In Georgia, the psychiatry system is predominantly institutionalized, with limited community-based services and inadequate funding for psycho-social rehabilitation. Government finds it challenging to refocus psychiatry care towards deinstitutionalization, often failing to understand the high importance of such a step and the reasoning behind turning it. This research proposal aims to explore strategies to enhance the cost-effectiveness of mental health services in this context.

Assess the current landscape of psychiatry services in a middle-income country, focusing on institutional care versus community-based services. Identify barriers and challenges faced by key actors in transitioning towards community-oriented psychiatry care. Investigate the cost-effectiveness of community mental health interventions compared to institutional care, considering long-term outcomes and societal impacts. Develop evidence-based recommendations to advocate for policy changes and resource allocation towards community-oriented services.

Literature Review: Conduct a comprehensive review of existing literature on cost-effective analyses and community interventions in middle-income countries.Policy Analysis: Examine existing mental health policies and budget allocations to identify gaps and opportunities for reallocating resources toward community-based care. Stakeholder interviews: interview policymakers, mental health professionals, and patients to collect information from different perspectives. Quantitative Analysis: Use health economics methods to analyze the cost-effectiveness of community-based mental health services compared to institutional care.

Insights into the economic impact of transitioning towards community-oriented mental health services in middle-income countries. Policy recommendations aimed at increasing investment in community-based interventions and resocialization programs. Increased awareness among key actors about the long-term benefits and cost savings associated with community-oriented mental health care. Improved understanding of societal attitudes and barriers towards mental health reform.

Key discussion points include: How can advocacy efforts be reinforced to persuade governments that community mental health care is more affordable and beneficial? What obstacles might stand in the way of expanding community-based services, and how might they be overcome? How can stakeholders work together to guarantee resocialization programs receive ongoing financing and support? What role can international partnerships and collaborations play in supporting mental health reform in Georgia? By addressing these critical questions, this research proposal seeks to provide a roadmap for enhancing the cost-effectiveness and accessibility of mental health services in Georgia and similar middle-income contexts.

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Clinical stageing models are well-established in many areas of medicine, most notably in oncology. These models are used to determine personalised treatment options and indicate prognosis. In psychiatry, staging models have been developed most prominently for psychosis and mood disorders. These models are being used to guide treatment and service provision, e.g. through development of high-risk and early intervention services and stage-appropriate treatment delivery. Clinical staging models for obesity, incorporating medical history, clinical and functional assessments and routine diagnostic investigations also exist and appear to show improved clinical utility in assessing obesity- related risk and prioritising treatment. Recent generic frameworks for staging in mental health have highlighted that there is much individual variability in people’s progression through different illness stages, and therefore there is a need to also specify stage modifiers (disease progression factors (e.g. cognitive or neural factors) and extension factors (e.g. physical complications)). Several staging models for eating disorders have been developed. Most of these focus on anorexia nervosa (AN). Criteria for stage differentiation are mostly based on combinations of cognitive, behavioural and physcial features, and illness duration. As yet most of these models are untested. In my talk I will summarise the available evidence on illness stages, stage modifiers and extension factors and their utility in AN and present evidence on what is known about stage-appropriate interventions. I will discuss implications for research and clinical practice.

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Resilience, the ability to adapt and thrive amid adversity, is particularly prominent in Tunisian women, who are recognized for their strength and adaptability despite societal pressures. Their resilience appears closely linked to cultural heritage, indicating a significant connection between resilience and cultural values. This study explores how cultural values shape the psychological resilience of Tunisian women.

To examine the influence of cultural values on resilience among Tunisian women.

A cross-sectional survey was conducted Tunisian women aged 18 and above, from June to August 2024. Sociodemographic data were gathered, while cultural values were assessed using the Individual Cultural Values Scale (CVScale) and the Centrality of Religion Scale (CRS-5). Resilience was measured with the 25-item Connor-Davidson Resilience Scale (CD-RISC 25).

We collected 695 responses in our survey. Participants had a mean age of 36.72 ± 12.23 years, with 90.9% holding university degrees, 56.5% employed, 49.2% married, and 50.6% with children. The mean resilience score was 68.26 ± 14.09, with 26.3% showing low resilience. Average scores for cultural values were “power distance” (9.13 ± 3.46), “uncertainty avoidance” (20.84 ± 2.95), “masculinity” (9.55 ± 3.99), “collectivism” (21.64 ± 5.07), “long-term orientation” (25.89 ± 2.94), and “centrality of religion” (3.95 ± 0.77).

Resilience correlated positively with “uncertainty avoidance” (p < 10⁻³, r = 0.145), “collectivism” (p < 10⁻³, r = 0.208), “long-term orientation” (p < 10⁻³, r = 0.267), and “centrality of religion” (p < 10⁻³, r = 0.186). Conversely, resilience was negatively correlated with “power distance” (p < 10⁻³, r = -0.104), and no significant correlation was observed with masculinity.

The findings reveal that cultural values significantly shape resilience in Tunisian women. Higher resilience was associated with uncertainty avoidance, collectivism, long-term orientation, and religious centrality, while power distance negatively impacted resilience. This emphasizes the need to incorporate cultural dimensions when designing initiatives to support resilience among women in Tunisia.

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Sleep disorders are commonly reported among patients diagnosed with multiple sclerosis (MS), particularly in the period following the disclosure of the diagnosis. The combination of psychological stress and the chronic nature of the disease contributes to significant sleep disturbances. Understanding the prevalence, causes, and implications of these disorders is crucial for improving patient care.

The aim of this study is to evaluate the prevalence and characteristics of sleep disorders in MS patients following the announcement of the diagnosis and to explore the contributing factors, including psychological and physical symptoms.

A descriptive and analytical cross-sectional study was conducted from March 1, 2023, to January 30, 2024, involving patients diagnosed with multiple sclerosis (MS)who were observed in the neurology department at Habib Bourguiba University Hospital in Sfax. We evaluated sleep disorders using the insomnia severity index scale which included 7 items to investigate sleep disturbance.

A total of 100 patients, with a mean age of 38 years ± 10 years, were included, with a strong majority of women (73%). No psychiatric history was noted. The median disease duration was 7.38 years (3-10.75). Among our patients, 64(64%) had attained a university level of education. In addition, 40(40%) were married, and 60 (60%) were single, divorced, or widowed.

The median Insomnia Severity Index was 5 (1-10.75). More than half of our patients (62%) did not suffer from insomnia. However, 9% had a mild subclinical form of insomnia, 10% had moderate clinical insomnia, and 19% suffered from severe clinical insomnia.

Primary education level was correlated significantly with mild sleep disorders n=33.3 (33.3%), (p=0.044). On the other hand, those with a higher education level showed a lower prevalence of mild sleep disorders n=22.2(22.2%) (p=0.01). However, a lower prevalence of severe sleep disorders was noted among married individuals (10.5% p=0.004), while a higher frequency was observed in divorced individuals (15.8%, p=0.). Only refusal of the diagnosis upon its initial announcement was significantly associated with severe sleep disorders (63.2%, p=0.012).

Addressing sleep disorders in MS patients requires a holistic approach that incorporates both psychological and symptom management strategies. Early interventions targeting anxiety, depression, and physical discomfort are essential for improving sleep quality and overall well-being in this patient population. Further research is needed to develop tailored therapeutic approaches that address the unique challenges faced by MS patient’s post-diagnosis.

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The cannabis use has increased widely in Tunisia during the ten past years, especially in adolescents and young adults. Cannabis use can lead to mental and physical health problems.

The aim of the study was to determine the factors associated to problematic cannabis use.

This was a cross-sectional descriptive and analytical study including 115 subjects arrested for suspected drug use, carried out using a pre-established questionnaire, the CAST (Cannabis Abuse Screening Test) for the assessment of cannabis use, the Hamilton Anxiety and Depression scale, the 5-word Test of Dubois for memory evaluation, and the Rosenberg scale for the assessment of self-esteem.

A urine dosage of cannabis was also performed.

The mean age of the study population was 25.19 ± 6.7 years. The sex ratio was 8.16. the problematic users represented 73.9% of the study population. The cannabis was used in the form of joints. Memory decline was noted in 73% of the cases, and 52% of users had anxiety and depression symptoms.

Problematic use was associated to male gender (p<0.001), to an age older than 21.5 years (p= 0.01), to early initiation (p= 0.005), to memory decline (p= 0.003) and the higher scores of anxiety (p< 0.001)

The frequency of cannabis consumption and the vulnerability factors of problematic use must be taken into account in prevention campaigns.

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Sleep disturbances are common among individuals with bipolar disorder (BD) and may be present even during euthymic phases and significantly impact illness course and quality of life. This preliminary analysis is part of BEGIN (The Bipolar Exposome-Gene Interaction Naturalistic study.

Here, we analyze the relationship between subjective sleep disturbances and various lifestyle and environmental factors in BD patients.

Eighty-seven patients diagnosed with BD (Mean age = 50.7 years, SD = 13.6; 44.7% female; Mean BMI = 26.9, SD = 4.61) all in a three-month euthymic phase, were recruited. At baseline, participants completed lifestyle questionnaires covering diet, light exposure, and time spent indoors, alongside assessments of clinical history and circadian rhythms using the BRIAN scale. Sleep quality was assessed through the Pittsburgh Sleep Quality Index (PSQI, with a cutoff >5 for sleep problems) and the Epworth Sleepiness Scale (ESS, with a cutoff >10 indicating excessive daytime sleepiness). Sociodemographic, clinical, and environmental factors were compared between BD patients with and without sleep disturbances.

Based on ESS scores, patients with excessive daytime sleepiness had significantly higher overall circadian rhythm disruptions, as indicated by the BRIAN total score (p = 0.049). A negative correlation emerged between excessive daytime sleepiness and age at first hospitalization (r = -0.36, p = 0.003). Disrupted eating patterns, reflected in the BRIAN eating subscale, also correlated with excessive daytime sleepiness (r = 0.27, p = 0.027). Based on PSQI scores tobacco smoking was positively associated with poor sleep quality (r = 0.42, p = 0.013), while more time spent with artificial light from electronic devices (r = -0.29, p = 0.019), and less time spent indoors (r = 0.39, p = 0.001) correlated with worse sleep quality. Patients experiencing poor sleep also showed less consistency in social routines (BRIAN social score, p = 0.028).

These preliminary findings suggest that sleep disturbances in BD patients may be intricately linked to lifestyle and environmental factors, such as circadian rhythm disruptions, smoking, and exposure to artificial light. These results highlight the importance of considering environmental and lifestyle modifications to support sleep quality in BD. Future longitudinal analyses will be essential to clarify causal pathways and develop targeted interventions that address circadian and lifestyle factors in managing BD.

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Cohort studies in first-episode psychosis (FEP) provide crucial insights into the diverse trajectories of clinical and functional recovery. These studies are invaluable for evaluating the effectiveness of new intervention models and informing resource allocation and policy development.

To synthesize quantitative and qualitative findings on mortality and clinical outcomes and to explore their interrelations in a multi-modal investigation of long-term outcomes in FEP. Specific objectives include appraising how this study’s findings have influenced the development of new models of care.

Data were drawn from the iHOPE-20 study, comprising cohort analyses and qualitative interviews with 171 FEP participants diagnosed between 1995–1999 in Dublin, Ireland. Participants with lived experience contributed to the design of the 20-year follow up assessments. Mortality rates were calculated; symptoms, functionality and quality of life trajectories were analyzed using mixed models; and personal recovery themes were derived through thematic analysis. Ongoing analyses are addressing predictors of the number, timing and sequencing of relapses/readmissions among baseline variables as foci for service development.

The study revealed substantial variation in long-term outcomes among individuals with FEP. Shorter DUP was consistently associated with better outcomes across all of the follow-up points. Mortality rates highlighted the importance of interventions to address physical health morbidity. Diagnostic instability over time underscored the dynamic nature of psychosis management. Employment status at follow-up highlighted the importance of strategies to support a return to education or employment after a first presentation.

Findings emphasize the enduring impact of DUP and the need for tailored interventions. Data from this cohort highlight the value of longitudinal insights as a benchmark for comparing the effectiveness of new intervention models. In such studies, addressing ethical and data protection challenges, incorporating the expertise of those with lived experience and harmonising outcome measures remain vital to advance recovery-oriented care models.

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Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition which is underdiagnosed and undertreated in women. For decades, the ADHD field has called for more insight into female-specific therapy. Preliminary findings postulate that changes in sex hormones during the menstrual cycle may influence the effectiveness of psychostimulant medication. Yet, pharmacotherapeutic interventions tailored to women with ADHD remain scarce. Previously, our group showed an increase in mood symptoms in the premenstrual week in women with ADHD. Premenstrual worsening of depressive and ADHD symptoms represent a treatment challenge.

In our adult ADHD clinic, we noted several women describing exacerbation of their ADHD and depressive symptoms in the premenstrual week and/or insufficient effect of their established dosage of psychostimulant. We responded to the need expressed by these women by increasing their stimulant dosage in the premenstrual week, while monitoring the response and side effects.

This community case study of nine consecutive women being treated for ADHD and co-occurring conditions (including depression and premenstrual dysphoric disorder), reports our local experience of increasing the individually prescribed psychostimulant dosage during the premenstrual period. We methodically monitored the effect of this increased dosage on ADHD symptoms, mood and somatic symptoms for the following 6-24 months.

With premenstrual dose elevation, all nine women experienced improved ADHD and mood symptoms with minimal adverse events. Premenstrual inattention, irritability and energy levels improved, and now resembled the other non-premenstrual weeks more closely. All women decided to continue with the elevated premenstrual pharmacotherapy.

Our preliminary results demonstrate potential benefits of increasing premenstrual psychostimulant dosage in women with ADHD, experiencing premenstrual worsening of ADHD and mood symptoms. The results concur with previous findings of diminished response to amphetamines in the late luteal phase. Increased dosage may help combat premenstrual worsening of cognitive and emotional symptoms in women with ADHD, with significant clinical implications. Better management of premenstrual ADHD and mood symptoms in vulnerable women can improve treatment outcome and meet an unmet need. However, implementation should be individually explored. Further investigation of luteal phase psychostimulant dose adjustment is required for safe, optimal and individualised treatment for women with ADHD. Specifically, we are currently applying for funding to set up the ADAPT-trial (Adjusting Premenstrual Psychostimulant Dosage for Women with ADHD: Enhancing Efficacy).

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Psychiatric patients, especially those with psychotic disorders, face an increased metabolic and cardiovascular risk, which ultimately leads to higher mortality from cardiovascular disease and reduced life expectancy. This is due to a multitude of risk factors, including those related to the course of the mental illness, lifestyle, socioeconomic and cultural circumstances, and the use of certain medications, such as atypical antipsychotics. This underscores the need for structured interventions during hospitalization to identify and manage these risks. Non-pharmacological interventions, such as physical activity and dietary education, have shown to be beneficial in managing weight and improving cardiovascular health. Pharmacological treatments, particularly the use of metformin and aripiprazol, have demonstrated efficacy in reducing metabolic disturbances such as weight gain, dyslipidemia, and hyperglycemia. The implementation of structured protocols to mitigate metabolic risk in psychiatric inpatients is recommended.

The main goal of the protocol is to guide the assessment, diagnosis, and therapeutic management of metabolic and cardiovascular risk factors in psychiatric inpatients. It also aims to guide the follow-up of these patients after discharge and coordination with other medical specialties.

The protocol was developed in an interdisciplinary manner, involving the specialties of Psychiatry, Endocrinology, and Internal Medicine, and is based on recent guidelines and recommendations from other countries on this matter. The protocol was also adapted to the current conditions of the psychiatric inpatient setting.

The protocol involves a thorough clinical evaluation, including medical history, physical examination, and extensive laboratory analysis to identify comorbidities. Cardiovascular risk is calculated using the SCORE2, PRIMROSE and QRISK3 models. Non-pharmacological interventions include physical activity programs and nutritional counseling, while pharmacological interventions involve adjusting antipsychotic medications, selecting antipsychotics with more favourable metabolic profiles, and the adjuvant use of medications like metformin, aripiprazol, and topiramate. These evaluations are conducted at regular intervals, including post-discharge, to assess the efficacy of these interventions.

Psychiatric inpatients, especially those on atypical antipsychotics, face significant metabolic and cardiovascular risks. A comprehensive assessment of risk factors and early intervention during hospitalization, combining lifestyle modifications and pharmacological treatments, can significantly reduce these risks and improve patient outcomes. Continued monitoring and coordination with outpatient services post-discharge are essential for sustained management of these health risks.

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Prenatal unipolar depression is a significant mental health challenge affecting a considerable number of pregnant women worldwide, with higher prevalence rates in developing regions. Due to the potential risks of antidepressant medications on fetal health, there is an increasing need for safe, non-pharmacological treatments. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising neuromodulation therapy, offering a non-invasive approach to treating depression. This systematic review explores the efficacy and safety of rTMS in addressing prenatal depression, aiming to provide evidence for its potential as an alternative therapy for this vulnerable population.

The primary objective of this review was to assess the therapeutic effectiveness and safety profile of rTMS in treating unipolar depression among pregnant women. The secondary aim was to identify gaps in the current literature and provide recommendations for future research to strengthen clinical guidelines for rTMS use during pregnancy.

A comprehensive search was conducted using the PubMed database without a time restriction, focusing on case reports, case series, uncontrolled studies, and randomized controlled trials that examined rTMS for prenatal depression. Inclusion criteria required studies to involve adult pregnant women diagnosed with major depressive disorder undergoing rTMS treatment. Data on depressive symptom improvements and any adverse effects on both mother and fetus were extracted for analysis.

Analysis of ten studies, including six case reports/series, three uncontrolled studies, and one randomized controlled trial, indicated that rTMS was well-tolerated by pregnant women and showed effectiveness in reducing depressive symptoms. Notably, no adverse effects were observed in fetal outcomes across these studies. Symptom improvement was significant, with high patient satisfaction reported, yet the limited sample sizes and variations in methodology underscore the need for more robust trials.

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The findings from this review suggest that rTMS is a promising, non-invasive alternative for managing prenatal depression with minimal fetal risk. However, due to the limited number of high-quality studies, further research is necessary to confirm these preliminary findings and establish standardized protocols for rTMS use in prenatal depression treatment. Expanding the evidence base will support the development of safe, effective treatment options tailored to the unique needs of expectant mothers facing depression.

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Perinatal psychiatry is a rapidly evolving subspecialty focused on diagnosing, recognising early, and treating mental disorders in pregnant and postpartum individuals, up to two years after childbirth (timeframes vary globally). The field has gained attention as governments around the world work to meet the United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (health and well-being) and SDG 5 (gender equality), aiming to improve maternal, infant, and child health outcomes.

In most countries, perinatal mental illness is managed by family doctors, midwives, and general adult psychiatrists, although some countries have developed specialist community and inpatient perinatal mental health services. The goal is effective treatment to improve pregnancy outcomes, parental mental health, social functioning, and child development. Studies show that infants of mothers with untreated perinatal depression and psychosis are at higher risk of long-term mental health disorders and poor social and educational outcomes. Early detection and efffective and acceptable interventions are key to breaking this cycle.

This presentation will address global advances and ongoing challenges. Significant progress includes increased awareness, emerging specialist services, novel pharmacological treatments with improved safety profiles, expanded evidence-based psychosocial interventions, and a focus on maternal suicide prevention, a key driver of maternal mortality. However, major challenges remain: perinatal suicide is a leading cause of maternal death, poor quality of evidence for prescribing in pregnancy and lactation, long-term morbidity due to untreated mental illness is often overlooked, and access to care is limited especially in low- and middle-income countries. Social stigma and structural barriers also prevent many from seeking help. Addressing these issues requires a global, multidisciplinary approach, integrating public health initiatives, policy changes, workforce training, and research innovations to ensure equitable access to high-quality perinatal mental health care worldwide.

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Excessive preoccupation of having a serious illness (EPHSI) or illness anxiety disorder is frequently reported by doctors and medical students

Our objectives were to estimate the frequency of EPHSI in a population of medicine residents in Tunisia and to determine the factors associated with this pathology.

This was a cross-sectional study via internet, carried out among 404 medicine residents practicing in Tunisia during the period of November and December 2020 and January 2021.

The information was collected using a pre-designed questionnaire, edited using the Google site and disseminated via social networks. This questionnaire was inspired by the Health Anxiety Questionnaire, the MSD score, and the DSM-5 criteria for illness anxiety disorder

In the end of the study period, 404 medicine residents responded to the questionnaire. The mean age was 27.4 years, the sex ratio was 0.47. Residents who fulfilled the DSM5 criteria of anxiety illness disorder represented 33.7% of the total group.

The most preoccupying diseases were neoplastic diseases (40.8%), neurodegenerative disorders (14.3%), and psychiatric disorders (10%).

EPHSI was associated to several sociodemographic, anamnestic and psychological factors

The establishment of psychological support systems for students, emphasizing coping and stress management techniques, should be implemented to prevent the EPHSI.

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A growing body of research has demonstrated the positive effects of Acceptance and Commitment Therapy (ACT) delivered in the workplace on employees’ well-being and psychological flexibility. Delivering ACT in the workplace aims to enhance employee performance and reduce stress levels by promoting psychological flexibility, a skill to consciously live in the present, observing thoughts and emotions, and engaging in value-driven actions.

The short-term effects of a 5-week ACT-based psychological flexibility training program were tested.

Participants were 21 corporate employees (62 % women, Mage = 43.9 years, SD = 9.5) recruited from a large company in the financial sector. The six core processes of psychological flexibility were examined before the first training session and after the fifth training session of the 5-week training. Psychological flexibility, value-driven living, thought suppression, five facets of mindfulness and cognitive fusion were assessed.

Results showed a statistically significant difference in one core process of psychological flexibility, namely Contact with the present moment. Acting with awareness, Describing and Nonjudge showed significant difference before and after the training. Presumably, changes in Cognitive defusion and Non-reactivity are also evident, however results did not show significant difference.

The present research has provided further empirical evidence for the effectiveness of ACT-based psychological flexibility training with regard to three aspects of Contact with the present moment, which is a core process of psychological flexibility (Acting with awareness, Describing, and Nonjudge). The findings provide a basis for future research to investigate longer-term effects, including monitoring how participants in the research program practice the learnt techniques in their everyday lives.

Á. Magyary Grant / Research support from: ÁM was supported by the ÚNKP-23-2 New National Excellence Program of the Ministry for Culture and Innovation from the source of the National Research, Development and Innovation Fund., Z. Demetrovics: None Declared, Á. Zsila: None Declared, N. Mészáros: None Declared

Alcohol Use Disorder (AUD) and its comorbidities can have a tremendous negative impact on various activities of daily living, including the capability to manage one’s finances. Adequate financial functioning is essential for an individual’s health and well-being and is key to leading an autonomous and independent life. Problems with financial functioning can have far-reaching personal and legal consequences, and may lead to financial insecurity or poverty, financial victimisation, placement under guardianship, and reduced opportunities for social and societal participation.

To evaluate the financial situation and the strengths and weaknesses in the everyday financial functioning of individuals with AUD.

The financial situation and financial performance of an AUD group (n = 52) were compared to a control group (CG) (n = 95), using the Financial Performance Scale (FiPS). In addition, associations between financial performance and everyday contextual factors (i.e., income, depressive symptoms (i.e., Beck Depression Scale - II), social support (i.e., Brief Perceived Social Support Questionnaire)) were explored.

As compared to the CG, the AUD group reported to have a significantly poorer financial situation, including lower income levels, more frequent debts, and fewer savings. Furthermore, the AUD group reported a significantly poorer overall financial performance (FiPS total score) than the CG, and significant group differences were observed for relatively complex financial tasks, such as financial goal setting and doing tax returns. The difficulties in financial performance of the AUD group were, however, considered as relatively mild, since most aspects of financial performance (i.e., FiPS item scores) did not differ between groups. In the total sample, a better financial performance was significantly associated with a higher income, more perceived social support, and fewer depressive symptoms.

Individuals with AUD reported a poorer financial situation and more difficulties with performing complex financial tasks compared to controls. These reported weaknesses may stem from cognitive and affective impairments associated with AUD, as well as from a scarcity of financial resources. Since a vicious cycle may exist between financial problems and AUD symptoms, it is relevant to enhance the financial well-being of those individuals with AUD who experience financial difficulties.

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Epilepsy is the most common chronic neurological disease in the general population. The role of the psychiatrist in this pathology is to consider the epileptic diagnosis within the diagnostic possibilities, its psychosocial consequences and the psychological and cognitive effects of common antiepileptics. It has been reported that 30% to 50% of all individuals with epilepsy present, at some point in their lives, psychiatric difficulties. An epileptic seizure is a transient paroxysmal pathophysiological alteration of brain function caused by spontaneous excessive neuronal discharge. Symptoms will depend fundamentally on the cerebral origin of the seizure and the spread of activity in the brain. Finally, to better understand the clinical case that will be presented, it is important to differentiate between partial epileptic seizures, which involve epileptiform activity in localized brain regions, and generalized seizures, which affect the entire brain.

The main objective of this work is to review the current scientific evidence on psychiatric symptons in epilepsy.

The case of a 75-year-old man with a neurological history and abrupt appearance of atypical psychiatric symptoms is presented. A detailed search was performed on UpToDate with the search terms “Epilepsy” and “psychiatric pathology.”

This is a 75-year-old man with an organic history of repeated cerebral strokes and vascular epilepsy who attended the Emergency Department due to the onset of autolytic ideation abruptly and without a biographical trigger. After the express request by psychiatry for a neurological study, an EEG was performed, where epileptiform activity was observed in the frontal lobe and a diagnosis of right frontal focal status epilepticus secondary to a chronic cerebrovascular lesion was diagnosed. Preictal events in complex partial epilepsy include autonomic sensations (gastric repletion, flushing and changes in breathing), cognitive sensations (déjà vu, jamais vu, forced thoughts), affective states (fear, panic, depression, euphoria) and automatisms.

Status epilepticus constitutes one of the main neurological emergencies. Convulsive status epilepticus is a life-threatening situation that requires immediate pharmacological treatment and life support measures, as well as recognition and treatment of a possible triggering cause. It is a prolonged epileptic seizure or one that repeats itself in time intervals that are short enough so that the patient does not regain consciousness between episodes. Among the possible symptoms in epilepsy with a focus on the frontal lobe, atypical behavioral alterations are included that can go unnoticed and be referred to psychiatry.

In conclusion, this case shows the need for organic screening in those patients with atypical symptoms that do not fit into the major neuropsychiatric syndromes.

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Artifical Intelligecne is sold as a magic solution, and yet its inscrutability poses a major problem. Who is the source of the knowledge? Who is accountable? Who is responsible? Who can edit or train it? Has it been trained on copyrighted material? If so, have the owners been compensated? If not, is it culturally relevant? Has the ‘black box’ aspect been addressed? Whether a provider of knowledge, a clinical decison aid or a decsion maker, troubling issues arise that as yet have not been solved by legisaltion or the market. We shall explore potential benefits, solutions, and actual problems with real world cases that shed light on where AI may take us, and where we may need constarints that lie beyond medical ethics.

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Treatment motivation is very important in the treatment of alcohol and substance use disorders. The evaluation of motivation, which is seen as the first step in addiction treatment, will also help understand the person’s interest and compliance with treatment. The lack of motivation of the person during the treatment process causes treatment abandonment and relapses.

An important issue in the treatment of alcohol use disorder is the trust of the person in the treatment. It is also important for the addict to have someone around him who has benefited from treatment, which is very important in terms of treatment compliance. With the influence of a person who has benefited from addiction treatment, the likelihood of applying for treatment and benefiting from treatment increases in a “snowball” manner.

The aim of this study was to evaluate whether people who are treated for alcohol use disorder have a treatment motivation for those around them. It was aimed to examine whether the people who have been treated are important in increasing the trust in treatment for other patients.

The study included cases who applied to the Seferihisar State Hospital Psychiatry Outpatient Clinic with complaints of alcohol use. The sociodemographic information form was filled out during the individuals’ first applications. The participants were asked whether there were people around them who had received inpatient treatment for alcohol use disorder at the hospital where the study was conducted, and the individuals were then administered the Readiness for Change and Desire for Treatment Scale (SOCRATES), Treatment Motivation Questionnaire (TMQ), and Alcohol Use Disorders Identification Test (AUDIT). The individuals were given the standard treatment recommended in our country’s treatment guidelines for the diagnosis of alcohol use disorder. The individuals participating in the study were interviewed at 1 month, 2 months and 3 months after starting treatment. The individuals’ answers and the decrease in the frequency and amount of alcohol use were recorded.

The rate of treatment attendance is 2.7 times higher for people who have received treatment for alcohol use disorder in their circle.

The rate of treatment confidence in treatment is 4.1 times higher for people who have received treatment for alcohol use disorder in their circle.

The frequency and amount of alcohol use has decreased more for people who have received treatment for alcohol use disorder in their circle.

It has been determined that those who are surrounded by people who have received treatment for alcohol use disorder have higher levels of treatment confidence and compliance. The assistance of these people to those around them can play an important role in increasing the success of addiction treatment.

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Cannabinoid Hyperemesis Syndrome (CHS) is a condition associated with long-term cannabis use, marked by recurrent episodes of nausea, vomiting and abdominal pain, typically relieved by hot showers—a nearly pathognomonic feature. It often develops after years of heavy cannabis use, with symptoms recurring cyclically every few weeks to months while the individual continues to use cannabis. Symptom resolution is generally observed after cessation. Though cannabis is commonly used to relieve nausea (as in chemotherapy-induced vomiting), in susceptible individuals, prolonged use paradoxically induces these symptoms, presenting a diagnostic and therapeutic challenge. Recognizing CHS is increasingly important as global cannabis consumption rises.

The aim of this study is to review the clinical presentation of CHS, highlighting key diagnostic features, current management strategies and treatment.

A comprehensive case report of a 27-year-old female with a history of heavy cannabis use was conducted. She presented with severe nausea and vomiting for two weeks following reported cannabis cessation. A thorough clinical evaluation was undertaken to better understand the clinical presentation of CHS. Additionally, a literature review was performed using PubMed to gather relevant clinical articles on CHS.

The patient exhibited hallmark features of CHS, including a prolonged history of cannabis use beginning in adolescence, recurrent episodes of severe nausea, vomiting, abdominal pain, the typical compulsive use of hot showers for symptom relief and lack of response to conventional antiemetic treatments. These features, combined with the patient’s lack of motivation to discontinue cannabis despite symptom recurrence, strongly support the diagnosis of CHS. Although she had a history of an eating disorder and presented with the Russell sign and dental damage consistent with chronic vomiting, no psychiatric comorbidities or body image disturbances were identified.

CHS remains an under-recognized condition that poses diagnostic challenges. This case reinforces the need to inquire about cannabis use in patients presenting with cyclic vomiting, abdominal pain and weight loss. CHS symptoms and pathophysiological mechanisms can mimic other important diseases, such as eating disorders or gastrointestinal pathologies. Challenges in managing CHS include patient skepticism regarding the role of cannabis as a cause of symptoms, perceived benefits of cannabis and a lack of other effective therapies. Management of CHS involves both acute symptomatic treatment and long-term cessation of cannabis use. Acute interventions may include fluid resuscitation, haloperidol administration, and topical capsaicin application. However, the only definitive treatment is complete abstinence from cannabis, which leads to symptom resolution in the vast majority of cases.

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Firefighters face routine occupational risks and high-stress environments. Accordingly, 96.4% are exposed to a potentially traumatizing event throughout their career (Nazari et al. Work 2020; 67(1):215-222). This is accompanied by high rates of trauma-related mental illnesses (TRMI) such as PTSD. First-line treatments of TRMI remain limited. A novel treatment that has emerged, Ketamine-Assisted Therapy (KAT) has shown meaningful improvements in PTSD treatment (Ragnhildstveit et al.Ther Adv Psychopharmacol 2023; 6:13).

The primary objective was to synthesize prevalent themes among participants, shedding light on their journeys to accessing KAT as well as highlighting internal motivations and societal barriers that exist.

In this study, there are six working firefighters, diagnosed with TRMI. They have enrolled in but not begun the 12-week Roots to Thrive (RTT) KAT program. Interviews were conducted individually and transcribed for further analysis. Data from the interview responses was analyzed by two independent reviewers and coded to create main themes of focus. The inconsistencies were managed by the third senior reviewer.

The major themes prevalent among participants include social stigma, self-advocacy/education, logistical barriers and feeling stuck with previous treatments.Throughout the interviews, participants indicated that the use of ketamine and their mental illness diagnosis were stigmatized. Some kept their treatment a secret from family members while others reported telling very few colleagues about their PTSD. In response to traumatic events at work, one participant explained that the prevalent attitude was “Suck it up. Move on.” The lack of administrative support prompted several participants to teach themselves about psychedelics and mental health in order learn about treatment possibilities. Logistical barriers included barriers to physically commuting, paying for and having time away for the KAT sessions. They pointed out that aside from the price of the treatment itself, paying for cabs and ferries adds to the costs. Each of the participants detailed their journey with trauma and mental illness before KAT. A common sentiment expressed was that they couldn’t cope anymore with symptoms like night terrors and extreme anxiety. Participants discussed a gradual build-up and burnout, as one explained, “You continually are always going to other trauma calls, so it kind of builds up layer, layer, layer after layer.” A reoccuring theme in their experiences was trying different treatment modalities (EMT, EMDR and CBT) with little permanent success.

Greater funding, awareness and administrative support is needed for firefighters diagnosed with PTSD to successfully receive and undergo treatment.

None Declared

The high prevalence of anxiety and depression among patients with cancer has an impact on a decrease in quality of life. there are practically no studies among people with lymphoproliferative diseases, which determines the relevance of our study.

Purpose: to assess the prevalence of anxiety-affective spectrum disorders and their impact on the quality of life and adaptability in patients with non-Hodgkin lymphoma (NHL), Hodgkin lymphoma (HL) and a group, including malignant neoplasm of the body of the stomach and T- and B- cellular lymphoma.

95 patients (women - 52, men - 44) diagnosed with NHL, HL, others were examined using a continuous sampling method.

Clinical interviews; the author’s questionnaire; HADS, EQ-5D, EQ-VAS, PSM-25. STATTECH were used to process the data.

The average age was 52.8±8.3 years (18 to 86). 3 groups: 1-non–Hodgkin’s lymphoma, 2-Hodgkin’s lymphoma, 3- malignant neoplasm of the stomach body and T- and B-cell lymphoma. In gr-s 1 and 2 (90% and 85%), no symptoms of anxiety were detected. In gr 3, clinically pronounced anxiety levels were uniformly detected in 50%. Depressive symptoms a predominantly absence in all groups (1 - 95%; 2 - 86% and 3 - 75%) p>0.05. The assessment of quality of life: in gr 1 and 2, most of the patients noted that they experience some difficulties in the final indicator (55% and 61%), pronounced problems prevail in gr 3 (50%). The mobility of the majority in all groups does not suffer or suffers to a minor extent, 80% of all noted the absence of difficulties in self-care. “daily activity” were a statistically significant - 64% maintained it at a high level (p=0.006); Pain/discomfort is experienced by more than half of the respondents to a moderate degree 55% (p=0.003). In gr 1 and 3, the average of EQ-VAS determined at a level of more than 70 (the arithmetic mean 78 and 73), which indicates a more favorable sense of self. In gr 2 the average was determined at 68, also characterizes a high level of assessment of their general condition, in all patients with CLL, according to PSM 25, the stress level was determined to be low, indicates a state of psychological adaptation to workloads in 100%. In the gr 1, 12 people (17%) were identified with an average level of stress and reduced adaptation and need the rest for this contingent.

our pilot study showed that patients with lymphoproliferative diseases are characterized by a slight decrease in their quality of life, a high level of life satisfaction, good stress resistance to workloads. The main symptoms (reliably expressed in 55%), are moderate severity of pain and discomfort. The obtained data make it possible to emphasize the heterogeneity of the prevalence and severity of anxiety-affective symptoms in patients with various types of oncological diseases.

None Declared