Mood in puerperium is a subject of great interest since it can undergo variations in such a significant period of a woman’s life as motherhood. It is equally true that the presence of a partner with a secure attachment style can constitute a stable base for a woman to lean and to rely, while it is more likely to hypothesize cracks in mood in absence of effective support in the relational context.

The aim of this research is to analyse the trend of puerperal mood in women in the period immediately following the delibery and after a few months. The study also examines the attachment styles of the partners of these women and the relationship between mood in women and the attachment of their partners.

The study was conducted on a sample of women and their partners.

The women were administered 2 administrations of the Edinburgh Peripartum Depression Scale (EPDS): the first within 24 hours of delivery and the second four months after delivery.

The Relationship Questionnaire (RQ) was administered to the male partners immediately after the evnt of delivery.

The data were analyzed from a statistical point of view, with analysis of variance (ANOVA) and post hoc tests.

A 2-way ANOVA with repeated measures was performed using the different attachment styles as emerged from the RQ (secure attachment and insecure attachment) in the partner group as the independent variable and the EDPS scores in the 2 times (EPDS1, EPDS2) of the women themselves as the dependent variable. The ANOVA described the main effect of Time as significant (F (1, 14) = 5.79; p < .05). The post hoc (LSD - Least Significant Difference test) highlights how there is a significant decrease in the EPDS score of women in the before-after comparison (M = 8.71 vs M = 4.93; p = .005) considering, as an independent variable, the secure attachment group of partners. While this decrease is not significant in the group of partners with insecure attachment.

The initial data of this study suggest that security in the attachment style of the partner can favor an increase in the mood of the woman after a delivery. In particular, the research data tend to highlight a significant improvement in the mood of women 4 months after giving birth. The proximity of a partner with secure attachment therefore seems to favor a good mood in the woman in pueperium.

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Schizophrenia is a major cause of severe global functional disability with negative symptoms that greatly affect functional outcomes. These symptoms are divided into expressive (e.g., facial affect and voice tone) and experiential (e.g., amotivation and asociality) dimensions.

This study assessed the effectiveness of Cognitive Behavioral Social Skills Training (CBSST) in enhancing functioning in individuals with schizophrenia. It examined the link between defeatist performance attitudes and functional changes post-CBSST.

We conducted a comprehensive search of PubMed, Embase, and Cochrane databases up to September 2024 for studies comparing CBSST with standard treatments for schizophrenia. We calculated the mean or standardized mean differences (MDs and SMD) for continuous outcomes along with 95% confidence intervals (CIs). Heterogeneity was evaluated using the I² statistics.

Our review included 7 studies with 462 patients, of whom 219 (47.4%) received CBSST. There were no significant differences between the groups regarding positive symptoms (SMD 0.19, 95% CI -1.01 to 0.64, I² = 95; Figure 1A), negative symptoms (SMD -0.84, 95% CI -1.85 to 0.17, I² = 93; Figure 1B), Depression Scale scores (SMD 0.18, 95% CI -0.20 to 0.57, I² = 62; Figure 1C), or the Independent Living Skills Scale (MD 0.05, 95% CI 0.04 to 0.06, I² = 0; Figure 2). However, the independent living skills scores were significantly lower in the control group.

Image 1:

Image 2:

CBSST is effective in enhancing functioning in individuals with schizophrenia. Along with other supportive goal-oriented interventions, it can alleviate symptom distress, boost motivation and self-esteem, and enhance life satisfaction. Individuals with severe defeatist performance attitudes may experience the greatest benefit from cognitive-behavioral approaches that target functional improvements.

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Numerous studies indicate that caregivers of patients with schizophrenia experience significant burden and exhibit depressive symptoms as measured by the CES-D scale. Specific psychoeducational programs like the multifamilal CBT based Profamille program may help alleviate these symptoms. However, it is yet to be established the extent to which these caregivers meet the criteria for clinical depression as defined by the DSM-5, as well as whether the interventions employed in this program can effectively reduce the prevalence of depressive disorder among caregivers.

Assess the prevalence of major depressive disorder among caregivers at the start and end of the Profamille psychoeducational multifamily program.

Caregivers were referred to the program by family organizations, welfare services or healthcare providers, or found out about the program through the local press.

A group consists of twelve caregivers of approximately ten patients, participating in 14 structured weekly sessions of Profamille program version V3.2, each lasting 4 hours. These sessions provide information about schizophrenia, develop coping strategies for caregivers, and employ behavioral and cognitive techniques to address depressive symptoms.

Mood was assessed using the PHQ-9, a self-report questionnaire consisting of nine items aligned with diagnostic criteria for major depressive disorder. Responses were analysed using an algorithm based on DSM-5 criteria to classify participants as having or not having major depressive disorder.

Given the paired nominal data, McNemar’s test was employed for analysis

A total of 507 caregivers were recruited, including 349 women. The average age of the participants was 58.0 years (SD = 9.0). At the beginning 14.6% of participants had a diagnosis of major depressive disorder. Fourteen sessions later this rate decreased to 5.7% (McNemar’s test, p-value < 0.00001)

The annual prevalence of depression in the general population is approximately 5%, indicating a threefold over-representation among caregivers participating in the program. This rate of over-representation is consistent with other studies utilizing the CES-D, which also captures subclinical depression. Given the implications of depression for participants’ physical health, this underscores the need for systematic investigations aimed at providing support. The Profamille program, which employed specific cognitive behavioral techniques in a group setting, resulted in a significant reduction in depression rates over 14 sessions, bringing the final rates more in line with those of the general population. These findings suggest that the program effectively normalized the prevalence of depression. However, the absence of a control group limits our ability to assess the natural progression of depressive symptoms without program participation

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As part of our comprehensive early intervention program for psychotic disorders (RIPEPP), we have been conducting psychodynamic group psychotherapy for family members since 2005. This type of therapy intended for family members of patients that are motivated for psychological work and the correction of maladaptive forms of family interactions. The 90-minute sessions are held every two weeks under the guidance of a psychiatrist – group analyst.

At the beginning of this new experience, we applied group analytical principles in the group. Due to the large drop out and specific dynamics, we gradually changed the therapeutic technique and became more flexible and supportive.

During the years of therapy, with the strengthening of group cohesion, it was gradually possible to switch again from a more flexible and supportive method to the classic group analytical technique.

In this presentation, we will show vignettes from the therapeutic process.

An overview of the need to modify the group-analytic technique in the treatment of family members of individuals with psychotic disorders.

Following the protocol of group sessions.

Over the course of the therapeutic process, the group members become more ready for group analytical work, which is adapted and applied in sessions in which they openly talk about themselves, their feelings and partner relationships. The modification of the group analytic technique is still at work with a continuously present psychodynamic understanding.

A group-analytic approach is applied in the treatment of family members of individuals with psychotic disorders. The frequent occurrence of dropouts among group members highlighted the need to modify the group-analytic technique, with the potential to revert to the classical method by strengthening group cohesion and improving family dynamics.

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Borderline Personality Disorder (BPD) is characterized by abandonment schemas, impairments in emotion regulation, and attachment issues. The literature shows significant evidence that psychotherapy is effective in the treatment of BPD in addition to pharmacotherapy. The therapeutic relationship established with the patient is a crucial component of psychotherapy processes and plays a vital role in the prognosis of the disorder. Working on the therapeutic relationship is essential to maintain an effective psychotherapy process in BPD treatment. The therapeutic alliance is at the core of the treatment’s success. When a therapist takes a break from the therapy process (due to reasons such as vacation, childbirth, or loss), ruptures may form in the therapeutic relationship with patients diagnosed with BPD.

This review compiles and synthesizes findings from empirical and case studies on the effects of breaks in psychotherapy treatment for BPD patients.

PsycArticles, Web of Science, PubMed, and Google Scholar were reviewed.

Immediately following a therapy break, BPD patients often experience intense feelings of anger, anxiety, and frustration. At the same time, in the long term, this can lead to distrust in the therapist and weaken the therapeutic relationship. Moreover, acting-out behaviors tend to increase during this period. For inpatient patients, this can be observed as non-compliance with clinic rules or using verbally inappropriate expressions.This break in the therapy process activates the abandonment schema, which is a core characteristic of BPD. Patients with borderline personality organization return to the dysfunctional coping strategies they had previously developed.

These results highlight several important areas of discussion for clinical practice and research. Firstly, BPD patients should be informed about upcoming therapy breaks and prepared for the absence, and expectations should be discussed openly. Secondly, after the break, working on the therapeutic relationship, mistrust, the activated abandonment schema, and negative emotions directed toward the therapist will contribute to the healing process. Thirdly, given the risk of suicide linked to impulsivity and acting out, the therapist should develop an action plan. Fourthly, maintaining the therapeutic framework is one of the most critical steps in the recovery of BPD patients, so it is crucial to preserve the framework even during therapy breaks. Lastly, due to the gap in the literature on this subject, there is a need for more empirical studies and research on how to repair potential ruptures in the therapist-patient relationship that occur during breaks.

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Clinically insight is a multifaceted phenomenon related to acceptance of one’s condition as being psychiatrically ill, recognition of symptoms as pathological, recognition of the social consequences of illness and treatment acceptance. The common features of psychotic disorders are symptoms classified through several dimensions: positive symptoms, negative symptoms, cognitive symptoms, affective symptoms and psychomotor symptoms. These symptoms often cause impaired reality testing and poor insight. Impaired insight is common during early stage of psychosis with its prevalence ranging from around 30-50% and may cause treatment delays, more severe symptoms, poorer treatment adherence, involuntary admissions, potentially aggressive behaviour, poorer social functioning and outcomes. Insight is directly related to the severity of psychotic symptoms and inversely related to depression score. Enviromental factors such as family beliefs and stigma can influence on insight level. Considering that the first symptoms of psychosis often appear in young adulthood while the affected still live with their parents, we believe that the role of parental insight is important in recognizing the signs and treating psychosis.

Aim of this study was to investigate level of patient’s and parent’s insight into early psychosis.

We performed a cross-sectional study on 105 diads parents - children suffering from early stage of the psychotic disorders, during disease < 5 years, diagnoses from the spectrum F20-F29, both sexes, aged 18-35 years who were hospitalized at “Sveti Ivan” Psychiatry Clinic. The purpose and objectives of the research were explained to all participants, and they signed informed consent. The instruments used: sociodemographic questionnaire, The Scale to Assess Unawareness of Mental Disorder - Abbreviated version (SUMD), The Positive and Negative Syndrome scale (PANSS) – The Five factor models, Clinical Global Impression-severity scale (CGI-s). The research was conducted in accordance with Helsinki declaration.

Among the patients, the male gender is slightly more represented, with a good level of education, mostly with the F23 diagnosis, while in the group of parents, mothers are significantly more represented. On the PANSS Five Factor scale, the patients showed significant improvement in all domains. The patients were more aware of their disorder than their parents. The fathers were more aware of their children’s disorders than mothers.

The research has contributed to clarifying the complexity of the issue of insight and complex relationships between parents and children, pointing to the necessity of family psychotherapy and psychosocial interventions in the treatment of patients in the early stages of psychotic disorders.

None Declared

Medical school is known for high levels of anxiety, and mental health challenges. Psychological flexibility - the ability to accept difficult thoughts and emotions while acting in alignment with one’s values- can protect against these challenges. ACT has been shown to enhance psychological flexibility and reduce mental health symptoms in various populations. However, its impact on medical students has not been extensively explored.

This study aimed to assess whether a brief ACT intervention could improve psychological flexibility and related psychological outcomes in medical students.

Forty-two medical students from Istanbul Medeniyet University participated in a four-day ACT program. Inclusion criteria included active enrollment in a medical program and willingness to participate. Exclusion criteria were severe psychiatric disorders or ongoing psychiatric treatment.The intervention involved four days of ACT-based activities, including mindfulness, cognitive defusion, and value-based exercises. Each session lasted 90 minutes and was conducted in a group format. To assess the impact of the intervention, we measured psychological flexibility and related factors at baseline and after the program using the following tools: the Multidimensional Experiential Avoidance Questionnaire (MEAQ-30), AAQ-US, SF-25, Valuing Questionnaire (VQ) and the DASS-21. Paired t-tests were used to compare pre- and post-intervention scores, with statistical significance set at p < 0.05.

The ACT intervention led to significant improvements in psychological flexibility and related factors. The ACT intervention led to significant improvements in psychological flexibility and related factors. Specifically, Distress Aversion (MEAQ-30, subscale B) decreased significantly (p = 0.010), while Distress Endurance (MEAQ-30, subscale F) increased significantly (p = 0.008). Additionally, Anxiety (DASS-A) decreased significantly (p = 0.004), and Stress (DASS-S) also decreased significantly (p = 0.004). No significant changes were observed in other subscale scores, including those for SF-36, depression (DASS-D), and scores for AAQ-US and VQ. These results suggest that ACT may be particularly effective in reducing anxiety and stress while enhancing cognitive flexibility and acceptance.

This study suggests that even a brief, four-day ACT intervention can significantly improve psychological flexibility and reduce anxiety and stress in medical students. These findings highlight ACT’s potential as an effective tool for supporting mental health and resilience in medical students. Further research with larger sample sizes and longer follow-up periods is needed to explore the long-term impact of ACT interventions in academic settings.

None Declared

Vicarious trauma (VT) was first described by Pearlman and McCann as the therapists’ internal experience that is “impacted as a result of empathic engagement with client’s traumatic material”. (JTS 1990. 3: 131–149). Furthermore, the authors used a constructivist framework to differentiate it from other forms of secondary trauma. In the context of mental illness, family elements of VT are be more subtle than primary trauma, but can remain identifiable across generations.

The primary focus of our study was to develop a theoretical framework for understanding severe mental illness (SMI) and its traumatic long-term consequences on the family. Our secondary aim was to explore the impact of SMI and of psychiatric stigma on 2nd and 3rd generation offsprings.

To begin with we conducted a narrative review of the scientific literature using Pubmed search engine. This was followed by a qualitative study with psychiatric patients who declared a family history of SMI in a first degree relative who received medical care in France. The methodology involved conducting 11 structured interviews, which were audio recorded, transcribed and thematically analyzed.

When family trauma develops, it is a complex phenomenon, seemingly infinite loop. It further impacts every aspect of the family’s communication and relational style, attachment and regulation.

On an individual level, the consequences can be viewed as a continuum from adverse childhood experiences and primary trauma to secondary traumatic responses. This study aims to advocate for identifying specific VT subtypes. Some specific complaints are often encountered in the initial presentation of psychiatric patients, even with adults as young as 18yo. Exploring family psychiatric history through the vicarious “trauma lens”, can allow us to have a better appreciation and understanding of the patient’s suffering: their system of meaning and beliefs regarding psychiatric diagnosis, treatment and case management are often disrupted, the nocebo effect is increased (by increased sensitization to all other trauma and by modified emotion control). When the sense of safety is disturbed on a family basis multi-generational level, the consequences could lead to extreme anti-psychiatry attitudes and predict negative mental health outcomes.

Current understanding of vicarious trauma is limited to specific job-related contexts. What has not been studied yet is the vulnerability of children to vicarious trauma due to perceived traumatizing treatment, or the way in which medical stories are recounted to children. Therefore, additional research is needed on this topic. For psychiatrists, the vicarious trauma approach can be one of the key entry points to building the therapeutic alliance, which further enhances patient adherence to the treatment.

None Declared

In the general population, the lifetime prevalence rates for obsessive-compulsive disorder (OCD) range between 1.9% and 3.3%. In patients with schizophrenia, the prevalence rates of OCD range between 7.8% and 26%. Accurate diagnosis has prognostic and treatment implications.The empirical basis regarding the optimal treatment for comorbid OCD in patients with schizophrenia is almost nonexistent.

We report a successful treatment course of intensive CBT for a patient with OCD comorbid with schizophrenia and reflect on the difficulties in the management and treatment of these cases.

We describe a case report in which OCD emerged gradually after the remission of positive symptoms of schizophrenia. The CBT involved psychoeducation, case formulation, cognitive restructuring, and exposure and response prevention.

The case is a 24-year-old male, single, with no comorbid somatic diseases. He was admitted to our psychiatric ward for self-muttering activity and delusion of thought broadcasting from the past year. A diagnosis of schizophrenia was made. We started risperidone gradually titrated to 6 mg/day. During his follow-up period, he reported having repetitive and intrusive thoughts of blasphemous nature despite well-controlled psychotic symptoms. He acknowledged these thoughts as originating in his own mind but was unable to stop them on his own accord. He also reported obsessions related to contamination and disgust. This led to compulsive hand washing and avoidance behaviour of some objects, which was both distressing and time-consuming. The diagnosis was revised to comorbid schizophrenia and OCD. Antipsychotic was changed from risperidone to amisulpride 800 mg daily in combination with paroxetine up to 60 mg/d. Since paroxetine was already optimized, the next step taken was to substitute it. He was then medicated with amisulpride, and clomipramine slowly increased up to 225 mg/d. There was no significant clinical improvement, regardless of the dose. Cognitive behavioural therapy (CBT) was commenced later. Medication was kept stable during the baseline, treatment, and follow-up period. Fourteen 1-hour sessions of CBT, including exposure and response prevention, were delivered each week over a period of 14 weeks. At the end of the intensive treatment, he reported a significant reduction in obsessions and compulsions. His score on the Y-BOCS dropped from 34 to 8 (76%) before treatment to 4-month follow-up.He reported that the decrease in OCD symptoms was associated with a significantly higher quality of life.

CBT appears to offer a valuable opportunity to reduce symptom severity in patients with OCD comorbid with schizophrenia.Further research within this field and systematic clinical evaluations are highly desirable.

None Declared

The relationship between childhood traumatic experiences and substance use disorders (SUD) has been the subject of considerable discussion in the literature. The development of efficacious therapeutic models for the treatment of these comorbidities remains an ongoing area of research. In particular, trauma-related disorders accompanied by dissociative changes and SUD may be effectively treated with ego-states therapy, which employs a combination of psychoanalytic and hypnoanalytic methods with other systemic approaches.

The objective of this presentation is to illustrate a case study from an interdisciplinary day clinic that employs an integrated approach to the treatment of substance use disorders (SUD) and other comorbidities. Furthermore, we will propose an innovative naturalistic method for addressing complex phenomenological manifestations of trauma-related disorders in individuals with SUD.

In this presentation, we will introduce a psychotherapeutic method from a day clinic in Lower Saxony, Germany, through a comprehensive case study.

Case:

A 40-year-old woman was referred to the day clinic following a period of ward treatment following the death of her father. This period led to an increase in her cannabis consumption and a concomitant increase in depressive symptoms. In her history, she revealed that her elder sister had committed suicide when the patient was in primary school. Consequently, she was tasked as a child with the responsibility of handling all bureaucratic matters with her parents, as she was the only member of her family who could speak German due to their migration background.

During the psychotherapeutic treatment, various ego states were identified and addressed through a combination of psychoanalytic, systemic-milieu therapeutic, and family therapeutic interventions. Particular attention was paid to those aspects that had been functional during childhood but were now manifesting in a destructive manner. The adult ego-states were activated to bring those processes into conscious awareness and promote psychological stabilization. By the end of the 6-week day clinic process, cannabis levels were no longer detected in the urine, and a significant reduction in depressive symptoms was observed.

Complex phenomenological presentations require multidisciplinary, holistic, and integrative therapeutic approaches. Further evidence-based evaluations are necessary to optimize treatment outcomes for such cases.

None Declared

Interpersonal Psychotherapy (IPT) has been recognized as an effective treatment for various eating disorders, particularly Binge Eating Disorder (BED) and Bulimia Nervosa (BN). IPT focuses on addressing interpersonal difficulties, such as role transitions, interpersonal disputes, and social deficits, which are common in individuals with eating disorders. While evidence supports its use for BED and BN, its effectiveness for Anorexia Nervosa (AN) remains limited. Group-based IPT has also shown promise by targeting interpersonal deficits that perpetuate disordered eating behaviors.

This literature review aims to evaluate the efficacy of IPT in treating eating disorders, with a focus on BED and BN. Additionally, it explores the role of interpersonal deficits as a central focus of IPT and compares the outcomes of individual and group-based IPT formats.

A review of peer-reviewed studies, clinical trials, and meta-analyses published between 2000 and 2024 was conducted. The review assessed the effectiveness of IPT in reducing disordered eating behaviors, improving interpersonal functioning, and maintaining long-term treatment gains. Studies on both individual and group IPT formats were included, with a focus on binge eating reduction, interpersonal relationship improvements, and relapse prevention.

The literature consistently shows that IPT is effective in reducing binge eating behaviors and improving interpersonal relationships in individuals with BED. Group IPT, in particular, has been shown to effectively address interpersonal deficits, providing social support and improving interpersonal skills, which contributes to sustained treatment outcomes. IPT has demonstrated comparable short-term efficacy to Cognitive Behavioral Therapy (CBT), with studies indicating superior long-term maintenance of treatment effects. However, evidence for IPT’s use in AN remains sparse.

IPT is a promising treatment for eating disorders, particularly for individuals with BED and BN who exhibit significant interpersonal deficits. Group IPT appears to be especially effective in addressing these interpersonal issues, providing long-term benefits. While CBT remains the most widely used therapy, IPT offers a valuable alternative, particularly for individuals who do not respond to CBT. Future research should focus on exploring IPT’s mechanisms and expanding its application to other eating disorders, including AN, where evidence is currently lacking.

None Declared

Electroconvulsive therapy (ECT) is a widely recognized and effective treatment for severe psychiatric conditions, including major depressive disorder, treatment-resistant depression, and some psychotic disorders. Although ECT is highly effective, administering it to patients with cranial metal implants—such as plates, screws, clips, or electrodes—presents potential safety challenges. Metal implants, particularly those made of ferromagnetic materials, may interact with the electrical currents in ECT, which can lead to heating, shifting of the implant, or other adverse effects, thereby raising safety concerns.

To review the safety and clinical considerations of electroconvulsive therapy in patients with cranial metal implants. This literature search aims to identify evidence on risks, contraindications, and guidelines to support safe and effective treatment in this population.

We conducted a literature search on PubMed to investigate the application of ECT in patients with cranial metal implants. The search included keywords “electroconvulsive therapy” and “ECT” combined with the terms “cranial metal implants,” “head metal implants,” and “metallic skull plate” interchangeably. We included only case reports. We used this approach to gather relevant studies addressing the safety, efficacy, and considerations of electroconvulsive therapy in individuals with metal implants in or near the skull.

The literature search identified 11 case reports documenting the successful administration of ECT in patients with cranial metal implants. Across these cases, ECT was performed without adverse events related to the implants, and treatment outcomes were reported as effective in managing psychiatric symptoms. Most reports emphasized careful planning and individualized assessment to minimize risks, particularly regarding implant location and material composition. Safety measures included conducting pre-treatment imaging to evaluate implant positioning.

The connection between cranial metal implants and ECT necessitates careful consideration of safety protocols to prevent potentially hazardous interactions. While metals such as titanium are generally not problematic for this therapy, it is essential to consider the type of metal, its location, and its magnetic properties before applying this technique. Our clinical experience also shows positive outcomes in patients with cranial metal implants, demonstrating safe and effective administration with proper evaluation and precautions. Further research and establishing safety guidelines will be crucial for optimizing treatment and minimizing risks for patients with metal implants.

None Declared

Ehlers-Danlos Syndrome (EDS) is a group of hereditary connective tissue disorders that primarily involve skin hyperelasticity, hypermobility of joints and fragility of blood vessels.This syndrome shows heterogeneous features.Recent studies have shown that patients with EDS have a higher risk of psychiatric conditions such as depression, suicide and schizophrenia.The existing literature on safe administration of ECT defines several case reports which incorporates connective tissue disorders.

This case report aims to define a rare case of EDS related psychosis including the clinical presentation and management.Furthermore, to show the administration of ECT in patients suffer from this medical condition after their assessment.

Comprehensive presentation of patient’s case and review of systematic literature using database, in regards to connective tissue disorders and psychiatric conditions.

A 42-year-old female patient,diagnosed with anxiety disorder 7 years prior, who has shown no remission and has experienced multiple hospital admissions over the past year due to various psychotic and depressive episodes, presented to our hospital with complaints that a “sorcerer” had cast spells on her.She reported delusions of mystical and somatic nature, describing that as a result of these spells, supernatural entities had caused her teeth to shrink, her skull to shift, the brightness in her eyes to diminish, her internal organs to decay and her physical presence to fade away.Additionally, she expressed paranoid-persecutory delusions that these entities would ultimately lead to her death.Treatment history included multiple SSRIs, antipsychotics and 6 sessions of TMS therapy, all with limited response.Her family history revealed that her father had died by suicide and her siblings were also diagnosed with depression/anxiety disorders.

The patient was admitted with a preliminary diagnosis of psychotic depression.Physical examination findings included hyperflexibility and hyperlaxity, suggestive of EDS.As the patient was at increased theoretical risk for complications; several consultations were requested to assess fitness for treatment prior to ECT.Based on these evaluations, ECT was deemed safe to proceed.Bifrontal ECT was successfully administered, resulting in marked improvement in the patient’s psychotic symptoms.

Even delusions are remarkably indicative for psychosis, it is crucial to recognize the underlying medical conditions may contribute to its onset and/or exacerbation.Psychiatric evaluations should be performed during EDS patients’ routine follow-ups.Additionally, as is already shown in other case reports, administration of ECT in patients with EDS should be considered.However, further research is required to understand the eligibility of ECT on connective tissue disorders also to expand our repertoire in the treatment.

None Declared

Transcranial magnetic stimulation (TMS) has been consistently recommended in international guidelines as first-line for treatment-resistant depression, due to its superior efficacy over the next antidepressant, with minimal side effects. However, owing to its high cost, lack of insurance coverage, the need for daily time commitment over a period of 4 to 6 weeks and its relative novelty, TMS is still not being offered to many eligible patients with MDD including at our hospital, leading to an under-utilisation of the service.

We aim to determine the rate at which TMS is being offered to eligible patients with MDD at our hospital in Singapore, explore the root causes behind why it is not being offered and utilised more often, and implement new models of care to increase this rate by at least two-fold over 6 months.

All patients who registered at our outpatient clinics from June to November 2024 were screened for the eligibility criteria for TMS. Flow charts, affinity diagram and fishbone diagram were drawn. Multi-voting was conducted to arrive at the top root causes for the low rate at which TMS was being offered to eligible depressed patients, determined on a Pareto chart. 5 Plan, Do, Study, Act cycles were carried out. Key interventions included: (a) Adopting evidence-based, shorter TMS protocols that reduced time to remission from 6 weeks to 2-3 weeks, (b) initiating a novel, nurse-led TMS counselling service, (c) improving promotional materials, and (d) using simple yet effective strategies to improve familiarity with TMS and encourage psychiatrists to consider it more often.

The rate at which TMS was offered to eligible patients with MDD increased from 15% to 80% over June to November 2024. 31% of these eligible patients took up TMS, and 100% of those who started TMS eventually completed the course. Patients who completed the course had a 69% reduction in clinician-administered depression rating scales. Psychiatrists were more inclined to offer TMS via the TMS counselling service run separately by TMS nurses, as this otherwise often took up substantial time in busy clinic settings. The increased awareness of TMS through promotional materials empowered patients such that they were bringing up TMS during consultations before they were being offered. The evidence-based, shorter TMS protocols involved conducting multiple sessions a day with adequate intervals, without compromising on efficacy and safety. Patients enjoyed the option of having less interruptions from work or school, and the quicker times to remission. Direct cost savings were observed.

We observed better quality of clinical care, increased patient, staff and stakeholder satisfaction, cost and time savings to patients, and increased productivity in both patients and staff, through effective and sustainable interventions which can be replicated in TMS clinics elsewhere.

None Declared

Cannabidiol (CBD) is a non-psychoactive cannabinoid with therapeutic potential in various fields, such as its effect on mental health or antiepileptogenic, among others. For this reason, the interest in research on the potential effects of this substance is booming and the sale and consumption by the general population is increasing.

To describe the observed effects of CBD use during treatment with electroconvulsive therapy (ECT).

To describe in detail the clinical case and to correlate the changes observed in the seizures and the electroencephalogram (EEG) of the ECT sessions when the patient performed concomitant consumption of CBD, in addition to the changes at the clinical level that he experienced during this period.

The subject is a 47-year-old man who required admission for a psychotic decompensation of his schizoaffective disorder bipolar subtype. In recent years, he had no adherence to psychopharmacological treatment or follow-up, and reported self-medicating with CBD cigarettes in varying amounts (he reported 5 to 15 units/day). During admission, pharmacological treatment was instituted with poor response and an acute course of ECT was performed due to a history of good response in a previous episode 10 years ago and the patient’s preference. He remained abstinent from CBD during hospitalization and it was agreed to remain non-consuming at discharge. He presented progressive improvement in the clinical signs from the 4th session, with remission in the 7th session. Upon discharge, it was agreed to perform consolidation ECT on an outpatient basis, initially with weekly sessions and then every two weeks.

From the 2nd outpatient session, a worsening of motor and electroencephalographic seizures was observed in the ECT sessions. A possible relapse into CBD use, which the patient denied, was explored. After the 3rd outpatient session, the patient recognizes relapse into CBD consumption with occasional consumption. During the following 2 sessions, the deterioration in the quality of the EEG pattern progresses and it is decided to interrupt ECT treatment due to the absence of seizures in EEG recording, coinciding with an increase in the daily amount of CBD consumed.

There is little literature on the management of the effects of CBD in ECT treatment. The observations in this clinical case provide valuable information about the combination of CBD and ECT that can be useful to other professionals with similar cases.

None Declared

Electroconvulsive therapy (ECT) has gained increasing attention as a therapeutic option for managing aggressive behavior in psychiatric patients. Aggression is a common symptom in several psychiatric disorders, such as schizophrenia, bipolar disorder, and severe depression, which can be resistant to conventional pharmacological treatments.

This literature review examines the efficacy and safety of ECT in reducing aggression across various psychiatric populations.

We have conducted a web resurch on Pubmed for articles published in the last ten years about the topic using key words like “agression”, “ECT”.

Evidence suggests that ECT can be particularly effective in cases where patients do not respond to medications or display dangerous behaviors. Significant reductions in aggression have been reported post-ECT, along with improvements in mood and overall functioning.

Although ECT remains controversial due to concerns about cognitive side effects, advancements in its application have enhanced its safety. This review emphasizes the need for further.

None Declared

“Psychosurgery” is defined as the human brain surgery to treat psychiatric symptoms.

This study aims to portray psychosurgery’s historical evolution.

A review of 35 articles from 2000 to 2024 on PubMed and Google Scholar, regarding psychosurgery.

The initial phase of psychosurgery dated in 1888, when Swiss psychiatrist Gottlieb Burckhardt, in en effort to control the symptoms of psychiatric patients, he performed the very first brain topectomies. Later on, in 1936, Portuguese neurologist Egas Moniz and neurosurgeon Almeida Lima, collaborated on performing the first lobotomy. After achieving 20 lobotomies, Moniz reported that 35% of patients showed complete remission of psychiatric symptoms, 35% of patients showed a mild improvement, and 30% of patients showed no improvement. It was Freeman’s (a neurologist) and Watts’s (a neurosurgeon) turn to perform in 1936 the first lobotomy on the USA ground, on a woman suffering from depression; Alice Hammatt. Unfortunately, six days post-operation, Hammatt experienced language difficulties, disorientation and agitation. However, the surgery was still considered a success. By 1942, Freeman and Watts had performed 200 lobotomies, declaring that 63% of patients improved, 23% of patients showed no relief, while 14% of patients suffered complications, including death. Freeman pursued with the development of a transorbital method which he tended to perform in outpatient departments, without any neurosurgical assistance, having patients anesthesized with a portable electroshock machine. Profoundly disapproving this method, Watts, decided to end their partnership. Further unsatisfactory outcomes like the lobotomy of Rosemary Kennedy (sister of President John F. Kennedy) shaped an additional negative image of Freeman’s work. Rosemary who initially was subjected to lobotomy due to mild developmental delays, anxiety and epilepsy, was postoperatively left severely disabled, without autonomy, being institutionalized for the rest of her life. Finally, the approval of chlorpromazine’s use in the US (1955) alongside public awareness over psychosurgery’s complications, such as the “post-leucotomy syndrome” causing disinhibition as well as “lobotomy criteria” which included female gender, non-obeidance, hospitalization in overcrowed institutions, opposite political opinion, leaded to psychosurgery’s dowfall.

Considering the dark history of psychosurgery, it is imperative to proceed to such treatments exclusively to diseases with a well decoded neurophysiology, always respecting human rights and protecting patients’ dignity and self-will.

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Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) are prevalent conditions that significantly affect quality of life. Many patients with MDD and GAD do not respond adequately to conventional therapies, such as psychotherapy and antidepressants, highlighting the need for alternative treatments. In this context, electrostimulation, particularly Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (tDCS), has shown promise by modulating brain activity to relieve symptoms.

To assess the efficacy of TMS and tDCS in treating MDD and GAD.

This systematic literature review was conducted in SciELO, PubMed, covering the period from 2014 to 2024. After an initial selection of 15 articles, six studies were chosen based on relevance and reliability. The analysis focused on outcomes from controlled and randomized studies as well as systematic reviews and meta-analyses, involving TMS and tDCS.

The reviewed studies demonstrated that TMS and tDCS significantly reduce symptoms in MDD and GAD compared to placebo. One study evaluated the combined effect of tDCS with antidepressants, indicating a more pronounced clinical response and suggesting potential synergy between neuromodulation and pharmacotherapy in cortico-limbic circuits. However, larger sample sizes are needed to achieve robust statistical validation, clarifying the isolated impact of each modality and their combination.

Both TMS and tDCS represent effective therapeutic alternatives for patients with MDD and GAD, especially those refractory to conventional approaches. Although promising, implementing these techniques faces challenges, including high costs, the need for specialized professionals, and stronger scientific validation to enable widespread use. Expanding clinical knowledge and disseminating evidence-based guidelines can promote safe access to and usage of these therapies.

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About 31 million people worldwide suffer from substance use disorders (SUDs), causing significant health and economic burdens.

SUDs are linked to reduced dopamine activity in the mesolimbic region of the brain, as well as dysfunction in the dorsolateral prefrontal cortex (DLPFC) and dorsal anterior cingulate cortex (dACC), which are responsible for decision-making and self-control. Additionally, the ventral prefrontal cortex (PFC), including the orbitofrontal cortex (OFC) and ventral anterior cingulate cortex (vACC), play a role in emotional processing and limbic arousal.

A promising approach to treating SUDs involves non-invasive neuromodulation techniques (NIBS), specifically repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS).

To better understand the role of non-invasive neuromodulation techniques in substance use disorders.

A search was conducted in various databases, including PubMed.

Many studies using rTMS to treat SUDs have targeted the DLPFC. When the left DLPFC is stimulated, the effects are generally positive, and the treatment produces clinically significant results for tobacco, stimulant, and opioid use disorders.

It has been found that the medial PFC (mPFC) could be a potential target for therapy, especially when using deep TMS, as demonstrated by studies involving alcohol and cocaine. Both the DLPFC and mPFC are promising targets for rTMS.

Regarding tDCS, it seems that right anodal DLPFC stimulation is the most effective method across all types of substances.

Much remains unknown regarding the mechanisms by which rTMS or tDCS induce therapeutic effects in SUDs. Further research is necessary to determine the clinical safety and efficacy of these treatments.

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Treatment resistance affects 20-60% of patients, leading to substantial personal and economic impact. Repetitive transcranial magnetic stimulation (rTMS) is effective, with theta burst stimulation (TBS) providing similar benefits more efficiently.

To assess high-dose TBS effectiveness and to explore how demographic and clinical factors influence treatment outcomes.

Accelerated high-dose (30 sessions) cTBS and iTBS was administered targeting the right and left dorsolateral prefrontal cortex (DLPFC) respectively (3600 pulses per session), with MRI-guided neuronavigation. Pre- and post-treatment HAM-D and HAM-A scores were analyzed with mixed-effects models. Response and remission rates were further examined using generalized linear models (GLM). All analyses were conducted using the R Studio.

The study included a total of 101 participants, of whom 89 had data available for HAM-D (56 [38.8–65] years; 69.7% females), and 82 had data available for HAM-A (56 [39–65] years; 70.7% females). 29.2% achieved HAM-D remission, 22% achieved HAM-A remission, with response rates of 46.1% for depression and 50% for anxiety.

Mixed-effects models showed a highly significant reduction in both HAM-D and HAM-A scores after TMS treatment (HAM-D: β = -12, p = 2.2e−15; HAM-A: β = -14.484, p = 1.1×10−14) (Fig. 1). For HAM-D, family history was associated with reduced treatment effectiveness (β = 5.302, p = 0.011). Sex also influenced HAM-D scores, with males showing a greater response than females (p = 0.018), although this trend was only marginally significant for HAM-A (p = 0.073).

Fig. 1. Pre- and post-treatment scores on the HAM-D and HAM-A showing significant reductions following rTMS.

The GLM analysis for HAM-D and HAM-A remission did not reveal statistically significant overall results. However, specific predictors were significantly associated with treatment response. A family history of mental health conditions was linked to a lower likelihood of response, based on HAM-D (OR = 0.058, p = 0.016) and HAM-A (OR = 0.074, p = 0.049). Age was a significant predictor for response on both HAM-D (OR = 1.1, p = 0.048) and HAM-A (OR = 1.115, p = 0.032) (Fig. 2). Additionally, regarding employment status individuals identified as “Housekeeper” or “Retired” had reduced likelihood of positive response (p < 0.05).

Figure 2. Influence of age on HAMA and HAM-D response outcomes in patients undergoing TMS treatment.

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High-dose accelerated bilateral TBS using the Sevilla Protocol significantly reduced depression and anxiety symptoms in treatment-resistant patients, with notable response and remission rates. Family history, age, and certain employment statuses significantly influenced treatment response, suggesting that TBS may benefit from tailored approaches. Larger, balanced samples are needed to confirm these findings and improve prediction models.

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