bluuebunny/crossref_metadata_2025 huggingface dataset:
Prescription of anxiolytics by other specialties: a survey of knowledge and attitudes
Authors: Zineb B. , Aicha T. , Imane K. , Maria S. , Fatima E. O.
Published: August 2023

Introduction

Benzodiazepines (BZDs) have a broad spectrum of therapeutic effects, with undeniable efficacy and low toxicity/lethality. The high prevalence of anxiety and sleep disorders makes them one of the most prescribed drugs in the world.

We have chosen to focus on these drugs because of the interest they arouse nowadays due to the potential danger linked to their prolonged or abusive use, which can have major consequences on the state of health of populations.

Objectives

The objective of this study is to evaluate the knowledge and attitudes of general practitioners in relation to the prescription of benzodiazepines, with a view to possibly proposing recommendations aimed at rationalizing the use of these drugs in Morocco.

Methods

The method used is therefore the semi-structured interview, lasting on average 40 minutes, a fairly free method which allows the collection of valuable information.

This method is relevant for analysing the meaning that prescribers give to their practices, to highlight the knowledge and reference points from which they orient themselves and determine their practices. It allows for a “continuous process of verification and reformulation of hypotheses”. As the survey progresses, new questions can be addressed.

A questionnaire was therefore developed and used as the basis for the interview. It included practical questions relating to the activity of the doctors, their practice in consultation, their training, their management of psychiatric pathologies, their knowledge of benzodiazepines, and finally, their opinion on the overprescription of this molecule.

Results

The survey was conducted among 10 general practitioners, 8 of whom prescribed benzodiazepines for the treatment of anxiety, insomnia and depression.

The first molecule prescribed was alprazolam, for an average duration of more than three months.

Conclusions

To this end, several measures have been taken in some developed countries to regulate prescribing in order to improve proper use, control consumption and avoid misuse of these drugs.

Disclosure of Interest

None Declared
Can we prevent anxiety in adults with congenital heart disease with good parenting practices in childhood?
Authors: Houchi C.
Published: August 2023

Introduction

Medical-technical advances are contributing to the increased life expectancy of children with congenital heart disease (CHD) (Ladouceur et al., 2021). As they grow up into adulthood, they face many challenges (eg. surgeries, hospitalizations, separations from family, cardiac symptoms, anxiety symptoms). It is known that some parenting practices like parental overprotection during childhood are associated with anxiety in the general population, but little is known in this population.

Objectives

We aim to measure the contribution of parental practices (global; positive: warm care, consistent structure, autonomy support; and negative: overprotection) to explain variance in anxiety symptoms in adults with CHD, beyond sociodemographic and antecedents of pediatric hospitalisations.

Methods

An observational cross-sectional study was conducted on 223 adults with CHD followed at the Montreal Heart Institute. We evaluated anxiety symptoms and retrospective parental practices using validated self-reported questionnaires, namely the Hospital Anxiety and Depression Scale, the Parental Bonding Inventory, the Perceived Parental Autonomy Support and the Multidimensional Parental Structure Scale. Sociodemographic and antecedents of pediatric hospitalisations information was collected from medical records and pediatric archives. Hierarchical multiple linear regression analyses were conducted.

Results

The average age of our participants is 46 years and the majority (59 %) were female at birth. The median number of hospitalisation before 18 years old was two. 15 % presented severe anxiety symptoms (HADS-A ≥ 11), 17 % had moderate symptoms (HADS-A = 8-10), and 68 % had mild or no symptoms (HADS-A ≤ 7).

The inclusion of parenting practices significantly increased the proportion of variance explaining anxiety symptoms. They explained more variance (13%) than sociodemographic and pediatric hospitalisations combined (10%).

In this model, only positive parenting practices were significantly associated with anxiety, in contrast to parental overprotection.

When the parental practices were analyzed separately, positive practices (autonomy, care, and structure) were negatively associated with anxiety symptoms, while overprotection was positively associated with anxiety symptoms.

Conclusions

Our results suggest that although our participants’ physical health may be limited by their CHD, the majority report a low anxiety scores. Further, parenting practices appear to be malleable predictors of anxiety. Beyond avoiding overprotective parenting style, positive and supportive parenting practices are potential targets for future initiatives to prevent anxiety symptoms in adults with CHD.

Disclosure of Interest

None Declared
The effect of pandemic as a trigger for first episode bipolar disorders
Authors: Cakir S.
Published: August 2023

Introduction

The traumatic effects of COVID-19 pandemic is well studied in community and fragile groups. The association between COVID-19 infection and development of severe mood disorders have not well studied.

Objectives

Nonetheless the casual relation or stressor effects of Covid-19 pandemic on chronic psychiatric illness is not known yet. The present study is aimed to investigate the effects of pandemic as a triggering factor in first episode Bipolar disorder (BD) patients that onset after pandemic.

Methods

The study included a total sample of 55 patients diagnosed with first episode BD according to DSM-5 criteria.

The two groups of patients that illness onset was before (BP)and after pandemic (AP), were investigated and compared for psychopathology and life evet stressors. Impact of Event Scale-Revised (IES-R) for PTSD symptoms, Generalize Anxiety Disorder scale for anxiety symptoms, The Montgomery–Åsberg Depression Rating Scale (MADRS) to examine depressive symptoms; and Young Mania rating Scale (YMRS) for manic symptoms, Brief Psychiatric Rating Scale-18 (BPRS) was used for psychotic symptoms.

Results

The statistical analyses were performed using the Statistical Package for Social Science, version 26. Thirty-five patients that illness onset before pandemic and 20 patients that illness onset after pandemic were compared.

The significant differences were come up in some clinical features between the two groups. The alcohol and substance abuse were higher in AP group. The severity of psychotic and manic symptoms were higher in AP group. The hospitalization was higher in AP group. The number of stressor events was higher and PTSD symptoms was more severe in the AP group also.

Conclusions

The effects of Covid-19 pandemic seems have a triggering role in onset of first episode BD. This effect whether cause biological or psychological stress in onset of illness is not known yet. The casual phenomenon of Covid-19 pandemic should be investigated for chronic psychiatric illness as BD in future studies.

Disclosure of Interest

None Declared
The impact of restrictions due to covid-19 on mental health of adolescents including the incidence of the social anxiety disorder and progression of already existing social anxiety symptoms
Authors: Pentjuša A.
Published: August 2023

Introduction

The Covid-19 pandemic has brought many changes to everyday life of adolescents. The purpose of this study is to evaluate the impact of restrictions due to Covid-19 pandemic on the mental health of adolescents: changes in everyday life that can potentially have an impact on their mental health, the prevalence and worsening of social anxiety symptoms and consequent depression symptoms

Objectives

To evaluate the impact of restrictions due to Covid-19 pandemic on the mental health of adolescents: changes in everyday life that can potentially have an impact on their mental health, the prevalence and worsening of social anxiety symptoms and consequent depression symptoms

Methods

Anonymised questionnaires were used to collect the data. They were given to the patients staying in the department of psychiatry of Children’s Clinical University Hospital in Riga, Jugla as well as to some adolescents visiting child psychiatrist in outpatient settings from January till the end of April, 2022. The following personal data were collected - age, gender, family status - as well as information about different factors affecting the mental health of adolescents during the pandemic: how often they spent time with friends, whether or not they have lost any friends, distance learning, seeking help from mental health professionals, quality of sleep and a chance to receive emotional support. Patients also filled Liebowitz social anxiety scale and PHQ-9: modified for adolescents’ depression scale.

Results

Restrictions due to pandemic mostly affect the participants negatively, promoting the worsening of social anxiety symptoms in 42% of the respondents with positive results of the Liebowitz scale. Statistically significant connection between social anxiety and depression symptoms was found. During the pandemic most of the patients were more often seeking professional help. Patients with worsening social anxiety symptoms were found to have statistically significant connection to losing friends during the pandemic. Most of the recipients with already diagnosed social anxiety were given this diagnosis during the pandemic (67% of the cases).

Conclusions

The restrictions due to Covid – 19 pandemics negatively affect adolescents including those with social anxiety, promoting the worsening of symptoms as well as prevalence of depression symptoms in these individuals. The results suggest that coping strategies must be implemented in order to decrease the consequences of the pandemic on adolescents.

Disclosure of Interest

None Declared
DISRUPTIVE IRRITABILITY & FAMILY DYSFUNCTION CORRELATION: ANALYSIS THROUGH FAMILY DRAWINGS
Authors: Vargas Castro A.
Published: August 2023

Introduction

Drawing represents mainly a motor activity of expression. Drawing represents a form of non-verbal language that is very important both cognitively and affectively. Therefore, it allows to hypothesise and evaluate the degree of neurodevelopment of individuals as well as their level of interaction with the environment.

Family sketches can be evaluated in a projective, neurocognitive and affective way to provide insights on the attachment system, degree of bonding, communication, social and affect interaction as well as difficulties or problems that have motivated emergency consultation.

Objectives

This study evaluate the possible correlation between family dysfunction and irritability as cause of request of consultation in an emergency department of mental health in child & adolescents through the analysis of family drawings.

Methods

This is a retrospective, observational study of correlation between the reasons of emergency consultations, dysfunctional irritability and family difficulties represented through family drawing. It is based on a randomised sample of 30 reports of emergency appointments of children between 8 to 13 years old that have been examined in the Child & Adolescent Psychiatry Emergency Department at the Pitié Salpêtrière Hospital during two years for Emotional or Irritability dysfunction.

An adaptation of both Goodenough-Harris Drawing projective test and Corman test were used to evaluate findings from family drawings as well as neurocognitive parameters of drawing technics, sociodemographic dates, cognitive level and family dysfunction.

Results

The degree of cohesion, identification and devaluation of adult figures have been important elements of interpretation in irritability dysfunction and family drawings.

Conclusions

The family environment could be a factor in the interpretation of chronic irritability and its manifestations on the child’s family drawings establish a clear correlation.

The adapted assessment of the family drawing could be an important tool in the nosological exploration of children’s mental health in emergency, especially on relational systemic representation and symbolization.

Disclosure of Interest

None Declared
Alexithymia in adolescents treated for psychiatric disorders: A study of the relationship with Alexithymia in parents and with the parental link
Authors: Mnif D. , Hadjkacem I. , Sellami R.
Published: August 2023

Introduction

Alexithymia is defined as a disorder involving difficulties in identifying, describing feelings and an outward-oriented way of thinking with restricted imaginary processes. Our objectives were to study the link between parents’ alexithymia and that of adolescents treated for psychiatric disorders on the one hand, and to study the relationship between alexithymia in adolescents and the parental link perceived by them, on the other hand.

Objectives

To study the relationship between the alexithymia of parents and that of adolescents followed for psychiatric disorders on the one hand, and to study the relationship between alexithymia in adolescents and the parental bond perceived by them on the other go.

Methods

A descriptive and analytical cross-sectional study was carried out at the pediatric psychiatry consultation at the Hédi Chaker University Hospital in Sfax during a period of one year from January 2019 to December 2019. We recruited 116 people: 53 adolescents, 44 mothers and 19 fathers. . We used an information sheet, the TAS-20 score (Toronto Alexithymia Scale) and the PBI (Parental Bonding Instrument)

Results

Two-thirds of the patients were alexithymic. A climate of domestic violence increased the adolescent’s emotional difficulties. Half of the mothers and one-third of the fathers were alexithymic. The total alexithymia score (TAS-20) in adolescents was positively correlated with the total alexithymia score (TAS-20) in the parents (p=0.03 for the mother and p = 0.02 for the father Adolescent difficulty in identifying emotions (DIE) was associated with difficulty describing emotions (DDE) in both parents (p=0.01 for mother and p<10-3 for father). The teenager had difficulty describing his own emotions when his mother was having the same difficulty. Outward thinking in adolescents were associated with more alexithymic traits in the mother. Maternal care scores were significantly and negatively correlated with adolescent TAS-20, DIE, and DDE scores (p=0.01, p=0.01, and p=0.04). Maternal protection score was positively and significantly correlated with TAS-20, DIE, and DDE scores (p=0.01, p=0.01 and p=0.02). The father’s protection score was positively and significantly correlated with TAS-20, DIE and DDE scores (p<10-3, p=0.04 and p=0.01). The overprotective attitude of parents perceived by the adolescent has therefore been associated with more alexithymia in adolescents.

Conclusions

Particular attention must therefore be paid to the emotional difficulties of adolescents followed in child psychiatry, as well as those present with their parents. These difficulties can create interpersonal difficulties and affect the parental bond perceived by the child.

Disclosure of Interest

None Declared
Yoga as an Adjunct Treatment for Attention Deficit Hyperactivity Disorder (ADHD)
Authors: Srinivas S. , Ashraf S. , Bachu A. , Kim F. , Shah K.
Published: August 2023

Introduction

Attention Deficit Hyperactivity Disorder (ADHD) affects about 9.4% (6.4 million) children in the United States. Pharmacological treatment, including stimulants, is a known therapy for ADHD. However, its possible subtherapeutic effectiveness, residual symptoms, and adverse effects have prompted us to explore the current evidence of Yoga as an add-on therapy that has shown synergistic effects in recent studies.

Objectives

1) We aim to assess Yoga’s efficacy as an add-on treatment for ADHD.

2) Assess the current evidence of Yoga as an add-on therapy for ADHD.

Methods

We searched PubMed, PubMed Central, Medline, Web of Science, and Biosis databases with the keywords “Attention Deficit Disorder with Hyperactivity” (MeSH) and “ADHD” in the context of “Yoga” (MeSH). Identified 4 relevant studies that were published until September 30, 2022.

Results

A study by Jensen et al. found improvement in impulsivity, hyperactivity, and restlessness in the ADHD with medications patient group after 20 Yoga sessions. Study utilized Conners’ Parents Rating Scales and found improvement in the Yoga group on Oppositional, Global Index Emotional Lability, Global Index Total, Global Index Restless/Impulsive, and ADHD Index scale, changes associated with the number of sessions (Jensen et al. J Atten Disord 2004; 7 205-216). In another study, children with ADHD showed significant improvement after 8 weeks of 16 Yoga sessions in accuracy rate and reaction time in the Visual Pursuit Test and Determination Test (Chou et al. Peer J 2017; 5 e2883). A nine-year-old male case showed improvement in inattentive and hyperactive-impulsive symptoms on Vanderbilt Assessment Scales from parents and teachers after 6 months of Yoga practice (Gunaseelan et al. Cureus 2021; 5, e2883). Another 6-week Yoga intervention randomized trial in pre-school ADHD children showed significant improvement in hyperactivity and inattention with fewer distractibility errors of omission and faster reaction time (Cohen et al. J Dev Behav Pediatr 2018; 39 200).

Conclusions

The results suggest that Yoga has beneficial effects as an adjunct treatment to pharmacotherapy in ADHD for reducing hyperactivity and inattentiveness. Additionally, studies indicate its effectiveness in managing stress, anxiety, energy levels, and impulse control by staying focused with the help of breath and mind control. To explore the full spectrum of benefits and effectiveness of Yoga as an add-on therapy for ADHD patients, we recommend robust well-design future studies.

Disclosure of Interest

None Declared
PANS Case Report. Assessment and management implications for a Liaison Child Psychiatry Program
Authors: Perez Moreno M. R. , Huete Naval M.
Published: August 2023

Introduction

Pediatric acute-onset neuropsychiatric syndrome (PANS) was described in 2010 not related to streptococcus infection (as PANDAS is), and with a clinically distinct presentation, defined as: I) Abrupt, dramatic onset of obsessive-compulsive disorder or severely restricted food intake; II) Concurrent presence of additional neuropsychiatric symptoms; III) Symptoms are not better explained by a known neurologic or medical disorder.

Objectives

To describe the clinical features in a scholar boy who suffered an abrupt obsessive-compulsive disorder and highlight the need of an specific medical and psychiatric assessment and management from a multidisciplinary perspective.

Methods

Clinical case: A 7-year-old boy brought to the emergency department due to his repetitive and hyperactive behavior. After the admission in the hospital a clinical history was identified with PANS diagnostic criteria. He presented repetitive language and ritualized behavior, emotional lability and hyperactivity that has begun in an abrupt manner in the last 5 days. Family history, medical history and physical examination, infectious disease evaluation, neurological assessment and child psychiatric assessment were carried out during hospitalization. Coordination between neuropediatric consultant and child psychiatry was necessary.

Results

Combinated treatment, psychofarmacologic and psychotherapeutic, was effective and the symptoms disapeared gradually in about three months.

Conclusions

In all school-age child presenting with abrupt obsessive-compulsive disorder or eating disorders a possible link to PANS should be evaluated and rule out. It is important a Liaison Child Psychiatry program for a complete multidisciplinary evaluation and management of these patients.

Disclosure of Interest

None Declared
How countries’ legislations can sustainably impact children’s mental health
Authors: Moro M. R. , Ogrizek A. , Dozio E. , Attias D. , Papazian-Zohrabian G. , Jesus-Martin J.-M. , Teicher M. , Baubet T.
Published: August 2023

Introduction

In a new era where, more and more children are standing up against governments concerning important subjects like climate change that will impact their physical health in a near future, it is time to question ourselves on all the other decisions that are being taken and that could have a sustainably high impact on some of our children’s development and mental health. Unfortunately, many of those children are forced to remain silent - unable to express themselves - or are just not being heard – unable to gain international medias’ attention - because of their social condition, cultural background, age or religion. But more sadly, most of them remain silent because they are just unaware of the consequences their living conditions or hardships might have on their future mental health, due to lack of information or education.

Objectives

Therefore, it is our responsibility as childhood experts and professionals to speak for those children who cannot, to stand up for themselves and promote the importance of putting their interest first no matter what.

Methods

We have chosen six different studies led in different contexts of struggle for children all around the world to illustrate the consequences on their development and mental health.

Results

We will communicate on the situations of children living in refugee camps, children living with their mothers in prison cells, children being forcibly separated from their mothers returning from Daesh territories in France or children being forcibly separated from their migrant mothers at the US border, we will describe the hardships but also the effective support provided to unaccompanied minors in Canada, and especially discuss with our cochair expertise how the issue is or could be different for them according to government policies and legislations.

Conclusions

By describing these different contexts of unstable living conditions or traumatic experiences orchestrated by government legislation regarding children care, we want to highlight the responsibility that every government legislation must consider when it comes to child care and how it should become an absolute priority.

Disclosure of Interest

None Declared
Emotional Experience, Physiological Reactivity, and Psychological Difficulties during middle childhood: a pilot study
Authors: Charpentier-Mora S. , Tironi M. , Bizzi F.
Published: August 2023

Introduction

Many studies linked expression and regulation of emotions as transdiagnostic variables involved in the emergence of psychopathological disorders. However, few studies investigated such processes during middle childhood, a critical period of life defined by significant psychological, physical, and social changes.

Objectives

Explore the relationship between child’s emotion regulation – both emotional subjective experience and physiological reactivity – and child’s psychological difficulties.

Methods

20 children (Mage=10.7, SD=1.25; 65% males) and their mothers were recruited from general population. Emotion regulation was assessed with (1) How I Feel (HIF) and Positive and Negative Affect questionnaires (PANAS) and (2) Heart Rate (i.e., Beats Per Minute, BPM) and Heart Rate Variability (i.e., High Frequency and Low Frequency ratio, LF/HF). Child’s psychological difficulties were measured with the parent report Child Behavioral Checklist 6-18 (CBCL-6/18).

Results

Statistically significant correlations emerged between the HIF-Positive emotions scale and both externalizing (rs = -.51) and internalizing (rs = -.46) difficulties; the HIF-Negative emotions scale and internalizing difficulties (rs = .49); LF/HF and internalizing difficulties (rs = -.58). Finally, a non-significant but moderate effect was found between the HIF-Negative emotions scale and externalizing difficulties (rs = .33).

Conclusions

Although the limited number of participants, data suggest an interesting role played by both child’s emotional experience and physiological reactivity on internalizing and externalizing difficulties as reported by mothers. More specifically, child’s experience of positive emotions is associated with fewer internalizing and externalizing difficulties, while child’s experience of negative emotions illustrates an opposite relationship, implying the relevance of looking at child’s emotional subjective experience in understanding psychological difficulties. Moreover, LF/HF ratio – labeled as the child’s sympathovagal balance – seems like it might be higher in children with less internalizing difficulties. Although doubts about LF/HF interpretation, several studies share this view showing a decrease in autonomic reactivity in internalizing problems, such as depression, in adults. Overall, our preliminary results underline the importance of studying the emergence of psychopathological outcomes in middle childhood connected to both psychological and physiological emotional processes.

Disclosure of Interest

None Declared
Psychological impact of motor impairment in tow forms of congenital muscular dystrophy
Authors: Boujelbene I. , Chaabane M. , Guirat M. , Ben Touhemi D. , Gharbi N. , Yousr M. , Kamoun H. , Ben Ayed I.
Published: August 2023

Introduction

Congenital muscular dystrophies (CMDs) represent a heterogeneous group of early-onset muscle disorders presenting primarily with hypotonia and delayed motor development. Several genes are known to be responsible for CMDs, including the LAMA2 gene, involved in merosin-deficient type 1A (MDC1A), and the FKRP gene involved in muscular dystrophy-dystroglycanopathy type B5 (MDDGB5). These two forms of CMD are autosomal recessive and are each characterized by the presence of a mutation with a founder effect in South Tunisia. Cognitive development associated with the founder mutation in the LAMA2 gene (c.8007delT) is often conserved, whereas in the founder mutation of the FKRP gene (c.1364 C>A), motor impairment is associated with intellectual disability (ID).

Objectives

To compare the psychological impact of motor impairment in children presenting these two forms of CMD and their families.

Methods

The study consisted of a survey of parents of children with a confirmed diagnosis of MDC1A (5 from 3 unrelated families) or MDDGB5 (3 from 3 unrelated families). The correspondent founder mutation was already identified in the homozygous state by targeted sequencing. Participants’ parents completed the Parent Strengths and Difficulties Questionnaire (SDQ), a behavioral screening tool designed for children aged from 2 to 17 years. The SDQ assesses emotional symptoms, behavior problems, hyperactivity, and peer relationships; The SDQ Impact Supplement assesses the impact of all these children’s difficulties on their families.

Results

The average age of the children was 4.95±3.92 with two children who were not assessable by the SDQ (age< 2 years). Unlike children with MDC1A, ID has been reported in all children with MDDGB5. The mean SDQ total score for children with MDC1A was 11, whereas the mean score for children with MDDGB5 was 14.875, reflecting greater difficulty for children with MDDGB5. The family impact score was higher in families with children with MDDGB5 than in children with MDC1A (10,5 vs 7), which may be due to the burden of management of the ID associated with the motor impairment. The more pronounced difficulties associated with MDDGB5 are likely to be related to the associated ID. Whereas in MDC1A, the difficulties observed are related to the direct impact of the motor impairment. The presence of cognitive disorders associated with a motor deficit aggravates behavioral adaptation and makes the management of these children more difficult.

Conclusions

In the absence of a comparable study in the literature, the present is conducting future studies on the behavioral profile of children with CMD to obtain a better understanding of their difficulties in everyday life and to develop interventions adapted to their families

Disclosure of Interest

None Declared
Possible psychotic episode after repeated ayahuasca intake: a case report
Authors: Prades Marin E. , Martínez Torres A. , Sánchez Díez P.
Published: August 2023

Introduction

Ayahuasca is a traditional brew containing the psychedelic 5-DMT (a tryptamine that acts as a 5HT2A-R agonist) used to achieve non-ordinary states of consciousness, with a long tradition among various cultures in ritual and therapeutic contexts. Ayahuasca is being studied as potential treatment in Mental Health, which has led to non-controlled and recreational use. This has led to a rise in the description of side effects, such as substance-induced psychosis.

Objectives

To describe a case of a possible psychotic episode related to the intake of ayahuasca brew in a ritual context.

Methods

Clinical assesment and bibliographic review of pertinent literature.

Results

We will present the case of a 43 year old woman, who participated in three ayahuasca sessions in three consecutive months. Two days after the last session, she suffered and episode of loss of consciousness, convulsions, loss of streng and paraesthesia in right forearm and righr side of the face and head; and apparition of perceptual alterations and delusions that she did not experience during the trip. Such alterations included the perception of electromagnetic fields (EMF) robbing her of her vital energy and lifeforce. She required ICU treatment for four days, after which se was hospitalized in Internal Medicine Unit and was assessed by Mental Health team. Though the symptoms were coherent with the previous beliefs of the patient, they were clearly exacerbated and interfered with her normal and previous functioning. She was treated with risperidone 1,5 mg, with complete symptom remission.

Conclusions

The case presented is consistent with other reports of ayahuasca-induced psychotic symptoms, though with less intensity and duration. We discuss prevalence and repercussions of the rising use of this powerful substance; that must be taken into consideration by clinicians worldwide.

Disclosure of Interest

None Declared
Cannabis use during first episode psychosis in Tunisia
Authors: Bergaoui E. , Lansari R. , Chehaider O. , Moalla M. , Larnaout A. , Melki W.
Published: August 2023

Introduction

Cannabis use is frequent among patients with psychotic disorders. However, the relationship between cannabis consumption and transition to psychosis has not been fully elucidated.

Objectives

The aim of this study was to assess the prevalence of cannabis use in first episode psychosis and its correlation with transistion to psychosis and severity of symptoms.

Methods

A cross-sectional study was conducted at the psychiatric department D of Razi hospital including 50 patients hospitalized for first episode psychosis. The evaluation focused on sociodemographic and clinical characteristics of the patients. We used the cannabis abuse screening test (CAST) and positive and negative syndrome scale (PANSS).

Results

The sex ratio of our patients was 4 men per 1 woman. The mean age was 25.6±6.16 years. Two-thirds of the patients had secondary education (n=24). Half of them had no occupation (n=17). Twenty-five patients (71%) had no psychiatric history. The total PANSS score showed a mean of 58.29±12.90 with extremes between 35 and 91. About 60% of the patients used cannabis with high addiction risk in 81% of cases. The mean duration of cannabis use was 7,04 years, 3 times a week. Cannabis use was correlated to the gender. However, no correlation was found between cannabis use and duration of untreated psychosis niether the negative or positive symptoms.

Conclusions

Although cannabis use is knownto accelerate transition to psychosis, it does not affect the severity of symptoms. Further work is necessary to identify the factors that underlie individual vulnerability to cannabinoid-related psychosis and to elucidate the biological mechanisms underlying this risk.

Disclosure of Interest

None Declared
Neuroradiological manifestations of drug use: description of clinical cases
Authors: Faria I. , Silva T.
Published: August 2023

Introduction

Drug use and misuse continue to create public health challenges in the world, leading to overdose deaths, infections, and other chronic health conditions. Illegal addictive drugs can lead to functional or structural impairment of the central nervous system (CNS). Because clinical findings alone are often nonspecific, and some patients are unlikely to admit substance abuse, the neuroimaging may play an important role in establishing the diagnosis and initiating treatment.

Objectives

We aim to provide an overview of the structural imaging findings on computed tomography (CT), magnetic resonance (MR) imaging related to chronic and acute abuse of commonly addictive substances, including cannabis, alcohol, cocaine, and opioids.

Methods

Non systematic review of the literature on the subject and description of three clinical cases.

Results

Pathomecanisms of drugs misuse include excitotoxicity, which may lead to an acute or subacute leukoencephalopathy, and vascular complications, including vasoconstriction, vasculitis, or hypertension, which may lead to intracranial hemorrhage or ischemia. Alcohol abuse may lead to Wernicke-Korsakoff syndrome, revealing in MR bilateral symmetrical hyperintense signals on T2-weighted; Marchiafava-Bignami disease (MBD) is a very rare condition which may present hypodense lesions in the corpus callosum; and alcoholic cerebellar degeneration is a common type of acquired cerebellar ataxia and may present cerebellar volume loss localized to the anterior superior vermis. One of our clinical cases is a female, 39 years, and present cocaine induced multifocal leukoencephalopathy, associated with inflammatory/immune mediated mechanism. Other clinical case (female, 24 years) demonstrate spongiform leukoencephalotpathy from “chasing” heroin, with a characteristic presentation.

Conclusions

The main pathomechanisms related to the abuse of drugs are ischemia, hemorrhage, and leukoencephalopathy related to excitotoxicity of the drug or its derivatives. Clinical findings are nonspecific, highlighting the need to recognize these complications at both CT and MR imaging. Therefore, diagnostic imaging modalities can play a pivotal role in the recognition and timely management of drug-related complications in the CNS.

Disclosure of Interest

None Declared
Exploring the concept and management of post ictal psychosis through a clinical case and review
Authors: Compaired Sánchez A. , Lázaro Alonso B. , Gómez-Arnau Ramírez J.
Published: August 2023

Introduction

Postictal Psychosis of Epilepsy (PIPE), part of the group collectively known as Psychosis of Epilepsy, is characterized by an onset of confusion or psychotic symptoms within one week of apparent normal mental function. PIPE has been argued to be underdiagnosed in the clinical population, perhaps due to a failure to recognize the temporal relation between the seizure and the psychotic episode.

Objectives

To explore the concept and management of post ictal psychosis.

Methods

We present a clinical case and a review of the literature concerning post ictal psychosis.

Results

We report the case of a 36 year old woman with focal refractory epilepsy after a likely episode of limbic encephalitis in 2015. Cognitive and psychiatric sequelae in the form of depressive symptoms, in treatment with neurology and psychiatry since 2021. One previous episode of psychotic symptoms during seizures. Worsening of seizure frequency since march of 2022 with apparent normalization (absence of seizures after dose reduction of eslicarbamazepine and introduction oflamotrigine) for about four days before being hospitalized in the neurology unit due tobehavioral abnormalities. During psychiatric exploration, the patient showed signs of partial clouding of consciousness with manierisms, ecopraxias and ecolalias; verbigerance in the form of the neurologist’s name and bizarre movements like looking behind suggestive of sensoroperceptive disturbances. The symptomatology resolved itself during the following week after treatment with diazepam.

Finally, a narrative review concerning the case was also performed; with particular emphasis on antipsychotic drugs with low risk of lowering seizure threshold (such as risperidone or aripiprazole) as the recommended treatment.

Conclusions

Our findings point to the relevance of Postictal Psychosis of Epilepsy as a clinical entity. Further studies on pathogenic mechanisms and therapeutic management are required.

Disclosure of Interest

None Declared
Analysis of the implementation of the collaboration programme between the headache unit and the liaison psychiatry programme
Authors: Garcia Lazaro F. , Gotor Sanchez Luengo F. , Garcia Ligero del Rincon E. , Luque Budia A.
Published: August 2023

Introduction

Headache is associated with a wide spectrum of comorbid, statistically and biologically related pathological processes. A person with headache is more likely to have a psychological disorder than the rest of the general population, even more so if the headache is chronic. Psychiatric comorbidity has been shown to act as a risk factor in the chronification of headache and may contribute to increased disability. Anxiety and mood disorders are the psychiatric comorbidities that most influence aspects of the disease such as prognosis, response to treatment and even quality of life.

Objectives

To analyse the results of the implementation of a joint consultation between the headache unit and the liaison psychiatry programme.

To evaluate the efficacy of interdisciplinary intervention in patients diagnosed with resistant headache.

Methods

We performed a descriptive analysis of the database of patients included in the headache programme including data on neurological diagnosis, psychiatric diagnosis, type of intervention, referral to psychiatric consultation and number of subsequent revisions.

Results

Diagnoses related to anxious and depressive symptomatology are the most common diagnoses in patients diagnosed with treatment-resistant headache.

In most of the patients analysed in the database a single joint intervention was necessary.

Referral to mental health consultations from the programme did not lead to an increase in urgent demands with a clinical correlation in terms of diagnostic orientation

Conclusions

Joint intervention in the management of these patients has been found to be beneficial in the reinterpretation of symptoms and progressive desensitisation to fear of chronic illness.

Training in symptom detection at the psychopathological level is important for professionals from other areas as well as training in interviewing skills.

More studies are needed to analyse the outcome of joint interventions in patients with difficult-to-manage chronic diseases and their comorbidities.

Disclosure of Interest

None Declared
Personalisation of the management of schizophrenia and other primary psychoses
Authors: Galderisi S.
Published: August 2023

In the treatment of persons with schizophrenia the goal has gradually shifted from the reduction of symptoms and prevention of relapse to recovery. However, this goal is achieved for a minority of persons with schizophrenia, while for most of them the disorder still is a major cause of disability, poor quality of life and premature death, and presents considerable social and economic costs.

Studies aimed at identifying variables with a significant impact on schizophrenia outcome indicate that early intervention, shared decision making, treatment continuity, physical comorbidities, negative symptoms, deficits in cognitive functions and functional capacity account for most of the functional impairment of patients but are often neglected in current clinical practice.

In this presentation, I will illustrate the role of these variables and the need for an in-depth clinical characterization of persons with primary psychoses to implement personalized treatment plans and improve the care of people with schizophrenia.

Disclosure of Interest

None Declared
Adjustment strategies adopted by higher education students during COVID-19 pandemic: focus group discussions
Authors: Laranjeira C. , Dixe M. , Charepe Z. , Querido A.
Published: August 2023

Introduction

With the closure of higher education institutions during the COVID-19 sanitary crisis, students have experienced problems such as interruptions to their education, loss of peer support networks, and mental health issues.

Objectives

This study aimed to explore adjustment patterns used by students to overcome the impact of the COVID-19 pandemic.

Methods

A qualitative descriptive study was developed by carrying out Focus Group Discussions (FGDs). Portuguese students enrolled in education levels above high school, including undergraduate and graduate programs, were considered eligible. Participants were recruited using convenience sampling. Each FGD took approximately 60–90 min.

Results

Twelve students were participated in 2 FGDs, each one with 6 participants. Mostly were undergraduate students (Bachelor’s degree), in the field of health area. The thematic analysis revealed three main themes. The first theme was related to the personal sphere and included most of adjustment strategies used, namely: pandemic as a “window of opportunity” to be involved in new academic and professional projects; work-life balance by organizing and separating work from private life; self-care through the adoption of healthy lifestyles; being compassionate with others and compliance with sanitary measures. In the social sphere, students evoked new ways of communicating via digital networking to compensate for the lack of physical proximity and stay in safe contact with friends and relatives. In the contextual sphere, students talked about the importance of adapting the “teaching/learning” environment. Tailored teaching support was a significant strategy, especially in maintaining their motivation.

Conclusions

Several strategies were pointed by students to stay mentally healthy and mitigate delayed-onset post-traumatic stress disorder during the COVID-19 pandemic. Besides, positive coping and hope should be integrated into the standard training of students across all study areas.

Disclosure of Interest

None Declared
SUICIDE AND COVID-19: A TEMPORAL-SPATIAL ANALYSIS IN THE STATE OF PARANÁ AND THE 15th HEALTH REGIONAL FROM 2010 TO 2020
Authors: Silva K. , Bettoni C. , Santos R. , Schoeler N. , Porcu M.
Published: August 2023

Introduction

Suicide occurs throughout all the life course, but in 2019 it was the fourth leading cause of death among 15-29 years old worldwide.

In Brazil, between 2010 and 2019, 112,230 deaths from suicide were recorded, with a 43% increase in the annual number of deaths from the beginning to the end of that period in all age groups. (SAÚDE, 2021).

Objectives

To accomplish a space-time analysis of the rate of suicide deaths in the state of Paraná and in its 15th Health Regional, from 2010 to 2020, in the population aged 20 to 69 years, contrasting the pre-pandemic periods (2010 to 2019) and during the COVID-19 pandemic (2020).

Methods

This is an ecological, observational, cross-sectional, retrospective study, using spatial and temporal analysis tools, based on secondary data obtained from the Department of Informatics of the Unified Health System (DATASUS), in the period 2010 and 2020, referring to the 5568 Brazilian cities, with emphasis on the 399 of the state of Paraná and the 30 cities of its 15th Health Regional (HR).

Exploratory Spatial Data Analysis (AEDE) techniques were used through GeoDA (version 1.20.0.8) and QGis (version 3.22.4) software to determine the existence of Spatial Autocorrelation (Moran’s Global Index or Moran I) and to calculation and visualization of the Local Spatial Association Indicator (LISA).

Global (Moran I) and local (LISA) spatial autocorrelation coefficients were considered significant when p < 0.05 at a 95% confidence level.

The Space Time Cube is a simultaneous spatial and temporal analysis methodology of ArcGIS Pro Software (ESRI, 2011) that evaluates the behavior of a value in space over a defined time interval.

Results

The arithmetic mean of the age at death by suicide, from 2010 to 2020, was 41.1 years, with a standard deviation of 13.3 years and a median of 40 years. Most deaths in the pre-pandemic period occurred among men aged 20 to 29, followed by women aged 30 to 39 years and men aged 40 to 49 years.

Regarding the most common causes and modes of suicide in the State, there was no significant difference between the periods from 2010 to 2019, pre-pandemic reference, and 2020 (pandemic) in a global perspective. The three main causes of death were: 1) Hanging, strangulation or suffocation (ICD-10 X70, T71) were the majority and accounted for more than half of all causes; 2) Self-harm by gunshot (ICD- 10 X74 and X72); 3) Self-poisoning by pesticides and drugs, respectively (ICD-10 X68 and X61).

Conclusions

This study showed an increase in suicide deaths in the state of Paraná, when analyzing the periods before and during the COVID-19 pandemic. The most affected population was men, aged 20 to 29 years.

Disclosure of Interest

None Declared
The impact of COVID-19 pandemic on inpatient admissions for bipolar disorder
Authors: Portela C. , Oliveira C. , Areias D. , Gonçalves M.
Published: August 2023

Introduction

In 2019, there were 39.5 million patients suffering from bipolar disorder worldwide, resulting in around 8.5 million disability-adjusted life years (DALYs) and in a significant economic burden. Bipolar disorder is known to be susceptible to factors that disrupt biological and social rhythms. The COVID-19 pandemic and the measures taken to control it, such as social distancing, home confinement and lockdowns, pose a risk to the stability of bipolar patients. Other factors, for example, reduced access to treatment and stress associated with the disease could also contribute to relapses. Studies have shown that, in 2020, more people with bipolar disorder were hospitalised compared to previous years, including patients without previous history of hospitalizations.

Objectives

This study aims to assess the impact of the COVID-19 pandemic on inpatient admissions for bipolar disorder.

Methods

Socio-demographic and clinical data were collected from electronic medical records. A retrospective observational study of patients who were admitted to a psychiatric ward between March 2019 and February 2021 was conducted. The characteristics of patients admitted before the pandemic (March 2019 to February 2020) and after (March 2020 to February 2021) were compared statistically.

Results

A total of 850 patient admissions were obtained, 15% of which had a main diagnosis of bipolar disorder. The authors will analyze all the variables in the population admitted. The authors expect to find differences between patients hospitalized before and after the beginning of the pandemic, both in clinical presentation (manic, depressive or mixed episode), psychiatric history, comorbidities, suicide attempts and socio-demographic factors.

Conclusions

The COVID-19 pandemic had a significant impact on mental health on a global level, plenty of which is still unknown. The findings of this study will likely show the effects of this crisis on bipolar disorder patients.

Disclosure of Interest

None Declared
The role of tDCS in psychiatrists toolbox
Authors: Järventausta K.
Published: August 2023

tDCS is a low-cost and well-tolerated neuromodulation treatment of depression. It seems to be a good and effective option to start the treatment of depression along or instead of medication in mild or moderate depression. tDCS can be used as an add-on treatment with psychotherapy or medication. Home based tDCS is easy to conduct. However, tDCS should be used with qualified protocols like any other neuromodulation treatment. When the tools in psychiatry are diversifying the precise diagnostics, careful defining of the clinical picture and effective early and individually planned management of depression are key elements gaining better outcomes and preventing treatment resistant depression.

Disclosure of Interest

None Declared