The COVID-19 pandemic has caused unprecedented stress for healthcare workers (HCWs), exacerbating existing mental health challenges such as depression and anxiety. HCWs have been on the frontlines, facing increased workloads, exposure to infection, and emotional distress due to patient outcomes. This study examines the long-term psychological impact of the pandemic on HCWs, focusing on depression severity and associated risk factors.

To evaluate the long-term mental health consequences of the COVID-19 pandemic on HCWs, specifically the prevalence and severity of depression, and to identify key factors contributing to psychological distress

A retrospective descriptive study was conducted on HCWs in Sousse, Tunisia, who took long-term sick leave due to depression between January 2010 and December 2021. Data from medical records were supplemented with a questionnaire covering pandemic-specific stressors and risk factors.

A total of 650 cases were identified. The mean number of depression cases almost doubled, increasing significantly by 89% after the onset of the pandemic (p < 0.01). However, no significant correlation was found between depression severity and the occurrence of COVID-19 itself.Among HCWs, the most affected groups included those working in emergency and critical care units, with a significant association between the number of night shifts and depression severity. Additional risk factors included previous psychiatric conditions, high job strain, and direct exposure to COVID-19 patients

The COVID-19 pandemic has amplified the mental health challenges faced by HCWs, particularly regarding depressive disorders. Targeted psychological support and workplace interventions are crucial to mitigate the long-term effects on this vulnerable population.

None Declared

The network theory of psychopathology posits that psychiatric disorders emerge from dynamic interactions among underlying symptoms. These interactions can lead to two alternative stable states: an ‘all-on’ state, where all symptoms are activated as in a full-blown mental disorder, and an ‘all-off’ state, where all activations dissipate, resulting in a healthy state. Network temperature (NT) has been proposed as a metric to measure the stability of symptom network, with a lower NT indicating a more ordered network in which symptoms are more aligned with either of the stable states. Limited research has used NT to understand the stability of symptom networks in psychiatric populations. In particular, the COVID-19 pandemic offers a unique opportunity to examine this, as elevated symptoms in psychiatric patients compared to healthy controls (HC) may reflect distinct network dynamics.

We compared the NT of symptom network of depression, anxiety and post-traumatic stress disorder (PTSD) between psychiatric patients and HC recruited during the 5th wave of the COVID-19 pandemic in Hong Kong.

Treatment-receiving psychiatric outpatients (N= 415) and demographically-matched HC (N= 399) completed the Patient Health Questionnaire-9, the Generalized Anxiety Disorder Scale-7, and the Impact of Event Scale in March–April 2020 to measure their depressive, anxiety, and PTSD symptoms, respectively. Networks of these symptoms were estimated separately using multigroup Ising models, with NT in HC fixed at 1. The bootstrapped 95% confidence intervals (CI) for estimates of NT were computed using 1000 group-stratified bootstrap samples. We compared NT of these symptoms between patients and HC, and then among patients with affective disorders (AD, n= 229), patients with psychotic disorders (PD, n= 138) and HC.

Patients had more severe and varied depressive, anxiety and PTSD symptoms than HC. Compared with HC, patients had lower NT for anxiety (0.85, 95% CI: 0.77-0.94) and PTSD (0.87, 95% CI: 0.78-0.97), but not depression. Subgroup analyses suggested that patients with AD (but not PD) exhibited lower NT for depression (0.90, 95% CI: 0.75-0.95) and anxiety (0.83, 95% CI: 0.75-0.95) than HC. The NT of PTSD was marginally lower in patients with AD (0.89, 95% CI: 0.79-1.00) and PD (0.85, 95% CI: 0.76-1.00) than in HC.

Compared with HC, psychiatric patients exhibited lower NT for anxiety and PTSD symptoms during the COVID-19 pandemic, indicating reduced stability in these symptom networks that potentially remained predominantly in the ‘all-on’ state. The increased polarization of psychiatric symptoms was more prominent in patients with AD. Our results highlight the utility of NT in understanding the vulnerability of psychiatric populations during the COVID-19 pandemic from a dynamic network perspective.

None Declared

Ethical issues in the management of the coronavirus crisis are multiple, restrictions of freedoms by the imposition of containment, mandatory reporting of the disease affecting professional secrecy. Health care workers (HCWs) are on the front line in the management of this health crisis

Determine the acceptance of the compulsory declaration of the disease, the feeling of guilt and the rate of social and professional stigmatization by the care personnel.

A descriptive cross-sectional study that interested HCWs at Charles Nicolle Hospital infected with SARS-COV2 who completed the return-to-work visit at the occupational medicine department, during the period from September 1 to December 31, 2020

During the study period 300 HCWs were included in the study. It was predominantly female with a sex ratio of 0.4. The mean age was 42±10 years. The HCWs were married in 70 % of cases. The professional categories were represented mainly by nurses in 36% of cases followed by technicians and physicians in 27% and 17.4% of cases respectively. The average professional seniority was 15 years (min=1 year; max=15 years).

Guilt was felt by 58% of the cases. Mandatory reporting of the disease was accepted by 98%.

Social stigma was reported by 32% and professional stigma by 21%. The stigmatized population was predominantly female (87%), the proportion of married people was 65%. The predominant professional category was nurses (36%) followed by senior technicians and workers (27% and 17% respectively). The average length of employment was 13 years.

Based on the results of this study, the social and occupational stigma of the SARS-COV2-infected HCWs was significant as well as the feeling of guilt. Other ethical issues raised by this pandemic need to be studied in order to develop prevention measures.

None Declared

In the context of the COVID-19 crisis, healthcare professionals were particularly exposed to the risk of infection due to the large number of patients they received. This disease involves not only physical symptoms but also psychological symptoms such as insomnia and depression.

To determine the prevalence and associated factors of insomnia among healthcare workers affected by COVID-19.

An analytical cross-sectional study was conducted among healthcare professionals at Farhat Hached University Hospital who were diagnosed with COVID-19 and followed in the Occupational Medicine Department over a six-month period. Data were collected using a questionnaire covering socio-professional characteristics and medical data. Insomnia was assessed using the Insomnia Severity Index (ISI).

A total of 477 cases were included, representing a response rate of 85.9%. The mean age of the study population was 39.95 years, with a predominance of females (78.2%). The professional categories most affected by COVID-19 were nurses (32.1%) and senior technicians (19.9%). According to the ISI score, 43.8% of participants suffered from insomnia. The proportion of women was significantly higher among subjects with insomnia (86.2% vs. 13.8%; p=0.021). Multivariate analysis identified the duration of confinement (OR=1.12, 95% CI \[1.08–1.16]), withdrawal from colleagues upon returning to work (OR=3.5, 95% CI \[2.1–5.8]; p<0.01), and residual symptoms (OR=3.1, 95% CI \[1.9–5.2]; p<0.01) as factors associated with insomnia.

The COVID-19 pandemic disrupted daily life in multiple ways. This study revealed that a significant number of healthcare workers suffered from insomnia. These findings underscore the need to strengthen preventive measures and provide psychological support to healthcare professionals, particularly those who have contracted the disease.

None Declared

The impact of COVID-19 on mental health has been continuously reported, especially among healthcare workers. In the literature, anxiety symptoms are not uncommon in infected individuals. However, there is a little data on these psychological events in healthcare professionals.

To determine the prevalence and the associated factors of anxiety symptoms among healthcare workers infected by COVID-19.

This is a cross-sectional study conducted among healthcare workers at Farhat Hached University Hospital infected by COVID 19. A self-administered questionnaire was used to collect data from the socio-professional and medical characteristics of the participants. Anxiety symptoms were assessed by the Hospital Anxiety and Depression Scale (HAD-S).

A total of 477 confirmed COVID-19 in healthcare works were included in this study (85.9%). The mean age of the participants was 39.9 ±10.8 years. Women represented 78.2%. The majority of the infected participants were nurses (32.1%). The pauci-symptomatic form of the disease was the most frequent (73.8%). After returning to work, 62.7% of the participants retained residual symptoms and 15.5% experienced stigma reaction from their colleagues. The overall prevalence of anxiety symptoms were 25.4%. Furthermore, residual symptoms and duration of confinement predicted anxiety symptomatology.

The psychological events of COVID-19 are frequent among healthcare workers. Thus systematic screening and early management of psychological disorders are necessary to preserve the human resources of the health sector.

None Declared

Emotional intelligence has a close association with management of stress in patients undergoing hemodialysis.

This pilot study aimed to assess the associations between emotional intelligence and stress regulation in individuals receiving hemodialysis.

In this pilot study, forty seven (n=47) patients on hemodialysis completed the questionnaires: i) Wong and Law Emotional Scale - WLEIS) and Trait Emotional Intelligence Questionnaire Short form (TEIQue-SF) for the assessment of emotional intelligence ii) Brief Cope for the assessment of stress management iii) A questionnaire about demographic and clinical characteristics. Spearman correlations coefficients (rho) were used to explore the association of two continuous variables and Mann-Whitney tests for comparison of a continuous variable between two groups. Analyses were conducted using SPSS statistical software (version 26.0).

More use of active positive coping of stress was significantly associated with greater self-control (p=0.014) greater well-being (p=0.032) and greater overall emotional intelligence (p=0.004). More use of humor as a strategy for coping with stress was significantly associated with greater self-control (p=0.034). Substance abuse was significantly and negatively associated with self emotion appraisal (p=0.016) and emotion appraisal of others (p=0.021).

Dialysis patients should attend training programs in order to acquire emotional intelligence skills for an effective stress management.

None Declared

Stress management is a predictive factor of adherence to hemodialysis regimen.

The aim of this study was to explore the association of stress management and adherence to hemodialysis regimen among hemodialysis patients.

In this pilot study, forty-seven (n=47) patients on hemodialysis completed the questionnaires: i) Brief Cope for the assessment of stress management ii) GR Simplified Medication Adherence Questionnaire (GR-SMAQ-HD) for the assessment of adherence iii) A questionnaire about demographic characteristics. Spearman correlation coefficients (rho) were used to explore the association of two continuous variables. Multiple linear regression, in a stepwise method, was used to find the factors associated with adherence. Analyses were conducted using SPSS statistical software (version 26.0).

The results of this pilot study showed that greater behavioral disengagement was associated with lower overall adherence to hemodialysis regimen (p<<0,001). Additionally, higher substance use was significantly associated with reduced overall adherence (p<0,029). Furthermore, increased expression of negative emotions was linked to lower adherence to medications (p<<0,001), diet/fluid restrictions(p<<0,001), and overall adherence (p<<0,001).

The use of positive thinking could be recommended to improve adherence among hemodialysis patients, since it can emphasize positive aspects of patients’ lives and training strategies for improvement their physical and mental capabilities.

None Declared

Diabetes mellitus (DM) is a chronic metabolic condition with substantial physical and psychological complications that profoundly impact patients’ daily lives and overall quality of life. Psychological factors such as depression and anxiety are increasingly recognized as major contributors to disease progression, while self-esteem may act both as an indicator and as a potential protective factor.

The present study aimed to examine the impact of self-esteem, anxiety, and depression on the well-being of adults living with DM.

A cross-sectional quantitative study was conducted with 100 adult patients with diabetes monitored at a public hospital in Attica, Greece. Data were collected using validated psychometric instruments, including the Depression Anxiety Stress Scale-21 (DASS-21), the Rosenberg Self-Esteem Scale (RSES), and the Mental Health Continuum–Short Form (MHC-SF). Sociodemographic and clinical data were also recorded and analyzed.

Significant negative correlations were found between depression, anxiety, stress, and psychological well-being, confirming their detrimental effect on patients’ quality of life. In contrast, higher self-esteem was positively associated with psychological, emotional, and social well-being, and negatively associated with anxiety and depression. Participants reporting comorbidities or chronic complications showed lower self-esteem and a greater psychological burden.

The findings underscore the role of self-esteem as a potential protective factor against the psychological consequences of DM and highlight the importance of a holistic approach to care that integrates psychological support and self-image enhancement. Interventions targeting self-esteem alongside the management of anxiety and depression may substantially improve the well-being of individuals with DM, particularly in primary healthcare settings. These results may inform the development of personalized care plans and preventive strategies for psychological distress in patients with chronic illness.

None Declared

FND represents a major source of disability within neuropsychiatry, characterized by neurological symptoms that are inconsistent with recognized disease patterns. FND is theorized to represent subconscious conversion of intolerable emotional distress into neurological symptoms, like motor problems and seizures due to disruptions in brain networks. According to DSM-V, psychological factors no longer need to coincide in time with the onset or worsening of a disorder, though psychological stressors may still be noted as a specifier. There has been progress in elucidating neurobiological underpinnings of FND and in developing multidisciplinary treatment approaches, however, integration of mechanistic findings into clinical care remains a critical challenge.

Aims to synthesize recent literature (2015-25) addressing the neurobiological mechanisms implicated in FND and the effectiveness of therapeutic interventions, including physiotherapy-based and psychological treatments in adults.

A literature review was conducted using PubMed for English-language studies published between January 2015 and June 2025. Eligible articles involved adult FND populations and reported either neurobiological findings or therapeutic outcomes. Randomized trials, cohort studies, and systematic reviews were included if they fit inclusion criteria. Data were synthesized to highlight evidence on pathophysiological mechanisms, intervention effectiveness, and remaining gaps in the literature.

Recent neuroimaging and electrophysiological studies consistently demonstrate altered activity and connectivity within sensorimotor, limbic, and salience networks, suggesting impaired self-agency and aberrant top-down attention control as central mechanisms. Although no single biomarker has been validated, reproducible group-level differences support FND’s status not as a diagnosis of exclusion, but rather as a positive-diagnosis entity. Intervention studies, particularly those involving specialized physiotherapy, cognitive-behavioral therapy, and integrated multidisciplinary programs, report moderate improvements in symptom severity and functioning. However, heterogeneity in outcome measures, limited follow-up durations, and small sample sizes constrain generalizability.

Current evidence supports FND as a disorder of dysfunctional brain network integration rather than malingering or purely psychogenic etiology. Modern brain imaging studies show consistent patterns: parts of the salience and limbic networks light up differently in people with FND, and their connections to motor planning areas are altered, meaning symptoms are produced by measurable changes in brain function. Future studies should prioritize standardized outcome metrics, mechanistic biomarkers of treatment response, and cross-disciplinary clinical collaboration to improve patient outcomes.

None Declared

Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system characterized by sensory and motor deficits and a wide spectrum of neuropsychiatric manifestations, including mood disorders, cognitive decline and behavioral disinhibition.Impulse control problems are rare but clinically relevant, as they may mimic primary neurodegenerative syndromes and complicate management.

We present a patient with MS with a progressive course and bilateral frontal lobe involvement manifesting impulsive and disinhibited behaviors. This case highlights the importance of recognizing MS-related neurodegeneration as a potential cause of dysexecutive syndromes and distinguishing it from frontotemporal dementia (FTD).

Psychiatric assessment included a mental status examination, neuropsychological testing and the Barratt Impulsiveness Scale–Short Form (BIS-11-SF). Neurological evaluation comprised lumbar puncture and cranial MRI.

A 57-year-old man presented with three years of progressively worsening inappropriate spending, perseverative gambling, and compulsive hoarding. His psychiatric history included irritability and aggression treated in 2016, and he was most recently on escitalopram 20 mg/day and mirtazapine 30 mg/day.On examination, he displayed indifference, delayed responses due to word-finding difficulty, impaired attention, apathetic mood, restricted affect, and poor abstraction, while other cognitive functions were relatively preserved and no psychotic features were observed. Neuropsychological testing demonstrated slowed mental control, impaired attention and markedly reduced verbal fluency, consistent with frontal dysfunction. On the BIS-11-SF, he scored 36 out of 60. MS had been diagnosed in 2011 after persistent left leg weakness, confirmed by CSF analysis and MRI. Initial therapy with glatiramer acetate was switched to rituximab in 2016 due to radiological and clinical progression, achieving clinical stability.However, cranial MRI in 2022 revealed global cortical atrophy disproportionate to age, most prominent in the bilateral frontal lobes, with confluent subcortical, juxtacortical and periventricular demyelinating lesions (Image 1–3).These findings, attributed to the progressive course of MS, could explain his cognitive, emotional and behavioral symptoms associated with a dysexecutive syndrome.Image 1:

MS with a progressive course may lead to cortical atrophy and neurodegeneration beyond demyelination, causing complex neuropsychiatric symptoms. In this case, frontal atrophy was associated with executive dysfunction, disinhibition and impulsivity. Radiological progression preceded behavioral symptoms and along with MRI evidence of widespread demyelination, supported MS-related neurodegeneration rather than FTD. Recognizing this distinction is essential for accurate diagnosis and appropriate management.

None Declared

Hypertension is a major chronic health issue affecting individuals in all parts of the world, with psychosocial factors playing a key role in adherence to treatment and engagement in essential self-care behaviors. Personality traits and perceived quality of life may influence these processes, making it essential to understand these associations for the development of personalized, psychologically informed interventions.

This study aims to investigate the psychosocial profile of adults diagnosed with hypertension in Greece and examine its relationship with self-care behaviors and medication adherenceSpecifically, the study will explore the associations between personality traits, quality of life, self-care behaviors, and adherence to antihypertensive treatment.

This is a cross-sectional, observational study currently underway, with data collection having commenced in early 2025. Data are being collected from a convenience sample of individuals with elevated blood pressure in primary care settings across Greece. The study instruments include: a demographic questionnaire, the SF-36 Health Survey (for quality of life assessment), the Eysenck Personality Questionnaire (EPQ) (for personality traits), the Self-Care of Hypertension Inventory, version 3 (SC-HI v3), and the 8-item Morisky Medication Adherence Scale (MMAS-8). Descriptive and inferential statistics are being employed to examine the associations between psychological factors, self-care, and medication adherence.

It is expected that certain personality profiles (e.g., high neuroticism, low conscientiousness) and lower levels of perceived quality of life will be associated with reduced adherence to antihypertensive therapy and lower self-care engagement. These findings align with existing literature, suggesting that psychosocial factors significantly influence treatment adherence and self-care practices among people living with hypertension. The results will help inform clinical practice by highlighting the importance of incorporating psychosocial assessments into routine hypertension management.

This protocol outlines a planned study examining the intersection of personality, quality of life, self-care, and medication adherence in people in Greece who are managing hypertension. By identifying psychological and behavioral patterns, the study seeks to provide a foundation for targeted psychosocial interventions aimed at improving outcomes for individuals living with elevated blood pressure.

None Declared

Chronic heart failure (CHF) remains a leading cause of morbidity and mortality worldwide. Depression is a frequent comorbidity in CHF (prevalence ~20-40%) and is linked to worse outcomes including poorer quality of life and increased hospitalizations. Emerging evidence suggests that inflammation and neurohormonal dysregulation may mediate the relationship between CHF and depressive symptoms. Clarifying these links could help in developing more targeted therapeutic strategies.

To review recent literature examining associations between inflammatory biomarkers (e.g. TNF-α, interleukins), NT-proBNP, and depressive symptoms, anxiety, or quality of life in patients with CHF.

A narrative literature search was performed in PubMed, Scopus, and Web of Science for articles published between 2020 and 2025. Criteria: studies in CHF patients; measurement of inflammatory markers or NT-proBNP; assessment of depression, anxiety, or quality of life. Both observational and interventional studies included.

Recent studies confirm that elevated inflammatory markers are associated with depressive symptoms in CHF. For example, in a cohort study, depressive symptomatology correlated positively with NT-proBNP and poorer health status (Balata et al., 2024). TNF-α and IL-6 are frequently reported elevated in CHF and are implicated in myocardial dysfunction and remodeling (Arvunescu et al., 2023). In a study of CHF outpatients, IL-6 levels were significantly correlated with psychosomatic psychopathology and depression indices after controlling for age, gender, NYHA class, etc. However, some studies fail to find a significant association for all cytokines; results are heterogeneous. There is also evidence that NT-proBNP is not only a marker of cardiac stress but is related to psychological distress: higher NT-proBNP levels associated with worse depressive symptoms and lower quality of life (Müller-Tasch et al., 2021).

The weight of recent evidence supports a link between inflammation, elevated NT-proBNP, and depressive symptoms in CHF. Nevertheless, heterogeneity in methods, depression scales, biomarker assays, and patient populations limits firm conclusions. Future longitudinal studies and randomized interventions are required to determine causality and to test whether anti-inflammatory or neurohormonal modulation strategies can improve both mood and cardiac outcomes.

None Declared

Heart transplantation (HT) constitutes a potentially life-saving intervention for patients with end-stage cardiac disease. Nonetheless, it remains one of the most invasive and psychologically demanding procedures available. Studies report psychiatric morbidity rates of approximately 50% among individuals undergoing HT, predominantly characterized by depressive and anxiety disorders. Although these rates tend to decline during the postoperative period, approximately one-third of HT recipients continue to experience psychological complications in the long-term course.

To assess depression and anxiety using the Hospital Anxiety and Depression Scale (HADS) in a cohort of patients followed for one year after HT.

An assessment was conducted on 37 adult patients enrolled in the HT program at the Hospital Clinic of Barcelona between 2016 and 2023. During the waiting list phase, the following variables were analyzed: age, sex, duration of disease progression, etiology of cardiopathy, Axis I disorders diagnosed using the Structured Clinical Interview for DSM-IV, HADS scores, and details of psychopharmacological treatment. Additionally, HADS assessments were repeated one year post-HT.

Demographic and clinical characteristics: The sample comprised 37 patients with a mean age of 53.65 ± 9.77 years. Among them, 26 were male (70.3%) and 11 female (29.7%). The average duration of cardiac disease progression was 11.11 ± 8.15 years. Ischemic cardiomyopathy was present in 54.1% of patients, while 21.6% had non-ischemic cardiomyopathy. The clinical characteristics of this cohort are consistent with the general patient profile typically enrolled in a heart transplantation program.

Psychiatric evaluation: Axis I psychiatric diagnoses were identified in 27% of the sample (10 patients), encompassing depressive, anxiety, sleep, and adjustment disorders. All diagnosed patients were receiving psychopharmacological treatment at the time of inclusion on the waiting list. T-test showed statistically significant differences on the three scores of HADS between the two assessments:

Waiting list period: the mean score of HADS was 10.68 (SD = 5.51), with a mean score of 6.08 (SD = 3.5) in anxiety subscale and 4.59 (SD = 2.83) in depression subscale.

12-month follow-up: the mean score of HADS was 7.73 (SD = 5.28), with a mean score of 4.84 (SD = 3.32) in anxiety subscale and 2.89 (SD = 2.59) in depression subscale.Table 1.

Although the HADS scores in our sample were below the established cut-off points for screening psychiatric morbidity (<12 for the total score and <8 for the subscales), a significant reduction in anxiety and depression symptoms was observed 12 months after HT.

None Declared

The relationship between aggressive or violent behavior and epilepsy has been a subject of extensive debate. Proposed links between aggression and epilepsy involve multiple factors, including postictal psychoses and rare instances of ictal aggression. However, unlike periictal or ictal violence, interictal violent behavior is generally considered unrelated to epilepsy or specific EEG abnormalities. Furthermore, there is a notable scarcity of research addressing aggressive behavior in the context of Interictal Dysphoric Disorder (IDD), particularly among patients with severe drug-resistant epilepsy (DRE).

The primary objective of this study was to examine the potential association between aggressive behavior and interictal psychiatric symptoms, specifically IDD in patients with DRE.

This cross-sectional, descriptive study included 453 patients with DRE from the Epilepsy Unit at Hospital Clinic, spanning the years 2008 to 2018. Sociodemographic and clinical variables were analyzed. Aggressive behavior was evaluated using the Hostility Subscale of the Symptom Checklist-90, which assesses thoughts, feelings, and actions characteristic of anger, including resentment, irritability, aggression, and rage. Statistical analyses were performed using IBM SPSS Statistics version 23 (Armonk, NY: IBM Corp.) for Microsoft Office 2013. Student’s t-test was employed to compare quantitative variables.

Out of the 453 patients, 132 (29.1%) were diagnosed with Interictal Dysphoric Disorder (IDD), while 321 (70.9%) were not. A statistically significant association was observed between IDD and scores on the Hostility Subscale of the Symptom Checklist-90, with mean scores of 1.22 in the IDD group compared to 0.83 in the non-IDD group (P = 0.000). Table 1 presents the sociodemographic and clinical characteristics of the study sample.Table 1.

Although previous studies have suggested that interictal violent behavior is generally unrelated to epilepsy, our findings demonstrate a significant association between hostile or aggressive behavior and IDD. Originally described by Blumer as a pleomorphic affective disorder in epilepsy, IDD includes paroxysmal irritability among its core symptoms, which may represent the primary factor underlying aggressive behavior and thus explain the observed association. Therefore, we conclude that assessment of violent behavior should be an integral component of the clinical evaluation of patients with IDD.

None Declared

The term Interictal Dysphoric Disorder (IDD) refers to a pleomorphic affective disorder observed in patients with epilepsy. The prevalence of IDD is believed to be substantial, particularly among individuals with drug-resistant epilepsy (DRE). Nevertheless, the existing literature offers limited evidence regarding the associations between IDD and clinical features, psychiatric disorders (PD), quality of life (QoL) or cognitive function in epilepsy patients.

The aim of this study is to investigate the potential relationship between IDD and PD, cognitive function, and quality of life in a cohort of patients with DRE.

This retrospective study included 281 patients diagnosed with drug-resistant epilepsy (DRE) from the Epilepsy Unit at Hospital Clinic, spanning the years 2008 to 2017. Axis-I psychiatric disorders were assessed using the Structured Clinical Interview for DSM-IV (SCID-IV). Cognitive function was evaluated through a comprehensive battery of tests, including the WAIS III, WMS III, Trail Making Tests A and B, Rey Auditory-Verbal Learning Test, and the Boston Naming Test. Quality of life (QoL) was measured using the Spanish version of the Quality of Life in Epilepsy Inventory-31 (QOLIE-31). Group differences were analyzed using Student’s t-test for continuous variables and the χ2 test for categorical variables.

Out of the 281 patients, 97 (34.3%) were diagnosed with Interictal Dysphoric Disorder (IDD), while 184 (65.7%) did not meet criteria for IDD. Among the IDD group, the mean age was 39.2 ± 12.26 years, with a majority being female (59.1%). Of the 97 patients diagnosed with IDD, 70 were also diagnosed with psychiatric disorders (PD) according to the SCID-IV assessment. A significant association was observed between IDD and mood and anxiety disorders (p < 0.05). No significant relationships were found between IDD and other psychiatric disorders. Regarding cognitive function, IDD was significantly associated with lower scores on the vocabulary subtest of the WAIS III (p < 0.05), while no significant associations were identified with other neuropsychological measures. Additionally, the presence of IDD was significantly correlated with lower scores across all domains of the QOLIE-31, indicating a reduced quality of life (p < 0.05).

Our findings indicate a pronounced negative impact of IDD on QoL, consistent with observations reported in recent literature. Furthermore, in alignment with a limited number of prior studies, we identified a significant association between IDD and psychiatric disorders, suggesting that patients with IDD are more likely to present with comorbid mood and anxiety disorders.

None Declared

The term medically serious suicide attempts (MSSA) is used to group those attempts that would have been fatal if not for medical intervention. Although studying MSSA is crucial for understanding the nature of suicide and developing prevention strategies, little is known about the underlying risk factors and demographic characteristics associated with it.

To describe and evaluate the characteristics of MSSA within the context of a general hospital consultation-liaison psychiatry (CLP) service.

Longitudinal observational case-control design, including adult inpatients consecutively referred to the consultation-liaison psychiatry (CLP) service at the University Clinical Hospital of Barcelona from 2007 to 2014. Cases were selected according to the criteria established by Beautrais in prior research for defining MSSA. The control group consisted of patients referred to the CLP service from medical or surgical units for reasons other than MSSA. All patients underwent assessment through a structured psychiatric interview based on the DSM-IV (SCID-CV). Data were collected prospectively via a computerized clinical database and included the following variables:

Sociodemographic factors: age, gender, and physical disability.

Psychiatric morbidity classified according to DSM-IV-TR categories, based on the SCID-CV assessment, along with history of psychiatric disorders and prior suicide attempts.

Psychosocial stressors and recent exposure to stressful life events.

Variables related to the current hospitalization and CLP intervention.

The study comprised 223 consultations involving patients with MSSA (4.1%) and 5,205 consultations for other reasons (95.9%). The sociodemographic and clinical characteristics of both subgroups are illustrated in the accompanying figure. Patients presenting with MSSA were significantly younger than those in the control group (47.3 vs. 55.3 years; p < 0.001). Additionally, they exhibited a higher prevalence of psychosocial stressors (54.3% vs. 24%; p < 0.001), prior suicide attempts (54.3% vs. 3.1%; p < 0.001), and psychiatric disorders (78.9% vs. 54.5%; p < 0.001), predominantly mood and personality disorders. Intensive care was required in 10% of MSSA cases, compared to only 0.9% in the control group (p < 0.001). During hospitalization, the majority of MSSA patients (77.1%) necessitated extensive follow-up within the CLP service, involving two or more visits. The mean length of hospital stay was significantly shorter for MSSA patients compared to controls (18.4 vs. 25.3 days; p < 0.003). Nevertheless, 24.3% of MSSA patients were eventually transferred to psychiatric inpatient units following discharge from medical or surgical wards.Image 1:

Our findings corroborate that patients with MSSA referred to consultation-liaison psychiatry exhibit distinct epidemiological and clinical characteristics, enabling the identification of specific risk factors.

None Declared

Functional gastrointestinal disorders (FGIDs), characterized by dysfunction in the bidirectional neurohumoral communication between the gastrointestinal tract and the central nervous system, are commonly comorbid with depression and anxiety disorders, which complicates the diagnosis, treatment, and outcomes of both conditions.

With this literature review, we aim to highlight the effectiveness of psychotropic medications, also known as neuromodulators, in treating FGIDs, both with and without the presence of mental disorders.

A systematic literature review was conducted to examine the effects of psychotropic drugs (neuromodulators) on FGIDs. Searches were performed in PubMed using relevant keywords. Only studies focusing on the use of these treatments in relation to FGIDs were included.

Many psychotropic drugs (antidepressants, antipsychotics, and antiepileptics) are successfully used to treat FGIDs. In addition to their effects on the central nervous system (central processing of visceral pain stimuli and responses to them), they also exert peripheral effects by influencing the sensitivity and motility of the gastrointestinal organs as well as the tone of the sphincters. The term “neuromodulator” is used instead of “psychotropic” to reduce stigma, emphasize clinical effectiveness, and improve therapeutic adherence.

Diagnosis and treatment of FGIDs is performed by gastroenterologists, while the psychiatrist acts as a consultant who diagnoses and treats psychiatric comorbidities and implements pharmacotherapy and psychotherapy. The following psychiatric approaches are recommended: when administering medication, the desired therapeutic effects of the drug should be utilized. Additionally, some side effects (e.g., sedation) can be beneficial. The rule is to “go slow and low”: monitor the clinical response and any bothersome side effects, adjust the dosage, switch medications, or augment treatment with a drug from a different class as needed. Psychotherapy should be applied when indicated. Treatment should be continued for an adequate duration, with emphasis on establishing a strong therapeutic relationship, educating the patient, and providing ongoing support.

None Declared

Acute Intermittent Porphyria (AIP) is a rare autosomal dominant disorder of heme biosynthesis. Although it typically presents with abdominal pain, autonomic instability, and motor neuropathy, psychiatric symptoms—especially acute psychosis—can occasionally precede the somatic signs, leading to misdiagnosis and treatment delays.

To illustrate the diagnostic challenges posed by atypical presentations of AIP, and to emphasize the importance of considering metabolic etiologies in first-episode psychosis with evolving neurological symptoms.

We describe the clinical course of a 44-year-old male with no prior psychiatric history, admitted to a psychiatric ward for suspected first-episode psychosis. During hospitalization, the patient developed progressive motor weakness and autonomic instability. Neurological assessment, laboratory testing (including urinary porphobilinogen), and clinical evolution led to the final diagnosis.

The patient initially presented with psychotic symptoms, including agitation, disorganized thinking, and paranoid delusions. Within days, he developed ascending muscle weakness and gait disturbances, followed by autonomic signs (tachycardia, hypertension), requiring transfer to the Intensive Care Unit. Elevated urinary porphobilinogen confirmed AIP. He received intravenous hemin and supportive treatment, leading to a favorable outcome with full remission of both neurological and psychiatric symptoms.

AIP should be included in the differential diagnosis of acute psychosis, especially when accompanied by emerging neuromuscular or autonomic symptoms.

• • Early identification and treatment are crucial to prevent severe complications.

• • This case reinforces the value of a multidisciplinary approach in atypical psychiatric presentations.

None Declared

Catatonia is a severe neuropsychiatric syndrome characterized by motor, behavioral and autonomic alterations. Its etiology varies. In the postoperative period, it is an unusual condition and is often confused with delirium, delaying diagnosis and increasing the risk of complications (Oldham et al., 2018).

To describe a case of catatonia as a rare complication in the surgical setting of a patient with a history of major depression, highlighting the importance of early diagnosis and favorable response to treatment with benzodiazepines.

We present the case of a 60-year-old woman with untreated major depression who underwent orthognathic surgery for a complex dentofacial deformity. There were no intraoperative complications. On the second postoperative day, she presented with an episode of psychomotor agitation, followed by neurological deterioration (Glasgow 6). She was intubated and transferred to the intensive care unit, where she received continuous sedation (opioid, GABAergic anesthetic, and benzodiazepine). She was successfully extubated at 48 hours with recovery of awake status (Glasgow 11). However, 72 hours after extubation, her neurological status deteriorated again (Glasgow 8). She was evaluated by the neurology department, which ruled out metabolic, infectious, and neurological etiologies through cerebrospinal fluid analysis, Gram staining, cultures and PCR testing for bacteria, viruses, and fungi, as well as a cranial CT scan ruling out space-occupying, ischemic or hemorrhagic lesions.

On clinical evaluation, the patient exhibited symptoms such as hypoactivity, mutism, motor negativism, waxy flexibility, and gegenhalten. The score on the Bush-Francis Catatonia Scale was 20. Based on these findings, the diagnosis of catatonia was established, and treatment with lorazepam (2 mg every 8 hours) via nasogastric tube was initiated. Within 12 hours of initiating treatment, marked clinical improvement was observed with complete neurological recovery.

Catatonia in the postoperative period represents a diagnostic challenge since its symptoms may simulate delirium or other neurological complications. In this case, the history of untreated major depression, added to the physiological stress of surgery, acted as a triggering factor. Recognizing the association of catatonia with mood disorders and considering it in the differential diagnosis is crucial to initiate effective treatment and improve the clinical prognosis of the patient.

None Declared

Irritable Bowel Syndrome (IBS) is a chronic and relapsing disorder of brain–gut interaction, often accompanied by considerable psychological distress. Prior research has linked IBS with elevated anxiety, depression, and pain, as well as reduced self-esteem and well-being. Yet, the complex interconnections among these psychological factors -and how they jointly influence well-being- remain poorly understood.

The study aimed to (a) examine differences between individuals with and without IBS in terms of anxiety, depression, pain, self-esteem, and well-being; (b) explore the role of demographic (age, gender) and clinical factors (relapses, therapeutic approach, age of diagnosis, surgical interventions) in psychological outcomes; (c) identify independent correlates of well-being among IBS patients; and (d) investigate the potential mediating role of self-esteem in the relationship between depression and well-being.

The sample comprised 239 adults (123 with IBS and 116 controls without gastrointestinal disorders). Participants completed the Hospital Anxiety and Depression Scale (anxiety and depression), the Mental Health Continuum-Short Form (mental well-being), the McGill Pain Questionnaire-Short Form (perceived pain), the Rosenberg Self-Esteem Scale (self-esteem), and a demographic and clinical questionnaire. Statistical analyses included parametric and non-parametric tests, correlation analyses, and analysis of covariance to control for confounders. Mediation models were applied to assess the direct and indirect effects of depression on well-being, with self-esteem examined as a potential protective factor.

Participants with IBS reported significantly higher levels of anxiety, depression, and pain, and lower levels of self-esteem and well-being compared to the control group, with elevated rates of probable clinical anxiety and depression. These differences remained significant after adjusting for age. Among IBS patients, flare status and number of relapses were linked to greater psychological burden, while prior gastrointestinal surgery was associated with more pain. In multivariable analyses, well-being was independently related to lower depression, higher self-esteem, female gender, and older age at diagnosis. Mediation analysis further showed that self-esteem partially mediated the association between depression and well-being, underscoring its potential protective role.

IBS was associated with substantial psychological burden, adversely affecting quality of life and mental well-being. Depression and self-esteem emerged as significant correlates of well-being, while self-esteem partly buffering the adverse impact of depression. These findings underscore the need for a holistic, interdisciplinary approach to IBS management, integrating medical and psychological care to promote comprehensive treatment and improve quality of life.

None Declared