The confinement associated with COVID-19 pandemic was an experience with significant physical and mental health implications, including higher stress levels, decreased sleep quality, pain symptoms and changes in lifestyle behaviours.

The main goal of this study was to analyze the relationship between stress and health variables (sleep, health symptoms, health perception, and lifestyle behaviours) in a Portuguese university during COVID-19 home confinement.

A cross-sectional online survey design was conducted. A sample of 263 Portuguese workers (64.3% females), with mean age of 48.3 years (sd=8.9), filled in the PSS10, answering questions concerning health symptoms (perceived health, pain symptoms and fatigue), lifestyle behaviours (sleep and eating habits, use of alcohol and tobacco) during COVID-19 home confinement. A descriptive statistical analysis, a Pearson correlation analyses and the t Student test, for independent samples, were performed.

The results showed significant correlations between stress and perceived health (r=-.404; p<.0001), arms pain (r=.212; p=.002), legs pain (r=.201; p=.003), back pain (r=.219; p=.001), headache (r=.289; p<.0001) and fatigue (r=.295; p<.0001). Concerning lifestyle behaviours, the results showed significant correlations between stress and sleep (r=-.552; p<.0001) and stress is significantly higher (p<.0001) in individuals who have changed their eating habits.

During the COVID-19 home confinement, higher stress levels are associated with a worse perception of health, more pain symptoms (legs, arms, back, headache), worse sleep quality and more fatigue. Moreover, the individuals with higher levels of stress have changed their eating habits. Lastly, health promotion interventions are needed in order to minimize the impact of home confinement in health.

The mental health law is not universal. In Portugal the urgent compulsory regimen is based on the principles of the presence of severe mental anomaly and risk to themselves or others.

Characterization of patients admitted in compulsory hospitalization (CH) between 2018 and 2020, in the University Hospital Center of Algarve - Faro Department

Retrospective study from January/2018 to August/2020. Social, demographic, epidemiological and clinical data were evaluated.

Of 1191 patients who were admitted 36% occurred in CH. There was a predominance in male sex (58%), the average age was 43 years old. For 62% it wasn´t the first hospitalization and 58% had a recent prescription. Admission occurred most frequently because of the presence of psychotic symptoms (figure1) and according to the international classification of disease (ICD10) the most frequent diagnosis was unspecified nonorganic psychosis (figure2). At discharge 59% of the patients remained on compulsory treatment (CT), where the most frequent diagnosis was schizophrenia. Although most of these patients were discharged with oral and long-term injectable antipsychotics, there were higher rates of readmissions when compared to non-CT group, were the most frequent diagnosis was mental and behavioural disorders due to psychoactive substance use and most of the patients were discharged only with oral therapy.

Patients in compulsory regimen have a severe mental illness with higher rates of readmission. We highlight the use of long-term injectable antipsychotics in terms of compliance. These findings corroborate the need for specialized and multidisciplinary approach in terms of psychosocial rehabilitation in these patients.

Survivors of critical illness stay frequently experience long-term mental health morbidity, suggesting that many critically ill patients with COVID-19 may also show a high prevalence of psychiatric conditions.

To describe depression in COVID-19 survivors 4-months post-hospital discharge and to examine its association with health-related quality of life (HRQoL).

This pilot study involved COVID-19 adult patients admitted in Intensive Care Medicine Service (ICMS) of a University Hospital. Exclusion criteria were: ICMS length of stay (LoS)≤24h, terminal illness, major sensory loss and inability to communicate at the time of assessment. All participants were evaluated at ICMS scheduled telephone follow-up appointment, with Patient Health Questionnaire (PHQ-9) (depression) and EQ-5D-5L (HRQoL). Critical-illness severity was assessed with APACHE-II and SAPS-II.

Twenty patients were included with a median age of 62(range: 24-77) y.o., the majority male (75%) and married (70%). Median (range) APACHE-II and SAPS-II was 17 (5-34) and 32.5 (7-77), respectively, and LoS was 18 (4-58) days. Overall, 25% patients presented depression symptoms and most reported problems on EQ-5D-5L domains of pain/discomfort (65%), anxiety/depression (55%) and mobility (50%). Depression scores were higher in patients with problems in EQ-5D-5L domains of usual activities (median 4 vs 1.5; p=0.046), pain/discomfort (median 0 vs 4; p=0.004) and anxiety/depression (median 4 vs 0;p<0.001).

These preliminary findings show that depression is frequent in COVID-19 survivors and it is associated with worse HRQoL. This pilot study highlights the importance of psychological assessment and treatment of COVID-19 survivors, in order to minimize its negative impact on HRQoL, optimizing their recovery.

Identifying distinct dimensions of negative symptoms in First Episode Schizophrenia (FES) might result in a better understanding and treatment of this invalidating symptomatology.

Aim of this study was to examine negative symptom structure in FES patients using the Positive and Negative Syndrome Scale (PANSS).

All 147 participants, aged 12–35 years, completed the PANSS and the Global Assessment of Functioning (GAF) scale. A principal component analysis with varimax rotation was performed to investigate PANSS negative symptom structure in the FES total sample.

A 2-factor model (i.e. “Expressive Deficits” and “Asociality” dimensions) was identified. Only “Expressive Deficits” domain had a significant negative correlation with baseline GAF score.

This bipartite solution seems to be adequate to describe the phenomenological variety of negative symptoms experienced by FES individuals at the point of entry in early intervention services.

No significant relationships.

Self-disorders (SDs) have been described as a core feature of schizophrenia-spectrum disorders. Previous studies conducted on heterogeneous clinical adult and adolescents samples demonstrated that SDs aggregate selectively in the schizophrenia spectrum disorders compared to other disorders.

To examine the specificity of SDs for schizophrenia spectrum disorders in adolescent inpatient sample.

Fifty-five adolescent inpatients admitted to the Child Psychiatry Unit at the Sapienza University in Rome were assessed for psychopathology using Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL), Structured Interview for Prodromal Syndromes (SIPS/SOPS),Examination of Anomalous Self-Experiences (EASE), Multidimensional Anxiety Scale for Children (MASC), Calgary depression scale for schizophrenia (CDSS)

Patients, aged 14-18 years, were divided in four diagnostic groups: schizophrenia spectrum disorders (5 pts.), mood disorders (19 pts.), anxiety disorders (27 pts.) and other disorders (4 pts.). Frequency of self-disorders was different among the 4 groups. Including patients schizotypal personality disorder in the schizophrenia-spectrum disorder group, the difference is still significant. Mann-Whitney U test shows no differences between EOP and UHR patients in SD. Furthermore, correlations between EASE total score and Calgary and MASC total scores were significant.

Our results confirm the specificity of SDs for schizophrenia spectrum disorders and also the belonging of schizotypal personality disorder to schizophrenia-spectrum.

Understanding suicidal ideation and its association with childhood adversity is crucial for preventing suicide. Although the “healthy immigrant effect”, whereby immigrants are healthier than the native-born population, has been well documented across studies, little research has examined the presence of such effect on lifetime suicidal ideation (LSI) and its association to early adversity.

The aim of this study was to compare the prevalence of LSI between the immigrant and native-born population in Chile and explore the association between childhood adversity and suicidal ideation in immigrants.

Data from two cross-sectional health surveys: the Santiago Immigrant Wellbeing Study (STRING, n=1,091; 2019) and the Chilean National Health Survey (ENS2016, n=3,432) were used. Each study used multistage probability sampling and estimates were weighted to approximate the distribution of demographic variables in each population. Outcomes included LSI measured by WHO-CIDI and an adapted version of the Adverse Childhood Experience Questionnaire. Multivariate logistic regression was employed.

indicated that immigrants were less likely to report LSI compared with the native-born population. Moreover, male and female immigrants had lower risk of having SI than native-born counterparts. After controlling for socioeconomic status, social support, and health conditions, childhood adversities predicted an increased risk of LSI in immigrants. No gender differences were found in the effects of childhood adversity on suicidal thoughts.

Findings confirm the presence of a healthy immigrant effect in LSI and support a life course perspective, highlighting the importance of assessing early life disadvantages to understand suicidal ideation among immigrants.

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

Empathy is a social emotive skill that let to experience the same feelings of another person without being in the same situation. It changes during the growth becoming more over sophisticated with the involving of cognitive functions such as perspective taking (Hoffmann, 2000). Several researches observed a correlation between empathy and psychopathologies that involve cognitive functions such as attention and executive functions (Abdel-Hamid et al., 2019; Blair, 2018; Pijper et al., 2018) or decision-making (Francis et al., 2019).

To investigate the impact of cognitive impairment on different empathy dimensions.

80 subjects with severe neurocognitive deficit were examined. WAIS-R, neuropsychological battery and IRI test were performed.

The impairment of perspective-taking dimension was significantly noticeable (=or<17/30). In addition, impairments of self-regulation process and inner-state monitoring mechanisms were also observed (=or<18/40).

According to previous researches, this study confirms that empathy can be reduced when cognitive functions are compromised by psychopathologies or other medical conditions. Personal distress and perspective taking are empathy dimensions more affected in these cases.

This study wants to identify elements that could be informative in diagnosis and prognosis process of all those subjects who, following traumatic experiences, may develop PTSD, or even show signs of a more general and pervasive adaptation disorder, allowing a more precise damage assessment.

In this perspective, the analysis of the Rorschach test according to the comprehensive system of Exner, reading Structural Summary and the analysis of the constellations, allows to make interesting inferences, in all the descriptive areas associated with the key variables as regards not only the cognitive area (Processing >> Mediation >> Ideation) but also the affective and relational area (Interpersonal Perception >> Self-Perception >> Controll >> Affect), so as to have a picture of the functioning of these subjects and, to be able to plan a more functional therapeutic plan.

It is based on a sample of 29 subjects, 20 women and 9 men with an average age of about 35 years (54-14 years), who came to the attention of the clinic, at the request of the reference psychiatrist for diagnostic personality assessment. All subjects complained of various kinds of discomfort, affective-relational difficulties and anxious-depressive symptoms.

The results that emerged, in line with the initial hypotheses, converge in describing a personality style, not very resilient that could suffer in overcoming difficulties and in the search for new equilibrium.

It’s emphasized how the weight of a traumatic event like abuse can evolve into an adaptation disorder,strongly affecting the functionality of the subjects and their social integration.

Workplace violence (WPV) is a worldwide health problem with major individual and societal consequences. Previously identified predictors of WPV include working in psychiatry and work stress.

To investigate WPV trends during Norwegian doctors’ careers and assess individual long-term predictors in a longitudinal study.

Two nationwide medical student cohorts (n=1052) who graduated 6 years apart were surveyed at graduation (T1, 1993/94 and 1999) and 4 (T2), 10 (T3), 15 (T4) and 20 (T5) years after graduation (Figure 1). WPV was measured as multiple threats or acts of violence experienced at least twice. Individual predictors were obtained at T1 and work-related factors at T2–T5. WPV was analysed using repeated measures (Generalized Estimating Equations).

The prevalence of multiple threats and acts of violence declined at T2–T5 (p<0.001). Adjusted predictors of threats were male gender (odds ratio, OR 2.76, [95% confidence interval] 1.73–4.40; p<0.001), vulnerability traits (OR 0.90, [0.82–0.99]; p=0.031), older cohort (OR 1.63,[1.04–2.58], p=0.035) and working in psychiatry (OR 7.50, [4.42–12.71]; p<0.001). Adjusted predictors of acts were male gender (OR 3.37, [1.45–7.84]; p=0.005), older cohort (OR 6.08, [1.68–21.97]; p=0.006) and working in psychiatry (OR 12.34, [5.40–28.23]; p<0.001).

Higher rates of multiple threats and acts of violence were observed during early medical careers, with men at higher risk. Low levels of vulnerability traits (neuroticism) predicted independently the experience of violent threats. A cohort effect indicated a reduction in WPV (both threats and acts) in the younger cohort.

SK has received royalties from Schuhfried (Austria) for cognitive test and training software.

Covid-19 intensified public demand for telehealth services in child psychiatry. The shift towards online services raised concerns related to safety and quality of services.

The objective of the study was to explore outcomes and perceptions regarding psychiatric telehealth services from the patients’ and professionals’ perspectives.

Survey and questionnaires were the main methods to collect feedback after 1129 sessions conducted by psychiatrists and psychotherapists for 559 young patients in 2020.

Overall, patients/caregivers were generally satisfied with the quality of services, despite some technical issues and limitations of the platform. The most common outcomes of the sessions were: psychotherapy, in-depth assessment, pharmacotherapy, in-patient treatment, referrals for in-person appointments with other specialists, parenting strategies. Professionals gave more positive feedback on telehealth services after a few months of practice and training. Psychiatrists preferred conducting telehealth appointments for the patients they have previously seen in-person. The most common diagnosis were various neurodevelopmental disorders (48,9%), as well as patients within F84.0-F84.5 27,9%, and F84.8 (19,8%). Identification challenges, confidentiality and safety maintenance were among the top concerns for mental health workers. Specific guidelines for caregivers helped to use the appointment time effectively, prevent some technical and organizational issues and decrease negative effects of limited communication capabilities during a telehealth appointment.

Telehealth services in psychiatry are meeting real needs of patients, caregivers and professionals, and require further development. Proper training for professionals and clear guidelines for caregivers are among the key factors that enhance the quality of services.

Stressful life events (SLE) may influence the illness course and outcome.

The present study aimed to characterize socio-demographic and clinical characteristics of euthymic major depressive disorder (MDD) outpatients with SLE relative to those without.

This sample included 628 (mean age=55.1 ± 16.1) currently euthymic MDD outpatients, among them 250 (39.8%) reported SLE and 378 (60.2%) did not.

After univariate analyses, outpatients with SLE were most frequently widowed and lived predominantly with friends/others. Furthermore, compared to outpatients without SLE, those with SLE were more likely to have a family history of suicidal behavior, manifested melancholic characteristics and higher Coping Orientation to the Problems Experienced (COPE) positive reinterpretation/growth and less likely to manifest a comorbid panic disorder, residual interepisodic symptoms, have used psychiatric medications, and use current antidepressant medications. After regression analyses, having a family history of suicide (OR=9.697; p=≤.05), history of psychotropic medications use (OR=2.888; p=≤.05), and reduced use of antidepressants (OR=.321; p=.001) were significantly associated with SLE. Mediation analyses demonstrated that the association between current use of antidepressants and SLE was mediated by previous psychiatric medications.

Having a family history of suicide, history of psychotropic medications use, and reduced use of antidepressants may confer a specific “at risk” profile related to the enhanced vulnerability to experience SLE.

No significant relationships.

CONTEXTUALIZATION: Palliative sedation is a resource used to control symptoms of terminal patients in general. It is considered that it should be discussed by the professionals involved in the process, based on the competence of each one, as well as with family members and patients when possible.

AIM: To understand symbolic meanings attributed by nursing professionals who provide assistance to the terminal patient regarding to the act of the palliative sedation.

Strategies: Clinical-qualitative design, semi-directed interview of open questions in depth. Nine oncologist nurses participated in the study; sample closed by the criterion of theoretical information saturation. Interviews were audio recorded, transcribed fully, categorized by qualitative content analysis. The results were discussed by colleagues of the Laboratory of Clinical Qualitative Research at the University of Campinas.

FINDINGS: The treatment of the data led to 6 emerging categories: (1) death maintains its ambivalent values in our culture; (2) serving the death symbolically on a tray; (3) the act of sedation and its “unfortunate coincidences”; (4) palliative sedation: agent of a pious death; (5) late sedation: cause for distress to the professional; (6) the professional’s self-comfort considering certain psychological strength from the patient and family.

Final considerations: palliative sedation takes a general and individual meanings for the professional and even in case of experienced professionals regard to palliative sedation, the death phenomenon conduct them to expresses multiple and peculiar emotional issues, not ever perceveid.

No significant relationships.

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.

Bipolar disorder (BD) is a severe and chronic illness characterized by episodic changes in mood. The average onset of BD symptoms is estimated between 18 and 22 years. However, many adults retrospectively report symptoms onset in childhood or adolescence. Over the last decades, pediatric bipolar disease (PBD) has been the focus of increased attention mainly due to controversies surrounding its prevalence, diagnosis and treatment in the pediatric population.

To analyze pediatric hospitalizations related to BD held in mainland Portuguese public hospitals between 2000 and 2015.

This retrospective observational study analyzed all pediatric (<18 years old) inpatient episodes from 2000 to 2015 with a primary BD diagnosis, using an anonymized administrative database including all hospitalization from mainland Portuguese public hospitals. ICD-9-CM codes 296.x were used (excluding codes 296.2x; .3x and .9x). Age at admission, admission type and date, sex, charges and length of stay (LoS) were analyzed.

A total of 348 hospitalizations were analyzed from 258 patients. Patients were mainly young girls (60.6%), with a mean age of 15.24±1.87 years. The majority of the admissions were urgent (81.0%), and the median LoS was 14 days (IQR: 7; 24). Mean hospitalization charges were 3503.1€ with a total sum of 1.2M€ for all the episodes.

PBD hospitalizations occur predominantly in female patients during adolescence. The majority of them are urgent admissions. Descriptive studies will help to describe and characterize sociodemographic and clinical trends in PBD in order to better prevent acute hospitalizations with inevitable social and economic implications.

There is a lack of objective evaluation with validated tools in school children with intellectual disability (ID). Standardized and validated tools, allowing children evaluations and follow-up, exist but are poorly used. Our action-study wishes to develop evaluation practices to better adapt to the specific needs of children with ID.

We evaluated the multidimensional profiles (cognitive, adaptative and behavioral) of children with ID attending regular or adapted school system.

School children, aged 5 to 13 years old, with mild to moderate ID were enrolled in this French cohort study. The multidimensional evaluation consisted of a school evaluation grid proposed by the French educational system, a scale of school needs (GEVA-sco), an intellectual assessment (WISC IV), a behavior adaptative scale (Vineland II) and a behavior rating scale (the French Nisonger Child Behavior Rating Form (Nisonger CBRF)). The results of this multidimensional assessment were analyzed.

Between November 2014 and June 2016, 121 children were enrolled, 3 children were lost to follow-up. Analysis was performed on 118 children. Seventy one (60.2 %) were male. Fifty-two (44.1%) were aged 6 to 9 years. Sixty-eight (57.6%) children were in regular schools and 50 (42.4%) in adapted schools. Children in regular schools had a higher mean IQ score (57.5) than children in adapted schools (43.5). The adaptative behavior profile of children in regular school is less severe than in children in adapted schools.

Multidimensional evaluations allow optimizing and personalizing support. Evaluation of adaptative behavior is more informative than cognitive profile which does not differentiate between children skills

No significant relationships.

The perceived self-efficacy, framed by Bandura, is one of the most important concepts within Cognitive Social (Villegas Barahona et al., 2018). General self-efficacy is defined, as the global confidence a person has in order to perform tasks successfully (Stanley & Murphy, 1997). The perception of stress may be more for people with lower level of self-efficacy (Shilpa & Prasad, 2017).

Students often suffer from stress (Saleh et al., 2019) and student health intervention and prevention programs must therefore act on this variable. The French version the General Self-Efficacy Scale could be an element for the validation of these programs.

955 French students aged 17 to 67 (M = 22.22; SD = 5.1) participated to the study. We performed an Exploratory Factor Analysis (EFA) to determine the most appropriate factor structure then a Confirmatory Factor Analysis (CFA).

Kaiser’s criterion pointed towards a one-factor model while Cattel’s criterion pointed towards a two-factor solution. Both models have been tested and the two-factor model seemed to be better. Indices showed an excellent fit between the model and the data (CFI = 0.97, TLI = 0.96, SRMR = 0.035).

We have tested two models and one of them, the two-factor model, presented better psychometric qualities. However, the one-factor result is also satisfactory and it will be discussed in the communication.