There has been an increasing socio-medical discourse on the humanitarian approach to the use of restraint in psychiatric inpatient units.

It is necessary to investigate the attitudes of psychiatric hospital staff toward the use of restraint in psychiatric inpatient units and to identify the factors influencing these attitudes.

This study examined the attitudes of psychiatric hospital staff toward the use of restraint in situations involving physical violence toward other patients, verbal violence toward other patients, physical violence toward staff, verbal violence toward staff, and disruption of the treatment environment. The study also investigated factors related to the considerations and perceived burdens (both legal and medical) associated with the use of restraint, comparing these findings with data from a survey conducted 10 years ago.Attitudes toward restraint were not significantly associated with gender, age, or years of service. However, staffs who exhibited less prejudice toward mental illness-related crime were less likely to find restraint necessary. Compared to 10 years ago, there was little change in the need for restraint in cases of physical violence (both toward patients and staff), but the need for restraint in response to verbal violence (toward both patients and staff) had decreased. The perceived burden, both legal and medical, associated with the use of restraint had increased.

Attitudes toward restraint were not significantly associated with gender, age, or years of service. However, staff who exhibited less prejudice toward mental illness-related crime were less likely to find restraint necessary. Compared to 10 years ago, there was little change in the need for restraint in cases of physical violence (both toward patients and staff), but the need for restraint in response to verbal violence (toward both patients and staff) had decreased. The perceived burden, both legal and medical, associated with the use of restraint had increased.

Psychiatric hospital staffs with less prejudice toward mental illness-related crime were less likely to perceive a need for the use of restraint. Compared to 10 years ago, the necessity of restraint in cases of verbal violence has decreased, which may be attributed to ongoing human rights education and increased legal and medical concerns. These findings provide important insights for future policy development aimed at promoting humanitarian approaches, such as non-restraint treatments.

None Declared

Humor is widely recognized for its potential to improve psychosomatic health, enhancing both physical and mental well-being.

To investigate the correlation between humor styles and psychosomatic health in older adults.

A cross-sectional study was conducted with 83 older adults (41 females, 42 males), aged 65 to 94 years (mean age: 74.1, SD = 8.1). Participants completed a sociodemographic questionnaire, the 32-item Humor Styles Questionnaire, and the 36-Item Short Form Survey (SF-36). Linear regression analysis was used to examine the relationship between humor styles and psychosomatic health outcomes.

Self-Enhancing Humor. For Aggressive Humor, the mean was 22.7 (SD = 7.95), and for Self-Defeating Humor, 26.3 (SD = 8.70). The mean scores for Physical Health and Mental Health were 277 (SD = 84.5) and 272 (SD = 70.6), respectively. Self-Enhancing Humor had a significant positive effect on Mental Health (B = 3.458, SE = 0.893, p < 0.001), RF (B = 0.7659, SE = 0.375, p = 0.044), GH (B = 0.7113, SE = 0.234, p = 0.003), MH (B = 0.9711, SE = 0.228, p < 0.001), and SF (B = 0.7165, SE = 0.329, p = 0.033). Additionally, Self-Defeating Humor showed a significant negative effect on RE (B = -1.093, SE = 0.474, p = 0.024).

The findings suggest that positive humor styles, particularly Self-Enhancing Humor, are strongly associated with better psychosomatic health in older adults. Incorporating humor-based interventions could be a valuable approach to enhancing psychosomatic health in this population.

None Declared

This research investigates gender differences in psychosomatic responses among individuals of various ages, who had been diagnosed with depressive or anxiety disorders, or were in remission. It evaluates symptoms using the Beck Depression Inventory–Second Edition (BDI) and DASS-42 scales in a cohort of 30 adults in an outpatient clinic environment.

The aim of the study was to demonstrate the relationship between the degree of development of nicotine and the severity of symptoms related to emotions and mood with patients suffering from schizophrenia.

A total of 30 adult participants (ages 21-69) were assessed using the BDI and DASS-42 scales. The study is focused on somatic symptoms (as measured by specific DASS-42 items) and their relationship to gender, age, and the severity of depression. The severity of depression was classified into mild, moderate, and severe categories based on BDI scores.

The study revealed that depression significantly affects both daily functioning and emotional responses to stress, with individuals suffering from severe depression showing psychosomatic symptoms most often, regardless of gender. The findings revealed that women diagnosed with depression reported higher rates of psychosomatic symptoms, such as dry mouth, breathing difficulties, and increased heart palpitations, compared to men. Men, on the other hand, exhibited difficulties in emotional regulation in response to stress, which can potentially indicate a general sense of insecurity and anxiety. Younger female individuals, under the age of 40, diagnosed with depression according to the BDI, exhibited more intense psychosomatic symptoms compared to older female patients. Furthermore, within the same cohort of women under 40, the intensity of psychosomatic symptoms was significantly higher in comparison to men in the same age group.

The study uncovered the strong and interconnected relationship between stress and depression. Moreover, it indicated that the severity of psychosomatic symptoms associated with depression and stress is influenced by gender and age. As a result, it is crucial to adopt a comprehensive and personalized approach when treating patients, considering the severity of their conditions. The BDI and DASS-42 scales are effective in capturing these differences, highlighting their usefulness in both clinical and research contexts.

None Declared

Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition which is underdiagnosed and undertreated in women. For decades, the ADHD field has called for more insight into female-specific therapy. Preliminary findings postulate that changes in sex hormones during the menstrual cycle may influence the effectiveness of psychostimulant medication. Yet, pharmacotherapeutic interventions tailored to women with ADHD remain scarce. Previously, our group showed an increase in mood symptoms in the premenstrual week in women with ADHD. Premenstrual worsening of depressive and ADHD symptoms represent a treatment challenge.

In our adult ADHD clinic, we noted several women describing exacerbation of their ADHD and depressive symptoms in the premenstrual week and/or insufficient effect of their established dosage of psychostimulant. We responded to the need expressed by these women by increasing their stimulant dosage in the premenstrual week, while monitoring the response and side effects.

This community case study of nine consecutive women being treated for ADHD and co-occurring conditions (including depression and premenstrual dysphoric disorder), reports our local experience of increasing the individually prescribed psychostimulant dosage during the premenstrual period. We methodically monitored the effect of this increased dosage on ADHD symptoms, mood and somatic symptoms for the following 6-24 months.

With premenstrual dose elevation, all nine women experienced improved ADHD and mood symptoms with minimal adverse events. Premenstrual inattention, irritability and energy levels improved, and now resembled the other non-premenstrual weeks more closely. All women decided to continue with the elevated premenstrual pharmacotherapy.

Our preliminary results demonstrate potential benefits of increasing premenstrual psychostimulant dosage in women with ADHD, experiencing premenstrual worsening of ADHD and mood symptoms. The results concur with previous findings of diminished response to amphetamines in the late luteal phase. Increased dosage may help combat premenstrual worsening of cognitive and emotional symptoms in women with ADHD, with significant clinical implications. Better management of premenstrual ADHD and mood symptoms in vulnerable women can improve treatment outcome and meet an unmet need. However, implementation should be individually explored. Further investigation of luteal phase psychostimulant dose adjustment is required for safe, optimal and individualised treatment for women with ADHD. Specifically, we are currently applying for funding to set up the ADAPT-trial (Adjusting Premenstrual Psychostimulant Dosage for Women with ADHD: Enhancing Efficacy).

None Declared

Personality traits are enduring and stable characteristics that reflect an individual’s behaviour, thoughts and feelings. Research indicates that specific traits can affect not only the well-being of healthcare professionals but also their interactions with colleagues and patients.

This study aims to assess the personality traits of healthcare professionals using the Big Five Inventory (BFI).

A descriptive cross-sectional study was conducted among healthcare personnel who consulted the department of occupational medicine of Hedi Chaker Hospital of Sfax to September 2024. The survey was conducted through a self-questionnaire that included sociodemographic data, lifestyles. We also used BFI which measures the Big Five personality traits through five key dimensions: extraversion, agreeableness, conscientiousness, neuroticism and openness.

The study involved 41 consultants (12 men and 29 women) with an average age of 31.2 ± 7.4 years. An urban origin was identified in 87.8% of the cases. Medical staff scored 3.36 ± 0.52 for extraversion, 3.21 ± 0.56 for agreeableness, 3.22 ± 0.61 for conscientiousness, 3.01 ± 0.78 for neuroticism and 3.2 ± 0.65 for openness. A significant association was found between neuroticism and urban versus rural origin (p=0.001). Moreover, associations were found between BFI dimensions: agreeableness with extraversion (p=0.007, r=0.41) and openness (p=0.002, r=0.46).

This study highlights the importance of assessing personality traits among healthcare professionals. Understanding these personality dimensions can provide valuable insights for improving workplace dynamics, enhancing team collaboration, and ultimately fostering better patient care outcomes.

None Declared

Bipolar disorders (BD) are among the most impairing of pediatric psychiatric disorders. Even though BD symptoms may begin in adolescence, they are frequently not diagnosed until adulthood. BD screening tests could aid diagnostic assessment in paediatric populations and are supported by The International Society for Paediatric Bipolar Disorders Task Force and empirical evidence.

This review synthesizes the evidence on the accuracy of BD symptom screening tests in distinguishing bipolar disorders from other psychiatric conditions or healthy cases in pediatric populations. Additionally, it examines a wide range of potential moderators that may influence diagnostic accuracy.

A systematic search was conducted across three databases (1980–2022), supplemented by searches of grey literature, citation chaining, and author contact. Data from relevant studies were combined using meta-analysis. A multilevel model was used to account for nested effect sizes, with 31 potential moderators tested in both univariate and multivariate models.

2,281 records were identified; 1712 titles-and-abstracts records were screened; 114 records were full-text screened; and 28 studies were included. The meta-analysis was based on all s=28 studies, 40 independent samples, k=115 effect sizes, and n=11,464 participants. Meta-analytic results showed that BD symptom index tests have high diagnostic accuracy in pediatric populations (g = 1.300; 95% CI: 0.982 - 1.619; p < .001) (see Fig. 1). Accuracy varied based on the comparison group, test content, test informant, and the specific scale or subscale used.

Image:

Screening tests focusing on mania-related symptoms, caregiver reports, and psychiatric comparison groups demonstrate clinical value in identifying pediatric BD. Also, other informants and symptom content combinations may not reliably identify pediatric BD. Importantly, tests derived from studies using psychiatric comparison groups, represent BD symptom non-specificity and BD symptom overlap with other disorders (eg. ADHD and depression), providing external validity and clinical utility. Screening tests with high accuracy and clinically useful are the GBI-73-P, MDQ-A-P and the YMRS-P.

None Declared

Auditory verbal hallucinations (AVH) are one of the primary symptoms of schizophrenia, but the biological mechanisms underlying them remain uncertain (1,2). Theoretical approaches have proposed that AVH are caused by abnormal activity in the auditory cortex; or that they represent misinterpreted cognitive activity such as inner speech. Recently, our group found, using a symptom capture task, that AVH did not trigger activity in the auditory cortex, but instead in language-related areas, thus shifting the focus towards cognitive theories of AVH (3). To date, cognitive approaches have only been preliminarily investigated, and mostly in psychological studies (1,2).

Our aim was to test the theory that a disturbance in inner speech processes underlie AVH. We used conjunction analysis to examine common activation patterns between the experience of AVH and phonological encoding.

Eleven patients meeting DSM-5 criteria for schizophrenia or schizoaffective disorder with near-continuous AVH underwent fMRI during symptom capture and during a phonological encoding task. In the symptom capture task, the patients were instructed to press their left index finger when they begin to hear an AVH, wait three minutes, mentally repeat what they heard, and then press their right index finger. The phonological encoding task required them to indicate, via button press, whether the names of two objects shown in line drawings rhymed.

Pre-processing and analyses were carried out with FSL software using linear models. Activation maps were thresholded at p<0.05, cluster-corrected for multiple comparisons. To find regions of common activation between the two tasks, the activation maps from the contrasts of interest were binarized and entered into a conjunction analysis. Regions showing significant activation in both tasks simultaneously were considered activated in the conjunction analysis.

The conjunction analysis showed common activation in several regions involved in phonological encoding, such as Broca’s area and its right homologue, supplementary motor area bilaterally, Wernicke’s area and cerebellum, in patients with AVH.

These results support a non-perceptual origin of AVH and link them to brain areas related to the phonological loop and working memory in schizophrenia.

None Declared

This knowledge exchange program was designed to enhance the clinical training of a Cambodian psychiatrist in general psychiatry and addiction care. Conducted between July 1, 2024, and August 30, 2024, the program involved immersive clinical experiences in the Netherlands and South Africa. The exchange facilitated engagement with leading mental health institutions, offering valuable insights into advanced psychiatric practices and addiction care models.

The primary objectives of the program were to improve clinical competencies in diagnosing and managing psychiatric and addiction disorders, to gain exposure to multidisciplinary and community-based care models, and to develop cultural competence in adapting psychiatric practices to low-resource settings like Cambodia. These goals were pursued through a combination of clinical visits and participatory learning activities.

The psychiatrist participated in clinical visits and hands-on learning at Radboud University Medical Center and Pro Persona in the Netherlands, as well as Rustenburg Addiction Care in South Africa. These experiences included observing advanced treatments and participating in community-based psychiatric care programs. The program’s structure combined hands-on training and multidisciplinary teamwork to provide a comprehensive learning experience.

The program yielded significant improvements in the psychiatrist’s ability to manage complex addiction cases and implement community-based care. Additionally, the experience fostered greater cultural competence, enabling the application of psychiatric practices suited to the Cambodian context. The collaboration also promoted potential future psychiatric training initiatives and international partnerships.

The knowledge exchange program was successful in enhancing the psychiatrist’s clinical skills and cultural awareness. It underscored the importance of international collaboration in psychiatry and addiction care, providing a model for how mental health professionals from low-income countries can benefit from exposure to global best practices and community-based care strategies.

None Declared

While most individuals adhere to preventive measures during pandemics, a subset engages in behaviors that may intentionally spread COVID-19, presenting unique challenges to public health efforts.

This study explores the psychological, social, and environmental factors influencing deliberate virus-spreading behavior in the Saudi Arabian population during the initial phase of the COVID-19 pandemic.

A cross-sectional online survey was conducted between April 3 and May 5, 2020, with 1,817 participants. The survey collected demographic information and variables related to virus-spreading inclinations. Descriptive statistics and Pearson’s chi-squared tests were used to analyze associations between deliberate virus-spreading behavior and various characteristics, with statistical significance set at p < 0.05.

Individuals who intentionally spread the virus (2% of the sample) were younger (mean age 22.9 vs. 29.3 years, p < 0.001), predominantly female (81.1% vs. 65.6%, p = 0.033), and more likely to have a history of mental health issues (24.3% vs. 8.5%, p < 0.001) and conspiracy beliefs (45.9% vs. 26.2%, p = 0.003) compared to those who did not engage in virus-spreading behaviors. No significant differences were found regarding marital status, education level, or traumatic life events.

This study highlights key factors associated with intentional virus-spreading behaviors, such as younger age, mental health history, and conspiracy beliefs, underscoring the need for integrated mental health support and targeted misinformation interventions. Public health strategies should include age-appropriate messaging and digital outreach to mitigate the risks posed by intentional spread behaviors and enhance pandemic response efforts. Further research with larger, more diverse samples is recommended to expand understanding and improve intervention strategies

None Declared

Psychological factors, including personality and temperament show an association with various somatic conditions and may also influence perioperative analgesic requirements. Understanding the role of psychological factors could help personalise pain management, improving well-being of patients and reducing postoperative complications. Affective temperaments (AT) have previously been associated with course and characteristics of several somatic conditions, but have not been studied in this context.

We aim to investigate the association between ATs and postoperative analgesic needs in a prospective study.

In our ongoing study we plan to enroll 350 women awaiting non-obsetrical, non-oncological gynecological surgery. Type of surgery and anesthesia are standardized. Psychological evaluation is carried out at three timepoints: 5 days preoperatively (ATs, anxiety, depression, pain catastrophizing)? 24 hours postop (amount and quality of pain experienced, anxiety, depression, current pain catastrophizing); 7 days postop (same as before, plus length of stay and quality of life). Tools include TEMPS-A (ATs), STAI-S and T (anxiety), PHQ9 (depression), PCS (pain catastrophizing) and BPI (pain experience and QoL). Intraoperative vital parameters and opioid use are also observed, as well as the use of postoperative analgesic medications. Statistical associations between pain and psychological factors are analysed using MANOVA, regression, correlation and path analysis.

Currently we are at 50% of our data collection (N=175). At this stage of our research we already have significant preliminary results. Apart from psychological factors, age has a negative predictive effect on pain experienced on day 1 (p<0.001, stβ=-0.327, R2=0.14) and also predicts the effectiveness of painkillers on day 1 (p=0.006, stβ=0.036). When controlled for age ATs also predict pain experienced on day 1: anxious scores predict amount of pain experienced (p=0.049, stβ=0.283), whereas higher dysthymic scores predict smaller amount of pain experienced (p=0.006, stβ=-0.382). Preoperative anxiety and pain expectations do not seem to predict pain, but pain expectations predict how pain effects overall mood (postop day 1 p=0.002, stβ=0.227 and day 7 p=0.035, stβ=0.226). Postop day 7 pain is less influenced by the investigated factors, but state anxiety on postop day 1 predicts postop pain on day 7 (p=0.028, stβ=0.251).

Our study may help in clinical practice to identify patients who are likely to experience more postoperative pain. While age is a significant negative predictor of early and late postoperative pain, when controlling for age, ATs seem to be sensitive predictors of early postoperative pain experience, whereas other investigated factors have a less direct effect on pain experience. Further data analysis with more complex models is needed after data collection is finished.

None Declared

Vitamin D deficiency is a significant problem that affects the population living in most countries. This issue is independent of place of residence, gender, age or skin color. It is mainly influenced by the climate we live in and anti-healthy lifestyle, including bad eating habits.

The aim of the study was to evaluate lipid profile, glucose level, vitamin D level, taking into account sociodemographic variables, smoking and alcohol consumption. The study also included assessment of depression taking into account sociodemographic variables and vitamin D levels in perimenopausal women.

The study was conducted in a group of 191 women. The study consisted of two stages. The first part was carried out by means of a diagnostic survey with the use of questionnaire technique. The survey form consisted of two parts: a questionnaire that included questions about sociodemographic data and selected medical information, and the Beck Depression Inventory. The second stage of the study involved the collection of peripheral blood from each respondent in order to determine lipid profile, glycemia and serum vitamin D levels.

The age of the female respondents ranged from 45 to 65 years, mean age was 53.1±5.37 years, median 53 years. Vitamin D result was below normal in 78%. 77% had elevated total cholesterol levels. 91.6% of the respondents had HDL fraction cholesterol levels within the normal range. On the other hand, 64.4% were characterized by too high LDL fraction cholesterol and 84.8% of women showed normal triglyceride levels. Among the respondents, 91.1% had normal glycemic levels. Analysis of collected data showed a weak negative correlation between serum vitamin D concentration and concentrations of: total cholesterol (rho=-0.14; p=0.05), LDL fraction cholesterol (rho=-0.16; p=0.026) and triglycerides (rho=-0.22; p=0.002) of the examined women. Only in the case of HDL fraction cholesterol (p=0.067) there was no statistically significant correlation. There was also no statistically significant correlation between serum vitamin D levels and glycemia and severity of depression (p=0.152).

Most of the women studied did not manifest depressive disorders. Of the various factors affecting the severity of depression, only education was associated with depression severity.

Smoking adversely affects serum vitamin D concentration in the examined women.

Cessation of menstruation influenced carbohydrate metabolism and vitamin D concentration. Blood glucose concentration increased with the age of the studied women.

There was a relationship between vitamin D concentration and values of total cholesterol, LDL fraction cholesterol and triglycerides. Therefore, considering the biological functioning of the studied women, it is important to maintain normal vitamin D levels.

None Declared

Healthcare providers are at a high risk of occupational stress, psychological distress, and mental health problems due to unique job demands. The unprecedented negative impact of the COVID-19 pandemic on healthcare further intensified the risk.

To find out the prevalence of anxiety, depression, and post-traumatic stress disorder (PTSD) in healthcare providers during the COVID-19 pandemic, and explore various associated factors.

We conducted a cross-sectional survey among clinicians across tertiary care hospitals in Lahore, Pakistan through online forms/ paper-based questionnaires, using the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7) Scale, and The Impact of Events Scale-Revised (IES-R) from July-November 2021. Physicians aged 20-60 years working at the public-sector hospitals of Lahore were included through non-probability convenient sampling. The non-parametric Mann-Whitney U, Kruskal-Wallis, and Chi-square test of independence were applied for inferential data analysis in SPSS version 26 at α=0.05.

Of 302 participants, the majority were males (54.6%), from medicine and allied departments (76.9%), junior staff (72%), and frontline workers (75%). 9.5% had a history of psychiatric illness. The prevalence of depression was 25%, anxiety 31.9%, PTSD 15.8%, severe depression 13.8%, and severe anxiety 7.2%. The total median (IQR) scores of depression, anxiety, and PTSD were 5(2-9.5), 4(0-7), and 10(1-23) respectively. Females and junior staff had comparatively severe symptoms of anxiety and depression. Psychiatric history was linked to severe depression (p=0.003) and PTSD (p=0.001) but not anxiety (p=0.136). There were no statistically significant differences in the anxiety and PTSD severity across genders, departments, and frontline/second-line work.

We found high levels of depression, anxiety, and PTSD in our physician sample even during the 4th COVID-19 wave. This has implications for emphasizing the significance of the mental well-being of healthcare providers and identifying effective interventions to prioritize it even after the pandemic.

None Declared

Lumateperone, an atypical antipsychotic drug approved in 2021 for bipolar depression, has a dual mechanism of action by combination of activity at central serotonin (5-HT2A) and dopamine (D2) receptors. In India, Quetiapine is one of the approved drugs for use in depressive episodes for bipolar disorder.

This post-hoc analysis of an Indian Phase 3 study was conducted to evaluate the correlation of severity of depression assessed via Montgomery-Asberg depression rating scale (MADRS) and quality of life assessed via Quality-of-life enjoyment and satisfaction-short form questionnaire (Q-LES-Q-SF) when treated with Lumateperone 42mg or Quetiapine 300mg.

The phase-III, randomized, multi-centric, assessor-blind, parallel-group, active-controlled, comparative, non-inferiority study included patients with Bipolar II depression with moderate severity having a MADRS score ≥20 and Clinical global impression–bipolar version–severity (CGI-BP-S) score ≥4. The study was conducted after receiving regulatory and ethics committee approvals. The patients were randomized (1:1) to either receive Lumateperone 42mg [Test] or Quetiapine 300mg [Comparator] for 6 weeks. In this post-hoc analysis, correlation between MADRS and Q-LES-Q-SF were evaluated and for safety outcomes treatment emergent adverse events (TEAEs) were assessed. [Clinical trial registration: CTRI/2023/10/058583]

This post-hoc analysis included 462 patients [231 each in Test and Comparator]. The baseline demographic characteristics were comparable in between treatment arms. The Pearson’s correlation coefficient between change from baseline in MADRS score and Q-LES-Q-SF score was statistically significant for both treatment arms at Day 42 [Test: -0.192, p=0.0043; Comparator: -0.299, p<0.0001] and the linear regression between 2 arms was not statistically significant (p=0.0853), indicating weak negative correlation between the 2 scales [Figure 1 and Figure 2]. The incidence of TEAEs were similar in both treatment arms [Test: 34.6%; Comparator: 35.5%] and no serious adverse events were reported.

Image 1:

Image 2:

This post-hoc analysis demonstrated that patient with Bipolar II depression when treated with Lumateperone 42mg or Quetiapine 300mg, the reduction in MADRS score is inversely proportional to Q-LES-Q-SF score.

A. Dharmadhikari: None Declared, P. Chaurasia: None Declared, Y. Patel: None Declared, D. Choudhary: None Declared, P. Dasud: None Declared, M. Bhirud: None Declared, P. Meena: None Declared, F. Shah: None Declared, G. Ganesan: None Declared, B. P. Rathour: None Declared, K. Mistry: None Declared, M. Dutta: None Declared, A. Ramaraju: None Declared, S. G. Goyal: None Declared, S. Mangalwedhe: None Declared, G. Kulkarni: None Declared, A. Mukhopadhyay: None Declared, P. Chaudhary: None Declared, G. T. Harsha: None Declared, M. Parikh: None Declared, S. Dey: None Declared, S. Sarkhel: None Declared, N. Jyothi: None Declared, A. Kumar: None Declared, N. Sooch: None Declared, S. Saha Employee of: Sun Pharma, A. Shetty Employee of: Sun Pharma, P. Devkare Employee of: Sun Pharma, A. Shetty Employee of: Sun Pharma, D. Patil Employee of: Sun Pharma, P. Ghadge Employee of: Sun Pharma, A. Mane Employee of: Sun Pharma, S. Mehta Employee of: Sun Pharma

Treatment-resistant schizophrenia patients have the worst clinical outcomes and poor quality of life, despite the administration of clozapine. Currently, the definition of resistance is based on treatment response, but evidence differentiating resistance remains unclear. The dysconnectivity theory suggests that disrupted brain interactions contribute to schizophrenia pathology. Advances in functional and structural neuroimaging allow exploration of connectivity patterns that may characterize treatment-resistant schizophrenia.

This study aimed to describe functional and structural connectivity patterns in schizophrenia patients on clozapine.

Patients taking clozapine (CLZ) or other antipsychotic (nCLZ) were recruited from the Hospital of the Medical School of Ribeirão Preto. Healthy controls (HC) were recruited from the Hospital database. Seventy-seven participants were selected: CLZ = 35, nCLZ = 27, and HC = 27. Functional connectivity (FC) was assessed via resting-state functional magnetic resonance imaging (rs-fMRI) and ROI-to-ROI analysis using the CONN toolbox. Structural connectivity was analyzed with diffusion tensor imaging and tractography using TRACULA toolbox. ANOVA and Tukey test were used for three-group comparisons, and the t-tests for two-group comparisons. Functional analysis was performed with a significance threshold of p < 0.05 and false discovery rate (FDR) set to p < 0.01.

Reduced frontotemporal FC and increased FC in the frontal-occipital were common in CLZ and nCLZ compared to HC. An increased FC between sensorimotor and the cerebellum was notable in CLZ compared to HC. Structural findings included increased axial diffusivity (AD) and mean diffusivity (MD) in 8 of 10 tracts in CLZ compared to HC. The corticospinal tract and inferior longitudinal fasciculus exhibited increased AD and MD in CLZ compared to nCLZ. The cingulum angular bundle showed significantly altered diffusion measures in nCLZ: increased AD, MD, and radial diffusivity (RD), and reduced fractional anisotropy (FA).

This study described a widespread functional and structural dysconnectivity in CLZ, characterized by reduced frontotemporal FC and increased frontal-occipital and sensorimotor–cerebellum FC. Altered AD and MD measures in the corticospinal tract and inferior longitudinal fasciculus were observed in the CLZ. Alterations in AD, MD, RD, and FA measures in the cingulum angular bundle, particularly noted in nCLZ, may be associated with antipsychotic administration. Further studies are necessary to establish whether these dysconnectivity patterns consistently characterize these patient groups.

None Declared

Obsessive-compulsive disorder (OCD) is a chronic condition that frequently co-occurs with mood disorders such as major depressive disorder (MDD) and bipolar disorder (BD), complicating both prognosis and treatment. The presence of MDD or BD in OCD patients is associated with more complex clinical presentations and worse outcomes.

Despite the high prevalence of these comorbidities, few studies have thoroughly compared the traits and states of OCD patients with comorbid mood disorders. This study aims to explore the differences in traits and states among OCD patients with comorbid mood disorders, including MDD, bipolar disorder I (BD1), and bipolar disorder II (BD2).

The study included 114 OCD patients: 21 without mood disorders, 32 with MDD, 47 with BD2, and 14 with BD1. Demographic variables such as family history of psychiatric disorders and history of pharmacological treatment for OCD were analyzed. Participants were evaluated using standardized tools such as the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A), Obsessive-Compulsive Inventory (OCI), Depressive Symptom Inventory Suicidality Subscale (DSI-SS). Statistical analyses including one-way analysis of variance (ANOVA) and chi-squared tests were conducted to identify significant differences between groups.

Patients with comorbid bipolar disorder (BD), particularly those with BD1, had a significantly higher prevalence of psychiatric family history (85.7%, p = .031). Pharmacological treatment for OCD was less frequent in patients with BD, with the lowest rate in the BD2 group (61.7%, p = .008). Compared to patients without mood disorders or those with MDD, OCD patients with BD showed higher scores in several temperament dimensions, including cyclothymic temperament (p < .001), depressive temperament (p = .007), hyperthymic temperament (p = .006), anxious temperament (p < .001), and irritable temperament (p < .001). These patients also exhibited more severe depressive symptoms (p < .001), higher anxiety levels (p < .001), and greater suicidality (p = .002). Obsessive-compulsive symptoms, particularly neutralizing behaviors (p = .010), ordering behaviors (p < .001), and hoarding behaviors (p < .001), were more pronounced in the BD groups.

OCD patients with comorbid BD show distinct clinical profiles compared to those with MDD. They have a stronger genetic predisposition to psychiatric disorders and are less likely to receive pharmacological treatment for OCD. These patients also experience more severe depressive symptoms, anxiety, and obsessive-compulsive traits, complicating treatment. The findings highlight the need for comprehensive evaluations and personalized treatment plans for OCD patients with mood disorder comorbidities.

None Declared

Diet-related support is urgently needed for people with serious mental illness underlying the role of nutrition in a biopsychosocial approach. Integrating healthy lifestyle practices such as a balanced diet and physical exercise could supplement and amplify the effects of existing pharmacotherapies and psychotherapies. Despite its considerable role, nutritional literacy of mental health professionals appears scarce. Specific nutrition training courses for mental health professionals are needed in order to increase awareness on nutrition as a well-being contributing factor in the biopsychosocial model.

The aim of this study is to investigate insight and attitudes on nutrition in mental health among a sample of psychiatrists and psychologists resident in Italy.

The survey was conducted from May to June 2024 and the questionnaire was anonymous and self-rated, accessible via Google forms. The sample comprised 110 Italian mental health professionals (adult and child psychiatrists, psychologists) who voluntarily completed the on‑line questionnaire.

110 participants (61 psychologists, 46 adult psychiatrists and 3 child psychiatrists) agreed to participate to our survey. 89.2 % (n= 91) of them worked in southern Italy.The majority of participants were female (77.98%) and reported working in a Mental Health Centre (n= 41, 37,27%), followed by psychiatric residential facilities (n=22, 20%), private practice (n= 19, 17.27%), hospital (n= 14, 12.73%), university research centre (n=4. 3.64%), other non specified institute (n=10; 9.09%). The numer of years of working as mental health professional was 19.27 ± 11.27 years. Adopting “sometimes” nutritional approach for the treatment of the patients was the answer mostly reported (n= 56, 51.4%) followed by “most of the time” (n= 28, 25.69%), “always” (n=11; 10.09%), “never” (n= 7, 6.42%), “almost never “(n= 7, 6.42%).

Despite the scientific evidence and some treatment guidelines in support of this relationship, the implementation of nutritional psychiatry into routine clinical practice remains limited. Integrating nutrition into the clinical practice of psychologists and psychiatrists and providing evidence-based nutritional advice represent an interesting mental health challenge to address in the coming years.

None Declared

In recent years, multiple observational studies have been conducted to investigate the hypothesis of a correlation between romantic love (RL) and the phenotypic expression of obsessive-compulsive disorder (OCD).

Our study aimed to evaluate the impact of RL on the clinical expression of OCD. Attention was specifically focused on investigating the onset of two OCD phenotypes with distinct characteristics, based on whether the subjects were at the onset of a romantic relationship or had experienced a romantic break-up, also considering the possible correlations with different clinical aspects and socio-demographic variables.

Our sample includes a total of 212 subjects with OCD recruited among outpatients at the University Psychiatric Clinic of Pisa, Italy, and the Federal University of Rio de Janeiro, Brazil. The following instruments were employed for psychometric assessments: the Structured Clinical Interview for DSM-5 (SCID-5), the Yale OCD Natural History Questionnaire, and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). The study participants were then divided into two groups (love-precipitated [LP-OCD] and break-up OCD [BU-OCD]) according to the romantic factor that was deemed responsible for the onset of OCD. An appropriate statistical analysis was applied.

The average age of onset of OCD was significantly different between the two groups, which may reflect a vulnerability of the brain’s maturational stages in young individuals who are at risk for OCD. A trend towards three types of obsessions and compulsions (aggression, sexual/religious and symmetry, ordering, and rearrangement) in the BU-OCD group emerged, which may reflect some normal features of a romantic relationship. However, total Y-BOCS obsessions and compulsions subscale scores were similar, indicating an overall severe clinical picture.

Despite some limitations, our results suggest that different stages of RL might influence some characteristics of OCD, namely age at onset and some specific dimensions, but would not appear to interfere with the overall severity of the disorder. These results should encourage further research on the topic to learn more about the characteristics of these individuals and to better understand how the most natural experience of humankind, that is love, may represent a vulnerability factor towards the onset and some features of OCD, similarly to other mental disorders, where the evidence is currently strongest.

None Declared

Medical improvisation, or HPTI (Health Professional Training Improv), enhances critical skills in healthcare professionals. These skills include communication, empathy, time pressure management, and creative problem-solving. Our presentation aims to showcase a practical application of HPTI, demonstrating its relevance and effectiveness in mental health training.

In this presentation, we will demonstrate our training method, including a short session with exercises adapted to healthcare professions. The session is divided into four parts. Each part is designed to maximize engagement and learning, with debriefing sessions to clarify teaching objectives and foster reflective practice.

Warm-Up Exercises: Physical and vocal exercises to optimize communication and awareness. Improvisation Techniques: Exercises focused on mastering emotions and various forms of communication, allowing participants to explore their strengths and limitations. Medical Scenario Applications: Short clinical scenarios to emphasize the cognitive and affective dimensions of empathy. Review of Existing Workshops and Research: Presentation of current workshops and research to encourage further exploration and application in training. Each part includes a debriefing session to clarify teaching objectives, develop a reflective approach, and identify areas for improvement.

For our ongoing comparative study we have implemented the following questionnaires for our training participants: IUS (uncertainty intolerance scale) and Acceptance and Action Questionnaire-II (AAQII). A total of 50 students participated in our research in both countries.

Hungarian training participants included medical school students in Hungary and fourth-year speech therapy students in France and included professional scenarios based on stress and emotion management, interdisciplinary collaboration and collaboration with the patient, and communication, with debriefing on their performance. The data is currently being collected.

Applied improvisation through HPTI offers a valuable approach to improving mental health training. By enhancing communication, empathy, and problem-solving skills, healthcare professionals can provide better patient care and navigate their roles more effectively. Our presentation demonstrates these techniques and encourages their integration into regular training programs.

None Declared

Healthcare workers (HCW) face a growing crisis marked by high burnout levels (40-60%) and a rising intent to leave the profession. Current interventions focus mainly on individual resilience but have limited collective impact. Emerging evidence suggests that “Moral Injury” (MI)—a deep discord between HCW values and their practice, often worsened by organizational and economic constraints—may play a key role in this crisis.

The primary aim of this study was to describe the manifestations of MI among HCW in France, with a healthcare system characterized by universal health coverage. Secondary objectives included the psychometric validation of the Moral Injury Inventory (MII) for HCW, analysis of organizational determinants of MI, and modeling of the underlying mechanisms of this phenomenon.

This cross-sectional, observational study was conducted nationally via an online survey. Measures included the MII, the Moral Injury Events Scale (MIES), the PHQ-9 for depression, the GAD-7 for anxiety, the Maslach Burnout Inventory (MBI), and the EuroQol 5-Dimensions (EQ-5D) for quality of life. Item Response Theory (IRT) was used to test the MII, including assessments of construct validity, and reliability. Structural equation modeling (SEM) was used to explore complex interactions between MI and other variables, including burnout, depression, and anxiety.

Nearly 3,000 HCW participated in the survey. Psychometric analysis confirmed that the MII met IRT model assumptions, including unidimensionality, local independence, and monotonicity, with fit indices indicating adequate model fit (RMSEA ≤ 0.08, CFI, TLI ≥ 0.95, and infit mean square statistic ranging between 0.7 and 1.0). Differential Item Functioning analysis revealed no item biases. Over 50% of HCW reported experiencing MI, with notable variability across structural/organizational characteristics. MI and burnout emerged as distinct yet frequently associated constructs, with moderate to strong correlations observed between them. Their combined presence had a cumulative negative impact on health outcomes, with affected HCW showing higher levels of depression, anxiety.

This study highlights the high prevalence of MI among HCW in France, even within a robust healthcare system with universal coverage, and confirms that MI is distinct from burnout. These findings underscore the need for systemic interventions that address organizational factors, beyond the current individual-focused approaches used for burnout. Such a shift in focus would also help move away from the current tendency to over-burden and even blame HCW for systemic issues beyond their control. Given the global nature of the healthcare crisis, an international study is essential to identify systemic factors across healthcare settings, paving the way for a holistic, worldwide approach to supporting the healthcare workforce.

None Declared

Depression is a chronic and recurrent mental condition, causing a high burden of disease, functional impairment, and significant economic costs worldwide.

To compare the neuropsychological profile, inflammation, and functionality in patients with a major depressive episode before and after treatment.

A longitudinal study was conducted, recruiting a total of 39 subjects, with a mean age of 42 years (12 men - 30.8% and 27 women - 69.2%) diagnosed with major depressive disorder (MDD). The neuropsychological profile was measured using the Screening of Cognitive Impairment in Psychiatry (SCIP) and the level of functionality with the Brief Assessment of Functioning (FAST) test. Both total scores and subscales were used, along with inflammatory biomarkers (IL-6, IL-1ß, TNF-α, PGE2) and oxidative stress markers (TAS, GSHtot, GSHfree, GSSG, CAT, SOD, GPx, and BDNF).

The paired t-test was used through the statistical program SPSS. A unilateral p-value less than 0.05 was considered statistically significant.

Significant differences were observed in both the Hamilton Depression Rating Scale (p < 0.001) and in the biomarkers total GSH (p < 0.15), GSH free (p < 0.029), and GSSG (p < 0.027) of patients at three months from the start of pharmacological treatment compared to baseline (Table 1). Differences were also observed at 3 months of treatment in the SCIP scale (p < 0.001) as well as in its subscales: Immediate verbal learning (p < 0.001), Working memory (p < 0.001), Verbal fluency (p = 0.007), and Delayed verbal learning (p < 0.001), and in the FAST scale (p < 0.001) and its subscales: Autonomy (p = 0.002), Cognitive (p = 0.004), Finances (p = 0.004), and Relationships (p < 0.001) (Table 2).

Image 1:

Image 2:

Our results indicate that there are improvements at the cognitive and functional level in subjects taking antidepressant treatment. Changes in GSH and GSSG biomarkers were also observed, whose antioxidant function is crucial for protecting cells from oxidative damage. The findings suggest that oxidative stress is a crucial factor in the pathophysiology of MDD. The study highlights the potential of these biomarkers to guide therapeutic strategies and improve the management of depression.

None Declared