The clinical course and progression of acute pancreatitis are poorly understood to date, necessitating more studies of clinical profiles during the disease. Moreover, understanding the etiologies and clinical presentations of acute pancreatitis (AP) in children can contribute to early diagnosis and, hence, earlier interventions. Therefore, this article aims to study the clinical profiles of children with acute pancreatitis (AP) in relation to complications and other variables. Study designWe retrospectively studied 56 patients who presented with AP to the pediatric department in Salmaniya Medical Complex between January 2006 and December 2017. Cases of chronic pancreatitis and ages above 12 years were excluded. The data concerned demographics, etiology, clinical data, hospital course, and outcomes. ResultsThe study included 56 patients aged a mean of 8.46 years (male:female -33:23). The average hospital stay was 7.68 days. Patients received parenteral feeds a mean of 2.77 days. All patients had an ultrasound, nine required CT scans (16.1%), and five MRIs (8.9%). There were 18 local complications (32.1%): pseudocysts (n=3, 5.36%), cholangitis (n=2, 3.6%), and edema (n=13, 23.2%). There were 23 intensive care unit (ICU) admissions (41.1%). No mortalities occurred but there were six recurrences (10.7%). Symptoms of abdominal pain, vomiting, fever, and nausea occurred in 100%, 57.1%, 35.7%, and 23.2% of patients, respectively. Etiologies were 41.1% biliary, 23.2% idiopathic, 19.6% traumatic, and 8.93% drug-induced. Leukocytes were elevated in 20 patients (35.7%), c-reactive protein (CRP) in five (8.93%), serum amylase in 45 (80.4%), and urinary amylase in all 56 patients (100%). ConclusionMost pediatric AP cases were attributed to biliary causes followed by trauma. Age was significantly correlated with complication rates (P=0.013). Abdominal pain was a more common symptom than vomiting. Leukocytosis was associated with ICU admissions. There was no significant relation between c-reactive protein, serum amylase, or urinary amylase, and complications or ICU admissions. Pediatric AP was selflimiting and there were no fatalities.

Foreign body ingestion is a commonly encountered problem in the pediatric population, which can be a source of severe distress to parents and caregivers. Certain foreign bodies such as magnets, bones, and button batteries can be particularly dangerous and lead to some serious complications like gastrointestinal obstruction, perforation, or bleeding depending on the nature of the foreign body, the location of impaction, and the period since ingestion. In this report, we discuss a case of a 23-month-old girl who ingested multiple magnets that got trapped within the appendix resulting in continuous vomiting.

Introduction Much has been learned about SARS-CoV-2. However, the mechanism of short or long-term neuropsychiatric symptoms remains unclear. several hypotheses, including lack of oxygen caused by lung damage, inflammation affecting brain cells, or Lack of blood flow caused by swelling of the small blood vessels in the brain, have been advanced to explain these symptoms. Objectives Herein, we presented a case of cognitive impairment diagnosed after infection with COVID 19. Methods We discussed, through a clinical case, the possible mechanisms and risk factors of cognitive impairment following COVID 19 infection. Results This case concerned a 28 –year-old patient. He had no personal or family psychiatric. In August 2021, he presented a SARS-CoV-2 infection without hypoxemia or respiratory failure. On day 10 the patient recovered. Two days after, he consulted our psychiatric department as he experienced impairment in memory. He had impairment in attention and executive function, and in particular verbal fluency. He said that his thinking was sluggish, fuzzy, and not sharp. He denied any alcohol or drug abuse. He was euthymic and he had no depressive symptoms. Arterial blood gas, laboratory, and clinical findings were normal. A brain CT scan with contrast was performed and did not show any abnormality. Conclusions This case highlighted the possible cognitive consequences of COVID-19 during the recovery phase. Further work is required to identify risk factors of psychiatric symptoms following COVID-19 infection and their management. Disclosure No significant relationships.

IntroductionBiological rhythms play an important role in the etiology of mood disorders. Several lines of evidence established a link between circadian rhythm disruption and mood episodes. Chronotypes are the behavioral manifestations of circadian rhythms and eveningness appears to be more frequent in bipolar disorder (BD). The influence of chronotype on mood symptoms needs yet to be clarified.Objectives-Identifying the predominant chronotype in a Tunisian sample of patients with BD -Assessing the association between chronotype and biological rhythm disruptions in the sampleMethodsFor this study, a total of 80 euthymic outpatients with bipolar disorder and 80 control subjects were recruited. Biological rhythms disruptions were assessed using the Biological Rhythm Interview of Assessment in Neuropsychiatry (BRIAN). Predominant chronotype was identified using the composite scale of morningness (CSM).ResultsBRIAN scores showed greater biological rhythms disruptions in bipolar patients than the control subjects (mean scores 35.26±9.21 vs 25.84±2.68). Low CSM scores in the patients’ group indicated a predominant evening chronotype whereas an intermediate chronotype was more frequent within the control group. The correlation analysis revealed a statistically significant negative correlation between the 2 scales (r=-0.716, p<0.001): the CSM scores decreased as the BRIAN scores increased.ConclusionsThis study indicates that eveningness is more common in BD. This chronotype is more likely to disturb biological rhythms which may increase the risk of mood symptoms and lead to a poor prognosis for BD, thus the relevance of treating rhythm alterations, especially in evening-type patients, in order to improve their quality of life and prevent mood episodes.DisclosureNo significant relationships.

IntroductionBipolarDisorders (BD) are regarded as a multidimensionaldiseaseinvolvingbothpsychological and physicaldeterminants. Althoughmood dimension andthymicinstability areconsidered as the « core » aspect of bipolardisorders, itis crucial to note thatsomaticproblemsfrequentlyoccur in BD,deeplyworsening the prognosis.ObjectivesHerewedescribea case of atwentyyearshistory of psychiatricimpairment, diagnosedlaterwithcardiac malformation.MethodsFemale patient H.G has been admitted for the first time to psychiatric department ‘A’ of Razi Hospital,treated for type 1 bipolar disorder since 2004 with poor therapeutic compliance. We reviewed the clinical and paraclinical data.ResultsThe patient was hospitalized for a severe manic episode with psychotic features, without cardiac personal history. The patient was asymptomatic and physical examination showed no abnormalities. Following a routine electrocardiogram, an acute coronary syndrom was discovered (inverted T waves seen in V1 to V6). Cardiac troponins were not elevated. According to cardiology recommandations, ischemic heart disease could not be ruled out and extensive cardiovascular investigations were needed. Antipsychotics and mood stabilizors were contraindicated.Therefore, the manic episode could only be managed using benzodiazepines. Given contradictions between clinical, electrocardioagraphic and imaging findings,coronary angiography was necessary. Results showed no significant stenosis of coronary arteries and a myocardial bridging of the left anterior descending artery and we were able to put her on antipsychiotics and moodstabilizer, almost two months after her admission.ConclusionsThis case underlines the significant impact of somatic comorbidities in therapeutic management of bipolar disorders. Cardiovascular diseases in particular cause a delay in treatment initiation and an increase in patient length of hospital stay.DisclosureNo significant relationships.

IntroductionBiological rhythm disturbance is etiologically involved in mood disorders. Previous literature focused on studying sleep disruption in bipolar disorders (BD). However, only a few studies addressed the influence of social rhythms and occupational functioning as they may affect circadian regularity and consequently be a critical pathway to mood symptoms.ObjectivesThe main aim of this study was to assess biological rhythms in remitted bipolar patients and to evaluate their social rhythms and occupational functioning.MethodsWe recruited a total of 80 euthymic outpatients with BD and 80 control subjects. Biological rhythm disruptions were assessed using the Biological Rhythm Interview of Assessment in Neuropsychiatry (BRIAN), an interviewer administered questionnaire that assesses disruptions in sleep, eating patterns, social rhythms, and general activity.ResultsPatients with BD experienced greater biological rhythm alterations than the control group (BRIAN total scores 35.26±9.21 vs. 25.84±2.68). In addition to their sleep-wake rhythm (mean scores 11.1±3.95 vs. 7.41±1.41), patients were particularly more impaired than the control group with regards to social rhythms (7.31 ± 2.57 vs. 5.24 ± 1.06) and general activity (8.9 ± 3.35 vs. 7.01 ± 1.4).ConclusionsOur study indicated that patients with BD experience major disruptions in their social rhythms and occupational functioning. These alterations may lead to unstable biological rhythms and to a higher risk of mood episodes. Therefore, consolidating social rhythms and functioning appears to be a crucial step for preventing relapses in patients with BD.DisclosureNo significant relationships.

IntroductionCriminality has become of increasing concern in the practice of psychiatry. However, violence among elderly psychiatric patients is an underestimated and understudied phenomenon.ObjectivesThe aim of the study is to identify differences in the socio-demographic, clinical and criminological profiles between elderly criminals under treatment for psychiatric disorders and those not known to have mental disorders prior to the criminal offense in Tunisia.MethodsWe present a retrospective study on twenty male criminal mental patients, aged sixty years or older, who were hospitalized in the Forensic Psychiatry Department of Razi Hospital during 18 years, following a dismissal for insanity under Article 38 of the Penal Code and Article 29 of Law 92/83 on Mental Health.ResultsPrevalence was higher among elderly criminals without a known psychiatric history (2.42% versus 1.98%). The average age was roughly the same, around 73 years old.Neurological and cardiovascular histories were the most common in both groups. The criminal act was indicative of dementia in 8 cases. Criminal history was more frequent in elderly patients with a personal psychiatric history (55.5% versus 18.2%). Patients whose act was revelatory of their mental disorder committed more violent crimes (63.7% versus 44.4%) using blunt objects (71.4% versus 0%).The victim most often belonged to the aggressor’s family, particularly the spouse (87.5%).ConclusionsScreening for criminal risk factors in the elderly, early diagnosis of mental disorders and a comprehensive therapeutic project are necessary to prevent the risk of violent behaviour.

Background: Despite heterogeneity in adult clinical presentation of psychotic disorders, the childhood precursors and genetic underpinnings of this heterogeneity are unclear. Risk profile scores (RPS) summarize an individual's risk for developing schizophrenia based on common genetic variants associated with the disease. The Philadelphia Neurodevelopmental Cohort (PNC) is a publicly available data set including genetic and psychopathology information for a large sample of adolescents/young adults. In light of findings of increased affective symptoms in youth at risk of schizophrenia, we examined the association of childhood psychosis spectrum (PS) characteristics and childhood depressive symptoms in relation to RPS. Methods: Complete neuropsychiatric and RPS data were available for 3217 participants of European-American ancestry (ages 11-21) from the PNC. From a large psychopathology assessment, items related to prodromal symptoms and psychosis-like experience were combined into a composite PS score. Using other items tracking DSM-IV criteria, we created binary variables representing "quasi-diagnoses" (QDx) for childhood psychiatric conditions including depression. RPS were calculated using the most strongly illness-associated genetic variants identified by the multinational Psychiatric Genetics Consortium. We tested for associations of PS and depression QDx with RPS using logistic regression, then tested for differences in RPS across QDx and levels of PS with mixed model analyses. Analyses in the full sample were repeated for "11-15" and "16 and older" subgroups. Results: We divided the sample into top 20%/bottom 80% PS groups for the analyses. Prevalence of the QDx for at least 1 depressive episode was 12.1%. PS group alone was not associated with RPS. Depression episode QDx was associated with RPS at the more restrictive RPS P value thresholds (e.g., RPS_5e-08 P = .003; R2 = .009). In mixed model analyses for the full sample (ages 11-20), we observed a small main effect of depression QDx on RPS for schizophrenia (e.g., RPS_5e-08 P = .003; η 2 = .003). We observed no effect of depression QDx or psychotic experience on RPS in the younger subgroup (11-15) and no interaction. The older group (16)(17)(18)(19)(20) again showed a main effect of depression (RPS_5e-08 P =.0003; η 2 = .009) and, also, a small but significant interaction of depression with PS(RPS_5e-08 P = .012; η 2 = .004). Findings were similar for males and females. Conclusion: Affective symptoms are frequently observed in youth at risk of schizophrenia. These analyses suggest that, especially in the years leading up to the typical age of onset, common genetic risk of schizophrenia may be more strongly associated with depressive symptomatology than with psychotic-like experience. The associations of RPS with psychopathology were evident for the RPS based on the most strongly associated ("GWAS significant") markers and not at more inclusive levels of RPS.