Lockdown due to coronavirus pandemic has been a stressful experience especially to mothers. Juggling work from home and childcare has led to maternal burn out and depression.

The aim of the present study was to assess maternal burn-out rate during lockdown and its eventual relationship with depression and associated factors

156 Tunisian mothers responded to online questionnaire posted on social network after 1 month of lockdown. The questionnaire evaluated burnout and depression as measured by the Maslach Burnout Inventory (MBI) and depression and anxiety symptoms (HADS) respectively.

The participants were aged between 24 and 64 years and 61.5% had more than one child. Mean score on the BMS10 was 4.11 out of 7 maximum score with 71.8% of participants fulfilling criteria for maternal burn-out. Among them, 30.1% had high level of burn out and 9.6% extreme burn out. The main factors associated with maternal burn out were age of children, financial difficulties and lack of leisure activities. Mother’s age, perceived husband support, medical or psychiatric history haven’t been associated with maternal burn out. HADS questionnaire indicated that 38.5% of mothers had moderate to severe anxiety disorder and 35,9% had moderate to severe depressive disorder. A postive correlation was found between burnout and anxiety (r=0.634, p<0.001) and burn out and depression (r=0.515, p<0.001).

The prevalence of maternal burn out during lockdown was significantly high resulting in higher rate of depression than ususal. However, severe forms of burnout may share several characteristics with depression raising the question of overlap of these two entities.

Case of a 17yo patient with high functioning ASD and OCD with obsessions about being a pedophile, with suicidal ideation and self-harming behaviors. He was followed in outpatient care for one year since his first contact with Mental Health, following an inpatient admission for suicidal ideation.

Differential diagnosis between OCD, ASD and possible pedophilia. Learn about different levels of care involved, and other possibilities. Therapy resources used.

Description of the case report: description of initial and final Mental Status Exam Differential Diagnosis: ASD vs OCD vs Pedophilia vs Depressive Disorder Children’s Yale-Brown Obsessive Compulsive Scale Therapy: family based therapy, and Exposure response prevention therapy.

Intrusive images, and reassurance seeking, helped with OCD diagnosis. ASD made symptoms harder to manage with SSRIs alone, which drove to add Aripiprazol at low doses in outpatient care. CY-BOCS showed obsessions other than doubts about being a pedophile. He participated in Exposure response prevention therapy with response, especially when antipsychotic medication was added. Family based therapy worked with his parents in not providing excessive reassurance, and with the patient in gaining insight about his OCD. Decreased anxiety, decreased self-deprecation and no new suicidal thoughts Functionality of the patient in the community improved, with possibility of going college next year.

Recommendation of good assessment of sexuality in ASD population Importance of individual and family therapy for OCD and specially when there is poor judgement and insight in the patient. Importance of combined treatment: pharmacology + therapy

Alicia Koplowitz Foundation

Psychiatric Patients Admissions in Mental health Service of Treviso (Italy) were compared from 2013 to 2017. Trends of Admissions take onto consideration, the presence of Menthal Health Service for Outpatients Care.

To point out the distribution of Diagnosis made in Different Years for different patients ages.

For every patient has been considered the following date : Sex, Age, Marital State, Profession, Psychiatric Diagnosis, Days of Admission, Geografic Origin and KInd of Admission (Voluntary / Involuntay).

It is noticeable the different percentage of Psychiatric Diagnosis in 2013 rather than in 2017. In 2017 it happened a more amount of Psychiatric Admission of Subjects with Substance Addiction Related Disturbs (Alcool included) and Atypical Depression Sindrome and Borderline and Cluster B Perrsonalòity Disorders. Lower amount instead was verified for Diagnosis of Schizofernia, Neurosis and Oligofrenia. Beside it was noticed, an earlier onset of Psychotic Sindrome in Young people often related with Substance Abuse. In the 2017 besides was lower the amount of Involuntary Admission (T.S.O. in Italy) compared with 2013.

Different distribution of Diagnosis is explained by the Evolution Diagnosis Orientation (from D.S.M. IV to I.C.D. 10) About the increased Diagnosis of Substance Addiction Disturbs and Younger age of same subjescts seems caused by a different treatment’s Strategy with brief selective Admissions. Furthermore lesser Involonary Admission seems due to best knowledge of every patients. The most of Theese were indeed already known by Ambulatory Outpatient Mental Health Service.

Tuberculosis is still a challenging disease, infecting around a third of the world’s population. As comorbidity with mental disorder is common, it is relevant to associate them at a diagnostic, therapeutic and prognostic level.

We present a clinical case describing a patient with psychosis, further diagnosed with tuberculosis during psychiatric treatment. Moreover, we present a summarized revision of the state of the art.

Revision of the state of the art, drawing from PubMed and using the keywords “mental health”, “psychosis” and “tuberculosis”, in the last 10 years.

Male, 61 years old, heavy smoker and alcohol drinker. Admitted for allegedly feeling “worms” in his body. After medical examination, a weight loss of 13 kg in five months and symptoms compatible with tenesmus stood out. Following diagnostic tests, the patient was diagnosed with Ekbom Syndrome and Ganglionar Tuberculosis; he was then medicated with the adequate antipsychotic and tuberculostatic agents, which resulted in overall clinical improvement.

This case illustrates the relationship between tuberculosis and mental disorders, in a patient with a low literacy level and a precarious socioeconomic background, known risk factors for mental disorder in patients with tuberculosis and are often associated with poor therapeutic adherence. Although proper treatment of the mental disorder is key to reducing the risk of tuberculostatic dropout, the stigma of mental disorder and tuberculosis decreases the probability of these patients seeking proper treatment. Thus, we alert the medical community for the possibility of psychiatric comorbidity in patients with diagnosed tuberculosis – and vice-versa –, allowing for an early intervention,

No significant relationships.

Decisions about use and safety of antipsychotic drugs during pregnancy it’s been a controversial issue in psychiatric practice because of the difficult finding the good choice, ethically and medically.

To provide an example of a real case to shed light about the psychopharmacological and ethical management of the situation helping a psychotic patient to make a voluntary decision.

Expose a clinical case of a patient in a psychiatric institution for several psychotic symptoms who we discover she’s pregnant during her hospitalization and treatment process. She is a 36 years old single woman who shows disorganized maniac psychotic behavior including disinhibition, promiscuity, persecutory and symbolic delusional ideas, self-surrender and insomnia. She’s admitted against her will in a University Hospital, being transferred to a Psychiatric Hospital with risperidone (2mg/24h) and clonazepam 2mg (2mg/24h). She had a positive pregnant test. Receiving the patient, we made an updated bibliographical review about use of antipsychotic during pregnancy, consult with the patient’s family and hospital legal advice’s service and coordinate with Gynecology’s service. The patient was ambivalent about the decision conditioned by her symptoms.

We decide to optimize drugs to olanzapine (until 30mg/24h) during the first week not using mood stabilizers because of malformations risk, with a great amelioration of symptoms, experiencing a back to reality with a coherent speech and eutimia, deciding a voluntary interruption of pregnancy.

Psychosis in pregnancy can be a bioethical challenge wich must be management according to science (practice clinical guidelines point olanzapine as a choice to be considered) and woman’s will.

Newborn infants can suffer permanent brain damage as a result of birth asphyxia (ASP), a severe obstetric complication (OC). However, effects of OCs on cognitive abilities and brain structure in schizophrenia (SZ) are unknown.

The main goals of this study were to investigate putative effects of a history of OCs on adult cognition and brain structure in SZ.

We utilized prospective data from the Medical Birth Registry of Norway to identify incidences of severe OCs in adult healthy controls (HC; n = 622) and patients with SZ (n = 607). IQ was assessed, and a subset of participants (n= 414) underwent magnetic resonance imaging.

Severe OCs (27%) and ASP (14%) were equally common in SZ and HC. SZ patients with OCs had lower IQ than patients without OCs, a difference not found in HC (p = .023). Having experienced more than one co-occurring severe OC was associated with lower IQ in both groups, wherein 81% of co-occurring OCs involved ASP. ASP was related to smaller intracranial volume and brain volumes in both groups. Smaller caudate volumes were found in SZ patients with ASP compared to patients without ASP, a difference not found in HC (p = .009).

Our findings give support for an effect of birth ASP on brain development in both patients with SZ and HC. OC history specifically impacts IQ in SZ. Smaller caudate volumes might be particularly related to disease development. These results warrant replication in an independent sample.

No significant relationships.

As a consequence of the impact of COVID-19 there are suggestions and projections that suicide rates will rise, although this is not inevitable. It is intriguing what impact it will have on Kosovo as a country with the lowest suicide rate in Europe.

The objective of this study was to understand the level of suicidal thinking as a result of the COVID-19 situation and possible associations with sociodemographic variables.

It’s a comparative study. We examined data of two cross-sectional online surveys conducted during the one-month periods 20.03.20 until 23.04.20 and 27.04.2020 until 05.06.2020. The participants were online respondents, N = 194 (first period) and N = 155 (second period); who completed the Albanian version of PHQ-9. We used the statement number 9 of questionnaire indicative of suicide.

Mean score of suicidal thinking resulted 0.58 (SD = .98) in the first period and 0.84 (SD = 1.16) in the second period. 10.1% of participants in March/April and 18.2% in May/June period scored that almost every day thoughts that would be better off dead, or of hurting yourself in some way. Significantly higher suicidal thinking resulted for females and for respondents who had previously had depression in both periods. Compared to two previous studies (2018 and 2019) in different settings only the results of the second period show an increase in suicidal thinking.

Further studies are needed to better scientifically elaborate these findings. It is important enhanced surveillance of COVID-19-related risk factors contributing to suicidal behaviors and timely preventive efforts.

No significant relationships.

Exercise has been repeatedly reported as an effective means of preventing and treating mood disorders. Therefore, there is a significant research interest for the way exercise is connected with depression and the effectiveness of different exercise parameters as intensity, duration and modality. There is significant research evidence supporting the hypothesis that exercise can alleviate the symptoms of clinical depression. Nevertheless, there has not enough evidence to compare the effectiveness of deferent types of exercise as complementary therapy in depression.

The purpose of the present study was to review the available research concerning the effect of exercise modality in depression and attempt to code and analyze the programs used in elderly (>65).

A systematic review was contacted of randomized control trials published in electronic journals. The electronic data bases PubMed, EBSCOhost and Trip Medical Database were used.

Combined programs are predominate used for improving mood in elderly and the combinations used more frequently was short-term, light to moderate sub maximal aerobic exercise combined with dynamic resistance exercise following by Short-term, light to moderate sub maximal aerobic exercise combined with static exercise. Other psychosocial factors that commonly included in the combined exercise programs are group interaction, mindfulness and music.

Combined exercise programs are as effective as simple programs in alleviated the symptoms of depression in elderly. Their advantages over simple programs are that they can promote other health benefits; they are less time consuming and more pleasurable to participants. Therefore, they are good exercise choice for elderly.

Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder often diagnosed between the ages of 7 and 10. The estimated prevalence of ADHD in adults is usually 2-5%, which means that in up to half of people this diagnosis persists into adulthood.

The aim of this sub-study was to determine whether there are significant differences in ADHD symptomatology between individuals who have taken or are taking prescription drugs and those who have never taken them.

Data collection was performed by STEM / MARK in January 2019 through the European National Panel. Respondents completed a demographic questionnaire focusing on the history of ADHD and a standardized ADHD Self-Report Scale (ASRS) questionnaire for the symptomatology of ADHD in adulthood.

Of the 1,518 respondents, 3% reported being diagnosed with ADHD / hyperkinetic disorder during their lifetime. According to the ASRS assessment, 119 respondents were classified as suspected ADHD. Overall, men scored higher symptoms of ADHD. The results also show that the group that states that taking medication has a statistically significantly higher average score in ASRS than unmedicated individuals. 6 individuals are taking medication to this day.

The data collected confirm our main hypothesis that ADHD symptomatology has an impact on the daily functioning of individuals in adulthood. Unlike peers with reduced or no ADHD symptoms, these people are far more likely to have time management issues, need to plan their day carefully, and yet often experience problems such as late arrivals due to a lack of anticipation.

Financial support was provided by grants : GA ČR – 18 -112 47 S, Progres Q06 1LF

According to psychoanalytic theory performing circumcision on a boy in phallic phase may aggravate this fear and cause sexual dysfunctions later in life. However this hypothesis is an unverified common-view rather than a scientifically proven conclusion.

We hypothesized that being circumcised during phallic phase is not a risk factor for sexual dysfunction. We also took a peak at how the experience of circumcision is being perceived and its psychological effects. Our secondary hypothesis was, sexual dysfunctions are more frequent among men who had a traumatic circumcision experience.

For this cross-sectional study, a total of 2768 sexually active, circumcised and voluntary men were recruited from 20 different urology outpatient clinics around Turkey.

There was no significant difference for PEDT and IIEF scores between participants who were circumcised at different ages (Graph-1,2). When participants were divided into 3 groups according to their circumcision age in accordance with psychoanalytic theory (before, after and during phallic phase) mean IIEF and PEDT scores did not differ. PEDT scores did not differ either by which emotion the participant describe their experience of circumcision or how vividly he remembered it. However participants who remembered their circumcision experience more vividly and had who describe their circumcision experience with fear/anxiety had a higher IIEF score (Graph-3).

The age of circumcision does not affect the risk of PE. This is one of the very few studies that challenges psychoanalytic theory with a scientific method. Remembering the circumcision experience with fear or anxiety did not increase the risk of sexual dysfunctions.

The medical case report (CR) is a vital and viable medical genre with a history of more than 3000 years. With a few exceptions, the CR has had a typical format that has been consistent with the ideals of brevity, conciseness, and a matter-of-fact approach. CR in general and psychiatric CR especially, may benefit from more systematically emphasising and integrating relevant biopsychosocial (BPS) aspects.

To discuss how to emphasise and integrate the BPS perspective in the CR.

Drawing on CR literature and our own experience as CR authors, we discuss how a broader BPS approach successfully can be included in the CR format.

Some central factors that could be considered when including a BPS perspective in the CR are: 1) Actively eliciting the patient’s perspective and including this in the final report. 2) Including relevant information about the life and circumstances of the patient beyond the basic demographic information. 3) Making an effort to preserve the patient’s privacy also when more BPS information is included. The psychological and social constituents of the patient’s life should be central in the BPS-inspired psychiatric CR.

The traditional CR has a long-standing history in medicine and follows a typial conscise and brief format. ‘Hard facts’ and biological information have typically filled most of the text. We argue that giving psychological and social information more attention would improve the quality of many CR, and that this is especially relevant for psychiatric CR.

Synesthesia is a non-pathological condition where sensory stimuli (e.g. letters or sounds) lead to additional sensations (e.g. color). It occurs more commonly in individuals diagnosed with Autism Spectrum Condition (ASC) and is associated with increased autistic traits and autism-related perceptual processing characteristics, including a more detail-focused attentional style and altered sensory sensitivity. In addition, autistic traits correlate with the degree of synesthesia (consistency of color choices on an objective synesthesia test) in non-synesthetes.

We aimed to investigate whether the degree of synesthesia for graphemes is associated with autistic traits and perceptual processing alterations within twin pairs, where all factors shared by twins (e.g. age, family background, and 50-100% genetics) are implicitly controlled for.

We investigated a predominantly non-synesthetic twin sample, enriched for ASC and other neurodevelopmental disorders (n=65, 14-34 years, 60% female), modelling the linear relationships between the degree of synesthesia and autistic traits, sensory sensitivity, and visual perception, both within-twin pairs (22 pairs) and across the entire cohort.

A higher degree of synesthesia was associated with increased autistic traits only within the attention to details domain, with sensory hyper-, but not hypo-sensitivity and with being better in identifying fragmented images. These associations were stronger within-twin pairs compared to across the sample.

Consistent with previous findings, the results support an association between the degree of synesthesia and autistic traits and autism-related perceptual features, however restricted to specific domains. Further, the results indicate that a twin design can be more sensitive for detecting these associations.

No significant relationships.

No significant relationships.

The acts of violence committed by adolescents are becoming increasingly more common, generating problems of a diverse nature.

To study the main characteristics of violent adolescent examined in a forensic psychiatric assessment.

This is a retrospective study which examined the expert files of the subjects aged between 14 and 20 years charged with violence, which were examined in the context of criminal psychiatric expertise in the psychiatry department of Hedi Chaker University Hospital in Sfax (Tunisia), between January 2002 and December 2018.

Our study included 34 forensic psychiatric assessments. The male sex was predominant (94,1%). The mean age was 19,2 years. The perpetrators were unmarried (100%), with a primary school level or less (55,9%), and low socioeconomic level in all cases. They had personal criminal records in 20,6% One-fifth had experienced emotional deprivation in childhood. The father was described as violent in 20,6% of cases. The most common diagnosis were antisocial personality disorder (55,9%) and mental retardation (29,4%). The main offences were homicide and attempted homicide (47.1%), assault and battery (26,5%) and sexual offences (20,6%). The experts had concluded to a “non-criminal responsibility” in 38,2% of cases.

The knowledge of epidemiology of violence perpetrated by adolescents highlights the need for targeted research, policy and programming responses for its prevention.

No significant relationships.

No significant relationships.

Integrated clinical and biological approaches in the study of disorders caused by alcohol consumption in people of different ethnic groups, are important for determining effective treatment strategies.

To study the clinical and dynamic features and the role of neuroendocrine factors of the formation and course of alcohol dependence in individuals of Tuvan ethnicity.

68 Russian alcoholics and 67 Tuvans alcoholics only men and 20 healthy male were monitored. Clinical assessment of the condition of patients was carried out with the traditional clinical description. Enzyme-linked immunosorbent assay kits were used to determine serum hormone levels in patients and volunteers.

The systematic consumption of alcoholic beverages develops among Tuvans in adulthood, in contrast to Russian men who begin to drink systematically young. Alcohol dependence in people of Tuvan nationality are formed several years later than in Russians: a symptom of loss of quantitative control over use was detected in Tuvans at 36.9±9.9 years, in Russian patients at 29,8±7.5 years; the formation of withdrawal syndrome in Tuvans occurs at the age of 37.7±8.4 years, unlike Russians, in whom the withdrawal syndrome develops on average at the age of 29.6±6.0 years. The index of the ratio cortisol/progesterone in the blood of examined Russian alcoholics is almost twice as high as the index of examined healthy donors; in patients of Tuvan ethnicity, index is almost five times higher.

Alcohol dependence among representatives of the Tuvan ethnic group indicates a greater vulnerability to the effects of alcohol.

No significant relationships.

The pandemic caused by the SARS CoV-2 virus (COVID-19) has a profound effect in the health care system (HCS). The therapeutic effect of communication skills is well known. Psychiatric patients are a vulnerable population and remote care via telephone was one of the first implemented measures during the lockdown.

The aim is to highlight the potential benefits and risks of remote follow up, according to the scientific evidence currently available.

Non-systematic review of the literature with the selection of scientific articles published in the last year. The search was performed in Pubmed database with the following Mesh terms: “COVID-19”, “psychiatry”, and “health communication”. Complementary references were also included.

For those with a stable psychiatric condition, remote appointments may guarantee the adequate follow up in a safe way throughout the COVID-19 pandemic. However, telephonic appointments are associated with a limited ability to perform psychopathological examination. A better assessment can be achieved if video call is used. Also, data protection and the ability of giving informed consent by psychiatric patients should be addressed. Additional training should be considered. A subgroup of patients with severe mental illness may require face-to-face visits.

COVID-19 pandemic is an unprecedented crisis and telemedicine is now emerging as an alternative. Remote consultation has advantages and, in some situations, it may replace or complement the in-person visits. Since social isolation is one of the most effective measures, digital means constitute a window of opportunity for the HCS.

The bioelectrical activity of the brain of suicidals has specific features.

Investigate neurophysiological features associated with high suicidal risk (SR) in dementias.

An electroencephalographic study of brain was performed in 66 patients with dementia, of which 33 (with high SR) were included in the main group, the other 33 (with low SR) – in the control group.

SR correlates include an increase in the spectral density and amplitude (in μV) of the α-rhythm in the right central (C4) (109.4) – in the main group, compared with (64.5) – in the control; in the temporal areas (T4) (132.2) - in the main group, (70.0) – in the control group (p<0.001). The predominance of the spectral density of the slow θ-rhythm over the entire surface of the brain (p<0.001) and δ-rhythm in the projection of Fp2 (82.3) – in the main and (116.1) – in the control groups (p<0.001), F3 (54.80) and (68.1), respectively, (p<0.05), F4 (52.4) and (67.3), respectively, (p<0.01), C4 (52.0) and (62.0), respectively (p<0.05), P3 (44.4) and (58.9), respectively, (p<0.01), O1 (67.6) and (89.41), (p<0.001), O2 (68.5) and (85.8), respectively (p<0.001) are a predictor of low SR in dementias.

With the progression of changes in the brain in dementias SR decreases. In the initial phases of the dementing process with a relatively preserved functional capacity of the brain SR is high.

No significant relationships.

The 2019 coronavirus epidemic (CoViD-19) in Italy originated in Lombardy, on February 21, 2020. Crowding has been defined as a worldwide problem and causes reduced quality of care. It is due and identified by three orders of factors: those at the access (input); those related to the patient’s process (throughput); and those at the exit from the ED (output).

We evaluated all the population who went to ED for mental disorder. Due to the high level of care needed and the simultaneous exposure to risk factors, an excessive duration of ED process can be counterproductive.

We evaluated all patients accessing our ED for mental disorder from February 22 to May 1, 2020 and during the same period of the previous year.

We enrolled 345 patients. The Crowding input factors are lower in the pandemic period: reduced attenders (142 vs 203) and reduced average waiting times (40 min vs 54 min). The Crowding throughput factors have instead worsened: LOS (length of stay) for both visit rooms (383 vs 271 min) and holding area (1735 min vs 797 min). The Crowding output factors also worsened: the percentage of access block is higher during the pandemic (100% vs 20%). The Total Access Block Time is significantly higher in the CoViD period for both the visit rooms (3.239 vs 649 min) and the holding area (590 vs 185 min).

The pandemic period presented a worsened crowding for these patients due to the Access Block.

The growth in the number of aged people in the population is considered a worldwide phenomenon, with direct consequences in health systems. The literature indicates an increase in the diagnosis of mental disorders and the use of psychotropic drugs for that population, as well as frequent complaints regarding to cognition.

To analyze the possible relationship between cognitive decline and use of psychiatric drugs in elderly with mental disorders, assisted by psychiatric outpatient clinics, city of Campo Grande, state of Mato Grosso do Sul, Brazil.

Quantitative, exploratory, descriptive and cross-sectional research, with 59 participants.Sociodemographic and clinical variables were collected through semi-structured clinical interviews and medical records. To screen for cognitive decline, the Mini Mental State Examination was used.

Majority of females, with a mean age of 66.75 ± 0.63 years, married, up to 8 years of completed studies and living with family members. The prevalence of depressive disorders was higher (52.54%), with selective serotonin reuptake inhibitor antidepressant use in 67.8%. Most were using 2 or more psychotropics the most prevalent combination being benzodiazepines and antidepressants. 52.5% of the elderly reported cognitive complaints and 45.8% presented Mini Mental scores, suggesting cognitive decline. It was associated with depressive disorders and the consumption of 2 or more psychotropics.

Although there is evidence that psychotropic drugs represent effective strategies for the treatment of mental disorders, the use for this group of elderly should be carefully analyzed, due to the predisposition or worsening of cognitive decline, with impairment to the quality of life of this population.