Lithium is used as a first-line treatment in perinatal bipolar disorder. Lithium is almost exclusively renal eliminated without undergoing metabolization. Renal changes associated with pregnancy are responsible for alterations in lithium pharmacokinetics that may impact lithium efficacy and toxicity in mother. Characterization of the trajectory of lithium disposition during the perinatal period (previous year of pregnancy, pregnancy and first year postpartum) is necessary to monitoring and dose adjustments to prevent bipolar symptom recurrence while minimizing adverse effects.

To characterize the disposition of lithium during the perinatal period ant to evaluate whether changes in serum lithium concentration are consistent with changes in renal function (creatinine).

Women treated with lithium carbonate and referred to the perinatal psychiatry out-patient clinic of a single tertiary university hospital (November 2006 -December 2018), were evaluated for eligibility to participate in this retrospective observational cohort study (HCB/2020/1305). The basis of this study was all samples analysed in the same laboratory for lithium during perinatal period obtained at steady-state and predose. Serum creatinine concentrations measurements were also extracted. Lithium concentrations were determined by means of an AVL 9180 electrolyte analyzer based on the ion- selective electrode (ISE) measurement principle. Detection limit (LoD) was 0.1 mEq/L and limit of quantification (LoQ) 0.2 mEq/L. Serum creatinine concentration was determined by molecular absorption spectrometry. Detection limit (LoD) was 0.10 mg/dL, and the limit of quantification (LoQ) was 0.15 mg/dL Linear mixed models were used to analyze lithium and creatinine serum concentrations.Time points extractions and lithium dose were included as fixed effects, while the individual mother was included as a random effect to account for repeated measurements.

In total, 1260 lithium and 1174 creatinine serum concentration measurements from 109 pregnancies of 95 women were available. Dose-ajusted serum lithium concentrations (C/D ratio) decreased and average of 23.9% and 27.6% during the first and second trimesters respectively, increased slightly in the third trimester but remained 16.9 % below the prconception time (reference period) and increased postpartum 11% . Serum creatinine concentration evidenced a similar longitudinal pattern during pregnancy (decreased 20%, 26.1% and 22.3% in first, second and third trimester respectively) and also decreased postpartum 4.3%.

We recommend monitoring lithium and creatinine serum concentration once every 4 weeks until 34 weeks of pregnancy, then weekly until delivery, followed in postpartum at day 2±1, (bi-)weekly during the first month, monthly until 6 months postpartum and then every 3-4 months to ensure adequate lithium dosing.

None Declared

Safe and effective handovers are crucial for patient safety in psychiatric hospitals and a digital record helps to prevent information loss and allow auditing. Trainees at our institution raised concerns about the lack of a reliable, traceable digital record for out-of-hours handovers. The pre-existing system of handwritten notes and emails was error-prone, cumbersome and untraceable. Therefore, a more efficient digital system was needed to match the demands of a busy in-patient psychiatric hospital.

To improve the safety and quality of medical handovers in our hospital.

A baseline survey was sent to resident doctors at The Maudsley Hospital, London, to gather feedback on handover practices. The Microsoft Planner application within Teams was introduced, providing a secure, live digital handover record accessible with two-factor authentication. It allows multiple users to edit tasks simultaneously and tracks all updates with clinician specific time stamps. Changes were communicated and feedback gathered through monthly meetings, emails, and encrypted messaging apps. After 12 weeks, we sent a follow-up survey and made further adjustments based on the feedback.

Nine doctors responded to the baseline survey, giving an average score of 2.5 out of 5 for quality and 2.4 out of 5 for safety. Forty-six percent struggled to prioritize tasks during on-call shifts, 54.6% found it hard to track task progress, and 18.2% reported frequent task delays or omissions. After the changes, nine doctors responded with improved scores of 4.6 out of 5 for quality and 4.2 out of 5 for safety. Seventy-eight percent rarely had difficulty prioritizing tasks, 66.7% found it easy to track progress, and 87.5% reported that tasks were rarely or never missed. Feedback highlighted that use of the platform varied amongst clinicians and access issues for emergency locum doctors, leading to the creation of a trust-wide protocol to standardise the use of this technology and respond to access issues.

A web-based task management platform was introduced in a large in-patient psychiatric hospital with significant improvements seen in clinician-rated quality and safety of medical handovers. This application is now commonly used across South London and Maudsley NHS Trust, the largest mental health trust in the United Kingdom. Over 450 NHS organizations have access to the Microsoft 365 and could therefore use this innovative technology to improve their clinical handovers. Given Microsoft’s global use, this could very likely be used throughout European mental health organisations.

None Declared

Psychogenic aging, an emerging field in biogerontology, seeks to integrate psychological factors into the biological framework of aging. Traditional models of aging emphasize molecular and cellular mechanisms, often overlooking the significant role of psychological well-being. Our studies show that psychosocial factors influence biological age similarly to physical health conditions. Psychogenic aging is a novel phenomenon that addresses this gap by providing a holistic understanding of the aging process that encompasses both biological and psychological components.

The primary objective of this research is to explore the relationship between psychological factors and biological aging. Specifically, it seeks to quantify the impact of psychosocial stressors and well-being on biological age and compare these effects with established biological markers of aging. This study also aims to position psychogenic aging within the established Hallmarks of Aging framework.

Data from the China Health and Retirement Longitudinal Study (CHARLS), including 16 blood biomarkers and psychological well-being indicators for over 11,000 adults, were used to train a deep neural network (DNN) to predict biological age.Psychosocial factors such as happiness and loneliness were regressed against biological age using elastic net regression to quantify their effects.

Additional findings from a non-systematic review on stress and aging were used to frame the psychogenic aging model within the Hallmarks of Aging framework by Lopez-Otín et al. 2013 Cell.

Galkin et al. Aging 2022 developed a deep-learning aging clock using blood test data to assess the influence of psychological factors on biological aging. The results show that negative psychological factors, such as loneliness and unhappiness, can accelerate biological age by 1.65 years, surpassing the effect of smoking, which contributes an additional 1.25 years. These findings highlight the substantial impact of mental well-being on biological age, comparable to serious health conditions like stroke and lung disease. Faria et al. Trans Psych 2024 developed a theoretical framework from which to conceptualize the mechanisms and mediators behind these psychogenic aging effects with the latest high-throughput methods.

Image 1:

Image 2:

Image 3:

The integration of psychogenic aging into the Hallmarks of Aging framework represents one of the most significant advancement in our understanding of the aging process. Psychological stressors and resilience should be recognized as fundamental contributors to aging, akin to molecular and cellular processes. By addressing both the biological and psychological dimensions of aging, this interdisciplinary approach offers novel opportunities for anti-aging therapies and interventions. Future research should focus on validating these findings across diverse populations and exploring the mechanistic pathways linking psychological health to biological aging.

None Declared

Functional neurological disorders (FND) are defined as neurological symptoms that are inconsistent and incongruent with classic neurological disorders. Over the past two decades, an interest in the potential underlying mechanisms of these disorders has occurred and a new pathophysiological framework based on current neurobiological theories about global brain function such as the predictive coding theory has emerged. Within this framework, abnormal or erroneous beliefs about symptoms, mediated by attention, are hypothesized to modulate perception and movements, ultimately leading to FND. Previous studies have evaluated cognitive biases such as the jumping to conclusion reasoning style in patients with functional movement disorders (FMD) and it has been suggested that they may play a role in symptoms production. In this study, we evaluated the behavior of patients with FMD when confronted with evidence that contradicts their beliefs through the “Bias Against Disconfirmatory Evidence” (BADE) and their tendency to accept implausible interpretations through the “Liberal Acceptance Bias” (LA).

To evaluate whether patients with FMD have greater difficulty integrating information based on disconfirming evidence than the general population.

Observational case-control study in which the presence of BADE and LA biases were assessed in a sample matched by sex and age using Woodward’s BADE task. Clinical and demographic characteristics of the participants were recorded (such as “Mini Mental State Examination” (MMSE) or “Peters et al. Delusions Inventory” (PDI -21), level of education, employment situation and marital status and cohabitation situation). The BADE test analyses the scores that the patient provides at 3 points in time on the plausibility of 24 scenarios after increasing the information received.

Twenty patients (median age 50.5 years, 75% female) and twenty people from the control group (median age 52.50 years, 75% female) were included. No differences were found on demographic features, MMSE or PDI -21 scores. When compared to healthy controls, FMD patients scored significantly lower in BADE (median 3.35, p=0.03) and significantly higher in LA (median 3.08, p=0.017). Also, when the maximum information was provided, patients scored significantly higher in implausible situations (p=0.01) and lower in true situations (p=0.02) than the control group.

Image 1:

Image 2:

Image 3:

Patients with FMD have greater difficulty in modifying their beliefs when confronted with disconfirming evidence and a greater tendency to accept less plausible options. These cognitive biases, among other factors, may facilitate the adoption of fixed beliefs, regardless of their plausibility, early and with little evidence. Our results may also explain why some patients with FMD remain with erroneous beliefs despite the explanation of the diagnosis.

None Declared

Some individuals with chronic pain using opioid analgesics may unknowingly experience mood improvement, which can lead to compulsive opioid use. To address this issue, the DOLMEN program was developed, involving a multidisciplinary team of clinical psychologists, psychiatrists, pain specialists, nurses, pharmacists, and geneticists for a comprehensive treatment approach.

Our objective was to describe the DOLMEN program and assess its effectiveness in improving emotional pain, psychiatric symptoms, functioning, quality of life, and pain management. The program also aimed to prevent medication errors through pharmacological guidance. We investigated genetic biomarkers related to clinical outcomes and evaluated patient satisfaction with the program.

We implemented a multidisciplinary pilot program and conducted an observational, unicentric, longitudinal, and ambispective study to evaluate its outcomes. The study included patients with chronic pain on high off-label opioid doses, those with mental disorders treated with opioids, and patients with pain refractory to standard treatments. Data were collected on psychiatric symptoms, substance use, CYP2D6, CYP2C19, and OPRM1 gene polymorphisms, and pharmacist interventions. To assess the intervention’s impact, a paired test analyzed changes in psychiatric measures and pain levels using the Visual Analog Scale (VAS) after structured psychoeducational sessions. A linear-by-linear association chi-square test examined associations between genetic polymorphisms and questionnaire results.

The sample consisted of 90 patients, the majority of whom were women (78.0%), with a mean age of 53.1 years. Among the participants, 23.0% exhibited problematic opioid use.

Significant improvements were observed in several clinical measures. The average Clinical Global Impression score improved from 3.7 to 2.58 (p=0.003), while the State-Trait Anxiety Inventory scores for state anxiety and trait anxiety decreased from 38.8 to 34.9 (p=0.0027) and from 40.1 to 35.8 (p<0.0001), respectively. The Beck Depression Inventory-II scores also showed a notable reduction from 33.1 to 27.8 (p<0.0001). Although improvements were seen in the EQ-5D-5L (from 41.1 to 50.2) and the EEAG (from 65.8 to 71.8), these changes were not statistically significant (p>0.05). Pain experience, as measured by the Visual Analog Scale, showed a reduction from 7.1 to 6.6 (p=0.0106). An association was identified between the OPRM1 polymorphism and the degree of problematic opioid use, as well as between the CYP2C19 genotype and the presence of depression (p<0.05). Additionally, pharmacists provided 64 recommendations to patients to prevent medication errors throughout the program.

The DOLMEN program demonstrated preliminary effectiveness in managing patients with chronic and emotional pain, as well as problematic opioid use.

None Declared

Methamphetamine (MA) is one of the most addictive drugs globally. Among its harmful consequences, methamphetamine use disorder (MUD) and methamphetamine-induced psychosis (MAP) are prevalent and increase the burden of mental health worldwide. Recent studies highlighted the relationship of the disorders and various factors including patterns of MA consumption and adverse childhood experiences (ACEs). Understanding the association between these factors and MUD and MAP is essential for advancing our knowledge and improving healthcare for our patients.

To investigate the association of MA use patterns, ACEs and the development of MUD and MAP.

This study analyzed data from a survey using the ThaiMIND questionnaire (September 2023 – June 2024). We collected participants’ socio-demographic details (including gender, age, income, employment, marital status, education), mental health history, other substances use, MA use patterns, ACEs, psychotic symptoms and their onset. The diagnosis of MUD and MAP were based on DSM-5 criteria. Univariate logistic regression was employed to examine the relationships, adjusting for socio-demographics and mental health history for MUD models, and adding other substances use and MUD diagnosis for MAP models.

In this study of 2,524 participants, 1,987 (78.72%) met the criteria for MUD, and 876 (34.71%) met the criteria for MAP. The use of yaba (MA or speed pill) reduced the risk of MAP compared to ice (crystalline MA)(OR = 0.32 [0.12 – 0.85]) while combining two types of MA raised the risk of MAP compared to ice alone (OR = 1.96 [1.37 – 2.81]). For MUD, more frequent MA use, compared to monthly or less, increased the risk with OR = 1.81 [1.34 – 2.43] (2-4 times/month), 2.27 [1.58 – 3.27] (2-3 times/week), and 4.00 [2.87 – 5.59] (4 or more times/week). Similarly, for MAP, using MA 2-3 times/week raised the risk (OR = 1.59 [1.14 – 2.22]), and using it more than 4 times/week further increased the risk (OR = 2.16 [1.62 – 2.87]). Additionally, MA injection significantly heightened the risk of MUD (OR = 6.29 [3.28 – 12.04]). Emotional abuse (OR = 1.84 [1.36 – 2.47]) and physical abuse (OR = 1.71 [1.29 – 2.27]) were linked to a higher risk of developing MUD. In addition, physical neglect (OR = 1.29 [1.02 – 1.65]), emotional neglect (OR = 1.47 [1.13 – 1.90]), and sexual abuse (OR = 1.46 [1.05 – 2.03]) were associated with an increased risk of MAP. The total number of ACEs also increased the risk of both MUD (OR = 1.28 [1.17 – 1.40]) and MAP (OR = 1.14 [1.05 – 1.24]).

The study demonstrates that MA use patterns and adverse childhood experiences significantly impact the risk of developing MA use disorder and MA-induced psychosis.

None Declared

Metabolic syndrome (MetS) is notably prevalent among individuals with bipolar disorder (BD). Despite numerous studies indicating an increasing MetS prevalence in this group over time, comprehensive investigations of associated risk factors remain limited.

This study aims to assess the prevalence and 1-year changes in MetS among BD patients. It also seeks to identify baseline clinical features that could predict the development of MetS during follow-up.

The study included euthymic BD type 1 patients consecutively admitted between July 2023 and July 2024. MetS was diagnosed uaccording to NCEP ATP-III criteria at baseline and after one year. Patients without MetS at baseline were analyzed to evaluate the association between initial clinical characteristics and MetS presence at follow-up through logistic regression.

A total of 98 patients completed the baseline and follow-up assessments. The prevalence of MetS significantly increased from 29.6% to 51.0% over the 1-year naturalistic follow-up. Initially, there were no significant differences between the groups with and without MetS regarding demographics, illness characteristics, treatment types, comorbidities, and chlorpromazine equivalent dose. By the end of the follow-up period, 29 new MetS cases were diagnosed after excluding those initially identified. This group exhibited higher numbers of total episodes, more manic episodes, and greater hospitalization rates (p = 0.04,-2.067; p = 0.03, -2.193; p = 0.03, -3.207), with no significant differences in other demographic or clinical variables.In the logistic regression analysis, which controlled for age, gender, number of depressive episodes, and the use of lithium and valproate, the equivalent chlorpromazine dose (p = 0.04, OR: 1.003) emerged as a significant predictor of metabolic syndrome, while the number of manic or hypomanic episodes demonstrated a trend towards significance (p = 0.05).

In conclusion, this study shows that the prevalence of MetS in patients with BD type-1 in Turkey increased from 29.6% to 51.0% over one year. Increased numbers of manic episodes and higher chlorpromazine doses were linked to the development of MetS. This underscores the importance of monitoring metabolic health, especially in patients with frequent manic episodes or high antipsychotic doses.

None Declared

Cognitive function, particularly verbal memory, is often compromised in Bipolar Disorder (BD). While studying risk factors for cognitive deficits has not identified causal factors, focusing on protective factors that support verbal memory can help tailor interventions for individuals with BD.

Investigate associations between daily rhythms and verbal memory in people with BD in full or partial remission.

This is a cross-sectional study. Participants were included if their Montgomery Asberg Depression Rating Scale (MADRS) score was ≤16 and Young Mania Rating Scale (YMRS) score was ≤8. Daily rhythms were assessed by self-report using the BRIAN scale, as was chronotype. Regularity and intensity of physical activity were measured with actigraphy, with devices worn on the wrist for up to ten days. Variables of interest included mean time per day in moderate to vigorous physical activity (MVPA), intensity and timing of the most active five hours per day (M5), and total intensity per 24 hours over the assessment period. Cognitive function was assessed using a validated, self-administered, web-based test platform for Norwegian-speaking participants, which included a verbal memory test. Actigraphy data were processed using specialized software to extract relevant metrics. Correlational analysis was conducted to evaluate the relationships between daily rhythms and verbal memory.

A total of 87 participants were included, comprising 30 men and 57 women, aged between 18 and 64 years. Among them, 57 had bipolar disorder type 2, and 30 had bipolar disorder type 1. The analysis revealed a significant positive correlation between verbal learning and the timing of the most active five hours, with better verbal learning observed for M5 timing later in the day. There was also a moderate positive correlation between better delayed verbal recall and the amount of time spent in moderate to vigorous physical activity.

Our findings suggest that modifiable factors, such as later timing of the most active five hours and amount of time spent in moderate to vigorous physical activity, are associated with better verbal learning and memory in individuals with bipolar disorder. These insights could inform interventions aimed at improving cognitive outcomes in this population.

None Declared

Despite the number of medications considered as effective in the treatment of bipolar disorder (BD), incomplete response to treatment is very prevalent (Perlis et al. Am J Psychiatry 2006;163(2):217-24). Existing evidence supports the effectiveness of clozapine for treatment-resistant BD (TRBD) with clinical guidelines recommending clozapine as a third-line treatment (Yatham et al. Bipolar Disord. 2018;20(2):97-170). There is evidence to support that a shorter delay before clozapine initiation is associated with a better response to this treatment (Griffiths et al. Psychol. Med. 2021;51(3):376-86).

This study aimed to identify clinical and sociodemographic characteristics at the time of the first bipolar diagnosis associated with future clozapine treatment.

We performed a population-based cohort study using nationwide data from Danish registries to investigate factors associated with initiation of clozapine treatment in incident BD. Cox proportional hazard regression analyses were used to investigate associations between patients’ characteristics at the time of the diagnosis of BD and a subsequent redemption of a prescription for clozapine, yielding hazard rate ratios (HRRs).

We identified a total of 29,696 patients registered with their first (incident) ICD-10 diagnosis of BD between 1999 and 2019, of whom 102 (0.3%) received clozapine treatment during follow-up. The median age at the first prescription of clozapine was 48.6 years (25-75 percentile: 37.7-59.9).  The multivariable Cox proportional hazards regression model showed that a prior diagnosis of psychotic disorder (other than schizophrenia or schizoaffective disorder) (HR: 2.10; CI: 1.13-3.93), having had three (HRR: 2.91; CI: 1.23-6.87), four (HRR: 2.89; CI: 1.15-7.24) or five or more (HRR: 3.17; CI: 1.19-8.44) previous psychopharmacological treatments prior to the diagnosis of BD, and being outside the labour force (HRR: 2.58; CI: 1.42-4.66) were positively associated with clozapine treatment after controlling for the remaining variables.

The results of this study suggest that there are clinical characteristics associated with subsequent clozapine treatment already at the time of diagnosis of BD. These findings may guide targeted interventions, such as an earlier initiation of clozapine treatment.

E. Salagre: None Declared, C. Rohde: None Declared, S. Østergaard Shareolder of: Dr. Østergaard reports ownership of units of mutual funds from companies with the stock tickers DKIGI, IAIMWC, SPIC25KL, and WEKAFKI; ownership/past ownership of units of exchange-traded funds with the stock tickers BATE, TRET, QDV5, QDVH, QDVE, SADM, IQQH, USPY, EXH2, 2B76, IS4S, OM3X, and EUNL during the conduct of the study, Grant / Research support from: Dr. Østergaard reported receiving the 2020 Lundbeck Foundation Young Investigator Prize; and grants from the Novo Nordisk Foundation (NNF20SA0062874), Lundbeck Foundation (R358-2020-2341 and R344-2020-1073), Danish Cancer Society (R283-A16461), Central Denmark Region Fund for Strengthening of Health Science (1-36-72-4-20), Danish Agency for Digitisation Investment Fund for New Technologies (2020-6720), and Independent Research Fund Denmark (7016-00048B and 2096-00055A) outside the submitted work

Patient-centered treatment and care is a key quality standard within substance use disorder (SUD) treatment services. Patient-Reported Outcome and Experience Measures (PROMs and PREMs) allow us to collect direct feedback from patients on how they perceive health outcomes and quality of care in a systematic way.

To identify current practices regarding the use of PROMs and PREMs in clinical practice in SUD treatment services and to develop an electronic self-report tool for routine assessment of PROMs and PREMs in SUD treatment services in Belgium.

We present results from a scoping review, identifying studies reporting on the use and routine implementation of PROMs and PREMs in SUD services. Additionally, preliminary results from a naturalistic longitudinal multicenter study assessing self-reported sociodemographic characteristics, clinical factors, PROMs, and PREMs in N=189 adults who recently started treatment for SUD in various treatment modalities are presented: the OMER-BE study (Outcome Measurement and Evaluation as a Routine practice in alcohol and other drug services in Belgium).

There is an increasing use of patient-reported measures in SUD services. However, there is large variation in the patient-reported measures that are used, how they are developed, and how and when patient-reported data are collected. The most important barriers and facilitators to the implementation of PROMs and PREMs in clinical practice include burden to and involvement of staff, and leadership and technical support. Alcohol and cocaine were the most commonly used substances among participants of the OMER-BE study, with 59.7% of participants reporting polysubstance use. The 45-, 90-, and 180-day follow-up assessments were completed by 64%, 59% and 54% of participants respectively. At 180-day follow-up, 56% of respondents were still in treatment for SUD.

Guidance is needed to support clinicians in selecting and implementing valid, meaningful, and comparable patient-reported measures to understand and benefit from the impact that PROMs and PREMs can have on treatment quality and outcome. The OMER-BE study provides an example of the insights that can be gained into patient needs through the use of an electronic self-report tool assessing PROMs and PREMs.

C. Migchels: None Declared, W. van den Brink Consultant of: Wim van den Brink reports a consulting/advisory relationship with Takeda Pharmaceutical Company Limited, Camurus AB, and Clearmind Medicine., A. Zerrouk: None Declared, W. Vanderplasschen: None Declared, C. Crunelle: None Declared

Alcohol use disorder (AUD) is associated with increased dopaminergic activity, and evidence suggests that α1b-adrenergic and 5HT2A serotonergic receptors play critical roles in modulating dopamine-mediated behavioral responses. Preclinical studies indicated that simultaneous blockade of these receptors with prazosin (α1b blocker) and cyproheptadine (5HT2A blocker) can reduce alcohol preference. This phase 2 clinical study aimed to evaluate the efficacy and safety of this combination in reducing alcohol consumption among patients with severe AUD.

The primary objective of the study was to assess the efficacy and safety of a combination of prazosin extended-release (ER) and cyproheptadine in reducing total alcohol consumption (TAC) in patients with severe AUD.

This was a phase 2, double-blind, parallel-group, placebo-controlled, randomized clinical trial conducted across 32 addiction treatment centers in France. A total of 154 participants (108 men and 46 women) with severe AUD were randomly assigned to one of three treatment groups for 3 months: 1) low-dose group (LDG) with 8 mg cyproheptadine and 5 mg prazosin ER daily, 2) high-dose group (HDG) with 12 mg cyproheptadine and 10 mg prazosin ER daily, or 3) placebo group (PG). The primary outcome was the change in TAC from baseline to Month 3. Secondary outcomes included changes in heavy drinking days, abstinence days, Obsessive Compulsive Drinking Scale (OCDS), and Beck Depression Inventory (BDI) scores. Safety was assessed through adverse events (AEs), sedation, and orthostatic hypotension (OH).

A significant main treatment effect in TAC change was observed in the intent-to-treat (ITT) population (p=0.039). Compared to the placebo group, the HDG showed a greater reduction in TAC from baseline to Month 3 (-23.6 g/day, p=0.016, Cohen’s d=-0.44), while the LDG also showed a reduction (-18.4 g/day, p=0.048). In the very high-risk drinking level subgroup (>100g/day of pure alcohol for men and >60g/day for women), the HDG showed a reduction of -29.8 g/day compared to the PG (p=0.031, d=-0.51). A significant dose-response relationship (p=0.027) was observed. Both low and high doses were well-tolerated, with AEs predominantly mild or moderate. No serious adverse events were reported in the HDG, and OH incidence was comparable across groups.

The combination of prazosin and cyproheptadine showed efficacy in reducing alcohol consumption in individuals with severe AUD, with a larger effect observed in the high-dose group. Both doses were well-tolerated, with a safety profile comparable to placebo. These findings suggest that the prazosin-cyproheptadine combination may be a promising treatment option for severe AUD and warrant further investigation in phase 3 trials.

J. Guiraud Shareolder of: Vergio, Employee of: Vergio

Seasonal patterns in bipolar disorder episodes, particularly manic episodes, have been widely studied, revealing a peak in early spring and a decline in late fall. However, less attention has been given to the seasonal variation of mixed states. Mixed episodes, a subtype of bipolar disorder, are characterized by both manic and depressive symptoms. Recent studies have suggested that mixed episodes may follow a different seasonal pattern compared to pure manic episodes, peaking in late summer. Understanding this seasonality can offer valuable insights into the timing and management of hospital admissions for bipolar disorder. In this study, we conducted a retrospective analysis of hospital admissions for bipolar disorder, evaluating the influence of meteorological factors on the frequency of admissions, particularly for mixed episodes.

This study aims to analyze the prevalence of hospital admissions due to bipolar disorder at the Psychiatry Service of ULS-VDL during 2021 and 2022, with a particular focus on mixed episodes. Additionally, it seeks to explore the relationship between meteorological factors, such as temperature and cloud cover, and the frequency of admissions, identifying any seasonal patterns associated with bipolar episodes. This analysis aims to explore the potential link between environmental changes, such as temperature and cloud cover, and the occurrence of mixed states in bipolar disorder.

A retrospective analysis was conducted of hospital admissions for bipolar disorder between 2021 and 2022 (n=71) at the Psychiatry Service of ULS-VDL. Monthly averages of meteorological data (temperature, precipitation, cloud cover, and solar radiation) were obtained from a local weather station. Poisson regression was used to assess the relationship between monthly admissions and meteorological variables.

Of the 71 total episodes, 16 were mixed episodes of bipolar disorder. The results showed a statistically significant association between decreased temperature (IRR=0.843, 95% CI [1.568-0.118], p=0.023) and increased cloud cover (IRR=0.162, 95% CI [0.023-0.302], p=0.023), compared to the previous month, and an increase in admissions for mixed episodes.

The findings of this study indicate a significant association between decreases in temperature and increases in cloud cover with higher rates of hospital admissions for mixed episodes of bipolar disorder. These results highlight the potential influence of meteorological factors on the seasonality of mixed episodes. Further research is needed to confirm these patterns and to explore their implications for the management and prevention of bipolar disorder hospitalizations.

Note: We intend to increase the number of years included and episodes.

None Declared

Gambling disorder is a rising concern among young adults, highlighting the need for effective screening to offer appropriate support and intervention.

This study aims to characterize gambling disorder among young adults (ages 18-25) in Portugal.

A quantitative cross-sectional study was conducted using a self-administered online questionnaire completed by young adults.

This study included a population of 554 participants, 166 of whom were gamblers. Among the gamblers, the prevalence was as follows: 63% did not show signs of pathological gambling, while the remaining participants exhibited gambling addiction at varying levels: 25% mild, 9% moderate, and 3% severe. The typical profile of a gambler was identified as a male university student with an average age of 23.5 years, of a middle economic status and residing in an urban area. The preferred types of gambling were sports betting and online casino games. Most online gamblers had previously engaged in offline gambling at the age of M=19.25. The primary attractions of online gambling for these individuals were accessibility, the variety of games, and the potential for economic gains. The main encouragements to gamble online were friend´s influence and online advertising. No significant differences were observed in depression (PHQ-9) and anxiety scores (GAD-7) between gamblers and non-gamblers (p > 0.05). However, among gamblers, a strong positive correlation was found between higher levels of addiction (assessed by DSM-V gambling disorder criteria) and both depression and anxiety scores (r = 0.732, r = 0.681; p < 0.01). Furthermore, severe gambling cases were associated with a higher prevalence of prior formal diagnoses of psychiatric disorders, such as ADHD, anxiety, and depression, although this association was not statistically significant (p > 0.05). All gamblers showed a higher prevalence of substance abuse (p < 0.01). However, this trend did not extend to alcohol consumption (p > 0.05). The Jacobs Dissociative Experiences Scale was used to assess the presence of dissociative symptoms in relation to the severity of gambling addiction, revealing a strong positive correlation (r = 0.721; p < 0.01). Gamblers reported negative impacts on their family and romantical relationships. In contrast, they did not perceive their gambling behavior as having an adverse effect on their friendships or work performance. The majority (71.4%) of high-severity gamblers did not seek professional help and were not receiving any psychopharmacological therapy.

This study features the critical need for effective screening and intervention strategies for gambling disorder among young adults, given its correlation with mental health disorders and substance abuse. Addressing these challenges is essential for enhancing support and improving outcomes for individuals with gambling disorder.

None Declared

Mental health disorders are a leading cause of disability in European Union countries. Previous evidence highlighted the role of socioeconomic inequalities on unmet mental health care needs, varying by income or education. Being both reducing inequalities’ gaps and mental health promotion current goals of European Union (EU), it is essential to understand the differences between EU countries and the role of socioeconomic factors on this.

The study aims to assess the socioeconomic inequalities on unmet needs for mental health care in EU countries in 2019.

This was a cross-sectional study using data from the 2019 European Health Interview Survey across 26 EU countries. The main outcome considered was the proportion of self-reported unmet needs for mental health care due to financial reasons. Inequalities for income, education and degree of urbanization were assessed by calculating the rural-city, primary-tertiary education and lowest-highest income quintiles, respectively.

The proportion of self-reported unmet need for mental health care in 2019 ranged between 1.1% (Romania) and 27.8% (Portugal), with a median of 3.6%. Regarding income inequality, all countries except Hungary (ratio=0.88) showed highest share of unmet need among inhabitants with the lowest income quintile. The country with the highest inequality was Greece with a ratio of 23.8. Regarding education inequality, 15 out of 26 countries showed that less educated inhabitants had highest unmet needs of mental health care, with values ranging from 0.5 in the Netherlands and 7.2 in Bulgaria. As for degree of urbanization, rurality showed lowest unmet needs for 21 out of 26 countries, with the highest ratio being 2 in Romania.

The study highlights significant and wide socioeconomic (income, education, and urbanization) inequalities in unmet mental health care needs across EU countries.

While income inequality plays a similar role across EU countries with the poorer quintile showing higher unmet needs due to financial reasons, EU is divided on the role that education plays. On the opposite side, there is also a tendency across the EU for rural areas showing lower unmet needs for mental health care. Policymakers should prioritize strategies to ensure financial access to mental health services, as well as promoting mental health literacy and improve service availability for vulnerable populations.

J. V. Santos Conflict with: This article was supported by National Funds through FCT - Fundação para a Ciência e a Tecnologia, I.P., within CINTESIS, R&D Unit (reference UIDB/4255/2020), V. Pinheiro: None Declared

Online workers are individuals who participate in crowdsourced work. They experience a higher rate of internalizing symptoms than the general population, a phenomenon dubbed the “Turker blues.” Three large trials of online single-session interventions (SSIs) failed to find statistical or clinically significant treatment effects in this population. Because these trials tested SSIs, it is unclear if online workers are unresponsive to SSIs in general or online interventions specifically. Moreover, participants in these studies were not selected based on their desire to learn skills online, raising the possibility that intervention effects would be present in treatment-seeking individuals.

We conducted a nationwide, fully remote two-arm randomized (1:1) controlled trial to test the efficacy of a 4-week self-guided online behavioral activation treatment for depression in online workers in the United States (N=804). The intervention was designed as an extension of the Common Element Toolbox (COMET), an SSI previously found ineffective in online workers.

804 online workers were randomized to COMET-BA or a waitlist control (WLC). Self-report measures of depression, anxiety, subjective well-being, behavioral activation, psychosocial function, and emotion regulation were collected weekly for 4 weeks, 1-week post-intervention, then at a 1-month follow-up.

There was a significant time-by-treatment interaction during the intervention phase on the study, suggesting those in the COMET-BA arm improved significantly more than those in the WLC, with a small-medium effect on depression symptoms (SMD=-0.32; 95% CI: -0.47, -0.17). All but two outcomes, suppression and functioning, demonstrated significant improvement. Improvements were maintained during the 1-month follow-up period but did not grow during this period. Attrition was comparable between the treatments and the results were sensitive to missing data imputation.

COMET-BA may be effectively delivered as an unguided online intervention for depression in online workers. Crucially, intervention effects were evident after the second iBA session, suggesting that SSIs may not be effective in adult online workers.

L. Lorenzo-Luaces Consultant of: I have consulted with Syra Health, Inc. who had no involvement in the current research, A. Peipert: None Declared

Childhood trauma (CT), especially experiences of abuse and/or neglect, is highly prevalent. Although CT significantly impacts mental health, those who experience it often avoid seeking treatment. Stigma –negative beliefs surrounding mental-health and trauma, is a primary obstacle to seeking care. We recently developed and demonstrated the efficacy of a brief video intervention designed to reduce stigma and increase openness to mental health care among CT survivors. This intervention was tested in a controlled environment (crowdsourcing platforms) to ensure that broader dissemination would cause no harm. Given the central role social media plays in the lives of youth, it is crucial to explore how it can be leveraged to deliver evidence-based mental health interventions effectively.

The current study aimed to test the feasibility and acceptability of delivering this evidence-based intervention via social media, specifically Instagram. We hypothesized that the intervention would be both feasible (demonstrating high reach) and acceptable, generating better social media engagement metrics – such as higher link clicks and lower recruitment cost-per-click (CPC) rates, which indicate the intervention’s cost-effectiveness, compared to the control video.

An eight-day Instagram campaign in February 2024 targeted U.S. youth aged 18-24. The campaign featured a 60-second personal story video, previously shown to reduce stigma among CT survivors, and a psycho-educational control video providing generic mental health facts, lacking social-contact elements. We assessed the campaign’s total cost-effectiveness and key social media engagement metrics: Impressions (number of times the video was displayed), reach (number of distinct viewers), link clicks (engagement with treatment resources), and recruitment cost-per-click (CPC).

The campaign generated 628,000 impressions, reached 209,000 Instagram users, and resulted in 4,015 link clicks, indicating its feasibility. The intervention video outperformed the control video in all measures, achieving 2,062 link clicks with a CPC of $0.79, compared to 1,953 link clicks and a CPC of $0.84 for the control group.

The findings suggest that Instagram can effectively disseminate cost-effective interventions, potentially improving attitudes about CT and encouraging youth to seek help.

None Declared

Digital mental health interventions have gained prominence as accessible and cost-effective solutions in workplace settings. However, our previous meta-analysis revealed a concerning trend: despite advancements in technology, the effectiveness of these interventions has not improved over time. This stagnation may be attributed to the significant and ongoing heterogeneity among interventions which indicates both variation in both sample and the intervention. We do not kow which theraputic approaches, design aspects or intervetnkion features enahnce efficacy.

We use a Bayesian meta-regression of an unpdated systematic review to develop a comprehensive framework to guide the design, development, and evaluation of workplace digital mental health interventions. By addressing the variability in intervention approaches and design and leveraging evidence-based practices, this framework seeks to enhance the quality and effectiveness of digital solutions for employee mental health.

A systematic literature review was conducted to identify randomized controlled trials of employee based digital mental health interventions. Eligible studies were assessed based on specific criteria, including participant characteristics, intervention characteristics, and outcome measures. Data extraction and coding were performed, followed by a Bayesian meta-analysis approach. This method allowed for a more nuanced evaluation of the effectiveness of various intervention features and designs, accounting for uncertainty and prior knowledge in the field.

The review identified 95 interventions involving approximately ˜25,000 participants. The Bayesian meta-analysis confirmed small positive effects in reducing mental ill-health symptoms. Both sample and intervention characteristics contributed to heterogeneity across studies. Stress management and mindfulness interventions, particularly those designed with input from mental health experts, demonstrated more effiacy than CBT based approaches. Several intervention features, such as videos, feedback scores, and reminder texts, were associated with positive mental health outcomes.

This review provides valuable insights into the optimal design and development of workplace digital mental health interventions. The identified framework and evidence-based practices offer guidance for developers to create effective interventions that address the heterogeneity within studies. Importantly, this framework has the potential to serve as a robust evidence base for app designers, enabling them to create more effective, personalised and engaging mental health applications.

None Declared

Recovery-oriented care requires a paradigm shift from a vulnerability to a protection model. However, protective factors and resources to recovery in urban milieus remain poorly understood. Whether material, emotional or social, the identification of those resources calls for user-led initiatives and a more situated understanding of environments, where those recovery trajectories occur.

The Lausanne-based Urban Remediation program is a multi-stakeholder (service users, psychiatrists, geographers, community actors and public authorities) initiative, which aims to identify key elements of an ‘urban recovery milieu for psychosis’ and create such a milieu in the city of Lausanne (Switzerland). This talk describes the participatory methods used to create a strategy to foster recovery from psychosis in cities to better inform city’s mental health plan and policies.

We implement a living lab approach aimed at real-world experimentation in four phases: (i) exploration, (ii) co-creation, (iii) experimentation, and (iv) implementation. During phase one, we’ve used participatory mapping, go-along interviews and photovoice for an in-situ engagement with 10 young patients to ensure a systematic understanding of obstacles and resources for recovery. For phase 2, qualitative analysis and collective workshops with the various stakeholders were used to co-elaborate relevant urban interventions and identify partners for further implementation.

Introducing a Living Lab methodology to experiment the recovery-oriented strategy in a limited area in a real-world setting provides us with solutions, which can be further scaled up to inform the creation of a more inclusive city. Lessons learnt with early psychosis patients can benefit to the community as a whole, as high sensitivity of psychotic patients can teach us a great deal both regarding urban stressors and resources common to the general population.

Using real-world methodologies in cities allows to mobilize actors and resources beyond individual resilience to support recovery trajectories. Consistent transdisciplinary efforts are needed to involve all stakeholders (urban planners, mental health plan developers and society at large) for effective user-based changes and implementation of sustainable solutions.

None Declared

Bullying, deliberate aggression by a peer or group of peers in a power imbalance that favors the aggressor, is a frequent and preventable traumatic event during adolescence (Abregú-Crespo R et al. The Lancet Child & Adolescent Health 2024; 8:122–134). Mitigating its impact could be a viable strategy for psychosis prevention (Fraguas, D. et al. JAMA Pediatrics 2021; 175, 44–55). A better understanding of its influence on brain development during adolescence could be crucial for implementing effective interventions.

To study the relationship between bullying exposure (BE), distressing psychotic-like experiences (DPLEs), and multi-scale functional network connectivity (msFNC) in the developing brains of 12-year-old adolescents.

We used cross-sectional data from 12-year-old adolescents from the Adolescent Brain Cognitive Development Study, which recruited a representative sample of healthy adolescents from across the United States. We fitted a linear mixed model to predict DPLEs (Prodromal Questionnaire-Brief Child Version) with BE (Peer Experience Questionnaire) as a predictor (n=10,388). We analyzed functional magnetic resonance imaging data with reference-informed independent component analysis and a canonical and replicable multi-scale intrinsic connectivity network template to extract whole-brain 5460 msFNC features (Iraji, A. et al. Hum Brain Mapp 2023 44, 5729–5748). We fitted 5460 linear mixed models to predict DPLEs with BE as a predictor and analyzed the mediation effect of each of the 5460 FNC features (n=5,409). All models were fitted with family and site as random effects, adjusted for covariates (age, sex, race, ethnicity, pubertal development, and family income), and corrected for multiple comparisons.

BE was significantly associated with DPLEs (β=0.39, CI[0.37, 0.41], t(10362) = 41.00, p<.001, R2=0.36, p<.000) (Fig.1). DPLEs were associated with msFNC predominantly between cerebellar, paralimbic, somatomotor, insulotemporal, frontal, temporoparietal, and central executive networks (Fig.2). The association between DPLEs and BE was primarily mediated by msFNC between the paralimbic, somatomotor, insulotemporal, frontal, and temporoparietal networks (Fig.3).

Image 1:

Image 2:

Image 3:

Bullying exposure may represent a modifiable risk factor for the development of DPLEs during adolescence. It may influence DPLEs through its effects on relevant functional brain networks. The implementation of targeted interventions to prevent BE during adolescence could serve as a viable strategy to mitigate potential functional brain alterations and reduce the risk of psychosis.

None Declared

Depression is a leading cause of disability among youth, with stigma significantly hindering mental health service utilization. Untreated depression is associated with greater severity, poorer outcome, and cognitive impairment. In addition to structural barriers to service use, stigma towards mental health is a profound obstacle that impedes individuals from seeking needed services. Reducing stigma toward depression can improve perceptions of treatment and engage young individuals with depressive symptoms in behavioral services.

This study evaluates the feasibility and acceptability of delivering brief video interventions, proven to reduce depression stigma, via Instagram to promote help-seeking among youth. We hypothesized that the intervention would be both feasible and acceptable, generating higher link clicks and lower cost-per-click (CPC) compared to control videos.

A two-week Instagram campaign in February 2024 targeted U.S. adolescents aged 14-22. The campaign featured a 60-second human-narrated personal story video, previously shown to reduce depression-related stigma. The video showcased a young individual sharing their experience with depression, misconceptions about treatment, and the support they received. Engagement metrics assessed included impressions (video displays), reach (distinct viewers), link clicks (engagement with mental health resources), and CPC (cost-effectiveness). These were compared to four control videos: AI-narrated personal story (“Control 1”), human-narrated educational text (“Control 2”), AI-narrated educational text (“Control 3”), and an un-narrated educational text with background music (“Control 4”).

All five videos successfully reached a broad audience, with a combined total of 808,000 impressions, 287,000 viewers, and 4,148 link clicks. The Human-Narrated Personal Story (Intervention) video was highly effective, achieving 874 link clicks and a competitive CPC of $0.92, outperforming three of the four control videos. The AI-Narrated Educational Text (Control 3) had the highest number of link clicks (985) and lowest CPC ($0.82), while the AI-Narrated Personal Story (Control 1) had the fewest link clicks (680) and highest CPC ($1.18).

The intervention video successfully engaged the target audience, supporting its feasibility and acceptability for broader dissemination. Instagram proves to be a viable platform for disseminating evidence-based mental health interventions aimed at reducing depression stigma among youth. The study supports the potential for using social media in public mental health strategies, though further research is needed to evaluate its impact on help-seeking behaviors and across diverse demographic groups.

None Declared