Schizophrenia (SCZ) is a mental disorder with as yet undefined aetiology and pathogenesis. It is currently considered as a neurodevelopmental disorder and one of the main causes of disability globally, with a prevalence of approximately 1%. About one in four individuals with SCZ is diagnosed with comorbid Cannabis Use Disorder (CUD). Aberrations in brain connectivity have been identified as contributing to the pathophysiology of SCZ.

To our knowledge, no resting-state functional magnetic resonance imaging (rs-fMRI) study has compared continued cannabis use in SCZ patients with CUD (SCZ-CUD+) vs. patients with SCZ without cannabis use (SCZ-CUD-). We hypothesised that continued cannabis use, could result in greater impairment of clinical and cognitive symptoms and in altered connectivity in the Salience Network (SaN), in striate/extended amygdala-cortical areas, and in those involved in planning and emotional control. Studying connectivity in patients with SCZ and CUD could elucidate the mechanisms underlying the development of psychotic symptoms and vulnerability to substance use relapse.

We included 14 SCZ-CUD+ and 20 SCZ-CUD- patients. All were assessed cross-sectionally through the Neurological Evaluation Scale, the Brief Assessment of Cognition in Schizophrenia, the Positive And Negative Syndrome Scale and the Clinical Global Impressions Scale-Severity, and underwent brain rs-fMRI with a 1.5 T scanner to explore functional connectivity (FC). Imaging protocol: All patients underwent a brain 1.5 T MRI scan (GE Signa Voyager) with 32-channel phased-array head coil. Beside the conventional morphological sequences, the functional MRI protocol included: 1) rs-fMRI obtained with a gradient-echo echo-planar imaging (EPI) sequence. Each scan session lasted for 6 min. 2) Structural imaging involved a sagittal three-dimensional sequence employing a magnetisation prepared rapid gradient echo (MPRAGE) over the whole brain.

CUD in SCZ patients was associated with higher impulsiveness and excitement, and lower negative symptoms and neurological soft signs (Fig.1). SCZ-CUD+ and SCZ-CUD- groups differed little on cognitive performance, except for Symbol Coding, where SCZ-CUD- outperformed SCZ-CUD+. Rs-fMRI, compared to SCZ-CUD-, showed reduced FC in patients with SCZ-CUD+ between regions of the salience network, including anterior cingulate and prefrontal cortices, and between right insula and dorsolateral prefrontal cortex and precuneus (Fig.2, Fig.3).

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Using rs-fMRI, we revealed differences in FC within the SaN between SCZ-CUD- and SCZ-CUD+. Continuous cannabis use reduces FC in cortical circuits, impacting connections already impaired in SCZ. In SCZ-CUD+ patients, altered self-relevance attribution and insular dysfunction may increase drug-related impulses and impair cognitive control.

None Declared

Fahr’s Syndrome is a rare disorder characterized by abnormal brain calcium deposits presenting as extrapyramidal signs, cognitive impairment, movement disorders, and psychiatric symptoms. Though well documented in association with hypoparathyroidism, its presentation secondary to pseudohypoparathyroidism (PHP) is exceptionally unusual.

To report a rare neuropsychiatric presentation of Fahr’s Syndrome secondary to PHP.

We report this rare case following the CARE Case Report guidelines.

A 25-year-old female was admitted to the neurology ward after a referral from the Psychiatry clinic for dysarthria, involuntary movements affecting gait and daily activities, worsening psychomotor slowing for five years & depressive symptoms for around a year. She had difficulty controlling anger for 2.5 years & 2 impulsive attempts at self-harm in the past 6 months with no suicidal intent in which she tried to slash her wrist & jump off the rooftop over verbal confrontations with family (Image1).

Neuroimaging revealed bilateral, symmetrical calcifications in basal ganglia, thalami, red nuclei, the gray matter of bilateral occipital and frontal lobes, and cerebellar hemispheres (Image 2). Image 3 shows MRI Brain (with contrast) axial section images: Altered hyperintense signals in bilateral basal ganglia & red nuclei of midbrain on T1WI, hypointense signals on T2/FLAIR, and Blooming artifacts on SWAN images.

She was diagnosed with PHP based on hypocalcemia, hyperphosphatemia, high intact parathormone (PTH), and normal Serum Vitamin D levels. The absence of Albright’s Hereditary Osteodystrophy (AHO) phenotype and normal thyroid profile suggested PHP-type 2/1B but we couldn’t perform the Ellsworth Howard test to distinguish due to the unavailability of synthetic PTH. She was treated with oral calcium supplements, oral active vitamin D (CALCITRIOL or 1, 25-DIHYDROXYCHOLECALCIFEROL), CALCIUM ACETATE, AMANTADINE, ALFACALCIDOL, and ESCITALOPRAM leading to significant improvement in depressive symptoms, and normocalcemia at one-year follow-up.

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The diagnosis and management of rare neuropsychiatric syndromes maybe challenging in low-resource settings and timely diagnosis and management necessitate looking beyond the mind-body dualism and ensuring a multidisciplinary approach. Our patient’s neurological features were overlooked at a specialist mental healthcare facility for 5 years which accentuates the significance of thorough neurological assessment during psychiatric evaluations and of incorporating neuropsychiatry and psycho-neuro-endocrinology into the training and practice of psychiatry and neurology in Pakistan. This case also provides insights into the economic barriers to the management of neuropsychiatric disorders in a lower middle-income country (LMIC), where high out-of-pocket expenditure on treatment may result in loss of follow-up.

None Declared

Previous resting-state fMRI studies have found hypoconnectivity between the areas underlying default mode and salience networks in OCD patients. A general dysconnectivity has been observed between the frontoparietal network and corticostriatal-thalamocortical loops in patients with OCD, We conducted a study to understand the neural correlates of OCD and its sub-types and compared them with healthy controls. As a part of the analysis of fMRI data, we also analyzed the resting state data for OCD patients and compared it to that of healthy controls.

To study the neural correlates of OCD using functional MRI by comparing the resting state functional connectivity in OCD patients with healthy controls.

We used the resting state functional MRI data of 8 OCD patients and compared it with 10 healthy controls. The healthy controls and patients were not age—and sex-matched. The resting state fMRI data was assessed using the CONN functional connectivity toolbox, version 15.d, in MATLAB. The Regions of interest (ROIs) were mapped using the MNI coordinate system. The functional connectivity (FC) was studied with ROI-to-ROI analysis and seed-to-voxel analysis.

1. In ROI to ROI analysis between resting state networks, only one significant result was found when FC between all the brain networks was compared. as shown in table 1 and image 1.Table 1.

2. Seed-to-voxel-based analysis revealed that at p-FWE <0.05 corrected, the left and right occipital pole and right intra-calcarine cortex were more active in OCD patients as shown in image 2.

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1. ROI TO ROI analysis: Attempts to gain control over automatic processes are taxing on the cognitive resources and effective control is lacking in OCD, which could explain higher functional connectivity in the areas linked to having selective attention for specific visual stimuli as found in our study. The lateral occipital cortex supports both visual perception and multisensory integration and visual cortices have been seen to contribute to impulsivity and disorders commonly associated with impulsivity. The rostral prefrontal area in the salience network is involved in sequence selection and evaluation and has a possible role in attention. DMN and corticostriatal networks were normal possibly due to the small sample size, patients on treatment, etc.

2. Seed to Voxel Analysis showed left as well as right occipital poles and right intra-calcarine cortex which process visual stimuli, were more active at rest in OCD patients. Some studies have highlighted deficits in visuospatial processing in OCD patients. The intra-calcarine cortex would require further research for a better understanding of its role in OCD patients.

None Declared

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that highly impacts children’s development, representing a significant challenge in pediatric healthcare. Parents of children with ASD are nowadays considered as real partners in their children’s care. Several parent-mediated interventions (PMIs) have proven to produce sustained improvements in autism symptomatology and social communication. However, widespread access to this type of intervention is still very limited mostly due to geographic and logistic constraints. The use of technology is therefore increasingly considered with the use of videoconferencing and online training modules. In this context, our team developed a novel parental coaching via E-learning (E-coaching) intended for parents of pre-school children with ASD.

The ongoing randomized controlled trial aims to evaluate the feasibility and preliminary efficacy of our E-Coaching program compared to a standard coaching and a control group with no PMI.

The present study is a monocentric randomized controlled trial with three arms (E-coaching, Standard coaching, Control) of 33 children (N=99). Feasibility was assessed across recruitment, acceptability and implementation using semi-structured interviews. The primary outcome will be the quality of parent-child interaction, measured using a range of behavioral observations and by monitoring parent and child gaze using two head-mounted eye-tracking systems during semi-structured standardized play sessions. Secondary outcomes will include child’s developmental level through neuropsychological testing, and parental wellbeing through several standardized parent-report questionnaires.

We present preliminary evidence supporting the feasibility and acceptability of the intervention, with participants reporting positive benefits on parent-child interaction. Preliminary observational data on the first families provided support for an improvement on parent-child interaction immediately after the end of the E-coaching intervention, as well as an increase of parental wellbeing.

We found initial feasibility for our E-coaching program, suggesting that parent-mediated E-learning interventions may be a promising format to implement with ASD families. Further evaluation to assess efficacy of the intervention is warranted and underway. If validated, E-coaching will enable us to reach a larger number of families and to have an early and meaningful impact on the developmental trajectory of these children, and on their quality of life.

None Declared

Digital wearable devices, such as smartphones and smartwatches, have shown potential for passively monitoring mental and physical health in individuals with Severe Mental Illness (SMI), such as schizophrenia and bipolar disorder. While research-grade devices are well studied, consumer-grade wearables could offer a more accessible alternative, though their utility in this specific context remains underexplored.

We conducted a systematic review to assess the utility of data from consumer-grade wearables in tracking and predicting changes in mental and physical health among adults with SMI. We focused on passively collected physiological data, such as sleep patterns, physical activity, and heart rate. We sought to a) identify relationships between data streams and both mental and physical health outcomes and b) recommendations for future digital phenotyping research.

A systematic review of multiple databases (Cochrane Central Register of Controlled Trials, APA PsycINFO, Embase, MEDLINE, and IEEE XPlore) was conducted in May 2024. Studies that collected passive physiological data for at least three days were included. Narrative methods were used to synthesise results across three key phenotypes: physical activity, sleep and circadian rhythms, and heart rate. Studies using invasive, or research-specific devices were excluded.

In total, 23 studies met the inclusion criteria, representing data from 12 distinct studies and more than 500 participants with SMI, mostly from high-income countries. The majority of studies used smartphones (N=15), with only eight utilizing smartwatches or other wrist-worn wearables. Eighteen studies focused on physical activity, 14 on sleep and/or circadian rhythms, and six on heart rate. We explore the findings of this study, focusing on practical recommendations for future research in the following areas: exploiting opportunities to promote physical health outcomes in SMI; greater standardization of reporting and methodologies; fine tuning longitudinal data collection and feature definition; and comparing alternative data analysis strategies.

Consumer-grade wearables hold significant promise for the passive monitoring of both mental and physical health in individuals with SMI, though current research focuses largely on psychiatric relapse prevention. The findings of this systematic review provide insights into research gaps and future research directions, including tackling physical comorbidities in this population.

L. Hassan: None Declared, C. Sawyer: None Declared, A. Milton: None Declared, J. Torous Grant / Research support from: Otsuka , Consultant of: Precision Mental Wellness, A. Casson: None Declared, A. Davies: None Declared, B. Ruiz-Yu: None Declared, J. Firth Consultant of: Atheneum, Informa, Bayer, HedoniaUSA, Strive Coaching, Angelini, ParachuteBH, and the Richmond Foundation.

Public health and policy require effective health strategies for diverse contexts. Despite numerous studies, a gap exists in translating knowledge to real-world scenarios. The RESPOND study’s stepped-care intervention has shown efficacy in anxiety and depression among healthcare workers, recognized by the European Commission as a best practice. Conducting a pilot trial in Madrid, we aimed to address this research-to-practice gap.

After evaluating a previous randomized controlled trial, we adapted our intervention for a primary care center in Madrid, implementing it over 5-6 weeks in November-December 2023. We used two strategies: remote delivery via app or website with weekly calls, and hybrid, with group sessions instead of calls.

Gathering data included sociodemographic (age, gender, and type of job), clinical (Kessler Psychological Distress Scale, K-10), and qualitative insights through interviews, to explore implementation outcomes from Proctor’s model (Acceptability, Appropriateness, Feasibility, Fidelity, and some ideas for future large-scale implementation). We used mixed methods to analyse data. For the quantative data, we used descriptive statistics such as means, frequencies and percentages to describe the results. For qualitative data, interview transcriptions were analysed following thematic analysis guidelines.

We included 17 out of 39 healthcare workers (44%) working at the primary care center, the sample included 8 doctors, 5 medical residents, 3 nurses, and 1 social worker. Only 3 were male. Over half chose the hybrid option, with 2 dropouts. Regarding clinical information, 88% of participants initially reported psychological distress, but after the intervention, this dropped to 66%. Participants found the intervention timely and appropriate, with an average satisfaction rating of 8 out of 10.

Preliminary findings show the intervention was well-received, and both strategies were successful, reaching a broad audience. Thematic analysis of the interviews is still ongoing. Preliminary results suggest that these strategies are appropriate /feasible for the Madrilenian healthcare system.

None Declared

ChatGPT is a language model based on artificial intelligence (AI) that is designed to generate human-like text. It offers potential applications in automating and simplification of clinical documentation tasks, addressing the increasing administrative burden that contributes to high rates of burnout in psychiatry. As discharge summaries are typically structured and repetitive, the use of ChatGPT to automate this task could offer significant benefits, such as reducing clinical workload, improving summary quality, and preventing delays in patient discharges. However, concerns about reliability, accuracy, and ethical considerations persist.

Explore the feasibility and implications of using ChatGPT to assist in writing discharge summaries in psychiatric settings.

A narrative review was conducted by searching PubMed and Google Scholar with the keywords “ChatGPT”, “discharge” and “psychiatry”. Relevant articles, including empirical studies, case reports, reviews, and expert opinions were selected.

We found only one empirical study that evaluated psychiatric discharge summaries generated with ChatGPT-4: human-written discharge summaries were rated significantly higher in quality than those generated by ChatGPT; the ChatGPT summaries fell short, particularly in coherence and specificity of formulations, though they performed reasonably well in summarizing relevant case information. Most of the literature consisted of theoretical discussions and expert opinions related to the broader use of AI in psychiatry. Despite this, the potential benefits, such as improving the efficiency and consistency of documentation, were frequently highlighted. However, concerns related to accuracy, the need for clinician oversight, and ethical implications were consistently noted.

ChatGPT shows promise in assisting with the generation of psychiatric discharge summaries, potentially alleviating the documentation burden faced by clinicians. However, further refinement of the model, integration with electronic health records, and the establishment of clear ethical safeguards are necessary for its safe and effective use. The current lack of empirical evidence highlights the need for targeted research that should also address challenges related to data governance, patient acceptance, and error management. Additionally, studies should evaluate the direct impact on clinician workload and compare the quality of AI-generated summaries with those written by psychiatrists and residents. Such research will be essential to facilitate the broader integration of ChatGPT in real-world psychiatric practice.

None Declared

Research indicates that detailed and sensational media coverage of suicide can contribute to suicide mortality, known as the Werther Effect. Other research indicates that responsible reporting of suicide can promote hope and resilience, which can reduce suicidality, known as the Papageno effect. This has led to the development of responsible reporting of suicide guidelines. In Canada, these are contained in a booklet called Mindset, which was co-created by journalists and mental health experts. Mindset lists bullet-pointed recommendations for journalists, and has been widely disseminated to newsrooms, journalism schools and media professionals across the country, in tandem with educational activities aimed at journalists by suicide prevention experts.

The overall aim of this study is to assess fidelity to Mindset responsible reporting of suicide guidelines in the Canadian media over a multi-year period. A secondary objective is to assess whether fidelity to responsible reporting of suicide guidelines during the COVID-19 pandemic was significantly different to pre/post pandemic reporting of suicide.

We collected articles from 47 different Canadian national and regional news sources mentioning the word suicide on a daily basis from April 1st 2019 to March 31st 2023 (N=3,232). Each article was read and assessed for adherence to 12 key suicide reporting guidelines using a purposely-built coding sheet, derived from the Mindset guidelines. Trends in reporting were analyzed through time series analyses using a GLARMA model in R. software, including measuring for change during the COVID-19 pandemic.

Significant increases in putatively protective content were observed over the four years, including rises in the inclusion of help-seeking information and the quotation of experts. Similarly, there was a general decrease in content that is putatively harmful, for example significantly fewer articles in latter years gave a monocausal explanation of suicide, used sensational language or described in detail any suicide method. That said, fewer than one-third of articles in the final year included educational content about suicide, help-seeking information, or quotes from suicide experts. Reporting of suicide during the COVID-19 pandemic showed some positive improvements compared to pre-pandemic reporting, but these were not sustained post-pandemic.

Fidelity to responsible reporting of suicide guidelines improved over the four-year period, especially recommendations concerning putatively helpful content. However there remains room for improvement regarding inclusion of putatively protective content such as including help-seeking information and educating the public about suicide. As such, further educational outreach to journalists is needed to encourage greater inclusion of protective content, while avoiding harmful content.

None Declared

Suicide remains a leading cause of death worldwide, representing a significant public mental health challenge across all populations. Moreover, suicide rates are notably higher in patients following discharge from inpatient psychiatric care. Existing evidence regarding the specific risk factors for suicide in this population, however, remains contradictory. This study aims to systematically investigate those risk factors for post-discharge suicide death from a large psychiatric care facility.

To identify the risk factors associated with suicide following discharge from psychiatric care.

Data from a 15-year single-centre cohort study were linked with national death registry records. Competing risk models were employed to calculate cumulative incidence rates. Key variables analyzed included sex, age at admission, discharge diagnosis, year of admission and length of stay. Subdistribution hazard ratios for these factors were computed using Fine-Gray models.

In the sample of 18,425 discharges from 10,973 individual patients (57.03% female), a relative excess hazard to die by suicide of 1.4 additional suicides per 100,000 population the first year after discharge compared to the general population was found. That risk of suicide after discharge was significantly higher for males (SHR = 1.67; p = 0.037) as well as for patients diagnosed with affective disorders (SHR = 3.56; p = 0.017) and neurotic stress and somatoform disorders (SHR = 3.73; p = 0.024). The risk of suicide decreased significantly in more recent discharge periods (SHR = 0.93; p = 0.006). The length of hospital stay did not show a statistically significant association with suicide risk (SHR = 0.98; p = 0.834).

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Male sex and specific diagnoses, notably affective and neurotic stress and somatoform disorders, were associated with an increased risk of suicide following discharge from psychiatric care. The observed decrease in risk over time could potentially point to improvements in post-discharge patient management and or treatment. These findings underscore the necessity for enhanced risk assessment tools and targeted interventions to address suicide risk in discharged psychiatric patients.

None Declared

Inspired by discussions at the EPA Summer School 2024 on suicide prevention, this poster explores local strategies implemented across European nations. Emphasizing the importance of tailored approaches, the study analyses successful initiatives and community-based programs, and investigates how country-specific factors influence suicide rates. Key findings from research papers on innovative methodologies were also examined, offering insights to inform future practices in suicide prevention.

The poster aims to:

• - Present local strategies for suicide prevention across European countries, focusing on the contributions of clinicians who attended the EPA Summer School.

• - Highlight how knowledge of diverse strategies can impact clinical practice in mental health across Europe.

• - Categorization: European countries are grouped by suicide rates—high, medium, and low—using WHO and European CDC data.

• - Summarization: Local prevention strategies and programs in each group are summarized.

• - Analysis: Various socio-economic and cultural factors influencing suicide rates are discussed, including stigma, economic conditions, and access to healthcare.

• - Comparative Approach: Strategies are compared to identify common successful elements and contextual challenges.

None Declared

34-year-old patient with multiple sporadic and brief contacts with mental health services, which he unilaterally chooses to discontinue. He has a long history of parasuicidal behavior dating back to adolescence. The patient does not report any prior diagnoses and has no history of inpatient admissions. The patient describes experiencing social isolation, lacking contact with his family of origin, and having no significant peer relationships.

The primary goal is to improve the patient’s engagement with mental health services, particularly in a case experiencing chronic, unaddressed symptoms, by utilizing intensive and structured programs. An additional objective is to address the patient’s self-identification with suicidal ideation.

The patient’s first contact with mental health services in this region of Spain was through the emergency department following a suicidal episode. During this encounter, the clinician introduced an intensive program designed to address suicidal ideation through regular visits over a set period. The patient agreed to participate and was subsequently enrolled in the PRISURE program at HGUGM in Madrid, where he received multiple sessions each month (between 2 and 4) with both a psychiatrist and a nurse from March to June 2024.

At the beginning of the program, the patient was fixated on the idea of suicide from a romantic/nihilistic perspective, displaying a pervasive rejection of interpersonal contact and a narcissistic element in interactions. He expressed persistent suicidal ideation. Over the course of frequent visits, the patient gradually began to connect with the chronic nature of his behaviors and started to identify additional symptoms. Despite partial engagement in the program, in this case with some missing consultations, his attendance at consultations improved significantly compared to his prior behaviors. An inpatient stay was initially offered and declined by the patient; however, after further consideration, he later presented to the emergency room and agreed to inpatient treatment. During the admission, a diagnostic assessment was carried out and discussed with the patient, revealing challenges in identity, object relations, and moral functioning, which were positioned within the spectrum of personality disorders, particularly highlighting narcissistic and antisocial traits.

Initially focused on his suicidal ideation, the patient, through the PRISURE program, gradually explored underlying difficulties contributing to his suicidal behavior. This process allowed him to accept further support, ultimately leading to an inpatient stay. Potential diagnoses were discussed openly with the patient, helping him to gain a clearer understanding of his lifelong challenges and enabling him to articulate these difficulties within the therapeutic context.

None Declared

Suicide is a global health issue. Clinicians still have difficulties to differentiate patients who will or not commit suicide. This process is influenced by emotional and rational factors. Emotional responses (also known as countertransference) refers to what emotions clinicians experience. When working with suicidal patients, clinicians frequently experience negative emotions, such as fear, guilt and hopelessness. Clinicians’ negative emotions responses contribute to their assessment of risk. Possible factors that influence emotional responses are myths and beliefs around suicide, contributing to stigma.

This study aims to investigate the relationship between emotional responses, knowledge and stigma about suicide when providing care to suicidal patients.

An anonymous web-based survey was implemented through the software REDCap. Data were collected by snowball sampling. Participation was voluntary and participants had the ability to opt out at any time. The study was approved by the University Ethics Committee. The survey consisted of the Informed Consent Form (ICF), Sociodemographic Questionnaire, Scale of Myths, Beliefs and Attitudes About Suicide (SMBAS) - which evaluates stigma about suicide trough true or false questions. We also included the Rating Scale for Countertransference (RSCT) which evaluates the main emotional responses towards suicidal patients, divided in approach, indifference or rejection. Other questionnaires were included for future research, beyond the scope of this study.

From 210 respondents, 179 (85.2%) completed the questionnaire. Sociodemographics: 108 (60.3%) were female; 166 (92.7%) were self-declared white-colored skin; The mean age was 37.22 (SD = 12.33), with 6 (0 to 48) median years of professional life [65(36.3%) were medical residents; 112(62.6%) were already specialists, 54(48.2%) of those declared to be psychiatrists]. Psychiatrists had highest rate of correct answers (M = 28,96, SD = 1,84) in SMBAS when compared with non-psychiatrists (M = 27,86, SD = 2,39 , p = 0,008); Psychiatrists presented more emotional responses of interest (M = 2,58, SD 0,68, p < 0,001), solidarity (M = 2,81, SD 0,45, p < 0,001) and desire to help (M = 2,83, SD 0,38, p = 0,010). Non-psychiatrists presented more emotional responses of hostility (M = 0,06, SD 0,25, p = 0,040) and distance (M = 0,32, SD 0,56, p = 0,002). Psychiatrists presented more approach (p=0,03) and non-psychiatrist indifference (p=0,03).

We find preliminary evidence that psychiatrist present higher knowledge around suicide theme, having lower stigma around suicide. Psychiatrists also present more countertransference of approach and less of indifference.

None Declared

Psychiatric disorders are risk factors for suicidality, but it is also considered a multifactorial phenomenon. Genome-wide association studies may provide an insight into the etiological background of distinct phenomena along the suicidal continuum, and may also help disentangle their overlapping genetic architecture with psychiatric disorders.

Our aim was to carried out a GWAS for suicidal ideation in a well-phenotyped sample.

We conducted a genome-wide association study (GWAS) in the NewMood (New Molecules in Mood Disorders, Manchester and Budapest) database, 1820 subjects were involved (533 males, 1287 females), the suicidal ideation and behaviour were investigated with a suicide-focused item of the Brief Symptom Inventory (BSI). SNP-level association was assessed employing linear regression models, assuming additive genetic effects, using PLINK2.0, with gender, age and the first ten principal components (PCs) of the genetic data as covariates. Bonferroni-corrected significance threshold on SNP-level was p ≤ 5.0 × 10-8, and the suggestive significance threshold was p ≤ 1.0 × 10-5. GWAS results including the identified significant results were interpreted using FUMA v1.5.2.

9 SNPs were identified, 2 with genome-wide significance and 7 with suggestive significance. The most significant SNP, rs79912020 (β=, P=3.21x10-10, Chr4) was located in the MANBA gene and the other genome-wide significant variant, rs10236520 (β=, P= 1.706x10-8, Chr7) is located near the gene LOC124901613. Furthermore, we have found more important variants with suggestive significance, rs117677616 (β= , P=1.199x10-6, Chr20) is identified in PTPRT gene, rs34475 (β= , P=1.981x10-6, Chr12) is located in CFAP54, rs711180 (β= , P= 2.934x10-6, Chr12) is near the gene VWA1 and the variant rs2655484 (β= , P=5.717x10-6, Chr12) is located near the GRIP1. No genes were identified in gene-level analysis with genome-wide significance.

We identified 9 SNPs with genome-wide or suggestive significance in association with suicidal ideation, with several lines of converging evidence supporting their involvement in the development of suicide risk. MANBA gene has role in the development of unipolar depression, PTPRT is associated with appearance of major depressive disorder, and the GRIP1 gene may be considered also as a potential biomarker for suicide, as it has been previously associated with psychiatric phenotypes indirectly linked to suicidal behaviour and in patients with increasing suicidal ideation during antidepressant treatment. The prevention of the suicides is a prominent aim in mental healthcare and these new variants may be helpful in establishing novel, focused and more filters for this vulnerability.

Funding: NAP2022-I-4/2022, K143391, 2019-2.1.7-ERA-NET-2020-00005, TKP2021-EGA-25

None Declared

Major depressive disorder (MDD) is the single most important risk factor for suicide. Interestingly, even with a high prevalence of suicidality, not all MDD patients develop suicidal thoughts or complete suicide. Thus, it is critical to examine the risk factors that can distinguish suicidality among MDD patients.

It has been hypothesized that epigenetic marks, such as DNA methylation, can be influenced by the environment, which may play a critical role in developing depression and suicidal behavior. The present study examined genome-wide DNA methylation in the prefrontal cortex of depressed suicide (DS), depressed non-suicide (DNS), and nonpsychiatric control subjects.

Genome-wide DNA methylation was examined in the prefrontal cortex of age- and sex-matched depressed suicide, depressed non-suicide, and nonpsychiatric control subjects using 850K Infinium Methylation EPIC BeadChip. The methylation β values were generated based on normalized signal intensities and background subtraction using negative control probes and were derived as the ratio of methylation probe intensity to the overall intensity. The hyper and hypo-methylated sites were also mapped across 22 autosomes using PhenoGram Plot. The significantly differentially methylated gene lists were used to determine the functional enrichment of genes for ontological clustering and pathway analysis.

The chromosome-wise methylation sites and mapping of methylated sites based on the number of CpG content and their relative distribution from specific landmark regions of genes identified 32958 methylation sites 12574 genes in NC vs. all MDD subjects, 30852 methylation sites across 12019 genes in NC vs. DNS, 41648 methylation sites across 13941 genes in NC vs. DS, and 49848 methylation sites across 15015 genes in DNS vs. DS groups. A comparison of methylation sites showed 33129 unique methylation sites and 5451 genes in the DNS group compared to the DS group. Functional analysis suggested Oxytocin, GABA, VGFA, TNFA, and MTOR pathways associated with suicide in the MDD group.

Our data show a discrete pattern of DNA methylation, the genomic distribution of differentially methylated sites, gene enrichment, and pathways in MDD subjects who died by suicide compared to non-suicide MDD subjects and suggest that epigenetic DNA modifications could be used to distinguish suicidality in MDD patients.

None Declared

Daridorexant, a dual orexin receptor antagonist [DORA] which works by selectively reducing the orexin-induced wake signalling, has been shown to induce a dose-dependent reduction in wake time after sleep onset [WASO] in patients with insomnia disorder (Dauvilliers et al. Ann Neurol 2020; 87 347–356).

This exploratory analysis examined the efficacy of daridorexant in reducing the duration of awakenings in each quarter of the night, when compared to placebo and to the GABA-receptor agonist zolpidem, which induces sleep through widespread CNS sedation.

This was a multi-centre, double-blind trial (NCT02839200), including adult (18–64y) patients with insomnia randomized (1:1:1:1:1:1) to placebo, daridorexant (5, 10, 25, or 50mg), or zolpidem (10mg) for 30 days. Polysomnography [PSG]-determined WASO was evaluated using descriptive statistics by quarter of the night (Q1–Q4) i.e. every 2 hours over 8 hours at Days 1 & 2, 15 & 16, and 28 & 29. Baseline was defined as the mean of the two PSG nights during the run-in period and Days 1&2 as the mean of the first two PSG treatment nights; Days 15&16 and 28&29 were defined similarly.

Dose-dependent decreases in mean change from baseline in Q1–Q4 WASO were observed with daridorexant (5–50mg) at Days 1 & 2 (Figure 1). Whereas the approved doses of daridorexant (25mg and 50mg) provided similar response to zolpidem 10mg in the first half of the night, mean reductions from baseline in WASO were numerically greater with daridorexant 50mg versus zolpidem 10mg during the second half of the night – with the difference most pronounced in the fourth quarter (mean WASO change from baseline Q3: –13.49 min versus –9.73 min; Q4: –17.51 min versus –7.81 min). Similar effects were seen at Days 15 & 16, and Days 28 & 29.

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In patients with insomnia disorder, daridorexant reduces the duration of awakenings throughout the entire night, including the last two quarters.

B. Steiniger-Brach Employee of: Idorsia Pharmaceuticals, O. Briasoulis Employee of: Idorsia Pharmaceuticals, A. Olivieri Employee of: Idorsia Pharmaceuticals, S. Pain Employee of: Idorsia Pharmaceuticals, L. Palagini Consultant of: Bruno, Fidia, Idorsia Pharmaceuticals, Pfizer, Sanofi, Pharmanutra, Neopharmed Gentili, D. Kunz Consultant of: Austrian Association of Skiing (ÖSV), Idorsia Pharmaceuticals, Speakers bureau of: AbbVie, Idorsia Pharmaceuticals, German Ministry for Economy (BMWi), Austrian Association of Skiing (ÖSV), P.-A. Geoffroy Consultant of: Apneal, Arrow, Biocodex, Dayvia, Di&Care, Idorsia Pharmaceuticals, Janssen-Cilag, Jazz pharmaceuticals, Myndblue, Mysommeil, Posos, ResilEyes, Withings, Speakers bureau of: Biocodex, Bioprojet, Ibsa, Idorsia Pharmaceuticals, Janssen-Cilag, Isis Medical, Jazz pharmaceuticals, Lundbeck, MySommeil, Withings.

The evaluation of trauma-related disorders is becoming increasingly significant in psychiatric assessments. According to the DSM-5, these disorders are categorized as Post-Traumatic Stress Disorder (PTSD), Acute Stress Disorder, Adjustment Disorders, Prolonged Grief Disorder, Reactive Attachment Disorder, and other specified trauma- and stressor-related disorders. International guidelines on post-traumatic symptoms report positive outcomes with trauma-focused cognitive-behavioral therapy and EMDR, as well as non-trauma-focused therapies, such as relaxation techniques. Acupuncture and acupressure techniques can be used not only for treating symptoms but also for addressing associated sleep disorders, headaches and affective disorders. These methods are clinically applied to patients with traumatic events, primarily as ear acupuncture using the NADA protocol, along with ‘Battlefield Acupuncture,’ which has been established among American soldiers. In our clinical work, we use a unique protocol called Acupuncture-Based Exposition (ABE) (Schottdorf & Musil, 2017).

The assessment of the effectiveness of the newly developed method of Acupuncture-Based Exposure (ABE).

The ABE (Acupuncture-Based Exposition) method was developed by Dr. Schottdorf and investigated by Dr. Musil and has already been clinically applied in their practice and clinic to a variety of patients. It has also been invetigated in an initial pilot study focusing on Type I trauma-related disorders, post-embitterment disorder as well as postpartum depression, and pain disorders. During ABE sessions, after a basic acupuncture treatment, patients are guided to visualize images of their traumatic experiences. The resulting physical sensations and emotions are addressed through corresponding acupuncture points until their intensity decreases. Finally, the imagined images are faded out using points on the head. Patients subsequently report a significant reduction in the burden of intrusive memories.

In an initial case series involving 24 patients with trauma-related symptoms, an average reduction in trauma-specific symptoms was observed after just 3.95 sessions, as measured by the Impact of Events Scale-Revised (IES-R), from 55.6 ± 23.0 to 16.2 ± 21.1 (Wilcoxon test: p < 0.002). Additionally, a decrease in depressive symptoms was noted, measured by the Beck Depression Inventory, from 38.3 ± 8.0 to 25.6 ± 8.0 (Wilcoxon test: p < 0.001) (Schottdorf, 2018). So far, there have been no investigations into the mechanisms of action of ABE beyond clinical experience and initial data from clinical pilot projects.

Particularly, integrating acupuncture as an adjunct to conventional treatments for mental disorders appears to offer promising results. Further clinical research in the field of acupuncture and the ABE method is necessary.

None Declared

Nightmares have been linked to childhood trauma and an increased risk for mental health problems, such as depression. Meanwhile, there is a high comrobdity of nightmares and insomnia. Yet relatively few studies have compared the clinical presentations of nightmares in different clinical groups. Additionally, considering the close association between childhood trauma, insomnia, and depression, there might exist potential unique interactions between childhood trauma and clinical diagnoses on nightmare experience.

This case-control study aimed to compare nightmare-related parameters (i.e., frequency, distress, severity, and impairment), and childhood trauma among adolescents with depression only (DG), insomnia only (IG), and healthy control (HG) groups. We explored the interaction between diagnosis and childhood trauma on nightmare parameters.

Participants completed a clinical interview to ascertain their eligibility. Data on demographic and clinical information, childhood trauma as assessed by the childhood trauma Questionnaire (CTQ) , and nightmare-related parameters, including nightmare frequency, nightmare distress, nightmare severity, and nightmare impairment, were analysed in the current study. Analysis of variance (ANOVA) and multivariate analysis of variance (MANOVA) were used to examine the group differences, and regression analysis was used to examine the interaction effect on study variables.

Adolescents with insomnia (N = 31; age 16.84 ± 1.88 years; female: 54.8%), female: 55.2%), depression (N = 22; age 17.50 ± 2.18 years; female: 54.5%) and healthy controls (N = 31; age 16.84 ± 1.88 years; female: 54.8%) were recruited. Compared to the HG, the IG and DG had greater nightmare distress (IG: p = .024; DG: p =.005) and nightmare impairment (IG: p = .007; DG: p = .031), but not nightmare frequency. However, only DG showed significantly higher nightmare severity (p = .038). No other significant differences were found in nightmare parameters between IG and DG (all p > .05). For childhood trauma, only DG showed significantly higher scores in emotional abuse (p =.013), emotional neglect (p = .021), and physical neglect (p = .012). No interaction effect of childhood trauma and clinical diagnosis was found on nightmare-related parameters (all p > .05).

This study showed that adolescents with insomnia or depression exhibited greater nightmare-related distress and impairment. Higher nightmare severity may be a unique characteristic in adolescents with depression but not for insomnia. Despite the depression group reporting significantly more childhood traumatic experiences, the potential interaction effect between diagnosis and childhood trauma was not observed on nightmare-related parameters. Future research may examine the relationship between the relevant variables in a larger sample size using a longitudinal design.

Y. Li: None Declared, H. F. Sit: None Declared, Y. L. Wong: None Declared, S. X. Li Grant / Research support from: This work was funded by Seed Fund for Basic Research, The University of Hong Kong and General Research Fund (Ref. 17613820), Research Grants Council, University Grants Committee, Hong Kong SAR, China.

Complex post-traumatic stress disorder (cPTSD) is a clinical entity characterized not only by the typical symptoms of hyperarousal, avoidance, and flashbacks but also by disturbances in self-organization. Given the well-known association between trauma and cognitive deficits, it is common to observe a significant prevalence of such alterations among patients with cPTSD.

The aim of this study is therefore to assess cognitive functioning in response to treatment using Eye Movement Desensitization and Reprocessing (EMDR).

Fifty-eight patients were recruited and divided into two groups (28 PTSD; 23 cPTSD), to whom scales for post-traumatic symptomatology (Impact of Event Scale – revised – IES-R; Clinician-Administered PTSD Scale – CAPS), along with cognitive tests (MATRICS Consensus Cognitive Battery - MCCB), were administered. The patients were evaluated at baseline (T0) and 6 months after the completion of the last EMDR session (T6).

EMDR was effective in the treatment of post-traumatic symptomatology (IES-R; CAPS - p<0.001). The PTSD group showed improvement in the domains of verbal learning (RAVLT), visual attention (TMT-A), and working memory (CBTT) (p<0.05). The cPTSD group reported improvement in the verbal learning domain (p<0.05).

In addition to clinical symptomatology, EMDR has been shown to be effective in treating cognitive deficits in patients with PTSD and cPTSD. However, further studies are needed to confirm the results and identify the underlying mechanisms of this effect.

None Declared

Sleep problems, particularly insomnia and sleep deprivation, are common among adolescents, and may increase their risk for poor psychosocial and metabolic health. Traditional classroom-based education programmes showed inconsistent results in promoting sleep behavioural changes. In contrast, enhancing training programme with experiential activities alongside classroom learning may be considered as a more sustainable means to promote healthy sleep in adolescents.

The present study evaluated the impact of a four-week enhanced sleep education programme on adolescents’ sleep quality, knowledge and behaviour, and their experience of participation.

Adolescent participants took part in the Youth Sleep Ambassadors Programme, which was designed to equip them with evidence-based information on sleep and circadian health through active learning and community outreach activities. A mixed-methods design was adopted to evaluate the programme. Participants completed self-administered questionnaires, including a sleep knowledge quiz, the Pittsburgh Sleep Quality Index (PSQI) to assess subjective sleep quality, and the Sleep Hygiene Index (SHI) to evaluate healthy sleep behaviour, before and after the programme. Additionally, two focus groups were conducted to understand participants’ experiences with the programme.

Thirteen participants, aged 15 to 17, participated in the progamme and rated the programme’s effectiveness at 4.38 out of 5. At post-programme, there were significant increases in total sleep time (baseline: 6.12hr, post: 7.31hr, p=.006) and time in bed (baseline: 6.83hr, post: 7.98hr, p=.046), in addition to a reduction in PSQI score (baseline: 5.92±1.98, post: 3.92±1.50, p=.031). There was a noticeable trend of improved sleep knowledge with a 13.5% increase in correct rate and healthy sleep behaviour (SHI: baseline: 24.4±6.76, post: 20.6±5.33). Focus groups revealed increased awareness and confidence to advocate for better sleep and mental health among peers. Participants praised the programme as professional and well-organised but expressed a preference for more experiential and research activity over classroom learning, underscoring the limitations of classroom-based sleep education.

The findings provided preliminary support for this enhanced sleep education programme as a viable strategy to engage adolescents in understanding and awareness of sleep and circadian health. Beyond traditional classroom education, self-discovery and knowledge application with experiential tasks can better develop their perspectives and advocate in their community.

None Declared

Daridorexant is a dual orexin receptor antagonist approved for the treatment of chronic insomnia. Phase 3 studies have demonstrated that consistent nightly use of daridorexant 50 mg significantly improved both subjective total sleep time (sTST) and daytime functioning (Insomnia Symptoms and Impacts Questionnaire [IDSIQ] sleepiness domain) at Months 1 and 3 in patients with insomnia disorder versus placebo (Mignot et al. Lancet Neurol 2022; 21 125-39).

This exploratory analysis evaluated how the effect of daridorexant on both sleep and daytime functioning are perceived by patients with insomnia over time (i.e. week by week), as compared to placebo.

In this multi-centre, double-blind trial (NCT03545191), adult (18–64y) and elderly (≥65y) patients with insomnia disorder were randomized (1:1:1) to receive daridorexant 25mg, 50mg or placebo every evening for 3 months. Patients completed daily eDiary entries throughout the study, and weekly mean changes from baseline in sTST and IDSIQ-sleepiness domain were used to assess patients’ perceived duration of sleep and daytime functioning, respectively.

Weekly mean changes from baseline of both the sTST (Figure 1) and IDSIQ-sleepiness domain (Figure 2) from Week 1 to Week 12 of treatment improved over time in all treatment groups. At each week, the observed improvements from baseline were numerically larger for daridorexant 25 and 50 mg than placebo, with the 50 mg group demonstrating the greatest response. For sTST, treatment differences versus placebo were seen from Week 1 of treatment (mean increases from baseline for 25 mg, 50 mg vs placebo of +23.83, +32.63 vs 10.07, respectively), and were maintained throughout the study. For IDSIQ-sleepiness domain scores, treatment differences vs placebo were seen from Week 1 (mean reductions from baseline for 25 mg, 50 mg vs placebo of –1.56, –1.90 vs –0.92, respectively), with further separation from placebo until Week 4.

Image 1:

Image 2:

The benefits of daridorexant treatment on total time asleep and daytime functioning start to be perceived from Week 1. With consistent nightly use, efficacy on sleep and daytime functioning continued to build over the course of the 3-month treatment period, with the greatest effect being observed with daridorexant 50 mg.

T. Bakker Employee of: Idorsia Pharmaceuticals, O. Briasoulis Employee of: Idorsia Pharmaceuticals, A. Olivieri Employee of: Idorsia Pharmaceuticals, S. Pain Employee of: Idorsia Pharmaceuticals, L. Palagini Consultant of: Bruno, Fidia, Idorsia Pharmaceuticals, Pfizer, Sanofi, Pharmanutra, Neopharmed Gentili, D. Kunz Consultant of: Austrian Association of Skiing (ÖSV), Idorsia Pharmaceuticals, Speakers bureau of: AbbVie, Idorsia Pharmaceuticals, German Ministry for Economy (BMWi), Austrian Association of Skiing (ÖSV), P.-A. Geoffroy Consultant of: Apneal, Arrow, Biocodex, Dayvia, Di&Care, Idorsia Pharmaceuticals, Janssen-Cilag, Jazz pharmaceuticals, Myndblue, Mysommeil, Posos, ResilEyes, Withings, Speakers bureau of: Biocodex, Bioprojet, Ibsa, Idorsia Pharmaceuticals, Janssen-Cilag, Isis Medical, Jazz pharmaceuticals, Lundbeck, MySommeil, Withings