Elderly institutionalization involves an emotional adaptation and the research shows that the risk of depression increases.

Evaluate the impact of a neuropsychological group rehabilitation program (NGRP) on depressive symptomatology of institutionalized elderly.

NGRP influences the decrease of depressive symptoms.

Elderly were assessed pre- and post-intervention with the Geriatric Depression Scale (GDS) and divided into a Rehabilitated Group (RG), a Waiting List Group (WLG), and a Neutral Task Group (NTG).

In this randomized study, before rehabilitation, 60 elderly people (RG; 80.31 ± 8.98 years of age; 74.2% women) had a mean GDS score of 13.33 (SD = 9.21). Five elderly included in the NTG (80.13 ± 10.84 years; 75.0% women) had a mean GDS score of 10.60 (SD = 4.72). Finally, 29 elderly in the WLG (81.32 ± 6.68 years; 69.0% women) had a mean GDS score of 14.93 (SD = 6.02). The groups were not different in GDS baseline scores (F = 0.74; P = 0.478). ANCOVA has shown significant differences (P < 0.05) in GDS scores between the three groups after 10 weeks. Sidak adjustment for multiple comparisons revealed that elderly in the WLG got worse scores in GDS, comparing with elderly in RG (P < 0.01), and with elderly in NTG (P < 0.05).

Elderly that are not involved in a task get worse in depressive symptomatology. Being involved in a structured group task means lower depressive symptoms and being in a NGRP means even greater results.

The authors have not supplied their declaration of competing interest.

Several studies suggested that having a history of posttraumatic stress disorder (PTSD) is associated with higher rates of somatic morbidity and disease.

The aim of the present study was to investigate systematically the long-term-consequences of PTSD on cardiovascular risk, quality of life and stress hormones in a sample of former refugee children.

In 25 subjects with chronic PTSD and 25 trauma-controlled subjects we measured variables of the metabolic syndrome supplemented by the ankle-brachial index and h-CRP. Quality of life was assessed by the SF-36. Cortisol, ACTH, DHEA were measured in the low dose dexamethasone-suppression-test. Additionally, salivary cortisol was assessed at 0800, 1200, 1600 and 2200 hours.

We found a significant group effect between participants with PTSD and without PTSD regarding quality of life, but not on any metabolic parameter including the ankle-brachial index or cortisol, ACTH and DHEA in plasma before and after dexamethasone or salivary cortisol.

Chronic PTSD was associated with diminished quality of life more than six decades after traumatization, but not with altered metabolic or endocrine variables. Nevertheless, search for subgroups of PTSD patients with childhood traumatization leading to different metabolic and endocrine long-term consequences in aging PTSD patients is needed.

Mood disorders in the elderly are a relevant clinical problem associated with high prevalence and frequent co-morbidity with chronic somatic diseases.

Study of clinical traits of depression in elder persons with somatic disorders.

The investigation was entered by 582 persons (women = 391 (67,1%), men = 191 (32,9%)), mean age of women has constituted 67,5 ± 5,8 years, men - 62,1 ± 3,8 years.

Age in women 55 years and higher, in men - 60 years and higher, clinical level of depression according to Beck Inventory more than 22 scores.

Affective disorders were represented by symptom complexes that masked depression and complicated diagnosis. Clinical symptoms in the kind of anhedonia and complaints about anergia dominated (73,6%), whereas depression, melancholy have moved behind and have constituted 26,4%. Psychopathologic disturbances presented against the background of lingering chronically flowing neurological and somatic diseases (cerebral atherosclerosis, brain blood circulation impairment, IHD, HI, respiratory organs’ diseases) in 73,6 %. High risk of emergence of depressive disorders was noticed in widows with low level of education, living in rural area and in persons with somatic diseases. In 32% of probands we have revealed depression that correlated with marital status and feeling of loneliness (p > 0,005). In persons with high level of depression and experiencing feeling of loneliness, risk of suicidal behavioral was higher 2,1 as much.

Study of affective disorders in the elderly allows assessing co-morbidity of somatic and mental disorders, developing tactic of psychotherapeutic and psychopharmacological assistance rendering.

Longer duration of untreated illness, longer duration of current episode, and severity of medication side effects may negatively influence the psychosocial functioning in major affective and anxiety disorders. Studies also suggested the involvement of sensory perception in emotional and psychopathological processes.

The objective of this study is to investigate the nature of the association between duration of untreated illness, duration of current episode, and severity of medication side effects.

The study is aimed to examine the relationship between sensory processing disorders (SPD), duration of untreated illness, duration of current illness episode, and the severity of side effects related to psychoactive medications.

The sample included 178 participants with an age ranging from 17 to 85 years (mean = 53.84 ± 15.55); psychiatric diagnoses were as follow: unipolar major depressive disorder (MDD) (50%), bipolar disorder (BD) (33.7%), and anxiety disorders (16.3%). subjects completed a socio-demographic questionnaire, the Udvalg for Kliniske Undersøgelser (UKU), and Adolescent/Adult Sensory Profile (AASP) questionnaire.

Longer duration of current episode correlated with greater registration of sensory input and lower avoidance from sensory input among unipolar patients, lower registration of sensory input, and higher tendency for sensory sensitivity/sensation avoidance among bipolar participants. In addition? longer duration of current episode correlated with lower sensory sensitivity/avoidance among anxiety participants, respectively. Mean UKU total scores were associated with lower sensory sensitivity among bipolar individuals as well.

SPD expressed in either hypo-/hypersensitivity may be used to clinically characterize subjects with major affective and anxiety disorders.

The authors have not supplied their declaration of competing interest.

Chronic insomnia, resistant to different treatments (pharmacological, sleep hygiene and cognitive-behavioral therapy) remains one of the greatest challenges in our daily practice as psychiatrists. The pharmacological options include benzodiazepines and their analogues (zolpidem, zopiclone, etc.). However, when trying to treat chronic insomnia the use of off-label drugs, including antidepressants with sedative action (such as trazodone), antipsychotics or antiepiletic drugs, is not uncommon.

Perampanel is a non-competitive AMPA receptor antagonist, marketed for the treatment of partial onset epilepsy and primary generalized tonic-clonic seizures. It has been used in the treatment of chronic insomnia with positive results and it has shown to improve the quality of sleep in a recent observational retrospective cohort study.

The most frequent adverse effects of Perampanel include dizziness and drowsiness. Perampanel can also cause psychiatric and behavioral adverse effects, aggression and irritability in up to 10% of patients, as well as depression, and suicidal ideation, with higher rates in patients with psychiatric history.

To draw attention to possible adverse effects of Perampanel and to add knowledge to improve the treatment for chronic insomnia.

Case report and non-systematic literature review of the current data.

A 33 year old woman with Anorexia Nervosa was admitted to the psychiatric hospitalization unit due to suicidal ideation and a history of chronic insomnia. Perampanel was started at a dose of 2mg/day, progressively titrated to 6mg/day, following patient’s informed consent. A week after the initiation of treatment, her sleep pattern had improved but she became aggressive, showed low tolerability to minor frustrations and suffered from an intensification of suicidal ideation. She became extremely hostile to the personnel, had severe tantrums and deliberate self injurious behavior. Perampanel was discontinued and in less than a week her aggressive behavior succumbed. Although she was not re-exposed to Perampanel the symptoms she presented are considered a very likely adverse drug reaction. Levomepromazine 20mg/day and Lormetazepam 0.5mg/day were reinstated as a treatment for insomnia.

Psychiatric comorbidity is known to be a risk factor for behavioral adverse effects of Perampanel. Therefore Perampanel as a treatment for chronic insomnia needs a careful individual benefit-risk assessment and monitoring for adverse effects.

None Declared

With about 12 million people, Roma constitute the largest ethnic minority group in the EU. Children from Roma communities are much more likely to be out of school than their peers from majority communities, with a strong impact in global mental health status.

This paper reports the findings of an integrative review conducted to analyze recent empirical and theoretical literature on the factors of school absenteeism in Roma Children.

A comprehensive multi-step search (published 2004–2014) using databases such as SciELOand search engine such as B-on and EBSCO-host was performed. A sample of 8 final research reports met the inclusion criteria and was included in the review. A systematic and interactive approach was used to extract and reduce the data to draw conclusions.

The integrative literature review shows that there are three major groups of factors related to school absenteeism in Roma children – factors related to the children, factors related 8 to the school organization and factors related to the Roma families. These factors exist at the individual, community and institutional levels and are largely consistent with conceptual and empirical framework on mental health vulnerabilities factor’s

Borderline personality disorder is associated with numerous symptoms that interfere with interpersonal relationships. Both mental health professionals and the general population often think negatively about patients suffering from this disorder, which may worsen the creation and maintenance of the supporting therapeutic relationship.

Research and review articles were identified using the Web of Science, Medline and Scopus. Keywords were represented byterms 'borderline”, 'stigma”, 'internalized stigma”, 'therapy”, 'treatment”, 'psychotherapy” and 'psychosocial treatment”.

Psychiatric staff´s opinions on the patients with personality disorders are strongly judgemental and stereotypic. Mental healthprofessionals stigmatize the patients with borderline personality disorder even more frequently than the general population does. The rule is that there is a conviction about incurability of the disorder, manipulative nature of self-mutilation or other symptoms, and thestrong traits of the patient are overlooked. The considerable percentage of medics tries to avoid the contact with these patients. Thesereactions partly arise from the patient’s real maladaptive behaviour; however they are partly the result of prejudice, negative stereotypes and unprocessed countertransference. Negative attitudes of medics lead to the marginalization of patients with borderline personality disorder within the health care system.

The health professionals often negatively and stereotypically evaluate the patients with borderline personality disorder, which can lead to an increase of maladaptive symptoms and worsening of treatment effectiveness in these patients.

Homelessness is a problem which affects all the areas of those who suffer it, affecting their health seriously. These risks increase when the affected person has carried out a migratory process. Another risk factor, apart from immigration, is to be woman.

To analyse the gender demographic differences in a total cohort of homeless people in the city of Girona in 2006 and continued until the present day.

Prospective longitudinal study of the total population of homeless people in Girona. In 2006, a list was made of all the homeless people detected by both specialized and non-specialized teams which have been followed until the present day.

The total number of women in the sample is lower (n = 106, 11.2%). There are fewer immigrant than autochthonous women (Chi2 = 23,1, df = 1, P < 0.001).

After following the total homeless population in 2006, we can confirm that currently we can still identify 62 people in the territory (6.7%). In this subsample there are no differences between genders (man: n = 54, 6.5% vs. woman: n = 8, 7.5%; Chi2 = 0.21, df = 2, P = 0.89). That is, men and women remain in their homeless condition in a proportional way. This fact presents great limitations, since we do not know what happened with the other 93% of the initial sample.

The masculinisation of the homeless people from Maghreb has tended to increase the gender differences in the homeless population, in itself more masculine. This presents a risk of increasing the invisibility of homeless women.

The authors have not supplied their declaration of competing interest.

The evolution of various pharmacological therapies for schizophrenia has given rise to several pharmacological models for the neuroreceptor targets of antipsychotics and the influence of various neuroreceptors on specific symptoms and side effects.

Experience in clinical practice affirms clozapine's position as the treatment of choice for patients with treatment-refractory schizophrenia. Unlike clozapine, risperidone has a more targeted profile of neurotransmitter binding, with particular predilection for dopamine and serotonin receptors. Risperidone is, to date, the most extensively documented clozapine augmentation agent.

The aim was to evaluate clinical efficacy, safety and tolerability of augmenting clozapine with risperidone in patients with treatment-resistant schizophrenia.

In a randomized, double-blind, placebo-controlled 8-week trial, 10 patients unresponsive or partially responsive to 300 mg/day of clozapine monotherapy (n = 5) received a steady dose of 450 mg/day clozapine combined with or up to 4 mg/day of risperidone (n = 5). Patient psychopathology was assessed at 2-week intervals with the Brief Psychiatric Rating Scale (BPRS), the Scale for the Assessment of Negative Symptoms (SANS) and Clinical Global Impression (CGI) improvement scale.

From baseline to week 4 and week 8, mean BPRS total and positive symptom subscale scores were reduced significantly in both groups, but the reductions were significantly greater with clozapine/risperidone treatment. Reductions in SANS scores were also significantly greater with clozapine/risperidone treatment than with clozapine monotherapy group. Clozapine/risperidone treatment did not induce additional weight gain or agranulocytosis compared with clozapine monotherapy treatment.

Clozapine augmentation with risperidone appears to be well tolerated, safe and may provide additional clinical benefit for patients who are nonresponsive or only partially responsive to clozapine alone.

The authors have not supplied their declaration of competing interest.

The sexuality of schizophrenics is a neglected dimension. The majority of schizophrenics experience a progressive deterioration in their social and sociosexual functioning. This deterioration often starts before the first psychotic episode and would be one of the negative symptoms of schizophrenia. All type of antipsychotics can lead to sexual dysfunctions. Impaired sexual functioning is believed to negatively impact treatment compliance as well as the quality of life.

The frequency of sexual dysfunctions in patients taking classic antipsychotics is not known. This study attends to ascertain the level of sexual dysfunction in such patients.

The level of sexual dysfunction was assessed in 41 patients taking classic antipsychotic medication and 28 normal controls. All the participants were physically healthy. We examined the following complaints or symptoms loss of libido, anorgasmia, impotence, premature ejaculation, galactorrhea, gynecomastia for males; amenorrhea, dysmenorrhea, dyspaurenia, galactorrhea, loss of libido and anorgasmia for females.

There were a significantly higher proportion of persons with sexual dysfunctions in the schizophrenic group compared with the normal controls. There were no significant differences in the demographic characteristics (age and gender) between the 2 groups. Male patient had normal levels of libido but were highly likely to report erectile and ejaculatory dysfunctions.

Patient taking conventional antipsychotic medication report high levels of sexual dysfunction. The high level of sexual dysfunctions indicated that clinicians should monitor and openly discuss these issues with patients in order to improve overall satisfaction and adherence to treatment.

INTRODUCTION TikTok is a social network (SN) that allows users to share short videos about different issues. Since the COVID-19 lockdown, there has been an increase in Pro-Ana and Pro-Mia videos in this specific SN.

OBJECTIVES To know the main characteristics about Pro-Ana and Pro-Mia contents among TikTok users.

METHODS A search was carried out using uncontrolled language with the term “TCA” (ED in English). The study included only Pro-Ana and Pro-Mia resources in Spanish. Resources under the category “recovery” were excluded. A random sample of 16 TikTok was used, since it is enough to estimate, with a confidence of 95% and an accuracy of +/- 20 percentage units, a population percentage that is expected to be around 20%. The studied variables were images, type of resources, “challenges” and misspelled words.

RESULTS In the sample, 68.75% of the profiles were created upon confinement, 56.25% had more than 500 followers and 68.75% had more than 3000 “likes”. 43.75% included more than 30% of ED advocacy content, 18.75% promoted challenges and 37.5% used misspelled words to avoid SN censorship.

CONCLUSIONS There has been a remarkable increase in ED-related content as a result of lockdown. In turn, the increasing number of users who are part of TikTok reveals that this is a SN that can be associated with ED advocacy.

No significant relationships.

To assess the level of emotional burn-out (EB) and its relation to affective state and personality characteristics of medical doctors in the region of Moscow.

A random sample of 80 medical doctors (MD) (mainly internists, aged 25 - 72, M/F 6/74) was given Boyko's Emotional Burn-out Test (BEBT), Spilberger's State/Trait Anxiety Inventory (STAI), Zung depression scale (ZDS), Minnesota Multiphasic Personality Inventory (MMPI), Job's Satisfaction Scale (JSS), Professional Attitudes/Locus of Control Scale and Specialty knowledge Test (SKT).

EB was present in 34/80 (42.5%) MD, with no difference between hospital and ambulatory doctors and no correlation with age, years in profession, SKT score, professional locus of control and attitudes towards patients' autonomy. It increased with the number of patients seen monthly (r=0.25, p<0.05) and was inversely related to JSS score (r= -0.47, p<0.001). MD's with EB, compared to those without, scored higher on state (33.5±10.5[32] vs. 26.9±9.0[25], p=0.004) and trait anxiety (52.4±10.6[52] vs. 43.1±8.4[45], p<0.001) and ZDI (37.9±7.6[39] vs. 33.4±6.7[32], p=0.008), respectively. MD's with EB scored significantly higher on MMPI scales Depression, Paranoia and Social Introversion and significantly lower on Masculinity.

EB, affecting a large proportion of MD's in the Moscow region, is only weakly linked to workload, if at all. It is associated with depressive/anxious affect and personality traits, such as more rigid thinking and low confidence with others, sensitivity and vulnerability, decreased ability/willingness to communicate. If some of these traits predispose to EB or represent various types of reaction to EB, remains to be assessed prospectively.

An impairment in the ability of experience pleasure has always been associated with schizophrenia. Although literature agrees that the anticipatory facet of pleasure is mainly impaired in Schizophrenia, contrasting results emerged on the discrepancy between pleasure experienced in the moment and the one reported through self-reported questionnaire (i.e. Emotion Paradox).

Comparing Schizophrenic patients (S) and Healthy Controls (HC) on Anhedonia scores, Subjective Experiences and Neurocognitive Deficits.

Clarify the role of anhedonia in Schizophrenia and evaluate its relationship with Cognitive deficits and subjective experiences and their emotional reverberations.

53 S and 46 HC completed the Physical Anhedonia Scale, the Revised Social Anhedonia Scale, the Temporary Experience of Pleasure Scale and the Snaith-Hamilton Pleasure Scale. Subjective Experiences (SE) were evaluated with the Frankfurter Beschwerde-Frageboden (FBF) and psychopathology with the Positive and Negative Syndromes Scale. Deficit in abstraction/representation were assessed with the Hopkins Verbal Learning Test-Revised and the Wisconsin Card Sorting Test.

S were higher in the anticipatory but not the consummatory subscale of the TEPS. FBF mediate the relationship between S and all the Anhedonia Scales. FBF Memory and Overstimulation subscales were the greatest predictors of all the anhedonia scores in the S group. We suppose that these experiences prevent patients from retaining a positive experience from past pleasant activities and, consequently, the lack of anticipatory pleasure would represent an avoidance of potentially stressing new scenarios.

Considering the primary nature of BS, anhedonia in schizophrenic patients could be seen as a secondary phenomenon.

The 2020 coronavirus pandemic sparked sudden change in all spheres of life, not least health services. Across Europe clinical research had to adapt. The virus peaked in different places at different times, with London’s first wave in March-May. The National Institute for Health Research paused all face to face research at NHS and social care sites except for nationally prioritised Urgent Public Health (UHP) Covid-19 studies. The first UPH studies focused on acute Covid-19, largely in physical health settings. Research leaders quickly highlighted the need for high quality research data on the effects of the pandemic on the mental health of the general population, as well as the mental health and neuropsychiatric effects of the virus itself, to allow for the development and evaluation of mitigation strategies. The major UK research funders have resourced this. Once the first wave abated, paused research was restarted according to national prioritisation guidance. In Maudsley we worked closely with research teams to develop strategies to make our research programmes as Covid-19 adaptive as possible, maximising remote interaction with research participants, with robust infection prevention procedures if face to face meetings were necessary. Examples of innovative strategies will be shared. In January 2021 with the more transmissible variant of SARS CoV2, face to face research paused again, except where risk was outweighed by patient benefit in continuing. As patients benefit hugely from research and innovation and have better outcomes if treated in ‘research-active’ hospitals, maintaining access to research opportunities without increasing risk of contracting Covid-19 will be key in coming months.

No significant relationships.

The Repetitive Transcranial Magnetic Stimulation (rTMS) can modulate the cortical activity. The goal of our study was to assess whether the rTMS would facilitate effect of serotonin reuptake inhibitors in patients suffering from panic disorder.

Fifteen patients suffering from panic disorder resistant to serotonin reuptake inhibitor (SRI) therapy were randomly assigned to either active or to sham rTMS. The aim of the study was to compare the 2 and 4 weeks efficacy of the 10 sessions 1 Hz rTMS with sham rTMS add on SRI therapy. We used 1 Hz, 30 minutes rTMS, 110% of motor threshold administered over the right dorso-lateral prefrontal cortex (DLPFC). The same time schedule was used for sham administration. Fifteen patients finished the study. The psychopathology was assessed using the rating scales CGI, HAMA, PDSS and BAI before the treatment, immediately after the experimental treatment and 2 weeks after the experimental treatment by an independent reviewer.

Both groups improved during the study period but the treatment effect did not differ between groups in any of the instruments.

The low frequency Repetitive Transcranial Magnetic Stimulation administered over the right dorso-lateral prefrontal cortex after 10 sessions did not differ from sham the Repetitive Transcranial Magnetic Stimulation that was add on serotonin reuptake inhibitors in patients suffering from panic disorder.

Supported by the project n. MŠMT ČR 1M0517