There is an evidence that the presence of first rank symptoms (FRS) in psychotic patients is associated with structural brain alterations and that the FRS severity is correlated with abnormal brain functioning. However, whether the severity of first rank delusions (FRD) or first rank hallucinations (FRH) correlates with structural alterations remains unclear.

We aimed at exploring correlations of FRS severity with structural brain alterations in schizophrenia patients with prominent first rank symptoms.

Twenty one right-handed patients (21.2-47.6 years, mean age 35.2±8.8, 2 females) with schizophrenia, presenting with prominent FRS and 21 one-to-one matched healthy controls (21.4-47.7 years, mean age 34.6±9.0, 2 females) underwent structural MRI at 3T scanner. MRI images were processed via FreeSurfer 6.0 to quantify cortical thickness and volumes for subcortical and brainstem (midbrain, pons, superior cerebellar peduncle and medulla) structures. The presence of FRS were diagnosed by professional psychiatrist (M.M.) using clinical interview and clinical-psychopathological method, severity of FRD and FRH were assessed with PANSS (P1 and P3 items accordingly). PANSS total for all patients: 88.1±20.6; PASNSS positive: 23.7±5.2 (P1: 4.9±1.3; P3: 4.6±1.3); PASNSS negative: 21.9±8.7.

Compared to healthy controls, patients with FRS showed widespread cortical gray matter thickness reductions (Image 1, A), and decreased volumes of hippocampus, amygdala, thalamus, caudate and nucleus accumbens bilaterally (Image 1, B). Patients with FRS also showed decreased volumes of whole brainstem and all of its substructures (midbrain, pons, superior cerebellar peduncle and medulla: Cohen’s d from −0.74 to −1.2).

No correlations between structural alterations and severity of FRD or FRH (PANSS P1, P3, P1+P3) were found.

Image 1. A: Clusters of decreased cortical thickness according to atlas of Desikan et al. (2006) in patients with FRS compared to healthy controls. B: Decreased volumes of subcortical structures in patients with FRS compared to healthy controls (nucleus accumbens are not shown).

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The results suggest that schizophrenia patients with prominent FRS have a pronounced widespread cortical and subcortical structural alterations consistent with findings in general schizophrenia research. However, the lack of correlations with clinical scores do not allow to conclude definitely whether the revealed structural abnormalities underlies FRD or FRH, which should be elucidated via further research.

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As traumatic brain injury (TBI) is a significant concern among military veterans, ongoing neuroimaging is a beneficial tool for monitoring functional brain changes and evaluating the progression of symptoms.

Highlighting the importance of follow-up neuroimaging assessments in guiding treatment adjustments and understanding the evolving relationship between TBI, post-traumatic stress disorder (PTSD), and neurocognitive dysfunction.

A 27-year-old male veteran injured by an IED experienced trauma to the right side of his body, resulting in 80% vision loss in the right eye and 20% in the left. He reported memory gaps and sleep disturbances. After inpatient and outpatient rehabilitation, he was prescribed Olanzapine (5 mg/day), Quetiapine (150 mg/day), and Venlafaxine (75 mg/day). On his second admission for increased sleep disturbances and anxiety, Quetiapine was increased to 200 mg/day. One year later, the patient developed new cognitive impairments and reported memory deficits and anterograde amnesia, concurrently PET scans revealed hypometabolism in the frontal lobe.

Neuropsychological Evaluation: The Raven Standard Progressive Matrices Test indicated potential issues in reasoning and problem-solving, while the Verbal Fluency Test suggested difficulties with cognitive flexibility and memory, and the Trail Making Test revealed problems with attention and sequencing. Imaging Findings: The initial CT scan demonstrated displaced linear fractures in the right temporal bone and two brain contusions shortly after the incident. On his visit nine months later, SPECT imaging showed relative hypoperfusion in the right posterior parietal cortex and bilateral temporal lobes. An EEG revealed slow wave anomalies in the right temporooccipital area and sharp spasms in the left temporal region. One year later, a follow-up PET scan revealed diffuse hypometabolism in the left frontal lobe, parietal lobes, and cerebellum.

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This case emphasizes the role of follow-up neuroimaging in managing complex cases of combat-related TBI and PTSD. The progression from structural damage to later functional changes like hypometabolism in the frontal and parietal lobes illustrates how neuroimaging helps track the long-term impact of brain injuries and provides a comprehensive understanding of the evolving neurocognitive challenges. Continued neuroimaging is crucial for monitoring neurodegenerative processes and guiding adjustments in treatment (Koerte et al., 2015b). This approach supports a more targeted treatment plan, improving the veteran’s long-term prognosis (Wilde et al., 2015). Future studies should prioritize large, multi-site longitudinal research to track long-term neurotrauma effects through imaging, providing insights into neurodegeneration, recovery, and neuroplasticity.

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In view of recent global trends in alcohol use, it becomes increasingly relevant to characterize health outcomes related to unhealthy alcohol use. Previous studies found that self-reported alcohol use was related to poor brain health. However, these studies remain inconclusive since they limited their analyses to very narrow demographic strata, considered only a subset of cortical regions, or didn’t validate self-reported alcohol use with biomarkers such as gamma-glutamyltransferase (gamma-GT).

This study aimed to comprehensively examine several aspects of brain health (cortical thickness, gray matter volume, and brain age gaps) in participants regularly exceeding the recommended limits of moderate alcohol use versus those who don’t, and to validate self-reported alcohol intake by comparing gamma-GT levels across groups.

This analysis was based on cross-sectional data from the population-based cohort of the BiDirect Study conducted in Münster (Germany). Individuals aged between 35 and 65 years were randomly selected from the local population register and invited to participate in the assessment that included a 3 Tesla magnetic resonance imaging (MRI) of the brain and a blood collection. Unhealthy alcohol use was defined as the regular consumption of at least three units of alcohol (one unit = 0.2L beer or 0.1L wine or 2cl spirits) per occasion at least twice a week. Regional cortical thickness and subcortical gray matter volumes were extracted from T1-weighted images in participants who underwent MRI. In addition, brain age gaps were estimated using an elastic net algorithm based on the imaging-derived phenotypes. Associations between unhealthy alcohol use, cortical thickness, subcortical gray matter volumes, and brain age gaps were analyzed using multiple regression models adjusted for age, sex, lifetime smoking status, education, and childhood trauma.

Participants engaging in unhealthy alcohol use had significantly higher gamma-GT levels. In addition, unhealthy alcohol use was associated lower regional cortical thickness across all four lobes of the brain. No differences in subcortical gray matter volumes were detected. In addition, we observed a significantly higher brain age gap (+ 1.11 years) in unhealthy alcohol users.

The results of this study indicate that the regular exceedance of the recommended levels of alcohol use is associated with poorer brain health as reflected by lower regional cortical thickness and advanced brain aging. The findings underscore the potentially adverse effects of alcohol on brain health, which are increasingly relevant in view of recent global trends in alcohol use.

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Apathy is a common non-motor symptom in Parkinson’s disease (PD), and its presence constitutes a risk factor for the development of cognitive impairment in this population (Burchill et al. Lancet Reg Health Eur 2024; 39:100870). β-amyloidopathy has been associated to shorter interval to dementia in PD and may also be a determinant of apathy.

We aimed to investigate β-amyloid burden in non-demented PD patients based on the presence or absence of apathy, and how both factors influence the rate of progression to mild cognitive impairment or dementia over a 3-year period.

Forty-eight PD patients underwent clinical and comprehensive neuropsychological evaluation, as well as [18F]-flutemetamol positron emission tomography. They were classified as apathetic (n=22) or non-apathetic (n=26) based on their score on the Starkstein Apathy Scale. Brain imaging analysis was conducted using the SPM software package.

We found statistically significant differences in disease duration when comparing clinical and demographic variables. Upon neuropsychological evaluation, apathetic patients performed significantly worse in attention domain (Digit Span and Trail Making Test A), executive function (Stroop Word-Colour Test and Trail Making Test B) and verbal memory (CERAD Total Word Recall). At follow up, 47.4% of apathetic patients progressed to dementia or MCI, compared to 12% of non-apathetic patients (χ² = 6.81, p <0.05). Brain imaging analysis revealed higher β-amyloid deposition in several cortical areas in apathetic PD patients (adjusted for disease duration and global composite cognitive z-scores).

The presence of apathy in PD patients is associated with greater cortical β-amyloidopathy and indicates a higher conversion rate to a worse cognitive diagnosis within a 3-year period.

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Neuropsychiatric symptoms (NPS), prevalent in individuals with mild cognitive impairment (MCI), are linked to functional decline, accelerated dementia progression, and reduced quality of life. In clinical practice, molecular imaging plays a key role in diagnosing cognitive and behavioral issues with high accuracy.

This study aims to analyze the correlation between NPS and molecular imaging findings in MCI-diagnosed patients.

A retrospective, descriptive study was conducted with MCI patients who had undergone Amyloid PET scans (APscan) between January 2019 and October 2024 at Infanta Leonor Hospital in Madrid. Data included demographics, neurological diagnoses, Global Deterioration Scale (GDS) scores, NPS (e.g., depression, psychosis, behavioral and sleep disturbances, anxiety, suicidal thoughts), and PET-FDG/APscan results. Statistical analysis was performed using Dataset and SPSS 22.0.

A total of 72 patients were included. The main characteristics of the sample are shown in table 1. Among these patients, 65.28% exhibited NPS; notably, 49.3% had depression, 23.61% behavioral disturbances, 19.44% sleep disorders, 16.67% anxiety, 4.17% psychosis, and 2.82% suicidal ideation. In patients with a positive APscan, 29.79% had NPS, including 34.29% with depression and 66.67% with psychosis. Patients with abnormal FDG-PET scans showed higher NPS prevalence (65.96%), particularly behavioral disturbances (64.71%), sleep disorders (57.14%), and depression (62.86%).

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This study underscores the high incidence of NPS in MCI patients, noting that NPS may exacerbate patient distress, contribute to autonomy loss, and increase institutionalization risk. Furthermore, molecular imaging patterns can help predict MCI progression to dementia and highlight NPS as potential predictors and outcomes of these biological changes.

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Auditory verbal hallucinations (AVH) are one of the primary symptoms of schizophrenia, but the biological mechanisms underlying them remain uncertain (1,2). Theoretical approaches have proposed that AVH are caused by abnormal activity in the auditory cortex; or that they represent misinterpreted cognitive activity such as inner speech. Recently, our group found, using a symptom capture task, that AVH did not trigger activity in the auditory cortex, but instead in language-related areas, thus shifting the focus towards cognitive theories of AVH (3). To date, cognitive approaches have only been preliminarily investigated, and mostly in psychological studies (1,2).

Our aim was to test the theory that a disturbance in inner speech processes underlie AVH. We used conjunction analysis to examine common activation patterns between the experience of AVH and phonological encoding.

Eleven patients meeting DSM-5 criteria for schizophrenia or schizoaffective disorder with near-continuous AVH underwent fMRI during symptom capture and during a phonological encoding task. In the symptom capture task, the patients were instructed to press their left index finger when they begin to hear an AVH, wait three minutes, mentally repeat what they heard, and then press their right index finger. The phonological encoding task required them to indicate, via button press, whether the names of two objects shown in line drawings rhymed.

Pre-processing and analyses were carried out with FSL software using linear models. Activation maps were thresholded at p<0.05, cluster-corrected for multiple comparisons. To find regions of common activation between the two tasks, the activation maps from the contrasts of interest were binarized and entered into a conjunction analysis. Regions showing significant activation in both tasks simultaneously were considered activated in the conjunction analysis.

The conjunction analysis showed common activation in several regions involved in phonological encoding, such as Broca’s area and its right homologue, supplementary motor area bilaterally, Wernicke’s area and cerebellum, in patients with AVH.

These results support a non-perceptual origin of AVH and link them to brain areas related to the phonological loop and working memory in schizophrenia.

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Globally, the number of international migrants has been rising, with Europe seeing a significantly higher increase compared to other regions. Migration has been frequently identified in the literature as a risk factor for various mental health issues (Schouler-Ocak et al. Indian J Psychiatry 2020; 62 242-6). Despite this, migrant populations often encounter significant challenges in accessing mental health care services, primarily due to language and communication barriers and cultural differences (Forray et al. BMC Public Health 2024; 24 1593). To improve mental health treatment for migrant populations, it is essential to not only provide cultural competence training for healthcare professionals and ensure access to professional interpreters but also to establish and maintain multicultural treatment teams (Machleidt W. Der Nervenarzt 2022; 73 1208-12). Addressing these needs, we have been operating a multicultural treatment team at our day clinic in Hamburg for the past year, providing care to Turkish-speaking migrants and native-born patients together.

To describe our efforts in developing a cross-cultural center and facilitating effective communication between migrant patients and native-born patients.

A descriptive overview of our efforts to establish a day clinic model adapted to the cultural and linguistic needs of the migrant (Turkish) population in Germany with a brief review of the relevant literature.

At our day hospital, we provide care for patients with psychiatric disorders who do not require inpatient treatment but for whom outpatient care is insufficient. Our multicultural treatment team is composed of healthcare professionals whose native languages are German and/or Turkish.In our day hospital, patients with a migration background receive psychotherapy and medical consultations in their native language, ensuring they can access the treatment they need without language barriers. Additionally, we aim to improve cultural understanding through collaborative activities. This approach facilitates the development of cross-cultural communication among patients and healthcare professionals from different backgrounds, while also contributing to equal opportunities in psychiatric treatment. The program addresses linguistic, cultural, and religious communication difficulties, aiming to build and sustain meaningful relationships.

The migrant population in Europe continues to grow each day, and mental health care services must adapt to this heterogeneous population and their diverse treatment needs. We advocate for the establishment of treatment centers where migrant populations and native-born patients are considered together, as such centers can play a role in bridging the intercultural communication gap.

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Unaccompanied Migrant Minors (UMMs) who travel alone and live apart from their families are particularly vulnerable to mental health issues and social exclusion in Spain. Risk factors related to the migratory cycle, including travelling alone, living away from family, and experiencing discrimination, can negatively impact their mental health and increase the risk of social exclusion.

This study aims to describe the profile of newly arrived UMM and identify the relevant health risk factors among them, considering factors before, during, and after migration and their impact on psychological distress.

The study involved face-to-face interviews with 230 minors in foster care placements. The interviews covered sociodemographic information, education and employment situations, factors related to the migratory process (before, during, and after migration), health status, and psychological distress. They were conducted in Arabic or French and translated into Spanish.

The findings revealed that UMMs generally perceived themselves as having good health before migration. However, they often held unrealistic expectations about their new life. Upon arrival, they had to cope with post-migration stressors such as stress (β = 0.468, SE = 0.142, p = 0.001) and discrimination (β = 0.357, SE = 0.121, p = 0.003), which adversely affected their mental health.

The study highlights the impact of post-migration factors on psychological distress among newly arrived UMM. It underscores the need for comprehensive mental health care that considers the different stages of the migratory cycle. Additionally, it advocates for promoting cross-cultural mental health care models and developing policies and services to address and mitigate the effects of post-migration factors, including discrimination against UMMs in Spain.

None Declared

11 years old, Syrian, he arrives alone in Italy after disembarking in Lampedusa, coming from Libya where he reports having stayed for a year. He is assigned to a community by the Juvenile Court of Catania.

A few days later, he exhibits multiple episodes of chest pain, difficulty breathing, drooling, muscle rigidity and tremors, and in the most severe case, he is taken to the emergency room and then hospitalized in pediatric neuropsychiatry.

Diagnosis ICD 10: Dissociative disorders (Code F44); Post-traumatic stress disorder (Code F53.1). Trazodone hydrochloride (60 ml) is prescribed, 5 drops three times a day.

Care of the person and resolution of symptoms through psychotherapeutic management by the “Medicina delle Migrazione e delle Emergenze Sanitarie” of ASP 3 Catania (Italy).

Hypnosis combined with virtual reality, a technique already experimented with by the writer, the procedure consists of: trance induction; awakening; application of the visor; re-induction of the trance through conditioning, simultaneously with the departure of the virtual stimulus; continuous feedback with peripheral device. The stimulus situations transmitted by the viewer have as object setting such as: Abstract: lights, colors, geometric shapes; Concrete: naturalistic and aquatic landscapes, animals, guided tours, etc.

He is a good hypnotic subject, responds well and after initial disorientation, benefits from psychotherapy, showing a slow but continuous improvement in behavior: anxiety progressively decreases, oppositional and rebellious behavior in the community wanes, conduct at school becomes appropriate where there were previously conflicts, sleep changes from disturbed to regular, and he interacts positively with adults and peers.

Marked interference is noted via phone from the family of origin, urging him to go to Germany where a half-sister resides (the procedure is feasible but very complex), leading to a resurgence of symptoms and feelings of guilt in the minor, who perceives himself as unable to meet the demands of his relatives.

During Ramadan (he is Muslim), there are difficulties with concentration and lack of energy due to the lack of food and water, leading to a temporary delay in the work.

In an advanced phase of treatment, the minor categorically refuses to come to the clinic, probably due to being mocked by peers in the community, and it is decided to discontinue the sessions, especially since the work had progressed effectively and there was already an intention to gradually discontinue it.

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It is believed that the use of hypnosis combined with virtual reality represents an appropriate treatment for post-traumatic stress disorder (PTSD), as it reduces anxiety, strengthens the ego, accelerates the process of change, and directs life in a positive direction.

The Juvenile Court has granted family reunification in Germany, and at present, the minor is awaiting departure.

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In Georgia, the psychiatry system is predominantly institutionalized, with limited community-based services and inadequate funding for psycho-social rehabilitation. Government finds it challenging to refocus psychiatry care towards deinstitutionalization, often failing to understand the high importance of such a step and the reasoning behind turning it. This research proposal aims to explore strategies to enhance the cost-effectiveness of mental health services in this context.

Assess the current landscape of psychiatry services in a middle-income country, focusing on institutional care versus community-based services. Identify barriers and challenges faced by key actors in transitioning towards community-oriented psychiatry care. Investigate the cost-effectiveness of community mental health interventions compared to institutional care, considering long-term outcomes and societal impacts. Develop evidence-based recommendations to advocate for policy changes and resource allocation towards community-oriented services.

Literature Review: Conduct a comprehensive review of existing literature on cost-effective analyses and community interventions in middle-income countries.Policy Analysis: Examine existing mental health policies and budget allocations to identify gaps and opportunities for reallocating resources toward community-based care. Stakeholder interviews: interview policymakers, mental health professionals, and patients to collect information from different perspectives. Quantitative Analysis: Use health economics methods to analyze the cost-effectiveness of community-based mental health services compared to institutional care.

Insights into the economic impact of transitioning towards community-oriented mental health services in middle-income countries. Policy recommendations aimed at increasing investment in community-based interventions and resocialization programs. Increased awareness among key actors about the long-term benefits and cost savings associated with community-oriented mental health care. Improved understanding of societal attitudes and barriers towards mental health reform.

Key discussion points include: How can advocacy efforts be reinforced to persuade governments that community mental health care is more affordable and beneficial? What obstacles might stand in the way of expanding community-based services, and how might they be overcome? How can stakeholders work together to guarantee resocialization programs receive ongoing financing and support? What role can international partnerships and collaborations play in supporting mental health reform in Georgia? By addressing these critical questions, this research proposal seeks to provide a roadmap for enhancing the cost-effectiveness and accessibility of mental health services in Georgia and similar middle-income contexts.

None Declared

India is facing a growing mental health burden, with significant disparities in access to services despite the introduction of the National Mental Health Program (NMHP) and the Mental Healthcare Act (MHA). While these policies aim to improve mental health care, their implementation remains inconsistent due to a range of challenges. Understanding these barriers is crucial to enhancing mental health services across the country.

This study aims to identify the key challenges impeding the effective implementation of existing mental health policies in India, with a focus on rural-urban disparities, resource constraints, and sociocultural factors.

A comprehensive literature review was conducted, examining peer-reviewed articles from databases such as PubMed, Scopus, and WHO policy documents, and reports from government and non-governmental organizations. Data was analysed to assess the primary obstacles related to funding, workforce shortages, stigma, policy integration, and infrastructure issues. Qualitative insights from key stakeholders in mental health services were also included.

The review revealed five primary challenges. Firstly, the insufficient financial allocation for mental health programs, leading to limited-service availability; secondly, a shortage of trained mental health professionals, particularly in rural areas; thirdly, a pervasive stigma surrounding mental health, hindering service uptake; fourthly, the poor integration of mental health care into primary health systems; and lastly, the bureaucratic inefficiencies and lack of infrastructure. These challenges disproportionately affect rural populations, exacerbating the urban-rural divide in mental health care delivery.

The effective implementation of mental health policies in India is undermined by systemic challenges such as inadequate resources, workforce gaps, and sociocultural barriers. Addressing these issues requires targeted interventions, including increased investment in mental health services, enhanced training programs, stigma reduction campaigns, and better integration of mental health care into general healthcare frameworks. A coordinated, multi-level approach is essential to overcoming these barriers and achieving meaningful improvements in mental health outcomes across India.

None Declared

The 2009 WHO and WONCA report (Integrating Mental Health in Primary Care: A Global Perspective) outlined best policies and practices for the integration of mental health into primary care. The arguments in favor are reduced stigma, improved access to care, holistic management of comorbidities, improved prevention and early detection of mental disorders, reduced losses to follow-up, lower costs, easier communication, improved social integration, protection of human rights, and improved uptake of the healthcare system (Greenhalgh T, 2009; Petersen et al, 2016). Nevertheless, mental health care in many countries remains separate from primary care, limiting access and equitable distribution. However, since the COVID-19 pandemic, the global need for mental health services have surged, causing a 25 to 27 per cent increase in the prevalence of depression and anxiety around the world, accelerating the demand for integrated care (Bower et al, 2023). So, the process of integration outlined in the 2009 WHO and WONCA report warrants an updated discussion.

International experts from Hungary, Greece, and Cyprus and of WHO, WONCA and WPA present different models of integration of mental health into primary care with special respect to public health crises.

Challenges, opportunities and best practices of each country will be presented, including policy recommendations, capacity building and advocacy strategies for mental health integration and public health crises, and monitoring, evaluation, and research for integrated services.

In all three countries, stigma, insufficient training of primary care providers, and inadequate policy frameworks present problems. In Greece, the dominance of a medically oriented health policy has hindered interdisciplinary integration (Lionis et al., 2019). Cyprus grapples with stigma surrounding mental health issues, which affects service utilization (Nikolaou & Petkari, 2021). Opportunities are leveraging community resources and enhancing collaboration among stakeholders to foster inclusive health services (Pinaka et al., 2022). Best practices involve training programs for primary care providers, promoting awareness, and developing evidence-based policies that prioritize mental health (Ashcroft et al., 2021). Advocacy strategies should focus on engaging policymakers and the community to address mental health needs, particularly in light of public health crises like COVID-19, which have exacerbated mental health issues (Galanis et al., 2020; Maulik et al., 2020). Monitoring and evaluation are crucial for assessing the effectiveness, ensuring accountability, and adapting strategies based on research findings (Glover-Wright et al., 2023; Saxena & Kline, 2021).

The need of updating the 2009 WHO and WONCA report is considered to include the latest evidence, experiences, and recommendations on mental health integration into primary care.

None Declared

Adult Attention Deficit Hyperactivity Disorder (ADHD) has been recognized as a condition with profound psychosocial implications, including a higher likelihood of encountering legal problems.

To characterize temperamental characteristics and risk factor for legal problems in a group of ADHD patients.

The study involved patients (>18 years) from the adult ADHD outpatient service of the Psychiatric Clinic of Ancona.ADHD was diagnosed using the Diagnostic Interview for ADHD in adults (DIVA5.0). The following rating scale were administered: Temperament Evaluation in Memphis, Pisa and San Diego(TEMPS-M), Coping Orientation to the Problems Experiences-new Italian version (COPE-NVI), Temperament and Character Inventory-Revised (TCI-R).

76% (n=170) of screened patients were diagnosed with ADHD in adulthood. Among them, 10.2% (n=17) reported legal problems. Men with ADHD were more likely to have legal issues (χ²=7.851; p=0.005). These patients often reported school failures(χ²=3.033; p=0.082) and being tutored by a support teacher(χ²=15.165; p<0.001). Legal issues were more common in those with a childhood diagnosis of ADHD (χ²=4.880; p=0.027) and in those who were admitted to a psychiatric ward (χ²=7.205; p=0.007).Additionally, those who smoked (χ²=6.695; p=0.035) or used substances (χ²=16.399; p<0.001) had more legal issues. Higher use of cannabinoids (χ²=14.311; p<0.001) and stimulants (χ²=12.445; p<0.001) in those who had legal problems are also reported. Generally, those with legal problems have lower schooling (p=0.005), more high school failures (p=0.047), smoke more cigarettes per day (p=0. 008) and have higher scores in the problem-solving subscale of the COPE-NVI (p=0.024), the ambitious subscale of the TCI-R (p=0.058), and the self-transcendence subscale of the TCI-R (p=0.078) and lower mean score in the self-acceptance subscale of the TCI-R (p=0.054). Logistic regression analysis showed to ascertain the effects of all TCI-R subscales, on the likelihood of developing legal problems. The logistic regression model was statistically significant, ▫▫2(1)=4.020, p=0.045. The model explained 14.6% (Nagelkerke R2) of the variance in patients with ADHD who have legal problems and correctly classified 91.9% of cases.Having legal problems was significantly predicted by TCI-R spiritual acceptance subscale (exp(B)=1.150, p=0.045).

The study highlight the significant psychosocial burden of ADHD in adulthood, particularly the increased likelihood of legal problems.Key risk factors include lower educational attainment, substance use, and specific temperamental traits, such as elevated problem-solving and self-transcendence tendencies, alongside lower self-acceptance.

None Declared

Equitable access to mental health services is essential for the well-being of European citizens. Despite advancements in health policies, significant disparities in access to care persist. Socioeconomic, geographical, cultural, and institutional factors contribute to these inequalities, disproportionately affecting vulnerable groups.

To analyze the inequalities in access to mental health services in Europe and identify effective strategies to promote equity in these services.

This study conducted a systematic literature review using PubMed, Scopus, and PsycINFO databases to identify studies published between 2015 and 2023. The keywords used were “mental health access,” “health equity,” “Europe,” and “mental health inequalities.” Inclusion criteria focused on studies addressing access to mental health services in Europe and strategies to promote equity. Extracted data were qualitatively synthesized, highlighting trends, barriers, and facilitators to equitable access to mental health services.

The review revealed significant inequalities in access to mental health services in Europe, primarily due to socioeconomic and geographical factors. Low-income individuals face major barriers, such as high costs and lack of coverage by health systems. Rural areas suffer from a shortage of specialized professionals and inadequate infrastructure, making continuous quality care challenging.

Cultural and linguistic factors add further complexity, particularly for migrants and ethnic minorities. The lack of culturally adapted services and sensitivity in therapeutic approaches often leads to inadequate care. Stigma surrounding mental health remains a significant barrier, preventing many from seeking help.

Variations in mental health policies and investments across European countries further exacerbate these inequalities, creating a fragmented landscape of care access. While some countries have robust strategies, others lack consistent policies and adequate funding. Addressing these disparities requires integrated policies, culturally sensitive professional training, and effective stigma-reduction programs.

There is an urgent need to address inequalities in access to mental health services in Europe. Integrated strategies are essential, including policies that promote equity, improvements in rural infrastructure, and culturally sensitive professional training. Reducing stigma through awareness programs is crucial to encourage help-seeking behavior. Harmonizing policies and investments among European countries can contribute to more equitable and effective access, ensuring equal opportunities for mental health treatment and support.

None Declared

Equitable access to mental health services is a challenge in Brazil, marked by socioeconomic and regional inequalities. Despite advances in policies such as psychiatric reform and the Psychosocial Care Network (RAPS), barriers persist, especially for vulnerable populations. Issues such as the unequal distribution of resources, stigma, and a lack of professionals impact both access and the quality of care.

To analyze the inequalities in access to mental health services in Brazil and identify strategies to promote equity.

A systematic review was conducted using the PubMed, Scielo, and Lilacs databases, covering studies published between 2015 and 2023. The keywords used were “mental health access,” “health equity,” “Brazil,” and “mental health inequalities.” Inclusion criteria focused on studies addressing access to mental health services in Brazil, highlighting barriers, facilitators, and strategies to promote equity. Data were qualitatively synthesized to identify trends and challenges.

The review revealed significant disparities in access to mental health services, influenced by socioeconomic, geographic, and cultural factors. Remote regions, such as the North and Northeast, suffer from a lack of infrastructure and specialized professionals. While urban centers offer more services, rural areas face considerable limitations. The unequal distribution of professionals, such as psychiatrists and psychologists, exacerbates these inequalities. Stigma surrounding mental illness and a lack of awareness further hinder help-seeking behavior. Vulnerable populations, including Indigenous peoples and residents of favelas, face additional barriers such as discrimination and a lack of culturally adapted services.

The Unified Health System (SUS) provides a model of universal access but faces challenges related to funding, infrastructure, and capacity to meet the growing demand. Despite the efforts of RAPS, many services are overwhelmed, resulting in long waiting times and insufficient care. Strategies like integrating mental health into primary care have shown effectiveness but require more support and expansion.

Equitable access to mental health care in Brazil is impacted by various barriers, including regional disparities and stigma. To promote equity, it is crucial to invest in expanding the mental health care network, focusing on underserved areas and vulnerable populations. Effective policies should include professional training, stigma reduction, and culturally sensitive services. Integrating mental health services with primary care, strengthened by the SUS, is essential to ensure more accessible and comprehensive care.

None Declared

The Brazilian psychiatric reform, initiated by Law 10.216 in 2001, brought a significant shift in the treatment of individuals with mental disorders. Focusing on deinstitutionalization and psychosocial care, the reform aimed to replace the hospital-centered model with a community-based services network. Over the past 23 years, this transformation has faced challenges, including the implementation of public policies, the guarantee of human rights, and the effective integration of mental health services.

To analyze the advances, challenges, and impacts of the Brazilian psychiatric reform from 2001 to 2024, with a focus on deinstitutionalization and psychosocial care.

A documentary and bibliographic review was conducted, including legislation, government reports, scientific articles, and data from the Unified Health System (SUS). The research covered publications from 2001 to 2024 in the PubMed, Scielo, and Lilacs databases. The search terms used were “Brazilian psychiatric reform,” “deinstitutionalization,” and “psychosocial care.” The qualitative analysis highlighted legislative changes, service implementation, and challenges.

The psychiatric reform led to significant advances in the structuring of the Psychosocial Care Network (RAPS), including Psychosocial Care Centers (CAPS) and therapeutic residential services. There was a substantial reduction in psychiatric hospital beds and an expansion of community-based services. However, challenges persist, such as regional disparities in service provision and a shortage of qualified professionals.

The implementation of RAPS varied between regions, with the Southeast and South being more developed compared to the North and Northeast. Deinstitutionalization brought benefits, such as social reintegration of patients, but also revealed gaps, including the lack of support for families and strategies for managing crisis situations.

There is an ongoing need for public policies to support the reform, including adequate funding and a focus on human rights. Recent debates on the reintroduction of psychiatric hospitals indicate tensions in mental health policy, underscoring the need to reinforce the principles of the reform.

From 2001 to 2024, the Brazilian psychiatric reform made progress in mental health care, emphasizing deinstitutionalization and the creation of a community-based network. However, challenges such as unequal service provision, a shortage of professionals, and political tensions indicate the need to strengthen the reform’s principles. Public policies should ensure humanized, integrated care based on the rights of individuals with mental disorders, ensuring the expansion of RAPS across the country.

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The term “co-occurring disorders” (COD) refers to the coexistence of two or more psychiatric disorders especially substance use disorder (SUD) and other psychiatric disorders. In particular, the prevalence of COD increases globally and is linked to a higher risk of worse outcome. Furthermore, especially in adolescence, the goal is to provide an early and proper answer both in terms of care and prevention. On the opposite, there is a lack of integrated management strategies requiring an effective collaboration of different mental health disciplines in order to receive appropriate care. Although European countries have established mental health policies, a lack of comprehensive and structured mental health intervention programs remains.To answer these needs we developed an Integrated Mental Health Service for patients with co-occurring disorders aged up to 30 years, lining varied challenges, including both the interception of patient’s needs and the practical organization of interventions.

This study aims to identify the impact of an Integrated Mental Health Service, “Polo Cassia”, coordinated by a team of professionals based in the same physical location, on the outcome of co-occurring disorders in patients aged up to 30 years at their first contact with mental health services. Furthermore, we aim to identify which transversal clinical dimensions and risk factors might benefit from an early integrated and tailored treatment.

The project is carried out at the Community Mental Health Center (CMHC) of District 15th, ASL Rome 1. The final study sample will include all the patients referred in one year to “Polo Cassia”. Clinical and socio-demographic parameters are collected in details, Global Assessment Functioning (GAF), and Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) are administered at baseline (To), after 6 months (T1) and 1 year (T2).

Among the study sample referred to Polo Cassia (53% male, mean age 20,33 ±4,47), 50% of the patients comes directly from a first triage evaluation, 35% from other mental health services and 15% from other health services (e.g. diabetes centre). The 60% of the patients have SUD coexisting with other psychiatric disorders. From updated results, we expect to be able to verify the impact of an early integrated treatment on global function and quality of life in our sample of patients. Furthermore, we expect to characterize the transversal clinical dimensions which will actually respond to an early integrated treatment with positive clinical outcomes and subjective satisfaction.

The experience of structured integrated models of care for co-occurring psychiatric disorders is necessary to inform the future development of Mental Health Services.

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The paradigms of diagnosis and evaluation in mental health are changing due to the incorporation of artificial intelligence (AI) into other fields. Understanding mental health conditions is greatly aided by insights from neuroscience, immunology, social and clinical psychology, and cultural theories. According to Martyn Evans’ commentary, interdisciplinary work generates new issues and solutions while multidisciplinary work preserves unique viewpoints. In this sense, the interdisciplinary field of psychoneuroimmunology has contributed significantly to our understanding of mental health. It has also contributed significantly to the interplay between the immune system, the endocrine system, and the nervous system. This field could rapidly emerge as a key component of integrative diagnosis and assessment.

This review emphasizes the need for comprehensive biopsychosocial assessment frameworks and the importance of harmonizing disciplines through multidisciplinary and interdisciplinary methodologies to enhance diagnostic possibilities via AI.

A critical review of clinical psychology was conducted, as well as a discussion of the necessity of using integrative methodologies in order to address the interconnected nature of both medical diseases and mental disorders, in light of recent advancements in artificial intelligence.

It has been explored how PNI can serve as an interdisciplinary ground for cross-disciplinary dialogue and how stakeholder perspectives may resolve complexities in clinical assessment and psychiatric diagnosis through extending PNI with AI and applications. Integrating AI into PNI is crucial for revolutionizing mental health care, utilizing machine learning to consolidate diverse data streams and predict outcomes.

Lastly, it was outlined some pragmatic frameworks for clinical assessment, taking into account time, budget constraints, and stakeholder interests. Ethical, governance, and practical challenges of AI integration are discussed. The paper proposes innovative AI-driven enhancements in psychiatric assessment, diagnosis, and treatment, fostering transformative developments in clinical psychology and promoting a humanistic approach to mental health care.

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The COVID-19 pandemic disrupted primary healthcare services, affecting mental health support and antidepressant prescriptions in England. This study examines shifts in GP referrals and antidepressant prescribing patterns during different phases of lockdown.

This research aims to (1) analyze changes in the rates of antidepressant prescriptions across lockdown periods, and (2) investigate how GP referrals to mental health services, including social prescribing, evolved, with a focus on disparities among ethnic groups.

Using a retrospective design, we analyzed electronic health record data from GP practices in North England, covering March 2018 to June 2023. We employed a two-level negative binomial-logit hurdle model for antidepressant prescriptions and a multinomial logit regression model for referral types.

Antidepressant initiation decreased during lockdowns, while ongoing prescriptions showed minor increases. GP referrals to social prescribing rose significantly, especially among ethnic minorities who also had fewer medical treatments. Lockdown phases influenced referral patterns, with reductions in secondary care referrals and growth in community-based support.

The study highlights a shift towards social prescribing amid the mental health strains of the pandemic, suggesting its role in a social model of health. Ethnic disparities in mental health care access emphasize the need for culturally inclusive, non-clinical mental health support.

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Burnout is an occupational phenomenon that may be a risk factor for several mental health disorders. It is defined by three dimensions namely emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). The nursing workforce experiences high levels of burnout taking a toll not only on their mental state but also their intent to stay leading to issues on shortage.

This study aims to assess association of burnout and its dimensions to intent to stay of medical nurses working in a private tertiary hospital in the Philippines.

Analytical cross-sectional study using secondary data conducted by the Nursing Services Group of the private tertiary hospital last March 2023. A survey was done on nurses’ perceptions of their working condition using Maslach Burnout Inventory and McCain’s Intent to Stay tools. Variables were assessed through simple and multiple linear regression analyses.

On simple linear regression, burnout, civil status, years of experience, and years of tenure revealed significance in their respective categories. EE and DP dimensions showed negative association to intent to stay. On multiple linear regression, only burnout (p< 0.000 and -0.028) and those married with children (p< 0.000 and -0.028) had significant association. EE consistently showed negative association however, DP and PA had positive association to intent to stay. In most literatures, DP is associated to lower intent to stay as it is equated to cynicism or detachment in interpersonal relations which can manifest as negative or inappropriate attitudes towards clients, irritability, loss of idealism, and withdrawal (Maslach et al. World Psychiatry 2016; 15 103-11). However, in this study, nurses who were more detached had surprisingly higher intent to stay which may show how cynicism can be protective. It is a cognitive method of creating a protective distance to prevent them from letting their job performance suffer especially when dealing with the physical and emotional exhaustion, and feelings of ineffectiveness caused by excessive and prolonged stress (Akyurt et al. Medical Science and Discover 2023; 10 918-928).

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Consistent with global studies, burnout is associated to lower intent to stay among nurses. However, it is beneficial to have more research looking further into the comprehensive role of cynicism in burnout. In this study, nurses have built some level of cynicism that is able to preserve themselves in negative situations. However, with no proper management, depersonalization can aggravate ultimately leading to feelings of inadequacy and lower intent to stay. A deeper and more contextualized understanding about this phenomenon may help administrators improve existing operations and policies that can help foster a healthier working environment for the nurses.

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