Despite differences in the onset and symptomatology, Autism Spectrum Disorder (ASD) and Schizophrenia (SCH) are neurodevelopmental conditions with evolving conceptual links in modern psychiatry. This stems from increasing evidence suggesting overlap in social cognition, attachment and the conceptualization as disorders of the self. A transdiagnostic approach, in which network analysis can play an important role, offers valuable insights into the complex interrelationships between symptoms and key constructs in the psychopathology of them. It may reveal underlying similarities and differences, contributing to more targeted interventions.

Our study aims to investigate the symptom structures of ASD, SCH, and neurotypical individuals (NTP) using network analysis. By comparing them, our explorative goal was to identify key constructs and their connections, providing potential intervention targets. We hypothesize that both ASD and SCH networks will significantly differ from the NTP network, and that mentalization and disorganized schizotypy would be the most central nodes in the networks of ASD and SCH.

In a cross-sectional study, 1694 participants were involved in the analysis (NNTP=1477, NASD=155, NSCH=62). Participants completed self-report questionnaires. Based on theoretical and methodological considerations we included psychological inflexibility, mentalization, insecure attachment, perceived social support, minimal and narrative self, negative and disorganized schizotypy, autistic traits, anxiety in the analysis. Gaussian Graphical Models were used to estimate relationships between constructs, with LASSO regularization, focusing on network centrality and predictability measures. Network Comparison Test was applied to unveil local and global differences.

A comparative representation with node scaling for predictability values are shown in image 1 and image 2. Minimal self was the most predictable node in each case. Central nodes in the ASD network were psychological inflexibility and minimal self, in the SCH network narrative self and insecure attachment, in the NTP network psychological inflexibility and minimal self. Significant differences in global strength were observed between ASD and NTP networks. Details of a relevant pattern are shown on image 3.

Image 1:

Image 2:

Image 3:

Our study highlights distinct symptom networks in ASD and SCH, with distinct centralities emerging. Results suggest interventions targeting psychological inflexibility and self-concept may be effective for ASD, while in SCH, narrative self experience and attachment insecurity may be beneficial. Results show that focusing on isolated constructs may overlook the importance of other constructs. By focusing to the strongest edges and relevant patterns, clinicians may benefit from interventions that simultaneously target the dimensions of the relationships, also considering the most central nodes in the network.

None Declared

Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are two common neurodevelopmental conditions, whose prevalence in the general population has significantly increased in the last decade (2.2% and 2.5%, respectively). The co-occurring prevalence of ASD and ADHD is estimated at approximately 28% (Lai et al. 2019), and the differential diagnosis between these two conditions has become increasingly challenging, especially in adulthood. For instance, both individuals diagnosed with either ASD or ADHD might present social difficulties, despite the underlying causes are notably different: individuals with ASD struggle with social approach and communication, while individuals with ADHD might show distractibility and rapid loss of interest in social activities, or even exhibit behaviors perceived as annoying or rude, such as interrupting and intruding conversations (Antshel & Russo, 2019). Most importantly, in both ASD and ADHD (and especially in women) copying strategies such as the well-known “camouflaging” were observed, to mask autistic- or ADHD-related traits, to try to fit into a society mainly structured by and for neurotypical individuals (Lai & Baron-Cohen, 2015), but ultimately affecting their physical and mental health.

Aim of this study was to estimate the prevalence of ADHD traits and diagnosis in a sample of adult individuals with ASD without intellectual disabilities, examine sex differences in ADHD features, and explore the association between impulsivity and autistic traits.

146 adults with ASD completed assessments for autistic-, ADHD-traits, and impulsivity. Those above the ADHD-traits cut-off underwent the Diagnostic Interview for ADHD in adults (DIVA-5).

42 subjects (28.8%) were diagnosed with ADHD comorbid with ASD (26 combined type, 16 inattentive, 0 impulsive). Most diagnosed subjects (71.4%) were females, but males scored higher on inattentive and hyperactive-impulsive symptoms. Autistic traits were positively correlated with attentive impulsiveness.

Adults with ASD without intellectual disabilities show a significant prevalence of comorbid ADHD, particularly with inattentive symptoms. Attention difficulties are common in both disorders. Further studies and tailored diagnostic processes are needed to assess sub-threshold symptoms in ASD, ADHD, and other neurodevelopmental conditions.

None Declared

Dysfunctions in mental imagery are linked to various psychopathologies, including intrusive memories from trauma, distorted perceptions of reality, and mood disorders. Therapeutic approaches, such as Imagery Rescripting (ImRs), address emotional dysfunctions by modifying mental images. ImRs is a cognitive-behavioral process requiring substantial visuospatial working memory, where distressing memories are recalled and actively altered to reduce their emotional impact. Neuroimaging studies suggest that ImRs engages mechanisms related to sensory perception and autobiographical memory recall.

The objective of this paper is to review recent functional neuroimaging evidence on the effects of ImRs on emotional regulation. Specifically, it seeks to explore the neurological mechanisms of ImRs, focusing on its interaction with visuospatial working memory and sensory-perceptual processes to influence emotional outcomes.

An integrative review of neuroimaging studies on ImRs was conducted using databases like PubMed and Google Scholar, with keywords such as “ImRs” and “functional MRI (fMRI).” The review focused on studies from the last 10 years. Brain areas involved in emotional regulation, such as the visual cortex, amygdala, prefrontal cortex, and hippocampus, were emphasized. Both experimental and clinical studies were included to provide a comprehensive understanding of ImRs’ neurobiological mechanisms.

ImRs improves emotional regulation by activating brain systems involved in visuospatial working memory and emotional responses. Neuroimaging studies reveal that ImRs stimulates the visual cortex and other regions, depending on the type of mental imagery. Emotional systems responsible for primary responses like fear and reward are influenced through these sensory-perceptual processes. Since these emotional systems develop before language, ImRs effectively modifies emotional responses tied to distressing memories by altering the brain’s sensory processing. The findings suggest that ImRs reshapes neural pathways related to visuospatial memory and emotional processing, with significant activation of the visual cortex, amygdala, and prefrontal cortex during rescripting. This highlights its potential as a therapeutic tool for emotional dysfunctions, such as trauma and mood disorders. However, gaps remain in fully understanding its long-term neurological effects and the complete range of brain regions affected by ImRs.

This review highlights the potential of ImRs in regulating emotions by influencing key brain regions. While ImRs shows promise in modifying emotional responses and neural pathways, there are still gaps in understanding its long-term effects. Future research should focus on these gaps, using advanced neuroimaging techniques and examining its effects across diverse clinical populations to fully elucidate its neurobiological mechanisms and optimize therapeutic applications.

None Declared

Auditory hallucinations (AH) are frequently considered a hallmark of psychotic disorders. Even in the absence of any other features, persistent AH will fall under the DSM-5 label of Other Specified Schizophrenia Spectrum and Other Psychotic Disorder. However, AH are not exclusive to psychosis and can occur across various psychiatric and neurological conditions. Furthermore, AH have been reported in the general population, with prevalence estimates ranging from 4% to 21%. While typically transient and sporadic, a minority may experience recurrent and persistent AH. These experiences, spanning from subclinical to pathological, have been lately understood within the framework of the “extended psychosis phenotype”.

This study aims to challenge the conventional view of AH as definitive indicators of psychotic disorders by examining their occurrence in different contexts and exploring the relevance of the “extended psychosis phenotype” in understanding these symptoms.

A literature review was conducted using the keywords “auditory hallucinations”, “extended psychosis phenotype” and “phenomenology” in the PubMed and Google Scholar databases.

Psychotic experiences seem to run in families, suggesting a transdiagnostic psychosis trait that may be passed down independently of emotional or thought regulation processes. As a result, psychosis - and AH in particular - can be expressed across multiple disorders, including schizophrenia, bipolar disorder, major depressive disorder, anxiety disorders, autism spectrum disorders, post-traumatic stress disorder (PTSD), and certain personality disorders, such as borderline personality disorder (BPD). Phenomenological differences of AH across these conditions remain unclear. Notably, evidence challenges the concept of ‘pseudohallucinations’ in BPD, showing that AH can be as severe and persistent as those in schizophrenia. Neurobiologically, AH are not always linked to abnormal dopamine activity, which calls into question the routine use of antipsychotics for all psychotic-like symptoms. Environmental and psychological factors, such as trauma, also play a role in AH, especially in BPD and PTSD. In such cases, psychosocial interventions, such as cognitive-behavioral therapy and trauma-focused therapies, are often more effective than pharmacological treatments. Finally, AH can occur in isolation, with a generally low risk of progressing into a full psychotic disorder unless accompanied by other psychotic symptoms or functional impairments.

The diagnostic approach to AH should be reconsidered to avoid automatic narrowing of differential diagnosis to psychotic disorders. AH can emerge from various mechanisms, including non-dopaminergic pathways. Recognizing the extended psychosis phenotype and transdiagnostic psychosis trait is crucial for understanding the continuum of psychotic experiences and improving treatment approaches.

None Declared

A growing body of literature focuses on psychosocial interventions that include positive outcomes such as resilience, posttraumatic growth, and meaning in cancer survivors. A research synthesis is needed to provide a comprehensive understanding of this field.

This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to determine the effectiveness of psychosocial interventions on resilience, posttraumatic growth, and meaning in cancer survivors.

CINAHL Plus with Full Text (EBSCOhost), CENTRAL, Pubmed, and WOS Core Collection databases were searched with no publication date or language restrictions. In addition, backward and forward citation searching was conducted in the Scopus database. The risk of bias of included studies was performed using the Revised Cochrane risk-of-bias tool for randomized trials (ROB2). The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used for rating the certainty of evidence assessment. Analyses were carried out using IBM SPSS Statistics 28, trial version.

The review included 14 RCTs with 1801 participants, published between 2005 and 2022. 10 of 14 RCTs reporting posttraumatic growth and/or meaning outcomes were involved in quantitative analysis. The overall risk of bias was judged as “some concerns” or “high” for all but one study. The pooled results suggested a small, beneficial effect in favor of psychosocial interventions on meaning “from pre-to immediately post-intervention,” compared with routine care (Cohen’s d = -0,298, 95% CI: -0,518 to -0,077; p = 0.008; I2 = 0%; 319 participants; low-certainty evidence), but no sustained effects “from pre-intervention to the longest follow-up” period (Cohen’s d = -0,172, 95% CI: -0,361 to 0,018; p = 0.075; I2 = 0%; 433 participants; low-certainty evidence). No significant differences were found for posttraumatic growth between the effects of psychosocial interventions and routine care “from pre-to immediately post-intervention” (Cohen’s d = -2.310, 95% CI: -5.735 to 1.115; p = 0.186; I2 = 99.6%; 498 participants; very low-certainty evidence) and “from pre-intervention to the longest follow-up” (Cohen’s d = -1.612, 95% CI: -3.847 to 0.623; p = 0.157; I2 = 99.6%; 947 participants; very low-certainty evidence) periods. The effects of psychosocial interventions on resilience could not be pooled since only two studies existed.

The effectiveness of psychosocial interventions on all study outcomes is uncertain, and additional evidence are needed. Future RCTs of high methodological quality are warranted to meet the robust effects of psychosocial interventions in cancer survivors.

None Declared

When an adolescent or young adult is diagnosed with cancer, they’re frequently accompanied by their caregiver. Literature shows that caregivers of adolescents and young adult cancer survivors (AYACS) frequently experience high anxiety and depressive symptoms. Being these caregivers an important source of support to AYACS during this challenging journey, one question emerges: does caregivers’ mental health impact AYACS’ quality of life (QoL)?

Considering this, this study examined the associations between caregivers’ mental health and AYACS’ QoL.

Forty-eight dyads were recruited in four hospitals and one association in Portugal. AYACS were mostly women (62.5%) and off-treatment (62.5%). They were, on average, diagnosed at 18.9 years (range: 15-25) and currently 21.98 (range: 15-38). Their caregivers were mostly women (77.1%) and, on average, 47.02 years (range: 19-76). Parent-child dyads were the most frequent. The Quality of Life Questionnaire Core-30 assessed the AYACS’ QoL. Caregivers’ mental health, the Hospital Anxiety and Depression Scale, and the FCR7 scale assessed caregivers’ anxiety and depressive symptoms and fear of cancer recurrence, respectively.

Preliminary results show that among AYACS’ QoL, only low social functioning was significantly related to high anxiety and depression in caregivers. Treatment status was also significantly positively related to AYAs’ social functioning and negatively to caregivers’ anxiety and depression. AYAs and caregivers’ ages at recruitment were also negatively correlated with caregivers’ anxiety. Age of AYACS at diagnosis, living with caregiver, and type of caregiver were not related to AYACS social functioning nor caregiver anxiety and depression. A model was tested, showing that caregivers’ anxiety and depression predict AYAs’ social functioning, having treatment status as covariable.

Caregivers’ mental health and treatment status were shown to be important for AYACS’ QoL, especially social functioning. This supports the need to assess how caregivers are adapting to this new stage of life and provide specialized support when needed. This could indirectly have a positive impact on the QoL of AYACS. It’s important that the support provided considers the diverse challenges these caregivers face, which can differ from other caregiver groups.

None Declared

Individuals at high familial or genetic risk of cancer face unique psychological challenges that can lead to significant distress, including worry, fear, and uncertainty about their future health and family members’ risk. This study assessed mental health challenges, including anxiety and depression, in this population and explored their preferred forms of psychological support.

To examine the prevalence of psychological distress in individuals at high hereditary cancer risk, the relationship between their current perceived support and distress, and preferred psychological support forms to inform the development of tailored mental health services.

Participants (N = 152; 95% female, 3% male, 2% non-binary; mean age = 42.6 ± 8.3) were cancer-free residents of the Republic of Ireland identified as high-risk for hereditary cancer through high-risk clinic attendance or self-reported genetic screening or family history. They completed a cross-sectional survey using standardised mental health assessments, including Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9), and self-reported adequacy of psychological support and preferences. Descriptive statistics and post-hoc tests were used to analyse psychological distress, support adequacy, and preferences.

Moderate to severe anxiety (GAD-7 ≥10) was reported by 23%, and moderate to severe depression (PHQ-9 ≥10) by 18%. Participants reporting inadequate support had significantly higher anxiety (M = 8.1 ± 6.2) and depression (M = 6.4 ± 5.7) scores than those with adequate support (GAD-7: M = 4.2 ± 3.9; PHQ-9: M = 3.6 ± 3.9). ANOVA indicated significant differences in anxiety (F (2,132) = 7.04, p = .001) and depression (F (2,130) = 4.68, p = .011) scores across support levels. Post-hoc Tukey tests showed poorer mental health for those without support (p < .001 for anxiety; p = .013 for depression). Mental health professionals (psychologists and counsellors) were the top preferences for support, chosen by 74.8% of participants, with 47.5% selecting a psychologist and 27.3% a counsellor. An additional 12.2% preferred a healthcare professional (e.g., General Practitioner or nurse).

This study provides important insights into the mental health challenges faced by individuals at high hereditary cancer risk, particularly those lacking adequate psychological support. Participants reporting inadequate support experienced significantly higher levels of anxiety and depression. These findings highlight the importance of ensuring adequate psychological support services for this population and their strong preference for professional psychological care. Integrating this care into routine genetic counselling and oncology services could help to address the unmet mental health needs of this underserved population.

None Declared

The high prevalence of anxiety and depression among patients with cancer has an impact on a decrease in quality of life. there are practically no studies among people with lymphoproliferative diseases, which determines the relevance of our study.

Purpose: to assess the prevalence of anxiety-affective spectrum disorders and their impact on the quality of life and adaptability in patients with non-Hodgkin lymphoma (NHL), Hodgkin lymphoma (HL) and a group, including malignant neoplasm of the body of the stomach and T- and B- cellular lymphoma.

95 patients (women - 52, men - 44) diagnosed with NHL, HL, others were examined using a continuous sampling method.

Clinical interviews; the author’s questionnaire; HADS, EQ-5D, EQ-VAS, PSM-25. STATTECH were used to process the data.

The average age was 52.8±8.3 years (18 to 86). 3 groups: 1-non–Hodgkin’s lymphoma, 2-Hodgkin’s lymphoma, 3- malignant neoplasm of the stomach body and T- and B-cell lymphoma. In gr-s 1 and 2 (90% and 85%), no symptoms of anxiety were detected. In gr 3, clinically pronounced anxiety levels were uniformly detected in 50%. Depressive symptoms a predominantly absence in all groups (1 - 95%; 2 - 86% and 3 - 75%) p>0.05. The assessment of quality of life: in gr 1 and 2, most of the patients noted that they experience some difficulties in the final indicator (55% and 61%), pronounced problems prevail in gr 3 (50%). The mobility of the majority in all groups does not suffer or suffers to a minor extent, 80% of all noted the absence of difficulties in self-care. “daily activity” were a statistically significant - 64% maintained it at a high level (p=0.006); Pain/discomfort is experienced by more than half of the respondents to a moderate degree 55% (p=0.003). In gr 1 and 3, the average of EQ-VAS determined at a level of more than 70 (the arithmetic mean 78 and 73), which indicates a more favorable sense of self. In gr 2 the average was determined at 68, also characterizes a high level of assessment of their general condition, in all patients with CLL, according to PSM 25, the stress level was determined to be low, indicates a state of psychological adaptation to workloads in 100%. In the gr 1, 12 people (17%) were identified with an average level of stress and reduced adaptation and need the rest for this contingent.

our pilot study showed that patients with lymphoproliferative diseases are characterized by a slight decrease in their quality of life, a high level of life satisfaction, good stress resistance to workloads. The main symptoms (reliably expressed in 55%), are moderate severity of pain and discomfort. The obtained data make it possible to emphasize the heterogeneity of the prevalence and severity of anxiety-affective symptoms in patients with various types of oncological diseases.

None Declared

Topiramate is a widely prescribed anticonvulsant and migraine prophylactic agent, recognized for its efficacy in treating epilepsy and preventing migraines. While its use is generally well-tolerated, it is known to cause a range of side effects. However, olfactory hallucinations, also referred to as phantosmia, represent a rare and poorly documented adverse effect of Topiramate. Phantosmia involves the perception of smells in the absence of an external odor source. This case report presents the case of a woman who developed olfactory hallucinations following the re-initiation of Topiramate for epilepsy. The hallucinations resolved completely upon discontinuation of the drug. This report highlights the need for clinicians to be aware of this potential side effect.

Topiramate is a well-established treatment for epilepsy and migraine prevention, but it can cause neurological and cognitive side effects like paresthesia, dizziness, memory issues and confusion. However, olfactory hallucinations are rare and underreported. This case report aims to contribute to the limited literature by documenting a case of reversible phantosmia related to Topiramate.

A woman presented with complaints of persistent olfactory hallucinations, perceiving unpleasant odors in the absence of any external source. Her medical history was unremarkable, apart from a diagnosis of epilepsy. After other treatments had limited success, she was started on Topiramate a couple of weeks before the manifestation of the olfactory hallucinations. Weeks after starting Topiramate, the patient began experiencing olfactory hallucinations which interfered with her daily life. The patient had no prior history of olfactory disorders, nasal pathology or psychiatric conditions and her physical examination was unremarkable. Upon investigation, no structural abnormalities were found.

The patient’s medication history revealed that the onset of olfactory hallucinations coincided with the initiation of Topiramate.After discussing the side effect profile of the drug, it was decided to discontinue Topiramate. Within two weeks of discontinuation, the patient reported a complete cessation of the olfactory hallucinations. A follow-up evaluation showed no recurrence of the symptoms after switching to an alternative therapy. Given the temporal relationship between the onset of olfactory hallucinations and Topiramate use, alongside the resolution of symptoms upon drug discontinuation, a diagnosis of Topiramate-induced phantosmia was made.

This case highlights a rare but significant adverse effect of Topiramate, olfactory hallucinations. Given the reversibility of this side effect upon discontinuation of the drug, physicians should be vigilant in monitoring for sensory disturbances in patients administered with Topiramate. Awareness of phantosmia as a potential adverse effect will allow for appropriate management, potentially preventing patient distress.

None Declared

International Medical Graduates add up to nearly one-third (23-28%) of the total physician workforce in the US, the UK, Australia, and Canada, of which around 40%-75% are from low-income countries. Pakistan is one of the three leading source countries following India and the Philippines. As per 2002 statistics by the Bureau of Emigration and Foreign Employment, only 10-15% of emigrated Pakistani physicians repatriate. No official data on the exact number of repatriated Pakistani physicians are available. This is the first original study that assessed satisfaction with life in physicians repatriating to a lower-middle-income country.

To assess satisfaction with life (SWL) and its correlation with psychological well-being in foreign-trained, repatriated Pakistani physicians.

We conducted this cross-sectional study from April’22 to Nov’23, through purposive sampling among foreign-trained Pakistani physicians who repatriated at least three months before participating. We used the Scale of Positive and Negative Emotions (SPANE), Flourishing Scale, and Satisfaction with Life (SWL) scale. After transforming data to normality in SPSS 25 through the Distribution Fraction method, the independent sample t-test, and one-way ANOVA were applied. We assessed the correlation between affect balance, flourishing, and SWL through Pearson’s correlation and ascertained the predictors of SWL through binary logistic regression (α=0.05).

Of 109 respondents, the majority (70.6%) were males, from Punjab (83.5%), trained in USA/Canada (68.8%), and from the private sector (69.7%), with a Mean±SD age of 47.31±7.9. The total Mean ± SD SWL scores were 27.48± 5.03. 99 (90.8%) were satisfied with life while only 9.2% weren’t. The currently married respondents (27.8±4.9 vs 24.6±5.4, p=0.04) while those from Sindh and KPK provinces had lower scores. We found a positive moderate correlation between SWL and flourishing (r=0.488), positive emotions (r=0.391), and affect balance (r=0.327) all at p=<0.001. We found good fitness of the final model with SWL as the outcome variable and Flourishing and Overall Affect Balance as predictors: Omnibus Tests of Model Coefficients (p=0.001) and Hosmer and Lemeshow tests (p=0.322). Only flourishing predicted SWL and with higher perceived flourishing, there were 1.3x higher odds of SWL.

This is the pioneer study to have addressed SWL and its correlation with psychological well-being in repatriated physicians, who using their skill sets and expertise, may help strengthen the healthcare system of the lower-middle income countries of origin, hence it’s imperative to identify factors linked to their psychological well-being. We recommend further research on this particularly qualitative exploration.

None Declared

Autism is a neurodevelopmental condition affecting 1 in 36 people worldwide. Approximately one third of autistic individuals report a diagnosed mental health condition. Autistic people constitute 20% of referrals to outpatient psychiatry clinics. Limited knowledge and awareness of autism is the main barrier to receiving appropriate diagnostic and therapeutic support. Autistic individuals’ increased mental health needs coupled with greater barriers to accessing healthcare necessitate that both primary care physicians as well as specialised services are well versed in working with these patients.

This study aimed to evaluate knowledge of autism and self-reported confidence in caring for autistic patients amongst psychiatrists and general practitioners (GPs) in Malta. This will facilitate identification of lacunae in doctors’ knowledge and advocating for greater training and awareness.

A online, anonymous questionnaire was distributed amongst psychiatrists and general practitioners in Malta as well as psychiatry and GP trainees. The questionnaire consisted of demographic questions, a 22-item modified Knowledge of Autism Scale as well as a 14-item Self-efficacy Scale targeting confidence in working with autistic patients. Data was analysed using SPSS and scores were adjusted for chance responses. Scores of the psychiatry group and the GP group were compared.

The questionnaire was answered by 98 participants of which 60% (n=59) were female. The mean score on the knowledge of autism scale was 89.2% (SD=7.7) for psychiatry and 83.1% (SD=8.5) for GP. Mann Whitney U test revealed that psychiatrists fared better than GPs with an effect size of 0.35 (p=0.0003). The mean self-efficacy score was 6.7 (SD=0.4) for psychiatry and 5.7 (SD=0.8) for GP. Independent sample t-test revealed that psychiatrists scored better than GP (p=0.0003, 95% CI [0.509,1.49]). In both groups, there was no significant correlation between knowledge of autism scales and self-efficacy scales (psychiatry p = 0.26; GP p = 0.14).

General practitioners, psychiatrists and their trainees overall have good knowledge about autism, and feel moderately confident in working with autistic patients. As expected, psychiatrists scored better than GPs for both knowledge and self-reported efficacy. The scores obtained are comparable to studies done on a similar population in the United Kingdom. Unfortunately, Malta stilll lacks autism diagnostic services in the public sector. Nonetheless, undergraduate medical education and postgraduate training must strive to prepare doctors for working with this common cohort of patients. This will ensure a high standard of care and avoidance of adverse health outcomes or iatrogenic harm.

None Declared

Alcohol use remains a significant public health issue across Europe, contributing to approximately 5% of premature deaths and 25% of all fatal road accidents. The effects of excessive alcohol consumption are widespread, impacting both physical and mental health. In Moldova, as in many other regions, alcohol use is a contributing factor to a range of health issues, including alcohol dependence and alcohol-induced psychoses. This underscores the importance of comprehensive strategies to address these challenges and promote better mental health outcomes.

This study aims to analyze the epidemiological trends of alcohol use in Europe, particularly Moldova, and its associated mental health consequences. It explores the role of alcohol in the development of psychiatric comorbidities, including depression and anxiety, and discusses strategies for prevention and treatment.

Data from WHO and local health authorities were used to assess the incidence and prevalence of alcohol dependence and alcohol-induced psychoses. The study tracked trends from 2019 to 2023 across different regions in Moldova, comparing them with European data. Furthermore, the study examined the links between alcohol use and mental health disorders like depression and bipolar disorder, highlighting the complexities of managing these co-occurring conditions.

The analysis of alcohol use patterns in Moldova revealed significant regional variations in both alcohol dependence and alcohol-induced psychoses. For instance, the Northern region experienced an increase in alcohol dependence rates from 79,2 cases per 100,000 in 2019 to 99,2 in 2023. Similarly, the prevalence of alcohol-induced psychoses in the Central region rose from 26,4 cases per 100,000 in 2019 to 35,2 in 2023. These patterns are consistent with trends observed across Europe, where alcohol consumption is frequently linked to heightened risks of developing mental health disorders, particularly depression and anxiety. Furthermore, alcohol-related psychiatric conditions pose challenges for effective treatment, often requiring integrated care that addresses both substance use and mental health.

The evolving patterns of alcohol use and its associated mental health consequences highlight the need for integrated, non-stigmatizing public health interventions. Prevention strategies that combine public health education, policy reform, and improved access to mental health services can help reduce the burden of alcohol use on individuals and communities. Early intervention and personalized care approaches are essential for mitigating the dual impact of alcohol and mental health issues.

None Declared

Attention Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by symptoms of inattention, hyperactivity, and impulsivity, which adversely affect an individual’s functioning across various domains, including home, work, and social environments. Recent research has underscored the presence of emotional dysregulation in individuals with ADHD, contributing to significant clinical and functional impairments.

This study aims to investigate the presence and severity of emotional dysregulation and childhood maltreatment in adults with ADHD and to explore the potential association between emotional dysregulation and childhood maltreatment within this population.

The study included 80 newly diagnosed adult patients with ADHD and 80 healthy control participants. ADHD diagnosis or exclusion was conducted using the Diagnostic Interview for ADHD in Adults (DIVA 2.0) based on DSM-5 criteria. Additionally, the ADHD group underwent screening with the DSM-IV Structured Clinical Interview (SCID-I). Participants were assessed using the Difficulties in Emotion Regulation Scale (DERS), the Childhood Trauma Questionnaire (CTQ), the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), and ADHD self-report scales (WURS and ASRS).

The ADHD group exhibited significantly higher total and subscale scores on the DERS compared to the healthy control group (p<0.001). Similarly, except for the “physical neglect” subscale, all subscale scores and the total score on the CTQ were significantly elevated in the ADHD group relative to the control group (p<0.001). Significant correlations were identified between the subscales and total scores of the DERS and CTQ. Depression and anxiety levels emerged as predictors of emotion regulation difficulties within the ADHD group. Across the entire sample, childhood trauma exposure (CTQ score), ADHD symptoms in adulthood (ASRS score), and levels of depression and anxiety were identified as predictors of emotion regulation difficulties.

The findings indicate that adults with ADHD exhibit more pronounced emotional dysregulation and higher levels of childhood maltreatment compared to healthy controls. Furthermore, childhood maltreatment appears to exacerbate emotional dysregulation in this population.

None Declared

Emotions wield a substantial influence on mental and physical well-being in old age, encompassing both positive and negative feelings, and effective emotional regulation is linked to aging well. Therefore, understanding the intricate connection between emotions and mental health is essential for promoting healthy aging in late adulthood.

This study aims to explore the dimensions between emotions and mental health and the crucial role of emotional wisdom in old age, shedding light on how it influences mental health and overall well-being among older adults.

This cross-national study included 348 older adults, aged 65 and older, from Portugal and England. Participants’ experiences were portrayed through semi-structured interviews, which were analyzed using content analysis.

Findings revealed four themes: (1) Emotional expression (88.3%), (2) Wisdom acquisition (79.2%), (3) Emotional self-regulation (71.7%), and (4) Ability to calm oneself (68.9%).

Through an exploration of emotional health and wisdom across various cultural lenses, this study illuminated the complex interactions between emotions and mental well-being. It emphasizes the imperative for nuanced understanding and targeted strategies that bridge emotional aging with mental health outcomes, advocating for policies and interventions that foster holistic psychological resilience in older adults.

Emotion; emotional regulation; emotional health; emotional wisdom; mental health; older adults.

None Declared

Over 55 million people currently have Alzheimer’s disease (AD), with estimates predicting a rise to 78 million by 2030. The burden of AD impacts not only the affected individuals but also their families and society due to the increasing care demands. Caring for people with AD is emotionally and physically taxing. The World Health Organization emphasizes the need for caregiver support.

This study aims to understand the caregiving experiences and needs of family caregivers for individuals with AD.

A qualitative descriptive design was used. Data were collected from 23 caregivers at a university hospital’s geropsychiatric clinic. Participants were family members caring for individuals with AD for at least four hours per day. Interviews were analyzed using content analysis.

Sample Characteristics: The mean age of participants was 57.82 and 57% were female. More than 85% lived with the care recipient, the average caregiving duration was 81.34 hours per week. The following themes were extracted from data collected during the interviews (Figure 1).

Stuck in Caregiving: Participants found caring for loved ones with AD to be an unexpected challenge. Many initially missed the onset of AD due to their loved ones’ previous abilities. Family conflicts over caregiving tasks, shaped by differing spiritual and cultural beliefs, were common. Caregivers faced difficulties, especially with stubborn behavior and personal care tasks.

A Life in Metamorphosis Most participants experienced profound changes in their personal lives, including social isolation and emotional turmoil. Half of the participants found meaning in caregiving, gaining new perspectives on life.

Caregivers identified specific needs, including psychosocial support, disease education, in-home care, and adult daycare services.

Image 1:

The gradual onset of AD delays symptom recognition, making diagnosis hard for families to accept. As caregiving demands increase, conflicts between caregiving and personal responsibilities cause stress and neglect of personal life. Despite these challenges, many caregivers find personal growth. They seek temporary care options, home assessments, and improved access to education and counseling, highlighting areas for better caregiver support.

None Declared

Late-life depression (LLD) is consistently linked with higher risk of subsequent dementia (Livingston G et al. Lancet 2024; 404: 572-628); however, predictors of progression from LLD to dementia are yet to be identified.

In this systematic review and meta-analysis, we focus specifically on cognitive phenotypes of LLD as predictors of progression to dementia. This review aims to summarize findings from longitudinal studies exploring which cognitive domains affected by LLD are more likely to predict progression to all-cause dementia and Alzheimer’s Disease.

MEDLINE, Embase and PsycINFO were searched for relevant studies published by April 18th, 2024. Study search and selection, data extraction and risk of bias assessment were performed by two reviewers separately, in accordance with the updated Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines (Page MJ et al. BMJ 2021; 372). Effect sizes for performance on neurocognitive tests were extracted and pooled separately for all-cause dementia and Alzheimer’s disease (AD) outcomes.

Six studies were selected for inclusion (See Fig. 1 for PRISMA flowchart). Conversion from LLD to all-cause dementia was strongly predicted by worse performance on delayed recall (SMD 0.84 [0.64 – 1.05]), immediate recall (SMD 1.02 [0.63 – 1.41]), attention/working memory (SMD 1.17[0.82 – 1.52]), processing speed (SMD 1.23 [0.37 – 2.10]), delayed recognition (SMD 1.30 [0.59 – 2.01]) and orientation (SMD 1.13 [0.90 – 1.36]); and moderately by verbal fluency (SMD 0.70 [0.50 – 0.91]), naming (SMD 0.54 [0.16 – 0.93]), and construction (SMD 0.67 [0.37 – 0.98]), but not intelligence (see Fig. 2). For AD, strong effects were observed for deficits in delayed recall (SMD 1.30 [0.59 – 2.01]), immediate recall (SMD 1.26 [0.74-1.79]), and orientation (SMD 1.64 [0.67 – 2.62]), and small to moderate for verbal fluency (SMD 0.47 [0.06 – 0.87]) and processing speed (0.66 [0.26 – 1.07]); attention or naming were not significant predictors (See Fig. 3).

Image 1:

Image 2:

Image 3:

There appear to be significant neurocognitive differences across a wide range of domains within an episode of LLD between those who convert to dementia and those who do not. Future studies should aim to establish a neurocognitive profile of LLD associated with risk of conversion to specific subtypes of dementia.

None Declared

Major Depressive Disorder (MDD) is a neuropsychiatric condition whose neurobiological characteristics include alterations in brain plasticity, modulated by Brain Derived Neurotrophic Factor (BDNF). In animal models, Environmental Enrichment promotes neuroplasticity and reduces depressive-like behaviors. It has been proposed to measure the level of Enriched Environment (EE) as a protective or risk factor for the development and severity of MDD using the EE Indicator (EEI).

Determine the relationship between the level of EE and serum levels of BDNF in participants with MDD and healthy controls.

Treatment-free MDD patients and controls were recruited, who underwent an analysis of their LES, clinical factors, and serum BDNF levels.

25 participants were recruited, of which 6 participants with MDD and the same number of controls were selected in a paired manner, who were divided into two groups:

medium and low EE. Although no differences were found between the concentration of BDNF between the groups, positive correlations were observed between social EE and BDNF, as well as negative correlations between this same domain with the Hamilton scale score for depression and the presence of this condition. No differences were found in the EE groups classified by total score between the cognitive, social and physical domains; But when breaking them down, it was observed that the sum between cognitive and social EE has a positive correlation with the serum concentration of BDNF (p=0.0451).

Image 1:

Image 2:

Image 3:

The level of EE is potentially modulating the presence and severity of MDD at a clinical level, but it can also influence at a neuroplastic level through promoting or limiting the concentration of BDNF.

None Declared

Parkinson’s disease (PD) is a progressive neurodegenerative disorder with a wide variety of clinical symptoms such as tremor, stiffness, and slowness. Additionally, prodromal features, psychological or cognitive problems may be observed which may complicate the treatment.

In this study, we aimed to investigate the rate and extent psychiatric comorbidity (PC) in PD patients admitting to psychiatric outpatient clinic.

A retrospective, cross-sectional study was designed. Electronic medical records were examined for data collection of all outpatients admitting to Erenköy Mental Health and Neurological Diseases Training and Research Hospital outpatient psychiatric clinics between June 1, 2023, and June 1, 2024 who had an ICD diagnosis of G20, G21, and G22, along with their subcategories. Informed consent was obtained.The findings were grouped according to PC.

Out of 37 533 outpatients, 61 outpatients (27 male, 34 female) of them were matching the inclusion criteria. Three of them had no PC and the prevalence of PC in PH was found as 95%. The patients presented with PC were chronologically categorized into 3 groups. Each of these categories was further divided into 6 subcategories based on ICD codes (F10–19, F20–29, F30–39, F40–48, G47.0–47.9, others) (See Table 1). Of note, 3 of 61 patients (4.9%) had dopamine dysregulation syndrome (DDS), characterized by addictive use of dopaminergic drugs, mood swings, compulsive and impulsive behaviors and psychosis (1).

Despite we have chronologically grouped the sample, it is not possible to determine with certainty whether the PC diagnosed before PD is a prodromal symptom or a seperate diagnosis.

Since the study was conducted at a mental health hospital, the prevalence of PC in our sample was higher than what is reported in the literature, which was expected due to sampling biases.

Image 1:

PC is common among PD patients. It may present as prodromal symptoms of PD, may occur due to disease or medication after the onset of PD, or primary neurological and psychiatric conditions may be concomitant.

PC are often overlooked in the diagnosis and treatment and this situation complicates treatment and increases burden. Multidisciplinary approach is essential.

In our study, the highest prevalence of PC being F 30–39 is consistent with the literature. It has been determined that the most common psychiatric disorders in PD are depression (31%) (2,3).

It is noted that the most common PC before and after the diagnosis of PD were F30–39 and F20–29, respectively. It is compatible with literature. PD may present prodromal symptoms such as depression, on the contrary, it may progress with psychotic symptoms. The prevalence of psychosis in PD varies between 43-60% (4).

Special attention should be given to DDS, which is 4,9% and consistent with the literature in our sample (The estimated prevalence of 3.4–4%) (5,6). DDS is a very challenging condition to treat.

None Declared

Herpes Simplex Encephalitis (HSE) and anti-NMDA receptor autoimmune encephalitis (ANMDARE) are severe neurological conditions that can lead to significant psychiatric symptoms. While these conditions commonly cause cognitive and behavioral disturbances, mania with psychotic symptoms is an uncommon manifestation. Understanding this rare presentation is crucial for accurate diagnosis and management.

To describe a case of mania with psychotic symptoms in a 33-year-old woman approximately one month after Herpes Simplex Encephalitis (HSE), further complicated by anti-NMDA receptor autoimmune encephalitis.

We conducted a detailed review of the clinical process and heteroanamnesis from family reports. A non-systematic literature review was performed using the terms “encephalitis,” “mania,” “psychosis,” “herpes simplex,” and “anti-NMDA” in the PubMed®/MEDLINE® database.

A 33-year-old woman, seven months postpartum with no prior psychiatric history, presented with psychomotor agitation, distractibility, elevated mood, verbose speech, tachypsychia, impulsivity, verbal perseveration, insomnia, and mystical and persecutory delusions, including auditory-verbal hallucinations, starting 15 days after discharge from hospitalization for HSE. Her subsequent hospitalization revealed severe and fluctuating behavioral changes, significant memory deficits, and spatial-temporal disorientation. Neuroimaging showed atrophy of the left temporal lobe, ipsilateral insula, and notable involvement of the left hippocampus. Cerebrospinal fluid analysis detected anti-NMDA receptor antibodies, leading to treatment with corticosteroids and immunoglobulins. The patient was stabilized on clozapine 150 mg/day, valproate 1000 mg/day, clonazepam 1 mg/day, and monthly injectable risperidone 100 mg.

HSE is a major cause of death in sporadic encephalitis cases, with a 12% relapse rate linked to viral reactivation and the development of anti-NMDA receptor encephalitis. ANMDARE, caused by anti-NMDA receptor IgG antibodies targeting the NR1 subunit, affects about 25% of HSE patients within three months. Psychiatric affective syndromes have been described both as possible initial symptoms of HSE and as long-term sequelae, but the underlying mechanisms remain not fully understood.

None Declared

Neuronal pentraxins (NPTXs), particularly NPTX2, play a key role in glutamate modulation and the stabilization of AMPA receptors, influencing synaptic plasticity. Studies have shown a positive correlation between NPTX2 levels and neurocognitive function in neurodegenerative diseases, and it has been proposed as a potential biomarker for synaptic degeneration (San José et al. J Neural Transm 2022; 129 207-230). However, the role of NPTX2 in the etiology of ADHD has not been explored in human samples.

This study aims to investigate the relationship between NPTX2 levels and ADHD symptoms in adults with ADHD, while also exploring the potential impact of NPTX2 on executive functions, which are frequently impaired in this population.

Adults with ADHD who were medication-free and had no comorbid psychiatric diagnoses, along with a similar control group with no psychiatric diagnoses, were included in the study. All participants were diagnostically assessed using the Structured Clinical Interview for DSM-5 Disorders-Clinician Version. Participants completed measurements related to both ADHD and comorbid conditions. In addition, participants underwent a battery of neuropsychological tests, including the Stroop Test, Cancellation Test, Serial Digit Learning Test, Wisconsin Card Sorting Test, and Judgment of Line Orientation Test. The serum samples obtained after centrifugation were stored at -80°C until the time of analysis, at which point NPTX2 levels were measured using the ELISA method. Informed consent was obtained from all participants, who voluntarily agreed to participate. The study was approved by the Local Ethics Committee of Selçuk University under decision number 2023/495.

The study included 79 adults with ADHD and 70 healthy controls. Among the participants, 57.7% (n=86) were female, with a mean age of 23.50 ± 4.37 years. Both groups were comparable in terms of age, gender, total years of education, and body mass index. Individuals with ADHD showed higher levels of ADHD- and comorbidity-related symptoms, as well as poorer executive function profiles, compared to healthy controls. NPTX2 levels were significantly elevated in the ADHD group. Significant positive correlations between NPTX2 levels and clinical and neurocognitive data were observed in the ADHD group, but not in the control group. Finally, linear regression analyses conducted separately for each group revealed significant F values, showing that in adults with ADHD, NPTX2 levels were significantly associated with ADHD symptoms independent of age, gender, years of education, and anxiety/depression scores, whereas this relationship was not observed in healthy controls (Image 1).

Image 1:

These results highlight the need for further research into the role of NPTX2 and other neuronal pentraxins in ADHD and suggest that NPTX2 may serve as a biological marker for this disorder.

None Declared