Patients suffering from schizophrenia have a higher risk of premature death. An unhealthy lifestyle contributes to increased risk of cardiovascular diseases, metabolic syndromes, suicides among them. In addition to the use of selected therapy with a restriction metabolic risk has become important to influence non-pharmacological factors such as proper diet, introducing the principles of a healthy lifestyle. A diet rich in fiber, the DASH diet, the Mediterranean diet may become beneficial in terms of lowering parameters metabolic, cardiovascular and immune related to premature mortality in schizophrenia.

Patients suffering from schizophrenia have a higher risk of premature death. An unhealthy lifestyle contributes to increased risk of cardiovascular diseases, metabolic syndromes, suicides among them. In addition to the use of selected therapy with a restriction metabolic risk has become important to influence non-pharmacological factors such as proper diet, introducing the principles of a healthy lifestyle. A diet rich in fiber, the DASH diet, the Mediterranean diet may become beneficial in terms of lowering parameters metabolic, cardiovascular and immune related to premature mortality in schizophrenia.

The objective of this study was to evaluate the influence of the lifestyle on the metabolic parameters in schizophrenia

In our study, we assessed the influence of diet, nutritional knowledge and lifestyle on parameters of metabolic syndrome (cholesterol, triglicerydes, glucose) in patients with schizophrenia.

In the results we have found positive co-relations between unhealthy diet and lifestyle and lack of knowledge on proper nutrition and increased parameters of metabolic syndrome.

Dietary intervention may become one of the therapeutic goals in schizophrenia.

None Declared

Although, emotional cues like facial emotion expressions seem to be important in social interaction, there is limited specific training about emotional cues for psychology professions.

Here, we aimed to evaluate psychologist’, psychological counselors’ and psychiatrists’ ability of facial emotion recognition and compare these groups.

One hundred and forty-one master degree students of clinical psychology and 105 psychiatrists who identified themselves as psychopharmacologists were asked to perform facial emotion recognition test after filling out socio-demographic questionnaire. The facial emotion recognition test was constructed by using a set of photographs (happy, sad, fearful, angry, surprised, disgusted, and neutral faces) from Ekman and Friesen's.

Psychologists were significantly better in recognizing sad facial emotion than psychopharmacologists (6.23 ± 1.08 vs 5.80 ± 1.34 and P = 0.041). Psychological counselors were significantly better in recognizing sad facial emotion than psychopharmacologists (6.24 ± 1.01 vs 5.80 ± 1.34 and P = 0.054). Psychologists were significantly better in recognizing angry facial emotion than psychopharmacologists (6.54 ± 0.73 vs 6.08 ± 1.06 and P = 0.002). Psychological counselors were significantly better in recognizing angry facial emotion than psychopharmacologists (6.48 ± 0.73 vs 6.08 ± 1.06 and P = 0.14).

We have revealed that the pyschologist and psychological counselors were more accurate in recognizing sad and angry facial emotions than psychopharmacologists. We considered that more accurate recognition of emotional cues may have important influences on patient doctor relationship. It would be valuable to investigate how these differences or training the ability of facial emotion recognition would affect the quality of patient–clinician interaction.

Clozapine (CZP) is the only antipsychotic approved for resistant schizophrenia 1. Due to its side effects, CZP is not the first therapeutic option in a psychotic episode. Its anticholinergic effects often cause constipation, however, diarrhea have also been described in literature.

We describe a patient with two episodes of severe diarrhea after clozapine initiation, which lead to CZP discontinuation.

Discuss about the differential diagnosis of diarrhea in CZP patients and the needing of a further studies for clarify the more appropriate management in CZP induced diarrhea.

We present a case report of a 46 years man diagnosed with schizoaffective disorder who presented two episodes of severe diarrhea with fever, which forced his transfer to internal medicine and UCI after CZP initiation.

At the first episode analytical, radiological and histological findings led to Crohn's disease diagnosis, which required budesonide and mesalazine treatment. In the second episode, the digestive team concluded that the episode was due to clozapine toxicity despite the controversial findings (clostridium toxin and Crohn's compatible biopsies)

Diarrhea caused by CZP has been controversial in the literature. However due to the severity of digestive episodes and the paucity of alternative treatments further studies for a better understanding of its physiopathology are warranted.

The authors have not supplied their declaration of competing interest.

Due to the professional activities acute stress disorder and PTSD are most diffuse disorders among military servants. Number of studies revealed relationships between post-traumatic stress and depression, anxiety or somatic complaints.

Though Georgian military personnel actively take part in the international peacekeeping missions since 2004 and no research was conducted to investigate the prevalence of abovementioned disorders.

Thus, this study aims to investigate the prevalence of PTSD, depression, anxiety and somatic complaints in the cohort of Georgian military servants.

The research participants were 2799 military servicemen who had been deployed on the 6 month long period to the peace-keeping missions and were screened for psychological problems after deployment. All of them were Caucasian males, with average age of 29.3 years. All participants were asked to complete a PTSD Checklist for DSM-5 (PCL-5), as well as a 15-item somatic subscale of the Patient History Questionnaire (PHQ-15), a 9-item depression subscale of the Patient History Questionnaire (PHQ-9), a 7-item anxiety subscale of the Patient History Questionnaire (GAD-7).

Prevalence rate of probable PTSD screened by the PCL-5 was 2.7%. Further investigation showed that depressive, anxiety and somatic symptoms among them was 21.6%, 8.7% and 21.7% respectively.

Appreciable positive relationship was found (r = 0.65–0.70; P < 0.001) between these variables in the deployed military servants. Therefore, it is recommended that military servants should be screened on all above mentioned conditions along with PTSD, in order to see full picture of co-morbid problems.

The authors have not supplied their declaration of competing interest.

Valproic Acid (VPA) is one of the most commonly used mood stabilizer drugs. Although uncommon, serious adverse effects have been reported. One particularly relevant side effect is the induced encephalopathy, usually secondary to Hyperammonemia. However, some descriptions have shown an altered mental state with normal serum levels of ammonia.

We aim to present a case of VPA induced-encephalopathy without hyperammonemia and emphasize its suspicion when patients taking VPA present altered mental states.

We present a clinical case of VPA induced-encephalopathy without Hyperammonemia and a qualitative review of this topic using the Pubmed database.

A 66-year-old woman, with an history of Major Depressive Disorder, previously medicated with Venlafaxine 75mg/day and Mirtazapine 30mg/day, was admitted in our acute psychiatric inpatient unit due to a first manic episode. During the stay, her antidepressants were interrupted, and she was started on VPA, then optimized to 750mg/day. After that, she presented an altered mental state with confusion and prostration. Analytical results were normal including normal ammonia levels and no imagiological abnormalities. Despite these results, we decided to stop VPA empirically. The patient clinical status resolved the day after.

Studies have shown that only a few patients have developed encephalopathy with normal serum levels of ammonia. Although the pathogenesis behind this remains unknown, a few mechanisms have been proposed. Therefore, it is important to remind that even without abnormal analytical status, VPA is a possible cause of encephalopathy. We also emphasize the need for further studies on the mechanisms behind this phenomenon.

No significant relationships.

In India, Coronavirus pandemic started in the month of march 2020 and is growing day by day. In view of India being one of the most populous countries, it is hard to follow social distancing and abide by the lockdown rules. Therefore, as of December 2020, total number of covid-19 cases has crossed the 10 million. But the recovery rate in India is high, so the fear due to Covid-19 has decreased in intensity.

To assess level of perceived stress in isolated covid-19 patients To assess level of hopelessness in isolated covid-19 patients

30 Patients of diagnosed Covid-19 positive,who were isolated in covid care setting in Uttar Pradesh(India),above 18yrs of age,of both sexes and willing to participate in the study were included, their socio-demographic data collected. Beck’s hopelessness scale and Perceived stress scale were administered. Infection severity upto moderate was selected and ICU patients were excluded. Results were analysed using SPSS software.

It was observed that level of hopelessness increased with increasing age and increasing severity of covid-19.Level of perceived stress also increased with increasing age and increasing covid severity. There was no relation seen between hopelessness level and perceived stress level and no difference was seen in the levels of hopelessness and perceived stress between the two sexes.

Levels of hopelessness and stress increased with increasing age and increasing severity of covid-19.No relation seen between hopelessness level and perceived stress level and no difference was seen in the levels of hopelessness and perceived stress between the two sexes.

No significant relationships.

Therapist led interventions form a core element in the management of children with Autism Spectrum Disorder (ASD) in India. COVID-19 pandemic has disrupted several aspects of ASD management.

This study aims to understand the impact of COVID-19 pandemic on ASD therapies from a therapist perspective.

An online survey was conducted using a google form questionnaire disseminated among ASD therapists. The form was open for response between 23rd of June and 23rd of July 2020. The responses were extracted into an excel sheet and analysed using descriptive statistics.

41 out of 75 therapists with mean age of 44 years (21 – 58 years) responded to the survey. 48% were women. Majority of them were either special educators (49%) or ASD therapists (32%) with professional experience of >5 years (63%). Majority of the therapists felt that there is significant disruption during the pandemic with reduction in conventional therapies (63% to 17%) and increase in online therapies (15% to 61%). They also felt that this disruption had moderate to severe impact on child’s learning (73%) and parents emotional and psychological well being (85%). Only 22% of therapists were using digital based therapy (DBT) before the pandemic. Although 51% of the therapists were not entirely sure whether DBT augments parents and therapists’ efforts, majority (65%) were willing to use them.

COVID-19 pandemic has significantly disrupted ASD therapy in India. Willingness to use online and digital based therapies could open up a new dimension. Reliable and effective Artificial-Intelligence based therapies are the need of the day.

Medical advisor for CognitiveBotics

Prevention, identification, and treatment of maternal psychopathology may be favourable for both mother and child. Both a low socio-economic position (SEP) and adverse life events are considered risk factors for symptoms of anxiety and depression during pregnancy. It is unknown whether the effect of adverse life events is modified by SEP.

To investigate the relationship between symptoms of anxiety and depression in pregnancy and adverse life events, and how this relationship is modified by SEP.

The population based Pregnancy, Anxiety and Depression (PAD) Study is a prospective study in Dutch obstetric care. We assessed symptoms of anxiety and depression in pregnant women, SEP (educational level of mother and partner, work status of mother and partner and family income), and the number of adverse life events, categorised by period in life. The association of the number of adverse life events with anxiety and depression, as well as effect modification by SEP was tested using linear regression analyses.

We included 4272 participants. The number of life events and low SEP were independantly associated with symptoms of both anxiety and depression during pregnancy. Additionally, we found that aspects of SEP: low maternal educational level, maternal unemployment, and low family income may increase the adverse effect of adverse life events.

A low SEP increases the adverse impact of adverse life events. In an early screening for anxiety and depression, the number of adverse life events and more important the above-mentioned aspects of SEP should play a key role.

The emergence of new psychoactive substances (NPS) has had a substantial impact worldwide. NPS mimic the effect of “existing” drugs and are specifically manufactured so that the new substances fall out of regulatory frameworks. Although the structural changes might be minimal, NPS often have marked differences in potency and subsequent harm.

The population of the Azores archipelago has been particularly affected by the rapid growing and changing nature of this phenomenon, mainly caused by the introduction and spread of the “newly” synthetic cathinones as a inexpensive and easily available street drug.

Before any educational, public health and socioeconomic policy changes be proposed to accurately tackle the problem, the basic step of knowing how these substances have been affecting their users, specially their neuropsychiatric effects, must be taken.

This project aims to characterize the neuropsychiatric side effects caused by the acute intoxication of NPS with a psychostimulant profile, namely synthetic cathinones.

Description of the neuropsychiatric symptoms of intoxicated users of stimulant NPS that present to non-governmental organizations specialized in addictions and also to the psychiatry emergency department in Sao Miguel - Azores.

Review of the forensic records of the deaths by suicide in 2021 in Sao Miguel, looking for evidence of recent abuse of NPS or previous history of “NPS use disorder”.

Non-systematic review of the recent and relevant scientific literature on this topic.

The desired effects are increased energy, mood enhancement, euphoria, mental clarity, improved concentration, improved sociability, increased talkativeness, empathy inducing effects, amplification of sound and colour and prosexual effects. Nevertheless, in the case of intoxication, the frequent neuropsychiatric side effects tend to be agitation, agressiveness, irritability, altered consciousness, brief psychosis with paranoid delusion, visual and auditive hallucinations, transient mania, enhanced sensorial experiences, headaches, dizzyness, seizures, confusion and amnesia. Usually, the acjute intoxication period tend to be followed by a “crash” with depression, craving, anxiety, panic, suicidal ideation and behaviours. A third of the deaths by suicides in Sao Miguel Island in 2021, 7 out of 21, were in stimulant NPS active or recent users.

Review of the neuropsychiatric effects of New Psychoactive Substances with a psychostimulant profile. Further studies of this population of synthetic cathinone users in the Azores are due, namely studying their socioeconomic background, looking for risk and protective factors, and also the long-term side effects.

None Declared

Cognitive deficits are considered central and persistent features of schizophrenia and have a significant impact on outcome and quality of life. The computerized interactive remediation of cognition (CIRCuiTS) is a new computerized cognitive remediation program aimed at improving different cognitive domains in patients with schizophrenia. In particular, the program was designed to mainly rehabilitate executive functions, attention and memory by training each cognitive function through several exercises and by improving metacognition.

In the present study, CIRCuiTS was translated and adapted into Italian. The applicability and feasibility of the Italian version was evaluated. Moreover, preliminary data on the effectiveness of the program were investigated.

Four patients with a diagnosis of schizophrenia were recruited for the study. We investigated the changes in neurocognition, psychopathology, self-esteem and functional outcome at the end of the remediation program. The level of satisfaction of operators and participants was evaluated by means of the client satisfaction questionnaire (CSQ).

For each patient, the entire program took place through 2 weekly sessions of 50 minutes for a total duration of 40 sessions.

CIRCuiTS produced an improvement in all domains of neurocognition, disorganization, self-esteem and real-life functioning in the areas “self-care” and “interpersonal relationships”. Moreover, high levels of satisfaction were shown by CSQ for both, operators and participants.

The Italian version of CIRCuiTS demonstrates high levels of acceptability and feasibility for both, patients and clinicians. Additionally, preliminary data suggest that the use of CIRCuiTS provides an improvement on several aspects of the disease.

The authors have not supplied their declaration of competing interest.

Deficit in the ability to understand others' mental conditions, opinions, beliefs, fantasies and desires have been reported among schizophrenic patients so far. However, fewer studies have examined the type of positive/negative symptoms and delusions on their social cognition abilities. The main purpose of this study was to investigate the theory of mind (ToM) performance in schizophrenic patients and compare it with healthy controls.

This cross-sectional study conducted at Ibn-e-Sina psychiatric hospital in Mashhad, included 28 schizophrenic patients, aged between 18 and 50, based on DSM-IV-TR criteria and 14 healthy subjects. Evaluation of symptoms was performed by positive and negative syndrome scale (PANSS) test and the ToM assessed by the 'Reading the Mind in the Eyes” Test.

Analysis of variance showed a significant impaired ToM in schizophrenic patients as compared with the healthy controls (p=0.00). But the ToM deficits did not differ in positive and negative symptoms (p=0.951), genders (p=0.286) and the frequency of episodes (p= 0.470). The delusions of persecution and grandeur showed a significant lower ToM performance as compared with the delusions of control (p=0.041).

Although the ToM abilities impairment in schizophrenia has been proved, its relationship with types of symptoms and delusions, and the duration of illness require further investigations. This may help to improve the possible treatments and prevention potentials in future.

Parkinson disease is a frequent neurodegenerative disorder. Presence of psychopathology is well described in this illness, nevertheless the etiology is still unknown.

The authors present a clinical case of a patient with idiopathic Parkinson disease with depressive symptoms after the decline of his functioning. We aim to emphasize the importance of a multidisciplinary approach and the central role of general physicians in screening these situations.

The patient is a male with 64 years old, reformed with a personal history of hypertension. With 62 years old he started with mild motor complaints that got worse over time, culminating after a year and half on him being almost dependant for most of his daily activities. He also started to express feelings of sadness, despair, and recurrent thoughts of death. He refused to seek out medical help, but was convinced by his wife to consult his general physician that observed the patient and referenced him to Neurology and Psychiatry consultations. He also started sertraline 50 mg/day. He was diagnosed with Parkinson disease and started medication with ropinirole, levodopa and carbidopa with a good response. In Psychiatry consultation the dose of sertraline was increased to 100 mg/day with improvement, and it was provided information on the disease to the patient and family and also supportive psychotherapy.

General physicians have a privileged position on screening patients with psychopathology when other physical conditions or illnesses are present. The fast and correct referencing of these patients can improve the prognosis.

The authors have not supplied their declaration of competing interest.

Madness and creativity are thought to be related from ancient ages. Nowadays, thanks to new scientific developments and researches we are able to identify common genetic and brain patterns between creativity and psychosis.

Taking the inspiration of a psychotic patient with some shocking drawings, we want to get deep into the actual knowledge about the relation between creativity and psychosis.

Case report and bibliographic review.

A 19-year-old man was brought to the hospital after having been found making strange rituals in the public way. In the anamnese he showed to have experienced mystic delusions and hallucinations. He made some particularly creative drawings.

We made a review which showed that this patients may have a diminished latent inhibition, which could make them experiencing usual live irrelevant stimuli as something very exciting and creative at the same time. Genome wide association studies show also that people having creative jobs and psychotic patients share some genes, which could be linked to this abnormal latent inhibition.

Latent inhibition abnormalities could be related with psychosis and creativity. There are differences within the course of people having this oversensibility, which could be explained due to the presence of protective and risk factors.

The authors have not supplied their declaration of competing interest.

Various social problems, financial difficulties and academic factors contribute to the fact that more and more students around the world experience mental health problems (Chen et al., 2013; Gotlib et al., 2019). On the other hand, all the sides of students’ lives – from education to family relationships – are mediated by information communication technologies, that may have broad and ambiguous influence on students mental health. What is undoubtedly that youth mental health can no longer be considered without touching on the digitalization, including in education.

The current study aims to point up positive and negative examples of intersection of education digitalization and mental health of modern youth.

Theoretical analysis of research publications and conceptualization of practical applications in education mediated by digital technologies.

A striking example of the negative impact of total digitalization of education was the sharp deterioration in mental health in the context of the transition to fully distant learning in conditions of the spread of coronavirus infection. Positive education as teaching form for both traditional skills and positive functioning and happiness provides a broad opportunities to combine the concepts of positive psychology with cutting-edge high-tech education approaches.

Digitalization of modern education can be accompanied by both mental health risks and new opportunities. Mental health support can be based on finding information about good functioning, learning and participating in community activities that are provided through websites and mobile applications. The reported study was funded by the Russian Foundation for Basic Research, project number 18-29-22049.

Early childhood aggressive behaviour is a predictor of future violence. Therefore, identifying risk factors for children’s aggressive behaviour is important in understanding underlying mechanisms. Maternal postpartum depression is a known risk factor. However, little research has focused on the influence of paternal behaviour on early childhood aggression and its interaction with maternal postpartum depression.

This study was performed in two cohorts: the Fathers Project, in the United Kingdom (n = 143) and the Generation R Study, in The Netherlands (n = 549). In both cohorts, we related paternal antisocial personality (ASP) traits and maternal postpartum depressive (PPD) symptoms to childhood aggressive behaviour at age two (Fathers Project) and age three (Generation R Study). We additionally tested whether the presence of paternal ASP traits increased the association between maternal PPD–symptoms and early childhood aggression.

The association between paternal ASP traits and early childhood aggressive behaviour, corrected for maternal PPD-symptoms, was similar in magnitude between the cohorts (Fathers Project: standardized β = 0.12, p = 0.146; Generation R: β = 0.14, p = 0.001), although the association was not statistically significant in the Fathers Project. Strikingly, and in contrast to our expectations, there was evidence of a negative interaction between paternal ASP traits and maternal PPD-symptoms on childhood aggressive behaviour (Fathers Project: β = −0.20, p = 0.020; Generation R: β = −0.09, p = 0.043) in both studies. This meant that with higher levels of paternal ASP traits the association between maternal PPD-symptoms and childhood aggressive behaviour was less and vice versa.

Our findings stress the importance of including both maternal and paternal psychopathology in future studies and interventions focusing on early childhood aggressive behaviour.

This study is about the clinical uses of three antidepressants( escitalopram, desvenlafaxine, vortioxetine) in the treatment of anxioun depression.

The purpose of this study was to compare the efficacy and safety of escitalopram, desvenlafaxine, vortioxetine, and aripiprazole augmentation with escitalopram in the acute treatment of anxious depression.

Patients (n=189) with DSM5 major depression and high levels of anxiety were evenly randomized to escitalopram, desvenlafaxine, vortioxetine, and aripiprazole augmentation with escitalopram in a six-week, randomized, rater-blinded, head to head comparative trial. Changes in overall depressive and anxiety symptoms were assessed.

Patients demonstrated similar baseline-to-endpoint improvement in HAMD and HAMA total scores. Patients also demonstrated similar response rate and remission rate in HAMD and HAMA. In analysis of individual HAMD and HAMA items, desvenlafaxine had greatly reduced scores for anxiety somatic (p=0.013), hypochondriasis (p=0.014), cardiovascular symptoms (p=0.005), respiratory symptoms (p=0.013) compared to escitalopram or vortioxetine. Each treatment were well tolerated with no significant differences.

These results showed no significant differences in efficacy and tolerability of escitalopram, desvenlafaxine, vortioxetine, and aripiprazole augmentation with escitalopram in this subtype of patients with anxious depression during the acute phase treatment.

No significant relationships.

The glucagon-like peptide-1 (GLP-1) receptor agonist Semaglutide has been widely used to manage type 2 diabetes due to its favourable effects on glycemic control and weight reduction. Proved to be safe in adults and elderly patients with renal or hepatic disorders demanding no dose modification. Affective symptoms are not listed as side effects in the product information. However, there is a recent investigation going on by the European Medicines Agency (EMA) after three flagged cases of suicidal thoughts in Iceland. In contrast, the Food and Drug Administration (FDA) recommend that patients with this treatment are monitored for suicidal thoughts or behaviour.

This case study explores the possible relationship between Semaglutide treatment and the onset of a manic episode in a 57-year-old male with no history of psychiatric disorders.

We present a 57-year-old male with no psychiatric history of interests, with a previous good functioning. A one-week history of disruptive behaviours started, characterized by excessive cheerfulness, heightened euphoria, and reduced need for sleep. Family members describe a complex situation at home, with frequent outings by the patient, engaging in conversations with strangers, getting lost, and becoming more irritable with them. The patient and family relate this mood change after initiating Semaglutide for diabetes control, starting at 7mg doses. The temporal relationship between the initiation of Semaglutide therapy, precisely a dose escalation to 7mg, and the onset of manic symptoms prompted family members to notify the patient’s endocrinologist. Due to the inability to manage the patient at home and his unpredictability, they sought help at the emergency department, resulting in a psychiatric admission. Imaging and analytical tests show no significant abnormalities.

During his stay in the psychiatry department, semaglutide dosage was reduced, and treatment with Aripiprazole was initiated at doses of 5mg, given the metabolic profile associated with medical comorbidities (obesity, chronic renal failure and diabetes). Subsequent clinical observations showed a gradual resolution of manic symptoms and an improvement in the patient’s overall mental state.

This case highlights the importance of monitoring and recognizing potential neuropsychiatric side effects associated with Semaglutide therapy, particularly in individuals without a prior psychiatric history. Further research is warranted to elucidate the underlying mechanisms linking Semaglutide with mood disturbances and to identify risk factors that may predispose certain patients to develop manic states in response to this GLP-1RA. Clinicians should remain vigilant and consider alternative treatment options if such side effects occur, ensuring comprehensive management of patients receiving Semaglutide for diabetes control.

None Declared