Caffeine is the worldwide most frequently consumed psychostimulant. Its availability is nearly unlimited and in Europe it is not subject to state regulation. n the DSM-5 “caffeine use disorder” is categorized as a possible future disorder that currently needs further study.

To describe clinical evaluation, diagnosis, treatment and evolution of a 24 years old female patient.

A 24-year-old woman admitted to the Dual Pathology Unit with a diagnosis of: unspecified psychotic disorder, mild intellectual disability and borderline disorder. In week 17 of admission, she decided to suspend the medication, with significant improvement. Therapeutic permits increase and Wais-III is repeated, resulting in having a limited intellectual capacity. Two months after being discharged, she was readmitted with manic symptoms. The nursing staff discover that she was drinkiing a large amount of caffeine (up to 4 liters / day). After gradually stopping caffeine intake, she was discharged without psychopharmacological treatment, being able to lead a normalized life, even studying a medium degree. No more incomes were need.

Caffeine produces psychomotor-activating, reinforcing, and arousing effects.

The pattern of caffeine use of patients should be considered in the medical practice. The psychostimulant properties of caffeine are reviewed and compared with those of prototypical psychostimulants able to cause substance use disorders.

The outbreak of the SARS-CoV-2 epidemic forced a change in the functioning of health care systems across the globe, requiring rapid adaptation to new conditions for the safe provision of services within all medical fields. General disruption has also affected the traditional program of a postgraduate training, which has been so far fixed with temporary solutions, but not given a proper evaluation in the times of big expectations and pressures from both patients and healthcare workers.

Outbreak of the COVID-19 put psychiatry trainees and Early Career Psychiatrists in an unprecedented position of responsibility for treatment of a variety of comorbidities they had no prior experience with due to closure of specialized hospital departments and limited access to regular diagnostic tools. In addition to changes in clinical practice and deployment to unfamiliar ground, rescheduling of different components of regular training, transferring most of the educational activities to distance learning, limiting professional growth by canceling most courses and conferences only strengthened the feeling of uncertainty caused by constant adjustments of the final examinations’ conditions.

The Speciality Training Section of the Polish Psychiatric Association decided to review changes forced by the COVID-19 outbreak in a traditional postgraduate training program in psychiatry.

Identified shortcomings pose questions about the necessity of a solid revision of the training in order to cope with more demanding working conditions.

Presented recommendations may be the starting point for a discussion on the programs’ evaluation across the entire region.

No significant relationships.

Empathy is considered one of the most relevant characteristics in the interaction between the doctor and the patient, highlighting the need to enhance it from the professional training stage. However, some studies have established that high levels of empathy could generate emotional exhaustion (Boujut, Sultan, Woemer & Zenasni, 2012). However, if a certain type of empathy can lead to burnout, it must also be considered that an optimal empathic posture can, on the contrary, relieve stress and exhaustion.

Establish the relationship between the level of emotional exhaustion and empathy in medical students.

A cross-sectional study of correlational scope was conducted in 182 (n = 90) medical students. The cognitive and affective empathy test (López, et al., 2008) and the adaptation of the MBI instrument for the Colombian population (Barbato, Córdoba, González, Martínez & Tamayo, 2011) were used to assess emotional exhaustion

Statistically significant correlations of positive magnitude were evidenced between the variables emotional exhaustion and cognitive empathy (Table 1)

It was possible to conclude that the higher levels of cognitive empathy (adoption of perspective) in medical students, also resulted in greater emotional exhaustion, revealing an inappropriate consequence of empathy, where professionals can excessively adopt the patient’s feelings, generating wear. It is essential to promote optimal levels of empathy, which are beneficial for both the patient and the doctor.

The COVID-19 pandemic caused employment related challenges worldwide. Adults diagnosed with Autism Spectrum Disorders (ASD) are especially vulnerable, due to pre-existing employment challenges, intolerance to changes and uncertainty and high levels of related anxiety.

To examine COVID-19 related changes in work experiences and mental health of employees with ASD who held a steady job before the COVID-19 outbreak.

Data were collected from 23 participants diagnosed with ASD (4 females), aged 20–49, who answered an online administered survey at two timepoints: prior to the COVID-19 outbreak, and during the outbreak. Self-reports included measures of background and employment status; mental health (General Health Questionnaire-12); job satisfaction (Minnesota Satisfaction Questionnaire); and satisfaction of psychological needs at work (Psychological Need Satisfaction and Frustration – Work domain).

Participants who continued to physically attend work maintained pre-COVID-19 levels on all assessed variables. Participants who transitioned to remote work from home preserved their salary levels and job satisfaction, but showed a marginally significant deterioration in mental health and a significant decrease in the satisfaction of their needs for competence and autonomy at work. Unemployed participants showed a significant decrease in mental health.

Results highlight employment as a protective factor from the potential negative implications of COVID-19 on mental-health of employees with ASD. Employees who transition to working from home require personalized work-support plans due to the possible negative effects of this transition on mental health. Maintaining the routine of physically reporting to work should be preferred, when possible.

Synthetic Cannabinoids were recognized as drugs of abuse since 2008, they are sold under various names (Kush, K2, Spice).

The Patient N., 17 years old male was admitted to the hospital with a first-time psychotic episode. He is fond of extreme sports (ski jumping, gymnastic and acrobatic elements).

The patient was fully examined.

Then he was taken to the admission department. About a week before admission he fell, injuring his leg and head. After that he did not sleep, became excited, aggressive, “said strange things”. During the admission patient showed disorganized behavior, agitation, paranoid ideation, beliefs that others were inserting thoughts into his head (“thought insertion”) and that his thoughts could be read by others (“thought broadcasting”), imperative “voices”, bizarre delusional thoughts. The UDT showed positive K2 analysis. The patient was prescribed Diazepam, Zuclopenthixol, Valproic acid. No improvement observed. Haloperidol was prescribed next day. Then Haloperodol was changed to Quetiapine, and after 10 days of treatment no improvement was observed. The patient started to show catatonia symptoms such as elective mutism, mild rigidity, signs of cog-wheeling or clasp-knife rigidity. He experienced anxiety, fear, did not take care of himself. Every day he started to be aggressive, impulsive, started to experience auditory hallucinations. Due to that fact it was decided to prescribe Haloperidol, Chlorpromazine, Phenazepame, Diphenhydramine.That treatment improved behavior.

Thus, the intensive treatment with antipsychotic medications in combination with benzodiazepines and diphenhydramine is much more preferable for the management of the cases of oneiroid catatonia due to the usage of Spice.

For populations with intellectual disability and autism spectrum disorder, it is essential to complete cognitive assessment with an adaptive behavior scale.

To translate VABS-II from English to French and establish norms for the French population.

We used the Parent/Caregiver form in order to assess psychometric characteristics of the VABS-II and to develop norms for the French population. VABS-II comprises 4 domains, 11 subdomains, and an optional maladaptive behavior index. The French translation of the VABS-II followed standard cross-cultural translation methods. The study was performed in the Rhône-Alpes-Auvergne department comprising 12 % of France inhabitants and well representing the French general population.

From 4576 VABS-II questionnaires distributed, 1707 were returned and 1654 were analyzed. The reason for exclusion was the impossibility to score one of the subdomains. From 174 questionnaires included in the test-retest, 95 were analyzed, and 79 questionnaires were excluded because 86 under 34 days, 8 > 3 months, and one participant that changed age group between test and retest. Scores based on French norms fluctuated around values based on US norms on all subdomains.

The French Vineland questionnaire is the single test with the adequate norms to allow identifying children with adaptive behavior difficulties. It should be used as a complement of the assessment of the intellectual quotient, according to DSM V, for the diagnosis of intellectual disabilities. It must be done in reference to the developmental and cultural standards specific to the environment in which the person is evolving.

No significant relationships.

According to the literature, cognition may be more preserved in late-onset schizophrenia (LOS) compared to early-onset schizophrenia (EOS), but data are limited.

To compare performance on cognitive tests in LOS and EOS.

LOS patients (n=14, mean age 58.1±8.2, 13 females, illness duration 1.07±1.5 years) and age-comparable controls (n=17, mean age 55.3±7.8, 12 females), EOS patients (n=25, mean age 20.7±3.9, 25 males, illness duration 0.75±0.62 years) and age-comparable controls (n=15, mean age 22.9±2.3, 15 males) underwent the Brief Assessment of Cognition in Schizophrenia (BACS) comprised of six subtests: Verbal Memory, Digit Sequencing, Verbal Fluency, Token Motor Task, Symbol Coding, and Tower of London. The Mann-Whitney U test with Bonferroni correction for multiple comparisons was applied (p <.05/8, i.e. p <.006).

Compared to LOS, EOS patients had lower score on Verbal Fluency (VF): U=78, p=.004; mean T-scores are 43.5±9.5 and 33.6±12.6 for LOS and EOS, respectively. Additionally, we compared VF performance in each clinical group with age-comparable controls and revealed significantly lower performance in both LOS (U=37.5, p=.001) and EOS (U=56.5, p=.000).

Performance on VF is deteriorated in clinical groups, but may be more intact in LOS compared to EOS. This result is of particular interest because low performance on VF is considered as a cognitive endophenotype of schizophrenia. Performance on VF requires preserved executive functions, language, and processing speed. Our results are in line with the idea that LOS and EOS may be different subtypes of schizophrenia. Limitation of this study is that the clinical groups are not sex-matched.

After the outbreak of a new coronavirus infection (COVID-19) on 31 December 2019 in Wuhan (China), an increasing amount of information and concerns are impacting global mental health. It is already evident that apart from physical suffering, the direct and indirect psychological and social effects of COVID-19 pandemic are pervasive and could affect mental health now and in the future.

The central aim of our study was to investigate the prevalence of common mental disorders in populations during Covid-19 outbreak. The study was done in 3 different countries (Albania, India, Iran) which gave us the opportunity to compare our findings and to have a bigger view of the impact of COVID-19 in individuals.

A Cross-sectional online survey was done across countries. We used demographic questions and different scales: Corona Anxiety Scale (CAS), The Obsession with COVID-19 Scale (OCS), Insomnia Severity Index (ISI) to evaluate psycho-social impact during covid.

We collected 469 responses in Albania, 442 responses in India and 402 responses in Iran. According to the data we found that symptoms of anxiety related with corona and obsession with corona were higher in Iran compared with the two other countries. Insomnia problems were also more frequent in Iran were only 16,66% of participants reported no insomnia, compared with 42,0% in Albania and 63,12% in India.

The emergence of mental health (MH) problems during a pandemic is extremely common, though difficult to address due to the complexities of pandemics.

No significant relationships.

Perinatal period is characterized by a broad range of physical, psychological and relational changes. Maternal perinatal depression (PD) is defined as an episode of major depression with the onset from pregnancy to the first year after delivery. Depressive symptoms influence the earlier mother-child interaction and impact on child cognitive, affective and behavioral development.

Purpose of our study was to evaluate the consequences of PD on sleep-wake patterns in the early stages of infant development. We aim to investigate the presence of poor sleep in infants/ toddlers and also to identify differences in sleep ecology variables.

We enrolled, from December 2019 to September 2020, a clinical sample of children born from women with PD (N=19, m.a.=13,7, SD= 7,6) and a healthy control group (N=21, m.a.=15,5, SD=5,43). Infant sleep data were obtained from the Brief Infant Sleep Questionnaire (BISQ). Poor sleepers were defined by the following criteria: >3 night wakings, nocturnal wakefulness >1 hr or total sleep duration <9 hr. Maternal depression was assessed with clinical and psychometric evaluation. T-test was used for comparison between the two samples.

Statistical analysis indicates that there were not significant differences between the two groups concerning night wakings (p= .678), nocturnal wakefulness (p= .815), total sleep duration (p= .209) and nocturnal sleep onset time (p= .475).

Our findings suggest that PD is not a risk-factor in the onset of infant sleep problems. Probably negative parentig, affective disengagement, delegation in maternal care and sedative effects of pharmacotherapy may affect mother’s perception of her infant’s sleep.

The identification of potential biomarkers is crucial to improve the management and treatment of mood disorders. Glycogen synthase kinase-3 (GSK-3) is a multifunctional enzyme with an important role in the etiology of mood disorders. Recent findings suggested GSK-3 as a putative biomarker in mood disorders.

The aims of the study are: - to evaluate GSK3 as potential biomarker for differential diagnosis (MDD and BD); - to analyze the regulation of GSK3 by psychopharmacological treatments.

Patients included fulfill the following criteria: (a) principal diagnosis of MDD or BD (DSM-5); (b) age ≥ 18 years; (c) drug-free for at least 4 weeks before the inclusion. For each patient included a healthy control is enrolled, matched by gender and age. All included subjects at the study entry point (t0) are assessed through: - semistructured clinical interview and clinical rating scales (Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale; Young Mania Rating Scale, Clinical Global Impression) - blood draw, to measure GSK-3 levels Patients with MDD or BD are assessed again after 1 week (T1) and after 2 month (T2) of specific pharmacological treatment.

So far, we enrolled 16 patients and 16 healthy controls. The enrollment is still ongoing.

We expect to find GSK-3 levels differently expressed between healthy controls, patients with DDM and patients with BD. This finding would be crucial as it could contribute to the improvement of differential diagnosis. Moreover, we expect to observe a change in GSK-3 levels after psychopharmacological treatments.

Disruptive behaviours underpin the most prevalent and costly psychiatric disorders in youth including ADHD and conduct disorder. Yet the association between childhood behavioural problems and economic and social outcomes in adulthood are rarely examined in a population-based samples where early detection and prevention may be possible.

To examine the association childhood behavioural problems and economic and social outcomes from age 18-35 years across three studies.

This study daws on 30-year Canadian birth cohort (n=3017) linked to government tax return records. Behavioural assessments – for inattention, hyperactivity, opposition, aggression, anxiety and prosociality – were prospectively obtained from teachers when children were aged 6-12 years. Regression models were used to link behavioural assessments in kindergarten (age 5/6 years) to earnings at age 33-35 years (Study 1) and to trajectories of welfare receipt (Study 2), while behaviour at age 10-12 years was linked to trajectories of partnering. Children’s IQ and family background were adjusted for.

Inattention, aggression-opposition (males only) and low low-prosociality in kindergarten were associated with lower earnings at age 33-35 years (Study 1), inattention, aggression-opposition and low prosociality in kindergarten predicted following a chronic welfare receipt trajectory from age 18-35 (Study 2), and inattention, aggression-opposition, anxiety and low-prosociality at age 10-12 years were associated with increased likelihood of being unpartnered and with partnership dissolution from age 18-35 years (Study3).

Behavioural assessments made by schoolteachers can identify children at risk of adverse economic and social outcomes in adulthood. The implications of for early screening and prevention will be discussed.

No significant relationships.

There is suggestive evidence linking hoarding with several problems in emotional regulation, and though this is shared with OCD patients, it may not correlate to the presence of obsessive symptoms.

The present study aimed to examine self-reported deficits in emotion regulation (ER) and obsessiveness among individuals with hoarding disorder (HD) in comparison with others with obsessive compulsive disorder (OCD) and healthy controls

Twenty-two adult outpatients with HD, twenty-two with OCD and twenty-two age and gender matched healthy control (HC) participants completed the Emotion Regulation Questionnaire (ERQ) which measures respondents tendency to regulate their emotions in two ways: Cognitive Reappraisal and Expressive Suppression. They fulfilled as well the OCI-R which evaluates six groups of OCD symptoms: Washing, Checking, Ordering, Obsessing, Hoarding, and Neutralizing.

The HD and OCD groups scored higher, (p 0.04), on Cognitive Reappraisal than did the HC group. There was no significant difference between groups in Expressive Suppression. HD and HC groups scored significantly lower, (p < 0.001), in OCI-R than OCD patients.

Results suggest that OCD and HD are characterized by self-reported deficits in ER, but this relationship in HD patients is not solely attributable to obsessive symptoms.

Immune system abnormalities exist across a range of psychiatric disorders. Autoimmunity, characterized by the production of antibodies against the body’s own antigens, is a feature of immune system dysfunction and could play a role in mental disorder pathophysiology. Better understanding of the associations of auto-immunoglobulin G (IgG) repertoires with clinical features of mental illness could yield novel models of psychosis pathophysiology and markers for biological patient stratification.

To undertake global screening for auto-IgG expression in a large cohort of people with psychotic disorders; to determine whether associations exist between autoantibody expression and clinical features.

Cross-sectional quantification of auto-IgGs in blood plasma of 461 people with established psychotic disorder diagnoses. For global screening, pooled samples of phenotypically representative patient groups were exposed to planar protein microarrays containing 42,000 human antigens. For targeted profiling, expression levels of 380 autoantibodies were quantified by suspension bead array (SBA) in each patient’s plasma.

We identified highly individual autoantibody profiles with no evidence for co-expression patterns. We found 6 autoantibodies robustly associated with specific psychopathology: anti-AP3B2, detected in 5% of the cohort of whom 100% had persecutory delusions; anti-TDO2 (5% of the cohort, 100% hallucinations); anti-CRYGN (4%, 86% initial insomnia); anti-APMAP (3%, 86% poor appetite); anti-OLFM1 (2.5%, 100% above median cognitive function); and anti-WHAMMP3 (2%, 90% anhedonia and dysphoria). Examination of the auto-IgG binding site on the TDO2 protein revealed a putative pathophysiological mechanism involving the kynurenine pathway.

We identified 6 frequently occurring autoantibodies that were associated with specific clinical features in people with psychotic disorders.

No significant relationships.

Prenatal attachment is a strong predictor of post-natal attachment. Identifying factors influencing this bond is important, especially maternal history of stressful life-events.

Determine which type of maternal trauma impacts prenatal attachment.

We conducted a transversal descriptive study in a first line clinical practice center and in an university gynecology-obstetrics department. We used Prenatal Attachment Inventory (PAI) to assess maternal-fetal attachment, the Childhood Trauma Questionnaire (CTQ) to evaluate maternal childhood stressful events and the Life-Threatening Events (LTE) to explore traumas during the past 6 months.

For the 125 pregnant women in our study, the mean age was 30 years and 5 months with 99,2% of them married. Mean gestational age was 33 weeks +1 day. PAI’s mean score was 55,58± 10,20; CTQ‘s mean score was 36,62 ± 9,53 revealing trauma in 28%. Women admitted being victims of IPV in 49,6% with almost the half (48,38%) being exposed to two or more forms of violence. Mean score for recent traumatic events in LTE was 1,87 with 65,2% being exposed to two or more life threatening event. A correlation between the total score of PAI and CTQ was found (p=0.021) particularly subscales of physical and emotional negligence of the CTQ (p=0.023 and p=0.006). We found no statistically significant correlation neither between PAI and IPV (p=0,453) nor between PAI and LTE (p= 0,360).

Providing an appropriate training for health care providers can enable them to detect pregnancies at risk in order to refer them to trauma-informed mental health services.

In Brazil there is high number of children with Intellectual Disability (ID) who begin basic education but did not receive a diagnosis. The basic education teachers can be important agents in identifying signs of ID in the student so that they can be referred to health services.

To develop and implement a decision-making model for basic education teachers to identify students with predictive signs of ID.

The sample was composed by 51 teachers from 20 public schools and their 1758 students eligible for the study enrolled in a educational network in São Paulo state, Brazil. A standardized model was developed for the evaluation process using an open-source software named BONITA. For the screening of students with ID signs the teachers answered a checklist based on the diagnostic criteria of the DSM-5 and the students were evaluated with neuropsychological test WASI (Wechsler Abbreviated Scale of Intelligence) and neuropsychiatric assessment. A Classification Based on Association Rules (CBA) generated the predictive models of sensitivity for confirming ID from the items in the checklists.

35 children had suspected ID. The CBA showed an accuracy of 82%, identifying only 1 false-negative case and 3 false-positive cases for ID. According to the teachers, the most accurate signs were deficits in abstract thinking skills, deficits in communication and conversation and difficulties in emotional regulation in social interactions.

The decision-making model by elementary school teachers to identify students with ID showed high levels of sensitivity and can help the waiting for diagnosis.

No significant relationships.

Stigma is a major burden and impediment for treatment and recovery in serious mental disorders, especially psychotic disorders. Therefore, it has been proposed to replace the term schizophrenia by psychosis susceptibility or psychosis spectrum disorder.

We have assessed stigma in the media through a 10-year survey of Flemish daily newspapers (2008-2017) by comparing the way schizophrenia and autism are portrayed. We added the term psychosis for the years 2013-17 to assess its suitability as a less stigmatising alternative.

Via the websites of the seven Flemish newspapers, we searched for all articles published between 01 Jan 2008 and 31 Dec 2017 containing the keywords autism, schizophrenia, and related terms. The collected articles (n = 5,337) were then graded to their stigmatising content. We added the term psychosis for the years 2013-17.

In the collected articles the coverage of autism was mostly positive, whereas the coverage of schizophrenia was predominantly negative. The contrast was very substantial (p < 0.0001) and stable over the years. The portrayal of psychosis turned out to be mostly positive in the broadsheet newspapers and mostly negative in the tabloid papers.

The social stigma attached to schizophrenia and psychosis is poignantly reflected in the Flemish newspapers. The fact that a comparable disorder such as autism is depicted in a much more favourable way than schizophrenia indicates that a more positive image of schizophrenia is not only desirable but also achievable. Psychosis gives mixed results, a finding up for discussion.

Schizophrenia patients with auditory verbal hallucinations (AVH) demonstrate impaired functional connectivity (FC) between brain regions, involved in executive functions and language. However, as most studies compare patients to healthy controls, the specificity of these findings either for schizophrenia in general or for AVH is unclear.

We aimed to compare whole-brain resting-state FC of main language brain regions between schizophrenia patients with and without history of AVH and healthy controls.

Schizophrenia male patients with (n=31; mean age 29,8±11,6) or without history of AVH (n=16; 29±12,4) and 39 healthy male controls (30±8,9) underwent resting-state fMRI on 3T Philips scanner. No between-group differences in age, illness duration, and severity of clinical symptoms except AVH were revealed. Regions of interest (ROIs) were taken from the independent fMRI study with conventional language localizer and included left inferior frontal gyrus (l_IFG) and superior temporal gyri (STG) bilaterally. Whole-brain FC of each ROI was compared between groups (ANCOVA; p<.005 voxelwise; p(FDR)<.017 clusterwise, corrected for number of ROIs) with post hoc tests.

Decreased FC between each STG (left and right) and anterior cingulate cortex (ACC) was revealed in all patients, compared to healthy controls. Patients with history of AVH, compared to other groups, showed decreased FC between l_IFG and ACC.

Disrupted fronto-temporal FC is non-specific for AVH and characterizes all schizophrenia patients. Patients with history of AVH have impaired FC between the l_IFG, underlying language production, and ACC, involved in differentiation between language production and comprehension. The study was supported by RFBR grant 18-013-01214.

The study was supported by RFBR grant 18-013-01214.

The Group of Studies and Research on Psychology and Cognition (GEPESPSI) in Brazil has developed important academic and clinical actions on mental health in contexts of difficult psychological handling.

GEPESPSI organized a symposium to discuss the psychological effects of isolation due to the strict measures of social distancing.

11 psychologists and one speech language pathologist discussed possible contributions to face social distancing in their specific fields of expertise in a virtual symposium of two days. The themes were: university teaching; support to the development of social and emotional competencies among children; the threat of the death of dreams in a phenomenological perspective; resilience and self-esteem; the repercussions of the lack of the school space for socialization; psychological tools for facing isolation; the challenges and perspectives of women who are victims of violence; online therapy for children; the health of workers; suicidal behavior; formulation of educational policies for remote learning and family mental health.

1094 people were enrolled with an average of 400 people participating in each period. 91,1% of which were graduate students of a university. 55,7% were students of Psychology, 12,8% of Pedagogy, 6% of Physical Therapy among other courses. 39,8% of them were from the city of Santos, the others were from different regions of the country.

The feedback given by the participants was positive and involved gains such as sharing experience and knowledge but mainly creating connections to exchange psychological tools as a way of facing the difficulties of social distancing among researchers and graduate students.

Coronavirus disease 2019 (COVID-19) pandemic has had a negative impact for mental health. ULS-Guarda in cooperation with Portugal National Health Service, provided the population of the district of Guarda with a mental health helpline (MHHL).

Provide a descriptive data analysis of the MHHL calls received between April 1st and September 20th of 2020.

The data was obtained through the filling out of questionnaires. It included fields for gender, age, the type of service provided, relation to COVID-19, symptoms displayed and the number calls made per patient. For the statistical analysis, Microsoft Excel TM was utilized.

MHHL received 191 calls. The largest volume was received during April, which saw 116 instances of patients seeking the MHHL. The number of calls then tapered progressively throughout the following months. The services provided were split between psychiatric assistance, psychologic assistance, and the renovation of medical prescriptions, in 44%, 31% and 19% of the cases, respectively. The 101 patients who resorted to the MHHL were unevenly distributed in gender, being 74 female and 27 male individuals. Their ages were mostly between 50 and 69 years old. The most common symptoms were anxiety, depressed humor and insomnia, in 35%, 16% and 11% of the cases, respectively.

The largest influx of calls coincides with the home confinement period, and decreased alongside the relaxation of the confinement measures held. The MHHL had enough adherence to warrant consideration of it being an alternative means of healthcare access, especially in situations where physical access to healthcare is restricted.

Social withdrawal is an early and common feature of psychiatric disorders. Hypothalamic-pituitary-adrenal (HPA)-axis activation through increased salivary cortisol (sC) and sympathetic activation through increased salivary alpha-amylase (sAA) may play a role.

We aimed to study whether the link between increased sC and sAA on the one hand and depression on the other hand is mediated by social withdrawal.

In this cross-sectional, observational study, sC and sAA measures were measured in seven saliva samples in 843 participants (231 psychiatric patients and 612 healthy controls). Social withdrawal was assessed through the Brief Symptom Inventory (BSI)-, the Short Form 36-, and the Dutch Dimensional Assessment of Personality Pathology social withdrawal subscales, and analyzed using linear regression and mediation analyses. On average, participants were 44.0 years old (SD=12.8; 64.1% female).

Basal and diurnal sAA were unrelated to any social withdrawal scale and depression. Certain sC measures were positively associated with the BSI social withdrawal subscale (i.e., area under the curve with respect to the increase, beta=0.082, p=0.02; evening sC value: beta=0.110, p=0.003; and mean sC value: beta=0.097; p=0.01). We found limited support for statistical mediation by social withdrawal (measured using a composite social withdrawal score) on the relationship between evening sC and depression.

Thus, although we found no support for a role of basal and diurnal sAA in social withdrawal, HPA-axis activation may partly aggravate social withdrawal in depressive disorders.