This systematic review estimates the pooled prevalence (PP) of Conduct Disorder (CD) among 5-to-18-year-old YP living in Europe, based on prevalence rates established in the last five years (LFY).

Trends of prevalence rates across countries, gender and level of education were analysed. The random effects pooled prevalence rate (REPPR) for CD was calculated.

A search strategy was conducted on three databases. Studies were also identified from reference lists and grey literature. Eligible studies were evaluated for reliability, validity and bias, and REPPRs were calculated.

The European REPPR for CD is calculated at 1.5% (Figure1). The REPPR among males is 1.8% whereas the rate among females is 1.0% (Figure2). The prevalence rate of CD in primary school children is 1.4 times lower than the prevalence of secondary school children.

Gender, culture and socioeconomic inequality may contribute towards diagnostic inequality and prevalence differences. It is recommended that these aspects are addressed, and routine screening and early intervention services are developed.

No significant relationships.

Clozapine is an effective Atypical antipsychotic used in the treatment of resistant schizophrenia .However it can induce liver dysfunction from a simple transient asymptomatic cytolisis (30 to50 %) toa serious fulminant liver failure (0.001 %).

To show the heptotoxicity potential of Clozapine and adress the importance of monitoring the liver function tests in clozapine titration to prevent sever conditions

A case report of a fifty-year old Tunisian male patient diagnosed with resistant schizophrenia who developed a hepatototoxicity under a low dose of clozapine within five days of treatment .

Mr F is a 50 year old patient diagnosed with schizophrenia in 2018 . He had received various antypical and typical antipsychotic treatments including ( Haloperidol , Risperidone , Amisulpride , Olanzapine ) at effective doses and minimal periods of six weeks . He had no history of systemic diseases or substance use disorder . He smokes 10 cigarettes a day . He had a history of hepatotoxicity on olanzapine. These medications have failed to resolve the persecutory delusion and auditory hallucinations , and the trial of clozapine was institued . Baseline examination and laboratory tests were normal . The previous antipsychotic medication was not continued and a dose of 25 mg clozapine was administred . A marking drowsiness was present in the fisrt days , so we decided to keep the same dose . Five days later , he had high levels of Liver function test (LFT) : Elevated aspartate ( 5 times above normal) and alanine aminotransferase levels (4 times above normal ) , white blood cell count and bilirubine levels were normal . He had no fever or jaundice . The abdominal examination showed a mild sensiblity in the right upper quadrant . Clozapine was immediatly discontinuated . 24 hours later LFT continued to escalate to 5 times greater then normal . Then it decreased continueosly

Clozapine has a potential of hepatotoxicity even at lower dose . Screening liver function tests must be integrated in survey recommendations of clozapine treatment . Further researches must be conducted to understand the mechanism of this side effect in order to avoid sever conditions .

None Declared

Attention-Deficit/Hyperactivity Disorder (ADHD) and Obesity are frequently comorbid. The prevalence of ADHD rises from around 2.8% in the general population (adults) to about 27% among those with obesity. Although neurobiological mechanisms explaining the strong association between ADHD and obesity are still unclear, several hypotheses have been proposed to explain the high comorbidity, including common genes, dopaminergic neurotransmission, deficits in executive functions (planning, adherence to weight loss programs or protocols after bariatric surgery) and circadian rhythm dysregulation.

Review on the relationship between ADHD and Obesity, focusing on possible biological mechanisms driving their high comorbidity.

We conducted a search in PubMed and ClinicalKey with the terms: “Attention-Deficit/Hyperactivity Disorder”, “Obesity”, “Dopamine”.

Altered reward processing and impaired inhibitory control are key features of ADHD and are also related to obesity. The ability to resist the impulse to eat and an appropriate reward response require normal function of these dopamine circuits. Both ADHD and obesity are usually associated with reduced volume of putamen, known to be a fundamental player in inhibitory control functioning. Human and animal studies have also demonstrated that obese individuals have decreased dopamine D2 receptor availability in the striatum. Recently genetic analyses implicated specifically Dopamine-DARPP32 Feedback in cAMP Signaling in both ADHD and Obesity.

ADHD and obesity are often comorbid. Dysregulated dopaminergic neurotransmission seems to be a fundamental factor underlying the overlap between ADHD and obesity, probably involving DARPP-32 signaling and possibly through neurobiological features of putamen, namely inhibitory control. Further studies are necessary to explain the neurobiological correlation between these entities.

Adverse childhood experiences (ACEs) and exposure to potentially traumatic events (PTEs) during military service are associated with mental health problems. However, knowledge about relative contributions of these factors to non-U.S women combat veterans’ posttraumatic sequalae is sparse.

To examine associations between ACEs, combat exposure, military sexual trauma (MST), potentially morally injurious events (PMIEs), posttraumatic stress disorder (PTSD) and complex PTSD symptoms among women veterans.

A volunteer sample of Israeli women combat veterans (n=885) and non-combat veterans (n=728) responded to self-report questionnaires in a cross-sectional design study.

Combat veterans reported more total average ACEs, were more likely to experience 3 or more ACEs and specific ACEs of physical abuse and emotional neglect, as compared to non-combat veterans. Combat veterans also reported higher levels of combat exposure, PMIEs, higher prevalence of MST and higher levels of PTSD symptoms, but not CPTSD symptoms, as compared to non-combat veterans. Importantly, ACEs, combat exposure, MST-assault and PMIEs of betrayal predicted PTSD symptoms, while only ACEs and PMIEs of betrayal predicted complex PTSD symptoms.

This study emphasized the relatively high exposure to PTEs and PTSD symptoms of women combat veterans as compared to non-combat veterans. Our findings also confirm prior studies demonstrating associations between ACEs, combat exposure, MST and mental health problems. Importantly, we demonstrated the unique contribution of betrayal based PMIEs and the differential associations of PTEs with PTSD and Complex PTSD symptoms among combat veterans.

None Declared

There is no direct relationship between migration and mental health, certain risk (e.g. acculturative stress) and protective factors of psychosocial well-being are inversely related with psychopathology. Acculturation strategies have been found to be related to psychopathology however this relationship has been minimaly examined with psychosocial well-being. The objectives of this study are to examine the relationship between acculturative stress, acculturation, and psychosocial well-being.

The sample consists of 150 immigrant inpatients hospitalized in tertiary care between 18 and 65 years of age. Acculturative stress, acculturation, social adaptation, anxiety and depression, as well as sociodemogrpahic and attitudinal items were evaluated.

With general health situation controlled, the study found a negative relationship between acculturative stress and psychosocial well-being, as well as between the marginalization acculturation strategy and psychosocial well-being. A relationship was found between acculturation strategies and acculturative stress. There is no positive relationship between the integration acculturation strategy and psychosocial well-being, although the majority of the study participants preferred integration, followed by assimilation. The latter is associated with lower levels of acculturative stress and higher psychosocial well-being. Separation, on the other hand, is associated with lower levels of anxiety and depression, and with a higher quality of life.

None of the acculturation strategies demonstrates a clear advantage in relation to psychosocial well-being, however, marginalization appears to be the least adaptive. It may be useful to revise the notion of what constitutes the most adaptive acculturation strategy for an individual, taking into account his or her psychosocial well-being.

The risk of suicide may be elevated in the presence of personality pathology. Adults with Obsessive Compulsive Personality Disorder (OCPD) may be vulnerable to depression and suicidal thoughts.

To identify factors associated with suicide in cases of OCPD.

Psychological autopsy procedures were used to gather detailed information about adults who died by suicide and natural causes. A total of 75 deceased adults were evaluated using psychological autopsy procedures. Family members were interviewed about a recently deceased adult, using structured diagnostic interviews (SCID and SIDP-IV). Diagnostic summaries, coroner’s reports and police records were reviewed by a psychiatrist, a psychologist, a social worker, and a neuroscientist until agreement was reached about final diagnosis. The final sample included 40 adults who met criteria for OCPD (18 had died by suicide; 20 had died by natural causes). An additional 40 cases were examined in which evidence of PD was absent (19 had died by suicide; 18 had died by natural causes).

The diagnosis of a Major Depressive Disorder was significantly more common in suicide completers with OCPD compared to suicide completers without OCPD (X2 = 6.74, p < .01) or cases of natural death with OCPD (X2 = 12.70, p < .001). Suicide completers with OCPD displayed many symptoms of depression, more often than suicide completers without OCPD or cases of natural death with OCPD (see Table 1). As compared to the cases of natural death, both groups of suicide completers were more likely to have previously attempted suicide prior to their final act (X2 = 8.52, p < .05).Table 1.Comparison of four groups using psychological autopsy procedures to identify the presence of diagnostic criteria for a Major Depressive Episode at the time of death.

Adults with OCPD appear vulnerable to a Major Depressive episode, and the combination of MDD with OCPD creates a significant risk for death by suicide. It is important to appreciate the influence of personality disorder or depression and suicide risk.

None Declared

One of the current concerns in the research on schizophrenia is the relationship between social functioning and emotion recognition abilities, more specifically of the role that this can have, as a potential pathway for building subsequent psychosocial intervention methods.

To establish the precise role that the ability to recognize emotions has on social functioning in subjects with a diagnosis of Schizophrenia.

To help develop psychotherapeutic intervention programs that will increase social functioning.

This paper analyzed a sample of subjects (N=31) with a diagnosis of Schizophrenia (according to the WHO ICD 10), who were selected based on inclusion/exclusion criteria. The following parameters were assessed: socio-demographic (gender, age of onset, level of education, family and professional status), social functioning (SFS scale) and the ability to identify emotions in the eyes (‘Reading the Mind in the Eyes’ test).

The ability of recognizing the emotion ‘anger’ is directly correlated with the ability to communicate and keep interpersonal relations (Spearman R = 0.310, p <0.05), the ability of independence/performance (Spearman R = 0.471, p <0.05), as well as the ability to relax (Spearman R = 0.456, p <0.05) and to engage in social activities (Spearman R = 0.473, p <0.05).

We noted that ‘anger’ is the only emotion that was correlated with social functioning. Anger must be understood beyond its negative connotation, also as a positive element, in the sense of positioning the individual in the society and of taking action in regard to personal needs.

In our study, the magnitude of EEG power spectra of delta, theta, alpha and beta power was examined to address the relationship between EEG spectral changes after activation methods and alcohol dependence. Electroencephalography has shown that the brain activity of alcoholics and nonalcoholics differs in some characteristic ways. These differences are consistent with an imbalance between excitation and inhibition processes in the brains of alcoholics.

We examined eyes-closed resting EEG and EEG after activation procedures (eyes-open, hyperventilation). A group of 54 male chronic alcoholics were selected according to inclusion and exclusion criteria. We compared this group with 54 age- and gender-matched control subjects from the group of healthy volunteers. All subjects in both groups were Caucasians.

Our results in power spectra of activated EEG /after eyes-open period, hyperventilation) showed statistically significant differences in reactivity to activation methods between alcohol dependent patients and healthy volunteers. Our data manifested significant contrast in modulation of alpha activity after EEG activation using eyes-open test.

In previous studies researchers compared eyes-closed resting EEG spectra in alcohol dependent study participants and age- and gender-matched control subjects. The present study reported statistically significant differences in reactivity to activation methods in both groups. Hence, the EEG spectra after activation methods in children of alcoholic, especially before alcohol exposure, need to be examined to consider these differences in reactivity to activation methods as an endophenotype marker of chronic alcoholism.

Studies from Pakistan reveal a high prevalence of depression in women. Evidence based and effective treatments are available, yet there is a significant gap between the number of women in need of treatment for depression and those who receive the services. This qualitative study identifies the barriers in access to mental health services for women with depression in Karachi from key informants' perspectives.

19 key-informant interviews were conducted with psychiatrists, psychologists, general health practitioners, pharmaceutical representatives, a government health department official and NGO workers working on women health issues.

Key-informants reported lack of awareness, misconceptions, self-medication, being young and unmarried and financial status as barriers for women in accessing mental health services. In addition, provider's lack of medical education about depression, mismanagement of cases by GPs, opposing mental health care and lack of referral system are also considered barriers to mental health services. Larger societal issues are stigma, gender bias, as well as poor resource allocation and management.

Key-informants considered women's education, mental health literacy and referrals as facilitators for women.

The study highlights the need for multipronged and multi-sector approach for increasing the access to mental health services for women in an urban context of developing country where mental health services are present but not accessed by women.

Patient G. D. born in 1975, trained as a textile worker, unemployed, married, mother of three children. The current hospitalization was due to suicide attempts and manifestation of depressive symptoms after a stressful event.

Our diagnostic dilemma was whether it concerns:

1. - depressive disorder with psychotic symptoms

2. - adjustment disorder in people with personality disorder

After applying diagnostic procedures and observations during individual psychotherapy sessions, as well as the response to a given therapy, psychotic depression is excluded. The stories provided from the patient were in conflict since they have changed in contact with different therapists in the same department, why we decided to consult other professionals from other departments at which the patient apparently was treated.

In this disorder the patient is aware that he is exaggerating and faking illness, but in core of the disease is irresistible urge for pointing attention, and the cause is most likely a lack of love and affection in childhood.

In psychoterapic process was included family therapist also. Family therapist confronted patient with family members, which resulted in a real insight into the mental state and allowed us to confirm a diagnose of histionic personality disorder with tendency to pathological lying- Munchausen syndrome.

In this presentation, we wanted to point out the necessity of cooperation of a psychiatrist with other specialists, considering that patients with this disorder are prone to change therapists, hospitals and faking the results of diagnostic tests.

National and International telepsychiatry service was established between Denmark and Sweden in order to increase access to cross-cultural expertise. Patient acceptability study was conducted to assess the patients’ attitudes toward the quality, advantages and disadvantages of telepsychiatry service.

Over a period January 2005-December 2007, 61 patients were treated via telepsychiatry by clinicians that speak patientsrespective mother tongues. Video-conferencing equipment connected the Little Prince Psychiatric Centre in Copenhagen with two hospitals, one asylum seekers’ centre and one social institution in Denmark. These stations were also connected to the Swedish department of the Centre. Number of languages spoken was 9 while the number of nationalities treated was 11. No interpreter assistance has been used.

After the end of the telepsychiatry contact all patients were asked to complete a satisfaction questionnaire.

Patients reported a high level of acceptance and satisfaction with telepsychiatry. They expressed a wish to use telepsychiatry via their mother tongue, rather than interpreter-assisted mental health care in the future.

The restricted physical contact and non-verbal communication of telepsychiatry was compensated by the fact that the doctor and patient spoke the same language and had similar cultural and/or national references. The results of the survey may contribute to further development of, primarily, European Telepsychiatry Network. However, this model may be used for conducting of larger international telepsychiatry service capable to provide mental health care toward diversity of patient populations underserved on their mother tongue worldwide.

Due to our fear of extinction or annihilation, there is a great deal of preoccupation with the subject of death, through which we attempt to learn to feel more at ease with the concept, and allowing us to cope with our fear of death.

The study assumptions seek to emphasize the correlations between:

1. A. Demographic characteristics and anxiety of death and dying;

2. B. Inner - personality characteristics and death and dying anxiety variable; and

3. C. Intrapersonal characteristics and death and dying anxiety.

Findings indicate that the war increased the death and dying anxieties especially among those elderly women and those who live within nursing homes. In general elderly people with a high level of self-evaluation and sense of mastery will experience lower levels of death and dying anxieties.

In spite of age, experience and knowledge, war has a powerful influence on elderly people. The phenomena in which innocent citizens became more and more involved in politics violence must be in front of policy makers.

Obsessive compulsive disorder (OCD) affects 2-3% of the general population. The neurobiology of OCD has been linked to dysfunction of cortico-striatal circuits connecting the orbitofrontal (OFC) to the striatum. Recently, this loop has become an approved target for non-invasive neuromodulatory treatment of OCD.

To explore structural and functional connectivity of the OFC in OCD subjects and healthy controls.

14 OCD patients and 12 age/sex-matched controls underwent magnetic resonance imaging (MRI) (3T-Philips scanner) for diffusion tensor imaging (DTI) and resting state functional connectivity (rsFC). DTI images were brain extracted and corrected for movement and eddy currents. A diffusion tensor model was fitted to each voxel and used to generate Fractional Anisotropy (FA) maps. Voxel-wise statistical analysis of FA was performed using Tract-Based Spatial Statistics. RsFC images were preprocessed and seed-based correlation (SBC) analysis was performed using Data Processing Assistant for Resting-State fMRI.

We found decreased values of FA in the body of the Corpus Callosum bilaterally (MNI_coordinates: x= 16, y= -16, z= 33 and x= -19, y= -16, z= 42) and left superior longitudinal fasciculus in OCD patients (fig 1, left), as well as decreased rsFC of the right superior orbitofrontal seed with the left inferior frontal gyrus and left middle occipital gyrus (fig 2, right).

Using an exploratory multimodal approach we found evidence of abnormal structural and functional long-range connectivity of the OFC in OCD. If confirmed in a larger sample these connectivity abnormalities could be explored as potential predictors of response to OFC-targeted non-invasive neuromodulatory interventions.

No significant relationships.

Cognitive impairments are well established findings in schizophrenia and are associated with significant impairment of social functioning. Episodic memory, working memory and executive function test scores are typically 1 standard deviation below healthy controls. There are reports suggesting the presence of neurocognitive deficits prior to illness onset, opening the possibility of using cognitive profiles as disease markers. Interest in exploring cognitive functioning in early stages schizophrenia has continued to grow, as earlier treatments could possibly lead to improved outcomes.

This is a cross-sectional assessment of cognitive profiles in patients with early psychosis. A total of 51 patients suffering from psychosis in the age group of 18–65 years were recruited and matched with 51 healthy controls. A wide range of neurocognitive domains were assessed using standardised neuropsychological tests.

There was evidence of statistically significant impairments in cognitive functioning across a broad range of cognitive domains in early-psychosis patients, as compared to healthy controls. More pronounced deficits were seen in executive function tests.

To our knowledge, this is the first study to report cognitive deficits across a range of domains in patients with first episode psychosis from a low-income country. This study found deficits across multiple domains, including language, memory, attention, executive function, and visuospatial function in patients with early psychosis. Evidence of neuropsychological deficits in the early course of the disease may highlight crucial therapeutic windows for both pharmacological treatments and cognitive rehabilitation. This may improve functional outcomes in this patient group in the longer term.

The authors have not supplied their declaration of competing interest.