Bore-out affects three times as many employees as burn-out. It results from a lack of activity during work, and the healthcare sector, due to its monotony, promotes the emergence of these disorders

Study the predisposition of hospital nurses to boredom, and investigate a possible relationship between this predisposition and their anxiety-depression profile.

This is a cross-sectional descriptive study conducted in April 2022 involving all nurses at the Sahloul University Hospital in Sousse. We used a pre-established questionnaire that included two validated tools: the Boredom Proneness Scale (BP) and the Hospital Anxiety and Depression Scale (HAD).

A total of 65 nurses took part in this study. The mean age was 36.62 ± 4.82 years and the sex ratio was 0.38. According to the BP Scale, 13 nurses were inclined towards boredom (20%). A predisposition to boredom has been observed among staff with less than 8 years of seniority (p= 0.001), those with no extracurricular activities (p= 0.020), those with a moderate or severe workload (p= 0.008), and those whose profession had no impact on their relationships with others (p= 0.012).The depression score on the HAD scale was moderate (32%), average (20%), and severe (12%). The HAD scale revealed that 29% of people had mild anxiety, 23% had moderate anxiety, and 12% had severe anxiety. No statistically significant relationship was found between the boredom disposition scale and the HAD scale.

Bore-out can worsen anxiety and depressive disorders by causing boredom and frustration. It is crucial to promote an engaging and varied work environment to protect employees’ mental health.

None Declared

Mental health reform was accepted in Slovenia in 2018 to provide accessible community treatment and care regionally for 40-70000 population. The implementation took place mostly with establishment of community mental health centers (CMHC), which included arround 20 000 patients in 16 community centers for the adult population. These CMHCs provide triage, needs assessment and treatment plans. The National Mental Health Plan did not adress the development of rehabilitation services. The institutional costs of treatment and care were not reduced, as well as not the number of institutional beds.

To assess the development of CMCH’s in Slovenia on the grounds of the data from the CMHC Logatec.

The data about 5761 patients included in the treatment process in one of the CMHCs were gathered regarding basic demographic data, diagnosis and treatment mode, including the definition of care coordination.

2654 patients were treated in the home environment. Medical nurses were coordinating treatment in the majority of these patients. Occupational therapist, social worker and psychiatrists were part of the team in this group. 816 patients in this group were diagnosed with dementia and had also somatic ilness. 1011 were diagnosed with schizoprenia or other psychotic disorders. 3107 patients were treated in the outpatient care, the majority of them by psychologists. Psychiatrists and social worker were included in these care coordinating teams. 1219 of them were diagnosed with depressive and 1001 anxiety disorders.

Community care teams in Slovenia included around 20 000 patients in three years time. The majority of these, specifically in Logatec are diagnosed with schizophrenia, dementia, depressive and anxiety disorders. Immediate access to service is still granted, with exception of psychological treatment which does not reach everybody in need in time. Development of CMCH’s should be led by needs assesment on the ground of developing data. It’s already obvious that increase of the number of psychologists to improve psychological assistance to people with cognitive decline and for young people in severe but mostly manageable psychological crisis is needed.

None Declared

Autism spectrum disorder(ASD) is a developmental disorder that includes social communication challenges, restricted interests, repetitive behaviors, and intellectual incapacity. The specific etiology of ASD is unknown. However, it is thought to be a combination of genetic and environmental factors. ASD has been linked to copy number variation (CNV), which alters chromosome structure at the submicroscopic level. 16p11.2 deletion is one of the most commonly documented cytogenetic causes of ASD, with an estimated incidence of 0.5% among ASD patients. (Ju et al. 2021; Frontiers in cellular neuroscience, 15, 718720.)

We investigated to explain the hereditary characteristics of a case of ASD that included intellectual disability and dysmorphic facial traits.

Our patient is 20 months old and applied to our clinic accompanied by his parents due to speech delay and with the story of forgetting a few words he had learned around 1 year old. When we evaluate it from a developmental perspective, he held his head at the 10th month, babbled at the 8th month, sat without support 13 the month, crawled at the 15th month, walked at the 17th month, said his first words at the age of one, but he has regression history around 1 year and 4 months old, and not completed his toilet training yet. At 18 months old, a genetic screening was conducted due to brachycephalic facial structure, prominent forehead ridge and protrusion in the frontal area, mild midface hypoplasia, hypertelorism (interocular distance of 2.9 cm), slightly slanted eye sockets, synophrys, anteverted nostrils, a small nose with a deeply set nasal bridge, mild prognathism, and deeply set, posteriorly rotated ears. The genetic screening revealed a 597.84 kb microdeletion in the short arm of chromosome 16(16p11.2) through CGH array analysis

During our examinations, it was observed that the child is generally passive, does not sufficiently use verbal and non-verbal communication, has inadequate eye contact, and responds inconsistently to their name. Based on the developmental tests and our evaluation, the child was found to be significantly behind in developmental milestones, leading to a consideration of autism and cognitive delay. It was recommended that the child begin special education.

The deletion of 16p11.2 may lead to developmental disorders and poor socio-cognitive performance by disrupting long-range prefrontal synchronization. This is supported by ASD-associated CNV and impaired macroscale connectivity. (Bertero et al. 2018; Brain, 141(7), 2055-2065) Deletions of 16q11.2 are associated with higher rates of psychopathology relative to familial controls, emphasizing the need for early identification, diagnosis, and intervention (Niarchou et al,2019; Translational psychiatry; 9(1), 8)

None Declared

The pharmacological effect is the result of both pharmacokinetic (e.g., how the body affects the medication) and pharmacodynamic (e.g., how the medication affects the body) processes occurring simultaneously. Pharmacokinetics includes the processes of liberation, absorption, distribution, metabolism, and elimination (LADME). These processes govern the steady-state plasma concentration (Css). Therapeutic drug monitoring (TDM) is a pharmacological tool used to select and adjust medications. TDM enables Css measurements and dose adjustment calculations. In this presentation, the presenter will cover the main pharmacokinetic issues related to TDM in this clinical case, including Css determination, therapeutic range, dose adjustment, and pharmacokinetic calculations. Participants will learn the fundamental pharmacokinetic aspects necessary for understanding the case.

None Declared

Numerous studies have highlighted the unmet needs in intimate and sexual relationships among patients with schizophrenia. Although research shows that patients with schizophrenia express a desire for romantic and sexual connections, they encounter difficulties in forming and sustaining these relationships. However, the underlying causes of deficits in sexual and romantic functioning remain unknown and unexplored.

The study aims to assess whether difficulties in forming intimate relationships could be connected to a decreased ability to interpret courtship signals.

49 male participants (36 patients, 13 controls) and 27 female participants (14 patients, 13 controls) were exposed to our experiment „Does she like me?” task. The task involves a video stimuli that depicts a woman/man displaying different nonverbal behaviors (rejection, courtship, and neutral attitude). Each participant evaluated the woman’s sexual interest/ man’s sexual interest on a nine-point scale. In addition, eye movements and pupil dilation were measured using the eye-tracking device Eyelink 1000plus. Patients and controls were compared on subjective report and psychophysiological eye tracking markers. For data analysis, we used Repeated measures ANOVA.

There was no statistically significant difference between the control group and patients in their assessment of women´s interest (F (2, 94) = 1.28, p = 0.28, ηp2= 0.03) or men’s interest (F (2,50) = 0.24, p = 0.79, ηp2= 0.01). Also, there was no difference in average pupil size. However, while both groups correctly identified the nonverbal cues and responded accordingly (with the greatest assessments of interest for positive stimuli, lesser for neutral stimuli, and the least for negative stimuli), male patients on average tended to overestimate women’s interest in all conditions (positive, neutral, negative) compared to the control group.

According to our results, the ability to interpret courtship signals does not differ significantly between patients and controls. However, male patients tend to overestimate women’s sexual interest on average, which may be one of the reasons why they face challenges in intimate relationships. Further research is needed to explore this.

The study was supported by the Czech Health Research Council, no. NU21J-04-00024 and by the Charles University, Fac Med1, GAUK no. 56123.

None Declared

Cranial and cervical spine injuries are serious traumatic situations with negative effects in the overall health and also in sports performace and health

Aim of this study is to present cases of deppresive disorders after combination of cranial and cervical spine injuries in amateur athletes

8 cases are presented. Range of age between 25 and 45 years old. All of them reported depressive disorders during the post traumatic period after combination of cranial and cervical spine injuries mainly during amateur athletic activities

All of them they receive appropriate neurological, psychiatric, psycological and rehabilitation support and treatment. They managed to have a good outcome after 36 months follow up.

The development of depressive disorders after such traumatic events remains a strong predictor of a variety of difunctions (social, personal, work etc). The emergence of depressive disorders in many cases remains unexplored and poorly understood. The effect into the the overall health remains a very important factor to investigate. The combination and collaboration of the various medical disciplines is essential in order to help young people.

None Declared

As the world population continues to age, understanding the psychological well-being of older people is becoming increasingly vital. Among the various aspects affecting their quality of life, psychological distress, feelings of loneliness and life satisfaction stand out as key dimensions to explore. With age, individuals face a multitude of physical, social and emotional changes that can significantly affect their overall well-being. Consequently, examining the complex relationship between these factors provides valuable insights for promoting healthy ageing and improving the overall quality of life of older people. Psychological distress, often resulting from a range of factors such as chronic health conditions, cognitive decline and social isolation, can manifest itself in various forms, such as anxiety, depression and stress.

To investigate the correlation between psychological burden (depression, anxiety, and stress), feeling of loneliness and satisfaction with life among elderly.

The sample consisted of 148 elderly people over 65 years old. The research instruments used were a) the Depression Anxiety Stress Scale-21, b) the Life Satisfaction Index, c) The UCLA Loneliness Scale, and d) the Athens Insomnia Scale (AIS).

There is a statistically significant association between engagement in domestic activities and a reduction in depressive symptoms. The frequency of children’s visits and the presence of social support networks significantly influence psychological burden. Those who received infrequent or no visits from their children exhibited higher levels of depression. Loneliness was affected by family interactions, and life satisfaction was influenced by gender and education. Participants who had people in their immediate environment helping them with daily needs reported reduced depressive symptoms. Finally, the study revealed statistically significant differences in reported life satisfaction based on participants’ gender and educational level.

These findings emphasize the need for personalized interventions that acknowledge the complex interplay of these factors in shaping the mental health of older adults.

None Declared

Psychiatric advance directives (PADs) are documents enabling individuals with mental health conditions to specify their treatment preferences for future mental health crises. Despite the benefits of PADs, their implementation has progressed slowly. Concerns about PADs among professionals seem to be part of the explanation. A commonly reported concern is that service users will use PADs to document extensive treatment refusals. Research has not yet explored professionals’ views on ethical conflicts arising from such refusals.

The objective of this study was to explore professionals’ perspectives on ethical conflicts arising from treatment refusals in legally binding PADs.

We carried out semi-structured interviews with 14 mental health professionals working in Germany with professional experience with PADs. We prompted discussions using a case report of an ethical conflict arising from a treatment refusal documented in a PAD. We analyzed the data thematically.

Professionals described the case as extreme yet not unfamiliar. While many felt obligated to respect the PAD, they also felt inclined to override it to promote service user well-being, restore service user autonomy, and protect others. Those inclined to override the PAD focused on scrutinizing its validity and applicability, raising doubts about information disclosure, voluntariness, decision-making capacity, and PAD irrevocability. Professionals believed ethics consultation would help address the ethical conflict.

Legally binding PADs can create ethical conflicts when they include treatment refusals. While the best policy response remains unclear, professionals can help prevent such conflicts by supporting service users in drafting PADs.

In consultation-liaison work, oftentimes the “consult question” is elusive. Primary teams can sense that there is a need for psychiatric consultation, but may not be able to formulate those concerns into the “right question.” Therefore, when the consult team receives the question, the presenting problem may be very different from the reason for consultation. This is never more true than in the case of delirium. Studies have shown that delirium often goes unrecognized by medical and surgical services. (Armstrong et al. Psychosomatics 1997;38:433-439).

This study sought to determine the reasons for consultation when a diagnosis of delirium was given by the consulting psychiatrist.

A retrospective chart review of one year of consecutive consults to the Psychiatry Consult & Liaison service was done for three hospitals comprising the majority of consults to the University of Pittsburgh Medical Center C&L service originating from other teaching services. This yielded approximately 3000 new consults. Each consult was coded for the following variables: the exact quotation from the referring team, the summary statement of what the consultant felt were the most relevant issues, and the DSM-V F-code. We analyzed the consults that were either specific requests for help managing delirium or that resulted in a diagnosis of delirium by the C&L service.

We found that a large majority of consults for “agitation” were ultimately aimed at helping to manage a patient with low cognitive reserve, in the form of dementia, delirium or traumatic brain injury. “AMA” consults were typically involving a patient withdrawing from alcohol or opioids. “Lack of engagement with the treatment team” corresponded to many patients who were delirious. Of the consults that resulted in the diagnosis of delirium the most common reasons for consultation were: delirium/altered mental status (AMS) (21%), depression/adjustment (16%), agitation (11%), psychosis (11%), substance use or overdose (10%), and previously existing psychiatric disorder (26%). Often more than one reason was given for consultation. When only one reason was given previously existing psychiatric disorder (18%), depression (11%), and delirium/AMS (10%) were the most likely reasons for consultation.

The role of the psychiatric team is often to help primary teams figure out which question to ask, and this is then the first step towards getting the patient the help they need. This work adds to the literature because shows patterns between consultation requests and ultimate diagnoses. If we can notice patterns in the diagnoses based on the types of questions that are asked, this may help teach the teams to broaden their differential to include patterns that we have noticed.

None Declared

Many people experience at least one traumatic event in their lifetime. Although such traumatic events can precipitate psychiatric disorders, many individuals exhibit high resilience by adapting to such events with little disruption or may recover their baseline level of functioning after a transient symptomatic period.

To investigate the prevalence and correlates of low resilience in patients before discharge from psychiatric acute care facilities.

Respondents for this study were recruited from nine psychiatric in-patient units across Alberta. Demographic and clinical information were collected via a REDCap online survey. The brief resilience scale (BRS) was used to measure low resilience. A chi-square analysis followed by a binary logistic regression model was employed to identify significant predictors of low resilience.

Overall, 1004 participants took part in this study; 360 (35.9%) were less than 25 years old, 269 (34.7%) were above 40 years old, and most participants were females 550 (54.8%) and Caucasians 625 (62.3%). The prevalence of low resilience in this cohort was (555/1004, 55.3%). Respondents who identified as female were one and a half times more likely to show low resilience (OR=1.564; 95% C.I.=1.79-2.10), while individuals with ‘other gender’ identity were three and a half times more likely to evidence low resilience (OR=3.646; 95% C.I.=1.36-9.71) compared to male gender persons. Similarly, Caucasians were two and one-and-a-half times respectively more likely to present with low resilience compared with respondents who identified as Black people (OR=2.21; 95% C.I.=1.45-3.70) and Asians (OR=1.589; 95% C.I.=1.45-2.44). Additionally, persons with a diagnosis of depression were more than two times and four times, respectively, more likely to present with low resilience than those with bipolar disorder (OR=2.567; 95% C.I.=1.72-3.85) and those with schizophrenia (OR=4.081;95% C.I.= 2.63-6.25)

Several demographic and clinical factors were identified as predictors of likely low resilience. The findings may facilitate the identification of vulnerable groups to enable their increased access to support programs that may enhance resilience.

None Declared

Lumateperone, an atypical antipsychotic drug approved for Bipolar II depression in 2021, has a dual mechanism of action by combination of activity at central serotonin (5-HT2A) and dopamine (D2) receptors.

This post-hoc analysis of an Indian Phase 3 study was conducted to evaluate the impact of Lumateperone 42mg compared to Quetiapine 300mg on quality of life of patients with Bipolar II depression assessed via Quality-of-life enjoyment and satisfaction-short form questionnaire (Q-LES-Q-SF).

The phase-III, randomized, multi-centric, assessor-blind, parallel-group, active-controlled, comparative, non-inferiority study included patients with Bipolar II depression with moderate severity having a Montgomery-Asberg depression rating scale (MADRS) score ≥20 and Clinical global impression–bipolar version–severity (CGI-BP-S) score ≥4. The study was conducted after receiving regulatory and ethics committee approvals. The patients were randomized (1:1) to either receive Lumateperone 42mg [Test] or Quetiapine 300mg [Comparator] for 6 weeks. This post-hoc analysis evaluated Q-LES-Q-SF total score and individual item scores [Physical health(1), Mood(2), Work(3), Household activities(4), Social relationships(5), Family relationships(6), Leisure time activities(7), Ability to function in daily life(8), Sexual drive, interest and/or performance(9), Economic status(10), Living/housing situation(11), Ability to get around physically(12), Ability to do work(13), Overall sense of wellbeing(14), and Overall life satisfaction and contentment(16)] for efficacy outcomes and for safety outcomes treatment emergent adverse events (TEAEs) were assessed. [Clinical trial registration: CTRI/2023/10/058583]

This post-hoc analysis included 462 patients [231 each in Test and Comparator]. The baseline demographic characteristics were comparable in between treatment arms. The improvement in Q-LES-Q-SF (total score and individual item scores) is significant from baseline to Day 42 in both treatment arms and comparable [Figure 1 and Figure 2 respectively]. Statistically significant improvement in Test over Comparator was observed for Item 7 (Leisure time activities) and Item 14 (Overall sense of wellbeing) [Figure 2]. The incidence of TEAEs were similar in both treatment arms [Test: 34.6%; Comparator: 35.5%] and no serious adverse events were reported.

Image 1:

Image 2:

This post-hoc analysis demonstrated that Lumateperone 42mg is comparable to Quetiapine 300mg in treatment of Bipolar II depression as assessed via Q-LES-Q-SF score from baseline to Day 42, and both treatments were found to be well tolerated.

A. Dharmadhikari: None Declared, P. Chaurasia: None Declared, Y. Patel: None Declared, D. Choudhary: None Declared, P. Dasud: None Declared, M. Bhirud: None Declared, P. Meena: None Declared, F. Shah: None Declared, G. Ganesan: None Declared, B. P. Rathour: None Declared, K. Mistry: None Declared, M. Dutta: None Declared, A. Ramaraju: None Declared, S. Mangalwedhe: None Declared, S. G. Goyal: None Declared, G. Kulkarni: None Declared, A. Mukhopadhyay: None Declared, P. Chaudhary: None Declared, G. T. Harsha: None Declared, M. Parikh: None Declared, S. Dey: None Declared, S. Sarkhel: None Declared, N. Jyothi: None Declared, A. Kumar: None Declared, N. Sooch: None Declared, A. Shetty Employee of: Sun Pharma, S. Saha Employee of: Sun Pharma, P. Devkare Employee of: Sun Pharma, A. Shetty Employee of: Sun Pharma, D. Patil Employee of: Sun Pharma, P. Ghadge Employee of: Sun Pharma, A. Mane Employee of: Sun Pharma, S. Mehta Employee of: Sun Pharma

In the digital era, online dating platforms have emerged as a prominent means for establishing social relationships. While these platforms facilitate connections, they also introduce a distinct form of external validation through likes, matches, and compliments. Despite their popularity, researchs on the psychological effects of this validation on users are limited.

This study aimed to reveal the profile of dating platforms users and assess whether these platforms foster a dependence on external validation and affect operator’s self-esteem

A cross-sectional study was shared via social media and online forums. In addition to socio demographic and work related variables, it comprised an evaluation of dependency on external validation through a series of targeted questions, and explored its relationship with the use of dating platform. The Rosenberg Self-Esteem Scale was used to assess participants’ self-esteem, with a score below 31 indicating low self-esteem.

The study included 55 participants aged between 19 and 40 years, with a mean age of 26.27. The gender distribution was nearly equal, with 49.1% male (n=27) and 50.9% female(n=28). Most participants (54.54%) were single, and 40% reported using dating apps primarily for casual dating and entertainment.

Among applications users, 46.7% engaged with the platforms several times a week, while 20% used them daily. Furthermore, 53.7% of users plan to continue using them.

Regarding external validation, 64.4% reported that receiving validation motivated them to use the applications more frequently, while 56.2% indicated they would adjust their behavior based on feedbacks. Additionally, 47.1% felt influenced by compliments, and 58.9% reported that criticism and rejection affected them negatively.

According to the Rosenberg Self-Esteem Scale, 33.3% of users exhibited low self-esteem and 28.5% of users reported that dating applications had a negative impact on their self-esteem. Notably, no significant correlation was found between dating applications’ usage and self-esteem (p = 0.53 > 0.05).

This study highlights a reliance on external validation among online dating users, suggesting that these platforms may encourage behaviors driven by the need for approval. This underscores the importance of further research into the psychological effects of such dependence.

None Declared

The modern urban landscape is increasingly characterized by the paradox of social isolation in physical proximity. Research consistently reveals a troubling link between social alienation and mental health issues, including a heightened risk for psychosis among vulnerable groups. As cities expand and diversify, understanding and mitigating the detrimental effects of urban alienation becomes crucial. This presentation explores the complex relationship between urban living, social alienation, and mental health, emphasizing the need for psychiatrists to have a more holistic understanding of socio-urban phenomena.

1. 1. To assess the clinical impact of urban alienation on mental health based on multi-disciplinary literature.

2. 2. To particularly examine urban mental health concepts from outside psychiatry that may be relevant to clinical practice.

3. 3. To identify possible strategies for integrating these interdisciplinary insights into daily practice and public mental health policy.

We performed a multi-disciplinary literature review, analyzing studies from psychiatry, sociology urban studies, critical theory, and public health to evaluate the impact of social alienation on mental health. Special attention was paid to identifying both gaps and overlaps between disciplines.

We grouped findings into three major disciplinary areas: psychiatry, sociology, and urbanist theory. While each of these fields has unique histories and contributions, the literature lacks consistent integration among them. For clinicians in particular, there is significant conceptual language that has not yet entered the psychiatric lexicon. Across fields, it is noted that city-dwellers face alienation due to resource limitations, systemic issues, ideological pressures, and cultural barriers. Proposed solutions vary significantly based on discipline, including community-building activities, mental health support services, and inclusive urban planning.

There is a breadth of research on cities, alienation, and mental health, and yet little integration of the disciplines. Addressing social alienation in urban environments requires psychiatric thought to move beyond isolated clinical interventions and toward collaborations with community organizations, policymakers, and urban planners. By aligning mental health expertise with the broader social and physical context, psychiatry can contribute to more meaningful, holistic interventions. Consequently, there is a pressing need for academic research bridging these fields, enabling more effective solutions that enhance community well-being in urban settings.

None Declared

Caprags syndrome is a rare syndrome characterized by a false belief that an identical duplicate has replaced someone significant to the patient. It is widely regarded as the most prevalent of the delusional misidentification syndromes and appears in psychiatric and non-psychiatric cases, including organic disorders.

To present a case report of 84 years old male patient with severe organic comorbidities who developed Capgras syndrome.

Psychiatric interview

An 84-year-old male patient came to the first psychiatric examination accompanied by his son, due to the suspicion and hostility he has been showing towards his wife for the past month. A few days before the examination, patient became extremely aggressive in the evening hours, he accused his wife that she was not his wife, that another person had been framed instead of her, he demanded that she show him her identity card and threatened to report her to the police. The wife locked herself in the bathroom in fear, but the patient broke down the door. Neighbors called the police, who then restrained him. The patient calmed down after that, but wife went to live with her son. During the examination, patient was completely calm and cooperative, with a neat appearance, oriented, his thought process was normal, conversation was conducted adequately in the desired direction. When asked about thought content he dissimulated it by stating that he was angry because his wife often hangs out with other women and doesn’t pay enough attention to him. He denied the presence of hallucinations. Affect was stable, cognitive capacities seemed appropriate for his age. Patient has been treated for several organic comorbidities, including prostate cancer, which was removed a few years ago, but due to problems with urination after surgery he wears a permanent catheter. He was diagnosed with atrial fibrillation and diabetes. He had a heart attcak a year ago, when a stent was implanted, while a bypass was implanted 12 years ago. Laboratory findings indicate elevated glucose and HbA1c values while other parameters are within reference values. He takes all prescribed medicine alone and on time. I diagnose Capgras syndrome and did psychoeducation. Patient showed an interest in taking medication and a desire for his wife to come back to live with him. Low doses of typical antipsychotic was prescribed, which led to cessation of psychomotor restlessness and harmonization of sleep rhythms. Further neuroradiological diagnostics and regular internist follow-up were recommended.

Previous studies showed the link between Capgras syndrome and aggression, which this case report confirms. Probable basis for emergence of this form of delusional disorder is this patient in not dementia, but rather the consequence of serious organic comorbidities. Further diagnostic processing is in progress.

None Declared

A large proportion of patients with schizophrenia do not have a sufficient response even to clozapine. Very little is known if any pharmacological augmentation treatment can improve the long-term outcome of these patients.

We studied the comparative effectiveness of oral risperidone, olanzapine, quetiapine, and aripiprazole augmentation of clozapine treatment on the risk of hospitalization due to psychotic episode as a marker for severe relapse among patients with schizophrenia.

In this population-based study, patients with schizophrenia or schizoaffective disorder using clozapine were included from Finnish (years 1996-2017) and Swedish (years 2006-2021) nationwide registers of inpatients care, specialized outpatient care, sickness absence, and disability pension. The risk of hospitalization associated with periods of antipsychotic augmentation vs. clozapine monotherapy (expressed as adjusted hazard ratio, aHR) was assessed by a within-individual design, using each individual as his/her own control, and analyzed with stratified Cox models. The two national cohorts were first analyzed separately, and then results were combined using a random-effect meta-analysis. Secondary outcomes were somatic hospitalization and composite outcome of psychosis/ somatic hospitalization.

In the meta-analysis of 23,206 clozapine users, medium dose (9-16.5 mg/day) aripiprazole augmentation was associated with the lowest risk of relapse among patients with low-dose (< 180 mg/day) (meta-analysis aHR 0.67, 95% CI 0.46-0.97, p=0.03), medium-dose (180-330 mg) (0.79, 0.70-0.91, p= 0.0006), and high-dose (>330 mg) clozapine (0.68, 0.62-0.75, p<0.0001), compared with the same clozapine dose as monotherapy. Augmentation with higher dose of aripiprazole or with other antipsychotics was associated with less favorable outcome. Only aripiprazole augmentations were associated with decreased risk of psychosis/somatic hospitalization, and the lowest risk was observed for medium-dose aripiprazole plus high-dose clozapine (0.70, 0.58-0.84, p=0.0001). Medium-dose aripiprazole plus high-dose clozapine was not associated with the risk of somatic hospitalization (0.66, 0.30-1.44, p=0.29), when compared with clozapine monotherapy in the same dose category.

This meta-analysis of two nation-wide cohorts totaling over 23,000 clozapine using patients indicates that 10-15 mg/day aripiprazole augmentation of clozapine treatment is associated with about 20-30% decreased risk of relapse compared with clozapine monotherapy periods within the same individuals.

J. Tiihonen Grant / Research support from: Janssen, Consultant of: Healthcare Global Village, HLS Therapeutics, Janssen, Orion, Teva, WebMD Global, Speakers bureau of: Janssen, Lundbeck, Otsuka, A. Tanskanen Grant / Research support from: Janssen, E. Mittendorfer-Rutz Grant / Research support from: Janssen, H. Taipale Grant / Research support from: Janssen, Speakers bureau of: Gedeon Richter, Lundbeck, Otsuka

Post-traumatic stress disorder (PTSD) is a mental health condition that violates everyday functioning, and it is a result of a traumatic event or life-threatening event. Symptoms of PTSD are nightmares, flashbacks, symptoms of negative emotions and perception, avoidance behavior, and social avoidance and it can affect children. Dissociative symptoms are a part of dissociative disorder in the form of anxiety disorder, but these symptoms can occur in dissociative form of PTSD.

The goal of this paper is to present a patient who is under neurological treatment, diagnosed with spastic paraplegia, and under psychiatric treatment diagnosed with PTSD, depression, and possible dissociative disorder.

This is a case report paper. A male patient, 57 years old, participated in Homeland War in Croatia for a duration of 18 months. He experienced many traumatic events and life-threatening events, such as the death of his friends. The first psychiatric symptoms occurred after war experiences, and the symptoms manifested as headache, insomnia, grumpiness, and paralyzing fear which led to the feeling that his legs were “taken away”. Similar symptoms persisted even after the war ended and in other stressful situations along with difficulty walking. He went under neurological testing and it turns out that it might be spastic paraplegia. He was diagnosed with prolactinoma, and since 2019 he has been in psychiatric ambulance treatment in the Daily Hospital of Clinical Hospital Split, diagnosed with PTSD, depression, and dissociative disorder.

We used psychotherapy methods such as socio-therapeutic and group psychotherapy, along with pharmacology therapy (sertraline, diazepam, olanzapine).

Pharmacology interventions might affect PTSD patients in a positive way and help them to function in everyday activities.

None Declared

In Germany there are about 40.000 licensed psychological psychotherapists, 4.000 physicians who work as psychotherapists only, 8.000 psychiatrists who also are specialised in psychotherapy, 4.000 physicians specialised in psychosomatic medicine and psychotherapy, 1.000 physicians of child psychiatry, 35.000 somatic physicians with a training in psychosomatic basic care. This accounts for about 1 therapist for 1.000 inhabitants or 1 per 200 persons with mental problems in ambulatory care. All these therapists are fully reimbursed by health insurance. About 60% of all persons with mental problems have been treated in specialised outpatient psychotherapy.

There are furthermore 900.000 patients per year who are treated for 30 days on average in inpatient departments of psychiatry, psychosomatic medicine and psychotherapy, and another 30.000 patients who are treated in about 300 psychosomatic rehabilitation hospitals for about four weeks.

Given these numbers and costs for psychotherapy, there are multiple regulations for the education and professional practice of therapists. Therapists must undergo three years of training either in cognitive behavior therapy or psychodynamic psychotherapy or systemic psychotherapy, while other forms of psychotherapy, such as Gestalt or Logotherapy are not allowed in training nor patient care. There are detailed requirements in regard to the number of theory lessons, therapeutic self-experience, and treatment with qualified supervision after four sessions. Psychotherapy practice is also restricted to these “scientifically accepted psychotherapies”, which is overseen by two state committees. Depending on the psychotherapy school, health insurance reimburses up to 36 sessions for systemic psychotherapy, 80 for cognitive behavior therapy, 100 for psychodynamic psychotherapy and 300 for analytical psychotherapy.

In summary, psychotherapy in Germany is part of regular patient care and therefore submitted to all respective regulations.

None Declared

Haloperidol (Haldol®) is first-generation antipsychotic that still have a place in the treatment of schizophrenia. However, this molecule is associated with numerous side effects, particularly extrapyramidal symptoms. Edema has been rarely described with haloperidol, and may have an immunoallergic or pharmacodynamic mechanism.

Our aim is to study a rare case of facial and limb edema attributed to haloperidol.

We report the case of a 22-year-old female patient with schizophrenia who developed facial and limb edema after taking haloperidol.

We report the case of a 22-year-old woman. She was admitted to our psychiatric department “A” as an involuntary inpatient after she threatened to stab her father. She was diagnosed with schizophrenia. The patient has no past medical history. The somatic examination and the admission report were correct.

Given the need for a slow-release neuroleptic, the patient was treated with haloperidol in gradually increasing doses up to 30 mg per day.

Six weeks after starting treatment, the patient developed progressive edema of the face, eyelids and all 4 limbs, with a marked increase in weight and body mass index from 31 to 36.6.

The patient was examined by internists. An etiologic investigation of this edema was initiated, excluding renal origin (strictly normal renal work-up and negative proteinuria), cardiac origin (in view of a negative pro-brain natriuretic peptide, D-dimer and troponins and a normal cardiac echography), hepatic (in the presence of a strictly normal work-up including: protidemia, albuminemia, transaminases, PAL, GGT, bilirubin and prothrombin levels) and endocrine (a normal thyroid work-up) origin.

The edema progressively worsened on haloperidol over a period of 10 days. A drug-induced origin was suspected. We contacted the regional pharmacovigilance center in Sfax, which incriminated haloperidol and recommended its immediate discontinuation.

After discontinuing the drug, the edema regressed progressively until it disappeared completely after 15 days, confirming that haloperidol was the drug responsible and contraindicating its further use.

The responsibility of haloperidol in the genesis of the edema was retained with a plausible score (C2S2I2B3). The scores were calculated according to the French Bégaud method.

Edema is not a common side effect of typical antipsychotics, especially haloperidol. However, it is important to emphasize that this effect, although rare, can occur. Clinicians are advised to be aware of edema in all patients taking first or second antipsychotics.

None Declared

Prenatal unipolar depression is a significant mental health challenge affecting a considerable number of pregnant women worldwide, with higher prevalence rates in developing regions. Due to the potential risks of antidepressant medications on fetal health, there is an increasing need for safe, non-pharmacological treatments. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising neuromodulation therapy, offering a non-invasive approach to treating depression. This systematic review explores the efficacy and safety of rTMS in addressing prenatal depression, aiming to provide evidence for its potential as an alternative therapy for this vulnerable population.

The primary objective of this review was to assess the therapeutic effectiveness and safety profile of rTMS in treating unipolar depression among pregnant women. The secondary aim was to identify gaps in the current literature and provide recommendations for future research to strengthen clinical guidelines for rTMS use during pregnancy.

A comprehensive search was conducted using the PubMed database without a time restriction, focusing on case reports, case series, uncontrolled studies, and randomized controlled trials that examined rTMS for prenatal depression. Inclusion criteria required studies to involve adult pregnant women diagnosed with major depressive disorder undergoing rTMS treatment. Data on depressive symptom improvements and any adverse effects on both mother and fetus were extracted for analysis.

Analysis of ten studies, including six case reports/series, three uncontrolled studies, and one randomized controlled trial, indicated that rTMS was well-tolerated by pregnant women and showed effectiveness in reducing depressive symptoms. Notably, no adverse effects were observed in fetal outcomes across these studies. Symptom improvement was significant, with high patient satisfaction reported, yet the limited sample sizes and variations in methodology underscore the need for more robust trials.

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The findings from this review suggest that rTMS is a promising, non-invasive alternative for managing prenatal depression with minimal fetal risk. However, due to the limited number of high-quality studies, further research is necessary to confirm these preliminary findings and establish standardized protocols for rTMS use in prenatal depression treatment. Expanding the evidence base will support the development of safe, effective treatment options tailored to the unique needs of expectant mothers facing depression.

None Declared

Burnout is a work-related syndrome characterized by emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment. It is particularly prevalent among physicians and it is associated with various personal and occupational risk factors. This study aims to assess the prevalence of burnout and its predictors among physicians across different specialties at Sultan Qaboos University Hospital (SQUH).

to assess the prevalence of burnout and its predictors among physicians across different specialties at Sultan Qaboos University Hospital (SQUH).

A cross-sectional study was conducted from October 2023 to January 2024 involving Omani and non-Omani physicians from all specialties at SQUH, Muscat, Oman. Data were collected via an electronic and paper-based survey that included the Oldenburg Burnout Inventory and a sociodemographic questionnaire. Stepwise regression analysis was used to identify independent predictors of burnout.

A total of 353 physicians participated, yielding a response rate of 79%. The prevalence of burnout was 56.7% (n = 200). The majority of respondents were male 56.4%, with 88.4% being married and 66.3% having one to four children. Of the participants, 45% were consultants or senior consultants, and 70% had been practicing for over ten years. Independent predictors of burnout included male gender [OR 1.62 (1.01-2.59), p = 0.007], older age [OR 1.12 (0.66-1.89), p = 0.02], less than 6 hours of sleep per night [OR 2.57 (1.62-4.10), p < 0.001], administrative responsibilities [OR 2.75 (1.41-5.34), p = 0.015], and involvement in research activities [OR 3.75 (1.77-7.95), p = 0.036].

The high prevalence of burnout among physicians at SQUH highlights the need for targeted interventions to mitigate burnout and its associated negative impacts. Addressing the identified risk factors is essential for promoting physician well-being and optimizing healthcare delivery.

None Declared