If stress, insomnia, anxiety, and depression persist for a long time and occur more than normal, it can become a serious illness. Based on the data from 263 mountain work reports submitted to the Department of Mining, Production, and Technology and the Coal Research Department of the Mineral Oil Department in 2018, a human resource survey of the industry was conducted. There are 56,635 registered workers in the mining sector, 96% of whom are Mongolian and 4% are foreign experts. 90% of all employees working in the mining industry are men, and 10% are women. In our country, there is a lack of research on the psychological health of mine workers and the factors affecting it, so this study is the reason for conducting this research.

To identify the anxiety of mine workers and to study some correlations and effects.

The survey was conducted from March 26, 2024, to April 5, 2024, by the employees of “TiTiGiViSiOu LLC,” located in Tsogtsetsii Sum, Umnugobi Province, according to GAD7, SRQ20, issued by WHO for doctors of primary health care institutions. Survey data were collected from mining workers using the PHQ9, 18 sleep disturbance questionnaires, and 10 general information questionnaires. IBM SPSS-26 software was used to analyze the research.

66.0% of the study participants had no anxiety, 23.3% had mild anxiety, 6.8% had moderate anxiety, and 3.9% had severe anxiety. Also, 70.9% work in the night shift, while 24.3% do not work in the night shift. However, 4.8% answered that they sometimes work the night shift. The majority of night shift workers are male workers. 66.0% of the respondents had no anxiety, 23.3% had mild anxiety, 6.8% had moderate anxiety, and 3.9% had severe anxiety. Anxiety has a strong direct correlation with stress (r = 0.7**, p = 0.00), depression (r = 0.87**, p = 0.00), and sleep disturbance (r = 0.58**, p = 0.00). degree was directly related. In univariate regression analysis, a one-point increase in stress score was associated with a 71% increase in anxiety. The depression score increased by 80% per unit increase, and the sleep disturbance score increased by 87% per unit increase. Multivariate linear regression analysis revealed that anxiety increased by 18.6% when the stress score increased by one and depression increased by 66.2% when the depression score increased by one.

Anxiety is strongly associated with stress, depression and sleep disturbances. An increase in stress, depression, and sleep disturbance scores leads to an increase in anxiety. Multivariate linear regression analysis reveals these relationships.

None Declared

Social anxiety disorder (SAD) and body dysmorphic disorder (BDD) share a unique and intricate relationship, often presenting with overlapping yet distinct anxieties about social evaluation. In patients who have undergone repeated surgical interventions, the added dimension of neuropathic pain further complicates the clinical picture, as seen in this 48-year-old male. His preoccupation with his perceived nasal and upper lip deformities, coupled with neuropathic pain from multiple reconstructive surgeries, underscored a profound interplay of psychological and somatic symptoms, warranting a multidimensional therapeutic approach.

To elucidate the diagnostic overlap between SAD and BDD in a patient with neuropathic pain post-surgery, to explore the off-label use of pregabalin in addressing both anxiety and neuropathic pain symptoms, and to highlight the subtle clinical distinctions between social phobia related to perceived physical flaws (BDD) versus the broader fear of negative evaluation in social contexts (SAD).

The patient’s history includes five reconstructive surgeries to correct perceived nasal and upper lip deformities, which resulted in significant spastic neuropathic pain. This pain was exacerbated by the patient’s intense anxiety regarding his physical appearance, manifesting as avoidance behaviors, fear of negative social evaluation, and repetitive self-evaluative behaviors typical of BDD. Initial treatment involved clonazepam and mirtazapine combined with psychotherapy. Despite partial relief of anxiety symptoms, neuropathic pain persisted, exacerbating his body image concerns. Pregabalin was introduced under the assumption that neuropathic pain was worsening his BDD-related distress and social anxiety symptoms.

Following the introduction of pregabalin, the patient demonstrated marked clinical improvements. The dual efficacy of pregabalin, particularly in its off-label role for social anxiety, contributed to a reduction in the fear of social situations, previously fueled by BDD-related preoccupations. The remission of neuropathic pain, in conjunction with improved social functioning, underscores the utility of pregabalin in addressing the complex somatopsychic interactions in patients with comorbid psychiatric and neuropathic conditions.

This case highlights the intricate diagnostic and therapeutic complexities in managing co-occurring social anxiety and body dysmorphic disorder, where psychosomatic pain further distorts the clinical picture. The addition of pregabalin, despite its off-label status for SAD, proved to be a pivotal intervention, addressing both the patient’s physical and psychological distress, incorporating psychopharmacology, pain management, and psychosocial interventions to effectively restore function and quality of life.

None Declared

Night shift work disrupts the natural circadian rhythms, leading to significant sleep disturbances that can adversely affect mental health. Nurses working these shifts often report higher levels of stress, anxiety, and depression compared to their day-shift counterparts.

This study aims to assess the prevalence of psycho-affective disorders among night-shift nurses.

Data were collected from a cross sectional study in the university hospitals of Sfax. We used a questionnaire exploring socio-demographic, professional data and pathological history. We evaluated absenteeism based on the number of days absent over the past year. Psychoaffective disorders were screened using the validated Arabic version of the Depression, Anxiety, and Stress Scale: DASS-21.

Our study included 114 nurses, with 65% being female. The mean age was 33.8 ans ± 7 years. Severe to very severe symptoms of depression, anxiety, and stress were found in 14%, 21%, and 18% of our participants, respectively. Among our workers, 58% reported being moderately satisfied at work. During the last 12 months, 68 nurses (59.6%) were absent for an average of 27.21 days ± 72.73 days. Significant associations were found between job satisfaction and severity of depression (p= 0.000), anxiety (p=0.027) and stress (p = 0.000). Absenteeism was significantly associated to depression (p=0.009, r=0.24), anxiety (p=0.014, r=0.23) and stress (p=0.35, r=0.19).

Psychoaffective disorders are common among paramedical staff working shifts in hospitals. It is essential to conduct screening consultations in occupational medicine to identify these disorders early on.

None Declared

PNEA- Psychogenic Non-Epileptic seizures resemble epileptic seizures, have no electrophysiological correlate or clinical evidence for epilepsy, whereas there is positive evidence for psychogenic factors that may have caused the seizure. The clinical presentation usually includes convulsive movements, tremor of the whole body, or just some of the parts, loss of awareness, unresponsiveness and sometimes amnesia. ( N.M.G. Bodde, J.L. Brooks, G.A. Baker, P.A.J.M. Boon, J.G.M. Hendriksen, O.G. Mulder, A.P. Aldenkamp, Psychogenic non-epileptic seizures—Definition, etiology, treatment and prognostic issues: A critical review, Seizure, Volume 18, Issue 8, 2009, Pages 543-553, ISSN 1059-1311, https://doi.org/10.1016/j.seizure.2009.06.006.). We were called for a psychiatric consultation for a 35 year old female patient who presented to the Emergency service of our hospital with a history of severe headache unresponsive to painkillers, seizures and a panic attack. A few days prior to this visit she was hospitalized in the Department of Neurology of a different hospital under suspicion of hydrocephalus.

The objective of our psychiatric consult was to determine whether the clinical presentation of seizures and headache could be caused by underlying psychological disturbances, rather than by somatic symptoms.

We reviewed the patient history and previous medical findings and treatment. Additionally, the patient underwent a series of diagnostic tests, with the most important one being video EEG monitoring.

On the MINI diagnostic questionnaire, she met the criteria for Mixed anxiety and depressive disorder and Dissociative and conversion disorder. Psychological testing confirmed a tendency to somatization, and development of secondary psychiatric symptoms on top of the existing physical symptoms. Also, continuous EEG recording for the duration of four days detected only functional seizures, and with other non-pathological findings, among others, through MR of the brain and MR angiography, confirmed the working diagnosis of PNEA.

The mutual cooperation between neurology specialists and liaison psychiatrists is vital in cases like this when there is an unclear cause of the symptoms. Accurate determination of the underlying cause of disturbances enables adequate treatment of the patient.

None Declared

The Covid-19 pandemic has been an integral part of our lives since late 2019, bringing significant changes to the way we live. These changes have brought with them a wave of pandemic-related psychological distress including fear, anxiety, feelings of threat. The Covid-19 pandemic presented several global challenges to the functioning of the health system in general and to medical personnel in particular. Unfortunately, the discussion on how staff in health facilities deal with pandemic-associated distress has remained in the background.

The main aim of our study was to investigate the impact of the COVID-19 pandemic on the mental health of healthcare workers and trainees and specifically on the development of anxiety symptoms. We aimed to track levels of anxiety among physicians, health care professionals, and medical students, and their relationship to various sociodemographic indicators-gender, age, marital status, education and occupation, familial predisposition to anxiety disorders, and previous consultation with a psychologist/psychiatrist.

The study was led among fifth and sixth year medical students in Sofia university and Trakia university and also doctors and nurses working in hospitals in Sofia and Stara Zagora - MHC “Prof. Н. Shipkovensky”, University Hospital “N.I Pirogov”, University Hospital “Prof. Dr. Stoyan Kirkovich”. The study used a questionnaire created by the researchers and the Coronavirus Anxiety Scale by Lee and the Covid-19 anxiety syndrome scale by Nikcevic and Spada.

The mean age of the study participants was 28.21±10.11 years ranging from 22 to 68. Majority of the study participants (72.3%) were students followed by doctors with 19.8% and nurses with 5.6%. After statistical analysis of the data, there was a linear relationship between having a close friend or relative who had died or had a serious illness due to Covid-19 infection and having marked anxiety and fear for the health of loved ones. In this group frequent checking for coronavirus symptoms, both in the respondents themselves and by them to their friends and relatives was observed more often. Pre-pandemic visits to a psychologist/psychiatrist for anxiety symptoms appeared to be a predictor of avoidance behaviour in respondents e.g.not using public transport to reduce the risk of infection.

Having a close friend or relative who had a severe infection with Covid-19 and pre-pandemic visits to a mental health professional were predictors of increased pandemic-related anxiety and avoidance behavior among health care professionals and medical students. Due to the high prevalence of this mental health problem among medical students and frontline health workers, it is suggested that healthcare institutions provide mental health services for these working groups in order to appropriately manage anxiety.

None Declared

Strength training approaches have seen a significant increase in popularity in the fitness and wellness industries in recent years. This rise is fueled not only by the desire for physical prowess and muscle development, but also by a growing awareness of its potential impact on mental health. While the traditional focus of research on strength training has primarily been on its physical benefits, there exists a developing enthusiasm within the scientific community to explore deeper into its implications for mental health, particularly with anxiety levels.

The purpose of this study is to examine the link between strength training intensity and anxiety levels among active gym-goers in Tunisia.

This is a cross-sectional study, conducted from February to March 2024. Participants were recruited online through social media platforms ( Tunisian facebook groups and fitness forums) using a posted survey link. We’ve included respondents who are 18 years of age or older who have been active in strength training with a gym membership for 1 month or more. The respondents were required to answer a questionnaire that included socio-demographic questions and to provide strength training intensity related details ( sessions frequency, duration, perceived overall intensity using likert scale). Anxiety levels were evaluated using the Generalized Anxiety Disorder 7 (GAD-7) scale.

The overall number of participants was 72, with 86% being male. The majority of responders (n=65, 90.2%) indicated that they performed strength training exercises at least three times per week, with an average session length of 45 minutes. In terms of strength training intensity, 38.8% (n= 28) of participants reported high-intensity sessions, 48.6%(n=35) moderate-intensity sessions, and the remaining participants reported low-intensity sessions.

Analysis showed a mean anxiety score of 6.1 (SD = 3.8) on the GAD-7 scale, indicating absent to mild anxiety symptoms among respondents.

Further analysis revealed a negative association between strength training intensity and anxiety levels (r = -0.59, p = 0.026), implying that higher intensity sessions were linked with lower anxiety scores.

In conclusion, this study provides insight into the level of anxiety of Tunisian gym-goers who participate in strength training, emphasising the potential of exercise interventions to improve mental health in this society. Moving forward, these findings can help to shape targeted interventions and wellness efforts, promoting holistic approaches to well-being that prioritise both physical and psychological health.

None Declared

Fibromyalgia (FM) is a chronic condition characterized by widespread muscle pain,with an unclear etiology. Pain-related behaviors are often closely tied to the individual’s mental state. This has made FM a significant area of psychiatric research, highlighting the need to understand the psychological factors that influence disease progression.

We aim to explore differences in psychological resilience between FM patients and healthy controls and its relationship with depression,anxiety,and fibromyalgia symptoms. Specifically,we seek to understand how resilience may influence disease development and progression. By examining these factors, the study aims to clarify the underlying causes of fibromyalgia,is closely linked to psychiatric factors and remains poorly understood in terms of etiology.

The study included FM patients treated at the Department of Physical Medicine and Rehabilitation at Çanakkale 18 Mart University and a control group of healthy volunteers matched for demographic factors. Pain intensity was measured using the Visual Analog Scale(VAS) and functional disability was assessed with the Fibromyalgia Impact Questionnaire(FIQ). Participants completed sociodemographic forms, the Beck Anxiety Inventory(BAI), the Beck Depression Inventory(BDI), and the Psychological Resilience Scale(PRS).

The study involved 40 female patients with FM and 35 healthy controls. No significant differences were found between the two groups in terms of demographic factors. The FM group showed significantly higher scores for BDI,BAI and PRS compared to controls (p<0.001 for BDI and BAI; p =0.04 for PRS). Correlation analysis revealed significant negative correlations between pain intensity and both PRS total and PRS dedication scores (r=-0.34, p=0.02; r =-0.35, p =0.02). Additionally,FIQ scores were negatively correlated with PRS dedication scores(r=-0.37, p=0.01). (Table 1).

Table 1: Psychological Status and Performance Scales (BDI, BAI, PRS, etc.)

BMI: Body Mass Index, BDI: Beck Depression Inventory, BAI: Beck Anxiety Inventory, PRS: Psychological Resilience Scale

This study highlights the complex interplay between psychological resilience,depression,anxiety and pain in FM patients. Psychological resilience was not significantly lower in FM patients compared to healthy individuals,but higher levels of depression and anxiety were inversely related to resilience.These findings underscore the need for treatment approaches that not only address physical symptoms but also aim to enhance psychological resilience in order to improve the overall quality of life in FM patients.

None Declared

Emetophobia, an intense and disproportionate fear of vomiting, is a chronic and debilitating condition characterized by the avoidance of situations or activities that may increase the perceived risk of vomiting. It is often accompanied by an overwhelming fear of losing control, becoming severely ill, or being perceived as repulsive by others. Treating emetophobia is particularly challenging, primarily due to the difficulties in implementing exposure-based interventions effectively. Data on the pharmacological management of emetophobia is limited, with only a few case reports in the literature suggesting potential benefits from selective serotonin reuptake inhibitors (SSRIs).

With this case report we aim to describe a case of emetophobia treated with an SSRI.

Description of a clinical case of a patient with emetophobia observed in a psychiatric outpatient consultation.

We present the case of a 21-year-old male with a one-year history of emetophobia. At the time of consultation, he was unemployed, having recently completed a computer engineering degree. He had no relevant past medical history and was not on any regular medication. The patient was referred for psychiatric evaluation after three years of psychotherapeutic treatment for generalized anxiety disorder. His anxiety symptoms worsened one year prior after an episode of vomiting, which triggered a fear of recurrence. This fear led to restrictive eating, resulting in a 10 kg weight loss over the preceding year (current weight: 63 kg), and significant social avoidance due to the fear of vomiting in public. Physical and neurological examinations revealed no abnormalities. Routine blood tests, urinalysis, and urine drug screening showed normal results. Given the limited efficacy of prior psychotherapeutic interventions, pharmacotherapy with escitalopram 10 mg daily was initiated. After one year of follow-up, the patient reported substantial improvement in anxiety symptoms and avoidance behaviors related to his fear of vomiting. He was able to resume normal eating patterns and gained 5 kg during this period.

This case highlights the potential efficacy of SSRIs, specifically escitalopram, in the treatment of emetophobia. After one year, the patient showed significant improvement, with the return of normal eating patterns and weight gain. While exposure-based interventions remain a cornerstone of treatment for specific phobias, pharmacological options like SSRIs can serve as a valuable adjunct, especially in cases with comorbid anxiety disorders. Further research is needed to better understand SSRIs’ role in managing emetophobia and refine treatment strategies for this complex condition.

None Declared

Cacosmia, the perception of neutral odors as foul, is an unusual and distressing postoperative complication. This case focuses on a 66-year-old female who experienced cacosmia after a colectomy, raising questions about the role of anxiety in postoperative sensory distortions. While colectomy is commonly associated with physiological complications, emerging research indicates that psychological factors, particularly anxiety, may influence sensory processing. Addressing these interactions is crucial for improving outcomes in patients with psychiatric comorbidities undergoing surgery.

1. 1. To examine the influence of pre-existing anxiety on the development of sensory distortions, specifically cacosmia, following colectomy.

2. 2. To investigate the relationship between the gut-brain axis and psychological factors, including anxiety, in the context of postoperative recovery.

3. 3. To highlight the gaps in the literature regarding sensory distortions in surgical patients and to propose potential areas for future research.

Patient: A 66-year-old female with a history of anxiety disorder developed cacosmia two weeks after undergoing colectomy.

She reported that food smelled like feces despite normal postoperative recovery and the absence of physical abnormalities.

a search was conducted using databases such as PubMed and Scopus with terms like cacosmia, postoperative sensory distortion, anxiety and surgery, and gut-brain axis. Articles exploring the relationship between anxiety and sensory distortions in surgical patients were included.

Gut-Brain Axis: The gut-brain axis is essential in regulating emotions and sensory processing. Disruptions from surgery can affect neurotransmitters, contributing to both anxiety and sensory misinterpretations like cacosmia. Anxiety’s Role: Anxiety is known to heighten sensory perception. The patient’s pre-existing anxiety likely amplified her awareness of sensory stimuli, leading to distorted odor perceptions.

While the role of anxiety in surgical recovery is recognized, there is a lack of research specifically addressing sensory distortions like cacosmia in the postoperative period.

This case underscores the importance of considering psychological factors, especially anxiety, in postoperative sensory distortions like cacosmia. The interaction between the gut-brain axis and sensory perception in anxious patients highlights the need for a more comprehensive, multidisciplinary approach to postoperative care. Current gaps in the literature suggest a need for future research on how anxiety and sensory processing intersect after surgery. Investigating preoperative interventions such as cognitive-behavioral therapy (CBT) or pharmacotherapy may help mitigate sensory distortions and improve postoperative recovery outcomes in patients with anxiety.

None Declared

Functional neurological disorder (FND) is a core neuropsychiatric condition that includes both physical and mental symptoms. Recently, a validated clinical phenotype termed neuroconnective endophenotype (NEP), which includes several physical and psychological characteristics together with joint hypermobility (hypermobility spectrum disorders), was found at a significantly higher frequency among patients with anxiety (Bulbena A et al. Adv Psychosom Med 2015; 34:143–157).

The purpose of the present study was to examine the presence of the NEP among patients with FND.

A multicenter case-control study was conducted comprising 27 FND patients and 27 healthy control participants (matched by sex and age) ages 13 to 58 years. Eight questionnaires were administered. Proportional differences were examined with Student’s t tests, one-way analyses of variance, and chi-square tests.

Differences between FND patients and control participants were observed. As presented on tables 1 and 2, FND patients had higher sensory sensitivity, increased prevalence of hypermobility features (including relevant physical signs and symptoms), greater frequency of polarized behaviors and an increase in the characteristics and sensations typical of anxiety. FND patients also presented a greater number of comorbidities, both psychiatric (generalized anxiety disorder or panic attacks (63%); phobias, including social anxiety, agoraphobia, and specific phobias (52%); and depression (44%)) and physical (migraine (59%), irritable bowel syndrome (48%), drug intolerances (44%), dark sclerae (41%), and chronic fatigue syndrome (41%)). Particularly striking was the presence of the hypermobility spectrum in more than 75% of FND patients compared with 15% among control participants (Table 3).

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FND patients presented higher scores in all five dimensions included in the NEP. Thus, this phenotype, solidifying the original association between anxiety and the hypermobility spectrum, could help to identify an FND subtype when evaluating and managing FND patients, because it provides a new global view of patients’ physical and mental symptoms. Limitations in this study included small sample size, possible selection and recall biases and lack of data on socioeconomic factors and education.

M. Martínez García: None Declared, A. Bulbena-Vilarrasa: None Declared, L. Pintor Pérez: None Declared, M. Camara: None Declared, N. Arbelo-Cabrera: None Declared, A. Bulbena-Cabré: None Declared, V. Pérez-Sola Grant / Research support from: AB-Biotics, AstraZeneca, Bristol-Myers Squibb, Centro de Investigación Biomédica en Red de Salud Mental, FIS-ISCiii, Janssen Cilag, Lundbeck, Otsuka, Servier and Medtronic, Consultant of: AB-Biotics, AstraZeneca, Bristol-Myers Squibb, Centro de Investigación Biomédica en Red de Salud Mental, FIS-ISCiii, Janssen Cilag, Lundbeck, Otsuka, Servier and Medtronic, C. Baeza-Velasco: None Declared

Iimpaired cognitive functions are an urgent problem of modern neurology and psychiatry. Cognitive failure appears to be as etiologically heterogeneous syndrome, characterized by a decrease in memory indicators below the age norm, with unimpaired intellectual functioning and well-preserved activity. The wide prevalence of affective disorders and the leading role of the cognitive component in the process of personal self-development determine the undoubted relevance of studying the frequency and severity of cognitive impairment in affective disorders.

The purpose of this work was to study the cognitive impairment frequency and features in patients with generalized anxiety disorder (GAD) or panic disorder with agoraphobia (PDA).

The study included 25 patients with an established diagnosis of GAD and 20 patients PDA. The control group consisted of 20 conditionally healthy volunteers. Cognitive function was assessed based on complaints, a study of visual-constructive skills, naming, memory, attention, praxis, speech, abstraction, orientation, using the Mini-mental State Examination scale and the Montreal Cognitive Function Rating Scale. The severity of anxiety disorders symptoms was determined during a clinical interview by a psychiatrist, as well as using the Hamilton Anxiety Scale (HDRS), Beck Anxiety Scale (BAI).

All patients in contrast to the healthy participants showed signs of cognitive impairment of varying severity. When studying cognitive function, the following was found:

1. patients with PDA were characterized by mild non-dementia cognitive impairment and showed signs of rumination - a tendency to think through the same stressful event over and over again. No memory or attention impairments were identified;

2. in patients with GAD moderate cognitive impairment was observed, the severity of which was obvious to both patients and their relatives in the form of impaired attention and memory, also in the absence of signs of dementia. The spectrum of cognitive impairment manifestations included impaired attention, executive functions and memory disorders. These patients were characterized by perfectionism, decreased confidence in their own memory, anxious doubts and double-checks.

Our data indicate that in all patients with affective disorders impaired cognitive functions are detected. GAD is characterized by a greater severity of cognitive deficits compared to those in PDA.

None Declared

Faculty of Medicine is often recognized as one of the most laborious. Student workload, constant exposure to stressful situations, fear of failure, pressure from parents, exposure to death and human suffering are some of the many factors associated with increasing levels of anxiety and depression among medical students.

The aim of this study was to estimate the severity of anxiety and depression disorders among medical students.

In this cross-sectional study, self-report anonymous online survey was distributed to the students of all six years of the Faculty of Medicine, University of Sarajevo. In this survey, which consisted of 33 questions, we gathered general information and the Beck’s Anxiety and Depression Inventory were used to assess the severity of anxiety and depression, whereby respondents received points by answering each question, and after scoring, they were categorized in different groups based on the severity of anxiety and depression.

129 students completed the survey. Considering the Beck’s Anxiety Inventory, 56% scored for the “Low anxiety” group, 33% scored for the “Moderate Anxiety” group, 11% scored for the “Potentially concerning levels of anxiety”. Considering the Beck’s Depression Inventory, 43% of the students scored for the group “These ups and downs are considered normal”, 21% scored for “Mild mood disturbances”, 9% for the “Borderline clinical depression”, 19% for “Moderate depression”, 6% for “Severe depression”, 2% for “Extreme depression”.

Psychiatric morbidity found needs to be identified and treated at the earliest, because it can lead to suicidal ideation. Medical students should be encouraged to seek help and adequate facilities should be available to all of them.

None Declared

Since the beginning of the full-scale war with Russia, 7.7 million Ukrainians have been forcibly displaced from their homes and are currently living in internally displaced persons (IDP) camps. According to the International Organization for Migration (IOM), the proportion of IDPs in Ukraine’s total population has reached 17.5%, indicating that one in six individuals has been displaced.

The purpose of the study is to investigate the clinical, psychological and pathological patterns of anxiety disorders of psychogenic genesis. The main group consisted of 93 IDP patients with anxiety disorders, both sexes, aged 20-55 years.

SCL-90-R; HAM-A, HAM-D; Spielberger-Khanin Scale and Questionnaire of neuropsychological stress by T.A. Nemchin.

It has been established that the clinical structure of anxiety disorders in the examined patients is represented by a mixed anxiety-depressive reaction (28.2±1.2% of the examined), panic disorder (36.4±1.3%) and generalised anxiety disorder (35.4±1.3%). At the same time, in the clinical structure of anxiety disorders in IDPs, along with the dominance of anxiety symptoms, there is a high severity of depressive manifestations. Based on data obtained in the course of our research, a multifactorial model of formation of anxiety disorders in IDPs was developed. The catalyst for anxiety disorders is the very fact of forced displacement, uncertainty of future, situations of loss, effects of combat stress, information stress and situations of increased responsibility.

High levels of anxiety, somatisation, depression, obsessive-compulsive disorders, interpersonal sensitivity, and phobic anxiety according to SCL-90-R scale are prognostically significant in formation of anxiety disorders; severe depressive and anxiety episodes according to the Hamilton Anxiety and Depression Scales; high levels of personal and situational anxiety according to the Spielberger-Khanin Scale and excessive levels of neuropsychological stress.

The basis for the formation of anxiety disorders in IDPs is a low level of resilience, which entails a high level of social frustration in this cohort. We have developed and tested a comprehensive personalised system for treatment of anxiety disorders in IDPs with differentiated use of psychopharmacotherapy, psychotherapy and psychoeducation.

None Declared

Response to treatment in pediatric social anxiety disorder (SAD) is highly variable. Atypical face processing has been suggested as a maintaining factor. A previous study reported that youth with SAD scan a more restricted area of faces than healthy controls during emotion recognition, potentially interfering with social cognition.

The current study examined whether visual scanning and arousal (pupil dilation) also predicts treatment response and changes as a function of successful treatment.

Youth with SAD (n = 55) were assessed prior to treatment with internet-delivered cognitive behavioral therapy (ICBT) or supportive therapy (ISUPPORT) and three and twelve months after treatment.

Restricted scanning of faces predicted worse treatment outcome, most consistently for youth receiving ICBT. No evidence for a change in social attention after treatment was found. Instead, visual social attention measures showed moderate to high stability. Children whose arousal decreased from baseline to three months follow up were most likely to benefit from ICBT rather than ISUPPORT, pointing to a role of arousal in treatment response.

Restricted scanning of faces may interfere with social interaction, thereby interfering with treatment. These results have implications for our understanding of social information processing in SAD.

None Declared

Manganese (Mn), an essential yet potentially toxic metal found naturally in the environment, has been implicated in various neurodegenerative and neuroaffective disorders due to its propensity for chronic intoxication.

This study explores the neuroprotective effects of Ethylenediaminetetraacetic acid (EDTA) against Mn-induced toxicity, with a specific focus on its potential to mitigate anxiety and depressive disorders.

Three groups of male Wistar rats were used: one group was injected with 25 mg/kg Mn, another with 25 mg/kg Mn plus 4 mg/kg EDTA, and the control group received NaCl. Injections were administered intraperitoneally daily for 12 weeks. Rat weights were monitored weekly, and following the exposure period, rats underwent a series of neurobehavioral tests to assess anxiety and depressive behaviors.

Rats receiving the 25 mg/kg Mn dose alone exhibited increased immobility in the forced swimming test (FST) and anhedonia in the sucrose preference test, indicative of depressive behaviors. In contrast, rats treated with Mn and EDTA displayed significantly reduced immobility times and maintained normal sucrose water consumption. Behavioral tests, including the open field test (OFT) and elevated plus maze (EPM), indicated increased anxiety in Mn-exposed rats, which was mitigated by EDTA treatment.

Mn exposure induces anxiety and depressive disorders in rats, but coadministration of EDTA significantly mitigates these effects, suggesting its potential as a neuroprotective agent against Mn toxicity.

None Declared

Functional gastrointestinal disorders (FGIDs) represent a significant global health burden, affecting approximately 15-20% of the population. These disorders can significantly impair quality of life, particularly in individuals facing high levels of psychological stress, such as medical students.

To study the association between psychiatric factors, specifically anxiety and depressive disorders, and the prevalence of FGIDs among medical students in Tunisia.

A cross-sectional study was conducted among second-year medical students at the Faculty of Medicine, Sousse, from March 2023 to February 2024. Data were collected using a self-administered questionnaire designed to assess gastrointestinal symptoms such as abdominal pain, bloating, diarrhea, constipation, and heartburn. Psychiatric conditions were assed using validated screening tools.

The study included 206 students, with a strong female predominance (80.1%). Among them, 46.1% (n=95) reported experiencing between 1 and 4 digestive disorders, primarily abdominal pain and bloating (66%). Psychiatrically, univariate analysis revealed a significant association between FGIDs and several psychological factors: female gender (p<0.01), a tendency towards anger in daily life (p<0.01), anticipatory anxiety (p<0.01), and the presence of panic attacks (p<0.01).

Functional gastrointestinal disorders (FGIDs) are prevalent among medical students and are often linked to anxiety and depressive disorders. Preventive measures focused on stress management and mental health could significantly improve the quality of life of these students and prevent digestive complications.

None Declared

Patients with somatization disorder frequently seek medical evaluations for unexplained symptoms, strongly believing they are physically ill and often rejecting psychosocial explanations. In Turkey, easy and low-cost access to healthcare and medications via the General Health Insurance system encourages frequent hospital visits. High patient loads and short consultation times hinder thorough assessments, complicating diagnoses like somatization disorder. Consequently, physicians may practice “defensive medicine,” over-ordering tests and medications to minimize risks. These practices reinforce patients’ beliefs in having an organic illness and increase the risk of polypharmacy.

This case discusses a patient with somatization disorder experiencing multiple hospital admissions and polypharmacy due to the dynamics of the Turkish healthcare system.

A 31-year-old woman was admitted after a suicide attempt, exhibiting depressive symptoms and psychosomatic complaints. Detailed examinations of her socio-demographic data, medical and psychiatric history, current complaints, medication use, and past hospitalizations were conducted.

Since age 16, the patient frequently presented with fainting, convulsions, nausea, and vomiting, undergoing extensive evaluations. She repeatedly visited emergency services for chest pain radiating to her left arm and jaw; coronary angiography found no cardiac pathology. Despite no organic cause, she was prescribed 15 different medications by various specialties, reaching 20 tablets daily, covering cardiovascular, gastrointestinal, endocrine, and respiratory systems. Due to family issues, divorce processes, and social stressors, she exhibited depressive and psychosomatic symptoms, attempted suicide 7 times, and was hospitalized in psychiatric wards 12 times. In her latest attempt, she ingested 15 fluoxetine tablets. Psychiatric evaluation revealed ongoing somatic complaints, and polypharmacy was adversely affecting her health. After consultations, unnecessary non-psychiatric medications were discontinued. Her treatment was adjusted to venlafaxine 300 mg/day, clozapine 50 mg/day, and mirtazapine 30 mg/day.

This case illustrates how structural issues in the healthcare system adversely affect patients with somatization disorder, increasing polypharmacy risk. Unnecessary tests and treatments reinforce beliefs in organic illness and complicate management. Healthcare professionals should approach such patients carefully, avoid defensive medicine practices, and consider early psychiatric evaluation. Policy-level changes are needed for the healthcare system to better address these patients’ needs.

None Declared

Severe asthma (SA), often associated with chronic rhinosinusitis with nasal polyps (CRSwNP), contributes significantly to global disability and mortality. A personalized treatment approach, including addressing treatable traits like mental health, is crucial for improving outcomes. The impact of panic disorder (PD) on asthma symptoms and outcomes requires investigation due to their epidemiological association.

To cross-sectionally compare the clinical presentation of outpatients with SA and/or CRSwNP, with and without PD, treated at the Personalized Medicine Asthma and Allergy Clinic, Humanitas Research Hospital.

Participants were consecutively recruited among outpatients attending follow-up visits to treat SA and/or CRSwNP from February to March 2024. All were previously enrolled in the SANI (Severe Asthma Network Italy) or RINET (Rhinosinusitis Italian Network) registries. Participants completed a comprehensive self-report survey on sociodemographic, lifestyle, medical, and psychiatric information, along with validated questionnaires assessing asthma control, severity of nasal obstruction, burden and emotional responses to physical symptoms, psychophysical well-being, and the PD module from the Patient Health Questionnaire (PHQ) screening tool, to identify provisional diagnoses for current or past PD. Data were analyzed using the Kruskal-Wallis, post-hoc Dunn’s, and Fisher’s exact tests, with Holm’s adjustment for multiple comparisons. The significance level was set at 0.05.

Seventy-nine patients, 46 women (58.2%) and 33 men (41.8%), participated in this study. Thirty patients (38%) had SA only, 44 (55.7%) had both SA and CRSwNP, and 5 (6.3%) CRSwNP only. Current PD was identified in 7 outpatients (8.9%), while 12 (15.2%) had past PD. Compared to patients who have never experienced PD, those with current PD had significantly worse asthma control, more severe nasal obstruction, greater dyspnea and physical symptom burden, as well as greater proneness to catastrophizing about asthma, heightened attentional focus on internal bodily sensations, and lower quality of life. Patients with past PD had greater dyspnea and physical symptom burden, swallowing difficulty, and reduced quality of life compared to those without PD. No significant differences were found between current and past PD groups.

The prevalence of current or past PD among patients with SA and/or CRSwNP was approximately three times higher than in the general population, corroborating previous epidemiological findings. PD was associated with poorer asthma and nasal symptom control, along with a higher burden and sensitivity to respiratory and physical symptoms. Our preliminary results suggest a need for PD screening and targeted interventions for these patients. Further studies with psychiatric interviews and objective respiratory measures are warranted.

None Declared

It is well-established that medical students often experience health-related anxiety, a phenomenon commonly referred to as “medical student syndrome” in the literature. This condition is believed to arise from exposure to life-threatening diseases during medical training.

Health anxiety is characterized by excessive worry about having a serious illness, often leading to heightened distress and maladaptive health-related behaviors.

The aim of this study was to explore and compare health anxiety levels between preclinical and clinical medical students.

A cross-sectional, descriptive, and analytical study was conducted at the Sfax Medical School from March to June 2024. Medical students were invited to voluntarily complete a self-administered questionnaire, which collected socio-demographic data, lifestyle-related factors (such as substance use, physical activity, and medical history), and the Short Health Anxiety Inventory (HAI-18). The HAI-18 assesses the frequency and intensity of health-related worries and behaviors experienced over the past six months. The total score ranges from 0 to 54 and includes two subscales: the Health Anxiety subscale (items 1–14, range 0–42) and the Negative Consequences of Illness subscale (items 15–18, range 0–12). A score of 18 or higher on the Health Anxiety subscale indicates significant health anxiety.

A total of 285 students participated in the study, with a predominance of females (73.7%).

The mean age was 21.96 ± 2.05 years. Preclinical students constituted 31.9% of the sample, while clinical students comprised 68.1%. Most participants (91.9%) resided in urban areas, and 82.1% reported a moderate socioeconomic status. Additionally, 69.5% of participants were living with their families. A medical history was reported by 21.8% of the participants, while 17.2% had a history of psychiatric difficulties. Among these students, 5% had been hospitalized for a serious illness, for a prolonged duration or on multiple occasions.

Health-related anxiety was observed in 24.6% of participants. It was significantly associated with female gender (p = 0.045), a history of psychiatric difficulties (p = 0.004), and being a clinical medical student (p = 0.04). These factors were identified as key predictors of increased health-related anxiety levels.

Female gender, a history of psychiatric difficulties, and clinical medical training were identified as significant risk factors for health-related anxiety among medical students. These findings suggest the need for targeted interventions to address and alleviate anxiety in these high-risk groups, potentially improving both mental health and academic performance within medical training environments.

None Declared

Cyberchondria, defined as excessive and anxiety-driven health-related internet searching, has become an increasingly significant issue in the digital age, where easy access to online health information can contribute to heightened health anxiety. Recent studies suggest that cognitive avoidance strategies, such as thought suppression, may worsen anxiety-related behaviors, including health-related internet searching.

The objective of this study was to investigate how the tendency to suppress thoughts (thought suppression) influences the development and intensity of cyberchondria in a sample of medical students.

A cross-sectional study design was employed, involving a sample of 213 medical students. The White Bear Suppression Inventory (WBSI) was used to assess participants’ tendency to suppress health-related thoughts. The Cyberchondria Severity Scale (CSS) was used to measure the extent and severity of health-related internet searching behaviors. Participants also provided information about their medical history, family medical history, and psychiatric background.

The sample consisted predominantly of females (74.2%), with a mean age of 22.11 ± 2 years. Among the 213 participants, 22.1% reported a personal medical history, and 20.2% had a documented history of psychiatric disorders. Regarding family medical history, 59.6% of participants reported a familial history of medical conditions, and 21.6% reported a familial history of psychiatric disorders. Additionally, 39% of participants reported that family members had been hospitalized for serious illness.

The levels of cyberchondria among participants were as follows: 36.6% of participants reported low levels of cyberchondria, 41.8% reported moderate levels, 20.7% reported high levels, and 0.9% reported very high levels of cyberchondria.

A significant positive correlation was found between WBSI scores (measuring thought suppression) and Cyberchondria Severity Scale (CSS) scores (measuring health-related internet searching) (r = 0.4, p=0.02). This suggests that medical students who engaged in higher levels of thought suppression were more likely to experience intrusive health-related thoughts and engage in heightened online health searching behaviors.

The findings of this study suggest that there is a positive relationship between thought suppression and the intensity of cyberchondria among medical students. These results highlight the importance of addressing cognitive avoidance strategies, such as thought suppression, in the management of health anxiety. Future research could explore interventions that aim to reduce thought suppression, such as cognitive-behavioral therapy (CBT) or mindfulness-based techniques, as potential strategies for alleviating cyberchondria and its associated health anxiety.

None Declared