Bruxism, characterized by the grinding and clenching of teeth, is often associated with psychiatric disorders such as anxiety and stress. Bruxism not only results in significant dental pathology but can also contribute to underlying neurophysiological disturbances.

To elucidate the relationship between bruxism and psychiatric medication by focusing on the neurophysiological mechanisms involved and the resultant dental pathologies.

A comprehensive literature review was conducted using databases such as PubMed, PsycINFO, and Google Scholar, focusing on studies from the last decade that investigate the association between bruxism, psychiatric medications, and neurophysiological factors. The review included clinical studies, neuroimaging research, and behavioral analyses.

The findings indicate a strong association between bruxism and the use of psychiatric medications, particularly antidepressants and antipsychotics. Neurophysiological studies reveal dysregulation in neurotransmitter systems, notably dopamine and serotonin, which play critical roles in both bruxism and the effects of psychiatric medications. This dysregulation affects motor control circuits and stress response pathways in the central nervous system, leading to involuntary teeth grinding and clenching.

Table 1: Neurophysiological Mechanisms

Table 2: Dental Pathologies Resulting from Bruxism

Bruxism is both a symptom and a potential side effect of various psychiatric medications, rooted in neurophysiological disturbances. The interplay between dysregulated neurotransmitter systems, psychiatric medications, and resultant dental pathologies highlights the need for integrated dental and psychiatric care. Effective management of bruxism through targeted dental interventions and tailored psychiatric treatments can significantly improve both dental health and psychiatric well-being.

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We present a case study of a 19-year old Ukrainian refugee presenting with delirious mania, with no personal or family psychiatric history. Delirious mania is a complex and severe neuropsychiatric condition that remains under-recognised in diagnostic manuals. Delirious mania describes a neuropsychiatric state where a patient is exhibits signs and symptoms of mania, delirium and often catatonia. Most of the patients described in past case reports are older in age than our patient and have a personal or family history of a mood disorder.

Our objectives were to investigate the signs and symptoms of delirious mania in this this 19 year-old patient. We sought to compare his presentation to the existing diagnoses in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition and International Classification of Diseases 11th Revision. These include delirium, mania and catatonia. In addition, we aimed to study existing literature on delirious mania as well as cross-cultural factors in formulation of this complex case.

We assessed this patient daily as part of the Liaison Psychiatry team and compared his presentation to existing diagnostic criteria of delirium, mania and catatonia. We performed a literature review of delirious mania to identify suggested diagnostic criteria, management strategies and cultural considerations.

Our patient presented to the Emergency Department with a four-day history of bizarre behaviour and poor sleep. He had no past psychiatric history. He was admitted to the general medical ward for a medical work-up, which ultimately yielded no organic pathology. During this time, our patient fulfilled separate diagnostic criteria for delirium, manic episode and catatonia. We found that there was no overarching diagnosis within international diagnostic manuals that encompassed this patient’s presentation. However, delirious mania has been described in the literature since 1849. There are various suggested diagnostic criteria for delirious mania suggested in the literature, such as those by Bond (1980) and Fink (1999). This patient was successfully treated with intramuscular lorazepam. In our discussion, we considered various unique factors in the formulation. These included the cultural considerations given that the patient had recently entered the country as a Ukrainian refugee, difficulties in assessment and treatment due to language and cultural barriers and the limitations of psychiatric treatment on a general medical ward.

Delirious mania continues to be unrepresented in diagnostic manuals, which in turn leads to confusion over diagnosis and treatment. Given the complexity of this neuropsychiatric condition, early recognition is key in providing effective treatment before progression into a malignant state. This would be aided by having delirious mania recognised in international classifications.

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The association between prenatal acetaminophen exposure and the development of Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) remains a subject of considerable debate. Despite extensive research, the evidence regarding this relationship is conflicting.

To perform a systematic review and meta-analysis of studies comparing the incidence of ADHD and ASD in patients that were either exposed or not exposed to acetaminophen prenatally.

We systematically searched Pubmed, Embase and Cochrane Central for eligible studies up until August 2024. Only studies which included participants with a medical diagnosis of ADHD/ASD and reported acetaminophen exposure as a binary measure were included. Available summary data was extracted from published reports and pooled with a random-effects model using odds ratios (OR) with 95% confidence intervals (CI). Hazard ratios (HR) adjusted for potential confounding factors were used for sensitivity analyses. All statistical analyses were conducted utilizing Review Manager 5.4.1. PROSPERO iD:CRD42024587662.

We included five studies with a total of 2,647,536 patients with ADHD (150,741) / ASD (63,726), of whom 271,126 were exposed to acetaminophen prenatally and 2,376,410 were not exposed. Prenatal acetaminophen exposure was associated with an increased risk of developing ADHD (OR 1.30; 95% CI 1.17 to 1.45; p<0.01; I2 = 73%; Figure 1) and ASD (OR 1.17; 95% CI 1.14 - 1.20; p<0.01; I2 = 0%; Figure 2). Sensitivity analyses revealed that acetaminophen exposure during the third trimester of pregnancy was associated with an increased risk of ADHD (HR 1.26; 95% CI 1.07 to 1.47; p<0.01; I2 = 0%; Figure 3), but not during first (HR 1.10; 95% CI 0.97 to 1.26; p=0.13; I2 = 0%; Figure 3) and second (HR 1.07; 95% CI 0.95 to 1.19; p=0.26; I2 = 0%; Figure 3) trimesters.

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In this systematic review and meta-analysis, prenatal acetaminophen exposure was significantly associated with risk of developing ADHD and ASD, especially if exposure occurs in the third trimester of pregnancy.

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Research shows a strong correlation between depression and memory disorders, suggesting the potential for cross-questionnaire data use in automated diagnostic systems. This study explores whether the Prospective and Retrospective Memory Questionnaire (PRMQ) can identify depressive symptoms and if the ZUNG Self-Rating Depression Scale (SDS) can predict memory-related disorders.

To evaluate the effectiveness of using questionnaires intended for one mental disorder to diagnose another through machine learning models on data from a large-scale self-assessment online questionaire.

The study is part of the Memory and Depression Study: MANDY, conducted by the 1st Department of Psychiatry and the Department of Neurology of Papageorgiou Hospital, Thessaloniki, Greece. Data from 3340 participants were collected via an online survey containing the PRMQ, SDS, demographic data, and health-related questions. Four predictive tasks were designed: two for predicting depression using memory responses (D-from-M score and class) and two for predicting memory disorders using depression responses (M-from-D score and class). Machine learning models including LightGBM, AdaBoost, Support Vector Machines, and Logistic Regression were evaluated. Performance metrics included precision, recall, F1-score, and AUC-ROC (Figure 1).

The LightGBM classifier was the top-performing model for the D-from-M class prediction task, achieving a precision of 0.75563, recall of 0.79125, an F1-score of 0.77303, and an AUC-ROC of 0.79319 on the test set (Table 1). This indicates a strong predictive capability for diagnosing depression from memory-related responses. The AdaBoost classifier had similar performance but was slightly inferior to LightGBM. For the M-from-D class task, the class imbalance (memory disorder prevalence at 5%) was a significant challenge. The best model, a Support Vector Classifier with ADASYN resampling, achieved a precision of 0.6, recall of 0.375, an F1-score of 0.46154, and an AUC-ROC of 0.86218. However, its performance was notably lower than LightGBM in predicting depression.

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The PRMQ, combined with specific demographic and health-related questions, showed promise in predicting depression, with the LightGBM classifier as the best overall model. This underscores the potential for cross-questionnaire data utilization for diagnosing depression. Conversely, predicting memory disorders using the SDS was less effective, indicating the need for more targeted diagnostic tools. Future research should include neurocognitive and biomarker data to enhance diagnostic accuracy for memory-related conditions.

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Pediatric bipolar disorder is a severe and disabling condition that affects around 1–3% of youth worldwide. The typical clinical course consists of alternating episodes of depressed or elevated mood, with intervals of well-being. Studies have shown that the onset of bipolar disorder is frequently of depressive polarity, and the long-term affective morbidity is primarily depressive, even in patients who have received treatment. This indicates that achieving an adequate response to these mood states remains a challenge.

In relation to a case of a patient with pediatric bipolar disorder who received treatment with SSRIs in the CABS program, we reviewed the existing literature regarding the efficacy, safety, and tolerability of antidepressant medications in the pediatric population with bipolar disorder.

We conducted a literature review of studies published in the past five years. We searched PubMed using the keywords “antidepressant,” “pediatric bipolar depression,” and “bipolar disorder.” We discuss the case of a 17-year-old patient undergoing treatment in the CABS program with a diagnosis of bipolar I disorder.

Studies have found that antidepressants are generally safe and well-tolerated. However, in bipolar disorders, antidepressants should be used in combination with mood stabilizers to reduce the risk of manic or hypomanic switching, especially in bipolar I disorder. The combination of olanzapine and fluoxetine has been found to be effective and has been approved by the FDA for both adults and adolescents with bipolar depression. SSRIs have shown effectiveness for pediatric bipolar depression in some studies, although the level of evidence is low. They are mainly used in cases of bipolar depression with comorbid anxiety. Bupropion is used off-label for ADHD in both pediatric and adult populations and is often prescribed for depression associated with bipolar disorder in adults. It is considered to have a lower risk of manic or hypomanic switch. Evidence for the use of ketamine in bipolar depression in adults remains unclear, particularly regarding long-term effects.

We present the case of a 17-year-old male with a diagnosis of bipolar I disorder who is undergoing treatment in the CABS program. He has a history of two hospitalizations and is currently being treated with aripiprazole. Escitalopram was added after he reported anxiety symptoms that aripiprazole was not addressing, resulting in a favorable response with no reported side effects.

Antidepressants may play a role in some cases of pediatric bipolar depression, especially when anxiety symptoms are also present and do not respond to psychotherapeutic approaches. It is important to balance the risks and benefits of using antidepressants in this population. Close monitoring is recommended to assess response and possible side effects. Further research regarding the treatment of pediatric bipolar depression is needed.

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Religion plays a big role in daily life in Palestine: it helps give meaning and purpose and creates communities and mutual understanding. Thus, individuals frequently bring up various thoughts and ideas with religious themes and undertones during psychiatric interviews, reflecting their inner and outer experiences. Religious references can be misunderstood when discussed by individuals of religious minorities, such as Palestinian Christians, who comprise around 1% of the Palestinian population in the West Bank (2023 Report on International Religious Freedom). Studies on the mental health of Palestinian minorities are almost nonexistent.

Examining the responsibility of psychiatrists to provide culturally sensitive care to their patients, including religious minorities.

A case report of a Palestinian Christian patient admitted to an acute psychiatric ward in Palestine. This 37-year-old male patient, who has struggled with mental health issues for the past 4 years, presented to Bethlehem Psychiatric Hospital after 10 days of suspiciousness, disturbed behavior, and verbal aggression toward family members. On examination, the patient was found to have a tense elevated mood with persecutory, reference, and grandiose delusions. The patient frequently brought content and references from the liturgy and the New Testament. Blood and urine tests were within normal range and showed no substance use. The patient was started on Olanzapine 15mg and Valproate 400mg.

A review of his hospital file revealed that after 2 weeks on medications, he no longer displayed ideas of delusional intensity. However, the patient mentioned events and lessons from the books of Revelation and Acts of the Apostles of the Christian Bible. He had a particular fascination with their relation to the Old Testament and the image of “tongues of fire” from the Pentecost. Due to his prior psychotic symptoms and limited overall knowledge of Christianity, it was difficult for many staff members to assess his thought content. These challenges were overcome by discussions with Christian hospital staff, gathering collaterals from his family, and self-education. The patient was using moments of transition in the Bible to describe his transition to a non-psychotic state. He was discharged soon after and referred to a community mental health center.

It is common for Arab patients to have psychiatric pathology of religious themes. These are important to distinguish from cultural expressions of emotions and experiences. To provide inclusive and comprehensive care, it is essential for clinicians to have an appropriate understanding of the religions, spirituality, and diversity of the populations they are serving.

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Fluoxetine, the first selective serotonin reuptake inhibitor, is the world’s most prescribed antidepressant. Several mechanisms of action underpin the effect of this antidepressant, such as enhancing serotonin (5-HT) neurotransmission, increasing hippocampal neurogenesis, neuronal survival and cerebral angiogenesis. The effects of fluoxetine on stem cell behaviour and tissue regeneration beyond the central nervous system have been little studied to date.

We investigated whether fluoxetine (FLX) might have broader peripheral regenerative properties using a recognized regenerative medicine paradigm such as the animal model of ad integrum muscle regeneration.

To investigate the impact of fluoxetine (FLX) on muscle at steady state, FLX was delivered per os at 18 mg/kg daily for six weeks to uninjured wild-type and specific transgenic mice. To investigate FLX´s regenerative capacity on skeletal muscles, we delivered FLX for six weeks and then performed notexin-induced injuries (phospholipase that induces a severe muscle necrosis) of the tibialis anterior muscle in wild-type and specific transgenic mice. Muscle force, muscle stem cells number, dividing muscle stem cells, differentiating muscle stem cells number, vessels number and muscle fiber parameters were specifically assessed.

After prolonged administration (6 weeks) of fluoxetine to male mice, we showed that prolonged FLX treatment increased the number of muscle stem cells and muscle angiogenesis in mice. FLX also improved skeletal muscle regeneration after single and multiple injuries induced by intramuscular notexin injection. The acceleration of muscle regeneration induced by FLX resulted from a triple action marked by an increase in the muscle stem cell pool, an increase in vessel density and a reduction in fibrotic lesions and inflammation. In vitro, we showed that the proliferative effects of FLX on immortalized myoblasts were dependent on 5-HT and 5-HT1B receptor activation. In vivo, mice lacking peripheral 5-HT treated with FLX did not show positive effects during muscle regeneration. Moreover, pharmacological, and genetic inactivation of the 5-HT1B receptor in muscle stem cells also abolished the FLX-induced improvement in muscle regeneration.

We show that FLX promotes a harmonious muscle regeneration underpinned by a combined action on myogenesis, angiogenesis and inflammation. These results highlight the serotonergic identity of skeletal muscle and point to a promising therapeutic strategy for endogenous muscle diseases. Beyond muscle and brain, this work opens new perspectives of investigation both on the role of serotonin and the 5-HT1B receptor in other types of stem cells and on the therapeutic potential of antidepressants in regenerative medicine.

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Treatment-resistant schizophrenia remains a major challenge in psychiatry due to its resistance to conventional therapeutic interventions, leading to persistent symptoms and functional impairment. Efforts to address it focus on exploring alternative approaches, including novel medications, psychosocial interventions, and neurostimulation techniques.

To determine the sociodemographic and clinical profile of patients with treatment-resistant schizophrenia.

We conducted a retrospective descriptive study involving patients diagnosed with treatment-resistant schizophrenia at Psychiatry Service D of Razi Hospital in Tunisia over a five-year period (2019-2023). Data collection was conducted retrospectively by initially referring to medical records and subsequently verifying and supplementing information through patient or family interviews. Sociodemographic variables included age, gender, educational level, socioeconomic status, marital status, and occupation. Clinical data of interest comprised age at onset of mental disorder, duration of untreated psychosis, illness duration, family history of mental illness, previous treatments and their dosages, medical and psychiatric comorbidities, therapeutic adherence, and clinical scores using the Positive and Negative Syndrome Scale (PANSS).

The sample size is 30 patients.

We identified a distinct demographic and clinical profile among patients diagnosed with treatment-resistant schizophrenia. The cohort exhibited a notable male predominance, constituting 60% (n=18) of the study population, with a mean age of 39 ± 14.58 years. The majority of patients were unmarried (70%, n=21) and belonged to a lower socioeconomic status (80%, n=24).

In terms of clinical characteristics, patients experienced an early onset of the disorder at 18 ± 3.58 years, coupled with a prolonged duration of untreated psychosis averaging 8 ± 2.65 years. There was a substantial prevalence of family history of mental illness among the cohort (80%, n=24).

The initial psychiatric assessment, based on PANSS scores obtained from the first hospitalization, revealed elevated symptomatology levels: Positive subscale score averaged 28 ± 5.23, Negative subscale score averaged 20 ± 4.53, and General psychopathology score averaged 65 ± 10.02.

Comprehensive clinical and sociodemographic profiling of individuals with treatment-resistant schizophrenia is essential for enhancing clinical outcomes and tailoring treatment strategies. This approach allows clinicians to better understand the unique challenges these patients face, enabling the development of more targeted and effective interventions to improve their quality of life.

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The subtle, subjective nature of basic symptoms (BS) has often led to doubt regarding their clinical significance.

We therefore examined the prevalence, clinical significance and course of BS over three years in a large sample (N = 2684) of 16- to 40-year-old residents of the Swiss canton of Bern (response rate: 64%). At follow-up, persons with a lifetime risk symptom at baseline were compared with control subjects (N = 834; response rate 66%). Fourteen criteria-relevant BSs were assessed by trained clinical psychologists over the telephone, along with information on symptomatic ultra-high-risk symptoms, mental disorders and functioning.

At baseline, 18% of the participants reported any lifetime BS, 10% had still experienced one in the three months prior to the interview. In general, BS were rare, and only 2% of the participants met any BS criteria, which was significantly associated with non-psychotic mental disorders (OR = 5) and especially with functional deficits (OR = 16). At follow-up, five individuals had developed psychosis, one with BS criteria and three more with BS at baseline. In addition, 95% of the participants no longer met the BS criteria, while 3% reported new BS criteria.

Although BS are not rare phenomena in the community, they rarely persist and rarely occur frequently enough to meet the requirements of the risk criteria. Furthermore, they do not appear to occur randomly, but are restricted to a subpopulation of vulnerable individuals – possibly occurring in times of stress and/or low mood and functional difficulties in these individuals.

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Nurses often face situations where they must deal with aggression from patients or even coworkers. This challenge can have negative consequences for both medical staff and patients.

The aim of this study is to examine the relationship between the level of aggression, the severity of fatigue, and the occurrence of sleep disorders among nursing staff.

The study was conducted in Szczecin and was survey-based, involving 241 nurses working in surgical wards, medical wards, outpatient clinics, and the emergency department. The following tools were used to collect data: a custom survey, the Fatigue Severity Scale (FSS), the Athens Insomnia Scale (AIS), the Buss-Perry Aggression Questionnaire (BPAQ), and the Pittsburgh Sleep Quality Index (PSQI).

It was found that a greater tendency toward overall aggression, verbal aggression, and higher levels of anger and hostility were associated with more severe insomnia problems (p<0.05). Data analysis showed statistically significant correlations (p<0.05) between overall, physical, and verbal aggression, as well as hostility (based on BPAQ) and sleep quality (based on PSQI). A statistically significant positive correlation (p<0.05) was also found between fatigue levels (FSS) and sleep quality (PSQI) — the higher the level of fatigue, the worse the sleep quality.

Table 1. Comparison of results according to BPAQ and AIS, PSQI

There is a link between aggression levels, fatigue, and sleep disorders. Individuals with stronger tendencies toward aggression were more likely to experience insomnia and sleep problems. Those with higher levels of fatigue also experienced more frequent insomnia and sleep disturbances. Preventive and therapeutic measures are necessary to improve the health of nursing staff.

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The SABAS is a single-factor measure of problematic smartphone use, with higher scores indicating a potential addictive tendency. Some researchers (Peng et al., 2023) suggest a cutoff point of 23 out of a maximum available score of 36. Other researchers consider a high mean a guideline without suggesting a possible threshold. This score will indicate the presence of the problematic factor under investigation, regardless of age.

Our study aims to identify a score for problematic smartphone use that may already indicate vulnerability to addiction. The research investigates the proposal of a possible cutoff point for problematic smartphone use based on several SABAS surveys over 9 years.

In our research, 1228 participants completed four online surveys between 2015 and 2023. The age distribution was 9-73 years, with 41.2% male and 58.8% female. Our research instrument was the Smartphone Application-Based Addiction Scale (Csibi et al., 2018) questionnaire, a 6-question questionnaire designed to detect problematic smartphone use. We hypothesized that SABAS scores that show a significant relationship with cutoff scores of clinical questionnaires with convergent validity (NMP-Q, SPAI, SHAI, FNPQ) could be as cutoff scores within the measure.

Our results showed a significant correlation between SABAS and NMP-Q scores (r(238) = .63, p = .001), with the mean of the moderate-severity nomophobia score (88.5 points) being the mean of the SABAS 23 score. For the response distribution corresponding to the NMP-Q prevalence of severe nomophobia (100 points or more), the SABAS score mean was 29 points. The mean scores on the SPAI questionnaire were 85.82 (SD=22.76) and 97.17 (SD=31.65), respectively, for the subscales Functional Impairment 22.47 (SD=8.41) and 27.29 (SD=9.59), Compulsive Behaviour 29.48 (SD=9,03) and 34.41 (SD=11.64), Withdrawal 21.77 (SD=6.41) and 23.41 (SD=8.55), and Tolerance 12.10 (SD=3.61) and 12.05 (SD=4.64). The correlation was also evident for the SHAI (r(439) = .67, p = .001), its subscales, and the FNPQ scale (r(398) = .27, p = .001).

The mean SABAS score indicating problematic smartphone use was 23 points, with scores above this point indicating increasingly severe use of analyzed behavior. Those with a score of severe nomophobia scored 29 or higher on the SABAS scale. The SABAS shows a significant relationship with the cutoff scores of the convergent validity questionnaires along the mean scores indicated above (23,29), so we suggest using these scores as cutoffs.

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Self-regulation refers to a structured mental process for initiating, organizing, maintaining, and managing internal and external activities directed toward achieving goals. Each individual exhibits a unique self-regulation style that influences their capacity to adapt to changing circumstances. During the COVID-19 pandemic, a significant rise in anxiety, depression, and stress levels was noted in Russia. Emotional disorders may relate to self-regulation styles, as they affect an individual’s adaptation to evolving internal and external stressors.

The study investigates relationships between self-regulation styles and depression, anxiety, and stress levels among humanities students and HIV-positive patients, shedding light on how behavioural self-regulation affects emotional responses in different population segments during the pandemic in the Russian Federation.

Data were collected from January to July 2021 using a Google form. The sample included 35 humanities students from Russian universities and 59 HIV-positive patients. V.I. Morosanova’s “Style of Self-Regulation of Behaviour” questionnaire was used to assess self-regulation styles, while the DASS-21, adapted for Russian contexts, measured levels of depression, anxiety, and stress.

We found that in the group of Russian university students, depression had negative correlations with behavioural programming (rs = -0.421, p < 0.05) and with outcome evaluation (rs = -0.401, p < 0.05). In the HIV patient group, depression had negative correlations with modelling (rs = -0.322, p < 0.05) and flexibility (rs = -0.285, p < 0.05), anxiety also with modelling (rs = -0.270, p < 0.05) and flexibility (rs = -0.261, p < 0.05). In both groups, stress was not related to self-regulation behaviour style.

The study highlights the association between emotional disorders and self-regulation was more pronounced in the HIV-positive group. Depression and anxiety corresponded with reduced reality assessment and flexibility in self-regulation. These patients found it more challenging to evaluate internal and external factors and adjust their self-regulatory processes amid changing conditions, indicating a greater vulnerability to disruptions in self-regulation. Within the students’ group, depression alone affected self-regulation, particularly diminishing abilities in programming and outcome evaluation. As depressive symptoms worsened, students struggled to effectively plan actions and assess their behaviour and achievements.

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In Spain, approximately 4% of the prison population suffers from severe mental disorders, with schizophrenia being more prevalent in this group compared to the general population. Although violent behavior is infrequent among individuals with schizophrenia, it holds significant clinical importance. Reoffending rates are low, and crimes are typically less severe. Comorbid substance abuse is also common.

This study examines the case of a man with schizophrenia who committed homicide under the influence of drugs, highlighting the complex relationship between schizophrenia and violence.

We present the case of a 30-year-old man with no prior medical or legal history, sentenced to five years and nine months in prison for homicide (of his sister), resisting arrest, and minor injuries. The homicide occurred after the consumption of MDMA. The initial forensic report revealed no severe psychopathy and a preserved sense of reality, while the defense argued moderate impairment of cognitive and volitional faculties due to intoxication and extreme fatigue.

After spending a few months in prison, he attempted suicide by hanging, which did not require admission and was considered reactive to a stressful life situation. During his incarceration, the patient exhibited progressive thought disorganization, eccentric behaviors, hallucinations, and delusional ideation unrelated to substance use. He also engaged in severe self-harm, requiring bilateral orchiectomy. Following this, he was diagnosed with schizophrenia and treated in a psychiatric unit. Since 2022, he has been included in the Integrated Care Program for Severe Mental Illnesses in Prison (PAIEM) and treated with extended-release paliperidone. After release, he was incorporated into the Continuity of Care Program, maintaining regular consultations with psychiatry, nursing, and social work. He has integrated well into the psychosocial rehabilitation center, showing no behavioral disturbances. He reports almost complete amnesia of the offenses for which he was convicted and exhibits some indifference towards them. He continues to receive treatment and is diagnosed with schizophrenia, predominantly with negative symptoms.

This case underscores the need to adequately assess negative symptoms of schizophrenia and their impact on violent behavior. The successful transition of the patient from prison to a specialized center highlights the importance of continuous treatment and monitoring in cases of severe mental disorders. Effective management of treatment and post-prison follow-up is crucial for minimizing risks and promoting successful community integration.

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Public health and policy require effective health strategies for diverse contexts. Despite numerous studies, a gap exists in translating knowledge to real-world scenarios. The RESPOND study’s stepped-care intervention has shown efficacy in anxiety and depression among healthcare workers, recognized by the European Commission as a best practice. Conducting a pilot trial in Madrid, we aimed to address this research-to-practice gap.

After evaluating a previous randomized controlled trial, we adapted our intervention for a primary care center in Madrid, implementing it over 5-6 weeks in November-December 2023. We used two strategies: remote delivery via app or website with weekly calls, and hybrid, with group sessions instead of calls.

Gathering data included sociodemographic (age, gender, and type of job), clinical (Kessler Psychological Distress Scale, K-10), and qualitative insights through interviews, to explore implementation outcomes from Proctor’s model (Acceptability, Appropriateness, Feasibility, Fidelity, and some ideas for future large-scale implementation). We used mixed methods to analyse data. For the quantative data, we used descriptive statistics such as means, frequencies and percentages to describe the results. For qualitative data, interview transcriptions were analysed following thematic analysis guidelines.

We included 17 out of 39 healthcare workers (44%) working at the primary care center, the sample included 8 doctors, 5 medical residents, 3 nurses, and 1 social worker. Only 3 were male. Over half chose the hybrid option, with 2 dropouts. Regarding clinical information, 88% of participants initially reported psychological distress, but after the intervention, this dropped to 66%. Participants found the intervention timely and appropriate, with an average satisfaction rating of 8 out of 10.

Preliminary findings show the intervention was well-received, and both strategies were successful, reaching a broad audience. Thematic analysis of the interviews is still ongoing. Preliminary results suggest that these strategies are appropriate /feasible for the Madrilenian healthcare system.

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ASD is a neurodevelopmental disorder with 1% prevalence among children and adolescents, with high comorbidity with Intellectual Disability. ASD imposes a significant disease burden and is a leading cause of disability among children and adolescents. Its aetiology is multifactorial, including both genetic and environmental factors. Although prior studies have explored the incidence, comorbidities and several prenatal risk factors, research especifically focusing on ASD categorization by ID is limited.

The aim of this study was to report the incidence and cumulative incidence of overall ASD, and HF and LF-ASD categorization, utilizing several national registers.

This study consisted of all singltone born in Finland between 1998 and 2015 (N=1,044,102), who were diagnosed with ASD from age 3 to 20. We devided study sample into four cohorts by birth year: 1998-2002, 2003-2007, 2008-2011 and 2012-2015. We also categorized ASD into LF-ASD and HF-ASD, based on their comorbidity with ID (ICD 10 codes: F70-F79). All cases (n=10,171) were matched with Controls (n=49,391) on the age, gender and place of birth. We limited our study of other psychiatric disorders comorbidities to the oldest birth cohort, born in 1998-2002. The association between sociodemographic risk factors and ASD cases and separately for HF-ASD and LF-ASD was analysed using Conditional logistic regression.

The incidence of ASD increased with age, specifically among girls. Among the birth cohorts, the cumulative incidence of HF-ASD increased from 0.52 (95% CI 0.49-0.54) to 0.89 (95% CI 0.84- 0.94), by age 10, while in the cumulative incidence of LF-ASD remained stable at 0.17 (95% CI 0.16-0.19). Several socio-demographic risk factors were associated with both HF-ASD and LF-ASD, except for parental immigration, which was only associated with LF-ASD. A total of 58.99% cases had at least one comorbid diagnosis, 35.91% of HF-ASD and 31.86% of LF-ASD. The most common comorbid diagnoses among HF-ASD cases were ADHD (33.9%), depressive disorder (25.4%) and anxiety disorder (23.9%). Among LF-ASD cases were ADHD (17.2%), anxiety disorder (10.5%) and Schizophrenia (5.2%).

The incidence of diagnosed ASD increased with age from 1998-2018, especifically HF-ASD. This result could indicate a real increase in incidence or is due to improved access to mental health services and enhanced awareness of ASD among population and professionals. The rise in ASD incidence underscores the need for specialized mental health services and social support. The association between immigration and the risk of ASD highlights the importance of ensuring mental health services are accessible to immigrants.

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The increasing incidence of mental disorders poses an urgent challenge for psychiatry—one that cannot be addressed by treatment alone. The only sustainable path forward is to prioritize mental health promotion and primary prevention at all levels: universal, selective, and indicated. While often seen as a long-term investment, primary prevention is cost-effective and essential for reducing the future burden of mental illness. This is not science fiction; it is a necessary shift that must happen now within our clinical services. In this lecture, I will show how primary prevention is already being implemented within the Institute of Psychiatry and Mental Health in Madrid, showcasing real-world programs that integrate prevention into everyday psychiatric practice. By embedding prevention into mental healthcare, we can move from a reactive to a proactive model—one that truly addresses the root causes of mental disorders and ensures a healthier future.

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Burnout is defined by the WHO as “a feeling of intense fatigue, loss of control and inability to achieve concrete results at work”. Among the most affected populations, are medical and paramedical teams, particularly those exposed not only to a sustained work rhythm but also to frequent confrontations with suffering and death, such as emergency staff.

Evaluate the frequency of burnout among medical and paramedical staff and determine the factors associated with it.

A 1-month cross-sectional study (November to December 2023) was conducted in the emergency department of Charles Nicolle’s hospital, Tunis. We included all medical and paramedical staff. Data were collected using an anonymous online questionnaire on Google Forms. We used the Maslach Burnout Inventory (MBI) as a rating scale.

Forty-five forms were completed. The average age was 29 ±2 years, with a male predominance (69%). Twenty-four percent were already being treated for a psychiatric condition. The average length of service in the emergency department was 8 ± 2 years.

The prevalence of burnout was 98%. Burnout was high in 43% of study participants. Fifty-two percent had a high level of burnout, 63% had a high level of depersonalization and 88% had a low level of sense of personal accomplishment. High burnout was more common among women (79% vs. 21%). Of the participants with high burnout: 31.6% were family doctors, 21% were nurses; 15.7% were emergency physicians (residents or seniors in emergency medicine) and 15.7% were emergency technicians.

Burnout risk factors were divided schematically into 3 categories: among organizational risk factors, 98% complained of work overload with insufficient human and material resources, 44% reported the absence of listening and support from hierarchy, and 31% experienced the feeling that their missions were imprecise. Among the professional risk factors, 78% reported an incompatibility between salary and workload, 67% did not receive any words of recognition from the patient or his family, and 53% did not have any specific training in stress management. Not being able to take time off as they wished was the most reported personal risk factor (76%).

A desire to improve working conditions was present in 80% of participants.

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A very high prevalence of burnout has been found within the emergency care team, which could explain their despair of the healthcare system and the increasing exodus rate leading to a potential medical and paramedical desert in Tunisia. It would therefore be urgent to improve working conditions and provide more facilities for young doctors and nurses, particularly in emergency departments.

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The therapeutic alliance (TA) is increasingly acknowledged as a fundamental quality of care indicator. Numerous guidelines advocate TA awareness in practice, but lack specifics on building a strong TA. Yet, previous studies have found independent associations between levels of self-esteem, the quality of TA and severity of clinical symptoms in people with schizophrenia and other psychotic disorders. It suggests that the TA possibly mediates the relationship between self-esteem and psychotic symptoms. The present study therefore examined the relationships between these three factors in people with psychotic disorders.

Investigating the mediating effect of TA on the relationship between self-esteem and psychotic symptom severity.

The short forms of the Self-Esteem Rating Scale and the Working Alliance Inventory, respectively, were used to assess self-esteem and TA. Psychotic symptoms were evaluated using the Positive and Negative Syndrome Scale. Linear regression models were applied, followed by a mediation-model when appropriate.

A higher self-esteem significantly predicted less severe psychotic symptoms (B = -.312; β = -.46, p <.001) and better TA (B = .123, β = .255, p = .009). There was no significant relation between TA and psychotic symptom severity (B = -.161; β = -0.109, p = .289), therefore no mediation-analysis was performed.

We found no association between TA and psychotic symptoms, which may be explained by the mild psychotic symptoms and overall high satisfaction scores on TA in our chronic sample. Another factor might be that current measurements assume a one-on-one relationship between a client and a professional, while nowadays multiple professionals are involved. We recommend re-evaluating the definition and assessment of the TA within chronic psychiatric populations. Our study results also offer practical guidelines for clinicians to improve their quality of care, such as the recommendation to focus on enhancing self-esteem in people with psychosis.

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Anesthesia and critical care professionals are particularly vulnerable to burnout due to the demanding nature of their work, including long hours, night shifts, high-stress situations, and the constant risk of medical errors. Emotional intelligence (EI) has emerged as a crucial factor in fostering positive professional relationships and mitigating burnout.

To study the association between EI and burnout among healthcare workers in anesthesia and critical care settings.

This is a cross-sectional descriptive and analytical study conducted over a period of 3 months in 2024. It included 72 healthcare workers in the anesthesia and critical care departments at the Sahloul University Hospital in Sousse. The survey was based on a self-administered questionnaire, including data on socio-demographic and professional characteristics, the Maslach Burnout Inventory (MBI), and the Schutte Self-Report Emotional Intelligence Test (SSEIT).

The majority of participants were female (58.3%) with an average age of 33 years. Most participants (61.1%) were nurses, and 40.3% worked in the surgical critical care unit. The average EI score was 103.26. Among the EI factors, emotion perception was the most affected, with a score of 30.69 ± 9.34. EI levels were low in 11.1% of cases. Severe burnout was present in 19.4% of participants, and 65.3% had a high emotional exhaustion (EE) score. Additionally, 70.8% had a high depersonalization score, and 58.3% exhibited low personal accomplishment. EI levels was statistically associated with time spent with family and friends (p = 0.027). Among the professional factors, job satisfaction was significantly associated with EI level (p = 0.001). The factors significantly associated with severe burnout were the absence of alcohol consumption (p = 0.000) and the absence of time spent with loved ones (p = 0.033). A significant relationship between EI and self-emotion management and EE was reported (p = 0.040).

EI is crucial for preventing burnout among healthcare workers in anesthesia and critical care. By enhancing positive attitudes, managing stress, and improving interpersonal skills, EI can improve work life and patient care. Incorporating EI training into health science curricula can equip future providers with essential tools for well-being.

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