Therapeutic Drug Monitoring (TDM) plays a crucial role in optimizing treatment for patients with psychiatric disorders and comorbid medical conditions, particularly in the elderly. This talk will focus on the practical application of TDM in managing polypharmacy and drug-drug interactions in a geriatric patient with mood disorders. Using a case-based approach, the discussion will highlight how TDM can guide dose adjustments, improve treatment efficacy, and minimize adverse effects in patients with multiple comorbidities.

Emphasizing real-world clinical challenges, this session will provide practical insights into integrating TDM into psychiatric practice, ensuring safer and more effective pharmacotherapy. Audience interaction will be encouraged through live voting and discussion to enhance learning and application in daily clinical settings.

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Although still somewhat reluctantly used (and thus underutilized) by many clinicians, it is the well-evidenced fact that clozapine is an effective drug for treatment-resistant schizophrenia. In order to optimize its therapeutic potential and to minimize side effects, therapeutic drug monitoring (TDM) of plasma clozapine and N-desmethylclozapine is an essential clinical tool. TDM can also help to reveal insufficient adherence or individual differences in the rates of metabolism. Moreover, clozapine plasma levels can be affected by other factor, such as smoking or concomitant medication (fluvoxamine). In our study sample, we were able to demonstrate the relationship between the dosage and clozapine plasma levels and their impact on clinical efficacy and safety.

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The pharmacological effect is the result of both pharmacokinetic (e.g., how the body affects the medication) and pharmacodynamic (e.g., how the medication affects the body) processes occurring simultaneously. Pharmacokinetics includes the processes of liberation, absorption, distribution, metabolism, and elimination (LADME). These processes govern the steady-state plasma concentration (Css). Therapeutic drug monitoring (TDM) is a pharmacological tool used to select and adjust medications. TDM enables Css measurements and dose adjustment calculations. In this presentation, the presenter will cover the main pharmacokinetic issues related to TDM in this clinical case, including Css determination, therapeutic range, dose adjustment, and pharmacokinetic calculations. Participants will learn the fundamental pharmacokinetic aspects necessary for understanding the case.

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The management of elderly patients receiving polypharmacy presents significant clinical challenges due to age-related physiological changes, the prevalence of chronic conditions, and the potential for drug-drug interactions and adverse drug reactions (ADRs). Blood level assessments of medications provide a critical tool for optimizing pharmacotherapy in this population. Here we present the benefits of therapeutic drug monitoring (TDM) and pharmacokinetic assessments in the personalized management of elderly patients with polypharmacy. Regular monitoring of blood drug concentrations can identify drug-drug interactions, related toxicity risks, and adherence issues, thereby informing dosage adjustments to achieve optimal therapeutic outcomes.

G. Schoretsanitis Consultant of: Dexcel, Saladax, HLS Therapeutics, Speakers bureau of: Saladax, HLS Therapeutics, Lundbeck, Thermo Fisher.

Psychiatrist working with ADHD-patients since 2007.

I have diagnosed and treated more than a 1000 patients with ADHD. I have always, when it has been possible, given one medication at a time to be able to evaluate how it works, and what gives side effects.

When stimulants suddenly don’t work anymore, I have searched for physical and psychological problems that could explain it. By solving these problems, the stimulants work again.

By working this way, we have noticed that patients have a high compliance, and there are a lot less cases of relapse with ADHD symptoms.

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Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition which is underdiagnosed and undertreated in women. For decades, the ADHD field has called for more insight into female-specific therapy. Preliminary findings postulate that changes in sex hormones during the menstrual cycle may influence the effectiveness of psychostimulant medication. Yet, pharmacotherapeutic interventions tailored to women with ADHD remain scarce. Previously, our group showed an increase in mood symptoms in the premenstrual week in women with ADHD. Premenstrual worsening of depressive and ADHD symptoms represent a treatment challenge.

In our adult ADHD clinic, we noted several women describing exacerbation of their ADHD and depressive symptoms in the premenstrual week and/or insufficient effect of their established dosage of psychostimulant. We responded to the need expressed by these women by increasing their stimulant dosage in the premenstrual week, while monitoring the response and side effects.

This community case study of nine consecutive women being treated for ADHD and co-occurring conditions (including depression and premenstrual dysphoric disorder), reports our local experience of increasing the individually prescribed psychostimulant dosage during the premenstrual period. We methodically monitored the effect of this increased dosage on ADHD symptoms, mood and somatic symptoms for the following 6-24 months.

With premenstrual dose elevation, all nine women experienced improved ADHD and mood symptoms with minimal adverse events. Premenstrual inattention, irritability and energy levels improved, and now resembled the other non-premenstrual weeks more closely. All women decided to continue with the elevated premenstrual pharmacotherapy.

Our preliminary results demonstrate potential benefits of increasing premenstrual psychostimulant dosage in women with ADHD, experiencing premenstrual worsening of ADHD and mood symptoms. The results concur with previous findings of diminished response to amphetamines in the late luteal phase. Increased dosage may help combat premenstrual worsening of cognitive and emotional symptoms in women with ADHD, with significant clinical implications. Better management of premenstrual ADHD and mood symptoms in vulnerable women can improve treatment outcome and meet an unmet need. However, implementation should be individually explored. Further investigation of luteal phase psychostimulant dose adjustment is required for safe, optimal and individualised treatment for women with ADHD. Specifically, we are currently applying for funding to set up the ADAPT-trial (Adjusting Premenstrual Psychostimulant Dosage for Women with ADHD: Enhancing Efficacy).

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Starting medication for attention deficit and hyperactivity disorder (ADHD) in adults begins with a thorough evaluation. Diagnostic evaluation should involve a careful investigation of the psychiatric and medical comorbidities and an interview with the patient and family members or partners. The next step is to assess the severity of ADHD symptoms, comorbidities and their impact on functioning. This will help guide the order in which targeted treatments are introduced. When selecting the medication, considerations such as the presentation of ADHD symptoms, the patient’s medical history, previous responses to ADHD treatments, and preferences about the effect onset are crucial. This choice typically lies between stimulant and non-stimulant options. The initial dose prescribed should be low enough to mitigate potential side effects while still effectively alleviating symptoms and gradually improving functioning. Treating comorbid psychiatric disorders, such as depression, anxiety, and substance use disorders, is equally important alongside ADHD treatment. The dosage should be slowly adjusted based on the patient’s response and any side effects that arise. Regular follow-up appointments are essential during this phase to monitor the medication’s effectiveness, identify side effects, and make necessary dosage adjustments. Dr Ozge Kilic will discuss key tips related to assessment, medication selection, titration, adjusting dosages, and managing side effects through clinical case vignettes.

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Artificial intelligence (AI) tools have gained attention for their potential to transform mental health care. However, in the context of psychotherapy, these tools reveal fundamental limitations that warrant critical analysis.

Psychotherapy is deeply rooted in relational dynamics, cultural sensitivity, and the ability to engage with the complex emotional landscapes of individuals. Current AI-based tools often struggle to address these dimensions adequately. While language models can generate coherent and seemingly empathetic responses, their inability to genuinely understand and respond to nuanced human emotions and interpersonal subtleties presents a significant barrier (Floridi & Chiriatti, 2020).

Ethical concerns also pose considerable challenges. The use of AI in psychotherapy raises questions about data privacy, algorithmic transparency, and the potential perpetuation of biases within AI systems. Such issues not only risk undermining the therapeutic process but may also erode trust in these technologies.

The therapeutic alliance—a critical factor in psychotherapy—represents another area of concern. Effective therapy relies heavily on building trust, mutual understanding, and a genuine connection, all of which are difficult to replicate with AI-based tools. Current research suggests that while AI can support certain therapeutic tasks, its capacity to maintain and enhance the therapeutic alliance remains unproven (Linardon et al., 2019).

This presentation will critically examine these limitations through case-based discussions and clinical reflections. By highlighting the inherent challenges of integrating AI into psychotherapy, it aims to encourage thoughtful and cautious exploration of its applications, emphasizing the importance of preserving the relational and ethical foundations of psychotherapeutic practice.

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This presentation explores the intersection of psychotherapy interventions and AI, focusing on how AI can be leveraged to augment traditional therapeutic methods. AI-powered tools such as chatbots, virtual therapists, and predictive analytics will be covered. Additionally, the talk will address the ethical implications, challenges, and opportunities posed by the use of AI in mental health care, emphasizing the importance of maintaining the human element in therapy. Drawing on current research and case studies, possible opportunities of AI assisted therapists in identifying patterns in patient behavior, improving treatment efficacy, and reducing barriers to mental health care, especially in underserved populations will be explored. The presentation will conclude with a forward-looking perspective on how AI and psychotherapy can collaboratively evolve to shape the future of mental health care.

Artificial Intelligence, Psychotherapy, Mental Health, Chatbots, Virtual Therapy, Ethical Considerations, Personalized Treatment.

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Artificial Intelligence (AI) is revolutionizing the field of psychotherapy by introducing innovative, accessible, and efficient methods for mental health care. AI-based psychotherapy practices leverage machine learning algorithms, natural language processing (NLP), and predictive analytics to provide personalized therapeutic interventions, support mental health practitioners, and enhance patient outcomes. These systems, including virtual therapists and chatbot platforms, are designed to simulate human empathy, analyze user inputs, and deliver evidence-based therapeutic techniques such as cognitive-behavioral therapy (CBT).

Moreover, AI systems assist clinicians by offering diagnostic support, monitoring patient progress through behavioral data analysis, and optimizing treatment plans. The integration of AI into psychotherapy practices has shown promise in addressing barriers such as stigma, geographic limitations, and therapist shortages. However, ethical challenges related to data privacy, algorithmic bias, and the therapeutic efficacy of AI-driven interactions remain significant concerns. This abstract explores the potential, applications, and limitations of AI-based psychotherapy, emphasizing the need for rigorous research and ethical considerations to ensure its effective and responsible integration into mental health care.

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Emerging research reveals a striking overlap between ADHD, hypermobility syndromes, immune dysfunction, and autonomic dysregulation. Studies suggest that approximately half of individuals with ADHD are hypermobile, while ADHD is significantly over-represented in those with hypermobility syndromes, such as Hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorder (HSD). Unlike benign joint hypermobility, these syndromes involve multisystem pathology, often accompanied by dysautonomia (e.g., postural orthostatic tachycardia syndrome, POTS), mast cell activation disease (MCAD), and autoimmune conditions.

This ‘somatic super-syndrome’ encompasses many of ADHD’s under-recognised somatic comorbidities, including hypermobility, allergy and autoimmunity, POTS, fatigue and pain syndromes (Chronic Fatigue Syndrome and Fibromyalgia Syndrome), and sensory processing issues, amongst others. A small but growing body of evidence suggests that mast cells - ‘first responder’ immune cells involved in allergic and inflammatory responses - play a critical role in neurocognitive function and that their excessive activation has been associated with a range of neurological and psychiatric/neurodevelopmental conditions. Could a similar issue with aberrant mast cell activation be contributing to the pathophysiology of ADHD.

Dr. James Kustow, consultant psychiatrist and adult ADHD specialist, will present the latest insights into this complex interplay between connective tissue dysfunction, chronic low-level inflammation, and autonomic dysregulation. He will explore how these factors may, in some, drive an ADHD-like syndrome and discuss emerging research on neuroimmune mechanisms linking ADHD with inflammatory disorders such as infections, asthma, rhinitis, and food allergies.

By illuminating these connections and reviewing the available evidence, this presentation will encourage a broader, integrative approach to understanding and managing ADHD. It will also consider how future research might inform novel therapeutic strategies targeting immune dysregulation and autonomic dysfunction in ADHD.

J. Kustow Consultant of: I have done some consultancy work for a couple of pharmaceutical companies but not for over 3 years, Speakers bureau of: I have previously spoken at and chaired events organised by pharmaceutical companies (but I dont speak on the subject of ADHD medication).

Jonathan will begin by outlining the impact of mental disorder and wellbeing. He will summarise effective public mental health interventions to treat mental disorder, prevent associated impacts, prevent mental disorder, and promote mental wellbeing and resilience. He will outline the scale of implementation failure of such interventions and the reasons for this. He will then set out required actions and real-world solutions to support scale implementation of public mental health interventions leading to sustainable reduction of the impact of mental disorder and the promotion of mental wellbeing.

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Jonathan will present the impacts of smoking on physical and mental health, the impact of smoking cessation on mental health and the need to reduce doses of some psychotropic medications after cessation in order to prevent toxicity. He will set out the low population coverage of evidence-based interventions for smoking cessation and prevention uptake particularly for people with mental health conditions, and the reasons for this. He will then outline implementable opportunities to scale up coordinated coverage of interventions by different sectors

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Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked genetic enzymopathy that impacts 4.9% of the population, with greater prevalence among Mediterranean, East Asian, and African populations. G6PD deficiency results in levels of nicotinamide-adenine dinucleotide phosphate (NADPH) and glutathione (GSH) that are insufficient for maintaining the balance of oxidation-reduction in the body. This results in elevated production of reactive oxygen species (ROS), oxidative stress on proteins and lipids, damage to DNA, and potential activation of chemokine and cytokine pathways by astrocytes and microglia. We propose that these direct and indirect effects of G6PD deficiency are associated with development of ADHD.

This study investigated the association between G6PD deficiency and Attention Deficit/Hyperactivity Disorder (ADHD).

The study involved 7,473 G6PD-deficient patients and 29,892 matched case-controls (selected at a 1:4 ratio) from a cohort of 1,031,354 within the Leumit Health Services database. Clinical characteristics were analyzed using Fisher’s Exact Tests for categorical variables and Mann-Whitney U tests for continuous variables.

The average age of patients was 29.2 ± 22.3 years, with 68.7% being male. The mean follow-up duration was 14.3 ± 6.2 years. Individuals with G6PD deficiency showed a significant 16% higher risk of being diagnosed with ADHD (Odds Ratio (OR) = 1.16 [95% CI, 1.08-1.25], p < 0.001) on follow up. Furthermore, G6PD deficiency was associated with a 30% greater likelihood of seeking care from adult neurologists (OR = 1.30 [95% CI, 1.22-1.38], p < 0.001) and a 12% higher probability of consulting adult psychiatrists (OR = 1.12 [95% CI, 1.01-1.24], p = 0.048). The use of stimulant medications among G6PD deficient individuals was 17% higher for methylphenidate class drugs (OR = 1.17 [95% CI, 1.08, 1.27], p < 0.001), and use of amphetamines elevated by 16% (OR = 1.16 [95% CI, 1.03, 1.37], p = 0.047).

This study establishes a significant association between G6PD deficiency and an increased risk of ADHD diagnoses. These findings suggest potential opportunities for the development of culturally sensitive interventions.

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People living with schizophrenia (PLWS) face one of the most significant health equality gaps in Europe. Their life expectancy is 15–20 years shorter than that of the general population, mainly because they are affected at an earlier age by preventable physical illnesses, but encounter barriers in accessing adequate care. PLWS did not benefit from prevention campaigns for cardiovascular, oncologic, or metabolic risk. Antipsychotics might add to the cardiometabolic risk and represent a further reason for monitoring and treating emergent conditions. Notwithstanding international guidance papers or national guidelines, PLWS do not receive adequate screening and treatment.

This presentation will summarize national and international efforts to reduce this health equality gap, illustrating the minimum screening procedures and several interventions that can be integrated into schizophrenia treatment to improve health outcomes of PLWS.

A. Mucci Consultant of: Angelini, Gedeon. Richter Bulgaria, Janssen Pharmaceuticals, Lundbeck, Otsuka Pharmaceutical, Pfizer, Pierre Fabre, Rovi. Pharma and Boehringer Ingelheim

Dysphoria and impulsivity are embodied experiences that pervade numerous psychiatric conditions and evade easy categorization within traditional diagnostic boundaries. Phenomenological approaches are needed in order to clarify underlying experiential structures. Psychopharmacology has traditionally been perceived as a “biological intervention”, where success is measured by its impact on symptom clusters outlined in the ICD and DSM frameworks, ignoring the specific impact of medication on lived bodies and existential states. An embodied approach to psychopharmacology integrates phenomenology, neuroscience, and physiology, moving beyond traditional reductive perspectives. By examining how medications influence not only symptoms but also the lived experience and embodied sense of self, we can develop a more nuanced understanding of their effects, and possibly strive towards development of distinct phenomenological profiles of medication, which would enhance our understanding of dysphoria and impulsivity.

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Gender dysphoria (GD) is defined by the presence of clinically significant suffering associated to the marked incongruence between the experienced gender and the one which was assigned at birth. The inherent duplicity to the human condition forces us to reflect on the fact that, in some cases, the body may be the most intimate piece of the Self, whilst also being the most foreign one. The experience of feelings of shame and hatred for oneself and the importance of the Other’s gaze are pressing in GD, which presents as deeply impactful in the individual’s functioning.

This review aims to identify and explore the phenomenology of the suffering so often mentioned by GD patients, but which has been ignored and remains mainly unidentified in the psychopathology realm.

Through the exploration of both the PubMed database and publications by philosophers who have been, throughout the years, approaching the gender theme and distinguishing its evolution along the years, I aim to review the qualitative literature available of the dissection of the different domains of GD.

GD is an ever growing psychiatric diagnostic, frequently presenting with psychiatric comorbidities. Its treatment poses as highly effective, while its consequences may be pervasive and affecting different domains of the individual’s functioning. The exploration of gender identity may be a never ending journey, which makes the acknowledgement of the associated psychopathology fundamental in the design of a truly empathic relationship with these patients.

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Aggressive emotions—such as anger, rage, envy, and resentment—play a complex role in human experience, spanning personal, social, and psychopathological dimensions. While anger can serve as a protective, communicative, or motivational force, it can also escalate into destructive emotions such as revenge, hatred, or resentment. This talk explores the phenomenology, psychology, and psychopathology of aggressive emotions, drawing from philosophical, psychoanalytic, and neuroscientific perspectives. These have a bodily-affective nature, shaping perception, behavior, and interpersonal dynamics (Schmitz, 2019; Landweer, 2020). While anger is often a reaction to a perceived transgression, it also functions as a regulatory mechanism for social norms and personal boundaries (Berkowitz, 1962; Bandura, 1973). I examine the ontological independence of emotions, showing how their spatial and embodied qualities influence their regulation and transformation (Fuchs, 2005). A key focus will be the transformation of anger into resentment and revenge, using Nietzsche and Scheler’s theories of ressentiment to explore how powerlessness fuels hostility (Nietzsche, 1887; Scheler, 1912). We discuss how pathological resentment differs from normative anger, leading to chronic hostility, ideological fixation, and moral superiority complexes. Finally, I analyze the role of aggressive emotions in psychopathology, considering their manifestations in personality disorders, trauma-related disorders, and psychotic states (Novaco, 1979; Cameron, 1943). From paranoia’s persecutory anger to the dysregulated aggression of borderline and antisocial personalities, the keynote explores how anger-related emotions are structured, experienced, and acted upon across clinical categories.

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Dysphoria is a complex phenomenon, which must be defined in the framework of different forms of affections. It belongs to the broader field of emotions, which are characterized by some essential features: i.e. movement, passiveness, transitoriness, and reference to the others. All these four essential features of emotion are specifically altered in depression. In discussing dysphoria, a first distinction is made between particular and global affections. The first type encompasses emotions and feelings, while the second one includes humor, mood and temper. Dysphoria belongs to one of these global affective states: the humor, which has to do with the spatial dimension of existence. In dysphoria, the patient experiences the world as oppressive and invasive of his/her intimacy; the others are lived as persons demanding answers or actions he/she is not able to fulfill. Finally, the phenomenology of dysphoria is analyzed through the four essential features described above and examples are given. Irritability – as Kraepelin taught us more than 100 years ago- is the most frequent psychic condition of these patients. The humor is very instable and depending, above all, on the interpersonal relationships. It is a typical humor of premenstrual disorder, but also of the borderline personalities, as Stanghellini and Rosfort (2013) have so clearly showed. We have also observed dysphoria in two other conditions, depression and mania, though with different nuances in the form of presentation. Finally, we would like to show how the different features characterizing emotion in general, which are derived from the etymology of the word, are present in dysphoria. First, the movement appears in dysphoria as a corporal restlessness always accompanying irritability. The dysphoric state is the opposite of being in peace with oneself and with the world. It is being under pressure, urgency, loss of control, impulsivity. Second, passivity: the subject cannot decide to be in one state or the other: dysphoria happens without notice and invades the subject, who is unable to defend himself against it. Borderline patients are unable to take distance from their emotional states and particularly from dysphoria, blaming others for the consequent discomfort. The third element is transitoriness. This feature is particularly observed in premenstrual disorder. Menstruation begins and the state disappears. Something similar occurs with pre-depressive dysphoria. In manias, by contrast, dysphoria only diminishes with the treatment. The last element we infer from the etymology of emotion is commotion, that is, its permanent reference to the other. The active participation of the other in the dynamic of dysphoria is particularly evident in borderline personalities, but also in depressive and manic dysphoria, but not in premenstrual syndrome.

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The main contributions of Spanish and Hispano-American authors to the study of basic symptoms, either published in Spanish and English, will be briefly presented. Former publications mainly included translation and validation of different versions of the Frankfurt Complaint Questionnaire, transversal and longitudinal studies, and their role for psychosocial rehabilitation, also in a Penitentiary Psychiatric Hospital. More recent research includes the network analysis of basic, attenuated, and frank psychotic symptoms on 460 subjects attending a German early detection service, where disorganized communication, delusions and hallucinations were the most central symptoms. Interestingly, cognitive and perceptual disturbances, included in basic symptom criteria, appeared to develop across attenuated symptoms to frank positive psychotic symptoms. Concerning the finding of three clusters of symptoms, “subjective disturbances”, “positive symptoms and behaviors”, and “negative and anxious-depressive symptoms”, the predominately attenuated hallucinations of both SIPS and PANSS joined the basic symptoms in “subjective disturbances”, therefore underlining the importance of insight in separating true psychotic hallucinations from other hallucinatory experiences and not justifying antipsychotic medication.

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