Transcranial magnetic stimulation (TMS) is a method of non-invasive stimulation of the cerebral cortex with an alternating magnetic field, used in the therapy of patients with depression, including cases where drug therapy is ineffective. The currently widely used high-frequency stimulation protocols with the application of an inductor to the projection of the left dorsolateral prefrontal cortex (LDLPC) have confirmed their effectiveness, while protocols with a significantly shorter procedure time are appearing in clinical practice. In this study, a clinical comparison of two protocols was conducted.

To conduct a comparative assessment of the clinical effect of TMS using theta-burst stimulation and high-frequency (10 Hz) stimulation.

The study included 34 patients (mean age 27.2±2.1 years) with a diagnosis F31-F34 and clinical depression confirmed by psychometric assessment data (HDRS=21.7±5.6). Patients received stimulation in the projection of the left dorsolateral prefrontal cortex for 3 weeks: 17 patients (group 1) received high-frequency stimulation (10 Hz) and 17 patients (group 2) intermittent theta burst stimulation. Symptom reduction, according to psychometric assessment, corresponding to 50% or more, was chosen as the criterion for response to treatment.

By the end of the study, the number of patients in the total sample who responded to treatment corresponded to 55.9% (n=19). Comparison of the effectiveness of the protocols showed that the group statistically significantly differed in the number of responders (p<0.05; 0.01): in group 1 47.06% (n=8), in group 2 64.71% (n=11). Patients who received theta-burst stimulation had a faster rate of symptom reduction and demonstrated higher adherence to treatment.

Thus, a comparative study of the effectiveness of two TMS protocols demonstrated a higher effectiveness of theta-burst stimulation, however, it is worth noting the overall effectiveness of this method regardless of the stimulation parameters, as well as a fairly rapid development of the clinical effect.

The study was supported by RSF grant 22-15-00437.

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Pregnancy and the immediate postpartum period are at high risk of decompensating or developing psychiatric disorders. Electroconvulsive therapy (ECT) is an effective treatment for severe and resistant mental disorders and could be a therapeutic option for psychiatric disorders during pregnancy.

The aim of our study was to investigate the safety and the efficacy of ECT in pregnant women through a systematic review.

A systematic review was conducted. PubMed via Medline, Google Scholar and Semantic Scholar were used as search engines. The keywords used were (“Electroconvuslive therapy” or “ECT”) and (“pregnancy” or “pregnant”). Clinical trials, case reports and case series assessing the efficacy and safety of ECT during pregnancy, published from inception to December 2023 and written in English or Frensh were included.

A total of 30 articles were included for the final analysis with a total of 96 cases. The mean age of patients was 30.1 years. ECT was mostly performed during the first trimester of pregnancy with 45.3% of patients. The main psychiatric diagnoses were major depressive disorder with 47.6% of patients, followed by bipolar disorder with 19.3%. The average number of sessions performed was 10.4 with a maximum of 22. A partial improvement or a total resolution of symptoms were noted in 78.6% of cases. Transient fetal arrhythmia (not requiring drug intervention) was the most common complication, occurring in 6.25% of cases (n=6). Fetal death or abortion were observed in 4.1% of cases (n=4).

ECT appears to be an effective treatment for severe psychiatric disorders in pregnant women. However, it needs to be performed as part of a multidisciplinary care team to reduce the risk of serious consequences for both the mother and the fetus.

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Deep brain stimulation (DBS) was first used in 1999 for the treatment of resistant obsessive-compulsive disorder (OCD), and it was not until 2009 that the Food and Drug Administration approved it for this purpose.

The aim of our study was to investigate the safety and efficacy of DBS through a systematic review.

A systematic review was conducted. PubMed via Medline, Google Scholar and Semantic Scholar were used as search engines. The keywords used were (“Obsessive compulsive disorder” or “OCD”) and (“Deep brain stimulation” or “DBS”). Clinical trials and observational studies assessing the efficacy of DBS for OCD, published from inception to December 2023 and written in English or Frensh were analysed. The inclusion criteria were a main diagnosis of OCD, DBS conducted for therapeutic purposes and a response to DBS assessed by the Yale-Brown Obsessive-Compulsive scale (Y-BOCS).

Thirty four studies were included in the final analysis with a reported total of 316 cases. In 58.2% of cases, patients were female. The average age at the time of surgery of implanting the stimulation device was 40.9 ± 7.8 years. The mean time from onset of symptoms to surgery was 22.4 ± 4.6 years. The mean initial Y-BOCS score was 33 ± 3.7. The mean response rate, defined as a reduction in Y-BOCS score of more than 35 % was 70.7% ± 24.8. The maximum symptom reduction was reached between 12 to 14 months after implantation in most studies. Hypomania was the most frequent side effect reaching 45% in some studies. Intracranial hemorrhage secondary to surgery was the most serious complication and did not exceed 5 % in any study. No clear predictive factors for response to DBS were identified.

DBS appears to be a promising therapy for patients with resistant OCD. This innovative approach, combined with ongoing advancements in neurotechnology, offers hope for the future of OCD treatment. However, no predictors of response have yet been established.

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Postpartum psychosis (PPP) is a psychiatric condition that arises shortly after childbirth. Electroconvulsive therapy (ECT) offers rapid symptom relief, particularly in severe cases. Despite reports of ECT effectiveness in PPP, its use remains limited and unstandardized.

This systematic review aims to evaluate the clinical effectiveness of ECT in treating PPP.

The electronic databases PubMed/MEDLINE, Cochrane, SciELO, SCOPUS, and WOS were screened for studies reporting ECT outcomes in PPP following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies published between 2004 and 2024, written in English, and focused on subjects up to 12 months postpartum were included. All studies were vetted by ≥ 2 reviewers. Bias was assessed with the JBI Critical Appraisal Tool.

A total of 255 studies were identified and 7 met the inclusion criteria. ECT was exclusively used in severe PPP refractory to pharmacological intervention. Symptom improvement was reported in 100% of cases and most achieved total remission. Total ECT sessions ranged from 5 to 15, with symptom improvement after 1-6 sessions and remission after 5-11 sessions. ECT side effects were transient and included memory loss, mild cognitive deficit, and pain.

High remission rates on ECT were demonstrated where pharmacological intervention was insufficient, highlighting its effectiveness as a rapid and safe intervention for PPP. Adverse effects were transient and manageable, underscoring ECT safety. Small sample sizes and variability in ECT protocols limit the generalizability of the findings. Further evidence from prospective studies is needed to consider ECT as a first line treatment for PPP.

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Bipolar affective disorder (BD) affects approximately 2% of the population. It’s an incapacitating condition that significantly impairs quality of life and functional capacity; depressive episodes in BD are highly debilitating and carry major suicide risk and treatment-resistant bipolar depression has been reported in about one-quarter of patients with bipolar disorders. Non-invasive neuromodulation procedures, such as repetitive transcranial magnetic stimulation (TMS), being an approved treatment for treatment-resistant unipolar depression, can also be an option for bipolar depression.

with this work we intend to assess the efficacy and outcomes of the intermittent theta burst TMS (iTBS) protocol in patients with bipolar depression, who underwent this treatment at Hospital de Magalhães Lemos, Porto, since July 2022. We also conducted a literature review on the subject.

analysis of clinical and sociodemographic characteristics of the 4 patients who underwent treatment and of the treatment outcomes using Beck’s Depression Inventory (BDI) score difference between first and last sessions and Montgomery-Asberg Depression Rating Scale (MADRS) as the secondary outcome, the last applied to only 2 of the patients. A computerized search was performed on PubMed, for articles published in the last 10 years, using the key-words “bipolar depression”, “bipolar depressive episode” and “tms”.

since July 2022, 4 patients with bipolar depression were submitted to iTBS treatment, 3 women and 1 man. Of these, 3 had a diagnosis of bipolar type 1 disorder and 1 of bipolar type 2. One of the women had a comorbid diagnosis of dementia and was not able to answer BDI. All 4 of these patients were referred to this treatment after failure to reach sustained symptomatic remission with at least two different treatment trials, at adequate therapeutic doses. We found positive changes in BDI in all 3 patients that completed this questionnaire and in MADRS in the 2 that answered. One of the patients had an elevated mood and an increase in energy levels following treatment but did not meet criteria for hypomanic/manic episode. No major side effects were reported.

Our results and literature review suggest that TMS, in our study iTBS protocol, may well be an effective treatment for bipolar depression, with some studies showing even higher response rates for bipolar depression when compared with unipolar depression, suggesting that bipolar disorder is more likely a better biological target. Furthermore, the low side effect profile of TMS and the fact that it is a minimally invasive procedure, makes it even more appealing as a treatment option. Risk of psychomotor agitation and hypomania/mania must be closely monitored in these cases.

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Repetitive transcranial magnetic stimulation (rTMS) is a clinically validated treatment, included in international guidelines for managing treatment-resistant depression (TRD). The conventional daily administration of rTMS protocols over several weeks can pose challenges for patients, such as work interruptions and commuting difficulties. To enhance the antidepressant effects and minimize the duration of treatment, increasing the frequency of daily rTMS sessions has been proposed as a potentially more effective approach.

This study aims to compare the efficacy and tolerability of standard versus accelerated rTMS protocols as supplementary treatments for patients with TRD

24 patients diagnosed with major depressive episodes (either unipolar or bipolar) and classified as partial responders or non-responders to adequate pharmacological treatment were randomized into two groups. One group received standard rTMS (one session daily, five days a week, over four weeks; n=9), while the other underwent accelerated rTMS (two sessions daily, five days a week, over two weeks; n=15). Both groups were treated on the left dorsolateral prefrontal cortex with high-frequency stimulation (10 Hz) at 120% of the motor threshold, delivering 3000 pulses per session. Primary outcome measures included scores from the Hamilton Depression Rating Scale (HAM-D), Montgomery-Åsberg Depression Rating Scale (MADRS), and Clinical Global Impressions-Severity (CGI-S) at baseline (T0), post-treatment (T1), and during follow-ups at one month (T2) and three months (T3). Tolerability was assessed based on reported adverse effects. Paired Samples t-Test was employed for continuous variable comparisons, while t-Test was used to analyze differences between groups.

Analysis of the overall sample revealed a significant reduction in HAM-D, MADRS, and CGI-S scores from T0 to T1 (p<0.001). These improvements were maintained at the one-month and three-month follow-ups (T1 vs T2: p=0.726, p=1.00, p=0.803; T2 vs T3: p=0.105, p=0.594, p=0.653). No significant differences were observed in response and remission rates between the two protocols (T1: p=0.722; T2: p=0.727; T3: p=0.979). The only reported side effect was mild, transient headaches during stimulation, with a minimal dropout rate (0.25%).

These preliminary findings align with previous literature, suggesting similar efficacy and tolerability between accelerated and standard rTMS protocols. Future studies with larger, controlled, and blinded designs are warranted to validate these results and explore treatment parameters for accelerated rTMS.

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Electroconvulsive therapy (ECT) is a recognized treatment for various psychiatric conditions (Bernardo et al., 2018). However, there is a lack of recent studies describing the clinical characteristics of patients undergoing ECT (Peltzman et al., 2020).

To provide an updated evaluation of the clinical characteristics, treatment parameters, and outcomes of patients receiving ECT at Clinica Universidad de Navarra (CUN), focusing on its effectiveness and evolution over recent years.

This cross-sectional descriptive study examines patients who underwent electroconvulsive therapy (ECT) at CUN’s Psychiatric Hospitalization Unit from January 2019 to August 2023. It focuses on those who received bifrontotemporal ECT, with stimulation power quantified using the DGx program on the Thymatron® machine. Collected data include age, sex, prior psychotropic medication use, ECT indication, comorbidities, Stimulus potency (%DGx), seizure duration (seconds on the electroencephalogram), and anesthetic induction type. Hamilton Anxiety and Depression Scales were recorded before and after treatment when clinically indicated.

ECT was administered in 80 cases, constituting 8.62% of admitted patients, with 33.75% being male. Among these, 33% had psychiatric comorbidities, most commonly being pathological personality traits (16%) and generalized anxiety disorder (5.3%) (Image 1). Non-psychiatric comorbidities included endocrine-metabolic conditions 49% and cardiac conditions 34% (Image 2.)

Pre-ECT, the most common psychotropic medications included benzodiazepines (87.5%), atypical antipsychotics (76.5%), and dual antidepressants (47.5%). Propofol was used for initial anesthetic induction in 86.25% of cases, with 30.43% requiring a switch to thiopental due to the reduced efficacy. The average number of ECT sessions per patient was 8.9 (range: 3-13), with a mean seizure duration of 30.5 seconds. The primary indications for ECT were depressive disorders (85%) and psychotic disorders (11%) (Image 3).

Before ECT, the average Hamilton Depression Scale score was 25.3, decreasing to 5.3 post-treatment. Similarly, the Hamilton Anxiety Scale score average was 23.72 before ECT and 4.6 after.

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Our sample revealed that the primary indications for ECT were affective and psychotic disorders, with a predominant impact on adult women. This supports its role as a key intervention for treatment-resistant conditions, a finding consistent with existing literature (Leiknes et al., 2012). These preliminary results represent an initial evaluation in a broader study aimed at exploring additional aspects of clinical response and comparing ECT with other treatment modalities.

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Major depressive disorder (MDD) is a very common and debilitating disorder. MDD accounts for 4.3% of the global burden of disease, is among the largest single causes of disability worldwide, and is an important cause of premature death. Depression expands its negative influence in all aspects of life, being estimate that 12 billion productive workdays are lost every year to depression and anxiety.

On top of that, non-response to first line pharmacological and psychotherapeutic treatments are substantial, with treatment-resistant depression (TRD) affecting approximately one third of these patients. These patients are thus candidates for non-invasive neuromodulation procedures such as repetitive transcranial magnetic stimulation (TMS), included in all major treatment guidelines.

With this work we intend to present a descriptive analysis of the efficacy of the intermittent theta burst TMS (iTBS) protocol in patients with TRD who underwent this treatment at Hospital de Magalhães Lemos, Porto, since July 2022.

We conducted an analysis of sociodemographic characteristics of patients who underwent treatment with iTBS. The primary outcome was the Beck’s Depression Inventory (BDI) score difference between the first and last sessions. Secondary outcome included the Montgomery-Asberg Depression Rating Scale (MADRS) applied to a smaller cluster of patients.

Since July 2022, more than 50 cycles of iTBS treatment have been performed.

More than 60% of the TRD patients enrolled scored positive changes with the treatment, on BDI. Improvements exceeded non-response in both sexes, irrespective of disease duration, and in nearly all age groups – except for the single patient under 25 years old. Positive changes were also observed with the MADRS, with more than 70% of this cluster of TRD patients scoring positive changes, including the patient under 25 years old who score non-response with BDI.

iTBS was also applied to a small number of patients diagnosed with treatment-resistant bipolar major depression, in whom positive changes outweighed non-response.

All iTBS cycles were performed without major adverse effects being reported.

TMs, represented here by the iTBS protocol, is safe and effective in improving depressive symptoms when first line treatments are not. The positive effects extend to patients diagnosed with BD, despite the small number of patients present in our patient pool.

Combined with the logistical ease of its use, not requiring general anaesthesia or induction of seizures like electroconvulsive therapy, TMS presents itself as an important alternative in the treatment of TRD.

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It is important to have early diagnosis and early intervention for generalized anxiety disorder(GAD) and panic disorder(PD). However, it is difficult to distinguish GAD from PD. Neurobehavioral markers that differentiate GAD and PD would be helpful to refine classification schemes based on neurobiological measures.

The aim of this study is to determine the distinguishing neurophysiological characteristics between generalized anxiety disorder and panic disorder using quantitative EEG.

The study included 36 patients with GAD and 25 patients with PD. Resting vigilance controlled EEG recordings were assessed at 64 electrode sites according to the international 10/20 system. QEEG were compared between GAD and PD groups by frequency bands (delta 1-3 Hz, theta 4-7 Hz, alpha 8-12 Hz, beta 12-25 Hz, high beta 25-30 Hz, gamma 30-40 Hz and total 1-40 Hz) made by spectral analysis.

The absolute powers of theta and alpha bands at the frontal area differed between GAD and PD group. The absolute power of the theta activity was decreased in FP1 and FP2 (p < 0.05) and the absolute power of the alpha activity was decreased in F3 (p < 0.05) in cases with GAD compared to PD.

The differences in QEEG power suggest that underlying pathophysiologic mechanisms may be different between GAD and PD. The findings that the decreased absolute powers of the theta and alpha activity at the frontal area in GAD may be the main neurophysiological characteristics of the GAD and help to have early differential diagnosis between GAD and PD.

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The research revealed significant correlations between cognitive performance, assessed by psychometric scales, and variations in frequency bands in the electroencephalography (EEG), illustrating the link between electroencephalographic activity and cognitive functions in schizophrenic patients

Our study aimed to explore the relationship between the electroencephalographic spectral power of slow frequency bands (delta and theta) and cognitive functions in patients with schizophrenia by comparing them to healthy subjects.

We conducted a cross-sectional, descriptive, and analytical study involving 15 schizophrenic patients and 15 healthy controls. The study was performed at the Psychiatry Department “C” outpatient unit at Hedi Chaker University Hospital in Sfax in Tunisia. We used the Arabic literary version of the Screen for Cognitive Impairment in Psychiatry (SCIP) scale to assess cognitive functions. Participants underwent a standard wakefulness EEG with eyes closed at the Functional Explorations Department of Habib Bourguiba Hospital in Sfax in Tunisia. Linear regression analysis was used to examine correlations between the total SCIP score and the absolute spectral density (ASD) values of EEG oscillations.

Linear regression analysis revealed a negative correlation between the total SCIP score and the delta wave ASD at T5 (left temporal) (r = -0.37; p = 0.025) and theta wave ASD at Fp2 (right prefrontal) (r = -0.131; p = 0.006). A positive correlation was found between theta wave ASD at F3 (left frontal) (r = 0.125; p = 0.02) and the total SCIP score. It revealed a negative correlation between the total SCIP score and the age of onset of schizophrenia (r = -0.647; p = 0.001).

These results suggest that theta and delta power at rest, as measured by EEG, may serve as potential biomarkers for cognitive deficits in patients with schizophrenia. These findings could contribute to a better understanding of the neurophysiological basis of cognitive alterations associated with this condition.

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Bruxism, characterized by the grinding and clenching of teeth, is often associated with psychiatric disorders such as anxiety and stress. Bruxism not only results in significant dental pathology but can also contribute to underlying neurophysiological disturbances.

To elucidate the relationship between bruxism and psychiatric medication by focusing on the neurophysiological mechanisms involved and the resultant dental pathologies.

A comprehensive literature review was conducted using databases such as PubMed, PsycINFO, and Google Scholar, focusing on studies from the last decade that investigate the association between bruxism, psychiatric medications, and neurophysiological factors. The review included clinical studies, neuroimaging research, and behavioral analyses.

The findings indicate a strong association between bruxism and the use of psychiatric medications, particularly antidepressants and antipsychotics. Neurophysiological studies reveal dysregulation in neurotransmitter systems, notably dopamine and serotonin, which play critical roles in both bruxism and the effects of psychiatric medications. This dysregulation affects motor control circuits and stress response pathways in the central nervous system, leading to involuntary teeth grinding and clenching.

Table 1: Neurophysiological Mechanisms

Table 2: Dental Pathologies Resulting from Bruxism

Bruxism is both a symptom and a potential side effect of various psychiatric medications, rooted in neurophysiological disturbances. The interplay between dysregulated neurotransmitter systems, psychiatric medications, and resultant dental pathologies highlights the need for integrated dental and psychiatric care. Effective management of bruxism through targeted dental interventions and tailored psychiatric treatments can significantly improve both dental health and psychiatric well-being.

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Cognitive deficits in schizophrenia are associated with impaired predictive processes, however, the neural mechanisms of these impairments at the early stages of the disease are poorly understood. A modified memory-guided saccade task can be informative for studies in this field. The contingent negative variation (CNV) slow negative potentials (SNP1, 2, 3 waves) in 1000-ms interval before a memory-guided response are considered to be neural correlates of attention, memory, motor, and inhibitory predictive processes.

We aimed to assess the CNV-type slow negative event-related potentials (ERP) during the latent period before the signal to perform remembered saccades in patients with clinical high risk (CHR) for schizophrenia.

An electroencephalogram (EEG) from 24 electrodes and electrooculogram of horizontal eye movements were recorded in 16 patients with CHR and 18 healthy controls. The participants had to remember the location of a peripheral stimulus (PS, 150ms) and perform a saccade or antisaccade (50% probability) when the central fixation stimulus (CFS) was turned off after a delay period of 2800–3000 ms. The СFS shape (cross or circle) defined a motor response type: saccade or antisaccade.

The task performance (assessed based on response latency and errors) was worse in CHR patients compared to controls. In the antisaccade condition, SNP1 was faster in CHR patients compared to controls possibly reflecting attention deficits in CHR patients. The SNP1 amplitude peaks were equally distributed across the EEG leads in CHR patients but were located predominantly in frontal and central leads in controls. Diffuse representation of the amplitude peaks may reflect a compensatory involvement of posterior temporal and parietal-occipital cognitive control networks at the early stages of schizophrenia. At the last 300 ms of the delay period, the late SNP3 wave was shorter before memory-guided antisaccades compared to saccades only in patients. This may reflect the violation of predictive attention processes as well as proactive inhibition deficits, that are well-known in schizophrenia, in CHR patients.

Based on our data we consider the SNP1 and SNP3 components in the memory-guided saccade task to be potentially significant neurobiological markers of cognitive control at the early stages of schizophrenia.

The research was carried out within the state assignment of Ministry of Science and Higher Education of the Russian Federation (theme No.121032500081-5 and No.AAAA-A19-11904049098-9).

None Declared

Electroencephalogram (EEG) has emerged to be valuable for understanding the neurophysiological mechanisms underlying cognitive dysfunctions in psychiatric disorders. EEG mental arithmetic enables to assesse cognitive abilities in schizophrenic patients, by inducing brain activity that can be observed through frequency band analysis

This study aimed to assess the absolute spectral density (ASD) of various EEG frequency bands in schizophrenic patients and healthy controls, at rest and during a mental arithmetic task, in order to identify specific neural differences

We conducted a cross-sectional, descriptive, and analytical case-control study involving 15 schizophrenic patients and 15 healthy controls. The study was carried out at the outpatient unit of Psychiatry Department “C” at Hedi Chaker University Hospital in Sfax, Tunisia. Participants underwent a standard wakefulness EEG with eyes closed at the Functional Explorations Department of Habib Bourguiba Hospital in Sfax, Tunisia. Each participant also performed a mental calculation test during the EEG recording

The ASD of the different EEGs was studied for each frequency band in the different cerebral lobes (Table 1). At rest, in schizophrenic patients, a significant difference was found between the mean ASD of the delta, theta, and beta1 frequency bands in the right and left occipital regions. Also, frequency band activity was more diminished in the left occipital regions than in the right. After mental calculation, the interhemispheric asymmetry disappeared in schizophrenic patients. In the control group, no significant differences were found between the mean ASD for any frequency band in the right and left frontal, temporal, and occipital regions, either at rest or after mental calculation (Table 1)

Table 1 : Comparison of EEG absolute spectral density between hemispheres in schizophrenics and controls at rest and after mental calculation task

These results underline the importance of considering cerebral lateralization in the diagnostic and therapeutic approach to schizophrenia. It is important to note that mental arithmetic involves complex cognitive processing, essentially working memory. Hence the importance of adopting a therapeutic approach incorporating not only pharmacological treatments, but also cognitive remediation therapies

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Studies reported an association between panic disorder (PD) and diminished heart rate variability (HRV) (Zhang et al. J Affect Disord 2020; 15, 267 297-306), potentially heightening their susceptibility to cardiovascular mortality and diminished quality of life. Preliminary research has demonstrated that HRV-biofeedback training can enhance the regulation of autonomic function in both healthy individuals (Schumann et al. Front Neurosci 202;15 691988) and patients with anxiety (Herhaus et al. Psychosom Med 2022; 84, 2 199-209).

We examined the impact of HRV-biofeedback training intervention on autonomic activity modulation among outpatients with PD with or without agoraphobia (AGO).

We conducted a retrospective observational pilot study including 10 outpatients (five females and five males; median age = 35.5 years) diagnosed with PD (9 with comorbid AGO and 1 without). The clinician-administered Panic Associated Symptoms Scale (PASS) was used to assess PD and AGO severity. All the included patients underwent a physiological assessment to determine HRV parameters and breathing rate during a 5-minute resting condition at baseline (T0) and follow-up (T1) assessment. Between T0 and T1 assessments, all patients underwent HRV-biofeedback training. Pre-post comparisons were conducted using the Wilcoxon Signed Ranks Test. To evaluate the impact of psychotropic medications, we used the Mann-Whitney U test to compare HRV parameters and disorder severity between patients with and without medications, at T0 and T1. Significance level was set at p<0.05.

HRV-biofeedback training among individuals with PD with or without AGO fostered notable enhancements in RMSSD (Z = -2.08; p < 0.01), SDNN (Z = -2.5; p = 0.01), and LF (Z = -2.09; p = 0.04) parameters at T1 compared to T0. Furthermore, a significant decrease in heart rate (Z = -2.19; p = 0.03) was shown. These enhancements didn’t seem related to psychopharmacological medications and disorder severity.

Despite limitations (e.g., small sample, no control group, lack of comorbidity and T1-PD severity assessment, missing inclusion/exclusion criteria, and unaccounted confounding variables affecting HRV), our study suggests that HRV biofeedback training may improve autonomic regulation in PD patients, aligning with existing literature (Herhaus et al. Psychosom Med 2022; 84, 2 199-209). Further research is needed to determine to what extent bio-feedback training can help to reduce panic symptoms and disorder severity.

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In recent years, scientific literature has focused on the study of neurophysiological indices, including parameters derived from electroencephalography (EEG), electrocardiography (ECG), and electrodermal activity (EDA), in order to identify potential biomarkers that could be useful in the assessment, monitoring, and prevention of psychiatric disorders.

The aim of this work is to investigate whether some neurophysiological indices are able to predict the symptomatic improvement and the socio-relational functioning of people hospitalized in acute psychopathological conditions at the Psychiatric Unit of the Bufalini hospital in Cesena, in a transversal manner in regard to the diagnostic category and the symptomatic severity of the psychiatric disorder.

To assess treatment outcomes from both a psychopathological and functional perspective, the Health of the Nation Outcome Scales (HoNOS) and Brief Psychiatric Rating Scale (BPRS) were administered at the start and end of hospitalization. Neurophysiological parameters were measured using the Rehacor-T device, which recorded frontocentral cerebral oscillations in Delta, Theta, Alpha, and Beta frequency bands, as well as heart rate and skin conductance. Data collection involved two phases: initially, participants viewed a calming landscape with eyes open, followed by a phase with eyes closed where they aimed to maintain tranquility. The Stroop test was then conducted. Statistical analyses were performed using JASP software.

The sample includes 112 patients (M = 57; F = 55), the average age of the participants is 44 years (SD = 16), while the average level of education is 11 years (SD =3).

The Beta frequency band in the eyes closed condition and the Delta frequency band in the eyes open condition show a positive regression with the changes in the HoNOS scale scores, indicating that an increase in Beta and Delta oscillations corresponds to an improvement in socio-relational functioning.

A positive regression was found between Delta oscillations in the Stroop test phase and changes in BPRS scores, suggesting that an increase in oscillations corresponds to an improvement in clinical symptoms.

Although several autonomic abnormalities are known in psychiatric disorders, our results did not show any prognostic ability from the ECG and EDA indices recorded in the sample.

In conclusion, in line with what has already been demonstrated in the literature, it is possible to confirm that EEG indices can reflect the adaptive resources of the person affected by psychiatric disorders in terms of the possibility of responding to treatment.

Deepen the research in this field could lead to the identification of new and more specific biomarkers for the prevention, diagnosis and treatment of psychiatric disorders.

None Declared

Historically, psychiatric disorders are studied according to a strictly behavioral approach taking into account the manifest symptomatology.

The present work aims to deepen the investigation of neural substrates through the use of neurophysiological recording techniques in an attempt to identify biomarkers related to these pathologies. Investigating whether neurophysiological indices are able to predict the symptomatic improvement and socio-relational functioning of the sample in a transversal manner with respect to the diagnostic category and the symptomatic severity of the psychiatric disorder. Further research is necessary.

The subjects were evaluated through the scale that measures psychopathological severity (BPRS, PANSS), global functioning (HoNOS) and cognitive (MMSE, CDT). The users were categorized based on the diagnosis and divided into the two Clusters, taking into account the number of hospitalizations of each user during the current year. The following neurophysiological parameters were detected using the Rehacor-T device: electroencephalographic (frontocentral brain oscillations), electrocardiographic (heart rate and HRV) and skin conductance (EDA). For a total procedure duration of 10 minutes (6 minutes of rest, 4 minutes in which the Stroop Test task was performed). Statistical analyses (Random Forest Clustering, Logistic Regression, ANOVA) were performed with the Jasp software (JASP 0.17.3.0).

83 users hospitalized at the Psychiatric Unit of the M. Bufalini hospital in Cesena were recruited and categorized according to the clinical diagnosis. Using a Random Forest Clustering algorithm the population was divided into two different Clusters based on the extent of improvement, assessed based on the low or high number of hospitalizations in the last year. Cluster 1 includes people with a higher number of hospitalizations, while Cluster 2 includes those with a lower number. From logistic regression analyses, a single neuropsychophysiological parameter was identified that was able to predict the classification of users within the two Clusters, namely the Beta oscillations (13-30 Hz) recorded in the fronto-central position in the resting state with eyes closed (resting state). Greater power was recorded in the group of subjects who reported a significant improvement in the symptomatic picture (Cluster 2). The variable of sex was not relevant, while the diagnosis, in Cluster 2, a greater concentration of people with depressive disorder was found.

This work highlights how the fronto-central Beta oscillations recorded in the resting state with eyes closed can be a predictive index of the improvement of the psychopathological conditions of the sample. The remaining neurophysiological indices taken into consideration (delta, theta, alpha and beta oscillations, ECG, EDA), did not show the same predictive capacity.

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One of the main mechanisms of action of LSD in psychedelic-assisted psychotherapy (PAP) is the activation of 5HT2A receptors. This triggers a cascade of neurochemical processes with the release of neurotransmitters and neurohormonal substances. The release of oxytocin in this process is well documented in pre-clinical studies, with recent evidence in healthy subjects. We have no data on oxytocin reactivity during LSD treatment in patients with psychiatric problems. It would be of great scientific interest to identify treatment biomarkers in this field.

The main objective of this pilot study is to obtain preliminary data on the reactivity of salivary oxytocin during a single LSD intake as part of PAP for anxiety disorders or depression. The secondary objective is to establish preliminary correlations between variations in oxytocin levels, intensity of perceived effects, intensity of psychedelic mystical experience, and the overall clinical response to treatment (anxiety-depression symptoms).

Participants are recruited among patients with resistant anxiety-depressive disorders enrolled in the psychedelic-assisted psychotherapy (PAP) program of the Division of Addictology, Department of Psychiatry (Geneva University Hospital). Salivary oxytocin is measured at four different time-points: before LSD intake, then 60, 90 and 180 minutes after intake. Self-perceived intensity of effects is also measured at these time points and a self-report questionnaire of mystical experience (MEQ-30) is administered at the end of the LSD session. Of note, self-reported symptoms of depression (BDI-II) and anxiety (SATI-T) are measured when participants enroll the PAP program, then a few months later right before the treatment and three weeks after treatment. ClinicalTrials.gov:NCT06557239

Six participants (out of 10 planned) have completed the entire protocol. Four additional participants will receive treatment within the next two weeks. Saliva samples are stored at -20.C and will be sent for analysis once recruitment will be over (November 2024). A significant effect of time (P= 0.02) of perceived intensity effects is observed across different time-points (30, 60, 90, 180, 360 minutes after treatment), with a peak effect at 180 minutes. We also observe a significant interaction (P=0.03) between self-perceived intensity of effects and the intensity of mystical experience measured with the MEQ-30. BECK and STAI-T scores will be analysed after post-treatment assessment.

Our preliminary data show a clear effect of self-perceived treatment intensity and a relation between this effect and self-reported mystical experience. It will be of great interest to include oxytocin data in this analysis as well as the evolution of self-reported symptoms of anxiety and depression. With the successful recruitment and easy adherence to the protocol, we will certainly have all data available by the end of 2024.

None Declared

Suicidal ideations are severe and serious symptoms in the clinical presentation of schizophrenia, as well as adverse reactions such as oculogyric crises. In certain situations, they may be associated with specific pharmacogenetic factors, such as gene variations for the serotonin transporter (SERT) and the CYP2D6 enzyme.

A 37-year-old patient with treatment-resistant schizophrenia, characterized by frequent suicidal ideations, is regularly treated with clozapine (100 mg/day). Additionally, during disease exacerbations, the patient is given haloperidol (10 mg/day) as supplemental therapy, resulting in the development of oculogyric crises.

Due to the lack of therapeutic response and a predisposition to side effects, a pharmacogenetic analysis revealed CYP2D6 genotype *4/*9 and 5-HTTLPR genotype SA/SA. This indicates CYP2D6 intermediate enzyme activity and SERT low activity. Due to these findings, haloperidol was discontinued, and paliperidone palmitate was introduced at a dose of 75 mg monthly, after which the oculogyric crises no longer occurred. The pharmacogenetic results showed reduced SERT activity, which may be associated with the decreased therapeutic response to clozapine and the persistence of suicidal ideations.

Haloperidol is metabolized via CYP2D6, and its intermediate activity can lead to higher plasma concentration, resulting in extrapyramidal side effects such as oculogyric crises. Paliperidone is a metabolite of risperidone, and the activity of CYP450 enzymes has a minimal impact on its therapeutic response and potential for adverse reactions. HTTLPR regulates the transcriptional activity of the 5-HTT gene, so genotypes with low expressions, such as S’/S’ or S’/L’, may exhibit a weaker response to clozapine, which may include the persistence of suicidal ideations.

The personalized antipsychotic treatment according to an individual’s pharmacogenetic profile may prevent adverse reactions and potentially explain therapeutic resistance in such cases where clozapine is otherwise indicated. Effective modern psychopharmacological treatment requires understanding pharmacogenetic factors and their influence on therapeutic response and the development of adverse reactions.

None Declared

Aripiprazole once monthly 400mg (AOM400) is a long-acting injectable (LAI) available with a two-injection start initiation regimen (AOM400-TIS) for the maintenance treatment of adult patients with schizophrenia stabilised with oral aripiprazole.

This survey sought to explore the perspectives and experiences of HCPs using AOM400-TIS across Europe.

HCPs who had prescribed and/or administered the AOM400-TIS regimen to ≥3 patients with schizophrenia were invited to participate in an online survey. The survey was launched in two waves across the target countries (wave 1: Italy, Germany, United Kingdom (UK); wave 2: Denmark, Italy, Sweden). The survey aimed to understand HCPs’ perspectives and attitudes towards prescribing and/or administering AOM400-TIS according to the European label in clinical practice, including reasons for its use, potential benefits, and common barriers and/or concerns. Analysis was descriptive; data was collected between February 1–March 21, 2024 (wave 1) and September 16-October 28 (wave 2).

216 HCPs completed the survey (wave 1: 31 from Italy, 31 Germany, 32 UK; wave 2: 28 from Denmark, 64 Italy and 30 Sweden) including psychiatrists (67%) and psychiatric nurses (27%). HCPs estimated 30.0% (median; IQR: 20.0–50.0) of patients in their caseload were diagnosed with schizophrenia, and of these, 50.0% were treated with LAIs (median; IQR: 25.0–65.0). 46% of HCPs were primarily responsible for prescribing AOM400-TIS, 26% for administering it, and 28% were responsible for both. HCPs estimated that 42% of patients typically spent 14–28 days on oral aripiprazole prior to AOM400-TIS, with HCPs rating the severity of symptoms of patients initiated with AOM400-TIS as mild (18% of HCPs), moderate (65% of HCPs) and/or severe (53% of HCPs). The most common reasons for initiating AOM400-TIS after transitioning from oral aripiprazole were poor adherence (88%) and relapse(s) (52%), and the most reported goals for prescribing AOM400-TIS were to improve adherence (69%) and prevent relapses (64%). Common barriers to the use of AOM400-TIS were patient reluctance to receive two injections (55%), concerns about tolerability (34%) and safety of administering a high dose in a single day (35%). Prior treatment adherence (56%) and efficacy (46%) were the most cited factors influencing prescribing of AOM400-TIS. Overall, HCPs “agreed”, or “strongly agreed”, that AOM400-TIS was easy to administer (84%) and that it had a similar safety/tolerability profile to the single injection start regimen (60%), while the majority were satisfied with patient outcomes with AOM400-TIS (85%).

Overall, HCPs with experience of using AOM400-TIS reported that it is easy to administer, well tolerated, and improves treatment outcomes, while barriers to its use include patient reluctance and perceived safety concerns.

M. Yildirim Employee of: Murat Yildirim is a full time employee of H.Lundbeck A/S, Valby, Copenhagen., C. Beckham Employee of: Clodagh Beckham is a full-time employee of Otsuka Pharmaceutical Europe Ltd., Berkshire, UK., A. Fagiolini Grant / Research support from: Angelini, Boehringer Ingelheim, Lundbeck, Janssen, Otsuka, Pfizer, Recordati, Viatris, Consultant of: Angelini, Boehringer Ingelheim, Idorsia, Italfarmaco, Lundbeck, Janssen, Medicamenta, Mylan, Otsuka, Pfizer, Recordati, Rovi, Sunovion, Teva, Viatris, K. Leopold Grant / Research support from: Janssen, Otsuka, Consultant of: Boehringer Ingelheim, Lundbeck, Janssen, Otsuka Recordati, ROVI, Speakers bureau of: Boehringer Ingelheim, Lundbeck, Janssen, Otsuka Recordati, ROVI, W. Cottam Employee of: Will Cottam is a full-time employee of OPEN Health (London)., J. Hickey Employee of: Joe Hickey is a full-time employee of OPEN Health (London)., O. Rogerson Employee of: Olivia Rogerson is a full-time employee of OPEN Health (London)., S. Pappa Grant / Research support from: Recordati, Janssen, Consultant of: Lundbeck, Janssen, Otsuka, Recordati, Rovi, Gedeon Richter, Sunovion, Speakers bureau of: Lundbeck, Janssen, Otsuka, Recordati, Rovi, Gedeon Richter, Sunovion.

The continuous exploration of new treatments in the field of psychopharmacology has brought a new light on psychedelics, raising the provocative question of how these drugs of abuse (DOA) may become useful in clinical practice. Psychedelics are included in the category of “psychoplastogens”, substances that are known for their effects of enhancing neuroplasticity in the nervous central system via the modulation of Brain-derived Neurotrophic Factor (BDNF) signaling. However, psychedelics were originally known as DOA; therefore, ascribing them to therapeutic use for patients with psychiatric disorders may seem largely counterintuitive.

To review the current data on the benefits and risks of psychoplastogens in patients with psychiatric disorders.

A literature review was conducted in four electronic databases (PubMed, EMBASE, Cochrane, and Clarivate/Web of Science) and the US National Library of Medicine database for clinical trials (www.clinicaltrials.gov) to find clinical and preclinical sources published between January 2000 and September 2024. The keywords used were “psychoplastogens,” “neuroplastogens,” “neuroplasticity,” “psychoactive drugs,” “drugs in the pipeline,” and all the main psychiatric diagnosis categories. Both primary and secondary reports were allowed, but only those published in English were selected.

Ketamine and each of its stereoisomers, as well as psilocybin, are the most extensively explored drugs in this class, but also MDMA, DMT, psilocin (ELE-101), CYB003 (a psilocybin analog), and lisuride have received increased attention in the last decade. Such agents are investigated for indications such as treatment-resistant major depression, posttraumatic stress disorder, binge eating disorder, and substance use disorders. One important direction of research is the evaluation of psilocybin in patients with cancer-related depression and/or anxiety. Hallucinations and altered states of consciousness that may receive mystical interpretations are typical for high doses of psychedelics, raising questions about the use of these drugs in clinical populations with already severe mood, thought and perceptual disturbances. Safety and tolerability aspects are extremely important in deciding when, to whom, and how much psychoplastogens may be recommended for different psychiatric disorders. Creating psychoplastogens with less or no psychotomimetic activity is expected to increase the interest of clinicians in the use of such agents for patients with psychiatric disorders, especially in treatment-resistant cases.

Although expected to be a paradigm-shifter in psychiatry, the exploration of psychoplastogens should consider not only the potential benefits, which require further and extensive studies, but also their adverse events. For this purpose, long-term studies are needed with both efficacy and tolerability outcomes carefully monitored.

None Declared