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Background:Late-life depression is a highly prevalent disorder that causes a large economic burden. A stepped collaborative care program was set up in order to improve care for patients with late-life depression in primary care in Germany: GermanIMPACT is the adaption of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) program that has already been established in primary care in the USA. The aim of this study was to determine the cost-effectiveness of GermanIMPACT compared with treatment as usual from a societal perspective.Methods:This study is part of a 12-month bi-centric cluster-randomized controlled trial aiming to assess the effectiveness of GermanIMPACT compared with treatment as usual among patients with late-life depression. A cost-effectiveness analysis using depression-free days (DFDs) was performed. Net-monetary benefit (NMB) regressions adjusted for baseline differences for different willingness-to-pay (WTP) thresholds were conducted and cost-effectiveness acceptability curves were constructed.Results:In total, n = 246 patients (intervention group: n = 139; control group: n = 107) with a mean age of 71 from 71 primary care practices were included in the analysis. After 12 months, adjusted mean differences in costs and DFDs between intervention group and control group were +€354 and +21.4, respectively. Only the difference in DFDs was significant (p = 0.022). According to the unadjusted incremental cost-effectiveness ratio, GermanIMPACT was dominant compared with treatment as usual. The probability of GermanIMPACT being cost-effective was 80%, 90% or 95% if societal WTP per DFD was ≥€70, ≥€110 or ≥€180, respectively.Conclusion:Evidence for cost-effectiveness of GermanIMPACT relative to treatment as usual is not clear. Only if societal WTP was ≥€180 for an additional DFD, GermanIMPACT could be considered cost-effective with certainty.

Background:Applying the concept of burnout to medical students before residency is relatively recent. Its estimated prevalence varies significantly between studies. Our objective was to estimate the prevalence of burnout in medical students worldwide.Methods:We systematically searched Medline for English-language articles published between January 1, 2010 and December 31, 2017. We selected all the original studies about the prevalence of burnout in medical students before residency, using validated questionnaires for burnout. Statistical analyses were conducted using the OpenMetaAnalyst software.Results:Prevalence of current burnout was extracted from 24 studies encompassing 17,431 medical students. Among them, 8060 suffered from burnout and we estimated the prevalence to be 44.2% [33.4%–55.0%]. The information about the prevalence of each subset of burnout dimensions was given in nine studies including 7588 students. Current prevalence was estimated to be 40.8% for ‘emotional exhaustion’ [32.8%–48.9%], 35.1% [27.2%–43.0%] for ‘depersonalization’ and 27.4% [20.5%–34.3%] for ‘personal accomplishment’. There is no significant gender difference in burnout. The prevalence of burnout is slightly different across countries with a higher prevalence in Oceania and the Middle East than in other continents.Conclusions:The results of this meta-analysis suggest that one student out of two is suffering from burnout, even before residency. Again, our findings highlight the high level of distress in the medical population. These results should encourage the development of preventive strategies.

There is conceptual overlap between negative and depressive symptoms: Mainly the ‘avolition’ factor of negative symptoms also encompasses main symptoms of depression. However, whereas in depression mood is low, mainly anticipatory anhedonia can be found in negative symptoms. Moreover, patients with schizophrenia (SCZ) show greater expressive deficits than those with Major Depressive Episode (MDE). We investigated if measures of depressive and negative symptoms differentiate SCZ subjects, subjects with MDE, and healthy controls (HC). 21 SCZ, 22 MDE, and 25 HC subjects were examined with a rater assessment and a self-rating for negative symptoms (Clinical Assessment Interview for Negative Symptoms (CAINS); Motivation and Pleasure – Self-Report (MAP-SR)) and depressive symptoms (Hamilton Rating Scale for Depression (HAMD-17); Beck Depression Inventory (BDI)). All measures differentiated the psychiatric samples from HC (all p’s < 0.01). The ratings of depressive symptoms (HAMD-17, BDI) and rater assessment of negative symptoms (CAINS) – specifically its sub scale measuring expressive deficits – managed to discriminate between subjects with schizophrenia and those with MDE (SCZ > MDE > HC for negative, MDE > SCZ > HC for depressive symptoms, all p’s < 0.05). The self-rating of negative symptoms (MAP-SR) did not. To differentiate negative symptoms and depression clinicians might look for (self-)reported low mood and observer-rated reduction in speech as well as in gestures and facial expression. Reduced expression and moderate levels of depression point towards a negative syndrome, whereas mostly unimpaired expression and high scores of self-reported depressive symptoms are more likely to indicate a depressive syndrome.

Background Mental disorders in comorbidity with chronic skin diseases may worsen disease outcome and patients’ quality of life. We hypothesized the comorbidity of depression, anxiety syndromes, or symptoms as attributable to biological mechanisms that the combined diseases share. Methods We conducted a systematic review based on the Preferred Reporting Items for Systematic Review and Meta-Analysis statement searching into PubMed, PsycInfo, and Scopus databases. We examined the literature regarding the comorbidity of psoriasis (Ps), atopic dermatitis (AD), or hidradenitis suppurativa with depression and/or anxiety in adults ≥18 years and the hypothetical shared underlying biological mechanisms. Results Sixteen studies were analyzed, mostly regarding Ps and AD. Brain-derived neurotrophic factor/tropomyosin receptor kinase B signaling and nuclear factor kappa-light-chain-enhancer of activated B cells/p38 mitogen-activated protein kinase pathways arose as shared mechanisms in Ps animal models with depression- and/or anxiety-like behaviors. Activated microglia and neuroinflammatory responses emerged in AD depressive models. As to genetic studies, atopic-dermatitis patients with comorbid anxiety traits carried the short variant of serotonin transporter and a polymorphism of the human translocator protein gene. A GA genotype of catechol-O-methyltransferase gene was instead associated with Ps. Reduced natural killer cell activity, IL-4, serotonin serum levels, and increased plasma cortisol and IgE levels were hypothesized in comorbid depressive AD patients. In Ps patients with comorbid depression, high serum concentrations of IL-6 and IL-18, as well as IL-17A, were presumed to act as shared inflammatory mechanisms. Conclusions Further studies should investigate mental disorders and chronic skin diseases concurrently across patients’ life course and identify their temporal relation and biological correlates. Future research should also identify biological characteristics of individuals at high risk of the comorbid disorders and associated complications.

Background Patients with depression are more susceptible to cardiovascular illness including vascular surgeries. However, health outcomes after vascular surgery among patients with depression is unknown. This study aimed to investigate associations of depression with post-operative health outcomes for vascular surgical patients. Methods A retrospective observational study was conducted using data from a large mental healthcare provider and linked national hospitalization data for the same south London geographic catchment. OPCS-4 codes were used to identify vascular procedures. Health outcomes were compared between those with/without depression including length of hospital stay (LOS), inpatient mortality, and 30 day emergency hospital readmissions. Predictors of these health outcomes were also assessed. Results Vascular surgery was received by 9,267 patients, including 446 diagnosed with depression. Patients with depression had a higher risk of emergency admission for vascular surgery (odds ratio [OR] 1.28; 1.03, 1.59), longer index LOS (IRR 1.38; 1.33–1.42), and a higher risk of 30-day emergency readmission (OR 1.82; 1.35–2.47). Patients with depression had higher inpatient mortality after adjustment for sociodemographic status (1.51; 1.03, 2.23) but not on full adjustment, and had longer emergency readmission LOS (1.13; 1.04, 1.22) after adjustment for sociodemographic factors and cardiovascular disease. Correlates of vascular surgery hospitalization among patients with depression included admission through emergency route for longer LOS, inpatient mortality, and 30-day hospital readmission. Conclusion Patients with depression undergoing vascular surgery have substantially poorer health outcomes. Screening for depression prior to surgery might be indicated to target preventative measures.

BackgroundDepressive symptoms are highly prevalent among partnered dementia caregivers, but the mechanisms are unclear. This study examined the mediating role of loneliness in the association between dementia and other types of care on subsequent depressive symptoms.MethodsProspective data from partnered caregivers were drawn from the English Longitudinal Study of Aging. The sample consisted of 4,672 partnered adults aged 50–70 living in England and Wales, followed up between 2006–2007 and 2014–2015. Caregiving was assessed across waves 3 (2006–2007), 4 (2008–2009), and 5 (2010–2011), loneliness at wave 6 (2012–2013), and subsequent depressive symptoms at wave 7 (2014–15). Multivariable logistic regression models were used to assess the association between caregiving for dementia and depressive symptoms compared to caregiving for other illnesses (e.g., diabetes, coronary heart disease (CHD), cancer, and stroke). Binary mediation analysis was used to estimate the indirect effects of caregiving on depressive symptoms via loneliness.ResultsCare for a partner with dementia was associated with higher odds of depressive symptoms at follow-up compared to those not caring for a partner at all (odds ratio [OR] = 2.6, 95% confidence intervals [CI]: 1.4, 5.1). This association was partially mediated by loneliness (34%). Care for a partner with other conditions was also associated with higher odds of depressive symptoms compared to non-caregiving partners (OR = 1.7, 95% CI: 1.2, 2.5), but there was no evidence of an indirect pathway via loneliness.ConclusionLoneliness represents an important contributor to the relationship between dementia caregiving and subsequent depressive symptoms; therefore, interventions to reduce loneliness among partnered dementia caregivers should be considered.

Background Symptoms may be more useful prognostic markers for mental illness than diagnoses. We sought to investigate symptom domains in women with pre-existing severe mental illness (SMI; psychotic and bipolar disorder) as predictors of relapse risk during the perinatal period. Methods Data were obtained from electronic health records of 399 pregnant women with SMI diagnoses from a large south London mental healthcare provider. Symptoms within six domains characteristically associated with SMI (positive, negative, disorganization, mania, depression, and catatonia) recorded in clinical notes 2 years before pregnancy were identified with natural language processing algorithms to extract data from text, and associations investigated with hospitalization during pregnancy and 3 months postpartum. Results Seventy-six women (19%) relapsed during pregnancy and 107 (27%) relapsed postpartum. After adjusting for covariates, disorganization symptoms showed a positive association at borderline significance with relapse during pregnancy (adjusted odds ratio [aOR] = 1.36; 95% confidence interval [CI] = 0.99–1.87 per unit increase in number of symptoms) and depressive symptoms negatively with relapse postpartum (0.78; 0.62–0.98). Restricting the sample to women with at least one recorded symptom in any given domain, higher disorganization (1.84; 1.22–2.76), positive (1.50; 1.07–2.11), and manic (1.48; 1.03–2.11) symptoms were associated with relapse during pregnancy, and disorganization (1.54; 1.08–2.20) symptom domains were associated with relapse postpartum. Conclusions Positive, disorganization, and manic symptoms recorded in the 2 years before pregnancy were associated with increased risk of relapse during pregnancy and postpartum. The characterization of routine health records from text fields is relatively transferrable and could help inform predictive risk modelling.

Background. This study aimed to identify clinical and cognitive factors associated with increased risk for difficult-to-treat depression (DTD) or treatment-resistant depression (TRD). Methods. A total of 229 adult outpatients with major depression were recruited from the mental health unit at a public hospital. Participants were subdivided into resistant and nonresistant groups according to their Maudsley Staging Model score. Sociodemographic, clinical, and cognitive (objective and subjective measures) variables were compared between groups, and a logistic regression model was used to identify the factors most associated with TRD risk. Results. TRD group patients present higher verbal memory impairment than the nonresistant group irrespective of pharmacological treatment or depressive symptom severity. Logistic regression analysis showed that low verbal memory scores (odds ratio [OR]: 2.02; 95% confidence interval [CI]: 1.38–2.95) together with high depressive symptom severity (OR: 1.29; CI95%: 1.01–1.65) were associated with TRD risk. Conclusions. Our findings align with neuroprogression models of depression, in which more severe patients, defined by greater verbal memory impairment and depressive symptoms, develop a more resistant profile as a result of increasingly detrimental neuronal changes. Moreover, our results support a more comprehensive approach in the evaluation and treatment of DTD in order to improve illness course. Longitudinal studies are warranted to confirm the predictive value of verbal memory and depression severity in the development of TRD.

Background. Eating disorders (EDs) are serious mental illnesses that can be life-threatening. Stage of illness models and early intervention strategies could be informed by a better understanding of symptomatology that precedes the onset of an ED. This review aims to explore which symptoms (both ED and other psychiatric disorder-related) exist prior to the onset of an ED and whether there any prospective associations between these symptomatologies. Methods. A systematic literature review was conducted in MEDLINE, Embase, and PsycINFO for large, longitudinal, prospective studies in nonclinical cohorts of children/adolescents that report symptoms prior to the onset of an ED. A quality assessment of included studies was conducted using the Newcastle-Ottawa Quality Assessment Scale. Results. A total of 22 studies were included, and over half were assessed to be of good quality. Studies identified the presence of a broad range of ED and other psychiatric disorder-related symptoms prior to ED onset. Possible prospective associations were identified, including early eating and feeding difficulties in childhood, to ED-related symptoms (e.g., dieting and body dissatisfaction) and other psychiatric disorder-related symptoms (e.g., anxiety and depression) in childhood/early adolescence, progressing to severe symptomatology (e.g., extreme weight control behaviors and self-harm) in mid-adolescence/emerging adulthood. Conclusion. The trajectory of symptoms identified to precede and possibly predict onset of an ED may inform early intervention strategies within the community. Suggestions for further research are provided to establish these findings and the clinical implications of these discussed, in order to inform how best to target prodromal stages of EDs.

Background: The 2019 coronavirus disease (COVID-19) pandemic, with its associated restrictions on daily life, is like a perfect storm for poor mental health and wellbeing. The purpose of this study was therefore to examine the impacts of COVID-19 on mental health and wellbeing during the ongoing pandemic in Sweden. Method: Standardized measures of depression, anxiety, and insomnia as well as measures of risk and vulnerability factors known to be associated with poor mental health outcomes were administered through a national, online, cross-sectional survey (n = 1,212; mean age 36.1 years; 73% women). Result: Our findings show significant levels of depression, anxiety, and insomnia in Sweden, at rates of 30%, 24.2%, and 38%, respectively. The strongest predictors of these outcomes included poor self-rated overall health and a history of mental health problems. The presence of COVID-19 symptoms and specific health and financial worries related to the pandemic also appeared important. Conclusions: The impacts of COVID-19 on mental health in Sweden are comparable to impacts shown in previous studies in Italy and China. Importantly, the pandemic seems to impose most on the mental health of those already burdened with the impacts of mental health problems. These results provide a basis for providing more support for vulnerable groups, and for developing psychological interventions suited to the ongoing pandemic and for similar events in the future.

Background. Aberrant activity of the subcallosal cingulate (SCC) is a common theme across pharmacologic treatment efficacy prediction studies. The functioning of the SCC in psychotherapeutic interventions is relatively understudied, as are functional differences among SCC subdivisions. We conducted functional connectivity analyses (rsFC) on resting-state functional magnetic resonance imaging (fMRI) data, collected before and after a course of cognitive behavioral therapy (CBT) in patients with major depressive disorder (MDD), using seeds from three SCC subdivisions. Methods. Resting-state data were collected from unmedicated patients with current MDD (Hamilton Depression Rating Scale-17 > 16) before and after 14-sessions of CBT monotherapy. Treatment outcome was assessed using the Beck Depression Inventory (BDI). Rostral anterior cingulate (rACC), anterior subcallosal cingulate (aSCC), and Brodmann’s area 25 (BA25) masks were used as seeds in connectivity analyses that assessed baseline rsFC and symptom severity, changes in connectivity related to symptom improvement after CBT, and prediction of treatment outcomes using whole-brain baseline connectivity. Results. Pretreatment BDI negatively correlated with pretreatment rACC ~ dorsolateral prefrontal cortex and aSCC ~ lateral prefrontal cortex rsFC. In a region-of-interest longitudinal analysis, rsFC between these regions increased post-treatment (p FDR). In whole-brain analyses, BA25 ~ paracentral lobule and rACC ~ paracentral lobule connectivities decreased post-treatment. Whole-brain baseline rsFC with SCC did not predict clinical improvement. Conclusions. rsFC features of rACC and aSCC, but not BA25, correlated inversely with baseline depression severity, and increased following CBT. Subdivisions of SCC involved in top-down emotion regulation may be more involved in cognitive interventions, while BA25 may be more informative for interventions targeting bottom-up processing. Results emphasize the importance of subdividing the SCC in connectivity analyses.

Background. During the outbreak of coronavirus disease 2019 (COVID-19), people are under the dual pressure of interpersonal isolation and concerns about infection. An evaluation of people’s psychological status and risk factors is needed to conduct target interventions. Methods. This was a nationwide, multicenter, cross-sectional study using quota and snowball sampling methods during the COVID-19 epidemic in China. Participants’ characteristics and experiences were obtained by an online questionnaire and telephone review. Psychological distress and sleep problems were measured by the Generalized Anxiety Disorder-7, the Patient Health Questionnaire-9, and the Insomnia Severity Index. Results. A total of 23,500 participants were recruited, and 19,372 valid questionnaires were received from 11 centers. Overall, 11.0–13.3% of the participants had anxiety, depression, or insomnia symptoms, and 1.9–2.7% had severe symptoms. The prevalence of psychological and sleep problems has increased. Working as frontline medical staff (Odds Ratio OR = 3.406), living in Hubei Province (OR = 2.237), close contacts with COVID-19 (OR = 1.808), and age 35–49 years (OR = 1.310) were risk factors for anxiety symptoms; no outside activity for 2 weeks (OR = 2.167) and age 35–49 years (OR = 1.198) were risk factors for depression symptoms; and living in Hubei Province (OR = 2.376), no outside activity for 2 weeks (OR = 1.927), and age 35–49 years (OR = 1.262) were risk factors for insomnia symptoms. Only 1.9% of participants received counseling during the epidemic. Conclusions. Psychological and sleep problems increased during interpersonal isolation due to COVID-19. Current psychological interventions are far from sufficient.

Objective:To extend evidence on the short-term variability of passive and active suicidal ideation (SI) and the association with suggested proximal risk factors such as interpersonal variables (perceived burdensomeness [PB], thwarted belongingness [TB], hopelessness, and depression) in real-time.Methods:This is an observational study using a prospective design applying ecological momentary assessments (EMA). Eligible for study inclusion were inpatients with unipolar depression, current or lifetime suicidal ideation, and fluent German. Over six days, 74 participants rated their momentary level of passive and active SI, PB, TB, depressiveness, and hopelessness up to 10 times per day on smartphones. Data was collected from August 2015 to July 2017. Compliance was excellent (89.7%).Results:Mean squared successive differences supported temporal instability for all variables. According intra-class correlations, between 25% and 47% of variance was accounted for by within-person variability. Multilevel analysis demonstrated significant positive associations between hopelessness, depressiveness, PB, and TB with passive SI. Prospectively, hopelessness and PB remained predictors of passive SI. For active SI, hopelessness, depression, PB, and TB were significantly associated cross-sectionally. Prospectively, hopelessness, PB, and the interaction PBxTB predicted active SI. All models were controlled for previous level of SI.Conclusions:This study provides further evidence on the short-term variability of SI in very short time frames implying the need of assessing SI repeatedly in clinical and research settings. The associations between interpersonal variables and passive and active SI were only partial in line with assumptions of the Interpersonal Theory of Suicide. Overall, the effects were small warranting further investigation.

Background:The study aimed to investigate severe hair loss related to psychotropic drugs (PDs) by using data from the drug safety programme Arzneimittelsicherheit in der Psychiatrie (AMSP).Methods:Data on PD utilization and reports of severe PD-related hair loss were collected in 83 psychiatric hospitals in Austria, Germany and Switzerland during the period 1993–2013.Results:Out of 432, 215 patients under surveillance, 404, 009 patients were treated with PDs for the main indications of depression, schizophrenic disorder, neurosis, mania, and organic psychosis. Severe hair loss related to PD treatment was reported in 43 cases (0.01%). The rates of hair loss under antipsychotic drugs were slightly lower than the mean rates of all PDs and antidepressant drugs. Valproic acid was related to the highest risk. In 6 of the 43 cases, hair loss was imputed to multiple drugs, with 4 cases imputed to double drug combinations and 2 cases to triple combinations. Rates of severe hair loss under valproic acid (VPA) and lithium salts were distinctly lower as compared with the overall rates reported in literature. Severe hair loss under PD treatment was reported significantly more often in female patients than in male patients (p < 0.01).Conclusion:The rate of severe PD-related hair loss was very low in the present survey. The large number of patients included in this multicentre study allows for assessment and comparison of hair loss rates related to different PDs and groups of PDs and provides new and supplementary information on PD-related hair loss.

Background:Numerous data suggests that the disorders of tryptophan catabolites (TRYCATs) pathway, including a decreased level of tryptophan or evaluated concentration of harmful TRYCATs −kynurenine, quinolinic acid, 3-hydroxyanthranilic acid, 3-hydroxytryptophan − may cause the occurrence of DD symptoms. In this work, we assessed the relationship between single-nucleotide polymorphisms (SNPs) of KAT1, KAT2 and IDO1 gene encoding, and the risk of depression development. Our study was performed on the DNA isolated from peripheral blood of 281 depressed patients and 236 controls. We genotyped, by using TaqMan probes, four polymorphisms: c.*456G > A of KAT1 (rs10988134), c.975-7T > C of AADAT (rs1480544), c.-1849C > A (rs3824259) and c.-1493G > C(rs10089084)of IDO1. We found that only the A/A genotype of c.*456G > A − KAT1 (rs10988134) increased the risk of depression occurrence. Interestingly, when we stratified the study group according to gender, this relationship was present only in male population. However, a gene–gene analysis revealed a link between the T/T-C/C genotype of c.975-7T > C − AADAT (rs1480544)or c.-1493G > C − IDO1 (rs10089084) and C/C-C/A genotype of c.975-7T > C − AADAT (rs1480544)and c. −1849C > A − IDO1 (rs3824259) and the disease. Moreover, we found, that the c.975-7T > C − AADAT and c. *456G > A KAT1 (rs10988134) polymorphisms may modulate the effectiveness of selective serotonin reuptake inhibitors therapy. Concluding, our results confirm the hypothesis formulated in our recently published article that the SNPs of genes involved in TRYCATs pathway may modulate the risk of depression. This provides some further evidence that the pathway plays the crucial role in development of the disease.

Background:Meteorological parameters and air pollen count have been associated with affective disorders and suicide. Regarding peripartum depression, the literature is restricted and inconclusive.Methods:This cross-sectional study included women (pregnant, n = 3843; postpartum, n = 3757) who participated in the BASIC (Biology, Affect, Stress, Imaging, and Cognition) study 2010–2015 and the UPPSAT (Uppsala-Athens) study (postpartum, n = 1565) in 2006–2007. Cases were defined according to presence of depressive symptoms during pregnancy (gestational week 32) and 6 weeks postpartum, using the Edinburgh Postnatal Depression Scale (EPDS). Exposure of sunshine, temperature, precipitation, snow coverage, and air pollen counts of durations of 1, 7, and 42 days prior to the outcome were studied for associations with depressive symptoms, using negative binomial regression.Results:Prior to Bonferroni correction, the concentration of mugwort pollen, both one week and six weeks before the EPDS assessment at gestational week 32, was inversely associated with depressive symptoms in pregnancy, both before and after adjustment for season. No associations were found between the exposure to meteorological parameters and pollen and depressive symptoms, at the same day of depressive symptoms’ assessment, the previous week, or the six weeks prior to assessment, either during pregnancy or postpartum after Bonferroni correction.Conclusions:There was no evidence that neither short-term nor long-term exposure to meteorological parameters or air pollen counts were associated with self-reported peripartum depressive symptoms in Uppsala, Sweden.

Metacognitive Training for Depression (D-MCT) is a highly standardized group program targeted at depression-related (“Beckian”) emotional as well as cognitive biases, including mood-congruent and false memory. While prior results are promising with respect to psychopathological outcomes (depression), it is unclear whether D-MCT also meets its goal of improving cognitive biases, such as false memories.In the framework of a randomized controlled trial (registered trial, DRKS00007907), we investigated whether D-MCT is superior to an active control condition (health training, HT) in reducing the susceptibility of depressed patients for false memories. False memories were examined using parallel versions of a visual variant of the Deese-Roediger McDermott paradigm.Both groups committed less false memories at post assessment after 4 weeks compared to baseline. Relative to HT, D-MCT led to a significant decrease in high-confident false memories over time.The study presents first evidence that D-MCT decreases the susceptibility of depressed patients for false memories, particularly for errors made with high confidence that are presumably the most “toxic” in terms of mood-congruent memory distortions.

Background:Information on individual mental healthcare costs and utilization patterns in Italy is scant. We analysed the use and the annual costs of community mental health services (MHS) in an Italian local health authority (LHA). Our aims are to compare the characteristics of patients in the top decile of costs with those of the remaining 90%, and to investigate the demographic and clinical determinants of costs.Methods:This retrospective study is based on administrative data of adult patients with at least one contact with MHS in 2013. Costs of services were estimated using a microcosting method. We defined as high cost (HC) those patients whose community mental health services costs place them in the top decile of the cost distribution. The predictors of costs were investigated using multiple linear regression.Results:The overall costs borne for 7601 patients were 17 million €, with HC accounting for 87% of costs and 73% of services. Compared with the rest of the patients, HC were younger, more likely to be male, to have a diagnosis of psychosis, and longer and more intensive MHS utilization. In multiple linear regression, younger age, longer duration of contact with MHS, psychosis, bipolar disorder, personality disorder, depression, dementia and Italian citizenship accounted for 20.7% of cost variance.Conclusion:Direct mental health costs are concentrated among a small fraction of patients who receive intensive socio-rehabilitation in community services. One limitation includes the unavailability of hospital costs. Our methodology is replicable and useful for national and cross-national benchmarking.

Background:The level of physical activity (PA) and the prevalence of depression both change across the lifespan. We examined whether the association between PA and depression is moderated by age. As sense of mastery and functional limitations have been previously associated with low PA and depression in older adults, we also examined whether these are determinants of the differential effect of age on PA and depression.Methods:1079 patients with major depressive disorder (aged 18–88 years) were followed-up after two-years; depression diagnosis and severity as well as PA were re-assessed. Linear and logistic regression analyses were used to test reciprocal prospective associations between PA and depression outcomes. In all models the interaction with age was tested.Results:PA at baseline predicted remission of depressive disorder at follow-up (OR = 1.43 [95% CI: 1.07–1.93], p =.018). This effect was not moderated by age. PA predicted improvement of depression symptom severity in younger (B = −2.03; SE =.88; p =.022), but not in older adults (B = 2.24; SE = 1.48; p =.128) (p =.015 for the interaction PA by age in the whole sample). The level of PA was relatively stable over time. Depression, sense of mastery and functional limitation were for all ages not associated with PA at follow-up.Conclusions:Age did not moderate the impact of PA on depressive disorder remission. Only in younger adults, sufficient PA independently predicts improvement of depressive symptom severity after two-year follow-up. Level of PA rarely changed over time, and none of the determinants tested predicted change in PA, independent of age.

Background:Psychotic depression (PD) is heavily understudied despite high mortality and the severe course of illness. A majority of the studies conducted so far are also largely based on selected clinical samples. The aim of this study was to examine the clinical characteristics of PD in a representative prospective birth cohort sample.Methods:The Northern Finland Birth Cohort 1966 is a well-known prospective population-based cohort including 12 058 people followed since mid-pregnancy. We identified 55 individuals with PD, analysed their characteristics and compared them with schizophrenia (SZ), non-psychotic depression (NPD), psychotic bipolar disorder (PBD) and other psychoses (PNOS).Results:The life-time prevalence of stable (no conversion to schizophrenia, bipolar disorder or schizoaffective disorder) PD was 0.5%. PD subjects were older than SZ and PNOS subjects during the first psychotic episode and compared to SZ, more often female. PD required hospitalization and transition to disability pension more often than NPD, but less often than SZ. Comorbid alcohol abuse disorder (44%) and personality disorder (40%) were highly common in PD. PNOS had a similar occupational outcome than PD but hospitalization rate was lower in the PNOS group. PBD and PD had mostly comparable outcomes.Conclusions:Our findings in a naturalistic cohort support the notion that the course of illness in PD is mostly similar to that of PBD, it is less severe than in schizophrenia, but worse than in non-psychotic depression. PD seems to have high psychiatric comorbidity.

The crisis in Syria has resulted in an unprecedented increase in the number of refugees seeking asylum in Syria's neighboring countries as well as in Europe. Syrian refugees may have been exposed to multiple war stressors such including sexual violence and destruction of their homes and livelihoods, and they have often undertaken a risky and stressful flight leaving their homes for an unknown future. Studies show that refugees are at considerable risk to develop common mental disorders, including depression, anxiety, posttraumatic stress disorder (PTSD) and related somatic health symptoms. The World Health Organization has developed a range of scalable psychological interventions aimed at reducing psychological distress and improving functioning in people living in communities affected by adversity. These interventions, including Problem Management Plus (PM+) and its variants, are intended to be delivered by lay, non-professional people who have not received specialized mental health training. Previous randomized clinical trial results in a conflict-affected area in Pakistan showed beneficial effects in terms of reductions in anxiety, depression, functional disability, and posttraumatic stress than those who received an enhanced treatment as usual. With these positive findings as a starting point, the recently EU-funded STRENGTHS project will implement, scale-up and evaluate this new generation of low-intensity interventions in the context of the Syrian refugee crisis. The PM+ programmes will be implemented by peer-refugees and evaluated across refugee settings in Europe (Netherlands, Turkey, Switzerland, Germany and Sweden) and the Middle East (Jordan, Lebanon, and Egypt). In this presentation, the evidence base for STRENGTHS project will be outlined. In addition, and preliminary results concerning identification of expected barriers and facilitators implementation of the PM+ programmes will be presented.

Introduction“Cotard syndrome” is a rare condition characterized by a constellation of clinical features, including hypochondriac and nihilistic delusions, the most characteristic of which are the ideas that one is dead or that their organs do not exist. It is more commonly associated with psychotic depression and schizophrenia but can also be found in several neurological disorders. In the clinical practice it generally appears as an “incomplete Cotard”, reduced to hypochondriac delusions attributed to the malfunction or occlusion of the organs, usually the digestive tract and abdominal viscera. Consequently it is common for these patients to reject food or medications. In literature it has been divided into three types, according to the clinical symptoms: psychotic depression, Cotard type I, and Cotard type II.ObjectivesLiterature review on Cotard Syndrome and its link with Multiple Sclerosis, based on a clinical case.MethodsPubmed and Google Scholar search using the keywords Cotard Syndrome, Multiple Sclerosis.ResultsHereby we present a clinical case of a 53-year-old female patient, with multiple sclerosis, who presented with hypochondriac and nihilistic delusions and refusal of food and medication. The patient was treated with olanzapine with rapid remission of delusional activity.ConclusionsMultiple sclerosis is an immunemediated chronic disease, affecting predominantly the sensory and motor function. In addition, psychiatric comorbidity is very frequent with up to 50 % lifetime risk of depression. While various neurological disorders have been described in association with Cotard syndrome, its link with multiple sclerosis has been scarcely reported.DisclosureNo significant relationships.

IntroductionBorderline Personality Disorder (BPD) is an impairing disorder with distinct features such as instability in self-image, relationships and affect. Considering the developmental nature of BPD, borderline features are not rarely exhibited in adolescence. These features tend to be associated with depression and suicide ideation, as well as with a negative self-to-self relationship. Self-compassion has been consistently identified as a positive attitude with oneself when experiencing suffering.ObjectivesThe aim of the current study was to explore the role of self-compassion in the relationship between borderline features and suicide ideation, when controlled depressive symptoms.MethodsSample was composed by 665 adolescents (58.5% females and 41.5% males), with a mean of 15.54 years of age (SD = 1.52), who completed self-report questionnaires. Data was analyzed using SPSS (version 23) and PROCESS Macro.Resultsshowed that girls presented higher borderline features and suicide ideation and lower self-compassion compared to boys. The moderation model explained 66% of suicide ideation, with gender and depression as covariates. The interaction of borderline features and self-compassion had a unique and significant effect on suicide ideation, when controlled depression and gender. Adolescents with higher levels of borderline features and lower self-compassion presented significantly higher suicide ideation, compared to those with higher self-compassion.ConclusionsThese findings suggest that developing self-compassion in adolescents with evident borderline features might attenuate their tendency to think about committing suicide.

IntroductionWe present the case of a 56 year old woman with a diagnose of Complex Partial Seizures since her teenage years, with a history of multiple hospitalizations in the psychiatric ward of our hospital and a challenging clinical evolution.ObjectivesTo review the different kinds of psychotic disorders that may arise in relation to epilepsia.MethodsLiterature review of scientific papers and classic textbooks on the issue, including references in both Spanish and English languages.ResultsFrom 2008 to 2011 our patient was hospitalized with episodes of different clinical features leading to different diagnoses (in 2008 the episode was compatible with a maniac phase and led to a diagnosis of possible Bipolar Disorder, in 2010 dissociative-like symptoms became more prominent and led to a diagnose of Dissociative Identity Disorder and in 2011 the symptoms pointed to an interictal depression), and a subsequent symptomatology that made clinicians consider a diagnose of unspecified schizophrenia. From 2015 to 2020 our patient suffered multiple decompensations resulting in up to six new hospitalizations, with psychotic symptoms in the shape of auditive hallucinations being consistent and affective symptoms varying widely. This evolution suggests a plausible diagnose of interictal chronic psychosis with bipolar-like affective episodes.ConclusionsAn extensive review of the available scientific literature shows, as so does this case, that along the course of an epileptic disease both schizophrenia-like psychosis and affective psychosis may arise, and that those might be divided along the categories of peri ictal and inter ictal disorders.DisclosureNo significant relationships.

IntroductionMIJ821 is a novel N-methyl-D-aspartate (NMDA) receptor antagonist, with a potentially low rate of the psychotomimetic side effects that limit the therapeutic utility of ketamine in treatment-refractory depression (TRD).ObjectivesTo assess efficacy and safety of MIJ821.MethodsAdults with TRD (>2 prior treatment failures; Montgomery-Asberg Depression Rating Scale [MADRS], >24) were eligible and were randomized (n=70) to low versus high doses of MIJ821, with two dosing regimens of weekly or biweekly, versus ketamine versus placebo. The primary outcome was change in MADRS total score at 24 hours and final follow up was at 6 weeks.ResultsAt 24 hours, adjusted mean differences (ΔAM) versus placebo were –8.25 (p=0.001), –5.71 (p=0.019) and –5.67 (p=0.046) and at 48 h were –7.06 (p=0.013), –7.37 (p=0.013), –11.02 (p=0.019) in the pooled MIJ821 low dose, high dose, and ketamine groups, respectively. At 6 weeks, ΔAM (80% CI) versus placebo on MADRS were –6.46 (–11.8, –1.15); p=0.059 for low dose MIJ821, –5.42 (–10.8, –0.02); p=0.099) for high dose MIJ821, and –5.24 (–10.4, –0.06); p=0.097 for ketamine. Further details on dosing, efficacy, and safety outcomes will be provided.ConclusionsIn this proof-of-concept study, MIJ821 was effective and tolerable in TRD. This study was funded by Novartis. Clinical trial.gov: NCT03756129Conflict of interestEmployee of Novartis.

IntroductionIn the first months of 2020 the COVID-19 epidemic spread in Italy, and the Italian government implemented a general lockdown. These events are at high risk for psychiatric symptoms in the general population, including anxiety/depression and post-traumatic stress symptoms (PTSS).ObjectivesTo characterize the psychopathological correlates of the spread of COVID-19 and lockdown in a sample of subjects from the Italian population, with a before-after follow-up.MethodsSix weeks after the lockdown, 671 subjects aged 18-60 years completed the Brief Symptom Inventory and Impact of Event Scale-Revised, for the evaluation of psychopathology and PTSS respectively. Environmental factors and subjectively-perceived deteriorations related to COVID-19 were also investigated. Pre-COVID-19 data on psychopathology, collected in December 2019/January 2020, were available for 130 subjects and were used for longitudinal analyses.ResultsWith respect to males, female subjects more frequently reported deteriorations of relations (21.5% vs 10.9%), household arguments (26.0% vs 12.6%), sleep quality (47.6% vs 26.6%), episodes of overeating (22.5% vs 12.5%), worries for oneself (19% vs 8.9%) and for loved ones (55.7% vs 36.5%). These changes were associated with increased psychopathology, PTSS, and numerous environmental conditions, including significant economic damage from COVID-19/lockdown. Longitudinal analyses showed an increase in phobic anxiety in the whole sample, and in depression for female subjects only, following the spread of COVID-19. Pre-existing psychopathology was a significant predictor of PTSS.ConclusionsCOVID-19 epidemic and lockdown have a high impact on psychopathology and PTSS. Female subjects and those with pre-existing psychopathology were found to be more vulnerable and may need additional support.DisclosureNo significant relationships.

IntroductionThe situation of Covid-19 disease, associated with a high threat to life and uncertainty, had not only somatic, but also psychological consequences for most patients. Emotional reactions of patients to hospitalization and ways to cope with what is happening have become the subject of study in different countries.ObjectivesTo assess the severity of signs of depression and anxiety and to study the methods used to regulate the emotional state in patients with COVID-19 at the time of hospitalization.MethodsThe study volunteered 127 hospitalized patients with Covid-19 (67 men (52.8%) and 60 women (47.2%), aged 19 to 77 years, who completed the following methods: Sociological questionnaire, Beck Depression Questionnaire, GAD-7, F-SOZU-22, CERQ, Dembo-Rubinstein self-assessment scales. The study was conducted from 04/25/2020 to 05/31/2020.ResultsA quarter of patients showed pronounced signs of depression and anxiety (25.4% and 24.13%, respectively), with women having higher rates of depression (M = 8.76 and M = 6.32, pConclusionsDespite the duration of the pandemic, there is still no specific pattern of effective coping with these experiences for patients.DisclosureNo significant relationships.

IntroductionThis systematic review estimates the pooled prevalence (PP) of depressive disorders (DD) among 5-to-18-year-old YP living in Europe, based on prevalence rates established in the last five years (LFY).ObjectivesTrends of prevalence rates across countries, gender and level of education were analysed. The random effects pooled prevalence rate (REPPR) for DD was calculated.MethodsA search strategy was conducted on three databases. Studies were also identified from reference lists and grey literature. Eligible studies were evaluated for reliability, validity, bias, and the REPPR for DD was calculated.ResultsThe European REPPR for DD is calculated at 2.0% (95%CI: 1.0%-4.0%). (Figure 1). The REPPR for each depressive disorder is shown in Figure 1. The prevalence among secondary school children is 4.2 times higher than that among primary school children.ConclusionsRoutine screening and early intervention strategies for eating disorders may improve the outcome of young people with these problems.DisclosureNo significant relationships.

IntroductionThe COVID-19 pandemic places older adults at increased risk for hospitalization and mortality. It also involves social isolation and negative effects of limited mental, social and physical activity. Holocaust survivors could be especially vulnerable to such effects due to their early life traumas. Previous research suggests that in times of life crises, Holocaust survivors may be both most vulnerable (i.e., wear-and-tear hypothesis); yet they may also demonstrate resilience.ObjectivesThus, the current study examines the effects of the COVID-19 pandemic on the mental health and well-being of Holocaust survivors in Israel, compared to adults who did not experience the Holocaust.MethodsWe collected data from 305 older adults aged 75 and above in Israel during the COVID-19 pandemic. Of these, 114 were Holocaust survivors and 191 did not experience the Holocaust. Participants were asked about their worries of COVID-19 infections, will to live, loneliness and depression and how these changed during the COVID-19 pandemic.ResultsHolocaust survivors were worried to a greater extent from COVID-19 infection and from close others becoming infected, compared to older adults who did not experience the Holocaust. Moreover, survivors reported greater loneliness and depression overall and also reported that these measures became worse during the pandemic. On the other hand, despite these differences, the two groups were similar in their will to live.ConclusionsHolocaust survivors seem to be more vulnerable to the COVID-19 pandemic, strengthening the vulnerability hypothesis. Policy makers and practitioners should pay special attention to this particularly vulnerable population during these difficult times.DisclosureNo significant relationships.

IntroductionThe effects on the population’s mental health due to the rapid global spread of COVID-19 are even greater for specific groups such as pregnant women.ObjectivesTo compare levels of depressive and anxiety symptoms of pregnant women before vs. during the COVID-19 pandemic and to analyze the role of COVID-19 fear in perinatal psychological disorder.Methods200 Brazilian women evaluated during the pandemic in May-June 2020 (Sample-1) with the Brazilian Covid-19 Fear Scale for the Perinatal Period (Barros et al. 2020) and Screening for Perinatal Depression and the Perinatal Anxiety Crawl Scale, both with α> .90. Sample-1 was compared with a sample of 300 Portuguese women; these responded to the same questionnaires, before the pandemic, in 2017 and 2018 (Sample-2).ResultsSample-1 had significantly higher mean scores of depression (52.73 ± 20.26 vs. 35.87 ± 16.98, t = 10.77, p ConclusionsThe Sample-1 being from a different country may be a confusing factor, however, the magnitude of differences in PPP levels and the relevant role of fear in COVID-19, alert us to be aware of perinatal mental health.

IntroductionQuarantine for suspected patients of being infected by the COVID-19 can lead to negative consequences for mental health and the appearance of depressive symptoms.ObjectivesTo assess the prevalence of depression in quarantined patients, and to analyze the associated factors.MethodsThis was a descriptive and analytical survey, carried out from April 4 to May 30, 2020, with 149 patients consulting the COVID-19 sorting box at the Hedi Chaker CHU in Sfax. Suspected COVID-19 patients were contacted by phone during their quarantine and invited to participate in our study. The Patient Health Questionnaire (PHQ-9) scale was used to assess the severity of depression. Cutoffs of 5, 10, 15, and 20 represent minimal, mild, moderate, moderately severe, and severe levels of depression based on PHQ-9 scores. A cutoff score of 10 determines major depression.Results The results showed a prevalence of major depression of 10.7%. Of all patients, 89.3% had minimal to mild depression; 10% had moderate to moderately severe depression and 0.7% had severe depression. The PHQ-9 score was statistically correlated with travel to a suspect area during the 14 days preceding the consultation (p = 0.008), contact with a subject confirmed COVID-19 (p = 0.01), previous follow-up in psychiatry (p = 0.047), the change of residence during quarantine (p = 0.045), the fear of transmitting the disease to relatives (p = 0.00) and the positive result of the nasopharyngeal swab (p = 0.00).ConclusionsPsychological distress was felt in our patients. We recommend that necessary measures should be taken to combat depression.

IntroductionThe term Munchausen syndrome was first used in 1951 after Baron von Münchhausen, a German nobleman known for his exaggerated storytelling. DSM-5 refers to it as factitious disorder imposed on self: “falsification of physical or psychological signs or symptoms, or induction of injury or disease, (…) in the absence of obvious external rewards”.ObjectivesTo report a case of Munchausen syndrome and highlight the impact on its physical and psychiatric approaches.MethodsDescription of a clinical case based on medical records and a brief review on Munchausen syndrome.ResultsA 57-year-old female, with no previous psychiatric history, was evaluated by Psychiatry for complaints of depression with suicidal ideation. She reported family conflicts and a list of medical conditions and surgical interventions. According to the patient she was waiting for a cardiac transplant and said she had type 1 diabetes, myasthenia gravis, hepatic steatoses, dyslipidemia, hyperuricemia, mitral valve prolapse and was submitted to a thymectomy and cervical herniated disc surgery. She was on many different prescription pills. Even though she had blocked the access to her clinical records in other institutions, at our hospital she had multiple admissions to the emergency room, numerous follow-up appointments of different specialties and several allergies documented. She displayed many incoherencies throughout the interview, had a circumstantial speech and exuberant appearance.ConclusionsMunchausen syndrome remains a challenging diagnosis to physicians. This condition is not only associated with significant morbidity and mortality, but also with unnecessary tests and procedures, iatrogenesis, prolonged hospitalizations and increased health costs.DisclosureNo significant relationships.

IntroductionInflammation is now known to be a key factor in the development of schizophrenia. In this regard, the study of the pathogenic role of inflammation in the early stages of schizophrenic process is of particular importance, making it possible to assess its activity and to predict the development of the disease.ObjectivesTo compare the dynamics of inflammatory markers in blood of first-episode psychosis (FEP) patients and people at risk signs for schizophrenia in the course of the treatment. Juvenile depression (JD) with attenuated symptoms of schizophrenic spectrum (ASSS) was investigated as a risk group.MethodsThe patients aged 17-25 years (20 people, of which 10 FEP patients (F20) and 10 JD with ASSS ones (F32.1-2, F32.38, F32.8)) were examined at admission to the hospital and at discharge. The controls consisted of 10 healthy volunteers. Symptom severity was collected using PANSS, SOPS, SANS, HDRS. The inflammation markers (TNF-α, IL-6, IL-10, leukocyte elastase (LE), CRP, α1-proteinase inhibitor (α1-PI), anti-S100-beta antibodies) were determined in blood.ResultsAn increase of inflammatory markers in both groups compared to controls was found (pConclusionsThe results confirm the pathogenic role of inflammation in the development of endogenous mental disorders. The inflammatory markers studied reflect the activity of the pathological process in the early stages of schizophrenia.DisclosureNo significant relationships.

IntroductionIn March 2020,World Health Organization characterized the COVID-19 outbreak as pandemic. This new health situation has created an anxiety-provoking climate among health professionalsObjectivesTo provide risks associated with the exposure of caregivers to COVID-19 for their mental health by studying the prevalence and predictors of post-traumatic stress disorder, anxiety and depression.MethodsOur study was descriptive and analytical cross-sectional, carried out with healthcare in different hospitals in Tunisia, between 13 May until 20 June 2020. An online survey was sent to caregivers. mental health was assessed using 3 scales: PCL-5:measure the symptoms of post-traumatic stress disorder HADS :screen for anxiety and depression. PSQI:see the existence of a disturbance in sleep qualityResults 125 caregivers participated in the survey. The average age was 32 years. The participants were predominantly female (72.8%), married (48%), and had at least one child (39.2%). 28.7% of participants had increased their consumption of coffee, especially anxious people (p = 0.001). Anxiety was retained in 44% and depression in 47.2%. Anxiety was significantly related to sex with (p = 0.039) and affects more women. The consumers of coffee developed more anxiety (p = 0.034) and depression (p = 0.026). 42.4% of participants had presented post-traumatic stress disorder. Three parameters were correlated with post-traumatic stress disorder: young age, having children and fewer years of professional experience. 62.4% of caregivers had a bad quality of sleepConclusionsThis health crisis had a major impact on the mental health of our heroes. So, we should provide for them with the necessary support.

IntroductionResearch has found that low mood including sadness and hopelessness is an important factor for decreased awareness in one’s oral health and lowered frequency of visit to the dental office, this relationship is not well studied in national representative samples. Poor mental wellbeing can lead to poor oral health.ObjectivesAim is to examine the relationship between feeling sad or hopeless and awareness for dental care.MethodsData were obtained from the Youth Risk Behavior Surveillance Survey (YRBS-CDC), USA, for years 2009-2017. All ages from 12 to 18 years, feeling sad or hopeless and dental visits were identified. Univariable relationship between feeling sad or hopeless (>2 weeks in the past year) and dental office visits for all dental care (during the past 12 months, 12-24 months, >24 months, and never) was evaluated using chi-square test.ResultsOut of a total of 53,098 youths, 30.5% of youths were feeling sad or hopeless. Within the youths feeling sad or hopeless, the prevalence of youth who never received dental care was higher at 37.1% in comparison to youths who received dental care >24 months ago 36.4%,12-24 months 33.7%, and visited the dental office in the past 12 months 28.9%. (pConclusionsFurther research is warranted to evaluate reduced oral health care awareness among participants feeling sad or hopeless.

IntroductionThe medical novelty of COVID-19 requires a comprehensive study of its impact on various areas of human health, including mental health.ObjectivesTo study the spectrum and severity of psychopathological disorders in previously healthy patients of different age groups who have had moderate and severe COVID-19 pneumonia.MethodsImmediately after stabilization of the physical condition, patients completed the Symptom Checklist-90-R, designed to assess 11 parameters: somatization (SOM), obsessive-compulsive (OS), interpersonal sensitivity (INT), depression (DEP), anxiety (ANX), hostility (HOS), phobic anxiety (PHOB), paranoid ideas (PAR), psychoticism (PSY). Patients with cognitive impairment were excluded.Results The study involved 148 patients aged from 26 to 84 years. In the general sample, psychopathological symptoms were detected mainly on the SOM, DEP, ANX, HOS scales. To a lesser extent - on the INT and PAR scales; were practically not determined on the PSY and PHOB scales. Most of the symptoms are significantly more intense in patients over 46 years old (n = 129) compared with the younger population (Conclusions Patients recovering from severe COVID-19 pneumonia require psychiatric evaluation and subsequent differentiated psychotherapeutic rehabilitation, especially for the age group over 46.Conflict of interestNo significant relationships.

IntroductionThe incidence of depression is associated with decreased social, occupational, and educational performance.ObjectivesThe aim of this study was assessing the prevalence of depression and its related effective factors among students at health faculty at Isfahan University of Medical Sciences in 2019.MethodsIn this cross-sectional study 177 students were included randomly. The Beak test included 21 questions were applied to collect data. Data were analyzed by SPSS software (version 22) and were presented as descriptive statistics and analyses included One-way analysis of variance, t-test and correlation Pearson.ResultsThe mean and standard deviation of the age of students was 22.15±3.88 years. More than 80% of students experienced some levels of depression. Of the participants 19.8% indicated no sign of distress, 26% mild distress, 37.3% average distress and 16.9% high depression. There was no statistical association of distress between female and male students (P=0.198). However, significant associations were Sedative drugs, parents level and occupation, Study Field, Future Career and Financial situation with depression (PConclusionsOverall, the prevalence of depression was higher among students compared with general population. Providing programs for improving student’s mental health is suggested.

IntroductionQuality of life is a broad and complex concept, but essentially refers to an individual’s well-being in a spectrum of life domains.ObjectivesThe aim of the present study was to investigate the relationship between spirituality, religiosity (S/R) and quality of life (QOL) among bipolar disorder (BD) patients.Methods Data were collected between July and December 2017.Participants were enrolled from the Mood Consultation of the Psychiatry (A) Department of the University Hospital HediChaker. We assessed symptoms of mania [Young Mania Rating Scale (YMRS)], depression [Beck scale], quality of life [World Health Organization Quality of Life-Brief Version (WHOQOL-BREF)]andquality of life aspects related to spirituality, religiousness and personal beliefs [World Health Organization Quality Of Life –Spirituality, Religiousness and Personal Beliefs (WHOQOL-SRPB)]Results Our sample included 60 patients. It consisted of 55% of female and the mean age was 44.94 (SD=12.76). The sample included 68% of participant diagnosed with BDI and 32% with BDII The median score of quality of live was 3 (minimum=1; maximum=5).The median of physic, psychic, social and environmental quality of life was respectively (25, 31, 81 and 19) (Minimum=0; Maximum=100). The mean score of WHOQOL-SPRB was 14.82 (Minimum=4, Maximum=20). S/R were correlated to psychic, social and environmental quality of life (p=0.006, p=0.011, p=0.016). We did not find a significant association between physic quality of life and S/R (p=0.234).ConclusionsOur study suggests that spirituality, religiosity have an important influence on most aspects of the quality of life among bipolar patients.

Apathy is a quantitive reduction of goal-directed activity either in behavioural, cognitive, emotional or social dimension in comparison to the person’s previous level of functioning in these areas. Apathy is prevalent across many neurodegenerative, neurological, and psychiatric disorders. It represents the most common behavioural and psychological symptom in people with Alzheimer’s Disease and is often observed in Parkinson’s disease, vascular dementia, stroke, traumatic brain injury, amyotrophic lateral sclerosis/motor neuron disease, frontotemporal dementia, progressive supranuclear palsy, major depression, and schizophrenia. However, the definition and terminology employed to refer to apathy can vary in the context of different conditions and specialities and the diagnostic criteria have evolved. Additionally, the term apathy is employed to describe both a symptom and a syndrome. Indeed, little progress has been achieved in assessing the validity of the same construct across different disorders (eg. neurodegenerative disorders, schizophrenia or affective disorders). In 2018, a new version of the diagnostic criteria for apathy (DCA) in neuropsychiatric disorders was published. The validity of this new consensus has yet to be assessed among all relevant populations, including schizophrenia. Six European centres (Naples, Geneve, Nice, Rennes, Barcelona, Cambridge) aimed to test the prevalence of apathy, measured with the 2018 DCA, in patients diagnosed with schizophrenia. As a second aim, we focused on the relationship between DCA and other measures of apathy and negative symptoms in schizophrenia (BNSS and PANSS). In this talk, we will compare the preliminary findings of this pan-European study in schizophrenia patients with previous studies on neurodegenerative disorders.DisclosureNo significant relationships.

IntroductionThe most common psychiatric conditions in epilepsy are depression, anxiety, behavioral, psychotic disorders and cognitive disorders as well as those which can be caused by convulsive seizures.ObjectivesThe aims of the research were to define cognitive and affective impairments in patients with epilepsy and their quality of life. Since the presents of cognitive impairments and affective disorders have a considerable impact on the functioning of patients, their socialization and the level of their disability.MethodsWe studied the features of clinical and psychopathological manifestations in patients suffering from epilepsy. The study covered 100 patients (47 men and 53 women) who were in inpatient care. The following psychodiagnostic techniques were used: the test of 10 words of Luria, the MOCA test, the Münsterberg test, Mini-Mult test, the quality of life scale, the Hamilton scale of depression and anxiety.ResultsThe following data of the study were observed: 88 % patients had decreased memory, 38% had symptoms of depression, 28% had mild situational or neurotic depression, 8% had moderate depression, 2% had severe depression, 20% had a state of severe anxiety, 16% had symptoms of anxiety. The average rate of quality of life among all examined people was 67.5 out of 100.ConclusionsThe results of the conducted research indicate the need for further study of the features of the comorbid pathology in epilepsy and development and implementation pharmacological and nonpharmacological methods for treatments of epilepsy.

IntroductionIsolation, life changes and increased stress lead to widespread concerns about the effects of the Covid-19 pandemic on psychiatric patients. The rise in depressive disorders is one of the negative effects associated directly and indirectly to the pandemic.ObjectivesThe purpose of this study was to investigate the impact of the COVID-19 pandemic on the prevalence of depressive disorders among the patients admitted to our hospital. The state of pandemia was declared on the 11th of March but it had already become a main stream media subject in our country at the beginning of the month with real life changes for our citizens.MethodsA retrospective study was performed at the Psychiatric Hospital ‘Elisabeta Doamna’ Galati, using the exact same period, between 01.03 and 30.09, in 2019 and 2020. ICD-10 criteria were used and pacients with either F32.x,F33.x or F38.x as discharge diagnosis were included.ResultsIn total, 7638 cases were admitted during the period in 2019, of which 751 (9,83%) had depressive disorders. In comparison with 2020 where out of 4050 admitted patients, the number had risen to 1034 (25,53%) a net increase in total number of cases by 37.6%.ConclusionsAnalysis of the data shows a 2.5 times increase in the percentage of depressive disorders among our patients. Even taking in account the lower admition rates, we have seen a clear shift in the psychiatric profile of the average pacient and this has to be taken into consideration in the long and short term treatment of any psychiatric patient.

IntroductionNegative consequences of social homonegativity and HIV status among older gay and bisexual men in Portugal are still to be documented.ObjectivesThis study seeks to evaluate depression and anxiety disparities among older gay and bisexual men, based upon their HIV status.MethodsThis is a quantitative, descriptive, comparative, and cross-sectional study. Responses were collected from a total of 201 men, with 16.9% being HIV positive, 80.6% identifying as homosexual and 13.9% identifying as bisexual. Participants responded to the Rosenberg Self-Esteem Scale, the BSI-18, and the CDRISC-10.ResultsThe sample collected revealed moderate levels of depression and anxiety that were below the average observed among the general population. Older gay men showed higher levels of depression when compared to older bisexual men. Self-esteem was negatively correlated with both depression and anxiety while being positively correlated with resilience. In contrast, depression was negatively correlated with resilience and, conversely, positively correlated with anxiety. Furthermore, anxiety was negatively correlated with resilience. Multiple linear regression models explain 33% of the general variation of depressive symptoms and 25% of the variation of symptoms of anxiety. Regarding comparisons based on HIV status, no statistically significant differences were found between HIV-positive and HIV-negative men.ConclusionsThis study offers a pioneering contribution to the literature on aging and mental health among older sexual minorities in Portugal, giving a voice to older HIV-positive and HIV-negative GBM in Portugal, in order to gain a better understanding of the barriers and obstacles that they face throughout the aging process.

Introduction Acute Polymorphic Psychotic Disorder is a psychotic disorder with an acute onset, presenting thought and perception disorders variable into hours. Often, an emotional fluctuation is present and it may have a sudden onset and a rapid remission.ObjectivesThe review’s objective is to manifest acute polymorhic psychotic disorders and possible effective medical interventions.MethodsThe current case concerns a 52-year old mother of 4 children with the manifestation of acute polymorphic psychotic disorder with a background of a stressful factor. The patient was involuntarily hospitalized in the Psychiatric Hospital of Thessaloniki from 04/01/ 2019 -21/ 01/2019 due to disorganization and acute confusing condition within the last 9 days. Delusional ideas of religious content were first observed, which alternated with ideas of greatness and then persecution, association and self-denial. She also presented auditory hallucinations while there was a fluctuation of emotion from excessive euphoria to depression. The patient had no previous hospitalization in a psychiatric clinic, however, 7 months ago she experienced another acute psychotic epeisode, while at the age of 17 and under the influence of intense stress, she described mood disorders.ResultsThe current symptoms subsided after one week from the day of admission. During her hospitalization, a brain CT was performed without presence of pathological findings. Initially, her medication included i.m. haloperidol 15mg / ml daily, followed by a change to per os paliperidone 9mg daily.ConclusionsHer mental status was improved, with no disturbances of consciousness noted and she was discharged on paliperidone as home medication.DisclosureNo significant relationships.

IntroductionPrevious research has suggested that offspring of parents with mental health problems, including depression and anxiety, are at an increased risk of developing anxiety disorders. Few studies have investigated this relationship in young adults.ObjectivesTo investigate the risk of anxiety symptoms in young adult offspring of parents with mental health problemsMethodsWe used data from the 1989-1991 cohort of the Western Australian Pregnancy (Raine) Study, which is a multi-generational birth cohort study following mothers and their offspring from pregnancy to 28 years of age. The Depression, Anxiety, and Stress Scale (DASS) was used to assess maternal anxiety and depression whereas a self-reported questionnaire was used to assess paternal emotional problems. Anxiety symptoms among offspring at age 20 were measured by using the short form of the Depression, Anxiety, and Stress Scale (DASS 21). A multivariable negative binomial regression model was used to quantify the associations.ResultsAfter adjustment, maternal anxiety [RR 1.60 (95% CI 1.11-2.32)] and paternal emotional problems [RR 1.32 (95%CI 1.03-1.68)] were associated with an increased risk of anxiety in offspring at age 20 years. Conversely, maternal depressive symptoms [RR 1.04 (95%CI 0.84-1.32)] were not associated with an increased risk of anxiety in offspring.ConclusionsThe present study suggests that maternal anxiety and paternal emotional problems were associated with an increased risk of anxiety in young adult offspring. However, maternal depressive symptoms were not associated with an increased risk of anxiety in the offspring. The findings suggest the potential for targeted screening and intervention of anxiety problems in the offspring.DisclosureNo significant relationships.

IntroductionElectroconvulsive therapy (ECT) is today one of the main treatments available and used in psychiatry for serious mental illnesses. Eighty years after its introduction, the ECT procedure has evolved to become a safe option based on scientific evidence. Nowadays there are no absolute contraindications for ECT, regardless of the type of population and clinical situation.ObjectivesTo illustrate the electroconvulsive therapy in medical comorbidities context with a case report.MethodsDescriptive case study.ResultsWe present a 66 years old patient who suffers from a psychiatric decompensation with a diagnosis of major depressive disorder with psychotic symptoms. Due to her cardiological history (prolongation of the QT interval of possible psycopharmacological origin and a 2:1 AV block, that required the implantation of a definitive pacemaker) and partial response to psychotropic medication, the initiation of electroconvulsive therapy is proposed as the best alternative. The pacemaker was previously studied by cardiology for a very complete analysis before the procedure. It was recommended to convert it to fixed rate pacing by using a magnet. To do this, we placed it over the pacemaker during the technique. While waiting for a clinical improvement, no incidence has been produced during the sessions.ConclusionsECT should not be postponed as a last resort. Numerous studies conclude that ECT is globally the treatment of choice (70-85% response) in severe depressive conditions, over and above antidepressant drugs. The incidence of relevant cardiac complications on ECT is relatively rare (0.9%). Regarding the use of pacemakers, electroconvulsive therapy represents an effective and safe option for the patient.DisclosureNo significant relationships.

IntroductionIn palliative care, depression and pain are prevalent variables with a reciprocal and controversial relationship. Depression is common in people with chronical diseases. In the last decades, self-compassion has been pointed as a protective psychological process to negative affect.ObjectivesThe current study aimed to test the role of self-compassion in the relationship between pain and depression in palliative patients.MethodsSample was composed of 33 patients in palliative care, with a mean of 74.12 years of age (SD = 12.76). Participants completed self-report questionnaires and data was analyzed using SPSS.ResultsFrom the descriptive analysis of the results of the Geriatric Depression Scale, 22 patients were depressed (66.6%), 9 of them in severe depression (27.7%). Self-compassion presented a negative and moderate correlation with depression. Depression was positively correlated with pain. A hierarchical regression to predict depression was conducted. Firstly, pain was entered as a predictive variable with a significant effect. Secondly, self-compassion was entered, and the model was significantly incremented, explaining 41% of depression. Only self-compassion was significant in this model.ConclusionsDiscussion and conclusion: The association between pain and depression in palliative care corroborate previous research. Results seemed to show that self-compassion has a significant effect in the relationship between pain and depression. Cultivating a compassion self-to-self relationship might have an important effect attenuating the link between pain and depression in palliative care.

IntroductionAlthough sleep hygiene is a well-studied factor of good sleep (Irish et al., 2015, McNail et al., 2016), less is known about its role in the complaints on anxiety and depression (wither direct or through sleep quality).ObjectivesThe aim was to reveal direct and indirect effects of sleep behavior on subjective sleep quality, anxiety and depression.Methods174 people aged 17-57 without diagnosed sleep disorders filled the Scale of Behavioral Factors of Sleep Disturbances (Rasskazova, Leonov, 2020), Insomnia Severity Index (Morin, 1993), Hospital Scale of Anxiety and Depression (Zingmond, Snaith, 1983), Beck’s Anxiety and Depression Inventories (Beck, Steer, 1993, Beck et al., 1996).ResultsTaking medications and non-medications before sleep, alcohol, tonic drinks and using gadgets in the evening, delaying bedtime, self-limitations after poor nights, poor adherence to the regimen and postponement of the morning rise were characterized by an indirect effect on anxiety and depressiveness through poor sleep (|β|=0,03-0,24). Self-limiting behavior and delaying the morning rise are associated with higher levels of anxiety and depression, even in the absence of sleep-related complaints (β=0,23-0,34, pConclusionsBased on the data we suggest that the dysfunctional role of behavior on anxiety and depression is predominantly indirect (through the perpetuation of complaints), but it can also be direct (regardless of complaints of sleep disorders). Research is supported by the Russian Foundation for Basic Research, project No. 20-013-00740.Conflict of interestResearch is supported by the Russian Foundation for Basic Research, project No. 20-013-00740.

IntroductionBipolar disorder (BD) is a serious and extremely recurrent illness frequently associated with cognitive and functional deterioration that poses many treatment challenges. However, over the years, with the evolution of more and more mood stabilizers and neuroleptics, there were controversies surrounding the use of electroconvulsive therapy (ECT).Objectives The present study was an attempt at studying the clinical profile of BD patients who receive ECT and to study its effectiveness.MethodsRetrospective data were collected from all bipolar patients submitted to acute ECT treatment, between June 2015 and June 2016, at the Department of Psychiatry of the University Hospital of Mahdia, Tunisia.ResultsDuring the study period, among all the patients who received ECT, 47% were diagnosed to have bipolar disorder. ECT was administered most commonly for mania with psychotic symptoms, followed by severe depression with psychotic symptoms. Most of patients showed more than 65% response (based on reduction in the standardized rating scales) with ECT. Few patients (18.7%) reported some kind of side effects.ConclusionsECT resulted very effective for all BD acute depressive and manic episodes not responding to conventional pharmacologic management.

IntroductionThe bipolar disorder is characterized by instability mood. It normally happens in the middle-aged. In elderly patients with a first manic episode, you have to dismiss organic pathology.ObjectivesTo present an elderly patient with a first manic episodeMethodsA descriptive study of a clinical case and literature reviewResultsA 67-year-old man, married. Consulted Mental Health 5 years ago, about low mood after his early retirement. With no psychiatric treatment. Somatic antecedents: Acute myocardial infarction, hypertension and dyslipidemia. Came to the hospital accompanied by his son-in-law presenting rapid speech and thinking, bright clothing, risky behaviour, irritability, grandiosity deliration ideas and less sleep; being necessary a hospital admission. Blood and urine analysis: with no abnormalities. No toxics in the urine. Asenapine 20mg and Lorazepam 3mg were prescribed with clinical improvement. Brain CT: with no abnormalities. After that, Lithium 400mg per day was prescribed to avoid the induction of depression. Clinical judgement: manic episode. Bipolar disorder Type IConclusionsAfter dismissing somatic causes, the symptomatic treatment of a manic episode in older patients is on the same lines as the treatment for mania in young adults. 8-10% of psychiatric inpatients over age 55-60 years are diagnosed with bipolar disorder. Since there is an increase in the number of individuals living longer, an expected increase in the number of older adults who will be diagnosed with bipolar disorder. Older adults with bipolar disorder will increase in absolute numbers as well as the proportion of the general populations.DisclosureNo significant relationships.

IntroductionThe coronavirus crisis has had an impact on the mental health of children and adolescentsObjectivesDetermine how it has affected this population and what mental pathologies are occurringMethodsLiterature bibliographic reviewResultsSchool closures and lockdown have been seen to have produced higher levels of anxiety, anger, and sleep and appetite disruption. On the one hand, the children had more anxiety and regressive behaviors, and the adolescents had more isolation, depressive symptoms and even autolytic ideation. The economic crisis and lockdown have affected the family environment, having reported greater situations of domestic violence and substance use among parents. Studies show a prevalence up to 28-34% of post-traumatic stress symptoms among adolescents. In Spain it has been determined that ¼ children present anxiety and / or depression. Their parents noticed in them greater irritability, less concentration and greater feelings of loneliness There has been an increase in addiction to new technologies. This is partly a method of maintaining social relationships, but prolonged use is associated with higher levels of anxiety and depression. Regarding to patients with mental pathology, they have presented greater tantrums, especially ADHD and ASD, due to the loss of structure and routine.ConclusionsConfinement and fear of COVID have affected mental health of children and adolescents, with anxiety and depression occurring more frequently. Is highlighted the presence of feelings of loneliness among adolescents and the increase in the use of screens. Finally close to 80% of patients who had mental health conditions referred that this crisis had worsed their symtponms