bluuebunny/crossref_metadata_2025_split huggingface dataset:
Consultation-Liaison Psychiatry in Italy: historical development and models of intervention
Authors: Mattei G. 
Published: August 2024

AbstractThe birth of Consultation-Liaison (CLP) in Italy was made possible thanks to Act 180/1978, which started a 20-year-process that led to closing asylums and fostered the implementation of small psychiatric units within the general hospitals. In the meantime, Italian CLP grew steadily, fostered also by the enactment of two “Objective Mental Health Care” Plans (1994-1996 and 1998-2000), that led to the implementation of the organizational model of the mental health department (MHD).As far as psychiatric referrals are concerned, the first Plan states that the MHD covers all territorial and hospital-based activities, in order to assure, among other services, the integration with hospital (with special attention paid to the Emergency Department and to consultation activity in non-psychiatric hospital wards) and general medicine (as well as other sectors, including mother and child health care).
With respect to psychiatric referral, the Second Plan states that “In the 24 months following the entry into force of the Plan, MHDs will adopt guidelines and procedure concerning several issues, including consultation-liaison activity in non-psychiatric hospital wards (which also includes mental health care for “psychiatric” patients hospitalized for non-psychiatric disease in the general hospital) and in Department of Addictions (for alcohol and other substances use disorders. According to the second Plan, Community Mental Health Services (CMHCs) provide, among other performances, CLP activity for general practitioners. Inside general hospitals, psychiatric referrals to non-psychiatric wards are provided by inpatient psychiatric units, when CLP Services are not available.
Since a standard definition of psychiatric consultation is not available, the one provided by the Italian region Emilia-Romagna will be used. The Region includes “consultation” among mental health services provided by CMHCs, and defines it as follows: “Psychiatric or psychological assessment carried out upon request from other [non psychiatric] Departments. The consultation includes both clinical interview with the patient and the medical report for the department that referred the patient.” The ways to identify consultation as one among other types of services provided by the MHD are defined, to count the overall number of consultations and monitor the clinical activity of health professional working in the different branches of the MHD. The following types of consultations are reckoned: consultations requested by general practitioners (who work within the Primary Care Department); consultations requested by the Department of Addiction (a branch of the MHD); and consultations requested by the Department of Child-Adolescent Psychiatry (which, as the previous one, is a branch on the MHD).Disclosure of InterestNone Declared
Difficulties in assessing the medical fitness of workers with mood disorders : A study of 101 cases
Authors: Chemingui S. , Brahim D. , Mersni M. , Mechergui N. , Methni M. , Ben Said H. , Youssef I. , Bahri G. , Yaich I. , Ben Said C. , Bram N. , Ladhari N. 
Published: August 2024

IntroductionAssessing the medical fitness of workers with mood disorders remains a topical issue, because of its organizational, socioeconomic and professional impact.ObjectivesTo assess the medical and occupational characteristics of workers with mood disorders.To evaluate the impact of these psychiatric disorders on the medical decision of fitness for work.MethodsDescriptive and retrospective study, over six years (January 1, 2018 to August 30, 2023) including all medical records of workers with mood disorders (bipolar disorder, anxiety disorder, and depression), referred to the occupational department of the Charles-Nicolle Hospital in Tunis for a medical fitness for work.ResultsThe study included 101 patients, mostly female (sex ratio = 0.4), with a mean age of 43.3 ± 9.2 years. The most represented sector of activity was health care. The participants were mainly nurses (25%), followed by technicians (22%) and workers (21%). The mean job seniority was 16.5 ± 9.3 years. A pathological history was found in 74.3% of cases, of which 47.5% were psychiatric disorders. Mood disorders identified in our population were: bipolar disorder (53.5%), anxiety disorder (43.5%), and depression (3%). After medical examination and the decision of treating physician, 39% of the patients (N=39) were declared fit for work, and 31.4% (N=32) were fit with ergonomic adjustments. These accomodations consisted mainly of night shift exemptions in 75% of cases. Temporary unfitness was declared in 24 patients (23.6%). Job mutation was recommended for four patients. Early retirement due to invalidity was proposed for two patients.ConclusionsThe decision on the medical fitness of workers with psychiatric disorders remains a delicate issue that requires the attention of both legislators and occupational health practitioners.Disclosure of InterestNone Declared
Neuropsychiatric symptoms in Multiple Sclerosis (MS): Case Report of a First Manic Episode in a Patient with Suspected MS
Authors: Pais M. A. N. C. , Fernandes T. M. F. , Cagigal M. 
Published: August 2024

IntroductionMultiple Sclerosis (MS) is an inflammatory disease affecting primarily the central nervous system, characterized by focal lesions of white-matter demyelination. It can present with a variety of neurological symptoms, including monocular vision loss, sensory loss, paresthesias, limb weakness, ataxia and bladder dysfunction, and has a typically chronic and progressive course. Neuropsychiatric manifestations including depressive or manic symptoms, anxiety disorders and psychosis, are also frequently observed, and are of particular importance to mental health practitioners.ObjectivesTo describe a case of a 45-year-old female patient with a history of suspected MS presenting with manic symptoms, and to discuss the possible neuropsychiatric manifestations of Multiple Sclerosis.MethodsClinical case report and literature review.ResultsA 45-year-old woman was brought to the emergency department presenting with severe acute agitation, irritable mood, rapid speech and persecutory delusions. She had no prior history of neuropsychiatric symptoms, but her medical history was notable for a suspected diagnosis of MS, having suffered an episode of optic neuritis 16 years before the present episode. Magnetic Ressonance Imaging performed 3 months before emergency admission documented non-specific white-matter lesions presenting as hyper-intense in long TR sequences, as well as a cervical lesion of atypical characteristics, representing possible spondylotic myelopathy or demyelination. A head CT performed at emergency admission did not reveal relevant acute findings. The patient was hospitalized and initiated risperidone and valproic acid therapy. She responded favorably to medication, with progressive stabilization of mood and remission of delusional ideas over three weeks.ConclusionsNeuropsychiatric symptoms are a common and concerning manifestation of Multiple Sclerosis. The present case illustrates that clinicians should be on alert for signs of mood and psychotic symptoms in patients with suspected or confirmed MS, as these can manifest at any point during the disease course.Disclosure of InterestNone Declared
Our old friend lithium and encephalopathy: a case report
Authors: Cameira M. P. , dos Santos C. F. , Pereira M. , Lisboa M. V. , Soares M. R. , Abreu P. 
Published: August 2024

IntroductionLithium is a well-established mood stabilizer used in the management of bipolar disorder, that is generally well-tolerated; however, it is associated with rare but potentially severe neurological side effects. Lithium-induced encephalopathy is characterized by a spectrum of symptoms, ranging from subtle cognitive deficits to severe manifestations such as altered mental status to overt delirium, seizures and coma. Risk factors include advanced age, concomitant medication and underlying renal impairment. This symptoms do not consistentely correlate with lithium concentrations.ObjectivesThis abstract aims to provide an overview of the clinical characteristics, underlying mechanisms, and management of lithium-induced encephalopathy.MethodsWe discuss a case of a 62-years-old woman diagnosed with bipolar disorder under treatment with lithium and olanzapine, without recent changes of posology. She presented to emergency department with subacute and fluctuating neuropsychiatric symptoms, including confusion, disorientation in time and space, complex visual hallucinations, delusional ideas, alteration in memory and logic thinking, dysarthria and dyspraxia. Neuroimaging showed no structural abnormalities, blood tests were normal and serum lithium levels were within the therapeutic range (0.8 mEq/L). Upon discontinuation of lithium, the patient exhibited a gradual resolution of symptoms. We conducted a comprehensive search of medical databases, including PubMed, to identify relevant articles related to lithium encephalopathy published up to September 2023.ResultsThis case challenges the conventionally established threshold of elevated serum lithium levels in the development of encephalopathy. The underlying pathophysiology is complex and multifactorial, with proposed mechanisms including alterations in neurotransmitter balance, oxidative stress, mitochondrial dysfunction and individual susceptibility to idiosyncratic reactions. Early diagnosis is challenging, necessitating a high clinical suspicion, neuroimaging and exclusion of other etiologies. Management strategies involve discontinuation of lithium, even when serum lithium levels are within the therapeutic range, supportive care, and, in severe cases, hemodialysis to reduce lithium levels rapidly.ConclusionsClinicians should maintain a high index of suspicion of lithium-induced encephalopathy, especially in patients presenting with neurological symptoms while on lithium treatment. Early recognition and intervention are essential for minimizing morbidity and preventing potentially irreversible neurological damage. Further research is needed to better understand the precise mechanisms underlying it, risk factors and to refine treatment strategies.Disclosure of InterestNone Declared
Use of aripiprazole long-acting injectable release as a stabiliser. About a case
Authors: Izquierdo De La Puente A. , del Sol Calderón P. , Fernandez Fernandez R. , da Silva M. V. , Garcia Moreno M. 
Published: August 2024

IntroductionA 56-year-old patient diagnosed with bipolar affective disorder type II, who remains stable, with no manifest episodes, thanks to aripiprazole 60mg daily.ObjectivesThe aim is to carry out a brief review of the use of the drug as the only stabiliser in bipolar affective disorder.MethodsA 56-year-old patient, who has been suffering from episodes of hypomania since the age of 40, with episodes of depression. After poor tolerance to the use of the usual stabilisers, and the impossibility of using antidepressants due to hypomanic swings, it was decided to start treatment with aripiprazole orally, up to a maximum of 60mg daily. Despite the fact that the patient, with this treatment, had no side effects and remained more stable psychopathologically, the patient did not comply adequately with the correct dosage, due to his rotating work shifts. This fact explained that although he acknowledged an improvement, he continued with episodes of depressive symptoms lasting several days followed by episodes of hypomanic characteristics.ResultsFor this reason, it was decided to change treatment to aripiprazole long-acting injectable, in order to ensure linear blood levels of the drug. Initially, it was decided to prescribe 400mg every 28 days. However, after the first administration, 20 days later, the patient began to show dysphoric mood, with marked emotional lability, living in an egodystonic manner. For this reason, the dose was increased to 600mg on a monthly basis. Since then, after a year and a half with the same treatment, the patient has been stable and in line. There has been no further decompensation of the underlying psychopathology and no side effects.ConclusionsAripiprazole in TAB is superior to placebo in type I patients, mainly affecting manic and mixed episodes, but not so much in depressive episodes. It has also been observed that it not only acts in the acute phases, but also has a stabilising function, preventing manic episodes.One study showed that up to 65% of patients on oral aripiprazole in whom it was replaced by AOM remained clinically stable. In the same study, approximately 50% of those who completed 52 weeks of follow-up were able to maintain clinical stability.Disclosure of InterestNone Declared
The role of cannabis in bipolar disorder relapse: a prospective study of hospital acute readmissions
Authors: Olivier L. , Giménez A. , Andreu Gracia H. , Bueno L. , De Juan Viladegut Ó. , Fernández T. M. , Ochandiano I. , Salmerón S. , Bracco L. , Tardón Senabre L. , Pacchiarotti I. 
Published: August 2024

IntroductionWith the rapid changes of attitude, investigation and legislation around cannabis and its subproducts in the Western world, there is a need to profoundly examine the consequences of its use in the general population and, specifically, in people affected by mental disorders. There is a clear relationship between cannabis use and psychosis, but there is also growing evidence of its relationship with manic episodes (Sideli et al, 2019).A systematic review published by the CANMAT Task Force in 2022 examined again the relationship between cannabis use and bipolar disorder (BD), establishing association with worsened course and functioning of BD in frequent users (Tourjman et al., 2023). On the other hand, some recent papers have highlighted the role of the endocannabinoid system (ECS) in BD, suggesting even possible beneficial effects, mainly through the CB2 receptor (Arjmand et al, 2019).ObjectivesTo describe the impact of cannabis in the psychiatric readmission in BD and to approach the differences in course in cannabis users with regards to non-users.MethodsWe conducted a prospective cohort study including the patients admitted to our acute psychiatric unit with the diagnosis of manic or mixed episode during the period between 2015 and 2019 (including patients with one of both final diagnosis: BD or schizoaffective disorder). We established a follow-up of 3 years from the date of admission in which hospital readmissions are examined.ResultsThe study, which included 309 patients, concluded that cannabis users were admitted and had the first episode at a younger age (p=0.005), a higher percentage of them did not have a previous diagnosis (p=0.026) nor a previous history of mental health issues (p=0.019) and it was more likely to be their first admission (p=0.011) and to suffer psychotic symptoms (p=0.002).As of treatment, the results were statistically significant regarding the fact that a lower proportion of patients had received previous psychiatric treatment (p=0.004) and previous electroconvulsive therapy (p=0.003). There was a higher chance of them being non-adherent with medication (p<0.001) and to be administered extended-release antipsychotic treatment during admission (p<0.001).The study did not find a statistically significant relationship with cannabis use and a higher rate of readmission in the 3 years of follow-up.ConclusionsAlthough a higher relapse rate could not be proven in our study, other previously identified factors related to a worse illness course (Sajatovic et al., 2009) did show a significant association with cannabis use, which could lead to one suggesting that our results are compatible with the actual evidence and that cannabis products are detrimental to people who suffer from BD and schizoaffective disorder.Disclosure of InterestNone Declared
Pattern of video game usage and video game disorder in Portugueses adolescents: A study about parental and peer attachment, parenting styles, and communication in parenting
Authors: Ribeiro A. M. , Maia B. R. 
Published: August 2024

Introduction
Video game disorder has been a subject of increasing interest, being associated with patterns of insecure attachment and authoritarian and permissive parenting styles. However, there is still a gap concerning the relationship between video game disorder and parent-child communication, one of the fundamental components of attachment to parents. Particularly in the Portuguese context, research on these topics and their interrelations is still scarce, thus remaining relatively unexplored.ObjectivesTo explore the pattern of video game usage and video game disorder, as well as their relationships with parental and peer attachment, parenting styles, and communication in parenting within a sample of Portuguese adolescents.Methods
150 Portuguese teenagers, recruited at public Portuguese schools, aged between 10 and 19 years old (mean age = 14.37, DP = 3.12; 52.7% girls (n = 79), and mostly living with both parents (79.7%, n = 106) fulfilled a sociodemographic and an academic questionnaire, a questionnaire on video game use patterns, the Video Game Disorder Scale - Short Version 9, the People in My Life Questionnaire, the Portuguese hetero-report version of the Parenting Styles and Dimensions Questionnaire: Short Versionand the Perception Scale of Parenting Communication.ResultsThe majority of the sample indicated 3rd childhood (n = 81, 54.0%), specifically at 8 years old, as the age of video game initiation and a playtime of less than or equal to 2 hours (n = 111, 74.0%), with only 2 participants found to have a video game disturbance index (1.3%). A positive association was found between video game disturbance and the average hours of gameplay, as well as a negative association with the age of game initiation. Additionally, relationships were explored, revealing that video game disturbance is negatively related to lower quality of attachment to parents and peers, positively related to an authoritative parenting style, and negatively related to less available, open, and affectionate parent-child communication.ConclusionsThis study provides an in-depth understanding of adolescents’ behavior regarding video games, contributing to the knowledge of the topic in the Portuguese context. Furthermore, the identification of factors associated with video game disturbance allows for the development of remediation and prevention programs for this addictive disturbance, which are essential tools in psychological practice.Disclosure of InterestNone Declared
Study of EEG sensitivity and specificity in loss of conciousness in adolescents
Authors: Bouchech R. , Fki A. , Kammoun I. , Kammoun I. , Masmoudi K. 
Published: August 2024

IntroductionAlthough the etiological diagnosis of loss of consciousness is essentially based on a careful history and clinical examination, electroencephalography (EEG) remains an important investigative tool.Objectives
The aim of this study was to identify the value of EEG in the management of adolescents with recurrent bouts of faintingMethodsThis was a retrospective descriptive study conducted from January 2019 to May 2022. We included all adolescents referred to the functional explorations department at Habib Bourguiba hospital, Tunisia for Electroencephalogram (EEG) as part of a workup to explore recurrent episodes of loss of consciousness.ResultsA total of 55 adolescents were included in this study, with a mean age of 15.4±2.3 and a 72.4% female proportion.The delay between the EEG and the onset of the seizure was greater than one week.67.3% of patients were referred by the child psychiatry department.29.1% of the 55 EEG reports were pathological. Epileptiform discharges were noted in 56.3% of adolescents. Slow waves were found in 43.7% of cases. The location of the abnormalities was predominantly frontal. Patients with temporal EEG anomalies had a notion of ascending epigastric pain preceding loss of consciousness in 90% of cases. Adolescents with EEGs containing epileptiform abnormalities had a history of paroxysmal movements in 30% of cases. The sensitivity of the EEG was estimated to be around 25%, and the specificity around 79%.ConclusionsAlthough the clinical examination is of great importance in the etiological diagnosis of loss of consciousness, the EEG remains a complementary examination of non-negligible interest in the etiological investigation.Disclosure of InterestNone Declared
Cyber victimisation and depression among adolescents in Tunisia: a case report study and review of literature
Authors: Bergaoui E. , Touiti A. , Maamri A. , Hajri A. , Zalila H. 
Published: August 2024

IntroductionCyber victimization is a form of violence that is perpetrated through social media, and its victims are primarily adolescents and young adults. This can have a negative impact on their psychosocial well-being.ObjectivesTo investigate the relationship between cyber victimization, depression, and suicide, identifying risk factors, prevention and intervention strategies through an case report.MethodsWe report the clinical case of a 16-year-old Tunisian man who developed a depressive disorder after being cyber-victimized. We also conducted a literature review in PubMed database keywords: depression, suicide, cybervictimisation, adolescents to identify risk factors, prevention and intervention strategies.ResultsThe adolescent was a member of a youth group called The Gung, which organized climbing challenges that were then broadcast on Facebook. He was the victim of cyberbullying after failing a challenge that was broadcast live. As a result, he was rejected by his group of friends and subjected to death threats and bullying. A clinical examination revealed major depressive disorder, low self-esteem, and low self-assertion. The patient was treated with a combination of medication and psychotherapy, and he had a good outcome with social and educational reintegration.Several studies have found that cyber victimization is associated with depressive disorders, anxiety disorders, and suicidal behavior among youth. Several risk factors have been identified, including low socioeconomic status, disrupted family dynamics, low self-esteem, and psychiatric disorders. Prevention and intervention strategies involve families, educational institutions, civil society, and health professionals.ConclusionsThe seriousness of cyber victimization among youth is undeniable. Early and personalized intervention is necessary to prevent suicidal behavior and restore the well-being of adolescents.Disclosure of InterestNone Declared