Diagnostic criteria are not always useful to discriminate major depression with anxious distress (ADS-D; Diagnostic and Statistical Manual for Mental Disorders, version-5 [DSM-5] criteria) from mixed depression (Koukopoulos’ criteria; KMX-D). So, clinicians need alternative tools to improve their diagnostic ability and to choose the most appropriate treatment. The aim of the present study is to identify socio-demographic and clinical features that discriminate patients with ADS-D from those with KMX-D.

Two hundred and forty-one consecutive outpatients with unipolar (51%) and bipolar (49%) disorder, fulfilling DSM-5 criteria for a current major depressive episode (MDE) and with a 21-item Hamilton Depression Rating Scale score ≥ 14, were recruited and treated in a prospective observational study.

Ten percent of patients met criteria for KMX-D, 22% ADS-D, and 37% for both. Irritable premorbid temperament, mixed depression polarity at onset, mixed depression recurrence, and a high number of mania symptoms at intake were typical features of patients with KMX-D. Depressive polarity at onset, a low number of mania symptoms at intake, and generalized anxiety disorder comorbidity were typical features of patients with ADS-D. Multinomial logistic regression confirmed that higher rate of irritable temperament and higher Young Mania Rating Scale total score differentiated patients with KMX-D from patients with pure MDE.

Our findings suggest some clinical features that could help differentiate between ADS-D and KMX-D in patients meeting both conditions and to select the appropriate treatment. However, the small sample size may have limited the power to detect differences between the groups. Further research is needed to confirm the results of present study.

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.

There is heterogeneity in the long-term trajectories of depressive symptoms among patients. To date, there has been little effort to inform the long-term trajectory of symptom change and the factors associated with different trajectories. Such knowledge is key to treatment decision-making in primary care, where depression is a common reason for consultation. We aimed to identify distinct long-term trajectories of depressive symptoms and explore pre-treatment characteristics associated with them.

A total of 483 patients from the PsicAP clinical trial were included. Growth mixture modeling was used to identify long-term distinct trajectories of depressive symptoms, and multinomial logistic regression models to explore associations between pre-treatment characteristics and trajectories.

Four trajectories were identified that best explained the observed response patterns: “recovery” (64.18%), “late recovery” (10.15%), “relapse” (13.67%), and “chronicity” (12%). There was a higher likelihood of following the recovery trajectory for patients who had received psychological treatment in addition to the treatment as usual. Chronicity was associated with higher depressive severity, comorbidity (generalized anxiety, panic, and somatic symptoms), taking antidepressants, higher emotional suppression, lower levels on life quality, and being older. Relapse was associated with higher depressive severity, somatic symptoms, and having basic education, and late recovery was associated with higher depressive severity, generalized anxiety symptoms, greater disability, and rumination.

There were different trajectories of depressive course and related prognostic factors among the patients. However, further research is needed before these findings can significantly influence care decisions.

Due to the COVID-19 pandemic, there is a steep rise in the acceptance of telemedicine and digital health, including increased interest in pursuing mental health treatment through telepsychiatry. Digital health helps following social distancing measures and increases the health outcomes.

To see the role of digital health in improving physical and mental well-being during COVID-19 Pandemic

This study is a part of a large global project where 240 people inquired advice on phone app during COVID-19-Pandemic. Later on, a short study was conducted on the same population through survey to evaluate the effectiveness of digital health/tele-mental health. We also searched PubMed, Google Scholar, PsychInfo, and Medline for words “Digital Health, Tele-mental health, COVID-19-Pandemic”. Reviewed 40 articles and included 3 in this review1,4,5.

We received a total of 98 responses. 65.6% people reported that online health resources are helpful in relieving pandemic-induced anxiety/stress, 66.2% reported to continue online health services after pandemic, 37.7% noted that digital health saves times in waiting areas, 46% reported lack of physical interaction with doctor as a disadvantage of digital health, and 40.3% reported comfort in using tele-mental health. Our literature review has shown barriers like privacy concerns and technological issues1. Provision of tele-psychiatry is safe and effective in continuity of mental health care.4,5

There has been an increased inclination towards digital health during any disaster. During COVID-19-Pandemic, digital health has increased access to mental health care and reduced risk of infection. The drawbacks include poor patient-doctor relationship, reimbursement concerns, and lack of confidentiality.

During the pandemic, health professionals had the unprecedented experience of dealing with a newdisease with high contagiousness and mortality. The workload, but also the fear of disease management, caused significant levels of stress. Each employee managed stress in his own way. This study detects the level of stress experienced by health workers during the pandemic and the coping strategies they selected accordingly.

The aim of this study was to investigate the coping strategies used by health professionals during the pandemic of coronavirus.

The sample comprised 180 health professionals that were working in a public hospital. The data collection tool was an anonymous questionnaire consisting of socio-demographic questions, the Toulouse Scale for coping , and a sub questionnaire to explore health professionals’ views on the pandemic.

Women (73.9%), young individuals (50.6% are up to 35 years old) and TEI graduates (53.9%) predominate in the sample. The sample consisted mainly of nurses (68.3%) and the great majority were contract workers (67%).

The most frequently used dimensions were “Active focus” (Average 3.91/5.00), “Acceptance” (3.86), “Cognitive Control and Planning” (3.61) and “Social Information Support” (3.60).

Also, health workers used more often the strategies of “Social support” (3.45), “Control” (3.33) and “Focus” (3.23), while they use the “Withdrawal” strategy less often (2.25). Finally, respondents used “Positive strategies” more often (3.54) than negative ones.

The health professionals in the present study preferred to ask for information and use cognitive and informative strategies more often and, to a lesser extent, they were overwhelmed by their emotions. The strategies of social support, control and focus were used more often, while the strategy of withdrawal was selected less often. Furthermore, positive strategies were used to a greater extent.

None Declared

No significant relationships.

Antisocial disorder is characterised by difficulty to adapt to social norms that normally rule different aspects of the person’s conduct in adolescence and adulthood. According to DSM-V, this disorder’s prevalence stands between 0.2% and 3%, and is more frequent in men.

Numerous studies have been made about the influence between the environment and genetics for the development of this disorder, finding in several patients a punctual mutation of the monoamine oxidase gen (MAOA); although impulsive behaviour has also been associated to the 5-HT tranporte gene (5-HTT), and the protein coding gene for Tryptophan Hydroxylase TPH1

The hospital admission for these patients must be made when there’s autoregressive or hetero aggressive behaviour, suicide attempts, psychotic symptoms, or symptoms that generate important repercussions in the person’s normal functions. Nevertheless, is important to identify during the hospitalization the improvement possibilities of these patients in order to make drug or psychotherapy adjustments; in the case that we don’t observe treatment benefits, the patient will be released from the hospitalization

The main treatment is psychotherapy.

There’s not much evidence of drug use in this disorder, however, mood stabilizers, antidepressants, atypical antipshychotics and benzodiazepines are used for rage control, impulsiveness, anxiety and aggressiveness.

No significant relationships.

Anorexia nervosa (AN) is a serious mental illness. One-third of people develop severe, enduring, illness, adversely impacting quality of life with high health system costs. This study assessed the economic case for enhanced care for adults newly diagnosed with AN.

A five-state 312-month-cycle Markov model assessed the economic impact of four enhanced care pathways for adults newly diagnosed with AN in England, Germany, and Spain. Enhancements were halving wait times for any outpatient care, receiving specialist outpatient treatment post-referral, additional transitional support post-referral, and all enhancements combined. Care pathways, estimates of impact, resource use, and costs were drawn from literature. Net monetary benefits (NMBs), impacts on health system costs, and disability-adjusted life years (DALYs) averted were estimated. Parameter uncertainty was addressed in multi-way sensitivity analyses. Costs are presented in 2020 purchasing power parity adjusted Euros.

All four enhanced care pathways were superior to usual care, with the combined intervention scenario having the greatest NMBs of €248,575, €259,909, and €258,167 per adult in England, Germany, and Spain, respectively. This represented maximum NMB gains of 9.38% (€21,316), 4.3% (€10,722), and 4.66% (€11,491) in England, Germany and Spain compared to current care. Healthcare costs would reduce by more than 50%.

Early and effective treatment can change the trajectory of AN. Reducing the untreated duration of the disorder is crucial. There is a good economic case in different country contexts for measures to reduce waiting times between diagnosis and treatment and increase access to enhanced outpatient treatment.

Adolescents and young adults are a vulnerable population to both alcohol use disorders and depressive major disorder. Use of cognitive-behavioral therapy (CBT) could help in diminishing depressive symptoms severity as well as alcohol dependence severity.

To evaluate CBT efficacy in young adults diagnosed with major depressive disorder and alcohol dependence.

A number of 12 patients, age 23–35, 7 male and 5 female, outpatients, diagnosed with alcohol dependence and major depressive disorder, moderate or mild episodes, according to ICD-10 criteria, were included in a 3 months CBT oriented program. All subjects were evaluated using a Visual Analogic Scale (VAS) for self-evaluation of alcohol problems severity (score ranging from 0 – absent to 10 – extremely severe), AUDIT scale, Hamilton Depression Rating Scale (HDRS) – 17 items, and Global Assessment of Functioning (GAF). Patients participated in 30 minutes individual CBT sessions, twice per week, for 12 weeks. Cognitive restructuring based on patients’ diary, coping skills training, and activation techniques have been applied in the CBT sessions.

After 12 weeks all patients reported decreases on VAS and AUDIT scores, with mean percentages of 55 and 50, while GAF increased with 45%. HDRS scores decreased with 65%. These changes were considered significant when compared to initial values (P = 0.007 for VAS, P = 0.009 for AUDIT, P = 0.012 for GAF and P < 0.001 for HDRS), according to dependent samples t-test P < 0.05, bivariate.

Cognitive-behavioral therapy, focused on cognitive restructuring, coping skills training, and activating techniques is an efficacious intervention in young patients with comorbid depressive and alcohol dependence.

The presenting author was speaker for Astra Zeneca, Bristol-Myers Squibb, CSC Pharmaceuticals, Eli Lilly, Janssen-Cilag, Lundbeck, Organon, Pfizer, Servier, Sanofi Aventis and participated in clinical research funded by Janssen-Cilag, Astra Zeneca, Eli Lilly, Sanofi Aventis, Schering Plough, Organon, Bioline Rx, Forenap, Wyeth, Otsuka Pharmaceuticals, Dainippon Sumitomo, Servier.

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

First psychosis programs have been developed during the past 30 years to influence the prognosis of a first psychotic episode by early integrative biopsychosocial interventions, with a focus on the processes that contribute to relapse. In the process of recovery, Navigate program emphasis on enabling a connection to what is important to the person (work, studies, relationships, intimacy), thus strengthening resiliency and quality of life and reducing self-stigma. Medication is part of any intervention program, however, there is a lot of ambivalence amongst the young person and family about its continuation and many will stop the medication altogether. Moreover, although evidence for the benefits of antipsychotic medication in short-term treatment is well established, there is an ongoing debate in the professional medical literature about the need and benefit of routine prophylactic long-term antipsychotics after first psychotic episode. There is also a significant uncertainty concerning the proportion of patients that will maintain remission without antipsychotics.

In this lecture, we will present some of the lessons that we have learned and are still learning from our clients, together with case examples.

In our Navigate Program, we have developed strategies based on literature and experience that enables the person/family to be part of the decision-making process, which at times presents dilemmas and risks but also promotes the potential for growth and transformation.

How do we talk about the medication issue? Who can continue without medication or with very low dosage? How can we taper antipsychotic treatment?

Are we willing to take the risk?

No significant relationships.

For developing suicide prevention interventions, epidemiologic, socio-economic and demographic factors influencing suicide rates are of high interest. One considerable factor in this respect is gender, as in most countries male suicide rates are much higher than female suicide rates with a global average male/female ratio of 3.6:1. The present study seeks to contribute to the clarification of the question what underlies the different suicide rates of men and women by analyzing gender-specific lethality of suicide methods.

Data on completed (fatal) and attempted (non-fatal) suicides from 2000 to 2004 were collected in two cities in the region of Bavaria, Germany. This data sample offers the opportunity to compare data of suicidal acts including completed as well as attempted suicides of the same region during the same time. The lethality for each suicide method was estimated by dividing the number of fatal episodes by the total episodes and then related to gender and age.

Lethality per method was higher for men than for women; significant differences could be shown for the majority of methods. Regarding age, lethality rising with age could be shown. Still, in higher age groups, differences in lethality between men and women were significant.

Results stress the importance of gender-specific suicide prevention. Male-specific suicide-prevention should be concerned with improving access to and treatment of men under risk for suicidal behaviour. Addressing the problem through multifaceted programs therefore is a promising approach.

Little is known about how young medical professionals view euthanasia (EUT) and assisted death activities. The aim of this study is to investigate and to compare Greek final year medical students and medical trainees' attitudes towards EUT and physician-assisted suicide (PAS).

To assess attitudes towards EUT and PAS we translated, adapted and modified, in a short version, the questionnaire developed by Ganzini et al (1996). The Greek version of the questionnaire consisted of 26 items. 251 final year medical students and 274 medical trainees completed the questionnaire. The survey was anonymous.

52% of medical students and 64% of medical trainees were for the acceptance of EUT. The view that PAS may be morally acceptable under some circumstances was endorsed by 76% of the students and by 79% of the trainees. 80% of the students and 81% of the trainees believed that withdrawing life sustaining medical treatments in terminally ill patients should be permitted. 54% and 38% of the students and trainees, respectively, believed that prescribing drugs to relieve pain in doses that may hasten death should be permitted.

A high percentage of the medical students and medical trainees were for the acceptance of EUT and PAS. Given the progress of legalization of EUT in many countries, the need for special education regarding many aspects of EUT is demonstrated.

Life expectancy of people with schizophrenia is reduced by 10-20 years compared to the general population. The excess mortality is part due to an increased prevalence of cardiovascular disease, prediabetes and obesity, which are in part due to antipsychotic treatment. Gaining weight is associated with reduced quality of life and also among the most frequently reported reasons for the discontinuation of treatment. Lifestyle changes have a time limited effect, and therefore, interest has focused on Glucagon-Like Peptide 1 receptor agonist treatment. Semaglutide, currently used to treat type 2-diabetes in doses up to 1.0 mg once-weekly, has shown promising results regarding weight loss in doses up to 2.4 mg once-weekly. It may also be able to reduce the risk of developing diabetes and cardiovascular disease.

The HISTORI Trial aims to reduce risk of developing diabetes and cardiovascular disease in people with schizophrenia, prediabetes and overweight and to investigate for an indirect effect of Semaglutide on psychotic symptoms and quality of life through a weight loss.

A 30 weeks randomized, placebo-controlled, double-blinded study with once-weekly injections of Semaglutide 1.0 mg. Primary inclusion criteria are age 18-40 years, schizophrenia, prediabetes, overweight and treatment with antipsychotics. Questionnaires and interviews regarding psychotic symptoms, quality of life, medication adherence and physical activity will be applied either monthly or every third month.

will not be ready for the congress. A poster outlining the feasibility challenges will be presented.

Perspective: Through weight loss, Semaglutide may indirectly be able to improve quality of life, medication adherence and psychotic symptoms.

No significant relationships.

Acute angle-closure glaucoma (AACG) is an ophthalmic emergency, accompanied with severe eye pain, headache, and visual changes because of acute intraocular pressure elevation. Among psychotropic drugs, several antidepressants, typical antipsychotics with strong anticholinergic effects, and topiramate have been known to increase a possibility of AACG. Benzodiazepines have been used widely in the treatment of mental and physical illnesses regardless of age or indication. Since benzodiazepines have some anticholinergic properties and affect pupillae muscles, their use could be theoretically a risk factor for AACG. However, it is unclear whether benzodiazepines actually increase the risk of AACG. To our knowledge, there was no population-based study on the risk of benzodiazepines to the occurrence of AACG.

To know whether benzodiazepines increase the risk of AACG in a geriatric population.

We will perform a case-control study using a geriatric cohort from the National Health Insurance database. Case subjects will be defined as cases diagnosed with AACG confirmed by the claim data of laser iridotomy, which is the definitive treatment of AACG. The controls, which were not diagnosed with AACG, will be matched with case subjects according to similar age, sex, and the scores of the Charlson comorbidity index.

The data handling and statistical analyses will be executed in autumn and winter 2016.

Any preliminary findings of this study will be presented at the EPA 2017. We will discuss the importance of a pharmaco-epidemiological study in the geriatric research.

The authors have not supplied their declaration of competing interest.

In January 2012, a drug consumption room (DCR) opened in an outpatient treatment center for alcoholism and drug abuse (CADA) to reach people who inject drugs (PWID) who did not seek treatment.

To evaluate the characteristics and evolution of 76 patients undergoing methadone maintenance treatment (MMT) during a year in a CADA, depending on whether they are DCR users or nonusers.

A retrospective cross-sectional observational study was conducted by reviewing data collected from patients in MMT during 2015, performing a statistical comparison between DCR users and nonusers. Outcome was evaluated through urine controls, considering a poor outcome when positive to heroin > 20%.

Of the 76 patients in MMT, the average age was 40 years, 21% were women, mean dosage of methadone was 48.2 mg/day and more than a half were DCR users (52.63%). Of the 40 patients, which formed the DCR user subgroup, the average age was 36.4 years, 20% were women and mean dosage of methadone was 47 mg/day. The outcome of all the patients in PMM was successful in 48.68% of the cases, presenting differentially the nonusers a 91.67% of good response and the users only a 10%.

Inclusion of a drug consumption room in an outpatient treatment center for alcoholism and drug abuse, which facilitates accessibility for people who inject drugs to treatment, poses new challenges in order to improve the effectiveness of the PMM.

The authors have not supplied their declaration of competing interest.

Over the last few years, there has been increased interest in the addictive potential of the internet. The current study was an attempt to replicate common findings in the literature and provide more evidence for the existence of internet addiction among school students - a population considered to be especially vulnerable.

Studies of general internet users suggest that some children's may experience psychological problems such as social isolation, depression, loneliness, and time mismanagement related to their internet use and failure at school.

All of the students (N = 650) came from 7 gymnasium schools and 6 high schools of Iasi, Romania. The students answered to a questionnaire comprising 34 questions related to computer activities. These were aimed at highlighting: 1. The frequency of internet use by the students; 2. The identification of a psychological problems; 3. Identification of a possible internet addiction.

Results show that the school students prefer to spend a considerable amount of time with their computers, over 5 hours/day. The purpose of this article is to describe how internet use affect socialization, academic performance, personality and to discuss how identity are constructed in cyberspace.

Excessive amounts of time at a computer can contribute to undeveloped social skills and a form of addictive behaviour, and failure at school. Internet addiction is marked by symptoms of increasing tolerance, withdrawal, mood changes, and interruption of social relationships. The results show that the parents don't recognize internet addiction.