-adrenal axis, (ii) depletion of brain serotonin and (iii) alteration of neurogenesis in the dentate gyrus of the hippocampus.

The gut bacterial has major impact on the brain development, behaviour and host immune system through the microbiota-gut-brain axis.

The objective of the research is to establish the role inflammation induced by gut dysbiosis plays in behavioural changes of patients suffering from major depressive disorders.

Clinical data and preclinical experiments were used to elucidate the role gastrointestinal bacterial play in the development and functional physiology of the nervous system and because of the bidirectional communication between the enteric nervous system in the gut and the central nervous system, through the vagal plexus, blood circulation and endocrine system; it was discovered that the appropriate population of intestinal microbiota affect the immunological state of the brain.

The intestinal microbiota has been able to maintain the attenuation and regulation of pro-inflammatory biomarkers in the brain and such had assisted in the healthy state of the brain; however, a disruption of gastrointestinal organisms in a condition called dysbiosis could result in breakdown of protective gastrointestinal mucosa barrier resulting in leaky gut and consequently, the permeability of the gut lining and migration of some bacteria, to the brain through the vagal networks and other channels.

These pathophysiological cascades appear to be triggered or sustained and reinforced by chronic inflammatory condition involving increased circulating markers of inflammation, which are able to cross the blood brain barrier to activate the microglia.

Studies in depression suggest that inflammatory biomarkers such as C-reactive protein can be used to enrich samples for anti-inflammatory clinical trials for depression that target inflammation-related symptoms such as anhedonia and anxiety.

Although, still at the developmental stages, imaging of neuroinflammation will help establish a target in the brain to further facilitate the testing of anti-inflammatory therapies for depression.

None Declared

Serotonin syndrome is a potentially life-threatening condition that is precipitated by the use of serotonergic medications, Selective Serotonin Reuptake Inhibitors (SSRIs) and Monoamine Oxidase Inhibitors (MAOIs). It usually occurs when high doses of serotonergic drugs are prescribed. It is a medical emergency that requires prompt recognition, cessation of offending drugs and supportive therapy.

We present a case of serotonin syndrome that occurred in a patient who was prescribed a low dose of sertraline, and aim to highlight the importance of early detection of this severe condition.

Details of the case were described. Information was gathered based on medical records.

Patient M was a 29-year-old Malay male with a history of major depressive disorder, who was previously trialed on fluvoxamine 100mg every night but subsequently switched to and maintained on sertraline 75mg every night in 2020. He then defaulted follow up appointments. In 2023, he presented to the emergency services for a suicide attempt and was diagnosed with major depressive disorder with psychotic features. He was restarted on sertraline 50mg every night and risperidone 0.5mg every night was newly started. Two days later, sertraline was increased to 100mg every night. Two days following this increase, he was noted to have altered mental state, fever of 39.3-degree celcius, tachycardia of 120 beats per minute, ocular clonus and generalized hyperreflexia. Sertraline and risperidone were immediately stopped. Blood tests including creatine kinase, lumbar puncture and magnetic resonance imaging (MRI) of the brain did not show any abnormalities. After stopping of the medications, the patient’s symptoms resolved within 24 hours. Based on clinical symptoms and a normal creatine kinase level, neuroleptic malignant syndrome (NMS) was ruled out. Subsequently, he was restarted on risperidone 0.5mg and mirtazapine 7.5mg every night. He developed symptoms of serotonin syndrome with a low dose of sertraline. Symptoms resolved after the discontinuation of the SSRI.

In this case, differential diagnoses of serotonin syndrome were also considered, such as NMS, encephalitis, meningitis and thyroid storm. NMS was less likely due to the rapid onset of onset and resolution of symptoms. Encephalitis and meningitis were unlikely in view of normal MRI brain and lumbar puncture findings.

There have been case reports of serotonin syndrome developing with lower doses of an SSRI in the pediatric population. There is, however, a lack of literature describing serotonin syndrome with low doses of SSRI in the adult population. To avoid a missed diagnosis, clinicians should monitor closely for SSRI toxicity, including serotonin syndrome, even when low doses of serotonergic drugs are used.

None Declared

The COVID-19 pandemic has certainly become a stressful event for medical workers, so the aim of this research was to study the pandemic-specific working conditions that may be associated with the professional burnout of medical workers in Russia.

To study the pandemic-specific working conditions that may be associated with the professional burnout of medical workers in Russia.

The Maslach Burnout Inventory (MBI) was used to measure the level of professional burnout. It was filled out by medical workers from January 2021 to November 2022.

The sample consisted of 314 medical workers (57 men and 255 women), whose average age was 36.97±11.93. According to the level of education, the sample included specialists with secondary general education (4.14%), with secondary special education (19.4%), with incomplete higher education (11.46%), with higher education (59.87%) and PhD (5.1%). 35 people (11%) of the surveyed medical workers worked in the red zone.

Working in the red zone is significantly associated with Emotional Exhaustion (p=0.002) and Depersonalization (p=0.002), but not with a Reduction in Professionalism.

The working conditions of medical workers who were significantly associated simultaneously with Emotional Exhaustion, Depersonalization and Reduction of professionalism (respectively): (1) Lack of confidence in support from the health system and the state in case of illness (r=0.170, p=0.002; r=0.202, p=0.000; r=-0.171, 0. 002); (2) Inability to meet the usual personal needs (daily routine, nutrition, communication with loved ones) as employment increases at work (r=0.200, p=0.000; r=0.154, p=0.006; r=-0.186, 0. 001); (3) Lack of confidence in their own professional competence in the fight against COVID-19 due to lack of knowledge about COVID-19 (r=0.202, p=0.000; r=0.148, p=0.009; r=-0.211, 0. 000); (4) Lack of confidence in their own effectiveness in the fight against COVID-19 due to the increase in the volume of work and the expansion of the scope of professional responsibilities (r=0.234, p=0.000; r=0.152, p=0.007; r=-0.177, 0. 002); (5) Lack of access to up-to-date information about COVID-19 (r=0.190, p=0.001; r=0.158, p=0.005; r=-0.140, 0. 013).

The Emotional Exhaustion scale is also associated with the fear of getting infected and getting sick with COVID-19 (r=0.125; p=0.026), as well as the lack of quick access to testing when COVID-19 symptoms appear (r=0.169; p=0.003).

Thus, not only work in the red zone, but also many specific working conditions during the COVID-19 pandemic can become a provocateur factor for the deterioration of the emotional state of medical workers.

Disclosure: Research is supported by the Russian Science Foundation, project No. 21-18-00624.

None Declared

Globally, there is a mental health crisis, and anxiety is the most prevalent mental health condition. However, the impact of the COVID-19 pandemic (COVID) on generalized anxiety disorder (GAD) prevalence has not been quantified across European countries, and such impact could establish a new baseline of GAD estimates in European countries.

To assess GAD by severity level before and during COVID in 5 European countries, using the 7-Item GAD Questionnaire (GAD-7).

Adults (age 18+) in France, Germany, UK, Italy, and Spain completed a short survey in May 2020 to assess the impact of COVID on their mental health. All respondents had previously participated in the National Health and Wellness Survey, a nationally representative survey of the adult general population in each country, before COVID (December 2019–March 2020). In both surveys, respondents completed the GAD-7. GAD symptoms were defined by GAD-7 score as mild (5-9), moderate (10-14), and severe GAD (≥15). Positive screen was defined as GAD-7 score ≥10. Positive screen and GAD symptom severity prevalence were reported for the pooled European sample and by country, both before and during COVID. Chi-square and McNemar’s tests were used to evaluate the difference in GAD severity across countries and changes over baseline in GAD positive screen during COVID. P-values were reported for both tests.

In total, 2401 adults were included in analysis (France, n=482; Germany, n=487; UK, n=487; Italy, n=474; Spain, n=471). Prior to COVID, 311 (13%) screened positive for GAD, with 208 (9%) moderate and 103 (4%) severe in the pooled European sample. During COVID, the distribution of GAD symptoms almost doubled, as 576 (24%) screened positive for GAD, and shifted towards greater severity with 337 (14%) moderate and 239 (10%) severe in the pooled European sample (Figure 1). Before COVID, the prevalence of positive screen ranged from 11% (France, Germany, Spain) to 16% (UK). Statistically significant increases in positive screen over baseline levels were observed across all countries (p<0.01), except Germany. Spain was the most impacted by COVID (increase: 16%), followed by Italy, France, and UK (increase: 14%, 12%, and 9%, respectively). Germany was the least affected, overall (increase: 4%) (Figure 2).

Image:

Image 2:

During COVID, estimates of positive screen for GAD increased substantially to 24% across 5 European countries. Surges in positive screen and GAD symptom severity were observed in all 5 countries, with more profound impact in Spain, Italy, France, and UK. With new baseline GAD estimates, the country-specific data of COVID impact on GAD could help to inform appropriate allocation of mental health resources.

D. Karlin Employee of: MindMed, S. Suponcic Shareolder of: Eli Lilly, Stryker, Abbott, Amgen, Consultant of: MindMed, Becton Dickinson Company, CSL Behring, N. Chen Consultant of: MindMed, C. Steinhart Employee of: MindMed, P. Duong Employee of: MindMed

Most patients with mental disorders exhibit multiple comorbidities. Without doubt the presence of multiple co-occurring somatic and mental disorders is associated with a higher insurance spending for the psychiatric patients. The details of this association need to be elucidated.

The aim of current study was 1) to delineate the typical nonmental comorbidities that occur among mental patients, and 2) to investigate social health insurance spending on comorbidities compared to the direct mental care costs of the same population. The analysis offers unique insight into the health care spending, since it focuses not only the costs of psychiatric care but reflects the whole range of treatments delivered to this group.

A database with the claim records of the Hungarian NHIF was created including direct healthcare costs for mental diagnosis. Patients were recorded either in primary or in specialist care with at least one mental health diagnosis in the last pre-pandemic year (2019). Adopting a case-control design, spending and comorbidities were compared to the control group, which comprised patients who did not have any mental diagnosis. Cases and controls were matched on demographic characteristics like age, gender, place of residence with deprivation index and marital status..

Mental problems affected in 2019 more than 1,5 million persons in Hungary. Half of them did not access specialist care but were only seen with the mental diagnosis by a GP. Direct insurance spending for mental care is around 156 million EUR/year with 4% of the total direct health spending. Besides these costs another 665 million EUR (+17% of all health spending) were reimbursed for the same patient group for the treatment of other diseases. With regards to affected patient numbers, the three most important comorbidities were cardio-vascular conditions (34% of mental patients with 14% of all spending of the group); diseases of the digestive system (29% vs 14%); and musco-sceletal conditions (28% / 9% ) In terms of spending three other disease groups also have to be considered as of high significance: carcinomas (4% patients vs 13% of spending); neurological disorders (13% /vs 7%); and diseases of the endocrine, nutritional and metabolic system (24% vs 6%).

The analysis aims to raise awareness for the complex issues of comorbidities of mental patients. We see that this patient group suffers heavily from other conditions the costs of which is much higher than the direct mental care costs. A better understanding of the coexistence of somatic and mental disorders and a holistic approach of treatment (care integration, reimbursement across different types of care, etc.) would be desirable.

None Declared

Kambó is considered an “ancestral medicine” by the indigenous tribes of the western region of the Amazon.

Through this clinical case, the aim is to present the particularities of the symptoms and management of patients with consumption of not so common substances, such as Kambo or salvia divinorum, as well as the evolution that will occur in a patient with a previous diagnosis of a Depressive Episode.

We present the case of a 23-year-old male, Gestalt therapy student. History of tobacco, THC, and recent use of salvia divinorum and Kambo. He began follow-up by psychiatry in a private setting three years ago due to a severe depressive episode, having required treatment with antidepressants, antipsychotics and benzodiazepines, and having been triggered by a serious assault. The episode is resolved and follow-up is discontinued. Family history of depressive syndrome and suicide.

He resumed contact through the Emergency Department, requiring hospital admission due to symptoms compatible with a manic episode with psychotic symptoms. It begins with behavioral alterations and global insomnia that are related to the consumption of some substance, initially unknown to them, making the skin lesions they presented suspect the consumption of kambo.

We assess the risk of consuming these substances, which are sometimes used as alternative therapies, and especially in this type of patient, who is more vulnerable and perhaps seeks a way out of the problems they present.

In our case, it triggered a manic episode with psychotic symptoms, which consisted of delusional ideation of mystical content accompanied by auditory hallucinations. The episode took about a month to subside, despite treatment. Subsequently, there have been more episodes with similar characteristics, and they have not been associated with the consumption of kambó, but have been linked to the consumption of “natural medicinal substances.”

None Declared

The glucagon-like peptide-1 (GLP-1) receptor agonist Semaglutide has been widely used to manage type 2 diabetes due to its favourable effects on glycemic control and weight reduction. Proved to be safe in adults and elderly patients with renal or hepatic disorders demanding no dose modification. Affective symptoms are not listed as side effects in the product information. However, there is a recent investigation going on by the European Medicines Agency (EMA) after three flagged cases of suicidal thoughts in Iceland. In contrast, the Food and Drug Administration (FDA) recommend that patients with this treatment are monitored for suicidal thoughts or behaviour.

This case study explores the possible relationship between Semaglutide treatment and the onset of a manic episode in a 57-year-old male with no history of psychiatric disorders.

We present a 57-year-old male with no psychiatric history of interests, with a previous good functioning. A one-week history of disruptive behaviours started, characterized by excessive cheerfulness, heightened euphoria, and reduced need for sleep. Family members describe a complex situation at home, with frequent outings by the patient, engaging in conversations with strangers, getting lost, and becoming more irritable with them. The patient and family relate this mood change after initiating Semaglutide for diabetes control, starting at 7mg doses. The temporal relationship between the initiation of Semaglutide therapy, precisely a dose escalation to 7mg, and the onset of manic symptoms prompted family members to notify the patient’s endocrinologist. Due to the inability to manage the patient at home and his unpredictability, they sought help at the emergency department, resulting in a psychiatric admission. Imaging and analytical tests show no significant abnormalities.

During his stay in the psychiatry department, semaglutide dosage was reduced, and treatment with Aripiprazole was initiated at doses of 5mg, given the metabolic profile associated with medical comorbidities (obesity, chronic renal failure and diabetes). Subsequent clinical observations showed a gradual resolution of manic symptoms and an improvement in the patient’s overall mental state.

This case highlights the importance of monitoring and recognizing potential neuropsychiatric side effects associated with Semaglutide therapy, particularly in individuals without a prior psychiatric history. Further research is warranted to elucidate the underlying mechanisms linking Semaglutide with mood disturbances and to identify risk factors that may predispose certain patients to develop manic states in response to this GLP-1RA. Clinicians should remain vigilant and consider alternative treatment options if such side effects occur, ensuring comprehensive management of patients receiving Semaglutide for diabetes control.

None Declared

It is well established that migrants have a 2 to 4 times increase in psychosis risk. However, estimates are highly heterogeneous and vary considerably depending on origin and destination country. It also seems that the relationship between migration and psychosis is complex.

In this review, we aim to explore the moderators, mediators and mechanisms behind migration psychosis.

We searched PubMed using the following terms: “psychosis,” “psychotic,” “migra*”, “immigra*”, “schizophreni*.” “pathogene*”. We limited the search to studies published after 2010 and we screened the title, abstract, and full text. We included a total of 47 studies in this narrative review.

Moderators identified in the literature were country of origin, vitamin D deficiency, male sex, and psychosocial adversity (e.g. exposure to war). Mediators were mostly social, namely discrimination, social exclusion and ethnic minority status, low ethnic density, as well as language distance, unstable housing, and unemployment. Most of the studies we retrieved found that substance use did not fully explain the increased risk for psychosis among migrants. We found that potential pathophysiological mechanisms include stress-induced alterations in dopaminergic neurotransmission, functional and structural alterations in ventral anterior cingulate cortex, as well as possible stress-resultant neuroinflammation.

This review highlights the pathway from psychosocial hardships to neurobiological alterations leading to migration psychosis. Further research is needed to translate these findings into developing preventive measures and tailoring treatment modalities to the migrant population.

None Declared

Consideration of the reserve problem would be incomplete without an analysis of the cytoprotective mechanism. The predominant molecular hallmark of aging and degeneration is the accumulation of altered gene products. Moreover, several conditions, including protein, lipid, or glucose oxidation, disrupt redox homeostasis and lead to the accumulation of unfolded or misfolded proteins in the aging brain in case of AD, and other neurodegenerative diseases that have as a common denominator abnormal protein production, mitochondrial dysfunction and oxidative stress. Some authors classify aging, pathological aging, and neurodegeneration as “protein conformational diseases”.

scientific publications

analytical review

The central nervous system has evolved a conserved unfolded protein response mechanism to cope with the accumulation of misfolded proteins. As one of the main intracellular redox systems involved in neuroprotection, the vitagene system becomes a potential neurohormetic target for novel cytoprotective interventions. Vitagens encode the cytoprotective heat shock proteins (Hsp) Hsp70 and heme oxygenase-1, as well as thioredoxin reductase and sirtuins. The cellular stress response is the ability of a cell to withstand stressful conditions, including the heat shock response. The production of heat shock proteins, including protein chaperones, is necessary for the folding and repair of damaged proteins, which promotes cell survival to avoid apoptosis.«Molecular chaperone» are proteins that function as part of an ancient defense system in our cells. They promote cell survival by sequestering damaged proteins and preventing their aggregation. Chaperone complexes are involved in the regulation of mitochondrial functions, assembly of the cytoplasmic proteolytic system of brain cells. The cellular response to stress requires the activation of survival pathways that are under the control of protective genes called vitagens. Vitagens are involved in the production of heat-shock protein molecules, glutathione, and bilirubin. They have antioxidant and anti-apoptotic activity and provide protection against oxidative stress.

Studies have shown that the heat shock response contributes to the maintenance of cellular homeostasis, the establishment of a cytoprotective state in a wide range of human diseases, including inflammation, cancer, aging, and neurodegenerative disorders. Endogenous proteins can be manipulated by food or pharmacological compounds, which represents an innovative approach to therapeutic intervention in neurodegenerative disorders, actually influencing reserve mechanisms and adaptive capacity.

None Declared

Ageist beliefs and attitudes may restrict the opportunities for older adults to participate actively in their communities, resulting in strong effects on mental health.

This study has three objectives: 1) To investigate the effect of ageism on older adults’ civic activities; 2) To analyze the influence of ageism on mental health; and 3) To explore the impact of civic participation on older adults’ mental health.

This qualitative study included 391 older people from three different nationalities (Portuguese, Brazilian and English) ranging in age from 65 to 88 years old. All the interviews went through the process of content analysis.

For the first objective, findings encompass four major themes: (1) Social disapproval (86%); (2) Perceived Ineptitude (84%); (3) Anticipated Failure (83%); and (4) Inability to Contribute (77%). For the second objective, findings indicated six categories: (1) Helplessness and Despair (89%); (2) Rage (81%); (3) Self-Perceived Inability (77%); (4) Sense of Unimportance (71%); (5) Anxiety (68%); and (6) Outbursts of Emotion (63%). For the third objective, the following five major subjects emerged: (1) Meaningfulness (81%); (2) Embracing Social Belonging (80%); (3) Cognitive Abilities (71%); (4) Personal Empowerment (67%); (5) Emotional Expression (54%). Additionally, findings indicated that the most verbalized themes for the three objectives were the same across the three nationalities.

The results of this study offered insight into how ageism, mental health, and civic engagement are related. Ageism seems to have a negative impact on mental health. Ageism also made it difficult for people to participate in civic life, which has been linked to better mental health. These findings emphasize the need to identify ageism and encourage inclusive civic involvement to improve older individuals’ mental health.

Keywords: Mental health; ageism; civic participation; older adults.

None Declared

Burnout syndrome arises as a result of chronic workplace stress that has either been inadequately managed or entirely unaddressed, leading to symptomatic manifestations of emotional exhaustion (EE), depersonalization (DP), and a decreased sense of professional accomplishment (PA).

This study evaluated the prevalence of burnout and investigated its correlation with resilience among healthcare professionals in Morocco.

A self-administered questionnaire survey was conducted in April 2023, comprehensively using the Connor-Davidson Resilience Scale (CD-RISC) and the Maslach Burnout Inventory (MBI) among 296 healthcare professionals stationed across three institutions located in the Casablanca-Settat region.

A total of 158 responses were obtained. Surprisingly, the results indicate that EE was highly prevalent, impacting 43.7% of respondents, while DP was notably affected 44.9% of participants. Conversely, PA was diminished in 58.2% of the respondents. It is worth noting that 44.3% of the participants displayed reduced levels of resilience. Furthermore, statistically significant correlations were observed between resilience and all three dimensions of burnout. Upon gender stratification, the analysis showed that resilience was significantly associated with two burnout dimensions, EE and PA, among male respondents, whereas among their female counterparts, resilience demonstrated a noteworthy correlation with all three dimensions of burnout.

These findings emphasize the pervasive nature of burnout among healthcare professionals and highlight deficiencies in resilience. It is crucial to consider these factors when crafting healthcare policies and devising focused approaches to effectively prevent and manage burnout.

None Declared

Bipolar disorder (BD) is characterised by heterogeneous phenotypic manifestations that may affect the achievement of a timely diagnosis delaying its therapeutic management. Increased circulating levels of pro-inflammatory cytokines and cortisol (CORT) have been observed in BD patients in addition to decreased levels of Brain-Derived-Neurotrophic Factor (BDNF) suggesting that the interaction among these mediators may play a role in the occurrence of affective episodes overall disrupting brain plasticity. However, knowledge on BD etiopathogenesis is still limited, including the causal relationship with inflammatory and neuroendocrine markers.

To assess whether variations in peripheral neuroendocrine and inflammatory markers during acute phases of the disease and euthymia might predict the occurrence of affective episodes; to evaluate whether the interplay among these biomarkers might be exploited as a signature of BD.

We are currently recruiting BD patients during depressive or manic/hypomanic phases together with age- and sex-matched healthy controls (CTRLs). Complete blood count, pro-inflammatory, anti-inflammatory cytokines and BDNF will be assessed in serum; salivary cortisol awakening response test will be used to evaluate hypothalamic-pituitary-adrenal axis activity. MADRS, YMRS and HAM-A will be used to assess psychiatric symptoms, PSP and C-SSRS for global functioning and suicidal risk, IPSS and SRRS for stress levels and CIRS to evaluate physical comorbidities. All assessments will be carried out at the time of recruitment (T0) and after 3 (T1) and 6 (T2) months.

Data have been so far collected on 28 BD patients (18 males, 10 females, age: 48.31±11.3) and 26 CTRLs (16 males, 10 females, age: 46.82±10.86). At T0, BD were characterised by a greater total number of white cells (7.83±1.86 BD vs. 6.78±1.87 CTRL, p<0.05), mean number of neutrophils (4.89±1.49 BD vs. 3.92±1.45 CTRL, p<0.05) and neutrophil/lymphocyte ratio (NLR) (2.52±1.1 BD vs. 1.9±0.69 CTRL, p<0.05). Moreover, BD patients showed overall a greater BMI (30.5±6.6 BD vs. 24.45±3.86 CTRL, p<.001). No difference was observed among groups with respect to sex and age.

Although preliminary, these results suggest that the active phases of BD are associated with a low-grade inflammatory state, potentially related to a different metabolic set-point in BD patients. Ultimately, this study will allow us to evaluate whether the presence of affective symptoms is correlated with fluctuations in the levels of inflammatory mediators, salivary cortisol and BDNF and to establish a reliable and highly predictive BD signature.

“Funded by: Bando Ricerca Indipendente ISS 2021-2023 to A. Berry project code ISS20-9286e4091f8e”

None Declared

This is a 13-year-old female patient admitted to the psychiatric unit active suicidal ideation.

the objective is to show through a clinical case how vortioxetine can be safe in adolescents.

Case report and literature review

She has a history of daily consumption of at least 2 units of cannabis per day. She presents high emotional distress secondary to academic failure, consuming the substance as a coping strategy. Due to prohibition and control by her parents, the patient stopped taking the substance, presenting severe depressive symptoms, self-injury and suicide ideation. For this reason she is admitted to the inpatient psychiatric unit. The electrocardiogram performed on admission shows a corrected QT index of 524. Exploring physical symptoms, she recognized episodes of syncope and palpitations. Coordination was made with cardiology, who performed an echocardiogram with normal results and began follow-up with them without prescribing medication. It was agreed not to use drugs that could prolong the QT index. Evaluating the clinical situation, it was decided to start treatment with Vortioxetine up to 10 mg. With this treatment there was no worsening of the electrocardiogram and the patient’s mood improved, anxiety and ideas of death were remitted

This work aims to show how vortioxetine has been effective and safe at the cardiological level in the case of moderate-severe depression in an adolescent with prolonged QT index

None Declared

The aim of this project is to study to which extent salience alterations influence the severity of psychotic symptoms. However, rather than studying them individually, we decided to focus on their interplay with two additional variables, that is: observing their effect in a vulnerability phase (adolescence) and with another added, well-recognized risk factor (cannabis use).

The reason for this study design lies in the fact that, in our opinion, it is fundamental to observe the trajectory of psychotic symptoms over a continuum; however, rather than adopting a longitudinal approach, we decided to structure it as a cross-sectional study confronting patients from two age brackets - adolescence and adulthood.

The primary purpose of this study was to assess a difference between THC-abusing and non-abusing patients in adolescent and adult cohorts, using the Italian version of the psychometric scale “Aberrant Salience Inventory” (ASI), and the possible correlation with more severe psychotic symptoms. The employment of several different psychometric scales and the inclusion of a variegated cohort allowed to pursue multiple secondary objectives.

We recruited 192 patients, subsequently divided into six subgroups based on age and department of recruitment (whether adolescent or adult psychiatric or neurologic units - the latter serving as controls). Each individual was administered a set of questionnaires and a socio-demographic survey; the set included: Aberrant Salience Inventory (ASI), Community Assessment of Psychic Experiences (CAPE), Positive and Negative Syndrome Scale (PANSS), Montgomery-Asberg Depression Rating Scale (MADRS), Mania Rating Scale (MRS), Hamilton Anxiety Scale (HAM-A), Association for Methodology and Documentation in Psychiatry (AMDP) and Cannabis Experience Questionnaire (CEQ).

The data analysis showed statistically significant (p<0.05) differences between adolescents and adults with psychotic symptoms in all of the three scales of PANSS and in MADRS. These two groups were homogenous for both cannabis use and ASI score. The intra-group comparison (either adolescent or adult) showed a hierarchical pattern in the scores of psychometric scales according to the diagnostic subgroup of allocation: patients with psychotic symptoms showed an higher level of psychopathology in all measures when compared to patients from the psychiatric unit without psychotic symptoms, which in turn scored higher than the patients from the neurologic unit.

Image:

The results of the present study may suggest that when salience alterations occur in adolescents with cannabis exposure, we might observe worsened positive and negative psychotic symptoms; their influence might be relevant also in other domains, especially regarding the depressive and anxiety spectrums.

None Declared

Stigma towards mental health disorders is an issue standing in the way of healing and integrating the patient into the social life. Stigmatising does not only come from the general population but also from health care providers. Studies found out that lack of knowledge and skills among health care professionals is associated with stigmatization, which affects the attitudes and the patient’s treatment process.

The main aims of this study were to evaluate the attitudes and knowledge about mental health among nurses and psychiatry residents working in psychiatric departments, to explore the relationship between knowledge and attitude toward mental health and to find out the possible link with sociodemographic and work characteristics

A cross-sectional questionnaire was conducted in two departments of psychiatry at RAZI hospital focusing on nurses and psychiatrist trainees. The sociodemographic informations, duration and choice of working in psychiatric field, personal experience with mental illness were collected .

The Mental Health Knowledge Questionnaire (MHKQ) and the mental illness clinicians attitude scale (MICA-4 )were used to evaluate the participants mental health knowledge and attitude towards psychiatry and people with mental disorders .

A total of 30 health care providers finished the questionnaire. Their median (± interquartile range) age was 29 (±9)  years within a range of 25 to 60 years old. Our participants were predominantly female (N = 26; 86.7%). The overall median of MHKQ scale was 10 (±6) with a higher score in psychiatrist trainees than nurses but no significant difference was found (p= 0.066) However there was a significant difference between the two groups regarding the MICA scale (p=0.02) with a negative attitude found in the group of nurses . Participants with no personal experience with mental illness along with those who were obliged to work in psychiatric facilities tend to have higher score on the MICA scale with significant statistically relationships, respectively, p =0.18 and p=0.09 We didn’t find any statistically significant relationship between the total scores of the MICA and MHKQ scales ( rho = -0.206, p = 0.275)

In our study negative attitude toward mental disorders were found in the group of nurses. Education about mental health disorders as well as addressing the importance of mental health outcomes must be included in the first year training of every healthcare provider. New strategies Focusing on improving the knowledge and skills among healthcare professionals are important to make due to their positive effect on the recovery.

None Declared

Transition to a consultant role is a challenging time for an early career psychiatrist, as the high level of structure and guidance available during psychiatric training ceases when training is complete. The Royal College of Psychiatrists, UK therefore pioneered the Startψell initiative to ease this transition. This consultant-led initiative proposed embedding good habits and robust coping mechanisms early on, to enable psychiatrists to thrive in their roles and is based on six main pillars (New consultants (StartWell) (rcpsych.ac.uk) Image 1: Startwell framework. Berkshire Healthcare NHS Foundation Trust (BHFT) is a mental healthcare provider based in Southeast England where we designed a project to enhance support to new consultants, based on Startψwell principles.

The aims of this project were to:

• - Improve the experience of early career psychiatrists taking on their first consultant role in BHFT.

• - Ensure that the new consultants are provided with relevant information and resources to fulfil their roles safely.

• - Set up a system for ongoing support for new consultants till they complete five years in their post.

Having discussed the feasibility of setting up a local Startwell initiative in BHFT, plans were presented to the medical director and medical staff committee including new consultants, for their input. Under the guidance from senior consultants, monthly meetings were arranged which offered professional development talks and peer support. As several themes emerged at these meetings, we stratified and aligned these local to the RCPsych Startψell framework (Image 2:Themes). An induction folder was also collated with all the relevant information in paper and digital format. In addition, a yearly bespoke induction event for new consultant psychiatrists was delivered from 2019-2022 except in 2021, during the pandemic.

We used Likert scales to gather quantitative feedback (Table 1) with free box for comments to capture qualitative feedback (Image 3). Feedback response rate for the three cohorts were 75%, 70% and 80% respectively.

Image:

Image 2:

Image 3:

The BHFT Startwell initiative has been running successfully for the past five years and been valued by the new consultants. We are therefore continuing to working towards embedding the programme futher and ensuring sustainably for the future. W e are looking to share our experience in the hope that similar programmes are set up and our newer colleagues can enjoy a long, fulfilling, and enjoyable career.

None Declared

Exploring the positive psychological and behavioural dimensions of people living with mental disorders can establish a firm ground in a therapeutic alliance for setting up positive life goals.

The present study aimed to explored whether the strength of the mental health capacities and the severity of mental disorder symptoms and the interaction of the two differ in the strength of their associations with several dimensions of well-being on Hungarian adult psychiatric and non-clinical community samples.

The psychiatric sample (129 patients (44 male, 85 female)) was collected in four Hungarian healthcare facilities using a cross-sectional design. The non-clinical community sample (253 adults (43 male, 210 female)) was collected online using a cross-sectional design. All the respondents completed the Mental Health Test, six well-being and mental health measures, and the Symptom Checklist-90-Revised.

Including both the mental health competencies and mental disorder symptoms variables in one regression model in both samples can predict patients’ well-being even more accurately. Mental health competencies related positively; mental disorder symptoms connected negatively to subjective well-being. In all models and both samples, mental health competencies were found to be a stronger determinant of well-being than the mental disorder symptoms. The interaction of mental health functioning and mental disorders is no more predictive of well-being in either psychiatric or non-clinical samples than when the effects of each are considered separately.

The assessment of mental health competencies has an important predictive value for well-being in the presence of psychopathological symptoms and/or mental disorders.

None Declared