Predicting acute affective episodes in individuals with Bipolar Disorder (BD) remains a clinical challenge. Specific environmental stressors, including air pollution, noise, and temperature variations might worsen affective symptoms or sleep in the general population, but their role in BD relapses is often overlooked. Indeed, they might exacerbate BD by perturbing circadian rhythms – fundamental aspects of BD.

We thereby present the protocol of this pilot study and future preliminary data. We aim to longitudinally assess sleep alterations, mood fluctuations, and environmental exposure to several factors (air pollutants, climate, noise, artificial light-at-night, green space access) in patients with BD and to check the association of these variables with BD relapses.

In this pilot study, we will recruit 40 patients with BD in a 6-month prospective study. Patients were assessed during baseline, at 3 and 6 months. Data recollected will consist of a subjective (questionnaires) and objective (through meteorological stations) evaluation of physical environmental factors around the home residence; clinical assessment of mood and circadian rhythms, and continuous tracking of sleep-wake patterns, energy, and movement using actigraphy.

Expected results will show that exposure to a worse environment (higher pollution, noise, light exposure, climate) will be associated with worse BD outcomes (i.e., relapse, mood symptoms, sleep alterations).

We will be sharing preliminary data from our ongoing study, offering insights into early patterns and findings that shed light on our objectives.

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Psychotic patients often require pharmacological treatment, which may prove ineffective, leading to treatment-resistant psychosis necessitating the use of clozapine. However, the emergence of side effects can result in discontinuation, potentially triggering a relapse of psychotic symptoms. One significant side effect is antipsychotic-induced weight gain which, over time, can lead to adverse metabolic events. Recent translational research is evaluating the impact of prenatal factors on the metabolic outcomes of psychotic patients, using a surrogate marker of the intrauterine milieu such as birth weight (BW).

We aim to evaluate the changes in leptin, adiponectin, and insulin levels in patients with treatment-resistant psychosis who initiate clozapine treatment due to persistent psychotic symptoms.

Subjects older than 18 years with a diagnostic of a major mental disorder and initiating clozapine were enrolled in this 18-months longitudinal study. Neurohormones levels, including leptin, adiponeptin, and insulin were measured at baseline, 8 and 18 months during follow-up. Statistical analysis were conducted by using a fixed-effects model.

A total of 23 subjects initiating clozapine were evaluated during the initial mandatory 18-week period. Neurohormones, specifically leptin and adiponectin, were measured at three time points: baseline, 8 weeks, and 18 weeks. The changes in leptin levels were significantly associated with birth BW with sex differences, being inversely correlated only in females. Adiponectin was significantly associated with BW, being inversely correlated in males. Conversely, there was no observed association between insulin levels and BW.

Our findings highlight the significance of prenatal factors in influencing the subsequent evolution of neurohormones in individuals initiating clozapine treatment. This suggests that subjects with lower BW tend to exhibit elevated neurohormone values, emphasizing the role of prenatal events in this context.

None Declared

Noise-induced hearing loss is the most prevalent occupational disease worldwide and is historically associated with the Industrial Revolution. This study analyses early descriptions of this disorder during the pre-industrial period in the work of the Italian physician Bernardino Ramazzini (1633–1714).

Primary and secondary historical literature were reviewed.

Ramazzini described hearing loss in corn millers and in coppersmiths and recognised that this disorder is irreversible and progressive when exposure to noise continues. He also seemed to describe tinnitus. He further suggested the use of earplugs as a preventive measure for these classes of workers. Ramazzini's anatomical and pathological knowledge appears to be based on ancient authors; he did not discuss contemporaneous medical authors’ work on hearing function.

Despite some limitations, Ramazzini's work appears pioneering for his time and represents an important milestone in the history of otolaryngology.

Elimination disorders (ED) include enuresis, defined as wetting from 5 years, and encopresis, defined as soiling from 4 years onwards after organic causes are excluded. They are highly prevalent in childhood and often associated with clinically relevant comorbid psychological disorders. However, no systematic review or meta-analysis examines their co-occurrence with internalizing and externalizing problems in children.

The aim of this study is to determine if, and to what extent, children with ED show higher internalizing and externalizing problems than their healthy peers.

A multistep literature search was performed from database inception until May 1st, 2022. PRISMA/MOOSE-compliant systematic review (PROSPERO: CRD42022303555) were used to identify studies reporting on internalizing and/or externalizing symptoms in children with an ED and a healthy control (HC) group. First, a systematic review was provided. Second, where data allowed for it, a quantitative meta-analysis using random effects model was conducted to analyze the differences between the ED and the HC groups for internalizing and externalizing symptoms. Effect size was standardized mean difference. Meta-regression analyses were conducted to examine the effect of sex, age, and study quality. Funnel plots were used to detect a publication bias. Where found, the trim and fill method was used to correct it.

36 articles were included, 32 of them reporting on enuresis (n=3244; mean age=9.4; SD=3.4; 43.84% female) and 7 of them on encopresis (n=214; mean age=8.6; SD=2.3; 36.24% female) [Image 1]. The ED group presented significantly lower self-concept (ES:0.42; 95%CI: [0.08;9.76]; p=0.017) and higher symptom scores for thought problems (ES:-0.26; 95%CI: [-0.43;-0.09]; p=0.003), externalizing symptoms (ES:-0.20; 95%CI: [-0.37;-0.03]; p=0.020), attention problems (ES:-0.37; 95%CI: [-0.51;-0.22]; p=0.0001), aggressive behaviour (ES:-0.33; 95%CI: [-0.62;-0.04]; p=0.025) and social problems (ES: 0.39; 95%CI: [-0.58;-0.21]; p=0.0001) [Image 2]. Significant publication biases were found across several of the studied domains [Image 3]. No significant effect of sex, age or quality of the study score was found.

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Children with an elimination disorder may have significant internalizing and externalizing problems, as well as impaired self-concept. It is recommendable to screen for them in children with ED and provide interventions as appropriate.

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Prior trials suggest that intravenous racemic ketamine is a highly effective for treatment-resistant depression (TRD), but phase 3 trials of racemic ketamine are needed.

To assess the acute efficacy and safety of a 4-week course of subcutaneous racemic ketamine in participants with TRD. Trial registration: ACTRN12616001096448 at www.anzctr.org.au.

This phase 3, double-blind, randomised, active-controlled multicentre trial was conducted at seven mood disorders centres in Australia and New Zealand. Participants received twice-weekly subcutaneous racemic ketamine or midazolam for 4 weeks. Initially, the trial tested fixed-dose ketamine 0.5 mg/kg versus midazolam 0.025 mg/kg (cohort 1). Dosing was revised, after a Data Safety Monitoring Board recommendation, to flexible-dose ketamine 0.5–0.9 mg/kg or midazolam 0.025–0.045 mg/kg, with response-guided dosing increments (cohort 2). The primary outcome was remission (Montgomery-Åsberg Rating Scale for Depression score ≤10) at the end of week 4.

The final analysis (those who received at least one treatment) comprised 68 in cohort 1 (fixed-dose), 106 in cohort 2 (flexible-dose). Ketamine was more efficacious than midazolam in cohort 2 (remission rate 19.6% v. 2.0%; OR = 12.1, 95% CI 2.1–69.2, P = 0.005), but not different in cohort 1 (remission rate 6.3% v. 8.8%; OR = 1.3, 95% CI 0.2–8.2, P = 0.76). Ketamine was well tolerated. Acute adverse effects (psychotomimetic, blood pressure increases) resolved within 2 h.

Adequately dosed subcutaneous racemic ketamine was efficacious and safe in treating TRD over a 4-week treatment period. The subcutaneous route is practical and feasible.

Patients with anti-N-methyl-d-aspartate (NMDA) receptor encephalitis (ANMDARE) show a wide range of behavioral abnormalities and are often mistaken for primary psychiatric presentations. We aimed to determine the behavioral hallmarks of ANMDARE with the use of systematic neuropsychiatric and cognitive assessments.

A prospective study was conducted, with 160 patients admitted to the National Institute of Neurology and Neurosurgery of Mexico, who fulfilled criteria for possible autoimmune encephalitis and/or red flags along a time window of seven years. Cerebrospinal fluid (CSF) antibodies against the NR1 subunit of the NMDAR were processed with rat brain immunohistochemistry and cell-based assays with NMDA expressing cells. Systematic cognitive, neuropsychiatric, and functional assessments were conducted before knowing NMDAR antibodies results. A multivariate analysis was used to compare patients with and without definite ANMDARE according to antibodies in CSF.

After obtaining the CSF antibodies results in 160 consecutive cases, 100 patients were positive and classified as having definite ANMDARE. The most frequent neuropsychiatric patterns were psychosis (81%), delirium (75%), catatonia (69%), anxiety-depression (65%), and mania (27%). Cognition was significantly impaired. A total of 34% of the patients had a predominantly neuropsychiatric presentation without seizures. After multivariate analysis, the clinical hallmarks of ANMDARE consisted of a catatonia–delirium comorbidity, tonic-clonic seizures, and orolingual dyskinesia.

Our study supports the notion of a neurobehavioral phenotype of ANMDARE characterized by a fluctuating course with psychotic and affective symptoms, catatonic signs, and global cognitive dysfunction, often accompanied by seizures and dyskinesia. The catatonia–delirium comorbidity could be a distinctive neurobehavioral phenotype of ANMDARE.

Maternal obesity may affect foetal programming representing a risk for adult mental health. Oxidative stress and inflammation associated with maternal obesity can alter the maturation of neuronal circuits affecting behaviour and mood.

We investigated the emotional phenotype of male and female mouse offspring born from a high-fat diet (HFD) fed dams. We also tested the efficacy of N-acetyl-cysteine (NAC – an antioxidant) in preventing the negative effects of HFD. We focused on adolescence, an age of main vulnerability for the onset of psychopathology.

Female C57BL/6N mice were fed HFD for 13 weeks and, after 5 weeks, were also exposed to NAC (1 g/kg b.w.) via drinking water, until delivery. The neurodevelopment of offspring was assessed through the homing test. Emotionality was assessed in 35-45-day-old adolescent mice through elevated-plus-maze (EPM) and social interaction tests (SIT). Transcriptomic analysis of hippocampal tissue were performed to identify mechanisms of action of both HFD and NAC.

NAC was effective in moderating body weight gain in HFD-fed dams. Neither HFD or NAC affected offspring development. Regardless of sex, prenatal HFD reduced exploration and decreased sociability, in EPM and SIT respectively. Prenatal HFD decreased hippocampal levels of BDNF in female offspring. Prenatal NAC administration prevented social anxiety and restored BDNF levels in the HFD group.

Data indicate long-term effects of maternal obesity on dams’ weight, offspring’s behaviour and hippocampal BDNF levels. These effects may be mediated by changes in oxidative stress as NAC was effective as a preventive agent. ERANET-NEURON-JTC 2018 (Mental Disorders) Project “EMBED”.

Researching from a symptom approach avoids possible spurious associations, given the co-occurrence of symptoms in a disorder (Costello, 1992). Here, we deepen the evidenced relationships among anxiety, delusions and hallucinations.

We intended to assess differences in Anxiety Sensitivity dimensions between patients with psychosis depending on presence/absence of hallucinations and/or delusions.

49 patients with DSM psychosis diagnosis (42 men and 7 women; mean age: 40), who attended a Mental Health Rehabilitation Service in 2008, of whom 7 only deluded, 6 only hallucinated, 11 deluded-hallucinated and the remaining 25 neither hallucinated nor deluded.

A Cross-sectional design (one measurement) for a co-relational method of comparison between groups.

We used the Spanish validated Anxiety Sensitivity lndex-3 -ASI 3- (Sandín et al., 2007), a 18-item Likert self-report that assesses fears of anxious symptoms. It presents a hierarchical structure (a general factor and three subscales -Physical, Cognitive and Social Concerns-). It's also used the first and third items (delusions and hallucinatory behaviour) of The Positive and Negative Syndrome Scale -PANSS- (Kay, Opler and Lindenmayer, 1988) to detect positive symptoms.

All analysis were accepted at p < .05. Patients only hallucinators showed a higher anxiety sensitivity in Social Subscale than non-hallucinative/non-delusional patients; the former presented lower punctuations in ASI-total and ASI-cognitive than patients with hallucinations and delusions. The latter showed a higher anxiety sensitivity in Cognitive Subscale than patients who only deluded.

It's hypothetized that both delusional and hallucinative activity is necessary for emergence of cognitive anxiety sensitivity.

An important corpus of scientist evidence is linking psychotic activity and anxiety-related processes (Freeman and Garety, 2003).

We intended to assess differences in Anxiety Sensitivity dimensions between patients diagnosed by psychosis with and without positive symptoms.

Participants: 49 patients with DSM psychosis diagnosis (42 men and 7 women; mean age: 40), who attended a Mental Health Rehabilitation Service in 2008, of whom 24 patients had positive symptomatology.

Design, materials and procedure: A Cross-sectional design (one measurement) for a co-relational method of comparison between groups.

We used the Spanish validated Anxiety Sensitivity lndex-3 -ASI 3- (Sandîn et al, 2007), a 18-item Likert self-report that assesses fears of anxious symptoms. It presents a hierarchical structure (a general factor and three subscales -Physical, Cognitive and Social Concerns-). It's also used the first and third items (delusions and hallucinatory behaviour) of The Positive and Negative Syndrome Scale -PANSS- (Kay, Opler and Lindenmayer, 1988) to detect positive symptoms.

Patients with positive symptoms showed a higher sensitivity to cognitive (z = -3.22, p < 0.01) and social anxiety (z = -2.66, p < 0.01), as well as higher punctuations in ASI-total (z = -2.91, p < 0.01), than patients without positive symptoms.

Patients with positive symptoms show significant fears of symptoms of different anxious domains (ASI-total) with regard to patients without this kind of symptomatology. Specially, they are worried about the possibility that concentration difficulties and restlessness lead to mental incapacitation (ASI-cognitive) and about social reactions before their own publicly observable anxiety manifestations (ASI-social).

There is increasing empirical evidence that links the classical separated psychopathological spectrums neurosis and psychosis. In this sense, anxiety is a factor for delusional/hallucinative development and maintenance (Freeman and Garety, 2003).

We intended to assess differences in Anxiety Sensitivity dimensions between patients with psychosis and a non-clinical sample.

Participants: 49 patients with DSM psychosis diagnosis (42 men and 7 women; mean age: 40), who attended a Mental Health Rehabilitation Service in 2008, were compared with a non-clinical sample (n = 582) from another study (Sandín, Valiente, Chorot and Santed, 2007).

A Cross-sectional design (one measurement) for a co-relational method of comparison between groups.

We used the Spanish validated Anxiety Sensitivity Index-3 -ASI 3- (Sandín et al., 2007), a 18-item Likert self-report that assesses fears of anxious symptoms. It presents a hierarchical structure (a general factor and three subscales -Physical, Cognitive and Social Concerns-). It's also used the first and third items (delusions and hallucinatory behaviour) of The Positive and Negative Syndrome Scale -PANSS- (Kay, Opler and Lindenmayer, 1988) to detect positive symptoms.

Patients present a higher anxiety sensitivity in the General Factor (t = 2.06, p < 0.05) and Cognitive Subscale (t = 3.91, p < 0.001) than nonpatient sample.

Patients with psychosis show significant fears of symptoms of different anxious domains (ASI-total) regarding a non-clinical sample. Particularly, they are worried about the possibility that concentration difficulties and restlessness lead to mental incapacitation (ASI-cognitive).

Albert Ellis’ Rational Therapy, founded in 1955, evolved into Rational-Emotive Therapy (RET) in 1959; and finally as Rational-Emotive Behavior Therapy (REBT) in 1992. This evolution has showed, much more, its resemblance to Acceptance and Commitment Therapy (ACT) (Ellis, 2005). REBT highlights treatment of secondary disturbances (berating oneself for having symptoms), beyond primary ones (nosographical symptoms), because these are ways of control and experiential avoidance which foster suffering.

To treat primary anxiety in a patient reducing his secondary disturbance through TREC.

Participants: A 40-year-old man diagnosed with Panic Disorder who attended a Public Mental Health Service. He was being treated with Alprazolam y Lorazepam, which he has taken before psychotherapy.

Design, materials and procedure: It's implemented a single-subject AB design during 4 months (7 therapeutic sessions). It's applied a weekly self-report to record panic attack frequency and variations in anxiolytics-taken. C Young (p < 0.01) was used for statistical analysis of data and the method of least squares to obtain trend line. 16 measures were registered at a weekly interval.

Significant declining trends are observed in panic attack frequency (C = .750, Zo = 3.201, Zt = 2.240), and collaterally in anxiolytics-taking (Alprazolam: C = .811, Zo = 3.462, Zt = 2.240; Lorazepam: C = .801, Zo = 3.420, Zt = 2.240) from beginning of therapy.

Techniques targeting symptoms-extirpation induced intolerance and self condemnation feelings when patient didn’t achieve the wanted control (as way of destructive experiential avoidance -Luciano and Hayes, 2001). Treating these feelings (secondary disturbance), based on symptomatology acceptance (Ellis, 2005), decreased distress related to panic attacks and paroxysmal crisis frequency itself.

Studies conducted with American and Australian samples of pre-adolescents and adolescent girls support the tenets of Stice and colleagues’ dual-pathway (DP) model. The DP model is a cohesive framework for understanding how sociocultural pressures are translated into behavioural and negative affect risk factors potentially promoting binge eating. Males are likely to exhibit sub-threshold binge eating disorder and are roughly equal to females in regard to the number of cases of any binge eating. To date, only preliminary support has been provided for the validity of the DP model's core predictions with adolescent males.

The current prospective study examined the suitability of the DM model in other western cultures (such as an Italian one) where adolescent boys are characterised by high levels of eating and body-related disturbances in response to sociocultural pressure.

221 Italian adolescent boys (Mage = 14.9) were examined at Baseline and after 1-year through semi-structured clinical interviews and self-reported measures. Data were analysed via a latent variable longitudinal structural equation modeling approach.

Perceived pressure and internalization of societal ideals regarding male body shape led to body dissatisfaction, which in turn led to dietary restriction. Both body dissatisfaction and dietary restriction predicted negative affect, which in turn predicted binge eating. However, data did not support the relationship between body mass index and body dissatisfaction or between dietary restriction and binge eating.

The prospective validity of the DP model was partially supported in adolescent boys: body dissatisfaction predicted binge eating only via negative affect.

Patients presenting Personality Disorders and specially Borderline Personality Disorder are often admitted to Psychiatry Units in General Hospitals. Their impulsivity, affective disregulation and difficulties in interpersonal relations complicate the therapeutic atmosphere and cause problematic interactions with staff and other patients.

To improve staff response to behavioural problems of patients presenting Personality Disorder in psychiatric units in the general hospital.

To develop a protocol to guide staff interventions with these patients.

After analyzing the patients flow from the emergency room to discharge and the current proposals in the literature on the subject, we create a protocol addressing more frequent problems using a task group composed of psychiatrists, psychologists and nurses involved in the daily care of these patients.

A protocol is delineated guiding clinicians and staff on how to deal with assistance at the emergency room, entrance to the ward, initial contract and agreement, responses to specific problems during treatment and final discharge.

A protocol to guide the staff dealing with behavioural problem of patients with PD in the general hospital can be developed and provides clinicians with a therapeutic frame that structures the different treatment interventions.

Patients presenting Personality Disorders and specially Borderline Personality Disorder are often admitted to Psychiatry Units in General Hospitals. Their impulsivity, affective disregulation and difficulties in interpersonal relations complicate the therapeutic atmosphere and cause problematic interactions with staff and other patients. We have developed a basic protocol to manage behavioural problems of those patients in the general hospital.

To study the effect of the protocol on the unit's work. Aims. To know the effect of the protocol on some specific variables related to the admission and specifically the use of mechanical restraint. Methods. Prospectively, we compare data on all patients admitted during 2010 (876 total, 87 PD) before establishing the protocol and all those admitted during 2011 (870 total, 112 PD) when the protocol was in use.

The proportion of patients with PD who experienced at least one mechanical restraint intervention went down from 43.7% in 2010 to only 2.7% in 2011 (p= 0.000). In the total group, figures also decreased from 17.3% in 2010 to 3.4% in 2011 (p= 0.000).

The use of mechanical restraints with PD patients in General Hospital Psychiatric Units can be drastically reduced using a protocol guiding the staff to better manage behavioural problems of the patients.