An important aspect of rehabilitation programmes is assessment of their effectiveness, which is carried out mainly through clinical and psycho-pathological examinations, psychometric and psychological scales and questionnaires. The use of biological markers of the schizophrenic process to assess the effectiveness of rehabilitation assistance is of considerable interest.

To compare the clinical and socio-psychological characteristics of schizophrenia patients receiving psychosocial treatment in various forms of psychiatric care with the level of immune system activation reflecting the activity and severity of the pathological process in brain.

77 schizophrenia patients in remission of varying quality were examined, of which 52 patients (the 1st group) participated in a long-term comprehensive rehabilitation programme (3.7±2.5 years) in non-profit organization, and 25 patients (the 2nd group) received medical and rehabilitation assistance in the psychiatric day hospital (duration of treatment no more than 60 days). PANSS, HDRS, SAS-SR, SF-36, BRS scales were used. The activity of the pathological process was evaluated by the level of inflammatory markers.

Both patient groups showed a similar increase in the level of inflammatory and autoimmune markers compared to control (p<0,01). The 1st group compared to the 2nd one had a significantly higher level (p<0,05) of social functioning, stress resistance, awareness of the disease, motivation, comprehensiveness, as well as less the severity of psychopathological symptoms.

The results indicate the effectiveness of a long-term comprehensive rehabilitation programme to stabilize clinical remission, improve social functioning and the quality of life in schizophrenia patients, despite the active pathological process in brain.

The COVID-19 pandemic has significantly impacted the delivery of mental health services globally. Within Australia, the COVID-19 pandemic and subsequent containment measures have led to reduced face-to-face attendances. To maintain access to mental health consultations, new telehealth services were introduced by the Australian Government in late March 2020.

We aimed to quantify the impact of the COVID-19 pandemic on patterns of mental health attendances in Australia using an interrupted time series model.

To characterise patterns of mental health service utilisation, monthly mental health attendances between January 2016 and June 2020 were extracted from the Medicare database, stratified by clinician type: general practitioner (GP), psychiatrist, and allied health. We used triple exponential smoothing to model attendances between January 2017 and December 2019. Observed and predicted attendances between January and June 2020 were compared with 95% confidence (p<0.05).

Our models showed decreased mental health attendances in March and April, consistent with all healthcare services during this time. While uptake of telehealth was significant, it only partially covered the reduction in mental health attendances.

Our modelling highlights the significant impacts of the COVID-19 pandemic on mental health services in Australia, with telehealth only partially compensating for the reduction in face-to-face attendances. These results suggest that telehealth services may not be suitable for all individuals (e.g. those without reliable internet access). Given that telehealth will likely remain a feature of mental health service provision, outreach and face-to-face services should be considered for vulnerable groups

No significant relationships.

BipolarDisorders (BD) are regarded as a multidimensionaldiseaseinvolvingbothpsychological and physicaldeterminants. Althoughmood dimension andthymicinstability areconsidered as the « core » aspect of bipolardisorders, itis crucial to note thatsomaticproblemsfrequentlyoccur in BD,deeplyworsening the prognosis.

Herewedescribea case of atwentyyearshistory of psychiatricimpairment, diagnosedlaterwithcardiac malformation.

Female patient H.G has been admitted for the first time to psychiatric department ‘A’ of Razi Hospital,treated for type 1 bipolar disorder since 2004 with poor therapeutic compliance. We reviewed the clinical and paraclinical data.

The patient was hospitalized for a severe manic episode with psychotic features, without cardiac personal history. The patient was asymptomatic and physical examination showed no abnormalities. Following a routine electrocardiogram, an acute coronary syndrom was discovered (inverted T waves seen in V1 to V6). Cardiac troponins were not elevated. According to cardiology recommandations, ischemic heart disease could not be ruled out and extensive cardiovascular investigations were needed. Antipsychotics and mood stabilizors were contraindicated.Therefore, the manic episode could only be managed using benzodiazepines. Given contradictions between clinical, electrocardioagraphic and imaging findings,coronary angiography was necessary. Results showed no significant stenosis of coronary arteries and a myocardial bridging of the left anterior descending artery and we were able to put her on antipsychiotics and moodstabilizer, almost two months after her admission.

This case underlines the significant impact of somatic comorbidities in therapeutic management of bipolar disorders. Cardiovascular diseases in particular cause a delay in treatment initiation and an increase in patient length of hospital stay.

No significant relationships.

Day care programs have been extensively used to treat people with acute psychiatric disorders. Day hospitals (DH) can act as an alternative to admission in patients with acute symptoms, shorten the duration of admission, be useful for rehabilitation and maintenance care or enhance treatment in patients with poor adherence to outpatient care. Few research has been conducted in delusional disorder (DD).

To investigate whether DH care increases adherence with psychiatric appointments in patients with DD. To describe functions of partial hospitalization in DD.

Comparative study including DD patients who attended a DH (Group 1:n=12) versus patients who did not receive DH care (Group 2;n=7). Patients attending DH were classified into 3 groups according to the program function at referral. Adherence with outpatient follow-up appointments (primary outcome) and pharmacy refill data (secondary outcome) were assessed after discharge over a 6-month period (DH) and compared with group 2. For statistical analyses, non-parametric tests were performed.

Program function (DH): alternative to admission (n=4); shortening of admission (n=5) and enhancing outpatient treatment (n=3). Patients receiving DH care were more frequently referred from the inpatient unit or emergency department compared to those who did not attend DH (commonly referred from primary care services). No statistically significant differences were found between both groups in adherence to psychiatric appointments. Patients who attended DH showed higher compliance with antipsychotics (89.29% vs.72.62, p<0.05).

DH care may be a useful alternative to increase adherence with antipsychotics in DD patients with poor awareness of illness.

AGR has received honoraria, registration for congresses and/or travel costs from Janssen, Lundbeck-Otsuka and Angelini.

It is large known that Coronavirus outbreak has had a psychological impact on the general population, specifically on those with a mental disease as Borderline Personality Disorder (BPD) and their relatives.

The aim of the study is to identify and examine the individual and familiar impact of the coronavirus outbreak on patients diagnosed with BPD and their parents.

A qualitative research design using focus groups was selected to identify and discuss participants’ experiences, beliefs, perceptions and attitudes. The target population consisted of patients with BPD and their parents. Participants were recruited from the BPD psychiatric service from the Hospital Universitari de la Vall de Hebron (Barcelona, Spain). Data was collected via two focus groups, one with patients with BPD and other with their parents. Content analysis was used to determine categories and themes.

The qualitative analysis of participants’ perceptions are presented using the following themes: changes and difficulties during lockdown, after lockdown concerns and challenges, general learning, and future needs. Results identify factors associated with the COVID-19 outbreak and other factors already present as family dynamics and individual difficulties.

Findings have been discussed focusing on individual and familiar impact, and allows us to consider challenges precipitated by the COVID-19 pandemic. The study evidence that a family intervention approach is essential to enhance BPD treatment.

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

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.

Health care workers in emergency department and intensive care are usually exposed to stressful situations, which require an early intervention.

To assess the prevalence of anxiety among health care workers in emergency department and to determine its associated factors.

It was a cross-sectional, descriptive and analytical study including health care workers assigned to emergency ward and intensive care unit of Hedi Chaker and Habib Bourguiba hospitals in Sfax and the regional hospital of Kebili. Data was collected by an anonymous and confidential self- administered questionnaire. We used hospital anxiety and depression scale (HAD) to assess anxiety and depression.

The participation rate was 48.8% (n=240). The mean age was 37 years, 59.2% were female and 62% were married. Mean work experience was 11 years. 79.2% assured night shifts (average= 1.5 night shifts per week) and 71.7% benefited of compensatory rest. Our study revealed that 32.5 % of health care workers were suffering from anxiety. In univariate study, anxiety was significantly correlated with the female gender (p=0.004), the lack of practice of leisure activities (p=0.004), with absence of compensatory rest (p=0.001), with sleep disturbances (p=0.001) and with depression (p<10-3). Multivariate study pointed that anxiety was associated with lack of practice of leisure activities (OR=2.7[1.09-6.99]; p=0.006), absence of compensatory rest (OR=2.7[1.3-5.5]; p=0.004), depression (OR=3[1.5-6]; p= 0.001) and with sleep disturbances (OR=2.8[1.4-5.7]; p=0.004).

Anxiety affected one in three emergency caregivers. Stress management programs for emergency caregivers can be of great help in dealing with this problem.

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.

Galactorrhea wiht antidepressants SSRIs or SNRI is a rarely adverse effect. Some authors believe that the risk of galactorrhea in women who use SSRIs is 8 times higher than in patients treated with other types of drugs. Serotonin is believed to be a potent physiological stimulator of prolactin release.Prolactin stimulates the growth of the mammary glands and the galactorrhea. The SSRIs would activate the serotonergic pathways, these in turn would stimulate the release of prolactin directly in the pituitary and in the hypothalamus, inhibiting the release of dopamine and increasing the release of stimulating factors. The main inhibitor of prolactin secretion is dopamine.

The objective is to reveal this rare complication through the report of a clinical case

A 45-year-old woman with a diagnosis of mixed anxiety-depressive disorder. Treatment with 20 mg of escitalopram was started, with a good therapeutic response, but with breast pain and swelling. She was switched to duloxetine 60 mg, with a good response and adequate tolerance. At 6 months of treatment, she begins to present breast pain and yellow-green breast discharge, with elevated prolactin levels and normal cranial MRI.

She was diagnosed with functional hyperprolactinemia, and treatment with vortioxetine was started. Finally, the Prolactin levels normalize.

Galactorrhea is a very rare and annoying side effect that can lead to discontinuation of treatment and requires a change in the therapeutic strategy.

No significant relationships.

Comorbid substance misuse in mental illness presents a significant challenge to mental health services. It may lead to higher rates of relapse, hospital admissions and poorer treatment outcomes. Up to 47% of inpatients in Irish mental health units may experience substance misuse. Despite the Irish government’s ‘Vision for Change’ policy (2006), access to specialised services remains variable.

Evaluate: -prevalence of substance misuse at an Irish mental health unit. -quality and detail of the recorded substance misuse history. -access to specialised services for patients experiencing substance misuse.

A retrospective chart review of inpatients in a mental health unit over 12 months, was completed. Information recorded included: demographic details, diagnosis, substance use history; access to substance misuse services. Microsoft Excel was utilised for data input and analysis.

267 patients were admitted over twelve months. Substance misuse was the primary diagnosis of 6% and the secondary diagnosis of 67%. 46% of patients reported current substance misuse, 52% reported historical substance misuse. Frequency and quantity of use was documented in 65% and 48% of cases respectively. 4% of patients with a substance misuse history were in current contact with addiction services.

Although 46% of patients reported substance misuse, only 4% were in contact with specialised addiction services. This highlights a significant unmet need. There was variability in the quality of the recorded substance misuse history. In order to fully understand comorbid substance misuse, this be addressed. The addition of a more formatted substance misuse section, to admission proformas, may help to alleviate this issue.

Conventional psychiatric services are not always acceptable to indigenous communities and people.

To present successful models of interactions of psychiatrists with indigenous patients and communities based upon our work with five communities in Maine.

We reviewed the strategies that worked for community interaction from our project for supporting indigenous communities to implement medication-assisted treatment and we reviewed the literature to see what other strategies are reported successful.

Psychiatrists working in these communities may need to share more personal details than to what they are usually accustomed to be accepted. They may need to acknowledge local culture and spirituality and work with traditional knowledge holders to create collaborative healing approaches. As part of this, a narrative approach appeared to work best in which the psychiatrist worked within the stories and beliefs of the community which required taking the time in dialogue to learn those stories and beliefs. Specifically, we address the challenges of flying into northern, rural, and remote communities, of academic physicians consulting to tribal-based opiate treatment programs, of modifying usual counseling techniques such as motivational interviewing to an indigenous population, and of the changes made in practice styles when taking into account the critiques made by indigenous people about medicine in general and psychiatry in particular.

We propose that participatory action-based approaches can improve service delivery to indigenous people. Indigenous cultures share a collectivist mindset in which the needs of the group supersede the needs of individuals, a reliance upon stories, and commitment to a biopsychosocial and spiritual approach.

Research has shown that negative affect leads to unhealthy eating, the top cause of death in the United States.

This project examined whether AR (Affect Regulation) can be applied to incidental negative affect to improve eating behavior.

We conducted four studies.

In Studies 1 and 2 (n=80), we developed a autobiographical negative affect induction, showed that it induces negative affect, and demonstrated that participants can learn to downregulate this negative affect. In Study 3 (n=40), participants completed a three-phase dietary food choice task. In phase 1, participants made food choices under neutral conditions. In phase 2, participants made food choices after receiving the negative affect induction from Studies 1 and 2. In phase 3, participants made food choices while downregulating the negative affect caused by the induction. In phase 2, participants placed less importance on health (b=-0.15, z=-5.99, p<.001) when making food choices than under neutral conditions (phase 1). In phase 3, participants successfully downregulated their negative affect (b=-1.2, t=-22.01, p<.001) and placed the same level of importance on health when making food choices as in phase 1, indicating that AR applied to incidental affect is an effective method for improving eating behavior. In Study 4 (n=120), we pre-registered and replicated our findings from Study 3. In addition, we fit drift-diffusion models to participants reaction time data and show that these results extent to the by-participant weights participants place on health when making food choices.

These results are a step towards scalable AR interventions to improve eating behavior.

No significant relationships.

The mental health impact of the COVID-19 pandemic is well documented. Portugal entered the emergency state on 19th march due to rising numbers of infected patients. The emergency state introduced regulatory measures that restricted people’s movements, applied a curfew, and closed most non-essential spaces and activities, such as shops and religious celebrations.

To evaluate the rates of suicides during the emergency state in Portugal.

We obtained the number of probable suicides during 19th march and 2nd may 2020, 2019 and 2018 from SICO/eVM (Real Time Mortality Electronic Surveillance). This system is used for health planning in Portugal and provides provisory data which is updated every 10 minutes. ExcelÒ was used for the statistical analysis.

During the Emergency State in Portugal there were 57 probable suicides. Comparing to the same period in 2018 and 2019, there were 62 and 70 probable suicides, respectively. Social isolation, anxiety, fear of contagion, chronic stress, and economic difficulties may lead to the development or exacerbation of depressive, anxiety, substance use, and other psychiatric disorders. Literature on suicides due to COVID-19 mention not only fear of infection, but also social isolation and distancing and economic recession as causes for suicide attempts and completions.

During the emergency state there was not an increase of probable suicides, compared to previous years. The greater vigilance of people’s movements may have deterred many attempts. However, policymakers and health care providers must be alert as the current psychosocial predispose to an increase in suicide rates.

No significant relationships.

Obsessive-compulsive disorder (OCD) and schizophrenia (SZ) are both severe psychiatric disorders. Though these two disorders have distinct typical symptoms, there are partial polygenic overlap and comorbidity between the two disorders. However, few studies have explored the shared and disorder-specific brain function underlying the neural pathophysiology of the two disorders, especially in the aspect of dynamics.

To explore the abnormal characteristics of the dynamic functional connectivity (dFC) in OCD and SZ as well as the association between dFC metrics and symptom severity.

The resting state functional magnetic resonance imaging data of 31 patients with OCD, 49 patients with SZ, and 45 healthy controls were analyzed using independent component analysis to obtain independent components (ICs) and assigned them into eight brain networks (Figure 1), then used the sliding-window approach to generate dFC matrices. Using k-means clustering, we obtained three reoccurring dFC states (Figure 2), and state transition metrics were obtained

In a sparsely connected state (state 1), SZ showed both increased fractional time and mean dwell time than controls (P=0.047 and P=0.033) and OCD (P=0.001 and P=0.003). In a state characterized by negative FC between networks (state 2), OCD showed both increased fractional time and mean dwell time than controls (P=0.032 and P=0.013) and SZ (P=0.005 and P=0.003). Moreover, the fractional time of state 2 was positively correlated with anxiety scores in OCD (r=0.535, P=0.021, FDR corrected) (Figure 3).

OCD and SZ patients showed distinct alternations of brain functional dynamics.

No significant relationships.

Long-acting injectable antipsychotics (LAIs) can reduce relapse and hospitalization risk but they are not widely used in first psychotic episode (FEP) patientes.

To examine the effcacy of two of the most used second generation LAI antipsychotics (paliperione 3 monthly and aripiprazol 1 monthly) to reduce hospitalization rates.

We evaluated in a naturalistic study a sample of patients (n=277) with a FEP. We carried out a mirror-design study to compare the number of hospitalizations and days in hospital before and after the introduction of LAI paliperidone (3 monthly) or LAI aripiprazol. In our Early Intervention Services (Lehenak) antipsychotic treatment is not protocolized and is established for each patient according to the psychiatrist criteria.

We review the oucome of 277 FEP treated in our Early Intervention Service “Lehenak” with LAI paliperidone 3 monthly (n=156) or LAI Aripiprazol (n=121)

Both LAI paliperidone 3 monthly and LAI aripiprazol had a postive impact on hospitalIzation rate, decreasing them significantly after their introduction. These data also support a more extensive use of LAI paliperidone 3 monthly in FEP.

Presenting author has received honouraria for lectures or advisory boards from Janssen, Otsuka, Lundbeck and Angelini in the last five years

A large part of the Central African population has been exposed to potentially traumatic events as a result of the recent conflict, which has led to the breakdown of social ties.

Faced with this situation, the NGO Action contre la Faim proposed a psychosocial intervention aimed at helping the displaced people to reduce their psychological suffering and strengthen individual and community resilience.

After psychoeducation sessions organized in communities affected by the conflict, people identified with traumatic symptoms are invited to participate in a psychological support intervention. The protocol used is based on the Problem Management Plus (PM+), developed by the WHO. The approach was adapted in groups to reach more suffering people and also to take advantage of the group dynamic in the possibility of recovering and developing better resilience.

946 IDPs in the country’s capital, participated in the group intervention led by a team of paraprofessionals. Data collected from 111 participants show that after five weeks of intervention, there was a significant reduction in post-traumatic symptoms (PCL-5) and functional impairment (WHODAS). These results were confirmed during the post-intervention evaluation four weeks later. In addiction, participants declared that they had observed effects on their ability to live together in the community and to regain social cohesion.

This experience gives encouraging results with regard to the feasibility and replicability of the group protocol, taking into account specific cultural and contextual adaptations.

No significant relationships.

A person who has gender dysphoria can experience some difficulties in his/her/their life (as we can see even in language). These difficulties are mostly because of the binary gender system. Especially in countries like Turkey, homophobia is very common. Because of that, a homosexual person can think that he/she/they is a transgender.

At this point, group psychotherapies are worthwhile, especially for differantial diagnosis. These individuals can share their experiences about the process. On this way, they can also explore themselves.

We have a monthly group psychotherapy for transgender and gender nonconforming adults in our clinic. We accept the individuals who have problems about gender identity. All trans adults who apply to us and are considered to be suitable are directed to the support group.

An individual, aged 20, who defines herself as a FtM trans has joined to the group for 4-5 months. She was in hurry and had decided to go under surgery for gender transition. She was referred to surgery by another clinic which didn’t have a group psychotherapy. So she applied to our clinic. During the group psychotherapy, she realized that she was homosexual and gived up gender transition.

Group psychotherapy is helpful for trans individuals to reduce psychological distress and manage their process. This study shows that it is not the only benefit of group support psychotherapy. It also helps the individuals to explore themselves, like our case. Its benefit can be as major as saving themselves from an irreversible step and its consequences.

Bulgaria has undergone a number of very significant political and social changes over the past 150 years that has also impacted on the delivery of mental health care. There has been a 40% reduction in the number of inpatient psychiatric beds in Bulgaria within the past 20 years leading to the current state of approximately European average bed numbers per 100 000 population. This does not appear to have been accompanied by an increased investment in ambulatory / outpatient mental health services.

Description of the advantages and disadvantages of mental health services in Bulgaria, available staff and distribution in the country. The project RECOVER-E and its activities in Bulgaria are described.

Sources of health statistics of Bulgaria are used and analyzed. Maps and tables were used for visualization.

Taking into account the situation described in this way and the EPA guidelines for change in the system, a mental health strategy has been proposed.

It has a long and significant legacy of underfunding of mental health services, which has undoubtedly caused significant economic damage to Bulgaria through surmountable results increasing health and social care costs, and surmountable loss of economic productivity. A significant increase in the budget allocated to mental health and related social care services.

No significant relationships.