Suicide is an international public health problem and a leading cause of death for youth and adults, worldwide. Prevention efforts in health care systems create opportunities for identifying medical patients with occult suicidality. Detecting suicide risk among patients in medical settings can be a challenge, but successful suicide risk screening programs have been demonstrated in hospital settings.

This presentation will discuss how a suicide risk screening tool that was developed for the pediatric emergency department was tested and then implemented in other medical settings in order to leverage healthcare providers as partners in combating the public health crisis of youth suicide..

Implementation and quality improvement projects in various medical settings that have adapted the ASQ will be described. Effective management of pediatric patients that screen positive for suicide risk and how mental health clinicians can best be utilized in efficient ways will also be discussed.

Average time to administer the ASQ was 20 seconds. Positive screen rates across ED, inpatient and outpatient settings ranging from 2-14% equating to one additional psychiatric consultation per week. The ASQ Toolkit was developed to help medical providers implement screening including scripts for nurses, flyers for parents and a brief suicide safety assessment (ASQ BSSA) to operationalize next steps for patients at risk.

The medical setting is a key venue for youth suicide risk detection and linking patients with effective interventions. Mental health clinicians have a role in guiding non-mental health providers in the identification and management of patients found to be at risk.

No significant relationships.

Important changes have been done in economic status of residents in 2018. The impact of these measures in changing opinion was checked.

The prioritization exercises of main factors related with psychiatric residents’ decision to emigrate could be a starting point of elaboration of a strategy of reforms.

The study was cross sectional evaluation at national level on a randomized selected sample of Romanian psychiatric residents’ opinion on factors which influence decision of migration in EU countries in two time points: 2015 and 2020.

38% of residents intend to work abroad comparing with 78% before the economic changes (25.84% versus 71.66% for a limited period of time and 15.73% versus 28.33% intend to emigrate) and 2% versus 5% intend to leave the speciality. The most important factors for decision to emigrate changed from “Better working conditions” (15.73 versus 37.31% residents) to “Better training” 20.25% residents and the factor “respect and appreciation by colleagues” remained important for 19.10% versus 17.91%. “Lack of working place for partner” was considered by 26.96% of responders as an important disadvantage of working abroad. “Being far from family members” which was considered 5 years ago by 64.18% of responders as an important disadvantage of working abroad, nowadays concerns only 6.74%, probably because it seems easier to go abroad together with the family members.

The factors (better training in psychiatry and psychotherapy, better supervision, more involvement in research) which influence the residents’ decision to emigrate represent the starting points on futures reforms in educational and medical system in psychiatry.

No significant relationships.

Hair loss resulting from childhood irradiation for tinea capitis has been linked to mental health effects in women. However, the association of hair loss severity with mental health in this population is unknown.

The aim of this study is to examine the association between hair loss severity and mental health outcomes in women irradiated for tinea capitis in childhood and to identify contributing factors to these outcomes.

Medical records, held at the archives of Israel National Center for Compensation of Scalp Ringworm Victims, were retrospectively reviewed for 2509 women who received compensation for full or partial alopecia resulting from irradiation in childhood for tinea capitis. Mental health outcomes were determined by the number of mental health conditions reported.

Among women with high hair loss levels, risk was increased for a range of mental health problems, including depression symptoms, emotional distress, social anxiety, low self-esteem, and suicidal ideation. Hair loss severity emerged as a significant predictor of mental health, adding to the effects of other predictors such as family, and social and physical health problems. Effects of hair loss severity on mental health outcomes were mediated by women’s negative social experiences.

Hair loss severity is a significant risk factor for mental health problems in women irradiated for tinea capitis in childhood. Further research is needed to assess mental health risks among women with severe hair loss associated with additional diseases.

No significant relationships.

Restraint theory (Herman and Polivy, 1975) suggests that human eating behaviour is under cognitive control and this leads to reduced sensitivity to internal cues for satiety, resulting in overeating in situations where cognitive control is under-mined (Johnson et al., 2012). In other words, restraint theory suggests that restraint (dieting) actually leads to leads to an excessive intake of food.

The present study sought to investigate the relationship between dieting, eating behaviours (uncontrolled eating, emotional eating, cognitive restraint) and rumination (repetitive negative thinking). The second objective was to determine whether rumination mediates the relationship between dieting and both uncontrolled eating and emotional eating.

The sample was composed of 188 women (Mage = 29.46 ± 8.94; MBMI = 23.16 ± 4.04). The Eating Attitudes Test, the Three-Factor Eating Questionnaire and the Perseverative Thinking Questionnaire were used in the present study.

Dieting for weight control (intentional weight loss) was associated with higher levels of uncontrolled eating, emotional eating, cognitive restraint and repetitive negative thinking. Mediation analyses showed that the relationship between dieting and inappropriate eating behaviours was mediated by rumination. The direct effect of dieting on both uncontrolled eating and emotional eating was significant, suggesting partial mediation.

Our findings support the relevance of rumination in linking dieting and eating behaviours among women. The current study may have clinical applications such as the potential integration of rumination for the prevention and changes in inappropriate eating behaviours.

No significant relationships.

Women who take lithium during pregnancy and continue after delivery may opt to breastfeed, formula feed, or mix these options.

To evaluate the neonatal lithium plasma concentrations and nursing infant outcomes based on these three feeding trajectories.

We followed 24 women with bipolar disorder on lithium monotherapy during late pregnancy and postpartum (8 per trajectory). Lithium serum concentrations were determined by an AVL 9180 electrolyte analyser with a 0.10 mEq/L detection limit and a 0.20 mEq/L limit of quantification (LoQ).

The mean ratio of lithium concentration in the umbilical cord to maternal serum being 1.12 (0.17). We used the Turnbull estimator for interval-censored data to estimate the probability that the LoQ was reached as a function of time. The median times to LoQ was 6–8, 7–8, and 53–60 days for formula, mixed, and breastfeeding, respectively. Generalised log-rank testing indicated that the median times to LoQ differed by feeding trajectory (p = 0.037). Multivariate analysis confirmed that the differences remained after adjusting for serum lithium concentrations at birth (formula, p = 0.015; mixed, p = 0.012). We did not found any acute observable growth or developmental delays in any of the neonates/infants.

Lithium did not accumulate in the infant under either exclusive or mixed-breastfeeding. Lithium concentrations declined in all trayectories. The time needed to reach the LoQ was much longer for those breastfeeding exclusively. Lithium transfer via breastmilk is much less than via the placenta. We did not found any acute observable growth or developmental delays in any infant during follow-up.

No significant relationships.

The Perinatal period is a time of vulnerability for developing psychiatric disorders of higher prevalence in the female gender - depression and anxiety1. Numerous authors have proposed that maternal psychological factors could influence pregnancy course and the well-being of mother and newborn2.

To explore the relationship between perinatal psychological disorder and physiological parameters evaluated at birth, such as the Apgar Index (AI; 1, 5 and 10 minutes), head circumference, weight, length and age.

533 women answered, in the second trimester of pregnancy (16.98±4.83 weeks of gestation), several questions about psychosocial variables, the Perinatal Depression Screening Scale3 and the Perinatal Anxiety Screening Scale4. Of these, 208 (39.0%) women were interviewed with the Diagnostic Interview for Psychological Distress5. Newborn physiological parameters were obtained from electronic health records.

AI was significantly (p<.01) and moderately (r≈.25) correlated with maternal anxious symptomatology, and with the experience of a stressful event in the last year (only AI 1 minute). Newborns of women with clinically relevant anxious symptomatology (>cutoff point, 14.6%) had significantly lower AI (p<.05), which was also observed in newborns of women who considered having had a stressful event (only AI 1 minute). Women’s newborns with maternal anxiety disorders during pregnancy (5.3%), had significantly lower values in AI, head circumference, weight and age of birth. Regression analyses showed that anxiety in pregnancy (symptoms and/or diagnoses) is a predictor of newborn physiological parameters, explaining significant percentages(r≈22%; p<.05) of its variability.

Early detection of psychological disorders in pregnancy, namely anxiety, is determinant to prevent adverse neonatal outcomes.

No significant relationships.

Patients with Attention Deficit/Hyperactivity Disorder (ADHD) have shown an increased risk of developing a DSM Cluster B (i.e., Borderline, OR=13.16; Antisocial, OR=3.03; Narcissistic, OR=8.69) and DSM Avoidant Personality Disorder (PD; OR=9.77; Miller et al., 2008). Although different comorbidities affect males and females with ADHD (Kooij et al., 2013), gender differences in personality traits and disorders have not yet been investigated.

To describe gender differences in personality traits and disorders among a sample of adult outpatients with ADHD.

A consecutive sample of DSM-5 ADHD outpatients was recruited at the Adult ADHD Center of the “San Luigi” University Hospital (Orbassano (TO), Italy) between Jan 2017 and Jan 2018. Patients’ personality was assessed by Millon Clinical Multiaxial Inventory (MCMI-III; Zennaro et al, 2008).

The study sample consisted of 82 males and 31 females. Sixty percent of men vs. 77% of women had a personality disorder (

Women with ADHD showed a higher frequency of personality disorders and higher rate of Masochistic PD than men. Moreover, the two most important clusters detected in women included severe personality components (i.e., Borderline and Paranoid) when compared with men. Further studies on larger samples should be conducted to confirm more severe personality profiles in women than in men.

No significant relationships.

Postpartum depression (PPD) is the commonest postpartum psychiatric condition, with prevalence rates around 20%1. PPD is associated with a range of adverse outcomes for both the mother and infant2. Therefore, identifying modifiable risk factors for perinatal depression is an important public health issue3.

To explore the role of dysfunctional attitudes towards motherhood in postpartum depressive symptoms and disorder.

247 women were evaluated in the third (12.08±4.25 weeks) and sixth months (31.52± 7.16 weeks) postpartum with the Attitudes Towards Motherhood Scale4, the Postpartum Depression Screening Scale5 and the Diagnostic Interview for Psychological Distress-Postpartum6. Correlation analysis was performed followed by linear/logistic regression analysis when the coefficients proved significant (p<.05), using SPSS.

Dysfunctional beliefs towards motherhood concerning judgement by others and maternal responsibility positively correlated with depressive symptoms at the third (.528; .406) and the sixth months (.506; .492) postpartum. Those dysfunctional beliefs were predictors of depressive symptoms at the third (ß=.440; ß=.151) and sixth months (ß=.322; ß.241) explaining 29.4% and 30.2% of its variance, respectively. Having dysfunctional beliefs at the third month significantly increase the likelihood of being diagnosed with Major Depression (DSM5) both in the third (Wald=9.992, OR=1.169; Wald=16.729, OR=1.231) and sixth months (Wald=5.638, OR=1.203; Wald=7.638, OR=1.301) (all p<.01).

Cognitive distortions should be included in the assessment of risk factors for PPD. Early identification of women presenting motherhood-specific cognitive biases may be crucial for implementing preventive interventions favoring a more positive and healthier motherhood experience.

No significant relationships.

The Unit of Clinical Psychiatry of the University Hospital “Ospedali Riuniti – Ancona”, in collaboration with the Marche Region Health System, is conducting a national observational project entitled “Measures related to the prevention, diagnosis, treatment and assistance of postpartum depressive syndrome”, aiming at promoting women’s Mental Health, particularly in pregnancy and peripartum period.

The primary objective is implementing all measures/interventions needed to promptly screening, early diagnosising, and supporting/caring women with mental health disease during pregnancy and peripartum period. A dedicated training program was performed by our clinical team belonging to the Peripartum Psychiatry Outpatient Service of the Unit of Clinical Psychiatry, at the University Hospital “Ospedali Riuniti”, Ancona, Italy, to a selected audience of Gynecologists/Obstetricians/Nurses/Psychologists/Psychiatrists/GPs and Pediatricians.

The training program is a 2-days residential course, held on 21-22th September, 2020. After the training program, all participants (n= 70) were asked to provide an informed consent and complete an online questionnaire to evaluate knowledge/opinions/experiences and clinical practices in the field of depression in pregnancy and postpartum.

A 40-items questionnaire investigated: a) general attitude in performing screening of depression/anxiety during pregnancy; b) overall knowledge about peripartum depression; c) overall knowledge about management/treatment; d) how physicians manage patients with peripartum depression/anxiety (i.e., how they perform screening/diagnosis/treatment during pregnancy, their levels of knowledge/confidence about psychopharmacology in pregnancy).

The findings of the residential course may allow clinicians to adequately inform and help in drafting a preventive, screening and management program able to assist regional stakeholders in the prevention, diagnosis, treatment and assistance of perinatal depression.

No significant relationships.

Motherhood-related beliefs are characterized by themes of failure and maternal role idealization. Recent studies found that postpartum depression/PPD is both predicted and a predictor by/for dysfunctional beliefs/DB. Additionally, it is possible that when contextual factors (eg. lack of social support) are present, women may anticipate the parenting experience as being of isolation, which in turn can lead to more dysfunctional attitudes.

To explore psychosocial risk factors for motherhood-DB.

233 women were evaluated in the second trimester (17.05±4.82 weeks) of pregnancy and in the third month (12.08±4.25 weeks) postpartum sociodemographically and psychosocially (years of education, previous children and social support) and the Portuguese validated self-report questionnaires to assess: perinatal depression; perinatal anxiety; perfectionism; negative affect; self-compassion; and repetitive negative thinking (all in T0). The Attitudes Towards Motherhood Scale was administered in the postpartum. When Pearson/Spearmen correlation coefficients proved significant (p<.05), linear/logistic (hierarchic) regression analysis were performed.

Motherhood-DB correlated significantly with all the variables, except for years of education, Other-oriented-Perfectionism and Common-Humanity. Motherhood-DB were significantly higher in women without previous children (p<.05). The final regression model was statistically significant (p<.001) explaining 15% of the Motherhood-DB variance, with Socially-Prescribed-Perfectionism and social support being the only statistically significant predictors. Hierarchic regression showed that even after controlling for social support, SSP significantly incremented the variance in 9%.

Our results highlight the need for preventive approaches to help women understand the origins of their dysfunctional beliefs (perfectionism, the myths of perfect motherhood) and for the promotion of positive cognitions.

No significant relationships.

Existing evidence regarding the association between hypertensive disorders of pregnancy (HDP) and the risk of maternal mental illness is inconclusive.

This study aimed (i) to investigate the relationship between HDP (pre-eclampsia and gestational hypertension) and the risk of depressive and anxiety symptoms during pregnancy and in the postpartum period and (ii) to test whether parity moderates the association between HDP and antenatal and postnatal anxiety and depressive symptoms.

The study cohort consisted of more than 8500 mothers who participated in the Avon Longitudinal Study of Parents and Children (ALSPAC), UK. Maternal antenatal and postnatal depressive and anxiety symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) and the Crown-Crisp Experiential Index (CCEI), respectively. Univariable and multivariable logistic and linear regression analyses were used to examine the associations.

Mothers with pre-eclampsia had a 53% (aOR= 1.53; 95% CI, 1.06-2.23) increased risk of antenatal depressive symptoms compared with those without pre-eclampsia. Having pre-eclampsia and being a nulliparous woman resulted in a 2.75 fold increased risk of antenatal depressive symptoms (p-value for interaction = 0.03). Gestational hypertension was associated with antenatal depressive and anxiety symptoms. We found no associations between pre-eclampsia and/or gestational hypertension and postnatal anxiety and depressive symptoms.

Our study showed that mothers with HDP were at higher risk of antenatal depressive and anxiety symptoms. Nulliparous women with pre-eclampsia are a higher risk group for depression during pregnancy.

No significant relationships.

The relation between insecure general attachment and social anxiety has long been established.

To explore the associations between social interaction and performance anxiety and avoidance, attachment styles, and parental marital status.

146 Portuguese adolescents, with a mean age of 18.99 years old (SD = .848; range: 18-20), filled in the Social Interaction and Performance Anxiety and Avoidance Scale and the Experiences in Close Relationships-Relationship Structures Questionnaire.

Distress/Anxiety was correlated with avoidance attachment to mother and father (rs = .17*, p = .04; rs = .18*, p = .03), to anxious attachment to romantic partner (rs = .21*, p = .01), and to anxious and avoidance attachment to best friend (rs = .25**, p = .00; (rs = .17*, p = .035). Avoidance was significantly correlated with avoidance to father and to romantic partner (rs = .18*, p = .03), and to anxious and avoidance attachment to best friend (rs = .21**, p = .009; rs = .18*, p = .03). A significant difference was found in avoidance attachment to father X2 = 10.246 (4, n = 146), p = .036, by parental marital status, with the adolescents with single/divorced parents presenting a higher mean score (Md = 111.10; Md = 82.93) than the other groups.

Distress/anxiety seems to be associated with more close relationships, and a single/divorced status with Avoidance. Longitudinal studies are needed to explore if insecure attachment to parents predicts insecure extra-familiar attachment, and to explore the long-term effects of parental marital status.

Psoriasis is a chronic inflammatory skin disease that affects approximately 2% of the population. It seems to have a multifactorial aetiology and it can be considered as a psychosomatic disorder.

To determine risk factors for anxiety and depression in psoriasis

Case-control study including 44 subjects with psoriasis and 50 controls without psoriasis. All participants answered the Hospital Anxiety and Depression Scale (HADS) to measure the severity of anxiety and depression

Descriptive study: We solicited 44 patients and the average age was 45.8 years. The majority of patients were married (70.5%), unemployed (40.5%), without medical heredity (84,6%). Psoriasis was in plaque (65.9%), guttate (20.5%), pustular (13.6.5%).Its severity, assessed by BSA, was mild to moderate in 72.7% of cases and associated arthropathy was noted in 29.5% of patients.the prevalences of anxiety and depression estimated at 29.54% and 18.18% respectively. Analytical study: Subjects with psoriasis, as opposed to controls, showed higher levels of anxiety (29,54% vs 15,9%) and depression (18,18% vs 4,54%) but there was no significant difference (p=0,335, p=0,573) Depression was significantly more important for single (p=0.043), for patients with associated arthropathy (=0.005) and for guttate form (p=0.015) According to the severity of the disease: patients with mild disease are more anxious and patients with severe disease are more depressed

Higher scores in anxiety and depression is common in psoriasis. Dermatologists should give special attention to this subgroup of persons with psoriasis in order to prevent future psychopathology.

Social Anxiety Disorder (SAD) is considered the most prevalent anxiety disorder with the highest disease burden amongst anxiety disorders. Despite available effective treatment with Cognitive Behavioral Therapy, a majority of individuals with SAD do not seek treatment and many drop out when confronted with elements of exposure. Several studies highlight the many advantages virtual reality exposure holds over in vivo exposure. In this study, we investigate the added effect of real-time biofeedback during virtual reality exposure.

The current study is part of a large scale study called VR8. The current study aims to develop and evaluate the feasibility of a VR-biofeedback-intervention for adults with mild to severe social anxiety disorder, before continuing randomized controlled trials.

Data from semi-structured interviews and surveys will be compared to biodata collected during VR exposure. Participants include a minimum of (n=10) patients and (n=10) clinicians from the Mental Health Services in the Region of Southern Denmark. Surveys include questionnaires used for assessment of anxiety symptoms, usability of technology, and presence in the virtual environment. Collected biodata includes heart rate variability and electrodermal activity. Behavioral markers include eye-gaze. The findings will be analyzed and discussed in a mixed methods design.

The study is ongoing. Preliminary results will be available at presentation.

Successful development and implementation of a biofeedback-informed virtual reality exposure intervention may provide increased reach for patients and individuals who would have otherwise not sought- or dropped out of regular treatment, as well as inform the clinician on how to proceed during virtual exposure.

Prof. Stephané Bouchard is consultant to and own equity in Cliniques et Développement In Virtuo, which develops virtual environments, and conflicts of interests are managed according to UQO’s conflict of interests policy; however, Cliniques et Développeme

Psoriasis is a chronic inflammatory skin condition affecting diverse racial/ethnic groups throughout the world. It has a major impact on the patient’s quality of life, influencing career, social activities, family relationships, and all other aspects of life

To evalue the quality of life in patients with psoriasis

Participants were outpatients of Hedi chaker University Hospital Center in sfax, Tunisia, recruited between January and July of 2017, diagnosed with psoriasis. A Demographic questionnaire and the Quality of life Questionnaire (SF-36) were administered in this study.

44 patients were included in this study. They had with a mean age of 45.8 ±12.1. The majority of patients were married (70.5%), unemployed (40.5%), without medical heredity (84,6%). Psoriasis was in plaque (65.9%), guttate (20.5%) and pustular(13.6.5%). Its severity assessed by BSA, was mild to moderate in 72.7% of cases and associated arthropathy was noted in 29.5% of patients. The overall average SF-36 scale scores for all patients ranged from 4 to 98 with an average of 55.97. The quality of life of patients was impaired in 45.5% of casesQuality of life was significantly more impaired in patients with associated arthropathy (p=0.004). There is no significant differences for the different dimensions of quality of life regarding the clinical form of psoriasis.

Psoriasis certainly has an impact on patients’ quality of life.So, dermatologists should give special attention to this subgroup of persons in order to prevent future psychopathology.

The data suggest that anxious drivers may engage in problem behaviors that expose them and others to an increased risk of negative traffic events.

To study the problematic behavior taxi drivers related to anxiety in three areas exaggerated safety/caution, performance deficits, and hostile/aggressive behaviors and to determine the factors who are associated with them.

This is a cross-sectional descriptive and analytical study of 58 taxi drivers in the city of Sfax, Tunisia. We used an anonymous questionnaire that included a socio-demographic fact sheet, and a driver behavior rating scale: Driver Behavior Survey (DBS) with 21 items.

The mean age of the drivers was 40.8 ± 10.2 years. The sex ratio was 0.98. 75.9% were married. 6.9% lived alone. 53.4% were smokers and 25.9% drank alcohol. Coffee and tea consumption were 59% and 33% respectively. 67% had a pathological personal history, including osteoarticular pathologies. 17.2% had a history of serious accidents. The behavior related to anxiety among taxi drivers was 74.66 ± 13.35. The hostile behavior was 18.88 ± 8, the exaggerated safety behavior was 38.31 ± 7.3 and the deficit performance related to anxiety was 17.47 ± 7.1. The problematic behavior in our population was significantly associated with lifestyle alone, coffee consumption and with serious accidents.

The results of our study identified some risk factors that could lead to poorly adaptive driving behaviors among Taxi drivers. These elements reinforce us in the idea that this population requires special care with a meeting with the doctor.

Studies on fear conditioning have made important contributions to the understanding of affective learning mechanisms as well as its applications (e.g., anxiety disorders, post-traumatic stress disorder). However, central mechanisms of sleep related consolidation of fear memory in humans have been almost neglected by previous studies.

In the current study we aimed to test effects of sleep and a period wakefulness on fear conditioned responses.

In our experiment in a group 18 healthy volunteers event-related brain potentials (ERP), heart rate variability (HRV) and behavioral responses were recorded during a fear conditioning procedure presented twice, before daytime sleep (2h) or control intervention (a period of wakefulness) and after. The conditioning procedure involved pairing of a neutral tone (CS+) with a highly unpleasant sound (UCS+).

Differential conditioning manifested itself in the contingent negative variance (CNV)-like slow ERP component. Both period of sleep and wakefulness resulted in an increased amplitude of the CNV to CS+. But we did not find an interaction effect of Time (Pre-Post) by Intervention (Sleep-Wake), suggesting that sleep did not affect the conditioned response differently as compared to a period of wakefulness. An apparent increase in HRV after a period of wakefulness did not affect fear conditioned responses (CNV and valence ratings).

To summarize, the data indicate that fear memories are consolidated with the course of time with no beneficial effect of sleep; relearning of fear causes stronger differential responses as measured by slow wave amplitude but not behavior; increase of HRV does not affect fear learning.

Pseudoneurological symptoms are frequent among children consulting in neuropediatrics. Psychogenic origin is often unrecognized, which may cause a major disruption and an increase of medical care expenses.

The purpose of this study was to identify clinical features of pseudoneurological symptoms through patients admitted in neuropediatrics.

A descriptive retrospective study of a population of 19 children and adolescents hospitalized in the neuropediatrics department at the National Institute of Neurology in Tunis, between January 2015 and April 2019, having recieved the diagnosis of psychogenic symptoms.

Twelve girls and seven boys were included in this study.The averge age were 11.5 years. All patients had normal cogntive and motor development. In most cases (84%), patients had a history of somatic illness. Only three patients had a history of psychiatric disorders. Family history of somatic disorders was found in 42 % of the sample and psychiatric disorders in three patients. Negative pseudoneurological symptoms such as loss of function, were detected in 60 % of patients, paraparesis and paraplegia were the most recurrent. Only one patient had pseudo-epileptic symptoms. Further investigations were performed in all patients, averaging 4 tests per patient. The average term between the beginning of the symptoms and the established diagnosis of psychogenic symptoms was 72 days with an average stay at hospital of 4 to 7 days. All patients had conversion disorder according to DSM V.

It is recognized that somatization could be a warning sign of psychological distress mainly among children. Conversion disorder, rarely seen in children, presents frequently as pseudo neurological symptoms.

Personality traits like neuroticism and trait-anxiety, as well as the predisposition to a greater sensitivity to pain, are risk factors for dental anxiety. Although perfectionism has been associated with both anxiety and pain, particularly when mediated by repetitive negative thinking/RNT (Macedo et al. 2015; Albuquerque et al. 2013), its role in dental anxiety has not yet been studied.

To analyze the role of perfectionism and RNT in dental anxiety.

A community sample of 552 adults (68.2% women; mean age=35.15±15.79 years) completed the Portuguese versions of:Hewit and Flett Multidimensional Perfectionism Scale–13, State-Trait Anxiety Inventory, Sensitivity to Pain Traumatization/SPT Scale, Fear of Dental Pain/FDP Questionnaire, Perseverative Thinking Questionnaire and Dental Fear Survey/DFS.

Trait-anxiety (r=.225), socially prescribed perfectionism/SPP (r=.177), SPT (r=.286), FDP (r=.509) and RNT (r=.274) were significantly (p<.01) correlated with dental anxiety (DFS total score). Serial mediation analysis using the PROCESS-macro 3.5 for SPSS (Hayes, 2020; Model 6) showed that even controlling for trait-anxiety and gender (as SPT, FDP and RNT mean scores were significantly higher in women, p<.01) SPP plays a significant indirect effect through SDT, FDP and RNT on dental anxiety, which are (isolated or sequentially) full mediators of this relationship (Total effect: .553, p<.001).

This study shows for the first time that negative perfectionism is a predictor of dental anxiety; its influence operates through the increase in levels of sensitivity to pain, DPA and RNT. We suggest that when intervening in this health problem it is important to evaluate perfectionism and try to mitigate its negative impact, namely diminishing RNT and the focus on pain and fear.

The main risk factor for dental anxiety is previous traumatic experiences of pain in the dental office. Other consistent etiologic factors are trait-anxiety and preparedness (genetic predisposition to increased sensitivity to pain and aversive stimuli). However, there is a wide inter-individual diversity in the anxiety experience – not all individuals with traumatic experiences at the dentist will develop dental anxiety anxiety

To explore potential paths by which a traumatic experience at the dentist (TRAUMA) can lead to dental anxiety.

A community sample of 552 adults (68.2% women; mean age= 35.15±15.790) completed the Portuguese validated versions of: Dental Fear Survey/DFS, State-Trait Anxiety Inventory, Sensitivity to Pain Traumatization/SPT Scale, Fear of Dental Pain/FDP Questionnaire and Perseverative Thinking Questionnaire–15.

140 participants (25.2%) had TRAUMA; it was significantly (p<.01) correlated with trait-anxiety (Spearman r=.190), SPT (r=.192), FDP (r=.333), RNT (r=.274) and dental anxiety (DFA total score; r=.418). In the mediation analysis (PROCESS macro 3.5 for SPSS; Model 81; Hays, 2020), trait-anxiety and gender were controlled (as RNT, SPT, FDP mean scores were higher in women, p>.01). Our model was significant (R2=17.15%; p<.001) and showed that TRAUMA predicted dental anxiety directely [direct effect: 10.25 (95% CI - 7.10-13.40)] and also through SPT, FDP and RNT (5 significant indirect effects).

This study underlines the importance of avoiding traumatic experiences in the dental office and of good clinical communication in pain management. If trauma still occurs, dentist should learn how to reduce its impact on the sensitivity and fear of pain and on the RNT.