The aging population in the developed world has implied increasing age diversity in the workforce of organizations. Consequently, mutual perceptions about one’s co-workers and age discrimination is becoming increasingly important.

This study aims to explore how perceptions about older workers’ work (un)adaptability, work effectiveness and workplace age discrimination vary according to participants’ psychosocial factors, such as age group, gender, education level and work sector.

This study included a sample of 453 workers in Portugal, diverse in terms of age, gender, education level and work sector. Four different instruments were used: (a) a sociodemographic questionnaire; (b) an older workers’ Work Adaptability scale; (c) an older workers’ Work Effectiveness Scale and; (d) the Workplace Age Discrimination Scale (WADS).

Middle-aged and older participants perceive older workers as more adaptable than younger participants. The oldest group of participants perceives older workers to be more work-effective and experience the highest levels of age discrimination in the workplace, when compared to the other age groups. Also, participants with lower levels of education tend to perceive higher levels of workplace age discrimination, when compared to participants with high school and higher education.

Generational perceptions in the workplace are perceived by workers differently, hence organizations should implement age management strategies to address age discrimination, particularly due to the increasing proportion of older workers.

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The Psychogeriatric Department of the Institute of Mental Health (IMH) in Singapore provides acute inpatient services for elderly patients with severe mental health problems. The average length of stay for inpatients in 2020 was 46 days, which was significantly higher than the ideal length of stay set by the hospital of 21 days. This contributed significantly to healthcare costs and reduced bed capacity for acute admissions from the Emergency Service. Prolonged inpatient stays can lead to physical decompensation including reduced muscle strength, pulmonary capacity and osteoporosis.[i]

[i] Creditor MC. Hazards of hospitalization of the elderly. Ann Intern Med. 1993 Feb 1;118(3):219-23. doi: 10.7326/0003-4819-118-3-199302010-00011. PMID: 8417639.

We aimed to profile and identify patients in acute psychogeriatric wards who had prolonged inpatient stays.

A cross-sectional audit was performed. We used a data collection sheet to capture demographic, social and clinical information of all inpatients residing in the acute psychogeriatric wards on 1st November 2020, whose inpatient stays exceeded one month (over-stayers).

Demographic profile: Out of 57 inpatients (28 male patients and 29 female patients), 26 patients (46%) were over-stayers. Out of these 26 over-stayers, 18 patients (69%) were female and 14 patients (54%) were above age 70.

Clinical profile (n=26): 19 patients (73.1%) were diagnosed with dementia. 18 patients (69.2%) had severe Behavioral and Psychological Symptoms of Dementia (BPSD). 22 patients (84.6%) required assistance in their basic activities of daily living.

Social profile (n=26): Caregivers of 18 patients (69%) were burnt out by patient’s behavior problems, which is commonly seen in caregivers for patients with dementia[ii]. Family members of 3 patients (11.5%) were estranged from them. Caregivers of 3 patients (11.5%) had difficulty engaging additional caregiver support for ADL assistance.

[ii] Reuben DB, Romero T, Evertson LC, Jennings LA. Overwhelmed: a Dementia Caregiver Vital Sign. J Gen Intern Med. 2022 Aug;37(10):2469-2474. doi: 10.1007/s11606-021-07054-3. Epub 2021 Aug 13. PMID: 34389938; PMCID: PMC9360256.

The above profiles enabled the department of Geriatric Psychiatry in IMH to identify elderly patients at risk of prolonged hospital stay at the beginning of their admission and improve the care of these patients to reduce their length of stay.

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Due to the effects of sleep on the central nervous system,it is thought that sleep problems have a special importance in the onset, course and treatment of psychiatric diseases. Although the negative effects of sleep problems on the occurrence, recurrence and clinical course of psychiatric disorders are well known, it is reported that clinicians do not spend enough time for sleep problems in practice.To our knowledge there is no study in the literature which examining its effect on frontal lobe functions or social functionality in schizophrenia.

In current study, it is aimed i- to examine the chronobiological characteristics of remitted patients with schizophrenia, ii- to determine the effect of chronobiology on sleep quality, frontal lobe functions, depressive symptoms, interpersonal relationships and social functionality in patients with schizophrenia, iii- thus to improve the quality of life and the treatment outcome of patients with schizophrenia.

185 patients with schizophrenia who met the Andreason remission criteria were included in the study. The patients were evaluated with Positive and Negative Syndrome Scale (PANSS), Morningness & Eveningness Scale (MEQ), Calgary Depression Index (CDI), Pitssburgh Sleep Quality Index (PSQI), Barratt Impulsivity Scale Short Form (BIS-11-SF), Frontal Assessment Battery (FAB), Personal Social Performance Scale (PSPS). Each patient was classified either as morning type (MT) or evening type (ET) or intermediate type (IT) according to MEQ scores.

The obtained MEQ responses indicated that 29 (15.7%) of the patients were “ET”, 124 (67.0%) were “IT”, and 32 (17.3%) were “MT”. In the “ET” group, the mean of CDI total score, the mean of PSQI total score, the mean of BIS-11-SF total and the mean score of BIS-11-SF planlessness and inattention subscale were higher than in both the “IT” and “MT”. The mean total scores PSPS of “ET” patients were found to be lower than the mean scores of both the “IT” and “MT” patients. There was no significant difference between the groups in terms of FAB total scores. According to Multiple Linear Regression Analysis, total MEQ score and PANSS-negative symptoms subscale score were found to have an effect on PSPS[1]Personal Social Realitionship subscale scores.

Although all patients included in current study were in remission, it was found that chronotype characteristics were effective on many clinical manifestations and comorbid conditions. The findings obtained from our study emphasize how important it is to question chronotypic features in daily psychiatric practice. In this context, being aware of the importance of chronotypic features in the treatment of schizophrenia patients, questioning the patients in this respect and taking necessary interventions may have the potential to improve functionality, which is one of the main treatment goals in patients with schizophrenia.

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Presenteeism is increasingly being seen as a threat to employee efficiency. Nursing professionals are exposed to occupational hazards that may compromise physical and mental health, interfere with the quality of life of the worker and the quality of care provided to the patient and cause illness and generate costs for the institutions.

This study aimed to evaluate which are the personal (age, sex, educational qualifications), professional (organization, seniority in the organization, seniority in function, employment relationship, work regime and professional category) and health variables, that best relate to sickness presenteeism.

A quantitative cross-sectional study was conducted. The sample is probabilistic and the universe of this study included all nurses who work in Portuguese health institutions (whether they are of a public, private or public-private nature). Inclusion criteria were nurses with clinical activity and/or management in institutions in the aforementioned modalities, and nurses in teaching activity in higher education institutions were excluded from this study, on an exclusive basis. The final sample was composed of 424 nurses.

Most of the nurses who answered the e-survey are female (86.8%), aged 40 years or over (59.9%), who live in the northern region of the country (31.4%), who work in public organizations (85.5%), in differentiated health care units (52.6%) and with an employment contract in public functions (63.7%). More than half (53.3%) of participants are specialist nurses and 72.4% of respondents did not have a previous disease condition. The variables that best correlated with presentism were the female gender, the organization where you work (public), and the presence of a previous disease condition.

The results presented may constitute a challenge for change for policymakers, managers and health professionals, in the sense of addressing presenteeism with the creation of occupational health programs directed to the needs of nurses. Other measures include flexible working hours, work policies that promote staff retention, and a strong commitment to the training and qualification of nurses capable of ensuring better performance and involvement in the organizational culture.

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Autism spectrum disorders (ASD) are complex neurodevelopmental conditions characterized by impairments in social cognition and repetitive behaviors with onset in early infancy. Deficits in emotion recognition, social perception, and communication have been identified as core symptoms of ASD.

Comorbid disorders are frequent, namely psychiatric illness, epilepsy, sleep disruption, and hyperactivity.

Immune profile changes during early life may contribute to pathogenesis of ASD. Other risk factors include advanced parental age, fetal environment, fertility treatments, medications, and nutritional and toxic factors.

Several brain regions are involved in the pathophysiology of ASD but the cerebellum is the structure most consistently found altered. An increased risk of ASD is associated with cerebellar damage.

To highlight the importance of understanding the key processes of cerebellar development and how altered cerebellar function leads to social and cognitive impairments, and consequently ASD.

Non-systematic review of the literature using Pubmed database. Papers were selected according to their relevance.

From imaging studies, we can understand that cerebellum is not just about motor function. Different tasks like adding working memory, emotional and social processing, and language seem to be part of core functions of the cerebellar circuit.

Adults with lesions in the cerebellum can develop cerebellar cognitive affective syndrome (CCAS), with core symptoms of impaired executive function, difficulties in spatial cognition, blunted affect, or inappropriate behavior. Some children who have tumor resection surgery for medulloblastomas also exhibit symptoms of CCAS, and some experience posterior fossa syndrome (PFS).

The linguistic, cognitive, and behavioral deficits in CCAS and PFS may contribute to explaining how cerebellar alterations are related to ASD, which is a neurodevelopmental disorder characterized by an earlier onset and broader spectrum of these symptoms.

The literature has suggested an important role for cerebellar dysfunction in etiology of ASD, under certain premises: (a) cerebellar expansion temporarily coincides with onset of ASD; (b) cerebellum is prone to lesions during this period; (3) cerebellar lesions contribute to dysfunctional social and language abilities.

Disturbances in cerebellar development lead to alterations in higher cognitive functions, due to changes in Purkinje cells. These dysfunctional neurons, once integrated into a brain circuit that controls complex tasks, lead to these functions becoming aberrant.

It is therefore fair to say that cerebellum is important for development of the so-called “cognitive and social brain” since it is itself part of this network. So, the cerebellum certainly plays a relevant role in pathophysiology of ASD.

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Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by cognitive deficits and/or behavioral disturbances. The symptoms begin before 12 years and must cause an impact in different contexts. It is now recognized that in 40–60% of cases, ADHD symptoms persist into adulthood and old age, representing nearly 4% of adults and seniors.

Executive and memory deficits have been described in other neurodevelopmental disorders, such as autism, and older adults with these disorders are observed, later in life, with mild cognitive impairment (MCI) or dementia.

MCI is conceptualized as a prodromal stage of a neurodegenerative process, for which the pathological processes are not yet known. The term “MCI” is currently used to designate subjective complaints and performance below expected levels, in any cognitive domain.

There is, therefore, an overlap between ADHD and MCI in older adults, related to cognitive and behavioral symptoms. This overlap makes both syndromes difficult to distinguish, particularly in older patients.

To highlight the importance of understanding the key processes of ADHD and MCI and how these entities may be related to each other.

Non-systematic review of the literature using Pubmed database. Papers were selected according to their relevance.

Sleep disturbances are present in about 70% of adults with ADHD, and 59% of those with MCI. Depression and anxiety, respectively, are observed in about 44% and 35% of adults with ADHD, and 27% and 14% of those with MCI.

In the literature, the relationship between ADHD and MCI/Dementia remains unclear, although there are some hypotheses: (a) ADHD and MCI represent two points along a single pathophysiological continuum; (b) ADHD increases the risk for MCI and dementia (through an unrelated mediator); (c) ADHD and MCI manifest highly similar neurobehavioral symptoms through fundamentally distinct mechanisms (are unrelated). However, these three hypotheses are not mutually exclusive, i.e. ADHD may share common antecedent causal factors with MCI/Dementia and also increase the risk of MCI/Dementia through an unrelated mediator.

Neuroimaging evidence tends to support the hypothesis that neurobehavioral symptoms in ADHD and MCI manifest via distinct processes within the brain, with frontostriatal, frontal-temporo-parietal, and fronto-cerebellar abnormal networks in ADHD and progressive neurodegeneration in MCI.

Whether or not ADHD is a phase of a neurodegenerative process, the current criteria for the diagnosis of MCI or Dementia may not be appropriate or valid in individuals with a premorbid history of ADHD.

The criteria for the diagnosis of MCI/Dementia in adults with a previous diagnosis of ADHD should therefore be revised to rely more on functional outcomes.

Future neurobiological and epidemiological studies are needed, to explore the relationship between MCI/Dementia and ADHD, in older adults.

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Attention Deficit Hyperactivity Disorder (ADHD) is the second most common psychiatric disorder in childhood, affecting 5-7% of the child population. The same disorder in adults is less documented and is estimated at 2.5% of the population. The mothers of children with ADHD are 24 times more likely to develop ADHD than mothers of children without ADHD. About 17% of mothers of children with ADHD meet criteria for the disorder themselves. The core symptoms of ADHD are inattention, hyperactivity and impulsivity.

The objective of this e-poster is to describe the effects of the mother’s ADHD on her parenting role

The current poster is based on the bibliographic reviews of papers via the ‘PubMed’ search engines.

In some studies mothers with ADHD may use ineffective discipline methods in order to limit their children.The mothers with ADHD often have difficulties with executive functions such as planning, organizing and implementing goals and with self-control. Characteristically, in a study with a sample of mothers with children aged 3-6 years were observed difficulties in defining the boundaries of the children, unstable behavior and low self-esteem. Additionally, mothers with ADHD may have difficulty forming and maintaining social relationships and this have a negative effect on children’s social skills. The maternal role is influenced by when the mother suffers from depression, anxiety, uses alcohol or psychotropic substances. In addition, her role is influenced by when there are problems in the marital relationship or she is a single parent. The reactions of the mother with ADHD may be influenced not only by whether she has ADHD but also by whether or not her child has been diagnosed with ADHD. The mother with ADHD and child with ADHD has to deal not only with her own symptoms but also with her child’s symptoms. The coexistence of the specific disorder in both may cause increased levels of stress to the mother. Nevertheless, some research reports that these mothers show empathy towards their children, i.e. they have a more positive and supportive behavior, they are more protective, less irritable and less frustrating (similarity-fit hypothesis). In other studies mothers with ADHD worsen their children’s symptoms with their behavior (similarity-misfit hypothesis). There is a significant correlation between the mother’s ADHD and the child’s emotional, behavioral and social functioning.

In conclusion, mothers with ADHD may experience difficulties in all developmental stages of their children. Therefore, the treatment of the disorder (medication and cognitive-behavioral psychotherapy) is necessary in order to improve the mothers’ symptoms, the mental condition of their children and the family’s quality of life.

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Patients with mental disorders frequently become non-adherent during their long term prescribed treatment. This situation frequently triggers clinical worsening and hospital admission. Therefore, non-adherence may result in poorer long term clinical outcomes and has economic implications for health-care providers (Carlos De las Cuevas et al. Neuropsychopharmacol Hung 2021; 23(4):347-362).

- To describe the adherence to oral and long acting injectable treatment in the sample of patients that were admitted to the short stay hospital unit during the period of study.

- To describe the adherence to treatment amongst psychiatric diagnosis in the sample of study.

It was a retrospective observational study with a duration of three months. Data was collected from all patients admitted to the short stay hospital unit during the period of study and there were no specific exclusion criteria. Descriptive statistics were performed. To assess the adherence to pharmachological treatment the patient report, the family report and the pharmacy dispensation according to the existent informatic prescription platform was considered. Regarding the long acting injectable treatment the formulary of administration in the clinical history was checked.

During the period of study 172 patients were admitted to the short stay hospital unit. Of those, 146 patients had a previous pharmacologic prescription. Data of treatment was not possible to obtain in 7 patients. In the sample of study, 83.5% were on oral and 16.5% on long acting injectable treatment. The general adherence to treatment in the sample was 61.87%. In the oral treatment group the adherence was 58.4% and in the long acting injectable treatment group was 65.2%.

Amongst the different psychiatric diagnoses the outcomes of adherence to treatment were: 60.4% in schizophrenia and related psychosis, 62.5% in bipolar disorder, 78.6% in depression, 58.3% in personality disorders and 62% in addictive disorders.

In our descriptive study adherence to treatment was higher in the long acting injectable treatment group, agreeing with the existent scientific literature.

The results of adherence for schizophrenia and bipolar disorder are similar to the ones found in scientific literature but differ from the ones for depression, being higher in our sample (Judit Lazary et al. Neuropsychopharmacol Hung 2021;23(4): 347-362). Moreover, in scientific literature it is found a similar prevalence of adherence across diagnosis (for schizophrenia, bipolar disorder and depression) whereas in our sample patients with depression showed a different and higher adherence to treatment (Judit Lazary et al. Neuropsychopharmacol Hung 2021;23(4): 347-362). In our sample, patients with personality disorders had the lowest adherence to treatment.

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In South Korea, all men at the age of 18 or older are required to serve at military for a certain period as an obligation. These recruits should be able to withstand psychological stress and pressures of rapid adaptation of the unique and new environment in military.

The current study attempted to identify distinct subgroups of patients referred for military service suitability and further to investigate whether there is a difference in clinical features such as treatment responsiveness and prognosis among those subgroups.

Subjects were male patients aged 18 to 28 years who visited the department of psychiatry at the University Hospital for evaluating mental health problems related to military service. We conducted a latent profile analysis (LPA) using 10 clinical scales of MMPI-2 as an indicator variable to investigate the subgroups of subjects. The clinical state of subjects was assessed with CGI-S and GAF scale for three time point (0, 3, and 6 month).

The results showed that the best fitting model corresponded to a three-class model: each class was named ‘Class 1: mild maladjustment’, ‘Class 2: neurotic depression and anxiety’, and ‘Class 3: highly vulnerable and hypervigilant’ respectively. Subsequent analysis was also carried out to identify changes in clinical symptoms and functional level across treatment time of each subgroup identified in LPA. We demonstrated that the three subgroups displayed differential characteristics in treatment responsiveness and clinical course evaluated by CGI-S and GAF over a treatment period of 6 months. Three subgroups indicated significant differences in the number of medications prescribed as well. Class 3 had more antidepressants and anxiolytics on use than Class 1 and 2. Antipsychotic agents and a combination of three antidepressants were prescribed more frequently in Class 3 than in Class 1 and 2.

While Class 1 and 2 significantly improved over 6 months, Class 3 showed little or no improvement in our clinical parameters even with more medications. This study has a clinical significance that it has classified qualitatively different subgroups within the sample by conducting LPA with clinical profiles of MMPI-2 and provides a basis for comprehensively understanding their differentiated clinical features. This study suggests clinical implications for treatment plan and intervention of each subgroup classified based on MMPI-2 clinical profiles of military recruits who might show maladjustment to serve.

None Declared

Erving Goffman described stigma as an attribute considered to be undesirable and unpleasant by society and which differentiates the stigmatised person from other members of the community that he or she should belong to. (Hankir AK, et al., 2014). Mental illness has been always associated with stigma, moreover people with serious mental illness have higher rates of mortality and morbidity. (Patrick W. Corrigan, et al., 2014). The contact mental-health-care professionals have with people with mental illness is associated with positive attitudes towards civil rights, however it does not reduce stigma as does social contact such as with friends or family members with mental illness. (Henderson C et al., 2014)

This is the Albanian substudy of a larger multicenter study. We aimed to investigate the attitudes of specialists and trainees in psychiatry in Albania.

An anonymous online questionnaire was sent by email to the participants. We used questions on sociodemographic and professional details as well as requested personal information regarding their lived experience. The self reporting Opening Minds Stigma Scale for Health Care Providers was used to measure stigmatising attitudes, which contains 15-statements and 3-subscales: Attitude, Disclosure and Help-seeking and Social distance.

Altogether 59 professionals completed the questionnaire, 59% of them worked as adult (n=35) and 41% as child psychiatrists (n=24). 58% were specialists (n=34) and 41% trainees (n=24). Based on their responses, 12% of them (n=7) have ever sought help for their own mental health problems. Regarding case discussion, supervision or Balint groups, 81% of the sample (n=48) was open to these; however, it was accessible for only 46% of the sample.

The median stigma scores were the followings: attitude: 13 (11-16), Disclosure: 10 (9-12) and Social distance: 12 (9-13), total score: 35 (31-40); however, none of these were associated with any of the above variables.

Stigma is present towards people with mental health problems and psychiatrist play their part in it as well. Further investigation is needed into Albanian psychiatrists’ stigmatising attitudes to find appropriate anti-stigma interventions for them.

None Declared

Stigma in mental illness has a negative impact on the daily functioning of the patient, their personal development and their clinical prognosis. Direct contact with people who suffer from this pathology could modify the stigma towards these populations.

The objective of the study is to assess whether the stigma of mental illness in university students is modified by contact with people suffering from mental illness, established through volunteering activities with that population.

Observational case-control study. The sample is made up of young subjects (18 to 35 years old) who have studied or are studying a university degree during the 2021-2022 academic year. The cases (n=91) are subjects who have ever volunteered with people diagnosed with mental illness. Those who have not had this experience constitute the control group (n=237).

The variables were collected by completing an anonymous online questionnaire. To analyze stigma, the Attribution Questionnaire-27 questionnaire was used, which offers a total score as well as 9 domains related to stigma. Statistical analysis (including multiple linear regression) was performed with the statistical package IBM SPSS Statistics, version 20.

Once adjusted for age and gender, the case group scores lower, with statistically significant differences, in the subscales Anger (p-value: 0.001), Dangerousness (p-value: 0.000), Fear (p-value: 0.000 ), Coercion (p-value: 0.028), Segregation (p-value: 0.000), Avoidance (p-value: 0.000), as well as in the Total Score (p-value: 0.000). Likewise, it is also observed that the group of cases score higher on the Help subscale (p-value: 0.002).

Previous contact with patients with mental illness through voluntary activities seems to favor less stigma towards mental pathology.

None Declared

Many psychiatric illnesses have been linked to the gut microbiome, with supplements such as probiotics showing some efficacy in alleviating the symptoms of some psychiatric illnesses. Though probiotics alone have been found to be efficacious in alleviating the symptoms of psychiatric illnesses, the combination of probiotics and first-line psychotropic medications has not been investigated as thoroughly.

The primary objective of this review was to evaluate the current literature investigating the effects of adjuvant probiotic or synbiotic administration in combination with first-line psychotropic treatments for psychiatric illnesses.

A systematic search of four databases was conducted using key terms related to treatments for psychiatric illnesses, the gut microbiome, and probiotics. All results were then evaluated based on specific eligibility criteria. The salient outcome measures from the studies that met this eligibility criteria were then extracted and analysed.

Eight studies met eligibility criteria and were analysed for reported changes in outcome measures used to assess the symptoms of psychiatric illness and the tolerability of treatment. All Major Depressive Disorder (MDD) (n=5) and Generalized Anxiety Disorder (GAD) (n=1) studies found adjuvant probiotic or synbiotic treatment to be more efficacious in improving the symptoms of psychiatric illness than the first-line treatment alone or with placebo. The schizophrenia studies (n=2) found adjuvant probiotic treatment to have no significant difference in clinical outcomes, but it was found to improve the tolerability of first-line antipsychotics.

The findings of the studies included in this review suggest the use of adjuvant probiotic treatment with selective serotonin reuptake inhibitors (SSRIs) for MDD and GAD to be superior to SSRI treatment alone. Probiotic adjuvant treatment with antipsychotics could be beneficial for improving the tolerability of the antipsychotics, but these findings do not suggest that adjuvant probiotic treatment would result in improved clinical outcomes for symptoms of schizophrenia.

None Declared

Vocal music has been a way for the expression of beautiful human emotions and gives a consolidated framework to words. Our review is centered on finding neuroplastic changes in exposure to music.

Our main Objective is to identify structural brain changes in different brain areas. Identification of motor and sensory changes that are produced in response to vocal music.

Detailed literature review was conducted using Pubmed and Google Scholar databases. The literature search was narrowed down to cover the research topic with the search terms [plasticity] OR [brain] OR [neurons] OR [music] OR [vocal]. Our Inclusion criteria included studies with effects of vocal music on neuronal plasticity regardless of age, gender, duration of training, type of training, medium of lanuage and profession. Exclusion criteria included instrumental music and forms of music other than vocal music.

Results showed that music impacts areas of the brain that are highly associated with human emotions. Any brain area can undergo neuroplasticity but is most commonly seen in the insular areas, paracortex, putamen, amygdala, and white matter. Music therapy promotes the formation of instant neural networks and the release of neurotransmitters like serotonin and dopamine. These microscopic changes increase depending on the duration of exposure to vocal music. Later, it appears as macroscopic changes visible with the help of neuroimaging. There is also a significant difference in the brain changes of vocalists and non vocalists. Vocal music impacts the left side of the cortex. Music activates reward system in the brain that leads to stimulation of dopaminergic pathways. It helps in neuronal division in post strock and post traumatic brain injury patients.

Music therapy is widely used as the rehabilitative process that combines music with therapeutic medications to promote therapeutic alliance and better results. It is used to direct focus toward the fulfillment of the emotional and cognitive needs of patients with psychiatric ailments. This area is needed to be explored more so that vocal music can be used for integrated therapy.

Keywords: Vocal music; Brain changes; neuroplasticity; therapy.

None Declared

Anemia due to iron deficiency is a highly prevalent medical condition in women and children. Iron deficiency presents with fatigue, low mood, anxiety, restlessness, palpitations, and headache. Poor nutritional intake can be the reason of iron deficiency in underprivileged populations. It can lead to behavioral symptoms that can manifest as chronic psychiatric ailments.

Our objective is to consolidate manifestations of iron deficiency anemia concerning psychiatric ailments. We will figure out if it impacts the severity of psychiatric symptoms. We aim to find out if there are any underlying factors that impact the correlation of iron deficiency with psychiatric disorders like depression, anxiety, sleep disorders, and restless leg syndrome.

Detailed literature review conducted using PUBMED, OVID, GOOGLE SCHOLAR with the search terminologies [iron] OR [sleep disorders] OR [depression] OR[deficiency] OR [anxiety] OR [ADHD] OR [VITAMINS] OR[PICA] OR [CHILDREN] OR [women] OR [antidepressants] OR [sleep medicine] OR [antipsychotics] that yielded 150 results that were narrowed down to be focused on our research area. Inclusion criteria included studies with participants with iron deficiency anemia regardless of age group, gender, economic and social background. Exclusion criteria included patients with normal hemoglobin levels.

Results yielded a positive impact of treating iron deficiency anemia in patients with psychiatric ailments. The symptoms of low mood, fatigue, anxiety, anhedonia, and sleeplessness get better as iron deficiency improves. According to the search, some physicians misdiagnose iron deficiency as depression. Antidepressants were found to be working better when added with iron supplements. Restlessness and palpitations can also be the manifestations of iron deficiency. Patients with underlying iron deficiency are more predisposed to developing psychiatric disorders. According to published data, restless leg syndrome was found to be associated with iron deficiency. Some psychiatric drugs can lead to iron deficiency and can provoke underlying iron deficiency even more. Iron deficiency impacts memory areas of the brain like the hippocampus and prefrontal cortex.

It is much needed more than ever before that proper consideration to the diagnosis of iron deficiency anemia must be given with the assistance of predesigned guidelines. Misdiagnosis of iron deficiency anemia as a psychiatric disorder can be misleading toward the insidious usage of psychiatric medications. Proper attention must be provided to this neglected area so that management of iron deficiency is tailored in the right direction and it is diagnosed at less severe stages. It will be helpful for general physicians and practicing psychiatrists in the field.

Keywords: Iron deficiency, Psychiatric Disorders, Anxiety, depression.

None Declared

There has been an increasing evidence in recent years that inflammation plays a role in the pathophysiology of bipolar disorder (BD). In addition to central inflammation, systemic immune response is thought to be associated with disease stages and course. HMGB1 protein is a member of damage-associated molecular pattern which plays a role in the regulation of cytokine release and is important for innate immunity. It has been revealed that HMGB1 levels change in many autoimmun and inflammatory diseases

Our study was designed to compare serum HMGB1 levels of inpatients with mania and healthy controls as well as analyzing its relationship with other inflammatory markers and disease severity. Another aim of our study is to determine the changes in serum HMGB1 levels before and after treatment in manic patients.

Our study included 35 patients who were hospitalized in our hospital between November 2020 and April 2021, diagnosed with bipolar disorder, manic episode according to DSM-5 criteria, and 35 healthy controls who matched to the patient group in terms of age and gender. The sociodemographic and clinical characteristics data forms of the participants were filled in, and the patients were evaluated with the Young-Mania Rating Scale (YMRS) and the Hamilton Depression Scale (HAM-D). Serum HMGB1, CRP levels and complete blood count values were measured in healthy controls and patients before and after the treatment.

The main finding of our study is that HMGB1 levels did not show a statistically significant difference in the patient and healthy control groups (p>0.05). In addition, there was no significant change in serum HMGB1 levels of the patients after treatment compared to the level before treatment (p>0.05). Our study has also revealed that manic patients had a higher level of CRP than the ones in control group at a statistically significant level. The platelet/lymphocyte and neutrophil/lymphocyte rates of the patients increased after the treatment compared to the pre-treatment period (respectively p=0,026, p=0,003).

The higher CRP levels in manic patients support the hypothesis of low-grade chronic inflammation, which is thought to be involved in the etiology of BD. The most important finding of this study is that there is no statistically significant difference of serum HMGB1 levels between the two groups. This can be explained by the fact that HMBG1 is one of the late mediators of inflammation and does not rise immediately during the acute period. However, since the inflammation process includes complex mechanisms involving many systems, it makes it difficult to comment on this issue.

None Declared

Choroid plexus (CP) is a physiological barrier, producing cerebrospinal fluid (CSF), neurotrophic, and inflammatory factors. It’s also involved in the neuro-immune axis, facilitating the interplay between central and peripheral inflammation, allowing trafficking of immune cells. Coherently, CP enlargement has been found in psychiatric diseases characterized by inflammatory signature. Although CP volume correlates with central microglia activation in major depressive disorder (MDD), it’s never been directly associated with peripheral markers in mood disorders.

Examine CP volume in mood disorders and healthy controls (HC) in relation to clinical features and peripheral inflammatory markers.

CP volume was extracted with FreeSurfer in 72 HC and 152 age- and sex-matched depressed patients: 79 BD and 73 MDD. Plasma analytes in patients were collected through immunoassay technology (Bioplex). We tested for the effect of age by group on CP volume. Then we focused on the interaction between illness duration and diagnosis in predicting CP volume. After testing the effect of specific analytes by diagnosis, we calculated moderated moderation models (SPSS, PROCESS) setting each analyte as independent variable, CP volume as predicted variable and illness duration and diagnosis as moderators. We get the effects’ significance with the likelihood ratio statistic, always controlling for age, sex, and intracranial volume.

Patients were comparable in illness duration and severity. CP volume is differentially distributed through groups (right: p=0.04; left: p<0.01), with higher volumes in the clinical groups. Age by group significantly predict right CP volume (p=0.01). Also, duration of illness differently predicts right CP volume in MDD and BD (p=0.03) (Figure1). Then, given the significant interaction effect of IL13 (p=0.02) and IL1ra (p=0.01) in predicting right CP, we run the moderated moderation model. Longer illness duration has an effect in strengthening the opposite predicting value of IL1ra (ΔR2=0.03, p<0.01) on right CP volume in MDD and BD (Figure2).

Image:

Image 2:

Our findings propose CP as a proxy of inflammation in depression, being significantly predicted by peripheral immune markers in MDD and BD. In particular, the signature of inflammation in depression, could represent the neurotoxic load of the disease over the illness, with a worse effect in BD, with possible disruption of brain barriers permeability and an opposite effect of tightening and central segregation in MDD. Further analyses are needed to better elucidate this neurobiological mechanisms across mood disorders.

None Declared

Despite the encouragingresearch findings concerning the predictive validity of the psychosis risk criteria, they are still insuffisant to justify treatment recommandations and attempts at preventive interventions for this early, non-specific illness phase. So far, diagnosis of the prodromal symptoms is largely based on patient reports of symptoms and/or collateral reporting, and yet remains relatively devoid of objective, brain-based biological markers. Adding specific predictors and biological markers to the clinical psychosis risk approach that could increase the predictive power of current psychosis risk criteria is a crucial step for early intervention efforts.

We reviewed all studies examining the biological markers in subjects with an ‘’At Risk Mental State” (ARMS) for psychosis and we discussed their predictive psychosis transition value.

A systematic search of the literature was performed using PubMed. The key words «Early psychosis / Prodromal symptoms / At risk mental state» in combination with «Biomarkers / Inflammatory markers / Stress» were used for the search.

We selected 18 papers: 2 literature reviews, 7 cross-sectional studies and 9 prospective studies. Aiello et al. (2012) reviewed studies examining biological markers of the stress response in the relatives of psychotic patients and in individuals at Ultra-High Risk (UHR) for psychosis. Karanikas and Garyfallos (2015) systematically reviewed data concerning the role of cortisol in patients at risk for psychosis mental state and its associations with psychopathological correlates. There was no review available of all biomarkers.

The biological markers that have been reported are mainly stress markers, endocrine and inflammatory markers.

Serum or salivary cortisol was the most studied marker. Studies stated that UHR subjects had higher cortisol levels than controls and that there was a positive correlation between cortisol levels and the severity of symptoms. Results of prospective studies were controversial.

High levels of prolactin were reported by 3 studies, including a prospective onewhichconcluded that prolactine may be considered as a biological marker of transition.

A prospective study found higher levels of interleukin-6 (IL-6) in UHR subjects than in controls. This study also reported significantly higher IL-6 levels in subjects who transitioned to psychosis compared to those who did not.

Despite advances in mental health research, there is still a lack of biological markers with clinical utility. The results of current studies should be interpreted with caution due to the small sample size of the prospective studies. The latter open up research perspectives in the identification of UHR subjects, taking into account other markers to better describe the profile of those who will present transition to psychosis.

None Declared

In recent years much focus has been put on the role of immune/inflammatory alterations in affecting Major Depression (MDD) development and antidepressant efficacy. Neutrophil-to-lymphocyte ratio (NLR) is an inexpensive inflammatory marker shown to be elevated in depressed patients, with large population studies reporting this effect only in women. However, its relation to treatment response is much less clear. Reduced hippocampal volumes (HV) are among the few consistent brain structural predictors of poor treatment response, and they have been shown to be influenced by inflammatory status.

To investigate the effect of NLR on treatment response in MDD patients, testing a possible moderating role of sex. To investigate the effect of NLR on HV and test a possible mediating role of the latter in the relation between NLR and treatment response.

Our study was performed on a sample of 120 MDD inpatients suffering from a non psychotic depressive episode (F=78; M=42). Depression severity was assessed via the Hamilton Depression Rating Scale (HDRS), both at admission and discharge; as a measure of treatment response, delta HDRS was calculated subtracting the two scores. NLR was calculated for each subject. Patients underwent 3T MRI acquisition and bilateral HV were estimated.

We found a significant moderating effect of sex on the relationship between NLR and Delta HDRS (p < 0.001): a negative relation was found in women (p < 0.001) and a positive one in men (p = 0.042). NLR was found to negatively affect left HV in the whole sample (p = 0.027) and in women (p = 0.038). A positive effect on Delta HDRS was found for both left (p = 0.038) and right (p = 0.027) HV. Finally, we found a significant indirect effect of NLR values on Delta HDRS through left HV in women (95% BCa CI [- 0.948, -0.017]); the direct effect of NLR on Delta HDRS also remained significant (p = 0.002).

Sex was found to moderate the relation between NLR and treatment response. The detrimental effect in women is in line with previous reports linking inflammation to hampered antidepressant effect; the positive one in men is more surprising: however, the only studies to date on the effect of NLR on antidepressant efficacy report a positive effect in patients with psychotic depression. In women we found NLR to affect treatment response partially through its effect on left HV, providing a possible, albeit incomplete, mechanistic explanation of the effect of inflammatory status on antidepressant efficacy.

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Over this decade, there has been progressive growth and evolution of the concept of autoimmune encephalitis. However, international consensus overly focus on major neurological signs, while discarding some attenuated presentations, sometimes with just psychiatric manifestations. It was only very recently that a new concept arouse from this disorder, named autoimmune psychosis, which can mimic schizophrenia. Unfortunately, there is still a lack of a structured approach of psychotic patients to cover this disorder. This has numerous implications, namely on management and prognosis of these patients. Not only, these patients have an increased risk of neuroleptic malignant syndrome, but it is also important to intervene early in the course of disease.

To conduct a review of the diagnostic and treatment guideliens of autoimmune psychosis

The authors conducted a non-systematic review, by resorting to the pubmed database, on the concept of autoimmune psychosis and updated proposals of diagnostic orienting lines.

Recently, in 2016, Graus et al proposed diagnostic criteria for possible autoimmune encephalitis, in which the authors acknowledge subacute onset of psychiatric symptoms as a possible clinical manifestation. The authors accept normal diagnostic tests, provided that new neurological focal findings exist. Since then, there have been described a list of signs/symptoms, which should raise suspicion for this diagnostic on psychiatric patients, so called red flags. In accordance to diagnostic guidelines for autoimmune psychosis, defined by Pollak et, the presence of this symptoms should lead clinicians to perform diagnostic exams, as MRI, eletroencephalogram and blood serological tests and lumbar puncture. However, others criticize this initial lineup arguing that some patients could be missed, because they do not have any neurological signs, and so they propose new diagnostic criteria.

Autoimmune psychosis represents an attenuated clinical form of autoimmune encephalitis, although demanding the same medication and prompt initiation of treatment as other autoimmune encephalitis. It is important to acknowledge that there are patients who are seronegative and that some of the diagnostic exams mentioned have sometimes limited availability. As acknowledged by Guasp et al, there are patients with first psychotic episodes that have an autoimmune etiology, but because of the lack of neurological signs, could potentially be missed of treatment. So, it is important to establish formal diagnostic guidelines for this disorder, namely orienting lines for first psychotic episodes, which is the most commson psychiatric manifestation. This also enlightens the need for neurologic and psychiatric cooperation for these patients.

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Several studies investigated the role of inflammation in the etiopathogenesis of psychiatric disorders, by also evaluating how CRP may exert a pathoplastic and/or psychopatological role in mood disorders.

The aim of our cross-sectional study is evaluating the high-sensitivity C-reactive-protein (hsCRP) levels in a cohort of unipolar and bipolar depressive inpatients, in relation with psychopathological, temperamental and chronotype features.

Among 313 screened inpatients, we recruited 133 moderate-to-severe depressive patients who were assessed for hsCRP levels, chronotype with Morningness-Eveningness Questionnaire (MEQ) and affective temperament with Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS).

hsCRP levels were significantly higher among those with previous suicide attempt (p=0.05), death (p=0.018) and self-harm/self-injury thoughts (p=0.011). In addition, hsCRP levels were significantly higher among patients with hypertension (p=0.020) and dyslipidemia (p=0.013). Moreover, positive correlation were found between hsCRP levels and the number of illness of years (p<0.001). Significant positive correlation were found between hsCRP levels and depressive (p<0.001) and cyclothymic (p<0.001) affective temperaments, while a negative correlations were reported between hsCRP levels and hypertimic (p<0.001) and irritable (p=0.029) affective temperaments. Eveningness chronotypes subject displayed higher hsCRP levels compared to intermediate-type and morningness-type chronotypes (p<0.001). Linear regression analyses, adjusted for all covariates, demonstrated that higher scores at the TEMPS-M depressive, while lower scores at the hyperthymic and irritable affective temperaments [F=88.955, R2=0.710, p<0.001] and lower MEQ scores [F=75.456, R2=0.405, p<0.001] statistically significantly predicted higher hsCRP.

Eveningness chronotype and a depressive affective temperament appeared to be associated with higher hsCRP levels during moderate-to-severe unipolar and bipolar depression. Further longitudinal and larger studies should better characterise patients with mood disorders by investigating the influence of chronotype and temperament.

None Declared