In recent years, advances in the areas of both bipolar disorder (BD) and borderline personality disorder (BPD) have generated considerable interest in the relationship between these two conditions, since that they are commonly comorbid.

We aimed to investigate the impact of BPD on course of illness in patients with BP.

We conducted a cross-sectional, descriptive and analytical study among 30 psychiatric outpatients diagnosed with BD in the Psychiatry « B » department, Hedi Chaker Hospital (Sfax, Tunisia). The McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) was used to screen for BPD. Clinical outcomes (hospital stays, comorbidities, suicidality…) were compared between BD- patients with or without BPD comorbidity.

The mean age was 41.63 years, with a sex ratio of ½. Among the patients, 2/3 were diagnosed with BD-I, while 1/3 presented a BD-II. Physical comorbidities, comorbid anxious and eating disorders were noted respectively in 36.7%; 16.7% and 43.3% of patients. Suicidal attempts were reported in 46.7% of cases. According to MSI-BPD, a comorbid BPD was noted in 30% of our sample. Patients with BD-II were significantly more likely to present BDP traits (50%) than those with BD-I (20%) (p<0.001). Patients with BPD were significantly more likely to attempt suicide (p=0.033), and to present physical comorbidities (p<0.001) and comorbid eating disorders (p<0.001).

Our study showed that BPD darkens the prognosis of BD, because of worse outcomes related to suicide, physical and psychiatric comorbidities. Thus, its co-occurrence complicates the management of BD.

No significant relationships.

This systematic review estimates the pooled prevalence (PP) of oppositional defiant disorders (ODD) among 5-to-18-year-old YP living in Europe, based on prevalence rates established in the last five years (LFY).

Trends of prevalence rates across countries, gender and level of education were analysed. The random effects pooled prevalence rate (REPPR) for ODD was calculated.

A search strategy was conducted on three databases. Studies were also identified from reference lists and grey literature. Eligible studies were evaluated for reliability, validity, bias, and the REPPR for ODD was calculated.

The European REPPR for ODD is calculated at 1.9% (Figure 1). The REPPR among males is 4.8%, whereas the rate among females is 2.7% (95% CI: 0.7%- 1.4%). The prevalence rate of ODD among primary school children is 1.8 times higher than the prevalence of secondary school children (Figure 2).

Gender, culture and socioeconomic diagnostic inequality may contribute to prevalence differences across countries. Routine screening and addressing these aspects may facilitate early intervention.

No significant relationships.

Antipsychotic drugs effectively control psychotic symptoms, but may cause important side effects, significantly increasing morbidity and mortality. Hematologic abnormalities are frequent and may be life-threatening in some patients. Many prospective investigations confirmed neutropenia as a frequent occurrence with virtually all atypical antipsychotics.

Define epidemiological, clinical and therapeutic characteristics of antipsychotics – induced leukopenia and neutropenia through a case report and a review of literature.

Patient 28 years old native of Tunis, with family history: brother who suffer of undifferentiated schizophrenia. Since the age of 16 years he has been followed for disorganized schizophrenia (DSM IV). He was initially put under Haldol Decanoate (2 months), fluphenazine (2 months), amisulpride (3 months), sulpride (2 months), olanzapine (3 months), Rispreridone (1 month), aripiprazole (5 months) leukopenia/neutropenia is occurring during treatment with each molecule and which promptly resolved after discontinuation. Reduced white blood cell count has also been reported after addition of lithium. Actually an ECT is proposed for this patient.

This case report shows the importance of hematological monitoring during the course of typical or atypical treatment.

The authors have not supplied their declaration of competing interest.

Delirium is a frequent and serious acute neuropsychiatric syndrome, namely in elderly hospitalised patients, described as a psychologically traumatic experience by patients, family/caregivers and health professionals(HPs). In this context, the Delirium Experience Questionnaire (DEQ) was developed as a face-valid instrument assessing the delirium experience recall and the degree of distress related to delirium episodes in patients, family/caregivers, and HPs.

To present the translation and cultural adaptation of the Portuguese version of DEQ (DEQ-PT).

The translation process followed ISPOR guidelines. After preparation, forward translation, reconciliation, back translation, back translation review, harmonization and cognitive debriefing (involving experts’ consensus), the DEQ-PT was tested (pre-test) in a group of elderly patients with delirium(≥ 65 years) in two Intermediate Care Units (Intensive Care Medicine Service-CHSJ, Porto). Exclusion criteria were: brain injury, blindness/deafness, unable to communicate, and Glasgow Coma Scale ≤ 11. Their families were also assessed, as well as the HPs (physicians/nurse) in charge of patients during hospitalisation.

After obtaining permission to use the instrument, the DEQ was successfully translated into Portuguese, with harmonization of all new translations. Pre-test included a group of 5 patients, 5 families and 5 nurses. This version revealed good cognitive equivalence with the original English version and also a good level of comprehensibility.

The DEQ-PT showed good feasibility, being suitable, quick and easy to use in the assessment of delirium experience in intermediate care units. These findings will be further developed by an ongoing validation study.

This work was supported by foundation for science and technology (SFRH/BPD/103306/2014).

The authors have not supplied their declaration of competing interest.

We all have the innate ability to tell our story and the way we do it can determine the impact that each problem has on our lives. Storytelling can play a critical role in psychiatric practice and, from this premise, a new way of practicing psychiatry has recently emerged: narrative psychiatry.

The objective is to offer a unified vision of narrative psychiatry, providing details on the historical and academic context of this approach.

A narrative-type literary review focused on narrative psychiatry will be presented.

Narrative psychiatry is an innovative clinical approach in line within narrative medicine and with a specific subtype of postmodern psychotherapy, the narrative therapy of Michael White and David Epston. This novel way of practicing psychiatry arises from critical movements within the discipline but it is an integrative and collaborative perspective: the position of each problem in the patient’s personal narrative is discussed and different therapeutic proposals are addressed, including for instance psychotropic drugs. This integrative posture gives the narrative psychiatrist enough flexibility to equally integrate the scientific achievements of biological psychiatry and the humanizing component of narrative practice. In this literature review, the key tools proposed by the main narrative psychiatrists worldwide for the narrative clinical interview will be exposed.

Narrative psychiatry is a novel approach that narrows the therapeutic relationship and that puts in evidence the history of resistance of the consultant, healing through its own storytelling.

Bipolar disorder (BD) is a complex mental illness described by recurrent episodes of mania and depression. One subtype of the illness is rapid cycling BD, characterized by experiencing four or more extreme mood swings within a year. Diagnosing and treating BD can be complicated by comorbid conditions, such as atypical anorexia nervosa (AAN), marked by disordered eating and disturbing weight-related thoughts.

To discuss the diagnosis and treatment plan of a patient with rapid cycling BD, who experienced adverse effects from prescribed medication and later was diagnosed with comorbid AAN.

We present a case of a 21 year-old man initially presenting with anxiety, low mood, and obsessive weight-related thoughts, ultimately diagnosed with major depression and mixed anxiety disorder.

21 year-old man was diagnosed with major depression and mixed anxiety disorder, initially treated with mirtazapine and fluoxetine (limited success), later attempting escitalopram and bupropion combination (partial remission). After 2 years the patient discontinued the treatment due to feeling “euphoric”, subsequently experiencing depression and manic episodes – the initial diagnosis was rapid cycling BD. The treatment was changed to sodium valproate (up to 1500 mg/day) and aripiprazole (up to 10 mg/day), however extremely rare adverse medication effects (nosebleeds, diarrhea with blood admixture, “high-frequency sounds”) were reported. Throughout valproate treatment, the patient experienced persistent diarrhea. During hospitalization for treatment adjustment lithium carbonate was introduced at a starting dose of 900 mg/day, maintaining blood lithium levels between 0.4 mmol/l and 0.49 mmol/l. Later the dose was adjusted and a therapeutic lithium blood level was reached with 1575 mg/day of lithium carbonate. Additionally, risperidone was prescribed, however, the patient experienced an uncommon adverse reaction – nasal congestion. Subsequently, amisulpride was introduced, which provoked severe anxiety and fear, resulting in medication discontinuation. During the latest outpatient visit, fluoxetine was added to the treatment due to observed depressive symptoms. Throughout the treatment, the patient episodically intermittently starved, had persistent distressing thoughts about weight and was diagnosed with AAN. While planning further treatment it was hypothesized that comorbid AAN might affect drug metabolism and the patient was referred to a specialized inpatient facility for eating disorder management.

This case report highlights the complexity of psychiatric disorders and the importance of monitoring and adjusting treatment based on patient response and side effects. Additionally, it emphasizes comorbid conditions significance in influencing the primary disorder’s dynamics as well as the metabolism and effectiveness of psychiatric medications.

None Declared

There is a lack of instruments evaluating self-stigma among adolescents with mental health issues in the Russian language for today. The questionnaire developed by Tally Moses (Moses, 2009) is convenient to fill that lack.

The study aims to compare the main parameters of the original questionnaire to that of the version translated in Russian.

The original questionnaire was translated into Russian and administered to 40 adolescents (21 males, aged 12 to 17) with mental disorders except for severe cognitive deficits or pervasive developmental disorders. Means and Cronbach’s alpha for each of the four scales were assessed and compared to the author’s questionnaire values.

Reliability analysis revealed similar Cronbach’s alpha for 3 of 4 scales (table 1) except the Secrecy scale (1 of 6 questions showed low consistency; its exclusion increased α from 0.63 to 0.74).

The means for each scale were compared with original data using a one-sample t-test. Only the Personal Rejection scale was significantly low on average than the original data.

Preliminary results showed that Russian adolescent patients perceived the translated questionnaire much the same way as American ones. Thus, our findings provide optimistical perspectives of further adaptation of the questionnaire.

No significant relationships.

The McGill Illnes Narrative (MINI) is a semiestructured, qualitative interview schedule, which is useful to explore individuals’ illnes narratives in sociocultural context. It has been used in first- time postmyocardial infarction patients and also in patients with hyperemesis gravidarum, but it has not yet been used in fibromyalgia.

A study was conducted using McGill Illness Narratives (MINI) with 20 patients who were recruited from a referral Rheumatology Service during 2009 and 2010, and met criteria of the American Association of Rheumatology for fibromyalgia syndrome (FMS) trying to explore:

• Narrative of illness experience

• Salient prototypes related to current health problem

• Explanatory models

• Help seeking and service utilization

• Impact of illness

The interviews were carried out and audiorecorded and the narratives were analyzed according to their structure and content.

The physical cause was the most common causal attribution. Most of them had been treated for different specialists, and reported problems in seeking diagnosis and help from professionals. Some patients were diagnosed by rheumatologists with celiac disease, lactose intolerance and undifferentiated spondylitis, termed “False Fibromyalgia”. Like previous research, negative emotional states were correlated with worsening pain. Many changes were related in their way of life.

Qualitative studies are essential to complement quantitative research methods and are imprescindible to understand FMS. The exploration of the explanatory models may stimulate exchange between disciplines and may give access to a popular cultural construct related to somatic conditions not yet documented in the literature.

The activity of military personnel is associated with risk and tension which can affect both physical and mental health. Hardiness reflects certain characteristics of a person that can motivate them to take an active part in overcoming difficult circumstances. Thou we considering Hardiness is a resource for the reliability of professional activity. The study was supported by the RFBR #19-013-00799.

Research of Hardiness as a military personnel professional reliability resource.

The research involved 315 participants, male. Average age 20.12 years (min – 18, max – 32). The participants completed 3 standardized questionnaires: The Occupational Stress Survey (Leonova, 2006), The 16 PF Questionnaire (rus. version, Kapustina (eds.), 2001), Hardiness Survey (rus. ver. by Leontiev, Rasskazova, 2006).

In our study Hardiness value was above-average (M = 101.3; SD = 15.96). Correlation analysis revealed a direct relationship between Hardiness and “Reliability of professional activity” (M = 0; SD = 1) – Chronic stress, Emotional Stability, Motivational Distortion, Apprehensiveness (p = 0.0001; r = 0.678). It also appeared that Hardiness is a predisposition factor of professional reliability activity (adj. R2=0.539). Correlation analysis also revealed an inverse correlation between Hardiness and Chronic stress (p = 0.0001; r = -0.730).

Thus Hardiness is a resource for the reliability of professional activity. These results can be used in practice for performing trainings to support specialists and help them develop resources for reliability of professional activity.

No significant relationships.

Parent training programs have high potential to promote positive parent-child relationships as well as reach and engage parents to participate. Digitally delivered programs may overcome the barriers associated with face-to-face interventions, such as stigma, logistic challenges and limited resources.

To assess the effectiveness and feasibility of digital universal parent training program for families with 3 years-old children, focusing on parenting skills and child´s behavior.

A non-blinded randomized controlled trial (RCT) with two groups: (I) the intervention group, in which participants receive the parent training and (II) the waiting list group, in which participants are placed on a waiting list to receive the parent training intervention after the first follow-up measurement have been completed. Participants must meet the following inclusion criteria: a) guardians having a child age 3 years, b) participating to annual health checkup in child health clinic, c) at least one of the guardian is able to understand the languages that intervention is provided.

Pilot study with feasibility assessment finished at early 2021. Recruitment of the wider RCT study is currently ongoing. The results from the pilot study and more detailed description about the intervention will be presented.

This study with good national geographical coverage is a unique possibility to evaluate universal parenting program on promoting parenting behaviors associated with the promotion of optimal child emotional development. This study also provides population level information about parenting skills and child´s behavior.

No significant relationships.

cocaine is a widely used illegal drug, known for its fast ability to induce euphoria and arousal. However, cocaine exposure can contribute to several mental and physical effects. Cocaine induced brain damage can be divided into 3 mechanisms: direct effect leading to toxic encephalopathy, secondary to vascular damage causing vasculitis, stroke and vasospasm, and tertiary effect due to hypoxia through a cardiovascular collapse.

Here, we report 2 young men who developed a subacute encephalopathy with different clinical and radiological presentation after a cocaine overdose

a case serie

we present two men aged respectively of 28 (P1) and 42 years-old (P2). Both had a history of alcohol consumption and toxicomania (mainly cocaine) during the past year. They manifested, 2 weeks following a cocaine overdose, with gait disorder and confusion. On examination, P1 was apathic and confused. He had a subcortical frontal syndrome with gait apraxia and grasping reflex, along with a quadri-pyramidal syndrome. While patient P2 developed a cognitive decline, parkinsonism with dystonic posture of the trunk and the right limbs, and a pseudobulbar syndrome. Brain MRI was performed in both patients and showed a bilateral multifocal leukoencephalopathy (P1) and the presence of bilateral hyper T2 and FLAIR weighted images affecting basal ganglia, the mesencephalon and the periventricular cerebral white matter. Cerebrospinal fluid (CSF) analysis showed no pleocytosis and normal proteinorrachia. Electroencephalogram was also normal. Infectious differential diagnosis including Human Immunodeficiency Virus (HIV) and syphilis were excluded and metabolic screening including copper analysis, serum and CSF lactate were normal. The urine toxic screening, performed 20 days following the drug overdose, was negative. Both patients were treated with benzodiazepine and fluids without significative improvement. They were discharged with major cognitive and motor impairment.

cocaine toxicity is associated with high morbidity and mortality. Usually, cocaine abuse can lead to cardio-vascular, pulmonary and nervous complication. Neuropsychiatric sequelae are uncommon with less recovery potential. To date, there is no drug to prevent or cure cocaine addiction. The key is to educate the patient when he or she presents to the emergency department. Patients should be urged to seek drug counseling.

None Declared

People with severe mental illness have an increased vulnerability to cardiovascular disease due to multilple biopsychosocial factors and a potential adverse effects of longer term treatment with anti-psychotic medications. Treatment of severe and enduring mental illness with antipsychotic medications is likely to cause metabolic changes leading to weight gain and dyslipidaemia, thus increasing risk of cardiovascular disease. Cardiometabolic risk screening can be done using Lester Tool which also provides recommendations for interventions.

To identify the compliance to Lester Tool in the monitoring of cardiometabolic risk factors and intervention provided on acute psychiatry inpatients.

We carried out a retrospective audit of 30 patients on regular antipsychotic medication on an adult inpatient ward in Macclesfield, United Kingdom. Electronic records were reviewed to establish whether the smoking status, lifestyle, BMI, blood pressure, blood glucose and blood lipid were documented with evidence of interventions being provided.

Of all 30 patients, none had shown compliance to all the parameters within the Lester Tool. 100% of the smoking status was documented, amongst which 78% were provided with interventions. 7% has lifestyle and diet status documented, of which 50% were given dietary advice. 80% had BMI documented, amongst which none were provided with any intervention. 90% had blood pressure documented, of which 50% were given any intervention. 40% had blood glucose documented, of which all were provided with intervention. 57% had blood lipid documented, of which none were provided with any intervention.

Our results have shown the need of further awareness on the usefulness of the Lester Tool in an acute inpatient ward. Our recommendation would be to regularly train and educate inpatient staff to ensure that all the necessary parameters be monitored and provided with interventions.

None Declared

The urgency of the problem of depression is due to their high prevalence and severity of consequences. At present, the pathogenetic role of heredity in the course of depressive disorders remains unclear. Therefore, studies related to this problem are designed to identify the relationship between hereditary factors and the characteristics of the clinic of depression.

The aim was to study the features of the influence of hereditary factors on the clinic of depressive disorders.

clinical-psychopathological, psychometric, genealogical, statistical.

Based on the study of clinical, psychometric (Hamilton scale (HDRS)), genealogical data of 87 patients with depression, a high level of family burden of depression at all levels of kinship in the pedigree of patients (73.56%), alcohol abuse (39.08%), the presence of hypertension (54.02%), heart disease (42.53%) and endocrine pathology (14.94%) were identified. Moreover, in the pedigree of the examined most often this pathology was found in relatives of I and II degree of kinship. When comparing the factors of heredity with the clinical structure and features of depression revealed the proportion of correlations of such factors as: observation by a psychiatrist of I and II degree of relatedness (p ≤ 0.01), depressive disorders mainly by II degree of relatedness (p ≤ 0.05), suicidal behavior according to I and II degree of kinship (p ≤ 0.005), alcohol dependence mainly on I degree of kinship (p ≤ 0.03). Selected leading symptom complexes: depressive, asthenic, apathetic, anxiety-phobic, somato-vegetative, hypochondriac.

The data obtained should be taken into account in diagnostic and preventive measures.

Childhood maltreatment is the most important risk factor for the onset of psychiatric disorders. Revictimization is really frequent as well as substance or alcohol abuse, often linked to self-treatment. Accordingly, our pilot study aims to analyze possible implication of childhood maltreatment on resilience and burnout.

Patients admitted to outpatients psychiatric department in a six month period (1st January 2015–30th June 2015) complaining low to moderate anxiety or depression have been administered childhood trauma questionnaire (CTQ) and Maslach burnout inventory.

CTQ results in 71 (87%) Emotional Neglect (EN), 2 (2.4%) Sexual Abuse (SA) and 2 (2.4%) Physical Abuse (PA). Twenty-one showed high emotional exhaustion, 21 high depersonalization, 9 moderate personal accomplishment while 1 showed low personal accomplishment. None of the patients who suffered child sexual abuse shows depersonalization or personal accomplishment difficulties linked to burnout. Patients negative to CTQ show respectively moderate emotional exhaustion (M = 20 ± 20.15), moderate depersonalization (11 ± 9.42) and high personal accomplishment (17 ± 12.38). Patients who suffered emotional neglect show the poorest profile at Maslach, particularly regarding emotional exhaustion. ANOVA reaches statistical significance among the 3 groups of detected abuse (EN, SA, PA) in personal accomplishment (P = 0.013) confirmed at POST HOC between EN and SA (P = 0.0004).

The results obtained in this pilot study highlight two important considerations. First, it seems urgent to stress the huge prevalence of emotional neglect among those referred to psychiatric outpatient department due to moderate anxiety or depression complain. Moreover, emotional neglect appears to be the most compromised factor of burnout, especially if compared to sexual abuse.

Internet gaming has become a topic of interest since it has positive but also negative effects.

To explore the relationship between internet gaming, aggression and psychological distress in young adults.

229 Portuguese subjects (55.5% females), with a mean age of 21.13 years old (SD = 2.075, range: 18-29) filled in the Internet Gaming Disorder Scale-Short Form, the Buss-Perry Aggression Questionnaire, and the Depression, Anxiety and Stress Scales-21.

The total score of internet gaming was of 15.90 (SD=6.32), 79.9% (n=183) of the sample used to play videogames and 24.5% (n=56) spent more than ten hours playing a week. Internet gaming was correlated with physical aggression (r=.23**), anger (r=.31**) and hostility (r=.35**); and with depression (r=.36**), anxiety (r=.28**), and stress (r=.31**). A Mann Whitney U test revealed significant differences in internet gaming disorder levels of males (Md=130.75, n=102) and females (Md=102.35, n=127), U=4871.000 z=-3.232, p=.001, r=4.49.

Internet gaming disorder is associated with aggression and psychological distress, and males presented higher internet gaming disorder levels. Future studies are needed to explore the bidirectional relationships between gaming disorder, aggression and psychological distress.

No significant relationships.