Tourette’s syndrome is a neuropsychiatric disorder marked by motor and phonic tics frequently associated with psychiatric comorbidities, beginning in childhood. While most cases improve or resolve with age, some are refractory.

To review new strategies for the management of Tourette’s Syndrome, following an outpatient clinical vignette.

We performed a review based on the PubMed® database.

A 50-years-old female patient with a long-term outpatient psychiatric follow-up presented with motor tics appearing in adolescence, including winking and facial grimacing, as well as episodes of coprolalia. Over the years, she developed an anxiety disorder and social isolation. In addition to psychological therapy, pharmacological therapy had already been approached with the use alpha-adrenergic agonists and several antipsychotics, such as risperidone and aripiprazole, with the patient showing only partial response to pimozide. In Tourette’s syndrome, the therapy must be adequate to the patient’s individual needs. Emerging treatments for refractory cases, such as anticonvulsants, cannabinoids or antiglutamatergic drugs have been the target of several studies. Botulinum toxin injections are particularly effective in patients with focal motor tics and complex phonic tics. Non-pharmacological treatment options, such as electroconvulsive therapy and deep brain stimulation may prove effective in some cases.

A significant proportion of patients fail to respond to conventional strategies. Thus, new pharmacological and non-pharmacological therapies are on the horizon and may represent an important step in treatment algorithms for refractory cases in the future.

This is the case of a 15-year-old boy who had been socially isolated in his house for over 1 year. He had become increasingly agitated, but refused any help offered.

To establish the role of community treatment in adolescents with mental health problems.

Summary of the interventions taken place during the treatment

Initially this young person refused any medical treatment, so we tried first supportive therapy and CBT. He dicho not obtain any benefits as he appeared experiencias paranoid ideation and thoughts of being persecuted in the streets. With support from the occupational therapist, the young person started to take care of his personal hygiene. Afterwards he started to take oral medication with partial response. We decided to switch to im treatment. In conjunction with CBT, the young person was gradually able to llaves the house. All the sessions during the first few months took place at his family home. These visits were weekly or twice weekly. Once he left the house, he attended the grupos at the day hospital. After 18 months, he was discharged without medication and he is currently studying for a degree.

Community treatment in adolescent with mental health problems is a better opción to establish good rapport and avoid stressful situations that could take place in an in-patient facilita.

No significant relationships.

Violence against women is a public health problem worldwide. During humanitarian crises such as wars, violence expands mainly to the detriment of the most vulnerable groups.

This study aims to assess the effect of the COVID-19-related lockdown on gender-based violence.

This study was conducted using an online survey, between April 25 and May 6, 2020. Women were asked about sociodemographic information, lockdown conditions, history involving exposure to violence before and during the COVID-19 lockdown and its types.

The number of included participants was 751. The age ranged from 18 to 69 years. Violence against women increased significantly during the lockdown (from 4.4 to 14.8%; p < 0.001). Psychological abuse was the most frequent type of violence (96%). Almost 90% (n = 98) of those who experienced violence during the lockdown did not seek assistance. Women who had experienced abuse before the lockdown were at an increased risk of violence during lockdown (p < 0.001; OR = 19.34 [8.71–43.00]).

Strengthening strategies to protect women during periods of crisis is urgent. However, a change in mentalities would take more time to set up. Violence against women necessitates a fundamental long-term struggle and practical intervention strategies.

No significant relationships.

Given the effectiveness and overall safety in several psychiatry conditions, electroconvulsive therapy remains a widely used procedure in current medical practice. Informed consent is still a requirement for the use of ECT both in voluntary and compulsory treatment; however, since severe mental illness can affect decision-making capacity and insight of the need for treatment, this requirement often constitutes an obstacle to its use. In addition, stigma around ECT still contributes to treatment refusal.

To summarize the most recent evidence published about ECT and discuss the ethical and legal implications of its use, enlightened by the empirical description of a clinical vignette.

Review of literature on the ethical and legal issues involving the ECT use in patients on compulsory treatment, considering the efficacy, risks, the mental health legislation in Portugal, and several international directives.

Informed consent is the basic tenet in the contemporary physician-patient relationship. In principle, ECT can only be administered to patients who prior consent to the treatment. In contemporary practice, providing the best medical assistance and respecting the patient’s autonomy are two fundamental principles. However, we often face an ethical dilemma, when severely ill patients, whose insight, the ability for self-determination and decision-making capacity may be impaired, refuse a potential beneficial treatment as ECT.

The use of ECT in severe mental illness is still hampered by legal and ethical constraints. A future revision of the law could protect patients from being excluded from a treatment that may change the course of the disease.

No significant relationships.

No significant relationships.

Non-compliance is a common problem in diabetes despite of the potentially drastic consequences. The study of the factors of compliance in adolescents with diabetes is not only important due to the possible practical implementations in health care, but also may be threated as a model for understanding the age-specific aspects of compliance behaviours.

The study was aimed to evaluate various, primary family-related, factors contributing to compliance behaviour.

Participants: 71 adolescents (f=44, m=27, age: 13-17) with diabetes mellitus type 1, without insulin pump usage, and their mothers. Instruments: compliance was accessed with MMAS and “Degree of compliance” (for 15-17-olders only) scales. Paternal attitudes were assessed by (1) ADOR questionnaire, yielding scores for: Positive interest, directiveness, hostility, autonomy, inconsistency; (2) Family anxiety analysis questionnaire, with scales: guilt, anxiety, tension. Illness attitudes were assessed with the Concerns of the illness progression model questionnaire. Interview data were used to assess such variables as duration of illness, frequency of therapist consultations y etc.

Stepwise regression analysis suggested the best model for compliance being predicted (R2=.203) by family anxiety (beta=-.406, p<.001), duration of illness (beta=-.218, p<.05) and frequency of consultations (beta=.0212, p<.05). For 15-17-olders only compliance was better predicted (R2=.499) by concerns about illness (beta=.876, p<.001), distraction copings (beta=.501, p=0.001), negative thinking (beta=-.421, p<0.02) and frequency of consultations (beta=.274, p<.05).

Low family anxiety, shorter duration, and more frequent contacts with therapist, as well as productive copings, absence of frequent negative thoughts and fantasies about illness contribute to compliance. Negative emotions hamper compliance instead of fostering it.

PPalliative medicine is aimed at achieving the best possible in a particular situation the level of quality of life of the patient.

The reaction of grief is one of the strongest and most painful human experiences.

There were 120 cancer patients observed. The reaction of grief consists of 4 stages: shock and protest - numbness, disbelief and acute dysphoria; absorption - acute longing, search and anger; disorganization - a sense of despair and acceptance of loss and decision.

The initial reaction of grief - shock, emotional numbness and disbelief. The excitement is most pronounced within about two weeks, followed by symptoms of depression, which reach its peak 4-6 weeks. Eventually, the former intense pain of severe loss begins to subside. In addition to the reaction of grief, there is a pathological, which is divided into suppressed (inhibited), delayed (delayed) and chronic. The role of the psychotherapist at this stage is to provide psychological support and assistance to both the patient and his environment to cope with this situation.

The principle of the concept of palliative care is the need to ensure the psychological comfort of the patient.

The COVID-19 pandemic has become a major challenge for both the overall health system and the individual ability for health professionals to stress coping.

To find the link between the perception of danger from coronavirus and the severity of burnout syndrome in medical workers during the COVID-19 pandemic in Russia.

We used a socio-demographic questionnaire (20 questions), a Stress Perception Questionnaire (Linville, 1987; Ababkov et al., 2016), a Modified Pandemic Perception Questionnaire (Broadbent et al.,2006;Yaltonsky et al., 2017), and Maslach Burnout Inventory (Maslach et al., 1996; Lozinskaya et a. 2007). 249 medical workers (58 men and 191 women) took part in the online survey between April 27 and October 26 in Russia.

The severity of stress is positively correlated with the perception of pandemic as threatening (r=0.532, p=0.000) and unknown disease (r=0.297, p=0.000). Stress severity also correlates with all burnout parameters: exhaustion (r=0.737, p=0.000), depersonalization (r=0.342, p=0.000), and belief in personal achievement (r=-0.417, p=0.000). The perception of pandemics as threatening events is significantly associated with exhaustionm (r=0.458, p=0.000), depersonalization (r=0.133, p= 0.036), and belief in personal achievement (r=-0.152, p=0.016).The feeling of uncertainty from the pandemic is statistically significantly associated with exhaustion (r=0.242, p=0.000), while the feeling of control over the pandemic is positively associated with belief in personal achievements (r=0.129, p=0.042) and negatively associated with exhaustion (r=-0.161, p=0.011) and depersonalization (r=-0.125, p=0.049).

Uncertainty and a sense of threat from the coronavirus and the pandemic are significant factors of stress and emotional burnout for health workers. To determine the interaction between parameters such as signs of burnout, perception of the COVID-19 pandemic and the severity of stress, further construction of a structural model is required.

Early screening of children at-risk to develop Autism Spectrum Disorder (ASD) needs to be improved to propose early interventions. This detection should allow diagnosis of ASD before the age of 3. An early screening performed at the general practitioner of the family should facilitate accessibility to diagnosis and a better collaboration between professionals.

Our primary objective is to estimate the positive predictive value of an early detection kit composed of 2 questionnaires (First screening: M-CHAT-R/F™ + CSBS DP™-ITC) and a confirmation of the detection with a phone call by a neuropsychologist. Patients with confirmed positive M-CHAT-R/F™ and/or CSBS DP™-ITC scores are referred to a level 2 team for pre-diagnosis and diagnosis assessment.

The KitCAT study is a cohort study of 1,700 children aged 16 to 24 months seen in routine care in general or pediatric practices, or in nurseries and child care centers.

Seven hundred and five children have already been enrolled in the study. Twenty nine patients, ie 4.1%, (with a confirmed positive M-CHAT-R/F™ and/or CSBS DP™-ITC scores) were referred to a level 2 team where a pre-diagnosis assessment was conducted by using the following test: ADI-R, ADOS 2, BLR, WPPSI-IV and Vineland II. The diagnosis of ASD (using the same test than the pre-diagnosis) was confirmed for the first two patients aged of 3.

The preliminary results confirm that the use of 2 questionnaires may optimize the reliability of the screening. A thousand children are still needed for the final analysis and further results are expected.

No significant relationships.

The intentional use of drugs before or during sexual intercourse (chemsex), due to its impact on mental health, is a phenomenon of high importance in men who have sex with men. The main drugs usually described in chemsex related research are methamphetamine, mephedrone and GHB/GBL.

We present a narrative review of the evidence about the mechanisms of action of different drugs used in chemsex context.

Narrative Review.

Different drugs have been associated with chemsex use: stimulants such as cocaine, stimulants with empathogenic properties such as mephedrone, methamphetamine, MDMA; stimulants with a psychedelic effect such as 2C-B; depressants such as GHB/GBL and ethyl chloride; and dissociative hallucinogens such as ketamine.

Classical chemsex research includes only mephedrone, metanphetamine and GHB as “chemsex drugs”. Recently, different drugs have been described associated with chemsex practice. Clinicians may encounter polydrug chemsex users and the different mecanisms of action, mental health problems related to every drug and polydrug use must be takek into account.

There is growing evidence that generalised joint hypermobility (GJH) is associated with several psychiatric conditions. There are no previous studies on adult ADHD.

To evaluate, in a large Swedish sample, if generalised joint hypermobility and adult ADHD are associated.

431 adults with ADHD and 417 controls were included. GJH was assessed by the Beighton Score, a physical examination, and the 5PQ, a self-report screening tool. Exploratively, reported musculoskeletal symptoms and abnormal skin manifestations suggestive of symptomatic GJH (e.g. Ehlers-Danlos syndrome), were assessed to differentiate this group from the general GJH group. Logistic regressions determined the influence of an ADHD diagnosis and known covariates (age, sex and ethnicity) on GJH and symptomatic GJH respectively.

ADHD was associated to GJH, as defined by the Beighton Score and the 5PQ, with adjusted odds ratios of 4.65 (CI 95% 3.01-7.18, p<.005) and 1.86 (CI 95% 1.39-2.48, p<.005), respectively. Likewise, ADHD and symptomatic GJH were associated with adjusted odds ratios of 6.94 (CI 95% 4.05-11.89, p<.005) and 2.66 (CI 95% 1.94-3.66, p<.005).

GJH and adult ADHD are associated conditions. Symptomatic GJH, defined as additional symptoms of pain and/or skin manifestations, has a considerably stronger link to adult ADHD than unspecific GJH has. GJH may represent a marker of an underlying systemic disorder with physical manifestations in connective tissue as well as behavioural manifestations including hyperactivity, impulsiveness and inattentiveness. Future studies should investigate if this represents a novel subtype of ADHD and if symptomatic GJH affects the ADHD management.

No significant relationships.

The coronavirus disease 2019 (COVID-19) has a great impact on health care workers (HCWs) who are exposed to high levels of stress and trauma leading to negative mental health outcomes, including stress-related symptoms and depressive symptoms.

The aim of this study was to investigate the prevalence of depressive symptoms, anxiety and post traumatic stress symptoms related to to the COVID 19 pandemic in Cyprus.

In this cross-sectional study, we report on mental health outcomes among HCWs in Cyprus. Data were collected between May 3rd and May 27th, 2020, using an online questionnaire that included demographics, the 9-item Patient Health Questionnaire (PHQ-9), assessing depressive symptoms, the Impact of Events Scale Revised (IES-R) measuring PTSD symptoms and the 10 item Perceived Stress Scale (PSS) measuring stress.

424 Health Care Workers (HCWs) participated in the study. 79 HCWs (18,6%) scored in PHQ-9 above the cut-off for depression while 62 HCWs (14,6%) scored high enough in IES-R indicating a diagnosis of post-traumatic stress disorder. The prevalence of depression and PTSD symptoms were significantly higher among nurses compared to doctors and other HCWs. (20.7% versus 10.8%; adjusted prevalence ratio, 1.70 [95% CI, 1.06 to 2.73]), after adjustment for age and sex.

Even in countries like Cyprus with minimum impact of the COVID-19 pandemic, the impact on the mental health of HCWs is substantial with nurses being more vulnerable.

It has been recently proposed that diagnoses traditionally framed in axis II of the DSM and diseases related to the elderly are progressively replacing serious mental illness in acute inpatient wards.

To study the clinical and sociodemographic characteristics of the patients in an acute psychiatric unit, and to compare them between a ten-year period.

Observational, descriptive, and retrospective study that analyzes the data recorded in the discharge reports from the acute ward of the Hospital Provincial de Castellón.

Among the studied patients, we found statistically significant differences regarding gender, age, readmission rate, and stay duration between the two periods. In the most recent one (2017-18), more women and elderly have entered, with shorter stays and fewer readmissions. In both periods, the most prevalent psychiatric diagnoses are by far serious mental illness (bipolar disorder, schizophrenia). By grouping the diagnoses into five broad categories (serious mental illness, dementias, personality disorders, drug misuse, and others), we found significant differences in their distribution. Lately, more personality disorders and dementias were admitted as the main diagnosis, while serious mental illness and substance use disorders increased their prevalence as accessory diagnoses.

The research carried out allows us to conclude that the clinical and sociodemographic profile of patients admitted to an acute unit is changing. It would be advisable to investigate the causes that motivate it and modify the devices to adapt to this new reality.

Unpredictable risks of COVID-19 morbidity and mortality make people suffer from threats and fears. Are there any psychological personality traits that correlate with a decrement in such feelings?

To specify the relationship between psychological characteristics of time perspective, hardiness and COVID-19-related life threat.

We used Zimbardo Time Perspective Inventory, Maddi Hardiness Scale and a 17-point Attitude towards COVID-19 Questionnaire to question 327 Russian university students on social networks. The survey was carried out in the second half of May 2020 in the period of increasing COVID-19 morbidity and mortality rates. The mean age of the respondents was 21.24±2.84; most of them were females (61.16%).

The survey showed that every fifth respondent had a high level of COVID-19-related life threat (21.10 %). At the same time, every tenth of the respondents (10.09%) saw no threat to their life in the situation of a fast spreading dangerous novel coronavirus infection. According to the correlation analysis, decrement in feeling personal threat related to the spread of COVID-19 was directly associated (p<0.05) with low indicators on the scales of Negative Past (r=0.16), Hedonistic Present (r=0.13) and Fatalistic Present (r=0.17). Certain inverse relation was found between the level of COVID-19 related life threat and such indicators as psychological hardiness – commitment (r=-0.16), and challenge (r=-0.23).

Dispositional orientation to the present and future, as well as psychological characteristics of hardiness may mediate COVID-19 related life threat; therefore, these may be used as a possible basis for preventing stress and mental disorders in population.

Acute and chronic exposure to cadmium (Cd), due to its increased use and application in the industry, can result in the development of atherosclerosis, the occurrence of cardiomyopathy, cerebrovascular stroke, as well as carcinogenesis in some organs. The target for cadmium action is thought to be the vascular endothelium.

The aim of this study is to investigate the occurrence of oxidative stress on blood vessel endothelium induced by subacute administration of cadmium, as well as the protective power of alpha-lipoic acid (α-LA) supplementation on the Wistar strain albino rat model system.

After anesthesia of rats in the vivarium of the Scientific Research Center for Biomedicine, Faculty of Medicine in Niš, blood was collected by cardiac puncture and sent to the Clinic of Nephrology, Clinical Center in Niš, Serbia for determination of hematological parameters.

According to the results of this study, it can be seen that the number of granulocytes is reduced due to cadmium intoxication, which is probably induced by the migration of neutrophils into tissues. The number of lymphocytes was increased due to subacute cadmium intoxication compared to the control group of animals. The positive efficacy of α-LA supplements in combating the adverse effects of cadmium on blood vessels is also confirmed.

Cadmium administration is thought to cause a systemic inflammatory reaction due to the formation of free radicals in the blood vessel endothelium. Administration of α-LA supplement confirms that it can be used as an antioxidant in the clinical management of many diseases and also in cadmium intoxication.

No significant relationships.

Akiskal proposed the bipolar spectrum concept with the aim of including those patients with atypical depressive presentations and mood temperaments. Also Koukopoulos accepted this proposal in those patients with poor response to antidepressants or highly recurrent course. Concretely bipolar disorder type IV was defined as clinical depression based on a lifelong hyperthymic temperament. Some years after DSM-III several experts in bipolar disorder continued in this work line even though DSM-IV and most recent DSM-V not considered to include this concept as a new diagnostic category.

To present a theoretical and practical review about bipolar spectrum and its relationship with hyperthymic traits.

We carry out a literature review about bipolar spectrum, accompanied by the clinical description of one patient with major depressive disorder and hyperthymic traits base.

45 years old female referred to our outpatient mental health service after episode of voluntary drug overdose. She presented long evolution depressive symptoms (sadness, apathy, anhedonia, anergy, irritability, anxiety, emotional lability, early awakening, social withdrawal, self-care neglect, hopelessness, cognitive failures, guilt feelings and death ideas) with onset in postpartum. She reported a previous depressive episode 9 years ago with good response to fluoxetine. Hyperthimic traits were described but no history of manic symptoms. An erratic evolution was observed with various antidepressant treatment and finally improved adding mood stabilizer.

We must propose to consider the diagnosis of bipolar spectrum in order to treat effectively patients with major depression dissorder and hyperthymic temperament in absence of manic symptoms.

No significant relationships.

Tunisian revolution has been a major upheavel in the tunisian history and has brought many political, social and economic changes. Little were found about the revolution’s potential impact on the psychiatric demand.

Compare the clinical profile of all the new consultants in the out ward psychiatry department before and after the revolution.

The study had a retrospective descriptive design including all the new consultants in the outpatient psychiatry department in the general hospital Fattouma Bourguiba in Monastir, Tunisia before (during 2007) and after (during 2016) the revolution. We used a pre-established questionnaire including sociodemographic and clinical data.

After the revolution, an increase in the number of new patients (p<10-3) 438 to 451 were found. In 2016, there were more unemployed consultants(p=0.004), having criminal record (p=0.01) and having a problematic substance use (p<10-3). An increase also concerned patients consulting for anxiety(p=0.002) and suicidal ideation (p=0.022). Considering the clinical diagnosis, there were also a significant increase regarding anxiety disorders (p=0.001) and mood disorders (p=0.011) essentially major depressive disorder (p=0.002). Although a significant decrease concerned somatoform disorder (p<10-3).

Our study showed a change in the profile of consultants after the Tunisian revolution. A study in the general population could find specific etiological factors. Thus highlight the importance of implementing preventive measures in general population in crisis’ times.

No significant relationships.

Due to the Covid 19 pandemic, the Tunisian government has taken several measures, which had a psychological impact on adults and children.

Studying the initial impact of the Covid 19 pandemic on Tunisian parents and children.

One week after the proclamation of sanitary lockdown in Tunisia, parents were invited to answer voluntarily an anonymous questionnaire posted on social media. The stress level of the parent was measured by the Impact Event Scale Revised (IES-R).

This questionnaire was answered by 138 parents.88% of them were mothers. Changes in working arrangements were made by 87.2% of fathers and 79.8% of mothers. Only 1% of parents did not teach their children about hygienic rules. Parents had a child aged 12 or less in 91% and aged more than 12 in 41.4%. Behavioral changes were reported in 60% for children aged 12 or younger (Graphic 1) and in 20% for those older than 12 (Graphic 2) The IES-R mean score was 28.9 ±18.The severity of the impact was associated with the female sex (p=0.04).We found a positive correlation between the IES-R score and the symptomatology of children with p=0.001 and r=0.518 when the age was superior to 12 and with p<0.001 and r=0,52 when the age was under 12.

The Covid pandemic in Tunisia affected both parents and children. Psychological intervention is essential to help them get out of this crisis with less damage.

Cyberchondria involves excessive and uncontrollable online searching of information about a perceived illness. This behavior can cause or maintain distress.

Little is known about cyberchondria during the COVID-19 pandemic or how cyberchondria in one individual may cause distress in their significant other if they are self-isolating together; our study sought to fill these gaps.

We conducted a Qualtrics Panel survey with 760 cohabitating Canadian couples; in June 2020, participants retrospectively reported on their cyberchondria behavior, general anxiety, and COVID-19 fears during the month of April 2020, while adhering to stay-at-home advisories. Two separate actor-partner interdependence models (APIMs) used cyberchondria excessiveness and compulsion to predict generalized anxiety and COVID-19 danger/contamination fears in the actor and partner.

Both cyberchondria excessiveness and compulsion were associated with higher general anxiety and higher COVID-19 danger/contamination fears in the individual (actor effects). Partner cyberchondria compulsion was associated with higher general anxiety in the individual whereas partner cyberchondria excessiveness was associated with higher COVID-19 danger/contamination fears in the individual (partner effects).

Findings suggest that excessive and uncontrollable searching of information about COVID-19 on the internet during lockdown may contribute to distress in both the individual engaging in the cyberchondria behavior, and in their romantic partner. Moreover, different aspects of cyberchondria in the partner (compulsion vs. excessiveness) appears to contribute to general vs. COVID-19-specific anxiety/fears in the partner, respectively. Future research should examine mechanisms underlying the observed partner effects (e.g., co-rumination, social contagion) and reasons for the differential partner effects of cyberchondria components.

Major mental disorders have typically a complex aetiology where both genetic and environmental risk factors have been implicated. It has also been suggested that these risk factors could be interactive rather than just additional. In the last decade, large genetic studies have began to unravel the genetic architecture of several of these disorders. While the mechanisms of action of environmental risk factors are still unclear. At the molecular level, gene expression can be regulated at the epigenetic level, e.g. chromatin modifications or DNA methylation. Epigenetic modifications can be affected by both genetic variations as well as environment variations. In this presentation, we will review recent results either from literature or from own data on how several known environmental risks for mental disorders can be associated with modifications of epigenetic markers, especially in DNA methylation. We will for instance look at the modifications associated with smoking, alcohol, cannabis, childhood trauma or obstetric complications. We will discuss also the limits of these studies and how epigenetic modifications can be relevant for the onset of mental disorders and their treatment.

No significant relationships.