Humanistic studies applied to the health-illness clinic go beyond explaining cause-effect relationships among disease phenomena, treatments, and preventions. Qualitative research aims to understand symbolic relationships built in life experiences among the manifestations and the people. How to act in front of a person whose physical appearance and odour can be unpleasant, such as in the HNC - Head Neck Cancer? Or whose life history may have been marked by deviant behaviours and negligence in self-care?

To interpret emotional meanings attributed through open interviews conducted with relatives about the domestic care of patients with HNC under clinical treatment.

Sample composed of family caregivers of patients with HNC, sent sequentially by colleagues from the clinical service who were informed of the research. The study used the Clinical-Qualitative Method (Turato. Portuguese Psychos. J, 2000 2(1): 93-108). Semi-Directed Interview with Open-ended Questions In-Depth and Field Notes was used for data collection. The employ of the Seven Steps of the Clinical-Qualitative Content Analysis (Faria-Schützer et al. Cien Saude Colet. 2021; 26(1): 265-274) has permitted the understanding of the topics. Sample closed with 12 persons according to the information saturation strategy (Fontanella et al. Cad Saude Publica. 2008; 24(1): 17-27), conducted by the first author, a female psychologist. To interpret the empirical material, we use Medical/Health Psychology, the psychodynamics of relationships of the Balintian framework, disease and illness while modes of un-health, psychic defence mechanisms against anguish. Validation by peers from the Lab of Clinical-Qualitative Research Laboratory, at the State University of Campinas.

For this presentation, we listed three categories from the free-floating re-readings: (1) Certain need to recognize the care provided as a handling strategy with effort, putting in this ‘validation’ their relief regarding natural suffering of the care process; (2) Caregiver’s psychological fantasies of omnipotence in the care process, frequently perceiving the reality a phenomenologically and necessarily distorted by the caregiver. (3) Moments of impotence feeling in front of the finitude reality that it knows will arrive.

The family caregivers can present certain emotional defences, such as subtle magical thinking, in which they distort the reality experienced as a management strategy and validation of their care. They act so to alleviate their psychological and existential suffering. Group meetings with family members to talk openly about the difficulties on the psychological management of patients with HNC, coordinated by a psychotherapist, are effective as a space for creativity in daily management at home and a space for catharsis.

None Declared

Adult and child psychiatry residents encounter unique stressors in their training distinct from those in other medical specialties. Patient suicide has been identified as one of the most distressing experiences during psychiatric training.

This study represents the first Tunisian investigation aiming to assess (1) the impact of patient suicide on psychiatry residents and (2) the limitations of the institutional support system in dealing with such cases.

A Google Forms questionnaire was distributed via email to all residents, gathering socio-demographic data, assessing traumatic impact using the PTSD Checklist for DSM-5 (PCL-5), and soliciting open-ended responses regarding personal experiences and expectations of the institutional support system.

Fifty-three residents participated in the study. Among them, 29 residents had encountered patient suicide, with 12 directly involved. Symptoms of PTSD were detected in three residents. The physician directly involved in treating the suicidal patient reported the highest PCL-5 score. The majority of residents (27 out of 29) expressed the need for a structured support and training program tailored to healthcare professionals dealing with suicide.

The findings suggest that psychiatric residents may require additional training and support to effectively address the complex issue of patient suicide. Implementing specific training programs could significantly enhance their ability to manage such situations.

None Declared

Delaware’s recent longevity and aging trends predict a continual increase in the number of cancer survivors. As the cancer survivors live longer and age, the prevalence of comorbid chronic conditions tends to increase. Dual burden of cancer and comorbid chronic conditions can have significant and wide-ranging ramifications for cancer survivors. Comorbidity potentially affects the development, stage at diagnosis, treatment options, recurrence and long-term survival of people with cancer. Detailed delineation of Delaware adult cancer survivors including an exploration of comorbidity is critical.

The primary objective was to characterize selected chronic conditions among Delaware adults with cancer in order to present: (i) disparities amongst cancer survivors by select sociodemographic and survivorship characteristics, and (ii) compare the prevalence of chronic conditions among cancer survivors and adult Delawareans without a cancer diagnosis.

Combined data (2018, 2020 and 2021) for Delaware were obtained from the Behavioral Risk Factor Surveillance System. The final data set included 927 Delawareans with at least one type of cancer (excluding skin cancers other than melanoma) and 11,917 participants without a cancer diagnosis. Descriptive statistics examined sociodemographic characteristics and chronic conditions in Delawareans with and without a cancer diagnosis.

Amongst adult Delawareans, 5.1% (CI: 4.6–5.5) were cancer survivors. Across the state, the majority of cancer survivors (76.8%) reported having only one cancer diagnosis. In this sample of Delaware cancer survivors, 83.5% identified as White. Majority were female (57.4%), aged 65 or older (58.9%), had some college or more education (63.7%), and with an income of $50,000 or more (51.1%). Arthritis (46.3%), diabetes (21.5%), depression (18.7%), asthma (14.1%), chronic obstructive pulmonary disease (13.7%) angina (11.9%) and heart attack (11.6%) were the most prevalent comorbid conditions. Prevalence of certain chronic conditions was 2-3 times higher among cancer survivors. Nearly 23% reported not receiving instructions regarding cancer follow-up care.

Cancer survivors have unique concerns. Results aim to facilitate targeted interventions aimed at coordinated managed care among cancer survivors in Delaware. This study bolsters the ongoing public health effort towards the Healthy People 2030 goal of increasing the proportion of cancer survivors.

None Declared

In the field of Alzheimer’s disease disease-modifying therapy, there has been a shift in diagnosis from the later dementia stages towards the earlier stages, with the potential for pre-symptomatic diagnosis. The development of truly ‘disease-modifying’ therapies that target the underlying mechanisms of Alzheimer’s disease has reached late stages of human clinical trials. The primary targets include beta-amyloid, whose presence and accumulation in the brain is thought to contribute to the development of Alzheimer’s disease, and tau protein which, when hyperphosphorylated, results in the self-assembly of tangles of paired helical filaments also believed to be involved in the pathogenesis of Alzheimer’s disease. Therapeutic strategies aimed at preventing Aβ formation, blocking its aggregation into plaques, lowering its soluble levels in the brain, and disassembling existing amyloid plaques are among the main strategies employed to slow the progression of AD. First anti-amyloid antibody treatments have proven effective in late-stage clinical trials and are now being approved for clinical use in some countries, initiating a new are of treatment. In terms of blood-based early diagnosis, the development of in vivo biomarkers has shifted the diagnosis of Alzheimer’s disease from the later dementia stages of disease towards the earlier stages and has introduced the potential for pre-symptomatic diagnosis. Recent study shows promising results for blood tests that could be used to identify Alzheimer’s changes in the brain before the onset of any symptoms, which could result in preventative treatments being used before any memory loss. This presentation will highlight the most exciting development of the past year in the Alzheimer’s disease therapy and diagnosis arena.

None Declared

New drugs in the treatment of dual psychosis: use of cariprazine in schizophrenia, other psychotic disorders and use of cocaine. A case series in a specific outpatient psychiatric clinic for substance use disorders.

The main objective of this case series is to observe and describe the tolerability and clinical response to different doses of cariprazine in a series of patients with dual psychosis, especifically cocaine users; with a special attention upon psychotic symptoms, disruptive behaviour, affective symptoms and cocaine use pattern.

This series consists of an observation of a total of 20 patients treated on an outpatient basis. All of them had a either a diagnosis of Schizophrenia or Other Non Specified Psychotic Disorder meeting the DSM-5 criteria, as well as a Cocaine Use Related Disorder meeting the DSM-5 criteria. All of them received treatment with cariprazine in different doses from 1,5mg to 6mg per day, as a solo treatment or as an adjuvant to another previous antipsychotic treatment when antipsychotic augmentation was justified. We observed patients that had started cariprazine in the past three months and that had active drug use or had had one in the past three months.

We monitored the tolerance to the treatment, the clinical response in terms of positive and negative symptoms of schizophrenia, affective symptoms, disruptive behavior, and the response in terms of substance use; for a period of six months of follow-up, with psychiatric consultation at least every month and nurse consultation every two weeks in our clinic.

95% of the patients did not present any side effect related to cariprazine. In one patient (5%) the treatment had to be stopped due to akathisia that did not disappear after two weeks and symptomatic treatment with benzodiacepines. 60% of patients either stopped using (50%) or reduced their use frequency (50%). 70% of the patients presented an improvement in positive symptoms and behavior. Also, one third of them presented a slight improvement in negative symptoms. 20% of patients referred a significant improve in depressive symptoms.

The main conclusion of this case series is that cariprazine at any dosis between 3mg and 6mg per day has a positive outcome, both in the psychotic domain and the substance use disorder. We hope this case series will help our colleagues treat their patients suffering from these pathologies in an optimal way. This could also set a basis to encourage a proper clinical trial to assess if new antipsychotics such as cariprazine could be a new standard for the treatment of Dual Disorders.

None Declared

People with severe mental illness (SMI), including schizophrenia and bipolar disorder, experience significant health inequalities and are more likely to develop long-term physical health conditions (LTCs), such as type 2 diabetes and cardiovascular disease. Many people with SMI rely on informal caregivers, typically friends and family, to support their health and enable them to live in the community. Informal caregivers of people with SMI experience high levels of caregiver burden, social isolation, and poor health outcomes. However, it is unclear how co-existing LTCs contribute to the caregiving experience.

The aim of this study was to explore the lived experience of informal caregivers of people with co-existing SMI and LTCs.

We conducted a qualitative study with informal caregivers of people with co-existing SMI and LTCs in England. We recruited 12 informal caregivers and conducted five semi-structured interviews and two focus groups between December 2018 and April 2019. The interviews and focus groups were audio recorded, transcribed verbatim and thematically analysed.

SMI impacts profoundly on the health and well-being of both service users and their informal caregivers. Service users were described as too unwell with their SMI to engage in self-management of their mental and physical health, with the primary responsibility for these tasks falling to informal caregivers. There were significant barriers to adequate physical healthcare for service users, therefore informal caregivers needed to advocate extensively for their loved ones to ensure access to services. Informal caregivers felt significantly under-supported and struggled with the caregiver burden associated with SMI and LTCs. This burden included the constant monitoring of risk, anxiety around the vulnerability of their loved one, repeated hospitalisations, physical health concerns, lack of respite services, lack of recognition of their role, the guilt associated with paternalistic care, shame and stigma, and the difficulties managing the changeable nature of SMI.

Informal caregivers of people with SMI face an additional caregiver burden resulting from co-existing LTCS. This adds substantially to their caring role, yet they do not receive the necessary support, and therefore their own health and wellbeing are negatively impacted. Improved recognition of the role of informal caregivers and additional support, including improved provision of respite services, are needed to improve the well-being of informal caregivers.

C. Carswell: None Declared, J. Brown: None Declared, D. Shiers Consultant of: DS is an expert adviser to the National Institute for Health and Care Excellence Centre for Guidelines; the views expressed are those of the authors and not those of National Institute for Health and Care Excellence., P. Coventry: None Declared, N. Siddiqi: None Declared

Lithium treatment is a proven method for bipolar disorder management, but its narrow therapeutic range and the risk of severe side effects, including lithium intoxication, pose significant clinical hurdles. Lithium intoxication, a potentially life-threatening complication, can occur during treatment, raising ongoing questions about its clinical factors, risk elements, and best practices for management.

Our objective is a comparative analysis between patients who have experienced lithium intoxication and those who have not, aiming to identify influencing factors and enhance clinical care.

We collected demographic data, age at lithium treatment initiation, treatment duration, therapeutic adherence, Mental Health consultations, and lithium level monitoring from 14 individuals requiring clinical attention due to lithium intoxication and 14 patients with similar gender, age, and diagnosis with lithium treatment but without intoxication during four years of follow-up.

Regarding the results, the age of onset of lithium treatment in patients with lithium intoxication was 30.2 years (SD=8), and the duration of lithium treatment averaged 11.1 years (SD=8.8), which did not significantly differ from the control group with ages of onset at 38.1 years (SD=15.1) and treatment duration of 9.27 years (SD=8.8), respectively. Lithium intoxication patients developed severe complications, including hospitalizations in medical-surgical units, the necessity for dialysis, and death, one fatal case. Although therapeutic adherence to lithium, measured through pharmaceutical dispensation, exceeded 90% and was comparable in both groups, patients affected by lithium intoxication exhibited a significantly higher treatment discontinuation rate (OR 32.5; 95% CI, 3.1 to 337.8) during the follow-up period. Patients who experienced lithium intoxication had an average of psychiatric consultations every 11.2 months (SD=13.4), with 35.7% not attending at least once a year, while the control group had an appointment every 5.31 months (SD=2.7) (p > 0.05). Lastly, despite both groups having a similar frequency of plasma lithium level monitoring, occurring approximately every 5.5 months (SD=2.6) and 7.8 months (SD=4.8), respectively, in 28.5% of those who suffered from lithium intoxication did not undergo any monitoring for periods exceeding 18 months (p < 0.05).

Our research highlights the significance of delivering thorough clinical care and continuous monitoring to patients receiving lithium treatment for bipolar disorder. Ensuring effectiveness therapeutic adherence and maintaining strict monitoring of lithium levels are critical factors that significantly enhance treatment safety. Appropriate management has the potential to improve the quality and safety of care for people with bipolar disorder who are dependent on lithium therapy.

None Declared

Headache is a very common health problem worldwide and in our country due to the increasing environmental damage and daily stress. The proportion of patients with headache in general practice is 4-5%, in neurology up to 30%. Chronic headache as a persistent stressor exhausts the body through central sensitisation, which can lead to the consolidation of maladaptive coping strategies such as avoidance, feelings of loss of control, catastrophising pain. This can lead to a deterioration in quality of life and depression also. The effectiveness of pharmacotherapy in coping with chronic pain is limited, so attention should be paid to modifying maladaptive pain behaviour, as recommended by the NICE guidelines. The international literature shows that mindfulness-based cognitive therapy (MBCT) has been shown to be effective in the management of chronic headache, primarily in improving quality of life, increasing self-efficacy and reducing pain catastrophisation and depression (Hunt et al., 2022).

Our first objective was to introduce mindfulness-based cognitive therapy in Hungary to patients suffering from chronic headache. Secondly, we wanted to measure the impact of the method on quality of life, coping with pain and depression.

N=28 patients, suffering from chronic headaches (tension headache and migraine) participated in the study at the Department of Clinical Psychology, Semmelweis University (BNO: G430, G431, G442). Selection criteria were: referral from a neurologist, age 18-65. The intervention was an 8-session mindfulness-based cognitive therapy for pain (Day, 2017) led by an MBCT teacher and a clinical psychology resident. Before the intervention, all patients had an individual first interview and filled in the questonnaires. Measures: Beck Depression Questionnaire, Pain Catastrophizing Scale, Comprehensive Headache-related Quality of life Questionnaire, Five Facet Mindfulness Questionnaire, Cognitive Emotion Regulation Questionnaire.

After the intervention, there was a significant reduction in the negative impact of pain on quality of life (p<0.05, Cohen’s d=0.6), pain catastrophization (p<0.01, Cohen’s d=0.74), and depression (p<0.001, Cohen’s d=0.84). In addition, several sub-factors of mindfulness increased, including non-reactivity and being non-judgemental (p<0.05, Cohen’s d=0.57), as well as adaptive cognitive emotion regulation strategies (p<0.05, Cohen’s d=0.49).

We can conclude, that in line with international findings, MBCT has been shown to be effective in reducing the negative impact of depressive symptoms, pain catastrophisation and headache on quality of life, and in helping people to cope with pain more adaptively, primarily through the acquisition of mindfulness skills.

None Declared

Behavioral and psychological symptoms (BPS) of Alzheimer’s disease, known as neuropsychiatric symptoms, involve a range of symptoms that include agitation, psychosis (hallucinations, delusions), affective symptoms (depression and anxiety), apathy, and sleep disturbances. These behavioral and psychological symptoms harm the patients’ daily lives and significantly burden their families. Managing BPS of Alzheimer’s disease requires a targeted approach focused on each symptom to achieve a better therapeutic response.

Providing practice pharmacological recommendations targeted to each of the behavioral and psychological symptoms of Alzheimer’s disease.

A literature review was conducted using Medline via PubMed, Embase, PsycINFO, and Cochrane databases until September 2023.

There is a consensus in the literature that non-pharmacological approaches should be recommended as the first-line treatment for most behavioral and psychological symptoms of Alzheimer’s.

Second-generation antipsychotics (risperidone and olanzapine, with improved efficacy; aripiprazole and quetiapine, with better tolerance) are recommended for severe agitation states with a risk of self or hetero-aggression, as well as for persistent psychotic symptoms in Alzheimer’s disease. The benefit-risk balance of these agents must be assessed, with close monitoring of heart arrhythmias, metabolic risk, orthostatic hypotension, and extrapyramidal symptoms. The recommendations suggest tapering antipsychotics within the first three months of their prescription. Selective serotonin reuptake inhibitors (SSRIs) such as Escitalopram, Citalopram, and Sertraline can be considered a therapeutic option for persistent affective symptoms (depression and anxiety) with significant functional impairment or suicidal risk, severe apathy, or constant agitation. Minimum effective doses are recommended for Escitalopram and Citalopram due to the risk of QT interval prolongation. There is limited evidence regarding the effectiveness of benzodiazepines, mood stabilizers, cholinesterase inhibitors, and memantine for various behavioral and psychological symptoms; the benefit-risk ratio and therapeutic response do not support the prescription of these agents. Melatonin and Mirtazapine have limited benefits for sleep disturbances, while benzodiazepines, antihistamines, and antipsychotics should be avoided.

The pharmacological approach should target a thorough clinical assessment of the psychopathological dimensions of behavioral and psychological symptoms of Alzheimer’s disease. The prescription should be based on evaluating the benefit-risk balance and adherence to literature recommendations for patient safety.

None Declared

Obsessive-compulsive disorder (OCD) is a chronic disorder with a wide range of manifestations but primarily intrusive thoughts (obsessions) and/or ritualized actions (compulsions) that can cause a huge distress in patients’ life. First-line treatment for OCD are selective serotonin reuptake inhibitors (SSRIs). Tricyclic antidepressants are used as second-line treatment due to secondary effects. Also antipsychotics such as aripiprazole are approved for treating OCD. Vortioxetine is has 5-HT3, 5-HT7 and 5-HT1D antagonists, 5-HT1B partial agonist and a 5-HT1A agonist and serotonin transporter inhibitor property. It is used in major depressive and anxiety disorders. A male 48 years old patient with an OCD diagnosis since he was 21, was reffered to psychiatry department. Previously, he had no response with SSRIs at full dosage and clomipramine 75mg was effective. At 46 years old, he had an acute myocardial infarction. He also admited not taking the medication regularly due to sexual disfunction and having affective symptoms related to the distress caused by OCD.

To evaluate efficacy of vortioxetine in treating OCD in a patient with contraindications for tricyclic antidepressants and no response to SSRIs.

Clomipramine dose was reduced until discontinuation. After one week without treatment, basal scores for Hamilton Scale and Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) were collected. Same data was collected again after 10 weeks treatment.

The dosage of vortioxetine was progressively titrated until 20mg daily in 3 weeks lapse. Diazepam 5mg was added in case of insomnia or anxiety. Aripiprazole 5mg was added in the third week of treatment as adjunctive treatment due to the recurrence of some intrusive thoughts (discontinued by himself because of akathisia). Finally, the patient reported an improvement in affective and OCD symptoms in the sixth week of treatment that was sustained until the tenth week, when data was recollected. The patient did not refer sexual disfunction.

The pre and post results are summarized in tables 1 and 2.Table 1.

Hamilton Depresion Rating Scale (0-52)

Dimensional Y-BOCS (0-15)

Vortioxetine might be a promising molecule for treating OCD in patients with contraindications for first and second-line treatments.

None Declared

Treatment choice when prescribing antidepressants for major depressive disorder (MDD) is often influenced by safety and tolerability profiles. A transient increase in suicidality following antidepressant treatment initiation is a key concern. Although rare, its unpredictability and consequences make them a significant worry. In 2004, the U.S. Food and Drug Administration (FDA) issued a “black-box” warning regarding a potential increase in suicidality in adolescents receiving antidepressant treatment for depression that was later expanded to include both young adults and a broader range of antidepressants.

The aim of this study is to evaluate the risk of increased suicidality during the treatment with serotonin and norepinephrine reuptake inhibitors (SNRIs) in young adults with MDD.

We conducted a non-systematic literature search on PubMed using the combination of MeSH terms ([Serotonin and Noradrenaline Reuptake Inhibitors] OR [Levomilnacipran] OR [Desvenlafaxine Succinate] OR [Venlafaxine Hydrochloride] OR [Duloxetine Hydrochloride]) AND [Suicide] AND [Young Adult], and the keywords [(“Serotonin and Noradrenaline Reuptake Inhibitors” OR “Levomilnacipran” OR “Desvenlafaxine” OR “Venlafaxine” OR “Duloxetine”) AND (“Suicide” OR “treatment-emergent suicidal ideation”) AND (“Young” OR “Youth”)].

A total of 31 manuscripts were retrieved and 6 were selected, 3 original research and 3 non-systematic reviews of randomized clinical trials. Only studies written in English that provided information about suicidality with SNRIs in young adults with MDD.

Globally, studies show that not only antidepressants decrease the risk of suicide attempt in depressed patients, but also there is no evidence of an increased suicidality in young adults treated with SNRIs.

Interestingly, one study showed that increasing suicidality could be related to side effects of the treatment, such as anxiety, agitation and irritability. The authors found that poor antidepressant response and greater severity of depression during follow-up were associated with treatment increasing suicidal ideation, as it was suggested in another study.

Another study reinforced that there may be an emotional component to the activating effects produced by some antidepressants that could explain their controversial association with rare cases of suicidal ideation and behaviour.

In conclusion, growing evidence shows that antidepressants overall decrease the risk of suicide attempt in depressed patients. Therefore, reducing antidepressant use over the FDA concerns about increased suicidal tendencies in young patients may actually increase suicide risks due to inadequate treatment of depression. Additional studies are essential to further confirm the importance of early treatment for depression.

None Declared

We are facing increased suicide attempts and deliberate self-harm from persons with borderline personality disorder (BPD) who are also on antidepressants, multiple antidepressant prescriptions and antidepressant augmentations. Our previous observations suggest that antidepressants might increase suicide attempts in those on this medication and who have BPD. The absent response to antidepressants is due mainly to the comorbid dysthymia, cyclothymia, rumination, autism and ADHD in BPD.

To generate forecasting models and preventive policies to deal with BPD crises and improve the effectiveness of the UK National Healthcare Service (NHS) in suicide prevention.

The underlying analysis framework is stochastic forecasting. We used current knowledge and data to complete systematic future predictions extracted from recent trends. A logical-mathematical model generated the required expressions. The software for logic prediction and annotation was Wolfram Alpha (Wolframalpha.com). The four parameters for stochastic predictions are, BPD (A), antidepressant No. 1 (B), antidepressant No. 2 (C), and suicide attempts (D). Boolean function metrics can help analyse the impact and truth of forecast modelling with truth density.

The logic expression for suicide prediction due to liberal antidepressant prescribing is Ψ = A intersects B, intersects C, intersects D; that is,. Ψ = A ∩ B ∩ C ∩ D, which yields a Boolean truth density of 6.25%. The truth table always has a positive outcome as long as any of the factors exist except when none is present.

The predictive Boolean function and truth table suggest that suicide presentation is predictable if there is a prescribing of one or more antidepressants in BPD and if there is an antidepressant augmentation or dose maximisation. We speculate that SSRI antidepressants block self-regulatory mechanisms of fear of death while triggering impulses to self-harm and suicide from overstimulation of SSRI receptors. Without fear mechanisms, death by suicide is felt as not terrifying.

None Declared

Negative symptoms are present in more than two thirds of schizophrenic patients throughout the evolution of the disorder. These include symptoms related to reduced motivation or pleasure, such as avolition, anhedonia and asociality, and reduced expressivity, including alogia and blunted affect.

We present the case of a 24-year-old man who was admitted to our Psychosis Day Hospital after several psychotic episodes, presenting with prominent negative symptomatology that was imbued with mystical delusional beliefs.

1. 1) To describe the clinical particularities of this case, focusing on the improvement of negative symptoms during the course of treatment at our Day Hospital.

2. 2) To review the available evidence regarding the pharmacological and psychotherapeutic management of negative symptoms of schizophrenia.

A review of the patient’s clinical history and complementary tests were carried out. Likewise, we reviewed the available literature in relation to the management of negative symptoms of schizophrenia in an ambulatory setting.

The patient was admitted to our Day Hospital after four psychiatric hospitalizations due to mystical delusions, ideas of grandiosity and hyper-spirituality, along with prominent negative symptoms at the moment of inclusion at our centre, including social withdrawal, diminished affective response, lack of interest in the academic sphere and poor social drive. Although previous positive symptoms were present in a lesser degree, the patient interpreted the presence of the negative symptoms described above as a “punishment” or “test” from spiritual creatures.

Management of negative symptoms represents a major unmet need in schizophrenia. Modest effect size evidence for pharmacological approaches favours the use of antipsychotic in monotherapy and augmentation of antipsychotic treatment with other agents, such as antidepressants. Scarce evidence regarding psychotherapeutic approaches to these symptoms points to the use of cognitive behaviour therapy and social skills training.

• - Clinical identification and characterization of negative symptoms is crucial when treating patients with schizophrenia, as these are associated with important disability and poorer functional outcomes.

• - Differentiation of primary and secondary negative symptoms is a key aspect in the evaluation and management of schizophrenic patients.

• - This case outlines the coexistence of positive and negative symptoms, and illustrates the challenges in the pharmacological and psychotherapeutic management of these symptoms at a Psychosis Day Hospital.

None Declared

Empathy plays an important role in everyday human relationships. It is the ability to put oneself in the place of others, to represent what they think and feel. In healthcare settings, several studies have highlighted its positive effects on patients in terms of physical and psychological well-being.

Evaluate empathy among caregivers.

This is a cross-sectional study, conducted over a 1- month -period and enrolling nursing staff working at Farhat Hached Academic hospital. Empathy was assessed using the Jefferson Scale of physician’s empathy (JSPE) scale.

A total of 92 caregivers were enrolled in this study. The average age was 40.41 years with a sex ratio of 0.95. The most represented category was nurses (64.1%) with an average seniority of 17.2 years. The average empathy score was 98.4. Scores above half were reported in 69.5% of cases. The presence of empathy was significantly associated with female gender (p=0.002).

Empathy is a key point in the patient-caregiver relationship. Thus, the nursing staff must be aware of this concept in order to improve the quality of care.

None Declared

357 million children live in conflict zones. Children’s mental health is a major but complex issue as needs and interventions depend on the age of the child, caregivers, daily safety and protection, etc. EMDR and CBT are the recommended therapies to treat PTSD according to the WHO, but there is not enough standardized evidence-based protocol for children. Testing and evaluating trauma management systems for children is essential for trauma treatment interventions to be implemented in emergency contexts, such as war and conflict situations.

This research compares two intervention protocols for children aged 6 to 17 years suffering from Post Traumatic Stress Disorder after exposure to conflict traumatic events in the Central African Republic: the protocol “Kôno” developed by Action contre la Faim, based on a CBT and narrative approaches and the EMDR/G-TEP (Group Traumatic Events Protocol). After a psychoeducation session, the children were assigned to the ACF-KONO or EMDR/G-TEP groups for 5 sessions. The Child Psychosocial Distress Screener (CPDS) to measure general well-being and functioning and the Child Revised Impact of Events Scale (CRIES) to assess trauma, were administered before and after treatment.

793 children participated in the research, 391 were included in the ACF-KONO protocol and 402 in the EMDR/G-TEP protocol. Both protocols have been shown to be equally effective in improving well-being and reducing traumatic symptoms. 185 children (90 ACF-KONO and 95 EMDR/G-TEP) were also re-evaluated after 5 months. The CPDS and CRIES-8 measurements reveal that the results are stable over time, with the use of both protocols. Detailed results will be presented.

This research contributes to the discussion on a framework for group protocols for children in mental health and psychosocial support interventions in humanitarian programs. The two protocols tested showed very good results in reducing symptoms of PTSD in children. How to choose between EMDR/G-TEP and CBT? What contextual and cultural adaptations are to be expected? Are there differences in children’s appreciation? And in that of mental health practitioners? Ideas for reflection will be shared.

It is possible to widen access to therapeutic treatment of PTSD for children in emergency situations such as war and conflict. Further research in other contexts is needed. These studies should explore qualitative elements, such as children’s appreciations, but also the impact of these different protocols on the vicarious trauma of professionals involved in the treatment of children’s trauma.

None Declared

Type 1 diabetes mellitus (T1DM) patients are treated via insulin which could result in weight gain. Studies have coined a new term, “Diabulimia” which refers to the limitation or skipping of insulin doses, with the objective of weight control. A previous meta-analysis has found that eating disorders (ED) are significantly associated with T1DM (Mannucci, E et al. J Endocrinol Invest 2005; 417-9), while a more recent one, has shown an insignificant association between ED and T1DM on analysis of diabetes-adapted questionnaires only (Young V, et al. Diabet Med. 2013:189-198)

We aimed to re-analyze the association between ED and T1DM, whilst taking into account recently published literature and the type of questionnaire utilized.

A literature search of PubMed, Scopus, and Web of Science was conducted on 17th January 2023, using the key terms “ T1DM”, “Eating Disorders”, and “ Bulimia”. Only Observational controlled studies were included.

T1DM was associated with increased risk of ED compared to non-diabetic individuals (RR = 2.47, 95% CI = 1.84 to 3.32, p-value < 0.00001), especially bulimia nervosa (RR = 2.80, 95% CI = 1.18 to 6.65, p-value = 0.02) and binge eating (RR = 1.53, 95% CI = 1.18 to 1.98, p-value = 0.001), while no significant association was seen between T1DM and anorexia nervosa. Our sensitivity analysis has shown that increased risk of ED among T1DM persisted regardless of the questionnaire used to diagnose ED; DM-validated questionnaires (RR = 2.80, 95% CI = 1.91 to 4.12, p-value <0.00001) and generic questionnaires (RR = 2.03, 95% CI = 1.27 to 3.23, p-value = 0.003). Furthermore, the Eating Attitudes Test-26 (EAT) showed a significant increase in the dieting subscale (MD = 2.95, 95% CI = 1.84 to 4.06, p-value < 0.00001) and bulimia subscale (MD = 0.78, 95% CI = 0.12 to 1.44, p-value = 0.02) among T1DM patients. Additionally, the Bulimic Investigatory Test, Edinburg (BITE) showed a significant increase in the symptom subscale (MD = 0.31, 95% CI = 0.12 to 0.50, p-value = 0.001), however, no significant difference was detected between T1DM and controls in the severity subscale. Prevalence of insulin omission/misuse was 10.3% (95% CI = 8.1-13); diabetic females demonstrated significantly higher risk of insulin omission (RR = 14.21, 95% CI = 2.66 to 76.04, p-value = 0.002) and insulin misuse (RR = 6.51, 95% CI = 1.14 to 37.31, p-value = 0.04) compared with diabetic males. Analysis of other potentially unhealthy weight control behaviors showed insignificant associations between fasting, excessive exercise, dieting pills misuse, diuretics misuse, and T1DM.

T1DM patients are at higher risk of developing ED according to both generic and diabetes-validated questionnaires. Moreover, female diabetics are at higher risk of insulin misuse/omission. Subsequently, patients should be regularly screened and early psychiatric management is warranted.

None Declared

The Pierre-Robin sequence (PRS), characterized by micrognathia, glossoptosis, and cleft palate, has long been a subject of clinical interest. Recent research suggests a potential association between PRS and cognitive or psychiatric disorders. This study explores this intriguing connection, shedding light on the complex interplay between craniofacial anomalies and mental health.

This study aims to establish a comprehensive understanding of the relationship between Pierre-Robin Sequence and psychiatric disorders. Specifically, our objectives include: assessing prevalence, evaluating impact and informing clinical practice. This research aims to improve the holistic care and mental well-being of individuals with craniofacial malformations, contributing to a more comprehensive approach in the field of psychiatry.

This cross-sectional study was conducted at a prominent referral hospital named Hospital de Clínicas de Porto Alegre, an international reference in Pierre-Robin Sequence, during the month of August 2023.

Participant Selection: Patients with PRS. Inclusion criteria encompassed individuals of all ages and both genders.

Data Collection: Trained medical personnel conducted structured interviews with participants to gather demographic information, medical history, and details of their craniofacial conditions.

Medical Records Review: Medical records were reviewed to corroborate craniofacial diagnoses and identify any comorbid conditions.

Statistical Analysis: Data were analyzed using appropriate statistical techniques to assess the association between PRS and psychiatric disorders.

Ethical Considerations: The study adhered to all ethical guidelines, with informed consent obtained from participants or their legal guardians. Ethical approval was obtained from the hospital’s Institutional Review Board.

Data Handling: Confidentiality and data security were ensured throughout the study, with all data anonymized to protect participant privacy.

In our study, we assessed 28 different patients with Pierre-Robin Sequence, comprising 13 females and 15 males. The youngest patient was 2 months old, while the oldest was 22 years old. The mean age of the patients was 4.75 years, with a median of 3 years and a standard deviation of 5.36 years.

Among the patients, 6 exhibited psychiatric disorders, split between 4 males and 2 females. Their average age was 10 years, with a median of 9 years and a standard deviation of 4.2. The youngest patient with evidence of a psychiatric disorder was 5 years old.

This study underscores a concerning reality within the Pierre-Robin population, pointing to a high prevalence of psychiatric disorders. These findings highlight the urgent need for integrated care, emphasizing the importance of early psychiatric assessment and tailored interventions to enhance the overall well-being of individuals facing the challenges of PRS.

None Declared

An increase in the prevalence of depressive symptoms can be seen in patients with severe somatic conditions, with a reduction in quality of life, an increase in sleep disturbances and an increased risk of suicide as some of the most serious consequences. However, few evidence-based interventions have been developed with the aim of reducing this comorbidity. The NEVERMIND system aims to address this issue by collecting psychometric and biomedical data via a smart shirt and a mobile app, which are used to predict patients’ depressive symptoms. Patients are then directed to personalised lifestyle behavioural advice, mindfulness-based therapy, and cognitive behavioural therapy.

The primary objective was to evaluate the effectiveness of the NEVERMIND system in reducing depressive symptoms in patients with somatic conditions compared to treatment as usual. Secondary objectives included the system’s effectiveness in preventing depressive symptoms, sustaining the effects at 24 weeks post-baseline, and reducing suicide ideation. Besides these, the usability, acceptability, and satisfaction of the system were examined in patients with breast or prostate cancer.

For this pragmatic randomised controlled trial, 425 patients diagnosed with myocardial infarction, breast or prostate cancer, kidney failure, or lower limb amputation were recruited from hospitals in Turin, Pisa and Lisbon. Data collection occurred at baseline, 12 weeks, and 24 weeks, with the primary outcome being depressive symptoms at week 12, measured by the Beck Depression Inventory II. Regarding the usability, acceptability and patient satisfaction, data from 288 patients was used.

The intervention group included 213 and the control group 212 patients, with the sample’s mean age being 59.41 (SD=10.70). Patients who used the system reported having statistically significant lower depressive symptoms at 12 weeks (mean difference=-3.05, p=0.004; 95%CI -5.12 to -0.99) compared to controls, with a clinically relevant effect size (Cohen’s d=0.41). Furthermore, significant reductions were found for suicide ideation (mean difference=-0.61, p=0.020; 95%CI -1.13 to -0.10) and incidence of depressive symptoms at week 12 (OR=0.43, p=0.019; 95%CI 0.22 to 0.87). The decrease in depressive symptoms was sustained at week 24 (mean difference=-1.34, p=0.015; 95%CI -2.41 to -0.26). The system was found to have good usability, with women rating the system more favourably than men and valuing its emotional support, while men used the system more frequently than women and valued the self-awareness that the system encouraged.

The NEVERMIND system was shown to be superior to standard care in reducing and preventing depressive symptoms among the studied sample. A new project will be launched in the near future to continue the examination of the system’s effectiveness.

None Declared

Due to the global humanitarian crisis, there has been a significant increase in global immigration.(1)

The migration process typically involves multiple trauma exposures that are sustained over time(2), which may result in an impact on the mental health of these individuals(3), such as posttraumatic stress disorder(3). A recent meta-analysis estimated that 25% of migrants had PTSD(15), which is significantly higher than the 0.2% to 3.8 percent prevalence data found for the general population(4). In addition, a number of meta-analyses indicate an increased risk of psychosis among immigrants(5). Despite this rise, there is a gap in trauma research in non-refugee immigrants, particularly those with psychotic disorders.

To describe and compare PTSD diagnosis between immigrants and locals recruited from mental health services in Barcelona.

Patients who have presented, according to DSM-V criteria, one or more non-affective psychotic episodes, were recruited in Acute and Chronic inpatients units at Hospital del Mar (Barcelona) from November 2019 to June 2021, leading to a total sample of 199 patients.

Demographic characteristics of patients, clinical data and main pharmacological treatment were recorded through a questionnaire. Database information was completed with electronic medical records. Global Assessment of Posttraumatic Stress Questionnaire (EGEP-5) was used as an instrument to assess PTSD diagnosis, main trauma nature and PTSD symptoms. Comparative analysis was performed with IBM SPSS Statistics (Chicago INC) using Chi-Square Test for qualitative variables and t-Student test for continuous variables. Covariate adjustment with demographic and clinical variables was performed by ANOVA test. Study received local ethics committee approval “CEIC” (No. 2019/8398/I).

From the total sample of 199 individuals, 98 were immigrants and 98 locals. From the total sample 39 individuals (19.69%) presented PTSD. 32.3% of the immigrants with psychotic disorders presented PTSD compared to 7.1% of the locals with psychotic disorders (F1=19.9, p=0.00). Most traumatic events related to PTSD in immigrants were: “murder of relatives” (33.1%), Physical violence (21.9%) and Terrorism (15.6%) in locals were: “physical violence” (28.6%). Immigrants and locals with psychotic disorders showed similar averages of symptoms, except for avoidance symptoms where locals showed a mean of 5.1 compared to a mean of 3.5 in the immigrant group. Finally, immigrants showed one more functionality affected area by PTSD (5.1) when compared to locals (4) (F7=3.9, p=0.05).

According to our results there are important differences in PTSD prevalence between immigrants and locals with psychotic disorders. These findings ought to be taken into consideration for programs that are both clinically and sociopolitically tailored to improve assessment and treatment for this population.

None Declared