The literature review on anxiety/depression rates during Covid-19 is inconsistent due to significant methodological challenges in quantifying the impact of the pandemic on the mental health of the population.

To identify and understand the prevalence of anxiety/depression as a result of the COVID-19 situation aiming to synthesize impact of COVID-19 in mental health of population in Kosovo.

It’s a classic literature review which involves a thorough examination of existing research in internet, including raw data of the individual empirical results from several repeated cross-sectional surveys. We examined data of eight published researches and nine cross-sectional surveys conducted during the period 2020 to end of 2021.

In the review of eight published studies (seven from 2020 and one from 2021) of cross-sectional type, online, with sample sizes from 155 to 904 (four with student population, two with healthcare workers and two with general population) the prevalence of anxiety was from 13% to 73% (average 47.07%; measured with HADS, DASS-21 and GAD-7) while the prevalence of depression was from 13.9% to 71.60% (average 34.42%; measured with HADS, DASS-21 and PHQ-9). The methodological quality of included studies was low. Analysis of raw data of our nine cross-sectional surveys conducted during the period 2020 to end of 2021 show pooled prevalence for anxiety (measured with GAD-7, ≥10) for 2706 participants (five samples) to be 34.59 % (95% CI, 33.11%-36.07%) and for depression (measured with PHQ-9, ≥10) for 3703 participants (seven samples) to be 40.84% (95% CI, 39.43%-42.25%). Mostly, younger age, females and low SES emerged as factors associated with higher levels of anxiety/depression.

Our anxiety/depression prevalence rates, mostly is above average in comparison to other countries in Europe. Despite awareness for methodological flaws of studies, measurement invariances and some evidence of variation in the estimated prevalence rates of depression and anxiety disorder across countries; high prevalence of mental health problems during the pandemic indicates need for mental health prevention, promotion and intervention programs to mitigate the consequences of the COVID-19 pandemic on the population.

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The SARS-CoV-2 virus, responsible for COVID-19, has been shown to affect the central nervous system (CNS), leading to a wide range of acute and long-term neuropsychiatric symptoms. These symptoms can profoundly impair cognitive and emotional functioning, highlighting the need for a deeper understanding of their underlying mechanisms and clinical manifestations. Addressing these sequelae is critical for developing effective management strategies and improving patient outcomes. Long COVID has been associated with conditions such as brain fog, depression, anxiety, and fatigue, which can further exacerbate pre-existing mental health conditions and impair quality of life.

This review aims to examine the neuropsychiatric manifestations associated with COVID-19, focusing on both acute and long-term (long COVID) effects, and to explore potential pathophysiological mechanisms, including neuroinflammation and immune dysregulation.

A systematic review of literature was conducted by searching databases such as PubMed and Scopus, using terms like ‘COVID-19’, ‘neuropsychiatric symptoms’, ‘long COVID’, ‘inflammation’, and ‘CNS involvement’. Only peer-reviewed articles published between 2020 and 2023 were included, with an emphasis on studies reporting acute neuropsychiatric symptoms and post-acute sequelae of COVID-19.

COVID-19, neuropsychiatric symptoms, long COVID, neuroinflammation, interleukin-6, CNS involvement

Acute neuropsychiatric manifestations of COVID-19 include encephalopathy, delirium, seizures, and mood disturbances. Approximately 22.5% of COVID-19 patients present with neuropsychiatric symptoms during the acute phase, including anxiety, depression, and cognitive impairment. In long COVID, persistent symptoms such as fatigue, depression, anxiety, sleep disorders, and cognitive dysfunction have been reported, with neuroinflammation and elevated interleukin-6 (IL-6) levels proposed as key mechanisms. Neuropsychiatric symptoms are observed in both hospitalized and non-hospitalized individuals, with risk factors including severe infection, female sex, and pre-existing mental health conditions.

COVID-19 is associated with a broad spectrum of neuropsychiatric symptoms that persist beyond the acute phase. The underlying pathophysiology likely involves immune dysregulation, cytokine-mediated neuroinflammation, and direct viral invasion of the CNS. Early recognition and targeted interventions are essential to mitigate long-term neuropsychiatric complications.

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Empathy is a fundamental component of the socio-emotional experience. Emotional empathy describes the emotional reaction of an observer to the emotional state of another person - “emotional contagion”. People with high empathy can become objects of “emotional contagion” in a stressful situation.

The aim of the study was to evaluate the mutual influence of stress and emotional aspects of empathy.

Online survey was used. The level of empathy was assessed by “empathy” of I7 (H.Eysenck), stress was assessed by SCL-90R; COPE and CTI (S.Epstein), questions whether they had ever sought psychiatric help, the presence of suicidal ideas and thoughts of death were used. N=157 (139 women) mean age 41,1. 47 had previously sought psychiatric help. Subgroups of “low” and “high empathy” were analyzed.

People who had previously sought psychiatric help did not differ from “healthy” people in terms of empathy.

Analysis of variance showed: “high empathy” subgroup had a higher level of experienced stress, including higher anxiety, depressive symptoms, and interpersonal sensitivity. Differences in coping strategies and thinking patterns highlight the personality traits of people with high empathy, which affect the stress resistance. The combination of focusing on one’s own emotions and reducing emotional coping does not allow to regulate emotional state under stress. Separately, using correlation analysis, the relationship between the level of empathy and the characteristics of emotional regulation and possible suicidal ideas and thoughts about death was assessed in the subgroup of subjects who had previously sought psychiatric help and in the “healthy” subgroup. Both in the group of those who sought help from a psychiatrist and in the “healthy” subgroup, a connection was found between empathy and the level of emotional regulation. In those who had previously sought help from a psychiatrist, the level of empathy positively correlated with the presence of “thoughts about death”.

Subjects with “high empathy” are distinguished by a higher level of experienced stress, which may be associated with a reduced ability to emotionally cope. Particular attention should be paid to people who have previously sought psychiatric help. Under stressful conditions with high “emotional contagion” they think about death more often and the risk of suicide may arise.

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The COVID_19 pandemic has affected all facets of living, notably our sleep-wake cycle. In fact, sleep disturbances have been reported, not only during the acute phase, but also after the episode. Previous studies have shown that some socio-demographic characteristics are associated with sleep problems.

To assess the relationship between sleep disturbances and the sociodemographic profile of the COVID-19 survivors.

We conducted a prospective cohort study including 121 Tunisian COVID-19 inpatients who had been discharged alive from hospital. Each enrolled patient was asked about the period before the hospital stay, and the 6-9 month-period after hospital discharge, using the Arabic validated version of Pittsburgh sleep quality index “PSQI” scale to assess sleep problems.

The median age of our participants was 59 years old. Among them, 62 (51.2 %) were females. One hundred and eleven patients were married (91.7%), 102 patients (84.2%) had at least a primary educational level, while 19 (15.7%) patients were illiterate. Among the participants 86 (71.07%) had a job at the time of the infection, among them, 9 (7.4%) were Heath care providers. Ninety-five (78.5%) participants were non-smokers. As for alcohol use, 11 patients (9.1%) consumed alcohol. According to PSQI, the incidence of sleep disturbances after COVID was 48.8%. Sleep duration, sleep quality as well as sleep onset latency, sleep disturbances and sleep efficiency were the most affected domains in the PSQI. Females showed significantly higher PSQI after the COVID-19 infection (p<0.001). Non-married participants reported significantly higher scores of hypnotic drug use and daytime dysfunction (p=0.006, p=0.02 respectively). Quality of sleep was significantly poorer in illiterate patients (p=0.036). Health care providers had worse daytime dysfunction in comparison to other occupations (p=0.035). Non-smokers showed a deteriorated sleep efficiency as well as daytime dysfunction (p=0.03, p=0.021 respectively). No statistical association was found between sleep problems and age nor alcohol consumption.

Our study highlighted several associations between sleep problems and sociodemographic characteristics of COVID-19 survivors. This helps clinicians to pinpoint the at-risk people, in order to intervene when needed.

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This study investigates the predictive value of ferritin, CRP, and BMI levels in predicting COVID-19 outcomes among psychiatric patients.

Understanding these markers is crucial given the increased vulnerability of psychiatric patients to severe COVID-19 outcomes.

We conducted a retrospective analysis of 100 psychiatric patients diagnosed with COVID-19. We collected clinical outcomes (survival or death) data, demographic characteristics, and comorbidities. Blood samples were analyzed for ferritin and CRP levels, and BMI was calculated based on recorded weight and height. Statistical tests, including t-tests and chi-square tests, were used to assess the relationships between these variables and COVID-19 outcomes. Survival analysis was performed using the Log-Rank test to evaluate the impact of these markers on patient survival.

Our results showed that higher ferritin levels were significantly associated with poorer outcomes, with survivors having a mean ferritin level of 246.2 (SD = 150.3) compared to 416.9 (SD = 215.9) in non-survivors (p < 0.001). Similarly, mean CRP levels were lower in survivors (1.58, SD = 1.96) compared to non-survivors (3.46, SD = 2.92) with a p-value of 0.002. BMI did not show a statistically significant difference between survivors and non-survivors (p = 0.429). Survival analysis revealed that elevated CRP and ferritin levels correlated with decreased survival rates.

The study highlights the significant role of ferritin and CRP as prognostic markers in psychiatric patients with COVID-19, suggesting that elevated levels of these biomarkers are associated with worse outcomes. However, BMI did not significantly affect survival, indicating that inflammatory markers might be more relevant for assessing prognosis in this population. These findings emphasize the need for vigilant monitoring of these biomarkers in psychiatric patients to manage their COVID-19 treatment better and improve outcomes.

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Since the beginning of the health crisis caused by COVID-19, the impact of the pandemic context on the mental health of healthcare professionals has been widely studied. However, few studies have assessed psychological manifestations in healthcare workers affected by COVID-19.

Determine the prevalence and factors associated with depressive symptoms in healthcare workers with COVID-19.

This is a cross-sectional analytical study of health professionals at Farhat Hached University Hospital with COVID-19 over a 6-month period from September 2020 to February 2021. Depressive symptoms were screened using the Depression Subscale of Hospital Anxiety and Depression Scale (HADS-D).

Our study included 477 healthcare professionals. The mean age was 39.9 ±10.8 years, with a predominance of women (sex ratio =0.27). Almost a third of the participants were nurses (32.1%), followed by doctors (27.9% of cases). Most of the healthcare workers affected developed a pauci-symptomatic form of the infection (73.8%), with an average confinement time of 14.9±6.9 days. On returning to work, 74 staff (15.5%) noticed that their colleagues were withdrawing from work. According to the HADS-D scale, depressive symptoms were observed in 19.1% of cases. The predictive factors were gender (p<10-3), age (p=0.016), the symptomatic form of COVID-19 (p= 0 ,038), the duration of confinement (p<10-3) and the withdrawn attitude experienced by colleagues on returning to work (p<10-3).

Our results showed that psychological suffering, particularly depression, among care staff depended on several predictive factors. Psychological support during and even after the period of confinement is therefore necessary

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Prolonged symptoms of SARS COV2 infection known as Long COVID, are defined as symptoms persisting for more than four weeks after the initial diagnosis of COVID-19. Psychiatric symptoms such as anxiety, depression, cognitive deficits, fatigue, qualities poor sleep and somatic symptoms are common in patients with long-term COVID and could last weeks, even months, after recovery.

In this study, we tried to identify the psychiatric symptoms that can start after infection with SARS COV2, what could be the risk factors for the onset of these symptoms and how the quality of life is affected in these patients.

The study included 116 patients diagnosed with COVID-19 in the Suceava County Clinical Hospital, who were monitored for 12 months by applying standardized questionnaires for depression (Patient Health Questionnaire-9), anxiety (General Anxiety Disorder-7) and cognitive disorders. (Montreal Cognitive Assessment), patients being periodically evaluated clinically, biologically, neurologically and psychologically.

A percentage of 26.9% of patients presented the following psychiatric symptoms more than 4 weeks after the diagnosis of SARS COV2 infection: anxiety (6%), sleep disorders (7.7%) manifested by insomnia or hypersomnia, lack of concentration and attention (10.3%), memory disorders (8.6%), depression (4.3%). The most frequent psychiatric manifestations were cognitive disorders (10.3%) expressed by deficits in attention and memory, followed by sleep disorders (7.7%). Women presented a higher percentage of psychiatric manifestations manifested by anxiety and depression, but we did not find a correlation between the age of the patients and the mental manifestations after COVID-19. The 2 patients with depression in the antecedents, presented an exacerbation of mental symptoms post COVID. Depression and anxiety were more frequent in patients who had prolonged hospitalizations or moderate and severe forms of the disease. In 12 patients who presented cognitive disorders, increased values of C-reactive protein and lactic dehydrogenase were found during SARS COV2 infection. The use of questionnaires showed an important impact on the quality of life, especially in patients diagnosed with depression, anxiety and insufficient sleep.

Recognition and treatment of psychiatric symptoms that started after SARS COV2 infection should be included in the management of the patient with chronic COVID. The use of screening questionnaires for depression, anxiety and cognitive disorders must be implemented in the current practice of post-COVID-19 monitoring. The collaboration between infectious disease specialist, psychiatrist and psychologist can be the key to success in the treatment of psychiatric disorders in patients with long-term COVID.

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The large-scale social stress of recent years (the COVID-19 pandemic, the large-scale invasion of the rf in Ukraine) has a powerful negative effect on the psyche of people and causes an increase in the incidence of stress-associated pathology. One of the vulnerable groups in the formation of distress conditions is patients with psychosomatic pathology, in particular, psoriasis, in the pathogenesis of which psychosocial stress plays an important role.

To determine the existence of a differentiated impact of a contain of the large-scale stressful events on the health of patients with psychosomatic pathology.

83 psoriasis patients interactively were examined using the Google Form developed by us, which provided for a structured interview with the purpose of determining anamnestic data and collecting subjective complaints of the patient in two time periods the year of quarantine due the Covid-19 pandemic (11.03.2020-11.03.2021), and the year from the beginning of full-scale russian aggression (24.02.2022-24.02.2023). Statistical analysis included descriptive statistics and assessment of the significance level of differences using Fisher’s exact test (one-sided).

In the 1st year of the Covid-19 pandemic, exacerbation of psoriasis was found in 36.1% of patients, of which 63.3% believed that this was associated with the

impact of stress through pandemic. The stress of war proved to be a more powerful psycho-traumatic factor (P<0.01): in the 1st year, exacerbation of psoriasis was observed in 61.4% of patients, 88.2% of whom associated it with the impact of war. The prevalence of almost all psychopathological symptoms in patients during a full-scale war was slightly higher than during the Covid-19 pandemic: fear and anxiety (80.0% VS 88.2%), reduced mood (66.7% VS 90.2%, P<0.01), dyssomnia (50% VS 45.1%), asthenia (36.7% VS 41.3%), emotional lability (33.3% VS 37.3 %).

The conducted study revealed the impact of strong social stress on the frequency of psoriasis exacerbations and mental maladjustment. The stress of the war turned out to be a more powerful stress factor, and the patients significantly more often associated this social stress, with the exacerbation of psoriasis. It is allows us to consider the content of the stress load and the peculiarities of individual perception of stress as a relevant factor in the exacerbation of psoriasis and comorbid mental disorders. But a larger study involving a larger number of patients is needed to reveal more subtle patterns.

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Acutely decompensated heart failure (HF) may be accompanied by depressive symptoms. Predictors of screening diagnosis of depression (SDD) in decompensated HF are poorly elucidated.

We sought to investigate independent determinants of SDD in patients with HF decompensation.

Enrolled were fifty-one patients with a median age of 67 years and left ventricular ejection fraction (LVEF) of <40% hospitalized due to HF decompensation. SDD based on the result of the Beck Depression Inventory (>10 points), PHQ-9 (>12 points) or Hamilton Depression Scale (lack of depression: <7 points; mild [<12 points], moderate [<17 points] or severe [≥18 points] depression). Neurotrophic potential and response to stress were assessed by brain-derived neurotrophic factor (BDNF) and FK506 binding protein 5 (FKBP5), respectively.

SDD was identified in 26 (51%) patients based on the Beck inventory and in 12 (24%) patients based on PFQ-9. According to the Hamilton scale mild SDD was found in 17 (33.3%), moderate in 9 (17.6%) and severe in 14 (27.5%) of patients. Male patients with HF decompensation had higher result of Beck inventory by 35% (P=0.029), PHQ-9 by 60% (P=0.014) and Hamilton scale by 64% (P=0.003) than female. The result of the Beck Depression Inventory was correlated with plasma levels of FKBP5 (R=0.34, P=0.017) and inversely correlated with BDNF (R=-0.39, P=0.004). In turn, LVEF was correlated with the result of PHQ-9 (r=0.33, P=0.020), Hamilton scale (r=0.33, P=0.18) and with BDNF (r=0.32, P=0.025) while inversely with FKBP5 (r=-0.32, P=0.023). By multivariate analysis the higher result of the Beck inventory was associated with male gender (β=0.26, P=0.048), a higher LVEF (β=0.27, P=0.042) and a lower plasma BDNF (β=-0.46, P<0.001).

SDD in patients with HF decompensation is independently associated with male gender, better preserved left ventricular systolic function and reduced plasma level of BDNF.

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Functional neurological disorder (FND) is diagnosed in approximately one-third of admissions to the general neurology outpatient clinic. Although it affects both gender in a wide age range, it occurs more frequently in women between ages of 35 and 50. As a common neuropsychiatric disorder affecting mostly young people at productive ages, FND also leads to an important socioeconomic burden. For this reason, clinical and research activities tended to increase recently in order to develop new neuroscientific approaches for the treatment of this disorder. Various new clinical centers that offer specialized and multidisciplinary treatment to FND patients, have been established around the world. Likewise, a study group was established in Hacettepe University Adult Hospital, where FND patients were started to be treated by a multidisciplinary team, by also considering the specific needs of our country’s population.

Here, we aim to share the phenomenological and clinical characteristics and treatment response of patients with functional neurological disorders (FND) who received short-term inpatient multidisciplinary treatment in a university hospital between 2020 and 2023.

FND study group at Hacettepe University Adult Hospital was founded by 2 neurologists, 2 psychiatrists, 1 psychologist and 2 physiotherapists.

Within the framework of the protocol, FND patients were first informed about the disease process by a neurologist and a psychiatrist and then followed up for further need for an inpatient multidisciplinary approach.

During hospital admission in the room reserved for FND patients in the neurology ward, the treatment protocol was implemented in such a way that each session included one hour of cognitive behavioral therapy-based psychotherapy and at least 2 hours of intensive physiotherapy including FND-specific approaches for at least 5 days.

Demographic and clinical characteristics of the patients were noted, their fitness levels before and after treatment were evaluated with a visual analogue scale, and the patients’ perceived improvement levels were also evaluated with VAS and recorded as a percentage.

The majority of patients were women (19/11).

The age range was wide, between 19 to 75 (average 44 years).

Patients were classified under four groups based on the predominant symptom (gait disorders:15, fixed dystonia: 9, swallowing and speech problems:3, sensorial problems:3)

The level of improvement perceived by the patients was the best in those with sensorial problems, and the worst in those with swallowing and speech problems (%40).

Those with the lowest level of perceived wellness in terms of general health were patients with dystonia component.

Multidisciplinary FND rehabilitation may provide different degrees of benefit to FND patients of different subtypes. Our results may have the potential to contribute to clinicians and academicians in predicting treatment outcomes.

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Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection (PANDAS) is an autoimmune disease caused by Group A Streptococcus bacteria. It usually affects children 3 to 12 years of age, however, have also been reported among adolescents. PANDAS presents with neuropsychiatric symptoms which can overlap or coincide with existing psychiatric disorders that often emerge further as children get older. Identifying the causation of events may be challenging making such cases difficult to manage.

To understand the presentation of PANDAS with concurrent mood disorder and its management.

Clinical case report

A 16-year-old female was initially admitted due to blank stares, disorganized behavior, paranoia, aggression, and depressive symptoms. Her EEG and MRI were normal. She did not tolerate Fluoxetine but improved with Olanzapine (12.5mg). At 17 years old, she had throat discomfort, colds, and headache with supportive management done. She felt depressed and suicidal due to school stress prompting her second admission. She was started on Escitalopram and Olanzapine was shifted to Quetiapine. Subsequently, she developed manic symptoms with hallucinations and worsened paranoia. Escitalopram was discontinued and Quetiapine was increased (300mg). Bipolar I Disorder with Psychotic Features was considered. Shortly after, she developed explosive motor and vocal tics, involuntary screeching with head gagging and jerking and urges to choke herself or hit her head on the wall. Quetiapine was discontinued and was placed on Clonazepam (0.25mg/8h). Work ups revealed normal EEG, positive ASO and ESR, and findings of Mild Rheumatic Heart Disease on 2D Echo, hence, the assessment of PANDAS. Treatment is multidisciplinary involving antimicrobial, immunomodulatory, and psychotherapeutic interventions. Medications were then adjusted to: Co-amoxiclav (625mg/10days) followed by Penicillin V (250mg/12h), Aripiprazole (15mg), and Divalproex Sodium (1000mg). Intravenous immunoglobulin was suggested due to her moderate to severe presentation. Henceforth, improvement of symptoms were noted and she was reintegrated back home.

Diagnosing PANDAS can be complex among adolescent due to concurrent issues with similar symptom presentation. PANDAS is episodic in nature but may also have sawtooth-like presentation which may indicate first admission as an episode and the second, a flare up. The case could have also been a combination of PANDAS and Bipolar Disorder thus the severity. Regardless, the interplay of biological and psychological facets have evidently magnified her predispositions leading to an intense manifestation of symptoms.

None Declared

This case highlights the interdisciplinary management of a 28-year-old Filipino female with recurrent depressive disorder and multiple medical comorbidities, including HIV, tuberculosis, and sexually transmitted infections. Managing depression in patients with complex medical conditions is especially challenging in resource-limited settings like the Philippines, where drug-to-drug interactions and access to high-quality care must be carefully navigated.

The objective of this case report is to illustrate the importance of personalized treatment decisions, the rationale for choosing Venlafaxine over SSRIs, and the value of psychodynamic psychotherapy in addressing underlying emotional conflicts in the context of maternal health challenges.

The patient was referred to the Psychiatry service due to suicidal ideations. She has a history of depressive episodes linked to family stressors and initial flashbacks and nightmares related to her physical abuse from her previous partner. Her extensive comorbidities made the usual first-line antidepressants (SSRIs) unsuitable due to drug interactions. Venlafaxine 75 mg/day was selected, and psychodynamic psychotherapy, trauma-informed psychotherapy, and psychoeducation were integrated into her treatment. Coordination with infectious disease, obstetrics, and internal medicine specialists ensured comprehensive care.

Venlafaxine was effective in improving mood, sleep, and appetite, with no significant side effects. Regular follow-ups confirmed adherence to the medication, and psychodynamic psychotherapy helped her address deep-seated emotional conflicts, particularly surrounding her history of trauma. Ongoing psychiatric care, along with monitoring her medical conditions, provided a supportive framework for her continued improvement. Despite financial constraints, the patient adhered to her treatment regimen, showing improved mental health and commitment to her care.

This case underscores the complexity of treating depression in patients with multiple comorbidities, particularly in resource-limited settings. The selection of Venlafaxine was crucial due to the potential interactions of SSRIs with the patient’s medical regimen. Psychodynamic and trauma-informed psychotherapy, combined with interdisciplinary collaboration, were key to the successful management of this case. This highlights the need for an integrated approach to mental health care, especially in low-resource environments, where interdisciplinary coordination is vital.

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Autoimmune encephalitis is a new and increasingly well-described entity. The most common is encephalitis caused by antibodies against the N-methyl-D-aspartate receptor on the surface of neurons (NMDAR encephalitis). It is a predominant entity in women and young patients and it is often associated with ovarian teratomas, neuroblastomas, Hodgkin’s lymphomas and others.

NMDAR encephalitis can manifest with a diverse range of neurological and psychiatric symptoms (personality change, anxiety, insomnia, confusion, attentional and short-term memory deficits, emotional lability, psychotic symptoms, language impairment, fluctuations in the level of consciousness, seizures and dysautonomia).

Clinical review of Anti-NMDAR Encephalitis for differential diagnosis with Functional Neurologic Disorder.

Clinical case and literature review.

We present the clinical case of a 27-year-old woman with a history of depression and anancastic personality disorder. The patient went to the Emergency Department different days presenting both neurological (facial paresthesias, hypoesthesia, weakness, high-intensity occipital headache, dizziness, loss of consciousness and anterograde amnesia) and psychiatric symptoms (obsessive thoughts, anxiety, visual and auditory hallucinations). She was admitted to the Neurology Unit. Complementary tests were performed: EEG, cranial CT scan, MRI, lumbar puncture, blood tests (including tumour markers) and urinalysis, founding no alterations suggestive of encephalitis or other systemic pathologies. She was also evaluated by the Psychiatry service. The patient described that as a result of a recent change in her job she presented emotional lability, obsessive ruminative ideas and anxiety. Treatment with Sertraline 100mg/day and Lorazepam 1mg/8 hours was started.

After ruling out autoimmune encephalitis, the patient was diagnosed with Functional Neurologic Disorder, given the temporal relationship of the symptoms with the stressful history at work.

Given their growing prevalence autoimmune causes, such as NMDA anti-receptor antibody encephalitis, should always be considered in the cases of neuropsychiatric alterations. It is very important to carry out a correct organic screening prior to the diagnosis of psychiatric pathology. It is also essential an adequate coordination between different medical departments for an accurate and comprehensive approach to the patient.

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Cytopenia is a common hematological issue in HIV/AIDS patients. Despite early disease identification and less toxic HAART reducing its prevalence, persistent thrombocytopenia remains. SSRIs, prescribed for depression in this population, can also cause thrombocytopenia. This review explores the potential combined impact of HIV and SSRI treatment on thrombocytopenia risk.

The objective of this study is to evaluate thrombocytopenia incidence in HIV/AIDS patients and those receiving SSRIs, and to provide clinical recommendations for monitoring in individuals affected by both conditions.

A comprehensive literature review was conducted using PubMed, MEDLINE, and the Cochrane Library. Studies on thrombocytopenia in HIV/AIDS patients or discussing SSRI-induced thrombocytopenia were included. Data on incidence and clinical management were extracted and synthesized to form a cohesive understanding of risks and recommended practices.

Thrombocytopenia (<150,000 platelets/μl) is a sentinel event frequently seen in HIV/AIDS patients, often prompting further evaluation. A 1982 study reported thrombocytopenia in up to 40% of AIDS patients pre-HAART. Recent data from the CHORUS cohort (1997-2006) showed a decreased prevalence of thrombocytopenia to 14%. However, 23% of those with severe thrombocytopenia (<30,000 platelets/μl) remained symptomatic despite HAART. A BC-CfE study found a 0.6% prevalence of symptomatic thrombocytopenia among HAART-treated patients (1996-2012), highlighting non-HIV causes. SSRIs can cause thrombocytopenia by interfering with platelet serotonin uptake, reducing platelet function and lifespan. Several case series reported isolated thrombocytopenia following SSRI introduction. While the concurrent use of SSRIs and HAART’s effect on thrombocytopenia risk is unclear, careful consideration and monitoring are necessary.

The relative risk of thrombocytopenia from the combined effect of HIV/AIDS and SSRI treatment has not been definitively established. HIV/AIDS patients on SSRIs should be carefully monitored due to the known hematological impacts of both the disease and medication. Regular monitoring of platelet counts is crucial, especially in those with advanced or poorly controlled HIV. Consider alternative psychiatric treatments with lower hematological risks where possible. Effective management requires interdisciplinary collaboration to address these patients’ complexities. This review underscores the importance of vigilant monitoring and individualized treatment strategies for HIV/AIDS patients on SSRIs to manage and mitigate the potential risk of thrombocytopenia.

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Hypertension, a major global public health challenge, is often associated with mental health conditions, particularly depression. Several studies suggest a bidirectional relationship between depressive symptoms and hypertension, which may negatively affect individuals living with hypertension’s ability to maintain essential self-care practices, including adherence to prescribed medications and necessary lifestyle modifications.

This study aims to build upon our previous systematic review (doi: 10.5455/msm.2024.36.65-72) by incorporating new data to further investigate the relationship between depressive symptoms and various aspects of self-care, with a particular focus on medication adherence among individuals diagnosed with hypertension.

The electronic database CINAHL was added to those of PubMed, Scopus, and PsycInfo, with the search extending from April 2023 to the present. Given the substantial diversity among the studies, a narrative synthesis of the results was conducted.

A total of five new studies were included alongside the existing eighteen, involving 11,733 individuals with hypertension who met our eligibility criteria. Among these studies, ten reported a statistically significant association, highlighting the negative impact of depressive symptoms on medication adherence. The remaining thirteen studies did not confirm this association.

This systematic review reaffirms the diverse landscape of research examining the relationship between depressive symptoms and medication adherence in individuals with hypertension. It is advisable to conduct more robust longitudinal studies to thoroughly explore this relationship.

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The alcohol use disorder has consequences on the metabolic, gastroenterological and especially neurological levels.

The somatic complications of alcohol use disorder add to the psychological and psychiatric complications and repercussions.

This involves presenting the case of Mr D;D admitted as part of the emergency for psychiatric evaluation.

Interest in highlighting multidisciplinary care for somatic and psychiatric liaison

Presentation of clinical case

Patient case

The management of patients with a psychiatric disorder or a request for psychiatric evaluation within the framework of the emergency liaison requires multidisciplinary and coordinated care.

Close collaboration allows early diagnosis and better overall patient care.

None Declared

Diabetes and hypertension are chronic conditions that significantly impact mental health. Managing these diseases involves constant monitoring, lifestyle changes, and dealing with potential complications, which can lead to increased sleep disorders, anxiety, and depression.

the objectives of our study were to determine the frequency of anxiety, depression and sleep disorders in patients with hypertension and diabetes and to investigate factors associated with their occurrence.

This is a descriptive cross-sectional study conducted over a three-month period from October 1 to December 31, 2022, involving 720 diabetic and/or hypertensive patients followed at the primary health centers (CSB) in Kalaa Kbira Sousse. The assessment of sleep disorders was performed using the Pittsburgh Sleep Quality Index. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale.

Among the 720 patients included, the majority were women (70.6%), with a gender ratio M/F of 0.41. The average age of the participants was 63.45 ± 13.16 years. The chronic illness was hypertension in half of the cases (49.3%), diabetes in a quarter of the cases (26.3%), and both conditions together in a quarter of the cases (24.4%). Anxiety was present in nearly half of the participants (47.1%), depression affected 40.2%, while anxiety-depressive disorder concerned half of the cases (46.5%).The prevalence of sleep disorders was 54.3% according to the Pittsburgh Sleep Quality Index (PSQI) with a median score of 6 [IQR: 3-9]. The subjective quality of sleep was rated as poor in 41% of cases.The prevalence of sleep disorders was 46% among diabetics, 54.6% among hypertensive patients, and 62.5% among those with both conditions simultaneously.In multivariate analysis, factors associated with poor sleep quality according to the PSQI included age ≥ 65 years (p=0.026), comorbidities (p=0.012), anxiety-depressive disorder (p≤10-3), poorly controlled diabetes (p≤10-3), and insulin therapy (p=0.022).

Understanding the mental health challenges faced by individuals with diabetes and hypertension is crucial for developing comprehensive care strategies that address both physical and psychological needs.

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Breast cancer (BC), one of the most common cancer types among women, affects one in four women according to global cancer statistics (Ferlay et al., 2021; Yusof et al., 2021; Sung et al. 2021; Li et al. 2023). Despite the increase in the life expectancy of cancer patients with advances in treatments and developing technology, its diagnosis as a disease with a high risk of death causes anxiety and stress in individuals (Solomon et al., 2000; WHO, 2018; Miller et al., 2019; Abdollahi et al., 2019).

In addition to physical and emotional changes, the diagnosis of cancer brings about changes in social relationships and roles. In coping with these processes, it has been reported that social support and social support management will have positive effects on coping with the problems brought by the disease, improvement in prognosis and self-management levels of patients (Xiang, 2010).

Interpersonal Relationship Psychotherapy (IRPT), which has been recommended as monotherapy for mild to moderate depression in treatment protocols in recent years (Spinelli, 1997; Spinelli and Endicott., 2003; APA, 2010; Brandom et al. 2012) Interpersonal psychotherapy has been found to be effective in the short and long-term treatment of cancer patients with major depressive disorder (Blanco, Hershman et al., 2014). Grief, interpersonal conflicts, role changes and social isolation (lack of interpersonal skills), which are the focus of IPT, are frequently experienced problems in cancer-related processes. IPT works by associating the social support and interpersonal problems that patients receive with disease symptoms (Sayar & Omay, 2019).

This study will examine the effect of Interpersonal Relationship Psychotherapy (IRPT), which is recommended as monotherapy for mild to moderate depression in treatment protocols, in breast cancer patients.

Studies conducted in the last 10 years and in Turkish-English are included.

95 publications were reached. 73 publications were reached after removing duplicate publications.

We included randomized controlled trials of interpersonal relationship psychotherapy in breast cancer patients, comparing it with combination therapy, and applying it by telephone. The study included 4 studies.

Having examined a total of 73 abstracts, we retrieved 10 full-text papers for further study. Of these, we excluded 6 papers that did not meet inclusion criteria. A total of 4 studies met all inclusion criteria and were included in this systematic review.

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When the results of four studies examining the effectiveness of interpersonal relationship psychotherapy were examined, it was found to have a positive effect for breast cancer patients. This study, which examines the effects of interpersonal relationship psychotherapy, a therapy with proven positive effects on depression in different samples, on breast cancer patients, is important because it provides evidence to the literature.

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Cholesterol is important for the normal functioning of the central nervous system. However, its reduction by certain agents might be related to the psychiatric adverse reactions, which could vary in frequency, but some can be serious and even fatal, such as suicidality and severe aggression.

With this case report, we would like to draw attention to the possibility of serious psychiatric adverse reactions in patients receiving lipid-lowering drugs.

Bibliographic search and description of a clinical case of a patient under follow-up in outpatient treatment.

A-60year old woman with generalized anxiety disorder and hyperlipidemia in a previously good remission reported increased anxiety, nervousness, insomnia and irritability on a regular check-up. There were no external stressors, except for an approaching retirement, which she was looking forward to. However, she forgot to mention that she was switched from fenofibrate to a pill consisting of a combination of rosuvastatin and ezetimibe. Her antianxiety medication needed to be increased and some cognitive behavior interventions were administered. However, her condition continued to deteriorate in the following months. She even developed suicidal ideation and verbal aggression. She refused to be hospitalized, while going to a trip with her husband. During the trip, she was not taking her new antilipemic medication and she never restarted it. After two days of discontinuation of the combination pill, her psychiatric condition gradually improved. At the following examination, she revealed the modification of her antilipemic treatment and the new medication could be identified as a cause of intensification of her anxiety. Subsequently, she was switched to atorvastatin (later on ezetimibe was added). She went into a full remission and she remained in it, while her psychiatric medications were reduced to the initial dosages.

The treatment of the patient’s symptoms in our case report was directed towards reducing a substantial worsening of the anxiety disorder while lacking the information on the previous replacement of a lipid-lowering drug. Luckily it ended well. With our case report, we would like to re-emphasize the importance of caution and monitoring of side effects, education of patient and interdisciplinary professional communication when treating with lipid-lowering drugs, especially in patients with a known mental disorder.

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Systemic Lupus Erythematosus (SLE) is an autoimmune disorder characterized by systemic inflammation and high prevalence of neuropsychiatric symptoms. Among these, suicidal ideation represents a significant concern, with reported higher rates than in the general population. The etiology of suicidal ideation in SLE is multifaceted, encompassing both disease-specific factors and psychosocial variables. Recent research has highlighted the intricate interplay between SLE and psychiatric symptoms, suggesting a bidirectional relationship mediated by inflammatory processes, neurological involvement, and psychosocial stressors. However, the specific contributions of these factors remain unclear.

This study aims to elucidate the primary predictors of suicidal ideation in a cohort of SLE patients.

A cross-sectional study was conducted with a cohort of SLE patients from the Autoimmune Diseases Unit at Cruces University Hospital (Biscay, Spain). Each patient underwent a thorough clinical evaluation by a psychiatrist, and relevant clinical and sociodemographic data were collected. Suicidal ideation was assessed using the Plutchik scale, while predictor variables included autoimmune factors such as cumulative corticosteroid dose, disease activity, and accumulated organ damage. Psychiatric symptoms were assessed using various psychometric scales. A multiple linear regression model was employed to examine the associations between these variables and suicidal ideation.

A total of 92 SLE patients in active follow-up were included, with a female predominance (91%). Most patients were in an inactive disease state, receiving low-dose prednisone and antimalarial therapy according to our clinical protocol; the majority were in remission, as reflected by a mean SLEDAI-2K score of 1.59(±2.44). Despite a median disease duration of over 10 years, cumulative organ damage was low (mean SDI score 0.33 ± 0.84). In a multiple linear regression analysis, the model showed a strong fit (R=0.732, R²=0.535, p<.001), explaining approximately 53.5% of the variability in suicidal ideation. Suicidal ideation was significantly associated with cumulative corticosteroid dose (β=0.172, p=0.011), total anxiety score (β=0.248, p<.001), and frequency of traumatic experiences (β=0.118, p<.001). Collinearity statistics (VIF 1.03–1.07) indicated no significant multicollinearity issues.

Suicidal ideation in our SLE cohort was associated with corticosteroid use, anxiety, and traumatic experiences, highlighting the importance of addressing these factors in suicide risk management. The relationship between corticosteroid dose and suicidal ideation may be linked to the neuropsychiatric effects of these drugs, while anxiety and traumatic experiences contribute to the emotional burden of the patient. Notably, disease activity was not linked to suicidal ideation in this cohort.

None Declared