It has been hypothesized that lowered antioxidant capacity, which leads to increased oxidative stress, may be involved in the pathophysiology of major depressive disorder (MDD) and anxiety disorders and might be altered by antidepressant treatment.

This study investigated the association of plasma uric acid, the greatest contributor to blood antioxidant capacity, with MDD, generalized anxiety disorder, social phobia, panic disorder, agoraphobia and antidepressants in a large cohort.

Data was derived from the Netherlands Study of Depression and Anxiety including patients with current (n = 1648) or remitted (n = 609) MDD and/or anxiety disorder(s) (of which n = 710 antidepressant users) and 618 controls. Diagnoses were established with the Composite Interview Diagnostic Instrument. Symptom severity was ascertained in all participants with the Inventory of Depressive Symptoms and the Beck Anxiety Inventory. ANCOVA and regression analyses were adjusted for sociodemographic, health and lifestyle variables.

Plasma uric acid was lower in those with current MDD and/or anxiety disorder(s) (adjusted mean 270 μmol/L) compared to those with remitted disorders (280 μmol/L, P < 0.001) or to controls (281 μmol/L, P < 0.001; Cohen's d 0.14). Within patients antidepressants were not associated with uric acid levels. Increasing symptom severity was associated with lower uric acid levels for both depression (β = –0.05, P = 0.001) and anxiety symptoms (β = –0.05, P = 0.004).

This large scale study finds that the antioxidant uric acid is lower in current, but not remitted, MDD or anxiety disorders and in persons with higher symptom severity, suggesting disturbances in redox homeostasis play a role in the pathophysiology of depression and anxiety disorders.

The authors have not supplied their declaration of competing interest.

Caregiving consequences have been addressed through strategies including family psychoeducation. Groups for relatives are feasible and target part of family needs. Although some forms of family work (FW) influence prognosis of schizophrenia, there is lack of evidence that relatives’ groups lower relapse rates or improve patients’ social functioning per se. Effectiveness of this approach is to be adequately tested in Portugal. The Families of Psychotic Patients (FAPS) survey nested a quasi-experimental group intervention study.

Non-randomised sampling: caregivers of patients with ICD-10 schizophrenia/related disorders, in Lisbon community mental health services (n=108). Relatives’ baseline assessments included caregiving consequences, distress, social support, coping and sense of coherence. Patients were given the BPRS,WHO-DASII and GAF. Family psychoeducational groups were offered to all caregivers and those who accepted were screened for illness-related information.

Needs for FW were not invariably expressed at baseline (adherence: 23,2%), but there were no intervention dropouts. Although satisfaction was remarkable, significant gains were only achieved in part of assessed outcomes: caregivers’ knowledge; some positive aspects of caregiving; social, practical and emotional support; positive communication.

Strain does not imply adherence to FW, sometimes in discrepancy with staff's expectations (as in another Portuguese FW implementation trial, within the Psychoedutraining Study). Our group intervention, albeit remarkably valuable, did not improve patients’ parameters and failed to diminish relatives’ burden or distress in a straightforward way. Results must be cautiously interpreted (accounting for sampling bias), but re-emphasise one should tailor FW approaches to each family unit in each moment of intervention.

Tuberous sclerosis is a multisystem genetic disorder. It is associated with significant psychiatric comorbidity mainly autistic disorders, hyperkinetic disorders, depression and anxiety. It is rarely associated with psychosis and bipolar disorder.

To describe the case of a 34-year-old male with concomitant diagnosis of bipolar disorder and tuberous sclerosis.

Case report based on clinical records. Brief literature review using articles searched in the PubMed/MEDLINE database using the terms “tuberous sclerosis”, “bipolar disorder” and “neuropsychiatric”.

The patient presented at our Emergency Department 3 years ago with a mixed episode with psychotic symptoms with 1 month of duration. Prior history of two hypomanic episodes, but no depressive episodes. High baseline functionality. Sporadic use of alcohol and cannabis. No family history of psychiatric or neurological diseases. Diagnostic work-up showed no relevant results, aside from small calcifications in brain CT. He was admitted to our ward and medicated with aripiprazol (titrated up to 30 mg), leading to full remission of the clinical picture. The patient was referred to our outpatient clinic and stayed with medication for 1,5 years. One year after, he presented a sudden episode of mutism and perplexity with quick remission. The EEG wielded no relevant results. New brain CT showed signs of tuberous sclerosis. He was referred to Neurology and subsequent assessments, including brain MRI, led to the fulfilment of clinical criteria for tuberous sclerosis.

This case illustrates the possibility of concomitant diagnosis of bipolar disorder and tuberous sclerosis. The possible association between these disorders is discussed.

No significant relationships.

Cannabis is among the most widely used substances in the world. it is associated with several mental health problems.

To assess self-esteem among a group of young Tunisian users of cannabis.

The total study sample was composed of 137 participants, who took part of a transversal descriptive study during two months (January and February 2020).

In our study population, the cannabis consumers were young adults aged between 18 and 35 years old, with a male predominance of 71%. Among those users, 65.9% were single and 29.7% dropped out of school or experienced academic failure. On a socio-economic level, we concluded to a rate of 5.8% (lower class), 60.9% (middle class) and 33.3% (upper class). Besides, 40.8% were employed. In total, 23.2% had a psychiatric history. Furthermore, the use of other substances was also prominent and frequent as follows: alcohol 72.5%, tobacco 74.6%, ecstasy 41.3% and 25.4% cocaine. The use of cannabis was considered as a means of indulgence and pleasure for 66.7%, as an anxiolytic for 26.8% and as a sedative for 23.9%. Self-esteem, among those cannabis users, was very low in 20% of cases, low in 38% of cases, medium in 15% of cases and high in 25% of cases.

These results lead us to question the relation between cannabis and self-esteem. The question that is evolved about the use of cannabis is the following: Is it used as a remedy or is it the cause of self-esteem deficiency?

No significant relationships.

Today telemedicine is a very popular and rapidly growing area, which allows the treatment, regardless of the distance between the patient and doctor. We present the latest research, conducted amongst polish doctors about the usefulness of telemedicine as a therapeutic tool in different medical specialties.

The aim of the study was to examine doctors’ attitude to telemedicine and usefulness of Platform ‘Moneo’ in the therapy of the areas other than psychiatry.

The first part was the polish telemedical project (grant no. POIG.01.04.00–04–219/12) conducted to assess medical Platform ‘Moneo’. It was based on a questionnaire filled by participants in scale 1 to 5. The second study based on authors’ anonymous questionnaires was distributed amongst 105 psychiatrists from Poland.

Everybody noticed advantages of medical platform. The Platform's functionalities, rated as the best by healthcare directors were: educational materials, appointment and therapy planning. Managers indicated parts, which could be improved in e-prescribing system, the process of collecting information about hospitalizations and operations. Functionalities indicated by doctors as desirable to increase the utility of the platform is e-prescribing system, reporting side effects, planning visits, educational materials. In study addressed to psychiatrists, only 15% of them claimed to have an extensive knowledge on telepsychiatry, but they had confirmed the potential of telemedicine in psychiatry.

Telemedicine is a useful method, which can improve quality of healthcare services and make an access to it possible for some people. However, lots of improvements in telemedical services are needed to make it an efficient medical tool.

To evaluate the efficacy and tolerability of once-daily quetiapine XR monotherapy in outpatients with moderate-to-severe GAD without major depressive disorder.

10-week (8-week active treatment, randomised phase; 2-week post-treatment drug-discontinuation/tapering phase), multicentre, double-blind, placebo-controlled, parallel-group comparison with paroxetine study (D1448C00011). 873 patients were randomised to receive quetiapine XR 50mg/day (n=221), 150mg/day (n=218), paroxetine 20mg/day (n=217) or placebo (n=217). Primary endpoint: change from baseline to Week 8 in HAM-A total score. Secondary outcomes included: change from baseline to Week 8 in HAM-A psychic and somatic clusters.

Mean HAM-A total score (overall baseline mean, 26.98) was significantly reduced at Week 8 by quetiapine XR 50mg/day (-13.95, p<0.05), 150mg/day (-15.96, p<0.001) and paroxetine (-14.45, p<0.01) versus placebo (-12.30).

At Week 8, mean HAM-A psychic cluster score (overall baseline mean, 14.40) was significantly reduced by quetiapine XR 50mg/day (-7.42, p<0.01), 150mg/day (-8.64, p<0.001) and paroxetine (-7.70, p<0.001) versus placebo (-6.27). Mean HAM-A somatic cluster score (overall baseline mean, 12.58) was significantly reduced by quetiapine XR 150mg/day (-7.37, p<0.001) versus placebo (-6.00), but not quetiapine XR 50mg/day (-6.54, p=0.15) or paroxetine (-6.74, p=0.05).

The incidence of serious AEs was low (<2%) in all treatment groups. During Weeks 1-8, most common AEs (>10%) were dry mouth, somnolence, fatigue, dizziness and headache with quetiapine; headache with placebo; and somnolence, dizziness, headache and nausea with paroxetine.

Once-daily oral treatment with quetiapine XR (50 and 150mg/day) was well tolerated and significantly reduced anxiety symptoms, demonstrating effects on both somatic and psychic symptoms, in patients with GAD.

Neural stem/progenitor cells derived from olfactory neuroepithelium (hereafter OE-NS/PCs) are emerging as a viable proxy and a valuable tool for translational studies on severe mental illnesses (SMI). In this respect, the use of OE-NS/PCs as a surrogate cellular model of schizophrenia (SZ) has enabled insights into cell signaling and cell cycle dynamics in this disease.

We explored whether mitochondrial dysfunction, which has been already associated with SZ, may have a role in the altered proliferation pattern previously observed in OE-NS/PCs of SZ patients.

OE-NS/PCs were collected from 20 patients and 20 healthy controls (Hcs) by nasal brushing, cultured in proper medium and expanded. Fresh OE-NS/PCs at passage 3 of both groups underwent BrdU proliferation assays or were frozen for later use. Mitochondrial ATP production was measured in both fresh and thawed OE-NS/PCs by using the ATPlite Luminescence Assay kit.

Fresh OE-NS/PCs of patients grew at a higher rate than those of HCs (M-W U=0; p<0.001), whereas the proliferation of thawed OE-NS/PCs of both groups exhibited an opposed pattern (at passage 6, p=0.002). Mitochondrial ATP production was significantly lower in OE-NS/PCs of patients than in those of HCs (M-W U=0; p=0.02), regardless of freeze-thaw conditions (M-W U=6; p=0.77).

Mitochondrial ATP production is negatively affected in OE-NS/PCs of SZ patients as compared to those of HCs. This evidence does not differ in fresh OE-NS/PCs and OE-NS/PCs undergoing freeze-thaw cycles, which instead perturb the proliferation pattern of SZ OE-NS/PCs.

The crime committed by mentally ill offenders has continued to attract higher degrees of media interest and concerns over public safety.

To explore study participants’ views over public perceptions of mental illness, and psychiatric illness and violent crime link.

To study public percetions of mental illness.

The study was coducted using a qualitative research design, using audi-taped, semi-structured interviews of 8 University students and healthcare professionals. Qualitative research themes and categories were obtained through qualitative data analysis of interview transcripts.

Qualitative categories were obtained using open, axial, and selective coding of transcribed data. The analysis identified a public fear of mental illness displaying in rejection of mentally ill and through expressive communication using stigmatizing language. The study identified that the public sources of knowledge about mental illness are derived from family and peer contact and also through media exposure rather than formal learning opportunities in schools.

The study highlights the need for a public policy debate on harmful effects of social stigma of mental illness and further need for ongoing attempts to educate general public and policy makers. Three major categories emerged through this process are:.

1. 1. Negative media portrayal of mental illness

2. 2. Sufferer stigma and caraer burden

3. 3. Mental illness and Moral Panic

The study identified that an atmosphere of moral panic exists against mental illness and that this moral panic is reflected in media coverage of crime by mentally ill offenders.

Study confirms negative public perceptions and stigma of mental illness.

The COVID-19 pandemic has completely changed the experience of higher education with potentially negative consequences for students’ wellbeing.

To compare medicine/dentistry students’ depression/anxiety/stress levels before versus during the pandemic and to analyse the role of COVID-19-related stressors in their psychological distress.

Students from the Faculty of Medicine University of Coimbra answered socio-demographic and personality questionnaires and the Depression, Anxiety and Stress Scale/DASS before (academic years 2016-2017-2018-2019 - SAMPLE1; n=1000) and during (September-December 2020 and January-March 2021 - SAMPLE2; n=650) the COVID-19 pandemic. Mean age (21.12±3.75), personality traits scores, and gender proportions (»75% girls) did not significantly differ between samples. SAMPLE2 also filled in the Fear of COVID-19 Scale and a new version of the Inventory of Sources of Stress During Medical Education/ISSDME, containing a COVID-19 -related dimension (restrictions on training and on socializing with friends/colleagues).

SAMPLE2 presented significantly higher mean scores of depression (3.89±3.55vs.3.33±3.34), anxiety (3.27±4.08vs.2.86±3.29), stress (7.07±5.72vs.6.18±4.59) and total DASS (12.28±10.55vs.13.65±11.13) than SAMPLE1 (all p<.05). Fear of COVID-19 was a significant predictor of DASS score (adjusted R2=2.9%, p<.001). COVID-19-related stressors continued explaining significant increments of DASS variance after controlling for each of the ISSDME dimensions: Course demands (R2 Change=1.8%), Human demands (2.5%), Lifestyle (2.3%), Academic competition (5.5%), and Academic adjustment (5.2%) (all p<.001).

This study adds to the evidence of the negative impact of COVID-19 on students and emphasizes its pernicious role on medical students’ psychological distress, which is already higher due to the individual and academic stressors to which they are more exposed.

No significant relationships.

Novel research concepts based on therapies aiming to modulate intestinal microbiota are emerging. The evidence is mounting that gut-brain axis plays an important role in the development of mood and depressive disorders [1]. The similarities between blood brain barrier (BBB) and gut vascular barrier (GVB) and their role in chronic diseases have been recently unraveled [2]. Especially convincing data come from animal models, where administration of probiotics and antibiotics in germ and pathogen free mice showed beneficial role in the regulation of behavior, cognition, pain, anxiety and mood.

Based on available data as well as on studies looking at the effect of multispecies probiotics (Ecologic® Barrier containing B.bifidumW23, B.lactisW52, L.acidophilusW37, L.brevisW63, L.caseiW56, L.salivariusW24, L.lactisW19, L.lactisW58) on cognitive reactivity to sad mood in healthy volunteers [3] we designed the human trial aiming to compare microbiome alterations and response to therapy in patients with depression and schizophrenia. Moreover, in vitro and in vivo data support the notion that multispecies probiotics are capable of improving gut barrier function [4] and may alleviate disorders affecting mood and depressive-like behavior. We postulate that therapies modulating the microbiome-gut-brain axis warrant further investigations.

Multispecies probiotics have the potential to influence the gut-brain axis and alleviate mental disorders. Ongoing clinical study in patients with depression and schizophrenia will help to further unravel the role of gut-brain axis in the treatment of patients with psychiatric disturbances.

The authors have not supplied their declaration of competing interest.

Psychological autopsy studies have constantly indicated a clear relation between mental disorders and suicide. This relation has been found in studies across the world, although the percentage of cases with at least one mental disorder diagnosed may vary between studies and specially, between countries and geographical regions.

Review of psychological autopsy studies of suicide completers which contained information on diagnostic distribution. Only studies carried out in Europe and North America were included.

A total of 14 studies, including 1519 suicides, were analyzed (Table 1).

Suicide risk is a multifactor phenomenon, however, it is strongly related to mental disorders. Mental health strategies should be directed to target clinical groups at high risk of suicide.

The authors have not supplied their declaration of competing interest.

Social impairments form one of the major deficits of Autism Spectrum Disorders and are frequently associated with anxiety in school-going children. Social skills programs have been most well-validated to address the issue but components of the programs require further examination.

The study aims to develop and evaluate a group-based Social Recreational program that encourages interaction and behaviour regulation among children with High-Functioning Autism through their participation in activities that address meaningful and functional skills in a naturalistic social setting. The components of the program are described.

30 children were enrolled in the 16-sessions weekly program. Attending psychiatrists rated the children on the Clinical Global Impression - Severity scale (CGI-S) at pre-, post-, 3-month, 6-month and one-year follow-up. Anxiety levels of the children were measured by self-reports on the Spence Child Anxiety Scale - Child (SCAS-C) and parent-reports on the Spence Child Anxiety Scale - Parent (SCAS-P).

Clinician ratings on the CGI-S showed significant improvements in the children upon completion of the program (Friedman, X2 = 22.69, p = .000) and the gains were maintained at follow-ups. Repeated measures ANOVA with a Greenhouse-Geisser correction showed lower self-reported anxiety in children after the program, F (2.89, 72.26) = 4.07, p = .004. Post-hoc pair-wise comparisons suggested that the children were significantly less anxious at the 6-month follow-up.

The program suggests promising benefits although there are no active anxiety remediation components. Its value lies in its applicability in wider community settings. Implications of its effectiveness are discussed.

The Family Assessment Device (FAD) is a self-report questionnaire, developed to assess the six dimensions of the McMaster Model of family functioning. It has been translated to the Greek language but never validated.

To evaluate the psychometric properties of the Greek version of FAD in a non-clinical sample.

In a sample of Greek families, FAD was administered together with the already validated Family Adaptability and Cohesion Evaluation Scale (FACES-III). In a subsample of 96 participants, the scales were administered again after 1 month.

A sample of 453 participants (194 children and 259 parents) had completed both questionnaires (151 families). Mean age of children was 23.62 (SD: 6.35), 68 (35%) were males. Mean age of parents was 51.4 (SD: 8.2), 117 (45.2%) males. All subscales of FAD had significant correlation (concurrent validity) with FACES-III (n = 453, P < 0.001). Test-retest reliability range from 0.58 to 0.82 (n = 96, P < 0.001). Internal consistency (Cronbach's alpha) range from 0.47 to 0.94. A model with the 6 factors had a good statistical fit but not all the items were loading in the same components as from the theory assumed.

The Greek FAD has good psychometric properties, although its factor structure might differ from the original version. Further evaluation of the Greek version of FAD in other settings and in different samples especially clinical remains a task for future research.

The authors have not supplied their declaration of competing interest.

Sodium valproate can cause serious developmental disorders in unborn babies if taken while pregnant, especially in the first trimester.

To review recent literature and advice or treatment for women who have or are using valproate whilst pregnant.

Literature review.

Literature review using Pubmed with search terms: ‘bipolar’; ‘pregnant’; ‘valproate’ and following up references.

There are several small methodologically flawed studies that attempt to address this question and will be reprised. Three key population register studies found high rates of malformations. A retrospective study of longer-term outcomes found high rates of developmental issues. There are several relevant treatment guidelines, including from the National Institute for Health and Clinical Excellence (NICE). There is a 40% risk of developmental disorder, a 10% risk of congenital malformations and a 3% risk of IQ deterioration.

Avoid valproate in women of childbearing age if at all possible, and consider effective contraception if used. If already pregnant then consider, with involvement from the patient, stopping or minimizing the dose of sodium valproate. Assess the risks and benefits of using sodium valproate during pregnancy versus stopping the treatment for the first trimester as symptoms of the disorder may return. Seek advice from a perinatal psychiatrist. Add 5 mg of folic acid daily for the remainder of the pregnancy.

The authors have not supplied their declaration of competing interest.

Digital mental health interventions, such as chatbots that promote mental health and wellbeing are a promising way to deliver low-threshold support 24/7 for those in need. According to current knowledge about the topic, health care professionals should participate in the design and development processes for digital interventions.

The aim of this presentation is to describe the interdisciplinary content development process of the ChatPal chatbot.

The content development process started in co-operation with mental health professionals and potential users to identify requirements. Content was created, evaluated and tested in international, multi-disciplinary group workshops, and online tools were used to allow the collaboration. Initial conversational scripts were drafted in English, and translated into Finnish, Swedish and Scottish Gaelic.

A multilingual chatbot was developed and the conversation scripts were structured and stored using a spreadsheet. The conversation scripts will be made freely available online in due course using this structured approach to formatting chatbot dialogue content. It will allow repurposing the content as well as facilitating studies that wish to assess the design of conversation scripts for mental health chatbots. Conversation design process also highlighted some challenges in turning empathetic and supportive conversations to short utterances suitable for a chatbot.

The ChatPal chatbot is now available in four languages. As literature about the topic is still scarce, it is important to describe and document the content development processes of mental health chatbots. Future work will develop a conversational UX toolkit that would allow health professionals to design chatbot scripts using design guidelines.

No significant relationships.

During cultural and social upheavals including manmade environmental factors like war and violence, drastic change takes place in people's expectations, “the meaning of life” and values. The purpose of this study was to examine the prevalence of psychiatric co morbidities in traumatic amputees in Kashmir (Indian Part).

Subjects were 100 consecutive patients with traumatic limb amputation. In addition to assessments of physical factors, psychiatric interviews were administered to examine mental disorders including PTSD and major depression.

The prevalence rates of PTSD and major depression were 20% and 63% respectively. It was followed by impulse control disorder 19%, phantom limb phenomenon 14%, generalized anxiety disorder 10% and panic disorder 6%. Motor vehicle accident and blast injuries were cause for 53% and 11% of limb amputations respectively. Majority (45%) of them were males in age group of 15-30 years. 61% were illiterate from rural areas (81%).

These findings suggest that psychiatric co morbidity is very common in amputees. Most of the patients are males of younger age group. Major depressive disorder is the most common psychiatric co morbidity followed by anxiety disorders in which PTSD is most prevalent, followed by impulse control disorder and phantom phenomenon respectively. Individuals suffering traumatic limb loss at any age are likely to suffer subsequent difficulties with their body image, but these relationships are more striking in the younger age groups who have experienced traumatic injuries.

Empathy has received a lot of attention with the creation of an Interpersonal Reactivity Index (IRI). IRI is assessed using a 28-item questionnaire with four 7-item scales:

– perspective-taking (PT) scale;

– fantasy (FS) scale;

– empathic concern (EC) scale and iv) personal distress (PD) scale.

Such questionnaires have been translated in many languages (see Table 1). This work aims to compare the original model with existing modified, hierarchical, shortened models in the literature and to also translate and validate the IRI for Portuguese.

A convenience sampling was used (n = 130) to conduct confirmatory factor analysis (CFA) using AMOS software. The original four-factor model is contrasted with modified, hierarchical and shortened models proposed in the literature, reporting internal consistency statistics and their fit indices.

The same structure of factors was found in the sample with reasonably good fit indices χ2/df = 1.57, CFI = 0.77, AGFI = 0.72 and RMSEA = 0.067. Internal reliability for each scale of the IRI was not excellent (< 0.90), but it is in line with the literature: PT with a Cronbach's alpha of 0.74, FS with 0.79, EC with 0.74 and PD with 0.65. The comparison with other modified versions of the IRI latent factor structure revealed that two models with better fit than the original version, and the potential for a shortened Portuguese version of the IRI.

IRI is a valid instrument to measure empathy in the Portuguese Population and is in line with previous findings. Some modifications to the original latent structure provide a better data fit than the original one.

The author has not supplied his/her declaration of competing interest.