Feigning is defined as “to represent falsely; to imitate so as to deceive” (McDermott et al. Int J Law Psychiatry 2013; 36:287-92). Malingering and dissimulation are subtypes of feigning: malingering involves intentionally producing symptoms for incentives (World Health Organization. ICD-11 2022), while dissimulation involves concealing symptoms to appear mentally well (Caruso et al. J Am Acad Psychiatry Law 2003; 31:444-50). The prevalence of feigning illness remains uncertain, and varies with context and incentives. Within the legal context, 17.5% feign incompetence to stand trial and 64.5% to plead not guilty by reason of insanity. Malingering has been reported in up to 56% of general offender samples (McDermott et al. Int J Law Psychiatry 2013; 36:287-92). In the public setting, the malingering prevalence constituted 30% of disability evaluations, 29% of personal injury evaluations, 19% of criminal evaluations and 8% of medical cases (Mittenberg et al. J Clin Exp Neuropsychol). In 2006, malingering resulted in approximately $150 billion in annual expenses for the US insurance industry (Mason et al. Perspect Psychiatr Care 2014; 50: 51-7).

To explore the challenges in differentiating psychiatric illness from feigning.

This case involves analysing the patient’s history, collateral information, and diagnostic interviews to distinguish psychiatric pathology from feigned symptoms.

A 31-year-old male with a history of paranoid schizophrenia, whose recent psychiatric admission was prompted by psychosis and charges of serious assault, property damage, and possession of a weapon. The admission raised suspicions of symptom feigning and patient wariness of the psychiatric stigma. Despite four years of engagement with mental health services (MHS), the patient disclosed shortly after admission that he had been feigning his symptoms to obtain an insanity plea, but now hopes to return to prison seeking a more favourable environment and the certainty of a confirmed guilty sentence. Collateral information from the community MHS and family members suggested underlying psychiatric concerns and manipulative tendencies of the patient, complicating the diagnosis and raising the possibility of dissimulation.

The case highlights the challenges of distinguishing genuine psychiatric illness from deceptive behaviour, emphasizing the importance of thorough history-taking, understanding symptom pathology, using diverse interview techniques, gathering collateral information, and conducting psychological assessments. Clinicians must carefully distinguish feigning from true pathology to provide accurate diagnoses, ensure proper treatment, reduce costs, and safeguard public safety.

None Declared

Academic procrastination is the deliberate action of postponing the completion of academic tasks that must be completed, despite the harmful effects that not completing them may entail, having a particularly high prevalence in university students. Numerous studies have analyzed the consequences of academic procrastination on mental health. Furthermore, scientific evidence has also found a high prevalence of suicide risk in youth and adolescents. Therefore, it is worth asking if academic procrastination is related to the risk of suicide and self-harming behavior in students.

To our knowledge, this is the first systematic review to analyze the relationship between academic procrastination and suicidality.

To analyze 1) the relationship between academic procrastination and suicidal tendencies, 2) whether this relationship, if it exists, is influenced by other variables.

Academic Search Premier, APA PsycArticles, APA PsycInfo, PSICODOC, Psychology and Behavioral Sciences Collection, MEDLINE, E-Journals, ERIC and Scopus were searched during October 2024. An additional search was also conducted using the Google Scholar search engine. The review was carried out following the criteria of the PRISMA 2020 declaration. Observational studies that analyzed the relationship between procrastination and suicidality were included, without language or time restrictions. Single case studies or case series, studies examining procrastination in non-academic settings, and studies using qualitative methodology were excluded. Each study was narratively summarized.

Ninety-three studies were identified; after eliminating duplicates and those works that did not meet the eligibility criteria, four studies were included for review. These studies varied in their origin (two articles from the United States, one from Spain, one from Peru, and one from Jordan) and the secondary variables evaluated. All studies found a positive and significant relationship between suicidality and academic procrastination (with correlation coefficients ranging from 0.19 to 0.51), observing a slightly higher correlation in women compared to men. Self-control was found to mediate the relationship between procrastination and suicidality.

Our findings suggest a strong positive relationship between academic procrastination and suicidality. However, there are still few studies that analyze this topic, so it is necessary to continue researching in this field.

None Declared

Autoscopic Phenomena (APs) are rare perceptual experiences where individuals perceive a visual double or duplicate of their own body. It has been recognized since ancient times, but gained significant attention in the 19th century, both through its depiction in romantic literature and in neuropsychiatric studies; in the literature, their association with epilepsy and schizophrenia is very extensively documented. Recent research brought new insights into the neurobiology of these phenomena.

In this article, we aim to review the phenomenology and psycopathology of APs.

Narrative literature review.

From a phenomenological perspective, three main conditions can be identified. In Autoscopy, the person sees a double, but does not feel a connection with it, meaning that they can distinguish between themselves and the double. In Out-of-body Experience (OBE), the individual feels as though they have left their body and observe themselves from an external perspective. In Heautoscopy, the boundary between the self and the double is blurred, causing uncertainty about where one’s “self” is located, representing a middle ground between autoscopy and OBE.

Current research suggests that APs are linked to dysfunctions in the normal integration of body ownership, self-location, and perspective-taking, caused by lesions in regions responsible for integrating multisensory inputs (visual, proprioceptive and vestibular). All types of APs have in common a dysfunction specifically in the temporo-parietal junction (TPJ), a brain area involved in processing self-location and integrating sensory inputs to create a unified sense of self; other common areas include the insula and cingulate cortex.

Regarding to the different networks of APs, Autoscopy primarily involves abnormalities in the visual processing regions (as the occipital and parietal lobes), causing a visual perception of double; OBEs are caused by dysfunctions in areas responsible for self-location and vestibular processing (such as the medial prefrontal cortex), leading to a sensation of floating outside one’s body; lastly, Heautoscopy engages more widespread brain dysfunctions, including the regions involved in self-representation and embodiment, leading to ambiguity in self-location.

APs challenge our understanding of the bodily self and how identity is constructed, raising questions about how the brain creates a unified sense of being in a body and how this can break down under certain pathological conditions. Although much is unknown, one thing is for sure: these phenomena demonstrate that the sense of self is not fixed, and the study of its disruption, by exploring its phenomenology and psychopatology, may contribute to reveal the underlying processes involved in bodily self-consciousness.

None Declared

Schizophrenia is one of the most disabling psychiatric disorders, with about 60% of patients also suffering from substance dependence—a rate significantly higher than in the general population. Mentally ill individuals have a suicide risk four times higher than healthy individuals, which doubles when comorbid mental disorders are present. Compliance with treatment in patients with schizophrenia is generally lower than in those with other psychiatric disorders, often due to a lack of continuity between psychiatric and addiction services.

This study aims to assess compliance in patients diagnosed with paranoid schizophrenia and substance dependence syndrome and compare it with compliance in patients diagnosed with paranoid schizophrenia without dependence.

The study included two groups: 15 patients with paranoid schizophrenia and 20 patients with paranoid schizophrenia and substance dependence. The average hospital stay for patients without substance dependence was 25.8 days, whereas it was 38.4 days for those with dependence.

Prolonged hospitalizations increase the economic burden on healthcare and introduce additional challenges, such as job loss, which heightens stigma and marginalization. The number of hospitalizations was also higher among patients with dependence, averaging 4.75 times over five years compared to 1.06 times in those without. Patients without dependence can often remain functional in society on monotherapy, requiring only one medication—a more convenient regimen. In contrast, patients with dependence typically require a combination of three or more medications, with a less flexible and more demanding dosage schedule. These regimens not only increase economic strain but also can worsen medication tolerance. This increases the risk of selective intake, reduced frequency, or complete discontinuation of medications, which often leads to rehospitalization. Frequent therapy adjustments may further erode patients’ adherence to new regimens, undermining their trust in the need to engage with psychiatric care.

As shown, compliance in patients with a “dual diagnosis” is a pressing issue in modern psychiatry. Addressing this complex problem requires multiple steps, including selecting appropriate therapies, addiction treatment, psychoeducation, and fostering a strong doctor-patient relationship in an outpatient setting. These measures collectively aim to reintegrate patients into society, reduce disease burden, improve quality of life, lower suicide risk, and decrease the frequency and length of hospitalizations.

None Declared

Previous research suggests that motivational factors relate to psychosocial functioning in SZ, both concurrently (Tobe et al. Compr Psychiat 2016; 65 103-109) and at follow-up (Fervaha et al. Acta Psychiat Scand 2014; 130 290-299). Importantly, no study has examined the influence of baseline motivation on the rate of change in response to rehabilitation

1. 1. To study the relationship between baseline measures of motivation/ effort with psychosocial functioning at follow-up

2. 2. To examine if motivation/ effort predict individual change in psychosocial functioning

Participants

Table 1 summarizes the sample characteristics

Figures 1 and 2 show individuals slopes for PSP and FAST, with a thick red line representing the average group slopes. For both PSP and FAST, models with only time as the independent variable and random intercepts indicated that time was a significant predictor (PSP: t=10.65, p<.0001; FAST: t =-6.13, p<.0001).

Baseline motivation/ effort → follow-up psychosocial functioning

No significant correlations were found for neither PSP scores (QLS: ρ=-.018, S=2343.3, p=.93, IMI: P=.23, t=1.09, p=.28, effort: ρ=.001, S=2297.3, p=.99) nor FAST scores (QLS: ρ=-.16, S=2674.9, p=.45, IMI: P=-.02, t=-0.09, p=.92, effort: ρ=.07, S=2128, p=.72).

Motivation → change in psychosocial functioning

For PSP, the interaction model (Table 2) shows that the interaction of effort and timepoint significantly predicts PSP scores

Figure 1. Individual slopes for PSP scores

Figure 2. Individual slopes for FAST scores

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Patients showed an improvement after rehabilitation. Effort can explain this trend. Finally, unlike previous studies, basal motivation did not predict follow-up psychosocial functioning

None Declared

Individuals with SZ show alterations at all levels of language: discourse, lexical-semantics, comprehension and syntax/ morphology. Linguistic capacities are associated with worse occupational, social and quality of life related outcomes (Ehlen et al. Front Psych 2023; 14). Still, language assessment is probably overseen in the cognitive assessment of individuals with SZ

1. 1. To review the role of language in the cognitive assessment in SZ

2. 2. To introduce the SchizoLang pilot study

We reviewed the available cognitive assessment tools in SZ to determine whether language is adequately represented. Consequently, we describe the SchizoLang pilot study

Available instruments for the assessment of cognition in SZ do not adequately evaluate language. Importantly, fluency tests are not representative of language. Table 1 shows the major cognitive assessment tools in SZ.

Table 1. Cognition assessment instruments in schizophrenia (adapted from Vita et al. Eur J Psychiat 2022; 65 1-24)

The Schizolang pilot study: bridging neurolinguistics and Psychiatry to characterize language in Schizophrenia

The aims of this pilot study are:

To explore which linguistic domains are altered in people with SZ

To explore the relationship between language and (a) formal thought disorders, (b) psychiatric symptoms, (c) neuropsychological alterations, (d) deficits in psychosocial functioning, and (e) quality of life

ACS.esp

ACs.esp is a digital battery for the assessment language in aphasia based on neurolinguistic research. It shows good preliminary validity and reliability (Ansorena et al. 2022; SSTaal, 95 237–240). ACS.esp includes novel measures (see Table 2): an extensive discourse protocol, tasks for sentence planning, and sentence comprehension and production at the syntactic and grammatical levels.

Table 1. ACS.esp’s structure with its factors, subfactors, input, stimuli and tasks. Auditory tasks are colored in blue and visual tasks in brown

ACs.esp is a digital battery for the assessment language in aphasia based on neurolinguistic research. It shows good preliminary validity and reliability (Ansorena et al. 2022; SSTaal, 95 237–240). ACS.esp includes novel measures (see Table 2): an extensive discourse protocol, tasks for sentence planning, and sentence comprehension and production at the syntactic and grammatical levels.

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Even if language is altered in SZ, it is not adequately assessed. An extensive characterization of language abnormalities in SZ can guide rehabilitation on communication and functioning; and consequently produce a greater well-being and quality of life. The SchizoLang pilot study will allow establishing a clinician-friendly protocol.

None Declared

Obsessive-compulsive symptoms (OCS) are frequently observed in both obsessive-compulsive disorder (OCD) and schizophrenia-spectrum disorders (SSD), creating significant diagnostic challenges. Historically, Karl Jaspers defined “true obsessions” as a struggle against intrusive ideas that appear nonsensical and “alien” to the personality, demarcating this concept from delusions and overvalued ideas, in which cases the person would be convinced of the relevance of the content. However, since the 1980s, the concepts of insight and resistance in OCD have been deemphasized in diagnostic criteria, broadening the definition of OCD to include cases with poor or absent insight. The broadening of these criteria has blurred the distinction between OCD and SSD and has narrowed the diagnosis of schizophrenia to primarily delusional and hallucinatory conditions, overlooking obsessive phenomena in this disorder.

The primary goal of this review is to differentiate the phenomenological features of OCS in OCD from those in SSD, focusing on the connection between obsessive-compulsive phenomena and disturbances in the basic self in SSD.

A literature review was conducted using the keywords “obsessive-compulsive symptoms”; “schizophrenia”; “obsessive-compulsive disorder”; “phenomenology” in the Pubmed and Google Scholar databases.

The findings suggest that the underlying nature and subjective experience of OCS may differ substantially between OCD and SSD. An essential component of this differentiation is the exploration of basic self-disturbances, which refer to profound disruptions in an individual’s sense of ownership of experience and agency of action - elements often impacted in SSD but less so in OCD. Patients with SSD often experience OCS in a more alien and automatic manner, with intrusive thoughts and compulsions lacking a clear sense of personal ownership or agency. These obsessions are more likely to blend with delusional thinking and other psychotic features, reflecting broader disturbances in the basic self. The lack of insight and the feeling that obsessive thoughts are externally imposed or intruding from outside the self is a hallmark in these cases. As for compulsions, these may serve as maladaptive strategies to manage or compensate for self-disturbances, rather than purely to neutralize distress as seen in OCD.

Accurate differentiation of OCS in SSD from those in OCD requires clinicians to focus on the quality of self-experience, particularly in terms of insight, ownership and agency. Recognizing how certain obsessive phenomena in SSD reflect disturbances in the basic self is crucial for improving diagnostic accuracy and ensuring appropriate treatment.

None Declared

Despite significant progress in the treatment of schizophrenia, the number of patients with schizophrenia who do not respond to treatment remains constant. Identification of biomarkers of therapeutic resistance in the schizophrenia can help in early prediction of these conditions, as well as in the development of new approaches to treatment. Inflammation is considered as one of the possible mechanisms involved in the development of the pathological process in the formation of resistance to therapy in schizophrenia. The main cells of innate immunity, neutrophils and monocytes, are involved in the implementation of the inflammatory response.

To compare the subpopulation composition of monocytes and the level of other inflammatory markers in patients with treatment-resistant schizophrenia and in the control group.

The study included 17 men with treatment-resistant schizophrenia (TRS) (27.0±8.0 years) and 15 healthy individuals without signs of mental and inflammatory diseases. The relative content of neutrophils and monocytes in the blood, as well as the ratio of monocyte subpopulations, estimated by the expression level of CD14 and CD16 receptors, were determined by flow cytofluorometry. The functional activity of neutrophils was determined spectrophotometrically by the activity of leukocyte elastase in plasma. The level of autoantibodies to S100B in plasma was estimated by ELISA.

A significant increase in the relative content of monocytes (U=28.0, p<0.01) and a decrease in neutrophils (U=35.0, p=0.036) were found in TRS patients compared to the controls. An increase in a proportion of the “transitional” CD14+CD16− subpopulation (U=61.5, p=0.04) and a decrease in the “classical” CD14++CD16− subpopulation (U=60.5, p=0.036) were accompanied by the proportion of “intermediate” inflammatory CD14++CD16+ and “non-classical” CD14+CD16+ subpopulations that did not differ from controls. A moderate increase in leukocyte elastase activity (U=34.0, p=0.001) and a high level of S100B autoantibodies (U = 55.0, p = 0.02) were found in blood plasma of patients. The proportion of “intermediate” CD14++CD16+ monocytes was negatively correlated with the level of autoantibodies to S100B (r= -0.55, p=0.021). It should be noted that this spectrum of immune parameters differs from the corresponding profile that we identified in patients with schizophrenia who responded to treatment. The main differences concern the proportion of “intermediate” monocytes, the relative content and functional activity of neutrophils.

The identified quantitative and functional characteristics of monocytes and neutrophils in patients with TRS indicate the possible involvement of the cellular component of immunity in the development of resistance to treatment and may be associated with the severity of the disease in a long-term pathological process in the brain.

None Declared

One of the mechanisms underlying the pathogenesis of mental disorders, including endogenous depression, is systemic inflammation. It is of interest to study the immunological aspects of the early stages of endogenous disorders and identify subgroups of patients with immunotypes that characterize a high risk of developing the first psychotic episode.

Comparative analysis of the spectrum of inflammatory markers in patients with a juvenile depression with high and low risk of developing psychosis.

The study involved 98 women 16 to 25 years (20.9 ± 5.14 years) with depression within the framework of various nosologies (F31.3-4; F33.0-1; F60.0-9; F21.3-4; F20.01-2; F25.1). Two groups of patients without a history of psychosis were identified: group 1 (n = 47) - without symptoms of psychosis risk, group 2 (n = 51) - with depression associated with psychopathological symptoms of psychosis risk. The control group consisted of 42 healthy women of the corresponding age. The severity of depressive symptoms was assessed using the HDRS-21, the severity of negative and positive symptoms was determined using the SANS and SAPS. In group 2, the severity of attenuated positive symptoms was determined using the SOPS. The activity of the leukocyte elastase (LE) and α1-proteinase inhibitor (α1-PI), as well as the level of autoantibodies (AB) to S100B and MBP, were determined in plasma.

The groups were characterized by a statistically significant increase in both LE and α1-PI (p<0.05), and the level of AB compared to the control (p<0.05), but no significant differences were found. In group 1, clinical and biological correlations were found between LE activity and the total score on the SANS (r=0,44, p=0.002). In group 2, a negative correlation was found between LE activity and the age of onset of the disease (r=-0.3, p=0.046).

The clustering of patients by LE activity and their distribution by immunological groups showed that 29.4% and 27.5% of patients in groups 1 and 2, respectively, were characterized by a high level of inflammatory markers and the absence of an autoimmune component to neuroantigens, which is a sign of a more favorable course of the pathological process. On the contrary, 70.6% and 72.5% of patients in groups 1 and 2, respectively, were characterized by the type of inflammatory response associated with an increase in the level of AB and varying degrees of insufficiency of the functional activity of neutrophils, which is considered an unfavorable factor that aggravates the course of the disease.

Comparison of the spectrum of inflammatory markers in juvenile depression with different risk of developing psychosis indicate their significant immunological heterogeneity. The immunotype characterized by a high level of AB and insufficient LE activity can presumably be considered as a predictor of the risk of developing psychosis.

None Declared

Autoimmune psychosis has gained increased recognition as a distinct entity and is known to mimic variants of primary psychosis, typically presenting with an acute onset of polymorphic psychotic symptoms. We describe a case of probable autoimmune psychosis in a young patient who experienced a severe first psychotic episode.

Reflection over the diagnostic challenges of autoimmune psychosis.

Clinical case report.

A 19-year-old male patient with no relevant medical history was admitted to the psychiatric ward due to a first psychotic episode with a peracute onset. The episode peaked with severe confusion, disorientation, and disorganized behavior, leading to his referral to the emergency room. This episode was characterised by delusional ideation with mystical, self-referential, and persecutory themes, complex auditory-verbal hallucinations, and marked negative and cognitive symptoms (including affective blunting, social withdrawal, apathy, alogia, impaired attention, decreased social cognition, and reduced speed of cognitive processing). The analytical study, substance screening, and brain CT upon admission were normal, leading to the assumption of a primary psychotic disorder. Antipsychotic therapy was initiated with progressive titration (risperidone, cariprazine, and clozapine), yet there was no significant improvement. Given the severe presentation and treatment resistance, a neurological examination was requested, which revealed no focal signs. A comprehensive laboratory workup showed positive ANAs, anti-recoverin antibodies, and hypocomplementaemia (C3 and C4). No significant abnormalities were observed in the brain MRI. CSF analysis revealed slight protein elevation (55 mg/dL) without pleocytosis, oligoclonal bands, or antibodies. EEG indicated mild to moderate encephalopathy with FIRDA bursts and focal paroxysmal activity in the left temporo-parieto-occipital region. Brain PET-FDG showed no significant abnormalities. Serum and CSF neurofilament levels were normal. Full-body CT and PET-FDG scans were also unremarkable. Given the findings, autoimmune psychosis was assumed. Treatment with IV immunoglobulin (30 g) and methylprednisolone (1 g for 5 days) was administered. The case was discussed in a multidisciplinary meeting, and a regimen of daily prednisolone (10 mg) was chosen. At follow-up, the patient showed slight improvement, with mitigation of the positive symptoms.

Psychosis that does not respond to antipsychotic treatment and presents with atypical signs should raise suspicion of secondary immune-mediated schizophreniform psychosis. However, the challenge lies in identifying these patients, selecting appropriate diagnostic tests, and establishing criteria for implementing treatment.

None Declared

Major depressive disorder (MDD) is a prevalent neuropsychiatric condition influenced by genetic, environmental, and inflammatory factors. Alterations in T helper (Th) cell subsets, including Th1, Th2, Th17, and regulatory T cells (Tregs), have been implicated in the immune dysregulation observed in MDD, linking the adaptive immune system to depression. However, the link between these T cell subsets, MDD severity and their connection with childhood trauma (CT), a major risk factor for depression, remain incompletely understood.

In this project we characterized peripheral blood T cell subsets and their association with CT and MDD.

In this study, we performed multiparameter flow cytometry analysis on peripheral blood immune cells from a subgroup of the FOR2107 cohort. T cell differentiation is characterized by their phenotypic markers. Age- and gender- matched groups of 46 individuals with depression and 55 healthy controls (HC) were included, both with and without a history of childhood trauma. Depression severity was assessed using the Hamilton Rating Scale for Depression), (HAM-D21), and CT was evaluated via the Childhood Trauma Questionnaire (CTQ). Correlational analyses examined relationships between T cell subtype frequencies, depression severity, and CT subtypes.

The analysis revealed an increased frequency of circulating Th17 cells in patients with MDD compared to healthy controls. In participants with a history of CT, the overall frequency of CD3+ T cells was decreased, while Th2 cells and Treg cell frequencies were reduced when compared to individuals without CT. Frequencies of specific T cell types correlate with CT subtypes, especially in depressive patients. Th1, effector memory T cells (Tem) and central memory T cells (Tcm) showed a positive correlation with physical abuse, while Treg cells correlated with the overall CTQ score and emotional neglect.

Our findings indicate dysregulations of the adaptive immune system in CT and MDD, characterized by alterations in peripheral blood Th17, Th2, and Treg cells. These data highlight the influence of early life adversity on immune function and its potential contribution to the pathophysiology of depression.

None Declared

Immune checkpoint inhibitors are being used in patients with advanced malignancies. Although it can effectively treat tumors, 30–60% of patients could experience immune-related adverse events such as encephalitis with antibodies against the NMDA receptor.

We present a case of a 57-years-old man with no prior mental health history who was diagnosed of kidney cancer and received treatment with checkpoint inhibitors. He developed incoherent speech, visual hallucinations, delusional megalomania, disorientation, sleepiness and a low-grade fever of 37.7ºC. He was admitted in Neurology unit and diagnosed of autoimmune limbic encephalitis in a patient treated with checkpoint inhibitors.

To describe a case of a psychotic episode associated with autoimmune limbic encephalitis in a patient treated with checkpoint inhibitors.

Clinical assesment and bibliographic review of pertinent literature.

During his admission in Neurology ward, the patient was suspicious, inattentive, aggressive with healthcare staff and he developed incoherent speech with visual hallucinations.

MRI suggested bilateral limbic encephalitis and the antibody test in cerebrospinal fluid were positive for NMDA receptor.

The psychotic episode was treated with olanzapine up to 20 milligrams and the limbic encephalitis with rituximab with a good response.

The case presented is consistent with other reports of psychotic symptoms and development of encephalitis associated with antibodies against the NMDA receptor.

The diagnosis of anti-NMDAR encephalitis is usually delayed.

The differential diagnosis should be established with primary psychiatric disorders.

None Declared

Previous studies have shown that neuroinflammation can play a significant role in the pathogenesis of schizophrenia. The search for inflammatory markers in late-onset schizophrenia are very important for diagnostics.

Determination of inflammatory markers in the peripheral blood plasma of patients with late-onset schizophrenia in relation to the clinical characteristics of patients.

The study included 46 patients with schizophrenia aged 61 [56; 69] years (2 men and 44 women); the age of disease onset was 51 [45; 60] years. The severity of mental disorders was assessed using the PANSS scale, and cognitive impairment was assessed using the MMSE and MoCA scales. The control group consisted of 77 people comparable in age with the patients (p=0.16). A spectrophotometric method was used to determine inflammatory markers (enzymatic activity of leukocyte elastase (LE), functional activity of α1-proteinase inhibitor (α1-PI)). The protease inhibitory index (PII) was calculated - the ratio of LE and α1-PI activity, indicating the direction of the inflammatory process. Comparative data analysis was performed using the Statistica 10.

The 1st cluster (22 patients (47.8%)) was characterized by a significantly increased α1-PI activity (p=0.000), decreased LE activity (p=0.000) compared to the control values, and, accordingly, a low PII value (p=0.000), which is an unfavorable prognostic factor for further development of the disease and response to therapy. A 28-day course of therapy with 1st and 2nd generation neuroleptics didn’t change the immunological parameters in patients of this cluster. In this cluster, a positive correlation was found between LE activity and scores on the MMSE (r=0.512, p<0.05) and MoCA (r=507, p<0.05) scales at the start of treatment, i.e. the lower score on the cognitive functioning scales and the more severe the disease correlate with lower the LE activity.

The 2nd cluster (24 patients (52.2%)) was characterized by a significant increase in inflammatory markers, LE and α1-PI activity (p=0.000, p=0.000, respectively) in relation to the control parameters, while the PII value didn’t differ from the control. In this group, paranoid and schizotypal personality were significantly less common in the premorbid period (41.6% of cases), and formal thinking disorders were expressed to a lesser extent. No clinical and immunological relationships were revealed. A 28-day course of therapy influenced the change in immunological parameters towards their relative normalization.

The obtained results confirm the involvement of the inflammatory link in the development of late-onset schizophrenia, as well as the heterogeneity of the patient group in terms of clinical and immunological parameters. Evaluation of the spectrum of inflammatory markers allows us to identify patients with an unfavorable course of the disease and resistance to therapy.

None Declared

Assessing psychiatric and neurological symptoms in emergency settings is crucial for accurate differential diagnosis. Psychosis, seizures, and cognitive impairment often overlap with various medical and psychiatric conditions, making early and precise identification essential for differentiating between potential causes, guiding appropriate treatment, and improving patient outcomes.

This report presents a clinical case with initial suspicion of psychotic symptoms accompanied by convulsive features to emphasize the importance of differential diagnosis in neuropsychiatric manifestations.

This report details a clinical case involving a 26-year-old woman with no prior psychiatric or neurological history, who presented to the emergency department with headaches, insomnia, and unusual behaviors. Three weeks earlier, she had a right parietal focal epileptic seizure and was being treated with lacosamide 100 mg every 12 hours. Post-seizure, she exhibited symptoms such as disorientation, memory lapses, thought blocking, soliloquies, disorganized thinking, and insomnia. Due to suspected psychotic symptoms, the emergency department consulted psychiatry. Both psychiatry and neurology were involved in her evaluation due to the neuropsychiatric nature of her symptoms. The differential diagnosis considered was a first psychotic episode, postictal psychosis, or encephalitis. She was initially prescribed anxiolytics and antipsychotics, including olanzapine 2.5 mg and clonazepam 0.5 mg. Complementary tests, including an EEG, showed right parietal epileptiform discharges and diffuse encephalopathy, but no evidence of status epilepticus. These findings, combined with convulsive symptoms, suggested a neurological origin, leading to her admission to the neurology department.

Further investigation revealed right temporoparietal cortical thickening on brain MRI, indicative of encephalitis, and lumbar puncture results were positive for anti-NMDA receptor antibodies. The patient was then treated with high-dose corticosteroids, later replaced by plasmapheresis every two days. A gynecological consultation was performed to exclude ovarian pathology, and a body CT scan was ordered to rule out tumor-related conditions. Although her condition has stabilized, it is still early to fully assess the effectiveness of the treatment.

This case emphasizes the critical importance of neuropsychiatric differential diagnosis. The overlapping symptoms of psychosis and cognitive impairment can mimic various conditions, making accurate diagnosis challenging. The collaboration between psychiatry and neurology was essential in distinguishing between psychiatric disorders and anti-NMDA receptor encephalitis. Timely and precise diagnosis enabled targeted treatment, demonstrating the need for a multidisciplinary approach in managing complex neuropsychiatric cases.

None Declared

Negative consequences of acute and chronic stress caused by information overload, environmental problems, natural disasters, man-made disasters, military clashes, and acts of terrorism have become increasingly evident in recent decades. They can lead to a painful “breakdown” of socio-biological adaptation mechanisms, a decrease in adequacy in assessing the environment, and, as a consequence, the formation of disturbances in the psycho-emotional sphere, manifested in the development of behavioral disorders (aggression and depression). Therapy for behavioral disorders does not provide a complete cure, apparently due to the formation of a “vicious circle” that can only be broken by normalizing the regulatory relationship between the central nervous system and the immune system. One way to solve this problem is to develop new methods of therapy based on immunological approaches. The method of choice may obviously be immunotherapy with autologous immune cells with a certain, including in vitro modulated, functional activity.

The aim of the study was to investigate the possibility of obtaining a positive psychoneuroimmunomodulatory effect in aggressive and depressive-like animals by transplanting immune cells, the functional activity of which was in vitro modulated by a psychoactive substance (PAS).

Male (CBAxC57Bl/6)F1 mice aged, in which aggressive or depressive-like states were formed under the influence of long-term social stress, were used as donors and recipients in the experiments. Immune cells for transplantation were obtained from a suspension of donor’s splenocytes, cultured in vitro with PAS (chlorpromazine or caffeine, respectively) and then intravenously administered to syngeneic recipients. In the control group of animals, cell preparation and transplantation were carried out under similar conditions, except that the latter were cultured without the presence of PAS. In recipients the parameters of the nervous and immune systems functional activity were recorded.

Transplantation of in vitro PAS-modulated splenocytes to recipients with stress-induced behavior patterns resulted in targeted changes in their motor and exploratory activity in the Open field test, motor activity in the Porsolt test, and decreased anhedonia in recipients with a depressive-like phenotype, recorded against the background of changes in the content of a number of pro- and anti-inflammatory cytokines IL-1β, IL-2, IL-4, IL-6, IL-10, IFNγ, TNFα in pathogenetically significant brain structures. In recipients, a positive change in the parameters of the immune system functional activity were also revealed.

The possibility of immunoediting stress-induced forms of behavior by transplanting in vitro PAS-modulated immune cells, which have a positive psychoneuroimmunomodulatory effect in the body of syngeneic recipients, has been demonstrated.

None Declared

It is well known that alcohol has a variety of pathologic effects on hematopoiesis. Long term alcohol abuse result in a significant suppression of both the production of blood cells and structural changes in precursors, namely the suppression of their maturation, up to pancytopenia. We first demonstrated the immunomodulatory properties of a synthetic GABAA-R ligand, meta-chlorobenzhydrylurea (m-CBU). We also showed that splenic lymphocytes modulated in vitro by m-CBU after intravenous administration to syngeneic long-term alcoholized recipients have a positive effect, manifested in the editing of behavior characteristic of alcoholism against the background of stimulation neuroplasticity and reduction of neuroinflammation.

The purpose of this work was to study bone marrow hematopoiesis and peripheral blood parameters in long-term alcoholized recipients after transplantation of syngeneic lymphocytes modulated in vitro by m-CBU.

Male (CBAxC57Bl/6)F1 mice with 6-month 10% ethanol exposure were undergoing the transplantation of syngeneic long-term alcoholized mice lymphocytes, pretreated in vitro with m-CBU. The number of bone marrow hematopoietic progenitors and cellular composition of the blood were assessed in the recipients.

Long-term alcoholization in mice led to a decrease in the colony-forming activity of hematopoietic precursors, mainly erythroid; in the peripheral blood of mice, a significant decrease in the number of erythrocytes, leukocytes, lymphocytes and platelets was recorded, while the population of segmented neutrophils significantly increased. Lymphocytes, precultured with m-CBU, in syngeneic long-term alcoholized recipients had a corrective effect on a number of hematopoietic parameters (colony-forming activity of erythroid precursors in the bone marrow, the number of erythrocytes, segmented neutrophils and lymphocytes in the peripheral blood) to indicators comparable to those in intact mice of the corresponding with tendency to increase the number of platelets in the peripheral blood.

The data obtained may indicate the effectiveness of m-CBU -modulated lymphocytes transplantation in correcting a number of changes in hematopoiesis provoked by long-term alcohol abuse.

None Declared

Suicidality is a critical concern in individuals with affective disorders, and environmental and biological factors may influence its risk. In recent years, seasonal variations and systemic inflammation, as indicated by high-sensitivity C-reactive protein (hsCRP), have garnered interest as potential contributors.

To assess the risk of suicidality in affective disorders among seasonality correlated with hsCRP.

A naturalistic, observational, cross-sectional study was carried out by retrospectively recruiting 353 adult inpatients affected by severe mental illness (SMI) consecutively hospitalized in the Psychiatry Clinic of the Ospedali Riuniti of Ancona, Italy. Patients affected by inflammatory pathology, alcohol/substance use disorders or treated by anti-inflammatory/immunosuppressive therapy were excluded. Only patients suffering from mood disorders were considered for this analysis (n=246). We administered a checklist for socio-demographic and clinical features (diagnosis, age of onset, disease duration, number of episodes, number of episodes per year, suicidal attempts and comorbidities). Subscale 5 of the Mini International Neuropsychiatric Interview (MINI-5-s) was administered to all the patients involved to assess suicidality risk. To normalize hs-CRP, a logarithmic transformation was performed (log-hsCRP). At the same time, season were codified as dummy variables. T-test for independent groups and multivariate linear regression were conducted.

47.2% (n=116) of the sample were male. The mean value of hsCRP was 5.7mg/L (SD=15.8). The mean score of MINI-5-s total score was 13.3 (SD=11.6). Patients admitted to our psychiatric ward in meteorological (p=0.013) and astronomical (p=0.049) autumn had a lower log-hsCRP compared to other seasons. A multivariate linear regression was observed between MINI-5-s total score (R² =0.74, F=9.639, Durbin-Watson=1.915, p<0.001) and hsCRP (B=0.94, p=0.041) and the meteorological autumn (B=-7.436; p<0.001).

This study highlights a significant association between seasonality, systemic inflammation (as measured by hsCRP), and suicidality risk in patients with mood disorders. Our results focus on the importance of considering biological and environmental factors in assessing and managing suicidality risk in affective disorders. Further studies are essential to link seasonal and inflammatory mechanisms.

None Declared

Vitamin D is a fat-soluble vitamin that together with parathyroid hormone (PTH) regulates blood calcium and phosphorus levels. Vitamin D also has anti-inflammatory, antioxidant, and neurotrophic properties. It acts through the vitamin D receptor (VDR), which has been found throughout the body, including the nervous system. Its deficiency is associated with various diseases, including depression and schizophrenia. It is estimated that approximately 1 billion people worldwide have vitamin D deficiency, while 50% of people worldwide (4 billion people) are thought to have insufficient levels of vitamin D.

The retrospective study aimed to determine whether routine laboratory tests in a psychiatric office/outpatient clinic can find a connection between vitamin D levels and inflammatory parameters such as CRP, leukocytes, and the neutrophil-to-lymphocyte ratio (NLR).

Data was collected from a psychiatric office/outpatient clinic between the years 2020 and 2023. We included the patients (and their basic data, such as gender, age, diagnosis during treatment) whose laboratory results had vitamin D levels as well as a complete blood count (leukocytes, neutrophils, and lymphocytes) and c-reactive protein (CRP). We calculated the ratio of neutrophils to lymphocytes (NLR) and performed Spearman’s correlation, where a p-value of <0.05 indicated a statistically significant change.

Between 2020 and 2023, 88 laboratory tests were conducted in the outpatient office, that included vitamin D levels, of these, 67 had all the necessary data. Vitamin D deficiency was present in 65% of patients. We found that CRP was not sensitive enough for our study, as 83% of CRP values were below 8 mg/L. After performing a correlation between vitamin D levels and leukocytes and NLR, we did not find a statistically significant connection.

We did not find statistically significant corelation between the level of vitamin D and NLR and leucocytes. We would recommend further research that uses a larger sample of patients and conduct measurements during acute illness or exacerbation to obtain more reliable conclusions.

None Declared

There is a need to search for new treatment options not only for depression but also its concomitant diseases. Particularly, depression and metabolic-health abnormalities often coexist, while inflammation and microbiota imbalance, may play a part in their pathophysiological overlap. Thus, the trials of interventions on the microbiota may result in establishing a safe adjunctive treatment option.

The primary aim of this seconadry analysis was to assess the effect of probiotic formulation on inflammatory parameters in adult patients with depressive disorders. The secondary aim was to assess some possible pretreatment determinants of probiotics action towards inflammation, e.g., dietary habits, inflammatory or metabolic status, severity and dimensions of psychiatric symptoms, medications used.

The parent trial was a two-arm, 60-day, prospective, randomized, double-blind, controlled design. The probiotic formulation contained Lactobacillus helveticus Rosell®-52 and Bifidobacterium longum Rosell®-175. The change in inflammatory parameters (e.g., C-reactive protein, complete blood count-derived markers, tumor necrosis factor-alpha) after intervention alone and in the context of basal lifestyle, psychometric, metabolic, and inflammatory parameters was assessed.

Probiotics significantly decreased CRP levels compared with placebo by 21.3 % (p = .047) with nearly moderate effect size as measured with Cliff’s delta (∆ = .249). Rates of CRP-responders (a minimum 50% decrease in CRP level) were non-significantly higher in the probiotic than placebo group (18.0 % vs. 5.26 %, respectively; χ2(1) = 3.20, p = .074); but the effect size was shown to be clinically meaningful (OR = 3.95; NNT = 7.85). In two-way ANOVA with interaction analysis, probiotics anti-inflammatory action was shown to be favoured by antidepressant use, and higher basal alanine aminotransferase. But, pretreatment chronic low-grade inflammation status counteracted probiotics anti-inflammatory properties.

There were no significant differences in complete blood count-derived parameters, nor in TNF-α levels.

We have found an anti-inflammatory action of probiotics in patients with depression, as shown in the assessment of CRP levels. Additionally, probiotics were revealed to be more effective for inflammation measured by CRP levels when used by subjects with certain pretreatment features. Further studies should be performed to replicate these results.

ClinicalTrials.gov identifier: NCT04756544.

None Declared

VEXAS syndrome is a newly recognized multisystem inflammatory disorder characterized by recurrent fevers, skin manifestations, and systemic symptoms, often leading to significant morbidity. While the physical aspects of this syndrome are increasingly documented, the psychiatric implications, particularly depressive symptoms, are less explored. This case study aims to elucidate depressive symptoms in a patient diagnosed with VEXAS syndrome, examine how these symptoms relate to prolonged diagnostic uncertainty, and assess the impact of receiving a definitive diagnosis on the patient’s mental health.

To evaluate the presence and severity of depressive symptoms in a patient with VEXAS syndrome. To analyze the psychological impact of prolonged diagnostic uncertainty on the patient’s mood. To investigate the effect of receiving a definitive diagnosis and a comprehensive treatment plan on the patient’s emotional well-being.

This case report describes a 61-year-old male patient with VEXAS syndrome, admitted for further evaluation of his condition. He presented to the psychiatry service with complaints of low mood and morning asthenia. A thorough psychiatric assessment revealed a history of psychiatric hospitalization 30 years prior and ongoing treatment for an adjustment disorder since 2007. The assessment utilized standardized scales to measure depressive symptoms and documented the patient’s emotional state and coping mechanisms throughout his medical journey.

The patient experienced persistent low mood episodes since the onset of organic symptoms in 2019, exacerbated by multiple misdiagnoses and inadequate treatments. After receiving a diagnosis of VEXAS syndrome in July 2023, he reported significant improvements in mood and a reduction in suicidal ideation. He attributed these changes primarily to the clarity provided by the diagnosis and the development of a new treatment plan, rather than solely to adjustments in his antidepressant medication (sertraline, 100 mg). Although he tolerated the medication well, he emphasized that the sense of being understood significantly enhanced his motivation. Additionally, the patient reported vivid nightmares over the last two weeks but denied current suicidal thoughts.

This case highlights the complex relationship between prolonged diagnostic uncertainty and depressive symptoms in chronic inflammatory diseases like VEXAS syndrome. The findings suggest that a definitive diagnosis and clear treatment strategy are crucial for improving mental health and overall well-being. This underscores the importance of a multidisciplinary approach that prioritizes both physical and psychological needs, enhancing the quality of care for patients navigating such complex conditions.

None Declared