Obsessive‐compulsive disorder (OCD) is a severe condition with a profound impact on the health, social and professional functioning of the patients. More than one third of the patients do not achieve remission of the symptoms after first‐line treatment with cognitive‐behavioral therapy and selective serotonin reuptake inhibitor medication. Neurofeedback is a promising technique that allows the non‐invasive self‐regulation of neural activity associated with symptomatic manifestation. Previous literature reported preliminary evidence of positive effects of functional magnetic resonance imaging (fMRI) neurofeedback on OCD symptoms. However, these studies have small samples and/or were not controlled. Additionally, these studies did not involve treatment‐resistant patients.

We aim at developing a fMRI neurofeedback task to treatment-resistant OCD patients and to explore the underlying brain changes.

We implemented a sham‐controlled double‐blinded fMRI neurofeedback protocol to target hyperactivity in orbitofrontal regions in treatment‐resistant OCD patients with contamination/cleaning symptoms. The protocol had two sessions of neurofeedback (72 min of total training). The patients included were under treatment‐as‐usual.

Our preliminary results with the experimental group (n = 10 patients) demonstrated decreased OCD and stress symptoms three months after the neurofeedback sessions. Moreover, immediately after the neurofeedback sessions, we observed reduced functional connectivity between orbitofrontal and temporoparietal regions, and increased brain activity in dorsolateral prefrontal and premotor areas during symptomatic provocation. The brain functional changes might be associated with a better control over obsessions.

fMRI neurofeedback led to long-term symptomatic reduction in treatment-resistant patients with OCD. Our results need further validation with the sham‐control group but highlight the efficacy of fMRI neurofeedback for refractory OCD and the necessity of prolonged neurofeedback protocols.

None Declared

Although not the most prevalent clinical presentation, obsessive compulsive (OC) symptoms have been reported after TBI. Post-TBI OC disorder (OCD) cases are rare, so that OC symptoms in this setting are frequently described as OC personality disorders (OCPD).

Generally, the clinical features of post-TBI OCD are thought to be similar to those observed in idiopathic OCD, assuming the probable involvement of structures such as the orbitofrontal cortex, basal ganglia, limbic and thalamic systems in its pathophysiology, although no anatomical location clearly associated with post-TBI OCD being recognized.

Brief systematic review of OCD post-TBI and case report.

Bibliographic research using Pubmed. Clinical interviews and file consultation, with patient informed consent.

We present a case of a 63-year-old patient referred to the Psychiatry Consultation due to obsessive thoughts of dirt and contamination, accompanied by compulsive cleaning and sanitizing behaviors with at least 3 years of evolution with a history of TBI and right frontopolar hemorrhage 5 years ago. These behaviors significantly impaired his functionality (cleaning objects on average 300 to 700 times a day, spending hours in the shower). The patient had insight for the excessive behaviors and its daily impairment.

Psychopathology in the post-TBI context is not infrequent, however reported cases of post-TBI OCD are described as rare in the current literature. The short description of this phenomenon implies the need for more studies focused on the study of the phenomenology of post-TBI OCD. For example, while OCD and obsessive-compulsive symptoms tend to be recognizable psychiatric phenomena, neurobehavioral sequelae in a post-TBI context can present multiple manifestations and resemble OC phenomena, without actually constituting OCD.

None Declared

Obsessive-Compulsive Disorder (OCD) is a chronic disabling condition, with considerable lifetime prevalence. There are interindividual differences regarding personality dimensions and how they affect obsessive- compulsive (OC) symptomatology. Furthermore, there is a connection between OC symptoms and the use of maladaptive emotion regulation strategies (expressive suppression) instead of using more cognitive reappraisal.

Explore the relationship between personality, emotion regulation strategies and OC symptoms by testing a path analytic model in a sample of healthy participants and in a sample of OCD patients.

Two samples of participants were utilized. Sample 1 consists of 787 healthy participants from the general Portuguese population. Sample 2 is composed of 33 OCD patients and 32 Healthy Controls (HC). Participants completed different scales: Emotion Regulation Questionnaire (ERQ), Neuroticism-Extraversion-Openness Five-Factor Inventory (NEO-FFI) and Obsessive-Compulsive Inventory-Revised (OCI-R), through online surveys (sample 1) or a clinical interview (sample 2). These questionnaires were then analyzed with a path-analytic approach.

In sample 2, we found significant differences between OCD patients and HC in every OCI-R subscale, except Hoarding and Neutralizing. In the NEO-FFI, OCD patients scored higher on Neuroticism and lower on Extraversion. No significant differences were found regarding the ERQ. Relatively to sample 1: path analysis results showed that 13,4% of the variance of OC symptoms was explained by the best-fitting model. Only Neuroticism and Extraversion were directly associated with higher OCI-R Total scores, whereas Agreeableness predicted less OC symptoms. The use of Expressive Suppression was associated with more OC symptomology, but no significant connection was found with Cognitive Reappraisal. Regarding sample 2, no model was found, showing no modifying effect of emotion regulation strategies on OC Symptoms.

There is a deep-rooted interconnection between personality and emotion regulation regarding OC symptomatology in a sample of healthy participants but no effect of emotion regulation was seen regarding OCD patients.

To sum up, promising results were obtained and it could be an important field for the OCD in terms of diagnostic, severity and treatment.

None Declared

The COVID-19 outbreak imposed several periods of lockdown to stop the pandemic, with a determinant impact on access to mental health services. In Portugal, the first State of Emergency was declared on the 18th of March 2020, with the obligation of mandatory confinement and circulation restriction. Restrictive measures were alleviated on the 2nd of May 2020.

We aimed to investigate the impact of the first confinement on the maintenance or loss of psychiatric and psychological follow-up. Also, we aimed to explore the outcomes in the mental health of losing psychiatric or psychological consultations.

We conducted an online survey among the Portuguese population to evaluate demographic, clinical and mental health variables (STAI, DASS-21, PHQ, OCI-R, Quality of Life [QoL] and PSS). Individuals were invited to answer the survey at two timepoints: third week of March 2020 and third week of May 2020. Concerning the first timepoint, we used independent t-tests to compare the mental health variables in the individuals who loss and who did not lose consultations. Then, we evaluated the impact of losing consultations across time in those individuals who continued responding in the second timepoint, through a Linear Fixed Model. All the analyses were performed using JASP software.

From the total sample (n=2040), 334 individuals (84.4% female gender) had psychiatric and/or psychological consultations previously to the confinement. In March 2020, the individuals who maintained the consultations (35.0%) showed best mental health indicators in the QoL Self Evaluation (p=0.002), QoL Satisfaction (p=0.037), STAI State (p<0.001), DASS-21 (p=0.001), PHQ (p<0.001), OCI-R (p=0.002) and PSS (p<0.001). Among the matched individuals who answered the survey in May 2020 (n=93), we found that the group who maintained follow-up (n=24) did not improve significantly more than the other group (n=69) for any of the mental health variables in study.

The results indicate that stopping psychiatric and psychological follow-up represented worse mental health outcomes at the beginning of the first confinement. However, anxiety feelings improved at the end of the first confinement, which happened independently of psychiatric/ psychological follow-up.

None Declared

Many internationally studies, in the last two decades, found problematic internet use associated with a variety of psychosocial problems, but in Portugal this is a recent research question specially in adults.

To explore the relationship between problematic Internet use, emotional regulation and self-esteem.

138 Portuguese subjects (77.5% females), with a mean age of 27.76 years old (SD = 8.98, range: 18-58) filled in the Portuguese versions of the Generalized Problematic Internet Use Scale-2, the Difficulties in Emotion Regulation Scale and the Rosenberg Self-Esteem Scale.

Negative consequences subscale of generalized problematic internet use was positively correlated with all the emotional regulation difficulties subscales and negatively with Self-Esteem, and positively with daily hours of internet usage. A similar result was found for Self-Deficient Regulation subscale, except for Clarity subscale. Mood Regulation was correlated with Strategies, Goals and Self-Esteem. Males showed higher levels of Negative Consequences. Age and age onset of Internet use were negatively correlated with Mood Regulation, Self-Deficient Regulation and Negative Consequences. A statistically significant difference in Mood Regulation, Self-Deficient Regulation and Negative Consequences in marital status levels, and in professional situation, with higher median scores in divorced and single without a relationship and in student subjects; no significant differences were found in educational level.

Generalized problematic Internet use, especially their Negative Consequences, is associated with higher emotional dysregulation, low self-esteem, lower age and lower age of Internet onset, being divorced or single without a relationship and being student, and it is more prevalent in males.

No significant relationships.

Psychogenic polydipsia associated with hyponatremia is a potentially dangerous and fatal condition observed on patients with psychiatric illness, specially schizophrenia. This results on a peripheral oedema and can lead to cerebral oedema, mental status deterioration and intracranial hypertension if not identified and treated urgently. We present a case of polydipsia as first signal of psychosis.

20-year-old man without significant past medical or psychiatric history attended to emergency service presenting exuberant lower limbs oedemas. The analytical study stated an hyponatremia and hipo-osmotic urine. A psychiatric evaluation was made after organic illness exclusion. The patient presented serious behaviour changes, delusions and eating disturbances (“eat raw meat to recover the red cells that they had stolen from him”), polydipsia and auditory hallucinations with 2 weeks of evolution. The patient was compulsory hospitalized, treated with risperidone and lorazepam and discharged 28 days after admission without psychotic symptoms.

The recognition and management of the polydipsia as a first signal of psychosis are difficult because sometimes patients are uncooperative and tend to hide their water intake, but is important to be awhare to this signal to prevent the morbidity and mortality associated with this disease.

Alcoholic dependence is an addictive disorder with high levels of mortality and morbidity, characterized by loss of ability to drink alcohol in moderation and continued drinking despite negative consequences. Therapeutic approaches include medical, psychological and social support. The aim of this study was to find factors that can improve outcomes.

Compare a population of alcoholics who have achieved one year of total abstinence from alcohol with individuals that relapse within the same period and identify individual and treatment-related factors that can predict success.

Multivariate logistic regression analysis was used to identify treatment related predictors of continuous abstinence in individuals above 18 years old who meet ICD-10 criteria for alcoholic dependence during the first year of treatment in Alcoholic Center of Hospital de Braga.

590 patients met the selection criteria. Treatment success rate (total abstinence) was 32,3%. Individual characteristics such as gender, age, civil state or level of instruction were not directly related to 1st year outcomes. Independent predictors of continuous abstinence were no prior inpatient treatment (OR 0.549, 95%CI = 0.322–0.936), inpatient treatment at beginning (OR 3.765, 95%CI = 2.061–6.879) and abstinence at beginning of treatment (OR 4.947, 95%CI = 2.223–11.008).

The results show that using different approaches for the initial treatment of alcoholic dependence can result in higher periods of total abstinence. These findings may be useful to help physicians to improve alcoholic dependence treatment outcomes.

Psychogenic excoriations are also called neurotic excoriations, dermatillomania or skin picking syndrome. Psychogenic excoriations are lesions caused by scratching, picking, lancing, rubbing or squeezing, usually, in areas that patient can easily reach (face, upper back and upper and lower extremities). They are initiated because an urge to excoriate an irregularity of the skin or by a disturbing sensation in the skin. The classic lesions are characterized by clean, linear erosions, scabs and scars that can be hypopigmented or hyperpigmented and are usually similar in size and shape. Association with psychiatric comorbidities are common, particularly mood and anxiety disorders. It is estimated to occur in 2% of dermatology clinic patients and is associated with functional impairment, medical complications (e.g. infection) or substantial distress. Psychotropic medications (e.g. SSRIs) and appropriate counseling can be effective treatments.

The purpose of the poster is to highlight the existence and characteristics of psychogenic excoriations. A

condition that can be chronic, causes significant impairment and is believed to be common but unreported.

Here we report the case of a 27 year-old woman, with a 10 years history of self-inflicted excoriations, associated to high anxiety levels, treated with an SSRI with good response.

Although it does not appear as a diagnostic category in DSM- IV, psycogenic excoriations is indeed a treatable condition that, isolated or associated with psychiatric comorbidity can cause marked distress, impairment and psychological suffering.

Paraphrenia is a disorder similar to paranoid schizophrenia characterized by phantastic, paralogical and extraordinary imaginative delusions, with better-preserved affect and rapport and much less personality and cognitive deterioration. Most affected patients are women, with onset of symptoms in late adulthood. It was firstly systematically described by Kraepelin in 1913 in order to define a group of psychotic patients who exhibited characteristic symptoms of dementia praecox, but with minimal disturbances of emotion and volition, and marked delusions. Later, it was considered to be unfounded and the term paraphrenia was not included in the current DSM-IV-TR and ICD-10 diagnostic criteria. However, several authors suggest that the concept of paraphrenia has not lost its usefulness and it seems to be that some psychiatrists recognize the illness, but labelled it as atypical psychosis or delusional disorder for the lack of a better diagnostic category.

The aim of this poster is to underline the modernity of Kraepelin's paraphrenia concept, suggesting that it could be possible to define and recognize the illness if practitioners would be induced to use a viable diagnostic entity.

Herein we report a case of a 51-year-old woman who presented three years ago with a psychotic disorder whose clinical features resemble de classical description of paraphrenia.

Very few systematic studies on paraphrenia have been carried out in the past 70 years. Further research in this field is needed in order to recognize the viability of this diagnosis and provide patients a better care and therapeutic management.

blepharospasm is a focal dystonia of the orbicularis oculi muscles, provoking intermittent or sustained eye closure, sometimes severe enough to cause functional blindness. Basal ganglia connections seem to have a major role in its still largely unknown physiopathology. Though usually idiopathic, in the last decades many authors have been linking it to neuropsychiatric diseases, such as obsessive-compulsive disorder. Hemifacial spasm (HFS) consists in unilateral, sudden and intermittent contraction of muscles innervated by the facial nerve. Unlike blepharospasm, an identifiable etiology is frequent. Current best treatment for both diseases consists in botulinum neurotoxin type A application (BoNT/A).

to characterize psychological profile of patients with idiopathic blepharospasm or HFS and analyze significant differences.

consecutive patients diagnosed with one of the above mentioned diseases, visiting an outpatient clinic of BoNT/A application, were evaluated regarding the existence of stress, depression, and obsessive-compulsive behavior. Personality traits, quality of sleep and quality of life were also analyzed. Validated scales were used to assess these domains.

eighty patients were included, 43 with HFS and 37 with idiopathic blepharospasm. After explanation and agreement, demographic, social and clinical data was collected, in addition to questionnaires. Statistical analysis focuses on group differences and correlation with clinical and psychological parameters.

the proposed involvement of basal ganglia in motor and affective domains of blepharospasm must lead to a comprehensive approach of these patients, including a psychological evaluation and pharmacological treatment directed not only to motor spectrum, as it is currently usual, but also matching coincident psychopathology.

Capgras syndrome is a misidentification syndrome typically characterized by the delusional belief that a close relative has been replaced by an impostor. This monothematic delusion can be found in numerous disorders such as paranoid schizophrenia, schizoaffective disorder, affective disorders, Alzheimer's disease, Lewy body dementia, head trauma, epilepsy, cerebrovascular disease and dementia, pituitary tumor, multiple myeloma, multiple sclerosis, viral encephalitis, frontal lobe pathology and AIDS. We present a case of a patient that presents Capgras Syndrome at the first psychiatric evaluation in the context of three-decades untreated paranoid schizophrenia.

A 56-year-old woman was brought to the psychiatric department for evaluation for aggressive behavior directed to relatives. She has a history of auditory hallucinations, experiences of self-reference and paranoid delusions with more than 30 years of evolution. More recently, she started becoming aggressive with relatives, saying her real family members had been taken by strangers to an unknown hospital. She also said that her ID photo had been replaced by another person's photo. After detailed psychiatric evaluation, blood analysis and imaging study, the diagnosis of Paranoid Schizophrenia was established. She was treated with olanzapine 20mg/day with behavioral improvement.

Although Capgras Syndrome is not a psychiatric diagnosis but a feature of several different conditions, psychiatrists should be aware of this syndrome as it can signalize underlying psychiatric disorders and is usually associated with violent behaviors that should be managed.

Stigma of mental illness can be defined as a set of stereotypes and prejudice established in the society that leads to discriminatory behavior against people who suffer from a psychiatric condition. Mental illness stigma is widely spread in community and reaches not only general population but also health professionals. The impact of these negative attitudes in mental ill people is severe and is becoming more relevant as mental illness gets more prevalent.

To characterize and evaluate attitudes and prejudicial reactions adopted by a population of medical students and doctors from psychiatry, internal medicine and surgery that study/work in Braga's region (North of Portugal).

Students and professionals were surveyed using a socio-demographic questionnaire and AQ27 questionnaire - Portuguese version, a validated questionnaire to measure stigmatizing attitudes and reactions. A total of 353 questionnaires were collected. Response rate was 68,8% among doctors (n=150) and 32,6% among medical students (n=203). Scores between groups and contributes of age, sex and past experience were analyzed with linear regression modeling.

High scores in several stigmatizing attitudes were found in both medical students and professionals. Psychiatrists displayed lower levels of stigmatizing attitudes in all categories analyzed, except “pity” which was dependent on age of responders. Interestingly, students showed significantly lower stigmatizing attitudes in help, pity and avoidance. No differences were found between groups among coercion and segregation.

The results show that both medical students and professionals, including psychiatrists, exhibit stigmatizing attitudes, which should be specifically addressed in order to improve care.

Psychiatric complications during the course of surgical treatment are well recognized and may include psychosis, depression, mania, disruptive ward behavior or addiction. Postoperative psychosis is associated with increased morbidity and requires acute management. We present a case of paranoid psychosis developed after orthopedic surgery that lasted for 3 months.

A 42-year-old woman without known significant past medical or psychiatric history was submitted to surgical correction of humeral fracture. Three hours after the surgery, she exhibited disruptive behavior associated with auditory and visual hallucinations, paranoid delusions and experiences of self-reference. the patient was acutely treated with haloperidol and diazepam and discharged five days later without psychotic symptoms. Three months after discharge was admitted to a psychiatric unit presenting persecutory delusions and experiences of self-reference. She was treated with paliperidone 9mg/day with good response.

Although the exact cause of postoperative psychosis has not been identified, awareness of this diagnosis and knowledge on its management are critical to provide better care to patients.

Koro syndrome is a culturally related disorder characterized by intense anxiety that the penis (vulva or nipples in females) is shrinking or retracting and will recede into the body. Usually it occurs in epidemics in Southeastern Asia, being extremely rare in western countries. The condition is more common in males and is classified within Obsessive Compulsive and Related Disorders.

A 27-year-old single man was referred to the psychiatric department. By the age of 23, he began worrying that his penis was shrinking and retracting into the abdomen. He described these thoughts as intrusive, ridiculous and repetitive. During the first months the thoughts were not very disturbing but he progressively developed an urge to verify the length of his penis several times a day. To diminish the anxiety provoked by the obsessive doubts on penis length, he started to have repetitive thoughts and mental images about sexual acts, to consume pornography compulsively and to increase his masturbatory behaviors (from some times a week to several times a day). He described those thoughts and behaviors as unpleasant and uniquely driven to reduce anxiety provoked by obsessions.

He was prescribed fluvoxamine 200 mg/day and initiated cognitive behavioral therapy with good response. Y-BOCS score decreased from 30 at initial evaluation to 18 after 3 months of treatment.

Koro syndrome is a very rare condition in psychiatry in western countries, usually presenting secondarily to other psychiatric disorders. Awareness of this diagnosis and knowledge on its management are critical to provide optimal care to patients.

The authors have not supplied their declaration of competing interest.