ADHD limits the ability to comply with Covid-19 prevention recommendations. We hypothesized that ADHD constitutes a risk factor for Covid-19 infection and that pharmacotherapy may lower that risk.

To test our hypothesis we studied the data of all patients admitted to (N=14,022) Leumit Health Services in Israel between February 1st - April 30th, 2020, who underwent at least one Covid-19 test.

Data were collected from the electronic health records. Purchasing consecutively at least 3 ADHD-medication-prescriptions during past year was considered drug-treatment.

1,416 (10.1%) subjects (aged 2 months - 103 years) were Covid-19-positive.They were significantly younger, and had higher rates of ADHD (adjOR 1.58 (95%CI; 1.27-1.96, p<0·001) than Covid-19-negative subjects. The risk for Covid-19-Positive was higher in untreated-ADHD subjects compared to non-ADHD subjects [crudeOR 1.61 (95%CI 1.36-1.89, p<0.001)], while no higher risk was detected in treated ones [crudeOR 1.07 (95% CI 0·78-1.48 p=0.65)].

Untreated ADHD seems to constitute a risk factor for Covid-19 infection while drug-treatment ameliorates this effect.

No significant relationships.

Eating Disorders (ED) tend to evolve chronically, with resistance to different therapeutic strategies. Chronicity is associated with high mortality rates, so it is necessary to study new therapeutic strategies. Transcranial Magnetic Stimulation (TMS) is a non-invasive, safe treatment method, whose application has been studied in several pathologies.

Determine the therapeutic potential of Transcranial Magnetic Stimulation in the treatment of Eating Disorders.

Bibliographic review of the literature published in English in the last 10 years, in the databases Pubmed, PsycINFO and Cochrane. The keywords used were: TMS, Transcranial Magnetic Stimulation, Eating Disorder, Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder. A review of the titles and abstracts of the resulting articles was made, and selected according to their relevance to the study.

Eighteen articles related to the treatment of ED with TMS were selected, either as primary or secondary outcome, of which six were review articles, ten were randomized controlled trials (RCT), one article was an oral communication and another article was a case report. Three RCTs showed improvement in bulimia nervosa, specifically in symptoms of “food craving”. Four RCT and one case report showed improvement in the symptoms of anorexia nervosa, one RCT showed no improvement in anorexia nervosa.

TMS appears to have some therapeutic potential for the treatment of ED, particularly in reducing food craving, despite some contradictory results. This work reinforces the need for more robust studies to evaluate the effectiveness of TMS, preferably randomized, with a longer follow-up and a cost-benefit analysis.

Health-related behavior correlates in critical ways with the current epidemic of chronic diseases. Modifiable behaviors increase the risk of chronic disease. Despite there are well-identified behaviors, efforts at behavior change are clinically-challenging and frequently ineffective.

We aim to establish how the current evidence and latest neuroscientific knowledge about behavioral change allow the most reliable assessment of patients with refractory health-related behaviors that negatively impact health outcomes.

We performed a literature review using Pubmed databases and UpToDate. The search included “behavioral change” and “health-related behavioral change”[MeSH Terms].

Habitual behavior consists of behavioral patterns operating below conscious awareness and acquired through context-dependent repetition. Behavioral change is a complex multi-level field of intervention. The Health Belief Model allows a careful description of the patient’s perceived vulnerability, perceived disease severity, self-efficacy, and change motivation. The identification of social variables is critical since they correlated with poor health outcomes, particularly in chronic diseases. Temperament and character traits can have a strong influence on the difficulty of changing habitual behavior. Psychopathology, if present, must be addressed because it can be a notable factor of behavior instability and correlates negatively to health outcomes. Assertive and efficient communication skills in the clinical context are imperative. Motivational interviewing skills can allow effective behavioral change.

Interventions addressing behavior change require careful, thoughtful work that leads to a deep understanding of the nature of what motivates people. Intervention based strategies focused on behavioral change must undergo further investigation in the future.

No significant relationships.

While coronavirus disease 2019 (COVID-19) spreads across the globe, many countries have closed schools to ensure physical distancing to slow transmission and ease the burden on health systems. Concerns regarding Coronavirus Disease 2019 (COVID-19) school closures often increase stress levels in parents.

This study examined whether higher levels of parental concerns were associated with children’s problematic behaviors and other factors during COVID-19-related primary school closures.

Participants were 217 parents who responded to a web-based questionnaire covering parental concerns, subjective stress, and depression; children’s sleep patterns, behavioral problems, and changes in activity level after COVID-19; previously received mental health services; and media usage during the online-only class period from community center in Suwon city.

The number of parental concerns was associated with children’s behavioral problem index (BPI) score (Pearson correlation 0.211, p < 0.01), sleep problems (0.183, p < 0.01), increased smartphone usage (0.166, p < 0.05), increased TV usage (0.187, p < 0.01), parents’ subjective stress levels (0.168, p < 0.05), and parental depression (0.200, p < 0.01). In families with children who previously received mental health services, the children reportedly suffered from more sleep and behavioral problems but not increased media usage, and parents noted more stress and depression. Parental concerns are related to family factors such as change of caregiver, no available caregiver, decreased household income, and recent adverse life events.

Ongoing monitoring of mental health at risky group and multiple support systems should be considered for parents having difficulty in caring their children.

Autoimmune encephalitis (AE) refers to a newly described, heterogeneous group of rare diseases characterized by brain inflammation and circulating autoantibodies. Various AE have been described and each of them is linked to the presence of specific autoantibodies directed against synaptic and neuronal cell surface antigens. The clinical picture includes a wide array of neuropsychiatric symptoms and is correlated with the associated antibody subtype. Since pronounced psychiatric symptoms are relatively common at the onset, patients can be misdiagnosed and initially driven to psychiatric institutions, thus delaying the adequate diagnosis and management of AE.

We aim to review and summarize the psychiatric manifestations of AE that might dominate the clinical picture. We also aim to describe the clinical signs that should alert the psychiatrist to the possibility of these diagnoses.

We performed an updated review in the PubMed database using the terms “autoimmune”, “encephalitis” and “psychiatric manifestations”. The included articles were selected by title and abstract. We also consulted a reference textbook.

We summarize the reported psychiatric manifestations of AE and also include two situations that can be helpful in AE diagnosis in the psychiatric setting: symptoms that should alert the physician for the possibility of AE and symptoms that should prompt an antibody detection test.

AE are rare diseases that present very frequently with psychiatric symptoms as the first manifestation. Psychiatrists need to be aware of the most common psychiatric manifestations of AE since the early recognition and treatment of AE is fundamental for a good outcome.

Most mental disorders tend to relapse (severe or mild pathologies such as anxiety or dystima disorders), which are potentially recoverable and yet, tend to evolve poorly, persisting residual symptoms without achieving a complete recovery.

The objective of this paper is to analyze the factors that influence process of recurrence and chronification, among which are our own therapeutic interventions.

A bibliographic search was performed from different database (Pubmed, TripDatabase) about the iatrogenic potential of our intervention (psychopharmacological or psychotherapeutic), analyzing influence and mechanisms involved, and the way to prevent them.

Anxiety is a necessary element for the development of people, both from a biological perspective (natural and adaptive psychological response that allows us to respond adequately to possible threats); as an evolutionary psychological (element involved in conflict resolution, in turn necessary for personal development). It would be a mistake to consider it as pathological and try to eliminate it through medication or psychotherapy, since we could interfere with the natural recovery processes, contributing to its chronification and preventing possibility of change. At times, anxiety can be pathological when it occurs disproportionately and exceeds ability to adapt, but we must not eliminate it but to study origin and factors involved, to achieve complete resolution.

In conclusion, we must consider possible iatrogenesis of our therapeutic interventions in process of chronification of mental disorders and try to avoid them by adequately studying individual factors and characteristics, before intervening.

MIJ821 is a novel N-methyl-D-aspartate (NMDA) receptor antagonist, with a potentially low rate of the psychotomimetic side effects that limit the therapeutic utility of ketamine in treatment-refractory depression (TRD).

To assess efficacy and safety of MIJ821.

Adults with TRD (>2 prior treatment failures; Montgomery-Asberg Depression Rating Scale [MADRS], >24) were eligible and were randomized (n=70) to low versus high doses of MIJ821, with two dosing regimens of weekly or biweekly, versus ketamine versus placebo. The primary outcome was change in MADRS total score at 24 hours and final follow up was at 6 weeks.

At 24 hours, adjusted mean differences (ΔAM) versus placebo were –8.25 (p=0.001), –5.71 (p=0.019) and –5.67 (p=0.046) and at 48 h were –7.06 (p=0.013), –7.37 (p=0.013), –11.02 (p=0.019) in the pooled MIJ821 low dose, high dose, and ketamine groups, respectively. At 6 weeks, ΔAM (80% CI) versus placebo on MADRS were –6.46 (–11.8, –1.15); p=0.059 for low dose MIJ821, –5.42 (–10.8, –0.02); p=0.099) for high dose MIJ821, and –5.24 (–10.4, –0.06); p=0.097 for ketamine. Further details on dosing, efficacy, and safety outcomes will be provided.

In this proof-of-concept study, MIJ821 was effective and tolerable in TRD. This study was funded by Novartis. Clinical trial.gov: NCT03756129

Employee of Novartis.

During the COVID 19 epidemic, the isolation helped virtual psychoterapy sessions, not to break up therapeutic relationship in critical moments.

This paper points out the traditional setting modification and how the interpersonal relationship can affect the therapeutic dynamics.

The experience could support the possibility to design adequate plans to test possible relational potentiality/prospect to respond to the pandemic emergency. The computer screen represents a very important new and rich element as “Skype” seems to have been the most used remote support. The screen plays a filter and separation function but physically represents the related presence in a shared timeframe. It is also a “mutual mirror”, reflecting the exclusive duality and resending to “different” space and time where the therapeutic relationship acts.

In this way the “analysis room” loses its physical feature to move towards a new dimension where the subjective experience are communicated/lived/re-elaborated by the mean of shared visual, modifyng the codified space of a traditional setting.

The screen is not only a mere vehicle of verbal communication, but fully gets in “hic et nunc” in space relationship assuming however an allegoric value, that, in the individual subjective, could go really beyond its “simple” and usual technological function.

Covid-19 causes neuro/psychiatric problems by cerebral hypoxia.

My therapy could allow us to cross Covid-19 infection by minimizing both immediate and chronic lung damage and would avoid many deaths and neuro/psychiatric problems from cerebral hypoxia.

In the case of a Covid-19 lung infection, the virus infects type II alveolar cells which consequently reduce the production of pulmonary surfactant. The surfactant has the function of reducing the surface tension of the alveoli. The less pulmonary surfactant there is, the more the alveoli tend to collapse due to the increased surface tension of their surface. Consequently, the lung would tend to collapse, that is, to reduce its volume, but collapse is prevented by the muscular movement of inspiration, which instead increases its volume. This means that a “low-pressure area” is created in the interstitial space which attracts liquid and substances which are often inflammatory and which organize over time, giving rise to interstitial pneumonia.

I propose to administer the pulmonary surfactant to the patient Covid-19 in the presence of dyspnea and certainly during assisted ventilation. This technique is routinely used in preterm infants suffering from lack of pulmonary surfactant production due to the immaturity of type II alveolar cells, pending that once matured these cells produce it autonomously.

Similarly, the administration of surfactant during Covid-19 lung infection would allow the correct amount of surfactant to be maintained during the acute phase of the infection and would give time for type II alveolar cells to heal and independently resume surfactant production.

No significant relationships.

During their career and sometimes during their training psychiatrists have to deal with the suicide of patients and have also to help other colleagues and families to cope with the situation. Suicide postvention should be integrated in psychiatric training and better implemented in both psychiatric and community contexts.

To discuss the concept of suicide postvention in Psychiatry. To discuss the importance of addressing suicide postvention in psychiatric settings including during specialized training of Psychiatry residents.

MEDLINE and PubMed databases searches for peer-reviewed studies, published in the last ten years, using combinations of the key-words suicide postvention and psychiatry. Selection of the relevant studies according to the study aims.

The literature search retrieved a total of 44 papers. All the articles that didn´t refer to the studied topic were excluded. Relevant articles discussing suicide postvention were selected, comprising a total of 22 articles. The reviewed papers discuss different contexts and strategies of suicide postvention that will be explored and critically discussed.

Addressing the topic of suicide postvention and implementing support programs and training in this field is crucial to psychiatry trainees, psychiatrists and other mental health professionals that integrate multidisciplinary teams, patients and their families and also to the community as a whole. Future research in this field can help to improve suicide postvention across different settings.

No significant relationships.

Autistic Spectrum Condition is often characterized by the presence of deficits in social interaction. An abnormal attentional processing may explain these difficulties, as it has been suggested that individuals with autism spectrum conditions may have problems with orienting attention to socially relevant stimuli and/or inhibiting their attentional responses to irrelevant ones.

The aim of the current study is to shed light on this issue by the assessment of the attentional orienting and inhibitory control to emotional stimuli (angry, happy, and neutral faces).

An antisaccade task (with both prosaccade and antisaccade blocks) was applied to a final sample of 29 children with autism spectrum conditions and 27 children with typical development.

The main findings were: i) children with autism spectrum condition committed more antisaccade error when seeing angry faces than happy or neutral faces, while children with typical development committed more antisaccade errors when seeing happy faces than neutral faces, and ii) latencies in the prosaccade and antisaccade blocks were associated with the severity of autism symptoms.

These results suggest that children with autism spectrum conditions show an impaired inhibitory control when angry faces are presented. This bias to negative high-arousal information is congruent with affective information-processing theories suggesting that threatening stimuli induce an overwhelming response in autism. From a clinical perspective, therapeutic strategies that focus on shifting attention to emotional stimuli may improve autism symptomatology and their socials functioning.

In 2018, it was implanted in a Brazilian public university, the UEPG Abraça Extension Program, which has as objectives to realize psychosocial care and accompaniment, offer psychotherapies and therapeutic groups to the university community, that is, students, professors and university staff to suicide prevention, coping with mental disorders and the problematic use of alcohol and other drugs. The Program has a multi-professional team composed of nurses, social worker, psychologists and psychiatrists, in an exclusive environment, thus guaranteeing comfort and secrecy to users.

To characterize the socio-demographic and clinical profile of users assisted by the UEPG Abraça Program and to disclose the importance of the service for the promotion of Mental Health.

Qualitative, quantitative, descriptive study, with a structured questionnaire as the research instrument. The collection took place in 2019 and the target audience were users who sought psychological care.

There were 469 admissions/visits and 35 of them continued with individual visits in 2020. The majority of users were female (58%) and had the age group between 17 and 20 years. The main mental health problems identified were anxiety, self-knowledge and university-related problems such as interpersonal conflicts and difficulties in the work process. The most attended undergraduate courses were Letters, Journalism and Dentistry.

It is noted the importance of a psychosocial care service at university level for the care and promotion of Mental Health.

No significant relationships.

Patients with Attention Deficit/Hyperactivity Disorder (ADHD) have shown an increased risk of developing a DSM Cluster B (i.e., Borderline, OR=13.16; Antisocial, OR=3.03; Narcissistic, OR=8.69) and DSM Avoidant Personality Disorder (PD; OR=9.77; Miller et al., 2008). Although different comorbidities affect males and females with ADHD (Kooij et al., 2013), gender differences in personality traits and disorders have not yet been investigated.

To describe gender differences in personality traits and disorders among a sample of adult outpatients with ADHD.

A consecutive sample of DSM-5 ADHD outpatients was recruited at the Adult ADHD Center of the “San Luigi” University Hospital (Orbassano (TO), Italy) between Jan 2017 and Jan 2018. Patients’ personality was assessed by Millon Clinical Multiaxial Inventory (MCMI-III; Zennaro et al, 2008).

The study sample consisted of 82 males and 31 females. Sixty percent of men vs. 77% of women had a personality disorder (

Women with ADHD showed a higher frequency of personality disorders and higher rate of Masochistic PD than men. Moreover, the two most important clusters detected in women included severe personality components (i.e., Borderline and Paranoid) when compared with men. Further studies on larger samples should be conducted to confirm more severe personality profiles in women than in men.

No significant relationships.

Anxiety Disorders (AnxDs) are highly prevalent in middle-aged and older individuals and are putative factors that might interfere with normal aging, by affecting cognitive functioning and neuroprogression.

This study aims to assess whether current AnxD in middle-aged and older subjects are associated with 1) lower neuropsychological performance, 2) shorter telomere length/lower plasmatic Amyloid-Beta, and 3) brain connectivity alterations, compared to subjects without lifetime psychiatric disorders (HCs).

This is an ongoing multicentric cross-sectional study. We collected preliminary data on neuropsychological performance through a standardized battery, in 60 outpatients with current AnxDs (DSM-5 criteria), 24 with psychopharmacological treatments (AnxDs+) and 36 without (AnxDs-), compared to 76 HCs, all aged 50-75 years. This study was supported by Fondazione Cariplo, grant n° 2014:0664.

AnxDs- patients showed poorer performance in the language domain, namely in semantic fluency (p=0.04), compared to HCs. No other significant differences were found between groups. Within the patients’ group, we found that a greater burden of psychiatric disorders or medical diseases, current use of benzodiazepines, or unhealthy lifestyle had significant detrimental effects on cognition, whereas current use of antidepressants, pharmacological treatments for medical conditions, and higher levels of physical activity exhibited the opposite effects.

We found only limited difference in cognitive performance between patients and controls. However, our preliminary results show that multiple factors influence cognitive performance in individuals with AnxDs, making these aspect important to monitor in clinical practice. So far, our results are provisional and further analyses in the final sample may provide more reliable conclusions.

The COVID-19 pandemic with the related containment measures is having a negative impact on the mental health of the general population worldwide. This event has been described as a new form of trauma, which is influencing not only physical and mental health, but also the society as a whole. Among Western countries, Italy has been one of the first severely hit by the pandemic in terms of number of cases and mortality rates. In March, 2020, strictly restrictive measures has been issued in order to contain the spread of the disease. This period has been known as “Phase one” of the national health emergency, where all not necessary activities were closed, almost 30,000 people died and almost 100,000 people were home-isolated. In this context, the COvid Mental hEalth Trial (COMET) network, including ten university Italian sites and the National Institute of Health, has been established in order to promote a national online survey for assessing the impact of lockdown measures on the mental health of the Italian general population. In the COMET survey, it has been included a specific focus on young people, which are expected to be the most vulnerable to the consequences of the pandemic and of the strict containment measures. Findings from this study can be useful to inform national and international associations on the importance to provide adequate support to the mental health of the young people.

No significant relationships.

Delusional disorder is a mental illness in which delusions are the dominant symptom. Delusional disorder is not well studied relative to other psychotic disorders - it is poorly understood in practically every aspect of its nature, including cause, phenomenology, prevalence, comorbidity, course, treatment, and prognosis.

To study the clinical and sociodemographic characteristics of individuals admitted for inpatient treatment with the diagnosis of delusional disorder, in particular the adherence to treatment.

Retrospective observational study of inpatient treatment of patients with delusional disorder diagnosis between january 1st2007 and 31th december of 2017 in the Psychiatry Service of CHUSJ. Follow up of 2 years from discharge. Data collected included sociodemographic characteristics and clinical features. Descriptive analysis of the results was performed using SPSS (v.26).

In the period of time analyzed, 152 hospitalizations were identified, corresponding to 114 patients: 38.2% male and 62.8% female. The average age was 58 years. 3 months after discharge: 65% of patients were going to the medical appointments, which dropped to 60% in 6 months, 55% in 12 months, 53% in 12 and 24 months. Regarding adherence to the treatment: 65% of patients were still adherent to medication in 3 months time, 55% in 6 months, dropping to 50% in a year and to 48% in 2 years. There is a relation between involuntary discharge and adherence to consultations and medication.

A cardinal characteristic of delusional disorder, conviction that one is not mentally ill, contributes complexity to the treatment challenges and profoundly affects the therapeutic relationship.

Breast cancer (BC) is one of the leading causes of cancer death worldwide. The problem of mental health and quality of life of patients is currently particularly relevant. Most patients with breast cancer in the process of adapting to the disease experience certain mental disorders: depressive, anxiety-phobic and psychosomatic disorders.

To study the severity of anxiety-depressive disorders in the clinical picture in patients with breast cancer and evaluate the effectiveness of specialized pharmacotherapy using antidepressants in combination with antitumor therapy.

The study included 30 patients with a first established diagnosis of breast cancer and 52 patients with a follow-up history of 3-17 years. The main method of work was the clinical, psychopathological, and statistical research methods (a method using contingency tables and the Fechner coefficient, a method - Chi-square test).

To assess the severity in the clinical picture of anxiety-depressive tendencies and the effectiveness of treatment, special scales were used: hospital scale of anxiety and depression (HADS); general clinical impression scale (CGI) for assessing disease severity (CGI-S “severity”) and improvement (CGI-I “improvement”). High antidepressant therapy efficacy indicators were obtained in combination with benzodiazepine drugs and hypnotics in a group of patients with anxiety-depressive nosogenia (15 patients, 88% of respondents with reduction in starting anxiety and depression scores HADS more than 50%, CGI 85%), in the group with chronic hypochondriac dysthymia and cyclotymic endoform depression.

The data obtained in the study confirm the effectiveness of psychopharmacotherapy with antidepressants in breast cancer patients with identified disorders of the anxiety-depressive spectrum.

No significant relationships.

Sleep disorders are a substantial public health issue with serious consequences on patients’ quality of life. Cannabis has been recently suggested as a potential treatment for patients with sleep disorders; however, research on the relationship between cannabis and sleep is still in its infancy.

The aim of this investigation was to assess whether cannabis use was associated with improved sleep quality.

Our study comprised 173 participants, 42 cannabis users and 131 non-cannabis users, who completed the Pittsburgh Sleep Quality Index (PSQI), the most common self-reported measure of sleep quality. The scale provides a global PSQI score and seven component domain scores, including subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime functions.

Cannabis users self-reported statistically significantly healthier scores than non-cannabis users in the global PSQI as well as the specific domains of subjective sleep quality, sleep latency, as well as sleep disturbances.

This preliminary evidence points to the possibility that cannabis could provide effective treatment for patients with sleep disorders. Research into the constituents of cannabis that may have a differential impact on sleep and sleep disorders is warranted.

Follie a deux is a rare syndrome characterized by the transference of delusions from a primary subject to a secondary one. This rare condition, and frequently forgotten in psychiatry pratice, is more frequent in feedlots, particularly in situations alike we face nowadays because of the pandemic.

To describe a clinical case and to discuss and highlight some clinical aspects of this entity.

Present a clinical case report and respective non systematic literature review

This clinical vignete describes a case of shared delusion between a mother and a son. The son suffers from an intelectual disability and shared with his mother a persecutory and prejudice delusion. Both live in the same house and because of the pandemic they spend all the time together. This situation was probably the main factor influencing the course of the symptoms.

It is highlighted the importance of a social isolation and close contact between the pair mother/son, more important in context of a global pandemic, viewed as an obstacle to promote the separation of both.

Multiple Sclerosis (MS) is an immune-mediated inflammatory demyelinating disease of the central nervous system. Concomitant psychiatric diseases are frequent in MS, with depression and anxiety disorders constituting the majority. The presence of psychotic disorders with MS is rare. Several studies have reported that psychotic symptoms usually develop after the neurological signs of MS and they are mostly linked to the side effects of treatment with interferon or with corticosteroids.

The authors report here the case of patient with MS without psychiatric history that developed psychotic symptoms.

Beside the medical record of the patient a non-systematic search of the literature was carried out in the databases Pubmed and Google Scholar with the terms “Multiple Sclerosis”, “Multiple Sclerosis treatment ”and“ Neuropsychiatric symptoms ”.

A 38 years old woman with MS, with no psychiatry history developed paranoid and reference delusions, several months after starting interferon beta-1a therapy. The inferferon therapy was stopped and the patient was started Risperidone 3 mg id with a rapid but only partial remission of the psychotic symptoms. The patient presented high blood levels of prolactine and the MRI showed a pituitary microadenome. The Risperidone was switched to Aripiprazol 15 mg also with partial remission of the psychtic symptons.

It is not possible to attribute our patient’s psychotic symptoms entirely to his Interferon therapy or to MS lesion load, but the occurrence during treatment, no psychiatric history and the rapid but parcial resolution with discontinuing suggest that Interferon therapy was at least contributory to the clinical picture.