Atypical antipsychotics are a new treatment option for patients with impaired impulse regulation as seen in Cluster B personality disorders. Preliminary data are available on the use of atypical antipsychotics especially in the treatment of impulsivity in borderline personality disorder. The aim of the present study is to investigate efficacy regarding impaired impulse regulation, different psychopathological symptoms and tolerability of quetiapine in a group of patients with Cluster B personality disorder.

Fifteen consecutive patients with a DSM-IV diagnosis of borderline, histrionic, or narcissistic personality disorder were treated for 8 weeks with open-label quetiapine at the dose of 400 mg/day. Patients were assessed at baseline, week 1, 2, 3, 4, 6, and week 8. The clinical efficacy and side effects were assessed using the following scales: Hamilton Scales for Depression (HAM-D) and Anxiety (HAMD-A), Beck-Depression Inventory (BDI), Barratt Impulsivity Scale version 10 (BIS-10), Brief Psychiatric Rating Scale (BPRS), and the Dosage Record and Treatment Emergent Symptom Scale (DOTES).

Twelve patients completed the study. Three patients (20%) dropped out due to noncompliance. A significant improvement was found for the scores of the following scales: BPRS (anxiety/depression subscale), HAM-D, and BDI. No significant result was found for impaired impulse regulation. Common adverse effects, possibly due to study medication, were mild-to-moderate somnolence, mouth dryness, agitation, nausea, and dizziness.

An 8 week open label treatment with 400mg quetiapine daily seems to improve depressive and anxiety, but not impulsivity symptoms in cluster-B personality disorders.

Anxiety disorders are the most common mental disorders, and their prevalence is substantially higher in women than in men. Research has confirmed the existence of gender differences in several types of anxiety disorders.

The current investigation sought to determine whether any observable gender differences existed in anxiety for a nonclinical sample.

the sample consisted of 300 males and 300 female students from a secondary school in Kuwait. The genders were matched in age (males = 16.52 ± 0.90 & females = 16.37 ± 0.96, t = 1.93, P > .05). The inclusion criteria for all participants: sample of the population of Al-Jahra city, aged between 15 and 18 years old, school grades 10, 11, 12, and the social status of the parents (married). The Arabic version of Beck Anxiety Inventory (BAI) was administered to participants. BAI reliabilities ranged from .88 to .87 with a mean .87 (alpha) denoting good internal consistency. The convergent correlations in eight samples between BAI and Kuwait University Anxiety Scale KUAS (mean r = .52) for validity coefficients.

The results revealed that females (18.67 ± 11.11) had significantly higher mean anxiety than their male (14.52 ± 10.37) counterparts (f = 22.27, P < .000).

Therefore, we can conclude that female preponderance of anxiety has been a consistent finding within literature.

The author has not supplied his declaration of competing interest.

The research was carried out in Poland between 7-19 March 2021 with the help of online questionnaire on a group of 183 male aged 18-20. The subjects were divided into two age groups: 18-29 and 30-40. The second division are chemsex and non chemsex users.

Objective of this research was to test whether attachment styles, ways of coping with stress and feeling of sense of life influence the risk of overusing chemsex in MSM groups aged 18-29 and 30-40.

Online questionnaire composed of demographics and 3 psychological tests: Ways of Attachment Questionnaire (Polpa 2008) Ways of Coping Questionaire (polish adaptation by P. Szczepaniak, J. Strelau, K. Wrześniewski) Life Attitude Profile - Revised (polish adaptation by R. Klamut)

Examinated chemsex users, based on life attitudes analysis, tend to lead a strongly oriented life, are convinced of having clear and well-defined goals. In terms of dealing with stress they are presenting focused-on-task style, they exhibit lowered levels of avoidant style than normally characteristic for addicts. The research did not reveal any connection between chemsex users and attachment styles.

The research did not allow to clearly point out any connections between risk factors and chemsex usage. During data analysis some weak links occurred, nevertheless too weak to state any risk factors. As results of carried out research it was possible to determine some models, which marked some specific values, obtained on given scales, and following connections between heightening and lowering chance of chemsex usage.

No significant relationships.

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

Humans learn how to behave both through rules and instructions as well as through environmental experiences. It has been shown that instructions can powerfully control people's choices, often leading to a confirmation bias.

To compare learning parameters in reinforcement learning task with and without instructions.

We recruited 52 healthy adult control subjects (21 males, 31 females, age 30 ± 6.5 years). Participants completed Repeatable Battery of Neuropsychological Status (RBANSS). Twenty-seven participants completed additionally Probabilistic Selection Task (PST) while twenty-five participants completed Instructional Probabilistic Selection Task (IPST). To analyze learning parameters, we used Q-learning model with 3 parameters: learning rate due to positive and negative reinforcements as well as exploration-exploitation parameter.

Both groups did not differ with respect to cognitive functioning measured with RBANSS (immediate and delayed memory, visuospatial abilities, language and attention); however, participants who completed PST had trend-level statistically faster learning rates due to positive (P = 0.099) and negative reinforcements (0.057) in comparison to participants who completed IPST. Both groups did not differ with respect to exploration-exploitation parameter (0.409).

In healthy adults, interference of confirmation bias can influence learning speed independent of cognitive functioning (immediate and delayed memory, visuospatial abilities, language and attention).

The authors have not supplied their declaration of competing interest.

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.

Pregabalin is a gamma-aminobutyric acid analogue used for the treatment of neuropathic pain, partial-onset-seizures, fibromyalgia, and anxiety disorders. Mirtazapine is an atypical antidepressant used in major depression and often prescribed off-label for insomnia. Delirium, an acute confusional state, is a very rare adverse reaction of both medications.

We report a case of an elderly patient treated with low dose pregabalin and mirtazapine who developed drug-induced delirium which resolved rapidly upon withdrawal of both drugs

A 75-year-old woman was admitted for symptoms of anxiety, various bodily complaints (dysphagia, headache, tinnitus, weakness) and sleep-onset insomnia over the preceding 2 months. On admission, examination revealed an apparently anxious, uneasy and emotional looking patient. Mini mental state examination, as well as clock drawing and copying were normal, suggesting absence of cognitive impairment. Physical examination was unrevealing except for high blood pressure recordings (150/90 mmHg). Laboratory testing indicated creatinine at 1.19 mg/dl, with a creatinine clearance moderately decreased at 38 ml/min. Upon admission, she was placed on pregabalin 25 mg bid and mirtazapine 30 mg ¼ tablet qd.

Three days after admission, pregabalin was increased to 25 mg tid. On the same day and about 2 hours after the night dose, the patient acutely developed delirium: she presented confusion, disorientation, incoherence, restlessness and deterioration of her anxiety. On physical examination she was afebrile with no hypertonia or ataxia. An urgent brain magnetic resonance imaging was grossly unrevealing. Pregabalin and mirtazapine were discontinued, as a drug-induced delirium was suspected. She received as a symptomatic treatment lorazepam progressively up to 4 mg qd. Symptoms of delirium resolved rapidly, and she was discharged days later with full functional recovery

Cases of delirium have been described following treatment with pregabalin, but in significantly higher doses. Pregabalin relies heavily on renal clearance for its excretion and the dose should be adjusted in patients with creatine clearance below 60 ml/min. As our patient had a moderate decrease in renal clearance, we prescribed a dose within suggested limits, but in combination with mirtazapine led to the appearance of a drug-induced delirium. In conclusion, combined therapy with low-dose pregabalin and mirtazapine seems to account for the development of delirium in our patient as based on its temporal association with the initiation of this drug combination and its prompt resolution upon withdrawal of these two agents

None Declared

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