Patients with Parkinson disease (PD) may present psychiatric manifestations like delusions and hallucinations which can significantly impact their quality of life. These psychotic symptoms may also occur during neuro-cognitive decline which poses a diagnostic challenge.

This case study aims to investigate the clinical overlap between psychosis and cognitive decline in Parkinson’s disease, focusing on the diagnostic difficulties in differentiating these psychiatric symptoms.

We report a single case of a patient admitted to the psychiatric department “B” of Razi Hospital, who exhibited symptoms of both psychosis and cognitive decline. We also conducted a literature review on Pubmed using the following keywords: Parkinson disease, Dementia, Delirium, psychosis.

Mr. T.J, a 64-year-old man with a 10-year history of PD, was treated with levodopa, amantadine, and pramipexole. He developed depression a year ago, managed with fluoxetine. Recently, he was admitted to the psychiatric ward due to severe behavioral disturbances, including hetero-aggressiveness towards his wife.

Psychiatric assessment revealed a delusional syndrome with themes of jealousy and persecution towards his wife, accompanied by a hallucinatory syndrome primarily characterized by auditory hallucinations that appeared 2 years ago.

A neurological examination identified an amnesic syndrome that preceded the onset of delusions, raising concerns about the differential diagnosis between psychosis and dementia in the context of PD with the added consideration of the iatrogenic effects of his Parkinson’s treatment.

In collaboration with neurologists, we adjusted the treatment regimen by tapering off amantadine and pramipexole while maintaining levodopa. We introduced 5 mg of olanzapine, which led to a favorable clinical response. After two weeks, Mr. T.J was considered stable enough for discharge. Improvements included a reduction in delusional ideation and a decrease in the frequency and severity of auditory hallucinations.

This case highlights the complexity of managing psychiatric symptoms in Parkinson’s disease, particularly the challenge of differentiating between psychosis and dementia. The positive outcome following medication adjustments underscores the importance of a multidisciplinary approach in addressing both motor and psychiatric symptoms in PD patients.

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Opioid use disorder (OUD) is a national public health concern. Craving is a diagnostic criterion and is also implicated in the risk of relapse to opioids. Although sleep impairment is believed to relate with OUD, little research to date has examined the relationship between sleep components and craving in individuals with OUD as well as the moderators in the relationship.

This cross-sectional study was designed to address the relationship between sleep disturbance and OUD.

Individuals with current OUD (n=51) were enrolled. Each participant completed validated scales, including the Pittsburgh Sleep Quality Index for sleep, and Barratt Impulsiveness Scale for impulsivity, and the Opioid Craving Scale for cravings. Correlation and moderation analyses were performed using SPSS, v29.

Total scores of the PSQI were significantly associated with cravings (r=0.44, p=0.006). Among sleep components, sleep quality, sleep efficiency, and sleep disturbance were significantly associated with cravings, while four other sleep components were not. Impulsivity moderated the relationship between sleep impairment measured using total score of the PSQI and cravings for participants (b=0.15, p<.05).

Although preliminary, the findings add to literature on craving, impulsivity, and sleep among individuals with OUD. Sleep impairment and impulsivity may be important targets of a comprehensive, long-term treatment plan for some patients with OUD.

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Introduction

Cannabis-induced psychosis (CIP) is often assumed to resolve with sustained abstinence, although recent studies report adverse long-term outcomes, such as a high risk of diagnostic transition to schizophrenia. Cannabis is also known to increase relapse rate in individuals with psychotic disorders in general, and there is a lack of knowledge on optimal treatment of this patient group.

In this presentation, data on incidence and mortality associated with CIP, and real-world effectiveness of antipsychotics in relapse prevention in persons with CIP will be presented.

Nationwide Scandinavian registers were utilized to identify persons with first-time CIP (ICD-10 F12.5) during the years 2000-2021. Incidence and mortality of CIP were investigated with Danish, Norwegian and Swedish register-based data, and antipsychotic use with Swedish data. Annual incidence rates of CIP per 100 000 persons were calculated. For mortality study, incident cases of CIP were matched by age- and gender with comparison persons without substance-induced psychosis and hazard ratios (HRs) were calculated for all-cause and cause-specific mortality. Association between use of specific antipsychotics (oral vs. long-acting injectable, LAI, forms) and risk of hospitalization due to any psychosis relapse was investigated in within-individual design where each person acted as his/her own control to minimize selection bias, analyzed with stratified Cox models.

The incidence rate of CIP increased in time in all Scandinavian countries and was the highest in Denmark throughout the study years (rate in 2016 5.6, vs. 3.0 in Norway and 2.7 in Sweden). CIP was associated with an increased risk of mortality, risk estimates (HRs) ranging from 6.6 in Denmark, to 7.6 in Sweden, and 9.0 in Norway, compared with general population controls. In within-individual models, antipsychotic use was associated with a decreased risk of hospitalization due to psychosis relapse, with an adjusted HR of 0.75 (95% Confidence Interval 0.67-0.84), compared with time periods when the same individuals did not use antipsychotics.

Incidence of cannabis-induced psychosis is increasing in Scandinavian countries, and it is associated with significant mortality risk. Antipsychotics are effective treatments in preventing psychosis relapses also in individuals with CIP.

H. Taipale Grant / Research support from: Janssen, Speakers bureau of: Gedeon Richter, Janssen, Lundbeck, Otsuka

Several mental disorders are more common within the LGBTQ+ population, including depression, anxiety, eating disorders, and substance use disorders. Despite this, LGBTQ+ individuals face more barriers when accessing mental health services than the general population.

The primary aim of this study was to assess the perceptions of Cardiff University medical students on the barriers faced by LGBTQ+ individuals when accessing mental health help. The study also aimed to assess recommendations Cardiff University medical students have for improvement of services and to make them more accessible to LGBTQ+ individuals.

A qualitative approach was used. An online questionnaire was created and distributed among Cardiff University medical students. It included 10 open-ended questions about their knowledge of LGBTQ+ mental health, the barriers to accessing it, and recommendations to decrease these barriers. Thematic analysis was performed on the answers.

The questionnaire had 12 participants. The thematic analysis produced 22 subthemes, which were grouped into the following five themes: i) perceptions of LGBTQ+ mental health, ii) factors affecting LGBTQ+ mental health, iii) general barriers to accessing mental health help, iv) LGBTQ+-specific barriers to accessing mental health help, and v) recommendations to improve access to mental health services. A scoping review was conducted on this subject to further analyse the current research. The scoping review produced nine studies, and the main themes that emerged were mental health stigma, LGBTQ+ discrimination, lack of LGBTQ+-affirmative services, the pathologisation of LGBTQ+ status, and financial barriers.

It was evident that more formal training on LGBTQ+ mental health at an undergraduate level for health professionals is needed, and that a lack of this is causing barriers to adequate provision of mental health services to this population. Furthermore, existing mental health services need to be more LGBTQ+-affirmative. Further research with a higher response rate could provide more generalisable results.

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Digital mental health interventions have gained prominence as accessible and cost-effective solutions in workplace settings. However, our previous meta-analysis revealed a concerning trend: despite advancements in technology, the effectiveness of these interventions has not improved over time. This stagnation may be attributed to the significant and ongoing heterogeneity among interventions which indicates both variation in both sample and the intervention. We do not kow which theraputic approaches, design aspects or intervetnkion features enahnce efficacy.

We use a Bayesian meta-regression of an unpdated systematic review to develop a comprehensive framework to guide the design, development, and evaluation of workplace digital mental health interventions. By addressing the variability in intervention approaches and design and leveraging evidence-based practices, this framework seeks to enhance the quality and effectiveness of digital solutions for employee mental health.

A systematic literature review was conducted to identify randomized controlled trials of employee based digital mental health interventions. Eligible studies were assessed based on specific criteria, including participant characteristics, intervention characteristics, and outcome measures. Data extraction and coding were performed, followed by a Bayesian meta-analysis approach. This method allowed for a more nuanced evaluation of the effectiveness of various intervention features and designs, accounting for uncertainty and prior knowledge in the field.

The review identified 95 interventions involving approximately ˜25,000 participants. The Bayesian meta-analysis confirmed small positive effects in reducing mental ill-health symptoms. Both sample and intervention characteristics contributed to heterogeneity across studies. Stress management and mindfulness interventions, particularly those designed with input from mental health experts, demonstrated more effiacy than CBT based approaches. Several intervention features, such as videos, feedback scores, and reminder texts, were associated with positive mental health outcomes.

This review provides valuable insights into the optimal design and development of workplace digital mental health interventions. The identified framework and evidence-based practices offer guidance for developers to create effective interventions that address the heterogeneity within studies. Importantly, this framework has the potential to serve as a robust evidence base for app designers, enabling them to create more effective, personalised and engaging mental health applications.

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Climate change beliefs influence people’s behaviours such as the adoption of pro-environmental actions, therefore it is crucial to effectively measure them. We developed a short measure (Climate Change Beliefs and Attitudes Measure/CC-BAM), comprising 4 items whose content was adapted from previous studies, namely Loram et al. (2019)’s 8 item climate change denial measure. To the best of our knowledge, there is no instrument that validly assesses these beliefs in the general Portuguese population.

To analyse the psychometric properties of the preliminary Portuguese version of the CC-BAM.

Item content validity was guaranteed by 7 experts. 599 Portuguese adults (mean age=34.40±16.18) answered to the Portuguese preliminary version of CC-BAM (4 items) and to the validated instruments: Climate Change Distress and Impairment Scale/CC-DIS and Pro-environmental behaviour scale/PEBS. Item 1 (“Do you believe in climate change?”) had three possible options of answer: a) “No”, b) “Yes, I believe they are a natural phenomenon” or c) “Yes, I believe they are caused by human activity”. Items 2 (“How convinced are you of your previous answer?”) and 3 (“Do you think climate change is a serious problem?”) were answered on a Likert scale from 0 (“Not much”) to 4 (“Very much”). Item 4 (“How often do you think about climate change?”) was answered on a Likert scale from 0 (“Never”) to 4 (“All the time”). SPSS 29 was used to perform Exploratory Factor Analysis/EFA, descriptive statistics and inferential analysis.

EFA revealed a 1-factor solution with an explained variance of 55.90% confirmed by parallel analysis. Cronbach’s alpha was of .704 (lower if any item excluded) and all items had a corrected item-total correlation >.20. All items correlated with each other (from r=.27 to r=.59) and with the total score (from r=.63 to r=.85, all p<.01). CC-BAM correlated with CC-DIS (r=.51) and PEBS (r=.49, both p<.01). Women had significantly higher mean scores in all items and total CC-BAM. Age correlated with CC-BAM total score (r=.12) and with item 4 (r=.35, all p<.01). 86.5% of participants (n=518) answered to item 1 with option c) (group 1); 12.5% (n=75) answered b) (group 2) and 1% (n=6) responded a) (group 3). Kruskal-Wallis test revealed that those 3 groups significantly differed in mean/median scores of items 2, 3 and 4 and of CC-DIS and PEBS.

The preliminary version of CC-BAM shows adequate psychometric properties, however more studies are needed. Although caution must be taken in the interpretation of this preliminary results, this study provides a novel, internally consistent and short (easily implementable) measure of climate change beliefs.

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A 13 years old girl, who has always been an A* student, was brought to our Emergency Room, referred by her Psiquiatrist, to be hospitalized in our Unit.

During the first interview in the ER, the patient reported that she refused to eat food that had empty calories, which were essentially everything except water, and even water at times was an issue. She had a IMC of 16,57 kg/m2.

The objetive of this case is to try and explain how serious of a disorder anorexia nervosa can be, at times severe enough to distort completely the patients reality.

The following patient will be presented, doing a thorough systematic bibliography review.

The patient remains admitted to our unit. After more than one month and a half, since first being admitted, the patient has both verbalized wanting to end her life before gaining weight, as well as improved her disorder awareness.

At first, she was bluntly negative to eat any food, to a point to such extent, that feeding via nasogastric tube was necessary.

After daily interviews, along with many consultations, both with clinical psychology and psychiatry, using both cognitive behavioral psychotherapy and psychotrpic drugs; we achieved a slight improvement by eating half plates of both first and second plate, as well as dessert of a 1300-1500kcal diet.

Nonetheless, the patient still manifest up to this day, her willingness of not to eat and to end her life if its necessary to avoid eating.

Given the severity of the eating disorder suffered by the patient, social work was notified of the refferral to a long-term center specialized in eating disorders. The patient verbalized not wanting to got there, but recognized her disorder was getting more severe and the need for a long-term Unit.

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Sleep problems are very prevalent among university students, affecting their mood, energy levels, daily functioning, and quality of life. Irregular sleep-wake patterns contribute to the disruption of their circadian rhythms. Cognitive behavioural therapy for insomnia (CBT-I) has been proven effective in adults, but research in university students is still limited.

The aim of this study is to investigate the effectiveness of a guided digital self-help intervention targeting sleep and the biological clock in university students to improve sleep and mental health outcomes.

We conducted a two-arm randomized controlled trial in nine Dutch Universities. We included 196 university students (Bachelor, Master, and PhD) with self-reported insomnia symptoms (Insomnia Severity Index ≥ 10) and randomly assigned them (1:1) to receive the 5-week ‘i-Sleep & BioClock’ intervention or online psychoeducation. The intervention is based on CBT-I with specific emphasis on the biological clock. It consists of 5 weekly online modules and is guided by online coaches. The primary outcome is insomnia severity. Secondary outcomes are depression, anxiety, daily functioning, academic performance, quality of life, and sleep & light exposure diary outcomes. Outcomes were measured at baseline, mid-treatment (3 weeks), post-treatment (6 weeks after baseline), and at 18 weeks follow-up. Data will be analyzed with intention-to-treat analysis using linear mixed models. The study is registered at ClinicalTrials.gov (NCT06023693).

Recruitment started on Nov 1st, 2023 and ended on Sept 5th, 2024. Data collection is currently ongoing and will be finalized in January 2025. We hypothesize that the guided digital self-help intervention will reduce insomnia severity and improve mental health outcomes in students (results will be presented).

Findings from this randomized controlled trial will contribute to the growing body of knowledge on digital sleep interventions and their potential impact on mental health. If the intervention proves effective, we aim to disseminate the intervention widely in higher education to benefit a broader student population.

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Cocaine use is a significant health problem, since its abuse constitutes a substance use disorder and can produce cardiovascular symptoms, including acute coronary syndrome (ACS). Tako-tsubo syndrome (TTS) is a transient dysfunction of the apical left ventricle that can manifest with intense chest pain and alterations in the electrocardiogram. TTS can be triggered by physical stressors (hyperthyroidism, cocaine or amphetamine abuse) or psychological stressors (grief or reaction to acute stress).

The objective is to present the case of a patient who developed tako-tsubo syndrome after harmful cocaine use.

A 50-year-old woman, under psychiatric follow-up, diagnosed with mixed personality disorder, with a medical history of hypothyroidism. The patient has been presenting for 2 months after mourning the death of her husband with anxiety-depressive symptoms with a great behavioral impact with episodes of heteroaggression and begins with abusive consumption of cannabis and cocaine toxins. The patient presents an episode of psychomotor agitation after acute consumption of cocaine, presenting psychotic symptoms. During the study in the emergency area, she verbalizes chest pain and complementary studies are performed with elevated cardiac enzymes and alterations in the electrocardiogram. Cardiology is contacted and after hospital admission and complementary studies, the diagnosis of acute coronary syndrome is reached, filiating it with Takotsubo syndrome triggered by cocaine consumption. The diagnoses presented by the patient with dual pathology would be a psychotic disorder due to toxins, a borderline personality disorder and harmful consumption of cocaine.

Dual pathology in patients with personality disorder with toxin abuse such as in this case cocaine is very frequent.The situation of grief is an acute stressful situation that leads to greater emotional instability and, together with the toxic effects of cocaine, can trigger Takotsubo syndrome in patients. Therefore, when approaching patients with substance use, it is very important to always take into account the possible somatic complications that can be triggered.The treatment chosen to treat the psychotic symptoms that the patient presented was lurasidone, since it has a tolerability and cardiological safety profile.

In patients with dual pathology, it is very important to address all possible complications, both somatic and psychiatric, for proper therapeutic management.

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Considering the need to conduct studies on the treatment of BPD and considering the high prevalence of this disorder and its negative effect on the quality of life, especially in young age range and possibility of this disorder being in the Bipolar spectrum, it is necessary to investigate the effect of lithium on mood improvement in patients with BPD. So, this study aimed to investigate the effect of lithium on mood improvement in these patients.

Due to the lack of an FDA approved treatment, as well as discussed in the introduction, we dicided to compare the effect of lithiumin mood improvement in this disorder with the effect of other mood stabilizers and antipsychotics.

For this reason, we reviewed the published articles on the effects of other mood stabilizers and antipsychotics on improving the mood of this patints and compare them with those related to lithium in order to make better treatment decision.

This study presents a comprehensive review of the studies conducted related to the effect of lithium in improving mood in BPD patients. We conducted a systematic review based on PRISMA guidelines of published and indexed articles from the following databases;

EMBASE, MEDLINE, Google scholar, SCOPUS.Cochrane Library, PsycINFO.

KEY WORD: Lithium, Mood stabilizer, borderline personality disorder. Of the 131 retrieved articles, 9 included our inclusion criteria.

The review of 9 selected studies showed that lithium is useful in reducing emotional and impulsive behaviors, mood stabilization and suicidal tendencies and was more effective than placebo in preventing recurrence of mood disorders. In the study significant heterogeneity was found between all group of patients which could be due to the difference in the selection of participants and different exposure in the pre-study phase. Quantitative data on participants general health and social functioning were not reported and the direction of effect was the same in all studies.

No studies reported a negative effect for lithium and compared to other mood stabilization, it is more effective in controlling emotional and mood changes and aggression, also its side effects are less if controlled regularly and consistently. However, due to the small number of studies in this field and small sample size in studies, we suggest that more studies be conducted in all age groups.

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Slow and inadequate implementation causes greater inequity and reduced quality in emergency psychiatric services. This symposium is based on five recommendations to improve health intervention research and implementation, presented by Professor Emma Mcginty (PhD), the leader of the Lancet Psychiatry Commission to transform implementation in mental health. This presentation will introduce each of these recommendations: I) integrate research into clinical practice to ease implementation II) embed equity in mental health intervention research III) use complexity science and bottom-up approaches to improve relevance of science and implementation IV) base implementation less additional methods beyond traditional RCT-based research V) use a transdisciplinary approach in development and implementation of research on new interventions.

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If untreated, mental health disorders are a leading cause of premature death due to physical illness and suicide. Typical onset is around the age of 15, and about 75% emerge by the age of 25. Thus early diagnostics and treatment to prevent chronic outcomes by early interventions is indispensable. We set up an intervention project in Frankfurt/Main, Germany, focusing on this vulnerable group aged 18 to 29.

The project aims to assess if a low-threshold, early-on psychosocial consultation model significantly reduces early symptoms of mental disorders among young adults and to evaluate whether community-based consultations reduce stigma and increase early service utilisation. We intend to measure changes in mental health literacy. Alongside consultations, we identify cooperation partners and give workshops to raise awareness and reduce stigma.

A team of university psychologists and psychiatrists developed the project with community organisations and local foundations. Consultations take place in a non-stigmatizing, informal setting: the space is not within a clinic, centrally located and easily accessible. Services may be utilised anonymously and without registration of health insurance. We offer qualified diagnostics, brief solution-focused counselling, psychoeducation, early pharmacological treatment, group therapy and referral pathways to specialised care when needed. Using questionnaires, we will refine the program for potential up-scaling. Since September 5th, 2024, 12 patients aged between 17 and 34 years have already made use of the offer. Pre-intervention symptoms at baseline were initially assessed while post-intervention symptom assessments will take place 3 months later. Qualitative data will be analysed via thematic coding. Quantitative data for symptom alteration will be collected via Likert scales and analysed using paired t-tests and regressions. Qualitative feedback will be collected via surveys. We hypothesise that psychological well-being will improve post-intervention. Additionally, we expect an increased mental health literacy, alongside increased utilisation and acceptance of mental health services.

Yet to follow.

Community-based mental health consultations represent a feasible early intervention strategy for young adults. Results are expected to support expanding such models to other community structures and refining protocols for scalability. We aim to optimise service delivery, assess long-term outcomes, and examine cost-effectiveness for potential implementation on a broader scale.

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Job satisfaction is undoubtedly one of the concerns that has given rise to the most research since the middle of the 20th century. It is one of the particularly important concepts in the study of ‘health at work’ determinants. Its evaluation may appear to be necessary in order to set up relevant preventive actions. However, in Tunisian hospitals, job satisfaction remains poorly assessed. It is therefore crucial to assess it and study its factors in order to promote a balanced work environment.

Assess the overall job satisfaction of health care workers (HCW) at Charles Nicole Hospital using a validated questionnaire in French and Arabic.

This was a cross-sectional study of consenting HCW at Charles Nicole Hospital during the period from 1st September to 31st October 2024. Data were collected by means of a 63-item questionnaire, which assessed participants’ well-being and satisfaction on several aspects using a four-point Likert scale with six dimensions: Perceived superior support at work, affective commitment, emotional exhaustion, work/family conflict, extrinsic efforts and job satisfaction. The questionnaire had good internal consistency and was validated in French and Arabic. The questionnaire was self-administered to the HCW who went to the occupational health department for a medical check-up.

A total of 30 participants were enrolled. The mean age was 45.37 ± 10.3 years, with a sex ratio of 2.3 (F/H). Eighty-six percent were married and had at least one child. The most common occupational category was senior technician (34%). The average length of service was 17.27 ± 10.1 years. Laboratory departments and surgical departments were the most represented in 32% and 26% of cases respectively. Eighty percent of HCW worked full-time. Teamwork was reported in 53% of cases. The number of staff in the work team was less than 10 in 83.4% of cases. Perceived support from a superior was found in 40% of cases. Nearly 20% of cases showed emotional exhaustion secondary to their work and 34% showed extrinsic strain. Affective commitment was present in 36.7% of cases. Only 14.3% of cases showed work/family conflict. Overall, 73.3% of HCW were satisfied with their work.

This study highlights the importance of working conditions and organisational support in the well-being of HCW. Job satisfaction, although mainly present, is put to the test by a mismatch between professional and personal life, extrinsic efforts and a lack of hierarchical support. Emotional exhaustion is a major warning sign, showing that better care and support could improve both emotional commitment and job satisfaction.

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Quality of life is a subjective evaluation that individuals make of the various aspects of their lives in relation to their health. Head and neck cancers and their surgical treatments, such as total laryngectomy (TL), change some of the most basic and important vital functions and can affect patients’ lives in many ways. The patient’s altered appearance, loss of their normally used voice, difficulty swallowing, and certain complications from this kind of surgery, all contribute to impaired quality of life by imposing daily limitations. Despite these considerable impacts, there is no or only very limited research addressing the quality of life of patients post- TL, highlighting the need for further exploration into this critical aspect of patient care.

The purpose of this study was to assess self-perceived quality of life in Tunisian male patients who underwent TL for laryngeal cancer.

A descriptive cross-sectional study was conducted in the Head and Neck Carcinologic Surgery Department at Salah Azaiez Institute. Socio-demographic and clinical data were gathered. All patients completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module (EORTC QLQ-H&N35), Depression, Anxiety and Stress scale, and Voice Handicap Index.

The study involved 30 male participants with a mean age of 62 years (±10 years). The mean EORTC QLQ-H&N35 total score was 60 ± 9.8. The areas of EORTC QLQ- H&N35 score most affected are shown in Figure 1.

Our results indicated that younger patients (P=0.002) and those from rural areas (P=0.04) tended to report better quality of life scores. Additionally, higher socioeconomic status was linked to a reduced quality of life (P=0.006). Patients who were classified as (N+) according to the Tumor, node and metastasis (TNM) staging, showed significantly better quality of life (P=0.004).A higher quality of life was significantly correlated with primary TL (P=0.004), while a lower quality of life was significantly associated with TL followed by radio-chemotherapy (P=0.005).Depression, anxiety, and stress were significantly correlated with poorer quality of life (P=0.002, P=0.001, P=0.001, respectively). Finally, lower quality of life scores were strongly associated with the Voice Handicap Index score (P=0.0001).

Figure 1. Distribution of patients according to their EORTC QLQ- H&N35 scores.

Image 1:

In conclusion, patients who underwent TL for laryngeal cancer seem to exhibit an impaired quality of life, with factors like age, socioeconomic status, treatment type, voice handicap and psychological distress likely playing an important role. These findings underscore the need for comprehensive post-surgical care aiming at improving quality of life for people affected by this condition.

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Teacher burnout is a pervasive challenge across the global educational sector, profoundly impacting educator well-being and the overall quality of education. A robust body of research highlights the link between organizational factors and burnout, underscoring the urgent need for an in-depth understanding of these dynamics across different cultural contexts.

This systematic review aims to delineate how workload and social support dynamically influence teacher burnout. Through a detailed examination of the complex interrelationships among these factors, we endeavor to elucidate the underlying mechanisms by which they influence teachers’ emotional and psychological health, thereby providing critical insights into potential evidence-based interventions.

We synthesized findings from a total of 40 relevant studies (35 cross-sectional and five longitudinal studies), adhering to the 2020 PRISMA guidelines. We utilized the Newcastle-Ottawa Scale for quality assessment due to its rigorous criteria, examining the impact of workload and social support on teachers’ stress levels across diverse educational settings.

High workload and insufficient social support were identified in 75% of the studies as significant predictors of emotional exhaustion among teachers globally. Excessive workloads were correlated with increased burnout levels, which negatively affected their mental health and job satisfaction. Conversely, strong social support networks, including collegial relationships and administrative support, were found to effectively mitigate burnout, bolstering teachers’ resilience and overall well-being. Furthermore, the review underlined that the quality of the evidence was moderate, highlighting the need for further, more robust research.

This review confirms the complex interactions within organizational dynamics that contribute to teacher burnout. It underscores the critical need for tailored interventions, such as professional development in stress management and policies that foster supportive work environments. By strategically addressing workload challenges and enhancing social support, stakeholders can significantly improve teacher well-being and reduce burnout risks globally.

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Clozapine is an atypical and complex antipsychotic that appears to benefit from actions on multiple neurotransmitter systems. While its mechanisms of action are not fully understood, this broad spectrum of activity accounts for clozapine’s superior efficacy in treating refractory schizophrenia and other conditions.

The aim of this paper is to review the main indications of clozapine and its applications in clinical practice, as well as to highlight key considerations for its safe and effective management.

A systematic review of the scientific and clinical literature on clozapine was conducted. The review included databases such as PubMed and Cochrane, covering articles from the past 20 years. The scientific evidence obtained was analyzed and synthesized.

Findings indicate that clozapine remains the treatment of choice for patients with treatment-resistant schizophrenia, showing a superior response rate compared to other antipsychotics. Additionally, its effectiveness in reducing suicidal behaviors in patients with schizophrenia and related disorders has been identified. The indications also extend to psychosis in Parkinson’s disease, substance use disorders, and a wide range of psychiatric and neurological disorders.

Clozapine is essential in the treatment of refractory schizophrenia and in reducing suicide risk. Its broad mechanism of action, affecting multiple neurotransmitters, allows its use in secondary psychotic disorders and complex comorbidities, such as Parkinson’s disease. However, its use is associated with significant risks, necessitating rigorous monitoring of adverse effects.

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The paradigms of diagnosis and evaluation in mental health are changing due to the incorporation of artificial intelligence (AI) into other fields. Understanding mental health conditions is greatly aided by insights from neuroscience, immunology, social and clinical psychology, and cultural theories. According to Martyn Evans’ commentary, interdisciplinary work generates new issues and solutions while multidisciplinary work preserves unique viewpoints. In this sense, the interdisciplinary field of psychoneuroimmunology has contributed significantly to our understanding of mental health. It has also contributed significantly to the interplay between the immune system, the endocrine system, and the nervous system. This field could rapidly emerge as a key component of integrative diagnosis and assessment.

This review emphasizes the need for comprehensive biopsychosocial assessment frameworks and the importance of harmonizing disciplines through multidisciplinary and interdisciplinary methodologies to enhance diagnostic possibilities via AI.

A critical review of clinical psychology was conducted, as well as a discussion of the necessity of using integrative methodologies in order to address the interconnected nature of both medical diseases and mental disorders, in light of recent advancements in artificial intelligence.

It has been explored how PNI can serve as an interdisciplinary ground for cross-disciplinary dialogue and how stakeholder perspectives may resolve complexities in clinical assessment and psychiatric diagnosis through extending PNI with AI and applications. Integrating AI into PNI is crucial for revolutionizing mental health care, utilizing machine learning to consolidate diverse data streams and predict outcomes.

Lastly, it was outlined some pragmatic frameworks for clinical assessment, taking into account time, budget constraints, and stakeholder interests. Ethical, governance, and practical challenges of AI integration are discussed. The paper proposes innovative AI-driven enhancements in psychiatric assessment, diagnosis, and treatment, fostering transformative developments in clinical psychology and promoting a humanistic approach to mental health care.

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In the modern world, the problem of infertility is becoming more significant. In particular, the number of women with experience of miscarriage is increasing. Problems with pregnancy, frustration of the desire to become a mother influence the formation of a woman’s motherhood and self-image as a mother, which can lead to intrapersonal problems of a woman and to a distortion of care practices and child-parent relations in relation to the future child.

To study the features of the self-image as a mother in women with experience of miscarriage.

A pilot study was conducted. Two methods were used in this study: “Unfinished sentences” (Sachs-Levy, mod. A.G. Dolgikh, 2018), method of semantic differential (spaces proposed by A.G. Dolgikh, 2018).

The study sample consists of 3 groups: 30 women with experience of miscarriage for medical reasons aged 25 to 35 years; 30 women aged 25 to 30 years who have no experience of pregnancy; 30 women raising children under the age of five.

The results of attitudes peculiarities psychodiagnostic study towards motherhood in women using the “Unfinished Sentences” technique demonstrate that generally more expressed positive attitude towards motherhood in general and attitude towards themselves as a future mother for the group of women with experience of miscarriage compared to other groups of women.

The self-image as a mother using the semantic differential method showed that the semantic universals of this image for both the entire sample and for a group of women with miscarriage experience are adjectives “reliability”, “caring”, “tenderness”.

The self-image as a mother semantic profiles comparative analysis revealed significant differences in the indicators of this image among the study groups. Women with the experience of miscarriage characterized themselves as more warm, more soft, more caring and more harmonious (p<0.05) compared with women from other groups. They also perceive the image of themselves as a future mother as lighter, more reliable, more anxious and more affectionate than women without experience of pregnancy and motherhood (p<0.05).

Women experienced miscarriage are characterized by more idealized ideas about motherhood probably due to problems with pregnancy and frustration of the desire to become a mother.

None Declared

Suicide represents a significant and growing public health challenge in Brazil, reflecting a complex interplay of social, economic, and mental health factors.

The increasing rates of suicide highlight the need for targeted interventions and policies. Understanding the demographic characteristics associated with suicide, particularly in relation to sex and age, is crucial for developing effective prevention strategies and health policies. This study utilizes data from the 2024 epidemiological bulletin, “Panorama dos Suicídios e Lesões Autoprovocadas no Brasil de 2010 a 2021.”

This study aims to provide an analysis of the mortality rates from suicide in Brazil for the year 2021. The primary focus is on exploring the distribution of suicide rates by sex and age group, as well as evaluating the proportional mortality in relation to the total number of deaths in the country.

The study utilized data sourced from the Mortality Information System (SIM) and the aforementioned epidemiological bulletin, which compiles comprehensive mortality data across Brazil. We analyzed the rates of mortality from suicide, categorizing the data by age groups: 05 to 14 years, 15 to 19 years, 20 to 29 years, 30 to 49 years, 50 to 69 years, and 70 years and older. The analysis further differentiated the data by sex, allowing for a nuanced understanding of demographic variations.

In 2021, Brazil reported a total of 15,507 deaths attributed to suicide. Of these, 12,072 (1.21% proportional mortality) were male, and 3,431 (0.43% proportional mortality) were female, indicating a substantial gender disparity in suicide rates. The mortality rates from suicide per 100,000 inhabitants varied significantly by age group: 0.7 for males and 0.9 for females in the 05 to 14 years age group; 9.3 for males and 4.5 for females in the 15 to 19 years group; 14.6 for males and 3.9 for females in the 20 to 29 years group; 14.9 for males and 3.8 for females in the 30 to 49 years group; 15.4 for males and 3.8 for females in the 50 to 69 years group; and 18.1 for males and 2.9 for females aged 70 years and older. Notably, among the leading causes of death, suicide ranked 11th for the 05 to 14 years age group (3.41%), 3rd for the 15 to 19 years age group (6.90%), and 4th for the 20 to 29 years age group (5.56%). These figures underscore the significant impact of suicide on young populations.

The high mortality rate from suicide in Brazil underscores the urgent need for public health policies focused on suicide prevention. Effective interventions should include mental health support, community outreach programs, and increased awareness campaigns aimed at reducing the stigma around mental health issues. By addressing the underlying social and economic factors contributing to suicide, Brazil can improve health outcomes and enhance the quality of life for at-risk populations.

None Declared

Older patients in palliative care often experience considerable stress due to physical, emotional and existential factors. Previous research has identified cortisol, a glucocorticoid hormone, as a key biomarker for stress assessment. This pilot study aimed to investigate the potential of hair cortisol as a potentially objective stress biomarker in a specific population (aiming for a broader aplicability), as well as to explore cognitive changes in older palliative patients using the Mini-Mental State Examination (MMSE-2).

This study objectives were to (1) assess changes in hair cortisol levels and cognitive function in older palliative care patients over three weeks of hospitalization and (2) evaluate the suitability of hair cortisol as a short-term stress biomarker in this patient group.

This monocentric pilot study included 19 patients from different palliative care hospital services in Croatia, gathered via a convenience sampling approach with strict inclusion/exclusion criteria. Hair cortisol levels were measured at baseline and after three weeks using an enzyme-linked immunosorbent assay (ELISA). Cognitive function was assessed using the 16-point MMSE-2. Statistical analyses included paired t-tests and linear regression, and significance was set at p<0.05.

A statistically significant increase in mean hair cortisol levels was observed after three weeks of hospitalization (p=0.007), suggesting heightened stress over time. In contrast, MMSE-2 scores showed no statistically significant change (p=0.064), indicating no detectable cognitive decline within the study period. No significant correlations were found between cortisol levels and MMSE-2 scores at either time point, and differences between male and female patients were not statistically significant.

The findings support the potential use of hair cortisol as a biomarker for stress in palliative care settings, especially for tracking the transition from acute to chronic stress. However, MMSE-2 may not be sensitive enough to detect cognitive changes over short time spans in this patient group. Consequently, further research with larger samples is needed to validate hair cortisol as a practical tool for monitoring stress and to explore its clinical implications for improving palliative care outcomes.

None Declared