Anxiety and depression, as well as alcohol use are widespread among teenagers, and constitute a huge public health burden worldwide.

To study the link between alcohol consumption and emotional distress (anxiety and depression) among adolescents.

We conducted a cross-sectional study in May and June 2016. The sample consisted of 314 pupils from 4 colleges and schools in Sfax (Tunisia). Alcohol Use Disorders Test (AUDIT) was used to evaluate alcohol dependence. Anxiety and depression levels were evaluated using the “Hospital Anxiety and Depression Scale” (HADS).

The mean age was 16 years with a sex ratio of 1.08. Among the participants, 18.9% reported having drunk alcohol at least once and 42.37% of them still consume. The main reasons for alcohol initiation were the search of new experiences (78%) or pleasure and well-being (39%) and the curiosity (49.15%). According to AUDIT, 1.7% of alcohol users presented an alcohol misuse and 20% presented dependence.

The prevalence of anxiety and depression were respectively 56.1% and 23.7%. Anxiety was correlated to alcohol experimentation (P = 0.03) and non-supportive environment (P = 0.003). Depression was correlated to alcohol experimentation (P = 0.001), AUDIT score (P = 0.009), somatic histories (P = 0.02), physical abuse (P = 0.02), non-supportive environment (P = 0.016) and graduating class level (P = 0.005).

Our study highlights the close association between alcohol consumption and emotional distress in adolescence, which seems to be bi-directional. When attempting to reduce the risk of alcohol consumption, we should focus a particular attention on adolescents studying in graduating class, reinforce adolescents’ family support and prevent physical abuse.

The authors have not supplied their declaration of competing interest.

Lithium is currently a drug of choice for treating persons with bipolar disorder and is widely used in this population. Approximately, 30% of patients taking lithium experience at least one episode of lithium toxicity. Treatment of acute toxicity involves correction of electrolyte abnormalities, volume repletion followed by forced diuresis, and dialysis in severe cases. A case report is described and it is reviewed some alternative treatment options before considering withdrawal of lithium treatment in lithium-induced nephrogenic diabetes insipidus.

A 58-year-old woman diagnosed of hypertension and bipolar disorder for 20 years. At first, she was controlled with valproic acid until she suffered a manic episode which required a mood stabilizer switch. She started a treatment with lithium 1200 mg/day and olanzapine to 10 mg/day and was completely recovered. After a year of stabilization, olanzapine was retired and she maintained stabilized with lithium 1000 mg/day during last 17 years. During last 8 months, she suffered polydipsia and polyuria (4 L/day). She was diagnosed of nephrogenic diabetes insipidus. Some measures like liquid restriction, lithium monodose and low sodium diet were carried out, obtaining a partial response. Taking into account, she was stabilised with lithium for many years, it was decided to introduce hydrochlorothiazide 25 mg/day, clinical and analytical resolution of nephrogenic diabetes insipidus was obtained. A year later, she maintains psychopathological stabilization, without any lithium secondary effects.

Some treatment options for lithium-induced nephrogenic diabetes insipidus could be introducing thiazides, amiloride, indomethacin, desmopressin or carbamazepine, instead of withdrawal lithium.

The authors have not supplied their declaration of competing interest.

The COVID-19 pandemic had a considerable psychosocial impact on healthcare workers (HCWs) who were constantly requested during this era with an increased risk of infection. This implies behavioural changes, especially in smoking behaviour.

To study smoking behaviour in HCWs with COVID-19.

A cross-sectional descriptive study conducted in the department of occupational pathology of Charles Nicolle Hospital in Tunis involving the smoking HCWs affected by COVID-19 during the period from September 1, 2020, to February 28, 2021. The data collection was carried out by a telephone call using a standardized questionnaire.

During the study period, 61 smoking HCWs were identified. Thirty-two patients agreed to answer the questionnaire, with a response rate of 52%. The mean age was 41±10 years. The sex ratio (M/F) was 1.46. Half of the participants had comorbidities. The most represented occupational categories were blue-collar workers (n=11) followed by nurses (n=10) and physicians (n=7). The median professional seniority was 13 [3.5; 20] years. The mean age of smoking initiation was 20±5 years. The most common mode of smoking was cigarettes (93%) with an average consumption of 19 cigarettes per day. Water pipe smoking was noted in 3 patients. All patients started smoking before the COVID-19 infection. Strong tobacco dependence was noted in 25% of patients. Twenty-one per cent of the population had moderate dependence. Half of the participants maintained the same level of smoking as before the COVID-19 infection. An increase in smoking was noted in 34% of patients. A decrease in the level of smoking was reported by 15% of respondents. Four participants stopped smoking after COVID-19 infection. The reasons for smoking cessation were COVID-19 damage (n=3) and confinement with family (n=1).

The change in smoking behaviour during the COVID-19 pandemic is notable, particularly in HCWs who are exposed to a high physical and mental load. The presumed association of smoking with severe forms of COVID-19 infection makes tobacco control in HCWs an obligation in order to preserve the continuity of care.

None Declared

Despite different treatment approaches many drug addicted patients continue to use drugs during and after treatment.

Personality traits are considered risk factors for drug use, and, in turn, the psychoactive substances impact individuals’ traits.

To describe the sample of 186 opioid addicted patients entered hospital treatment and assessing the differences in personality traits between abstinent and non-abstinent after one year.

A cohort of 186 patients consecutively admitted to the detoxification unit was investigated. The research interview, the Big Five Inventory (BFI), the Treatment Outcomes Profile (TOP) were administered during the first week of admission to the detoxification unit. Urine test was administered on the day of admission and at each follow-up point in combination with the TOP (after three, six and twelve months). Illicit drugs abstinence during one year after intake was selected as a treatment outcome measure.

Twelve months after admission 82 (44.9%) patients abstained completely. Agreeable patients remain in treatment longer (r = 0.20, P = 0.07). Extraversion and openness are negatively correlated with abstinence after six and twelve months (r = –0.15, P = 0.041; r = –0.15, P = 0.044). Neuroticism is in negative correlation with duration of treatment (r = –0.20, P = 0.006). Patients who are less open to new experiences are more likely to abstain from drugs 6 months after admission (r = –0.17, P = 0.021).

Personality measured with BFI correlates with treatment outcome poorly. At the same time personality could have an important role in responding to treatment, but personality traits could be at the same time protective as well as risk factors.

The authors have not supplied their declaration of competing interest.

Cancer is a disease that all human beings are afraid of it and anyone, of any age may be affected.

The objectives of this research are relationship between well-being and life expectancy in patients with cancer in Noshahr Shahid Beheshti hospital is the general purpose of this research.

Studying the relationship between happiness, general health and life expectancy of cancer patients.

The method used in this research is descriptive and correlation. Statistical population contains all the patients who were diagnosed with cancer in Shahid Beheshti hospital Noshahr. The panel sampling used as sampling method and the sample size was limited to 50 people.

In order to collect the data, we used Oxford's happiness questionnaire containing 29 multiple-choice phrases, Life expectancy questionnaire by Schneider (1991) and general health questionnaire (GHQ-28). In descriptive review of the collected data the mean, standard deviation and frequency tables were used and in inferentially section in order to determine and compare the obtained scores in these 3 tests, according to the findings, parametric methods were used.

The results show that the correlation between mental health, happiness and life expectancy was significant.

As life expectancy increases accountability; Happiness and mental health in patients with cancer increases by the same amount.

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

Alzheimer’s disease is common among the modern population. Emotional support for caregivers and a stable social role contribute to the maintenance of cognitive resources in Alzheimer’s.

To investigate the protective mechanisms that protect the brain from premature aging

Clinical, sociological

Violations of the higher cerebral functions of speech, gnosis, praxis are the neuropsychological basis for the development of psychological symptoms of dementia. Speech disorders, gnosis disorders contribute to the formation of painful ideas, perception disorders, eating disorders and affective symptoms. The level of functional activity is low and does not depend on the state of severe microsocial dementia, total aphasia and apraxia. The social, work, family and marital status of caregivers for patients with moderate to severe dementia is declining. An increase in the degree of dementia can reduce the functional activity of the caregiver. Caregivers often suffer from neurotic, affective and other mental disorders. A person with dementia plays a subordinate role in the family. Changing roles in the family occurs when the patient has delusion, agitation / aggression, anxiety, unstable mood / irritability. In these cases, the interpersonal distance in the “care-patient” pair increases. Caregivers have a high level of emotional involvement in the care process. A change in the role of the family, a change in place of residence, and a high level of “expressive” emotions of the guardian negatively affect the formation of psychosis, anxiety and aberrant behavior in patients with dementia. Microsocial factors influence cognitive retention in dementia

Protective psychosocial factors strengthen the cognitive reserve

No significant relationships.

Patients with Attention Deficit/Hyperactivity Disorder (ADHD) have shown a high risk to develop a DSM cluster B (i.e., Borderline, OR = 13.16; Antisocial, OR = 3.03; Narcissistic, OR = 8.69) and DSM Avoidant personality disorder (OR = 9.77). Similarly, higher rates of DSM cluster B personality disorder were found among adult ADHD patients (6-25%) than general population. Although some authors investigated the prevalence of personality traits and disorders among adult ADHD patients, no studies have been yet reported about the assessment of Millon's Evolution-Based Personality profiles in adult ADHD patients.

To explore the prevalence of personality traits and disorders among adult ADHD patients.

Millon's personality traits and disorders were assessed in a consecutive sample of 35 adult ADHD outpatients accessing the Service for Adult ADHD of the AOU San Luigi Gonzaga (Orbassano, TO) using the Millon Clinical Multiaxial Inventory–III (MCMI-III).

According to the MCMI-III manual, ADHD patients in our sample showed more frequently both Cluster C and Cluster A traits and disorders, with a high prevalence of avoidant/depressive (8.6%/14.3%) and negativistic/self-defeating (20%/5.7%) personality disorders. Conversely, we found a low prevalence of Narcissistic (5.7%) and Histrionic (5.7%) traits, and no patient showed Borderline personality traits or disorder.

Unexpectedly, the dimensional assessment of adult ADHD personality reveals a high prevalence of cluster C and cluster A personality traits and disorders, and a low prevalence of cluster B personality disorders.

The authors have not supplied their declaration of competing interest.

Evidence from previous small trials has suggested the effectiveness of early social communication interventions for autism.

The Preschool Autism Communication Trial (PACT) investigated the efficacy of such an intervention in the largest psychosocial autism trial to date.

To provide a stringent test of a pre-school communication intervention for autism.

152 children with core autism aged 2 years - 4 years 11 months in a 3 site 2 arm single (assessor) blinded randomised controlled trial of the parent-mediated communication-focused intervention added to treatment as usual (TAU) against TAU alone. Primary outcome; severity of autism symptoms (modified social communication algorithm from Autism Diagnostic Observation Schedule-Generic, ADOS-G). Secondary outcomes; blinded measures of parent-child interaction, child language, and adaptation in school.

At 13 month endpoint the treatment resulted in strong improvement in parental synchronous response to child (adjusted between-group effect size 1.22 (95% CI 0.85, 1.59) and child initiations with parent (ES 0.41 (0.08, 0.74) but small effect on autism symptomatology (ADOS-G, ES -0.24 (95% CI -0.59, 0.11) ns). Parents (not blind to allocation) reported strong treatment effects on child language and social adaptation but effects on blinded research assessed language and school adaptation were small.

Addition of the PACT intervention showed clear benefit in improving parent-child dyadic social communication but no substantive benefit over TAU in modifying objectively rated autism symptoms. This attenuation on generalisation from ‘proximal’ intervention effects to wider symptom change in other contexts remains a significant challenge for autism treatment and measurement methodology.

The author has not supplied his declaration of competing interest.

Tardive dyskinesia (TD) is a serious medical condition that affects a significant proportion of patients treated with antipsychotic agents.

To report a patient who developed tardive dyskinesia after initiation of antipsychotic and antidepressant treatment.

Miss H. is 24-year-old Tunisian woman who had been diagnosed with bipolar disorder 6 years ago. She received various drugs: olanzapine, haloperidol, amisulpride, sertraline, paroxetine, etc. On November 2013, she first complained of hand tremor and then developed severe dystonia of the trunk and chorea. A series of laboratory tests was performed after the onset of these involuntary movements. It included complete blood count, liver, renal, and thyroid function tests, blood prolactin level, blood glucose level, blood copper level and ceruloplasmin level. A brain MRI was also performed. These examinations showed no specific findings. The diagnosis of TD was presumed. The patient was first treated with amisulpride, lorazepam, avlocardyl and piracetam until May 2014. Then, amisulpride was substituted by olanzapine until August 2015. The luck of improvement led to her admission. We stopped antipsychotic treatments and prescribed her vitamin E (900 mg/day), clonazepam (6 mg/day) and vitamin B6. The follow-up led to the decline of the Abnormal Involuntary Movement Scale (AIMS) score of 7 points over 6 weeks.

TD remains a serious side effect that worsens the prognosis and affects the quality of life of patients. Cluster randomised trial should be done in order to develop practice recommendations for prevention and management of TD.

The authors have not supplied their declaration of competing interest.

Ippokrateio Therapeutirio in the city of Larissa, Thessaly, Greece is a private for-profit psychogeriatric hospital focusing on Long Term Care on patients with dementia. During the COVID-19 era lockdown visits by carers/relatives/friends were forbidden due to the preventive government measures. At that same time appearance and/or exaggeration of neuropsychiatric symptoms was observed. In order to restore communication issues we performed telecommunication sessions (videocalls) and measured, among other factors, neuropsychiatric symptoms before and after sessions.

Primary objective was to check for relations between video-calls and changes in neuropsychiatric symptoms using NeuroPsychiatric Inventory (NPI). Secondary objective was to check for carers and patients satisfaction, mainly through qualitative information.

120 patients with diagnosis of minor or major neuroconitive disorder of any type participated in the video call sessions. Two video calls per patient took place (1 per week) with a 10-inches tablet. Neuropsychiatric Inventory (NPI) was performed before the start of the video-calls. NPI had been performed again the week after both sessions were completed. Satisfaction of carers and patients was recorded, mostly as qualitative data.

Neuropsychiatric symptoms improved in patients with mild or moderate neurocognitive decline. In more severe cases though anxiety, irritability and sleep problems worsened. Satisfaction reached almost 95% of the carers.

Video calls could be a very good way to surpass the communication burden during the pandemic restrictions for LTC dementia patients. Caution should be given to severely demented patients since clinical observations show that a cluster of symptoms worsens.

Many experience low mood and energy during winter. Brain serotonin is involved in the regulation of many physiologic and pathologic functions that vary with season. Seasonal variations in peripheral serotonergic markers have been described in clinical and nonclinical populations, and a postmortem study shows seasonal differences in hypothalamic serotonin concentration.

We investigated the molecular background of seasonal changes in serotonin function by conducting a series of studies on serotonin transporter (5-HTT) density and function in depression and health.

In a large study in drug-free patients with seasonal affective disorder (SAD) we aimed at detecting state-related alterations in 5-HTT-mediated inward and outward transport in platelets. Another study in healthy subjects aimed at detecting seasonal variations in 5-HTT binding in the living human brain using [11C] DASB positron emission tomography. Regional 5-HTT binding, an index of 5-HTT density, was assessed in a large sample of drug-naïve healthy volunteers, and was related to meteorological and astronomical data.

In patients with SAD we showed that the 5-HTT is in a hyperfunctional state during winter depression, and normalizes after light therapy and in natural summer remission. In healthy subjects, 5-HTT binding was higher in autumn/winter as compared to spring/summer. Regional 5-HTT binding correlated negatively with daily sunshine, such that higher values occurred at times of lesser light.

Since high 5-HTT density is associated with low synaptic serotonin levels, regulation of 5-HTT density and 5-HTT function by light is a mechanism that may explain seasonal changes in normal and pathologic behaviours.

L’étude de la mémoire autobiographique dans l’autisme a été principalement réalisée chez l’adulte [1] et plus rarement chez l’enfant, révélant principalement des déficits en mémoire épisodique [2]. Il n’existe qu’une étude chez l’adolescent [3] cherchant à caractériser les souvenirs épisodiques, incluant notamment leurs propriétés sensorielles. L’objectif de notre étude est d’évaluer les productions épisodiques d’événements à la fois passés et futurs, chez des adolescents avec trouble du spectre autistique, en utilisant un support et en explorant les détails phénoménologiques, émotionnels et les capacités de récollection.

Un échantillon de 16 adolescents avec un diagnostic de trouble du spectre autistique sans déficience intellectuelle (TSA-SDI), et un groupe de 16 enfants au développement typique, ont réalisé une tâche de mémoire autobiographique originale, ludique et contrôlée, comprenant à la fois une évaluation rapide et indicée de la composante sémantique et plus détaillée de la composante épisodique.

Les participants avec TSA-SDI présentent des difficultés de restitution des souvenirs épisodiques comparés aux témoins et bénéficient significativement de l’indiçage. Au niveau des propriétés perceptives, les adolescents avec TSA fournissent moins de couleurs que les témoins, alors que le nombre total de détails perceptifs ne diffère pas entre les deux groupes. Enfin, la reviviscence diffère selon la période évoquée : la reviviscence d’évènements passés est moins précise que la projection dans le futur.

Ces résultats confirment l’existence de troubles en mémoire épisodique chez les adolescents avec TSA-SDI, améliorés en présence d’un support visuel. Les propriétés sensorielles semblent être impliquées différemment dans l’organisation des souvenirs, notamment les couleurs, probablement en relation avec une perception atypique chez les personnes avec TSA-SDI [4]. L’impact de la perception des couleurs sur la mémoire est une piste de recherche à approfondir.

Irritability is the most frequently reported symptom in child and adolescent depression. The association of both has been linked with high rates of chronicity, comorbility and impairment.

To study the association between irritability and depressive symptoms in children and adolescents.

We have studied 857 participants recruited from the only child and adolescent mental health clinic in a catchment area of 122,968 people under 18 (2004–2010). A sample of 857 participants (112 controls and 745 patients) was included to carry out a cross-sectional study. Irritability was measured by a Visual Analog Scale (VAS irritability)–scored from 0 to 10–, and depressive symptoms by the Children's Depression Inventory (CDI). The participants were categorized into controls and patients, and according to their irritability (≤ 4 [I], 5 [II] and ≥ 6 [III]). The mean of CDI score was calculated for each of the groups, adjusted by sex and age, and analyzed by ANCOVA.

The following means were obtained from the controls: 13,71 (group I), 9,82 (group II) and 17,45 (group III). Regarding to the patients: 13,92 (group I), 11,54 (group II) and 15,64 (group III). A quadratic association (P < 0.0015) was found between VAS irritability score and CDI score.

There is not a linear association between irritability and depressive symptoms in children and adolescent. High rates of depressive symptoms were associated both with high and low rates of irritability. Several questions remain unexplained about the status of irritability in psychiatry, as Stringaris group has been pointed out.

The authors have not supplied their declaration of competing interest.