Recently, the seasonal pattern of bipolar disorder has been accepted, with the clinical, diagnostic, treatment and prognostic consequences that this entails. It is interesting to study its epidemiological characteristics, such as the influence of gender on this pattern.

To study the influence of gender in the Seasonal Pattern of Bipolar Disorder.

A systematic review was carried out by means of a bibliographic search in Ovid MEDLINE of articles published in the last ten years (2010-2020), using the following keywords: bipolar disorder, seasonal pattern and gender: Those studies carried out in patients who presented a seasonal pattern were selected, and the influence of gender on this was studied.

The initial search showed a total of 92 articles, of which 7 met the inclusion criteria. It was found that, indeed, gender influences both the clinical characteristics and the course, management and prognosis of the seasonality of bipolar disorder.

The diagnosis of the Seasonal Pattern in Bipolar Disorder continues to be an important challenge. Women more frequently present PE, associated with manic, depressive or mixed episodes, while men in depressive episodes. Men are more frequently associated with Bipolar Disorder type II and depressive episodes, and women with rapid cycling and eating disorders. Male manic episodes are associated with psychotic symptoms, and with greater severity in admissions. Women have a higher risk of Seasonal Pattern than men, with the clinical and prognostic repercussions that this entails.

Nowadays we know that autism spectrum disorders (ASD) and Schizophrenic spectrum (SS) are different types of disorders in their etiology, symptoms and prognosis, but the clinical distinction is often difficult to make due to comorbidity and similar symptoms.

With this project, the authors intend to explore the differential diagnosis between ASD and SS specially when we talk about critical ages of onset.

An analysis of articles searched on Pubmed (articles between 2010-2020) with the key words “adult autism”, “childhood onset schizophrenia”, “childhood psychosis”.

Early-onset schizophrenia (EOS) is defined as occurring before age 18 years. The condition share key diagnostic symptoms with adult-onset schizophrenia (AOS) but his prognoses and comorbidities differ. Autism spectrum disorder (ASD) is a common neurodevelopmental disorder characterized by difficulties since early childhood across reciprocal social communication and restricted interests and behaviors. ASD is a lifelong neurodevelopmental disorder, however there is a lack of answers and research for adults with ASD. There are shared aspects of odd thinking, rigid behaviors and impaired socialization in schizophrenia and ASD and COS seems to have a strong relationship with ASD, being comorbid in up to 50% of cases.

Usually the evaluation of the developmental history of the person, prodrome and onset, its course and the presence of positive symptoms of schizophrenia is enough to help us find a diagnosis. Unfortunately, in some ages the conclusion is not so easy to find. However is essential to determine whether the clinical manifestations belong to the autistic spectrum, the schizophrenic or result from comorbidity.

The term “two-eyed seeing” is spreading across North America as a concept for explanatory pluralism. The concept was brought into academic science by Albert Marshall, a M’iqmaq from Nova, Scotia, Canada. It speaks to the idea that indigenous knowledge is an equally valid way of conceptualizing a phenomenon as is contemporary science. Marshall’s famous example compares a traditional M’iqmaq story about the origins of the large tides in the Bay of Fundy with contemporary oceanographic geology findings and simulations.

We wanted to explore how this two-eyed seeing model could be applied to mental health to facilitate a dialogue between psychiatry and traditional cultural healers.

We reviewed the existing literature on two-eyed seeing within mental health care using PubMed, IndexMedicus, OneSearch, and Google Scholar. We presented a course on two-eyed seeing for indigenous mental health services and two-eyed seeing for addressing trauma in indigenous communities and surveyed the participants about the two-eyed seeing concept. We offered this course primarily to providers within indigenous communities and also for other interested counsellors.

Participants in our trainings were enthusiastic about the role of two-eyed seeing for improving communication among indigenous providers and patients and non-indigenous providers. Most indigenous counselors had not heard of two-eyed seeing and were quite enthusiastic about its affirming nature and how it gave them a basis for dialogue with non-indigenous practitioners.

Two-eyed seeing allows a rich dialogue between European-derived practitioners and indigenous people that enabls each to appreciate the other’s perspectives, leading to greater cooperation and collaborative treatment.

No significant relationships.

Clozapine is a second-generation antipsychotic indicated in treatment-resistant schizophrenia. Patients taking clozapine are likely to experience an increase in salivation or sialorrhea. Clozapine‐induced sialorrhea (CIS) may lead to sleep disturbances or aspiration pneumonia. Treatment options include locally administered anticholinergic medication with atropine ophthalmic drops applied sublingually.

To review the current evidence for the effectiveness, safety, side effects and dosage of sublingual application of atropine in reducing or resolving of CIS.

Systematic review. Data were obtained from PubMed/Medline, EMBASE, PsycINFO, Cochrane Plus, Trip Database, Science Direct and Scopus searches of English-language articles, without restriction for date of publication and study design, reporting the sublingual use of atropine in the treatment of CIS. Large clinical studies with appropriate statistical methods and recruited adults were preferred.

12 selected articles (of 458 references) consisted entirely of case reports and case series. A total of 29 patients with CIS were reported, of whom 24 responded favorably to sublingually administered atropine drops 1% (1-2 drops a day). One limitation of its utilization is the dose-related dry mouth, which can be addressed by lowering the number of drops administered. CIS can occur at different clozapine doses, in various stages of treatment.

The reviewed articles suggest that the use of sublingual atropine is a promising local treatment for CIS. Oral anticholinergic and alpha-2 agonist medications have been used to treat CIS with variable efficacy, but can cause systemic anticholinergic side effects. Further experimental research is needed.

No significant relationships.

Handwriting disorder is considered to be one of the major public health problems among school-aged children worldwide. All the scales in the literature use handwriting tasks but it could be interesting to investigate a more accurate assessment of handwriting difficulties before the development and acquisition of handwriting as such.

The objective of our study is to examine the validity of a prescriptural task consisting of copying a line of cycloid loops in the diagnosis of handwriting disorders.

35 children with handwriting disabilities and 331 typically developing right-handed children in primary school, aged 6-11 years old, were included in the study. They performed a copy of a line of cycloid loops, in an ecological setting, with a paper sheet put on the table. The kinematic measures were recorded with a digital pen. A Receiver Operating Characteristic method (ROC curve) was used to determine whether the loops line copy may be a sensitive test to diagnose handwriting disorders.

Six kinematic variables recorded during the prescriptural task were found to be relevant markers of handwriting disorders with a sensibility between 0.743 and 0.880: strokes number, total and effective drawing time, in-air pauses times, loops number, number of peaks velocity.

The graphomotor task of copying a line of cycloid loops showed a good sensitivity to diagnose handwriting disorders and appeared to be a good predictor test, more particularly with the variables reflecting the strokes temporal organization.Drawing loops is a rapid graphomotor task, useful for exploring prerequisites of handwriting in screening for handwriting disorders.

The general confinement in Tunisia in the covid-19 pandemic is a new event for the Tunisian society with economic, social and psychological repercussions.

To evaluate the behavior of Tunisians during the general confinement of 2020.

descriptive and analytical study through a questionnaire sent online under the model of “google forms”.

Our sample is composed of 500 people, mostly women, with an average age of about 40 years, an average to good economic level, and a secondary and higher education level. In the Tunisian family, the most discussed topic during the lockdown is the covid-19 and its evolution in the world and the country. The most avoided subject is the behavior of neighbors. The Tunisian’s main sources of information on covid-19 are television and social networks. The behavior most adopted to avoid contamination is hand washing. Only 2/3 of the group applied the measures announced by the government. A quarter of our sample spent more than 5 hours in front of the computer screen or smartphone. During confinement the most important behaviors are smoking, eating, doing nothing and playing cards. Only 10% of our sample have plans for next year.

For our sample, covid-19 has greatly transformed the behavior in daily life which has become dominated by anxiety and fear of contamination.

Anorexia nervosa (AN) and bulimia nervosa (BN) occur predominantly females, take one of the first places in the risk of fatal outcome among mental disorders, have a tendency to chronicity, disability with social disadaptation, high suicidal risk. The psychopathological basis of these diseases is dysmorphophobia, characterized intrusive, overvalued or delusional ideas of physical disability. The significant role of dysmorphophobia determines the urgency of the detailed study using psychometric techniques.

Assess the degree of satisfaction/dissatisfaction with one’s body and its separate parts in patients with AN and BN.

130 female patients with AN and BN at the age of 13-44 years (the average age is 18). The disease duration from 6 months to 24 years. The psychometric method using the validated Questionnaire image of one’s own body (QIOB) and the Scale of satisfaction with one’s body (SSOB).

According to QIOB 84,62% in the category expressed dissatisfaction with their appearance, 15,38% in moderate category. According to SSOB, 32,31% of the patients is not satisfied with characteristics that belong to head, 45,38% is not satisfied with characteristics that belong to torso, 56,92% is not satisfied with characteristics that belong to the lower part of body. The number of dissatisfied with all of these body parts equals 38% which indicates the presence of polydismorfofobia.

High rates of dissatisfaction with one’s appearance, which are consistent with the severe somatic state of patients, affect the dynamics and outcome of the disease. Publication was prepared with support of the “RUDN University Program 5-100”.

Religious people suffer less from depression disorder than less or non-religious people. According to a longitudinal study investigating religiousness and negative life events, religious participants demonstrated fewer depressive symptoms than non-religious. Furthermore, depressed patients with higher religiosity scores show lower values of depression symptoms.

The purpose of the study was to investigate the relationship between religiosity and patients with depression symptoms in the Neuro-Psychiatric Center in Riem (NPZR). The correlation between religiousness and life satisfaction as well as anxiety level was analyzed. Additionally, possible gender differences are also assesed.

The patients of the NPZR were selected as sample of the study (N =106, F=61, M=45). The participants were provided with three surveys including the life satisfaction questionnaire, state trait anxiety inventory and the Centrality Scale. A Pearson Correlation was conducted to investigate the association between life satisfaction, level of anxiety and religiousness. T-Test was carried out to find out the differences between female and male patients.

There was a positive relationship between religiousness and life satisfaction of the depressed patients (r = .608, p= .001). There was also a significant relationship between religiosity and anxiety level (r = - .548, p < .001). However there was no significant difference between male and female patients with regard to their religiousness (t= .149, p= .882).

The findings indicate that while there is a significant relationship between life satisfaction, level of anxiety and religiousness of the patients, the gender of the patients has no impact on the religiosity of participants.

Intergenerational programs involving children and the elderly promote intergenerational interactions and can positively affect physical and mental health, and the quality of life of the elderly.

To test the effects of an intergenerational intervention in social isolation, depressive symptoms and quality of life of the elderly.

This study employed a pretest-posttest design. Measures: Portuguese versions of Geriatric Depression Scale, Lubben Social Networks Scale and WHOQOL-OLD. Participants: 12 elderly, 75% females, with mean age of 80.8 years (sd=8.8) and 20 kindergarten children (65% female) with mean age of 4,1 years (sd=0.79). The intervention ran for 6 weeks, with 11 intergenerational group sessions, each range between 30 and 120 minutes. A nonparametric paired samples tests was conducted to evaluate the impact of the intervention.

After the intervention, when comparing elderly with and without depressive symptoms, results showed significant differences in the total value of quality of life (p=.048) and in the facets: 1) Sensory functioning, 2) Autonomy, 3) Past, present and future activities (p=.003; p=.018; p=.030, respectively). 12,5% of de elderly with depressive symptoms before the intervention no longer have depressive symptoms after the intervention. Regarding social networks, there were no significant differences (p=.576) between the mean values of the two assessments.

The implemented intergenerational program was effective in promoting quality of live and minimized depressive symptoms. After the intervention, the number of the elderly without depressive symptoms have increased and these presented a higher quality of life. Finally, longitudinal studies with a large sample are needed to consolidate results.

It is known that negative body image can cause significant emotional distress for an individual and thus lead to lower subjective well-being. Previous research has shown that both disordered eating and body mass are connected to negative body image.

To examine how disordered eating and BMI can predict different aspects of body image.

A sample of 180 healthy respondents (152 Female, 28 Male, mean age 22,62±7,35) were recruited in Moscow. Disordered eating was measured by Eating Attitude Test (EAT-26; Garner D. et al., 1982), body image was measured by Multidimensional Body-Self Relations Questionnaire (MBSRQ; Cash T. F., 1990). Body mass index (BMI) was calculated on the basis of self-reported data (height and weight). Multiple linear regression analysis was performed in IBM SPSS Statistics 22.0.

Regression model with both predictors determined self-classified weight (SCW; R2=0,569, p<0,0001), overweight preoccupation (OWP; R2=0,497, p<0,0001), body areas satisfaction (BASS; R2=0,259, p<0,0001), and appearance evaluation (R2 = 0,229, p<0,0001), but only disordered eating symptoms predicted appearance (R2 = 0,193, p<0,0001) and health (R2 = 0,036, p<0,05) orientation, and none of the predictors affected fitness or health evaluation and fitness orientation.

Symptoms of disordered eating and body mass index in normal population can predict self-evaluation of one`s appearance as less attractive, body size as bigger and weight as heavier. Only symptoms of disordered eating predicted higher extent of investment in one’s appearance and health. And neither IBM, nor disordered eating predicted self-evaluation of one`s health and fitness or the extent of investment in fitness.

Suicide is the second most common cause of adolescent mortality worldwide.

To study the characteristics of a sample of adolescents (<18years of age) who died by suicide in Greece.

We investigated all suicides that took place within the area of the Piraeus Department of Forensic Medicine (population covered ~700,000) for the period 1992-2016, based on the victims’ forensic records.

During the 25-year period, 16 adolescents (and 1162 adults) died by suicide. They were mostly males (11/68.75%) and of Greek Nationality (14/87.5%). The mean age was 15.56 years (range: 12-17, standard deviation: 1.46). Two (12.5%) were under psychiatric medication (an antipsychotic and an antidepressant, respectively); none was receiving a benzodiazepine or a mood-stabilizing antiepileptic. None had used amphetamine, cannabis, cocaine or heroin. Two (12.5%) -one girl one boy- had consumed alcohol. The suicides took place primarily at home (12/75%), followed by outdoors (3/18.75%); one (6.25%) took place in a correctional facility. Hanging was the most prevalent method (6/37.5), followed by jumping (5/31.25%), shooting by a firearm (2/12.5%), drowning (1/6.25%), medication overdose (1/6.25% -amitriptyline poisoning) and a case of suffocating death (1/6.25%). Most suicides happened in September (5/31.25%) and April (3/18.75%). No significant differences were noted with the adult sample.

The methods chosen by the adolescents who died by suicide in our sample differ strikingly from those of usual suicide attempts at that age (medication overdose/self-cutting). The periods when the suicides took place may imply a role for school stress. Our study was retrospective and focused primarily on a large urban area.

This article will focus on the case of patient whose disease manifested after episode of dehydration at 16 years of age and within 8 years led to his death. During the eight years of illness, the patient suffered from polymorfic psychotic states accompanied by various types of epileptic seizures, including absence and grand-mal seizures, resistant to drug therapy. In addition, he suffered from multiple motor disorders, skeletal and mimiс muscle atrophy, as well as progressive cognitive decline from very high level of cognitive functions to level of moderate deterioration. Despite repeated evaluations, there was no unequivocal diagnosis of his disorder.

Male, born in 1994, without a known hereditary pathology in the field of neurology or psychiatry. Pregnancy and childbirth proceeded without features and the early stages of cognitive-motor development were marked as normative, with the exception of a single epileptic seizure at the age of 3 years (according to the description of the parents). Until the age of 16, the patient was not under the supervision of a neurologist or psychiatrist, developed on a par with his peers, successfully attended school with high marks in the exact sciences, and went in for sports.

Case report

Case report

A patient is considered with a non-standard course of psychosis and epilepsy, which was accompanied by multiple neurological and psychiatric symptoms.In Israel there are only 13 patients with a resemble clinical picture and there is no diagnosis or group of diagnoses in ICD, DSM or any neulogical classificatin tha can describe his disease.

There is growing evidence that generalised joint hypermobility (GJH) is associated with several psychiatric conditions. There are no previous studies on adult ADHD.

To evaluate, in a large Swedish sample, if generalised joint hypermobility and adult ADHD are associated.

431 adults with ADHD and 417 controls were included. GJH was assessed by the Beighton Score, a physical examination, and the 5PQ, a self-report screening tool. Exploratively, reported musculoskeletal symptoms and abnormal skin manifestations suggestive of symptomatic GJH (e.g. Ehlers-Danlos syndrome), were assessed to differentiate this group from the general GJH group. Logistic regressions determined the influence of an ADHD diagnosis and known covariates (age, sex and ethnicity) on GJH and symptomatic GJH respectively.

ADHD was associated to GJH, as defined by the Beighton Score and the 5PQ, with adjusted odds ratios of 4.65 (CI 95% 3.01-7.18, p<.005) and 1.86 (CI 95% 1.39-2.48, p<.005), respectively. Likewise, ADHD and symptomatic GJH were associated with adjusted odds ratios of 6.94 (CI 95% 4.05-11.89, p<.005) and 2.66 (CI 95% 1.94-3.66, p<.005).

GJH and adult ADHD are associated conditions. Symptomatic GJH, defined as additional symptoms of pain and/or skin manifestations, has a considerably stronger link to adult ADHD than unspecific GJH has. GJH may represent a marker of an underlying systemic disorder with physical manifestations in connective tissue as well as behavioural manifestations including hyperactivity, impulsiveness and inattentiveness. Future studies should investigate if this represents a novel subtype of ADHD and if symptomatic GJH affects the ADHD management.

No significant relationships.

Due to the Covid 19 pandemic, the Tunisian government has taken several measures, which had a psychological impact on adults and children.

Studying the initial impact of the Covid 19 pandemic on Tunisian parents and children.

One week after the proclamation of sanitary lockdown in Tunisia, parents were invited to answer voluntarily an anonymous questionnaire posted on social media. The stress level of the parent was measured by the Impact Event Scale Revised (IES-R).

This questionnaire was answered by 138 parents.88% of them were mothers. Changes in working arrangements were made by 87.2% of fathers and 79.8% of mothers. Only 1% of parents did not teach their children about hygienic rules. Parents had a child aged 12 or less in 91% and aged more than 12 in 41.4%. Behavioral changes were reported in 60% for children aged 12 or younger (Graphic 1) and in 20% for those older than 12 (Graphic 2) The IES-R mean score was 28.9 ±18.The severity of the impact was associated with the female sex (p=0.04).We found a positive correlation between the IES-R score and the symptomatology of children with p=0.001 and r=0.518 when the age was superior to 12 and with p<0.001 and r=0,52 when the age was under 12.

The Covid pandemic in Tunisia affected both parents and children. Psychological intervention is essential to help them get out of this crisis with less damage.

Yoga may pose a promising complementary therapy in the multimodal treatment of schizophrenia spectrum disorders (SSD). However, to date, no studies have qualitatively examined the patients’ experience of practising Yoga.

This qualitative study aimed to assess the mechanisms and processes of Yoga-based group therapy (YBGT) for in-patients with SSD by exploring their subjective experiences.

Twenty-five semi-structured interviews were conducted with in-patients with SSD after they participated in a YBGT session. Interviews were transcribed, coded by two independent researchers, and analysed using an inductive thematic approach. The research team collaboratively discussed emerging categories to reduce redundancy and form meaningful themes and subthemes.

The analysis revealed seven main themes. YBGT was perceived as feasible and focusing on individual adaptation, captured by the theme ‘inclusivity’. Nevertheless, participants encountered ‘challenges’; thus, physical limitations need to be considered. While practising together, participants experienced ‘interconnectedness’ and developed a ‘mindful stance’ as they accepted their limitations and adapted exercises with self-compassion. Following the flow of asanas required physical persistence, which ultimately led many participants to experience ‘confidence’ and ‘relaxation’. YBGT affected ‘symptom representation’ as heightened awareness led participants to notice impeding as well as improved symptoms.

YBGT seemed to have various promising effects on in-patients with SSD. Future research should examine to what extent these effects can be sustained and how the mindful approach during YBGT can be transferred to areas outside the Yoga class. Furthermore, a randomised-controlled trial could investigate the effectiveness of a manualised YBGT.

No significant relationships.

A meta-analysis from 2016 estimates prevalence of hepatitis C to be superior in people with severe mental illness than general population. In France, positivity for hepatitis C is estimated at 0,75% of general population and 0.3% with a detectable viral load. No recent study was conducted to determine seroprevalence of hepatitis C in population admitted in psychiatric institution.

The aims of this study are to determine seroprevalence of hepatitis C in population admitted in psychiatric institution and describe the profile of infected patients.

From january 2020 to october 2020, screening test for hepatitis C, hepatitis B and HIV was proposed to every patient admitted at the reception unit of Ravenel Hospital. In case of positivity, viral load was realised.

Between January 7th and Octobre 1st , 407 patients greed to the screening test. Among them, 17 (4,2%) were tested positive to hepatits C and viral load was detectable in 9/17 positives, which lead to a 2,2% seroprevalence of hepatitis C infection in the studied population. The patients with positive screening had a mean age of 40 years old. 82% of them were males. 16 admit using intoxicating substances and 10 were still current users at the time of the study. They were hospitalized for addictology purpose (5/17), psychosis (6/17), mood disorder (5/17), personality disorder (2/17), adjustement disorder (2/7). 10/17 had an alcohol use disorder.

This study confirms seroprevalence of hepatitis C infection in psychiatric population is seven times that of general population. This justifies a systematic screening of this population.

No significant relationships.

Wishplash cervical spine injuries are serious traumatic situations

Aim of this study is to present cases of deppresive disorders after wishplash cervical spine injuries in young females

4 cases are presented. Range of age between 20 and 30 years old. All of them reported depressive disorders during the post traumatic period after wishplash cervical spine injuries mainly due to road traffic accidents.

All of them they receive appropriate neurological, psychiatric, psycological and rehabilitation support and treatment. They managed to have a good outcome after 12 months follow up.

The development of depressive disorders after such traumatic events remains a strong predictor of a variety of difunctions (social, personal, work etc). The emergence of depressive disorders in many cases remains unexplored and poorly understood. The effect into the the overall health remains a very important factor to investigate. The combination and collaboration of the various medical disciplines is essential in order to help young people.

No significant relationships.

Studies indicated that breast cancer cause alexithymia that having adverse effect on resilience. Recognizing and expressing emotions are very crucial to cope with the difficulties.

This study aimed to examine the role of alexithymia on psychological resilience and related variables in women with breast cancer.

In this descriptive study, 70 women with breast cancer who apply to a medical oncology outpatient between June 2019-February 2020 were included. 9-questions questionnaire was used to determine the sociodemographic and cancer related characteristics of the participants. The Multidimensional Scale of Perceived Social Support (MSPSS), Toronto Alexithymia Scale (TAS-20), Psychological Resilience Scale (PRS) were used to determine perceived social support, alexithymia and psychological resilience levels. Descriptive statistics, correlations, ANOVA and t-test were used for data analysis.

The MSPSS (20.07 ± 10.54) and TAS-20 were found low (47.71 ± 11.96) and PRS were high (132.24 ± 16.47). A negative, weak, significant relationship was found between the alexithymia (r=-0.370, p=0.02) and perceived social support (r=-0.496, p=0.01) with psychological resilience. There was no significant difference between the psychological resilience and age, education level, marital status, having children, profession, employment status, duration of illness, type of treatment, having metastases, and becoming caregiver (p> 0.05).

The psychological resilience of women with breast cancer was negatively related to their alexithymia and perceived social support levels. It indicates that being able to recognize the emotions and having social support systems would positively affect the recovery process.

No significant relationships.

Pediatric acute bacterial meningitis is a life-threatening illness that results from bacterial infection of the meninges and leaves some survivors with significant sequelae. Given the potential trauma induced by the disease itself and the hospitalization, it is important to have an insight on how the parents cope with this aversive event, and especially how they give sense to this experience.

(1) To explore the lived experience of close family ascendants whose child or grandchild had survived acute bacterial meningitis (2) To investigate how they give meaning to this specific experience.

Participants were recruited through two association of persons affected by meningitis. Convenience sample of eleven family ascendants. Their family descendants were aged between 0.2 and 20 years old at the time of the meningitis diagnosis (M= 4.1, SD= 7.3). In average, 9.4 years had passed between the onset of illness and the relative’s interview (SD= 5.4).

6 superordinate themes and 2 meaning-making processes were identified: 1. Sick child becoming a “hero” (comparison with other children). 2. Engaged action/attitude: finding the “positive” of the traumatic experience and engaged action to improve the care system.

This is one of the first studies exploring the first-hand experience of family ascendants confronted to acute bacterial meningitis. Findings highlighted factors characterising the disease experience and the psychological adjustment of meningitis survivors’ families. They demonstred (1) the multidimensional impact of the disease on family ascendants and their need for professional psychological support, (2) the importance of direct involvement of parents in identifying key aspects of care.

One of the central debates in the psychiatric community is the difficulty in distinguishing Dissociative Identity Disorder (DID) from Borderline Personality Disorder (BPD). The fact that core symptoms of these pathologies such as emotional dysregulation, alterations in sense of Self, amnesia, depersonalization, self harm, hearing voices, difficulties in maintaining relationships, are symptoms that feature in both disorders can lead physicians to a misdiagnosis, thus depriving patients with DID of adequate treatment.

To report a complex clinical case of a DID patient initially misdiagnosed as BPD.

Clinical case report.

A 45-year-old Caucasian woman with a history of childhood intrafamilial sexual abuse and domestic violence, substance use disorder, autolesionistic and suicidal behaviour with an active diagnosis of BPD presented to our ambulatory mental health care service. A more thorough examination revealed a history of emotional and affect dysregulation, depersonalization, amnesia, intrusive traumatic memories and nightmares with affective, cognitive, and sensorimotor aspects, persistent negative Self-perception. Auditory verbal hallucinations were also present described as inner space with commentary and derogatory nature with one of them being a child voice. The diagnosis of tertiary structural dissociation and DID was finally made when three Apparently Normal Personalities emerged with several Emotional Personalities, authorising for cautious partial pharmacological washout and initiation of three phase-orientated treatment approach.

DID is more common than is assumed and the overlap of core symptoms with other disorders can lead to a misdiagnosis. A careful clinical interview and evaluation of symptoms is mandatory to a correct DID diagnosis with a consequent appropriate therapy.

No significant relationships.