Given the high rates of disengagement of psychological and/or psychopharmacological treatment in individuals with severe mental illness (SMI), building a strong therapeutic alliance (TA) in treatment is crucial. Despite the awareness of a favorable role of the TA in mental health care for people with SMI, there is a paucity of research that contributes to the formulation of concrete guidelines for establishing a strong TA.

This review aims to systematically synthesize existing literature of associated factors of the TA across six domains: client, mental health professionals (MHPs), clinical, social, care, and other. These include the views of clients with SMI, MHP, and independent raters of the TA.

Parallel literature searches in PsycInfo, Medline, and PubMed between 2000-2022 identified 2699 possible articles, of which n=53 met inclusion criteria.

Associated factors of better client-rated TA were: high insight, secure attachment, higher outcome expectancy at baseline, specific personality traits, less internalized stigma, more therapists’ empathy and frequent use of supportive techniques by MHP. MHP-rated and/or independent observer-rated TA was significantly related to: more insight, sex of client (female), MHP without anxious attachment, and less severe symptomatology of client.

Clinical symptom severity only affected TA when rated by MHP, but not when rated by clients. Attachment style affects the TA bidirectionally: clients’ secure attachment to the MHPs may help modify maladaptive attachment patterns, and anxious/insecure attachment style from either client or MHP affects the TA negatively. Furthermore, having an early positive click with the client builds the foundation for a later stable and supportive relationship, making the client more likely to continue perceiving the alliance as positively as treatment progresses. It is therefore crucial to provide a warm and supporting environment from the start of treatment, where clients have the opportunity to overcome perceived (self-)stigma and develop a positive mindset towards outcome expectations. Focusing on supportive techniques like providing feedback or shared agenda setting instead on the clients clinical symptomatology solely might result in a more favorable perception of the TA. Notably, current TA measurements assume a one-on-one relationship between clients and MHP, while nowadays multiple MHPs are involved. We recommend re-evaluating the assessment of TA within SMI care.

None Declared

With 1 in every 8 people living with a mental disorder according to the World Health Organization, the need for appropriate identification and treatment of mental health conditions is paramount. As the majority of people with mental health problems seek help and receive their mental health care from primary care providers (PCPs), PCPs assume an important role in the identification of mental illness.

This study examined mental health literacy and predictors of disorder recognition among primary care providers (PCPs) in Hungary.

Hungarian PCPs (n = 208) completed a survey assessing demographics, mental health stigma, and exposure to mental health. Participants read six vignettes describing obsessive-compulsive disorder (OCD) harm/aggression subtype (OCD-Aggression), OCD order/symmetry subtype (OCD-Order), generalized anxiety disorder (GAD), social anxiety disorder (SAD), panic disorder (PD), and major depressive disorder (MDD) and were asked to identify each condition and provide treatment referrals. Descriptive analyses were used to characterize disorder recognition rates, perceived disorder causes, and treatment referrals. Binary logistic regression analyses were conducted to examine the degree to which demographic characteristics, mental health stigma, and exposure to mental health predict accurate disorder recognition.

Identification rates for each vignette were: OCD-Aggression (27.9%), OCD-Order (75.5%), SAD (34.1%), GAD (76.0%), PD (78.8%), and MDD (91.3%). First-choice treatment referrals were a psychiatrist for OCD-Aggression (63%), OCD-Order (53.8%), and MDD (46.6%), a psychologist/therapist for SAD (58.7%) and GAD (48.6%), and a PCP for PD (39.9%). Anxiolytics (e.g., benzodiazepines) were the most commonly recommended medication for the anxiety disorders. Mislabeling conditions was significantly associated with older age (for GAD, OCD-Aggression, PD and MDD), male gender (for GAD), greater mental health stigma (for OCD-Order), and not having a family member/friend with a mental health condition (for SAD).

Findings highlight strengths (e.g., depression recognition) and limitations (e.g., OCD-Aggression) in knowledge of mental health conditions among PCPs in Hungary. Our findings add to the literature by outlying potential intervention targets (e.g., increasing education on appropriate anxiolytic use) to improve mental health literacy in primary care. Future research should investigate the efficacy of psychoeducation interventions, particularly for OCD and anxiety disorders, in improving the mental health literacy of PCPs in Hungary.

V. Swisher Grant / Research support from: This work was supported in part by U.S. Student Fulbright Association., D. Ori: None Declared, R. Wernigg: None Declared

Multiple sclerosis (MS) is a chronic and progressive inflammatory autoimmune disease of the central nervous system. Beyond physical symptoms, it can cause various socio‐affective symptoms such as depression, anxiety, sleep disorders and loneliness, leading to a significant psychosocial burden.

This study aimed to identify factors contributing to loneliness in MS patients and to examine its associations with psychological distress, stigma, and resilience.

We conducted a nationwide cross-sectional study of patients with MS from October 2022 to January 2023. Data were collected using an online questionnaire, which included socio-demographic information, disease characteristics, experiences of social stigma, psychological distress, coping strategies, and perceived social support. Validated tools used were the Stigma Scale of Chronic Illness (SSCI-8), Kessler Psychological Distress Scale (K10), Brief Resilient Coping Scale (BRCS), and UCLA Loneliness Scale.

A total of 108 patients, 69.4% women, mean age 44.8 years, participated in the study. Higher loneliness scores were associated with greater psychological distress (p<0.001) and higher perceived stigma (p<0.001). Inversely, higher loneliness levels correlated with lower resilience (p<0.001). Patients living in small urban or rural areas reported higher levels of loneliness compared to those in large urban centers (p=0.002). Additionally, full-time employment (p=0.032) and better financial status (p = 0.025) were associated with reduced loneliness, while a family history of psychiatric illness was linked to higher loneliness (p=0.043).

This study reveals that loneliness is an important issue in MS patients and is associated with mental health problems, stigma and reduced coping resilience. Patients living in smaller urban areas, with poorer financial status, or a family history of psychiatric illness are particularly vulnerable. Addressing loneliness should be a priority in psychosocial interventions to improve quality of life. Future research with larger samples is recommended to confirm and extend these findings.

None Declared

The phenomenon of minority stress frequently emerges as a contributing factor to mental health discrepancies among sexual and gender minority people, manifesting in elevated rates of mental distress, anxiety, depression, suicidality and substance misuse (Plöderl et al. Int. Rev. Psychiatry 2015; 27 367-385, Russell et al. Annu Rev Clin Psychol. 2016; 12 465–487). Building on insights from previous research, the Mental Health Protection Programme BOJE (Colours) was launched to offer comprehensive support tailored to the needs of LGBTQIA+ individuals within the Croatian public mental healthcare system.

The presentation of the BOJE - Mental Health Protection Programme that aims to address minority stress to offer specialized support tailored to the unique needs of LGBTIQ+ individuals, fostering resilience and well-being.

In October 2023, a multidisciplinary team at the University Psychiatric Hospital Sveti Ivan in Zagreb, Croatia, formed a Mental Health Protection Programme BOJE which consists of a counseling center, an outpatient clinic and a three-month therapeutic and educational cycle for LGBTQIA+ users. Additionally, a platform was provided for training healthcare professionals in LGBTQIA+ affirmative practice. The goal is to offer support, create an inclusive, safe environment and raise awareness of LGBTQIA+ mental health needs.

To date, 50 participants have been supported, with 50% identifying as TGD. We had approximately 574 procedures (counsellings, psychiatrist consultations and reviews and psychotherapies) and two cycles of closed-group workshops have been completed with a low dropout rate, and most participants rated the program as useful or very useful for their mental well-being.

Despite the recognition of the mental health disparities between sexual and gender minority people and the general population there is still limited availability of gender-affirming mental and physical health services. The investigation of how affirming healthcare access influences resilience building among transgender and gender non-binary individuals highlighted the urgent need for additional interventions in public healthcare systems. Following this, a mental health program for LGBTQIA+ individuals was launched within the Croatian healthcare system to buffer the negative health effects of minority stress and improve mental health among sexual minorities and gender-diverse populations.

None Declared

Accidents, whether minor or severe, can have significant psychological impacts, especially in elderly populations. Stress related to accidents often exacerbates pre-existing conditions or leads to new mental health challenges such as anxiety, depression, or post-traumatic stress disorder (PTSD). The psychological impact of accidents on elderly individuals is often compounded by physical frailty, social isolation, and diminished coping mechanisms. Following an accident, elderly individuals may face prolonged recovery periods, limited mobility, and a reduced sense of independence, all of which can heighten stress levels. Additionally, the fear of future accidents may lead to avoidance behaviors, further isolating them from social interactions and routine activities, thus exacerbating anxiety and depression. Pre-existing mental health conditions, such as mild cognitive impairment or chronic illness, can worsen under accident-related stress.

This study aims to explore recent trends in understanding and addressing accident-related stress in elderly individuals, focusing on the psychological, social, and physiological factors contributing to their vulnerability. The primary objective of this study is to examine the psychological, social, and physiological factors that increase the vulnerability of elderly individuals to accident-related stress.

A mixed-methods approach was used, combining a systematic review of literature from 2015 to 2024 and interviews with mental health professionals. The sample consisted of 30 peer-reviewed studies and 25 elderly individuals aged 65 and above who had experienced accidents within the last year. Studies were selected based on relevance to accident-related stress in the elderly, with an emphasis on post-accident psychological outcomes and interventions.

Results indicated that the elderly are more susceptible to prolonged stress responses following accidents due to physical fragility, social isolation, and reduced coping mechanisms. The review also highlighted an underutilization of mental health services in this demographic, despite the availability of stress-reduction programs. Furthermore, findings showed that older adults who participated in targeted mental health interventions, such as cognitive-behavioral therapy and peer support groups, experienced better outcomes in managing stress compared to those who did not.

In conclusion, accident-related stress in the elderly presents unique challenges that require specialized attention. Healthcare providers should prioritize early identification and tailored interventions to mitigate the long-term psychological effects of accidents in this vulnerable population.

None Declared

Depressive disorder is one of the health problems that carries the greatest burden of morbidity, with high prevalence and impact on people’s quality of life. It also affects the family environment and contributes to the social and economic burden on health systems (World Health Organization, depression, 2023). Currently, the treatment of depression has limitations and there is a high frequency of patients who do not respond despite multiple trials of antidepressants. Up to two-thirds of patients diagnosed with depression do not achieve remission despite treatment, and 30% of patients are considered treatment-resistant, defined as a minimum of two failures to previous treatments, in adequate doses and duration (Gaynes et al., 2019). Recent innovations in the management provide promising opportunities to improve the symptomatology of these patients. New drugs such as ketamine and esketamine, which have glutamatergic neuromodulatory properties, are used under supervision for the treatment of patients with treatment-resistant depression (Vasiliu, 2023).

The aim is to describe a sample of real-world patients with a diagnosis of resistant depression referred to esketamine/ketamine treatment. The individuals were being followed by psychiatrists of a public hospital in the city of Barcelona and were selected to start treatment indicated by the refractoriness and severity of the episode.

We used a database that collected multiple sociodemographic, clinical and treatment variables of 32 patients with refractory depression who were referred to treatment with esketamine/ketamine. SPSS software was used for data processing. All the patients in the group were followed up by psychiatry in a public hospital in the city of Barcelona during the period from July 2015 to September 2024.

Of the 32 patients evaluated, 11 were male (34.4%) and 21 were female (65.6%). The mean age at the time of receiving ketamine/ketamine treatment was 53 years with a standard deviation of 10.7. Nearly 60% had a comorbid psychiatric diagnosis. Twenty-eight percent had undergone electroconvulsive therapy. The mean number of previous episodes was 3.72 with a median of 2.5. Regarding the response to treatment we found that it was partial in 15 patients (46.9%) and complete remission could be obtained in 7 patients (21.9%), with no response to treatment in 10 of them (31.2%). In 5 patients the response was considered a late response.

In most of the patients a partial improvement was assessed as evidenced by a reduction in the Montgomery-Asberg Depression Rating Scale (MADRS). Few cases obtained a complete remission with treatment.

As limitations to the results, we can refer to the small sample size. However, we consider that the severity and chronicity of the episodes make the description of the response in a real world group seem of interest for future studies.

None Declared

Esketamine has been linked to dissociation, which was claimed to predict or not to predict antidepressant response. Speculations regarding predictivity were based on results obtained with the CADSS, a scale investigating dissociative symptoms, with higher scores indicating more symptoms.

To investigate the effect of intranasal esketamine on dissociation and its subsequent influence on clinical response, we administered the CADSS 40 minutes after inhalation at the first esketamine administration and 40 minutes after the ninth inhalation and measured clinical response through the Clinical Global Impressions-Severity (CGI-S), the Young Mania Rating Scale (YMRS), the Montgomery-Åsberg Depression Rating Scale (MADRS), and the 24-item Brief Psychiatric Rating Scale (BPRS).

We included 61 adults (33 women and 28 men; age, mean, 52.69±11.80, range 20-73 years) with Thase & Rush (J Clin Psychiatry 1997;58 [Suppl 13]:23-29) treatment-resistant depression. All patients received intranasal esketamine spray and were assessed at the first and ninth administrations (one month after the first administration, i.e., the end of the induction period and the beginning of maintenance), at the day of the spray after 40 min with the CADSS and 1 month later with the CGI-S, the BPRS, the MADRS, and the YMRS.

CADSS scores dropped from 6.59±7.42 40 min after the first administration to 3.12±4.41 40 minutes 1 month later (dropped by 3.48 points, 47.27% of baseline); t=3.15; p=0.0021. CGI-S scores dropped from 5.12±0.61 at baseline to 3.95±0.76 1 month later (t=9.32; p<0.00001). BPRS scores dropped from 51.85±11.55 at baseline to 41.21±10.64 after 1 month (t=5.29; p<0.00001). MADRS scores dropped from 34.29±7.89 at baseline to 22.61±9.07 after 1 month (t=7.59; p<0.00001). Responders (≥50% drop of MADRS from baseline) were 12 patients (19.67%), while remitters (MADRS score≤10) were 2 (3.28%). YMRS scores moved from 2.18±2.59 at baseline to 1.72±2.37 1 month later (t=1.02; p=0.309, n.s.), always in the normal range. Blood pressure 40 minutes after spray at the first administration was unchanged in 35 patients, increased in 16 (maximum by 20 mmHg), and decreased in 10 (maximum drop 20 mmHg). Contrary to previous claims, CADSS scores did not correlate at any time with scores on clinical scales or therapeutic response (Pearson’s r from 0.232 with p=0.072 to 0.013 with p=0.918). As for side effects, 15 patients reported dissociation, 15 sedation, 8 vertigo, 8 dizziness, 6 confusion, 5 headache, 4 nausea/vomiting, and 0 hypertension.

Patients in our sample scored very low on the CADSS. At the end of the induction period, esketamine was associated with significant decreases in the severity of psychopathology.

None Declared

Affective temperament is associated with various clinical characteristics in patients with mood disorders. However, little is known about clinical characteristics based on affective temperament specifically in patients diagnosed with major depressive disorder (MDD).

This study aims to explore the impact of affective temperament on both the traits and states of individuals diagnosed with MDD.

This study consecutively recruited 247 outpatients, aged 18 to 49, presenting for their initial visit to a mood disorder clinic. Affective temperament was assessed using the Temperament Evaluation of the Memphis, Pisa, Paris and San Diego-Autoquestionnaire. A Z-score of 1 or higher on each affective temperament was defined as a dominant affective temperament. The patients completed various assessments, including the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Seasonal Pattern Assessment Questionnaire, Alcohol Use Disorders Identification Test, Hypomania Checklist-32, Interpersonal Sensitivity Measure, and Depressive Symptom Index - Suicidality Subscale. Multiple linear regression analysis was conducted to identify the impact of affective temperament on both psychiatric states and trait characteristics.

This study comprised 247 patients with a mean age of 29.34 ± 9.16, of whom 152 (61.5%) were female. Depressive (β = 0.247, p < 0.001) and irritable temperament (β = 0.138, p = 0.032) were positively associated with the severity of depressive symptoms, while hyperthymic temperament (β = -0.123, p = 0.041) showed a negative association. Furthermore, depressive (β = 0.246, p < 0.001), irritable (β = 0.195, p = 0.002) and cyclothymic temperament (β = 0.148, p = 0.018) were positively associated with the severity of anxiety symptoms. Cyclothymic (β = 0.211, p = 0.001) and anxious temperament (β = 0.136, p = 0.027) were positively correlated with seasonality. Hyperthymic temperament showed a positive correlation with harmful drinking patterns (β = 0.179, p = 0.006). Also, hyperthymic (β = 0.200, p = 0.002) and cyclothymic temperament (β = 0.140, p = 0.036) were positively correlated with hypomanic features. Cyclothymic (β = 0.255, p < 0.001) and anxious temperament (β = 0.173, p = 0.004) were positively correlated with hypersensitivity to interpersonal rejection. Depressive temperament (β = 0.184, p = 0.004) was positively associated with the severity of suicidality.

Among patients with MDD, variations in psychiatric states and traits were observed based on the dominant affective temperaments. This suggests a correlation between affective temperaments and diverse psychopathological manifestations. Consequently, there appears to be a need for further research to elucidate the therapeutic implications associated with affective temperaments.

None Declared

Chronic toxoplasmosis has been reported to cause neuroinflammation in humans, linking it to neuropsychiatric disorders, including depression.

To assess the prevalence of Toxoplasma gondii IgG antibodies in patients diagnosed with depression from Western Romania and compare the findings with a control group of healthy volunteers from the general population without any psychiatric disorders.

We included 230 participants, consisting of 115 psychiatric patients diagnosed with depression at the Psychiatric Clinic, County Emergency Hospital of Arad, Western Romania. These patients were matched by age and gender with a healthy control group of 115 volunteers. Clinical evaluations, a brief questionnaire to assess the risk factors, and laboratory tests were conducted, including serological testing for the presence of Toxoplasma gondii IgG antibodies.

In both the study group and the control group the mean age was 52.96 ± 10.29 years and 72/115 (62.61 %) were female. A significantly higher seroprevalence of Toxoplasma gondii IgG antibodies was demonstrated in patients with depression when compared to healthy volunteers (p value <0.001). We noted a higher prevalence of Toxoplasma gondii IgG antibodies in depressive patients aged between 50-59 years (p value = 0.008) and 60-69 years (p value = 0.03) when compared to their counterparts from the control group. Females diagnosed with depression presented a significantly higher seroprevalence of Toxoplasma gondii IgG antibodies (p value <0.001) when compared to healthy female volunteers. No difference between the two groups was noted when we assessed the participants educational level, contact with the soil, consumption of undercooked meat and contact with cat feces.

The presence of Toxoplasma gondii IgG antibodies was significantly higher in depressive patients attending the Psychiatric Clinic in Arad County, Western Romania, when compared to healthy controls. Our findings suggest a potential link between chronic Toxoplasma gondii infection and depression.

None Declared

Intravenous (IV) ketamine has garnered increasing attention as a rapid-acting treatment for severe psychiatric conditions such as major depressive disorder (MDD) and suicidal ideation, particularly in treatment-resistant cases. Unlike traditional antidepressants, which often take weeks to exhibit therapeutic effects, IV ketamine can provide relief within hours. While the nasal spray form of ketamine has been approved for clinical use, it remains costly and may not be accessible to all patients. Developing a standardized, cost-effective protocol for the outpatient administration of IV ketamine could enhance treatment accessibility while maintaining safety and efficacy.

To develop and evaluate a protocol for the outpatient administration of IV ketamine that ensures patient safety, maximizes clinical effectiveness, and reduces costs compared to alternative ketamine formulations, while maintaining practical outpatient management without requiring inpatient monitoring.

This study enrolled 46 patients diagnosed with treatment-resistant MDD. Each patient received an initial IV ketamine infusion at a dose of 0.2 mg/kg, followed by 0.5 mg/kg in subsequent sessions, administered over 45 minutes in a 100 mL saline solution. Treatments were performed in an outpatient setting with close monitoring during the infusion and for one hour post-infusion. Symptom improvement was evaluated using standardized psychiatric assessment tools, such as the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Hamilton Depression Rating Scale (HAM-D). The protocol also outlined strategies for managing side effects, including transient dissociation, nausea, and hypertension.

The outpatient ketamine protocol demonstrated rapid and significant symptom relief in the majority of patients, with most reporting improvement after the first or second session. Adverse effects were generally mild, with the most common being transient dissociation and elevated blood pressure, both of which resolved without requiring additional intervention. Importantly, the need for expensive inpatient care or nasal spray formulations was minimized, making the treatment more accessible. The cost savings compared to other ketamine delivery methods were notable, making this protocol a viable option for outpatient psychiatric care.

This study establishes that IV ketamine can be safely and effectively administered in an outpatient setting, offering rapid symptom relief for treatment-resistant MDD while minimizing side effects and reducing overall treatment costs. The protocol presents a practical, cost-effective alternative to more expensive ketamine formulations, providing a feasible solution for broader clinical use in psychiatric outpatient settings. Further research is recommended to validate these findings across larger patient populations and explore long-term outcomes.

None Declared

Multiple sclerosis (MS) is a chronic, immune-mediated disorder that affects the central nervous system, leading to a range of neurological impairments. Depression is a common comorbidity in MS, affecting up to 50% of patients over the course of the disease. This association not only worsens functional outcomes but also increases disability, reduces treatment adherence, and negatively impacts overall quality of life.

The aim of this study is to assess the prevalence of depression in patients with MS and identify its associated factors.

A cross-sectional study was conducted in the neurology department of Razi University Hospital (Tunisia) between October 2023 and June 2024. Patients with a diagnosis of MS based on the 2017 McDonald criteria were recruited, excluding those with active disease relapses. Participants completed questionnaires covering sociodemographic data, medical history, clinical and radiological characteristicsand psychological symptoms. Disability was evaluated via the Expanded Disability Status Scale (EDSS). Depression, anxiety and stress were assessed using the DASS-21 scale. Insomnia was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Data analysis was performed using SPSS version 26.

A total of 83 patients with MS were recruited, with ages ranging from 19 to 66 years. The study population had a predominantly female sex ratio of 3.4. The majority of participants (75.9%) were from urban areas, and 74.7% had a university-level education. Moreover, 49.1% were married, and 60.2% were employed. Regarding medical history, 40.3% had a comorbid condition, and 30.1% had a psychiatric history. The mean age at disease onset was 26 ± 10 years. First-line treatments (interferon, glatiramer acetate, teriflunomide, dimethyl fumarate) were prescribed to 27.7% of patients. Second-line treatments (natalizumab, ocrelizumab, fingolimod) were prescribed to 69.9% of patients.

In our study, the prevalence of depression was 52.6% according to the DASS-21 scale. In our population, 24.1% had severe depression, 18.1% had moderate depression, and 10.4%. Depression was significantly associated with employment status (p=0.05), socioeconomic status (p=0.02), personal organic history (p=0.01), personal psychiatric history (p=0.02), the presence of more than 10 lesions on MRI (p=0.01), disability status measured by the EDSS score (p=0.03), as well as anxiety, insomnia, and stress (p<0.001).

The relationship between MS and depression is complex. Routine screening for depression during MS follow-ups is crucial. Effective management of mood disorders in MS patients can significantly improve their quality of life.

None Declared

The most important conditions for the using of antidepressants in cardiological practice are good tolerability, minimal interaction with other drugs, and the absence of a toxic effect. All of the above qualities among antidepressants have a multimodal antidepressant – vortioxetine.

Evaluation of the efficacy and safety of vortioxetine in the treatment of concomitant depressive disorders in cardiological patients.

37 patients aged 45-66 years who were admitted for inpatient treatment at the Regional Clinical Cardiology Dispensary with a diagnosis of “coronary heart disease, Angina pectoris II-III FC” were examined. Upon the hospitalization, they were consulted by a psychiatrist. During the consultation, the patients were diagnosed with a Major depressive disorder, single episode, moderate (F 32.1 according to ICD – 10). Therapy of depressive disorder was carried out in average therapeutic doses with vortioxetine for 8 weeks. To evaluate the efficacy, scales and questionnaires were used: HADS, PDQ–20, CGI–C, SF–36. Statistical processing of the material was carried out using a package of applied statistical programs: Excel, Word (version 2108).

Analysis of the results of assessing the severity of depressive and anxiety manifestations on the HADS scale and the level of cognitive functioning using the PDQ questionnaire allowed us to state that at the end of 8 weeks of therapy with vortioxetine, 89% of patients showed significant clinical improvement. The positive dynamics of patients is confirmed by data on the CGI–C scale. The answers to the SF–36 questionnaire indicate an improvement in the life quality indicators. Statistically significant changes were observed in the parameters “Physical condition”, “Mental health” and “Vital activity”.

The tolerability of vortioxetine in all patients was good, side effects in 13.5% of the subjects in the form of dizziness, nausea and daytime drowsiness were reduced within 1 week.

There were no significant changes in the biochemical parameters of blood, coagulogram, electrolyte composition. When assessing the indicators of blood pressure, heart rate, there was a significant improvement in indicators by the end of the research. In 8 weeks, the frequency of angina attacks and arrhythmias significantly was decreased.

When prescribing vortioxetine to patients with cardiological pathology for 8 weeks, there was distinct positive dynamics both in terms of indicators of the cardiovascular system, and in the emotional sphere, cognitive and social functioning.

None Declared

There are limited data to guide treatment continuation decisions for clinicians caring for patients with treatment resistant depression (TRD). Identifying the magnitude of early improvement (at Weeks 4 and 8) as a predictor of long-term outcomes for TRD can guide treatment continuation decisions.

To evaluate the probability of achieving response or remission by Week 32 in patients with TRD after 4 or 8 weeks of esketamine nasal spray (ESK-NS) treatment, flexibly dosed in combination with an ongoing selective serotonin/serotonin-norepinephrine reuptake inhibitor (SSRI/SNRI).

ESCAPE‑TRD was a randomised phase IIIb trial comparing the efficacy of ESK-NS versus quetiapine extended release, both in combination with an ongoing SSRI/SNRI, in patients with TRD (Reif et al. NEJM 2023; 389 1298–309). Remission was defined as a Montgomery-Åsberg Depression Rating Scale (MADRS) total score ≤10, and partial response and response as ≥25% and ≥50% improvements, respectively, in total MADRS score (or remission). Long-term outcomes were based on the best outcome on-treatment across 32 weeks (≥1 instance of response or remission) from earliest outcome endpoint onwards. Non-responder imputation (NRI) was applied after treatment discontinuations.

336 patients were randomised to ESK-NS; 334 received ≥1 dose. Table 1 shows long-term outcomes following at least partial response, response or no partial response at Weeks 4 and 8. For example, among those who had at least a partial response at Week 4, 94.1% and 79.8% had response and remission by Week 32, respectively.

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This analysis demonstrated a relationship between short- and long-term outcomes. Presence of at least partial response at Week 4 led to more favourable outcomes by Week 32. Moreover, most patients with response by Week 4 achieved remission by Week 32. Continued symptom improvements were observed beyond the induction phase even in some patients with no partial response at Week 4.

None Declared

Major Depressive Disorder (MDD) is one of the most well-known causes of disability worldwide. It is characterized by a persistent pattern of low mood, low self-esteem, and loss of interest and pleasure, leading to extensive functional impairment. Another characteristic is emotional dysregulation, leading to mood instability (MI), a frequent and intense fluctuations in emotions over time. MI affects the daily function of people with MDD. MI and daily function difficulties disrupt the ability to manage daily routine, causing impairment in occupational balance (OB) and affecting the resilience and quality of life (QoL) of people with MDD.

A preliminary cross-sectional study was conducted to advance the understanding of MI and its relationships to daily function, OB, and QoL in people with MDD.

“MOBILE” Model Development: Data was collected using various assessments, utilized by Ecological Momentary Assessment (EMA), zooming in on real-life patterns of daily lives of people with MDD. Based on the research findings, a theoretical model, the Mood-Occupation Balance Reciprocal Model (MOBILE), was constructed, presenting the relationships between the variables.

This presentation will showcase the research findings and the reciprocal relationships between study variables, which form the foundation for this model development.

The “Mobile” model addresses the two core components of depression - MI and functional impairment, and explores their relationships to QoL, OB, participation, and personal resilience in people with MDD. The model serves as a platform for building a personalized clinical intervention, which will be tested in further research.

Currently, most treatments offered for MDD combine pharmacological and psychosocial treatments. Yet, their efficacy in improving functional abilities is limited. The development of the current model, and subsequently the development of a clinical intervention, allows for the expansion of treatment options for people with MDD. In this way, it may assist in reducing the heavy burden of the disease, improve functioning, and prevent recurrence. Additionally, the use of EMA allows for the efficient and accurate collection of data, thereby extending the diagnostic and treatment processes from the clinic to everyday environments.

None Declared

Electroconvulsive therapy (ECT) is a treatment received by approximately 1.4 million people worldwide annually, depressive disorder being the most prevalent indication. Retrograde autobiographical amnesia (RAA) refers to difficulties in retrieving memories of past events. Despite being the most commonly reported side effect of ECT, its nature, duration and impact on patients’ lives remains uncertain.

(1) Assessing RAA severity in patients treated with ECT for depression compared with other treatment methods. (2) Assessing RAA severity in patients treated with right unilateral (RUL) vs bilateral (BL) ECT for depression. (3) Assessing overall RAA severity (pre-post effect) following an acute course of ECT. (4) Summarising patients’ lived experiences of RAA following ECT for depression.

This systematic review was registered prospectively with PROSPERO (CRD42024445105). Seven databases were searched for eligible articles. Quantitative and qualitative studies assessing RAA in patients treated with ECT for depression published since 1985 were included. Abstract, full-text screening and data extraction were done in duplicates and independently. Quantitative data were meta-analysed using random effects model and qualitative data were analysed using thematic meta-synthesis.

Of initial 6126 records, 22 quantitaive and 20 qualitative studies were included. ECT caused significantly greater RAA compared with other treatments (SMD -0.73, 95% CI -1.31; -0.15, I2=54%, Figure 1). BL treatment caused significantly greater RAA than RUL (SMD -0.29, 95% CI -0.57; -0.01, I2=32%, Figure 2). The pre-post effects were big for RUL (SMD -0.77, 95% CI -1.15; -0.38, I2=93%, Figure 3) and BL ECT (SMD -1.16, 95% CI -1.79; -0.52, I2=93%). The main effect moderator was RAA assessment tool. Few studies reported delayed effects of ECT on RAA. Four analytical themes were identified from qualitative data: (1) Uncertainty regarding the cause, nature and severity of memory loss may cause distress for patients, undermine the quality of information provision and post-ECT care. (2) Ambiguous testimonies – perception of memory loss often shaped by ECT effectiveness. (3) Returning to ‘normal’ daily life may be a challenging, frustrating and lonely process, which requires developing adaptive coping strategies. (4) Some memories may not come back for years; re-leaning facts about oneself and reshaping own identity may be important steps on the journey to recovery.

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Image 3:

ECT causes more severe (sometimes long-lasting) RAA than other forms of treatment with BL being more harmful than RUL. RAA measurement is not unified hindering identifying technical aspects of ECT, which may impact memory loss. Information provision and post-ECT care could be improved by reducing uncertainty around the nature and severity of RAA.

None Declared

Higher prevalence & incidence rates of depressive disorder in women compared with men are among the recurring findings from epidemiologic & clinical studies. The literature suggests that this is not due to a lower need for treatment of depression in men. In the context of the concept ‘male depression’ (MD), it is often argued that men tend to have so called ‘non-typical’ depressive symptoms. These symptoms (such as aggressiveness, irritability, alcohol use, risk-taking & antisocial behavior) are rarely considered in the diagnosis of depressive disorders, which may lead to underdiagnosis. With regard to the occurrence of ‘non-typical’ depressive symptoms and the concept MD, the importance of masculine personality traits is often discussed. The topic of the session is the extent to which gender-related personality traits such as masculine, feminine, androgynous & undifferentiated are associated with the occurrence and severity of ‘non-typical’ and ‘typical’ depressive symptoms in women and men with a depressive disorder.

The results of a study in a clinical setting will be presented. The aim of the study was to investigate whether above mentioned gender-related personality traits are associated with increased severity of depressive symptoms and whether there are differences between women & men.

Depressive symptoms (GMDS & BDI II) and gender-related personality traits (GEPAQ) were assessed in female & male patients (≥ 18 years) with an unipolar depressive disorder (ICD-10). Participants were recruited from inpatient settings & day clinics of specialized psychiatric-psychotherapeutic hospitals in Germany. The multicenter study with a cross-sectional design has been completed. Data from the clinical sample were analyzed using multiple linear regression analysis.

Multiple linear regression analysis: criteria variable GMDS & predicting variable GEPAQ (masculine pt) b-coefficient women = -1.36 (n.s.) & b-coefficient men = -1.48 (p ≤ .01); criteria variable GMDS & predicting variable GEPAQ (feminin pt) b-coefficient women = .12 (n.s.) & b-coefficient men = .79 (n.s.); criteria variable BDI II & predicting variable GEPAQ (masculine pt) b-coefficient women = -1.72 (n.s.) & b-coefficient men = -4.23 (p ≤ .01); criteria variable BDI II & predicting variable GEPAQ (feminin pt) b-coefficient women = .95 (n.s.) & b-coefficient men = .-24 (n.s.)

Gender-related personality traits are associated with the occurrence and severity of ‘non-typical’ & ‘typical’ depressive symptoms. They should be considered in the diagnosis & treatment of depression. Gender differences have also been identified. In men, the expression of masculine personality traits does not lead to an increase in depressive symptoms, especially not in ‘non-typical’ depressive symptoms, as was originally thought. Based on these and other recent findings, the concept of MD can be critically discussed.

None Declared

ESCAPE-LTE was a phase 4, long-term, open-label extension (OLE) study for patients (pts) with treatment resistant depression (TRD) who were continuing esketamine nasal spray (ESK-NS) treatment following ESCAPE-TRD. ESCAPE-TRD was a randomised, phase IIIb trial comparing the efficacy and safety of ESK-NS versus quetiapine extended release (Q-XR), when both were flexibly dosed alongside an ongoing selective serotonin/serotonin-norepinephrine reuptake inhibitor (SSRI/SNRI), in pts with TRD. The study demonstrated that ESK‑NS significantly increased the probability of achieving remission at Week 8, and of being relapse‑free through Week 32 after remission at Week 8, versus Q-XR (Reif et al. NEJM 2023; 389 1298–309).

To assess the long-term safety, tolerability and efficacy of ESK-NS alongside an SSRI/SNRI in pts with TRD. Here, the study design of ESCAPE-LTE is described; top-line results will be reported in the poster.

ESCAPE-LTE was a single-arm, 2-year OLE to ESCAPE-TRD in 14 countries. Pts eligible for ESCAPE-LTE were those who completed ESK-NS treatment in combination with an SSRI/SNRI in ESCAPE-TRD through to the end of the study (Week 32), continued to benefit from the ESK-NS treatment regimen and for whom commercial ESK-NS was not accessible in their country. The starting dose of ESK-NS was based on the pts’ dose (28 mg [≥65 years and adults of Japanese ancestry], 56 mg or 84 mg) and frequency (weekly or biweekly) at completion of the maintenance phase (Week 32) of ESCAPE-TRD. Investigators were able to change the dose and frequency within label recommendations during the OLE based on clinical judgment.

The primary objective was to assess the long-term safety and tolerability of ESK-NS. The secondary objective was to assess the long-term efficacy of ESK-NS based on the proportion of pts being relapse-free at Week 104 (or end-of-study).

The primary endpoints were the number of pts who developed treatment-emergent adverse events, and suicidal ideation and behaviour, assessed by the Columbia-Suicide Severity Rating Scale (C-SSRS). Safety assessments also included body weight and vital sign measurements and clinical laboratory tests. The secondary endpoint was no relapse until the end of the prospective observation at Week 104 (or end-of-study); relapse was defined as a worsening of depressive symptoms as indicated by a total Montgomery-Åsberg Depression Rating Scale (MADRS) score of ≥22 at two consecutive assessments; hospitalisation for worsening depression, suicide prevention or attempt; or any other event assessed by the investigator to be indicative of relapse.

183 pts were enrolled in the ESCAPE-LTE. Top-line study results will be reported in the poster.

Results from the ESCAPE-LTE will provide evidence for the long-term safety, tolerability and efficacy of ESK-NS as a treatment for pts with TRD.

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In a multi-centre, double-blind, randomised, placebo- and reference-controlled clinical Phase III trial in patients with a mild to moderate major depressive episode, Silexan, a special essential oil from Lavandula angustifolia, demonstrated a clinically meaningful and statistically significant antidepressant effect (Kasper et al. Eur Arch Psychiatry Clin Neurosci 2024; Apr 1, Epub ahead of print). Patients with depression often experience functional impairment, i.e. in their ability to perform activities of daily living, in their capacity to form and maintain interpersonal relationships, and in their work productivity.

We present data from the trial to assess the impact of the symptoms of the depressive episode on the patient`s functional abilities in daily living.

Adult patients (≥18 years) suffering from a major depressive episode of mild to moderate severity according to ICD‑10 were included. Further inclusion criterion was a total score of 19 – 34 points in the Montgomery-Åsberg-Depression Rating Scale (MADRS). Randomised patients took 80 mg Silexan, 50 mg Sertraline, or placebo once daily over 8 weeks. Functional impairment was assessed using the change of the Sheehan Disability Scale (SDS total score) between baseline and week 8, changes of each SDS single item “work” (item 1), “social life/leisure activities” (item 2), and “family life/home responsibilities” (item 3), as well as the number of lost (DL) and underproductive days (DU). The scientific questions if the active treatment groups are superior to placebo in improving functional impairment was investigated as secondary objectives, which were analysed descriptively using an analysis of covariance model with factors for treatment and centre and the baseline value as covariate.

The full analysis set consisted of 498 patients. The changes of the SDS total score differed by 2.40 (p<0.001) points (adjusted mean difference) in favour of Silexan compared to placebo and by 0.82 (p=0.267) points in favour of Sertraline compared to placebo. The mean differences between Silexan and placebo were 0.98 points for item 1, 0.65 for item 2, and 0.78 for item 3 (p<0.05, each). Compared to placebo, both DL (p=0.055) and DU (p=0.011) occurred less frequently with Silexan. In the primary efficacy endpoint of the trial, the change of the MADRS total score, Silexan was significantly superior to placebo (p<0.01).

With Silexan treatment, patients with a major depressive episode coped better with work, social life, or family responsibilities and had fewer lost or underproductive days.

H.-P. Volz Consultant of: Lundbeck, Pfizer, Schwabe (Spitzner), Bayer, Janssen, neuraxpharm, AstraZeneca, S. Klement Employee of: Dr. Willmar Schwabe GmbH & Co. KG, E. Seifritz Grant / Research support from: Swiss National Science Foundation and University of Zürich, Consultant of: Lundbeck, Schwabe, Janssen, Otsuka, Mepha Pharma, Otsuka Pharma, Recordati, OM Pharma, Takeda, Sunovion Pharma and Angelini, S. Kasper Consultant of: Angelini, Biogen, Boehringer, Esai, Janssen, IQVIA, Mylan, Recordati, Rovi, Sage and Schwabe, Speakers bureau of: Angelini, Aspen Farmaceutica S.A., Biogen, Janssen, Recordati, Schwabe, Servier, Sothema, and Sun Pharma

Treatment-resistant depression (TRD) poses a significant challenge in clinical psychiatry, affecting a substantial proportion of patients who do not respond adequately to standard antidepressant therapies. Recent studies have rekindled interest in thyroid hormone therapy as a potential augmentation strategy for enhancing treatment outcomes in both unipolar and bipolar depression. Thyroid hormones, particularly levothyroxine (LT4) and triiodothyronine (LT3), have been shown to influence mood regulation through their interactions with neurotransmitter systems, thereby offering a promising avenue for improving depressive symptoms in TRD patients.

This study explores the potential of thyroid hormones, specifically levothyroxine (LT4) and triiodothyronine (LT3), to enhance treatment outcomes for patients who have not adequately responded to standard antidepressant therapies. It also synthesizes recent findings on the safety profile of thyroid hormone therapy and examines potential gender differences in treatment response.

A comprehensive review of the literature was conducted, focusing on studies published in the ten years that examined the role of thyroid hormones in TRD. Databases such as PubMed were searched for randomized controlled trials, meta-analyses, and observational studies that assessed the effects of LT3 and LT4 on depressive symptoms and treatment outcomes.

The literature review shows that adjunctive triiodothyronine (T3) significantly enhances treatment response in treatment-resistant depression. A randomized trial found that 53% of patients on T3 had a ≥50% improvement in depression scores after three weeks, compared to 19% for those on levothyroxine (LT4). While LT4 may benefit chronic cases, T3 is generally preferred for its superior efficacy. Thyroid hormone therapy also benefits bipolar depression, especially in rapid cycling patients. Functional imaging studies indicate that supraphysiologic LT4 can improve symptoms by modulating anterior limbic network activity. Some evidence suggests women may respond better than men. Overall, thyroid hormone therapy is well tolerated, with low incidences of adverse effects like tremor, anxiety, and palpitations. However, long-term efficacy remains mixed, with some studies showing no significant differences compared to placebo, and the safety of high-dose therapy is uncertain, highlighting the need for further research.

Thyroid hormone therapy, particularly LT3 and LT4, is a promising augmentation strategy for treatment-resistant unipolar and bipolar depression. While LT3 is noted for its rapid response, further research is needed to clarify its long-term safety and optimal dosing. These findings highlight the importance of considering thyroid therapy for patients who do not achieve satisfactory outcomes with conventional antidepressants.

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Fatigue is one of the most significant factors impairing functionality in patients with multiple sclerosis (MS). Research has demonstrated that psychological factors, in addition to neurobiological ones, play a crucial role in fatigue among MS patients. Previous research has demonstrated that emotional neglect and emotional abuse are associated with fatigue in patients with MS (Pust et al. Front Psychiatry 2020; 11:811). While the role of emotion dysregulation as a mediator between adverse childhood experiences and long-term effects of childhood trauma has been studied, this relationship has not been previously examined in patients with MS.

This study aims to investigate the association between adverse childhood experiences and fatigue and to examine the mediating effect of emotion dysregulation in patients with MS.

Patients with MS followed in the Neurology Outpatient Clinic at Marmara University, who were evaluated during their clinical examination to be cognitively competent and without any physical disabilities that would prevent them from completing the forms, were included in the study. Adverse childhood experiences were assessed using the expanded version of the Childhood Trauma Questionnaire (CTQ-33), emotion dysregulation was measured by the 16-item Difficulties in Emotion Regulation Scale (DERS-16) and fatigue was evaluated using the Fatigue Severity Scale. The impact of CTQ subscale scores on fatigue and the mediating role of emotion dysregulation were analyzed using SPSS with Process Macro v4.2.

A total of 119 patients completed the survey, with a mean age of 37.45 years, and 71.4% of the participants were women. Emotional abuse and emotional neglect were associated with fatigue in patients with MS. The effect of emotional abuse on fatigue was mediated by emotion dysregulation, with the total effect being 0.81 (95% CI [0.04, 1.58]), the direct effect -0.12 (95% CI [-0.86, 0.63]), and the indirect effect 0.93 (95% CI [0.50, 1.55]). Similarly, the relationship between emotional neglect and fatigue was also mediated by emotion dysregulation, with the total effect being 0.66 (95% CI [0.10, 1.22]), the direct effect -0.05 (95% CI [-0.60, 0.49]), and the indirect effect 0.71 (95% CI [0.39, 1.10]). These results indicate that emotion dysregulation fully mediates the effects of both emotional abuse and emotional neglect on fatigue in patients with MS.

Our findings indicate that the link between fatigue severity and emotional neglect or abuse in MS patients is fully mediated by difficulties in emotion regulation. Consequently, it is suggested that interventions aimed at enhancing emotion regulation strategies may potentially mitigate the effects of adverse childhood experiences on MS-related fatigue. Further research, especially focused on intervention strategies, is needed in this area.

None Declared