Psychiatry Service Research Articles

Longer wait time after identification of peripartum depression symptoms is associated with increased symptom burden at psychiatric assessment

Untreated peripartum depression (PD) affects one in seven women and is associated with negative maternal outcomes. This retrospective observational study used health record data from an integrated health system in Texas to assess the extent to which time to access reproductive psychiatry influences the mental health of peripartum women. Women with at least one screening for depression symptoms conducted in obstetric or pediatric settings between May 2014 and October 2019 and subsequently seen by the reproductive psychiatry clinic (n=490) were included. Descriptive and inferential statistics were used to assess timing and factors related to psychiatry follow-up. Findings from this study demonstrated that the average time between a positive screen and a psychiatry assessment was 5 weeks. At psychiatry referral appointments, 85% of women continued to screen positive for PD symptoms. Depression symptom scores at the psychiatry appointment were significantly higher than scores precipitating the referral (p = 0.002). Wait time between initial positive screen and referral appointment was positively correlated with clinically meaningful increases in depression symptom scores (p < 0.001). Each week spent waiting for an appointment produced a 13% increase in odds of clinically meaningful worsening of PD scores and 9% increase in odds of developing new self-harm ideation. Given the findings that a longer period between primary care referral and subspecialty appointment has a negative impact on the mental health of women, this study supports the need for earlier psychiatric assessment to minimize decompensation. Expansion of reproductive psychiatry services are needed to support peripartum women and improve maternal outcomes.

Brain Morphometric Correlates of Depressive Symptoms among Patients with and without Dementia

Introduction: Findings regarding brain morphometry among patients with dementia and concomitant depressive symptoms have been inconsistent. Thus, the aim of the present study was to test the hypothesis that dementia and concomitant depressive symptoms are associated with structural brain changes in the temporal lobe measured with structural magnetic resonance imaging (MRI). Methods: A sample of 492 patients from Norwegian memory clinics (n = 363) and Old Age Psychiatry services (n = 129) was studied. The assessment included the Cornell Scale for Depression in Dementia (CSDD), Instrumental Activities of Daily Living Scale, Mini Mental State Examination, and MRI of the brain, processed with FreeSurfer to derive ROI measures of cortical thickness, volume, and area using the Desikan-Killiany parcellation, as well as subcortical volumes. Dementia was diagnosed according to ICD-10 research criteria. Correlates of brain morphometry using multiple linear regression were examined. Results: Higher scores on the CSDD were associated with larger cortical volume (β = 0.125; p value = 0.003) and area of the left isthmus of the cingulate gyrus (β = 0.151; p value = <0.001) across all patients. Inclusion of an interaction term (dementia × CSDD) revealed a smaller area in the left temporal pole (β = −0.345; p value = 0.001) and right-transverse temporal cortex (β = −0.321; p value = 0.001) in patients with dementia and depressive symptoms. Discussion/Conclusion: We confirm the previous findings of structural brain changes in temporal regions among patients with dementia and concomitant depressive symptoms. This may contribute to a better understanding of the mechanisms underlying depression in dementia. To the best of our knowledge, this is the largest study conducted on this topic to date.

Locked in and locked out: sequelae of a pandemic for distressed and vulnerable teenagers in Ireland

ObjectiveThe aim of this study is to investigate the impact of the coronavirus pandemic on teenage psychiatry referrals following crisis presentation to the adult emergency department (ED) of an Irish tertiary hospital. In doing so, this study will specifically examine the effect of COVID-19 on self-injurious behaviour, suicidality and substance use among older adolescents (age 16/17 years).MethodsThis is a retrospective descriptive analysis of acute adolescent psychiatry referrals assessed out-of-hours via the adult ED psychiatry service across three consecutive time points (during the months of March, April and May) from pre-pandemic, 2019 (T1); initial pandemic, 2020 (T2); and peak pandemic, 2021 (T3). Data were obtained via the hospital’s ED-specific electronic database, review of original assessment notes and cross-referenced by manually extracting data logged in the on-call register.ResultsCrisis psychiatry assessments of teenagers during on-call hours trebled during the period of this study (p < 0.001). Although ED/crisis referrals initially decreased overall at the start of the pandemic, the rate of teenage referrals remained constant, before increasing as restrictions tightened in lockdown. The negative impact of COVID-19 on teenagers’ ability to cope was found to be statistically significant (p = 0.001). Changes in rates of self-harming and/or suicidal behaviours were not statistically significant between 2019, 2020 and 2021 (p = 0.082). Alcohol misuse occurred in up to one-third of cases across each timeframe and remained virtually constant throughout the pandemic. Drug misuse decreased from onset of COVID-19 (p = 0.01).ConclusionsTo our knowledge, this is the first study to specifically examine the impact of COVID-19 on suicidality, self-harming behaviours, substance misuse and on-call ED presentations of teenagers in Ireland. This study demonstrates that coronavirus-related stress is associated with negative mental health sequelae for vulnerable at-risk older adolescents, as evidenced by a rise in ED presentations and on-call referrals since the onset of the pandemic. Presentation of increased numbers of under-18’s for psychiatry assessment at the adult ED/general hospital indicates a deepening chasm between available and aspirational emergency (adolescent-specific) psychiatric care in the community. Mobilising resilience factors and maximising coping skills for at-risk youth will inform tailored intervention and support strategies along with adequate resourcing of services for vulnerable adolescents in the community.

Anxiety/Depression Predominance in Liaison-Psychiatry Users of a South-East Mexico Tertiary Hospital.

Patients at tertiary hospitals may find themselves in need of mental health support due to the distress associated with the illness that may or not lead to a psychiatric condition. Here is an overview of the clinical cases treated by the liaison psychiatry service of a public tertiary hospital from Southeast Mexico during its first years of operation (2008–2018), with the purpose of gathering information about the status and needs of this population. A sample of 304 clinical records of patients treated for the first time by the psychiatry service was reviewed, and the distribution by demographic characteristics, diagnosis of mental illness and medical area of reference was analyzed. Anxiety and depression symptoms were the most frequent. Most patients were women, lived in Merida and returned after the first appointment. The neurology service referred most patients, yet most attended directly. General tertiary hospitals should prioritize integrating ad hoc mental and physical health care. Adult women with a profile of anxiety and/or depression would be the first target group. Some areas of opportunity for further research and improvement of mental health services are: preventive services for anxiety and depression, follow-up of patients, attention to relatives of patients at intensive care units, implementation of telehealth alternatives, training on mental health screening and inter- and intra-institutional collaboration.

Initiation of Antipsychotic Treatment for Amphetamine Induced Psychosis and Its Impact on Length of Stay

Introduction: A risk of amphetamine use is amphetamine-induced psychosis (AIP). Symptoms of AIP include hallucinations, delusions, and agitation. While AIP may resolve with abstinence from amphetamines, antipsychotics are commonly used despite not being FDA approved. The primary objective of this study was to compare length of stay (LOS) for patients with AIP treated with antipsychotics vs untreated. Secondary aims were to determine antipsychotic prescribed, proportion of patients utilizing as needed doses, time to initiation, and readmissions. Methods: A retrospective chart review conducted at an academic medical center identified adult participants who were diagnosed with AIP, admitted to inpatient psychiatry service, and had a urine drug screen (UDS) positive for amphetamines. Patients were excluded if they were already taking an antipsychotic, had active prescriptions for amphetamine salts, or were in the emergency department for more than 48 hours. Demographics were assessed with descriptive statistics. Length of stay was compared between treatment groups using Kruskal-Wallis. Secondary aims were assessed using chi-square, Mann-Whitney U, and Kruskal-Wallis. Results: Sixty-nine patients were included. Median LOS for patients treated with antipsychotics (n = 35) was longer than untreated patients (n = 34), (5 days vs 2.5 days, P = .001). Type of antipsychotic used and time to initiation of antipsychotic were not found to affect LOS. There was no difference in readmissions rates and positive UDS on readmission between groups. Conclusion: This study found patients with scheduled antipsychotics for AIP had a longer LOS than patients who did not receive scheduled antipsychotics. Future studies are needed to evaluate antipsychotic use in AIP.

Characteristics of 100 consecutive patients with COVID-19 referred to consultation-liaison psychiatry services in Qatar: A comparison of patients with delirium versus other psychiatric diagnoses.

Introduction: Coronavirus disease 2019 (COVID-19) can present with various neuropsychiatric manifestations. This study reports on patients with COVID-19 who were referred to the consultation–liaison (CL) psychiatry services in Qatar and compares the clinical and sociodemographic characteristics of those diagnosed with delirium versus other psychiatric diagnoses. Methods: This is a retrospective review of the first 100 consecutive patients with COVID-19 who were referred to the CL services. Results: Within the total cohort (n=100), most patients (92%) were male, and the mean age was 46 years. About 27% of patients had asymptomatic COVID-19, 35% had a past psychiatric history, and 48% reported pandemic related psychosocial stress. Delirium was the most common psychiatric diagnosis (n=29), followed by acute stress reaction/adjustment disorder, depression, mania, anxiety, non-affective psychosis, and dementia. Among patients with delirium, agitation was the most common symptom (76%), 86% were treated with psychotropic medications, and 17% died. Higher age, longer hospital stays, lower oxygen saturation, lower lymphocytic count, and higher C-reactive protein (CRP) values were significantly associated with delirium versus other psychiatric diagnoses. Higher age and lower oxygen saturations predicted delirium.Conclusion: Delirium was associated with a range of clinical variables and had significant mortality, despite the relatively young age of the patients. COVID-19 should be considered in patients presenting with delirium. Finally, early identification and management of delirium should be integral to COVID-19 protocols.

Feasibility and Effectiveness of a Psychosis-Specific Intensive Outpatient Program.

ObjectiveIntensive outpatient programs (IOPs) are rarely designed specifically to treat psychosis. In 2016 UCLA established the Thought Disorders Intensive Outpatient Program (TD IOP), combining a time‐limited, group‐based intervention called cognitive behavioral social skills training (CBSST) and medication management to treat individuals with psychosis. The purpose of this study is to assess the feasibility of developing an IOP for individuals with psychosis and the effectiveness of the program in improving psychotic symptom severity.MethodsAdults were referred to the TD IOP from inpatient and outpatient settings. Programming included 3 hours of CBSST and 6 hours of additional groups weekly as well as individual psychiatry and social work services. Primary outcomes were symptom changes as measured at intake and discharge by the Clinician‐Rated Dimensions of Psychosis Symptom Severity scale. Program feedback was solicited from a small subset of patients.ResultsOf the 92 enrolled subjects, 71 completed the program (77.2%). Average length of stay was 52 ± 30 days across all enrolled. Participants showed significant (p < 0.05) improvement with small‐moderate effect sizes across five of eight psychosis symptom domains (hallucinations, delusions, disorganized speech, depression, and mania). Patient‐reported program satisfaction was high (86.6 ± 12.7 score, range 0–100).ConclusionsThe current study indicates that targeted treatment for psychosis is successful within an IOP framework, with minimal additional training required for Master's level clinicians. Participants demonstrated significant symptomatic relief from group‐based, time‐limited treatment. Further work is needed to determine the full range of program benefits on patient well‐being and illness morbidity.

An Audit of Risk Acknowledgment of Valproate Use in Women (General Adult Psychiatry)

Aims•To enable identification, recall of all women (18–60 years) who may be of childbearing potential and are currently prescribed sodium valproate and identify those that are at risk.•To check that the patients continue to meet the conditions of the Pregnancy Prevention Programme.•To ensure that the guidelines by MHRA are adequately followed.•To evaluate our practice relating to completing the Risk Acknowledgement Form for Sodium Valproate.MethodsFirst audit cycle August 2021:From the General Adult Database (NHS GRAMPIAN), we identified 33 women between the ages of 18–60 years who were prescribed Sodium Valproate as a mood stabiliser in the period between August 2020 until August 2021. Data were obtained from patients’ records to ensure patients were still open to psychiatry services, compliant with Sodium Valproate, had regular contact with specialists and identified Valproate risk acknowledge form existed and adequately filled.Univariate analysis was used to analyze the result.THE INCLUSION CRITERIA: •Adult female patients(18–60) who are open to psychiatry services.•On Sodium Valproate as a mood stabilizer.Second audit February 2022:A second audit was conducted using the same standards and timescale as for the primary audit. Using telephone and emails, the teams were contacted and encouraged to complete the relevant documentation.ResultsFirst audit cycle August 2021:•There were a total of 33 patients included in the audit.•97% of the patients were in contact with psychiatry services and specialists.•Only one patient had an Annual Risk Acknowledgement Form (ARAF) filled and scanned to her E-notes.•66% of women were between the ages of 45–60 years of age.Second audit cycle February 2022The results showed 39 female patients (18–60) were on Sodium Valproate as a mood stabiliser. The mean age was 45 (18–60). We identified Completed Annual Risk Acknowledgement Form (ARAF) forms on 21 patients.The proportion of completed ARAF was increased from 3% to 54%.ConclusionConclusion of the first cycle:97% of the patients were in contact with psychiatry services and specialists.• Only one patient had an Annual Risk Acknowledgement Form (ARAF) filled and scanned to her E-notes.Conclusion of the second cycle:There was a significant increase in compliance with the MHRA guidelines regarding Sodium Valproate prescription in women of childbearing age in our department.The proportion of completed ARAF was increased from 3% to 54%.•Valproate is highly teratogenic, and evidence supports that use in pregnancy leads to neurodevelopmental disorders (approx. 30– 40% risk) and congenital malformations (approx. 10% risk).•Valproate must not be used in women and girls of childbearing potential unless the conditions of the Pregnancy Prevention Programme are met and only if other treatments are ineffective or not tolerated, as judged by an experienced specialist.•The MHRA advises that all healthcare professionals must continue to identify and review all female patients on valproate.•The Annual Risk Acknowledgement Form should be used for all future reviews of female patients on valproate•Specialists should comply with guidance given on the form if they consider the patient is not at risk of pregnancy, including the need for review in case her risk status changes.

Assessment of intellectual disability in Klinefelter’s Syndrome associated with other Prenatal and Perinatal risk factors. A case report

IntroductionKlinefelter’s syndrome (KS) is considered as a genetic risk factor for intellectual disability and specifically for impairment on verbal skills. Prenatal and perinatal morbidity concurrent with this diagnosis determine the entity and typology of neurodevelopmental deficits.ObjectivesTo describe the intellectual and adaptive functioning of a patient with KS and prenatal and perinatal difficulties, assessed in the Service of Psychiatry, Clinical Psychology and Mental Health at La Paz University Hospital (Madrid).MethodsA descriptive study was conducted of a 6 year and 7-month-old boy with diagnosis of KS (karyotype XXY), extremely low weight at birth (752 gr.), Arnold Chiari type I malformation with post-hemorrhagic hydrocephalus and periventricular leukomalacia, bronchopulmonary dysplasia, intra-atrial septal defect, left kidney agenesis with iatrogenic adrenal insufficiency, and acute ventriculitis due to E. Coli. Neuropsychological evaluation was carried out in October 2021. Leiter-3 scale was selected due to the absence of expressive language; and his parents completed the questionnaire Adaptive Behavior Assessment System-II.ResultsThe nonverbal intelligence quotient was observed in the very low range (full-scale IQ = 69). The result of general adaptive behavior (z = -2.83), showed very high functional disability both in the conceptual, social, and practical domains.ConclusionsThe high number of causes of disability in this patient is consistent with a high degree of functional disability. Efficient evaluation sessions of intellectual performance, adaptive functioning, and necessary supports, due to the absence of expressive language and limited receptive language, are required. A specific neuropsychological evaluation profile should be established for KS.DisclosureNo significant relationships.

Neuropsychological profile of Turner Syndrome in relation to deficits in academic and psychosocial areas. A case report

Introduction Previous reviews reported an association between Turner Syndrome (TS) and a profile of deficits in some neurocognitive domains (visual-spatial domains, mathematics, and executive functions: cognitive flexibility, working memory, cognitive inhibition, and problem solving), although pointing out individual variability.ObjectivesTo describe the neuropsychological profile of a patient with diagnosis of TS and psychosocial difficulties attended at the Service of Psychiatry, Clinical Psychology and Mental Health at La Paz University Hospital (Madrid).MethodsA descriptive study is conducted on a single case of a 11-year-old woman with diagnosis of TS attended by a clinical psychologist at a child-adolescent Mental health center for social, family and academic difficulties. Neuropsychological assessment was completed in October, 2021. The Wechsler Intelligence Scale for Children-Five Edition (WISC-V) and Neuropsychological Assessment of Executive Functions in Children (ENFEN) batteries were administered.ResultsThe full-scale intelligence quotient was observed in the normal range, with lower scores in non-verbal tasks. Deficits (range from z = -2.00 to -1.75) were observed in tests of working memory, processing speed and complex problem-solving tasks. The results showed great variability in other executive functioning tasks (selective attention tasks: from z = -1.75 to -0.75; and cognitive flexibility tasks: from z = -2.25 to 0.25).ConclusionsThe neurocognitive profile described in the literature was partially consistent with the results obtained in this study. The neuropsychological assessment can support the elucidation of clinical diagnostic and therapeutic factors in TS patients with relevant psychosocial or cognitive difficulties.DisclosureNo significant relationships.

A Pilot Study of Service Utilisation Pathways of Patients With Distinct Psychotic and Antisocial Typologies

AimsThere is a developing body of research that suggests that there may be distinct categories of patients that can explain the relationship between psychosis and antisocial behaviours. Specifically, three pathways of offending, antisocial behaviour and psychosis have been described and there is an evolving empirical evidence base to suggest that these pathways are aetiologically distinct. Firstly, there is a pathway for early-start offenders, which have been identified as those with psychosis preceded by Conduct Disorder (SZ + CD). Secondly, a group that start to display antisocial behaviours in parallel to the onset of psychosis (SZ-AS). The third group involves those with a long history of a psychotic disorder and no history of antisocial behaviours, who will present to services following a first conviction for non-violent or violent crime (SZ). The authors hypothesise that each typology will utilise services differently throughout the clinical trajectory. This pilot study aimed to (i) examine the concurrent validity of the antisocial behaviour and psychosis typologies, and (ii) examine differences in the service utilisation patterns of patients between these groups.MethodsThe sample consisted of adult male patients admitted to low and medium secure forensic hospitals within the Northwest of England. A total of 90 patients were used.A categorisation checklist was developed, and the typology of patients determined from data collected from electronic health records. Data were collected on patient demographics, psychiatric diagnosis, aetiological factors, and service utilisation. Two researchers reviewed the data and determined the typology. Statistical analysis aimed to assess the difference in aetiological variables between the typologies and examine the relationship with how each typology utilised services.ResultsThis study provided further evidence of distinguishing characteristics emphasising typology heterogeneity.The CD-SZ group were more likely to have utilised mental health services &lt;18 years (70%, p = 0.062), and to have used services preceding a diagnosis of psychosis (60%, p = 0.011). Following the onset of a psychotic disorder, the AS-SZ and SZ groups had a higher proportion that used general adult psychiatry services (p = 0.031), with CD-SZ coming in to contact with forensic psychiatry services and criminal justice services earlier and more frequently.ConclusionThis study demonstrates that each typology has a different clinical trajectory through mental health services. This provides further empirical evidence towards different clinical typologies and trajectories of individuals with psychosis and anti-social behaviour. Understanding more about how these typologies utilise services will enable clinicians to introduce interventions help develop effective management plans that address the distinct characteristics of each typology of offender with psychosis.

Mental health service requirements after hospitalization due to COVID-19: a 1- year follow-up study

IntroductionLong-term COVID-19 effects has been recently described as persistent and prolonged symptoms after an acute and severe SARS-COV-2 (1). An important concern is that the sequelae of severe COVID-19 may suppose a substantial outpatient 's burden for the specialized services in reopening pandemic phase (2).ObjectivesTo describe the frequency of mental health service use in COVID-19 hospitalized patients after discharge and to estimate the costs associated to the post- discharge consultations.MethodsWe used a 1-year follow-up cohort of 1455 COVID-19 inpatients hospitalized in La Paz University Hospital of Madrid, Spain between March 16th and April 15th, 2020. Data were retrieved from Psychiatry Service (PS) electronic health records and we described the frequency of mental health reason for consultation. We used information published by the Madrid health Office to estimate the cost of initial and following appointments.ResultsOur sample consisted of 1,455 patients admitted with a COVID-19 diagnosis between March 16th and April 15th, 2020, and then discharged. Roughly half of them were men (776, 53%), 238 (16%) had a prior history of mental health problems, and 44 (3%) died. 193 participants (13%) visited the mental health department after being discharged. The total cost was estimated in 103,581 USD, of which two-thirds corresponded to patients with prior history of mental health problems.ConclusionsOur results indicate that the mental health burden of severe COVID-19 inpatient s after discharge was substantial during the first year of follow-up. This generate important economic impact to mental health providers and society at large.DisclosureNo significant relationships.

Changes in psychiatric emergencies during COVID-19 pandemic lockdown in El Bierzo (Spain)

IntroductionThe interest have focused in the effects of COVID-19 in mental symptoms. However, the pandemic and restrictions such as the lockdown decreed in Spain limited access to resources and lead to a change in assistance organization.Objectivesto compare the incidence and characteristics of psychiatric emergencies during the Spanish 2020 Lockdown with the same period in 2019MethodsAll the emergencies attended the the emergency room (Hospital El Bierzo) From 01/02/2019 to 30/06/2019 and those from 01/02/2020 to 30/06/2020 were analysed by two senior psychiatrists. Cases were selected if attended by any psychiatric reason. The cases were evalueated identifying ICD-10 diagnosis (according to clinical records and best criteria matching), sociodemographics, factors associated to the emergency and resolution.Results23360 cases were attended in 2019 (799 psychiatric), 14907 (578) in 2020. That means a 36.19% of reduction in general emergencies and 27.66% in psychiatric emergencies (psychiatric emergencies proportion increased form 3.42% to 4.03%). The reduction started the week just before the lockdown declaration, minimal records coincided with the highest COVID-19 incidence and the recovery starts in early june for psychiatric and late June for general emergencies (figure 1). A decrease of 62.79% of anxiety cases and 45.9% of depresion was observed with no incresaes in any diagnosis. A slight increase in suicide attempts (two cases) was observed.ConclusionsThe lockdown seem to decrease psychiatric emergency care. Only suicidability was maintained/increased during the period. Psychiatry services must be aware of the risk of unattended inicidence that may cause an increase of cases after the lockdown.DisclosureNo significant relationships.

Dual disorders in liaison-consultation psychiatry. A descriptive study of patients with substance use disorder admitted to a general hospital

Introduction Several studies describe that the coexistence of a substance use disorder with another psychiatric condition or “dual disorder” (DD) is associated with a worse evolution at all levels, including a greater burden of medical illnesses and greater mortality.ObjectivesTo describe the presence of DD and related factors in patients admitted to a General Hospital that required assessment by a psychiatry service.MethodsA descriptive study that includes patients admitted to the Hospital del Mar in Barcelona for all medical-surgical reasons and attended by the specific addiction psychiatry consultation service between January 2016 and October 2021. Sociodemographic and clinical data are collected including the history of consumption and the diagnosis of dual disorder. Chi-square test was used for comparison between groups.ResultsThe sample was 1796 patients (Women: 345. Mean age: 50.3 years; SD: 12.6). 43.7% of the sample presented DD, with axis 1 disorders being the most frequent. There was an association of DD to factors as: being woman (54 vs 41.2% p &lt;0.001), HIV positive serologies (54 vs 42.7% p &lt;0.001), being homeless (49 vs 31.7% p &lt;0.001) and cocaine consumption compared to other substances (53.4 vs 39.8% p &lt;0.001).ConclusionsIn our sample, almost half of patients had DD. The representation of women was significantly lower, however they presented a higher proportion of DD. In this study we describe an association of DD with other biopsychosocial problems, and further studies are necessary to determine in which sense they are related and optimize patient care.DisclosureNo significant relationships.

The effects of Workplace violence on healthcare workers in Tunisia

IntroductionExposure to violence affects employees and has implications for the quality of care provided.ObjectivesThis study aims to describe the effects of workplace violence on nurses in psychiatric and emergency departments.MethodsThis was a cross-sectional and descriptive study involving 60 nurses practising in the psychiatry and emergency services at the Hedi Chaker and Habib Borguiba University Hospital in Sfax. We collected the socio-demographic and professional data of the participants using a pre-established questionnaire.ResultsThe average age was 35 years and 51 % of respondents were female. Ninety-three percent of the respondents were victims of an act of violence. The violence was verbal in 90%, physical in 70%, psychological in 62% and sexual in 11% of cases. The classification of acts of violence according to the scale of seriousness of the national observatory of violence in health care revealed a predominance of level 1 violence characterised by insults (66%) and level 2 violence with threats to physical integrity (65%). Level 3 violence (physical violence) was the most frequent (70%). Two cases of level 4 violence with knives were reported. These acts of violence generated wounds in 21%, fractures in 10%, haematomas in 10% and bruises in 8% of cases. Thirty-six nurses (60%) reported that the act of violence was responsible for a feeling of insecurity.ConclusionsThe results of this study indicate the need for hospital center managers to set up organizational policies against workplace violence and to apply them in a rigorous and transparent manner.DisclosureNo significant relationships.

When Parents have a Severe Mental Illness : Can we Prevent Family Separation and Adverse Effects after Childbirth?

This presentation will review the current state of knowledge about severe maternal perinatal mental illness. Severe disorders are associated with a higher prevalence of somatic difficulties during pregnancy, poorer quality of pregnancy follow-up and potential impairment of infant care. These children are therefore very vulnerable and require specific care. We will present how graduated care coordinated and above all integrated between psychiatry, obstetrics, neonatal pediatrics and child protection services allows for early and effective preventive interventions, both for the child’s development and maternal mental health. The concept of shared parenting will be particularly developed.DisclosureNo significant relationships.

Identification of violence in the hospital environment: perceptions of nurses

IntroductionViolence is recognised by the WHO as a major and ubiquitous public health problem, that is constantly worsening.ObjectivesThe aim of our work was to estimate the frequency of aggressions against nurses in psychiatric and emergency departments, and to identify the factors associated with it.MethodsThis was a cross-sectional, descriptive and analytical study. It took place between January and March 2021, at both hospitals of Sfax (Tunisia).This study targeted 60 nurses in the psychiatry and emergency services.ResultsThe sample comprises 35 nurses (58%) from psychiatric services and 25 nurses (42%) from emergency services, mainly females (51%) and with average age of 35 years.(+/-9). The nurses interviewed were exposed to violence quite often, in 93% of cases. Almost all nurses (90 %) experienced verbal violence, 70 % experienced physical violence and more than half (62 %) experienced psychological violence. Nearly 11% of nurses reported a sexual violence. Factors that explain or contribute to violence mentioned by the participants were as follows; The Verbal violence was significantly correlated with poor reception conditions (p=0.013). The Sexual violence was significantly correlated with young age of nurse (p=0.005). As for psychological violence, it was significantly correlated with work overload (p=0.004), a poor caregiver-patient relationship (p=0.02) and poor patient care (p=0.04).ConclusionsOur study showed that violence against nurses was frequent in psychiatric and emergency departments. Various factors could modulate their occurrence such as training and improvement of the working conditions.DisclosureNo significant relationships.

Education and Training in Psychiatry: Challenges and Consequences of the Last Two Years, Future Perspectives and Actions Needed

Pandemic-related extraordinary work burden on all healthcare professionals had a greater toll on younger colleagues, especially residents in diverse medical fields. Although psychiatry residents’ degree of engagement in COVID-19 related services depends on the state’s and institution’s management of the crisis, it has often led to a significant interruption in the schedule of the training requirements. This interruption also was a consequence of the change in provision of the psychiatric services during the pandemic, such as a decrease in the size of the inpatient clinics, lower number o patients in the outpatient services, fewer ECT. These changes made it more difficult to fulfill the training requirement, which was adopted in some countries. Even when the tasks related to the training were accomplished the quality was difficult to determine. Furthermore, most of the educational activities were switched to online format due to pandemic-related precautions, a change that persists in some activities. Psychiatry education and training, not only postgraduate but also during medical school, requires observation and direct engagement. The switch from face-to-face to online in psychiatry training, including supervision, and service provision constituted a major challenge in psychiatry education. This required further adaptations by the teaching staff as well as the trainees, in their methods of teaching, learning, and interaction. The assessments of competencies presented another challenge for the psychiatry training. Despite all, the introduction of online education provided increased diversity in resources and in some situations increased access. Some challenges required modifications, whereas some beneficial changes are there to maintain.DisclosureNo significant relationships.

Arson and Schizophrenia: A Case Report and Review of Literature

IntroductionFiresetting is a behavior, arson is a crime, and pyromania is a psychiatric diagnosis. Arson is a criminal act in which a person or group of persons willing fully and maliciously sets fire or aid in firesetting to cause harm to property, people, and infrastructure. The likelihood of an arson offender having schizophrenia is 20 times greater than that in the general population. Here, we describe the case of a male in his 50’s, a first-time arsonist, who suffered from schizophrenia since his late teens prior to the onset of random firesetting behavior.ObjectivesTo understand the association between Arson and Schizophrenia.MethodsA case report, as well as a review of the literature, was conducted.ResultsThe patient is a male in his 50’s carrying a diagnosis of Schizophrenia with over 50 inpatient hospitalizations. He was observed standing on the threshold of a neighbor’s apartments where he allegedly set fire to a pile of clothing. These charges are based upon allegations that he attempted to set fire to a 14-storey apartment building. At the time of his assessment, he was floridly psychotic. He was found not fit to stand trial. He was restarted on Clozapine and Depakote which is the medication he had the most success with.ConclusionsLiterature shows that Arson and firesetting behaviors are quite commonly seen in patients with mental disorders. Arson often has sequelae that negatively impact the community. The strong correlation between firesetting behavior and mental disorders needs extensive, detailed collaboration between psychiatry, legal expertise, and fire services.DisclosureNo significant relationships.

Structuring of specialized treatment applied to people with suicidea ttemptin an academic psychiatric service in Rio de Janeiro city

IntroductionDescription of a specialized treatment program for people attempting suicide in an academic health service focused on psychiatry and drug addiction in the city of Rio de Janeiro.ObjectivesDescribe actions developed to treat suicidal behavior.MethodsBased on a survey of the prevalence of suicidal behavior in the Brazilian population over a lifetime, reaching a total of 12,000 cases per year of the Brazilian population, this academic service of psychiatry and drug addiction established the following actions for hospitalized patients: 24-hour surveillance, reduced access to methods of committing suicide (forks and knives removal, shoelaces and ropes removal), strengthening the GVV (Life Valuation Group), strengthening the Cognitive Behavior Therapy application groups, conducting group dynamics, lectures, art therapy and physical activities.Results Of 370 patients admitted to this service from January 1st, 2019 to September 1st, 2019, 137 had suicidal behavior and only 2 died.ConclusionsOf these two cases, one abandoned treatment and the other occurred during the treatment period.DisclosureNo significant relationships.