Compared to specialized care, primary care is considered to be more accessible, less stigmatizing, and more comprehensive since it manages physical ailments along with mental disorders (MD). Thus, MD are mainly treated by general practitioners (GP), even though their ability to diagnose and treat these diseases is often considered unsatisfactory.

This study aimed to analyze perceptions of GP capacity to manage MD, and to assess the difficulties encountered during this management.

A cross-sectional web-based survey design was adopted between August 22 and September 23, 2020, so that 47 responses of GP were included.

The mean age of respondents was 37.3 years. Among them, only 17% attended a post-university psychiatric training. On average, 6.3% of GP visits were MD-related. Anxious disorders and depression were perceived as very frequent respectively in 82.9% and 40.4% of cases. Among GP, 17% considered bipolar disorder as a difficult pathology to diagnose, followed by schizophrenia (12.7%), while the pathologies perceived to be most difficult to treat were dementia (17%), acute agitations (14.9%) and schizophrenia (10.6%). Anxiolytics and antidepressants use was very frequent (40.4% and 27.7% respectively), and 34% needed training in antipsychotics prescription. Difficulties encountered during MD management were related to lack of psychiatric continuing education (19.4%) and lack of collaboration with mental health professionals (12.5%). Among participants, 93.6% requested a psychiatric training: theoretical 29.3%, practice exchange 24.7%.

Our study confirmed that MD related visits are common in primary care and highlighted several obstacles in their management. Further continuous education, training,and collaboration between practitioners is required.

Long-acting injectable (LAI) antipsychotics are related to proven compliance to treatment and more constant medication levels (hence the apparent lower side-effect burden).

To highlight the experience with LAI antipsychotic treatment during pregnancy.

Literature review.

Seven cases are reported. A 35year old with schizophrenia received zuclopenthixole LAI (mostly 200mg/monthly) during both her pregnancies (of healthy girls born at weeks 39 and 40). A 35year old with schizophrenia was under risperidone LAI (25mg/2 weeks) and gave birth to a healthy girl at week 37. Another 35year old (probably with schizophrenia) was on olanzapine LAI (300mg/month during the last quarter of her pregnancy) that led to the birth of a healthy girl at week 40. A 37year old with schizophrenia received paliperidone LAI (100mg/monthly, last injection at week 28) and gave birth to a healthy boy at week 39. Paliperidone LAI (50mg/monthly) was the treatment of another 34year old with schizoaffective disorder that gave birth to a healthy boy at week 40, as well as of a 26year old (263mg/3-monthly), mother of a healthy boy as well (born at an unspecified week of pregnancy). Finally, a 43year old with bipolar disorder was on aripiprazole LAI (300mg/monthly) during her pregnancy that led to the birth of a healthy girl at week 40.

All pregnant women on LAI antipsychotic treatment gave birth to (apparently) healthy babies. LAI doses were mostly low. Long-term follow-up could clarify eventual delayed aftereffects. Based on the literature, LAI antipsychotic treatment could be considered as an option for selected pregnant patients.

No significant relationships.

Empathy is generally viewed as a “positive” trait, while the Dark Triad traits are regarded as a “negative” side of a Dark personality. The perception of Risk is less univocal, as it plays a role in both courage and questionable behavior.

We posed the following research questions: 1. Is risk linked to empathy and the Dark Triad traits? 2. Which traits help distinguish between participants with contrasting latent profiles (determined cumulatively for the specified personality variables)?

Participants (n=250) completed three questionnaires: the Dirty Dozen, Personality Factors of Decision-making and the Questionnaire of Cognitive and Affective Empathy (QCAE). Correlation and Latent profile analysis (LPA) were performed.

Risk was linked to Machiavellianism, psychopathy, and decentration (positively) and to emotion contagion and affective empathy (negatively). Rationality was positively correlated with cognitive empathy. Machiavellianism correlated negatively with rationality and online simulation (a cognitive empathy subscale). Empathy subscales were linked to psychopathy (negatively) and to narcissism (positively). LPA established two latent profiles: the smallest BIC value was obtained for the model with two profiles (log-likelihood: -3204.013, df=77, BIC=-6833; VEE). Analysis of means revealed that Class 1 was characterized by significantly higher Dark Triad values and higher Risk, whereas Class 2 was characterized by lower Dark Triad traits, lower Risk, and higher Rationality (see Figure 1).

Figure 1. Latent profile analysis

The Dark Triad traits and Risk are the more discriminative variables, while Empathy subscales do not help distinguish between the two classes of participants. The study was supported by the Russian Foundation for Basic Research, project 19-29-07069.

Marriages’ dissolution phenomenon had increased in recent years in Tunisia. The impact of divorce on children depends on the interweaving of several factors and is not inevitably pathological. We have noticed in our daily practice a concomitant increase in the number of request for expert opinions concerning children.

Determine the clinical children’s profile of separated parents carried out within the framework of legal expertise.

We carried out a retrospective study in the outpatient child psychiatry ward at Fattouma Bourguiba general hospital in Monastir, Tunisia. Including all the expert reports of children affected by parental separations during a period of two years (2017 to 2019).

56 children were included in our study. The average age were (6.7 years) with a majority of males (58.2%). School failure concerned (24%). In most cases, the request for expertise was made in the context of mistreatment’s suspicion (60.7%), than following the parents’ separation (16.1%). Concerning the clinical picture: a normal psychiatric examination was found in the majority of cases (55.4%), anxiety symptoms concerned (32.1%). Cases of depression, global developmental delay and autism were also found.

According to our study, the vast majority of children presented a normal psychiatric examination. Moreover, a preponderant part of the symptoms seemed to result from educational errors. While parental separation poses risks for children, research shows that these negative effects are not the same for everyone. Several factors can reduce these risks and promote children’s resilience. Thus, first-line psychosocial care should be offered for families and children in seprations’ context.

No significant relationships.

Placebo research investigated the underlying mechanisms of placebo effects, but they are rarely used to optimize treatments. Ethical and legal concerns have been raised, but research demonstrated that placebo mechanisms can be used without patients’ deception: Experimental studies showed that half of drugs in treatment of attention-deficit/hyperactivity disorder (ADHD) combined with open-label placebos could be as effective as standard medication to reduce ADHD symptoms.

To estimate the health economic advantages of harnessing the combination of open-label placebos with standard medication in ADHD.

For preliminary estimation of the mean treatment costs, the 12-months prevalence of ADHD in children and adolescents aged 5 to 14 years as well as the percentage of medication treatments were extracted from the literature. Mean treatment costs per patient and year were calculated for four treatment plans (different drugs and dosages) with both treatment with standard medication and half of drugs in combination with placebos.

A 12-months prevalence of 4.3% equals around 260,000 children and adolescents with a compulsory health insurance in Germany. Of those, around 40-50% are equally treated with two standard drugs and two different dosages. Full standard drug treatments cost around 119 million EUR, and treatment with half of drugs in combination with placebos cost around 66 million EUR.

The combination of open-label placebos with half of standard medication could considerably reduce health costs. Reduction of side effects still must be considered. However, current studies are of experimental nature and lasted for no longer than two weeks.

Chronic pain is common, costly, and associated with significant disability and negative effects on well-being and mental health. The treatment is challenging, requiring a multidisciplinary approach. Acceptance and commitment therapy (ACT) aims to help patients in engaging in a flexible and persistent pattern of values-directed behavior while in contact with continuing pain and discomfort.

To provide an updated review on the efficacy of ACT for the management of chronic pain.

We conducted a systematic review based on the PubMed® and EBSCO databases up to April 2020.

Fifteen trials were included. The results were in favour of ACT in pain acceptance, functioning and pain intensity with small to large effect sizes. Few studies evaluated quality of life, but half of those were favourable to ACT. We also focused our analysis on ACT online interventions, considering the current demands due to the COVID-19 pandemic.

The current systematic review points in favour of ACT for the management of chronic pain conditions, though the studies included suffered from methodological limitations, which may have led to overestimated effects. Methodologically robust trials are required to further understand the clinical efficacy of ACT for chronic pain and which patients most benefit from this intervention.

Research has found that low mood including sadness and hopelessness is an important factor for decreased awareness in one’s oral health and lowered frequency of visit to the dental office, this relationship is not well studied in national representative samples. Poor mental wellbeing can lead to poor oral health.

Aim is to examine the relationship between feeling sad or hopeless and awareness for dental care.

Data were obtained from the Youth Risk Behavior Surveillance Survey (YRBS-CDC), USA, for years 2009-2017. All ages from 12 to 18 years, feeling sad or hopeless and dental visits were identified. Univariable relationship between feeling sad or hopeless (>2 weeks in the past year) and dental office visits for all dental care (during the past 12 months, 12-24 months, >24 months, and never) was evaluated using chi-square test.

Out of a total of 53,098 youths, 30.5% of youths were feeling sad or hopeless. Within the youths feeling sad or hopeless, the prevalence of youth who never received dental care was higher at 37.1% in comparison to youths who received dental care >24 months ago 36.4%,12-24 months 33.7%, and visited the dental office in the past 12 months 28.9%. (p<0.0001). In youths who had dental care in the last 12 months, the prevalence of sadness or hopelessness was lower at 65% vs 70%, while it was higher in youths who had never had dental care at 3.3% vs 1.7%.

Further research is warranted to evaluate reduced oral health care awareness among participants feeling sad or hopeless.

Chronic diseases have often been associated with depression or other psychiatric conditions. Despite the fact that renal transplantation offers children a chance at a better life, it could also raise some challenges. Dealing with a severe medical condition such as chronic renal disease and multidrug therapy with potential long term side-effects from the early years of life can affect a child’s emotional and social development.

Reporting a case which represents a challenge in treating an adolescent with depression and renal failure.

Case Report

A 15 year old male with multiple admissions (between the ages of 12 and 15) for recurrent feelings of inadequacy and worthlessness due to his appearance, impaired social skills, hostility towards society, suicide ideation and aggressive behaviour. Moreover, his medical history includes CRS (congenital renal disease), kidney transplant at the age of 2 followed with transplant rejection in 2019. Currently he is under haemodialysis and multiple drug prescriptions associated with his severe medical condition which interferes with the psychotropic treatment.

This case quests what the better choice of intervention is for depression associated with aggressive behavior in a child with kidney failure and with no significant improvement in psychotherapy?

The present aimed to examine the mental health conditions of children, ages 7-11 years, living in conditions of war and conflict conditions in two districts of a Nagorno-Karabakh, Azerbaijan.

The study surveyed teachers of 617 primary school children (mean age 8.9, SD 1.24; 50.7% female) across nine schools in Agdam and Karabakh districts.

The children were evaluated with the previously validated Azerbaijani version of the Strengths and Difficulties Questionnaire (SDQ) Teacher Form. The total difficulty and five subscale scores (emotional problems, conduct problems, hyperactivity/inattention, peer relationship problems, and prosocial behavior) were assessed.

About a third of children (32.7%) had abnormal total scores, and a fifth (21.4%) were in borderline range. The SDQ subscale scores included emotional problems (19.4%); conduct problems (20.3%), hyperactivity/inattention (12.2%), peer relationship problems (31.1%), and pro-social behavior difficulties (13.1%). Boys had higher level of difficulties than females (p<.01) with a negative correlation of children’s school performance with maternal education.

The findings of the study show that more than half of the children living in the war zone in Azerbaijan have significant mental health problems. The psychological effects of the war environments have a profund effect on child development and education and need to be revisited under the United Nations Sustainable Development Goals. These include the provision of implicit supports in terms of their emotional, behavioral, psychosocial development and education of children and protection of children from wars, conflicts, and persecution.

No significant relationships.

Eating Disorders are a frequent pathology, particularly among teenagers, a group characterized by its vulnerability and body dissatisfaction. Social networks (SN) can be a gateway to ED, mainly with Pro-Ana and Pro-Mia resources. Despite the aforementioned, SN can also be helpful for professionals, either as a tool of approach to vulnerable groups or as a way of interaction in patients already diagnosed.

To study the relationship between ED and SN, using the open access evidence available in Pubmed over the last 5 years.

A single-phase computerised search was carried out in Pubmed. The search terms were: (“Anorexia Nervosa”[Mesh] OR “Bulimia Nervosa”[Mesh] OR “Feeding and Eating Disorders”[Mesh] OR “Eating Disorders”[Tiab] OR “Eating Disorder”[Tiab] OR “Disorder, Eating”[Tiab] OR “Disorders, Eating”[Tiab] OR “Anorexia”[Tiab] OR “Bulimia”[Tiab]) AND (“blogging”[Mesh] OR “social media”[Mesh]). The filters applied were: “free Full Text” and publications for the last 5 years.

36.84% studied SN as a positive tool for ED. 47.37% revealed negative influence, only 44.44% focused on Pro-Ana and Pro-Mia. 15.79% provided both positive and negative arguments. The most studied SN were Twitter and Facebook.

Despite the known negative effect that SN can have on ED, they can also be used as a supportive recovery framework. They can be used to identify dangerous behaviours and intervene or as a prevention tool.

No significant relationships.

The Coronavirus pandemic has originated unprecedented sanitary control measures that have conditioned people’s lifestyles and habits. Little is known about the impact of such measures, especially the most restrictive, on recent and growing phenomena such as exercise addiction, use of enhancement drugs, and Body Dysmorphic Disorder (BDD).

The objective was to investigate the above-mentioned phenomena during COVID-19 pandemic and how they relate.

The sample consisted of 3161 participants (65% women), from Portugal (11%), Italy (41%), Spain (16%), the UK (12%), Lithuania (12%), Japan (6%), and Hungary (4%). Mean age was 35.05 (SD = 12.10). Participants responded online to the Exercise Addiction Inventory (EAI), the Appearance Anxiety Inventory (AAI), and questions about use of enhancement drugs.

4.3% of the participants scored above the cut-off point of the EAI, with higher values registered in the UK and Spain. Exercise addiction was higher among men. Appearance anxiety and body satisfaction problems were found in participants of all participating countries, with 15.2% scoring over the cut-off point for BDD. Higher numbers of those at risk of BDD were found in Italy, Japan, and Portugal. About 29% reported the use of fitness supplements to make them look better, with 6.4% starting a new use during the lockdown. Change in supplements use and exercise are predicted by EAI scores. Change in mental health is predicted by AAI scores.

This study helps to shed light on how COVID-19 lookdown induced behavioral changes and how they affect physical and mental health-related aspects in different countries.

The gut microbiota constitute the largest and most diverse community in the body which is primarily responsible for the maintenance of the intestinal wall integrity and the protection against pathogens. Besides having an important role in the regulation of host energy metabolism, the gut microbiota can also influence neurodevelopment, modulate behavioral and might contribute to the development of psychiatry disorders.

The authors elaborated a narrative literature review to understand how gut microbiota can influence depression.

Using PubMed as the database, a research was conducted about how Gut Microbiota relates with Depression.

The microbiota-gut-brain axis encompasses the strong bidirectional communication between the gut microbiota and the CNS. Multiple mechanisms may be involved in this bilateral communication, including immune, endocrine and neural pathways. Permutations in the gut microbiome composition trigger microbial lipopolysaccharides production that activates inflammatory responses. Cytokines send signals to the vagus nerve, which links the process to the hypothalamic-pituitary-adrenal axis that consequently causes behavioral effects. Beyond this, gut microbiota have the capacity to produce many neurotransmitters and neuromodulators such as serotonin and can induce the secretion of the brain-derived neurotrophic factor, an important plasticity-related protein that promotes neuronal growth, development and survival.

Neuroinflammatory processes like those that occur in depression are deeply modulated by peripheral inflammatory stimuli, especially those from the intestinal microbiota. However, the knowledge is currently limited and the information available is not enough to understand the exact mechanisms. Therefore, more studies are required to show how gut microbiota influences the human brain.

No significant relationships.

Cognitive deficits are considered a key feature of schizophrenia due to their substantial influence on the psychosocial outcome of subjects affected by this disorder. Several studies showed that moderate to severe cognitive impairments, including dysfunctions of social cognition, are already present during the early phases of the illness, in subjects with first-episode psychosis (FEPs). Psychosocial interventions, such as social skill training (SST), could therefore be implemented already upon occurrence of the first episode of psychosis to improve the overall functional outcome of schizophrenia, which represents to date an unmet need in the care of these patients.

The study aims to evaluate the use of SST to enhance social skills and real-life functioning in FEPs.

The sample included 7 FEPs (age between 15 and 40). The SST intervention included 30 sessions lasting 2 hours and delivered twice a week. Psychopathology, neurocognition, real life functioning, functional capacity and social cognition were assessed at baseline ad after training. Paired samples t-tests were performed to evaluate the effects of the intervention. All subjects were treated with second generation antipsychotics.

Significant improvements were observed in negative symptoms, social cognition, problem solving skills, as well as in global functioning (all p<0.05). Within real-life functioning, the improvement was greater for the domain of interpersonal relationships.

These preliminary findings suggest that SST might complement pharmacological treatment in FEPs to improve functional outcome in these subjects. Further studies with a higher sample size and a longer follow-up are required in order to confirm the present results.

Protracted abstinence syndrome represent group of attenuated psyc that lead to a persistant sense of discomfort among misuse patients after detoxification and may last for some months.Poor sleep in terms of duration and quality is one of the major symptoms of protracted abstinence syndrome

To assess polysomnography parameters as potential risk for relapse over six months

60 male patients with heroin misuse according to DSM V have been recruited immediately after detoxification phase, they were not receiving other psychactive substances or medications, polysomnography was done in the second week after detoxification to allow washout of medications used during detoxification and then a monthly sleep assessment through sleep diary and daytime sleepiness using visual analogue scale. Relapse was prooved through urine test.

Sample contained 60 male patients with heroin misuse disorder, detoxified successfully with a mean age 35.47±7.32 and addiction severity index total score 3.21±0.22, polysomnography was done to all sample patients one week after detoxification, 20% relapsed by the third month, rising to 30% by the six month. NREM stages I and II, both limb movement and arousal indices showed significant differnce between relapsed and non-relapsed patients.

Sleep disturbance is common among detoxified heroin misuse patients. Polysomnographic parameters such as percentage of NREM I and I, arousal index and limb mouvement index can potentially predict future relpase over six month follow up period.

At Coombe Wood Mother and Baby unit (MBU) there are daily multi-disciplinary team (MDT) handover meetings and a weekly MDT ward round attended by 7-8 team members. There are concerns that the handover is too time consuming, utilising time which could be spent on other clinical duties, and concerns regarding the relevance of information that is handed over.

To perform a service evaluation to determine the efficiency and quality of MDT handover meetings in an MBU setting.

Data was collected from September to October 2020. A checklist was designed listing information felt to be relevant to handover and contained the following data points – ‘current situation’, ‘mental health’, ‘level of observations’, ‘risk’, ‘physical health’, ‘baby care’, ‘baby supervision levels’ and ‘tasks and responsibilities’. The start and stop times of each MDT handover meeting were noted and a record was made as to whether these topics were discussed.

Mean meeting duration was 32.2 minutes (range: 13 – 45 minutes) and amounted to 2.68 hours spent in MDT handover over a 5-day working week. This equates to 21.4 person-hours (based on 8 staff) a week. 928 data points were generated. 50.7% (468) data points were recorded and commonly omitted data points were – ‘tasks and responsibilities’, ‘risk’, ‘level of observations’ and ‘physical health’. On all occasions, ‘current situation’, ‘mental health’ and ‘baby care’ were handed over.

The results of this service evaluation provide compelling evidence for a wider improvement project. Involving MDT staff in designing interventions will make handover meetings more meaningful.

Research on the association between internet use and concerns about body image is still scarce.

To explore the associations between generalized problematic internet use, number of social networks, and appearance schemas.

216 Portuguese late adolescents (89.3% females), with a mean age of 18.62 years old (SD = .488, range: 18-19) filled in an internet patterns of use questionnaire, the Generalized Problematic Interne Use Scale 2 (GPIUS2) and The Appearance Schemas Inventory-Revised (ASI-R).

A total of 99.6% of the students use social networks. Subjects were divided into three groups (group1: 1-2 social networks; group 2: 3 social networks, and group 3: >3 social networks). There was a statistically difference in Motivational Salience scores (ASI-R) for the three groups [F (2, 503) = 6.0, p = .003]. Post-hoc comparisons indicated that the mean score for group 3 (M = 28.29, SD = 4.95) was significantly different from group 1 (M = 26.69, SD =4.55), and from group 2, (M = 26.87, SD =4.95). Generalized problematic internet subscales (Mood Regulation, Self-Deficient Regulation, and Negative Consequences) and total score were significantly correlated with both dimensions of ASI-R: Self-Evaluation Salience (coefficients varied from r = .31** to r = .47**) and Motivational Salience (from r = .14*, to r = .31**).

Generalized problematic internet use and the number of social networks are associated with adolescent’s cognitive-behavioural investment in one’s own appearance. Study carried out under the strategic project of the Centre for Philosophical and Humanistic Studies (CEFH) UID/FIL/00683/2019, funded by the FCT.

Intensive professional training is widely used in modern organizations, as it helps employees adapt to dynamic work and technology changes (Noe, 2010; Patrick, 2000). Relaxation techniques may reduce the negative effects of intense learning processes (i.e. fatigue, anxiety and stress). They can also enhance the productivity of the training itself by helping to achieve optimal states for the completion of learning goals.

Our study concerns differences in mastering relaxation techniques by employees of younger and middle-age groups during intensive professional training.

Sample - 62 employees, participants of communication training. The 15-min session of progressive relaxation combined with autogenic formulae was conducted after 5 hours of intensive training. Measures: standard psychological and physiological functional state tests (Leonova & Kapitsa, 2003); an information perception task.

The efficiency of the relaxation techniques varied between different age groups: younger participants (aged 20-30) were more successful in managing both tasks – learning new relaxation skills and achieving deeper rest (including more apparent positive physiological effects). They were also more prepared for completing the information perception task (they made less mistakes). Older participants (aged 30-50) experienced more difficulties with the new relaxation skills and used relaxation primarily to restore their psychophysiological resources, rather than to prepare for the upcoming training task.

The results showed that relaxation techniques provide a system optimization effect on the participants of intensive training programs, though participants’ individual differences (ie age, length of service) should be taken into account when planning the outcomes of such interventions.

No significant relationships.

Academic procrastination is a specific sub-type of procrastination, assessing the tendency to delay academic tasks in connection with the preparation of courses or exams.

To determine the impact of academic procrastination on studies and academic performances and identify associated factors.

We conducted a cross-sectional descriptive study in students from three different universities: a medical school, a law school and an engineering school. Socio-demographic, clinical and academic data were collected. Procrastination was assessed using the Academic Procrastination Scale. We further administered the Short Version of the impulsive behaviour scale, the Satisfaction with Life Scale, the Perfectionism scale, and the one item Self-esteem Scale.

Our sample consisted of 1019 students. The mean age was 22 ± 2.25 years, and 62% were females. About one third of study participants used tobacco or alcohol, and 10% used drugs (cannabis or others). We found a significant positive correlation between procrastination and academic failure (r=0.22 p= 0.00) and a negative correlation with academic success (r= -0.27 p=0.00). Multivariate regression analysis showed the following risk factors for academic procrastination: alcohol consumption (ORa= 1.74 [1.14; 2.67]), study field (with reference to medicine: law ORa= 1.50 [1.02; 2.19], engineering studies ORa= 2.01 [1.34; 3.02]), and impulsivity (ORa= 2.11 [1.55; 2.86]).

Academic procrastination has a negative impact on academic achievement and performance. This impact appears to differ depending on the field of study. It also seems closely related to impulsiveness and alcohol use. Our findings might contribute to find new ways of helping students to improve academic performance.

No significant relationships.

The discovery and development of drugs for treatment of brain disorders is an extremely challenging process requiring large resources, timelines, and associated costs. Positron Emission Tomography (PET) enables in vivo neuroimaging of various components of receptors, transporters, enzymatic activity and other types of proteins. PET also allows for studying the response to physiological or drug interventions in experimental medicine studies. Moreover, PET neuroimaging can assist to establish diagnoses in certain brain disorders and thereby improve patient selection and stratification for clinical trials. Over the past couple of decades, PET neuroimaging has thus become a central component of the evaluation of novel drugs for brain disorders, enabling decision-making in phase I studies, where early discharge of risk provides increased confidence to progress a candidate to a later phase testing at the right dose level or alternatively to kill a compound through failure to meet key criteria. The so called "3 pillars" of drug survival, namely; tissue exposure, target engagement, and pharmacologic activity, are particularly well suited for evaluation by PET imaging. Molecular neuroimaging has thus increasingly established itself as a unique tool that not only can demonstrate drug penetration and kinetics in the brain, but also identify pharmacodynamic effects, e.g., changes in glucose metabolism. It can also quantitate therapeutic action in vivo by determining, e.g., drug occupancy whereby the relevant dose ranges to be used in clinical efficacy trials can be determined.

No significant relationships.

An uncommon adverse event of antidepressant discontinuation is the paradoxical withdrawal hypomania or mania. It is rarely described in the literature and its true incidence is unknown, may it be a consequence of underrecognition or misattribution.

Alert clinicians of the uncommon Antidepressant-Withdrawal Mania

Report and discuss, based on online pubmed database, a case of Antidepressant-Withdrawal Mania with Citalopram

A 34 year old woman, with a previous unipolar depressive episode, presents to the emergency department in june/2020 with anxiety, recurrent thoughts of death without a plan, low energy, anhedonia, loss of appetite, sadness and insomnia developing over a period of 7 months. She was prescribed Quetiapine 50 mg XR, Lamotrigine 100 mg, and sent to a psychiatry consultation. After a month and a half there was no important clinical improvement and Citalopram 20 mg was started. The patient reported slow improvement and by august she had a complete symptomatic response. In the beginning of september the patient stopped citalopram abruptly. Three weeks later, she was presented with an irritable mood, increased energy with decreased need for sleep, sweet cravings, easy irritability, racing thoughts, pressure to keep talking and suicidal thoughts. After 2 weeks of Quetiapine 300 mg XR id, Lamotrigine 100 mg id and Olanzapine 5 mg there was a partial symptomatic response.

Antidepressant withdrawal manic states are an under-recognized phenomena, with ill defined patho-physiological pathways and nosology. It is important to continue close follow up of the patient and to investigate whether it can be included on the bipolar spectrum.