There are no published data on how family burden changes over time in alcoholism. We present 6-month follow-up data on the burden of families of alcohol dependent individuals.

The sample comprised 87 caregivers (63 females, 24 males) of alcohol dependent individuals who completed a 4-6 week inpatient alcohol detoxification in the Specialized Drug and Alcohol Addiction Clinic at the Eginition Hospital, Athens University Medical School. During hospitalization, a brief supportive intervention for the relatives took place. After detoxification all participants were followed-up as outpatients for a 6-month period in an affiliated service. Burden and psychopathology of caregivers were assessed with the Burden of Care Scale, and the General Health Questionnaire (GHQ-28). T-tests for paired samples were used for comparisons between different time points (admission-discharge-six months). A logistic regression model was used to identify factors which influence relatives’ relief.

Caregivers exhibited high scores of burden in terms of financial, household, interpersonal relations and parental roles at admission; mild psychopathological symptoms were also recorded. By the end of detoxification scores significantly decreased in most relatives (admission vs. discharge, p< .000); this improvement was determined by the patients’ soberness.

Alcohol dependence may have a considerable impact on family interaction as shown by the high scores of burden and mild psychopathology recorded in the caregivers. Our findings suggest that the relatives’ relief was dependent on the achievement of abstinence and the number of relapses. Therefore, a brief supportive intervention is recommended.

The top biomedical research institutions have traditionally been assumed to provide better medical treatment for their patients. However, this may not necessarily be the case. Low-to-moderate negative associations between research activity and the quality-of-care provided by clinical departments have been described. We aimed to examine this relationship in the psychiatric units of the largest hospitals in Spain.

Scientific publications for 50 hospitals were retrieved from the Web of Science (2006–2015), and quality of mental healthcare data were gathered from Spanish National Health System records (2008–2014). Spearman-rank correlation analyses (adjusting for number of beds and population) were used to examine the associations between research data and quality-of-care outcomes in psychiatry. Stepwise regression models were built in order to determine the predictive value of research productivity for healthcare outcomes.

We found a positive association between research activity indicators (i.e., number of publications, number of citations, cumulative impact factor, and institutional H-index) and better quality-of-care outcomes in psychiatry (i.e., number of readmissions, transfers, and discharges from hospital). In particular, a higher research activity predicted a lower level of readmissions for individuals with psychoses (p = 0.025; R = 0.317), explaining 8.2% of the variance when other factors were accounted for.

Higher research activity is associated with better quality of mental healthcare in psychiatry. Our results can inform decision-making in clinical and research management settings in order to determine the most appropriate quality measures of the impact of research on the prognosis of individuals with psychiatric conditions.

Internet gaming disorder appears to be associated with self-concept deficits and increased identification with one's avatar. For increased social network use, the few existing studies suggest striatal-related positive social feedback as an underlying factor. Furthermore, few study findings indicate that internet addicts generally have problems in emotional inhibitory control processing.

Pathological and addicted internet gamers as well as social network users were compared with healthy controls regarding psychometric and neurobiological measures of self-concept-related characteristics, avatar identification and emotional inhibitory control processing.

Psychometric results indicated that both subgroups showed higher self-concept deficits compared to healthy controls. Neurobiologically, different brain activation patterns were observed in the subgroups during self-knowledge retrieval and inhibition of emotional stimuli. Furthermore, addicted internet gamers showed a higher identification with the own avatar, mirrored in an increased left angular gyrus activation, a region functionally associated with identification processing and feelings of empathy.

These findings provide a starting point for the deduction of specific psychotherapeutic treatment approaches for addicted internet gamers and social network users.

The authors have not supplied their declaration of competing interest.

Both in consultations with the general practitioner and with the psychiatrist, antidepressants are one of the most used drugs (1). These have multiple indications, and there are different groups according to their mechanism of action. In relation to this case, we are going to talk about Venlafaxine, a dual-type antidepressant, that is, it inhibits the reuptake of serotonin and norepinephrine. One of the most common side effects is digestive discomfort, which usually resolves after a few weeks (2). However, we should not ignore these symptoms, since they can hide something more serious.

Presentation of a clinical case on a patient who presented an increase in pancreatic amylase after starting treatment with Venlafaxine.

Bibliographic review including the latest articles in Pubmed on side effects of antidepressant treatment, and more specifically at the gastrointestinal level (in this case we will talk about pancreatitis).

We present the case of a 49-year-old woman, who was hospitalized 2 years ago, due to a first depressive episode. During this admission, psychopharmacological treatment was started for the first time, on that occasion with a selective serotonin reuptake inhibitor (SSRI), treatment of first choice (3). The patient had no side effects at that time, but the response was very modest, so it was decided to replace that antidepressant with Venlafaxine (with dual action), up to 150mg. The depressive symptoms improved markedly, however the patient began to feel digestive discomfort (which at first did not seem to be of great importance). A general analysis was performed, in which an increase in lipase (978 U/L) and amylase (528 U/L) was detected. An echoendoscopy, an abdominal scan, and a magnetic resonance cholangiography were performed; Pancreatitis secondary to drugs was suspected (a severe condition). Luckily, no significant lesions were found in the tests, and the levels of amylase and lipase decreased when Venlafaxine treatment was withdrawn (without reaching the normal range). The patient was discharged and continued to attend consultations. In the last control, amylase had dropped to 225 U/L. His abdominal pain disappeared. Treatment with Vortioxetine (a multimodal antidepressant) was started, however the amylase levels continue to be monitored, and the patient continues to see the gastroenterologist.

Gastrointestinal side effects are very common when taking antidepressant treatment, and in most cases they do not usually represent a serious problem.

However, it is described in the scientific literature that in some cases, acute pancreatitis secondary to some drugs, including Venlafaxine, can occur (4). In order to detect it, it is necessary to perform a blood test and sometimes also other complementary tests.

For its treatment, the fundamental thing is to withdraw the causing drug, trying to find other alternatives, and carry out a control to monitor possible complications

None Declared

Despite growing acceptance of same-sex sexuality in the Western World, identity development of lesbian, gay and bisexual (LGB) individuals is still restricted by negative societal attitudes, which maintain the experience of stigmatization and discrimination.

The purpose of this study was to document the frequency of discriminatory events experienced by sexual minorities and their association with indicators of mental health in a Portuguese self-identified LGB sample.

To determine the association of harassment and discrimination with levels of mental health, and to establish a predictive relation between these variables.

A total of 610 LGB participants completed an online survey (mean age = 34.48, SD = 11.54). Most participants were single and self-identified as gay (73.8%). The survey included the following categories of survey items: demographic information, mental health, and discrimination experiences. Mental health was measured using the subscale of Emotional Wellness from the SF-36 questionnaire and the K10 questionnaire.

Between one-fifth and one-fourth of the participants in this sample frequently felt the need to hide their sexual orientation to prevent discrimination experiences. Close to 20% reported having suffered from verbal abuse, followed by close to 10% who suffered from written threats, harassment, and physical threats. A hierarchical multiple regression analysis was performed to assess the effects of anticipated and actual discrimination on mental health. The analysis explained 17% of the overall variance.

Stigma/discrimination create discriminatory experiences which impact LGB people's mental health.

The author has not supplied his declaration of competing interest.

Coping strategies, competence, and locus of control (LOC) beliefs are important predictors of mental health (MH). However, research into their complex interactions has produced mixed results. Our study investigated them further in the previously unexplored context of clinical high-risk (CHR) of psychosis.

We tested six alternative structural equation models in a community sample (N = 523), hypothesizing a mediating role of coping and treating CHR symptoms as (i) an additional mediator or (ii) a specific outcome. Our measurement model included two latent factors of MH: (1) psychopathology (PP), consisting of presence of mental disorders, global and psychosocial functioning, and (2) self-rated health (SRH) status.

In the model with the best Akaike Information Criterion and the latent factors as outcome variables, maladaptive coping completely mediated the impact of maladaptive LOC on PP and SRH. Additionally, CHR symptoms partially mediated the effect of maladaptive coping on PP and SRH in the community sample, as long as sex was not entered into the model. In the clinical sample (N = 371), the model did not support a mediation by CHR symptoms, despite significant pathways with both coping and MH outcomes; further, competence beliefs directly impacted SRH.

Coping strategies are an important intervention target for MH promotion, especially in the community. In clinical populations, interventions focusing on coping strategies may improve CHR symptoms, thus potentially supporting better MH, especially SRH. Additionally, due to their mostly cascading effects on MH, improving competence and LOC beliefs may also promote psychological well-being.

The past years BDSM (an acronym for bondage and discipline, dominance and submission, and sadism and masochism) has gained a significant amount of attention and popularity in the general population, portraying an inaccurate image of BDSM and the people who share these interests. Yet despite this increasing popularity, only little empirical research has focused on this subject and it’s possible driving mechanisms so far, sustaining the existing misconceptions and stigma towards BDSM in general and BDSM practitioners in specific.

We aimed to gain more insights on understanding the underlying psychological mechanisms, such as sensation seeking and coping, in people who participate in BDSM-related activities, as well as into the factors which contribute to the existing stigma and discrimination

In a national survey study 256 Dutch-speaking BDSM-practitioners were compared to a matched sample of people from the general Belgian population (N = 300) who lack any interest in BDSM in two separate studies.

About 86% of the general population maintained stigmatizing beliefs about these sexual interests and practices. In regard to sensation seeking and coping, compared to controls, BDSM practitioners reported signifcantly higher levels of sensation seeking for all dimensions, as well as the use of more active coping skills.

People who do not conform to the current social standards of our society often seem to remain the subject of stigmatization and discrimination. Further research is needed to explore the psychological processes that drive BDSM interests in order to destigmatize and normalize consensual BDSM-related activities.

No significant relationships.

The term ‘revolving door (RD) phenomenon” was coined to define recurrent hospitalizations of chronically ill patients after closure of psychiatric hospitals and implementation of community treatments.

Continued readmissions require a large portion of Mental Health Departments’ resources.

To analyze the RD phenomenon in an acute psychiatric ward during a 5-year period.

We retrospectively selected all patients with 3 or more hospitalizations per year from 01/01/ 2009 to 31/12/2013 in SPDC-Modena Centro. From their medical records we collected selected variables, potential predictors of RD phenomenon. Data were statistically analyzed.

In the 5-year period, a sample of 105 patients (47 females, 58 males) with an average age of 40.25 years (± 13.47 SD), 5.68 % of all inpatients (n = 1850), realized 778 hospitalizations, 23.94 % of all admissions (n=3250). The most frequent reason for admission was ‘worsening of psychiatric symptomatology” (55.27%). The most frequent diagnoses at discharge were ‘Schizophrenia” (41.26%) and ‘Personality Disorders” (25.32%). Most of RD patients (87%) were Italian, only 15 % were employed and 50 % lived with family. The mean duration of RD hospitalizations (12.23 days ± 18.37 SD) was statistically significantly different from all others in the 5-year period (10.39 days ± 11.09 SD, p=0.0008, t test) as was the frequency of compulsory admissions (RD hospitalizations 18% vs. 26% all others, chi2, p<0.001).

Our RD patients represented a small percent of all inpatients but required many and long hospitalizations, probably due to severe and disabling illness.

Clozapine has proven to have a unique efficacy on treatment-resistant schizophrenia (TRS). Nevertheless, studies show that 47%-63% of clozapine-treated patients may fail to respond after around 12-years of treatment (CRS). Several augmentation strategies have been proven to be effective in CRS.

Hereby, we present two clinical cases of CRS successfully managed with brexpiprazole augmentation.

A 48-year-old man without comorbid substance use, treated with clozapine-brexpiprazole augmentation, and a 20-year-old man with comorbid substance use, treated with clozapine-brexpiprazole combination and subsequently with twice-injection aripiprazole (TIA). They were administered with the following assessments at t0, t1-3 (first month), t4-8 (monthly until 6-month follow-up): CGI, BPRS, PANSS, CDSS, Craving VAS, BARS, BIS-11, HRS-A, MADRS, YMRS, AIMS.

At 1-month follow-up, both patients showed a considerable improvement (respectively 75% and 55.9% reduction of PANSS total score). At 6-month follow-up, reached only with the first patient, we noticed a further improvement (an overall 37.5% reduction of PANSS total score from the baseline).

The present work is the first report describing combination treatment strategies with clozapine and brexpiprazole which appear to give promising results.

No significant relationships.

The Beck Scale for Suicidal Ideation (BSS) is a self-report 19-item scale preceded by five screening items. The BSS and its screening items are intended to assess a patient's thoughts, plans and intent to commit suicide. All 24 items are rated on a three-point scale (0 to 2). In this study, scores from the five screening items were included in the overall score. Therefore, total scores could range from 0 to 48.There is no study until this date that examines the factor structure of BSS among Kuwaitis.

The current study investigated the original three-factor model of the (BSS) in non-clinical sample.

Sample one consisted of 285 males and 300 female students from Kuwait University while sample two consisted of 201 males and 302 females from Kuwait University. The Arabic version of BSS was administered to participants. Explanatory factor based on sample 1 and conformity factor analysis based on sample 2 of BSS were used in this study.

The explanatory and confirmatory factor analysis of (BSS) extracts three factors and three structures of BSS. Factor I = active suicidal desire; Factor II = preparation; Factor III = passive suicidal desire. In addition, the results revealed no significant gender differences in the factor structure of BSS.

The results of both confirmatory and exploratory factor analysis indicated that the original three-factor model provided the best fit for the two genders.

Melatonine (N-acetyl-5-methoxytryptamine) is an endogenous neurohormone produced by pineal gland. It is related to sleep-wake circadian rhythms, and nowdays it is sold without prescription as a “natural treatment” for sleep disorders. Most common side effects of melatonin overdose are drowsiness, dizziness, fatigue, headache, confusion, nightmare, hypotension, tachycardia and hypothermia. Supportive measures and control of vital signs are essential for an early discharge of the patient.

To present a case of an 42-year-old woman who was taken to the emergency department after voluntary ingestion of 60 tables of melatonin 2mg (Total amount 120mg), in a suicide attempt. To describe the most common side effects of melatonine overdose a the literature review.

Clinical case presentation and retrospective literature review.

A 42-year-old woman who was taken to the emergency department after voluntary ingestion of 60 tables of melatonin 2mg (Total amount 120mg), about 1 hour before coming, in a suicide attempt. After clinical evalutation, gastric lavage was performed. ang 50g activated charcoal given. Drowiness and mild hypothermia (34ºC) was detected. After 12 hours of vital signs observation the patient was discharged and to psychiatry consultation, where depressive mood disorder and chronic insomnia was diagnosed.

Melatonin is one of the least toxic medication. Most common side effects of overdose are drowsiness, dizziness, fatigue, headache, confusion, nightmare, hypotension, tachycardia and hypothermia. Supportive measures and control of vital signs are essential for the treatment.

No significant relationships.

Studied the role of self-esteem in the regulation of mental states in the educational activities of students.

The aim of the research is to reveal the interrelationships of states’ substructures (mental processes, experiences, behavior) with the level of self-esteem of students.

The study involved 69 students of the 1st and 2nd year, all humanities. The study was carried out in various situations of educational activity: at lectures, seminars, exams. Used the methods to study mental states, style of self-regulation and self-esteem.

Found that as the level of self-esteem increases, the intensity of mental states’ substructures also increases, and vice versa. As a result of ANOVA use, found that the regulatory properties “independence” (p <0.001) and “ability to program actions” (p <0.002) exert the greatest influence on the interaction of mental states and self-esteem. In lectures, seminars students with a low level of self-esteem mostly experience states of low intensity. Students with an average level of self-esteem are characterized by positive states of an increased level of intensity: from cheerfulness and anticipation to interest and fun. Students with high self-esteem experience mental states different in modality, intensity. As the level of self-esteem increases, the intensity of mental states’ substructures manifestation increases, and vice versa.

Average self-esteem is most optimal for the regulation of mental states. In the case of high self-esteem, the most optimal states are experienced when the subject is highly independent. Low self-esteem students, experience the least intense states. This work was supported by the RFBR grant № 20-013-00076.

No significant relationships.

The authors have not supplied their declaration of competing interest.

To develop consensus-based clinical diagnostic criteria for neuroleptic malignant syndrome (NMS).

A 17-member international expert panel of psychiatrists, neurologists, anesthesiologists and emergency medicine specialists was asked to identify clinical features that are most important or valuable in diagnosing NMS; when the feature was quantitative in nature, they were also asked to provide the corresponding critical value. The Delphi technique is a formal consensus procedure that employs a postal survey method to solicit opinions from each panel member, and to feed this information back to the entire panel in the form of anonymous, statistically aggregated data. This iterative process of information exchanges (opinions collected, group responses analyzed, feedback given to panel), or “rounds”, continues until consensus has been reached. In the present study, the predetermined consensus criterion was a round-round mean change of 10% or less for any survey item, and 5% or less across all items.

The expert panel reached consensus on the following diagnostic criteria in five iterations:

1. (1) exposure to a dopamine antagonist, or dopamine agonist withdrawal, within past 72 hours;

2. (2) hyperthermia;

3. (3) rigidity;

4. (4) mental status alteration;

5. (5) creatine phosphokinase elevation;

6. (6) sympathetic nervous system lability (2 or more of blood pressure elevation, blood pressure fluctuation, diaphoresis, urinary incontinence);

7. (7) tachycardia and tachypnea; and

8. (8) negative work-up for infectious, toxic, metabolic and neurological causes.

These are the first consensus-based diagnostic criteria for NMS, and may be preferred to previous ad hoc approaches to diagnosing this disorder.

Determine if the use of new technology (The Internet-Videogames-Mobile Phones-TV) by adolescents, could share the same pattern, even adiction, as seen in eating disorders-ED, and externalizing disorders.

New technology provides a better quality of life. The problem is their addictive potential for adolescents, and about all, in young people with impulse control disorders, such as eating disorders (bulimia Nervosa, obesity, binge disorder, pica, e.g) and externalizing disorders (attention deficit hyperactivity disorder, conduct disorder, oppositional defiant disorder, e.g) in the Institute of Trastorns Alimentaris-ITA, and our program ITA-Conduct.

This is a descriptive-comparative study, with diagnosis, according to our protocol(DSM-IV/CIE-10), and the application of four individual instruments: BIS.11 (Barratt-Impulsiveness-Scale),DENA(Screening Questionnaire of New-Addiction),IAT (Internet-Addiction-Test), and PVP (Problem-Video-Game-Playing). The population was divided into two groups:Eating Disorders(n=12) and Externalizing Disorders(n=14), within the ages of 12 to 17 years old, at our Argentona and Barcelona Centers, in treatment inpatient.

There is not significative differences in the Impulsivity(cognitive, motor and unplanned)among ED and externalizing-disorders. The unplanned impulsivity is associated with higher scoring in trials to Internet Addiction and Video-Game-Play. The mobil-phone use is higher in ED.

The use and potential abuse of new technology is similar in adolescents hospitalized for Eating Disooders and pathologies related to Externalizing Disorders, providing a problematic area: channeling symptoms without a proper approach of its implications.

Alcohol dependence is a serious problem in Central Europe and the treatment effect depends on level of patient's motivation. The theory of change assumes that therapeutic approaches should be adapted to the motivation stage.

To examine the state of readiness to change at the beginning and the end of inpatient 6-week and 12-week therapeutic program in Slovakia, Poland, and Czechia.

To compare readiness to change with insight and motivation. To find out, whether patients change during the therapeutic program and how this change leads to advances in treatment.

A total of 380 inpatients were examined using Alcohol Use Disorders Identification Test (AUDIT), the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES), Readiness to Change Questionnaire (RCQ), and Demographic Questionnaire.

Measured by AUDIT, single patients declared higher severity of alcohol dependence than married or divorced patients. A majority of patients were at the stage of action (68.5%) or preparation (26.3%) according to RCQ at the beginning of the treatment. Readiness to change was higher at the end of both programs in terms of taking steps in married patients and in terms of Decreasing of Ambivalence in single patients. The results of the 6-week program appear to be slightly better than 12-week treatment.

The intention and motivation to treatment changed during therapy. Marital status may increase the active component for readiness to change, while passive component (decreasing the ambivalence) is observed in single patients. Duration of the program does not seem to be crucial for readiness to change.

The authors have not supplied their declaration of competing interest.

The increasing global migration has made migrants’ health a pertinent topic. This article aimed to examine whether migrants were less likely than Danish-born residents to receive guideline recommended care when hospitalized for major depressive disorder (MDD) and potential differences in clinical outcomes, including all-cause mortality, suicidal behavior, and readmissions during 1-year follow-up after first-time admission.

A national cohort study was performed, including all adult MDD inpatients at mental care units in the period 2011–2017. Migrants and two migrant subgroups (non-Western and Western) were compared with Danish-born patients. Quality of care was examined using multivariable Poisson and linear regression models. Clinical outcomes were examined using Cox proportional hazards regression analysis.

Migrant-status was associated with a non-significantly lower chance of receiving high-quality care (relative risk [RR] = 0.93, confidence interval [CI] 0.86:1.01) and lower readmission rates for depression (hazard rate ratio [HR] = 0.93, CI 0.86:1.01), and significantly higher all-cause mortality (HR = 1.55, CI 1.19:2.01) and lower all-cause readmission rate (HR = 0.88, CI 0.83:0.94). No clear association was found regarding suicidal behavior. While associations were comparable for migrant subgroups regarding readmission, the associations with low quality of care and of all-cause mortality appeared strongest among Western migrants.

Among inpatients with MDD in a universal tax-financed healthcare system, being a migrant was associated with a potential lower quality of in-hospital care and worse clinical outcomes. These results warrant further investigation to clarify the underlying explanation for these inequalities and to develop and test interventions to ensure better quality of care and clinical outcomes for migrant patients.

Perinatal mental health disorders (PMHD) remain often undetected, undiagnosed, and untreated with variable access to perinatal mental health care (PMHC). To guide the design of optimal PMHC (i.e., coproduced with persons with lived experience [PLEs]), this qualitative participatory study explored the experiences, views, and expectations of PLEs, obstetric providers (OP), childcare health providers (CHPs), and mental health providers (MHPs) on PMHC and the care of perinatal depression.

We conducted nine focus groups and 24 individual interviews between December 2020 and May 2022 for a total number of 84 participants (24 PLEs; 30 OPs; 11 CHPs; and 19 MHPs). The PLEs group included women with serious mental illness (SMI) or autistic women who had contact with perinatal health services. We recruited PLEs through social media and a center for psychiatric rehabilitation, and health providers (HPs) through perinatal health networks. We used the inductive six-step process by Braun and Clarke for the thematic analysis.

We found some degree of difference in the identified priorities between PLEs (e.g., personal recovery, person-centered care) and HPs (e.g., common culture, communication between providers, and risk management). Personal recovery in PMHD corresponded to the CHIME framework, that is, connectedness, hope, identity, meaning, and empowerment. Recovery-supporting relations and peer support contributed to personal recovery. Other factors included changes in the socio-cultural conception of the peripartum, challenging stigma (e.g., integrating PMH into standard perinatal healthcare), and service integration.

This analysis generated novel insights into how to improve PMHC for all users including those with SMI or autism.