The paper presents the results of one international study due by our team in the period of restrictions imposed by Covid-19, between March and June 2020.

To inform the population about the risks concerning the excessiv use of internet To prevent the effects of those behaviors which affects the global functioning of individuals

Questionnaire applied to a number of 549 subjects, 18 to 60 years old, 217 from Romania and 332 from other European and Asian countries

The results allowed us to verify the assumption that there is a change in communications needs of individuals, as well gender and age differences in terms of time spent on the internet during the covid period.

The issue of psycho-education regarding the awareness of dangers and the traps of the virtual era remain relevant.

While prison inmates have an increased risk of mental illness, psychiatric services are often less accessible and insufficient for this group. A low level of awareness or a fear of becoming stigmatised could also influence the help-seeking behaviour of some inmates.

To study the knowledge and beliefs regarding mental health and mental illness as well as the help-seeking behaviour of inmates in Norwegian prisons.

We describe a study of help-seeking behaviour and mental health literacy of prisoners. This is a qualitiative study involving in-depth interviews with inmates in prisons in North Norway.

Recruitment and data collection is ongoing. Central topics in the interviews are inmates’ associations regarding positive mental health and how they can enhance their own well-being while in prison, and how other external factors can contribute to increased well-being. Furthermore, the inmates are asked about their attitudes, beliefs, and knowledge regarding mental illness, and what they think might be factors that can contribute to the development of mental illness. Moreover, we cover topics such as the inmates’ beliefs regarding the treatment of mental illness, strategies for handling such health problems, and sources of information regarding mental health and mental illness.

The study will increase knowledge about how prisoners think about mental health and mental illness and the help-seeking behaviours of prison inmates. In a next step, this understanding can be utilized in improving information about well-being, mental illness, and psychiatric services to prisoners.

Blood pressure (BP) refers to the pressure that the blood exerts on the walls of blood vessels. There is a number of evidences that show that depression, anxiety, and also stress have a high incidence in people suffering from hypertension.

To correlate blood pressure levels with psychopathological symptomatology levels and to compare differences between genders, age and education levels.

This was a descriptive, inferential and correlational study encompassing 1407 participants, aged from 18 – 89 years of age (average age = 36 years). Measures included biomedical data - systolic blood pressure and diastolic blood pressure, arrhythmias and heartbeat, as well as the demographic variables - sex, age and education of the participants; mental health (psychopathological symptomatology) was measured using the Portuguese version of the BSI.

In the present study there were no statistically significant relationships between Systolic Blood Pressure, Diastolic Blood Pressure and General Symptom Index, as well as for each BSI dimension. Nevertheless, statistically significant differences were found between Diastolic Blood Pressure and obsessions-compulsions, interpersonal sensibility and hostility. Also, there are statistically significant differences for BP according to gender and education.

This study brings important contributions to the study of the associations between blood pressure and mental health, with import implications for intervention and prevention.

Mental disorders in Europe represent the leading cause of disability and the third leading cause of overall disease burden, following cardiovascular disease and cancers. As future healthcare professionals, with an imminent role in tackling this global health issue, we acknowledge that Mental Health is not adequately included in the medical curriculum. To address this gap, this workshop was created to equip medical students with the knowledge and skills that will empower them to lead a pioneering role in advocating for mental health for their patients, peers, and communities.

By the end of the workshop, all participants should have: - Increased their knowledge in the field of Mental Health disorders - Increased their skills in the field of Mental Health (preventive practices, intervention strategies towards others, etc.) - Explored the relations between stigma, vulnerability, and Mental Health - Strengthened the international perspective and global understanding concerning mental health issues

This workshop utilized principles of non-formal education and was planned according to the 4MAT system to meet all four learning styles through theory blocks, space for reflection, practical application of knowledge, and future opportunities for application of content. This was achieved through various methodologies including presentations, self-discovery activities and exercises, roundtable debates, simulations, and role-playing.

obtained

This workshop highlighted the importance of building the capacity of medical students to tackle the burden of Mental Health globally and within the region, and how similar student-led initiatives can further empower them to be change agents and impactful advocates for better Mental Health in their own communities.

In the United Kingdom, the move from trainee to consultant psychiatrist can be both exciting and daunting. Trainee psychiatrists have access to support and weekly supervision that is not available to consultants. Having an organised meeting for new consultants could help bridge this gap with peer-led support.

Improving support and guidance to new consultants Networking with peers Promoting wellbeing, good clinical practice and career development

We identified a group of 85 consultants in their first five years of practice. Meetings were held online using videoconference. Senior leaders presented at each meeting, with a group discussion at the end. We surveyed attendees using an online platform.

We had excellent attendance rates from the group, with 30 to 45 consultants attending each webinar. Over 60% of attendees had been a consultant for less than a year. For 90%, this was their first experience of a new consultant forum. Attendees gave excellent feedback (Table). Being able to meet consultants from different specialties, hearing career stories from senior leaders and how they have managed the COVID-19 pandemic were cited as benefits.

The forum was popular and the feedback was excellent. Using an online format worked well and made it easier to organise and plan sessions. There is potential to implement similar fora for other senior psychiatrists across Europe.

In recent years there has been increasing interest in knowing the function of the microbiota, especially its role in the gut-brain axis. The microbiota is the set of millions of microorganisms that coexist in a symbiotic way in our body and are located in the digestive tract mainly. Numerous evidences show that the microbiota could modulate the information directed to the brain and therefore the pathogenic basis of numerous psychiatric and neurological disorders.

A better understanding of the microbiota and its interaction with the brain and mental health.

Review of recent literature about the implications of the gut microbiota in psychiatry.

The connection between the microbiota and the central nervous system (gut-brain axis) occurs through the vagus nerve, the systemic pathway (through the release of hormones, metabolites and neurotransmitters) and the immune system (through the action of cytokines). Changes in the microbiota are associated not only with gastrointestinal diseases, but also with disorders such as depression, anxiety, autism, anorexia, attention deficit and hyperactivity, Alzheimer’s disease and Parkinson’s disease. As some research indicates, changes in diet and composition of the microbiota can reduce the risk of suffering these diseases or reduce their symptoms. Other therapeutic alternatives postulated are the use of probiotics or fecal microbiota transplantation.

Despite growing interest in the microbiota in the last few years, little is known about the mechanisms underlying this communication. More research is expected to contribute to the design of strategies that modulate the gut microbiota and its functions in order to improve mental health.

A relationship between childhood trauma, psychotic experiences, and psychosis is well established, although causality is not yet ascertained. There are several hypotheses linking trauma and psychosis, regarding genetic vulnerability and/or other environmental factors, possibly also mediated by psychological mechanisms. Long-term modifications to the transcriptome are likely mediated by epigenetic mechanisms. There is also growing evidence supporting an association between childhood trauma and adulthood dysregulation of the immune system, which could help clarify the relationship between trauma and mental disorders, namely psychosis.

Review evidence regarding the relationship of childhood trauma, immune system and psychosis.

Literature review using Medline database.

The prevalence and severity of childhood trauma is characterized by both biological alterations and increased risk of experiencing symptoms of psychosis. Childhood trauma, namely through its effects on IL6 levels, may be a risk factor for schizophrenia in general. Some studies point to a direct relationship between childhood trauma, immunity and psychosis when examined along a continuum from non-clinical controls to psychotic disorders such as schizophrenia.

For better understanding this association, these findings must be replicated in larger cohorts. If the impact of childhood trauma on immune function in adulthood does indeed contribute to psychopathology, an improved understanding of this relationship may lead to new and possibly more specific treatment options. Other clinical implications of these findings include increased emphasis in establishing more comprehensive screening of early trauma in patients with psychotic symptoms, as well as the importance of screen and follow children who report traumatic events for emergence of psychotic symptoms.

Inflammation is an important factor in the pathogenesis of endogenous psychosis. An inducer of inflammatory reactions can be endotoxin aggression of intestinal origin.

To determine the level of inflammation markers and indicators of systemic endotoxinemia in blood of patients with endogenous psychosis in relation to assessment of the treatment effectiveness.

25 patients with endogenous psychosis (F20, F25) were examined before and after treatment. The control group consisted of 25 healthy people. The activity of inflammatory markers - leukocyte elastase, α1-antitrypsin, antibodies to S-100B, and indicators of systemic endotoxinemia – endotoxin concentration and antiendotoxin immunity activity were measured in blood serum. The treatment effectiveness was assessed by the dynamics of inflammatory markers.

Based on the results of determining the studied parameters before treatment, all patients were divided into two groups. In the 1st group (6 patients, 24%), an increase of inflammatory markers activity and high concentration of endotoxin in the blood serum were revealed (p<0,001, p<0,05, respectively). In the 2nd group (19 patients, 76%), only activation of inflammatory reactions (p<0,001) was detected. After therapy in the 1st group of patients, there was no positive dynamics of all studied markers, which indicated an active course of the pathological process. In the 2nd group, the normalization of inflammatory markers was shown (p<0,05), which corresponded to the formation of remission.

The results indicate that endotoxic aggression contributes to reduction of the effectiveness of endogenous psychosis therapy and can be considered as an additional therapeutic target.

Current studies indicate the involvement of inflammation in the pathogenesis of chronic non-infectious diseases, and therefore it is of interest to study the role of inflammation markers in non-psychotic mental disorders (NPMD).

To identify a number of inflammatory markers in serum of patients with NPMD.

73 patients with NPMD were examined (F43.2; F06.6). The comparison group consisted of 76 patients with endogenous psychosis (EGP) (F20.0; F25.0). The control group included 80 healthy people. The serum activity of leukocyte elastase (LE), α1-proteinase inhibitor (α1-PI) and the level of autoantibodies (aAb) to neuroantigens were determined.

Three groups of patients with different variants of inflammatory response to the pathological process were identified. In group 1 (23.3%), all indices corresponded to the control values, which indicated the absence of the pathological process in brain. In group 2, there was a significant increase in activity both LE and α1-PI compared to control (p<0.05). This type of immune reaction characterized a balanced inflammatory response. It was found in 52% of patients with NPMD and in all patients with EGP. The aAb level also exceeded the control values (p<0.05). Group 3 (24.7%) showed an increase in α1-PI activity (p<0.05), but not in LE activity compared to control. Insufficient LE activity reflects a decrease in the functional activity of neutrophils.

The immune heterogeneity of NPMD according to the level of inflammatory markers was identified. 52% of patients with NPMD have a pronounced activation of inflammatory reactions accompanied by increased levels of aAb to neuroantigens.

It is known that the intensity of inflammation weakens with age, and therefore it is of interest to study the clinical features of schizophreniс process in relation to the level of inflammatory markers.

To determine the level of inflammatory markers (the activity of leukocyte elastase (LE) and α1-proteinase inhibitor (α1-PI), autoantibodies (aAB) to neurotrophin S100b and myelin basic protein) in plasma in different years old groups of patients with schizophrenia.

Two groups of patients with schizophrenia were examined: the 1st group - 19 women aged 60 to 78 years; the 2nd group - 24 women aged 19 to 42 years.

An increase in activity both of LE and α1-PI was found in young patients. This characterizes a balanced inflammatory response. Elderly patients showed a similar increase in the activity of α1-PI, however, LE activity did not exceed the control values. Insufficient LE activity probably characterizes a decrease in the functional activity of neutrophils. The negative correlation was revealed between the activity of LE and TotPsy (PANSS) in the group of elderly patients (r=-0.62, p<05) and positive correlation between aAB to S100b and TotNeg in both groups (r=0.56 and r=0.49, p<05 respectively). There is relationship between age, the activity of psychopathological symptoms and the rate of development of schizophrenia: the rapid course and variety of disorders at a young age, against the poverty of symptoms and a slow rate in the elderly.

There is relationship between the features of inflammatory reactions and clinical picture in elderly and young patients with schizophrenia.

Anti-NMDA-receptor encephalitis is a severe rare acute form of encephalitis caused by an autoimmune process with the synthesis of autoantibodies to the glutamate receptors. The average age of onser is estimated to be 23-25 years. A typical clinical picture consist of prodromal, psychotic, areactive, hyperkinetic phases, and a phase of gradual regression of symptoms. The disease usually lasts for a several weeks with spontaneous recovery or fatal outcome and caused by neoplastic process. Our case demonstrates that the course of anti-NMDAR encephalitis is possible at more mature age in the form of a long process with cultural features, without significant catadrome, inflammation and associated neoplastic process.

50-year-old woman complained about hypomnesia, anosmia and dissomnia. The disease began with impaired consciousness, disorientation, seizures and memory loss 4 years ago. After 3 weeks IgG to the herpes simplex and cytomegalovirus were detected. Then after a discharge with no improvement and visit of Lama, the symtoms described above spontaneously reduced and schizophrenia-like psychosis developed, accompanied by mild neurological and severe neurocognitive symptoms, weight loss, intolerance to antipsychotics in minimal daily doses. This state was mantained till 2020.

Examination included: CBC, metabolic panel, coagulogram, tumor markers, CSF, MRI, PET, specialists.

CBC, metabolic blood analysis, tumor markers - within the reference values. CSF: cytosis 9/3, glucose 5.5 mmol/l, Pandi++, Nonnet-Apeltau+, antibodies to the NMDA receptor - 8. MRI: signs of the consequences of encephalitis. PET: no signs of metabolic activity of the malignant process.

This case brings additional data about a couse, age of onset, duration and trigger factors for anti-NMDAR encephalitis.

Multiple Sclerosis (MS) is an immune-mediated inflammatory demyelinating disease of the central nervous system. Concomitant psychiatric diseases are frequent in MS, with depression and anxiety disorders constituting the majority. The presence of psychotic disorders with MS is rare. Several studies have reported that psychotic symptoms usually develop after the neurological signs of MS and they are mostly linked to the side effects of treatment with interferon or with corticosteroids.

The authors report here the case of patient with MS without psychiatric history that developed psychotic symptoms.

Beside the medical record of the patient a non-systematic search of the literature was carried out in the databases Pubmed and Google Scholar with the terms “Multiple Sclerosis”, “Multiple Sclerosis treatment ”and“ Neuropsychiatric symptoms ”.

A 38 years old woman with MS, with no psychiatry history developed paranoid and reference delusions, several months after starting interferon beta-1a therapy. The inferferon therapy was stopped and the patient was started Risperidone 3 mg id with a rapid but only partial remission of the psychotic symptoms. The patient presented high blood levels of prolactine and the MRI showed a pituitary microadenome. The Risperidone was switched to Aripiprazol 15 mg also with partial remission of the psychtic symptons.

It is not possible to attribute our patient’s psychotic symptoms entirely to his Interferon therapy or to MS lesion load, but the occurrence during treatment, no psychiatric history and the rapid but parcial resolution with discontinuing suggest that Interferon therapy was at least contributory to the clinical picture.

Autoimmune encephalitis (AE) refers to a newly described, heterogeneous group of rare diseases characterized by brain inflammation and circulating autoantibodies. Various AE have been described and each of them is linked to the presence of specific autoantibodies directed against synaptic and neuronal cell surface antigens. The clinical picture includes a wide array of neuropsychiatric symptoms and is correlated with the associated antibody subtype. Since pronounced psychiatric symptoms are relatively common at the onset, patients can be misdiagnosed and initially driven to psychiatric institutions, thus delaying the adequate diagnosis and management of AE.

We aim to review and summarize the psychiatric manifestations of AE that might dominate the clinical picture. We also aim to describe the clinical signs that should alert the psychiatrist to the possibility of these diagnoses.

We performed an updated review in the PubMed database using the terms “autoimmune”, “encephalitis” and “psychiatric manifestations”. The included articles were selected by title and abstract. We also consulted a reference textbook.

We summarize the reported psychiatric manifestations of AE and also include two situations that can be helpful in AE diagnosis in the psychiatric setting: symptoms that should alert the physician for the possibility of AE and symptoms that should prompt an antibody detection test.

AE are rare diseases that present very frequently with psychiatric symptoms as the first manifestation. Psychiatrists need to be aware of the most common psychiatric manifestations of AE since the early recognition and treatment of AE is fundamental for a good outcome.

Apathy is a neuropsychiatry syndrome, conceptualised as a loss of motivation free of altered consciousness, cognitive impairment or emotional distress, associated with a wide range of brain disorders such as Dementia, Major depression and schizophrenia. Even though under-recognized and under-diagnosed, apathy hardly appears uncommon. Its reported frequency in various neurologic and psychiatric conditions varies widely, from less than 10 to over 80%, reflecting differences in population characteristics and assessment procedures.

The aim of this article is to review the concept of Apathy and clarify its nosology, pathopshysiology and treatment.

An online bibliographic search was carried out on PubMed and Medline using “Apathy” as a term.

The literature reviewed shows that apathy is a multi-dimensional clinical construct with a current definition and validated diagnostic criteria. Analysis reveals that apathy is strongly associated with disruption particularly of anterior cingulate cortex (ACC), ventral striatum (VS) and nucleus accumbens (N acc). Remarkably, these changes are consistent across clinical disorders and imaging modalities, playing a crucial role in normal motivated behaviour.

The neuromodulator dopamine is heavily implicated in ACC and VS. Therapeutically, numerous small studies suggest that psychostimulants, dopaminergics, and cholinesterase inhibitors may benefit those manifesting this syndrome. However, no adequately powered, randomized controlled trials have reported success and no medication have ever been approved for this disorder Further research is needed to help understand the functional neuroanatomy, neuromodulators involved and possible treatment options of this clinical construct.

Capgras syndrome, where patients have the conviction that one or more close people have been replaced by a “double,” is the most prevalent delusional misidentification syndrome. It appears in psychiatric illness and organic brain damage. It seems to be due to damage of bifrontal and right limbic and temporal regions, mainly in the right hemisphere.

To review the pathologies associated to Capgras Syndrome and the relevance of the differential diagnosis

53-year-old female was admitted due to great sadness, crying, social withdrawal and severe paranoid concerns over the last month. Follow-up in Mental Health since 2014, because of anxious depression. After her mother’s death, she felt being followed because of old faults. Since then, low dosis of antipsychotics were used. Now she is afraid of being harmed in relation to petty thefts she committed over 15 years ago. In recent days, she has been noticing small details indicating that her family members have been impersonated by strangers, showing anguish regarding their whereabouts.

During her admission, high doses of antidepresants and paliperidone 6 mg/day were used with the complete disappearance of Capgras Syndrome and her anguish. Mild guilty thoughts were present after her discharge. That is why she was diagnosed with psychotic depression.

Capgras syndrome can be encountered in primary psychiatric diagnosis (particularly in schizophrenia and mood disorders) – where an organic element may exist in about a third of all cases – or secondary to organic disorders or medication-induced, through to overt organic brain damage, particularly in neurodegenerative disease.

Impulse control disorders (ICDs) are an adverse effect of dopamine agonists (DAAs) that affects the quality of life and can lead to legal, criminal and familiar problems.

Presenting a review of the mechanisms, prevalence and factors associated with the development of an ICD due to DAA use.

Search on Pubmed database with combination of the following keywords were used: “Impulse control disorders”, “dopamine agonist” or “therapy”. We focused on data from studies published between 2015 and 2020. The articles were selected by the author according to their relevance.

DAAs are mainly indicated in the treatment of Parkinson’s Disease (PD), and are also used on symptoms of restless legs syndrome (RLS) and prolactinoma or lactation inhibition. Dopamine replacement therapy act on dopamine receptors in the nigrostriatal and the reward pathways, which plays a role in addictive behavior. The prevalence of ICDs ranged from 2.6 to 34.8% in PD patients and a lower prevalence in RLS patients. Some of the ICDs reported were pathological gambling, hypersexuality, compulsive shopping, obsessive hobbying, punding, and compulsive medication use. The factors associated with the development include the type of DAAs, dosage, male gender, younger age, history of psychiatric symptoms, earlier onset of disease, longer disease duration, and motor complications in PD.

Further studies are needed to clarify the pathophysiology of the ICD in DAA therapy and determinate premorbid risk factors. The percentage of patients with ICDs is underrated, so it’s important to improve the patient’s evaluation, using validated and consensual assessment tools.

Day care programs have been extensively used to treat people with acute psychiatric disorders. Day hospitals (DH) can act as an alternative to admission in patients with acute symptoms, shorten the duration of admission, be useful for rehabilitation and maintenance care or enhance treatment in patients with poor adherence to outpatient care. Few research has been conducted in delusional disorder (DD).

To investigate whether DH care increases adherence with psychiatric appointments in patients with DD. To describe functions of partial hospitalization in DD.

Comparative study including DD patients who attended a DH (Group 1:n=12) versus patients who did not receive DH care (Group 2;n=7). Patients attending DH were classified into 3 groups according to the program function at referral. Adherence with outpatient follow-up appointments (primary outcome) and pharmacy refill data (secondary outcome) were assessed after discharge over a 6-month period (DH) and compared with group 2. For statistical analyses, non-parametric tests were performed.

Program function (DH): alternative to admission (n=4); shortening of admission (n=5) and enhancing outpatient treatment (n=3). Patients receiving DH care were more frequently referred from the inpatient unit or emergency department compared to those who did not attend DH (commonly referred from primary care services). No statistically significant differences were found between both groups in adherence to psychiatric appointments. Patients who attended DH showed higher compliance with antipsychotics (89.29% vs.72.62, p<0.05).

DH care may be a useful alternative to increase adherence with antipsychotics in DD patients with poor awareness of illness.

AGR has received honoraria, registration for congresses and/or travel costs from Janssen, Lundbeck-Otsuka and Angelini.

Insight is a complex and multidimensional phenomenon. Metacognition, awareness of illness or anosognosia are some of the terms used to designate this feature of the mental state exam.

To attempt to explore the evolution of the concept of insight as a psychiatric symptom over the years and to bring up some up-to-date features on this theme.

Literature review, using the most relevant papers, with the keywords “psychiatric insight”, “awareness of illness”, “metacognition” and “phenomenology”.

The term ‘insight’ has been described since 1896 when Kraepelin had noticed that patients with dementia praecox were unaware of their condition. Nowadays, it is recognized in several psychiatric disorders, with different meanings in each one. Overall, insight in psychiatry involves an attempt to see one’s thinking and behaviour ‘objectively’ and comparing it to some representation of mental health. Impaired insight has been linked to poor treatment compliance and outcomes, overall symptom severity, higher relapse, lower self-esteem, and impaired psychosocial functioning. White matter and connectivity problems may be related to poorer insight, as well as impaired frontal lobe functioning. In psychotic disorders, lack of insight is a primary symptom with poorer outcomes. Regarding affective disorders, the lower the mood the better the insight. Neuroimaging has been correlating insight with the inferior frontal gyrus, anterior insula, inferior parietal lobule, and ventromedial prefrontal cortex. In everyday practice, there are scales used to assess insight.

Inferences about patients’ insight are important to evaluate severity of illness, suicidal risk, compliance, and response to treatment.

Lying can be defined as stating a deliberate falsehood with the intent to deceive. It is part of our everyday life but it can be pathological, without motivation and a symptom of psychiatric illness. Although pathological lying has been debated for a century, it remains a controversial issue in Psychiatry.

We aim to perform a review regarding pathological lying and related issues.

We performed an updated review in the PubMed database and GoogleScholar using the terms “pathological lying”, “compulsive lying”, “mythomania” and “pseudologia fantastica”. The included articles were selected by title and abstract. We also consulted reference textbooks.

We described the difference between normal and pathological lying and debated the different types of pathological lying, such as compulsive lying, mythomania and pseudologia fantastica.

Recognizing lying is crucial for a skilled patient interview and distinguishing between pathological and non pathological lying may be decisive for an accurate differential diagnosis.

Animal hoarding is characterized by hoarding of a large number of animals without providing minimum conditions of nutrition and sanitation, accompanied by lack of insight for the behavior and by social isolation. Despite studies detecting an increasing incidence, the behavior is still poorly understood.

To review clinical evidence on animal hoarding and to report a clinical case.

We report a clinical case based on patient’s history and clinical data, along with a review of the literature on animal hoarding. The terms “Noah syndrome” and “animal hoarding disorder” were searched on PubMed® database.

We present the case of a 51-years-old woman, living alone, with higher education. His first contact with psychiatry was in August 2019 upon aggravated self-neglect and behavioral disorganization. She was living with around 40 cats, her home was extremely deteriorated. In December 2019 she was admitted to a psychiatric unit. A schizophrenia diagnosis was established and pharmacological treatment was initiated. She was discharged to a chronic psychiatric institution. Studies found out that animal hoarders are typically middle age/older women living alone in squalid conditions. Animal hoarding is characterized by a chronic course and intense emotional attachment to animals. It seems to be associated with traumatic situations, as well as mental disorders such as schizophrenia or dementia. Published data on intervention and treatment is still limited.

Animal hoarding phenomenon requires further investigation, regarding developmental risk factors and co-morbid mental disorders. Comprehensive approaches to clinical intervention and management strategies in animal hoarding are necessary.