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Introduction Koro, also known in Cantonese as Shook Yang, which literally translates to “shrinking penis”, has its roots in a cultural belief that a mythological figure would steal the penis of his victims. Predominantly reported in Southeast Asia, it involves an acute fear of genital retraction, often accompanied by the belief that this retraction may lead to death. Over the last two centuries, Koro has undergone several attempts to establish its definition and classification, without a true consensus having been reached. Objectives This study aims to explore the cultural nuances surrounding Koro and reflect on the various conceptualizations that modulated its definition and nosological classification, from Ancient China until the present. Methods A non-systematic literature review with the keywords “koro” and “culture” was conducted. Results Koro was only introduced to the Western world during colonial expansion, drawing the attention of several psychiatrists who, in Asian territory, reported numerous cases in natives, making the very first attempts at a nosological classification, whether as an anxiety neurosis, or as an obsessive-compulsive disorder. The literature reveals significant cultural variations in the manifestation of Koro, challenging the traditional psychiatric understanding rooted in Western diagnostic categories. Cultural factors, including societal beliefs, religious practices, and regional variations, emerged as influential contributors to the prevalence and presentation of Koro. Additionally, the study identified instances of Koro evolving in response to cultural shifts and globalization, emphasizing the dynamic nature of this syndrome. Conclusions This review underscores the need for a comprehensive understanding of Koro that acknowledges its diverse conceptualizations across cultures. Its occurrence, not only in multiple parts of the world, but also in close relation with various comorbidities, has contributed to the dissolution of its primary identity as a culture-bound syndrome, turning Koro into a moving target. Disclosure of Interest None Declared

Introduction With the increasing push to legalize cannabis in Western nations, there is a need to gauge the potential impact of this policy change on vulnerable populations, such as those with mental illness, including schizophrenia, mood and anxiety disorders. Objectives Understand the effects of cannabis in people with mental illness and the impact of policies legalizing cannabis in societies. Methods Literature review performed on PubMed and Google Scholar databases, using the keywords “cannabis”, “mental health”, “psychiatry”. Results Cannabis use is a modifiable risk factor for the development and exacerbation of mental illness. The strongest evidence of risk is for the development of a psychotic disorder, associated with early and consistent use in youth and young adults. Cannabis-related mental health adverse events precipitating Emergency Department (ED) or Emergency Medical Services presentations can include anxiety, suicidal thoughts, psychotic or attenuated psychotic symptoms, and can account for 25–30% of cannabis-related ED visits. Up to 50% of patients with cannabis-related psychotic symptoms presenting to the ED requiring hospitalization will go on to develop schizophrenia. With the legalization of cannabis in various jurisdiction and the subsequent emerging focus of research in this area, our understanding of who (e.g., age groups and risk factors) are presenting with cannabis-related adverse mental health events in an emergency situation is starting to become clearer. Conclusions There’s a need to provide a reconciliation of the addiction vulnerability and allostatic hypotheses to explain addiction comorbidity in mentally ill cannabis users, as well as to further aid in developing a rational framework for assessment and treatment of problematic cannabis use in these patients. Disclosure of Interest None Declared

Introduction Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by social and communication deficits and restricted and repetitive or stereotyped behaviours. The prevalence of ASD has been thought to be higher in men, which may reflect aspects of the own aetiology of the disorder. Still, it may also be associated with misdiagnosis or missed diagnosis of females with autism due to specific phenotypic traits. Objectives To explore the differences between sex/gender in autism’s clinical presentation. Methods Non-systematic literature review using the most relevant papers found on PubMed and Google Scholar using the following keywords: “autism spectrum disorder”, “gender differences”, and “autistic women”. Results Autistic women seem to have a “camouflage” phenomenon, characterized by a high level of functioning, less unusual play or restricted interests, better socio-emotional reciprocity and coping behaviours. Therefore, women with ASD commonly have an anteriority of multiple diagnoses, which delays their access to the support and care they need. Conclusions Professionals must be aware of the sex/gender clinical differences to prevent the misdiagnosis or missed diagnosis of females with autism. Moreover, the current clinical criteria used to diagnose ASD may underserve the female population and deserve to be reviewed. Disclosure of Interest None Declared

Introduction Research on life stress in bipolar disorder largely fails to account for the possibility of a dynamic relationship between psychosocial stress and episode initiation. The kindling hypothesis states that over the course of recurrent affective disorders, there is a weakening temporal relationship between major life stress and episode initiation that could reflect either a progressive sensitization or progressive autonomy to life stress. Objectives To explore the concept of the Kindling model applied to bipolar disorder and to present a clinical case of a bipolar patient whose latter mood episodes were caused by adverse life events. Methods We performed a non-systematic literature review using the most relevant papers found on the database PubMed with the keywords “kindling effect”, “allostatic load”, “bipolar disorder” and “prevention”. Description of the clinical case report. Results The phenomenon of kindling was first discovered by Goddard in 1967 who described it in epilepsy. Later, Post applied it to the bipolar disorder, arguing that the initial episodes of both unipolar and bipolar affective disorders are often precipitated by psychosocial stressors, but after multiple recurrences, not only do precipitated episodes continue to occur, but so do spontaneous ones as well. We present the case report of a 62 years old woman, divorced, diagnosed with type 1 bipolar disorder since she was 20 years old. She always have had poor adherence to her medication and follow-up with Psychiatry consultation, with a non-containing sociofamily environment that does not promote clinical stability. Over the time, her admissions on the Psychiatry ward were more frequent and precipitated by adverse life events, mainly caused by the deteriorated relationship with her children. Conclusions The kindling model clarifies aspects of the longitudinal course of episode development, recurrence, and progression to spontaneity, as well as further conceptual and theoretical rationales for intervention in order to prevent illness progression. Disclosure of Interest None Declared

Introduction Obsessive-compulsive disorder (OCD) is a clinical syndrome whose hallmarks are excessive, anxiety-evoking thoughts and compulsive behaviours that are generally recognized as unreasonable, but which cause significant distress and impairment. OCD may also occur in the context of other neuropsychiatric disorders, most commonly other anxiety and mood disorders. The question remains as to whether these combinations of disorders should be regarded as independent, cooccurring disorders or as different manifestations of an incompletely understood constellation of OCD spectrum disorders with a common aetiology. Objectives To review critically whether there is a robust basis for the concept of an obsessive–compulsive (OC) spectrum of disorders, and if so, which disorders should be included. Methods Literature review performed on PubMed and Google Scholar databases, using the keywords “obsessive–compulsive disorder”, “obsessive–compulsive spectrum”, “body dysmorphic disorder”, “hypochondriasis”, “trichotillomania”, “psychiatry”. Results Obsessive–compulsive disorder (OCD) itself is a heterogeneous condition or group of conditions, and this needs to be appreciated in any articulation of a ‘spectrum’ of OC disorders. The basis for ‘membership’ of the spectrum is inconsistent and varied, with varying level of support for inclusion in the putative spectrum. Conclusions A more fruitful approach may be to consider behaviours and dimensions in OCD and OC spectrum disorders, and that this should be encompassed in further developments of the OC spectrum model. Disclosure of Interest None Declared

Introduction Psychedelics - including LSD (lysergic acid diethylamide), psilocybin, DMT (N, N-dimethyltryptamine), ayahuasca and mescaline - have an ancient history across various civilizations. In 1950, after LSD’s discovery by Hofmann, psychedelics enjoyed a short-lived relationship with psychiatry, before prohibitive legislature emerging in response to the recreational use in the mid-1960s. However, the last decade has witnessed a renewed scientific interest in psychedelics - a phenomenon referred to as the ‘Psychedelic Renaissance’. Objectives Review the pharmacology of psychedelic drugs and the latest evidence of its therapeutic potentials in anxiety, mood and addictive disorders. Methods Literature review performed on PubMed and Google Scholar databases, using the keywords “psychedelics”, “hallucinogens”, “d-lysergic acid diethylamide (LSD)”, “psilocybin”, “ayahuasca”, “mescaline”, “DMT (N,N-dimethyltryptamine)”. Results The psychedelics or “classic hallucinogens” can be subdivided into three sub-classes: the plant-derived tryptamines (psilocybin and ibogaine) and phenethylamines (mescaline), and the semisynthetic ergolines (LSD). The therapeutic potentials are mediated by an agonist action on 5-HT2A receptors expressed in frontal and paralimbic structures involved in mood and emotion regulation, introspection, interoception and self-consciousness. Stimulation of 5-HT2ARincreases the glutamatergic tone and neuroplasticity and is accompanied by reduced amygdala activity, reducing anxiety. Experimental, open-label, and RCTs showed anxiolytic, antidepressive, and antiaddictive effects with psychedelics. As examples, psilocybin and LSD reduced anxiety and depression in cancer patients and symptoms of alcohol and tobacco dependence, and ayahuasca reduced depression in treatment-resistant depression. Conclusions Despite the promising effects of psychedelics on anxiety, depression and addiction, the evidence is still preliminary, waiting for long-term studies with bigger samples. Conflict of interest No significant relationships.

Introduction Suicide is an intriguing act of the human being. The reasons behind the violation of an instinct for survival is far from being understood. Besides, the emergence of assisted dying is raising even more questions about the concept of rational suicide, defined as a well-thought-out decision to die by whom is mentally competent. Objectives Understand the concept of rational suicide, in parallel with suicide, by exploring the views on this debate over the years and elucidating the relationship with mental disorders, mental capacity and patient’s rights. Methods Literature review performed on PubMed and Google Scholar databases, using the keywords “rational suicide”, “assisted death”, “suicide”, “phenomenology”, “mental capacity” and “responsibility for life”. Results The theological condemnations of suicide – as sin or crime – were put aside with psychiatric development in the last century. Durkheim was the first important precursor of the contemporary view - suicide is a form of mental illness (psychosis or depression) not compatible with rational deliberation. With the increasingly open debate on assisted dying, this vision is being tested by cases of terminally ill patients subjected to experiences that many wouldn’t choose to tolerate. Moral right to self-determination and needless suffering are examples of arguments in favor of rational suicide. Conclusions The need for an open discussion about rational suicide is raising, specifically in relation to psychiatric disorders, mainly to resolve the conflict between the duty of care of psychiatrists and the autonomy of patients. Disclosure No significant relationships.

Introduction Insight is a complex and multidimensional phenomenon. Metacognition, awareness of illness or anosognosia are some of the terms used to designate this feature of the mental state exam. Objectives To attempt to explore the evolution of the concept of insight as a psychiatric symptom over the years and to bring up some up-to-date features on this theme. Methods Literature review, using the most relevant papers, with the keywords “psychiatric insight”, “awareness of illness”, “metacognition” and “phenomenology”. Results The term ‘insight’ has been described since 1896 when Kraepelin had noticed that patients with dementia praecox were unaware of their condition. Nowadays, it is recognized in several psychiatric disorders, with different meanings in each one. Overall, insight in psychiatry involves an attempt to see one’s thinking and behaviour ‘objectively’ and comparing it to some representation of mental health. Impaired insight has been linked to poor treatment compliance and outcomes, overall symptom severity, higher relapse, lower self-esteem, and impaired psychosocial functioning. White matter and connectivity problems may be related to poorer insight, as well as impaired frontal lobe functioning. In psychotic disorders, lack of insight is a primary symptom with poorer outcomes. Regarding affective disorders, the lower the mood the better the insight. Neuroimaging has been correlating insight with the inferior frontal gyrus, anterior insula, inferior parietal lobule, and ventromedial prefrontal cortex. In everyday practice, there are scales used to assess insight. Conclusions Inferences about patients’ insight are important to evaluate severity of illness, suicidal risk, compliance, and response to treatment.

Introduction Nowadays, ‘Acute and transient psychotic disorders’ in ICD-10 and ‘Brief psychotic disorders’ in DSM-5 are both classifications of the same clinical entity. Over the years, several concepts have been formulated to define the same syndrome. Objectives To explore the historical evolution of brief psychotic disorders and relate them to current nosologies. Methods Literature review, using the most relevant papers, with the keywords “brief psychosis”, “bouffée délirante”, “cycloid psychosis”, “psychogenic psychosis”, “atypical psychosis” and “holodysphrenia”. Results Initially, in 1896, Kahlbaum coined the term ‘dysphrenia’, a group of severe form of psychosis that remitted without showing the typical sequence of disease states and without leaving a lasting alteration. Later, Kraepelin included this kind of disorder in manic depressive illness, which he first named as ‘periodic delirium’ and then as ‘delirious mania’. Magnan, in the pre-Kraepelinian era, created the term ‘bouffée délirante’, a sudden onset of delusional ideas with rapid evolution and intense symptomatology with complete remission usually followed after a short time. Later on, Henry Ey grabbed this entity and renewed it, contrasting it to the defined concept of schizophrenia. Other psychiatric schools have proposed numerous designations: ‘cycloid psychosis’ by Kleist from the German school, ‘psychogenic psychosis’ by Wimmer of the Scandinavian school and ‘holodysphrenias’ by Barahona-Fernandes from the Portuguese school. Cultural variants are also observed, as ‘amok’ seen in Malaysia or ‘shinbyung’ in Korea. Conclusions The intensity and polymorphism of brief psychosis present a clinical challenge. The historical evolution may be helpful on recognizing this entity in current clinical practice.