Psychosis includes positive (e.g., hallucinations) and negative symptoms (e.g., anhedonia), with tools like the PANSS traditionally used for evaluation. Although clinician-administered scales are considered the gold standard, patient self-reports provide critical insights into subjective experiences.

This study explores the discrepancies between patient-reported and clinician-assessed symptoms, aiming to improve psychosis diagnosis and treatment.

Part of the BSNIP project, this study analyzed data from 159 participants (primarily male, average age 34.33) at the Boston site. Diagnoses were based on SCID, with most participants having schizophrenia, schizoaffective disorder, or bipolar disorder with psychotic features. The DSM-5 Level 1 Cross-Cutting Symptom Measure assessed psychiatric domains, including depression, anxiety, suicidal ideation, and psychosis, and was compared with clinician-reported assessments of the same symptoms.

Clinicians generally reported higher anxiety levels than patients with SZ (Z = -2.462, p = 0.014), while no significant differences were observed for the bipolar disorder (BP) and schizoaffective disorder (SAD) groups. Regarding suicidal ideation, patients typically reported higher levels than clinicians, particularly in the SZ group (Z = -3.507, p < 0.001) and the SAD group (Z = -2.007, p = 0.045). Similarly, patients in the BP (Z = -2.822, p = 0.005) and SAD (Z = -2.145, p = 0.032) groups reported more hallucinations compared to clinician assessments, while clinicians reported higher levels of hallucinations in the SZ group (Z = -3.451, p = 0.001). In terms of delusions, clinicians generally reported higher levels than patients in the SZ group (Z = -2.925, p = 0.003). Additionally, neither insight (PANSS_G12) nor cognitive function (BACS Composite) significantly impacted the discrepancies between patient and clinician reports of suicidal ideation, hallucinations, or delusions.

The study highlights significant discrepancies in the reporting of anxiety, suicidal ideation, hallucinations, and delusions, especially in schizophrenia, where patients tend to underreport anxiety and psychotic symptoms but report higher suicidal ideation. Our findings point to the value of obtaining both patient and clinician assessments when evaluating psychosis.

None Declared

Persons with schizophrenia are currently excluded from psychedelic-assisted therapy due to concerns about psychedelic-induced acute or persistent psychotic symptoms. However, meta-analytic evidence of the precise risk for psychedelic-induced de novo and exacerbation of psychosis in people with pre-existing psychotic disorders is lacking.

We conducted an overview of reviews, systematic review, and meta-analysis to examine the incidence of psychedelic-induced psychosis and the exacerbation of psychotic symptoms in schizophrenia.

Our pre-registered protocol (CRD42023399591) covered: LSD, psilocybin, mescaline, DMT, and MDMA. Embase, PubMed, PsyARTICLES, PsyINFO, and trial registries were searched from inception until 11/2023.

The incidence of psychedelic-induced psychosis was computed using a random-effects model, and standardized assessments of study quality was performed. We retained 131 publications: 14 systematic reviews, 20 reviews, 35 randomized-controlled trials (RCTs), 10 case-control studies, 30 uncontrolled trials (UCT), and 22 cohort studies with overall low study quality. The meta-analysis included nine studies. Incidence of psychedelic-induced psychosis was 0.002% (95%CI 0-0.006, I2=0%, N=123,800; n=2) in population studies; 0.2% (95%CI 0.1-0.3, I2=0%, N=6,535; n=6) in UCT, and 0.6% (95%CI 0.2-1.8, I2=0%, N=563; n=3) in RCTs excluding individuals with a history of psychotic symptoms. In UCT including patients with schizophrenia, 3.8% (95%CI 1.6-8.9, I2=0%, N=133; n=2) developed long-lasting psychotic symptoms. In cohort studies, 13.1% (95%CI 9.4-17.9, I2=24%, N=353; n=3) of those with psychedelic-induced psychosis developed schizophrenia. Sensitivity analyses confirmed the main findings. The incidence for psychedelic-induced psychosis is low but slightly higher in studies including patients with schizophrenia. The risk of transition to schizophrenia after psychedelic-induced psychosis is considerable.

In summary, the reviewed evidence suggests that schizophrenia might not be a definite exclusion criterion for clinical trials exploring safety and efficacy of psychedelics for treatment-resistant depression and negative symptoms. However, given the low quality and limited number of studies, more high-quality research is needed, and a conservative approach is recommended until further data is available.

None Declared

Case management is a model of community intervention in people with severe mental illness.

To explore the treatment adherence and effectiveness of patients with severe schizophrenia undergoing treatment in a community-based, case management program (CMP) with an integrated pharmacological and psychosocial approach compared to the standard treatment.

An observational, longitudinal study was conducted with a ten-year follow-up of patients with severe schizophrenia (CGI-S ≥ 5) treated in mental health units (MHUs) or on a CMP (N = 688). All causes of treatment discontinuation, psychiatric hospital admissions, suicide attempts, and antipsychotic (AP) medications were recorded. Clinical severity was assessed with the CGI-S.

Adherence to the CMP was higher than to the standard treatment (p < 0.001). There were fewer hospital admissions and suicide attempts on the CMP than in standard care (p < 0.001). Clinical severity decreased more in the CMP than in MHUs (p < 0.005). Long-acting injectable (LAI) AP medication was more closely related to these outcomes than oral APs (p < 0.001) in both settings, but especially on the CMP.

Treatment clinical outcomes after 10-year follow-up

N: number of patients %: percentage of patients Av: average SD: standard deviation

*: basal (at beginning of program) **: standard treatment ***: Program treatment

The treatment of patients with severe schizophrenia in a multicomponent, case-managed program recorded higher compliance and effectiveness compared to standard care. Treatment with LAI antipsychotics was linked to these outcomes. A combination of case management, psychosocial approach, and LAI AP medication contributed more to the achievement of clinical goals in these patients than the standard treatment and oral APs.

None Declared

The majority of antipsychotic users at some point want to stop their antipsychotic medication and many do so without consulting their attending physician. So-called non-adherence to antipsychotics has been estimated to be as high as 60% and it has been identified as the most important predictor for relapse, resulting in a four times higher risk of relapse. When asking antipsychotic users, different reasons for wanting to stop are mentioned. These reasons include severe side effects, reduced functioning, experiencing no benefits and long-term physical health concerns. From the perspective of patients, wanting to stop can be considered an understandable and rational reaction given the burdens that antipsychotic use often imposes. Given the current uncertainties surrounding stopping antipsychotics, and given the patients’ wish to be involved in treatment decisions and a move away from a paternalistic mental health care model, several shared decision initiatives have been formed to involve patients more in the decisions about stopping or reducing the dose of their antipsychotic. In order to support shared decision-making, insight is needed in which questions antipsychotic users have.

The current study aims to gain insight in which questions antipsychotic users and their relatives have, and which factors influence stopping or reducing the dose of antipsychotics, by qualitatively analysing questions posted on an online expert Q&A.

Data were used from a Dutch existing publicly available anonymous expert Q&A. Questions about stopping or reducing the dose of antipsychotics were analysed using an inductive thematic approach. Questions antipsychotic users and their relatives had about this topic and factors that influences the process were identified.

In total 194 out of 3000 screened questions were about stopping or reducing antipsychotic dose. The most common question was whether it was sensible to stop or reduce the dose. Questions focused on how fast to reduce the dose, what their minimum dose should be and where they could find support. Those that were phasing out their antipsychotic asked when withdrawal symptoms or side effects would subside. Motivations to stop were side effects, difficulties in assuming a normal life and social roles and experiencing no benefits. Barriers were lack of support and return of symptoms. Facilitators were support from others and experiencing a relief from side effects and/or symptoms. Finally, questions were asked about activities that might support discontinuation.

Antipsychotic users continue to be left with many questions about stopping or reducing the dose of antipsychotics. These questions reveal attitudes, preferences and concerns regarding antipsychotic treatment that are important to address when discussing antipsychotic treatment.

None Declared

Adverse childhood events have been associated with immune aberrations. Herpes simplex virus 1 (HSV1), a neurotropic pathogen, establishes persistent infection after primary exposure. Elevated HSV1 immunoglobulin (IgG) levels have been found in HSV1-infected patients with severe mental illness (SMI), which likely reflects immune dysregulation.

We assessed childhood maltreatment and HSV1 IgG concentrations in adult patients with SMI and healthy controls. We hypothesized that maltreatment would be associated with elevated HSV1 IgG concentrations reflecting a failure in immune competence, and that such a putative association would be stronger in or even restricted to patients.

We included 448 adult patients with SMI (mean age=31 years, 48% women, 46% HSV1 seropositive), i.e., 259 patients with schizophrenia spectrum and 189 patients with bipolar disorders, and 271 adult healthy controls (mean age=32, 41% women, 46% HSV1 seropositive). We assessed childhood maltreatment with the Childhood Trauma Questionnaire (CTQ), a 28-item retrospective self-report scale. We evaluated circulatory HSV1 IgG concentrations, expressed as continuous and dichotomous measures. In our main analyses, we applied sex- and age-adjusted multiple regressions on HSV1 IgG concentrations.

In patients with SMI (p=0.002) but not in healthy controls (p=0.203), CTQ total score was associated with HSV1 IgG seropositivity. Among seropositive patients (p<0.001) but not healthy controls (p=0.957), CTQ total score was associated with increased HSV1 IgG concentrations. Post-hoc analysis among seropositive patients showed that the five subscale scores for physical (p=0.002), sexual (p=0.019) and emotional abuse (p=0.002), and physical (p=0.012) and emotional neglect (p=0.016) were all associated with increased HSV1 IgG concentrations.

Among patients with SMI, childhood maltreatment is associated with an increased risk of HSV1 infection. Further, among HSV1-infected patients, maltreatment is associated with elevated HSV1 antibody concentrations which may reflect a link between childhood adverse experiences and an immune system dysregulation.

D. Andreou: None Declared, N. E. Steen: None Declared, K. N. Jørgensen: None Declared, T. Ueland: None Declared, I. Drabløs: None Declared, L. Wortinger: None Declared, O. Andreassen Consultant of: HealthLytix, Speakers bureau of: Speaker’s honoraria from Lundbeck and Sunovion, R. Yolken: None Declared, I. Agartz Speakers bureau of: Speaker’s honoraria from Lundbeck

Treatment of schizophrenia remains a challenge despite the development of numerous antipsychotics (AP) (Pompili et al CNS NDDT 2017; 16 870-884). The various strategies to address patients’ unmet needs, such as AP polypharmacy or switching AP, do not seem to provide adequate benefit. A reason for this may reside in the similarity of mechanisms of action of most APs. However, the monoaminergic systems targeted by these drugs are not always disrupted in schizophrenia, as it is widely accepted that patients who fail to respond to AP have glutamatergic, but not dopaminergic dysfunctions (Moghaddam et al NPP 2012; 37 4-15). Evenamide normalizes excessive glutamate release without affecting its basal levels, and it does not interact with >150 CNS targets. It has been shown to be effective in animal models of psychosis as monotherapy and add-on to AP. Previous trials indicate that evenamide benefits patients with schizophrenia with inadequate response and have shown clinically important benefits lasting up to 1-year in TRS (Anand et al IJNPP 2023; 26 523-528).

Study 008A, a phase 2/3 international, randomized, double-blind, placebo-controlled, 4-week trial, assessed the efficacy and safety of evenamide 30 mg bid as add-on in patients poorly responding to an SGA.

Outpatients with a diagnosis of schizophrenia, still symptomatic (PANSS 70-85; CGI-S 4-6) despite treatment with an SGA at a therapeutic dose (confirmed through plasma levels) for an adequate period, were enrolled. Efficacy was assessed on the PANSS, CGI-S, and LOF through the comparison of changes from baseline to Day 29 between evenamide and placebo groups using a MMRM analysis. Moreover, the proportion of patients reaching a clinically important improvement on the PANSS and CGI-C were compared between groups using a logistic regression model (chi-square test). Safety measures comprised: TEAEs, vital signs, labs, ECG/EEG, seizure checklist, physical/neurological/eye examinations, C-SSRS, ESRS-A, CDSS.

291 patients were randomized in the study in 11 countries (EU, Asia and LATAM), and 280 completed the study. The low attrition rate (<4%), and proportion of patients with TEAEs (~25% in both groups) indicate that evenamide was well tolerated. A statistically significant greater improvement was found on the PANSS total score and on the CGI-S in the evenamide compared to the placebo group. Furthermore, a significantly higher proportion of patients treated with evenamide, compared to those receiving placebo, experienced clinically meaningful benefit measured on the PANSS (≥20% improvement) and CGI-C (at least much improved).

This is the first randomized, placebo-controlled trial to demonstrate the clinical benefit of adding a NCE modulating glutamate in patients with schizophrenia who did not experience adequate response from treatment with a SGA.

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 Consultant of: Newron Pharmaceuticals SpA.

Orthorexia Nervosa (ON) is characterized by an obsessive focus on healthy eating, leading to extreme restrictions and negative impacts on mental and social health. ON shares traits with eating disorders (EDs) and obsessive-compulsive disorder (OCD), but its diagnostic status remains unclear. Recent studies suggest ON may be linked to personality traits like perfectionism, common in both EDs and OCD (3,5). The COVID-19 pandemic has exacerbated these issues, stressing the need for better understanding of ON and its overlaps with other disorders (6).

This study reviews literature from the past seven years to explore the connections between ON, EDs, and OCD. It examines ON as a possible distinct diagnosis, focusing on the role of personality traits like perfectionism and evaluates the clinical implications and treatment needs, considering cultural and contextual factors.

A systematic review was conducted using PubMed, PsycINFO, and Scopus, covering studies from 2017 to 2023. The studies included clinical and non-clinical samples, focusing on psychopathological features and personality traits linked to ON, EDs, and OCD (1-2). The review analyzed diagnostic criteria, prevalence, personality trait correlations, and the impact of contextual factors like the COVID-19 pandemic.

ON has a complex relationship with EDs and OCD. In ED patients, especially those with anorexia nervosa (AN) and bulimia nervosa (BN), orthorexic behaviors were more prevalent, suggesting ON might be a subtype of EDs rather than a separate condition. ON scores in ED patients decreased after targeted treatment, supporting this connection (1). Personality studies showed that orthorexic individuals often display perfectionism, particularly concerns about mistakes and unrealistic standards. These traits are transdiagnostic, affecting ON, EDs, and OCD (2-3). ON was also linked to specific personality profiles, such as paranoid and narcissistic traits, which worsen symptoms and complicate treatment (2). ON symptoms were strongly correlated with anxiety, depression, and ED and OCD symptoms, indicating shared psychopathological mechanisms (5). The ego-syntonic nature of ON, where behaviors are seen as normal, may lead to underdiagnosis and reduced treatment-seeking (5). The COVID-19 pandemic further exacerbated orthorexic behaviors, highlighting the need for tailored clinical interventions for at-risk individuals (6).

ON should be viewed within the ED spectrum, with significant overlaps with OCD and influence from traits like perfectionism. Cultural and definitional differences complicate its classification as a distinct disorder. The COVID-19 pandemic has highlighted the clinical importance of ON and the need for effective prevention and treatment strategies. Future research should aim to develop standardized diagnostic criteria and explore personality traits to improve ON diagnosis and treatment.

None Declared

Sydenham chorea (SC) is the most common form of autoimmune chorea and is one of the major clinical manifestations of acute rheumatic fever. Although related to group A streptococcal infection, its pathogenesis is not fully understood, and neither is its contribution to the development of Obsessive-Compulsive Disorder (OCD), with hypotheses like autoimmune mechanisms and neuroinflammation being probable. The prevalence of OCD in SC patients is higher than in the general population, with one study reporting obsessive-compulsive symptoms in 24% of SC patients (Moreira et al. Parkinsonism Relat Disord 2014;20(2):233-236). Psychiatric symptoms often fluctuate with motor symptoms, but their prognosis is poorly understood.

To describe a case of a patient who developed OCD symptoms after SC.

We report a case of OCD that followed the development of chorea, and we perform a non-systematic review of the literature.

A 34-year-old woman is referred to a Liaison Psychiatry consultation due to cognitive anxiety related to her non-psychiatric history. The patient, with no previous psychiatric history, has a personal history of rheumatic fever (9 years ago) and SC previously evaluated by Neurology consultation where brain magnetic resonance imaging and head computed tomography changes were ruled out, as well as the genetic panel for Huntington disease. No relevant family history. Medicated with sertraline 100mg daily, alprazolam 1mg three times a day, clopidogrel 75mg daily, propranolol 10mg three times a day and atorvastatin 10mg daily. Upon the evaluation, the patient referenced anxiety related to a programmed cardiac surgery and initial and intermediate insomnia. When questioned, the patient reported, after the development of chorea, obsessive ideas and verification rituals/compulsions. These symptoms are time-consuming and cause clinically significant distress and impairment in her work and social functioning. The patient was started on risperidone 0.5mg daily due to its high-potency dopamine D2 receptor blockage that could benefit the chorea and its proprieties in obsessive-compulsive disorder. Six months later, the patient presented an improvement in motor symptoms and a satisfactory Y-BOCS reduction response to the initiated plan.

This case underscores the unusual but significant association between SC and the development of obsessive-compulsive symptoms, contributing to the growing body of evidence that autoimmune processes may underlie neuropsychiatric manifestations such as OCD. The patient’s favorable response to risperidone, a dopamine receptor antagonist, emphasizes the role of dopaminergic dysregulation in both SC and OCD. This case underscores the need for a multidisciplinary approach, including neurology and psychiatry, to manage SC’s neuropsychiatric effects. Further research is needed to clarify how SC relates to OCD and to improve treatment strategies.

None Declared

The rigid maintenance of an acquired response in participants with obsessive-compulsive (OC) traits has been widely reported in the literature (e.g., Hassoulas et al., 2014; 2017; 2024). As such, demonstrating flexibility in responding to concurrently presenting stimuli with differing rates of reinforcement has also been shown to be difficult for those diagnosed with OCD (e.g., Clayton et al, 1999). Matching Law proposes a quantifiable description of behaviour when consequences to responding under two concurrently presented schedules of reinforcement differ. The application of a matching procedure, whereby participants exhibiting OC traits are presented with concurrent schedules of reinforcement, would highlight this difficulty in distinguishing between stimuli that provide different rates of reinforcement. That is, the competing sources of reinforcement would relate to the concurrent stimuli that individuals with OCD have been shown to have trouble attending to separately.

Sensitivity to concurrent schedules has not been previously investigated in the context of OCD. As such, two experiments were designed to measure matching behaviour between groups of participants with and without OC traits.

A total of 60 participants (33 females, 27 male) were recruited to take part in the two studies. The Maudsley Obsessive-Compulsive Inventory (MOCI) was used to screen for the presence of OC traits. Concurrent variable intervals (VI) were presented over ten trials, with an aversive auditory stimulus serving as a punisher superimposed during every second trial. During the first experiment, VI 20-second schedules were concurrently presented with VI 40-second and VI 60-second schedules. The ratio between concurrent schedules was widened during the second experiment; with VI 20-second schedules presented alongside VI 100-second and VI 180-second schedules.

A significant interaction of trial with OC traits was revealed when the punisher was presented in experiment 1, F(4,68)=2.68, p < 0.05, but not in experiment 2 (p>0.05). The findings suggest that the presence of an auditory punisher facilitates schedule-sensitive responding in participants with OC traits, but that schedule-sensitivity is lost when intervals between concurrent schedules are widened. Figures 1 and 2 display response ratios for both high and low scoring groups during experiments 1 and 2 respectively.

Image 1:

Image 2:

The widening of the schedule ratios in the second experiment disrupted sensitivity to the schedule contingencies for the OC group. Greater flexibility in responding within this group can therefore be facilitated by considering specific parameters and rates of reinforcement.

None Declared

Subjective well-being (SWB), defined as the way people think and feel about their lives, is often used to evaluate happiness. Separated into three components—positive affect, negative affect, and life satisfaction—SWB has been indirectly related to psychiatric symptoms and disorders. However, the relationship between SWB and obsessive-compulsive disorder (OCD) remains relatively unknown.

To determine whether SWB components correlate with the clinical features of OCD.

This was a cross-sectional study evaluating 68 individuals with OCD. Sociodemographic data were collected, treatment histories were taken, and validated instruments were applied (Y-BOCS, Dimensional Y-BOCS, USP-Sensory Phenomena Scale, BDI-II, BAI, Positive and Negative Affect Schedule (PANAS), and Satisfaction with Life Scale (SWLS)).

All three SWB components showed inverse correlations with the severity of depressive/anxiety symptoms and total OCD symptom scores. Life satisfaction and positive affect showed inverse correlations with suicidality. Life satisfaction and negative affect showed inverse correlations with the hoarding and contamination/cleaning OCD dimensions, respectively. No SWB aspect correlated with any other OCD dimension.

Some OCD-specific factors appear to correlate with SWB. However, it seems that the effect size is greatest for depressive symptoms, which suggests that depression mediates the relationship between OCD and SWB. Studies with larger samples and control groups are needed to confirm our findings.

None Declared

Eating disorders, in particular Anorexia Nervosa (AN), are serious psychiatric disorders with a chronic course and high levels of disability and mortality. These disorders are characterized by a misrepresentation of body image and intense fear of putting on weight, leading to cognitive distortions related to food and weight control, as well as dysfunctional behaviors aimed at weight loss.

The aims of this paper are to provide a summary of the current literature concerning involuntary treatment in patients with eating disorders and to assess whether there is a difference in terms of baseline characteristics and treatment outcomes between patients treated both voluntarily or involuntarily.

Relevant articles were identified by searching the following terms: “treatment refusal”, “involuntary/compulsory/coercive/forced treatment/admission”, “eating disorders”, “anorexia nervosa”, “bulimia nervosa”. Research was restricted to articles concerning humans and published between 2014 and 2024 in English.

The treatment of eating disorders consists in a combination of weight control/weight gain methods and psychotherapy, as well as the treatment of organic complications associated with starvation and low body weight.

Involuntary treatment is usually intended for patients having worse baseline conditions. Factors associated with increased involuntary treatment utilization were female sex, lower age, psychiatric comorbidities, more severe disease with lower weight at admission and a longer course.

Concerning short term outcomes, the involuntary treatment can be life saving and half of these patients accept the treatment in 2 weeks time. Studies show that the involuntary treatment did not have a significant negative impact in the doctor-patient therapeutic relation. In terms of long term outcomes, patients treated involuntarily had similar outcomes to those treated voluntarily, having better outcomes in some domains, including menstruation, number of admissions and functionality.

The denial of the illness and lack of insight in AN raise practical and ethical questions relating to the autonomy of the patient and the responsibility of the family and health care practitioners. The involuntary treatment of eating disorders is a complex area and further research including quantitative and qualitative studies is needed.

None Declared

Hormones such as ghrelin and the recent described human liver expressed antimicrobial peptide-2 (LEAP-2) play a pivotal role in regulating food intake and energy metabolism. In this context, their aberrant functioning has been suggested as a mechanism underlying the pathophysiology of eating disorders (ED) and obesity. Considering the high comorbidity between binge spectrum disorders (BSD) and obesity, whether this dysfunction could be a potential shared neurobiological mechanism remained underexplored.

To analyze plasma ghrelin and liver expressed antimicrobial peptide-2 (LEAP-2) concentrations in fasting among individuals with obesity (OB), with and without an eating disorder (ED), and compare them with a group of healthy controls (HC). Besides, to assess associations between these concentrations, psychopathological variables, and body mass index (BMI) in the clinical sample with OB.

The sample comprised 162 adult women (67 OB-ED, 35 OB+ED, and 62 HC). Peripheral blood samples, eating psychopathology, trait impulsivity, food addiction (FA), fat mass, and BMI were collected. The between-group comparisons were performed using analyses of covariance (ANCOVA), adjusting for age and fat mass, and the link between variables was evaluated through correlation and path analyses.

Individuals with OB (with and without an ED) showed lower significant ghrelin concentrations than HC (p<.001). The OB+ED group reported significantly higher eating psychopathology, trait impulsivity, and FA than the OB-ED and HC groups. In the OB+ED group, LEAP-2 concentrations positively correlated with BMI, fat mass, novelty seeking, and FA scores. The path analysis showed that higher LEAP-2 levels and FA scores were linked to more severe eating psychopathology

The results suggest an interplay between biological and clinical factors that contribute to delineate vulnerability pathways in ED and OB, which could help fit more tailored therapeutic approaches.

None Declared

• - Obsessive- Compulsive Disorder (OCD) is a neuropsychiatric illness affecting 2-3% of the United States population during their lifetime. It is a highly prevalent chronic disorder, often refractory to treatment, an understanding of the pathophysiology of OCD is crucial to optimize treatment. The most common comorbid diagnosis is major depressive disorder (MDD). In 2018, the US Food and Drug Administration cleared the treatment of resistant OCD with high frequency deep repetitive transcranial magnetic stimulation (dTMS) over the dorsomedial prefrontal and anterior cingulate cortices (DMPFC-ACC) with the H7 coil based on the efficacious results of a multi-center study. Compare to H7 coil, H1 coil which is approved for the treatment of resistant MDD, targets and stimulate the left prefrontal cortex more than the medial and right prefrontal cortices.

• - Carmi L, Tendler A, Rodrigues da Silva D,

To assess the effect of TMS in patients with refractory OCD

We conducted literature review search on treatment- specific for OCD on four databases, i.e google scholar, PubMed, PsycINFO and Mount Sinai’s Levy Library.

The meta-analysis combined the results of individual randomized controlled trials (RCTs) to evaluate the effectiveness of repetitive transcranial magnetic stimulations (rTMS) on obsessive-compulsive disorder (OCD). It showed that rTMS were moderately effective in reducing OCD symptom severity (studies indicated a medium-sized effect, Hedges’ g = 0.59-0.65) and a threefold augmentation of treatment effects as compared with sham conditions. Studies also reported a marked heterogeneity in treatment response, which appeared to be particularly seen in patients with comorbid depression. Clinical improvement in depression was associated with greater reductions in OCD symptoms.

Certain rTMS protocols, including low-frequency stimulation (LF-rTMS) over the dorsolateral prefrontal cortex (DLPFC) and supplementary motor area (SMA), consistently showed more effects. Longer session durations and targeted stimulation of non-DLPFC regions, such as the orbitofrontal cortex and pre-SMA, were also associated with more positive outcomes.

But there are limitations - These studies were small, heterogeneous, and prone to publication bias, and few studies reported serious side effects, though some protocols especially those using high-frequency stimulation yielded higher rates of adverse effects.

To conclude, rTMS use as a new therapy for treatment-resistant OCD, particularly OCD comorbid with depression, is promising. However, due to study design inconsistencies and limited statistical power in individual trials, the quality of evidence is currently low. Studies using this approach need further improvement and more evidence to refine stimulation parameters better, increase our understanding of the underlying mechanisms, and confirm sustained efficacy.

None Declared

The Autonomous Region of the Azores faced considerable challenges in providing comprehensive, efficient, and integrated mental health care services, exacerbated by geographical isolation, resource constraints, and the absence of a cohesive system for referrals and quality assessment in mental health care.

Despite the recognized need, the integration of mental health services into primary health care (PHC) and the broader health system in the Azores was fragmented. Key issues included lengthy waiting lists, inadequate referral systems between primary care and specialized psychiatric services, and a lack of standardized quality assessment and performance indicators for mental health care. Additionally, there was a significant need for community mental health teams, emergency management of agitated patients, and comprehensive training for health professionals in psychiatric care.

Through collaborative efforts, the region achieved notable advancements, including the creation of referral criteria from PHC to psychiatry services, structuring inter-service referrals, reactivation of Community Mental Health Teams, and establishment of a “Physician’s Bank.” Noteworthy was the elimination of a waiting list of over 1,000 patients and the development of quality assessment and performance indicators. The construction of a courtyard for involuntarily hospitalized patients and the creation of an emergency room on Faial Island further exemplified the tangible improvements in patient care and system efficiency. Training programs were extensively implemented across various professional groups, enhancing the capacity for mental health care delivery at all levels.

The integration efforts underscored the value of cross-sector collaboration, stakeholder engagement, and the adaptation of models like the SURE framework and COM-B theory to address the multifaceted barriers to mental health care integration. Key facilitators included the development of guidelines, training, and clinical supervision, alongside innovative approaches to public health interventions.

The transformative work in the Azores exemplifies how integrated care models, supported by strategic collaborations and policy reforms, can significantly enhance mental health service delivery in geographically isolated regions. It underscores the importance of systemic approaches to training, infrastructure development, and stakeholder engagement in achieving sustainable improvements in mental health care.

None Declared

From March 2020 to 2021, the risk of youth developing a mental health issue increased by 50% in Canada. To address the detrimental effects of the COVID-19 pandemic, this project collaborated with youth and community partners in Ontario, Canada, to co-design a Preventative Online Mental Health Program for Youth (POMHPY) focused on improving mental, physical, and social well-being.

1. (1) To co-design a preventative online mental health program tailored to the needs of Ontario youth. (2) To evaluate the program’s efficacy in improving mental well-being and health-related quality of life. (3) To engage youth in the development and continuous improvement of the program.

Initially, literature reviews were conducted to identify evidence-based programs that could be integrated into POMHPY. Surveys and focus groups were used to capture youths’ mental health concerns and program needs. The findings were presented to community partners for additional feedback and refinement of the program. A second survey and focus group explored the likelihood of program use and piloted the first session. Subsequently, 53 youths (mean age=19.15) participated in the POMHPY program during the summer of 2023. Pre-, post-, and follow-up surveys measuring mental well-being were administered. Preliminary descriptive statistics and t-test analysis were conducted to measure the program’s efficacy. A subset of participants (n = 21) attended 90-minute focus groups to discuss program perceptions, perceived benefits, impact on personal life, and areas of improvement.

Youths’ mental well-being, measured by the Warwick-Edinburgh Mental Well-being Scale, significantly improved after the completion of the program [t (24) =-2.91, p=.008]. Health-related quality of life, measured by the AqoL-6D, also significantly improved [t (6) =-3.34, p=.016]. These improvements were maintained one month after completing the program. Participants viewed the skills and strategies learned in POMHPY as beneficial in improving their stress and well-being. Peer facilitators in the same age range as participants contributed to meaningful discussions and interactive activities that contrasted with a lecture-style learning environment. Suggestions for improvement included flexible scheduling, increasing reminders, and enhancing understanding of program components.

Preliminary analysis supports the program’s efficacy in improving mental well-being and health-related quality of life. Participants also reported a positive experience with the program and suggested improvements for integration. The program will be scaled nationally in the next phase, ensuring broader access to preventative mental health care for youth across Canada.

None Declared

NAVIGATE, is a comprehensive manual based intervention developed in the US for young people experiencing a first episode psychosis (FEP). The intervention is based on four main service components: Individual Resilience Training (IRT), supported employment and education (SEE), family psychoeducation (FEP) and medication management.

To describe the process of implementing NAVIGATE in Israel with an emphasis on cultural adaptation, fidelity, patterns of use and their relation to outcomes.

Between 2017-2021 demographic and diagnostic, service utilization data and ratings of functioning and symptoms were collected from clinical registries of 142 NAVIGATE participants.

Most participants were males (70%), aged 23.5 (SD 5.5, Range 16-43). On average, participated in the program over a year. IRT was the most utilized intervention (M=23, SD 11.51). Overall, three clusters of program usage were found. Number of sessions and their frequency were highly correlated. Number of family psychoeducation meetings showed the highest correlation with improvement overtime in functioning and symptoms severity. Program Fidelity rates ranged from 2.8 to 3.3 (range 0-4).

The NAVIGATE program in Israel demonstrated significant clinical and functional outcomes across all service use patterns. NAVIGATE was formally offered for two years and included four components, in reality, service users attended less than what was offered. It is possible that when an effective comprehensive team-based intervention is offered flexibly to meet the often rapid changes needs of young people with FEP, the actual use is less than one might expect, which has important implications for policy and practice.

None Declared

Just as our bodies have immune systems to defend against harmful biological agents, our souls also need psychological “immune competencies” to cope with stress. These competencies include effective emotional, psychological, social and spiritual functioning, resilience, creative and executive efficiency, self-regulation and savoring, the ability to enjoy positive experiences.

The aim of the present study was to investigate whether the mental health competencies, the symptoms of mental disorder, or the interaction of the two have a stronger predictive power on subjective well-being among Hungarian adult psychiatric patients.

The psychiatric sample of 129 patients (44 men, 85 women) was recruited in a cross-sectional design in four Hungarian health care facilities. Participants completed the Symptom Checklist-90-Revised, the Mental Health Test and six well-being questionnaires.

Mental health competencies are stronger predictors of the three indicators of well-being (β = 0.61; 0.79; 0.51 p < 0.05) than mental disorder symptoms (β = 0.17; 0.12; 0.25, p < 0.05). Including both mental health competencies and mental disorder symptoms in a regression model more accurately predicts indicators of well-being (BIC = 310; 359.7; 170; AIC = 289; 337.3; 148.3; R2 = 0.74; 0.52; 0.58, p < 0.05) than either the effect of the two separately (BIC = 310.3; 365.4; 170.2; AIC = 291.1; 345.8; 151.1; R2 = 0.73; 0.48; 0.56, p > 0.05) or the effect of their interaction (BIC = 314.9; 363.6; 173.6; AIC = 290.3; 338.4; 149.1; R2 = 0.74; 0.52; 0.57, p > 0.05). Mental health competencies were positively (B = 0.88; 1.64; 0.54, p < 0.05) while mental disorder symptoms were negatively (B = -0.50; -0.28; -0,17, p < 0.05) related to indicators of subjective well-being.

The results underscore the potential of mental health competencies as protective factors that can enhance well-being and restore daily functioning even in the presence of mental disorder symptoms.

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Severe mental disorders and rare genetic diseases are chronic and highly disabling conditions requiring continuous assistance by caregivers, whose personal and social burden may result in mental health problems.

The current study aims to compare objective and subjective burden as well as levels of general well-being, anxiety, depressive symptoms, PTSD symptoms, sleep quality and suicidality between caregivers of patients with severe mental disorders, caregivers of patients aged 0-18 with rare genetic diseases, and caregivers of patients aged 50-85 with rare genetic diseases.

Caregivers of patients with severe mental disorders were recruited at the Department of Psychiatry of University of Campania, Naples, if they were more than 18 and released consent. Caregivers of all patients with rare genetic diseases were recruited at the Inherited and Rare Cardiovascular Disease Unit of University of Campania, Naples, if they were more than 18 and released consent. Caregivers’ levels of personal and social burden, anxiety, depressive symptoms, PTSD symptoms, sleep quality and suicidality were assessed through standardized tools and compared between groups by carrying out analyses of variance.

Seventy-seven caregivers were included, mostly women (74.0%) with a mean age of 52.2±12.5 years. Caregivers of patients with severe mental disorders were mainly mothers (31.8%) or partners (31.8%) of patients, showing the highest levels of subjective burden, as well as avoidance and need to be informed about the illness adopted as problem-solving strategies. Caregivers of patients aged 0-18 with rare genetic diseases were mainly mothers of patients (76.5%), reporting the highest levels of received support and PTSD symptoms. Caregivers of patients aged 50-85 were usually partners of patients (52.4%), who showed the lowest levels of need to be informed about the illness and PTSD symptoms.

Caregivers of patients suffering from chronic and disabling diseases such as severe mental disorders and rare genetic diseases are prone to develop mental health problems due to the persistent exposure to high levels of personal and social burden. To this extent, family psychosocial interventions may be effective strategies to be implemented in order to relieve the levels of burden, by taking into account the features of patient’s disease.

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The challenge of loneliness underlines the need for studies that allow us to analyse and understand this phenomenon, particularly in vulnerable groups. Although loneliness can occur at any stage of life, it seems to be more prevalent during phases of transition, where changes in social relationships are frequent (Mund et al., 2020). In the younger population, a significant restructuring of social life is observed, with peer relationships becoming more central while family ties become less prominent. This often coincides with key life transitions such as change of residence, first romantic relationships, work experiences, etc. (von Soest et al., 2020). This is especially noticeable during the university stage, a period often accompanied by academic pressure due to personal, familial or societal expectations and/or needs. Furthermore, this stage is especially critical from a mental health perspective, as most mental health problems appear for the first time before the age of 25.

1) To analyse the impact that loneliness has on the student community at the Complutense University of Madrid (UCM). 2) To find out the prevalence and types of loneliness as well as its association with different problems of mental health.

This study follows a two-phase mixed-methods approach. In the first phase, two focus groups were conducted to explore the definition and characteristics of loneliness in-depth. The convenience sample consisted of 8 to 10 students per focus group from different educational levels and academic disciplines. A pre-designed guide with open-ended questions facilitated the session (e.g., “Reflecting on your university experience, what situations or experiences have made you feel lonely?”). In the second phase, a cross-sectional observational study was conducted. While we estimated a sample size of 246 participants to explore the prevalence of loneliness, we aim to obtain a representative sample of students from the UCM. The following measures were included: loneliness (frequency, type), mental health (depression, anxiety, psychotic experiences, suicidal behaviour), well-being and social relationships, academic performance, non-behavioural addictions and lifestyle. Data is being processed and analysed using appropriate statistical and qualitative analysis software. This study has received ethical approval from the participating institution.

Data from the focus groups and the online survey were compared from different educational levels and academic disciplines to explore characteristics of loneliness and mental health problems.

This study seeks to gain a deeper understanding of loneliness among university students. These findings aim to promote changes that integrate a new form of care and promotion of mental health in this group (i.e., identification, prevention and management of loneliness) as well as to encourage further research in this area.

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Mental healthcare systems in Europe differ greatly in terms of access and care settings. Whereas comparisons of the structures partly exist (e.g. REFINEMENT project), not much is known neither about the patient journeys for specific disease entities nor about outcomes of these differently organized systems.

The first objective is to review the existing literature on structural differences in mental healthcare sytsems in Europe. The second objective is to discuss options for studies that gather differences in patient journeys and outcomes for specific disease entities.

Narrative review about structural differences in mental healthcare in Europe and discussion of a study protocol for assessing patient journeys for 6 important disease entities (Severe Major Depressive Disorder, Schizophrenia, Behavioural disorders in Dementia, Borderline Personality Disorder, PTSD, Alcohol Addiction).

European mental healthcare systems differ greatly in terms of structures of mental healthcare provision. E.g. Belgium had 141 hospital beds per 100,000 inhabitants, Germany 131, the Netherlands 112, Switzerland 95, Austria 75, and Denmark 5 (eurostat, 2024a). However, what these numbers mean for the patient journeys and for the systems outcomes is unclear. We discuss an approach for examining prototypical patient journeys for the above-mentioned disorders and for comparing their outcomes in terms of quality of life and global psychosocial functioning.

We are looking for European partner institutions for establishing a mental health systems research network. The goal is to set up studies that allow to compare patient journeys and outcomes within the differing European Mental Healthcare Systems as a basis for mutual learning from best practice examples.

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