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.

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.

Generalized problematic internet use/GPIU has recently been associated with the impulsive-compulsive spectrum/ICS, but its mapping onto these behaviour dimensions is relatively unexplored.

To compare patterns of internet use and scores of BIG-5 personality traits, perfectionism and psychological distress between groups with low/high levels of GPIU.

475 university students (78.9% girls; mean age 20.22±1.695) answered the Portuguese versions of: GPIU Scale, Multidimensional Perfectionism Scale-13, NEO-FFI-20, Depression, Anxiety and Stress Scales and other questions about internet use. Chi-square and Mann-Whitney tests were performed using SPSS.

Individuals with high levels of GPIU (median+2SD; n=18; 3.8%) spent significantly more time/day in online activities, exceeding what they have planned; had no other hobbies and used social networks to meet friends; reported that GPIU interfered with affective/work relationships and academic performance (all p<.05). There were no significant differences in the purposes of the internet use (e-mail, social networks, shopping, videogames, multimedia, sexual, work…), unless for general information searching and betting games (both p<.05). High-PGIU group also presented significant higher levels of neuroticism, negative (but not positive) perfectionism, depression, anxiety, and stress (all p<.001).

Our results indicate that unlike the purposes of internet use, personality, perceived interference and the associated cognitive-emotional processes and symptoms (psychological distress) may help distinguishing between functional vs. dysfunctional internet use. Considering the preponderance of processes over contents and the presence of certain dimensions, such as perception of uncontrollability, interference and social isolation we add more evidence to consider PGIU as falling within the spectrum of impulsive-compulsive disorders.

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 the COVID-19 pandemic, the Albanian authorities declared mandatory stay-at-home measures, closing businesses, schools and public places.

To investigate the impact of these immediate changes on the mental wellbeing of the population.

Respondents (N=1678) from 18 to 60 years old were selected through a convenient sampling method. Questionnaires were administered online reporting time spent daily in the COVID-19 topic and genealities; the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7.

Findings suggest a significant negative correlation between age and anxiety scoring (r(n=1678)=-.121, p≤.001) and age and depression scoring (r(n=1678)=-.232, p≤.001), shown also on the ANOVA test for age and anxiety (F=6.019, p≤.05) and age and depression (F=20.326, p≤.05). Differences on the level of education resulted in a lower score of anxiety and depression respectively (F=3.524, p≤.05), (F=7.739, p≤.05) on respondents with higher education. Those who were jobless from the pandemic scored higher on anxiety and depression respectively (F=9.760, p≤.05) (M=6.21, ds=4.686) and (F=16.051, p≤.05) (M=8.18, ds=5.791). Significant differences were found related to different amounts of time spent on the COVID-19 topic, respectively for anxiety and depression (F=25.736, p≤.001), (F=5.936, p≤.003), with people who spend less than 1 hour scoring higher on depression (M=7.57, ds= 5.849) and those who spend more than 3 hours scoring higher on anxiety (M=6.76, ds=5.60).

Higher education individuals, having a job and being in a romantic relationship relate to lower levels of depression during Covid-19 quarantine in Albania. Spending more time on the COVID-19 topic daily and being a female relate to higher level of anxiety.

No significant relationships.

Individuals with autism spectrum condition (ASC) frequently report difficulties in social communications, combined with restricted inflexible behaviors. However, it is unclear whether this rigidity is pervasive across cognitive flexibility (CF) and affective flexibility (AF) in situations which resolve different social conflicts.

To study CF and AF levels and associated brain activity in individuals with ASC.

Individuals with ASC and with typical development (TD) performed a moral dilemma task during functional magnetic resonance imaging. For CF, participants made decisions on (1) whether to enforce result-oriented actions to prioritize social/public benefits; and (2) judged whether these actions are right or wrong. For AF, participants made decisions on (1) whether to permit social norm/rule violations in sympathy-evoking situations; and (2) permit these identical violations in no sympathy-evoking situations. We calculated participants’ CF/AF levels by computing the switching-rate of decisions in CF/AF sessions (switching was defined as: CF, judging the actions as wrong but choosing to enforce the action in the same vignette; AF, judging the violations as not permissible in a no sympathy-evoking circumstance, but permissible in a sympathy-evoking circumstance).

For CF, ASC participants showed a marked decrease in CF switching-rates compared to TD participants (p < 0.05), and in corresponding brain activity for executive functioning. For AF, although the AF switching rate difference was non-significant, we observed unique brain activities in each group (e.g., TD activation of the greater dorsomedial-prefrontal cortex and ASC activation of the cingulate cortex).

Our results suggest ASC inflexibility may be further characterized by both CF and AF.

No significant relationships.

Children in Autism Spectrum Disorder (ASD) have a qualitative deficit in social interaction. The DIR/Floortime (Stanley Greenspan and Serena Wieder) is based on the Child’s Functional Development, Individual Differences and Relationships (D for development, I for individuality or individual differences and R for relationship), aiming at building the foundations for social, emotional and intellectual skills of children.

To determine the results of 18 months DIR/Floortime™ parent training for an additional benefit in encouraging children with ASD climbing the developmental “ladder”.

The participants are 15 children with ASD aged between 2 and 6 years-old. The follow-up occurs in two private DIR Floortime Model service centers in Brazil. Protocols: Functional Emotional Assessment Scale – FEAS and Functional Emotional Developmental Questionnaire – FEDQ. The participants were followed-up one on one every four months.

At the first month of assessment the children showed lack of self regulation, social interaction and engagement with their parents in a symbolic, sensory and motor play setting. At the following evaluations, they showed increase of social interaction and engagement in the same play setting. Besides the high affect of the parents during the play time promoted a two way purpose communication and behavioral organization.

Children showed a good development of functional and emotional capacities during the study period, demonstrating the effectiveness of the DIR/Floortime model in the intervention.

E-cigarette use has increased over the last years. Many studies have examined teenagers’ attitudes towards smoking, but did not examine adolescents’ attitudes towards e-cigarettes.

The aim of this study was to examine high school students’ attitudes regarding e-cigarette safety, addictive properties and social norms and to compare e-cigarettes perceptions among e-cigarette users and non-users in Tunisia.

A survey was conducted with a sample of 234 students in Mohamed Ali high school in Sfax, a town in South of Tunisia, in February 2020. Socio-demographic data and questions about vaping and attitudes towards e-cigarettes were used to evaluate students’ perceptions towards e-cigarettes.

Among high school students aged 15 to 20, 58,8% have ever used e-cigarette, 38,3% had done so within the previous 30 days and 20,5 % were regular users of vapes. 53.8% of students believed that e-cigarettes are harmful. 78.4% of them thought they were less harmful than regular cigarettes and 50.5% thought they could be addictive, 45.4% of students believed e-cigarette smoking decreased anxiety and a third thought it made them sociable (33.3%) and confident (30.6%).Adolescents who used e-cigarettes had significantly more favorable e-cigarette attitudes than non-users: they believed they were less harmful than tobacco (p=0,019), they were not addictive (p=0,005), they decreased anxiety (p=0,001) and they made the user sociable (p<0,001) and confident (p=0,01).

Our results suggest the need to provide teenagers with the correct information about e-cigarettes risks, and the balance risk-benefit of their use.

No significant relationships.

The H2020/PERISCOPE project, including 32 partners from European universities & agencies, began 1st November 2020 and will last 36 months. The overarching objectives of PERISCOPE are to map and analyse the unintended impacts of the COVID-19 outbreak; develop solutions and guidance for policymakers and health authorities on how to mitigate the impact of the outbreak; enhance Europe’s preparedness for future similar events; and reflect on the future multi-level governance in the health as well as other domains affected by the outbreak. During this session we will report about early lessons learnt from the mapping and assessments of the impacts of the COVID-19 outbreak on mental health at national and subnational level in the EU with respect to individuals, communities and societies. Further, we will comment on their comparability. The aim is to explore differences between countries regarding the occurrence of mental ill health, and especially the impact on vulnerable groups, and how this is related to exposure to SARS-CoV-2, differences in policies over time, and effects on the economy. We will reflect on the short- and long-term consequences on mental health and health inequalities, report on the ongoing development of holistic policy guidelines for health authorities & other authorities, and from the analysis of multilevel governance, at local, regional and national level, memberstate – EU-level, and EU - global governance level. PERISCOPE will continue collecting data and updating a common data ”Atlas”, which would lead the consortium to engage in modelling and experiments to provide “continuous nowcasting” of the outbreak.

No significant relationships.

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.

Delusional parasitosis/infestation or Ekbom syndrome is an uncommon psychotic disorder characterized by a false belief that there is a parasitic infestation of the skin - the delusion that insects are crawling underneath the skin.

This work aims to summarize and evaluate the currently available evidence regarding Delusional parasitosis, and for this purpose, we will illustrate a case report of a patient admitted in the emergency room.

The authors have conducted online research in PubMed with the words “Delusional parasitosis” “delusional infestation”, “Ekbom syndrome”, from the outcome, the articles considered to be relevant were collected and analyzed.

Delusional parasitosis can be classified into primary delusional parasitosis without other psychiatric or organic disorders present, secondary – functional (secondary to several mental disorders such as schizophrenia, depression, dementia, anxiety, and phobia), and organic forms (associated with hypothyroidism, anaemia, vitamin B12 deficiency, hepatitis, diabetes, infections (e.g., HIV, syphilis), and cocaine abuse. It is most commonly seen in middle-aged women. The patients became frequently socially isolated, prone to the development of depression symptoms.

This syndrome often presents a high level of psychosocial morbidity. Patients often seek dermatologists help in the first place, although there is no medical evidence. Psychiatrists play a major role in the diagnosis and treatment of these patients. Psychopharmacological therapy is quite challenging because of the patient’s belief that they have a parasitic infestation and not a psychiatric condition.

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

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.

Pseudoneurological symptoms are frequent among children consulting in neuropediatrics. Psychogenic origin is often unrecognized, which may cause a major disruption and an increase of medical care expenses.

The purpose of this study was to identify clinical features of pseudoneurological symptoms through patients admitted in neuropediatrics.

A descriptive retrospective study of a population of 19 children and adolescents hospitalized in the neuropediatrics department at the National Institute of Neurology in Tunis, between January 2015 and April 2019, having recieved the diagnosis of psychogenic symptoms.

Twelve girls and seven boys were included in this study.The averge age were 11.5 years. All patients had normal cogntive and motor development. In most cases (84%), patients had a history of somatic illness. Only three patients had a history of psychiatric disorders. Family history of somatic disorders was found in 42 % of the sample and psychiatric disorders in three patients. Negative pseudoneurological symptoms such as loss of function, were detected in 60 % of patients, paraparesis and paraplegia were the most recurrent. Only one patient had pseudo-epileptic symptoms. Further investigations were performed in all patients, averaging 4 tests per patient. The average term between the beginning of the symptoms and the established diagnosis of psychogenic symptoms was 72 days with an average stay at hospital of 4 to 7 days. All patients had conversion disorder according to DSM V.

It is recognized that somatization could be a warning sign of psychological distress mainly among children. Conversion disorder, rarely seen in children, presents frequently as pseudo neurological symptoms.

No significant relationships.

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.

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.

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.