The intestinal microbiota has been indicated to have a role in the pathophysiology of AN.

Aim of this study was to analyze fecal microbiome profiles of AN women before and after weight restoration and to combine them with fecal metabolomic profiles according to a multi-omics approach.

The gut microbiome and fecal metabolites were characterized in 21 underweight AN women and after weight restoration and compared with those of 20 healthy women. Microbiome data were correlated with the relevant fecal metabolites.

AN subjects showed a decreased intra-individual bacterial richness, an increased Bacteroidetes-to-Firmicutes abundance ratio and significant changes in the relative abundances of several bacteria at different order levels in both the underweight and weight-restored condition compared to healthy women. The untargeted metabolomic procedure allowed the characterization of 224 metabolites involved in energy, lipid and amino acid metabolism. A genetic algorithm identified 49 relevant metabolites. The relationships among these fecal metabolites and bacteria genera showed structures of different complexity in the 3 groups. In particular, a quarter of those relationships showed a divergent direction in the acute phase of AN than in the weight-restored phase or normal controls. Finally, in acute AN 70% of those correlations showed a negative sign suggesting a prevalent metabolites consummation by gut microbiome.

Our results provide a picture of the connections between gut bacteria and fecal metabolites in both the acute phase of AN and after short-term weight restoration. Further studies should aim to investigate the significance of gut microbiome perturbations in development and treatment of AN.

Today, approximately one fifth of employees in the European Union works in the shift system. Insomnia is one of the most common consequences of occupational stress and shift work. Identifying factors contributing to poor sleep quality among shift workers, especially in healthcare professions, is important because insomnia increases the risks for numerous health disorders and impacts work ability.

The aim of this research was to investigate to what extend does an inability to withdraw from work influences the link between occupational stress and insomnia among shift workers. We operationalized occupational stress within the Effort-Reward Imbalance Model (ERI). An imbalance between individual effort and reward obtained at work leads to experiencing a stressful work environment.

153 shift working female nurses completed a short questionnaire about work schedule, the Effort-Reward Imbalance questionnaire with the Overcommitment (OC) scale and the Insomnia Severity Index (ISI). To estimate the mediating effect of OC on the association between ERI and ISI, we conducted a mediation analysis using PROCESS v3.4 macro in SPSS.

The model including ERI and OC accounted for 12.25% of the variance in ISI scores. ERI significantly predicted OC and OC significantly predicted insomnia. The direct effects of ERI on ISI remained significant after controlling for the effects of overcommitment. 35.07% of the effect of ERI on ISI was through OC.

Ability to detach from work-related thoughts during leisure time is crucial for successful recovery from occupational stress. The research is supported by a grant no. 2019/33/N/HS6/02572 from the National Science Center in Poland.

No significant relationships.

Bipolar disorder (BD) is a serious and extremely recurrent illness frequently associated with cognitive and functional deterioration that poses many treatment challenges. However, over the years, with the evolution of more and more mood stabilizers and neuroleptics, there were controversies surrounding the use of electroconvulsive therapy (ECT).

The present study was an attempt at studying the clinical profile of BD patients who receive ECT and to study its effectiveness.

Retrospective data were collected from all bipolar patients submitted to acute ECT treatment, between June 2015 and June 2016, at the Department of Psychiatry of the University Hospital of Mahdia, Tunisia.

During the study period, among all the patients who received ECT, 47% were diagnosed to have bipolar disorder. ECT was administered most commonly for mania with psychotic symptoms, followed by severe depression with psychotic symptoms. Most of patients showed more than 65% response (based on reduction in the standardized rating scales) with ECT. Few patients (18.7%) reported some kind of side effects.

ECT resulted very effective for all BD acute depressive and manic episodes not responding to conventional pharmacologic management.

Pica is a strange eating disorder that consists of eating non-nutritive substances, inappropriate to the developmental level/ cultural normative of the individual. The prevalence is not widely studied, but might occur in the context of other mental disorders, such as schizophrenia, that hinders the management and treatment of these patients.

To report a severe pica in a patient with late schizophrenia, and highlight the impact this syndrome might cause on the life of these patients.

We present a case of a 65 year-old-woman with schizophrenia attended in the emergency area for dysphagia due to the intake of a metal washer. Reviewing the patient medical history, an early and severe schizophrenia was described. Within years, disorganization and residual symptoms have become the main disabilities, developing a pica eating disorder with preference in greater metal objects (images are included).

The management has been hindered due to the consequences of pica eating disorder. The patient describes an unstoppable urge to make the intake when she sights wide metallic objects (batteries, docks, washers…). Different antipsychotic drugs have been used, combined with psychotherapy and family education. Despite this, the patient has required multiple attentions in the emergency area due to esophagueal impaction, intestinal obstruction, perforation and peritonitis, that have led to countless surgeries and hospitalizations.

Pica can become a highly dysfunctional syndrome that may lead to severe organic and life impact. The comorbidity with schizophrenia is understudied, but further investigation might be useful to show up specific management strategies of these patients.

No significant relationships.

Stigma is a major burden and impediment for treatment and recovery in serious mental disorders, especially psychotic disorders. Therefore, it has been proposed to replace the term schizophrenia by psychosis susceptibility or psychosis spectrum disorder.

We have assessed stigma in the media through a 10-year survey of Flemish daily newspapers (2008-2017) by comparing the way schizophrenia and autism are portrayed. We added the term psychosis for the years 2013-17 to assess its suitability as a less stigmatising alternative.

Via the websites of the seven Flemish newspapers, we searched for all articles published between 01 Jan 2008 and 31 Dec 2017 containing the keywords autism, schizophrenia, and related terms. The collected articles (n = 5,337) were then graded to their stigmatising content. We added the term psychosis for the years 2013-17.

In the collected articles the coverage of autism was mostly positive, whereas the coverage of schizophrenia was predominantly negative. The contrast was very substantial (p < 0.0001) and stable over the years. The portrayal of psychosis turned out to be mostly positive in the broadsheet newspapers and mostly negative in the tabloid papers.

The social stigma attached to schizophrenia and psychosis is poignantly reflected in the Flemish newspapers. The fact that a comparable disorder such as autism is depicted in a much more favourable way than schizophrenia indicates that a more positive image of schizophrenia is not only desirable but also achievable. Psychosis gives mixed results, a finding up for discussion.

Lockdown imposed by the Tunisian government had a psychological impact such as depression, stress and anxiety, which triggered the development of eating disorders especially binge eating disorder.

To screen the binge eating disorder among general population in Gabes (south of Tunisia) and to identify factors associated with it.

We conducted a cross-sectional, descriptive and analytical web-based survey, from April 19, 2020, to May 5, 2020 on Facebook on citizens living in south of Tunisia. During this period, the total confirmed cases of COVID-19 exceeded 900 in Tunisia. We used a self-administered anonymous questionnaire containing citizen’s sociodemographic and clinical data. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria were used to assess Binge-Eating Disorder.

A total of 331 persons were included. They were females (65%) and singles (43,2%). 71% of our population were aged between 20 and 40 years old. Among citizens of southern Tunisia, 6,9% suffered from binge eating disorder during this period of the lockdown. Binge eating disorders were associated to past psychiatric history (2,1% vs 4,53%, p<10-3), history of eating disorder (4,5% vs 2,4%, p<10-3), social isolation (5,1% vs 1,8%, p=0,015) and lack of physical activity (3,3% vs 3,9%, p=0,025).

Our study showed that lockdown during the COVID-19 pandemic has changed the eating behavior of citizens of southern Tunisia. It is therefore important to screen them in order to manage them before complications emerge.

The intersection between bipolar disorders and creativity has been investigated in western literature. Although psychopathology has been proposed for famous artists in painting, writing, music and other forms of art, there is no systematic study examining bipolar disorders and music production in composers.

The aim of this review is to investigate this relationship by providing an overview of published studies.

The search included papers published in English as abstracts as well as in full length until October 2020. The literature search was conducted using the MEDLINE, EMBASE, PUBMED and GOOGLE SCHOLAR databases. For all the searches, the terms/key words that were used were “bipolar disorder”, “music”, “creativity”, and “composers”.

Search results for composers from different music genres and musical periods indicated that the proposed origin of the overall bipolar pattern is attributed to several stressful environmental factors which are taking the form of interpersonal problems regarding the expressed emotion, life events, and paucity of stress-management skills. In addition to that, bipolar psychopathological patterns seem to influence the quantity of music composing activity indirectly due to changes in everyday functional abilities.

Published reports, although based on biographical research, do provide evidence in support of a strong bipolarity-music creativity/production link for famous composers. Further well-designed studies in living music professionals engaged in music composition are needed.

The modality of assessment used at a University Clinical Practice in Brazil is interventive psychodiagnosis in which the active participation of children and families is considered. Orientation is given following the input provided by children and their parents.

Evaluating the use of an electronic form to be fulfilled during the observation of a child’s play in psychological session.

A child at the age of 5yrs 4m was brought for psychological assessment with the complaint of aggressiveness and irritability. His parents answered the Child Behavior Checklist (CBCL -1 1/12 5 yrs) and the Psychology interns had to observe the child’s play and fulfill an electronic form in which the choice of toys and plays, motricity, creativity, symbolic abilities, frustration tolerance, adequation with reality were verified.

The results of CBCL indicated that the child was within the clinical range regarding anxiety and depression along with somatic complaints. The indicators observed in the electronic form such as rigidity in the modality of play, the lack of adequate ability of impersonating in role-playing, the difficulty of using creativity during play unless he was guided by peers or the Psychology interns and the constant anguish of separating himself from his parents were crucial for parents’ orientation. The psychological treatment lasted five months and benefited from the information obtained through the form once the symptoms of irritability and aggressiveness were reduced.

This modality of assessment can be instructional for parents and may also reduce financial and time costs once provides specific indicators to observe during play.

The development of original drugs - new generation GABAA receptor modulators (GABAAR), with an anti-alcohol orientation, non-addictive and stimulating detoxification processes, makes it possible to increase the effectiveness of therapy and reduce the cost of treatment.

Study the mechanism of interaction between m-Cl-BHU and GABAA - receptor

Molecular docking was performed to study the molecular docking of m-Cl-BHU with at the binding site of the target protein GABAAR.Radioreceptor studies were carried out using [3H] flunitrazepam binding with synaptosomal receptors in the cerebral cortex of Wistar rats in experimental alcoholism under the influence of therapy with m-CL-BHU. Kinetic parameters (T1/2, Clt, MRT, MET, AUC) of a model substrate - antipyrine were determined in the saliva of healthy volunteers and alcoholic patients.

IResults of molecular docking (Schrödinger program (Glide) showed: m-CL-BHU (meta-chlorobenzhydryl urea) is complementary to the benzodiazepine GABAAR. Binding energy is low) (scoring (GScore) -11.14 kKal/mol); m-CL-BHU interacts with key amino acids at the α1γ2 interface: Tyr159, Tyr209, H101 Phe77 and is characterized by a high degree of model fit - dG insert: 0.741 Binding of [3H] flunitrazepam to the benzodiazepine site of GABAAR in rat brain in experimental alcoholism, who received 14 days of m-CL-BHU at 100 mg/kg /day, increased in receptor affinity. Changes in the kinetic parameters (T1/2, Clt, MRT, MET, AUC) of a model substrate - antipyrine in the saliva of healthy volunteers and alcoholic patients using Galodif (m-CL-BHU) at 300 mg/day 21 days

m-CL-BHU - GABAA receptor modulator with an alternative mechanism of action

No significant relationships.

The crisis caused by the ongoing COVID-19 pandemic is affecting the lives of billions of people across the world. Individuals with mental illness are suspected to be particularly affected by the societal consequences of the pandemic, but there is very limited data on this important aspect.

The aim of this study is to gauge the longitudinal impact of the COVID-19 pandemic on the psychological well-being and symptom levels of individuals receiving treatment for mental disorder in psychiatric hospital services.

We are in the process of conducting a two-wave, questionnaire-based survey among patients with mental disorders receiving treatment in the psychiatric hospital services of the Central Denmark Region. The first wave was conducted in July 2020 and had 1180 respondents representing all major diagnostic categories. The main finding was that the majority of the respondents reported that their mental health had deteriorated during the COVID-19 pandemic. We are currently planning the second wave of the survey, which will be fielded in the fall of 2020. Here, we will reassess the mental health of the respondents from wave 1.

Will be presented at the meeting.

Longitudinal studies of the impact of the COVID-19 pandemic of mental health are lacking. We therefore expect that the findings of this study will be of significant interest to the field.

No significant relationships.

Depression is very common in adolescent patients and impacts on their quality of life and functioning. Indeed, depression is an important clinical aspect for treatment, outcome, and prognosis.

This pilot study investigated the factorial structure of the Calgary depression scale for schizophrenia (CDSS) in a sample of help seeking adolescent patients, stratified in three clinical diagnostic subgroups: early onset psychosis (EOP), clinical high risk (UHR) and clinical control (CC). The relationships between these factors and SIPS domains and subjective experiences were also explored.

Sixty-nine subjects were examined to assess the severity of depressive symptoms and the degree of subjectively felt cognitive-affective vulnerability (i.e. basic symptoms)

Principal component analysis revealed CDSS to include two main factors, namely: “guilty idea of reference-pathological guilt” (factor I), “depression-hopelessness” (factor II). Two factors revealed multiple correlations with SIPS domains and subjective experiences.

The results confirm the dual factorial structure of CDSS previously reported in the literature in adult samples, further increase our knowledge of the psychopathological components of depression in adolescents, and strongly suggest that CDSS can also be used in early diagnostic settings

No significant relationships.

Psychiatric symptoms related with menstrual cycle vary from dysphoria to psychosis. There are only a few cases of menstrual psychosis reported, all characterized by acute onset, against a background of normality, brief duration, with full recovery and a circa-mensual periodicity.

We report a case of dissociative disorder, in a teenage girl, with atypical presentation and an unusual periodicity of symptoms and recoveries.

Presentation of a case of dissociative disorder, followed by a review of the similar cases described in the literature.

We are presenting a case of a 15 years old female, who presented in our Emergency Department for confusion, anxiety, negativism in verbal and non-verbal response, bradylalia and bradypsychia, insomnia for over 48 hours. The symptoms suddenly began two days before arrival in our clinic. From the patient’s personal history, we retain the following: menarche at 14 years old, irregular periods, hypermenorrhea. Patient was born premature, G=1200g, spastic diplegia, periventricular leukomalacia (MRI – 2018). Three similar episodes happened a year ago, with one month periodicity, with spontaneous remission after 5-6 days. Patient was treated with antipsychotics and benzodiazepines for the second and the third episode, but the treatment was stopped six month ago. The investigations results were normal, except for a high level of plasmatic cortisol. Patient fully recovered in the day the menses stopped.

We considered this case to be atypical due to the sudden debut and recovery and there are still some remaining questions. Is it hormonal related, menstrual related or is it exclusively a psychiatric condition?

No significant relationships.

The armed conflict in Colombia manifests and lasts as barbarism in the contemporary world (Zuleta, 2006). Against this background, it is possible to identify among the victims the prevalence of pathologies associated with traumatic events such as forced displacement (Andrade, 2008). Studies indicate a harmony between resentment and other psychosocial effects (Arcos, Muñoz, Uribe, Villamil, Ramos, 2018).

The results of the study are presented, which has aimed to analyze the relationship between resentment and forgiveness with victims of forced displacement in three cities of Colombian.

A correlational study has been carried out with a sample of 40 (n = 40) subjects of which 52.5% are men and 47.5% women, the mean age is 57.52 (σ = 13.591), all with a history of forced displacement; to the data collection has been used the CAPER instrument of Rosales, Rivera and Garcia (2017) (α = .592).

There is evidence of a positive bilateral correlation between the variables studied (r = .000; p = .681), the greater the personal restoration, the greater the feeling of guilt.

It is important that the intervention processes designed for the victims of forced displacement focused on forgiveness include in their content elements associated with resentment.

Religion belongs among well-documented coping strategies, through which one can understand and deal with stressors.

The aim of this study was to examine religious coping responses face to the outbreak of COVID-19 pandemic among Tunisian people.

The survey was conducted using the online anonymous questionnaires and distributed through social networks from 24 April to 23 May 2020. It included sociodemographic questions, participants’ experience of SARS-CoV-2related stressful events and the frequency of religious practice during the COVID-19 pandemic. The Brief RCOPE was used to assess religious coping.

Our study included 80 participants: 71.3%female and 42.5%married. The mean age of the participants was 29.30 years (SD = 8.72). The religion of all participants was Islam, and 72.5% of them had religious practices. Participants reported much lower levels of negative religious coping than positive religious coping (5% versus 37.5%). There were no significant differences in religious coping activities as a function of gender (p=0.180, p= 0.192). Significant relationships were found only for demographic variables: level of education with Higher-educated reported more PRC (p=0.002). Having a family member with a suspected or confirmed infection was correlated with PRC (p=0.016).Concern with becoming infected or having a friend with a suspected or confirmed infection did not correlate with any coping strategy (p=0.112; p=0.489). No correlation was found between religious commitment and religious coping (p=0.897; p=0.504) however increasing religious activity during this pandemic was correlated with PRC (p=0.013).

Our findings suggest that lockdown experience is associated with higher use of NRC strategies.

Discovered in December 2019, COVID has affected the entire planet, through direct exposure to its virus; SARS-COV-2, or indirectly through the media, Indeed, on January 20, 2020, the World Health Organization declared COVID-19 to be “a public health emergency of international concern.” Along with other public health crises and other collective trauma (terrorism, H1N1 epidemic or SARS-COV), exposure to publicized information on this virus generates psychiatric disorders, in particular anxiety and absence of well-being. Objective: To link exposure to information about this pandemic through social media and anxiety and lack of well-being.

Explore the relationship between anxiety, well-being and exposure to social medias

Use of a questionnaire consisting of three sections, individual status and conditions, the French versions of the GAD-7 scale for anxiety (Generalized anxiety scale of 7items) and the WHO-5 (five well-being index). This questionnaire is dedicated to the general population who have not been in direct contact with the virus, but through the media.

We were able to collect 209 participants, they were essentially females with a mean age of 28yo, 17,7% had psychiatric history of anxiety and depression, the median use of social medias was 5.7 hours per day. And they were essentially getting their information about the pandemic from Instagram, Facebook, the Moroccan ministry of health’s website and electronic newspapers. 31,1% of our participants had anxiety which was above a Chinese study, and had a poor well-being.

The use of social media to get information about the pandemic had an impact on well-being and anxiety.

No significant relationships.

Literature highlights that interpersonal sensitivity represents an important development and maintaining factor for Eating Disorder (ED). Mentalizing and empathy are two psychological constructs that play a crucial role in social functioning. However, the role of mentalizing and empathy in the socio-emotional processing deficits of ED patients has been under investigated.

We aimed to assess the complex interactions between the sub-components of mentalizing and empathy and ED symptoms through a network analysis approach.

Seventy-seven women with EDs were included in our study. Eating disorder and affective symptomatology were investigated with self-report questionnaires. All patients underwent two computerized tasks: Movie for the Assessment of Social Cognition (MASC), assessing emotional and non-emotional mental state inferences; Empathic Accuracy Task-Revised (EAT-R), measuring accuracy in identifying and sharing others’ emotions. A partial correlation network and bridge function analyses were computed.

In the partial correlation network inference of cognitive mental states and shape concern were the nodes with the highest strength centrality. Inference of emotional mental states was the node with the highest bridge strength in the cluster of social cognition functions. Empathic and mentalizing abilities were directly connected with each other and with ED symptoms.

This is the first network analysis study which integrates self-reported symptoms and objective socio-cognitive performance in people with Eds. Our results provide evidence of the complex interactions between mentalizing, empathy and psychopathological symptoms in people with EDs. Therefore, confirm that the ability to infer others’ mental state may represent a useful target for clinical intervention in EDs.

Immune system abnormalities exist across a range of psychiatric disorders. Autoimmunity, characterized by the production of antibodies against the body’s own antigens, is a feature of immune system dysfunction and could play a role in mental disorder pathophysiology. Better understanding of the associations of auto-immunoglobulin G (IgG) repertoires with clinical features of mental illness could yield novel models of psychosis pathophysiology and markers for biological patient stratification.

To undertake global screening for auto-IgG expression in a large cohort of people with psychotic disorders; to determine whether associations exist between autoantibody expression and clinical features.

Cross-sectional quantification of auto-IgGs in blood plasma of 461 people with established psychotic disorder diagnoses. For global screening, pooled samples of phenotypically representative patient groups were exposed to planar protein microarrays containing 42,000 human antigens. For targeted profiling, expression levels of 380 autoantibodies were quantified by suspension bead array (SBA) in each patient’s plasma.

We identified highly individual autoantibody profiles with no evidence for co-expression patterns. We found 6 autoantibodies robustly associated with specific psychopathology: anti-AP3B2, detected in 5% of the cohort of whom 100% had persecutory delusions; anti-TDO2 (5% of the cohort, 100% hallucinations); anti-CRYGN (4%, 86% initial insomnia); anti-APMAP (3%, 86% poor appetite); anti-OLFM1 (2.5%, 100% above median cognitive function); and anti-WHAMMP3 (2%, 90% anhedonia and dysphoria). Examination of the auto-IgG binding site on the TDO2 protein revealed a putative pathophysiological mechanism involving the kynurenine pathway.

We identified 6 frequently occurring autoantibodies that were associated with specific clinical features in people with psychotic disorders.

No significant relationships.

Sexting is sending / forwarding erotic-sexual content voluntarily through technological devices and / or the internet. (Fleschler-Peskin, 2013). Real Participation (RPS), Active Disposition (ADS) and Emotional Expression (EES) was studied.

Compare sexting in two groups of participants: female and male

Comparison of data means measured by the Cronbach alpha sexting behavior scale α = 0.92, (Chacon-Lopez, et al, 2016). Sample N = 900 (447 female and 453 male)

The ADS and RPS decrease between 18 to 20 years old and increase between 20 to 22 years old. EES decreases when increasing age, except in 20 years old. Applying multiple regression analysis, control variable sex and reference group age 18 old, presents statistically significant difference, excepting 19 years old in EES and 22 years old in RPS. (Figure 1)

Comparing age and gender, ADS men present higher levels than women, excepting 19 years old. EES and RP, no significant differences are observed. Comparing women’s mean show lower AD levels than men with Cohen’s effect size d = 0.62, (Cohen, 1988). Related to PRS averages, women present lower levels than men without statistically significant differences. Comparing means, women show lower ADS levels than men effecting d Cohen d = 0.46, (Cohen, 1988). (Figure 2)

Evidence difference between men and women, in ADS and EES, without pattern associated with age, young men and women sexting

The Covid-19 Pandemia is not a turning point for e-health It might seem meaningful that this e-health approach will also continue in mental health care after the Covid-19, given the obvious pragmatic advantages. But several issues could at least delimitate a future use of e-health technology in psychiatry/psychotherapy: Patient with severe depression and suicidality seem not to be the right target group Same with other serious mental disorders First contact patients (depending among others on their personality characteristics), often have problems to open themselves at phone or video contacts In Germany (and probably other European countries?) a relative high percentage of psychiatrists/psychotherapists are reluctant or at least ambivalent against video based interventions A quite high percentage of psychiatrists/psychotherapists in Germany believe that a relevant proportion of their patients might not accept this very technical approach of doctor-patient-interaction. Currently in Germany, probably also in some other European countries, complain that some legal and billing issues are not fully solved. Some of these problems could decrease in the future and insofar it is difficult to make a valid prediction of the place of e-health technology in psychiatry/psychotherapy. Beside this one point seems of great importance to me: the current e-health success, driven by the Covid-19 Pandemia, should not be the direction of more cost saving psychiatry/psychotherapy, generally neglecting the need for personal interaction between patients and therapists.

No significant relationships.

This is a quasi-experimental and pioneering study in Portugal.

(1) to provide assessment materials for symptoms of internalized homophobia, depression, and anxiety targeted at LGBT people; (2) offer support materials for psychotherapeutic work-oriented in the areas of internalized homonegativity, depression, and anxiety; and (3) offer monitoring measures throughout the program to demonstrate changes. It consists of three phases (pre-program evaluation, therapeutic activities and post-program evaluation).

38 LGBT + individuals participated, average age was 34.15 years, 30 self-identified as male. Measures used for the pre and post-intervention assessment were the sociodemographic questionnaire, the LGBT identity questionnaire, the Rosenberg self-esteem scale, and the BSI-18. Participants were invited to join the program online, through a platform created for this purpose, where ethical aspects were clarified, namely: confidentiality and commitment to adherence. Therapeutic tasks were sent by email or WhatsApp depending on the preference of each participant.

Relevant differences in internalized homophobia, depressive, and anxious symptoms between the pre and post-intervention moments were observed, indicating that the program is effective in changing these symptoms.

The importance of validating this type of program allows reaching “hidden” populations by offering online support that minimizes the effects of sexual stigma on LGBT + populations.