The Internet is a new technology that has affected the world and provides many benefits to its users. In the same time it became a serious threatening to adolescents’ psychological wellbeing because of their more and more tendencies towards the internet addiction.

To analyze the prevalence of internet addiction amongst secondary school adolescents, and to assess it's association with the levels of depression, anxiety and aggressiveness.

The sample consisted of 226 students of the first and fourth grade from two secondary schools in Tuzla, who at home have access to the Internet. We used the Internet YIAS, BDI, BAI, State trait anger expression inventory – STAXI-2 Staxi.

The adolescents used the most frequently social networks on the Internet. Obtained results showed that 17.3 % of 226 met criteria for Internet Addiction. There were significant positive association of the Internet addiction level with the severity of depression (Pearsons’ 'r”=0,310, P=0,001) and anxiety (Pearsons’ 'r”=0,219, P=0,001) amongst the tested adolescents. On the other side, level of the Internet addiction was not associated with the severity of aggressiveness (Pearsons’ 'r”= -0,018, P=0,791).

Excessive internet use is associated with a variety of psychosocial problems among young people. Internet addiction was positively associated with the depression and anxiety severity, but it was not associated with the severity of aggressiveness amongst school adolescents.

More than in other conditions, fear is associated with infectious diseases, and is directly associated with its transmission rate, morbidity and mortality. High levels of fear can affect the individual’s ability to think clearly, react proportionately and make rational decisions in the context of COVID-19. Recently, Mertens et al. (2020) developed the Fear of Covid-19 Scale (FCV-19S) to measure this construct.

To analyse the psychometric properties of the FCV-19S Portuguese version, namely construct validity, internal consistency and convergent validity.

A community sample of 234 adults (75.6% women; mean age= 29.53±12.51; range:16-71) completed an on-line survey with the Portuguese versions of the FCV-19S, the Covid-19 Perceived Risk Scale (CPRS) and the Depression Anxiety Stress Scale (DASS-21).The total sample was randomly divided in two sub-samples: sample A (n=117) was used to perform an exploratory factor analysis/EFA; sample B (n=117) to make a confirmatory factor analysis/CFA.

EFA resulted in one component. CFA revealed that the unifactorial model presented acceptable fit indexes (X2/df=3.291; CFI=.977; GFI=.932; TLI=.919; p[RMSEA≤.01]=.091). Cronbach alpha was α=.855. The total score significantly correlated with Covid-19 Perceived Risk (r=.529, p<.01) and with anxiety from DASS-21 (r=.132, p<.05).

This study provides preliminary evidence for the validity and reliability of the Portuguese version of FCV-19S, which will be used in an ongoing research project on the relationship between fear of Covid-19, personality, cognitive processes and adherence to public health measures to contain the pandemic.

Polydrug abuse seems to be especially popular in Ibiza, an important market for new psychoactive substances (NPS). The misuse of psychoactive substances can lead to serious psychiatric symptoms.

To evaluate symptoms induced by NPSs and other club drugs, correlating with the main classes of drugs.

Ninety subjects (M/F 59/31) admitted in the Psychiatric Unit of Can Misses Hospital (Ibiza) referring a recent intake of substances were enrolled. The following scales were administered: TLFB (Timeline follow-back); Positive and Negative Symptoms Scale (PANSS); Symptom checklist-90 (SCL-90) ; Young Mania Rating Scale (YMRS) ; Hamilton Depression Scale (HAM-D); Hamilton Anxiety Scale (HAM-A); Modified Overt Aggression Scale (MOAS); Columbia Suicide Severity Rating Scale (C-SSRS).

Polydrug abuse was reported by 67.4% of the sample; the sample was grouped by the main preferred substance in THC-, stimulants-, and depressors-users. The majority of patients reported a previous psychiatric history. Positive symptoms resulted to be higher among THC-users (P < .05). Anxiety evaluated by SCL-90 was prevalent in the group of Depressors-users (P < .05). The scores of MOAS and SCL-90 subscale for hostility/aggression resulted to be significantly (P < .01) greater in the THC-users group.

Some specific psychiatric symptoms are characteristic of some classes of substances and may help to identify them when a urine sample is not available. The possibility to develop psychiatric symptoms after a recent drug use is more common in two situations: (1) patients with a previous psychiatric history; (2) subjects with a history of very strong substance use.

The authors have not supplied their declaration of competing interest.

Effectiveness of medication treatment is determined by three components: treatment efficacy (symptom reduction), tolerability/safety, and adherence. Compared with efficacy and safety, research into adherence has been lacking. Nevertheless, medication non-adherence is a risk factor for relapse and for aggressive behavior in association with substance abuse in schizophrenia patients. Non-adherence has been estimated to cause approximately 40% of relapses in patients with schizophrenia. High rates of treatment discontinuation in all arms of the CATIE study illustrate the widespread nature of non-adherence. Most of previous research has defined non-adherence as a complete discontinuation of medication. However, many schizophrenia patients show partial adherence: they do not completely discontinue their medication, but they do not take all that has been prescribed. Partial adherence is more difficult to define and study than complete non-adherence.

e had the opportunity to study partial adherence in the context of a randomized, double-blind, 8-week, fixed-dose study comparing olanzapine 10mg/d, 20 mg/d and 40 mg/d for patients with schizophrenia or schizoaffective disorder (N=599). Medication non-adherence was measured by pill counts. Baseline characteristics including demographics, illness history and symptom severity were investigated as potential risk factors for treatment non-adherence.

Approximately 1/3 of patients were non-adherent with their medication at least once during the 8-week study. These non-adherent patients had significantly less improvement compared to adherent patients. Adherent patients had greater weight gain than the non-adherent ones. Among the available baseline measures, greater baseline depression severity appeared to be a significant risk factor for non-adherence.

“The wounded healer” (TWH) is an innovative method of pedagogy that blends art with science that is delivered by an award-winning doctor with first-hand experience of a mental health condition. The aim of this study is to evaluate the effectiveness of TWH at reducing stigma from healthcare professionals and students towards their peers with a mental health condition.

TWH has been delivered to more than 30,000 people in 9 countries on 5 continents worldwide and has been integrated into the medical school curricula of 4 UK universities. TWH also featured in the 2015 iMed Congress in Lisbon, Portugal, the largest medical student congress in Europe (n = 1000).

We conducted a cross-sectional, mixed-methods study on participants who attended TWH in venues across the UK. Paper questionnaires containing stigma constructs with response items on a Likert-scale were hand distributed to participants. Free-text comments were subjected to thematic analyses.

Two hundred and nineteen over 256 participants recruited responded (85% response rate); 207/219 (94%) of respondents agreed or strongly agreed that TWH made them realise that medical students and doctors who experience mental distress can recover and achieve their goals.

Themes that emerged from analyses of free-text comments included, “inspirational”, “merits of blending art with science”, and “benefits of receiving a talk from a doctor with first-hand experience of a mental health problem”.

Our findings suggest that TWH might be effective at reducing stigma from healthcare professionals and students towards their peers with mental health problems. More robust research in this area is needed.

The authors have not supplied their declaration of competing interest.

Lithium is the most effective maintenance drug in Bipolar Disorder (BD), although it has a narrow therapeutic index, between 0.6 and 1.5 mEq/L; recommended doses for maintenance are 0.6-1.2 mEq/L.

To describe a clinical case of lithium intoxication and discuss relevant literature.

Clinical examination of a patient and her medical records; non-systematic PubMed review on “lithium intoxication”.

A 73-year-old woman, diagnosed with BD, stabilized on lithium monotherapy for twenty-five years, was admitted to the Emergency Room (ER) with nausea, lethargy, drowsiness, confusion, cough, and fever. A respiratory tract infection is diagnosed, based on clinical presentation, x-ray and blood analysis. Blood tests also revealed a serum lithium concentration of 2.4 mEq/L and impairment of renal function, indicating lithium intoxication; hemodialysis was initiated, with lithium discontinuation. Over weeks, renal function and general state improved, and BD treatment was reinitiated, this time with valproic acid 800mg/day. Two weeks after discharge, she was admitted again at the ER, for an episode starting in the week prior, compatible with a manic episode; olanzapine 10mg was added to the prescription. A week after, the patient is admitted again in the ER, still in a manic episode.

There are no clear indications in the literature about reinitiating lithium on someone who had an intoxication. Given that lithium brings an unparalelled quality of life to BD patients, careful consideration about reintroduction, with close monitoring, should be made, but there is a critical need of more studies and guidelines to orient clinical practice.

No significant relationships.

The authors have not supplied their declaration of competing interest.

There are many screening instruments available for the detection of dementia. However, they were not tested in very old age and often not in the primary care setting for which they are developed.

We condensed a screening battery of all elements of common tests (MMSE, TFDD, DEMTECT, Clock Test…). Nine primary care practices took part in the study. The practice assistants were trained to approach all patients over 75y visiting the practice. Only patients with already diagnosed dementia, severe hearing or vision disability or communication deficits were excluded. After informed consent they applied the screening. Within the next days a second independent neuropsychological examination was arranged in the memory clinic of the University of Goettingen. This included established neuropsychological tests (CERAD-NP, WMS-R, TMT.) and further scales were applied (NPI, CDR..). All patients with CDR=0.5 were approached 1.5y later for a follow-up by phone.

N=90 patients (25M, 65F) took part in the initial evaluation. From N=54 with CDR=0.5 only N=14 could be reached for follow-up. None of them returned to CDR=0, most progressed up to CDR=4. There were some correlations to education and dementia severity. All available screenings showed a good effect size of >0.70 (MMSE, DEMTECT, TFDD, RDST).

Elements for an optimal screening of the oldest old are discussed.

The objective of this study is to assess the frequency of adult Attention Deficit Hyperactivity Disorder (ADHD) comorbidity and the effect of ADHD comorbidity on various demographic and clinical variables in patients diagnosed with bipolar disorder (BD).

103 patients with BD (51 female, 52 male) presenting at outpatient clinic of the BD Unit of the Department of Psychiatry of Çukurova University Faculty of Medicine were included in this study. All patients were evaluated for the presence of adult ADHD diagnosis and comorbidity using the entire SCID-I and the childhood ADHD sections of K-SADS-PL. Furthermore, the patients have also completed the Wender Utah Rating Scale (WURS-25) and Present Symptoms Scales.

13 of the 103 patients diagnosed with bipolar disorder (12.6%) were diagnosed with adult ADHD. BD patients with ADHD comorbidity had mood episodes at an earlier age and had higher numbers of previous total episodes, depressive and hypomanic episodes and higher numbers of hospital admittances than those without comorbidity. Overall, a larger portion of the patients with comorbidity had axis I comorbidities and panic disorder and alcohol abuse disorders were found at higher rates.

Adult ADHD is a common comorbidity in BD patients, which adversely affects the course of the disease and disrupts the social adjustment of the patients. Regular monitoring and scanning that keeps in mind the diagnosis of ADHD, will help prevent the problems and complications in the disease process, particularly in patients with early onset BD.

Rasd2 is a striatal GTP-binding protein that modulates Akt and mTOR signaling cascades, well known to be highly vulnerable pathways in psychiatric disorders.

We investigated the association of Rasd2 and its genetic variation with a series of prefronto-striatal phenotypes related to psychosis in rodents and humans.

We want to provide evidence that Rasd2 controls the vulnerability to schizophrenia-related behavior induced by psychothomimetic drugs in mice. Moreover, we aim to find genetic variations within the Rasd2 gene that influence a series of brain schizophrenia-related phenotypes in human.

Rasd2 knockout mice were employed to evaluate schizophrenia-like behaviors induced by psychotomimetic drugs like amphetamine and phencyclidine. Furthermore, we investigated if RASD2genetic variations in humans are associated with mRNA expression in post-mortem prefrontal cortex, as well as prefrontal and striatal grey matter volume and physiology during working memory as measured with MRI in healthy subjects. Finally, we assessed RASD2mRNA expression levels in post-mortem brains of patients with schizophrenia and bipolar disorder.

We found that both psychotomimetics triggered greater vulnerability to motor stimulation and to prepulse inhibition deficits in Rasd2 mutants. In humans, we found that a genetic variation (rs6518956) within RASD2 predicts prefrontal mRNA expression as well as prefrontal grey matter volume and prefronto-striatal activity during working memory. Finally, we reported that RASD2 mRNA expression is slightly reduced in post-mortem prefrontal cortex of patients with schizophrenia.

Collectively, our data suggests that RASD2represents a gene of potential interest in psychiatric disorders for its ability to modulate prefronto-striatal phenotypes related to schizophrenia.

It has been suggested that Music Therapy (MT) may be a suitable treatment modality for behavioural and psychological symptoms of dementia (BPSD). A Cochrane review in 2004 found the methodological quality of existing studies was generally poor, and better quality research was required.

This review aimed to examine the evidence since 2004 to determine whether more rigorous studies have been published.

A systematic review of the literature was conducted. MEDLINE, PsycINFO and the Cochrane Library were searched for randomized controlled trials (RCTs) of MT interventions in patients with dementia, between July 2004 and February 2011. Six studies, with 262 participants, reported outcomes in BPSD.

The value of MT depends on intervention type and symptom targeted. Two studies evaluated interactive music interventions, focusing on patient-therapist relationships. Both showed significant reductions in BPSD (measured by the Neuropsychiatric Inventory), specifically improvements in delusions, agitation and anxiety. the remaining studies examined passive music listening interventions, with varied results. Two examined individual music listening programmes, showing significant improvements in anxiety, depression and physical agitation, but no effect on verbal agitation. Two others, looking at group therapy, also had mixed success. A music and movement intervention showed improvements in agitated behaviours. However, a group-singing programme had no significant effect on agitation/anxiety.

The trials included in this review were high quality single-blind RCTs, leading to reduced bias and stronger evidence base. Although all studies reported positive effects from music, the most significant results came from interactive, targeted programmes, focusing on therapeutic relationships.

Transcranial direct current stimulation (tDCS) is a form of neuromodulation most commonly used in depression. tDCS aims to modulate cortical activity by the application of a weak electrical current to the brain via electrodes placed on the scalp. Several studies have identified the potential of tDCS for managing behavioural and psychological symptoms in a range of dementias, including Alzheimer’s disease, vascular dementia, dementia with Lewy bodies and frontotemporal dementia. Although the preliminary data on efficacy is promising, the safety of repeatedly neuromodulating the brain of a person with dementia, by tDCS, has not been extensively reported.

Our aim was to review the current literature on how safe it is to repeatedly neuromodulate a brain with dementia.

Advanced literature searches of PubMed and the Web of Science Core Collection were conducted to identify relevant publications. The search terms deployed were: “tDCS” or “transcranial direct current stimulation” and “frontotemporal dementia” or “vascular dementia” or “Lewy body” or “Alzheimer’s disease”. The following inclusion criteria were applied to the search: (1) publications which focused on the use of tDCS in patients with either frontotemporal dementia, vascular dementia, dementia with Lewy bodies or Alzheimer’s disease, (2) studies involving human participants and, (3) publications written in, or readily translated to English.

216 articles were returned in the initial search. Following the removal of 54 duplicate articles, the remaining 162 underwent eligibility screening using the titles and abstracts. 31 articles were then selected for a full text reading and following this, 12 studies were selected to be included in the review. Across all 12 studies, 3590 sessions of active tDCS were performed with no severe adverse effects being reported. The most commonly occurring adverse effect was a tingling/burning sensation underneath the electrodes, followed by headache and skin changes. These reported effects tended to be mild and short lived.

Overall, the results of the reviewed papers suggest that repeated neuromodulation by tDCS can be safely performed in dementia patients. More and larger studies should aim to perform a greater number of sessions of tDCS, across a longer time period. Few studies assessed for potential brain damage as a result of tDCS and future studies should consider using MRI or monitoring biomarkers to further investigate this.

None Declared