Medical improvisation, or HPTI (Health Professional Training Improv), enhances critical skills in healthcare professionals. These skills include communication, empathy, time pressure management, and creative problem-solving. Our presentation aims to showcase a practical application of HPTI, demonstrating its relevance and effectiveness in mental health training.

In this presentation, we will demonstrate our training method, including a short session with exercises adapted to healthcare professions. The session is divided into four parts. Each part is designed to maximize engagement and learning, with debriefing sessions to clarify teaching objectives and foster reflective practice.

Warm-Up Exercises: Physical and vocal exercises to optimize communication and awareness. Improvisation Techniques: Exercises focused on mastering emotions and various forms of communication, allowing participants to explore their strengths and limitations. Medical Scenario Applications: Short clinical scenarios to emphasize the cognitive and affective dimensions of empathy. Review of Existing Workshops and Research: Presentation of current workshops and research to encourage further exploration and application in training. Each part includes a debriefing session to clarify teaching objectives, develop a reflective approach, and identify areas for improvement.

For our ongoing comparative study we have implemented the following questionnaires for our training participants: IUS (uncertainty intolerance scale) and Acceptance and Action Questionnaire-II (AAQII). A total of 50 students participated in our research in both countries.

Hungarian training participants included medical school students in Hungary and fourth-year speech therapy students in France and included professional scenarios based on stress and emotion management, interdisciplinary collaboration and collaboration with the patient, and communication, with debriefing on their performance. The data is currently being collected.

Applied improvisation through HPTI offers a valuable approach to improving mental health training. By enhancing communication, empathy, and problem-solving skills, healthcare professionals can provide better patient care and navigate their roles more effectively. Our presentation demonstrates these techniques and encourages their integration into regular training programs.

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Perinatal psychopathology, encompassing a spectrum of psychiatric disorders such as perinatal depression, generalized anxiety disorder, post-stress traumatic disorder (PTSD), bipolar disorder, and postpartum psychosis, has been increasingly recognized for its potential to disrupt early mother-infant interactions. These disruptions may have profound consequences on the formation of secure attachment, which is crucial for healthy infant neurodevelopment. Attachment theory posits that early relational experiences shape the foundation of emotional regulation and social functioning, making it essential to understand how maternal psychopathology influences this critical developmental period.

This study aims to explore the impact of perinatal psychopathology on the development of attachment between mothers and their infants. Specifically, it seeks to identify how various mental health disorders affect maternal sensitivity and responsiveness, and how these alterations contribute to insecure or disorganized attachment styles in children.

A comprehensive review of the literature was conducted by searching major medical databases (e.g. PubMed and Google Scholar), giving preference to studies published between 2000 and 2024. Articles were selected based on relevance to perinatal psychopathology and attachment theory. This narrative review includes both quantitative and qualitative studies, clinical trials, and observational research that examine how maternal mental health conditions during pregnancy and the postpartum period affect attachment processes. Key themes and findings were extracted to provide a holistic view of the current state of knowledge on this subject.

The findings align with existing research on the impact of maternal mental health on early attachment, reinforcing the role of maternal sensitivity as a mediator between psychopathology and attachment security. Psychiatric conditions impair the mother’s ability to engage in synchronous interactions with her infant, disrupting the child’s ability to develop a secure base. Moreover, the presence of comorbid psychiatric conditions and chronicity of symptoms were identified as risk factors for more severe attachment disruptions. Pharmacological treatment and psychotherapy were shown to mitigate these effects, highlighting the need for integrated perinatal mental health services.

Perinatal depression, PTSD, and psychosis significantly compromise maternal-infant attachment, increasing the risk of insecure or disorganized attachment styles. Timely psychiatric interventions can enhance maternal mental health and promote healthier attachment outcomes. This review underscores the importance of integrating maternal mental health treatment into perinatal care to prevent long-term developmental issues in children and foster secure attachment relationships.

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The use of artificial intelligence (AI) in suicide risk assessment is gaining prominence as AI algorithms are capable of processing and analyzing large volumes of data quickly. Suicide risk assessments are traditionally carried out by psychiatrists and clinical psychologists following established protocols, but AI systems can provide valuable support in this area, particularly in prevention and faster detection. Based on the collected data, AI algorithms can create predictive models that identify individuals at the highest risk. These models can take into account previous mental health disorders, suicide attempts, and other social or economic factors.

The aim of our study was to test a suicide prediction model using an XGBoost machine learning tool.

We included 357 individuals, out of which 146 were psychiatric patients with a history of suicide attempts in their anamnesis, 154 were psychiatric patients without a history of suicide attempts, and 57 individuals formed the sine morbo control group. Initially, 71 individuals (test dataset) were randomly selected from the total 357, and the remaining sample (training dataset) was used to train the XGBoost machine learning tool. This training process involved optimizing and selecting the best parameters. Afterward, the final model was tested on the reserved test dataset consisting of 71 individuals.

During the machine learning process, we were able to very accurately predict who had a history of suicide attempts and who did not, with a high performance indicated by a ROC AUC score of 0.96. This demonstrates the model’s excellent ability to distinguish between individuals with and without suicide attempts based on the data used.

AI systems can complement traditional methods in suicide prevention, but they cannot replace human expertise. It is also important to pay attention to ethical issues, such as data protection and the reliability of these systems. AI can be a powerful tool in predicting suicide risk if properly integrated into mental health services.

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Disasters, including natural catastrophes, accidents, and man-made events, impose significant challenges on communities and individuals. First responders, such as rescue teams, firefighters, and prehospital emergency medical services personnel, play a crucial role in mitigating these impacts. Beyond their physical capabilities, these individuals must possess high levels of psychological resilience to perform effectively under extreme and stressful conditions. Understanding the factors that influence this resilience is essential for improving their performance and well-being. This systematic review aims to identify and examine the factors that affect psychological resilience among first responders and rescue team members during disasters and emergencies. The goal is to provide a comprehensive understanding of how resilience can be supported and enhanced in these critical professionals.

To identify the key factors that influence psychological resilience in first responders and rescue team members during disaster response. To evaluate current research on resilience building interventions and their effectiveness in enhancing psychological resilience in these professionals. To highlight gaps in the existing literature and suggest directions for future research on supporting psychological resilience in first responders.

A thorough literature search was conducted across several databases, including Web of Science, Scopus, Cochrane, PubMed, Medline, and Embase, focusing on articles published between 2019 and 2023. The search terms used were (emergency OR disaster) AND (psychological resilience) AND (rescue workers OR first responders OR firefighters OR ambulance personnel AND prehospital emergency medical services). Articles were selected based on inclusion and exclusion criteria, and only full-text articles published in English or Turkish were considered. Qualitative synthesis was used to analyze the data and draw insights.

The review reveals several critical factors affecting psychological resilience, including stress management techniques, emotional regulation strategies, social support systems, and training programs. It also identifies areas where existing research is lacking, particularly regarding specific interventions designed to bolster resilience in high-stress environments.

Enhancing psychological resilience in first responders is crucial for both their individual well-being and the effectiveness of disaster response efforts. This review provides valuable insights into the factors that contribute to resilience and highlights the need for targeted interventions and support systems. By addressing these factors and promoting resilience, it is possible to improve both the performance of first responders and their capacity to cope with the demands of disaster situations.

Psychological resilience, first responders, rescue workers, mental health.

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Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder with increasing prevalence (1 in 36 children, CDC 2023), associated with difficulties in social interaction and repetitive behaviors. These characteristics make it challenging for individuals with ASD to access quality healthcare. Additionally, people with ASD experience a higher number of underlying and intercurrent comorbidities compared to neurotypical individuals.

In Spain, we have a public healthcare system intended to provide universal health coverage for all citizens. In 2009, the AMITEA program was created in central Madrid to address healthcare needs for 6,000,000 people (Parellada et al., Eur Psychiatry 2013; 28(2):102-109). However, despite this, patients in our hospital, located in Majadahonda on the outskirts of Madrid, continued to face difficulties accessing healthcare. Main challenges include leaving familiar surroundings and healthcare professionals, long waiting times, difficulties understanding the public healthcare system, and lack of coordination between services. We realized that, even with the program, our patients were still not receiving adequate care.

• - To create an integrated program in our hospital that addresses the most common health issues for individuals with ASD.

• - To provide ASD patients with healthcare attention as similar as possible to that of neurotypical patients within their referral hospital.

Given the difficulties our patients faced, professionals from Child Psychiatry, Neuropediatrics, Neurophysiology, and the Pediatric ER formed a network in 2018 to improve healthcare for ASD patients in our hospital. Child Psychiatry acted as a link between services. We held group meetings with department leaders to develop the program in each service. Neurophysiology was the first to fully implement it (Mayoral-Fernandez et al., Metas Enferm 2022; 25(5):70-8).

Thanks to our efforts and support from hospital management, a part-time nurse joined the program in October 2023. With her help, we adapted medical procedures using Alternative Communication systems, trained and advised staff, adjusted hospital spaces, and maintained continuous coordination with professionals and families, humanizing care at our hospital.

By January 2024, our network included 17 services and over 50 professionals. With group support, each service developed its own level of adaptation. Professional satisfaction increased, and specialist coordination improved.

Adaptations like those implemented through ADAPTATEA improve the healthcare experience for ASD individuals at their referral hospitals, highlighting the need for more programs of this kind.

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During the last decades, clinical practice for patients with first-episode psychosis has shifted to early intervention programmes that aim to accelerate access to treatment and also ensure adherence to antipsychotic (AP) medication. However, recent pragmatic, randomised controlled trials still report very high discontinuation rates of the initially prescribed AP treatment due to lack of efficacy, side effects, or other reasons. The CLinical Utility of early intervention including the 5-Step Precision Medicine (5SPM) Method in first-episode Psychosis (CLUMP) Project is a translational research initiative focused on improving adherence to antipsychotic medications and therapeutic outcomes in first-episode psychosis patients using pharmacogenetics. We present a preliminary descriptive analysis of this project based on a retrospective cohort.

• - To establish discontinuation rates of the first antipsychotic treatment administered to patients with a first-episode psychosis before the implementation of the CLUMP project.

• - To describe reasons for such discontinuations.

We conducted an observational study on a consecutive, retrospective cohort of 49 patients who experienced a first-episode psychosis in Salamanca, Spain, before the implementation of CLUMP, in order to subsequently determine the impact this project might have on AP treatment discontinuations. We reviewed their clinical records to collect variables such as sex, age, first prescribed antipsychotic medication, and any discontinuation within the first year post-treatment initiation, recording reasons for discontinuation or treatment changes, such as lack of efficacy, non-adherence, side effects, or others.

Of the 49 patients included in the analysis, 7 were excluded due to inaccessible information, leaving a final sample of 42 (26 males). Age ranged between 16 and 48 years, with a mean age of 25.9 (9.2). 38 patients (90.47%) discontinued treatment within one year, with similar rates in men (92.3%) and women (87.5%) (See Figure 1). 16 reported side effects as the main reason for discontinuation, 1 lack of efficacy, 9 lack of adherence, and 12 other reasons (Figure 2). Among the 16 who discontinued due to side effects (Figure 3), 3 experienced extrapyramidal symptoms, 3 drowsiness, 3 sexual dysfunction, 2 hyperprolactinemia/galactorrhea, 1 metabolic syndrome, 1 excessive salivation, and 3 did not specify the symptom.

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Most patients in our sample discontinued antipsychotic treatment within the first year post-treatment initiation, mainly due to side effects. These data indicate the need to restructure clinical care for patients with first-episode psychosis to ensure adherence to AP and reduce trial-error approaches to treatment choice from start. The CLUMP project proposes an individualised strategy, based on pharmacogenetics, to improve therapeutic adherence and outcomes in patients with FEP.

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As a complementary or stand-alone treatment, sport and exercise therapy (SET) can have a therapeutic effect on the symptoms of mental illness as well as having a therapeutic or preventive effect on physical comorbidities. Therefore, treatment guidelines recommend the integration of exercise therapy as a complementary approach in a multimodal treatment. In a clinical inpatient setting SET are supervised by specialised professionals and conducted in an individual or group setting. Low level of participation in SET during treatment points to the need for research into influencing factors. One study suggests, that SET during mental health treatment increases the likelihood of meeting the physical activity recommendations.

The purpose of the study is to investigate the extent to which SET can increase patients’ levels of physical activity during inpatient treatment and, in particular, promote a physically active lifestyle after inpatient treatment, thereby supporting long-term stabilisation. In order to gain further insight into the factors that influence participation in SET during treatment, this study analyses both intrapersonal and interindividual factors.

Patients (age ≥ 18 years, all genders) in partial- or full-time inpatient treatment at a psychotherapeutic and psychosomatic specialist clinic in Lower Saxony, Germany are examined by online self-report questionnaire. It’s a longitudinal study design with 3 time points (start of treatment, end of treatment, 12 weeks after the end of treatment). Patients participate in SET as part of their treatment. Physical activity in minutes per week and the therapeutic alliance between exercise therapists and patients are measured. In addition, self-efficacy expectations, sport- and exercise-related self-concordance and the subjectively perceived effectiveness of SET are assessed as further factors influencing physical activity.

The results of the inferential-static data analysis will be reported.

Based on the results, possible implications for the focus of SET and the role of exercise therapists are discussed. Conclusions based on motivational aspects of maintaining a physically active lifestyle after the end of treatment are considered.

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University hazing is a common practice that impacts students’ mental health and well-being, especially in medical schools. Despite its common occurrence, there is a lack of reliable tools to assess hazing experiences and perceptions among students.

This study aimed to evaluate hazing experiences, attitudes, and impacts and to develop and validate the University Hazing Self-Report Scale (UNI-Hazing) among Brazilian medical students.

This was a cross-sectional study conducted among Brazilian medical students. The UNI-Hazing scale was developed as a four-part questionnaire designed to assess personal experiences with hazing, students’ opinions, and its perceived impact on their well-being. Participants also completed a sociodemographic questionnaire and established scales including the Johns Hopkins Learning Environment Scale (JHLES), the Medical Student Stress Factor Scale (MSSF), the Generalized Anxiety Disorder 7-item (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9). We conducted exploratory factor analysis to uncover latent factors and assessed internal consistency, test-retest reliability, and convergent validity.

1,017 medical students from 74 universities across Brazil participated in the study. While the majority of students did not report being victims or witnesses of hazing, certain hazing behaviors, such as body painting and forced solicitation for money, were relatively common. Hazing incidents most frequently occurred at parties, followed by sports associations and fraternities, with fewer on-campus incidents. Students largely held negative views on hazing. Factor analysis revealed three subscales within UNI-Hazing: “Social Pressure and Institutional Responsibility”, “Emotional Harm and Ethical Concerns” and “Physical Hazing and Power Dynamics”. The scale demonstrated strong internal consistency (Cronbach’s alpha: 0.93, 95% CI: 0.92–0.93) and test-retest reliability (Pearson correlation coefficients: 0.44–0.84). Correlations with the external scales supported the scale’s validity, showing positive correlations with MSSF, GAD-7, and PHQ-9, reflecting the psychological impacts of hazing, and negative correlations with JHLES, indicating that as hazing experiences increase, positive life experiences may decrease.

The UNI-Hazing scale is a reliable and valid measure for assessing hazing experiences and perceptions among medical students in Brazil. The findings highlight the need for universities to implement anti-hazing policies and support systems for students impacted by hazing practices.

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Fluoxetine, the first selective serotonin reuptake inhibitor, is the world’s most prescribed antidepressant. Several mechanisms of action underpin the effect of this antidepressant, such as enhancing serotonin (5-HT) neurotransmission, increasing hippocampal neurogenesis, neuronal survival and cerebral angiogenesis. The effects of fluoxetine on stem cell behaviour and tissue regeneration beyond the central nervous system have been little studied to date.

We investigated whether fluoxetine (FLX) might have broader peripheral regenerative properties using a recognized regenerative medicine paradigm such as the animal model of ad integrum muscle regeneration.

To investigate the impact of fluoxetine (FLX) on muscle at steady state, FLX was delivered per os at 18 mg/kg daily for six weeks to uninjured wild-type and specific transgenic mice. To investigate FLX´s regenerative capacity on skeletal muscles, we delivered FLX for six weeks and then performed notexin-induced injuries (phospholipase that induces a severe muscle necrosis) of the tibialis anterior muscle in wild-type and specific transgenic mice. Muscle force, muscle stem cells number, dividing muscle stem cells, differentiating muscle stem cells number, vessels number and muscle fiber parameters were specifically assessed.

After prolonged administration (6 weeks) of fluoxetine to male mice, we showed that prolonged FLX treatment increased the number of muscle stem cells and muscle angiogenesis in mice. FLX also improved skeletal muscle regeneration after single and multiple injuries induced by intramuscular notexin injection. The acceleration of muscle regeneration induced by FLX resulted from a triple action marked by an increase in the muscle stem cell pool, an increase in vessel density and a reduction in fibrotic lesions and inflammation. In vitro, we showed that the proliferative effects of FLX on immortalized myoblasts were dependent on 5-HT and 5-HT1B receptor activation. In vivo, mice lacking peripheral 5-HT treated with FLX did not show positive effects during muscle regeneration. Moreover, pharmacological, and genetic inactivation of the 5-HT1B receptor in muscle stem cells also abolished the FLX-induced improvement in muscle regeneration.

We show that FLX promotes a harmonious muscle regeneration underpinned by a combined action on myogenesis, angiogenesis and inflammation. These results highlight the serotonergic identity of skeletal muscle and point to a promising therapeutic strategy for endogenous muscle diseases. Beyond muscle and brain, this work opens new perspectives of investigation both on the role of serotonin and the 5-HT1B receptor in other types of stem cells and on the therapeutic potential of antidepressants in regenerative medicine.

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Diabetes management in lower-middle-income countries is becoming more challenging with an ever-increasing prevalence. It encompasses emotional distress, regimen, physician-related & interpersonal distress. Diabetes Distress is associated with poor psychosocial well-being & self-management, depression, medication non-adherence, poor glycemic control, & diabetic complications. There is a shortage of literature on diabetes distress, in terms of original studies from Pakistan.

To assess the prevalence of Diabetes Distress and its associated factors in Type 2 Diabetes Mellitus (T2DM) patients attending a teaching hospital.

This cross-sectional study was conducted at the Endocrinology clinic, Mayo Hospital Lahore Pakistan from November 2023 to May 2024. 254.

Type 2 Diabetes Mellitus patients, 30-80 years old, diagnosed according to American Diabetes Association diagnostic criteria at least 6 months before data collection were included. Those who had any terminal illness, substance dependence, active psychosis, or couldn’t understand & speak Urdu were excluded. Diabetes Distress Scale-17 (DDS-17) was used for data collection. It has four dimensions & 17 items, each rated on a 6-point Likert scale. SPSS 26 IBM Corp was used for data analysis. Quantitative variables were presented as Mean (SD) & qualitative as f(%). The association of diabetes distress with various factors was elicited using the Chi-square test of independence at α ≤ 0.05.

The mean age of the respondents was 53.62 ± 8.55 & duration of illness 8.86 ± 6.7. Mean DDS-17 scores were 2.732 ± 1.036 SD, equivalent to moderate level distress. Emotional Burden & Regimen-related distress had comparatively higher scores than Physician-related & interpersonal distress. 40.9% had high & 33.5% had moderate level distress. Only 25.6% of participants had little to no diabetes distress. There was no statistically significant relationship between diabetes distress severity & age, employment, marital status, & urban or rural living. There was a statistically significant relationship of diabetes distress severity with gender (p=0.001), education (p=0.05), socioeconomic status (p=0.01), & illness duration (p=0.05). Female gender, lack of education, and low & middle socioeconomic status had considerable association with greater severity of diabetes distress. Participants with < 1-year duration of diabetes distress had a higher proportion reporting little to no diabetes distress.

This study concludes that a considerable proportion had moderate to high level distress: emotional burden and regimen-related distress being of the utmost significance. The concerted efforts from all stakeholders will ensure early and timely screening of Diabetes Distress to avoid adverse psychosocial and patient outcomes. Integrating mental health with diabetes care in Pakistan could be the first step towards improving patient outcomes.

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Recently it was highlighted that individuals not only vary in their beliefs but also in the manner of their thinking, and this diversity can significantly predict various crucial psychological outcomes.

This research addresses the underexplored relationship between cognitive styles and psychosocial factors like hope, subjective well-being, coping and social support, specifically in Kosovo. These variables have not been investigated in Kosovo before, making this study the first of its kind.

Its cross-sectional study. The sample consisted of 490 students aged 15 to 23 (Mage=19.06; SD=4.17). Participants completed the instruments below: Adult Hope Scale ; Brief COPE Scale ; Oslo 3-item Social Support Scale; WHO-5 Well-Being Index ; Rosenberg Self-Esteem Scale and Cognitive Reflection Test . Data processing was done with SPSS 27.0 and Microsoft Excel 2019.

Significant negative correlations were observed between Cognitive Reflection Test scores and gender (r = -.197, p < 0.00), Adult Hope Scale score (r = -.173, p < 0.00), WHO-5 Well-being Index (r = -.098, p < 0.04) and Emotion–Focused Coping (r = -.125, p < 0.01). However, no significant correlations were found with Social Support, Problem-Focused-Coping, or Dysfunctional Coping (all p > 0.05). The correlational analysis, suggested that individuals with higher analytical thinking tendencies are more likely to be male, have lower levels of hope, employ less emotion-focused coping strategies and reported lower subjective well-being.

The study emphasized that psychosocial factors are intricate, influenced by diverse elements. While cognitive abilities, as measured by the Cognitive Reflection Test, played a role in some aspects of these factors, they didn’t fully explain their complexity. Therefore, the research suggests that further investigation is needed to grasp the underlying mechanisms and implications of these correlations in a Kosovo context.

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According to WHO data, currently more than 50 million people suffer from epilepsy, about 30% of these people are diagnosed with drug-resistant epilepsy. Drug-resistant epilepsy involves multiple psychological problems such as cognitive impairment, emotional and behavioural disorders, which contribute to a reduced quality of life.

The aim of our study was a comparative analysis of the affective peculiarities of patients with drug-resistant epilepsy and patients with well-controlled epilepsy.

The research took place during 2020-2023 within the National Centre of Epileptology, Chisinau, Republic of Moldova. The study was conducted on a group of 102 subjects with epilepsy (aged 18-62 years), including 62 subjects with drug-resistant epilepsy and 40 subjects with well-controlled epilepsy. We applied the Beck Depression Inventory (BDI) and Hamilton Anxiety Rating Scale (HAM-A). Statistical methods used are analysis of frequencies and percentage values, comparison of means by descriptive statistics, determination of Pearson correlation coefficients, difference of means by independent T-test.

According to the research results, depression is present in 43% of subjects, of which 23% in subjects with well-controlled epilepsy and 56% in those with drug-resistant epilepsy. Anxiety is present in 44 % subjects with epilepsy, of which 53% are subjects with drug-resistant epilepsy and only 33% with drug-controlled epilepsy. Statistical results reveal significant differences in the manifestation of depression (t=3.50 and p=0.001) and anxiety (t=3.09 and p=0.003) in subjects with drug-resistant epilepsy compared to those with well-controlled epilepsy. At the same time, no significant gender differences were found, but we find that women with drug-resistant epilepsy are 3.3 times more depressed and 2.6 times more anxious compared to women with well-controlled epilepsy. Divorced, non-employed, secondary technical education subjects with epilepsy of unknown aetiology are most affected by depression and anxiety, while subjects with higher education and those employed are more protected from suffering from anxiety and depression. As the disease progresses over time and the number of epileptic seizures increases, so does the level of depression and anxiety.

Patients with drug-resistant epilepsy have significantly higher values for the depression and anxiety, compared to subjects with well-controlled epilepsy. Depression and anxiety were found in more than half of the drug-resistant subjects and twice less in subjects with well-controlled epilepsy.

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Although diagnostic instability in first-episode psychosis (FEP) is of major concern, little is known about its determinants.

To examine the long-term diagnostic stability of FEP diagnoses, the baseline predictors of diagnostic change to schizophrenia and the timing of diagnostic change.

This was a longitudinal and naturalistic study of 243 subjects with FEP who were assessed at baseline and reassessed after a mean follow-up of 21 years. The diagnostic stability of DSM-5 psychotic disorders was examined using prospective and retrospective consistencies, logistic regression was used to establish the predictors of diagnostic change to schizophrenia, and survival analysis was used to compare time to diagnostic change across diagnostic categories.

The overall diagnostic stability was 47.7%. Schizophrenia and bipolar disorder were the most stable diagnoses, with other categories having low stability. Predictors of diagnostic change to schizophrenia included a family history of schizophrenia, obstetric complications, developmental delay, childhood adversity, poor premorbid functioning in several domains, long duration of untreated continuous psychosis, spontaneous dyskinesia, lack of psychosocial stressors, and poor early treatment response (Table 1). There were no significant differences between specific diagnoses regarding time to diagnostic change. At 10-year follow-up, around 80% of the diagnoses had changed.

Table 1. Main baseline predictors of diagnostic change to schizophrenia over the follow-up (univariate logistic regression)

FEP diagnoses other than schizophrenia or bipolar disorder should be considered as provisional. Considering baseline and background predictors of diagnostic change to schizophrenia may help to enhance diagnostic accuracy and guide therapeutic interventions.

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Attitude towards death is an individual’s psychological reaction to death, which includes basic components, such as thinking about death, fear of death, and defence mechanisms. Due to the nature of their work, nurses often accompany patients at the end of life and choose different ways to cope with this difficult situation.

The aim of this study was to analyze the psychological aspects of nurses’ attitudes towards the death of a patient, and to determine the variables that influence their choice of strategies to deal with this difficult situation.

This survey-based study was performed using the author questionnare, and standardized research tools, namely the Polish adaptation of the Death Attitude Profile Revised (DAP-R-PL), and the Mini-COPE inventory.

The study involved 315 subjects with a license to practice nursing, 85.7% of whom were women. The age of the respondents ranged from 21 to 70 years, and was on average 40.5 years (SD = 10.7). The nurses’ dominant attitudes towards death were neutral acceptance (5.40 ± 0.97 points) and escape acceptance (5.09±1.01 points). Age, sex, work experience, and having a specialty credential influenced the attitudes towards death according to the DAP-R-Pl. The predominant stress coping strategies among the nurses according to the Mini-COPE were: self-distraction (1.98 ± 0.75 points), active coping (1.88 ± 0.69 points), planning (1.87 ± 0.77 points), and acceptance (1.84 ± 0.62 points). Factors that had an impact on the choice of stress coping strategies according to the Mini-COPE were: sex, place of residence, marital status, education, having a specialty credential, work experience, and place of work. Based on the collected data, statistically significant correlations were also found between the nurses’ attitudes towards death according to the DAP-R-PL and stress coping strategies according to the Mini-COPE.

The nurses showed different attitudes towards the death of a patient, the most common of which were neutral acceptance and escape acceptance. Age, sex, marital status, and place of residence had a significant impact on the nurses’s attitudes towards the patient’s death. Contact with dying patients evokes many negative emotions in nurses, such as sadness, compassion, helplessness, regret, and a sense of injustice. Therefore, it is important to provide them with psychological support when not coping with the death of a patient. Due to the strong emotional reaction associated with the death of a patient, nurses choose coping strategies, such as: self-distraction, active coping, planning, and acceptance. Both sociodemographic and work-related variables influence the choice of coping strategies for the patient’s death.

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People experience psychological changes during adaptation process to stress; a person is angry to others or the environment but later he falls in depression. Although there are so many scales for measuring stress, they only measure the severity of stress or evaluate single emotions. None of them can track the psychological changes during the adaptation to stress.

The purpose of this study is to develop a comprehensive scale that can measure various psychological symptoms occurring in stressful situations. Specifically, the goal is to create a tool that can track an individual’s adaptation to stress over time through repeated measurements. Furthermore, the objective is to accurately understand the individual’s current state and stress adaptation patterns, enabling appropriate interventions at each stage.

We established constructs and subscales based on the Kubler-Ross stages which defines general psychological change to five phase: denial, anger, bargaining, depression, acceptance. To assess the clarity and validity of the preliminary items developed, content validity was evaluated by 12 clinical psychologists and face validity was assessed with 32 adults.

A total of 107 initial items were developed based on literature analysis and discussions. After the content validation and face validation, items with a CVI below .83 were either revised or removed. This process resulted in a final set of 88 items: denial(18 items), anger(17 items), bargaining(19 items), depression(17 items), and acceptance(17 items). The item content validity index (I-CVI) ranged from 0.833 to 1 and the scale content validity index (S-CVI/Ave) for denial, anger, bargaining, depression and acceptance was 0.91, 0.97, 0.96, 0.98 and 0.99 respectively. In addition, exploratory and confirmatory factor analyses indicated a good level of model fit, and the internal reliability of each subscale was also found to be satisfactory.

This results indicate that the PRS is highly valid, and that it can be utilized as an effective measure of the person’s current state. PRS can help the clinicians to understand how the patients percept the stressful situation and their stress adaptation pattern.

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Healthcare professionals are exposed to numerous stressors in their work environment, which can lead to psychiatric disorders.

To describe the profile of healthcare professionals who requested a fitness-for-duty evaluation due to a psychiatric disorder and to identify the recommended workplace adaptations.

A retrospective study was conducted in the University Hospital Sahloul of Sousse (Tunisia) over a three-year period (2022-2024). Data from healthcare staff who consulted for fitness-for-duty evaluations related to psychiatric conditions were collected, including age, work experience, job position, psychiatric diagnosis, and fitness-for-duty decisions.

The study included 13 healthcare professionals comprising 6 senior technicians, 6 nurses, and 1 worker. The average age was 45 ± 3.2 years, with an average seniority of 11 ± 2.8 years. The most common psychiatric conditions were anxiety-depressive syndrome (10 cases), post-traumatic stress disorder (2 cases), and obsessive-compulsive disorder (1 case). All patients were on antidepressants and/or anxiolytics at the time of consultation. The fitness-for-duty decisions included recommendations for avoiding night shifts and exposure to stressful situations.

Psychiatric disorders among healthcare workers present significant challenges for occupational health services. Workplace adaptations, such as avoiding night shifts and stressful environments, may be necessary to facilitate a return to or continuation of work.

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Workplace violence, particularly in the healthcare sector, is on the rise and severely affects the quality of life and performance of healthcare workers. The psychological repercussions of such violence are particularly concerning, making it imperative to develop appropriate prevention strategies.

To evaluate the prevalence of assaults against healthcare staff at the Farhat Hached University Hospital in Sousse over a 20-year period, describing the characteristics of the victims, the circumstances of the assaults, and the psychological impacts observed.

This retrospective descriptive study, covering the years 2004 to 2023, analyzes workplace injury reports related to violence at the Farhat Hached University Hospital. The sample includes healthcare workers who were victims of reported assaults, with data collected on a synoptic sheet detailing sociodemographic aspects, the circumstances of the assaults, and their consequences.

Out of a total of 5695 workplace accidents, 110 were recorded as assaults, representing a prevalence of 1.9%. The victims had an average age of 46.8 ± 6.72 years, with a strong female predominance (69.1%). The most affected professions were nurses (50%) and workers (25.5%), with the most impacted departments being maternity (15.5%), emergency (13.6%), and psychiatry (11.8%). The majority of assaults (68.2%) occurred in the morning, and the perpetrators were primarily patients themselves (38.2%) or their relatives (33.6%).

Regarding the psychological aspects of the assaults, 42.7% of incidents involved psychological violence, such as verbal abuse, intimidation, or threats. The psychological consequences were significant: 26.4% of the victims developed disorders such as post-traumatic stress disorder (PTSD) and sleep disturbances.

The high prevalence of assaults and their psychological repercussions highlight the urgent need to strengthen preventive measures. Specific training on conflict management and psychological support strategies should be implemented to improve the safety and well-being of healthcare staff.

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Visual snow syndrome (VSS) is a rare condition that presents as a form continuous visual disturbance that occupies the entire visual field, described as tiny flickering dots. Although VSS might be expressed in patients with migraine as visual aura, persistent VSS has been accepted as a distinct clinical entity. Symptoms of VSS commonly emerge in late adolescence and early adulthood, but it can affect people of any age. In the literature,a few cases of childhood VSS have been reported.The peculiarity of this condition is that it remains rare and challenging to diagnose.

Here, we report an uncommon case of VSS in a Tunisian female adolescent aged 17 years, that has been misdiagnosed for years as Conversion Disorder/Functional Neurological Disorder.

A clinical history, neurological assessment and visual tests were performed, leading to the diagnosis VSS in a misdiagnosed 17-year-old Tunisian female.

A nine-year-old girl with no prior medical history started experiencing symptoms of vision of white lines in a net and abnormal image persistence throughout her entire visual field. The patient initially consulted an ophthalmologist, then a neurologist. The patient’s visual field testing, retinal imaging, and eye examination were all within the normal range. Electroencephalography, cerebrospinal fluid analysis, and brain MRI revealed nothing unusual. The psychogenic origin was initially considered, and the patient was referred to a psychiatrist. The diagnosis of functional neurological disorder was established. The patient underwent cognitive behavioral therapy with no improvement.Over the next years, the patient consulted several psychiatrists, but her visual symptoms did not improve. Gradually, her symptoms worsened, with a significant impact on her academic performance. New symptoms such as entopic phenomena appeared, with floaters, sparkling dots, and luminous flashes associated with palinopsia and photophobia. A tinnitus was also associated. At the age of 17, and given the therapeutic impasse, her treating psychiatrist concluded that she needed to be referred back to neurology and ophthalmology. She had to undergo all the complementary tests again, which once more came back without abnormalities. The neurologist retained the diagnosis of VSS. The patient was put on anti-epileptic and migraine medications, which were ineffective. Food supplements were also prescribed to reduce stress. The patient underwent psychotherapy with partial recovery. Being correctly diagnosed helped her better cope with her symptoms. Her academic results substantially improved.

Despite its rarity, VSS should be taken into consideration in any patient whose vision has been continuously pixelated. More research is required to pinpoint the actual cause of this condition. Beyond its difficult diagnosis, the pathogenesis is uncertain, which the treatment plan problematic as well.

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Dissociative episodes are characterized by disruptions in consciousness, identity, or perception of reality and can be confused with other psychiatric disorders, such as manic episodes. This case describes a patient with both manic-like and dissociative symptoms, highlighting the need for a precise differential diagnosis. The case emphasizes how prolonged stress and psychosocial factors triggered a dissociative crisis, which improved significantly with anxiolytic and antidepressant treatment, a key factor in clarifying the diagnosis.

To describe a case of dissociative episode with manic-like symptoms, emphasizing the importance of differential diagnosis and appropriate treatment.

We present the case of a 43-year-old woman who was admitted to the emergency department following an acute dissociative episode. The patient arrived with a behavioral disturbance that had begun abruptly a few days earlier. She reported experiencing feelings of clairvoyance, mystical thoughts, and the sensation of receiving “alphanumeric codes,” interpreting gestures and everyday objects as messages with special meaning. During this episode, she exhibited behavioral disorganization, prolonged insomnia, euphoria, and a sense of hyperactivity, with impulses to compulsively reorganize her surroundings. These symptoms escalated until the patient, recognizing she could not control the situation, alerted her husband, who decided to take her to the emergency department due to the severity of her condition.

Disorganized behavior, with accelerated and delusional speech and megalomaniacal thoughts were present. Complementary tests were performed, ruling out organic causes. After administering midazolam for imaging procedures and initiating a fixed regimen of Lorazepam, the symptoms improved markedly, allowing for a more accurate assessment. The episode was interpreted as dissociative, with identified triggers including work-related stress, her relationship with her daughter, and the recent death of a friend. Pharmacological treatment with anxiolytics and antidepressants proved effective, leading to significant improvement in the following weeks, with resolution of delusions and insomnia.

This case highlights the importance of differential diagnosis between a dissociative episode and a manic episode, given the shared symptoms such as megalomaniacal delusions, insomnia, and euphoria. The rapid response to anxiolytic and antidepressant treatment suggests that the episode was more related to a stress-induced dissociative disorder rather than a bipolar affective disorder that would have required mood stabilizer treatment. This therapeutic approach resulted in a complete remission of symptoms, demonstrating the importance of a treatment plan tailored to the patient’s specific needs.

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Climate change beliefs influence people’s behaviours such as the adoption of pro-environmental actions, therefore it is crucial to effectively measure them. We developed a short measure (Climate Change Beliefs and Attitudes Measure/CC-BAM), comprising 4 items whose content was adapted from previous studies, namely Loram et al. (2019)’s 8 item climate change denial measure. To the best of our knowledge, there is no instrument that validly assesses these beliefs in the general Portuguese population.

To analyse the psychometric properties of the preliminary Portuguese version of the CC-BAM.

Item content validity was guaranteed by 7 experts. 599 Portuguese adults (mean age=34.40±16.18) answered to the Portuguese preliminary version of CC-BAM (4 items) and to the validated instruments: Climate Change Distress and Impairment Scale/CC-DIS and Pro-environmental behaviour scale/PEBS. Item 1 (“Do you believe in climate change?”) had three possible options of answer: a) “No”, b) “Yes, I believe they are a natural phenomenon” or c) “Yes, I believe they are caused by human activity”. Items 2 (“How convinced are you of your previous answer?”) and 3 (“Do you think climate change is a serious problem?”) were answered on a Likert scale from 0 (“Not much”) to 4 (“Very much”). Item 4 (“How often do you think about climate change?”) was answered on a Likert scale from 0 (“Never”) to 4 (“All the time”). SPSS 29 was used to perform Exploratory Factor Analysis/EFA, descriptive statistics and inferential analysis.

EFA revealed a 1-factor solution with an explained variance of 55.90% confirmed by parallel analysis. Cronbach’s alpha was of .704 (lower if any item excluded) and all items had a corrected item-total correlation >.20. All items correlated with each other (from r=.27 to r=.59) and with the total score (from r=.63 to r=.85, all p<.01). CC-BAM correlated with CC-DIS (r=.51) and PEBS (r=.49, both p<.01). Women had significantly higher mean scores in all items and total CC-BAM. Age correlated with CC-BAM total score (r=.12) and with item 4 (r=.35, all p<.01). 86.5% of participants (n=518) answered to item 1 with option c) (group 1); 12.5% (n=75) answered b) (group 2) and 1% (n=6) responded a) (group 3). Kruskal-Wallis test revealed that those 3 groups significantly differed in mean/median scores of items 2, 3 and 4 and of CC-DIS and PEBS.

The preliminary version of CC-BAM shows adequate psychometric properties, however more studies are needed. Although caution must be taken in the interpretation of this preliminary results, this study provides a novel, internally consistent and short (easily implementable) measure of climate change beliefs.

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