Patients with schizophrenia often require civil capacity assessments when participating in civil activities. The primary focus of the assessment involves evaluating patients’ understanding of the issues at hand, their awareness of potential choices and the corresponding outcomes, and their ability to make decisions after considering the advantages and disadvantages. As such, the ability to make decisions is the fundamental neuropsychological mechanism underlying civil activities.

This study systematically reviewed existing research on decision-making ability in patients with schizophrenia.

Both major international and Chinese databases were systematically searched. Relevant studies were summarized in aspects of the assessment, neuropsychological mechanisms, and neurobiological mechanisms of decision-making ability in patients with schizophrenia.

1. 1. The most frequently employed experimental paradigms in studies focusing on economic decision-making include the Iowa Gambling Task (IGT) and the Game of Dice Task (GDT). Patients with schizophrenia performed significantly worse on the IGT compared to healthy individuals, often overestimating immediate gains and losses while failing to learn from the frequency of wins. There are relatively few studies utilizing the GDT, and the findings are inconsistent across studies.

2. 2. Cognitive domains related to the decision-making ability in patients with schizophrenia could be executive function, verbal memory, and working memory. Psychiatric symptoms related to the decision-making ability include diminished motivation, lack of interest, depressive symptoms, and negative symptoms. Moreover, emotion plays a critical role in decision-making behaviors. Decision-making ability can also be influenced by medication and the overall severity of the illness; however, some studies found no association between decision-making ability and psychiatric symptoms, the illness stage, or medication usage.

3. 3. Imaging studies consistently indicate that the prefrontal cortex is a critical brain region associated with decision-making abilities. Brain areas such as the orbitofrontal and ventromedial prefrontal cortex, amygdala, frontoparietal cortex, medial prefrontal cortex, dorsomedial prefrontal cortex, bilateral thalamus, and the left dorsal anterior cingulate cortex may play a role in decision-making processes in patients with schizophrenia. Nonetheless, some research found no association between decision-making ability and the functioning of the dorsomedial prefrontal cortex.

Deeply exploring the neuropsychological and neurophysiological mechanisms behind decision-making ability can help the understanding of the decision-making behavior of patients with schizophrenia in civil activities and can benefit forensic evaluation of civil capacity.

None Declared

While clincial practice guidelines are an effective means of improving healthcare, they are not always adequately implemented. A recent study of the German S3 guideline for schizophrenia (version 2019) revealed low rates of adherence among medical professionals (Khorikian-Ghazari et al. Eur Arch Psychiatry Clin Neurosci 2023, 1-12). The factors impeding adherence are numerous and encompass individual, contextual, and guideline-related elements. The present study (Halms et al. 2024 BMC Medicine 2024, 22(1) 311) examines the efficacy of a digital guideline version in comparison to print/PDF formats with respect to guideline knowledge.

The primary aim of this study was to assess whether healthcare professionals using a digital version of the schizophrenia guideline achieved greater knowledge gains than those using traditional print or PDF formats. Secondary objectives included examining the usability of the formats, shared decision-making capabilities, and confidence in clinical decision-making.

A multicenter, cluster-randomized study was conducted in psychiatric hospitals in South Bavaria, Germany. Medical and psychological staff were divided into two groups: Implementation of the guideline via the digital MAGICapp platform or the conventional print/PDF version. The study comprised a baseline assessment (T0) and a post-intervention assessment (T1) after a six-month implementation phase. The primary outcome measure was guideline knowledge, measured by knowledge questions about the contents of the German S3 guideline for schizophrenia.

A total of 217 subjects participated at the initial assessment (T0), while 120 subjects completed the follow-up assessment (T1). Both groups demonstrated notable gains in knowledge, yet no significant differences were observed between the two groups. At T0, 43.6% of the control group and 52.5% of the intervention group met the specified criterion. With regard to the primary outcome (≥ 30 of 46 knowledge questions and all five cardinal questions answered correctly), no significant difference was found at either T0 or T1 (T0: Chi²(1) = 1.65, p = 0.199, T1: Chi²(1) = 0.34, p = 0.561). Following the intervention, 58.2% of the control group and 63.5% of the intervention group met the primary outcome.

Overall, a significant improvement in guideline knowledge was demonstrated throughout the implementation process. The digital guideline version did not demonstrate superiority in knowledge gain, but it did show potential advantages in shared decision-making. The results may have been influenced by familiarity with conventional formats and barriers to implementing digital applications. The study highlights the importance of needs-based, structured implementation strategies, particularly for younger practitioners with less professional experience.

T. Halms: None Declared, G. Gaigl: None Declared, C. Lorenz: None Declared, D. Güler: None Declared, N. Khorikian-Ghazari: None Declared, A. Röh: None Declared, S. Leucht Consultant of: S.L. has received honoraria for advising/consulting and/or for lectures and/or for educational material from Angelini, Boehringer Ingelheim, Eisai, Ekademia, GedeonRichter, Janssen, Karuna, Kynexis, Lundbeck, Medichem, Medscape, Mitsubishi, Neurotorium, Otsuka, NovoNordisk, Recordati, Rovi, Teva., A. Hasan Grant / Research support from: This research project is part of the G-BA (Gemeinsamer Bundesausschuss) funded project SISYPHOS—Strukturierte Implementierung digitaler, systematisch aktualisierter Leitlinienempfehlungen zur optimierten Therapeutenadhärenz bei Schizophrenie, funding reference number 01VSF20024. Work on the manuscript was also supported by the German Center of Mental Health (grant number: 01EE2303C)., Consultant of: A.H. was a member of advisory boards and received paid speakership by Boehringer-Ingelheim, Lundbeck, Otsuka, Rovi, and Recordati. He received paid speakership by AbbVie and Advanz. He is editor of the AWMF German guidelines for schizophrenia.

In the last decades, research has focused on investigating cognition and psychopathological symptoms as variables contributing to functional outcomes. However, in recent years the study of motivation has attracted interest as a research target related to functional outcome (Miley et al Psychol Med. 2023;53(5):2041-2049).

We aimed to study the relationship of clinical symptoms, motivation, socio-affective capacity and cognition with functioning in social and occupational areas in patients with a psychotic disorder.

A sample of 97 patients with a DSM-5 psychotic disorder diagnosis was included. Assessments included the Specific Levels of Functioning Scale (SLOF; Schneider et al. Soc Work Res Abstr 1983;19(3):9-21) to assess functioning; the Comprehensive Assessment of Symptoms and History (CASH; Andreasen et al. Arch Gen Psychiatry 1992; 49(8):615-23) for clinical symptoms; and the Cognitive Assessment Interview (CAI-Sp; Ventura et al. Schizophr Res 2010; 121(1-3): 24-31) and a comprehensive neuropsychological battery to assess cognition. Motivation and socio-affective capacity were assessed by means of the Quality of Life Scale (QLS; Heinrichs et al. Schizophr Bull. 1984; 10(3):388-98). Both domains were derived from items of the Intrapsychic Foundations subscale of the QLS. Motivation was derived from items 13, (sense of purpose), 14 (degree of motivation) and 15 (curiosity). Socio-affective capacity comprised items 20 (capacity for empathy) and 21 (capacity for engagement and emotional with the interviewer).

Spearman correlations were calculated. Variables which correlated significantly (p<0.05) with SLOF scores were included in the regression analyses.

All the clinical, cognitive and related with motivation and socio-affective capacity variables included in the analyses were significantly correlated with SLOF scores (Table 1), except for positive symptoms with SLOF activities and work. However, in the hierarchical analyses most of the variables were not significant. Specifically, regarding SLOF social scores, positive symptoms and motivation explained 51.5% of the variance. Motivation also explained 40.1% and 68% of the variance of the scores of SLOF activities and work, respectively (Table 2).

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Motivation has a great value as a predictor factor in social, activities and work functioning. Therefore, motivation should be considered as a target related to improving functioning in early intervention programmes for psychotic disorders.

None Declared

Many individuals with long-term use benzodiazepines and benzodiazepine-like hypnotics, commonly prescribed for the short-term management of anxiety or sleeping problems, develop addiction. It is therefore important to better understand what motivates individuals with addiction to quit. Few prior qualitative studies have explored patients’ perceptions and experiences of addiction to benzodiazepines in the context of motivation to seek treatment.

This study explored how individuals perceive addiction to benzodiazepines and aimed to describe the experiences that motivated them to seek treatment.

This exploratory qualitative study was conducted among nineteen adults (≥18 years) diagnosed with sedative, hypnotic, or anxiolytic use disorder. Participants were purposively recruited from a publicly funded outpatient addiction clinic in Sweden and were undergoing tapering treatment at the time of their in-depth interviews. The interviews, which followed a semi-structured guide, were completed between April 2021 and February 2023. Transcripts were analyzed using reflexive thematic analysis by a multidisciplinary team. All participants provided written informed consent and the study was approved by the Swedish Ethical Review Authority (Dnr. 2019-05302).

Participants described perceptions of addiction and motivation to quit in terms of the growing harms they experienced from continued use of benzodiazepines. We identified three themes that reflect the nonlinear process and multifaceted consequences which to a “tipping point” where individuals made the decision to seek treatment. Theme one described how benzodiazepine use required increasing mental energy and time, and how participants felt their freedom was restricted by the need to “hunt” for medication. In theme two, participants described facing a crossroads regarding their benzodiazepine use as the effectiveness decreased. Some participants defined addiction in relation to the negative cycle of dose escalation and withdrawal symptoms they experienced, which also motivated them to seek treatment. Theme three discusses the ways that benzodiazepines negatively impacted different psychosocial and practical aspects of daily life, including conflicts related to changes in personality and negative impacts on relationships, which resulted in further areas of motivation.

The results suggest that individuals with addiction to benzodiazepines reach the decision to seek treatment both through processes of change over time and through individual factors that act as a tipping point. These motivational factors are of clinical importance in the decision to seek treatment and should be identified by healthcare providers and cultivated in individuals with addiction to benzodiazepines.

None Declared

More than 150,000 adults with mental disabilities live in social shelters in Russia and almost 50% of them do not use speech for communication and can’t communicate at all. Social institutions lack a system for training those in need of Augmentative and alternative communication (AAC).

Development and testing of an algorithm for selecting AAC method for adults with mental disorders and severe speech communication disorders.

A questionnaire for people with mental disabilities who do not use speech for communication was developed and tested. It included questions accompanied by illustrations, photographs and graphic symbols. A survey was conducted among 50 people of both sexes, aged 17-58 living in social welfare institutions. 56% of them had a diagnosis of intellectual disability, 18% - Autism, 26% - Schizophrenia. An algorithm for preparing and including respondents in the study was developed, consisting of several components (Establishing primary contact, Determining the preferred means of communication, Determining the ability to understand and use oral speech, Determining the ability to understand and use gestures, images and symbols, written speech).

92% of people completed the full study. 4 respondents withdrew from the experiment due to their mental state (psychosis, passivity, profound intellectual disability, fatigue). Despite successfully completing the preparatory stage, 74% managed to obtain full results.

The study made it possible to identify potential opportunities for using communication tools, analyze barriers in communication with others, and develop personal recommendations for using AAC, which will undoubtedly improve the quality of life of a person with mental disabilities.

None Declared

Depression is a significant global health issue among children and adolescents. It has been identified as a leading cause of disability among this population worldwide.

This study compares the characteristics and related factors of depressive disorders among child and adolescent patients in Thailand between 2014 and 2022, with the aim of enhancing treatment and screening strategies.

We included child and adolescent patients diagnosed with depressive disorders at Siriraj Hospital, comprising 93 patients in 2014 and 172 patients in 2022. Data on demographics, personal and social history, diagnoses, comorbidities, and treatment outcomes were collected from medical records. Results were analyzed using relative risk, 95% confidence intervals, and p-values through modified Poisson regression.

The proportion of female patients significantly increased from 49.5% in 2014 to 73.7% in 2022 (p<0.001). The prevalence of domestic violence rose from 7.5% in 2014 to 20.3% in 2022 (p=0.006). Suicidal ideation increased from 16.1% to 51.2% (p<0.001), and self-harming behaviors rose from 22.7% to 57.6% (p<0.001). Referrals to psychologists doubled from 22.6% in 2014 to 43.9% in 2022 (p<0.001), while hospitalization rates within the first year of treatment also increased from 6.5% in 2014 to 15.2% in 2022 (p=0.037). No significant differences were observed in age, family structure, parenting style, disease-triggering factors, psychotic symptoms, comorbidities, medication use, or remission rates between the two years. Our regression analysis indicated that authoritative parenting significantly influenced remission rates, with patients under authoritative parenting being 1.98 times more likely to achieve remission compared to those under other parenting styles (p=0.042).

There is a rising trend in the prevalence of depressive disorders among female child and adolescent patients, accompanied by more severe symptoms such as increased suicidal ideation and self-harming behaviors. Hospitalization rates within the first year of treatment have also increased. Despite these trends, remission rates have remained unchanged. The study highlights the potential role of authoritative parenting in improving remission rates. These findings underscore the need for enhanced screening protocols, updated treatment guidelines, and targeted parental counseling to improve depression management in the future.

None Declared

Dissociative Identity Disorder (DID), as defined in the DSM-5-TR, involves two or more distinct personality states within an individual, along with memory gaps for daily or traumatic events [1]. It is strongly associated with early trauma, such as childhood abuse, and linked to severe psychiatric comorbidities, including depression, anxiety, and self-harm, with an elevated risk of suicide attempts [2][3]. Stress-related neurobiological responses, particularly HPA axis hyperactivity, contribute to identity fragmentation in DID patients. Treatment, often through cognitive-behavioral therapy, aims to integrate dissociated states, reduce self-destructive behaviors, and improve quality of life [2][3].

In this case study, we present two compelling cases of dissociative identity disorder following a state of stress. We hope this case study will help reveal the possible association of the disorder with stress

This is a retrospective and descriptive case study aimed at exploring the manifestations and associated factors of dissociative identity disorder in patients who have experienced traumatic events.

Clinical Case Summary of Case 1 :

A 24-year-old student developed dissociative identity disorder after witnessing a fatal accident caused by a drunk driver. This trauma fragmented his personality into three identities: a child expressing needs through crying, a rebellious adolescent who smokes, and a feminine, seductive personality. These identities appear involuntarily, especially during periods of stress, causing him anxiety and memory loss regarding these episodes.

Clinical Case Summary of Case 2 :

A 23-year-old single, unemployed patient with a long psychiatric history was admitted following a suicide attempt by jumping. She experiences recurrent depressive episodes, suicidal thoughts, and engages in self-harm to manage her anxiety. Salma has dissociative identity disorder, with an alternate identity named “RUBY” that emerges under stress, driving her towards self-destructive behaviors and exacerbating her distress. Her history includes significant childhood trauma, such as sexual abuse and physical violence, contributing to her identity dissociation. She also exhibits alcohol abuse, consuming up to 1 liter daily to manage her anxiety.

Dissociative identity disorder is a complex condition, often linked to early trauma, characterized by the presence of multiple distinct identities within the same individual. This disorder causes significant distress and impacts patients’ daily functioning, especially in stressful situations. Treatment primarily involves therapeutic approaches aimed at integrating the different identities and reducing self-destructive behaviors. Understanding and managing this disorder require a personalized approach and long-term follow-up.

None Declared

Neurohormone oxytocin plays an important role in the pathogenesis of mental illness, and also moderates the relationship between stress factors, especially those acting in the early stages of development, and the development of mental disorders. Literature data indicate that environmental risk factors significantly increase the risk of schizophrenia and the severity of its clinical presentation.

To study the association between the oxytocin receptor (OXTR) rs468302 and rs7632287 polymorphisms and negative symptoms of schizophrenia, taking into childhood adversity (CA), i.e. events that could adversely affect the psychoemotional state and development of the child in the period up to 18 years. CA includes abuse in the family, alcohol or drug addiction in parents, mental disorders.

The study included 592 patients with schizophrenia (items F20. according to ICD-10). Information about the presence of CA was obtained from case histories and patient interviews. Analysis of covariance was used for statistical data processing; in post-hoc pairwise comparison, Tukey’s test was used.

A significant effect of the interaction between CA and OXTR gene polymorphism rs7632287(G\A) on the severity of negative symptoms in patients with schizophrenia was revealed. For rs4686302 (C\T) polymorphism the association was found at the trend level. In patients without CA, polymorphisms did not have a significant effect.

The OXTR rs468302 and rs7632287 polymorphisms, previously associated with phenotypes related to social behavior, may be associated with negative symptoms of schizophrenia, and the association is mediated by the presence of a history of psychotraumatic events acting at an early stage of development.

None Declared

The need to study and clarify the neurobiological basis of depression is due to the widespread prevalence and heavy socioeconomic burden of this disease. In order to prevent relapses, it is recommended to continue treatment for depression for a long time after the relief of the main depressive symptoms. However, delayed EEG changes have been almost completely unstudied.

The aim of the study was to analyze the dynamics of spectral-coherent EEG parameters during long-term treatment for endogenous depression in young female patients.

The study included 20 female patients aged 16-25 years who underwent quantitative clinical (using the HDRS-17 and GAF scales) and neurophysiological (multichannel resting EEG recordings with subsequent analysis of absolute spectral power and EEG coherence) examination three times: upon admission to hospital before the start of the course of treatment (at visit 1), upon discharge from the hospital at the stage of remission establishing (at visit 2) and one year after discharge from the hospital on maintenance therapy (at visit 3). The clinical and EEG changes were statistically assessed using the Wilcoxon test.

After the course of stopping treatment (at visit 2), there was a significant (p<0.01) reduction in depressive symptoms. This was associated with an EEG slowdown in the form of a generalized increase in the spectral power of theta-delta activity (2-4 Hz and 4-8 Hz), which was significant (p<0.05) in the frontal-central leads, and a significant (p<0.05) decrease in the alpha2 (9-11 Hz) and alpha3 (11-13 Hz) components of the alpha rhythm in the occipital zones. Further improvement in the clinical condition (according to the HDRS-17 scale) and social functioning (according to the GAF scale) was noted a year later (at visit 3), and was associated with the same EEG pattern, including a significant (p<0.05) increase of theta2 sub-band (6-8 Hz) spectral power in the central-parietal-occipital leads.

The observed EEG slowdown is considered to be a reflection of a complex restructuring of brain activity into a mode more adequate for these patients, ensuring the suppression of depressive symptoms and restoration of the social functioning of patients, rather than traditionally considered general decrease of the brain functional state.

None Declared

The diagnosis of persistent insomnia according to DSM-5 and ICD 11 is based on clinical criteria, specially in relation to dissatisfaction with the quantity/quality of sleep and the discomfort or impairment of social and occupational functioning that it generates. On the other hand, in 2023, Spain has positioned itself as the world leader in the consumption of benzodiazepines.

We present the case of a 62-year-old man admitted to neurosurgery for a cerebrospinal fluid fistula and evaluated by the liaison psichiatry for persistent insomnia. The patient was abusing benzodiazepines to improve his night’s rest. Different drugs are prescribed to improve sleep and avoid abusive consumption of benzodiazepines such as trazodone, quetiapine, clotiapine, gabapentin with little or no improvement of insomnia. Finally, a dual orexin receptor antagonist, daridorexant, is prescribed and its effectiveness is evaluated.

The aim of this work is to evaluate the effectiveness of daridorexant in persistent insomnia, as well as to assess the possibility of its use in benzodiazepine addiction for hypnotic purposes.

The Oviedo Sleep Questionnaire (COS), which is a structured and hetero-applied instrument, was administered to facilitate the diagnosis and monitoring of sleep pre and post treatment.

A literature search was carried out in PubMed and the conclusions found in the literature were compared with the clinical case presented.

Permission is requested from the patient to present this case anonymously.

After 30 days of treatment with daridorexant, the COS score decreased, and improvement was also observed in the anamnesis, without verbalizing complaints that could be interpreted as side effects.

Regarding lorazepam consumption, this could be gradually reduced until its withdrawal.

Daridorexant is a drug that may be effective in resolving persistent insomnia in patients addicted to benzodiazepines for hypnotic purposes.

The review of the available literature suggests that daridorexant is a safe and effective option for the treatment of persistent insomnia. This has been fulfilled in our patient, given that he has not reported side effects, that the analytical parameters have not changed since its introduction and that it has improved in general terms the quality of sleep and functionality during the day. On the other hand, since the hypnotic purpose of lorazepam was replaced by daridorexant, the former could be withdrawn, which opens the door to the possibility that we are dealing with a drug that reduces the consumption of benzodiazepines.

It should be borne in mind that in Spain daridorexant was recently approved in September 2023, with not much experience in practice.

None Declared

Attention-Deficit/Hyperactivity Disorder (ADHD) often coexists with insomnia. Challenges of ADHD, like racing thoughts and restlessness, can exacerbate sleep issues. Addressing both conditions concurrently is crucial for comprehensive treatment and improved quality of life.

The aim is to identify factors promoting insomnia in patients with ADHD.

The study is conducted on patients >18 years referred to the adult ADHD outpatient service of the Psychiatric Clinic of Ancona (Università Politecnica delle Marche, Italy). The Diagnostic Interview for ADHD in adults (DIVA 5.0) was used for diagnosis. Administered rating scales included Temperament Evaluation in Memphis, Pisa and San Diego (TEMPS-M), Coping Orientation to the Problems Experiences-new Italian version (COPE-NVI), Temperament and Character Inventory-Revised (TCI-R) and Insomnia Severity Index (ISI).

76% (n=170) of all screened patients were diagnosed with ADHD in adulthood. In our sample of ADHD subjects, those who have bipolar disorder in comorbidity tend to suffer more frequently from insomnia (χ²=4.290; p=0.038). A multivariate linear regression was observed between the ISI (R2=0.237; F(3,56)=13.150; p<0.001) and TEMPS-M cyclothymic temperament subscale (B=0.206; p=0.027), TCI-R responsibility subscale (B=-0.255; p=0.005), and TCI-R self-transcendence subscale (B=0.101; p=0.06). A logistic regression analysis was performed to ascertain the effects of all TCI-R, COPE-NVI, TEMPS-M subscales, on the likelihood of developing insomnia. The logistic regression model was statistically significant, ▫▫2(1)=4.539, p=0.033. The model explained 62.3% (Nagelkerke R2) of the variance in patients with ADHD and insomnia and correctly classified 76.7% of cases. Insomnia was significantly predicted by TEMPS-M irritable temperament subscale (exp(B)=1.272; p=0.003), TCI-R disorderliness subscale (exp(B)=0.628, p=0.004), TCI-R purposeful subscale (exp(B)=0.781, p=0.003), TCI-R social acceptance subscale (exp(B)=1.232, p=0.052), TCI-R compassion subscale (exp(B)=0.795, p=0.001) and TCI-R transpersonal identification subscale (exp(B)=1.268, p=0.002).

Findings suggest a link between ADHD patients with comorbid bipolar disorder and a higher incidence of insomnia. Personality traits such as cyclothymic temperament, low sense of responsibility, and high self-transcendence are significantly associated with insomnia in ADHD. The logistic regression model accurately predicted and identified key predictors for insomnia in ADHD patients, highlighting the substantial role of irritable temperament, rigidity in being orderly, low determination, high friendliness, low compassion, and high transpersonal identification. Understanding these associations is pivotal in developing targeted interventions and support strategies for individuals with ADHD prone to insomnia, emphasizing the intricate role of temperament and personality traits in sleep disturbances.

None Declared

Depressive disorders are one of the most disabling mental illnesses with a significant impact on society. In Romania the mean annual total costs per depression patient are EUR 5553, a much higher figure than the mean annual total costs per patient ranged worldwide.

Even though their roles in depression have not been elucidated, a plethora of potential biomarkers in multiple body fluids for the early diagnosis of depression has been suggested. Blood circulating microRNAs (miRNAs) are potential biomarkers for several human diseases, including psychiatric disorders. Different studies have shown that micro RNAs are involved in a series of pathophysiological processes and could be useful markers for diagnosis and prognosis of depression.

This preliminary case-control study was designed to identify putative blood circulating miRNAs associated with the diagnosis of depression in Romanian patients.

In this study, 20 patients with depression and 24 non-depressed controls were enrolled. All the individuals have been interviewed and screened using the following scales: the Hamilton Anxiety Scale (HAM-A), the Becks Depression Inventory (BDI) and the Perceived Stress Scale (PSS). The expression of 179 miRNAs in plasma have been evaluated by qRT- PCR. The difference in the expression of miRNAs between the two groups, as well as the correlations with the scores of the scales have been analyzed.

A panel of 28 miRNAs was identified as differentially expressed between patients and controls. Only miRNAs showing a -2>FC>2.0 and p<0.05 have been considered significant. Seven miRNAs (miR-143-3p, miR-331-3p, let-7f-5, miR-502-3p, miR-145-5p, miR-7-1-3p, miR- 29a-3p) were found up-regulated in the depression group, while 21 miRNAs (miR-885-5p, miR- 425-3p, miR-32-5p, miR-23b-3p, miR-590-5p, miR-30a-5p, miR-132-3p, miR-376a-3p, miR-223-5p, miR-133b, miR-142-5p, miR-92b-3p, miR-140-3p, miR-16-2-3p, miR-28-3p, miR-27a-3p, miR-15b-3p, miR-106b-3p, miR-877-5p, miR-30e-3p, miR-140-5p) showed a down-regulation in the group of patients compared to the controls. Some of the significant correlations between miRNA expression and the scale scores are reported: a positive correlation between let-7f-5 and miR-7-1-3p with the BDI score (p=0.003 r=0.526, and p=0.008 r=0.477, respectively) and a negative correlation between miR-425-3p with BDI (p=0.002 r=-0.502) were found.

The results reported in this communication represent preliminary findings. Due to the nature and heterogeneity of depression, the number of patients and controls in the two cohorts will be enlarged to correlate these miRNAs with other patient features.

None Declared

Type 1 Diabetes (T1D) is an invisible condition, yet it can be difficult for young people to accept. Many attempt to hide or downplay their illness, potentially leading to significant psychological distress.

The objective of this study is to determine the prevalence and characteristics of academic failure among children with T1D, as well as the associated risk factors, including the impact of substance use such as tobacco, alcohol, and cannabis.

This is a retrospective, descriptive, and analytical study conducted at the Endocrinology Department of Farhat Hached Hospital in Sousse, covering the period from January 2015 to January 2020. The study analyzed the school and professional trajectories of T1D patients, considering their clinical, biological, and social data. Academic failure, the dependent variable, was defined as either the interruption of studies or the repetition of at least one academic year. Additionally, the prevalence of smoking, alcohol, and cannabis use in this population was recorded.

The study included 70 patients (31 males and 39 females), with a mean age of diagnosis of T1D at 7.36±4.41 years. Academic repetition was observed in 71.4% of cases, and school dropout in 47.1%. The reasons for academic delays were attributed to recurrent hospitalizations (31.4%) and glycemic instability, including hyper/hypoglycemic episodes (17.1%). Multivariate analysis adjusted for diabetes type revealed that significant risk factors for academic failure included: ≥5 hospitalizations for ketosis (p=0.037) and higher mean HbA1c levels at recent consultations (p=0.001). Protective factors were functional insulin therapy (p=0.031) and the use of insulin analogs (p=0.004). Concerning substance use, tobacco addiction was present in 22.9% of patients, alcohol consumption in 14.3%, and cannabis use in 8.6%. Patients using tobacco and alcohol exhibited a higher risk of school dropout and lower academic performance, with a significant correlation between cannabis use and glycemic instability.

The risk of academic failure among T1D patients is substantial and should not be underestimated. Frequent hospitalizations, poor glycemic control, and substance use (especially tobacco and cannabis) further exacerbate this risk. The physical and psychological complications of T1D, combined with the socioeconomic challenges and limited access to medical care in rural or isolated areas, contribute to school dropout. This study highlights the importance of comprehensive medical and psychosocial support to improve both health and academic outcomes in this vulnerable population.

None Declared

“Psychosurgery” is defined as the human brain surgery to treat psychiatric symptoms.

This study aims to portray psychosurgery’s historical evolution.

A review of 35 articles from 2000 to 2024 on PubMed and Google Scholar, regarding psychosurgery.

The initial phase of psychosurgery dated in 1888, when Swiss psychiatrist Gottlieb Burckhardt, in en effort to control the symptoms of psychiatric patients, he performed the very first brain topectomies. Later on, in 1936, Portuguese neurologist Egas Moniz and neurosurgeon Almeida Lima, collaborated on performing the first lobotomy. After achieving 20 lobotomies, Moniz reported that 35% of patients showed complete remission of psychiatric symptoms, 35% of patients showed a mild improvement, and 30% of patients showed no improvement. It was Freeman’s (a neurologist) and Watts’s (a neurosurgeon) turn to perform in 1936 the first lobotomy on the USA ground, on a woman suffering from depression; Alice Hammatt. Unfortunately, six days post-operation, Hammatt experienced language difficulties, disorientation and agitation. However, the surgery was still considered a success. By 1942, Freeman and Watts had performed 200 lobotomies, declaring that 63% of patients improved, 23% of patients showed no relief, while 14% of patients suffered complications, including death. Freeman pursued with the development of a transorbital method which he tended to perform in outpatient departments, without any neurosurgical assistance, having patients anesthesized with a portable electroshock machine. Profoundly disapproving this method, Watts, decided to end their partnership. Further unsatisfactory outcomes like the lobotomy of Rosemary Kennedy (sister of President John F. Kennedy) shaped an additional negative image of Freeman’s work. Rosemary who initially was subjected to lobotomy due to mild developmental delays, anxiety and epilepsy, was postoperatively left severely disabled, without autonomy, being institutionalized for the rest of her life. Finally, the approval of chlorpromazine’s use in the US (1955) alongside public awareness over psychosurgery’s complications, such as the “post-leucotomy syndrome” causing disinhibition as well as “lobotomy criteria” which included female gender, non-obeidance, hospitalization in overcrowed institutions, opposite political opinion, leaded to psychosurgery’s dowfall.

Considering the dark history of psychosurgery, it is imperative to proceed to such treatments exclusively to diseases with a well decoded neurophysiology, always respecting human rights and protecting patients’ dignity and self-will.

None Declared

Major depressive disorder (MDD) is one of the most prevalent and disabling mental health conditions globally. Approximately one-third to half of MDD patients, suffer from difficult-to-treat depression (DTD), a condition marked by persistent symptoms that do not respond to multiple standard treatments. DTD is often associated with comorbid physical and psychiatric conditions leading to chronic disability and a reduced quality of life. The complexity of DTD poses a considerable challenge in clinical practice, underscoring the need for innovative treatment options.

Despite the demonstrated efficacy of esketamine in controlled clinical trials, real-world evidence is limited. This study aimed to address this gap by assessing the effectiveness of esketamine in routine clinical practice in DTD patients.

This prospective, naturalistic, open-label, observational study was conducted at Marqués de Valdecilla University Hospital in Cantabria, Spain. It included 33 patients diagnosed with DTD, comprising both unipolar and bipolar depression, as well as persistent depressive disorder (see table 1). Esketamine was administered intranasally in doses ranging from 56 mg to 84 mg, across three phases: induction, consolidation, and maintenance. Treatment effectiveness was measured using the MADRS, Clinical Anxiety Scale (CAS), and Clinical Global Impression (CGI). Functionality and quality of life were assessed with the Brief Functioning Scale (FAST) and the EQoL-5D (ESH). Assessments were conducted at baseline, 1-month, and 3-month. Data analysis was performed using SPSS v26, with repeated measures ANOVA and Pearson’s χ² tests employed to evaluate changes over time.

The final analysis included 33 patients with DTD and long-lasting current MDD episodes (table 2). Baseline MADRS scores indicated severe depression (39.12 ± 6). Significant reductions in MADRS scores were observed at both one month (21.61 ± 11.15) and 3-month (19.70 ± 11.65) compared to baseline. At 3-month, 54.5% of patients achieved a ≥50% reduction in MADRS scores, and 30.3% reached remission (MADRS < 12). Similar improvements were seen in anxiety (CAS) and health status (ESH) scores, with significant reductions noted over time. However, functional improvements (FAST) were not statistically significant (see table 3).

Esketamine demonstrated substantial effectiveness in reducing both depressive and anxiety symptoms in DTD patients over three months. More than half of the patients achieved a significant reduction in depression severity, with nearly a third reaching remission. The presence of late responders suggests that esketamine may benefit those initially unresponsive to treatment. These findings support esketamine as a valuable therapeutic option for DTD in real-world clinical settings.

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The results of many previous studies report a high prevalence of overweight and obesity in children and adults with Down syndrome (hereinafter DS). According to different authors, the incidence of obesity in them varies between 23 and 70%. The age of onset of overweight formation was 2–3 years.

Glucose transporter (abbreviated GLUT) is a large group of membrane proteins responsible for the transport of glucose across the cell membrane. Since glucose is a vital source of energy, these proteins are present in all types of living organisms. GLUT, or SLC2A, is a separate family of glucose transport proteins found in most mammalian cells. Thus, the human genome encodes twelve proteins of the GLUT family. They are transport uniporter proteins.

We studied PCR of scrapings of the mucous membrane of the inner side of the cheek to search for GLUT1 genes in 31 patients with DS, ьen and women aging from 8 to 39 years. The control group consisted of 67 healthy donors by the same ages and genders.

It was found that the expression of GLUT1 genes was significantly reduced. A decrease in the expression of these genes correlated with an increase in body weight and symptoms of bulimia in patients with Down syndrome.

Eating disorders, namely bulimia, in DS is a serious condition that aggravates the course of the underlying disease. Hereditary factors affect the expression of glucose transporter genes. Taking these circumstances into account would help in developing personalized pharmacotherapy.

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South African adolescents are exposed to significant levels of trauma exposure, resulting in high levels post-traumatic stress disorder (PTSD). Sleep disturbances are among the most frequently reported difficulties faced by those dealing with PTSD.

The current study aimed to determine the feasibility and preliminary efficacy of the SAASI on PTSD symptom severity and sleep disturbance when delivered in group format to South African adolescents with PTSD.

Sixty-one adolescents with PTSD diagnoses and sleep disturbance were randomly assigned to either one individual and four group sessions of the sleep intervention (SAASI) or a control group. At baseline, post- and 1-month follow-up participants completed the Child PTSD symptom scale for DSM5 (CPSS-5) and the Pittsburgh Sleep Quality Index (PSQI) among other sleep and psychiatric measures. The trial was registered on the Pan African Trial Registry (PACTR202208559723690).

There was a significant but similar decrease in PSQI scores in both groups over time indicating no overall intervention effect. Interaction between groups on the CPSS-5 was also not significant. Despite this overall finding, the mean difference in CPSS-SR-5 scores increased over time, with the difference between groups post-treatment and at the 1-month follow-up suggesting that PTSD symptom severity decreased more in the intervention group than the control group. The dropout rate was higher than expected for both the intervention and control groups. Reasons provided for dropout were mostly school commitments or travel related.

Conclusions: Early findings suggest a trend towards dual improvement in sleep quality and PTSD symptom severity in adolescents with a sleep disturbance and PTSD receiving a group sleep intervention (SAASI). Further investigation in a properly powered RCT with detailed retention planning is indicated.

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Post-traumatic stress disorder (PTSD) is characterized by intrusive thoughts and flashbacks involving the traumatic event, hypervigilance and avoidance behavior. On the other hand, complex post-traumatic stress disorder (complex PTSD) can result from experiencing chronic trauma. It involves similar stress reponses, such as flashbacks, nightmares, and also avoidance of places and situations related to the traumatic event. Sleep disturbance is a central element of both disorders (PTSD and complex PTSD). While nightmares qualify as a re-experiencing symptom, initiation and maintenance of sleep stem from a hyperarousal state (Paiva et al., 2021). Evidence implies that treatment for PTSD-related sleep disturbance also improves other trauma-related symptoms. As pharmacological therapy, some clinicians use prazosin, an adrenergic inhibitor, which is a lipophilic drug originally developed to treat hypertension. It blocks α1 receptor sites and ameliorates the increase in noradrenergic activity in PTSD-diagnosed individuals (Lipinska G et al. 2016). Studies differ regarding the effectiveness of this drug to alleviate sleep disorders and other trauma-related symptoms (Bajor et al., 2022; Yücel et al., 2020; Zhang et al., 2020; Petrakis et al. 2016).

Through this case series study we want to understand the utility and effectiveness of prazosin in patients diagnosed with PTSD and complex PTSD for the improvement of nightmares and other PTSD-related symptoms.

For this purpose we have reviewed in 10 patients with a diagnosis of either PTSD (4 out of 11) or complex PTSD (7 out of 11) the improvement of nightmares and other trauma-related symptoms, especially flashbacks. The patients indicated whether there was no, partial or total improvement of these symptoms. The doses used were between 1 to 2mg.

In this Case series study (n= 11), we focus on the reports from PTSD - and complex PTSD-diagnosed (4 out of 11 vs 7 out of 11) patients treated with prazosin regarding their sleep disturbance and other trauma-related symptoms.

Forty percent of the patients report a reduction in the frequency and intensity of nightmares, while 3 patients of the sample reported absolute extinction of nightmares.

Our findings reveal almost half of the patiens (4 out of 11) expressed as well a reduction in other PTSD symptoms, specifically in flashbacks.

We have not found a significant better outcome in either PTSD or complex PTSD- diagnosed patients. The entire sample were female patients.

Improvements in hypervigilance and avoidance behavior have hardly been reported in enrolled patients (3 out of 11).

In our sample, the use of prazosin appears to be an acceptably good option, especially for the improvement of nightmares. Nevertheless, further studies should be conduced.

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Sudan is currently experiencing the largest child displacement crisis worldwide. Since the conflict erupted in 2023, over 4.6 million children have been internally displaced within Sudan, and nearly one million are seeking refugee in neighboring countries (UNICEF, 2023). The mental health of these children has been overlooked, and there is a noticeable lack of data on their psychological wellbeing.

To assess the prevalence of PTSD, anxiety and factors associated with them among internally displaced Sudanese children during war in IDP camps in Al Jabalain district, White Nile state, Sudan, 2024

A cross-sectional study was conducted among internally displaced Sudanese children in 11 camps in Al Jabablain district. Children were interviewed using a standerdised questionnaire consisting of the PTSD Civilian Checklist Version 5 abracic version and the Hamilton Scale arabic version to assess the prevalence of PTSD and anxiety. Data analysis was conducted using IBM® SPSS, version 26.0.

The sample included 223 children; age median was 12 years (IQR: 9-15). 127 (57%) of them were females, with majority 128 (57.4%) in primary school. Participants who met the criteria for probable PTSD were 23 (14.3%), (median: 32, IQR: 17-28). 150 (67.3%) participants had mild anxiety, with a median score of 11 (IQR: 9-14). Older children had higher levels of PTSD and anxiety. Also, both scales were significantly associated with gender, displacement frequency and separation from close ones (p value <0.05). Females were more likely suffer from anxiety 116/127(91%) in comparison to males 76/96(79%). Yet, 19(59.4%) of children with probable PTSD were males. Children displaced more than four times were more prone to PTSD symptoms and moderate to severe anxiety. Interestingly, recently displaced children were more likely to have higher PTSD scores and lower anxiety scores. Educational level was significantly associated with PTSD, with about one-third of high school students experienced PTSD symptoms. Anxiety scale was significantly associated with direct exposure to violence, as 13.6% of those exposed to violence experienced mild to moderate anxiety.

This study identified significant levels of PTSD and anxiety among internally displaced children in the Al Jableen camps, highlighting the urgent need for mental health interventions, which promotes resilience and coping skills. Factors such as age, gender, frequency of displacement, direct exposure to violence, and educational level significantly impact the development of these mental health conditions.

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Post-traumatic stress disorder (PTSD) is a chronic condition resulting from exposure to traumatic events. The utilization of stellate ganglion block (SGB) as a potential treatment for PTSD has garnered increased interest in recent years. SGB acts by blocking sympathetic outflow, offering promise in alleviating autonomic dysfunction associated with PTSD symptoms. However, the evidence supporting SGB’s efficacy compared to established recommendations remains limited.

To bridge this knowledge gap, a systematic review was conducted following PRISMA guidelines to assess the clinical applications and implications of stellate ganglion block (SGB) in the management of post-traumatic stress disorder (PTSD). The study aimed to identify pertinent literature, synthesize findings from diverse sources, evaluate outcomes of SGB therapy for PTSD, analyze factors such as anesthesia preferences and procedural methods, scrutinize symptom alleviation post-SGB sessions, explore reported side effects and symptom recurrence, and shed light on existing limitations within the current discourse on SGB’s utility in treating PTSD.

The systematic review involved the evaluation of 14 studies meeting predetermined inclusion criteria, incorporating a total of 550 participants. Notably, the majority of participants were military service members and veterans, with a median age of 36.9 years. The review focused on anesthetic practices, procedural techniques, timing of SGB administration, and symptom progression post-SGB therapy sessions.

Analysis of the selected studies highlighted the prevalent use of 0.5% ropivacaine as the preferred anesthetic for SGB, with the right-sided technique being the most commonly employed. Timing of the initial SGB session varied widely, with symptom improvement typically observed immediately or within the first week post-procedure. Positive outcomes often coincided with reductions in alcohol intake, medication use, and enhanced mood. Recurrence of symptoms was noted, necessitating additional SGB sessions, while reported side effects were predominantly mild and transient in nature.

While promising, caution is advised when interpreting the benefits of SGB due to challenges such as the absence of standardized clinical trial data, variabilities in reported outcomes, and potential reporting biases. Addressing these limitations through standardized assessment and reporting in future studies is crucial to enhance comprehension of SGB’s efficacy, safety, tolerability, and appropriate indications for treating PTSD. This endeavor is pivotal in advancing a more nuanced understanding of SGB’s role as a therapeutic modality in PTSD management.

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