Very few research about atrioventricular blocks (AVB) and use of antipsychotic drugs has been made, although it may play an important role in the outcome of any patient affected by psychosis and AVB.

To describe a case and review clinical data about AVB progression and neuroleptic treatment.

We describe a 37 years old inmate male patient who suffered from a first degree AVB and Schizophrenia, being long term treated with neuroleptics (risperidone 9mg/day, switched to paliperidone 9mg/day). Our patient presented very mild symptoms of asthenia and dizziness. An EKG was performed, showing AVB progression to Mobitz Type I1. No structural pathology was assessed by ecocardiography. Holter EKG showed also episodes of third degree AV block. Electrophysiology studies were performed showing a supra-hisian AV Block.

Lower doses of Paliperidone were used (6mg) and maintened until nowadays. Control EKG showed regression to a known first degree AVB.

Being asymptomatic and studies revealing a supra-hisian AVB, no pacemaker was needed.

There is only a few cases described in scientific literature, and very limited data about AVB and neuroleptic drugs, although it is described as possible side effect using risperidone at higher doses. We suggest monitoring EKG to patients affected by AVB, using high doses of neuroleptic drugs. There is no data available about paliperidone metabolites and a possible progression of AVB.

We suggest more studies are needed to better understand and prevent side effects of neuroleptic drugs.

No significant relationships.

. Cluj-Napoca in Transylvania, Romania, has a historically multiethnic population who maintain their language-based cultural identities. In order to harmonize interethnic relations in our multicultural society, art-therapeutical methods depend on the need to establish a sensitive relationship between the cultural horizon of individuals, thus increasing self-confidence, tolerance, resilience.

The objectives are : to develop social skills, which facilitate the social and professional integration of children and adolescents belonging to ethnic groups living together, including those with disabilities.

Clinical art therapy have unfolded within interdisciplinary teams: a neuropsychiatry doctor, a psychologist, a pedagogue, a social worker, an art therapist– each one having a specialized role. A medical project was transformed into an artistic project: E xperimenting with complex relationships: shape of the human body – shape of man-made objects and the creation of personal shapes conduct to harmonize interethnic relations in a multicultural place.

Focus on several objectives: - practicing the abilities to express one’s feelings - the consolidation of self-respect and of confidence - the training of empathy - the development of personal problem and conflict solving strategies -the breaking through the emotional blockages - the improvement of cognitive abilities -the release of tension, frustrations, anxieties, stress -the development of social skills

Benefits arise from experiences based in artistic creativity: materializing ideas and coping with unexpected outcomes.

No significant relationships.

Obsessive-compulsive disorder (OCD) is a chronic and impairing condition included in the DSM-5 Obsessive-Compulsive Spectrum Disorders. Despite psychopharmacological and psychotherapeutic measures, there are patients who remain refractory to different therapeutic strategies.

The authors aim to present different alternatives in approach, treatment and management of refractory OCD, based on a review of the existing literature.

Analysis of the data about this subject, considering the review articles and the case reports published at current time and highlighting the most essential topics, concerning the latest developments in the area.

Therapeutic options are presented, including transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), deep brain stimulation (DBS) and ablative neurosurgery.

The treatment of OCD represents a great challenge in clinical practice. Despite the advances accomplished by a more extensive knowledge of the disease and a burden of new techniques in the last decades, more treatment strategies are needed, especially for patients with non-response to conventional treatment.

No significant relationships.

During Covid-19 pandemic schools in Greece were closed and distance education instituted.

To find out whether the pandemic circumstances and the catholic internet access affected the time students spend on web activities other than educational duties.

Our sample consisted of 1213 parents with children from 4th, 5th, and 6th elementary school grades. They were collected with snowball sampling through internet, and they filled closed ended questions anonymous questionary.

During the pandemic the amount of time that children spent on the internet for purposes other than school obligations (social media, videogames, videos) was increasing by the time. On holidays and weekends this time was further increased. Parents mentioned reduced sleep time, reduced interest in hobbies and activities, as well as in person social communication with friends and loss of interest for school and educational matters. Children spend a lot of time on internet activities and sometimes they use it to avoid loneliness and negative situations. According to parents if their child doesn’t spend its preferrable time on the internet, get anxious, irritable, and sad. Often the child hides the time of internet use. Children from families with low socioeconomic, educational level, family income are more vulnerable to develop internet problematic use.

Social isolation, school closures, distance education, cancellation of after school activities and the facile internet access increased problematic internet use. This use is associated with behavioural, emotional and psychosocial problems. It is important to give information and implement educational programs for parents about how to control internet use of their children.

No significant relationships.

Ekbom’s syndrome, also known as delusional parasitosis, is a neuropsychiatric disorder characterized by the delusional belief that the body is infested by parasites, small organisms or materials. Multiple etiologies have been described such as psychiatric and neurological disorders, substance intoxication or other medical conditions. We present a case of Ekbom’s syndrome in an individual infected with the human immunodeficiency virus (HIV).

To report a case of a patient with Ekbom’s syndrome and HIV.

A 33-years-old man assists to the emergency unit in order to excessive drowsiness. During the evaluation an antihistamin overdose is confirmed. The patient justifies taking it by claiming to have parasites all over the skin, a fact that is ruled out. Medical history is reviewed presenting multiple visits to GP for thinking that he has parasites, performing medical examinations without alterations. Toxicological, hemogram, biochemistry, hormonal and vitamin study did not show alterations.

Due to the symptoms presented, it was decided to start antipsychotic therapy. At the beginning, the patient is not aware of needing treatment other than antiparasitic. After optimizing the olanzapine dose to reach 20 mg / day, the patient denied experiencing tactile and visual hallucinations.

Ekbom’s syndrome is a multifactorial neuropsychiatric disorder, individuals infected with HIV are at increased risk of psychotic disorders. The patient was diagnosed of psychotic disorder due to another medical condition because the history of HIV preceded the history of delusional content.

No significant relationships.

No significant relationships.

Mental health problems (MHP) are common among elite athletes (EA) and have received increased attention recently, revealing the need to assess them properly. Although EA are increasingly speaking out on their own MHP in public, research-informed approaches for practitioners are still lacking.

We aim to perform an overview of the MPH among EA, emphasizing the potential risk factors and interventions.

We conduct a non-systematic review of the recent evidence on the topic using PubMed/Medline database.

Although EA have comparable prevalence rates of MHP to the general population, they are exposed to various sports-related stressors. Studies reveal that 50% of EA face MHP during their career, with onset peak around 19 years. Therefore, there is a need for early detection and intervention. Burnout, alcohol abuse, anxiety, depression, insomnia and eating disorders are some MHP reported. Their management should address psychosocial and environmental aspects. Psychoeducation and psychotherapy are considered the first line treatment. Moreover, EA may encounter barriers to seeking mental healthcare. Therefore, it is important to promote positive attitudes about MHP, create an environment that supports mental well-being, resilience, psychological flexibility, self-compassion and coping skills. Screening tools may facilitate the process, so there is a need for validated athlete-specific questionnaires for MHP screening and measuring.

Mental health is an integral dimension of EA wellbeing and performance and should be assessed. Specific programs to support EA mental health are recommended and research targeting common MHP for athletes are needed to better understand how to minimize their distress.

No significant relationships.

First-episode psychosis is a critical period for early interventions to reduce the risk of poor outcomes and relapse as much as possible. There are now many studies revealing the patterns of course in the short and medium terms, but uncertainties about the long-term outcomes of symptomatology remain to be ascertained.

First, we ascertained whether the structure of psychopathological symptoms, dimensions and domains of psychopathology remains invariant over time between first-episode psychosis and long-term follow-up. Second, we analysed the changes in the interrelationships of psychopathological symptoms, dimensions and domains of psychopathology between FEP and long-term follow-up at three levels.

We performed network analysis to investigate first-episode and long-term stages of psychosis at three levels of analysis: micro, meso and macro. The sample was a cohort of 510 patients with first-episode psychoses from the SEGPEP study, who were reassessed at the long-term follow-up (n = 243). We used the Comprehensive Assessment of Symptoms and History (CASH) for their assessments.

Our results showed a similar pattern of clustering between first episodes and long-term follow-up in seven psychopathological dimensions at the micro level, 3 and 4 dimensions at the meso level, and one at the macro level. They also revealed significant differences between first-episode and long-term network structure and centrality measures at the three levels.

Our findings suggest that disorganization symptoms have more influence in long-term stabilized patients. The main results of the current study add evidence to the hierarchical, dimensional and longitudinal structuring of first-episode psychoses.

No significant relationships.

Obsessive-compulsive symptoms (OCS) have been described in many neurological disorders, including dementia. A meta-analysis by the authors (2021) reported a prevalence of OCS in dementia of approx. 35.8%, and a higher percentage in frontotemporal dementia (FTD) (46.7%). The literature also points that obsessive-compulsive disorder with late-life onset is rare, but those cases are frequently associated with neurologic injury, and some authors suggest a role of cognitive disfunction.

Our main goal was to describe the neurobiologic and cognitive underpinnings of OCS in patients with dementia.

MEDLINE, CENTRAL and PsycNet databases were searched for articles about obsessive-compulsive symptoms in dementia. Search terms included “obsessive”, “compulsive”, “OCD”, “cognitive decline”, “cognitive dysfunction” and “dementia”. Titles, abstracts and full texts were screened independently by 2 reviewers.

Correlations between dysfunction / lesions in various circuits in the context of dementia and OCS were found, such as (1) frontal regions (specially the orbitofrontal cortex) and anterior cingulate cortex (2) fronto-striatal-thalamic circuits (3) temporal structures; (4) cerebellar structures; (5) serotoninergic, dopaminergic, and cholinergic neurotransmission. A high proportion of studies concerned FTD. Regarding cognitive mechanisms, there is a focus on the importance subjective concerns about cognitive functioning, which could exacerbate obsessional beliefs and maladaptive responses to intrusions.

The main brain circuits implicated in dementia, specially FTD, and OCS are those involving frontal regions and the fronto-striatal-thalamic circuits, with areas such as the temporal and cerebellar structures algo being studied. The correlation between dysfunctional circuits in dementia and OCS could give us new hints about OCD and its treatment.

No significant relationships.

Depression is a common psychiatric disorder and chronic stress is considered its main environmental risk factor. Recently, immune processes including adenosine triphosphate mediated P2X7 receptor (P2X7R) signalling via microglia and macrophages (M/Ms) were found to play a critical role in depression genesis, by linking environmental stress to depression biology and symptoms.

To characterize the role of human P2X7R (hP2X7R) in psychosocial and immune stress conditions, both in vitro and in vivo.

Several, custom designed mouse lines expressing the loxP-flanked, hP2X7R-sequence in the murine P2X7R locus were established. In addition, these mice possess a Cre-sensitive reporter and express a Cre recombinase fused to a mutant estrogen receptor ligand-binding domain in M/Ms. This enables conditional, tamoxifen-inducible hP2X7R inactivation and simultaneous tdTomato expression. First, we established primary microglia cell cultures and characterized them at baseline and following immune stimulation. Next, we performed behavioural assessment of hP2X7Rwt and microglia-specific hP2X7RKO mice following chronic psychosocial stress. Last, we developed a novel in vivo two-photon microscopy (TPM) approach by use of frontolimbic cranial windows.

Primary hP2X7RKO microglia displayed significantly lower IL-1β production, increased survival and decreased morphological activation upon immune stimulation. Although hP2X7RKO mice showed a significant increase of locomotor activity at baseline, there was no impact on anxiety- and depressive-like phenotypes. Longitudinal in vivo TPM enabled morphometric characterization of cortical M/Ms over several weeks.

Our results illustrate the great potential of this humanized mouse line for translational psychiatry. In the future, this system could proof useful to evaluate immunomodulatory approaches in chronic stress and depression.

No significant relationships.

Dysfunctional breathing is a pattern of respiratory movements that do not correspond to the physiological needs of the body and can lead to a series of respiratory, cardiovascular, digestive, sensory and neurological symptoms ( Vidotto et al., 2019). The causes of dysfunctional breathing are a combination of biological, psychological and social factors.

To examine the relationship between anxiety and occurrence of dysfunctional breathing in the Russian population under the conditions of the COVID-19 pandemic.

We used a socio-demographic questionnaire, the Naimigen questionnaire (Van Dixhorn, Duivenvoordent, 1985), the State-Trait Anxiety Inventory (Spielberger et al., 1983). The study was conducted online from April 27 to December 28, 2020. It was attended by 1,362 people from all regions of Russia, including 1,153 women and 209 men aged 15 to 88 years (38.3 ±11.4)

It was revealed that with a low level of state anxiety (< 35 points), dysfunctional breathing was detected in 4.8% of respondents; while with a borderline level of anxiety (> 60 points) there were at 55.9%. A similar dependence was found for personal anxiety: at a low level (< 35 points), dysfunctional breathing was detected in only 4% of respondents;while at a borderline level of anxiety (> 60 points) at 62.8%.

Dysfunctional breathing can occur among people with high and borderline levels of situational and personal anxiety during the COVID-19 pandemic. Results allows us to conclude that dysfunctional breathing and anxiety are not equivalent concepts, although they have a common phenomenological field. The study was supported of the Russian Science Foundation, project No. 21-18-00624.

The study was supported of the Russian Science Foundation, project No. 21-18-00624.

Neuroleptic malignant syndrome (NMS) may be a life-threatening neurologic crisis primarily emerging as an idiosyncratic reaction to antipsychotic agent use, and characterized by a particular clinical syndrome of mental status alter, rigidity, fever and dysautonomia. Mortality results straightforwardly from the dysautonomic manifestations of the disease and from systemic complications.

To describe an unusual clinical case in order to determine the management regarding medication and electroconvulsive therapy (ECT), and provide an overview of NMS for the general practitioner with the most up-to-date information on etiology, workup, and management.

We report a case involving a 55-year-old man with paranoid schizophrenia disorder who presented with hyperthermia, hemodynamic instability, miosis, muscular rigidity, urinary incontinence, catatonic signs and mutism after combining several antipsychotics at the same time: long-acting injectable form of paliperidone, aripiprazol and haloperidol.

Guidelines for specific medical treatments in NMS are based upon case reports and clinical experience. Generally used agents are dantrolene, bromocriptine, and amantadine. A conceivable approach is to start with benzodiazepines along with dantrolene in moderate or severe cases, followed by the addition of bromocriptine or amantadine. ECT is generally reserved for patients not responding to other treatments.

NMS is an uncommon adverse drug reaction, with a multifactor pathophysiology and manifestation. Early diagnosis and interruption of antipsychotic therapy is the first-line treatment, followed by supportive care and pharmacotherapy. ECT is an effective treatment when supportive treatment together with pharmacotherapy fails. It could be considered first line in severe life-threatening situations. It is advisable to consider maintenance ECT due to the high risk of relapse.

No significant relationships.

Latvia is listed as a country with one of the highest suicide mortality rates in European Union (National Statistical System of Latvia, 2021).

To assess the sequences for reporting of suicidal behaviours (SB) in Latvian general population.

The study is based on secondary data of the Health Behaviour Among Latvian Adult Population survey, provided by the Centre for Disease Prevention and Control of Latvia (representative sample of the Latvian population aged 15-64 in 2010, 2012, 2014; 15-74 in 2016, 2018; (n=16,105). Respondents were asked to report the occurrence of life-weariness (LW), death wishes (DW), suicidal ideation (SI), suicidal plans (SP), suicide attempts (SA) during the previous year.

Statistically significant differences between genders were found for LW (Χ²=17.118; df=1; p<0.001; AR=±4.1), DW (Χ²=17.764; df=1; p<0.001; AR=±3.8) and any type of SB (Χ²=15.721; df=1; p<0.001; AR=±3.8). Frequencies of individual sequences of reporting last year SB are presented in Table.

Further research is warranted to identify vulnerable groups in the Latvian general population in relation to suicidality and thus to develop targeted preventive measures.

This work has been developed with financing from the European Social Fund and Latvian state budget within the project no. 8.2.2.0/20/I/004 “Support for involving doctoral students in scientific research and studies at Rīga Stradiņš University.

Endorphins have been associated with analgesia and pleasurable activities. However, the so-called “happy chemicals” are far more complex than initially thought. Research shows that their impact on human behavior is modulatory, with the main goal not being “happiness” but a “return to the most desirable state” – which can be highly context-dependent.

Review of the modulatory functions of endorphins on human behavior and their possible implications in psychiatric conditions.

Pubmed search consisting of the MeSH terms “Endorphins”, “Opioid Peptides”, “Behavior”, and “Psychiatry”.

Endorphins elicit pleasure via stimulation of the release of dopamine from the ventral tegmental area to the nucleus accumbens. They are known to be involved in analgesia and stress response and social interaction. Endorphins can be released in a multitude of circumstances that may seem contradictory – having both inhibitory and stimulating roles in appetite, sexual response, and memory– but are modulatory effects depending on what constitutes homeostasis in each context. Peripheral levels of endorphins have been found low in depression and post-traumatic stress disorder. In schizophrenia, studies suggest that peripheral levels are high during psychosis, low in chronic disease and that naltrexone seems to improve auditory hallucinations. Endorphins may also have a role as markers of treatment response.

Endorphins have a complex role in behavior and homeostasis. These molecules could have implications in psychiatry- given that they are part of our stress response and are released to promote a more “desirable state”. Their role as a marker of illness or response to treatment needs further investigation.

No significant relationships.

Reflection on the impact of this law on people with a Mental health disorder is required. It is a complex issue, in which it must be considered that these disorders are very prevalent, can greatly affect the quality of life and are often resistant to treatment.

Explore the first request of this type and review aspects to consider in patients with mental health disorders.

Collection of data from the first patient who requests it and review related aspects.

This is a patient with a personality disorder who presents significant suffering, in a chronic context, but at the same time makes the request in a moment of crisis as an impulsive gesture.

Pending evolution, we consider that it is difficult to assess compliance with the requirements of the law in patients of this type and we recommend caution.

No significant relationships.

Executive function organizes and directs behaviour but alterations in this cognitive domain can lead to inaccurate perception, interpretation and response to environmental information, which could be a risk factor for suicide.

To explore executive function performance of depressed recent suicide attempters in comparison to depressed past suicide attempters, depressed non-attempters and healthy controls.

96 participants from the Psychiatry Department of the Araba University Hospital-Santiago were recruited as follows: 20 patients with a recent suicide attempt (<30days) diagnosed with a Major Depressive Disorder (MDD), 33 MDD patients with history of attempted suicide, 23 non-attempter MDD patients and 20 healthy controls. All participants underwent a clinical interview and neuropsychological assessment on executive function with the Wisconsin Sorting Card Test. Backward multiple regressions were performed adjusting for significant confounding variables. For group comparisons ANOVA test and Bonferroni post hoc test were performed with p<0.05 significance level.

Patient groups did not differ regarding severity of depression. All patient groups performed significantly worse than healthy controls on executive function. Adjusted comparisons between patient groups indicated that recent suicide attempters had a poorer performance in this cognitive domain in comparison to both depressed lifetime attempters and depressed non-attempters (B=0.296, p=0.019 and B=0.301, p=0.028 respectively).

Executive function performance is altered in recent suicide attempts. As impaired executive function can be a risk factor for suicide, preventive interventions on suicide should focus on its assessment and rehabilitation.

No significant relationships.

Since the beginning of the pandemic, the Sars-cov2 virus remains unclear concerning its clinical manifestations and its sequelae. Few studies have evaluated the existence of cognitive impairment in patients with COVID-19 and estimated its imputability in the development of these disorders.

The objectives of this study is to assess cognitive disorders in post-COVID patients.

A descriptive observational survey was conducted by the psychiatry department of Mongi Slim hospital in Tunis-Tunisia during May-June 2021 among covid-19 patients selected at the first post covid consultation (at 1 month). First, sociodemographic and clinical data were collected, then the evaluation of the cognitive disorders was carried using many scales: MMS (mini mental state), FAB, TMT and the maze task.

Eight patients met the selection criteria with a sex ratio of 6:2 and an average age of 67.5 years (6 with a primary level). The extent of the lesions varied between 10% and 75%. Among the participants, 4 required hospitalization in intensive care: 3 with non-invasive ventilation and 1 needed intubation. The 1-month evaluation found that all the patients had good memory and execution skills with MMS scales >25 and FAB scales >14. Regarding flexibility and planification: 4 of them needed more than 78 seconds to complete the TMT-A ,3 took more than 273 seconds to complete the TMT-B and 2 needed more than 60 seconds to accomplish the maze task (deficient scores).

The screening of cognitive disorders in post-COVID patients is very important for a better management that may require early neurocognitive rehabilitation.

No significant relationships.

The influence of sexual hormones on mental disorders have been extensively reported. In fact, recent studies suggest that sex hormones may play a relevant role in the pathophysiology of psychosis, may be a precipitant when exogenously administered or even be used as a treatment agent of psychotic disorders.

To describe the case of a patient with a recent diagnosis of delusional disorder (DD) with an onset in the perimenopausal period.

Case report and narrative review focused on the impact of sexual hormones on depressive symptoms and alcohol use comorbidity during perimenopause in DD women by using PubMed database.

Case report: A 48-year-old woman diagnosed with DD. The clinical assessment of climacteric symptoms, as well as the gonadotropins (elevated levels of follicle-stimulating hormone -FSH- and luteinizing hormone -LH-) and estrogen levels monitoring (variations on 17-β-estradiol -E2-) enabled to link the endocrine changes with the onset and course of the psychiatric disorder. During the development of the disease, the patient also presented comorbid depressive symptoms and alcohol use disorder. Review: Estrogen depletion seems to increase the risk of psychosis, while scientific literature is not conclusive in establishing a definitive relationship between depressive symptoms and hormonal imbalance in DD. Alcohol use disorder is a common comorbidity in both perimenopausal women and patients with DD.

Multiaxial management of the case helped clinicians to achieve clinical stabilization. Sex differences as well as hormonal pattern disturbances should receive special attention due to the seminal implications in pharmacotherapy and clinical outcomes.

No significant relationships.

Metabolic syndrome (MetS) is common in chronic psychosis but also exists in the early stages. HOMA-IR is an independent predictor of cardiovascular diseases and has already been described in first episode of psychosis.

To determine whether HOMA levels differ according to MetS at each time assessment over 2 years.

MetS and HOMA levels are determined at baseline and at 6, 12, 18 and 24 months in a sample of 50 patients participating in the PEPsNa Early Intervention Programme during two years of follow-up. Adult Treatment Panel III (ATP III) criteria are used to define MetS. Insulin resistance measured with the Homeostatic Model Assessment (HOMA-IR) is computed with the formula fasting plasma glucose (mg/dL) times fasting insulin (mIU/mL) divided by 405. Mann-Whitney U Test are used to compare HOMA variable according to presence of metabolic syndrome.

The results showed that HOMA levels differed statistically significantly between patients who met MetS criteria and those who did not at 12 (p<0.046) and 24 (p<0.004) months of treatment.

Given the small sample size the results of our study indicate that there is a sustained relationship over time between HOMA levels and Metabolic Syndrome (MetS) and that the HOMA IR may be useful in identifying those patients with an increased metabolic and cardiovascular risk.

No significant relationships.

Psychiatry emergencies in India is major challenge for emergency service providers due to rapid growth of various behavioural, higher morbidity and mortality rate. Despite, psychiatry conditions are neglected area related to stigma, share, lack of awareness, and superstitious beliefs. There is an urgent need for specialist psychiatric emergency services, which can fill the huge gap between policymakers and health service providers joined together.

Present feasibility study has been undertaken to evaluate the safety and efficacy of combined emergency and Ayurveda medicine management of psychiatric emergencies in community-based settings.

Ayu-Emergency Care project was developed in partnership with policy makers, researchers and health care providers, a collaborative platform of emergency medicine and Ayurveda medicine (Indian Traditional Medicine) for developing whole-system perspective, where providers work in a coordinated and joined-up way. Twenty trained care providers in psychiatry emergency and Ayurveda management worked in partnership with community-based organisation.

Patients with major clinical difficulties, in the acute phase were treated and managed by Ayu-Emergencypractitioners. Severe Agitation and violence relating to substance abuse, anxiety disorder and psychosis were the most common admission diagnoses. 2-weeks results indicate that Ayurveda intervention can reduce anxiety(p<0.01), aggression (p< 0.001) and agitation (p<0.01) significantly with no side effects reported. Intervention found to be clinically beneficial and cost-efficient alternative to out-of-home placements (i.e., Incarceration, psychiatric hospitalisation).

The study’s findings highlight safety, efficacy and feasibility of intervention. Patients both prefer and seem to benefit from community-based ayu-psychiatric care, and early-intervention community program could be a good model for such care.

No significant relationships.