Infection control guidelines for cystic fibrosis (CF) stress cleaning of environmental surfaces and patientcare equipment in CF clinics. This multicenter study measured cleanliness of frequently touched surfaces in CF clinics using an ATP bioluminescence assay to assess the effectiveness of cleaning/disinfection and the impact of feedback.

Eight surfaces were tested across 19 clinics (10 pediatric, 9 adult) over 5 rounds of testing. Rounds 1 and 2 served as uncleaned baseline, and Round 3 occurring after routine cleaning. Rounds 4 and 5 were performed after feedback provided to staff and measured after cleaning. Pass rates defined as <250 relative light units were the primary outcome.

Of the 750 tests performed, 72% of surfaces passed at baseline, and 79%, 83%, and 85% of surfaces passed in Rounds 3, 4, and 5, respectively. The overall pass-rate was significantly higher in adult compared to pediatric clinics (86% vs 71%; P < 0.001). In pediatric clinics, blood pressure equipment and computer keyboards in the pulmonary function lab consistently passed, but the exam room patient/visitor chairs consistently failed in all rounds. In adult clinics blood pressure equipment, keyboards in exam rooms and exam tables passed in all rounds and no surface consistently failed.

We demonstrate the feasibility of an ATP bioluminescence assay to measure cleanliness of patient care equipment and surfaces in CF clinics. Pass rates improved after cleaning and feedback for certain surfaces. We found that surfaces are more challenging to keep clean in clinics taking care of younger patients.

Anorexia Nervosa (AN) is common in adolescents and has a high mortality and morbidity rate with a lifetime prevalence of 0.5% to 2%.1,2 We aim to review the neurobiology correlation of Anorexia Nervosa in Autism Spectrum Disorder as they are often associated together.

1. Understand the correlation between the neurobiology of Autism Spectrum Disorder (ASD) and Anorexia Nervosa.

2. Assess the association and prevalence of Anorexia nervosa in the ASD population.

3. To focus on the implications for the pathogenesis of Anorexia Nervosa and treatment of this disorder in the ASD population.

We searched PubMed, APA PscyINFO, Embase, CINAHL, and Google scholar databases with the keywords Autism Spectrum Disorder AND Anorexia Nervosa and included 6 relevant human studies out of 187 published in English.

Neilson et al. studied the outcome of ASD in teenage onset AN, and a statistically significant negative dose-response relationship is found in all the 3 Morgan-Russell Outcome Assessment Schedule (MROAS) domains in stable ASD over time, and the results on the subscales ‘mental state,’ ‘psychosexual state’ and ‘socio-economic state, “personal contacts,’ ‘social activities’ and ‘employment record.’3 The outcome of AN onset in adolescence is generally favorable regarding mortality and the persistence of eating disorders in adulthood. A study by Pruccoli et al. noted a high prevalence of ASD traits in a group of young AN patients, predominantly seen in 4 specific EDI-3 subscales and independent of BMI.4 Margari et al. found only AN diagnosis had a statistically significant difference (p = 0.04) in females vs. males when comparing sex differences for comorbidities.5

Morphological changes in brain areas are linked to social cognition and increase the risk of eating disorders in ASD. We recommend future studies with robust study design to explore the full spectrum of pathogenesis and association of AN in ASD.

None Declared

Anxiety disorder affects nearly 9.4% of children aged 3-17 years.1 Virtual Reality (VR) provides an alternative for managing anxiety due to immersive, multisensory, and excellent distraction.

The aim is to evaluate the efficacy of VR therapy in managing anxiety in children.

We searched PubMed, Medline, Embase, Web of Science, and Biosisdatabases with the keywords “Virtual Reality” in the context of “AnxietyDisorders” and included 8 relevant studies published in English until February 10, 2023, for our qualitative synthesis.

The VR-Guided relaxation (VR-GR) effectively decreased anxiety immediately after administration. In another trial, 4 of the 9 patients completely overcame their fears, and 8 of 9 saw an improvement in target behaviors in the autism population even after six weeks after the therapy, and the effect lasted 1 year post-treatment. In another study, VR-based therapy helped reduce anxiety and behavioral scores significantly in the VR group vs. the control. In another study, they found during pediatric intravenous catheter placement, patients who received VR therapy showed significantly less anxiety and pain compared to those who did not. In another study, they found VR therapy helped reduce anxiety during the induction of pre-operative anesthesia in children undergoing elective surgery.

A study discovered benefits with statistically significant results in reducing anxiety in children immediately after VR-based therapy. To explore the full spectrum of benefits and efficacy of VR-based therapy for anxiety as a standalone or adjunct to pharmacotherapy, we recommend future trials with robust study designs.

None Declared

In recent times, Health Professionals (HPs) people may feel a sense of discomfort and nervousness when disconnected from their smartphones, causing the emergence of the new phenomenon of “No Mobile Phone Phobia,” or Nomophobia.

We aim to study lifestyle-related factors that influence HPs’ Nomophobia.

From April- June 2023, a global cross-sectional study was conducted using the modified Nomophobia questionnaire (NMP-Q). The original 20 NMP-Q questions (Qs) were reduced to 14 to avoid repetitive Qs with similar meanings. The Qs were categorized into 4 sections, A- Not Being Able to Access Information; B- Losing Connectedness; C- Not Being Able to Communicate; and D- Giving Up Convenience. A new section, “E- Daily Habits”, and “F- Smartphone Type”, and “Hours Spent Daily” were added. Before the launch, it was internally and externally validated by trained psychiatrists as well as experienced researchers. We utilized social media, WhatsApp, text and emails to share it with HPs of different specialties worldwide. The survey was anonymous and IRB-exempt.

Total 105 countries’ HPs participation led to 12,253 responses. Total 47.3% of HPs agreed/strongly agreed (A/SA) that they prefer to use their smartphone before bedtime. Over half (57.8%) of HPs A/SA checked their notifications immediately after waking up in the morning. Only 19.4 % of HPs A/SA that woke up in the middle of the night to check notifications. Total 40.5% of HPs A/SA, 22% were neutral, and 37.3% of HPs disagreed /strongly disagreed (D/SD) with using smartphones while eating their meals. A total of 52.7% of HPs preferred smartphone usage over exercising as a break, while 454.9% of HPs A/SA that they chose smartphones over exploring other hobbies for relaxation. A total of 44.2% of respondents A/SA with smartphone usage in the restroom, 39.8% D/SD. 37.4% of participants D/SD with getting distracted by notifications and resisted the urge to answer any calls or texts while performing a focused task, whereas 39.6% A/SA and 23% were neutral. A total of 80% of respondents met the modified criteria for moderate-severe nomophobia.

In a large-scale survey-based study on Nomophobia, additional Qs in NMP-Q may help recognize that nomophobia can be a result of daily lifestyle decisions rather than an isolated issue.

None Declared

Persistence in physician-scientist careers has been suboptimal, particularly among women. There is a gender gap in self-confidence in medicine. We measured the impact of our physician-scientist training programs on trainee’s confidence in professional, personal, and scientific competencies, using a survey measuring self-rated confidence in 36 competencies across two timepoints.

Results were analyzed for the full survey and for thematic subscales identified through exploratory factor analysis (EFA). A mixed effects linear model and a difference in differences (DID) design were used to assess the differential impact of the programing by gender and career level.

Analysis included 100 MD-PhD or MD-only medical student or resident/fellow trainees enrolled between 2020 and 2023. Five subscales were identified through EFA; career sustainability, science productivity, grant management, goal setting, and goal alignment (Cronbach’s alpha 0.85–0.94). Overall, mean scores increased significantly for all five subscales. Women significantly increased their confidence levels in all five areas, whereas men increased only in science productivity and grant management. Mixed effects models showed significant increases over time for women compared to men in career sustainability and goal alignment. Residents and fellows had greater increases than medical students across all subscales.

Physician-scientist trainees fellows increased their confidence in personal, professional, and scientific skills during training. Training had a greater impact on women than men in building confidence in sustaining careers and aligning their goals with professional and institutional priorities. The magnitude of increased confidence among residents and fellows exceeded that in medical students.

The prevalence of medical illnesses is high among patients with psychiatric disorders. The current study aimed to investigate multi-comorbidity in patients with psychiatric disorders in comparison to the general population. Secondary aims were to investigate factors associated with metabolic syndrome and treatment appropriateness of mental disorders.

The sample included 54,826 subjects (64.73% females; 34.15% males; 1.11% nonbinary gender) from 40 countries (COMET-G study). The analysis was based on the registration of previous history that could serve as a fair approximation for the lifetime prevalence of various medical conditions.

About 24.5% reported a history of somatic and 26.14% of mental disorders. Mental disorders were by far the most prevalent group of medical conditions. Comorbidity of any somatic with any mental disorder was reported by 8.21%. One-third to almost two-thirds of somatic patients were also suffering from a mental disorder depending on the severity and multicomorbidity. Bipolar and psychotic patients and to a lesser extent depressives, manifested an earlier (15–20 years) manifestation of somatic multicomorbidity, severe disability, and probably earlier death. The overwhelming majority of patients with mental disorders were not receiving treatment or were being treated in a way that was not recommended. Antipsychotics and antidepressants were not related to the development of metabolic syndrome.

The finding that one-third to almost two-thirds of somatic patients also suffered from a mental disorder strongly suggests that psychiatry is the field with the most trans-specialty and interdisciplinary value and application points to the importance of teaching psychiatry and mental health in medical schools and also to the need for more technocratically oriented training of psychiatric residents.

The needs of young people attending mental healthcare can be complex and often span multiple domains (e.g., social, emotional and physical health factors). These factors often complicate treatment approaches and contribute to poorer outcomes in youth mental health. We aimed to identify how these factors interact over time by modelling the temporal dependencies between these transdiagnostic social, emotional and physical health factors among young people presenting for youth mental healthcare.

Dynamic Bayesian networks were used to examine the relationship between mental health factors across multiple domains (social and occupational function, self-harm and suicidality, alcohol and substance use, physical health and psychiatric syndromes) in a longitudinal cohort of 2663 young people accessing youth mental health services. Two networks were developed: (1) ‘initial network’, that shows the conditional dependencies between factors at first presentation, and a (2) ‘transition network’, how factors are dependent longitudinally.

The ‘initial network’ identified that childhood disorders tend to precede adolescent depression which itself was associated with three distinct pathways or illness trajectories; (1) anxiety disorder; (2) bipolar disorder, manic-like experiences, circadian disturbances and psychosis-like experiences; (3) self-harm and suicidality to alcohol and substance use or functioning. The ‘transition network’ identified that over time social and occupational function had the largest effect on self-harm and suicidality, with direct effects on ideation (relative risk [RR], 1.79; CI, 1.59–1.99) and self-harm (RR, 1.32; CI, 1.22–1.41), and an indirect effect on attempts (RR, 2.10; CI, 1.69–2.50). Suicide ideation had a direct effect on future suicide attempts (RR, 4.37; CI, 3.28–5.43) and self-harm (RR, 2.78; CI, 2.55–3.01). Alcohol and substance use, physical health and psychiatric syndromes (e.g., depression and anxiety, at-risk mental states) were independent domains whereby all direct effects remained within each domain over time.

This study identified probable temporal dependencies between domains, which has causal interpretations, and therefore can provide insight into their differential role over the course of illness. This work identified social, emotional and physical health factors that may be important early intervention and prevention targets. Improving social and occupational function may be a critical target due to its impacts longitudinally on self-harm and suicidality. The conditional independence of alcohol and substance use supports the need for specific interventions to target these comorbidities.

The COVID pandemic caused an unprecedented public health crisis and adversely impacted children’s well-being. It has negatively affected children’s mental health due to social isolation, human losses, and remote learning. Our goal is to learn about the challenges and factors that these children and young adults face upon returning to school and college, which could further decline their mental health. We also need to understand parents’ concerns about this transition to a back-to-school routine.

1) To learn about the mental health challenges for children, adolescents, and young adults returning to school after the beginning of the COVID pandemic.

2) To identify the factors and challenges that parents and caregivers face during the COVID regarding the return of their children to school.

We conducted a literature search using relevant medical subject heading (MeSH) terms in PubMed, PubMed Central, Web of Science, and Medline databases. We identified all published relevant articles until June 4, 2021. After a thorough review of relevant published articles until October 30, 2022, we included 5 articles in our qualitative synthesis.

A cross-sectional study in China measured depression, anxiety, and social support in back-to-school students via PHQ-9, GAD-7, and SSQ, respectively. They found a significant rise in anxiety and depression among these students. This correlation was weak at higher social support. Data collected from 15 children’s hospitals found that students want to participate actively in returning to school and the recovery process as they are concerned about their future, family, and society. Another 2021 cross-sectional study in Texas revealed that parents are concerned about their children’s health and prefer an onsite-virtual hybrid learning setup over in-person learning (Limbers C. A. et al. The Journal of school health 2021; 91(1), 3–8.). Parents in Italy favored school reopening with reduced student numbers (70.1%), social distancing within classes (45.3%), and masks as they were concerned about their children due to COVID (Pierantoni, L et al. 2021; Acta paediatrica (Oslo, Norway : 1992), 110(3), 942–943 ). Fewer White parents were supportive of a mask mandate for students and staff members (62.5%) than parents of ethnicities like Hispanic (79.5%, p= 0.026) and other racial/ethnic groups (66.9%, p = 0.041) (Gilbert, L. K. et al. MMWR. Morbidity and mortality weekly report 2020; 69(49), 1848–1852).

The return to school after COVID is challenging for students and parents due to the rise in anxiety and depression in children. Social support has been found to be protective of children’s mental health. Future well-designed studies should identify challenges and factors that can help safeguard children’s mental health and develop appropriate policies.

None Declared

Methylphenidate (MPH) is used to treat attention deficit hyperactivity disorder (ADHD) and has shown unique benefits in children and adolescents with autism spectrum disorder (ASD). In addition to improving attention, hyperactivity, and repetitive movement, it also improves cognition in ASD. Our focus is to explore the understudied benefits and safety of methylphenidate use for cognition in ASD children.

1) To study the response and benefit of methylphenidate in autistic kids to improve cognition and life function.

2) To assess the safety profile and risks of using methylphenidate at different doses in children with autism as a guiding tool for prescribing physicians.

A literature search was conducted using relevant medical subject headings (MeSH) terms in PubMed, Medline, and PubMed Central. We identified all published articles from inception until September 30, 2022. Initial search results found 41 studies, of which 15 were excluded as they did not meet inclusion and exclusion criteria. After a thorough full-text review, we included 5 studies in our final qualitative synthesis review.

Methylphenidate was found to have the unique benefit of increasing cognitive processing speed, thus improving everyday life function in ASD and ADHD children compared with only ADHD, with a clinical significance of p<0.001. Stimulants may improve the processing of social situations and interactions or social functions due to this unique response (Peled, J et al. Nordic journal of psychiatry 2020; 74(3), 163–167) A clinically significant performance gain on cognitive tasks was identified with a linear dose-response at three different doses (10 mg, 15 mg, 20 mg) of methylphenidate. ASD children with ADHD made significantly fewer omission errors, [F(3,69) = 7.21, p < 0.001], and commission errors [F(3,69) = 4.64, p = 0.005] on MPH, compared to placebo. They also showed more response at higher MPH doses, [F(3,69) = 10.45, p < 0.001]. Thus, the children were faster, more accurate, and had fewer errors at higher MPH doses (Pearson, D. A. et al. Journal of child and adolescent psychopharmacology 2020; 30(7), 414–426). There were no serious side effects or suicidality reported for low dose and a medium dose of MPH in ASD children assessed with Response Impressions and Side Effects Checklist-Kids (RISC-K), A 38-item parent rating scale (Kim, S. J. et al. Journal of autism and developmental disorders 2017; 47(8), 2307–2313).

The findings support the positive response of methylphenidate on cognitive function in ASD children. No serious adverse effects or suicidality were noted. Multi-center well-designed studies are recommended to determine further efficacy and safety of MPH in ASD children for cognition.

None Declared

Aripiprazole is the third generation Antipsychotic, and Dopamine serotonin system stabiliser.It is partial agonist at D2 and 5 HT1 A and antagonist at 5 HT2.Most commonly seen adverse effects are Akathesia, fatugue,insomnia and headache the major advanatage is less propensity for extrapyramidal side effects and lmetabolic side eefects.

To report a case of Schizophrenia treated with Aripiprazole 15mg/day developiing occular gyric crisis which was tratment resistant.

We administered Electroconvulsvive therapy, bidirectional brief pulse constant current 8 ECTS, under General anesthesia with medical fitness .

Patient Showed complete resolution of Dystonia after second ECTs and Showed improvment in Pyschosis Parameterd. Assessment using Naranjo Protocol made.

Electroconvulsive therapy therapy is viable alternative to manage Dystonia when medical treatment fails

None Declared

Sexual orientation is one’s romantic preference of attraction, may it be towards the same gender or the opposite. Since ages, lot of communities have considered orientation other than heterosexuality as a taboo. Possession Trance disorder is a trance state in which there is a marked alteration in the individual’s state of consciousness and customary sense of personal identity is replaced by an external ‘possessing’ identity and in which the individual’s behavior and movements are experienced as being controlled by the possessing agent as per ICD 11. While lot of theories for such disorder are established, core of each theory lies at an unconscious underlying conflict that is not acceptable by individual’s psyche. Here is an interesting case of 30yrs old homosexual female having possession trance disorder.

To discuss a rare case of possession trance disorder due to unconscious conflict secondary to unexpressed sexual orientation.

A 30yrs old married female patient diagnosed with Possession Trance disorder as per ICD-11 was on treatment for the same since 3 yrs without improvement. She used to get possession episodes by a religious leader for few hours and would preach to his followers during such episodes. Later she was admitted in indoor facility to understand and explore her illness so as to provide an effective management. After serial interview with the patient and her relatives it was discovered that she had sexual orientation towards females(homosexual). Later on, during the course it was found that patient was attracted to a female disciple of that religious leader and to spend time with her, she used to get possession episodes. This however was not acceptable socio-culturally and by patient herself. This lead to lot of conflicts and dysfunctional marital life with husband. To begin with, patient was unable to accept this fact and reported intense guilt for the same. After serial psychotherapy sessions and pharmacotherapy, she improved significantly. Family based interventions for comprehensive improvement were carried out and the patient was discharged with significant improvement.

Discussion: Lot of communities still has immense stigma against homosexual orientation, at times upto extent to consider it to be some mental illness or supernatural interference. This leads to severe psychological trauma to the person and gives rise to inner conflicts in accepting the true self. This emphasizes a need to develop awareness amongst the communities.

This was an interesting rare case highlighting the need for community based interventions to normalize issues related to human sexuality. There is a need to bring awareness and involvement of community to improve mental health of individual as well as community.

None Declared

Attention Deficit Hyperactivity Disorder (ADHD) affects about 9.4% (6.4 million) children in the United States. Pharmacological treatment, including stimulants, is a known therapy for ADHD. However, its possible subtherapeutic effectiveness, residual symptoms, and adverse effects have prompted us to explore the current evidence of Yoga as an add-on therapy that has shown synergistic effects in recent studies.

1) We aim to assess Yoga’s efficacy as an add-on treatment for ADHD.

2) Assess the current evidence of Yoga as an add-on therapy for ADHD.

We searched PubMed, PubMed Central, Medline, Web of Science, and Biosis databases with the keywords “Attention Deficit Disorder with Hyperactivity” (MeSH) and “ADHD” in the context of “Yoga” (MeSH). Identified 4 relevant studies that were published until September 30, 2022.

A study by Jensen et al. found improvement in impulsivity, hyperactivity, and restlessness in the ADHD with medications patient group after 20 Yoga sessions. Study utilized Conners’ Parents Rating Scales and found improvement in the Yoga group on Oppositional, Global Index Emotional Lability, Global Index Total, Global Index Restless/Impulsive, and ADHD Index scale, changes associated with the number of sessions (Jensen et al. J Atten Disord 2004; 7 205-216). In another study, children with ADHD showed significant improvement after 8 weeks of 16 Yoga sessions in accuracy rate and reaction time in the Visual Pursuit Test and Determination Test (Chou et al. Peer J 2017; 5 e2883). A nine-year-old male case showed improvement in inattentive and hyperactive-impulsive symptoms on Vanderbilt Assessment Scales from parents and teachers after 6 months of Yoga practice (Gunaseelan et al. Cureus 2021; 5, e2883). Another 6-week Yoga intervention randomized trial in pre-school ADHD children showed significant improvement in hyperactivity and inattention with fewer distractibility errors of omission and faster reaction time (Cohen et al. J Dev Behav Pediatr 2018; 39 200).

The results suggest that Yoga has beneficial effects as an adjunct treatment to pharmacotherapy in ADHD for reducing hyperactivity and inattentiveness. Additionally, studies indicate its effectiveness in managing stress, anxiety, energy levels, and impulse control by staying focused with the help of breath and mind control. To explore the full spectrum of benefits and effectiveness of Yoga as an add-on therapy for ADHD patients, we recommend robust well-design future studies.

None Declared