Comprehensive care programs, which include individually planned pharmacotherapy are associated with higher rates of recovery1 and better long-term prognosis2. However, there are barriers to individually optimised antipsychotic treatment both from both the patients and treatment teams perspectives.

To summarize the potential contribution of adequate long-term antipsychotic treatment to recovery or better outcomes in schizophrenia.

Review of research data.

Results A shorter duration of untreated psychosis, a lower number of relapses, and the absence of a chronic course of psychosis are associated with higher rates of recovery and a better prognosis. The OPUS early intervention program was associated with better outcomes for up to 10 years, but not for more than 20 years3. Second generation antipsychotics are associated with lower mortality rates, including suicides in young people with schizophrenia.4

Higher doses of antipsychotics are associated with poorer outcomes and with potential structural brain changes, while adequate (lower) doses of antipsychotics are associated with lower side effect burden and better overall outcomes5. A significant proportion of patient may benefit from polypharmacy (combination of 2 antipsychotics)6. Antipsychotic treatment discontinuation strategies are associated with the development of treatment resistance.7

Adequate (low dose) antipsychotic treatment is part of the complex early intervention programs and long term treatment of schizophrenia, which are associated with higher rates of recovery and good outcomes. The role of polypharmacy (combination of 2 antipsychotics) may need a reconsideration in the treatment guidelines of schizophrenia.

1. 1. Kane JM et al. The Journal of clinical psychiatry. 2015 Mar 25;76(3):16590.

2. 2. Posselt CM et al. 2021. American Journal of Psychiatry, 2021, 178(10):941-951

3. 3. Hansen HG et al. 2023. JAMA Psychiatry, 2023, 80(4): 371-379.

4. 4. Correll CU et al. World Psychiatry. 2022 Jun;21(2):248-71.

5. 5. Andreasen NC et al. 2013 Jun;170(6):609-15.

6. 6. Katona L et al. 2014 Jan 1;152(1):246-54.

7. 7. Emsley R et al2013 Feb 1;33(1):80-3.

None Declared

Systematic reviews show a high prevalence of mental distress among victims of human trafficking. In criminal proceedings in Spain, a forensic expert assessment of survivors may be ordered by the courts. Its aims are mainly, albeit not exclusively, to determine the consequences of trafficking on the physical, mental, and social health of the victims. The Institute of Legal Medicine and Forensic Sciences is the public institution providing psychiatric expert assessments in the autonomous region of Catalonia (Spain). Recently, a unit devoted to the forensic assessment of human trafficking victims has been created at the central headquarters of the Institute in Barcelona.

To describe the characteristics and the mental health status of trafficked people identified as victims in criminal proceedings.

Retrospective study of case records of victims of human trafficking at the Institute of Legal Medicine and Forensic Sciences of Catalonia (2016-2023).

Case records of 50 survivors were identified. 38 (76%) were female; mean age was 30,5 years (SD 10,42; range 17 to 69 years). All of them were foreigners, mainly from Latin America (24; 48%). Most of them were trafficked for sexual exploitation (32; 64%). 11 (22%) were assessed immediately after their rescue (emerging cases). Some of the victims had previous mental health problems, including intellectual disability (3; 6%). Among the non-emerging cases, the most frequently recorded mental disorders at the moment of the psychiatric expert assessment were post-traumatic stress disorder (PTSD; 21; 53,8%) and anxiety (12; 30,8%). Complex PTSD was observed in 1 case.

The majority of human trafficking survivors in the forensic setting suffer from persistent mental health problems as a consequence of their victimisation. A trauma-informed forensic psychiatric assessment is recommended.

None Declared

Synthetic drugs pose one of the most significant drug problems worldwide. In this category, W18 emerges as a potent drug of abuse chemically related to fentanyl. W18 has an analgesic potency 10,000 times greater than morphine. Recent in-vitro studies reported no activity of W18 towards opioid receptors. However, its presence in seized drug samples indicates its use as a precursor in fentanyl synthesis. This emphasizes the need to develop methods for its detection in developing countries dealing with emerging new drugs.

To develop an analytical method for the determination of W18 in urine samples.

Standards with W18 concentrations ranging from 5-500 ng/ml were prepared in negative urine along with deuterated internal standard. The samples were diluted with methanol, centrifuged and the supernatant was subjected to Liquid chromatography-tandem mass spectrometry (LC-MS-MS) with time of flight (QTOF) analysis. For chromatographic separation, a C18 column with 50 degrees oven temperature was used. The mobile phase consists of formic acid, water, and acetonitrile. The TOF MS was operated in positive ion mode and multiple reaction monitoring was used for quantification.

The retention time of W18 was obtained at 9.57 minutes. The parent ion with molecular weight 422.1 along with precursor ions Q1-273, Q2-111.0, Q3-150.0 g/mol were measured. The area of the standards ranges from 1 to 9.0 log 5 with R square of 0.99. The limit of detection (LOD) and quantitation were 5 and 20 ng/ml respectively. The recovery of W18 was estimated to be 96% from the from spiked urine standards.

The developed method is able to detect W18 presence in urine samples. This method has the potential to be used in clinical and research studies.

None Declared

Internet and smartphone use that reaches the level of addiction often leads to deterioration in the quality of life and functionality of individuals.

In our study, we aimed to investigate possible differences in retinal nerve fiber layer (RNFL) thickness and central macular thickness obtained by optical coherence tomography in internet and smartphone addiction.

A total of 212 volunteer university students participated in our study. All participants were administered the Sociodemographic Information Form, Chen Internet Addiction Scale, Smartphone Addiction Scale-Short Form. Participants who completed the scales underwent routine eye examinations by experienced physicians in the ophthalmology outpatient clinic. Retinal nerve fiber layer (RNFL) thickness and central macular thickness were measured by optical coherence tomography (OCT).

In our study, internet addiction rate was 17% and smartphone addiction rate was 38.2%. RNFL thickness was found to be statistically significantly increased in the temporal superior and temporal inferior quadrants in those with internet addiction compared to healthy subjects (p<0.05). In smartphone addiction, RNFL thickness was found to be statistically significantly increased in the temporal inferior quadrant compared to healthy subjects (p<0.05). In the analyses comparing OCT measurements according to sex, it was found that nasal inferior (p<0.01) and global (p<0.05) quadrants in women and central macular thickness (p<0.01) in men were statistically significantly increased.

The correlation analyses in our study revealed statistically significant positive correlations between internet addiction scale scores (p<0.01) and smartphone addiction scale scores (p<0.01), RNFL temporal superior quadrant thickness (p<0.01); smartphone addiction scale scores and RNFL temporal superior quadrant thickness (p<0.05).

Internet and smartphone addiction are seen considerable rates among university students. In OCT measurements, RNFL thickness was found to be increased in various quadrants in patients with addiction. In addition, RNFL thickness was found to be increased in all quadrants in female gender and central macular thickness was found to be increased in male gender. Correlation analysis revealed that internet addiction scale scores, smartphone addiction scale scores, and RNFL temporal superior quadrant thickness were positively correlated. In addition, there was a positive correlation between smartphone addiction scale scores, and RNFL temporal superior quadrant thickness

None Declared

Stress is a significant issue among healthcare professionals and impacts both their personal well-being and the quality of care they provide.

This study evaluated the prevalence of stress among healthcare professionals and investigated the possible effect of physical activity on perceived stress levels.

In 2019, a cross-sectional observational study of 30 nurses was conducted at the Hassan II Oncology Center in Oujda. A self-administered survey was used to gather information regarding the participants’ sociodemographic and professional characteristics. The Perceived Stress Scale was employed to gauge stress levels, whereas the Ricci-Gagnon questionnaire was used to determine physical activity levels and engagement in sports.

The study findings indicate that the sample had moderate levels of stress measured by the Perceived Stress Scale (PSS) and struggled with managing stress in diverse situations. Physical activity was common among 87% of the participants, as indicated by the Ricci-Gagnon questionnaire. In addition, a statistically significant correlation was found between stress levels and family situation (p = 0.05). The Perceived Stress Scale and the Ricci-Gagnon questionnaire exhibited high internal consistency, with Cronbach’s alpha values of 0.79 and 0.64, respectively.

The study results have raised significant concerns regarding the effectiveness of different coping strategies in managing stress. In particular, the results indicate that engagement in physical activity and sports does not significantly affect stress levels. Thus, stress management training is recommended as the best strategy for stress prevention.

None Declared

Heightened affective responses to daily life stressors, referred to as elevated affective reactivity to stress (or ‘stress sensitivity’), have been proposed as a putative mechanism of schizophrenia. Previous studies on stress sensitivity mainly used a case-control design; given that schizophrenia is heterogeneous its relationship with specific symptoms (e.g. paranoia) is yet to be addressed. In view of the continuum approach of understanding psychotic symptoms, the relationship between stress sensitivity (especially ‘social stress sensitivity’) and paranoia in the general population is important. Supported by emerging evidence of the relationship between hostile attribution bias (i.e. a tendency to interpret others’ actions as hostile and intentional) and paranoia, we hypothesized that social stress sensitivity mediates the relationship between hostile attribution bias and momentary experiences of paranoia.

Using experience sampling method, this study aimed to examine the association between social stress sensitivity, hostile attribution bias and momentary paranoia in non-clinical young adults. We also tested the role of social stress sensitivity as mediator of the relationship between hostile attribution bias and momentary paranoia.

Consented participants free from any past and current psychiatric diagnoses (confirmed with the Structured Clinical Interview for DSM-IV Disorders) completed the measure of hostile attribution bias (i.e. abbreviated Ambiguous Intentions Hostility Questionnaire). Participants then filled in an ESM questionnaire measuring momentary levels of paranoia, social stress (i.e. pleasantness of and preference for being alone or with others) and negative affect on a mobile phone app repeatedly, ten times per day over six days. Social stress reactivity was calculated as the within-moment correlation between social stress and negative affect. The associations between social stress sensitivity, hostile attribution bias and momentary paranoia, and the mediating role of social stress sensitivity, were tested with multilevel modelling.

The final sample consisted of 131 participants (57.3% female, mean age= 20.36 (SD= 2.93)). The mean compliance rate was 71.9% (SD= 0.16). Social stress sensitivity was positively associated with momentary paranoia (B= 0.03, p= .002). Hostile attribution bias was associated with momentary paranoia (B= 0.41, p< .001), as well as social stress reactivity (B= 0.10, p= .003). The mediating effect from hostile attribution bias to momentary paranoia via social stress sensitivity was significant (ab= 0.05, 95% CI [0.03-0.07]).

Social stress sensitivity was related to momentary paranoia, as well as hostile attribution bias. Our finding suggests social stress reactivity as a potential mechanism underlying the relationship between hostile attribution bias and paranoia.

None Declared

In Switzerland, alcohol consumption is even decreasing, with an exception for old people after retirement.35%of them have a heavy or addictive consumption (OFSP, consommation d’alcool en Suisse, fait et chiffres. 01.2023). This is also the case for home residents.

The alcohol consumption by old poeple has negatives consequences on the health (falls, fractures, cognitives disorders).

The autors conduct a crossectionnal enquiry in the homes of Fribourg area to identify addictive behaviour and different existing supports. After a review, the authors present the results of their enquiry

Identify how much home-residents have a problematic or an addictive alcohol problem

Identify if there is existing support

Hinghligthing the training need for the staff

Crossectionnal enquiry was sent in 42 Home of the Fribourg area, with 3 relances

The premliminary result will be completed at the end of 2023:

• - Every home identify at leat 4-5 residents with a problematic alcohol consumption

• - Most of them, the staff have no specific addictive trainig and no needs for it

• - The staff authorise alcohol consumption in the home, to avoid alcohol withdrawal

• - The psychiatric consultant in the home can help the staff to manage the counter-attitudes

Home residents are not eligible for specialized addictive care, whil the generally respond well to motivationnal interviewing or to controlled consumption. The lack of staff training could be an hypothesis. The lack of interest in the neagtives conséquences oh alcool on th health of people at the enf of their lives is anothers hypothesis

Nursing home residents are not eligible for specialized addictive care. The enquiry results are astonishing: no need of specialized training, authorization of continous drinking in the different homes, while the literature points the effectivnesse of motivationnal interviewing or controlled approaches by old people with addictive disorders.

Further studies are needed, ethical consideration on the management of alcohol addiction in the elderly should be proposed.

None Declared

Patients and the research community need better and more cost-effective randomised trials. These are the ‘gold standard’ way of seeing if a new treatment works or not, and take years of effort involving lots of patients and funding. However, around half of trials fail to show that the new treatment is better than what it is being compared with. In cancer, this problem has been recognised. They use trial designs which test multiple treatments, and find out quicker answers to more questions. These ‘efficient trials’ are able to involve patients at a faster rate and to improve the chances of patients receiving a treatment that works. In mental health, the whole toolbox of trial designs is not being used. Sometimes there are valid reasons for this, but sometimes it is simply that researchers do not know about them – this talk will expand on the concept of ‘efficient trials’ in mental health, and present the opportunities and challenges to using these.

None Declared

Tunisia marked a significant milestone in the fight against gender-based violence with the adoption of Organic Law No. 2017-58. This pioneering law in the region enhanced the protection of women and girls’ rights and introduced harsher penalties for perpetrators of sexist violence. However, the journey toward eradicating violence against women is complex and multifaceted.

Our aim is to explore how tunisian women perceive gender-based violence and their attitudes towards it.

A cross sectional online survey designed using Google Forms and distributed on social media platforms (Facebook, Instagram) was conducted from August 30th to September 25th 2023. The questionnaire, presented in the tunisian dialect, included questions about personal experiences with violence, knowledge of gender-based violence laws as well as their perceptions and attitudes towards gender-based violence. The sample consisted of women from various regions of Tunisia.

In our study, we analyzed a sample comprising 110 tunisian women, with 46.4% falling within the 20 to 30 age bracket and 36.4% belonging to the 30 to 40 age range. Half of the survey participants were unmarried, and the majority of them (97.3%) had attained a university-level education.

Our research revealed that 45.5% of the surveyed women reported instances of gender-based violence in Tunisia. However, only a minority of these individuals (22.2%) initiated legal proceedings, primarily citing a lack of confidence in the judicial system and fear of potential reprisals as their reasons.

A majority of the participating women expressed deep concern regarding the issue of violence against women in Tunisia.

When asked about their perceptions of the most prevalent types of violence in Tunisia, 76.36% believed that psychological violence was the most common, followed by sexual violence (21.3%). Economic and physical violence were perceived as less frequent (9.9%; 12.6%). These women attributed the primary factors contributing to violence against women in Tunisia to cultural norms and laws that they considered inadequately stringent. Indeed, 83.3% of them believed that the current legislation was not stringent enough to deter potential perpetrators, and 37.3% indicated that they were unaware of the existing legal framework.

Despite legislative advancements, gender-based violence remains a pressing concern in Tunisia. These findings underscore the importance of increasing awareness about available resources for victims, educating individuals about women’s rights and mental health, and building trust in the judicial system.

None Declared

Health science students in post-secondary institutions experience high levels of depression and anxiety due to increased stress levels, workload, low socioeconomic status, and history of family mental illness, among other factors. Given the significant negative impact that depression and anxiety can have on undergraduate health science students, it is essential to understand the prevalence and correlation of these conditions in this population.

This scoping review aims to identify, document and analyze the literature on the prevalence and determinants of anxiety and depression among undergraduate health sciences students and identify gaps in knowledge for future research.

The scoping review was planned and executed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for the Scoping Reviews statement. A comprehensive and systematic search was carried out for five databases, namely MEDLINE, Scopus, EMBASE, CINAHL and PubMed.

From the literature identified by our search strategy, the lowest prevalence for anxiety was 5.8%, and the highest was 82.6%, with a median of 44.25%. The prevalence of depression ranged from a high of 88.8% to a low of 2.1%, with a median value of 34.8%. Our analysis revealed that correlates of anxiety and depression among health science students include sociodemographic factors such as age, sex, gender, relationships, ethnicity and family history, personal health conditions, and academic and socioeconomic issues.

Image:

With the high incidence of anxiety and depression among health science students, there is an increasing need to find practical remedies to support these students. It is also essential for policymakers and university authorities to implement interventions such as supportive text messages and other strategies geared toward providing support and improving the psychological well-being of health science students.

None Declared

Vocal and motor tics are characteristic for Tic disorders (TD) and Tourette’s syndrome (APA 2022) . Because of the pathophysiology of the disorders not being fully understood and the presence of the externally measurable symptoms; great attention has been paid to the cortico-striatal regions of patients with TD . In addition to the alterations in motor symptoms patients can experience a premonitory urge (PU) which can be felt before a tic (Reese et al. Behav. Ther. 2014; 45 177–186) . Previous studies found an impact of these urges on sensory perception, attention and social cognition as well as an involvement of the brain regions insula, anterior cingulate cortex (ACC) and the temporoparietal junction (TPJ) (Seeley J. Neurosci. 2019; 39 9878–9882, Kucyi et al. J. Neurophysiol. 2012; 108 3382–3392, Uddin et al. Brain Topogr. 2019; 32 926–942) . These findings lead to the idea of altered functional connectivity of the salience network (SN) in patients with TD.

This study aims to investigate the connectivity changes of the SN in patients with TD. We examined functional resting-state scans of patients with TD and searched for possible correlations between the tic and PU severity and the connectivity of the SN.

21 Patients (mean age: 30.9 years ± 10.0 [range = 19–57], 6 females) diagnosed with TD, and 20 healthy controls (mean age: 29.7 years ± 8.9 [range = 18–50], 5 females) underwent a resting-state fMRI scan. Functional and anatomical images were conducted on a 3T Siemens Prisma fit MRI scanner. PU and tic severity were measured by the Premonitory Urges for Tics Scale (PUTS) and the Yale Global Tic Severity Scale (YGTSS). The connectivity analysis of the resting-state scans was done using the CONN toolbox v21.a. After pre-processing and de-noising steps, a whole-brain seed-based connectivity analysis was carried out with the seeds being the major cortical nods of the SN. For the correlation analysis a linear regression of the YGTSS score/PUTS score and the brain connectivity of the seed regions was conducted.

The PUTS score was 25.3±5.4 (range 10-33) and the YGTSS total tic score was 23.1±7.9 (range 10-38) for the patients. The connectivity analysis revealed a significant difference in connectivity between the groups for the ACC, the right insula and the TPJ. A negative correlation between the YGTSS scores and the connectivity of the left insula and the right superior frontal gyrus (SFG) was shown in the correlation analysis. No significant correlation was found for the PUTS scores in the investigated seed regions.

The right SFG mediates motor urgency and inhibitory control. Since we found a negative correlation between the insula and the right SFG regarding to higher YGTSS scores of the patients, our results might shed some light on the pathophysiology regarding lower inhibitory control in patients which experience higher tic severity.

None Declared

There is a growing concern about the link between musculoskeletal disorders (MSD) and psychosocial risk (PSR) among electricians. Both MSD and PSR represent a threat to the electrician’s health, quality of life and productivity.

This study aimed to assess the link between PSR and MSD among electricians.

The study was conducted in a group from an electricity society. Data were gathered between January-June 2022 using a self-administered questionnaire evaluating socio-professional characteristics, the Nordic musculoskeletal questionnaire during the previous year and the validated French version of the questionnaire KARASEK.

Our study included 68 male electricians. The mean age was 39.2 ± 10.3 years. The average job tenure was 16± 11.4 years. According to the Nordic musculoskeletal questionnaire, 50% of participants experienced pain during the last 12 months.

About half of the electricians had high psychological demand (48.5%), 63.2% had a low latitude, and 76.5% had low social support. According to the Karasek model, tense electricians accounted for 26.5% and assets 22.1%. MSDs were associated with high psychological demand at work (p = 0.02).

This study demonstrated that PSR and MSDs are associated among electricians and are highly prevalent. They represent an important concern of the occupational and safety health system. The prevention of MSD should take into account the specific working conditions of electricians to reduce their exposure to psychosocial risk factors in the workplace.

None Declared

Psychotic patients often require pharmacological treatment, which may prove ineffective, leading to treatment-resistant psychosis necessitating the use of clozapine. However, the emergence of side effects can result in discontinuation, potentially triggering a relapse of psychotic symptoms. One significant side effect is antipsychotic-induced weight gain which, over time, can lead to adverse metabolic events. Recent translational research is evaluating the impact of prenatal factors on the metabolic outcomes of psychotic patients, using a surrogate marker of the intrauterine milieu such as birth weight (BW).

We aim to evaluate the changes in leptin, adiponectin, and insulin levels in patients with treatment-resistant psychosis who initiate clozapine treatment due to persistent psychotic symptoms.

Subjects older than 18 years with a diagnostic of a major mental disorder and initiating clozapine were enrolled in this 18-months longitudinal study. Neurohormones levels, including leptin, adiponeptin, and insulin were measured at baseline, 8 and 18 months during follow-up. Statistical analysis were conducted by using a fixed-effects model.

A total of 23 subjects initiating clozapine were evaluated during the initial mandatory 18-week period. Neurohormones, specifically leptin and adiponectin, were measured at three time points: baseline, 8 weeks, and 18 weeks. The changes in leptin levels were significantly associated with birth BW with sex differences, being inversely correlated only in females. Adiponectin was significantly associated with BW, being inversely correlated in males. Conversely, there was no observed association between insulin levels and BW.

Our findings highlight the significance of prenatal factors in influencing the subsequent evolution of neurohormones in individuals initiating clozapine treatment. This suggests that subjects with lower BW tend to exhibit elevated neurohormone values, emphasizing the role of prenatal events in this context.

None Declared

POTION is an EU funded project (No. 824153) within the Horizon2020 initiative that aims at understanding the nature of chemosignals in humans and their sphere of influence on social interaction. The emotional state of one person can be transmitted to another through volatile molecules contained, for example, in the sweat. These molecules, or chemosignals, are processed by the receiver who is not only able to identify the feelings of the sender but also to respond accordingly.

Whitin this project, we conducted a study with the aim of exploring the possible catalyst effects of body odour on social anxiety. We hypothesized that subjects exposed to human chemosignals, while undergoing mindfulness treatment, would show an enhanced reduction in anxiety symptoms in comparison to the control group (exposed to clean air).

To this aim, a study including 96 women aged between 18 and 35 years with symptoms of social anxiety was conducted. Ater recruitment, subjects were randomly allocated to one exposure group (happiness, fear or neutral human body odour or clean air) and followed a mindfulness intervention while being exposed to one of the odour or clean air. The same intervention was repeated twice, over two consecutive days. The main outcome was change in the State-Trait Anxiety Inventory (STAI) scores for which data was collected before and after treatment at each day. Mixed model analysis revealed significant changes in STAI scores in all groups during both days of trial. However, a greater decrease in anxiety symptoms was observed in subjects exposed to fear chemosignals during both days. A post-hoc comparison of the group exposed to clean air and the group exposed to fear chemosignals showed a trend level time x odour interaction during the second day of trial (F(1,45)=3.74, p=0.07).

In conclusion, our pilot study indicated a potential use of human body odours as a catalysts of social anxiety treatment. While the small sample size restricts the generalizability of our findings, the observed trends offer a promising foundation for future research.

None Declared

Aggressive behaviors have been reported to be more frequent in people with eating disorders (ED), especially bulimia nervosa (BN). Network Analysis (NA) is particularly useful or examining the interactions among symptoms of comorbid conditions through the identification of “bridge symptoms,” defined as those symptoms playing a key role in the connection between two syndromic clusters.

The aim of the present study was to investigate the association of ED core symptoms and ED-related psychopathology with aggressiveness in a clinical sample of women with BN through NA.

A NA was conducted, including ED symptoms and aggressiveness measures. The bridge function was implied to identify symptoms bridging ED symptoms and aggressiveness.

The most connected nodes among communities were asceticism and impulsivity from ED-related psychopathology, drive for thinness from ED- core psychopathology and guilt and suspicion from aggressiveness domain. In particular, drive for thinness connected ED-core community to verbal hostility, while impulsivity connected ED-related symptoms to guilt and suspicion of aggressiveness community.

In conclusion the present study showed that in people with BN guilt is the specific negative emotion of the hostile dimensions that may be bidirectionally associated with ED symptoms.

None Declared

New prevalence and time trend data from various Asian countries show that Eating Disorders (ED) are increasingly common in Asia. (Youl-Ri Kim. Int J Eat Disord. Dec 2020). A recent study estimating the prevalence of ED in Singapore found an alarming 6.2% screened positive for a clinical ED diagnosis, 19.5% were screened to be at high risk, and estimated the point prevalence of Anorexia Nervosa (AN) to be 0.9%. (Chua SN et al. Int J Eat Disord. Jan 2021).

The ED unit in Singapore General Hospital (SGH) was set up in 2003 as a National Treatment Programme for patients with ED.

Two local studies have been published to date on the demographics and clinical profile of patients with AN. The first study examined 126 patients from 1994 – 2002 (HY Lee et al. Singapore Med J 2005; 46(6): 275-281). The second study reported on 271 cases from our SGH ED unit from 2003-2010 (Kuek et al. SIngapore Med J 2015; 56(6): 324-328). There have been no further studies in the last decade.

1. 1. Study the demographics and clinical profile of patients who presented with AN to our ED unit from 2011-2022

2. 2. Compare our data with the 2 previous studies and examine for any changes and trends in the past 30 years.

We conducted a review of the ED unit new case registry at SGH from 2011-2022. A total of 910 patients were diagnosed with AN at presentation. The data was analysed with approval from the hospital instituitional review board.

A total of 910 cases presented with AN over 12 years. Comparing with the 2 previous studies, the number of new cases each year has continued to increase from <15 in the 1990s to hit a peak of 109 per year in 2022. 94% were females, with a mean presenting age of 19. 79.2% were Chinese, 5.2% were Indians and 2.9% were of Malay ethnicity. The Malay population continue to be under-represented whereas other ethnic groups continue to be over-represented, increasing from 3.2% to 7% in the previous studies to 11.1%. Referrals were mainly from tertiary healthcare intuitions accounting for 41.4% of cases. Self-referrals have decreased over the last decade whereas referrals from primary care has increased. The mean presenting body mass index (BMI) was 15.9. Compared to a previous study, there was a significant increase in presenting BMI (15.9+/- 0.78 vs 14.4 +/- 1.77, p value 0.0074).

The number of new cases of AN has seen an almost 10-fold increase in the last 30years. The Malay ethnicity continues to be under-represented – more research is needed if they are somehow culturally protected or if they are not coming forth for treatment. Majority of referrals are from tertiary healthcare institutions but referrals from primary care have increased, reflecting a possible increase in awareness amongst primary care doctors. The mean presenting BMI has increased – hopefully reflecting an increase in ED awareness such that patients are coming forward earlier for treatment.

None Declared

Attachment refers to the emotional bond between a child and their primary caregiver, reflecting the child’s confidence in the caregiver’s capacity to offer security. Evaluating attachment styles in individuals with schizophrenia spectrum disorders holds significance in pinpointing a potential factor affecting therapeutic relationships. This, in turn, indirectly aids in comprehending the emergence of low adherence as a significant barrier to schizophrenia

The goal of this study is to assess attachment styles in women with schizophrenia spectrum disorders.

We conducted a descriptive and analytical cross-sectional study at the Psychiatry “B” department of Hedi Chaker University Hospital in Sfax, Tunisia, during May and June 2023. Our study involved stabilized female patients diagnosed with either schizophrenia or schizoaffective disorder. We utilized the 26-item Revised Psychosis Attachment Measure (PAM_R) questionnaire translated into Arabic and the Positive and Negative Syndrome Scale (PANSS) score to assess schizophrenic symptoms.

We enrolled a total of 41 female patients in our study, with 65.9% diagnosed with schizophrenia and 34.2% with schizoaffective disorder. The average age of the participants was 49.19 years, ranging from 17 to 79 years old. In terms of attachment styles, avoidant attachment was the most prevalent (60.97%), followed by anxious attachment (24.39%), and disorganized attachment (14.63%). Our study revealed significant associations between avoidant attachment and several factors. Patients who began psychiatric follow-up with hospitalization had a significantly higher level of avoidant attachment compared to those starting with outpatient consultation (p < 0.001). The type of therapy also influenced avoidant attachment, with a significant difference (p < 0.001). Insight into their condition also played a significant role (p < 0.001). Moreover, the age at which psychiatric follow-up began showed a statistically significant correlation with avoidant attachment (Spearman’s ρ = 0.000, p < 0.001). Individuals with higher avoidant attachment tended to have a longer duration of untreated psychosis, supported by a statistically significant positive correlation (Spearman’s ρ = 0.082, p < 0.001). There was also a statistically significant relationship between avoidant attachment and the equivalent dose of chlorpromazine, with a positive correlation (Spearman’s ρ = 0.091, p < 0.001), indicating that individuals with higher avoidant attachment may require higher equivalent doses of chlorpromazine. Finally, higher levels of avoidant attachment were associated with a lower presence of positive symptoms in schizophrenia (Spearman’s ρ = -0.026, p < 0.001).

Insecure attachment is a valuable mechanism for understanding the evolution of schizophrenia spectrum phenomenology and may be a useful target for prophylactic interventions.

None Declared

“Folie à deux,” or shared psychosis, is a fascinatingpsychiatric phenomenon characterized by the transmission of delusional beliefs and psychotic symptoms from one individual (the “inducer”) to another (the “recipient”) who share a close emotional bond. Despite its rarity, “Folie à deux” presents unique challenges and insights into the understanding of psychosis and the intricacies of interpersonal relationships.

The primary objective of this review is to analyze the recent clinical literature on “Folie à deux” to better comprehend its clinical presentation, diagnostic criteria, etiological factors, and therapeutic approaches. By synthesizing the latest research findings, we aim to enhance the awareness and understanding of this intriguing phenomenon among mental health professionals.

A case report of a couple of a 34-year-old male and a 43-year-old female with a shared delirium. The male was brought to the emergency department by ambulance after being found in the street with behavioral disturbances and delusional symptoms. Individual interviews with both members of the couple revealed shared delirium. He was admitted to the psychiatric ward for the clinical picture consisting of a chronic delusional disorder of years of evolution and and new symptoms such as restlessness and behavioral disturbances.

The review reveals that “Folie à deux” remains a rare but clinically relevant phenomenon, with reported cases spanning diverse cultural and familial contexts. Diagnostic criteria, as outlined in the DSM-5, have been useful in guiding clinicians in identifying and managing cases. The literature emphasizes the importance of a thorough psychiatric evaluation to distinguish “Folie à deux” from other psychopathological conditions. Recent research has also shed light on potential neurobiological mechanisms and genetic factors contributing to shared psychosis. Therapeutically, early intervention and tailored treatment plans are crucial in achieving favorable outcomes. While antipsychotic medications remain a cornerstone of treatment, family therapy and psychoeducation have emerged as valuable adjunctive approaches to address the unique challenges posed by shared psychosis.

In conclusion, “Folie à deux” continues to be a captivating and clinically relevant phenomenon in contemporary psychiatry. This bibliographical review underscores the importance of recognizing and diagnosing shared psychosis in clinical practice. Moreover, it highlights the need for further research to unravel the underlying mechanisms and genetic predispositions associated with this condition. Ultimately, a multidisciplinary approach, including pharmacological, psychotherapeutic, and family-based interventions, holds promise in improving the prognosis of individuals affected by “Folie à deux.”

None Declared

Exposure to potentially traumatic events (PTEs) during military service is associated with mental health problems such as posttraumatic stress disorder (PTSD) and depression symptoms. However, knowledge regarding the implications of maladaptive personality traits in psychopathology among female veterans is sparse.

The present study aims to use the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–5) -- an alternative model of personality disorder, to examine associations between maladaptive personality traits, PTSD and depression symptoms, among female Israeli veterans.

A volunteer sample of female Israeli combat veterans (n=616) and non-combat veterans (n=484) responded to self-report questionnaires in a cross-sectional study.

Combat veterans reported higher levels of combat exposure and PTSD symptoms, but not depressive symptoms, than non-combat veterans. Combat veterans also reported lower levels of negative affectivity but higher levels of disinhibition than non-combat veterans. All five traits were positive predictors of psychological distress, with psychoticism constituting the strongest predictor. A moderated-mediation analysis indicated four traits (negative affectivity, detachment, disinhibition, and psychoticism) that had a moderating effect on the relationship between combat exposure and PTSD symptoms, and two of the traits (antagonism and disinhibition) that had a moderate effect on the relationship between combat exposure and depressive symptoms.

Maladaptive personality traits play an important role in psychological distress following female veterans’ combat service. Future prospective research is necessary to determine the temporal associations between pre-enlistment maladaptive personality traits and post-deployment mental health of veterans.

None Declared

Clinical features and structural changes in the brain of patients with late-onset schizophrenia and schizophrenia-like psychosis are important in predicting the effectiveness of treatment.

Identification the dependence of effectiveness of psychopharmacotherapy on the clinical features and structural brain changes in late-onset schizophrenia and schizophrenia-like psychosis.

111 patients, age from 52 to 89 years with ICD-10 diagnosis F20, F25, F22.8, F06.2 were investigated for 28 days. Clinical, psychometric methods with PANSS, CGI, HAMD, CDSS, MMSE scales were used. MRI/CT were performed. Effectiveness of treatment was measured in two ways: 1. Percentage ratio of reduction in total scores to the 1st value of scales. 2. The number of responders (patients with a decrease in PANSS by 30% or more).

The effectiveness of treatment in the overall group was 29,4% on the PANSS scale (from -13,6% to 77,2%). The greatest effectiveness was on subscale of positive syndromes (34,9%), the lowest – on the subscale of negative syndromes (18,6%). The number of responders (R) was 43 patients (38,7%), non-responders(NR) – 68 patients (61,3%). The responder group was characterized by a greater severity of acute psychosis before the begging of treatment. Early insomnia, excitement and anxiety, decreased appetite, valuated by HAMD scale were significantly more pronounced. Treatment effectiveness had negative correlates (p<0,05) with number of acute attacks, number of hospitalizations and the duration of current attack. The predominance of negative symptoms has a negative correlation with effectiveness by PANSS and CGI scales. According to the results of MRI/CT examination, cortical atrophy, vascular changes and leucoaraiosis were more often represented in NR group.

The connection between the effectiveness of treatment and the clinical and psychopathological features and structural changes in late onset schizophrenia and schizophrenia-like psychosis was shown.

None Declared