Bullying is a serious problem for school youth. It is prevalent across the elementary and secondary school years and it has serious consequences for both bullies and victims.

The aim of this study was to investigate the relationship between self-esteem and bullying behavior.

We conducted a cross-sectional study including children enrolled in two high schools in Sousse, Tunisia. The students were asked to complete two questionnaires: the Adolescent Peer Relations Instrument witch is a multidimensional scale designed to assess bullying involvement both as target and perpetrator and the Rosenberg self-esteem scale.

We recruited 600 adolescent. The mean age of our population was 13.76 ±1.37 and the sex ratio was 1. More than 95% of adolescent who reported that they had been victims of bullying had a very low self-esteem comparing to those who stated that they had never been bullied (4.4%). Our results have also shown that bullies had a lower self-esteem than children who had not bullied others.

We found that both victims and bullies tend to have low self-esteem. Our findings could help to understand better the role that individual characteristics and personal qualities such as self-esteem play on bullying, and provide the scientific knowledge to develop successful strategies to prevent this phenomenon.

Cognitive complaints and psychological distress are common in oncologic patients, in particular many studies have focused on women with breast cancer.Patients presenting the phenomenon of “chemofog” show changes after chemotherapy with regard to memory and emotional regulaiton.

To explore brain connectivity prior to chemotherapy that nevertheless,is understudied.

We used fMRI to investigate the resting state connectivity in 24 patients before chemotherapy and 15 controls.Patients were assessed with self-administered questionnaires,such as the Patient’s Assessment of Own Functioning Inventory (PAOFI) that quantifies the decrease in perceived functioning in memory, language and problem solving (Image 1).We used a preliminary structural analysis in order to choose which neuropsychological test was affected in correlation with a significant anatomical volume alteration,as showed in the p-value table.Therefore, patients were ranked and divided into two group of “Impaired vs Preserved”, measured using the median of the questionnaire results.Higher scores indicate a poor cognitive self-perceived performance.

Connectivity was altered in amygdala and hippocampus, in the subgroup of patients with higher subjective cognitive complaints i.e with a high PAOFI Memory score.More specifically, we found an association between memory impairment and the increase of the resting state connectivity of both right structures, as opposed to a reduction in left amygdala (Image 3).

These findings may suggest a potential effect on brain functional connectivity of the psychological awareness and stress of cancer itself. We found connectivity alterations for both amygdala and hippocampus, two structures belonging to the limbic system, that is involved in the interplay between cognition and emotions, such as anxiety and fear.

Obesity is one of the leading problems of today’s society. According to WHO, 650 million people worldwide are obese, which is 13% of total population (in Croatia 21.5%). There are various psychodynamic theories that interpret the psychological aspects of obesity.

The aim of this paper is to present psychodynamic and contemporary psychiatric concepts that explain the interrelated phenomena presenting in obese patients.

The review of the literature included the investigation of the existing studies in the field of modern psychiatry, as well as previous knowledge in the field of psychodynamics.

Obesity is associated with the emptiness of not recognizing one’s own emotions from hunger, and the need for constant replacement. The everyday life of the obese is filled with shame, an uncomfortable perception that is so intense that can be unbearable. The emptiness and shame which overwhelm and create discomfort cannot be fulfilled by constant food intake and are associated with pathological narcissism (grandiose or vulnerable), which in turn is associated with more regressive behaviour. Thus, obesity may sometimes be associated with addictive behaviours, and a cognition that a bad pattern of rewarding behaviour through food has been adopted in parallel with poor self-control.

Relationship between psychodynamic phenomena and obesity is complex and multidimensional. Further research is needed in order to ameliorate our understanding of these connections.

No significant relationships.

Violence in intimate relationships is a prevalent worldwide health problem and it is underreported, underrecognized and underadressed by health care professionals.This problem affects women more commonly than men and occurs in heterosexual and same-sex relationships. Violence can include physical, emotional, sexual and financial abuse, as well as control over contraception or pregnancy and medical care and it tends to be repetitive, with an escalation in frequency and severity over time. Abused patients exhibit chronic physical and emotional symptoms and injuries resulting from physical and sexual violence.

We conducted a review on violence in intimate relationships and the impact on mental health of the victims.

Comprehensive search of literature in the medical databases MEDLINE, PsycINFO, SciELO using the keywords: women, violence, intimate relationship violence, mental health, self injury.

Research has established a relationship between violence and mental health outcomes among women and girls. Violence or inter-personal trauma render women vulnerable to a range of psychiatric symptoms - depression, post-traumatic stress disorder (PTSD), suicide, and substance use are most common. Women reporting bidirectional violence had higher rates of depression and PTSD. When examining differences in rates of psychiatric disorders by the type of violence, it was found that all types of violence were strongly associated with all types of psychiatric disorders. Severity of psychiatric symptoms increased stepwise with increasing severity of violence.

Caring for patients in abusive relationships can be challeging - continuous supportive care improves patient outcomes. Physicians shoul be able to recognize and manage this situations in order prevent its negative outcomes.

During the last 15 years, an ideation-to-action framework has been proposed that has prompted the development of several models that account for the transition from ideator to attempter. Previous research on one such model, the Integrated Motivational Volitional Model of Suicide (IMV), suggests it accurately distinguishes between suicide ideators and attempters. However, no study has examined the utility of the model with a psychiatric sample of depressed suicide ideators and attempters.

To address this gap in previous research, this study examines the ability of the IMV to distinguish between depressed adult suicide ideators with and without a history of suicide attempt presenting to the emergency department.

After providing informed consent and with the approval of the appropriate institutional review board, 68 adults presenting to the Emergency Department were recruited to participate in the study. Ideators and attempers were compared on sociodemographics, severity of depression/hopelessness/current suicide ideation, and volitional factors including, access, planning, exposure to family suicide, impulsivity, pain tolerance, fearlessness about death, and mental imagery of death. Group differences were evaluated using chi-square and t-tests. Multivariate group analyses were performed using logistic regression.

Of the regression analysis indicate that fearfulness about death significantly predicts suicide attempt history (OR=10.560, p=.05). Ethnicity was also found to significantly predict suicide attempt history (OR=0.67, p=.006). No other sociodemographic variables or volitional moderators were significant.

Results of this study contribute to improving accuracy in this area and suggest that fearlessness about death should be routinely included in comprehensive suicide risk assessments.

No significant relationships.

Clozapine is a second-generation antipsychotic indicated in treatment-resistant schizophrenia. Patients taking clozapine are likely to experience an increase in salivation or sialorrhea. Clozapine‐induced sialorrhea (CIS) may lead to sleep disturbances or aspiration pneumonia. Treatment options include locally administered anticholinergic medication with atropine ophthalmic drops applied sublingually.

To review the current evidence for the effectiveness, safety, side effects and dosage of sublingual application of atropine in reducing or resolving of CIS.

Systematic review. Data were obtained from PubMed/Medline, EMBASE, PsycINFO, Cochrane Plus, Trip Database, Science Direct and Scopus searches of English-language articles, without restriction for date of publication and study design, reporting the sublingual use of atropine in the treatment of CIS. Large clinical studies with appropriate statistical methods and recruited adults were preferred.

12 selected articles (of 458 references) consisted entirely of case reports and case series. A total of 29 patients with CIS were reported, of whom 24 responded favorably to sublingually administered atropine drops 1% (1-2 drops a day). One limitation of its utilization is the dose-related dry mouth, which can be addressed by lowering the number of drops administered. CIS can occur at different clozapine doses, in various stages of treatment.

The reviewed articles suggest that the use of sublingual atropine is a promising local treatment for CIS. Oral anticholinergic and alpha-2 agonist medications have been used to treat CIS with variable efficacy, but can cause systemic anticholinergic side effects. Further experimental research is needed.

No significant relationships.

Schizophrenia is one of the most severe mental disorders. Haloperidol and other first-generation antipsychotics are widely used for schizophrenia treatment, but have prominent side effects, primarily extrapyramidal symptoms (EPS). The EPS severity is highly variable and may be underlied by genetic factors.

We performed a prospective study to test the association of DRD2/ANKK1 Taq1A polymorphism (rs18000497) and CYP2D6 phenotype, predicted from genotypes using 8 CYP2D6 alleles (*3, *4, *5, *6,*9, *10,*41, xN) with EPS severity during haloperidol treatment in schizophrenia spectrum disorders patients.

57 inpatients with schizophrenia spectrum disorders (42,1% females; mean age - 46,7±11,8 y.o (M±SD) of European ancestry were enrolled in the study. Abnormal Involuntary Movement Scale (AIMS), Barnes Akathisia Rating Scale (BARS), Simpson-Angus Scale (SAS) were used to assess EPS on two timepoints: day 1 and day 21 of haloperidol treatment.

TaqIA T-allele carriers in contrast to wild-type allele homozygous patients had higher scores of BARS (p=0.029) and SAS (p=0.024) on day 21. After stratification by CYP2D6 phenotype, these differences were observed only in extensive metabolizers (p=0.006 and p=0.001 respectively), although the CYP2D6 phenotype itself was not associated with EPS severity. The combined effect of TaqIA T allele with CYP2D6 extensive phenotype on BARS score on day 21 was confirmed by General Linear Model (p=0.013).

Our results show that minor TaqIA T-allele is associated with the severity of EPS after 3 weeks of haloperidol treatment only in CYP2D6 extensive metabolizers. That highlights the importance of using both pharmacokinetic and pharmacodynamic genetic markers in pharmacogenetic EPS risk assessment.

No significant relationships.

It is clear from the literature that depressive disorder is closely related to lifestyle, however the relationship between burnout and lifestyle remains unclear.

The aim of this study was to present a comprehensive overview of depressive symptoms, burnout and lifestyle over the years. Furthermore, this study looks at the relationship between burnout, depressive symptomatology and lifestyle and seeks to clarify the extent to which burnout can be explained by these variables.

Data collection took place in three waves. The first data collection was in 2014 (October/November), the second in 2017 (March) and the third in 2020 (March). The STEM/MARK agency conducted the data collection and collected answers from a representative sample of respondents using the CAWI method - computer-assisted questioning. These respondents were selected from the European National Panel. Because the target group was adults (18-65 years), an online survey was chosen. Internet penetration in this target population is sufficient and it was not necessary to use a combination of methodologies.

All 3 data collections identically show that for the model explaining burnout statistically significant variables are: age, depression and fatigue during the day. Other variables related to healthy lifestyles did not reach statistical significance.

Even though the variables regarding healthy lifestyles have not reached statistical significance, their importance should not be underestimated. Mental well-being is closely linked to physical health and therefore a holistic approach to health should be emphasized and the rate of burnout should be regularly monitored.

No significant relationships.

The COVID-19 pandemic may cause elevated levels of anxiety in healthcare professionals (HCP). Identifying factors that could help maintain mental health especially social support could be helpful in facing this stressful situation.

The aim of this study was to asses the relationship between the trait-anxiety and perceived social support among Tunisian HCP in the current pandemic wave of COVID-19.

A cross- sectional descriptive and analytic study conducted among Tunisian HCP during November and December 2020. The data were collected by an online questionnaire. The trait-anxiety was assessed using the “General Anxiety questionnaire of Spielberger” (STAI-Y-B). We used the “Social Support Questionnaire” to measure availability and satisfaction regarding perceived social support.

Participants were 135 HCP, and aged from 24 to 61 years old (average age 31.98 years). The sex ratio was 1.1 (71 males and 64 females). Of HCP involved in the study, 61.5% were single, 36.3% were married and 2.2% were divorced. The average scores of availability and satisfaction regarding perceived social were 7.79 (SD=3.56) and 28.41 (SD=6.75), respectively. Seventy-two of the HCP had a trait-anxious. Analysis showed that social support satisfaction scores were significantly lower in trait-anxious HCP (p<0.001). However, there was no significant difference in the score of availability according to trait-anxiety (p=0.49).

Our study highlighted the existence of a deficit on perceived social support satisfaction among trait-anxious Tunisian HCP. Perceived social support as a determinant of trait anxiety should be the focus of social work in this period.

No significant relationships.

Treating addiction is more challenging when there are co-addictions. Tobacco smoking is commonly associated with substance abuse, alcohol use disorders, excessive caffeine intake and pathological gambling among other addictions. Smoking reduction and cessation programmes´ objectives benefit from interventions targeting co-addictions.

Difficulties arising from smoking reduction and cessation in the context of co-use of cannabis prompt literature review and reflection of a smoking cessation programme team.

Pubmed and Google Scholar literature search using terms smoking cessation / tobacco cessation and cannabis.

Co-use of tobacco and cannabis is: 1) very common, 2) associated with greater prevalence of morbidity and social problems, 3) associated with greater dependence of the other substances, 4) negatively influences quit outcomes of either, 5) increases the risk of relapse. Co-users are more likely to perceive the harmful effects of tobacco, have greater motivation and are more likely to quit tobacco than cannabis, which may be perceived as low risk. Treatment of either tobacco smoking or cannabis use may lead to compensatory increase in use of the other substance. There is a significant lack of literature on co-use treatment strategies.

Co-use of tobacco and cannabis makes cessation and relapse prevention of either addiction more difficult and should be taken into account in smoking reduction and cessation programmes and in cannabis treatment interventions. Treatment targetting both tobacco and cannabis use, either simultaneously or sequentially, is likely more successful than interventions targeting only either one. Much remais to be studied on how to treat co-use of tobacco and cannabis.

Religious people suffer less from depression disorder than less or non-religious people. According to a longitudinal study investigating religiousness and negative life events, religious participants demonstrated fewer depressive symptoms than non-religious. Furthermore, depressed patients with higher religiosity scores show lower values of depression symptoms.

The purpose of the study was to investigate the relationship between religiosity and patients with depression symptoms in the Neuro-Psychiatric Center in Riem (NPZR). The correlation between religiousness and life satisfaction as well as anxiety level was analyzed. Additionally, possible gender differences are also assesed.

The patients of the NPZR were selected as sample of the study (N =106, F=61, M=45). The participants were provided with three surveys including the life satisfaction questionnaire, state trait anxiety inventory and the Centrality Scale. A Pearson Correlation was conducted to investigate the association between life satisfaction, level of anxiety and religiousness. T-Test was carried out to find out the differences between female and male patients.

There was a positive relationship between religiousness and life satisfaction of the depressed patients (r = .608, p= .001). There was also a significant relationship between religiosity and anxiety level (r = - .548, p < .001). However there was no significant difference between male and female patients with regard to their religiousness (t= .149, p= .882).

The findings indicate that while there is a significant relationship between life satisfaction, level of anxiety and religiousness of the patients, the gender of the patients has no impact on the religiosity of participants.

Attention Deficit Hyperactivity Disorder (ADHD) is a Neurodevelopmental Disorder characterized by persistent pattern of inattention and hyperactivity / impulsivity. There is considerable difficulty in diagnosing ADHD, mainly to discriminate what could be symptoms arising from ADHD or typical age behaviors. The decision tree model is a statistical algorithm, a predictive model built with comparisons of values for a given objective that can be compared with other constant values, placing these variables in a database at hierarchical levels.

This study aims to apply the decision tree model in directing the screening of ADHD complaints to analyze which cognitive and behavioral parameters would be better associations with ADHD accurate diagnosis

We used a database of research protocol with 202 children assessed with complaints of ADHD and a control group with 185 participants. Decision tree analyzed parameters selected from the cognitive instruments, such voluntary attention, Continuous Performance Test indexes, WCST indexes, Wechsler Intelligence indexes and behavioral scales from CBCL/6-1 and TRF/6-18.

The highlighted results points to WCST index like: “Perseverative answers” and “Perseverative errors” and “learning to learn” joint to “CPT omissions” and behavioral scales as “CBCL ADHD”, and “CBCL Problems of Attention” produces accuracy of diagnosis discrimination from 84.7% to 60% in the precision of the decision tree.

The decision tree and machine learning approaches can be effective in directing the screening of typical ADHD complaints.

No significant relationships.

Over half of patients with mental disorders are seen by primary care physicians. However, as for patients with somatic problems, referral to psychiatrists seems to be sometimes necessary.

The present study aimed to identify reasons and difficulties perceived by general practitioners (GP) in mental health referrals.

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

The mean age of respondents was 37.3 years. Their seniority as doctors was 8 years on average. Among them, only 17% attended a post-university psychiatric training. The participants reported that they refer on average 32.5% of patients with mental disorders to psychiatrist: 85.1% to psychiatric hospital, 40.4% to liberal psychiatrists and 21.3% to clinical psychologists. Regarding the reasons for referral to mental healthcare structures, 70.2% of doctors justified their doing so by their insufficient training in mental healthcare; 66% by a need for hospitalization, 57.4% by the presence of delusions, while in 27.7 % of cases, the transfer was carried out at the request of the patient or his family. The difficulties mentioned by GP were patient refusal to consult a psychiatrist (70.2%) and difficulties related to the management delay (44.7%).

Patient and health system factors, as well as physicians experience seem to have important influences on mental health referral. Open communication and ease of consultation with psychiatrists can make the care of patients with mental health problems even more rewarding to the primary care physician.

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.

No significant relationships.

This systematic review estimates the pooled prevalence (PP) of Conduct Disorder (CD) among 5-to-18-year-old YP living in Europe, based on prevalence rates established in the last five years (LFY).

Trends of prevalence rates across countries, gender and level of education were analysed. The random effects pooled prevalence rate (REPPR) for CD was calculated.

A search strategy was conducted on three databases. Studies were also identified from reference lists and grey literature. Eligible studies were evaluated for reliability, validity and bias, and REPPRs were calculated.

The European REPPR for CD is calculated at 1.5% (Figure1). The REPPR among males is 1.8% whereas the rate among females is 1.0% (Figure2). The prevalence rate of CD in primary school children is 1.4 times lower than the prevalence of secondary school children.

Gender, culture and socioeconomic inequality may contribute towards diagnostic inequality and prevalence differences. It is recommended that these aspects are addressed, and routine screening and early intervention services are developed.

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.

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.

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 COVID-19 outbreak poses a challenge for health care professionals due to a surge in care demands, overwork, fear of contagion and concerns on the availability of protective equipment, and coping with distress of patients and their families. Although there is emerging evidence on prevalence of stress and its predictors, less is known on the trajectory of stress symptoms and the differences between cohorts of health care professionals.

To sustain and restore health care professionals the Leiden University Medical Center has launched the Digital Stress Buddy, a mobile app, to assess psychological stress, depressive symptoms, anxiety and posttraumatic stress symptoms.

Participants fill in a 14-item questionnaire on stress and resilience resources, followed by a COVID-related questionnaire and finally a set of validated questionnaires on depression and anxiety (DASS-21), posttraumatic stress-symptoms (IES-R), burn-out (CBI) and resilience (RES).

To date, 959 health care workers have completed the stress monitor, of whom 223 (23%) showed relevant stress levels. Within this group, anxiety and posttraumatic symptoms were most prevalent (45%), followed by depressive symptoms (15%). Predictors of stress were being female, coping with distress of patients and their families, teleworking, and overwork.

By identifying vulnerabilities and resilience for psychological distress, we are able to tailor the support interventions for health care workers within our hospital. This is an ongoing study and future follow-up during the second wave of the pandemic will provide more insight on the trajectories of stress-related symptoms.

No significant relationships.