Insufficient efficacy of conventional treatment of auditory hallucinations (AH) in schizophrenia supports rising interest to brain stimulation techniques including transcranial magnetic stimulation (TMS). Left temporo-parietal cortex (TP3) is involved in emergence of AH, thus neuromodulation of this area might be reasonable.

Comparison of efficacy and tolerability of 2 protocols of TMS (1 Hz and cTBS) over TP3 and sham-TMS for treatment resistant AH in schizophrenia.

76 schizophrenia (ICD-10 - F20) patients with prominent AH (PANSS P3 ≥ 4, AHRS ≥ 15), who had failed to respond to previous antipsychotic treatment, were randomized into 3 groups: 1) 1 Hz TMS (30 patients); 2) cTBS (25 patients); 3) Sham-TMS (21 patients). Sessions were performed 5 days a week for 3 weeks. Antipsychotic medication was continued throughout the study. Patients were assessed weekly with PANSS, AHRS, CDSS, CGI-S by blinded raters. The criterion of efficacy was 30% AHRS score reduction after 3 weeks of treatment.

The number of responders were 13 (43,3%) in 1 Hz TMS group, 14 (56%) – in cTBS group, 4 (19,1%) in sham-TMS group. There was no statistically significant difference in efficacy between 1 Hz TMS and cTBS, but each of the active protocols was more effective than sham-TMS. Treatment was generally well tolerated in all groups, nobody was discontinued the study due to adverse events.

Both protocols of TMS (1 Hz and cTBS) over TP3 are safe and effective in the treatment of schizophrenic patients with pharmacotherapy resistant AH. Further studies are needed.

No significant relationships.

The article is devoted to the study of adaptation to the covid-19 pandemic conditions in Russian men and women in the first part of 2020. Respondents assessed the degree of potential danger of various types of social threats caused by the pandemic, as well as the level of their adaptation to changed living conditions during the first lockdown.

The purpose of this study was to identify key differences in adaptation to pandemic conditions in groups of men and women.

The author’s methodology was developed to assess the level of adaptation to COVID-19. The questionnaire included 6 scales on different aspects of life during the lockdown (for example, physical and emotional state, communication, employment during the pandemic, etc.). The sample was N = 80 (residents of Russia age 18-37).

Men significantly higher estimated the potential danger of an epidemic threat to themselves than women. The level of adaptation to conditions caused by the COVID-19 pandemic also differed in two gender groups according to t-test on the scale “Employment in a pandemic”: men were better adapted to work or study in conditions caused by the COVID-19 pandemic than women.

This can be interpreted from the point of view of the stereotype existing in Russian culture which postulates the performance of household duties and child care is more perceived as a woman’s responsibility. The adaptation of women to remote work during the lockdown was forced to be combined with an increased workload in the family and household sphere.

No significant relationships.

There are two common hypotheses to explain such high comorbidity between nicotine dependence and schizophrenia (SZ): self-medication for decreasing psychiatric symptoms or common environmental risk factors can predispose to both nicotine dependence and other risky behaviors in SZ

Little is known about the influence of cigarette smoking comorbidities such substance use disorder (SUD), criminal history, or risky decision among patients with SZ.

The Iowa Gambling test (IGT) was administered to thirty-nine patients with SZ of whom 69% reporting cigarette smoking. Both groups were evaluated using a socio-demographic questionnaire and clinical assessment using PANSS and self-report questionnaire the Barratt Impulsiveness Scale (BIS-11). To evaluate decision making was evaluated with the Iowa Gambling Task (IGT).

The full SZ sample performed worse on the IGT then normal population. Smokers with SZ performed significantly worse than nonsmokers on the IGT primarily because they preferred “disadvantageous” decks to a greater degree. The PANSS and impulsivity tendencies (BIS-11) did not predict overall performance on the IGT. Smokers with SZ had impaired affective decision-making. Behavior suggested preferential attention to the frequency amount of gain and inattention to amount of loss suggesting impairments in risk/reward decision-making

This study is the first to compare IGT in smokers and nonsmokers with SZ with adjustment of SUD, criminal history, and existing tattoo to further examine IGT performance. These results support the hypothesis that comorbidities between nicotine dependence and SZ can be linked to other common factor that is associated with other externalizing behaviors in SZ.

No significant relationships.

During the COVID-19 pandemic, telesimulation became particularly important to continue the education of medical students during disrupted clerkships while maintaining social distancing.

To describe our experiences of adapting to telesimulation and evaluate this from student and faculty perspectives.

The intervention was evaluated using anonymous surveys consisting of statements rated on a five-point Likert scale from strongly disagree to strongly agree and open-ended questions asking students and facilitators what went well, what they would change and why, and for any other comments.

Adaptations addressed the logistics of online delivery and the structure and content of scenarios. Logistical considerations included central organization of sessions to relieve pressures on clinicians. Pre-session case discussions were introduced to maximise time with simulated patients and give students space to socialise. Content was modified to ensure functionality online and reflect the context of the pandemic. A total of 278 students and 24 facilitators participated in the telesimulation sessions. 98.1% of students (N=109) rated the sessions as very good or good. Students benefited from practicing skills, especially clinical situations which they would rarely encounter as students, and receiving feedback. Facilitators (N=6) felt that students learnt both skills for online consultations and skills that can be transferred to face-to-face situations, but were ambivalent on whether students would benefit more from face-to-face sessions.

Telesimulation is a safe and effective option that offers additional opportunities for students to develop telemedicine skills. Going forward, telesimulation should complement face-to-face delivery to develop future clinicians who are proficient in both remote and face-to-face working.

No significant relationships.

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.

Provision of holisitc, accessible and high quality mental health care to the patients requires sharing of responsibilities & resources, enhanced communication & collaboration at the interface (primary care systems and secondary care mental health services). An innovative model of single point of care for people with severe and enduring mental health problems hosted at a primary care (GP) setting has been developed and evaluated in Walsall, UK.

To develop and evaluate an integrated (multidisciplinary) approach of managing health & social care needs of people with severe mental health disorders.

People with severe & enduring mental health problems were reviewed in primary care (N=65). A comprehensive physical, mental and psychosocial assessments were undertaken by the clinicians that included GP, Psychiatrist and Care-Coordinator.The reviews included: 1) A review of physical health indicators based on the Lester toolkit by practice pharmacist/nurse, including lifestyle, body weight, BMI and blood pressure. 2) Individualised interventions included physical / psychiatric prescribing, social prescribing and advise on lifestyle changes. Stable patients were recommended for stepping down from the secondary care. Outcomes included Patient Satisfaction Questionnaire (PSQ).

Satisfaction on the PSQ was rated from very good to excellent. Results highlighted multiple benefits including trust generation, improved communication among professionals, physical health screening and prompt clinical decision making (e.g. referral / prescribing). Other benefits included patient access & satisfaction, time and cost efficiency by reducing the number of reviews.

The integtrated CPA reviews offers efficient, holisitc & cost effective model of care with high satisfaction levels for patients and is replicable.

No significant relationships.

The discovery of second-generation antipsychotics represented an authentic breakthrough for the management of psychotic disorders. Nevertheless, they still don’t adequately manage some aspects of these disorders, such as negative symptoms (NS), cognitive impairment, or extra-pyramidal symptoms (EPS). New-generation antipsychotics present different pharmacological mechanisms and have been reported to ameliorate these aspects. Among them, cariprazine acts as a D2/D3 partial agonist with variable affinity with serotoninergic receptors, and many studies show its efficacy for preventing and treating positive symptoms as well as for the management of NS and EPS.

To report a case of a patient diagnosed with schizophrenia with highly invalidating antipsychotic-induced EPS that remitted after switching to cariprazine, while maintaining clinical stability. To review literature about cariprazine and its relationship with NS and EPS.

We describe the case of a 66-year-old woman diagnosed with schizophrenia and under treatment with three-month injectable paliperidone 175mg. During her follow-up at outpatient clinic, she presented a progressively highly invalidating non-trembling parkinsonian syndrome attributable to medication. Paliperidone plasmatic levels were within therapeutic range. An antipsychotic switch was agreed, and cariprazine was started.

The switch from a second-generation antipsychotic to cariprazine entailed the remission of a highly invalidating EPS while improving some of the NS and maintaining psychopathological stability.

Assessing and differentiating NS and EPS is of an utmost importance during the follow-up of patients under antipsychotic treatment. Cariprazine is an interesting alternative when treating patients diagnosed with psychotic disorders that present mostly NS and antipsychotic-induced EPS.

No significant relationships.

No significant relationships.

First responders to disasters are at risk of developing post-traumatic stress disorder (PTSD). The trajectories of post-traumatic stress symptom severity differ among individuals, even if they are exposed to similar events. These trajectories have not yet been reported in non-Western first responders.

We aimed to explore post-traumatic stress symptom severity trajectories and their risk factors in first responders to the 2011 Great East Japan Earthquake (GEJE)— a historically large earthquake that resulted in a tsunami and a nuclear disaster.

56 388 Japan Ground Self-Defense Force (JGSDF) personnel dispatched to the GEJE were enrolled in this seven-year longitudinal cohort study. PTSD symptom severity was measured using the Impact of Event Scale-Revised (IES-R). Trajectories were identified using latent growth mixture models (LGMM). Nine potential risk factors for the symptom severity trajectories were analyzed using multinomial logistic regression.

Five symptom severity trajectories were identified: “resilient” (54.7%), “recovery” (24.5%), “incomplete recovery” (10.7%), “late-onset” (5.7%), and “chronic” (4.3%). The main risk factors for the four non-resilient trajectories were older age, personal disaster experiences, and working conditions. These working conditions included duties involving body recovery or radiation exposure risk, longer deployment length, later or no post-deployment leave, and longer post-deployment overtime.

The majority of first responders to GEJE were resilient and developed few or no PTSD symptoms. A substantial minority experienced late-onset and chronic symptom severity trajectories. The identified risk factors can inform policies for prevention, early detection, and intervention in individuals at risk of developing symptomatic trajectories.

No significant relationships.

Facing educational difficulties related to COVID-19, some teachers can no longer adapt, making them potential candidates for burnout.

We aimed to assess burnout among high school teachers during the COVID-19 pandemic and to determine its prevalence and factors associated with it.

We conducted a cross-sectional, descriptive and analytical study, carried out on google drive in May 2021, and relating to 97 Tunisian junior and secondary school teachers from the Sfax region. Burnout was evaluated by the Burnout Measure Short version (BMS-10).

The sex-ratio (M/F) of our population was 0.32 and the average age was 44.23 ± 7.81 years old. The labor load was low, medium and high in respectively 1.4%, 57.6% and 41% of cases. Almost a third of participants (30.6%) reported a low satisfaction with working conditions. The average BMS score was 40.19 ± 13.98. According to the BMS scores, 36.1% of teachers had a very low to a low degree of burnout, 23.6% had burnout while 40.3% had a high to very high degree of exposure to burnout. Furthermore, the BMS score was associated with the female gender (p=0.002), sleep disturbances (p<0.001), suicidal thoughts (p<0.001) and with a medium to a high labor load (p=0.045).

In this study, Tunisian high school teachers in times of COVID-19 reported a high burnout rate. Thus, the protection of this vulnerable population must be an important component of public health measures.

No significant relationships.

SARS-Co-V2 neuroinvasive ability might be the basis for the onset of delirium and neuropsychiatric outcomes.

We hypothesized that some infected patients with preexisting cognitive dysfunction may present delirium as unique manifestation of COVID-19 infection or as a prodrome of a new episode consistent with the psychiatric history.

We conducted a PubMed literature search to verify whether cognitive impairment might predispose to COVID-19. We included three patients with mild cognitive impairment and delirium at admission for SARS-Co-V2 suspected infection. Delirium was diagnosed according to DSM-5 criteria‚ Cognitive Assessment Method and Coma Glasgow Scale.

Literature analysis evidenced patients presenting delirium or delirium-like symptoms as clinical manifestation of COVID-19, plus a cognitive impairment‚ from mild to severe‚ which preexisted or was evidenced during the acute phase or after the infection. Most studies described delirium in patients with a past neurological/psychiatric history. Contrasting data emerged on the potential link between COVID-19 and delirium in patients with cognitive impairment and without a past neuropsychiatric history. Our patients had no history of other medical complications. Our first patient had no psychiatric history‚ the second reported only a depressive episode‚ and the third had story of bipolar disorder. Delirium resolved completely after 2 days in the first patient. The other patients required 4 and 14 days to resolve: delirium appeared as the prodrome of a new psychiatric episode in line with their past history.

Clinicians should acknowledge the possibility that COVID-19 infection may appear as delirium and acute psychiatric sequelae as unique manifestation.

No significant relationships.

The search for approaches to creating a precision personalized virtual reality for the treatment of mental disorders is urgent. (Belkasim, 2005; Park M.J. et all., 2019).

To develop a new approach to personalize the form of virtual reality content to the neurophysiological and anatomical parameters of the patient’s brain, to improve the quality of precision VR therapy for mental disorders.

The MRI study was carried out on a GE Optima 450w apparatus with a magnetic field induction of 1.5 Tesla. We used a radio frequency coil for the head. T1-weighted images were obtained with a field of view (FOV) of 24.4 x 14.8 cm and a slice thickness of 0.5 mm. Later, the images were built in three standard mutually perpendicular planes. Measurements were carried out using standard tools on an eFilm 4.0 WorkStation. FreeSurfer 4.5.0 was used to calculate the surface area of the cerebral hemispheres. To estimate the surface area of the room and the design of the shape in VR closed environment Autodesk AutoCAD 2018.

A new approach to personalization of the form of virtual reality content has been developed (Patent No. RU (11) 2 668 697 (13) C1, 2018;Patent No. RU (11) 2 753 234 (13) C1, 2020). It is based on the use a single morphometric indicator for a closed VR space and brain.

Research and applied analysis of the developed approach is required. The development of this area will make it possible to create precision products for the therapy and rehabilitation of mental disorders.

No significant relationships.

Meta-analyses suggest that patients with schizophrenia show deficit in working memory – both verbal and visual – and are more distractible. Working memory disturbances are even regarded as the central deficit in schizophrenia by some researchers. Theta synchronization (especially over fronto-central areas) is related to cognitive control and executive functioning during working memory encoding and retention.

The main goal of the study was to gain more understanding of the nature of working memory deficit and attentional distractibility in schizophrenia.

35 patients with schizophrenia and 39 matched controls were enrolled in our study. Participants performed a modified Sternberg working memory task that contained salient and non-salient distractor items in the retention period. A high-density 128 channel EEG was recorded during the task. Event-related theta (4-7 Hz) synchronization was analyzed during working memory encoding (learning) and retention (distractor filtering) in a later time window (350-550 ms).

Patients with schizophrenia showed weaker working memory performance and increased attentional distractibility compared to the control group: patients had significantly lower hit rates (p < 0.0001) and higher distractor-related commission error rates (p < 0.0001). Theta synchronization was modulated by condition (learning < distractor) in both groups but it was modulated by salience only in controls (salient distractor > non-salient distractor, p[patients] = 0.95, p[controls] < 0.001).

Our results suggest that patients with schizophrenia show diminished cognitive control compared to controls in response to salient distractors. Difficulties in cognitive control allocation may contribute to the behavioral results observed in this study.

No significant relationships.

The Inventory of Academic Sources of Stress in Medical Education (IASSME) evaluates the presence and intensity of the main sources of academic stress for Portuguese Medicine students in five dimensions: Course demands/CD, Human demands/HD, Lifestyle/LS, Academic competition/AC, and Academic adjustment/AA.

To further validate the ISSME using Confirmatory Factor Analysis and to analyze[ATP1] the psychometric properties of a new version including additional sources of stress.

Participants were 666 Portuguese medicine (82.6%) and dentistry (17.4%) students (81.8% girls); they answered an online survey including the ISSME and other validated questionnaires: Maslach Burnout Inventory – Students Survey (MBI-SS) and Depression Anxiety and Stress Scales (DASS).

Confirmatory Factor Analysis showed that the second order model composed of five factors (the original structure by Loureiro et al. 2008), but excluding item 11 (loading=.371), presented good fit indexes (χ2/df=3.274; RMSEA=.0581, p<.001; CFI=.917; TLI=.904, GFI=.919). The Cronbach’s alfas were α=.897 for the total and from α=.669 (F2-HD) to α=.859 (F1-CD) for the dimensions. The expanded version, including two additional items related to lack of interest in medicine/dentistry (F6, α=.543) and two additional COVID-19 stress-related-items (F7, α=.744) also showed acceptable fit indexes (χ2/df=3.513; RMSEA=.061, p<.001; CFI=.88.; TLI=.866, GFI=.892). This new version’s α was of .896. Pearson correlations between ISSME and the other measures were significant (p<.01) and high: >.55 with DASS and >.50 with MBI-SS. Girls presented significantly higher ISSME scores. F6 score was significantly higher in dentistry students.

This further validation study underlines that IASSME presents good validity (construct and convergent) and reliability.

No significant relationships.

Obsessive-Compulsive Disorder (OCD) is a common mental disorder and a major cause of disability worldwide. Typically, it has a chronic course, marked by recurrent intrusive thoughts (obsessions) and repetitive behaviors (compulsions). Its pharmacological first line of treatment has been well established for several years now, with the Serotonin Reuptake Inhibitors (SRIs). However, about half of the patients are resistant to this approach, representing a therapeutic challenge for clinicians. Evidence suggests that other medications can augment SRIs, enhancing its effects and achieving a bigger efficacy in these patients’ treatment. Also, there is an increasing interest in neurosurgical interventions in these patients.

The main goal of this work was to assess the clinical efficacy of adjunctive therapeutic strategies in patients with OCD resistant to SRIs.

A literature review was conducted searching PubMed and ScienceDirect databases from the 1st of January 2000 to the 1st of September 2021 to identify clinical trials comparing an active drug/neurosurgical intervention with placebo as an adjunctive therapeutic strategy in SRI-resistant OCD.

Sixteen studies were selected for data extraction, including a total of 585 patients. Risperidone, aripiprazole, N-acetylcysteine, lamotrigine, pindolol, riluzole, memantine and methylphenidate were efficacious for augmenting SRIs in OCD. Ablative surgery (ABL) and deep brain stimulation (DBS) were equal effective in the treatment of refractory OCD.

Several therapeutic options presented as potentially effective in OCD when it is resistant to SRIs, although this is still an area for further research.

No significant relationships.

Description of a structured work of primary prevention, based on a survey of the prevalence of suicidal behavior in the Brazilian population throughout life, performed by an academic service of psychiatry and chemical dependence. We describe a survey of the probability of suicide attempt in an academic internment service focused on psychiatry and drug addiction in the city of Rio de Janeiro.

Raise awareness of the need to call for help and 24-hour distress hotline phone outreach. Calculate a possible demand for mental health services to patients with severe suicidal behavior aiming at the necessary equipment to attend this population.

Clarification actions through the press, development of a suicide prevention lecture program given in schools, surveillance cameras, military institutions, companies and laws, promotion of public events with music, activities, distribution of t-shirts, booklets and leaflets.Using the mental health care implementation system: identifying the patient, raising their needs and available resources, breaking resistance, advocating and treating, we raised in this institution that from January 01, 2019 to September 01, 2019, 137 patients were hospitalized with a serious suicide attempt.

According to a survey of the prevalence of suicidal behavior in the Brazilian population over the course of life, where out of 100 patients, 17 had suicidal thoughts, 5 planned, 3 attempted suicide and 1 was treated in the emergency room.

The suicide prevention program has been very successful as the press promotes of the telephone number for immediate relief. His survey highlighted the need to create a specific suicide treatment and prevention program.

No significant relationships.

Infectious diseases can disrupt the environment in which children live and have negative consequences for the well-being, development and mental health of this population.

Our aim is to compare the number and diagnoses of patients admitted during the first COVID-19 pandemic year to patients admitted during the same period in the previous year.

Retrospective observational study of patients admitted between March 1, 2020 and February 29, 2021 and the analogous period of 2019-2020 in a child psychiatry unit. Microsoft Excel was used for descriptive statistics.

In our first pandemic year, there were 47.9% less admissions to our inpatient unit (n=717), comparing to the previous year (n=1376). Regarding the outpatient-type evaluations, there were 37.7% more admissions than the previous year (n=1813). Considering the fact that the number of inpatiens was limited in 2020 due to the restrictive measures imposed, most of our patients were consulted on an outpatient basis. During the 5 weeks nationwide lockdown, 72 children were consulted, 42.8% representing psychiatry emergencies. Regarding the diagnoses made in the whole pandemic year, disorders of psychological development were the most common, with almost half of the total of admissions (44.4%). The number of autistic outpatients in the pandemic year (n=1004) was almost double than the one before (n=572).

Even though there was a reduction of admissions to the child psychiatry inpatient unit during the first pandemic year, we did not identify major differences regarding the discharge diagnoses comparing to the year before.

No significant relationships.

Previous studies applying the Lausanne Trilogue Play (LTPc), a semi-structured method for observing family dynamics, highlighted dysfunctional interaction patterns in the families of individuals affected by restrictive eating disorders (REDs). Family-centered approaches are considered the first-line treatment for severe cases of REDs in adolescence.

To investigate family functioning in the families of adolescents with severe REDs assessed before and 6 months after a multidisciplinary family treatment program that combined psychodynamic psychotherapy, parental role intervention and triadic or family-centered intervention.

Sixty-seven families of adolescent patients diagnosed with REDs were assessed for eligibility between July 2017 and October 2020. Family functioning was assessed using the clinical version of LTPc. Nutritional counseling and neuropsychiatric monitoring were also provided.

We observed a significant change in the family functioning score for the LTPc phase 2, in which the father interacts with his daughter while the mother acts as a silent observer. This suggests that the fathers, when playing an active role, could improve dyadic family functioning. The treatment was not found to change triadic functioning: a 6-month treatment may not be long enough to modify interactions at the triadic level.

A brief multidisciplinary treatment program may significantly improve family functioning in the families of patients diagnosed with severe REDs. Although appropriate clinical trials are needed to further test the efficacy of this treatment, our study reinforce the concept that treatment programs targeting the individual patient and both the parents should be a first-line approach in adolescents with severe REDs.

The authors declare that they do not have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstrac.

Digital mental health interventions, such as chatbots that promote mental health and wellbeing are a promising way to deliver low-threshold support 24/7 for those in need. According to current knowledge about the topic, health care professionals should participate in the design and development processes for digital interventions.

The aim of this presentation is to describe the interdisciplinary content development process of the ChatPal chatbot.

The content development process started in co-operation with mental health professionals and potential users to identify requirements. Content was created, evaluated and tested in international, multi-disciplinary group workshops, and online tools were used to allow the collaboration. Initial conversational scripts were drafted in English, and translated into Finnish, Swedish and Scottish Gaelic.

A multilingual chatbot was developed and the conversation scripts were structured and stored using a spreadsheet. The conversation scripts will be made freely available online in due course using this structured approach to formatting chatbot dialogue content. It will allow repurposing the content as well as facilitating studies that wish to assess the design of conversation scripts for mental health chatbots. Conversation design process also highlighted some challenges in turning empathetic and supportive conversations to short utterances suitable for a chatbot.

The ChatPal chatbot is now available in four languages. As literature about the topic is still scarce, it is important to describe and document the content development processes of mental health chatbots. Future work will develop a conversational UX toolkit that would allow health professionals to design chatbot scripts using design guidelines.

No significant relationships.