Nomophobia among university students is recognized as an addictive issue, as their attention is often difficult to divert from smartphones, especially during class. This issue is increasingly evident among nursing students, who frequently check their smartphones during class (p < 0.001), making nomophobia an important concern.

We conducted an umbrella review aimed at assessing the prevalence of different psychological and behavioral symptoms among nursing students, including nomophobia, anxiety, sleep disturbances, fear, and stress.

This meta-synthesis combined evidence from 20 systematic reviews and meta-analyses, incorporating 354 primary studies. Publication records were retrieved from PubMed, CINAHL, PsycINFO, and Scopus. The methodological quality of each meta-analysis was assessed using the AMSTAR-2 tool. Reporting followed the PRISMA guideline checklist.

Our synthesis revealed that 28% (95% CI: 24%–33%) of nursing students experience psychological and behavioral symptoms. Nomophobia/smartphone addiction was observed at 30% (95% CI: 12%–49%). Other prevalent symptoms included anxiety at 29% (95% CI: 17%–40%), sleep disturbances at 48% (95% CI: 5%–91%), stress at 27% (95% CI: 17%–37%), and fear at 41% (95% CI: 7%–75%).

Our findings suggest that nursing students are increasingly involved in nomophobia. As smartphones play a central role in daily life, digital detoxification is not easy. Although our research did not explore the relationship between nomophobia and other symptoms, the presence of issues such as anxiety, sleep disturbances, fear, and stress in nursing students warrants further investigation.

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Subacute combined degeneration (SCD) of the spinal cord is a well-known neurological disorder commonly associated with vitamin B12 deficiency. However, the condition can also present in individuals with normal B12 levels, making diagnosis more difficult.

This paper aims to examine the diagnostic challenges posed by subacute combined degeneration of the spinal cord in patients with normal B12 levels. Specifically, it aims to highlight the importance of early screening for nitrous oxide use and the complexities introduced by co-occurring functional gait disorders.

Literature research was conducted using PubMed databases. The following keywords were used “whippets” or “nitrous oxide” or “inhalant use disorder”, and “subacute degeneration of spinal cord” and/ or “normal B12 levels”. Furthermore, a comprehensive clinical evaluation was conducted, including a detailed inquiry into the patient’s substance use history.

The 56-year-old patient developed symptoms of subacute combined degeneration (SCD) despite normal B12 levels. He experienced worsening tingling sensations, starting in the extremities and moving upward, along with new gait instability requiring a cane. Initially denying substance use, he later admitted to daily nitrous oxide inhalation, which disrupts B12 metabolism and causes spinal demyelination, leading to neurological deficits even with normal B12 levels. The presence of a functional gait disorder complicated the diagnosis, but persistent questioning about substance use and recognizing the effects of nitrous oxide were key to accurate diagnosis.

This case highlights the importance of early and comprehensive substance use screening, particularly in patients presenting with unexplained neurological symptoms. The disruption of B12 metabolism by nitrous oxide can cause significant spinal cord degeneration, even when serum B12 levels are normal. This underscores the need for detailed, persistent questioning about substance use in clinical settings, particularly for patients with risk factors for inhalant abuse. Additionally, an awareness of the multifaceted nature of functional gait disorders is essential for accurate diagnosis and optimal patient outcomes. Routine screening for nitrous oxide use and a thorough examination of gait abnormalities can aid in the timely detection and treatment of subacute spinal degeneration, preventing further neurological damage. By incorporating recommended screening questions and being vigilant about the neurological effects of nitrous oxide, clinicians can better address the diagnostic challenges of SCD and functional gait disorders.

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First-episode psychosis (FEP) provides a crucial opportunity to investigate these biological markers before the influence of long-term treatment or disease progression. Both bipolar disorders with psychotic features and schizophrenia spectrum disorders are linked to systemic inflammation, and examining blood cell counts and inflammatory ratios may provide insights into the biological foundations of these conditions.

This study aims to compare key hematological parameters and inflammation markers (neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR)) between untreated first-episode psychosis patients diagnosed with psychotic mania, schizophrenia spectrum disorders, and healthy controls, examining potential differences between these groups.

55 patients (F:28, M:27) diagnosed with schizophrenia spectrum disorder, 68 patients (F:38, M:30) diagnosed with bipolar disorder, all without a history of treatment, who were admitted to psychiatric clinics due to a first-episode psychosis, and 61 healthy volunteer individuals (F:24, M:37) matched for age and gender were included in the study. Hemogram data were obtained from medical records, and the hemograms taken within the first 48 hours of the patients’ admissions were used in the study.

The white blood cell, neutrophil, and monocyte counts were significantly higher in both patient groups than healthy individuals. The eosinophil count varied between the groups, with patients diagnosed with schizophrenia spectrum disorder having significantly lower counts compared to healthy individuals (p=0.003). When the analysis was conducted by gender, white blood cell, neutrophil, and monocyte counts were found to differ in women from both patient groups compared to healthy individuals, while in men, only the eosinophil count was lower in patients diagnosed with schizophrenia spectrum disorder (p=0.023). There were no significant differences in the NLR and PLR between the groups. The MLR value showed no difference between male patients and healthy individuals, but it varied between the groups in women, with patients diagnosed with psychotic mania having higher MLR compared to the other groups (p=0.01).

Changes observed in specific hematological parameters in both bipolar disorder and schizophrenia spectrum patients may contribute to understanding the pathophysiology of these disorders. However, given the heterogeneity in the presentation and etiology of these conditions, larger-scale and prospective studies are needed to determine the roles of these parameters in their pathophysiology. It may also be necessary to consider gender-based differences when assessing the potential roles of these hemogram parameters in the pathophysiology of the diseases.

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Heart Rate Variability assesses the autonomic system function. We have previously reported increased sympathetic activation (i.e. increased proarrhythmic risk) and asymptomatic left ventricular myocardial dysfunction in a group of drug-naïve, First Episode Patients with psychosis. We performed the same cardiological evaluation in a subgroup of these patients one year after the initiation of antipsychotic treatment.

To find out the impact of antipsychotic medications in cardiac function.

Thirty three consecutive patients diagnosed with first psychotic episode were included in the current analysis. None of the patients had a previous history of cardiovascular diseases. All patients were assessed by 24-hour Holter ECG monitoring (including QT analysis and heart rate variability indices) and a thorough echocardiographic study (including myocardial strain analysis – global longitudinal strain GLS) at baseline (shortly after stabilization) and 1 year after treatment.

The mean age of our population was 29±7 years, 75% were males and their body surface area was 1.87±0.21 m2. At baseline 1) the mean value of QTc was normal in all subjects although the greatest QTc value measured was above 500msec in 35% of patients, 2) SDNNI<50 msec was observed in 50% of the patients, all patients had an abnormal HRV index, low RMSSD <20 msec was observed in 35% of patients, no patient had abnormally low PNN50 values. No patient had evidence of overt structural heart disease and the value of left ventricular ejection fraction was within normal range (57.5±5.1 %). GLS was decreased (i.e. < -16%) in 25% of patients. At follow-up maximum QTc value (517±52 vs 485±69, p=0.014) and PNN50 (14.1±12.1 vs 9.8±10.5, p=0.05) were increased while left atrial volume index (20.1±6.3 vs 23.3±6.4, p=0.031) and GLS (-18.6±2.5 vs -17.5±2.5, p=0.007) were decreased compared to baseline. No other significant changes were observed at follow-up. At follow-up, abnormal GLS, QTc max, SDNNI, HRV index, RMSSD and PNN50 values were observed in 16%, 60%, 38%, 96%, 15% and 0% respectively of included patients.

Normal values

SDNNI >100 (especially <50)

HRV INDEX >60

RMSSD 13-48 MS

Pnn50 -3 – 43%

In patients with a first psychotic episode without a previous history of cardiovascular disease or risk factors, a significant proportion showed abnormal autonomous system function and subclinical myocardial dysfunction of the left ventricle. After 1 year of treatment, improvement was observed in left ventricular function and parasympathetic system activity with a concomitant increase QTc interval. Optimal management of psychotic episodes may lead to an amelioration of the risk of future myocardial impairment without affecting the risk for arrhythmias and sudden death.

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Treatment-resistant schizophrenia (TRS) develops in ˜30% of patients, resulting in higher hospitalization rates, morbidity, mortality, and suicidality, and increased costs (Pompili et al CNS NDDT 2017; 16 870-884). Despite inconsistent findings of its efficacy, antipsychotic polypharmacy (APP) is frequently prescribed in an attempt to treat refractory symptoms (Correll ClinNorthAm 2012; 35 661-681). While marketed APs all act through the modulation of 5HT/DA transmission, clozapine, the only drug approved for TRS, seems to act on multiple receptor systems (Brunello et al NPP 1995; 13 177-213). The need to modulate non-monoaminergic targets is supported by findings of excessive glutamatergic activity, rather than increased dopamine synthesis, in patients with TRS (Demjaha et al BioPsy 2014; 75 11-3). Evenamide, devoid of biological activity at >150 CNS targets, is able to normalize excessive glutamate release without affecting basal levels. Evenamide has demonstrated benefits in several animal models of psychosis (monotherapy and add-on to AP). Benefit of evenamide as add-on was demonstrated in a phase 2, open-label trial (Anand et al IJNPP 2023; 174 216-229) and in a phase 2/3 randomized, double-blind study in patients not responding adequately to SGAs.

Evaluate the efficacy, safety, and tolerability of evenamide 30 mg bid as add-on treatment in patients with documented TRS receiving AP treatment but not adequately benefitting from a stable therapeutic dose.

This is a prospective, potentially pivotal, phase 3, randomized, double-blind, placebo-controlled, 1-year international study, with a primary efficacy endpoint at 12 weeks and long-term efficacy endpoints at 26 and 52 weeks. Eligible patients must have a diagnosis of TRS according to the TRRIP consensus guidelines (Howes et al AmJPsy 2017; 174 216-229). During the 6-week screening period and throughout the study, adherence to background AP(s) and evenamide will be confirmed through measurements of plasma levels. Selection criteria include CGI-S of mildly to severely ill (3-6); BPRS total score ≥45, with a score ≥18 on core symptoms of psychosis, and PANSS total score ≥70. An Independent Eligibility Committee will determine patients’ eligibility. Patients improving ≥20% on the BPRS or ≥1 category on the CGI-S during the screening period will be excluded. Efficacy (PANSS, CGI-S/C, Q-LES-Q-SF, PSP scales) and safety (vital signs, ECG, lab tests, physical/neurological/eye exams, ESRS-A, CDSS, C-SSRS) will be evaluated at regular intervals.

Results from this study will determine whether addition of evenamide 30 mg bid to APs is associated with clinically important benefit in TRS patients.

Positive results would support the role of glutamate modulators for the optimal treatment of TRS.

R. Anand Consultant of: AbbVie, Acadia, BiolineRx, Domain, Enkam,Erydel, Forest, Janssen, Hoffman La Roche, Lundbeck, Noema, Ono, Pfizer, UCB, Shire, Sigma-Tau, Takeda, Teva, A. Turolla Employee of: Newron Pharmaceuticals SpA, G. Chinellato Employee of: Newron Pharmaceuticals SpA, R. Giuliani Employee of: Newron Pharmaceuticals SpA, F. Sansi Employee of: Newron Pharmaceuticals SpA, R. Hartman Employee of: Newron Pharmaceuticals SpA

There is a growing interest in the field of men’s mental health, given that men experience elevated rates of certain mental health outcomes including suicide, substance use disorder and overdoses. Evidence suggests that certain male sub-populations are at particular risk, including fathers who are divorced or separated. This increased risk has been attributed to several factors including painful separation from children, an intense decrease in social support, and a sense of failure and shame associated with marital breakdown. Despite these risks, there is a lack of official services targeted at divorced or separated fathers with mental health issues, with only a few grassroots programs available for this demographic. One such service is a peer support program known as Pères Séparés (seperated fathers). This program is officially accredited by the ministère de la Santé et des Services sociaux du Québec to provide psychosocial support including one-on-one peer coaching, weekly support groups and financial/legal advice to divorced or separated men in Montreal.

We set out to conduct a project using a method known as participatory video. The aim was to elicit the lived experience of service users, including their experiences within the peer support program, and represent these experiences in a short video that can be used for the education of other peers, health care providers, family members and the general public.

The project involved creating a workgroup of program service users who were initially trained in basic video-techniques. Workgroup members then interviewed each other about their experiences on camera. All interviews were transcribed, with workgroup members reading the transcripts and distilling prominent themes from these interviews for inclusion in the final video.

The resultant 20 minute video contained three themes (i) the unique struggles of separated fathers including intense loneliness, isolation, depression, and suicidality; (ii) the important of the program in reducing this isolation and providing invaluable social support; and (iii) the rehabilitative role of peer support in providing psychosocial education regarding self-care, social reintegration and pathways to recovery from mental health issues. The video was shown in a series of screenings at targeted settings including health-care, community and educational venues. It was also uploaded to social media where it has been viewed over 5,000 times.

The results imply that such grassroots peer-support programs are very well-situated to help vulnerable fathers in their recovery. Moreover, this program provides a model that can be used as a template elsewhere. Indeed, relevant organizations, funders and service providers could consider creating and implementing similar peer support programs oriented towards seperated fathers. These can benefit such men, their families and society as a whole.

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Psychosocial treatment is a crucial component of the rehabilitation process for individuals with serious mental illness (SMI). However, adherence to these interventions is often low, with high dropout rates posing challenges to successful outcomes. Understanding the factors that influence patient adherence, and dropout is essential for improving program efficacy and patient well-being.

This study aims to analyze the demographic, clinical, and motivational factors that contribute to adherence or dropout from the “Programa Mais de Perto” (PMDP), a psychosocial rehabilitation initiative for individuals with SMI, in order to enhance patient retention and optimize therapeutic outcomes.

The study included all patients with SMI enrolled in the PMDP activities until December 2023. Data were collected through clinical file reviews and telephone interviews using a structured questionnaire, including the World Health Organization Disability Assessment Schedule (WHODAS 2.0). Demographic and clinical variables, as well as patient-reported experiences, were analyzed to identify factors associated with continued participation or dropout.

The study initially included 87 patients, of whom 41 adhered to the program and 46 dropped out. However, after further filtering and questionnaire analysis, a subset of 36 patients was evaluated in detail (22 in the adherence group and 14 in the dropout group). The adherence group had lower disability scores on WHODAS 2.0 and reported higher intrinsic motivation, such as improving physical and mental well-being. In contrast, the dropout group highlighted external pressures from mental health professionals as reasons for initial participation and cited fatigue, lack of integration, and distance from the program as reasons for discontinuation. Tai Chi Chuan was the most popular activity (39% participation), while the Book Club had the lowest engagement (3%).

Intrinsic motivation is a key predictor of adherence to psychosocial rehabilitation programs, while external pressures may increase dropout risk. Enhancing flexibility, offering a wider range of activities, and fostering peer support systems could improve retention rates. These findings reinforce the importance of adapting psychosocial interventions to the needs and motivations of individuals with SMI for better long-term outcomes.

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Physical rehabilitation is usually required after serious illness or injury; there is a significant need for simultaneous psychiatric rehabilitation as well. Psychiatric consultation to inpatient rehabilitation units presents with unique clinical questions distinct from consultation to other units.

To present a literature review and an illustrative case series of common psychiatric referrals from physical rehabilitation units.

First, the current literature was reviewed on PubMed looking at current models of psychiatric consultation to inpatient physical medicine and rehabilitation units. Second, cases were reviewed from tertiary post-acute care units including stroke, acquired brain injury, post-fracture fast and slow stream, and complex continuing care. Third, thematic analysis was performed to extract illustrative themes presented in a case series of four mock patients.

There is a paucity of literature on psychiatric consultation to inpatient physical rehabilitation units. The current literature, however, supports high utilization of psychiatric consultation in comorbid physical illness (Daly et al 2023, PMR). Four major themes emerged on psychiatric consultation to inpatient physical rehabilitation: (1) Interdisciplinary management of basophobia [the fear of falling], (2) Managing severe persisting mental illness and addressing medications that increase the risk of falling, (3) Managing new onset trauma-related disorders and pain-related disorders, (4) Assessing partial cognitive improvement and impairment in the setting of brain injury.

Psychiatrists often deal with patients recovering from an episode of serious physical illness or injury. There is significant overlap between the work done in physical and psychiatric rehabilitation. Patient and staff education, judicious prescribing and de-prescribing, and interdisciplinary management are critical to successful outcomes.

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Circular economy is a model of production and consumption entailing both environmental and social aspects. The collaborative dimension of this model is evident in the reuse of waste that can constitute a resource for other productive processes, encouraging cooperation and exchange. Also, the regeneration of disused spaces, in both urban and rural contexts, can stimulate social participation, cohesion and community development, thus becoming a resource for community-oriented interventions in the field of mental healthcare.

In 2024 a horticultural activity has been developed on the fields surrounding the facility, to grow edible species (mainly herbs and small fruits). The activity involved people hosted in the TC, local farmers, students of one agricultural high school and one catering school, to develop processes of agricultural products’ cultivation, exchange and transformation, as well as mutual learning. In particular, the project entails the reuse of TC’s organic waste (to produce compost), the cultivation of culinary plants and fruits, the production of derivatives (e.g. juices and jams) in the cooperation with the abovementioned schools, local producers, and consumers. The exchange of both products and skills aims to constitute (also metaphorically) fertile ground for the germination of new opportunities, supporting care in a broad sense and cultivating new individual and group identities. The original meaning of the acronym – “dreams” – points to the dreamlike dimension of a project that – within the controlled, safe perimeter of a pilot intervention – introduces innovative (sometimes bizarre) practices and unprecedented relationships between heterogeneous social actors, inviting the latter to “suspend every judgment”. Hopefully, configurations experienced during the pilot project and evidence supporting their therapeutic potential will be translated into the waking life, providing the basis for improved practice that intersects mental health, sustainability, and social cohesion.

observational work and data collection conducted by healthcare professionals and an ethnographer.

The performance of practical tasks and the prolonged time of the activity throughout months provided each person with the time needed to gradually explore new relational spaces. The aim of growing food, a necessary step in this circular and collective enterprise, supported motivation as well as the development of a social identity of the group, who felt part of the wider community and actively involved in its development.

Preliminary findings suggest further investigation and encourage collaboration between different social actors to develop inclusive, effective, and community-based interventions in the field of mental health and recovery.

None Declared

Addressing severe mental illness requires assertive community intervention. The “Assertive Program – Step by Step”, implemented in 2016, involves a mental health team in the Sintra region (Lisbon). Through a case manager model and regular patient contact, an Individualized Care Plan is developed to ensure treatment continuity, coordinate psychosocial interventions, and reduce both the frequency and duration of hospital admissions. The goal is to contribute to clinical improvement, enhance social functioning, and improve the quality of life for individuals with severe mental illness through several measures: regular psychiatric consultations; promotion of adherence to psychopharmacological treatment; individual or group psychological support; participation in rehabilitation programs; psychoeducational programs for patients and families; and facilitation of general medical consultations and social support.

This study aims to characterize the sociodemographic profile, occupational status, and number of hospital readmissions among patients followed by the Assertive Program, and to reflect on the relevance of these interventions in preventing relapses.

A retrospective analysis of data collected from the clinical records of patients enrolled in the Assertive Program in September 2024, with a minimum follow-up period of one year.

In September 2024, a total of 29 patients were enrolled in the Assertive Program, with 19 receiving follow-up for more than one year. The average age was 36.4 years, and 68.4% were male. The majority of patients were either single (68.4%) or divorced (21.1%), and most were not working, with 52.6% being unemployed and 5.3% retired. The predominant diagnosis was schizophrenia (52.6%), followed by Bipolar Affective Disorder (31.6%) and Psychosis Not Otherwise Specified (10.5%). The average number of total hospital admissions was 2.9 (maximum 12, minimum 0). After joining the Assertive Program, 68.4% (n=13) of patients were not readmitted to the hospital. Of those readmitted (31.6%; n=6), most had a diagnosis of schizophrenia (n=4) and were unemployed (n=5).

This study highlights the specific sociodemographic profile of patients with severe mental illness, who appear to be predominantly single and unemployed. The proposed program may help reduce the number of relapses in the care of this patients. Hospital readmissions appear to occur primarily among unemployed patients, underscoring the need for close, personalized follow-up, with a focus on improving occupational functionality.

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Neuropsychiatric symptoms associated with valproic acid were already described in the 1980s. Valproic acid is known to cause valproate encephalopathy and hyperammonemia(1,2). Rarely it can cause drug induced lupus erythematosus(5). Previous studies and case reports have documented manifestations such as rash, pulmonary involvement, pleuritis and carditis due to valproate-induced lupus erythematosus. However, little is known about other manifestations(3,4,6). To date, there are no descriptions of cerebral drug-induced lupus erythematosus due to valproic acid.

We report the case of a female 63-year-old patient who was initially treated in our inpatient clinic for prolonged delirium and major neurocognitive disorder following severe traumatic brain injury with bilateral traumatic intracerebral temporal bleeding eight months prior. Symptoms from the severe traumatic brain injury included aphasia, impulse control disorder, reduced frustration tolerance and depression, which were treated with valproic acid and quetiapine. The patient experienced a strongly fluctuating, progressively deteriorating neuropsychiatric syndrome that began six months before hospitalization. Additionally, a fluctuating neurological syndrome including temporary complete hemiparesis, hyperreflexia and loss of consciousness, which lasted from 30min to hours, and halluzinations was observed. The patient also developed epileptic seizures, which could not be managed by a combined antiepileptic therapy with valproic acid, brivaracetam and clobazam. Previous examinations (brain-MRI and CT, CFS, extended lab testing) excluded acute cerebrovascular insult, encephalitis and hyperammonemia.

The diagnosis of cerebral vasculitis was considered after excluding infection or cerebrovascular insult. Anti-nuclear antibodies and anti-histone Antibodies were detected in the blood sample. Anti-NMDA receptor antibodies as well as antibodies for paraneoplastic syndromes and Bickerstaff encephalitis were not detected. MRI scans over eight months showed an increase of white matter lesions periventricular and in the brain stem.

Based on these results and the medical history, we considered a drug-induced vascular lupus erythematosus due to valproic acid. We initiated immunosuppressive therapy with high-dose prednisone while tapering valproate acid. Within days, the neurological symptoms declined and epileptic seizures ceased.

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This is the first described case of valproic acid-induced cerebral lupus erythematosus. There are no established recommendations for therapy or knowledge about the course and outcome of this condition. This case highlights the importance of evaluating valproate-induced lupus erythematosus in patients with fluctuating neuropsychiatric symptoms under valproic acid medication, in addition to valproate-induced encephalopathy. Prednisone might be a viable treatment option.

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Hashimoto’s encephalopathy (HE) is a rare, steroid-responsive neuropsychiatric disorder associated with Hashimoto’s thyroiditis. The pathophysiology of HE remains unclear, but it is hypothesized to involve an autoimmune mechanism, distinct from thyroid hormone levels. The condition often presents with a variety of neurological and psychiatric symptoms, including cognitive decline, seizures, mood disorders, and movement abnormalities. Timely diagnosis and treatment are crucial to prevent further neurological impairment.

This report highlights a case of HE in a patient with bipolar disorder and hypothyroidism.

A 42-year-old male patient, followed in psychiatry for bipolar disorder type I and in endocrinology for hypothyroidism secondary to Hashimoto’s thyroiditis, was admitted to the endocrinology department of Farhat Hached hospital, Sousse, due to fatigue, psychomotor retardation, and an enlarged goiter, in the context of discontinuation of his replacement therapy. Laboratory tests revealed a significantly elevated TSH level of 17.5mUI/L, indicating profound hypothyroidism. Hospitalization was therefore prompted by this endocrine decompensation to reinitiate treatment and to monitor him to prevent complications.

During the hospital stay, thyroid hormone replacement therapy was resumed. However, despite adequate treatment, the patient quickly became unstable, exhibiting vague persecutory delusions, marked irritability, changes in behavior, distractibility, attention problems, insomnia and confusion. This clinical picture raised the possibility of either a manic relapse with psychotic features, potentially triggered by the resumption of thyroid treatment, or Hashimoto’s encephalopathy.

Further investigations, including brain imaging and anti-thyroid peroxidase antibodies (ATPO) measurement, were performed. Brain imaging was normal, and ATPO were elevated. Given the clinical history and elevated thyroid antibodies, the diagnosis of Hashimoto’s encephalopathy was considered. The patient was started on corticosteroid therapy (prednisone), leading to a significant improvement in both psychiatric and cognitive symptoms within weeks.

This case illustrates the importance of considering HE in patients with neuropsychiatric symptoms and underlying thyroid disease. The combination of elevated ATPO levels and progressive psychiatric deterioration, with normal neuroimaging, and significant improvement with immunomodulatory treatment supports the diagnosis of HE. It is a rare condition with a reported prevalence of 2.1/100000. It presents with a wide range of neurological and psychiatric symptoms and the presentation varies among patients.

This case underscores the need for increased awareness of HE as a differential diagnosis in patients with thyroid disorders and neuropsychiatric manifestations.

None Declared

Schizophrenia is a complex and highly heterogeneous psychiatric disorder, and it is crucial to understand the different pathophysiology among patients to realize precision psychiatry.

This study aims to evaluate the potential of plasma microRNAs (miRNAs) as clinical biomarkers to stratify schizophrenia patients based on molecular profiles and understand the heterogeneous pathophysiology.

We measured the Positive and Negative Syndrome Scale (PANSS) scores, which are severity scores of clinical symptoms of schizophrenia, along with levels of 179 plasma miRNAs in 26 schizophrenia patients experiencing acute psychosis. We applied hierarchical clustering analysis for the plasma samples on miRNA levels to explore patient subgroups. We then conducted miRNA set enrichment analysis, literature-based text mining and manual literature survey on characteristic miRNAs for each patient subgroup to interpret the heterogenous pathophysiology. This study has been approved by the Ethical Research Practice Committee of Daiichi Sankyo Co., Ltd.

The schizophrenia patients were stratified into three subgroups based on the plasma miRNA profiles. One of these patient subgroups showed a tendency to have relatively high PANSS scores. This patient subgroup was characterized by distinctively low levels of four miRNAs. The enrichment analysis revealed an enrichment of ‘Immune Response’ pathways associated with these four miRNAs. Consistent with the enrichment results, literature-based text mining confirmed that these four miRNAs were frequently associated with ‘inflammation’ and IL-1β, IL-6, and TNFα in the literature. We also identified literature-based experimental evidence demonstrating that these four miRNAs reduce IL-1β, IL-6 and TNFα. These results suggest that the patient subgroup with high PANSS scores has relatively high inflammation.

miRNAs may potentially be clinical biomarkers that reflect both the symptoms and molecular pathology of schizophrenia, and they may be able to identify patient subgroups with relatively high inflammation. Such patient stratification based on molecular profiles is expected to be a key tool to realize precision psychiatry, e.g., prescribing right drugs for right patients.

T. Miyano Employee of: Daiichi Sankyo Co. Ltd., T. Mikkaichi Employee of: Daiichi Sankyo Co. Ltd., K. Nakamura Employee of: Daiichi Sankyo Co., Ltd., Y. Yoshigae Employee of: Daiichi Sankyo Co., Ltd., K. Abernathy Employee of: Sirtsei Pharmaceuticals, Inc., Y. Ogura Employee of: Daiichi Sankyo Co., Ltd., N. Kiyosawa Employee of: Daiichi Sankyo Co., Ltd.

ADHD (Attention-Deficit/Hyperactivity Disorder) is a common treatable disorder that impairs daily functioning along the life span. Pharmacotherapy plays a central role in managing ADHD, but adherence rates can be low, impacting treatment effectiveness.

To compare the adherence to the specific medication used to treat ADHD on specific patient populations.

In this study, we used “Clalit Medical Services” anonymized data base and focused on the first year of treatment with the four available first-line pharmacotherapy products: Methylphenidate tablets, Methylphenidate Slow Release tablets, Methylphenidate Long Aacting capsules, and Oros Methylphenidate tablets. Analyzing data from 214,035 patients of all ages diagnosed with ADHD who initiated pharmacotherapy between 2000 and 2022, we used a Negative Binomial Regression to develop a model to predict the number of prescriptions purchased in the first year of treatment, serving as a proxy for adherence. Our main focus was on identifying medications that enable better adherence.

Oros Methylphenidatehad the highest number of predicted purchases (RR CI 95%: 5.85-5.96). After adjusting for calendar year effects, our results identified gender, age group, and socioeconomic status (SES) as significant predictors of adherence. A significant interaction effect revealed that the predicted number of purchases for a specific medication is influenced by the patient’s SES level, i.e., for the lower SES levels adherence with Methylphenidate was better than adherence with Oros Methylphenidate.

The choice of the specific medication available as first-line treatment for ADHD, has a significant effect on adherence. Oros Methylphenidatehas has better adherence than the other MPH formulas. This would guide physicians to prefer the use of Oros Methylphenidateas first line therapy. This is not true for the lower SES. Strengthening our assumptions that knowledge about medication adherence and patient characteristics are potential indicators for improving the treatment of ADHD.

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Drug resistance is a major clinical challenge in psychiatry, with limited understanding of influencing factors. Personality traits and psychopathological symptoms may contribute to drug resistance, affecting treatment response to standard interventions.

This study aims to assess whether personality traits, mainly neuroticism and extraversion, and psychopathological symptoms correlate with drug resistance profiles in clinically stable patients with severe mental disorders.

The study included 36 outpatients (17 males, 19 females) consecutively treated at the Mental Health Centre of Rieti, Italy. Patients were diagnosed with Major Depressive Disorder (39%), Bipolar Disorder (25%), Schizophrenia (28%), and other diagnoses, including Obsessive-Compulsive Disorder (8%). Drug resistance was defined as a lack of response to previous antidepressant treatments, requiring either dual antidepressant therapy, add-on therapy with a tricyclic or lithium, or a lack of response to atypical antipsychotic treatments, necessitating either dual atypical antipsychotic therapy, the addition of a typical antipsychotic, or the prescription of clozapine. Mann-Whitney U tests were used to compare 11 patients with a drug resistance profile to the remaining 25, and stepwise logistic regression was conducted to assess the association between drug resistance (dependent variable) and study variables, including the Brief Psychiatric Rating Scale (BPRS), Eysenck Personality Questionnaire factors (e.g., extraversion, neuroticism), and Global Assessment of Functioning (GAF) scores. The local ethics committee approved this study (Protocol No. 0948/2023).

Mann-Whitney U tests revealed significant differences between groups in total BPRS scores (p = 0.032) and the BPRS Negative Symptoms subscale (p = 0.001), with higher scores in the drug-resistant group. GAF scores also differed significantly (p = 0.022), with lower scores in resistant patients. Logistic regression showed that extraversion had a significant negative association with drug resistance (β = -0.803, p = 0.033), suggesting higher extraversion is linked to reduced resistance. The BPRS Negative Symptoms factor had a significant positive association (β = 0.467, p = 0.026), while Positive Symptoms showed a trend toward a positive relationship (β = 0.508, p = 0.059). The final model explained a substantial proportion of variance (McFadden’s R² = 0.543) and improved over previous models (ΔΧ², p = 0.042).

Extraversion negatively correlates with drug resistance profiles in clinically stable patients with severe mental disorders. BPRS negative symptoms are positively correlated with resistance, and positive symptoms show a similar trend. This study highlights the importance of personality and psychopathological aspects in treatment response and the need for personalized interventions for patients with drug resistance.

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Pain has a significant impact on a person’s quality of life, limiting general activity (work, social interaction, problems with family relationships, hobbies/interests, self-care ability), contributing to the development of mental disorders such as depression and anxiety.

Our study aimed to determine the level of anxiety, depression, and functional disabilities caused by chronic pain among outpatients in order to further dynamic research of the long-term consequences.

The study group included 85 outpatients with chronic pain. As a part of psychiatric screening, the HADS depression and anxiety scale was used to study psychopathological symptoms. The WHO self-questionnaire WHODAS 2.0 was used to study the dysfunction caused by chronic pain.

The study found that a significant part of patients with chronic pain had symptoms of anxiety 38% and depression 46% of varying severity. The medial WHODAS 2.0 score among all patients with pain and patients with comorbid depression and anxiety was 23.62 (95% CI: 21.19-24.63), 32.80 (95% CI: 30.33-35.16), and 34.35 (95% CI: 32.11-37.60), respectively. Disability was significantly higher in patients with depression (1.72, p <0.01) and anxiety symptoms (1.60, p <0.01) than in patients with chronic pain without anxiety and depression.

Effective treatment of chronic pain requires a comprehensive approach using psychotherapeutic, psychopharmacological, and physical therapy.

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Procrastionation is commonly conceptualized as an irrational, conscious, and sometimes intentional tendency to delay the start or to complete tasks or decisions, despite consequences. The behavior may be present in several psychiatric disorders, especially OCD, ADHD and anxiety disorders However, there is no consensus definition of procrastination, nor established pathophysiology or motivation.

To analyze the descriptive psychopathology as well as the presence or absence of associated symptoms, motivations, and consequences of procrastination. In sequence, to conceptualize the construct of “procrastination” based on the literature published and define the motivations and consequences of the behavior for the individuals.

The scoping review complies with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and included articles published English, Spanish and Portuguese, between 1973-2023 and indexed in PubMed/MEDLINE, LILACS, Scielo, EMBASE, Scopus, Web of Science, and PsycINFO database. Research conducted in animals, poster publications, conferences in scientific conclaves, and letters to the author were excluded.

We found 387 studies with different designs (295 [76,2%] were cross-sectional, 12 [3,1%] systematic reviews and 5 [1,3%] were meta-analysis) and published in English (86,6%), Spanish (9,3%) and Portuguese (3,9%). Only 5 studies (1.3%) used populations with AHDH and 1 study (0.02%) used a population with OCD, 7 studies (1.8%) used populations with other disorders (Depression, Anxiety) and 374 studies (96.4%) involved students (mainly university students), workers, or the general population. Of the population the majority was female (63,98%), single, young and has some occupation. In 323 articles, at least one scale was used to assess procrastination, with a total of 40 different ones. Furthermore, 337 studies define procrastination and 305 use the definition of other authors.

Procrastination is a complex event, so far without a defined concept. More investigation is necessary for a more comprehensive understanding of this phenomenon.

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Measurements of event-related potentials (ERP), recorded through electrophysiology (EEG) during sensory and cognitive processing tasks, have been widely employed to investigate the pathophysiological basis of mental health disorders. In the last two decades, the analysis of EEG microstates (MS) has been increasingly applied to ERP data. This methodology allows the detection of spatio-temporal changes in neuronal activity potential at the scalp level, providing new insights into neurobiological alterations detectable in psychiatric disorders.

The current systematic review aims at providing an extensive and detailed description of the studies that characterized alterations in ERP-microstates in psychiatric and neurodevelopmental disorders.

A systematic review of English articles using PubMed, Scopus and Web of Science databases was undertaken in April 2024. The review included case-control studies that employed ERP-microstates analysis to compare MS features between subjects (age > 10 years) diagnosed with a mental health disorder and healthy controls.

Out of the 756 records screened, 15 studies were included in the final qualitative synthesis. The studies included patients with schizophrenia (n=7), alcohol use disorder (n=2), borderline personality disorder (n=1), panic disorder (n=1), autism (n=1), major depressive disorder (n=1), post-traumatic stress disorder (n=1) and attention-deficit/hyperactivity disorder (n=1).

The studies investigated alterations of MS characteristics through different types of tasks. Cartool and RAGU were the main software used for MS analysis. Only rarely studies used similar tasks, showing comparable microstate maps. Fourteen of 15 studies showed a significant difference (p<0.05) in MS characteristics between patients and healthy controls. Main differences regarded parameters such as duration, area under the curve and the order of occurrence of MS.

The present literature review aims to highlight the effectiveness in using microstate analysis to identify spatio-temporal alterations in brain electrical activity in subjects with psychiatric disorders, showing the possible implications of the use of this technique in clinical practice and its advantages, as compared to ERP peak analysis.

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Parkinson’s disease (PD) is characterized by basal ganglia dopamine depletion, leading to motor symptoms. Psychiatric symptoms, like psychosis, are associated with dopamine overactivity in the mesolimbic and mesocortical system. PD patients sometimes require both motor and psychiatric treatment. However, the pharmacologic treatments for each have opposing dopaminergic effects. Understanding the balance between dopamine antagonists to treat psychosis while increasing dopamine agonists (DAs) to treat PD is a difficult clinical task.

We aim to explore how dopamine agonists and antagonists affect the responsiveness of dopamine receptors in various brain regions.

We conducted a comprehensive literature review on pharmacological management of patients with PD and concurrent psychiatric symptoms. Special attention was given to balancing dopamine agonists (e.g., Carbidopa-Levodopa) for PD and dopamine antagonists (e.g., Quetiapine) for psychiatric symptoms.

While dopamine agonists and antagonists appear counterintuitive when used concurrently, their efficacy is contingent on target brain regions. DAs (Carbidopa-Levodopa) are most beneficial for increasing dopamine deficits in the striatum and nigrostriatal pathway, where voluntary movement is controlled. In PD, this pathway is primarily affected, and DAs are used to target the striatum’s high concentration of D1 and D2 sub-receptors. Gold-standard DAs mainly target D1 and D2 receptors.

Dopamine antagonists mitigate excess dopamine activity in the mesolimbic and mesocortical systems, which affect reward, memory, and executive functioning. These systems possess a high concentration of D3 and D4 sub-receptors. Typical antipsychotics have strong D2 receptor affinity, making them counterintuitive to DA motor treatment. Atypical antipsychotics have partial D2 affinity, but also readily bind D3 and D4. Some atypicals minimize D1/D2 affinity to allow DAs to be more effective. Quetiapine is currently used for psychosis in PD, but the drug’s MOA is not fully understood. Cariprazine binds D3 well but does cause extrapyramidal effects with its D2 affinity. Clozapine strongly binds D4 but can have severe adverse effects. Additionally, pramipexole and ropinirole have strong D3 and D4 affinity. Ultimately, the key lies in symptom control: achieving optimal motor function while controlling psychiatric manifestations.

PD management with concurrent psychiatric disease requires diligent pharmacologic balance of countering dopamine treatments. Dopamine agonists and dopamine antagonists do have opposed pharmacodynamics, but clinicians must understand that certain pharmacologic agents do not all target the same brain area nor dopamine sub-receptor. Clinicians must use this pharmacologic knowledge to carefully balance these therapies by adapting to the individual patient’s symptomatology and treatment response.

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Although the literature suggests a strong association between attention deficit hyperactivity disorder (ADHD) and obesity, the underlying mechanisms remain unclear. Eating attitudes and appetite-regulating hormones (ARH) are considered to play a role in this relationship. Recent studies have shown that ARH may be linked to executive functions, and dysregulation of these hormones may help explain the connection between ADHD and obesity.

We aimed to investigate the levels of ARH, executive functions, eating attitudes, and ADHD symptoms in adults with ADHD compared to healthy controls.

The study included 44 drug-naive non-obese adults with ADHD who had no comorbid psychiatric diagnoses and 44 healthy controls matched for age, gender, education, and body mass index (BMI). All participants were diagnostically assessed using the Structured Clinical Interview for DSM-5 Disorders-Clinician Version. Also, participants completed the Adult ADHD Self-Report Scale, the Mind Excessively Wandering Scale, the Hospital Anxiety and Depression Scale, and the Eating Attitude Test (EAT). A battery of neuropsychological tests—Stroop Test (ST), Cancellation Test, Serial Digit Learning Test (SDLT), Wisconsin Card Sorting Test (WCST), and Judgment of Line Orientation Test (JLOT)—was administered. The serum samples obtained from fasting blood, after centrifugation were stored at -80°C until the time of analysis, at which point ARH levels (insulin, leptin, neuropeptide Y, orexine A, ghrelin, adiponectin) were measured using the ELISA method. The study was approved by Selçuk University Local Ethics Committee with the decision numbered 2023/328.

Adults with ADHD exhibited worse ADHD symptoms, disordered eating attitudes, more severe anxiety and depression, and reduced executive functioning compared to healthy controls. Although ADHD groups showed more disordered eating attitudes compared to healthy controls, there was no significant difference in ARH levels between the two groups; however, these hormone levels were associated with specific parameters from ST, SDLT, WCST, and JLOT. Linear regression analyses to identify factors associated with each ARH separately revealed significant F values, except for ghrelin, which explained a unique variance ranging from 23.5% to 36%. These results indicated that visuospatial ability was associated with each ARH levels, even after controlling for age, gender, years of education, body mass index, severity of disordered eating attitudes, and the absence of an ADHD diagnosis.

Our findings suggest that dysregulation of ARH may associate cognitive processes related to executive functioning independent of disordered eating attitudes, BMI, and ADHD diagnosis. However, these hormones may be mediating factors in relation between ADHD and obesity, and to figure out this relation, longitudinal clinical studies with larger samples are needed.

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