The exposure to child maltreatment increases the lifetime risk for many psychopathological symptoms: depression, anxiety disorders, bipolar disorder, schizophrenia, post-traumatic stress disorder, personality disorder and dissociation. Besides, adopted children, especially those with a history of institutional living before adoption, are at greater risk for a range of developmental, behavioral and attachment concerns. The case report is of a 17-year-old male, with reactive attachment disorder (RAD). He suffered child maltreatment in his family of origin before the international adoption.

The aim of this study is to present a case-report illustrating the relationship between chil maltreatment, adopted children and the reactive attachment disorder.

A bibliographic search was performed about reactive attachment disorder. Information regarding the clinical case was obtained by consulting the patient’s file.

A 17-years-old male who was adopted at age of 9 from Spain. According to reports from the orphanage, the patient suffered severe maltreatment by his family of origin, with scars on his back. The patient presents impulse control disorder, with verbal and physical heteroaggressiveness in situations of frustration, hunger and sleep. He stopped attending the institute at the age of 12, with marked isolation and reversal of the sleep-wake cycle. His treatment plan are partial hospitalization, psychotherapy and pharmacotherapy.

Both child maltreatment and adoption are risk factors for the presence of psychopathology during the lifetime. Especially during the pre-adoption process and the first years after adoption, both the family and the child should be able to use specialized Mental Health services.

No significant relationships.

Huntington Disease (HD) is a genetic, progressive neurodegenerative disorder. Its clinical features include motor dysfunction, cognitive impairments, and psychiatric symptoms. The association between HD and suicide is well documented, and the risk of suicide in HD is higher than in patients with other neurological diseases.

We aim to review the literature regarding suicidal behaviour in HD.

We performed an updated review in the PubMed database using the terms “suicide”, “suicidal behaviour” and “Huntington Disease”. The included articles were selected by title and abstract.

The most relevant risk factors associated with suicidality in HD are depression, anxiety, and aggression, so the presence of psychiatric diagnoses should be closely monitored. No consistent results have been found regarding gender. Evidence for periods of elevated risk of suicidal behaviour in HD is mixed and the data on specific pharmacological interventions for alleviating suicidal ideation in HD is scarce.

Patients with HD are at a high risk for suicide. This risk is further increased when a comorbid psychiatric disorder is present. It is important for the practicing psychiatrist to be aware of this association to correctly manage patients with HD, thus helping prevent suicidal behaviour.

There is a plenty of literature on providing psychological services for psychiatry inpatients and outpatients. Seeing a psychiatrist for the first time can be stressful.

This paper will identify challenges in setting up a clinical psychology service for consultees seen in Reception Department with consultative and primary specialized health care. ‘Clinical psychology service’ is a project in Moscow Research Institute of Psychiatry providing services within the Reception Department setting. A need to address mental ill health issues (getting a diagnosis and treatment plan) within the broader psychosocial needs of consultees has been identified.

Clinical psychology established a brief intervention ‘service’ for consultees. Issues of establishing trust within this population suggested the need to provide a ‘named’ male or female psychologist. The psychologist accompanied psychiatric consultants’ recommendations to familiarize a consultee of the availability of the service. Evaluation of the service, including uptake, client satisfaction, and outcome, is ongoing using quantitative and qualitative methods. Data is presented on key themes identified in providing psychological services to consultees.

Key themes identified included: 1. Service development: establishing trust, ensuring confidentiality, close between consultants working, flexibility, crisis management, safety, establish links with other agencies; 2. Complex psychological and social needs: mental health issues, trauma, substance misuse, domestic and sexual violence.

Consultees present with a range of complex psychosocial needs. While this population may have reservations about accessing ‘standard’ mental health services, a flexible psychology service working in close liaison with psychiatric consultants may be effective in addressing these needs.

This presentation focuses on two major problems in psychiatric hospital care: patient violence and lack of patient engagement. Interventions already exist for managing patient violence. However, the challenge in using these interventions is poor integration to clinical practice and these methods do not entail elements of patient engagement.

The aim of the presentation is to give on overview of a project aiming to develop and test new structured intervention for violence risk management. Intervention aims to increase safety in care environments and engagement of patients.

Intervention Mapping protocol together with staff and patients will be used in the project. Quasi-experimental design is used to test the intervention in 4 month period in two psychiatric hospital units.

By the end of the year 2020, development of the the new violence risk management intervention is nearly finished. The presentation will give an outline of the developed intervention and how staff and patient engagement in the development phases were ensured.

The project described in this presentation is an example how a feasible violence risk management method can be developed together with staff and patients receiving psychiatric care. By ensuring engagement of the target groups, here staff and patients, it is possible to promote real integration of a new working method to psychiatric inpatient care. This project was funded by the Academy of Finland (316206).

Antipsychotics have been classically considered the treatment of choice for delusional disorder (DD) and antidepressant medications have been restricted to patients with comorbid depression.

Our aim is to describe the case of a patient with DD with delusions of parasitosis, who responded to paroxetine as monotherapy. We also aimed to review the recent literature on the potential use of antidepressants as the main treatment for somatic type DD.

After the case report, we present a narrative review on the use of antidepressants in DD, somatic type (DSM-criteria) by using PubMed database from inception until 2020.

Case: 74 year-old woman without previous psychiatric diagnosis who suffered from long-term cutaneous and vulvar pruritus. She was referred to psychiatry from dermatology to assess thought content and sensoperceptive disturbances. In the past, she had received unsuccessful treatment with antihistamines. The patient brought a collection of “the identified parasite” (matchbox sign) to our first appointment. On assessment, she was diagnosed with DD with delusions of parasitosis. Risperidone 1mg/day was poorly tolerated (excessive sedation). She refused further antipsychotic treatment, so we started paroxetine up to 20mg/day. The patient went into total remission of her pruritus and delusions of parasitosis. Review. In line with our case, 6 studies reported on the successful use of antidepressants as monotherapy for DD, somatic type. Most of studies report the successful use of an antipsychotic/antidepressant combination (case-series, case reports).

Although antipsychotics are the treatment of choice, antidepressant medications may be an effective alternative in somatic type DD when patients refuse antipsychotics.

Globalization as lead to a more heterogeneous population than ever which makes intercultural communication an issue of modern times. Although this is positive in many ways, the differences in culture and beliefs, as well as a linguist barrier may impair clinical communication.

The authors aim to shed light in the issues regarding intercultural communication.

Review of the literature including studies focusing on the the various facets of intercultural communication.

People from different cultural backgrounds have less access to health care and are less referenced to specialized care. Also, these patients report less satisfaction after their appointments. Although language proficiency in pointed as one of the most determinant factors, acceptance and comprehension of the patient beliefs regarding health and disease seems to play a very important role. Different cultures express symptoms differently and have different expectations when meeting a doctor. When these factors are overlooked, the doctor-patient relationship suffers and so does the treatment adherence. Doctors tend to have an identical approach to intercultural patients and native patients and to evaluate their interview as very positive, even when the same doesn’t happen with the patients.

Although the difficulties regarding intercultural communication are widely known, most doctors fail adequate their interventions to the specific needs of their patients, not taking into consideration their different beliefs and expectations. This raises very important questions as patient dissatisfaction leads to failure to report symptoms and consequent misdiagnosis and non-compliance to the proposed treatment which ultimately results in a less efficient health care in these populations.

No significant relationships.

The countertransference of the therapist is crucial in psychotherapy. Although the concept of countertransference arose from psychoanalysis, it is considered a construct that occurs in any type of therapy.

The purpose of this review is to examinate the relationship between personality disorders and countertransference.

A systematic literature review was performed on PubMed using the keywords “personality disorder” and “countertransference”. All papers published between 2015 and 2020 were evaluated.

There were significant relationships between and patients’ personality disorders and patterns of countertransference. Criticized countertransference were associated with paranoid and antisocial personality disorders. Borderline personality disorders was related to helpless, overwhelmed, and overinvolved responses. Narcissistic and schizotypal personality disorders were associated with disengaged therapist responeses. Helpless countertransference was associated with schizoid personality disorders. Avoidant personality disorders was associated with postive responses. Special/overinvolved therapist responses were associated with obsessive-compulsive personality disorders

Several studies suggest that therapists’ emotional responses occur consistently in any kind of therapy. Moreover, specific personality disorders are associated with concrete emotional responses. Therefore, therapists can make therapeutic and diagnostic use of their conuntertransference.

Sexual dysfunction is common in eating disorders (EDs), but its relevance is often overlooked.

To describe different ED clinical subgroups in terms of psychopathology, putative biological correlates, and consequences of dysregulated sexuality, focusing on the role of childhood trauma.

Healthy controls (n=60), binge-purging (n=38), and restricting patients (n=24) were compared (age- and BMI-adjusted ANOVA; Bonferroni post-hoc tests), using total scores of Eating Disorder Examination Questionnaire (EDE-Q), Emotional Eating Scale (EES), SCL-90-R Global Severity Index (GSI), Barratt Impulsiveness Scale (BIS-11), Difficulties in Emotion Regulation Scale (DERS), Childhood Trauma Questionnaire (CTQ), Female Sexual Functioning Index (FSFI), Hypersexual Behaviour Inventory (HBI), and patients’ hormonal profiles (gonadal and pituitary hormones, ghrelin). Self-reported voluntary termination of pregnancy (VTP) and promiscuous sexual activity were recorded. For ED patients (N=62), regression analyses between significant variables and HBI were carried, applying moderation models for different CTQ scores.

Table 1 outlines significant between-group comparisons (°: different from controls; *: different from restricting patients; p<0.05). Binge-purging patients had higher FSH, LH, and ghrelin levels, more VTPs and promiscuity. HBI showed significant correlations with EES, SCL-90-R-GSI, DERS, CTQ, and ghrelin levels. CTQ moderated interactions for DERS and EES (Figure 1).

Dysregulated sexuality is linked to emotion dysregulation and childhood trauma. Binge-purging patients experience adverse behavioural consequences.

No significant relationships.

A relationship was found between the use of breast milk and infant formula milk and a decrease in the incidence and number of clinical complications caused by hypoxic-ischemic encephalopathy hypoxic-ischemic encephalopathy.

To assess the efficacy and safety of breast milk and infant formula milk in terms of reducing of hypoxic-ischemic encephalopathy, the level of morbidity, the severity of damage to brain structures, the time before switching to full-fledged enteral nutrition and the frequency of detecting feeding intolerance in premature infants.

Prospective observation of the development of 254 premature babies were treated up to six months of corrected age at the Department of Neurology of Early Growth in 2016-2018. The effect of breast milk and formula milk on neurological status was compared.

In comparison, breast milk and formula milk didn’t show any effect on the frequency of severe hypoxic-ischemic encephalopathy (p <0,05), the severity of brain damage(р <0,01). Breast milk showed a statistically significant effect in terms of reducing the average number before switching to full enteral nutrition (p <0,01).

Breast milk and formula milk does not affect the frequency of development of hypoxic-ischemic encephalopathy, the severity of brain damage. Breast milk significantly reduces the frequency of feeding intolerance, accelerates the transition to enteral nutrition, reduces the duration of hospitalization in premature infants.

No significant relationships.

The persistent and recurrent use of the internet to engage in games, often with other players, which leads to clinically considerable deficits and online dependency still lacks more research support its impact of attentional levels and Sleep Quality.

To assess levels of Online Gaming Dependency, its impact on attention levels and quality of sleep among online gamers.

The following instruments were used: a sociodemographic questionnaire, as well as the Video Game Behavior Assessment Scale (α = .842) and the Portuguese version of Color and Words Stroop Test. The sample consists of 66 individuals, 92.3% male and 7.7% female, with an average age of 23.1 (SD ± 4.07).

Mild levels of online gaming dependency were obtained. Male gamers presented higher motivation to play online games, and higher levels of Stroop interference. Regarding the association between gaming behaviors and quality of sleep, results show that individuals who have difficulty falling asleep show greater motivation to play online games, a greater degree of concern with daily life and a greater frequency of negative behaviors in relation to online gambling.

The results show the importance of an increase in investigations in this area, as well as to the development of psychological assessment instruments and psychological intervention strategies, based on scientific evidence, on the different variables under study, in order to improve the quality of life in of individuals.

Nowadays, many relevant gene-drug associations have been discovered, but pharmacogenomics (PGx)-guided treatment needs to be cost-effective as well as clinically beneficial to be incorporated into standard health-care.

To address current challenges, this systematic review provides an update regarding previously published studies, which assessed the cost-effectiveness of pharmacogenomics testing for the prescription of antidepressants and antipsychotics.

Our initial screening revealed 1159 articles, which was subsequently reduced to 32 articles, deducted by analysis of their abstract. Full-text analysis performed by all authors resulted in 18 papers that were further included in the analysis.

Of the 18 studies evaluations, 16 studies (88.89%) drew conclusions in favor of PGx testing, of which 9 (50%) were cost-effective and 7 (38.9%) were less costly based on cost analysis. In brief, we found sufficient evidence on the cost-effectiveness of PGx in psychiatric disease care. More precisely, supportive evidence exists for CYP2D6 and CYP2C19 gene-drug associations and for combinatorial PGx panels, but evidence is limited for many other drug–gene combinations. Amongst the limitations of the field are the unclear explanation of perspective and cost inputs in many economic studies, as well as the underreporting of study design elements, which can influence significantly the economic evaluations.

Overall, this systematic review highlights the need for additional research on economic evaluations of PGx implementation with an emphasis on psychiatric pharmacogenomics.

When depression is comorbid with tuberculosis, it will lead to decreased quality of life, lack of adherence to anti-Tb drugs, progression to MDRTB and will end in death with mortality from the disease.

We aimed to study the association of Tuberculosis and depressive disorders in children aged 7-18 years compared to non-tuberculosis diseases and their correlation. We hypothesized that depression will be significantly more common in patients with tuberculosis than in non-TB patients, who served as a control.

A prospective observational case-type study for a period of 2 years, 2018-2020. The patients included in the study are patients diagnosed and treated in the Child Pneumology Department of the Pneumoftiziology Hospital “Sfantul Spiridon” Galati and in the TB Dispensaries in Galati County divided into the study group consisting of patients diagnosed with Tuberculosis and the control group of patients without a diagnosis of Tuberculosis or other previous chronic disease. For the diagnosis of depression in the case of the two groups, we used the CDI questionnaire (Depression Inventory for children).

Out of 100 children with TB, 68% had depression compared to the control group, which showed that only 9% had depression.

Depression can affect all parts of a child’s life, including behavior, appetite, energy levels, sleep patterns, relationships, and academic performance. We observe a wide range of symptoms in the group of children with tuberculosis compared to the control group.

The literature shows a high prevalence of psychopathological problems, anxiety and depression among university students because of academic expectations, uncertain future plans, staying away from their family, economic issues and peer relationships. Although these problems show high prevalence among university students, providing them a professional care is limited so most of problems remain untreated. Nowadays the students use digital technologies commonly therefore web based and computer delivered interventions may be useful for them to improve resilience and coping strategies.

The intent of the study was to review systematically the impacts of web based and computer delivered interventions regarding stress management among university students.

Several databases were searched with using key words such as university students, online interventions, web based interventions and stress management. Randomised controlled studies were reviewed.

We found 284 article with the key words. Only four of them met the including criterias. All results of reviewed articles show that web based online interventions have an impact to reduce depression, stress and anxiety level among students. According to the results students improved coping skills against stress after web based online sessions.

The findings show that web based and computed delivered interventions can be effective to improve resilience and reduce students` depression, anxiety and stress symptoms when compared non-interactive and inactive controls. In addition online interventions regarding stress management may provide us to reach out large group of university students.

No significant relationships.

Attention deficit hyperactivity (ADHD) disorder is a common childhood neurodevelopmental disorder, and Methylphenidate (MPH) is a first-line therapeutic option for treating ADHD.However, how brain complexity and entropy changes with methylphenidate treatment the clinical implications of possible changes in entropy and the clinical implications of possible changes in entropy have yet to be studied.

This study aimed to reveal how the MPH treatment affects the complexity in the brain of children with ADHD by entropy-based qEEG analysis. In addition, the presence of the relationship between possible neurophysiological changes to be detected with clinical variables and how they are two other important questions of this study to be answered.

During eyes-open resting, EEG signals were recorded from 25 boys with ADHD-combined type before MPH administration and at the end of the 1st month of the treatment. Approximate entropy (ApEn), sample entropy (SampEn), permutation entropy (PermEn) were used to analyse.

A statistically significant decrease in entropy level was found with MPH treatment in the F4 channel according to approximate entropy (ApEn) and sample entropy (SampEn) analysis (p<0.05). In addition, according to permutation entropy (PermEn) analysis, the decrease in entropy with MPH treatment in the regions indicated by F3, F4, P4, T3, T6, and O2 channels was found to be statistically significant (p <0.05).

This is the first study to investigate how MPH treatment affects the complexity in the brain of children with ADHD. Entropy-based qEEG analysis may be a new method that can be used in diagnostic, clinical and prognostic predictions in ADHD.

No significant relationships.

Early grief is a concept about which there is little literature. This generates difficulties in order to perform a differential diagnosis, as it poses complications to determine if the symptoms that the patient suffers are relative to the mourning or if they appear as part of a comorbid disorder.

To assess the difficulty in discriminating when accompaniment is necessary and when the patient can benefit from pharmacological, psychotherapeutic or combined treatment.

Patients’ data is obtained from their medical history as well as psychological interviews carried out during the process.

32-year-old woman, with a previous history of depression. The patient was living abroad when her father was diagnosed with a terminal illness, so she decided to return home, making a radical change in her life. She is currently facing the functional deterioration of her father, who is rapidly getting worse. The patient shows symptoms of anxiety, tendency to cry and apathy. 34-year-old woman, with no history in Mental Health. As a result of her father’s illness, the patient develops a clinical manifestation of anxiety and low spirits. After one year, the clinic is maintained according to the variations in the health of her father. She also reports problems concentrating, fatigue, ruminative thoughts and structured autolithic ideas. Finally, she is referred to begin a psychotherapeutic follow-up.

Bearing in mind that we are facing an increase in diagnoses of terminal illnesses, I consider it is necessary to reflect on this concept in order to provide a better response to patients.

No significant relationships.

A variety of psychological determinants, such as vulnerability to stress, low levels of psychological well-being and several comorbidities, have been hypothesized to play a role in the development, and maintenance of Internet Gaming Disorder (IGD). However, evidence has been insufficient to sustain an overarching model of the causal pathways leading to IGD.

. This study aimed to depict a model of the causal links between vulnerability to stress, psychological well-being, and symptoms of common mental disorders (e.g., depression, generalized anxiety, phobic anxiety, obsessive-compulsive disorder, somatization, and hostility).

. A community-based sample of Portuguese gamers (N = 153; Mage = 21.92; 15.29% female) completed measures of IGD (IGDS9-SF), mental health (SCL-90-R), psychological well-being (EBEP), and vulnerability to stress (23QVS). A machine learning algorithm – Greedy Fast Causal Inference – was used to infer a model of the causal pathways linking those psychological determinants to IGD.

. Hostility and psychological well-being were directly involved with a subgroup of IGD symptoms (i.e., gaming used as escape, tolerance, withdrawal, and loss of control). Stress vulnerability and symptoms of mental disorders were only indirectly implicated in the causal pathways leading to IGD.

. It is likely that several psychological factors implicated in the causal pathways leading to IGD, have not been yet identified. Future research should directly test specific models of the causal pathways involved in the development and maintenance of IGD symptoms.

No significant relationships.

On March 13th 2020, in execution of the Law Decree 14/2020 regarding the reorganization of National Health Care related to COVID-19 emergency, all non-urgent outpatient healthcare services were suspended in Italy. The present work describes remote support and online group psychotherapy set in motion during COVID-19 emergency for outpatients with Binge Eating Disorder.

Aim of the present work is to describe and evaluate online support and group psychotherapy for outpatients with Binge Eating Disorder during lockdown due to COVID-19 emergency. Outcomes were evaluated by remote administration of questionnaires.

20 outpatients with Binge Eating Disorder, treated by psychotherapists of Hospital Psychology Unit in Psychiatry Day Hospital of an Italian General Hospital, received remote support by phone calls and online group psychotherapy from march to may 2020. During the first two weeks, patients were supported via phone calls. From the third week on, they took part to online group psychotherapy sessions, held every week at the same day and time. Pre-post remote administration of Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) and the Questionnaire of Eating Behaviours (Scheda dei Comportamenti Alimentari, SCA) was used to evaluate outcomes. Data were analyzed by Student’s t-test.

No significant difference was found, thus indicating stability of symptomatology.

Lockdown was a highly stressful period, in which many people lost control on eating behaviours and those with Binge Eating Disorder were expected to have an exacerbation of symptoms. Remote support and online group psychotherapy proved effective in protecting patients from a possible aggravation of their condition.

Burning mouth syndrome (BMS) is a chronic condition characterized by a burning sensation of the oral cavity and is often associated with taste disturbances and xerostomia.

To study the psychotropics as part of the possible etiologies of this síndrome.

A 67-year-old woman complained of burning pain in the tongue and oral mucosa, taste disorder, and sensory impairment. Slight improvement after treatment with Gabapentine 300mg (1-0-0). The pain is constant, with sharp characteristics. Improves when eating, the ability to taste is preserved. Subsequently, treatment with 2% lidocaine rinse (3-4 times / day) is tested, with temporary pain relief. Lorazepam 1mg (1-0-0), without improvement. Patient in follow-up by the Neuropsychiatry consultation for 3 years, due to major depressive disorder in treatment with Quetiapine 100mg (0-0-1).

In the first consultation the treatment is modified, adding Duloxetine 60 mg (1-0-0) and Alprazolam 0.5mg (1 / 2-1 / 2.0), and reducing the dose of Quetiapine to 75 mg and then 50mg. In the subsequent consultation, one month later, she only manages to reduce the neuroleptic dose by half, without noticing clinical improvement. After two months, she has completely removed the quetiapine, and completely disappearing the burning mouth sensation, improving his affective clinic in the same way.

There are a large number of drugs that produce xerostomia, in intimate relationship with the burning mouth. Among those we can find antihistamines, neuroleptics, antihypertensives, and benzodiazepines. In many cases, correcting or eliminating these etiologic agents does not improve or stop the initial symptoms, but sometimes, it does.

According to numerous studies, the origins of most endogenous mental diseases, in particular, autism, lie in early childhood. This concept is based on the classical theories of diathesis.

The purpose of this study was to clarify the phenomenology of mental disorders in children with an assessment of the prognostic significance of symptoms that preceded the development of the disease for future mental health.

The clinical material was collected during the survey of a child population. Selected for prospective observation was 40 children (1-3 years old) from the high-risk group for schizophrenia with functional disorders of the endogenous spectrum. All patients were examined by clinical methods and pathopsychological, neurophysiological. Psychometric scales PANSS, CARS were used. The results were mathematically evaluated using the Statistica 7 program.

The clinical picture of the mental state of young children, in children with autistic disorders in 1,5-3 years, was determined by a specific complex of disorders, which were reduced to a general deficit, especially in the emotional sphere, vegetative dysregulation, most often, the sleep-Wake rhythm. Motor skills, as a rule, did not lag significantly behind the age standards. The onset of actual autistic disorders was noted older than 1 year of life. Сhildren received medication and corrective therapy. The detailed clinical picture of violations developed gradually. Dynamics of psychopathological picture in (80,0%) children was regressive.

The study shows the importance of preventive measures in people related to ASD, sparing individual approach in education and therapy.

The relationship between epilepsy and depression has been recognized for a long time. In fact, the presence of depression could worsen the disease outcome.

we aimed to study the prevalence of depression in patients with epilepsy and to assess the determinant factors of its genesis.

54 patients with epilepsy, aged more than 18 years, attending the neurology department of Habib Bourguiba Hospital, Sfax, Tunisia, were enrolled for the study. All patients were administered Mini-International Neuropsychiatric Interview (MINI) for evalution of psychiatric comorbid disorders especially depression. Socio-demographic and clinical data were collected.

A total of 54 patients were included, of whom 63% (n =34) were men. Mean duration of epilepsy was 20.13 years. The most frequent type of seizure was generalized 72.7%. Depression was present in 7.3 % of patients. Alcoholism (p=0.027) was significantly associated with occurrence of depression. Drug resistence (p = 0.03) and longer duration of epilepsy (p = 0.046) were significantly associated with occurrence of depression. No significant association was found between type of seizure, seizure frequency, medication compliance and depression. Depression wasn’t associated with anti-epileptic drug. We didn’t find any association between depression and other psychiatric comorbidities.

Depression wasn’t frequent in our study contrary to literature. The possible explanations are the reduced simple size and the sensitivity of the used tool to assess depression in epilepsy. Pursuant to literature, we found significant association between Alcoholism, drug resistance and long duration of epilepsy.