Antipsychotics effectively manage psychotic symptoms but may have side effects. Patients with schizophrenia often lack insight into their condition, leading to nonadherence. Long-acting injectable (LAI) antipsychotics aim to overcome this, reducing relapse risks. Paliperidone LAI, a second-generation antipsychotic, has a lower side effect profile when compared to first-generation counterparts. Blood dyscrasias, like neutropenia and lymphopenia, increase infection susceptibility. This case report describes an instance of leukocytopenia arising during paliperidone LAI treatment, which quickly resolved after the discontinuation of the medication.

This case report describes an instance of leukocytopenia arising during paliperidone LAI treatment, which quickly resolved after the discontinuation of the medication.

While cases of agranulocytosis have been reported in association with the use of other antipsychotics these antipsychotics do not require the same monitoring as clozapine. Our case emphasizes the need for vigilant blood dyscrasia monitoring during antipsychotic therapy.

None Declared

Clozapine is an atypical antipsychotic synthesised in 1958. It was withdrawn from the market in the 1970s due to the appearance of agranulocytosis, but was reintroduced due to strong evidence of its efficacy and superiority over other antipsychotics in treatment-resistant schizophrenia.

To describe the adequate response to clozapine in treatment-refractory psychosis.

Review of the scientific literature based on a relevant clinical case.

A 16-year-old woman was admitted to a psychiatric inpatient unit for psychotic symptoms and behavioural disorders. She lives with her father and older sister; she has not been in contact with her mother, who lives in another country, for several years. She attends secondary school, with poor academic performance. Maternal diagnosis of schizophrenia. She started using cannabis two years ago, with a progressive increase up to 20 grams per week. He reports the onset of a feeling of strangeness a year ago, with progressive isolation in his room, referring to delirious ideation of harm towards classmates and people from his town, self-referentiality and delirious interpretations of religious mystical content (“God speaks to me through a dove”). He comments on the phenomenon of theft and thought-reading. Soliloquies and unmotivated laughter are observed.

Treatment was started with risperidone, progressively increasing the dose up to optimisation, without achieving a decrease in positive symptoms, but with the appearance of excessive sedation and sialorrhoea. It was combined with aripiprazole up to 20mg, maintained for a couple of weeks, without significant clinical improvement. Given the failure of two lines of therapy, it was decided to change to clozapine up to a dose of 75mg, with adequate tolerance and response, achieving a distancing of the delirious ideation. Regular haematological controls were performed, with no alterations in haemogram or troponins.

None Declared

Electroconvulsive therapy (ECT) is a therapeutic method that induces artificial seizure by electrical stimulation to resolve various psychiatric symptoms. ECT is particularly effective in resistant schizophrenia and may improve response to medication despite the presence of potential adverse side effects. Post-ECT delirium and Headaches are some of the most frequent side effects presented in literature. Fever is yet another unexplained reaction, however there are a few case reports and retrospective studies that report on it.

We aim to illustrate through a clinical case and a review of literature the prevalence of post ECT fever as well as the possible explanatory mechanisms.

In this study we report the case of a man with ultra-resistant schizophrenia who was treated successfully with ECT despite the development of transient febrile reaction and we present a review of literature on pubmed using the following key words : ECT, fever,resistant psychosis, mechanisms.

Our patient is a 48-year-old man with a psychiatric history of schizophrenia evolving since the age of 34. He has a history of matricide in 2021 resulting in his hospitalisation in a forensic psychiatric ward. He underwent trials of classic and atypical antipsychotics that weren’t efficacious thus he was diagnosed with resistant schizophrenia in 2022. He was treated initially with clozapine 500 mg per day and then with the association (clozapine + amisulpride) yet it wasn’t effective on his persecutory delirium and fratricide ideas. Plus, there was no reduction in his PANSS (Positive and Negative Syndrome Scale) scores. The diagnosis of ultra-resistant schizophrenia was established. The staff indicated the adjunction of ECT to Clozapine. In the inpatient unit, hours after his fourth ECT session he developed a fever (40°C), his blood pressure (120/80 mm Hg), pulse(85 beats per minute),and respiratory rate(20 breaths per minute) were normal. Blood samples, including cultures, were drawn, which showed normal blood cell count and CPK(140U/L) but CRP was elevated (31 U/L), a chest x-ray showed no acute pulmonary disease, and his urinalysis result and Covid test were negative. His fever resolved then spontaneously after two hours. The same transient febrile reaction occurred again 3 times. It was postulated in literature that fever may be due to inadequate muscle reaction. Data also suggested the potential influence of ECT on the hypothalamus that is a key region in regulating body temperature.

Further studies are required in order to establish the real prevalence of this side effect and its possible causes.

None Declared

Recurrent Depressive Disorder is a chronic condition that significantly impacts the quality of life. Despite various treatment options, some patients face severe and treatment-resistant relapses. This case is related to research on ketamine in Electroconvulsive Therapy (ECT) for RDD. One study highlighted the efficacy and safety of ketamine compared to other anaesthetic agents in ECT for major depression. Additionally, another study explored subanesthetic doses of ketamine before each ECT session to improve therapeutic outcomes and sleep quality in patients with major depressive disorder.

To present a clinical case of a patient with Recurrent Depressive Disorder (RDD) who improved following a change in the Electroconvulsive Therapy (ECT) protocol using ketamine as an anaesthetic inducer.

We examined the patient’s medical records, including her medical history, previous treatments, and therapeutic responses.

A 65-year-old childless woman with a history of stroke, bilateral carotid atheromatosis, and hypothyroidism suffered from RDD. Despite multiple prior treatments and ECT, she experienced a severe depressive relapse. Eight intensive ECT sessions were administered, with observed memory lapses. Due to the lack of response, the anaesthetic inducer etomidate was replaced with ketamine, resulting in a positive response. The patient continued pharmacological treatment with improved mood, but recent and evident memory alterations persisted, possibly related to anterograde amnesia.

This case highlights the complexity of RDD in patients with comorbidities and treatment-resistant relapses. The change in the ECT protocol using ketamine was effective, emphasizing the importance of alternative therapeutic approaches in refractory cases. The successful treatment of RDD in this patient using ketamine in ECT underscores the need for personalized therapeutic options in treatment-resistant patients. These scientific resources reinforce the relevance of exploring therapeutic alternatives in contemporary clinical practice. We need more research to understand the underlying mechanisms and how this approach could be enhanced in similar cases.

None Declared

Anxiety may be associated with diverse medical conditions, among which joint hypermobility syndrome. Joint hypermobility (JHM) is characterized by increased elasticity and can be advantageous in specific activities, such as dance or gymnastics. On the other hand, joint hypermobility syndrome (JHS) is a more complex condition including other clinical symptoms, especially a history of injuries, skin signs, instability and pain.

To investigate the prevalence of JHM and JHS throughout ballet career and the association between anxiety and joint hypermobility in a sample consisting of ballet dancers.

study included 145 dancers, divided into three groups: students (n=59), teachers (n=37) and professional ballerinas (n=49). Participants completed self-rating instruments assessing JHM (five-part questionnaire), anxiety (BAI), social anxiety (SPIN), panic (Patient Health Questionnaire – Brief PHQ) and pain (Brief Pain Inventory [BPI]; Self-Estimated Functional Inability because of Pain [SEFIP]). Ballet dancers also underwent a clinical evaluation based on Beighton score and Brighton criteria.

Participants with JHM had higher scores in neurophysiological subscale of the BAI, but less social anxiety symptomatology. JHS correlated with the subjective and panic subscales of the BAI and with SPIN. Participants with JHS also presented higher scores in specific items of BAI as in specific items of SPIN.

our data suggest that JHS seems to be more consistently associated with anxiety than the 'isolated hypermobility” (JHM). Nevertheless, the strenght of the correlation between anxiety and JHS was moderate. Data also provided elements to discuss important features of JHM, JHS and pain throughout the ballet career.

In psychotherapy, the object of study is not directly perceptible and material, but involves human mind complexity and specific content

In psychotherapeutic relationship we propose a method to inspect by deduction non-conscious mind, patient hidden mood, hate, affectivity.

The aim of this work is using a modern physics research method in psychotherapy, in order to focus on what is not directly perceptible in clinical practice.

We can examine, instead of 'inductive method”, the 'deductive method”, adapted from physics theoretical approach. We have taken into consideration 'Human Birth Theory”, formulated in 1971 by psychiatrist Fagioli. The author conceived the beginning of human life as a neuropsyche reaction to light. Given the intrauterine dark, Fagioli deducted that brain at birth are activated by 'the absolutely new stimulus”, light. He also deducted 'vitality” and 'capability to imagine” as non-conscious mind features. We have checked recent neurobiological data in literature.

Functional maturation of 'subplate zone”, light-inducted Immediate Early Genes activation, SATs variations, from foetus to newborn, retina instant activation by photon, 'viability” support Fagioli’s theory.

In relativistic physics and quantum field theory, deduction is finalised to discover hidden processes, in order to know the primum movens, not perceptible. In psychodynamic psychotherapy, the object par excellence is not just brain, like in neurology, but psyche. Its content is not directly knowable, but can be known also by deductive method, involving intuition, together perception of patient. In psychotherapy physics method can be applied, to discover the non-conscious thought, previous to pathological behaviour. Clinical examples can be reported.

Body- art is associated with an increased risk of self- harming behaviours and suicide attempts (SA) in adolescents, but there is no concluding evidence for adults yet.

We investigate the relationship between ‘body art’ (i.e. tattoos, piercings) and SA in adult patients.

All patients admitted to the Psychiatric Clinic of Genoa for a SA between October 2012 - January 2013 were enrolled. Age, gender, education, previous SA, psychiatric diagnosis were analyzed. The patients underwent first a clinical interview where the presence of body-art, type, number, location, time between its performance and previous or present SA were assessed along with its meaning for the patient, then SCID I & II.

44 patients were enrolled (24 females). Mean age 47 years. 26 had at least a tattoo, among them six females. Eight had at least one piercing, of whom six were females. 58,3% had a diagnosis of MDD, 41.6% of PD (BPD 72%;NPD 34%; OCPD 42%; PPD 23%). 75% of patients with more than one tattoo had a diagnosis in both axes and attempted suicide more than once. These results show that 40% of our sample has a tattoo and one third a piercing, which presence in the same-age American population is estimated to be 26%. However, these results have a limited statistical significance because of the small sample size.

These results suggest a particular mind-body bond which would correlate SA and body art in adult patients, while previous studies found such evidences only in the adolescent population.

Cerebellar cognitive affective syndrome (CCAS) is a condition that arises from cerebellar lesions. CCAS can easily be overlooked by medical teams; therefore a bibliographic review will facilitate the understanding of symptoms in order to effectively diagnose and provide a holistic early treatment approach.

A case report of a 72-year-old woman with bilateral cerebellar lesions with high pre-morbid function presented with classic symptoms of CCAS. Multidisciplinary workup included medical, psychiatric, neuropsychological assessment (R-BANS (Form 1), Digit Span, Verbal fluency tests, the Hayling Test, the Delis-Kaplan Executive Function System) as well as other investigations (neuroimaging and blood tests) were conducted on the patient to confirm CCAS and exclude other differential diagnoses.

The results from the medical assessments conducted showed symptoms of cerebellar dysfunction. A psychiatry and neuropsychological review revealed aggression, irritability, disinhibition, deterioration in cognitive function and personality changes. A multidisciplinary team was formed to rehabilitate the patient however patient was non-compliant with therapy. The patient was prescribed Seroquel 50 XR and she responded well to the medication.

This case review illustrates the challenges associated with engaging a CCAS patient in rehabilitation activities due to cognitive and mood disorders. The use of psychotropic medications can be an effective method in improving cognition and mood disorders in CCAS patients. Early psychiatry and psychological intervention can significantly improve the overall outcome of a patient diagnosed with CCAS.

Nil.

The author has not supplied his declaration of competing interest.

Behavioral and psychological symptoms in dementia are known to increase caregiver stress and proceed admission to a nursing home. We studied caregiver stress due to the impact of sleep disturbances in different types of mild dementia.

A sample of 151 persons with mild dementia from the Norwegian DEMWEST- cohort and their caregivers. Sleep problems in dementia were studied with the Mayo Sleep Questionnaire and the Neuropsychiatric Inventory. Caregiver stress was studied with the Relative's Stress Scale.

Caring for a person with mild dementia with any sleep disturbance significantly increased caregiver stress as compared to caring for a person with mild dementia without any sleep disturbances. (18.2 vs. 13.0, p=0.017) Caregivers to patients diagnosed as having mild Dementia with Lewybodies with any sleep disturbance reported significantly more stress as compared to caregivers to person with mild Alzheimer's Disease with any sleep disturbance. (14.7 vs. 21.7 p=0.010).

Sleep disturbances in mild dementia significantly impact on caregiver stress, more so in DLB as compared to AD.

Pregnancy represents a critical life stage for its physical and emotional changes. Maternal thoughts are often oriented to the worry to lose control on their body, and to their new physical shape. According to this, literature on eating disorder (ED) highlights how pregnancy is usually associated to a temporary interruption of the dysfunctional eating habits due to the move of concerns about the self and the body toward the caregiving of the baby.

The goal of the present study is to explore the impact of generalized difficulties in emotion regulation (as a stable trait) versus specific difficulties in emotion regulation (as pregnancy-related) in women with pre-pregnancy eating problems.

The sample is made by 15 women previously overweight and recruited during their 3^rd trimester of pregnancy. The following measures were administered: Difficulties in Emotion Regulation Scale (DERS), Eating Attitudes Test (EAT-26), Emotional Difficulties Specific to Pregnancy Scale (EDS), and the Adult Attachment Interview (AAI).

Preliminary findings have shown how higher scores on the DERS Impulse scale as well as higher difficulties in handling emotional states related to pregnancy (e.g. fear of the delivery) are associated to the existence of dysfunctional eating behaviors during the 3rd trimester.

Emotion regulation has emerged as a transversal skill during the life cycle. Difficulties in this area seem to represent a stable trait in the individual functioning, with the risk to affect the eating behaviors, as well as the health of the mother and the baby during pregnancy.

Facebook use among Teenagers has become a very common phenomenon. Its use can resuly in Facebook addiction .

To estimate the prevalence of problematic Facebook use among a sample of school-going adolescents.

This is a cross-sectional and descriptive study carried out among 110 school-going adolescenthe at 2 state colleges in Sidi Bouzid. We used a pre-established self-questionnaire containing 2 parts: a part exploring the socio-demographic data of the adolescent and a psychometric part: Bergen Facebook addiction Scale.

Study participants had a mean age of 14.4 years with extremes of 12 to 17 years. The sex ratio (M / F) (46/64) of the participants was 0.71.In our population, 13 students (11.8%) were smokers. Two students (1.8%) consumed alcohol. Cannabis use was noted in only one student.The majority of students (102), or 92.7%, had been online for more than a year.The daily Facebook connection time was more than 4 hours for 20.9%. Boredom was the number one reason for logging into Facebook for 82 students (74.5%) followed by curiosity for 45 students (40.9%). Fifteen students (13.6%) were addicted to Facebook (score> 10 on the Bergen Addiction Scale.

Facebook can be a useful and interesting tool to maintain and develop a network of relationships and create new ones. Its problematic use or addiction to Facebook has become a new scourge of public health. Faced with the negative impact of this addiction, It would be necessary to rationalize this use.

No significant relationships.

The purpose of this study was to assess the factors that influence attitudes of people neighbouring to residential care facilities that host chronic psychiatric patients formerly hospitalized in a psychiatric hospital, 2 years after their deinstitutionalization.

One member of at least 30 households neighbouring to 8 community-based psychiatric facilities (hostels and sheltered apartments) was interviewed by a group of specially trained social workers. The structured interview used was compiled specifically for the needs of this study.

Less than 25% of our sample had adequate knowledge of the term ‘deinstitutionalization’ and in particular people with higher education and that have been visited by a psychiatric resident. Nevertheless, their attitudes were in general positive. In a regression analysis, attitude towards deinstitutionalization was found to be positively correlated with having visited a psychiatric facility, years of education, and living near 4 out of the 8 psychiatric hostels [R-squared=0.20]. Female neighbours were generally more favourable, but this effect was only marginally significant. Attitude towards the psychiatric patient was best predicted by years of education, having visited a psychiatric hostel and living near 2 out of the 8 psychiatric hostels [R-squared=.21]. Age was generally negatively correlated with attitudes towards the patient [r=-0.23]. There were also significant differences among the attitudes of the various hostel neighbourhoods.

Apart from education, age, and gender the most important factors in influencing attitudes towards deinstitutionalization and patients are local. Choice of favourable locations for psychiatric facilities and cultivation of a positive neighbourhood climate are important.

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.

The heritability of the brain’s structure and function in schizophrenia remains elusive

To assess the influence of genetic and environmental factors on executive function in schizophrenia.

A twin-sibling study of 206 subjects; 163 twins, varying in their zygosity and concordance for schizophrenia, and 43 singletons from sibling clusters varying in their concordance for schizophrenia. We assessed performance and regional brain activation using functional magnetic resonance imaging, during a phonological verbal fluency task.

Patients and their unaffected relatives developed greater activation in the left inferior frontal gyrus, and greater deactivation in the middle temporal gyri bilaterally. These features were maximally evident in subjects with schizophrenia. When the analysis was restricted to the unaffected relatives and healthy controls, a similar pattern was evident. Heritability was greatest in the left hippocampus and the right middle temporal gyrus. Genetic modelling indicated a phenotypic correlation between schizophrenia and increased activity in the inferior frontal gyrus and reduced activity in the left middle temporal gyrus and left hippocampus, which appeared principally due to shared genetic effects.

Both schizophrenia and its familial vulnerability were associated with altered frontal, parahippocampal and temporal activation during verbal fluency. The altered left inferior frontal activity was particularly associated with schizophrenia, while altered left medial temporal and right middle temporal activity were more heritable. The latter was more intimately linked to the genetic risk for schizophrenia, and thus the better candidate intermediate phenotype.

The aim of the study was to evaluate sexual satisfaction during pregnancy using the Hudson's Index of Sexual Satisfaction (ISS) questionnaire.

One hundred and thirty seven couples who met the study criteria were recruited by voluntary participation. Participants anonymously completed a self-administered questionnaire (demographic questions, Hudson's Index of Sexual Satisfaction (ISS), Hospital Anxiety and Depression Scale (HADS)). Demographic data, ISS and HADS scores were analyzed and compared among trimesters.

Data of 38 couples for the first (28%), 40 for the second (29%) and 59 for the third (43%) trimesters of pregnancy were collected for the analysis. The median age was 28 (25 – 30 years) for women and 29 (26-32 years) for men. Women's ISS score was influenced by age of woman (b=0,12), woman's HADS score (b=0,25), and ISS score of the partner (b=0,55).

Women's HADS score (b=-0,18), women's ISS score (b=0,63) and men's HADS score (b=0,25) were factors influencing men's ISS score. Women's level of sexual satisfaction (ISS scores) didn't differ among trimesters. For men, the highest level of sexual satisfaction was reported in the third trimester.

Our results don't support previous observations that the level of sexual satisfaction decreased significantly throughout pregnancy.