Negative symptoms are a key aspect of schizophrenia, significantly impacting a patient’s functioning and quality of life. Although hospitalizations are often associated with positive symptoms, negative symptoms can also dominate the clinical picture in in-patients. Female patients are usually underrepresented in schizophrenia studies.

To analyse the changes of negative symptoms in female in-patients.

This was an observational study with data recorded at hospital entry and release. Adult inpatients with a schizophrenia diagnosis according to the International Classification of Diseases 10th edition who exhibited predominant negative symptoms according to clinical judgement were included. Patients received pharmacological and some non-pharmacological treatment as usual.

The primary outcome measure was the modified Short Assessment of Negative Domains (m-SAND), an anamnesis-based scale that is composed of 7 items: two positive items (delusions and hallucinations) and five negative items (anhedonia, alogia, avolition, asociality and affective flattening). Each item is rated from 0 to 5 (not observed; mild; moderate; moderately severe; severe; and extreme). Other measurements included the Self-evaluation of Negative Symptoms (SNS).

Least squares (LS) means were calculated for the change from baseline to final visit using a mixed model for repeated measures (MMRM).

63 female patients were included in the study. The mean age was 41.6 years with 14.2 years of mean duration of illness. All patients had predominant negative symptoms, in fact, 65% of them was hospitalized because of it. 30% of the patients also had secondary negative symptoms, mainly due to positive symptoms. The mean duration of hospital stay was 38 days. All patients received pharmacotherapy. At baseline, 9.5% were on cariprazine monotherapy and 84.1% on cariprazine combined with another antipsychotic such as olanzapine (23.8%) or quetiapine (7.9%). By the end of the hospital stay, 14.3% of female patients received cariprazine monotherapy and 82.5% cariprazine combination treatment with olanzapine (30.2%) or clozapine (15.9%). Significant decrease was detected in m-SNAD total score (LS mean change from baseline: -10.95) and SNS total score (LS mean change from baseline: -9.74). Functioning increased from poor (76%) to ‘manifest disabilities’ according to PSP (81%).

In summary, female patients had significant improvement during their hospital stay in terms of negative symptoms. The most utilized pharmacotherapy during the hospital stay was cariprazine both in a form of mono- and polytherapy.

J. Dragasek: None Declared, Z. Dombi Employee of: I am an employee of Gedeon Richter Plc., originator of cariprazine., P. Herman Employee of: I am an employee of Gedeon Richter Plc., originator of cariprazine., V. Dzurilla Employee of: I am an employee of Gedeon Richter Plc., originator of cariprazine., Á. Barabássy Employee of: I am an employee of Gedeon Richter Plc., originator of cariprazine.

Children with mild intellectual disability (MID) face specific challenges threatening their development, particular their mental health. They face a heightened risk of psychopathology (Buckley et al. ANZJP 2020; 54 970–984). This heightened susceptibility is theorized to be shaped by a complex interplay of diverse socio-demographic factors experienced by these children, collectively known as social determinants of mental health (SDOMH), include ethnicity, socioeconomic status, household conditions, family dynamics, and neighborhood deprivation (Allen et al. IJP 2014; 26 392–407).

This study examined the collective and unique role of diverse social determinants of mental health (SDOMH) associated with mental health problems (MHP) for children with MID, compared to peers with and without MHP.

Combining microdata from Statistics Netherlands, municipality data from The Hague and mental health care records, this population-based case-control study included four groups aged 0-17 years (Mage = 10.6, 35.6% female). Two groups of children receiving outpatient mental health care for MHP with MID (n=505) and without MID (n=2,767), each with a matched control group from the general population (n=2,525 and n=13,835, respectively), were studied. Through multivariate logistic regression analyses, both MHP groups were compared to their control group and each other to examine the likelihood of a particular SDOMH associated with receiving mental health care for MHP in children with and without MID.

Children with MID receiving mental health care showed significant differences in multiple domains compared to their control group and to children receiving mental health care without MID. In the multivariate model, they were less likely to have European-born mothers, more likely to have parents with moderate or low education levels, and tended to live in smaller, single-parent, lower-income households. Similar, though less deviant, patterns were observed for children without MID receiving mental health care compared to the general population, except for parental education. Additionally, children without MID were more likely than their controls to reside in densely populated areas with lower neighborhood education levels.

Our study highlights that diverse SDOMH are associated with the likelihood of receiving care for MHP in children. Moreover, children with MID face disproportionate disadvantages, particularly regarding low parental education and household income. Thus, interventions should not only target the child but also their family and environmental context.

None Declared

The nature-based therapeutic perspective includes: green therapy, blue therapy, animal-assisted therapy, and natural landscape therapy. Until now researchers haven’t clearly recognized underlying mechanisms of nature-related mental health well-being.

The study aimed to clarify the relationships between experienced nature connectedness (NC) and social connectedness (SC) before and after blue nature based intervention and mental health (WHO-5, PHQ-4)

Study group included 54 adults (Mean = 30.6; SD 13,2). Participants completed semi-structured questionnaires before and after blue interventions (one week high sea sailing under supervision of two psychologists). The questionaire measured following variables: nature connectedness, social connectedness, well-being, and mental health.

Results showed a significant increase in social and nature connectedness as well as in mental well-being after the blue interventions. Full results will be shown on the e-poster.

The mental health and wellbeing benefits of contact with nature are becoming increasingly recognized in psychology and medicine. The findings support hypothesis that nature connectedness and social connectedness increased after nature based interventions, and therefore they seem to be important factors conected with mental health.

None Declared

While gambling problems are increasingly recognized as a public health concern, knowledge of the prevalence and impact within psychosocially vulnerable populations is scarce. Never before has the prevalence of gambling problems been studied in a forensic psychiatric patient population. Given the risk for gambling problems to exacerbate existing mental health conditions, cause financial strain, and contribute to criminal behavior, understanding its prevalence and associated factors within this population is critical.

The study aims to estimate the prevalence of gambling behavior and gambling problems among forensic psychiatric patients in Denmark and compare the results to the general Danish population. Additionally, the study seeks to identify associations between psychosocial and demographic variables and the occurrence and severity of gambling problems. Lastly, the study will explore gambling motives and their relation to gambling problems in this patient population.

This observational, cross-sectional study will include inpatients and outpatients in Central Denmark Region forensic psychiatric care and inpatients in Capital Denmark Region forensic psychiatric wards from June 1 to December 31, 2024. Participants must be 18, and speak Danish, English, or Greenlandic. Data will be collected via self-report questionnaires and electronic patient records. Key measures include gambling behavior (past year gambling, frequency, and expenditure), gambling problems (the Problem Gambling Severity Index), and gambling motives (the Gambling Motives Questionnaire-Financial).

Data collection ends by December 31, 2024; preliminary findings will be presented at the conference.

Results will provide valuable insights into the prevalence and characteristics of gambling problems in this population, informing clinical care and potentially guiding the development of targeted interventions. By highlighting the need for attention to gambling issues in forensic psychiatric settings, the study may enhance rehabilitation and recovery efforts and successful discharge by addressing potential risk factors for recidivism.

None Declared

The Epidemiological Study of Cognitive Impairment in Schizophrenia (EPICOG-SCH) is a brief battery to screen for cognitive impact of schizophrenia in outpatient settings. The EPICOG-SCH includes well-known subtests available worldwide that cover key cognitive domains demonstrated to be related to a variety of functional outcomes. Novel composite scores are modelled to predict patient’s functionality in daily life at short, mid and long term.

We want to progress in the elaboration of specific algorithms first episodes of schizophrenia at different follow up periods by modelling cognitive performance to predict short, mid and long term functionality.

Data for the present investigation were obtained from an the epidemiological and three-year longitudinal intervention program of first-episode psychosis (PAFIP) conducted at the outpatient clinic and the inpatient unit at the University Hospital Marques de Valdecilla, Spain. The cohort is composed by 167 patients with a diagnose of Schizophrenia and 160 healthy controls recruited between February 2001 to February 2014. For all analyses, a subset of measures was selected corresponding to the EPICOG-SCH domains with the Rey Auditory Verbal Learning Test (RAVLT) task ifor Logical Memory. Functional outcomes were measured by the Disability Assessment Scale (DAS) and the General Assessment for Function (GAF) scales. Functional measurements were conducted regarding premorbid, baseline set at clinical stabilization and 1, 3 year follow-up, and cognitive assessments where conducted at baseline and 1, 3 years of follow up.

A cohort of 122 patients and 114 Controls completed the study with a 3-year follow up were included in the analysis. Changes across evaluations is tested in patients and controls. A regression analysis including the different EPICOG-SCH subtests at baseline as predictors of functionality at the different time points to explore the best predictive algorithms at 1 and 3 years of patient’s functionality in daily life following a first-episode.

The EPICOG-SCH brief battery is modelled to be a useful first to screen for the cognitive impact of schizophrenia in daily functionality daily life. This research work will validate the composite scores for a context of use of first-episodes schizophrenia and follow up. To date it has not been described an efficient and straightforward way for clinicians working with schizophrenia to transfer quantitative information about patient cognitive profile into real life. The EPICOG-SCH global composite score provides valuable information to clinicians which can facilitate disease management, drawing a roadmap for cognitive rehabilitation, and planning of supportive resources from the community and health care system.

None Declared

Schizophrenia is associated with impaired mentalizing abilities, often conceptualized through Theory of Mind (ToM) paradigms, which highlight deficits in understanding cognitive and affective mental states. Empirical findings suggest that affective ToM impairments reduce the likelihood of violence, while deficits in cognitive ToM may increase its propensity. However, phenomenological approaches challenge the primacy of ToM, suggesting that schizophrenia’s core disturbance lies in the embodied self, specifically in the domain of interaffectivity—the pre-reflective, affective resonance between self and others.

Interaffectivity, rooted in early embodied interactions, forms the foundation of social and emotional connectedness. In schizophrenia, disruptions in this fundamental capacity result in a disconnection from the social environment and a breakdown in shared affective states. This disturbance may contribute to violence by impairing empathic resonance and fostering misinterpretations of social cues.

Phenomenological approaches offer a critical lens for understanding these disturbances, emphasizing the embodied and relational aspects of schizophrenia. By shifting the focus from purely cognitive deficits to fundamental disruptions of interaffectivity, these approaches may provide a roadmap for developing interventions that address the precursors of violence, fostering a multifaceted understanding and management of schizophrenia.

None Declared

Chronic pain is very prevalent in the population, with an estimated prevalence of 20.5% of the adult population experiencing pain every day or most days. Chronic pain is one of the main factors that generate dysfunctionality in patients, and it can even lead to dependence in activities of daily living. Chronic pain is strongly associated with depression, and can induce a major depression which, due to its characteristics, will become chronic. Several studies have shown that intravenous ketamine can be effective in the treatment of chronic pain. Major depression associated with chronic pain has a worse outcome and is more frequently associated with resistance to pharmacological treatment, making the management of these patients a clinical challenge.

The present study shows the response in a series of cases with major depression and chronic pain treated with inhaled esketamine, showing their evolution through the Montgomery-Asberg Depression Rating Scale (MADRS) and Fibromyalgia Impact Questionnaire (FIQ) as main outcomes.

The main objective of this study is to describe the use of inhaled esketamine in patients with major depression and chronic pain in real clinical practice, using the MADRS and FIQ as main outcomes to show the evolution.

Retrospective descriptive study with a sample selected by non-probabilistic consecutive sampling, retrospective type, in a time interval of 2 years. The patients selected were those who completed treatment with inhaled esketamine and had a diagnosis of major depression and a diagnosis of chronic pain at Hospital Universitario Infanta Elena. A descriptive analysis was performed. Mean and standard deviation were calculated for quantitative variables and N and percentage for categorical variables.

A total of 5 patients with a diagnosis of major depression and chronic pain (n: 5) all treated with inhaled esketamine were included in the study. The efficacy of inhaled esketamine was high in the reduction of pain during the months of treatment with it, presenting an improvement in the MADRS and the FIQ. At the end of treatment, there was a significant difference between patients who had made changes in their daily life habits (sport, improved daily activities, improvement in the quality of life) and those who had not made changes in their daily life habits.

This study shows that inhaled esketamine may be a useful drug in the treatment of major depression associated with chronic pain. Treatment with esketamine improved depressive symptoms and also chronic pain. A significant influence of changes in lifestyle habits was observed in maintaining the response to pain relief once treatment with esketamine was finished. Longitudinal studies must be carried out to confirm this hypothesis.

None Declared

The scientific literature recognizes the Gut-brain axis (GBA) as a crucial connection between gastrointestinal health and mental well-being. Patients with inflammatory bowel disease (IBD) are at a disproportionately higher risk of developing psychiatric disorders due to factors including gut dysbiosis and chronic inflammatory changes. Recent developments in artificial intelligence (AI) and machine learning, provide novel opportunities to predict the comorbid psychiatric outcomes in patients with IBD by analyzing complex datasets including but not limited to the gut microbiome and neuroimaging data.

This systematic review discusses the current evidence for AI-driven models to aid in the prediction of psychiatric disorders in IBD patients, with a focus on their performance and potential challenges around their clinical implementation.

A systematic search on PubMed, EMBASE, Scopus, and Cochrane databases, identified 28 studies utilizing AI-based models to examine gut microbiota and neuroimaging data in patients with IBD. Data extraction illuminated the following artifacts: classification thresholds (i.e. predictive), relevant supervised learning or deep learning modeling (e.g. random forest classifiers, convolutional neural networks, and unsupervised models like attention-based learning), sensitivity, specificity, accuracy, and both accuracy measures and AUC-ROC curve values.

A pooled analysis of the included studies demonstrated an estimated sensitivity of 81% (95% CI: 77-85%) and specificity of 78% (95% CI: 73-82%) to predict psychiatric disorders in patients with IBD with the highest predictive accuracy elicited by studies based on microbiome and neuroimaging data. Yun et al. (2024), for instance, demonstrated a predictive accuracy of 86% using microbiome profiles and structural brain imaging data while Fil et al. (2024) elucidated the positive correlation between gut dysbiosis and psychiatric symptoms based on microbial signature models. Additionally, the variability noted in the predictive performance of the models was found to be based on the patient population, quality of data, and machine learning strategy.

AI models present promising evidence in predicting psychiatric disorders in IBD patients by leveraging microbiome and neuroimaging datasets. Overall, the meta-analysis reports strong predictive strength with high sensitivity and specificity. Future work in this field should focus on the validation of these prediction models in various clinical populations, improving their generalizability and standardization to enable widespread use and integration in the field of personalized psychiatry, especially in patients with IBD.

None Declared

Work-related mental health issues are becoming increasingly prevalent, particularly in professions involving direct communication and care, such as healthcare. Primary Health Care (PHC) plays a critical role in prevention, health promotion, and the management of emergency situations. The mental and emotional well-being of healthcare professionals in PHC is essential for maintaining high levels of performance and work effectiveness. However, there is limited research on the psychosocial conditions of healthcare staff in PHC settings, particularly regarding anxiety, stress, depression, and psychological distress.

The objective of this study is to evaluate the prevalence of anxiety, stress, depression, and psychological distress among medical and nursing staff working in primary healthcare units in Peloponnese. Additionally, the study aims to examine the associations between these mental health indicators and various individual and professional characteristics, such as age, gender, and professional role.

An online survey was conducted to gather data from a final sample of 103 healthcare professionals. A questionnaire was constructed ad hoc and comprised two well-established measurement tools. The Depression, Anxiety, and Stress Scale (DASS-21) was employed to assess anxiety, stress, and depression, while the K6+ was used as a self-report measure to evaluate psychological distress.

The results demonstrated that the participants exhibited generally low levels of anxiety, stress, and depression. As indicated by the DASS-21 scale, approximately 75% of respondents reported minimal to no anxiety, with only 7.8% reporting severe anxiety. Similarly, 75% of respondents indicated minimal to no stress, with only 4% reporting severe stress. Regarding depressive symptoms, 76% of participants exhibited minimal to no depressive symptoms, while only 4% demonstrated severe depressive symptoms. However, approximately 20% of the sample exhibited signs of psychological distress, which may indicate a significant mental health concern. Significant correlations were found through statistical analysis: older employees exhibited lower levels of anxiety, while nursing staff demonstrated higher levels of anxiety compared to medical staff. Additionally, women reported higher anxiety levels than their male colleagues.

In conclusion, while anxiety, stress, and depression levels are generally low among healthcare professionals, a notable portion of the workforce is at risk of serious psychological distress. These findings indicate the need for targeted mental health interventions, particularly for younger staff, nurses, and female employees, to ensure the well-being of healthcare professionals and maintain the efficacy of primary healthcare services.

None Declared

Adropin is a unique hormone or biomarker that is produced in the liver, brain, and peripheral tissues such as the heart and gastrointestinal tract. It was discovered in 2008 by Kumar and others. It is encoded by a gene associated with energy homeostasis. Adropin plays a key role in the development of various CNS disorders such as stroke, schizophrenia, bipolar disorder, Alzheimer’s disease, and Parkinson’s disease.

Depressive disorder affects a large number of people worldwide, with symptoms such as loss of energy and motivation, sadness, fatigue, and weakness significantly impacting quality of life and functionality. Numerous studies have shown that depression has various neurobiological mechanisms. Deregulation of energy metabolism in the brain is one of the mechanisms associated with the onset of depressive disorder. Adropin can activate BDNF, and since BDNF plays a crucial role in neurogenesis, synapse formation, plasticity, learning, memory, and has a neuroprotective function, adropin may play an important role in the development of depression.

We conducted a study in which we examined adropin concentrations in depressive disorder in individuals who were diagnosed with depression for the first time and compared adropin levels with healthy controls. We followed up with depressive patients after six months of introducing SSRIs (Selective Serotonin Reuptake Inhibitors) antidepressants.

The adropin values after the introduction of antidepressants and improvement of depressive symptoms were significantly higher after six months compared to the initial blood draw.

Our study measured serum adropin levels in patients who had not previously been treated for depressive disorder. After introducing SSRIs (Selective Serotonin Reuptake Inhibitors) and six months after the initiation of therapy, we repeated the adropin measurements. The results showed a statistically significant difference between the first and second measurements. In the second measurement, adropin levels were higher than in the first. We can conclude that with the improvement of depressive symptoms, the serum adropin levels, as a neuroprotective biomarker, also increased.

None Declared

Huntington’s disease (HD) is a hereditary neurodegenerative disorder characterized by motor, cognitive, and psychiatric symptoms. Initially, the patient’s involuntary movements were attributed to anxiety-related restlessness and psychomotor agitation, leading to a diagnosis of anxiety disorder. During hospitalization, the patient was referred to neurology for his movements, where functional movement disorder was considered. However, due to worsening cognitive decline, apathy, and the psychiatrists’ suspicion that the movements were not functional, further investigations were conducted. Cranial MRI, followed by a dementia protocol MRI, revealed caudate nucleus atrophy, leading to the diagnosis of HD.

To illustrate the diagnostic challenges in identifying Huntington’s disease in a patient initially misdiagnosed with anxiety disorder and functional movement disorder.

A 58-year-old male presented with anxiety and involuntary movements, leading to initial diagnoses of anxiety disorder and functional movement disorder. As symptoms progressed—including worsening involuntary movements and cognitive decline—a comprehensive reassessment was conducted. This included neurological examination, neuroimaging, neuropsychological testing, and genetic testing via blood test for CAG repeat analysis.

Cranial MRI revealed bilateral caudate atrophy and dilated lateral ventricles, consistent with Huntington’s disease. Neuropsychological assessment showed significant impairments in verbal learning, memory, and executive function. The patient was treated with venlafaxine 150 mg/day, mirtazapine 30 mg/day, and haloperidol 6 drops/day, leading to significant improvement in anxiety symptoms and a reduction in chorea.

This case underscores the importance of considering neurodegenerative disorders such as Huntington’s disease in the differential diagnosis of patients presenting with psychiatric symptoms and involuntary movements. Early identification, comprehensive assessment, and a thorough understanding of HD’s clinical presentation are crucial for appropriate management.

None Declared

Institute of Mental Health (IMH) is the only tertiary psychiatric hospital in Singapore and does not provide acute medical care. The on-call doctors, who are Advanced Cardiac Life Support (ACLS) certified, respond to medical emergencies. Resuscitation skills are expected to decay with time when not used frequently and thus can pose an important challenge to maintain the doctors’ skills in settings with low volumes of code blue situations (Au et al. Resuscitation 2009;138:284-296). Our code blue aduits revealed significant competency gaps. IMH introduced a biannual resuscitation training program which includes a video demonstration of the optimal code blue response, hands-on session to review airway management techniques, operation of the defibrillators used in IMH, recognition and management of cardiac arrest rhythms including a pre-course ECG worksheet, familiarisation with the emergency drugs used in IMH, and a code blue drill. Due to COVID-19, the original course was shortened by removing the video demonstration and code blue drill, augmenting the home-based question paper with IMH-specific clinical vignettes.

We aimed to determine the common conditions resulting in code blue activations and whether the modified course was equivalent to the original course or ACLS in maintaining resuscitation currency and doctors’ confidence in responding to emergency scenarios.

Data was collected from June to August 2023 with consent via an electronic feedback form, to reduce non-response bias, from doctors who have responded to code blue activation in IMH. Qualitative justification on the responses were collated. Efforts were made to collect at least 25 responses from doctors with different levels of experience to minimize sampling bias. Surveys were anonymised, questions were vetted by 2 senior doctors and the survey was kept short to reduce response bias. Binary responses were tabulated for analysis and content analysis was done for feedback obtained.

Of 28 respondents, most were Psychiatry trainees (60.7%) with 1-2 years of experience working in IMH (36.7%) and more than 30 overnight duties (53.6%). The most commonly encountered emergency scenarios were hypotension (31%) and desaturation (20%). 92.9% of participants agreed that the modified course was useful for emergency scenarios faced. 53.6% of participants attended both the full and modified course, amongst whom, 60% reported that the modified course was equivalent to the full course. Only 50% felt that ACLS alone would suffice. Qualitative feedback obtained from participants reiterated that it was a context-specific and timely refresher course.

IMH doctors were satisfied with the modified resuscitation course and found it effective for frequently encountered emergency scenarios suggesting it as a valuable training adjunct in low code blue volume settings.

None Declared

Sleep deprivation (SD) is a global health concern that impairs cognitive and psychomotor functions (PF). While it can temporarily improve mood, its effects on mood and connection to depressive symptoms (DS) remain unclear. These impacts may involve circadian rhythm gene regulation, though distinct evidence from human studies is lacking.

To assess the impact of SD on the expression of circadian rhythm regulation genes and its associations with the alleviation of DS. Additionally, to explore the relationship between changes in gene expression and PF following SD.

Participants (n = 72) underwent a baseline sleep assesment by polysomnography (PSG), later being subjected to SD. In total, evaluation of mood And cognitive functions (Bimanual Eye-Hand Coordination Test - BEHCT) was conducted four times, pre/post PSG and SD. Moreover, circadian rhythm regulation genes expression: Circadian Locomotor Output Cycles Kaput (CLOCK), Brain and muscle Arnt-like protein-1 (BMAL1), Period Circadian Regulator 1 (PER1), Cryptochrome Circadian Regulator 1 (CRY1), Nuclear Receptor Subfamily 1 Group D Member 1 (NR1D1) and Neuronal PAS Domain Protein 2 (NPAS2) was evaluated. Participants were divided into respondents (RE, n = 49) and non-respondents (NR, n = 23) depending on changes in DS under the influence of SD by the Montgomery–Åsberg Depression Rating Scale evalluation.

No relationship was found between BEHCT parameters and the studied genes in the entire study group. NRs exhibited a negative correlation in number of motor function errors in relation to all examined genes of CLOCK (r=-0.52, p=0.02), BMAL1(r=-0.55, p=0.007), CRY1(r=-0.45, p=0.048), PER1(r=-0.6, p=0.023), and NR1D1 (r=-0.19, p=0.523) is except for NPAS2. Additionally, In NRs, the BEHCT error time negatively correlated with the PER1 and NR1D1 (r=-0.6, p=0.006; r=-0.52, p=0.045; respectively). In contrast, within the RE group, only NPAS2 expression showed a positive correlation with the number of errors (r= 0.35, p=0.049).

Reduced expression of CLOCK, BMAL1, CRY1, PER1, and NR1D1 is associated with impaired PF, only in individuals with worsening DS after SD. Increased NPAS2 expression appears to be an orgin of reduced PF results in the RE group. These genes, integral to the circadian system’s feedback loop, may mediate the complex effects of SD on mood and cognitive function, warranting further investigation.

None Declared

Psychiatric patients, especially those with psychotic disorders, face an increased metabolic and cardiovascular risk, which ultimately leads to higher mortality from cardiovascular disease and reduced life expectancy. This is due to a multitude of risk factors, including those related to the course of the mental illness, lifestyle, socioeconomic and cultural circumstances, and the use of certain medications, such as atypical antipsychotics. This underscores the need for structured interventions during hospitalization to identify and manage these risks. Non-pharmacological interventions, such as physical activity and dietary education, have shown to be beneficial in managing weight and improving cardiovascular health. Pharmacological treatments, particularly the use of metformin and aripiprazol, have demonstrated efficacy in reducing metabolic disturbances such as weight gain, dyslipidemia, and hyperglycemia. The implementation of structured protocols to mitigate metabolic risk in psychiatric inpatients is recommended.

The main goal of the protocol is to guide the assessment, diagnosis, and therapeutic management of metabolic and cardiovascular risk factors in psychiatric inpatients. It also aims to guide the follow-up of these patients after discharge and coordination with other medical specialties.

The protocol was developed in an interdisciplinary manner, involving the specialties of Psychiatry, Endocrinology, and Internal Medicine, and is based on recent guidelines and recommendations from other countries on this matter. The protocol was also adapted to the current conditions of the psychiatric inpatient setting.

The protocol involves a thorough clinical evaluation, including medical history, physical examination, and extensive laboratory analysis to identify comorbidities. Cardiovascular risk is calculated using the SCORE2, PRIMROSE and QRISK3 models. Non-pharmacological interventions include physical activity programs and nutritional counseling, while pharmacological interventions involve adjusting antipsychotic medications, selecting antipsychotics with more favourable metabolic profiles, and the adjuvant use of medications like metformin, aripiprazol, and topiramate. These evaluations are conducted at regular intervals, including post-discharge, to assess the efficacy of these interventions.

Psychiatric inpatients, especially those on atypical antipsychotics, face significant metabolic and cardiovascular risks. A comprehensive assessment of risk factors and early intervention during hospitalization, combining lifestyle modifications and pharmacological treatments, can significantly reduce these risks and improve patient outcomes. Continued monitoring and coordination with outpatient services post-discharge are essential for sustained management of these health risks.

None Declared

Postpartum depression (PPD) affects approximately 9% of new mothers and can have profound consequences on both maternal well-being and infant development. Additionally, around 50% of women experience depressive symptoms or mood disturbances during pregnancy and lactation. A growing body of research suggests a potential link between omega-3 polyunsaturated fatty acids (PUFAs) and mood regulation, particularly in the prevention of PPD. Omega-3 PUFAs, primarily docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), are found in high concentrations in oily fish and seafood. Over the past century, dietary intake of omega-3 fatty acids has significantly declined in industrialized societies, coinciding with increased rates of mood disorders. Notably, populations with higher fish consumption, such as those in Hong Kong, China, and Japan, report lower incidences of depression compared to Western countries, where lower fish consumption has been linked to higher rates of PPD. During pregnancy and lactation, women become particularly depleted in omega-3 PUFAs, as these essential fats are preferentially diverted to support fetal development, potentially increasing the risk of depression in mothers.

This study aims to explore the effectiveness of omega-3 PUFAs in preventing PPD.

A comprehensive literature review was conducted to evaluate the effectiveness of Omega-3 in preventing PPD. The search was performed on PubMed using key terms such as “Omega-3,” “Postpartum Depression,” and “Prevention.”

In one study, women with low LCP intake were supplemented with 220 mg of DHA, which had no effect on depression, like in another study that reported no effect of 1,8 g of Omega-3 PUFAs on maternal depressive symptoms. Another trial involving 2,399 women found no significant difference in depressive symptoms between those receiving 800 mg of DHA and a control group during the first six months postpartum. A randomized controlled trial of 126 women at risk PPD also showed no benefit from EPA or DHA supplementation in reducing Beck Depression Inventory (BDI) scores compared to placebo. A meta-analysis of 11 trials (N = 3,181) similarly found no significant difference in depression scores between Omega-3 and placebo groups, and no association between the daily doses of DHA or EPA and PPD prevention

Based on the reviewed trials, there is insufficient evidence to recommend Omega-3 fatty acid supplementation (DHA and EPA) at any dosage for the prevention of postpartum depression.

None Declared

Chronic pain is a prevalent issue among breast cancer survivors, often causing significant distress, disability, and interference with daily activities. Affecting around 18% of the global population, chronic pain is the leading cause of years lived with disability. Among breast cancer survivors, it has become a key focus due to its high prevalence and impact on quality of life.

To assess the prevalence and characteristics of chronic pain in breast cancer survivors and examine its correlation with anxiety, depression, and interference with daily life activities.

This is a cross-sectional descriptive and analytic study conducted on 100 women treated for breast cancer at the medical oncology department of Fattouma Bourguiba University Hospital. The study spanned eight months (June 2021–February 2022). Pain characteristics were assessed, and anxiety and depression levels were measured using the Hospital Anxiety and Depression Scale (HADS). Pain-related catastrophic thinking was evaluated with the Pain Catastrophizing Scale (PCS), and family functionality was measured using the Family APGAR score.

The study involved 100 breast cancer survivors, with a mean age of 53.6 ± 10.1 years.

Our entire population confirmed having chronic pain for more than 3 months, most of them (53%) had it from 2 to 5 years

The median duration of chronic pain was 3 years [IQR: 2-5], with the most common pain locations being the breast area (72%) and upper limb (27%). Pain intensity was predominantly mild (62%), followed by moderate (34%), and severe (4%).

Chronic pain significantly interfered with daily activities, especially in patients with moderate to high pain intensity (p < 0.001), affecting both affective and activity clusters. The mean Pain Catastrophizing Scale score was 7.79 ± 5.25, indicating mild catastrophic thinking, which was most likely due to the low pain intensity experienced by the majority.

Anxiety levels were significantly correlated with higher pain intensity (p = 0.013), whereas depression, though elevated in patients with more severe pain, did not demonstrate a statistically significant association (p = 0.135).

The majority of participants were from highly functional families, with 88% reporting strong family support

Despite the prevalence of chronic pain, fatigue was not significantly related to pain intensity.

Chronic pain in breast cancer survivors significantly interferes with daily activities, particularly among those with moderate to high pain intensity. Anxiety is notably more prevalent in patients experiencing more severe pain. These findings underline the importance of comprehensive pain management strategies and psychological support for breast cancer survivors.

None Declared

Laughter can be regarded as a distinct form of cathartic experience, arising from the violation of various well-established cultural norms. The balance between the emotions of laughter and fear depends on the extent and nature of the norm violation, as well as the specifics of its perception. The development of regulatory functions enables younger schoolchildren to comprehend increasingly complex forms of humor, which involve the transgression of cultural norms—ranging from behavioral violations to breaches of logical and linguistic norms.

To examine the specific features of humor perception and production by younger schoolchildren, as well as the potential for regulating their subjective experiences of danger and safety in situations involving norm violations in humor.

The empirical study involved 360 younger schoolchildren (aged 7-10). The “Sometimes It Happens” (T. Artemyeva) method was used to study humor. The analysis of the schoolchildren’s responses was based on the following indicators: identification of rules (norms) in academic, extracurricular, and family interaction situations; the creation of humorous event scenarios; and the selection of event outcomes (adaptive or maladaptive humor).

The study revealed that the development of regulatory functions in younger schoolchildren allows them not to fear violating certain cultural norms or rules of social interaction in a joke. The positive correlation between maladaptive event outcomes and the identification of norms and rules by younger schoolchildren indicates the development of their regulatory function, mastery over their own cognitive processes, and their ability to interpret “dangerous” or “fear-inducing” scenarios as subjectively non-threatening, allowing them to emotionally distance themselves from such situations. Younger schoolchildren recognize the potential of humor in violating cultural norms, understanding that something in the event does not occur as it should according to the rule. In the child’s view, adherence to cultural norms guarantees a sense of safety in interactions with adults and peers.

The findings of the study provide a foundation for the development of programs aimed at enhancing the regulatory functions of younger schoolchildren.

This paper has been supported by the Kazan Federal University Strategic Academic Leadership Program (PRIORITY-2030).

None Declared

Infertility is a significant source of emotional stress for couples worldwide. In Tunisia, it affects approximately 15 to 20% of couples of reproductive age. Studies indicate that women experience higher rates of depression (35% vs. 15%) and anxiety (52% vs. 28%) compared to men, largely due to cultural pressures. For these reasons, understanding these gender differences in coping mechanisms is essential.

To analyze the coping styles of infertile couples and identify gender differences in coping mechanisms to inform tailored psychological support.

We conducted a cross-sectional study involving couples undergoing infertility treatment at a specialized Assisted Reproductive Technology center inTunis. The participants provided information related to socio-demographic data. Coping strategies were assessed using the Brief Cope scale administred in the Tunisian dialect. These strategies were classified into three categories: problem-focused, emotion-focused, and avoidant coping.

A total of 60 infertile couples participated in the study. The average age of men was 41.1±6 years, while the average age of women was 35.07±4 years. Among them, 68% resided in urban areas, and 73% were from a middle socioeconomic background. Educationally, 47% of women held a university degree, compared to 17% of men. Approximately half of the women were unemployed, while 52% of men were employed.

Problem-focused coping emerged as the most frequently utilized strategy (5.93±1.02), followed by emotion-focused coping (5.32±0.82) and avoidant coping (3.95±0.70).

Women significantly employed problem-focused and emotion-focused strategies more than men (p=0.017; p<0.01). They also scored higher in emotional support, expression of feelings, active coping, planning, and religious coping (p<0.05; p=0.01). Conversely, men displayed a greater inclination towards acceptance, distraction, and substance use.

In conclusion, addressing gender-specific coping strategies is essential for providing effective psychological support to infertile couples. Healthcare professionals should promote problem-focused coping to help couples actively manage their challenges.

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Depressive disorders and anxiety disorders are typical comorbidities in autism spectrum disorder (ASD), with a reported prevalence of 20% and 9%, respectively (Lai, 2019). Autistic subjects are more at risk for suicidal thoughts and behaviors compared to typically developing peers; moreover, depressive symptoms are often resistant to both pharmacological and psychotherapeutic treatments. In 2019 intranasal esketamine was approved in Italy for treatment-resistent depression (TRD). We observed two young outpatients affected by autism (diagnosis made by “Lab-Aut”, a specialized mental health service in Pavia) treated with esketamine in our ambulatory for TRD. Clinical information and personal details were summarized in Image 1.

To evaluate the clinical response to intranasal esketamine in subjects with major depression in ASD and to compare the outcome with neurotypical patients.

Autism diagnosis wase made according to ADOS-2 and ADI-R scores, confirmed by a clinical judgment of senior psychiatrist. Our follow-up protocol during esketamine treatment consists in the following scales: MADRS, C-SSRS, DES-II, Psychace Scale, Reading the Mind in the Eyes Test, HAM-A, HAM-D, BDI, PANSS. Psychometric evaluation was performed at T0 (before esketamine), T1 (one week of pharmacotherapy), T2 (one month), T3 (2 months) T4 (3 months) and T5 (6 months). We collected results from neurotypical patients (n=12) and autistic patients (n=2) between 2022 and 2024.

Both in autistic patients and in neurotypical ones we noticed a premature decrease in depressive symptoms and a reduction of suicidal thoughts. This improvement was testified by a reduction from T0 to T1 in MADRS total score and in C-SSRS sub-score focused on intensity of suicidal ideation. The reduction was maintained during the observation period (Image 2). Due to the small sample size of autistic patients, we couldn’t reach the statistical significance threshold for this population. Considering the entire sample (n=14) we obtained significant results (T0-T1: MADRS decrease p=0,00006, C-SSRS decrease p=0,00009. T0-T5 MADRS and C-SSRS variations p<0,00001). Comparing our sub-samples, it’s possible to notice a similar trend in follow-up between autistic and neurotypical patients. (Image 3).

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Our preliminary data coming from clinical experience suggest the efficacy of intranasal esketamine in depressive episodes occurring in autistic patients. A larger sample size of autistic patients will be necessary to set a comparative study and to give significance to these results. Esketamine could represent an important therapeutic option in depressed patients with ASD comorbidity.

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Ekbom syndrome, also known as delusional parasitosis, is a psychiatric disorder in which the affected person is firmly convinced that their body is infested with parasites, insects, or any other microorganism, despite the lack of medical evidence to support it.

A 56-year-old woman presents to the emergency department, referred by her primary care physician, due to a sensation of worms in her vagina and rectum. She reports that larvae are coming out of her nostrils, ears… and she feels them settling in her kidney. She is accompanied by her husband, who mentions that on some occasions, she has shown him the supposed parasite.

The objectives of this clinical case are to understand whether Ekbom syndrome can be related to any secondary organic pathology, as well as to identify the conditions with which the differential diagnosis should be made, and to determine the most effective treatments.

Examination: Sensory-perceptual disturbances in the form of cenesthetic hallucinations. High levels of anxiety with functional impact on her daily life.

Complementary tests: A referral was made to Internal Medicine to rule out the presence of parasites, and to Neurology for an MRI with contrast, which revealed a white matter lesion in the brainstem. Tests for anti-AQP4 and anti-MOG antibodies were also conducted, and both were negative. After these studies, it was concluded that the criteria for secondary Ekbom syndrome due to organic pathology were not met.

The differential diagnosis should be made with other psychiatric disorders such as schizophrenia, major depression, or substance-induced psychosis. Neurological diseases, such as dementia, multiple sclerosis, or meningoencephalitis, should also be ruled out. Lastly, it is advisable to rule out dermatological conditions, such as scabies.

Treatment was initiated with Risperidone and Alprazolam, with good response and improvement in delusional ideation.

Treatment with atypical antipsychotics is effective for this syndrome, reducing delusional ideas and significantly improving the psychiatric symptoms that accompany the delusion, such as anxiety, depression, and insomnia.

Good collaboration between different medical professionals is essential to rule out associated secondary pathology.

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