Co-occurring substance use disorders (SUDs) among individuals with schizophrenia are a prevalent and complex psychiatric comorbidity, which is associated with increased symptom severity, worsened illness trajectory and high rates of treatment non-adherence. Recent evidence suggests that the use of depot antipsychotics may provide an effective treatment option for individuals with this dual-diagnosis.

Hypothesis testing: “Depot antipsychotics are associated with i) reduced hospitalizations, ii) improved quality of life and iii) improved patient functionality in dual diagnosis of psychosis and SUD”.

68 patients in community of Eastern Crete (Greece) participated (Male to Female ratio corresponds to 2.4:1). All of them manifested psychosis (24 with F.20 ICD-10 and 44 with F29.0 ICD-10). The median age was 41 years. 29.41% had dual diagnosis of psychosis and alcohol use disorders, 7.35% had dual diagnosis of psychosis and cocaine use disorders, while 26.47% had dual diagnosis of psychosis and cannabis Use disorder. 80.88% were on aripiprazole LAI, 8.82% on paliperidone LAI, 2.94 % on risperidone LAI and 7.35% on haloperidol LAI. For the evaluation of our hypotheses the instruments WHOQOL-BREF questionnaire and the CGI-S scale were used. The quality of life and the functionality of the patients and also the number of their hospitalizations were compared in each patient, before the initiation of the LAI medication and during the active treatment period. The minimum of follow-up period was 6 months.

In our sample of 68 patients with depot antipsychotics therapy administrated at least for 6 months: a) Hospitalizations decreased statistically significantly from 1.01 ±1.54 to 0.01±0.12 (Paired Samples Wilcoxon Signed Rank Test p-value<<0.001), b) The CGI-S score decreased statistically significantly from 5.72 ±0.88 to 2.94±1.33 (Paired Samples Wilcoxon Signed Rank Test p-value<0.001), c) The score of the WHOQOL-BREF scale increased statistically significantly from 0.57 ±0.53, to 3.35±0.84 (Paired Samples Wilcoxon Signed Rank Test p-value<0.001). The same sample with depot antipsychotic treatment administrated at least for 3 months: a) The CGI-S score decreased statistically significantly from 5.72 ±0.88 to 2.34±0.89 (Paired Samples Wilcoxon Signed Rank Test p-value<0.001), b) The score of the WHOQOL-BREF scale increased statistically significantly from 0.57 ±0.53, to 2.3±0.89 (Paired Samples Wilcoxon Signed Rank Test p-value<0.001).

Depot antipsychotics medication significantly reduces the number of hospitalizations, when patients with psychosis and substance use disorders remain in therapy at least for 6 months. In addition, the administration of depot therapy, at least for 6 months, improves the quality of life and the functionality of these patients.

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Nearly 40% of individuals with schizophrenia are resistant to medication. Treatment-resistant schizophrenia leads to increased health-risk behaviors and reduced quality of life. Avatar therapy via virtual reality seems to be a very promising solution for individuals with treatment-resistant schizophrenia. This therapy targets refractory auditory verbal hallucinations, one of the core positive symptoms of schizophrenia. This symptom is thought to reflect a direct experience of the aberrant salience of internal representations according to the aberrant salience hypothesis of psychosis. Strong evidence suggests that the striatum plays an important role in the development of positive symptoms, as individuals with schizophrenia show an increased activation of this brain region at rest. One of the mechanisms underlying Avatar therapy may involve a reduction in aberrant salience. However, the neural processes involved in this therapeutic approach remain largely unexplored.

This study aims to investigate the brain mechanisms underlying Avatar therapy in treatment-resistant schizophrenia by examining spontaneous brain activity at rest using functional magnetic resonance imaging (fMRI).

Fourteen participants with treatment-resistant schizophrenia participated in nine sessions of Avatar therapy. They underwent resting-state fMRI scans before and after the therapy. Voxel-wise analyses of fractional amplitude of low-frequency fluctuations (fALFF) were performed to examine differences between post- and pre-therapy in regional patterns of spontaneous brain activity.

Importantly, after the therapy compared to before the therapy, we found that participants with treatment-resistant schizophrenia had reduced fALFF in the right putamen. We also observed increased fALFF in the bilateral occipital, right inferior temporal, right angular gyrus, left medial temporal and left supramarginal gyri after the therapy.

The putamen is a part of the striatum which is known to play a significant role in the emergence of psychosis. Mainly, our results suggest that Avatar therapy regulates putamen activity at rest, suggesting that the neural mechanisms underlying the therapy involve the alleviation of aberrant salience.

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Antipsychotics are used to manage psychotic symptoms and reduce the risk of relapse. However, the side effects associated with antipsychotic treatment are seen to hinder societal recovery and happiness by antipsychotic users.

In this study, we investigate the association of side effects, antipsychotic dose and antipsychotic polypharmacy with societal recovery and happiness.

Data from a naturalistic longitudinal cohort was used (PHAMOUS, 2013-2021; n> 3000). Mixed effect linear regression models were used to investigate the association between subjective side effect burden, antipsychotic dose and antipsychotic polypharmacy with societal functioning and happiness. Moreover, the association of single antipsychotic side effects with societal recovery and happiness were investigated with mixed effect linear regression models.

The subjective antipsychotic side effect burden and total antipsychotic dose were both negatively associated with societal recovery and happiness. Polypharmacy was additionally negatively related to societal recovery. Cognition, mood and anticholinergic side effects were most strongly associated with societal functioning. Mood, sedation, cognitive, and sexual related side effect were most strongly associated with happiness.

The association between side effects and the antipsychotic dose and societal functioning and happiness in this population in long term care shows the importance of addressing overtreatment at an early stage. Future research should focus on whether addressing side effects, especially mood and cognition related side effects, is beneficial for societal recovery and happiness in the long-term.

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The present study aimed to investigate the causal relationships among cognitive impairment, psychopathology, and real-life functioning in a large sample of people with schizophrenia, using a data-driven causal discovery procedure based on partial ancestral graphs (PAGs).

This method may provide additional insights for identifying potential targets of therapeutic interventions to promote recovery in people with chronic schizophrenia.

State-of-the-art instruments were used to assess the study variables. Two PAGs were generated at baseline and after 4 years of follow-up to explain the nature of the causal relationships linking psychopathology, cognition, and functioning.

The study sample was composed of 612 clinically stable patients with schizophrenia at baseline and 602 at follow-up. The PAGs suggested that working memory deficit is the first ancestor of the causal links, influencing all the other neurocognitive domains, social cognition, and functional capacity, which in turn affects everyday life functioning. From this domain of functioning a causal link is directed to disorganization and positive symptoms, and another to work skills and interpersonal relationships domains; the latter had a direct link to asociality and the other domains of negative symptoms. The structure of the PAGs did not differ significantly between baseline and follow-up, indicating the stability of the causal relationships.

The role of working memory deficits in the pathways to functional outcomes in schizophrenia highlights the importance of implementing integrated pharmacological and cognitive remediation interventions targeting neurocognition. The impact of everyday life and interpersonal functioning on the clinical presentation of schizophrenia suggests that integrated and personalized treatments, promoting relevant skills to improve these functional outcomes, may have a beneficial impact on clinical outcomes.

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Huntington’s disease (HD) is a progressive neurodegenerative disorder characterized by motor dysfunction, cognitive decline, and psychiatric symptoms. Among these psychiatric manifestations, psychosis occurs in a subset of patients, presenting significant challenges for both diagnosis and treatment. While pharmacological interventions, such as antipsychotics, are commonly used to manage psychosis in HD, they often come with limited efficacy and a high risk of adverse effects. Electroconvulsive therapy (ECT), traditionally employed in the treatment of severe mood disorders and treatment-resistant psychosis, has garnered minimal attention as a therapeutic option for psychosis associated with HD. This is proven by the absence of literature focusing specifically on the use of ECT for treatment of Huntington’s Psychosis. This underexplored avenue holds potential, given ECT’s neuroplastic and neurochemical effects, which may counteract the neurodegenerative processes seen in HD. Exploring the efficacy of ECT in HD-associated psychosis could not only provide symptom relief but also offer insights into the broader neuropsychiatric management of the disease.

This review aims to highlight the therapeutic potential of ECT as a novel intervention in Huntington’s psychosis, addressing the current gap in clinical research and therapeutic strategies.

A non-systematic review of the published literature using the PubMed/MEDLINE database with the MESH terms “huntington,” “psychosis” and “ECT” was made. The articles were selected according to relevance.

There were found 14 relevant publications that adress the use of ECT in HD. 11 of them were case reports and 3 were case series. Most of the studies show good results from the use of ECT in HD. There was improvement in several areas of the patient’s mental state, namely depressive symptoms, irritability, psychotic symptoms and psychomotor agitation.

Few case studies reported worsening of the clinical picture, namely aggravation of the catatonic symptoms or cognitive impairment.

The limited but promising evidence from case reports and case series suggests that ECT may be an effective therapeutic intervention for addressing psychiatric symptoms, including psychosis, in patients with Huntington’s disease. The majority of studies demonstrate positive outcomes. However, the findings are not universally positive, with a few reports noting potential worsening some symptoms. Given the complexity of managing psychiatric symptoms in HD, ECT presents itself as a valuable treatment option, particularly when pharmacological approaches prove ineffective or poorly tolerated. Nonetheless, the absence of larger, controlled studies on ECT for HD psychosis underscores the need for further research to validate its safety and efficacy.

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So far, the effects of intermittent theta-burst stimulation (iTBS) treatment—a form of repetitive transcranial magnetic stimulation (rTMS) technique—on the hypothalamic-pituitary-thyroid (HPT) axis activity are poorly understood. In depression, and especially in treatment resistant depressed patients (TRDs), this axis is often dysregulated. We have previously demonstrated that the difference between the 23:00 h and 08:00 h thyrotropin (TSH) response to protirelin (TRH) tests on the same day (∆∆TSH test) is a very sensitive chronobiological index since it is reduced in about three quarters of major depressed inpatients.

The present study aimed at assessing the effects of iTBS treatment applied to the left dorsolateral prefrontal cortex (LDPFC) in hospitalized TRDs (defined as having at least 2 treatment failures) with abnormal chronobiological HPT functioning at baseline (BL).

The ∆∆TSH test was performed in 18 TRDs and 18 matched healthy hospitalized control subjects (HCs). To be enrolled in this study, patients had to show at BL reduced ∆∆TSH values (i.e., < 2.5 mU/L) and a score of 18 or greater on the 17-item Hamilton Rating Scale for Depression (HAMD-17). All included TRDs were treated with antidepressants at the time of hospital admission. Drug dosages remained unchanged over the past month and kept stable throughout the course of iTBS. The ∆∆TSH test was repeated in all inpatients after 20 iTBS sessions (single daily session for 5 days of the week). Clinical response was defined as a reduction in HAMD-17 total score > 50% from BL and a final HAMD-17 score ≤ 8.

Compared to HCs, ∆∆TSH values were lower in TRDs at BL (p < 0.00001 by U test). After 20 iTBS sessions, HAM-D scores decreased (p = 0.001 by T-test) and ∆∆ TSH values increased (p = 0.01 by T-test) compared to BL, although endpoint ∆∆TSH values remained lower than those of HCs (p = 0.02 by T-test). However, there was a relationship between the reduction in HAM-D scores from BL to endpoint and the increase in ∆∆TSH values (rho = - 0.54; n = 18; p = 0.02). At endpoint, 10 patients (55%) showed ∆∆TSH normalization (among them 8 [80%] were responders), while 8 patients (45%) did not normalize their ∆∆TSH (all were non-remitters) (p = 0.001 by Fisher Exact test).

Although the underlying mechanisms remain to be elucidated, the results of our present pilot study in TRDs suggest that successful iTBS treatment can restore a normal chronobiological activity of the HPT axis and vice versa.

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Postictal delirium (PD) following Electroconvulsive Therapy (ECT) and Post-Anesthesia Delirium (PAD) are significant postoperative cognitive disturbances often encountered in the post-anesthesia care unit (PACU). While both manifest with cognitive impairments, their etiologies, clinical features, and management strategies differ. Recognizing these distinctions is essential to enhance patient care and outcomes, particularly in critical recovery settings where prompt recognition and intervention are paramount.

This study compares delirium’s onset, duration, and course following ECT-induced seizures and general anesthesia. It aims to elucidate the clinical features of PD and PAD and offer evidence-based recommendations for distinguishing and managing these conditions in the perioperative setting.

A comprehensive literature review was conducted, focusing on studies from 2000 to 2023 sourced from PubMed, MEDLINE, and Cochrane Library. Search terms included “postictal delirium,” “Electroconvulsive Therapy,” “post-anesthesia delirium,” and “perioperative cognitive disorders.” Key variables analyzed included onset, duration, cognitive and behavioral symptoms, associated risk factors, and treatment protocols for both conditions.

The analysis revealed key differences between PD and PAD. PD generally presents immediately after ECT and resolves within minutes to hours, whereas PAD has variable onset, occurring immediately after surgery or several days later, with symptoms lasting hours to days. Cognitive symptoms also differ. PD is characterized by brief confusion and both anterograde and retrograde amnesia, while PAD presents with prolonged confusion, disorientation, and short-term memory impairment. Behaviorally, PD often involves repetitive, patterned, involuntary movements (stereotypies), such as hand flapping and rocking, whereas PAD is characterized by non-patterned agitation, including both voluntary and involuntary movements. PD typically includes fatigue and altered consciousness, while PAD may present with hallucinations, delusions, and significant sleep disturbances. Risk factors for these syndromes also vary. PD is linked to the intensity of the ECT stimulus and pre-existing neurological conditions, while PAD is influenced by factors such as patient age, type of surgery, anesthesia duration, and baseline cognitive status.

PD and PAD share clinical overlap, particularly in cognitive symptoms, but they differ in onset, duration, behavioral patterns, and associated risk factors. PD following ECT is typically brief and marked by stereotyped movements, while PAD presents with prolonged confusion and non-patterned agitation. Accurate differentiation between these conditions is crucial for appropriate diagnosis and management in the PACU setting. Further research is needed to uncover the underlying mechanisms and enhance therapeutic strategies for these syndromes.

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Depressive disorder is a common mental disorder, with an estimated 3.8% of the population experiencing it. Despite the advent of new antidepressant medication, many patients presenting with Major Depressive Disorder (MDD) do not recover after multiple trials. Although the prevalence of treatment-resistant depression (TRD) is not clear due to the lack of a standard definition, its prevalence ranges from approximately 30 to 70 percent.

Considering the high prevalence of treatment-resistant depression, this work aims to evaluate the effectiveness of alternative treatments, namely Noninvasive Neuromodulation Therapies in the treatment of MDD.

Non-systematic literature review, using Pubmed as database, with the keywords “depression treatment”, “neuromodulation” and “noninvasive neuromodulation”.

We can divide non-invasive neuromodulation into convulsive therapies (CV) and therapies that do not involve inducing a seizure. Additionally, we can also divide them into clinically available therapies and others only available in investigational settings.

Regarding clinically available CV, we have Electroconvulsive Therapy (ECT), the oldest neurostimulation procedure. Being heavily studied, ECT is superior to pharmacotherapy for MDD based upon meta-analyses of randomized trials and is generally considered the most efficacious treatment for depression, albeit recurrence following remission is common.

Other CV, but still in investigational stages, are Magnetic seizure therapy (MST) and Focal electrically administered seizure therapy (FEAST) both showing positive results in prospective studies and MST in a small head-to-head randomized trials with ECT, that showed a similar efficacy between these two therapies.

Other clinically available, but not convulsive therapies, are Repetitive Transcranial Magnetic Stimulation (rTMS) and Cranial Electrical Stimulation (CES). Meta-analyses of randomized trials indicate that rTMS is beneficial for treating TRD, being also approved by the FDA. In its turn, multiple reviews indicate that no high-quality studies have demonstrated that CES is efficacious for MDD or TRD.

Additional non-convulsive therapies, available in investigational settings, include Transcranial Direct Current Stimulation, Transcranial Low Voltage Pulsed Electromagnetic Fields, Trigeminal Nerve Stimulation, Low Field Magnetic Stimulation and Transcutaneous Vagus Nerve Stimulation, with all of them showing positive effects in the treatment of MDD or TRD, except for Low field magnetic stimulation.

With this review, we were able to verify that clinically available non-invasive neurodomulation therapies, such as ECT and rTMS, present robust results in the treatment of MDD and TRD, however, resistance to these therapies also exists.

Considering the positive results of multiple novelty therapies, these could be the solution to this scourge.

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Aging well in a cross-cultural perspective may encompass pertinent challenges in terms of adjustment, sexual well-being and satisfaction with life in the late years.

Considering the paucity of empirical data concerning cultural diversity of experiencing aging, this study aims to help fill this gap by assessing the specific patterns of sexual satisfaction, adjustment to aging (AtA), and life satisfaction with life (SwL) of older adults in Portugal and Spain.

This cross-national study included 443 older adults, aged 65 and older, from Portugal and Spain. Five instruments were applied: (a) Adjustment to Aging Scale (ATAS); (b) Satisfaction with Life Scale (SwLS); (c) New Sexual Satisfaction Scale - Short (NSSS-S); (d) Mini-Mental State Exam; and (e) Sociodemographic, health and lifestyle questionnaire. K-means cluster analysis was employed to identify and characterize the clusters considering adjustment to aging, sexual satisfaction and life satisfaction. One-way ANOVAs were conducted to analyze differences for sexual-well-being among clusters.

Findings indicated three clusters, which explained 79.3% (R-sq = 0.793) of the total variance: Cluster #1: “Well Adapted” (n = 37, 8.8%), Cluster #2: “Struggling to Adapt” (n = 141, 31.8%), and Cluster #3: “Active Agers” (n = 265, 59.8%). Participants in Cluster #1 were mostly Portuguese, with high levels of AtA, sexual satisfaction, and SWL. Conversely, Cluster #2 integrated mostly Portuguese participants with moderate sexual satisfaction, and lower levels of AtA and SwL. Participants from Cluster #3 were mostly Spanish with moderate levels of AtA and reduced sexual satisfaction and SwL.

This study innovates by exploring the elaborate interplay among sexual satisfaction, AtA, and SwL in a cross-cultural perspective, with implications for tailoring interventions, service planning, development and evaluation of culturally-diverse older populations.

Adjustment to aging; cluster analysis; older adults; satisfaction with life; sexual satisfaction.

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Sexuality in the elderly has become an increasingly important topic in healthcare as the global population continues to age, raising new challenges and considerations related to the quality of life and well-being of older adults.

This work aims to explore the barriers faced by the elderly regarding sexuality and propose strategies for promoting healthy and fulfilling sexuality at this stage of life.

A narrative review was employed on the topic, aiming to broadly and exploratorily understand the main aspects related to sexuality in the elderly population.

Recent studies suggest that sexual activity can remain an important part of life for older individuals, positively influencing both mental and physical health. The main obstacles to healthy sexuality in old age can be broadly categorized into physiological, psychological, and sociocultural factors. Physiological changes include a natural decline in hormone levels, such as estrogen in women and testosterone in men, leading to reduced libido, vaginal dryness, and erectile dysfunction. Chronic illnesses like cardiovascular disease, diabetes, and arthritis, along with medications for these conditions, can further impact sexual function. Psychological factors, such as anxiety, depression, and reduced self-esteem due to aging-related body changes, also play a significant role in diminishing sexual desire and activity. Sociocultural factors include long-standing societal taboos around older adults and sexuality, which can lead to embarrassment, reluctance to discuss sexual health issues, and feelings of shame. Healthcare professionals can adopt several strategies to improve sexuality in aging such as open communication. Regular sexual health assessments should be integrated into routine care, including questions about sexual function, relationship satisfaction, and any challenges faced. Medical interventions, such as hormone replacement therapy or treatments for erectile dysfunction can address physiological barriers. Psychosocial support can improve communication, body image issues, and mental health factors like anxiety or depression that often accompany aging.

The approach to sexuality in the elderly should be multifaceted, integrating biopsychosocial perspectives, with an emphasis on promoting sexual education and providing appropriate treatments that address individual challenges. Healthcare professionals shouldadopt a welcoming and open attitude, encouraging dialogue on this topic to improve the quality of life of older adults.

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Alzheimer’s disease, necessitates continuous, long-term care primarily provided by family members. As the disease progresses, caregivers experience increasing stress and burden. Research indicates that caregivers of Alzheimer’s patients are at higher risk for depression, social isolation, and health problems. In order to help the caregivers, multi-component support programs, which integrate approaches such as education, psychoeducation, and social support, have shown more positive outcomes. However, systematic reviews and meta-analyses examining the impact of these programs remain limited.

This systematic review and meta-analysis aimed to evaluate the effectiveness of multi-component support programs on the caregiver burden of individuals caring for Alzheimer’s patients.

The research was conducted through searches in five databases (CENTRAL, CINAHL, PsycINFO, PubMed, WOS), focusing on randomized controlled trials that met the inclusion criteria. Two researchers independently evaluated the full texts, assessing risk of bias with the Cochrane ‘Risk of Bias-2’ tool and evidence quality using the GRADE tool. Participants included individuals aged 18 and older who were the primary caregivers for those diagnosed with Alzheimer’s disease and had provided care for at least three months. The intervention included at least two types of support, such as skill training, education, counseling, or therapy. The primary outcome was caregiver burden.

The review included 8 studies overall. Among the 1147 participants, only one study was web-based, while the other seven interventions were conducted face-to-face. The components of the interventions were mainly educational, supportive, and skill-building, with only one intervention including respite care. Overall risk of bias assessment recorded one study with high risk, four with unclear risk, and one with low risk. The effect sizes of the interventions were calculated based on the means and standard deviations of caregiver burden scores before and after the intervention, as well as follow-up measurements. The multi-component intervention programs were found to have an uncertain short-term effect (Cohen’s d = 0.12; 95% CI: -0.06 - 0.29; p = 0.39) but were effective in the long term (Cohen’s d = 0.21; 95% CI: 0.03 - 0.38; p = 0.02). The certainty of evidence for caregiver burden outcomes was determined to be low before the intervention and follow-up, and very low from pre-intervention to post-intervention measurements. The data is current as of 12/12/2023.

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Multi-component support programs are effective in reducing caregiver burden for Alzheimer’s caregivers in the long term; however, more high-quality studies are needed to confirm this effectiveness.

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Due to longer life expectancies, improvements in psychiatry, and reduced stigma about mental health in Tunisia, we are seeing more elderly people hospitalized for the first time in our department. Caring for this group presents both social and clinical challenges. While we are getting better at handling the clinical aspects, we often forget the social factors, which are crucial for the progress, follow-up, and mental well-being of older patients. These social issues can also lead to relapses or new mental health problems in this population.

Determine the evolution of elderly patients hospitalized for the first time in the psychiatric department.

This is a retrospective study. We examined the records of all patients aged over 65 who were admitted to the Avicenne Psychiatric Department at Razi Hospital from September 2022 to September 2024.

A total of 22 patients were identified, including 16 men and 6 women. The average age of these patients was 68 years, with ages ranging from 64 to 80 years. The majority came from an urban background (81%). The educational level of our patients was primary at 19%, an university level at 34% and a secondary school education at 47%. Among our patients, 13% are still professionally active and 57% retired. The socioeconomic level of our patients was affluent in 42%, average in 34%, and low in 24%. Within our patient population, 61% were married, 24% divorced, 10% were single and 4% widow or widower. 23% of our patients were living alone and 77% were living with one or more family members. Concerning the diagnosis, we observed mental confusion caused by an organic pathology in 9%, a purely neurological cause of the disorder in 14% ( dementia in 10% and Parkinson’s disease in 4%), a depressive episode in 31%, a manic episode within the context of bipolar disorder in 37%, and schizophrenia in 9%. During hospitalization, 27% of the patients experienced family rejection from their relatives. After leaving the hospital, a significant number of patients were lost to follow-up (63%), 22% had regular follow-up and 13% attended appointments irregularly.

This study shows that more elderly patients are being hospitalized for the first time in psychiatry. Many face social challenges, such as family rejection and losing contact after leaving the hospital.The creation of retirement homes and social support systems may be a solution to provide safe living and support for these patients, helping them stay healthy and connected after hospitalization.

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Neurodegenerative disease prevalence is high in the elderly, as aged brains accumulate molecular and cellular damage. Protein misfolding and aggregation are pathological processes underlying neurodegeneration, as seen in dementia. This coupled with oxidative stress, disrupted ubiquitin-proteosome system and neuroinflammation may contribute to neuronal damage. Lewy body dementia (LBD) collectively refers to Parkinson’s disease (PD), Parkinson-disease dementia and dementia with Lewy bodies (DLB) (Delenclos, Moussaud, & McLean, 2017). It is characterised by Lewy body (LB) deposits in the CNS, predominantly compromised of misfolded α-synuclein protein. Disease-modifying therapy (DMT) targets underlying protein misfolding and promotes LB clearance.

• - To review international trial data on DMT safety, tolerability and efficacy in DLB.

• - To consider molecular basis for protein misfolding and DMT in DLB.

Two international registries (ClinicalTrials.gov; EU clinical trials register) were consulted to identify agents being tested in completed, ongoing and recruiting trials. Both databases were searched by disease “Lewy body dementia” or “LBD” or “alpha-synuclein pathology” and study type “interventional” for phase I-III trials. Trials solely investigating diagnostic biomarkers, approved symptomatic DLB treatment or PD without dementia symptoms were excluded from final analysis.

11 trials were found studying DMTs for DLB. 10 out of the 11 trials were in phase II and one in phase I. The main agents investigated were tyrosine-kinase inhibitors (TKIs), phosphodiesterase-9 inhibitors, β-adrenergic agonists, and β-GCase chaperones. Primary and secondary outcome measures were “safety/tolerability of agent”, “changes in cognitive function” or “changes in serum/CSF α-synuclein”. Results from a phase I trial demonstrated a 3.85 and 3.5-point increase in mini-mental state examination scores at 6 months with nilotinib doses 300mg and 150mg, respectively (Pagan et al., 2016). Slight reduction was observed in CSF/plasma α-synuclein levels. Phase II trials for bosutinib versus placebo showed no significant difference in cognitive function (Pagan et al., 2022). Ambroxol trials, a β-GCase enzyme enhancing inhibitory chaperone, remain in recruiting stages but have proven drug tolerability. Data on CSF biomarker changes in DLB was unavailable.

Current understanding of protein misfolding in α-synucleinopathies suggests that a single DMT may be insufficient in mixed pathology. Cocktail therapy targeting various misfolded proteins may be necessary for a cure. DMTs have limited use as most patients are diagnosed with advanced DLB. Sensitive diagnostic biomarkers with high specificity are required for accurate DLB diagnosis in the prodromal phase, a critical window for protein misfolding reversal with DMT. TKI cardiotoxicity may also limit clinical use of this DMT, especially in the elderly.

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Young general practitioners allocated in the rural area sustain the community healthcare frontline and endure the limited medical resources and social supports. Physician mental health could affect the quality of healthcare.

We examined the association of work-related experience with mental health in young public health physicians in the rural area.

Study promotional document was posted on the Korean Association of Public Health Doctors (PHD) website (http://kaphd.org) on July 2023. Three-hundred PHD (among the total 1,256 PHD) completed a web-based self-reported questionnaire on demographics, working experiences, and mental health on a first-come, first-served basis. Adjusted odds ratios(aOR) of depression, anxiety, lower self-esteem, and distress for working experiences in PHD were calculated in the multivariable logistic regression model with the best fit combinations of significant explanatory variables (P<0.05) in univariate logistic regression.

Distress, depression, anxiety, and lower self-esteem were reported by 39.7%, 25.3%, 11.3%, and 8.7% of the PHDs, respectively. Higher odds of worse mental health in PHD were associated with patient-physician conflicts at workplace, isolated residence from local facilities, and higher workload. Conversely, perceived expertise utilization and social connections with peers were related to the lower odds of worse mental health in PHD.

This study highlights the needs of governmental policy targeting the young general practitioners in rural area to enhance the expertise utilization and social connectedness, and to reduce the patient-physician conflict.

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People with psychotic-like experiences (PLE) have slow movements and uncontrolled movements, which are indicative of transition to psychotic disorders afterwards. Earlier research has reported that rhythmic auditory stimulation (RAS) is a promising therapeutic technique for movement abnormalities in people in the psychosis continuum. However, the small sample size was a major limitation in earlier research and restricted result generalizability.

This study was to increase the sample size and examine if faster RAS induced faster movements and less uncontrolled movements at both hands in people with PLE.

A total of 55 right-handed people with PLE (age: 20.51±2.50 years; 28 females) and 55 age- and gender-matched right-handed healthy controls (age: 20.53±3.10 years; 24 females) were recruited. Participants used the index finger to perform the alternate touching task for each hand when the motion capture system recorded the movement procedure. They were required to follow each beat of RAS with the normal tempo (100% of the fastest movement tempo without RAS) and the fast tempo (110% of the fastest movement tempo), the order of which was counterbalanced, when performing the alternate touching task. Kinematic variables were calculated to reflect severity of slow movements and uncontrolled movements in participants.

Two-way analysis of variance showed no interaction between groups and RAS in right-hand and left-hand kinematic values. People with PLE had slow movements at both hands and uncontrolled movements at the right hand. Faster RAS induced faster movements and less uncontrolled movements at both hands in people with PLE.

The major contribution of this study was to use a relatively large sample size to demonstrate effectiveness of faster RAS on inducing faster movements and less uncontrolled movements at both hands in people with PLE and thus increase result generalizability. Given that movement abnormalities are initial signs in the psychosis continuum and risk factors of transition to psychotic disorders, when healthcare practitioners design early intervention for movement problems in people with PLE, incorporating RAS in therapy is suggested.

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Mental health disorders, including anxiety and major depressive disorder, are highly prevalent among college students, often leading to significant impairments in academic functioning and psychosocial well-being. Loneliness, characterized as subjective distress arising from a perceived deficit in social connectivity, is frequently associated with the exacerbation of psychiatric symptoms. In contrast, psychological resilience, defined as the capacity to adaptively manage stress and adversity, is increasingly recognized as a key protective factor against the development of psychopathology.

Despite understanding the roles of loneliness and resilience, their combined effects on mental health, specifically anxiety and depression, have not been fully explored in a large-scale, diverse population of college students in the United States. This study seeks to address this gap.

Using data from the 2023-2024 Healthy Mind Study (N=104,729), we employed logistic regression to assess the predictors of anxiety and depression, focusing on two key predictors: loneliness and resilience. Our models also controlled for other relevant factors, such as campus climate, financial stress, and sociodemographic control variables, including sex, race/ethnicity, and traditional student status. Analysis was conducted with a sample delimited to undergraduate students (n=22,927).

Feeling lonely was positively related to moderate-to-severe depression (β = 2, p < 0.001) and moderate-to-severe anxiety (β = 1.45, p < 0.001). Resilience was a protective factor and was negatively associated with self-reported moderate-to-severe depression (β = -1.54, p < 0.001) and moderate-to-severe anxiety (β = -1.54, p < 0.001). The effect of loneliness and resilience on depression and anxiety remains consistent with the baseline models after controlling for campus climate, financial stress, and sociodemographic variables. High levels of financial stress and perceived poor campus climate were positively related to moderate-to-severe depression and anxiety. Finally, female, non-White, and non-traditional-aged students were less likely to exhibit moderate-to-severe depression and anxiety.

The findings highlight the importance of loneliness and resilience in shaping mental health outcomes among undergraduate college students. Loneliness was negatively associated with the evaluated mental health burdens, while resilience emerged as a protective factor against these outcomes. Our findings underscore the importance of considering loneliness, resilience, financial stress, and campus climate as variables of interest when designing mental health interventions to improve academic performance and overall well-being among undergraduate college students.

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Postpartum mental health challenges are common, with some women experiencing anxiety, depressive symptoms, or difficulties related to childcare and familial support. To address these issues, the University Psychiatric Hospital Vrapče in Zagreb, Croatia, launched the “Postnatal” outpatient program in 2023, offering structured support for women in the postpartum period.

The objective of the program is to provide psychological support for women with children aged 0–2 years through a combination of online and in-person group therapy, to address postpartum mental health issues and provide a supportive environment.

The program is promoted through the clinic’s website, social media, maternity hospitals, pediatric centers, and visiting nurse services. Women join the program through self-referral or on the recommendation of healthcare professionals. A team of three psychiatrists conduct an initial assessment, and approximately 80% of those evaluated are admitted into the program. The program comprises two 90-minute weekly sessions: an online educational workshop and an in-person group therapy session. Each cycle lasts for 8 weeks, followed by monthly 90-minute in-person group meetings.

A total of 45 participants have completed the program so far. About 30% of participants met the clinical criteria for anxiety or depressive disorders, while there were two cases of postpartum psychosis. The majority reported non-specific concerns, such as tension, insomnia, fatigue, and emotional instability. Around 30% indicated a lack of support from their partners, and 10% had pre-existing psychological diagnoses (including OCD, borderline personality disorder, and anxiety-depressive disorder). Most participants were first-time mothers, with around 10% being second or third-time mothers. In the program, participants share experiences related to conception, pregnancy, maternity hospital stays, postpartum mental health changes, and the challenges of maternal care. Participation rates have been consistently high, with only one dropout. Post-program evaluations show a high level of satisfaction, with participants highlighting the group meetings and peer support as the most valuable aspects.

The “Postnatal” program has demonstrated positive outcomes in providing support to postpartum women. The combination of educational workshops and group therapy has been effective in addressing both clinical and non-specific postpartum challenges. Further cycles and long-term follow-ups are recommended to evaluate the program’s sustained impact.

None Declared

The constant contact with death and dying processes increases the risk of mental suffering in nurses. The evidence suggests the need for training programs in the area of promoting emotional competence that allow the management of emotions and consequently the improvement of care for people at the end of life.

Capacitate a group of nurses to promote emotional competence towards end-of-life patients, through a specialized intervention in Mental Health and Psychiatric Nursing; and evaluate attitudes and coping with death and levels of emotional competence [and respective capabilities], pre and post-intervention.

A continuous quality of care improvement project was carried out based on the Deming cycle, with pre and post intervention evaluation. The following instruments were applied: Veiga-Branco Emotional Competence Scale - Reduced (EVCE-reduced); Scale for Assessment of the Profile of Attitudes about Death; and, Coping with Death Scale. The training program consisted of seven in-person sessions, in groups, with approximation to the principles of psychoeducational intervention and based on the cognitive- behavioural sequence.

Eleven nurses participate in program. Most of respondents were female (90%) aged between 26 and 50 years (M=36±7.98). Regarding the coping with death scale, it was possible to observe in the factor “coping with one’s own death”, after application of the program, an overall average of 73.38 (SD=4.21), verifying statistically significant differences between the pre- and post-intervention (Z=1.963, p< 0.05). It was also possible to observe an increase in the global score of EVCE-reduced (M=170.01; SD=20.88), accompanied by a slight increase in capabilities: self-awareness (M=45.88; SD=4.64) and empathy (M=28.13; SD=3.44). Regarding the scale referring to the profile of attitudes towards death, there was an increase in the attitude of acceptance by approach (M=44.00; SD=12.22). On the contrary, there was a decrease in the fear attitude (M=24.63; SD=9.61), in the avoidance attitude (M=11.25; SD=4.49) and the attitude of acceptance as an escape (M=14.25; SD=4.50), compared to pre-intervention values.

Our findings indicate that there is an integration of death as a natural event and an integral part of life. On the other hand, adequate management of fear of death and a non-avoidance attitude contribute to more compassionate care, and therefore more centered on the person at the end of life. Besides, this study allow us to confirm the importance of training programs in socio-emotional regulation, as they focus on the mobilization of intra and interpersonal resources, as well as the expressiveness of emotions in the face of one’s own death and the death of others, enabling the development of deeper levels of introspection.

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Mental illness stigma continues to be a significant challenge in healthcare. Trainees in different medical fields may have varying levels of exposure and understanding, which can shape their attitudes towards patients with mental health conditions.

To examine differences in stigmatizing attitudes towards people with mental illness between Family Medicine trainees and psychiatry trainees.

A comparative study was conducted. Psychiatry trainees affiliated with the faculties of medicine in Tunisia (n=120) and Family Medicine trainees affiliated with the faculty of medicine of Sousse (n=206) were invited to respond to a survey comprising the Attribution Questionnaire (AQ-27), a measure that evaluates nine stigma factors, blame, pity, anger, help, dangerousness, fear, segregation, avoidance, and coercion. Higher scores indicated more endorsed stigma. Self-report measures of affirming attitudes were also used, including the Self-Determination Scale (SDS), the Empowerment Scale (ES), and the Recovery Scale (RS). Higher scores represent enhanced views of these concepts.

In total, 94 psychiatry trainees and 66 Family Medicine trainees responded to the survey, with respective response rates of 78% and 32%. The two groups were comparable in terms of age, gender, family and personal psychiatric histories.

Family Medicine trainees reported significantly higher AQ-27 total scores (p=.042). Additionally, they reported significantly higher scores for blame (p=.025), dangerousness (p=.006), fear (p=.048), and segregation (p=.005) stigma factors.

No significant differences between the two samples were found in avoidance (p=.525), coercion (p=.379), pity (p=.741) and help (p=.092).

Concerning affirming attitudes, there were no significant differences between the two groups in SDS (p=.148), RS (p=.552), and ES (p=.727) scores.

Results revealed that psychiatry trainees endorse less stigmatizing attitudes towards patients with mental illness, particularly regarding the dangerousness of these patients. Nevertheless, they still endorse negative attitudes regarding the concept of recovery and affirming attitudes towards patients with mental illness. Anti-stigma interventions should promote not only increased contact but also other strategies that will promote believing in recovery and social inclusion.

None Declared

People with unbearable psychiatric suffering and a chronic death wish are a subgroup of patients with Severe and Persistent Mental Illness (SPMI; Moureau et al., FiP 2023; 14:1094038). They suffer from at least one, but usually multiple psychiatric disorders, in a chronic course, resulting in severe limitations in psychosocial functioning (Woods et al., CJP 2008; 53 725-736.). Their chronic death wish is rooted in their struggle with life and death and diminished perspective on the alleviation of their suffering. They are at risk for suicide and/or are eligible to request euthanasia as legislated in Belgium. Reakiro is a Belgian pilot project and a drop-in, care and expertise centre developing tailored mental healthcare for this target population in addition to continued care as usual.

To describe psychological and existential characteristics, care needs, experienced changes and the correlations between these variables in 107 consecutive Reakiro patients who agreed to participate in this study.

The Beck Scale for Suicide Ideation (BSSI), Dutch Empowerment Scale (DES), Herth Hope Index (HHI), Meaning In Life Measure (MILM), Existential Concerns Questionnaire (ECQ), Outcome Questionnaire-45 (OQ-45) and the Change Questionnaire (CQ) were administered combined with an assessment of their life and death wish and of how they experience the care in Reakiro.

The BSSI (M = 21.78, SD = 8.48), DES (M = 113.39, SD = 20.42), HHI (M = 24.15, SD = 5.40), MILM (M = 5.39, SD = 1.50), ECQ (M = 62.13, SD = 12.10) and OQ-45 (M = 98.93, SD = 20.50) show heightened levels of suicidality, existential anxiety and symptomatology and lowered levels of hope, meaning in life and empowerment, compared to other psychiatric and non-clinical samples. Longer trajectories in Reakiro were correlated with heightened hope and lowered symptomatology, but not with suicidality. The preliminary CQ-analysis revealed 31 participants reporting positive changes in their relation to life and death, to self and others and to hope and future; 8 participants reported negative changes in their relation to life and death.

The results depict a concrete profile of the severity of the suffering and suicidality in these patients. The mixed-methods design reveals a major group that does not report any change and suffers greatly, but also a minor group that reports positive changes and even lowered suicidality. Clinical implications for psychiatric healthcare professionals will be discussed.

None Declared