Hyperthymia was studied by many eminent psychiatrists considering it mainly within the framework of the subsyndromic course of affective disorders (Akiskal H.S., Angst J., Benazzi F.). Statistical data on the prevalence of hyperthymic personalities are scarce, which is associated with rare requests for help and diagnosis of this condition within the framework of character traits. Given the above, the study of the psychopathological and dynamic features of hyperthymia seems to be very relevant, since previously hyperthymic characterological features were not always taken into account in the diagnosis of the disease, the selection of drugs and the prediction of remission.

Determination of the clinical features of the course of an affective disease in patients with hyperthymic features.

The sample consisted of, 48 patients (39 women, 9 men) who were on inpatient or outpatient treatment at the clinic since 2019 to 2022. Patients were examined by clinical-psychopathological, clinical-anamnestic methods due to the presence of a phase affective state.

The subjects were diagnosed with two diseases - bipolar affective disorder and cyclothymia. There were 2 variants of affective phases - affective-mixed and “double” mania. In bipolar disorder, there were anxiety-hypochondriacal depressions (10 patients, 38.5%), polymorphic depressions (4 patients, 15.4%), asthenic hypomania (5 patients, 19.2%), hypochondriacal manias (3 patients, 11. 5%), alternating states (4 patients, 15.4%), “double” manias (8 patients, 23.5%). In cyclothymia, anxiety-hypochondriac depression (8 patients, 57.1%), somatoform decompensation (2 patients, 14.3%) and asthenic hypomania (4 patients, 28.6%) were observed.

Thus, bipolar disorder was the most common among hyperthymic individuals. Anxiety-hypochondriacal depression prevailed in both nosologies. Manic and hypomanic states were most often observed in patients with bipolar disorder (“double” manias - exclusively in bipolar disorder).

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Substance use during adolescence is linked to adverse biopsychosocial events, including poor mental health, cognitive deficits, low academic performance, and delinquency (Deas & Brown J Clin Psych 2006; 67 18; Armstrong & Costello JCCP 2002; 70 1224; Cox et al. JSH 2007; 77 109-115; Chassin JJSU 2008; 165-183). Identifying risks for these events is critical, given they are associated with adverse outcomes in adulthood.

Post-pandemic, rates of adolescent depression and anxiety have more than doubled (Racine et al. JAMA Ped 2021; 175 1142-1150). Adolescents often use substances, most commonly alcohol and cannabis, to manage mental health (Colder et al. JCCP 2019; 87 629).

Cannabis is increasingly viewed by adolescents as safe, while alcohol is viewed negatively (SAMHSA 2021). Non-disordered alcohol use (ND-AU), alcohol use below diagnostic criteria level, has adverse developmental impacts for adolescents, including increased risk-taking behavior and heavy substance use in adulthood (Marshall Alcohol Alcohol. 2014; 49 160-164).

With growing normalization of cannabis use, important questions still remain whether non-disordered cannabis use (ND-CU) among adolescents is linked to adverse life events.

Using data from the 2018-2020 National Survey on Drug Use and Health (NSDUH), an annual US representative survey on substance use and mental health, we compared associations among common adolescent substance use and adverse life events.

Responses from adolescents aged 12-17 (N=32,407) from the 2018-2020 NSDUH were analyzed. Logistic regression was used to evaluate associations between substance use disorder (SUD) diagnoses and adverse adolescent life events. Adjusted odds ratios (aOR) were obtained while controlling for age, sex, and race/ethnicity. Analyses included sampling weights to account for the US population. Adolescents in ND-CU and ND-AU groups were defined by either past-month or past-year use without their respective SUD diagnosis.

Approximately 5% of adolescents had any SUD, and 1.3% had more than one SUD (Table 1). All SUD variables, including cannabis use disorder (CUD) and alcohol use disorder (AUD), were significant for all adverse adolescent life events (Table 2). Adolescents with a SUD were nearly 3 times more likely to have major depression in the past year, 2.5 times more likely to have a C+ or below grade average, and 10 times more likely to be arrested, than controls. These risks increased with more than one SUD (Table 2). Adverse events were similar between ND-CU and ND-AU. (Figure 1).

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Given the biopsychosocial risks to ND-CU and ND-AU in adolescents, there may be reason to reevaluate whether the DSM adequately captures the population of youth affected by their cannabis and alcohol use. Clinicians can use these nationally representative data to stratify risks and direct to appropriate treatment.

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The COVID-19 outbreak and the related containment measures led to the emergence of psychological distress in youth populations, possibly due to concern for their families, social isolation, increased time spent on the Internet and social media, and anxiety about the future.

The study aims to evaluate differences in the access of children, adolescents, and young adults to a psychiatric emergency setting before and after the onset of the COVID-19 pandemic.

Data concerning the psychiatric consultations carried out at the Emergency Department of the University Hospital of Perugia was collected. Socio-demographic and clinical information, including diagnostic and treatment features, was entered into an electronic database. We considered two different time spans, one before (01.06.2017-31.12.2018) and one after (01.06.2020-31.12.2021) the COVID-19 pandemic outbreak. The characteristics of consultations carried out before and after the pandemic outbreak were compared by means of bivariate analyses (p<0.05).

2,457 psychiatric consultations were carried out in the index periods. 1,319 (53.7%) were requested before, while 1,138 (46.3%) after the COVID-19 outbreak. As for the latter, these were more frequently requested for female subjects (64.2% vs 54.5%, p=0.0042), while institutionalized people underwent psychiatric consultations less frequently in the post-COVID-19 period (5.6% vs 18.2% p<0.001). A significant difference in the prevalence of anxiety disorders (9.7% post-COVID-19 vs 18.8% pre-COVID-19, p=0.009) and adjustment disorders was found (7.1% vs 1.5%, p=0.009). Substance-related disorders were significantly reduced (8.0% vs 15.8%, p=0.016) after the COVID-19 outbreak. About psychopharmacological treatment, there was an increase in people who had received treatment in the past but were no longer on treatment (52.3% vs 30.8%, p<0.001). The prescription of antipsychotics also increased (29.3% vs 18.5%, p=0.012). At discharge, subjects were more frequently hospitalized in the Psychiatric Inpatient Unit in the post-COVID-19 period (22.2% vs 12.8%, p=0.012).

Our data confirms the vulnerability of youth populations during the pandemic. The consequences of health emergencies on the psychological well-being of this population must not be underestimated and tailored treatment strategies should be implemented.

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During the course of COVID-19 pandemic, the respiratory system is the most commonly affected while many neuropsychiatric manifestations of the disease have been observed.

Emphasize the importance of detecting psychiatric symptoms in patients infected with Covid 19.

Presentation of case report

A 44-year-old woman with no personal history of chronic diseases and with no psychiatric family history. About her experience with covid 19, her mother died as a result of covid 19 infection and our patient had been hospitalized for 17 days for pulmonary infection covid 19, during her hospitalization in COVID 19 unit she presented insomnia and anxiety without behavioural disorders. She had a good evolution of the respiratory symptoms and she was discharged under corticotherapy and anticoagulants.

She was admitted in our department after 45 days of her covid 19 infection for acute behavioural disorders.

On physical examination: she was hemodynamically stable and well oriented. Neurological examination was with no abnormalities. Cerebral CT scan was normal and lumbar puncture was indicated and the analysis of the CSF did not reveal any anomalies. At the psychiatric interview she was extremely agitated, anxious and hallucinated, she had disorganised speech with derailment and neologisms, she was disinhibited and her mood was exalted. She presented also a delusion of grandeur and delusion of persecution.

In individuals presenting with COVID-19 infection, consideration should be made for psychiatric manifestations because COVID-19 diagnosis predispose vulnerable patients to psychosis.

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COVID-19 had a significant impact on the mental health of the affected population. Such multifactorial risk for a deterioration of mental health suggests the need to identify groups of patients with psychiatric vulnerability and to establish strategies of intervention based on scientific evidence.

The aim of the study was to identify psychiatric outcomes one year after recovery and possible associations between these and the clinical, anamnestic, and sociodemographic variables.

The Mini International Neuropsychiatric Interview was employed to assess current and lifetime mental illness in a cohort of 100 patients discharged between March and April 2020 from COVID-19 wards of the San Paolo Hospital in Milan, Italy. The Kendall rank correlation coefficient was administered to measure the ordinal association between clinical-demographic variables and the psychiatric diagnoses of patients. Bivariate correlation was used to explore the association between psychiatric outcomes and the sample characteristics.

Almost one third of subjects screened positive for a diagnosis of a new psychiatric disorder, and a novel onset of psychiatric morbidity did not differ significantly in patients with and without a positive history of mental illness (42 and 58%). New psychiatric disorders were grouped into stress reactions, anxiety-group disorders and mood disorders. Concerning demographic characteristics, advanced age represented a protective factor against the onset of new psychiatric disorders (rτ = -0,203, p =0,008). Despite a lower risk of contracting the infection, women in our cohort were more vulnerable to psychiatric post-Covid symptoms (rτ =0,190, p =0,029). The correlation between the onset of new psychiatric disorders and some pre-admission vulnerability factors, such as an overweight condition (rτ =0,185, p =0,026) and a positive medical history for cigarette smoking (rτ =0,203, p =0,026), were statistically significant. Moreover, subjects who reported taking a therapy to control the infection prior to hospitalization were more likely to receive a new psychiatric diagnose (rτ =0,269, p =0,005). Of note, variables related to the severity of hospitalization such as oxygenation intensity, days of hospitalization, or requirement of intensive car were not associated with new psychiatric diagnoses.

The onset of psychiatric disorders shows a relevant frequency in patients hospitalized for COVID-19, suggesting that mental health services should structure adequate screening and diagnosis methods. Three levels of intervention can also be expected to reduce the overall risk and burden of psychiatric morbidity: increasing awareness regarding modifiable risk factors; guaranteeing a minimal level of mental health support to patients hospitalized for COVID-19; providing personalized interventions with respect to gender and age groups.

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Despite emerging evidence suggesting the efficacy of psilocybin in the treatment of mood disorders such as depression, the exact mechanisms by which psilocybin is able to elicit these antidepressant effects remains unknown.

As the use of psilocybin as a treatment modality for depression has garnered increasing interest, this study aims to summarize the existing evidence of the mechanism of action with which psilocybin alleviates depressive symptoms, focusing specifically on the neurobiological effects of psilocybin in human subjects.

Four databases (Ovid MEDLINE, EMBASE, psychINFO, and Web of Science) were searched using a combination of MeSH terms and free text keywords in September 2021. The original search included both human and animal studies and must have included testing of the mechanism of action of psilocybin. Only antidepressant effects were considered, with no other mood disorders or psychiatric diagnoses included. Two independent researchers screened at every stage of the review, with a third researcher resolving any conflicts. Though a full systematic review outlining the current literature on the complete mechanisms of action of psilocybin on depression was conducted, this abstract will focus specifically on the nine papers that included human subjects, disregarding the five animal models. PROSPERO registration number: 282710.

After removing duplicates, the search identified 2193 papers and forty-nine were selected for full text review. Out of nine papers outlining the mechanisms of action of psilocybin use in human subjects, three papers investigated psilocybin’s effect on serotonin or glutamate receptor activity, two found an increase in synaptogenesis in regions such as the medial frontal cortex and hippocampus. Four found variation in blood flow to the amygdala, two found altered blood flow to the prefrontal cortex, and one found a reduction in delta power during sleep. Four papers found changes in functional connectivity or neurotransmission, most commonly in the hippocampus or prefrontal cortex.

Overall, the exact mechanism of psilocybin’s potential antidepressant effect remains unclear. Multiple pathways may be involved, including alterations in serotonin and glutamate receptor activity, as well as shifts in amygdala activity, neurogenesis, and functional connectivity in various brain regions. The relative lack of studies, and the variety of neurobiological modalities and endpoints used challenged the consolidation of data into consensus findings. Further studies are needed to better characterize psilocybin’s mechanism of action and to better understand the clinical effects of the use of psilocybin in the treatment of depression.

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Electroconvulsive therapy (ECT) is a procedure performed under general anaesthesia involving triggering an intentional brief seizure through small electrical currents through the brain. The anaesthetic depth should be adequate prior to shock and measured with BIS, a processed electroencephalogram (EEG) monitor. Adjusting the hypnotic dose allows to decrease the ictal threshold and thus improve the response to treatment and decrease side effects.

Our goal is detecting elements such as spontaneous epileptiform activity after ECT without tonic-clonic activity with the spectral density matrix (SDM).

Our patient: an 87-year-old woman, diagnosed with F20.2 catatonic schizophrenia and under antipsychotic treatment since her youth. She has required multiple hospital admissions due to psychopathological decompensations until starting monthly maintenance ECT sessions in 2014. Since then she no new hospital admissions have been required.

Images 1D and 1E shows the SDM, a spectrogram of the EEG. The X axis show time (minutes), the Y axis shows the frequency (Hz) and the Z axis shows the energy or intensity of that electrical activity in the frequency bands replaced by colors: warm colors (red) reflecting high intensity electroencephalographic activity and cool colors (yellow, blue and green), low activity. Images 2 and 3’s EDM shows spontaneous epileptiform activity after electroconvulsive therapy without tonic-clonic activity. We observed an initial EDM of an awake patient, with warm colours in practically all frequency bands, including the beta band (13-30 Hz), characteristic of waking states. Around 9:50 anaesthetic induction occurs, activity increases in slow frequencies (red colours in alpha, theta and delta), plus an increase of cold colours in beta, reflecting the disappearance of brain activity in that frequency. The asterisk reflects the EEG response to the electrical discharge, followed by a postcritical state with brain activity exclusively in slow waves and high amplitude (delta and some theta) and absence of activity in other frequencies (blue colour in the beta and alpha bands) around 9:57. At about 10:00 there is an abrupt appearance of high intensity brain activity (warm colours) in beta and alpha and delta, mainly, reflecting spontaneous epileptiform activity after treatment and clinically reflected as a patient absent and disconnected from the environment, but without tonic-clonic activity. New postcritical state in which blue colour predominates, reflecting little brain activity, and warmer colours reappear in all frequency bands, including beta, reflecting the progressive recovery of wakefulness.

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Psychiatric pathology can be reflected in the SDM, which allows to observe changes in the EEG, correcting the electrical stimulus of the shock and the dose of anesthetic appropriate to the patient to trigger an intentional brief seizure under general anesthesia.

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Growing evidence supports a possible link between gut microbiota and attention-deficit/hyperactivity disorder (ADHD) via the gut-brain axis. Short-chain fatty acids (SCFAs), the major metabolites produced by gut microbiota through anaerobic fermentation, may influence gut-brain communication.

To determine the alterations of gut microbiota and fecal SCFAs in children diagnosed with ADHD compared to healthy subjects.

Fecal samples were collected from children with ADHD (n=10), and age- and sex-matched healthy controls (n=10) for gut microbiota and SCFAs analysis.

There were no significant differences in the abundance of any bacterial phyla in feces between groups. However, fecal concentrations of acetic acid, propionic acid, and butyric acid were significantly lower in children with ADHD compared to those of controls (Figure1). Interestingly, acetic acid and propionic acid levels were negatively correlated with ADHD symptoms (Table 1). Macronutrient and fiber intake, determined from food frequency questionnaires, did not differ between groups.Table 1.The regression analyses predicting ADHD symptoms scores from fecal short-chain fatty acids level.

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Our findings suggested that gut dysbiosis was possibly developed in children with ADHD, as indicated by a significant decrease in fecal SCFAs. In fact, fecal acetic acid, propionic acid, and butyric acid may potentially be the early detector for ADHD. In addition, fecal acetic acid and propionic acid could be potential biomarkers for the severity of ADHD.

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Depression, anxiety and suicide are serious psychiatric conditions that affect Mexican youth (Institute for Health Metrics and Evaluation, IHME, 2022), with depression showing a prevalence greater than 16%. Suicide ranks as the second most important cause of deathin this age group, (6/100,000 deaths), the first being violent deaths by firearms (15/100,000 deaths;IHME, 2022).

To identify factors related to age of onset of pediatric depression.

A cross-sectional study was carried out during 2018-2020 in two Children’s Psychiatric Hospitals in Mexico City. Data were collected using a survey method. All participants signed an informed consent form. We applied Cox hazard analysis, with the hazard event being the onset of psychiatric symptoms.

Data from 400 patients were analyzed, 148 girls (37%) and 252 boys (63%). Mean patient age was 12 years, and mean age of symptom onset was 8 years. The most common diagnoses were hyperkinetic disorder (51%), depression (34%), and anxiety (7.8%). Age of depression onset was significantly reduced in association with male sex (HR=1.46), family history of psychiatric disorder (familial depression HR=2.34; hyperkinetic disorder HR=2.67; psychoactive substance abuse HR=5.09), and certain medical comorbidities (asthma HR=6.41; enuresis HR=3.03). These same covariates were not associated with age of onset of hyperkinetic disorder or anxiety.

These analyses indicate that a subgroup of pediatric depression has an early onset and is associated with familial hyperkinetic disorder and depression, the male sex, and certain medical comorbidities.

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Accelerated biological ageing might contribute to the higher prevalence of age-related diseases and excess mortality amongst individuals with mental disorders. Recent advances in machine learning and the collection of high-dimensional molecular “omics” data allow for the quantification of biological age.

The aim of this study was to use machine learning methods to predict biological age from nuclear magnetic resonance spectroscopy metabolomics data and to identify psychiatric traits associated with accelerated biological ageing.

The UK Biobank is a multicentre community-based observational study that recruited >500,000 middle-aged and older adults. 168 metabolomic measures were quantified using the Nightingale Health platform. Phase 1 release of these data included a random subset of 118,462 UK Biobank participants. Metabolomic age delta (MetaboAgeΔ) was defined as the difference between predicted biological age and observed chronological age. We estimated group differences in MetaboAgeΔ between individuals with and without mental disorders and examined whether polygenic scores for mental disorders predicted MetaboAgeΔ.

Up to 110,780 participants with complete data on all metabolomic measures were included in the analysis. Individuals with a history of mental disorders had higher MetaboAgeΔ values than people without a mental illness. For example, MetaboAgeΔ suggested that the difference between predicted biological age and observed chronological age was about two-years greater amongst individuals with bipolar disorder than amongst people without mental illness. Polygenic scores for mental disorders were positively correlated with MetaboAgeΔ.

These findings suggest that individuals with a history of mental disorders or with higher polygenic scores for mental disorders were biologically older than their chronological age.

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Poor social inclusion, as a cause and consequence simultaneously, has been associated with schizophrenia spectrum disorder (SSD). It can bring a substantial burden to individual families and the society. Previous studies lack 1) the quantitative exploration of (multidimensional) social inclusion which can enable the measurement and monitor of the level of social integration, 2) longitudinal and multivariate study designs, and 3) methodological comparison between the traditional and data-driven approaches for a better clinical suitability of monitoring and managing social inclusion.

To build and compare 3-year models predictive of multidimensional social inclusion (mSI) among the SSD patients, using standard and data-driven approaches.

We used the baseline and 3-year follow-up data of 1,119 patients from the Genetic Risk and Outcome in Psychosis. Social functioning (Social Functioning Scale, SFS) and quality of life (the brief version of the World Health Organization Quality of Life, WHOQOL-BREF) were used as a proxy of mSI. K-means clustering over the 13 subscales of SFS and WHOQOL-BREF was applied to identify mSI subgroups. Prediction models were built and internally validated via multinomial logistic regression (MLR) and random forest (RF). The MLR and RF model performance was compared by accuracy and the discriminability of mSI subgroups (i.e., p-value of one-sided binomial test between the accuracy and no information rate).

Five mSI groups were identified: 1) “very low (in SFS)/very low (in WHOQOL-BREF)” (8.58%), 2) “low/low” (12.87%), 3) “high/low” (49.24%), 4) “medium/high” (18.05%), and 5) “high/high” (11.26%). Both MLR and RF models included 22 predictors and demonstrated accuracies of 59.16% (95CI%: [55.75%, 62.58%], p = 0.994) and 61.61% (95%CI: [54.90%, 68.01%], p = 0.013) correspondingly. The mSI was robustly and mainly and robustly predicted by genetic predisposition, premorbid social functioning, symptoms (i.e., positive, negative and depressive), number of met needs and baseline satisfaction with the environment and social life.

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Notwithstanding comparable accuracies, we cautiously consider the RF model outperforming primarily due to its better discriminability. As the baseline conditions of the patients with SSD could indicate the 3-year mSI level, customized amount and types of resources and interventions can be designed to improve the level of multidimensional social inclusion of all SSD patients.

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Obsessive-compulsive disorders are complex pathologies causing a major psychosocial handicap. However, their association with a disabling somatic pathology such as rheumatoid arthritis makes management more difficult.

To investigate through a case analysis and a review of literature the association between obsessive-compulsive disorder (OCD) and rheumatological disorders.

We reported a case of a woman with a long history of obsessive compulsive disorder who presented rheumatoid arthritis and we conducted a review of literature through search on Pub-Med/MEDLINE following the terms “obsessive-compulsive disorder”, “rheumatoid arthritis”, “association”, “inflammation”.

Case presentation: A 62-years old woman who had been followed at the psychiatric consultation for 20 years for OCD. She had been stabilised on clomipramin at a dose of 100 mg per day until 2012 and since then she had been lost to follow-up with the notion of poor compliance with the treatment. She re-consulted in August 2022 for worsening psychiatric symptoms such as phobic obsessions with delusional beliefs, verification compulsions, sleep disorders and multiple somatic complaints including diffuse arthralgia and chronic arthritis evolving for 6 months.

The patient was put on risperidone 2mg with anxiolytic without improvement. She was referred to the rheumatology consultation where the diagnosis of very active rheumatoid arthritis was retained, hence she was put on 20mg of prednisolone per day with methotrexate.

The evolution was marked by the accentuation of obsessions and compulsions with the appearance of depressive elements, hence the introduction of fluoxetine 40 mg per day, the increase in the dose of risperidone to 4 mg with the anxiolytic with an improvement on the somatic and psychiatric symptoms.

Literature had shown that patients with this OCD usually suffer from inflammatory or rheumatological comorbidities. This association could complicate the management of these patients.

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Catatonia is a treatable but often undiagnosed condition in children and adolescents. The majority of Pediatric catatonia cases occur at a puberal ages. It is associated with neurodevelopmental disorders. In these cases the diagnosis can be more difficult due to the overlap of symptoms.

Report the case of a 11- year - old girl who developed catatonia. She had a previous psychiatry history of intellectual disability, delayed speech and motor slowness. She had a positive Lorazepam challenge test with resolution of the most catatonic symptoms. More studies were completed and according to the clinical history the diagnosis of autistic spectrum disorder was made.

Genetic test revealed a Phelan Mc Dermid Syndrom.

A year 11-year-old girl presented to the pediatric emergency department with a 2- days history of worsening anxiety and rigidity, seeming lost and distant. The previous 4 months there was a history of progressive functional and social decline. Her speech was minimal and she required assistance with dressing and feeding. She displayed stereotypias and mannerism. All medical studies were unremarkable. A Lorazepam challenge test (2 mg IV) showed evidence of response. She recovered from catatonia and the basal situation was studied. She was diagnosed of autistic espectrum disorder attending the psychiatric and medical history. Apart from other medical studies, a genetic test showed a mutation in a gene called SHANK 3 according to a Phelan Mc Dermid Syndrom.

Pediatric catatonia is associated with neurodevelopmental disorders such as autistic spectrum disorders. There is not always a clear identifiable cause and it is necessary to rule out possible organic causes of pediatric catatonia. The treatment is similar to adults. It is essential to do a complete medical and psychiatric history to an accurate diagnosis such as an autistic spectrum disorder. Genetic testing must be included. In this case, genetics showed a Phelan Mc Dermid Syndrom with a delayed diagnosis. This disorder can cause a wide range of symptoms varying in severity. These symptoms could include global developmental disorders, intellectual disability, delayed speech, autistic spectrum disorders and minor dysmorphic features.

It is crutial to emphasize the high incidence of catatonic symptoms in individuals with Phelan Mc Dermid Syndrome as catatonia often goes unrecognized or undertreated in individuals with developmental disabilities. Significant cognitive and behavioral regression beyond a baseline level of disability has been reported. This case also highlights the relevance of genetic testing in the work of individuals with intellectual disabilities and acute psychiatric illness or regression. Symptoms indicative of catatonia may occur in context of infections, hormonal status and stressful life events. Treatment is centered on the symptoms.

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ASD is a heterogeneous group of pathological conditions.

Sensory Functions in Children with Autism

A brief review of scientific publications is presented, formed by the search result for the keywords: autism spectrum disorders, artificial intelligence, machine learning.

Patients with ASD respond to sensory information hyper-reactively and hypo-reactively. Patients, regardless of age and severity of ASD, have atypical information processing patterns in all sensory modalities. Atypical processing of stimuli correlates with social, cognitive and communication disorders.

To normalize sensory deviations, it is necessary to build corrective and prognostic models of the child’s connection with the environment. Machine learning models, Data Mining methods to make medical management decisions and develop personalized therapeutic strategies.

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It is estimated that the prevalence of severe Intellectual Disability (ID) is 6 per 1,000 people. ID is sometimes the cause of Behavioral Disorders (BD) with aggressive and impulsive behaviors that make family and social life difficult. However, despite its high prevalence, the number of studies on it is very scarce.

When BD appears, it should be evaluated if there is a physical or psychiatric cause that causes it and assess non-pharmacological treatments. If they are insufficient, treatments such as risperidone are used to manage BD. When these are ineffective, the use of drugs with greater difficulties in their effects and clinical management, such as clozapine, is required.

The objective is to describe the use of clozapine in patients with severe ID associated with BD.

Retrospective descriptive study. Patients older than 18 years with severe ID and BD, treated with clozapine for at least two years were included. Those with medical or psychiatric comorbidity were excluded.

The sample consisted of 12 patients, 16.67% women (n=2) and 83.33% men (n=10), aged 47.57±9.27 years. Prior to the introduction of clozapine, a mean of 2.67±1.21 antipsychotics had been tested. The mean dose of clozapine was 264.24±70.50 mg/day. The patients had received treatment for 51.57±25.67 months, following the usual controls. None had hematological adverse effects or other serious adverse effects.

Clozapine can be an effective and safe therapeutic alternative in the treatment of BD in intellectual disabled patients which do not respond to other treatments. The clinical benefits of clozapine treatment seem to outweigh the potential risks associated with the treatment. However, more studies are needed to evaluate the effects of clozapine in patients with intellectual disabilities.

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Catatonia is a clinical syndrome characterized by behavioral alterations, which may include motor immobility or excitation. As a symptom, catatonia may be present in several mental disorders, primarily schizophrenia and mood disorders. Symptoms can be severe and can lead to dangerous and lethal conditions if not diagnosed and treated properly.

To describe the complicated evolution of a case of major depression with psychotic symptoms, which developed catatonic status. We discuss the psychopharmacological approach and non-pharmacological therapies (ECT).

Case summary. We have conducted a systematic review of the descriptions published to date, regarding this case.

We present a case of extreme severity, in a 55-year-old male, with a broad differential diagnosis with organic pathology, which required multidisciplinary management in conjunction with other specialties and multiple complementary tests.

Eventually diagnosed with major depression with psychotic symptoms evolving into a catatonic state. During more than one year of follow-up, multiple drugs have been tested sequentially: SSRI antidepressants, dual action, low-dose antipsychotics (caripracin, lurasidone, aripiprazole, olanzapine).

Finally, a good response was obtained in the treatment with lorazepam 1mg /6h and 12 sessions of ECT administered concomitantly.

In this case, the patient presented a refusal to eat and weight loss with a BMI of malnutrition. We had to be coordinated with the endocrinology service for a nutritional restitution strategy through dietary supplements. Once nutritional restitution was achieved, we started treatment with clomipramine, with good results on affective symptoms.

Nowadays, the origin and treatment of catatonia are still unclear.

We present the case of a man with melancholic depression with psychotic symptoms, who evolved into a catatonic syndrome. A good response was achieved with the combination of ECT and benzodiazepines.

We want to highlight nutritional recovery as an important point to achieve good absorption of antidepressant drugs. Once achieved, we started treatment with clomipramine with good results.

During the treatment, he has presented multiple difficulties and finally, he was able to leave after five months of hospitalization in the acute mental health unit.

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The COVID-19 pandemics brought numerus changes in the European mental health systems. One of the major, was the widespread introduction of digital psychiatry across the globe, as the only possible option to maintain the psychiatric care. On February 28th 2022, the European Psychiatric Association has started a network of solidarity for Ukraine to respond to the needs of people in Ukraine as verbalized by the Ukrainian mental health professionals, but also to the need of surrounding countries where people from Ukraine fled to. As verbalized by the colleagues from Ukraine and surrounding countries, one of the unmet educational needs was the education for first line helpers and volunteers from Ukraine and countries surrounding Ukraine where displaced persons fled to. This resulted in the series of webinars on the topics detected as unmet needs (what is normal response to trauma, how to triage dispaced persons in need of help, how to provide first psychological help, how to approach to children of different ages, how to take care of one-self and what is the role of supervision). The webinars were delivered by experienced clincians, trauma experts and experts with lived experince in the war zones, incliding the ones from Ukraine. These are available freely at the EPA website https://www.europsy.net/resource-page/, in several languages.

None Declared

Coronavirus infection affects the CNS and modulates the immune system. The associated processes of neuroplasticity play an important role in the pathogenesis of depression.

The aim of the study is to identify the relationships between EEG and immunological parameters in depressive patients who recovered from coronavirus infection, in order to clarify the features of neuroimmune interaction after suffering COVID-19.

30 female patients aged 16-25 enrolled in the study were admitted for treatment during the pandemic in 2020-2022 (“COVID” group). Previously, they had been ill with COVID-19 in a mild or asymptomatic forms on a background of depressive state (F31.3-4, F21.3-4 + F34.0, according to ICD-10) from 3 months to 2 years before the examination.

All patients underwent pre-treatment multichannel background EEG recordings in a state of quiet wakefulness with eyes closed and analysis of the absolute EEG spectral power (SP) in 8 narrow frequency sub-bands.

As well, markers of neuroplasticity ─ the levels of autoantibodies to the S100b protein (AAT-S100b) and to the myelin basic protein (AAT-MBP) were measured in each patient’s blood plasma using the laboratory technology “Neuro-immuno-test”.

The EEG and immunological parameters of the “COVID” group were compared with similar data of 40 depressive patients who were treated in 2018-2019, that is, they did not have COVID-19 (“pre-COVID” group), but matched by sex, age, syndrome structure, as well as the pre-treatment severity of depression (according to the HDRS-17 scale) to patients of the “COVID” group.

Statistical analysis of the data obtained was carried out by the correlation analysis method of the IBM SPSS Statistics, v.22 software package.

In the “COVID” group, the AAT-S100b level valuespositively correlated with the EEG delta sub-band (2-4 Hz) SP valuesin T3, T4, P4, and O1 leads. The values of the AAT-MBP level correlated with the SP values of delta (2-4 Hz) and theta1 (4-6 Hz) EEG sub-bands in C3, T4, P3, P4, O1, and O2 leads. In the “pre-COVID” group, the values of the AAT-S100b level correlated positively with the SP values of not slow-wave, but alpha2 (9-11 Hz) and alpha3 (11-13 Hz) EEG activity in T3, P3, O1, and O2 leads.

Positive correlations of the AAT-S100b level with alpha2 and alpha3 SP values indicate that in the “before COVID” group, the AAT-S100b level reflects rather the reparative processes of neuroplasticity. On the contrary, in the “COVID” group, positive correlations of the AAT-S100b and of the demyelination marker AAT-MBP levels with the SP values of slow-wave (delta and theta1) EEG frequency components, reflecting a reduced brain functional state, indicate that elevated levels of AAT-S100b and AAT-MBP in this group are markers of nerve tissue damage caused by coronavirus infection.

The study supported by the Russian Science Foundation (grant No. 21-18-00129).

None Declared

Although mania is commonly associated with bipolar disorder, it can have many etiologies. Thus, “primary mania” results from bipolar disorder, whereas “secondary mania” results from pharmacological, metabolic, or neurologic causes. Older adults are at risk for secondary mania because of increased medical comorbidities and neurological changes. In one retrospective study of 50 patients with mania who were older than 65 years, it was the first manic episode for 28% of the patients and 71% had a comorbid neurological disorder.

The etiology of mania is important because although acute symptomatic treatment of both primary and secondary mania may be similar, appropriate treatment of secondary mania includes addressing the cause. We present here two case histories of secondary mania in older adults, discuss their presentations and differential diagnosis in turn, and discuss treatment.

We will present a clinical case of a patient. Ms. A, a 63-year-old divorced woman with no prior medical or psychiatric history, was seen for an acute manic episode with mixed features. She was in her usual state of health until 2 weeks before admission, when she presented with a status epilepticus requiring a one-week hospitalization in the neurology département and treated by Carbamazepine. She then developed an abnormally excited and labile mood, motor excitability accompanied by rapid thoughts, with a total loss of desire and pleasure and thoughts of death.

In our study, the patient presented a manic episode with mixed characteristics secondary to a status epilepticus.

The patient was treated both somatically and psychologically, and the evolution was positive. The patient was stabilised after being put on an antiepileptic drug associated with an antipsychotic drug.

In our study, the patient presented with a manic attack with mixed characteristics secondary to a status epilepticus.The patient was treated both somatically and psychologically, and the evolution was favourable. The patient was stabilised after being put on an antiepileptic drug associated with an antipsychotic drug.

Late onset psychiatric disorders often represent a challenge for the psychiatrists as far as the diagnosis and management issues are concerned. The elderly patients have generally been reported to have associated medical, especially neurological illnesses and are also prone to side effects of various psychotropic medications.

None Declared

One of the factors influencing the symptoms of schizophrenia, which may indicate changes in the cognitive functioning of patients, is the fluctuating level of inflammatory cytokines.

The aim of the review was to analyze the available literature on the importance of selected inflammatory factors [interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), of tumor necrosis α (TNF-α)] in schizophrenia and the assessment of the impact of changes in cytokine levels on the occurrence of schizophrenia symptoms.

For this purpose, available scientific publications from following databases: PubMed, Scopus, Google Scholar were used to prove that the levels of selected inflammatory parameters changed in people suffering from schizophrenia. Moreover, fluctuations in cytokine concentrations influenced the occurrence of negative symptoms of schizophrenia, including cognitive disorders, as well as psychotic symptoms.

An increase in the concentration of IL-1β in the cerebrospinal fluid of patients with the first episode of schizophrenia has been described, which may indicate the involvement of the cytokine in the inflammatory process involving the CNS. The increased level of IL-6 is associated with the occurrence of psychotic disorders, it is also noted in stressful conditions. IL-6 is qualified as an indicator of exacerbation of schizophrenia, which normalizes after antipsychotic treatment. In the blood of patients with paranoid schizophrenia, elevated levels of IL-8 and IL-6 were detected compared to healthy individuals, which indicates the development of an inflammatory process in schizophrenia. The relationship between the level of IL-8 in women in the second trimester of pregnancy and the risk of developing schizophrenia spectrum disorder in children has been proven. Untreated patients with acute psychotic symptoms showed an increase in the level of TNF-α in the blood serum (compared to healthy subjects). An increase in the level of TNF-α in the blood serum of patients with an acute relapse of schizophrenia or the first episode of psychosis was also demonstrated. In conclusion, the relationship of IL-6 and TNF-α with the occurrence of psychotic disorders, the relationship of IL-1β with the appearance of changes in mood, behavior, including cognitive dysfunction, the relationship of IL-8 with the risk of developing schizophrenia spectrum disorder in children, the relationship of reduced concentrations of IL-10 with the intensification of negative symptoms, including cognitive deficits.

In conclusion, the analysis showed that patients with schizophrenia fluctuate in the concentration of inflammatory cytokines, which affects the occurrence of clinical symptoms.

None Declared