OPEN is a structured intervention program for patients who present with untreated psychosis at an early stage, under the guidance of a case manager and a periodic evaluation performed by a multidisciplinary team.

The aim of the OPEN program is to create an individual care plan, promoting recovery, functionality, quality of life and prevent relapses. One year after implementation of the program, we present the first results.

We performed a retrospective review of the patients’ clinical profiles included in the OPEN program.

Nine patients were included in the program. The most frequent diagnosis was schizophrenia (n=5). By the time of inclusion in the program, 5 patients used cannabis frequently; one patient kept substance use. At the 6th month assessment, 4 in 5 patients showed an improvement in social functioning (Personal and Social Performance Scale; ± 16 points), and a decrease in symptom severity in all (Brief Psychiatric Rating Scale; ± 11 points). Due to COVID-19 pandemics, group interventions were suspended, and some visits were performed by teleconsultation. No patients lost follow-up.

We observed an overall positive result of the first months of this program, regarding both functionality and clinical outcomes. The main obstacle so far is the impossibility of performing group interventions since the start of the contingency measures regarding COVID-19 pandemics. We expect further results of the OPEN program with the inclusion of more patients.

Insomnia is strongly associated with Major depressive disorders (MDD). There is strong evidence that it is one of the risk factor for suicide. Studies have shown the relationship of suicidal behavior in MDD patients with insomnia. However, it has not been evaluated in a large inpatient sample.

To evaluate suicidality in MDD patients with insomnia compared to those without insomnia.

From the National Inpatient Sample (NIS 2006-2015) database using ICD-9 code, we obtained patients with the primary diagnosis of MDD and comorbid diagnosis of insomnia disorders (MDD+S). We compared it with MDD patients without insomnia disorders (MDD-S) by performing a 1:2 match for primary diagnosis code in the unweighted dataset. Suicidal ideation/attempt data were compared between the groups by multivariate logistic regression analysis.

After the diagnostic code matching, 139061 patients were included in the MDD+S group and 276496 patients in the MDD- S group. MDD+S patients were older (47 years vs 45 years, p < 0.001) compared to the MDD-S group. Prevalence of Suicidal ideation/attempt was 56.0% in the MDD+S group and 42.0% in the MDD-S group (p < 0.001). After adjusting for age, sex, and race, MDD+S was associated with 1.8 times higher odds of suicidal behavior compared to the MDD-S group. (Odds ratio: 1.79, 95% confidence interval 1.68-1.91, p < 0.001).

Insomnia in MDD patients is significantly associated with the risk of suicide. It is important to be watchful for insomnia in MDD patients.

No significant relationships.

Faced with recent onset psychotic symptoms in patients over 60 years of age without a psychiatric history, it is important to carry out an adequate differential diagnosis.

The objective is to carry out a review of Charles Bonnet syndrome through the presentation of a case

75-year-old patient who suddenly began to present auditory hallucinations. The patient had no relevant psychiatric history or medical history. She reported that suddenly, two months ago, she had begun to listen to his neighbor through the walls of his home. She heard him talk about her, threatening and insulting her. Later, as a result of these hallucinations, she began to believe that in the bathroom he was spying on her through a camera, forcing her to shower in the dark. Weeks later, she thought that he was also chasing her down the street through a chip that had implanted her. She was distressed and highly anxious. She had started not sleeping out of fear of this neighbor.

In addition to the psychiatric evaluation, an MRI was requested to rule out incipient cognitive deterioration, as well as a hearing examination. It was found that he had severe hearing loss in the left ear. Given these findings, he was diagnosed with Charles Bonnet syndrome.

Charles Bonnet syndrome is normally associated with blindness, however, it is also described in deafness. It occurs with hallucinations of the lost sensory organ. It is a clinical picture that does not respond well to treatments.

No significant relationships.

The presence of psychological impact on relatives of patients admitted for Covid-19 has been described. The effectiveness of psychological first aid in critical situations has also been described. The first psychological aid describes a human response supporting another person who is suffering. This intervention is indicated for those affected by a traumatic event.

To present a theoretical review about psychological first aid and to describe data about it on relatives of patients admitted for Covid-19.

Literature review about psychological first aid and data description of telephone intervention carried out by mental health professionals on family members of patients admitted for Covid-19.

From an initial pool of 77 Covid-19 patients, 50 were selected as telephone contact with relatives was possible. Mean age was 68.9 years, 13 were female and 37 male. 90% were admitted in internal medicine department and 10% in intensive care unit. First telephone intervention in all cases was to introduce the psychiatrist in charge of the follow-up and provide contact number of psychiatry department. In 13 relatives` support, emotional ventilation and active listening was provided and 2 of them also received therapeutic guidelines. Further phone contact was required in 12 relatives. In follow-up phone calls, all relatives received therapeutic guidelines and 3 was referred to our outpatient clinic.

Family members of patients admitted for covid-19 may present emotional symptoms, many of them normal reactions in context of a crisis situation. A large percentage do not require a structured psychotherapeutic intervention but can benefit from a first psychological help.

No significant relationships.

There is no doubt that the symptoms of depression is the loss of appetite and loss the ability to taste food. However there is unanswered question how depression disorder impact different preferences of food tastes, which was sought to be explored in this study.

were to evaluate changes in characteristics of food tastes in patients with depressive disorder and healthy controls; and to find the association with clinical expression of depressive severity.

74 patients with depressive disorder (according DSM-V, MINI 6.0.0) and 38 healthy controls, 18 to 55 age old, were included into this study. The subjects were interviewed using the sociodemographic and the food sensory questionnaires. The severity of depression was rated using Montgomery-Asberg Depression Rating Scale (MADRS).

There were significantly more patients with depressive disorder in comparison to healthy controls preferred non-spicy taste of food (66.2 % vs. 47.4 % respectively, p=0.025) and non-sour taste of food (66.2% vs 50.0 %, respectively, p=0.015), without significant differences in preference of salty and sweet food tastes. Among study patients with depressive disorder, the majority (71.6%) suffered from moderate severe depression, 23 % - severe depression and 5.4 % had mild severity depression. The preferences of tastes of the food (sour, sweet, salty, spicy) were independent of the severity of the depressive disorder (p>0.05)

Patients with depressive disorder prefer non-spicy and non-sour food tastes, without differences in salty and sweet foods; it have found independent of the severity of the depressive disorder.

Therapist led interventions form a core element in the management of children with Autism Spectrum Disorder (ASD) in India. COVID-19 pandemic has disrupted several aspects of ASD management.

This study aims to understand the impact of COVID-19 pandemic on ASD therapies from a therapist perspective.

An online survey was conducted using a google form questionnaire disseminated among ASD therapists. The form was open for response between 23rd of June and 23rd of July 2020. The responses were extracted into an excel sheet and analysed using descriptive statistics.

41 out of 75 therapists with mean age of 44 years (21 – 58 years) responded to the survey. 48% were women. Majority of them were either special educators (49%) or ASD therapists (32%) with professional experience of >5 years (63%). Majority of the therapists felt that there is significant disruption during the pandemic with reduction in conventional therapies (63% to 17%) and increase in online therapies (15% to 61%). They also felt that this disruption had moderate to severe impact on child’s learning (73%) and parents emotional and psychological well being (85%). Only 22% of therapists were using digital based therapy (DBT) before the pandemic. Although 51% of the therapists were not entirely sure whether DBT augments parents and therapists’ efforts, majority (65%) were willing to use them.

COVID-19 pandemic has significantly disrupted ASD therapy in India. Willingness to use online and digital based therapies could open up a new dimension. Reliable and effective Artificial-Intelligence based therapies are the need of the day.

Medical advisor for CognitiveBotics

The Promoting Activity, Independence and Stability in Early Dementia (PrAISED) is delivering an exercise programme for people with dementia. The Lincolnshire partnership NHS foundation Trust successfully delivered PrAISED through a video-calling platform during the COVID-19 pandemic.

This qualitative case-study identified participants that video delivery worked for, and highlighted its benefits and challenges.

Interviews were conducted with participants with dementia, caregivers and therapists, and analysed through thematic analysis.

Video delivery worked best when participants had a supporting carer, when therapists showed enthusiasm and had an established rapport with the client. Benefits included time-efficiency of sessions, enhancing participants’ motivation, caregivers’ dementia awareness and therapists’ creativity. Limitations included users’ poor IT skills and resources.

The COVID-19 pandemic required innovative ways of delivering rehabilitation. This study supports that people with dementia can use tele rehab, but success is reliant on having a caregiver and an enthusiastic and known therapist.

The prevalence of adult Attention Deficit and Hyperactivity Disorder (ADHD) has been investigated in the general population by multiple studies. However, few studies have focused on identifying its prevalence in the military population, particularly among military parents of children with ADHD.

The aim of our study was to screen for adult ADHD among military parents of ADHD children followed-up at the child and adolescent psychiatry department in the Military Hospital of Instruction of Tunis, Tunisia.

This prospective study was carried among military parents (one or both parents belonging to the national army) of ADHD children. Children were diagnosed with ADHD based on the 5th Diagnostic and Statistical Manual ADHD criteria and the Conners Comprehensive Behavior Rating Scale. Whereas adult ADHD was screened for using the Adult ADHD Self-Report Scale-V1.1.

Fifteen children and twenty-nine parents were included in the study: sixteen of the parents were military members and thirteen were civilian spouses. Eight (50%) of the sixteen military parents, and four (30,7%) of the civilian spouses were screened positive for ADHD. Whereas 73% of these children had at least one parent screened positive for ADHD, and 53% had at least one military parent screened positive for ADHD. These results suggest a high prevalence of adult ADHD among this population.

ADHD occurs in childhood and may persist into adulthood. The findings of this study indicate that ADHD symptoms are not limited to the youth and are common in military population. Implications on screening, management, preventive measures and research should be discussed.

Epilepsy and its psychiatric comorbidities have been studied frequently over the course of the last years. However, few studies have aimed to establish the relationship between psychogenic non-epileptic seizures (PNES) and personality disorders.

The aim of the current study is to discuss the relationship between different personality disorders and PNES in comparison to patients diagnosed of epilepsy but no PNES.

A case of a 48 year old female patient who attends an intensive following unit at a psychiatric day hospital is presented. The patient was diagnosed with epilepsy at 25 years old. In the last 10 years she has grown completely dependent on her family, presenting at least one epileptic seizure or PNES during the day. She attends the psychiatric unit after neurologists diagnose highly frequent PNES with interference in her day to day routine. During her follow-up at the psychiatric unit different personality disorders are considered. Furthermore, PubMed, Web of Science and PsycInfo databases were searched, using a pre-established strategy in order to identify recent related studies. Afterwards, studies were selected in a systematized manner.

According to different studies up to 75% of patients with PNES have a comorbid personality disorder. Borderline personality disorder seems to be the most frequently simultaneous axis II diagnosis.

Psychiatric disorders are more frequent in patients with psychogenic non-epileptic seizures than patients with only epileptic seizures

Emigration is a widespread phenomenon in our country for the last three decades.Various risk factors for mental disorders are related to emigration,like social-economic status,language,cultural shock,racism etc.

The objectives of this study is assess how much of a risk factor is emigration in the development of psychiatric disorders.

This is retrospective study done on 178 patient charts from The Comunity Mental Health Center Nr.3 in Tirana,of patients who durin the last 20 years had their first episode of mental health disorder durin emigration.

Emigrants before year 2004 had more psychotic disoders,whereas those after that year manifested more mood disorders.The mean age for starting MDD is 35 years old,and the mean age for schizophrenia is 25.Females develope more mood disorders,whereas males manifest more schizophrenia.

Emigration affects deeply mental health,and is a risk factor for developing psychiatric disorders,with females being prone to have mood disorders,whereas males schizophrenia.Schizophrenia start in an earlier age compared to depression.

The rapid spread of the SARS‐CoV‐2 pandemic among the world poses challenges to the management of both physical and mental health. This unexpected situation could predict an exacerbation of anxiety, depressions, obsessions, and even multiple cases of psychosis.

The aim of this literature review is to identify and analyze studies conducted in 2020 that investigate the incidence of psychotic disorders, related to COVID-19 pandemic and describe its symptoms.

A systematic search in the PubMed electronic database was performed using keywords “COVID-19”, “pandemics”, “psychotic symptoms”, and “ first episode of psychosis” Relevant literature was limited to articles describing studies conducted and published in 2020.

9 papers met the inclusion criteria. The selected studies reported 20 cases of psychosis in patients with no psychiatric history, directly triggered by stress derived from the COVID-19 pandemic and by social distancing and quarantine. All cases were characterized by sudden behavioral changes out of character, increased concern about coronavirus risk infection, anxiety, psychomotor agitation, and insomnia. In multiple cases, psychotic symptoms were characterized by thoughts of reference, persecution, and structured delusional. 5 patients were convinced that COVID-19 Pandemic was part of a conspiracy and that someone was trying to infect them by diffusing the COVID-19 or other pollutants. Half of the patients had the delusional conviction that they got infected and they were contagious.

COVID-19 pandemic appears to be the trigger for precipitating psychosis which has a high risk of suicidal behavior. During pandemics, mental health professionals should carry out more focused diagnostic and therapeutic strategies.

No significant relationships.

The reception of a patient in the psychiatric ward is an important step that determines the proper course of care. The welcome is the first stage of the relationship, it is essential to take the measure of the importance of this moment.

Assess psychiatric inpatients’ knowledge of their rights and obligations.

This was a descriptive and cross-sectional study based on a self-administered questionnaire containing about twenty questions (20), which assessed the knowledge of patients hospitalized in the HMPIT psychiatry department about their rights and obligations.

Twenty-five (25) patients agreed to answer the questionnaire and two (2) patients refused. Sixty percent (60%) of the patients were unaware of their rights. Sixty-eight percent (68%) of the patients did not know their duties. Forty-eight percent (48%) of the patients did not know the rules and conditions of hospitalization in psychiatry.

Patients hospitalized in the psychiatric ward have limited knowledge about their rights and duties and about the conditions and rules governing hospitalization. In addition to the poster on patients’ rights and duties, a welcome leaflet will provide all the information on the rules of hospitalization.

The Covid-19 Pandemia is not a turning point for e-health It might seem meaningful that this e-health approach will also continue in mental health care after the Covid-19, given the obvious pragmatic advantages. But several issues could at least delimitate a future use of e-health technology in psychiatry/psychotherapy: Patient with severe depression and suicidality seem not to be the right target group Same with other serious mental disorders First contact patients (depending among others on their personality characteristics), often have problems to open themselves at phone or video contacts In Germany (and probably other European countries?) a relative high percentage of psychiatrists/psychotherapists are reluctant or at least ambivalent against video based interventions A quite high percentage of psychiatrists/psychotherapists in Germany believe that a relevant proportion of their patients might not accept this very technical approach of doctor-patient-interaction. Currently in Germany, probably also in some other European countries, complain that some legal and billing issues are not fully solved. Some of these problems could decrease in the future and insofar it is difficult to make a valid prediction of the place of e-health technology in psychiatry/psychotherapy. Beside this one point seems of great importance to me: the current e-health success, driven by the Covid-19 Pandemia, should not be the direction of more cost saving psychiatry/psychotherapy, generally neglecting the need for personal interaction between patients and therapists.

No significant relationships.

From 2014 on, the rate of persons with a migration background in Germany rose steadily, in forensic psychiatric hospitals even disproportionally. Although daily work is aggravated through language barriers and cultural differences, general therapy processes have not been appropriately adapted yet and extensive research is lacking.

Therefore the aim was to get a picture of the current situation of patients with a migration background in 11 Bavarian forensic psychiatry.

237 Patients with a migration background (first or second generation) were asked about their sociocultural background, their acculturation tendency (by rating the Frankfurter Acculturation Scale), their German language ability and their estimation of the ward climate (by the Essen Climate Evaluation Schema).

51.8% of the participants were able speak German on an A- level, 13.1% on a B- level and 35.1% on a C- level. Patients of our sample oriented themselves more towards Germany and less towards their country of origin, compared to the control sample. Further, they experienced safety significantly lower and patient cohesion and mutual support higher than the forensic reference sample.

One possible explanation for the patients’ orientation is the lack of possibilities to act out their cultural traditions. Because of the patients’ limited German knowledge and cultural misunderstandings, they could feel less safe. To conclude, the group of patients with a migration background is important not solely due to its size. But its heterogeneity makes universally applicable statements not easy. Migration backgrounds have to be considered within the psychiatric setting and individual therapy plans have to be made.

Child sexual abuse is a major public health problem in Sri Lanka, with prevalence rates ranging from 14-44%.

We aimed to describe the victim and perpetrator characteristics, pattern of disclosure and psychological consequences of sexual abuse in children presenting to a tertiary care hospital in Sri Lanka.

This was a retrospective file review study of 164 victims who presented to a Teaching Hospital in Colombo, Sri Lanka, with alleged sexual abuse over a period of 5 years from 2015-2019.

Majority of the victims were female and older than 12 years. Majority (73.6%) have been subjected to penetrative sexual abuse with 58.5% of victims reporting more than one incident of abuse. Almost all (99.9%) of the perpetrators were male, with 94.5% being known to the child. Only 42.7% (n=70) of the children revealed about the incident within the first week. Delayed disclosure (i.e. more than 1 week since the incident) was significantly higher in penetrative abuse (p<0.01), multiple incidents of abuse (p<0.01) and in abuse by a known person (p<0.05). Children who disclosed after one week were significantly less likely to disclose about the incident spontaneously (p<0.01). Psychological sequel was seen in 28.7%, with depression being the commonest diagnosis (8.5%). Psychological consequences were significantly in higher those who had physical evidence of abuse (p<0.01), delayed (after 1 week) disclosure (p<0.05) and in those who did not disclose spontaneously (p<0.01).

The victim and perpetrator characteristics, pattern of disclosure is comparable with previous literature.

No significant relationships.

Given the suboptimal acceptance of iCBT for depression, finding ways to increase the acceptance and uptake is crucial for its dissemination. Moreover, it remains unknown to what extend the Unified Theory of Acceptance and Use of Technology (UTAUT) could aid the design of DTC in psychological service.

To explore whether the regulatory processes theorized in the UTAUT (Performance Expectancy, Effort Expectancy, Social Influence, and Facilitating Condition) could be modified and mediate the change of acceptance of iCBT.

This randomized controlled trial recruited 219 individuals with at least mild level of depression. Upon completion of pre-assessment, participants were randomly allocated to an intervention (IG) and a control group (CG). The IG received a 7-minute UTAUT-driven promotion video, while the CG received a video of same length on general psychoeducation. Both groups completed a post-assessment.

Repeated measures ANOVA revealed a significant time by group effect on treatment acceptance. The video in IG was perceived to be clearer and more persuasive. Mediation analysis showed that the intervention effect was mediated by increase in perceived performance expectancy of iCBT, and the indirect effect was conditional on dispositional help seeking stigma.

Pre-treatment acceptance of iCBT can be improved by brief DTC promotion video. The finding casts light that performance expectancy was the most modifiable and mediatable regulatory process on iCBT acceptance, although such relation could be attenuated by high help-seeking stigma. In sum, DTC marketing could aid implementation of Internet-based interventions, effort in stigma reduction should continue to encourage uptake of effective treatment.

No significant relationships.

Valproic Acid (VPA) is one of the most commonly used mood stabilizer drugs. Although uncommon, serious adverse effects have been reported. One particularly relevant side effect is the induced encephalopathy, usually secondary to Hyperammonemia. However, some descriptions have shown an altered mental state with normal serum levels of ammonia.

We aim to present a case of VPA induced-encephalopathy without hyperammonemia and emphasize its suspicion when patients taking VPA present altered mental states.

We present a clinical case of VPA induced-encephalopathy without Hyperammonemia and a qualitative review of this topic using the Pubmed database.

A 66-year-old woman, with an history of Major Depressive Disorder, previously medicated with Venlafaxine 75mg/day and Mirtazapine 30mg/day, was admitted in our acute psychiatric inpatient unit due to a first manic episode. During the stay, her antidepressants were interrupted, and she was started on VPA, then optimized to 750mg/day. After that, she presented an altered mental state with confusion and prostration. Analytical results were normal including normal ammonia levels and no imagiological abnormalities. Despite these results, we decided to stop VPA empirically. The patient clinical status resolved the day after.

Studies have shown that only a few patients have developed encephalopathy with normal serum levels of ammonia. Although the pathogenesis behind this remains unknown, a few mechanisms have been proposed. Therefore, it is important to remind that even without abnormal analytical status, VPA is a possible cause of encephalopathy. We also emphasize the need for further studies on the mechanisms behind this phenomenon.

No significant relationships.

The COVID-pandemic context is characterized by a global ambiguity, reflecting the unexpected onset of pandemic, unpredictability and amplitude of the related dangers, questionability and the side effects of the policy measures used to protect people.

The development of theoretical framework for understanding variability in the reactions to COVID situation and self-regulatory mechanisms.

Conceptualization and analysis of individual psychotherapy cases in the framework of psychodynamic approach.

Five typical patterns of anxiety, defensive functioning and mentalization structures were identified: Paranoial pattern is marked by flooding with persecutory anxiety, exaggerated subjective uncertainty. reflected in chaotic boundlessness, incoherence, fantasies of hostility, splitting and polarization of self and others. Depressive pattern reflects inability to sustain ambiguity due to deficiency of internal supports, overly dependence on others, conformity, obedience to authority and denial of personal standards and individuality. Noogenic pattern refers to negative affective states, generated by the ambiguity, contradictions and ambivalence of information. The means to regulate it include the lowering of the level of psychical functioning, with cognitive simplification, preference for order, routine and predictability. Transgression pattern suggests maniacal fascination with the dissipation of limits, normative restraints and rules, and the triumph of the narcissistic-perfectionist permissiveness. Constructivity pattern consists of the pleasure from explorations and insights, creation of new meanings, creative reappraisal and reconstruction of ambiguous situations.

The typical patterns of experiencing ambiguity that were singled out may have diagnostic and prognostic significance in evaluating the individual resource potential in situations of COVID related dangers and isolation.

This is a quasi-experimental and pioneering study in Portugal.

(1) to provide assessment materials for symptoms of internalized homophobia, depression, and anxiety targeted at LGBT people; (2) offer support materials for psychotherapeutic work-oriented in the areas of internalized homonegativity, depression, and anxiety; and (3) offer monitoring measures throughout the program to demonstrate changes. It consists of three phases (pre-program evaluation, therapeutic activities and post-program evaluation).

38 LGBT + individuals participated, average age was 34.15 years, 30 self-identified as male. Measures used for the pre and post-intervention assessment were the sociodemographic questionnaire, the LGBT identity questionnaire, the Rosenberg self-esteem scale, and the BSI-18. Participants were invited to join the program online, through a platform created for this purpose, where ethical aspects were clarified, namely: confidentiality and commitment to adherence. Therapeutic tasks were sent by email or WhatsApp depending on the preference of each participant.

Relevant differences in internalized homophobia, depressive, and anxious symptoms between the pre and post-intervention moments were observed, indicating that the program is effective in changing these symptoms.

The importance of validating this type of program allows reaching “hidden” populations by offering online support that minimizes the effects of sexual stigma on LGBT + populations.

Psychosocial rehabilitation is a challenge in a society with demands unsuitable for those with severe mental illness (SMI). The Mental Health Department of Matosinhos Local Health Unity (MHD-MLHU) has developed a solidarity project aiming to evaluate and elaborate individualized rehabilitative responses with people with SMI, including people from the community motivated for solidarity initiatives.

To describe a psychosocial rehabilitation project focused on community integration of people with SMI, considering needs and resources of the population, and to present the individualized rehabilitation plans carried out for people with SMI.

In January 2019, we began the home evaluation of people with SMI monitored in the MHD-MLHU. To develop solidary based play-occupational groups, we interviewed people from the community and from the common mental pathology outpatient clinic willing to participate.

We present the description and evaluation of the psychosocial responses developed by the project. These responses include recreational-occupational groups, tailored to interests of each person with SMI, and using the community support group built for the purpose. These responses promote face-to-face activities, and enhance the destigmatization of SMI. The constraints resulting from the COVID-19 pandemic led to the creation of digital responses aimed at people with SMI and the community in general.

This experience has revealed the great potential of rehabilitating the community context of people with SMI, rather than just contemplating pre-existing structured responses. The pandemic created specific challenges but made the initiative even more relevant for SMI people and for promoting the mental health of the general population.