Mood disorders are complex illnesses possibly resulting from the interaction of genetic, physiological, psychological, and environmental factors.Within this framework, a role for early life stressors has been proposed. Although this association is probably not specific to Bipolar Disorders BDs, with early life stressors predisposing to trans nosological indicators for severity of psychiatric disorders, it may represent an early marker both for triggering and long-term clinical manifestations of BDs.

Insomnia likely plays a triggering role in the onset and maintenance of BDs, as it may might play a key role in BDs by potentially dysregulating the systems involved in mood and emotion regulation, including stress and inflammatory systems and circadian rhythms alterations. Early life stressors have been demonstrated to alter sleep regulation. It has been hypothesized that sleep disruption related to early life stressors might contribute to the development pathways towards BDs in adult life through the epigenetic re-reprogramming of stress and inflammatory systems.

We aimed to study their association with mood symptoms and suicidal risk in BDs with and without clinically significant insomnia symptoms. Since hopelessness is a construct strongly predicting depressive symptoms and suicidal risk in BDs and it has also been related to early life stress and to insomnia symptoms we aimed to specifically assess this symptom in our research.

a sample of 162 adult participants with BD I or II were assessed during depressed phase using the Structural Clinical Interview for DSM-5 (SCID-5), the Beck Depression Inventory-II (BDI-II), the Young Mania Rating Scale (YMRS), the Early Trauma Inventory Self Report-Short Form (ETISR-SF), the Beck Hopelessness Scale (BHS), the Insomnia Severity Index (ISI) and the Scale for Suicide Ideation (SSI). Participants with or without clinically significant insomnia were compared and we carried out correlations, regression and mediation analyses.

Participants with insomnia showed a greater severity of depressive symptoms,of suicidal risk, of the cognitive component of hopelessness and of early life stressors. Insomnia symptoms mediated the association among early life stress and depressive symptoms (Z = 2.72, p = 0.0006), the cognitive component of hopelessness (Z = 3.02, p = 0.0001) and suicidal ideation and plans (Z = 2.07 p = 0.0006).

fnsomnia may mediate the relationship between early life stress and clinical manifestations of BD. Assessing the evolution of insomnia symptoms could offer an approach to characterize BD and to formulate treatment strategies. In particular targeting insomnia symptoms might potentially modify the clinical features of BD in response to early life stressful events.

None Declared

The relationship between a series of periodic limb movements in sleep (PLMS) and heart rate variability (HRV) is not clearly established. HRV reflects changes in heart rate (HR) and autonomic nervous system (ANS) tonus as 2 main components: low-frequency HRV (HRV LF) and high-frequency HRV (HRV HF). An accumulating body of evidence suggests that a single PLMS alters HRV parameters. However, less is known about the impact of HRV changes when a series of PLMS occurs. Both PLMS and HRV have been reported to show associations with cardiovascular and psychiatric diseases.

PLMS have been associated with diverse psychiatric diseases in numerous studies. Longitudinal data demonstrate that patients with PLMS have an increased risk of depression and anxiety, and dementia. It should be noted, however, that it remains unclear how a series of PLMS affects the autonomic nervous system, cardiovascular system, and mental health. Therefore, the aim of this study was to verify the hypothesis that a series of PLMS is connected with a higher range of abnormalities in systolic and diastolic blood pressure (SBP and DBP, respectively), with particular interest in HRV HF and HRV LF scores before the series of PLMS and after the end of the series.

We undertook a retrospective analysis of polysomnography (PSG) and demographic and medical data of 5 patients with a total number of 1348 PLMS. We analyzed HR, HRV LF, HRV HF, systolic blood pressure (SBP), and diastolic blood pressure (DBP) for 10 heartbeats before the series of PLMS and 10 consecutive heartbeats as beat-to-beat measurements. The stage of sleep and duration of limb movement in each PLMS were also assessed. Statistics analysis was performed using IBM SPSS Statistics (v28.0.0.0). The Kruskal–Wallis test was performed to find statistically significant changes from the baseline.

No statistically significant changes in HR, SBP, or DBP were found in our group. HRV changed after the series of 8 PLMS, with both HRV HF and HRV LF increasing.

Our study presents for the first time the co-activation of both HRV HF and HRV LF, pointing toward the possible autonomic dysregulation in patients with a series of PLMS.

None Declared

Both women and men experience potentially stressful events during their reproductive periods and both are at risk of developing peripartum depression. Men have a reproductive period that is difficult to define, and research on their mental health has rarely considered the effects of paternity. A prevalence of postpartum depressive symptomatology of 10.4% has been described worldwide (Paulson J et al. 2010). Paternal depression is also a risk factor for peripartum maternal depression (Escribá et al, 2011; Paulson et al., 2016). Among the risk factors for developing postpartum depression in men are identified: personal history of depression, conflictive relationship, lack of family and social support, unemployment, older age, lower educational level, and the father’s ability to support his new role as a father (Morse et al., 2000).

Screening to investigate and identify early objective biomarkers in recent fathers of early depression.

An anonymous survey is carried out through GoogleForms, to 57 men, fathers, with children born alive under 1 year of age, which includes biopsychosocial aspects and a questionnaire for depression: PHQ9.

Of the total of 57 parents, the average age is 36 years. 4 of them are unemployed, 1 is a student, the rest have active work or parent´s licency. Only 10% refer to present economic problems. 36% reported that their partner had a risky pregnancy and 22% had a peripartum complication. 9% describe an unsatisfactory or very unsatisfactory relationship with the mother of their child(ren). 51% have a personal and/or family history of depression and/or anxiety. 57% are overwhelmed in their role as fathers. 33% feel they have little or no social/emotional support. 5% have increased the consumption of alcohol/psychotropic medication and 94% report that their sleep pattern has been affected. 3.5% refer self-injurious thoughts or that they would be better off dead. 14% have considered requesting/consulting with a psychiatrist/psychologist since the arrival of the baby.

In relation to PHQ 9, 5% present moderate/severe depression.

In conclusion, it seems relevant to think about a screening to investigate and identify early objective biomarkers and rapid intervention, not only in mothers but also in fathers and thus take a first step to broaden the view from the mother-child dyad to the triad, thus understanding that mental health does not exist in isolation, it is a contextual and relational phenomenon and also reduce the negative impact of this problem, such as: dysfunction and family well-being, marital satisfaction, growth and development of your child/ren . In this context, primary care health professionals (midwives and primary care doctors) could play a fundamental role in recognizing the importance of incorporating parents as relevant figures in health .

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Sleep and circadian markers are of increasingly growing interest to help better predicting suicide. Indeed, specific sleep disorders and circadian rhythm disorders have been associated to suicidal behaviors, and the most replicated findings are insomnia and nightmares. Nevertheless, these interesting preliminary studies did not examine the chronology and trajectories of these dream contents’ alterations before a suicidal crisis.

In this context, we decided to perform a naturalistic study to better understand the characteristic of this population during suicidal crisis, and to evaluate their past dream contents. We aimed to distinguish in this phenomenology three different experiences: bad dreams, nightmares (i.e. awakening bad dreams), and suicidal scenarii during dreams. We hypothesized that these dream experiences may have different chronologies of emergence, and that individuals with dream alterations, compared to individuals without dream alterations, present with different clinical characteristics.

This naturalistic study included individuals hospitalized between January 2021 and May 2021 in a psychiatric post emergency unit for suicidal crisis (thoughts and attempts).

The study observed that 80% (n=32/40) of patients had altered dreams (AD) before the suicidal crisis, including 27 (67.5%) with bad dreams, 21 (52.5%) with nightmares -awakening bad dreams- and 9 (22.5%) with suicidal scenarii during dreams. No differences were observed between the AD group versus no altered dream (ND) regarding sociodemographic characteristics. We observed a progression of dream content alterations: bad dreams appear 111 days (4 months) before the suicidal crisis, then nightmares appear 87.3 days before (3 months), and suicidal scenarii were reported 45.2 days before (1.5 month). For the AD and ND population in suicidal crisis, 80% met at least one subtype of dream alterations, 40% had bad dreams and nightmares, and 17.5% had the 3 subtypes. The AD group, compared to ND, had significantly more family history of insomnia (p=0.046). Almost all patients (97.5%) had depressive symptoms (MADRS≥7; 82.5% had moderate to severe symptoms, MADRS≥20), 60% had insomnia (ISI>14), 92.5% had altered sleep quality (PSQI>5), and 57.5% reported sleepiness (ESS>10).

Dream alterations and their progression could be readily assessed and may help to better identify prodromal signs of suicidal behaviors.

None Declared

Sleep is one of the most important factors for well-being. Numerous studies have linked poor sleep to negative consequences such as depression (Guo et al., 2014), substance use (Comasco et al., 2010), obesity (Wu et al., 2015), and suicidality (Liu & Buysse, 2006). Understanding the causes of poor sleep is an important public health concern. Childhood trauma can have a lifelong influence on mental health and development. However, many examinations of childhood trauma focus on the number of experiences and not the impact of specific experiences. Research has shown gender differences in both insomnia and childhood maltreatment outcomes (Lee et al., 2014); however, less attention has been paid to the potential role of gender in the link between other types of childhood trauma and sleep disturbance.

The goal of the current study is to understand the role of gender in the relationship between childhood traumas and sleep problems among a community sample of emerging adults. This research aims to build on and extend previous work in three different ways: 1) add to the literature on childhood trauma among emerging adults; 2) examine specific types of childhood traumas; and 3) expand the categories to explore the role of some less studied adversities.

The study included a sample of 211 young adults from an urban community. Traumas were measured with the Brief Trauma Questionnaire (BTQ; Schnurr et al., 1999) and sleep was measured with the Pittsburgh Sleep Quality Index (Buysse et al., 1989). Logistic regression was used to calculate odds ratios for the relationship between sleep problems and five traumas (involved in a serious accident, experienced serious injury, violent death of a close family member or friend, witnessed someone’s serious injury or death, and natural disaster).

Results showed that males and females experienced similar rates of trauma. Trauma experienced during childhood was associated with an increased prevalence of poor sleep. In the male model, being involved in a serious accident (OR=1.47), experiencing serious injury (OR=1.24), and experiencing a natural disaster (OR=1.11) were all significantly associated with poor sleep. In the female model, the violent death of a close family member or friend (OR=2.02), witnessing someone’s serious injury or death (OR=1.78), and experiencing a natural disaster (OR=1.69) were all significantly associated with poor sleep.

Traumatic events may impact men and women differently. Women in the study showed greater sleep problems in the wake of childhood traumatic events. They also responded more strongly to events that they saw happening to other people, while men were more greatly affected by things that happened directly to them. Natural disasters are a relatively common event that has a strong impact on sleep. Intervention efforts addressing trauma and poor sleep should be aware of gender differences for greater efficacy.

None Declared

Daridorexant, a dual orexin receptor antagonist, was shown to be effective and safe in improving sleep and daytime functioning in subjects with insomnia in two Phase 3 studies. All patients screened had subjective insomnia, but many did not meet the study eligibility criteria.

As the randomized subjects represent only a subsection of the real-world population, we analyzed differences in sleep microarchitecture between included and excluded subjects in both studies.

Out of 7016 screened subjects, 1851 randomized (included) subjects and 602 screen-failure (SF, excluded) subjects that had at least 1 scored eligibility polysomnography available, were included in this analysis. For the remaining SF subjects, no scored polysomnography was available. The randomized subjects met the DSM 5 insomnia disorder criteria and objective and subjective criteria for disrupted sleep. The main reasons for the 602 SF subjects were not meeting at least 1 objective sleep criteria for sleep onset latency, sleep maintenance, or total sleep time, however all excluded subjects had subjective insomnia. Delta (1-3Hz), theta (4-7Hz), alpha (8-12Hz), and beta (13-38Hz), band spectral power of sleep EEGs were estimated using multi-taper spectrograms (2s window/1s overlap). Relative power was computed using the sum of these four band powers within the 2s window as the denominator. The resulting relative and band power ratios were then aggregated to 30s epochs and assessed by sleep stages (N1, N2, N3, REM, Awake). Sleep spindles (amplitude, peak frequency, oscillation count, symmetry index, slow oscillation phase peak, duration, density, and dispersion) were calculated in N2 sleep using an open-source Luna package. Statistical analysis was done using a univariate analysis of spindle and spectral features via linear mixed-effects regression.

Age and sex distribution were similar between groups (Median age: 59vs59 years and 68%vs70% Females for included and excluded subjects, respectively). Included subjects had higher relative alpha power (5.6%; p<0.001) and lower relative delta power (-2.3%; p0.031) in N1 than excluded subjects. The mean relative spectral power did not differ significantly for other relative powers in N1 and for any relative powers in stages N2, N3, REM and AWAKE. Included subjects had lower spindle density (-9.8%; p0.005) than excluded subjects. Other spindle features did not significantly differ between the groups.

This comparison of sleep architecture between included and excluded subjects, showed only minor differences in sleep microarchitecture. This suggests that the sleep microarchitecture of the randomized subjects is similar to a broader insomnia population that has subjective insomnia but that does not meet all eligibility criteria including objective and subjective sleep duration thresholds.

T. Di Marco Employee of: Idorsia Pharmaceuticals Ltd, Y. Dauvilliers Consultant of: Idorsia Pharmaceuticals Ltd, T. Scammell Consultant of: Idorsia Pharmaceuticals Ltd, Neurocrine, Epilog, Roche and Jazz Pharmaceuticals, I. Djonlagic Grant / Research support from: NIH, Consultant of: Idorsia Pharmaceuticals Ltd, UCSD, A. Datta Consultant of: Idorsia Pharmaceuticals Ltd, Neurocrine, Epilog, Roche and Jazz Pharmaceuticals, G. Zammit Grant / Research support from: Idorsia Pharmaceuticals Ltd, Consultant of: Idorsia Pharmaceuticals Ltd, D. Seboek Kinter Employee of: Idorsia Pharmaceuticals Ltd, N. Tjiptarto Grant / Research support from: Idorsia Pharmaceuticals Ltd, J. Donoghue Grant / Research support from: Idorsia Pharmaceuticals Ltd.

Substance use disorders(SUDs) are a major health concern and current treatment interventions have proven only limited success. Despite increasing effectiveness, still about 50–60% relapse within 6–12 months after treatment [Cornelius et al., Addict Behav. 2003;28 381-386]. SUDs are defined as chronic disorders of brain reward system, motivation, and memory processes that have gone awry. Medication reducing craving and substance use is mainly available for alcohol dependence and to a lesser extent for other substances.

Hallucinogens may represent a group of agents with potential anti-craving properties subsequently reducing substance use in SUD patients. For instance, lysergic acid diethylamide(LSD) and psilocybin have previously been shown to effectively alleviate symptoms of alcohol and nicotine dependence.

New treatments preferably focusing on reducing craving and subsequent substance use are therefore urgently needed. The hallucinogen psilocybin may provide a new treatment option for SUD patients, given the beneficial results observed in recent studies

Systematic revision of literature.

In the 1950s, a group of drugs with potential to alter consciousness were discovered (hallucinogens). Several studies suggested their anti-SUD potential, improving self-acceptance and interpersonal relationships, reducing craving and alcohol use. As a result of its recreational popularity during the 1960s, they were banned in 1967, greatly hampering scientific research in this field. Recently, psilocybin, an hallucinogenic substance in psilocybin-containing mushrooms has gained popularity in neuropsychological research, showing to increase trait openness, cognitive and behavioral flexibility, and ratings of positive attitude, mood, social effects, and behavior and even reported persistent positive changes in attitude and behavior. These findings might suggest a valuable compound for the treatment of psychiatric conditions with several additional studies providing supportive evidence for the therapeutic potential of psilocybin for SUD treatment and relapse prevention.

With the reported limited amount of side effects and potential beneficial effects of psilocybin in SUD, there are valid reasons to further investigate the therapeutic efficacy and safety of psilocybin as a potential SUD treatment. On the one hand, psilocybin may exert its anti-addictive properties by beneficial effects on negative emotional states and stress. On the other hand, psilocybin may improve cognitive inflexibility and compulsivity. Research on the efficacy of psilocybin on SUD is still limited to a handful of published studies to date. As a result, many important questions related to the use of psilocybin as a complement to current treatment of SUD and its working mechanisms remain unanswered. Before psilocybin can be implemented as a treatment option for SUD, more extensive research is needed.

None Declared

Addiction has long been recognized as a disease that may have a dramatic influence on the addicted individual’s family members, manifesting as stress or trauma-related physical and psychological symptoms, resulting in increase in the usual family’s use of health-care services. There is little research available to identify and explore problems of families associated with such patients. In this study, we will evaluate stress among family members of substance abuse patients and try to focus on how these family members are dealing with these stress factors. The study will also compare different types of coping mechanisms among family members of patients taking licit and illicit substances.

To identify stress among families of patients abusing licit and illicit drugs and assess and compare their coping mechanisms.

175 family members of patients with licit substance abuse cases and 175 family members of patients with illicit substance abuse were taken for study after informed consent. Stress among participants was evaluated using Symptom Rating Test and The Depression Anxiety and Stress Scales (DASS). Coping Questionnaire (CQ) and Breif COPE was used to assess coping among them.

The study demonstrated that the total number and severity of symptoms, including psychological and physical symptoms, are found lesser in caregivers (participants) of patients abusing licit substances than in patients abusing illicit drugs. These symptoms among family members grow as the patient’s age rises. Symptoms in participants are more if their patient is female as compared to male. And also, total symptoms are more if they are living in nuclear family (Table 1). In our results, total coping and engaged coping mechanisms in family members are found to be not significant as per drug type and remains the same for both licit and illicit drugs abusing patients’ families. Avoidant coping mechanisms in family members are more if their patient is female and in nuclear family.Table 1

In our study, it was clearly noticed that the total symptoms, both physical and psychological, were found more in family members of patients abusing illicit drugs. Impact of substance abuse related problems is found more in female members compared to male members of family.

None Declared

The social consequences of alcohol affect not only drinkers, but also the people communicate with him. They are including: mental health, quality of life, health, living conditions and needs in using health system resources.

1,531 people were examined, who belonged to three qualitatively different comparison groups: patients with alcohol addiction (329 people); healthy relatives of patients with alcohol addiction (238 persons) and representatives of the general population (964 persons).

clinical, clinical and psychopathological, methods of quantified scales and mathematical statistics.

The data obtained indicate that the majority of respondents who caused some harm to the respondents were men. But the level of harm of alcohol abuse of women was significantly higher. Alcohol abuse problems of microsocial environment (substance abuse, employment, financial problems, and health effects) had a more significant effect on depressive disorders in the control group than in the alcohol addiction group and their relatives. Significant correlation of depressive disorders due to the drunkenness of others was associated with fear for children, the possibility of aggression. Depressive disorders in the group relatives of patients with alcohol addiction correlated with aggression towards them with patients with alcohol addiction or persons in a state of alcohol intoxication, discomfort due to being with their relatives in public, at parties, inability to control alcohol use. It was shown that the presence of drinkers in the company of women significantly increases the specific weight of people with depressive disorders among them, while such an effect was not found among male respondents. It has been established that in the case of the presence of drinkers in the environment, the expressiveness of such manifestations of depression as insomnia increases the most in women; weight loss, sexual disorders; suicidal tendencies and feelings of guilt. The influence of presence of drinkers in the environment of children on tfrequency of manifestations of their discomfort is described. It has been confirmed that the most frequent cause of children’s ill health is their drinking parents, as well as other (besides parents and siblings) drinking relatives. It was found that in healthy respondents, the unfavorable features of the behavior of relatives and close drinkers are always directly correlated with indicators of the ill health of children in their environment, while in respondents addicted to alcohol, these correlations have a complex, mosaic nature.

The study found the prevalence of depressive disorders in the microsocial environment of drinkers. A significant decrease in the quality of life was noted primarily in children and women who had drinking relatives with a large number of drunk days.

None Declared

Work addiction is currently an increasingly frequent phenomenon in several sectors of activity, particullarly the engineering sector, given the importance of technological advances and the development of organizational climates favoring competition.

To describe work addiction impact among tunisian computer engineers.

A descriptive cross sectional study was carried out from September first, 2020 to December 31st, 2020 including computer engineers working in several private engineering companies located at Grand Tunis area. Data collection was done through an online self-administered questionnaire. The level of work addiction was assessed by the Work Addiction Risk Test (WRAT) in its French version validated with 25 items evaluating five dimensions namely : Compulsive tendencies, control, lack of communication, inability to delegate and self-esteem. Burnout was identified by The Maslach Burnout Inventory.

A total of 92 computer engineers were included. The average age was 27 ± 4.7 years with extremes ranging from 23 to 55 years. The sex ratio (M / F) was equal to 1.48. Sixty-nine percent (69%) of engineers considered that their work takes so much energy and time that it had a negative impact on their private lives (less time spent with family, more marital conflicts, etc…). Fifty-four percent (54%) of engineers suffered from sleep disorders (difficulty falling asleep, repetitive nocturnal awakenings, etc). The results of the WART questionnaire showed that 58% of engineers were at risk of work addiction, of which 27% had a high risk. This group of engineers with a medium to high risk of work addiction had an average age of 26 ± 3.6 years with extremes ranging from 23 to 42 years. The sex ratio was equal to 1.52. They reported more negative impact of their work on their personal lives (p=0.010) and more reproaches from family members (p= 0.038). They were at risk of burnout syndrome (p=0.038). No statistically significant relationship between the risk of work addiction and the occupational characteristics (occupational category, seniority in the engineering position, number of hours spent at work / week, etc.) was found.

The occupational physician has a crucial role in screening work addiction and its consequences among engineers. Early detection among at-risk populations must be carried out by a multidisciplinary team for appropriate management of workaholic employees.

None Declared

There is some limited evidence of an association between technology addictions and the emergence of pre-psychotic symptoms, high psychoticism , psychotic like experiences, and high schizotypy among young non-clinical adults. These addictions and their subsequent distress are likely to contribute to transition to psychosis in individuals at risk .

we aimed to explore the association between Internet addiction and distress in the high schizotypy group , expecting that the two would be associated .

From a pool of 700 students, the final sample consisted of 74 low schizotypal and 70 high schizotypal students. Data were collected using a self-administered questionnaire which contained five research scales: The Schizotypal Personality Questionnaire (SPQ) , the Depression, Anxiety and Stress Scales (DASS-21) , the Internet Addiction Test (IAT).

Bivariate analyses revealed significant positive correlations between Internet addiction and depression (r=.344, p<.0001), anxiety (r=.320, p<.0001) and stress (r=.336, p<.0001) in the high schizotypy group. In this same group, positive symptoms of schizotypy correlated positively with internet addiction (r=.294 ;p=.014).

After controlling for demographics, psychosocial factors and schizotypy symptoms, Internet addiction predicted psychological distress in the high schizotypy group (R2= 0.380, F (13, 55) = 2.597, p<0.001) and explained an additional 19.7% of variation in DASS total scores in the final model (R2 Δ= 0.197)

This study’s results portrayed a statistically significant relationship between addiction to Internet and psychological distress in this at risk group.Although preliminary, our findings shed light on relatively new avenues for prevention and early intervention in psychosis. Given the widespread use of Internet among individuals with schizotypy, clinicians and researchers should find ways to utilize it as a potential resource to help these vulnerable individuals in their care pathways, by turning it into a protective rather than stressor factor.Finally, our findings highlight the need for further studies to better understand Internet use patterns and effects on young individuals in order to help mitigate its risks and increase its benefits.

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Over the past decades, the digital landscape has been rapidly changing worldwide, and the number of social media users has been constantly increasing. social media usage is widespread among the age groups going from Adolescents (aged 16-24 years) to young adults (aged 25-34 years) the vast majority of Tunisian students (98.4%) reported using social media platforms, with Facebook being the most widely used (94.3%), followed by YouTube (90.5%) and Instagram (65.0%) (Feten Fekih-Romdhane et al., 2021)

We aimed to compare Facebook addiction between low and high schizotypal individuals

the final sample included in this study was comprised of 700 students. Based on the Schizotypal Personality Questionnaire (SPQ) total scores, the sample was classified into two groups of low (the lower 10% of a standardization sample) and high (the upper 10%) schizotypy(Raine, 1991).

From the overall pool of 700 students (67.6% females, mean age of 21.5 ± 2.5 years), 74 identified as belonging to the low schizotypy group and 70 were classified as having high schizotypal traits .

Students of the high schizotypy group displayed significantly greater scores on Facebook (p=.001) addiction scales, as compared to those of the low schizotypy group

High schizotypal participants spent in average 7.4 hours on on social media use per day, as compared 3.9 hours on social media in their low schizotypal counterparts

Our study showcases that schizotypy is related to a certain level of addiction to social media. These results can be used as a way to help this at risk population by making social media into a safe space where we can provide help lines and protection

None Declared

Currently, there is an active development of methods for the laboratory diagnosis of alcohol abuse using biochemical markers.

The aim of this work was to estimate the prevalence of alcohol abuse among the urban population of Belarus using the concentration of phosphatidylethanol in the blood as a biochemical marker of alcoholism.

220 blood samples from Grodno residents of both sexes aged 15 to 65 were analyzed. The AUDIT questionnaire was used as a screening tool. Determination of the concentration of phosphatidylethanol in the blood was carried out using the method of high performance liquid chromatography - tandem mass spectrometry (HPLC - MS).

The average concentration of phosphatidylethanol in the blood of men and women was 266.11±54.57 and 55.27±9.43 nmol/ml, respectively. In 9.6% of blood samples, the concentration of phosphatidylethanol exceeded the threshold level of alcohol abuse. It was found that the concentration of phosphatidylethanol in the blood does not correlate with the total score, as well as the frequency and quantitative characteristics of the AUDIT screening test.

Determining the concentration of phosphatidylethanol in the blood is a more reliable way to diagnose alcohol abuse than using screening tools.

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The therapeutic use of lithium in bipolar disorder is often restricted due to its narrow therapeutic window and adverse drug reactions. Lithium-induced early renal dysfunction is clinically important as it may lead to sodium depletion due to natriuresis leading to lithium retention and lithium toxicity. This is most often seen in the initial phases of therapy, and psychiatrists struggle titrating the dose of lithium and stabilizing the serum lithium level.

The present study was conducted to evaluate the effect of add-on sodium chloride on serum lithium levels in bipolar disorder.

The present randomized controlled trial (NCT04222816) was conducted in 60 patients with type I bipolar disorder who were randomized into the control group who received lithium carbonate with the advice not to take additional salt (at the table) and the test group who received sachets of sodium chloride (1 g/d) as an add-on to lithium carbonate and were advised to restrict their additional salt intake (at the table) to 1 g/d. After baseline assessments, all patients were followed up at 4 weeks, 8 weeks, and 12 weeks when serum lithium, sodium and potassium were estimated. Serum creatinine and aldosterone were repeated at 12 weeks.

In the test group, the fluctuation rate in serum lithium (26.7%) was significantly (p=0.01) lower than in the control group (63.3%). There was a significant difference in serum lithium in the control group at different time points; however, the changes were not significant in the test group. There was a significant difference in serum lithium between the groups at 8 and 12 weeks of follow-up. There were no significant differences in the change in serum sodium, potassium, creatinine, aldosterone, creatinine clearance, and blood pressure within the group and between the groups. A significant positive correlation was found between serum lithium and aldosterone at baseline.

Intake of add-on sodium chloride (1 gm/day) may reduce the fluctuations in serum lithium during the maintenance phase of lithium therapy in type I bipolar disorder.

None Declared

Childhood maltreatment (CM) has been associated to an increased risk of developing bipolar disorder (BD). A role of the hypothalamus-pituitary-adrenal (HPA) axis in mediating trauma-related risk for adult psychopathology has been suggested but scarcely investigated in BD.

The aim of this study is to explore the impact of childhood maltreatment on clinical features of BD and on the activity of the HPA axis.

One hundred and six patients participated in the study. On the basis of their history of childhood trauma, as assessed by the Childhood Trauma Questionnaire (CTQ), they were divided into a group with a history of childhood maltreatment (CM+) and a group without (CM−). Twenty-nine participants (16 with a history of childhood trauma and 13 without) underwent the cortisol awakening response (CAR) test. Saliva cortisol concentrations were determined by an enzyme immunoassay method, using a commercially available ELISA kit.

According to CTQ, 62 had a history of childhood maltreatment and 44 had not. CM was significantly more frequent in females than males. CM+ patients showed significant higher body mass index (p = .01), number of suicide attempts (p = .03), and more severe mania symptoms (p = .01) than CM− ones. Significant associations between lifetime suicide attempts and any type of childhood maltreatment (OR = 2.79; CI = 1.01-7.73) and between emotional abuse and the presence of psychotic symptoms (OR = 2.74, CI = 1.11-6.74) or mixed mood episodes were found (OR = 2.62, CI = 1.07-6.43). Moreover, CM+ individuals with BD exhibited a significantly reduced CAR with respect to CM− ones.

Our results add to literature findings showing a worse clinical course in BD patients with a history of childhood maltreatment and show for the first time that childhood trauma exposure is associated to impaired CAR in adults with BD.

None Declared

Myasthenia gravis (MG) is an autoimmune disease that affects the neuromuscular junction. It causes generalized muscle weakness that may include the respiratory muscles, potentially leading to a medical emergency known as a myasthenic crisis. Several medications, including some antipsychotics, have been shown to worsen myasthenia gravis symptoms.

We aim to summarize the current knowledge on the use of psychopharmacological treatments in patients with MG.

Non-systematic review of the literature was performed in PubMed/Medscape database. Case report of a patient who was admitted and treated in our inward patient unit.

We present a clinical case of a 64-year-old man diagnosed with Bipolar Disease at the age of 18 and recently diagnosed with MG (he was hospitalized in Neurology Department, pyridostigmine was introduced and lithium was reduced to half dose). Three months later he was admitted to the emergency department due to behavior and speech disorganization, persecutory delusional ideas, insomnia and caregiver exhaustion. During his hospitalization lithium was increased to 1200 mg. At day 8 of admission the patient started to show weakness of neck extensor muscles, due to that he was evaluated by neurology, lithium was stopped and haloperidol was increased resulting in clinical improvement.

Psychotropic choice in patients with MG can be challenging due to their anticholinergic properties that can exacerbate MG symptoms with potential deterioration to a myasthenic crisis. There is a great need for evidence-based data on the safety and efficacy of psychotropic medications in MG.

None Declared

Depressive episodes represent the most frequent mood alteration in bipolar disorder (BD). Persistent depressive episodes and subsyndromic depressive symptoms often lead to poor quality of life and increase suicide risk. Recent studies have also shown that BD patients with a history of predominant depressive episodes generally show poorer response to pharmacological treatments. Although not specifically approved in Italy for use in bipolar depression, the scientific literature produced so far suggests the possible use of cariprazine in clinical conditions of bipolar depression that do not respond to conventional treatments.

The aim of the study was to evaluate, in a real-world multicentric Italian clinical setting, the efficacy and safety of cariprazine augmentation strategy in a sample of patients suffering from treatment-resistant bipolar depression.

16 resistant bipolar depressed patients, whose resistance was defined according to The CINP Guidelines on the Definition and Evidence-Based Interventions for Treatment-Resistant Bipolar Disorder, were observed for 4 weeks after the add-on to previous mood stabilizing treatment of a cariprazine 1,5 mg fixed dose. Psychopathology at time 0 and at 1, 2, 3, and 4 weeks of treatment was evaluated using the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Young Mania Rating Scale and the Brief Psychiatric Rating Scale; safety and tolerability of the therapy was measured by the UKU Side Effect Rating Scale.

Clinical improvement induced by 1,5 mg cariprazine add-on was effective and well tolerated in the study sample. Improvement in depression scores started from the first week, reaching about 35% reduction within 15 days and almost 50% in the following weeks (mean HDRS score from 24,7 to 13,2, GLM r.m. p<0,001); global psychopathology improved (mean BPRS score from 29,9 to 15,3 GLM r.m. p<0,001) as well as anxiety symptoms (mean HARS score from 26,5 to 16,5 GLM r.m. p=0,003). No manic shifts were observed during the observation period and the treatment was generally well tolerated.

Despite the small number of patients examined and the short term of observation, cariprazine could represent an effective and safe enhancement strategy for patients with bipolar depression resistant to common pharmacological treatments. Further studies on larger samples are needed to confirm these preliminary findings. In addition, a more prolonged observation would be appropriate to highlight whether the beneficial effect of cariprazine add-on persists over time.

None Declared

Psychiatric diseases are often accompanied by medical comorbidities, and cardiovascular system disease is one of the most important causes of death in bipolar disorder (BD) and schizophrenia (SCH) [1]. The QRISK3 algorithm calculatesa person’s risk of developing cardiovascular disease over the next ten years and it has been used in psychiatric research in recent years [2].

In this study, we aimed to evaluate the relationship between cardiovascular risks (by using QRISK3 algorithm) and treatment options in patients of BD and SCH.

Thirty-six patients with bipolar disorder and thirty-two patients with schizophrenia recruited between the years 2016-2022. All of the patients were treated with long-acting injectable (LAI) antipsychotics. Sociodemographic information, clinical features and medical treatment agents of individuals were recorded. The risk of development of cardiac disease of the patients were evaluated by the QRISK3 algorithm. Descriptive and regression statistical analysis was performed with Statistical Package for the Social Sciences (SPSS).

More than half of the patients were male (n= 39, 57.4%) and single (n= 40, 58.8%). The mean duration of education was 9.2 ±3.5 years and the mean age was 39.7 ±11.9 years of the patients. Nearly half of the patients had a diagnosis of BD (n= 36, 52.9%) while others had SCH (n:32, 47.1%). Most of the patients were treated with LAI of aripiprazole (n= 36, 59.2%) and the rest of them were treated with LAI of paliperidone (n= 32, 40.8%). When demographic and clinical data of BD and SCH patients were compared, there was no significant difference in terms of age. However, SCH patients had a longer disease duration (t= 2.56, p= 0.013) and more hospitalization (t= 3.35, p= 0,002) than BD patients. Our findings showed positive correlations between age (r= 0.74, p<0.01), duration of disease (r= 0.57, p< 0.01), and duration of LAI use (r= 0.55, p< 0.01) with QRISK. A regression analysis to examine related factors associated with QRISK found that having a diagnosis of schizophrenia (β= 0.27, t= 2.58; p= 0.01) and a long disease duration (β= 0.67, t= 6.50, p< 0.01) were associated with the development of cardiovascular disease. However, there was no relationship between LAIs (paliperidone vs aripiprazole) used in the treatment and QRISK.

The significant correlation found between duration of disease and QRISK -that indicate the risk of development of cardiac disease- confirming the progressive nature of the BD and SCH. Moreover, the significant correlation between SCH and QRISK suggests that SCH is a chronic and severe disease that causes more cardiac dysfunction than BD. However, we could not find a significant difference between LAIs in terms of QRISK, these results can be changed by evaluating other variables such as comorbidities, other medical treatments and physical activities in future research.

None Declared

Emotion dysregulation (ED) is a multidimensional construct involving the lack of awareness, understanding and acceptance of emotions, a reduced access to adaptive and appropriate strategies to modulate the intensity or duration of emotional responses, and the inability to control behaviors in accordance with desired goals when experiencing negative emotions. ED is outlined in the general population and several psychiatric disorders, including bipolar disorder (BD), and influences its clinical course and management, quality of life, and daily social functioning.

The objective of this systematic review was to examine the correlations between maladaptive (i.e., positive and negative rumination, negative focus, risk taking behaviors, suppression, and dampening) and adaptive (i.e., cognitive reframing, adaptive coping, and acceptance) strategies of emotion regulation (ER) and depressive and manic symptoms of BD.

We searched the literature from inception to April 12, 2022, and included studies focusing on ER/ED assessed with a validated scale. We conducted multiple pairwise meta-analyses for correlations between ED dimension (or overall ED) and the measures of depressive and manic symptoms of BD, and separate Bayesian network meta-analyses to examine which aspects of emotion regulation were most closely associated with depressive and manic symptoms of BD. The Pearson’s r coefficients were adjusted using sample-size weights and Fisher’s r-to-z transformed was conducted.

A total of 13,826 records was identified and, after duplicate removal and title/abstract evaluation, 442 were explored at the full text. Sixteen studies were finally included. Results from pairwise meta-analyses are shown in Figure 1, results from network meta-analyses in Figure 2 and 3. Both depressive and manic BD symptomatology were found to be related to maladaptive ER strategies, with the only difference of positive rumination, associated only to manic symptoms. Negative rumination and risk-taking behaviors were the strategies more correlated to both manic and depressive symptoms, as confirmed by both pairwise metanalyses and network metanalyses. On the other hand, depressive symptomatology appeared more correlated with decreased adaptive strategies than manic symptomatology.

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ED has a significant correlation with BD symptomatology, therefore it should be explicitly considered during clinical assessment, diagnosis, and intervention on BD, and specific treatments should be implemented. More studies, and with longitudinal design, are needed to better explore these associations and their causal direction. In addition, future studies should mainly focus on the complex interactions between cognitive, social, and cultural aspects, and biological correlates to improve knowledge on a topic that is still poorly investigated.

V. Oliva: None Declared, M. De Prisco: None Declared, G. Fico Grant / Research support from: “La Caixa” Foundation (ID 100010434 - fellowship code LCF/BQ/DR21/11880019), Consultant of: Angelini, Janssen-Cilag and Lundbeck, A. Murru Grant / Research support from: Spanish Ministry of Science and Innovation (PI19/00672) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdirección General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER), Consultant of: Angelini, Idorsia, Lundbeck, Pfizer, Takeda, M. Fornaro: None Declared, A. Serretti Consultant of: Abbott, Abbvie, Angelini, AstraZeneca, Clinical Data, Boehringer, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Innovapharma, Italfarmaco, Janssen, Lundbeck, Naurex, Pfizer, Polifarma, Sanofi, Servier, and Taliaz, J. Radua Grant / Research support from: Spanish Ministry of Science and Innovation (PI19/00394, CPII19/00009) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdirección General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER) and the Instituto de Salud Carlos III, E. Vieta Grant / Research support from: Spanish Ministry of Science and Innovation (PI18/00805, PI21/00787) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdirección General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER); the Instituto de Salud Carlos III; the CIBER of Mental Health (CIBERSAM); the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2017 SGR 1365), the CERCA Programme, and the Departament de Salut de la Generalitat de Catalunya for the PERIS grant SLT006/17/00357. Thanks the support of the European Union Horizon 2020 research and innovation program (EU.3.1.1. Understanding health, wellbeing and disease: Grant No 754907 and EU.3.1.3. Treating and managing disease: Grant No 945151), Consultant of: AB-Biotics, AbbVie, Angelini, Biogen, Boehringer-Ingelheim, Celon Pharma, Dainippon Sumitomo Pharma, Ethypharm, Ferrer, Gedeon Richter, GH Research, Glaxo-Smith Kline, Janssen, Lundbeck, Medincell, Novartis, Orion Corporation, Organon, Otsuka, Rovi, Sage, Sanofi-Aventis, Sunovion, Takeda, and Viatris

Most of the research explored the attrition rate and predictive factors for the smartphone application of emotion monitoring in bipolar disorder patients. However, there is less focus on the efficacy of maintaining the retention rate if the incentive system is employed.

The aim of our research is to evaluate the efficacy of two different kinds of incentive systems on improving frequency of using the Smartphone Mood Relapse Warning application (MRW-APP) (Su et al., 2021) in bipolar patients.

A one-group pretest-posttest pilot study was conducted. Participants with bipolar disorder (n = 63) recorded their moods and symptoms through MRW-APP for 29 weeks with the attrition rate of 44%. Two different kinds of incentive systems, reward and lottery, were implemented. To know whether incentive implementation could play a role in motivating the participants to better adhere to the app, we used Friedman’s test and paired sample t-test to analyze the participants’ app-using frequency in the corresponding weeks.

There was no significant difference in the participants’ app-using frequency (p>.05) before and after we implemented the first incentive system, reward (n=63). For the second incentive system, lottery (n=41), a significant difference in app-using frequency was still not observed (p>.05) after the intervention. But, for those who both had experienced two kinds of incentive systems (n=35), there were significant changes in their app-using frequency (p<.05).Table 1.Demographics (n=63)

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This research found the two incentive systems, award and lottery, may help increase the using frequency of the smartphone monitoring app for participants with bipolar disorder. The results from our study can be a reference for mood monitoring apps development in the future, and it also suggested that incentive system has its potential on encouraging patients’ adherence to e-healthcare.

None Declared