Attention Deficit and Hiperactivity Disorder (ADHD) is a neurobiological disorder, affecting executive functions and defined by hyperactivity, attention deficit and/or impulsivity symptoms. This neurodevelopmental disorder affect up to 7% of children. It is observed as a chronic pathology appearing on childhood with other comorbid diseases. Often, remarkable symptoms use to change with the age, however a real improvement is also related with other -external- factors, as social environment.

-To highlight variability of ADHD symptoms and complexity of available treatments in childhood. -To analize influence of personal and familiar factors, which affect to evolution of ADHD and the response to treatment.

Comparative-study. Retrospective selection of 8 patients with treatment for ADHD and currently stable. A 12-months ADHD confirmed diagnosis in Child and Adolescent Mental Health Unit and follow-up after diagnosis. They are compared by aged-pairs (females and males) at the different development school-stages (preschool 3-6 years, primary school 7-12 years and adolescence 13-16 years). *Pairs of study: male-5 years/female-6 years; male-7 years/female-8 years; female-10 years/male-11 years; female-13 years/male-15 years

-Evolution of ADHD highlights the influence of age-factor about remarkable symptoms mainly (from hiperactivity to inattentiveness). -Comorbid disorders seems related with sex-factor (impulsivity-eating disorders on females and irritability-mood disorders on males). -Children social environment, specially family support, is an important external factor for all these patients (low self-steem or somatization disorders).

1. ADHD as a chronic disorder whose evolution depends on the age, sex and social factors 2. Genetic component or familiar support are also considered as influencers factors 3.Multidisciplinary approach to objectives: motivation, organization and maturity 4. Treatment is consider according to side effects and comorbidity

Despite the high prevalence of substance use disorders, the majority of affected individuals do not seek any medical help or receive treatment targetting mainly symptoms of intoxication, withdrawal or general medical conditions due to chronic use of psychoactive substances. Patients with substance use disorders are more likely to remain undiagnosed regarding other psychiatric illnesses. Electronic patient-reported outcomes (ePRO) provide an easy-to-use instrument for detailed assessment at low economic cost.

To assess patients’ attitude towards self-reporting of symptoms related to substance use, mood, anxiety, quality of sleep, medication intake, social performance, and psychotic symptoms.

Mobile application consisting of seven questionnaires (Mood, Anxiety, Substance Use, Sleep, Medication, Social Activity and Various symptoms) was offered for use to patients with substance use disorder. Enrolled subjects were encouraged to use the app to report their actual condition in accordance with their own willingness and lifestyle.

Throughout the study a total of 1077 completed questionnaires were submitted, of which 193 (17.9%) were on mood, 188 (17.5%) - on substance use, 187 (17.4%) – on sleep, 155 (14.4%) – on anxiety, 139 (12.9%) – on medication intake, 111 (10.3%) – on psychotic symptoms, and 104 (9.7%) – on social performance.

Our research revealed that patients with substance use disorder are likely to share concerns regarding variety of psychiatric symptoms besides these attributed to their primary diagnosis. Implementation of ePROs can be a valuable tool for in-depth assessment and subsequent meeting the needs of such patients.

No significant relationships.

Clozapine is a neuroleptic commonly used in treatments resistant to schizophrenia. However, despite the benefits, clozapine might cause some serious side effects. Hence, it is of the utmost necessity to keep an exacting control of the patients.

To study some of the therapeutical approaches to the treatment of clozapine induced neutropenia and agranulocytosis.

Review of some articles in Mental Health Journals.

The treatment with clozapine, substratum of aminergic and muscarinic receptors, entails a 0.9% risk of causing agranulocytosis, and approximately a 2.7% risk of causing neutropenia. Both occur, over 80% of them, during the first 18 weeks of treatment. Thus, before starting it, it is necessary to draw some blood and analyze the complete blood count (CBC). Also, we must analyze CBCs weekly during the first 18 weeks. Other dyscrasias like leukopenia, leukocytosis, anaemia, eoshinophilia, thrombocythaemia or thrombocytopenia can also be observed. When agranulocytosis appears, it can be treated by discontinuing the clozapine treatment, but also using granulocyte-colony stimulating factor or lithium, both separated or combined with clozapine. Lithium produces reversible leukocytosis onceplasma levels of > 0.4 mmol/L are reached. Despite the simultaneous treatment with lithium, clozapine can trigger some neurological side effects, it seems that seizure risk remains invariable.

Some of the clozapine's side effects, like neutropenia or agranulocytosis, are potentially lethal. Their treatment consists of discontinuing clozapine or initiating granulocyte-colony stimulating factor or lithium. These are good options that can give rise to a later continued treatment with clozapine.

The authors have not supplied their declaration of competing interest.

There is a growing concern about the potential risk that the use of certain antipsychotics may have on the QTc prolongation, electrocardiographic parameter key to assess the potential risk of developing a potentially lethal ventricular tachyarrhythmia:“Torsade de Pointes”. Previous studies highlights the existence of low levels of potassium in severely agitated patients versus moderately agitated ones (1). So if we take into account that seriously agitated patients tend to receive higher antipsychotic doses, and mainly antipsychotic with a more sedative profile, we face a hotbed for causing a potentially lethal tachyarrhythmia.

Evaluate the presence of hypokalemia in agitated psychiatric patients.

We chose a random sample of 31 agitated psychotic patients attending emergency room and we make a determination of potassium level at that time, compared to a sample of 33 others randomly as control who donate their blood in the hospital blood bank group. Final results, showed that agitated patients presented potassium figures significantly lower than the control group. (3.88 average in agitated versus 4.14 control group), (p = 0,048).

These data confirm our hypothesis of work and the relationship between hypokalemia and psychomotor agitation in psychotic patients attending the emergency ward, increasing notably the risk for “Torsade de Pointes”.

One of the most serious forms of abuse is sexual abuse (SA), especially when the victims are children. Questions still remain: what actual long-term consequences of child sexual abuse effect the mental health of children.

Examined-68 people (22 boys, 46 girls) having detected by physicians fact of SA, and recognized as victims in legal status. The group was split by age (3-6 years), and by the type of SA: family abuse and extrafamilial abuse. Group of 38 children – catamnesis study over a 5-year period.

To reveal long-term mental health consequences of child SA taking into accountd the type (family and extrafamilial).

All the children were examined repeatedly during the follow-up period, clinically and paraclinically by psychiatrist (clinical observation, dialog with the child and parents), by neurologist and clinical psychologist (projective techniques and standardized personality questionnaires).

Psychopathologic consequences of SA are divided into acute (reaction to stress), subacute (6 months after the trauma) and remote (observation during 5 years). In acute and subacute period the disorders are qualified as acute reaction to stress and PTSD.

In long-term period clinical characteristics were defined as conduct disorder (personality development disorder), primarily of mixed type. In the structure of remote psychopathologic presentations, especially as the consequences of family SA are – hyperemotivity, neuroticism (trichologia, onychophagia, enuresis and encopresis, asthenic syndrome and subdepressive syndrome, obsessive fears, dysmorphophobia and others).

In prepubertal period-runaways, promiscuity, early alcoholization, taking drugs, behavior as a victim, sex-role identification disorder.

There are above 170 PICUs in the UK, most of them being gender mix or male only. There is no specific data available about management of patients diagnosed with Borderline Personality Disorder (BPD) in PICUs.

Review of sociodemographic, clinical, outcome characteristics, care pathways and financial implications when managing BPD population in Female PICU.

To measure rates of compliance with NICE guidelines using such criteria as: comprehensive care plan provided on admission to PICU and at discharge from PICU; patient being involved in discussion about discharge plans; specialist assessment / treatment started before admission to Female PICU was continued during the admission; referral for psychological therapies was considered/made during stay in Female PICU; prescribing practice by referring and admitting teams; availability of specialist Personality Disorders (PD) services locally.

Retrospective cross sectional review of patient records.

76% of patients are admitted to Female PICU with a comprehensive multi-disciplinary care plan. 80% of patients transition from ECH was discussed carefully with the patient beforehand. Specialist assessment/treatment started before admission to ECH was continued during the admission 100%. Most of the patients would receive treatment by various psychotropic meds prior and during the admission. Referrals to psychological therapies were considered for 19% of patients. There is a lack of specialist PD services.

BPD is the most costly population in comparison with other patient groups in Female PICU which requires multidisciplinary team input, specialist services involvement, better adherence to NICE guidelines, support and training for MDT.

Gambling disorder was reclassified as a first behavioral addiction in the DSM-5 in 2013. In 2018, gaming disorder was included in the ICD-11. In this presentation, research findings regarding the psychological and neurobiological mechanisms in gambling disorder and other behavioral addictions are highlighted. Specifically, neural and behavioral responses regarding reward expectation, reward outcomes, and the role of specific mechanisms in gambling like near wins, and in gaming, like lootboxes are highlighted. Besides the recognition of gambling disorder, the broader perspective of gambling harms is highlighted and related to psychosocial, financial, and health consequences. The perspective of interaction between human design factors (e.g. psychological and neurobiological mechanisms, such as decision making, reward processing) and gambling design factors (e.g. near wins, multiline betting) is reviewed. Evidence with regard to psychological and pharmacological interventions are discussed and future directions for research perspectives are discussed.

A. Goudriaan Grant / Research support from: Anna Goudriaan received grants from the Dutch Foundation for Scientific Research (NWO and ZonMw) and from VCVGZ Foundation

The use of antipsychotics (APS) is essential. Despite their great efficacy, some of them are associated with an increase in prolactin levels that can lead to hormonal changes needing to be identified and managed [1,2,3]. Hormonal changes use to have clinical implications including hypogonadism, infertility and sexual dysfunction

To evaluate possible hormonal alterations and some clinical implications produced by hyperprolactinemia (HPRL) derived from the use of some antipsychotic compounds.

A complete fasting blood test was performed on a sample of 113 subjects (69 men and 44 women). 54% (n = 61) showed a normal prolactin level and 46% (n = 52) showed hyperprolactinaemia ( >50ng / ml). On the global sample, 39.8% (n = 45) was treated with some hyperprolactinemic drug , mostly risperidone and paliperidone.

Some differences were found depending on the gender of the subjects. A highly significant inverse relationship between the values of prolactin and testosterone was found in males (p=0.020, r=-0.285). In females, increased prolactin level was significantly related to decreased cortisol values.

Antipsychotic-related Hyperprolactinaemia ( mainly risperidone and paliperidone) is related with a decrease in testosterone levels in males and with an increase in cortisol levels in females.

No significant relationships.

The treatment of first-episode psychosis patients is different from those with multiple-episode schizophrenia: the response to antipsychotics is better, the required doses are lower and the sensitivity to side-effects is higher. As such, current guidelines recommend a “start slow, go slow” strategy and an active avoidance of side-effects.

To know the patterns of antipsychotic prescription in first-episode psychosis patients of our inpatient unit.

We retrospectively reviewed the clinical data of all non-affective first-episode psychosis patients admitted to the Inpatient Unit C of Hospital de Magalhães Lemos during 2015. The antipsychotics prescribed at admission and discharge were recorded, as well as the doses.

A total of 29 patients were identified. The mean age was 36.6 and 65.5% were man. At admission, all patients were medicated with second-generation antipsychotics: 62.1% with risperidone, 27.6% with olanzapine, 6.9% with paliperidone and 3.4% with aripiprazol. The mean dose of risperidone was 3.5 mg/day. By the time of discharge, 34.5% of patients were prescribed a depot antipsychotic, half of them risperidone. Among those with oral medication only, 55.5% were prescribed risperidone, 22.2% paliperidone and the remainder 22.3% other antipsychotics (aripiprazol, olanzapine or quetiapine). The mean dose of risperidone was 3.7 mg/day.

Second-generation antipsychotics are clearly preferred. The mean dose by the time of discharge is similar to that used in clinical trials. However, antipsychotics are initiated at doses above the minimum effective dose. On discharge, an important proportion of patients are prescribed depot antipsychotics, which are known to improve medication adherence.

The authors have not supplied their declaration of competing interest.

A 28-year old male patient was admitted involuntarily to the 4th PICU of the Mental Health Hospital of Thessaloniki, due to severe psychotic symptoms and disorganised behaviour. Upon mental health examination the symptoms included auditory hallucinations, tangible speech, delusional ideas of somatic and persecutory type and significant neglect of his personal hygiene. The onset of his psychotic illness was 3 years prior, with two hospitalizations in the UK, and several unsuccessful attempts of outpatient monitoring.

The study of persistent hiccup as an adverse effect of antipsychotic medication.

Monitoring for adverse effects during admission.

On the 8th day of admission, oral olanzapine 10 mg was commenced at night. On the 9th day, olanzapine was increased to 20 mg per day. Discontinuation of intramuscular medication occurred on the 16th day. After presenting no clinical improvement for 27 days with the administration of olanzapine as monotherapy, amisulpride at 2ml per day was initiated alongside the Olanzapine. In the context of medication titration, amisulpride reached 8ml per day, equivalent to 800mg per day after 2 months of hospitalisation.

Apart from minor constipation, no other gastrointestinal health problems were reported in his records. The onset of the hiccups occurred along the dosages of 800mg/day of amisulpride and 20mg/day of olanzapine.

There was a satisfactory response to treatment evidenced by a 30% reduction on the Positive scale of the PANSS, however, the hiccups did not recede.

None Declared

Cardiovascular disease represent the leading cause of death worldwide, and is also responsible for the consumption of many medical resources, work absenteeism and worse Quality of Life. On the other hand, psychiatric diseases have recently gained more relevance worldwide as one of the principal causes of disability.

Evaluate a possible relationship between cardiovascular risk factors (CVRF) and anxious or depressive symptoms.

Observational and cross-sectional study in a non-probabilistic and convenience sample, composed by patients followed on five primary healthcare facilites, who voluntarily accepted to answer the questionnaire through an interview, between July 2020 and January 2021. After an informed consent, a questionnaire was carried out including sociodemographic characterization, presence of cardiovascular disease and/or cardiovascular risk factors and the Portuguese version of HADS. Descriptive and inferential statistics were performed, using Mann-Whitney U test. A value of p<0,05 was considered statistically significant.

Sample of 179 people, 53,1% female, with an average age of 51,05 ± 22,02 years, in which 57,5% had one or more CVRF and 59,8% had CVD and/or CVFR and the most prevalent CVRF were hypertension (48%) and dyslipidemia (43,6%). There was a statistically significant relationship between diabetes and anxiety (p<0,05).

There was a greater prevalence of anxiety symptoms in people with diabetes compared to people without diabetes. This suggests the importance of giving attention to anxiety in patients with diabetes, given the relevance of this comorbidity in their quality of life. The main limitation of the study is related with the sample size.

No significant relationships.

To determine the incidence of traumatic events in Ecuadorian women exposed to domestic violence and other complex social situations and their relationship with PTSD.

We applied a transversal descriptive study accomplished by the INEC (National Institute of Statistics and Census). The INEC recruited Ecuadorian women from 15 years old and more, the surveys were focused on this population. In total, 18,800 rural and urban housings were selected all over the country, 24 provinces. Date of the survey: November 16–December 15 of 2011. A, D and G were taken as references for guidelines following the criteria diagnosis of DSM V (Diagnostic and Statistical Manual of Mental Disorders) to determine a Traumatic Event.

The average age of the sample was 28 years old. The standard deviation was 21, ages: 15–25 years old: 14.265 (21.6%), 25–35 years old: 9.324 (14.1%), 35–45 years old: 8.132 (12.3%), 45–55 years old: 6.283 (9.5%), 55–65 years old: 4.302 (6.5%), > 65 years old: 23.745 (35.9%). Prevalence of the traumatic event (DSM-V) 4.6%. Women experienced any kind of violence 60.6%: 61.4% urban, 58.% rural. Types of abuse: psychological: 53.9%, physical: 38.0; sexual, patrimonial: 35.3%. Domestic violence 76.0% y other types of violence 24.0%.

Domestic violence rate is high, also, in this study, we determined that women face an important index of violence during their daily activities. Psychological abuse is the highest abuse, higher in the urban areas. These results based on acute traumatic events may predispose women to develop PTSD. The prevalence of traumatic events must be an alert to the Mental Health Organizations, not only in Ecuador but also in Latin American.

The authors have not supplied their declaration of competing interest.

Hearing-impaired adults with hearing aids or cochlear implants have been proved to suffer from social isolation and that the under-use of these devices is possibly related to its impact on one's body image. The aim of the research was to evaluate the presence of social phobia and body image preoccupation, handicap perception, social functioning and psychopathological distress in patients with hearing aids or cochlear implant.

A clinical group of 70 hearing aid and/or cochlear implant wearers was compared with a control group of 75 healthy adults (age: 18-65) referred to the ENT Clinic of Modena University from 01/01/09 to 01/ 09/09. Both groups were administered the following psychometric instruments: Social Functioning Questionnaire, Brief Symptom Inventory, Liebowitz Social Phobia Scale, Body Uneasiness Test. Hearing-impaired subjects were also assessed by means of the following tests: International Outcome Inventory for Hearing Aids, Attitude towards Hearing Loss Questionnaire, Hearing Handicap Inventory for Adults.

the case group statistically differed from the control group as to lower level of social functioning (p< .05), higher level of somatization (p< .01), obsessive compulsive behaviour (p< .01), interpersonal sensitivity (p< .01), depression (p< .01), anxiety (p< .05), phobic anxiety (p< .01), paranoid ideation (p< .01), psychoticism (p< .01), social phobia (p< .001) and body image preoccupation (p< .05).

Social phobia and body image preoccupation are critical aspects in determining the psychosocial well-being and the compliance, the benefit and the personal satisfaction of hearing-impaired subjects in using the hearing aid and/or cochlear implant.

We investigated the links between familial loading, preadolescent temperament, and internalizing and externalizing problems in adolescence, hereby distinguishing effects on maladjustment in general versus dimension-specific effects on either internalising or externalising problems.

In a population-based sample of 2230 preadolescents (10-11yrs) familial loading (parental lifetime psychopathology) and offspring temperament were assessed at baseline by parent report, and offspring psychopathology at 2.5-year follow-up by self-report, teacher and parent report.

Familial loading of internalising psychopathology predicted offspring internalising but not externalising problems whereas familial loading of externalising psychopathology predicted offspring externalising but not internalising problems. Both familial loadings were associated with Frustration, low Effortful Control, and Fear. Frustration acted as a general risk factor predicting severity of maladjustment; low Effortful Control and Fear acted as dimension-specific risk factors that predicted a particular type of psychopathology; whereas shyness, high-intensity pleasure, and affiliation acted as direction markers that steered the conditional probability of internalising versus externalising problems, in the event of maladjustment. Temperament traits mediated a third of the association between familial loading and psychopathology. Findings were robust across different composite measures of psychopathology, and applied to girls as well as boys.

It is important to distinguish general risk factors (Frustration) from dimension-specific risk factors (familial loadings, effortful control, fear), and direction markers that act as pathoplastic factors (shyness, high-intensity pleasure, affiliation) from both types of risk factors. About a third of familial loading effects on psychopathology in early adolescence are mediated by temperament.