For decades, the standards of gender-related healthcare provided to trans and gender-diverse people have been prepared by international professional associations. These standards are often expected to rely on research evidence, but when the research evidence is not conclusive, an expert consensus is sought. In addition to the standards and guidelines updated with intervals, such as the Standards of Care for the Health of Transgender and Gender Diverse People, Version 8, and the Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline of the Endocrine Society, there are several national guidelines developed by the professionals in some European countries. There are significant similarities among these care principles concerning practical recommendations. However, the practice may vary depending on the differences in healthcare delivery systems and, more importantly, legal regulations. In general, international guidelines provide room for flexibility in practical applications. Yet, in recent years, there has been a significant change in many European countries with respect to the public appreciation of gender diversity and gender-related healthcare, mainly resulting from a politicized debate triggered by more conservative arguments rather than evidence. This backlash, which has also had a profound impact on the medical professional sphere, is a cause for concern. In this climate, it is becoming more challenging to develop and implement the standards of care for trans and gender-diverse individuals in many countries. Similarities of challenges in the implementation of standards also exist in the means of handling these challenges.

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Recently, there have been wide-ranging debates about gender affirming treatment for young people with gender incongruence. The ethical principle of self-determination of young people must be reconciled with a careful assessment and weighing up of the risks and benefits of medical treatment steps. The focus is on psychosocial support for young people struggling with gender incongruence in adolescence. The evidence for the effectiveness of medical interventions in adolescence is still limited. Nevertheless, there is a great need among affected adolescents. In a literature review and based on international debates, guidelines and treatment recommendations, a cautious and balanced approach to the question of the right support for adolescents with gender dysphoria is recommended.

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Despite the crucial need for objective diagnostic procedures in psychiatry, the research of the quantitative neural bases of mental disorders is in its infancy, and currently there are no well-validated markers that could be translated into clinical practice. Candidate brain markers for neurodevelopmental, psychotic, and mood disorders have been proposed, but confounding factors and low statistical power leave most of these markers at the very early stage of development. Increasing evidence suggests a crucial role of biological, especially including sex, and environmental factors in shaping behavioral development and psychopathological risk. Moreover, such risk seems associated with greater susceptibility to cardiovascular problems, possibly mediated by alterations in the brain-heart axis. In this context, the study of brain maturation trajectories and brain-heart interactions in relation to sex and environment can provide key insights on the etiology of complex mental illnesses.

This lecture will provide an overview of our recent research on the interactions among biological factors, in particular sex, environmental risk, brain morphology and function, and cardiac autonomic regulation in affective and psychotic disorders using multivariate analysis approaches. Evidence obtained from juvenile cohorts, including samples of twins, will be presented to provide useful information on the genetic and environmental determinants of behavioral developmental trajectories, and on sex differences in these trajectories. The complex relationships among sex, environmental risk, autonomic regulation, brain morphology and connectivity, and mental and physical health will be explored in transdiagnostic samples of young adults and elders. Special focus will be given to sex-shared and sex-specific brain and autonomic mechanisms affected by social stressors, including discrimination, bullyism, and chronic stress, and their possible role in determining the heterogeneous clinical dimensions of psychotic and affective disorders.

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Sex differences in psychiatric disorders are well-documented, yet clinical diagnoses remain primarily symptom-based, overlooking underlying neurobiological distinctions. Despite evidence of sex-specific symptomatology leading to similar diagnostic labels, treatment paradigms often follow a one-size-fits-all approach, contributing to misdiagnosis, suboptimal treatment, and delayed functional recovery. Women, in particular, are disproportionately affected, as psychiatric research has historically prioritized male cohorts to control for hormonal fluctuations and reproductive events (e.g., menarche, pregnancy, menopause), resulting in a gap in sex-specific interventions.

With the advancement of precision psychiatry, integrating sex-informed, multimodal approaches into clinical decision-making is imperative. Machine learning (ML) provides a promising avenue for improving diagnostic accuracy and individualized risk prediction, moving beyond conventional categorical diagnoses.

Here I will highlight findings from two studies leveraging ML to analyze sex-related neuroanatomical patterns:

• Neuroanatomical Sex Differences in Early-Phase Psychiatric Disorders – Investigating grey matter volume alterations in individuals at clinical high risk for psychosis (CHR), recent-onset psychosis (ROP), and recent-onset depression (ROD) using a Support Vector Machine (SVM) model.

• Sex Differences and Neuroanatomical Classification in Transgender Individuals – Exploring whether ML classifiers trained on cisgender populations accurately reflect neurobiological patterns in transgender individuals, considering sex assigned at birth, gender identity, and hormone therapy.

This research does not seek to exclude individuals with Differences in Sex Development (DSD) but rather aims to establish biological sex as a critical, yet underutilized, variable in psychiatric research. Recognizing sex-specific neurobiological mechanisms is a necessary step toward developing targeted risk calculators (e.g., for postpartum depression, suicide risk) and advancing personalized mental health interventions. By refining ML-based models and integrating sex-informed frameworks, this work contributes to the broader goal of precision psychiatry—tailoring psychiatric care to the diverse biological and psychological realities of individuals.

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Early diagnosis and intervention are essential for managing and improving long-term outcomes of severe mental illness, highlighting the need for reliable early biomarkers. This longitudinal study explores whether there are sex differences in the development of the brain during childhood and adolescence differs between offspring of parents with and without a diagnosis in the mood-psychosis spectrum.

We obtained 286 T1-weighted and diffusion weighted MRI scans of 184 offspring (aged 8–18 years at baseline) of at least one parent diagnosed with bipolar disorder (n=78) or schizophrenia (n=52) and offspring of parents without severe mental illness (n=54); 102 offspring underwent a follow-up scan (on average 3.9 years between scans). Global brain measures, regional cortical thickness and surface area, gyrification and sulcul morphology were computed. Anatomical brain networks were reconstructed into structural connectivity matrices. Network analysis was performed to investigate anatomical brain connectivity. Group comparisons and the interaction with age were analysed with (non)linear mixed-effects models. Explorative analyses will be done on the interaction with sex. To correct for multiple comparisons, we applied a Benjamini-Hochberg false discovery rate (FDR) correction (q=0.05).

A significant effect of age was found on most of the included brain features, with suggestive evidence for subtle deviations in trajectories in the cortical thickness and network metrics, but not in the gyrification index and sulcul morpholoy in offspring of parents with schizophrenia. Sex effects will be discussed during the meeting.

Our findings suggest the brain development in familial high-risk youngsters is associated with being at familial risk for schizophrenia.

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Comparing long-term outcomes in psychosis can be challenging due to widely differing definitions, measures, and populations. The remission working group led by Andreasen et al. suggested remission criteria based on positive symptoms and duration. However, there is no internationally agreed definition of functional recovery. The TIPS study is one of very few with very long-term follow-up, and this presents a unique opportunity both to investigate outcomes as well as use findings to develop valid definitions for the future.

In this longitudinal study, we explore remission patterns and functional status with regards to social contacts, living situation and employment status over 20 years.

A representative sample originally consisting of 201 first episode psychosis patients from two Norwegian well defined catchment areas in the Scandinavian TIPS study have been followed for more than 20 years with symptom and functional measures. Assessments have taken place at inclusion, one, two, five, ten and twenty years. At the 20-year follow-up, 43% of living participants were retained; 15% had died.

Data analysis is in progress, and symptoms and function results will be presented.

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The Danish OPUS trial was originally a randomized controlled trial testing Early Intervention Services among individuals diagnosed with schizophrenia spectrum disorders between the years 1998-2002. Today, the OPUS trial includes a unique cohort of individuals (n=578) longitudinally followed and clinically assessed for more than two decades after a first diagnosis within the schizophrenia spectrum. Using longitudinal Danish register data and clinical data from the Danish OPUS cohort, we explored the effects of early intervention services including symptom remission, use of antipsychotics, hospitalization, global functioning and other aspects of life including social relations, parenthood, and mortality.

Investigating modern-era treatment facilities in 20 years of follow-up of the OPUS trial, we found no evidence for long-term disease-modifying effects from two years of Early Intervention Services compared to Treatment as Usual. While a majority of participants experienced a reduction and stabilization of psychotic symptoms over time it seems half of all the participants experienced no significant improvements in negative symptoms. Still, 17% were in clinical recovery, and 40% were in symptom remission. Combining clinical data from the Danish OPUS cohort with the Danish registers, we found that 29% (n=120) of individuals were in current treatment with antipsychotic medication after 20 years of follow-up. A total of 36% (n=51) of the clinical sample were in remission of psychotic symptoms and off antipsychotics with better clinical outcomes compared to individuals in non-remission off/on medication. Additionally, a substantial proportion of 38% (219 out of 578) of individuals in the OPUS cohort had become parents over two decades, and on average, they had better functional and clinical outcomes than their counterparts without children. A mortality rate of 14.2 was found. Suicide was the single most common cause of death, but death due to natural causes and death due to unnatural causes made of roughly half of all deaths each.

While many patients may achieve remission of psychotic symptoms, our findings suggest negative symptoms are of a much more chronic nature. Investigating the use of antipsychotics over 20 years a substantial proportion were in remission and off medication. Since an observational study design cannot differentiate between cause and effect, these individuals still set a benchmark for good outcomes in schizophrenia. Also, 38% of individuals had become parents over two decades, and cross-sectionally, they had better illness prognosis and lifetime course than their counterparts without children. Finally, one in seven of the participants in the OPUS trial had died during follow-up. Suicide is a vital problem even many years after diagnosis and suicide-preventive measures are needed in the later course of illness.

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People with psychosis present a significantly higher premature death, leading to a reduction of life expectancy of up to 15-20 years.

To a high extent, this premature mortality is due to a higher incidence of common physical conditions, appearing earlier than in the general population. Traditionally, the focus has been put on the cardiovascular diseases. However, more recently, there ir mounting evidence of the contribution of other conditions to this premature mortality, such as repiratory (e.g.: chronic obstructive pulmonary disease) and liver (MAFLD) conditions.

We are presenting results from PAFIP and ITPCan early intervention programs (Cantabria, Spain), regarding the early impact of psychosis on physical health, observing early alterations at the organic level (e.g.: liver, lung), which precede the development of chronic organic pathology causing premature mortality in the general population.

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Cohort studies in first-episode psychosis (FEP) provide crucial insights into the diverse trajectories of clinical and functional recovery. These studies are invaluable for evaluating the effectiveness of new intervention models and informing resource allocation and policy development.

To synthesize quantitative and qualitative findings on mortality and clinical outcomes and to explore their interrelations in a multi-modal investigation of long-term outcomes in FEP. Specific objectives include appraising how this study’s findings have influenced the development of new models of care.

Data were drawn from the iHOPE-20 study, comprising cohort analyses and qualitative interviews with 171 FEP participants diagnosed between 1995–1999 in Dublin, Ireland. Participants with lived experience contributed to the design of the 20-year follow up assessments. Mortality rates were calculated; symptoms, functionality and quality of life trajectories were analyzed using mixed models; and personal recovery themes were derived through thematic analysis. Ongoing analyses are addressing predictors of the number, timing and sequencing of relapses/readmissions among baseline variables as foci for service development.

The study revealed substantial variation in long-term outcomes among individuals with FEP. Shorter DUP was consistently associated with better outcomes across all of the follow-up points. Mortality rates highlighted the importance of interventions to address physical health morbidity. Diagnostic instability over time underscored the dynamic nature of psychosis management. Employment status at follow-up highlighted the importance of strategies to support a return to education or employment after a first presentation.

Findings emphasize the enduring impact of DUP and the need for tailored interventions. Data from this cohort highlight the value of longitudinal insights as a benchmark for comparing the effectiveness of new intervention models. In such studies, addressing ethical and data protection challenges, incorporating the expertise of those with lived experience and harmonising outcome measures remain vital to advance recovery-oriented care models.

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A growing body of literature report, that vulnerable groups eg refugee, asylum seeker and forcibly displaced groups across Europe face social and psychological challenges linked to their minority status, often involving discrimination and racism. Moreover, they have to overcome many other barriers to accessing healthcare and preventive interventions. There is increasing evidence that a large proportion of refugees or forcibly displaced persons suffer from the consequences of traumatic events and exhibit psychological problems or develop mental disorders, including post-traumatic stress disorder, depressive and anxiety disorders, and relapses in psychotic episodes. European countries are aware that psychosocial and health services face major challenges and need to develop or expand strategies to overcome them. The direct and indirect consequences of humanitarian catastrophes cannot be estimated at present. In this presentation, strategies to improve the access of forcibly displaced people to mental health care services will be presented and discussed.

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In this talk I will discuss current findings related to therapeutically informed (e.g., Mindfulness and CBT based) universal school-based interventions for mental health. For example, I will highlight the evidence showing that many of these interventions often lead to null or unstained positive effects, have the potential to elicit negative effects and are not well liked by young people themselves. I will end by suggesting the field moves away from these universal interventions, towards more effective alternatives such as targeted, indirect and 1:1 interventions

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Children and young people spend much time in school and therefore the school setting provides an important setting in which to intervene to promote, protect and enhance mental health. This presentation will provide an overview of the importance of making an economic case for action within schools. A scoping review has been undertaken to map the types of interventions that have been subject to cost-effectiveness evaluation. Aspects of the strengths and weakness of the existing evidence are presented. Implementation and sustainability challenges are also discussed, given the need for collaboration between the health and education sectors.

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Children in special education schools are particularly susceptible to developing mental health issues. Specifically, it is estimated that 40% of individuals with intellectual disabilities have a comorbid mental disorder diagnosis (1). However, access to mental health services for patients with intellectual disabilities remains far below expectations. Numerous barriers impede this access, including a lack of coordination between professionals and service providers responsible for their care (2).

Therefore, interventions within special education schools, promoting early detection and intervention for psychopathology and facilitating coordination between educational and healthcare services, are critically important.

We present an innovative mental health care resource designed for special education schools in the Community of Madrid, Spain. This initiative combines multi-disciplinary expertise with flexible, hybrid care delivery to ensure accessibility for students across 14 public schools. The team consists of a psychiatrist, a clinical psychologist, and a mental health nurse who provide both in-person and remote assistance, addressing the psychopathology exhibited by their students.

Preliminary results suggest that this intervention has the potential to improve early detection rates of mental health issues and foster better coordination between education and healthcare systems. This model could serve as a blueprint for similar programs worldwide, addressing significant gaps in mental health care for children with intellectual disabilities.

(1) Cooper, S. A., Smiley, E., Morrison, J., Williamson, A., & Allan, L. (2007). Mental ill-health in adults with intellectual disabilities: prevalence and associated factors. The British Journal of Psychiatry, 190, 27–35. https://doi.org/10.1192/bjp.bp.106.022483

(2) Whittle, E. L., Fisher, K. R., Reppermund, S., Lenroot, R., & Trollor, J. (2017). Barriers and enablers to accessing mental health services for people with intellectual disability: A scoping review. Journal of Mental Health Research in Intellectual Disabilities, 11(1), 69–102. https://doi.org/10.1080/19315864.2017.1408724

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Mental health issues among children and adolescents have risen, particularly following the COVID-19 pandemic. Despite increased awareness, less than half receive necessary care, leading to long-term consequences. The World Health Organization advocates for integrated, preventive community interventions to address this gap. This paper presents the Mental Health Clinical Liaison Programme for Schools in the Community of Madrid, Spain, which provides school-based activities led by multidisciplinary mental health teams. The programme focuses on early detection, intervention, and prevention strategies for children and adolescents. We describe its implementation, review supporting evidence, provide preliminary data, and discuss its scope and challenges. Between 2023 and 2025, the programme has reached over 100 primary and secondary schools, identifying more than 1,700 cases, evaluating over 500 students, and referring 232 to specialized services. It has also supported interventions for more than 400 students already in mental healthcare and facilitated 45 reintegrations following psychiatric hospitalization. Additionally, anti-stigma workshops have engaged approximately 2,500 students. Ongoing research aims to assess the programme’s effectiveness and cost-effectiveness to ensure continuous improvement in mental health services for young people.

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Alcohol use disorder (AUD) has a significant impact on the individuals affected, their relatives, and the society at large. Given the limited efficacy of currently available treatments, there is a pressing need for a more comprehensive mechanistic understanding. In particular, consideration must be given to the dynamical and real-world aspects. The objective of this study was to investigate the association of dynamic variations across menstrual cycle phases (indicative of progesterone-to-estradiol ratios) in women with AUD and progesterone-to-estradiol ratios in men with AUD with real-world problem drinking. To this end, longitudinal data from the German TRR265 cohort (comprising smartphone entries on alcohol consumption, craving, and loss of control, self-reports on menstrual cycle phases, and blood progesterone-to-estradiol ratios) were subjected to analysis. In women with AUD, the lowest levels of problem drinking, craving, and loss of control were observed during the late luteal phase, when the progesterone-to-estradiol ratios reached their peak. Similarly, in men with AUD, higher progesterone-to-estradiol ratios were associated with lower problem drinking, craving, and loss of control. Some of these effects were moderated by the severity of the AUD. The results highlight the progesterone-to-estradiol ratio as a promising future treatment target and point to the necessity of cycle phase-tailored treatments for women with AUD.

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Clinically derived approaches take the different psycho-social and biological conditions into regard and thus render more homogeneous groups, than the current diagnostic criteria, like ICD-11 or DSM 5. Precision medicine, moreover, shows that the amount of drinking, the reason for drinking and thereby also gender seems to be relevant for testing different anticraving drugs. Precision medicine indicates the necessity for more homogeneous subgroups, in order to find differences in the effects of anticraving substances. Many typologies in AUD render more homogeneous subgroups (Lesch et al, 2020). They could increasingly be used for testing anticraving drugs. After presenting these basics in anticraving research, the results of two trials will be presented. First, some genetic results could only be defined in Lesch type 3 female patients (Procopio et al, 2013). Second, in a treatment trial of ondansetron the genetic conditions lead to better sobriety rates only in the not very high drinking group (less than 10 drinks per day) but not in the very high drinking group (Addolorato et al, 2024). Summarizing these research results we see that for anticraving trials we need even more carefully defined subgroups of AUD patients. References: Lesch OM, Walter H, Wetschka Ch, Hesselbrock MN, Hesselbrock V, Pombo S: Alcohol and Tobacco. Medical and Sociological Aspects of Use, Abuse and Addiction. Springer Verlag, 2nd Edition, 2020. Addolorato G, Alho H, Bresciani M, DeAndrade P, Lesch OM, Liu L, Johnson B.: Safety and compliance of long-term low-dose ondansetron in alcohol use disorder treatment. Eur.J.Intern Med, Sept. 127: 43-49; 2024. Procopio DO, Saba LM, Walter H, Lesch O, Skala K, Schlaff G, Vanderlinden L, Clapp P, Hoffman PL, Tabakoff B. Genetic markers of comorbid depression and alcoholism in women. Alc Clin Exp Res. Jun. 37 (6): 896-904, 2013.

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Dual diagnosis, the co-occurrence of substance use disorders (SUD) and mental health conditions, presents unique challenges influenced by gender-related factors. This narrative review explores the role of gender in the epidemiology, treatment access, environmental factors such as intimate partner violence, clinical features, and outcomes of dual diagnosis, highlighting structural and social determinants that exacerbate disparities. Women and gender minorities with dual diagnosis face heightened stigma, higher rates of trauma, and significant barriers to healthcare, often resulting in delayed treatment and poorer prognoses. Additionally, traditional gender roles and caregiving responsibilities influence coping mechanisms and treatment adherence. Despite increasing awareness, research on gender-responsive interventions remains limited. This review underscores the need for gender-sensitive approaches in dual diagnosis treatment, advocating for integrated, trauma-informed care that addresses the specific needs of diverse gender identities.

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Alcohol is a major risk factor for mortality and morbidity worldwide (Agabio et al., 2017). Women are affected by specific alcohol-related consequences, including a dose-dependent increased risk of breast cancer from relatively low levels of alcohol consumption, of which many women remain unaware (Agabio et al., 2022), and risk of foetal alcohol syndrome, in their offspring, if alcohol is consumed during pregnancy (Minozzi et al., 2024). Alcohol use disorder (AUD) is a severe and frequent mental disorder with devasting consequences (Agabio et al., 2017). In US, approximately one out of 4 women suffer for this disorder during their lifetime (MacKillop et al. 2022). Although effective treatments are available (Agabio et al., 2024), AUD is undertreated, with stigma being one of the main reasons for not seeking medical treatment (MacKillop et al. 2022) Women usually experience more severe barriers to AUD treatment than men, with pregnant women experiencing more severe barriers than non-pregnant women (Agabio et al., 2017). Another reason of the scarce use of medical treatment is constituted by the widespread belief that available medications are not effective, or rather, are not effective for all people with AUD. Although sex and gender differences have been described in the response to medications, AUD medications have been studied almost exclusively in men (Agabio et al., 2016). In addition, the number of women with AUD is increasing and services for treatment of AUD should (a) consider women’s specific needs, and (b) realize effective policies to reduce latency prior to accessing medical treatment for both men and women with AUD (Agabio et al., 2021). Nevertheless, recent studies show that only a small number of services have adopted a gender medicine approach in AUD treatment (Vignoli et al., 2024).

Agabio et al. Efficacy of Medications Approved for the Treatment of Alcohol Dependence and Alcohol Withdrawal Syndrome in Female Patients: A Descriptive Review. Eur Addict Res. 2016.

Agabio et al. Sex Differences in Alcohol Use Disorder. Curr Med Chem. 2017.

Agabio et al. Gender Differences among Sardinians with Alcohol Use Disorder. J Clin Med. 2021.

Agabio et al. Alcohol Consumption Is a Modifiable Risk Factor for Breast Cancer: Are Women Aware of This Relationship? Alcohol Alcohol. 2022.

Agabio et al. Efficacy of medications for the treatment of alcohol use disorder (AUD): A systematic review and meta-analysis considering baseline AUD severity. Pharmacol Res. 2024.

MacKillop et al. Hazardous drinking and alcohol use disorders. Nat Rev Dis Primers. 2022.

Minozzi et al. Psychosocial and medication interventions to stop or reduce alcohol consumption during pregnancy. Cochrane Database Syst Rev. 2024.

Vignoli et al. Needs of female outpatients with alcohol use disorder: data from an Italian study. Alcohol Alcohol. 2024.

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Open-door policy is a WHO-recommended framework to maximise safety, prevent coercion, and enhance recovery-based practices during admission to mental health wards. This talk will describe the open-door policy intervention, present results from our 1-year RCT and preliminary 5-year results from the Lovisenberg Open Acute Door Study (LOADS). LOADS is a 5-year in-clinic dual RCT study of open-door policy co-created with user representative and staff in our inner-city acute mental health wards in Oslo, Norway. By combining random allocation, effectiveness outcomes and implementation research, LOADS aims to address the need for faster development of clinically relevant knowledge in mental health.

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Coercive practices in mental health care can infringe upon human rights, necessitating urgent global action to eliminate them. However, inconsistencies in clinical practice, fragmented research on effectiveness, and limited understanding of barriers and facilitators hinder the real-world transformation of services. As part of the COST Action FOSTREN (Fostering and Strengthening Approaches to Reducing Coercion in European Mental Health Services), Working Group 4 Implementation Science conducted a systematic review to examine the models, theories and frameworks employed by studies in implementing programs aimed at reducing coercion in mental health settings and the reported implementation outcomes. A comprehensive search was conducted across multiple databases, resulting in the inclusion of eight studies (nine papers). The identified coercion reduction programs utilized holistic approaches, risk assessment methods, staff training, and sensory modulation interventions. All of them were conducted in inpatient settings. Eight different implementation tools were identified, but none of the studies reported all sought implementation outcomes. The most frequently reported outcomes were acceptability and adaptation, while no studies provided data on implementation costs. Overall, the quality of the studies assessed was relatively low. The review highlights the underutilization of systematic implementation models, theories and frameworks when embedding coercion reduction interventions in routine mental health care, especially in emergency psychiatry settings. Further research, incorporating the perspectives of service users and carers, is needed to address this gap and determine the costs and resources required for implementing complex interventions with implementation models, theories and frameworks guidance.

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