Outcome after first episode psychosis is heterogeneous, but knowledge about the distribution and predictive factors is limited.

To investigate medication and rehospitalizations for five years after first episode hospital treated psychosis.

Swedish population registers were used to select a nation-wide cohort of 962 cases (589 or 61% men) with a first hospitalization for psychosis at ages between 16–25 years. Cases were categorized year by year for 5 years after the initial hospitalization with regard to rehospitalizations and dispensations of antipsychotics and other medications.

The 5-years mortality was 4% (n = 39) with suicides in 16 cases (1.6%, 11 of which were men). Additionally, 139 cases (23% of women and 10% of men) had hospitalizations for suicide attempts within 5 years. A bimodal distribution of years with medication was found indicating two different trajectories of outcome. One peak was seen for cases with dispensations of antipsychotics 5 of 5 years (40% of the cohort). Another peak was seen at dispensations during at most 1 of 5 year (30%). During year 5, 514 (56% of 923 cases surviving 5 years) had dispensations of neuroleptics and 257 (28%) were hospitalized, whereas 356 cases (39%) had no dispensation of neuroleptics or hospitalization.

The population of young cases with first episode psychosis is heterogeneous with at least two clearly separable trajectories based on medication and hospitalizations. The high mortality and high incidence of suicide attempts during a five-year period demonstrate a need for careful monitoring of these patients.

The authors have not supplied their declaration of competing interest.

Electroconvulsive therapy (ECT) remains a valuable treatment for major depression with psychotic symptoms. However, it is necessary to pay special attention when there is a history of fractures.

Through the description of the following clinical case, we will emphasize the importance of screening for vertebral fractures within ECT and the different procedures that must be taken if that occurs.

We undertook a narrative literature review by performing a search on PubMed for English-written articles. The query used was “Electroconvulsive Therapy” AND “Vertebral Fractures”.

A 71-year-old woman was admitted with an episode of psychotic depression. Basic tests were performed and were all normal. After not responding to pharmacologic treatment, she was referred for ECT. The patient had a full recovery after 4 weeks of biweekly sessions. She was discharged and proposed for maintenance ECT. However, she started complaining of back pain after falling and did an X-ray and CT scan which revealed fractured L1 and L2. It was suggested conservative treatment with a Jewett orthosis. Within this period, the ECT was suspended and after a 4-week treatment, the fracture was consolidated. As there was no risk of neurological compression, the treatment was restarted with the same dosage of succinylcholine, and it was achieved complete muscular relaxation. The patient fully recovered without any orthopedic sequel.

Electroconvulsive therapy can be safely performed after conservative treatment of vertebral fractures, if special attention is provided to complete muscular relaxation. For this effect, the dosage of succinylcholine can be adjusted.

No significant relationships.

To describe a cohort of adolescents presenting to an emergency department with mental health problems.

An Emergency Department (ED) computerized record system and hospital records were used to obtain data on adolescents aged from 12 to 17 years who presented to an ED of a General Hospital with emotional or behavioural problems.

There were 213 presentations of 182 adolescents in a 12-month period. 77% were female, 56% were 16 or 17 years old, 8% did not live with immediate or extended family. There was a wide variety of presenting symptoms including anxiety, self-harm, suicide attempts (14,5% presented with suicidal behaviour), behavioural disorders, depression, eating disorders, acute psychosis, developmental disability, substance abuse. Psychosocial problems were frequent. Medication was prescribed in 38% of the presentations and 7.5% of the cases were admitted to a psychiatry ward. 54% had no previous psychiatric history.

Many adolescents with mental health problems had no previous or current treatment and were referred to local mental health resources for further evaluation. Psychiatric ED evaluations are an opportunity for recognition of risk factors, screening and early intervention in youth with mental health disorders and their management involves collaborative efforts with multidisciplinary services.

There have been a growing interest in the effectiveness of task-shifting as a strategy for targeting expanding health care demands in settings with shortages of qualified health personnel.

To explore the reasons for task-shifting and the healthcare settings in which task-shifting are successfully applied as well as the challenges associated with task shifting.

Literature searches were conducted on PubMed and Google Scholar using the search term – ‘Task shifting’ and Task-shifting’.

Reasons for task-shifting including: a reduction in the time needed to scale up the health workforce, improving the skill mix of teams, lowering the costs for training and remuneration, supporting the retention of existing cadres by reducing burnout from inefficient care processes and mitigating a health system's dependence on highly skilled individuals for specific services. Clinical settings in which task-shifting models of care have been successfully implemented, include: HIV/AIDS care, epilepsy and tuberculosis care, hypertension and diabetes care and mental healthcare. Finally, challenges which hinder the successful implementation of task-shifting models of care, include professional and institutional resistance, concern about the quality of care provided by lower lever health cadres and lack of regulatory and policy frameworks as well as funding to support task-shifting programmes.

The review brings to light important health policy and research priorities which can be explored to identify the feasibility of using task-shifting models of care to address the critical shortage of health personnel in managing emerging communicable and non-communicable diseases, including opportunities for expanding mental health care in conflict and under-resourced regions globally.

The author has not supplied his/her declaration of competing interest.

To investigate whether maladaptive strategies to cope with shame feelings were associated with psychopathic traits.

To examine the association between four maladaptive shame coping were positively related with psychopathic traits.

A sample of male offenders incarcerated in Italian jails completed the Self-Report Psychopathy Scale (Paulhus et al., 2015) and the Compass of Shame Scale (Elison et al., 2006).

As hypothesized, maladaptive shame regulation strategies did predict psychopathic traits in the offender sample examined. Specifically, significant and meaningful associations occurred between avoidance and attack other coping styles and psychopathic traits.

The present study is among the first in providing evidence of a possible relationship between maladaptive strategies to cope with shame feelings and psychopathic traits, and such link can be informative to tailor treatment programs for these hard-to-treat patients.

The authors have not supplied their declaration of competing interest.

Clozapine is licensed for treatment-resistant schizophrenia and when clozapine is not able to be used, less evidence based practices may be required. Full remission may require combinations or high doses of psychotropic medications having greater potential for interactions and side effects. If this is not successful, symptoms may persist and long-term disability may occur.

To explore safety and efficacy of a rechallenge of clozapine in a patient with treatment resistant schizoaffective disorder, who previously developed pericardial effusion. Collateral history reported best improvement with clozapine compared to other medications.

To improve level of functioning and reduce need for less evidence based choices of medication.

Initial consultation with clozapine monitoring service over prospects of rechallenge. Full medication history and review. Consultation with a cardiologist regarding validity of local monitoring strategy. Obtain consent from the patient and his family. Titrate clozapine slowly. Once clozapine initiated, measure temperature, blood pressure, pulse rate and monitoring of symptoms of pericarditis including chest pain, cough and dyspnoea daily. ECG and echocardiography at baseline and 2 and 4 weeks after initiation of the rechallenge. ECGs monthly thereafter, with a further echocardiogram at 3 months. Weekly troponin and CRP for three months to monitor developing myocarditis and pericarditis.

Successful rechallenge of clozapine with significant reduction in psychopathology, improvement in functioning and no adverse events reported. Reduction of risk enabled transfer to open ward conditions.

There is increasing evidence of successful rechallenges of clozapine however, further research is necessary to aid such clinical decisions.

The authors have not supplied their declaration of competing interest.

The Social Distance Scale (SDS) is an established tool in the measurement of discriminatory attitudes towards those with mental illness.

To send an electronic questionnaire incorporating the SDS to both healthcare and nonhealthcare undergraduates.

To compare attitudes using the SDS of both student groups towards vignettes describing active and medically resolved cases of mental illness.

567 first year healthcare and 501 non-healthcare (law and english) university students were sent a questionnaire randomly containing one of six possible vignettes (describing either active or medically resolved depression, schizophrenia or asthma). The SDS as used by Nordt (2006), was then completed, indicating what level of social closeness would be accepted with the person described.

180 responses were received for the healthcare group (31.7% response rate) and 125 for the non-healthcare group (25% response rate). Very good reliability of the Social Distance Scale (Cronbach's a=0.91) was observed in the sample. Statistical analysis was performed using SPSS. A linear regression model was applied which explained 20% of the variance. A significant difference was observed in attitudes between healthcare and non-healthcare students towards both the active and resolved schizophrenia, with the Non-healthcare group expressing higher social distance towards these vignettes (+0.31; P=0.043) compared to the healthcare group. The two groups did not differ significantly in social distance towards the depression and asthma vignettes.

The non-healthcare students were significantly more socially distant towards both active and resolved schizophrenia vignettes. The findings for the remaining vignettes were similar between the two groups.

Suicide is one of the leading external causes of death worldwide. The alarming increase in the occurrence of suicide in Belarus in recent years has resulted in the country having one of the highest suicide rates in the world. It is well recognized that both acute and chronic alcohol use are among the major behaviorally modifiable factors that are associated with suicidal behavior. Several studies have reported relatively high proportion of suicide cases positive for blood alcohol concentration (BAC).

The present study was designed to collect data on BAC-positive suicides in Belarus.

This study was based on the official autopsy reports of the Bureau of Forensic Medicine. The sample consisted of 1135 male subjects (76.3%) and 356 female subjects (23.7%).

In the present study 61% of males and 30.6% of females were BAC-positive at the time of death. It should be noted that the proportion of BAC-positive suicide in Belarus is among the highest in the world. Positive blood alcohol cases were found more frequently in men age 30-59 (66%) and women age 19-39 (48%). The average BAC was 2.2 ± 0.004 g/dL for males and 2.1 ± 0.005 for females.

In this study, substantial percentages of suicide victims tested positive for alcohol. These results are consistent with previous studies suggesting that acute alcohol intoxication may function as an important effect modifier to the act of suicide. The outcome of this study also suggests that alcohol-related suicide is mainly a male phenomenon.

Heart rate variability (HRV) reflects the oscillations of successive heartbeats (variability of R-R periods). It is considered to be decreased in various psychiatric conditions, for example in depression (1). We ask if a treatment with psychotherapy can have a positive effect on HRV.

To assess whether a 10-week systematic dynamic group psychotherapy treatment influences HRV. There were the following parameters of HRV assessed: high frequency (HF), low frequency (LF), total power (TP), mean square successive differences (RMSSD), stress index (SI).

The measurement of HRV was carried out under standard conditions. We have recorded ECG with the use of TESLAGRAPH® device.

10 women and 5 men attending a 10-week treatment. The psychiatric diagnoses were various anxiety and neurotic disorders.

(median: before treatment - after a 10 week treatment): HF (442 Hz - 305 Hz; p = NS); LF (709 Hz - 556 Hz; p = NS); TP (1835 ms2 - 2371 ms2; p = 0,NS); RMSSD (28 ms2 - 33 ms2; p = 0,NS); SI (106 – 66; p = NS).

An improvement was found in all characteristics of HRV after the treatment, however the differences are not statistically significant.

The COVID‑19 pandemic has raised multiple psychological challenges among most healthcare workers, from anxiety to depression, burnout, sleep disorders, and substance use disorders. Thus, the burden caused by this prolonged medical crisis has inevitably drastically lowered the quality of life of the medical staff. In order to mitigate the negative effects of the pandemic, healthcare workers resorted to various coping strategies, with better or worse outcomes.

The present study aims to identify Romanian physicians’ main coping mechanisms and evaluate the role of positive and negative stress-reducing strategies on quality of life.

A cross‑sectional national survey was conducted using a web-based questionnaire among physicians practicing in Romania (n=265). In addition to socio-demographic and professional information, the questionnaire addressed participants’ coping mechanisms using the COPE inventory and quality of life with the WHOQOL-Brief scale. Descriptive statistics, Pearson correlations, and multiple linear regressions were used in the statistical analysis.

In total, 265 physicians consented to their participation in the survey. Of those who responded, 84.5% identified as female, 92.1% had a permanent residence in a urban setting, 63.8% were married and 55.1% attained a master’s degree, a PhD diploma or equivalent level of education. The results showed that optimism was higher in male professionals, while avoidance coping was higher in female health professionals. The mean values of QoL subscales were: 74.7± 18.3 for the general quality of life, 70.8± 20.7 for health satisfaction, 64.0± 14.2 for the physical area, 61.7± 16.2 for the psychological area, 61.2± 20.3 for the social relationships area and 64.7± 12.7 for the environment area. Specific coping mechanisms (emotional venting, behavioral and mental disengagement) were associated with lower quality of life. In contrast, emotion-focused (positive reinterpretation and acceptance), problem-focused strategies (planning, active coping, suppression of competing activities) and humor were associated positively with most QoL subscales scores.

Our data points to specific protective characteristics and some detrimental factors on physicians’ quality of life during the pandemic, with the implication that these factors may be important considerations for mitigating distress and psychiatric disorders for healthcare workers during times of high stress. Concerted initiatives to improve wellness in healthcare workers ought to develop targeted programs to ensure adequate psychological support.

None Declared

Childhood trauma (CT) is a relevant environmental stressor for bipolar disorder (BP). Amygdala and hippocampus are key areas involved both in the pathophysiology of BP and in mediating the biological response to stress.

Structural neuroimaging studies help clarifying neural correlates of the relationship between BP diagnosis and CT.

To verify the impact of CT on amygdala and hippocampus and hippocampal subfields volumes in BP patients and healthy control (HC).

We assessed 105 outpatients, diagnosed with BPI or BPII according to DSM-IV-TR criteria, and 113 HC subjects. History of CT was obtained using the childhood trauma questionnaire (CTQ). High-resolution magnetic resonance imaging was performed on all subjects and volumes of amygdala, hippocampus, nucleus accumbens, caudate, pallidum, putamen, thalamus and hippocampal subfields were measured through FreeSurfer.

All deep gray matter structures were smaller in BP than HC. CT modulated the impact of the diagnosis on bilateral amygdala and hippocampus, in particular on subiculum, presubiculum and cornu ammonis CA1. It was associated with bilateral decreased volumes in HC and increased volumes in patients with BP.

Childhood trauma impacts on the amygdala and hippocampus, brain areas involved in response to stress and emotion processing, and specifically on the hippocampal subfields most implicated in learning trough positive/negative reinforcement.

The authors have not supplied their declaration of competing interest.

The problem of cognitive dysfunction in eating disorders remains controversial and the research results are not univocal. Because of that, research was undertaken on a homogenous group of young patients suffering from eating disorders, hospitalized in the adolescent unit.

The cognitive functions were assessed by Wisconsin Card Sorting Test (WCST) and Digit Span Test in the group of 60 adolescent girls (30 anorectic, 30 bulimic) of the same age and compared with the control group of 39 healthy adolescent girls. Also the relation of cognitive disorders with some clinical features of the illness such as the degree of weight loss, BMI at the admission and discharge and the results of EDI test were assessed.

Research results did not show statistically significant differences in the performance in the WCST between anorectic and bulimic patients and the control group. However, the group of anorectic patients show the tendency to perform worse in some parameters of WCST (TA, TE, PE, %PE, %CLR) than the control group, althought the results do not reach statistical significance. The results of the bulimic patients were better (p=0.04) than the control group in the Digit Span Test.

No correlation was found between clinical data and results in WCST in eating disorder groups of patients while the correlation was found between results of Digit Span Test and BMI at admission in both clinical groups.

The research does not fully confirms that patients suffering from eating disorders show deficits in cognitive functions.

Recent developments in psychiatric diagnosis risk downgrading psychological and social aspects of personal recovery and marginalise the individual needs and aspirations of people, considered in their local context. The publication of the fifth edition of the Diagnostic and Statistical Manual for Mental Health Disorders (DSM-5) by the American Psychiatric Association (APA) prompted MHE to establish the Beyond the Biomedical Paradigm Task Force (BBPtf) to investigate, debate and report on these issues.

Mental Health Europe (MHE) – along with others both within and outside mainstream psychiatry – has noted with concern the increasing dominance of a biological approach to mental health problems. We see a risk of diagnoses being misused when they become part of a complex managerial health system responding mainly to the economic and issues of safety or social control. This kind of misuse could breach the principles of the UN CRPD. MHE welcomes the role of the WHO in coordinating internationally appropriate classification systems. However, we want to ensure that systems based on biomedical, economic and managerial issues are balanced with systems based on knowledge of personal experiences, life stories and direct relationships, which have proven outcomes and which respect human rights and dignity.

This workshop will explore the complex philosophical issues associated with psychiatric diagnosis and, in particular, the ICD-10 revision process.

I am President of the British Psychological Society and a member of both Mental Health Europe's “Beyond the Bio-Medical Paradigm Task Force” and the Council for Evidence Based Psychiatry. I am currently in receipt of funding from the National Institute for Health Research (NIHR) and the Economic and Social Research Council (ESRC), and I have previously received funding from a variety of sources.

The others authors have not supplied their declaration of competing interest.

Pain management is connected to use of Opioids and analgesics at the emergency care units and interfere with ability of emergency care provider to manage patient if patient identified as drug seeking. Pain has been reported as the main reason for seeking emergency care; therefore, emergency care providers have great difficulty defining or accurately predicting those patients who present with factitious complaints to obtain pain medications, and fear of additions and abuse.

Was to investigate meaning and knowledge level of emergency nurses in Jordan in relation to drug seeking behaviors at the emergency units in Jordan.

A descriptive-correlational study used to collect data related to drug seeking from 305 emergency nurses using self-report questionnaires.

The analysis showed that emergency nurses in Jordan have wide variation and moderate level of agreement on meaning of drug seeking. Emergency nurses also lack the knowledge and ability to detect drug seeking patients, and lack the effective interventions required to manage drug seeking if identified. Although nurse had low level of knowledge and low level of management skills, the analysis also showed that there was a positive association between level of knowledge and management skills. Also nurses ‘knowledge had negative association with nurses’ age, number of years of experience in nursing, and number of years of experience in emergency units.

The study provoke attention to quality of pain management and interventions provided at the emergency units

Psychotic symptoms are the most important non-motoric symptoms of the Parkinson disease (PD). The quality of life of those patients can be significantly improved with an appropriate therapy. In this article we provide evidence about the etiology, differential diagnosis and therapeutic possibilities with a work-up for the clinics.

To provide a case report of patient with PD who developed a paranoid psychosis after administration of levodopa/carbidopa, followed by a literature review on psychotic symptoms evoked by psychotropic medication by patients with PD.

An English-language literature search was conducted using Pubmed, EMBASE searching for case reports and observational studies reporting iatrogenic psychotic symptoms by patients with PD.

Ms. C. was a 65-year old woman with PD who was observed in a polyclinic setting and who used a levodopa/carbidopa combination. She developed paranoid psychosis with a following admission to the psychiatric ward. We have gradually lowered the dose of anti-Parkinson medication. Subsequently, treatment with clozapine was initiated and the psychotic symptoms resolved within five months.

Parkinson psychosis is due to a complex interaction of neurodegenerative changes and pharmacological therapy. Therefore, the role of iatrogenic factors must be always carefully assessed. Psychosis inducting agents should be lowered or stopped before the treatment with antipsychotic medication.

The authors have not supplied their declaration of competing interest.