Day Treatment Programs are on the uprise in Germany. The Pfalzinstitut's Day Treatment Program in the south-western part of Germany was established in 2006 and provides multi-professional, non-residential psychiatric and psychotherapeutic treatment to mentally disturbed children and adolescents aged 6 to 18 years. This program addresses patients with moderate to severe mental health disorders thereby offering access to patients who were referred to in-patients departments in earlier years. Work with adolescents will be outlined as most day treatment units in Germany focus on work with children aged 6 – 13 years. The treatment approach includes psychiatric and psychotherapeutic consultation (Individual and group), psycho-educational groups, pharmacotherapy, occupational and recreational therapy and school.

Data despription of a five years' clinical population. Variables include demographics, length of stay, diagnoses using multiaxial classification, problem severity and clinical outcome. The spetrum of diagnoses is compared to Pfalzinstitut's in-patient department data from the same period.

Non-residential day treatment can replace in-patient admission in a broad spectrum of psychiatric diagnoses in children and adolescents. The number of personal contact between parents and the therapeutic team is higher than in the in-patient variant of treatment. However, certain disorders such as psychosis, severe eating disorder, severe self injury and suicidal behaviour must be excluded from day treatment programs. Step-down treatment from former in-patient to day treatment is often less tolerated by adolescent patients.

Day treatment appears to be effective and equally efficient as in-patient treatment in a large spectrum of psychiatric diagnoses.

The work is supported by the project of Russian Foundation of Basic Research No 14-04-01157a.

Although controversial in many countries, in The Netherlands euthanasia or physician assisted death has increased in patients with early stages of dementia, psychiatric illness and in conditions described as ‘being tired of life’ in the oldest old. There is a strong debate about this practice in the community and among professionals often with exclamation marks ranging from medical murder to providing ultimate care.

To provide figures, describe current practice and debate in The Netherlands with regard to capacity evaluation in older psychiatric patients and end of life questions.

Review of literature, case reports and own experience in the past decade.

There are few studies on the important issue of capacity making in psychiatric patients. The research that was performed does not show that a high threshold of capacity is required for granting euthanasia. Research on physician-assisted death in early dementia is scarce. With regard to end of life questions the debate in The Netherlands is still ongoing.

The author has not supplied his declaration of competing interest.

Street working children are often poor, deprived of love and care, and lack supervision by responsible adults. The Kurdistan region of Iraq has experienced war conflicts for decades. Many families have been displaced and their children forced into the streets. However, little is known about mental health among the street working children in this region.

To explore mental health and trauma among street working boys in Duhok.

A cross sectional study was conducted on street working boys (n=100), eight to 16 years old in Duhok. A control group of age-matched school boys (n=100) were recruited. The Child Behaviour Checklist 6-18 was used for assessment of the children’s competences and behavioural problems. Mental disorders were assessed by using the Mini-International Neuropsychiatric Interview for Children and Adolescence. Experienced trauma was assessed by the Harvard-Uppsala Trauma Questionnaire for Children.

Sixty-one percent of the street working boys had at least one psychiatric disorder (57 % anxiety disorders). Street working boys reported more traumatic events than school boys, 96% vs 64% (X²= 32, p < 0.001), the largest effect size was found for torture (OR 28.4) and the smallest effect size for maltreatment or assault (OR 2.7). Also, they reported higher levels of internalising symptoms, T-score 59.4 (8.2). There was a significantly increased risk of more externalising symptoms with increasing working hours, OR 2.90 [95% CI 1.02; 8.29].

Internalizing symptoms, anxiety disorders and trauma were more common in street working boys compared to school boys. More working hours increased the risk for more externalising symptoms.

No significant relationships.

Research into the relationship between the subjective perception of clinical change and the objective evidence of the same is very limited. Less is known about the relationship between clinical judgments by mental health experts and the patient's perception of symptom change, in particular across different diagnostic groups.

This study aims to determine the level of concordance between the HONOS as a tool for clinical outcome monitoring and the self-reported change in psychopathology in a total sample of psychiatric patients as well as stratified by their primary diagnosis at admission.

A consecutive sample of patients admitted to a Swiss psychiatric hospital for either alcohol use disorders, schizophrenic psychoses, mood disorders, anxiety and somatoform disorders, or personality disorders, was assessed using the Brief Symptom Inventory (BSI) at admission and at discharge. The HoNOS were rated by the responsible clinicians. Complete data of admission and discharge were available from approximately 600 cases. Reliable change index (RCI) will be calculated to determine a clinically meaningful change based on the HoNOS scores. Concordance of RCI and change in BSI scores will be explored and compared between different diagnostic groups.

According to our preliminary results from this ongoing evaluation program, we hope to provide a step towards a deeper understanding of the interrelationship between clinical judgments and the course of subjectively experienced mental health problems.

The authors have not supplied their declaration of competing interest.

Smoking among adolescents is still a major public health problem and a global concern. Early onset and long-term smoking are associated with physical and psychological health problems.

To identify risk factors and comorbidities for occasional and daily smoking among European adolescents.

In the context of the Europe-wide 'Saving and Empowering Young Lives in Europe” (SEYLE) study we surveyed 12,328 youths at the age of 13 to 17 from 11 countries. We applied questions from the Global School-Based Student Health Survey to determine nicotine consumption as well as other risk behaviors. Psychiatric symptoms were assessed by the Strengths and Difficulties Questionnaire, the Becks Depression Inventory-II, the Zung Self-Rating Anxiety Scale,the Deliberate Self-Harm Inventory and the Paykel Suicide Scale.

On average 30.9% of adolescents reported daily smoking and the onset of smoking was reported by 35.3% between the age of 12 and 13 already. Multinomial logistic regression model showed significant correlations between adolescent smoking and migration background, living in single parent households, no physical activity, parental smoking and physical fights. Further it revealed significant associations of adolescent smoking with alcohol consumption, illegal drug use, anxiety, conduct problems, hyperactivity, suicidal ideation, self-injury and internet-dependence.

Our data show that adolescent smoking is associated with psychosocial factors, especially family setting and parental behaviors. Further, smoking and psychiatric problems are highly correlated. Therefore, early preventive measures are necessary and essential not only for adolescents but also for their parents.

Long-acting injectable antipsychotics have undergone a great development in recent years, becoming useful tools to facilitate therapeutic adherence. Once-monthly risperidone ISM is a new way of treatment which has been commercialized in Spain since September 2022.

In this study we will analyze our clinical experience with this treatment, especially in terms of tolerance and efficacy, during its first year of widespread use.

Longitudinal retrospective study of monhtly risperidone users in a mental health center in the Autonomous Community of Madrid (Spain), between September 2022 and September 2023.

A sample of 13 patients was selected, collecting both sociodemographic (age, gender) and clinical variables (diagnosis, dose, time elapsed, number of hospital readmissions, adverse effects and monotherapy or combined use). A descriptive analysis of the collected data was then carried out.

Monthly risperidone was used in 13 patients: 15% (n=2) were women, and 85% (n=11) were male. The mean age of the patients was 43.6 years. The most frequent diganosis of these patients was “psychotic disorders” (84,6%, n= 11), with other diagnoses such as schizoaffective disorder (7,7%, n=1) and obsessive compulsive disorder (7,7%, n=1).

The doses used of risperidone were 100mg every month in 61,5% of patients (n=8) and 75mg in 38,5% of patients (n=5). The mean time since the first administration was 4.35 months.

Concerning monotherapy, 84,6% (n=11) of patients on monthly risperidone were on antipsychotic monotherapy, while 15,4% (n=2) required more than one antipsychotic. Among the switches made to monthly risperidone, 69,2% (n=9) were previously treated with oral risperidone, 15,4% (n=2) were treated with once-biweekly risperidone long-acting injectable, 7,9% (n=1) with oral paliperidone and 7,9% with aripiprazole monthly injectable.

During the study period, hospital readmissions for psychiatric descompensations occurred in one patient (7,9%, n=1), while the rest of the patients (92,1%, n=12) did not present decompensations that required psychiatric admission.

Moderate or severe effects occurred in one patient (7,9%, n=1), in the form of acute dystonia, which led to the interruption of injectable treatment. The rest of the patients (92,1%, n=12)) did not present severe adverse effects. Minor adverse effects appeared in 3 patients (25%); these adverse effects were already present in the previous treatment with oral risperidone and did not condition the suspension of the treatment.

In the sample analyzed, once-monthly Risperidone ISM had reasonable tolerance levels. Also, it´s shown to be effective in preventing psychotic decompensations and hospital admissions.

Therefore, this new injectable of monthly risperidone represents a therapeutic alternative to consider in order to guarantee therapeutic adherence and improve the quality of life of patients with psychotic symptoms.

None Declared

The stigma of mental illness is still a major challenge for psychiatry. For patients, stigma experiences and self-stigma are associated with reduced quality of life and increased vulnerability to a more chronicle illness course. Nevertheless, there is a scarcity of validated therapeutic approaches addressing strategies for coping with stigma.

A manualized psycho-educational group therapy for stigma coping and empowerment (STEM) should be tested for efficacy in patients with depression and schizophrenia. The study was funded by a research grant of the Federal Ministry of Education and Research.

A cluster-randomized RCT with two arms including 30 mental health care services (psychiatric inpatient services, day-units, and outpatient services, as well as inpatient psychiatric rehabilitation services) was conducted. The intervention consisted of 8 sessions regular psycho-education group therapy and 3 sessions addressing stigma coping and empowerment. Controls received 11 sessions regular psycho-education. Primary outcome variable was quality of life (WHO-QOL). Assessments were conducted directly before and after the intervention, and at 3, 6 and 12 months follow-ups.

A total of 469 patients participated and more than 300 participants (approx. 65%) completed the 12-month follow-up. First results of the analysis will be presented at the conference.

Since the statistical analysis is currently in progress, no conclusions concerning the efficacy of the tested therapeutic approach can be done by now. Nevertheless there is a strong need for supporting patients in developing positive stigma coping strategies. STEM is the first therapeutic approach to our knowledge tested for efficacy in a RCT.

The author has not supplied his declaration of competing interest.

Clinical studies point toward a potential role of the serotonin transporter (SERT) binding as a predictor of clinical outcome in the treatment of depression. After long-term treatment with clinical doses of SSRIs the expected SERT occupancy is about 80%. Here, we were interested to investigate the relationship of SERT occupancy values between short- and longterm treatment.

To test if the SERT occupancy at steady-state can be predicted based on the single dose occupancy by escitalopram (S-citalopram) or citalopram (racemate of S-citalopram and R-citalopram).

18 patients with major depressive disorder received either escitalpram (10 mg/d) or citalopram (20 mg/d) in a double-blind, randomized, longitudinal study. They underwent three PET scans using the radioligand [11C]DASB: PET1 baseline, PET2 6 hours after first drug intake and PET3 after three weeks of daily oral treatment. Occupancy of SERT was quantified in six subcortical regions: thalamus, N. caudatus, putamen, mibrain, dorsal raphe and median raphe nuclei. Data was analyzed by means of multiple linear regression models corrected for baseline SERT availability values using SPSS 15.0.

Single dose occupancy of the SERT significantly predicted steady-state occupancy after three weeks in three regions: thalamus (r2 = 0.45, p = 0.009), N. caudatus (r2 = 0.4, p = 0.006) and putamen (r2 = 0.43, p = 0.005). Other regions did not show significant relationships.

In this study we demonstrated that single-dose occupancy in SERT rich regions such as thalamus, N. caudatus and the putamen could serve as reliable predictors for steady-state occupancy. However, a linear model failed to explain the relationship in regions known for serotonergic cell origin.

Medical plants have been used for centuries as a medicinal agent in treatment of depression and anxiety. The purpose of this study was to explore the effects of the lavendula officinalis on depression in patients using citalopram.

This clinical trial study was performed in Hajar hospital, Shahrekord, Iran. In this study eighty patients randomly allocated into two groups (40 patients in each group). Patients who complained from depression were studied during a two-month double-blind study. In control group, patients were given 20 mg citalopram twice daily plus placebo and case group were treated with 5 g arial part of dried Lavendula officinalis and citaloperam (20 mg, twice per day). After 4 and 8 weeks, patients were followed for evaluations of their depression and complications. Depression severity was scored using standard Hamilton’s depression questionnaire. Data were analyzed using Chi square and Paired-t test.

After 1 month treatment, mean depression score in case and control groups were 15.2 ± 3.6 and 17.5 ± 3.5, respectively (P < 0.05). After 2 months the mean score of depression in case and control groups was 14.8 ± 4 and 16.8 ± 4.6, respectively (P < 0.01). The most common side effects in two groups were confusion and dry mouth, which were not significantly different between two groups.

Lavendula officinalis has a positive effect on depressed patients and may be useful to decrease the severity of depression in patients using other antidepressants.

The current psychopharmacological and psychotherapeutic treatment strategies are not successful in all subtypes of Major Depressive Disorder (MDD). Electroconvulsive therapy (ECT) has an important role in the treatment of the melancholic subtype of MDD. We are however currently not able to accurately predict the response to ECT. Earlier studies suggested a role for psychomotor retardation and agitation, but included only small numbers of patients and often made no distinction between psychomotor retardation and agitation.

Our project will validate psychomotor retardation and agitation as prognostic factors for ECT-response. This will help us to optimalize treatment of the severely depressed patient.

50 unipolar and bipolar depressive ECT-candidates will be evaluated with the CORE Assessment of Psychomotor Functioning (CORE) <1 week before starting ECT. A score on the different subscales will be registrated. The Hamilton Rating Scale for Depression (HAM-D) will be scored < 1 week before starting ECT and weekly after start of ECT to guide treatment. Within a week from the last treatment, the definitive HAM-D score will be registered. Patients can be classified as non-responders (<50% lower HAM-D score), responders (>50% lower HAM-D score) or as being in remission (HAM-D ≤ 7).

Patients are currently recruited. Patients with more severe psychomotor disturbance seem to respond better to treatment with ECT (more response, remission). Further analysis of the score on CORE-subscales has to be executed.

We carefully conclude that psychomotor disturbance assessed by CORE, is a good predictor of response to ECT.

This study aims to investigate Internet addiction among young adult university students and to examine the correlation between excessive Internet use, dissociative symptoms, and socio-demographic features. University student Internet use patterns are also investigated.

The study was conducted among 1034 students, aged between 18 and 27 years, from the Duzce University. Internet Addiction Scale (IAS), Dissociative Experiences Scale, and a sociodemographic query form was employed in the collection of data. Pearson correlation analysis, the t-test, one-way analysis of variance, and chi-square test were used for data analysis.

According to the IAS, 9.7% of the study sample was addicted to the Internet. The Internet addicts were more likely to use alcohol (p < 0.001). The pearson correlation analysis results revealed a significan positive correlation between dissociative experiences and Internet addiction (r = 0.220, p < 0.001) and weekly internet use (r = 0.227, p < 0.001). Levels of internet addiction were significantly higher among male students than females (p < 0.001). The internet use pattern also differed significantly between genders.

According to the results of this study, Internet addiction is a relatively frequent phenomenon among young adult college students in Turkey. Excessive internet use is associated with higher levels of dissociative symptoms and alcohol use.

Mental disorders are among the most prevalent chronic diseases in the elderly worldwide and depression is the most common. Often not properly identified or treated, depression contributes to impairment in functional capacity and to considerable burden for family members and health services.

Study the prevalence of depressive symptoms and associated factors in the elderly interned in a Brazilian university hospital.

A cross-sectional study evaluated 189 participants using the Geriatric Depression Scale, the Mini-Mental State Examination and the Katz and Lawton Index, to assess dependence regarding activities of daily living (ADL).

The majority of the participants were women, aged between 60 and 92 years-old, with low educational level and personal income and nonqualified occupations. The prevalence of depressive symptoms was 56.1%, but only 3% had a psychiatric diagnosis registered in their medical records. Univariate analysis showed significant associations between depressive symptoms and low educational level and income, marital status, number of hospitalizations in the previous year, cognitive decline, dependence regarding basic and instrumental ADL and death. After logistic regression, the only variables that remained significantly associated with depression were low educational level, dependence regarding basic ADL and death.

Depressive symptoms were independently associated with low educational level and dependence regarding basic ADL. More importantly, hospitalized elderly with depressive symptoms were more likely to die. It is essential to properly diagnose and treat depression in this population, to minimize its negative impact on patients, family members and health services.

To explore changes in daily functioning (C-GAS) and quality of life (ILC) in children and adolescents with ADHD OROS®-MPH and their parents.

Full analysis. Open label non-interventional trial in children & adolescents with ADHD (ICD-10 criteria) treated with flexible dose OROS MPH for 3 months (42603-ATT-4001). Effectiveness parameter were C-GAS, ILC adolescents and parents and IOWA Conners' parent rating scale at baseline and endpoint.

598 patients with ADHD (ICD-10 criteria; Ø age 10.4 years ± 2.6; 84.8% male) were documented. 81.6% completed the observation. Mean OROS MPH dose at last observation was 33.5 mg/day (SD ± 13.3). Patients improved on C-GAS from 58.9±14.7 to 71.2±15.1 (p<0.001). IOWA Connors Symptoms decreased from 29.0 ± 10.5 to 18.5 ± 10.6 (p<0.0001). ILC improved from 18.8 ± 4.0 to 20.8±3.8 in children and adolescents (p<0.0001) and from 17.2±3.9 to 19.7±3.9 in parents (p<0.001). At endpoint, 76.8% of patients showed at least minimal improvement on CGI-C. Adverse events were reported in 28.8% of patients. AEs listed in ≥2% of patients were insomnia (7.7%), anorexia (3.9%), ineffectiveness (2.8%), headache (2.3%), nervousness (2.2%) and involuntary muscle contractions (2.2%). There were no significant changes in blood pressure or pulse.

Treatment with OROS®-MPH was associated with a clinically relevant improvement in daily functioning in patients with ADHD and Qol improved significantly in patients and their parents. Treatment with OROS®-MPH was well tolerated.

Suicide is a leading cause of death and suffering worldwide, mental disorder being a major risk factor for it. Recent data suggest that the underlying temperament may be more important as a risk factor than the exact psychiatric diagnosis.

A cross-sectional non-interventional study of 79 patients with DSM-IV major depressive episode (58 females, 21 males; aged 19–66 years), evaluated by M.I.N.I. Their temperament was assessed through the self-rated TEMPS-A. Patients were distributed into four groups: 1) fMDE - first major depressive episode (n=16); 2) RMD - recurrent major depression: at least 5 years duration of illness, no previous (hypo)manic/mixed episodes, and no first-degree relatives with bipolar disorder (n=23); 3) BDI - MDE with at least one previous manic episode (n=19); 4) BDII – two or more MDE with at least one previous hypomanic episode (n=21).

No significant intergroup differences in the level of suicidal risk measured by the M.I.N.I. No gender difference in the M.I.N.I. risk for suicide, however, female gender was associated with a higher number of previous suicide attempts (p=0.001). The fMDE group had higher mean score for hyperthymic temperament, and the RMD group had higher mean score for anxious temperament. After controlling for the diagnosis and gender, a significant positive correlation was found between level of suicidal risk and mean score for depressive, cyclothymic, and irritable temperament (p<0.05), while the correlation was negative for hyperthymic temperament (p=0.001).

We suggest that hyperthymic temperament is a protective factor against suicide in patients with affective disorders.