Anorexia nervosa (AN) and bulimia nervosa (BN) take one of the first places in the risk of fatal outcome among eating disorders, have a tendency to chronicity and high suicidal risk. Psychopathological basis for AN and BN is a dysmorfofobia or a pathological dissatisfaction with one’s body, characterized by intrusive, overvalued or delusional ideas of physical disability. Dysmorfofobia affects the formation of affective pathology and reduces the life quality.

The study of the correlation between the degree of dissatisfaction with one’s bodies, affective disorders and life quality of patients with AN and BN.

130 female patients with AN and BN at the age of 13-44 years (the average age is 18). The disease duration from 6 months to 24 years. Validated Questionnaire image of one’s own body (QIOB) and the Scale of satisfaction with one’s body (SSOB); Hospital anxiety and depression scale (Zigmond A.); Questionnaire for the assessment of life quality (SF-36); Microsoft Excel standard correlation calculation.

Dissatisfaction with one’s body based on QIOB and SSOB tests has a significant positive correlation with anxiety and depression, a significant correlation with the psychological component of health, a weak correlation with the physical component of health.

Dissatisfaction with one’s body or dysmorfofobia of patients with AN and BN significantly affects their affective state and psychological component of life quality which leads to a decrease in functioning up to social maladaptation and disability to social maladjustment. The publication was prepared with the support of the “RUDN University Program 5-100”.

In the dynamics of bulimia nervosa, a significant proportion of patients show a pathological attraction to purifying behavior in the form of artificially induced vomiting. This variant of the pathology of the drives significantly aggravates the symptoms, causes a severe degree of maladaptation of patients and great difficulties in the treatment of the disease.

To identify and describe the manifestations of vomitomania in patients with bulimia nervosa, the impact on the outcome of the disease.

Clinico-psychopathological, psychological, catamnestic.

120 patients with bulimia nervosa were examined: 112 women and 8 men aged 22-43 years. 86 of them (80 - women, 6 - men) were found to have vomitomania (a pathological urge to induce vomiting). Patients with pleasure, without feeling shy, awkward, described their own vomiting behavior - noted the expectation of vomiting, prepared for its implementation, observing complex rituals, imagined the vomiting act and its consequences in their minds, imagination. Describing vomiting, patients used superlative degrees of comparison, noted a sense of bliss, pleasure, “high” in the implementation of this irresistible desire. If it was impossible to induce vomiting, there was a feeling of depression, depressed mood, irritability, anger, physical distress - in fact, manifestations of withdrawal syndrome. Critical attitude to the above-described pathological behavior was absent in a significant part of cases.

Special pathological attraction to vomiting – vomitomania - is a widespread symptom of bulimia nervosa and drive disorders in this disease. It presents significant challenges for therapy especially in comorbid bulimia nervosa with personality disorders and schizotypal disorder.

Clinical case of 10-year-old patient with anorexia nervosa at the stage of severe cachexia. Features of the disease, diagnosis, treatment and methods of restoration of nutrition. Anorexia nervosa is an eating disorder (ED), severe pathology, manifested by severe complications, high disability and can cause death. ED has traditionally been perceived as a disease affecting women. However, this pathology occurs men, is 10-25% of the total number of patients with ED, or 1-2% in the population.

Describe the difficulties in identifying ED in men that affect diagnosis and treatment, especially if they are underage patients.

Patient I. 10 years, selectivity in food from 4 years, during the week before hospitalization complete rejection of food and water. When entering the clinic height 127, weight 19 kg, BMI 11. In the clinical picture anxiety, low mood, fear of eating and weight gain. The duration of the disease for about one year. Clinical and psychopathological method.

Diagnosis F50.0 anorexia nervosa in the stage of severe cachexia. Treatment: olanzapine and fluvoxamine in the age dosages, parenteral Kabiven infusion, individual and group psychotherapy. Psychoeducation of parents and Maudsley method therapy. As a result of treatment improved mood, decreased anxiety associated with eating and weight gain. At the time of discharge from the clinic height 127, weight 30 kg, BMI 18.

The clinical case indicates the need to increase the attention of pediatricians, psychologists, psychiatrists and other doctors in connection with the growth and rejuvenation of ED in the male population.

Eating disorders (ED) are characterized by perturbed eating habits or behaviors (APA, 2013). Even if treatments are available, they need to be more adapted to ED (Monthuy-Blanc, 2018). A complementary approach as yoga or mindfulness demonstrated positive effects with ED, such as an augmentation of mindfulness while eating (Rachel, Ivanka, Amanda, & Carlene, 2013), a better body satisfaction (Beccia, Dunlap, Hanes, Courneene, & Zwickey, 2018; Neumark-Sztainer, MacLehose, Watts, Pacanowski, & Eisenberg, 2018) and less preoccupation with food (Carei, Fyfe-Johnson, Breuner, & Brown, 2010). As the effects of yoga and mindfulness vary between the different ED and different uses, it is difficult to generalize the results obtained about the efficacy of yoga or mindfulness with ED.

A scoping review is actually done to map the evidence about the use (length, intensity, frequency) of yoga and mindfulness among ED and their effects.

The realization of the scoping review is based on the Joanna Briggs Institute Methodological Framework(Peters, Godfrey, McInerney, Baldini Soares, Khalil, & Parker, 2017). Research will be done in the following databases: CINAHL, PsycInfo, PubMed/MEDLINE, Web of Science, EBM Reviews/Cochrane. Different types of papers are going to be included and a content analysis is going to be done among the extracted data.

Preliminary results of the scoping review are going to be presented.

Among the different treatments used with ED, yoga and mindfulness have demonstrated positive effects. These approaches as part of integrative health are helpful to improve physical and mental health of individuals suffering from ED.

Eating Disorders (ED) tend to evolve chronically, with resistance to different therapeutic strategies. Chronicity is associated with high mortality rates, so it is necessary to study new therapeutic strategies. Transcranial Magnetic Stimulation (TMS) is a non-invasive, safe treatment method, whose application has been studied in several pathologies.

Determine the therapeutic potential of Transcranial Magnetic Stimulation in the treatment of Eating Disorders.

Bibliographic review of the literature published in English in the last 10 years, in the databases Pubmed, PsycINFO and Cochrane. The keywords used were: TMS, Transcranial Magnetic Stimulation, Eating Disorder, Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder. A review of the titles and abstracts of the resulting articles was made, and selected according to their relevance to the study.

Eighteen articles related to the treatment of ED with TMS were selected, either as primary or secondary outcome, of which six were review articles, ten were randomized controlled trials (RCT), one article was an oral communication and another article was a case report. Three RCTs showed improvement in bulimia nervosa, specifically in symptoms of “food craving”. Four RCT and one case report showed improvement in the symptoms of anorexia nervosa, one RCT showed no improvement in anorexia nervosa.

TMS appears to have some therapeutic potential for the treatment of ED, particularly in reducing food craving, despite some contradictory results. This work reinforces the need for more robust studies to evaluate the effectiveness of TMS, preferably randomized, with a longer follow-up and a cost-benefit analysis.

Obesity has been associated with certain psychiatric disorders, especially in patients seeking treatment. It is known that obesity is not a psychiatric disorder in itself, however, it should be noted that a significant part of the population has some type of clinical eating disorder.

This study aims to assess levels of Binge Eating Disorder, Night Eating Syndrome and Emotional Eating patterns, according to different groups of Body Mass Index categories.

A sample of 220 subjects, aged between 18 and 81 years old, with an average age of 33 years participated in this study. 140 (63.6%) were female and 80 were male (36.4%) The sample was divided into three comparison groups, according to the Body Mass Index (BMI). The following measures were used: Sociodemographic questionnaire, Binge Eating Scale, Night Eating Habits Questionnaire, and the Emotional Eating Scale.

When comparing the different BMI groups, it was found that obese subjects were the ones that most reported binge eating behavior. Overweight subjects had higher levels of binge eating when compared to normal-weight participants, but this was not true for Night Eating habits. Subjects with normal weight reported more nocturnal eating behavior, followed by obese individuals.

The prevalence of binge eating disorder seems to be more frequent in obese people, tending to increase according to the level of severity of obesity. Normal-weight subjects reported more nocturnal eating behavior, so they may be more likely to develop this syndrome and, consequently, overweight or obesity.

We present the case of a patient with schizophrenia who presents with restriction of intake, fear of gaining weight and alteration in the way of perceiving herself in which we ask ourselves if these behavioral alterations are secondary to her diagnosis of schizophrenia to an anorexia nervosa independent of previous diagnosis.

We propose to carry out a differential diagnosis of alterations in the perception of self-image in a patient with a diagnosis of schizophrenia. We suggest that these alterations may be secondary to alterations in the experience of the self present due to their psychosis.

In the differential diagnosis of the cause of alterations in self-image and fear of gaining weight, we rely on the psychiatric interview, the study of previous history and different scales: - Eating Disorders Inventory (EDI) - Gardner Body Image Assessment - Weight, body image and self-esteem scale E-PICA - IPASE scale

In this patient in whom the differential diagnosis of the cause of her dietary restrictions and weight loss is proposed, there does not seem to be any psychotic symptoms that produce these alterations.

In the alterations in self-image in those psychotic patients, there is a doubt as to whether these could be secondary to alterations in the perception of the self typical of psychotic diseases or, on the contrary, be secondary to the spectrum of Eating Disorders.

Therapeutic Education (TE) is a powerful tool in the multidisciplinary intervention to improve lifestyle and acquire management skills for chronic diseases, including obesity, a clinical condition whose cure is highly threatened by low long-term adherence to therapeutic recommendations. The urgent need to promote persistent lifestyle change and concordance to treatment in PwO is globally recognized. TE programs offer a vast number of long-term management skills, but it yet deals with a consistent drop-out rate, and we believe that Assistive Technologies (AT) can become a powerful tool to boost independence and improve participation.

The goal of our study was to devise and validate an innovative multidisciplinary approach to obesity and binge eating disorder, based on the sinergy between the medical-psychological field and assistive techonolgy.

We developed “TERESA” (Therapeutic Educational Robot Enhancing Social interActions) (fig. 1), a social humanoid robot, and implemented it to collaborate in a TE programs in order to enhance social interactions, improve knowledge acquisition and adherence to treatment. The specific TE intervention, called Education towards Choice and Awareness, was based on 3rd generation cognitive-behavioral approaches and consisted in eight informative and experimental meetings.

Taking part in the TE-TERESA integrated protocol determined and improvement in psychopathological domains (anxiety, negative mood, quality of life) and a stronger concordance to the therapeutic protocol.

Our research paves the way for the clinical use of Assistive technology (AT), highly promoted by the WHO to help people with numerous disabling clinical conditions improve their quality of life and acquire self-management skills.

A large body of literature suggests that childhood trauma exposure is a non-specific risk factor for development of eating disorders (EDs) later in life. One potential mechanism through which early traumatic experiences may increase the risk for EDs is represented by long-lasting changes in the body stress response system.

We investigated the activity of the hypothalamus-pituitary-adrenal axis and of the sympathetic nervous system in adult ED patients with or without a history of childhood trauma exposure.

We recruited 35 women with EDs, admitted to the Eating Disorders Center of the Department of Psychiatry of the University of Naples “Luigi Vanvitelli”. Participants filled in the Childhood Trauma Questionnaire (CTQ), to assess exposure to childhood trauma. They were instructed to collect saliva samples at awakening and after 15, 30 and 60 minutes, in order to measure cortisol levels and salivary alpha-amylase (sAA), a marker of the sympathetic nervous system activity.

According to the CTQ cut-off scores, 21 ED women were classified as maltreated (Mal) participants and 14 women as no-maltreated (noMal) ED participants. Compared to noMal ED women, Mal ED participants showed significantly decreased cortisol awakening response (CAR) and sAA morning secretion.

Present findings confirm that childhood trauma exposure impairs the CAR of adult patients with EDs and show that also the morning secretion of sAA is decreased in childhood maltreated adult ED patients. Therefore, our study shows for the first time a dampening in the basal activity of both components of the endogenous stress response system in childhood maltreated adult ED women.

Diabetic patients are asked to focus on their eating habits and calories intake. Together with individual factors, this could increase the risk of developing Eating Disorders (ED) associated with diabetes. A score of 20 points at the Diabetes Eating Problem Survey-Revised (DEPS-R) scale is considered as a valid threshold to identify Disordered Eating Behaviours (DEB) in diabetic patients. DEB can be considered as altered eating behaviours not fully meeting criteria for ED. As DEB are not formally recognised as specific ED in DSM-5, there is a great risk of not detecting them, thus underestimate their consequences.

To meta-analyse literature on ED and DEB, when in comorbidity with Type 1 and Type 2 Diabetes Mellitus, focusing on pathological medical consequences.

PRISMA guidelines were followed for this meta-analysis. Articles were identified in literature by searching into PubMed, PsycINFO and Embase.

1141 records were identified through database search. Figure 1 shows six studies comparing HbA1c % values for 2857 diabetic patients versus 752 diabetic patients with DEB. HbA1c % levels appear to be higher in patients with DEPS-R ≥ 20, compared to those with DESP-R scores below 20.

Routine screening for DEB using DEPS-R scale could favour early identification of diabetic individuals, at risk for progression into a proper ED. Clinicians should be vigilant about potential DEB when patients show poor long-term glycaemic control; similarly, patients with a DEPS-R score over 20 points may require more frequent glycaemic checks. This could help prevent serious medical complications.

Although the Eating Disorder Examination Questionnaire (EDEQ; Fairburn et al. 2008) is the most used instrument worldwide for the assessment of eating disorders symptoms, its factorial structure considerably varies, which limits its construct validity. Using exploratory factor analisys in data from a sample of overweight women, our group found a three-factors structure of the EDEQ Portuguese version (Peixoto et al. 2013), Although it was in accordance with other psychometric studies (eg. Peterson et al 2007), it was different from the original matrix. Further investigation regarding its factor structure has been conducted, with studies supporting a modified seven-item-three-factors structure (dietary restraint, shape/weight overvaluation, body dissatisfaction) with improved psychometric properties (Grilo et al. 2013, 2015), including with Portuguese samples (Machado et al. 2018; Santos et al. 2019).

To analyze if the EDEQ version composed of seven items and three factors is replicated in a Portuguese sample of overweight women.

The EDEQ was administered to an outpatient sample of 276 women (Mean age= 43.85±11.89 years; Mean BMI=32.82±5.43 Kg/height2) attending a weight loss treatment consultation in a public hospital.

Confirmatory factor analysis (CFA) revealed an adequate fit of the EDEQ-7 second order model with three dimensions (χ2/df=1.5497; RMSEA=.0452, CFI=.9955, TLI=.9914, GFI=.xxx; p<.001). The EDEQ7 Cronbach’s alphas for the total and its dimensions were α<.70.

Given its good psychometric properties, the overlap of the measurement model with those found with different samples and the reduced number of items, the EDEQ7 will be very useful both in research and clinical settings with/for overweight women.

Psychiatric emergencies are acute disturbances in thought, behavior or mood which require immediate medical intervention. As a substantial number of patients with mental illness present as psychiatric emergencies, the sustainability and management of psychiatric emergency services becomes significant.

In this study we aimed to examine the factors associated with psychiatric emergency care, taking the boarding time in the emergency department as primary outcome measure.

Charts of 466 psychiatric emergency cases admitted to the Hacettepe University Emergency Department (ED) between December 2018 – September 2019 were evaluated. Boarding time (BT) in the ED, presence of self-harm, psychotic symptoms and agitation were noted.

In the examined period, number of patients admitted increased with time significantly (r= 0.562, p <0.01). However, increase in the number of patients was not correlated with an increase in BT. Patients with psychotic symptoms had greater BT compared to non-psychotic patients (7.01 hours vs. 11.24 hours, T= -2.796 df = 182.717 p <0.01). Patients with self-harm also had greater BT (7.47 hours vs. 9.85 hours, T = -2.013 df = 433 p <0.05). Patients with self-harm in relation with previous suicidal ideation displayed significantly a longer BT when compared with patients admitted due to self-harm without any suicidal plan (U=2572,5 p<0.01).

A significant increase in BT with psychosis and self-harm due to a suicidal plan supports the need of intermediate facilities between the ED and inpatient units, as such facilities would create a positive impact in the care of psychotic and suicidal patients.

Self-amputation, the most severe form of self-mutilation, is unusual. In most cases, self-mutilation is related to psychiatric disorders, mainly psychotic spectrum disorders and substance abuse.

This case report aims to describe a case of unusual self-amputation in a man with a psychiatric history.

Case report and literature review.

A 35 years old man patient, divorced, unemployed, with 15 years of treatment history for anxiety and low mood. The patient reported history of childhood trauma. He was inpatient (2019) after a suicide attempt. The psychiatrist who was treating him did not give a diagnosis (referral diagnosis). The patient mentioned several times that he desired feet amputation, without planification, in context of high anxiety. He was distressed by the shape and noise of his ankles. The patient was not diagnosed with genuine hallucinations or delusions. Four months after his divorce he amputated his feet with an electric saw. He denied any intention to commit suicide by committing this act. He admitted that he wanted to get rid of discomfort. Despite this drastic action, his mood did not improve.

Self-amputation is not a common condition. Although some cases of self-amputation have been reported, this case illustrates not only the difficulty of making a differential diagnosis (psychosis, dissociation, trauma, dysmorphophobia, body identity integrity disorder…) but also the challenge of a multidisciplinary approach in the treatment of patients with self-amputations.

Gayet Wernicke Encephalopathy (GWE) is a diagnostic and therapeutic neuropsychiatric emergency due to thiamin deficiency (vitamin B1).

The purpose of our work is to recall some clinical situations suspecting GWE, along with radiological and evolutionary profile.

We conducted a retrospective study concerning patients who were hospitalized in the neurology department of Habib Bourguiba Hospital between 2013 and 2020 for management of GWE.

The median age of 7 patients was 39.57 years with sex ratio (H/F):1.33. The most common risk factor found is incoercible vomiting (5 patients), followed by chronic alcoholism (3 patients). Confusional state was the most frequent symptom found in 4 patients. The characteristic clinical triad of confusion, oculomotor disorders and ataxia was only found in 2 patients. Neuroimaging showed a typical aspect in 3 patients. The serum levels of thiamine were low in five patients and normal in two patients. After receiving parental than oral thiamin supplementation, three patients were independent after one month with a mRS score <3.

GWE is an acute neuropsychiatric emergency. Chronic alcoholism is recognized as its most common cause. The clinical triad is not constantly present. MRI shows typically bilateral symmetrical hyperintensities in periaqueductal area, periventricular region, thalami and mammillary bodies. Thiamin level can be normal since it does not accurately represent body thiamine status or in case of mutations in a thiamine-transporter gene. Thiamine therapy is warranted if any component of the GWE triad is present in an appropriate clinical setting to prevent irreversible neurological sequelae.

Serotonin syndrome (SS) is a toxic state characterized by increased serotonin activity. It has been suggested that severe serotonin syndrome usually involves monoaminoxidase inhibitors (MAOIs).

To quantify in how far severe SS is associated with MAOIs.

Systematic review and quantitative analysis of all SS cases published between 1 January 2004 and 31 December 2014. Severe SS was defined as cases, either requiring intensive care or resulting in death. Cases were included if they met the diagnostic criteria for SS according to at least one of the three diagnostic criteria systems (Hunter, Radomski and Sternbach).

Of the 299 included cases, 118 (39%) met the definition for severe SS. Eight cases had insufficient information to enable severity classification. Of the severe cases, 48 (40%) involved a MAOI. Of these, 67% related to psychiatric MAOIs, such as phenelzine and moclobemide and 33% to a somatic MAOI, such as methylene blue and linezolid. Of the remaining 173 non-severe SS cases, 24 cases (13%) involved a MAOI. In these, 12% related to a psychiatric MAOI and 83% to a somatic MAOI. One case (4%) had a combination of both. The odds ratio for MAOI involvement in severe versus non-severe serotonin syndrome was 4.3 (CI 2.4 – 7.5; p < 0.001).

In the majority of published case reports, drugs other than MAOIs are involved in serotonin syndrome, even in severe cases. MAOIs are, however, more common in severe serotonin syndrome than in non-severe cases.

M. Ott: scientific advisory board member of Astra Zeneca, Sweden. U. Werneke: received funding for educational activities on behalf of Norrbotten Region; Astra Zeneca, Eli Lilly, Janssen, Novartis, Otsuka/Lundbeck, Servier, Shire, Sunovion. Others: None

Withdrawal states with delirium, having convulsive syndrome in their structure, are one of the most severe emergency conditions in psychiatry.

A total of 160 patients were examined with delirium alcohol withdrawal. Prognostic factors of occurrence of convulsive syndrome in the withdrawal syndrome of alcohol were studied.

Clinical, psychopathological, electrophysiological.

It was found that the most significant prognostic factors seizures were: severe bloating condition, the duration of hard drinking, the total dose of drinking alcohol before the breakdown of consumption alcohol. Convulsive syndrome not always correlated with marked vegetative disorders in the state of withdrawal of alcohol. Convulsive syndrome that appeared after the development of delirious syndrome often indicated a more serious conditionIt is suggested that the convulsive pattern of response to the severe condition of alcohol withdrawal is formed in some young patients under the influence of endogenous factors, but is realized under certain situational conditions - long binge drinking, massive consumption o alcohol before the break of the reception of alcohol, the use of psychoactive drugs with stimulating effect. In the electrophysiological examination, there were significant differences in the group of patients with convulsive syndrome in the current admission from the group of patients with convulsive syndrome in the past and the group without convulsive syndrome in the state of abolition of alcohol.

It is emphasized that when indicating the seizures in the state of abolition of alcohol in the past, the beginning of treatment is necessary to begin even in a state of binge drinking.

Schedule II of the 2013 Mental Health Act is part of the legal framework for involuntary admission to a licensed mental healthcare facility in Malta (Mount Carmel Hospital) for observation.

To identify trends in presenting features cited by registered specialists in psychiatry in Schedule II applications as well as impact of time of day on involuntary admission.

Schedule II forms relating to all involuntary admissions to Mount Carmel Hospital between 01 June 2018 and 01 June 2019 were retrieved from paper files (n=364). Details relating to reason for using this legal framework were recorded and processed through custom linguistic analysis. Timings of application were also assessed. Data Protection permissions to retrospectively access patient files were obtained. All data collected was de-identified at source.

The commonest reason for use of Schedule II was psychosis (n=139). Substance abuse was recorded in 68 cases, with alcohol and cannabinoids the commonest substances cited. 155 instances relate to situations of increased risk, the commonest being aggressive behaviour (n=74). 61 cases recorded suicidal intent. Peak use of this schedule occurs between 17:00 and 18:00, which is outside normal working hours.

Predominance of psychosis as a reason for involuntary admission concurs with trends reported internationally, including recent German, Irish and Dutch reports, as does increased use of involuntary admission with out-of-hours presentations. Practices relating to involuntary admission to a mental healthcare facility in Malta appear to reflect general trends in other European cohorts, despite differing legal frameworks.

Pandemic are known to generate traumatic events, such as job losses or violence [1]. Several studies have shown that epidemics and related health measures (quarantine, confinement) lead to an increase of acute stress disorders (ASD), post-traumatic stress disorders (PTSD), anxiety and depression in the adult population [2]. In the pediatric population, few studies have been carried out on the psychiatric outcomes during and after epidemics and associated measures [3].

The aim of this study was to explore ASD symptoms during stay-at-home and Covid 19 pandemic and its impact on children and adolescent mental health.

Sixty participants (53% girls and 47% boys; mean age= 9 years 5 months) were included in this longitudinal study [4]. The measures consist in an emergency semi-directed interview designed to assess symptoms of ASD according to the age of children.

Patients’ age modulated psychiatric outcomes. Children under the age of six shown more developmental regressions and more restlessness than older ones. Children from 6 to 12 years were characterized by more oppositional behaviors than adolescents. Finally, adolescents were characterized by more social isolation than younger ones. Other symptoms appear to be more stable across ages: sleep disturbance, fear behavior and somatization.

Young children experienced more externalized symptoms (opposition and agitation) and developmental regressions than older children [5]. Thus, it appears necessary during pandemic to take into account the psychiatric consequences of confinement to reduce psychosocial long-term outcomes in particular in younger patients who appeared to develop specific and age-related psychiatric disorders.

Psychiatric patients visiting the Emergency Department (ED) often require ‘medical clearance’. We aim to review patient work-up in the ED to facilitate the management of these patients.

- To identify common demographic variables, diagnoses and mental health legislative status of patients presenting to the ED requiring psychiatric admission - To assess whether patients underwent a medical work-up in the ED, and what investigations were carried out - To produce a hospital proforma for the management of psychiatric patients presenting at the ED

Data on adult psychiatric patients visiting the ED over a six month period was collected retrospectively, which was then analysed accordingly.

473 patient admissions were reviewed. 32.8% were admitted to a non-psychiatric specialty before being accepted to psychiatry, with the most common reasons being due to overdose (30.3%), alcohol-related problems (19.4%), and medical complaints (18.7%). 63.2% of all patients were investigated in the ED, including 23.5% undergoing CT Brain imaging. The majority had a final diagnosis falling under F10-19 (30.2%) and F30-39 (30.9%) chapter categories of the ICD-10, with the former having the highest absolute number of patients undergoing testing in the ED. The F20-29 group (13.7%) was highest in total patients investigated (75.4%), CT brain imaging (56.9%), and rate of involuntary admissions (33.8%), suggesting they are the most resource intensive group.

Patients with acute mental disorders present significant challenges to emergency physicians. Staff education and an inter-departmentally agreed upon proforma, taking into account the results of this study, may facilitate management of these patients within the ED.

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

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

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

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

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