The recent addition to both ICD-11 and DSM-V of “Prolonged Grief Disorder” “PGD” raises questions regarding the complexity of the clinical manifestations and the nuances of “normal/abnormal” grief. The lack of consensus in diagnosing emphasizes grief as a non-homogeneous process highly dependent on cultural nuances and the proportion of losses.

Provide an open discourse on (PGD) emphasizing its multicultural aspects in the diagnosis, and debate whether it reinforces mental health stigma by “pathologizing” grief in today’s multicultural society.

Non-systematic review of literature using key words “Grief”, “Prolonged Grief Disorder”, “Multicultural aspects of Grief”, “Major Depressive Disorder” and “Disenfranchised Grief”, on the platforms PubMed, Medline, Google Scholar, “European Commission”, “International Migration Outlook 2022” and “Pordata”.

Literature has not clearly provided a universal definition of grief, grief processes or the threshold of abnormality. Grief lasting longer than expected is often equated to Major Depressive Episodes, given symptomatic similarities. Migration, war and the pandemic have played a significant role in how people currently grieve. Evidence showed that in 2021 alone there was a 22% increase in the permanent immigrant population. Moreover, the top five nationalities applying for first time asylum in the EU (2022) were: Syrian, Afghan, Venezuelan, Turkish, Columbian, and as of September 2022, 5 million Ukrainian refugees were registered. These figures are not neglectable and show the multiculturality of todays EU population. However, the development of transcultural psychometric tools accessing grief has not been uniform, lacking consistency in validating various transcultural factors. On the other hand, actively diagnosing “Prolonged Grief Disorder” has shown helpful to clinicians in recognizing the debilitating effects of some pernicious grief responses and quickly providing the necessary help.

Diagnosing “PGD” might lead to “psychiatrization” and “medicalization” of normative emotional processes, given different cultural backgrounds, especially due to the absence of universally applicable tools validating transcultural factors. Consequently, an inadequate consideration of context leaves patients feeling invalidated, non-supported and disenfranchised. A culturally sensitive approach is crucial, focusing on individual differences for effective grief intervention and support.

None Declared

Adults diagnosed with Borderline Personality Disorder (BPD) likely have a history of psychological trauma. There has been research about the connection between Complex Post-Traumatic Stress Disorder (c-PTSD) and BPD.

This paper provides a review of the relationship between complex trauma and key features of BPD.

Review of the literature from 2015 to present, using search engines such as Pubmed and Google Shoolar, using the following keywords: borderline personality disorder, complex post-traumatic stress disorder, trauma

Traumatic victimisation and compromised primary caregiving relationships have been hypothesized to be key aetiological factors in the subsequent development of BPD. c-PTSD was defined as a syndrome with symptoms of emotional dysregulation, dissociation somatisation and poor self-esteem, with distorted cognition about relationships, following traumatic interpersonal abuse. It was proposed as an alternative for understanding and treating people who had suffered prolonged and severe interpersonal trauma, many of whom were diagnosed with BPD. Although, the boundaries between c-PTSD and BPD remain vague. Currently, the main difference is the assumption that symptoms of c-PTSD are sequelae of exposure to traumatic stress, which is not inherent in the current DSM-5 definition of BPD. Furthermore, to date, the neurochemistry and neurostructural changes seen in c-PTSD, BPD and PTSD do not clearly differentiate the three conditions.

BPD and PTSD are relatively distinct with regard to the precise qualitative definitions of their diagnostic features, but nevertheless have substantial potential overlap in their symptom criteria.

No significant relationships.

About a decade ago, the idea of a Late-Onset Post Traumatic Stress Disorder (LO-PTSD) emerged, in order to characterize the later-life emergence of symptoms related to early-life warzone trauma among aging combat Veterans.

This paper provides a review of the changes happened during the onset of a late form of PTSD and how can mental health professionals intervene.

Review of the literature from 2015 to present, using search engines such as Pubmed and Google Schoolar, using the following keywords: Late-Onset Post Traumatic Stress Disorder, triggers, prevention, intervention

At first, there was hypothesized that aging-related challenges (role transition and loss, death of family members and friends, physical and cognitive decline) might lead to increased reminiscence, and possibly distress, among Veterans who had previously dealt successfully with earlier traumatic events. However, recent studies have proposed that in later life many combat Veterans confront and rework their wartime memories in an effort to find meaning and build coherence. Through reminiscence, life review, and wrestling with issues such as integrity versus despair, they intentionally reengage with experiences they avoided or managed successfully earlier in life, perhaps without resolution or integration. This process can lead positively to personal growth or negatively to increased symptomatology.

Therefore the role of preventive intervention in enhancing positive outcomes for Veterans who reengage with their wartime memories in later life should be reconsidered.

No significant relationships.

CHD increases the risk of infective endocarditis due to the substrate of prosthetic materials and residual lesions. However, lesion-specific and mortality risks data are lacking. We sought to analyse clinical course and mortality of infective endocarditis in a cohort of adult CHD.

Retrospective analysis of all cases of proven and probable infective endocarditis (Duke’s criteria) followed in our adult CHD clinic between 1970 and August, 2021. Epidemiological, clinical and imaging data were analysed. Predictors of surgical treatment and mortality were assessed using regression analysis.

During a mean follow-up of 15.8 ± 10.9 years, 96 patients had 105 infective endocarditis episodes, half with previous cardiac surgery (corrective or palliative). The most frequent diagnoses were: ventricular septal defect, bicuspid aortic valve, Tetralogy of Fallot and pulmonary atresia. The site of infection was identified by echocardiography in 82 episodes (91%), most frequently in aortic (n = 27), tricuspid (n = 15), and mitral (n = 13) valves. Blood cultures were positive in 79% of cases, being streptococci (n = 29) and staphylococci (n = 23) the predominant pathogens. Surgery was necessary in 40% and the in-hospital mortality was 10.5%, associated with heart failure (p < 0.001; OR 13.5) and a non-surgical approach (p = 0.003; OR 5.06).

In an adult CHD cohort, infective endocarditis was more frequent in patients with ventricular septal defect and bicuspid aortic valves, which contradicts the current guidelines that excludes them from prophylaxis. Surgical treatment is often required and mortality remains substantial. Prevention of this serious complication should be one of the major tasks in the care of adults with CHD.

We aimed to investigate the heterogeneity of seasonal suicide patterns among multiple geographically, demographically and socioeconomically diverse populations.

Weekly time-series data of suicide counts for 354 communities in 12 countries during 1986–2016 were analysed. Two-stage analysis was performed. In the first stage, a generalised linear model, including cyclic splines, was used to estimate seasonal patterns of suicide for each community. In the second stage, the community-specific seasonal patterns were combined for each country using meta-regression. In addition, the community-specific seasonal patterns were regressed onto community-level socioeconomic, demographic and environmental indicators using meta-regression.

We observed seasonal patterns in suicide, with the counts peaking in spring and declining to a trough in winter in most of the countries. However, the shape of seasonal patterns varied among countries from bimodal to unimodal seasonality. The amplitude of seasonal patterns (i.e. the peak/trough relative risk) also varied from 1.47 (95% confidence interval [CI]: 1.33–1.62) to 1.05 (95% CI: 1.01–1.1) among 12 countries. The subgroup difference in the seasonal pattern also varied over countries. In some countries, larger amplitude was shown for females and for the elderly population (≥65 years of age) than for males and for younger people, respectively. The subperiod difference also varied; some countries showed increasing seasonality while others showed a decrease or little change. Finally, the amplitude was larger for communities with colder climates, higher proportions of elderly people and lower unemployment rates (p-values < 0.05).

Despite the common features of a spring peak and a winter trough, seasonal suicide patterns were largely heterogeneous in shape, amplitude, subgroup differences and temporal changes among different populations, as influenced by climate, demographic and socioeconomic conditions. Our findings may help elucidate the underlying mechanisms of seasonal suicide patterns and aid in improving the design of population-specific suicide prevention programmes based on these patterns.

The belief that specific stages of the lunar cycle are related to human biology or behaviour has been present in popular culture since antiquity. Based on folklore or on clinical experience, several studies investigating possible links between the lunar cycle and mental illness were performed, with controversial results. To date, according to our knowledge, no study has yet considered a possible variability of the relationship with the seasons.

Our study aims to explore the relationship between the lunar cycle and acute manic states in bipolar patients, including a differentiation by seasons.

We designed an exploratory study, retrospectively analysing admissions of manic episodes over the period 2007/2013. Admission dates and dates of last symptomatic worsening were separated into seasons and then distributed into one of four quarters of the moon's synodic cycle. The last symptomatic worsening dates were obtained using information from admission notes, being considered whenever mentioned accurately and within no more than one week of admission.

Concerning the Autumn/Winter (n=221), we found a statistically significant disparity in the distribution of cases by lunar quarters in the admission dates of manic episodes (p=0.038), especially in episodes with psychotic symptoms (n=196; p=0.018), and in the last symptomatic worsening of manic episodes (n=60; p<0.001). No statistical significance was found during the Spring/Summer.

The lunar cycle appears to be strongly associated with acute manic states in bipolar patients, but the association seems determined by the season. Further studies are needed to corroborate or refute these results.

Tuberous sclerosis complex is a rare genetic disorder leading to the growth of hamartomas in multiple organs, including cardiac rhabdomyomas. Children with symptomatic cardiac rhabdomyoma require frequent admissions to intensive care units, have major complications, namely, arrhythmias, cardiac outflow tract obstruction and heart failure, affecting the quality of life and taking on high healthcare cost. Currently, there is no standard pharmacological treatment for this condition, and the management includes a conservative approach and supportive care. Everolimus has shown positive effects on subependymal giant cell astrocytomas, renal angiomyolipoma and refractory seizures associated with tuberous sclerosis complex. However, evidence supporting efficacy in symptomatic cardiac rhabdomyoma is limited to case reports. The ORACLE trial is the first randomised clinical trial assessing the efficacy of everolimus as a specific therapy for symptomatic cardiac rhabdomyoma.

ORACLE is a phase II, prospective, randomised, placebo-controlled, double-blind, multicentre protocol trial. A total of 40 children with symptomatic cardiac rhabdomyoma secondary to tuberous sclerosis complex will be randomised to receive oral everolimus or placebo for 3 months. The primary outcome is 50% or more reduction in the tumour size related to baseline. As secondary outcomes we include the presence of arrhythmias, pericardial effusion, intracardiac obstruction, adverse events, progression of tumour reduction and effect on heart failure.

ORACLE protocol addresses a relevant unmet need in children with tuberous sclerosis complex and cardiac rhabdomyoma. The results of the trial will potentially support the first evidence-based therapy for this condition.