The optimal duration of antipsychotic treatment following remission of first-episode psychosis (FEP) is uncertain, considering potential adverse effects and individual variability in relapse rates. This study aimed to investigate the effect of antipsychotic discontinuation compared to continuation on recovery in remitted FEP patients.

CENTRAL, MEDLINE (Ovid), Embase, and PsycINFO databases were searched on November 2, 2023, with no language restrictions. RCTs evaluating antipsychotic discontinuation in remitted FEP patients were selected. The primary outcome was personal recovery, and secondary outcomes included functional recovery, global functioning, hospital admission, symptom severity, quality of life, side effects, and employment. Risk of bias was assessed using the Cochrane risk-of-bias tool 2, and the certainty of evidence was evaluated with GRADE. Meta-analysis used a random-effect model with an inverse-variance approach.

Among 2185 screened studies, 8 RCTs (560 participants) were included. No RCTs reported personal recovery as an outcome. Two studies measured functional recovery, and discontinuation group patients were more likely to achieve functional recovery (RR 2.19; 95% CIs: 1.13, 4.22; I2 = 0%; n = 128), although evidence certainty was very low. No significant differences were found in hospital admission, symptom severity, quality of life, global functioning, or employment between the discontinuation and continuation groups.

Personal recovery was not reported in any antipsychotic discontinuation trial in remitted FEP. The observed positive effect of discontinuation on functional recovery came from an early terminated trial and an RCT followed by an uncontrolled period. These findings should be interpreted cautiously due to very low certainty of evidence.

Road rage is a term used to describe driving usually extreme in nature. There seems to be a multifactorial relationship between the situational characteristics of an anger provoking road situation and the feelings of anger and road behaviour.

To examine driver anger with regards to various sociodemographic parameter.

282 participants completed an internet-based survey including sociodemographic profile, anger assessment while driving using the Deffenbacher Driver Anger Scale, details of the driving. Participants were recruited through networks of authors, institution. The survey was disseminated through social media applications and email by snowball sampling method.

Mean age of the sample was 26.1 years with age group 24-29 years making half of the population. Majority sample were males (62.1%), graduates (53.2%), professionals (45.7%), urban locality based, nuclear family type. People experienced greater anger on Defenbacher likert scale for the following situations, when Someone is driving very close to your rear bumper (mean= 3.09), Someone cuts in right in front of you on the motorway(mean= 3.44), Someone cuts in and takes the parking spot(mean= 3.19), Someone coming towards you does not dim headlights at night(mean= 3.26), driving behind a vehicle smoking badly or giving off fumes(mean= 3.38).

The results revealed a prevalence of high anger scores amongst Indian drivers. The rage didn’t vary significantly within gender, locality, type of vehicle, however the anger scores were significantly higher in younger population. Strategies targeting at driving safety and reducing road rage should be implemented by authorities with sensitization of the drivers.

No significant relationships.

Research has demonstrated that greater cognitive flexibility and perspective taking skills are associated with positive outcomes throughout the lifespan. Cognitive flexibility is a core component of executive function allowing us to control goal-directed behaviour and to face new and unexpected conditions in the environment. Perspective-taking or Theory of Mind (ToM) refers to the capacity to make inferences about and represent others’ point of view, mental states and intentions.

The aim of this study was to assess age-related effects on executive functions and the role of cognitive flexibility in perspective-taking skills.

Two age groups (34-44 years and 45-55 years) were compared on a task-switching paradigm the MATeM neuropsychological software (Maria Grazia Inzaghi, 2019) and all participants completed the Edinburgh Handedness Inventory (Oldfield, 1971), the IRI Interpersonal Reactivity Index (Davis, 1980), the RMET Reading the Mind in the Eyes (Baron-Cohen, 2001) and the BIDR-6 Balanced Inventory of Desirable Responding (Paulhus, 1991).

suggested that increased age was associated with decreased set-shifting, perspective-taking, mindreading abilities and increased tendency to give overly positive answers (socially desirable responding). Furthermore, participants with reduced cognitive flexibility (higher switch cost) were less able to attribute mental states to others and to appreciate another person’s point of view.

It can be argued that readiness to appropriately adjust one’s behaviour according to a changing environment is related to flexibly shift between conflicting psychological perspectives. Future research include training studies which would further our understanding of these relationships and allow more effective cognitive and social interventions.

Because emotional symptoms are common in attention-deficit/hyperactivity disorder (ADHD) patients and associate with much morbidity, some consider it to be a core feature rather than an associated trait.

Assess the possibility that symptoms of emotional dysregulation should be considered as core diagnostic feature of ADHD.

It’s a cross sectional study, including 60 children with ADHD and 60 children without ADHD ranging from 6 to 19 years of age (mean age 10.43 years). We defined moderate emotional dysregulation if a child had an aggregate cut-off score of ˃180 on the Anxiety/Depression, Aggression, and Attention scales of the CBCL and severe emotionaldysregulation if a child had an aggregate cut-off score of ˃ 210. This profile was selected because of its conceptual congruence with the clinical concept of emotionaldysregulation.

Sixty-three percent of children with ADHD had a severe emotional dysregulation versus 12% of controls (P˂0.001). Emotional dysregulation was associated with elevated rates of hyperactivity and impulsivity : Ninety-six percent of the children with hyperactivity-impulsivity, according to the Conners scale, had emotional dysregulation. With a significant correlation between emotional dysregulation and hyperactivity-impulsivity (p = 0.001). Also all children with attentional disorders exhibited emotional dysregulation and a significant correlation between emotional dysregulation and inattention has been found in both groups (p=0.000).

Emotional dysregulation is now known to play a causal role regarding ADHD symptomatology. It should therefore be included in future theoretical models of ADHD, as well as in clinical practice when identifying the major impairments in this diagnostic group and when deciding therapeutic strategies.

Hyponatremia (hypoNa) is a potentially serious adverse event of treatment with antidepressants. Previous research suggests that risk of drug-induced hyponatremia differs between antidepressants.

This meta-analysis sought to determine the risk of antidepressant-induced hypoNa, stratified by different compounds and classes.

PubMed and Web of Science were searched for studies reporting on incidence or risk of hypoNa in adults using antidepressants (PROSPERO, CRD42021269801). We modelled random-effects meta-analyses to compute overall incidence and risk of any and clinically relevant hypoNa for each compound and class, and ran head-to-head comparisons based on hypoNa incidences. We conducted subgroup analyses for geriatric populations, study context and sodium cut-off value.

Thirty-nine studies (n = 8,459,033) revealed that exposure to antidepressants was associated with significantly increased odds of hypoNa (OR = 2.82 (1.79 – 4.45)). The highest event rates were found for SNRIs (7.17%), SSRIs (5.20%), and TCAs (2.26%); the lowest for mirtazapine (1.02%) and trazodone (0.89%). The highest odds ratios were found for MAOIs (4.12 (1.92 – 8.86)), SNRIs (3.16 (1.77 – 5.67)), and SSRIs (2.78 (1.57 – 4.91)); the lowest for mirtazapine (2.82 (1.87 – 4.21)) and TCAs (1.85 (1.28 – 2.69)). Compared to SSRIs, SNRIs were significantly more likely (OR = 1.27 (1.13 – 1.42), p < 0.001) and mirtazapine significantly less likely (OR = 0.61 (0.39 – 0.96), p = 0.032) associated with hypoNa.

Our meta-analysis demonstrated that, while no antidepressant can be considered completely risk-free, for hypoNa-prone patients mirtazapine should be considered the treatment of choice and SNRIs should be prescribed more cautiously than SSRIs and TCAs.

None Declared

Perfectionism, as a multiform trait of character, plays an important role in the formation of motivation of achievements in socially significant activity. Adaptive perfectionism, together with the desire to achieve recognition in one’s professional community and insure the emotional stability. Maladaptive (neurotic) perfectionism is directed towards the achievement of excessively high (non-relevant) standards of activity, a constant anxiety, internal stress and lack of self-confidence

To pinpoint the types of perfectionism that graduating medical students at Medical University experience, those who, during all the years of study, showed high academic results

Forty-nine graduating medical students volunteered to take part in the study, their average mark being not lower than 4.75 (maximum was 5). Their average age was 22.41±0.75. The following scales measured the level of expressiveness of perfectionism: A.A. Zolotareva, Hewitt and Flett, I.I. Gracheva

The results of the study undertaken showed two distinct groups. Students of the first group (79.6%) aimed at high internal standards in their study that would make them very well prepared professionally for their future work as doctors. They consciously accepted the common rules and norms of their society. Students of the other group (20.4%), consciously and subconsciously, estimate their high academic results as a good way of overcoming personal disturbances. They have excessive non-realistic demands towards self and others

The results of our study make it possible for us to suppose that medical students of the second group will experience quite a lot of difficulties in their future professional activity

No significant relationships.

Lithium is considered the gold standard mood stabiliser for bipolar disorder, yet its use during pregnancy remains controversial, demanding careful consideration of potential risks and benefits. Classically, it has been associated with an increased risk in congenital heart defects, however, recent studies point towards a much lower absolute risk than was previously believed. Furthermore, discontinuation of lithium before or during pregnancy poses a high risk of destabilisation and lithium has been shown to reduce the risk of relapse both in pregnancy and in the postpartum period. Hence, treatment planning is of the upmost importance in this patient group and individual risk stratification should be undertaken for patients to make informed decisions about their treatment.

To describe the case of a patient with bipolar disorder who discontinued lithium treatment while attempting to conceive and subsequently presented with a manic episode and to expand the scientific knowledge on this topic.

Case report and brief literature review.

A 41-year-old patient with a diagnosis of bipolar disorder, previously on lithium 900mg/day, was admitted to the emergency department with symptoms suggestive of a manic episode. One month prior, the patient had discontinued treatment with lithium due to her desire to pursue pregnancy and interrupt treatment while trying to conceive. The patient had a history of postpartum psychosis followed by various depressive and manic episodes with psychotic symptoms, leading to a bipolar disorder diagnosis and commencing treatment with lithium. Her consultant psychiatrist had informed her of the individualised risks of interrupting treatment with lithium and had advised to continue treatment alongside frequent follow-up due to the high-risk of relapse. Despite her consultant’s recommendation, she decided to interrupt treatment and hence a personalised lithium tapering regime and advice to continue treatment with quetiapine 200mg/day was given.

During the ED stay, treatment with olanzapine was introduced which helped to stabilise her symptoms. Lithium levels were subtherapeutic (lithium serum level 0.11 mmol/L). Inpatient psychiatric admission was avoided due to rapid symptom improvement, strong social support in the community and her preference for ambulatory care. Lithium was gradually reintroduced and antipsychotic treatment was adjusted at follow up appointments, which ultimately led to the resolution of symptoms and stabilisation.

This case highlights the significance of considering continuing lithium treatment in bipolar disorder during pregnancy planning. Decisions about medication in pregnancy are multifaceted, making appropriate risk stratification imperative in order to inform individualised care plans to minimise the risk of relapse in these patients.

None Declared

Science has focused on types of treatments and their differential effects in achieving treatment outcomes. However, there is a growing body of evidence to support the investigation of clinician factors and how they affect the treatment outcomes of patients. The aim of the presented study was assess and analysis clinician therapeutic optimism in treatment of mental health disorders.

To assess therapeutic optimism we used the Elsom Therapeutic Optimism Scale (ETOS), which was designed to provide a reliable means of measuring mental health clinician optimism. The ETOS consists of 10 items to which respondents rate their agreement on a 5-point Likert scale ranging from strongly disagree to strongly agree.

A convenience sample composed of forty five mental health clinician working in a variety of settings is being collected. The results demonstrate that the most of clinicians (n=45; agree 64,4%; strongly agree, 26,7%) believe that have the capacity to positively influence outcomes for people with mental disorders, can help a lot of number of people of mental illness (n=45; agree,77,8%) and the majority of patients benefit from their intervention (n=45; agree 64,4%; strongly agree, 22,2%). We have applied additional measures to assess adherences strategies and medication beliefs.

Future research should assess the utility of the ETOS for predicting treatment outcomes. If clinician optimism does in fact have a predictive relationship with treatment outcomes, the assessment of clinician optimism using measures such as the ETOS will enable services to identify and rectify the effects of negative clinician beliefs on patient outcomes

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

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

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

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

The authors have not supplied their declaration of competing interest.

Nowadays, suicide is a global public health problem thus detection of risk factors more specifically individual factors can be used as a method for prevention and intervention.

The aims of our study were to assess the incidence of suicidal recurrence and its individual associated factors.

A retrospective descriptive and analytical study was undertaken including all patients consulting for the first time at Gabes psychiatry department (in southern Tunisia) from the 4th March 2009 to the 25th September 2020 for suicidal attempt. Sociodemographic and clinical data as well as suicidal attempts’ characteristics were assessed. The statistical analysis was executed on the software SPSS (20th edition).

278 patients were collected including 217 female. The mean age was 26. Suicidal patients were unmarried (75.9%), childless (79.1%) and unemployed (47.5%). The common suicidal attempt method was voluntary drug intoxication (67.8%). Interference of individual factors was reported in 77% of cases, especially difficulties to cope with stress (46.4%), followed by low self-esteem (36.5%), personal psychiatric history (17.3%), personal medical history (8.3%) and alcohol or drug abuse (6.1%). A suicidal re-attempt was notedin 24.9 % of cases. Recurrence was associated with the female gender (72.4%), difficulties to cope with stress (<10-3) and low self-esteem (p=0.012).

After the first suicidal attempt, it’s crucial to identify the individual factors that seems to have an influence on subsequent suicidal behaviour in order to ensure a proper treatment.

The relationship between alcohol use and dementia is complex. There is a J-shaped relationship between alcohol use and cognitive impairment and evidence shows that one-quarter of the dementia population have alcohol related problems. It is estimated that alcohol-related dementia (ARD) contributes for about 10% of all cases of dementia, especially early-onset dementia, but is largely overlooked or seen as a comorbid factor.

To clarify the relationship between alcohol use, alcohol-related brain damage and dementia; to review the clinical features, neuropathology, nosology and neuropsychology of ARD and alcohol-induced persisting amnestic syndrome (Wernicke-Korsakoff syndrome- WKS).

We performed a review of systematic reviews from the last 10 years. A total of 28 systematic reviews were identified.

Heavy alcohol use has been shown to be a contributory factor and necessary factor in the development of multiple brain diseases. It may cause brain damage in multiple ways: direct neurotoxic effect of acetaldehyde; thiamine deficiency. It is also a risk factor for other conditions, such as hepatic encephalopathy, epilepsy and head injury.

Clinical observation favors the diagnosis of ADR as a distinct entity, but broader evidence reflects significant commonality between ARD and WKS, tough neuropsychological studies have largely attempted to differentiate these syndromes. Repeated episodes of WKS may cause cognitive deterioration. In contrast to other common causes of dementia, the decline in cognitive functioning in ARD is relatively non-progressive if abstinence is maintained, or even partially reversible, as supported by neuroimaging evidence. Given the increase in per capita consumption, it is expected a disproportionate increase in ARD.

Over the past few years, Psychiatry has undergone a significant transformation with the integration of Artificial Intelligence (AI). This shift has been driven by the increasing demand for mental health services, as well as advances in AI technology. AI analyzes extensive datasets, including text, voice, and behavioral data, aiding in mental health diagnosis and treatment. Consequently, a range of AI-based interventions has been developed, including chatbots, virtual therapists and apps featuring cognitive-behavioral therapy (CBT) modules. Notably, chatbots, as conversational agents, have emerged as valuable tools, assisting users in monitoring emotions and providing evidence-based resources, well-being support, psychoeducation and adaptive coping strategies.

This study aims to investigate the impact of AI chatbots on improving mental health, evaluate their strengths and weaknesses and explore their potential for early detection and intervention in mental health issues.

A literature review was conducted through PubMed and Google Scholar databases, using keywords ‘artificial intelligence’, ‘chatbot’ and ‘mental health’. The selection focused on the most relevant articles published between January 2021 and September 2023.

Mental health chatbots are highly personalized, with a primary focus on addressing issues such as depression or anxiety within specific clinical population groups. Through the integration of Natural Language Processing (NLP) techniques and rule-based AI algorithms, these chatbots closely simulate human interactions and effectively instruct users in therapeutic techniques. While chatbots integrating CBT principles have gained widespread use and extensive research attention, some also incorporate alternative therapeutic approaches, including dialectical behavior therapy, motivational interviewing, acceptance and commitment therapy, positive psychology or mindfulness-based stress reduction. AI chatbots provide substantial advantages in terms of accessibility, cost-effectiveness and improved access to mental health support services. Nonetheless, they also exhibit limitations, including the absence of human connection, limited expertise, potential for misdiagnosis, privacy concerns, risk of bias and limitations in risk assessment accuracy.

AI-based chatbots hold the potential to enhance patient outcomes by enabling early detection and intervention in mental health issues. However, their implementation in mental health should be approached with caution. Further studies are essential to thoroughly evaluate their effectiveness and safety.

None Declared

Eating disorders (EDs) exist on a continuum ranging from innocuous but persisting dieting, through subthreshold states of uncertain significance, to full-blown cases of anorexia nervosa (AN) and bulimia nervosa (BN). Subthreshold EDs resemble AN or BN, but do not meet all their diagnostic criteria. The terms “partial syndromes” and “atypical EDs” are also used to identify these conditions.Objectives. To verify whether atypical syndromes are less severe forms of EDs or represent starting phases of EDs, we designed a two-step prospective study assessing the natural outcome of those syndromes over a 4-year time period.

In the first step, we screened 495 female students attending the first year of their high school by means of ad hoc rating questionnaires. Those students identified to being at risk for an ED underwent a psychiatric diagnostic interview. In the second step, 4 years later, we reassessed 140 of those schoolgirls who had participated in the first step.

In the first step, we identified 1 subject with full-blown BN, 1 with partial-syndrome BN, 2 with subclinical BN and 8 with subclinical AN. At the reassessment 4 years later, none of the girls had received any form of help. The full-blown BN case, the partial-syndrome BN case and 1 of the subclinical AN cases persisted unchanged; 1 of the subclinical BN cases shifted to subclinical AN; the remaining subclinical cases remitted spontaneously.

Present findings provide the evidence that subclinical AN and subclinical BN represent unstable states that can spontaneously remit over time.

People with severe mental disorder (SMD) determine the goals and paths of recovery with professional and nonformal supporters such as family and friends. It is crucial that these people, as well as everyone who participates in the recovery process, are familiar with all the elements that contribute to the recovery of mental health in order to help people with SMD identify goals and assess their achievement. We have therefore created a Recovery Helm to assess the functioning in the various areas necessary for recovery to help us assess the needs and monitor the recovery process of people with mental health problems.

The goal is to assess the initial state of mental health and monitor the effects of the mobile rehabilitation team program on the recovery of people with SMI through the use of the Recovery Helm.

We used the Recovery Helm: http://shorturl.at/gyCDQ as an instrument for the initial assessment of all areas crucial for recovery to determine the goals of recovery and interventions needed to achieve these goals of rehabilitation in 30 patients included in the program of the mobile rehabilitation team applying different psychosocial interventions according to the individual recovery plan made as a mutual agreement between patients and rehabilitation team. The status of recovery is evaluated after 3 and 6 months.

The results indicate significant improvements in most areas of the recovery assessed at the Recovery Helm selected as individually important goal for a person included in the rehabilitation program

The Recovery Helm is an excellent clinical assessment instrument that helps determine recovery goals and rehabilitation interventions that promote recovery and monitor the achieved results.

None Declared

The DSM-5 defines dissociation as “disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior”. The disorders in this group include depersonalization/derealization disorder, dissociative amnesia, and dissociative identity disorder, the last being a controversial entity.

Dissociative disorders are associated with elevated levels of disability, impaired quality of life, high economic cost, and a significantly increased risk of suicide attempts.

In this work we present the case of a 21-year-old man that was assisted in the Emergency Room with dissociative symptoms. We intend to do a non-systematic review on the subject of dissociation symptoms, the psychiatric disorders in which they are present, identified risk factors, how to access the psychopathology features and the recommended treatment to best address them.

For a comprehensive approach of this subject we proceeded to a non-systematic review in PubMed using the following keywords “dissociation”, “dissociative identity disorder” and “dissociative disorders”.

In this work we present the case of a 21-year-old man assisted in the Emergency Room describing dissociative symptoms that were suggestive of Dissociative identity disorder. He referred out-of-body experiences and a sense that he was not controlling his actions while self-injuring himself and being aggressive towards his family. He described “three Selfs”: the “Normal Self”, the “Suicidal Self” and the “Bad Self”.

Symptoms of dissociation are present in a variety of mental disorders namely depression, anxiety disorders, posttraumatic stress disorder, borderline personality disorder and eating disorders.

Dissociative disorders appear to be linked to trauma, interpersonal stress, and strongly associated with a history of chronic child abuse. An association with alexithymia, depression and suicidality were also found. Some studies found structural and functional abnormalities, particularly a reduction in grey matter volume in limbic system structures, a dysregulation of prefrontal–limbic circuitry and dysfunction of the hypothalamic–pituitary-adrenal axis.

Psychotherapy appears to be the cornerstone of treatment for dissociative disorders, namely Cognitive-Behavior therapy and Eye-movement desensitization and reprocessing.

Symptoms of dissociation are not only present in dissociative disorders, but they may be present in almost all mental disorders. The evaluation of possible dissociative symptoms should be a part of every psychopathological assessment. There is a need for further studies to better understand this diagnostic entity and improve the therapeutic intervention.

None Declared