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IntroductionFor many people, January is the most depressing month of the year. “Blue Monday” encompasses the generally accepted belief that Monday is the hardest day of the week compared to Friday and Saturday, which are the most anticipated days of the week. The connection between the color blue and Monday is in the emotional stage, which is presented as emotional anger. The third Monday in January is currently known as the most depressing day of the year. Speaker Cliff Arnall was the first to declare that day in 2014. The theory says that this is the time of the year when respiratory diseases are common, the day is shorter, the weather conditions are worse, and the time when people are burdened with guilt about whether they will achieve their New Year’s resolutions.ObjectivesThe aim of this work was to investigate that on third Monday in January there were more suicide attempts and that there were more depressive disorders in emergency psychiatric admissions.MethodsIn the research, we included participants who were examined at the Emergency Psychiatric Admission of the Clinical Hospital Center in Split, in the period from 2019. until 2023. Inclusion criteria were respondents of both sexes, examined in the outpatient clinic on Mondays in January for five years.ResultsThere were 198 of them in total. The primary outcome of the research is to determine the occurrence (incidence) of psychological deterioration in patients diagnosed with the anxiety-depressive spectrum. The secondary research outcomes are of a descriptive nature, patient follow-up, examination outcome, and psychiatric heredity.ConclusionsFor now, there are no strong scientific foundations that justify the formula of “the most depressing day” of the year, some scientists believe that it is a marketing trick to achieve higher tourist revenues. However, the post-holiday period can have an impact on individuals.Disclosure of InterestNone Declared

IntroductionIn this study we have studied the impacts of natural disaster yash on the development of PTSD in a rural hamlet of West Bengal.ObjectivesCorrelation of natural calamity and trauma ie post traumatic stress disorder in exposed population.MethodsSetting of the study was a relief camp operated for victims of climate change and natural disasters ie cyclone yash 2021.Tool for data collection - PCL 5 questionnaires, socio demographic pro forma, data was analyzed by using statistical SPSS.ResultsAnalysis shows that there is statistical correlation between post traumatic stress disorder and subjects exposed to climate change events such as cyclone Yash.PCL-5 cut-off score between 31-33 is indicative.ConclusionsOur study clearly demonstrates the impact of climate change and natural disasters on the development of post traumatic stress disorder in the study group.Disclosure of InterestNone Declared

IntroductionPsychosurgical procedures gained an infamous reputation during the 20th century with the implementation of the lobotomy as treatment for several psychiatric illnesses. However, modern-day psychosurgery is a flourishing field that provides valid treatment alternatives to neuropsychiatric patients thanks to increasingly accurate and safe stereotactic procedures. As more than 80% of people with mental disorders reside in Low and Middle Income Countries (LMICs), investigating the impact of psychosurgical procedures has a global relevance. People living in LMICs are exposed to a variety of stressors which could facilitate the development of psychiatric and neurological diseases. The immense gap that still exists between the population of LMICs and adequate medical and surgical care is an important obstacle to the reduction of global mental health burden. A scoping review will be conducted to investigate the extent of the existing literature and identify key themes, challenges and research gaps on the implementation and outcomes of psychosurgery in LMIC settings.Objectives- To comprehensively map the existing literature: Provide an extensive overview of the literature on the use of psychosurgery in low and middle-income countries.- To identify key themes: Recognize recurring themes and topics within the literature related to psychosurgery in these settings.- To assess challenges: Analyze the challenges and barriers associated with the implementation of psychosurgery in resource-constrained contexts.- To identify research gaps: Highlight areas within the existing literature where further research is needed to enhance our understanding of psychosurgery in low and middle-income countries.MethodsThe methodology consists of five stages, consistent with Arksey and O’Malley’s framework. Using the PICO model, the Research Question, Inclusion/Exclusion Criteria and search methods were developed. Electronic Medical Databases (Medline OVID, Cochrane Library, Embase, PubMed, Scopus) will be searched for relevant studies. The PRISMA-ScR framework is used to guide the reporting process. Quantitative and Qualitative data will be extracted, including key information such as study type, demographics and methods used to assess the outcomes of psychosurgical interventions. Data will be presented discursively, supported with statistics and graphs where appropriate. No ethical approval is required.Results/ConclusionsThe results will be useful to healthcare professionals in LMICs involved in neuropsychiatric care, evaluating the current uses of psychosurgery and their potential benefit for the affected population whilst highlighting gaps in knowledge with the aim of propelling further research.Disclosure of InterestNone Declared

IntroductionDepression in psychosis has been more or less neglected as a field of study, due to its vague nosographic framework. Some studies have nevertheless focused on certain features of depression in psychosis, such as post-psychotic depression. This is a frequent phenomenon with a nosographic and etiopathogenic complexity that can lead to confusion.ObjectivesTo study the characteristics of post-psychotic depression and compare results with those in the literature.MethodsIt is a prospective, descriptive, case series study conducted at the Ar-Razi psychiatric hospital in Salé. Inclusion criteria were patients diagnosed with a brief psychotic disorder, schizophreniform disorder or schizophrenia, in remission, who met the criteria for a DSM 5 characterized depressive episode. Data are collected during the psychiatric interview with the patient, using a questionnaire.ResultsOngoingConclusionsOngoingDisclosure of InterestNone Declared

IntroductionWe present the case of an elderly patient with a severe depressive episode who, in order to maintain psychopathological stabilisation, receives ECT on an outpatient basis.ObjectivesThe objective is to briefly review the use of ECT as a maintenance treatment for severe depression in the elderly.MethodsPatient aged 76 years, multipathological, with a history of hypertension, DM and LBP. Femoral head fracture, myelodysplastic syndrome, severe osteoporosis with vertebral crushing, requiring rescue treatment with tramadol, and renal failure.She came for consultation, reporting depressive symptoms of months’ duration, together with delusions of ruin and nihilism. Despite antidepressant and stabilising treatment with duloxetine at daily doses of 120mg, extended-release quetiapine 600mg, lorazepam 2.5mg and mirtazapine 45mg, the patient began to show negative behaviour towards accepting food, clinophilic behaviour and abandonment, which led to her being admitted to the short-term hospitalisation unit.ResultsDue to the severity of the depressive symptomatology, it was decided to start ECT, administering a total of 12 sessions, which were effective, and outpatient follow-up was resumed. However, after a week, the patient again began to show marked apathy and abulia, as well as complete anorexia lasting more than 24 hours, which led to a new admission. It was then that it was decided to maintain the ECT treatment, on an outpatient basis, as maintenance treatment, together with pharmacological treatment.ConclusionsECT is indicated in severe depression, with or without psychotic symptoms, with malnutrition and organic pathology. According to studies, it has a beneficial response of more than 60%. However, the rate of receiving depressive symptomatology in a severe episode is high, despite ECT, so studies and clinical practice recommend maintenance ECT. It is usual to start with weekly sessions, and progressively space them out to maintain the minimum that guarantees stability.Disclosure of InterestNone Declared

IntroductionGaming Disorder (GD) has not been officially recognized as a diagnostic entity in the DSM-5, being listed in the “conditions for further study” section. However, it is described in the ICD-11, and clinically, it is observed that an increasing number of individuals, particularly the younger population with easier access to technology, are affected by this issue. Nefarious consequences include loss of performance at school/work and a potential for failing other responsibilities such as in the familiar and social spheres.ObjectivesDespite its harm, psychiatrists are generally less familiar with this entity when compared to other psychiatric disorders. Thus, our main goal was to establish a comprehensive and hollistic review of its approach.MethodsA bibliographical research on the topic was conducted from the available scientific literature on the topic, with the utmost priorization of evidence-based sources.ResultsThe overall prevalence of Gaming Disorder is challenging to assess precisely, but it is estimated to be around 3%, making it comparable to obsessive-compulsive disorder and some substance use disorders. It is more common than pathological gambling. Clinically, GD is characterized by an excessive preoccupation with gaming that supersedes all aspects of life. It may also involve a compulsion to play and the presence of withdrawal symptoms from periods when there are no gaming activities. The behavior is driven by the ACE triad (anonymity, convenience, and escape). Often, individuals with GD do not seek treatment. Although there are no specific pharmacological agents, antidepressants, mood stabilizers, and naltrexone have shown some success. In psychotherapies, cognitive-behavioral therapy has the strongest evidence.ConclusionsThere is a limited amount of information on GD, and when researching the topic, one primarily encounters information on other substance-related addictive disorders and, in the case of behavioral disorders, gambling. However, as young people are increasingly exposed to screens and video games with potential harmful effects on their development, and in adults, inhibiting them from taking on work and family responsibilities, it is essential to conduct more studies on the subject to prevent these deleterious consequences.Disclosure of InterestNone Declared

IntroductionPsychic trauma profoundly affects a person’s confidence in himself and others. There is a sudden experience of helplessness, loss of control, fear for one’s own life, and the humiliation of having been violated. The victim may run out of internal and external reference elements.ObjectivesDescribe the factors that influence the development of Post-traumatic stress disorder after experiencing traumatic experiences.MethodsReview in the literature of the different factors that influence the subject’s response to the traumatic experience.Results1) Predisposing and precipitating factors:– characteristics of the traumatic evento: severity of the stressor agent: dose-dependent, Characteristics of the same: sudden, prolonged, repetitive, intentional; decrease the ability to control the situation and develop effective coping strategies; they question basic cognitive schemas; the symbolic meaning of the traumatic evento.– characteristics of the person (predisposing factors of vulnerability): genetic-constitutional vulnerability, adverse experiences in childhood, previous traumatic events: increased vulnerability, personality characteristics, recent stressors or life changes, inadequate support system, use of alcohol, perception locus control more external than internal, pre-existing psychiatric symptoms: neuroticism, anxiety, depression, critical ages of development: time of greatest vulnerability (11-16 years).2) Perpetuating and empowering factors: sharing traumatic events, seeking the logic of the facts, rupture of affective ties.3) Elements of Resistance: tendency to selectively remember the positive elements in autobiographical memory, acceptance of a certain dose of uncertainty in life, perceiving themselves as survivors, perception of the stressful stimulus as less threatening, Less physiological reactivity to stress, use of humor, positive emotions counteracting during the traumatic process.4) Elements of Resilience: ability to extract and assimilate positive elements from negative situations.ConclusionsTrauma threatens 3 basic assumptions of life: the world is good, the world has meaning, the self has value. The knowledge of these mentioned factors allow a better psychotherapeutic approach to Psychic Trauma.Disclosure of InterestNone Declared

Introduction The night eating syndrome (NES, DSM-V: 307.59) was described in 1955 as a disorder defined by morning anorexia, nocturnal hyperphagia (25% of the daily intake of food during sleep) and insomnia. Attributed to a delay in the circadian rhythm of feeding is characterized by suppression of the daytime appetite and increased in the early morning. It is more prevalent in obese people. Treatment focuses on selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioural therapy (CBT). Objectives Description of a NES clinical case demonstrated satisfactory response to pharmacological treatment with trazodone. Methods Brief case presentation and review of the NES literature. Results A 40-year-old woman diagnosed with binge eating disorder followed by Endocrinology. She had morbid obesity grade III. After the failure of various treatments addressed to impulse control and early morning intakes (topiramate, zonisamide, liraglutide, gastric balloon, hydrochloride Naltrexone/Bupropion and SSRI) she was referred to a mental health center. She was started on Trazodone therapy. Interestingly, Insomnia/binge decreased from 7 to 2 episodes/ week leading to a significant weight reduction with a 500 mg/week rate, loosing 4 kg. The case was oriented as a NES but successfully treated as maintenance insomnia. Conclusions NES leads to frequent awakenings and early morning intakes. Awareness of the episode and ability to remember differentiates NES from the sleep-related eating disorder, where the nighttime ingestions cannot be remembered. Unlike binge eating disorder, where the goal is satiety and not falling asleep, so the hypnotic function of nocturnal intake is key in the differential diagnosis with NES . Trazodone, indicated in insomnia of maintenance, has not been reported as a treatment of choice in the NES, enabling a significant decrease on awakenings and consequently the intake. Disclosure of Interest None Declared

Introduction Insomnia is a prevalent global health problem that affects 11.7% - 36% of the population (Grewal et al. Clinical Handbook of Insomnia Int 2017; 13 - 25). It is a risk factor for depression, poor quality of life, and accidents. Increasingly, insomnia has been identified as a suicide risk factor (Lin et al. BMC Psychiatry 2018: 18; 117) We present a case report of a 43-year-old male patient with insomnia-induced suicidal ideation (SI). Objectives 1. Learn the mechanism of insomnia-induced SI 2. Understand the current insomnia treatments 3. Discuss the possible mechanism of ECT treating insomnia-induced SI Methods A 43-year-old single male with past psychiatric diagnoses of social anxiety, borderline personality disorder, chronic SI, and severe recurrent depression was admitted to inpatient due to intractable SI from insomnia. He failed trials on SSRIs/SNRIs, bupropion, trazodone, lithium, vortioxetine, quetiapine, zolpidem, and ketamine. The patient was initiated on electroconvulsive therapy (ECT) three times a week with 20mg vortioxetine and 100mg quetiapine for sleep initiation. Results After 6-sessions, the patient’s mood, affect and sleep had improved considerably, and his suicidal ideations resolved. The patient was discharged with outpatient follow-up and ECT as rescue therapy. His sleep gradually improved to 4-6hrs/night and his mood was back at baseline. Conclusions ECT is an effective treatment for refractory insomnia-induced SI, likely due to persistent REM suppression and reduced dendritic arborization and excitatory synapses in the amygdala (Doghramji et al. Sleep 2000; 23 - S16 - S20; Lahmeyer et al. Sleep Respiratory 1989; 18 346). Possible mechanisms for insomnia-induced SI include impaired decision-making, abnormalities in 5-HT function, or HPA dysfunction leading to a hyperarousal state and cortisol release (Chatzittofis et al. Euro Neuropsychopharmacology 2013; Elmenhorst et al. Sleep 2012; 35 1615 - 1623; Keilp et al. Psychol Medicine 2013; 43 539-551; Novati et al. 2008 Sleep; 31 1579 - 1585). Current insomnia treatments address underlying medical/psychological problems and non-pharmacologic and pharmacologic strategies. The predominant non-pharmacologic approach is Cognitive Behavioral Therapy Insomnia (CBT-I), such as relaxation techniques, sleep hygiene education, cognitive structuring, and sleep restriction (Rossman et al. American Journal of Lifestyle Medicine 2019; 13 544 - 547). Pharmacologic options include benzodiazepines, non-benzodiazepine hypnotics, tricyclic antidepressants, trazodone, and antihistamines (Saddichha et al. Annals of Indian Academy of Neurology 2010; 13 94-102). ECT should be strongly considered for the treatment of refractory insomnia-induced SI, and its early application may avoid rapid deterioration improving the quality of life. Disclosure of Interest None Declared

Introduction The incidence of psychological disorders in patients with cancer is very high (30–60%), with approximately 29–43% fulfilling the diagnostic criteria for psychiatric disorders. The most commonly encountered mental problems encompass depressive symptoms associated with mixed anxiety and adjustment disorder or depressive mood or major depression. Objectives The aim of this research is to highlight the characteristics of psychiatric manifestations in patients with cancer and to analyse the risk factors that influence the occurrence of these psychiatric manifestations. Methods Α bibliographical review was performed using the PubMED platform. All relevant articles were found using the keywords: cancer, psychiatric manifestations, risk factors. Results Sleep problems, irritability, tendency to cry easily, sadness, and pain were among the leading symptoms at baseline. Women reported sleep problems, tendency to cry easily, irritability, pre-occupation with the illness, and sadness as the first five most frequent issues, and men reported sleep problems, irritability, pain (usually incompatible with their medical conditions), sadness, and tendency to cry easily as the most frequent problems. Conclusions Significant risk factors that increased the mood disorders were recurrence, presence of secondary cancer, other chronic medical illnesses, history of psychiatric disorder, low income level, poor social support, and being single or divorced. Disclosure of Interest None Declared