Foreign students are confronted to the multiple obstacles along their university studies. These obstacles can be related to the nature of the medical studies, the diversity and dense quantity of the subjects, and also to the interaction of the students with their colleges, their patients and the paramedical staff during the training. Psychological distress can, also affect the process of integration in society.

To assess the factors influencing the social integration and the satisfaction of the foreign students in the faculty of medicine in Sfax-Tunisia.

We conducted a cross-sectional, descriptive and analytical study, carried out between July and September 2023 among foreign students at the Sfax Faculty of Medicine, via an anonymous self- questionnaire via “Google Forms shared via social media. Social integration was evaluated via the French version of the need to belong scale by Richer and Vallerand. The satisfaction of the medical studies was evaluated using the scale of satisfaction of studies by Vallerand and Bissonnette. Psychological distress was assessed using the “DASS-21” Depression, Anxiety and Stress Scale.

Seventy-two foreign medical students completed the survey. The average age was 25 ± 3.45 years. Males represented 57% of the total participants. The majority of the participants were north Africans 87.5% (Moroccan: 68.05%, Mauritanian: 18.05% and Algerian 1.4%). The majority of respondents were single (77.8%). Sixty-one percent were enrolled in the third cycle of medical studies, 26.5% were enrolled in the second cycle of medical studies and 12.5% were enrolled in the first cycle of medical studies. The average length of stay in Tunisia was 6.5 years. Seventy-seven percent were satisfied with the choice of Tunisia for the medical studies. The male gender was statistically associated to the feeling of a better social integration (p=0.045). In addition, social integration was statistically associated to satisfaction in medical studies (p=0.004, r=0.034) and to academic performance (p=0.008). We found no statistical association between the level of the students nor the length of the stay in Tunisia. We found no statistical association between social integration and psychological distress.

The feeling of being an integral part of the social community can help alleviate the stress of adjusting to a new environment and improve emotional well-being, which can positively influence the learning experience and satisfaction of these foreign students.

None Declared

Eating disorders (EDs), including binge-eating disorder (BED), bulimia nervosa (BN), and anorexia nervosa (AN), represent serious mental health conditions characterized by disturbances in eating behavior and body image concerns. These disorders significantly impair health, psychosocial functioning, and quality of life. Evidence-based psychotherapies have shown effectiveness in treating EDs.

This study aims to evaluate and compare the effectiveness of various psychotherapies for treating BED, BN, and AN, with a focus on both short-term and long-term outcomes. A secondary objective is to assess the applicability of transdiagnostic psychotherapy approaches across different EDs.

A literature review was conducted using articles from PubMed, focusing on the terms “eating disorders”, “evidence-based psychotherapy”, “cognitive-behavioral therapy”, and “interpersonal psychotherapy”. The selection prioritized the most relevant clinical trials and meta-analyses.

Cognitive-behavioral therapy (CBT) consistently demonstrated significant short-term effects in reducing binge-eating episodes and EDs psychopathology, particularly in BED and BN. It outperformed both inactive controls (e.g., wait-lists) and other psychotherapies. Long-term, CBT continued to show sustained improvements in symptom reduction, particularly for BED, though it was less effective for BN and AN.

For the treatment of AN, most guidelines recommended psychological interventions, particularly family-based therapy (FBT) for younger patients. CBT and structured therapies like Maudsley Anorexia Nervosa Treatment for Adults (MANTRA) were also recommended. Interpersonal psychotherapy (IPT) received limited support due to insufficient evidence.

In BN, CBT was widely endorsed as the first-line treatment. IPT was recommended as an alternative, noted for its slower symptom \reduction but equivalent long-term efficacy. FBT was recommended for younger patients.

For BED, CBT was consistently recommended as the first-line treatment, with growing evidence supporting guided CBT self-help. IPT was recommended by several guidelines as an alternative.

CBT was the most consistently recommended treatment for all EDs, particularly for BN and BED, offering faster symptom reduction, higher remission rates, and better long-term outcomes. While IPT is a viable alternative, particularly for BED, it generally takes longer to achieve comparable results. The findings emphasize the need for more personalized treatment approaches and the exploration of adjunctive therapies to improve outcomes, especially for AN. Further research is required to refine therapy selection and address the distinct challenges posed by different ED subtypes, particularly in achieving long-term treatment success.

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Suicide is an unresolved issue in psychiatry to this day. Suicide risk (SR) is highest for psychiatric patients with bipolar affective disorder (BD). Recent studies suggest an immunological dysregulation in the background of suicidality, and in accord with former results, our research group has previously found monocyte-to-lymphocyte ratio (MLR) and further inflammatory parameters to be reliable indicators of SR in patients with major depressive disorder.

Determining SR remains a challenge for clinicians. Alterations in the number and ratio of inflammatory cells have been proposed as potential biomarkers of SR, therefore our aim was to investigate changes of these parameters in relation to acute and long-term SR in BD patients.

In our restrospective study, we investigated laboratory parameters of psychiatric inpatients diagnosed with BD between January 2020 and June 2024. Data was collected regarding the following parameters: white blood cell, neutrophil, lymphocyte, monocyte and platelet count, MLR, neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), red blood cell distribution width (RDW) and mean platelet volume (MPV). Individuals with recent (≤ 48 hours prior) suicide attempt (SA) (n = 21) and with past (> 48 hours prior) SA (n = 16) represented the high SR group (n = 37). BD patients with no history of SA (n = 79) composed the intermediate SR group. Statistical analyses were carried out using the GraphPad Prism 10.3.1 programme.

We found a significant increase in MLR (p = 0.0021, Fig. 1), monocyte count (p = 0.0045), CRP (p = 0.0036), ESR (p ≤ 0.0001) and MPV (p ≤ 0.0001) in patients with recent SA compared to those with no history of SA. Comparing high and intermediate risk patients, MLR (p = 0.012, Fig. 2), monocyte count (p = 0.0293), CRP (p = 0.0499, Fig. 3), ESR (p = 0.0009) and MPV (p = 0.008) remained elevated in the former group. We found no significant differences regarding the rest of the parameters. According to ROC analysis, the probability of the significant results was outstanding in case of ESR and acceptable for the rest of the parameters.

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As implied by previous research, immunological mechanisms may contribute to the emergence of suicidality. Investigating BD patients as the subgroup most at risk, we found MLR, monocyte count, CRP, ESR and MPV to show significant alterations in recent attempters, signalling acute SR. Furthermore, all of these markers were significantly elevated in high risk patients, therefore they may be indicative of long-term SR. Changes in these inflammatory markers further strengthen the assumption of immunological processes in the background of suicidality, and these parameters may serve as potential future biomarkers of SR.

The study was supported by the EKÖP-24-3-II-PTE-168 project.

None Declared

Severe personality disorders have a significative impact not only on patients but also among their families, causing emotional distress and relevant burden related to care giving. Psycho-educational intervention targeting family members can improve their understanding of the disorder and their ability to cope with symptoms.

Forlì Mental Health Centre multi-professional team undertake this study with the scope to evaluate the efficacy of a nine sessions’ psycho-educational program targeting a group of family members, based on the dialectical behavioral therapy (DBT) principles and skills.

12 participants completed the program and filled self report questionnaires administered at the first (t0) and ninth (t1) session: Symptom Checklist - 90 (SCL-90) and Zarit Burden Interview (ZBI). They also answered a qualitative format investigating their subjective experience.

Results at baseline (t0) indicate high scores on the SCL-90 subscales such as Somatisation (mean = 1,21; st. dev = 0,91), Depression (mean = 1,08; st. dev = 0,86), Sleep disturbances (mean = 1,39; st. dev = 1,03).

Statistical analysis suggest an increase of SCL-90 subscales, at the end of the program (t1), such as Somatisation (mean = 1,38; st. dev = 0,85), Obsessions and compulsions (mean = 1,19; st. dev = 0,78), Depression (mean = 1,40; st. dev = 0,93), Paranoia (mean = 0,93; st. dev = 0,78), Sleep disturbances (mean = 2,18; st. dev = 1,03). ZBI questionnaire total scores indicate an increase of perceived caregiving burden(mean = 42; st. dev = 24,7). Qualitative indicators were administered at the end of the program showing a general satisfaction for the intervention described as “useful”, “important”, “helpful”, “comforting”. The most liked session was the one about “validation” skill.

Despite the perceived psychological distress and burden’ increase, participants have intended the psycho-educative program as useful and worth it. Results suggest that their learnings may be paired with complementary skills and their generalization to enable a significative reduction of psychological impact of caregiving. Future development will include a follow up session to explore this possibility.

None Declared

Currently, we see an increase in the identification and diagnosis of girls with Autism Spectrum Disorder (ASD) over the years, but where are these girls, now adult women, in the Brazilian population? There are barriers that delay and prevent early diagnosis and intervention in women with ASD, such as active attempts to camouflage or mask the signs of ASD in challenges related to social situations. It is known that people with ASD have high rates of depression, self-harm, and suicidal thoughts, which are exacerbated by difficulties in accessing treatment, professional, and family support. In this sense, obtaining the correct diagnosis and treatment for women with ASD is a challenge, as the measures developed and validated are primarily based on male samples and may not be sensitive to the female autism phenotype. With this in mind, the use of screening protocols is a tool that could minimize these impacts, improve quality of life, and drastically change the referral pathways for adult women with ASD.

To present the results of the use of the Girls Questionnaire for Autism Spectrum Condition (GQ-ASC) protocol.

The screening questionnaire, Girls Questionnaire for Autism Spectrum Condition (GQ-ASC), developed by Brown et al., 2020, was used. In this study, a freely translated version was used, as there is no cross-cultural adaptation to Brazilian Portuguese. The questionnaire was sent via an online form, where participants who accepted the Informed Consent Form had access to the GQ-ASC. The study was approved by the Research Ethics Committee under protocol 65890317.9.0000.0065. The questionnaire consists of 21 items, assessed on a 4-point Likert scale (1=Strongly Disagree, 2=Disagree, 3=Agree, 4=Strongly Agree) that evaluate specific clinical characteristics of ASD presentation in adult females across five dimensions: imagination and play, camouflage, sensory sensitivity, socialization, and interests. At the end, the scores are summed, with a total score above 56 indicating a high level of autistic traits, with 80% sensitivity in the author’s studies.

31 women with self-reported ASD diagnoses responded to the questionnaire. The average age was 24.09 years, 80.64% identified as white, 61.29% reported incomplete higher education, and 22.58% postgraduate education, 25.80% identified as bisexual, and 25.80% as heterosexual. For the GQ-ASC questionnaire, 83.87% of the participants scored above 56, with an average final score of 64.12 and a standard deviation of 7.95.

The results of the pilot study demonstrated that the final score of the GQ-ASC corroborates the self-reported diagnosis of ASD in adult women. The GQ-ASC can be considered a screening tool for this population, requiring cross-cultural adaptation to Brazilian Portuguese and validation so that more research and refinement of this tool can improve the quality of life for these women.

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Major depressive disorder (MDD) presents as episodes lasting at least two weeks, affecting mood, cognitive, and neurovegetative functions, leading to significant distress [1]. Remission is challenging, with rates of only 30-50% after 6-8 weeks of antidepressant treatment [2]. The STAR*D study shows that 30-40% of patients achieve remission with first-line treatment, and a third fail even after four trials [3]. Recurrence risk is high, reaching 90% after three or more episodes [4][5].

The study aims to identify predictive factors for recurrence in major depressive disorder patients at Arrazi Psychiatric Hospital in Salé and to assess the impact of sociodemographic, biological, psychological, socio-environmental, and treatment-related factors on recurrence risk.

This retrospective, descriptive, and analytical study will collect data from medical records of major depressive disorder patients at Arrazi Psychiatric Hospital in Salé, including sociodemographic, clinical, and therapeutic details. Standardized data extraction ensures anonymity, and factors will be analyzed through univariate, bivariate, and multivariate statistical methods (logistic regressions), with adjusted odds ratios calculated for significant factors and a p-value threshold of < 0.05 applied.

The study shows that women represent approximately 60-70% of patients, with an average age of 30-40 at the first episode and often limited social support in 50-60% of cases. About 40% present psychiatric comorbidities, and 20-30% have physical comorbidities. Nearly 50% of patients have recently experienced stressful events, and 30-40% live in precarious conditions. Therapeutic adherence is insufficient for 30-40% of cases, and 25-35% discontinued treatment prematurely. Meanwhile, those who benefited from combined therapy represent 50-60%, showing a lower recurrence risk.

The recurrence of major depressive disorder poses a major clinical challenge, impacting long-term patient management. Identifying risk factors can enhance preventive interventions and therapeutic follow-up, while an integrative approach considering sociodemographic and psychological factors may help reduce relapse rates. These findings underscore the need for further research into the mechanisms of recurrence in major depressive disorder.

None Declared

Nowadays thousands of students choose to get into medical universities in foreign countries for a plethora of reasons. Tunisia represents one of these destinations, thanks to its geographic localization, weather, biological diversity as well as its ethnical and cultural background.

To determine the effect of anxiety and psychological distress on the motivation of studies in foreign students in Tunisia.

We conducted a cross-sectional, descriptive and analytical study, carried out between July and September 2023 among foreign students at the Sfax Faculty of Medicine. Data collection was carried out using an anonymous self-questionnaire via “Google Forms shared via social media. Psychological distress was assessed using the “DASS-21” Depression, Anxiety and Stress Scale. Motivation was assessed using the French version of the “SMMS-R-FR” Study Motivational Strength Questionnaire.

Seventy-two foreign medical students completed the survey. The average age was 25 ± 3.45 years. The majority of students were male (57%). Coffee and tobacco were the most consumed substance by the students (88.9%, and 47.2% respectively). The mean score for score anxiety score was 6.59, 7.2 for depression and 7.83 for stress. The mean score for the strength of motivation was 42.4. We found a negative statistical association between the anxiety dimension and the strength of motivation (p=0.011, r= -0.29). We found no statistical association with the depressive symptoms dimension nor with the stress dimension.Smoking was correlated with anxiety and depression in our foreign students (p=0.02 and p=0.027 respectively).

Identifying psychological distress and screening for them can help prevent the deterioration of mental health of foreign students and therefore the deterioration their academic performance.

None Declared

There is a need to search for new treatment options not only for depression but also its concomitant diseases. Particularly, depression and metabolic-health abnormalities often coexist, while inflammation and microbiota imbalance, may play a part in their pathophysiological overlap. Thus, the trials of interventions on the microbiota may result in establishing a safe adjunctive treatment option.

The primary aim of this seconadry analysis was to assess the effect of probiotic formulation on inflammatory parameters in adult patients with depressive disorders. The secondary aim was to assess some possible pretreatment determinants of probiotics action towards inflammation, e.g., dietary habits, inflammatory or metabolic status, severity and dimensions of psychiatric symptoms, medications used.

The parent trial was a two-arm, 60-day, prospective, randomized, double-blind, controlled design. The probiotic formulation contained Lactobacillus helveticus Rosell®-52 and Bifidobacterium longum Rosell®-175. The change in inflammatory parameters (e.g., C-reactive protein, complete blood count-derived markers, tumor necrosis factor-alpha) after intervention alone and in the context of basal lifestyle, psychometric, metabolic, and inflammatory parameters was assessed.

Probiotics significantly decreased CRP levels compared with placebo by 21.3 % (p = .047) with nearly moderate effect size as measured with Cliff’s delta (∆ = .249). Rates of CRP-responders (a minimum 50% decrease in CRP level) were non-significantly higher in the probiotic than placebo group (18.0 % vs. 5.26 %, respectively; χ2(1) = 3.20, p = .074); but the effect size was shown to be clinically meaningful (OR = 3.95; NNT = 7.85). In two-way ANOVA with interaction analysis, probiotics anti-inflammatory action was shown to be favoured by antidepressant use, and higher basal alanine aminotransferase. But, pretreatment chronic low-grade inflammation status counteracted probiotics anti-inflammatory properties.

There were no significant differences in complete blood count-derived parameters, nor in TNF-α levels.

We have found an anti-inflammatory action of probiotics in patients with depression, as shown in the assessment of CRP levels. Additionally, probiotics were revealed to be more effective for inflammation measured by CRP levels when used by subjects with certain pretreatment features. Further studies should be performed to replicate these results.

ClinicalTrials.gov identifier: NCT04756544.

None Declared

Treatment-resistant depression (TRD) poses a significant challenge in clinical psychiatry, affecting a substantial proportion of patients who do not respond adequately to standard antidepressant therapies. Recent studies have rekindled interest in thyroid hormone therapy as a potential augmentation strategy for enhancing treatment outcomes in both unipolar and bipolar depression. Thyroid hormones, particularly levothyroxine (LT4) and triiodothyronine (LT3), have been shown to influence mood regulation through their interactions with neurotransmitter systems, thereby offering a promising avenue for improving depressive symptoms in TRD patients.

This study explores the potential of thyroid hormones, specifically levothyroxine (LT4) and triiodothyronine (LT3), to enhance treatment outcomes for patients who have not adequately responded to standard antidepressant therapies. It also synthesizes recent findings on the safety profile of thyroid hormone therapy and examines potential gender differences in treatment response.

A comprehensive review of the literature was conducted, focusing on studies published in the ten years that examined the role of thyroid hormones in TRD. Databases such as PubMed were searched for randomized controlled trials, meta-analyses, and observational studies that assessed the effects of LT3 and LT4 on depressive symptoms and treatment outcomes.

The literature review shows that adjunctive triiodothyronine (T3) significantly enhances treatment response in treatment-resistant depression. A randomized trial found that 53% of patients on T3 had a ≥50% improvement in depression scores after three weeks, compared to 19% for those on levothyroxine (LT4). While LT4 may benefit chronic cases, T3 is generally preferred for its superior efficacy. Thyroid hormone therapy also benefits bipolar depression, especially in rapid cycling patients. Functional imaging studies indicate that supraphysiologic LT4 can improve symptoms by modulating anterior limbic network activity. Some evidence suggests women may respond better than men. Overall, thyroid hormone therapy is well tolerated, with low incidences of adverse effects like tremor, anxiety, and palpitations. However, long-term efficacy remains mixed, with some studies showing no significant differences compared to placebo, and the safety of high-dose therapy is uncertain, highlighting the need for further research.

Thyroid hormone therapy, particularly LT3 and LT4, is a promising augmentation strategy for treatment-resistant unipolar and bipolar depression. While LT3 is noted for its rapid response, further research is needed to clarify its long-term safety and optimal dosing. These findings highlight the importance of considering thyroid therapy for patients who do not achieve satisfactory outcomes with conventional antidepressants.

None Declared

As a result of dissatisfaction with genital appearance, even the most intimate genital organs have become open to change, leading to the emergence of female genital cosmetic surgery (FGCS). Although there is known to be a significant increase in the number of women seeking these procedures, the psychosocial aspects and motivations of women undergoing these procedures are not fully understood. It is believed that satisfaction with genital appearance is related to body satisfaction, self-esteem and the importance placed on appearance. Many women are known to have negative perceptions regarding their genital organs.

Given the lack of research on the subject in our country and the need to better understand women’s perceptions of their own genital appearance, the primary aim of this study is to examine the validity and reliability of the Genital Appearance Satisfaction Scale in Turkish women. In this context, it is planned to conduct the Turkish adaptation of the “Genital Appearance Satisfaction Scale” in order to identify the factors contributing to the development of genital appearance dissatisfaction in women and to determine the current state of the issue.

The research is a descriptive, methodological and cross-sectional study. The population consists of women aged 18-65 and data were collected through a web-based survey. First, the scale was translated from English to Turkish and after evaluation by experts, it was back-translated. The translations were compared and presented for expert opinion. The scale was created by applying content validity. To test the clarity of the items, a pilot study was conducted and the final version of the scale was formed. The data obtained from the research were analyzed using SPSS 24 with descriptive statistics, analyses required for psychometric standardization (item correlations, factor analysis, internal consistency coefficient, etc.), comparison and correlation statistics. The construct validity of the scale was tested using confirmatory factor analysis with the AMOS program. The test-retest measurements of the scale were tested with a paired t-test and correlation analysis.

A reliability analysis was applied to the scale, and the Cronbach’s Alpha coefficient was found to be 0.83. The Cronbach’s Alpha values for the subscales were calculated as follows: 0.88 for the “Genital Appearance” subscale, 0.85 for the “Impact of Genital Satisfaction on Daily Life” subscale, and 0.85 for the “Impact of Genital Satisfaction on Sexual Life” subscale.

The fit indices calculated via confirmatory factor analysis showed that the scale is acceptably compatible with the previously identified factor structure. When the standardized coefficients were examined, it was found that the factor loadings were high, standard error values were low and t-values were significant. These results confirmed the construct validity of the previously identified factor structure.

None Declared

The phenomena of regret and detransition in individuals undergoing gender-affirming treatments raise significant medical and bioethical challenges for professionals working in this area.

This work aimed to gather the most current evidence regarding the approach to the issues of regret and detransition, characterizing the main factors involved and reflecting on possible prevention strategies.

A literature review was conducted through research on PubMed, using the keywords “gender dysphoria,” “regret,” and “detransition”. Only articles in English were included. Additional bibliography was selected by consulting the references of the initially included articles.

Regret and detransition are distinct concepts. In fact, there can be regret without detransition and detransition without regret, with the narratives and experiences of these individuals being very diverse. Detransition may be motivated by external or internal factors, depending on whether transgender identity is preserved or lost. Originally thought to be rare, it has been challenging to assess the actual prevalence of these phenomena, whose increase is expected in the future. In an effort to counter this trend, the literature emphasizes the importance of a multidisciplinary and comprehensive approach to individuals with gender dysphoria, based on effective and assertive communication, ensuring responsible and informed decision-making. Regular follow-up combined with psychosocial support throughout the entire transition process is also crucial. Therapeutic approach should be individualized and integrated into a continuing care plan, grounded in an empathetic and non-judgmental attitude.

Regret and detransition are not necessarily synonymous with medical error. Considering the complex spectrum of experiences involving these phenomena, a comprehensive approach that allows for an integrated view of each person and their needs is essential. Further research and development of guidelines regarding the approach and support for this group of individuals are needed.

None Declared

Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is a hereditary cerebrovascular disorder caused by point mutations in the NOTCH3 gene located on chromosome 19. The condition is primarily characterized by three core MRI lesions: white matter hyperintensities (WMH), lacunar infarcts, and cerebral microbleeds. Unlike age-related MRI lesions, which can be attributed to multiple factors such as aging, hypertension, and diabetes, the lesions in CADASIL are linked to a single genetic cause, offering a more uniform model for studying the impact of lesion location.

This study focuses on CADASIL patients and aims to identify factors associated with dementia while examining the relationships between total WMH volume, WMH location, lacunar infarct count, cerebral microbleeds, and cognitive performance.

A total of 81 participants were included in the study. Each participant underwent both brain MRI and the CERAD neuropsychological battery. White matter hyperintensity (WMH) volume was assessed via MRI, and the WMHs were categorized by their proximity to the ventricular surface into three types: juxtaventricular (JVWMH), periventricular (PVWMH), and deep white matter hyperintensities (DWMH). DWMH included lesions located beyond 13 mm from the ventricular surface. Additionally, MRI was used to evaluate the number of lacunar infarcts and cerebral microbleeds (CMB) present.

The prevalence of dementia among CADASIL patients was 18.5%. Logistic regression analysis revealed an odds ratio of 1.078 (95% CI = 1.011–1.150) for WMH volume. Similarly, However, the number of lacunar infarcts and CMB did not demonstrate a significant relationship with dementia risk. Linear regression analysis indicated that total WMH volume was significantly linked to performance on several cognitive tests. When WMH volume was categorized by distance from the ventricular surface, JVWMH volume and PVWMH volume werr significantly associated with performance on various cognitve tests. Conversely, DWMH volume did not demonstrate a significant association with cognitive performance in CADASIL patients. The number of lacunar infarcts was correlated with performance on the trail-making test A, the Stroop word test, and the Stroop color test, while cerebral microbleeds did not show significant associations with cognitive performance.

Core MRI-detected lesions exhibit diverse impacts on cognitive function in CADASIL patients. Total WMH volume and JVWMH volume showed a significant correlation with dementia diagnosis. However, DWMH volume did not demonstrate a significant relationship with either dementia diagnosis or specific cognitive functions. The number of lacunar infarcts was notably associated with visual search speed, while CMB were not significantly connected to dementia diagnosis or any particular cognitive functions

None Declared

Metabolic syndrome (MetS) is highly prevalent among adults and is frequently accompanied by depressive symptoms. While high-sensitivity C-reactive protein (hsCRP) has been proposed as a potential indicator of depression, existing evidence remains inconclusive.

This study aimed to determine whether increased serum hsCRP or other immune-metabolic biomarkers are associated with depressive symptoms in drug-naïve individuals with obesity and MetS.

A total of 88 drug-naïve patients with obesity and MetS but without coronary-artery disease were enrolled and serum levels of neuro-immune and metabolic biomarkers were assessed.

In MetS, the severity of depression, as assessed using the von Zerssen Depression Rating (VZDR) scale was significantly associated with interleukin (IL)-6, leukocyte numbers, triglyceride x glucose (Tyg) index, low-density lipoprotein cholesterol, Apolipoprotein B (all positively) and mean platelet volume (MPV), visfatin and adiponectin (all negatively). There were no significant associations between hsCRP and severity of depression. In MetS patients, hsCRP is strongly associated with increased leukocyte numbers, alkaline phosphatase, γ-glutamyl transferase, uric acid, platelet numbers and MPV, thereby shaping a distinct subtype of MetS, which is not related to depression.

Our findings indicate that depressive symptoms in MetS patients are associated with immune–metabolic biomarkers indicating immune activation, atherogenicity and insulin resistance, but not with hsCRP. The reason is that hsCRP in MetS is a biomarker of a specific MetS subtype that is characterized by megakaryopoiesis, hepatocyte activation, and uric acid production, which were not associated with depression.

Parkinson’s disease (PD) is the second most common neuropsychiatric disorder, affecting approximately 6.1 million people worldwide. Its incidence has increased over the last two decades, with a higher rate observed in industrialized countries, suggesting that pollution and social isolation may contribute. Some studies even identify loneliness as an independent risk factor. PD is characterized by a slow progression of disability, often lasting decades, with significant impact on both individuals and caregivers. In addition to its hallmark motor symptoms (rigidity, bradykinesia, and tremor), neuropsychiatric symptoms are now better understood, and some researchers have also identified social symptoms.

Our aim is to describe the social symptoms of PD and assess the impact of these symptoms on patients’ quality of life.

A narrative literature review was conducted through bibliographic research in the PubMed and Google Scholar databases, using the terms “Parkinson’s disease,” “social symptoms,” and “social impact.”

The so-called social symptoms arise from various changes that occur in PD, affecting both the verbal and non-verbal components of communication. “Facial masking” results from facial muscle bradykinesia, leading to a diminished ability to produce facial expressions. Research has shown that individuals with PD have a reduced capacity to modulate emotional expressions, which are crucial for eliciting empathy and facilitating social interactions. Additionally, patients demonstrate difficulties in recognizing emotions, possibly due to a dysfunctional theory of mind (Embodied Simulation Theory). Reduced prosody leads to monotonous, emotionless speech, which contributes to negative self-perception and a feeling of impaired communication abilities. Furthermore, in more advanced stages of PD, there appears to be a deficit in interpreting prosody.

These factors contribute to stigma, dehumanization, and social isolation among PD patients, with significant consequences for their quality of life, which has been demonstrated in several studies.

Social symptoms, though often overlooked, are prevalent in PD and substantially reduce patients’ quality of life. It is crucial to further investigate these symptoms and develop interventions to mitigate their impact.

None Declared

Most outbreaks associated with contaminated antiseptics and disinfectants had been attributed to user errors, as identified in our previous review in 2007. Although numerous regulations and guidelines have been established for proper use of antiseptics and disinfectants since then, such outbreaks continue to occur. To address this issue, we conducted a literature review of outbreaks and pseudo-outbreaks linked to contaminated antiseptics and disinfectants, aiming to update the outbreak characteristics and propose new prevention strategies.

We searched the published literature from 2006 to 2024 via the PubMed database.

Among 2,307 publications identified, twenty-one outbreaks and 4 pseudo-outbreaks were reviewed. Among the outbreaks, seventeen (81%) were linked to antiseptics including chlorhexidine or low-level disinfectants including quaternary ammonium compounds. A median of 12 individuals (range: 3–256) developed infections, including ventilator-associated pneumonia, skin and soft tissue infections, or catheter-related infections, resulting from direct use of contaminated mouthwashes and skin antiseptics on patients, leading to 55 fatalities. Thirteen (62%) outbreaks were attributed to intrinsically contaminated products, which led to product recall and regulatory changes. Seven (33%) were linked to extrinsically contaminated antiseptics or disinfectants, all associated with improper practices in preparation and storage. Control measures included use of sterile water for preparation, disinfection or replacement of dispensers and containers, and prohibition of using solutions prepared in the hospital laboratory.

To avoid outbreaks associated with contaminated antiseptics and disinfectants, healthcare personnel should understand the risks of contaminated antiseptics and disinfectants, and prevention strategies to avoid extrinsic contamination.

Institute of Mental Health (IMH) is the only tertiary psychiatric hospital in Singapore and does not provide acute medical care. The on-call doctors, who are Advanced Cardiac Life Support (ACLS) certified, respond to medical emergencies. Resuscitation skills are expected to decay with time when not used frequently and thus can pose an important challenge to maintain the doctors’ skills in settings with low volumes of code blue situations (Au et al. Resuscitation 2009;138:284-296). Our code blue aduits revealed significant competency gaps. IMH introduced a biannual resuscitation training program which includes a video demonstration of the optimal code blue response, hands-on session to review airway management techniques, operation of the defibrillators used in IMH, recognition and management of cardiac arrest rhythms including a pre-course ECG worksheet, familiarisation with the emergency drugs used in IMH, and a code blue drill. Due to COVID-19, the original course was shortened by removing the video demonstration and code blue drill, augmenting the home-based question paper with IMH-specific clinical vignettes.

We aimed to determine the common conditions resulting in code blue activations and whether the modified course was equivalent to the original course or ACLS in maintaining resuscitation currency and doctors’ confidence in responding to emergency scenarios.

Data was collected from June to August 2023 with consent via an electronic feedback form, to reduce non-response bias, from doctors who have responded to code blue activation in IMH. Qualitative justification on the responses were collated. Efforts were made to collect at least 25 responses from doctors with different levels of experience to minimize sampling bias. Surveys were anonymised, questions were vetted by 2 senior doctors and the survey was kept short to reduce response bias. Binary responses were tabulated for analysis and content analysis was done for feedback obtained.

Of 28 respondents, most were Psychiatry trainees (60.7%) with 1-2 years of experience working in IMH (36.7%) and more than 30 overnight duties (53.6%). The most commonly encountered emergency scenarios were hypotension (31%) and desaturation (20%). 92.9% of participants agreed that the modified course was useful for emergency scenarios faced. 53.6% of participants attended both the full and modified course, amongst whom, 60% reported that the modified course was equivalent to the full course. Only 50% felt that ACLS alone would suffice. Qualitative feedback obtained from participants reiterated that it was a context-specific and timely refresher course.

IMH doctors were satisfied with the modified resuscitation course and found it effective for frequently encountered emergency scenarios suggesting it as a valuable training adjunct in low code blue volume settings.

None Declared

Docimology is the science that assesses the quality of tests and items, based on different indices and coefficients.

The purpose of our study was to perform a docimological analysis, based on docimological indices, of the items and exams of Child psychiatry of psychiatry certificates porposed for the students of the Third Year of the Second Cycle of Medical Studies in the Faculty of Medicine of Tunis.

We carried out a retrospective and descriptive study. We have included the scores of main sessions’ psychiatry certificate exam of six academic years (2016-2017 to 2021- 2022). We did not include the scores of this certificate obtained at the control sessions during the period of our study. We carried out a global docimological analysis of the psychiatry exam, of the child psychiatry exam and its items.

We included a total of 2780 exam scripts spread over 12 main sessions. We found an annual pass rate of 96.7% in the psychiatry certificate and 85.3% in the discipline of child psychiatry. The study of the internal homogeneity of the psychiatric tests showed that the Alpha index of Cronbach varied between 0.64 and 0.82 with an average index of 0.74 which corresponds to an internal homogeneity at least acceptable. We found that the maximum scores obtained in the discipline of child psychiatry varied from 16.5 to 19.75 out of 20. The average rate of students, who passed the psychiatry certificate test without passing the discipline child psychiatry, was 11.9%. The questions were easy in 51.7% (62 questions) ans have at least good discrimination in 31.7%. We found also that 25 questions (65,7%) were “ideal”.

Child psychiatry examination in the Faculty of Medicine of Tunis meets globally the docimologic recommendations. This is the first step to build up a bank of items regularly enriched with “ideal” questions with metric qualities known in advance.

None Declared

Methadone maintenance treatment (MMT) and protracted abstinence (PA) effectively reduce the craving for heroin among individuals with heroin use disorder (HUD). However, the difference in their effects on brain function, especially the coupling among the large-scale brain networks (default mode [DMN], salience [SN], and executive control [ECN] networks), remains unclear. This study analyzed the effects of the MMT and PA on these networks and the predictive value of the bilateral resource allocation index (RAI) for craving for heroin.

Twenty-five individuals undergoing the MMT, 22 undergoing the PA, and 51 healthy controls underwent resting-state functional magnetic resonance imaging (rs-fMRI). Independent component analysis identified the ECN, DMN, and SN. The SN-ECN and SN-DMN connectivity and the bilateral RAI were evaluated. The relationships between network coupling and clinical and psychological characteristics were analyzed. The multiple linear regression model identified significant variables for predicting craving scores.

The MMT group showed significantly stronger SN-left ECN (lECN) coupling and left RAI than the PA group. In the MMT group, SN-lECN connectivity and bilateral RAI were positively correlated with the total methadone dose. In both treatment groups, SN-right ECN (rECN) connectivity and right RAI were negatively correlated with craving. The models revealed that the bilateral RAI and the MMT and PA were associated with the craving.

The MMT enhances SN-lECN coupling and the left RAI more than the PA, possibly due to higher control modulation. The RAI could help predict heroin craving in individuals with HUD undergoing either treatment program.