Gilles de la Tourette Syndrome (GTS) is characterised by tics which appear as sudden, rapid, purposeless motor movements and vocalisations. In contrast to other movement disorders, temporary and purposeful suppressibility for a few minutes at a time can be achievable. However, this is ineffective over time. Apart from the physical consequences incurred, tics and their associated neuropsychiatric symptoms can diminish individual quality of life.

To present an adult single case study of the implementation of Habit Reversal Training (HbRT) for the treatment of a motor tic and to determine the clinical efficacy of the intervention over time (i.e., post-intervention and at a one-, three- and six-month follow-up).

A twenty-six-year-old male patient with a well-established diagnosis of GTS was referred to a tertiary-care neuropsychiatry outpatient clinic. Prior to the HbRT intervention, the patient had well-tolerated a continuous tetrabenazine prescription (25mg twice a day). His tic consisted of twitching of his nostrils and sudden and repeated head nods. The tic was reported to being experienced throughout the day and almost always being preceeded by a premonitory sensation. The patient’s history was unremarkable with respect to pre, peri-, and postnatal development. There was no family history of tics nor any other movement disorders. Formal measures revealed the following: Clinical Outcomes in Routine Evaluation-Outcome Measure (11), Frost Multidimensional Perfectionism Scale (117), Autism-Spectrum Quotient (2), Adult Attention Deficit Hyperactivity Disorder Scale (1), and Yale-Brown Obsessive Compulsive Scale (15).

By the end of a five-week fifty-minute one-to-one intervention window and at a one-, three-, and six-month follow-up appointment, the following main results are reported: [i] at post-intervention, a self-reported tic improvement score (measuring effectiveness of competing response on tic management since the first appointment) of eighty percent was achieved, [ii] self-reported tic improvement scores carried over to all three follow-up appointments, and [iii] week-to-week monitoring revealed that tic management improved by fifty percent by the third week of the intervention.

This study has accomplished its objectives of offering additional support for the implementation of HbRT for the treatment of a motor tic and to establish the clinical efficacy of the intervention over time. With these objectives in mind, TD and GTS continues to provide clinicians, clinician-scientists, and researchers with an abundance of possibilities for future research. For instance, on a clinical level, it is essential to further characterize variations in motor tic phenotype so that the factors that modify tic behaviour can be clarified. It would also be fascinating to longitudinally study and explore changes in tic frequency and intensity over time following a behavioural intervention such as HbRT.

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Self-esteem, defined as an individual’s overall sense of self-worth and confidence, plays a crucial role in shaping how people interact with their environment. It has been strongly linked in the literature to both mental health and resilience. Tunisian women, known for their achievements despite numerous challenges, provide a compelling population for exploring the dynamics between self-esteem and resilience.

To assess the impact of self-esteem on resilience among Tunisian women.

This cross-sectional study surveyed Tunisian women aged 18 and above, between June and August 2024, using an online questionnaire. General health information was gathered through a structured survey. Self-esteem levels were evaluated using the Rosenberg Self-Esteem Scale, while resilience was measured with the 25-item Connor-Davidson Resilience Scale (CD-RISC 25).

Data were collected from 695 Tunisian women, with participants having a mean age of 36.72 ± 12.23 years. Of the respondents, 22.3% reported using psychoactive substances: 20.4% smoked, 9.4% consumed alcohol, and 2.5% used cannabis. Additionally, 22.2% had somatic conditions, 24.5% reported a personal psychiatric illness, 28.2% had a family psychiatric history, 39.3% had seen a psychiatrist at least once, and 15% were using psychotropic medications. The average resilience score was 68.26 ± 14.09, with 26.3% of participants displaying low resilience. The mean self-esteem score was 29.38 ± 5.64, with 55.8% of participants exhibiting low self-esteem. No significant correlation was found between resilience and substance use. However, resilience was significantly associated with personal psychiatric illness (p < 10⁻³), family psychiatric history (p < 10⁻³), psychotropic medication use (p < 10⁻³), and psychiatrist visits (p < 10⁻³). In contrast, there was no correlation between resilience and somatic conditions. A strong association was found between resilience and self-esteem: only 6.8% of participants with normal to high self-esteem exhibited low resilience, compared to 41.8% of those with low self-esteem showing low resilience.

This study demonstrates a significant relationship between self-esteem and resilience among Tunisian women, indicating that higher self-esteem is linked to greater resilience. These findings suggest that interventions aimed at enhancing self-esteem could improve resilience, particularly for women facing psychological difficulties. Future research could explore targeted strategies to boost self-esteem as a pathway to strengthen resilience and overall mental well-being in this population.

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Substance Use can be a lifelong issue. Recovery is not necessarily easy and not necessarily predictable. Treatment can be expensive and is potentially offset by other influences.

We wanted to predict the likelihood of returning to use for Indigenous clients being treated for Substance Use Disorders in the United States.

We interviewed 35 people who had been diagnosed with a Substance Use Disorder and had been treated in a conventional detox program followed by 30 to 120 days of residential treatment. The participants were obtained by word of mouth referrals, posters and flyers announcing the studiekeeeeeeWe gathered their life stories using a modification of the Northwestern University Life Story Interview which we called the Maine Life Story Interview. We correlated elements from the life story with the likelihood of return to use. By virtue of where the authors worked (Clinics providing services to Indigenous people), all the clients were Indigenous, though we did not aim for that at the outset. Logistic regression methods were used to predict return to use.

The combination of an ACE Score of 5 or greater, a history of substance use for 4 or more years, couipled with returning to the environment of the original substance abuse (physical and/or human) was associated with a 100% probability of return to use regardless of substance used and despite treatment received., With an ACE score of less than 5, the probability of return to use dropped to 80%. The length of treatment before returning to community did not matter. Adverse Childhood Events were measured using the ACE score and resiilience was assessed using a qualitative rating that has been shown to be reliable. Logistic regression confirmed the above -- that the most powerful predictors were returning to the community in which the abuse began and returning to the same social network of people who abused. These variables predicted 84% of the variance. Treatment type or duration did not emerge as significant.

For Indigenous clients, returning to the environment of substance abuse and to the people with whom substance have been used is a powerful factor that overrides the effects of treatment. The higher the ACE score, the more likely the return to use. The length of treatment (ranging from 10 to 130 days) did not seem to matter. Based upon this data, one could argue that tretment should take place in the community from which the person came and be oriented toward changing social networks and eliminating environmental cues. If this is not possible, returning to community appears frought with peril, though inevitable for Indigenous people who need to come home again. Resilience was not a predictive factor once one had returned to the social and environmental locale of the original substance use.

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Since the COVID-19 pandemic, the attention to mental health at work has increased. According to recent WHO reports, 12 billion working days are lost every year to depression and anxiety. The working conditions, particularly the organizational climate, can impact nurses’ well-being and mental health. Specifically, in Portuguese nurses, little is known about the relationship between work climate and mental health.

To characterize the nurses’ lifestyle and mental health and correlate the organizational climate to nurses’ mental health.

A cross-sectional correlational study was conducted in a Medical-surgical ward in a Portuguese acute hospital. A convenience sample was recruited, excluding the nurses with long-term sick leave. An e-survey was sent to the nurses by the head nurse via institutional emails after the approval of the Ethics Committee. The nurses were asked to fill in sociodemographic, professional, anthropometric and lifestyle inquiry, Mental Health Inventory (MHI– 5) and Work Climate Questionnaire (WCQ). Data was analyzed using SPSS 29.0.

46 Portuguese nurses participated in the study. Most women (87%), aged between 26 and 64 years, have worked for 18 years (±8.4). Most nurses consider BMI median=25.6 (±5.4), 75% exercise regularly, 93% are non-smokers, and 67% consume alcohol occasionally. Most nurses rated their sleep as poor quality. Nurses considered they have good health (43.5%) in general and evidenced reasonable mental health (MHI Mean=19.8± 3.9). Male nurses experienced higher mental well-being than females. As for the level of organizational climate, it was found that, on average, scores are close to 4 (neither agree nor disagree). There was a positive correlation between organizational climate and nurses’ mental health.

This study evidenced a neutral perception of confidence and experience of autonomy of nurses working in an acute hospital in Portugal. There is a need to deepen the knowledge of the level of autonomy experienced by nurses in their work in larger samples and different contexts. The results indicate the need to study this correlation in different settings to explore its effect and impact on nurses’ mental health and patient quality of care.

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Visual snow syndrome (VSS) is a rare condition that presents as a form continuous visual disturbance that occupies the entire visual field, described as tiny flickering dots. Although VSS might be expressed in patients with migraine as visual aura, persistent VSS has been accepted as a distinct clinical entity. Symptoms of VSS commonly emerge in late adolescence and early adulthood, but it can affect people of any age. In the literature,a few cases of childhood VSS have been reported.The peculiarity of this condition is that it remains rare and challenging to diagnose.

Here, we report an uncommon case of VSS in a Tunisian female adolescent aged 17 years, that has been misdiagnosed for years as Conversion Disorder/Functional Neurological Disorder.

A clinical history, neurological assessment and visual tests were performed, leading to the diagnosis VSS in a misdiagnosed 17-year-old Tunisian female.

A nine-year-old girl with no prior medical history started experiencing symptoms of vision of white lines in a net and abnormal image persistence throughout her entire visual field. The patient initially consulted an ophthalmologist, then a neurologist. The patient’s visual field testing, retinal imaging, and eye examination were all within the normal range. Electroencephalography, cerebrospinal fluid analysis, and brain MRI revealed nothing unusual. The psychogenic origin was initially considered, and the patient was referred to a psychiatrist. The diagnosis of functional neurological disorder was established. The patient underwent cognitive behavioral therapy with no improvement.Over the next years, the patient consulted several psychiatrists, but her visual symptoms did not improve. Gradually, her symptoms worsened, with a significant impact on her academic performance. New symptoms such as entopic phenomena appeared, with floaters, sparkling dots, and luminous flashes associated with palinopsia and photophobia. A tinnitus was also associated. At the age of 17, and given the therapeutic impasse, her treating psychiatrist concluded that she needed to be referred back to neurology and ophthalmology. She had to undergo all the complementary tests again, which once more came back without abnormalities. The neurologist retained the diagnosis of VSS. The patient was put on anti-epileptic and migraine medications, which were ineffective. Food supplements were also prescribed to reduce stress. The patient underwent psychotherapy with partial recovery. Being correctly diagnosed helped her better cope with her symptoms. Her academic results substantially improved.

Despite its rarity, VSS should be taken into consideration in any patient whose vision has been continuously pixelated. More research is required to pinpoint the actual cause of this condition. Beyond its difficult diagnosis, the pathogenesis is uncertain, which the treatment plan problematic as well.

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Multimorbidity is increasingly common among older adults in Sub-Saharan Africa (SSA), yet the role of social determinants in shaping its prevalence and outcomes remains underexplored.

This review aimed to (a) identify the prevalence, types, and patterns of multimorbidity among older adults in SSA; (b) examine the influence of social determinants such as income, education, healthcare access, and geographic location; (c) evaluate current approaches for prevention and management; and (d) propose directions for future research.

A systematic search of six databases (PubMed, EMBASE, PsycINFO, Google Scholar, CINAHL, and Global Index Medicus) was conducted to identify quantitative studies published between 2000 and 2024 on adults aged 50 and above. Of 841 records screened, 16 studies met inclusion criteria and passed quality appraisal. The review protocol was registered in PROSPERO (CRD42024607875).

Multimorbidity ranged from 5.4% in Botswana to 71% in Nigeria. Cardiometabolic conditions often co-occurred with infectious and mental disorders. Poverty and low education significantly increased risk (OR: 1.44–7.44). Rural residents faced limited healthcare access, while urban dwellers had higher risks from lifestyle factors. Obesity and food insecurity further heightened vulnerability, especially among women and older adults.

Findings indicate that social determinants critically shape multimorbidity risk and outcomes in SSA. Integrated care models, targeted interventions, and policies addressing structural inequalities are urgently needed. Future research should apply longitudinal and qualitative approaches to clarify causal pathways and inform context-sensitive strategies.

Traumatic brain injury (TBI) is a critical public health issue that often results in lasting cognitive and behavioral impairments.

These impairments include heightened risks for psychiatric disorders, such as aggression, social withdrawal, and mood instability.

Managing TBI-related behavioral symptoms can be complex, particularly in adolescent patients, where non-adherence to medication presents additional challenges.

To evaluate the effectiveness of long-acting injectable paliperidone palmitate in managing severe behavioral disturbances following TBI in an adolescent patient with a history of non-adherence to oral antipsychotic treatments.

A case study approach was employed to detail the treatment and outcomes of a 16-year-old male who developed persistent aggressive and impulsive behaviors following a severe TBI at age 9.

The patient’s treatment history involved multiple oral antipsychotic trials, each limited by adherence issues or side effects, before transitioning to paliperidone palmitate injections.

Behavioral outcomes were monitored, and family-reported assessments of improvement were collected.

Following the initiation of monthly paliperidone palmitate injections at an initial dose of 100 mg, later increased to 150 mg, the patient showed significant reductions in aggression and improved behavioral control.

Family members observed fewer aggressive outbursts and better social interactions.

Mild side effects, including weight gain and an increase in prolactin levels, were reported, but these were generally well tolerated by the patient.

This case demonstrates the potential benefits of long-acting injectable antipsychotics for managing behavioral dysregulation in TBI patients who struggle with medication adherence.

Paliperidone palmitate was effective in stabilizing the patient’s behavior, underscoring the need for tailored, multidisciplinary treatment plans that incorporate both pharmacological and psychosocial interventions to optimize long-term recovery in TBI-related neuropsychiatric care.

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Coercive practices in mental health care can infringe upon human rights, necessitating urgent global action to eliminate them. However, inconsistencies in clinical practice, fragmented research on effectiveness, and limited understanding of barriers and facilitators hinder the real-world transformation of services. As part of the COST Action FOSTREN (Fostering and Strengthening Approaches to Reducing Coercion in European Mental Health Services), Working Group 4 Implementation Science conducted a systematic review to examine the models, theories and frameworks employed by studies in implementing programs aimed at reducing coercion in mental health settings and the reported implementation outcomes. A comprehensive search was conducted across multiple databases, resulting in the inclusion of eight studies (nine papers). The identified coercion reduction programs utilized holistic approaches, risk assessment methods, staff training, and sensory modulation interventions. All of them were conducted in inpatient settings. Eight different implementation tools were identified, but none of the studies reported all sought implementation outcomes. The most frequently reported outcomes were acceptability and adaptation, while no studies provided data on implementation costs. Overall, the quality of the studies assessed was relatively low. The review highlights the underutilization of systematic implementation models, theories and frameworks when embedding coercion reduction interventions in routine mental health care, especially in emergency psychiatry settings. Further research, incorporating the perspectives of service users and carers, is needed to address this gap and determine the costs and resources required for implementing complex interventions with implementation models, theories and frameworks guidance.

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Impulsivity implies difficulties in control, leading to non-premeditated actions, and troubles resisting distraction and remaining focused on a goal. It is a transdiagnostic construct that is associated with several disorders, including Attentional Deficit and Hyperactivity Disorder (ADHD), Borderline Personality Disorder and Obsessive-Compulsive Disorder (OCD). It is possible to divide impulsivity between impulsive actions, associated with the ability to inhibit actions, and choice impulsivity, that involves decision-making. It is also common to differentiate between trait impulsivity, that involves more stable characteristics, and state impulsivity, in which the impulsive behavior is more transient.

To investigate the association between action impulsivity as a trait (using self-report measures) and as state (using different level of analysis in a computerized task, i.e., behavioral and neuroimaging measures).

52 university students (mean age = 21.4; standard deviation = 3.33) filled the BIS-11 self-report questionnaires and completed a Stroop-matching/stop-signal task while they had their behavioral and hemodynamic brain activity collected using Functional Near- Infrared Spectroscopy (fNIRS). The Stroop-matching/stop-signal task had three conditions varying the inhibitory demands: Congruent/Unrelated; Incongruent/Unrelated and Incongruent/Related. Spearman correlations were performed between scores of the BIS-11 subscales (Attentional, Motor and Non-planning impulsivity) and the reaction time (RT) and hemodynamic responses (β) of the Stroop-matching/stop-signal task. Alpha level = 0.05.

RTs in all conditions of the task were positively correlated with Motor Impulsivity scores (Congruent/Unrelated, rho = .31, p = .025; Incongruent/Unrelated, rho = .27, p = .049; Incongruent/Related, rho = .38, p = .005). Brain activity in the left temporoparietal region was positively correlated with Attention Impulsivity scores (rho = .29, p = .033).

Motor and attentional aspects of trait impulsivity can be differently correlated with behavioral and neurophysiological measures of state impulsivity. In this study, motor impulsivity was correlated with more peripherical measures of inhibition (reaction times) while attentional impulsivity was correlated with activity in temporoparietal regions commonly associated with inhibition of distractive stimuli. Greater levels of motor and attentional impulsivity were associated with slower responses and greater brain activity, respectively.

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Gender significantly impacts the diagnosis and treatment of mental disorders. This case shows how being a woman, alongside trauma and violence exposure, shaped a patient’s diagnoses over time, affecting recovery, and culminating in a late-stage lung cancer diagnosis.

Analyze how experiences of violence, trauma, and social stigmatization shaped the diagnostic path of a female patient with schizophrenia, multiple hospitalizations, and a fatal outcome, with delayed lung cancer diagnosis despite recurrent emergency visits for respiratory issues.

We reviewed the clinical course of a 55-year-old woman with schizophrenia. She was admitted to a psychiatric care unit from November 2000 until 2017. In her final years, she was treated for respiratory issues that eventually led to a diagnosis of lung cancer with vertebral metastasis. The late diagnosis underscores the impact of her psychiatric history on care quality.

Violence and Trauma:

• - The patient experienced early-life violence: parental abandonment, her mother’s suicide, and her own suicide attempts.

• - In later years, she faced recurrent respiratory issues overlooked due to her psychiatric background.

Gender Conditioning:

• - Perceived as “emotional” and “exaggerating,” physical symptoms were minimized, delaying the advanced lung cancer diagnosis.

• - Respiratory difficulties were dismissed as secondary to mental health, resulting in a delayed cancer diagnosis.

• - Lack of social support and healthcare barriers led to the progressive decline in her physical and mental health.

• - Lung cancer with vertebral metastasis was diagnosed after multiple admissions, highlighting how her psychiatric condition delayed the oncological diagnosis.

• - After 17 years in a psychiatric facility for schizophrenia, she developed respiratory symptoms that were inadequately explored, leading to a delayed lung cancer diagnosis, followed by her passing after palliative care.

This case highlights the need to consider gender-based biases in diagnosing women with mental health conditions. Her psychiatric history and gender contributed to the downplaying of her symptoms, delaying the crucial lung cancer diagnosis. Gender and mental health stigma can cause serious healthcare delays. A gender-sensitive approach is essential to ensure timely, thorough medical evaluations for women. Integrated mental and physical health care can prevent delays in diagnosis and improve outcomes for women with psychiatric disorders.

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First-episode psychosis (FEP) provides a crucial opportunity to investigate these biological markers before the influence of long-term treatment or disease progression. Both bipolar disorders with psychotic features and schizophrenia spectrum disorders are linked to systemic inflammation, and examining blood cell counts and inflammatory ratios may provide insights into the biological foundations of these conditions.

This study aims to compare key hematological parameters and inflammation markers (neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR)) between untreated first-episode psychosis patients diagnosed with psychotic mania, schizophrenia spectrum disorders, and healthy controls, examining potential differences between these groups.

55 patients (F:28, M:27) diagnosed with schizophrenia spectrum disorder, 68 patients (F:38, M:30) diagnosed with bipolar disorder, all without a history of treatment, who were admitted to psychiatric clinics due to a first-episode psychosis, and 61 healthy volunteer individuals (F:24, M:37) matched for age and gender were included in the study. Hemogram data were obtained from medical records, and the hemograms taken within the first 48 hours of the patients’ admissions were used in the study.

The white blood cell, neutrophil, and monocyte counts were significantly higher in both patient groups than healthy individuals. The eosinophil count varied between the groups, with patients diagnosed with schizophrenia spectrum disorder having significantly lower counts compared to healthy individuals (p=0.003). When the analysis was conducted by gender, white blood cell, neutrophil, and monocyte counts were found to differ in women from both patient groups compared to healthy individuals, while in men, only the eosinophil count was lower in patients diagnosed with schizophrenia spectrum disorder (p=0.023). There were no significant differences in the NLR and PLR between the groups. The MLR value showed no difference between male patients and healthy individuals, but it varied between the groups in women, with patients diagnosed with psychotic mania having higher MLR compared to the other groups (p=0.01).

Changes observed in specific hematological parameters in both bipolar disorder and schizophrenia spectrum patients may contribute to understanding the pathophysiology of these disorders. However, given the heterogeneity in the presentation and etiology of these conditions, larger-scale and prospective studies are needed to determine the roles of these parameters in their pathophysiology. It may also be necessary to consider gender-based differences when assessing the potential roles of these hemogram parameters in the pathophysiology of the diseases.

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Obsessive-compulsive symptoms (OCS) are a prevalent and under-recognized complication of clozapine treatment in schizophrenia, with significant implications for clinical practice and patient outcomes. This synthesis of four longitudinal studies explores the interplay between psychosis, clozapine dose, and OCS, emphasizing their phenomenology, prevalence, and impact.

OCS, particularly checking compulsions, affect up to 47% of clozapine-treated patients, with risk factors including psychosis severity, duration of clozapine therapy, and antiserotonergic properties of the drug. A two-phase model of OCS development is proposed: during active psychosis, compulsions emerge as goal-directed responses to hypervigilance, while post-remission, they persist as maladaptive habits mediated by clozapine’s serotonergic effects. While clozapine improves psychotic symptoms, its dose and plasma levels are positively correlated with OCS persistence after psychosis remission, suggesting a dose-dependent effect.

Notably, OCS significantly reduce subjective well-being independently of depressive and psychotic symptoms but do not impair general functioning, highlighting the ego-syntonic nature of compulsions. Screening for and addressing OCS in clinical practice is critical for optimizing therapeutic outcomes.

This integrated perspective advances our understanding of the nuanced relationship between schizophrenia, clozapine treatment, and OCS, with implications for personalized treatment strategies.

E. Fernández-Egea Grant / Research support from: Dr Fernandez-Egea is supported by the 2022 MRC/NIHR CARP award (MR/W029987/1) and this research was supported by the NIHR Cambridge Biomedical Research Centre (BRC-1215-20014). The views expressed are those of the author(s) and not necessarily of the NIHR or the Department of Health and Social Care. , Consultant of: EFE has received consultancy honoraria from Boehringer-Ingelheim (2022), Atheneum (2022) and Rovi (2022-24), speaker fees by Adamed (2022-24), Otsuka (2023) and Viatris (2024) and training and research material from Merz (2020) and editorial honoraria from Spanish Society of Psychiatry and Mental Health (2023-).

Adolescence is a critical period of physical, cognitive and emotional development. Mental health among adolescents is a major public health issue. The number of teenagers requiring psychiatric care is constantly increasing and several studies have found high prevalences of psychiatric disorders in this group.

The aim of the study was to describe sociodemographic and clinical characteristics of adolescents hospitalized in an adult psychiatric department.

We carried out a retrospective descriptive study. It included adolescent patients, aged between 16 and 19 years, who were admitted to the department G of Razi Hospital (Tunisia), between May 2019 and May 2024 (the minimum age for hospitalization in adult psychiatric wards was 16). Data were collected from patients’ files.

Thirty-five adolescents were included. The mean age was 17.8 ± 0.8 years. A male predominance was noted with 65.7% of patients. We found that 57.1% of teenagers were using at least one psychoactive substance. Tobacco was the most used substance (54.3%), followed by cannabis (42.9%) and alcohol (40%). The most common motive for hospitalization was behavioral disturbances with 79.1% of patients. The most common psychiatric disorders were schizophrenia (32.6%) and schizophreniform disorder (18.6%). Antipsychotics were the most prescribed medication (58.13%) followed by benzodiazepines (30%).

Knowing the profile of adolescents hospitalized in psychiatry, their sociodemographic and clinical characteristics would enable us to better the care we offer to them.

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Some acts of murder are committed out of insanity by individuals suffering from psychotic mental disorders. According to the law in many countries, these individuals do not have criminal responsibility. They are defined as not guilty due to insanity and therefore cannot be punished.

This study aims to explore the sociodemographic, psychiatric, criminal and forensic characteristics/factors of insanity murders and murderers. This examination has not yet been conducted in Israel, which is a multicultural country with social, religious, ethnic complexity.

This study examined the hospital records (investigation material, indictments, admission summaries, and expert testimonies) of all 80 inpatients who had committed murder and been hospitalized in the maximum security unit from its opening in 1997 until 2021, and were found not guilty due to insanity.

Demographics characteristics (at the time of the offense). The participants were men ages 18-85 (M=36.11, SD=11.84). 58.8% were born in Israel, 21.3% immigrated from the former Soviet Union, 6.3% from Ethiopia, and 13.8% from other countries. The majority (82.5%) were Jewish, 16.4% were Arab. Most lived in urban centers (86.3%). Most were not married at the time of the offense: Single (62.5%), divorced (21.3%). Only a minority was married (16%).

Psychiatric characteristics. Most participants were diagnosed with schizophrenia (90%); had at least one hospitalization prior to the offense (70%), and had a previous hospitalization due to violence. Most of them were not compliant with psychiatric treatment and follow-up (only one participant was fully compliant). In most cases (74%) pre-murder deterioration was recorded.

Criminal characteristics. At least 52.5% had a criminal record prior to committing the offense (a higher number is possible, the information is based on the medical file only, there was no access to an official criminal record).

Murder/forensic characteristics. At least 48.8% there was no prior planning. In most cases (66.6%) the motive described was paranoid delusions and only in 5% there is command hallucinations. In most cases the murders took place in the home of the victim and/or the assailant (67.5%), one person was murdered (91%) and the victim was known to the assailant (88.8%), most of them a family member (61.3%). In at least 75% of the cases there was a brutal murder with multiple stabbings, use of multiple means/actions, abuse of the body or dismemberment. Following the murder, 58.3% of the assailants remained at the site of the crime and/or called for help, 27.4% left the site (no information for the remaining subjects).

The findings are consistent with existing knowledge and may assist in identifying at-risk populations, develop and implement relevant prevention programs as well as improving the therapeutic continuum from hospitalization to the community.

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Attention-Deficit/Hyperactivity Disorder (ADHD) is characterized by deficits in attention, impulsivity, and hyperactivity, but some cognitive phenomena within ADHD remain under-researched. One such phenomenon is hyperfocus, referring to prolonged, intense concentration on tasks of high interest. While inattentiveness is a hallmark of ADHD, hyperfocus presents a paradox where individuals become deeply absorbed in activities, often neglecting other necessary responsibilities. This focus can lead to productive work but also negative outcomes like missed deadlines or personal neglect.

This study investigates the prevalence of hyperfocus in adults with ADHD, explores its relationship to core symptoms, and examines its impact on functional outcomes, including academic performance, employment, and relationships. It also seeks to understand individuals’ perceptions of hyperfocus’s benefits and drawbacks.

A mixed-methods approach was used to capture both quantitative and qualitative data. A total of 50 adults diagnosed with ADHD, aged between 18 and 45, were recruited. Participants completed the ADHD-Focused Attention Questionnaire (AFAQ), designed to measure the frequency, intensity, and duration of hyperfocus episodes. Additionally, the participants were asked to complete a structured life events questionnaire, assessing the impact of hyperfocus on various functional domains, including academic performance, employment, and personal relationships.

The study found that 68% of participants reported frequent hyperfocus, with episodes lasting from several hours to days. The most common triggers were work-related tasks (35%), creative activities (25%) and gaming (20%),. While hyperfocus during gaming and creative tasks brought personal satisfaction, it often resulted in neglected responsibilities (40%). Hyperfocus at work increased productivity for 30% of participants, particularly in flexible or creative roles. There was also a strong correlation between hyperfocus and productivity, especially in flexible environments. However, hyperfocus also correlated with missed deadlines and neglected self-care, especially in less structured routines. Interviewees highlighted hyperfocus as a double-edged sword: it provided intense concentration but left many feeling “trapped,” struggling to shift attention. Regarding relationships, 55% of participants said hyperfocus negatively impacted their social lives, with partners feeling neglected. However, 15% found that hyperfocus occasionally enhanced shared activities.

Hyperfocus in ADHD boosts productivity but can disrupt routines and relationships. Its unpredictability complicates balancing responsibilities. Recognizing hyperfocus as a core feature in ADHD could lead to better management strategies, such as time management training, external reminders, and structured breaks.

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Many grieving individuals report sensory and phenomenological experiences involving deceased loved ones, such as visual, auditory, or sensed presences. These experiences are common across cultures, with 40-70% of bereaved spouses reporting them. They can provide comfort or cause distress, and can last from brief moments to several years. Despite their prevalence, there is limited empirical research on these occurrences, leaving mental health professionals often unprepared to address them.

This study aims to explore the phenomenology of sensory experiences with the deceased, the factors associated with these experiences, and their impact on grieving individuals.

A bibliographic review was conducted using PubMed, using terms like “Bereavement,” “Hallucinations,” “Phenomenology,” and “Sensory Experiences.”

The review indicates that sensory experiences involving deceased loved ones should not automatically be viewed as pathological. Rather, these experiences may function as adaptive responses that help maintain emotional bonds with the deceased, facilitating the grieving process. Research highlights that “sensing a presence” is the most frequently reported phenomenon, followed by visual and auditory encounters. Key factors influencing these experiences include sensory deficits, cognitive difficulties and poor sleep.These phenomena are particularly common among older adults, with women more likely than men to report them. Strong emotional ties, marital satisfaction, and having children with the deceased correlate positively with these sensory experiences. High levels of avoidant coping are significant predictors of experiencing these phenomena, while a more detached coping style appears to help in accepting the finality of the loss. Studies suggest that those who have these experiences often report greater levels of prolonged grief, PTSD, depression, and feelings of emotional loneliness compared to those who do not. However, these experiences do not necessarily result in better or worse clinical outcomes. Mental health professionals must create a supportive environment where individuals can discuss these experiences without fear of judgment or being labeled as mentally ill. Understanding these phenomena as psychologically meaningful and significant to the bereaved can promote healing.

This review emphasizes the need for a nuanced understanding of sensory experiences involving the deceased, moving beyond simplistic interpretations as signs of mental illness. Instead, these experiences should be seen as contextually meaningful and part of the bereaved’s relationship with the deceased. For those distressed by these experiences, therapeutic interventions could focus on reshaping their relationship with the deceased or modifying their responses.

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Attention-Deficit/Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder characterized by symptoms of inattention, hyperactivity, and impulsivity. Recent research highlights a significant comorbidity between ADHD and pain, suggesting that individuals with ADHD may experience altered pain perception and a higher prevalence of pain conditions.

This review aims to explore the possible link between pain and ADHD, specifically examining the relationship between ADHD and pain perception, the effects of methylphenidate (MPH) on pain thresholds, and the potential underlying mechanism connecting these two conditions.

A non-systematic review of the literature was conducted, focusing on key studies published in the last 15 years. The search terms included “pain,” “ADHD,” and “methylphenidate.”

Based on this review, several key findings emerged:

• • Dopamine’s Role in Pain: Accumulating data suggest that dopamine is implicated in pain processing. Many regions of the CNS involved in pain processing have high dopamine receptor density, whose activation can be analgesic.

• • Increased Prevalence of Chronic Pain: Individuals with ADHD show a higher prevalence of chronic pain conditions, indicating a significant comorbidity between ADHD and pain.

• • Altered Pain Perception: Individuals with ADHD are more likely to exhibit lower pain thresholds and increased pain sensitivity, particularly in untreated individuals.

• • Impact of Methylphenidate: Methylphenidate, a common treatment for ADHD, partially reverses altered pain responses, suggesting its potential role in normalizing pain perception through dopaminergic modulation.

• • Neuroinflammation as a Link: Neuroinflammation has been suggested as a potential factor linking ADHD and pain, particularly through dopaminergic dysregulation.

This review underscores the need for increased awareness of the pain-ADHD comorbidity. Understanding altered pain perception in ADHD is crucial for improving patient care and developing targeted treatments. While current evidence suggests treatments like methylphenidate may help modulate pain sensitivity, further research is essential to clarify the mechanisms and establish guidelines for managing pain in ADHD patients.

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Women are diagnosed with depression twice as often as men. Although depression is more common in women, men have higher suicide rates. Instead of seeking help, men tend to use various coping mechanisms that can be considered dysfunctional. These behaviors include risk-taking behaviors, aggressive behaviors, and alcohol and substance use. In addition, men’s failure to seek mental health services may be related to their beliefs about gender and masculinity. That symptom cluster is called a male depressive syndrome and can be seen in both sexes.

The present study aimed to measure depression with a widely used scale and a gender-sensitive scale among men with addiction disorders. Additionally, the study aimed to evaluate relations between addiction severity, depression and masculinity.

Fifty-one male patients with alcohol and substance addiction participated in the present study. BAPİRT-alcohol and BAPİRT-drug questionnaires, Beck Depression Scale, Gender Sensitive Depression Scale, and Precarious Manhood Beliefs.

The mean age of the patients was 40.56 ± 12.35, and most were single (64.7%). Regarding the cut-off scores of BAPİRT scales, 45.9% of patients screened as high risk for substance addiction, and 86.27% screened as high risk for alcohol addiction. Depression scores were evaluated using the cut-off values. Both the Beck Depression Scale and the Gender Sensitive Depression Scale determined a depression prevalence of 60.8%, with diverse participants. Table 1 shows the intersection of the depression screening with the two scales.

Male patients with addiction showed a high prevalence of depression (%60.8). Gender-sensitive depression was related to substance addiction severity.

Male patients with addiction may experience depression with a specific symptom cluster, which includes irritability.

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Many patients with mental health and emotional problems often see the transition period in the community after hospital discharge as a test of their resilience and a threat to their recovery. Most often, some doubt their ability to cope with the everyday challenges that may confront them in the community.

This paper assesses how demographic and clinical characteristics predicted resilience, personal recovery and quality of life.

Data were collected from psychiatric inpatients prior to their discharge into the community using the REDCap, an online survey platform. Resilience, personal recovery, and quality of life were assessed using the Brief Resilience Scale (BRS), Recovery Assessment Scale (RAS), and EQ-Visual Analogue Scale (EQ-VAS), respectively. One-way analysis of covariance between groups (ANCOVA) was conducted to compare the relationships between groups. The dependent variables comprised mean scores of BRS, RAS and EQ-VAS. Demographic and clinical variables such as age, gender, ethnicity, and mental health diagnosis groups were independent variables, and covariates comprised demographic/clinical factors such as gender, ethnicity, and mental health diagnosis

The survey results indicate that males had significantly higher resilience scores compared to females ( Mdiff = 0.270, CI= 0.144– 0.397, p=.<.001) and others (Mdiff =0.470, 0.093- 0.846, p=<.001); Black people indicated significantly higher quality of life than Caucasians (Mdiff = 8.79, 2.73- 14.85, P= <.001), and Indigenous people (Mdiff = 14.50, 6.45 - 22.51, p=<.001), respectively. In terms of relative recovery, participants with depression had significantly lower recovery compared to those with bipolar disorder (Mdiff = -10.25, -14.40- -6.10, p=<.001), schizophrenia (Mdiff f = -8.60, -13.20- -3.99, p=<.001), and substance use disorder (Mdiff = -8.30, -15.50- -1.42, p=<.005).

The present results indicate that women, younger adults, and Indigenous peoples may be more challenged in adapting to the challenges of post-discharge life in the community. Our data may be helpful in communicating to policymakers and providers of funds the need to implement and evaluate outcomes of inpatient and community programs focusing on supporting resilience to improve recovery outcomes after discharge from the patient setting.

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Digital self-harm refers to the use of information and communication technologies (ICTs) to post or share self-deprecating or harmful content. This often occurs on forums or social networks, where the use of verbal and non-verbal codes (hashtags, emojis) complicates external monitoring. The rise in ICT usage and self-destructive behaviors online has raised concerns among mental health and education professionals, as these actions are linked to conditions such as depression, anxiety, and traditional physical self-harm in young populations.

To explore the phenomenon of digital self-harm and its effects on adolescents.

To examine the role of AI tools in addressing this issue through a clinical case.

A brief literature review on digital self-harm.

Analysis of a clinical case: A 15-year-old female with a history of multiple hospitalizations due to suicidal risk and self-harming behaviors. Under treatment with Venlafaxine and Aripiprazole, she is diagnosed with “emotion dysregulation disorder of adolescence” and “mixed adaptive disorder.” Her social interactions are mostly limited to online networks. She describes her self-harm as “addictive,” used not only as an anxiolytic but as a way to achieve “social positioning,” posting about it in forums and comparing herself with others. When she reported her self-harm impulse to an AI (artificial intelligence) chatbot for suicide prevention, emergency services were activated, leading to her hospital admission.

International studies indicate that between 6% and 9% of adolescents have engaged in digital self-harm behaviors. In Spain, reports from the ANAR Foundation and UNICEF have shown an increase in this phenomenon since the Covid-19 pandemic. These “online support communities” can foster dynamics of rivalry and become harmful, as they not only share images but also techniques to avoid detection or hospitalization. In the presented case, the patient’s initial isolation led her to use ICTs as a way to seek social affirmation and a sense of belonging. Upon encountering specific forums, self-harm, which initially served an anxiolytic function, evolved into a mechanism for achieving social relevance. On the other hand, the AI chatbot for suicide prevention facilitated early intervention in her case.

While the internet can provide social support for isolated adolescents, it also has the potential to normalize and even reinforce self-harming behaviors among vulnerable populations. Therefore, it is crucial to further investigate the psychosocial factors involved in digital self-harm and to develop new tools for mental health professionals. Additionally, AI could serve as an entry point and tool for younger generations, offering potential for both prevention and therapeutic intervention.

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