The need to implement a program of autonomy in the handling of oral medication has been observed at the time of discharge from the hospital.

- That the patient is able to know his medication, differentiating between active ingredient and commercial brand. - That the patient is able to interpret the guideline in the electronic prescription. - That the patient is able to prepare his weekly medication autonomously.

- The doctor in charge indicates the Program in those patients susceptible to benefit of the same and after consensus with the multidisciplinary team. He validates and prints the electronic prescription well in advance. Preferably the patient himself (alone or accompanied by family members or Educators) get their medication and a weekly “polydosis” at a pharmacy office bringing him with him to the Unit. - Occupational Therapy helps the patient interpret the electronic prescription guideline and place the weekly medication in the “polydosis” and works with the patient in forecasting execution tasks of medication needs for outpatient follow-up.

The program is well accepted by patients. None of the patients included so far have had an early relapse.

The program has helped patients interpret the medical indications given mnesical and executive difficulties of patients with severe mental disorder.

No significant relationships.

Early grief is a concept about which there is little literature. This generates difficulties in order to perform a differential diagnosis, as it poses complications to determine if the symptoms that the patient suffers are relative to the mourning or if they appear as part of a comorbid disorder.

To assess the difficulty in discriminating when accompaniment is necessary and when the patient can benefit from pharmacological, psychotherapeutic or combined treatment.

Patients’ data is obtained from their medical history as well as psychological interviews carried out during the process.

32-year-old woman, with a previous history of depression. The patient was living abroad when her father was diagnosed with a terminal illness, so she decided to return home, making a radical change in her life. She is currently facing the functional deterioration of her father, who is rapidly getting worse. The patient shows symptoms of anxiety, tendency to cry and apathy. 34-year-old woman, with no history in Mental Health. As a result of her father’s illness, the patient develops a clinical manifestation of anxiety and low spirits. After one year, the clinic is maintained according to the variations in the health of her father. She also reports problems concentrating, fatigue, ruminative thoughts and structured autolithic ideas. Finally, she is referred to begin a psychotherapeutic follow-up.

Bearing in mind that we are facing an increase in diagnoses of terminal illnesses, I consider it is necessary to reflect on this concept in order to provide a better response to patients.

No significant relationships.

When studying the multiple aspects of the problem of criminal offences of a sexual character committed by adult males towards teenage girls, the role of digital communication technologies is not taking into account.

To reveal the negative aspects of social and family connections and the influence of digital communications on the formation of deviations in psycho-sexual development of teenage girls who had become victims of sexual delicts of a non-violent character.

We have studied the specifics of psycho-sexual behavior of seventeen teenage girls, aged 12-16 and their Internet and SMS correspondence with adult males by analysis of semantics and pathos-psychological markers.

Intellectually, all the teenage girls are within normal age limits. They were bringing up in full, materially well-off families. Most of the girls’ parents experience a formal attitude towards them. The disrupted emotional ties of the teenage girls with mother or both parents leads to deviations in the development of normal teenage reactions, sexual attitudes. Their feeling of loneliness within the family, forces them to turn towards support to Internet-society or other adults of the opposite sex to their parents’ acquaintances. The desire to ascertain perfectionist expectations and self-assertion leads the teenagers to the realization of various forms of auto-destructive sexual behavior. They actively demonstrate in the Internet obscene photos of their genitals. While trying out their sexual importance, they persistently urge adult males towards sexual contacts.

Thus, the negative aspects of psycho-sexual development of teenage girls can disrupt their sexual behavior in adulthood.

No significant relationships.

Corpus callosum agenesis (CCA) is a rare congenital disorder in which there is a partial or complete absence of the corpus callosum. Within the framework of an anatomoclinical approach to schizophrenia, a few studies have focused on its association with neurological disorders, including CCA.

In this perspective, we report a rare case of an adolescent with intellectual disability, with whose complete CCA was revealed by a recent-onset schizophrenia.

A case report and literature review.

The teenager M.A. is from a first degree consanguineous marriage. He had no family history, no special habits and no history of seizures. Since early childhood, he had had a psychomotor acquisition delay and relationship difficulties that tended to worsen later. At school, he was teased by his peers and failed 4 times in different rows. At the age of 15, he dropped out of school. Verbal and physical aggressiveness, soliloquy, unmotivated laughter and vague ideas of persecution suddenly appeared, hence his psychiatric consultation one month later. Neuropsychological tests indicated current low Intelligence Quotient (60). Brain imaging revealed complete ACC (see Figure 1). He was diagnosed with schizophrenia and put on antipsychotic treatment at adequate doses and durations, with poor therapeutic response.

Our observation provides additional support for neurodevelopmental models of schizophrenia, and confirms literature data indicating that severe structural brain abnormalities would lead to early onset psychotic symptoms which are often refractory to pharmacological treatments

The year 2020 was marked by the COVID-19 pandemic. Health services were overwhelmed by the demands for care. Paramedics were both the main actors in the fight and the victims of this pandemic.

The objective of our work was to assess paramedics’ feelings and beliefs about COVID-19.

Descriptive and cross-sectional study including paramedics (nurses, orderlies) from the military hospital of Tunis. Data collection was carried out by a clinical psychologist. we studied paramedics’ feelings and beliefs about COVID-19.

A total of 161 paramedics agreed to answer our questionnaire. The average age was 37.73 years. The average number of years worked was 14.95 years. There were 85 women (52.8%) and 76 men (47.2%). The feelings about COVID-19 were anxiety in 127 (78.9%) paramedics and indifference in 34 (21.1%). The factors that could influence the spread of the pandemic were divine influence (25.5%), the organized fight against viruses (70.2%), our genetics (9.9%), mutations of the virus (6.8%), the BCG vaccine (21.7%), the Tunisian climate (5.6%), our food (13%).

The beliefs and feelings of paramedics regarding COVID-19 are many and varied. These factors must be taken into consideration because they influence the involvement of paramedics in the fight against the virus and their compliance with health and safety rules.

No significant relationships.

There is a plenty of literature on providing psychological services for psychiatry inpatients and outpatients. Seeing a psychiatrist for the first time can be stressful.

This paper will identify challenges in setting up a clinical psychology service for consultees seen in Reception Department with consultative and primary specialized health care. ‘Clinical psychology service’ is a project in Moscow Research Institute of Psychiatry providing services within the Reception Department setting. A need to address mental ill health issues (getting a diagnosis and treatment plan) within the broader psychosocial needs of consultees has been identified.

Clinical psychology established a brief intervention ‘service’ for consultees. Issues of establishing trust within this population suggested the need to provide a ‘named’ male or female psychologist. The psychologist accompanied psychiatric consultants’ recommendations to familiarize a consultee of the availability of the service. Evaluation of the service, including uptake, client satisfaction, and outcome, is ongoing using quantitative and qualitative methods. Data is presented on key themes identified in providing psychological services to consultees.

Key themes identified included: 1. Service development: establishing trust, ensuring confidentiality, close between consultants working, flexibility, crisis management, safety, establish links with other agencies; 2. Complex psychological and social needs: mental health issues, trauma, substance misuse, domestic and sexual violence.

Consultees present with a range of complex psychosocial needs. While this population may have reservations about accessing ‘standard’ mental health services, a flexible psychology service working in close liaison with psychiatric consultants may be effective in addressing these needs.

Psychosis are complex disorders due to their symptomatic and evolutionary heterogeneity. The genetic-environmental interaction model is the most accepted etiopathogenic model, in which neurobiological processes (genetic factors, connectivity and brain structure) and environmental factors (for example: childhood trauma) are studied. The association between suffering traumatic events in childhood and the subsequent development of a Mental Disorder is of increasing interest.

Analyze if a childhood trauma is a modulating factor of psychotic symptoms in patients with Mental Disorder. Analyze the implication of childhood trauma in long-term functionality.

The sample is made up of 37 patients with psychosis and their healthy brothers. Different sociodemographic, clinical and evolutionary variables were collected in all groups. The sample was evaluated using the semi-structured interview CASH, the WHODAS scale and the self-applied questionnaire CTQ.

We did not find significant differences between the scores of CTQ between patients with psychosis and their healthy brothers. Sexual abuse is significantly correlated with the presence of hallucinations, inappropriate affect, formal thought disorders and catatonic symptoms. Emotional neglect is significantly correlated with the presence of hallucinations, inappropriate affect, affective blunting, and anhedonia. Physical neglect is significantly correlated with flattery and blunt affection. Sexual abuse is correlated with poorer personal care. Emotional neglect is correlated with poorer personal care, poorer family functioning, and worse overall functioning in the last year.

The intensity of traumatic experiences throughout childhood could be considered a modulating factor of psychotic symptoms (positive, negative, disorganized and catatonic) and overall functioning (occupational, family, social and personal care).

Parkinson’s disease is a neurodegenerative pathology characterized by motor and non-motor symptoms. Hallucinations, especially visual ones, are frequent in this context, with an estimated prevalence of 16 to 40% and associated with a less favorable prognosis. These hallucinations can range from coarse formations to well-defined structures.

To assess the prevalence of visual hallucionations in a sample of patients diagnosed with Parkinson’s Disease.

A cross-sectional descriptive study conducted in a Neurology Department of a Level III portuguese hospital. The sample included patients with Parkinson’s Disease observed in an outpatient Neurology appointment between October 1 and December 9, 2019.

In the period considered, 100 patients with Parkinson’s disease were observed, 65% male, with an average age of 69 years. In 11% of the patients visual hallucinations were reported, of which about half were well defined. All of them had no previous history of visual hallucinations and were under dopaminergic medication.

The results show an inferior prevalence when comparing to the literature, albeit still frequent. Therapeutic adequacy has a well recognised impact at a functional level and prognosis. Therefore we stress the importance of a regular follow-up of these patients, recommending a rigorous and comprehensive clinical review.

Smart care in offices and industrials approach has the best way for the results of staying healthy in the transmission chain and this issue is not only a moral necessity but also it can be a successful plan where personal care centers start keeping the patients, employees, and experts of healthcare ward healthy by digital industries. In this project, the environment along with the individual`s body scan and accessing his /her biomarkers, the environment mechanism will be approached to the welfare level to disappear the disease, then change the air by antiseptic materials for air conditioning desirably.

Designing the self-care environment by accessing the smart elements decreases the pathogenic factors in the environment, by scanning the individual`s case and inquiring from health base, the features of the environmental elements will be optimized to normal situation.

Content analysis of environmental components of space and categorizing of sensors. Determining the basic model for programming Designing the architectural environment in accordance with the standards set in the previous section, preparation of the model with thermal, biological, biochemical,.sensors.

Designing the self-care environment by accessing the smart elements decreases the pathogenic factors in the environment, by scanning the individual`s case and inquiring from health base, the features of the environmental elements will be optimized to normal situation.

By a positive design in architectural changes in care units in the field of public spaces, offices and industrial parts, we can easily control individual behaviors in the face of pandemic diseases and decline their psychic side effects.

Our work experience requires investment to run on a real scale

The COVID-19 pandemic led to changes in how healthcare was accessed and delivered. It was suggested that COVID-19 will lead to an increased delirium burden in its acute phase, with variable effect on mental health in the longer term. Despite this, there are limited data on the direct effects of the pandemic on psychiatric care.

1) describe the mental health presentations of a diverse acute inpatient population, 2) compare findings with the same period in 2019, 3) characterise the SARS-CoV-2 positive cohort of patients.

We present a descriptive summary of the referrals to a UK psychiatric liaison department during the exponential phase of the pandemic, and compare this to the same period in 2019.

show a 40.3% reduction in the number of referrals in 2020, with an increase in the proportion of referrals for delirium and psychosis. One third (28%) of referred patients tested positive for COVID-19 during their admission, with 39.7% of these presenting with delirium as a consequence of their COVID-19 illness. Our data indicate decreased clinical activity for our service during the pandemic’s peak. There was a marked increase in delirium, though in no other psychiatric presentations.

In preparation for further exponential rises in COVID-19 cases, we would expect seamless integration of liaison psychiatry teams in general hospital wards to optimise delirium management in patients with COVID-19. Further consideration should be given to adequate staffing of community and crisis mental health teams to safely manage the potentially increasing number of people reluctant to visit the emergency department.

The quality of life is a multidiimensional and subjective construct, based on the patient’s experience.

The objective of this study is to observe if at the HIV - positive patient the quality of life in relation to health is a consequence of disease and treatment and if his perception about the disease changes his ability to have a full and useful life.

We centralized the data coming from a number of 600 patients registered in the Iasi Regional Center, for a period of 12 months. The side effects reported by the patients emerged from discussions with the infectious diseases specialist and the psychologist.

From 600 pacients, 59% of them were male with mean age of 21.1 years old. Approximately 14% of the patiens had stable jobs, the rest were unemployed or had part-time jobs. 38% came from foster care units of from broken homes. The average number of days of hospitalization was 4 days, 25% of them were at their first scheme, 10% in the seventh-eighth scheme. Among the antiretroviral side effects patients complained nausea and vomiting in 85% of cases, lipodystrophy symptoms in 25% of cases, diarrhea in 15% of the cases; regarding the psychological aspects, 65% of patients showed an above level of anxiety, 40% had depressive manifestations, 10% had specific obsessions-compulsions and 10% neurotic and hysterical tendencies.

We need a close collaboration between the infectious diseases specialist and the psychologists in order to enhance the quality of life of the HIV patient.

Covid-19 pandemic represents a sanitary crisis with social, economic and political negative impacts. Studies had well established the link between stress and the display or maintenance of addictive behaviour. Measures like social distancing and confinement imposed by governments during this pandemic, could explain an outbreak of internet addiction cases.

Assess the prevalence of internet addiction in times of the covid-19 pandemic and to study its relationship with personal and family factors but also with the psychiatric comorbidities.

We conducted a cross sectional analytical study during the period of the covid-19 pandemic, using an internet survey exploring socio-demographic and clinical data: through Hamilton depression and anxiety rating scale and the Rosenberg self esteem scale. The assessment of internet addiction was carried out using Young’s Internet Addiction test.

Our study included 150 users, the average age was 36 years, mainly made up of women, married, having children, with a good socioeconomic level and of university education. The prevalence of depressive and anxious symptoms were respectively 7.3% and 18.7%. The prevalence of internet addiction in our study was 9.4% including 0.7% having severe repercussions. Being married (p<10-3) and having children (p=0.006) were considered as protective factors against internet addiction. People having an internet addiction were at bigger risk of having low self esteem (p=0.023), depressive (p=0.04) and anxious symptoms (p<10-3).

Internet addiction is a new concept, though it’s impact on the well being is well established and it’s likely to worsen in times of pandemic. Therefore, it’s necessary to take preventive measures to deal with it.

No significant relationships.

Obsessive compulsive disorder (OCD) is a disabling condition that affects the quality of life of both the patient and the caregivers. Similarly, in patients with physical medical illness, caregivers face a significant amount of stress.

This study aimed to assess and compare the caregiver strain index between patients of OCD and medical illness. Moreover, this study will also compare the care giver strain index in the patients of OCD and physical medical illness depending on the severity and duration of the illness.

Study was done at Department of psychiatry, Teerthanker Mahaveer University, Moradabad. In this Cross-sectional study 2 groups of caregivers were included. The group 1 included 30 caregivers of obsessive compulsive disorder patients and group 2 included 30 caregivers for physical medical illness. The Yale-Brown Obsessive Compulsive Scale was used for measuring the severity of OCD and the stress in caregivers were drawn from Caregiver strain index.

This study reported a high objective burden among caregivers of OCD compared with the physical medical illness (P-value=0.002). The age of the caregivers also showed to be significantly associated with the stress in both the groups. The severity of the OCD was shown to be correlated well with the stress of the caregivers (P-value=0.032). In contrast, in physical medical illness the duration of the disease showed no significant association with the caregiver’s stress.

This study showed that in patients with OCD caregivers face a higher strain compared with the physical medical illness.

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 as cause of reduced quality of care and patient satisfaction. 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 intossication and substance abuse. Due to the high level of care needed by these, an excessive duration of LOS (length of Stay) can be counterproductive.

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

We enrolled 142 patients. The Crowding input factors are lower in the pandemic period: reduced attenders (41 vs 101) and reduced average waiting times (59 min vs 86 min). The Crowding throughput factors have instead worsened: LOS for both the visit rooms (810 vs 544 min) and the holding area (1205 min vs 947 min). The Crowding output factors also worsened: the percentage of access block is higher during the pandemic (10% vs 5%). The Total Access Block Time is significantly higher in the CoViD period for the holding area (1053 vs 930 min).

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

Electroconvulsive therapy (ECT) can be rapidly effective in treating severe depression. Right unilateral (RUL) or bitemporal (BT) electrode placement may affect the speed of ECT effectiveness although our current understanding of demographic and clinical factors for predicting predict speed of response and remission with ECT is limited. We investigated differences in improvement speed and also time to achieving response and remission criteria between brief-pulse moderate-dose (1.5 x seizure threshold) BT ECT and high-dose (6 x seizure threshold) RUL ECT. Additionally, we explored the influence of demographic and clinical characteristics.

Se analysed weekly 24-item Hamilton Depression Rating Scale scores obtained from severely depressed patients participating in the EFFECT-Dep trial (ISRCTN23577151). Improvement speeds in patients treated randomly with a course of either BT (n = 69) or RUL ECT (n = 69) were compared using independent sample t-tests. Weekly proportions of responders and remitters were compared using chi-square tests. Cox regression analyses were used to explore predictors of speed to achieve response and remission status.

Se found no differences between RUL and BT ECT in speed of improvement or time to achieve response or remission. Exploratory analyses indicated that a wide variety of demographic and clinical features did not serve to predict speed of response and remission to ECT.

Electrode placement did not substantially influence speed of improvement, response and remission with twice-weekly brief-pulse ECT. Minimising the cognitive side-effects of ECT may be of more relevance when choosing between BT and RUL electrode placement for ECT.

Declan M. McLoughlin has received speaker’s honoraria from Mecta and Otsuka and an honorarium from Janssen for participating in an esketamine advisory board meeting. The other author reports no conflicts of interest. This work was supported by awards from

1 in 4 women in Europe will experience domestic violence and abuse (DVA) in their lifetime. Abuse can take many forms, including, psychological, physical, sexual, financial, and emotional abuse. There is growing recognition of the health consequences of DVA in public policy and academic research across Europe and the globe. These include but are not limited to: a negative impact on mental health; increased substance misuse; increased presentation in emergency departments; increased rates of abortion or miscarriage; and increased presence of any sexual health problem. International and national policy guidance indicates that healthcare professionals have important roles in responding to patients experiencing DVA, usually with regard to identifying abuse and referring for specialist support. Barriers to engaging in DVA relate to lack of confidence in recognising abuse or initiating conversations about it, stigma surrounding DVA, fears of exacerbating violence, limited awareness of the resources available to support patients, and limited training in providing trauma-informed medical care. This session will give insight into efforts to improve the healthcare response to DVA. It will draw together examples of healthcare DVA programmes from across the globe and bring together lessons learnt about what works and what does not work in addressing DVA in clinical settings, with specific insights for professionals working in mental health services.

No significant relationships.

The term Munchausen syndrome was first used in 1951 after Baron von Münchhausen, a German nobleman known for his exaggerated storytelling. DSM-5 refers to it as factitious disorder imposed on self: “falsification of physical or psychological signs or symptoms, or induction of injury or disease, (…) in the absence of obvious external rewards”.

To report a case of Munchausen syndrome and highlight the impact on its physical and psychiatric approaches.

Description of a clinical case based on medical records and a brief review on Munchausen syndrome.

A 57-year-old female, with no previous psychiatric history, was evaluated by Psychiatry for complaints of depression with suicidal ideation. She reported family conflicts and a list of medical conditions and surgical interventions. According to the patient she was waiting for a cardiac transplant and said she had type 1 diabetes, myasthenia gravis, hepatic steatoses, dyslipidemia, hyperuricemia, mitral valve prolapse and was submitted to a thymectomy and cervical herniated disc surgery. She was on many different prescription pills. Even though she had blocked the access to her clinical records in other institutions, at our hospital she had multiple admissions to the emergency room, numerous follow-up appointments of different specialties and several allergies documented. She displayed many incoherencies throughout the interview, had a circumstantial speech and exuberant appearance.

Munchausen syndrome remains a challenging diagnosis to physicians. This condition is not only associated with significant morbidity and mortality, but also with unnecessary tests and procedures, iatrogenesis, prolonged hospitalizations and increased health costs.

No significant relationships.

During an out-of-hours shift, the initial assessment of a CAMHS patient is performed by the paediatric trainee, usually the paediatric SHO (senior-house-officer). During my placement as a paediatric SHO, I was aware of a gap in formalised metal state examination teaching for paediatric juniors, which would be crucial for a thorough assessment of these patients, and to better guarantee they are safely managed until further assessment.

The aim is to provide a short teaching session on mental state examining of the CAMHS patent to paediatric SHOs in order to improve their confidence in assessment.

In order to assess initial confidence in assessing the mental-state of a CAMHS patient, a pre-teaching questionnaire was given to the paediatric SHOs. A 30-minute teaching session on the mental state exam was then carried out and a post-teaching questionnaire was then given to the same trainees.

Paired sample Wilcoxons signed rank test found that training significant improved trainees’ confidence in taking a psychiatric mental state exam (p= 0.005, r = 0.628), and improved their confidence in presenting a mental state exam (p = 0.0041, r = 0.6420).

Being able to confidently assess the mental state of a CAMHS patient in an on call shift is important for the initial assessing paediatric trainee. However this is often not taught in the paediatric curriculum and trainees have expressed some anxiety in performing this assessment overnight, before a more comprehensive assessment by a CAMHS professional. A simple teaching session may help to reduce this anxiety and improve trainees’ confidence.

The demand for mental health care is increasing globally as a result of societal challenges such as automation, increased economic competition, unemployment and the growing impact of climate change. The direct and indirect economic costs of mental health problems are substantial, totalling over € 600 billion yearly across the EU (OECD 2018). The COVID-19 crisis has led to an additional increase in demand and has changed the way care is delivered. Since March 2020 there has been a significant increase in the use of e-mental health (eMH), telemental health in particular. eMH can contribute to keeping services, accessible, affordable and patient focused. The eMEN project (funded by the EU Interreg North-West-Europe programme) is promoting the latter through a European cooperation platform for eMH development, research and implementation. This platform focuses on high quality and professional ‘blended care’, which combines face-to-face and online treatment. The implementation of eMH has been slow and varies considerably between EU countries, even though this technology has been on the market for over 20 years. The reasons for this are related to quality problems (e.g. validation, usability), resistance from clinicians, lack of blended care treatment protocols, digital skills, reimbursement systems and policies and other barriers. Many service providers and public health authorities are increasing their efforts to overcome these barriers. This presentation will give a short overview of how the eMEN project is trying to overcome these barriers and accelerate the eMH implementation process.

No significant relationships.