Traumatic brain injury (TBI) is a rare, yet possible cause of psychosis (Fujii D et al. Psychiatr Clin North Am. 2014; 37(1):113-24), with one of the main challenges being distinguishing between Psychosis secondary to traumatic brain injury (PSTBI) and schizophrenia (SZ).

To discuss the diagnostic challenges in patients with psychosis and history of TBI.

In addition to describing a case report of a male with psychotic symptoms presenting after a severe traumatic brain injury, research was undertaken in PubMed and other databases using the keywords “traumatic brain injury”, “psychosis” and “schizophrenia”.

Our patient is a 36 year-old male who suffered a severe TBI at age 22, with consequent frontal and temporal encephalomalacia. Initially he presented with persecutory delusions, delusional perceptions associated with colors, social isolation and decline in academic performance, which were attributed to Post-Concussion Syndrome. However, these symptoms would remain for years to come, leading to the new diagnosis of SZ, at age 25. This way, he started intramuscular antipsychotic medication, which reduced psychotic symptoms and improved his academic performance. This amelioration, at age 30, led to the belief in another diagnosis: Brief Psychotic Episode (after brain trauma). Consequently a reduction in antipsychotic dosage was tried but a resurgence of psychotic symptoms was observed at age 33, which led to the reintroduction of antipsychotic medication, and the reconsideration of the diagnosis of SZ. When we examined him, at age 36, he presented similar symptoms to those observed after the brain injury, intensified by years without antipsychotics. We also found that he had regular use of cannabinoids since age 16 and that his brother was diagnosed with Schizoaffective disorder.

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PSTBI usually occurs after a TBI with frontal and temporal lesions, and psychotic symptoms like persecutory delusions, with the frontal lesions being a possible explanation for the decline in cognitive function by causing deficits in attention, executive functions and memory (Fujii D et al. Journal of Neuropsychiatry Clinics in Neuroscience 2002;14:130-140). SZ can similarly explain many of the findings presented, like psychotic symptoms, social isolation and decline in cognitive function due to negative symptoms, specially considering the use of cannabinoids and genetic vulnerability present in this patient and the fact that TBI is also a risk factor for the development of SZ. This case highlights the difficulty in the differential diagnosis between PSTBI and SZ, given that it presents aspects that can point in both directions.

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Mental health is essential for overall well-being and resilience in facing life’s challenges. Self-esteem, a crucial mental health determinant, affects how individuals perceive and manage stress, and may be linked to worse health outcomes when conditions like anxiety and depression are concerned. Consequently, understanding the role of self-esteem in mental health is essential for developing effective preventive strategies and interventions.

In this study we aimed to investigate the relationship between self-esteem levels and anxiety, depression and stress, with a hypothesis that the presence of the aforementioned mental health challenges is significantly correlated with lower levels of self-esteem. We sought to explore the potential impact of self-esteem as both a risk factor and a target for interventions in mental health care.

A cross-sectional study design was employed, involving 100 participants based in the Republic of Croatia and divided equally into two groups: support-seeking individuals or patients from the daily clinical setting and a control group with no psychiatric treatment history. Participants completed the Rosenberg Self-Esteem Scale (RSE) and the Depression Anxiety Stress Scale (DASS-21). The self-esteem scores classified individuals into low, average or high self-esteem categories. Statistical analyses, including chi-square tests and Mann-Whitney U tests, assessed differences in DASS-21 scores between groups, with adjustments for sociodemographic factors.

Psychiatric patients showed significantly lower self-esteem (mean = 20.84, SD = 7.161) than the control group (mean = 29.84, SD = 7.709). Additionally, psychiatric patients experienced higher levels of anxiety (mean = 12.60, SD = 5.237), depression (mean = 12.04, SD = 5.595) and stress (mean = 14.06, SD = 4.433) when compared to the control group, which exhibited mild anxiety (mean = 5.14, SD = 5.018), low depression (mean = 4.90, SD = 5.296) and minimal stress levels (mean = 6.96, SD = 4.973). Statistical analysis revealed a statistically significant association between low self-esteem and support-seeking or patient status (p = 0.001). Additionally, low self-esteem was associated with more severe mental health symptoms across all categories (p < 0.05).

This study emphasizes the interconnectedness between self-esteem and mental health, demonstrating that lower self-esteem is associated with higher anxiety, depression and stress levels. Therefore, integrating self-esteem enhancement into therapeutic settings may be an effective strategy for mitigating mental health risks, providing a proactive approach to psychological care and prevention.

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The puerperium, or postpartum period, begins immediately after childbirth and is typically considered to last for six to eight weeks. During this time, there is an increased risk of psychiatric pathology, particularly psychotic and affective disorders, due to various factors such as the heightened stress of caring for a newborn and hormonal changes.

To analyze the different diagnostic options for a patient presenting with acute psychotic symptoms during the postpartum period, including those not recognized by the DSM-V.

Presentation of a patient’s case and a review of the existing literature concerning the possible diagnoses that were considered.

We present the case of a 31-year-old female with a history of allergy to beta-lactam antibiotics as her only significant medical history, and a personal psychiatric history of anorexia nervosa (currently resolved) and bipolar disorder. The bipolar disorder had been treated with valproic acid and olanzapine since 2015, medications she discontinued upon learning of her pregnancy. She gave birth to a baby boy four days before seeking care in the emergency department. On the same morning of the consultation, her baby was diagnosed with a renoureteral malformation and prescribed amoxicillin treatment. The patient presented to the emergency department with very acute psychotic symptoms that had started that same day, notably a very disorganized speech and delusional ideas of harm, expressing the belief that her family was poisoning her with the prescribed amoxicillin. During her admission to the acute psychiatry ward, her condition evolved rapidly and very favorably, in around 48 hours and she was treated with olanzapine. Several diagnostic possibilities were considered, including postpartum psychosis, brief psychotic episode, manic episode, or even an organic cause. The rapid onset and therapeutic response ruled out the diagnosis of a manic episode. No organic cause was found to explain the symptoms. It also did not meet the temporal criteria required for a postpartum psychosis. Finally, the diagnosis was brief psychotic episode, triggered by an acute stressor.

When managing a patient in the postpartum period, it is crucial to have a comprehensive understanding of the various diagnostic possibilities, including those not covered by the DSM-V or those that may have a somatic cause, in order to provide appropriate and holistic care.

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COVID-19 wreaked havoc across the world killing millions along its path. All attempts were made to lower and eventually control the death toll from the pandemic. The “trace, test and treat” approach had its limits since the latter were not developed fast enough. Vaccines were seen as the best hope to protect individuals from the coronavirus and COVID-19. Thus, vaccination was encouraged and promoted widely. Aside from vaccines, interventions emphasised non-pharmaceutical self-protective behaviours to protect against coronavirus infection. Subsequently, there were various levels of compliance and observance of self-protection within nations. Yet studies have not attempted to explore the research implications of compliance patterns.

The present study’s aim was to (i) identify latent classes of individuals’ varying levels of compliance with COVID-19 self-protective behaviours; and (ii) explore the capacity of the latent classes to separate individuals according to their levels of Perceived Infectability, Germ Aversion and Fear of COVID-19.

Data for the current study was extracted from a cross-district COVID-19 study conducted among high school level learners (N = 1609; girls = 59%; rural areas = 43%) in South Africa. Latent classes were derived based on the scores obtained by learners on a self-developed index of non-pharmaceutical self-protective behaviours. Three classes were identified, and they were compared against their obtained Perceived Infectability, Germ Aversion and Fear of COVID-19 scores.

Scores of all three knowledge groups did not differ on Perceived Infectability (p > .05), but the highest scorers, the “knowledgeable group”, scored higher than the “moderately knowledgeable group” and the “relatively low knowledge group” on Germ Aversion and Fear of COVID-19. The scores of the “moderately knowledgeable group” and the “relatively low knowledge group” did not differ on the Fear of COVID-19.

The study supports an approach where learners are classified according to their knowledge of COVID-19 self-protective behaviours, and their motivation for self-protection established according to the classification.

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The MAPS-T is a screening instrument currently under development in Brazil, designed for patients over 50 years of age and administered in a computerized format, either online or with assistance. Its purpose is to assess memory binding abilities, which involve integrating complex elements into unified representations, crucial for both short- and long-term memory. Conjunctive binding in short-term memory is responsible for the temporary retention of associations or combinations of features, such as color and shape. Screening instruments like the MAPS-T aim to be low-cost, quick, and non-invasive tools that provide indicators of potential clinical conditions.

To investigate the relationship between performance on memory tasks involving binding and the variables age and educational level.

A total of 33 individuals aged between 50 and 78 years (M=62.09; SD=6.67) with 6 to 35 years of education (M=19.88; SD=5.63) were evaluated. Participants with reported neurological/psychiatric conditions or uncorrected sensory impairments were excluded. Data collection was conducted on a computer by a trained administrator in sessions lasting 15 minutes. The memory binding task required the recognition of a nameable figure and the color and geometric shape surrounding it. Data were analyzed using Spearman’s correlation.

Spearman’s correlation coefficients indicated that age did not show a significant correlation with total recognition, binding score, or dichotomous score (p > 0.05), suggesting that this variable does not have a relevant association with performance in these scores. In contrast, education demonstrated a moderate and significant correlation with total recognition, binding score, and dichotomous score (p < 0.05), suggesting that more years of education are associated with better performance in these areas.

Descriptive Statistics

Education showed a positive and consistent association with performance across all test measures (total recognition, binding score, and dichotomous score). Age, in turn, did not show a significant correlation with these variables, indicating that, in this sample, education is a more important factor than age in explaining performance on the MAPS-T scores, particularly in the binding stage.

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The MAPS-B is part of a project focused on the construction of instruments for cognitive assessment in the Brazilian population. Comprising eight subtests, MAPS-B aims to enhance understanding of cognitive functioning in individuals over 50 years old. The subtests assess autopsychic and allopsychic orientation, perception, naming, memory, praxis, visual and auditory focused attention, working memory, automatic language, inhibition, and semantic memory. Validity evidence is essential to ensure the safe use of new instruments in psychological assessments. Content-based validity evidence reflects the degree to which the instrument aligns with and adequately measures the construct of interest. Such evidence can be derived from expert judgment.

To investigate the content-based validity evidence of the MAPS-B.

The analysis involved four judges with expertise in neuropsychological assessment, who completed a questionnaire on MAPS-B’s subtests. The judges assessed the adequacy and clarity of the instructions and the relevance of each subtest for measuring the proposed construct, using a Likert scale (0 to 4). Space was also provided for comments and suggestions. Responses were analyzed using the Content Validity Index (CVI), calculated individually (CVI-I) and globally (CVI-T) for the instrument. A CVI score above 1 was considered acceptable (Yusoff, Education in Medicine Journal Int 2019; 51). Additionally, items with suggestions from the judges were qualitatively reviewed.

Expert analysis indicated total agreement across all subtests, with individual and total CVI scores of 1, demonstrating adequacy in terms of relevance, clarity, and overall suitability. However, qualitative adjustments were suggested for two subtests assessing orientation and perception. Following analysis and consensus among the authors, modifications were made as shown in Table 1.

Table 1

This study provides content validity evidence for the MAPS-B, showing that its subtests adequately represent the constructs being assessed. All items achieved satisfactory CVI scores in line with literature recommendations (CVI > 1), indicating agreement on item relevance and suitability. The qualitative suggestions from experts contributed to refining the MAPS-B. Although the current results are satisfactory for the instrument’s proposed use, future studies are needed to gather further validity evidence and investigate the instrument’s reliability.

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Patients admitted to psychiatric services present with several acute and long-term somatic health problems. Psychiatrists have limited time and expertise to manage those conditions. Nevertheless, general practitioner (GP) hospitalists rarely exist in psychiatric facilities.

To examine the effects of a novel hospitalist service we describe performance of GP hospitalists.

HUS Helsinki University Hospital Psychiatry has 12 hospital campuses (550 beds in total) and over 30 outpatient clinics in Southern Finland. During February-May 2024 the organization had three part-time GP hospitalists covering 11 acute adult psychiatric wards (307 beds), six forensic psychiatric wards (120 beds), and two out-patient clinics. Hospitalist assessments at hospital wards and outpatient clinics included structured health checks and consultations from psychiatrists and registered nurses. The hospitalists collected characteristics from consecutive assessments by filling in an online survey. Somatic health conditions assessed in consultations, and those needing attention in health checks were coded according to ICD-10 classification.

The hospitalists provided 245 assessments: 223 consultations and 22 health checks. The majority (n=146,60%) of the assessments lasted for 30-90 minutes, one third (n=82,33%) lasted less than 30 minutes, while some (n=17,7%) took over 90 minutes. Of the assessments 49% (n=120) were hospitalist’s appointments, 12% (n=29) were provided by a phone call, 1% (n=3) were video appointments and 38% (n=93) were solved based on patient records. The most common conditions in the consultations were endocrine and cardiovascular related (Image 1). The hospitalists estimated that eight referrals to emergency departments and 22 to somatic specialists were avoided with the help of the consultations. In turn, hospitalists themselves referred 18 patients to somatic specialists. In the health checks the hospitalists identified 56 somatic conditions needing attention: cardiovascular, endocrine, gastrointestinal, dermatological and vision related problems were the most prevalent (Image 2).

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The variety and amount of untreated chronic common diseases and specific somatic conditions related to psychiatric diseases/medications was substantial, and even for the GP hospitalists, time-consuming to handle. Cardiometabolic problems were the most prevalent of health concerns. GP hospitalists are one of the real-world solutions in improving the overall health of patients with severe mental illnesses, and in alleviating the heavy workload of treating psychiatrists.

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In recent years, the concept of Self/Other distinction (SOD),the ability to differentiate one’s own body, actions and mental states from those of others,has recieved increasing interest. Studies that have explored SOD in psychiatric or neurodevelopmental disorders generally used static images or movies that progressively morph from one’s own face to another’s. However, these paradigms may be insufficient for SOD assessment given the centrality of embodiment in the pathophysiology of these disorders.The new Alter Ego double mirror paradigm was developped to specifically explore SOD under greater ecological conditions.This innovative device allows the progressive morphing of one’s own face to that of another between two subjects physically facing each other on either side of the device.

Two pilot studies were conducted to investigate self-recognition and self/other distinction respectively in adolescents with Anorexia nervosa (AN) and Autism Spectrum Disorder (ASD) compared with matched healthy controls through a self/other face identification task using the “Alter Ego” TM double mirror system.

Participants had to watch a double mirror in which their own face was gradually morphed into the face of an unfamiliar other (self-to-other) or vice versa (other-to-self), requiring them to indicate at which point they judged the morph to look more like their own face than the other’s face.Two judgment criteria were used: 1) M1: Threshold at which the subject starts recognizing his own face during the other-to-self morphing sequence 2) M2: Threshold at which the subject starts recognizing the other’s face during the self-to-other morphing sequence. For participants with AN, in a second part, SOD was reassessed during five different sensorimotor tasks aimed at increasing body self-consciousness.

Compared to controls, participants with ASD and AN showed an earlier self recognition in the other-to-self direction and a delayed other recognition in the self-to-other direction. Moreover, contrasting with controls, in ASD and AN participants, the critical threshold for switching between self and other varied with the direction of morphing. Finally, when participants with AN were seated with a backrest and footrest reinforcing the median axis of their body, the self-recognition threshold (M1) increased significantly approaching that of controls.

The preliminary results of these studies uncovered novel findings showing first behavioral evidence of impaired self/other distinction in individuals with ASD and AN through an embodied face-recognition paradigm. These results confirm the interest of the Alter Ego double mirror paradigm for the study of alterations in self-consciousness and Self/Other Distinction as a transosographic dimension common to various neurodevelopmental or psychiatric disorders.

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Since the COVID-19 pandemic, the attention to mental health at work has increased. According to recent WHO reports, 12 billion working days are lost every year to depression and anxiety. The working conditions, particularly the organizational climate, can impact nurses’ well-being and mental health. Specifically, in Portuguese nurses, little is known about the relationship between work climate and mental health.

To characterize the nurses’ lifestyle and mental health and correlate the organizational climate to nurses’ mental health.

A cross-sectional correlational study was conducted in a Medical-surgical ward in a Portuguese acute hospital. A convenience sample was recruited, excluding the nurses with long-term sick leave. An e-survey was sent to the nurses by the head nurse via institutional emails after the approval of the Ethics Committee. The nurses were asked to fill in sociodemographic, professional, anthropometric and lifestyle inquiry, Mental Health Inventory (MHI– 5) and Work Climate Questionnaire (WCQ). Data was analyzed using SPSS 29.0.

46 Portuguese nurses participated in the study. Most women (87%), aged between 26 and 64 years, have worked for 18 years (±8.4). Most nurses consider BMI median=25.6 (±5.4), 75% exercise regularly, 93% are non-smokers, and 67% consume alcohol occasionally. Most nurses rated their sleep as poor quality. Nurses considered they have good health (43.5%) in general and evidenced reasonable mental health (MHI Mean=19.8± 3.9). Male nurses experienced higher mental well-being than females. As for the level of organizational climate, it was found that, on average, scores are close to 4 (neither agree nor disagree). There was a positive correlation between organizational climate and nurses’ mental health.

This study evidenced a neutral perception of confidence and experience of autonomy of nurses working in an acute hospital in Portugal. There is a need to deepen the knowledge of the level of autonomy experienced by nurses in their work in larger samples and different contexts. The results indicate the need to study this correlation in different settings to explore its effect and impact on nurses’ mental health and patient quality of care.

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Cognitive difficulties in people with psychosis are present at the time of the first episode, even from periods of high risk to early stages of psychosis, their nature and severity seem similar to those observed in patients with a more chronic evolution, since it seems to be an impairment that in most people remains stable, although there is a group of people that worsens. Therefore, these deficits cannot be fully explained by treatments, hospitalizations, or chronicity, and appear more as an intrinsic characteristic of the disease. The course of their trajectory through the progression of the disease remains uncertain.

This study aimed to evaluate changes in cold, hot, and social cognition during acute psychotic episodes in hospitalized patients, to better understand their relationship with psychotic symptomatology.

A prospective longitudinal study was conducted with 10 patients (age range: 18-65) admitted to the psychiatric acute unit at Jerez de la Frontera Hospital, diagnosed with schizophrenia, schizoaffective disorder, or other psychotic disorders. Cognitive assessments included SCIP (cold cognition), Hinting Task (social cognition), and OSCARS (hot cognition), alongside psychiatric evaluations using PANSS, BPRS, and GAF scales. Statistical analysis was performed to identify correlations between cognitive domains and psychotic symptoms.

Analysis of the 10 selected patients reveals that the levels of impairment in cold, warm, and social cognitive functions vary significantly. The mean obtained for the SCIP-S scale total (64.60) suggests a moderate impairment in cold cognition, which aligns with previous research indicating that this type of impairment is an intrinsic feature of psychotic disorders, regardless of the time course of the illness.The mean on the Hinting task (14.00) and OSCAR total score (52.60) reflect impairment in social and warm cognition, respectively. Regarding the PANSS scale, scores indicate a predominance of positive psychotic symptoms, with a mean of 31.50 on PANSS-P, suggesting a high degree of active symptomatology.

These results are congruent with the hypothesis that alterations in warm cognition could precede and perhaps influence the exacerbation of these psychotic symptoms, as has been suggested in previous studies.

This study provides preliminary evidence of the complex relationship between cold, warm, and social cognitive functions in patients with acute-phase psychotic disorder. The findings suggest that although these functions are impaired in psychosis, their interrelationship is not as strong as might be expected, underscoring the need for differentiated interventions that address each cognitive domain specifically.

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Occupational burnout in education is a major problem, especially among elementary school teachers (ESTs) who have the dual task of imparting knowledge and nurturing children’s emotional intelligence. Research in recent years focuses on understanding, preventing and addressing teachers’ burnout.

We aimed to evaluate professional burnout levels among ESTs and identify associated factors.

We conducted a cross-sectional study among ESTs in southwestern Greece from September to December 2022. Participants answered to a self-administered questionnaire that included the Maslach’s Burnout Inventory Educator Survey (MBI-ES), socio-demographic, and other characteristics.

A total of 126 ESTs (63.5% kindergarten, 36.5% elementary school) participated in the study, 81% were female, 39.7% were 31-40 years old, and 51 (40.5%) had 11-20 years of work experience. The majority (63.5%) had a permanent job, mainly as a preschool teacher. Teachers experienced moderate to high levels of job burnout, as indicated by measures of emotional exhaustion (mean 30.03), depersonalization (mean 9.45), and feelings of low personal achievement (mean 46.42). Male teachers had higher levels of emotional exhaustion (50% vs. 46.1%) and female teachers had significantly higher rates of low personal accomplishment (80.4% vs. 66.7%). More experienced teachers showed higher emotional exhaustion (11-12 years: 58.8% vs. 6-10 years: 44.4%). Finally, kindergarten teachers were more likely to report low levels of personal accomplishment compared to other teachers (84% vs. 68.6%).

Elementary school teachers experience moderate to high levels of job burnout, which is influenced by factors such as gender, years of service, employment status, and phase of teaching. These findings can serve as a basis for prevention strategies and interventions to reduce the effects of burnout in elementary school teachers.

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Immigration has been pivotal in shaping societies, especially post-war, but is associated with a 2 to 3 times higher risk of psychotic disorders for migrants compared to natives [5]. Psychotic disorders, affecting about 0.7% of the population, often involve chronic symptoms with high morbidity and mortality [1][3]. This increased risk in migrants highlights public health issues, particularly due to limited access to care [6][7]. Studies suggest that reducing specific ethnic risk factors could lower psychosis rates by 22% [8].

To identify risk factors and explanatory hypotheses for the development and symptomatic reactivation of psychoses in immigrant patients who were hospitalized at the Arrazi Psychiatric Hospital in Salé.

This is a retrospective, descriptive, and analytical study. Data will be collected from the medical records of immigrant patients hospitalized for psychotic disorders at the Arrazi Psychiatric Hospital in Salé using a data extraction form. This form will include socio-demographic data, primary reason for migration, migration-related stress, social and professional situation, and access to mental health care.

Approximately 60% of immigrant patients hospitalized for psychotic disorders reported migration-related stress as a significant contributing factor. Around 45% experienced social isolation upon arrival, and 50% faced difficulties accessing mental health services. Additionally, 30% of these patients reported unemployment or precarious job situations, and nearly 40% cited family separation as a source of emotional strain, potentially exacerbating their symptoms.

Psychosis in immigrants is often influenced by specific stress factors related to the migration experience, such as social isolation, economic insecurity, and limited access to mental health care. These elements increase the psychological vulnerability of migrants and can trigger or exacerbate psychotic disorders. Tailored support and policy measures are essential to mitigate these risks. These observations highlight the need for in-depth research to better understand and manage the risk factors for psychosis in this population.

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Lithium is a mood stabilizer, causing various dose related adverse effects. Cardiac adverse effects are seen more frequently in patients with previous cardiac diseases, overdoses, and chronic use.

We report the case of a woman treated with lithium who developed bradycardia and syncope, which are rare adverse effects of lithium.

A 39-year-old woman was hospitalized due to suicidal ideation during a psychotic depressive episode. She had a previous supraventricular tachycardia episode requiring ablation but was asymptomatic for a long time. On admission, she was using sertraline 100 mg/day and olanzapine 10 mg/day. Lithium was initiated at 600 mg/day due to previous suicide attempts and being in the fourth depressive episode. On the second day of lithium therapy, the patient had a syncope lasting a minute. Electrocardiogram (ECG) showed sinus bradycardia at 46 bpm and 417 msec of QTc. She was normotensive. Her serum electrolytes, myocardial enzymes, thyroid hormones, and thyroid-stimulating hormone levels were within normal limits. Lithium was stopped. The following ECG showed sinus rhythm at 65 bpm. Cardiology consultation resulted in no contraindication to lithium therapy. Lithium was reinitiated with 300 mg, no syncope or bradycardia was observed, and the patient was discharged after 9 days. Lithium concentration was 0.66 mEq/L. The Naranjo Advers Drug Reaction Scale was scored as 5, indicating a probable relationship between syncope, bradycardia, and lithum. She is still using lithium 300 mg/day for four months with no adverse-effects.

At both therapeutic and toxic lithium levels, ECG changes such as T-wave inversions, sinus bradycardia, sinoatrial blocks, PR prolongation, QTc prolongation, and ventricular tachyarrhythmias can be observed. Lithium cardiac adverse effects have been shown to increase with age and duration of treatment and can be seen in both therapeutic and toxic concentrations. Our case is unique, occurring in a relatively young patient in the early phase of lithium treatment.

Other causes of bradycardia should be eliminated by performing a workup that includes calcium level, thyroid function, and cardiac workup, and checking medication interactions. Lithium-induced bradycardia is reversible upon discontinuation of lithium, but irreversible sinus node may occur when long-term lithium therapy is required. As lithium is an indispensible option for such patients with severe recurrent depression, lithium may be rechallenged with a lower dose and close followup of the ECG despite previous episodes of bradycardia and syncope.

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Military personnel are exposed to intense stress and potentially traumatic environments, making them particularly vulnerable to psychiatric disorders. These pathologies can lead to prolonged periods of convalescence, affecting not only the health of individuals, but also the operational readiness of the armed forces.

To identify the most common psychiatric causes of convalescence in military personnel and assess their impact on the operational readiness of the armed forces.

This was a retrospective study of a descriptive nature, from January 1, 2023 to August 30, 2024, which focused on military personnel who presented a request for convalescence to the occupational pathology consultation at the Military Center for Occupational Medicine and Professional Safety in Tunis.

During the study period, 275 patients were included in the sample, with a mean age of 40.83 ± 9.93 years and a sex ratio of 2.77. Their average length of service was 15.62 ± 11.87 years. Depression was the most frequent psychiatric pathology, accounting for 70.9% of convalescence causes, followed by anxiety disorder at 8.7%. The most affected category was non-commissioned officers, accounting for 54.7% of cases. The ranks most affected were warrant officer in 12% of cases, chief sergeant in 11.6% of cases and head warrant officer in 10.9% of cases. Military healthcare and administration were the most represented specialties, in 17.5% and 14.2% of cases respectively. The most common workstations were nurses (15.6% of cases), administrative officers (12.4%) and infantrymen (6.2%). The average length of convalescence was 74.78 ± 88.77 days. Convalescence lasting more than 180 days accounted for 10.3% of cases.

Our study shows that psychiatric pathologies have a significant impact on operational readiness. The often prolonged periods of convalescence highlight the importance of implementing effective prevention and management strategies to mitigate the impact of psychiatric disorders within the armed forces.

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Military personnel, faced with stressful and often extreme situations, can develop psychiatric disorders which require specific management to maintain both their well-being and the operational effectiveness of units. These disorders pose significant challenges for the assessment of their fitness for military service.

To study the impact of psychiatric pathologies on fitness for military service.

This was a retrospective study of a descriptive nature, from January 1, 2023 to August 30, 2024, which was conducted among military personnel referred to the occupational pathology consultation at the Military Center for Occupational Medicine and Professional Safety in Tunis to assess their fitness for duty due to psychiatric disorders.

During the study period, 42 patients were included, with a mean age of 38 ± 10 years, all male. The study population was divided into non-commissioned officers (45.2%), unlisted men (40.5%) and officers (14.3%), 44.5% of whom belonged to the army, 19.4% to the navy, 11.1% to the air force and 25% to the joint services. The ranks most affected by psychiatric pathologies were the first-class soldier at 21.4%, the master corporal and the warrant officer at 16.7% each. The most common specialties were infantry and transport at 28.6% and 11.9% respectively. The most common work positions were administrative officer (19.1%) and infantryman (9.5%). The predominant pathologies were anxiety-depressive syndrome in 31% of cases, depression in 26.2%, anxiety disorder in 14.3% and post-traumatic stress disorder in 11.9%. Eighty-one percent were exempted from carrying weapons, 57.1% from guard duty and 2.4% from field trips, with an average exemption duration of 5 months. All requests for exemption were accepted, of which 22% led to a reform file, 14% to psychiatric care, and 5% to a notice of fitness for military service. A change of specialty was indicated in six cases, all of them to an administrative position.

Psychiatric disorders strongly affect fitness for military service, leading to exemptions and changes of specialty. Enhanced psychological care and rigorous follow-up are essential to preserve the operational effectiveness and well-being of military personnel.

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Some individuals might be more prone to acquire assertive behaviors earlier in their lifespan than others. Nevertheless, assertiveness can be learnt, and studies suggest that developing them would be beneficial in various fields, including healthcare and medical studies.

This study was conducted to assess medical students’ level of assertiveness, and to characterize the factors that might influence it.

A cross-sectional study was conducted, targeting a representative sample of undergraduate medical students. In total, 91 medical students agreed to participate in an online questionnaire survey. They completed a sociodemographic questionnaire as well as the French validated versions of Rathus Assertiveness Scale (RAS), Depression, Anxiety and Stress Scale, Rosenberg Self-Esteem Scale, General Self-Efficacy.

The response rate was 31.1%. Results showed that 53.8% of participants were considered nonassertive. Assertiveness training was requested by fifty-six students (61.5%). Moderate to extremely severe levels of depression, anxiety and stress were reported by 61.5%, 69.2% and 43.9% of participants respectively. Medical students who practiced individual sport or played music showed significantly lower RAS scores, indicating a higher level of assertiveness (p= .022 and p = .003 respectively). Rosenberg self-esteem scores and general self-efficacy scores were strongly correlated with assertiveness. Depression, anxiety and stress scores were strongly and positively correlated with assertiveness scores. Hierarchical regression analysis revealed that playing music, Self-esteem and self-efficacy were independent predictive variables of assertiveness with beta values of -.219, -.247, and -.209, respectively, explaining 44% of the model.

Assertive communication can provide medical students with an opportunity to become more effective in dealing with those around them, fostering better relationships, and promoting mental well-being. Reinforcing music and individual sports activities may serve as valuable preventive and interventional strategies to improve assertiveness in medical students.

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In Japan, the Comprehensive Support for Persons with Disabilities Act, which unifies the three disabilities of physical, intellectual, and mental health, came into effect in 2006, and labor transition support offices were institutionalized. The labor transition support business office is a business in the welfare sector that places persons with disabilities in general companies for a period of two years.

• • In addition, Japan has the Law for Employment Promotion of Persons with Disabilities in the labor field, which imposes an employment rate for persons with disabilities on companies.

• • As of April 2024, the employment rate of persons with disabilities in companies is 2.5%.

In order to achieve employment for as many people with disabilities as possible, we analyzed two groups of people with and without workplace retention made by disability at labor transition support offices. This is a secondary data analysis of a national survey conducted in 2022.

The survey instrument included basic attributes of respondents and establishments, as well as the number of people who found employment in general companies in FY 2019 and their workplace retention status, whether or not employment assistance was provided to people with employment difficulties, and the state of practice of approaches to employment assistance. All statistical analyses were conducted using SPSS. Ethical review was conducted with the approval of the Ethical Review Committee of Nagano University (2021-006).

The types of disabilities of the establishments (n=1321) indicated 19 establishments with physical disabilities, 286 establishments with intellectual disabilities, 250 establishments with mental disabilities, 52 establishments with developmental disabilities, 495 establishments with no specific disability, and others.

In this analysis, from the above-mentioned establishments with intellectual disabilities (n286) and establishments with mental disabilities (n250), we divided them into two groups: those with intellectual disabilities (n181) and those with mental disabilities (n181) that discharged employed persons in FY2019.

It was found that the labor transition support offices that were placing people in employment with mental disabilities as their primary disability were accepting those with fewer weeks of use of the offices and with more difficulties in employment.

It became clear that even though the legal system unifies the three disabilities, the approach differs depending on the characteristics of the disability. Furthermore, it was also found that there are some offices that are able to place users in employment even if they have difficulties in finding employment. This suggests that there is a possibility that labor transition support offices, which are unable to produce job seekers, will be able to produce job seekers in the future.

None Declared

Stressful experiences and traumatic events are major contributors to the development of mood disorders, which affect about 8% of the global population. The interaction between stress, trauma, and mood disorders is multifaceted, involving neurobiological, psychological, and social factors. This study aims to analyze the prevalence, gender differences, and neurophysiological changes linked to these conditions, highlighting the importance of timely interventions for prevention and treatment.

To investigate how chronic stress and trauma contribute to the development of mood disorders, examine the impact of resilience factors, and explore the associated neurochemical and structural brain changes.

A review of literature was performed using psychiatric textbooks, clinical guidelines, and databases such as PubMed/MEDLINE, NCBI, PsycINFO, and Google Scholar. The analysis focused on studies published between 2016 and 2023, with search terms including “chronic stress”, “traum”, “mood disorders” and “resilience”.

An analysis of 30 studies revealed that 65% of individuals exposed to prolonged stress experience mood disorders. Trauma survivors have increased risk of developing depression, women 35% more likely to suffer from depression than men. In contrast, men show a 25% higher incidence of developing bipolar disorder following trauma. Resilience factors such as family support and psychological counseling can reduce the risk of mood disorders by 20%. Additionally, 35% of patients with mood disorders exhibit comorbidities such as PTSD or substance use disorders. Neurochemical changes include a 50% reduction in dopamine levels, while 40% of individuals show hippocampal atrophy linked to chronic stress.

Chronic stress and trauma are key factors in the onset of mood disorders, with distinct gender differences and significant neurobiological changes. Early intervention, focusing on resilience enhancement and psychosocial support, can reduce the long-term effects of stress and trauma, improving mental health outcomes.

None Declared

A case series of patients diagnosed with comorbid ASD and ADHD in adulthood is presented.

To make a comparison between the situation and social difficulties before and after specific ADHD treatment, in order to reinforce that it is not only a treatment for academic functioning, but also helps social interaction and therefore general functioning.

Four clinical cases are presented, three females and one male, with a mean age of 45 years. All of them were diagnosed with ASD and comorbid ADHD, with a predominance of impulsive component, in 2023.

All of them, prior to the diagnosis of ASD, were diagnosed with GAD, social phobia or even avoidant personality disorder. For these diagnoses, from a very early age, they received different SSRIs and benzodiazepines with little response.

In the consultation, after taking a complete clinical history, and fundamentally a biographical history, the examination was complemented with ADOS and CPT.

Due to the results obtained in CPT, it was decided to start treatment with lisafentamine between 50 and 70mg DMD.

CPT was performed again, obtaining better results in all cases, with a decrease in impulsivity and attention, mainly. At a subjective level, patients reported a substantial improvement, especially at a social level, which favoured their functioning in basic activities of daily living.

In adults, a correct diagnosis is important given that many of them present symptoms compatible with one or more neurodevelopmental disorders not diagnosed in childhood. Likewise, treatment in accordance with these disorders improves functionality and avoids polypharmacy and side effects of unnecessary treatments.

None Declared

Following the COVID pandemic, there has been an increase in mental health consultations in recent years, often referred to as a ‘fourth wave’. However, what has been observed in mental health centres is that these consultations are not so much about serious mental disorders, but rather occasional disorders due to social and work-related factors.

The aim of this study is to analyse the data collected from referrals to psychology in a mental health centre.

Referrals to psychology from primary care at the Majadahonda Mental Health Centre were analysed for the period from October 2022 to April 2024 in a specific weekly consultation for the psychology waiting list.

The data collected are the diagnoses of these patients, whether or not they attend the assessment consultation and whether or not they are discharged after the first consultation.

A total of 115 patients were seen between October 2022 and April 2024. These patients were all notified of the appointment one week in advance.

Of the total number of patients who attended, 29 consulted for depressive-anxiety-adaptive disorder, 22 were referred for work-related reasons (burn out), 12 for marital problems, 7 for parenting problems, 12 had no clinical reason for referral to Mental Health and 25 did not attend the consultation.

Those who were discharged at the first consultation were 33.

Given the scarce resources and long waiting lists, it is important at all levels of patient care not only to adjust expectations with regard to specialised care, but also to promote an appropriate setting. In this way it will be possible to run an efficient mental health care system.

None Declared