Cognition is key to long-term outcomes in first-episode psychosis (FEP). Obstetric complications affect working and verbal memory in schizophrenia (Amoretti et al. Psychol Med, 2022;52:2874-2884). Among them, birth weight (BW), an indicator of prenatal development, has been studied in relation to cognition (Krishna et al. Int J Geriatr Psychiatry, 2019;34:1139-1169). Higher cognitive reserve (CR) is associated with better cognitive and functional outcomes (Amoretti et al. Psychol Med, 2022;52:526-537). It is hypothesized that low BW impacts fetal brain development, reducing CR and later functioning (Krishna et al. Int Psychogeriatr, 2021;1-14)

To examine the relationship between BW and functioning one year after the onset of psychosis, mediated by CR and cognitive performance

117 FEP patients and 224 healthy controls (HC) were recruited. BW was collected as a continuous variable in grams. The Functioning Assessment Short Test (FAST) assessed functioning. CR was quantified via premorbid IQ, educational attainment, and lifetime participation in leisure and social activities. A complete neurocognitive assessment was performed. Correlational analyses explored relationships between BW, CR, and cognition in FEP and HC. Serial mediation analysis (PROCESS Model 6) examined indirect effects of BW on functioning through CR and cognition

No significant differences were found in BW between patients and HC (p=0.719). HC had higher CR than patients (p<0.001) (Figure 1). In patients, BW correlated with CR (r=0.20, p=0.027), though no correlation was found in HC (r=0.10, p=0.216) (Figure 2). The mediation model confirmed that BW was associated with CR (β=0.01, p=0.015), CR was linked to verbal memory (β=2.21, p=0.001) and verbal memory with functioning (β=0.07, p=0.004). The direct and total indirect effects of BW on functioning were non-significant. Among the indirect paths, only the one involving CR and verbal memory was significant (95%CI [0.0001, 0.0016]) (Figure 3).

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While BW did not have a direct impact on psychosocial functioning, it does influence CR, which in turn affects verbal memory.

None Declared

Cognitive disruption is a key feature in schizophrenia, and the identification of the neurophysiological underpinnings is of particular interest. One of the most promising markers of cognition is aperiodic activity, which is considered as a proxy measure of excitation inhibition (E/I) balance, stemming from the equilibrium between glutamatergic and GABAergic neurotransmission. E/I alteration has been found in multiple disorders, but its relationship with cognition in schizophrenia has never been explored.

This study aims at demonstrating the link between aperiodic activity and cognition in schizophrenia, and at creating neuropsychophysiological profiles, associated with clinical and functional features.

48 patients with schizophrenia were assessed for cognition, well-being and the severity of psychopathology and underwent an electroencephalogram (EEG) recording during a resting state. EEG tracks were processed to extract aperiodic parameters (offset and exponent). Pearson correlation analyses between aperiodic and cognitive measures were performed. Aperiodic indexes and the related cognitive domains were used to create neuropsychophysiological profiles, using a two-step cluster analysis. Analyses of Variance were performed to characterize significant differences in severity of psychopathology and well-being between profiles. Moderation analyses were run to identify the interplay between profiles, psychopathological severity and well-being.

The mean aperiodic offset was -12.45 (± 0.65), while the mean exponent was 0.85 (± 0.28). Significant correlations with aperiodic parameters were found for: Working Memory, Processing Speed and Psychomotor Speed (Fig1-2). Cluster analysis identified two profiles (Profile1 N=15, Profile2 N=33): Profile1 had a higher offset, a steeper slope. ANOVAs revealed that Profile1 showed significantly higher scores in Working Memory and Processing speed, and lower levels of General Psychopathology, Anxiety/Depression and Uncontrolled Excitement and Hostility. Lastly, mediation models, showed an interaction between Profiles (R2=0.21, p=.04) and Anxiety/Depression as well as between Profiles and General psychopathology (R2=0.30, p=.003) on Self-Acceptance, with significant negative relationship only in Profile2 in both models (Fig 3).

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Our data support an altered E/I balance in schizophrenia and innovatively show a direct link between aperiodic activity and the cognitive disruption. This relationship is further confirmed by the identification of two profiles, characterized by distinct neuropsychological and neurophysiological measures, with a flatter aperiodic slope, corresponding to an altered E/I balance, being associated with more severe cognitive impairment and illness severity. The clinical relevance is highlighted by the interplay between symptoms severity and neuropsychophysiological patterns on subjective well-being.

None Declared

Neuroinflammation and the Kynurenine Pathway (KP) have gained attention in the last decades in the pathogenesis of cognitive impairment in schizophrenia. Pro-inflammatory cytokines and microglia activation induce oxidative stress, neurodegeneration, white matter (WM) disruption and increased synaptic pruning and, importantly, activate the KP, whose metabolites have neurotoxic/neuroprotective and neuromodulatory properties on cholinergic and glutamatergic neurotransmission, two pivotal systems in cognitive processes.

This study aims to investigate the relationship between levels of inflammatory markers and KP metabolites and cognition in schizophrenia with a focus on the differential impact of these biomarkers on the different phases of the illness.

Associations between levels of biomarkers and cognitive domains in the wholw sample of 120 patients with schizophrenia were firstly assessed. Then, patients were divided in two subsamples depending on the duration of illness, with the aim to evaluate the impact of inflammatory biomarkers and kynurenines on cognition depending on disease progression. Finally, we performed cluster analysis to investigate kynurenines as possible clustering variables with the final aim to attribute a different cognitive profile to each cluster.

In the whole sample we found negative correlations between multiple inflammatory markers including IL-1β, IL-6, TNF-α, and cognitive functions, particularly verbal memory. Negative associations between verbal memory and TNF-a, IFNg and IL-5 were found in early-phase patients compared to late-phase patients, who showed a less strong associations. Interestingly, kynurenines showed significant associations with cognition in multiple areas regardless of the duration of illness. Regarding clustering, Cluster 1 included patients with lower levels of Tryptophan, Quinolinic Acid, and Kynurenic Acid, as well as higher levels of 3-hydroxykynurenine, compared to Cluster 2 (Fig. 1). Interestingly the two clusters showed different cognitive profiles. Verbal memory, psychomotor speed and attention significantly differed between the two clusters, with Cluster 1 showing the most impaired cognition in all these domains (Fig. 2).

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These results stress the primary importance of inflammation and KP abnormalities in cognitive impairment. The effects of inflammation on cognition seems to decline over time, while metabolites of the kynurenine pathway continue to have an impact. Probably, pro-inflammatory cytokines impact cognition more in patients with a shorter duration of illness as the biological bases of cognitive functions are more preserved (cortical volumes, synapses, WM integrity), whilw the neuromodulation of KP metabolites combined with their neurotoxic/neuroprotective profile can explain the diferential effect.

None Declared

Schizophrenia is a severe mental disorder linked to a life expectancy 15-20 years shorter than the general population1, due to higher rates of cardiovascular disease, cancer, metabolic disorders, and increased risk of suicide and accidental deaths2.

This study aims to analyze survival and causes of death in a cohort of schizophrenia patients over a 10-year period, providing insights into mortality patterns in this population.

This 10-year retrospective study followed 635 schizophrenia patients, aged 18 or older, enrolled from 2010 to 2013 at the Clinical Hospital of Psychiatry and Neurology, Brasov, Romania. Patients with schizo-affective or other psychotic disorders were excluded. Data included demographics, clinical history, and survival outcomes, with causes of death confirmed by a Forensic Medical Specialist.

The study included 635 patients diagnosed with schizophrenia. The mean age at baseline was 48,01 ± 11.36, 42.04% were males, and the mean age of onset of schizophrenia was 26.68 ± 8.01.The average duration of illness was 21.27 ± 11.41 years. Among the cohort, 20.31% patients were treated with LAIs antipsychotics, and 17.16% were on clozapine. Of the 635 patients followed, 123 (19.4%) died during the 10-year follow-up. The average age at death was 59.04±11.96. According to the 2023 Eurohealth report and the World Health Organization, the overall life expectancy in Romania is 76.3 years 3. The data on schizophrenia patients suggests a significant disparity between their average age at death and the overall life expectancy in Romania. Schizophrenia patients in Romania live, on average, about 17 years less than the general population. Of the deceased, 13% died in psychiatric wards, and 17.88% were in chronic care at the time. Among the deceased patients, 18 were on typical antipsychotic LAIs. None of the patients in the deceased cohort were on atypical LAIs. Cardiovascular disease was the leading cause of death (27.64%), followed by infections (17.07%) and cancer (12.19%). Metabolic causes accounted for 4.06%, respiratory for 1.62%, hepatic for 3.25%, and both neurological and gastrointestinal causes for 0.81%. The cause of death was undetermined in 15.45% of cases. Violent deaths accounted for 17.07% of cases, with 8 suicides and 13 accidents. Out of the 13 accidental deaths, 7 were due to choking-related asphyxiation during eating. Four of these patients were on haloperidol, 2 on quetiapine, and 1 on flupenthixol.

The 17-year lower life expectancy for schizophrenia patients highlights the urgent need for targeted public health interventions and improved preventive care. Additionally, the high mortality from cardiovascular disease, cancer, and infections, along with choking-related risks from antipsychotic medications, underscores the importance of careful medication management to enhance patient safety and survival.

None Declared

Early Intervention in Psychosis (EIP) services have been youth-focused since their inception. Recently, NICE recommend the expansion of the age acceptability criterion to 65 years, from the previous cut-off of 35 years.

The aim of this study is to compare the demographic and clinical characteristics between patients below and above 35 years of an epidemiological cohort of first-episode psychosis patients treated in the Early Intervention Service of Cantabria (ITPCan).

This is an study of the 207 consecutive patients aged from 17 to 65 who were admitted to the Service of University Hospital Marqués de Valdecilla, Spain, from January 2020 to July 2024. Descriptive statistics and between groups comparisons are reported.

A large proportion (51.2%) of those who presented a first episode of psychosis did so after the age of 35. The over 35s were predominantly female (65,1%), whilst the under 35s were predominantly male (58.4%) (χ2=11.495, P=0.01).

No significant differences were found between the age groups in terms of the need for psychiatric care in the different facilities (emergency care, day hospital, acute unit admission or mid-stay unit admission), nor in the presentation of autolytic attempts or the requirement for mechanical restraint.

DUP was significantly higher in the over 35s (u=4183.5, P=0.006), with a median of 4 months versus a median of 2 in the under 35s.

As for the use of drugs, 36.6% of the under 35s regularly consume cannabis compared to 6.6% of the over 35s (χ2=15.783, P=0), while there are no differences in the consumption of tobacco or alcohol.

There was a higher proportion of patients over 35 with diabetes (4.7% vs. 0%, χ2=4.407, P=0.036), hypercholesterolemia (20.8% vs. 4%; χ2=11.750, P=0.001) and a history of cardiovascular disease (7.5% vs. 1%, χ2=4.678, P=0.03), but no significant differences were observed between groups in the history of cerebrovascular disease or hypertension.

In reference to diagnosis, non-affective psychosis was more frequent in both groups (73.3% in under 35s and 90.6% in over 35s), with the diagnosis of delusional disorder being more frequent in the group over 35s (18.9% vs 1%, χ2=16.127, P=0). On the other hand, the diagnosis of manic episode with psychotic symptoms was significantly higher in those under 35 years of age (22.8% vs 9.4%, χ2=6.867, P=0.009).

Despite the high proportion of patients who have a late onset of psychosis, specially women, this remains an understudied group. EIP services focused on young people are gender and age inequitable. There are some clinical and demographic differences between the two age groups and EIP services should ensure that the treatments offered are tailored to the needs of both groups.

None Declared

Psychotic disorders are a major cause of global disability. While antipsychotic treatments are effective, their impact is limited. Metacognitive Training (MCT) reduces positive and negative symptoms, but neurocognitive deficits hinder therapy. Cognitive Rehabilitation (CR) may help improve these skills. Combining both therapies could offer better results, but studies are lacking to confirm whether there is any real improvement.

Compare the efficacy of combined CR+MCT therapy vs. MCT alone in clinical and functional recovery in nonaffective psychotic disorders.

This ongoing randomized trial includes 85 patients (56.5% female, mean age 40.40±10.17), with 38 receiving CR+MCT and 47 receiving MCT only. Sociodemographic and clinical data (WHO-DAS-II, PANSS, GAF, and criteria for clinical remission and functional recovery) were collected pre-and post-treatment. Generalized linear models were used, with post-treatment scores as the dependent variable, baseline scores, and RC+MCT group as covariates.

No significant differences were found between groups. However, CR+MCT showed a greater reduction in positive symptoms (Mpost-pre = -3) vs. MCT (Mpost-pre = -2.2) with no changes in negative symptoms. CR+MCT presented a higher percentage of clinical remission (12,1%) vs MCT (0%) post-treatment. Both groups improve in functional recovery, with greater results in MCT alone (10,9%CR+MCT vs 22,8%MCT). CR+MCT also had greater reductions in functional disability (Mpost-pre = -3,4) vs. MCT alone (Mpost-pre = -2,2).

The group that has received the combined RC+MCT therapy has shown better results in clinical remission and functional recovery, the last in terms of disability, than the MCT-only group. The small sample size limits statistical significance.

None Declared

Emerging research suggests that retinal structure, assessed via optical coherence tomography (OCT), may be a potential biomarker in Schizophrenia Spectrum Disorders (SSD). However, the relationship between retinal and cognitive parameters in the early stages of the disease remains underexplored.

To examine the correlation between retinal structure and cognitive functioning in patients with early-course SSD.

A cross-sectional sample of 26 SSD cases and 25 age- and gender-matched healthy controls (HCs) underwent OCT imaging. Peripapillary retinal nerve fiber layer (pRNFL), macular, and ganglion cell-inner plexiform layer (GCL+IPL) thicknesses were measured. Cognitive domains, including verbal memory (California Verbal Learning Test, CVLT[Delis et al. 2000]), working memory (WAIS-III Letter–Number Sequencing Subtest[Wechsler 2011]), processing speed (Trail Making Test-A, TMT-A[Reitan et al.Clin Neuropsychol 1995;9:50-6]), sustained attention (Conners’ Continuous Performance Test, CPT[Rosvold et al.J Consult Psychol 1956;20:343]), executive function (Wisconsin Card Sorting Test, WCST[Heaton 2008]), and social cognition (Mayer-Salovey-Caruso Emotional Intelligence Test, MSCEIT[Mayer et al.Emotion 2003;3:97-105]), were assessed and then transformed into t-scores. A Principal Component Analysis(PCA) was conducted, and associations between retinal and cognitive parameters were explored with Pearson/Spearman correlations; statistical significance was set at p<0.05.

SSD patients (mean age:31.9years[SD=1.2]; males n=11[44%]; mean duration of illness:32.5months[SD=22.3]) exhibited thicker pRNFL in both the right (t=-2.25,p=0.03) and left (t=-2.08,p=0.04) eyes compared to HCs (mean age:32.7years[SD=1.9]; males n=13[50%]). A thicker pRNFL was associated with a poorer cognitive performance: verbal (r=-0.53,p=0.04) and working memory (r=-0.64,p=0.01) was correlated with average pRNFL thickness; processing speed was associated with superior temporal pRNFL thickness (rs=-0.54,p=0.02); sustained attention was correlated with inferior nasal pRNFL thickness (rs=-0.54,p=0.04); social cognition was correlated with average pRNFL thickness (r=-0.72, p=0.03) and temporal pRNFL thickness (r=-0.82, p=0.01). Executive function was not associated with retinal measures, and macular and GCL+IPL thickness did not correlate significantly with cognitive variables.

Our findings suggest relationships between increased pRNFL thickness and impaired cognitive functioning in early-course SSD patients. Previous studies have reported that pRNFL might be thicker during the initial stages of SSD and thins as the disease progresses, highlighting the role of inflammatory processes in both retinal changes and cognitive impairment. Further longitudinal multimodal research is warranted to explore the utility of retinal imaging in monitoring cognitive outcomes in SSD.

None Declared

The effectiveness of Es-ketamine therapy in the treatment of psycho-pathological symptoms is the subject of growing interest in the scientific community. Through the use of validated psychometric instruments, this study aims to delineate more precisely the mechanisms of action and clinical potential of this therapy, contributing to the advancement of knowledge in psychiatry.

The main objective of the present study is to analyses in depth and systematically the onset and development of the dissociative state, as well as the different forms of dissociation, in patients undergoing treatment with Es-ketamine (Spravato). Particular attention will be paid to the distinction between drug-induced dissociation and dissociation of a psychotic nature.

Two psychometric instruments were used: the Clinical Global Impression (CGI) and the Dissociative Experience Scale II (DES II). The CGI assessed symptom severity (Severity of Illness, SI), the overall clinical improvement (Global Improvement, GI) and treatment effectiveness with respect to side effects (Efficacy Index, EI). DES II measured the frequency and intensity of dissociative symptoms, considering a score of ≥30 as pathological. The initial sample of 16 patients was reduced to 15 (6 males and 9 females) due to the exclusion of one participant due to incomplete data.

Preliminary results indicate that treatment with Es-ketamine led to significant clinical improvement in the majority of patients. Quantitative analysis showed an improvement between the initial (T0) and subsequent (T1) assessment on both scales used. In the DES II, a mean effect of +0.98 was found, with a cumulative reduction of 14.65 points, indicating a decrease in dissociative symptomatology. In the CGI, the mean improvement presented an effect size of +56.57, with a range from +30.4 to +117.9, suggesting significant variability in treatment response. In two patients, a 31-year-old man and a 19-year-old woman, a clinical worsening associated with high levels of dissociation was observed, highlighting the potential role of factors such as age and dissociative vulnerability in treatment response.

The CGI and DES II scales proved effective in monitoring clinical changes in patients treated with Es-ketamine, highlighting their complementarity. This study represents the first attempt to differentiate between traumatic and psychotic dissociation in Es-ketamine-treated patients, suggesting new opportunities to tailor therapeutic interventions therapeutic interventions. Further studies with larger samples and more robust methodological designs are needed to confirm the preliminary results, as well as to investigate the long-term impact of Esketamine on dissociation and the potential associated risks.

None Declared

Based on potential risk of torsade de pointes (TdeP; a rare arrhythmia), regulatory agencies have issue warning for two specific antidepressants. This has translated in clinic as a class effect in that every antidepressant monography or guideline warns against this side effect. Current data suggest that excessive caution in the face of this undesirable effect could have a deleterious effect on mortality. Most research on antidepressant/antipsychotic drugs and TdeP is based on its intermediate marker, the corrected QT interval (QTc) on the electrocardiogram, or case reports.

Our objective is to measure the contribution of psychotropic drugs (antidepressants and antipsychotics) to the arrhythmia itself, and measure its weight among all other risk factors.

We completed a retrospective case-control study at the Montreal Heart Institute, with a 1:3 ratio (n=440). We performed hierarchical logistic regression for TdeP (cases vs controls), and included the following independent variables: sex, age, hypokalemia, acute myocardial infarction, left ventricular dysfunction, hepatic failure and/or renal failure, other QTc-prolonging drugs, and psychotropic drugs. We then calculated population attributable risks (PAR).

In our final model which adjust risk factors for one another, women, acute myocardial infarction, hypokalemia, left ventricular dysfunction, QTc-prolonging drugs, and use of ≥2 antidepressants were significantly associated with TdeP. Age, hepatic and/or renal failure and antidepressants/antipsychotic drug monotherapy were not. The PAR for use of ≥2 antidepressants was 6.3%, while those of other QTc-prolonging drugs, female sex, and left ventricular dysfunction were 55.1%, 41.8%, and 25.6%, respectively.

When adjusting for concomitant risk factors, monotherapy with antidepressant or antipsychotic drugs is not associated with TdeP. On its side, the use of ≥2 antidepressants is associated with TdeP, with a PAR of lesser magnitude than sex, left ventricular dysfunction, and other QTc-prolonging drugs. This research provides a more nuanced perspective on the relationship between psychotropic drugs and the occurrence of this arrhythmia.

None Declared

Clozapine stands out among all other antipsychotics due to its superior efficacy in treatment resistant schizophrenia. Despite its proven superiority, it is not the first antipsyhotic choice on grounds of serious side effects. Clozapine remains underutilized, primarily due to its troubled safety profile.Lower prescription rates may be related with physicians’ hesitation because of side effects rather than patients’ unwillingness to use the drug.

To elaborate on the life-threatening side effects and discontinuation of clozapine, we retrospectively reviewed the medical records of all patients admitted to the inpatient psychiatry unit at the Hospital of Hacettepe University Faculty of Medicine, Ankara, Türkiye between January 2010 and April 2022.

Hospital records of inpatients with psychotic disorders, identified by ICD-10 codes (F20.X, F25.X, F.22, F28, F29), and patients with bipolar affective disorder, identified by ICD-10 code (F31.X) who discontinued clozapine during their hospitalization due to serious side effects were thoroughly investigated.

Among a total of 2298 patients hospitalized during the specified period, 178 patients with psychotic disorders and 21 patients with bipolar affective disorder were clozapine users. In this sample, 14 patients with psychotic and 3 patients with bipolar affective disorders had a serious side effect due to clozapine which led to discontinuation in 15 patients (7.53%). The median age of the cases was 32-years (min-max:18-62), the median duration of illness was 10-years (min-max:2-30), and the mean clozapine dose at onset of the serious side effect was 245±149.95 mg/day. The observed serious side effecs associated with clozapine included myocarditis (n=10, 58.8%), agranulocytosis (n=3, 17.6%), neutropenia (n= 1, %5.88), pancreatitis and myocarditis (n=1, 5.88%), refractory increase in level of C-reactive protein (n=1, 5.88%), refractory constipation, weight gain and worsening in obsessive-compulsive symptoms (n=1, 5.88%), and suspicion of neurotoxicity of clozapine in a patient with mutation in multi-drug resistance-1 gene (n=1, 5.88%). There was no report of sudden death, cardiac arrest or need for intensive care unit. The majority of serious side effects (88.2%) occurred within the first 6 months of clozapine initiation. Two patients (11.7%) were able to continue clozapine with clinical management. Among patients who discontinued clozapine, 3 (20%) were rechallenged with clozapine in which 2 attempts (66,6%) were successful.

An examination of 12 years of inpatient clozapine treatment at a University Hospital clinic revealed that even life-threatening side effects of clozapine can be managed successfully with close clinical care. Physicians’ concern about serious side effects should not lead to underutilization of clozapine in patients who could benefit from its trial.

D. Koçyiğit: None Declared, R. Aktaş: None Declared, S. Çoşkun: None Declared, E. Özçelik Eroğlu: None Declared, E. Mutlu: None Declared, A. E. Anıl Yağcıoğlu Grant / Research support from: Janssen, Boehringer Ingelheim, Consultant of: Janssen, Boehringer Ingelheim, Abdi Ibrahim Otsuka, Paid Instructor of: Abdi Ibrahim Otsuka, Speakers bureau of: Abdi İbrahim, Nobel, Janssen, Santa Farma.

Recent post-marketing data reports an increased incidence of depression and suicidal ideation in patients using glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for diabetes and obesity management compared to metformin. Despite ongoing FDA evaluations finding no causal link, various studies present mixed findings and propose several biologically plausible mechanisms for GLP-1 RA-induced depression. Increased depression rates observed post-bariatric surgery suggest similar outcomes following significant weight loss with GLP-1 RAs. This review explores these mechanisms to provide a comprehensive understanding and guide clinical practice.

To evaluate theoretical mechanisms underlying GLP-1 RA-induced depression in patients undergoing obesity treatment and to offer insight for later clinical decision making.

A comprehensive literature review was conducted using PubMed and MEDLINE, alongside current FDA updates. The review focused on GLP-1 RA side effects related to depression and included case reports of depression in patients on GLP-1 RA therapy. Data on incidence and clinical management were synthesized to develop a cohesive understanding of associated risks and recommended practices.

The review identified several theoretical mechanisms through which GLP-1 RAs may induce depression. Firstly, GLP-1 RAs may reduce food cravings by altering hedonic tone, potentially diminishing pleasure from various activities. Secondly, rapid changes in gut microbiota may lead to gut-brain axis dysregulation, contributing to depressive symptoms. Thirdly, GLP-1 RAs have been linked to reduced absorption of vitamin B-12 and other essential nutrients, impacting brain function and mood. Social media data and individual case reports reveal mixed mental health outcomes, with some users reporting improved mood and others experiencing mood deterioration.

The evidence on GLP-1 RAs and depression is mixed. While some studies suggest negative mood effects, others, including the FDA’s large-scale evaluations, have not established a causal link. Notably, semaglutide may be associated with a lower risk of suicidal thoughts. These findings emphasize the complexity of this issue and the necessity for ongoing monitoring and personalized patient care. Regular mental health screenings for patients on GLP-1 RAs, especially those with a history of depression, are recommended. Addressing potential nutrient deficiencies through dietary adjustments or supplements is crucial. Patients should be informed about potential mood changes and encouraged to report any adverse effects. Further research, particularly more longitudinal and large-scale studies, is needed to clarify the relationship between GLP-1 RAs and mental health outcomes.

None Declared

Negative symptoms in CHR-P people are generally not responsive to treatments and commonly related to poorer functional outcome. However, less research attention has been dedicated to Persistent Negative Symptoms (PNS), defined as clinically stable negative symptoms of moderate severity evident for at least 6 months.

This study aims to (a) determine the prevalence of PNS in a sample of young people at CHR-P; (b) investigate any association of PNS with functioning and clinical features; (c) examine longitudinal course of PNS across 2 years of follow-up and changes in PNS severity levels with specialized treatments.

One Hundred Eighty CHR-P participants were recruited and were divided into CHR-P/PNS + and CHR-P/PNS− subgroups according to the presence/absence of PNS. The clinical assessments were based on the PANSS and the GAF and were conducted at baseline and every 12 months during the follow-up. Association of PNS with sociodemopgraphic, clinical, psychopathological and treatment variables were examined using linear regression analysis.

Twenty four participants showed PNS at entry. Of them, 21 concluded the 2-year follow-up period. At baseline, the CHR-P/PNS + participants showed more educational and employment deficits, and more social and functioning impairment. During the follow-up, the CHR-P/PNS + subgroup had a significant longitudinal decrease in negative symptoms, which was specifically related to antidepressant treatment. CHR-P/PNS + subjects also showed a higher incidence of new hospitalization and a lower functional recovery over time.

Our findings support that the persistence of negative symptoms in CHR-P people is longitudinally related to worse daily functioning and more severe clinical conditions that are at higher risk of hospitalization and are less responsive to specialized treatments.

None Declared

Social deficits are a significant impairment in adult ASD, leading to difficulties in socio-emotional cognition, communication, and relationships. Effective social skills interventions are crucial during the transition to adulthood. The UCLA PEERS® (Program for the Education and Enrichment of Relational Skills) for young adults is a prominent and well-researched intervention, implemented in over eighty countries and translated into numerous languages. This program includes concurrent sessions for young adults and their parents, aiming to improve social skills and reduce ASD-related social issues

The current study aimed to test the effectiveness of a culturally adapted Persian -translated version of PEERS® for young adults with ASD without intellectual disabilities.

Three psychiatrists and two psychologists underwent PEERS® training and translated the manual into Farsi, adapting it culturally for Iran. Twenty-four young adults with ASD and their parents participated in the study, randomly assigned to a treatment group or a control group. Inclusion criteria were males aged 18-30 years with an ASD diagnosis, predominant social difficulties, motivation to participate, and a family member acting as a social coach. Exclusion criteria included intellectual disability, major psychiatric conditions, and significant verbal or literacy difficulties.

Participants attended 16 weekly 90-minute group sessions, covering topics like conversations, humor, electronic communication, dating etiquette, conflict management, and bullying. Sessions were led by a PEERS-certified psychologist and an assistant behavioral coach. Weekly meetings were held to align session content and address potential issues.

The culturally adapted Persian -translated version of PEERS® was perceived as beneficial by young adults with ASD and their caregivers, improving social skills and quality of life. However, quantitative measures did not show significant changes, indicating a need for further refinement and investigation to achieve measurable improvements in social functioning.

While qualitative feedback indicates that both young adults with ASD and their caregivers found the caregiver-assisted social skills intervention to be beneficial in improving social skills and overall quality of life, the quantitative measures did not show significant changes. This suggests that while the intervention may have positive perceptual impacts, further refinement and investigation are needed to achieve measurable improvements in social functioning.

None Declared

Chronic Fatigue Syndrome (CFS) is marked by physical and cognitive fatigue, as well as increased susceptibility to fatigue. While the precise causes of CFS remain unclear, there is growing interest in the role of the stress response system in its development.

Given that early adverse experiences might affect one’s ability to handle stress effectively, the aim of this study was to examine whether such early life events could predispose patients with CFS to higher self-reported stress levels when confronted with psychosocial stressor.

76 patients with CFS and 45 healthy controls (HC) underwent the Maastricht Acute Stress Test (MAST) to induce stress. Subjective stress levels were assessed before, during and after the task. The Childhood Trauma Questionnaire (CTQ) was used to retrospectively evaluate abusive and neglectful experiences in childhood

Patients with CFS reported significantly higher levels of subjective stress at all stages of the MAST compared to HC (main effect of group; p<0.0001). Additionally, CFS patients had higher CTQ scores than HC (p=0.04). Within patients, higher levels of childhood trauma was associated with higher levels of self-reported stress (p = 0.0047) throughout the MAST. The results of the link are visualized in the attached figure.

Image 1:

Patients with CFS experience heightened stress levels during a validated stress-inducing task compared to HC. Furthermore, a history of greater childhood abuse and neglect is associated with increased stress levels later in life, potentially contributing to the development of CFS.

None Declared

Caregiving to individuals with schizophrenia is intensive, complex, and long lasting. In developing countries, the primary caregivers are family members who rarely receive adequate preparation for their role. The diversity and intensity of caregiving roles also may result in caregiver strain and burden. Interaction with nature even in form of hearing sounds have been found to reduce stress markers. Immersive Virtual Environments (IVEs) can result in restorative effects such as increased positive affect, decreased negative affect, and decreased stress.

To assess and compare the effect of combined use of nature-based VR and nature-based sounds to nature-based sounds only on physiological parameters (heart rate, respiratory rate, oxygen saturation, systolic and diastolic blood pressure) in caregivers of individuals having schizophrenia.

Sixty caregivers (aged more than 18 years) of inpatients with schizophrenia as per Diagnostic & Statistical Manual (DSM-5) will be recruited with consecutive sampling. Caregivers should have been staying with patient for at least previous 1 year and have been staying in the ward for previous 7 days for at least 12 hours/day. Individuals with hearing or visual deficits, history of having received treatment for mental illness/epilepsy, or taking sleeping pills/sedatives/hypnotics/cough syrup currently would be excluded. Paid caregiver and those not willing to provide written informed consent would be excluded from the study. Data collection tools will include a semi-structured proforma for mentioning the socio demographic details, checklist for observing physiological parameters (Heart Rate, Respiratory Rate, Oxygen Saturation, and Blood Pressure), Perceived Stress Scale (PSS), Pittsburg Sleep Quality Index (PSQI), Satisfaction with Life Scale (SwLS), Subjective stress on Visual analogue scale (VAS), User Satisfaction Evaluation Questionnaire (USEQ) and VR Experience Questionnaire (VEQ). Participants would be divided randomly into two groups with group 1 (n=30) individuals receiving only nature-based sounds intervention and those in group 2 (n=30) would receive combined nature-based VR and nature-based sounds intervention.

Primary outcome will be change in physiological parameters using repeated measures ANOVA. Additional outcomes like acceptability and feasibility of the intervention will also be reported as descriptive data. Pearson’s correlation will be done between scale scores and change in physiological parameters in different groups based upon nature of intervention, illness based or gender based.

The study provides insight into the utility of upcoming VR interventions to cater the needs of caregivers to individuals with schizophrenia in moderating the stress levels.

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Decision paralysis, defined as the inability to make decisions due to overwhelming options or uncertainty, is an often overlooked symptom of Attention-Deficit/Hyperactivity Disorder (ADHD). Individuals with ADHD frequently struggle with executive dysfunction, making it difficult to prioritize tasks, evaluate choices, and make timely decisions. Despite its significance, decision paralysis remains under-researched, particularly in terms of its impact on daily functioning and quality of life.

This study aims to assess the prevalence and severity of decision paralysis in adults with ADHD, explore its relationship with executive dysfunction, and analyze its impact on various life outcomes such as career performance, interpersonal relationships, and overall well-being.

A total of 50 adults diagnosed with ADHD participated in this study. Self-report measures, including the Decision-Making Competence (DMC) scale and the ADHD Executive Dysfunction Questionnaire (AEDQ), were administered to assess participants’ decision-making difficulties, indecision, and executive functioning. Additional data were collected on life satisfaction, perceived stress levels, and the degree of daily functional impairment due to decision paralysis.

The results indicate that 82% of participants reported frequent difficulties with decision-making, with 68% indicating that decision paralysis significantly affected their work performance. Decision paralysis was strongly correlated with executive dysfunction scores and was a significant predictor of reduced life satisfaction and increased perceived stress. Additionally, 74% of participants reported that indecision contributed to delays or avoidance in making important life choices, such as career changes or financial decisions, leading to long-term dissatisfaction. Notably, 58% of participants experienced decision paralysis at least once a week, with 35% reporting daily occurrences. Furthermore, 61% of participants indicated that decision paralysis led to missed opportunities in both personal and professional contexts, contributing to feelings of regret and frustration.

This study highlights the widespread impact of decision paralysis in adults with ADHD, significantly affecting both personal and professional domains. The strong correlation between decision paralysis and executive dysfunction suggests that addressing this symptom could be critical in improving quality of life for individuals with ADHD. Further research is needed to explore the development of specific interventions targeting decision paralysis.

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The connection between well-being and various sociopsychological factors such as age, gender, education level, and more is a growing and significant area of interest in today’s studies.

The aim of this study is to examine the relationship between sociodemographic factors, life satisfaction, levels of anxiety, and religiosity. To achieve this goal, the study explored whether religiosity has an effect on anxiety and life satisfaction on the one hand, and whether sociodemographic variables influence the centrality of religion in participants’ lives on the other.

To ensure honest responses, the surveys were filled out anonymously. Statistical analyses were conducted using the SPSS program, applying Pearson Correlation and Analysis of Variance (ANOVA) to determine if there was a correlation between sociodemographic data and questionnaire scores.

In the Analysis of Variance (ANOVA) of total STAI-G scores and religiosity, a significance level of 0.010 was observed, while the Post-Hoc Test suggested that this significance may be found between atheist participants and those who identified with a religion other than Islam, Christianity, or Judaism, with a value of 0.019. Additionally, there is a strong significant correlation of 0.018 between participants’ native language and total CRS-10 scores, which may imply that native language, encompassing important factors like cultural background, can influence participants’ religious beliefs and practices. Lastly, a significant correlation of 0.041 was found between alcohol consumption and total CRS-10 scores. This correlation could indicate that religious participants are more likely to consume less alcohol compared to non-religious participants, possibly due to their religious beliefs.

This study highlights the importance of examining the connections between sociodemographic factors, life satisfaction, anxiety, and religiosity in relation to mental well-being. The findings aim to provide useful guidance for the evolution of interventions that focus on and enhance well-being and continuity, while emphasizing the quality of life experienced by patients from diverse cultures and backgrounds.

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In Italy, in 2000, the estimated annual economic burden of schizophrenia was 25.000 € per patient, of which 30% were direct costs and 70% indirect costs (Tarricone et al., 2000). Yet, a steep growth has been observed throughout the years: a study showed a yearly expenditure of 41.290 € per patient in 2020 (Latorre et al., 2022).

The aim of this study was to better characterize the association between direct costs and clinical and psychosocial variables in schizophrenia spectrum disorders (SSD).

A total of 276 individuals with schizophrenia spectrum disorders receiving treatment from the Community Mental Health Centers of Brescia (Italy) were included in the study: for each participant socio-demographic, clinical and functional characteristics were assessed, and data related to the use of services in 2022 (then converted to costs) were collected. Clinical and functional characteristics were assessed using the Clinical Global Impression-Severity (CGI-S) scale, the Personal and Social Performance Scale (PSP) scale and the Positive and Negative Syndrome Scale (PANSS). Correlations between the included variables were performed using SPSS v28; values of p <0.05 were considered statistically significant.

Our analyses identified a direct healthcare expenditure of 16477.23 € per patient per year. A positive correlation was observed between higher costs and higher scores at the CGI-S (p<0.001), the PANSS total (p<0.001) and all the PANSS subscales (all p<0.001). Moreover, a negative correlation between higher costs and age of onset (p=0.010) and PSP total score (p<0.001), were observed.

An earlier age of onset, a more severe clinical presentation and a worse psychosocial functioning are associated to a higher expenditure in terms of direct costs associated to use of services in SSD. These results prompt to the implementation of interventions that aim at improving not only clinical aspects, but also functional ones: a full functional recovery would not only benefit patients, but also lead to a lower impact of SSD on healthcare systems. One limitation of the present study is that the estimation of the costs was based on a direct analysis of costs related to the use of services, therefore excluding indirect costs. Future studies should include data on pharmacological treatments, comorbidities and other clinical variables central to the disorder, such as cognition.

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Evidence suggests that immigrants and minorities with mental distress underuse mental health services compared with the majority population. Such under-utilization, combined with other socio-cultural factors, can impede recovery from mental illness. The population of Canada is becoming increasingly diverse, primarily due to record levels of immigration. These immigrants come from a variety of traditions including Muslim, Christian, and Jewish backgrounds. For such immigrants, their religious beliefs, practices and activities are often central to their lives and influence important decisions regarding health and well-being. These changing demographics have prompted calls for more research and action regarding the mental health service experience of religious immigrants.

The objective of this study was to identify and understand self-identified barriers to mental health service utilization among religious immigrants, including eliciting experiences within the mental health care system.

To meet these aims, we employed a qualitative community-based approach, conducting in-depth semi-structured interviews with 58 first- or second-generation immigrants to Canada who identified as people of religious faith, comprising Christians, Muslims and Jews. All participants had used a mental health service in recent years, and they reported a variety of mental disorders, mostly depression and anxiety. Interviews were transcribed and data was analyzed using thematic analysis techniques.

Analysis revealed three core barriers to service utilizations. First, participants often reported that some people in their social circle (such as parents and clergy) held stigmatizing views of mental illness, including sceptical views about the reality of mental illness. This contributed to self-stigma, inhibited disclosure and delayed help-seeking. Second, participants stated that service providers typically had a very limited understanding of the cultural and religious context of their lives, and sometimes conveyed a dismissive or ignorant attitude towards their deeply-held religious beliefs and practices. This negatively affected service utilization and the development of a therapeutic alliance. Third, some participants noted that they (and other members of their communities) lacked knowledge about mental illness, available treatments, and effective therapies, meaning they were unaware of potential services and supports.

The results suggest an urgent need for a multi-pronged approach to better engage religious minorities with mental distress. On the clinical side, there is a need for more religious and cultural competence training for Canadian clinicians. On the community side, culturally-appropriate anti-stigma and mental health literacy interventions may need to be co-created and implemented in partnership with different immigrant communities in Canada.

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Nefashot, meaning “Souls” and “People” in Hebrew, is an initiative dedicated to promoting mental health awareness through cultural and artistic expressions, fostering inclusive dialogue. Art serves as a critical tool in this mission, using its visual language to make difficult conversations possible and amplify voices that are often unheard.

The “Nomadic souls” project aims to raise awareness about the intersection of migration and mental health through the presentation of high-quality contemporary art in exhibitions, curated by professional curators and researchers. By showcasing diverse artistic perspectives, it seeks to foster deeper understanding and dialogue around these critical issues.

This project is a collaboration between Nefashot, the art initiative KAKDELART, and curators Vera Gailis and Anna Smoliarova, who together launched a call for Israeli artists with diverse immigrant backgrounds under the theme “Nomadic Souls.” The call invited artworks exploring the connection between migration and mental health. So far, the project has produced two exhibitions: “Being Singular/Plural,” which centered on the concept of belonging, and “A Semiotics of the Start,” which delved into the experience of language acquisition. Each exhibition was accompanied by events like literature readings, artist networking, and pop-up photo exhibitions, fostering community engagement and inclusivity.

The project made significant strides in building collaborations and laying the foundation for a platform that facilitated discussions on migration and mental health within both immigrant and local communities. It successfully increased public awareness of these issues and established sustainable partnerships that continued to support the community. Community engagement was central to the project. The exhibitions and related events actively involved migrants as participants, artists, and audience members. Collaborations with the city’s youth department for immigrant assistance were crucial, including co-funding an event that attracted a relevant and engaged audience. Beyond the exhibitions’ objecthood, the project addressed deeper issues such as suicide, anxiety, and depression. Additionally, an academic webinar with immigration professionals was held, focusing on the second exhibition catalog, further broadening the project’s impact and reach.

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The Nefashot initiative highlights the power of art and community collaboration in addressing complex mental health issues related to migration. By fostering dialogue and partnerships, the project has expanded its reach, connecting both local and migrant communities in meaningful ways. The ongoing and future exhibitions aim to continue this momentum, establishing a lasting platform for dialogue, collaboration, and support.

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