Obesity and weight gain are major clinical problems for people with severe mental illness (SMI), such as schizophrenia and bipolar disorder. While psychopharmacological treatment, particularly with atypical antipsychotics and mood stabilisers, is the ‘core’ of treatment for these disorders, it can increase the risk of overweight/obesity, metabolic and cardiovascular disease. Most guidelines on how to manage overweight and obesity in these patients share an initial conservative approach. These guidelines include diet, physical activity, lifestyle coaching and behaviour modification. Only then are pharmacological or, eventually, surgical treatments added.

This study evaluated the effectiveness of a group behavioural weight management program in a real Italian outpatient setting.

100 patients diagnosed with schizophrenia or bipolar disorder who participated in a group weight management program were followed up for 12 months. The intervention consisted of 8-week training in which patients received nutritional and lifestyle coaching in groups of 10. Weight, BMI, waist circumference, blood glucose and blood pressure were measured at 0, 6 and 12 months.

Mean body weight (kg) decreased from 98.01±18.30 at baseline to 93.29±17.36 at 6 months (p>0.001) and to 90.35±17.90 at 12 months. There were also statistically significant reductions in BMI, waist circumference, blood glucose and systolic blood pressure. There was no significant reduction in diastolic blood pressure. After segmenting the patients at baseline according to their initial body weight (normal weight, overweight and obese according to the World Health Organisation), a statistically significant difference in weight only occurred between baseline and the first 6 months of follow-up, suggesting that the programme was successful in the short term and that the results were maintained over the following 6 months.

Despite the study’s limitations, the intervention demonstrated feasibility in an outpatient setting, a high retention rate with no drop-outs during the programme, and significant weight loss in the first six months, followed by long-term maintenance at the end of the study. Current NICE recommendations suggest that people with SMI, particularly those receiving antipsychotic treatment, should receive integrated diet and exercise programmes. Future research should focus on the cost-effectiveness of this type of intervention and its reliability in the medium and long-term in different health care settings.

None Declared

Violence against women is a significant public health issue with devastating consequences for victims. It’s a complex and often hidden phenomenon rooted in deep-seated gender inequalities. Faced with distress and trauma, some victims may develop self-medication behaviors, such as substance use.

This descriptive study aims to characterize the experiences of violence among 53 women who sought help from the ATL, MST SIDA, and ATIOST associations.

Data was collected through individual interviews with each of the 53 participants. An interview guide was developed to cover different types of violence (physical, psychological, sexual, economic), their frequency, intensity, and their consequences on substance use, using the DUDIT questionnaire.

The sample consisted of women with an average age of 36.04 ± 10.31 years, ranging from 18 to 58. The results show that all participants experienced multiple and recurrent forms of violence, primarily psychological (insults, denigration, control, isolation) and physical (hits, slaps, threats). Sexual violence, although less frequently reported, was also identified in 32%. The most common type of violence was physical (77%), mainly occurring within the couple (49%). 72% of women presented a substance use disorder. The most commonly used substances were cannabis (53%), followed by benzodiazepines (41%), and pregabalin in third position (36%).

This descriptive study highlights the complexity of the experiences of violence faced by women seeking help from harm reduction associations. The results underscore the urgent need to address this issue and develop tailored responses to the specific needs of these women. Future research could explore in greater detail the risk and protective factors associated with violence against women, as well as the long-term effects of this violence on mental and physical health.

None Declared

Affective temperament is associated with various clinical characteristics in patients with mood disorders. However, little is known about clinical characteristics based on affective temperament specifically in patients diagnosed with major depressive disorder (MDD).

This study aims to explore the impact of affective temperament on both the traits and states of individuals diagnosed with MDD.

This study consecutively recruited 247 outpatients, aged 18 to 49, presenting for their initial visit to a mood disorder clinic. Affective temperament was assessed using the Temperament Evaluation of the Memphis, Pisa, Paris and San Diego-Autoquestionnaire. A Z-score of 1 or higher on each affective temperament was defined as a dominant affective temperament. The patients completed various assessments, including the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Seasonal Pattern Assessment Questionnaire, Alcohol Use Disorders Identification Test, Hypomania Checklist-32, Interpersonal Sensitivity Measure, and Depressive Symptom Index - Suicidality Subscale. Multiple linear regression analysis was conducted to identify the impact of affective temperament on both psychiatric states and trait characteristics.

This study comprised 247 patients with a mean age of 29.34 ± 9.16, of whom 152 (61.5%) were female. Depressive (β = 0.247, p < 0.001) and irritable temperament (β = 0.138, p = 0.032) were positively associated with the severity of depressive symptoms, while hyperthymic temperament (β = -0.123, p = 0.041) showed a negative association. Furthermore, depressive (β = 0.246, p < 0.001), irritable (β = 0.195, p = 0.002) and cyclothymic temperament (β = 0.148, p = 0.018) were positively associated with the severity of anxiety symptoms. Cyclothymic (β = 0.211, p = 0.001) and anxious temperament (β = 0.136, p = 0.027) were positively correlated with seasonality. Hyperthymic temperament showed a positive correlation with harmful drinking patterns (β = 0.179, p = 0.006). Also, hyperthymic (β = 0.200, p = 0.002) and cyclothymic temperament (β = 0.140, p = 0.036) were positively correlated with hypomanic features. Cyclothymic (β = 0.255, p < 0.001) and anxious temperament (β = 0.173, p = 0.004) were positively correlated with hypersensitivity to interpersonal rejection. Depressive temperament (β = 0.184, p = 0.004) was positively associated with the severity of suicidality.

Among patients with MDD, variations in psychiatric states and traits were observed based on the dominant affective temperaments. This suggests a correlation between affective temperaments and diverse psychopathological manifestations. Consequently, there appears to be a need for further research to elucidate the therapeutic implications associated with affective temperaments.

None Declared

There exponential rise in prescribing SSRIs and antipsychotic medication have highlighted the paucity of shared decision making, holistic therapies and weight management programmes. Guidelines are vague about checkpoints and deprescribing, seeming to ignore the metabolic consequences, failing to advocate for physical health monitoring.

We undertook a retrospective analysis of (n =492) patients initiated on psychotropic medication to understand the physical consequences, assessing the metabolic consequences of long-term prescribing of psychotropic medication in a rural primary care population.

Electronic patient records were analysed from depression and serious mental health registers across three primary care sites. Data collected included the start date of treatment, BMI measurements before and after treatment.

Among the 220 patients studied, 150 (67.7%) experienced weight gain, while 70 (31.8%) lost weight. The average treatment duration was 11.5 years. Weight gain was more prevalent among males (71.6%) compared to females (66.7%). Patients who gained weight were, on average, prescribed cumulatively more psychotropic medications (3.21) than those who lost weight (2.89).

Shared decision making and acknowledgement of the metabolic consequences of these medications at the point of initiation, and identification of pre-existent metabolic risks, monitor weight gain, and ensure adequate life-style changes to mitigate side effects. These methods should continue throughout the duration of treatment, and when possible, the option of deprescribing should always be available to the patient. It is time care bundles for patients with mental health illness are resourced for primary care.

None Declared

Delusions and hallucinations can appear in various psychiatric and neurological pathologies. When these psychotic symptoms are of late onset, in geriatric age, it may be necessary to make a differential diagnosis between dementia or other psychiatric disorders.

To describe the differential diagnosis between dementia and delusional disorder.

Review of the scientific literature based on a relevant clinical case.

70-year-old woman who lives with her husband. She has two independent daughters. History of a depressive episode in her youth related to her husband’s gambling addiction. She attended the emergency department due to behavioural alteration at home with verbal heteroaggressiveness towards her sister and several neighbours. At the hospital she was approachable, with some psychomotor restlessness, reporting that a neighbour wanted to harm her and spoke of her, making delirious interpretations of harm and referring to visual hallucinations in the form of animals in the courtyard of her house. A brain CAT scan was performed, with normal results.

Her family reports that for about a year she has been saying incoherent things on occasions and behaving strangely. It was decided to admit her to the acute care unit.

During hospitalisation she didn’t present behavioural alterations. Treatment with risperidone was introduced with adequate tolerance and response, with distancing of the delusional ideation of harm. MOCA test was performed: 23/30 (suggestive of cognitive impairment), so PET-CT was requested with results not suggestive of neurodegenerative disease and neurodiagnostic tests (SCIP-S and BCSE); the results indicate heterogeneous cognitive performance, and no global cognitive impairment could be observed at the present time and a repeat assessment was recommended in one year’s time. Due to the results of the tests and the decrease in positive symptomatology with antipsychotic treatment, a diagnosis of delusional disorder was made upon discharge.

None Declared

Fahr’s Syndrome is a rare disorder characterized by abnormal brain calcium deposits presenting as extrapyramidal signs, cognitive impairment, movement disorders, and psychiatric symptoms. Though well documented in association with hypoparathyroidism, its presentation secondary to pseudohypoparathyroidism (PHP) is exceptionally unusual.

To report a rare neuropsychiatric presentation of Fahr’s Syndrome secondary to PHP.

We report this rare case following the CARE Case Report guidelines.

A 25-year-old female was admitted to the neurology ward after a referral from the Psychiatry clinic for dysarthria, involuntary movements affecting gait and daily activities, worsening psychomotor slowing for five years & depressive symptoms for around a year. She had difficulty controlling anger for 2.5 years & 2 impulsive attempts at self-harm in the past 6 months with no suicidal intent in which she tried to slash her wrist & jump off the rooftop over verbal confrontations with family (Image1).

Neuroimaging revealed bilateral, symmetrical calcifications in basal ganglia, thalami, red nuclei, the gray matter of bilateral occipital and frontal lobes, and cerebellar hemispheres (Image 2). Image 3 shows MRI Brain (with contrast) axial section images: Altered hyperintense signals in bilateral basal ganglia & red nuclei of midbrain on T1WI, hypointense signals on T2/FLAIR, and Blooming artifacts on SWAN images.

She was diagnosed with PHP based on hypocalcemia, hyperphosphatemia, high intact parathormone (PTH), and normal Serum Vitamin D levels. The absence of Albright’s Hereditary Osteodystrophy (AHO) phenotype and normal thyroid profile suggested PHP-type 2/1B but we couldn’t perform the Ellsworth Howard test to distinguish due to the unavailability of synthetic PTH. She was treated with oral calcium supplements, oral active vitamin D (CALCITRIOL or 1, 25-DIHYDROXYCHOLECALCIFEROL), CALCIUM ACETATE, AMANTADINE, ALFACALCIDOL, and ESCITALOPRAM leading to significant improvement in depressive symptoms, and normocalcemia at one-year follow-up.

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The diagnosis and management of rare neuropsychiatric syndromes maybe challenging in low-resource settings and timely diagnosis and management necessitate looking beyond the mind-body dualism and ensuring a multidisciplinary approach. Our patient’s neurological features were overlooked at a specialist mental healthcare facility for 5 years which accentuates the significance of thorough neurological assessment during psychiatric evaluations and of incorporating neuropsychiatry and psycho-neuro-endocrinology into the training and practice of psychiatry and neurology in Pakistan. This case also provides insights into the economic barriers to the management of neuropsychiatric disorders in a lower middle-income country (LMIC), where high out-of-pocket expenditure on treatment may result in loss of follow-up.

None Declared

Chronic insomnia is prevalent in secondary care mental health populations and is associated with emotional distress, interpersonal impairment and reduced quality of life. In addition, it contributes to the aetiology of major mental health conditions and substance use. CBT for insomnia (CBTi) is a well-established evidence-based treatment approach for chronic insomnia and is recommended as the first-line treatment for adults in the UK by National Institute for Health and Care Excellence (NICE). Despite this, CBTi is not accessible for most secondary care mental health patients and therefore few benefit from this intervention.

To examine the feasibility and effectiveness of a 6-week group CBTi programme for people using secondary care mental health and addictions services with chronic insomnia, using a case series design.

Each participant underwent an initial screening assessment to evaluate their suitability for the programme, the nature and impact of their sleep problem, and exclude other causes of insomnia. Self-reported measures of insomnia, personality functioning and depression were examined pre- and post-intervention using the Pittsburgh Sleep Quality Index (PSQI), Level of Personality Functioning Scale (LPFS) and Patient Health Questionnaire-9 (PHQ-9) respectively. PSQI was also re-assessed at 3-months’ follow-up.

Of 42 people referred to the service (26 from mental health and 16 from addictions services), 25 attended baseline assessment, 19 started the group and 12 completed sessions. The most common primary diagnoses were Alcohol Use Disorder (n=8), Treatment Resistant Depression (n=5), Bipolar Affective Disorder (n=3) and Personality Disorder (n=3). There were 9 men and 16 women. The severity of sleep disturbance was high with a cohort average PSQI of 15.4 (s.d. 2.7, range 12-20). Additionally, the level of personality functioning was high (mean 31.0, s.d. 7.6 range 13-45) as well as depressive symptoms (PHQ-9 cohort mean 18.0, s.d. 5.5, range 7-26).

Among the completers, cohort mean PSQI score decreased from 14.1 to 12.0 (p=0.12). Of 10 patients with 3-month follow-up data, there was a relative reduction of 20.3% from baseline, to a cohort mean PSQI score of 11.5 (p=0.16). At 3-months other facets of sleep quality like total sleep time had improved in the cohort by 45 minutes, and onset latency reduced by 35 minutes. Post-group there were also reductions in cohort mean LPFS scores by a relative 10.3% (31.4 at baseline to 28.3 post-group, and in cohort mean PHQ-9 by 14.8% (16.4 to 13.8).

Group CBTi is a potentially scalable and feasible intervention that effectively treats chronic insomnia, depression and personality dysfunction in secondary care mental health and addictions populations. Further research should focus on replicating these findings in larger cohorts, and examine factors associated with uptake and completion of CBTi.

None Declared

Lumateperone, an atypical antipsychotic drug approved in 2021 for bipolar depression, has a dual mechanism of action by combination of activity at central serotonin (5-HT2A) and dopamine (D2) receptors. In India, Quetiapine is one of the approved drugs for use in depressive episodes for bipolar disorder.

This post-hoc analysis of an Indian Phase 3 study was conducted to evaluate the correlation of severity of depression assessed via Montgomery-Asberg depression rating scale (MADRS) and quality of life assessed via Quality-of-life enjoyment and satisfaction-short form questionnaire (Q-LES-Q-SF) when treated with Lumateperone 42mg or Quetiapine 300mg.

The phase-III, randomized, multi-centric, assessor-blind, parallel-group, active-controlled, comparative, non-inferiority study included patients with Bipolar II depression with moderate severity having a MADRS score ≥20 and Clinical global impression–bipolar version–severity (CGI-BP-S) score ≥4. The study was conducted after receiving regulatory and ethics committee approvals. The patients were randomized (1:1) to either receive Lumateperone 42mg [Test] or Quetiapine 300mg [Comparator] for 6 weeks. In this post-hoc analysis, correlation between MADRS and Q-LES-Q-SF were evaluated and for safety outcomes treatment emergent adverse events (TEAEs) were assessed. [Clinical trial registration: CTRI/2023/10/058583]

This post-hoc analysis included 462 patients [231 each in Test and Comparator]. The baseline demographic characteristics were comparable in between treatment arms. The Pearson’s correlation coefficient between change from baseline in MADRS score and Q-LES-Q-SF score was statistically significant for both treatment arms at Day 42 [Test: -0.192, p=0.0043; Comparator: -0.299, p<0.0001] and the linear regression between 2 arms was not statistically significant (p=0.0853), indicating weak negative correlation between the 2 scales [Figure 1 and Figure 2]. The incidence of TEAEs were similar in both treatment arms [Test: 34.6%; Comparator: 35.5%] and no serious adverse events were reported.

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This post-hoc analysis demonstrated that patient with Bipolar II depression when treated with Lumateperone 42mg or Quetiapine 300mg, the reduction in MADRS score is inversely proportional to Q-LES-Q-SF score.

A. Dharmadhikari: None Declared, P. Chaurasia: None Declared, Y. Patel: None Declared, D. Choudhary: None Declared, P. Dasud: None Declared, M. Bhirud: None Declared, P. Meena: None Declared, F. Shah: None Declared, G. Ganesan: None Declared, B. P. Rathour: None Declared, K. Mistry: None Declared, M. Dutta: None Declared, A. Ramaraju: None Declared, S. G. Goyal: None Declared, S. Mangalwedhe: None Declared, G. Kulkarni: None Declared, A. Mukhopadhyay: None Declared, P. Chaudhary: None Declared, G. T. Harsha: None Declared, M. Parikh: None Declared, S. Dey: None Declared, S. Sarkhel: None Declared, N. Jyothi: None Declared, A. Kumar: None Declared, N. Sooch: None Declared, S. Saha Employee of: Sun Pharma, A. Shetty Employee of: Sun Pharma, P. Devkare Employee of: Sun Pharma, A. Shetty Employee of: Sun Pharma, D. Patil Employee of: Sun Pharma, P. Ghadge Employee of: Sun Pharma, A. Mane Employee of: Sun Pharma, S. Mehta Employee of: Sun Pharma

Schizophrenia is a chronic psychiatric disorder with a complex and diverse pathology (Owen et al. 2016). Currently, the main form of treatment is antipsychotic therapy (AP), which involves the use of either oral antipsychotics (OAP) or long-acting injectable antipsychotics (LAIs) (Stępnicki et al. 2018). Although it affects only about 1% of the population, schizophrenia represents an important socioeconomic problem. The employment rates among individuals with schizophrenia are notably low, with only 10–30% maintaining employment, while approximately 80% are reliant on disability pensions (Holm et al. 2021).

The aim of the study was to analyse the association between early administration of LAIs and the socioeconomic status in patients with long lasting schizophrenia and compare the differences between female and male patients.

This is a retrospective clinical study. We collected socioeconomic and sociodemographic data on all individuals and reviewed each patient’s medical history from their first hospitalization up to the study period. Then we analysed the data. The inclusion criteria were ages from 18 up to 65 years, the diagnosis of schizophrenia or other psychotics disorders for at least 5 years, use of AP therapy for at least 5 years and current use of LAIs for at least 6 months. Exclusion criteria included the diagnosis of treatment-resistant schizophrenia, or the diagnoses classified under F70–79 in the ICD-10 classification.

From the sample of 100 patients, the ones with early initiation of LAIS, within 2 years of onset of disease, had statistically higher rates of employment than those with late initiation of LAIs (p=0,04). We could not prove that the rate of employment was higher among early initiation female patients (p = 0,825), but we could for the male patients (p = 0,005) (Image 1). Meanwhile we couldn’t prove the same for financial independence (p = 0,398), also there was no statistically significant result based on sex (p = 0,367, p = 0,692).

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Results suggest that patients with earlier initiation of LAIs have higher rates of employment. The difference between sexes (Image 2 and 3) is also an interesting part of the study as it shows that female patients have a later onset than male patients and therefore receive the first does of LAIs at a much older age than men, which could be influencing the higher rate of unemployment and insufficiency among female patients.

None Declared

Previous results show that women who suffered from perinatal depression (PND) have a higher risk of suicidal behavior. However, clinical tools for predicting suicidal behavior among patients with PND are lacking.

To develop a prediction model for suicidal behavior after PND using machine learning.

Leveraging nationwide Swedish register data, we included 57,848 women with PND diagnosed during 2001-2018 and identified 2,303 events of suicidal behavior up to 5 years after PND diagnosis. Based on our previous association studies, 16 predictors containing information on demographics and pregnancy characteristics were included after multiple imputation. The sample was randomly split into 80% as a training set and 20% for testing. Classification and Regression Tree (CART), Random Forest (RF), Naïve Bayes (NB) and Logistic regression (LR) were used to establish prediction models with area under the curve (AUC) assessed for prediction performance. 10-fold cross-validation was used to evaluate the algorithms on unseen data.

In the prediction models, the CART yielded the best performance for suicidal behavior within 5 years after PND diagnosis (AUC 0.78, 95% CI 0.76-0.81). The population that scored highest (17%) in CART model had 84% risk of suicidal behavior. LR also had a comparable performance (AUC 0.78, 95% CI 0.76-0.81), whereas RF (AUC 0.74, 95% CI 0.72-0.76) and NB (AUC 0.70, 95% CI 0.68-0.72) had relatively poor performance. Notably, suicide history was a main contributor in all four models. Other predictors like household income, gestational age and education level were also important indicators of suicidal behavior risk.

The machine learning models have promising prediction performance for suicidal behavior after PND. Yet, further improvement is needed before clinical implementation.

None Declared

Major Depressive Disorder (MDD) is one of the most common psychiatric conditions, while cannabis is the most widely used illicit drug globally. Both MDD and Cannabis Use Disorder (CUD) hold significant epidemiological and health implications. Emerging evidence suggests a co-occurrence between cannabis abuse, dependence and depression, though studies remain limited.

To estimate the percentage of individuals with CUD who have comorbid MDD and those with MDD who have comorbid CUD.

PubMed, SciELO, and Google Scholar were searched using keywords: ((abuse, cannabis[MeSH Terms]) OR (cannabis dependence[MeSH Terms])) AND ((depressive disorder, major[MeSH Terms]) OR (depressive disorder[MeSH Terms])). Original articles in English or Portuguese were included. Data collection followed PRISMA, MOOSE guidelines, and JBI critical appraisal. The final sample included 53 articles: 36 for the first meta-analysis and 17 for the second. A heterogeneity test (Q test) and "leave-one-out meta-analysis" were used. Prevalence rates were aggregated using random-effects models. Meta-regression and sensitivity analyses were conducted.

MDD showed a high prevalence among individuals with CUD, at 31.12% (95% CI: 25.71% to 36.80%). Prevalence was not significantly influenced by year, age, gender, population type, assessment period, region, or diagnostic criteria. CUD prevalence among those with MDD was 10.95% (95% CI: 7.08% to 15.53%), with higher rates in men and younger individuals. CUD prevalence appears to be increasing over time, though population type and assessment period did not significantly affect overall prevalence.

This meta-analysis reveals a high prevalence of MDD among individuals with CUD and a significant prevalence of CUD among those with MDD, confirming a strong comorbidity. Cannabis use may exacerbate depressive symptoms, while those with MDD are at higher risk of developing CUD. Age, gender, and geographical factors influence this relationship. With increasing cannabis use, particularly among younger populations, the CUD-MDD comorbidity presents a growing public health issue. Further research is needed to explore the longitudinal link between these disorders.

None Declared

COVID-19 has had a major impact on public health globally, prompting mass vaccination campaigns to curb virus transmission and severe disease outcomes. Vaccination uptake among young adults, including university students, plays a crucial role in achieving herd immunity. However, perceptions about vaccine safety, effectiveness, and necessity influence vaccination rates and acceptance.

Assessing the prevalence of COVID-19 vaccination among students at the Higher Institute of Technological Studies in Ksar Hlel, Tunisia, and exploring their perceptions regarding vaccination, including willingness to receive future doses and attitudes toward vaccine mandates.

This is a cross-sectional descriptive study conducted from the 6th to the 15th December 2021, involving a sample of students from the Higher Institute of Technological Studies (ISET) in Ksar Helal, Tunisia, using a pre-established questionnaire. Data entry and statistical analysis were performed using SPSS software, version 22.

Our sample consists of 315 students, of whom 43.5% were aged between 18 and 20, and 42.9% were in their first year. The sex ratio was 0.53. Ninety-nine students (31.4%) had contracted COVID-19, with 76 rapid or PCR tests (24.1%) conducted. COVID-19 had affected 190 of the students’ family members (60.3%). COVID-19 vaccination coverage among the students was 76.8% (242 students). Among the vaccinated, 135 students (55.8%) received one dose, and 107 (44.2%) received two doses. Regarding the reasons for vaccination, 183 students (75.6%) accepted the vaccine to prevent transmitting COVID-19 to their family or friends, 179 students (74%) to protect themselves from the virus, and 152 (62.8%) to help end the COVID-19 pandemic. Adverse effects from vaccination were reported by 86% of students (208) including headaches (97.9%), arm pain (68.4%), and fever (58.3%). In our sample, 202 students (64.1%) were convinced of the benefits of vaccination, while 176 (55.9%) opposed mandatory vaccination, and 228 (72.4%) were against receiving a third dose. Among the unvaccinated students, 11 (15.1%) expressed confidence in the vaccination and indicated willingness to get vaccinated in the future.

The study reveals a high prevalence of COVID-19 vaccination among students, with a majority expressing confidence in the vaccine’s benefits. However, there is notable resistance to mandatory vaccination and additional doses, indicating mixed perceptions and lingering concerns.

None Declared

In 1975 Clozapine was retired after 16 cases of severe neutropenia, with a mortality of 50%. It wasn´t until 5 years later when its effectiveness in treatment resistant schizorenia, with a mandatory hematological follow up.

In studies available we find that clozapine treatment is related to neutropenia and not leukopenia. In the case we present below neutrophils are within range, but it´s lymphocytes that are affected.

We hope that our expirience, and review can help other professionals in the future who find themselves in this situation.

We used the Pubmed and Uptodate databases.

We present the following clinical case.

Male, 36 years old, with a diagnosis of Schizophrenia. Several admissions to the Acute Unit over the years, requiring treatment with ECT. Maintenance treatment with Olanzapine, with which he maintained some delirious ideation and tendency to isolation. He was admitted again in 2023 due to a destabilization of his pathology, presenting delusions of harm, persecution, self-referentiality, auditory hallucinations, imperative phonemes, etc. with important affective and behavioral repercussions. Several pharmacological treatments were tried (Olanzapine, risperidone, aripiprazole), finally the patient showed some improvement with Lurasidone although his functionality was still impaired.

It was decided to start treatment with Clozapine, to minimize the psychotic symptoms, after a hemogram study, which was normal.

During the weekly follow-up of the treatment, a decrease in lymphocytes was observed, with normal neutrophils. The treatment was proving to be ineffective, so it was decided to continue in this line.

Seven months after starting the treatment, the patient suffered a catarrhal process, and once resolved, we observed in addition of the lymphopenia, anaemia and grade 2 neutropenia in the hemogram. Succeeding a consult with hematology specialist we decided to stop the treatment.

The week following the suspension of the treatment, the hemogram normalizes, but the psychotic symptomatology worsens (inability to relate to others, thought blocks, etc.). Taking into account that the blood alterations occured after a cold, and the mental deterioration that the patient presented, it is agreed with the family and the patient to restart the treatment. Wich resulted in improvement of the psychotic symptoms but a new leukopenia due to a slight lymphopenia is observed again.

The average time described for the resolution of severe neutropenia is 12 days. In our case, the hemogram started to improve by the fifth day following the suspensión of the treatment. As it is an infrequent side effect, we do not have studies on the effects of lymphopenia secondary to Clozapine.

We decided to mantein the Clozapine treatment due to the great improvement of the patients quality of life.

Currently he is taking Clozapine 75mg a day and remains stable.

None Declared

The use of artificial intelligence (AI) in suicide risk assessment is gaining prominence as AI algorithms are capable of processing and analyzing large volumes of data quickly. Suicide risk assessments are traditionally carried out by psychiatrists and clinical psychologists following established protocols, but AI systems can provide valuable support in this area, particularly in prevention and faster detection. Based on the collected data, AI algorithms can create predictive models that identify individuals at the highest risk. These models can take into account previous mental health disorders, suicide attempts, and other social or economic factors.

The aim of our study was to test a suicide prediction model using an XGBoost machine learning tool.

We included 357 individuals, out of which 146 were psychiatric patients with a history of suicide attempts in their anamnesis, 154 were psychiatric patients without a history of suicide attempts, and 57 individuals formed the sine morbo control group. Initially, 71 individuals (test dataset) were randomly selected from the total 357, and the remaining sample (training dataset) was used to train the XGBoost machine learning tool. This training process involved optimizing and selecting the best parameters. Afterward, the final model was tested on the reserved test dataset consisting of 71 individuals.

During the machine learning process, we were able to very accurately predict who had a history of suicide attempts and who did not, with a high performance indicated by a ROC AUC score of 0.96. This demonstrates the model’s excellent ability to distinguish between individuals with and without suicide attempts based on the data used.

AI systems can complement traditional methods in suicide prevention, but they cannot replace human expertise. It is also important to pay attention to ethical issues, such as data protection and the reliability of these systems. AI can be a powerful tool in predicting suicide risk if properly integrated into mental health services.

None Declared

Nowadays, gambling has become a common form of entertainment for many young people. Gambling is essentially divided into dice games, card games (especially poker), casino games, sports betting, lotteries and, in recent years, online gambling. As a result, gambling has become a major international business, especially among young students.

Evaluate the practice of gambling in a population of young students and describe its characteristics.

We conducted a descriptive and analytical cross-sectional study among university students.

This survey involved a population of Tunisian students recruited through students’ Facebook groups.

A questionnaire was designed to collect information related to participants’ background characteristics and gambling-related details.

DSM-5 criteria were used to screen for pathological gamblers.

A total of 151 students responded to our questionnaire. Gambling was found in 29.1% of the students in our study (n=44).

Thirty players (68.4%) were occasional players. The lottery (54.5%), followed by sports betting (29.5%) and blackjack (27.3%) were the most reported gambling games by students.

Among the players, nineteen (43.2%) experienced a Big Win. The average amount of money spent on gambling per month was 107.14 ± 123.58 TND, with extremes of 4 and 600 TND.

The majority (77.3%; N=34) played online. Among players, 61.4% (N=27) were used to play with friends.

Almost the half of gamblers (45.5%) have started gambling for less than a year and 6.8% have been gambling for 4 to 5 years.

Pathological gamblers represented 13.9% (n=21) of the students in our population.

Our study highlights the prevalence and characteristics of gambling among university students in Tunisia. With nearly 30% of participants engaging in various forms of gambling. These findings suggest a need for targeted awareness and prevention strategies to address potential risks associated with gambling among young adults, particularly in educational settings. Further researches are essential to explore the long-term implications of gambling behaviors on student well-being and academic performance.

None Declared

Orthorexia Nervosa (ON) is an eating disorder, characterized by rigid and irrational rules about nutrition and food preparation. Although it is not officially recognized by the DSM-5 as a mental disorder, individuals with ON exhibit compulsive and obsessive behaviors related to their diets, with an interest that starts moderate but gradually becomes excessive and potentially pathological.

To assess individuals facing eating disorders, with an emphasis on Orthorexia Nervosa (ON) and Obsessive-Compulsive Disorder (OCD).

This is an integrative literature review, with analyses conducted on the National Library of Medicine (PUBMED) using the descriptors and boolean operators: (Orthorexia Nervosa) AND (Eating Disorders) AND (Obsessive-Compulsive Disorder) AND (obsessive compulsive). Filters applied included: articles published in the last 10 years and available in full text. All articles were analyzed a priori based on the information in the title, followed by reading the abstract, and subsequently, reading the full article.

Seventeen studies were found. According to the data, the age range between 23 and 26 years is at the highest risk for ON, while the risk is lower in individuals between 16 and 19 years. Orthorexic tendencies are more prevalent among Hispanics/Latinos and individuals with overweight or obesity. ON is frequently associated with patients who have body distortions, dissatisfaction with body image, excessive desire for thinness, and eating disorders such as anorexia and bulimia nervosa. Additionally, ON is linked to compulsive behaviors, obesity, strict diets, perfectionism. In individuals on diets, behaviors and problems similar to those seen in eating disorders are often observed, including orthorexic tendencies and obsession with adhering to strict dietary rules. Perfectionism is a common trait among these patients, who often begin with the desire to improve their diet and adopt a healthier lifestyle. However, this pursuit can become excessive, leading to behaviors such as social isolation, high spending on food, and nutritional deficiencies. Various tests conducted in the analyzed studies showed effects in identifying patients with ON, indicating the need for further research to better understand risk factors in different populations and to develop effective strategies for diagnosis, prevention, and treatment.

While a careful diet is not pathological in itself, severe dietary restrictions and social problems should raise the possibility of ON. Improving the identification of risk factors and behaviors may contribute to a better understanding, prevention, and management of ON.

None Declared

Functional neurological disorder (FND) is a core neuropsychiatric condition that includes both physical and mental symptoms. Recently, a validated clinical phenotype termed neuroconnective endophenotype (NEP), which includes several physical and psychological characteristics together with joint hypermobility (hypermobility spectrum disorders), was found at a significantly higher frequency among patients with anxiety (Bulbena A et al. Adv Psychosom Med 2015; 34:143–157).

The purpose of the present study was to examine the presence of the NEP among patients with FND.

A multicenter case-control study was conducted comprising 27 FND patients and 27 healthy control participants (matched by sex and age) ages 13 to 58 years. Eight questionnaires were administered. Proportional differences were examined with Student’s t tests, one-way analyses of variance, and chi-square tests.

Differences between FND patients and control participants were observed. As presented on tables 1 and 2, FND patients had higher sensory sensitivity, increased prevalence of hypermobility features (including relevant physical signs and symptoms), greater frequency of polarized behaviors and an increase in the characteristics and sensations typical of anxiety. FND patients also presented a greater number of comorbidities, both psychiatric (generalized anxiety disorder or panic attacks (63%); phobias, including social anxiety, agoraphobia, and specific phobias (52%); and depression (44%)) and physical (migraine (59%), irritable bowel syndrome (48%), drug intolerances (44%), dark sclerae (41%), and chronic fatigue syndrome (41%)). Particularly striking was the presence of the hypermobility spectrum in more than 75% of FND patients compared with 15% among control participants (Table 3).

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FND patients presented higher scores in all five dimensions included in the NEP. Thus, this phenotype, solidifying the original association between anxiety and the hypermobility spectrum, could help to identify an FND subtype when evaluating and managing FND patients, because it provides a new global view of patients’ physical and mental symptoms. Limitations in this study included small sample size, possible selection and recall biases and lack of data on socioeconomic factors and education.

M. Martínez García: None Declared, A. Bulbena-Vilarrasa: None Declared, L. Pintor Pérez: None Declared, M. Camara: None Declared, N. Arbelo-Cabrera: None Declared, A. Bulbena-Cabré: None Declared, V. Pérez-Sola Grant / Research support from: AB-Biotics, AstraZeneca, Bristol-Myers Squibb, Centro de Investigación Biomédica en Red de Salud Mental, FIS-ISCiii, Janssen Cilag, Lundbeck, Otsuka, Servier and Medtronic, Consultant of: AB-Biotics, AstraZeneca, Bristol-Myers Squibb, Centro de Investigación Biomédica en Red de Salud Mental, FIS-ISCiii, Janssen Cilag, Lundbeck, Otsuka, Servier and Medtronic, C. Baeza-Velasco: None Declared

Anorexia nervosa (AN) and autism spectrum disorder (ASD) share symptoms that complicate diagnosis and treatment, including rigidity in thinking and behavior. This inflexibility often manifests as strict food routines in anorexia. Both conditions involve excessive preoccupation with control and perfection, leading to restrictive behaviors and heightened anxiety.

To show the clinical presentation of Anorexia Nervosa and austism spectrum disorder through the presentation of two cases.

Cases presentation and literature review

Case 1

A 15-year-old girl is receiving psychiatric follow-up for restrictive eating habits. She developed normally and has used sophisticated language since childhood. However, during her infancy, she did not engage in symbolic play. Academically, she performs exceptionally well. She describes herself as having a very rigid personality and struggles with understanding irony and certain social behaviors. She has few friends, viewing friendships as a waste of time. Her interests lie deeply in literature and science, and she tends to wear childish clothing.

She expresses feelings of jealousy towards her younger sister and mentioned that she reduced her food intake to prevent growing taller and to achieve “thinner ankles.” As she begins psychotherapy, she shares that she finds it challenging to grasp what the psychologist means due to her tendency for literal thinking.

Case 2

The patient is a 14-year-old male from Peru, who arrived in Spain 8 months ago. Developmental milestones within the normal range. Little symbolic play and difficulty with non-verbal language. Highly ritualised behaviours and tendency to obsessions, requiring psychological intervention due to compulsion to clean in the COVID-19 pandemic. The patient was admitted to the inpatient unit for weight loss of 6 kilograms in one month, with food restriction and excessive increase in physical exercise. Selective mutism is associated with months of selective mutism, as ‘he does not speak to people who do not speak with a Peruvian accent’. Parents speak of a rigid and literal idea of ‘having to be thin in order to make friends and strong in order not to be weak’.

Both cases reflect how the rigidity and literal thinking of autistic disorder can lead to extreme behaviours such as ‘don’t eat so as not to grow up’ in the first case, or ‘don’t eat to make friends’ in the second case, lived with no flexibility

There is a recognized connection between ASD and AN, with studies indicating a prevalence of 20-25%. Inflexible thinking associated with ASD can negatively impact the prognosis of AN, as ASD may contribute to the chronicity of the eating disorder. Additionally, psychotherapy can present challenges, and research suggests that behavioral techniques, particularly Applied Behavior Analysis (ABA), tend to yield better outcomes for individuals with AN.

None Declared

Lack of compliance is well-known limiting factor in achievement of the therapeutic targets in medical care. The frequency of noncompliance as well as the factors contributing to this condition are currently not well understood. In hemodialyzed patients lack of precise adherence to medical recommendations is particularly important for long time survival. Depression occurrence may have an adverse impact on the medical compliance of these patients.

The aim of this study was to analyze prevalence of depression symptoms and its impact on compliance to medical recommendations in patients on chronic hemodialysis.

Forty (M=26;F=14) patients undergoing routine hemodialysis session have taken part in a two-part survey consisting: Beck’s Depression Inventory and IMB-Q - The Information-Motivation-Behavioural Skills Questionnaire. IMB test includes three subcategories as a basis for tailoring of the model to an individual health-related behavior – a) information about disease and treatment, b) motivation and c) behavioral skills to comply with treatment. Additionally, in all patients weight gain between dialysis session was analyzed.

Seventeen patients (47.5%) fulfilled depression criteria, out of which 5 (12.5%) had moderate or severe grade disease. Depression symptoms were inversely correlated with behavioral skills to comply with treatment measured by IMB-Q test in men (r= -0,416; p=0,034). There was no significant correlation between results of Beck Depression Inventory and body mass change between dialysis sessions. There was also no significant difference in the interdialytic weight gain between patients with and without depression.

Depression is frequently found in male patients with end stage kidney disease treated with chronic hemodialysis. Male hemodialysis patients with depression are less likely to be compliant to medical recommendations because of weaker behavioral skills. Improvement of the compliance in hemodialysis patients may play an important role in the prolongation of life in these group.

None Declared