Early stages of autoimmune encefalitis (AE) often present cognitive and neuropsychiatric symptoms such as personality change, irritability, axiety, depression, behavioral disorders, hallucinations, disorientation, sleep-wake cycle reversals, …). Thus often these cases are first treated as psychiatric disorders.

A literature review throughout a case report presentation.

We present the case of a 25-year old female with a medical history of iron-deficiency anemia who arrives at the emergency service. She presents the following one week of evolution clinical picture: complex auditive hallucinations, behavioral disturbances, sleep disorder and short term memory impairment. Neurological examination, LP and craneal CT are all normal. CSF analysis has no abnormalities. Thus she entered the psychiatric ward. There she was treated with neuroleptics with no improvement of symptoms presenting a severe psychomotor agitation and language impairment. After neurology interconsultation AE is suspected.

She was performed an EEG (left temporal epileptiform activity), CSF (inflammatory pattern), MRI (bilateral temporal lobe hyperintensity). Suspecting limbic encephalitis the presence of anti-NMDAR antibodies was tested , which turned out to be positive. First she was treated with corticotherapy with mild results. Then she was treated with intravenous immunoglobulin improving significantly.

Anti-NMDAR encephalitis is usually a multistage illness. Early in the course of disease psychiatric manifestations are not rare. Therefore the proper diagnosis and approach of AE may requiere a highly organized assessment, starting with detailed history and physical examination and an appropriate testing to exclude other possible relevant pathologies.

No significant relationships.

Electronic health (eHealth) interventions integrate different elements of care in treating and preventing mental ill-health in patients with somatic illnesses. Identifying different sociodemographic characteristics that might be associated with higher perceived usability can help in improving the usability of these e-health interventions.

This study aimed to identify sociodemographic characteristics that might be associated with the perceived usability of the NEVERMIND e-health system, comprised of a mobile application and a sensorized shirt, developed to reduce co-morbid depressive symptoms in patients with breast or prostate cancer.

The study included 129 patients with a diagnosis of breast or prostate cancer who received the NEVERMIND system. Sociodemographic data were collected at baseline. Usability outcomes included the System Usability Scale (SUS), the Mobile Application Rating Scale: user version (uMARS), and a usage index.

The analysis was based on 108 patients (68 breast cancer and 40 prostate cancer patients) who used the NEVERMIND system. The overall mean SUS score at 12-weeks was 73.4 with no statistical differences among different sociodemographic characteristics. The global uMARS score was 3.8, and females scored the app higher than males (β coefficient= 0.16; p=.03, 95% CI 0.02 - 0.3). Females had significant lower usage (β coefficient= -0.13; p=.04, 95% CI -0.25 to -0.01) after adjusting for other covariates.

There was a higher favourability of the mobile application among females compared to males. However, males had significantly higher usage of the NEVERMIND system. The NEVERMIND system does not suffer from ‘digital divide’ where certain sociodemographic characteristics are more associated with higher usability.

No significant relationships.

Metabolic side effects of psychotropic medications are a major drawback to patients’ effective treatment. Among the mechanisms underlying their development, DNA methylation may be involved.

The aim of this study was to estimate DNA methylation changes occurring secondary to psychotropic treatment and evaluate associations between 1-month metabolic changes and baseline DNA methylation or 1-month DNA methylation changes, using an epigenome-wide approach.

Seventy-nine psychiatric patients recruited as part of PsyMetab study, who started a treatment with either an antipsychotic, a mood stabilizer or mirtazapine were selected. Epigenome-wide DNA methylation was measured using the Illumina Methylation EPIC BeadChip at baseline and after one month of treatment.

A global methylation increase was observed after 1 month of treatment, which was more pronounced in patients whose weight remained stable (i.e., <2.5% weight increase). Epigenome-wide significant methylation changes were observed at 52 loci in the whole cohort and at one site, namely cg12209987, located in an intergenic region within an enhancer, specifically in patients who underwent important early weight gain (i.e., ≥5% weight increase) during the same period of treatment (p<5*10-8). Multivariable analysis confirmed an association between an increase in methylation at this locus and weight gain in the whole cohort (p=0.004). Epigenome-wide association analyses failed to identify any significant link between other metabolic changes (e.g. glucose or lipid levels) and methylation data.

These findings give new insight into the mechanisms of psychotropic drug-induced weight gain. With improved understanding of the metabolic side effects, the use of precision medicine with epigenetics may become possible

No significant relationships.

During the pandemic of new coronavirus infection, some medical students were actively recruited to work with infected patients, which could provoke depression, anxiety, and stress. The concept of baseline beliefs predicts characteristics of individuals’ experience of trauma.

The study aimed to determine depression, anxiety, and stress levels in medical students and examine their baseline beliefs, as well as the relationship between baseline beliefs and emotional reactions.

Data were collected in the spring and summer of 2020 using a Google form that we developed. Thirty-seven medical students participated in the study. The WAS-37 questionnaire was used to examine baseline beliefs and the DASS-21 to measure depression, anxiety, and stress. Both questionnaires were adapted for use in Russia.

We found that 78 % of the respondents had no depression, 86 % had no manifestations of anxiety, and 83 % felt stress-free. The mean values on the “Benevolence in the World” scale (M = 32.3±8.0) were within the average normative values, those on the “Justice” scale (M = 19.8±5.0) were below them, and those on the “Self-Image” scale (M = 29.6±5.9), “Luck” (M = 32.5±6.9) and “Controlling Beliefs” (M = 27.3±4.1) were above the average normative values. We found only one statistically significant relationship between emotional reactions and baseline beliefs, a negative correlation between depression and luck (rx = -0.360, p < 0.05).

In pandemic medical students, beliefs about one’s luck were associated with lower levels of depression.

No significant relationships.

Cannabis-induced psychotic disorder (CIPD) is defined by the development of psychotic symptoms during or briefly after intoxication with cannabis or withdrawal from cannabis. The social measures and restrictions implemented following the COVID-19 pandemic might have had an impact on cannabis availability, as suggested by patients from our clinical practice, reporting a shortage of the substance.

To compare sociodemographic, clinical characteristics and admission rates of inpatient treatment for cannabis-induced psychotic disorder in COVID-19 pandemic period and pre-pandemic period.

Retrospective observational study of inpatient admissions for CIPD in a psychiatry inpatient unit of a tertiary hospital. The statistical analysis was performed using SPSS software, version 27.0.

Our sample included 120 inpatient admissions, corresponding to 80 patients. Compared to 2018 and 2019, in 2020 there was an overall reduction of 21.5% in inpatient admissions (n=618, 549 and 458, respectively). The number of admissions for CIPD in 2018, 2019, 2020 and 2021 up to september were, respectively, 29, 32, 10 and 31 (5.2%, 6.1%, 2.2% and 7.2% of respective annual admissions). We found no statistically significant differences regarding sociodemographic and clinical characteristics in patients admitted for CIPD during 2020.

These results suggest a disproportionate reduction of inpatient admissions due to CIPD in 2020, followed by an expressive increase in the number of admissions in 2021up to september. This might be related to cannabis availability returning to regular levels. However other factors must be considered, such as the delay of treatment due to reduced accessibility to health care.

No significant relationships.

The mild encephalitis (ME) hypothesis of severe mental disorders, ME to be caused by infections, autoimmunity , toxicity and trauma ( Bechter 2001, updated Bechter 2013), is now emergingly supported from neuroimaging and CSF and postmorten findings.

Review about the present status of ME hypothesis and autoimmune psychosis and remainig challenges to assess and categorize mild neuroinflammation.

expert review

Autoimmune Encephalitis presenting with exclusive psychiatric symptoms and all cases of Autoimmune Psychosis (international consensus criteria in Pollak et al, Lancet Psychiatry, 2020) match the proposed ME criteria ( Bechter 2001 & 2013). Majority of these cases of an autoimmune type of ME are well treatable with immune modulatory treatments. It remained unclear, whether CNS antibodies are causal or contributive by shaping the observed clinical syndrome. The increasing evidence of mild neuroinflammation present in considerable subgroup of schizophrenia or psychosis spectrum cases from ongoing clinical studies, including CSF ( Bechter et al 2010, Endres et al 2018, 2020, aso.) and neuroimaging plus the observed clinical improvement with immune modulytory therapies, strongly support ME hypothesis, potentialy even in considerably larger subgroup of SMDs,supported by brain biopsy (Najjar et al ,several papers) and post mortem studies (Bogerts et al group ,Weickert et al group, several papers).

Beyond ME even more refined categories of mild neuroinflammation, including parainflammation ( proposed by Medzhitov 2008) and neuroprogression ( proposed by Berk et al 2010/11) need to be considered in further research on the possible role of mild neuroinflammation in SMDs (Bechter 2020, Frontiers Psychiatry).

No significant relationships.

No significant relationships.

SSRI’s are consistently associated with violent events in the adult population. However, the causality between SSRI use and violent behaviour was never found. Several recent studies draw the attention to this hypothesis while they were inspired by several mass murderers in the United States.

A literature research on studies exploring the association between SSRI use and violent behaviour.

The authors performed a literature search (1966–2020) using PubMed and Embase to review studies where a possible link between SSRI’s and violent behaviour in adults was assessed.

94 studies were identified, of which 6 studies were included. There is no association between the use of SSRI’s and violent behaviour in the general population. However, an increased hazard of violent behaviour was observed in young man and those with a history of violent crime.

Overall, SSRI treatment is safe in the general population. Certain subgroups can, however, be vulnerable to aggressive flare-ups, especially during on-treatment period and the first 12 weeks after drug discontinuation. Therefore, careful monitoring throughout these critical periods is strongly recommended.

No significant relationships.

The COVID-19 pandemic brought unbearable psychological pressure to people worldwide, because of serious threats to one’s physical health and life. From early stages of this pandemic, concerns have been raised about its effect on mental health. However, we still know little whether pre-existing psychiatric disorder (PD) affects the susceptibility and evolution of this infection.

We aimed to assess the interactions between COVID-19 infection and PD.

We conducted a litterature review through pubmed database, using the keywords :«COVID 19», «psychiatry», «mental disorders», « schizophrenia », « anxiety », « depression », «insomnia».

On one hand, prior surveys suggested that the infection is associated with increased incidence of a first psychiatric symptom. Mental health disturbances mostly include anxiety, depression, sleep disturbances, cognitive impairment and post-traumatic stress disorder. On the other hand, recent studies showed that patients with pre-existing mental disorders were associated with high susceptibility to be infected, increased risk of intensive care unit admission and a high mortality. The susceptibility to contracting COVID-19 was associated with pre-existing mood disorders, anxiety, and attention-deficit hyperactivity disorder. Infection severity was associated with pre-existing or subsequent mood disorders and sleep disturbances; or a pre-extisting schizophrenia. Mortality is increased in patients diagnosed with schizophrenia.

The complicated interactions between COVID-19 infection and PD have several implications. Enhanced psychiatric follow-up should be considered for survivors of COVID-19. Besides, early detection and intervention for PD are needed to control morbidity and mortality induced by the COVID-19 infection.

No significant relationships.

The specific learning disorders (SpLD) are neurology based development disorders which are characterized by significant difficulties in acquiring learning skills. SpLD are often accompanied by mental health problems because of emotional and behavioral consequences of the diagnosis. While the presence of SpLD can worsen psychological well-being among school aged children, resilience factors can neutralize these harmful effects.

The aim of this research is to identify protective factors promoting development of psychologial well-being and mental health in adolescents with SpLD compared to a control group of peers without this diagnosis.

Hungarian primary school students (N = 174; M = 13.34 years, SD = 1.14) participated in the study aged between 11 to 15 years. Of these, 23.6% students had a SpLD diagnosis. Participants completed a paper pencil-based questionnaire that included: EPOCH Psychological Well-being Questionnaires of Adolescent, WHO Well-being Index, Satisfaction With Life Scale, Multidimensional Perceived Social Support Scale, The Connor-Davidson Resilience Scale, and Self-regulation Scale.

Psychological well-being in both groups shows positive correlation (p<0.01) with general well-being, satisfaction with life, social support, self-esteem and self-control. In the SpLD group, the engagement and connectedness subscales do not relate to the general well-being and life satisfaction, in contrast with the control group in which these are associated with both. Self-control shows stronger correlation with general well-being and with engagement and connectedness subscales as compared to the control group (p<0.01).

There are differences in contributing factors of general psychological well-being in adolescents with SpLD and those without this diagnosis.

No significant relationships.

It has been broadly anticipated that COVID-19 pandemic-related experiences may constitute traumatic stressors in vulnerable populations, and that older adults’ might be especially at risk of experiencing mental health symptoms during the pandemic.

The present study aimed to examine older adults’ psychological distress: posttraumatic stress, Covid-related fears, anxiety, and depression during the pandemic, and the relationship between present distress, defensive functioning, and childhood trauma. We also explored potential differences between younger-older adults (between 65 and 74 years), and older-older adults (75 years and above).

Data was collected in a large-scale online survey during the early months of the pandemic, for the present study, we included participants above 65 years old (N = 1,225).

showed that age, adverse childhood experiences, and overall defensive functioning were all significantly related to posttraumatic stress, anxiety, and depression. Specifically, younger age and more reported childhood adversity were related to higher distress, whereas higher defensive functioning was related to less distress. Covid-related fears were not associated with age. Our final model showed that defensive functioning mediated the relationship between childhood trauma and distress.

Our results support the relative resilience of older-older adults compared to younger-older adults, as well as the long-lasting impact of childhood adversity through defensive functioning later in life, specifically in times of heightened stress, such as the COVID-19 pandemic. Future studies are warranted to identify further factors affecting defensive functioning as adults age, as well as processes that are associated with resilience in response to stressors in older adulthood.

No significant relationships.

NATSUKASHII: Japanese word that means happy nostalgia, it is the moment in which memory transports you to a beautiful memory that fills you with sweetness. NOSTALGY: (from the classical Greek [nóstos], “return”, and [algos], “pain”) feeling of sadness, suffering of thinking about something that has been had or lived in a stage and now not. In bipolar disorder, patients are more likely to complain of dysphoria than euphoria. Hypomanic periods often provide pleasant relief from depression. Patients experience this situation as pleasant, positive and longing once it has remitted, since they feel more creative, active and sociable.

We intend to draw attention to the blurred limits of the state of euthymia, even when stable there is a sustained emotional hypersensitivity, which must be learned to identify and coexist. Behind the desire to be euthymic, in certain patients there is a desire to remain hypomanic and / or manic due to the fact that they have tasted absolute happiness.

After several interviews with stable patients, we have realized that a great majority want to re-experience the sensations of a hypomanic episode.

After a bibliographic search we have realized that in the West there is no term in psychopathology that describes that longing that they verbalize as “maniac lives happier”

Special attention must be paid to these patients since they have less adherence to treatment and risk of abandoning it.

No significant relationships.

In Finland more than 40% of fertile aged women used some type of hormonal contraception (HC) in the period 2010-2013. A proportion of women using HC complains of side effects, including mood symptoms. The relationship between the use of HC and the risk of attempted suicide (AS) is still a matter of debate.

To assess the association of the use of HC with the risk of AS during 2017-2019.

Data were retrieved from the Prescription Centre, Care Register of Health Care, Register of Primary Health Care Visits and Statistics Finland. A total of 587 823 women, aged 15-49 years, using and not using HC in 2017 were analysed in the initial incidence study. All incident AS cases during 2018-2019, and their 4:1 age-matched controls (1 174 346 person-years) were analysed in a nested case-control setting via conditional logistic regression models.

Altogether 818 AS cases occurred during the follow-up (incidence rate: 0.70/1000 person-years, 95% CI 0.65–0.75), with an IRR of HC vs. no-HC use of 0.73 (0.63–0.83). Current use (in the 180 days before the event) of estradiol- or ethinylestradiol-containing HC was associated with a lower risk of AS (0.53, 0.33–0.87; 0.49, 0.37–0.64, respectively) compared to non-use of HC. After controlling for covariates (marital and socioeconomic status, education level, use of psychotropic medications), only current use of HC containing ethinylestradiol remained significant (0.39, 0.23–0.65).

A lower risk of AS is associated with the use of HC, and specifically of ethinylestradiol-containing HC.

No significant relationships.

The COVID-19 pandemic has focused attention on the challenges and risks faced by frontline healthcare workers (HCW).

To describe the quality of management of HCW affected by the COVID-19.

This is a cross-sectional study enrolling all HCW of Farhat Hached Academic hospital who had been affected by COVID-19 during the period from september to December 2020.

During the study period, 267 HCW were affected with a mean age of 42.3 ±10 years and a ratio-sex of 0.25. The most represented category was nurses (33.3%) followed by technicians (26.1%). Gynecology department had the highest number of affected HCW (14.4%).The majority of participants (97.4%) reported a medical care. Twelve HCW (4.5%) were hospitalized with an average length of hospital stay of 7.55 ± 6.12 days. The average length of sick leave was 18.68 ± 10.99 days. During the lockdown, 38.6% of HCW took care of their children without any external help. All of the HCW were supported by phone calls from colleagues in 88.4% of cases, the hierarchy in 67.4% of cases, occupational medicine in 60.3% of cases.

The impact of COVID 19 is greater in HCW than in the general population. The affected staff should have a multidimensional management to avoid post covid sequelae in both physical and mental levels.

No significant relationships.

Atherosclerosis can result in serious cardiovascular disease (CVD) and is associated with inflammation and psychopharmacological treatment in bipolar disorder.

We attempt to investigate the effects of lithium and inflammation on the atherosclerotic development in older bipolar adults at high risk for cardiovascular disease.

The euthymic out-patients with bipolar I disorder aged over 45 years and concurrent endocrine or cardiovascular disease were recruited to measure their bilateral carotid intima media thickness (CIMT) and circulating levels of lithium, valproate, sTNF-R1, sIL-6R, and lipid profile. All clinical information were obtained by directly interviewing patients and reviewing all medical records.

Forty eight patients with mean 48.3 years old and mean 27.2 years of age at illness onset were recruited. After controlling for the body mass index, multivariate regression analyses showed that older age, lower lithium level, and higher plasma sTNF-R1 level were associated with higher CIMT and collectively accounting for 33.1% of the variance in CIMT. Blood level of low density lipid or valproate has none relationship with CIMT.

Lithium treatment may protect older bipolar patient, even those at high risk for CVD, from atherosclerotic development. Furthermore, persistent inflammatory activation, particularly macrophage activation, may be associated with the accelerating development of atherosclerosis.

No significant relationships.

The HIV is a retrovirus, which is immunosuppressive, predisposing the individual to opportunistic infections and certain neoplasm. In addition to impairment in immune functions, evidence has suggested that HIV is neurotropic. It should therefore be anticipated that neuropsychiatric complication might be common in HIV positive individuals during all phases of HIV related illness. The neuropsychiatric aspect of the AIDS remains a challenge for psychiatrists involved in patients care.The relationship between HIV and psychiatric symptoms and conditions is complex and the direction of effects between severe mental illness and HIV infection is unclear. In general, people with severe mental illness are at increased risk of contracting and transmitting HIV, and the prevalence of HIV infection among them is higher than in the general population.

To determine how frequently psychiatric symptoms in an HIV positive adult population occur, as well as to determine social, demographic and clinical factors that are associated with the presence of these symptoms.

Literature review on Pubmed

Depression has a high prevalence in HIV-positive individuals, ranging between 5.8 and 36.0%. Typical features of depression are similar to those in HIVnegative people, although fatigue, loss of appetite and weight, impaired concentration, hopelessness and guilt are more common.Depressed HIV-positive individuals are at high suicide risk.Apathy has also been more commonly reported among HIV patients than in the general population.The prevalence of anxiety among HIV-positive individuals ranges from 4.3 to 44.4%

The rate of psychiatric symptoms in HIV positive patients in this population is high. Most of them go unnoticed and therefore untreated.

No significant relationships.

Throughout this period we were confronted with news and information about the Corona virus and its consequences. Which led to the development of a huge sense of fear among people. Although fear has helped to maintain restrictions, it has also had a significant impact on mental health, especially among patients with a psychiatric history.

In this paper I will highlight the consequences of the nocebo effect of the pandemic among people with a psychiatric history.

To complete this work I used medical articles, studies, and specialized information on the subject.

The pandemic’s restrictions have made it difficult for psychiatric patients to be compliant treatment by avoiding regular psychiatric exams.Isolation and fear of infection has led to new decompensations in existing psychiatric pathologies.

The exacerbations of psychiatric pathology increased both in number and in their intensity, ultimately determined by the increase in the number of hospitalizations in psychiatric emergencies.

No significant relationships.

INTRODUCTION: According to the Universal Declaration of Human Rights, everyone has the right to start a family. Under the Slovenian Infertility Treatment Act, everyone has the right to infertility treatment. A case of a patient in compulsory psychiatric treatment who participated in the process of IVF is presented.

CASE REPORT: A 40-year-old male with paranoid schizophrenia has already been hospitalized thirteen times. He often discontinued therapy, abused drugs and repeatedly exhibited violent behaviour. He already had a child from a past relationship he didn’t care of.

During the compulsory psychiatric treatment ordered by the court his mental status improved because his treatment with antipsychotics was supervised. He was in a relationship with a thirty-year-old partner. After unsuccessful attempts to become pregnant, they expressed a desire to conceive with biomedical assistance. Their application was considered and approved by the IVF Commission.

The procedure was successful but in the 13th week of pregnancy, the patient’s partner changed her mind due to his aggression. Because she was pregnant for more than 10 weeks, she had to submit a request for artificial termination to the Commission for abortion. Her request was granted and the pregnancy was terminated.

CONCLUSION: We live in time of endless possibilities. Despite of violent acts in the past and severe form of mental illness, the couple was granted IVF procedure. Everyone has the right to start a family; however, the question that has to be raised is the extent and reasonableness of involvement of medical profession and/or health care system.

No significant relationships.

Functional gastrointestinal disorders (FGID) are common in children and adolescents (CA), cause functional disability and high health care use. Internet based cognitive behavioral therapy (i-CBT) have shown promising effect in Sweden. The treatment is exposure based and target avoidance behavior. Cognitive biases regarding bodily symptoms are suggested to be part of development and maintenance of functional disorders in adults, and could therefore be an important treatment target. Little is known about cognitive biases in CA with FGID, and hence the potential importance, it is crucial to explore more in depth. This study is embedded in The Danish FGID Treatment Study which aims to test Swedish i-CBT treatment in a Danish context.

1) Examine cognitive biases in CA with FGID, compared with healthy controls. 2) Asses these biases before and after treatment for FGID to investigate changes and impact on treatment effect.

We developed a novel experimental approach to examine possible cognitive biases in CA. It consists of a picture task and a FGID-specific version of the Health Norms Sorting Task. We will examine 60 CA with FGID, who are included in The Danish FGID Treatment Study before and after treatment. In addition we will perform the test on 100 healthy controls.

The results are expected to improve our understanding of maintaining cognitive factors in CA with FGID, and how these may affect outcome and change during treatment, and how they differ from the general population.

This study can provide new targets for treatment approaches.

No significant relationships.

Perfectionism, as a multiform trait of character, plays an important role in the formation of motivation of achievements in socially significant activity. Adaptive perfectionism, together with the desire to achieve recognition in one’s professional community and insure the emotional stability. Maladaptive (neurotic) perfectionism is directed towards the achievement of excessively high (non-relevant) standards of activity, a constant anxiety, internal stress and lack of self-confidence

To pinpoint the types of perfectionism that graduating medical students at Medical University experience, those who, during all the years of study, showed high academic results

Forty-nine graduating medical students volunteered to take part in the study, their average mark being not lower than 4.75 (maximum was 5). Their average age was 22.41±0.75. The following scales measured the level of expressiveness of perfectionism: A.A. Zolotareva, Hewitt and Flett, I.I. Gracheva

The results of the study undertaken showed two distinct groups. Students of the first group (79.6%) aimed at high internal standards in their study that would make them very well prepared professionally for their future work as doctors. They consciously accepted the common rules and norms of their society. Students of the other group (20.4%), consciously and subconsciously, estimate their high academic results as a good way of overcoming personal disturbances. They have excessive non-realistic demands towards self and others

The results of our study make it possible for us to suppose that medical students of the second group will experience quite a lot of difficulties in their future professional activity

No significant relationships.