The COVID-19 pandemic has led to a significant number of patients presenting with post COVID-19 condition, commonly referred to as long COVID, which can affect any individual exposed to SARS-CoV-2, resulting in diminished quality of life, reduced productivity, increased healthcare expenditures, and broader economic implications. The most prevalent symptoms include neuropsychiatric manifestations such as fatigue, cognitive impairment, anxiety, and depression. Beneficial effects of Silexan, a herbal medicine derived from Lavandula angustifolia, were reported in long COVID patients with subsyndromal psychiatric symptoms (Bartova et al. Eur Neuropsychopharmacology 2023;70:47-48). However, research is lacking regarding psychopharmacotherapy in patients with persistent symptoms. Esketamine, noted for its modulation of NMDA receptors, has also demonstrated immunomodulatory effects, positioning it as a promising intervention for Long COVID (Johnston et al. Neuropsychopharmacology. 2024; 49(1): 23-40).

Our objective was to examine two patient cases to identify patterns, explore potential treatment options, and contribute insights to clinical practice in psychiatry.

This case series reports the clinical histories, demographic information, diagnostic findings, and treatment details of two long COVID patients who were treated in analogy to the well-established guideline for treatment-resistant depression.

A 33-year-old female patient, who failed to respond to phytotherapy and conventional psychopharmacological treatments, including two trials of antidepressants and augmentation with an atypical antipsychotic agent received 10 intravenous esketamine treatments, administered at doses of up to 50 mg (0,86 mg/kg/hour). She experienced substantial clinical improvement without any adverse effects within 8 weeks. A 34-year-old non-responding female patient received 9 sessions of intranasal esketamine, targeting a dosage of 84 mg, resulting in complete remission without significant adverse effects within 6 weeks.

There is an urgent need for effective and sustainable treatment options that address the debilitating neuropsychiatric symptoms of long COVID. This condition disproportionately affects young women, a group that is frequently underrepresented in research and insufficiently recognized in clinical practice. In this case series, we report on two female patients with severe physical and social impairment from long COVID, who showed significant clinical improvement following add-on esketamine administration.

I. Bozic: None Declared, D. Ivkic: None Declared, L. Reinfried: None Declared, J. Donath: None Declared, C. Schmidt Grant / Research support from: Eli Lilly, S. Graf: None Declared, P. Handschuh: None Declared, M. Dold Grant / Research support from: Medizin Medien Austria, Janssen and Universimed, Consultant of: Medizin Medien Austria, Janssen and Universimed, D. Winkler Paid Instructor of: Angelini, Lundbeck, Medical Dialogue, and MedMedia Verlag, A. Naderi-Heiden: None Declared, N. Praschak-Rieder: None Declared, D. Rujescu-Balcu Grant / Research support from: Janssen and Lundbeck, Consultant of: Janssen and Rovi, Speakers bureau of: Janssen and Pharmagenetix, A. Weidenauer: None Declared, L. Bartova Grant / Research support from: Alpine Market Research, Angelini, Biogen, Diagnosia, Dialectica, EQT, Iqvia, Janssen, Johnson & Johnson, Lundbeck, Market Access Transformation, Medizin Medien Austria, Novartis, Schwabe and Universimed, Consultant of: Alpine Market Research, Angelini, Biogen, Diagnosia, Dialectica, EQT, Iqvia, Janssen, Johnson & Johnson, Lundbeck, Market Access Transformation, Medizin Medien Austria, Novartis, Schwabe and Universime

Aripiprazole once monthly 400mg (AOM400) is a long-acting injectable (LAI) available as 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 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) 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; wave 2: Denmark, Italy, Sweden). Analysis was descriptive; data was collected between February 1–March 21, 2024 (wave 1) and September 16-October 28 (wave 2). Data from Italian HCPs are presented.

31 HCPs from the 1st wave and 64 from the 2nd wave completed the survey including psychiatrists (69%), psychiatric nurses (23%), community nurses (4%) and general practitioners/primary care practitioners (1%). HCPs estimated 30.0% (median; IQR: 20.0–50.0) of patients in their caseload were diagnosed with schizophrenia, and of these, 45.0% were treated with LAIs (median; IQR: 25.0–62.5). 47% of HCPs were primarily responsible for prescribing AOM400-TIS, 24% for administering it, and 28% were responsible for both. HCPs estimated that 44% of patients typically spent up to 14 days on oral aripiprazole prior to AOM400-TIS, with HCPs rating the severity of symptoms of patients initiated with AOM400-TIS as mild (22% of HCPs), moderate (68% of HCPs) and severe (40% of HCPs). The most common reasons for initiating AOM400-TIS after transitioning from oral aripiprazole were poor adherence (80%) and patient preference (49%), and the most reported goals for prescribing AOM400-TIS were to improve adherence (75%) and prevent relapses (69%). Common barriers to the use of AOM400-TIS were patient reluctance to receive two injections (39%), concerns about tolerability (24%), safety of administering a high dose in a single day (23%). Prior treatment adherence (54%) 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 (81%) and that it had a similar safety/tolerability profile to the single injection start regimen (69%), while the majority were satisfied with patient outcomes with AOM400-TIS (83%).

Overall, Italian 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.

C. Beckham Employee of: Clodagh Beckham is a full-time employee of Otsuka Pharmaceutical Europe Ltd., Berkshire, UK., M. Yildirim Employee of: Murat Yildirim is a full-time employee of H.Lundbeck A/S, Valby, Copenhagen., 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., 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)., 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

Antipsychotic medications, particularly atypical antipsychotics, are commonly associated with metabolic side effects such as weight gain, dyslipidemia, and insulin resistance. These disturbances significantly increase the risk of cardiovascular disease and mortality, especially in patients treated with clozapine and olanzapine. It is not always feasible to discontinue these treatments, as the decision largely depends on the clinical context. Therefore, addressing these metabolic side effects requires specific pharmacological interventions to mitigate their impact.

This non-systematic review aims to assess the evidence supporting pharmacological interventions in managing antipsychotic-induced metabolic disturbances.

Relevant and recent studies or reviews were selected from the PubMed electronic database using search terms related to antipsychotic-induced metabolic disturbances and pharmacological interventions to manage them.

Current evidence suggests the need for early and aggressive pharmacological intervention in patients experiencing antipsychotic-induced weight gain. Non-pharmacological interventions, such as physical activity and dietary changes, are often insufficient to mitigate these iatrogenic effects. Pharmacological interventions to reduce metabolic risk in individuals with severe mental illness may include the introduction of an antipsychotic with a more favourable metabolic profile, modification of antipsychotic therapy (dose adjustment, augmentation with another antipsychotic with a lower metabolic risk or switching to another antipsychotic with a lower metabolic risk) and treatment of medical conditions (through the use of drugs such as metformin, statins, among others). Based on updated scientific evidence, the most effective pharmacological treatments for reducing weight gain associated with second-generation antipsychotics are metformin, GLP-1 receptor agonists, topiramate, zonisamide, and nizatidine. The adjunctive use of aripiprazole also reduces lipid levels and weight and attenuates negative symptoms in patients with schizophrenia and metabolic syndrome. Metformin is considered the best-tolerated intervention, while topiramate is the least tolerated.

Pharmacological interventions, particularly the use of metformin and GLP-1 analogues, offer promising results in managing antipsychotic-induced metabolic disturbances. These interventions improve weight management, glucose levels, and lipid profiles. More large-scale randomized trials are needed to further validate these interventions and assess long-term safety and efficacy.

None Declared

Risperidone In Situ Microimplants (ISM®), a novel long-acting injectable (LAI) antipsychotic, rapidly achieves therapeutic plasma levels, with a significant first plasma peak occurring at 48 hours. This rapid onset of action, without the need for oral supplementation or loading doses, offers a promising new approach for effective management of acute symptoms (Walling et al. Drug Des Dev Ther 2021;15 4371-4382).

To evaluate the efficacy and safety of risperidone ISM (R-ISM) in the treatment of acute manic episodes with psychotic symptoms, focusing on symptom change over time.

This preliminary and retrospective study included 15 inpatients with schizoaffective disorder who were started on R-ISM during a manic episode. RISM was administered after 6 days of oral risperidone. We retrospectively examined the Young Mania Rating Scale (YMRS) scores obtained in routine clinical practice at baseline (Dx), on the day of inpatient admission, on the day of injection (D0) and then 24 hours (D1), 48 hours (D2), 7 days (D8) and 28 days (D28) after the injection.

A statistically significant improvement in the total YMRS score was observed as early as the day of injection, with the median score decreasing from 37 [IQR: 4.5] at baseline to 27 [IQR: 2.5] at D0 and further to 20 [IQR: 4] at 24 hours after the injection 1 (D1) (p < 0.01). The improvement remained statistically significant at all assessment time points, reaching 11 [IQR: 1.5] at day 28 (D28) (see Image 1).

Single-item analysis showed rapid and significant improvement across all YMRS items, in particular the following symptoms (see Image 2):

• - Irritability: Significantly decreased from a score of 6 [IQR: 0] at baseline to 3 [IQR: 0.5] at D1 and to 1 [IQR: 0.5] at D28 (p < 0.01).

• - Disruptive-Aggressive Behavior: Significantly decreased from a score of 3 [IQR: 2] at baseline to 1 [IQR: 1] at D1 and to 0 [IQR: 1] at D28 (p < 0.01).

• - Sleep Disturbances: Significantly decreased from a score of 3 [IQR: 1] at baseline to 0 [IQR: 0.5] at D28 (p < 0.01).

• - Speech (Rate and Amount): Significantly decreased from a score of 4 [IQR: 1] at baseline to 1 [IQR: 0] at D28 (p < 0.01).

• - Content (Delusions; Hallucinations): Significantly decreased from a score of 6 [IQR: 0.5] at baseline to 3 [IQR: 1] at D28 (p < 0.01).

• - Insight: Significantly decreased from a score of 3 [IQR: 2] at baseline to 2 [IQR: 1] at D28 (p<0.01).

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This preliminary and retrospective study suggests the possible efficacy of risperidone ISM (approved for schizophrenia) for acute manic episodes. However, due to the retrospective design of the study, the small sample size, and the presence of concomitant treatments, the results are primarily exploratory and no conclusions can be drawn until prospective, randomized, placebo-controlled trials are conducted.

None Declared

Schizophrenia affects approximately 1% of the population aIts treatment is mainly based on antipsychotics, although therapeutic non-compliance is common due to lack of illness insight and side effects. Long-acting injectable antipsychotics emerged as an alternative to improve treatment adherence. This study investigates relapses in patients with severe mental illnesses treated with long-acting injectable antipsychotics, originating from the province of Salamanca.

To evaluate and compare the efficacy of different long-acting injectable treatments available in the market in preventing relapses in patients with Severe Mental Disorder (SMD), through retrospective analysis of epidemiological, clinical, and treatment data obtained from electronic medical records.

This is an observational, retrospective, and comparative study using anonymized data extracted from electronic medical records of patients diagnosed with Severe Mental Disorder (SMD) who have been treated with Long-Acting Injectable (LAI) medications. The study period covers from January 2018 to December 2022.

The study contains information from 161 patients, with a uniform distribution by age and sex. The main group presents psychotic disorders (74.5%), followed by bipolar disorder (18%). Monthly Long Acting aripiprazole is the most used injectable antipsychotic (39.8%). Side effects were recorded, such as extrapyramidal symptoms (11.9%) and sexual dysfunction (8.8%). Antipsychotic switching occurred in 19.5% of patients. The absence of relapses was higher for six-month long-acting paliperidone palmitate (80%) and lower for Monthly Long Acting aripiprazole (69.4%), a survival analysis was performed using the Kaplan-Meier method.

The comparative study reflects that, although Abilify Maintena was the most used, no significant differences were found in relapse prevention among different treatments. Survival analysis also did not yield conclusive results. Although the study has some limitations, such as a small sample size and missing data in some medical records, it provides a starting point for future research.Despite the limitations of this study due to the small sample size and lack of statistically significant results regarding the efficacy of injectable antipsychotics, the study provides information on the use of these treatments in patients with Severe Mental Disorder. Although Monthly Long Acting aripiprazole was the most used, side effects do not seem to be related to its efficacy. The results suggest that there are no significant differences between long-acting injectable antipsychotics available in the market. However, it is important to note the significance of this research topic for the future, given its clinical implications.

None Declared

Obesity has reached epidemic proportions globally, significantly increasing the risk of cardiovascular diseases, diabetes, and various cancers. In the United States, as of 2017-2018, the prevalence of obesity among adults was approximately 42.4% (CDC, 2020). Worldwide, over 650 million adults were obese in 2016 (WHO, 2020).

Bariatric surgery, which includes a variety of procedures aimed at weight loss, While these surgeries primarily aim to induce weight loss and improve metabolic health, they also present challenges for patients taking psychotropic medications, such as antidepressants, antipsychotics, and mood stabilizers.

Understanding the Impact of Bariatric Surgery on Psychotropic Medication Management

1. 1. Changes in Pharmacokinetics: Bariatric surgery can significantly alter the absorption, distribution, metabolism, and elimination (Smith et al., 2018).

2. 2. Drug Interactions:Post-surgery changes in gastrointestinal physiology can impact drug interactions and the efficacy of psychotropic medications. (Alvarez et al., 2020).

3. 3. The need for Monitoring and Dosing Adjustments:

4. 4. Understanding Nutrient Deficiencies: can lead to deficiencies in essential nutrients like vitamin B12, vitamin D, iron, and calcium, which can exacerbate psychiatric symptoms or affect the metabolism of psychotropic medications (Courcoulas et al., 2020).

A thorough literature review was carried out, with emphasis on research done within the the last 5 years.

On thorough reiew of literature, better outcomes resulted from implementing the following

1. 1. Individualized Monitoring: Regular assessment of weight loss, nutritional status, and psychiatric symptoms can inform dosage adjustments to maintain therapeutic efficacy (Zachariah et al., 2015).

2. 2. Consideration of Formulations: Immediate-release formulations may ensure consistent absorption and therapeutic effects due to altered gastrointestinal transit times (Lopez-Nava et al., 2017).

3. 3. Collaborative Care:A multidisciplinary team, including bariatric surgeons, psychiatrists, pharmacists, and dietitians, can optimize medication regimens and address nutrient deficiencies (Smith et al., 2018).

Also considered the Benefits of Long-Acting Injectable (LAI) Psychotropics Post-Bariatric Surgery which improved the following

Post Bariatric surgery,Clinicians must carefully monitor medication efficacy, adjust doses as needed, and manage nutrient deficiencies to ensure optimal mental health outcomes.

Ongoing research and multidisciplinary collaboration are essential to refining guidelines and improving the long-term management of these complex patient populations. By integrating personalized care strategies and considering LAI formulations, healthcare providers can optimize treatment outcomes for patients undergoing bariatric surgery.

None Declared

Auditory verbal hallucinations (AVH) are prevalent in schizophrenia but also occur in bipolar disorder, yet differences in their phenomenology remain poorly understood. This ongoing study aims to fill this gap by comparing the phenomenological characteristics of AVH in schizophrenia and bipolar disorder.

The research questions we are interested in are:

• - The nature of hallucinations. We hypothesize that hallucinatory experiences in bipolar disorders is connected to the mood, for example mania.

• - We hypothesize that auditive verbal hallucinations in bipolar disorders will not have the immanent character as in schizophrenia and won’t be experienced in a pathologically altered private space.

• - We hypothesize that bipolar patients after a remission from the episode will consider their voices as a sign of disease whereas the patients with schizophrenia will continue to ascribe extraordinary meanings to their hallucinations.

Building on our prior research in schizophrenia, we are conducting semi-structured, phenomenologically oriented qualitative interviews with patients diagnosed with bipolar disorder who experience AVH. Participants are recruited from outpatient clinics and hospital wards in Denmark. Data will be analyzed using thematic analysis with a bottom-up approach.

Preliminary findings from our ongoing study will be presented.

A deeper understanding of AVH phenomenology in schizophrenia and bipolar disorder can lead to more accurate differential diagnoses, reducing the risk of misdiagnosis and ensuring that patients receive appropriate and timely treatment.

None Declared

The term self-disorder investigated in this study refers to a disorder of the minimal self. It is a disturbance at the basic pre-reflective level typical in schizophrenia spectrum disorder, These disturbances are often present in the prodromal face of schizophrenia.

In 2003 Sass and Parnas proposed the ipseity-disturbance model (ipseity also sometimes termed minimal self, basic self, experimental self, and for-meness). Since 2003 Parnas and colleagues have published EASE (Examination of anomalous Self-experience): a semi-structured interview guide to allow for a systematic, qualitative and quantitative assessment of self-disorders.

The EASE-scale consist of a checklist of 57 items divided into 5 domains: 1) Cognition and Stream of Consciousness, 2) Self-Awareness and Presence, 3) Bodily Experiences, 4) Demarcation/Transitivism and 5) Existential Reorientation. The domains serve to structure the interview and to aid the interviewer to navigate and cover all 57 items during the interview.

In the last 20 years, several studies using EASE have supported self-disorders to be a central psychopathological feature of schizophrenia. A systematic review from 2021 showed that self-disorders hyper- aggregate in schizophrenia spectrum disorders but not in other mental disorders. However, self-disorder aggregation and distribution in between schizophrenia spectrum disorders have not been investigated before.

The purpose of this study is to compare overall EASE-sums in types of schizophrenia spectrum disorders including subtypes of schizophrenia (ICD10).

We hypothesize that there will not be a significant difference in overall EASE-score, reflecting self-disorder to be a core disturbance in schizophrenia spectrum disorders.

Furthermore, we plan to perform explorative statistical analysis on item-level of the EASE-scale, to investigate whether self-disorders presents differently and characteristically in-between schizophrenia spectrum disorders.

Data is pooled from 6 different studies, totaling 236 patients.

All patients were examined using the EASE-guide by a professional clinicians who were trained in the semi-structed EASE-interview. The patients were furthermore assessed thoroughly for psychopathology and diagnosed according to ICD10 and DSM-IV or V.

Ongoing

Ongoing

None Declared

Charles Bonnet Syndrome (CBS) is characterized by complex hallucinations in patients with sensory impairment. The World Health Organization in 2018 outlined the diagnostic criteria for CBS as follows: complex visual hallucinations; partial or complete vision loss; and absence of mental disorders (Dhooge Patty et al. AES 2022;7:12). Notably, auditory hallucinations are excluded from this definition, and recent reviews argue that CBS should not encompass sensory or auditory hallucinations (Rojas LC, Gurnani B. StatPearls 2024). Although their frequent association with psychotic disorders, a broad differential diagnosis is crucial given the diverse etiologies. Recently, there has been growing literature of cases of auditory hallucinations which were only explained as a CBS.

The work aims to explore and discuss the auditory variant of Charles Bonnet Syndrome (CBSa).

Based on two clinical cases, we conducted a literature review on this topic using PubMed database.

We describe two patients with severe sensorineural hearing loss and auditory hallucinations. The first patient, a 95-year-old independent in daily activities, presented with sudden-onset external voices. The second, an 81-year-old institutionalized woman, exhibited musical auditory hallucinations that developed over several months. Both patients maintained insight into the unreality of their hallucinations.

Comprehensive evaluations ruled out other potential causes, including neurological, psychiatric, pharmacological, and toxic-metabolic origins. Given the symptoms and and the exclusion of alternative diagnoses, CBSa was determined as the underlying cause.

The course of CBSa is known to be variable; hallucinations may diminish or resolve spontaneously or when the hearing deficit is ameliorated. Therefore, management is directed toward addressing the primary cause. No standardized treatment exists; however, medications such as antipsychotics, antidepressants, or antiepileptics may alleviate symptoms (Perez PA et al. Open Neurol J 2017 Feb 28;11:11-14). In our cases, both patients were treated with risperidone at 1 mg/24h, resulting in good tolerance and complete resolution of symptoms.

Despite the absence of definitive diagnostic criteria for CBS, it is predominantly associated with visual hallucinations without concomitant neurological or psychiatric pathology, excluding auditory manifestations. However, if patients experience hallucinations in non-visual sensory modalities while retaining insight into their unreality, they should not be excluded from a CBS diagnosis. Recent case studies support the existence of such variants.

This paper advocates for the refinement of CBS diagnostic criteria to encompass these additional manifestations. Expanding these criteria could enhance psychiatric epidemiology by addressing the current underestimation of CBS prevalence and improving the recognition and management of this condition.

None Declared

In the last decades, research has focused on investigating cognition and psychopathological symptoms as variables contributing to functional outcomes. However, in recent years the study of motivation has attracted interest as a research target related to functional outcome (Miley et al Psychol Med. 2023;53(5):2041-2049).

We aimed to study the relationship of clinical symptoms, motivation, socio-affective capacity and cognition with functioning in social and occupational areas in patients with a psychotic disorder.

A sample of 97 patients with a DSM-5 psychotic disorder diagnosis was included. Assessments included the Specific Levels of Functioning Scale (SLOF; Schneider et al. Soc Work Res Abstr 1983;19(3):9-21) to assess functioning; the Comprehensive Assessment of Symptoms and History (CASH; Andreasen et al. Arch Gen Psychiatry 1992; 49(8):615-23) for clinical symptoms; and the Cognitive Assessment Interview (CAI-Sp; Ventura et al. Schizophr Res 2010; 121(1-3): 24-31) and a comprehensive neuropsychological battery to assess cognition. Motivation and socio-affective capacity were assessed by means of the Quality of Life Scale (QLS; Heinrichs et al. Schizophr Bull. 1984; 10(3):388-98). Both domains were derived from items of the Intrapsychic Foundations subscale of the QLS. Motivation was derived from items 13, (sense of purpose), 14 (degree of motivation) and 15 (curiosity). Socio-affective capacity comprised items 20 (capacity for empathy) and 21 (capacity for engagement and emotional with the interviewer).

Spearman correlations were calculated. Variables which correlated significantly (p<0.05) with SLOF scores were included in the regression analyses.

All the clinical, cognitive and related with motivation and socio-affective capacity variables included in the analyses were significantly correlated with SLOF scores (Table 1), except for positive symptoms with SLOF activities and work. However, in the hierarchical analyses most of the variables were not significant. Specifically, regarding SLOF social scores, positive symptoms and motivation explained 51.5% of the variance. Motivation also explained 40.1% and 68% of the variance of the scores of SLOF activities and work, respectively (Table 2).

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Motivation has a great value as a predictor factor in social, activities and work functioning. Therefore, motivation should be considered as a target related to improving functioning in early intervention programmes for psychotic disorders.

None Declared

Health Related Quality of Life (HRQOL) is a key outcome in the treatment of patients with psychosis. It is considered Patients should assess their HRQOL through PROMs. This subjective assessment could be combined with other sources of information

The aims of the present study are to evaluate HRQOL and other related variables in a sample of Spanish schizophrenia spectrum patients, who start treatment in a Rehabilitation Unit and to evaluate if there are improvements in HRQOL and in these variables after receiving a rehabilitation treatment

A sample of 127 of schizophrenia or schizoaffective disorders patients were included in the study (Table 1). These patients started a multi-professional treatment in a Rehabilitation Service. Patients have been evaluated twice – at the beginning and treatment end. Patients have assessed their general and specific HRQOL with the EUROQOL-5D-5L and SQLS-R4 scales. Professionals have evaluated main symptoms of psychosis SSPI, general functioning (objective QOL) PSP and basic and instrumental Daily activities VAVDI. Frequencies in the demographic, clinical and questionnaire scores were calculated. Changes in the questionnaires between the two assessments (Wilcoxon and Chi Square tests) (Table 1).

HRQOL scores were moderate in the EQ-5D-5L health and SQLS-R4 factors and total score (M=37.9; ST=20.9) in the first assessment, and high in the EQ-5D-5L value. The PSP score (objective QOL) at the first assessment shows notable difficulties. Significant changes HRQOL improvement were found in the EQ5D5L health, in the SQLS-R4 factors and total score (effect size range between .35-.39 small effect). General functioning (PSP) scores improved (effect size .68, middle effect) and Daily activities (0.34 small effect). A significant reduction in symptoms was observed in the total SSPI score, especially in negative symptoms, and anxiety/depression, with the effect size being particularly large (Table 2).

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These results of the present study outcomes have shown an improvement in both the perceived subjective and objective quality of life of patients. It seems patients and professional may have different criteria to evaluate HRQOL. The relevance of integrating patients’ HRQOL assessment into intervention strategies for the treatment of serious mental disorders is highlighted.

None Declared

One of the main symptoms of schizophrenia is auditory hallucinations. Although reliable epidemiological data is limited, the prevalence of schizophrenia among the deaf community seems to be about the same as in the general population. Approximately 50% of deaf individuals diagnosed with schizophrenia report ‘hearing’ voices or experiencing the sensation of communication in the absence of external input. Minimal information is available regarding the perceptual aspects of voice hallucinations in congenitally deaf individuals.

With this case report, we aim to describe auditory hallucinations in a patient with congenital deafness and discuss auditory hallucinations in deaf individuals. We will also examine how these phenomena may fit into explanatory subvocal articulation hypotheses, providing insights into language modality and auditory deprivation.

Description of a clinical case of a deaf patient with auditory hallucinations in a psychiatric outpatient consultation.

The authors report a case of a 26-year-old male patient with congenital deafness and no prior psychiatric or relevant medical history. He communicated preferably by sign language and also by lip reading. The consultation was realized with the presence of a sign language interpreter. The patient was referred to a psychiatric outpatient appointment due to a 1-year history of bizarre behavior, social isolation, and apparent psychotic symptoms. He lived with his parents and was currently unemployed. According to his mother and brother, he “spoke and laughed alone, like he was talking with someone”. In his mental status examination, he presented a religious delusion and likely auditory hallucinations. He had no changes in his physical and neurologic examination. Blood tests, urinalysis, and urine screening for drug abuse were performed, with normal results. Computed tomography of the brain and an electroencephalogram were also performed, with no significant changes. Over time, the patient was diagnosed with schizophrenia and was medicated with paliperidone with remission of his symptoms.

These findings highlight how auditory hallucinations in congenitally deaf individuals offer a unique view of the interplay between sensory perception and the experience of ‘voices.’ The subvocal articulation hypothesis suggests that auditory hallucinations may arise from disruptions in inner speech mechanisms—subtle, unconscious movements that the brain misinterprets as external voices. In deaf individuals, this experience may manifest through sensory feedback loops adapted to visual modalities, such as the perception of sign language movements, rather than through purely auditory sensations. This shows how language and sensory experiences shape hallucinations, emphasizing the need to consider sensory differences in psychotic symptoms across populations.

None Declared

The COVID-19 pandemic has evolved into substantial mortality and morbidity worldwide, with 5-8% of patients requiring intensive care. Years after the emergence of COVID-19, there is a heightened interest about the Long COVID, a heterogeneous condition characterized by persistent or emergent symptoms that last for weeks or months after patient’s recovery from acute infection, with a negative impact on physical and mental health. Research indicates that depression and anxiety often co-occur and may serve as predictors for Long COVID. Given the scale of the pandemic, even a small proportion of patients with long-lasting symptoms will create a significant health burden. Therefore, gathering data on the long-term evolution and outcomes of these patients is of utmost importance.

To identify depressive and anxiety symptoms in severe COVID-19 survivors 1-year after discharge and to analyse their association with sex, age and fear of recurrence and sequelae of COVID-19.

The cohort analysed is part of MAPA research project and includes adult patients admitted due to COVID-19, in an Intensive Care Medicine Department of a University Hospital in Portugal. Participants were evaluated 1-year after discharge to home with a comprehensive protocol, which included Patient Health Questionnaire (PHQ-9; depressive symptoms), General Anxiety Disorder scale (GAD-7; anxiety symptoms) and a brief questionnaire about fear of recurrence and sequelae of COVID-19.

The final sample (n=159) had a mean age of 62.2 years and mostly (69%) was male. About 19% and 21% of survivors scored for depressive and anxiety symptoms, respectively. Both symptoms were significantly more prevalent among younger participants (p=0.031; p<0.001) and were associated with fear of recurrence (p=0.002; p=0.009) and sequelae (p=0.001; p<0.001) of COVID-19 1-year after discharge.

Overall, there is a significant prevalence of anxiety and depressive symptoms among COVID-19 survivors 1-year after discharge. These findings emphasize the need for greater attention to these symptoms in this population, since its recognition and treatment can improve quality of life and reduce symptoms in the long term, especially in younger patients.

This work was supported by National Funds through FCT - Fundação para a Ciência e a Tecnologia,I.P., within CINTESIS, R&D Unit (reference UIDP/4255/2020)

None Declared

Parent-child relationships significantly influence psychological and social development, with lasting effects on mental health. Warm and supportive relationships are linked to higher emotional well-being, while neglectful or strict parenting increases the risk of mental disorders [1]. Even non-abusive but conflictual relationships can raise the risk of psychological issues in adulthood [2][3], and stable family bonds contribute to resilience in facing life challenges [4][5].

This study aims to explore and assess the impact of parent-child relationships on mental well-being in adulthood.

This study uses a Google Forms questionnaire with six sections to assess the impact of parent-child relationships on mental well-being in adulthood. Univariate analysis was conducted in Excel, and multivariate analysis, including a logistic regression model, was performed in R Studio to measure this impact.

Approximately 65% of participants who reported a warm parental relationship exhibit high mental well-being in adulthood. In contrast, 45% of those who experienced frequent parental conflicts report symptoms of psychological disorders. Among participants who experienced neglect in their parental relationships, 55% developed signs of anxiety in adulthood, while 40% show increased resilience to challenges when family relationships during childhood were stable and secure

The parent-child relationship plays a crucial role in mental health in adulthood. Warm and stable relationships are associated with increased emotional well-being and better resilience in facing challenges. In contrast, relationships marked by neglect or conflict increase the risk of long-term psychological disorders. These findings highlight the importance of the family environment for psychological development and the prevention of mental health issues.

None Declared

Deficits of cognitive control and performance monitoring play a critical role in the psychopathological manifestations of ADHD and ASD. However, relatively few studies have used a transdiagnostic approach to examine deficits in cognitive control and performance monitoring deficits across diagnostic boundaries.

Using a transdiagnostic approach, we examined post-error slowing (PES), a principal measure of cognitive control and adaptive behavior, in subjects with ADHD and ASD compared to typically developing (TD) subjects. We also investigated the signal detection ability in the three study groups using the d-prime index, which characterizes the observer’s ability to select the right stimuli while avoiding the wrong ones based on the commission and omission errors.

Participants included adults (18-65 years) with the DSM-IV diagnosis of ADHD (n=22) or ASD (n=24), as well as TD subjects (n=25). We used pictures from the International Affective Picture System as stimuli, displayed in random sequence. Stimuli were shown centrally every 1400 msec for 800 msec. A total of 243 stimuli were shown in two blocks (negative, positive & neutral pictures with equal probability). Subjects were asked to push a button as soon as possible upon appearance of the stimulus pictures (Go trials); they were, however, asked not to respond if a picture was repeated (NoGo trials). Generalized Linear Model (GENMOD) analysis was used to test post-error slowing (decrease of reaction time after an error) and the d-prime index, applied as dependent variables in the analyses. Study group (ADHD, ASD, TD) was used as independent variable.

The analysis indicated a significant (p<0.05) overall group difference in PES among the three study groups. Post-hoc analyses showed that as compared to TD subjects, patients with ADHD manifested a markedly increased PES (˜70msec, p<0.05), while subjects with ASD showed no significant change. Additionally, we found a significantly reduced value for the d-prime index in both the ADHD and ASD groups as compared to TD subjects, with no difference between the ADHD and ASD group.

While the reduction of signal detection ability was similar in the ADHD and ASD groups, subjects with ADHD and ASD showed a distinctive profile of post-error adjustment in a behavioral response inhibition task. While patients with ADHD show decreased inhibition and fail to make the adjustment that TD subjects make (as indicated by the decreased PES in ADHD), adults with ASD showed intact behavioral reactions after errors (i.e., with post-error slowing reactions similar to that observed in TD subjects).

Hungarian Brain Research program,#NAP2022-I-4/2022

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Auditory Hallucinations (AH) can be distressing experiences lived by clinical samples but can also be observed in the general population. Predictive Coding Theories of AH argue that when strong priors are favoured over sensory input, AH would emerge. Powers and collaborators (2017) and Benrimoh et al. (2024) have employed the Conditioned Hallucinations task (CHT) to demonstrate that strong priors were linked to AH. In the CHT, conditioned hallucinations (CH) were created using tones, which neglects the fact that most patients describe AH as verbal and characterised by negative content. Consequently, little is known about the effect of the nature (i.e., verbal) and valence of the AH within the Predictive coding framework of hallucinations. More specifically, the role of emotional voice content in CH has not been explored.

Thus, our goal is to replicate and expand these results by manipulating the content valence of voices in the CHT. This will allow us to test a possible interaction effect of voice content and the proneness to AH on the rise of CH.

We will recruit 400 French participants from the general population presenting different levels of proneness to AH. Participants will undergo an adapted version of the CHT with two different blocs where either negative or neutral voice content will be presented. Following Powers et al. (2017), for both the negative and neutral conditions, participants will undergo a QUEST maximum-likelihood-based procedure to derive individual thresholds. After, they will complete 12 blocs, during which the number of signals present and their volume will decrease. A no-signal condition will also be presented. The speech presented will be French translation of Baumeister et al. (2022) stimuli. They were created to simulate verbal AH. Since some voice content resemble inner dialogue, we will measure the inner dialogue forms of participants through the Forms of Self-Criticizing/Attacking & Self-Reassuring Scale. Hallucination proneness will be measured through the Launay and Slade Hallucination Scale Extended we modified. Our local ethical committee approved this study following the Helsinki and APA principles.

We are currently collecting data and are not able to communicate any results at this time. Data collection should be done by April 2025. Our data will be analyzed through the signal detection theory, a logistic regression on the probability of saying a signal is present and through Hierarchical Gaussian Filter Analysis.

A better understanding of the mechanisms behind AH and the role of emotions will help us improve predictive coding theories of AH that can also used to improve interventions targeting them.

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First-episode psychosis is one of the major challenges of mental health research worldwide because it is a traumatic experience for patients and their families. Patients who experience these episodes may experience fear, distress, and isolation.

The early phase of psychosis is a critical period when long-term outcome is predictable and biological, psychological and psychosocial influences are developing and display maximal plasticity. This phase presents important opportunities for secondary prevention and delaying treatment may affect the chance of recovery. The main goal is to reduce the duration of untreated psychosis and ensure that, in addition to symptom remission, there is also psychosocial recovery. Currently, the clinical and research focus in psychotic disorders has shifted toward first episode psychosis, early detection of the prodromal phase of psychosis, and an effective integrated treatment model known as “Early Intervention.”

Selective review of the literature on first episode psychosis.

The studies strongly support the efficacy of antipsychotic medication as both acute and maintenance treatment for patients with a first episode of psychosis.

Early intervention may improve outcomes in first episode psychosis. The use of new antipsychotics with greater efficacy and fewer side effects may improve medication adherence and reduce morbidity associated with repeated relapses. However, the optimal duration of maintenance treatment has not been determined and a long duration of untreated psychosis may be associated with a poorer treatment response. Finally, services for Early Intervention should be easily accessible, non-threatening and non-stigmatising.

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A 26-year-old man presented with his first-episode psychosis (FEP) following a 15-month period marked by a progressive sense of estrangement from his surroundings, ideas of reference, persistent anxiety, difficulty focusing, and social withdrawal. Two years prior, he began stimulant treatment for suspected attention-deficit/hyperactivity disorder (ADHD), though he discontinued the medication shortly after, as he perceived no improvement. Over the past year, he became increasingly distant from friends and eventually resigned from his job. About three months before hospitalization, he began experiencing first-rank symptoms of schizophrenia. This case will serve as a starting point to discuss the complexities of diagnosing the prodromal phase of FEP.

This clinical review aims to examine the phenomenology of the prodromal phase of FEP and address the diagnostic challenges posed by symptom similarities between this phase and neurodevelopmental conditions like ADHD.

A literature review was conducted using the PubMed database, covering studies from the past 20 years. Studies were selected if they included phenomenological descriptions of the prodromal phase in FEP and/ or examined the impact of neurodevelopmental conditions on the emergence of psychosis.

The review identified several key phenomenological markers characterizing the prodromal phase of FEP, which can aid in distinguishing it from other psychiatric conditions. The prodromal phase of FEP is frequently marked by subtle but progressive alterations in cognition, perception, and affect, including experiences such as derealization-depersonalization, ideas of reference, paranoid ideation, and social withdrawal. Evidence suggests that prodromal symptoms intensify over time, evolving from vague unease to specific disruptions in reality testing. Although ADHD and the prodromal phase of a FEP may share some overlapping characteristics - particularly when symptoms are assessed in a cross-sectional manner - ADHD symptoms are generally regarded as stable traits that persist consistently into adulthood.

This case underscores the need for careful differential diagnosis, especially when evaluating individuals in high-risk age groups for psychosis who present with subtle symptoms that do not clearly fit a single diagnostic category. In such cases, clinicians should avoid premature conclusions and instead adopt a longitudinal and comprehensive approach, considering whether genetic, neurodevelopmental, or social risk factors may be contributing to the presentation. A phenomenological perspective can help clinicians detect subtle yet significant shifts in perception, cognition, and affect, enhancing diagnostic accuracy and enabling timely intervention.

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In 1760, Charles Bonnet, a Genoese naturalist and philosopher, described the case of his grandfather, who experienced vivid, elaborate, and recurrent visual hallucinations and who also suffered from visual impairment. Bonnet himself later developed visual impairment and experienced similar symptoms. Since then, there have been multiple reports and cases in the European literature regarding this syndrome.

Auditory Charles-Bonnet syndrome describes a rare condition presenting with sensorineural hearing loss, which can result in auditory-musical hallucinations in the absence of an acoustic stimulus. It has been reported in patients with diseases such as psychiatric disorders and organic brain diseases. However, the most common are idiopathic musical hallucinations that occur along with deafness in elderly people. Musical hallucinations that accompany hearing loss may reflect impaired brain function.

We present the case of a 84-year-old woman with a long-standing history of depression, who also presents mild bilateral pantonal sensorineural hearing loss with associated subjective tinnitus, without other associated somatic and/or psychiatric symptoms. In addition, a CT study of the head was performed which revealed severe fronto-temporal cortical atrophy.

The treatment remains the subject of extensive research. Some authors have reported that hearing aids, antiepileptic drugs, benzodiazepines and antipsychotics can alleviate musical hallucination, which in the case of our patient was eradicated, so the contribution of this case could enrich the current bibliography.

This is unfrecuently presentation of Charles Bonnet symdrom.

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Progressive supranuclear palsy (PSP) is a neurodegenerative disorder characterised by supranuclear ophthalmoplegia (SNO), parkinsonism, and postural instability. Overlap with frontotemporal dementia (FTD) has been suggested, with PSP-FTD considered a specific phenotype. Common psychiatric symptoms include apathy and depression, while hallucinations and delusions are rare. Hallucinatory palinopsia is the persistence or recurrence of vivid visual images after the stimulus has been removed. It results from aberrant activation of visual memory circuits, and, while uncommon, is typically seen in conditions such as strokes, space-occupying lesions and seizures.

To present a case highlighting unique psychopathology in a patient with PSP-FTD phenotype.

Clinical case description and literature review.

An 80-year-old male with a 6-year history of progressive behavioural changes, memory disturbances, and motor dysfunction presented initially with apathy and social withdrawal. Memory impairment and gait difficulties followed, along with irritability, aggression, and hypersexual behaviours like inappropriate touching or gesturing towards family members or masturbating in public. Asymmetric intention tremors (left > right) and stereotypic hand movements developed over time. In the past year, the patient began experiencing visual hallucinations, particularly hallucinatory palinopsia, where he persistently saw objects like lizards or water bottles that had been removed from view. These occurred in clear consciousness, were not perceived by others, and would typically last for about an hour. By a multidisciplinary approach, the possibility of delirium was ruled out. A diagnosis of PSP with FTD phenotype was made based on clinical evaluation, including SNO, and neuroimaging. The patient was started on Syndopa and Donepezil. Psychiatric evaluation revealed high scores in domains of Apathy, Disinhibition, Agitation, and Hallucinations on the Neuropsychiatric Inventory (NPI). Psychoeducation was provided, and Quetiapine 12.5 mg was initiated, leading to mild improvement in behavioural symptoms. The patient remains under regular follow-up with plans for medication optimization and physiotherapy inclusion.

Behavioural symptoms in PSP are prevalent and challenging to manage. This case highlights the importance of distinguishing between apathy and depression, as misdiagnosis can lead to unnecessary antidepressant use. The patient’s presentation, including disinhibition, hypersexuality, and less commonly reported visual hallucinations, emphasises the need for comprehensive evaluation and a multidisciplinary approach to management in PSP-FTD cases.

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