Bipolar affective disorder (BD) affects approximately 2% of the population. It’s an incapacitating condition that significantly impairs quality of life and functional capacity; depressive episodes in BD are highly debilitating and carry major suicide risk and treatment-resistant bipolar depression has been reported in about one-quarter of patients with bipolar disorders. Non-invasive neuromodulation procedures, such as repetitive transcranial magnetic stimulation (TMS), being an approved treatment for treatment-resistant unipolar depression, can also be an option for bipolar depression.

with this work we intend to assess the efficacy and outcomes of the intermittent theta burst TMS (iTBS) protocol in patients with bipolar depression, who underwent this treatment at Hospital de Magalhães Lemos, Porto, since July 2022. We also conducted a literature review on the subject.

analysis of clinical and sociodemographic characteristics of the 4 patients who underwent treatment and of the treatment outcomes using Beck’s Depression Inventory (BDI) score difference between first and last sessions and Montgomery-Asberg Depression Rating Scale (MADRS) as the secondary outcome, the last applied to only 2 of the patients. A computerized search was performed on PubMed, for articles published in the last 10 years, using the key-words “bipolar depression”, “bipolar depressive episode” and “tms”.

since July 2022, 4 patients with bipolar depression were submitted to iTBS treatment, 3 women and 1 man. Of these, 3 had a diagnosis of bipolar type 1 disorder and 1 of bipolar type 2. One of the women had a comorbid diagnosis of dementia and was not able to answer BDI. All 4 of these patients were referred to this treatment after failure to reach sustained symptomatic remission with at least two different treatment trials, at adequate therapeutic doses. We found positive changes in BDI in all 3 patients that completed this questionnaire and in MADRS in the 2 that answered. One of the patients had an elevated mood and an increase in energy levels following treatment but did not meet criteria for hypomanic/manic episode. No major side effects were reported.

Our results and literature review suggest that TMS, in our study iTBS protocol, may well be an effective treatment for bipolar depression, with some studies showing even higher response rates for bipolar depression when compared with unipolar depression, suggesting that bipolar disorder is more likely a better biological target. Furthermore, the low side effect profile of TMS and the fact that it is a minimally invasive procedure, makes it even more appealing as a treatment option. Risk of psychomotor agitation and hypomania/mania must be closely monitored in these cases.

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Depression is widespread globally and is expected to be the leading cause of disability by 2030, according to the Global Burden of Disease study. Psychosocial factors, such as gender, life events, and migration experiences, increase the risk of depression, with migrants and asylum seekers showing particularly high depression rates. However, cultural differences and social background of individuals are often not adequately addressed in medical settings, which lead to misdiagnoses and mismanagement. Language and cultural barriers may complicate communication of subjective experiences, which consitute a critical part of the expression of symptomatology in depression. Depressed patients may have challenges in verbal expression of their symptoms and distress may be communicated through somatic symtoms, or what might be called as “organ language” or “somatic idiom”, especially in the context of migration. Indeed, somatization is closely linked to the experience of migration stress and can be a form of cultural adaptation. Moreover, the degree of somatization in migrants is found to be related to their level of integration into the host culture. Therefore, the diagnosis and management of depression in the intercultural context can be challenging, as somatic complaints may obscure the recognition of underlying psychological distress. This can delay the seeking of psychiatric help, as patients are often reluctant to attribute their symptoms to psychological causes. Fear of stigma, or perceiving the patient as overly-dependent or attention-seeking might hinder processes of treatment and care. Existing treatment modalities with highest level of evidence, such as CBT, should be culturally adapted. Cultural adaptations involve modifying language, metaphors, and treatment goals to resonate with the patient’s cultural context. While there is some evidence on the positive impact of culturally-adapted interventions including CBT, more research is needed to refine these approaches and address gaps in the literature. Psychotherapy in the intercultural context requires both cultural competence and time for dialogue.

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Emergency departments (ED) and intensive care units (ICU) are high-stress environments where healthcare professionals are continuously exposed to critical situations. This results in substantial mental health burdens, leading to increased levels of depression, anxiety, stress, and burnout. These issues negatively affect both the well-being of professionals and patient care.

This study aims to evaluate the prevalence and severity of depression, anxiety, stress, and burnout among ED and ICU professionals. The goal is to understand mental health issues and identify contributing factors to improve prevention and support systems.

A total of 242 healthcare professionals from Bezmialem Vakif University Hospital were included: 120 ICU staff (80 females, 40 males), 66 ED personnel (42 females, 24 males), and 56 office personnel (38 females, 18 males) serving as a control group. The study employed validated instruments: the Beck Depression Inventory, the Beck Anxiety Inventory, Perceived Stress Scale, and Maslach Burnout Inventory. Non-parametric tests (Kruskal-Wallis H and Chi-Square) were used due to non-normal data distribution, with pairwise comparisons adjusted using Bonferroni correction. The significance level was set at p < 0.05.

The results showed significant differences in age, depression scores, stress levels, and burnout indicators between the ICU, ED, and control groups. ICU and ED staff reported significantly higher depression scores compared to the control group (p < 0.001). Stress levels were also significantly elevated in ICU workers compared to office personnel (p = 0.001). Burnout indicators were notably higher in ICU professionals (p = 0.011). Conversely, no significant differences were observed in anxiety scores, emotional exhaustion, and hours of sleep.Table 1:

Summary of Key Results

The findings underscore the necessity for targeted interventions to reduce psychological distress among ED and ICU professionals. Implementing support systems, promoting work-life balance, and improving mental health resources can significantly alleviate the mental burden on these professionals, thereby enhancing both their well-being and patient care quality.

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Mentalizing (operationalized as reflective functioning; RF), emotion regulation (ER), and reactivity (operationalized as physiological reactivity; PR) are highly relevant protective factors during development. However, limited research has examined these constructs during middle-childhood using a multimethod approach.

The first aim compared differences in these constructs between children with behavioral disorders and a non-clinical group, measuring PR during a dyadic stress task involving conflict with the mother. The second aim explored the relationship between RF and both ER and PR considering the moderating role of externalizing symptomatology.

The study involved 50 children with behavioral disorders (Mage = 11.3, SD = 1.76; 58% male) and 89 non-clinical children (Mage = 10.6, SD = 1.64; 48% male). The Child Reflective Functioning Scale applied to the Child Attachment Interview was used to assess RF, the How I Feel to assess self-reported ER over the past three months, and the Positive and Negative Affect Scale for Children to assess self-reported ER before and after the dyadic stress task. Shimmer 3 GSR+ device has been applied to measure physiological indexes of heart rate variability (HRV) and galvanic skin response (GSR) to assess PR during the dyadic stress task. Mothers completed the Child Behavior Checklist to assess child’s externalizing symptomatology.

Children with behavioral disorders showed lower levels of both global and others-oriented RF and reported higher levels of negative emotions in the previous three months, compared to their non-clinical peers. Both global and others-oriented RF were negatively correlated with reported negative emotions. In contrast, the non-clinical group exhibited higher levels of positive emotions in the previous three months and greater PR during the dyadic stress task. Additionally, externalizing symptomatology moderated the association between others-oriented RF with 1) physiological reactivity (i.e., GSR), only at lower levels of externalizing symptoms; 2) emotion regulation (i.e., emotional control subscale of the How I Feel), only at higher levels of externalizing symptomatology.

These findings reinforce prior research suggesting that children with behavioral disorders exhibit lower levels of RF, especially towards others, and negative emotions which may be risk factors for the development of behavioral disorders. Using a multimethod approach allowed to both evaluate ER and PR, highlighting the differences between the subjective perception of emotions and their physiological response. Lastly, the lower PR during the dyadic stress task in the clinical group could be a consequence of greater habituation to conflict, a hypothesis that could be explored in future research.

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Bullying, deliberate aggression by a peer or group of peers in a power imbalance that favors the aggressor, is a frequent and preventable traumatic event during adolescence (Abregú-Crespo R et al. The Lancet Child & Adolescent Health 2024; 8:122–134). Mitigating its impact could be a viable strategy for psychosis prevention (Fraguas, D. et al. JAMA Pediatrics 2021; 175, 44–55). A better understanding of its influence on brain development during adolescence could be crucial for implementing effective interventions.

To study the relationship between bullying exposure (BE), distressing psychotic-like experiences (DPLEs), and multi-scale functional network connectivity (msFNC) in the developing brains of 12-year-old adolescents.

We used cross-sectional data from 12-year-old adolescents from the Adolescent Brain Cognitive Development Study, which recruited a representative sample of healthy adolescents from across the United States. We fitted a linear mixed model to predict DPLEs (Prodromal Questionnaire-Brief Child Version) with BE (Peer Experience Questionnaire) as a predictor (n=10,388). We analyzed functional magnetic resonance imaging data with reference-informed independent component analysis and a canonical and replicable multi-scale intrinsic connectivity network template to extract whole-brain 5460 msFNC features (Iraji, A. et al. Hum Brain Mapp 2023 44, 5729–5748). We fitted 5460 linear mixed models to predict DPLEs with BE as a predictor and analyzed the mediation effect of each of the 5460 FNC features (n=5,409). All models were fitted with family and site as random effects, adjusted for covariates (age, sex, race, ethnicity, pubertal development, and family income), and corrected for multiple comparisons.

BE was significantly associated with DPLEs (β=0.39, CI[0.37, 0.41], t(10362) = 41.00, p<.001, R2=0.36, p<.000) (Fig.1). DPLEs were associated with msFNC predominantly between cerebellar, paralimbic, somatomotor, insulotemporal, frontal, temporoparietal, and central executive networks (Fig.2). The association between DPLEs and BE was primarily mediated by msFNC between the paralimbic, somatomotor, insulotemporal, frontal, and temporoparietal networks (Fig.3).

Image 1:

Image 2:

Image 3:

Bullying exposure may represent a modifiable risk factor for the development of DPLEs during adolescence. It may influence DPLEs through its effects on relevant functional brain networks. The implementation of targeted interventions to prevent BE during adolescence could serve as a viable strategy to mitigate potential functional brain alterations and reduce the risk of psychosis.

None Declared

Spinal cord stimulation (SCS) is used to treat chronic neuropathic pain (CNP) resistant to other therapies and procedures. The treatment involves implanting a device that delivers electrical stimulation along the ascending nerve pathways. According to the bio-psycho-social model of pain, the success of SCS is influenced by more than just the technical aspects of the procedure. Psychological and context-related factors also play a crucial role.

To profile a sample of Italian patients with CNP in the pre-implant phase from a psycho-social perspective, using such data to predict the SCS outcome.

Candidates for SCS at the Pain Therapy Center of the University Hospital of Verona (Italy) undergo a psychological assessment at the Clinical Psychology unit before the implantation. This assessment includes an interview to evaluate the impact of pain, coping strategies, and family support, as well as any history of traumatic experiences, psychiatric conditions, and lifetime use of alcohol or substances. Additionally, a series of questionnaires are administered to assess pain (Brief Pain Inventory, BPI), psychopathology (Symptom Checklist 90, SCL-90), personality (Minnesota Multiphasic Personality Inventory, MMPI-2), coping style (Coping Strategies Questionnaire, CSQ), the tendency to catastrophize (Pain Catastrophizing Scale, PCS), family and social support (Multidimensional Scale for Perceived Social Support, MSPSS), and self-efficacy (General Self-Efficacy Scale, G-SES). Patients are evaluated at 6 months follow-up (now ongoing).

To date, 131 patients (mean age 62.6±13.8; 56% females) have been evaluated at baseline. Overall, they show high percentages of somatization (71% of the sample), sleep disturbances (70%), depressive (40%), and obsessive-compulsive (38%) symptoms, together with moderate levels of catastrophizing (18.4±9.4 on the 0-36 range of the catastrophizing CSQ subscale), and a personality profile characterized by health worries (26%), somatic complaints (19%), and cynism (26%). Overall, they perceive a moderate level of self-efficacy (30.83±4.9 on the 0-40 range of the G-SES) and good family or social support (84%).

Patients with CNP who are candidates for SCS show a peculiar psycho-social profile in terms of personality traits, coping strategies, and psychopathology. Using a pre-implant psycho-social assessment has significant implications for clinical practice since it allows to identify patients at a higher risk of SCS failure. It also enables the early detection of individuals who may benefit from psychological support before or after the SCS procedure.

None Declared

In 1943, Manfred Bleuler noted that late-onset schizophrenia (LOS) is an overlooked patient group, but accounts for 20% of all patients diagnosed with schizophrenia. There is a limited interest in this subgroup perhaps because of the focus on patients with early onset of schizophrenia currently. Patients with LOS differ from those with earlier onset by showing better premorbid functioning, cognitive and social skills and a less disorganized. There is limited information about the presence of premorbid near-psychotic or psychotic experiences in these patients.

The main aims of this qualitative study were to investigate 1) the extent to which patients with LOS experience near-psychotic or psychotic episodes during their lives prior to their first contact with psychiatry, 2) whether their premorbid social life and level of functioning were affected, and 3) potential triggers before their initial interaction with the mental health care system.

Inclusion criteria comprised patients with a diagnosis of ICD-10 schizophrenia given at ages 36-59 years. They should not have had any prior contact with the psychiatric healthcare system before their first interaction with psychiatry. A semi-structured interview guide was developed for the study. All interviews were audio recorded and subsequently transcribed. The qualitative analysis consisted of an interaction between theoretical knowledge and empirical results aiming to identify interaction between psychopathology and social factors prior to the first contact with psychiatry.

Most patients with LOS had experienced psychotic symptoms ranging from weeks to years before their first contact with psychiatry. Many had experienced nonspecific symptoms such as depression, fatigue, anxiety or sleeping disturbances for several years before their first psychiatric consultation. The majority reported feeling different throughout their life.

Eleven patients had been married for over three years, six divorced in the months preceding the outbreak. Nine participants had been out of the labor market for several years, the other had been dismissed or went on sick leave shortly just before their contact with psychiatry.

Many stressful life events occurred before their initial psychiatric consultation.

The diagnosis of LOS can easily be overlooked as these patients do not present the typical profile of persons with schizophrenia. However, they experience non specific and psychotic symptoms over years. A closer examination of these patients’ coping strategies during the premorbid phase could provide new psychoeducational insights that may support the recovery of other patients with schizophrenia. The presence of psychotic symptoms several years before the first contact with psychiatry highlights that the onset of the illness is not merely a technical issue, but also a conceptual one.

None Declared

The perinatal period is a vulnerable time for women, with specific risk factors for mental health issues. Puerperal psychosis typically presents within the first month postpartum, although the perinatal period extends through the first year after delivery. This condition is understudied, and its nature and pathophysiology remain subjects of debate.

To describe a case of late-onset puerperal psychosis, highlighting the challenges in decision-making regarding medical approach.

A clinical case report and a non-systematic review of the literature.

A 39-year-old woman was brought to the Emergency Unit by her relatives due to paranoid delusions that her partner and in-laws were attempting to poison her. She had previously sought mental health care only once, as an adolescent, for anxiety symptoms following her parents’ divorce. She is the mother of a 5-year-old child and a 10-month-old infant, with no reported complications during pregnancy or delivery.

The patient reported experiencing strange occurrences over the preceding 10 days, beginning during a family vacation when she became suspicious of the food and the organization of meals. She believed her in-laws were poisoning her and expressed concern about transmitting poison to her infant through breast milk. Upon returning home, these fears intensified, extending to suspicions that her husband, mother, and sister were involved. She had drastically reduced her food intake the prior days before consulting, her appearance was malnourished and disheveled.

Further psychopathological exploration revealed delusional beliefs centered on being poisoned and potentially poisoning her baby through breastfeeding. These delusions were accompanied by confusion, perplexity, and heightened anxiety. She denied experiencing hallucinations and had no thoughts of harm toward herself or others.

Low-dose olanzapine treatment was initiated and outpatient management was initially chosen to minimize disruption to her role as a mother, in accordance with the patient’s preference and the presence of family support. However, hospitalization ultimately became necessary, resulting in complete resolution of psychotic symptoms after 14 days, with olanzapine titrated to a higher dose (20 mg per day).

Puerperal psychosis is a complex condition with potentially severe consequences for both maternal and infant health, including disruptions in mother-child bonding. This case underscores the need for further research and resource allocation in this area. Specifically, the development of more psychiatric mother-baby units could help prevent unnecessary separations, promote bonding, and provide opportunities for early parenting interventions.

None Declared

Vagal Nerve Stimulation (VNS) therapy has emerged as a promising treatment for individuals suffering from treatment-resistant unipolar and bipolar depression. Initially approved for epilepsy, VNS therapy’s potential to improve mood symptoms in patients unresponsive to conventional treatments like antidepressants, psychotherapy, ECT, and TMS has garnered growing interest in psychiatry. This systematic review provides a comprehensive overview of the side effects associated with VNS therapy. It aims to offer a balanced perspective on the therapy’s safety profile, aiding informed decision-making for depression.

1. 1. To identify the most common side effects of VNS therapy.

A literature search was conducted within 2 databases (PubMed and Google Scholar). The PubMed search employed MeSH terms as follows: ((vagus nerve stimulation) OR (vagal nerve stimulation)) AND ((major depressive disorder) OR (MDD) OR (depression) OR (unipolar depression) OR (bipolar depression)) AND (side effects). Google Scholar search utilized Boolean operators as follows: “vagus nerve stimulation for depression” “adverse effects” “side effects.” Tools that were native to the browsers of these respective databases were used to apply the following filters: publication date (2019-2014), free full text, English, no abstracts, no miscellaneous documents and the remaining results were reviewed independently by 2 investigators to screen for the remaining inclusion and exclusion criteria. Specifically, studies were only included if they reported on the side effects of VNS therapy for depression. Studies were excluded if they did mention the side effects, or if they were not accessible to the investigators due to pay-walls, for example.

A total of 380 articles were identified from searching in both databases, and screening with application of our inclusion and exclusion criteria left 14 articles to be considered. The side effects of VNS therapy can range from mild and transient to more significant, and most frequently mentioned side-effects included: headache, local skin irritation, intolerable pain, and voice alteration (Jung 2023). Headache and dizziness was common for all forms of VNS, while local skin irritation was far more common in non-invasive methods of VNS involving electrodes, and serious complications from damage to the vagus nerve resulting in arrhythmias and aspiration (Bruer 2022) potentially impacting the overall quality of life and adherence to treatment.

Vagus Nerve Stimulation (VNS) offers a promising treatment option for patients with treatment-resistant depression, providing symptom relief when other therapies fail. However, side effects, particularly laryngeal, and variability in patient response highlight the need for personalized approaches. Future research on transcutaneous VNS and optimized protocols is essential to enhance outcomes.

None Declared

Since its inception in 1997, the term orthorexia nervosa (ON), derived from the Greek words for “right” and “appetite” (Donini et al, 2022), has been utilized to describe an obsession with “correct” or “healthy” eating. Despite numerous authors suggesting diagnostic criteria and the publication of several theoretical papers, consensus regarding a definition or even the existence of ON remains elusive (Dunn and Bratman, 2016). Conversely, anorexia nervosa (AN) has been recognized since the first iteration of the DSM (Bhattacharya et al, 2022; Dell’Osso et al 2016). Layperson awareness of these conditions has been increasing, with a notable increase in interest in “orthorexia” over the past several years, potentially influenced by popular culture and increased social media use (Sharma et al, 2023)

The purpose is to understand shifts in public interest as well as the ever-present influence of the online world on patients, especially those with disorder eating patterns.

This study compared United States Google search trends for the terms “orthorexia” and “anorexia”. Using Google Trends data, we reviewed the average monthly search volume from January 2004 to March 2024. We analyzed the data to determine if there was a significant difference in search volume over time.

Google search data revealed a monthly search volume of ˜7000 queries for “orthorexia” in January 2004, and analysis of the volume revealed that there has been a significant and sustained increase in the searches for “orthorexia”. Additionally, searches for the term “anorexia” reached a height of 2.1 million in 2007, but have been steadily declining in the past several years.

While anorexia remains the more prominent search term, over time the queries for anorexia have decreased from their peak in the early 2000’s. The rise in the term orthorexia may be partly due to the proliferation of highly visual social media platforms, particularly YouTube and TikTok, where content creators often focus on healthy eating and lifestyle trends (Sharma et al, 2023).

Additionally, there is a possibility that orthorexia is being used on these platforms to describe a subset of AN. Some individuals with anorexia may present with behaviors resembling orthorexia, such as a fixation on healthy eating or a rigid adherence to specific dietary guidelines.

The findings indicate a shift in the public’s interest in orthorexia and anorexia during the past several years, possibly influenced by increased social media use. Further research is needed to understand the implications of this trend on individuals’ attitudes towards healthy eating and body image.

None Declared

ECT is a well-evidenced, cost-effective intervention for treatment-resistant depression. In Ireland acute (twice-weekly) outpatient ECT for depression has not been reported, though common elsewhere. Ireland has among the lowest number of inpatient psychiatry beds per person in Europe. We observed a clinical need for acute outpatient ECT for people who could not access elective inpatient care.

We describe the process, interventions, outcomes and stakeholder feedback for four cases of acute outpatient ECT.

All cases provided written informed consent. A multidisciplinary (psychiatry, anaesthesiology, nursing) protocol for assessment and delivery of acute outpatient ECT was developed and implemented, cases described and feedback from stakeholders sought in an acceptability forum.

Four medically stable patients (ASA Grades 2-3) completed acute outpatient ECT (Table 1), receiving between n=6 and n=12 ECT treatments, attending from home. N=140 inpatient psychiatry bed days were saved, and n=45 community psychiatry reviews were required. No adverse events or medical interventions occurres. Three people had CGI outcome of “very much improved” and one person halted their treatment course when “minimally improved”, citing lack of response. Stakeholder feedback in an acceptability forum highlighted the increased resource intensity of twice-weekly community review for outpatient ECT, and the positive outcomes for treatment-resistant depression.

Acute outpatient ECT was safe and effective in this case series and resulted in n=140 psychiatry inpatient bed days being saved. There was an increased need for reviews from the community team during the treatment protocol. Medically stable patients with substantial social support were eligible for this pilot phase, thus a priority for future development must be equity of access to this effective intervention.

None Declared

Nurses play a crucial role in patient care. Indeed, this profession requires a high level of emotional, mental and physical workload. Improving the well-being of these workers means taking into account the impact of workload on their job satisfaction.

Our study aims to assess the relationship between perceived workload and job satisfaction among nurses.

We conducted a descriptive, analytical and cross-sectional survey among nurses using a self-administrated questionnaire. We collected socio-professional data. We assessed perceived workload using the National Aeronautics and Space Administration Task Load Index (NASA-TLX). Job satisfaction was evaluated using the single-item measure of job satisfaction.

Our population comprised 202 nurses, 67% of whom were female. The mean age of participants was 35.1 ± 8.1 years. The nurses’ length of service in the department was 6.9 ±7.5 years. The mean score of mental demand, physical demand, performance, effort, frustration level and temporal demand were respectively 77.8±22.6, 76.9±23.5, 67.9±31.9, 81.4±20, 66.6±25.2 and 59.8±30.2. The mean score of Raw TLX was 71.44 ±14.8. Among our participants, 74 (37%) were satisfied with their jobs. We found that the job satisfaction was positively correlated with the overall RAW TLX score (p=0.02) and with the physical (p=0.04) and temporal (p=0.00) demands.

Our findings highlight a correlation between high perceived workload and job dissatisfaction. Therefore, it is crucial to assess and improve working conditions to ensure a safe, comfortable and well-equipped environment, thus promoting nurses’ satisfaction and quality of care.

None Declared

Previous studies show contradictory results about the relationship between the age of menarche and the intensity of anxiety symptoms. Some studies found that anxiety symptoms were significantly higher in patients with earlier age of onset of menarche. Recent studies show that early puberty and menarche are associated with greater rates of morbidity of anxiety and other psychiatric illnesses than relatively late menarche. It is presumed that girls who achieve menarche earlier are less prepared for puberty and tend to have more negative emotions associated with menstruation.

The purpose of this research was to determine the correlation between onset of menarche and intensity symptoms of anxiety in female patient with affective and anxiety disorders.

The research is prospective and includes female patients with established diagnoses of depressive disorder, anxiety-depressive disorder, bipolar disorder (depressive episode) aged 18-65. The patients had their laboratory parameters determined, including sex hormones (estrogen, progesterone, testosterone, FSH, LH and prolactin), filled out a demographic questionnaire and questionnaires: The Suicide Behaviors Questionnaire-Revised (SBQ-R), Generalised Anxiety Disorder Assessment (GAD-7), Patient Health Questionnaire (PHQ-9), Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI), Matthey Generic Mood Question. Montgomery-Asberg Depression Rating Scale (MADRS), Hamilton Anxiety Rating Scale (HAMA) i Hamilton Depression Rating Scale (HAMD).

The preliminary data of the prospective study showed that there was a statistically significant proportion of patients in whom a correlation was found between the age of onset of menarche and the intensity of anxiety.

Age of menarche could be an influence on intensity of anxiety symptoms in female patients.

None Declared

The impact of bipolar disorder on occupational health and work ability has garnered increasing attention, as it significantly influences individuals’ professional functioning

To examine the socio-professional characteristics of workers diagnosed with bipolar disorder and evaluate their fitness for work.

Retrospective descriptive study of patients with psychiatric disorders seeking medical assessments at the occupational pathology department between January 2011 and January 2024.

A total of 17 patients with bipolar disorder were included, with a mean age of 36.3±8.6 years and a sex ratio of 0.42. The average professional seniority was 10.8±7.7 years. In terms of marital status, 37.5% were married, and 62.5% were single. Regarding educational level, 37.5% had completed secondary education, while 58.8% had a higher education degree, and 50% reported a family history of psychiatric disorders. Concerning lifestyle habits, 37.5% of patients were smokers, and 6.3% consumed alcohol. The most common sectors of activity were telecommunications (31.3%), transportation (18.8%), healthcare (18.8%), and cleaning and maintenance (12.5%). Workplace exposures included solvents (12.5%), noise (43.8%), imposed work pace (35.3%), lack of autonomy (35.3%), and conflicts with hierarchical superiors (62.5%). Work schedules varied, with night shifts (43.8%), alternating shifts (24.9%), and fixed hours (31.3%). Reported challenges included irritability (94.1%), sadness (93.8%), sleep disturbances (81.3%), appetite changes (43.8%), concentration difficulties (31.3%), and suicidal thoughts (25%). The disorder impacted work performance in 66.7% of cases, and 53% of patients required sick leave with an average duration of 7.4 months; 75% reported improvement under treatment. Medical assessments for work ability found that 18.8% were fit for work, 12.5% were permanently unfit, and 6.3% were temporarily unfit, while 56.3% required workplace adjustments, including avoidance of answering phone calls (12.7%), fixed work hours (23.5%), exclusion from night shifts (11.8%), and avoidance of public contact (17.6%); 6.3% underwent job reassignment.

Bipolar disorder has a substantial impact on work ability, highlighting the need for customized interventions and job accommodations to ensure that workers can maintain their roles and productivity.

None Declared

The dopaminergic hypothesis of schizophrenia has been constantly revised and virtually all the antipsychotics currently available for the treatment of schizophrenia are based on this pathogenetic hypothesis. However, the involvement of cholinergic, glutamate, gamma-amino-butyric acid, serotonin, neurotrophins, and pro-inflammatory cytokines in the onset of psychotic disorders is attracting more and more interest. This interest is fueled by the high rates of treatment resistance in schizophrenia, which reaches 15-40% (Wong et al Transl Psychiatry 2024;50 14) and requires second-line treatment, frequently associated with significant adverse events. Finding new pharmacological agents that can be used either as monotherapy or as add-ons to the ongoing treatment in patients with schizophrenia is essential for improving the chances of functional recovery.

To review the evidence supporting the modulation of cholinergic neurotransmission as a potential pharmacological target for treating schizophrenia.

Two clinical studies repositories (US National Library of Medicine- clinicaltrials.gov and WHO International Clinical Trials Registry Platform-https://www.who.int/clinical-trials-registry-platform) and the PubMed database were explored using “choline*” and “schizophrenia” or “psychotic disorders” or “schizophrenia spectrum disorders” for studies and reviews focused on cholinergic agents targeting symptoms of schizophrenia.

Positive allosteric modulation of the α7 nicotine receptors and M1/M4 muscarinic receptor agonism are the two pharmacodynamic mechanisms explored for cholinergic-based antipsychotics. Other possible mechanisms of interest are positive allosteric modulation of the M5 muscarinic receptors, selective M4 positive allosteric modulation, and cholinesterase inhibition. Out of these preclinically explored options, only xanomeline, an M1/M4 muscarinic receptor agonist, has reached phase III of clinical research with significant antipsychotic effects. The currently explored formula is an association of a fixed dose of xanomeline (selective M1/M4 cholinergic agonist) and trospium (a cholinergic antagonist), the last agent being included to decrease the risks of peripheric cholinergic adverse events. Studies investigating cholinesterase inhibitors have not been associated with favorable results, and the tolerability was low. Positive allosteric modulators of the α7 nicotine receptors are investigated in preclinical studies, but in phase 1b such an agent, i.e., AVL-3288, failed to show efficacy versus placebo.

The association of xanomeline, an M1/M4 receptor agonist, and trospium, a peripheric cholinergic antagonist, led to favorable results in phase III trials. Other molecules with cholinergic mechanisms are also explored in schizophrenia, but the results are not yet clinically significant.

None Declared

The study of the neurobiological characteristics of borderline personality disorder (BPD) in youth is actual due to its high prevalence, but quantitative EEG studies of BPD have yielded mixed results.

The aim of the study was to assess the EEG features in patients with different clinical subtypes of borderline personality disorder (BPD).

Total of 52 patients aged 16-25 years (mean age 20.4±3.2 years) with BPD (F60.31 by ICD-10) were enrolled in the study. Three groups of patients with different subtypes of BPD (with predominance of “affective storm”, “addictive adrenalin mania” and “cognitive dissociation”) were identified based on clinical and psychopathological characteristics. A pre-treatment multichannel resting EEG was recorded with measurements of EEG spectral power and coherence in narrow frequency sub-bands. Between-group differences in clinical and neurophysiological parameters were identified using Mann-Whitney criteria.

The groups did not differ in EEG spectral power values, but significant (p<0.05) differences between the groups were revealed in the spatial organization of the EEG namely in the number of “highly coherent” functional connections (with coherence coefficients above 0.9) that was the least in the group with “cognitive dissociation”. Low values of the number of such connections in the alpha2 EEG sub-band (9-11 Hz) in the frontal-central-temporal brain regions reflect a relatively poor functional state of the prefrontal cortex in this group.

The noted features of the spatial functional organization of brain activity in patients with different BPD subtypes may underlie differences in their clinical conditions, in control of emotions and behavior.

None Declared

Acutely decompensated heart failure (HF) may be accompanied by depressive symptoms. Predictors of screening diagnosis of depression (SDD) in decompensated HF are poorly elucidated.

We sought to investigate independent determinants of SDD in patients with HF decompensation.

Enrolled were fifty-one patients with a median age of 67 years and left ventricular ejection fraction (LVEF) of <40% hospitalized due to HF decompensation. SDD based on the result of the Beck Depression Inventory (>10 points), PHQ-9 (>12 points) or Hamilton Depression Scale (lack of depression: <7 points; mild [<12 points], moderate [<17 points] or severe [≥18 points] depression). Neurotrophic potential and response to stress were assessed by brain-derived neurotrophic factor (BDNF) and FK506 binding protein 5 (FKBP5), respectively.

SDD was identified in 26 (51%) patients based on the Beck inventory and in 12 (24%) patients based on PFQ-9. According to the Hamilton scale mild SDD was found in 17 (33.3%), moderate in 9 (17.6%) and severe in 14 (27.5%) of patients. Male patients with HF decompensation had higher result of Beck inventory by 35% (P=0.029), PHQ-9 by 60% (P=0.014) and Hamilton scale by 64% (P=0.003) than female. The result of the Beck Depression Inventory was correlated with plasma levels of FKBP5 (R=0.34, P=0.017) and inversely correlated with BDNF (R=-0.39, P=0.004). In turn, LVEF was correlated with the result of PHQ-9 (r=0.33, P=0.020), Hamilton scale (r=0.33, P=0.18) and with BDNF (r=0.32, P=0.025) while inversely with FKBP5 (r=-0.32, P=0.023). By multivariate analysis the higher result of the Beck inventory was associated with male gender (β=0.26, P=0.048), a higher LVEF (β=0.27, P=0.042) and a lower plasma BDNF (β=-0.46, P<0.001).

SDD in patients with HF decompensation is independently associated with male gender, better preserved left ventricular systolic function and reduced plasma level of BDNF.

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Transgender healthcare has increasingly gained importance, particularly in understanding how individuals align with their affirmed gender in various physiological and sociological aspects. Transfemales, individuals assigned male at birth who transition to female, represent a group that is less studied in gender research. There remains uncertainty regarding the degree of similarity transfemales exhibit to cisgender males or females post-transition. This study aims to address this by using a binary logistic regression model to compare transfemales with gender-affirming males and females.

The primary objective of this study is to determine whether transfemales are more similar to gender-affirming males or gender-affirming females. Using a binary logistic regression model previously validated on a cohort of transmales, we aim to categorize transfemales based on personality traits.

A binary logistic regression model, initially developed to distinguish between gender-affirming males and females, was applied to a dataset that included transfemales. The model was trained using characteristics of cisgender males, females and transgender participants. The dataset included 108 gender-affirming males, 260 gender-affirming females, 142 transmales and 20 transfemales, ages 15-25, from Europe. The primary outcome was the classification of transfemales into the male or female categories according to personality trait assessment, using the regression function trained on the gender-affirming cohort.

The binary logistic regression model categorized the vast majority of transfemales as females, with a classification accuracy close to that of gender-affirming females being categorized as female. Specifically, 85% of transfemales were classified as female, which is slightly lower than the 93% classification accuracy for gender-affirming females but significantly higher than the 34% classification accuracy for gender-affirming males being categorized as female. Detailed results are presented in the attached table.

The results suggest that transfemales are more similar to gender-affirming females than to gender-affirming males in their personality traits based on the binary logistic regression model. However, caution must be exercised when interpreting these findings due to the limited sample size of transfemales (n = 20). Furthermore, the predictive accuracy of the model was modest, highlighting the need for further research with larger and more diverse datasets. These findings contribute to the understanding of gender identity and its alignment with personality traits, yet emphasize the complexity of such classifications in transgender populations.

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The existing studies found that stigma expands also among healthcare professionals when it comes to psychiatric patients, where a particular group is represented by substance use disorder patients, who are often perceived as manipulative, irresponsible or non-compliant.

The aim of this case presentation is to emphasize the importance of stigma reduction especially among healthcare professionals.

A 26-year-old female patient with medical history of treatment-resistant epilepsy and misuse of cannabis and alcohol was brought into the Psychiatry ward after multiple grand-mal seizures, which occurred after weeks of daily use of alcohol and no adherence to the medical treatment.

Prior to the admission, the patient was directed to the Neurology ward, where the hospitalization was declined due to her psychiatric history and the multi-drug test result, which turned positive for THC.

On the first day after admission, the patient had two seizure episodes, lasting 10 and respectively 30 minutes, after which she was transferred to the ICU department, where she was stabilized. Therefore, she returned to the psychiatric ward, where the patient enters status epilepticus, for which she underwent an neurological examination and received emergency treatment successfully.

The following day, the patient presents another episode of status epilepticus, after which she does not recover her respiratory function spontaneously and suffers cardiac arrest. The resuscitation protocol was initiated, an Emergency Medical team was requested to take over. After 4 minutes of CPR, the patient became pulmonary and hemodynamically stable.

Stigma is one of the factors that can influence the quality of the healthcare services provided by physicians. In the given case, stigma led to a life-threatening scenario, in which the patient was denied to receive adequate neurological treatment due to cannabis and alcohol use disorder. The impact of stigma on healthcare delivery and the barriers to receiving adequate treatment in these cases emphasize the need for training and education for all healthcare professionals.

None Declared