Depressive disorders are one of the most disabling mental illnesses with a significant impact on society. In Romania the mean annual total costs per depression patient are EUR 5553, a much higher figure than the mean annual total costs per patient ranged worldwide.

Even though their roles in depression have not been elucidated, a plethora of potential biomarkers in multiple body fluids for the early diagnosis of depression has been suggested. Blood circulating microRNAs (miRNAs) are potential biomarkers for several human diseases, including psychiatric disorders. Different studies have shown that micro RNAs are involved in a series of pathophysiological processes and could be useful markers for diagnosis and prognosis of depression.

This preliminary case-control study was designed to identify putative blood circulating miRNAs associated with the diagnosis of depression in Romanian patients.

In this study, 20 patients with depression and 24 non-depressed controls were enrolled. All the individuals have been interviewed and screened using the following scales: the Hamilton Anxiety Scale (HAM-A), the Becks Depression Inventory (BDI) and the Perceived Stress Scale (PSS). The expression of 179 miRNAs in plasma have been evaluated by qRT- PCR. The difference in the expression of miRNAs between the two groups, as well as the correlations with the scores of the scales have been analyzed.

A panel of 28 miRNAs was identified as differentially expressed between patients and controls. Only miRNAs showing a -2>FC>2.0 and p<0.05 have been considered significant. Seven miRNAs (miR-143-3p, miR-331-3p, let-7f-5, miR-502-3p, miR-145-5p, miR-7-1-3p, miR- 29a-3p) were found up-regulated in the depression group, while 21 miRNAs (miR-885-5p, miR- 425-3p, miR-32-5p, miR-23b-3p, miR-590-5p, miR-30a-5p, miR-132-3p, miR-376a-3p, miR-223-5p, miR-133b, miR-142-5p, miR-92b-3p, miR-140-3p, miR-16-2-3p, miR-28-3p, miR-27a-3p, miR-15b-3p, miR-106b-3p, miR-877-5p, miR-30e-3p, miR-140-5p) showed a down-regulation in the group of patients compared to the controls. Some of the significant correlations between miRNA expression and the scale scores are reported: a positive correlation between let-7f-5 and miR-7-1-3p with the BDI score (p=0.003 r=0.526, and p=0.008 r=0.477, respectively) and a negative correlation between miR-425-3p with BDI (p=0.002 r=-0.502) were found.

The results reported in this communication represent preliminary findings. Due to the nature and heterogeneity of depression, the number of patients and controls in the two cohorts will be enlarged to correlate these miRNAs with other patient features.

None Declared

Type 1 Diabetes (T1D) is an invisible condition, yet it can be difficult for young people to accept. Many attempt to hide or downplay their illness, potentially leading to significant psychological distress.

The objective of this study is to determine the prevalence and characteristics of academic failure among children with T1D, as well as the associated risk factors, including the impact of substance use such as tobacco, alcohol, and cannabis.

This is a retrospective, descriptive, and analytical study conducted at the Endocrinology Department of Farhat Hached Hospital in Sousse, covering the period from January 2015 to January 2020. The study analyzed the school and professional trajectories of T1D patients, considering their clinical, biological, and social data. Academic failure, the dependent variable, was defined as either the interruption of studies or the repetition of at least one academic year. Additionally, the prevalence of smoking, alcohol, and cannabis use in this population was recorded.

The study included 70 patients (31 males and 39 females), with a mean age of diagnosis of T1D at 7.36±4.41 years. Academic repetition was observed in 71.4% of cases, and school dropout in 47.1%. The reasons for academic delays were attributed to recurrent hospitalizations (31.4%) and glycemic instability, including hyper/hypoglycemic episodes (17.1%). Multivariate analysis adjusted for diabetes type revealed that significant risk factors for academic failure included: ≥5 hospitalizations for ketosis (p=0.037) and higher mean HbA1c levels at recent consultations (p=0.001). Protective factors were functional insulin therapy (p=0.031) and the use of insulin analogs (p=0.004). Concerning substance use, tobacco addiction was present in 22.9% of patients, alcohol consumption in 14.3%, and cannabis use in 8.6%. Patients using tobacco and alcohol exhibited a higher risk of school dropout and lower academic performance, with a significant correlation between cannabis use and glycemic instability.

The risk of academic failure among T1D patients is substantial and should not be underestimated. Frequent hospitalizations, poor glycemic control, and substance use (especially tobacco and cannabis) further exacerbate this risk. The physical and psychological complications of T1D, combined with the socioeconomic challenges and limited access to medical care in rural or isolated areas, contribute to school dropout. This study highlights the importance of comprehensive medical and psychosocial support to improve both health and academic outcomes in this vulnerable population.

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“Psychosurgery” is defined as the human brain surgery to treat psychiatric symptoms.

This study aims to portray psychosurgery’s historical evolution.

A review of 35 articles from 2000 to 2024 on PubMed and Google Scholar, regarding psychosurgery.

The initial phase of psychosurgery dated in 1888, when Swiss psychiatrist Gottlieb Burckhardt, in en effort to control the symptoms of psychiatric patients, he performed the very first brain topectomies. Later on, in 1936, Portuguese neurologist Egas Moniz and neurosurgeon Almeida Lima, collaborated on performing the first lobotomy. After achieving 20 lobotomies, Moniz reported that 35% of patients showed complete remission of psychiatric symptoms, 35% of patients showed a mild improvement, and 30% of patients showed no improvement. It was Freeman’s (a neurologist) and Watts’s (a neurosurgeon) turn to perform in 1936 the first lobotomy on the USA ground, on a woman suffering from depression; Alice Hammatt. Unfortunately, six days post-operation, Hammatt experienced language difficulties, disorientation and agitation. However, the surgery was still considered a success. By 1942, Freeman and Watts had performed 200 lobotomies, declaring that 63% of patients improved, 23% of patients showed no relief, while 14% of patients suffered complications, including death. Freeman pursued with the development of a transorbital method which he tended to perform in outpatient departments, without any neurosurgical assistance, having patients anesthesized with a portable electroshock machine. Profoundly disapproving this method, Watts, decided to end their partnership. Further unsatisfactory outcomes like the lobotomy of Rosemary Kennedy (sister of President John F. Kennedy) shaped an additional negative image of Freeman’s work. Rosemary who initially was subjected to lobotomy due to mild developmental delays, anxiety and epilepsy, was postoperatively left severely disabled, without autonomy, being institutionalized for the rest of her life. Finally, the approval of chlorpromazine’s use in the US (1955) alongside public awareness over psychosurgery’s complications, such as the “post-leucotomy syndrome” causing disinhibition as well as “lobotomy criteria” which included female gender, non-obeidance, hospitalization in overcrowed institutions, opposite political opinion, leaded to psychosurgery’s dowfall.

Considering the dark history of psychosurgery, it is imperative to proceed to such treatments exclusively to diseases with a well decoded neurophysiology, always respecting human rights and protecting patients’ dignity and self-will.

None Declared

Major depressive disorder (MDD) is one of the most prevalent and disabling mental health conditions globally. Approximately one-third to half of MDD patients, suffer from difficult-to-treat depression (DTD), a condition marked by persistent symptoms that do not respond to multiple standard treatments. DTD is often associated with comorbid physical and psychiatric conditions leading to chronic disability and a reduced quality of life. The complexity of DTD poses a considerable challenge in clinical practice, underscoring the need for innovative treatment options.

Despite the demonstrated efficacy of esketamine in controlled clinical trials, real-world evidence is limited. This study aimed to address this gap by assessing the effectiveness of esketamine in routine clinical practice in DTD patients.

This prospective, naturalistic, open-label, observational study was conducted at Marqués de Valdecilla University Hospital in Cantabria, Spain. It included 33 patients diagnosed with DTD, comprising both unipolar and bipolar depression, as well as persistent depressive disorder (see table 1). Esketamine was administered intranasally in doses ranging from 56 mg to 84 mg, across three phases: induction, consolidation, and maintenance. Treatment effectiveness was measured using the MADRS, Clinical Anxiety Scale (CAS), and Clinical Global Impression (CGI). Functionality and quality of life were assessed with the Brief Functioning Scale (FAST) and the EQoL-5D (ESH). Assessments were conducted at baseline, 1-month, and 3-month. Data analysis was performed using SPSS v26, with repeated measures ANOVA and Pearson’s χ² tests employed to evaluate changes over time.

The final analysis included 33 patients with DTD and long-lasting current MDD episodes (table 2). Baseline MADRS scores indicated severe depression (39.12 ± 6). Significant reductions in MADRS scores were observed at both one month (21.61 ± 11.15) and 3-month (19.70 ± 11.65) compared to baseline. At 3-month, 54.5% of patients achieved a ≥50% reduction in MADRS scores, and 30.3% reached remission (MADRS < 12). Similar improvements were seen in anxiety (CAS) and health status (ESH) scores, with significant reductions noted over time. However, functional improvements (FAST) were not statistically significant (see table 3).

Esketamine demonstrated substantial effectiveness in reducing both depressive and anxiety symptoms in DTD patients over three months. More than half of the patients achieved a significant reduction in depression severity, with nearly a third reaching remission. The presence of late responders suggests that esketamine may benefit those initially unresponsive to treatment. These findings support esketamine as a valuable therapeutic option for DTD in real-world clinical settings.

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The results of many previous studies report a high prevalence of overweight and obesity in children and adults with Down syndrome (hereinafter DS). According to different authors, the incidence of obesity in them varies between 23 and 70%. The age of onset of overweight formation was 2–3 years.

Glucose transporter (abbreviated GLUT) is a large group of membrane proteins responsible for the transport of glucose across the cell membrane. Since glucose is a vital source of energy, these proteins are present in all types of living organisms. GLUT, or SLC2A, is a separate family of glucose transport proteins found in most mammalian cells. Thus, the human genome encodes twelve proteins of the GLUT family. They are transport uniporter proteins.

We studied PCR of scrapings of the mucous membrane of the inner side of the cheek to search for GLUT1 genes in 31 patients with DS, ьen and women aging from 8 to 39 years. The control group consisted of 67 healthy donors by the same ages and genders.

It was found that the expression of GLUT1 genes was significantly reduced. A decrease in the expression of these genes correlated with an increase in body weight and symptoms of bulimia in patients with Down syndrome.

Eating disorders, namely bulimia, in DS is a serious condition that aggravates the course of the underlying disease. Hereditary factors affect the expression of glucose transporter genes. Taking these circumstances into account would help in developing personalized pharmacotherapy.

None Declared

South African adolescents are exposed to significant levels of trauma exposure, resulting in high levels post-traumatic stress disorder (PTSD). Sleep disturbances are among the most frequently reported difficulties faced by those dealing with PTSD.

The current study aimed to determine the feasibility and preliminary efficacy of the SAASI on PTSD symptom severity and sleep disturbance when delivered in group format to South African adolescents with PTSD.

Sixty-one adolescents with PTSD diagnoses and sleep disturbance were randomly assigned to either one individual and four group sessions of the sleep intervention (SAASI) or a control group. At baseline, post- and 1-month follow-up participants completed the Child PTSD symptom scale for DSM5 (CPSS-5) and the Pittsburgh Sleep Quality Index (PSQI) among other sleep and psychiatric measures. The trial was registered on the Pan African Trial Registry (PACTR202208559723690).

There was a significant but similar decrease in PSQI scores in both groups over time indicating no overall intervention effect. Interaction between groups on the CPSS-5 was also not significant. Despite this overall finding, the mean difference in CPSS-SR-5 scores increased over time, with the difference between groups post-treatment and at the 1-month follow-up suggesting that PTSD symptom severity decreased more in the intervention group than the control group. The dropout rate was higher than expected for both the intervention and control groups. Reasons provided for dropout were mostly school commitments or travel related.

Conclusions: Early findings suggest a trend towards dual improvement in sleep quality and PTSD symptom severity in adolescents with a sleep disturbance and PTSD receiving a group sleep intervention (SAASI). Further investigation in a properly powered RCT with detailed retention planning is indicated.

None Declared

Post-traumatic stress disorder (PTSD) is characterized by intrusive thoughts and flashbacks involving the traumatic event, hypervigilance and avoidance behavior. On the other hand, complex post-traumatic stress disorder (complex PTSD) can result from experiencing chronic trauma. It involves similar stress reponses, such as flashbacks, nightmares, and also avoidance of places and situations related to the traumatic event. Sleep disturbance is a central element of both disorders (PTSD and complex PTSD). While nightmares qualify as a re-experiencing symptom, initiation and maintenance of sleep stem from a hyperarousal state (Paiva et al., 2021). Evidence implies that treatment for PTSD-related sleep disturbance also improves other trauma-related symptoms. As pharmacological therapy, some clinicians use prazosin, an adrenergic inhibitor, which is a lipophilic drug originally developed to treat hypertension. It blocks α1 receptor sites and ameliorates the increase in noradrenergic activity in PTSD-diagnosed individuals (Lipinska G et al. 2016). Studies differ regarding the effectiveness of this drug to alleviate sleep disorders and other trauma-related symptoms (Bajor et al., 2022; Yücel et al., 2020; Zhang et al., 2020; Petrakis et al. 2016).

Through this case series study we want to understand the utility and effectiveness of prazosin in patients diagnosed with PTSD and complex PTSD for the improvement of nightmares and other PTSD-related symptoms.

For this purpose we have reviewed in 10 patients with a diagnosis of either PTSD (4 out of 11) or complex PTSD (7 out of 11) the improvement of nightmares and other trauma-related symptoms, especially flashbacks. The patients indicated whether there was no, partial or total improvement of these symptoms. The doses used were between 1 to 2mg.

In this Case series study (n= 11), we focus on the reports from PTSD - and complex PTSD-diagnosed (4 out of 11 vs 7 out of 11) patients treated with prazosin regarding their sleep disturbance and other trauma-related symptoms.

Forty percent of the patients report a reduction in the frequency and intensity of nightmares, while 3 patients of the sample reported absolute extinction of nightmares.

Our findings reveal almost half of the patiens (4 out of 11) expressed as well a reduction in other PTSD symptoms, specifically in flashbacks.

We have not found a significant better outcome in either PTSD or complex PTSD- diagnosed patients. The entire sample were female patients.

Improvements in hypervigilance and avoidance behavior have hardly been reported in enrolled patients (3 out of 11).

In our sample, the use of prazosin appears to be an acceptably good option, especially for the improvement of nightmares. Nevertheless, further studies should be conduced.

None Declared

Sudan is currently experiencing the largest child displacement crisis worldwide. Since the conflict erupted in 2023, over 4.6 million children have been internally displaced within Sudan, and nearly one million are seeking refugee in neighboring countries (UNICEF, 2023). The mental health of these children has been overlooked, and there is a noticeable lack of data on their psychological wellbeing.

To assess the prevalence of PTSD, anxiety and factors associated with them among internally displaced Sudanese children during war in IDP camps in Al Jabalain district, White Nile state, Sudan, 2024

A cross-sectional study was conducted among internally displaced Sudanese children in 11 camps in Al Jabablain district. Children were interviewed using a standerdised questionnaire consisting of the PTSD Civilian Checklist Version 5 abracic version and the Hamilton Scale arabic version to assess the prevalence of PTSD and anxiety. Data analysis was conducted using IBM® SPSS, version 26.0.

The sample included 223 children; age median was 12 years (IQR: 9-15). 127 (57%) of them were females, with majority 128 (57.4%) in primary school. Participants who met the criteria for probable PTSD were 23 (14.3%), (median: 32, IQR: 17-28). 150 (67.3%) participants had mild anxiety, with a median score of 11 (IQR: 9-14). Older children had higher levels of PTSD and anxiety. Also, both scales were significantly associated with gender, displacement frequency and separation from close ones (p value <0.05). Females were more likely suffer from anxiety 116/127(91%) in comparison to males 76/96(79%). Yet, 19(59.4%) of children with probable PTSD were males. Children displaced more than four times were more prone to PTSD symptoms and moderate to severe anxiety. Interestingly, recently displaced children were more likely to have higher PTSD scores and lower anxiety scores. Educational level was significantly associated with PTSD, with about one-third of high school students experienced PTSD symptoms. Anxiety scale was significantly associated with direct exposure to violence, as 13.6% of those exposed to violence experienced mild to moderate anxiety.

This study identified significant levels of PTSD and anxiety among internally displaced children in the Al Jableen camps, highlighting the urgent need for mental health interventions, which promotes resilience and coping skills. Factors such as age, gender, frequency of displacement, direct exposure to violence, and educational level significantly impact the development of these mental health conditions.

None Declared

Post-traumatic stress disorder (PTSD) is a chronic condition resulting from exposure to traumatic events. The utilization of stellate ganglion block (SGB) as a potential treatment for PTSD has garnered increased interest in recent years. SGB acts by blocking sympathetic outflow, offering promise in alleviating autonomic dysfunction associated with PTSD symptoms. However, the evidence supporting SGB’s efficacy compared to established recommendations remains limited.

To bridge this knowledge gap, a systematic review was conducted following PRISMA guidelines to assess the clinical applications and implications of stellate ganglion block (SGB) in the management of post-traumatic stress disorder (PTSD). The study aimed to identify pertinent literature, synthesize findings from diverse sources, evaluate outcomes of SGB therapy for PTSD, analyze factors such as anesthesia preferences and procedural methods, scrutinize symptom alleviation post-SGB sessions, explore reported side effects and symptom recurrence, and shed light on existing limitations within the current discourse on SGB’s utility in treating PTSD.

The systematic review involved the evaluation of 14 studies meeting predetermined inclusion criteria, incorporating a total of 550 participants. Notably, the majority of participants were military service members and veterans, with a median age of 36.9 years. The review focused on anesthetic practices, procedural techniques, timing of SGB administration, and symptom progression post-SGB therapy sessions.

Analysis of the selected studies highlighted the prevalent use of 0.5% ropivacaine as the preferred anesthetic for SGB, with the right-sided technique being the most commonly employed. Timing of the initial SGB session varied widely, with symptom improvement typically observed immediately or within the first week post-procedure. Positive outcomes often coincided with reductions in alcohol intake, medication use, and enhanced mood. Recurrence of symptoms was noted, necessitating additional SGB sessions, while reported side effects were predominantly mild and transient in nature.

While promising, caution is advised when interpreting the benefits of SGB due to challenges such as the absence of standardized clinical trial data, variabilities in reported outcomes, and potential reporting biases. Addressing these limitations through standardized assessment and reporting in future studies is crucial to enhance comprehension of SGB’s efficacy, safety, tolerability, and appropriate indications for treating PTSD. This endeavor is pivotal in advancing a more nuanced understanding of SGB’s role as a therapeutic modality in PTSD management.

None Declared

Multidisciplinary cooperation is an imperative prerequisite for good clinical practice in general, and for healthcare of gender-variant people in particular. Although self-determination of one’s gender identity is regarded a human right and self-medication in the trans community widespread, gender-affirmative treatment (GAT) with its far-reaching consequences (including reimbursement by social insurances) still is based upon diagnostics – and more importantly – by indication of mental health professionals (MHP). Empathy and affirmative encounter cannot detract from the fact that medical interventions in general cannot be carried out without a diagnosis. It is the assignment and duty of MHPs to make a diagnosis of gender incongruence or gender dysphoria prior to GAT carried out by somatically oriented doctors. This mutual dependency is a constituent of transgender healthcare, not only at the beginning of a transition trajectory but life spanning. Mental and somatic health care are interdependent. Gender affirmative hormonal treatment and its potential side-effects as well as surgical intervention and its potential complications may have large impact on mental health, and vice versa mental health disorders impact medical conditions. MHPs and somatically oriented doctors are socialized and trained in different ways, sometimes complicating understanding. This presentation deals with the needs, peculiarities and obstacles of joint mentoring gender-variant patients from a medical perspective, not only at the beginning of transition but also in times of crisis or in the course of getting older.

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With 1 in every 8 people living with a mental disorder according to the World Health Organization, the need for appropriate identification and treatment of mental health conditions is paramount. As the majority of people with mental health problems seek help and receive their mental health care from primary care providers (PCPs), PCPs assume an important role in the identification of mental illness.

This study examined mental health literacy and predictors of disorder recognition among primary care providers (PCPs) in Hungary.

Hungarian PCPs (n = 208) completed a survey assessing demographics, mental health stigma, and exposure to mental health. Participants read six vignettes describing obsessive-compulsive disorder (OCD) harm/aggression subtype (OCD-Aggression), OCD order/symmetry subtype (OCD-Order), generalized anxiety disorder (GAD), social anxiety disorder (SAD), panic disorder (PD), and major depressive disorder (MDD) and were asked to identify each condition and provide treatment referrals. Descriptive analyses were used to characterize disorder recognition rates, perceived disorder causes, and treatment referrals. Binary logistic regression analyses were conducted to examine the degree to which demographic characteristics, mental health stigma, and exposure to mental health predict accurate disorder recognition.

Identification rates for each vignette were: OCD-Aggression (27.9%), OCD-Order (75.5%), SAD (34.1%), GAD (76.0%), PD (78.8%), and MDD (91.3%). First-choice treatment referrals were a psychiatrist for OCD-Aggression (63%), OCD-Order (53.8%), and MDD (46.6%), a psychologist/therapist for SAD (58.7%) and GAD (48.6%), and a PCP for PD (39.9%). Anxiolytics (e.g., benzodiazepines) were the most commonly recommended medication for the anxiety disorders. Mislabeling conditions was significantly associated with older age (for GAD, OCD-Aggression, PD and MDD), male gender (for GAD), greater mental health stigma (for OCD-Order), and not having a family member/friend with a mental health condition (for SAD).

Findings highlight strengths (e.g., depression recognition) and limitations (e.g., OCD-Aggression) in knowledge of mental health conditions among PCPs in Hungary. Our findings add to the literature by outlying potential intervention targets (e.g., increasing education on appropriate anxiolytic use) to improve mental health literacy in primary care. Future research should investigate the efficacy of psychoeducation interventions, particularly for OCD and anxiety disorders, in improving the mental health literacy of PCPs in Hungary.

V. Swisher Grant / Research support from: This work was supported in part by U.S. Student Fulbright Association., D. Ori: None Declared, R. Wernigg: None Declared

Past studies found lack of left frontal asymmetry in major depressive disorder (MDD) patients, also during task execution, probably depending on thought disorders associated to MDD. Indeed, individuals suffering from depressive mood are more likely to develop specific symptoms, i.e., rumination (R) (Thomsen, 2006) and perseverative thoughts (PT). According to Martin & Tesser (1996), rumination could be defined as “[…] a class of conscious thoughts that revolve around a common instrumental theme and that recur in the absence of immediate environmental demands requiring the thoughts”. Following this definition, this symptom can be represented along a continuum ranging between healthy individuals and patients with full-blown mood disorder.

The present study aimed at investigating the psychophysiological markers underlying the risk to develop mood disorders, in a community sample selected for two important psychiatric transdiagnostic domains, i.e., perseverative thoughts and ruminations (PT/R).

In order to prompt a rumination state, we developed a new mood induction paradigm based on presentation of brief, validated videoclips able to evoke sadness, psychological sufferance and feelings of loss. Subjective reports and high-density EEG data from 20 students with high (≥80th) and 20 with low (≤20th percentile) PT/R were collected. Subjective data analyses included self-perceived valence and arousal for ‘love abandonment’, ‘loneliness’ and ‘city documentary’ (i.e., neutral) clips. sLORETA source analyses on EEG bands were carried out to unmask the cortical areas involved in rumination.

Regardless of group, emotional clips elicited greater valence and arousal scores than neutral videos. Between-group sLORETA analysis revealed greater delta and theta activity in low vs. high PT/R participants in left superior parietal lobule during viewing of ‘love abandonment’ clips. Within-group analysis carried out in low PT/R participants showed that, compared with neutral clips, the ‘love abandonment’ and ‘loneliness’ conditions elicited greater alpha activity in superior (left) and middle (right) frontal gyri, respectively. On the contrary, high PT/R participants showed similar right (pre)cuneus alpha increase, regardless of emotional content.

Results suggest a decreased sensitivity to negative videoclips in high PT/R individuals, together with the loss of the specialized frontal hemispheric valence-dependent asymmetry that is typically found in low PT/R participants.

None Declared

Apathy is a common non-motor symptom in Parkinson’s disease (PD), and its presence constitutes a risk factor for the development of cognitive impairment in this population (Burchill et al. Lancet Reg Health Eur 2024; 39:100870). β-amyloidopathy has been associated to shorter interval to dementia in PD and may also be a determinant of apathy.

We aimed to investigate β-amyloid burden in non-demented PD patients based on the presence or absence of apathy, and how both factors influence the rate of progression to mild cognitive impairment or dementia over a 3-year period.

Forty-eight PD patients underwent clinical and comprehensive neuropsychological evaluation, as well as [18F]-flutemetamol positron emission tomography. They were classified as apathetic (n=22) or non-apathetic (n=26) based on their score on the Starkstein Apathy Scale. Brain imaging analysis was conducted using the SPM software package.

We found statistically significant differences in disease duration when comparing clinical and demographic variables. Upon neuropsychological evaluation, apathetic patients performed significantly worse in attention domain (Digit Span and Trail Making Test A), executive function (Stroop Word-Colour Test and Trail Making Test B) and verbal memory (CERAD Total Word Recall). At follow up, 47.4% of apathetic patients progressed to dementia or MCI, compared to 12% of non-apathetic patients (χ² = 6.81, p <0.05). Brain imaging analysis revealed higher β-amyloid deposition in several cortical areas in apathetic PD patients (adjusted for disease duration and global composite cognitive z-scores).

The presence of apathy in PD patients is associated with greater cortical β-amyloidopathy and indicates a higher conversion rate to a worse cognitive diagnosis within a 3-year period.

None Declared

Suicide remains a leading cause of death worldwide, representing a significant public mental health challenge across all populations. Moreover, suicide rates are notably higher in patients following discharge from inpatient psychiatric care. Existing evidence regarding the specific risk factors for suicide in this population, however, remains contradictory. This study aims to systematically investigate those risk factors for post-discharge suicide death from a large psychiatric care facility.

To identify the risk factors associated with suicide following discharge from psychiatric care.

Data from a 15-year single-centre cohort study were linked with national death registry records. Competing risk models were employed to calculate cumulative incidence rates. Key variables analyzed included sex, age at admission, discharge diagnosis, year of admission and length of stay. Subdistribution hazard ratios for these factors were computed using Fine-Gray models.

In the sample of 18,425 discharges from 10,973 individual patients (57.03% female), a relative excess hazard to die by suicide of 1.4 additional suicides per 100,000 population the first year after discharge compared to the general population was found. That risk of suicide after discharge was significantly higher for males (SHR = 1.67; p = 0.037) as well as for patients diagnosed with affective disorders (SHR = 3.56; p = 0.017) and neurotic stress and somatoform disorders (SHR = 3.73; p = 0.024). The risk of suicide decreased significantly in more recent discharge periods (SHR = 0.93; p = 0.006). The length of hospital stay did not show a statistically significant association with suicide risk (SHR = 0.98; p = 0.834).

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Male sex and specific diagnoses, notably affective and neurotic stress and somatoform disorders, were associated with an increased risk of suicide following discharge from psychiatric care. The observed decrease in risk over time could potentially point to improvements in post-discharge patient management and or treatment. These findings underscore the necessity for enhanced risk assessment tools and targeted interventions to address suicide risk in discharged psychiatric patients.

None Declared

Children and adolescents are a fairly vulnerable population for diabetes.

Caregivers of children and adolescents with diabetes were most involved in their care.

Measuring the burden endured by caregivers is a good indicator of the negative repercussions on caregivers when caring for their loved ones.

• - Determine the level of burden among family caregivers of children and adolescents with diabetes.

• - Identify factors associated with a high level of burden.

The study was conducted at the University Hospital of Gabès, in the pediatrics and internal medicine departments, as well as in outpatient clinics with caregivers of children and adolescents during the period from March 2024 to May 2024.

We collected sociodemographic and clinical data for each caregiver and child or adolescent followed for diabetes.

We used :

Burden scale (Zarit): explores the psychological, physical and social impact of patient care on the caregiver. The higher the score, the greater the burden. A score above 61 means a severe burden.

The study included 32 caregivers. The mean age was 35.55 years with extremes of 22 and 55 years and the sex ratio (M/F) was 0.6.

Workload was shared equally by 66% of caregivers (65.7%; n=21). The majority of the sample (62.5%) did not seem to have experienced family conflicts related to the caregiver’s role.

Among the participants, the majority, 78.1% (n=25), presented symptoms of psychological distress. A high level of stress was perceived by 43.7% of caregivers and satisfaction was noted by 34.4%.

A mean burden score was 35.59 (SD =15.37) with extremes from 8 to 59. We reported that 40.6% of caregivers presented a moderate to severe burden and 34.4% presented a light to moderate burden.

According to our results, heavy burden was statistically more common among caregivers with unequal workload sharing (p=0.006) and family conflict (p=0.01).

We found a statistically significant correlation between burden and symptoms of psychological distress (p=0.001), daily stress level (p=0.001) and overall satisfaction (p=0.001).

Our study shows that the burden endured by caregivers of diabetic children and adolescents represents a real issue in the care of these patients.

Several factors seem to be inherent to the disease, the caregiver and the social context.

For this reason, it is imperative to develop specific support programs for family caregivers of diabetic children and adolescents. These programs should include interventions to reduce burden.

None Declared

Boarding schools, seen across various cultures and regions, aim to broaden access to quality education, especially for disadvantaged groups. These schools, operated by different institutions, offer distinct educational approaches. State-affiliated boarding schools centralize resources to provide conditions not easily available elsewhere, fostering independence and discipline. Families often send their children to boarding schools, hoping they will gain opportunities to improve their lives and possibly benefit the family as a whole. However, early separation from family can have both positive and negative long-term effects on children’s socio-emotional development.

One of the potential outcomes is undoubtedly separation anxiety, which may arise from early separation from the family. On the other hand, this separation might also result in an increase in psychological resilience, as it forces individuals to live independently at an early age. In this study, we aimed to explore how separation anxiety and psychological resilience are impacted by this experience, and how these effects influence the parental attitudes that individuals adopt when raising their own children.

The study was designed as a case-control study, and participants were recruited through snowball sampling. Data were collected either through face-to-face interviews or online surveys. To gather data, a Sociodemographic Data Form, which included personal and educational information, along with the DSM-5 Separation Anxiety Disorder Severity Scale-Adult Form, the Resilience Scale for Adults (RSA) and Parentıng Attıtude Scale (PAS) were used. After examining whether the data were normally distributed based on Skewness and Kurtosis values, Student’s t-test, Mann-Whitney U, and Chi-square tests were used for group comparisons. Relationships between variables were analyzed using Pearson and Spearman correlation tests, as well as Stepwise Regression analysis.

A total of 107 volunteers who attended boarding school during adolescence participated in this study. Of these, 41 were male (38%), and 39 (36%) attended boarding school during high school. The average total score for separation anxiety was 0.890 for those who attended boarding school and 0.675 for those who did not.

This study has allowed us to gain a deeper understanding of the impact of an educational and social phenomenon, such as attending boarding school, on mental health. It is valuable in demonstrating the effects of established social institutions on individual mental health, and to the best of our knowledge, it is among the first studies of its kind. The examination of its impact on parental attitudes also sheds light on the intergenerational transmission of these changes.

None Declared

Women who experience childhood trauma may be at a greater risk of developing postpartum depression (PPD), which can result in significant harm to both mothers and their children. Few studies have longitudinally evaluated the effect of childhood trauma on PPD.

This study aimed to evaluate the impact of childhood trauma on PPD among Brazilian postpartum women.

This prospective longitudinal study was conducted with 153 women evaluated at two time points: T1 (immediate postpartum) and T2 (three months postpartum). PPD symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) and childhood trauma was assessed using the Childhood Trauma Questionnaire (CTQ). To verify the differences in PPD scores in the periods assessed and in relation to childhood trauma, generalized estimating equations (GEE) were used. EPDS scores were categorized with values ≥10 defined as the presence of PPD. Multinomial logistic regression analyses were performed to evaluate the influence of trauma on PPD risk subgroups as follows: early PPD (risk of depression at T1), late PPD (risk of depression at T2), and chronic PPD (risk of depression at T1 and T2).

The results demonstrated that women who suffered trauma in childhood had significantly higher EPDS scores at both time points evaluated when compared to women who did not suffer from trauma. However, there was no significant difference in EPDS scores over time or in the interaction between time and childhood trauma, indicating that PPD scores and the impact of childhood trauma on PPD remained constant over time. All types of childhood trauma were significantly associated with late or chronic PPD. Emotional abuse, physical abuse, and emotional neglect are significantly associated with early PPD.

The present study demonstrated that women who experienced childhood trauma had significantly greater symptoms of PPD. However, PPD symptoms did not vary between the two assessments and remained stable. Mental health screening and interventions must be adopted during pregnancy monitoring and in the postpartum period.

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Chronic heart failure (CHF) is a progressive condition often accompanied by comorbid depression, which exacerbates the overall disease burden and worsens clinical outcomes. Inflammatory processes play a crucial role in the pathophysiology of both CHF and depression. Biomarkers such as C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-α) are known to be elevated in these conditions. Vortioxetine, a multimodal antidepressant, is recognized for its efficacy in treating depression, but its impact on inflammatory markers and heart failure outcomes remains underexplored.

1. 1. To assess the impact of Vortioxetine on CRP levels in patients with CHF and comorbid depression.

2. 2. To evaluate the effect of Vortioxetine on TNF-α levels in the same patient population.

3. 3. To measure the improvements in quality of life and functional outcomes using the MLHFQ and KCCQ scales.

4. 4. To determine the significance of the observed changes in both biomarker levels and functional outcomes.

• - Patients: A cohort of 30 patients with chronic heart failure and comorbid depression was selected. Baseline inflammatory biomarker levels and functional outcomes were recorded.

• - Intervention: All patients were treated with Vortioxetine at a dose of 10 mg/day for six months.

• - Biomarkers: CRP and TNF-α levels were measured before and after six months of treatment.

• - Functional Outcomes: MLHFQ, and functional status was evaluated using the KCCQ. Both assessments were conducted before and after the treatment period.

Biomarkers:

• - CRP: Baseline CRP levels ranged from 2 mg/L to 256 mg/L, with a mean of [89mg/L]. After six months of treatment, CRP levels significantly decreased, ranging from [2mg/L], with a mean post-treatment CRP level of [10,2mg/L].

• - TNF-α: Baseline TNF-α levels ranged from 0 pg/mL to 523 pg/mL, with a mean of [118pg/mL]. After treatment, TNF-α levels showed a significant reduction, with a range of [0pg/mL] and a mean post-treatment level of [18,9pg/mL].

Functional Outcomes:

• - MLHFQ Scores: The mean MLHFQ score before treatment was [67], which improved by 54% after six months of Vortioxetine treatment.

• - KCCQ Scores: The mean KCCQ score before treatment was [12], which improved by 46% after treatment.

Vortioxetine has demonstrated significant potential in treating both the mental and physical aspects of chronic heart failure and comorbid depression. The observed reductions in CRP and TNF-α levels, along with the notable improvements in MLHFQ and KCCQ. scores, highlight its ability to address both inflammatory processes and patient-reported outcomes. Further research is needed to explore the long-term effects of Vortioxetine in larger patient populations and to better understand the mechanisms underlying its anti-inflammatory properties.

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Major depressive disorders (MDD) and bipolar disorders (BD) are strongly associated with suicide attempts in youth. However, little is known regarding the differences in prevalence and clinical-related features of suicide attempts between these two disorders.

The study aimed to examine the prevalence of suicide attempts and related factors in children and adolescents with major mood disorders and compare clinical features between BD and MDD patients who attempted suicide.

A cross-sectional study was conducted at the Child and Adolescent Psychiatry Department of the Institute of Psychiatry and Mental Health Gregorio Marañón. Patients with diagnosis of major mood disorder were included. All patients were evaluated with K-SADS, CGI (Clinical Global Impression), HDRS (Hamilton Depression Rating scale), YMRS (Young Mania Rating Scale), Conners Rating Scale and CGAS (Children’s Global Assessment Scale). Bivariate analysis was conducted to compare patients with and without suicide attempts and BD versus MDD attempters. Subsequently, a multivariate analysis was performed to assess the combined influence of suicide attempts related factors.

The sample included 145 patients (58 males, 87 females) aged 7 to 17 years (mean 15.15), with diagnosis of BD (55.2%) and MDD (44.8%). The prevalence of suicide attempts for MDD and BD were 58.5 % and 28.8 %, respectively (p< 0.001). 56,5 % of BD attempters reported medically serious suicide attempts versus 28.9% of MDD (p=0.03). 61 patients with suicide attempts were compared to 84 patients without suicide attempts. Suicide attempts were associated with female sex (p<0.001), internalizing disorders (p= 0.003), hopelessness (p=0.001), higher punctuation on HDRS score (p=0.03), suicidal ideation (p<0.001) and NSSI (p<0.001). In the multivariate analysis, it was found that female sex (p<0.001), suicidal ideation (p<0.001) and hopelessness (p=0.048) were independently related to suicide attempts. Comparing suicide attempters with BD versus MDD, BD patients showed higher impulsivity (p=0.04) and a more alcohol use proportion (p=0.04) than MDD patients.

Female sex, suicidal ideation and hopelessness are strongly related to suicide attempts in youth with major mood disorder. The findings revealed some differences between BD and MDD for patients with suicide attempts and accentuate the need for early identification of BD and accurate differentiation between BD and MDD in children and adolescents, to treat them adequately and minimize suicidal behaviors.

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In this presentation I will show that mental health treatment for people with dual diagnosis is not very different from treatment of mental disorders without addiction problems. There are a few points that will be raised like interactions with the drug of choice for the patients and the problem arising from compliance.

The most important point that will be presented is the fact that too many people with dual disorders go untreated. There is a need to rise awareness of this problem within our profession.

The main aim of treatment is often to replace some of the effects that the patients experience using drugs like depression, irritability, fluctuating thoughts and sleep problems.

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