No significant relationships.

Serotonin syndrome is a potentially life-threatening condition that is precipitated by the use of serotonergic medications, Selective Serotonin Reuptake Inhibitors (SSRIs) and Monoamine Oxidase Inhibitors (MAOIs). It usually occurs when high doses of serotonergic drugs are prescribed. It is a medical emergency that requires prompt recognition, cessation of offending drugs and supportive therapy.

We present a case of serotonin syndrome that occurred in a patient who was prescribed a low dose of sertraline, and aim to highlight the importance of early detection of this severe condition.

Details of the case were described. Information was gathered based on medical records.

Patient M was a 29-year-old Malay male with a history of major depressive disorder, who was previously trialed on fluvoxamine 100mg every night but subsequently switched to and maintained on sertraline 75mg every night in 2020. He then defaulted follow up appointments. In 2023, he presented to the emergency services for a suicide attempt and was diagnosed with major depressive disorder with psychotic features. He was restarted on sertraline 50mg every night and risperidone 0.5mg every night was newly started. Two days later, sertraline was increased to 100mg every night. Two days following this increase, he was noted to have altered mental state, fever of 39.3-degree celcius, tachycardia of 120 beats per minute, ocular clonus and generalized hyperreflexia. Sertraline and risperidone were immediately stopped. Blood tests including creatine kinase, lumbar puncture and magnetic resonance imaging (MRI) of the brain did not show any abnormalities. After stopping of the medications, the patient’s symptoms resolved within 24 hours. Based on clinical symptoms and a normal creatine kinase level, neuroleptic malignant syndrome (NMS) was ruled out. Subsequently, he was restarted on risperidone 0.5mg and mirtazapine 7.5mg every night. He developed symptoms of serotonin syndrome with a low dose of sertraline. Symptoms resolved after the discontinuation of the SSRI.

In this case, differential diagnoses of serotonin syndrome were also considered, such as NMS, encephalitis, meningitis and thyroid storm. NMS was less likely due to the rapid onset of onset and resolution of symptoms. Encephalitis and meningitis were unlikely in view of normal MRI brain and lumbar puncture findings.

There have been case reports of serotonin syndrome developing with lower doses of an SSRI in the pediatric population. There is, however, a lack of literature describing serotonin syndrome with low doses of SSRI in the adult population. To avoid a missed diagnosis, clinicians should monitor closely for SSRI toxicity, including serotonin syndrome, even when low doses of serotonergic drugs are used.

None Declared

A bidirectional association between type 2 diabetes and depression has been consistently reported. It is associated with worse biomedical outcomes and increased mortality. One possible question is whether the co-occurrence of type 2 diabetes and depression is due to genetic and/or environmental vulnerabilities in common to the two traits.

To examine the genetic relationship between type 2 diabetes and depression at a population level.

To quantify the genetic overlap between type 2 diabetes and depression using the Swedish Twin Registry.

The study included 43,565 twin pairs (12,363 monozygotic pairs and 31,202 dizygotic pairs). The primary outcomes were lifetime diagnosis of type 2 diabetes and depression from the Swedish National Hospital Discharge Registry. Standard bivariate twin models were fitted to the raw data to estimate the genetic and environmental (co)variance of the two traits.

Heritability estimates for lifetime diagnoses of type 2 diabetes and depression were similar to previous estimates, at 77% and 42% respectively. The phenotypic correlation between type 2 diabetes and depression was 0.14 (95%CI: 0.11-0.17), of which 58% was due to shared genetic influences. When covariates (age and gender) were included, the genetic contribution to the phenotypic correlation reduced to 51%.

This is the first study to demonstrate a small but significant genetic overlap between type 2 diabetes and depression at a population level, using hospital-registry records.

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.

Lebanon is a medium-income country in the Eastern Mediterranean which has seen a surge in interest in mental health following years of stagnation. The mental health needs of the country for severe psychiatric disorders are underserved.

The aim of our study is to describe community mental healthcare services in Lebanon and to address local opportunities and challenges.

A review of the literature using local resources along with expert opinion was undertaken to synthesize the evidence.

Political instability, chronic underfunding and widespread stigma have contributed to maintaining a traditional model of private clinics affiliated with inpatient and long-stay psychiatric units. A number of initiatives have been launched to cater for patients with psychotic disorders and to offer partial hospitalization for others with mood-related conditions. In parallel, the Ministry of Public Health, with international funding, has been instrumental in efforts to standardize care at a national level, particularly for early detection and treatment in primary care. The priorities of the national mental health programme are consistent with the global trend in shifting services to the community. Hurdles remain, in line with those facing countries with similar socio-demographics and resources. These include limited third-party coverage of mental health, absence of training opportunities in multidisciplinary community settings and some clinicians’ reluctance to update their ways of working.

Development of a local workforce dedicated to providing a patient-centred approach in the least restrictive settings, is essential for consolidating community care in Lebanon. This would be reinforced by (overdue) legislation and implementation of a mental health law.

IGA MZ CR NT 11047-4/2010

Mental disorders are a major cause of disability in Europe [1]. However, organizational structures and information systems are focused on delivery of care, rather than providing value [2]. In the digital era, we have the capacity to change priorities through the analysis of heterogeneous databases that could support patients’ and professionals’ decisions.

to analyse the contradictions between the design and the theoretical structure of mental health services and the possibilities to evaluate the actual value of the delivered care.

To reflect on changing the trend using a different conceptualization of objectives and evaluating methods.

We used a tool provided to clinicians by the Madrid's Regional Health Service SERMAS (‘ConsultaWeb’) combining primary care, pharmacy and hospital data (n = 395,073 patients for the catchment area), and a set of hospital-based data (patients attended by psychiatrists at the ER, n = 13,877, and patients admitted to the Psychiatric Inpatient unit n = 3318), to explore some of the present professional information resources.

Currently used healthcare databases only describe the diagnostic or therapeutic categories of patients and might be used to detect abnormal behaviours. However, they are neither able to show the functional status of patients nor designed to predict their clinical course.

A clearer definition of value in patient outcomes is needed. This might help to organize the healthcare delivery and to create a new information system that would allow to asses health outcomes.

The authors have not supplied their declaration of competing interest.

The presentation considers the peculiarities of late adulthood, different views on the periodization of older ages (World health organization, I. Burnside, H.S. Pryazhnikov).

The research is aimed at studying the peculiarities of late adulthood.

The method of work is a bibliographic analysis.

Reveals the structure of psychological age (concept by L.S.Vygotsky), the specificity of the development in late adulthood and features of the social situation of development. Reveals modern ideas of ageing as a process not only of involution and loss, but also a process of continued development. The greatest attention is paid to the peculiarities of development tasks at older ages and the difficulties faced by older people trying to cope with them. There are the brief overview of the positions of C.G.Jung, A.Adler, E.Erikson, R.Peck, G.M.Bryugman, A.G.Liders, N.S.Pryazhnikov, E.E.Sapogova, I.V.Shapovalenko, V.I.Slobodchikov, G.A.Zuckerman, etc. regarding the development tasks in late adulthood. The comparison of the development tasks of early and late age periods by G.M. Bryugman, which shows that the tasks of aging worse defined, at least sequentially ordered, and the results of solution of development tasks is less predictable than in earlier ages.

We can say that in old age is important not only the task of adjusting to different changes of pace of life, quality of life, social circle, etc., and overcome the negative aspects of aging but also issues of self-development. As the primary development task in late adulthood is considered an achievement of his own integrity and finding the meaning of life.

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

Valproic acid (VPA) is considered a well-tolerated antiepileptic drug used in Bipolar Disorder as a mood stabilizer. Nevertheless, VPA has been related to several adverse effects. Neutropenia is included as a potential adverse effect, although in clinical practice it is not often measured with regularity.

To report a case of a patient with Bipolar Disorder type 2 and Personality Disorder Cluster B treated with VPA with a neutropenia caused by VPA.

A 61-year-old woman assists to the outpatient psychiatric unit in order to a pharmacological treatment adjustment. A blood test is performed showing a decrease in the levels of neutrophiles in comparison with previous tests. Psychiatric history is revised finding and association between the prescription of VPA and the reduction of neutrophile levels. When this drug was removed, neutrophile levels had increased again up to normal levels.

Due to the relationship between neutropenia and VPA treatment, we decided to discontinue this drug. At the beginning the patient doesn’t agree with the withdrawal of VPA treatment due to its effectiveness in her mood stabilization. Psychoeducation sessions are performed in order to explain risk and benefits of potentials treatment alternatives versus maintaining the same prescription. Finally the patient accepts the switch of the mood stabilizer treatment to oxcarbazepine with a good tolerability and effectiveness.

Periodical blood test monitoring is needed in order to study adverse effects as neutropenia in patients with VPA treatment.

The author has received support from Janssen-Cilag, Otsuka-Lundbeck, Italfármaco, Angelini Pharma and Casen Recordati; and declares no support related to the subject of this article.

Hair loss resulting from childhood irradiation for tinea capitis has been linked to mental health effects in women. However, the association of hair loss severity with mental health in this population is unknown.

The aim of this study is to examine the association between hair loss severity and mental health outcomes in women irradiated for tinea capitis in childhood and to identify contributing factors to these outcomes.

Medical records, held at the archives of Israel National Center for Compensation of Scalp Ringworm Victims, were retrospectively reviewed for 2509 women who received compensation for full or partial alopecia resulting from irradiation in childhood for tinea capitis. Mental health outcomes were determined by the number of mental health conditions reported.

Among women with high hair loss levels, risk was increased for a range of mental health problems, including depression symptoms, emotional distress, social anxiety, low self-esteem, and suicidal ideation. Hair loss severity emerged as a significant predictor of mental health, adding to the effects of other predictors such as family, and social and physical health problems. Effects of hair loss severity on mental health outcomes were mediated by women’s negative social experiences.

Hair loss severity is a significant risk factor for mental health problems in women irradiated for tinea capitis in childhood. Further research is needed to assess mental health risks among women with severe hair loss associated with additional diseases.

No significant relationships.

After the outbreak of a new coronavirus infection (COVID-19) on 31 December 2019 in Wuhan (China), an increasing amount of information and concerns are impacting global mental health. It is already evident that apart from physical suffering, the direct and indirect psychological and social effects of COVID-19 pandemic are pervasive and could affect mental health now and in the future.

The central aim of our study was to investigate the prevalence of common mental disorders in populations during Covid-19 outbreak. The study was done in 3 different countries (Albania, India, Iran) which gave us the opportunity to compare our findings and to have a bigger view of the impact of COVID-19 in individuals.

A Cross-sectional online survey was done across countries. We used demographic questions and different scales: Corona Anxiety Scale (CAS), The Obsession with COVID-19 Scale (OCS), Insomnia Severity Index (ISI) to evaluate psycho-social impact during covid.

We collected 469 responses in Albania, 442 responses in India and 402 responses in Iran. According to the data we found that symptoms of anxiety related with corona and obsession with corona were higher in Iran compared with the two other countries. Insomnia problems were also more frequent in Iran were only 16,66% of participants reported no insomnia, compared with 42,0% in Albania and 63,12% in India.

The emergence of mental health (MH) problems during a pandemic is extremely common, though difficult to address due to the complexities of pandemics.

No significant relationships.

There is a need for systematic evaluation of treatment of out-patients in mental health services. Very few instruments for such evaluation that has been translated to Norwegian have been properly validated.

To document the psychometric properties of the Norwegian translation of the outcome-measure Clinical Outcomes in Routine Evaluation (CORE-OM).

A clinical sample (N = 528) was collected from out-patient mental health services. A non-clinical convenience sample (N = 473) was also collected. A sub-sample of 81 from the non-clinical sample filled in the questionnaire four times, with one week between tests, alternating between the Norwegian translation and the original English version. The same sub-sample of 81 students was posed a question to measure psychological strain.

There were no significant differences in mean-scores between the sexes, neither in the non-clinical nor in the clinical sample. All mean scores were significantly higher in the clinical than in the non-clinical sample. The cut-off point for the Well-being items was higher for women, while the cut-off point for risk of suicide/harm to others was higher for men. Cut-off scores for Problem-items and Function-items was similar for men and women. The scores increased after exposure to psychological strain. Acceptability, internal consistency, test-retest stability, and the differences between scores in non-clinical and clinical samples were at the same level as in English data. Regarding cut-off scores, these are very similar also.

The Norwegian translation of the CORE-OM have psychometric properties very simialer to the English original, and could be recommended for general use.

Clinicians treating patients with Major Depressive Disorder (MDD) might favor one second-generation antidepressant (SGA) because of perceived benefits for the accompanying symptoms of MDD.

To compare the efficacy of bupropion, citalopram, desvenlafaxine, duloxetine, escitalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, sertraline, trazodone, and venlafaxine for the treatment of the accompanying symptoms of MDD.

This review is part of a larger review on the comparative effectiveness of SGAs for MDD. We searched MEDLINE, Embase, The Cochrane Library, and the International Pharmaceutical Abstracts up to May 2010. Two persons independently reviewed the literature, abstracted data, and rated the risk of bias.

We located 26 head-to-head and 7 placebo-controlled trials that provided evidence for this review. We did not locate any studies on treating accompanying appetite change, low energy, melancholia, or psychomotor change. There was no evidence for many comparisons and we were unable to conduct quantitative analysis for any comparisons. For the comparisons that were studied, we concluded that the SGAs are similarly efficacious for treating anxiety, insomnia, pain, and somatization. The strength of the evidence for these conclusions is low (meaning further research is very likely to have an important impact on our confidence in the estimate of the effect and is likely to change the estimate).

Our findings indicate that the existing evidence does not warrant the choice of one second-generation antidepressant over another based on greater efficacy for the accompanying symptoms of depression.

The night eating syndrome (NES) is a categorized in the diagnostic and statistic manual (DSM-5) as an “Other Specified Feeding or Eating Disorder” and it is characterized by a reduced feeding during the day, evening hyperphagia accompagned by frequent nocturnal awakenings associated with conscious episodes of compulsive ingestion of food and abnormal circadian rhythms of food and other neuroendocrine factors. Frequently it is associated with obesity and depressed mood.

The purpose of this review is to investigate the state of art concerning the psychopharmacological treatment of NES.

A Medline enquiry of published articles from 2005 to October 2015 was performed using the following keywords: “NES, pharmacological treatment, SSRI, antidepressants, antipsychotic, sertraline, citalopram, escitalopram, duloxetine, venlafaxine, paroxetine, fluoxetine, fluvoxamine, topiramate”. Reviews, single case studies and RCT were also analyzed.

Only few studies met the selection criteria. A recent 8-week double-blind placebo controlled study, in 34 patients with NES, has confirmed the efficacy of sertraline. Sertraline was associated with significantly greater improvement than placebo in overall symptomatology.

SSRIs should be considered the drug of choice for the treatment of NES not only because of evidence in the literature but also since they display the best pharmacological profiles with fewer adverse events. More evidence of efficacy is shown for some SSRIs such us paroxetine, fluvoxamine and especially sertraline. Topiramate should be reserved for cases resistant to treatment with SSRIs.

The authors have not supplied their declaration of competing interest.

To explore safety, tolerability, treatment response and hospitalizations in adult patients with schizophrenia treated with long-acting injectable risperidone (RLAI) or oral antipsychotic standard of care (oAP) in routine clinical practice.

Prospective one-year open-label non-interventional study exploring flexible doses of RLAI and oAPs. Primary outcome was the number of hospitalizations from baseline to endpoint. Additional outcomes were changes in the Clinical Global Impression of Schizophrenia (CGI-SCH), patient functioning (Global Assessment of Functioning) and treatmentemergent adverse events (TEAEs).

The intent-to-treat analysis included 561 patients on RLAI and 522 patients on oAPs (44% female gender, mean age (±SD) 42.2±13.1 years). Demographics and baseline characteristics were comparable, yet RLAI-treated patients had higher disease severity, lower baseline functioning and more substance abuse. The number of hospitalizations did not differ between the two groups while median duration of hospitalization was significantly shorter with RLAI (12.3 vs 20.6 days). Positive, negative, cognitive symptoms, disease severity, patient functioning and medication satisfaction improved significantly better with RLAI than oAPs. The most frequently reported TEAEs (=2% in any group) for RLAI and oral APs were increase of body weight (5.0%; 5.6%), psychotic disorder (2.7%; 4.0%), schizophrenia (2.5%; 3.1%), anxiety (2.3%; 2.7%), insomnia (0.9%; 3.1%) and somnolence (0.4%; 2.5%), respectively.

This one-year non-interventional study supports results of recent randomized controlled trials that treatment with RLAI is associated with less days spent in hospital, better symptomatic and functional outcomes and higher patient satisfaction with medication compared to oral APs.

Despite the huge effect eating disorders (Eds) have on the lives of sufferers and their families there has been little research on the effect an ED has on siblings even though their lives are repeatedly significantly affected by the situation. It is important to gain more insight into the experiences and needs of siblings as the nature and magnitude of the effect of patients EDs on non-affected siblings is mixed in the current research.

To conduct a systematic review allowing an extensive search of the current literature to identify where the current research is lacking. Also, to highlight the need for a greater focus on the effect of EDs on siblings both in research and clinical practice.

A systematic review is being conducted to gain an understanding of the gaps in the literature.

It is expected that the systematic review will reveal a lack of literature regarding siblings’ experiences of having a brother or sister with an ED. As well as showing the conflicting emotions felt by the siblings, both positive due to the love they feel for their sibling and negative due to the burden they feel.

By raising awareness of the needs of non-affected siblings this research should have a notable impact on their experiences by highlighting the need for specific interventions and support services as well as education about their siblings’ ED.

No significant relationships.

After Russia decided to start COVID-19 vaccination of international students who are getting their education on its territory, they received an opportunity to get a single dose of COVID-19 Sputnik Light vaccine. What motives can such international students have for being vaccinated in the situation of uncertainty?

Our goal is to define the structure of motivation for COVID-19 vaccination among international students who are getting education at different departments of the university.

In October 2021, we surveyed 409 international students getting education at Ulianov Chuvash State University in Cheboksary, who agreed to COVID-19 vaccination.

Those who applied for vaccination were mostly 3rd year students (32.03%) and 4th year ones (21.52%). 8 students out of the surveyed (1.96%) had been vaccinated outside Russia, 4 – in Russia (0.98%). 8.56% of the pool had had COVID-19, 57.7% had not, 33.74% could not give a certain answer. Main motives for COVID-19 vaccination were: unwillingness to be ill (57.21%), unwillingness to have any limitations imposed (22.98%), unwillingness, especially of medical students, to have problems in their studies (12.22%), inclination towards following their relatives’ advice (5.13%), desire to follow the surrounding people’s example (1.98%). In personal conversations, the students often expressed their wish for being vaccinated with a 2-component Sputnik V vaccine for a better protection from illness.

The survey of the international students’ motives showed that most of them have positive attitude to COVID-19 vaccination and feel inclined to be vaccinated with a Russian vaccine in order to reduce the risk of getting ill.

No significant relationships.

Clinical benefits of antipsychotic treatment depend on the efficacy and on the patients’ tolerability and compliance. To reduce patient initiated treatment discontinuation, timely detection of treatment emergent side effects is essential. The Glasgow Antipsychotic Side-effects scale for clozapine (GASS-C) is a recently developed instrument to measure subjectively experienced clozapine side effects.

Timely detection of unreported clozapine related side-effects.

Documenting the prevalence of side-effects in schizophrenia or chronic psychotic disorder with the Serbian version of the GASS-C.

The sample included 95 in and outpatients with schizophrenia or chronic psychotic disorder. All subjects filled out the Serbian version of the GASS-C and a sociodemographic questionnaire.

The median age was 46.1 years; 53.7% of subjects were male. Clozapine doses ranged from 25 to 423 mg. Drowsiness (78%) was the most commonly reported side-effect. Overall, 16.8% of the patients added other complaints, such as headache, pain, hand or leg numbing or nightmares. According to GASS-C total score categorization [2], only 4.2. % of subjects were rated with severe side-effects, while 14% of themselves rated their symptoms as severe or distressing. More side effects were reported by female patients and by inpatients. Only a weak positive correlation was found between the severity of the side effects and clozapine dosage.

We found the GASS-C to be a useful instrument that elicits both unknown side-effects and patients rating of their severity. Side effects did not clearly relate to the prescribed dose. Future research should include the relation of clozapine plasma levels with side effects assessed with GASS-C.

The authors have not supplied their declaration of competing interest.