Machine learning has increasingly been applied to classification of psychosis spectrum in neuroimaging research. However, a number of multimodal studies using MRI and electroencephalography (EEG) is quite limited.

To assess the power of multimodal structural MRI (sMRI) and EEG data to provide pairwise discrimination between first-episode schizophrenia (FES) patients, individuals at ultra-high-risk of psychosis (UHR), and healthy controls (HC) using machine learning algorithms.

46 FES male patients, 39 UHR individuals, and 54 matched HC underwent sMRI (3T Philips scanner) and electroencephalography. T1-weighted images were processed via FreeSurfer to obtain cortical and subcortical measures. L2 regularized logistic regression was used to evaluate the efficacy of diagnostic prediction.

The accuracies of pairwise discriminations were: 87% for FES vs HC (specificity 83%, sensitivity 91%); 77% for FES vs UHR (specificity 76%, sensitivity 79%); 75% for UHR vs HC (specificity 77%, sensitivity 73%).

Current findings suggest that the patterns of anatomical and functional variability have potential as biomarkers for discrimination between schizophrenia, UHR, and healthy subjects. Furthermore, results show that the selection and multimodality of feature types are important. Specifically, adding EEG data to morphometric measures improved accuracy rates in FES vs HC and FES vs UHR contrasts, whereas standalone EEG data provided higher accuracy compared with morphometric or multimodal data in UHR vs HC discrimination. Expectedly, predictive power for the UHR was smaller than for the FES due to its intermediate anatomical features, located between those observed in healthy controls and those found in patients. The work was supported by RFBR grant 20-013-00748

Clozapine is a neuroleptic commonly used in treatments resistant to schizophrenia. However, despite the benefits, clozapine might cause some serious side effects. Hence, it is of the utmost necessity to keep an exacting control of the patients.

To study some of the therapeutical approaches to the treatment of clozapine induced neutropenia and agranulocytosis.

Review of some articles in Mental Health Journals.

The treatment with clozapine, substratum of aminergic and muscarinic receptors, entails a 0.9% risk of causing agranulocytosis, and approximately a 2.7% risk of causing neutropenia. Both occur, over 80% of them, during the first 18 weeks of treatment. Thus, before starting it, it is necessary to draw some blood and analyze the complete blood count (CBC). Also, we must analyze CBCs weekly during the first 18 weeks. Other dyscrasias like leukopenia, leukocytosis, anaemia, eoshinophilia, thrombocythaemia or thrombocytopenia can also be observed. When agranulocytosis appears, it can be treated by discontinuing the clozapine treatment, but also using granulocyte-colony stimulating factor or lithium, both separated or combined with clozapine. Lithium produces reversible leukocytosis onceplasma levels of > 0.4 mmol/L are reached. Despite the simultaneous treatment with lithium, clozapine can trigger some neurological side effects, it seems that seizure risk remains invariable.

Some of the clozapine's side effects, like neutropenia or agranulocytosis, are potentially lethal. Their treatment consists of discontinuing clozapine or initiating granulocyte-colony stimulating factor or lithium. These are good options that can give rise to a later continued treatment with clozapine.

The authors have not supplied their declaration of competing interest.

Evidence on the negative outcomes of untreated mental disorders during pregnancy and in the first year after childbirth on women’s and children’s health has stimulated interest in how to develop and sustain high-quality mental health care during the perinatal period. In Italy, there is a lack of knowledge about how mental health services support women with perinatal mental disorders (PMDs). This study aims to describe the adoption of good practices for the prevention and care of PMDs by the Italian mental health departments (MHDs).

This is a nationwide cross-sectional survey conducted online using LimeSurvey. Starting from the Ministry of Health Registry’s 127 MHDs were invited to participate between February and March, 2023. Characteristics of the participating MHDs were reported as descriptive statistics.

One hundred nineteen MHDs participated, with a response rate of 93.7%. Regarding the prevention of PMDs, 69 (58.0%) MHDs offer preconception counseling, whereas only 6 (5.0%) have information material for this purpose. Written integrated care pathways for PMDs are not available in 94 (79.7%) MHDs. A reference professional for psychopharmacological treatment during pregnancy or breastfeeding is available in 55 (46.2%) MHDs, while a specific treatment plan for women with PMDs is adopted by 27 (22.7%) MHDs. Thirty-four (28.6%) MHDs have established an outpatient clinic for PMDs, whereas there are no inpatient psychiatric facilities designed for mothers and infants (mother-baby units).

There is a need to improve the care of women with PMDs in Italy. The provision of pre-conception counseling, integrated care pathways, and specialist skills and facilities for PMDs should be prioritized.

There has been an escalation of therapeutic use and abuse of opioids. Aberrant drug related behaviors (ADRB) have prevalence between 2.8% and 62.2% in chronic pain patients treated with opioids and dependence is estimated around 3.27%.

To estimate the prevalence of dependence, ADRB, risk of opioid abuse, and co-occurring disorders in patients with chronic pain in our environment.

A total of 115 (n = 115) patients attending our pain clinic were screened to evaluate the risk of opioid abuse and presence of dependence including a clinical interview, hamilton depression scale (HAD), opioid risk tool (ORT), diagnostic criteria for substance abuse and dependence (DSM IV-TR) and a checklist of ADRB.

Among the patients, 78.26% were taking opioids, aberrant opioid related behaviors were detected in 20% and 8.9% met criteria for abuse or dependence; 11.3% had high risk and 20% moderate risk of opioid abuse (ORT). The most prevalent substance use disorders were sedative (11.3%) and alcohol (5.2%). There was a significant difference in means (t = -3.20 P < 0.005) in ORT scores between patients with current opiod dependence (x = 7.70 [s.d. = 3.07]) and without it (x = 2.88 [s.d = 3.58]); 30.4% had anxiety, 20% depression and 3.5% adjustment disorders; 57.5% and 48.3% had a score > 10 on anxiety and depression respectively on the HAD.

A systematic screening of risk of opioid abuse and of dependence as well as psychotherapy to treat comorbid psychopathology should be part of the treatment protocol.

The authors have not supplied their declaration of competing interest.

Valproic acid (VPA) has been used in clinical practice since the 60’s, with a relatively favourable safety and efficacy profile. Pancreatitis, hepatotoxicity and teratogenicity are the most significant adverse drug reactions. VPA is also known for causing hyperammonemia, which may be asymptomatic or can present with encephalopathy. VPA-induced hyperammonemic encephalopathy (VHE) is a serious but reversible condition, which requires high clinical suspicion for diagnosis. It may occur acutely or after chronic use of VPA.

Review how frequent is for valproic acid to cause hyperammonemic encephalopathy, signs to watch out for and how it can be treated.

Presentation of a patient’s case and review of existing literature, in regards to encephalopathy caused by valproic acid as a result of ammonia elevation.

In the case displayed here, the patient is diagnosed of hyperammonemic encephalopathy after being treated with valproic acid as treatment for borderline personality disorder.

Reviewing literature, cases of hyperammonemia are rarely reported as VPA-induced, probably because this increased level of ammonia in blood can vary between asymptomatic, and clinically relevant levels. Symptomatology due to VPA-induced hyperammonemia include: lethargy, impaired consciousness, focal neurological signs and symptoms and increased seizure frequency. More rare described symptoms are: aggression, ataxia, asterixis, vomiting and coma.

There are multiple treatment modalities for patients diagnosed with VHE, the primary treatment being the discontinuation of VPA. Other treatments frequently used are Lactulose and Carnitine.

VHE is a rare occurrence, however can have fatal outcomes if not recognized and managed in time. Physicians should be vigilant while initiating Valproate therapy to patients. Clinicians should consider the possibility of VHE in patients with unexplained altered mental status, regardless of the duration of VPA therapy. A timely diagnosis is essential to prompt effective treatment, thus ensuring the patient’s safety and decreasing the length of hospitalisation and the cost of care in hospitals.

None Declared

“Head banging” is a common form of self-harm, linked to numerous negative outcomes including significant brain damage. However, little research has investigated the prevalence and correlates of head banging behaviour in clinical populations.

Head banging episodes were identified from the incident records (n = 5417) of two inpatient forensic services (one intellectual disability and one mental health), using relevant search terms. Rates were compared between individual patients, by gender, diagnosis and level of security. Incident accounts were analysed qualitatively using thematic analysis.

Two hundred and twenty nine incidents of head banging were recorded, occurring approximately every three days in each service. The prevalence of the behaviour between individual patients varied widely, ranging from one to 38 incidents within one year. Women and patients with intellectual disability appeared more likely to engage in head banging. Qualitative incident reports indicated that head banging was associated with mental distress, anger, and psychotic experiences.

Head banging occurs frequently in forensic services, and has documented associations with traumatic brain injury in affected individuals, thus negatively impacting progress through the care pathway and treatment outcomes. Further research should investigate short and long term management strategies and treatment approaches, in order to minimise harm.

The authors have not supplied their declaration of competing interest.

We investigated the links between familial loading, preadolescent temperament, and internalizing and externalizing problems in adolescence, hereby distinguishing effects on maladjustment in general versus dimension-specific effects on either internalising or externalising problems.

In a population-based sample of 2230 preadolescents (10-11yrs) familial loading (parental lifetime psychopathology) and offspring temperament were assessed at baseline by parent report, and offspring psychopathology at 2.5-year follow-up by self-report, teacher and parent report.

Familial loading of internalising psychopathology predicted offspring internalising but not externalising problems whereas familial loading of externalising psychopathology predicted offspring externalising but not internalising problems. Both familial loadings were associated with Frustration, low Effortful Control, and Fear. Frustration acted as a general risk factor predicting severity of maladjustment; low Effortful Control and Fear acted as dimension-specific risk factors that predicted a particular type of psychopathology; whereas shyness, high-intensity pleasure, and affiliation acted as direction markers that steered the conditional probability of internalising versus externalising problems, in the event of maladjustment. Temperament traits mediated a third of the association between familial loading and psychopathology. Findings were robust across different composite measures of psychopathology, and applied to girls as well as boys.

It is important to distinguish general risk factors (Frustration) from dimension-specific risk factors (familial loadings, effortful control, fear), and direction markers that act as pathoplastic factors (shyness, high-intensity pleasure, affiliation) from both types of risk factors. About a third of familial loading effects on psychopathology in early adolescence are mediated by temperament.

Dyslexia is a reduced reading comprehension despite normal IQ. This may affect sufferers’ ability to be competitive in high end degrees. We investigated the prevalence of dyslexics in 4 degree disciplines.

4 cohorts were analysed consisting of Engineering, Medical, Law, and Dentistry students. These were all students drawn from UK universities. They were polled, voluntarily through an online resource. Qualitative and Quantitative data was collected and analysed. Due to data collection being by way of a poll, ethical approval was not required

18 Engineering, 46 Medical, 22 Law and 11 Dentistry students responded. Of these 5/18 (28%) Engineering students classified themselves as dyslexic in comparison to 7/46 (15%) Medical students, 1/22 (5%) Law students and 1/11 (9%) of Dentistry students. Qualitative analysis showed the importance of teachers in the pre university years. Students felt they benefited from extra time in exams and that this ‘leveled the playing field’.

This study is limited by self-reporting of dyslexia, and the potential for respondent empathy to the subject.

This study highlights a larger than previously reported prevalence of dyslexia in high performing disciplines, markedly Engineering. Other studies have focused on dyslexics IQ-reading gap, and our results support this, with Law – a literature intensive subject, actually having the lowest prevalence. Engineering focusses on mathematic methods, and the increased dyslexic prevalence suggests they are more comfortable with subjects not focused on reading.

The aim of this paper is to study the profile of Moroccan users to contextualize interventions and to identify if specific requirements are observed.

A descriptive statistical analysis of sociodemographic and clinical variables are performed to acknowledge the differences between Moroccan users (n = 6) compared to the group of Spanish users (n = 12).

The following was found in the Moroccan users: the average age was 7 years higher. The percentage of Toxic abuse was slightly higher (83% vs 75%), although in comparison to the Spanish users the Moroccan users had double the percentage of patients treated in the Addictions center.

There were no significant differences in the duration of untreated psychosis (DUP) and in the duration of untreated illness (DUI). According to the referral, the Moroccan users were better detected in Primary care (50%/8%).

Regarding the PANSS negative symptoms predominated in Moroccan (45/20 percentile) and general psychopathology (65/35 percentile).

In the Social Functioning Scale (SFS), there are only differences in Autonomy Execution (T score = 104/T = 92).

The Family Questionnaire (FQ) shows that families reported greater frequency and discomfort of symptoms and the user as less capable of controlling themselves. Finally, the Global Assessment of Functioning (GAF) offers an average of nearly 15 points lower.

The training area stands out as a handicap in the rehabilitation process. Clinically negative symptoms and general discomfort are factors that limit the overall functioning. More specific interventions are also required for the families of these users.

The authors have not supplied their declaration of competing interest.

Alexithymia is a multifactorial personality trait observed in several mental disorders, especially those with poor social functioning. Although it has been proposed that difficulties in interpersonal interactions in highly alexithymic individuals may stem from their reduced ability to express and recognize facial expressions, this still remains controversial.

In everyday life, faces displaying emotions are dynamic, although most studies have relied on static stimuli. The aim of this study was to investigate whether individuals with high levels of alexithymia differed from a control group in the categorization of emotional faces presented in a dynamic way. Given the highly dynamic nature of facial displays in real life, we used morphed videos depicting faces varying 1% from neutral to angry, disgust or happy faces, with a video presentation of 35 seconds.

Sixty participants (27 males and 33 females) were divided into high (HA) and low levels of alexithymia (LA) by using the Toronto Alexithymia Scale (TAS-20). Participants were instructed to watch the face change from neutral to an emotion and to press a keyboard as soon as they could categorize an emotion expressed in the face.

The results revealed an interaction between alexithymia and emotion showing that HA, compared to LA, were more inaccurate at categorizing angry faces.

The authors have not supplied their declaration of competing interest.

The aging population in the developed world has implied increasing age diversity in the workforce of organizations. Consequently, mutual perceptions about one’s co-workers and age discrimination is becoming increasingly important.

This study aims to explore how perceptions about older workers’ work (un)adaptability, work effectiveness and workplace age discrimination vary according to participants’ psychosocial factors, such as age group, gender, education level and work sector.

This study included a sample of 453 workers in Portugal, diverse in terms of age, gender, education level and work sector. Four different instruments were used: (a) a sociodemographic questionnaire; (b) an older workers’ Work Adaptability scale; (c) an older workers’ Work Effectiveness Scale and; (d) the Workplace Age Discrimination Scale (WADS).

Middle-aged and older participants perceive older workers as more adaptable than younger participants. The oldest group of participants perceives older workers to be more work-effective and experience the highest levels of age discrimination in the workplace, when compared to the other age groups. Also, participants with lower levels of education tend to perceive higher levels of workplace age discrimination, when compared to participants with high school and higher education.

Generational perceptions in the workplace are perceived by workers differently, hence organizations should implement age management strategies to address age discrimination, particularly due to the increasing proportion of older workers.

None Declared

Research on the association between internet use and concerns about body image is still scarce.

To explore the associations between generalized problematic internet use, number of social networks, and appearance schemas.

216 Portuguese late adolescents (89.3% females), with a mean age of 18.62 years old (SD = .488, range: 18-19) filled in an internet patterns of use questionnaire, the Generalized Problematic Interne Use Scale 2 (GPIUS2) and The Appearance Schemas Inventory-Revised (ASI-R).

A total of 99.6% of the students use social networks. Subjects were divided into three groups (group1: 1-2 social networks; group 2: 3 social networks, and group 3: >3 social networks). There was a statistically difference in Motivational Salience scores (ASI-R) for the three groups [F (2, 503) = 6.0, p = .003]. Post-hoc comparisons indicated that the mean score for group 3 (M = 28.29, SD = 4.95) was significantly different from group 1 (M = 26.69, SD =4.55), and from group 2, (M = 26.87, SD =4.95). Generalized problematic internet subscales (Mood Regulation, Self-Deficient Regulation, and Negative Consequences) and total score were significantly correlated with both dimensions of ASI-R: Self-Evaluation Salience (coefficients varied from r = .31** to r = .47**) and Motivational Salience (from r = .14*, to r = .31**).

Generalized problematic internet use and the number of social networks are associated with adolescent’s cognitive-behavioural investment in one’s own appearance. Study carried out under the strategic project of the Centre for Philosophical and Humanistic Studies (CEFH) UID/FIL/00683/2019, funded by the FCT.

The observance of possible somatic and environmental causes is essential to improve safety and efficacy in the treatment of agitated states. Severe agitation is considered a medical emergency requiring immediate psychopharmacologic intervention.

To establish a clinically applicable consensus statement based on evidence- as well as eminence-based medicine with respect to schizophrenia and mania.

The recommendations given are based on information from psychopharmacologic treatment studies as well as logistic and practical factors intrinsic to clinical settings.

Atypical antipsychotics given orally together with Lorazepam are considered the first-line treatment of agitated states in psychotic patients. Adequate communication with the patient is considered essential for effective oral administration. A novel alternative, Loxapine 4.5 mg or 9.1 mg (approved by the EMA 2013), is administered via an inhaler and exerts its sedative effects within 10 minutes. Inhalation may carry the benefit of greater patient acceptance. In contrast, intramuscular administration of antipsychotics is typically perceived by patients to be more invasive and persuasion or coercion may be necessary in severely ill patients. On the other hand, Aripiprazole, Haloperidole, Olanzapine and Ziprasidone show clinical efficacy within 15-30 minutes in psychopharmacologic trials when administered intramuscularly (i.m.). When taking extrapyramidal symptoms, QTc-prolongation and potential for combination with benzodiazepines into account, Aripiprazole i.m. carries the highest recommendation grade. Lorazepam may be administered intravenously. Currently, no antipsychotics are approved for intravenous administration.

This project gives recommendations which consider risk-benefit ratios and patient compliance.

Apropos of a case we show that antidepressant drugs may cause a switch phenomenon in patients diagnosed with a psychiatric illness other than bipolar disorder.

To describe a case of antidepressant-induced mania in a patient with obsessive compulsive disorder (OCD).

X is an 18 year-old male who presented obsession with books and compulsive reading. He went to the psychiatric consultation and initiated treatment with sertraline 25mg. 24 hours later he began with soliloquies, restlessness, verbosity, increased performance of activities without purpose and persistent insomnia.

After the antidepressant was removed, the manic symptoms disappeared and the patient remained euthymic. Treatment with risperidone 1 mg was established and the obsessions and compulsions partially improved.

This case raises the hypothesis of a possible comorbidity between OCD and bipolar disorder.

Recovery in mental health care comprises more than symptomatic improvement, but preliminary evidence suggests that only collaborative care may improve functioning of depressed older adults. This study therefore evaluates the effectiveness of behavioural activation (BA) on functional limitations in depressed older adults in primary care.

This study uses data from a multicentre cluster randomised controlled trial in which 59 primary care centres (PCCs) were randomised to BA and treatment as usual (TAU), and 161 consenting older (≥65 years) adults with clinically relevant symptoms of depression participated. Interventions were an eight-week individual BA programme by a mental health nurse (MHN) and unrestricted TAU. The outcome was self-reported functional limitations (WHODAS 2.0) at post-treatment (9 weeks) and at 12-month follow-up.

At the end of treatment, the BA participants reported significantly fewer functional limitations than TAU participants (WHODAS 2.0 difference −3.62, p = 0.01, between-group effect size = 0.39; 95% CI = 0.09–0.69). This medium effect size decreases during follow-up resulting in a small and non-significant effect at the 12-month follow-up (WHODAS 2.0 difference = −2.22, p = 0.14, between-group effect size = 0.24; 95% CI = -0.08–0.56). MoCA score moderated these results, indicating that the between-group differences were merely driven by those with no cognitive impairment.

Compared to TAU, BA leads to a faster improvement of functional limitations in depressed older adults with no signs of cognitive decline. Replication of these findings in confirmatory research is needed.

It is difficult to establish whether a patient has late onset schizophrenia or frontotemporal dementia. The object of the following case report is to point out the difficulty of making a differential diagnosis between these two entities.

A 49-year-old female patient was admitted to our hospital after presenting with auditory and visual hallucinations, formal thought disorder, persecutory delusions, ideas of reference, insomnia. Memory, executive function and attentional tasks were severely compromised. Computerized tomography showed incipient frontal lobe atrophy. There were no significant abnormalities found in blood and urine samples or physical and neurological examinations. After showing no response to olanzapine, and extrapyramidal side effects to fluphenazine, risperidone was initiated which subsequently led to complete withdrawal of positive symptoms.

Patients presenting with psychotic symptoms after the age of 40 presented a diagnostic quandary, as they were less likely to present with negative symptoms, formal thought disorder or affective blunting, and more likely to have systematised delusions and visual hallucinations. Frontotemporal dementia is a disorder that can present itself with cognitive decline and a large range of psychiatric symptoms. The risk of late onset schizophrenia is greater in women, possibly implicating a causative role of female sex hormones. Atypical antipsychotics risperidone and olanzapine seem to be an adequate treatment.

Schizophrenia is a heterogeneous disease with a large variety of clinical manifestations. Special care should be given to patients with age over 40, including neurocognitive assessment, laboratory and hormone tests, and a long-term follow-up.

The authors have not supplied their declaration of competing interest.