Potentially chronic diseases often have a critical point in their course beyond which treatment becomes less effective. In support of this, early treatment in schizophrenia and other psychoses has been linked to better outcome.

The emergence of simultaneous brain volume changes in those ultra-high-risk individuals who develop psychosis indicate an active biological process, and underline the importance of pre-onset treatment. However, pre-psychotic intervention has also been questioned as, using current criteria, only 20–50% of individuals classified as prodromal develop a psychotic disorder within a 1–2 years period.

Treatment agents in the pre-psychotic phase should, therefore, not have major side effects. Bioactive lipids are molecules that have both intra- and intercellular roles, including mediation, modulation and control of neurobiological processes, such as ion channel and receptor activity, neurotransmitter release, synaptic plasticity, second messenger pathways and neuronal gene expression.

Long-chain omega-3 polyunsaturated fatty acids (PUFAs) have been shown effective for both, mood and psychotic symptoms, and they have neuroprotective properties. Because of the controversy concerned with the extent to which an intervention may produce harm which outweighs its benefits, omega-3 PUFAs are prime candidates for evaluation in putatively prodromal individuals.

We report on the first randomized, placebo-controlled trial on the preventive use of omega-3 fatty acids in 81 ultra-high-risk individuals.

Supplementation with long-chain omega-3 PUFAs reduces the risk of progression to psychotic disorder, and offers a safe and efficacious strategy for indicated prevention in individuals at ultra-high-risk of developing a psychotic illness.

The aim of this study is to identify the correlation between mild cognitive impairment (MCI), educational status and intellectual activity in elderly patients.

The study comprises 40 elderly patients diagnosed with MCI. the diagnosis of MCI was established applying to all patients MMSE (Mini Mental State Evaluation). Also a Clock Drawing Test (CDT) was applied. A MMSE score between 28-21points was considered as MCI.

We consider that a patient has intellectual activities if he performs at least one of the following: reading a book or a newspaper, solving puzzles or mind games.

The exclusion criteria were: patients with moderate and severe cognitive impairment and patients with no educational level.

The average of age was 69.65 years. the average of MMSE score was 24.65 points. the correlation between MMSE and CDT is significant at the 0.01 level. the MMSE and CDT scores are smaller as the educational level is lower. 3 subjects have fourth grade education, 17 subjects have eighth grade education, 16 subjects have high-school education and 4subjects have college education. the patients with small scores at cognitive evaluation have no intellectual activity in the present. the intellectual activity is in direct relationship with high educational level; patients with high-school and college education are performing intellectual activities in the present.

Patients with actual intellectual activity have the highest MMSE and CDT scores.

Intellectual activities are protective factors against cognitive impairment.

This paper represents the screening part of a grant PNCDI2 41-057/2007 from the Romanian Ministry of Education and Research.

Specialists in biology, medicine, and psychology need to pay special attention to theoretical and practical research on the implementation of the fight or flight mechanism in humans in conditions of war and hostilities. Adaptation mechanism of fight or flight is related to individual and social forms of behavior among people and animals, and is aimed at the homeostasis preservation in difficult living conditions. The evolutionary fight or flight mechanism in the functional connection with stress as a general adaptation syndrome and stress reactivity has individual features due to the strengthening of the functions of certain body systems. The systemic mechanism of fight or flight is accompanied by the corresponding functional and clinical symptoms and significantly influences physical and mental health of a person in various conditions of activity.

In this regard, the main goal of this work was to determine the relationship between the behavioral strategy of fighting or escaping under stress and during sports activities.

The following research methods were used to realize the goal of the work: theoretical analysis and generalization of literary sources and Internet data.

In our opinion, possible versions of Walter Cannon’s concept of the fight-or-flight mechanism are: 1) attack-or-flight mechanism; 2) defense or escape mechanism; 3) pursuit or escape mechanism. At the same time, it is advisable to consider aggression as a struggle, and escape as a struggle. In addition, in line with the concept of Walter Cannon and Hans Selye, it is possible to distinguish the stress of struggle and the stress of flight. Any intense muscle activity is accompanied by changes in the hormonal and nervous regulation of metabolism, as a result of which the body adapts to a certain physical load. In the athlete, these functional changes are observed even before the start of physical exercises, in particular, in the conditions of the pre-start and start state. The nature and reaction of neuro-endocrine mechanisms in the pre-start state depend on the nature of the load, as well as on the individual characteristics of the athlete (age, gender, type of nervous system, temperament, character, training, sports experience, etc.). It is important that the pre-start changes in metabolism contribute to the mobilization of the athlete’s functional potential even before the start of the corresponding physical activity. Moderate activation of the neuro-endocrine mechanisms of the athlete’s body (“combat readiness” state) is optimal. Functionally, it is less beneficial for the athlete’s body to have a sharp strengthening of neuro-endocrine mechanisms (“pre-start fever” state) or their paradoxical inhibition (“pre-start apathy” state).

Thus, in humans, sports activities include a behavioral mechanism of fight or flight in combination with physiological and psychological stress.

None Declared

Catatonia due to cerebrovascular stroke is a rare condition that needs further observation and research.

To review the opinions of psychotic disorders experts worldwide as to this issue based on evidence and clinical experience and to consider strategies for future investigations.

This case shows a 64 years old female who suddenly developed wish for isolation, followed 10 days later by discontinuity of ideas, hallucinatory behavior and food refusal. She had verbal and physical aggression due to a fixed belief that family members are conspiring somehow to harm her.

On examination she was mute with waxy flexibility and negativism. Extensor plantar reflex was evident. MRI Brain showed small vessel disease and right basal ganglia acute ischemic infarction. On IV midazolam 7.5 mg, patient’s mutism, negativism and waxy flexibility improved. Lower limb Venous Duplex revealed acute right popliteal and left soleal veins thrombosis. CT angiography showed Bilateral pulmonary embolism with no pulmonary infarction. D dimer was positive.

Early diagnosis and intervention improves outcome if psychiatric teams gives attention and has enough awareness with warning symptoms and prompt necessary interventions.

None Declared

ADHD is associated with psychopathic traits, both in the general population and in perpetrators, due to the impulsivity, but not the affective component of psychopathy.

To analyze this relationship among a sample of inmates from a high-security male prison, using an instrument that further divides the callous-unemotional factor of psychopathy into boldness and cruelty, and see if they relate to ADHD independently from the impulsivity/disinhibition.

One hundred and one subjects aged 18–65, with at least 4 years of formal education, were interviewed for socio-demographic data and completed the ASRS-v1.1 (Adult ADHD Self-Report Scale) and the TriPM (Triarchic Psychopathy Measure). Subjects were divided into ADHD positive or negative according to their score in the ASRS-v1.1, and then compared regarding TriPM score (total, disinhibition, boldness and cruelty) using Student's t-test. Linear regression was used to assess independency between the subscales of TriPM.

Seventeen subjects scored positive for ADHD. They significantly differed from the non-ADHD group regarding all psychopathy scores (total, t = −5.03, P < 0.0001; disinhibition, t = −3.53, P = 0.0006; and cruelty, t = −4.96, P < 0.0001), except for boldness (t = 1.97, P = 0.005). The cruelty score is independent from boldness (R2 = 0.03) but not from the disinhibition score (R2 = 0.24). Disinhibition and boldness are also unrelated (R2 = 0.01).

In line with previous work, our study shows a strong association between ADHD and psychopathy, with both conditions sharing the disinhibition/impulsivity factor. Although ADHD subjects score higher for cruelty, this isn’t independent from disinhibition, and may be a result of them being more prone to admit to cruel behaviours, due to deficient response inhibition.

The authors have not supplied their declaration of competing interest.

Interferon combined with ribavirin is widely used to decrease the burden of Hepatitis C virus (HCV), but some serious side effects might limit its usefulness. There has been recently a growing awareness about neuropsychiatric complications of many drug treatments. Anecdotal case reports of HCV treatment induced psychosis were published but there seems to be no consensus about the causative relation and no systematic reviews were done to the date.

To describe a paradigmatic case that was managed as an iatrogenic psychotic episode following interferon associated with ribavirin.

Call attention to problems that interfere with the recognition, diagnosis and management of drugs induced psychosis.

Bibliographic research was conducted through the PubMed in the Medline library and clinical information was obtained through medical records and clinical interviews with the patient.

A 50-year-old Brazilian woman, with a previous episode of postpartum depression, presented with paranoid psychosis six months after initiating HCV antiviral therapy. Psychotic symptoms consisted of persecutory delusions and auditory hallucinations and developed together with agitation and aggressive behavior. Psychiatric hospitalization was required and psychosis resolved with discontinuation of therapy and initiation of risperidone. Laboratory tests and brain images were of no help in the etiologic investigation.

There are many drugs known to possibly cause neuropsychiatric symptoms. It is the job of every physician to be aware of this hypothesis especially in cases with acute onset and atypical presentations.

The authors have not supplied their declaration of competing interest.

Bariatric surgery is a procedure that results in a complex network of emotional experiences. One of the objectives of surgery is to bring about an improvement in the quality of life. Many patients fail because of psychological difficulties, a fact that reinforces the need for specific studies on the psychological dynamic.

to understand the meanings for patients when undergoing bariatric surgery.

Clinical-qualitative method.

The main emotional experiences are social re-insertion, personal acceptance, the risk of disillusion with the results of surgery, recovery of self esteem, improvement in quality of life and in body image.

It is important to identify those aspects of a patients’ psychological make-up which would be expected to improve or worsen their prognosis, and to provide the necessary pre- and post-operative psychosocial counselling. We offer some markers to assist the health professionals, which will allow an appropriate psychosocial plan to be developed and help the health team to identify factors that may affect prognosis. We propose some recommendations for a better psychological evolution: psychotherapy focusing on improving self-esteem; identifying feelings of shame related to a greater exposure; identifying how patients deal with feelings of competitiveness, envy and jealousy; assessing if obesity has defensive function; providing realistic parameters with regards the results of surgery; distinguishing between realistic necessity for plastic surgery and unreal expectations; observation of deviations to other compulsions; acceptance of skin folds and scars; clarifying the misunderstanding between emotional and physical hunger; confidence in own ability to adopt new behavioural models.

Mental disorders are associated with many harmful health behaviors such as smoking, abuse of alcohol or drugs, physical inactivity and overweight. Abdominal obesity has been positively associated with depressive symptoms independent of general obesity (BMI). Adult obesity has been associated with depression, especially in women. Recent evidence implies that causal link goes from depression to obesity. This study set out to investigate the relationship between depression, sleepiness, health behavior, BMI and inflammation.

The study based on a cardiovascular risk sample drawn from the participants of a population survey, (aged 45-70) which was carried out in in southwestern Finland. The subjects filled in several internationally known questionnaires: STAI-S (state-anxiety), BDI (depression), EQH5 and RAND-36 (health-related quality of life), Berlin, ESS and PSQI (sleep disorders), smoking and generic measures on health behavior (e.g. physical exercise, time spent watching TV and using PC, intake of calories and fat). Blood samples were drawn from the subjects to measure among other things hsCRP (n=1318).

We found a statistically highly significant correlation between BMI and hCRP (r=0.22, p< 0.001). Total daily minutes watching TV correlated with hsCRP (0.12, p< 0.001). Partial correlation between total minutes spent watching television and hsCRP while adjusting for depression or BMI did not render it the correlation insignificant not diminish its size.

High level of TV use was associated with silent inflammation despite BMI. Heavy use of TV may be an indicator of harmfully increased stress levels.

53 patients and 47 matched controls were studied using a new questionnaire (SEXSAM Scale) measuring relevance of sexual and emotional relationships in patients’ daily life. A specific Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ-SALSEX Montejo 2001-2008), Sexual Activity Assessment Scale modified from Kinsey (Montejo 2006) and the HONOS Scale measuring bio-psychosocial functioning were also applied.

Sexuality (physic and emotional) was scored as high valuable and the main motivation for sexual activity was looking for love and fondness in both groups. No differences were found in the value of more affective behaviours such as kissing, caressing, hugging or massaging. Global satisfaction in sexual and emotional life was significantly superior in control group and linked to the higher frequency of sexual relations. Many patients suffered for sexual dysfunction related to the treatment use and many of then were dissatisfied with their sexual life. Just a few numbers of patients had regular sexual intercourses. Patients describe an improvement in the self-perception of mood, appetite, sleep, anxiety level, humour sense and self-esteem when they have sexual relations. Predominant sexual activity for patients was masturbation. Prostitution use was higher in patient group. All these findings are negatively influencing personal satisfaction and quality of life.

Relevance of sexual and emotional life in patients is as high as in normal population. These patients are more concerned about affection and companionship than about physical pleasure.

The emergence of new psychoactive substances (NPS) has had a substantial impact worldwide. NPS mimic the effect of “existing” drugs and are specifically manufactured so that the new substances fall out of regulatory frameworks. Although the structural changes might be minimal, NPS often have marked differences in potency and subsequent harm.

The population of the Azores archipelago has been particularly affected by the rapid growing and changing nature of this phenomenon, mainly caused by the introduction and spread of the “newly” synthetic cathinones as a inexpensive and easily available street drug.

Before any educational, public health and socioeconomic policy changes be proposed to accurately tackle the problem, the basic step of knowing how these substances have been affecting their users, specially their neuropsychiatric effects, must be taken.

This project aims to characterize the neuropsychiatric side effects caused by the acute intoxication of NPS with a psychostimulant profile, namely synthetic cathinones.

Description of the neuropsychiatric symptoms of intoxicated users of stimulant NPS that present to non-governmental organizations specialized in addictions and also to the psychiatry emergency department in Sao Miguel - Azores.

Review of the forensic records of the deaths by suicide in 2021 in Sao Miguel, looking for evidence of recent abuse of NPS or previous history of “NPS use disorder”.

Non-systematic review of the recent and relevant scientific literature on this topic.

The desired effects are increased energy, mood enhancement, euphoria, mental clarity, improved concentration, improved sociability, increased talkativeness, empathy inducing effects, amplification of sound and colour and prosexual effects. Nevertheless, in the case of intoxication, the frequent neuropsychiatric side effects tend to be agitation, agressiveness, irritability, altered consciousness, brief psychosis with paranoid delusion, visual and auditive hallucinations, transient mania, enhanced sensorial experiences, headaches, dizzyness, seizures, confusion and amnesia. Usually, the acjute intoxication period tend to be followed by a “crash” with depression, craving, anxiety, panic, suicidal ideation and behaviours. A third of the deaths by suicides in Sao Miguel Island in 2021, 7 out of 21, were in stimulant NPS active or recent users.

Review of the neuropsychiatric effects of New Psychoactive Substances with a psychostimulant profile. Further studies of this population of synthetic cathinone users in the Azores are due, namely studying their socioeconomic background, looking for risk and protective factors, and also the long-term side effects.

None Declared

Patients hospitalized in the case of COVID19 have had to face a complex and potentially very stressful situation. In this context a screening program for psychological distress in patients with COVID19 is necessary.

To screen for post-traumatic stress disorder post COVID19 and to identify the epidemiological and clinical factors correlated with this disorder in post COVID19 patients.

A descriptive and analytical cross-sectional study that took place during the period from 1st March to 15th May 2021 with 154 patients who were hospitalized at the COVID19 unit at Hedi Chaker Hospital Sfax.

We used a pre-established form to record sociodemographic, clinical and therapeutic data. The post-traumatic stress disorder was assessed by the “Impact of Event Scale-Revised”.

The mean age was 66.62 ± 13.34 years with a male predominance of 60.4%. In our sample, 77.9% of the patients had a somatic history, of which hypertension was the most frequent pathology (46.1%). The average length of hospitalization was 9.5 days ± 6.3. The form was considered severe in 27.9 cases.

According to the IES-R scale, twenty-one patients (13.6%) had post-traumatic stress disorder, with a predominance of women (57.1%).

A significant association was found between marital status and post-traumatic stress disorder. Thus, married or widowed patients are more likely to develop PTSD.

In the present study, we did not find statistically significant associations between the clinical characteristics of the disease (severity of the disease, length of hospitalization, functional signs) and post-traumatic stress disorder.

Psychological support interventions in surviving patients of COVID 19 is necessary aiming to increase resilience, manage coping strategies and decrease the deleterious impact of the pandemic on mental health.

None Declared

It is well recognized that both acute and chronic alcohol use are among the major behaviorally modifiable factors that are associated with suicidal behaviour. High suicide rate in the former Soviet Republics and its profound fluctuation over the past decades have attracted considerable interest. There is mounting evidence that the role of alcohol is a crucial in understanding this phenomenon.

To estimate the aggregate level effect of alcohol on the suicide rate in the former Soviet republic Belarus.

Trends in alcohol consumption per capita and suicides rate from 1979 to 2007 were analyzed employing ARIMA time series analysis.

According to Bureau of Forensic Medicine autopsy reports the number of BAC-positive suicides increased by 47.7% (from 10.7 to 15.8 per 100.000) and number of BAC-negative suicides increased by 31.4% (from 7 to 9.2 per 100.000). Alcohol in blood was found in 62% suicide victims for the whole period, with the minimum figure 49.3% in 1988 and maximum 68.5% in 1981. The results from the time series analysis indicated the presence of a statistically significant association between the alcohol consumption and BAC-positive suicide rates, while changes in the number of BAC-negative suicides were not related to fluctuation in alcohol consumption level. The analysis suggests that a 1 litre increase in alcohol consumption per capita would result in a 10,9% increase in a number of BAC-positive suicides.

The results of present study support the idea that alcohol was responsible for the fluctuation in suicide rate in Belarus.

Cognitive deficits are considered central and persistent features of schizophrenia and have a significant impact on outcome and quality of life. The computerized interactive remediation of cognition (CIRCuiTS) is a new computerized cognitive remediation program aimed at improving different cognitive domains in patients with schizophrenia. In particular, the program was designed to mainly rehabilitate executive functions, attention and memory by training each cognitive function through several exercises and by improving metacognition.

In the present study, CIRCuiTS was translated and adapted into Italian. The applicability and feasibility of the Italian version was evaluated. Moreover, preliminary data on the effectiveness of the program were investigated.

Four patients with a diagnosis of schizophrenia were recruited for the study. We investigated the changes in neurocognition, psychopathology, self-esteem and functional outcome at the end of the remediation program. The level of satisfaction of operators and participants was evaluated by means of the client satisfaction questionnaire (CSQ).

For each patient, the entire program took place through 2 weekly sessions of 50 minutes for a total duration of 40 sessions.

CIRCuiTS produced an improvement in all domains of neurocognition, disorganization, self-esteem and real-life functioning in the areas “self-care” and “interpersonal relationships”. Moreover, high levels of satisfaction were shown by CSQ for both, operators and participants.

The Italian version of CIRCuiTS demonstrates high levels of acceptability and feasibility for both, patients and clinicians. Additionally, preliminary data suggest that the use of CIRCuiTS provides an improvement on several aspects of the disease.

The authors have not supplied their declaration of competing interest.

This study examined the effect of Delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) on brain activation during a motor inhibition task.

Functional magnetic resonance imaging and behavioural measures were recorded while 15 healthy volunteers performed a Go/No-Go task following administration of either THC or CBD or placebo in a double-blind, pseudo-randomized, placebo-controlled repeated measures within-subject design.

Relative to placebo, THC attenuated activation in the right inferior frontal and the anterior cingulate gyrus. In contrast, CBD deactivated the left temporal cortex and insula. These effects were not related to changes in anxiety, intoxication, sedation, and psychotic symptoms.

These data suggest that THC attenuates the engagement of brain regions that mediate response inhibition. CBD modulated function in regions not usually implicated in response inhibition.

Electroconvulsive therapy (ECT) is an efficacious treatment for many mental disorders, but is underutilized because of fears of adverse effects, including the risk of death.

To provide a full picture of the magnitude of ECT-related mortality worldwide.

We performed a systematic review and meta-analysis (PubMed and Embase) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Only publications reporting on a specific number of ECT treatments as well as specific number of ECT-related deaths were included in our analysis. The ECT-related mortality rate was calculated by dividing the total number of ECT-related deaths by the total number of ECT treatments. The 95% confidence interval (95% CI) of this estimate was calculated using Bernoullis principle of distribution.

Fourteen studies with data from 32 countries reporting on a total of 757,662 ECT treatments met the predefined inclusion criteria. Fifteen cases of ECT-related death were reported – yielding an ECT-related mortality rate of 2.0 per 100,000 treatments (95% CI: 1.0–3.0). In the eight studies published after 2001 (covering 406,229 treatments), no ECT-related deaths were reported.

The ECT-related mortality rate was estimated at 2 per 100,000 treatments. For comparison, a recent meta-analysis on the mortality of general anaesthesia in relation to surgical procedures reported a mortality rate of 3.4 per 100,000. Thus, our systematic review and meta-analysis documents that death caused by ECT is extremely rare. This information can be used to reassure patients in need of ECT.

The authors have not supplied their declaration of competing interest.