Cognitive dysfunction has been identified as a key mediator of functional impairment in major depression and a contributing factor to antidepressant resistance. Theta burst stimulation (TBS) is a novel form of transcranial magnetic stimulation (TMS) that has shown greater efficacy and efficiency than conventional TMS in the treatment of treatment-resistant depression (TRD). However, its effects on cognitive symptoms in depression remain largely unstudied.

The objective of this study is to evaluate the impact of TBS on neurocognition in unipolar and bipolar TRD patients treated at a public hospital. Additionally, clinical, demographic, and treatment predictors of cognitive change were explored.

This is a follow-up study of n=64 patients with TRD (unipolar=48, bipolar=16) who received daily adjunctive TBS for 6 weeks. Cognitive performance was assessed before and after TBS using different versions of the Screening for Cognitive Impairment (SCIP-S), which measures immediate verbal learning, working memory, verbal fluency, delayed verbal learning, and processing speed. Cognitive performance in each domain was compared using paired t-tests. Global cognitive change was assessed by quantifying pathological domains at baseline and at the end of TBS. Differences in neurocognition between clinical responders (50% reduction on the HDRS) and non-responders to TBS were compared using ANOVA models. Additionally, possible predictors of cognitive change in each domain were explored using correlation analyses and multiple linear regressions, which included factors such as age, diagnosis, number of TBS sessions, treatment type, TBS modality (left unilateral vs. bilateral), clinical response, and baseline severity.

Patients treated with TBS achieved significant clinical response (68%) and cognitive improvement in the domains of immediate verbal learning, working memory, verbal fluency, and processing speed (mean differences of 2.16, 2.31, 1.30, and 1.05, respectively). Neurocognitive improvement was independent of clinical response. The percentage of improvement on the HDRS was only associated with improvement in the verbal fluency domain (p = .007). Left unilateral TBS and bipolar diagnosis predicted better global cognitive improvement in SCIP in regression models (p = .042, p = .037, respectively).

The results support the utility of TBS in treating cognitive dysfunction associated with TRD. Further larger studies are needed to clarify clinical and treatment predictors of cognitive improvement.

None Declared

Early-onset bipolar disorder (BD) and attention-deficit hyperactivity disorder (ADHD) have recently been the subject of a highly controversial debate, due to theories regarding the underlying pathophysiological processes and a clinical overlap of symptoms. Epidemiological data, clinical aspect, neuroimaging, neurochemical and genetic studies suggest that there may be a possible relationship between biological factors and clinical characteristics in the development of symptoms.

Investigation of the prevalence of ADHD symptoms in bipolar patients compared to the control group.Investigating differences in age of onset, clinical presentation, and course of affective illness between bipolar disorder patients with childhood ADHD symptoms compared to those without childhood ADHD symptoms.

The study included 20 patients with bipolar disorder, hospitalized in the Psychiatric Hospital accompanied by their parents/relatives and 30 healthy controls (matched age, sex, socio-economic status) recruited through avalanche sampling in the Directorate of QSU “Mother Tereza”. The Abbreviated International Neuropsychiatric Interview (MINI) was used to identify cases with bipolar disorder or possible psychiatric pathology. The Diagnostic Interview for ADHD Adults (DIVA 2.0) was used to explore the presence of symptoms of attention deficit hyperactivity disorder (ADHD) in childhood and at the current age.Descriptive analysis in SPSS was used for data analysis.

It resulted that 80% of bipolar patients had ADHD symptoms in childhood compared to 16.67% in the control group. The age of onset of bipolar disorder was 17.31 years earlier in the group of cases with history of ADHD in childhood compared to the age of 21.25 years in cases without ADHD in childhood. In cases with history of ADHD, 43.75% had longer duration of manic episodes/ hypomanic compared to 25% in the group of cases without childhood ADHD. The number of suicide attempts 1 or >1 was more frequent in patients with a history of ADHD (25% and 12.5 %) compared to cases without a history of ADHD (25 %). In psychotic symptoms during mania, it was found that in patients with a history of ADHD in childhood, the prevalence was higher (81.82%) compared to (50%) in those without a history of ADHD in childhood. The prevalence of adult ADHD in cases was 35% compared to controls 6.66%. Apparently, the number of cases with comorbid ADHD with impaired social/family functioning was higher compared with the group of controls with comorbid ADHD.

The associations of each clinical component of bipolar disorder with the presence or absence of ADHD in childhood were not statistically significant. However, it is worth noting that in complexity, the number of patients with more severe features of bipolar disorder is higher in cases with ADHD in childhood compared to cases without ADHD in childhood in our sample.

None Declared

Substance use disorders are among the leading causes of morbidity and mortality worldwide. SUDs are highly comorbid with other mental health disorders. Given this comorbidity, a transdiagnostic view on treatment, seems appropriate. Within such a transdiagnostic perspective, treatment outcome can be described as a decrease in comorbid clinical symptomatology and not merely in terms of abstinence/relapse in substance use. A promising transdiagnostic factor within the RDoC framework is temperament, more specifically reactive and regulative temperament. According to the dual pathways model, psychopathology arises from an imbalance between two complementary neurobiological systems: the bottom-up reactivity system in terms of behavioral inhibition (BIS) and behavioral activation (BAS) (reactive temperament) and the top-down regulation in terms of Effortful Control (EC) (regulative temperament).

We want to investigate whether reactive (BIS/BAS) and regulative temperament (EC) are associated with treatment outcome in terms of a decrease in clinical symptomatology in a sample of adult inpatients with a SUD. When these temperamental factors turn out to be significant predictors of clinical symptomatology, treatment interventions targeting reactivity (high BAS or BIS level) or aiming at strengthening EC could possibly result in better treatment outcomes for patients with SUDs and comorbid disorders.

The sample consisted of 612 inpatients with a SUD ((76,5% males, mean age 42,9 years) admitted at a specialized treatment unit for addiction. At the start of the treatment (pre) self-report questionnaires were administered to assess the reactive temperament dimensions (the Behavioral Inhibition/Behavioral Activation System Scales), the regulative temperament dimension (the Effortful Control Scale from the Adult Temperament Questionnaire) and clinical symptomatology (Symptom-Checklist-90-Revised, SCL-90-R). At discharge, the SCL-90-R was administered again to assess treatment effectiveness (post).

Paired sample t-test showed significant decreases between pre- and posttreatment symptom scores indicating that treatment was effective in decreasing symptomatology. A hierarchical regression analysis showed that higher levels of EC were associated with a stronger decrease in levels of psychological symptoms and that higher levels of BIS were associated with a lower decrease. There was however no moderating role of EC in the relation between reactive temperamental dimensions and treatment outcome.

We found that reactive and regulative temperament could predict psychological symptomatology after a residential treatment period of 8 weeks in a specialized addiction unit. These results point out that interventions aiming at either strengthening EC or lowering anxiety (BIS) could possibly result in better treatment outcomes for patients with SUDs their comorbid disorders.

None Declared

Metabolic syndrome (MetS) is notably prevalent among individuals with bipolar disorder (BD). Despite numerous studies indicating an increasing MetS prevalence in this group over time, comprehensive investigations of associated risk factors remain limited.

This study aims to assess the prevalence and 1-year changes in MetS among BD patients. It also seeks to identify baseline clinical features that could predict the development of MetS during follow-up.

The study included euthymic BD type 1 patients consecutively admitted between July 2023 and July 2024. MetS was diagnosed uaccording to NCEP ATP-III criteria at baseline and after one year. Patients without MetS at baseline were analyzed to evaluate the association between initial clinical characteristics and MetS presence at follow-up through logistic regression.

A total of 98 patients completed the baseline and follow-up assessments. The prevalence of MetS significantly increased from 29.6% to 51.0% over the 1-year naturalistic follow-up. Initially, there were no significant differences between the groups with and without MetS regarding demographics, illness characteristics, treatment types, comorbidities, and chlorpromazine equivalent dose. By the end of the follow-up period, 29 new MetS cases were diagnosed after excluding those initially identified. This group exhibited higher numbers of total episodes, more manic episodes, and greater hospitalization rates (p = 0.04,-2.067; p = 0.03, -2.193; p = 0.03, -3.207), with no significant differences in other demographic or clinical variables.In the logistic regression analysis, which controlled for age, gender, number of depressive episodes, and the use of lithium and valproate, the equivalent chlorpromazine dose (p = 0.04, OR: 1.003) emerged as a significant predictor of metabolic syndrome, while the number of manic or hypomanic episodes demonstrated a trend towards significance (p = 0.05).

In conclusion, this study shows that the prevalence of MetS in patients with BD type-1 in Turkey increased from 29.6% to 51.0% over one year. Increased numbers of manic episodes and higher chlorpromazine doses were linked to the development of MetS. This underscores the importance of monitoring metabolic health, especially in patients with frequent manic episodes or high antipsychotic doses.

None Declared

ADHD (Attention-Deficit/Hyperactivity Disorder) is a common treatable disorder that impairs daily functioning along the life span. Pharmacotherapy plays a central role in managing ADHD, but adherence rates can be low, impacting treatment effectiveness.

To compare the adherence to the specific medication used to treat ADHD on specific patient populations.

In this study, we used “Clalit Medical Services” anonymized data base and focused on the first year of treatment with the four available first-line pharmacotherapy products: Methylphenidate tablets, Methylphenidate Slow Release tablets, Methylphenidate Long Aacting capsules, and Oros Methylphenidate tablets. Analyzing data from 214,035 patients of all ages diagnosed with ADHD who initiated pharmacotherapy between 2000 and 2022, we used a Negative Binomial Regression to develop a model to predict the number of prescriptions purchased in the first year of treatment, serving as a proxy for adherence. Our main focus was on identifying medications that enable better adherence.

Oros Methylphenidatehad the highest number of predicted purchases (RR CI 95%: 5.85-5.96). After adjusting for calendar year effects, our results identified gender, age group, and socioeconomic status (SES) as significant predictors of adherence. A significant interaction effect revealed that the predicted number of purchases for a specific medication is influenced by the patient’s SES level, i.e., for the lower SES levels adherence with Methylphenidate was better than adherence with Oros Methylphenidate.

The choice of the specific medication available as first-line treatment for ADHD, has a significant effect on adherence. Oros Methylphenidatehas has better adherence than the other MPH formulas. This would guide physicians to prefer the use of Oros Methylphenidateas first line therapy. This is not true for the lower SES. Strengthening our assumptions that knowledge about medication adherence and patient characteristics are potential indicators for improving the treatment of ADHD.

None Declared

Up to 30-70% of patients with treatment-resistant schizophrenia (TRS) remain symptomatic despite gold standard treatment, clozapine. To date, commonly used antipsychotics have demonstrated little therapeutic benefit as augmenting agents in comparison to placebo. Emerging evidence suggests that novel D2-D3 partial agonist cariprazine is a promising augmentation strategy to clozapine for TRS.

This systematic review aims to collect the available real-world evidence of effectiveness and tolerability of cariprazine and clozapine combination treatment.

A systematic review was performed using PubMed, MEDLINE, EMBASE and Cochrane databases from January 2017 until September 2024 for cases where cariprazine was used as an augmentation strategy for clozapine with the following terms: (cariprazin*) AND (clozapin*) AND (‘case report*’ OR ‘case report’/de OR ‘case stud*’ OR ‘case study’/de OR ‘case seri*’ OR ‘add-on’ OR augmentation OR combin*).

After removal of duplicates, 108 studies were retrieved, of which 20 studies were included (one prospective pilot study and 19 case reports). Total cases comprised of 47 patients (30 male, 17 female), with diagnoses of schizophrenia (n=40), schizoaffective disorder (n=6) and emotionally unstable personality disorder (EUPD) and autism spectrum disorder (n=1). Patients were treated with clozapine (dose range 37.5-850 mg/day) and cariprazine (doses 1.5-6.0 mg/day) for a median of 122 days (range 18-456). Although a variety of subjective and objective outcome measures were employed, cariprazine was generally found to be a well-tolerated and effective adjunct to clozapine in a wide range of different symptom profiles; demonstrating efficacy across positive, negative and affective symptoms, quality of life and global functioning in the majority of cases. Additional benefits of weight loss and improving commonly experienced adverse side effects of clozapine were also frequently reported. In 3 cases cariprazine augmentation did not improve symptomatology, whereas in 6 cases the combination resulted in the exacerbation of different symptoms such as anxiety or restlessness.

By targeting different receptors, cariprazine and clozapine appear to act synergistically allowing for a well-tolerated and effective antipsychotic combination. Large-scale RCTs are warranted to further evaluate its effectiveness compared to placebo.

S. Pappa: None Declared, Z. Dombi Employee of: I am an employee of Gedeon Richter Plc., originator of cariprazine., E. Caldwell-Dunn: None Declared, R. Csehi Employee of: I am an employee of Gedeon Richter Plc., originator of cariprazine., Á. Barabássy Employee of: I am an employee of Gedeon Richter Plc., originator of cariprazine.

Cannabis use in young adulthood is common, yet few studies have explored how it predicts changes in psychopathology and functional well-being in community samples. We assessed these links using both self-reported frequency of cannabis use and hair THC concentrations.

Data came from a community sample of young adults (N = 863) who reported cannabis use (weekly-to-daily use: n = 150) and provided hair samples at age 20 (cannabis detected: n = 110). Liquid chromatography–tandem mass spectrometry quantified delta-9-tetrahydrocannabinol (THC) and cannabinol (CBN) concentrations in hair. At ages 20 and 24, participants reported psychopathology (psychotic-like experiences, problematic substance use, internalizing symptoms, and aggression) and functional wellbeing (general well-being, delinquency, and not being in employment, education, or training). Multiple linear and logit regression models tested associations between six different continuous and dichotomous operationalizations of self-reported and objective cannabis exposure at age 20 and psychological and functional well-being at age 24, adjusting for sex, sociodemographic characteristics, and the outcomes measured at age 20.

Both self-reported frequency of cannabis use and hair THC concentrations predicted increases in psychotic-like experiences and internalizing symptoms, increased aggression, decreased general well-being, higher odds of not being in employment, training, or education, and more problematic substance use from age 20 to 24, with small effect sizes. Composite exposure scores derived from self-reports and hair data were not more informative than either source alone.

Frequent cannabis use predicted adverse changes in psychopathological outcomes from ages 20 to 24, regardless of how it was assessed.

Delirium, as described in the DSM-V, is a disruption in attention and consciousness that develops over a brief period, representing an acute change from baseline awareness. First-generation antipsychotics, such as haloperidol, are often advised as the first line of pharmacological treatment. In comparison to haloperidol, olanzapine appears to be more beneficial in terms of efficacy and safety, according to a 2016 systematic review and meta-analysis of randomized clinical studies. However, most of the research included were single-center investigations with tiny sample numbers, diverse study demographics, and bias potential.

The aim of this systematic review was to identify the current best evidence on the effectiveness of olanzapine versus haloperidol in various clinical settings to guide best practices for healthcare professionals. Also, this literature review seeks to provide a up-to-date synthesis of the current evidence on this subject.

We conducted a systematic search of four databases (PubMed, PsycINFO, CINAHL, and Cochrane Central) from inception through January 31st, 2024, using keywords related to delirium (acute confusion, confusion state, confusional state), olanzapine, and haloperidol. The search was limited to randomized controlled trials comparing olanzapine with haloperidol, without restrictions on dose, route of administration, or drug exposures. When analyzing outcomes with a robust number of studies, we applied a random-effects model. For outcomes with fewer studies, we used a fixed-effects model. Additionally, we conducted sensivity and subgroup analyses. All statistical evaluations were performed using the RevMan software.

Seven studies met our inclusion criteria. Haloperidol was associated with a significantly lower severity of delirium after 2-3 days of treatment compared to olanzapine, with a small effect size (g = 0.40, 95% CI [0.02; 0.78], p = 0.04) based on three studies (n = 110). However, no significant difference was observed after 4-7 days (g = 0.09, 95% CI [-0.26; 0.44], p = 0.61) across five studies (n = 306). There was no significant difference in overall side effect rates between haloperidol and olanzapine (p = 0.29, 7 studies, n = 530), but haloperidol resulted in significantly more extrapyramidal side effects (p = 0.008). Sedation as an adverse effect did not differ significantly between the two drugs (p = 0.54, 4 studies, n = 284).

Haloperidol may offer superior short-term efficacy in reducing delirium severity but is associated with a higher risk of extrapyramidal symptoms. No significant differences were found in long-term efficacy or sedation rates between olanzapine and haloperidol. These findings support the need for careful consideration of drug safety profiles in the treatment of delirium.

None Declared

Resilience plays an essential role in many settings, including medical resident training. This group undergoes a unique educational process that demands the development of both clinical and interpersonal skills, as well as a high level of personal responsibility for patient care.

The aim of this study was to evaluate resilience among medical residents and identify the factors that influence it.

We conducted a cross-sectional study involving medical residents in training at Tunisian hospitals. Data were collected anonymously through a questionnaire-based survey using Google Forms between October 2023 and January 2024. Participants completed a sociodemographic form, followed by two scales: the Brief Resilience Scale (BRS) to measure resilience and the Perceived Stress Scale (PSS-4) to assess mental health disorders.

Our study included 127 participants, with the majority being women (74.8%). The average age was 27.24 ± 1.34 years. Most participants were single (81.8%), and only 5.5% were international residents. Approximately one-third (37%) engaged in physical activity. A psychiatric history was reported in 17.3% of the residents. The mean Brief Resilience Scale (BRS) score was 3.167 ± 0.77. Low resilience scores were observed in 34.6% of participants, while only 6.3% had high resilience scores. The mean Perceived Stress Scale (PSS-4) score was 7.08 ± 2.7. Univariate analysis revealed that lower resilience levels were more common among females (p = 0.000) and residents with a history of psychiatric disorders (p = 0.06). Additionally, lower resilience levels were associated with higher stress levels (p = 0.00; r = -0.512).

The study highlights the need for targeted interventions to enhance resilience among medical residents, particularly for those in vulnerable subgroups. Improving resilience through tailored support strategies can significantly benefit their overall well-being and training outcomes.

None Declared

• - Obsessive- Compulsive Disorder (OCD) is a neuropsychiatric illness affecting 2-3% of the United States population during their lifetime. It is a highly prevalent chronic disorder, often refractory to treatment, an understanding of the pathophysiology of OCD is crucial to optimize treatment. The most common comorbid diagnosis is major depressive disorder (MDD). In 2018, the US Food and Drug Administration cleared the treatment of resistant OCD with high frequency deep repetitive transcranial magnetic stimulation (dTMS) over the dorsomedial prefrontal and anterior cingulate cortices (DMPFC-ACC) with the H7 coil based on the efficacious results of a multi-center study. Compare to H7 coil, H1 coil which is approved for the treatment of resistant MDD, targets and stimulate the left prefrontal cortex more than the medial and right prefrontal cortices.

• - Carmi L, Tendler A, Rodrigues da Silva D,

To assess the effect of TMS in patients with refractory OCD

We conducted literature review search on treatment- specific for OCD on four databases, i.e google scholar, PubMed, PsycINFO and Mount Sinai’s Levy Library.

The meta-analysis combined the results of individual randomized controlled trials (RCTs) to evaluate the effectiveness of repetitive transcranial magnetic stimulations (rTMS) on obsessive-compulsive disorder (OCD). It showed that rTMS were moderately effective in reducing OCD symptom severity (studies indicated a medium-sized effect, Hedges’ g = 0.59-0.65) and a threefold augmentation of treatment effects as compared with sham conditions. Studies also reported a marked heterogeneity in treatment response, which appeared to be particularly seen in patients with comorbid depression. Clinical improvement in depression was associated with greater reductions in OCD symptoms.

Certain rTMS protocols, including low-frequency stimulation (LF-rTMS) over the dorsolateral prefrontal cortex (DLPFC) and supplementary motor area (SMA), consistently showed more effects. Longer session durations and targeted stimulation of non-DLPFC regions, such as the orbitofrontal cortex and pre-SMA, were also associated with more positive outcomes.

But there are limitations - These studies were small, heterogeneous, and prone to publication bias, and few studies reported serious side effects, though some protocols especially those using high-frequency stimulation yielded higher rates of adverse effects.

To conclude, rTMS use as a new therapy for treatment-resistant OCD, particularly OCD comorbid with depression, is promising. However, due to study design inconsistencies and limited statistical power in individual trials, the quality of evidence is currently low. Studies using this approach need further improvement and more evidence to refine stimulation parameters better, increase our understanding of the underlying mechanisms, and confirm sustained efficacy.

None Declared

We are seeing an increasingly diverse population in the Emergency Department. There have been increasing numbers of displaced Ukrainians attending the Emergency Department and referred from the general medical/surgical wards for psychiatric assessment since the Russian invasion of Ukraine in 2022.

The objective of this retrospective audit was to examine the demographic and clinical characteristics of displaced Ukrainians presenting to the University Hospital Galway with psychiatric presentations. Our aim was to review the impact of psychiatric presentations of displaced Ukrainians on the Liaison Psychiatry/on-call Psychiatry service

We utilised the Liaison Psychiatry patient database to extract data on status as a displaced Ukrainian, presenting complaint, working diagnosis, use of interpreter, location of review, outcome of review and other demographic data. This was a retrospective audit using anonymised data.

We found that a total of twenty-eight patient presentations were seen by Liaison Psychiatry or by the on-call Psychiatry doctor from March 2022 to December 2023 (inclusive). Twenty-three patient presentations (82.1%) were seen in the Emergency Department. Nineteen patient presentations (67.9%) required the services of an interpreter. 16 patient presentations (57.1%) were in relation to low mood with or without suicidal ideation. 16 patient presentations (57.1%) resulted in a referral to a Community Mental Health Team.

There is a significant number of Ukrainian refugees attending the Emergency Department for psychiatric reasons. The vast majority of these patients do not speak English and require an interpreter. Being able to communicate effectively is crucial in taking a psychiatric history and further improvements should be made to improve the experience that this population of patients have in the Emergency Department. This audit can be used to inform service development in the Liaison Psychiatry department to better serve the needs of displaced Ukrainians, such as through the introduction of translated patient information documents.

None Declared

Digital interventions are increasingly popular in addressing various issues, including mental health problems, executive functions, and social cognitive skills in clinical and non-clinical populations. Previous studies have revealed that neurotypical individuals with elevated autistic traits may be more susceptible to other mental health conditions such as anxiety disorders, mood disorders, internet addiction, substance abuse, and suicidal risk. While there is no definitive explanation for this susceptibility, social and cognitive impairments may be contributing factors, including problems with executive functions and social cognitive skills.

The main goal of this research is to develop an online social cognitive training program and conduct a pilot study to assess its feasibility within the current sample.

36 participants (randomly assigned to 16 for the experimental group and 20 for the control group) were recruited for the pilot study and the experimental group completed 6 weeks of an online intervention program, while the control group was assigned to the waiting list. Autism Quotient, Depression Anxiety Stress -21, Patient Health Questionnaire -9, and Generalized Anxiety Questionnaire– 7 were used to assess mental health symptoms. Executive functions were evaluated using the Wisconsin Card Sorting Task, N-back Task, and Go/No-Go task. At the same time, social cognition was assessed through the Interpersonal Reactivity Index, The Eyes test, and the Self-Assessment Manikin.

2 x 2 mixed repeated measure ANOVA was conducted. The main effect of time and group was significant for mental health symptoms and working memory (p < 0.5). However, the interaction of time and group was not significant (p > .05). Communication and attention switching (two components of autistic traits) have significant impacts on the scores (p < 0.5).

This pilot study demonstrated significant improvements in mental health scores, laying a solid foundation for further development and efficacy testing of the digital intervention program. This suggests that the intervention holds promise, particularly in targeting mental health improvements. Attention switching and communication contribute to the overall main effects highlighting the program’s potential in addressing key aspects of mental health.

None Declared

Ethical practices are fundamental to the training and professional development of psychiatry and child psychiatry residents. However, challenges such as stigmatization, discrimination, and ethical dilemmas in clinical and research settings can impact the quality of their training experience.

1. 1. To assess the degree of exposure of residents to stigmatization during their residency training.

2. 2. To explore the level of awareness among residents regarding the practice of ethics in their clinical and research activities.

This is a cross-sectional study conducted by the National College of Psychiatry and Child Psychiatry from January 13 to January 16, 2024. An anonymous Google Forms questionnaire about ethic aspects during during residency training was sent to psychiatry and child psychiatry residents via the college email and private groups.

We received 71 responses. The participants had an average age of 29.9 years, with a sex ratio of 0.1. Among them, 50.7% were child psychiatry residents, and 49.3% were psychiatry residents. Residents reported experiencing discrimination in 49% of cases, with the following breakdown: from senior staff (61.1%), paramedical staff (47.2%), and doctors from other specialties (33.3%). The primary cause of discrimination was the residency level (56.3%). Residents reported experiencing discrimination in role distribution within the department (35.2%) and in scientific work (31%).

Regarding their thesis work, 8.5% of residents felt obliged in choosing their thesis supervisor, and 16.9% felt pressured in selecting their thesis topic. Residents submitted their thesis work to the local committee in 58.5% of cases, informed participants about the study in a satisfactory manner in 75.4% of cases, and obtained oral informed consent from participants (or their parents) in 46.2% of cases. The residents felt that training in psychiatric ethics was necessary in 94.5% of cases and that specific training in research ethics in psychiatry was necessary in 91.8% of cases.

Taking into account the various findings of our survey and raising awareness among different stakeholders, including doctors and paramedical team members, are essential measures to ensure that psychiatry and child psychiatry residents can complete their specialty training while adhering to fundamental ethical principles.

None Declared

The evaluation of trauma-related disorders is becoming increasingly significant in psychiatric assessments. According to the DSM-5, these disorders are categorized as Post-Traumatic Stress Disorder (PTSD), Acute Stress Disorder, Adjustment Disorders, Prolonged Grief Disorder, Reactive Attachment Disorder, and other specified trauma- and stressor-related disorders. International guidelines on post-traumatic symptoms report positive outcomes with trauma-focused cognitive-behavioral therapy and EMDR, as well as non-trauma-focused therapies, such as relaxation techniques. Acupuncture and acupressure techniques can be used not only for treating symptoms but also for addressing associated sleep disorders, headaches and affective disorders. These methods are clinically applied to patients with traumatic events, primarily as ear acupuncture using the NADA protocol, along with ‘Battlefield Acupuncture,’ which has been established among American soldiers. In our clinical work, we use a unique protocol called Acupuncture-Based Exposition (ABE) (Schottdorf & Musil, 2017).

The assessment of the effectiveness of the newly developed method of Acupuncture-Based Exposure (ABE).

The ABE (Acupuncture-Based Exposition) method was developed by Dr. Schottdorf and investigated by Dr. Musil and has already been clinically applied in their practice and clinic to a variety of patients. It has also been invetigated in an initial pilot study focusing on Type I trauma-related disorders, post-embitterment disorder as well as postpartum depression, and pain disorders. During ABE sessions, after a basic acupuncture treatment, patients are guided to visualize images of their traumatic experiences. The resulting physical sensations and emotions are addressed through corresponding acupuncture points until their intensity decreases. Finally, the imagined images are faded out using points on the head. Patients subsequently report a significant reduction in the burden of intrusive memories.

In an initial case series involving 24 patients with trauma-related symptoms, an average reduction in trauma-specific symptoms was observed after just 3.95 sessions, as measured by the Impact of Events Scale-Revised (IES-R), from 55.6 ± 23.0 to 16.2 ± 21.1 (Wilcoxon test: p < 0.002). Additionally, a decrease in depressive symptoms was noted, measured by the Beck Depression Inventory, from 38.3 ± 8.0 to 25.6 ± 8.0 (Wilcoxon test: p < 0.001) (Schottdorf, 2018). So far, there have been no investigations into the mechanisms of action of ABE beyond clinical experience and initial data from clinical pilot projects.

Particularly, integrating acupuncture as an adjunct to conventional treatments for mental disorders appears to offer promising results. Further clinical research in the field of acupuncture and the ABE method is necessary.

None Declared

Lithium enjoyed its first golden age between 1965 and 1990, but interest in the molecule has not waned, on the contrary, the last 20 years have seen a veritable renaissance in lithium publications. This literature is fuelled by the ongoing exploration of lithium’s unique mood-stabilizing, anti-suicidal and neuroprotective properties, a panoply of properties never before observed in a single molecule. In spite of this, the literature describes little use of lithium, despite ample evidence of its benefits.Our study points the perceptions and misperceptions of lithium and their effects on it use in our hospital.

To study and identify the perceptions and misperceptions of doctors at Ar-razi Hospital about lithium, and thus discuss both of efficacy and safety misperceptions through a litterature review. This study will have as a first objective to correct these mispercetions in order to promote a proper care of our patients.

This is a descriptive study. Data collection was carried out on 50 psychiatrists and trainees. By using an online and handout forms focusing on physicians perceptions and misperceptions of the efficacy and safety of lithium at Ar-razi Hospital in Salé. Jamovi 2.3 was used for data entry and statistical analysis.

our study results were resumed in 2 images. Image 1 is a table that shows the status of our professionnals and also their use of lithum as first or second molecule.

image 2 resumes efficacy perceptions of lithium among our psychiatrists and trainees.

although many other results will be shown by text:

• - 58% thinks that Lithium should not be used in women of childbearing age due to teratogenic risk

• - 73% have the perception that Lithium should be avoided in elderly patients suffering from a lack of efficacy data and safety concerns.

• - 53% thinks that other thymoregulators are safer and should be systematically used in women of childbearing age with bipolar disorder instead of lithium.

• - 84% acclaim that lithium treatment is stopped because of it security profile, when 44% of them thinks that hypothyroidism is prevalent as a secondary effect and causes treatment stop.

Image 1:

Image 2:

Our study finds that our hospital professionnals have many misperceptions about lithium, especially about it security, which may affect the treatment plan for many patients. This study and it discussion throught the litterature review will change these perceptions, furthermore give the patients a proper care.

Disclosure of new knowledge is essential to refute misconceptions about lithium and enable patients to access its unique therapeutic constellation.

None Declared

Complex Regional Pain Syndrome (CRPS) is a chronic neuropathic pain condition that significantly reduces patients’ quality of life. Few studies have examined the application of short-term Behavioral Activation (BA) programs for patients with CRPS, and studies that include informational support messages are scarce.

This study is intended to investigate the effects of an online BA program, accompanied by informational support messages, on pain intensity, pain interference, pain catastrophizing, depression, life satisfaction, and behavioral patterns in patients with CRPS.

Two patients with CRPS participated in an eight-session online BA program using a multiple-baseline design. After the first session, participants completed daily activity monitoring sheets, and the baseline was measured. The BA intervention began in the third session, and from that point until the eighth session, participants received immediate informational support messages once they completed their monitoring sheets. The informational support messages consisted of graphs comparing the previous day’s pain intensity, depression levels, and activity levels, as well as linear trendline graphs based on recorded data. Additionally, questionnaires were used to measure pain intensity, pain interference, pain catastrophizing, depression, life satisfaction, and behavioral patterns pre-intervention, post-intervention, and at a four-week follow-up, and effect sizes (Cohen’s d) were calculated.

Daily activity monitoring sheets indicated that activity levels significantly increased during the intervention phase and were maintained or further increased at follow-up. Depression levels gradually decreased from the intervention phase, but pain intensity showed no significant change.

Questionnaires revealed that pain catastrophizing and depression decreased post-intervention and at follow-up compared to baseline, while life satisfaction increased, and pain avoidance behaviors decreased. However, pain intensity increased compared to baseline, and pain interference decreased at follow-up. Effect sizes, measured by Cohen’s d, indicated large effects for all variables except behavioral patterns and pain interference post-intervention, and for all variables except behavioral patterns at follow-up.

These findings suggest that an online BA program with informational support may be effective for patients with CRPS.

M. Jung Grant / Research support from: National Research Foundation of Korea Grant funded by the Korean Government (NRF-2022S1A5A2A03050752), S. Cho Grant / Research support from: National Research Foundation of Korea Grant funded by the Korean Government (NRF-2022S1A5A2A03050752)