Bipolar disorder or manic-depressive illness is a mental disorder which consists of abnormal and long-lasting changes in a person’s mood, energy, and ability to function. The ongoing COVID-19 pandemic restrictions precipitate the condition of those with bipolar affective disorder.

We searched for significant differences before and during the pandemic by analyzing socio-demographic data.

We carried out a research activity at the I Psychiatry Clinic of the Clinical Hospital of Neuropsychiatry Craiova. We formed two groups of hospitalized patients during 2019 and during 2020, when the pandemic broke out. The inclusion criterion was the presence of bipolar affective disorder as a primary diagnosis.

The number of cases and the total number of hospitalization days was higher during the pandemic, 101 cases versus 94 cases, 1667 days versus 1184 days. We identified a predominance of females during the pandemic, whereas in the previous year the distribution by sex was approximately equal. Regarding environment, the number of patients from urban and rural areas was approximately equal in 2019, while during the pandemic those in urban areas predominated, possibly due to easier access to psychiatric services. The ages of patients maintained a Gaussian distribution with a concentration of cases between 35-55 years.

While other psychiatric disorders were less present in the clinic during the pandemic, the number of bipolar affective disorder cases increased. Bipolar affective disorder is a major challenge due to the wide range of symptoms which cross with comorbidities that increase the likelihood of a SARS-CoV-2 infection.

No significant relationships.

Some projects have described post-disaster psychosocial services and planning across Europe. However, little is known about the real psychosocial disaster responses such as low-intensity initiatives after a terrorist attack

This study aims (1) to describe psychological support (PS) in the immediate (<48 hours), post-immediate (48 hours – 1 week) periods and more than one week after a terrorist attack among terror-exposed people, and (2) to identify factors associated with a lack of short-term PS among those who suffered from mental health disorders.

This study used data from a longitudinal survey of 189 civilians exposed to the January 2015 terrorist attacks conducted 6 months after the attacks. Factors associated with lack of PS after the attacks was identified using a Robust Poisson regression in three separate models (for the 3 periods).

Among participants who suffered from PTSD (n=34), depression (n=74), or anxiety (n=59) 6-9 months after the terrorist attacks, respectively, 9%, 18% and 12% did not received psychological support. The lack of immediate PS was associated with geographical distance, type of exposure, and support in daily life. The lack of post-immediate PS was associated with geographical distance, peri-traumatic reactions and past psychological follow-up. The lack of PS after one week was associated with geographical distance and social isolation.

Characteristics of exposition and social support seem to play an important role in lack of PS after a terrorist attack and highlights the need to use strategies to reach out to people regardless of the type of exposure.

No significant relationships.

Best practice requires the treating physician to understand the needs and hopes of his/her patient, particularly in relation to pregnancy and childbirth preferences. This is even more necessary for women with Severe Mental Illness (SMI) because of the complicated decisions they face balancing the need to continue medication in pregnancy to prevent relapse against any possible harm to the foetus. Objectives: To explore what women themselves view as most important when discussing pregnancy and childbirth with psychiatrists and what barriers there are to a) having a meaningful conversation and b) achieving optimum outcomes. Qualitative methods were used to analyse the data from in-depth interviews with 21 women, recruited from a South London NHS organisation (76%) and the UK’s national bipolar charity (24%). The views of 25 health professionals, including 19 psychiatrists, were also collected and analysed. Results: Many themes emerged but principally women wanted: information, continuity of care, better training for health professionals, to co-produce a detailed care plan, access to a Mother and Baby Unit, peer support and more research on medications in pregnancy. Conclusions: This study highlighted the importance of understanding women’s needs and fears and giving them the necessary information to make the difficult decisions that face them. Such understanding is likely to lead to more positive therapeutic relationships and better long-term outcomes.

No significant relationships.

The COVID-19 pandemic and social and mobility restriction measures have had a negative impact on the mental health of the population.

The objective is to demonstrate the impact of the pandemic on mental disorders.

64-year-old man who is taken to the emergency room after a suicide attempt, by hanging with a belt out of concern and measuring the contagion of the COVID-19 virus in the context of long-standing delirious ideas of contamination and hypochondriacal neurosis. Adaptive disorder in relation to previous divorce. Psychopathologically, the patient is anxious and restless, conscious, inattentive and poorly oriented in space and time. Accelerated language with monothematic discourse about the possibility of contagion that has caused isolation behavior to the point of shredding organic waste and throwing it down the toilet so as not to have to go out to throw it out for fear of contagion. Faced with a neighbor’s wake-up call due to a blocked pipe, he suffers a crisis of guilt and anxiety and attempts to commit suicide. COVID-19 PCR=negative. Beck’s Depression Inventory 24=moderate depression. IPDE accentuated obsessive and avoidant personality traits.

Diagnosis: Moderate depressive episode with psychotic symptoms. Hypochondriacal disorder. Ananchastic personality disorder. Treatment: Paliperidone 3mg/24h. Sertraline 100mg/24h

In obsessive personalities and hypochondriacal neuroses, the COVID-19 pandemic has posed an increased risk of decompensation for affective disorders and even suicide attempts. Isolation, lack of treatment and prior monitoring, as well as the difficulty of identifying vital stressors, must be taken into account if an early intervention is to be carried out.

No significant relationships.

Weight gain and obesity are important health problems associated with psychiatric disorders and/or with psychotropic drug treatments. There is a high inter-individual variability in the susceptibility to drug induced weight gain and/or other cardiometabolic disorders.

To study the genetic and environmental risk factors for weight gain and onset of metabolic syndrome during psychotropic treatment

Analysis in PsyMetab, a large (n>3000) ongoing longitudinal prospective cohort study investigating cardiometabolic disorders in psychiatric patients.

Aside from well-known clinical risk factors for metabolic worsening (e.g. young age, first episode status, rapid weight gain during the first month of treatment and/or low initial BMI), additional risk factors have been recently identified. We showed an inverse association between socio-economic status (SES) and worsening of cardiometabolic parameters, adult patients with a low SES having a three-fold higher risk of developing metabolic syndrome over one year versus patients with a high SES (n=366). In addition, a causal inverse effect of educational attainment on BMI was revealed using Mendelian randomization in the UKBiobank (n=30’069). Results from an epigenome-wide association study (EWAS) performed in 78 patients before and after one month of treatment and from a genome-wide association study (GWAS) in 1924 patients will also be presented.

Differences in clinical, genetic and environmental factors contribute to the differences in weight gain and metabolic disorders induced by psychotropic drugs. When starting a psychotropic drug at risk, a prospective monitoring of clinical (e.g. weight and blood pressure) and biochemical (fasting glucose, lipid levels) parameters is essential.

Prof. Eap received honoraria for conferences or teaching CME courses from Janssen-Cilag, Lundbeck, Otsuka, Sandoz, Servier, Sunovion, Vifor-Pharma, and Zeller in the past 3 years. The other authors report no potential conflicts of interest. This work has

Kratom (Mitragyna speciosa) is an herb found in South East Asia belonging to the Rubiacea family, the active constituents being Mitragynine and 7-hydroxymitragynine. Sold as a dietary supplement in the form of a leaf, tablet, and powder, it has been gaining popularity as a natural supplement to alleviate pain, anxiety, depression, and manage opioid withdrawal symptoms. Our case report centers around a patient encountered with high-dose Kratom use who presented to our Psychiatric ER with psychosis.

The objectives of this case report are to raise awareness regarding the use of a newly popular substance easily available over-the-counter and the potential impacts it has on mental health.

PubMed was searched for the criteria Kratom AND Intellectual Disability, with a secodary search for Kratom AND Psychosis.

A 29-year-old male with a past psychiatric history of Schizoaffective Disorder, Borderline Intellectual Functioning, Polysubstance Use, ADHD, and six prior suicide attempts was brought to the Psychiatric ED by ambulance activated by his mother for severe psychiatric decompensation following ingestion of 270 pills of Kratom over the course of three days.

This case report further increases awareness of the dangers of Kratom use as well as brings to light the psychoactive properties of Kratom. This case report exposes areas where research can further expand understanding regarding the impacts Kratom can have on psychiatric populations.

No significant relationships.

As the incidence of gender incongruence (GI)/gender dysphoria (GD) rises yearly, public understanding of transgender is also increasing, whereas this improvement cannot be achieved without extensive transgender-related surveys. However, most of the surveys were only issued to people who identify themselves as transgender with the absence of medical confirmations in most situations. These result in a gap between transgender survey and diagnosed GI/GD.

This study aims to discover the gap between self-reported and diagnostically confirmed transgender and GI/GD individuals among students in China.

We chose two middle schools and one college from Changsha (a city in China) at random with a total of 2047 students. Among them, 1661 students gave us certain gender identify responses in which we categorized them into two types (cisgender and gender minorities). Professional psychiatrists then used ICD-11 and DSM-5 criteria to confirm whether the self-reported gender minorities could be diagnosed with GI/GD via phone or in person.

In total, 7.5% of the college students and 5.8% of the middle school students reported themselves as gender minorities. Although 29% of college students and 43.8% of middle school students did not cooperate with the subsequent psychiatric interviews, none of the self-reported gender minority students meet the GI/GD criteria of ICD-11/DSM-5.

The epidemiological investigation of transgender is heavily affected by the definition and the data sources. There is a huge heterogeneity between self-reported transgender and diagnosed GI/GD. Future transgender studies should strictly control inclusion criteria.

No significant relationships.

No significant relationships.

Vascular dementia (VaD) accounts for approximately 15% of all cases of dementia. While there are many different definitions of vascular dementia, it is generally understood to refer to “disease with a cognitive impairment resulting from cerebrovascular disease and ischaemic or haemorrhagic brain injury”. Research suggests that 30% of patients with VaD also suffer from depression. The treatment of depression in VaD with pharmacological therapy is relatively well-established, with the first line drug being a selective serotonin reuptake inhibitor (SSRI). However, a relatively under-researched area is the use of brain stimulation and neuromodulation therapies for the treatment of depression in VaD.

This review aims to provide a critical analysis on the efficacy and safety of brain stimulation therapies in treating depression in VaD to determine whether it is an appropriate treatment option.

The databases used were PubMed and WebofScience. The available literature was analysed which resulted in three papers which met the inclusion criteria and were critically appraised.

In all three studies, depressive symptoms improved after ECT was administered, regardless of the specific tool used to measure the severity of depression. The side effects experienced were also only temporary and resolved independently which speaks to the safety of ECT as a treatment option.

The results of the study prove that ECT is a safe and effective option in treating depression in VaD. However, more research is needed for the medical community to fully understand the different treatment options and say with certainty which is the safest and most effective.

No significant relationships.

Since last year there has been a lively ethical discussion in Poland about the influence of religion and new cultural currents on medical ethics. There are many ways to work towards increasing ethical sensitivity in education of mental health care professionals.

This paper presents the ethical discourse in the bulletin “Primum” of Bydgoszcz Medical Chamber (24 chambers in Poland associate doctors and dentists): www.bil.org.pl/primum - English translations: www.dropbox.com/s/xthu7wyt56ecjwp/Primum_translations.docx?dl=0.

All texts dealing with issues described were collected and divided into three groups: promoting new currents of thought, faithful to tradition, others. Presented views were analyzed basing on Polish Code of Medical Ethics (nil.org.pl/uploaded_images/1574857770_kodeks-etyki-lekarskiej.pdf) and compared with dominating philosophical schools.

A total of 33 articles were published: 20 presenting new approach to medical ethics, supported by the Editorial Board (72% of the total), 7 embedded in traditional values (22%), 6 without a clear stand or denying the discourse on ethical issues (6%). Articles presented philosophical views (personalism, virtue ethics, utilitarianism, constructionism), discussed ethical standards, actions contrary to the dignity of medical profession, value of human life, compliance of arguments with medical knowledge, principles of dealing with patients in terminal states, the duty of care for the pregnant woman and her child.

All texts show dilemmas in our environment, reflect views in Polish society and in ethical discourse around the world. Thanks to them, readers familiarize themselves with the contemporary ethical debate and form their own opinions; also they are encouraged to reach for the indicated sources and their own research.

No significant relationships.

No significant relationships.

Alteration of GABergic neurotransmission is accused to be sharing in the cognitive impairment in schizophrenia. Exploring the relation between the neuronal expression of GABergic genes and cognitive impairment in living patients through modeling of schizophrenia is an important step to know more about the core of the pathophysiology of this disorder

Altered genetic expression of GAD 67 may have an important role in the pathophysiology of cognitive impairment in schizophrenia

. Reprogramming of human fibroblasts into human induced pluripotent stem cells (hIPSc) then neuronal differentiation was performed in 20 patients presenting with schizophrenia and 20 matched controls. Real time Polymerase chain reaction was done for measurement of genetic expression of GAD 65, GAD 67 and GABA beta 2. The Digit Symbol task, block design, block design task and similarities tasks from the Wechsler Adult Intelligence Scale., Trail A and Trail B making tests in addition to Rey-Osterrieth Complex Figure Test (ROCF) were applied to measure cognitive functions .

There were lower means of GAD65, GAD67 and GABA beta2genetic expression in the patients group with significant statistical difference between the 2 groups. The down regulation of GAD 67 in patients presenting with schizophrenia is positively correlated with impairment in executive functions.

GAD 67 gene expression had the most significant correlations with the cognitive assessment in both patients and controls. The presence of those statistically significant correlations in both groups points to the possible role of GAD 67 gene functioning in the pathophysiology of cognitive impairment in schizophrenia

No significant relationships.

Noonan-like syndrome with loose anagen hair (NSLH MIM 607721) is associated to mutations in PTPN11, RAF1, BRAF and SHOC2 genes.

Here, we report behavioral phenotype of a child suspected to have NSLH.

A 2-years-old Tunisian child harboring severe pulmonic valvular stenosis was referred to our genetic counselling for genetic assessment. Medical dysmorphology, cytogenetic analysis as well as genetic exploration of RAS-MAPK pathway genes were conducted.

The child had short stature and ectodermal features including ichthyotic skin and thin-soft nails. He has specific hair appearance associated to NS features. In fact, he had a small nasal tip, thick lips and sticking-out rotated ears. He harbored typical nasal voice and loose anagen hair with ungrowing thin hair, sparse and pale scalp hair and eyebrows. He showed cognitive deficits with mental retardation and hyperactive behavior. Considered as having NSLH, cytogenetic analysis revealed a 46,XY formula, but molecular screening of PTPN11, RAF1, BRAF, RIT1 and SHOC2 genes was negative.

Mutations within the RAS‐MAPK signaling pathway affect neurophysiologic activity in brain regions underlying attention and executive functions. Children with rasopathies demonstrated higher rates of attention deficit-hyperactivity (ADHD) and autism spectrum disorders. However, no studies have examined specifically the aspects of behavioral attention in the various types of Rasopathies. A recent study demonstrated that ADHD seems to be higher in children with NSLH and SHOC2 mutation, which is the case of our patient. We suggest that assessment of inattentive and hyperactivity symptoms in children should consider Rasopathies with specific molecular screening.

No significant relationships.

There are several case reports describing clozapine side effects such as agranulocytosis, constipation,tachycardia but rarely cases describing oesophagitis caused by clozapine were reported.

To report the first case in our country about clozapine induced oesophagitis.

We describe a case in which a patient who has no gastrointestinal past history,has developed an oesophagitis stage 2 of Savary and Miller Classification without any gastroesophageal reflux disease, few weeks after introducing clozapine at therapeutic dose.

A 25 years old male patient with resistant schizophrenia managed with clozapine,was admitted to reinitiate his treatment after weeks of stopping his medication.During hospitalization, our patient developed a sudden haematemesis in 10 days after commencement of clozapine. The patient had no history of gastrointestinal symptoms or disease. The clinical examination and blood tests did not find any signs of bleeding severity.A gastroscopy was performed, revealing esophagitis stage 2 of Savary and Miller classification and a cardiac polyp removed with biopsy forceps that showed no malignant lesions .The patient was treated with acid suppressant therapy.There was no further episode of haematemesis and our patient healed uneventfully within a week.As for clozapine, it wasn’t interrupted and we continued increasing doses very carefully with no further incident.

Although it is a rare side effect, oesophagitis may appear at therapeutic doses of clozapine, and this possibility should be taken into account when treating patients with resistant psychiatric disorders.

No significant relationships.

The extant findings have been of great heterogeneity due to partial volume effects in the investigation of cortical gray matter volume (GMV), high comorbidity with other psychiatric disorders, and concomitant therapy in the neuroimaging studies of social anxiety disorder (SAD).

To identity gray matter deficits in cortical and subcortical structures in non-comorbid never-treated patients, so as to explore the “pure” SAD-specific pathophysiology and neurobiology.

Thirty-two non-comorbid free-of-treatment patients with SAD and 32 demography-matched healthy controls were recruited to undergo high-resolution 3.0-Tesla T1-weighted MRI. Cortical thickness (CT) and subcortical GMV were estimated using FreeSurfer; then the whole-brain vertex-wise analysis was performed to compare group differences in CT. Besides, differences in subcortical GMV of priori selected regions-of-interest: amygdala, hippocampus, putamen, and pallidum were compared by an analysis of covariance with age, gender, and total subcortical GMV as covariates.

The SAD patients demonstrated significantly decreased CT near-symmetrically in the bilateral prefrontal cortex (Monte Carlo simulations of P < 0.05). Besides, smaller GMV in the left hippocampus and pallidum were also observed in the SAD cohort (two-sample t-test of P < 0.05).

For the first time, the current study investigated the structural alterations of CT and subcortical GMV in non-comorbid never-treated patients with SAD. Our findings provide preliminary evidences that structural deficits in cortical-striatal-limbic circuit may contribute to the psychopathological basis of SAD, and offer more detailed structural substrates for the involvement of such aberrant circuit in the imbalance between defective bottom-up response and top-down control to external stimuli in SAD.

No significant relationships.

Electroconvulsive therapy (ECT) is proposed to exert an effect on white matter (WM) microstructure, but the limited power of previous studies made it difficult to highlight consistent patterns of change in diffusion metrics.

We initiated a multi-site mega-analysis and sought to address whether changes in WM microstructure occur following ECT.

To this end, diffusion tensor imaging (DTI) data (n=58) from 4 different sites were harmonized before pooling them by using ComBat, a batch-effect correction tool that removes inter-site technical variability, preserves inter-site biological variability and maximizes statistical power. Downstream statistical analyses aimed to quantify changes in Fractional anisotropy (FA), Mean Diffusivity (MD), Radial Diffusivity (RD) and Axial Diffusivity (AD), by employing whole-brain, tract-based spatial statistics (TBSS).

ECT increases FA in the right splenium of the corpus callosum and the left cortico-spinal tract. Both the left superior longitudinal fasciculus and the right inferior fronto-occipital fasciculus showed increases in AD. Increases in MD and RD could be observed in overlapping white matter structures of both hemispheres. Finally, responders showed significantly smaller FA values in the left forceps major and smaller AD values in the right uncinate fasciculus compared with non-responders.

This is the first and largest multi-site mega-analysis to demonstrate that ECT normalizes altered WM microstructure in important brain circuits that are implicated in the pathophysiology of depression. Furthermore, responders appear to present a more decreased WM integrity at baseline, which if replicated could serve as a biomarker for ECT response.

No significant relationships.

Post-traumatic stress disorder (PTSD), is a Mental Health condition due to a traumatic experience. There are four types of Gender Violence in Latin America: physical, sexual, psychological or patrimonial violence, when it occurs between intimate partners it is called intimate partner violence (IPV). PTSD is highly associated with IPV.

Determine the statistical index of IPV and PTSD in women and men in Guayaquil-Ecuador.

We carried out a descriptive cross-sectional study, the sample was collected at the Florida Prosecutor’s Office in Guayaquil-Ecuador by UCSG medical students in 2018. The sample was 239 individuals, 195 women, 44 men. Individuals were separated into groups by gender, marital status, children, age, habits and PTSD. We applied Beck test for Depression, Davidson and DSM-5 for PTSD.

In this study we observe a male population suffering from IPV. Complaints of IPV 195 women (81.59%), 44 men (18.41%). PTSD positive 159 women (81.96%), men 35 (18.04%). More prevalent in age ranges 25-34. PTSD with children 147 (76%) and without children 47 (24%).

Factors such as being a woman, having children and younger ages are linked in this study as predisposing to suffer from IPV and PTSD. We highlight a male population that reports suffering from IPV despite the lack of support, especially in Latin America. It is worth mentioning that the final consequence in many cases is femicide and homicide. Although IPV is serious and frequent, Medical professionals still do not focus on IPV diagnosis, therefore affected individuals don t receive support.

No significant relationships.

No significant relationships.

With the Covid-19 pandemic numerous questions about the behaviour of gambling addicts have risen, with the lockdown causing a lack of structure, peer supervision and support. The first reports have suggested an increase in activity and riskier choices.

Our aim was to explore how the Covid-19 pandemic has influenced gambling habits.

Data was collected from companies in Germany and Croatia which provide online gambling services, and statistically analyzed.

In Germany in April 2020, there was a 51.19% decrease in number of players when compared to April 2019, but a 116.46% rise in the number of tickets per player. In comparison, in April 2021 a rise of 704.43% occurred in number of active players compared to April 2020, with a 277.56% increase in ballots and a decrease in number of tickets per player by 53%. Additional results showed a 1.2% decrease in spendings on sports events in April 2020 compared to April 2019, but a 277.88% increase for sporting events spendings in April 2021. Preliminary results from Croatia show an increase in online gambling activities.

In 2020, despite a drop in active players, the increase in stakes and frequency of play resulted only in a slight decrease in sporting events spendings. In 2021 the recorded increase in all categories except in frequency, points to the idea that restoring life to usual rhythm reduces the frequency of an individual’s play. In conclusion, further research and monitoring of gambling addicts’ behaviour in the “new normal” is needed.

No significant relationships.

Mixed states in mood disorders present significant clinical and prognostic challenges. Although the DSM-5 has broadened diagnostic criteria for mixed states with the development of the ‘mixed features’ specifier and its application to unipolar depressive disorders, some mixed episodes might still be overlooked.

to evaluate the frequency and the factors associated with mixed depression according to the broader Koukopoulos criteria in a sample of patients with a major depressive episode

We included 99 consecutive patients presenting for a major depressive episode of bipolar (n=10) or unipolar major depressive (n=89) disorder at our outpatient clinic. Major depression was ascertained using SCID- IV criteria, and mixed features were determined using Koukopoulos’ diagnostic criteria

Mean age of the sample was 35.5 years [14-58]. Women accounted for 63.6% of patients. Mixed features were found in 19.5% (n=19) of the sample, 80% (n=8) among patients with bipolar disorders (BD) and 12.3% (n=11) among those with major depressive disorder (MDD). Individuals with mixed features had more substance abuse (p=0.005) and more suicide attempts (p=0.01). Individuals receiving antipsychotics had a lower risk of mixed features (p=0.000) while antidepressant treatment did not have any affect. A family history of BD, psychosis, suicide and substance abuse were found in these patients. Mixed features in depression were more frequent in patients with BD than in MDD.

Our study showed a high frequency of mixed features in depression, especially bipolar depression when Koukopoulos criteria are applied. Special attention should be given to these patients given the association with substance use and suicidality

No significant relationships.