Five medications have been approved for the treatment of bipolar depression, though no medication has been approved for the treatment of depression with mixed features. Post-hoc analyses of the bipolar depression trials examined efficacy in depressed patients with and without mixed features. Each study also examined the emergence of manic symptoms as a possible negative outcome, and each found that the frequency of emergent manic symptoms was more frequent in the patients treated with placebo than with medication though in no study was the difference statistically significant. However, the studies were not powered to detect a significant difference in treatment emergent (hypo)manic episodes thereby prompting the current pooled analysis.

The goal of the present pooled analysis was to examine whether second-generation antipsychotics that have been found effective in treating depression with mixed features protect against the emergence of (hypo)manic episodes in depressed patients with concurrent manic symptoms.

Five placebo-controlled studies of the effectiveness of second-generation antipsychotics in the treatment of depressed patients with mixed features reported information on the emergence of manic symptoms.

The 5 studies included 1,829 depressed patients with mixed features—1,620 with bipolar disorder and 209 with major depressive disorder. In each study, the frequency of treatment-emergent manic episodes was higher in the group treated with placebo, though in no study was this difference significant. Summed across studies, the frequency of treatment emergent (hypo)manic episodes was higher in the patients receiving placebo (4.0% vs. 2.4%, X2=3.66, p=.056). Excluding the patients treated with olanzapine, which has not been found to be effective in treating bipolar depression, the frequency of emergent (hypo)manic episodes was significantly higher in the patients receiving placebo, (4.0% vs. 1.8%, X2=7.31, p=.007).

The results of the present analysis suggest that the second-generation antipsychotics that are effective in treating bipolar depression also protect against a (hypo)manic switch in depressed patients with mixed features.

None Declared

Electrodermal activity (EDA) measures the skin’s electrical properties. It varies according to the sweat gland’s activity which responds to the sympathetic nervous system (Boucsein W. Electrodermal Activity. Berlin: Plenum Press; 2012). Previous literature has reported lower EDA during bipolar and unipolar depressive episodes (Sarchiapone M, et al. BMC Psychiatry 2018; 18: 22 & Valenzuela-Pascual C, et al. Acta Psychiatr Scand 2024). Historically, heightened anxiety has been correlated with increased EDA, although findings in this area have been inconsistent (Naveteur J, et al. Int J Psychophysiol 2005; 56(3): 261–269).

This study aimed to determine whether significant differences in EDA exist among depressed patients based on their levels of anxiety.

We analysed EDA recordings from an E4 wearable device utilised by 29 depressed patients with bipolar disorder. They wore the device for a period of 48 hours without altering their daily routines. The tonic mean and phasic peaks parameters of EDA were extracted and analysed via a mixed-effects model for repeated measures, incorporating sleep state and anxiety level as variables. Anxiety levels were assessed based on the scores from item 10 on the Hamilton Rating Scale for depression, which reflects psychic anxiety.

The results indicated that anxiety levels did not significantly influence any of the models examined. However, in the phasic peaks model, there is a noteworthy interaction between anxiety level and sleep status (p < 0.01). Both models demonstrated a tendency towards increased EDA values in the high anxiety group although these findings did not reach statistical significance. This trend was consistent across both sleep states for the tonic mean model (Image 1). In contrast, the high anxiety group exhibited higher phasic peaks values (M [SD] = 2.33 [0.80-3.86]) compared to the low anxiety group (M [SD] = 2.33 [0.80-3.86]) only during wakefulness, although this difference was not statistically significant (p > 0.05) (Image 2).

Image 1:

Image 2:

These findings should be interpreted with caution due to the small sample size and the imbalance in the distribution of low (17%) versus high anxiety (83%) participants. Furthermore, anxiety is a multifaceted symptom that should be evaluated using a more comprehensive assessment tool. To validate these preliminary observations, it is essential to increase the sample size and use a more precise measure of anxiety.

None Declared

Lumateperone, an atypical antipsychotic drug, has a dual mechanism of action by combination of activity at central serotonin (5-HT2A) and dopamine (D2) receptors.

This subgroup analysis of an Indian Phase 3 study was conducted to evaluate the efficacy and safety of Lumateperone 42mg compared to Quetiapine 300mg in treatment of Bipolar II depression when stratified based on prior hypomanic episodes.

The phase-III, randomized, multi-centric, assessor-blind, parallel-group, active-controlled, comparative, non-inferiority study included Indian patients with Bipolar II depression with moderate severity having a Montgomery-Asberg depression rating scale (MADRS) score ≥20 and Clinical global impression–bipolar version–severity (CGI-BP-S) score ≥4. The study was conducted after receiving regulatory and ethics committee approvals. The patients were randomized (1:1) to either receive Lumateperone 42mg [Test] or Quetiapine 300mg [Comparator] for 6 weeks. The patients were stratified based on number of prior hypomanic episodes in lifetime: Subgroup 1 [S1]: 1 episode and Subgroup 2 [S2]: >1 episode. For efficacy outcomes MADRS score, CGI-BP-S (total score, depression subscore and overall bipolar illness subscore), and Quality of life enjoyment and satisfaction-short form questionnaire (Q-LES-Q-SF) score were evaluated and for safety outcomes treatment emergent adverse events (TEAEs) were assessed. [Clinical trial registration: CTRI/2023/10/058583]

This subgroup analysis included 462 patients, out of which 251 in S1[Test=129; Comparator=122] and 211 in S2[Test=102; Comparator=109]. The baseline demographic characteristics were comparable in between treatment arms across subgroups. The primary endpoint of reduction in MADRS score from baseline to Day 42 in Test arm was non-inferior to Comparator arm in both subgroups [Figure 1] as the upper 95% CI was below the pre-defined margin of 3.0. The reduction of CGI-BP-S (total score, depression subscore and overall bipolar illness subscore) from Day 14 to Day 42 were comparable in both Test and Comparator arms in both subgroups. The improvement in Q-LES-Q-SF score from baseline to Day 42 were comparable in both Test and Comparator arms in both subgroups. The incidence of TEAEs were similar in both treatment arms [S1: Test=37.2% and Comparator=35.2%; S2: Test=31.4% and Comparator=35.8%] and no serious adverse events were reported.

Image 1:

This subgroup analysis demonstrated that Lumateperone 42mg is non-inferior to Quetiapine 300mg in treatment of Bipolar II depression as assessed via MADRS score from baseline to Day 42, irrespective of number of previous hypomanic episodes and both treatments were found to be well tolerated.

A. Dharmadhikari: None Declared, P. Chaurasia: None Declared, Y. Patel: None Declared, D. Choudhary: None Declared, P. Dasud: None Declared, M. Bhirud: None Declared, P. Meena: None Declared, F. Shah: None Declared, G. Ganesan: None Declared, B. P. Rathour: None Declared, K. Mistry: None Declared, M. Dutta: None Declared, A. Ramaraju: None Declared, S. Mangalwedhe: None Declared, S. G. Goyal: None Declared, G. Kulkarni: None Declared, A. Mukhopadhyay: None Declared, P. Chaudhary: None Declared, G. T. Harsha: None Declared, M. Parikh: None Declared, S. Dey: None Declared, S. Sarkhel: None Declared, N. Jyothi: None Declared, A. Kumar: None Declared, N. Sooch: None Declared, A. Shetty Employee of: Sun Pharma, S. Saha Employee of: Sun Pharma, P. Devkare Employee of: Sun Pharma, A. Shetty Employee of: Sun Pharma, D. Patil Employee of: Sun Pharma, P. Ghadge Employee of: Sun Pharma, A. Mane Employee of: Sun Pharma, S. Mehta Employee of: Sun Pharma.

Compared to the general population, mood disorders (MD) patients show an increased risk of developing type II diabetes and obesity, which are associated with changes in brain correlates and a worse clinical outcome[1]. According to the literature, MD patients with a dysregulated metabolic system are characterized by a reduction in white matter (WM) integrity, lower global functioning, and suicidal behaviors (SB) [2],[3],[4]. However, little is known about the impact of early stages of metabolic dysregulation, namely insulin resistance (IR), in relation to the clinical course of MD[1].

Therefore, the present study aims to investigate the effect of IR on WM integrity in MD patients with suicidal behaviors (s-BP, s-UP) compared to those without suicidal behaviors (ns-BP, ns-UP). Finally, we have hypothesized that obesity may be linked to SB through a biological pathway involving inflammatory and IR markers.

Our sample was composed of 184 depressed patients (92 BP, 92 UP) who were assessed for SB via the Beck Suicidal Scale (BSS). Patients underwent 3T Magnetic Resonance imaging, and blood samples were collected to determine levels of insulin and glucose and blood cell counts. The Homeostatic Model Assessment for Insulin Resistance (HOMA) and systemic-immune-inflammation index (SII) were then computed. To investigate the effect of HOMA and SII on WM microstructure, we performed voxelwise DTI analyses: first, we tested whether the relation between HOMA, SII, and DTI measures differed between s-BP and ns-BP patients; then, post-hoc analyses were performed for analyzing the effect of HOMA, and SII separately in 40 s-BP and 52 ns-BP. The same analyses were replicated on 43 s-UP and 49 ns-UP. Moderated mediation analyses were performed with the macro PROCESS for SPSS.

The relationship between BMI and suicidal behaviors was fully serial mediated by SII and HOMA only in BP (b=0,031, 95% BCa CI [0.003, 0.088]). Specifically, we found that higher BMI was sequentially associated with increased SII and HOMA levels, ultimately leading to higher BSS scores. A significant interaction between s-BP and ns-BP was identified for the effect of (1) HOMA on mean diffusivity (MD), axial (AD), and radial diffusivity (RD). However, no significant interaction was found for the effect of IR and SII markers in UP. Performing the analyses separately in the two groups, s-BP showed (1) a negative widespread association between HOMA and FA, and a positive effect between HOMA and RD, AD, and MD. In ns-BP, no significant results were found.

These findings may suggest that IR may play a key role in the biological pathway underlying suicidal behaviors in BP but not in UP. Therefore, metabolic system dysregulation should be taken into consideration during the treatment.

None Declared

Lumateperone, an atypical antipsychotic drug, has a dual mechanism of action by combination of activity at central serotonin (5-HT2A) and dopamine (D2) receptors.

This subgroup analysis of an Indian Phase 3 study was conducted to evaluate the efficacy and safety of Lumateperone 42mg compared to Quetiapine 300mg in treatment of Bipolar II depression when stratified based on baseline body mass index (BMI).

The phase-III, randomized, multi-centric, assessor-blind, parallel-group, active-controlled, comparative, non-inferiority study included patients with Bipolar II depression with moderate severity having a Montgomery-Asberg depression rating scale (MADRS) score ≥20 and Clinical global impression–bipolar version–severity (CGI-BP-S) score ≥4. The study was conducted after receiving regulatory and ethics committee approvals. The patients were randomized (1:1) to either receive Lumateperone 42mg [Test] or Quetiapine 300mg [Comparator] for 6 weeks. The patients were stratified based on baseline BMI: Subgroup 1 [S1]: <25Kg/m2 and Subgroup 2 [S2]: ≥25Kg/m2. For efficacy outcomes MADRS score, CGI-BP-S (total score, depression subscore and overall bipolar illness subscore), and Quality of life enjoyment and satisfaction-short form questionnaire (Q-LES-Q-SF) score were evaluated and for safety outcomes treatment emergent adverse events (TEAEs) were assessed. [Clinical trial registration: CTRI/2023/10/058583]

This subgroup analysis included 462 patients, out of which 276 in S1[Test=139; Comparator=137] and 186 in S2[Test=92; Comparator=94]. The baseline demographic characteristics were comparable in between treatment arms across subgroups. The primary endpoint of reduction in MADRS score from baseline to Day 42 in Test arm was non-inferior to Comparator arm in both subgroups [Figure 1] as the upper 95% CI was below the pre-defined margin of 3.0. The reduction of CGI-BP-S (total score, depression subscore and overall bipolar illness subscore) from Day 14 to Day 42 were comparable in both Test and Comparator arms in both subgroups. The improvement in Q-LES-Q-SF score from baseline to Day 42 were comparable in both Test and Comparator arms in both subgroups. The incidence of TEAEs were similar in both treatment arms [S1: Test=38.1% and Comparator=36.5%; S2: Test=29.3% and Comparator=34.0%] and no serious adverse events were reported.

Image 1:

This subgroup analysis demonstrated that Lumateperone 42mg is non-inferior to Quetiapine 300mg in treatment of Bipolar II depression as assessed via MADRS score from baseline to Day 42, irrespective of baseline BMI and both treatments were found to be well tolerated. Hence, Lumateperone can be considered as valuable treatment option in management of Bipolar II depression.

A. Dharmadhikari: None Declared, P. Chaurasia: None Declared, Y. Patel: None Declared, D. Choudhary: None Declared, P. Dasud: None Declared, M. Bhirud: None Declared, P. Meena: None Declared, F. Shah: None Declared, G. Ganesan: None Declared, B. P. Rathour: None Declared, K. Mistry: None Declared, M. Dutta: None Declared, A. Ramaraju: None Declared, S. Mangalwedhe: None Declared, S. G. Goyal: None Declared, G. Kulkarni: None Declared, A. Mukhopadhyay: None Declared, P. Chaudhary: None Declared, G. T. Harsha: None Declared, M. Parikh: None Declared, S. Dey: None Declared, S. Sarkhel: None Declared, N. Jyothi: None Declared, A. Kumar: None Declared, N. Sooch: None Declared, A. Shetty Employee of: Sun Pharma, S. Saha Employee of: Sun Pharma, P. Devkare Employee of: Sun Pharma, A. Shetty Employee of: Sun Pharma, D. Patil Employee of: Sun Pharma, P. Ghadge Employee of: Sun Pharma, A. Mane Employee of: Sun Pharma, S. Mehta Employee of: Sun Pharma

Agitated Depression (AgD) is a unique subtype of depression marked by impulsivity, higher suicide risk, treatment resistance, and worse clinical outcomes compared to Non-Agitated Depression (Non-AgD). Despite these clinical distinctions, the underlying neuropsychological mechanisms that differentiate AgD from Non-AgD remain poorly defined.

This study aims to explore the neurocognitive correlates that differentiate AgD from Non-AgD.

The study cohort included 722 participants, divided into five groups: AgD, Non-AgD, subjects in a manic state (Mnc), euthymic subjects with bipolar disorder (Eu), and healthy controls (HC). All participants underwent a comprehensive neurocognitive assessment including the Wisconsin Card Sorting Test (WCST), the Interference Component of the Stroop Test (ST), the Semantic Fluency Test (SFT), the Trail-Making Test A and B (TMT-A, TMT-B), and Raven’s Progressive Matrices (RPM). Data were analyzed using one-way ANOVAs and Tukey post-hoc tests to compare cognitive performance across groups.

Non-AgD showed inferior performance compared to AgD on the WCST (non-perseverative errors: p=0.037; perseverative errors: p=0.010; categories identified: p=0.026), ST (p=0.000), TMT-A (p=0.046), and TMT-B (p=0.001). Non-AgD also underperformed Mnc at ST (p=0.002), SFT (p=0.025), TMT-A (p=0.007), TMT-B (p=0.005), and RPM (p=0.012). HC consistently outperformed AgD, Non-AgD, Mnc, and Eu individuals on all neurocognitive tests except for the WCST, where no significant differences were observed between HC, Eu, and AgD. Eu demonstrated superior performance on the WCST (p≤0.001), ST (p=0.000), and TMT (p=0.000) compared to Non-AgD, with no significant differences compared to AgD.

The findings reveal distinct neurocognitive profiles for AgD and Non-AgD. The excitatory mechanisms associated with AgD may contribute to enhance attentional resources and cognitive flexibility but also greater impulse control difficulties. The neuropsychological profile of Eu patients resembles that of AgD, suggesting residual cognitive differences compared to HC. This study enhances our understanding of AgD by highlighting the differences in cognitive profiles of AgD, Non-AgD, Mnc, and Eu, and emphasizing the need of considering neurocognitive factors in the characterization and treatment of AgD.

None Declared

Treatment for bipolar disorder (BD) predominantly focuses on psychopharmacology, including lithium, antipsychotics, and anticonvulsants. Electroconvulsive therapy (ECT) is highly effective for managing manic or depressive episodes, yet studies on the effects of anticonvulsant therapy as a modifying factor of clinical outcome during ECT are scarce.

To evaluate how concurrent anticonvulsant use affects seizure parameters and clinical outcomes of ECT in BD patients.

A comprehensive search of multiple databases (MEDLINE, Embase, Web of Science, PsycINFO, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov) was conducted on October 2, 2024, without language or publication date restrictions. Eligible studies included clinical trials and retrospective analyses comparing BD patients undergoing ECT with and without anticonvulsant use. Random-effects models were applied for a sufficient number of studies, while fixed-effects models were used for fewer studies. Subgroup and sensitivity analyses were conducted.

Six studies met the criteria, involving 359 participants (mean age: 29.7 years; 31.2% female). Five studies focused on the effect of concomitant treatment with valproate during a manic episode, and only one study included subjects in treatment with other anticonvulsants during different mood episodes of BD. Anticonvulsant users required significantly higher minimal electrical dosages to achieve adequate seizures (SMD = 0.71, 95% CI [0.46 to 0.95], p < 0.0001), as indicated by higher seizure thresholds and stimulus doses. Additionally, anticonvulsant use was associated with a significantly shorter seizure duration (SMD = -0.75, 95% CI [-1.10 to -0.41], p < 0.0001). However, no significant differences in symptomatic improvement were found between those using and not using anticonvulsants (SMD = 0.03, 95% CI [-0.19 to 0.25], p = 0.78).

Concurrent anticonvulsant use in BD patients undergoing ECT is associated with higher seizure thresholds and shorter seizure durations, but this does not affect clinical outcomes regarding disease severity. Based on these findings, discontinuation of anticonvulsants during ECT may not be necessary. This review was limited by the small number of studies, small sample sizes, and considerable heterogeneity. Additionally, the majority of the studies analyzed only included patients in the manic state of the illness. Further research is needed to explore whether variations in seizure parameters are linked to individual clinical outcomes in BD patients, the impact of different anticonvulsants on these parameters and the outcome for depressive and mixed episodes of bipolar disorder.

I. Borja De Oliveira: None Declared, E. Tolotti Leite: None Declared, I. Santos Raposo Andrade: None Declared, M. Geremias: None Declared, A. Stephany: None Declared, A. de Vasconcelos: None Declared, D. Xavier: None Declared, F. Wagner: None Declared, G. A. M. Alves: None Declared, M. O. Pozzolo Pedro: None Declared, D. Soler Lopes: None Declared, A. Balduino de Souza: None Declared, M. Carbajal Tamez: None Declared, J. Quevedo Shareolder of: Instituto de Neurociencias Dr. Joao Quevedo, Grant / Research support from: LivaNova; and receives copyrights from Artmed Editora, Artmed Panamericana, and Elsevier/Academic Press, Consultant of: EMS, Libbs, and Eurofarma, Speakers bureau of: Myriad Neuroscience and AbbVie.

Treatment motivation is very important in the treatment of alcohol and substance use disorders. The evaluation of motivation, which is seen as the first step in addiction treatment, will also help understand the person’s interest and compliance with treatment. The lack of motivation of the person during the treatment process causes treatment abandonment and relapses.

An important issue in the treatment of alcohol use disorder is the trust of the person in the treatment. It is also important for the addict to have someone around him who has benefited from treatment, which is very important in terms of treatment compliance. With the influence of a person who has benefited from addiction treatment, the likelihood of applying for treatment and benefiting from treatment increases in a “snowball” manner.

The aim of this study was to evaluate whether people who are treated for alcohol use disorder have a treatment motivation for those around them. It was aimed to examine whether the people who have been treated are important in increasing the trust in treatment for other patients.

The study included cases who applied to the Seferihisar State Hospital Psychiatry Outpatient Clinic with complaints of alcohol use. The sociodemographic information form was filled out during the individuals’ first applications. The participants were asked whether there were people around them who had received inpatient treatment for alcohol use disorder at the hospital where the study was conducted, and the individuals were then administered the Readiness for Change and Desire for Treatment Scale (SOCRATES), Treatment Motivation Questionnaire (TMQ), and Alcohol Use Disorders Identification Test (AUDIT). The individuals were given the standard treatment recommended in our country’s treatment guidelines for the diagnosis of alcohol use disorder. The individuals participating in the study were interviewed at 1 month, 2 months and 3 months after starting treatment. The individuals’ answers and the decrease in the frequency and amount of alcohol use were recorded.

The rate of treatment attendance is 2.7 times higher for people who have received treatment for alcohol use disorder in their circle.

The rate of treatment confidence in treatment is 4.1 times higher for people who have received treatment for alcohol use disorder in their circle.

The frequency and amount of alcohol use has decreased more for people who have received treatment for alcohol use disorder in their circle.

It has been determined that those who are surrounded by people who have received treatment for alcohol use disorder have higher levels of treatment confidence and compliance. The assistance of these people to those around them can play an important role in increasing the success of addiction treatment.

None Declared

Alexithymia, the limited ability to recognize and describe emotions, reflects impairments in emotional awareness and is a prevalent dysfunctional trait in individuals with addiction. Pain is an interoceptive feeling processed through interoceptive pathways and serves as a homeostatic emotion that can motivate behavior. Pain sensitivity may play a role in the development and progression of alcohol use disorder (AUD). Interoceptive awareness (IA) refers to the ability to perceive the internal state of the body. Both interoceptive accuracy (IAc) and interoceptive sensibility (IS), the objective and subjective dimensions of IA, have been shown to be implicated in individuals with AUD.

Our objective was to compare alexithymia, pain sensitivity, IAc, and IS levels between abstinent patients with AUD and healthy controls. Additionally, we aimed to investigate the potential associations between the dimensions of IA and both alexithymia and pain sensitivity.

The study comprised 52 abstinent patients with AUD and 52 healthy control subjects. 92.3% (n=48) of the participants in each group were male, and 7.7% (n=4) were female. Alexithymia was assessed using the 20-item Toronto Alexithymia Scale (TAS-20). Pain sensitivity was measured with the Pain Sensitivity Questionnaire (PSQ). IAc was assessed using the heart rate tracking task, which measured participants’ awareness of their own heartbeat by comparing the number of heartbeats they perceived with an objective heart rate measurement. IS was evaluated using the Multidimensional Assessment of Interoceptive Awareness Version 2 (MAIA-2). The study included patients who had completed detoxification and been abstinent for at least three weeks while participating in or undergoing a 28-day abstinence-based inpatient treatment program.

Individuals with AUD scored significantly higher on self-reported measures of alexithymia (AUD group: 53.35 ± 11.83; control group: 44.63 ± 6.43; p < 0.001, F = 21.768) and significantly lower on the heart rate tracking task (IAc) (AUD group: 0.65 ± 0.15; control group: 0.84 ± 0.13; p < 0.001, F = 43.615). No significant difference was found in self-reported IS scores (AUD group: 114.06 ± 21.38; control group: 113.37 ± 13.52; p = 0.844, F = 0.039) or pain sensitivity scores (AUD group: 5.22 ± 1.67; control group: 5.18 ± 1.06; p = 0.892, F = 0.018). Alexithymia scores showed significant negative correlations with IAc scores (r = -0.256, p = 0.009) and IS scores (r = -0.361, p < 0.001). However, pain sensitivity scores did not significantly correlate with alexithymia (r = 0.083, p = 0.402), IAc (r = -0.103, p = 0.299), or IS scores (r = 0.136, p = 0.169).

Our findings support the hypothesis that alexithymia, which is linked to the development and progression of AUD, is associated with the dimensions of IA.

None Declared

Quitting alcohol use has been described as the main factor capable of modifying the prognosis of alcohol-related liver disease (ArLD). However, retention to the addiction treatment in these patients is low, and relapse in alcohol use is common. Misconceptions in the patients knowledge of the disease and the treatment impact retention. To improve retention, we have designed a blended intervention consisting in a presential brief intervention combined with a gamified webapp (MyWayUp). The intervention provides information regarding the liver disease and treatment, how to improve the prognosis, healthy lifestyles and how to achieve behavioural changes. The intervention was designed using a co-creation approach, and is based in well-stablished psychological principles (cognitive behavioural therapy, CBT; motivational interviewing, MI; psychoeducation; game-based learning).

The main objective is to explore the efficacy of the MyWayUp for improving retention to the addiction treatment in patients with ArLD at six months follow-up. As secondary objectives we explore: retention at 1 and three months, adherence to the treatment (attended visits from the total programmed), patterns of alcohol use and quality of life.

Prospective, randomised controlled trial, 6 months. Patients with ArLD onset would be invited to participate. If signed the informed consent, they would be randomised to the experimental or control condition. The experimental group would receive the brief intervention and given access to the webapp with a unique access code. Patients in the control group received treatment as usual, and after six months, if they had not adhered to the addiction unit, they would be invited to participate as experimental group. Both groups would be programmed the first visit with a psychiatrist, and followed at months 1, 3 and six after inclusion. The study was blinded for professionals and patients, and only one member in the research team would know the allocation group of each patient.

At baseline, sociodemographical variables were collected, as well as clinical data (presence of comorbidities), pattern of alcohol or other substances use (AUDIT; timeline follow back, TLFB), quality of life (EQ-5D-5L) and functionality (FAST). Several measure were taken at months 1, 3 and six: being active in the treatment at the assessment point (retention); adherence; alcohol and other substance use (TLFB) quality of life and functionality.

The final sample consisted of 82 patients, with a mean age of 55.3 (SD = 11.4). 38.2 % were women, and 53% of the participants were allocated to the experimental group.

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Image 2:

MyWayUp has shown efficay in improving treatment retention and adherence as well as in improving abstinence rates.

None Declared

Alcohol withdrawal syndrome is a significant challenge in the management of alcohol use disorder, with traditional treatments often relying heavily on benzodiazepines like diazepam. This study aimed to explore the efficacy and safety of incorporating baclofen (30 mg/day) alongside minimal, tailored diazepam doses—adjusted according to alcohol intake and CIWA-Ar scores—to manage withdrawal symptoms more effectively than conventional diazepam protocols. By reducing the total diazepam needed and shortening detoxification time, the study highlights the potential of baclofen to offer a faster, safer approach to alcohol withdrawal treatment.

To evaluate the efficacy and safety of combining baclofen (30 mg/day) with minimal diazepam doses—calculated based on alcohol consumption and adjusted by CIWA-Ar scores—in managing alcohol withdrawal symptoms more rapidly than standard diazepam protocols.

Sixty-nine patients with alcohol use disorder were enrolled and randomized into two groups. The baclofen group (n = 32) received baclofen 30 mg/day plus minimal diazepam, with initial diazepam doses based on average daily alcohol units consumed (1 mg diazepam per unit) and adjusted using CIWA-Ar scores. The standard group (n = 37) received a conventional diazepam-based detoxification regimen with fixed starting doses adjusted by withdrawal symptoms. Primary outcomes were the total diazepam dosage required and the duration of detoxification. Secondary outcomes included daily CIWA-Ar scores and incidence of adverse effects. Statistical analyses employed independent t-tests and chi-square tests, with p < 0.05 considered significant.

The baclofen group required significantly less diazepam compared to the standard group (mean total dose: 30 ± 10 mg vs. 50 ± 15 mg; p < 0.001). They also experienced a shorter detoxification duration (mean: 15 ± 1 days vs. 19 ± 1 days; p = 0.01), indicating a faster withdrawal process. CIWA-Ar scores were consistently lower in the baclofen group throughout detoxification (mean: 6 ± 2 vs. 10 ± 3; p < 0.001), reflecting milder withdrawal symptoms. No significant adverse effects were observed in either group, including over-sedation, respiratory depression, or hallucinations.

Combining baclofen (30 mg/day) with minimal diazepam—calculated based on alcohol consumption and adjusted by CIWA-Ar scores—effectively controlled alcohol withdrawal, reduced diazepam use by 40%, and shortened detoxification by about four days. The protocol was well-tolerated and may benefit patients at risk from high benzodiazepine doses or in settings aiming to limit benzodiazepine use. These findings suggest baclofen can reduce medication needs and speed up recovery. Larger trials are needed to confirm these results and evaluate long-term outcomes like relapse rates and sustained abstinence.

None Declared

Eating disorders comprise various conditions yet do not cover chronic overeating that may result in extreme obesity. Binge eating disorder with chronic somatic effects is not included in DSM-V; behavioural addictions do not comprise chronic overeating either. Neither do impulse control disorders. There are no actual screening tools for chronic overeating, and research is scarce on its chronic psychological effects

This research aims to find the distinctive psychometric characteristics of addiction using MMPI-2 data taken from patients who underwent gastric surgery due to high-risk obesity or moderate-risk obesity with alarming comorbidities.

This study employed a consecutive patient cohort to evaluate complication rates and the efficacy of Single-Anastomosis duodeno-ileal bypass with Gastric plication (SADI-GP). Patient recruitment commenced in October 2018 and ceased in June 2019. The process involved preoperative assessment, surgery, and several postoperative follow-up appointments at 1, 3, 6, and 12 months. The Minnesota Multiphasic Personality Inventory (MMPI-2) was administered during the 12-month follow-up. Participants aged between 18 and 65 years were included in the study, with body mass indexes (BMIs) exceeding 40 for individuals without comorbidities related to morbid obesity, and exceeding 35 for those with comorbidities related to morbid obesity, particularly related to glucose metabolism.

MMPI-2 scales previously confirmed to be related to SUD were analyzed, and common psychological comorbidities of SUD were searched for using these scales

High scores on MAC-R, AAS, and APS scales are well-represented in the sample (Table 1).

The sample includes a high number of high scorers on Rc4 and a moderately high number of high scorers on Rc9 (Table 2).

Elevated individual scale scores form dual or triplet peak settings in the MMPI-2 results and may describe certain conditions, like SUD. The majority of the subjects showed SUD-like personality settings (Figure 1). This study is constrained by limitations about sample size, a dropout rate exceeding expectations, stringent exclusion criteria, male-to-female ratio, short-term results, and the absence of longitudinal data on psychological characteristics.

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Image 2:

Image 3:

We found the MacAndrews Revised (MAC-R) scale strong, with AAS and APS as intermediate indicators for non-substance-based behavioural addiction in our sample (Table 1). RC4 also seems to be a strong indicator (Table 2), along with Pd-D and Pd-Pa peaks (Figure 1).

None Declared

In the last 50 years, obesity has become a leading cause of morbidity and decreased life expectancy, being associated with the development of cardiovascular disease, decreased mental health and overall decreased quality of life. The development of bariatric surgery as a treatment strategy in those in which attempts at conservative treatment yielded no satisfactory results has revolutionized treatment of refractory obesity. While short term gains in cardiovascular health are undeniable, long-term impact remains uncertain. More recently, there is emerging evidence of bariatric surgery being associated with de novo alcohol use disorder.

We aimed to study the possible correlation between bariatric surgery and alcohol use disorder, specifically the individual risk factors that may promote such outcome. Moreover, we aimed to evaluate which surgical procedures are more eliciting of alcohol use disorder.

We performed a literature review using the database MEDLINE and obtained 241 results using the query terms “bariatric surgery” and “alcohol”. Of these, we read all the summaries and subsequently selected 51 different scientific articles which we afterwards read in full. We then performed a literature review aiming to understand the maladaptive alcohol consumption patterns following bariatric surgery

Most studies report maladaptive alcohol use following bariatric surgery. Outstandingly, this consumption pattern develops only at later follow up stages, usually over 3 years after surgery. Furthermore, not all types of bariatric surgery appear to pose the same iatrogenic risk. Gastric bypass poses the highest risk of new onset alcohol misuse, in comparison to sleeve gastrectomy or gastric band surgery. It is not yet fully understood the mechanism behind this pattern of alcohol misuse following surgery, but common reasons have been identified, including different social interaction patterns, addiction transfer, ambivalence towards bodily changes, increased mental vulnerability and different body response to the effects of alcohol.

The screening of alcohol misuse before and after bariatric surgery is of paramount importance to decrease the surgical iatrogenic risk and improve outcomes. Further research should be developed in understanding what are the risk factors and mechanistic pathways for alcohol misuse following bariatric surgery. Also, it should be investigated whether the treatment of alcohol misuse disorder differs between patients submitted to bariatric surgery or not.

None Declared

Social support can significantly influence mental health help-seeking (Rickwood et al., 2005). At MHWS, many patients are older and receiving late diagnoses for ADHD, often after experiencing lifelong difficulties. Research shows that women’s mental health issues are frequently overlooked due to gender biases in healthcare (Kuehner, 2017), with men often underestimating the severity of their partners’ mental health challenges (O’Neil, 2008; Cummings & Davies, 2002). This study explores whether similar patterns of underrepresentation occur in ADHD diagnoses, particularly in relation to observer gender and relationship to the patient.

The study aimed to explore differences in ADHD assessment scores between patients and their observers based on the observer’s gender and relationship to the patient. Additionally, it sought to determine whether the underrepresentation of ADHD symptoms differs based on these variables.

A cross-sectional comparative study was conducted involving 196 patients (123 females, 73 males) and their observers (135 females, 61 males) using the Conners’ Adult ADHD Rating Scales (CAARS). The DSM-IV ADHD Symptoms Total was analyzed by comparing scores between patients and observers. The significance level was set at 0.10 for exploratory purposes. Statistical analyses included the Mann-Whitney U test and Kruskal-Wallis test to explore the effects of observer gender and relationship on the discrepancy in ADHD symptom reporting.

1. 1. Gender of the patient did not influence self-reported ADHD scores (U = 5057.500, p = 0.705), but observer gender significantly impacted their rating of the patient’s symptoms (U = 5312.500, p = 0.032).

2. 2. Female patients’ ADHD symptoms were underrepresented more than male patients’ (U = 3941.500, p = 0.019).

3. 3. Male observers underreported symptoms more than female observers (U = 4772.500, p = 0.075).

4. 4. Observer relationship to the patient did not significantly affect ADHD symptom score discrepancies (H(3) = 4.928, p = 0.177).

5. 5. Female partners were less likely to underrepresent ADHD symptoms compared to female parents, female and male family members, and male partners (p = 0.028, 0.002, <0.001).

Female patients were more likely to have their ADHD symptoms underrepresented, particularly by male observers and male partners, indicating potential gender biases in perception. The findings suggest that clinicians should be cautious of possible underreporting of ADHD symptoms by male observers and particularly male partners. Future research should explore whether hyperactivity or inattentiveness is more frequently underrepresented and further validate these exploratory findings.

None Declared

Intimate partner violence (IPV) is a major public health concern. One of the most common forms of interpersonal violence concerns IPV, one in three women which is approximately 35% of women who experience physical and sexual violence by an intimate partner at some points in their lives. Women with mental illness are a vulnerable risk group for IPV.

The current study aimed to assess the prevalence and clinical correlates of IPV among women outpatients with mental illness in a tertiary care psychiatric hospital.

118 participants with a primary diagnosis of schizophrenia spectrum disorders or depression were recruited. Data on intimate partner violence (IPV) were assessed on the World Health Organization Violence Against Women (WHOVAW) scale, consisting of three domains-psychological, physical and sexual intimate partner violence. Psychopathology was measured using Brief Psychiatric Rating Scale-18 items (BPRS) questionnaire, consisting of five domains- positive symptoms, negative symptoms, resistance symptoms, activation symptoms, and affect symptoms. Data on socio-demographic characteristics were also obtained. Multivariable logistic regression was used for analysis.

The mean (SD) age of women participants was 32.63 years (10.96). The overall prevalence of IPV among women with mental illness was 55.1%. Participants who were separated/widowed/divorced (versus single) were significantly more likely to experience total VAW scores (OR=14.57), and psychological (OR=21.64), and physical (OR=11.30) domains. Those who belong to Malay ethnicity (versus Chinese ethnicity) were significantly more likely to experience sexual abuse (OR=6.25). Women who were unemployed (versus employed) were significantly more likely to experience sexual IPV (OR=3.94). Women who experienced IPV (OR=1.36), psychological abuse (OR=1.30) and physical abuse (OR=1.25) were significantly more likely to have positive symptoms compared to those who did not experience IPV. Women who experienced IPV (OR=1.14) and psychological abuse (OR=1.13) were significantly more likely to have affect symptoms compared to those who did not experience IPV.

The study highlights the prevalence of IPV among women with mental illness. Overall VAW scores, psychological and physical IPV were strongly associated with higher score on the positive and affect symptoms on psychopathology scale. The high prevalence of IPV among this group of patients is concerning and mental health professionals should actively identify IPV and implement holistic interventions to ensure good care of women with mental illness.

None Declared

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that often persists into adulthood, significantly impacting daily functioning and quality of life. Studying sex differences in ADHD is crucial as females are frequently underdiagnosed or misdiagnosed, which can delay treatment and worsen outcomes. ADHD presents in three main subtypes: inattentive, hyperactive-impulsive, and combined. The combined subtype tends to cause more significant impairments, particularly in academic and social contexts. Males are more likely to be diagnosed with hyperactive-impulsive or combined types, while females often present with the inattentive subtype. A subtype-specific approach is essential, as it guides targeted interventions to address distinct behavioral and cognitive challenges, enhancing treatment efficacy and outcomes.

This study aims to analyze differences in ADHD severity, comorbidity with other conditions, and socio-functional impact by ADHD subtype and sex, as well as to evaluate interactions between these variables.

This population-based study included 900 adults diagnosed with ADHD from a specialized ADHD clinic. Participants were classified by ADHD subtype and sex. Diagnostic and severity assessments were conducted using validated tools, including the CAADID-I, DIVA-5, ADHD Rating Scale (ADHD-RS), Wender Utah Rating Scale (WURS), and Clinical Global Impression Severity Scale (CGI-S). Comorbid psychiatric conditions and psychosocial functioning were evaluated using the BDI-II, STAI, BIS-11, PSQI, FAST, and WHODAS scales. Statistical analyses included bivariate, multivariate, and General Linear Model (GLM) methods.

Females were diagnosed with ADHD later than males (p=0.001) and exhibited greater severity (ADHD-RS, p<0.001) and higher levels of depression and anxiety. No significant sex differences were observed in impulsivity or sleep quality. The combined ADHD subtype was associated with greater clinical severity and functional impairment. An interaction effect was found between sex and ADHD subtype only for WHODAS scores, with females in the combined subtype showing greater impairment.

ADHD presents differently across sexes and subtypes, with specific interactions observed in functional impairment. These findings emphasize the importance of considering sex and ADHD subtype independently to enhance diagnostic accuracy and inform targeted treatment strategies.

None Declared

Infertility is a biopsychosocial crisis. While there are studies demonstrating heightened negative affect (e.g., depression and anxiety) in women undergoing in vitro Fertilization (IVF), the findings are still inconsistent. The network paradigm allows for a more in-depth examination of symptom dynamics behind specific psychopathological states. A recent development allows one to compare networks from different groups using three characteristics: global strength (overall level of network node connectivity), edge strength (level of association between symptoms), and network structure (comparing all edges in the network across two groups).

This study aims to compare the networks of anxiety, depression, and negative affect across women who have fertility issues or undergoing IVF and women without these issues.

Sample 1 consisted of 197 women with fertility issues (age: M = 37.73, SD =5.13) and 370 women without such issues (age: M = 36.25, SD = 6). Sample 2 consisted of 205 women undergoing IVF (M = 40; SD = 5.29) and 222 mothers without fertility issues (M=28; SD = 4. 93). Sample 3 consisted of 162 women undergoing IVF (M= 35.58; SD=5.04) and 129 mothers without fertility issues (M= 34.37; SD= 4.94). PHQ-9 (Patient Health Questionnaire; depression measure) was administered to the sample 1, GAD (generalized anxiety disorder measure) was administered to sample 2, and PANAS - NA (negative affect measure) was administered to sample 3. NetworkComparisonTest R package was used to compare the networks. EBICglasso was used to estimate the networks.

Regarding the depression symptoms (sample 1; image 1) - the networks across the two groups are highly similar with respect to overall connectivity (S =.051; p = .73) and overall network structure (M = .16, p =.87). Regarding generalized anxiety symptoms (sample 2; image 2), the findings are replicated with overall connectivity being the same across the two groups (S =.10, p = .34) and network structure being the same across the two groups (M = .28, p= .09). Finally, the negative affect (sample 3; image 3) network connectivity (S = .02, p = .93) and network structure (M = .23, p = .53) are identical across the two groups.

Image 1:

Image 2:

Image 3:

The networks of negative affect, depression, and anxiety are highly similar across women with fertility issues and women without such issues. Therefore, fertility issues do not seem to affect the structure of symptoms of depression, anxiety, and negative affect. Finally, it is argued here that the knowledge of these disorders (and negative affect) can be generalized to the population of women who have fertility issues.

N. Ćirović Grant / Research support from: Nikola Ćirović was supported by the Science Fund of the Republic of Serbia, #GRANT No 1568, Identity Crisis in Women Facing Infertility: Mixed Methods Approach – InsideMe., J. Opsenica Kostić Grant / Research support from: Jelena Opsenica Kostić was supported by the Science Fund of the Republic of Serbia, #GRANT No 1568, Identity Crisis in Women Facing Infertility: Mixed Methods Approach – InsideMe., M. Mitrović Grant / Research support from: Milica Mitrović was supported by the Science Fund of the Republic of Serbia, #GRANT No 1568, Identity Crisis in Women Facing Infertility: Mixed Methods Approach – InsideMe., M. Guberinić Grant / Research support from: Mila Guberinić was supported by the Science Fund of the Republic of Serbia, #GRANT No 1568, Identity Crisis in Women Facing Infertility: Mixed Methods Approach – InsideMe., M. Spasić Šnele Grant / Research support from: Miljana Spasić Šnele was supported by the Science Fund of the Republic of Serbia, #GRANT No 1568, Identity Crisis in Women Facing Infertility: Mixed Methods Approach – InsideMe., I. Janković Grant / Research support from: Ivana Janković was supported by the Science Fund of the Republic of Serbia, #GRANT No 1568, Identity Crisis in Women Facing Infertility: Mixed Methods Approach – InsideMe., M. Trenkić Grant / Research support from: Milan Trenkić was supported by the Science Fund of the Republic of Serbia, #GRANT No 1568, Identity Crisis in Women Facing Infertility: Mixed Methods Approach – InsideMe.

Sexual dysfunction is a multifaced issue that significantly affects women’s physical and psychological health, contributing to broader emotional challenges such as dissatisfaction and inadequacy. In Tunisia, cultural and social factors, including gender roles and societal expectations, further shape women’s perceptions and experiences of their sexual well-being. Self-esteem, a core component of psychological health, plays a crucial role in how women view and experience their sexuality, with lower self-esteem often intensifying sexual dysfunction.

This study aims to explore the relationship between sexual dysfunction and self-esteem among Tunisian women within this cultural context.

a cross-sectional study was conducted online using a Google Forms questionnaire between July and August 2024.The inclusion criteria were sexually active women aged 18 years or older who provided informed consent to participate. Participants completed a self-administered questionnaire that included sociodemographic information, personal medical history, lifestyle habits, and psychometric assessments.

The Female Sexual Function Index (FSFI) was used to evaluate sexual function and self-esteem was assessed using the Rosenberg Self-Esteem Scale (RSE).

A total of 180 women participated in the study. The average age of the sample was 32.79, with ages ranging from 21 to 60 years. In our study, 97.78% of the women were from urban areas 94.44% had a university degree 80% were employed and 62.78% were married. Regarding medical history, 21.11% reported organic issues, while 27.22% had a psychiatric history.

Lifestyle habits indicated that 18.9% of women smoked, and 21.1% consumed alcohol, while only 1.1% reported using psychoactive substances. . The majority, 93.89%, had a single partner, and 93.89% identified as heterosexual.

The evaluation of sexual function using the Female Sexual Function Index (FSFI) showed an average score of 23.37 ± 9.64, with 43.33% of participants experiencing sexual dysfunction. Specifically, 75.6% had issues with sexual desire, 83.3% reported pain during intercourse, and 71.7% experienced problems with sexual arousal.

The average self-esteem score, was 32.25 ± 5.75. A significant correlation was found between sexual dysfunction and self-esteem (p < 10^-3). Among the women with very low self-esteem, 80% experienced sexual dysfunction, while only 20% of those with very high self-esteem reported dysfunction.

Addressing both sexual health and self-esteem is essential for improving the emotional and psychological well-being of women in Tunisia. These findings underscore the importance of comprehensive sexual health interventions that promote positive self-esteem, ultimately enhancing the overall quality of life and fostering psychological resilience among Tunisian women.

None Declared

Sustained attention deficit is a core feature of schizophrenia, however, its between-subjects and within-subject fluctuations are little understood. Moreover, although the pertinence of sustained attention for daily functioning has been widely discussed in the literature, research has not consistently demonstrated this association in schizophrenia. One possible reason is a use with non-ecological tasks for evaluation of SA, which may not fully capture real-world attentional demands. Indeed, existing tools demonstrate low ecological validity.

This study aimed to develop daily-life task-based test of SA - Ecological Sustained Attention Task (Eco-SAT), and investigate its reliability and criterion, construct, and ecological validity in schizophrenia.

Eco-SAT was developed based on well-established CPT paradigm (320 trials presented for 500-3000ms, 12 min) simulating vacuum cleaning task. Twenty-one individuals with schizophrenia (age: M=42, SD=12.5; female: N=12, 57%) and 34 matched by age and gender healthy controls completed the Eco-SAT, non-ecological CPT, measures of cognition (MATRICS consensus cognitive battery: BACS, TMT, RBVMT & CFT), schizophrenia symptoms, and daily functioning using Observed Tasks of Daily Living test (OTDL, functional capacity) and Adults Subjective Assessment of Participation in daily life in an interchangeable order during one session.

Eco-SAT demonstrated excellent test-retest reliability for Average RT (ICC = 0.84). Schizophrenia patients performed Eco-SAT significantly worse than controls on Average RT (U=545, p < 0.01), and variance RT (U=518, p < 0.01). Eco-SAT showed correlations with non-ecological SA task (all parameters; 0.45<r<0.75, p<.001), MATRICS sub-tests of BACS (d prime, average RT, RT variance: -0.54<r<0.3, p<.5), TMT-B (average RT: r=0.3, p<.05), RBVMT (average RT, RT variance: -0.5<r<-0.4, p<.01), and CFT (average RT, RT variance:-0.35<r<-0.34, p<.001), positive schizophrenia symptoms (hit rate: r=0.3, p<.05) and the OTDL (RT variance, d prime, hit rate: -0.35<r<0.3,p < .05).

The study provides initial evidence of the psychometric properties of the Eco-SAT, an ecological measure of sustained attention in schizophrenia. Criterion validity was established for all Eco-SAT indices, while reliability, construct validity, and ecological validity were demonstrated for specific indices. The results suggest that average RT and RT variance are the most trustworthy indices. Although further research is required, these findings indicate that this ecological measure may offer a more accurate way to assess attentional deficits in real-world activities, enhancing our understanding of attentional mechanisms in schizophrenia for both research and clinical applications.

None Declared

Psychiatric assessment of psychotic disorders has traditionally relied on categorical classification systems, but there is a shift towards a dimensional approach in DSM-5 and ICD-11. Schizophrenia is increasingly viewed as a spectrum disorder, with genetic studies indicating shared risk factors among schizophrenia, schizoaffective disorder, and bipolar disorder. However, there is currently no widely used transdiagnostic dimensional assessment tool in clinical practice. At Semmelweis University we have developed a scale which takes into account four major symptom groups (catatonia, affective-, positive and negative symptoms) and several important “specifiers” (disorganisation, bipolarity, prodromal symptoms, childhood onset, etc.). Clinicians should assess their patients with CPAN based on the long-term clinical presentation, contrary to PANSS and other cross-sectional tools, since our theory is that long-term traits represent underlying “biology” in a more precise manner than the rapidly changing status of patients, and therefore should show higher correlation with biomarkers like genetic and imaging data.

We aimed to test the clinical usability of CPAN and its alignment with DSM-5 diagnostic categories and medication correlations in outpatient settings. Additionally, we planned a validation process to assess the tool’s validity, interrater reliability, and test-retest reliability.

In our pilot study, six clinicians assessed 104 outpatient patients using CPAN, analyzing DSM-5 diagnoses and medications. Patients were clustered into four groups based on leading symptoms. In the validation study, 100 inpatients with severe psychotic symptoms will be assessed three times by two raters—one from the clinical team and one independent. We will compare CPAN’s validity to PANSS results and assess test-retest reliability with three assessments.

The pilot study demonstrated that CPAN is user-friendly, taking 1-2 minutes for familiar clinicians to complete. Four symptom clusters were identified: 1) schizophrenia with catatonic symptoms, 2) schizophrenia without catatonic symptoms, 3) schizoaffective disorder with negative symptoms, and 4) schizoaffective disorder without negative symptoms/bipolar disorder. Prescription patterns were correlated with symptom groups, but detailed analysis was limited due to the small sample size. Validation results are pending.

CPAN is a practical tool for assessing long-term symptom presentation in patients with psychotic disorders. Widespread use of this scale could provide valuable real-life data linking symptoms to medication use and clinical outcomes. The ongoing validation study will further establish the scale’s validity and reliability

None Declared