Dissociative identity disorder is a quite popular psychiatric diagnosis in general public but in actuality has a very low prevalence rate. Dissociative identity disorders are characterized by disruption of identity characterized by two or more distinct personality states with its own memories, behaviour, and preferences.

Authors present a case report about a patient of Dissociative identity disorder with Elektra complex as unconscious conflict.

A case report along with literature review forms the basis of discussion.

Mrs A, 30 years female, a housewife, belonging to low socioeconomic status, reported to the OPD, along with her husband. About 1 year ago her family members noticed that her behaviour and action became altered. Such alteration in behaviour was only episodic. A detailed evaluation was done and a diagnosis of Dissociative identity disorder was established. The treatment included psychotherapy facilitated by hypnosis addressing the conflict along with escitalopram 10 mg once a day and clonazepam 0.5mg at night, clonazepam was tapered and stopped within 1 month while escitalopram was hiked upto 20 mg and patient improved along with decrease DES scores.

In Freudian psychology the girl child identifies with her mother and represses her sexual feelings toward her father commonly known as the Elektra complex. In spite of trance and possession syndrome being more prevalent in countries like India, we urge to keep dissociative identity disorder as a differential in order to catch the eye of the clinicians and researchers on the recognition of clinical manifestation and exploration of therapeutic strategies.

No significant relationships.

Indigenous people think about mind and mental health differently from contemporary psychiatry, particularly in relation to the symptoms that comprise psychosis.

We aim to present the Maori (New Zealand) and the North American indigenous (primarily Lakota, Cherokee, and Wabanaki) views of extraordinary experience and to explore opportunities for dialogue and understanding among these perspectives, leading to genuine, respectful collaboration.

Auto/ethnographic methodology was used to describe a process in which psychiatrists and traditional cultural healers came to understand each others’ perspectives, dialogued, and forged a collaboration. We describe how this process unfolded in New Zealand and in North America, discussing similarities and differences among these two regions and cultures. We present cases to illustrate the level of cultural collaboration.

The opportunity for cross-cultural dialogue arose when the psychiatrists observed that the traditional cultural healers were reaching and helping patients with whom they had been unsuccessful. This led to dialogue in the fashion of Two-Eyed Seeing, a North American indigenous concept of explanatory pluralism. We present the case of a young man whom the psychiatrist described as hallucinating and prescribed medication that did not help. The cultural healer assisted the young man to see how he had broken cultural taboos, helped him repair the damage, and the hallucinations disappeared. Other cases further illustrate the collaboration. Two-eyed seeing allows both perspectives to be correct and permits genuine dialogue.

Through cultivation of genuine listening without interpretation or judgment (see Jacques Lacan), cultures can begin to understand and collaborate together for the benefit of patients.

The original Profile of Mood States (McNair et al. 1971) is composed of 65 items to measure six affect dimensions. There is a Portuguese shorter version (POMS-27) for the perinatal period (Bos et al. 2013), which reduced the number of items (adjectives) down to 27. Although briefer, it still covers relevant mood states with good psychometric properties, being considered a good alternative to use during this demanding and busy period.

To test if PoMS-27, composed of four dimensions (Depression, Anxiety, Vigour, Fatigue) and one second-order factor (Negative Affect, composed by the former two) is valid and reliable to be used with pregnant women from Brazil.

After confirming the items semantic equivalence and slightly adapt two adjectives from European to Brazilian Portuguese, 350 pregnant women (Mean age: 30.01±5.452; Mean gestation weeks=25.17±6.55), with uncomplicated pregnancies, completed the PoMS-27 and the Brazilian recently validated versions of Perinatal Depression Screening Scale and Perinatal Anxiety Screening Scale (PDSS; PASS; Barros et al. 2021). SPSS and AMOS software were used.

After deleting two items (20 and 22) and some errors were correlated, CFA indicated that the PoMS-25 four-dimensional model presented an acceptable fit (χ2=3.163; RMSEA=.079, CFI=.868, TLI=.849). The Cronbach alphas of the dimensions were: Depression (.82), Anxiety (.86), Negative Affect (.89), Fatigue (.80) and Vigor (.50).

Within this psychometric study we found useful, valid and reliable measure of negative and positive affect for Brazilian pregnant women. From now on we will denominate it Profile of Mood States-25Br

Impulsivity is a psychiatric symptom that seems to be more prevalent in some mental disorders such as bipolar disorders (BD). It is a trait that seems to be influenced by many socio-demographic variables across BD.

The aim of our study is to examine the relationship between impulsivity and these variables.

We performed a cross sectional study on 30 patients diagnosed with BD and consulting at the Psychiatric department of Hedi Chaker Hospital. Patients were euthymic during the time of the study confirmed by administration Young Mania Rating Scale (YMRS) and Montgomery Depression Rating Scale (MDRS). The socio-demographic data was obtained. Impulsivity was evaluated using the Barratt Impulsiveness Scale (BIS-11)

The study sample consisted of 30 patients (10 men and 20 women). The mean age of the sample was 45.83 years (SD= 11. 63). Seventeen patients (56.7%) were married. More than half of the subjects (76.7%) were unemployed and 26.7% were not educated. Of the studied patients 83.3% were drug free, 43.3% were smoker and 16.7% were alcoholic. The mean BIS11 score was 75. 60 (SD=5.51) and 76.7% had a high level of impulsivity. No correlation was found between the level of impulsivity (BIS-11 scores) and age, gender, marital status, being a current smoker, using drug or alcohol or job status (p=0.082; p=0.760; p=0.087: p=0.977; p=0.847; p=0.708).

Further studies should be realized to fully characterize impulsivity in BD and, therefore, make it a target for future therapeutic models.

Kleine-Levin Syndrome (KLS) is an extremely rare disorder of unknown etiology. It affects mainly male adolescents and is thought to follow a relapse-remitting course. During episodes of illness, a wide array of neuropsychiatric symptoms may present and a psychiatric diagnosis might be incorrectly made.

We aim to review the literature on the clinical manifestations of KLS, as well as the current evidence regarding this disorder’s management.

We performed an updated review in the PubMed database using the terms “Kleine-Levin Syndrome”. The included articles were selected by title and abstract.

KLS usually presents with recurrent episodes, lasting days to weeks, of severe hypersomnia, cognitive impairment, major apathy and derealization, among other neuropsychiatric symptoms. Although it was previously thought that complete normalization occurred between episodes, recent evidence suggests that around one third of patients have mild cognitive impairment and there are alterations in brain blood flow during the asymptomatic periods. During episodes of illness, management comprises environmental measures as well as drug therapy. Corticosteroids and amantadine have been successful in stopping episodes and lithium may be useful in a preventative role, however, there are no randomized controlled trials focusing on KLS treatment.

KLS remains an elusive entity since it is an extremely rare disorder with unclear etiology, course, and no consensual treatment. Further research is warranted in this area, namely randomized controlled trials. It is important for the practicing psychiatrist to be aware of this illness in order to recognize it and adequately manage it.

Posttraumatic stress disorder is a prevalent mental health condition with substantial impact on daily functioning that lacks sufficient treatment options. Previous research has led to the designation of 3,4-methylenedioxymethamphetamine (MDMA) as a Breakthrough Therapy for treatment of post-traumatic stress disorder (PTSD) when administered as an adjunct to psychotherapy.

Here we report the findings of the first randomized, double-blind, Phase 3 trial assessing the efficacy and safety of 3 sessions with a flexible dose of MDMA or placebo administered under direct observation to participants with severe PTSD (n = 100) as an adjunct to inner-directed psychotherapy.

Change in PTSD symptoms (CAPS-5) and functional impairment (SDS) were assessed by a central, blinded Independent Rater Pool at baseline and following each treatment session. Adverse events (AEs), concomitant medications, suicidal ideation and behavior were tracked throughout the study. Vital signs were measured during experimental sessions. The primary endpoint was 18 weeks post-randomization.

Change in CAPS-5 and SDS, placebo-subtracted Cohen’s d effect size, and a responder analysis will be presented. There were three serious AEs of suicidal ideation or behavior reported. MDMA was well tolerated, with some treatment emergent AEs occurring at greater frequency for the MDMA group during and after experimental sessions.

If MDMA-assisted psychotherapy significantly attenuates PTSD symptomatology and associated functional impairment, these results will form the basis for marketing authorization applications worldwide, including among participants with dissociative subtype of PTSD, depression, history of alcohol and substance use disorders, and adverse childhood experiences.

No significant relationships.

Parental mental health problems have been found to have a significant impact on a range of aspects of parental caregiving during the postnatal period, with significant implications in terms of key aspects of the child’s development. Video feedback is a generic term that refers to the use of videotaped interactions of the parent and child to promote parental sensitivity, and a recent meta‐analysis of 20 studies (1757 parent‐child dyads) found that video feedback can improve parental sensitivity compared with a control or no intervention up to six months’ follow‐up. This paper will examine the ways in which video feedback might contribute to the ability of parents with mental health problems to provide the type of caregiving that will promote the development of a secure attachment in the infant.

No significant relationships.

Transsexuals are considered to be stable in their identity (White Hughto et al., 2016). Meanwhile, the stages of medical transition affect the mental state of transsexuals differently.

The aim was to reveal relationships between salience of self-identification in transsexual people being on different stages of medical transition.

151 transsexual people: 55 pre-operated Female-to-Male (FtM I), 25 FtM on a hormonal therapy (FtM II), 25 FtM after some surgical operations (FtM III); 12 pre-operated Male-to-Female-Transsexual (MtF I), 16 MtF on a hormonal therapy (MtF II), 18 MtF after some surgical operations (MtF III). The participants filled the modificated Kuhn’s test “Who am I?” (Tkhostov et al., 2014). The modification includes a Likert scale for evaluating one’s self-identifications in terms of salience: “How often do You think or remember this answer?” (Stryker, 2007).

There were differences between identity salience and stages of medical transition (F = 7,177; P < 0,001; η2 = 0,108). Transsexuals before medical transition demonstrated higher levels of identity salience (average score is 7,62 in FtM I and 7,75 in MtF I). Transsexuals on a hormonal therapy demonstrated sharply decreased level of identity salience (6,97 in FtM II and 6,19 in MtF II). Transsexuals after surgical operations reported increased level of salience (7,81 in FtM III and 7,23 in MtF III). There were no statistically significant differences between the groups by gender assigned at birth.

Data suggest that medical transition could change the salience of self-identification. Hormone therapy is associated with a sharp revision of the salience of self-identifications for transsexuals.

Compared with adult onset, early onset schizophrenia is typically characterized by greater illness severity and less favorable prognosis.

To evaluate the proportion of adolescent patients with schizophrenia who achieved sustained remission and recovery during 2 years of treatment with lurasidone.

Patients aged 13-17 years with a DSM-IV-TR diagnosis of schizophrenia, and a Positive and Negative Symptom Scale (PANSS) total score ≥70 and <120, were randomized to 6 weeks of double-blind (DB), fixed-dose treatment with lurasidone (37 or 74 mg/d) or placebo. Patients who completed 6 weeks of DB treatment were eligible to enroll in a 2-year, open-label (OL), flexible dose extension study of lurasidone (18.5-74 mg/d). Criteria for sustained remission, were the 6-month consensus criteria summarized by Andreasen (Am J Psych 2005;162:441-9). Criteria for sustained recovery consisted of meeting sustained remission criteria with a Children’s Global Assessment Scale (CGAS) score ≥70 for at least 6-months indicating no clinically significant functional impairment.

A total of 271 patients completed the 6-week DB study and entered the extension study, and 186 (68.6%) and 156 (57.6%) completed 52 weeks and 104 weeks of treatment, respectively. During OL treatment with lurasidone, 52.8% met sustained remission criteria, with a Kaplan-Meier (KM) estimate of 64.1 weeks for median time to sustained remission; and 28.8% met sustained recovery criteria, KM estimate of 104.6 weeks for median time to sustained recovery.

For adolescents with schizophrenia, treatment with lurasidone was associated with high rates of sustained remission and sustained recovery over a two-year period.

Employee of Sunovion Pharmaceuticals Inc. The study summarized in this Abstract was supported by funding from Sunovion Pharmaceuticals Inc

Post-Intensive Care Syndrome (PICS) is a physical, cognitive, emotional and functional condition resulting from prolonged stays in ICU (Intensive Care Unit). In pathologies with clinical characteristics similar to SARS-CoV-2 pneumonia, most patients showed cognitive deficits after discharge from ICU. Further studies are needed on verbal working memory among PICS patients.

To analyse the verbal working-memory performance among patients with PICS after COVID-19 infection in a Functional Rehabilitation Unit in Madrid (Spain) using the Spanish version of the Screen for Cognitive Impairment in Psychiatry (SCIP-S).

This study was conducted in the Hospital Central de la Cruz Roja, in Madrid (Spain). A sample of 17 PICS adult patients was included, with age ranging from 56 to 74 years old (mean = 68.35 years; 13 males). Patients were assessed around three weeks after referral from their reference hospital. The Working Memory Test (WMT) of the SCIP-S was used as outcome. Descriptive analyses were conducted (mean and standard deviation) on standardized scores (z) based on age-adjusted general population norms. Significant impairment was set at z < -1.5.

Mean z-score on WMT was -.64 (S.D. = .60) from the total sample, with 5.9% of cases with significant impairment (mean = -1.53).

These preliminary results show low probable presence of impairment on verbal working memory among PICS patients after COVID-19 infection. Longitudinal studies, with larger samples, are needed where the premorbid cognitive level is considered.

No significant relationships.

Substance use disorders in adolescents are a growing problem worldwide. These disorders are often unrecognised, unvalued by families, society and clinicians and as a result underdiagnosed, with serious future consequences if improperly addressed.

Updated review of the recent literature on this topic.

Unsystematic review of the most recent and relevant literature.

Review of neurobiology, risk factors, co-morbidity, differential diagnosis, diagnostic criteria, evaluation and treatment of substance use disorders in adolescence.

Substance use disorder in adolescence includes a variety of behaviours related to the use of alcohol and/or drugs, for instance, inability to control substance use, impairment of function at school, home or work, interpersonal problems and hazardous use of substance. Further knowledge in identifying, early diagnosing and adequate intervention in adolescents’ substance use disorder may have paramount prognostic features.

No significant relationships.

Lower quality of life (QoL) scores are associated with suicidal behavior, both in the general population and in psychiatric patients. Nonsuicidal self-injury (NSSI) behavior is a public health concern because of its increasing prevalence and high risk of lifetime suicide attempt. Despite its significance QoL in patients with NSSI is underinvestigated. There is a gap in knowledge on the influence of suicidal ideation (SI) on certain domains and facets of QoL in patients with NSSI.

The study aimed to assess the impact of SI on QoL of patients with NSSI.

We conducted a case-control study (1:3): 13 consecutive patients (11 female) with non-psychotic mental disorders and NSSI without lifetime SI were compared to 39 age and gender matched patients with NSSI and SI. All patients were evaluated by a psychiatrist, underwent Self-Injurious Thoughts and Behaviors Interview (Nock MK et al., 2007) and filled out the World Health Organization Quality of Life Assessment 100 (WHOQOL-100). Mann-Whitney and Fishers exact test were used as statistical methods.

The overall QoL (p=0.001) and the perception of life (p=0.005) were significantly higher in patients without SI. Patients with SI had a lower scores in psychological (p=0.002), social (p=0.036) and spiritual (p=0.005) domains as well as lower rates in energy (p<0.02); positive emotions (p<0.001); thinking, learning, memory and concentration (p=0.007); self-esteem (p=0.013); negative emotions (p=0.035); activities of daily living and participation (p=0.014) and opportunities for recreation/leisure facets (p=0.007).

SI in patients with NSSI was found to be associated with worse QoL

Autism spectrum disorder (ASD) is characterized by persistent deficits in social communication and social interaction across multiple contexts and it is marked by repetitive sensory–motor behaviours and restricted interests or activities. Now recognized to occur in up to 1% of the population, the prevalence of ASD has registered a steady increase in the past two decades. Heterogeneity of presentation is a hallmark with comorbid psychiatric and medical morbidities frequently reported. Comorbidities mask and delay the diagnosis and are the cause of inadequate therapies.

In the present paper, we studied a cohort of patients with ASD, investigating the rates and types of psychiatric and medical comorbidities.

A retrospective study of psychiatric and medical comorbidities was carried out on a sample of 120 participants that met ASD criteria according to DSM-V. The patients were examined with a detailed medical history, physical examination, as well as some additional functional, imaging, laboratory and genetic investigations. The associated conditions considered were: attention deficit/hyperactivity disorder (ADHD), epilepsy, intellectual disability, gastrointestinal symptoms, ophtalmologic manifestations, infections.

Of the 120 ASD subjects referred, 25 (20.8%) received the diagnosis of epilepsy. ADHD was established in 24 cases (20%). IQ score was obtained in half of the patients, 43.3% of them presenting a severe intellectual disability (IQ<35). Respiratory disorders occured in 25% of the cases. Ophtalmological findings were observed in 9.1% of the cases. Other frequent comorbidities included motor disturbances and feeding problems.

A better understanding of comorbidities in ASD patients improves interdisciplinary collaboration, thus facilitating effective treatment programs.

No significant relationships.

Mental health stigma and discrimination interact with gender inequality and the discrimination of women and girls to their mental health detriment.

Present and discuss the challenges and opportunities of a human rights based approach to womens’ mental health.

Non-systematic review of policy and practice of human rights based interventions for womens’ mental health.

Current mental health as well as gender equality legislation converge towards the realization of longstanding demands of equality for women as well as for persons with mental health problems: removal of barriers, respect and enablement of autonomy, renewed efforts toward effective inclusion in all spheres of life. Essential changes through non-discrimination laws concern key areas, including family planning, marriage and parenthood, employment, housing, education, health, standards of living and social, political and cultural participation, along with the right to be free from exploitation, violence and abuse. Because of the cumulation and the interaction of gender-based and other forms of discrimination, legislations such as the UN-Convention on the Rights of Persons with Disabilities (UN-CRPD) include a focus on gender-specific human rights needs of women and girls. Family advocacy in mental health is prominently supported by female activists as is the user movement.

The opportunities of a successful development towards non-discrimination and gender equality in mental health care are dependent on a viable understanding of these concepts within the mental health community as well as updated expertise concerning tools for implementation of support systems sensitive to the human rights needs of women and girls.

No significant relationships.

Schizophrenia is a chronic mental disorder that requires long-term treatment. Non-adherence to antipsychotics is common and associated with poor outcomes.

Our study is aimed to describe the therapeutic adherence and to identify the factors associated with poor adherence among schizophrenic patients.

This was a cross-sectional study conducted at psychiatry consultation of the university medical center of Mahdia, Tunisia. Data collection occurred between the months of January and March 2018, including patients suffering from schizophrenia. The evaluation of adherence was performed using the MARS scale (Medication Adherence Rating Scale).

In our sample of 131 schizophrenic patients, there is a male predominance (76%), as well as unmarried status (58.7%), unemployed (72%). The rate of non compliance treatment was 73%. Low levels of education, poor insight and polytherapy were associated to poor adherence. Although patients aged more than 40 years, who were married and diagnosed with undifferentiated schizophrenia were good compliant to treatment (p<0.05).

We suggest a proper treatment strategy for each patient based on the identification of non adherence risk factors.

During COVID 19 epidemic it has been interesting to observe the gradual transformation of the daily routine into death, sorrow and pain. The moment of transition from life to death was really changed by distressing for survivors who had to face with unexpected ways to live their mourning.

The paper would like to analyze the mounring ritual during COVID 19 epidemic.

During COVID 19 tragedy victims and survivors have been first associated by the infection and then dramatically separated by its effects. It has been necessary to re-relaborate new procedures of separation from deceased, as far for laws prohibitions it was no longer possible to use the traditional ones.

So a leaving “ritual” re-emerged very similar to the “crying ritual” of the Southern Italy folkloric culture. The traditional wailers have been substitued by the windows flash mobs trying to replace the forced absence of “pietas”, with a moment of positive sharing of physical distance between life and death, using sounds, songs, tools that always, in farming culture help to exorcise and take away death.

The relevant starting powerlessness to face the fast disease diffusion, its intrinsic seriousness, inspired surprising capabilities of immediate reaction and active mobilization in response to the attack suffered by Koerper and Leib (in Heidegger sense) which actualized in the research of a new “separation” dimension. In the end, as psychiatrists, we have to notice how this collectivization practice is actually a big distress container and wonder where and how this distress will finally arrive

Alcohol amnesia and palimpsests belong to understudied areas in addictology concerning the pathogenesis, risk factors, and development of effective integrated, targeted modalities of therapy, prevention, and after-treatment care.

Development of a new integrated, pathogenetically grounded approach to the emergency and routine therapy for immediate and long-term consequences of amnestic alcohol intoxication.

Modern complex clinical-psychopathological, pathopsychological, laboratory, electrophysiological, biochemical examination; method of analogues and prototype analytical examination.

Integrated anti-amnestic pharmacotherapeutic triad: Noobut IC (Phenibut) orally, before meals, for 6 days, twice a day: 250 mg in the morning, 500 mg at night, within days 7-14 250 mg twice: in the morning and at night; Vitaxon 2.0 ml daily, intramuscularly, No10 totally; ozone therapy for 10 days (ozone dissolved in olive oil, 6 mg/100 ml concentration), 5 ml orally 3 times a day. Complex therapy is concurrent with synergistic psychotherapeutic potentiation. Supportive anti-relapse prevention of alcohol-induced amnesia, palimpsests with Noobut IC: 1 tablet (250 mg) orally in the morning for 2 months. The pathogenetic support of the pharmacotherapeutic triad in treatment for alcohol addiction, comorbid with amnestic disorders, is pathogenetically focused on pharmacological properties of each component of the triad and their potentiating effects, involving most pathogenetic mechanisms of this disease.

Relieving and prophylactic efficacy of the proposed pharmacological triad (Noobut, Vitaxon, ozone and concurrent psychotherapeutic potentiation) is proven by the statistical reliability method and illustrated by clinical examples of patient-specific research.

Lebanon is a medium-income country in the Eastern Mediterranean which has seen a surge in interest in mental health following years of stagnation. The mental health needs of the country for severe psychiatric disorders are underserved.

The aim of our study is to describe community mental healthcare services in Lebanon and to address local opportunities and challenges.

A review of the literature using local resources along with expert opinion was undertaken to synthesize the evidence.

Political instability, chronic underfunding and widespread stigma have contributed to maintaining a traditional model of private clinics affiliated with inpatient and long-stay psychiatric units. A number of initiatives have been launched to cater for patients with psychotic disorders and to offer partial hospitalization for others with mood-related conditions. In parallel, the Ministry of Public Health, with international funding, has been instrumental in efforts to standardize care at a national level, particularly for early detection and treatment in primary care. The priorities of the national mental health programme are consistent with the global trend in shifting services to the community. Hurdles remain, in line with those facing countries with similar socio-demographics and resources. These include limited third-party coverage of mental health, absence of training opportunities in multidisciplinary community settings and some clinicians’ reluctance to update their ways of working.

Development of a local workforce dedicated to providing a patient-centred approach in the least restrictive settings, is essential for consolidating community care in Lebanon. This would be reinforced by (overdue) legislation and implementation of a mental health law.

No significant relationships.

Patients with life-limiting oncologic conditions should be approached by multidisciplinary teams that contribute to improve their quality of life, including support from mental health dedicated professionals. It is the role of the psychiatrist to understand the relationship between mental health and general health outcomes, specific of this type of patients. Terminally ill and dying patients benefit from psychiatric support, and it seems to have real effects in terms of patient care and medical staff education.

To identify approaches and mental health professionals’ practices regarding end-of-life issues in terminally ill cancer patients.

Review of the most recent literature regarding end-of-life issues in terminally ill cancer patients. The research was carried out through the Cochrane, UptoDate, PubMed, MedLine, LILACS and SciELO databases, using the terms “oncology”, “psychiatry” and “end of life”, until December 2020.

While symptoms of anxiety and depression are common in palliative care settings, generally related to feelings of helplessness and fear of death, they should not be assumed to be an inevitable part of it. For terminally ill patients, anxiety and trauma-related disorders can manifest in various ways and it is important to establish personalized treatment approaches, based on a supportive clinical team, and, if necessary, psychotherapy and psychopharmacologic or complementary treatments.

It is extremely important to assess terminally ill patients from the mental health point of view. It is required that psychiatrists take part in clinical care and research on the treatment of these patients with severe medical conditions, in order to increase their quality of life.

No significant relationships.