Neuroticism is a significant predictor of adverse psychological outcomes in patients with cancer. Less is known about how this relationship manifests in those with noncancer illness at the end-of-life (EOL). The objective of this study was to examine the impact of neuroticism as a moderator of physical symptoms and development of depression in patients with amyotrophic lateral sclerosis (ALS), chronic obstructive pulmonary disease (COPD), end-stage renal disease (ESRD), and frailty in the last 6 months of life.

We met this objective using secondary data collected in the Dignity and Distress across End-of-Life Populations study. The data included N = 404 patients with ALS (N = 101), COPD (N = 100), ESRD (N = 101), and frailty (N = 102) in the estimated last 6 months of life, with a range of illness-related symptoms, assessed longitudinally at 2 time points. We examined neuroticism as a moderator of illness-related symptoms at Time 1 (∼6 months before death) and depression at Time 2 (∼3 months before death) using ordinary least squares regression.

Results revealed that neuroticism significantly moderated the relationship between the following symptoms and depression measured 3 months later: drowsiness, fatigue, shortness of breath, wellbeing (ALS); drowsiness, trouble sleeping, will to live, activity (COPD); constipation (ESRD); and weakness and will to live (frailty).

These findings suggest that neuroticism represents a vulnerability factor that either attenuates or amplifies the relationship of specific illness and depressive symptoms in these noncancer illness groups at the EOL. Identifying those high in neuroticism may provide insight into patient populations that require special care at the EOL.

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

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

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

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

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

None Declared

Obsessive–compulsive disorder (OCD) is a chronic, prevalent, and highly impairing psychiatric illness. Although the pathophysiology of OCD remains unknown, pathways involved in oxidative stress (OS) have been implicated. However, the complete clinical picture has been rarely considered, and it remains unclear whether oxidative dysregulation is inherent to OCD pathophysiology, or whether it is a consequence of confounding factors such as age, body mass index (BMI) or smoking.

In this work, we aim to assess oxidant and antioxidant markers and its clinical correlates in a well characterized sample of patients with OCD and controls, to test the hypothesis that altered OS markers are associated with OCD, rather than to illness-related behavioral changes or comorbidities.

60 patients with OCD and 60 age and sex-matched control volunteers were recruited and assessed for sociodemographic and clinical variables using the Yale-Brown Obsessive-Compulsive Scale-II, the Beck Depression Inventory-II and the State-Trait Anxiety Inventory and Mini International Neuropsychiatric Interview. Three oxidant [8-hydroxy-2’-deoxyguanosine (8-OhdG), malondialdehyde, protein carbonyl] and three antioxidant [catalase, glutathione-peroxidase and superoxide dismutase (SOD)] markers were assessed in serum using Enzyme-Linked Immunosorbent Assay (ELISA). After comparing between groups, the association between OS markers and OCD characteristics, psychiatric medication and psychiatric comorbidities was assessed among patients with OCD. All analyses were adjusted for BMI, smoking and presence of physical comorbidities.

The six OS markers were similar between patients with OCD and controls. Among patients with OCD, patients with more obsessive and depressive symptoms had lower concentrations of 8-OHdG, although this correlation may be sensitive to extreme values. Also, those who were on higher doses of antidepressants had lower concentrations of SOD. The remaining OS markers were not associated with OCD characteristics, psychiatric medication, or comorbidities.

Our results suggest that OS markers in blood do not seem to be a good biomarker of disease in symptomatic adult patients with OCD, and that OCD characteristics and comorbidities do not seem to have a clear impact on OS profile. Several factors contribute to the robustness of our findings, namely the sample size, the adjustment for confounding factors, and the assessment of a representative panel of OS markers using strict experimental methods. Future studies should always control for confounding factors when assessing OS markers and study OS profile in more specific samples, such as children or treatment-naïve patients.

None Declared

The use of selective serotonin reuptake inhibitors (SSRIs) has increased exponentially and worldwide in the last decade. Taking into account their tolerability and safety profile, they constitute the first line, in all age groups and in polimedicated population, for treatment of depressive, anxious, and phobic disorders, among others. Although safe, especially when compared to first generation antidepressants, they are not totally exempt of adverse effects, and may cause, especially in this context, some degree of cognitive impairment, which may or may not be completely reversible. On the other hand, and despite the controversy related to the subject, some studies suggest a possible protective effect of this pharmacologic class regard the development of cognitive disfunction, which, although not very consistent, should not be neglected.

To understand the cognitive impact of short- and long-term use of SSRIs, given the increasing use in an aging, polymedicated population.

Brief sistematic review of selected articles from Pubmed, Medline and Uptodate databases, with the keywords “SSRIs”, “cognitive”, “impairment”, “adverse effects”, “dementia”.

SSRIs are not entirely exempt from cognitive effects, despite their recognized safety profile. Some of the adverse effects typically related to the class, such as hyponatraemia, especially when insidious and silent course, as well as anticholinergic activity (typically associated with first generation antidepressants, but not exclusive) interfere with global functionality and may clinically present as mild cognitive impairment or even major neurocognitive disorders. Furthermore, given their potential to induce or inhibit the cytochrome P450 system, they are significantly implicated in pharmacokinetic drugs interactions that increase cognitive burden associated with other psychotropic drugs.

In the long term, and in certain patient populations, it has been hypothesized that they may exert some protective effect on physiological and pathological cognitive functions decline, by preventing neuronal death, acetylcholine decrease and amoyloidogenesis.

Despite their benign adverse effect profile, when compared with tricyclic antidepressants, SSRIs are not devoid of adverse effects on cognitive domains. However, and despite contradictory and inconsistent results, when well tolerated, SSRIs may confer benefits in terms of preserving global functionality, far beyond the affective symptoms resolution that motivated their introduction in the first place.

None Declared

Obsessive-compulsive disorder (OCD) is a psychiatric disorder affecting 1.3% of the population worldwide where both genetic and environmental factors, such as perinatal events and neuroinflammation, are thought to contribute to the etiology of the disorder. In the past, the description of clinical entities such as Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS), in which an acute neuropsychiatric syndrome with prominent obsessive-compulsive features emerges in children infected with group-A beta-hemolytic streptococcus (GABHS), sparked the hypothesis that infections may be a risk-modifying factor for the development of OCD. Along with streptococcal infections, other pathogens such as Toxoplasma gondii have been implicated in the pathophysiological models of the disorder, although causal associations have not been established for any of beforementioned pathogens.

To perform a systematic review and meta-analysis about the presence of biological evidence of infection in patients diagnosed with OCD.

We conducted a systematic review and a meta-analysis (PROSPERO registration CRD42021223415) by performing a standardized electronic database search in MEDLINE/PubMed, Web of Science, Embase and Scopus. Search was conducted on 17/10/2022. Eligible papers included case-control and cohort studies using a comparator group, that tested for specific biomarkers providing evidence of infection in patients diagnosed with OCD; exclusion criteria included studies without quantitative or qualitative measures of infection, case reports, systematic or scope reviews, and animal studies. Selection process was conducted according to PRISMA 2020 statement guidelines. Study quality was assessed through Newcastle-Ottawa Quality Assessment Scale.

We identified 8911 records through the search after duplicate removal. A total of 22 studies met inclusion criteria after selection process, and 15 were eligible for meta-analysis. Most evidence concerned Toxoplasma gondii (10 studies), and patients with OCD appear to have higher odds of being infected compared to controls, with a meta-analytic odds ratio of 2.39 (95% IC 1.60-3.58), when comparing 467 patients with 5411 controls. However, most studies were methodologically heterogeneous, which compromises the interpretation of meta-analytic results. Information regarding other agents, including GABHS, Borna disease virus and Toxocara canis was gathered but due to an insufficient number of papers it was not possible to perform a meta-analysis for each of them.

Our work suggests that albeit exhaustively reported in the literature, there is no strong evidence of the over-representation of biomarkers of infection in patients with OCD compared to control volunteers. Methodologically robust studies are needed to further test this hypothesis.

None Declared

The aim of this study was to investigate the psychometric properties of the Spanish version of the Stigma of Occupational Stress Scale for Doctors (SOSS-D) and the factors associated with Physician Burnout in Paraguay.

Participants included 747 Paraguayan healthcare workers, aged 24–77 years old, of both sexes. SOSS-D was translated into Spanish and validated through an exploratory and confirmatory factor analysis. Participants were also scored with the Oldenburg Burnout Inventory (OLBI), the CAGE questionnaire, and the stigma subscale of the Perceived Barriers to Psychological Treatment (PBPT) measure.

Three factors had a raw eigenvalue greater than 1, and explained 61.7% of total variance. The confirmatory analysis confirmed that the scale is three-dimensional. The model adjustment was good, according to all fit indices. OLBI results indicate clinically significant disengagement in 85.9% and clinically significant exhaustion in 91.6% of participants. Of the 747 participants, 57.6% reported alcoholic beverage consumption and among those, 19.3% had problematic alcohol consumption according to the CAGE questionnaire. The correlation between SOSS-D and the stigma subscale of the PBPT was statistically significant (r = 0.245, p < 0.001).

The Spanish version of the SOSS-D was found to have good psychometric properties and adequately reproduces the three-dimensional model of the original English version.

Obsessive-compulsive disorder (OCD) is a chronic, prevalent, and highly impairing psychiatric illness. While its aetiology remains unknown, several infectious agents have been associated to obsessive-compulsive symptoms, including herpes simplex virus 1 (HSV-1) and Toxoplasma gondii.

To evaluate the serostatus for HSV-1 and Toxoplasma gondii in sample of patients with OCD, as well as its clinical and brain imaging correlates.

Twenty-six patients with OCD and 30 healthy controls recruited in Lisbon were assessed for sociodemographic and clinical characteristics using the Yale-Brown Obsessive-Compulsive Scale-II (YBOCS-II) and the Beck Depression Inventory-II (BDI-II). Seropositivity for HSV-1 and Toxoplasma gondii was assessed in serum using ELISA, and volumes of cortical and subcortical structures were assessed using T1-weighted magnetic resonance imaging.

YBOCS-II and BDI-II scores were significantly higher in patients, while age, sex, smoking status, and seropositivity for HSV-1 and Toxoplasma gondii were similar between the two groups. Among OCD patients, those seropositive for HSV-1 had significantly lower volumes of total white-matter, total grey-matter, left and right putamen, while for HSV-1 seropositive healthy controls, only the last two were significantly smaller. In multiple regression analyses to control for age, associations between HSV-1 and brain volumes were conserved, while the effect of age was not significant. No significant differences were found in brain volumes of patients with OCD according to seropositivity for Toxoplasma gondii.

Our preliminary results suggest that in patients with OCD, seropositivity to HSV-1 is associated with smaller volumes of total white- and grey-matter in the brain.

No significant relationships.

Despite the multitude of clinical manifestations of post-acute sequelae of SARS-CoV-2 infection (PASC), studies applying statistical methods to directly investigate patterns of symptom co-occurrence and their biological correlates are scarce.

We assessed 30 symptoms pertaining to different organ systems in 749 adults (age = 55 ± 14 years; 47% female) during in-person visits conducted at 6–11 months after hospitalization due to coronavirus disease 2019 (COVID-19), including six psychiatric and cognitive manifestations. Symptom co-occurrence was initially investigated using exploratory factor analysis (EFA), and latent variable modeling was then conducted using Item Response Theory (IRT). We investigated associations of latent variable severity with objective indices of persistent physical disability, pulmonary and kidney dysfunction, and C-reactive protein and D-dimer blood levels, measured at the same follow-up assessment.

The EFA extracted one factor, explaining 64.8% of variance; loadings were positive for all symptoms, and above 0.35 for 16 of them. The latent trait generated using IRT placed fatigue, psychiatric, and cognitive manifestations as the most discriminative symptoms (coefficients > 1.5, p < 0.001). Latent trait severity was associated with decreased body weight and poorer physical performance (coefficients > 0.240; p ⩽ 0.003), and elevated blood levels of C-reactive protein (coefficient = 0.378; 95% CI 0.215–0.541; p < 0.001) and D-dimer (coefficient = 0.412; 95% CI 0.123–0.702; p = 0.005). Results were similar after excluding subjects with pro-inflammatory comorbidities.

Different symptoms that persist for several months after moderate or severe COVID-19 may unite within one latent trait of PASC. This trait is dominated by fatigue and psychiatric symptoms, and is associated with objective signs of physical disability and persistent systemic inflammation.

No significant relationships.

Coronavirus disease (COVID-19) has been associated with the development mental and behavioural symptoms and psychiatric disorders. This association is stronger in severe cases of the disease and in those needing inpatient treatment, particularly in intensive care units (ICU).

To determine the incidence of psychiatric disorders in a Portuguese hospital-based sample of patients with COVID-19. To describe relevant demographic and clinical data.

We reviewed all COVID-19 inpatients assessed by liaison psychiatry at our hospital between April and September 2020. Patients admitted due to a psychiatric disorder were excluded from the analysis. We reviewed medical records and retrieved relevant clinical data. ICD-10 was used to classify diagnoses.

We identified 36 cases with a mean age of 62.64 years-old (SD 19.23). The most common disorder was delirium, which occurred in 41.7% of our sample (15 patients), followed by adjustment disorder (22.2%, n=8), and depressive episode (16.7%, n=8). Most patients had no personal (61.1%, n=22) nor family (75%, n=27) history of a psychiatric disorder. Mean length of admission was 36.89 days (SD 28.91). Seventeen cases (47.22%) had at least one risk factor for severe COVID-19 disease and 14 (38.89%) were admitted at some point to the ICU.

In our sample, delirium was the main cause for mental or behavioural symptoms in COVID-19 patients. However, we observed a wide array of presentations in our center. A larger sample would allow to better characterize this often-overlooked symptoms and identify risk factors to psychiatric syndromes.

No significant relationships.

COVID-19 is a respiratory disease and its main symptoms are fever, dry cough and difficulty breathing. It spread to several countries, which led the World Health Organization to decree, on March 11, 2020, a pandemic state that deeply affected Brazil. Due to the impossibility of leaving the house, the routine of children with autism was changed. Children in Autism Spectrum Disorder (ASD) have a qualitative deficit in social interaction. Clinical and daily observations reinforce several scientific studies that defend the importance of maintaining a routine as stable as possible for people with ASD, without this stability they may become emotionally disorganized, feel discomfort or even irritability.

Investigate the impact caused by social distancing on the development of children and adolescents with autism.

An online questionnaire based on the DIR/Floortime basic map of emotional functional capacity development was distributed in Brazil from April to May, 2020. The results were analyzed using SPSS software.

Results obtained from 122 questionnaires showed that after 30 days of quarantine 20% of children no longer had the characteristic of being able to remain calm and organized for at least 2 minutes; 11% no longer initiates interactions with their parents; 27% demonstrated more protests and anger than before the social distancing; 18% demonstrated more emotions such as anger, fear and intimacy, 28% began to understand their limits and 12% of the children are using greater facial expression during the social distancing.

This study brings results that can help to understand the processes in a child with autism.

Obsessive compulsive disorder (OCD) affects 2-3% of the general population. The neurobiology of OCD has been linked to dysfunction of cortico-striatal circuits connecting the orbitofrontal (OFC) to the striatum. Recently, this loop has become an approved target for non-invasive neuromodulatory treatment of OCD.

To explore structural and functional connectivity of the OFC in OCD subjects and healthy controls.

14 OCD patients and 12 age/sex-matched controls underwent magnetic resonance imaging (MRI) (3T-Philips scanner) for diffusion tensor imaging (DTI) and resting state functional connectivity (rsFC). DTI images were brain extracted and corrected for movement and eddy currents. A diffusion tensor model was fitted to each voxel and used to generate Fractional Anisotropy (FA) maps. Voxel-wise statistical analysis of FA was performed using Tract-Based Spatial Statistics. RsFC images were preprocessed and seed-based correlation (SBC) analysis was performed using Data Processing Assistant for Resting-State fMRI.

We found decreased values of FA in the body of the Corpus Callosum bilaterally (MNI_coordinates: x= 16, y= -16, z= 33 and x= -19, y= -16, z= 42) and left superior longitudinal fasciculus in OCD patients (fig 1, left), as well as decreased rsFC of the right superior orbitofrontal seed with the left inferior frontal gyrus and left middle occipital gyrus (fig 2, right).

Using an exploratory multimodal approach we found evidence of abnormal structural and functional long-range connectivity of the OFC in OCD. If confirmed in a larger sample these connectivity abnormalities could be explored as potential predictors of response to OFC-targeted non-invasive neuromodulatory interventions.

No significant relationships.

Obsessive-Compulsive Disorder (OCD) is an incapacitating Neuropsychiatric condition characterized by the presence of obsessions and/or compulsions. Although the disorder’s phenotype is well described, its pathophysiology remains elusive (Aouizerate et al, 2004). Over the last decade, techniques to noninvasively study the brain’s neurophysiology, such as Transcranial Magnetic Stimulation (TMS), have found widespread use in psychiatric research. For OCD, single- and paired-pule TMS protocols have been used to explore abnormalities in motor cortex excitability and cortical neuroplasticity. Here we propose to systematically review and, where possible, metanalyse existing case-control studies that compared such measures in patients and healthy subjects.

To systematically review and meta-analyse published case-control studies comparing cortical excitability measures, as measured by single- or paired-pulse TMS, in subjects with OCD and healthy controls.

We have conducted a systematic review of published literature (PROSPERO registration CRD42020201764) reporting measures of cortical excitability as measured by single or paired-pulse TMS, in patients with OCD and healthy controls. We searched 4 different electronic libraries (PubMed, Web of Science, EMBASE, PsycINFO). The resulting list of articles was reviewed, separately, by two researchers. Disagreements were discussed and resolved by consensus, until a final list of eligible articles was obtained.

13 studies reporting motor cortex excitability measures were included in our final list. The total number of participants included in our analyses is 615 (349 OCD; 180 healthy subjects; 86 other conditions)

A sufficient number of studies was found to allow for metanalyses, currently ongoing.

Perfectionism is a consistent risk factor for various psychopathological conditions, including psychological distress and eating disorders. Recently, we have shown, for the first time, that there is a relationship between perfectionism and generalized problematic internet use/GPIU (Sobral et al. 2020). Specifically, we found that the role of perfectionism in psychological disorder is partially mediated by GPIU. On the other hand, it has been suggested that the widespread use of digital media can lead to negative body image perception and abnormal eating attitudes and behaviors.

To explore, for the first time, the relationship between perfectionism, GPIU and disordered eating behavior.

475 university students (78.9% girls; mean age 20.22±1.695) answered the Portuguese validated versions of: Composite Multidimensional Perfectionism Scale, GPIU Scale and Eating Attitudes Test-25. SPSS and Hayes’ Process Macro (2020) were used.

Bulimic Behaviours/BB significantly and moderately correlated with Perfectionist efforts (r=.263), Perfectionist concerns (r=.284) and GPIU (r=.25) (all p<.001). The mediation analyses revealed that GPIU is a partial mediator of the relationship between both perfectionism dimensions and BB.

The evidence that both negative and “positive” perfectionism dimensions are associated to eating pathology is in line with our previous research. The present study adds, for the first time, that one of the perfectionism pathways of influence on BB operates through UGPI. Assessment and intervention to diminish eating psychopathology should focus on perfectionism and compulsive traits which could be involved in both ED and GPIU and in their comorbidity.

No significant relationships.

The aim of this study is to test the psychometric properties of the Spanish validation of the Fear of COVID-19 Scale (FCV-19S) in a Paraguayan population.

Participants were recruited through an Internet-based survey. All participants whose scores in the Hospital Anxiety and Depression Scale (HADS) and The Fear Questionnaire (FQ) were greater than zero were included. 1245 subjects responded voluntarily: 1077 subjects, scoring >0, were considered.

To establish construct validity of the FCV-19S, an exploratory factor analysis was performed using the KMO test, which was adequate, and the Bartlett sphericity test, which was significant (p <.0001). The CFI, NFI, GFI, TLI and RMSEA indices were used to evaluate the model and showed good adjustment. Cronbach’s α showed valid internal consistency (α = 0.86). This validation was supported by significant correlation (p <.001) with the HADS scale for anxiety and depression and with the FQ scale for specific phobia.

The Spanish version of the FCV-19S is a 7-item scale with two dimensions, psychological symptoms and physiological symptoms, which demonstrated robust psychometric properties in a Paraguayan population.

Using as a starting point a clinical case, the authors performed a literature review to clarify the relationship between Behçet disease and acute psychosis.

Analysis of the patient's clinical process and brief review of the latest available literature on the subject, published in PubMed/Medline databases.

Male patient, 55 years old, brought to the emergency room by fever, headache, hetero-aggressive behavior, disinhibited behavior, mood swings, euphoria, persecutory delusions and insomnia, in the last 4 days. He had no insight into his illness. There was no personal or family history of psychiatric illness and toxicological habits were irrelevant. Due to the personal history of posterior uveitis with bilateral macular edema, retinal vasculitis, genital aphthosis, papulo-vesicular lesions and recurrent bipolar aphthosis, the hypothesis of neuro-behçet was raised.

Behçet's disease can present with neurological involvement - neuro -behçet - and can manifest itself with several psychiatric symptoms (euphoria, lack of insight, disinhibited behavior, agitation or psychomotor retardation, persecutory delusions, obsessive thoughts, anxiety, depression, insomnia or memory changes). Fever and headache usually appear in the prodromal stage and can be signs of onset or recurrence of the disease. The prevalence of neuro-behçet ranges from 2 to 50% and usually occurs 1 to 10 years after the first symptoms of the disease. Since it appears as the first manifestation of the disease in only 3% of cases, it is difficult to diagnose. The literature suggests that symptoms are generally resistant to treatment with conventional psychotropic drugs and so it is an important cause of morbidity and mortality.”

To investigate the role of perfectionism in the development of disordered eating behaviours.

382 female university students completed the Hewitt & Flett MPS and the EAT-40 at baseline, one year after (T1) and two years later (T2).

Perfectionism at baseline was significantly associated with long-term abnormal eating attitudes/behaviours. Self-Oriented Perfectionism (SOP) and Socially Prescribed Perfectionism (SPP) were significant predictors of disordered eating behaviours. SOP at baseline was predictive of diet concerns, at T1 and T2. Baseline SPP was correlated with overall eating disturbance at T1 and T2. Regression analysis revealed that only SPP was a significant predictor of bulimic behaviours and social pressure to eat at T1, but not at T2.

Our findings contribute to a more clear understanding of the association between perfectionism and eating disorders. SOP and SPP were prospectively associated with abnormal eating attitudes/behaviours and SOP was found to be predictive of diet concerns.