Suicide remains a major risk factor for individuals suffering from Schizophrenia. Recent studies have established that patients in the prodromal Schizophrenia state (i.e. Ultra High Risk for Psychosis) also experience significant rates of suicidal ideation and behaviour. However, less is known about the prevalence of suicidality among the adolescent and youth UHR population, a demographic particularly vulnerable to the psychosocial and environmental risk factors of psychosis.

This review aims to synthesise the existing literature on the prevalence of suicidal ideation and behaviour in the adolescent and youth at Ultra High Risk for Psychosis (UHR), and the relevant associations between suicidality and its correlates.

The databases PsycINFO, PubMed, Embase, Cochrane Library, Web of Science and Scopus were accessed up to July 2024. References within selected journals were further hand-searched for eligible articles. Keywords and controlled vocabulary used consisted of: (‘Ultra High Risk’ OR ‘At Risk Mental State’ OR ‘Clinical High Risk’) AND (‘Schizophrenia’ OR ‘Psychosis’) AND (‘Self-Harm’ OR ‘Suicide’ OR ‘NSSI’) AND (‘Adolescent’ OR ‘Youth’). Articles that included participants with an established diagnosis of schizophrenia or intellectual disability, history of frank psychotic episodes and extended use of antipsychotics were excluded. A meta-analysis of prevalence was subsequently performed for lifetime suicidal ideation, lifetime non-suicidal self-injury, lifetime suicidal attempt and current suicidal ideation. A narrative review was also carried out for the correlates of suicidality amongst the adolescent and youth UHR population.

Fourteen studies were included in this meta-analysis. Meta-analysis revealed a high prevalence of lifetime suicidal ideation (56%), lifetime non-suicidal self-injury (37%), lifetime suicidal attempt (25%) and current (2-week) suicidal ideation (58%). Narrative review revealed that personal transition to psychosis and positive family history of psychosis was strongly associated with suicidal attempt, while CAARMS (Comprehensive Assesment of At Risk Mental States) severity score was associated with suicidal ideation. Depression was strongly associated with both suicidal attempt and suicidal ideation, whereas positive symptoms and self-disturbance were associated with self-injury.

The prevalence of suicidal ideation and behaviour among UHR adolescent and youth is high and comparable to the general UHR population. Effective detection and management of suicide risk will be especially crucial in the adolescent UHR population. Existing measures that mitigate suicide risk in the general UHR population should be adopted for the youth and adolescent context.

None Declared

IMPORTANCE Changes in suicide rates after a nationwide trauma may be different from changes in psychiatric symptoms or general distress after such events. However, very few studies have examined short-term suicide-related reactions after such an event.

To evaluate the short-term outcome of the events in Israel on October 7, 2023, a large-scale terror attack and unfolding war, on changes in suicidality as reflected in percentages of suicide-related calls in relation to all calls to a national mental health first aid helpline, the Israeli Association for Emotional First Aid (ERAN).

DESIGN, SETTING, AND PARTICIPANTS The data included all interactions via the various ERAN helpline services between January 1, 2022, and December 31, 2023.

EXPOSURES The October 7, 2023, terror attack on Israel.

MEAN OUTCOMES AND MEASURES Changes in the numbers of overall calls and suicide-related calls to the ERAN helpline using an interrupted time-series analysis.

RESULTS. Analysis indicated that overall calls increased significantly on October 7. However, the number of suicide-related calls in the 3 months before October 7 was 1,887, whereas 1,663 suicide-related calls were registered in the 3 months after. The percentage of suicide-related calls decreased significantly on October 7 and gradually increased in the following period.

CONCLUSIONS AND RELEVANCE The findings suggest that although short-term emotional distress increased after national trauma, the percentage of suicide-related calls decreased. These results support previous studies suggesting that suicidality is not one of the immediate reactions to such traumas

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Previous results show that women who suffered from perinatal depression (PND) have a higher risk of suicidal behavior. However, clinical tools for predicting suicidal behavior among patients with PND are lacking.

To develop a prediction model for suicidal behavior after PND using machine learning.

Leveraging nationwide Swedish register data, we included 57,848 women with PND diagnosed during 2001-2018 and identified 2,303 events of suicidal behavior up to 5 years after PND diagnosis. Based on our previous association studies, 16 predictors containing information on demographics and pregnancy characteristics were included after multiple imputation. The sample was randomly split into 80% as a training set and 20% for testing. Classification and Regression Tree (CART), Random Forest (RF), Naïve Bayes (NB) and Logistic regression (LR) were used to establish prediction models with area under the curve (AUC) assessed for prediction performance. 10-fold cross-validation was used to evaluate the algorithms on unseen data.

In the prediction models, the CART yielded the best performance for suicidal behavior within 5 years after PND diagnosis (AUC 0.78, 95% CI 0.76-0.81). The population that scored highest (17%) in CART model had 84% risk of suicidal behavior. LR also had a comparable performance (AUC 0.78, 95% CI 0.76-0.81), whereas RF (AUC 0.74, 95% CI 0.72-0.76) and NB (AUC 0.70, 95% CI 0.68-0.72) had relatively poor performance. Notably, suicide history was a main contributor in all four models. Other predictors like household income, gestational age and education level were also important indicators of suicidal behavior risk.

The machine learning models have promising prediction performance for suicidal behavior after PND. Yet, further improvement is needed before clinical implementation.

None Declared

Social determinants of health (SDOH) have been linked to disparities in suicide rates across various demographics, including racial/ethnic groups, sex, age, and geography in the U.S. However, most studies have focused on individual or selected SDOH, rather than examining comprehensive, multi-dimensional SDOH factors. A more nuanced understanding of how clusters of SDOH contribute to suicide disparities across counties is needed to inform targeted prevention strategies.

To identify multi-dimensional SDOH county clusters and estimate their geographic and temporal associations with county-level suicide rates.

This study used national SDOH data from 3,109 U.S. counties over three time periods (2009, 2014, and 2019), matching them with county-level suicide rates from the National Vital Statistics System aggregated into three-year periods (2008-2010, 2013-2015, and 2018-2020). A total of 284 county-level SDOH variables, spanning six domains (social context, economic context, education, physical infrastructure, healthcare context, and natural environment), were analyzed using unsupervised machine learning algorithms to identify SDOH clusters. Associations between SDOH clusters and county-level suicide rates were estimated using negative binomial and LASSO regression.

Three distinct SDOH clusters were identified (Figure 1):

• • Cluster 1 (“REMOTE”) included rural counties with elderly, marginalized populations and substandard housing.

• • Cluster 2 (“COPE”) represented counties with complex family dynamics, overburdened health systems, poverty, and extreme heat challenges.

• • Cluster 3 (“DIVERSE”) encompassed densely populated areas with immigrants, racial/ethnic minorities, environmental challenges, and economic inequality.

Geographically, REMOTE was more common in North and Central U.S., COPE in the South and Central U.S., and DIVERSE along the coasts. Suicide rates were highest in REMOTE counties, especially among men. COPE counties had elevated suicide rates among Whites, while DIVERSE counties saw higher rates among women and Black/Hispanic populations. Most counties (70%) remained within the same cluster over time, with stable suicide rate associations.

This study identified three multi-dimensional SDOH clusters that were associated with varying suicide rates across U.S. counties. These clusters offer insight into the social and environmental conditions contributing to suicide risk. Future prevention strategies should focus on addressing the distinct challenges within each cluster, such as housing inadequacies, healthcare access, and economic inequality, to reduce overall suicide rates and related disparities.

None Declared

Deliberate self-harm (DSH) is a strong predictor of future suicide attempts (SAs), highlighting the need to evaluate interventions that reduce recurrence risk.

This systematic review and meta-analysis aimed to evaluate pharmacological and non-pharmacological interventions for preventing repeated DSH in individuals recently engaged in DSH. We also examined how participants’ characteristics and trial inclusion criteria impacted interventions’ effectiveness.

Randomized controlled trials (RCTs) with participants engaged in DSH within one month before enrollment were included. Studies with participants showing only suicidal ideation or older DSH were excluded. We searched five databases (PubMed, Embase, PsycINFO, WHO ICTRP, and ClinicalTrials.gov) with no language restrictions through September 2023. Two reviewers independently selected studies and resolved discrepancies through discussion. Outcomes were assessed at three time points: T1 (0–6 months), T2 (6–12 months), and T3 (>12 months). The primary outcome was repeat DSH; secondary outcomes included suicidal ideation, suicide deaths, all-cause mortality, anxiety, depression, hopelessness, and quality of life. Interventions were categorized by type and delivery format (individual or group, remote or in-person).

The PRISMA flowchart is shown in Image 1. Sixty-one trials involving 125 comparisons and 21,147 participants were included in this review. Average age was 31.5 years, with most being female (66.58%), unmarried (60.82%), and white (65.49%). Participants’ history of self-harm was noted in 48 studies, with at least 56% having engaged in another act before inclusion. In 42 studies, suicidal intent was either not investigated or not required. The most common types of interventions were Treatment As Usual (TAU) (46 arms), Psychotherapy (36), and Active Contact and Follow-up (25). Interventions were primarily applied individually and in person (84), with Cognitive Behavioral Therapy (16) being the most frequent psychotherapy framework. Psychotherapies were associated with a reduced risk of new self-harm acts within the first six months (T1) compared to TAU (k = 12; N = 2110; OR = 0.69; 95% CI 0.48–0.99). Active contact and follow-up interventions outperformed TAU in the longer-term follow-up (T3) (k = 4; N = 3724; OR = 0.83; 95% CI 0.70–0.99).

Image 1:

The superiority of psychotherapies at six months was not sustained at twelve months. However, active contact and follow-up interventions may offer benefits in reducing the risk of self-harm recurrence after one year.

None Declared

Suicidal behavior is a complex phenomenon that affects all demographics, with children and adolescents being particularly vulnerable. It is associated with multifactorial conditions that must be considered for the development of more effective prevention strategies. The use of machine learning (ML) models to predict suicide attempts is becoming widespread, as they allow for the simultaneous testing of numerous factors, their complex interactions, and non-linearity in predictive model creation. The Millennium Cohort Study (MCS) is an observational, multidisciplinary cohort study that encompasses a wide range of dimensions, including psychological, genetic, biological, familial, social, and economic factors, as well as traumatic life events, family history, and medical history. This allows for the exploration of their relationship with suicidal behavior throughout individual development using ML models.

The aim was to develop a statistical method that applies ML models to retrospectively predict suicide attempts using structured tabular data from an adolescent cohort defined by the MCS.

The sample consists of 9,824 MCS participants (age 17) who were asked if they had ever purposely hurt themselves in an attempt to end their life. Of these, only 7.4% (725) responded affirmatively. Before starting the modeling phase and fine-tuning any algorithm, several stages were completed: data cleaning, feature extraction and engineering, and feature scaling and selection. We used a wide range of algorithms, from low-complexity (linear regression) to high-complexity (neural networks), while tracking their effectiveness, robustness, generalization, sensitivity, and accuracy.

Even though overall accuracy ranged from 0.83 to 0.87, we generally obtained low f1-scores (˜0.45-0.55) for the targeted class (suicide attempt) and high f1-scores (˜0.95) for the control class. Similar results were observed for precision scores; however, the recall scores were good for both classes, ranging from 0.67 to 0.87. The best performing models were logistic regression and neural networks.

These preliminary results shows that ML models trained with multidimensional data from a young cohort are sensitive in classifying individuals who have attempted suicide. We aim to improve the f1-score and area under the curve (AUC) metrics for the target class through several techniques: over/under-sampling, target encoding, class weight adjustments, ensemble methods, and various neural network architectures.

None Declared

Registry-based studies are efficient to investigate population mental health and suicide risk, but are largely absent in Europe outside of Scandinavia and the UK.

To investigate suicide risk associated with mental disorders in the Catalan population (7.6 million), stratified by gender and history of psychiatric hospitalization.

Population-representative retrospective registry-based cohort study including 764,938 Catalan residents in the period 2014-2019. Data sources included suicide mortality, electronic health registries from five healthcare settings, and administrative data. Suicide deaths were identified through judicial death registers using ICD-10 codes X60-X84. ICD-9CM and ICD10CM codes from all inpatient and outpatient healthcare contacts were used to categorize 109 mental disorders. Age-sex standardized mortality ratios (SMRs) were calculated using indirect standardization, with expected deaths based on official general population mortality rates in Catalonia.

Suicide risk was significantly elevated among Catalan residents diagnosed with any mental disorder (SMR [95%CI] = 1.6 [1.3-1.9] for females; SMR = 1.8 [1.6-2.0] for males). In females, suicide risk was highest for sedative or hypnotic abuse (SMR = 46.1 [3.7-88.5]), cocaine abuse (SMR = 42.8 [9.0-76.6]), borderline personality disorder (SMR = 33.0 [10.7-55.3]), polysubstance abuse (SMR = 32.9 [2.1-63.8]), and mental disorder not otherwise specified (SMR = 24.9 [11.7-38.1]). In males, risk was highest for obsessive-compulsive disorder (SMR = 20.2 [10.7-29.8]), acute and transient psychotic disorders (SMR = 17.9 [1.1-34.8]), mental disorder not otherwise specified (SMR = 17.2 [10.1-24.3]), paranoid schizophrenia (SMR = 16.8 [9.4-24.1]), and opioid abuse (SMR = 16.1 [1.6-30.6]). Suicide risk was substantially elevated in individuals with a history of psychiatric hospitalization (SMR = 18.3 [15.5-21.2]] for females; SMR = 13.4 [12.0-14.8] for males). In females with psychiatric hospitalization history, risk was highest for dependence on stimulants other than cocaine (SMR = 105.4 [11.6-199.3]), attention deficit hyperactivity disorder (SMR = 86.2 [19.2-153.2]), polysubstance abuse (SMR = 66.0 [33.6-98.3]), opioid abuse (SMR = 60.1 [2.1-118.1]), and cocaine abuse (SMR = 57.2 [32.6-81.8]). In males with psychiatric hospitalization history, risk was highest for obsessive-compulsive disorder (SMR = 45.7 [30.6-60.8]), schizoid personality disorder (SMR = 36.9 [13.5-60.2]), unspecified disorders of adult personality and behaviour (SMR = 35.0 [9.6-60.3]), schizotypal disorder (SMR = 34.3 [6.7-61.9]), and histrionic personality disorder (SMR = 32.5 [1.2-63.9]).

Risk of suicide in the Catalan population varies substantially by mental disorder type, gender, and psychiatric hospitalization history, highlighting the need for targeted and diversified prevention strategies.

P. Mortier Grant / Research support from: Miguel Servet CP21/00078 (ISCIII co-funded by the ESF+); project 202220-30-31 (Fundació la Marató de TV3); PI22/00107 (ISCIII, cofunded by the European Union); AC22/00006 (ISCIII and the European Union NextGenerationEU, Mecanismo Para la Recuperación y la Resiliencia), L. Latorre-Moreno: None Declared, F. Amigo: None Declared, M. López: None Declared, A. Portillo-Van Diest Grant / Research support from: PFIS FI23/00004 (ISCIII co-funded by the ESF+), L. Ballester: None Declared, J. Alonso Grant / Research support from: AGAUR 2021 SGR 00624; CB06/02/0046 (CIBERESP - ISCIII), G. Vilagut: None Declared

Suicide is a global public health issue. According to the World Health Organization (WHO), more than 700,000 people die by suicide worldwide each year. In 2019, it was the fourth leading cause of death among those aged 15 to 29 globally. In Spain, suicide has been the leading cause of external death in recent years, which has motivated in some regions the implementation of preventive strategies, such as Codi Risc de Suïcidi (Suicide Risk Code).

This study examines the epidemiology of suicidal behavior in the Catalan population between 2010 and 2019, exploring geographical disparities and the influence of different sociodemographic and clinical variables on the incidence of suicidal ideation and suicide attempt.

All residents in Catalonia who attended the public health system from 2010 to 2019 were included in the study. Data were obtained from the Program d’analítica de dades per a la recerca i la innovació en salut (PADRIS) of the Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS). Data on geographical, sociodemographic, and clinical variables were collected for subsequent statistical analysis. Statistical significance was set at p<0.05.

A total of 1,421,510 individuals were included. Overall, 6921 cases of suicidal ideation (0.5%) and 1143 suicide attempts (0.1%) were registered, which an accumulated incidence of 487/100,000 inhabitants for the first outcome and 804/1,000,000 inhabitants for the second. From the whole sample, 83,592 individuals (5.9%) had a severe mental illness (SMI), whereas the proportion of patients with a SMI in the group of suicide attempters was 9.6%. The majority of individuals who attempted suicide were women (64.1%). The highest proportion of individuals with suicidal thoughts or attempts was found in the age range from 15 to 19 years. The presence of a somatic illness, low socioeconomic status, tobacco use and the presence of a severe mental illness were significantly associated with suicidal ideation and attempt. Those patients with suicidal behavior had a higher number of emergency visits during the 10-year period, and also a higher probability of being prescribed antidepressants, antipsychotics, benzodiazepines or lithium. Geographical disparities in the incidence of suicidal behavior were found, with specific regions showing higher rates. In a logistic regression analysis, all associations remained significant.

This study highlights the association between sociodemographic and clinical factors, which should have been assessed in clinical practice, with suicidal behavior. Geographical disparities may be attributed to various factors, including access to mental health services and socioeconomic factors. This study underscores the importance of identifying specific profiles at a higher risk for committing suicide, and also to implement policies and prevention programs in order to address this public health issue comprehensively.

None Declared

Adolescents are at increased risk of developing suicide-related behaviour (SRB). Varying contributing factors may play an important role across the different forms of SRB. Perfectionistic concerns may become a cognitive moderator influencing volitional moderators (e.g., non-suicidal self-harm, NSSH) and suicidal ideation escalation.

To identify profiles of perfectionistic concerns in a community sample of adolescents. Also, to study the relationship between suicide-related outcomes and NSSH, according to perfectionism profile.

A sample of 1,526 adolescents (54.3% female; M= 13.81 years, SD= 1.28) participated in our study. A wide range of SRB and motivational and volitional risk factors were evaluated in school settings. Six types of perfectionistic concerns, assessed by the Frost Multidimensional Perfectionism Scale (FMPS), were used to identify perfectionism profiles, through latent profile analysis.

Almost one in five adolescents (19.5%) showed SRB risk and more than one in three adolescents (35.1%) engaged in NSSH in the last year. Five profiles of perfectionism were identified (Figure 1). The profile featured by higher concerns across perfectionistic domains (7.2% of participants) showed significant relationship with SRB risk (OR = 2.84) and suicidal ideation (OR = 1.22), in comparison to the minimal concern profile. On the other hand, the profile featured by high parental concerns (18.2% of adolescents) was associated with increased risk of ideation (OR = 2.75) and NSSH (OR = 1.51).

Image 1:

Perfectionism may constitute a key risk factor for NSSH and SRB development. The promotion of prevention programmes to enhance cognitive regulation skills may help prevent suicide in adolescents.

None Declared

Our patients often come to us through wait-lists, but when does the wait really start? Early intervention psychosis programs have introduced policies and benchmarks aimed at minimizing the time between referral and first contact. While programs that meet these targets are often celebrated for their success in reducing untreated psychosis, these targets leave out a critical piece of the puzzle: the time elapsed from symptom onset. Understanding how patients and caregivers experience the wait for care in its entirety is critical to further reducing treatment delays in psychosis.

This presentation aims to first examine a disconnect between early intervention wait-list policies and patients’ experiences. Next, it will explore how patient and family member narratives reflect the complex and nuanced nature of waiting for care. Finally, it will propose clinically relevant solutions for reducing the delay between symptom onset and appropriate treatment.

We conducted individual semi-structured interviews with patients and caregivers accessing early intervention psychosis services across Canada. For this presentation, three interviews from different geographic and socio-cultural regions were selected for their distinct perspectives. We performed a two-reviewer narrative inquiry to derive emergent narratives about waiting for services.

Patient and caregiver experiences revealed two distinct waiting periods. Aside from the “wait-list” period between referral and first contact that is addressed by early intervention policies, participants noted experiencing a much longer initial waiting period, with narratives beginning at symptom onset. Participants described this period as an active, dynamic, frustrating, and often traumatic process that involves multiple ER visits and attempts at receiving care.

We propose formally distinguishing between two forms of waiting for services: passive waiting, which is the state of being on a wait-list, and active waiting, which begins at symptom onset and includes the complex struggle to receive stable care. Early intervention programs’ efforts to reduce passive waiting are important, but the high burden of active waiting suggests a need for larger efforts such as clinician education and systemic changes in how patients access healthcare. Reducing active wait times could truly transform how first episode psychosis is managed and improve outcomes for those in urgent need.

None Declared

Service disengagement is a major problem for “Early Intervention in Psychosis” (EIP). Understanding predictors of engagement is also crucial to increase effectiveness of mental health treatments, especially in young people with First Episode Psychosis (FEP). No Italian investigation on this topic has been reported in the literature to date. The goal of this research was to assess service disengagement rate and predictors in an Italian sample of FEP subjects treated within an EIP program across a 2-year follow-up period.

The goal of this research was to assess service disengagement rate and predictors in an Italian sample of FEP subjects treated within an EIP program across a 2-year follow-up period.

All patients were young FEP help-seekers, aged 12–35 years, recruited within the “Parma Early Psychosis” (Pr-EP) program. At baseline, they completed the Positive And Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF) scale. Univariate and multivariate Cox regression analyses were carried out.

489 FEP subjects were enrolled in this study. Across the follow-up, a 26 % prevalence rate of service disengagement was found. Particularly strong predictors of disengagement were living with parents, poor treatment adherence at entry and a low baseline PANSS “Disorganization” factor score.

More than a quarter of our FEP individuals disengaged the Pr-EP program during the first 2 years of intervention. A possible solution to reduce disengagement and to facilitate re-engagement of these young patients might be to offer the option of low-intensity monitoring and support, also via remote technology and telemental health care.

None Declared

First psychotic episodes (FPE) have a significant impact not only on the individual who experiences them but also on their close environment, particularly their family. The onset of a FPE typically occurs in the early twenties, a stage of life where individuals are planning and developing their adult life project. The changes in family dynamics following a FPE are part of the recovery process and are considered a prognostic factor for recovery.

Since the beginning of the Comprehensive Care Program for First Psychotic Episodes, a weekly support group for families has been conducted. The group is open, lasts 90 minutes.The group has an open theme and is co-facilitated. Participants may attend after starting the psychoeducation workshop for FPE and can continue attending even after the patient has been discharged from the facility.

The aim is to analyze the predominant family figures, age range, and gender, as well as the main themes that arise and concern the families of patients with first psychotic episodes.

A retrospective study with a mixed-method approach (qualitative and quantitative) is proposed, based on the narrative records collected during the weekly sessions from 2023 until June 2024.

The average attendance is 10.7 participants per group, mostly women (80%). The range age is from 18 to 70 years, with and average of 58 years. In terms of the roles concerning the patient: parents (95%), siblings (5%), with no representation of partners during the period analysed.

The predominant themes identified from the analysis of the collected verbatims include: guilt regarding the onset of the illness; the timing of recovery and managing the sense of urgency from the institution, the family, and the patient; regression in relational family dynamics; caregivers’ fear of their own death; shame and stigma; the traumatic experience of hospitalization; the distinction between behaviors associated with personality versus the illness; the rupture with identity; the fear of relapse and suicide.

Families highlight the role of the group as an emotional support, an improvement in communication strategies and bonding with the sick relative, better capacity for mentalization, and managing their own anxieties and emotions related to guilt and self-care.

The onset of a FPE generally affects the entire family system. Past conflicts and regressive attachment dynamics are activated. Communication based on guilt harms the elements of the system. Family support groups play a crucial role in the recovery process and in helping to establish new dynamics that promote the well-being and autonomy of both the patient and caregivers. The group stands out as a source of hope, which is the main healing factor. Additionally, participants report gaining healthy coping tools and reducing their experience of isolation and stigma.

None Declared

Childhood trauma (CT) and bullying have been shown to be associated with autistic traits (AT) and to mediate the relationship between AT and psychotic experiences (PEs). Understanding how different childhood adversity subtypes influence distinct domains of PEs can provide important insights for preventing PEs in individuals with high AT.

This study aimed to investigate the impacts of childhood adversity subtypes on the relationship between AT and PEs in a general population twin sample.

We analyzed data on 792 twins and siblings from the first wave of the TwinssCan Project, a longitudinal general population twin cohort. AT were measured using the Autism-Spectrum Quotient (AQ), and PEs using the Community Assessment of Psychic Experiences (CAPE) which consists of three subscales (positive, negative and depressive). CT subtypes were assessed using the Childhood Trauma Questionnaire (CTQ), evaluating emotional, physical, and sexual abuse, as well as emotional and physical neglect. Bullying was assessed using the Retrospective Bullying Questionnaire (RBQ). Multilevel linear regression analyses were conducted. Positive, negative, and depressive PEs were regarded as the dependent variables, interactions of CT subtypes and bullying with total AQ were regarded as independent variables in separate models. All models were adjusted for age and sex. Bonferroni correction (p<0.008) was applied for multiple comparisons.

The mean of the age of the participants was 17.5 ± 3.6 years and 60.2% of the sample was female. Emotional abuse (B = 0.12, 95% CI: 0.08 to 0.15), physical abuse (B = 0.15, 95% CI: 0.07 to 0.22), sexual abuse (B = 0.10, 95% CI: 0.03 to 0.16), emotional neglect (B = 0.05, 95% CI: 0.02 to 0.09) and physical neglect (B = 0.07, 95% CI: 0.03 to 0.11) significantly moderated the positive relationship between AT and positive PEs. However, only emotional abuse uniquely moderated the relationship between AT and both negative and depressive PEs (B = 0.09, 95% CI: 0.04 to 0.13; B = 0.09, 95% CI: 0.04 to 0.14) with physical neglect showing a trend toward significance for depressive PEs (B = 0.08, 95% CI: 0.02 to 0.13). Bullying did not moderate any domain of PEs.

Emotional abuse may play a unique role in moderating the relationship between AT and PEs, affecting all domains of psychosis expression. Conversely, other forms of CT predominantly influence positive PEs. Further research is needed to clarify the distinct pathways through which distinct types of childhood adversity impact the association between AT and PEs.

M. Karaçam Doğan: None Declared, T. Prachason: None Declared, B. Lin: None Declared, L.-K. Pries: None Declared, A. Arias-Magnasco: None Declared, R. Bortoletto: None Declared, C. Menne-Lothmann: None Declared, J. Decoster: None Declared, R. van Winkel: None Declared, D. Collip: None Declared, P. Delespaul: None Declared, M. De Hert: None Declared, C. Derom: None Declared, E. Thiery: None Declared, N. Jacobs: None Declared, J. van Os: None Declared, B. Rutten: None Declared, N. Brondino : None Declared, M. Colizzi Consultant of: GW Pharma Limited, GW Pharma Italy SRL and F. Hoffmann-La Roche Limited, outside of this work. , L. Fusar-Poli: None Declared, S. Guloksuz: None Declared

The increasing prevalence of metabolic syndrome in persons with schizophrenia has driven research into the underlying mechanisms of its pathophysiology. Overlapping neurobiological profiles of metabolic risk factors and psychiatric symptoms, particularly shared genetic liabilities, suggest that oxytocin system dysfunction may be a common mechanism underlying both schizophrenia and metabolic syndrome. Given its prosocial and anorexigenic effects, intranasal oxytocin has been studied for its therapeutic potential in schizophrenia and obesity. However, the pathophysiology and mechanisms of oxytocin in schizophrenia are complex and it is too early to draw definitive conclusions.

This study aims to investigate the correlation between plasma oxytocin levels and metabolic syndrome and to test whether oxytocin system dysfunction could serve as a putative endophenotypic marker of schizophrenia.

This prospective cohort study involved 90 persons with schizophrenia, all of whom were responsive and maintained on stable monotherapy with either olanzapine, risperidone, or aripiprazole, without any alterations to their antipsychotic regimen, alongside 60 healthy controls. All participants were followed for 24 months. Anthropometric measurements, metabolic parameters, and the presence of metabolic syndrome were assessed. Plasma oxytocin levels were measured. The psychopathology of persons with schizophrenia was evaluated using the Positive and Negative Syndrome Scale (PANSS), and quality of life was assessed using the World Health Organization Quality of Life (WHOQOL-BREF) scale. Other potential confounding factors, including dietary habits, caffeine and nicotine use, and menstrual cycle, were considered in the analysis.

Plasma oxytocin levels were inversely associated with the presence of metabolic syndrome in persons with schizophrenia, regardless of antipsychotic treatment. Persons with schizophrenia who had metabolic syndrome at baseline showed lower baseline plasma oxytocin levels. Among those with metabolic syndrome at baseline, higher plasma oxytocin levels were associated with better metabolic parameters at the end of the follow-up period. Conversely, for those without metabolic syndrome at baseline, lower plasma oxytocin levels were predictive of a higher risk of developing metabolic syndrome over time.

This study highlights the potential role of oxytocin in the pathophysiology of metabolic syndrome in schizophrenia. Lower plasma oxytocin levels were associated with both the presence and risk of developing metabolic syndrome, suggesting that oxytocin system dysfunction may contribute to metabolic dysregulation in schizophrenia. These findings support the hypothesis that oxytocin could be a putative endophenotypic marker for metabolic vulnerability in schizophrenia, while future studies should further investigate the therapeutic implications of targeting the oxytocin system.

None Declared

Patients with schizophrenia experience uncertainty due to unpredictable symptoms, disease progression and lack of information about the illness, treatment and prognosis. Studies underline that illness uncertainty is a risk factor in schizophrenia, while psychological well-being and quality of life are critical outcomes. Psychological resilience is also recognised as having a mediating role.

The aim of this study was to examine the relationships between illness uncertainty, psychological resilience and psychological well-being in people with schizophrenia.

In this cross-sectional study, 150 participants with a diagnosis of schizophrenia (DSM-5) were recruited. Data were collected using the Mishel Uncertainty in Illness Scale-Community Form, the Psychological Well-being Scale and the Connor-Davidson Resilience Scale. Data were analysed using descriptive statistics, independent samples t-test, one-way ANOVA and pearson correlation analysis.

The mean age of people diagnosed with schizophrenia who participated in the study was 37.52±10.62 years, 41.3% (n=62) were high school graduates, 68.7% (n=103) were single, 53.3% (n=80) had income equal to expenses, 59.3% (n=89) were not working, 54.7% (n=82) lived with their parents and 38.7% (n=58) had children. The study found a negative and weak relationship between the mean MUIS-C total score and the mean PWBS total score (r=-0.359), and also a negative and weak relationship between the mean MUIS-C total score and the mean CD-RISC total score (r=-0.287).

It is important for health professionals to assess the uncertainty experienced by people with schizophrenia, to examine its impact on their psychological well-being and to understand how they cope with their illness.

None Declared

Psychotic experiences (PEs) are subclinical symptoms of psychosis affecting about 10% of children and adolescents. They may cause significant distress and impair daily functioning. Moreover, when persisting over time they are more likely to result in psychotic disorders.

This longitudinal study aimed at assessing the effects of polygenic and environmental risk factors for schizophrenia on distressing and persisting PEs in a cohort of adolescents.

Data were obtained from participants of European ancestry derived from the Adolescent Brain and Cognitive Development Study, Release 5.1. Past-month PEs were assessed using the Prodromal Questionnaire-Brief Child Version. The primary outcome was distressing PEs at 3-year follow-up. Secondary outcomes included varying levels of persistence of distressing PEs, occurring in 1, 2, 3, or all 4 waves. Polygenic risk score for schizophrenia (PRS-SCZ) was calculated using the continuous shrinkage approach (PRS-cs). The exposome score for schizophrenia (ES-SCZ) was generated by summing up the weighted risk of nine environmental exposures across lifetime: emotional neglect, physical neglect, emotional abuse, physical abuse, sexual abuse, cannabis use, winter birth, hearing impairment, and bullying. Multilevel logistic regression was carried out to test the individual associations of PRS-SCZ and ES-SCZ with the outcomes; the relative excess risk due to interaction was calculated to determine the additive interaction between PRS-SCZ and ES-SCZ on distressing PEs. Main analysis was adjusted for age and sex as covariates; sensitivity analysis also included family income and parental education.

ES-SCZ was significantly associated with 3-year follow-up distressing PEs (OR 1.27 [95% CI 1.14, 1.43], p<.001) and lifetime distressing PEs at all degrees of persistence, with an increasing magnitude of association for a higher degree of symptom persistence (≥1 wave: OR 2.77 [95% CI 2.31, 3.31], p<.001; ≥2 waves: OR 3.16 [95% CI 2.54, 3.93], p<.001; ≥3 waves: OR 3.93 [95% CI 2.86, 5.40], p<.001; all 4 waves: OR 3.65 [95% CI 2.34, 5.70], p<.001). PRS-SCZ was significantly associated with distressing PEs persisting for more than one (OR 1.29 [95% CI 1.08, 1.53], p=.040) or two waves (OR 1.34 [95% CI 1.08, 1.65], p=.070) and also additively interacted with ES-SCZ for these outcomes (≥1 wave: RERI 1.26 [95% CI 0.14, 2.38], p=.027; ≥2 waves: RERI 1.79 [95% CI 0.35, 3,23] p=.015). Sensitivity analysis confirmed all main results.

PRS-SCZ and ES-SCZ showed independent and joint effects on distressing PEs. The more pronounced contribution of ES-SCZ on distressing PEs and its gradient effects on the degree of persistence calls for particular attention to environmental risk factors for schizophrenia on the development and persistence of PEs.

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Understanding the complex interplay between cognitive and functional domains in schizophrenia is crucial for improving patient functional outcomes.

Metacognition has emerged as a critical factor in the functioning and rehabilitation of individuals with schizophrenia. Additionally, the role of disorganization and clinical insight in this complex disorder has been extensively studied due to their role in shaping in the trajectory and real-life functioning outcomes of the disorder.

This study aimed to assess the differences and relationships between disorganization, clinical insight, metacognition, and various functional domains in patients with short (< 5 years) and long (≥ 5 years) illness duration.

A network representation of the relationships between variables and the calculation of centrality and clustering indices were performed within each group. The two groups were compared with a network comparison test.

Eighty-nine patients with early and one hundred and six with late phase SZ were included. We found no significant differences in the overall network structure between the two groups despite patients with longer illness duration showing significant worsening across all examined domains. Interestingly, the relationships between the network variables remained stable regardless of disease duration.

One notable difference emerged in the correlation between interpersonal functioning and unawareness of symptoms, negatively correlated only in the group with longer illness duration. These results suggest that the link between social functioning and clinical insight may become more pronounced as the disorder progresses. Decentration was more central in the group with short disease duration, whose patients do not yet show marked impairment of metacognition, particularly in the ‘understanding other’s mind’ domain. Regarding clustering indices in the group with short illness duration, the misattribution of symptoms to the disorder is more clustering. On the other hand, metacognitive mastery, was highly clustering in both the short and long illness duration.

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The stability of the relationships between metacognitive variables, clinical insight, and functional outcomes, regardless of disease duration, suggests that interventions targeting metacognition may be beneficial for improving functioning in patients with schizophrenia. Additionally, the emerging negative correlation between interpersonal functioning and unawareness of symptoms in patients with longer illness duration highlights the importance of addressing both social skills and clinical insight as the disease progresses. These findings underscore the potential utility of integrated treatment approaches that address cognitive, social, and functional domains to optimize functional outcomes for individuals with schizophrenia across the course of the illness.

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Level of functioning is often severely affected in individuals diagnosed with psychosis. Often, negative symptoms have been proposed as an important treatment target to improve functioning. Most research on the topic is conducted in adult samples, but the functional impairments associated in adolescents with schizophrenia spectrum disorders might differentiate from adults. A detailed understanding of the functional impairments and its association to clinical symptoms is important to develop meaningful and effective treatments adjusted to the needs of this young patient group.

The aim of this study is 1) to explore functional capacity across different domains of function, and 2) to examine associations between functioning and clinical symptoms in youth with early-onset psychosis.

The study sample consists of 290 children and adolescent aged 12-17 years with early-onset psychosis included in the OPUS YOUNG trial. All participants’ level of functioning was assessed with the Personal and Social Performance Scale (PSP), ranged 0-100. The level of psychosis symptoms was assessed with Scale for the Assessment of Positive Symptoms in Schizophrenia (SAPS) and Scale for the Assessment of Negative Symptoms in Schizophrenia (SANS). Data on affective symptoms, duration of untreated psychosis, cognitive functioning, quality of life, and substance use was also collected.

The participants had a mean age of 15.6 (SD=1.6) years and 72% were females. Mean PSP total score was 49.9 (SD=13.8) and most participants had manifest to marked difficulties on the domains Socially useful activities, Personal and social relationships, and Self-care. Few participants had impairments in the domain of Disturbing and aggressive behavior. On average, levels of positive symptoms, negative symptoms, disorganized symptoms, and affective symptoms were of mild severity. Preliminary correlation analyses showed that all symptom categories were statistically significantly associated with PSP total score, and negative symptoms showed the strongest association.

Level of functioning was markedly impaired across most domains while symptom levels were of mild severity in most participants. We suggest that improvement of functioning should be a primary treatment target in parallel with symptom alleviation of this patient group.

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“FareAssieme” (“Doing Together”) is a community psychiatry approach adopted by the Mental Health Service of Trento (SSM) since 1999. It is based on the active involvement of users and families, valuing “experiential knowledge”—the insights gained from their experiences with illness and recovery—to enhance mental health care and rehabilitation pathways.

To describe the “FareAssieme” model and analyze the effectiveness of Peer Support Experts (ESPs) in recovery processes, stigma reduction, and improving patient-perceived quality. ESPs are users or family members who have achieved life balance in their recovery journey and developed coping skills, sharing their stories to support others within the SSM of Trento.

The approach was implemented by systematically including ESPs in all SSM areas, such as front-office services, community mental health teams, territorial and hospital crisis areas, and residential facilities. Evaluation methods included satisfaction questionnaires, systematic PREMs and PROMs (Patient-Reported Experience and Outcome Measures), focus groups, and direct field observations, with particular attention to integrating ESPs into professional teams.

Introducing ESPs led to significant service quality improvements, increased active user involvement, and a better working climate. Patients reported greater trust in services and enhanced recovery experiences. ESPs helped overcome users’ initial resistance, especially among those less willing to trust health services, fostering stronger therapeutic relationships. Professional resistance diminished as the added value of ESPs became evident. The “FareAssieme” model also fostered the establishment of a Participatory Planning Group (GPP), a diverse team including ESPs and professionals. The GPP discusses relevant topics for the SSM’s operations and has produced several “Operational Guidelines”—recommendations compiled into booklets serving as operational instructions for all users, families, and service operators.

The “FareAssieme” model in Trento represents an effective example of recovery-oriented community psychiatry. ESPs have uniquely contributed to improving perceived service quality and promoting a culture of respect and co-participation, reducing the stigma associated with mental illness. The GPP has also served as a representative for mental health issues, voicing the SSM’s shared views through mass media to disseminate anti-stigma messages.

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Healthcare workers globally face an elevated risk of mental health conditions. Despite the critical need for mental health support, access remains inconsistent, hindered by both systemic gaps and barriers like stigma and regulatory constraints. Recognizing this unmet need, we established the Staff Mental Health Service (SMHS) in Cambridgeshire, UK, in September 2020. SMHS offers prompt assessments and treatments for healthcare workers across various professional roles.

To assess costs, clinical outcomes and waiting times associated with treatment at the SMHS compared to NHS Talking Therapies (TT), a nationally-delivered primary care mental health service.

A cost-consequence analysis comparing costs and clinical outcomes for a hypothetical cohort of patients (N=1,000) between two options: (1) treatment either at SMHS or TT ; and (2) treatment at TT only. SMHS costs and outcomes were collected from routinely collected patient-level data, while those for TT were informed by published literature. Only costs borne by the health system were assessed; and model outcomes were compared for one treatment period (i.e., from treatment start to discharge).  Primary model outcomes included average total treatment costs (GBP - £); and mean score changes on the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Assessment (GAD-7) measures for symptoms of depression and anxiety, respectively. Uncertainty in model parameters was explored using deterministic and probabilistic sensitivity analyses. Mean waiting times from referral to initial assessment and first treatment appointment for the SMHS and TT were analysed independently.

Average total treatment costs per patient for the option consisting of treatment at either SMHS or TT was £825 less costly than the option consisting of treatment only at TT (£617 vs £1,442). Main drivers of cost difference included the notably higher cost and average number of appointments associated with treatment at TT. Treatment at either SMHS or TT also led to better patient outcomes on both the PHQ-9 (mean score reductions of 7.2 vs 6.1) and GAD-7 (mean score reductions of 6.3 vs 4.8) scales. Mean waiting times (days) for treatment at SMHS were considerably shorter than at TT: referral to initial assessment (19 vs 25 days); and referral to first treatment appointment (28 vs 53 days).

Preliminary results showed that a specialised mental health service for healthcare workers was associated with lower costs, better patient outcomes, and shorter waiting times compared to standard treatment options.

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