Huntington’s Disease is a neurodegenerative disease inherited in an autosomal dominant fashion.The underlying genetic defect is unstable CAG trinucleotide repeat expansion with a repeat length longer than 36 resulting in pathological aggregation of abnormal protein causing cell death.

The clinical symptoms encompass 3 main domains-motor,cognitive and psychiatric.The psychiatric symptoms often in atypical form appear decades before other symptoms causing significant impact on patient’s functioning and quality of life.

Here, we discuss an unusual presentation of Huntington’s Disease causing diagnostic dilemma.

Case report discussing the unusual presentation of Huntington’s Disease.

Case: Mr X is a 61 year old Caucasian male.He had an uneventful birth and early childhood attaining milestones appropriately. He experienced childhood adversity in the form of sexual abuse between ages 2-14 years. His mental health difficulties started following sexual abuse when he attempted to end his life by hanging and overdosing at age 15. He got married twice, both of which broke down. There is a history of significant alcohol abuse between ages 40-50. Following this, he had a myocardial infarction and a stroke requiring stenting.

He presented to Psychiatric Outpatient Services in 2011 with auditory hallucinations, social anxiety with panic attacks, OCD type rituals, claustrophobia and feeling hot all the time. He was started on an antipsychotic medication for psychosis ,but clinically deteriorated. He started having anger outbursts, marching on the spot ,and head banging. He was diagnosed with Huntington’s Chorea in 2021 after he had developed chorea. He currently has low mood and is head banging for hours.

Psychiatric symptoms in HD can span a variety of domains but most common are symptoms of frontal lobe dysfunction-disinhibition, poor attention, irritability, impulsivity and personality change. Apathy, emotional blandness and social withdrawal are also prominent features.

Mr X had strong family history of Paranoid Schizophrenia (aunt and cousin).There was no family history of HD. His mental health problems started early in life with DSH, Depression and Harmful use of Alcohol. He presented predominantly with psychotic symptoms like auditory hallucinations, social anxiety, paranoia. Motor symptoms started late which he incorporated into voluntary movements like head banging which made it difficult to differentiate from deliberate self harm.

Psychiatric symptoms constitute the core of HD. Studies have shown that though depression and personality change are typical of HD, there are number of other psychiatric symptoms that can impair quality of life. Early diagnosis and treatment of these symptoms will help patients and families to cope better with severe symptoms of this progressive disease.

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The advent of artificial intelligence (AI) and machine learning has sparked interest in its applicability in the mental health domain, offering potential improvements in the efficiency and personalization of psychiatric services.

To characterize the methodological and technical approaches in studies utilizing machine learning and natural language processing (NLP) within mental health, to evaluate their potential and impact in psychiatric clinical practice, and to address the associated ethical concerns.

A systematic review, adhering to the PRISMA guidelines, was conducted across four primary medical databases. Emphasis was placed on studies that applied machine learning and NLP techniques to psychiatric contexts, extracting data from sources such as medical records and social media.

From 327 identified articles, 58 were considered relevant. Major themes included symptom extraction, illness severity classification, therapy effectiveness comparison, and psychopathological insight derivation. Notably, most studies focused on specific populations like social media users, emergency room attendees, or those within medical databases. Methodological findings showcased a preference for efficient classifiers and Python as the primary platform.

Machine learning and NLP offer a promising new avenue for psychiatric research and clinical practice, enabling the extraction of previously inaccessible patient information and supporting the decision-making process. However, the field must address inherent limitations, ethical considerations, and ensure that the tools augment, rather than replace, clinical judgment.

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Depression, a pervasive mood disorder, significantly impairs one’s quality of life. Early Maladaptive Schemas (EMS), ingrained thought patterns stemming from early life experiences, play a pivotal role in shaping adult beliefs and behaviors. This study delves into the relevance of specific EMS domains—Emotional Inhibition (EI), Negativity/Pessimism (NP), and Social Isolation/Alienation (SI)—in influencing the severity of depression among medical students and diagnosed patients.

Our primary goal was to assess the correlation between specific EMS domains and depression severity in medical students and clinically diagnosed patients. We aimed to elucidate whether these schemas could serve as indicators for potential depressive tendencies or if they had a stronger association in those already diagnosed with depression.

We conducted a prospective cross-sectional analysis involving 73 medical students and 61 diagnosed depression patients (aged 18-32). Four key variables—Depression, EI, NP, and SI—were measured using the Beck Depression Inventory-2 and The Young Schema Questionnaire-Short-form-3 in the Romanian context. Statistical analyses, including correlation coefficients and t-tests, were employed to explore the relationships between EMS domains and depression severity.

In the non-clinical sample, we identified moderate, statistically significant correlations between depression and EI (r=0.63), NP (r=0.71), and SI (r=0.59). Conversely, the clinical sample exhibited slightly weaker, yet significant correlations (EI-r=0.42, NP-r=0.39, SI-r=0.29). Notably, significant differences emerged between the groups in all measured variables. These findings imply that while a positive correlation between EMS variables and depression exists in both samples, the association weakens in diagnosed patients, indicating that these schemas may be less predictive in this population.

Our study underscores the importance of understanding EMS domains in assessing depression severity. While specific schemas—EI, NP, and SI—correlate with depression in both medical students and diagnosed patients, this link is notably weaker in the latter group. Elevated EMS variables suggest a potential for future subclinical depression in medical students, but they might not strongly predict depression in those already diagnosed. These nuanced insights have implications for preventive interventions and therapeutic approaches tailored to individuals at different stages of depression, thereby enhancing targeted mental health care strategies.

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Medical students face an enormous amount of stress (Dyrbye LN et al. Ann Intern Med 2008; 149: 334-41). They suffer from higher rates of depression, anxiety, and suicide compared to the general population. Despite experiencing more mental health problems, there is a lack of research exploring ways to improve their mental health. Although there are a few small sample studies investigating the effectiveness of Mindfulness-Based Stress Reduction (MBSR) on medical students, there is no study comparing its effectiveness against an active intervention group in the literature (van Dijk I et al. Acad Med 2017; 92: 1012-1021)

We aimed to compare the effects of the Mindfulness-Based Stress Reduction (MBSR) and the Cognitive Behavioural Based Stress Reduction (CBSR) group interventions on depressive and anxious symptoms and perceived stress of medical students.

323 medical students applied to participate in one of the group interventions and were assessed with the Mini International Neuropsychiatric Interview. Of these, 253 (77% female, mean age=21.9 ± 2.9 years) were allocated into online MBSR (n=127) and online CBSR (n=126) groups after randomization. Their anxiety and depressive symptoms and perceived stress levels were assessed at baseline and after 8 weeks of interventions. 33,2% of participants (MBSR: n=39; CBSR: n=45) completed the protocol by attending five or more sessions. Both intention-to-treat (ITT) analysis and per-protocol (PP) analysis were used to assess outcomes. In the ITT analysis, we used multiple imputation to address missing values. All assessments and group interventions were done online.

In the ITT analysis, both MBSR and CBSR were found to be slight to moderately effective in reducing symptoms of depression (MBSR: d=.50; CBSR: d=.40), anxiety (MBSR:d=.73; CBSR: d=.52), and perceived stress (MBSR: d=.48; CBSR: d=.42), but they were no superior to each other. In the PP analysis, both interventions moderately to strongly improved the symptoms of depression (MBSR: d=1.03; CBSR: d=.74), anxiety (MBSR: r=-.74; CBSR: r=-.72), and perceived stress (MBSR: r=-.80; CBSR: r=-.68). While there was no statistically significant difference between them in reducing depressive symptoms and perceived stress, MBSR was found to be significantly more effective than CBSR in reducing anxiety symptoms (u=469, z=-2.756, p=0.006).

Both MBSR and CBSR improve symptoms of depression and anxiety in medical students after 8 weeks of interventions. Completing the protocol or attending more sessions may increase the effectiveness of the interventions. While the interventions did not show superiority to each other in terms of effectiveness in reducing depressive symptoms and perceived stress, MBSR appears to be more effective in reducing anxiety symptoms compared to CBSR in the group that completed the protocol.

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Bipolar Disorder (BD) is a complex psychiatric condition that typically manifests during late adolescence and early adulthood. Over the past two decades, international studies have reported that BD often goes unrecognized and untreated for several years, which can lead to negative clinical and functional outcomes. However, the components of delay in the diagnosis and treatment of BD in adolescents and young adults and various factors influencing those components have not been systematically explored.

To determine the known factors that contribute to delays in the treatment of BD in adolescents and young adults and identify current knowledge gaps.

A conceptual framework based on the Model of Pathways to Treatment by Scott and colleagues was used as a foundation for our search and extraction strategy to ensure all components of delay and potential factors influencing each component are explored. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline (PRISMA-ScR) to systematically search the electronic databases of MEDLINE (OVID), EMBASE, PsycINFO and CINAHL for peer-reviewed original research articles published from January 01, 2000 through March 29, 2023. Inclusion was restricted to studies with quantitative or qualitative data on individuals diagnosed with bipolar spectrum disorders with symptomatic onset or study participation between the ages of 13-24. Grey literature and studies not published in English were excluded due to resource limitations. Two independent reviewers screened the references retrieved by the literature search based on our inclusion criteria. The findings of included studies were summarized in a narrative and tabular form according to component of delay.

Our search yielded 5180 unique citations, of which 44 articles met our inclusion criteria. We present findings on the patient, illness, and healthcare provider/mental health system factors contributing to the delays in illness appraisal, help-seeking, diagnosis, and treatment.

To the best of our knowledge, this is the first systematic scoping review to explore the potential factors that influence delays in the treatment of BD in adolescents and young adults. Findings from this review will inform clinical practice and policy. We also demonstrate the utility of a systematic approach to identifying the components of delay, from symptom recognition through treatment, as a methodology to help identify knowledge gaps to inform future research.

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Despite promising research there is still hesitation in implementing peer support work in some hospitals. Especially in forensic hospitals reservations are held against peer support workers.

We aim to give an overview of reviews about the effects of peer support work in psychiatric settings and its implementation. Special emphasis on implications for forensic psychiatric settings shall be given.

Five electronic databases and archives of four relevant journals were searched in December 2019 and updated in April 2022. In addition, references of articles were searched and relevant authors were contacted for unpublished data. Results of reviews were clustered by one author and checked by another.

22 reviews were identified of which 15 reported on effects of peer support work and six on factors influencing its implementation and one review on both. Several effects of peer support work on clinical, psychosocial, organizational and other outcomes (e.g., cost savings) were described. Psychosocial outcomes were the most promising ones whereas no effects were described in most reviews for clinical, organizational and other outcomes. Factors influencing the implementation of peer support work were described during preparation, recruitment, early employment and further development of the peer support worker’s roles. Most factors, beneficial and challenging, were described for the preparation stage of the implementation process.

The authors of the reviews often reported concerns about the low quality of the included studies. Therefore, the present results have to be considered as preliminary. Nevertheless, it is clear that peer support has a positive influence on psychosocial factors and thus complements classic therapeutic approaches. To achieve the best possible effect, the implementation of peer support needs to be carefully planned. Further studies are necessary in order to be able to consider the effect of recovery support in a more differentiated way.

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Borderline personality disorder (BPD) is associated with excess suicide risk, natural-cause mortality, comorbid medical conditions, poor health habits and stress related epigenomic alterations. This presentation will report findings of BDNF and stress system associated epigenetic alterations in a group of severely impaired BPD and suicidal patients. Further, findings of GrimAge – a state-of-the-art epigenetic age (EA) estimator- in patients with BPD and attempted suicide patients will be presented. Genome-wide methylation patterns were measured using the Illumina Infinum Methylation Epic BeadChip in whole blood from well characterized 97 BPD patients, 88 suicide attempters and 32 healthy controls.

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Deinstitutionalization has resulted in diverse mental health care models, influenced by local resources, funding, and cultural factors. In Italy, 127 Department of Mental Health (DMHs) provide care for individuals with mental disorders. People with severe mental disorders (SMD) live independently or in residential facilities (RFs). Approximately half of the Italian DMH budget is allocated to RFs, serving around 3.6% of people with SMD. Italian RFs prioritize personal recovery, empowering individuals with SMD to live fulfilling lives despite symptoms and psychosocial challenges. While personal recovery is known to improve well-being and cost-effectiveness, its implementation in Italian RFs remains incomplete. There is insufficient evidence regarding its impact on various outcomes for residents, including health, psychosocial, and biological factors.

The EMPOWER Study aims to assess whether adding personal recovery to Treatment As Usual (TAU) in Italian RFs could improve functioning (primary outcome), health, biological status, productivity and interpersonal relationships (secondary outcomes) among patients receiving the personal recovery-oriented treatment, compared with TAU. Additionally, data will be collected from informal caregivers, mental health professionals, and concerning the recovery orientation of RFs.

This study employs a longitudinal cohort design, gathering data at baseline and six-month follow-up in Italian RFs. A cohort of residents over 18 y.o. who receive a personal recovery-oriented treatment, the Mental Health Recovery Star (N=20), is compared to a matched group of residents receiving the TAU (N=20). International standardized assessments collect patients’ data on functioning, psychopathology, need for care, quality of life (QoL), positivity, social network, service satisfaction, and patient stigma. Informal caregivers’ data includes burden, QoL, positivity, and service satisfaction. Mental health professionals’ data encompasses burnout, stress, stigma, positivity, and work satisfaction. The working alliance between professionals and patients is assessed. Clinical and biological exams (blood and saliva samples) are collected, along with actigraphy data on patients’ circadian rhythm and physical activities. Digital data through a mobile app captures psychopathology, productive activities, social network, using the Experience Sampling Method with questions defined with patients. Focus groups with patients, professionals, and informal caregivers are facilitated by an expert by experience. Recovery orientation of RFs is assessed.

Not yet available.

This study aims to generate novel insight that could improve our treatment approaches for patients in residential facilities.

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Symptoms of depression, anxiety and stress are more common in the population of nurses working in psychiatric hospitals than in many other segments of the health care system. These three elements of psychological distress (depression, anxiety, stress) may reduce the nurse’s ability to establish quality therapeutic relationships with patients, which are very important in the treatment of mental disorders. Some studies suggest that prosocial personality traits may have a protective role. Other research suggests that high levels of empathy, for example, may increase secondary traumatisation and lead to more pronounced symptoms of distress.

The main objective of the study was to examine the association of prosocial personality traits with symptoms of depression, anxiety and stress in nurses employed in a psychiatric clinic. The hypothesis was that more pronounced prosocial personality traits are associated with a lower expression of symptoms of depression, anxiety and stress.

The target population were nurses employed in a psychiatric hospital working directly with patients. No sample was selected, but the whole available population was invited to participate. The independent variable was prosocial personality traits measured by the Prosocial Personality Battery (PSB). The outcome was symptoms of distress (depression, anxiety and stress) measured using the Depression, Anxiety, Stress Scale-21 (DASS-21). The hypothesis was tested using three linear regression analyses.

Total of 63 MST were included with a median (interquartile range) age of 34 (24-42) years. Prosocial personality traits were statistically significantly associated with scores on the DASS-21 subscale measuring depression: personal distress (PD) (r = 0.32; P = 0.01) and self-reported altruism (r = 0.30; P = 0.02). Only the subscale measuring the specific personality trait of personal distress (PD) was statistically significantly correlated with the scores of the other two DASS-21 subscales, anxiety and stress (anxiety: r = 0.54; P < 0.001; stress: 0.46; P < 0.001). Helpfulness was negatively related to anxiety (b = -0.29; P = 0.03).

This research partially confirmed the hypothesis that stronger prosocial personality traits are associated with a lower prevalence of symptoms of depression, anxiety and stress in the MST of employees in a psychiatric clinic.

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Limbic encephalitis (LE) is a subacute or chronic, non-infectious inflammation of the brain, usually occurring in adulthood, with predominant involvement of mesiotemporal structures and a clinical manifestation consisting mainly of new memory impairment, affective disorder, temporal lobe epilepsy, psychoses, etc.

To point out the importance of knowledge of potentially treatable dementia syndromes such as atypical manifestation of probably LE.

We present a clinical case of a 47-years-old woman with an atypical dementia syndrome and typical radiological findings corresponding to a LE, among others, but without the previously known immunological antibodies.

According to the literature, the diverse subsyndromes of LE can be subsumed under the two main categories of “paraneoplastic” and “non-paraneoplastic”. In addition to the acute and subacute courses, there is increasing evidence for chronic, slowly progressive courses, which expand the spectrum of potentially treatable dementia syndromes. Understanding and knowledge of the broad, clinical syndrome of LE have increased dramatically in recent years. Both nosological classification through differentiated diagnosis and specific therapeutic protocols have become increasingly developed and established. Nevertheless, there are rare clinical cases with a clinical phenotype and radiological findings that correspond to LE, but are both non-paraneoplastic in origin and seronegative with respect to the previously known immunological typing by autoantibodies. This gray area of nosological entity represents a diagnostic and therapeutic challenge.

The authors would like to point out the importance of an adequate diagnosis of the forms of LE that have been nosologically classified so far and are partly well treatable. Limbic encephalitis is an important differential diagnosis in dementia, especially in young patients with atypical courses. There is a need for further research regarding better diagnosis and therapy of the so far immunologically unidentifiable forms of clinical LE.

Literature:

Bazir Ahmad et al., Practical Neurology 2011

Guidelines of the German Neurological Society (DGN), 2008

Leypoldt et al., Akt Neurol 2012

Prüss et al., Neurology 2012

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Experience of chronic stress among professionals is a risk factor for poor mental and physical well-being. There is limited knowledge regarding the kinds of interventions, and outcomes achieved using different modalities to address stress and burnout among teachers.

To undertake a scoping review of recent literature to determine psychological interventions and reported outcomes related to stress and burnout among teachers.

The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was followed. Relevant search terms were used to determine different interventions adopted to reduce teachers’ stress and burnout. Articles published between 2018 and 2022 were identified using five bibliographic databases. Relevant articles were extracted, reviewed, collated, and thematically analyzed, and findings s were summarized.

Forty studies conducted in Asia, North America, Oceania, Europe, and Africa, met the inclusion criteria. Sixteen kinds of burnout and stress-reduction interventions were identified. The most popularly studied intervention were Mindfulness-Based Interventions alone or in combination with yoga or Cognitive Behavioural Therapy (CBT), followed by Rational Emotive Behavioral Therapy (REBT). Mindfulness-Based Interventions led to decreased overall Teacher Stress Inventory (TSI) and emotional exhaustion subscale scores. REBT, primarily used with special education teachers, especially in Africa, has also shown positive results. Other interventions reporting positive outcomes include Inquiry-Based Stress Reduction (IBSR), the Stress Management and Resiliency Training Program (SMART), Cyclic Meditation, Group Sandplay, Progressive Muscle Relaxation, Autogenic Training, Sport-Based Physical Activity, Emotional Intelligence Ability Models and Christian Prayer and Prayer-Reflection

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Stress and burnout can have a negative impact on teachers and, very often, on the students they teach. Implementing suitable school-based interventions are necessary to improve teachers’ stress-coping ability, reduce the likelihood of burnout and improve general well-being. Policymakers, governments, school boards and administrators should prioritize the implementation of school-based awareness and intervention programs to mitigate teacher stress and burnout.

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Symptoms of anxiety can worsen cognitive decline in people with dementia, and symptoms of dementia and fears of further cognitive decline can cause anxiety. Advanced dementia is not necessarily associated with a loss of emotion, which means that people may still experience anxiety, but their ability to cope in a healthy way is reduced. The problem is exacerbated by the fact that hospital care alone can contribute to the severity of anxiety symptoms due to change in routine of daily activities, unfamiliar surroundings, uncertainty about health status, prognosis and various medical procedures. There are differences between women and men in the prevalence, course and manifestation of both dementia and anxiety disorders.

To examine whether there are differences between women and men in the association of hospital anxiety with eight symptoms of dementia: difficulties with memory, orientation, judgement, problem solving, fulfilling social obligations, daily activities at home and with hobbies, or personal care, in patients with mild to moderate dementia.

A cross-sectional study was conducted at Sveti Ivan Psychiatric Clinic in Zagreb in June 2023. The target population were hospitalised patients diagnosed with dementia, both genderes, aged 60-90 years, without psychotic disorder. Anxiety during hospitalisation was measured using the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), and the severity of dementia symptoms was measured using the Dementia Assessment Instrument (CDR). The hypothesis was tested using Wald test of differences between women and men in unstandardised linear regression coefficients of the HADS-A on individual dementia symptoms, after adjustment for age, education, presence of a married or stable non-marital partner and duration of current hospitalisation.

We enrolled 65 women and 35 men of comparable age. There were significant gender-related differences in the association between hospital anxiety and difficulties with judgement (P = 0.01), fulfilling social obligations (P < 0.001), difficulties with home and hobbies (P = 0.02), and personal care (P = 0.00). In women, more pronounced difficulties with judgement and with home and hobbies were associated with higher anxiety, and in men the presence of these two symptoms of dementia was associated with lower anxiety. Difficulties with fulfilling social obligations are associated with lower anxiety in women and higher anxiety in men. Difficulties with personal care were associated with lower anxiety in both genders, but this effect was stronger in men.

There are differences between women and men in the association between anxiety during hospital treatment and the severity of individual dementia symptoms. These differences are present in difficulties with judgement, fulfilling social obligations, home, hobbies and personal care.

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It is a well-known fact that regular physical activity (PA) has a positive effect on a person’s somatic health. Does PA have similar correlations with self-esteem in medical students of different cultural backgrounds?

To determine the intensity and correlations of PА and self-esteem in domestic and foreign undergraduate medical students

We carried out a survey of 305 domestic and 241 international medical students of both genders at Ulianov Chuvash State University. For this aim we used the Sociocultural Health Questionnaire (E. Nikolaev)

We have established that with the same duration of the sessions the average frequency of physical activity (PA) of foreign medical students is higher than that of domestic students (p=.001). The latter more often exercise in gyms (p=.001) and consume bodybuilding supplements (p=.01). Foreign medical students’ self-assessment of their health (p=.001) and sportiness (p=.001) is higher than that of domestic students (7.90 vs 6.98 и 6.72 vs 5.82 correspondingly). Higher frequency of PA correlates in domestic medical students with higher self-assessment of their successfulness (r=.47), attractiveness (r=.46), and confidence (r=.43); while in foreign students – of their sportiness (r=.49), confidence (r=.25), sociability (r=.23). Longer sessions of PA by domestic medical students are interrelated with higher self-assessment of their intellect (r=.35), confidence (r=.34), happiness (r=.34); while in foreign students – of sportiness (r=.47), health (r=.36), and successfulness (r=.36).

The revealed data testify to the fact that PA of both domestic and foreign medical students closely correlates with positive assessment of their own personality.

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Over the past decade (2010-2019), the number of people admitting to using cannabis in the European Union (including the United Kingdom, Norway, and Turkey) increased by 27%, from 3.1% to 3.9%. Notably, Portugal, Spain, and Luxembourg topped the list with the highest percentages of daily cannabis users among those who had consumed the substance in the last month.

With the relaxation of recreational cannabis laws in various European countries, such as Germany, Malta, and Luxembourg, there is a growing need for a public health-oriented and preventative approach. Drawing parallels with alcohol-related strategies, this session aims to explore this evolving landscape from a clinical perspective.

The focus will be on the World Health Organization’s definition of risky substance use, aiming to make it practical and applicable. Two existing proposals from Canada and Spain will be reviewed, with an emphasis on the role of standardized cannabis units in defining risk and the quest for consensus in this regard.

Additionally, the session will examine the similarities between alcohol and cannabis consumption, looking at the effectiveness of the Standard Drink Unit in early intervention and prevention of alcohol-related problems. Insights from the alcohol domain will be discussed, offering valuable lessons for preventing cannabis-related harm.

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Misophonia is a condition characterized by extreme emotional reactions, such as irritation or anger, triggered by specific sounds. Despite its prevalence, there is a lack of evidence-based treatment methods for misophonia.

This case report aims to explore the effectiveness of combining psychoeducation with Cognitive Behavioral Therapy (CBT) in the treatment of a misophonic patient. The focus is on reducing the patient’s emotional distress and improving their quality of life.

The patient is a 28-year-old woman employed as a salesperson in a busy city. Mouth smacking, gum chewing and clock ticking are the sounds that bother her the most. She has never used any medications or attempted any methods to alleviate her misophonia. Neither she, nor her family has a history of a psychiatric disorder.

The therapeutic intervention spanned eight sessions, each lasting around half an hour. The first two sessions, a patient history was taken and Mısophonia Interview Scale (MIS) was conducted. MIS comprised the Misophonia Checklist (MCL), which involved reading fifty misophonic sounds to the patient one by one. She then rated her discomfort in response to each sound on a four-point Likert-type scale. From the MCL responses, a total severity score (Misophonia Total Score - MTS), was calculated.

The treatment commenced with a psychoeducational component focused on enhancing the patient’s comprehension of misophonia. This phase aimed to elucidate the neurobiological underpinnings of the condition, common triggers, and the emotional reactions associated with it.

Then, CBT was employed to identify and challenge the patient’s negative automatic thoughts (NATs) linked to her misophonia. Three sessions primarily concentrated on identifying and managing NATs associated with her misophonia. These sessions equipped the patient with the skills to recognize and confront NATs through structured discussions and practical assignments.

The last three sessions centered on exposure therapy, with the goal of reducing emotional and physiological responses to triggers. Homework assignments during this phase encouraged the patient to independently practice exposure exercises.

The initial MTS was 54, indicating significant distress. After the interventions, the final MTS decreased to 35 and the impact of misophonic symptoms on her life decreased from severe to moderate.

Misophonia is a challenging disorder to treat due to its limited evidence-based interventions. This case report demonstrates that a combination of psychoeducation and CBT methods may hold promise in managing misophonic symptoms. However, it is essential to acknowledge the need for further research in this area, as misophonia’s treatment strategies require more robust empirical support. This case highlights the potential benefits of psychoeducation and CBT, emphasizing the need to explore and develop effective treatments for this debilitating condition.

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Diagnosis of behaviors in advanced neurocognitive disorders (aNCD) is one of exclusion, and the framework has been laid out in DSM-V. However, clinical assessments in aNCD become increasingly unreliable, and commonly used psychometric tools for clinical assessments lack reliability and validity, thereby making outcomes unreliable. Consequently, the syndromic and symptom management approaches for behaviors in aNCD behaviors have yielded poor results. To address this, the focus has shifted towards understanding the ‘meaning’ of behaviors in aNCD, recognizing them as a ‘mode of communication’. To date, there are no existing frameworks to ascribe ‘meaning’ to behaviors in aNCD.

LuBAIR™ paradigm is the first step in offering such a framework for understanding the ‘purpose’ and ‘meaning’ of behaviors in NCD. The ‘meaning’ ascribed to each behavioral category was used to guide the use of atypical antipsychotics in their management. De-prescribing was attempted on patients who qualified to enter this retrospective study. De-prescribing was defined as successful if individuals were completely withdrawn from AAP and remained off them for 60 days without the re-emergence of behaviors.

The data collected on the second occasion, in the successful and failed de-prescribed groups, were compared in this retrospective study. MANOVA, Chi-Square paired t-test statistical analyses were used to detect the differences in the behavioral categories between the two cohorts. Cohen d was used to measure effect size.

Patients who did not have Mis-Identification and Goal-Directed Expressions were more likely to successfully de-prescribe: X2 (1, N = 40) = 29.119 p < 0.0001 and X2 (1, N = 40) = 32.374, p < 0.0001, respectively. Alternatively, the same behavioral categories were more likely present in patients who failed de-prescribing: MANOVA and paired t-test (p < 0.0001). Atypical antipsychotics, in their role as an antipsychotic and mood stabilizer, may be used to manage Mis-Identification and Goal-Directed Expressions, respectively.

LuBAIR paradigm has the potential to guide the development of specific behavioral care plans and the use of AAP in managing individual behavioral categories. AAP use can be justified for managing Misidentification and Goal-Directed Expressions. Vocal expressions may warrant the use of AAP, pending further study. The LuBAIR paradigm offers guidance for de-prescribing AAP for all other behavioral categories in the LuBAIR Inventory. This study is also a preliminary step in validating the psychological theories used to support the individual categories. This workshop will educate the participants on the LuBAIR paradigm and its application in developing person-centered interventions for behaviors in a NCD.

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A 56-year-old patient diagnosed with bipolar affective disorder type II, who remains stable, with no manifest episodes, thanks to aripiprazole 60mg daily.

The aim is to carry out a brief review of the use of the drug as the only stabiliser in bipolar affective disorder.

A 56-year-old patient, who has been suffering from episodes of hypomania since the age of 40, with episodes of depression. After poor tolerance to the use of the usual stabilisers, and the impossibility of using antidepressants due to hypomanic swings, it was decided to start treatment with aripiprazole orally, up to a maximum of 60mg daily. Despite the fact that the patient, with this treatment, had no side effects and remained more stable psychopathologically, the patient did not comply adequately with the correct dosage, due to his rotating work shifts. This fact explained that although he acknowledged an improvement, he continued with episodes of depressive symptoms lasting several days followed by episodes of hypomanic characteristics.

For this reason, it was decided to change treatment to aripiprazole long-acting injectable, in order to ensure linear blood levels of the drug. Initially, it was decided to prescribe 400mg every 28 days. However, after the first administration, 20 days later, the patient began to show dysphoric mood, with marked emotional lability, living in an egodystonic manner. For this reason, the dose was increased to 600mg on a monthly basis. Since then, after a year and a half with the same treatment, the patient has been stable and in line. There has been no further decompensation of the underlying psychopathology and no side effects.

Aripiprazole in TAB is superior to placebo in type I patients, mainly affecting manic and mixed episodes, but not so much in depressive episodes. It has also been observed that it not only acts in the acute phases, but also has a stabilising function, preventing manic episodes.

One study showed that up to 65% of patients on oral aripiprazole in whom it was replaced by AOM remained clinically stable. In the same study, approximately 50% of those who completed 52 weeks of follow-up were able to maintain clinical stability.

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Internet gaming disorder has been associated with an excessive number of hours spent playing video games, which leads to a detriment of other daily activities and interests. In addition, it is associated with personality traits such as aggression and anger. In Portugal this relations are almost unexplored.

To explore the relationship between video game use, internet gaming disorder and aggression.

This study was applied to a sample of 202 subjects, aged between 18 and 29 years old (M = 22.5, SD = 3.006). Subjects fulfilled a sociodemographic and viodeogame pattern questionnaire, and the Portuguese versions of the Internet Gaming Disorder Scale (short form), and the Buss-Perry Aggressiveness Questionnaire.

In this study 20.3% (n = 27) of the males and 5.8% (n = 4) of the females use excessively videogames, considering the screen time recommended by the American Academy of Pediatrics. However, 81% (n = 70) of the sample have a positive self-perception of their use. 21.4% (n = 45) use videogames during day, 71% (n = 49) during night and 3.8% (n = 8) during dawn. The total score for internet gaming disorder was of 15.17 (SD = 6.006), but only 1 subject (0.5%) presented probable videogame disorder considering the sutt-off points. A positive and significant correlation was found between internet gaming disorder and physical agressiveness (.32**), verbal agressiveness (.28**) and hostility (.45**). Finally, a positive correlation was found between internet gaming disorder and time spent playing video games.

Our results, despite being merely exploratory, show us the relationship that exists between the use of video games, internet gaming disorder and aggressiveness. In that sense it is important to continue to explore internet gaming etiology and consequences.

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Tunisia marked a significant milestone in the fight against gender-based violence with the adoption of Organic Law No. 2017-58. This pioneering law in the region enhanced the protection of women and girls’ rights and introduced harsher penalties for perpetrators of sexist violence. However, the journey toward eradicating violence against women is complex and multifaceted.

Our aim is to explore how tunisian women perceive gender-based violence and their attitudes towards it.

A cross sectional online survey designed using Google Forms and distributed on social media platforms (Facebook, Instagram) was conducted from August 30th to September 25th 2023. The questionnaire, presented in the tunisian dialect, included questions about personal experiences with violence, knowledge of gender-based violence laws as well as their perceptions and attitudes towards gender-based violence. The sample consisted of women from various regions of Tunisia.

In our study, we analyzed a sample comprising 110 tunisian women, with 46.4% falling within the 20 to 30 age bracket and 36.4% belonging to the 30 to 40 age range. Half of the survey participants were unmarried, and the majority of them (97.3%) had attained a university-level education.

Our research revealed that 45.5% of the surveyed women reported instances of gender-based violence in Tunisia. However, only a minority of these individuals (22.2%) initiated legal proceedings, primarily citing a lack of confidence in the judicial system and fear of potential reprisals as their reasons.

A majority of the participating women expressed deep concern regarding the issue of violence against women in Tunisia.

When asked about their perceptions of the most prevalent types of violence in Tunisia, 76.36% believed that psychological violence was the most common, followed by sexual violence (21.3%). Economic and physical violence were perceived as less frequent (9.9%; 12.6%). These women attributed the primary factors contributing to violence against women in Tunisia to cultural norms and laws that they considered inadequately stringent. Indeed, 83.3% of them believed that the current legislation was not stringent enough to deter potential perpetrators, and 37.3% indicated that they were unaware of the existing legal framework.

Despite legislative advancements, gender-based violence remains a pressing concern in Tunisia. These findings underscore the importance of increasing awareness about available resources for victims, educating individuals about women’s rights and mental health, and building trust in the judicial system.

None Declared

Obsessive-compulsive disorder (OCD) has a high prevalence and causes a significative reduction in functionality and quality of life.

First and second line treatment is ineffective in a variable percentage of patients. In such cases transcranial magnetic stimulation (TMS) may be considered.

The goal of this study is to evaluate the impact of TMS treatment on obsessive-compulsive, anxious and depressive symptomatology in patients with OCD.

A prospective observational study was conducted, including all patients diagnosed with OCD who underwent TMS in the Psychiatry department of Centro Hospitalar Universitário de São João since March 2023.

Symptomatology was assessed using the Yale Brown Obsessive-Compulsive Scale (Y-BOCS), the Hamilton Anxiety Rating Scale (HAM-A) and the Hamilton Depression Rating Scale (HAM-D) before and after treatment.

Statistical analysis was performed using the SPSS-Statistics program. A significance level of 0.05 was considered.

As of October 31, 2023, nine individuals with OCD completed treatment with TMS, 33% male and with a median age of 40 years (range 33-57).

The median Y-BOCS score pre-TMS was 30 (range 20-33) and post-TMS 28 (range 16-34). The median difference was 2.5 (range -5-14) and was not statistically significant (p=0.128).

The median score on the HAM-A pre-TMS was 21 (range 9-41) and post-TMS 18 (range 11-24). The median difference was 0 points (range -4-21) and was not statistically significant (p=0.345).

The median HAM-D score pre-TMS was 26 (range 14-40) and post-TMS 19 (range 10-32). The median difference was 2.5 (range -3-20) and was not statistically significant (p=0.225).

Preliminary findings suggest that the impact of TMS on obsessive-compulsive, anxious, and depressive symptomatology in patients with OCD does not appear to be clinically or statistically significant.

Further results are necessary to confirm this trend.

None Declared