Rumination is a transdiagnostic phenomenon that is linked to psychological and physical symptoms not only in adulthood but also in childhood. Several distal and proximal factors are believed to underlie the development of ruminative tendencies, with parental characteristics and modelling being among those with a potential association with the increased levels of children’s rumination.

The primary aim of the study was to investigate the link between rumination in children and parental functioning, including rumination, worry and depressive symptoms. Additionally, we aimed to test the association between rumination and psychological and somatic health in a sample of healthy children and early adolescents.

153 children (87 girls, mean age = 10.74; SD = 0.91 years) and their parents (130 females, mean age = 42.65; SD = 4.08 years) participated in the study. For children, Kid Rumination Interview (KRI; Baiocco et al., 2017) was used, alongside the assessment of nine subjective health complaints. KRI employes 4 images to measure the frequency of rumination. Self-reported questionnaires were also completed by parents to report on worry, rumination, and depressive symptoms.

Contrary to our expectations, there was no significant association between children’s rumination and parental rumination (r = .06, p = .506), worry (r = -.02, p = .850) and depressive symptoms (r = -.01, p = .979). Psychosomatic complaints in children exhibited a positive albeit weak association with parental depressive symptoms (r = .17, p = .046). Regression analysis revealed that the frequency of rumination occurring in the four situations associated significantly with psychosomatic symptoms (β = .266; t = 3.321; p = .001) after controlling for sex and age.

Our findings are in line with previous studies demonstrating the relationship between rumination and psychosomatic symptoms in older adolescent samples. However, parental perseverative cognitions and depression were unrelated to ruminative tendencies in children. Nevertheless, the modest sample size and the employment of a different assessment approach compared to self-report questionnaires may have influenced our findings.

None Declared

juvenile chronic depression is characterized by high prevalence, difficulties in diagnosis, nosological qualification and prognostic assessment. According to epidemiological data, the frequency of these conditions ranges from 1.5% to 3% in the general population (Gutiérrez-Rojas et al. Braz. J. Psychiatr 2020; 42 657-672), and among all depressions in adolescence, a chronic course develops in about 20% of cases (Blanco C., 2010 et al. The J clinical psychiatry 2010; 71(12) 6501). Due to the polymorphism of the clinical picture and the peculiarities of juvenile ontogenesis, difficulties arise in nosological and prognostic assessment.

to study the long-term prognosis of chronic depression, depending on the variant of its course.

Catamnestic examination was performed on 64 patients of adolescent age (16-25 years), for chronic depressive state lasting more than two years (F31.3, F31.4, F32 (except F32.3), F33 (except F33.3), F34, F34.1, F21, F20 according to ICD-10). The duration of the catamnesis is more than 10 years. The PSP scale was used for psychometric assessment.

when analyzing the ten-year course of juvenile chronic depression, three variants were identified: regredient (23.4%), monotonous (35.9%) and progredient (40.6%). The regredient course was characterized by a marked reduction or disappearance of psychopathological disorders with the formation of further remission with a high level of functioning in all spheres of life and complete social and labor adaptation (81-100 points on the PSP scale). The monotonous course was characterized by low variability and insignificant dynamics of individual manifestations throughout the disease with the preservation or some decrease in the level of educational and labor adaptation with the restoration of previous social contacts and a fairly high quality of life (scores 61-80 on the PSP scale). The progressive course was characterized by the gradual addition of new psychopathological disorders, or the aggravation of existing ones, patients had a distinct decrease in educational, labor and social adaptation (scores 50-31 on the PSP scale) or complete maladaptation of all spheres of life (scores <40 on the PSP scale).

The high incidence of progressive and monotonous course in juvenile chronic depression, contributing to a decrease in the level of functioning of patients, indicates the importance of timely detection of these conditions and the need for careful selection of therapy.

None Declared

Emotional dysregulation are considered early manifestations of neuropsychiatric disorders. Recent research has shown that a threatened preterm labour (TPL) represents an adverse prenatal event that involves temperament disturbances, even in absence of prematurity. Thus, full-term TPL infants at 6 months of age are characterized by lower positive affect, higher negative affect, and worse emotional regulation relative to a full-term non-TPL control group.

The aim of this study is to explore the predictors of change of emotional infant competences.

This prospective cohort study recruited mothers who suffered from a TPL. Infants’ temperament assessment was performed at 6 and 30 months of age using the Rothbart Behaviour Questionnaires, examining positive affectivity/surgency, negative emotionality, and orienting and emotional regulatory capacity. A regression model was carried out, including gestational age at birth, maternal anxiety trait, maternal history of psychological traumas, prenatal and postnatal maternal depression, anxiety, and cortisol as well as parenting stress as predictors.

Increased positive affectivity was related with lower paternal stress (p = .044). Maternal history of trauma and parenting stress was associated with increased negative emotionality (p = .037 and p = .045, respectively). Increased emotional regulation disturbance was linked to low gestational age at birth (p < .001), higher postnatal depression (p = .002), higher prenatal anxiety at TPL diagnosis (p = .039) and higher postnatal anxiety (p = .008).

Therefore, maternal previous traumas, maternal psychopathology from pregnancy to postpartum as well as parenting stress should be considered in psychological treatment to improve infant’s emotional competences and prevent subsequent neuropsychiatric disorders.

None Declared

Friendships are vital relationships throughout the lifespan, but become especially meaningful during adolescence. Adolescents between the ages of 10 and 18 name a friend as one of the most important people in their lives (Kiesner et al., 2004). Authentic social groups, defined as mutual social relationships that adolescents voluntarily engage in, are sources of support and companionship for adolescents, more than parents (Furman & Buhrmester, 1992). Past research shows adolescents turn to their friends most for mental health support in a crisis, yet less than half report finding the support helpful (Geulayov et al., 2022). Thus, it’s crucial to understand friendship dynamics of adolescents in order to address an appropriate intervention. Past literature has demonstrated gender differences in how adolescents approach friendships and social relationships (Lempers & Clark- Lempers, 1993).

I aim to investigate whether girls, boys, and gender non-binary individuals differ in their perceptions of friendship quality and friendship dynamics (i.e. social support seeking) and whether these differences have implications for their mental health outcomes. By studying gender differences in friendship quality and mental health, I hope to shed light on potential avenues for promoting inclusivity and positive mental health outcomes for both gender binary and gender non-binary adolescents.

A cross-sectional survey (OxWell) was administered online to students across secondary schools and further education colleges in England to assess their self-reported friendship quality. The RCADS and WEMWBS scales were used to assess depression and anxiety symptomology, and well-being, respectively. The results from the survey were analysed in R.

Gender-binary and gender non-binary adolescents differed in friendship quality, friendship dynamics, mental health scores, and help-seeking behaviours. Gender non-binary adolescents had the worst mental health scores and reported lowest friendship quality compared to girls and boys. Boys had the best mental health when compared to girls and gender non-binary adolescents, and were more likely to perceive support provided by their friends as helpful. Surprisingly, gender non-binary adolescents reached out to their friends the most (when compared to girls and boys) for mental health support, despite having proportionally lower quality friendships, and were the least likely to find support received from friends helpful.

This data presents evidence for the difference in social relationships across adolescents of all genders. It highlights the need for specialized and inclusive mental health support being made available for gender non-binary youth in England—a minoritized group in need of intervention. This data hopes to inform school-based friendship interventions targeted to improve friendships and mental health of gender non-binary youth.

None Declared

Mental health professionals pay particular attention to adolescents, as many psychiatric disorders begin at this age, and the mental state of adolescents has been deteriorating worldwide in the last decade. Based on previous international research, the ability to regulate negative emotions and mentalizing - that is, the ability to identify the thoughts and emotions behind one’s own and others’ behaviour - mediate the negative effects of attachment difficulties experienced in close relationships on the quality of life. This relationship has not yet been investigated among Hungarian adolescents. Adolescent events can have a long-term effect on a person’s mental health, so it is very important to examine the factors that influence the quality of life.

This research aimed to examine the relationship between attachment, mentalizing, emotion regulation and quality of life among adolescents between 14 and 18 years of age.

In our non-clinical cross-sectional research, 141 adolescents filled out the Experiences in Close Relationships questionnaire, the Difficulties in Emotion Regulation Scale, the Reflective Functioning Questionnaire and the Quality of Life Scale after informed consent. We tested two mediator models, in which emotion regulation and mentalizing were the mediating variables in the relationship between attachment difficulty and quality of life.

In our analyses, attachment difficulties (c’ = -1,87, p < .001, β = -0.41) and emotion regulation problems (b = -0.08, p < .001, β = -0.39) also predicted a reduced quality of life. Attachment problems also reduce the quality of life of young people through emotional regulation difficulties (∑ab = -0,81 [-1,21 – -0,45], β = -0.17). However, mentalizing was not significantly related to the adolescents’ quality of life (b = -0,05, p = .10, β = -0,11). Mentalizing also did not mediate the relationship between attachment and quality of life (∑ab = -0.09 [-0.27 – -0.02], β = -0.02).

Our results suggest that adolescents’ emotion regulation has a prominent role in their quality of life in addition to attachment styles. To improve the quality of life among adolescents, we recommend using techniques that develop emotion regulation.

None Declared

In clinical practice, significant delays in requesting help are observed in patients with depressive symptoms and suicidal ideation.

The objective of this study was to determine factors associated with the time of untreated illness in a population with depressive disorder attending mental health for the first time in the area of Hospital Clínico Universitario de Valladolid (HCUV).

Methods: This is an observational study including adult patients of both sexes, referred to their first mental health consultation from their Primary Care Physician, with a picture of depressive symptomatology associated with an identifiable stressor. Informed consent was obtained from the patients and authorized by the Ethics Committee of the HCUV. R Studio ® statistical analysis.

The degree of emotional confusion was quantified with item 1 (“I am often confused about the emotions I feel”) of the Toronto Alexithymia Scale (TAS). This item is scored ( 1-5 )from most severe (1) to least (5). On the other hand, the time in weeks between symptom onset to referral, age and symptom severity according to the Montgomery Scale (MADRS) were recorded.

Results: We present data collected in an initial sample of 278 treated patients, with a female predominance (68%), a MADRS severity score (18.05 ± 5.01) and a calculated time without treatment of 59.66 ± 62.26 weeks (Tables 1,2,3).

A subsample of 72 patients with death ideation was studied, with a female predominance (75%) compared to the overall sample (X2 =1.99, p = 0.1585) (Table 4).

It was also observed that death ideation was higher in younger patients (t = 3.18, p = 0.001907) and with a severe MADRS depression score (t = -7.92, p < 0.0001), however they took a similar length of time to receive mental health treatment (T student t = -1.6605, p = 0.099); (Table 5).

There is no previous published evidence that considers the timing of untreated symptoms. According to test statistics, there are differences in untreated symptom time considering gender and TAS score (Table 6).

Death ideation is a current health problem that deserves attention. In multivariate analysis models, an association with clinical and demographic factors has been found; however, there is up to 20% of the variation in prevalence that is not explained by the aforementioned factors. The factors that determine the time delay in seeking help (treatment delays) have not been studied so far.

In this study we observe how a single variable doesn’t explain the delay in the first visit. The interaction between age, gender, alexithymia and hypoprosexia explains the delay in seeking help, although symptom severity doesn’t seem to be related. These data suggest that unexplained causality in multivariate studies may be related to the interaction between clinical and neuropsychological factors.

None Declared

What is the psychiatrist’s role on a burning planet? As our world faces the existential ramifications of irreversible climate change, clinicians are contending with what purpose a normalizing institution like psychiatry can have in increasingly abnormal times.

This presentation investigates the role of the modern mental health clinician by examining psychiatry’s current impotence in the face of climate crisis. It will be shown that current approaches are often complicit in psychiatry’s historical depoliticization of mental health and subsequent individualization of social concerns. It will be argued that the only way psychiatry can maintain its ethical obligations to its patients is by taking a courageous sociopolitical stance.

Emerging from a multidisciplinary literature review on the relationship between psychiatry and social crises, this work examines our field’s response to climate change in particular. A focus is made on literature that explores psychiatry’s political obligations, current trends in climate psychiatry, and proposed social psychiatric approaches to the climate crisis.

It is shown that while ecological collapse tangibly affects our patients, psychiatry often fails to engage socio-politically with the crisis’ root causes. Framing intense reactions to climate change as trauma responses and developing neo-diagnoses such as “ecoanxiety” both risk individualizing inherently social experiences. However, Psychiatrists are also uniquely positioned to speak with authority about social crises and to articulate what a more comprehensive medical response to climate change might look like.

Given climate change’s disproportionate effects on disenfranchised populations, it is increasingly clear that health is inextricable from social circumstances. As a result, political inaction is incompatible with our ethical duty to serve patients’ health, both in the clinic and beyond it.

None Declared

There’s large heterogeneity present in major depressive disorder (MDD) and controversial evidence on alterations of brain functional connectivity (FC), making it hard to elucidate the neurobiological basis of MDD. Subtyping is one promising solution to characterize this heterogeneity.

To identify neurophysiological subtypes of MDD based on FC derived from resting-state functional magnetic resonance imaging using large multisite data and investigate the differences in genetic mechanisms and neurotransmitter basis of FC alterations, and the differences of FC-related cognition between each subtype.

Consensus clustering of FC patterns was applied to a population of 829 MDD patients from REST-Meta-MDD database after data cleaning and image quality control. Gene transcriptomic data derived from Allen Human Brain Atlas and neurotransmitter receptor/transporter density data acquired by using neuromap toolbox were used to characterize the molecular mechanism underlying each FC-based subtype by identifying the gene set and neurotransmitters/transporters showing high spatial similarity with the profiles of FC alterations between each subtype and 770 healthy controls. The FC-related cognition in each subtype was also selected by lasso regression.

Two stable neurophysiological MDD subtypes were found and labeled as hypoconnectivity (n=527) and hyperconnectivity (n=299) characterized by the FC differences in each subtype relative to controls, respectively. The two subtypes did not differ in age, sex, and scores of Hamilton Depression/Anxiety Scale.

The genes related to FC alterations were enriched in ion transmembrane transport, synaptic transmission/organization, axon development, and regulation of neurotransmitter level for both subtypes, but specifically enriched in glial cell differentiation for hypoconnectivity subtype, while enriched in regulation of presynaptic membrane and regulation of neuron differentiation for hyperconnectivity subtype.

FC alterations were associated with the density of 5-HT2a receptor in both subtypes. For hyperconnectivity subtype, FC alterations were also correlated with the density of norepinephrine transporter, glutamate receptor, GABA receptor, 5-HT1b receptor, and cannabinoid receptor.

Both subtypes showed correlations between FC and categorization, motor inhibition, and localization. The FC in hypoconnectivity subtype correlated with response inhibition, selective attention, face recognition, sleep, empathy, expertise, uncertainty, and anticipation, while that was related to inference, speech perception, and reward anticipation in hyperconnectivity subtype.

Our findings suggested the presence of two neuroimaging subtypes of MDD characterized by hypo or hyper-connectivity. The two subtypes had both shared and distinct genetic mechanisms, neurotransmitter receptor/transporter profiles, and cognition types.

None Declared

Major depressive disorder (MDD) is a common multifactorial disorder, but the exact pathophysiology is still unknown. in vivo and post-mortem studies document volumetric and cellular changes in the hippocampus of depressed patients. Chemical synapses are key functional units of the central nervous system and earlier studies found reduced number of synapses in the prefrontal cortex of depressed patients (Kang HJ et al. Nature Medicine 2012;18(9):1413-1417). Mitochondria are intracellular powerhouses generating chemical energy for cellular biochemical reactions. Recent findings suggest that individuals with impaired mitochondrial function may be vulnerable to develop psychopathologies.

We investigated synapses and mitochondria in post-mortem hippocampal samples from psychiatric patients.

The three study groups were: 1) MDD patients (n=11); 2) patients with alcohol dependence (n=8) and 3) controls (n=10). Controls were individuals who accidentally deceased and had no neuropsychiatric disorders. Three sub-regions of the hippocampus (dentate gyrus, CA3 and CA1 areas were investigated. Ultrathin sections were examined, and photomicrographs were taken for further analysis using a JEOL JEM 1400 FLASH transmission electron microscope. Systematic quantitative analysis was conducted with the Neurolucida system using unbiased counting principles.

We could not detect any differences in synapse and mitochondria densities between the patients and controls subjects.

Our preliminary data suggest that despite our expectations hippocampal synapse and mitochondrial densities are rather constant parameters which are not easily affected by psychopathology or alcohol consumption. Potential methodical limitations may also explain this negative finding.

FUNDING:

This research was founded by the Hungarian Brain Research Program 3 and by the TKP2021-EGA-16 project. A.S.T. was supported by the ÚNKP-23-3-I New National Excellence program of the Ministry for Culture and Innovation from the source of the National Research, Development and Innovation Fund.

None Declared

Among many polypharmacy term definitions, the most common definition refers to the concurrent use of five or more medications. Multiple medication administration is highly prevalent in older populations with multimorbidity. Apart from polypharmacy impacts on physical health, it might be detrimental to mental health.

The present study aims to evaluate the association between depression and poor adherence in multimorbidity Iraqi older population using five or more medications.

This cross-sectional study was conducted in Iraq during July and August 2023, involving a sample of 196 older adults recruited from private clinics and hospital clinical medicine wards, all of whom had polypharmacy regimens. The questionnaire includes age, gender, medication regimen adherence and Patient Health Questionnaire-8 (PHQ-8) using a cutoff score of 10. Chi-square and binary logistic regression were performed to determine the association between poor adherence and the presence of depressive symptoms.

A total of 196 respondents, mean age = (61±11.4), 49 (25%) male and 147 (75%) female, 178 (90.8%) good adherence and 18 (9.2%) poor compliance, 81 (41.3%) participants have PHQ-8 score was equal or less than ten while 115 (58.7%) have PHQ-8 score was more than 10. Depressive symptoms and patient adherence showed a significant association (p = 0.02). Moreover, poor adherence polypharmacy participants were more likely to have depression odd ratio (OR) = 3.9, 95% confidence interval (CI = 1.09 – 13.9; p = 0.036).

Our findings suggest that depressive symptoms are associated with poor adherence polypharmacy older adults and, highlighting the importance of addressing medication management and mental health in this population.

None Declared

In ESCAPE-TRD esketamine nasal spray (ESK-NS) significantly increased the probability of achieving remission at Week (Wk) 8 and being relapse‑free through Wk32 after remission at Wk8 versus (vs) quetiapine extended release (Q-XR) in patients (pts) with treatment resistant depression (TRD) (Reif et al. DGPPN 2022; P-01-04). We report ESK-NS vs Q-XR effects on pt-reported health-related quality of life (HRQoL) over 32 wks.

Evaluate pt-reported HRQoL using the generic 36-item Short-Form Health Survey version 2 (SF-36v2, 4-wk recall, 2009 US population norms) in ESCAPE-TRD.

ESCAPE‑TRD (NCT04338321) was a randomised phase IIIb trial comparing the efficacy of ESK-NS vs Q-XR, both alongside an ongoing selective serotonin/serotonin-norepinephrine reuptake inhibitor, in pts with TRD. SF-36v2 was assessed every 4 wks (on-treatment and retrieved dropout visits). Domain scores and change from baseline (CfB) were analysed using a mixed model for repeated measures (MMRM; observed cases) adjusted for age, prior treatment failures, baseline score. Higher scores indicate better HRQoL. P values were not adjusted for multiple testing.

336 and 340 pts were randomised to ESK-NS and Q-XR. Baseline domain scores were below general population norms and lowest in Role Emotional, Mental Health and Social Functioning (Figure 1A). All scores improved to Wk32 in both arms (Figure 1B). At Wk4, CfB was significantly higher (better HRQoL) with ESK-NS vs Q-XR across domains (all p<0.01). At Wk8, CfB was significantly higher with ESK-NS vs Q-XR across all domains (p<0.05) except Bodily Pain and Role Physical. At Wk32, CfB was significantly higher with ESK-NS vs Q-XR for Mental Health (p=0.014), Role Emotional (p=0.001), Role Physical (p=0.046) and Social Functioning (p=0.006); a trend of numerical advantage was seen for all other domains (Figure 2).

Image:

Image 2:

In addition to the superior clinical benefits provided by ESK-NS vs Q-XR in ESCAPE-TRD, pts receiving ESK-NS experienced significantly greater improvements in HRQoL vs Q-XR over 32 wks.

We thank the patients who participated. Study funding: Janssen, medical writing: Costello Medical, UK.

A. Young Grant / Research support from: Received grants from Janssen; independent research funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London; the views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health, Consultant of: Received consulting fees from Allegan, AstraZeneca, Bionomics, Eli Lilly, Janssen, Johnson & Johnson, LivaNova, Lundbeck, Servier, and Sumitomo Dainippon Pharma and Sunovion, Speakers bureau of: Received speaker’s honoraria from Allegan, AstraZeneca, Bionomics, Eli Lilly, Janssen, Johnson & Johnson, LivaNova, Lundbeck, Servier, and Sumitomo Dainippon Pharma and Sunovion, B. Baune Grant / Research support from: Received research grants from private industries or non-profit funds from AstraZeneca, Lundbeck, and Sanofi-Synthélabo; received research grants from the BMBF and BMG Germany, the DFG, Germany, the National Health and Medical Research Council, Australia, and Horizon Europe 2021; received research grants from the Fay Fuller Foundation, and James & Diana Ramsay Foundation, Adelaide, Consultant of: Received consulting fees for roles with the National Health and Medical Research Council, Australia; received honoraria from Angelini, AstraZeneca, Biogen, BMS, Boehringer Ingelheim, Johnson & Johnson, LivaNova, Lundbeck, Otsuka, Pfizer, Roche, Servier, Sumitomo Dainippon Pharma and Sunovion, and Wyeth; served on advisory boards for Biogen, Boehringer-Ingelheim, Janssen-Cilag, LivaNova, Lundbeck, Novartis, and Otsuka, N. Cardoner Grant / Research support from: Received research grants from the Ministry of Health, Ministry of Science and Innovation (CIBERSAM), and the Strategic Plan for Research and Innovation in Health (PERIS) for the period 2016–2020, as well as from Marato TV3 and Recercaixa, Consultant of: Served on advisory boards for Angelini, Esteve, Janssen, Lundbeck, Novartis, Pfizer and Viatris, Speakers bureau of: Received speaker’s honoraria from Angelini, Esteve, Janssen, Lundbeck, Novartis, Pfizer and Viatris, R. Frey Grant / Research support from: Received travel fees from Janssen and LivaNova; received grants or contracts from Alkermes (Principal Investigator), Janssen (Principal Investigator), LivaNova (Principal Investigator) and Medizinisch‑Wissenschaftlicher Fonds des Bürgermeisters von Wien (academic study), Consultant of: Received consulting fees from Boehringer Ingelheim and Janssen, Speakers bureau of: Received speaker’s honoraria from Janssen and Lundbeck, T. Ito Shareolder of: Johnson & Johnson, Employee of: Janssen, Y. Kambarov Employee of: Janssen, A. Lacerda Grant / Research support from: Received grants from Azidus, Biophytis, Boehringer-Ingelheim, Cellavita, Celltrion, CNPq, Eli Lilly, EOM, FAPESP, Genova, IQVIA, Janssen, Nordisk, Novartis, Novo, Parexel and PPD, Consultant of: Received consulting fees from Aché, Apsen, Biogen, Boehringer-Ingelheim, Cristalia, Daiichi, Eurofarma, Sankyo, EMS, Janssen, Libbs, LivaNova, Lundbeck, Sanofi and Torrent, Speakers bureau of: Received speaker’s honoraria from Aché, Apsen, Biogen, Boehringer-Ingelheim, Cristalia, Daiichi, Eurofarma, Sankyo, EMS, Janssen, Libbs, LivaNova, Lundbeck, Sanofi and Torrent, B. Rive Employee of: Janssen, C. von Holt Shareolder of: Johnson & Johnson, Employee of: Janssen, A. Oliveira-Maia Grant / Research support from: Received grants from Compass Pathways, Ltd., Janssen, and Schuhfried GmBH; investigator‑driven research funded by Fundação para Ciência e Tecnologia (PTDC/SAU-NUT/3507/2021; PTDC/MED-NEU/1552/2021; PTDC/MED‑NEU/31331/2017), Fundação para Ciência e Tecnologia and FEDER (PTDC/MED-NEU/30845/2017_LISBOA-01-0145-FEDER-030845; PTDC/MEC-PSQ/30302/2017_LISBOA-01-0145-FEDER-30302), the European Research Council (ERC-2020-STG-Grant 950357), the European Commission Horizon 2020 Research and Innovation program (H2020‑SC1‑2017‑CNECT‑2‑777167‑ΒΟUNCE; H2020‑SC1‑DTH‑2019‑875358‑FAITH), and the European Joint Programme in Rare Diseases (Joint Translational Call 2019) through Fundação para Ciência e Tecnologia (EJPRD/0001/2020), Consultant of: Received payment or honoraria from MSD (Portugal), Neurolite AG, and the European Monitoring Centre for Drugs and Drug Addiction; received support for attending meetings from Janssen (Portugal); participated in advisory boards for Angelini (Portugal) and Janssen (Portugal), Employee of: Vice-President of the Portuguese Society for Psychiatry and Mental Health; Head of the Psychiatry Working Group for the National Board of Medical Examination (GPNA) at the Portuguese Medical Association and Portuguese Ministry of Health

Substance use disorder is a common comorbidity with bipolar disorder, delaying its diagnosis and making treatment of both disorders more complex and challenging.

We aim to analyze the types of substances used by patients with bipolar disorder and to find if there’s a relationship between the substance used both with treatment adherence and maintenance of abstinence.

We collected, retrospectively, data from the hospital platform and analyzed it on SPSS Statistics 26, along with a literature review. Our study looks over 3 years, and all patients analyzed have a dual diagnosis of both bipolar disorder and substance use disorder and were hospitalized in the psychiatric ward of a tertiary university hospital.

There were 2384 hospitalizations in the Coimbra’s University Hospital psychiatric ward, and 88 hospitalizations were coded with a dual diagnosis of bipolar disorder and substance use disorder.

Tobacco was the substance more consumed by the patients (53.4%), followed by alcohol (46.6%) and cannabinoids (30.7%). In 18.2% of the patients was identified consumption of cocaine and in 6.8% there was an abuse of opioids. It is important to highlight that 20.5% of the patients used 2 or more substances at the same time.

Regarding adherence to treatment for both their bipolar disorder and substance use disorder, in 25% of the patients, there wasn’t a satisfactory compliance with the treatment prescribed.

In the group of patients with polydrug use, half of them didn’t comply with the treatment. In the patients consuming only one substance, we found out that 30% of patients who use alcohol didn’t adhere to the treatment, while around 13% of the patients using cannabinoids didn’t comply with the suggested treatment.

The relationship between the type of substance used and treatment adherence was statistically significant with a p=0.004 (considering p<0.05).

Regarding abstinence from consumption, around 42% of the patients keep using at least one substance. In the group with polydrug use, around 65% of the patients were not abstinent in the last appointments, while in the cannabinoids users’ group around 50% of them were still using the drug. In the group with patients using alcohol, around 43% of them are not abstinent.

The relationship between the type of substance used and maintenance of abstinence was found to be statistically significant with a p=0.037 (considering p<0.05).

Substance use disorder can have a huge impact on adherence to treatment, worsening the prognosis of the comorbid bipolar disorder. On the other hand, this dual diagnosis can impact the maintenance of abstinence.

Early detection of both diagnosis and simultaneous treatment from an early phase are essential to improve the prognosis of both diseases.

None Declared

Parkinson’s disease (PD) is the most common serious movement disorder in the world, affecting about 1% of adults older than 60 years. The disease is attributed to selective loss of neurons in the substantia nigra, and its cause is enigmatic in most individuals. Patients with PD display both motor and non-motor symptoms. For some patients, the non-motor symptoms are more bothersome than the motor symptoms. One of the most common non-motor symptoms of PD is depression.

Treatment of depression with antidepressant drugs is well established. In the last 20 years use of antidepressant has risen mainly due to the introduction of the selective serotonin reuptake inhibitors (SSRIs). Our primary aim was to demonstrate an improvement in depressive symptoms in patients who started treatment with vortioxetine. A secondary aim was to show those who was successfully treated with vortioxetine but was unresponsive to paroxetine and escitalopram without worsening the extrapyramidal symptoms of PD.

In collaboration with the Department of Neurology, we included patients who are being treated for Parkinson’s disease and who meet the criteria for depressive disorder after a psychiatric examination. We divided the patients into two groups: those who had not previously taken any antidepressant drugs and those who were already on therapy with paroxetine and escitalopram but without the expected therapeutic response. All patients were prescribed vortioxetine in their treatment, and the Hamilton Depression Rating Scale (HDRS) was determined during their first meeting with the psychiatrist, and then again after 6 weeks of taking the medication. Also, we used Mini mental state examination (MMSE) to measure cognitive impairment.Our primary outcome measure was the number of patients in each treatment group who responded to treatment. Response was defined as the proportion of patients who had a reduction of at least 50% from the baseline score on the Hamilton Depression Rating Scale (HDRS)

Our primary outcome measure was the number of patients in each treatment group who responded to treatment. Response was defined as the proportion of patients who had a reduction of at least 50% from the baseline score on the Hamilton Depression Rating Scale (HDRS)

In our research, vortioxetine has proven to be effective in treating depressive symptoms without worsening Parkinson’s disease, unlike paroxetine and escitalopram, which resulted in partial effects.

None Declared

The tumors of the diencephalon region (thalamic-hypothalamic-pituitary system) include a large group: pituitary adenomas, craniopharyngiomas, gliomas, and others. Tumors differ in the histological structure, and manifestations of the clinical symptoms; by hormonal data; by approaches and methods in treatment.

Psychic symptoms are revealed in disease in addition to cerebral, neuroendocrine symptoms, neurological disorders. Psychoorganic syndrome is represented by emotional, motivational, personal, cognitive impairments, inversion of the sleep-wake cycle, seizures.

Disorders of mental activity are detected in all tumors of this localization in varying degrees, according to the different authors from 20 to 100%; affective pathology varies from 2 to 80% by the literature.

To study the emotional disorders in the structure of psychoorganic pathology in tumors of diencephalon region

290 patients (18-78 years old, mean age 38+2): pituitary adenomas (PA), as the most common – 170 (58,6%), craniopharyngiomas (CG), as with the most varied manifestation of mental symptoms – 120 (41,4%). Methods: psychopathological, data from endocrinological, neurological, neuroimaging methods.

Emotional disorders were detected in patients from 30 to 68% of cases, depending on the histology of the tumours: PA with excessive secretion of growth hormone - emotional disorders are in 60%; PA with excessive secretion of adrenocorticotropic hormone - in 50%; PA with excessive secretion of prolactin - in 30%; with excessive secretion of thyroid-stimulating hormone - in 40%; non-functioning PA - in 16%; CG - in 68%.

Emotional disorders were more often represented by changeable mood, depression, apathy, sleep disturbance, and visceral symptoms. Symptoms differed depending on the histology of the tumor (type and level of hormones), the volume of the lesion and direction of growth, and concomitant hypertensive-hydrocephalic symptoms. Emotional disturbances often include memory impairment, personality and behavior changes.

Emotional disorders are detected in patients in 30-68% of cases in the structure of psychoorganic pathology with damage to the diencephalon region (in particular, with pituitary adenomas and craniopharyngiomas); are determined by the topography of the tumor and histology with the involvement of the corresponding structures and nuclei in the pathological process.

None Declared

Bipolar disorder (BD) is a complex mental illness described by recurrent episodes of mania and depression. One subtype of the illness is rapid cycling BD, characterized by experiencing four or more extreme mood swings within a year. Diagnosing and treating BD can be complicated by comorbid conditions, such as atypical anorexia nervosa (AAN), marked by disordered eating and disturbing weight-related thoughts.

To discuss the diagnosis and treatment plan of a patient with rapid cycling BD, who experienced adverse effects from prescribed medication and later was diagnosed with comorbid AAN.

We present a case of a 21 year-old man initially presenting with anxiety, low mood, and obsessive weight-related thoughts, ultimately diagnosed with major depression and mixed anxiety disorder.

21 year-old man was diagnosed with major depression and mixed anxiety disorder, initially treated with mirtazapine and fluoxetine (limited success), later attempting escitalopram and bupropion combination (partial remission). After 2 years the patient discontinued the treatment due to feeling “euphoric”, subsequently experiencing depression and manic episodes – the initial diagnosis was rapid cycling BD. The treatment was changed to sodium valproate (up to 1500 mg/day) and aripiprazole (up to 10 mg/day), however extremely rare adverse medication effects (nosebleeds, diarrhea with blood admixture, “high-frequency sounds”) were reported. Throughout valproate treatment, the patient experienced persistent diarrhea. During hospitalization for treatment adjustment lithium carbonate was introduced at a starting dose of 900 mg/day, maintaining blood lithium levels between 0.4 mmol/l and 0.49 mmol/l. Later the dose was adjusted and a therapeutic lithium blood level was reached with 1575 mg/day of lithium carbonate. Additionally, risperidone was prescribed, however, the patient experienced an uncommon adverse reaction – nasal congestion. Subsequently, amisulpride was introduced, which provoked severe anxiety and fear, resulting in medication discontinuation. During the latest outpatient visit, fluoxetine was added to the treatment due to observed depressive symptoms. Throughout the treatment, the patient episodically intermittently starved, had persistent distressing thoughts about weight and was diagnosed with AAN. While planning further treatment it was hypothesized that comorbid AAN might affect drug metabolism and the patient was referred to a specialized inpatient facility for eating disorder management.

This case report highlights the complexity of psychiatric disorders and the importance of monitoring and adjusting treatment based on patient response and side effects. Additionally, it emphasizes comorbid conditions significance in influencing the primary disorder’s dynamics as well as the metabolism and effectiveness of psychiatric medications.

None Declared

Delaware’s recent longevity and aging trends predict a continual increase in the number of cancer survivors. As the cancer survivors live longer and age, the prevalence of comorbid chronic conditions tends to increase. Dual burden of cancer and comorbid chronic conditions can have significant and wide-ranging ramifications for cancer survivors. Comorbidity potentially affects the development, stage at diagnosis, treatment options, recurrence and long-term survival of people with cancer. Detailed delineation of Delaware adult cancer survivors including an exploration of comorbidity is critical.

The primary objective was to characterize selected chronic conditions among Delaware adults with cancer in order to present: (i) disparities amongst cancer survivors by select sociodemographic and survivorship characteristics, and (ii) compare the prevalence of chronic conditions among cancer survivors and adult Delawareans without a cancer diagnosis.

Combined data (2018, 2020 and 2021) for Delaware were obtained from the Behavioral Risk Factor Surveillance System. The final data set included 927 Delawareans with at least one type of cancer (excluding skin cancers other than melanoma) and 11,917 participants without a cancer diagnosis. Descriptive statistics examined sociodemographic characteristics and chronic conditions in Delawareans with and without a cancer diagnosis.

Amongst adult Delawareans, 5.1% (CI: 4.6–5.5) were cancer survivors. Across the state, the majority of cancer survivors (76.8%) reported having only one cancer diagnosis. In this sample of Delaware cancer survivors, 83.5% identified as White. Majority were female (57.4%), aged 65 or older (58.9%), had some college or more education (63.7%), and with an income of $50,000 or more (51.1%). Arthritis (46.3%), diabetes (21.5%), depression (18.7%), asthma (14.1%), chronic obstructive pulmonary disease (13.7%) angina (11.9%) and heart attack (11.6%) were the most prevalent comorbid conditions. Prevalence of certain chronic conditions was 2-3 times higher among cancer survivors. Nearly 23% reported not receiving instructions regarding cancer follow-up care.

Cancer survivors have unique concerns. Results aim to facilitate targeted interventions aimed at coordinated managed care among cancer survivors in Delaware. This study bolsters the ongoing public health effort towards the Healthy People 2030 goal of increasing the proportion of cancer survivors.

None Declared

Familial adenomatous polyposis (FAP) is a condition characterised by multiple polyps inside the colon or rectum, leading to colorectal cancer in all patients who do not perform prophylactic colectomy and a higher risk of cancer in other organs. Nevertheless, it has been reported that 14-48% of patients do not comply with regular endoscopic surveillance, which seems to be related to the lower levels of emotional distress observed in these patients. Also, APC gene polymorphisms have been described as being related to neurodevelopmental disorders, such as autism.

To study the prevalence of alexithymia, autistic traits and emotion regulation strategies in patients with FAP.

We conducted a cross-sectional study of patients with a genetic or clinical FAP diagnosis and assessed for alexithymia, autistic traits and emotion regulation using psychometric tests - Toronto Alexithymia Scale - 20 items (TAS-20), Autism-Spectrum Quotient Test (AQ) and Emotion Regulation Questionnaire (ERQ), respectively. The control group were patients with Lynch Syndrome. Statistical analysis was performed using SPSS vs.26.

We recruited a total of 20 patients (10 with FAP vs 10 with Lynch Syndrome). Nine patients were male (45%) versus 11 female (55%). The mean age was 53,35 years (SD 18,4). Half the sample presented a low educational level (equal or inferior to 4th grade).

The overall prevalence of alexithymia was 65%, with an 80% prevalence in FAP patients and 50% in Lynch Syndrome. TAS-20 total score was higher in FAP patients (69,0 vs 60,7; p=0,68). Externally-oriented thinking subscale score was statistically higher in FAP patients (p=0,024).

The overall prevalence of autistic traits was 25%, and the mean AQ score was higher in FAP (23,4; SD 4.97) compared to Lynch Syndrome patients (20,2; SD 5.57), but there were no statistically significant differences between the diagnoses (p=0,192).

A moderate positive correlation exists between Total AQ and Total TAS (r=0.51; p=0.020).

Concerning the scores obtained on the ERQ scale, most participants (14; 70%) use Expressive Suppression as a regulation strategy. Patients with Lynch Syndrome had higher scores than those with FAP, both in the Cognitive Reappraisal (4.22; SD 1.58 vs 4.28; SD 0.90) and Expressive Suppression (4.58; SD 1.08 vs 5.15; SD 1.03) domains.

The average AQ score for patients who mostly use expressive suppression is significantly higher than for those who use cognitive reappraisal (23.86 (3.63) vs 17.00 (6.6); p=0.039).

The preliminary results of this study point to high levels of alexithymia and autistic traits in this population, and a higher tendency to regulate emotions by expressive suppression.

The main limitation of the study was the small sample size, which reduced the power of the study to find statistically significant differences. Also, in future studies, a different control group should be considered.

None Declared

Motor Conversion Disorders (also called Functional Movement Disorders, FMD) are a group of neuropsychiatric conditions characterized by neurological symptoms of altered voluntary motor function that cannot be explained by typical neurological diseases or other medical conditions. In the last decade, several hypotheses have been formulated with respect to their pathophysiology, and a major line of research, trying to integrate psychological, cognitive, and neurobiological factors, focused on the subjective experience that patients feel of their own bodies. However, no study has, so far, directly investigated their Body Schema (the implicit sensorimotor representation of one’s own body) and its plasticity.

To investigate the Body Schema in patients with FMD through a paradigm specifically designed to assess their perceived body metrics, through a spatial estimation of body parts length, and to compare their results with the ones obtain on a group of healthy control subjects (HC)

10 patients with FMD and 11 HC underwent the Forearm Bisection Task, aimed at assessing perceived body metrics, which consists in asking the subject, blindfolded, to repeatedly point at the perceived middle point of their dominant forearm with the index finger of their contralateral hand, and a psychometric assessment for anxiety, depression, alexithymia, and tendency to dissociation.

FMD patients bisected their forearm more proximally (with an increased shift towards their elbow equal to 7.5%) with respect to HC; average bisection point was positively associated with anxiety levels in the whole sample, and with the tendency to dissociation in the FMD group.

FMD patients seem to perceive their forearm as shorter than HC do, which might suggest an alteration of their Body Schema. The Body Schema can go through short- and long-term plastic changes in the life course, mainly related to the use of each body segment; we speculate that, despite FMD being a disorder of functional nature, characterized by variability and fluctuations in symptomatology, the lack of sense of agency over a body part might be interpreted by the nervous system as disuse and hence influence the Body Schema, as deficits of organic aetiology do.

None Declared

Delirium is common in hospital settings, with approximately 3% to 45% of older patients in hospitals developing delirium during their stay. Among the elderly and those with severe or advanced medical conditions, the reported percentage of patients with delirium is over 56%. The three motor subtypes of delirium are hyperactive, hypoactive, and mixed. Another way to characterize delirium is based on whether it is reversible, irreversible, or terminal.

Identifying appropriate pharmacological treatment options among antipsychotics and their correlation with various precipitating and predisposing factors in the in-hospital context

This was a retrospective, cross-sectional, observational study that utilized a database created by the psychiatry department at the National Medical Center 20 de Noviembre, with data collected from April 2021 to April 2022. The database contains anonymized administrative and clinical data of patients who were seen in the psychiatry department for the diagnosis of any type of delirium, using the CAM scale for classification. The database includes records and data of hospitalized patients, encompassing all specialties at this medical center

A total of 139 patients were included in the study, of which 39% were female and 61% were male, with a mean age of 67 and a median age of 68 years. It was observed that the average duration of delirium symptoms, from receiving the consultation to remission, was approximately 6 days (p <0.005) (OR 5.12-6.62), and the average length of hospital stay was approximately 20 days (OR 17.3-22.09). Among the patients, 50.39% were overweight, 63% had hypertension (HTA), 29% had chronic kidney injury, 24% had a history of delirium, and 73% had recent surgical interventions. Patients with diabetes mellitus had a 3.1 times higher risk, those with HTA had a 2.8 times higher risk, and those with kidney injury had a 3.8 times higher risk of having a positive CAM result. It was observed that haloperidol, used in 84% of the patients, showed the highest percentage reduction in CAM scores

Image:

Image 2:

The results of this study emphasize the importance of identifying risk factors associated with delirium and implementing effective treatment for this condition. It was observed that the average duration of delirium symptoms was approximately 6 days, which is relevant for understanding the course and management of this illness. Furthermore, it was found that the average hospital stay was 20 days, underscoring the burden that delirium can place on healthcare systems.

In conclusion, this study highlights the importance of identifying risk factors and providing appropriate treatment, such as the use of haloperidol, to improve outcomes in patients with delirium.

None Declared

Substance use disorders (SUDs) are a growing public health concern in the Arab world. To our knowledge, no previous study in Lebanon assessed the characteristics, management, and outcomes of patients with SUDs seen and managed by a consultation-liaisoin psychiatry (CLP) service.

This study explores the characteristics and management of individuals with SUDs who were referred to the CLP service in a tertiary care center in Lebanon.

As part of the Consultation-Liaison at the American University of Beirut (CLAUB) analysis, we conducted a retrospective record review of patients referred to our CLP service between February 2019 and May 2020. We assessed differences between SUD and non-SUD consults using Chi-square analysis, Fisher’s exact test, or Mann-Whitney U test, as appropriate.

Of 1475 patients, 278 (18.8%) received a diagnosis of SUD. They were mostly males (73.7%) with an average age of 38.8 years. The most used substances were alcohol (60%) and cannabis (28.4%). Compared to non-SUD consults, patients with SUDs were more likely to be males (odds ratio OR=3.18, p<0.001) and to get intubated during admission (OR=1.81, p=0.048). Predictors of intensive care unit admission in patients with alcohol use disorder included pulmonary or endocrinological disease, benzodiazepine use disorder, and days until CLP referral.

The results of this study highlight the high prevalence of alcohol use among individuals with SUD referred to the CLP service. Additionally, they underscore the limited treatment avenues available in this part of the world. The institution of a comprehensive CLP service is crucial to address the unmet needs of patients with SUDs who present to a general hospital setting.

None Declared