bluuebunny/crossref_metadata_2025 huggingface dataset:
Addressing negative symptoms of schizophrenia in a Psychosis Day Hospital: a case report
Authors: Mayor Sanabria F. , Fernández Fonollosa E. M. , Gil Sánchez C. M. , Fuentes Merlos A. , González Vivero E. X. , Puyal González S. , Fernández Fariña M. , Serván Rendon-Luna B.
Published: August 2024

Introduction

Negative symptoms are present in more than two thirds of schizophrenic patients throughout the evolution of the disorder. These include symptoms related to reduced motivation or pleasure, such as avolition, anhedonia and asociality, and reduced expressivity, including alogia and blunted affect.

We present the case of a 24-year-old man who was admitted to our Psychosis Day Hospital after several psychotic episodes, presenting with prominent negative symptomatology that was imbued with mystical delusional beliefs.

Objectives

1)

To describe the clinical particularities of this case, focusing on the improvement of negative symptoms during the course of treatment at our Day Hospital.

2)

To review the available evidence regarding the pharmacological and psychotherapeutic management of negative symptoms of schizophrenia.

Methods

A review of the patient’s clinical history and complementary tests were carried out. Likewise, we reviewed the available literature in relation to the management of negative symptoms of schizophrenia in an ambulatory setting.

Results

The patient was admitted to our Day Hospital after four psychiatric hospitalizations due to mystical delusions, ideas of grandiosity and hyper-spirituality, along with prominent negative symptoms at the moment of inclusion at our centre, including social withdrawal, diminished affective response, lack of interest in the academic sphere and poor social drive. Although previous positive symptoms were present in a lesser degree, the patient interpreted the presence of the negative symptoms described above as a “punishment” or “test” from spiritual creatures.

Management of negative symptoms represents a major unmet need in schizophrenia. Modest effect size evidence for pharmacological approaches favours the use of antipsychotic in monotherapy and augmentation of antipsychotic treatment with other agents, such as antidepressants. Scarce evidence regarding psychotherapeutic approaches to these symptoms points to the use of cognitive behaviour therapy and social skills training.

Conclusions

-

Clinical identification and characterization of negative symptoms is crucial when treating patients with schizophrenia, as these are associated with important disability and poorer functional outcomes.

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Differentiation of primary and secondary negative symptoms is a key aspect in the evaluation and management of schizophrenic patients.

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This case outlines the coexistence of positive and negative symptoms, and illustrates the challenges in the pharmacological and psychotherapeutic management of these symptoms at a Psychosis Day Hospital.

Disclosure of Interest

None Declared
Evaluation of clinical and sociodemographic characteristics of hospitalised patients with schizophrenia spectrum disorder
Authors: Demirel H. R. , Yıldız E. , İspir S. N. , Aydın M.
Published: August 2024

Introduction

Schizophrenia and other psychotic disorders are disorders in which the individual’s assessment of reality is impaired and which progress with exacerbations and become chronic, leading to disability, loss of function, social communication problems and frequent hospitalisations.

Objectives

The aim of our study was to evaluate the clinical and sociodemographic data of patients followed up in the outpatient clinic for psychotic disorders and hospitalized at least once in any time during their treatment.

Methods

The sample of the present study consisted of patients who were followed up in the psychotic disorders outpatient clinic of Selçuk University Faculty of Medicine Hospital and who were hospitalised at least once. Patients were identified by retrospective file search and those with sufficient information about their sociodemographic-clinical characteristics were included. The study approved by the ethics committee of Selçuk University Faculty of Medicine.

Results

Of the 130 patients, 52 (40%) were female and 78 (60%) were male; mean age was 40.8 ± 12.0 years. Almost half of the patients (n=53, 40.8%) had primary school education. 73 (59.2%) of 130 patients were receiving long-acting antipsychotic medication. 100 patients (76.9%) were using oral antipsychotics. 63 out of 100 patients were on clozapine. 22 of 63 patients used clozapine as monotherapy. The mean duration of untreated psychosis (n=90) was 15.8 ± 32.1 months. The mean number of hospitalisations was 3.4 ± 2.5. 15 patients (11.5%) were lived in a nursing home. The mean number of hospitalisations of patients receiving long-acting treatment (3.8±2.9) was significantly higher than that of patients receiving oral treatment only (2.7±1.6) (p=0.004). There was no significant difference in the mean number of hospitalisations when comparing according to the presence of clozapine in the treatment (p>0.05).

Conclusions

The primary goal in the treatment of patients with schizophrenia is to prevent relapses, hospital admissions and improve patients’ quality of life and functioning. Therefore, the variables related to hospitalisations, which are an indirect indicator of the frequency of psychotic episodes, should be well evaluated. Our study was mainly descriptive and evaluated the relationship between several parameters and hospitalisations. It was thought that the high number of hospitalisations in patients on long-acting treatment might be related to the fact that long-acting treatment in our country is mostly started in the late stages of the disease. Large-sample studies of predictive parameters are needed to prevent psychotic episodes and reduce the number of hospitalisations.

Disclosure of Interest

None Declared
Duration of untreated psychosis and involuntary hospitalization in first-episode psychosis
Authors: Gomes H. J. , Moreira R. A. , Correia J. P. , Maldonado E. , Barros J. M. , Gomes J. R.
Published: August 2024

Introduction

Duration of untreated psychosis (DUP) is defined as the time between the onset of psychotic symptoms and the initiation of appropriate treatment. DUP has been the subject of intensive research to understand how it is associated with a poorer prognosis in patients with first-episode psychosis (FEP). Involuntary treatment is often necessary in the context of FEP.

Objectives

To characterize the relationship between the duration of untreated psychosis (DUP) and the type of hospitalization (voluntary versus involuntary) in patients admitted for FEP.

Methods

We conducted a retrospective observational study, collecting data from patients admitted between January 2019 and December 2022, in the psychiatric unit at our hospital in Bragança, Portugal. We used the information recorded in the clinical records and statistical analysis of the data was performed using the SPSS program.

Results

Over the 4-year study period, 81 patients with first-episode psychotic symptoms at admission were selected. The average age was 46.98 years, with a slight male predominance. 46.9% (n=38) were admitted involuntarily, and 53.1% (n=43) were admitted voluntarily. The average DUP was 73 days. DUP was 95.92 days for patients admitted involuntarily and 54.72 days for voluntary admission. This difference was not statistically significant.

Conclusions

There was a longer DUP in patients admitted involuntarily, although this association was not statistically significant. However, it is important to emphasize that involuntary hospitalization is frequently linked to more severe cases and poorer prognosis. Therefore, recognizing psychotic symptoms as early as possible is essential to facilitate prompt identification and effective treatment for patients experiencing their first episode of psychosis, ultimately leading to an improved prognosis.

Disclosure of Interest

None Declared
The Relationship Between Internal Stigmatisation, Recovery and Treatment Adherence in Individuals with Schizophrenia
Authors: Keskiner M. S. , Aktaş S. , Aktaş M. C. , Ayhan H. , Aslan K.
Published: August 2024

Introduction

Schizophrenia has a clinical course that has a great negative impact on the daily life of the person due to the cognitive and social problems it causes. Internalised stigmatisation is a very common negative phenomenon in individuals diagnosed with schizophrenia. It is known that treatment adherence is low in schizophrenia patients with high levels of internalised stigma. Lack of adequate treatment adherence in these patients is a negative factor in terms of recovery. Reducing the level of internal stigmatisation and reinforcing treatment adherence in schizophrenia has a positive effect on recovery. Considering this situation, it is important to determine the relationship between internal stigmatisation, treatment adherence and recovery in schizophrenia patients. In the literature review, there were no studies in which the relationship between internal stigmatisation, recovery and treatment adherence in individuals diagnosed with schizophrenia was carried out together.

Objectives

In this study, it was aimed to fill the existing gap in the relevant field and to be a resource for further intervention programmes.

Methods

The study was planned as descriptive. The sample of the study consisted of individuals diagnosed with schizophrenia aged 18 years and over who met the inclusion criteria and accepted to participate in the study by purposive sampling method. In the power analysis, the sample number was calculated as (N=80) with a margin of error of 0.5. Personal information form, Internalised Stigma Scale in Mental Illness (ISMI), Recovery Assessment Scale (RAS) and Medication Adherence Rating Scale (MARS) were used for data collection. IBM SPSS 27.0 package programme was used for statistical analysis.

Results

The data are still being analysed in detail by the researchers. The findings and relational results of the study will be presented.

Conclusions

It is thought that the results of the study will contribute to the reporting of the relationship between intrinsic stigma, recovery and treatment adherence in individuals diagnosed with schizophrenia, and by revealing the relationship between the variables, it is thought that it will be a source for planning interventions that will increase the treatment adherence and recovery perceptions of schizophrenia patients and reduce their intrinsic stigma.

Disclosure of Interest

None Declared
Psychotherapies for generalized anxiety disorder in adults: systematic review and network meta-analysis of randomized-controlled trials
Authors: Papola D. , Miguel Sanz C. , Mazzaglia M. , Franco P. , Tedeschi F. , Romero S. A. , Patel A. R. , Ostuzzi G. , Gastaldon C. , Karyotaki E. , Harrer M. , Purgato M. , Sijbrandij M. , Patel V. , Furukawa T. A. , Cuijpers P. , Barbui C.
Published: August 2024

Introduction

Generalized anxiety disorder (GAD) is one of the most common mental disorders in adults. Psychotherapies are among the most recommended treatment choices for GAD, but which should be considered as first-line treatment still needs to be clarified.

Objectives

To examine the most effective and accepted psychotherapy for GAD both in the short and long-term, via a network meta-analysis.

Methods

We searched MEDLINE, Embase, PsycINFO, and the Cochrane Register of Controlled Trials – CENTRAL, from database inception to January 1st, 2023, to find randomized controlled trials (RCTs) of psychotherapies for GAD. Eight psychotherapies (behaviour therapy, cognitive-behaviour therapy, cognitive restructuring, psychoeducation, psychodynamic therapy, relaxation therapy, supportive psychotherapy, and third-wave CBTs) were compared with each other and two control conditions (treatment as usual, waiting list). We followed Cochrane standards when extracting data and assessing data quality and used PRISMA guidelines for the reporting. We conducted random-effects model pairwise and network meta-analyses. We assessed risk of bias of individual studies through the second version of the Cochrane’s Risk of Bias tool and used the Confidence in Network Meta-Analysis (CINeMA) to rate certainty of evidence for meta-analytical results. Severity of GAD symptoms and acceptability of the psychotherapies were our outcomes of interest.

Results

We analysed data from 66 RCTs. Effect size estimates on data from 5,597 participants suggest third wave cognitive-behavioural therapies (standardized mean differences [SMDs] =-0.78; 95%CI=-1.19 to -0.37; certainty=moderate), cognitive-behavioural therapy (CBT) (SMD=-0.68; 95%CI=-1.05 to -0.32 certainty=moderate), and relaxation therapy (SMD=-0.54; 95%CI=-1.04 to -0.05; certainty=low) reduced generalized anxiety symptoms more than treatment as usual (TAU). Relative risks for all-cause discontinuation signalled no differences compared with TAU for all psychotherapies. When excluding studies at high risk of bias, relaxation therapy lost its superiority over TAU. When considering anxiety severity at three to twelve months after completion of the intervention only CBT remained significantly more efficacious than TAU (SMD=-0.58; 95%CI=-0.93 to -0.23).

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Conclusions

Given the evidence for both acute and long-term efficacy, CBT may represent the reasonable first-line psychological treatment for GAD. Third-wave CBT and relaxation therapy have short-term efficacy and may also be offered. Results from this investigation should inform patients, clinicians, and guidelines. This project is funded by the European Union’s HORIZON EUROPE research programme under grant agreement No 101061648.

Disclosure of Interest

None Declared
Clinical and cognitive factors associated to insight in first psychotic episodes
Authors: Gonzalez Salvador T. , Cabello Rojano I. , Boi S. , Gutierrez Labrador R. , Capilla P. R.
Published: August 2024

Introduction

Insight is a field of interest in psychosis, due to its influence on the course and prognosis of the desease and as well as adherence to treatment.

Objectives

The present work aims to evaluate the influence of cognitive and psychopathological variables on awareness of illness in first psychotic episodes.

Methods

It is a cross-sectional study of a sample of 26 patients with diagnosis of a first psychotic episode admitted in a Brief Hospitalization Unit, who have been evaluated using the Positive and Negative Symptom Scale (PANSS), the Screening for Cognitive Impairment (SCIP) and the Scale of Non-awareness of Mental Disorder (SUMD).

Results

A positive correlation was found between SUMD and negative PANSS (the worse insight, the greater negative psychopathology) and between the level of cognitive performance and the awareness of having negative symptoms (affective blunting, anhedonia and associability) and their attribution to the desease.

Conclusions

This findings suggest the importance of addressing awareness of negative symptoms from the first episodes in psychoeducational family therapy and rehabilitation programs, taking into account that this process is hindered by the cognitive dysfunctions.

Disclosure of Interest

None Declared
From positive projection to delirium. About a case
Authors: Barea M. V. , Rodriguez L. S. , Bailen S. C.
Published: August 2024

Introduction

Erotomania, was described in 1942, is more common in women than in men, although the incidence is unknown. This syndrome is usually characterized by a young woman with the illusion that a man whom she considers to be of a higher social or professional position is in love with her. Developing an elaborate delusional process about this man, his love, his pursuit and total commitment to the idea. Two forms, pure or secondary, are described. As well as fixed or recurring

52-year-old female patient in outpatient follow-up with a diagnosis of schizophrenia with long-term follow-up, start of follow-up by a new therapist, in this context intensive follow-up is carried out in the event of the appearance of pharmacological secondary effects, pharmacological readjustment is carried out with good results.

During the joint follow-up with nursing, the cessation of secondaryisms is confirmed and we are informed of the gradual appearance of overvalued ideas in relation to the new therapist, which are gradually structured in the form of erotomanic delirium that coincides with the cessation of follow-up by said therapist. Consultations in the emergency room occur on a couple of occasions due to mild behavioral alterations secondary to messages and communications that he reports receiving where said love is confirmed. Despite readjustments, there continues to be an increase in clinical symptoms due to abandonment of medication, finally producing serious alterations aimed at the search for said therapist, finally culminating in admission to the acute care unit for containment of said condition.

Objectives

The objetives is the diferencial diagnosis, in this case symptoms could be classified as positive symptoms of schizophrenia, although it is its own nosological entity.

Methods

.

Results

.

Conclusions

This patient represents a classic example of De Clerambault syndrome and is a faithful expression of the recurrent syndrome associated with delusions of grandeur, eroticism and jealousy. There have also been ideas of reference and agitated behavior associated with his delusional process.

Disclosure of Interest

None Declared
Management of cognitive symptoms in schizophrenia.
Authors: Jupe T. , Kourtesis I. , Sarris I.
Published: August 2024

Introduction

Cognitive impairment is the frequent symptom occurring in nonelderly patients with schizophrenia or other neurodegenerative disorders. Cognitive dysfunction in patients with schizophrenia was described by Kraepelin more than a century ago. Increased awareness and advancements in the area of neuropsychological assessment and neuroimaging techniques have now rendered cognitive impairment an important focus of theories on the etiology and treatment of schizophrenia. Cognitive enhancement still remains a clinically unresolved challenge. Till date, there is no effective treatment available for enhancing cognitive function in patients with schizophrenia

Objectives

This e-poster aimed to summarize evidence regarding clinical data on the nonpharmacologic and pharmacologic management of cognitive symptoms of schizophrenia, also known as cognitive impairment associated with schizophrenia (CIAS), and highlight the selection of appropriate treatment options.

Methods

A bibliopgraphical review was performed using PubMed platform. All relevant articles were found using the keywords: schizophrenia, cognitive symptoms, menagement.

Results

Many different drug targets and strategies for drug development have been employed for enhancement of cognition in schizophrenia. Receptor targets have been identified on the basis of pharmacologic challenges that mimic schizophrenia (e.g., dopamine agonists and NMDA receptor antagonists), receptor abnormalities found on postmortem analysis of schizophrenia brain, and genetic linkage studies. Treatment with a D1 agonist was shown to “sensitize” D1 receptors and improve memory in both aged and antipsychotic-treated monkeys. Clinical trials of D1 agonists in schizophrenia have been delayed due to poor tolerability related to orthostatic hypotension and nausea. The glycine-site agonists, glycine, D-serine, and D-alanine, produced improvement in negative symptoms in small trials and some improvement in measures of cognition, although formal cognitive testing was not performed.

Conclusions

Although the evidence supporting cognitive remediation has not yet achieved the level necessary to merit inclusion in evidence-based treatment guidelines, this approach, combined with other psychosocial interventions, is promising. Several pharmacologic approaches are currently under study to facilitate neuroplasticity.

Disclosure of Interest

None Declared
Cariprazine efficacy in a 40-year untreated case of a woman with predominantly negative symptoms of psychosis: A case report
Authors: Mara A. , Myriknas S.
Published: August 2024

Introduction

Several studies have demonstrated the unfavorable and neurotoxic effects of untreated psychosis (UP) on the brain. An estimated 10 to 12 cc of brain tissue could be potentially damaged due to neuroinflammation and oxidative stress when a first episode of psychosis goes untreated. Other studies have found a correlation between the duration of untreated psychosis (DUP) and treatment resistance or nonresponse. Evidence-based schizophrenia treatment mainly relies upon the use of first and second-generation antipsychotics, without solid evidence that the former is superior to the latter regarding the treatment of negative symptoms. Both groups, however, can come with a risk of side effects. Cariprazine, a third-generation antipsychotic, represents a safe and effective treatment, targeting both the positive and negative symptoms of schizophrenia.

Objectives

To report a clinical case of a woman with an extreme DUP with predominantly negative symptoms of schizophrenia and highlight the favorable outcome cariprazine monotherapy had on her global functioning.

Methods

We report a clinical case of a 58-year-old woman with a history of a 40-year UP successfully treated with 4,5mg of cariprazine. The woman was brought involuntarily for psychiatric assessment at the emergency department with a clinical image of catatonic stupor and predominantly negative symptoms of psychosis. Her total PANSS score at admission was 129. The negative subscale score was 49. She was initially treated with 3mg cariprazine and 10mg olanzapine and was gradually left on 4,5mg cariprazine monotherapy with an adjunctive 30mg mirtazapine.

Results

The patient was dismissed after 47 days of hospitalization. Cariprazine was effective in targeting both the cognitive and affective symptoms of long-standing UP. In the long-term, cariprazine also improved remnant delusional ideas of somatic and persecutory types, enhancing the patient’s social life, ensuring her support network, and assisting her integration into the community. The patient did not report any side effects, and her blood test results were within the normal range.

Conclusions

Not all cases of schizophrenia are dramatic at presentation - some can have a chronic and insidious course predominated by negative symptoms. UP can lead to disastrous consequences for the patient’s biopsychosocial well-being, leading to future treatment resistance and disability. Although such cases of untreated psychosis seem to be from the past, we should be conscious of their existence and treat them with a patient-personalized and symptom-centered approach. Cariprazine was successful and effective in treating this patient with a remarkable course of UP.

Disclosure of Interest

None Declared
Cognitive impairment assessment in schizophrenia. purposely a case
Authors: Ogando Portilla N. , Bañón González S. M. , Gamo Bravo B. , González Laynez M. E. , Urbanos M. A. , Cortés M. M.
Published: August 2024

Introduction

Significant and measurable cognitive symptoms are present at the onset of the disorder and these remain stable in the subsequent period between 2 and 5 years. Their deterioration increases with the course of the disease. Attention, concentration, psychomotor speed and resolution of conceptual tasks are usually affected and are more significant in the presence of positive symptoms.

Objectives

Sometimes, the typical positive or negative symptoms of the disease do not adequately reflect the severity of cognitive impairment. Measuring this deterioration can be very relevant when evaluating the severity and the prognosis of the disorder.

Methods

31-year-old male with a previous diagnosis of schizophrenia of 4 years of evolution. He gets a maintained treatment with amisulpiride 400mg with an apparent good response. A single hospitalization at the onset of the disease. An assassination attempt on his mother is done by suffocation with a pillow and observing a significant cognitive impairment despite an apparent control of the symptoms of schizophrenia.

Results

An exhaustive neuropsychological evaluation is carried out, observing a very important cognitive deterioration that had not been previously detected and allowing a pharmacological adjustment of the underlying disease with global improvement of the patient.

Conclusions

It is very important to evaluate the patient as a whole without forgetting the frequent cognitive damage that these patients can have. An intense neuropsychological study can be very useful to evaluate the prognosis and adequate treatment of the patient in order to reduce serious risks.

Disclosure of Interest

None Declared
Self-stigma in a Tunisian population of stabilized outpatients with schizophrenia
Authors: Ajmi S. , Bouhamed M. , Ouali R. , Masmoudi R. , Feki I. , Sallemi R. , Masmoudi J.
Published: August 2024

Introduction

The internalized stigma associated with mental illness is considered as an additional burden faced by people with mental disease. Among mental illnesses, schizophrenia is considered as the most stigmatizing.

Objectives

To Assess the level of stigma in a sample of people with schizophrenia

Methods

This is a cross-sectional and descriptive study carried out on 72 stabilized patients followed at the post-cure psychiatry consultation ‘A’ at the CHU Hedi Chaker in Sfax diagnosed with schizophrenia according to the DSM 5 criteria. Socio-demographic and clinical data were collected using a pre-established sheet

We used The Internalized Stigma of Mental Illness (ISMI) scale to assess internalized stigma

Results

The mean age of the patients in our study was 46.83 ± 11.6 years, with a sex ratio (M/F) of 2.

They were single in 48.5%, unemployed in 69.4%. Their level of education did not exceed primary school in 44.4% and their socio-economic level was low in 63.9%. 2% of the patients had no somatic history and 36.1% had a history of attempted suicide.

The median for the total ISMI score was 2.45, which corresponded to the absence of strong stigma. The median of the subscales was distributed as follows: 2 for the level of alienation, 2.28 for stereotype endorsement, 2.4 discrimination experience, 2.36 for social withdrawal and 2.60 for stigma resistance.

In our study, 45.8% of patients reported experiencing high levels of self-stigma (total score>2,5).

Conclusions

Our study found levels of self-stigma in individuals with schizophrenia that align with previous research, suggesting that schizophrenia-related stigma is a global phenomenon unaffected by factors such as origin or ethnicity.

Disclosure of Interest

None Declared
The SLC6A1 Mutation Schizophrenia case — A Comprehensive Case Study With iPSC Generation
Authors: Mikhailova V. , Kondratyev N. , Alfimova M. , Kaleda V. , Lezheiko T. , Ublinsky M. , Ushakov V. , Lebedeva I. , Galiakberova A. , Artyuhov A. , Dashinimaev E. , Golimbet V.
Published: August 2024

Introduction

The main finding of a large-scale collaborative study (Rees et al. Nat Neurosci 2020;23(2) 179-184), which focused on de novo mutations in schizophrenia, was the discovery of an enrichment of these mutations in the SLC6A1 gene. This gene encodes the gamma-aminobutyric acid (GABA) transporter GAT1, thereby encouraging further research into novel schizophrenia targets within the GABA pathway. However, the gene was not highlighted in recent schizophrenia genetic studies, while typically pathogenic SLC6A1 mutations result in epilepsy, motor dysfunction, autistic spectrum disorder (ASD) and developmental delay. The absence of genetic replication for SLC6A1’s involvement in schizophrenia and the differing clinical spectrum for SLC6A1 mutations led us to study in depth one of the only three original probands from the Rees et al. 2020 study.

Objectives

In our comprehensive case study, we delved deep into the relationship between the SLC6A1 mutation and schizophrenia.

Methods

Our subject, a patient who first presented with acute mania symptoms at age 15 and was later diagnosed with schizophrenia, carried the SLC6A1 Arg211Cys mutation. Over a detailed 25-year follow-up, we conducted an array of assessments and tests, including cognitive testing, personality assessments, EEG, and 1H-MRS.

Results

Notably, we discovered abnormal GABA levels, potentially indicating a dysfunction in GABA reuptake, adding a new layer of complexity to our understanding. Further analysis revealed a significant correlation between the patient’s clinical picture and a polygenic background, rather than the SLC6A1 mutation. Despite having a high polygenic risk score for bipolar disorder, the dominant features of his condition were more representative of schizophrenia. Interestingly, neither the patient nor his father, who also showed a higher BP PRS, had a diagnosis of bipolar disorder. The pathogenic significance of the mutation warrants investigation in cells of neuronal origin. We generated induced pluripotent stem cells (iPSC) from the patient and his parents. This approach provides us with a platform for future investigations into the pathogenic significance of the mutation in neuronal cells. The Human Pluripotent Stem Cell Registry accession numbers of those cells are MHRCCGi001-A (patient), MHRCCGi005-A (mother) and MHRCCGi004-A (father).

Conclusions

In the presented case the clinical picture is rather explained by the polygenic background than by the SLC6A1 Arg211Cys mutation. The study is supported by Russian Science Foundation, grant 21-15-00124 (https://rscf.ru/project/21-15-00124)

Disclosure of Interest

None Declared
Sport-based psychosocial interventions for people suffering from severe mental disorders: EASMH pilot actions from 4 European Countries
Authors: Di Vincenzo M. , Sampogna G. , Borgi M. , Collacchi B. , Cirulli F. , Cerino S. , Rullo S. , Luciano M. , Di Tommaso V. , Moliterni S. , Bichi A. , Garside J. , Kivistö S. , Iarion A. , Walker M. , Fiorillo A.
Published: August 2024

Introduction

The European Alliance for Sport and Mental Health (EASMH) is a partnership of scientific institutions, charity associations and sport organizations, funded by EU-Erasmus+. It aimed at developing good clinical practice in psychiatric rehabilitation through sport-based interventions as an integration of pharmacological and psychological therapies. Within the framework of the EASMH projects, several actions have been promoted including an assessment of the dissemination of sport-based interventions, a training course for specialized coaches and the implementation of pilot actions in four European Countries.

Objectives

To briefly describe EASMH pilot actions performed in Finland, Italy, Romania and United Kingdom, where trained coaches delivered sport-based interventions to patients with severe mental disorders.

Methods

After completing pilot actions, charity associations and sport organizations belonging to EASMH network described general and specific aims, sport activities, composition of staff, timing and tools for assessing the outcomes.

Results

In Italy, “Crazy for Rugby”, including adolescents and young patients, and “Not only headshots”, a football project for adults with severe mental disorders were performed. In UK, a football-based activity called “Imagine Your Goal” and a walking-football program for participants aged more than 40 were delivered. In Romania, two courses including gymnastics, yoga and pilates called “Get fit!” were provided. Different team sport-based activities were implemented in Finland, where “Multiple Sport Group” and “Rehabilitating Sports” aimed at increasing patients’ autonomy. Assessment of psychopathological, social, cognitive and sport/fitness outcomes confirmed the overall beneficial effects of sport on mental health.

Conclusions

Pilot actions represent the final step of EASMH project, which showed improvement of mental health outcomes by also delivering sport-based rehabilitation to patients with severe mental disorders. Institutions and stakeholders are now called to promote the implementation of such initiatives on a broader scale.

Disclosure of Interest

None Declared
SCHIZOPHRENIC DREAMS: A Brief Description of Sleep Disturbances in Schizophrenia
Authors: Jesus Magueta S. , Costa A. L. , Simões G. , Gomes A. I. , Madaíl Grego C. , Garrido P.
Published: August 2024

Introduction

Shakespeare wrote that “We are such stuff as dreams are made on; and our little life is rounded with a sleep.” Sleep is a fundamental part of our being, so much so, humans tend to spend one third of their lives in this immobile and vulnerable state. Disorders of sleep have been the target of much scientific curiosity and investigation, with inumerous articles, reports and books dedicated to the theme. The bidirectional relationship between psychiatric disorders and those of sleep is also well described. Schizophrenia is a heterogenous psychiatric disorder which is often associated with sleep disturbances of various kinds.

Objectives

The authors aim to briefly explore the relationship between schizophrenia and sleep disturbances. Potential underlying mechanisms and risk factors, as well as therapeutic interventions will be addressed.

Methods

The authors conducted a brief non-structured narrative literature review using articles published in the Medline/Pubmed, ScienceDirect and Google Scholar databases. The keywords used during the research, alone or in combination, included: sleep disturbance, sleep disorder and schizophrenia.The studies consulted in this work included: cross-sectional studies, cohort studies, literature reviews and clinical case reports. Works that were included, were written in the English language and deemed as pertinent to the explored theme.

Results

Although sleep disturbances do not make up part of the criteria formal diagnosis of schizophrenia, they are present in approximately 80% of those with the condition and have been identified as a common symptom in prodromic clinical pictures. The problems in sleep are as heterogenous as the presentations in schizophrenia, ranging from insomnia, restless legs syndrome, obstructuve sleep apnea, circadian rhythm disfunctions to hypersomnia. Sleep has been identified as fundamental for the reparation and restoration of various bodily systems, it is no surprise that sleep irregularities, especially in schizophrenia, can significantly reduce quality of life and promote deterioration. Some studies have stated the role that D2 receptors have in the classic symptoms of schizophrenia as well as on sleep disturbances. Second-generations antipsychotics have not only demonstrated much promise on psychotic symptoms, but they appear to aid in sleep regulation and quality.

Conclusions

Sleep is fundamental for mental health. Various sleep disturbances have been identified in those suffering with schizophrenia. Slepe disturbances have been associated with worse outcomes, more florid clinical pictures and significant deterioration. Thus, bettering sleep quality in these patients, would permit better health outcomes which are fundamental in those who live with schizophrenia.

Disclosure of Interest

None Declared
Postpartum insomnia in a woman who has given birth to twins : A case report
Authors: Arroyo Sánchez E. , Setién Preciados P. , Diaz Mayoral C.
Published: August 2024

Introduction

Postpartum insomnia is a significant and often overlooked mental health concern affecting mothers during the postnatal period. Sleep disturbances during this critical time can have far-reaching implications for maternal well-being and the quality of care provided to newborns.

Objectives

The primary objective of this review is to analyze recent clinical literature on postpartum insomnia to gain a deeper understanding of its epidemiology, clinical features, and management approaches. By synthesizing the latest research findings, this review aims to inform healthcare professionals and policymakers about the significance of postpartum insomnia and promote early recognition and intervention.

Methods

A case report of a 43-year-old woman in the fifth month postpartum after a twin birth who comes to the emergency department accompanied by her partner with thoughts of death and impulse phobias due to insomnia of months of evolution. Also a systematic search of the PubMed database was conducted using the keyword “Postpartum insomnia,” and articles published between 2013 and 2023 were included. A total of 20 clinical articles meeting the inclusion criteria were analyzed to provide a comprehensive overview of postpartum insomnia.

Results

The review reveals that postpartum insomnia is a prevalent and often underdiagnosed condition, affecting a significant proportion of new mothers. Risk factors such as maternal age, parity, social support, and hormonal fluctuations have been identified. Diagnostic challenges arise due to the overlap of symptoms with postpartum mood disorders, necessitating a comprehensive clinical assessment. Recent research emphasizes the importance of non-pharmacological interventions, including sleep hygiene education, cognitive-behavioral therapy for insomnia (CBT-I), and mindfulness-based approaches, as the first-line treatment options. However, pharmacotherapy may be considered in severe cases. Untreated postpartum insomnia has been associated with adverse maternal and infant outcomes, including impaired bonding, increased risk of postpartum depression, and developmental delays in infants.

Conclusions

In conclusion, postpartum insomnia is a prevalent yet often underrecognized mental health concern with multifaceted clinical implications. This review highlights the importance of early detection and intervention to mitigate its impact on maternal well-being and infant development. The integration of non-pharmacological interventions, particularly CBT-I and mindfulness-based strategies, into routine postpartum care holds promise in improving sleep quality and overall postnatal mental health. Healthcare providers should be vigilant in assessing and addressing postpartum insomnia to optimize the well-being of both mothers and infants

Disclosure of Interest

None Declared
Sleep architecture disturbance due to the use of benzodiazepines
Authors: Jupe T. , Provi K. , Giannopoulos I.
Published: August 2024

Introduction

Insomnia, which is characterized by difficulty in initiating or maintaining a physiological sleep, is a relevant clinical issue, affecting not only the elderly population (from 20% to 40%), but also the general population since 30% of adults report problems in sleeping properly. In addition, 30-40% of adults report complaints about sleep quality lifetime, and10-15% report chronic insomniaBenzodiazepines (BZDs) are commonly prescribed to treat insomnia and sleep disorders. BZDs show a rapid sedative and anxiolytic effect, successfully used in the acute treatment of insomnia as well as anxiety, agitation, or anxiety associated with any type of psychiatric disorder. Their use is associated with potential side effects such as residual daytime sleepiness, ataxia, and dizziness. Long-term BZDs use may lead to drug abuse, tolerance, drug dependency, and abstinence. For instance, BZDs abrupt withdrawal can lead to severe symptoms such as insomnia and/or rebound anxiety, an increase in heart rate and blood pressure, nausea and/or vomiting, sweating, diarrhea, convulsions, and other neurological and psychiatric symptoms.

Objectives

This e-poster aimed to summarize evidence regarding the effect of BZDs treatment on human Sleep Architecture.

Methods

A bibliopgraphical review was performed using PubMed platform. All relevant articles were found using the keywords: benzodiazepines, sleep architecture, insomnia.

Results

Prolonged use of benzodiazepines leads to an increase of time spent in stages 2 and a decrease of time in stages 1, 3, and 4. The increased NREM stage 2 is associated with a subjective improvement in sleep quality. The decrease in NREM sleep time in stages 3 and 4 is usually associated with lesser “rest” for the brain, which leads to a lack of concentration.

Conclusions

BZDs use modified sleep architecture in the short and long term.

Disclosure of Interest

None Declared
Exploring the Role of Attachment Styles, Life Scripts, and Parental Mandates in Suicidal Behavior: Implications for Prevention and Intervention
Authors: Romero Otalvaro A. , Galván Patrignani G. , Ruiz Gonzalez E. P.
Published: August 2024

Introduction

The scientific literature widely acknowledges the multitude of factors contributing to suicide, emphasizing the intricate and dynamic interplay among genetic, biological, psychological, and social dimensions (Van Heeringen, 2001). Despite this consensus, each suicide case is unique, shaped by an exclusive combination of these factors. One relatively underexplored risk factor in the realm of suicidal behavior is attachment style. As posited by attachment theorists, avoidant and anxious/insecure attachment styles may hold predictive value for suicide attempts (Sheftall et al., 2014).

Objectives

This study undertakes a comprehensive review of the relationships between attachment styles, life scripts, parental mandates, and suicidal behavior.

Methods

This study delves into the interconnections between attachment styles, life scripts, parental mandates, and suicide, drawing from an extensive body of research and theory. A comprehensive review of existing literature was conducted to elucidate the intricate relationships among these variables and their potential influence on suicidal behavior.

Results

The synthesis of existing research highlights a compelling link between attachment styles, life scripts, and parental mandates. Attachment styles, formed in early life, profoundly influence an individual’s interpersonal relationships, emotional regulation, and sense of self-worth. These attachment patterns lay the foundation for the development of life scripts—internalized narratives that dictate one’s beliefs, values, and expectations regarding their life course. Parental mandates, often transmitted explicitly or implicitly during childhood, further shape these life scripts by imposing conditions or constraints on the individual’s choices and aspirations.

Crucially, within this framework, suicidal behavior emerges as a possible outcome. Individuals with maladaptive attachment styles, burdened by parental mandates that discourage autonomous living or impose conditional acceptance, may perceive suicide as a way to escape perceived unmet expectations or alleviate emotional distress.

Conclusions

This study underscores the intricate interplay between attachment styles, life scripts, parental mandates, and suicidal behavior. Understanding these complex relationships is pivotal in both prevention and intervention efforts. Recognizing the significance of family history, parental approaches, maladaptive beliefs, attachment patterns, and early caregiver interactions can inform the development of targeted strategies aimed at mitigating suicide risk in diverse contexts, including schools, communities, and clinical settings. By identifying these factors and their influence on suicidal behavior, practitioners and researchers alike can contribute to more effective prevention and intervention initiatives tailored to individual needs.

Disclosure of Interest

None Declared
Content analysis of suicidal notes - the verbal behaviour
Authors: Fekete J. D. , Fekete S.
Published: August 2024

Introduction

There have been numerous studies on attempted and completed suicides in an attempt to understand better the phenomenon - the tragedy- of self-destructive behaviour through the analysis of the suicidal notes – their last personal documents, that many individuals write before carrying out suicide. Understanding and interpretation of these analyses could happen on several theoretical frameworks and background Research has systematically demonstrated what most clinicians assume, namely that individuals sharing significant patterns of nonverbal behavior express these tendencies in their manner of speaking and writing (e.g. in suicidal notes, farewell letters) . Through this research – by analyzing these texts, documents,” messages”,- was it possible to study not only semantic,and lingistic aspects of them but likely also as manifestations of psychological defense or coping mechanisms or reflected psychopathology in speech by isolating categories. A number of clinical investigations have been carried out to associate speech pattern and verbal style (spoken or written) with these psychopathological states

Objectives

The purpose of the present study is to understand better of written “suicidal” communication; to analyze suicidal notes - namely, as last “messages” of the self destructed individuals in suicidal notes in an empirical sample.

Methods

The present study compared the content of suicide notes (n=113) from attempted suicides, completed suicides and a non-suicidal controls. The content analysis examined formal, syntactical characteristics, as well as speech patterns and verbal expressions (Weintraub method, Absolutists index, SPSS, - Anova, KW)

Results

The notes from completed suicides had significantly higher scores for heteroaggression (blaming others, evaluators) negations, absolutistic expressions, nonpersonal references and lower scores for expression of feelings. Sex (male versus female) and age had no impact on these differences.

Conclusions

The suicide notes had reflected irrational thinking, characterized by frequent negation, and absolutistic words, self-preoccupation, high scores for emotional categories and a tendency toward polarized thinking These results may help in the understanding of the psychodynamic background or suicidal individuals’ risk assessment, in clinical work or in suicide hotlines, but also in prevention

Disclosure of Interest

None Declared
Implementing policies and predictive stochastic models to attend to borderline personality disorder crises: rationalising ssri antidepressants prescription in suicide prevention
Authors: Lazzari C. G.
Published: August 2024

Introduction

We are facing increased suicide attempts and deliberate self-harm from persons with borderline personality disorder (BPD) who are also on antidepressants, multiple antidepressant prescriptions and antidepressant augmentations. Our previous observations suggest that antidepressants might increase suicide attempts in those on this medication and who have BPD. The absent response to antidepressants is due mainly to the comorbid dysthymia, cyclothymia, rumination, autism and ADHD in BPD.

Objectives

To generate forecasting models and preventive policies to deal with BPD crises and improve the effectiveness of the UK National Healthcare Service (NHS) in suicide prevention.

Methods

The underlying analysis framework is stochastic forecasting. We used current knowledge and data to complete systematic future predictions extracted from recent trends. A logical-mathematical model generated the required expressions. The software for logic prediction and annotation was Wolfram Alpha (Wolframalpha.com). The four parameters for stochastic predictions are, BPD (A), antidepressant No. 1 (B), antidepressant No. 2 (C), and suicide attempts (D). Boolean function metrics can help analyse the impact and truth of forecast modelling with truth density.

Results

The logic expression for suicide prediction due to liberal antidepressant prescribing is Ψ = A intersects B, intersects C, intersects D; that is,. Ψ = A ∩ B ∩ C ∩ D, which yields a Boolean truth density of 6.25%. The truth table always has a positive outcome as long as any of the factors exist except when none is present.

Conclusions

The predictive Boolean function and truth table suggest that suicide presentation is predictable if there is a prescribing of one or more antidepressants in BPD and if there is an antidepressant augmentation or dose maximisation. We speculate that SSRI antidepressants block self-regulatory mechanisms of fear of death while triggering impulses to self-harm and suicide from overstimulation of SSRI receptors. Without fear mechanisms, death by suicide is felt as not terrifying.

Disclosure of Interest

None Declared