The surgical treatment process involves not only physical recovery but also the management of psychiatric and psychosocial issues. Psychiatric disorders can negatively affect postoperative recovery, complicate adherence to treatment and decrease the quality of life (Begum et al. World J Surg 2022; 46(6) 1408-1419).

This case series highlights less commonly encountered psychiatric conditions that arise after surgery and emphasizes the importance of considering how these conditions interact with pre-existing diseases during postoperative follow-up.

This case series examines three distinct cases of psychiatric disorders following surgical interventions:

Delusional disorder after hypophysectomy

Somatization disorder after cystoscopy

Psychotic depression following colostomy creation

Informed consent was obtained from all patients.

Case 1

A 62-year-old male patient diagnosed with hypophyseal macroadenoma underwent transsphenoidal hypophysectomy. Two months after surgery, he developed paranoid delusions, believing his wife was having an affair. Initially treated with aripiprazole 15 mg/day, the patient did not improve. His treatment was switched to risperidone 2 mg/day, resulting in resolution of his symptoms.

Case 2

A 58-year-old male with benign prostatic hyperplasia (BPH) developed persistent groin pain after cystoscopy. Despite urological treatment, the pain did not subside, and he was referred to algology for gabapentin, which was ineffective. Referred to psychiatry, he reported pain radiating to his back and arms, worsened by stress, and trouble sleeping due to his pain. Diagnosed with somatization disorder, he was treated with olanzapine 2.5 mg/day and cognitive interventions, which led to decreased pain.

Case 3

A 72-year-old male patient with rectal cancer, following abdominoperineal resection and colostomy creation, began consuming other people’s medications. He exhibited disorganized behavior and suicidal ideation, and was diagnosed with psychotic depression. Treated with olanzapine 5 mg/day and venlafaxine 75 mg/day, his disorganized behavior resolved during follow-up, and olanzapine was discontinued. He remains in remission on venlafaxine 75 mg/day.

This case series illustrates the diversity of psychiatric conditions that can arise after surgical interventions and emphasizes the importance of postoperative psychiatric monitoring. Although there is a lack of sufficient studies on this topic, a postoperative follow-up study conducted with a group of 200 patients found that the risk of developing anxiety after surgery was 31%, and the risk of developing depression was 56% (Basak et al. Int J Surg 2015; 23 18-22). Psychiatric symptoms can complicate physical recovery, affect adherence to treatment, and reduce quality of life. A multidisciplinary approach is essential to support both physical and psychological recovery, ultimately improving the overall health status of patients.

None Declared

Aging leads to a progressive deterioration at the communicative level. The identification of language impairment in older adults could help to prevent or slow down the development of a possible neurocognitive disorder.

To evaluate psychopathological manifestations in language and communication by means of a psychopathological evaluation protocol in a control group of subjects matched by age and sex to a group of people with mild cognitive impairment.

The sample consists of twenty healthy older adults (75% female, 25% male) with mean age of 84.15 years (SD = 6.81). A descriptive and observational study was carried out. Subjects of both sexes between 70 and 95 years of age, with absence of possible cognitive impairment, were included. The Mini-Cognitive Examination was used to assess cognitive performance, the PRESEEA interview was used to obtain the speech sample and a psychopathological assessment protocol.

Increasing age is associated with greater intensity of language impairment (R2 = .02, p = .047). In the MEC-35 total score, the control group shows a significantly higher performance than the patient group (F = 49.11, p < .001). A negative correlation appears between the total score of psychopathological manifestations and the variables ‘educational level’ (R2 = .23, p = .029) and ‘socioeconomic level’ (R2 = .33, p = .007).

Anomia, perseverations, disintegrated language, concretism and paragrammatism are possible early indicators of cognitive impairment. The elaboration and application of both assessment protocols and speech therapy intervention programs in older adults may improve communication skills.

None Declared

Psychotic experiences (PEs) are subclinical symptoms of psychosis affecting about 10% of children and adolescents. They may cause significant distress and impair daily functioning. Moreover, when persisting over time they are more likely to result in psychotic disorders.

This longitudinal study aimed at assessing the effects of polygenic and environmental risk factors for schizophrenia on distressing and persisting PEs in a cohort of adolescents.

Data were obtained from participants of European ancestry derived from the Adolescent Brain and Cognitive Development Study, Release 5.1. Past-month PEs were assessed using the Prodromal Questionnaire-Brief Child Version. The primary outcome was distressing PEs at 3-year follow-up. Secondary outcomes included varying levels of persistence of distressing PEs, occurring in 1, 2, 3, or all 4 waves. Polygenic risk score for schizophrenia (PRS-SCZ) was calculated using the continuous shrinkage approach (PRS-cs). The exposome score for schizophrenia (ES-SCZ) was generated by summing up the weighted risk of nine environmental exposures across lifetime: emotional neglect, physical neglect, emotional abuse, physical abuse, sexual abuse, cannabis use, winter birth, hearing impairment, and bullying. Multilevel logistic regression was carried out to test the individual associations of PRS-SCZ and ES-SCZ with the outcomes; the relative excess risk due to interaction was calculated to determine the additive interaction between PRS-SCZ and ES-SCZ on distressing PEs. Main analysis was adjusted for age and sex as covariates; sensitivity analysis also included family income and parental education.

ES-SCZ was significantly associated with 3-year follow-up distressing PEs (OR 1.27 [95% CI 1.14, 1.43], p<.001) and lifetime distressing PEs at all degrees of persistence, with an increasing magnitude of association for a higher degree of symptom persistence (≥1 wave: OR 2.77 [95% CI 2.31, 3.31], p<.001; ≥2 waves: OR 3.16 [95% CI 2.54, 3.93], p<.001; ≥3 waves: OR 3.93 [95% CI 2.86, 5.40], p<.001; all 4 waves: OR 3.65 [95% CI 2.34, 5.70], p<.001). PRS-SCZ was significantly associated with distressing PEs persisting for more than one (OR 1.29 [95% CI 1.08, 1.53], p=.040) or two waves (OR 1.34 [95% CI 1.08, 1.65], p=.070) and also additively interacted with ES-SCZ for these outcomes (≥1 wave: RERI 1.26 [95% CI 0.14, 2.38], p=.027; ≥2 waves: RERI 1.79 [95% CI 0.35, 3,23] p=.015). Sensitivity analysis confirmed all main results.

PRS-SCZ and ES-SCZ showed independent and joint effects on distressing PEs. The more pronounced contribution of ES-SCZ on distressing PEs and its gradient effects on the degree of persistence calls for particular attention to environmental risk factors for schizophrenia on the development and persistence of PEs.

None Declared

Intercultural psychotherapy aims at an understanding of and translating between cultural differences which may be experienced between the psychotherapist and the client. This is especially important when considering that due to crisis, conflict and war, but also due to globalisation and increased mobility, an increased number of clients with a migration background seek to undergo psychotherapy. In this presentation, current literature on needs and challenges of intercultural psychotherapy is discussed with regard to an intersectionality framework and more specifically in the context of power and privileges. These frameworks provide a useful understanding of cultural competency and sensitivity in intercultural psychotherapy.

None Declared

Auditory verbal hallucinations (AVH) are prevalent in schizophrenia but also occur in bipolar disorder, yet differences in their phenomenology remain poorly understood. This ongoing study aims to fill this gap by comparing the phenomenological characteristics of AVH in schizophrenia and bipolar disorder.

The research questions we are interested in are:

• - The nature of hallucinations. We hypothesize that hallucinatory experiences in bipolar disorders is connected to the mood, for example mania.

• - We hypothesize that auditive verbal hallucinations in bipolar disorders will not have the immanent character as in schizophrenia and won’t be experienced in a pathologically altered private space.

• - We hypothesize that bipolar patients after a remission from the episode will consider their voices as a sign of disease whereas the patients with schizophrenia will continue to ascribe extraordinary meanings to their hallucinations.

Building on our prior research in schizophrenia, we are conducting semi-structured, phenomenologically oriented qualitative interviews with patients diagnosed with bipolar disorder who experience AVH. Participants are recruited from outpatient clinics and hospital wards in Denmark. Data will be analyzed using thematic analysis with a bottom-up approach.

Preliminary findings from our ongoing study will be presented.

A deeper understanding of AVH phenomenology in schizophrenia and bipolar disorder can lead to more accurate differential diagnoses, reducing the risk of misdiagnosis and ensuring that patients receive appropriate and timely treatment.

None Declared

Burnout is a set of experiences and symptoms which occurred in the context of stress and high ideals in the helping professions who feel drained, exhausted, tired, listless and unable to cope. Burnout leads to disengagement, blunted emotions, helplessness and hopelessness with feeling trapped causing detachment and depression. Prevention of burnout is important and includes interventions at policy, institutional and personal levels. These resources must include financial and human resources where appropriate; prompt and culturally acceptable help is available and easily accessible. Institutions must allocate sufficient funds for well-being of its staff. Various steps can be taken but perhaps most important is accessibility of services in a non-stigmatising manner. These services must be confidential, fit for purpose and widely advertised and accessible. Physical space to rest and access to affordable nutritious food are important. Access to occupational heath services or primary care are important.

Dinesh Bhugra

None Declared

Chronic medical conditions like hypertension may increase the risk of mental disorders such as anxiety and depression.

This study aimed to investigate if hypertension is associated with a higher incidence of major mental disorders, including anxiety disorders, depressive disorders, bipolar disorders, psychotic disorders, sleep disorders, vascular dementia, and Alzheimer’s dementia, compared to controls.

I analyzed standardized data from patients with hypertension (n = 48,466) and those without hypertension (n = 442,660) at a university hospital. Clinical data was standardized into a common data model. Using propensity score matching (PSM) at a 1:5 ratio, I compared the incidence of mental disorders between the hypertension and control groups over a 5-year period. A multivariate Cox proportional hazards model was used to estimate the risk of mental disorders, with hazard ratios (HR) and 95% confidence intervals (CI).

After PSM, the hypertension group had a higher prevalence of being elderly (over 60 years old) and having conditions like diabetes, hyperlipidemia, atrial fibrillation, cerebrovascular disease, and heart disease compared to controls. The hypertension group also had significantly increased use of antithrombotic agents, beta-blockers, calcium channel blockers, diuretics, acid-related disorder drugs, diabetes medications, lipid-modifying agents, and opioids. The incidence rates per 1,000 patient-years for mental disorders were as follows: anxiety disorders (7.22 vs. 4.49), depressive disorders (8.51 vs. 5.47), bipolar disorders (1.13 vs. 0.91), psychotic disorders (0.18 vs. 0.22), sleep disorders (16.32 vs. 8.60), vascular dementia (0.77 vs. 0.14), and Alzheimer’s dementia (9.29 vs. 2.53). Compared to controls, the hypertension group had a higher risk of developing vascular dementia (HR, 6.03; 95% CI, 4.34–8.44; p<0.01), Alzheimer’s dementia (HR, 3.89; 95% CI, 3.56–4.24; p<0.01), sleep disorders (HR, 1.96; 95% CI, 1.85–2.07; p<0.01), anxiety disorders (HR, 1.69; 95% CI, 1.56–1.83; p<0.01), and depressive disorders (HR, 1.64; 95% CI, 1.52–1.76; p<0.01). There were no significant differences for bipolar disorders (HR, 1.17; 95% CI, 0.95–1.43; p=0.12) or psychotic disorders (HR, 0.85; 95% CI, 0.51–1.34; p=0.50).

Hypertensive patients have an increased risk of major mental disorders, particularly vascular dementia, Alzheimer’s dementia, sleep disorders, anxiety disorders, and depressive disorders. Older age, age-related diseases, and various medication uses contribute to this increased risk.

None Declared

Our patients often come to us through wait-lists, but when does the wait really start? Early intervention psychosis programs have introduced policies and benchmarks aimed at minimizing the time between referral and first contact. While programs that meet these targets are often celebrated for their success in reducing untreated psychosis, these targets leave out a critical piece of the puzzle: the time elapsed from symptom onset. Understanding how patients and caregivers experience the wait for care in its entirety is critical to further reducing treatment delays in psychosis.

This presentation aims to first examine a disconnect between early intervention wait-list policies and patients’ experiences. Next, it will explore how patient and family member narratives reflect the complex and nuanced nature of waiting for care. Finally, it will propose clinically relevant solutions for reducing the delay between symptom onset and appropriate treatment.

We conducted individual semi-structured interviews with patients and caregivers accessing early intervention psychosis services across Canada. For this presentation, three interviews from different geographic and socio-cultural regions were selected for their distinct perspectives. We performed a two-reviewer narrative inquiry to derive emergent narratives about waiting for services.

Patient and caregiver experiences revealed two distinct waiting periods. Aside from the “wait-list” period between referral and first contact that is addressed by early intervention policies, participants noted experiencing a much longer initial waiting period, with narratives beginning at symptom onset. Participants described this period as an active, dynamic, frustrating, and often traumatic process that involves multiple ER visits and attempts at receiving care.

We propose formally distinguishing between two forms of waiting for services: passive waiting, which is the state of being on a wait-list, and active waiting, which begins at symptom onset and includes the complex struggle to receive stable care. Early intervention programs’ efforts to reduce passive waiting are important, but the high burden of active waiting suggests a need for larger efforts such as clinician education and systemic changes in how patients access healthcare. Reducing active wait times could truly transform how first episode psychosis is managed and improve outcomes for those in urgent need.

None Declared

Stigmatization and self-stigmatization remains an actual problem for patients with endogenous mental illnesses, as it is an obstacle to seeking psychiatric help. Taking this into account, it is necessary to develop effective psychosocial interventions aimed at reducing self-stigmatization and improving patients’ integration into society.

To identify the features of self-stigmatization in patients with schizophrenic spectrum disorders and, taking into account these features, to develop a program to reduce it.

30 patients with schizophrenic spectrum disorders (F20, F23, F25 according to ICD-10) were included in the study. The average duration of the disease was 13.5±3.2 years. Among them, 14 were males, 16 were females, and the median age of the patients was 42.21±10.36 years. To assess the severity of self-stigmatization and to determine its components, the “Questionnaire for assessing the phenomenon of self-stigmatization in psychiatric patients” (Yastrebov V.S., Mikhailova I.I., Yenikolopov S.N. et al., 2005) was used.

A rather high general level of self-stigmatization (1.20±0.57 points) was revealed in the studied patients, exceeding the average indices according to the mentioned questionnaire. The most pronounced were the indicators on the following scales: “Overestimation of inner activity” (1,61±0,67 points); “Overestimation of self-actualization” (1,48±0,78 points); “Willingness to distance from mentally ill patients in the social sphere” (1,44±0,72 points); “Violation of self-identity” (1,17±0,59 points). Taking into account the identified disorders, a program including psychoeducation, as well as art-therapeutic training based on the approach of Z. Russinova et al. “Anti-stigma photovoice Intervention” (2014) was developed and adapted for the Russian population. The psychoeducation included three sessions where the manifestations of mental disorders, their treatment, forms of psychiatric care, issues of stigmatization and its overcoming were discussed. The training included six sessions discussing the following topics: “My daily life”, “Health and illness”, “Me and others”, “Accepting help and giving help”, “My achievements and my possibilities”, and “The next chapter of my life”. Participants provided pictures according to the session topic and discussed personal experiences, their emotions and feelings. The sessions were held in a closed group, the number of participants from 8 to 12 people, and the duration of the session was 90 minutes.

The developed program contributed to the identification of resources that help in overcoming the disease and reducing self-stigma. The program can be used for patients in the initial stages of the disease and with a long-term course of the disease.

None Declared

Emetophobia, an intense and disproportionate fear of vomiting, is a chronic and debilitating condition characterized by the avoidance of situations or activities that may increase the perceived risk of vomiting. It is often accompanied by an overwhelming fear of losing control, becoming severely ill, or being perceived as repulsive by others. Treating emetophobia is particularly challenging, primarily due to the difficulties in implementing exposure-based interventions effectively. Data on the pharmacological management of emetophobia is limited, with only a few case reports in the literature suggesting potential benefits from selective serotonin reuptake inhibitors (SSRIs).

With this case report we aim to describe a case of emetophobia treated with an SSRI.

Description of a clinical case of a patient with emetophobia observed in a psychiatric outpatient consultation.

We present the case of a 21-year-old male with a one-year history of emetophobia. At the time of consultation, he was unemployed, having recently completed a computer engineering degree. He had no relevant past medical history and was not on any regular medication. The patient was referred for psychiatric evaluation after three years of psychotherapeutic treatment for generalized anxiety disorder. His anxiety symptoms worsened one year prior after an episode of vomiting, which triggered a fear of recurrence. This fear led to restrictive eating, resulting in a 10 kg weight loss over the preceding year (current weight: 63 kg), and significant social avoidance due to the fear of vomiting in public. Physical and neurological examinations revealed no abnormalities. Routine blood tests, urinalysis, and urine drug screening showed normal results. Given the limited efficacy of prior psychotherapeutic interventions, pharmacotherapy with escitalopram 10 mg daily was initiated. After one year of follow-up, the patient reported substantial improvement in anxiety symptoms and avoidance behaviors related to his fear of vomiting. He was able to resume normal eating patterns and gained 5 kg during this period.

This case highlights the potential efficacy of SSRIs, specifically escitalopram, in the treatment of emetophobia. After one year, the patient showed significant improvement, with the return of normal eating patterns and weight gain. While exposure-based interventions remain a cornerstone of treatment for specific phobias, pharmacological options like SSRIs can serve as a valuable adjunct, especially in cases with comorbid anxiety disorders. Further research is needed to better understand SSRIs’ role in managing emetophobia and refine treatment strategies for this complex condition.

None Declared

Autism is defined as a broad and complex neurodevelopmental disorder with alterations in behavioral and social communication aspects. Sensory symptoms also occur prevalently in autism spectrum disorder (ASD) and are present early in the etiology, however, little is known about the early developmental patterns of these symptoms (Mccormick et al. Autism 2016; 5 572-579). Among these various sensory-perceptual alterations, auditory hypersensitivity is a prevalent sensory alteration in the ASD population (Dunlop et al. Front Hum Neurosci 2016; 10 1-12), defined as excessive or abnormal sensitivity and distress to auditory stimuli that are evident in the individual’s behavioral reactions (Stefanelli et al. CoDAS 2020; 32 1-9). Furthermore, auditory hypersensitivity can trigger atypical reactions that can impact social and academic domains (Danesh et al. Audiol. Res 2021; 11 547-556).

This research aimed to identify the occurrence and describe the auditory hypersensitivity behaviors presented by children with Autism Spectrum Disorder.

This is a cross-sectional and descriptive study, composed of parents/guardians of 161 children diagnosed with ASD. The sample consisted of parents of children of both sexes, aged 4 to 12 years. Caregivers answered a sociodemographic form and reported on the presence or absence of auditory hypersensitivity and the behaviors presented by the child. The study was approved by the Ethics and Research Committee under opinion number: 5,862,943.

161 parents of children with ASD participated, who declared that 108 (67.1%) of the children had auditory hypersensitivity and 53 (32.9%) did not, with 83 (69.2%) of the children being male and 37 (30.8%) female. The most frequently reported behaviors were: difficulty sleeping (79.8%), difficulty concentrating (76.8%), put your hands over ears (74.8%), nervousness (74.6%), fatigue and stress (72%), and irritability (71.8%) in the presence of sound (Table 1).

Tabela 1. Comportamentos de hipersensibilidade auditiva na percepção de pais de crianças com TEA

Image 1:

The results suggest that there is a high prevalence of auditory hypersensitivity in children with autism spectrum disorder and that this symptom can have negative impacts on the individual’s quality of life.

None Declared

Pain has a significant impact on a person’s quality of life, limiting general activity (work, social interaction, problems with family relationships, hobbies/interests, self-care ability), contributing to the development of mental disorders such as depression and anxiety.

Our study aimed to determine the level of anxiety, depression, and functional disabilities caused by chronic pain among outpatients in order to further dynamic research of the long-term consequences.

The study group included 85 outpatients with chronic pain. As a part of psychiatric screening, the HADS depression and anxiety scale was used to study psychopathological symptoms. The WHO self-questionnaire WHODAS 2.0 was used to study the dysfunction caused by chronic pain.

The study found that a significant part of patients with chronic pain had symptoms of anxiety 38% and depression 46% of varying severity. The medial WHODAS 2.0 score among all patients with pain and patients with comorbid depression and anxiety was 23.62 (95% CI: 21.19-24.63), 32.80 (95% CI: 30.33-35.16), and 34.35 (95% CI: 32.11-37.60), respectively. Disability was significantly higher in patients with depression (1.72, p <0.01) and anxiety symptoms (1.60, p <0.01) than in patients with chronic pain without anxiety and depression.

Effective treatment of chronic pain requires a comprehensive approach using psychotherapeutic, psychopharmacological, and physical therapy.

None Declared

Schizophrenia is a severe mental disorder often diagnosed in early adulthood, significantly impacting quality of life and increasing mortality risk. Xanomeline-trospium (KarXT), a combination of a muscarinic cholinergic receptor agonist and a peripheral antagonist, offers a potential new approach.

We aimed to perform a systematic review and meta-analysis to assess the efficacy of KarXT compared to placebo in reducing the symptoms of schizophrenia.

We systematically searched PubMed, Embase, and Cochrane for randomized controlled trials (RCTs) enrolling patients with schizophrenia treated with KarXT versus placebo. Our outcomes included the overall improvement in schizophrenia symptoms, measured by the Positive and Negative Syndrome Scale (PANSS) total score, as well as specific symptom domains assessed by the PANSS positive and PANSS negative subscales. Additionally, the Clinical Global Impressions-Severity (CGI-S) score was used to measure the overall severity of the disorder. We computed mean difference (MD) with 95% confidence intervals (CIs) using R version 4.3.2. Heterogeneity was assessed using I² statistics.

Three RCTs were included with 640 patients, of whom 314 (49.1%) received KarXT. There were 509 males (79.5%) and 131 females (20.5%). The average body mass index (BMI) was slightly higher in the KarXT group (29.1) compared to the placebo (28.8). KarXT resulted in a greater decrease in the PANSS total score (MD: -9.74; 95% CI -12.40, -7.08; p<0.001; I²=0%; Figure 1A), PANSS positive (MD: -3.20; 95% CI -4.04, -2.36; p<0.001; I²=0%; Figure 1B), PANSS negative (MD: -1.55; 95% CI -2.28, -0.81; p<0.001; I²=22%; Figure 1C) and CGI-S score (MD: –0.60; 95% CI -0.75, -0.45; p<0.001; I²=24% Figure 2).

Image 1:

Image 2:

Our systematic review and meta-analysis of RCTs showed that KarXT is significantly more effective than placebo in reducing schizophrenia symptoms.

None Declared

Avatar therapy is a digital therapy supported by a therapist in which voice hearers dialogue with a digital embodiment of their most distressing voice. Our previous randomised controlled trial of AVATAR therapy showed 6 sessions had a superior and substantial reduction in the severity of voices compared to that achieved by supportive counselling. Limitations included that the study was carried out in a single site, and six sessions limited what might be achieved by an extended approach to include a greater focus on individual biographical characteristics that had a bearing on the voice hearing experience . In the latest AVATR2 trial, we aimed to replicate these early results and deliver therapy by a wider workforce across several centres in the UK. We also tested the effectiveness of two forms of therapy -AVATAR Brief 6 sessions (AV-BRF) and AVATAR-Extended 12 sessions (AV-EXT). In this presentation I report the results of this clinical trial. We hypothesised that both forms of therapy alongside treatment as usual would be effective and superior to treatment as usual alone in reducing voice related distress (the primary outcome) at 16 and 28 weeks follow up. We found that both treatmetns did indeed reduce distress at 16 weeks and that this reduction was maintained at 28 weeks though was no longer statistically significant in compoariuson to treatment as usual at this point. The frequency of voices also reduced at both time points for AV-EXT that also achieved several other important outcomes in cluding enhanced wellbeing and reductions in delusional beliefs associated with the voice. There were no related serious adverse events. A health economic analysis was also carried out that also supports AV-EXT The next phase of the development of AVATAR therapy towards release for routine use is briefly described.

T. K. J. Craig Grant / Research support from: Research Grants Wellcome Trust; NIHR UK

The Convalescence Unit provides semi-open inpatient care during the subacute phases of psychiatric illness, with the goal of restructuring and reorganizing the personality after a crisis or relapse.

The main objective is to observe the profile of patients admitted to the Convalescence Unit who could benefit from this type of resource.

A retrospective, observational study was conducted by collecting and analyzing data in 2019, which 61 patients were admitted in this resource. The profile of patients during the year 2019 was analyzed.

Of a total of 61 patients, 47 were referred from the Brief Hospitalization Unit (UHB), 11 from the Mental Health Team (ESM), and 3 from other facilities. By gender, there were 38 women and 23 men. The average age was 44.16 years. Regarding the type of admission, 29 were voluntary and 32 involuntary. Seventeen patients had been readmitted from previous years. The diagnoses were: 10 patients with bipolar disorder, 14 with schizophrenia, 6 with substance-induced psychosis, 2 with schizoaffective disorder, 10 with anxiety-depressive syndrome, 5 with dysthymia, 2 with obsessive-compulsive disorder, 7 with delusional disorder, and 6 with personality disorders. Of these patients, 58 received therapeutic discharge, 1 voluntary discharge, and 2 were transferred to other facilities. Regarding marital status, 43 were single, 7 married, 4 widowed, and 7 divorced. The average length of stay was 48.56 days.

As for the profile of patients admitted to the Convalescence Unit, it is not possible to determine a statistically significant pattern. However, we observed that most are women with severe mental health disorders. Notably, the majority are single, suggesting less family support, and a high percentage are admitted involuntarily, often from the UHB, to extend their stay for the management of subacute conditions in a more controlled environment. This helps ensure adherence to treatment, which is both difficult and crucial for a favorable outcome in these patients.

None Declared

It is well-established that medical students often experience health-related anxiety, a phenomenon commonly referred to as “medical student syndrome” in the literature. This condition is believed to arise from exposure to life-threatening diseases during medical training.

Health anxiety is characterized by excessive worry about having a serious illness, often leading to heightened distress and maladaptive health-related behaviors.

The aim of this study was to explore and compare health anxiety levels between preclinical and clinical medical students.

A cross-sectional, descriptive, and analytical study was conducted at the Sfax Medical School from March to June 2024. Medical students were invited to voluntarily complete a self-administered questionnaire, which collected socio-demographic data, lifestyle-related factors (such as substance use, physical activity, and medical history), and the Short Health Anxiety Inventory (HAI-18). The HAI-18 assesses the frequency and intensity of health-related worries and behaviors experienced over the past six months. The total score ranges from 0 to 54 and includes two subscales: the Health Anxiety subscale (items 1–14, range 0–42) and the Negative Consequences of Illness subscale (items 15–18, range 0–12). A score of 18 or higher on the Health Anxiety subscale indicates significant health anxiety.

A total of 285 students participated in the study, with a predominance of females (73.7%).

The mean age was 21.96 ± 2.05 years. Preclinical students constituted 31.9% of the sample, while clinical students comprised 68.1%. Most participants (91.9%) resided in urban areas, and 82.1% reported a moderate socioeconomic status. Additionally, 69.5% of participants were living with their families. A medical history was reported by 21.8% of the participants, while 17.2% had a history of psychiatric difficulties. Among these students, 5% had been hospitalized for a serious illness, for a prolonged duration or on multiple occasions.

Health-related anxiety was observed in 24.6% of participants. It was significantly associated with female gender (p = 0.045), a history of psychiatric difficulties (p = 0.004), and being a clinical medical student (p = 0.04). These factors were identified as key predictors of increased health-related anxiety levels.

Female gender, a history of psychiatric difficulties, and clinical medical training were identified as significant risk factors for health-related anxiety among medical students. These findings suggest the need for targeted interventions to address and alleviate anxiety in these high-risk groups, potentially improving both mental health and academic performance within medical training environments.

None Declared

Psychiatric hospitalization to manage acute symptoms of mental disorders in children and adolescents may be necessary, although there is a growing concern about the clinical and economic effectiveness of psychiatric admission in this population. This suggests the need for the implementation of new intensive family and community care models that would reduce hospitalization.

Home hospitalization provides an opportunity to offer the child or adolescent with intensive treatment within the infrastructure of their home and the supervision of their family or primary caregivers. It therefore requires fewer resources than traditional inpatient treatment while allowing the patient‘s immediate environment to be involved in the treatment, potentially reducing the risk of a failed transition to the home once the patient is discharged.

The main objective is to analyze the cost-effectiveness of two Mental Health Home Hospitalization interventions for adolescents as an alternative to traditional hospitalization in two hospitals in Madrid, Spain (La Paz University Hospital and Principe de Asturias University Hospital).

This is a quasi-experimental pre-post intervention study that examines two models of Mental Health Home Hospitalization as an alternative to full hospitalization. It will analyze various outcome variables, including clinical, functioning, satisfaction, quality of life, and costs /use of clinical resources.

Participants must be adolescents and young adults aged 12 to 18 years (inclusive), who present a psychiatric decompensation requiring an intensity of care similar to that provided in the hospital. Assessments, including CGI, HoNOSCA, C-SSRS, CSQ-8, EQ-5D-Y, will be conducted at the baseline visit, and at the end of the treatment. Resource use and costs will be recorded at the baseline and six months after the treatment.

Home-based mental health hospitalization for adolescents is an emerging area of interest in the treatment of acute symptoms of mental disorders in this population, but there are not standard protocols for such interventions. Several issues remain to be clarified, including the care pathways for adolescents in crisis who require hospital care and whether organizational differences between interventions impact the outcomes.

None Declared

Adolescents face significant stress, which can undermine their subjective health, often manifesting as psychosomatic symptoms. Perceived self-efficacy is a critical resource for resilience, potentially buffering the impact of stress on subjective health. While action self-efficacy indicates one’s perceived ability to set goals and take initiative, coping self-efficacy refers to one’s ability to achieve the goals. By investigating both components, researchers and mental-health professionals can better understand how different aspects of self-efficacy influence the stress-symptom relationship, providing a more nuanced view of coping mechanisms.

The aim of this study is to determine how these key components of self-efficacy - action self-efficacy and coping self-efficacy - moderate the relationship between stress and psychosomatic symptoms.

The analyses were based on the Hungarian contribution to the representative international Health Behaviour in School-aged Children (HBSC) survey, collected in 2021/2022. The study population comprised self-report data from high-school students (N = 3,410; mean age = 16.77 years). We examined the main effects of self-efficacy dimensions and perceived stress, and their interactions in explaining psychosomatic complaints, using linear regression analysis with Hayes’ PROCESS macro (Model 1) in SPSS. Age and gender were controlled for as covariates.

Coping self-efficacy: The overall model explained 33% of the variance in psychosomatic symptoms (R² = 0.33, F(5, 3404) = 330.96, p < .001). The results showed that stress (b = 1.93, p < .001), coping self-efficacy (b = 2.18, p = .02), and their interaction (b = -0.33, p = .002) were significant explanatory variables. This suggests that the relationship between stress and psychosomatic symptoms is weaker among adolescents who reported stronger coping self-efficacy. Action self-efficacy: In contrast, the interaction between stress and action self-efficacy was not significant (p = .16), implicating that the ability to set goals did not mitigate the effect of stress on symptoms.

The findings imply that coping self-efficacy significantly reduces the relationship between stress and psychosomatic symptoms. Adolescents with stronger coping skills are better equipped to mitigate the adverse effects of stress. However, action self-efficacy did not show a significant moderating effect, highlighting the distinct roles different self-efficacy components play in stress management. These results emphasize the importance of enhancing coping skills, such as cognitive reappraisal, in primary prevention interventions to reduce stress-induced psychosomatic symptoms.

adolescents, HBSC, psychosomatic symptoms, self-efficacy, stress

This study was supported by the Hungarian National Research, Development, and Innovation Office (K139265 and K143764).

None Declared

Adult Attention Deficit Hyperactivity Disorder (ADHD) has been recognized as a condition with profound psychosocial implications, including a higher likelihood of encountering legal problems.

To characterize temperamental characteristics and risk factor for legal problems in a group of ADHD patients.

The study involved patients (>18 years) from the adult ADHD outpatient service of the Psychiatric Clinic of Ancona.ADHD was diagnosed using the Diagnostic Interview for ADHD in adults (DIVA5.0). The following rating scale were administered: Temperament Evaluation in Memphis, Pisa and San Diego(TEMPS-M), Coping Orientation to the Problems Experiences-new Italian version (COPE-NVI), Temperament and Character Inventory-Revised (TCI-R).

76% (n=170) of screened patients were diagnosed with ADHD in adulthood. Among them, 10.2% (n=17) reported legal problems. Men with ADHD were more likely to have legal issues (χ²=7.851; p=0.005). These patients often reported school failures(χ²=3.033; p=0.082) and being tutored by a support teacher(χ²=15.165; p<0.001). Legal issues were more common in those with a childhood diagnosis of ADHD (χ²=4.880; p=0.027) and in those who were admitted to a psychiatric ward (χ²=7.205; p=0.007).Additionally, those who smoked (χ²=6.695; p=0.035) or used substances (χ²=16.399; p<0.001) had more legal issues. Higher use of cannabinoids (χ²=14.311; p<0.001) and stimulants (χ²=12.445; p<0.001) in those who had legal problems are also reported. Generally, those with legal problems have lower schooling (p=0.005), more high school failures (p=0.047), smoke more cigarettes per day (p=0. 008) and have higher scores in the problem-solving subscale of the COPE-NVI (p=0.024), the ambitious subscale of the TCI-R (p=0.058), and the self-transcendence subscale of the TCI-R (p=0.078) and lower mean score in the self-acceptance subscale of the TCI-R (p=0.054). Logistic regression analysis showed to ascertain the effects of all TCI-R subscales, on the likelihood of developing legal problems. The logistic regression model was statistically significant, ▫▫2(1)=4.020, p=0.045. The model explained 14.6% (Nagelkerke R2) of the variance in patients with ADHD who have legal problems and correctly classified 91.9% of cases.Having legal problems was significantly predicted by TCI-R spiritual acceptance subscale (exp(B)=1.150, p=0.045).

The study highlight the significant psychosocial burden of ADHD in adulthood, particularly the increased likelihood of legal problems.Key risk factors include lower educational attainment, substance use, and specific temperamental traits, such as elevated problem-solving and self-transcendence tendencies, alongside lower self-acceptance.

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Huntington’s disease (HD) is a hereditary neurodegenerative disorder characterized by motor, cognitive, and psychiatric symptoms. Initially, the patient’s involuntary movements were attributed to anxiety-related restlessness and psychomotor agitation, leading to a diagnosis of anxiety disorder. During hospitalization, the patient was referred to neurology for his movements, where functional movement disorder was considered. However, due to worsening cognitive decline, apathy, and the psychiatrists’ suspicion that the movements were not functional, further investigations were conducted. Cranial MRI, followed by a dementia protocol MRI, revealed caudate nucleus atrophy, leading to the diagnosis of HD.

To illustrate the diagnostic challenges in identifying Huntington’s disease in a patient initially misdiagnosed with anxiety disorder and functional movement disorder.

A 58-year-old male presented with anxiety and involuntary movements, leading to initial diagnoses of anxiety disorder and functional movement disorder. As symptoms progressed—including worsening involuntary movements and cognitive decline—a comprehensive reassessment was conducted. This included neurological examination, neuroimaging, neuropsychological testing, and genetic testing via blood test for CAG repeat analysis.

Cranial MRI revealed bilateral caudate atrophy and dilated lateral ventricles, consistent with Huntington’s disease. Neuropsychological assessment showed significant impairments in verbal learning, memory, and executive function. The patient was treated with venlafaxine 150 mg/day, mirtazapine 30 mg/day, and haloperidol 6 drops/day, leading to significant improvement in anxiety symptoms and a reduction in chorea.

This case underscores the importance of considering neurodegenerative disorders such as Huntington’s disease in the differential diagnosis of patients presenting with psychiatric symptoms and involuntary movements. Early identification, comprehensive assessment, and a thorough understanding of HD’s clinical presentation are crucial for appropriate management.

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