Optimizing psychiatric assessments could help to standardize the use of structured instruments in clinical practice. In recent years, several research groups have applied Computerized Adaptive Tests (CATs) to simplify assessments in depression, anxiety and also suicidal behaviors. We aimed to construct a shortened test to classify suicide attempters using a decision tree methodology that allows the integration of relevant clinical information, namely the history of past suicide attempts, in the construction of the test.

The sample was composed of 902 adult participants in three subsamples: first-time suicide attempters, psychiatric inpatients that never attempted suicide and healthy controls. The performance of a decision tree built using the items of a previously developed scale for suicidal risk was examined. The history of past suicide attempts was used to separate patients in the decision tree. The data was randomly divided in a training set and a test set. The test set, that contained 25% of the data, was used to determine the accuracy of the decision tree. Twenty-five cross-validations of this set up were conducted.

The first four items of the decision tree classified correctly 81.4% of the patients.

As a result of a methodology based on decision trees that, contrary to CATs, can incorporate relevant information in building the test we were able to create a shortened test capable of separating suicidal and non-suicidal patients. Using all the information that is available improves the precision and utility of instruments adapted for psychiatric assessments.

The authors have not supplied their declaration of competing interest.

Histamine intolerance (HI) is a disorder associated with an impairment of ability to metabolize ingested histamine. The incidence of HI in general population is 1-3%. Clinical manifestation of HI contains nonspecific predominantly gastrointestinal, but also extraintestinal symptoms. HI could be primary with genetic predisposition, or secondary with lower activity of diaminooxidase (DAO) without positive genetic screening.

This study aims to evaluate the prevalence of HI by patients with anxiety disorders. HI can imitate anxiety symptoms, therefore we predict higher prevalence HI in patients with anxiety disorders than in general population.

It is observational cross-sectional study on cohort of anxious patients for detecting the prevalence of HI. Patients were screened by scale for histamine intolerance questionnaire. Patients with positive questionnaire were examined for serum DAO and genetically examined.

113 patients fulfilled the HI questionnaire. From this cohort 35.4% (40 subjects) were positive at screening. Biomarkers of HI were screened only in case of positivity in this questionnaire. Table No. 1: Results of our study from cohort with positive screening, 35.4 % (40 subjects).

This pilot study shows that the prevalence of HI could be higher in group of patients with anxiety disorders than in general population. For further confirmation other studies with control group and larger cohort should be done.

No significant relationships.

The racial riots of 2020 in the US, beginning in Minneapolis, had a global impact inciting protests internationally. We look at the impact of COVID, the social isolation and frustration that therefore existed and how this effected the instigation of the riots.

--To review the history of racism in the United States and the abolition theories, comparing US and UK. --To consider the impact of international immigration on the cultural tension in the US; Minnesota accepted a large population of Somalis in 1992 as refugees. --To explore how this progress toward racial equality has stagnated under the leadership of President Donald Trump. --To look at how COVID in the context of the above historical factors has served as a unwitting catalyst to racial riots and global protests.

Literature research including historical accounts of principles of abolition, post-civil war reconstructive political manuevers, 1950’s segregation protests and political supports (US and UK), refugee relief efforts made by the US [specifically related to Somalia], and reports regarding the impact of COVID on the 2020 reaction to racial injustice.

Evidence suggests that across time periods, recourses of politicians [US and global] resulted in negative relations internationally with respect to immigration. The unique situation created by COVID resulted in a crucible effect following the death of George Floyd.

Previous attempts at creating equality have proven unsuccessful and apathetic on the part of those in power. This has lead to a situation where COVID created a perfect storm in order to ignite racial tensions in the US.

Guanfacine extended release (GXR) is a non-stimulant treatment for attention-deficit/hyperactivity disorder (ADHD).

To separate efficacy and sedative treatment-emergent adverse events (TEAEs) associated with GXR in four randomized, controlled trials in children (6–12 years) and adolescents (13–17 years) with ADHD.

SPD503-301 (n = 345) and SPD503-304 (n = 324) were 8 and 9 week studies of fixed-dose GXR (≤ 4 mg/day). SPD503-312 (n = 314; adolescents only) and SPD503-316 (n = 338) were 10–13 week studies of dose-optimized GXR (1–7 mg/day).

In fixed-dose studies, pooled incidences of sedative TEAEs with GXR were highest at week 1 (GXR, 13.9–18.7%; placebo, 8.7%) and decreased to placebo levels at week 8 (0–1.4%; placebo, 0%). In contrast, proportions of responders (≥ 30% reduction from baseline in ADHD Rating Scale IV [ADHD-RS-IV] total score) increased from week 1 (GXR, 29.6–34.8%; placebo, 25.0%) through endpoint (GXR, 66.7–72.2%; placebo, 42.6%). Incidences of sedative TEAEs, but not proportions of responders, increased with GXR dosing. GXR was associated with a statistically significant reduction in ADHD-RS-IV total score from baseline to endpoint in patients without sedative TEAEs in both fixed-dose and dose-optimized studies (GXR versus placebo, effect size = 0.49 and 0.67, respectively; P < 0.001). GXR was associated with statistically significant improvements compared with placebo in both ADHD-RS-IV Hyperactivity/Impulsivity and Inattentiveness subscale scores (P < 0.001).

These data from pooled GXR clinical trials indicate that incident sedative TEAEs do not contribute to increased treatment response over time, and that sedation and symptomatic improvement are distinct effects of GXR.

The authors have not supplied their declaration of competing interest.

Psycho-Oncology (PO) is a specific psychiatric approach to cancer patients. The main psychiatric disorders observed are delirium and adjustment disorders (AD) and the most frequent treatments used are pharmacologic and psychotherapeutic.

With regard to the type of cancer, the most frequent in Portugal are breast, digestive and prostate.

Analyze the activity of PO in a district general hospital in Portugal.

Demonstrate that the main core in PO is similar in the world.

Prospective longitudinal study, during one year.

The sample had 130 patients (369 evaluations), mainly male, with the mean age of 64.22 years. The most frequent psychiatric diagnoses were delirium (56 cases; 43%) and AD (44; 34%) and the main interventions used were pharmacologic and psycho-education. The most common frequent cancers were digestive (54; 42%), urologic (16; 12%) and breast (15; 11%). This high frequency of urologic cancer was interpreted as a consequence of the sample and its geographic location, but it was also a reflection of the large number of requests made by this specialty. The majority of cancers had an advanced stage (84% vs 16%) that can be explained by the sample but also by health culture in Portugal, which is reflected in the inpatient services: Oncology (51; 39%) and Palliative Care (25; 19%).

The type of psychiatric disorders and treatments offered in PO is preserved around the world. The authors propose to do more studies, namely if the relation with others specialties affects psychiatric treatment of the patient.

The authors have not supplied their declaration of competing interest.

Mental health professionals’ derogatory attitudes towards patients diagnosed with borderline personality disorder (BPD) may negatively affect treatment outcomes.

We aimed to identify a) negative attitudes exhibited by mental health professionals towards BPD patients and b) the effects of disgust propensity and disgust sensitivity on theses negative attitudes.

Mental health professionals (N = 136) completed questionnaires on attitudes towards BPD patients, disgust propensity/sensitivity, and sociodemographic variables.

Significant differences in negative attitudes toward BPD patients based on gender, marital status, occupational subgroup, educational level, psychotherapy training, level of exposure to BPD patients, and political ideology were found. Results suggested BPD patients are viewed by mental health professionals as ineffective, incomprehensible, dangerous, unworthy, immoral, undesirable to be with, and dissimilar to the mental health professionals. Moreover, disgust propensity and the pathogen component of disgust sensitivity were associated with stronger negative attitudes towards BPD patients.

The findings emphasize the importance of mental health professionals’ awareness of the emotion of disgust as a relevant factor to their negative attitudes towards BPD patients.

No significant relationships.

Internet addiction is a behavioural problem that has gained increasing scientific recognition in the last decade, with some researchers claiming it is a '21st Century epidemic”, leading the APA to include Internet Gaming Disorder in the appendix of the DSM-5.

Internet addiction treatment literature is scarce, particularly regarding the expert view on Internet addiction. To fill this gap in knowledge, this paper aims to explore how Internet addiction therapy experts experience the presenting problem of Internet addiction in psychotherapy.

A total of 20 psychotherapists from 6 different countries (i.e., Germany, UK, USA, Canada, Austria and Switzerland) were interviewed regarding their individual experience of treating clients suffering from Internet addiction. Data were analysed using Interpretative Phenomenological Analysis.

Two superordinate themes were identified during the analysis: 'risk” and 'addiction”. Risk factors included individual, situational and structural characteristics. Psychotherapists treating Internet addiction viewed Internet addiction as actual psychopathology, containing addiction symptoms, criteria and diagnosis, and drew on its similarities with other addictions.

Internet addiction treatment experts highlight the existence and severity of Internet addiction as psychopathology requiring professional therapy. Clients who seek help for their Internet addiction-related problems experience their condition as distressing and as significantly impairing their functioning. Internet addiction fulfils the conditions for a mental disorder classification as outlined in the DSM-5, and should be taken seriously not to marginalise those affected. Parents and significant others, researchers and clinicians, and healthcare and insurance providers may benefit from the presented insights.

To explore functionality and quality of life outcomes in adolescents with ADHD transitioning from IR MPH, ER MPH or ATX onto PR OROS MPH.

Pooled analyses of two similar 12 week open label, flexible dose, non-interventional trials exploring outcomes in adolescents with ADHD (ICD-10) transitioning from either IR / ER MPH, or Atomoxetine onto PR OROS MPH. Connor's parents rating scale (CPRS), children's global assessment scale (CGAS) and quality of life (ILC) were measured.

186 adolescents (84.4% boys; median age 14yrs) were analyzed. Starting dose of OROS MPH was based on clinical judgment. Median dose of PR OROS MPH at baseline and endpoint was 36mg/day. Functionality based on C-GAS as well as burden of disease scores measured in parents and adolescents improved at endpoint (p< 0.001). 80% girls and 67% of boys achieved an at least 30% reduction on CPRS. ILC-LQ0-28 in adolescents and their care givers improved (p< 0.05). 56 adolescents (30,1%) experienced at least one treatment emergent adverse event (AEs≥4% were insomnia (4,8%), headache (3,7%), muscle twitches (3,2%).

Adolescents with ADHD transitioning onto PR OROS MPH showed clinically relevant improvement in daily functioning and quality of life aspects. Burden of disease in patients and their care givers was lowered.

Breast Cancer is the most frequent cause of death by cancer in Women. Therefore Breast Cancer is a priority of the Portuguese Health Ministry. Mental illness, as Depression, is also a priority of that Ministry and breast cancer presents higher psychopathology comorbidity than general population. These both facts emphasize the relevance of the studies about interventions to promote mental health of Portuguese breast cancer women. Simultaneously, there are little studies about the applicability and efficiency of Cognitive Behavior Group Therapy in the European context and in Portugal in particular.

We purpose to develop a group cognitive behavior therapy (CBT) program to breast cancer survivors and implement it in a Portuguese group.

After a proper review of cognitive behavior group therapy programs to oncologic patients, we will adapt them to the Portuguese population. Then, a study will be made with a group of breast cancer survivors. We intent to assess them before and after the therapy in respect to the following psychological variables: self-concept, optimism, coping, quality of life and psychopathology.

We expect to improve the knowledge about the applicability of Cognitive Behavior Group Therapy in Portuguese (and European) context.

In sum, we expect to contribute with efficient psychological interventions to Breast Cancer Women survivors, in respect to self-concept, optimism, coping, quality of life and psychopathology.

During the COVID-19 pandemic people experience higher levels of negative emotions, as well as face many negative and intense emotions felt by others. Thus, it is important to look for risk and protective factors that allow and help individuals to regulate these negative emotions and adapt to the hardships of the COVID-19 pandemic.

The main aims of the study were to (i) test how empathic dimensions (perspective taking, empathic concern and personal distress) and emotion regulation abilities were related to intensity of depressive symptoms during the COVID-19 lockdown in Poland, as well as to (ii) check if emotion regulation difficulties and personal distress predicted slower decrease in depressive symptoms over the two months in which the number of COVID-19 cases declined in Poland.

A total of 792 participants took part in the three-wave panel study. The sample was representative of the Polish population in terms of gender, age, and place of residence. Participants completed the following online questionnaires: The Patient Health Questionnaire-9, The Difficulties in Emotion Regulation Scale Short Form, and Brief version of the Empathic Sensitivity.

Significant positive correlations were found between depressive symptoms and both personal distress and emotion regulation difficulties during the lockdown. Moreover, emotion regulation difficulties were the only significant predictor of slower decrease in depressive symptoms over time during the COVID-19 pandemic.

It seems that interventions focused on improvement of emotion regulation abilities could be particularly beneficial in reducing depressive symptoms during the pandemic and preventing potential negative long-term outcomes.

Global estimates suggest over 130 million girls and women have undergone FGM. While practiced in Africa, Asia and the Middle East, due to immigration trends it is now prominent in Western society. While studies have focused on physical health consequences, post-2000 a small but growing number of studies have reported on the psychological impact of FGM. This paper reports on a project exploring the mental health consequences of FGM, the effectiveness of therapeutic support, and the sustainability of a new service through training peer mentors.

To establish and evaluate 3 drop-in clinics, offering emotional support to women who have experienced FGM. Build capacity through training peer mentors to continue the work of supporting women.

Community-based participatory research (CBPR) was used for this two-part project. In part 1, 30 women participated, data being collected via the Warwick-Edinburgh Mental Well-being Scale (WEMWS) and follow-up interviews. Part 2 involved the training of 12 peer mentors. Data was analysed using descriptive statistics and thematic analysis and evaluation respectively.

Improvement was found in the women's mental well-being, with themes (1) Speaking the unspoken (2) Emancipation of emotion (3) Harnessing hope, being identified. Of the 12 peer mentors successfully completing the course, 9 are now volunteering.

Mental health professionals are best placed to enable women to address FGM traumas and improve their mental well-being. Additionally, they can raise public and professional awareness and, through research, can help develop more appropriate and sensitive services for migrant women from practicing communities.

The authors have not supplied their declaration of competing interest.

A 56-year-old female admitted to psychiatry clinic due to complaints of forgetfulness, visual and auditory hallucinations, inability to go outside alone, washing hands in closet cabin, difficulty finding words for the last one year, progressing in last four months. Personal and family background was unremarkable. Vital signs and physical examination revealed no abnormalities. In neuropsychiatric examination, Glasgow Coma Scale score was 15 without any meningeal irritation signs or gait abnormalities. Cranial nerves, extrapyramidal, motor, cerebellar, and sensory systems were intact. All aspects of orientation (time, place and person) were impaired. She scored 12 points out of 30 in Mini Mental Test. Speech was non-fluent with looseness of associations. Impaired recall, abstract thinking, judgment, behaviour planning and attention were noted. Visiospatial disorientation and contructional dressing apraxia were revealed. MR Imaging reported a T2-weighted signal intensity change in nodular fashion suggesting a granulamatous lesion. Differential diagnoses included granulomatous diseases, neoplasms, infections and Behcet's disease. After necessary excluding evaluations were undergone, a diagnosis of NS was made due to increased angiotensin converting enzyme levels in cerebrospinal fluid. The clinical picture responded well to prednisone treatment and symptoms resolved within one month.

Increased awareness is essential to identify rare granulamotous diseases as a differential diagnosis in encountering psychotic symptoms accompanying demantial clinic presentation.

The authors have not supplied their declaration of competing interest.

The study aims to assess the prevalence of depressive symptoms among Palestinian deaf adults.

A quantitative cross-sectional design was adopted to answer the research question for the study. The framework is based on factors derived from previous studies on the Patient Health Questionnaire PHQ-9 (Robert & Spitzer et al, 2001). The subject population was composed of 217 adults from three representative West Bank Palestinian cities. Participants ranged in age from 15 to 65 years divided as males (n=136) and females (n=81). All participants attend special deaf centers and use the Palestinian Sign Language (PSL).

The data analyzed using Statistical Package for Social Sciences (SPSS). We used mean, standard deviation, and multivariate logistic regression. According to the multivariate analysis results of the study showed, (OR=2. 0) (95% CI, 1.2-3.4) minimal depression, (OR= 1.7) (95% CI, 1.2-2.3) mild depression, (OR=1. 4) (95% CI, 1.1-1.9) moderate depression, and (OR=0. 9) (95% CI, 0.7-1.2) severe depression.

The concluded result of our study is that more than half of the respondents suffer from depression at varying levels, which is considered significant conclusion. Tendency for depression might be a common health problem among deaf adults attending primary health maintenance installations. Further research on socio-demographic characteristics and the force of depression on their health status is required.

When other options fail, physical restraint is used in inpatient psychiatric units as a means to control violent behavior of agitated inpatients and to prevent them from harm. The professional and social discourse regarding the use of restrictive measures and the absence of the inpatients’ attitudes towards these measures is notable. Our research therefore tries to fill this gap by interviewing inpatients about these issues.

To assess the subjective experience and attitudes of inpatients who have undergone physical restraint.

Forty inpatients diagnosed with psychiatric disorders were interviewed by way of a structured questionnaire. Descriptive statistics were conducted via use of SPSS statistical software.

Inpatients reported that physical restraint evoked an experience of loneliness (77.5%) and loss of autonomy (82.5%). Staff visits during times of physical restraint were reported as beneficial according to 73.6% of the inpatients interviewed. Two thirds of the inpatients viewed the use of physical restraints as justified when an inpatient was dangerous. Two thirds of the inpatients regarded physical restraint as the most aversive experience of their hospitalization.

Our pilot study explored the subjective experience and attitudes of psychiatric inpatients towards the use of physical restraint. Inpatients viewed physical restraint as a practice that was sometimes justified but at the same time evoked negative subjective feelings. We conclude that listening to inpatients’ perspectives can help caregivers to evaluate these measures.

The authors have not supplied their declaration of competing interest.

To study the effect of baclofen in preventing drug use in persons with cannabis misuse.

An open label study to asses the effect of baclofen in treating persons with cannabis dependence (ICD-10 criteria) with assessments of outcome every month for a period of three months.

20 male subjects (mean age of 29.70 ± 10.19 years) with a mean age at development of dependence of 20.75 ± 09.34 years and mean duration of cannabis use of 89.40 ± 57.41 months, were treated with baclofen (mean dose of 33.75 ± 04.83 mg./day). At three months 12 subjects (60%) completely stopped, 6 subjects (30%) decreased the frequency and 2 subjects (10%) continued the same frequency of the cannabis intake.

Our findings provide preliminary support for the use of baclofen in maintaining abstinence and improving outcome in patients with cannabis dependence.

Schizophrenia is a severe mental disorder, with complex symptoms involving psychosis, negative symptoms and cognitive impairment. The Trail Making Test (TMT) has been widely used to assess attention and executive function. Functional transcranial Doppler sonography (fTCD) of basal cerebral arteries allows monitoring of aberrant cerebral hemodynamics during cognitive tasks in this patient group.

We assessed cerebral hemodynamics in the middle cerebral arteries (MCA) using fTCD while patients with schizophrenia and healthy subjects performed the TMT and a control task.

Fifteen patients with chronic schizophrenia and 15 healthy controls performed the TMT-A and -B during fTCD measurements of the MCA. Dependent measures were performance, mean cerebral blood flow velocity (MFV) and the lateralization.

Patients demonstrated an overall decreased speed of solution (P = 0.002), and there was no significant effect of age. They showed a significantly increased flow pattern for the TMT-B (P = 0.005). There were no lateralization differences between diagnostic groups.

There was a performance deficit in patients with schizophrenia for both TMT-A and -B that fits well with results of existing literature. The aberrant hemodynamic response supports the idea that cognitive performance elicits an aberrant cerebral hemodynamic correlate. It adds to the notion that fTCD is a valuable tool to correlate psychological paradigms with brain perfusion in patients with schizophrenia.

The authors have not supplied their declaration of competing interest.

Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in childhood. ADHD is a risk factor for the development of overweight and obesity. One neuropsychological factor that may play a prominent role in the relationship between ADHD and obesity is executive functioning.

The aim of this study is to investigate the relationship between comorbid obesity/overweight and cold executive functions, verbal short-term memory, and learning in children with ADHD. This is the first study to examine relationship between verbal short-term memory-learning and obesity in patients with ADHD.

This study was conducted with 70 patients with ADHD and 30 healthy controls. In this study, patients diagnosed with ADHD were divided into two groups according to body mass index (BMI) as <85 percentile and ≥85 percentile. Cold executive functions were evaluated by Stroop Test (ST) and Cancellation Test (CT). Serial Digit Learning Test (SDLT) was administered to measure verbal short-term memory and learning capasity. In order to evaluate the severity of ADHD objectively, parents completed the Conners’ Parents Rating Scale-Revised Short Version (CPRS-RS).

The ST, SDLT and CT scores were significantly lower in both groups with ADHD than the control group. The CPRS-RS subscale scores were significantly higher in both groups with ADHD than the control group. There was no statistically significant difference in ST, SDLT, CT scores and CPRS-RS subscale scores between the two groups with ADHD.

This study show that overweight/obesity comorbid with ADHD was not associated with cold executive functions, verbal short-term memory, learning, or ADHD symptom severity.

No significant relationships.

Attention deficit hyperactivity disorder (ADHD) is a neurobehavioral disorder, characterized by developmentally inappropriate levels of overactivity, inattention and impulsivity. Measuring inattention is a controversial question in ADHD diagnosis. Eye movement could provide a method to assess distractibility. Several studies have related visual attention and perceptual dominance in binocular rivalry.

To assess visual attention through the measurement of fixations in a binocular rivalry task in ADHD children and control groups.

We proposed a task for the assessment of distractibility and to enhance the diagnosis of attention disorders.

Forty children, 20 with ADHD-combined type and 20 controls, matched by gender, age and intelligence, were tested with a binocular rivalry task (i.e. an anaglyph image) with an exogenous distractor appearing regularly. The stimulus was divided in four Areas of Interest (AOI). Measurements of duration of the periods of exclusive dominance, perceptual alternations in dominance / suppression and fixations were taken by an eye tracker and a response box. Analysis of Variance was used to test differences between ADHD and control groups.

Significant differences between ADHD and control groups were found in dwells at the main AOI. Also, significant differences between groups in “Fixation over alternations ratio” were found.

ADHD participants looked at the relevant region (AOI_1) for a shorter time than the control group; they also looked at the no demanded regions (AOI_2, AOI_3, AOI_4) longer than the control group. Moreover, the ratio fixations/alternations were greater for the control group than the ADHD group.