Risk assessment tools are used to enhance patient safety and promote quality care by limiting adverse outcomes to the greatest extent possible. In the Republic of Ireland, risk is monitored and regulated by the Mental Health Commission (MHC). A 2023 report by the MHC identified high numbers of recorded episodes of sexual assault on the acute inpatient unit in the Department of Psychiatry (DOP), University Hospital Waterford (UHW). Standard risk assessment tools are used in the DOP, however, these risk assessment tools failed to identify those who were at high risk of perpetrating a sexual assault.

The purpose of this research was to determine if there were risk assessment tools with a higher predictive value of identifying risk of sexual assault in an acute adult inpatient psychiatric setting. I also wanted to establish whether there were risk assessment tools available which assess risk of sexual assault in those with no history of perpetrated sexual assault.

This scoping review was prepared according to the PRISMA-Scr guidelines. Databases including Embase, Medline, CINAHL, UptoDate, TRIP, Cochrane and PsychINFO were searched. Keywords included inpatient, psychiatry, mental health, risk assessment tools, risk assessment scales, risk management, sexual assault and sexual offense. There was no limit on the date of publication or country of origin of articles. Only articles that used risk assessment tools on adults, who were inpatients in an acute psychiatric setting, in the English language were included. Only risk assessment tools that included assessment of risk of sexual assault were included.

A total of 15 articles were identified. There was a dearth of literate that compared risk assessment tools in this population with regards to risk of sexual assault. Most articles exploring risk of sexual assault focused on the study of those who were offenders and explored the risk of recidivism through the use of risk assessment tools.

Risk cannot be accurately predicted or eliminated. However, determining the most appropriate and comprehensive risk assessment tools, with the highest probability of identifying risk of sexual assault has the potential to enhance patient safety and improve the quality of care provided. There is a lack of risk assessment tools that assess sexual assault, especially in those with no prior history of perpetrating a sexual assault.

None Declared

The variety and efficacy of biomarkers available that may be used objectively to diagnose Major Depressive Disorder (MDD) in adults are unclear. This systematic review aims to identify and evaluate the variety of objective markers used to diagnose MDD in adults.

This systematic review aims to identify and evaluate the variety of objective markers used to diagnose MDD in adults.

The search strategy was applied via PubMed and PsycINFO over the past 10 years (2013-2023) to capture the latest available evidence supporting the use of biomarkers to diagnose MDD. Papers were excluded if they were published in a non-peer-reviewed journal and/or not published in English; featured non-primary study designs (e.g. systematic review, meta-analysis, literature review); included children or adolescents in the study population; featured participants without a clinical diagnosis of MDD; featured participants with a diagnosis of other forms of MDD such as treatment resistant depression, vascular depression, remitted depression. Data was reported through narrative synthesis.

42 studies were included in the review. Findings were synthesised based on the following measures: blood, neuroimaging/neurophysiology, urine, dermatological, auditory, vocal, cerebrospinal fluid and combinatory – and evaluated based on its sensitivity/specificity and area under the curve (AUC) values. The best predictors of blood (MYT1 gene), neuroimaging/neurophysiological (5-HT1A auto-receptor binding in the dorsal and median raphe), urinary (combined albumin, AMBP, HSPB, APOA1), cerebrospinal fluid-based (neuron specific enolase, microRNA) biomarkers were found to be closely linked to the pathophysiology of MDD.

A large variety of biomarkers were available to diagnose MDD, with the best performing biomarkers intrinsically related to the pathophysiology of MDD. Potential for future research lies in investigating the joint sensitivity of the best performing biomarkers identified via machine learning methods and establishing the causal effect between these biomarkers and MDD.

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The COVID-19 pandemic has had a profound impact on mental health globally, exacerbating existing mental health disorders (MHD) and substance use disorders (SUD). Various measures have been implemented to mitigate these adverse mental health consequences. Nevertheless, the significant rise in mental health challenges has underscored the role of psychotropic drug prescriptions as an important metric for assessing mental health trends in certain populations. During the pandemic, data from high-income countries, indicate an increase in the prescription of psychotropic drugs. This might reflect heightened mental health needs in the general population, but also may underscores the exacerbated vulnerability of individuals with pre-existing concurrent MHD/SUD. Prescribing psychotropic drugs can be complex due to the potential for misuse and the need for careful monitoring to balance therapeutic effects with the risks.

This study aimed to evaluate 1) the number of prescriptions of psychotropic drugs in persons with concurrent MHD and SUD in the years before and during the two COVID-19 pandemic years (2020 and 2021) and 2) to study the impact of the COVID-19 pandemic on the consumption of psychotropic drugs among this population.

We conducted a retrospective cohort study based on a data file constructed by merging individual-level information from the Norwegian Patient Register and the Norwegian Prescribed Drug Registry, analysing data from 2019-2021. The International Classification of Diseases (ICD)-10 main diagnosis, chapter V have been used to identify persons with MHD/SUD. We recognised 35.000 individuals who received a diagnosis of co-occurring MHD/SUD between the years 2019-2021. A graphical approach and descriptives were applied to study the population. Interrupted time series analysis was used to compare changes in trends in the prescriptions dispensed by eight psychotropic drug classes, according to the consecutive COVID-19 waves during the first two years of the pandemic.

Preliminary analysis show, an increased prescription rate in all eight psychotropic drugs classes in persons with MHD/SUD during the first two years of the pandemic, compared to 2019. The largest increases were shown to appear parallel with the COVID-19 waves. Antipsychotics and anxiolytics were the most prevalent prescribed drugs, followed by opiates, hypnotics & sedatives and antidepressants. Being female and older age was associated with higher odds of receiving a prescription, regardless psychotropic drug class.

The prescription of psychotropic drugs has gradually increased from 2019-2021. More research is needed to differentiate increases due to unmet needs versus overprescribing and further, to study the long-term effects of the pandemic regarding the utilization of psychotropic drugs in this vulnerable patient group.

None Declared

Emerging evidence on the bidirectional connection between gastrointestinal microbiota and brain, through the gut-brain axis, and its influence on mental disorders makes the gut microbiota a potential target for novel therapeutic approaches.

We aim to study and synthetize the current data about the influence of gut microbiome on psychiatric disorders.

Our literature research focused on some of the most significative English-written articles published in the last decade.

Most of the relevant literature suggests that the presence of a healthy and diverse gut microbiota is essential to normal cognitive and emotional processing. Also, it has been shown that consumption of probiotics can modify the functional activity of the areas in the brain that are implicated in cognitive functions.

The literature also supports that stress can change gut permeability as well as the composition of gut microbiota resulting in a pro-inflammatory profile of cytokines produced by gut microbiota. Besides, gut microbes can modulate the stress response and the level of anxiety through alterations in serotonin signaling.

It has been also demonstrated that in animal models of depression the composition of gut microbiota was changed. On the other hand, other studies demonstrated certain probiotics can attenuate depressive symptoms in rodent models.

Regarding eating disorders, Anorexia Nervosa seems to have impact on the gut microbiota balance through restrictive diets and the abrupt change in diet during nutritional rehabilitation. The use of prebiotics, probiotics, antibiotics or faecal transplantation looks promising as important novel adjuvant treatments.

The effect of gut microbiota on several mental disorders is supported by a increased volume of experimental data.

However, research in this field is still unfolding and more studies should be performed to apply new techniques focusing on gut-brain axis in clinical practice.

None Declared

One of the main symptoms of schizophrenia is auditory hallucinations. Although reliable epidemiological data is limited, the prevalence of schizophrenia among the deaf community seems to be about the same as in the general population. Approximately 50% of deaf individuals diagnosed with schizophrenia report ‘hearing’ voices or experiencing the sensation of communication in the absence of external input. Minimal information is available regarding the perceptual aspects of voice hallucinations in congenitally deaf individuals.

With this case report, we aim to describe auditory hallucinations in a patient with congenital deafness and discuss auditory hallucinations in deaf individuals. We will also examine how these phenomena may fit into explanatory subvocal articulation hypotheses, providing insights into language modality and auditory deprivation.

Description of a clinical case of a deaf patient with auditory hallucinations in a psychiatric outpatient consultation.

The authors report a case of a 26-year-old male patient with congenital deafness and no prior psychiatric or relevant medical history. He communicated preferably by sign language and also by lip reading. The consultation was realized with the presence of a sign language interpreter. The patient was referred to a psychiatric outpatient appointment due to a 1-year history of bizarre behavior, social isolation, and apparent psychotic symptoms. He lived with his parents and was currently unemployed. According to his mother and brother, he “spoke and laughed alone, like he was talking with someone”. In his mental status examination, he presented a religious delusion and likely auditory hallucinations. He had no changes in his physical and neurologic examination. Blood tests, urinalysis, and urine screening for drug abuse were performed, with normal results. Computed tomography of the brain and an electroencephalogram were also performed, with no significant changes. Over time, the patient was diagnosed with schizophrenia and was medicated with paliperidone with remission of his symptoms.

These findings highlight how auditory hallucinations in congenitally deaf individuals offer a unique view of the interplay between sensory perception and the experience of ‘voices.’ The subvocal articulation hypothesis suggests that auditory hallucinations may arise from disruptions in inner speech mechanisms—subtle, unconscious movements that the brain misinterprets as external voices. In deaf individuals, this experience may manifest through sensory feedback loops adapted to visual modalities, such as the perception of sign language movements, rather than through purely auditory sensations. This shows how language and sensory experiences shape hallucinations, emphasizing the need to consider sensory differences in psychotic symptoms across populations.

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Patients following traumatic injury (TI) are at increased risk of developing dementias, yet an efficient, validated screening instrument is lacking.

In the current study, we developed the Dementias following Traumatic Injury Screening (DEMTIS) score, a brief post-TI dementias screening tool.

We identified 270,843 electronic health records from Hong Kong patients admitted for TI between 2001 and 2021. The records were randomly split into training (80%; n=258,739) and testing cohort (20%; n=50,883). The DEMTIS was developed based on a backward stepwise multivariate Cox proportional hazard model predicting first-ever dementia diagnosis. Competing risk survival analyses were used to predict the risk of Alzheimer’s disease (AD) and vascular dementia (VD), while taking the risk of other dementias into account. Model discrimination of the three scores was evaluated using concordance statistics (c-statistic) calculated as the area under the receiver operating characteristic curve. Statistical significance was set at p<.01.

The 5-year, 10-year, and 20-year risk of all-cause dementias following TI was 2.1% (95% CI 0.020-0.021), 3.8% (95% CI 0.037-0.039), and 6.5% (95% CI 0.063-0.066), respectively. The final model included sex, TI characteristics, physical covariates, history of mood and anxiety disorders, and cerebral degenerative disease (See Table 1). The population mean of DEMTIS was 59.45 (SD=21.29). The optimal threshold of DEMTIS predicting dementia was determined at 75 using the closest top left rule. Individuals at high risk (DEMTIS≥75) were associated with a 6.0% (95% CI 0.059-0.061) risk of dementia in 5 years, whereas those at low risk were associated with a 0.5% (95%CI 0.004-0.005) risk (see Figure 1; Figure 2). The model predicting 5-year dementia has an overall c-statistic of 0.835 (95% CI 0.832-0.839) in the testing data (see Figure 3). We further developed risk scores for 5-year AD and VD based on the findings from competing risk models; the c-statistics of model for AD and VD are 0.857 (95% CI 0.844-0.871) and 0.837 (95%CI 0.821-0.853) respectively.Table 1:

Calculation of the DEMTIS

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As a novel, easily accessible screening instrument, DEMTIS can identify patients at elevated risk of dementia following TI. It assists clinicians in evaluating patients’ risk of dementia and providing personalized care.

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In recent years, multiple observational studies have been conducted to investigate the hypothesis of a correlation between romantic love (RL) and the phenotypic expression of obsessive-compulsive disorder (OCD).

Our study aimed to evaluate the impact of RL on the clinical expression of OCD. Attention was specifically focused on investigating the onset of two OCD phenotypes with distinct characteristics, based on whether the subjects were at the onset of a romantic relationship or had experienced a romantic break-up, also considering the possible correlations with different clinical aspects and socio-demographic variables.

Our sample includes a total of 212 subjects with OCD recruited among outpatients at the University Psychiatric Clinic of Pisa, Italy, and the Federal University of Rio de Janeiro, Brazil. The following instruments were employed for psychometric assessments: the Structured Clinical Interview for DSM-5 (SCID-5), the Yale OCD Natural History Questionnaire, and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). The study participants were then divided into two groups (love-precipitated [LP-OCD] and break-up OCD [BU-OCD]) according to the romantic factor that was deemed responsible for the onset of OCD. An appropriate statistical analysis was applied.

The average age of onset of OCD was significantly different between the two groups, which may reflect a vulnerability of the brain’s maturational stages in young individuals who are at risk for OCD. A trend towards three types of obsessions and compulsions (aggression, sexual/religious and symmetry, ordering, and rearrangement) in the BU-OCD group emerged, which may reflect some normal features of a romantic relationship. However, total Y-BOCS obsessions and compulsions subscale scores were similar, indicating an overall severe clinical picture.

Despite some limitations, our results suggest that different stages of RL might influence some characteristics of OCD, namely age at onset and some specific dimensions, but would not appear to interfere with the overall severity of the disorder. These results should encourage further research on the topic to learn more about the characteristics of these individuals and to better understand how the most natural experience of humankind, that is love, may represent a vulnerability factor towards the onset and some features of OCD, similarly to other mental disorders, where the evidence is currently strongest.

None Declared

Nurses can play a critical role in suicide prevention, especially in hospital settings. The management of patients at risk of suicide requires specific nursing skills, including early recognition of warning signs and knowledge of preventive and protective strategies. Knowing risk factors and recognizing warning signs for suicide should be part of the professional background of any nurse training programs.

In this study we aimed to investigate nurses’s comfort, confidence and competence related to preventing suicide with a view to identify correct preventive strategies regarding the nursing management of patients at risk of suicide.

Our study presents the preliminary descriptive findings from an online survey in nursing staff working in different areas (medical, surgical, critical and emergency) in the Puglia Region. The survey aimed to assess the current knowledge, attitudes, behaviors and training needs of nurses regarding suicide prevention. 84 nurses working in the Puglia Region filled out the questionnaire.

Data highlighted that the majority of participants (81%) recognized the significant role of the nurses in the management of a patient at risk for suicide but only 14.3% believed they had specific training on patients at risk of suicide. 50% of them stated they do not have adequate preparation regarding the possible preventive strategies in suicidal patient. 57.1% of interviewed reported that they had never become aware of protocols or guidelines on the prevention and management of hospitalized patients at risk of suicide. Only 14.3% of those interviewed are satisfied with adequate training on suicidal risk factors in hospitalized patients and even only 7.1% state that they have never received adequate training on possible nursing interventions for the prevention of suicidal risk. Although endorsed suicide prevention guidelines in the health institution where they work, 57.1% responded that they have never viewed them and only 38.9% partially.

Our study highlighted the need to implement specific training programs for nurses on the management of patients at risk of suicide.

None Declared

People with severe mental illness die 10-20 years earlier than the general population. This is largely due to non-communicable diseases (NCDs) such as hypertension, diabetes and hypercholesterolaemia increasing the risk of cardiovascular disease, which is the greatest contributor to the excess mortality seen. The effect of these NCDs is likely to be greater in low-and middle-income countries such as Bangladesh, India and Pakistan due to additional barriers to health care access, lack of resources and other sociodemographic variables.

Our study aimed to estimate the proportion of individuals with SMI in Bangladesh, India, and Pakistan who were screened for NCDs and offered health risk modification advice. Furthermore, we also explored socio-demographic factors associated with the likelihood of being screened for NCDs within this demographic.

This cross-sectional study gathered data from three national mental health institutions in South Asia. Participants aged ≥18 years diagnosed with SMI were included. Data collection involved face-to-face interviews based on the World Health Organisation Stepwise (WHO-STEPS) approach to NCD risk factor surveillance, supplemented by anthropometric measurements and blood tests to confirm NCDs. The prevalence of screening, diagnosis, health risk modification advice, and treatment for diabetes, hypertension, and high cholesterol was assessed. A logistic regression model assessed the associations of sociodemographic characteristics with NCD screening.

3,989 participants were recruited. Screening prevalence varied by country and disease, with hypertension being the most commonly screened NCD (Bangladesh = 52.5% [50.0-55.1], India = 43.1% [40.3-45.9], Pakistan = 60.9% [58.2-63.5]), and cholesterol was the least common (Bangladesh = 4.1% [3.2-5.2], India = 14.8% [12.9-17.0], Pakistan = 9.6% [8.1-11.3]). Characteristics such as BMI, age and education level were positively associated with screening, and females were more likely to be screened than males. The provision of health risk modification advice was most common in India (diet = 66.7% [62.1-71.1], physical activity = 71.5% [67.0-75.6], smoking = 17.1% [13.8-21.0]), and least common in Bangladesh (diet = 17.8% [15.8-20.0], physical activity = 12.0% [10.3-13.8], smoking = 9.8% [8.3-11.5]).

There is a consistent gap in the screening of NCDs among individuals with SMI in South Asia, with marked sociodemographic disparities. There is a pressing need for standardised screening protocols and health risk modification interventions tailored to South Asian populations. Improving health literacy and implementing culturally sensitive, cost-effective prevention strategies could mitigate the increased risk of NCDs in South Asian individuals with SMI.

None Declared

Technological advancements have identified numerous genetic variations linked to mental disorders, providing potential explanations and, in some cases, enabling targeted treatments. However, clinical genetic testing remains underutilised in psychiatric care, potentially due to inconsistent clinical guidelines across Europe.

This scoping review aims to compile, summarise and evaluate European clinical practice guidelines (CPGs) on genetic testing in mental disorders, identifying gaps and variations in recommendations to inform current practice and future guideline development.

A scoping review was conducted across scientific databases (PubMed/MEDLINE and Ovid) and grey literature sources (Image 1. Flow diagram). Inclusion criteria centred on European CPGs published in English from 2010 onward with specific recommendations on genetic testing in mental disorders. Quality assessment was performed using the International Centre for Allied Health Evidence (iCAHE) checklist. Data extraction focused on guideline characteristics, target populations, and genetic test recommendations.

Sixteen CPGs met the inclusion criteria, displaying considerable heterogeneity in quality and content, and covering a limited range of mental disorders. Six guidelines addressed neurodevelopmental disorders. Most recommended genetic testing in Autism Spectrum Disorder (ASD) when indicators such as intellectual disability (ID) or dysmorphic features were present; however, one guideline recommended routine testing. Only one guideline included recommendations for genetic testing in ID; routine access to Fragile X testing, chromosomal microarray, and whole genome sequencing was recommended as standard care.

Eleven guidelines provided recommendations on genetic testing in neurodegenerative disorders. In dementia, consensus on routine testing was generally limited to young-onset cases or those with distinct genetic profiles. APOE genotyping was generally discouraged. Guidelines for diagnostic testing for Huntington’s Disease (HD) were consistent. Access to predictive testing with appropriate genetic counselling for at-risk adults was also recommended.

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Based on our findings and the wider literature, we recommend considering genetic testing for: 1) all patients with ID, 2) patients with ASD exhibiting features suggestive of a genetic cause, such as ID and dysmorphic traits, and 3) patients with dementia with a young age of onset or a family history indicative of a Mendelian disorder. For HD, testing should be informed by phenotypic features and family history. Establishing harmonised, evidence-based guidelines is essential to integrate testing effectively. Key considerations include clinical utility, patient autonomy, and access to genetic counselling to ensure informed and supportive care.

None Declared

Treating substance-dependent mothers and their children presents unique challenges in psychiatric and psychotherapeutic practice. These cases require intensive, coordinated interventions that span mental health, social support, and medical care. Substance dependence in mothers can disrupt early attachment, increase psychiatric risk in children, and challenge the therapeutic alliance. Effective intervention demands seamless interdisciplinary collaboration to provide holistic care that supports recovery and strengthens maternal-infant bonds.

This study examines the role of interdisciplinary collaboration in psychiatric and psychotherapeutic care for substance-dependent mothers and their children. Specifically, it aims to assess how collaborative frameworks between psychiatrists, psychotherapists, and allied mental health professionals impact therapeutic outcomes, focusing on reducing burnout and enhancing resilience among care providers.

A cross-sectional survey was conducted with 91 mental health professionals across 12 agencies involved in the care of substance-dependent mothers and their children. Participants completed an electronic questionnaire assessing demographic data, collaboration experiences, and perceptions of treatment effectiveness. The Maslach Burnout Inventory (MBI-22) and Resilience Evaluation Scale (RES) were utilized to measure burnout and resilience, exploring their influence on therapeutic collaboration and patient outcomes.

Findings show that interdisciplinary collaboration positively correlates with enhanced resilience and lower burnout among professionals, factors crucial in maintaining therapeutic efficacy. Significant associations were found between demographic factors—such as age, gender, and years of service—and both resilience and burnout. Increased resilience appeared to support deeper therapeutic engagement, while low burnout levels were associated with sustained therapeutic consistency.

Interdisciplinary and interagency collaboration is essential in the psychiatric and psychotherapeutic treatment of substance-dependent mothers and their children. Resilience fosters more effective therapeutic engagement, while low burnout levels support sustainable practice. These findings underscore the value of collaborative, resilient mental health teams in achieving positive psychotherapeutic outcomes for this vulnerable population.

None Declared

Major Depressive Disorder (MDD) is a prevalent mental health condition that significantly impairs daily life and increases suicide risk. Selective serotonin reuptake inhibitors (SSRIs), such as paroxetine, are widely prescribed due to their efficacy and favorable safety profile. However, SSRIs can impact glucose metabolism, leading to both hyperglycemia and hypoglycemia, particularly in diabetic patients.

In rare instances, SSRIs have induced hypoglycemia in non-diabetic individuals. Paroxetine, known for its strong inhibition of serotonin reuptake, has been implicated in cases of hypoglycemia, though the precise mechanisms remain unclear.

With the present report, we examined wheter the hypotesis that paroxetine induces hypoglycemia is valid.

This case report discusses an episode of paroxetine-induced hypoglycemia in a 60-year-old female, non-diabetic patient with a history of MDD.

The patient was admitted to our in-patient psychiatric unit due to worsening depressive symptoms and recurrent episodes of sweating, dizziness, tremors, and loss of consciousness, suggestive of hypoglycemic crises. Over the previous three years the patient had been on paroxetine 40 mg/day, thus the drug was suspected as a potential cause of these hypoglycemic episodes and it was discontinued whereas fluoxetine and trazodone were administered. By discharge, her depressive symptoms and insomnia had improved significantly

This case highlights the potential for SSRIs, particularly paroxetine, to induce hypoglycemia even in non-diabetic patients. Although hypoglycemia is typically linked to diabetic treatments, this case demonstrates that antidepressants can also play a role in disrupting glucose regulation. In this case, the symptoms subsided after the discontinuation of paroxetine, strongly suggesting its role in the hypoglycemic episodes, as supported by a "probable" causality score on Naranjo’s scale. Given the nonspecific nature of hypoglycemic symptoms and the risk of misdiagnosis as psychiatric or somatic conditions, it is crucial for healthcare providers to consider medication-related causes. This report underscores the importance of monitoring glycemic levels in patients on SSRIs, particularly when presenting with atypical symptoms. Increased awareness can help prevent misdiagnosis and facilitate timely intervention to avoid severe complications.

None Declared

Total laryngectomy is a major surgical procedure involving the complete removal of the larynx, often necessary to treat severe conditions such as laryngeal cancer. Although this operation is often life-saving, it leads to significant and often disabling consequences that impact mental health, including increased levels of anxiety and depression.

Determine the prevalence of anxiety and depression among a group of patients who have undergone total laryngectomy and to investigate the factors associated with their occurrence.

This is a descriptive cross-sectional study with an analytical aim conducted over a period of 6 months from December 2021 to June 2022, involving patients followed for laryngeal cancer who had undergone total laryngectomy at the Otolaryngology department of Hospital Tahar Sfar Mahdia. Anxiety and depression were assessed using the Hamilton Anxiety Rating Scale and the Beck Depression Inventory , respectively.

A total of 40 patients participated in the study. The average age was 62±9 years, with a population consisting of 100% males. A score greater than 20 indicating the presence of anxiety symptoms was noted in 50% of patients. Depression was noted in 78% of patients, with moderate intensity in 42% and severe in 25% of cases. We found that shorter postoperative follow-up was associated with greater anxiety symptoms (p=0.005). However, other factors such as diabetes and impact on social life could be related to anxiety, though no statistically significant associations were found. Regarding depressive symptoms, only the presence of postoperative complications was statistically related to moderate or severe depressive symptoms (p=0.004) in our study. Other factors such as radiotherapy and impact on work might be related to depressive symptoms, although no statistically significant associations were found.

Total laryngectomy has undeniable repercussions on the mental health of patients. Medical and social support is essential to help them better cope with this disability.

None Declared

Obesity has reached epidemic proportions globally, significantly increasing the risk of cardiovascular diseases, diabetes, and various cancers. In the United States, as of 2017-2018, the prevalence of obesity among adults was approximately 42.4% (CDC, 2020). Worldwide, over 650 million adults were obese in 2016 (WHO, 2020).

Bariatric surgery, which includes a variety of procedures aimed at weight loss, While these surgeries primarily aim to induce weight loss and improve metabolic health, they also present challenges for patients taking psychotropic medications, such as antidepressants, antipsychotics, and mood stabilizers.

Understanding the Impact of Bariatric Surgery on Psychotropic Medication Management

1. 1. Changes in Pharmacokinetics: Bariatric surgery can significantly alter the absorption, distribution, metabolism, and elimination (Smith et al., 2018).

2. 2. Drug Interactions:Post-surgery changes in gastrointestinal physiology can impact drug interactions and the efficacy of psychotropic medications. (Alvarez et al., 2020).

3. 3. The need for Monitoring and Dosing Adjustments:

4. 4. Understanding Nutrient Deficiencies: can lead to deficiencies in essential nutrients like vitamin B12, vitamin D, iron, and calcium, which can exacerbate psychiatric symptoms or affect the metabolism of psychotropic medications (Courcoulas et al., 2020).

A thorough literature review was carried out, with emphasis on research done within the the last 5 years.

On thorough reiew of literature, better outcomes resulted from implementing the following

1. 1. Individualized Monitoring: Regular assessment of weight loss, nutritional status, and psychiatric symptoms can inform dosage adjustments to maintain therapeutic efficacy (Zachariah et al., 2015).

2. 2. Consideration of Formulations: Immediate-release formulations may ensure consistent absorption and therapeutic effects due to altered gastrointestinal transit times (Lopez-Nava et al., 2017).

3. 3. Collaborative Care:A multidisciplinary team, including bariatric surgeons, psychiatrists, pharmacists, and dietitians, can optimize medication regimens and address nutrient deficiencies (Smith et al., 2018).

Also considered the Benefits of Long-Acting Injectable (LAI) Psychotropics Post-Bariatric Surgery which improved the following

Post Bariatric surgery,Clinicians must carefully monitor medication efficacy, adjust doses as needed, and manage nutrient deficiencies to ensure optimal mental health outcomes.

Ongoing research and multidisciplinary collaboration are essential to refining guidelines and improving the long-term management of these complex patient populations. By integrating personalized care strategies and considering LAI formulations, healthcare providers can optimize treatment outcomes for patients undergoing bariatric surgery.

None Declared

Narcolepsy is known as an autoimmune disease which altered metabolic functions. It is believed that narcolepsy makes more pregnancy complications. However clinical evidence in narcolepsy patients, especially in pregnant women, is limited.

We aim to find out whether there is relationship between narcolepsy and pregnancy complications.

We examined data from the South Korean nationwide health insurance claims database from 2010 to 2019. Out study included women narcolepsy patients who gave birth, and age- and sex- matched controls without narcolepsy. We estimated the odds ratio of narcolepsy with pregnancy complications and control group with pregnancy complications using multivariate logistic regression analysis.

Our study included 1,836 women with narcolepsy who gave birth and 28,796 women who gave birth without narcolepsy. We found that women with narcolepsy have a slightly high risk of preterm birth (OR, 1.191; 95% CI, 1.034-1.372). Patients with narcolepsy were at a significantly lower risk of spontaneous abortion, caesarean and gestational diabetes (OR, 0.763; 0.682-0.854, OR, 0.679; 95% CI, 0.560-0.824 and OR, 0.656; 95% CI, 0.556-0.774, respectively).

This study is the first study about pregnancy complications in narcolepsy patients in South Korea. We found that preterm birth happened more in the patient with narcolepsy during pregnancy. But patient had lower risk of spontaneous abortion, caesarean, gestational diabetes compared to heath control group. These findings suggest that narcolepsy is not a definite risk factor for pregnancy complications. Further research is needed to investigate the reasons why narcolepsy patients had lower risk of spontaneous abortion, caesarean, gestational diabetes compared to health control.

None Declared

The lack of accessible plasma biomarkers to identify target populations limits the promise of precision medicine for Alzheimer’s Disease (AD). Amnestic mild cognitive impairment (aMCI) is an important risk for AD and often occurs years before the onset of AD.

Based on an emerging mechanistic model of mitochondrial mechanisms of brain plasticity, we studied the role of acetylcarnitine and free-carnitine levels assayed in plasma as potential markers of cognitive dysfunction in subjects with aMCI or early-AD.

We used available samples from two independent cohorts well characterized for clinical and neuropsychological characteristics together with ultraperformance liquid chromatography-tandem mass spectrometry and computational approaches. Cerebrospinal fluid (CSF) measures of b-amyloid accumulation and t-Tau levels were also available and used in computational modeling.

Within the primary cohort, our data showed decreased levels of carnitine in relation to cognitive function as assessed by using the Mini Mental Status Exam (MMSE) in women but not men with CI as compared to age- and sex-matched HC. Furthermore, the magnitude of carnitine deficiency reflected the severity of cognitive dysfunction in a sex-specific manner (women: p = 0.015; men: p = 0.441). Our data also replicated the prior finding of decreased LAC levels in both women and men with AD, supporting the robustness of the study samples assayed in our new study. Using computational approaches, we found that the integration of these mitochondrial measures with canonical CSF biomarkers improves diagnostic accuracy. A second cohort provides a validation of the sex-specific relationship between free-carnitine deficiency and the severity of cognitive dysfunction.

Taken together with prior mechanistic studies in rodents, the current findings support future research on the development of individualized treatment models targeting sex-specific changes in mitochondrial metabolism.

None Declared

Previous research suggests that motivational factors relate to psychosocial functioning in SZ, both concurrently (Tobe et al. Compr Psychiat 2016; 65 103-109) and at follow-up (Fervaha et al. Acta Psychiat Scand 2014; 130 290-299). Importantly, no study has examined the influence of baseline motivation on the rate of change in response to rehabilitation

1. 1. To study the relationship between baseline measures of motivation/ effort with psychosocial functioning at follow-up

2. 2. To examine if motivation/ effort predict individual change in psychosocial functioning

Participants

Table 1 summarizes the sample characteristics

Figures 1 and 2 show individuals slopes for PSP and FAST, with a thick red line representing the average group slopes. For both PSP and FAST, models with only time as the independent variable and random intercepts indicated that time was a significant predictor (PSP: t=10.65, p<.0001; FAST: t =-6.13, p<.0001).

Baseline motivation/ effort → follow-up psychosocial functioning

No significant correlations were found for neither PSP scores (QLS: ρ=-.018, S=2343.3, p=.93, IMI: P=.23, t=1.09, p=.28, effort: ρ=.001, S=2297.3, p=.99) nor FAST scores (QLS: ρ=-.16, S=2674.9, p=.45, IMI: P=-.02, t=-0.09, p=.92, effort: ρ=.07, S=2128, p=.72).

Motivation → change in psychosocial functioning

For PSP, the interaction model (Table 2) shows that the interaction of effort and timepoint significantly predicts PSP scores

Figure 1. Individual slopes for PSP scores

Figure 2. Individual slopes for FAST scores

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Patients showed an improvement after rehabilitation. Effort can explain this trend. Finally, unlike previous studies, basal motivation did not predict follow-up psychosocial functioning

None Declared

Job satisfaction reflects on overall life quality involving social relationship, family connection and a feeling of enjoyment or fulfillment specially for family medicine residents’ contentedness with their job.

This study aims to assess factors associated to job satisfaction in a population of Tunisian family medicine residents.

We conducted a cross-sectional study from January to July 2024. Family medicine residents participated in the survey through a Google Forms questionnaire. They were queried about their sociodemographic information and work conditions, including daily working hours, the number of night shifts per month, and the average number of patients seen each day. To assess participants’ job satisfaction, we used the validated physician’s job satisfaction scale which covered five domains: patient care, burden, income-prestige, personal reward, and professional relations.

We enrolled 108 family medicine residents (65 women and 43 men) with an average age of 26 ± 2 years [22-37 years]. The average daily working hours were 6.62 hours, with an average of 15 patients seen each day. Additionally, the average number of night shifts completed per month was 5. Positive correlations were found between age and satisfaction with time spent with family friends or leisure activities (p=0.001, r=0.3), burden’s average mean (p=0.01, r=0.2) and opportunities for continuing medical education (p=0.03, r=0.1). However, a negative correlation was found between satisfaction with professional relations and the number of night shifts per month (p=0.01, r= - 0.2).

This research highlights the critical factors influencing job satisfaction among family medicine residents in Tunisia, with a particular focus on their working conditions. Addressing these issues is essential for enhancing the overall satisfaction of these residents. By creating a supportive work environment, we can ultimately improve patient care and treatment outcomes.

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Functional neurological disorders (FND) are defined as neurological symptoms that are inconsistent and incongruent with classic neurological disorders. Over the past two decades, an interest in the potential underlying mechanisms of these disorders has occurred and a new pathophysiological framework based on current neurobiological theories about global brain function such as the predictive coding theory has emerged. Within this framework, abnormal or erroneous beliefs about symptoms, mediated by attention, are hypothesized to modulate perception and movements, ultimately leading to FND. Previous studies have evaluated cognitive biases such as the jumping to conclusion reasoning style in patients with functional movement disorders (FMD) and it has been suggested that they may play a role in symptoms production. In this study, we evaluated the behavior of patients with FMD when confronted with evidence that contradicts their beliefs through the “Bias Against Disconfirmatory Evidence” (BADE) and their tendency to accept implausible interpretations through the “Liberal Acceptance Bias” (LA).

To evaluate whether patients with FMD have greater difficulty integrating information based on disconfirming evidence than the general population.

Observational case-control study in which the presence of BADE and LA biases were assessed in a sample matched by sex and age using Woodward’s BADE task. Clinical and demographic characteristics of the participants were recorded (such as “Mini Mental State Examination” (MMSE) or “Peters et al. Delusions Inventory” (PDI -21), level of education, employment situation and marital status and cohabitation situation). The BADE test analyses the scores that the patient provides at 3 points in time on the plausibility of 24 scenarios after increasing the information received.

Twenty patients (median age 50.5 years, 75% female) and twenty people from the control group (median age 52.50 years, 75% female) were included. No differences were found on demographic features, MMSE or PDI -21 scores. When compared to healthy controls, FMD patients scored significantly lower in BADE (median 3.35, p=0.03) and significantly higher in LA (median 3.08, p=0.017). Also, when the maximum information was provided, patients scored significantly higher in implausible situations (p=0.01) and lower in true situations (p=0.02) than the control group.

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Patients with FMD have greater difficulty in modifying their beliefs when confronted with disconfirming evidence and a greater tendency to accept less plausible options. These cognitive biases, among other factors, may facilitate the adoption of fixed beliefs, regardless of their plausibility, early and with little evidence. Our results may also explain why some patients with FMD remain with erroneous beliefs despite the explanation of the diagnosis.

None Declared