Were violent/non-violent traumatic life events and victimization by/witnessing violence associates of attempted suicide among depressed adolescents who were also less resilient at early adulthood?

The present study examined a subset of mainly depressed, age-and-gender matched, adolescents derived from a representative sample of 2464 students (T1, mean age = 13.7 years) followed-up after one year (T2Q) and reassessed 5 years later (T3, n = 252, mean age = 20.0 years, 73% participation), with a questionnaire, including the Connor-Davidson Resilience Scale and K-SADS-PL psychiatric interviews which also tapped traumatic life events.

Logistic regression analyses revealed that attempters were victims, not witnesses of violence; more depressed and less resilient than non-attempters, and that resilience was a moderator of lifetime violent events and attempted suicide, even in the presence of antecedent depression.

Nitrous oxide (NO), also known as “laughing gas” is a colorless gas used as an anesthetic, a propellant in some foods, an engine performance enhancer and a recreational drug. When inhaled, it is known to provoke a rapid feeling of euphoria or excitement for a short period of time, dissociative phenomena and sometimes laughter. As its fellow anesthetic agent and NMDA-receptor antagonist, ketamine, NO is being studied for its possible therapeutic profile in treatment resistant major depression (TRMD).

TRMD is a serious illness, that urges for effective alternative treatments. In that regard, we explored the recent studies conducted in these patients, using NO in different dosages when compared to placebo.

The authors revised the published literature about this topic, selecting relevant articles with the topic words: “Depression”, “Treatment Resistant Major Depression” and “Nitrous Oxide” in scientific data base.

Since 2018, at least two randomized clinical trials have demonstrated that NO has considerable antidepressant effects in TRMD, when compared to placebo. Investigators noted that these positive effects where maintained at least for two weeks after a single 1-hour inhalation. In a more recent study, scientists compared different NO concentrations (25% vs. 50%) concluding that the 25% concentration had similar efficacy with a lower risk of adverse effects.

There appears to be encouraging results when treating patients with TRMD with NO in a 25% concentration. Nonetheless, there is need for further investigation, namely through studies that compare NO with other valid TRMD treatments and not only versus placebo.

No significant relationships.

Stigma is one of the most important barriers to help-seeking, treating maintenance and recovery for people suffering mental disorders. These attitudes, when present in mental health workers, may have a negative effect on the quality of health care.

to evaluate the levels of stigma in a representative sample of mental health workers and to explore potential modifiable factors associated to stigma attitudes.

An online survey was conducted on the mental health workers of Castilla y León (Spain, 2409164 habs) while projecting the 2022 Mental Health Humanization plan in order to asses educational skills, burnout (Maschlach MBI), Professional Quiality of life (CVP-35) and Stigma attitudes (Mental Illness: Cinician’s Attitudes Scales, MICA4) together with sociodemographic and work position variables.

193 workers completed completed the survey. Stigma Attitude values of the sample were low (MICA4: 31.71; SD:7.3) and burnout were low or medium (medium Emotional Exhaustion: 19.22; SD8.89; low Depersonalization: 4.91; SD:3.61; Medium Personal Accomplishment: 34,17; 6.3). In the linear regression (R2=0.249; F:11,527; p<0,001), a lower Stigma was predicted by psychologist (Beta:0,207; p=0,003) or psychiatrist position (Beta:0,204; 0,005), Self-efficacy assessed by the item “I am qualified” in the CVP-35 (Beta:-10,144; p=0,023), and a higher stigma was predicted by nurse assistant position (Beta: -0.230; p=0.001), Depersonalization Burnout dimension (Beta:0,351; p<0,001) and years of service (Beta:0.148; p=0,023)

Some groups of mental workers are more vulnerable to develop stigma attitudes. These, may be increased by fatigue and burnout. Future interventions should determine if reducing burnout and increasing capacitation may be effective in stigma eradication

No significant relationships.

Plenty of antidepressants have been reported to induce unpleasant tastes and/or odors as well as altered chemosensations when administered alone or in combination with other medications. Trazodone induced hypogeusia (decreased taste sensation) is a rare side effect. In this report, we would like to present a male patient with with hypogeusia after trazodona use and persisting for 3 months after the drug was discontinued will be discussed.

A 52-year-old male, Trazodone 50 mg/day was started 4 months ago due to difficulty in falling asleep. On the 25th day of her daily treatment, her sense of taste began to decrease and gradually became more severe. So he stopped his treatment and he applied to the internal medicine and neurology polyclinics. Routine blood tests were within normal limits. To rule out the possibility of covid 19, 2 pcr tests were done and it was found negative. No recommendations other than chewing gum. The patient applied to the psychiatry polyclinic with the complaint of decreased taste sensation that in the 3rd month of his complaints.

CASE REPORT

CASE REPORT

Chemosensory side effects due to drugs are frequently seen in the elderly and in polypharmacy. It is usually accompanied by a decrease in salivary secretion. It resolves shortly after the causative drug(s) are stopped. It is important that our patient is middle-aged, does not have additional medical diseases and does not use drugs, and his complaints continue for 3 months after the stopped of Trazodone.

No significant relationships.

Holiender and Hirsch defined hysterical psychosis in 1964 and, while hysteria has a contemporary equivalent in somatoform/dissociation disorder, hysterical psychosis remains set adrift in the nosological understanding of psychiatric disorders.

To present a case report of a hysterical psychosis and to review this nosological construct.

Clinical interview, consultation of clinical records and review of literature using the Pubmed platform.

The authors present a case of a 38 year-old woman, admitted in a psychiatric emergency department for bizarre behavior, restlessness, auditory (pseudo)hallucinations and emotional lability, starting 1 week after a personal development retreat. This is the second episode of this nature, the first being a 15-day hospitalization 7 years ago, with rapid stabilization, extensive examination and restitium ad integrum. The patient initiated Olanzapine and was referred to an outpatient clinic, with rapid stabilization and restitium ad integrum throughout follow-up. Given the episode and patient characteristics, a hysterical psychosis diagnosis may be accurate, taking into account the acute onset and course, the pleomorphic nature of symptoms and the presence of a disturbing life event. The authors propose reviewing the concept of hysterical psychosis regarding its clinical implications and debating its therapeutic and prognostic utility.

Hysterical psychosis may not be a mere historic footnote and encompasses an entity with distinctive diagnostic, prognostic and therapeutic characteristics. While its etiology may not be understood, its clinical implications ensure the need for future research.

No significant relationships.

Circadian rhythms and quality of sleep have been associated with temperament characteristics in healthy populations. Since temperaments are personality traits concerning the behavioral, motivational and emotional responses, adaptive capacity for sleep and circadian rhythm may also be related with temperament traits.

To identify the determinants of sleep quality (SQ) and biological rhythm (BR) in bipolar disorder, schizophrenia and depression among temperament measures.

Patients with bipolar disorder (BD, n = 49), major depression (MD, n = 35), schizophrenia (SZ, n = 30) and a healthy control group (HC, n = 36) were enrolled. Pittsburgh Sleep Quality Index (PSQI), Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN) and the Temperament and Character Inventory (TCI) were the measures. One-way ANOVA, Spearman Correlation Test and Linear Regression analyses were the other comparisons.

Determinants of sleep quality were self-directedness in MD [F(1,26) = 6.10, P = 0.020] and BD [F(1,31) = 10.88, P = 0.002] groups. Self-transcendence (P = 0.004), self-directedness (P = 0.038) and persistence (P = 0.05) were the determinants of sleep quality in schizophrenia group [F(3,21) = 9.71, P < 0.001]. Harm-avoidance was the determinant of sleep quality in the HC group [F(1,28) = 7.97, P < 0.001]. Determinants of biological rhythms were harm-avoidance in the BD group [F(1,32) = 9.65, P = 0.004] and self-directedness in the SZ group [F(1,23) = 11.09, P = 0.003] and harm-avoidance (P < 0.001) and self-transcendence (P = 0.039) in the HC group [F(2,27) = 15.81, P < 0.001].

Self-Directedness was associated with circadian rhythm and sleep quality in MD, BD and SZ groups. Extreme temperament features may contribute to emotional and behavioral dysfunction, which may lead to abnormal sleep patterns in psychiatric disorders.

The authors have not supplied their declaration of competing interest.

We have recently found that Perfectionism and Perseverative Negative are both correlates of psychological distress/PD and that PNT mediates the relationship between perfectionism and PD (Macedo et al., 2015).

To investigate if perfectionism and PNT are prospectively associated to PD and if PNT is a longitudinal mediator between perfectionism and PD, controlling for perceived stress and gender.

A total of 227 university students (80.1% girls) filled in the Portuguese validated versions of Perseverative Thinking Questionnaire (PTQ), Multidimensional Perfectionism Cognitions Inventory (MPCI), Profile of Mood States and Perceived Stress Scale, with an additional item to evaluate perceived social support/PSS at T0 and after approximately one year (T1) (Mean months = 12.77 ± 1.137). Only variables significantly correlated with the outcomes (Tension/Anxiety at T1 and Depression at T1) were entered in the conditional process analysis. The moderating role of perceived support on the link between Concern over Mistakes (MPCI) and psychological distress and between PTQ total score and psychological distress (anxiety and depression separately) was examined via conditional process analyses.

The estimated models were significant (F = 4.257, P = .002; F = 6.476, P < .001) explaining 15.9% of tension-anxiety and 25.5% of depression variance. A significant conditional indirect effect of PTQ total score on psychological distress at average and higher levels of perceived support was found, in both models (anxiety and depression). On the contrary, the two models showed a non-significant conditional direct effect of Concern over Mistakes on psychological distress only at any level of perceived support.

PNT prospectively mediates the relationship between negative perfectionism and PD.

The authors have not supplied their declaration of competing interest.

The author has not supplied his declaration of competing interest.

Monoaminergic neurotransmitters affect motor control, emotions and cognitive functions. Their relative abundance depends on the action of monoamine oxidase A (MAOA) which catalyses their degradation into inactive metabolites. Brunner syndrome is a rare chromosome X-linked recessive inheritance genetic disorder, which causes loss of function of the MAOA gene, leading to a relative increase in monoamines in affected individuals (typically males). It manifests with moderate intellectual developmental disturbance associated with maladaptive externalising behaviours, low frustration tolerance and marked impulsivity.

To present a clinical case of patient diagnosed with Brunner Syndrome presenting with suicidal and homicidal ideation and to discuss it based on a non-systematic review of the literature.

Case report and non-systematic review of the literature.

Male born with neonatal asphyxia that consequently presented developmental retardation characterised by learning difficulties and emotional dysregulation. At 18 years of age, he began follow-up in Psychiatry due to self-injurious behaviours and several reactive suicide attempts (SA), being diagnosed with Intellectual Disability. At 22, he was hospitalised due to reactive depression, being discharged doing well with valproate, fluoxetine and olanzapine. Shortly after, he was arrested (aged 23-28) for attempted murder followed by SA. During imprisonment, he was diagnosed with Brunner’s Syndrome after his younger brother diagnosis. At 31, he was hospitalised for suicidal and homicidal ideation, revealing high impulsiveness and low frustration tolerance, and was discharged with compulsory psychiatric treatment. Three weeks later he was again hospitalised for symptoms recurrence having improved on Sertraline 50mg and Aripiprazole 400mg monthly.

Although scarce, the available evidence suggests that dietary modifications and the use of selective serotonin reuptake inhibitors may improve behaviour, reduce serotoninergic symptoms and possibly reverse some neurochemical abnormalities.

Brunner syndrome is a rare genetic disorder with neuropsychiatric manifestations, whose course, treatment and prognosis are currently poorly known. Thus, the current treatment is empirical and further studies are needed.

None Declared

The burden on society by depression is undisputable, partly due to a chronic course pattern and depression’s large heterogeneity that contributes to non-response to standard treatments. Using data from the Netherlands Study of Depression and Anxiety (NESDA, www.nesda.nl), Penninx will illustrate both points. When examining the course of depression, especially when also considering the transitions into other affective disorders over time, chronicity is clearly more the rule than the exception (Verduijn et al. BMC Med 2017). Considering depression’s heterogeneity could lead to precision psychiatry approaches that help reduce depression’s chronicity. Immuno-metabolic dysregulations seem to vary as a function of depression heterogeneity: dysregulations map more consistently to “atypical” neurovegetative symptoms reflecting altered energy intake/expenditure balance (hyperphagia, weight gain, hypersomnia, fatigue and leaden paralysis). Findings are confirmed when utilizing genome-wide gene expression as well as DNA information (Milaneschi et al. Biol Psychiatry 2020). Preliminary treatment studies suggest that the presence of immuno-metabolic dysregulations in depression moderates antidepressant effects of standard or novel (immunomodulatory) interventions. An immuno-metabolic depression dimension could dissect depression’s heterogeneity and potentially match depressed subgroups to treatments with higher likelihood of clinical success.

None Declared

Opsoclonus myoclonus syndrome (OMS) in childhood still remains unexplored from the perspective of clinical psychology.

The research was aimed at defining types of psychological development in the group of children with OMS. The study included 18 children between ages 2 years 4 months and 9 years with OMS (8 boys, 10 girls).

The following methods were used: analysis of patient's development and medical record, psychological interview with parents, neurological state assessment and pathopsychological assessment.

Patients were divided into three groups according to cognitive development level:

– group with normal intelligence level (n = 4);

– group with developmental delay (n = 11);

– group with intellectual disability in different forms (n = 3).

Several children in group 1 (n = 3) and in group 2 (n = 4) expressed neurotic behavior with increased levels of anxiety and fear of trying unusual actions during psychological assessment. Children with delay in psychoverbal development (n = 7) and with developmental delay (n = 1) expressed psychopathy-like states with verbal aggression and had difficulties controlling their emotions. In some cases (n = 2), the psychological state of the patient was defined as borderline state with emotional instability, especially in mother–child interaction.

Psychological features of children with OMS indicate heterogeneity of their development types that implies different prognosis and developmental dynamics for each type. The results point out the necessity of detailed psychological examination aimed at correlation of psychological help to children with OMS and their families with their psychological state.

The authors have not supplied their declaration of competing interest.

Aripiprazole is a newer atypical antipsychotic with a favorable side-effect profile, especially a low propensity to result in metabolic syndromes.It is effective at treating bipolar disorder, the positive symptoms of schizophrenia and has the potential to treat negative and cognitive symptoms.

However, prior studies suggested that aripiprazole seem to be associated to a risk of inducing certain impulse control behaviors, such as uncontrollable gambling, hyper sexuality, as well as compulsive eating.

We proposed to assess the evidence for compulsive eating associated with the use of aripiprazole.

We report a rare case of new onset aripiprazole induced compulsive eating behavior in a patient with bipolar disorder. Then, we conducted a literature review using“PubMed” database and keywords “Aripiprazole”, “Impulse Control Behaviors”, “Compulsive Eating”.

He was a 21-year-old patient, diagnosed with bipolar 1 disorder. He was prescribed Aripiprazole, after a neuroleptic malignant syndrome induced by haloperidol (which was prescribed during the first episode psychosis).

One month following the treatment initiation, the patient complained of eating excessively. He was not able to control his eating and gained 30 Kg over the period of 4 months. Metabolic assessment showed a hypercholesterolemia.

Aripiprazole is a promising novel antipsychotic in mental diseases. However current evidence associates compulsive behaviors like eating with the use of Aripiprazole, probably due to the drug affinity to 5-HT receptors. More studies are needed to confirm this rare side effect.

None Declared

Being a victim of work-related upper extremity injuries is a source of physical damage and mental damages. Psychological distress related to this type of accident is usually underestimated.

Evaluate anxiety and depression among victims of work-related upper extremity injuries.

We conducted a 10-month cross-sectional analysis on workers consulting for an Impairment Rating Evaluation after an upper extremity injury due to an occupational accident. We collected socio-professional data, characteristics and outcomes of the accident. Anxiety and depression were evaluated by the Hospital Anxiety and Depression scale. The pain was evaluated by a Visual Analogue Scale.

Our population consisted of 90 cases of work-related upper-extremity injuries. The mean age was 43.10 and the sex ratio 3.7. The most represented category was blue-collar workers (71.1%). Medical history of chronic diseases was reported in 23% of cases and 3.3 % had mental health antecedent. Dominant upper limb injuries were found in 62% of cases. Hand and wrist injuries were the most affected part (63%), and 33.3% had fingers’ injuries. The prevalence of anxiety and depression were 31.1% and 20% respectively. About thirty-one per cent rated their current pain greater than or equal to 8. Both anxiety and depression were positively correlated with male gender (p= 0.001, p=0.007) and shoulder injuries (p=0.001, p=0.018). Depression was correlated to fingers’ injuries and pain (p=0.002).

The studied population present an important rate of anxiety and depression. Assessing Mental health after upper extremities injuries are necessary to prevent serious mental illness and to promote a successful return to work.

No significant relationships.

Burnout is a condition characterized by emotional exhaustion, depersonalization and reduced personal accomplishment, resulting from the inability to cope with chronic job stress. Healthcare providers at pediatric oncology units, who care for children with life-threatening illnesses, are exposure to high levels of stress, which increases the risk for developing burnout, with consequences in their personal health and quality of patient care.

To assess the prevalence and sources of burnout on a multidisciplinary team of a pediatric oncology unit.

Participants were a convenience sample of 16 pediatric oncology professionals, including medical, nursing, and related health staff from a Portuguese pediatric oncology center. Participants completed the Portuguese version of the Copenhagen Burnout Inventory.

All three subscales that compose this Inventory were found to have burnout below normal levels (cut-off ≥ 50 points). However, personal and work-related subscales showed mean values in the superior limit of normality (48 ± 14, 18 points and 49, 48 ± 12, 23 points, respectively). Nevertheless, when analyzed the patient-related subscale, we found low levels of burnout in the majority of responders. These findings are similar to the existing literature, which suggests that patient care and interactions with children are the least stressful aspect of working in this specialty.

Despite the high levels of stress exposure in pediatric oncology units, results suggest that the majority of professionals are not actually in burnout. However, the obtained values advice for the need of prevention and workplace approaches to staff's well-being and stress reduction, in order to avoid burnout development.

The authors have not supplied their declaration of competing interest.

In the midst of a global pandemic with a rising death toll, the children´s mental health can be easily overlooked in the country’s response. But this overlook would have devastating consequences for years to come.

The objective of this research is to compare children’s physical and mental development before, during and after the situation of social isolation caused by the pandemic of COVID-19.

The parents/guardians of 100 children aged between 0 and 5 years and 11 months old were asked to answer questions based on the ASQ-3 (Ages and Stages Questionnaire III), containing questions related to Communication, Gross Motor, Fine Motor, Problem Solving, and Personal-Social and ASQ- SE (Ages and Stages Questionnaires Social-Emotional) addressing issues of self-regulation, compliance, social-communication, adaptive functioning, autonomy, and affect. In addition, behavioral issues related to children’s mental health will be included, such as: aggressiveness, insomnia, lack of appetite, apathy, sadness, tiredness, lack of interest, hyperactivity, manias, tantrum, morning among others. Child development data will be collected before and during quarantine / isolation and later, in a second stage, after the end of social isolation.

The data will be analyzed in order to characterize child behavior before, during and after the period of social isolation, correlating the different areas of child development, especially mental health.

As argued, socially isolated children are at increased risk of health problems in adulthood. Furthermore, studies on social isolation have demonstrated that a lack of social relationships negatively impacts the development of the brain’s structure.

No significant relationships.

Quality of life should be an important issue to everyone. In the general population and in various medical disciplines, this topic has been studied extensively. In forensic psychiatry, this topic has received little attention so far.

Within this project a questionnaire that measures the quality of life in forensic hospitals was developed.

As a basis the questionnaire measuring the quality of prison life (MQPL) by Liebling et al. (2011), which was designed only for using in prisons, was used. First, this questionnaire was translated, then adapted to the living conditions in forensic hospitals and supplemented by questions regarding therapeutic support. For the psychometric evaluation of the instrument, a one-time survey was conducted at 13 forensic hospitals in Bavaria. A total of 255 patients took part, 25 of whom were female. In summary, the reliability of the MQPL can be rated as very good.

The factor structure was checked with a confirmatory factor analysis and was confirmed. There are significant differences between the 13 Bavarian forensic hospitals in the subscales admission to a forensic hospital, equal treatment, quality of accommodation and therapeutic services.

The great importance of the quality of life in the penal system is shown by the fact that a good quality of life contributes to reduced psychological distress of inpatients.

Iatrogenic factors, such as polypharmacy and prescription cascade, are some of the main causes of delirium in the elderly. We present a case of delirium of months of evolution that improved after applying a pharmacological de-prescription strategy.

To report a case and review the available literature on the concepts of prescription cascade and de-prescription in delirium in the elderly.

A 92-year-old woman with a history of cerebrovascular accidents and no psychiatric history or dementia was admitted to a psychogeriatric clinic due to disorientation, delusions of harm and gait apraxia. Several months earlier she had required admission to the general hospital for agitation. In view of the suspicion of delirium, an exhaustive examination and complementary tests were performed, including a neuropsychological assessment and a brain scan (Image 1).

The patient had previously received multiple high-dose psychotropic drugs (Gabapentin, trazodone, Zolpidem, Quetiapine), which had reduced the agitation but had not resolved the problem. Organic causes were treated in a multidisciplinary team (pressure ulcers), together with a gradual tapering of medication. Although underlying vascular dementia was diagnosed, the patient’s gait and cognitive status improved, with a significant impact on her autonomy and quality of life.

Despite an extensive literature on the subject, delirium in the elderly remains an under-diagnosed medical condition, especially the hypoactive subtype, just as cascade prescribing remains common. It is important to raise awareness among specialists in training to prevent and diagnose it.

No significant relationships.