Parkinson’s disease (PD) and manganism share similar etiological cellular mechanisms, notably the accumulation of manganese (Mn) in mitochondria, which triggers oxidative stress and neurotoxicity. Both disorders are characterized by irreversible motor and non-motor symptoms, including frequent depressive and anxiety disorders.

This study evaluates the levels of oxidative stress in various nervous structures affected by PD and examines the correlation between Mn exposure and the resulting neuroaffective disorders.

Male Wistar rats were administered varying doses of Mn (6 mg/kg, 25 mg/kg, and 40 mg/kg) via daily intraperitoneal injections for 12 weeks. Body weights were monitored weekly. Following exposure, the rats were euthanized, and the striatum, frontal cortex, prefrontal cortex, hippocampus, and olfactory bulb were harvested for analysis. Tests were conducted to measure levels of nitric oxide (NO), lipid peroxidation (LPO), and catalase activity (CAT), indicators of oxidative stress.

Chronic exposure to Mn at doses of 25 and 40 mg/kg significantly induced PD-like symptoms and altered affective behavior, leading to anxiety and depressive behaviors in rats. Notably, these doses resulted in increased LPO levels in the hippocampus, frontal cortex, and prefrontal cortex. Conversely, the 40 mg/kg dose caused an increase in LPO across all tested structures. Elevated doses also resulted in increased NO levels and CAT activity across all structures, contrasting with the 6 mg/kg dose, which did not significantly differ from control values.

The findings demonstrate that chronic Mn exposure has neurotoxic effects that adversely affect neuroaffective behavior, manifesting as symptoms of depression and anxiety. These results highlight the critical association between Mn-induced oxidative stress and the development of neuroaffective disorders.

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Attachment styles formed in early childhood can influence mental health across the lifespan. Secure attachment often correlates with resilience, while insecure or disorganized attachment styles may increase vulnerability to mental health issues such as traumas during formative years and can disrupt typical emotional and psychological development, increasing the risk of later mental health issues, including suicide. Early trauma can influence the impact of adult attachment on suicidal behavior. For instance, people with high early trauma levels may experience heightened sensitivity to attachment-related stressors, increasing suicide risk.

Our aim was to analyse the role of adult attachment styles and early traumas in suicidal behaviour, focusing on the potential mediating effect of attachment style in the relationship of early traumas and suicidal behavior.

357 subjects, 18-85 years of age (mean 37.02 SD=12.86), 33.6% male and 66.4% female. 146 with suicide history, 154 clinical sample without suicide history and 57 non-clinical sample we included in the study. The Adult Attachment Scale (AAS), the Childhood Trauma Questionnaire (CTQ) and the Early Trauma Inventory Self Report Short Form (ETISR-SF) were used. To model the relationship between the variables logistic regression, generalized linear models and mediation analysis were conducted. All models were adjusted for basic demographics.

Severity of emotional abuse (OR=1.064, p=0.004) and neglect (OR=1.064, p=0.007) and the total severity of traumatization by CTQ (OR=1.021, p=0.006) significantly predicted higher risk for suicidal behavior. Higher levels of secure attachment style predicted lower risk of suicide attempt (OR=-0.091, p=0.004). Secure attachment style significantly mediated part of the total effect of early traumatization severity on suicidal behavior (indirect effect=0.0032, p<0.05, Pm=16.5%). We also modeled the relationship between early traumas and attachment style and found multiple associations. For avoidant attachment, significant associations were found with total traumatization scores (ETI: B=0.337, p<0.001; CTQ: B=0.866, p<0.001) and specific adversities, including emotional abuse (ETI: B=2.703, CTQ: B=0.524), emotional neglect, physical abuse, and physical neglect (B=0.469–0.949, all p<0.001). Anxious-ambivalent attachment was linked to total ETI and CTQ scores (B=0.375, 0.088 all p<0.001), emotional abuse (ETI: B=1.605, CTQ: B=0.388), and physical neglect (B=0.261, all p<0.001). Lower secure attachment was associated with CTQ scores for overall traumatization, emotional, and sexual abuse (B=-0.039 to -0.163, all p<0.05).

Our results contributes to understanding how attachment styles and early traumas influence suicidal behavior. Addressing these factors in treatment can lead to personalized and effective interventions, potentially reducing suicide risk among vulnerable individuals.

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Previous studies have shown that unwanted pregnancy and abortion, particularly in adolescents, are associated with a higher risk of suicidal thoughts and behaviors. Moreover, women with a history of abortion faced a significantly higher risk of various mental health problems, including suicidal behaviors, compared to those who did not undergo abortion. This is often due to a combination of psychological and social pressures. Factors such as the feeling of shame, social isolation, and a sense of being a burden can exacerbate the mental distress that pregnant women or adolescents experience, especially when the pregnancy is unplanned. Additionally, women who attempted suicide often report high levels of stress related to social expectations, family conflict, and lack of support during pregnancy. In some cases, individuals who were born from unwanted pregnancies or whose mother attempted abortions have also shown a higher risk of suicidal behavior later in life. However, our understanding of the risk and protective factors is uncomplete.

In our study the connection between unwanted pregnancy, abortion and suicide attempts were analysed and identify their role as potential suicide risk factors.

: Structural clinical interview was used to explore trauma history of induced abortion and unwanted pregnancy. 324 subjects were involved in the analysis. 134 of them with history of suicide, 135 clinical sample without suicide history 55 non-clinical sample. We assessed the moderator effect of the attachment style and childhood trauma using the Adult Attachment Scale (AAS) and the Childhood Trauma Questionnaire (CTQ).

We found no significant effects regarding whether the individual was born from unwanted pregnancies (β = -1.509, p = 0.110, OR = 0.221), and whether they lost their child (β = 0.247, p = 0.892, OR = 0.981). However, whether their mother attempted abortion when pregnant with them have shown a higher risk of suicidal behavior later in life (β = 6.939, p = 0.007, OR = 1031.427). The participants who undergone abortion were also more likely to attempt suicide (β = 2.397, p = 0.011, OR = 10.988). In both cases, childhood trauma was a mediator variable on a significant level (in case of mother’s abortion: β = -0.130, p = 0.005, OR = -2.804) or as a trend (in case of participant’s abortion: β = -0.034, p = 0.050, OR = 0.966).

The perinatal period, particularly for those experiencing unwanted pregnancies, is a critical time for mental health interventions to prevent suicide attempts.

None Declared

OBJECTIVES: Insomnia is the most prevalent sleep disorder in the general population and depresive symtoms, and one of the most frequent reasons for consultation in the Sleep Units. Paroxetin is an antidepresive also effective on the structure of sleep.

We describe the study that evaluates Paroxetin in patients with depression and insomnia.

Observational retrospective study of 40 patients with depression and insomnia. All patients attended in Neurology or Psychiatry Consultation, from November 2022 to November 2023. They were treated with Paroxetin 30 mgrs. We reviewed age, sex, depressive symtoms and insomnia, and the results of paroxetin for insomnia after 6 months of treatment, measured by the improvement of 3 or more points in the ISI and Pittsburgh scales, as well as the average of hours of sleep gained. The depressive symtoms measured with Hamilton scales.

RESULTS: 40 patients with depression and insomnia, 24 women (60%), 16 men (40%). Average age 46,5 years

Main etiology: depression 40 cases (100%). After the treatment with Paroxetin the total number of hours of sleep improves in 2.5 hours, the scale ISI improves by 6 points (± 2.1 SD, p=0.02), and Pittsburgh scale improves in 4 points (± 1.7, p =0.04). The Hamilton scales improves in 19 points. The treatment was abandoned by 2 patients (5%): 1 due to pregnancy wish and 1 due digestive symtoms.

CONCLUSION: The Paroxetin 30 mgrs/day improves the quality of sleep measured by ISI and Pittsburgh scales (statistically significant), and improves the depressive symtoms.

None Declared

Light therapy is a treatment that involves daily exposure to bright light. It is most commonly used to treat seasonal affective disorder (SAD). The standard light therapy regimen for SAD typically involves sitting in front of a light box that emits 10,000 lux of light at a distance of 20 cm from the eyes for 30 minutes per day, preferably in the morning. Sandkühler et al. suggested that increasing the illuminance in light therapy, using a Bright, whole-ROom, All-Day (BROAD) approach, may enhance its effectiveness. Both the standard light therapy regimen and BROAD light therapy involve radiant light sources, which emit light that disperses quickly and produces shadows that vary in size depending on the distance of the object from the light source. This makes them visibly different from sunlight. This study aims to investigate the efficacy of collimated light therapy, which uses a reflective parabola placed behind an LED to generate a parallel light beam, brightly illuminating a whole room in the patient’s home (Collimated Light Therapy), similar to natural sunlight.

H1.0) To measure the difference in symptom severity between baseline and after 4 weeks of treatment using the SIGH-SAD questionnaire on SAD symptoms. H1.1) To assess the difference in symptom severity between baseline and after 4 weeks of treatment using the BDI-SAD. H1.2) To determine the fraction of patients in remission after 4 weeks.

This study includes adult patients diagnosed with SAD according to DSM-5-TR criteria. Participants must be at home for at least 6 hours in the morning and afternoon (before 19:00) on at least 5 days per week. Exclusion criteria include a history of manic episodes, light therapy in the previous 4 months, and recent changes in antidepressant medication. We will test hypotheses H1.0 and H1.1 using independent-sample t-tests to compare average scores on the SIGH-SAD and BDI-SAD scales between the collimated light therapy and standard light therapy groups after four weeks. Hypothesis H1.2 will be tested with a chi-square test for association, comparing remission rates between the two groups after two and four weeks.

Our hypotheses are: (1) Home-based collimated light therapy for at least 6 hours/day reduces winter depression symptoms more than standard light therapy (light box, 10,000 lux, 30 minutes/day) after four weeks, as measured by the SIGH-SAD. (2) After four weeks, collimated light therapy shows greater improvement in symptoms as measured by the BDI-SAD. (3) Collimated light therapy results in a higher fraction of patients in remission after four weeks.

This trial is the first RCT to compare the efficacy of collimated light therapy with standard light therapy for treating SAD. This groundbreaking trial could open a new therapeutic frontier, offering a potentially more effective option for patients suffering from SAD.

None Declared

There is an ongoing need to explore new treatment options not just for depression, but also for its associated conditions. Depression often coexists with hematologic health issues, especially anemia, and both can be influenced by factors such as inflammation and imbalances in gut microbiota. Therefore, investigating interventions that target microbiota holds promise for developing safe and effective adjunctive therapies for both depression and its related disorders.

The main objective of this secondary analysis was to evaluate the impact of probiotic supplementation on parameters related to red blood cells in individuals suffering from depressive disorders. The secondary goal was to evaluate several potential pretreatment determinants of probiotic activity on RBC, such as dietary habits, inflammatory or metabolic condition, severity and dimensions of psychiatric symptoms, and taken medications. The third goal was to evaluate probiotics’ effects on RBC parameters in addition to their effectiveness in treating depression.

The parent study was a two-arm, 60-day, prospective, randomized, double-blind, controlled study involving eighty-nine participants. The probiotic formulation used in the trial included Lactobacillus helveticus Rosell®-52 and Bifidobacterium longum Rosell®-175. The current analysis assessed changes in red blood cells-related markers following the intervention using the Χ² test. Linear regression and two-way ANOVA analyses were performed to assess the effects of all major clinical variables on the changes (post- minus pre- intervention values) of RBC parameters.

Probiotic intake did not significantly alter the levels of red blood cell parameters, including red blood cell count, hematocrit, hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin concentration, and red cell distribution width, in comparison to placebo.

None of the linear regression, nor ANOVA models were statistically significant.

In the PLC group, increases in RBC counts and HCT levels were associated with a deterioration in self-assessed depressive and anxiety symptoms. Furthermore, this group also exhibited a positive correlation between MCH and MCHC changes and the differences in MADRS score.

Despite the potential benefits of probiotics in treating anemia, our study found limited evidence of significant changes in red blood cell parameters following probiotic supplementation. However, the precise details regarding the clinical sample characteristics, intervention duration, dosage, and specific probiotic strain used are not fully elucidated.

But, probiotic supplementation appeared to may help prevent some alterations in RBC and HCT levels, as well as in MCH and MCHC in depressed individuals.

ClinicalTrials.gov identifier: NCT04756544.

None Declared

Depressive disorders among healthcare workers (HCWs) exhibit a range of clinical manifestations, from mild to severe forms, leading to significant consequences such as hospitalization, extended sick leave, and suicide attempts. Understanding these clinical features is essential for the implementation of effective mental health interventions and support services.

This study aims to analyze the clinical features of depressive disorders among HCWs, and to assess the relationships between these factors.

A retrospective descriptive study was conducted over an 11-year period on HCWs in Sousse, Tunisia, who took long-term sick leave for depressive disorders. Data were collected from medical records, and completed with a telephone questionnaire.

Out of 650 cases examined, 48% were classified as having severe depression, while 50% experienced moderate depression, and 2% had mild forms. Anxiety was the predominant clinical feature, occurring in 71.4% of cases and showing a significant correlation with depression severity (p = 0.001). Melancholic features were identified in 33% of the cohort and were also significantly linked to severe depression (p = 0.005). Hospitalization due to depression was necessary for 11.2% of cases, with 4.2% requiring multiple hospitalizations; notably, all hospitalized patients exhibited severe depression (p = 0.001). Additionally, 1.2% of the study population reported a history of suicide attempts, all of whom presented severe depression, although this finding did not attain statistical significance.

This study highlights the importance of understanding the clinical specifications of depressive disorders in HCWs, as severe forms are often associated with hospitalizations and a higher risk of suicide attempts. The results emphasize the need for early intervention and targeted support strategies to address these severe outcomes.

None Declared

A growing body of evidence suggests that physical activity can be an effective treatment for depression. In consideration of individual conditions, Sports and Exercise Therapy may be used as standalone or complementary treatment during partial or full-time inpatient treatment. However, current data indicate that only a minority of patients make use of it during the course of their treatment. The beneficial health effects of exercise on mental health can only be realized if the exercise is actually undertaken. Therefore, further research is required on the motivational psychological aspects of participation in Sports and Exercise Therapy. It can be assumed that it is crucial to consider the individual patient preferences when initiating and sustaining physical activity. Moreover, there are notable differences between men and women in terms of their motivation for engaging in exercise.

The present study examines gender-based differences in the motivation underlying the participation in Sports and Exercise Therapy during the course of inpatient treatment for depression, whether on a partial or full-time basis.

In a psychotherapeutic and psychosomatic hospital, motives for Sports and Exercise Therapy of female and male (age 35-64) patients with a primary diagnosis of depression were recorded using the Bernese Motive and Goal Inventory in Leisure and Health Sports. The motives analysed include contact, body/appearance, competition/performance, distraction/catharsis, health, fitness and aesthetics. The survey was conducted within seven days of admission to either partial or full-time inpatient treatment setting.

The total number of patients included in the analysis was 140, comprising 65.0% male (mean-age=48.0, 21.0% full-time treatment) and 35.0% female (mean-age=50.7, 43.0% full-time treatment). The most important motives for both men and women are health (M male=4.29, M female=4.37), fitness (M male=4.20, M female=4.20) and distraction/catharsis (M male=3.72, M female=3.80) due to the highest mean scores. Compared to women (M=1,60, SD=0.77) men (M=2.19, SD=1.93) reported significantly higher mean score for the competition/performance motive (U-test, z=3.987, p<.001). No further significant gender differences were identified.

Significant gender differences were found only for the motive competition/ performance, despite this motive rated lowest on average. The absence of further gender differences may be due to the fact that gender differences may be of less importance for Sports and Exercise Therapy in the treatment context. On average health, fitness, and distraction/ catharsis were rated highest by both genders. This is consistent with typical symptoms during depression, which involve distraction from negative thoughts as well as recovering physical fitness to cope with everyday life. All authors of this study declare that they have no conflicts of interest.

None Declared

Major Depressive Disorder (MDD) significantly impacts global disability and quality of life. Some variables such as the trait anxiety and experiencing stressful life events (SLEs) are usually related to the MDD. However, the relationship between these variables in depression needs further investigation. Emerging research suggests the STAI-trait could be a nonspecific measure of negative effect and increase susceptibility to stress-induced depression.

This study assesses the State-Trait Anxiety Inventory (STAI) trait scores and SLEs, depressive symptoms, outcomed and functionality in MDD patients, with the hypothesis that STAI-trait may predispose individuals to stress-induced depression.

A prospective observational study was conducted with 25 MDD patients recruited at Hospital Universitari de Bellvitge. The STAI-trait and SLE exposure were measured during the initial visit. Depression symptom and outcome variables were assessed in three sequential clinical evaluations.

Preliminary findings show a significant association between anxiety trait and SLEs, high STAI-trait scores correlated positively with increased SLEs. This, correlating with more severe MDD symptoms and a complex disease course.

These findings support the notion of the STAI-trait as a possible mediator between life stressors and depression.

They highlight that increased STAI-trait anxiety might lead to greater vulnerability to stress and its potentially depressive effects, underscoring the need to consider this trait in clinical practice and the development of preventive strategies.

None Declared

Suicidality is one of the leading causes of death in young adults. Most of the suicidal patients suffer from background depression. Developments in the last few years in brain simulation technology as dTMS enables a more intensive care in accelerated protocols that have already been approved in the treatment of the depression field. However, most major studies in the field excluded the participation of patient with active suicidality.

This study focuses on efficacy of dTMS in patients with active suicidality.

This double-blind randomized study offers an accelerated protocol dTMS treatment in the span of 10 treatment days, while the patient is maintained in full hospitalization and secure conditions. The study examined the efficacy of the dTMS accelerated protocol (which includes 3 treatments a day for the course of 10 treatment days) on suicidality indicators. This treatment was given in addition (add-on) to standard ward treatments in three arms (1:1:1) sham, active H1 coil and active H7 coil.

38 patients were enrolled in the study. 30 patients successfully completed 10 treatment days. 8 patients did not complete treatment due to withdraw of informed consent before starting treatment (N = 4), panic attack (N = 2), discharge from the ward (N = 1) and suicide attempt (N = 1). Patients received active treatment (both H1 and H7) showed superior response (defined as >50% improvement in depression scale) compared to placebo arm (PA) (p = 0.03). Additionally, clinically close to significance improvement in suicidality intensity scales was found after 5 and 10 days of treatment in active treatment compared to placebo (p = 0.09). However, no significant difference was found regarding suicidality type scores. No major differences in depression and suicidality were found comparing H1 and H7 coils. The main side effects were headaches and dizziness, motoric tremor during the treatments, vomiting and general exhaustion. One patient (placebo group) completed suicide a month following the end of the study.

Active suicidality is a major challenge in treating severe mental disorders, and death by suicide is still a leading cause of death among patients. However, most clinical studies in mental health still exclude patients with active suicidality, hence treatment options are limited. In this study, we found deep TMS accelerated protocol (both H1 and H7 coils) to be both safe and effective in decreasing suicidality intensity and depression symptoms among inpatients with severe mental disorders accompanied by suicidality. Further studies are needed to differentiate H1 and H7 coils effectiveness in different depression sub-types and common psychiatric comorbidities.

None Declared

Individuals with psychiatric illnesses still face significant stigma and discrimination around the world. These individuals are reluctant to seek treatment due to fear of stigma, and when they begin treatment, their exclusion from society is a significant obstacle to their well-being. In order for individuals with mental illness to live in a society without stigma and discrimination, it is important to increase the knowledge and understanding of that society towards mental illnesses and develop positive attitudes. Depression is quite common and is the mental disorder that causes the most disability.

This study aimed to measure the relationship between individuals’ level of knowledge about depression, seeking psychological help and stigmatization.

The study group consisted of individuals who were diagnosed with major depression according to DSM 5-TR diagnostic criteria and applied to Eskişehir Osmangazi University Psychiatry Outpatient Clinic where the study would be conducted. The Hamilton Depression Rating Scale, Depression Knowledge Test, Stigma Scale, Attitudes Towards Seeking Professional Psychological Help Scale-Revised Form and Stigma Towards Seeking Psychological Help Scale were administered to the participants. Currently, 33 individuals were included in this study, and this number is planned to be 60 by the congress date. Eskişehir Osmangazi University Clinical Research Ethics Committee approved the study on 09.02.2023.

A total of 33 people were included in the study, 25 (75.8%) female and 8 (24.2%) male. The average age of the participants, ranging from 20 to 65 years old, was 41.48. The mean HAM-D scale score was 14.97. Education levels were calculated in years, and the mean years of education of the participants were determined to be 12.44 (5-20). According to the preliminary results of this study, a negative and significant relationship was found between depression knowledge level and stigma (rspearman: -,466, p: ,006). A negative and significant relationship was found between stigma and attitudes towards seeking psychological help (rspearman: -,308, p: ,029), and a positive and significant relationship was found between stigma and social stigma due to seeking psychological help (rspearman: -,354, p: ,043).

Stigma and stigmatization in mental illnesses are a major obstacle to diagnosis and treatment. In our study, preliminary data support the literature and show a relationship between depression knowledge level and stigma, and between stigma and psychological help-seeking behavior. These preliminary results show that psychoeducation interventions may have an important role. Results from 60 people will be presented at the congress.

None Declared

Major depressive disorder (MDD) is a prevalent and debilitating mental health condition that affects millions of individuals globally and has the highest risk of associated suicide. The underlying etiology of depression and suicide is not clearly understood, impeding the development of effective therapy. Further, the risk factors associated with suicide among MDD patients have not been delineated.

Conducting extensive brain gene expression profiling has emerged as a valuable approach to gaining a comprehensive understanding of the root causes of MDD and MDD-associated suicide from a genomic perspective. The objective of the study was to gain further insight into the precise molecular dysregulation underlying depression and suicide at the cellular level.

Transcriptome deconvolution was deployed on postmortem human hippocampus samples. The integrated dataset of the human hippocampus contained a total of 73 samples, including 29 healthy controls (C), 15 MDD non-suicide patients (D-S), and 29 MDD patients who died by suicide (D+S). Single-nucleus RNA sequencing (snRNASeq) data was analyzed to establish a reference gene expression profile for deconvolution, identifying 13 cell-type clusters encompassing 11 major hippocampal cell types. Cell type proportions were assessed using MuSic2, revealing variability across sample groups, with endothelial cells predominating, followed by pyramidal cells.

Cell type-specific gene expression deconvolution using bMIND showed distinct patterns among cell types and sample groups. Cell type-level differential expression analysis yielded a higher number of differentially expressed genes than the bulk transcriptome, varying across comparisons and cell types. In pyramidal neurons, a notable contrast was observed between non-suicidal and suicidal MDD patients. The former exhibited an enrichment of cytoskeleton-related pathways and molecular functions, while the latter demonstrated immune-related terms. The dysregulated genes identified as depression and suicide-specific bear relevance to the molecular implications in individuals who die by suicide due to depression.

Our findings of cell-type-specific gene expression and functions in hippocampus serve as a foundational framework for comprehending the complexities of MDD and suicidality. The differences observed in the enriched pathways and biological processes within each cell type underscore the molecular underpinnings of the observed phenotype and delineate the risk genomic factors associated with suicide among MDD patients.

None Declared

Approximately 280 million people worldwide suffer from depression. A significant proportion of these patients (10–30%) fail to achieve full remission after receiving antidepressant treatment with at least two different antidepressant medications. These patients are treatment-resistant (Al-Harbi, 2012; Jaffe et al., 2019; Rush et al., 2006). Theta-burst stimulation (TBS) is a non-invasive brain stimulation technique where a brief magnetic field passes through the scalp to induce an electric current in the cerebral cortex in high frequencies and is used to treat treatment-resistant depression in adjunction to antidepressant treatment.

This study aimed to evaluate the short-term efficacy of TBS added to pharmacological treatment in patients with treatment-resistant depression.

Patients with depression who were treatment-resistant and were treated with pharmacological treatment together with a course of 15 – 30 TBS sessions in an outpatient clinic of the Lithuanian University of Health Sciences Hospital Kaunas Clinics between 2021 and 2024 were enrolled in the study. TBS protocol stimulated in trains of 50 Hz triplets with 5 Hz frequency, a total of 20 trains in a session. The session frequency varied from once to twice daily, five days a week. The severity of depressive symptoms was evaluated with the Patient Health Questionnaire 9 (PHQ—9) before the first session of TBS and every two weeks afterward. The primary outcome measured was the mean change in the PHQ-9 score. We checked for the normality of the distribution of our variables and performed a paired sample t-test for statistical analysis of our sample.

40 patients were included in this study. There was a statistically significant reduction in mean PHQ-9 score following the 2-week TBS intervention (t = 6.134; 95% CI: 2.631-5.219; p < 0.001). Overall, 32 participants (80.0%) improved their PHQ-9 scores. In contrast, three participants (7.5%) showed no change in their scores, while five participants (12.5%) experienced a worsening of their symptoms. Mean pre- and post-treatment PHQ-9 scores and the mean change of the PHQ-9 score are presented in Table 1. Mean post-treatment PHQ-9 scores had no significant difference between patients whose PHQ-9 scores improved, showed no change, or worsened (p > 0.005).

TBS is a valuable short-term intervention for patients with treatment-resistant depression in an outpatient setting.

None Declared

Depressive symptoms that do not respond to 2 lines of antidepressant treatment in adequate doses for 6-8 weeks are known as resistant depression. As therapeutic alternatives we currently have, among other options, intranasal esketamine and electroconvulsive therapy (ECT).

To present two cases of resistant depression in combined treatment with esketamine and ECT as an effective tratment

2 cases report

The first one is a 60-year-old male with a diagnosis of recurrent depression who was admitted after an autolytic attempt by drug overdose. Our second patient is a 59-year-old male with a diagnosis of bipolar disorder, current major depressive episode with psychotic symptoms. He had a history of previous depressive episodes, requiring treatment with ECT on 2 occasions due to resistance to psychopharmacological treatment.

Both patients had major depressive symptoms resistant to conventional pharmacological treatment, with a predominance of sadness, apathy, anhedonia, hopelessness, psychomotor inhibition and self-induced suicidal ideation. One of them also presented psychotic symptoms congruent with mood.

The first patient received treatment with intranasal esketamine with partial response, so a combination with ECT was started once the 8 biweekly sessions of the induction phase were completed. The second patient was initially ambivalent to a new cycle of ECT. For this reason, treatment with esketamine was proposed and after 6 biweekly sessions he agreed to overlap treatment with ECT. In both patients there was a clear improvement in clinical symptoms and adequate tolerability, allowing discharge home.

There are few data in the literature on combined treatment with intranasal esketamine and ECT. Our experience in the 2 cases described points to an adequate response and tolerability. Specific studies would be necessary in this regard.

None Declared

Major Depressive Disorder (MDD) is a prevalent mental health condition that significantly impairs daily life and increases suicide risk. Selective serotonin reuptake inhibitors (SSRIs), such as paroxetine, are widely prescribed due to their efficacy and favorable safety profile. However, SSRIs can impact glucose metabolism, leading to both hyperglycemia and hypoglycemia, particularly in diabetic patients.

In rare instances, SSRIs have induced hypoglycemia in non-diabetic individuals. Paroxetine, known for its strong inhibition of serotonin reuptake, has been implicated in cases of hypoglycemia, though the precise mechanisms remain unclear.

With the present report, we examined wheter the hypotesis that paroxetine induces hypoglycemia is valid.

This case report discusses an episode of paroxetine-induced hypoglycemia in a 60-year-old female, non-diabetic patient with a history of MDD.

The patient was admitted to our in-patient psychiatric unit due to worsening depressive symptoms and recurrent episodes of sweating, dizziness, tremors, and loss of consciousness, suggestive of hypoglycemic crises. Over the previous three years the patient had been on paroxetine 40 mg/day, thus the drug was suspected as a potential cause of these hypoglycemic episodes and it was discontinued whereas fluoxetine and trazodone were administered. By discharge, her depressive symptoms and insomnia had improved significantly

This case highlights the potential for SSRIs, particularly paroxetine, to induce hypoglycemia even in non-diabetic patients. Although hypoglycemia is typically linked to diabetic treatments, this case demonstrates that antidepressants can also play a role in disrupting glucose regulation. In this case, the symptoms subsided after the discontinuation of paroxetine, strongly suggesting its role in the hypoglycemic episodes, as supported by a "probable" causality score on Naranjo’s scale. Given the nonspecific nature of hypoglycemic symptoms and the risk of misdiagnosis as psychiatric or somatic conditions, it is crucial for healthcare providers to consider medication-related causes. This report underscores the importance of monitoring glycemic levels in patients on SSRIs, particularly when presenting with atypical symptoms. Increased awareness can help prevent misdiagnosis and facilitate timely intervention to avoid severe complications.

None Declared

Postpartum depression (PPD) includes any non-psychotic depressive disorder that occurs during the first year after childbirth, with an estimated prevalence of 10-15%. Mothers suffering from PPD often exhibit irritability, loss of appetite, lack of interest in their surroundings, insomnia, or excessive sleep unrelated to the baby’s sleep-wake rhythm, and are less responsive to their infants’ needs. This not only impairs the bond between mother and child but also the child’s cognitive, behavioral, and social-emotional development and physical health. While studies suggest a multifactorial etiology of PPD, such as psychosocial stressors and biological factors, the etiology of PPD remains unclear.

Reviewing certain constellative factors of the newborn as potential risk factors for the occurrence of PPD in the early postpartum period.

A prospective study included 30 mothers and their newborn babies. The presence of depression was determined using the Edinburgh Postnatal Depression Scale (EPDS). The EPDS was filled in by mothers after giving birth, retesting was performed on the 3rd and 6th months postpartum. The diagnosis of PPD was established if the score on the EPDS after the 3rd and 6th month postpartum was greater than 9. Constellating factors of the newborn were extracted from the newborn’s medical records.

Constellation factors of the newborn, body weight, body length of the child at birth, and APGAR score did not significantly differ between the examined groups of mothers. The gestational age of the newborn was significantly higher in the group of mothers who developed PPD compared to the group of healthy mothers (p<0.01).

A few papers have been published on the subject of the influence of constitutive factors of the newborn (gender, body weight, body length, APGAR score, clinical age, and gestational age) on the occurrence of PPD. No strong evidence was found for an increased risk of PPD for any of the investigated factors individually. However, some authors from this group of newborn constellation factors single out the low birth weight of the newborn, below 1500 g, as one of the risk factors for the occurrence of PPD, which does not coincide with the results of our research. In our research, the gestational age of the newborn is a risk factor for the occurrence of PPD. Early detection of potential risk factors can significantly prevent the occurrence of PPD and significantly affect the central psychological process in the postpartum period, which is related to the development of the emotional relationship between mother and child.

None Declared

Depression is a pervasive mental health disorder that can significantly influence symptomatology, which remains a crucial area of research. This study aims to investigate whether gender correlates with PHQ-9 total scores, enhancing the general understanding of depression across different demographic groups.

This study examines the correlation between gender and PHQ-9 total scores, investigating the hypothesis that gender influences various depressive symptoms as measured by the PHQ-9. We aim to determine whether there is a significant difference in depression severity between male and female participants.

To fulfill this purpose, we collected data from a total of 146 participants, primarily Turkish immigrants of the first and second generation, who were recruited from the Neuro-Psychiatrisches Zentrum Riem. First, we gathered the participants’ sociodemographic data, including gender, marital status, and education level. Furthermore, they were asked to complete the PHQ-9 questionnaire, and we conducted a Pearson correlation analysis.

The PHQ-9 total scores and gender show a significant correlation, with a p-value of 0.040. Furthermore, these results indicate that female participants had higher average PHQ-9 scores compared to male participants, suggesting a greater intensity of depressive symptoms among women. Since the participants were predominantly Turkish immigrants, these findings may suggest that Turkish women are more prone to severe depressive symptoms, potentially as a consequence of their immigration history.

This study emphasizes the significance of gender in relation to depressive symptoms, as measured by the PHQ-9 questionnaire. However, future research should investigate other factors, besides gender, that may influence the severity of depressive symptoms in immigrant participants. It is recommended that these studies focus on the long-term effects of immigration, depression, and gender by including a diverse range of participants, such as immigrants from the first, second, third, and fourth generations. These generational differences could indicate significant variations in the experiences and consequences of severe depressive symptoms.

None Declared

Postpartum depression (PPD) is a serious mental health condition that can be challenging to diagnose due to its varying symptoms. As a result, multiple healthcare providers collaborate in its prevention, screening, and treatment. Nurses play a pivotal role in this process, requiring essential knowledge and skills

To assess nurses’ knowledge and attitudes regarding PPD.

A cross-sectional study was conducted among maternity nurses at a university hospital who have direct contact with postpartum patients. Our sample was a convenience sampleData was collected using a self-administered anonymous questionnaire. The questionnaire consisted of two parts : the first part collected demographic information about the nurses, and the second part assessed nurses’ knowledge and attitudes regarding postpartum depression.

A total of 50 nurses participated in the study. Nearly half (49%) of participants had over 10 years of professional seniority. The majority (92%) were aware of the postpartum period during which the disorder occurs, as well as the early warning signs of PPD (82%). However, more than half of the participants (52%) were unaware of the risk factors for PPD. The majority (92%) were aware that nurses play a major role in early detection of this disorder. Only 52% knew that the Edinburgh Postnatal Depression Scale (EPDS) is the screening tool for PPD. Nearly half of the suggestions to improve the management of PPD (46%) focused on improving patient conditions and well-being. Moreover, 40% of participants made suggestions centered on collaboration and communication.

Despite their involvement in postpartum care, nurses demonstrated limited knowledge of postpartum depression risk factors, emphasizing the need for enhanced education and support.

None Declared

Ketamine is widely recognized for its dissociative anesthetic properties, particularly in procedural sedation and severe pain management among children, adolescents, and young adults. Despite its noted applications, research investigating ketamine’s impact on mood and suicidality within this specific demographic remains limited. This retrospective review seeks to address this gap by characterizing ketamine usage and psychiatric comorbidities in Treatment-resistant depression (TRD).

This review aims to provide an initial assessment of the safety and efficacy of esketamine in adolescents suffering from TRD with concurrent comorbidities such as GAD and SUD, and infer common drug-drug interactions that may arise from utilizing esketamine in adolescents. This preliminary overview will contribute valuable insights toward optimizing treatment strategies for this vulnerable population.

This systematic review evaluates the evidence for ketamine use in children with treatment-resistant mood disorders. Two to four authors independently screened studies and extracted data on safety, tolerability, and efficacy. We searched two electronic databases for English-language studies on the therapeutic effects and side effect profiles of ketamine in youth aged 14-23 with treatment-resistant mood disorders, including those with treatment-resistant depression (with and without psychotic features) and bipolar disorder.

Recent studies, including a randomized, midazolam-controlled trial, indicate that IV ketamine can effectively reduce depressive symptoms in adolescents with treatment-resistant depression (TRD), with mild and manageable side effects like dissociation. No serious adverse events or instances of misuse were reported.

In conclusion, esketamine has demonstrated effectiveness in treating treatment-resistant depression. Additionally, when combined with SSRIs, esketamine improves depressive symptoms in TRD patients, irrespective of their anxiety status. These findings highlight the potential of esketamine as a valuable treatment option for this challenging patient population. Future research will focus on optimizing dosing, exploring complementary therapies such as cognitive behavioral therapy (CBT), and identifying biomarkers for response, while considering the unique risks to the developing adolescent brain.

None Declared

Depression and suicide risk are particularly concerning mental health issues in the workplace, especially among nurses. This group of workers often faces high levels of stress and pressure due to the demanding nature of their job.

Our study focuses specifically on describing depression and suicide risk among nurses.

This is a descriptive study, conducted during January and February 2023, involving 55 nurses working at Sahloul University Hospital in Sousse. Data were collected through a self-administered questionnaire and the Beck Depression Inventory which assesses subjective aspects of depression.

51% of the participants report that working as a nurse constitutes a significant mental burden. During their hospital careers, 47% have faced violence from patients’ family members or companions. (43%) experienced violence from colleagues, mainly in the form of verbal aggression. Nearly all the nurses surveyed (94%) reported demotivation toward their work, with (97.9%) attributing it to work overload and (39.4%) to workplace conflicts. According to the Beck scale, (38%) of the nurses did not present depression, moderate depression was found in (58%) of participants and only 4% had severe depression. Reduced job performance was noted in (16%) of cases. Concerning suicidal ideation, it was reported by only 2 nurses.

Early identification of mental distress and the implementation of appropriate psychological support strategies, are crucial to mitigating these risks. Recognizing psychological risks in hospitals not only improves the well-being of nurses but also enhances the quality of care they provide to patients.

None Declared