Prevalence estimates of childhood and adolescent mental health disorders appear to vary between 20 to 30% worldwide. It is therefore unsurprising that studies have yielded inconsistent findings in regards to the trends of prevalence of mental health disorders. Some reasons for the discrepancy in findings include use of survey data and its associated attrition and selection bias.

First, to determine and compare the prevalence of mental health disorders derived from a survey and a population cohort. Second, to evaluate trends of mental health prevalence over time.

As population data (i.e., linked health records) may be used to overcome the issues presented by survey data, we compared the prevalence estimated from a prospective survey cohort (the Western Australian Pregnancy Cohort (Raine study) to another estimate from a prospective population cohort (linked population data; data from the Hospital Morbidity Records and Mental Health Registration).

As expected, the Raine cohort yielded a larger estimate of prevalence when compared to the linked population data. However each cohort also revealed opposite trends of prevalence, where the Raine cohort showed the prevalence of mental health disorders to decrease as children age.

We therefore recommend that estimates of prevalence be interpreted with the type of cohort in mind, as estimates from survey cohorts will provide different information to that from population cohorts.

Early-Onset Schizophrenia (EOS) is a rare and severe form of schizophrenia that begins in childhood and it is often associated with genetic risk factors, poorer prognosis, and increased treatment resistance compared to adult-onset schizophrenia (Hatzimanolis et al. Eur Psychiatry 2020;63(1):e44). This case report presents two siblings diagnosed with EOS and treated at the same inpatient clinic in different years.

The aim is offering a perspective on the clinical characteristics, genetic and enviromental implications, and treatment challenges of two siblings with EOS and seeking to enhance understanding of EOS’s complexity, particularly in the context of treatment resistance.

A comprehensive retrospective review of the siblings’ all medical records was conducted, focusing on their psychiatric history, symptoms, treatment trials, and responses of treatment. Both cases’ current clinical situations were evaluated cross-sectionally.

Older sibling: 19 year-old male, was diagnosed with EOS following the onset of symptoms as social withdrawal, negativism and suspiciousness at the age of 14. He referred to the inpatient clinic with the cause of drug intake refusal. Risperidone treatment started but there was no significant response. Risperidone to olanzapine switch made and clinical remission observed. After his discharge, 4 more hospitalisations in 5 years needed due to low socioeconomic status, parental neglect and him having no insight and stopped taking his medications repeatedly. Several depot form antipsychotic injections started to prevent recurrent hospitalisation. Despite that he needed several hospitalisations to adult psychiatry inpatient clinics.Younger sibling: 14 year-old female, were diagnosed with EOS following the symptoms as auditory hallucinations, suspiciousness, disorganised speech and behaviours at the age of 13. She referred to the same inpatient clinic with suicidal risk after 2 years of his brother’s last hospital stay. She responded good to olanzapine treatment like her brother’s, during her first stay. After 2 weeks of her discharge, her psychotic symptoms started again with no specific reason. Second hospitalisation needed due to her homicidal and suicidal risk. Clozapine and aripipirazole treatment started and she discharged in partial remission. She is being followed in outpatient clinic, with low functioning.

Despite trials of multiple antipsychotic medications and adjunctive treatments, both siblings demonstrated significant treatment resistance. These sibling cases underscore the complexity and challenges in managing EOS, particularly when it presents with treatment resistance. The shared familial environment and potential genetic factors demand further investigation to elucidate the pathogenesis of EOS and optimize therapeutic approaches.

None Declared

The frequent use of psychiatric emergency poses problems due to the loss of their adaptative capacity and diagnosis, orientation and therapeutic difficulties for clinicians.

To estimate the prevalence of frequent visitors to psychiatric emergency and to describe their sociodemographic and clinical characteristics.

It is a cross-sectional study of twelve months including patients who consulted at least twice to medical emergency department in the university hospital of Mahdia. Data were collected using a predefined questionnaire.

The prevalence of recurrence was 30,2%. The main characteristics were: a mean age of 35,5 years, a male gender (64,5%), being unemployment (72,3%), a single status (71%), a request from the family (55,5%) and the presence of psychiatric personal history (91,6%). Previous hospitalizations were noticed in 69% of cases. 44,5% of the patients had problems with the primary support group and the social environment. In 78,6% of cases, patients had visited emergency twice to four times. The most encountered reason for consultation was heteroagressivity (27%) and the most frequent syndromic diagnosis was psychomotor excitation (25.2%). Hospitalization concerned 47.1% of patients. Schizophrenia and bipolar disorder were the most diagnosed disorders in 54,2% and 25% of cases.

Absence of intermediate structures and lack of coordination between the various stakeholders involved in the management of patients are the two main encountered problems.

Emigration is a complex process of social changing through which an individual moves from a certain cultural environment/context to another, aiming to achieve persistent or long-term residency, causing distress. There is sustainable evidence that incidence of all forms of psychosis is higher in migrants.

This study aims to gather data of other research conducted in the field according to emigration as a risk factor for development of different psychosis.

Scientific articles searched in MEDLINE, regarding the incidence of mental disorders in different emigrant populations, for the period 1995 - 2015.

The average relative risk of schizophrenia and of other psychosis occurrence among first generation emigrants was 2.7 (95% confidence interval [CI]=2.3-3.2). Statistical analysis performed among studies of first and second generation of emigrants, and among studies which don’t make difference between generations, results in a relative risk of 2.9 (95% CI=2.5-3.4) of mental illness.

The data presented in this study emphasize the impact of migration on central symptoms of schizophrenia. Emigration process, cultural and social adaptation, play an important role on the individual mental health.

No significant relationships.

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.

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.

Electroconvulsive therapy (ECT) presents itself as a highly effective therapeutic approach in various psychiatric conditions, especially affective disorders and catatonia. Although obsessive-compulsive disorder (OCD) is not an established indication for ECT, there are several positive results that have been replicated, giving us an account of its potential applicability.

To emphasize the importance of defining predictors of response to ECT in OCD.

The authors’ clinical experience is combined with the review of clinical cases, available in the literature, related to the application of ECT in OCD.

Personal or family history of affective pathology and obsessions of sexual content were identified as potential predictors of response to ECT in patients with obsessive and compulsive symptoms.

Although preliminary and based solely on case reports, the replicability of results should promote special attention to situations in which OCD is marked by particular characteristics that favor the response to ECT. In this way, it would be possible to prevent the dragged consumption of health resources and minimize the expected chronicity associated with this clinical condition.

olanzapine and carbamazepine are effectively used in treatment of schizoaffective disorder but they can have numerous side effects including skin eruptions that can be severe sometimes.

To study the relationship between toxidermia and treatment with Olanzapine and Carbamazepine.

We report the case of a patient who developed a psoriasiform skin rash following the intake of Olanzapine and Carbamazepine.

Mrs SL, 46 years old, with no prior medical or surgical history, has been diagnosed with schizophrenia since the age of 26. She was initially treated with Haloperidol and Risperidone with an irregular follow-up. Then, due to the emergence of mood disorder symptoms, the patient was put on 20 mg/day of Olanzapine and 400 mg/day of carbamazepine. One month later, the patient presented a generalized rash requiring the discontinuation of the current medications. She was treated with corticosteroids, and then she was referred to our department to make the appropriate adjustment of her psychiatric treatment.

In view of the persistence of a dry erythroderma with erosive lesions of scratching and palmoplantar keratoderma, a skin biopsy was performed showing a psoriasiform and eosinophilic dermatosis that could be consistent with a toxidermia. The pharmacovigilance investigation concluded the incrimination of Olanzapine and carbamazepine in this symptomatology and recommended to avoid their prescription for this patient.

The need for a mood stabilizer presented us with a challenge, particularly in view of the potential risk of cross-toxicity. We opted for the reintroduction of Risperidone with strict monitoring of the skin condition.

Each prescribed drug must be considered as potentially capable of causing cutaneous reactions as an adverse effect. Both the prescriber and the patient must be made aware of this phenomenon.

None Declared

Many women in fertile period of their lives experience some mental and physical symptoms that begin on 7–10 days before menses and cease after bleeding. Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) are the terms to indicate these symptoms. The prevalence of PMS has been estimated to be about40% to70%, PMDD has lower prevalence.

This study has evaluated the frequencies of PMS and PMDD along with related factors in students of girls’ high schools in Kermanshah.

In this descriptive-analytic study, 800 students of girls’ high schools were chosen by incidentally and clustery sampling. Everyone who was volunteer included in the study. Excluding criteria were: history of depression; medical illnesses like epilepsy, meningitis, encephalitis, heart diseases…; history of consumption of β-blockers or other drugs of heart diseases, Phenobarbitals, and anticonvulsants. The diagnosis was made according to DSM.IV.TR. The data was processed using SPSS software, version 11.5, and by descriptive and analytic statistical methods.

Results

1. 1. The frequencies of PMS and PMDD were 41.5% and 9.4% respectively.

2. 2. The disorder was more frequent in students older than 16 years-old.

3. 3. Mood symptoms were the most frequent, followed by physical and behavioral symptoms respectively.

4. 4. There was lower frequency of the disorder in students whose mothers were high educated.

5. 5. The frequency of PMS was higher in those with positive family history.

The high frequencies of PMS and PMDD which result to problems in education of students need serious considerations to elevate mental health of students and to refer the severe cases to specialized centers.

Abusive childhood experiences are claimed to be more prevalent in people with schizophrenia (SCZ) than in the general population. The exposure to childhood trauma can have adverse effects on cognitive function.

To investigate whether there is a relationship between childhood trauma (CT) and cognitive functioning in patients with SCZ.

Fifty-eight outpatients with stable SCZ were recruited. The participants completed the Childhood Trauma Questionnaire retrospectively assessing five types of childhood trauma (emotional, physical and sexual abuse, and emotional and physical neglect). They also completed a neurocognitive battery comprising the following tests: the Hopkins Verbal Learning Test–Revised (HVLT-R), the Letter Digit Substitution Test (LDST), the Stroop Test (ST), the “Double Barrage” of Zazzo (DBZ), the Modified Card Sorting Test (MCST), the Verbal Fluency (VF), the Trail Making Test-Part A (TMT-A) and the Digit Span (DS).

The patients with a history of physical abuse (P = 0.03) or emotional neglect (P = 0.07) performed worse at the delayed recall of the HVLT-R. A history of emotional neglect was also correlated to a significantly worse performance in theTMT-A (P < 0.0001), while physical abuse was correlated to worse DS (P = 0.015). High emotional abuse scores were significantly correlated to poorer efficiency in DBZ (P = 0.025).

The results need replication, but underline the necessity of investigating biological and psychosocial mechanisms underlying these subjects’ cognitive impairment.

The authors have not supplied their declaration of competing interest.

Compliance is a major issue in the treatment of schizophrenia. Many studies have attempted to identify factors that influence it.

To assess treatment adherence in patients with schizophrenia. To identify factors correlated with poor adherence.

It was a cross-sectional, descriptive and analytical study, involving 37 outpatients with DSM-IV diagnosis of schizophrenia, followed in the psychiatry department at the Hédi Chaker University Hospital of Sfax (Tunisia). The questionnaire included socio-demographic, clinical and therapeutic data. We also used the Medication Adherence Rating Scale “MARS”, the Insight Scale “IS” and the Stigma Scale (9 items).

The average age was 36.4 years. The majority of patients was male (68.8%), did not exceed the level of secondary education (89.2%) and had a low socioeconomic level (84.4%).

Paranoid schizophrenia was the most frequent type of schizophrenia (54.1%). Atypical antipsychotic were prescribed in 40.5% of cases.

Patients were non-adherent to treatment in 56.8% of cases. The factors correlated with poor adherence were: psychoactive substance use (P = 0.036), sexual dysfunction (P = 0.036), complexity of treatment (P = 0.036), poor insight according to the subscale “awareness of the need for treatment” of the IS (P = 0.047) and high score on the subscale “discrimination” of the Stigma Scale (P = 0.008).

Tunisian schizophrenic patients have a poor adherence to treatment. Acting on risk factors (such as substance use, sexual side effects, poor insight and discrimination perception) would improve patient compliance and management of schizophrenia.

The authors have not supplied their declaration of competing interest.

In the literature, service users and informal caregivers have been critical towards psychiatric inpatient care. However, little is known about their fears related to hospital care.

We describe service users’ and informal caregivers’ experiences of fear in psychiatric hospital settings.

The data were collected from seven mental health associations located in six Finnish cities. Focus group interviews (f=8) were conducted (2015–2016) with service users (n=20) and informal caregivers (n=15), and were guided to focus on violence and challenging situations in psychiatric care. In a secondary analysis, experiences of fear were extracted from the transcriptions and analyzed using inductive content analysis.

Both groups’ experiences of fear focused on themes related to staff, treatment and fellow patients. Additionally, service users had experiences of fear related to the hospital environment. Fears related to staff involved intimidating personnel using force or acting in threatening ways. Participants also described staff seemingly being afraid of patients and care givers. Three types of fears related to treatment were described: fear of not being admitted to hospital even if needed, fear of being admitted to hospital, and fear of coercive methods used in care. Fear of fellow patients involved being afraid of aggressive, unpredictable behaviors, which could cause, e.g., a lack of sleep at night for service users. Fears related to the environment itself were also discussed.

Being hospitalized can be a difficult experience for service users and informal caregivers. These results can help psychiatric healthcare staff acknowledge areas in care that may potentially cause feelings of fear.

No significant relationships.

Presently, the concept of preparing youth for the labor market in the 21st century receives much attention because of the rapidly changing nature of work and the soft skills and hard skills required by employers. Therefore, graduates need to be competent at work skills necessary for the 21st century to be able to face challenges of work in the present age and to have new perspectives for facing challenges and changes of work. According to the Federation of Thai Industries, the estimated number of workers needed by 14 groups of manufacturing industries during 2013-2017 included 58 percent of high school graduates.

The current study aims to survey and assess essential skills development in high school students in Southern Thailand for the workforce in the 21st century.

The cross-sectional study was applied to 1,200 subjects consisting of 400 employers and 800 high school students. Data was analysed using means, standard deviation and t-test

The results revealed that communication, digital literacy, creativity, critical thinking, collaboration, and responsibility were the major skills development needs of high school students in the 21st century labor market. The results indicated that high school students’ levels of skills were lower than those required by employers in four skills: communication, digital literacy, critical thinking, and creativity at the statistical significant level of .001, as presented in table 1.Table 1.Means different for skills development need by sample group.

The high school students possess skills needs for work in the 21st century at lower levels than those needed by employers. This is the issue requiring attention from individuals involved in educational management as they must find ways to develop the teaching and learning methods that can upgrade students’ skills that are needed for work and seen by employers as highly important. These skills are communication, digital literacy, critical thinking, and creativity. The teaching and learning styles should be more active rather than passive to stimulate students to think, to be proactive instead of passively to respond to whatever happens, to propose their ideas or to express differing opinions and using the appropriate language or communicating tools. The fact that these skills are at a moderate level could result in limitations for young people’s development or employment as these skills are required for work in this century where analytical thinking and creativity are necessary for invention both in the workplace and in private life.

None Declared

EHRs contain a rich source of real-world data that can support evidence generation to better understand mental disorders and improve treatment outcomes. However, EHR datasets are complex and include unstructured free text data that are time consuming to manually review and analyse. We present NeuroBlu, a secure, cloud-based analytic tool that includes bespoke NLP software to enable users to analyse large volumes of EHR data to generate real-world evidence in mental healthcare.

(i) To assemble a large mental health EHR dataset in a secure, cloud-based environment.

(ii) To apply NLP software to extract data on clinical features as part of the Mental State Examination (MSE).

(iii) To analyse the distribution of NLP-derived MSE features by psychiatric diagnosis.

EHR data from 25 U.S. mental healthcare providers were de-identified and transformed into a common data model. NLP models were developed to extract 241 MSE features using a deep learning, long short-term memory (LSTM) approach. The NeuroBlu tool (https://www.neuroblu.ai/) was used to analyse the associations of MSE features in 543,849 patients.

The figure below illustrates the percentage of patients in each diagnostic category with at least one recorded MSE feature.

Delusions and hallucinations were more likely to be recorded in people with schizophrenia and schizoaffective disorder, and cognitive features were more likely to be recorded in people with dementia. However, mood symptoms were frequently recorded across all diagnoses illustrating their importance as a transdiagnostic clinical feature. NLP-derived clinical information could enhance the potential of EHR data to generate real-world evidence in mental healthcare.

This study was funded in full by Holmusk.