Antipsychotic-induced hyperpolactinemia (AIH) is associated with disturbing clinical symptoms, such as sexual dysfunctions, menstrual disorders and galactorrhea. Long-term studies of dopamine agonists in AIH are scarce.

To assess efficacy and safety of cabergoline use in psychiatric patients with AIH, including impact on sexual function and quality of life(QoL).

It was an open-labeled non-randomized naturalistic prospective comparison of cabergoline vs nо treatment in 84 chronic psychiatric patients (F/M = 77/7) with AIH. Cabergoline treatment was started in 44 patients, the сontrol group included 40 patients who rejected the treatment with cabergoline. For assessment of QoL, sexual dysfunction and other hyperprolactinemia symptoms, UKU side effects rating scale (UKU) and SF-36 were used.

The main and control groups were comparable on all main clinical and psychiatric characteristics. The effective cabergoline dose was 0,25-3 (median-0,5) mg weekly; total cabergoline exposure–534 patient-weeks. Normal prolactin levels were achieved after 4-44 (median-14) weeks in 95% of patients. At 3 months after cabergoline discontinuation, prolactin remained normal in 71%, and AIH recurred in 29% of patients. Prolactin normalization was associated with significant reduction of menstrual disorders, galactorrhea, improvement of UKU scores on sexual desire, orgastic dysfunction, total UKU score and SF-36 scores on subscales of social functioning (P = 0,006), role-emotional (P = 0,042), and mental health (P = 0,049). The rate of psychosis exacerbation in control group was higher than in the treatment group (37,5% vs 0%; P < 0,001).

Cabergoline is effective and safe in majority of AIH patients. Long-term cabergoline treatment is not associated with psychosis exacerbation. Beyond reversal of typical AIH symptoms, treatment with cabergolin improves sexual function and QoL.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Mood disorders in patients with ASD (Autism Spectrum Disorder) have a significant impact on their well-being. Major depression and bipolar disorder are among the most common co-occurring psychiatric diagnoses in autism. Prevalence estimates range from 10-50% for depression and approximately 5% for bipolar disorder. These figures are markedly higher than those reported in the general population.

The diagnosis of these disorders in patients with autism poses several challenges: mood problems may be “overshadowed” by the diagnosis itself, symptoms vary between individuals and may present “atypically” (psychomotor agitation, regression, reduced self-care, and severe irritability). The use of assessment tools based largely on criteria developed and validated in the general population is common.

A case of a patient diagnosed with ASD and co-occurring mood disorder is presented followed by a theoretical review on the topic.

A case is presented with a bibliographic review.

A 20-year-old patient with a diagnosis of severe autism spectrum disorder was referred to the emergency department for behavioral disturbances based on episodes of heteroaggressiveness and self-aggressiveness, with a daily frequency, in the last 2 months. His parents attribute this decompensation to the introduction of Sertraline and changes in his routine, which has implied less stimulation. Having ruled out underlying organic pathology, given that her father refers to frequent episodes of crying and abandonment of leisure activities of his liking, we suspect a mood disorder.

In hospitalization, Sertraline was withdrawn and Valproic Acid was introduced. Likewise, Risperidone dose was increased, already prescribed in outpatient care. Progressively, a notable improvement was observed.

Current clinical recommendations on the use of selective serotonin reuptake inhibitors (SSRIs) for mood problems are largely based on evidence from typically developing groups. However, it has been shown that some individuals with autism show different neural responses to pharmacological challenge compared to neurotypical individuals. In addition, the use of SSRIs in ASD may result in increased adverse side effects, such as agitation, impulsivity, hyperactivity, stereotypy, and insomnia, and it has been suggested that they should therefore only be considered on a “case-by-case” basis. A systematic review reported that mood stabilizers (Lithium, Valproic Acid) are preferable to atypical antipsychotics, which are associated with a large number of side effects.

Because of the lack of strong evidence on the efficacy of pharmacologic interventions and issues regarding safety and side effects, risperidone and aripiprazole are among the few medications approved by the FDA for the treatment of irritability in people with autism. More research aimed at effective medications to treat mood problems in ASD needs to be advocated.

None Declared

Illicit drug use is well known as an important contributor to the global burden of diseases, but the physical and psychopathological risks of recreational drugs misuse are often underestimated and drug-related fatalities in specific settings are under-investigated.

In the framework of the EU-funded project “EU-Madness”, we collected and analysed all the reports of drug-related fatalities in Ibiza from January 2010 to September 2016, with the aim of characterising the sample, and identifying the involved substances and the nature of deaths associated with their consumption.

Overall, 58 drug-related fatalities were registered from 2010 to September 2016 (87.9% males, 12.1% females, mean age 33.16; females were significantly younger than males). Most of the deceased were Britons (36.2%), followed by Spanish (22.4%), Italians (6.9%) and Germans (5.2%). In half the cases, the substance identified in post-mortem analyses was a stimulant; in 24.1% of the sample it was a depressor a prescription drug or more than two substances in 22.4%. Most of the fatalities were due to cardiovascular accidents (62%); 22.4% were deaths by drowning, 12% by fall from heights and 3.4% were due to mechanical asphyxia.

According to the results from our sample, stimulants (mainly MDMA and cocaine) are the substances of abuse involved in most drug-caused fatalities. The number of fatalities per year has been steadily increasing, but the growing diffusion of novel psychoactive substances (NPS) does not seem to be a direct cause (although better methods of their analysis in post-mortem samples should be designed).

The authors have not supplied their declaration of competing interest.

Previous studies have found substantial weight gains in forensic mental health patients (FMHP) during hospitalisation. However, previous studies have not compared in- and outpatients, thus the weight change could be a general change over time. Research on the association between proportional hospitalization time (PHT) and weight change is lacking.

To investigate the association between time hospitalized and weight change among FMHP.

Retrospective cohort study including FMHP with schizophrenia or bipolar disorder treated in the Region of Southern Denmark between 01jan2016 and 06apr2020. Patient characteristics and data on body weight was extracted from electronic medical records. The association between PHT and weight change per year was analyzed using linear regression. PHT was determined between each measurement as the total number of days hospitalized divided by the total number of days. Analyses were adjusted for gender, age, smoking, and antipsychotic medication.

The cohort included 328 FMHP, of which 91% were diagnosed with schizophrenia. PHT had a significant positive dose-response association with weight change, with an estimated difference of +4.0 kg/year for FMHP who were hospitalized 100% of the time, compared to FMHP who were exclusively treated as outpatients. The associations were different for FMHP belonging to different categories of BMI at baseline (test for interaction; p=0.006). Underweight hospitalized FMHP had the largest difference in weight gain compared to FMHP treated outside hospitals (+18.0 kg/year, p=0.006), and the difference was smallest in obese FMHP (+2.3 kg/year, p=0.21).

PHT was positively associated with weight change among FMHP.

No significant relationships.

To determine the incidence of traumatic events in Ecuadorian women exposed to domestic violence and other complex social situations and their relationship with PTSD.

We applied a transversal descriptive study accomplished by the INEC (National Institute of Statistics and Census). The INEC recruited Ecuadorian women from 15 years old and more, the surveys were focused on this population. In total, 18,800 rural and urban housings were selected all over the country, 24 provinces. Date of the survey: November 16–December 15 of 2011. A, D and G were taken as references for guidelines following the criteria diagnosis of DSM V (Diagnostic and Statistical Manual of Mental Disorders) to determine a Traumatic Event.

The average age of the sample was 28 years old. The standard deviation was 21, ages: 15–25 years old: 14.265 (21.6%), 25–35 years old: 9.324 (14.1%), 35–45 years old: 8.132 (12.3%), 45–55 years old: 6.283 (9.5%), 55–65 years old: 4.302 (6.5%), > 65 years old: 23.745 (35.9%). Prevalence of the traumatic event (DSM-V) 4.6%. Women experienced any kind of violence 60.6%: 61.4% urban, 58.% rural. Types of abuse: psychological: 53.9%, physical: 38.0; sexual, patrimonial: 35.3%. Domestic violence 76.0% y other types of violence 24.0%.

Domestic violence rate is high, also, in this study, we determined that women face an important index of violence during their daily activities. Psychological abuse is the highest abuse, higher in the urban areas. These results based on acute traumatic events may predispose women to develop PTSD. The prevalence of traumatic events must be an alert to the Mental Health Organizations, not only in Ecuador but also in Latin American.

The authors have not supplied their declaration of competing interest.

Suicidogenic effects COVID-19 pandemic are expected to reveal themselves not immediately, but within a longer period.

To evaluate the prevalence of suicidal tendencies in university students during the COVID-19 outbreak and specify the psychosocial characteristics of the students with a low anti-suicidal barrier to mitigate their suicide risks.

The research was done via an on-line survey, which covered 536 students of both sexes (aged 21.46±2.95), who studied in Russian universities and who filled in a structured questionnaire during their distance learning due to COVID-19 outbreak.

We revealed that 11.38% of the respondents (57.47% of whom are males) with a low anti-suicidal barrier showed suicidal tendencies by allowing the possibility of committing a suicide in a certain situation. Among them were more Russian students than international ones (p=.0272). They also certainly exceeded the students with the developed anti-suicidal barrier in taking alcohol (p=.0126), in underestimating their own health (p=.0053), in expressing happiness (p=.0001), and in degree of religious belief (p=.0001). They perceived the situation associated with the COVID-19 outbreak with a more strongly manifested anxiety due to the fear of their own infection with coronavirus (p=0.0347). At the same time, they acted less responsibly in following personal restrictive measures aimed to reduce the risk of infection (p=.0002).

Students with suicidal tendencies during the COVID-19 outbreak present a risk group in COVID-19 spread and infection. The pandemic can intensify anti-vital sufferings and enhance the risk of committing suicide in individuals with suicidal tendencies, which should be taken into account in prevention programs.

Recent genetic evidence implicates glutamatergic-receptor variations in schizophrenia. Glutamatergic excess during early life in people with schizophrenia may cause excitotoxicity and produce structural deficits in the brain. Cortical thickness and gyrification are reduced in schizophrenia, but only a subgroup of patients exhibits such structural deficits. We delineate the structural variations among unaffected siblings and patients with schizophrenia and study the role of key glutamate-receptor polymorphisms on these variations.

Gaussian Mixture Model clustering was applied to the cortical thickness and gyrification data of 114 patients, 112 healthy controls, and 42 unaffected siblings to identify subgroups. The distribution of glutamate-receptor (GRM3, GRIN2A, and GRIA1) and voltage-gated calcium channel (CACNA1C) variations across the MRI-based subgroups was studied. The comparisons in clinical symptoms and cognition between patient subgroups were conducted.

We observed a “hypogyric,” “impoverished-thickness,” and “supra-normal” subgroups of patients, with higher negative symptom burden and poorer verbal fluency in the hypogyric subgroup and notable functional deterioration in the impoverished-thickness subgroup. Compared to healthy subjects, the hypogyric subgroup had significant GRIN2A and GRM3 variations, the impoverished-thickness subgroup had CACNA1C variations while the supra-normal group had no differences.

Disrupted gyrification and thickness can be traced to the glutamatergic receptor and voltage-gated calcium channel dysfunction respectively in schizophrenia. This raises the question of whether MRI-based multimetric subtyping may be relevant for clinical trials of agents affecting the glutamatergic system.

Mindfulness-based cognitive therapy (MBCT) is a third wave cognitive-behavioral therapy (CBT) that incorporates meditation exercises in the classical, structured intervention. Mindfulness has been associated with psychological well-being, and certain symptoms that occur in major depressive disorder (MDD), e.g. worries, ruminations, ideas of incapacity or self-devaluation, are considered potential targets for MBCT.

To evaluate the current level of evidence for the MCBT efficacy in MDD.

A literature serach was performed in the main electronic databases, targeting clinical trials that evaluated in a randomized manner the efficacy of MCBT versus active comparators or placebo in patients with MDD.

MBCT was efficient in a 10-week randomized controlled trial (RCT) versus standard treatment, and it decreased ruminations, increased patients quality of life, mindfulness abilities, and self-compassion. In another randomized, 8-week RCT, MBCT prevented relapses in MDD, with similar rates when compared to psychoeducation and standard treatment. A 26-month follow-up study evidenced the persistence of symptoms improvement detected after 12 months of the trial, when compared to active control group and treatment as usual. MCBT was compared to cognitive therapy in a randomized 8-week trial, and both treatments had similar efficacy in MDD relapse prevention.

MCBT may be an useful adjuvant to the current treatment in acute MDD, but it may also decrease the risk of relapse after psychotherapy termination.

Delusional Disorders with Religious Content (DDRC) require careful study concerning their prevalence, psychopathological heterogeneity and the risk of destructive behavior.

To classify the clinical forms of DDRC

By clinical-psychopathological, follow-up and statistical approaches 2523 cases of patients with mental disorders who received inpatient care in a state clinic for year were analyzed; in 225 cases of total 2523 delusional disorders in schizophrenia (ICD-10: F20.0, F20.01, F20.02) were diagnosed.

The comparative analysis of delusional disorders (225 cases, 100%) with religious (70 cases -31.1%) and non-religious content (155 cases - 69.9%) revealed prevalence of DDRC in non-believers (p <0.01). Delusional destructive behavior occurred in 47.1% of 70 cases in patients with DDRC (15% of total 225).

The predominant content of DDRC (among the Delusions of Possession, Sinfulness/guilt, Messianism, Manichaean and the End-world Delusions) was the Delusions of Possession - 36.8%. Psychopathological heterogeneity of DDRC was identified and specific types of DDRC were described.

DDRC is associated with the development of massive psychopathological symptoms and significant severity, and often accompanied by various forms of destractive behavior. This circumstance requires constant and careful management of these patients, collection of their religious history and asks for specific therapeutic approaches.

No significant relationships.

Teenagers’ Internet addiction can be supported by a wide variety of Internet content.

To study the structure of the content consumed by Siberian adolescents with Internet addiction.

200 (69 boys and 131 girls) Internet addicted adolescents aged 11-18 years and living in the urban area of Central Siberia (Krasnoyarsk) were surveyed. Content consumption was studied using Game Addiction Scale for Adolescents and The Social Media Disorder Scale.

19.0% of adolescents were addicted to Internet games, 22.5% of adolescents were addicted to social media. A combination of both types of addictions was found in 23.5% of adolescents. Other types of content addiction was found in 35% of adolescents. Boys prefer Internet games (62.3% of boys vs. 32.1% of girls), while girls prefer communication on social media (55.0% of girls vs. 29.0% of boys), p <0.001. Combined addiction is observed equally in both sexes (23.2% and 23.7% respectively). For older adolescents, there is observed a decrease in the interest to Internet games (from 48.4% at 11-14 y.o. to 37.6% at 15-18 y.o.) and to social media (from 49.5% to 43.1%). At the same time, interest to other types of content is growing (from 27.5% to 41.3%).

Boys with internet addiction are more likely to be addicted to internet games, while girls are more likely to get engaged in social media. Older adolescents show a decrease in the interest both to Internet games and social media, while their interest to other types of content increases. The study was funded by RFBR project № 18-29-2203218.

The study was funded by RFBR project № 18-29-2203218.

Romantic relationship quality (RRQ) and break-ups (RRB) among young adults have been associated with the onset of a first major depressive episode or suicide attempts. However, the size of these associations varies across studies and the relative weight of RRB versus RRQ needs to be understood.

To investigate (1) the size of the association between adolescent RRQ/RRB and psychopathology (i.e., depression, suicide ideation, deliberate self-harm, and suicide attempt); and (2) the role of potential moderators (e.g., gender, age, and nationality).

A meta-analysis of 20 manuscripts reporting on 21 studies (n = 19623) was conducted, focusing specifically on adolescents and young adults. Studies focused on physically abusive relationships were excluded.

A model combining relationship quality and break-up yielded a highly significant association between relationship measures and depression/self-harm but the strength of this relationship was modest (r = .229). The strength of the association between depression/self-harm and RRQ (r = .279) was statistically different from RRB (r = .145) (P = .006). Location (US vs. Non-US) had no effect. Age was not significant, B = -0.005, 95% CI [-0.026, 0.016], P = .647. Gender was a weak moderator (B = .160, 95% CI [-0.021, 0.340], P = .083).

The association between psychopathology and RRQ/RRB was statistically significant but relatively small. RRQ was a stronger predictor of depression compared to RRB. This association was slightly stronger for women than for men. Implications for practice and future research will be discussed.

The authors have not supplied their declaration of competing interest.

Quetiapine, a short-acting atypical anti-psychotic drug for the treatment of bipolar I disorder and schizophrenia, is increasingly used off-label for the treatment of sleep disturbances or insomnia. However, data supporting this off-label prescription of quetiapine are limited.

To report and discuss the effects of “off-label” use of quetiapine for the treatment of sleep disturbances.

An English-language literature search was conducted using Pubmed, EMBASE and Cochrane library (December 1980–December 2015) using the search terms quetiapine, insomnia, sleep disorders, sleep disturbances, and sleeplessness.

During the last decade, there is an enormous increase in prescribing quetiapine. This anti-psychotic drug is among the best selling drugs worldwide. For the approved indications, the usual therapeutic dose range is 400–800 mg/day. However, off-label use of quetiapine was most evident for the 25 mg/day to 100 mg/day. In some countries, off-label uses are promoted to non-psychiatrists for the treatment of insomnia, dementia, agitation, and aggression. Inappropriate anti-psychotic use may lead to serious health problems, including metabolic effects, increased sudden cardiac death, and age-related side effects with increased risk for orthostatic hypotension, fractures, pneumonia, cognitive impairment, and stroke.

There is growing concern regarding the potential harm from off-label prescription of anti-psychotics, particularly quetiapine. There is little evidence supporting the enormous off-label uses of quetiapine. In addition, prescribing quetiapine for indications that are not evidence based has ethical, financial, and safety implications, especially in the older population.

The authors have not supplied their declaration of competing interest.

This research aims to enrich the reflection on the current affairs and is an invitation to think about worrying phenomena in youngsters: self-injuries or cuts. A focused study was conducted on twenty young people

This ris a reflection oabout worrying phenomena in youngsters: self-injuries or cuts. We try to figure out the underlying cause of such behaviour

Through a qualitative methodology, using clinical interview and questionnaire, we try to find the constitutive elements of self-injuries or cuts, considering three levels of analysis: Sociocultural, individual, and family changes. We examined twenty cases

It appeared in the analysis that one of the triggers of the cutting phenomenon was related to experiences of rejection of significant figures, which is lived by the young person as a situation of abandonment that generates high amounts of anguish. This distressing experience generates a sensation of lack of control, appearing as unregulated affections, which they are unable to handle or manage. The intense anxiety is carried through the body, being an act of attack to the body, provokes physical pain an emotional relief

Young people’s subjective perception of the maternal figure is that of a dominant, controlling and demanding personality, which hinders an adequate differentiation process. With respect to the description that the young people make of themselves, we see that they refer to a marked emotional lability and the presence of dysthymic experiences. It appeared in the analysis that one of the triggers of the cutting phenomenon was related to experiences of rejection or separation of significant figures.

No significant relationships.

Despite the high prevalence of substance use disorders, the majority of affected individuals do not seek any medical help or receive treatment targetting mainly symptoms of intoxication, withdrawal or general medical conditions due to chronic use of psychoactive substances. Patients with substance use disorders are more likely to remain undiagnosed regarding other psychiatric illnesses. Electronic patient-reported outcomes (ePRO) provide an easy-to-use instrument for detailed assessment at low economic cost.

To assess patients’ attitude towards self-reporting of symptoms related to substance use, mood, anxiety, quality of sleep, medication intake, social performance, and psychotic symptoms.

Mobile application consisting of seven questionnaires (Mood, Anxiety, Substance Use, Sleep, Medication, Social Activity and Various symptoms) was offered for use to patients with substance use disorder. Enrolled subjects were encouraged to use the app to report their actual condition in accordance with their own willingness and lifestyle.

Throughout the study a total of 1077 completed questionnaires were submitted, of which 193 (17.9%) were on mood, 188 (17.5%) - on substance use, 187 (17.4%) – on sleep, 155 (14.4%) – on anxiety, 139 (12.9%) – on medication intake, 111 (10.3%) – on psychotic symptoms, and 104 (9.7%) – on social performance.

Our research revealed that patients with substance use disorder are likely to share concerns regarding variety of psychiatric symptoms besides these attributed to their primary diagnosis. Implementation of ePROs can be a valuable tool for in-depth assessment and subsequent meeting the needs of such patients.

No significant relationships.

Suicide is a universal, complex, and multifaceted public health problem that is among the leading causes of preventable death worldwide. The impact of suicide affects families, communities, and societies; hence its prevention is an emerging priority for public health systems.

The current systematic review aims to investigate the efficacy of distance suicide prevention strategies implemented through synchronous technology-based interventions (i.e., any digital tool that allows interactive and immediate real-time communication conducted remotely).

The bibliographic search has been carried out in the electronic databases MEDLINE/PubMed, PsycInfo, Scopus, and Web of Science, with no restrictions on the publication period and limited to publications in English or Spanish. Two reviewers independently will conduct screenings, data extraction, risk of bias (RoB), and methodological quality assessment.

The preliminary data searches seem to support the effectiveness of providing active contact to persons who have made a suicide attempt and indicate that receiving early specialized assistance decreases the relative risk of recurrence. The reduction would be attributable to improved detection of patients at increased risk and effective referral to emergency services.

Telematics suicide prevention has been an emergent field for years, facilitated by the notably increased in acceptance and availability. Considering that distance programmes can reach affected individuals regardless of their location, it stands to reason that these interventions will be part of future suicide prevention efforts. The results will be discussed regarding (a) the effect size of the intervention outcomes and (b) the main moderators of the effectiveness found.

No significant relationships.

Analysis of the first-episode psychosis remission, including post-psychotic affective and primary negative symptoms as well as personality changes, is necessary to personalize therapy and rehabilitation.

We aimed to identify different trajectories of psychosis remission in young adults.

First-episode psychosis patients (n=56, mean age 19.8±2.5 years, all males) underwent psychopathological assessment at the stage of remission.

Three trajectories of remission were identified. The thymopathic trajectory (33.93%, 19 patients) was characterized by the gradual increase of subclinical affective symptoms and resulted with a high-quality remission. In 63.61% cases in this group persistent depressed mood was present after a psychotic episode. Some patients (36.84%) became prone to depressive reactions. The pathocharacterological trajectory (39.28%, 22 patients) was characterised by personality changes with increase of existing traits or the development of traits previously not present. Types with an increase of schizoid (14.29%), histrionic (19.64%), and anxiety-hypochondriacal (5.36%) traits were identified. Patients in this group had high- as well as low-quality remission. The destructive trajectory (26.79%, 15 patients) was characterised by residual positive or single negative symptoms. Patients in this subgroup had low-quality remission with poor functioning and signs of treatment resistance.

Analysis of trajectories of the first-episode psychosis remission allowed us to choose the most effective strategy for personalized supportive treatment.

No significant relationships.

The use of antipsychotics (APS) is essential. Despite their great efficacy, some of them are associated with an increase in prolactin levels that can lead to hormonal changes needing to be identified and managed [1,2,3]. Hormonal changes use to have clinical implications including hypogonadism, infertility and sexual dysfunction

To evaluate possible hormonal alterations and some clinical implications produced by hyperprolactinemia (HPRL) derived from the use of some antipsychotic compounds.

A complete fasting blood test was performed on a sample of 113 subjects (69 men and 44 women). 54% (n = 61) showed a normal prolactin level and 46% (n = 52) showed hyperprolactinaemia ( >50ng / ml). On the global sample, 39.8% (n = 45) was treated with some hyperprolactinemic drug , mostly risperidone and paliperidone.

Some differences were found depending on the gender of the subjects. A highly significant inverse relationship between the values of prolactin and testosterone was found in males (p=0.020, r=-0.285). In females, increased prolactin level was significantly related to decreased cortisol values.

Antipsychotic-related Hyperprolactinaemia ( mainly risperidone and paliperidone) is related with a decrease in testosterone levels in males and with an increase in cortisol levels in females.

No significant relationships.