Firefighters face routine occupational risks and high-stress environments. Accordingly, 96.4% are exposed to a potentially traumatizing event throughout their career (Nazari et al. Work 2020; 67(1):215-222). This is accompanied by high rates of trauma-related mental illnesses (TRMI) such as PTSD. First-line treatments of TRMI remain limited. A novel treatment that has emerged, Ketamine-Assisted Therapy (KAT) has shown meaningful improvements in PTSD treatment (Ragnhildstveit et al.Ther Adv Psychopharmacol 2023; 6:13).

The primary objective was to synthesize prevalent themes among participants, shedding light on their journeys to accessing KAT as well as highlighting internal motivations and societal barriers that exist.

In this study, there are six working firefighters, diagnosed with TRMI. They have enrolled in but not begun the 12-week Roots to Thrive (RTT) KAT program. Interviews were conducted individually and transcribed for further analysis. Data from the interview responses was analyzed by two independent reviewers and coded to create main themes of focus. The inconsistencies were managed by the third senior reviewer.

The major themes prevalent among participants include social stigma, self-advocacy/education, logistical barriers and feeling stuck with previous treatments.Throughout the interviews, participants indicated that the use of ketamine and their mental illness diagnosis were stigmatized. Some kept their treatment a secret from family members while others reported telling very few colleagues about their PTSD. In response to traumatic events at work, one participant explained that the prevalent attitude was “Suck it up. Move on.” The lack of administrative support prompted several participants to teach themselves about psychedelics and mental health in order learn about treatment possibilities. Logistical barriers included barriers to physically commuting, paying for and having time away for the KAT sessions. They pointed out that aside from the price of the treatment itself, paying for cabs and ferries adds to the costs. Each of the participants detailed their journey with trauma and mental illness before KAT. A common sentiment expressed was that they couldn’t cope anymore with symptoms like night terrors and extreme anxiety. Participants discussed a gradual build-up and burnout, as one explained, “You continually are always going to other trauma calls, so it kind of builds up layer, layer, layer after layer.” A reoccuring theme in their experiences was trying different treatment modalities (EMT, EMDR and CBT) with little permanent success.

Greater funding, awareness and administrative support is needed for firefighters diagnosed with PTSD to successfully receive and undergo treatment.

None Declared

Chronic medical conditions are increasingly recognized as significant contributors to suicide risk, especially in patients without prior psychiatric diagnoses (Østergaard et al. JAMA Psychiatry 2024). This case examines the psychiatric impact in a 65-year-old male admitted to general surgery for abdominal pain, who subsequently underwent an ileocolectomy for suspected gastrointestinal malignancy.

To explore the psychiatric impact of medical morbidity on suicide risk, emphasizing recent findings suggesting heightened attention for patients without a psychiatric history.

The patient, with no prior psychiatric history, was observed by liaison psychiatry after verbalizing suicide ideation without intent or plan. The ideation was associated with worsening mood, particularly over the past week. Emotional distress escalated after perceived medical setbacks and was compounded by familial dynamics, particularly the wife’s expressed anxiety. A diagnosis of adjustment disorder with depressive symptoms was considered, with initial treatment involving mirtazapine and psychosocial support.

The case reflects evidence supporting the idea that suicide risk may follow a dose-response pattern based on the disability burden in patients without prior psychiatric history (Østergaard et al. JAMA Psychiatry 2024). This suggests clinicians may need to be particularly vigilant in medically ill patients without a psychiatric background, as their suicide risk may increase as disability burdens mount – contrary to the understandable and maybe more intuitive focus on those with established psychiatric diagnoses.

This case highlights the importance of thorough suicide risk evaluation in patients without psychiatric histories, particularly following a major medical diagnosis. While suicide risk remains high in psychiatric patients, clinicians must be equally or even more vigilant with medically ill patients without psychiatric histories. Psychiatric care should be integrated early, with attention to the timing of suicide risk, the disability burden, and psychosocial stressors. This highlights the need for careful monitoring and early intervention, particularly in the acute phase following medical complications, where risk evaluation may be more nuanced.

None Declared

Shared psychotic disorder (folie à deux) is a rare mental health condition where delusions are transmitted from one person to another within a close relationship. Understanding these complex dynamics is crucial for effective diagnosis and treatment.

To present two cases of shared psychosis involving close relatives diagnosed with schizophrenia, aiming to open discussion on the complex dynamics of familial relationships and their impact on mental illness.

2 case reports.

We present two cases of shared psychosis involving close family members. The first case involves two sisters, aged 43 and 48, both diagnosed with paranoid schizophrenia. The 43-year-old sister was admitted following a suicide attempt and exhibited active psychosis with paranoid delusions. During her hospitalization, the older sister displayed identical delusions and refused her sibling’s treatment, leading to her own admission. Both sisters, previously untreated and highly educated, were managed with antipsychotic medications. While the delusions were encapsulated during treatment, concerns remain about their shared living environment and its potential influence on their ongoing recovery.

The second case involves a 33-year-old woman with a decade-long history of schizophrenia who was brought to the emergency room malnourished and uncommunicative, having not eaten for over a week. She was fed via a nasogastric tube during her lengthy hospitalization and placed on a regimen of Clozapine. The patient exhibited severe negative symptoms and behaviors suggestive of auditory hallucinations. Her mother, also of low educational and socioeconomic status, was present throughout her stay but displayed delusional beliefs that interfered with her daughter’s treatment. Following restrictions on the mother’s access to the patient, the daughter showed slight improvement and began eating independently.

These cases highlight the significant impact that familial relationships and shared psychosis can have on the progression and management of schizophrenia. The challenge in treating shared delusions lies not only in addressing the symptoms but also in mitigating the interpersonal dynamics that may perpetuate them. Further investigation into family-based psychosis and its treatment is warranted.

None Declared

Obsessive-compulsive disorder (OCD) is a chronic mental health condition characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions), which significantly impair daily functioning and quality of life. While common obsessions often revolve around contamination, symmetry, or safety, rarer forms of OCD can involve highly specific and unusual fears.

The aim of this case analysis is to comprehensively examine the possible causes and treatment approaches of obsessive-compulsive disorder, focusing on the investigation of various obsessive conditions that are rarely observed in the literature.

The patient’s history was thoroughly examined, and interviews conducted with the patient’s family were also included in the evaluation. Possible causes of the disorder (from a biopsychosocial perspective) and treatment approaches such as psychotherapy and pharmacotherapy were analyzed through a literature review. Additionally, the patient was assessed using the Yale-Brown Obsessive Compulsive Scale (YBOCS), Brown Beliefs Scale, Beck Anxiety Inventory, and Beck Depression Inventory.

The patient, N.C., is a 64-year-old woman whose general appearance is somewhat older than her age, with partially diminished self-care, having insight, divorced, and living with three of her six children. The patient experiences intense anger when any product containing sweets enters her home, including fruits. She feels discomfort even when using or hearing the word “sweet.” The patient insists that no family member brings any sweet-containing products into their home, leading to frequent arguments on the subject. She reports high levels of anxiety, difficulties in social relationships, and significant limitations in daily life activities. Her relatives have also observed and reported these challenges. The patient mentions feeling a sticky sensation on her hands when she sees sweets and experiences a compulsion to wash her hands when this sensation occurs. Her symptoms are consistent with the classical symptoms of obsessive-compulsive disorder, including obsessions (persistent thoughts about sweets and associated anger) and compulsions (the need to wash her hands). The diagnosis was made by Dr. Ece Ilgın.She has been started on fluvoxamine 50 mg/day, which will be titrated. She will return for a follow-up appointment at the clinic in one month.

The symptoms of obsessive-compulsive disorder in patient N.C. include obsessions related to sweets, fruits, a sense of ‘stickiness’ that cannot be clearly identified, and avoidance obsessions linked to these. These symptoms significantly impact the patient’s quality of life and family relationships. It is believed that a combination of psychotherapy and pharmacotherapy will be effective in alleviating the patient’s symptoms and improving their quality of life.

None Declared

Lumateperone, an atypical antipsychotic drug, has a dual mechanism of action by combination of activity at central serotonin (5-HT2A) and dopamine (D2) receptors.

This subgroup analysis of an Indian Phase 3 study was conducted to evaluate the efficacy and safety of Lumateperone 42mg compared to Quetiapine 300mg in treatment of Bipolar II depression when stratified based on prior hypomanic episodes.

The phase-III, randomized, multi-centric, assessor-blind, parallel-group, active-controlled, comparative, non-inferiority study included Indian patients with Bipolar II depression with moderate severity having a Montgomery-Asberg depression rating scale (MADRS) score ≥20 and Clinical global impression–bipolar version–severity (CGI-BP-S) score ≥4. The study was conducted after receiving regulatory and ethics committee approvals. The patients were randomized (1:1) to either receive Lumateperone 42mg [Test] or Quetiapine 300mg [Comparator] for 6 weeks. The patients were stratified based on number of prior hypomanic episodes in lifetime: Subgroup 1 [S1]: 1 episode and Subgroup 2 [S2]: >1 episode. For efficacy outcomes MADRS score, CGI-BP-S (total score, depression subscore and overall bipolar illness subscore), and Quality of life enjoyment and satisfaction-short form questionnaire (Q-LES-Q-SF) score were evaluated and for safety outcomes treatment emergent adverse events (TEAEs) were assessed. [Clinical trial registration: CTRI/2023/10/058583]

This subgroup analysis included 462 patients, out of which 251 in S1[Test=129; Comparator=122] and 211 in S2[Test=102; Comparator=109]. The baseline demographic characteristics were comparable in between treatment arms across subgroups. The primary endpoint of reduction in MADRS score from baseline to Day 42 in Test arm was non-inferior to Comparator arm in both subgroups [Figure 1] as the upper 95% CI was below the pre-defined margin of 3.0. The reduction of CGI-BP-S (total score, depression subscore and overall bipolar illness subscore) from Day 14 to Day 42 were comparable in both Test and Comparator arms in both subgroups. The improvement in Q-LES-Q-SF score from baseline to Day 42 were comparable in both Test and Comparator arms in both subgroups. The incidence of TEAEs were similar in both treatment arms [S1: Test=37.2% and Comparator=35.2%; S2: Test=31.4% and Comparator=35.8%] and no serious adverse events were reported.

Image 1:

This subgroup analysis demonstrated that Lumateperone 42mg is non-inferior to Quetiapine 300mg in treatment of Bipolar II depression as assessed via MADRS score from baseline to Day 42, irrespective of number of previous hypomanic episodes and both treatments were found to be well tolerated.

A. Dharmadhikari: None Declared, P. Chaurasia: None Declared, Y. Patel: None Declared, D. Choudhary: None Declared, P. Dasud: None Declared, M. Bhirud: None Declared, P. Meena: None Declared, F. Shah: None Declared, G. Ganesan: None Declared, B. P. Rathour: None Declared, K. Mistry: None Declared, M. Dutta: None Declared, A. Ramaraju: None Declared, S. Mangalwedhe: None Declared, S. G. Goyal: None Declared, G. Kulkarni: None Declared, A. Mukhopadhyay: None Declared, P. Chaudhary: None Declared, G. T. Harsha: None Declared, M. Parikh: None Declared, S. Dey: None Declared, S. Sarkhel: None Declared, N. Jyothi: None Declared, A. Kumar: None Declared, N. Sooch: None Declared, A. Shetty Employee of: Sun Pharma, S. Saha Employee of: Sun Pharma, P. Devkare Employee of: Sun Pharma, A. Shetty Employee of: Sun Pharma, D. Patil Employee of: Sun Pharma, P. Ghadge Employee of: Sun Pharma, A. Mane Employee of: Sun Pharma, S. Mehta Employee of: Sun Pharma.

Pain has a significant impact on a person’s quality of life, limiting general activity (work, social interaction, problems with family relationships, hobbies/interests, self-care ability), contributing to the development of mental disorders such as depression and anxiety.

Our study aimed to determine the level of anxiety, depression, and functional disabilities caused by chronic pain among outpatients in order to further dynamic research of the long-term consequences.

The study group included 85 outpatients with chronic pain. As a part of psychiatric screening, the HADS depression and anxiety scale was used to study psychopathological symptoms. The WHO self-questionnaire WHODAS 2.0 was used to study the dysfunction caused by chronic pain.

The study found that a significant part of patients with chronic pain had symptoms of anxiety 38% and depression 46% of varying severity. The medial WHODAS 2.0 score among all patients with pain and patients with comorbid depression and anxiety was 23.62 (95% CI: 21.19-24.63), 32.80 (95% CI: 30.33-35.16), and 34.35 (95% CI: 32.11-37.60), respectively. Disability was significantly higher in patients with depression (1.72, p <0.01) and anxiety symptoms (1.60, p <0.01) than in patients with chronic pain without anxiety and depression.

Effective treatment of chronic pain requires a comprehensive approach using psychotherapeutic, psychopharmacological, and physical therapy.

None Declared

The relationship between psychosis and ayahuasca use is a topic of considerable interest and debate in the scientific and medical community. Ayahuasca is traditionally used in shamanic ceremonies in the Amazon, composed mainly of the Banisteriopsis caapi vine and the leaves of Psychotria viridis, which contain DMT (dimethyltryptamine), a powerful hallucinogen.

Ayahuasca induces altered states of consciousness, with experiences that can include visions, deep introspection, and changes in the perception of reality. The experience can be intense and emotionally overwhelming. In individuals with a history of psychosis or psychiatric disorders, ayahuasca may more easily trigger a psychotic episode. The interaction with neurotransmitters and the serotonergic system can influence their appearance.

We report a case of a patient who, after consuming ayahuasca, presented a psychotic episode that required hospitalization. After the initiation of treatment with antipsychotics, the condition had a favorable evolution towards the complete resolution of the symptoms.

Given the increasingly frequent use of ayahuasca in developed societies, the current case highlights the needs to understand, regulate and research the use of ayahuasca. Additionally, raising awareness of the potential risks of ayahuasca use through psychoeducation should be implemented.

Describe the case of a psychotic episode induced by ayahuasca: Clinical debut, symptoms and evolution after initiation of treatment.

Description of a clinical case as well as bibliographic review.

The relationship between hallucinogens and psychosis is a critical area of study due to the intense and potentially destabilizing effects that hallucinogens can have on people with this condition. Hallucinogens can trigger or aggravate psychotic symptoms, which may include hallucinations and delusions. We must keep in mind that hallucinogens can interact negatively with antipsychotics or other medications used to treat psychosis. These interactions may reduce the effectiveness of treatment or cause adverse side effects, as well as affect adherence to treatment, as it may lead to an alteration in the perception of the need for medication or the ability to follow the treatment regimen.

Ayahuasca use can have profound and potentially destabilizing effects, especially in people with a history of psychotic disorders. Although there is therapeutic potential, it is crucial to proceed with caution and under the supervision of trained professionals. Proper preparation and risk assessment are essential to minimize potential adverse effects.

None Declared

The COVID-19 pandemic has placed immense psychological pressure on healthcare workers (HCWs) worldwide. In addition to the physical risks of infection, HCWs have faced high levels of anxiety due to their proximity to the virus, overwork, and the challenges of providing care in an ever-evolving environment. These psychological effects are expected to persist well beyond the initial phase of the pandemic.

This study explores the long-term impact of COVID-19 on both anxiety and depression among HCWs and identifies the main contributing factors.

This cross-sectional study was conducted among HCWs infected with SARS Cov-2 between January and August 2022. Sociodemographic and professional data were extracted from participants’ medical records. Anxiety and depression were evaluated using the GAD-7 (Generalized Anxiety Disorder) and PHQ-9 (Patient Health Questionnaire) scales, respectively, through phone interviews conducted at least one year after their last COVID-19 infection

This study included a total of 184 healthcare workers (HCWs). The mean age of the participants was 41.93 years (± 8.6), with 95.1% being over 30 years old. Women comprised 81.4% of the cohort, and the majority of participants were nurses (45.7%), followed by administrative staff (20.1%). The median occupational seniority was 16 years. Notably, 28.3% of HCWs were employed in COVID-19 wards. Anxiety symptoms were reported by 92.9% of participants, with 17.3% experiencing mild anxiety, and 38.5% severe anxiety. Depression was prevalent in 69.1% of HCWs, with 27.2% presenting mild symptoms, and 24.5% experiencing moderate to severe depression. Female HCWs and those aged over 40 were significantly more likely to report symptoms of anxiety and depression (p < 0.001). Furthermore, HCWs with pre-existing conditions, such as diabetes, as well as those directly exposed to COVID-19 patients, exhibited significantly higher anxiety and depression scores. Nurses demonstrated particularly elevated levels of psychological distress, especially those working in COVID-19 wards.

The COVID-19 pandemic has had a profound and lasting psychological impact on healthcare workers, with anxiety and depression levels remaining elevated long after the acute phase of the crisis. This study emphasizes the need for targeted psychological support interventions. Addressing the mental health needs of HCWs is crucial not only for their well-being but also for ensuring the ongoing efficacy and resilience of the healthcare workforce in times of crisis. Further research is warranted to explore long-term impacts and effective strategies for mental health support in this population.

None Declared

Major depressive disorder is a common, disabling mental disorder characterized by extensive etiological and phenotypic heterogeneity. This heterogeneity makes treatment approaches imprecise and often ineffective. Insight into the underlying biological mechanisms underpinning depression and its subtypes may enable more personalized treatments.

A review of the literature as well as data analyses from 2981 individuals from the Netherlands Study of Depression and Anxiety (NESDA), of whom ˜1900 persons have or lifetime or current Major Depressive Disorder and 650 were healthy controls.

Significant immuno-metabolic dysregulations are present in about 20-30% of people with depression. Such immuno-metabolic depression is characterized by the clustering of 1) atypical, energy-related depressive symptoms such as hypersomnia, fatigue, hyperphagia, and possibly anhedonia, 2) systemic low-grade inflammation with elevated levels of e.g. C-reactive protein, cytokines and glycoprotein acetyls, and 3) metabolic abnormalities involving e.g. obesity, dyslipidaemia, insulin and leptin resistance. Evidence for such clustering is confirmed in large-scale proteomic, metabolomic, gene expression as well as genome-wide data analyses. Persons with immuno-metabolic depression are at a higher risk for cardiometabolic diseases and – from pooled analyses of 4 RCTs in over 1000 individuals - seem to respond less well to standard antidepressant treatment.

Interventions targeting inflammation, metabolism or lifestyle may be more effective treatment options for individuals with immuno-metabolic depression, in line with principles of precision psychiatry.

None Declared

Cognitive impairments represent core features in schizophrenia, impact the functional capacity of patients, and are highly predictive of poor functional outcomes. There is a huge unmet need for improvement of these impairments, and the development of new therapies is conditioned by understanding underlying pathophysiology that is not clear enough. Kynurenic acid (KYNA) is the major matabolite of kynurenine (KYN) pathway (KP) of tryptophan (TRP) degradation, which acts as the inhibitor of NMDA and α7-nicotinic receptors that are crucial for cognitive functioning. Excessive antagonism of these receptors by KYNA is hypothesized to contribute to cognitive deficits while data indicate that proinflammatory cytokyines activate this TRP catabolic cascade.

The objective of this study was to assess correlation between blood levels of TRP, KYNA, KYN, KYN/TRP ratio, IL-8, IFN-γ, IL-1β and cognitive functioning in clinically stable schizophrenia patients.

We measured plasma concentrations of TRP, KYNA, KYN, IL-8, IFN-γ, IL-1β and conducted assessment of cognitive functioning in domains of verbal memory, working memory, attention and processing speed, motor speed, verbal fluency, and executive functions using Brief Assessment of Cognition in Schizophrenia Scale (BACS) in 64 clinically stable schizophrenia (SCZ) patients. Patients were matched by age, sex and body mass index and exclusion criteria included obesity class 2 or higher, any concomitant organic mental or neurological disorder, acute or chronic inflammatory disease, and use of immunomodulatory drugs or psychoactive substances.

A significant positive correlation was observed between BACS verbal fluency subtest score and kynurenine levels (p<0.05), along with a significant negative correlation with IL-β levels (p<0.05). There were no other significant correlations of blood levels of TRP, KYNA, KYN, KYN/TRP ratio, IL-8, and IFN-γ, and cognitive impairments in domains of verbal memory, working memory, attention and processing speed, motor speed, and executive functions.

While the relationship between KP metabolites and cognitive functioning in schizophrenia in domains of verbal and working memory is more reported, specific correlation between KYN levels and verbal fluency observed in our study is less studied and understood. Furthermore, negative correlation between IL-1β levels and verbal memory performance is a valuable finding and can be further explored in the context of suggested detrimental role of IL-1β on hippocampal neurogenesis. Our findings should be interpreted cautiously and corroborated in larger studies with parallel measurement of preferal and central levels of analyzed parameters since there are data that suggest that peripheral concentrations of TRP, KYNA, KYN, IL-8, IFN-γ, IL-1β do not mirror those in the central nervous system.

None Declared

Since its inception in 1997, the term orthorexia nervosa (ON), derived from the Greek words for “right” and “appetite” (Donini et al, 2022), has been utilized to describe an obsession with “correct” or “healthy” eating. Despite numerous authors suggesting diagnostic criteria and the publication of several theoretical papers, consensus regarding a definition or even the existence of ON remains elusive (Dunn and Bratman, 2016). Conversely, anorexia nervosa (AN) has been recognized since the first iteration of the DSM (Bhattacharya et al, 2022; Dell’Osso et al 2016). Layperson awareness of these conditions has been increasing, with a notable increase in interest in “orthorexia” over the past several years, potentially influenced by popular culture and increased social media use (Sharma et al, 2023)

The purpose is to understand shifts in public interest as well as the ever-present influence of the online world on patients, especially those with disorder eating patterns.

This study compared United States Google search trends for the terms “orthorexia” and “anorexia”. Using Google Trends data, we reviewed the average monthly search volume from January 2004 to March 2024. We analyzed the data to determine if there was a significant difference in search volume over time.

Google search data revealed a monthly search volume of ˜7000 queries for “orthorexia” in January 2004, and analysis of the volume revealed that there has been a significant and sustained increase in the searches for “orthorexia”. Additionally, searches for the term “anorexia” reached a height of 2.1 million in 2007, but have been steadily declining in the past several years.

While anorexia remains the more prominent search term, over time the queries for anorexia have decreased from their peak in the early 2000’s. The rise in the term orthorexia may be partly due to the proliferation of highly visual social media platforms, particularly YouTube and TikTok, where content creators often focus on healthy eating and lifestyle trends (Sharma et al, 2023).

Additionally, there is a possibility that orthorexia is being used on these platforms to describe a subset of AN. Some individuals with anorexia may present with behaviors resembling orthorexia, such as a fixation on healthy eating or a rigid adherence to specific dietary guidelines.

The findings indicate a shift in the public’s interest in orthorexia and anorexia during the past several years, possibly influenced by increased social media use. Further research is needed to understand the implications of this trend on individuals’ attitudes towards healthy eating and body image.

None Declared

While many evidence-based mental health prevention, promotion, and treatment interventions exist, they are poorly and inequitably scaled across populations. Too often, research produces interventions and implementation strategies that are difficult to scale due to misalignment with culture, policy, system, community, provider, and individual realities. This presentation will introduce the Lancet Psychiatry Commission on Transforming Mental Health Implementation Research, which makes five recommendations to transform the research enterprise to produce more actionable evidence and address the mental health implementation gap. These recommendations focus on strategies for integrating research and real-world implementation; centering health equity in mental health intervention and implementation research; using a complexity science lens to study strategies for scaling effective interventions; expanding research designs beyond the traditional randomized clinical trial; and using transdisciplinary approaches. The Commission also made cross-cutting recommendations related to elevating work on mental health systems and policy and the importance of strengthening mental health implementation research globally.

None Declared

Psychiatry focuses on disorders of affect, behavior, and cognition (ABC), with half of all psychiatric disorders emerging by age 14 and three-quarters by age 24. Disorders are categorized into four types: Type 1 (affective disorders like depression and anxiety), Type 2 (behavioral disorders like ADHD and ODD), Type 3 (developmental disorders like mental retardation and speech/language issues), and Type 4 (dysfunctional disorders, including psychotic illnesses and mood disorders). These categories—emotional, behavioral, cognitive, and dysfunctional—form the ABCD framework in child psychiatry.

The study aimed to categorize childhood and adolescent mental and behavioral disorders into four groups: developmental, disruptive, emotional, and dysfunctional. It also sought to examine intra- and inter-group comorbidities, and analyze the clinical variables of these groups and their comorbidities by age and sex.

This was an observational cross-sectional study conducted at Gauhati Medical College Hospital (GMCH), Guwahati, Assam, from September 7, 2018, to September 6, 2019. Existing diagnostic systems do not distinguish between child/adolescent and adult mental health, and there is a lack of a unified “common language” for childhood and adolescent mental and behavioral disorders. The study aimed to address this gap, particularly in the local geo-cultural context, where data for a new classificatory system is scarce. Participants included children and adolescents admitted to the Child Psychiatry Unit or attending the Child Guidance Clinic. Demographic (age, sex) and clinical variables (ICD-10 diagnoses) were studied, with diagnoses categorized into types 1–4.

Total sample size was 137. Adolescents (ten to 18 years of age) were almost double in numbers to that of children (below ten years of age). Boys outnumbered girls. Adolescents were more than children in both among girls and boys (even the single third gender was an adolescent). Most of the children and adolescents were having type 3 disorders, followed by type 1 and type 2 disorders. While majority had type 3 disorders below ten years of age (children), type 1 disorders were highest in the adolescents. Type 1 and type 3 disorders were almost equally distributed among girls, while boys predominantly had type 3 disorders. Within group comorbidity was maximum with type 3 disorders. Across group comorbidity was found mostly in type 2-type 3 disorders.

John Lennon “imagined” of having no countries and no religion too; thus, there will be nothing to kill and die for! Bono of U2 wanted to be there “where the streets have no name”! Likewise, we too dream of a land for child and adolescent psychiatry where if we cannot live without names then let us at least have a few and simple ones: ABCD!

None Declared

Aggression in the psychiatric environment has negative consequences for both patients and staff. Accurate measurement of patient aggression towards staff, and its prevention, remains elusive. The Staff Observation of Aggression Scale-Revised (SOAS-R) is a measure describing the incidence and characteristics of aggressive events. Although not exclusive to staff aggression, our study used this scale to provide a more or less standardized measure for assessing and understanding the trends and potential triggers of staff aggression. This will enable better management of such situations. This in turn will lead to better working conditions and improved quality of care.

To describe the incidence of aggressive events against various mental health staff at Ar-Razi Hospital over the course of a year, their characteristics and the factors involved. this study will provide and enable better managment of these situations, furthermore leading to better work conditions and better quality of care.

• - Our study is a cross-sectional study, data collection were by a questionnaire sent online to hospital staff, the questionnaire was bases on the SOAS-R items.

• - Descriptive and analytical statistical study wad done by Jamovi 2.3 software.

• - Statistical differences were calculated using the chi-2 test, and a p<0.005 value was considered statistically significant.

Our study results(SOAS-R items) concerning the agressions towards staff of our hospital were resumed in image 1 and 2.

Also the prevalence of participating staff by status in our study was: 78% of physical assaults were against nurses. The association between the prevalence of assaults and staff status was statistically significant using the chi-2 test (p=0.0037<0.001).

Image 1:

Image 2:

Agression is known to have negative impacts for both staff and patients. Our study suggests that mental health staff in our facility are victims of aggression. Improved methods of measuring aggression and a wider study of different psychiatric institutions will help to prevent aggression and create a healthy work environment, which in turn will help the staff to develop and improve the quality of care for patients.

None Declared

Migrant people may constitute a vulnerable population with an increased risk of suicide-related behaviour due to the accumulation of multiple risk factors, such as migration-related stress, the history of traumatic experiences and socioeconomic situation in the country of immigration.

To study the prevalence of suicide attempts from migrant population in hospital emergency departments. Moreover, it aimed to study suicide-related outcomes, according to migration status.

Data from 754 patients (73.1% female; m= 40.23, sd= 15.72) with a recent suicide attempt from 10 Spanish hospitals were included. Assessment protocols were delivered within the 15 days after the index attempt. Suicide-related outcomes, clinical and sociodemographic factors were assessed by administering a wide range of clinical tools (C-SSRS, MINI, BIS-21, BSI, ACSS-FAD, CTQ).

One in four patients was foreign-born, mostly being from Latin American countries (74% of foreign-born patients). Foreign-born patients were younger, higher psychopathology symptom severity, child trauma scores (Figure 1), than their counterparts (p < .01). Higher proportion of employed people and lower amount of people receiving pension benefits, were found in the foreign-born group. No between-group differences were observed regarding suicide-related outcomes. Finally index attempt in foreign-born group was featured by using more lethal methods (p < .05) (Figure 2).

Image 1:

Image 2:

Significant proportion of attempts attended in clinical settings may come from migrant people, mainly featured by child trauma history. Attempts from migrant populations may be featured by more lethal methods. Health care provision adjustment becomes mandatory to meet migrant people needs in current times.

None Declared

There exponential rise in prescribing SSRIs and antipsychotic medication have highlighted the paucity of shared decision making, holistic therapies and weight management programmes. Guidelines are vague about checkpoints and deprescribing, seeming to ignore the metabolic consequences, failing to advocate for physical health monitoring.

We undertook a retrospective analysis of (n =492) patients initiated on psychotropic medication to understand the physical consequences, assessing the metabolic consequences of long-term prescribing of psychotropic medication in a rural primary care population.

Electronic patient records were analysed from depression and serious mental health registers across three primary care sites. Data collected included the start date of treatment, BMI measurements before and after treatment.

Among the 220 patients studied, 150 (67.7%) experienced weight gain, while 70 (31.8%) lost weight. The average treatment duration was 11.5 years. Weight gain was more prevalent among males (71.6%) compared to females (66.7%). Patients who gained weight were, on average, prescribed cumulatively more psychotropic medications (3.21) than those who lost weight (2.89).

Shared decision making and acknowledgement of the metabolic consequences of these medications at the point of initiation, and identification of pre-existent metabolic risks, monitor weight gain, and ensure adequate life-style changes to mitigate side effects. These methods should continue throughout the duration of treatment, and when possible, the option of deprescribing should always be available to the patient. It is time care bundles for patients with mental health illness are resourced for primary care.

None Declared

Eating disorders, in particular Anorexia Nervosa (AN), are serious psychiatric disorders with a chronic course and high levels of disability and mortality. These disorders are characterized by a misrepresentation of body image and intense fear of putting on weight, leading to cognitive distortions related to food and weight control, as well as dysfunctional behaviors aimed at weight loss.

The aims of this paper are to provide a summary of the current literature concerning involuntary treatment in patients with eating disorders and to assess whether there is a difference in terms of baseline characteristics and treatment outcomes between patients treated both voluntarily or involuntarily.

Relevant articles were identified by searching the following terms: “treatment refusal”, “involuntary/compulsory/coercive/forced treatment/admission”, “eating disorders”, “anorexia nervosa”, “bulimia nervosa”. Research was restricted to articles concerning humans and published between 2014 and 2024 in English.

The treatment of eating disorders consists in a combination of weight control/weight gain methods and psychotherapy, as well as the treatment of organic complications associated with starvation and low body weight.

Involuntary treatment is usually intended for patients having worse baseline conditions. Factors associated with increased involuntary treatment utilization were female sex, lower age, psychiatric comorbidities, more severe disease with lower weight at admission and a longer course.

Concerning short term outcomes, the involuntary treatment can be life saving and half of these patients accept the treatment in 2 weeks time. Studies show that the involuntary treatment did not have a significant negative impact in the doctor-patient therapeutic relation. In terms of long term outcomes, patients treated involuntarily had similar outcomes to those treated voluntarily, having better outcomes in some domains, including menstruation, number of admissions and functionality.

The denial of the illness and lack of insight in AN raise practical and ethical questions relating to the autonomy of the patient and the responsibility of the family and health care practitioners. The involuntary treatment of eating disorders is a complex area and further research including quantitative and qualitative studies is needed.

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Pedophilic disorder is characterised by a sustained, focused, and intense pattern of sexual arousal involving pre-pubertal children. In addition, the individual must have acted on these thoughts, fantasies or urges or be markedly distressed by them (ICD - 11).

Beyond its obvious ethical and legal implications, this disorder is often associated with substantial mental health comorbidities, including depression, anxiety, and substance abuse. One particularly alarming yet understudied aspect is the elevated risk of suicidal ideation and behavior among individuals diagnosed with pedophilic disorder. The intersection between pedophilic disorder and suicide risk is critical to understand, as it can inform the development of more effective intervention strategies and support systems.

The present review aims to explore the intersection between pedophilic disorder and suicide risk, shedding light on the psychological factors that contribute to suicidal ideation and behavior among individuals with this disorder, including those who have never sexually engaged with children.

PubMed, Web of Science and Google Scholar were searched using the following keywords “pedophilic disorder”, “suicide risk”, “suicidal ideation”, and “stigma”. Articles published within the last decade were included.

The review showed several risk factors, perhaps the most significant being the psychosocial effects of the intense stigma, social isolation, and internalized shame. Other risk factors are prior mental health treatment, weaker attraction to adult women, history of sexual abuse, young age, less education, and additionally, the lack of access to appropriate mental health services.

The relationship between these individuals’ emotional distress and their likelihood of sexually engaging with a child is not known, but there is evidence that impulse control is compromised by negative affect. Moreover, literature posits that stigma raises the risk of sexual activity with children via disturbances in emotional, social, cognitive, and health service utilization domains.

It is evident that this population faces unique challenges that require specialized attention and addressing this intersection necessitates a comprehensive approach.

Strategies aimed at reducing stigma, promoting social support, enhancing access to mental health services and fostering supportive environments have the potential to mitigate suicidal risk factors and enhance overall well-being. Furthermore, efforts to destigmatize help-seeking behaviors and improve access to confidential and non-judgmental support services are crucial in reducing the incidence of suicide and promote mental health among this population.

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Alcohol Use Disorder (AUD) and its comorbidities can have a tremendous negative impact on various activities of daily living, including the capability to manage one’s finances. Adequate financial functioning is essential for an individual’s health and well-being and is key to leading an autonomous and independent life. Problems with financial functioning can have far-reaching personal and legal consequences, and may lead to financial insecurity or poverty, financial victimisation, placement under guardianship, and reduced opportunities for social and societal participation.

To evaluate the financial situation and the strengths and weaknesses in the everyday financial functioning of individuals with AUD.

The financial situation and financial performance of an AUD group (n = 52) were compared to a control group (CG) (n = 95), using the Financial Performance Scale (FiPS). In addition, associations between financial performance and everyday contextual factors (i.e., income, depressive symptoms (i.e., Beck Depression Scale - II), social support (i.e., Brief Perceived Social Support Questionnaire)) were explored.

As compared to the CG, the AUD group reported to have a significantly poorer financial situation, including lower income levels, more frequent debts, and fewer savings. Furthermore, the AUD group reported a significantly poorer overall financial performance (FiPS total score) than the CG, and significant group differences were observed for relatively complex financial tasks, such as financial goal setting and doing tax returns. The difficulties in financial performance of the AUD group were, however, considered as relatively mild, since most aspects of financial performance (i.e., FiPS item scores) did not differ between groups. In the total sample, a better financial performance was significantly associated with a higher income, more perceived social support, and fewer depressive symptoms.

Individuals with AUD reported a poorer financial situation and more difficulties with performing complex financial tasks compared to controls. These reported weaknesses may stem from cognitive and affective impairments associated with AUD, as well as from a scarcity of financial resources. Since a vicious cycle may exist between financial problems and AUD symptoms, it is relevant to enhance the financial well-being of those individuals with AUD who experience financial difficulties.

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Female sexual dysfunction (SD)has gained attention in recent years. Multiple factors contribute to women’s sexual vulnerability, including neurobiological, sociocultural, psychological, and interpersonal factors.

To assess the prevalence of SD and to determine sociodemographic and clinical factors related to this dysfunction.

We conducted a cross-sectional and descriptive study including married and sexually active female medical residents from different specialties.Data were collected using a self-questionnaire published by GOOGLE FORMS. The questionnaire included sociodemographic characteristics, substance use, marital life information, professional data, and information related to sexual life. Female Sexual Function Index (FSFI) was used to assess female sexual dysfunction.

A total of 65 medical residents completed the online questionnaire. Four residents (6.20%) considered the work environment to be unfavorable, 3.1% were smokers and 55.4% had children. The average frequency of sexual intercourse was 6.61 ± 4.18 times per month. Nine participants (13.8%) reported having sexual intercourse under partner pressure. Sexual dysfunction was observed in 49.2% of the cases. The factors correlated with the total FSFI score were an unfavorable work environment (p=0.02), smoking (p=0.007) and high frequency of sexual activities (p=0.02; r=0.28).The factors correlated with the “Desire” dimension were: sexual intercourse under partner pressure (p=0.002) and high frequency of sexual activities (p=0.001; r=0.41).The factors correlated with the “Arousal” dimension were: an unfavorable work environment (p=0.01) and psychiatric history (p=0.05).The “Lubrication” domain was associated with an unfavorable work environment (p=0.006) and smoking (p=0.02). The “Satisfaction” domain was associated smoking (p=0.004), sexual intercourse under partner pressure (p=0.03) and high frequency of sexual activities (p=0.003; r=0.36). The “Orgasm” domain was inversely correlated with age (p=0.04; r=-2.47), and it was associated with a high frequency of sexual activities (p=0.04; r=0.24). The “Pain” domain was correlated with the presence of children (p=0.02).

The findings underscore the impact of various sociodemographic and clinical factors on sexual health and well-being. Addressing these underlying factors is essential for improving their sexual health and overall quality of life.

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