The coronavirus pandemic continues to impact all aspects of the daily life of the public worldwide. With decreased economic activity, the sports industry faces significant challenges of maintaining athletes’ mental health while seeking the best strategies for eventual return to sports competition.

We aim to evaluate COVID-19 related factors impacting on the mental health of athletes and provide appropriate management steps.

We examined MeSH terms “Athletes,” “Sports,” “COVID-19,” in the context of “Mental Health,” “Mental Disorders,” “Behavioral Medicine,” “Risk Factors.” We identified seven studies for the qualitative synthesis per the PRISMA guidelines, searching Medline, PubMed, PubMed Central, and PsychInfo databases until July 2020.

The pandemic has negatively impacted athletes’ mental wellbeing due to decreased physical activities, limited resources, fears, and delays or cancellations of the sporting event. The negative psychological impact on athletes is due to self-isolation measures leading to worries of less preparedness for the lockdown, reduced physical activity, loss of competitive advantages, fear of being infected, social isolation, and loneliness. During this period, athletes struggled to maintain baseline routine and engaged in excessive calorie intake, eating low-quality food, substance use, and sleep disruption. It has caused anxiety, depression, PTSD, and mood disorder at varying degrees of severity in athletes.

Limited resources during a pandemic have caused adverse mental impact on athletes. We recommend improving physical activity through confined or virtual training programs with colleagues. A collaborative approach is required by clinicians, psychologists, coaches, sports organizations, government bodies to limit the pandemic’s mental health impact.

To investigate the use of a video monitoring system for automatic event recognition for the assessment of autonomy in Instrumental Activities of Daily Living (IADL) in dementia patients.

Three groups of participants (healthy control, Mild Cognitive Impairment and Alzheimer's disease) had to carry out a standardized scenario consisting of directed tasks (single and dual task) and IADLs such as preparing pillbox. During this time they were recorded by 3D video cameras capturing all their activities. The performance quality of each participant was manually annotated and assessed based on the amount of successfully carried out activities. Recorded data was processed by a platform of video signal analysis in order to extract kinematic parameters detecting activities undertaken by the participant. We developed a classifier based on the extracted video features for diagnostic prediction and further autonomy performance prediction.

Overall activities were correctly automatically detected. The most accurate detected activities were: using the phone with 91% accuracy and preparing pillbox with 88% accuracy. The diagnostic group classifier based on the automatically extracted video features obtained accuracy of 71.79 % when combining directed tasks and IADLs. Autonomy group classifier obtained an accuracy of 84.61% when combining directed tasks and IADLs.

The results suggest that it is possible to assess autonomy with the help automatic video monitoring system (AVMS) and that the use of such technologies could provide clinicians with diagnostic relevant information and improve autonomy assessment in real time decreasing observer biases.

Female sexual dysfunction (FSD) has been increasingly recognized as an extremely important public health issue. It has direct impact on the health, well-being and quality of life of women. Cultural factors and deeply embedded health beliefs may play a decisive role in defining the health seeking behavior for sexual problems among Egyptian women.

the aim of the study was to estimate the prevalence of Female Sexual Dysfunctions among married women attending Family Health Centers (FHCs) in Alexandria and to investigate help seeking behaviors among them.

A cross-sectional study was conducted in Alexandria targeting 369 married women attending Family Health Centers in Alexandria. Female Sexual Dysfunctions were assessed using the Arabic version of Female Sexual Function Index (ArFSFI) and help seeking behaviors were assessed using a pre-designed structured questionnaire.

The prevalence of (FSD) was estimated to be 72.4%,13.3% of women had one type of sexual disorders while 59.1% had multiple sexual disorders. Although 77.9%of women reported feeling distressed by their sexual problems, none of them had thought professional help, The most common cause for not seeking help identified as “The topic is embarrassing” and believing that “No treatment for such problems”.(84.1% and 4.9% respectively). Educational level and occupational status of of women were significant predictors for seeking help.

The study findings indicated that FSDs were highly prevalent and many women didn't seek help for their sexual problems.“The topic is embarrassing” and “No treatment for such problems” were the most reported reasons for not seeking help among Egyptian women.

Prenatal maternal stress is an important phenomenon. Evidence on this topic suggests that women who experience high stress during pregnancy are more likely to deliver preterm infants.

The goal of this study was to evaluate the influence of Yoga exercises training on stress reduction during pregnancy.

In the current study we included 20 women who participated in the Yoga exercises training during pregnancy. The control group included 20 women who were in the reading control condition during pregnancy. Women were eligible to participate if they were experiencing elevated levels of perceived stress or pregnancy-specific anxiety (PSA), as indicated by responses to the Perceived Stress Scale and the PSA scale on a screening questionnaire. Women enrolled between 12 and 26 weeks gestation were randomly assigned to either the Yoga exercises training or to the reading control condition. Effects of training were analyzed by means of an ANOVA with repeated measurements.

ANOVA has revealed (p<.05) that women in the Yoga exercises training experienced larger decreases from pre- to postintervention in pregnancy-specific anxiety and pregnancy-related anxiety than participants in the reading control condition.

This pilot study suggests that Yoga exercises training during pregnancy can effectively reduce pregnancy-related anxiety. However, it is necessary to do further research on the impact of Yoga exercises on stress reduction during pregnancy.

Suicide is a serious phenomenon associated with psychiatric disorders.

In the present study, we investigated factors that can predict follow-up at the psychiatric clinic after medical care at the emergency room (ER).

Medical records of the 145 patients treated at the ER following suicide attempt from Jan 1, 2009 to July 31, 2009 were reviewed. Age, sex, past psychiatric history, impulsiveness and medical severity of suicide attempt, risk-rescue rating scores, reasons for suicide attempt and methods of suicide were examined. Psychiatric diagnoses were made by psychiatrists at the initial interview with patients at ER.

The mean age of the patients was 42.9 ± 15.7 years, and 68.3 % were women and 31.7% were men. Among the suicide methods, psychotropics were the most common (69%), and ingestion of pesticides was the second (19.3%). Interpersonal problems were the most common precipitating event (57.9%), and depression was the most common (89%). About a half had previous psychiatric disorders and about one third had previous suicide attempt. Fifteen patients (10.3%) attempted planned suicide and 124 patients (85.5%) attempted impulsively. Mean risk and rescue rating scores was 8.6 ±1.6 and 12.3 ± 2.2. About one third had a follow-up psychiatric visit. The most important predictor of psychiatric follow-up was risk rating scores.

This study suggests that women with interpersonal problems and depression should be carefully monitored to reduce suicide attempt. Patients commit less risky suicide attempts tend to more loss to psychiatric follow-up, thus, need more attention to prevent suicide re-attempts.

The concept of male depression is based on the hypothesis that typical symptoms of depression in men often seem to be masked by non-typical male distress symptoms not considered in common depression inventories. Despite clinical evidence, scientific evidence is still lacking. The study describes symptoms reported by males (on the Gotland Male Depression Scale (GMDS) in a community study and these were further validated against MDS criteria.

In a community study in Reykjanes Iceland, 534 males were rated by the GMDS. In the second phase a sub-sample of healthy and depressive males were examined by a trained psychiatrist in a semi-structured interview (N=137). Diagnosis was according to the DSM-IV for MDD. The symptoms on GMDS are self-rated from 0-3.

In the community sample the prevalence (>1 GMDS) of single symptoms was following: More stressed out than usual (16.8%), aggressiveness (11.8%), feeling of being burned out (14.5%), tiredness (18.2%), more irritable (15.3%), difficulty making decisions (10.8%), sleep problems (21%), anxiety/uneasiness (10.5%), increased use of alcohol/substances, hyperactivity ( 10.3%), behavioural changes (4.7%), feeling sad/hopeless (10.4%), self-pity (4.8%). All symptoms on GMDS correlated strongly with MDD. In a stepwiselogistic regression model, controlling for medication and age, three items contributed independently to MDD diagnoses. These were aggressiveness, being more irritable and anxiety/uneasiness.

Sleep problems and tiredness were most commonly reported symptoms. The best predicting symptoms for MDD were anxiety and acting out symptoms, aggression and irritability. This is of interest as these symptoms are not in the criteria for MDD.

Alcohol use disorder is a pressing problem in our society. However, only a small percentage of patients with alcohol use disorder are ever treated. Nalmefene acts as an antagonist of mu opioid receptors preventing the pleasurable sensation that often accompanies alcohol consumption, while its modulation of kappa opioid receptors can decrease the dysphoria associated with alcohol withdrawal.

Studying the effect of nalmefene on patients with alcohol use disorder who are trying to reduce their daily alcohol consumption.

This is a descriptive study that pretends to assess the effect of nalmefene 18 mg/day on alcohol intake in a sample of five patients (3 men and 2 women) that came to our psychiatric consultation from March to September 2016. They all had tried in the past to stop or reduce their alcohol consumption but were unable to do so. We initiate follow-up with the patients in psychiatric consultation for the next three months with a monthly frequency.

Out of the 5 patients, 4 reported to have reduced their alcohol consumption over the observation time, going from 32 drinks per week to 18 drinks per week on average. The fifth patient abandoned prematurely the treatment due to the appearance of side effects (nausea). No other relevant side effects were detected.

Nalmefene appears to be effective and safe reducing abusive alcohol intake and avoiding alcohol withdrawal syndrome. Therefore, nalmefene can be considered a good therapeutic option helping reduce alcohol consumption in patients with alcohol use disorder.

The authors have not supplied their declaration of competing interest.

In late 2019, an epidemic outbreak emerges in China caused by a new coronavirus with high transmission and human infection potential which in March 2020, was characterized by WHO as a pandemic. The lockdown has repercussions on the population’s well-being, reflected in their food choices. There is a tendency to increase the consumption of energy dense food, rich in fat and carbohydrates, which are related to an increased risk of depression.

The main goal of this non-systematic literature review was to understand the impact of the Mediterranean Diet on Mental Health promotion in SARSCoV-2 pandemic.

Literature from Pubmed database were searched, with the following keywords: COVID-19, Depression, Anxiety, Mental Health and Mediterranean Diet.

Studies indicate that a diet based on the Mediterranean Diet is associated with a decreased risk of developing depressive symptoms, especially when there is moderate to high adherence to this dietary pattern. High consumption of plant and fish foods, reduced consumption of sugary products, processed and red meats and the use of olive oil as a fat source, are principles of the Mediterranean diet, associated with an improvement in endothelial function, increased levels of eicosanoids and serotonin synthesis and regulation of serotonin which seem to explain this protective effect.

In addition to decreasing the risk of obesity, diabetes, and hypertension, comorbidities associated with the most serious disease of COVID-19, the Mediterranean Diet seems to play an important role in promoting mental health, with a decreased risk of developing depressive symptoms.

No significant relationships.

The burnout syndrome is a blend of physical exhaustion and emotional fatigue that impairs an individual’s performance at work. In Tunisia, factors like working hours, the frequency of monthly shifts, and the physical and emotional abuse that physicians face from patients have collectively led to a significant incidence of burnout among medical professionals.

To evaluate the prevalence of burnout syndrome among medical residents working in healthcare facilities in Tunisia and to pinpoint the contributing factors.

This study is a descriptive cross-sectional survey conducted among medical residents completing their training in various healthcare facilities in Tunisia. The study employed an online self-administered questionnaire and assessed burnout across three dimensions: personal burnout, professional burnout, and relational burnout, using the Copenhagen Burnout Inventory (CBI).

A total of 50 physicians took part in the survey. Among them, 72% were female, 80% were single, and the average age at the time of the study was 27.72 years. Concerning their professional status, 84% worked in university hospitals, 16% specialized in surgery, 40% specialized in medicine, and 44% were family physicians. The majority were students from the Faculty of Medicine in Sfax (56%), with 30% in Monastir, 8% in Tunis, and 6% in Sousse. Regarding their work hours, more than 40 hours per week were reported by 32% of participants. According to the CBI scale, 12% of participants had scores indicating severe personal burnout, while 20% had scores indicating moderate personal burnout. Additionally,16% reported severe professional burnout, and 12% had scores suggesting severe relational burnout. In contrast, only 8% had scores indicating moderate relational burnout. The sociodemographic and professional factors that were studied, such as weekly working hours, monthly shifts, specialty, and workplace, did not show a significant correlation with the presence of burnout syndrome.

Burnout syndrome among medical resident physicians not only impacts their physical and mental well-being but also reduces their effectiveness and motivation at work. It is essential to introduce stress management strategies within hospitals to foster a healthier work-life balance.

None Declared

Recently, there is an interest on the possible association between quetiapine and hypothyroidism. the aim of this study is to critically review all the reported cases in the international literature.

A Medline search for all studies dealing with quetiapine induced hypothyroidism was carried out from January 1997 to June 2008.

Published literature on quetiapine's impact on thyroid function consists of 1 double-blind study, 1 observational study, 2 open studies, 3 case reports and data from the product monograph. A study on elderly psychotic patients revealed only small decreases in T4 levels, while another one in adolescents show trends for decrease in T4 and a marked increase in TSH. an observational study of thyroid function in patients treated with quetiapine and other antipsychotics, found a decrease in T4 with no changes in TSH and T3 and another one only slight increases in TSH. in the case reports all patients excibited clinical hypothyroidism. in one case there was a positive history for hypothyroidism, while in another one the patient had experienced lithium induced hypothyroidism in the past. According to quetiapine manufacturer 0.4% of the patients experienced TSH increases with half of them requiring thyroid replacement treatment. in studies, where quetiapine was adjunct to lithium or divalproate, 12% of patients had elevated TSH levels.

We suggest a careful thyroid monitoring for patients initiating quetiapine, since hypothyroidism may emerge and masquerade psychopathologic manifestations. However, there is an open question whether thyroid dysfunction is a permanent or reversible condition.

Attention Deficit Hyperactivity Disorder (ADHD) is characterized by a persistent pattern of inattention, hyperactivity, and impulsivity, which begins in childhood and often persists into adulthood. ADHD has a heterogeneous expression with diversity in behavioral symptoms, cognitive deficits, and comorbidities. So, it is possible to consider it a spectrum with different losses.

To describe clusters of multiple neuropsychological, attentional, and behavioral measures in adults with symptoms of ADHD. It could help to seek new directions to examine heterogeneity from a dimensional approach to ADHD.

120 adults between 18 and 52 years old (m= 29.5) with ADHD symptoms participated in this study. Performance indices on computerized neuropsychological tests of attention (voluntary, automatic, temporal, and sustained), behavioral self-report scales for ADHD (ASRS-18), impulsivity (BIS-11) executive dysfunction (BDEFS), and functionality, emotional and behavioral problems (Adult Self-Report - ASR of ASEBA) were analyzed. Cluster analysis processed the data to find subgroups based on the scores of instruments. The NbClust tested the best number of clusters that converge to a solution.

The 3 clusters solution was obtained by comparing Z scores for each indicator. In cluster 1, the ADHD symptoms were equivalent but expressed more hyperactivity than in other clusters. Also, higher levels of functional impairments and executive dysfunctions (motivation, emotional regulation, and anxiety/depression) were identified. In the attentional neuropsychological tasks, the indices express a lower level. Cluster 2 expressed a higher level of inattention and attentional, motor, and non-planning impulsivity, and functional impairments in the academic, professional, and legal risk areas. Cluster 3 was the subgroup with the lowest level of symptoms of ADHD.

This study identified differences in performances that contribute to understanding the cognitive, behavioral, and emotional expressions of ADHD. Three groups of different prejudices levels should be considered in the development of evaluative models in new studies to consider the spectrum of ADHD.

Financial support: FAPESP [grant 2019/20757-5, 2019/21773-4, 2020/14800-2]; CAPES Proex [grant 0426/2021, 23038.006837/2021-73]; Mackpesquisa; CNPq [grant 307443/2019-1]

None Declared

In the conflict torn developing countries, where adoption and foster care are little practised, orphanages remain one of the few means of survival of inumerable orphans. Critical research, however, has potrayed orphanages as a breeding ground for psychopathology.

This study was taken up to examine this opinion.

An orphanage for girls in Srinagar was surveyed by Psychiatrists, and using DSM IV guidelines screened children were evaluated for psychopathology.

Children were in the age group of 5–12 yrs. PTSD was the commonest psychiatric disorders (40.62%), easily attributable to the prevailing mass trauma state of almost two decades. Next commonest diagnoses were MDD (25%) and conversion disorder (12.5%).

A high psychopathology in orphanages could be an important guide for policy makers to plan for better rehabilitation and social reintegration of orphans.

To describe a rare case of Acromegaly presenting as psychotic disorder without neurological signs, in a 19 years old boy.

Single case report.

We describe the case of a 19 years old boy, that was taller than his peers and had started to grow his hands. He suddenly presented with an acute psychotic episode. He presented with persecutory delusions, perceptual abnormalities, disorganization and marked fluctuation in his behavior, he showed marked emotional liability, fluctuations in orientation and psychotic symptoms in the form of grandiosity, persecutory delusions and delusional misidentifications. At times, he was seen talking to himself, although he denied hearing any voices. There was no impairment of consciousness. His mood was irritable. An urgent CT and subsequent MRI scan revealed a pituitary macro adenoma, extending into the cavernous sinus. The initial diagnosis of prolactinoma was revised to acromegaly. His symptoms responded to combination of olanzapine and valproic acid, followed by trans sphenoid resection of the adenoma.

This case highlights the need for investigation, especially of neuroimaging, in atypical presentations of psychosis, which may be first manifestation of rare disorders like acromegaly. Despite a lack of information regarding the path physiology, this particular case emphasizes the importance of ruling out an organic cause for atypical presentation of psychosis.

The authors have not supplied their declaration of competing interest.

Aripiprazole is a third generation atypical antipsychotic and a dopamine serotonin system stabilizer, effective against positive and negative symptoms of schizophrenia. Within the group of atypical antipsychotics, aripiprazole shows a relatively benign safety profile (e.g. lower metabolic impact, mild effect on cardiovascular parameters), although the reported rate of extrapyramidal side effects is measurable.

Oculogyric crisis (OGC) is a rare movement disorder characterized by a prolongued involuntary upward deviation of the eyes, lasting minutes to hours. In most cases, OCG is a drug-induced adverse event with acute or tardive onset often attributable to a functional impairment of dopaminergic neurotransmission.

OGC is seldom reported in children and young adults during treatment with aripiprazole, althouh it is commonly used in youths.

We report a case of an aripiprazole-induced oculogyric crisis in a 19 year old girl who diagnosed with schizophrenia (paranoid).

There was a complete remission of the OGC’s following aripiprazole dose reduction, suggesting the clinical manifestation was a dose-dependent phenomenon.

The present report should raise awarness among clinicians for this relevant possible adverse event, that can happen also with the use of aripiprazol, not only with typical or more antidopaminergic antipsychotics. Future research in the field should emphasize neurobiological dysfunctions as the basis of EPS/OGC in patients.

None Declared

Depression in the elderly is common and closely interrelated with the deterioration of the quality of life, especially in the institutionalized elderly.

In this work, we propose to determine the prevalence of depression in the elderly in institution, to assess their quality of life and to evaluate the correlations between depression and the quality of life.

Our study concerned 30 elderly subjects institutionalized at the retirement home(Sousse, Tunisia). Three validated Arabic version scales were used: The 30-item GDS (Geriatric Depression Scale), the MMSE (Mini Mental State Examination) and the SF36 (assessing the quality of life).

The mean age of our population was 75±7.3 years, the sex ratio was 1.73. The prevalence of depression was 37%. The elderly had a cognitive impairment in 16.7%. The mean global SF36 score were 11.2, attesting an altered quality of life in all our subjects: the mental component (9.43) were more altered than the physical one (13.03). No correlation between depression and quality of life was found. Depression was significantly correlated with the presence of a medical history (p=0.05). Depression had a negative and statistically significant correlation with the physical score of SF36 (r=-0.41, p=0.02) and tended towards significance for the “general health” dimension of SF36 (r=-0.32, p=0.08).

Our study shows a high frequency of depression in the institutionalized elderly as well as a deterioration in their quality of life. Depression is strongly linked to deterioration in physical condition.Our results underline the influence of somatic diseases as a major risk factor for depression in the elderly.

No significant relationships.

the relationship between hypothyroidism and mood disorder espacially depressive disorder is well described. However, there are few studies reporting psychotic symptoms (such as delusions, auditory or/and visual hallucination) in the setting of thyroid hormone defeciency.

this study highlights psychosis as a possible presenting symptom in hypothyroidism.

case report and review

we report the case of a female patient aged 36 years old with no family or personal psychiatric history, who presented with delusion, depressive disorder and auditory hallucination . the CT scan was without abnormality . the thyroid screening finds a severe hypothyroidism after 3 months of radiotherapy witn Iodine131 [FT4 = 2.49 ρmol/l, TSH 135.28 μUI/ml]

psychotic symptoms are an uncommun presentation of hypothyroidism and treatement choices are contreversial.