Parkinson’s disease (PD) is a chronic, neurodegenerative disorder leading to dopamine deficiency. Phenotypically, there is a wide spectrum of motor and non-motor symptoms (NMS). Among NMS, sexual dysfunction (SD) is one of the most disabling and crippling symptom. However, SD are usually neglected and underdiagnosed in PD patients.

Our study aimed to estimate the effect of motor disability and the disease course on sexual dysfunction in PD patients.

This retrospective study included 42 patients (18 males and 24 females) from the department of neurology of the National Institute of Neurology Mongi Ben Hmida in Tunis, Tunisia, diagnosed with PD between 1999 and 2022. The diagnosis of PD was confirmed according to the Movement Disorder Society (MDS) diagnostic criteria of PD. The MDS Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) motor was used to estimate motor disability and Hoehn and Yahr (H&Y) stage was used to rate disease severity. The SD of PD patients was measured by applying the sexual items of Scales for Outcomes in Parkinson’s Disease - Autonomic Dysfunction (SCOPA-AUT).

SD was observed in only 11 patients (26.2%) with a sex-ratio of M/F = 1.2 and a mean age of 52 (between 40 and 72). The mean age of PD onset was 47. According to the MDS-UPDRS part III, 1 patient had a severe motor disorder (MDS-UPDRS> 59), and according to the H&Y scale, no patient had a severe stage of the disease. Nine patients had motor complications such as motor fluctuations and L-Dopa induced dyskinesia.

The SD described by our patients were: women reported Vaginal Dryness (4 patients), with difficulties reaching an orgasm (3 patients); men reported erectile dysfunction (6 patients), and difficulties in reaching an orgasm (6 patients). Among these patients, 3 were treated for SD with Tadalafil (all males).

In our study, no significant gender-related differences were found in scores related to SD in patients with PD. Neither the disease severity nor the motor disability was significantly associated to sexual disorders (respectively p=0.26 and p=0.12). Also, Motor complications induced by L-Dopa medication, assessed by the part IV of MDS-UPDRS scale, had no significant effect in the occurrence of SD in PD (p=0.78).

Sexual behavior has neuronal and hormonal modulation. Lack of dopamine seems to have an important role in the development of SD. However, it occurs independently of the disease severity and the motor disability. Thus, clinicians should be aware of the importance of assessing and treating such symptoms since the beginning of the disease.

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One fairly common side effect of psychopharmaceuticals is sexual dysfunction. They can influence various aspects of sexual function, including lubrication, desire, ejaculation, and orgasmic intensity… This may worsen mental health conditions and make it challenging for patients to adhere to the Treatment. We’ll examine how these drugs affect the area of sexual activity.

To emphasise how different antipsychotics and antidepressants may affect sexual function.

We conducted a narrative review about the available literature on the subject. Articles were selected based on their clinical relevance.

All SSRI antidepressants carry a considerable risk of sexual dysfunction. According to some research, escitalopram and paroxetine may pose the greatest risk among this group. Similar risks of sexual issues exist with SNRIs. Bupropion, on the other hand, has a lot of evidence demonstrating low or no risk. Agomelatine, mirtazapine, and moclobemide also have a minor impact on sexual performance.

Hyperprolactinemia has been specifically linked to sexual impairment in antipsychotic medication, hence antipsychotics that cause hyperprolactinemia such as haloperidol, risperidone, paliperidone, and amisulpride are more likely to induce sexual disturbances. Aripiprazole, quetiapine, and ziprasidone have been demonstrated to be less or not connected to sexual dysfunction.

Although sexual dysfunction is not an unusual side effect of psychiatric medications, it is frequently underdiagnosed. Sexuality needs to be explored by therapists because it may affect patient’s treatment compliance and well-being. It’s critical to understand how each psychotropic drugs can impair sexual function in order to select the best option based on the individual traits of each person.

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Priapism is a painful and prolonged penile erection in the absence of sexual stimulation. It is a urology emergency that, if not treated, may cause erectile dysfunction. Pharmacologically induced priapism is the most common form of priapism and almost half of all cases are caused by antipsychotic (AP) drugs. Considering priapism is a rare but important side effect, it is of major importance that psychiatrists be aware of it. Thus, we herein report the case of a 46-year-old man that developed priapism upon receiving intramuscular APs in a psychiatric emergency setting.

To alert for the importance of priapism as a potential side effect of AP drugs and to understand the physiological mechanisms involved in antipsychotic-induced priapism.

A non-systematic review of the literature was carried out on PubMed. We looked for reviews and case reports published in the last 10 years containing the terms “priapism”, “antipsychotics” and “psychopharmacology priapism”. We also present a clinical case of antipsychotics-induced priapism.

We report the case of a 46-year-old man that was brought to the Psychiatric ER by police authorities due to disruptive and aggressive behaviour, a sense of increased energy and power and delusional speech of grandiose and persecutory content. No clinical records of psychosis or bipolar disorder were known, and the patient had never been medicated with AP drugs. The patient was involuntarily admitted to the psychiatric inward for treatment. Due to the aggravation of his aggressive behaviour, with potential danger for himself, other patients and the nursing staff, he was medicated with 5 mg of haloperidol and 25 mg of chlorpromazine. About an hour later the patient developed a painful erection that lasted at least for 4 hours. He was promptly sent to the Urology ER where an intracavernosal aspiration followed by injection of phenylephrine was needed to reverse priapism. APs are the most common cause of drug-induced priapism. Even though typical APs were pointed as more prone to cause this side effect, it is now known that atypical APs, including third-generation ones such as aripiprazole, may also cause priapism. It is thought that the α1- adrenergic antagonist action of most APs inhibits the contraction of smooth muscle in the corpus cavernosum of the penis, impeding venous outflow and thus causing ischemic priapism. To reduce the risk, the dosage of the AP may be reduced or changed to an AP with lower affinity for α1- adrenergic receptors.

Priapism is a rare but important side effect of APs. Being aware of it and of its physiological mechanism is of major importance when treating patients with APs.

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Early ejaculation is besides erectile dysfunction the most common exual dysfunction amog males. It can create suffering and inflence relationships. Selective serotonin reuptake inhibitors has known side effect and sometimes are used as treatment for early ejaculation.

To present successful off-label treatment of early ejaculation.

Case report. Two cases.

Two male patientes with early ejaculation problems that influenced their romatic and sexual life. Older one of them has devorced because of that. Younger has never had romantic or sexual relationship for the same reason. Prescribing SSRI make their love life more productiv. Older one married for the second time and has functional and stabile relationship. Younger one established several romantic and sexualn relatinship and currently is in a stabile romantic relationship.

Longterm use of low doses SSRI can be very beneficial in treatment of early ejaculation.

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Antipsychotics are among the most widely prescribed molecules in psychiatry. Their sexual side effects are frequent, generally underestimated by clinicians and subjectively poorly tolerated by patients. They contribute to the significant non-compliance reported in treated patients. Most antipsychotics are non-selective and have actions on a multitude of receptors, both central and peripheral. Among these, the anti-dopaminergic action could have a deleterious effect on sexual function including spermatogenesis.

The aim of our study is to report, according to the analysis of the collected data, the impact of the treatment with antipsychotic drugs on spermatogenesis and the counteraction of its consequences to a possible infertility in patients.

The studies related to the treatment of DMDD were collected and analyzed. This study retrieved related articles from PubMed, SpringerLink, ScienceDirect, NCBI, CAIRN, and GOOGLE SCHOLAR. Use keywords “antipsychotics” AND “spermatogenesis” AND “infertility” AND “male” OR " hyperprolactinemia" AND “spermatogenesis” OR “risperidone” OR “olanzapine” OR " haloperidol" OR " fluphenazine" AND “spermatogenesis” AND “infertility” OR “psychotropics” AND “infertility” OR “spermatogenesis”.

Antipsychotics are responsible, by blocking the secretion of dopamine in the central nervous system, for hyperprolactinemia, indirectly leading to hypogonadism. They are the pharmacological class most implicated in the occurrence of hyperprolactinemia. several studies have shown changes in the levels of sex hormones with alteration in the quality of the product of spermatogenesis, and others have demonstrated abnormalities in testicular architecture in rats after regular administration of doses of antipsychotics. thus, all antipsychotic molecules, whether classic or atopic, are likely to cause abnormalities in spermatogenesis.

Antipsychotics are molecules with multiple indications in mental health, yet their adverse effects can become disabling or even irreversible. Sexual dysfunction and infertility are widespread among patients under antipsychotic treatment. The mechanisms of the effects of treatment with these molecules on spermatogenesis are poorly elucidated, since the vast majority of prospective studies are carried out on rats. However, this undesirable effect seems to be obvious and real.

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In Morocco, the only legal setting for sexuality is marriage, which presumes automatic consent between the couple, as much so that Islam has authorized any sexual practice between spouses except for anal sex .

In our socio-cultural context, it is difficult to determine the extent of the phenomenon, the subject being taboo with a jurisprudence that refuses to recognize the reality of rape between spouses.

The objective of this work is to emphasize this phenomenon of marital rape, its psychological repercussions, its legal and religious framework in order to debanalize this phenomenon and act in favor of women’s mental health.

Our study is conducted on 3 patients seen in liaison psychiatry admitted to the surgical departments for organic complications of medium to severe severity, secondary to rape in the marital context where our expertise was requested in front of the great psychic distress of the latter.

We collected information by taking notes after our psychiatric examination.

Our three patients were victims of rape and violence by their husbands on several occasions, prior to this hospitalization but never reported such an incident. Our patients presented a wide spectrum of psychiatric pathologies: post-traumatic stress disorder, depression, generalized anxiety, suicidal ideas. One of them has acted out on the latter . In addition to these psychological repercussions, two patients had presented complications of a gyneco-obstetrical nature (a miscarriage and a premature delivery). It should be mentioned that these acts of rape in our three patients were always accompanied by physical violence.

In our Moroccan context, rape within a married couple is not yet recognized by our society, which admits that a woman does not have the right to refuse sexual relations to her husband.

Much remains to be done to familiarize and sensitize society to the reality of marital rape and to ensure that women victims obtain adequate support and care.

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Paraphilias constitute a set of psychiatric conditions that are often chronic and require a combination of treatment approaches, such as pharmacotherapy and psychotherapy. Sexual interest toward prepubescents and pubescents (pedophilia and hebephilia) is frequently identified in criminal settings, within numerous child sexual abuse and child pornography offenses. The high prevalence rates and negative consequences of these acts, causing distress in multiple important areas of health and functioning, reveal the importance of preventing these offenses as a clinical and social matter. Secondary prevention programs, which provide treatment and support for those with paraphilia disorders before sexually abusive behaviors and legal system involvement, show as ethically and socially necessary.

We aim to discuss and bring insights into the knowledge on pedophilia and hebephilia treatments and prevention programs, in the fields of psychotherapy as well as pharmacologic strategies.

We present a non-systematic review of the updated literature on this subject from the data found on the PubMed and PsycInfo databases.

Preliminary results of recent works show that at-risk individuals with paraphilia disorders are often willing to seek treatment without external pressure from the legal system, and report benefits from early treatments. Most studies found that gonadotropin-releasing hormone agonists reduce the risk of child sexual abuse in men with pedophilia. An injectable form has shown to lower this risk 2 weeks after the initial injection, suggesting its use as a rapid-onset treatment option. Cyproterone acetate and medroxyprogesterone acetate are other anti-androgen drugs that inhibit hypersexual behavior, with important side effects to be considered. The combination of androgen deprivation treatment and psychotherapy has a greater effect on preventing fantasies, urges, and behaviours in paraphilic patients. Cognitive-behavioural psychotherapy shows the best results and should soon be initiated in all patients. Biomolecular studies revealed that serotonin and prolactin inhibit sexual arousal, being SSRIs used as first treatment in younger patients, particularly in less severe cases.

Evidence-based treatments from randomized clinical trials for paedophilic and hebephilic disorders are lacking. These current numbers reveal the need for widespread implementation of primary and secondary prevention initiatives, that go beyond the prevention of a repeated offense. There is a need for further research using controlled, randomized trials to examine the effectiveness of sexual offender treatment including psychotherapeutic and pharmacologic interventions. The development of more specific, more effective, and better-tolerated medications for these disorders should be recognized as a program worthy of greater support from government and pharmaceutical industry sources.

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Disorders of sex development (DSD) are characterized by an atypical development of chromosomal, gonadal, and anatomic gender. DSD are divided to three classes with male normal, female normal and abnormal karyotypes and have an incidence at birth of approximately 1 in 5000. DSD patients are exposed during their long-term follow-up to severe psychological stress.

The aim of our study was to determine the behavioral concerns of adults with DSD and to identify the major factors that may influence their emotional and psychological well-being.

We explored, through our genetic counselling reports at the medical University of Sfax, the quality of life and the psychological concerns of all adults patients assessed for DSD with and without chromosomal and/or molecular genetic abnormalities. We also assessed their need of psychological support.

During the last two decades of our genetic counselling experience, 46 adult patients (age superior to 18 years) were selected for this study. The analysis of data revealed that the major psychological concern in our DSD patients was related to their reproductive capacity. In contrast, they have poor subjective norms of communicating sexual and reproductive issues with their partners. Patients who presented non-corrected ambiguous genitalia were in the majority anxious and depressed with a constant feeling of social shame.

Sex development plays a fundamental role in determining the physical attributes of the body, the structure of the brain, behavioral tendencies, and the self-concept. The clinical and social approaches of DSD conditions in our society need to be improved. Genetic and psychological counselling should thorough a deep medical education regarding reproductive and sexual health in each particular case of DSD. We emphasis, that early genetic diagnosis, involvement of patients and families in a patient-centered decision-making process, and consideration of long-term health-related quality-of-life outcomes should be considered in DSD.

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Pregnancy is a period of important physical, psychological and hormonal changes. All these changes affect daily life, relationships with others, the relationship with the body and particularly the intimate and sexual aspect within the couple.

to describe the sociodemographic and clinical profile of pregnant women, explore their perceptions and practices regarding sexuality during an uncomplicated pregnancy and to assess the impact of pregnancy on the couple’s sexuality.

This is a cross-sectional, descriptive study conducted among pregnant women followed at the outpatient prenatal and women in immediate postpartum who gave birth in the obstetrics department of EPS Tahar Sfar Mahdia, during a period of 6 months from 01 September 2019 to 28 February 2020. The evaluation of women’s sex life during pregnancy was conducted using a predefined questionnaire and the validated scale translated into Arabic “Arabic Female Sexual Function Index (ArFSFI)”.

A total of 110 patients were included. The average age of the patients was 30.2 +/- 4.98 years. In 60 % of the cases, the patients were from rural areas. More than half (55%) of our patients had a primary education and were housewives (64%). They were married for love in 59% and the marriage was arranged for 41% of the women. More than 2/3 of our patients (71%) reported a good marital relationship. In relation to the current pregnancy: the majority of patients (70%) were in immediate post partum, the pregnancy was desired (98.1%), well experienced (62%).

For most of the patients (58,2%), sexual intercourse was possible and without risk during the whole pregnancy, but some women thought about the risk of abortion or premature delivery (37.3%), the risk of metrorrhagia (10%) and the risk of infection (6.4%). Most patients (87.2%) reported a decrease in the frequency of sexual intercourse during pregnancy. Most women reported a decrease in desire (51.8%), and sexual satisfaction (55.6%) during their pregnancies. For partner sexuality, desire was stationary for 89% and sexual satisfaction was decreased in 61.1% of cases. Almost half of our patients (42.7%) talked about sexuality : to the husband in 74% of cases, followed by social networks in 58% of cases. The motivation for talking about sexuality was in the majority of cases (61.7%) secondary to a complication (metrorrhagia/ Threatned premature labor..).The mean FSFI total score was 25.3 ± 2.8. More than 2/3 of the patients (70%) had a score <26.55 indicating female sexual dysfunction.

Performing sexual acts during pregnancy has very low risk, contraindications are rare and specific. It is therefore important that patients be informed and reassured on this subject. Information on sexuality during pregnancy should be systematically provided to women during their pregnancy follow-up.

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Epidemiology and etiology of sexual disorders and problems have been described in detail for heterosexual men. In the case of MSM, scientific studies are much more limited, and the presented frequencies depend largely on the methodology of the study and the population covered by the study (socio-cultural differences, influence of minority stress). For chemsex users, the data is even more enigmatic; the subchapter presents data from the research currently conducted in Poland that has not yet been published.Most studies in the recent past have focused on assessing the risk of HIV transmission, sexual dysfunction associated with diagnosis, and the use of antiretroviral drugs. Only recently have been published papers, though still few, assessing the frequency of specific sexual dysfunctions among MSM, which are included as a whole group. It should be emphasized that there is currently no conclusive evidence to suggest a different diagnostic or therapeutic approach for sexual dysfunction in MSM patients.

Most studies in the recent past have focused on assessing the risk of HIV transmission, sexual dysfunction associated with diagnosis, and the use of antiretroviral drugs. Only recently have been published papers, though still few, assessing the frequency of specific sexual dysfunctions among MSM, which are included as a whole group. It should be emphasized that there is currently no conclusive evidence to suggest a different diagnostic or therapeutic approach for sexual dysfunction in MSM patients. The aim of the presented report is to supplement the knowledge about the MSM population of Chemsex users.

A focus group of 60 men aged 18-50 split was assembledinto four groups depending on the type of sexual contact (ChemSex non-ChemSex) and HIV +/-. The focus data was supplemented with research tools: a questionnaire containing 75 questions - elements of medical and sexological interview, and a standardized scale: The quality of life questionnaire in relation to sex - Male (Polish version of the SQoL-M), Premature ejaculation questionnaire and the International Index of Erectile Function (IIEF).

The results are being analyzed. The full report will be presented at the conference.

The aim of the project is to assess the quality of sexual life and to examine the frequency of sexual dysfunction in the MSM population, active Chemsex users and the frequency of sexual contacts, the number of sexual partners, perceived sexual needs and satisfaction, as well as to determine the psychosocial / medical factors influencing the occurrence of sexual dysfunction.

Supplementing knowledge in this field will allow for more effective therapeutic effects.

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Sexual orientation is one’s romantic preference of attraction, may it be towards the same gender or the opposite. Since ages, lot of communities have considered orientation other than heterosexuality as a taboo. Possession Trance disorder is a trance state in which there is a marked alteration in the individual’s state of consciousness and customary sense of personal identity is replaced by an external ‘possessing’ identity and in which the individual’s behavior and movements are experienced as being controlled by the possessing agent as per ICD 11. While lot of theories for such disorder are established, core of each theory lies at an unconscious underlying conflict that is not acceptable by individual’s psyche. Here is an interesting case of 30yrs old homosexual female having possession trance disorder.

To discuss a rare case of possession trance disorder due to unconscious conflict secondary to unexpressed sexual orientation.

A 30yrs old married female patient diagnosed with Possession Trance disorder as per ICD-11 was on treatment for the same since 3 yrs without improvement. She used to get possession episodes by a religious leader for few hours and would preach to his followers during such episodes. Later she was admitted in indoor facility to understand and explore her illness so as to provide an effective management. After serial interview with the patient and her relatives it was discovered that she had sexual orientation towards females(homosexual). Later on, during the course it was found that patient was attracted to a female disciple of that religious leader and to spend time with her, she used to get possession episodes. This however was not acceptable socio-culturally and by patient herself. This lead to lot of conflicts and dysfunctional marital life with husband. To begin with, patient was unable to accept this fact and reported intense guilt for the same. After serial psychotherapy sessions and pharmacotherapy, she improved significantly. Family based interventions for comprehensive improvement were carried out and the patient was discharged with significant improvement.

Discussion: Lot of communities still has immense stigma against homosexual orientation, at times upto extent to consider it to be some mental illness or supernatural interference. This leads to severe psychological trauma to the person and gives rise to inner conflicts in accepting the true self. This emphasizes a need to develop awareness amongst the communities.

This was an interesting rare case highlighting the need for community based interventions to normalize issues related to human sexuality. There is a need to bring awareness and involvement of community to improve mental health of individual as well as community.

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Insomnia is a prevalent global health problem that affects 11.7% - 36% of the population (Grewal et al. Clinical Handbook of Insomnia Int 2017; 13 - 25). It is a risk factor for depression, poor quality of life, and accidents. Increasingly, insomnia has been identified as a suicide risk factor (Lin et al. BMC Psychiatry 2018: 18; 117) We present a case report of a 43-year-old male patient with insomnia-induced suicidal ideation (SI).

1. 1. Learn the mechanism of insomnia-induced SI

2. 2. Understand the current insomnia treatments

3. 3. Discuss the possible mechanism of ECT treating insomnia-induced SI

A 43-year-old single male with past psychiatric diagnoses of social anxiety, borderline personality disorder, chronic SI, and severe recurrent depression was admitted to inpatient due to intractable SI from insomnia. He failed trials on SSRIs/SNRIs, bupropion, trazodone, lithium, vortioxetine, quetiapine, zolpidem, and ketamine. The patient was initiated on electroconvulsive therapy (ECT) three times a week with 20mg vortioxetine and 100mg quetiapine for sleep initiation.

After 6-sessions, the patient’s mood, affect and sleep had improved considerably, and his suicidal ideations resolved. The patient was discharged with outpatient follow-up and ECT as rescue therapy. His sleep gradually improved to 4-6hrs/night and his mood was back at baseline.

ECT is an effective treatment for refractory insomnia-induced SI, likely due to persistent REM suppression and reduced dendritic arborization and excitatory synapses in the amygdala (Doghramji et al. Sleep 2000; 23 - S16 - S20; Lahmeyer et al. Sleep Respiratory 1989; 18 346). Possible mechanisms for insomnia-induced SI include impaired decision-making, abnormalities in 5-HT function, or HPA dysfunction leading to a hyperarousal state and cortisol release (Chatzittofis et al. Euro Neuropsychopharmacology 2013; Elmenhorst et al. Sleep 2012; 35 1615 - 1623; Keilp et al. Psychol Medicine 2013; 43 539-551; Novati et al. 2008 Sleep; 31 1579 - 1585). Current insomnia treatments address underlying medical/psychological problems and non-pharmacologic and pharmacologic strategies. The predominant non-pharmacologic approach is Cognitive Behavioral Therapy Insomnia (CBT-I), such as relaxation techniques, sleep hygiene education, cognitive structuring, and sleep restriction (Rossman et al. American Journal of Lifestyle Medicine 2019; 13 544 - 547). Pharmacologic options include benzodiazepines, non-benzodiazepine hypnotics, tricyclic antidepressants, trazodone, and antihistamines (Saddichha et al. Annals of Indian Academy of Neurology 2010; 13 94-102). ECT should be strongly considered for the treatment of refractory insomnia-induced SI, and its early application may avoid rapid deterioration improving the quality of life.

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Poor sleep quality is a major health problem worldwide. University students tend to suffer from problems of sleep regularity, quantity and quality, which can affect their academic performance, and have a serious impact on their psychological and physical well-being.

The aim of this study was to assess the prevalence of insomnia among Tunisian university students, and to identify its associated factors.

We conducted a cross-sectional web-based study among university students from several Tunisian faculties. Data were collected using a questionnaire spread throughout social media (Facebook), using the Google Forms® platform, during September and October 2022.

We used the “Insomnia Severity Index” (ISI) to assess the severity of insomnia.

A total of 144 students completed the questionnaire. Their mean age was 23.38±3.27 years, with a sex-ration (F/M) of 2.8. Among them, 70.1% were single and 68.8% lived with family. Among our participants, 10.4% were followed for chronic somatic disease, 11.1% for chronic mental disease, while 29.2% have already been diagnosed and treated for sleep disturbances.

ISI showed that 72.2% of students suffered from insomnia: 45.1% Subthreshold insomnia, 19.4% moderate clinical insomnia and 7.6% severe clinical insomnia. Insomnia was significantly more frequent among psychoactive substances users (75.7% vs 57.6%; p=0.043). ISI scores were significantly higher among cannabis users (17.4 vs 11.06; p=0.025).

Our study highlighted that insomnia is prevalent within the university student population, and psychoactive substances consumption seems to worsen it. Thus, when designing interventions to improve sleep quality among students, the main determinants need to be taken into consideration.

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Dissociative amnesia (DA), one of several dissociative disorders, is characterized by the inability to recall autobiographical information that is inconsistent with normal forgetting. Generalized amnesia is a rare subtype of amnesia distinguished by the acute onset of complete loss of memory for one’s life history, in which the patients may lose semantic knowledge, procedural knowledge or personal identity.

The objective of this paper is to highlight that the diagnosis of generalized DA can be controversial and a comprehensive history, as well as collateral information, are essential for an accurate diagnosis.

We present the case of a 37-year-old female, with no premorbid medical illness and one year psychiatric history which was admitted to our clinic for severe deficits of the memory and attention functions, emotional lability, social withdrawal, strong socio-professional dysfunctionality, altered behavior marked by the subjective changes of memory and thinking processes, affective ambivalence towards parents, mixed insomnia. The hetero-anamnesis revealed that our patient presented two fugues during the last 4 months. During her mental status evaluation, she showed temporal and spatial orientation, demonstrative attitude, spontaneous speech centered on her mental suffering, euthymic disposition, delusional ideas with somatic content, intermittent and inconstant facial motor stereotypes.

Multiple neurological examinations were performed, all being within normal limits. The magnetic resonance imaging of the brain identified an enlarged adenohypophysis and a possible microaneurysm that do not correlate with the symptoms. The endocrinological investigations invalidated the suspicion of acromegaly. The psychological examination suggested the tendency to mask less acceptable feelings, inadequacy, rigidity, the presence of conflicts of a sexual nature, regression to an infantile stage, with a deficit of concentrated attention. The emergent symptoms and signs were resistant, failed to resolve with antidepressant and antipsychotic medication and continued to persist across all settings. Corroborating evidence, we established the diagnosis of DA.

DA represents a controversial diagnostic entity that incorporates elements of psychogenic fugue states, repressed memory, traumatic amnesia, and conversion. Some clues in the history such as psychological traumas can support a diagnosis of DA rather than medical causes. As with most other psychiatric disorders, it is important to rule out organic causes first before considering psychiatric etiologies. A thorough sequential history and collateral information are key components in effective diagnosis and management of this condition. In the absence of a favorable response to psychotropic drugs, psychotherapy represents the best treatment approach for DA.

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Brunner syndrome is a recessive X-linked disorder characterized by impulsive aggressiveness and mild mental retardation associated with Monoamine Oxidase – A (MAOA) deficiency (Brunner et al. Science 1993; 262 578-580).

To present a REM sleep behavior disorder (RBD) case in a patient with Brunner syndrome.

The present study is a case report of a patient followed in our hospital’s outpatient care. We also searched for previous case reports of sleep disorders and other clinical features in Brunner syndrome using a pubmed query.

A 46-year-old Spanish male, diagnosed with Brunner syndrome due to the mutation c.1438A>G/iVS14-2 A>G, a loss-of-function mutation in the X-linked MAOA gene. He suffers from mild mental retardation and psychotic disturbances treated with SSRI and antipsychotic drugs. The patient was referred to our outpatient care to assess his sleep abnormal behaviors. He had been presenting with episodes of sleep-related vocalization and complex motor behaviors during sleep for the last 3 years, correlating with dream mentation. His relatives recounted episodes of talking, screaming, gesturing, kicking, falling out of bed and crying during sleep. Dream content referred by the patient was often related to persecutions, attacks and fights.

Polysomnography revealed vocalization and gesticulation during REM sleep compatible with the diagnosis of RBD. The addition of clonazepam to his treatment at doses of 1-3 mg per day achieved significant clinical response of the sleep disorder.

The clinical presentation suggested the diagnosis of RBD case in a patient with Brunner syndrome. Although sleep disorders are not one of the most important or frequent clinical features in Brunner syndrome, they are described in the literature and can significantly affect the patient’s quality of life. To our knowledge, this is the first report about clinical management of RBD case in Brunner syndrome.

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Gender dysphoria is defined as a multisystemic medical condition in which a person has a marked mismatch between their biological sex and the gender with which they identify.

To highlight the psychological impact and social repercussions of gender dysphoria and to discuss the different aspects of management aimed at optimising a better quality of life for these patients.

We describe the clinical cases of 5 patients followed at the child psychiatry department and the adolescent diagnostic centre of agdal, who were diagnosed with gender dysphoria.

Clinical vignette:

• - A.B: 15-year-old patient, followed in our training for a recurrent depressive disorder comorbid with borderline personality and gender dysphoria. This patient is a victim of school bullying altering his psychosocial functioning and generating thoughts of death.

• - H.A: 16 year old patient, followed in our training for gender dysphoria comorbid with adrenal hyperplasia, indicating feminization surgery.

• - I.D: 17 year old female patient, victim of sexual assault, admitted to our training for suicide attempt. She presents a gender dysphoria, comorbid with a borderline personality.

• - C.G: 22 year old patient, followed in our training for gender dysphoria comorbid with a panic disorder. She is a patient describing an anxious experience with dysthymia.

• - L.K: 23-year-old patient, followed in our training for gender dysphoria. He is a patient who would have been a victim of verbal and physical aggression generating a post-traumatic stress disorder having had a significant impact on his socio-professional life.

Primary care physicians need to be aware of gender-related disorders and the importance of early recognition of these emerging disorders. A multidisciplinary approach is needed to manage these disorders.

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Chronic insomnia, resistant to different treatments (pharmacological, sleep hygiene and cognitive-behavioral therapy) remains one of the greatest challenges in our daily practice as psychiatrists. The pharmacological options include benzodiazepines and their analogues (zolpidem, zopiclone, etc.). However, when trying to treat chronic insomnia the use of off-label drugs, including antidepressants with sedative action (such as trazodone), antipsychotics or antiepiletic drugs, is not uncommon.

Perampanel is a non-competitive AMPA receptor antagonist, marketed for the treatment of partial onset epilepsy and primary generalized tonic-clonic seizures. It has been used in the treatment of chronic insomnia with positive results and it has shown to improve the quality of sleep in a recent observational retrospective cohort study.

The most frequent adverse effects of Perampanel include dizziness and drowsiness. Perampanel can also cause psychiatric and behavioral adverse effects, aggression and irritability in up to 10% of patients, as well as depression, and suicidal ideation, with higher rates in patients with psychiatric history.

To draw attention to possible adverse effects of Perampanel and to add knowledge to improve the treatment for chronic insomnia.

Case report and non-systematic literature review of the current data.

A 33 year old woman with Anorexia Nervosa was admitted to the psychiatric hospitalization unit due to suicidal ideation and a history of chronic insomnia. Perampanel was started at a dose of 2mg/day, progressively titrated to 6mg/day, following patient’s informed consent. A week after the initiation of treatment, her sleep pattern had improved but she became aggressive, showed low tolerability to minor frustrations and suffered from an intensification of suicidal ideation. She became extremely hostile to the personnel, had severe tantrums and deliberate self injurious behavior. Perampanel was discontinued and in less than a week her aggressive behavior succumbed. Although she was not re-exposed to Perampanel the symptoms she presented are considered a very likely adverse drug reaction. Levomepromazine 20mg/day and Lormetazepam 0.5mg/day were reinstated as a treatment for insomnia.

Psychiatric comorbidity is known to be a risk factor for behavioral adverse effects of Perampanel. Therefore Perampanel as a treatment for chronic insomnia needs a careful individual benefit-risk assessment and monitoring for adverse effects.

None Declared

Sleep related sexual behaviors or sexsomnias are unconscious behavioral activities that occur during sleep (e.g. parasomnias). Behaviors could range from sexual vocalizations, orgasms, sexualized movements, masturbation, or full sexual intercourse with a subsequent amnesia. Early epidemiological studies showed a prevalence of 7.1%, with a male predominance. While intended as a rare condition, leads to important physical and psychological consequences for both the patient and their bed partner. For our knowledge this is the first case of sexsomnia reported in Portugal.

To report the clinical and psychosocial impact of a Sexsomnia case in a young woman which was misdiagnosed with depression.

Patient´s clinical files consultation and literature review using Pubmedâ and the keywords: sexsomnia.

A 18-year-old female referred to a psychiatric consultation to be assessed and treated from a diagnostic of depressive disorder. This was a young woman with a previous history of sleepwalking during childhood, with no recurrent episodes since adolescence. A familiar positive history for sleepwalking was confirmed (mother). She reported the beginning of her sleep related sexual behavior six months before the consultation, conflicting with the moment in which she started pharmacological therapy for Chron Disease, diagnosed at that time.

After she slept with her boyfriend, she was told by him about the recurrence of masturbatory activity during sleep. These episodes were told to occur as often as 1 to 2 times a night, shortly after falling asleep, with posterior amnesia for the event.

As for medical or psychiatric history, only Chron’s disease is highlighted, being under control with azathioprine. Likewise, he took 1mg of melatonin/night.

Pittsburgh Sleep Quality Index at presentation was 7/21 and the STOP-Bang questionnaire revealed a low risk of Obstructive Sleep Apnea.

A Type I Polysomnographic study was performed revealing decreased sleep efficiency and fragmented sleep presenting an alternating cyclic pattern. The existence of significant respiratory events during sleep, as well as periodic movements, was excluded.

Cognitive behavioral therapy by means of highlighting the need of improvement on sleep hygiene measures was prescribed and the dose of melatonin was increased up to 3mg. Despite the good clinical response, the patient discontinued the melatonin treatment mainly due to familiar and personal reasons and failed to comply with the prescribed hygienic measures, with a further worsening of the clinical condition.

This particularly challenging case representing the emerging medicolegal issues and psychosocial aspects related with the still poorly understood sleep disorders like sexomnia, shows up how much awareness is required from psychiatric team members to better assist and refer patients, promoting both an assertive diagnostic and an effective management.

None Declared

Anxiety and sleep disorders are common and associated comorbidities of dementia. Previous studies has proven the association between anxiety and sleep disorder with a reduced quality of life in hospitalized patients with dementia. However, it is not clear whether the sleep disorders change the association between anxiety and quality of life.

To test the hypothesis that sleep quality modify the association between anxiety and quality of life in hospitalized patients with mild or moderate dementia.

We performed this cross-sectional study during 2017 at University Psychiatric Hospital “Sveti Ivan”, Zagreb, Croatia. Data were collected on a consecutive sample of patients diagnosed with mild or moderate dementia. The outcome was the association between anxiety measured using the Hospital Anxiety and Depression Scale, and quality of life measured using the EQ-5D-5L visual-analogue scale. The independent variable was sleep quality measured using the Pittsburgh Sleep Quality Index (PSQI). We performed a moderation analysis using the Johnson-Neyman technique as implemented in Andrew F. Hayes macro “Process” Template 1, after adjusting for age, gender, education, body mass index, age at the time of onset of dementia, duration of hospitalization, severity of condition measured using Clinical Global Impression scale and Clinical Dementia Rating Scale, treatment with antidementives by multiple linear regression.

The median (interquartile range) age of 47 participants was 80 (76-83) years, 24 (51%) were women, 24 (51%) had nonspecific dementia, 16 (34%) Alzheimer’s Disease and 21 (46%) severe dementia. Hospital anxiety and quality of life were significantly, linearly, and inversely correlated both in bivariable, and in multivariable, adjusted analysis (r= -0.39; p=0.006; adjusted semipartial r= -0.41; p=0.017). After the adjustment for all covariates, the interaction between hospital anxiety, quality of life and sleep quality was not significant. However, hospital anxiety and quality of life were significantly correlated when PSQI score was ≥5.6, that is in 37% patients with the worst sleep quality.

We partially confirmed the hypothesis that sleep quality modifies the association between hospital anxiety and quality of life in patients with mild to moderate dementia.

None Declared

Primary insomnia is frequently present in the general population, with epidemiologic research reporting prevalence values from 10% to as high as 60%. Chronic insomnia is associated with a significant impact on professional, academic, and daily life functionality, and it also may be responsible for decreasing the quality of life. Multiple generations of drugs for insomnia have been launched in clinical use in the last decades, but each class of pharmacological agents has its shortcomings (i.e., low efficacy, risk of addiction, diurnal sedation, risk of falls and fractures, etc.). Initially, research on orexin receptor antagonists has been considered with enthusiasm, due to these agents’ low risk of adverse events and good safety profile in the medium and long term.

To assess the evidence supporting the efficiency and safety of orexin receptor antagonists in the treatment of insomnia.

A literature review was performed through the main electronic databases (PubMed, Cochrane, Clarivate/Web Of Science, and EMBASE) using the search paradigm “primary insomnia” AND “orexin receptor modulators”. All papers published between January 2000 and September 2022 were included.

Suvorexant is a dual antagonist of orexin 1 and 2 receptors (DORA), FDA-approved for the treatment of insomnia, both for difficulties in falling and staying asleep. Daridorexant is another DORA, approved by FDA and EMA for the same indications as suvorexant, but EMA considers „additional monitoring” necessary for this drug. Lemborexant is a DORA approved for use in US and Japan, while vornorexant, which is included in the same class, is under development for the treatment of insomnia and sleep apnea (in phase 2 and 1 clinical trials, respectively). Almorexant is a DORA that was discontinued from clinical research due to hepatic safety concerns. Seltorexant is an orexin 2 receptor antagonist (SORA2) explored in phase II trials for the treatment of insomnia. Somnolence and fatigue are the most frequently reported adverse events of DORAs, but sleepwalking and sleep driving, sleep paralysis, or hypnopompic and hypnagogic hallucinations have been described in clinical studies. Seltorexant was associated with somnolence, headache, and nausea.

Dual antagonism of orexin 1 and 2 receptors is a mechanism that produced three currently available drugs for insomnia, and other clinical applications of these agents are still under investigation. At least one other agent from this class is under investigation, therefore the potential clinical utility of DORAs is far from being exhausted. Also, the selective orexin 2 receptor antagonism could be a promising mechanism of action for the treatment of insomnia.

None Declared