Since its inception in 1997, the term orthorexia nervosa (ON), derived from the Greek words for “right” and “appetite” (Donini et al, 2022), has been utilized to describe an obsession with “correct” or “healthy” eating. Despite numerous authors suggesting diagnostic criteria and the publication of several theoretical papers, consensus regarding a definition or even the existence of ON remains elusive (Dunn and Bratman, 2016). Conversely, anorexia nervosa (AN) has been recognized since the first iteration of the DSM (Bhattacharya et al, 2022; Dell’Osso et al 2016). Layperson awareness of these conditions has been increasing, with a notable increase in interest in “orthorexia” over the past several years, potentially influenced by popular culture and increased social media use (Sharma et al, 2023)

The purpose is to understand shifts in public interest as well as the ever-present influence of the online world on patients, especially those with disorder eating patterns.

This study compared United States Google search trends for the terms “orthorexia” and “anorexia”. Using Google Trends data, we reviewed the average monthly search volume from January 2004 to March 2024. We analyzed the data to determine if there was a significant difference in search volume over time.

Google search data revealed a monthly search volume of ˜7000 queries for “orthorexia” in January 2004, and analysis of the volume revealed that there has been a significant and sustained increase in the searches for “orthorexia”. Additionally, searches for the term “anorexia” reached a height of 2.1 million in 2007, but have been steadily declining in the past several years.

While anorexia remains the more prominent search term, over time the queries for anorexia have decreased from their peak in the early 2000’s. The rise in the term orthorexia may be partly due to the proliferation of highly visual social media platforms, particularly YouTube and TikTok, where content creators often focus on healthy eating and lifestyle trends (Sharma et al, 2023).

Additionally, there is a possibility that orthorexia is being used on these platforms to describe a subset of AN. Some individuals with anorexia may present with behaviors resembling orthorexia, such as a fixation on healthy eating or a rigid adherence to specific dietary guidelines.

The findings indicate a shift in the public’s interest in orthorexia and anorexia during the past several years, possibly influenced by increased social media use. Further research is needed to understand the implications of this trend on individuals’ attitudes towards healthy eating and body image.

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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.

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Attention Deficit and Hyperactivity Disorder (ADHD) is a neurodevelopmental condition characterized by persistent patterns of inattention, hyperactivity, and impulsivity. Beyond these core symptoms, ADHD seems to present complex associations with certain personality traits and to share several clinical features with personality disorders (PDs), particularly those within Cluster B. This overlap of symptomatology may lead to diagnostic challenges and potential misdiagnoses. This paper reviews the literature on the relationship between ADHD and personality traits, highlighting overlaps with personality disorders and exploring their clinical and diagnostic implications.

The primary objective of this review is to understand the potential associations between ADHD and specific personality traits, focusing on the extent to which these traits overlap with clinical features of personality disorders.

A non-systematic literature review was conducted using major databases such as PubMed, Wiley and ScienceDirect targeting peer-reviewed studies published over the last two decades. The search terms included “ADHD,” “personality traits,” “personality disorders,” and “diagnostic overlap.” Relevant studies were selected based on their focus on adult ADHD and its association with personality traits and personality disorders. Review articles and cross-sectional studies were included.

The currently available literature reveals significant associations in the clinical presentation of ADHD and specific personality traits (changing accordingly to different models of personality assessment), as well as a relevant diagnostic overlap with Cluster B personality disorders, particularly Borderline Personality Disorder (BPD) and Antisocial Personality Disorder (ASPD). Shared features include impulsivity, emotional dysregulation, and difficulty in maintaining relationships. The presence of ADHD seems to increase the likelihood of personality pathology, with some studies suggesting a high co-occurrence of ADHD with traits of increased neuroticism and novelty-seeking, and decreased conscientious inhibition.

ADHD and personality disorders share multiple overlapping clinical features, making accurate diagnosis challenging and potentially delaying adequate treatment. Thus, as suggested in some of the articles reviewed, an integrative and dimensional approach to such clinical pictures may be more adequate, so to ensure a profound understanding of the difficulties presented by patients, aiming at providing accurate and tailored treatment. Further research is needed to refine diagnostic criteria and strengthen a standardized dimensional thinking to address this diagnostic ambiguity.

None Declared

Attention-deficit hyperactivity disorder (ADHD) significantly impacts adults’ work performance, yet their lived experiences and perceptions of their work challenges remain underexplored. Understanding these subjective viewpoints is crucial for capturing the complexities of this population’s daily work challenges and needs, serving as a foundational step in developing targeted intervention to enhance work performance and participation.

This study aimed to explore the work performance experiences, challenges, and needs of adults with ADHD.

Twelve adults (ages 20-46) diagnosed with ADHD participated in three separate online focus groups, each comprising four participants.

Participants reported key challenges in executive functions, including difficulties with time management (lateness, missing deadlines), planning (prioritizing tasks, multitasking), working memory (forgetting instructions and names), maintaining focus, managing distractions, and emotional regulation (struggles in relationships with colleagues and employers). These challenges often led to frustration, stress, and low occupational self-efficacy. Identified needs included psychoeducation, self-regulation strategies, work and environment accommodations, and personalized interventions.

The study highlights the unique executive challenges and emotional consequences faced by working adults with ADHD. Hence, it emphasizes the need for personalized interventions to enhance work performance, participation, and overall well-being in this population.

None Declared

Representative surveys have shown a decline in alcohol and tobacco use among adolescents over the last years. The rapid spread of adolescents’ activities in digital space may have contributed to these changes. However, there is still considerable scope for examining the relationship between activities in digital space and substance use behaviour of adolescents.

The study aims to assess the association between adolescents’ alcohol use, cigarette smoking and their activities in digital space. The respective associations are controlled for adolescents’ subjective well-being as a putative confounder related to both substance use and digital activities.

Data from the 2022 Czech part of the Health Behaviour in School-aged Children study were used. Only 15-year-old respondents were analysed (N=4263, 50.7% boys). To measure substance use, data on the frequency of alcohol use and cigarette smoking in the past 30 days were used. Digital activities were measured by data on typical daily free time spent on social media and computer gaming. To control for subjective well-being the WHO-5 scale was used. Pairwise associations between substance use, social media use, and computer gaming were examined using Spearman rank correlation coefficients (rho). Ordinal logistic regression models were used to adjust the respective associations for gender and psychological well-being.

Significant pairwise associations were found between time spent on social media and both frequency of alcohol use (rho = 0.181, P<0.05) and cigarette smoking (rho = 0.191, P<0.05). In contrast, computer gaming was not significantly correlated with either alcohol use or cigarette smoking (rho = -0.015 and rho = -0.014, respectively; P>0.30). Poor subjective well-being was a significant risk factor for substance use and time spent on social media. Controlling for adolescents’ well-being did not significantly attenuate the former relationship between the substance use and social media use.

The results suggest that among adolescents, different forms of digital activity have markedly different associations with substance use. While increased time spent on social media was significantly associated with higher frequency of substance use, no such association was found for computer gaming. Future research will focus on whether the relationship between specific digital activities and substance use can be explained by other factors related to mental health.

The study was supported by the OP Johannes Amos Comenius (CZ.02.01.01/00/22_008/0004583).

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

Infertility is a significant source of emotional stress for couples worldwide. In Tunisia, it affects approximately 15 to 20% of couples of reproductive age. Studies indicate that women experience higher rates of depression (35% vs. 15%) and anxiety (52% vs. 28%) compared to men, largely due to cultural pressures. For these reasons, understanding these gender differences in coping mechanisms is essential.

To analyze the coping styles of infertile couples and identify gender differences in coping mechanisms to inform tailored psychological support.

We conducted a cross-sectional study involving couples undergoing infertility treatment at a specialized Assisted Reproductive Technology center inTunis. The participants provided information related to socio-demographic data. Coping strategies were assessed using the Brief Cope scale administred in the Tunisian dialect. These strategies were classified into three categories: problem-focused, emotion-focused, and avoidant coping.

A total of 60 infertile couples participated in the study. The average age of men was 41.1±6 years, while the average age of women was 35.07±4 years. Among them, 68% resided in urban areas, and 73% were from a middle socioeconomic background. Educationally, 47% of women held a university degree, compared to 17% of men. Approximately half of the women were unemployed, while 52% of men were employed.

Problem-focused coping emerged as the most frequently utilized strategy (5.93±1.02), followed by emotion-focused coping (5.32±0.82) and avoidant coping (3.95±0.70).

Women significantly employed problem-focused and emotion-focused strategies more than men (p=0.017; p<0.01). They also scored higher in emotional support, expression of feelings, active coping, planning, and religious coping (p<0.05; p=0.01). Conversely, men displayed a greater inclination towards acceptance, distraction, and substance use.

In conclusion, addressing gender-specific coping strategies is essential for providing effective psychological support to infertile couples. Healthcare professionals should promote problem-focused coping to help couples actively manage their challenges.

None Declared

Patients with End-Stage Renal Disease (ESRD) undergoing hemodialysis (HD) are particularly susceptible to psychological disorders, such as anxiety and depression, which can significantly affect their quality of life and clinical outcomes. However, in spite of its prevalence, psychiatric comorbidity in this population remains under-recognized, contributing to worse health outcomes and increased mortality.

The primary aim of this study is to explore the prevalence of psychiatric comorbidities, particularly depression and anxiety, among HD and PD patients. Insights into the different psychological effects of different dialysis treatments are offered, emphasizing the importance of integrated mental and physical healthcare in improving patient outcomes.

A narrative review was carried out using PubMed and Google Scholar to identify relevant articles with the keywords “dialysis,” “psychiatry,” and “comorbidities.”

The review underscores the important burden of psychiatric disorders among dialysis patients. Studies suggest that depression may affect up to 50% of these individuals. Both HD and PD patients exhibit varying degrees of psychological distress, exacerbated by factors such as the invasiveness of dialysis, comorbid medical conditions (e.g., diabetes), and socioeconomic challenges. The evidence suggests that HD patients may experience an even more heightened psychiatric burden due to the more invasive nature of HD compared to PD, which imposes greater restrictions on daily activities. Psychiatric disorders in these patients are often underdiagnosed, leading to treatment non-compliance, increased hospital admissions, and elevated mortality rates. The findings stress the necessity of regular mental health screenings and the integration of psychiatric care into routine dialysis practice.

Psychiatric comorbidities are prevalent among dialysis patients, with HD patients exhibiting a greater psychological burden. This review highlights the urgent need for routine mental health screening and intervention within the dialysis care framework. The integration of mental health support into dialysis treatment protocols could lead to improved patient outcomes, fewer hospitalizations, and better treatment adherence. Future research should focus on developing customized mental health interventions that address the specific challenges faced by dialysis patients, thereby enhancing their quality of life and clinical outcomes.

None Declared

Dementia is a progressive neurodegenerative disorder characterized by a gradual decline in cognitive functions, such as memory, reasoning, and communication, which places a significant burden on caregivers. Dementia caregiving presents unique challenges that contribute to elevated stress levels. Caregivers of dementia patients often face increased psychological and physical strain, exacerbated by the disease’s progressive nature and complex caregiving demands. This systematic review explores the perceived stress among dementia caregivers, highlighting the impact of caregiving responsibilities and identifying potential coping mechanisms. Our review seeks to offer evidence-based recommendations to support caregivers and improve their quality of life, thereby addressing a crucial gap in dementia care.

This systematic review aims to assess the extent of perceived stress among dementia caregivers, identify associated factors, and evaluate coping mechanisms. The goal is to highlight critical stressors and propose evidence-based strategies for improving caregiver support.

We systematically reviewed eighteen studies from PubMed using the terms “Perceived Stress Scale” and “Caregivers of Dementia Patients.” Our analysis included data from 3,385 caregivers, focusing on stress levels, cortisol measurements, and psychological impacts.

The review consistently identified high levels of perceived stress among dementia caregivers. Cortisol levels, assessed in three studies, were significantly elevated in caregivers compared to non-caregivers (Williams et al., 2021; Kim & Park, 2022; Nguyen et al., 2023). Perceived stress showed a significant correlation with cognitive decline and sundowning behaviors. Additionally, caregivers reported elevated depressive symptoms, with stress levels showing a direct association with these symptoms (Jones et al., 2021). The review also identified that higher education was associated with reduced anxiety and depression, while female caregivers reported higher stress levels compared to males (Miller et al., 2022). Effective coping strategies included seeking information, participating in culturally adapted interventions, and enhancing social support networks (Patel & Singh, 2023).

Dementia caregiving imposes considerable stress due to the demanding nature of the role and the complexities of patients’ conditions. Interventions should prioritize culturally sensitive support programs, expand educational opportunities for caregivers, and strengthen social support systems to alleviate caregiver stress. Future research should further investigate the influence of gender, social isolation, and healthcare access on caregiver stress, particularly in low- and middle-income countries (LMICs) and during global crises such as the COVID-19 pandemic. Addressing these factors will be crucial in developing comprehensive strategies to support dementia caregivers effectively.

None Declared

Treatment motivation is very important in the treatment of alcohol and substance use disorders. The evaluation of motivation, which is seen as the first step in addiction treatment, will also help understand the person’s interest and compliance with treatment. The lack of motivation of the person during the treatment process causes treatment abandonment and relapses.

An important issue in the treatment of alcohol use disorder is the trust of the person in the treatment. It is also important for the addict to have someone around him who has benefited from treatment, which is very important in terms of treatment compliance. With the influence of a person who has benefited from addiction treatment, the likelihood of applying for treatment and benefiting from treatment increases in a “snowball” manner.

The aim of this study was to evaluate whether people who are treated for alcohol use disorder have a treatment motivation for those around them. It was aimed to examine whether the people who have been treated are important in increasing the trust in treatment for other patients.

The study included cases who applied to the Seferihisar State Hospital Psychiatry Outpatient Clinic with complaints of alcohol use. The sociodemographic information form was filled out during the individuals’ first applications. The participants were asked whether there were people around them who had received inpatient treatment for alcohol use disorder at the hospital where the study was conducted, and the individuals were then administered the Readiness for Change and Desire for Treatment Scale (SOCRATES), Treatment Motivation Questionnaire (TMQ), and Alcohol Use Disorders Identification Test (AUDIT). The individuals were given the standard treatment recommended in our country’s treatment guidelines for the diagnosis of alcohol use disorder. The individuals participating in the study were interviewed at 1 month, 2 months and 3 months after starting treatment. The individuals’ answers and the decrease in the frequency and amount of alcohol use were recorded.

The rate of treatment attendance is 2.7 times higher for people who have received treatment for alcohol use disorder in their circle.

The rate of treatment confidence in treatment is 4.1 times higher for people who have received treatment for alcohol use disorder in their circle.

The frequency and amount of alcohol use has decreased more for people who have received treatment for alcohol use disorder in their circle.

It has been determined that those who are surrounded by people who have received treatment for alcohol use disorder have higher levels of treatment confidence and compliance. The assistance of these people to those around them can play an important role in increasing the success of addiction treatment.

None Declared

Participatory research can enhance the relevance, quality, and impact of studies, increase recruitment, and optimize research methods. It can also help to secure third-party funding,. The participatory inclusion of forensic psychiatric patients in research has so far primarily been implemented in the UK. With the establishment of the PART advisory board, founded in December 2023, this gap is intended to be closed in Germany by creating sustainable, previously lacking structures for the involvement of forensic psychiatric patients. The acronym PART refers to participation/ participatory. In the PART advisory board, people with lived experience and researchers actively cooperate in projects in the field of forensic psychiatry. In preparation for their role, people with lived experience received training where they were provided with knowledge and skills for their work. The board has now advised several research projects and issued recommendations.

The purpose of this presentation is to critically reflect on the first experiences and consider how to incorporate these insights to improve the structure and working methods of the advisory board: What experiences have researchers, people with lived experience and those presenting their research projects made? How were participants involved? What impact did the advisory board have on specific research projects? What challenges arose, and how were they addressed? What are the lessons learned so far?

To answer these questions, various evaluation tools were used. These include feedback questionnaires from participants assessing each advisory board meeting and project presentation, interviews with participants at least two times throughout the project, statements from the advisory board to project presenters, and responses from the presenters on how the board’s recommendations were implemented. Additionally, the perspectives of involved project staff were considered.

By the time interim results are presented at the EPA Congress 2025, the PART Forensic Advisory Board will have met at least 12 times and at least five research projects will have been presented to the board and received its recommendations. It has already become clear that involving participants, especially in forensic psychiatric settings, requires specific framework conditions. These address overarching structural aspects, disease specific patient relevant needs, as well as knowledge- and method-based issues relevant to participants.

Even at this stage, the advisory board can be considered successfully implemented. Participatory research with people with lived experience in forensic psychiatric settings is possible, feasible, and above all, meaningful.

None Declared

Esketamine has been linked to dissociation, which was claimed to predict or not to predict antidepressant response. Speculations regarding predictivity were based on results obtained with the CADSS, a scale investigating dissociative symptoms, with higher scores indicating more symptoms.

To investigate the effect of intranasal esketamine on dissociation and its subsequent influence on clinical response, we administered the CADSS 40 minutes after inhalation at the first esketamine administration and 40 minutes after the ninth inhalation and measured clinical response through the Clinical Global Impressions-Severity (CGI-S), the Young Mania Rating Scale (YMRS), the Montgomery-Åsberg Depression Rating Scale (MADRS), and the 24-item Brief Psychiatric Rating Scale (BPRS).

We included 61 adults (33 women and 28 men; age, mean, 52.69±11.80, range 20-73 years) with Thase & Rush (J Clin Psychiatry 1997;58 [Suppl 13]:23-29) treatment-resistant depression. All patients received intranasal esketamine spray and were assessed at the first and ninth administrations (one month after the first administration, i.e., the end of the induction period and the beginning of maintenance), at the day of the spray after 40 min with the CADSS and 1 month later with the CGI-S, the BPRS, the MADRS, and the YMRS.

CADSS scores dropped from 6.59±7.42 40 min after the first administration to 3.12±4.41 40 minutes 1 month later (dropped by 3.48 points, 47.27% of baseline); t=3.15; p=0.0021. CGI-S scores dropped from 5.12±0.61 at baseline to 3.95±0.76 1 month later (t=9.32; p<0.00001). BPRS scores dropped from 51.85±11.55 at baseline to 41.21±10.64 after 1 month (t=5.29; p<0.00001). MADRS scores dropped from 34.29±7.89 at baseline to 22.61±9.07 after 1 month (t=7.59; p<0.00001). Responders (≥50% drop of MADRS from baseline) were 12 patients (19.67%), while remitters (MADRS score≤10) were 2 (3.28%). YMRS scores moved from 2.18±2.59 at baseline to 1.72±2.37 1 month later (t=1.02; p=0.309, n.s.), always in the normal range. Blood pressure 40 minutes after spray at the first administration was unchanged in 35 patients, increased in 16 (maximum by 20 mmHg), and decreased in 10 (maximum drop 20 mmHg). Contrary to previous claims, CADSS scores did not correlate at any time with scores on clinical scales or therapeutic response (Pearson’s r from 0.232 with p=0.072 to 0.013 with p=0.918). As for side effects, 15 patients reported dissociation, 15 sedation, 8 vertigo, 8 dizziness, 6 confusion, 5 headache, 4 nausea/vomiting, and 0 hypertension.

Patients in our sample scored very low on the CADSS. At the end of the induction period, esketamine was associated with significant decreases in the severity of psychopathology.

None Declared

Clinical practice involves many stress factors for nursing students. Stress in clinical practice causes positive or negative outcomes for students. Students show physical, emotional and behavioural reactions to stress. Therefore, progressive muscle relaxation and breathing exercises with music can be a method that students can easily learn and apply, reducing stress and negative bio-psycho-social responses.

This study aimed to examine the effects of progressive muscle relaxation and breathing exercises accompanied by music on the stress levels of undergraduate nursing students and their bio-psycho-social responses to stress.

This randomized controlled study was conducted at a university in Turkey with ethics committee approval. A total of 154 undergraduate nursing students were randomized, 77 in the intervention group and 77 in the control group. 44 of the students were sophomores, 52 were third-year students, and 58 were fourth-year students. Progressive muscle relaxation and breathing exercises were applied to the intervention group for six weeks with music. No intervention was applied to the control group during the research period. Research data were collected using the Personal Information Form, the Perceived Stress Scale for Nursing Students, and the Biopsychosocial Response Scale for Nursing Students. The scales were applied to the intervention and control groups before the exercises, at the end of the six-week exercises, and two weeks after the exercises ended. Data were collected between October 2022 and January 2023. Shapiro-Wilk test was used in the analysis of normality of data; Independent Samples t-test, Dependent Samples t-test, and Analysis of Variance were used in the analysis of variables.

In the pre-test measurements of the groups, it was found that there was no significant difference in terms of the students’ stress levels in clinical practice and bio-psycho-social response scores (p>0.05). In the post-test and follow-up measurements, it was seen that the stress and bio-psycho-social response scores were significantly lower in the intervention group than in the control group (p<0.05). There was also a significant group*time interaction between the groups in terms of stress and bio-psycho-social response scores (p <0.05).

The findings showed that the intervention helped students reduce their stress levels and negative bio-psycho-social responses to stress, and the effects were found to be sustained in the short term. These positive results are promising in the use of progressive muscle relaxation and breathing exercises with music as an effective and easy method to reduce the stress level and negative physical, emotional and behavioral responses to stress in the clinical practice of undergraduate nursing students.

None Declared

There is a growing evidence that a presence of mild behavioral impairment (MBI) in geriatric patients with mild cognitive impairment (MCI) increases the risk of Alzheimer disease. However, neurobiological patterns underling such additional risk remains unclear.

We aimed to investigate structural cortical patterns in MCI patients that differentiate converters from non-converters to Alzheimer disease (AD) and to explore correlations of such patterns with mild behavioral impairment.

Thirty five right-handed geriatric patients with amnestic type of MCI (aMCI) were followed up during the period of 11.3±6.9 months and divided into converters to AD (n=11, mean age 74.6±7.5, 10 females) and non-converters (n=24, mean age 72.6±8.1, 18 females). Patients and matched healthy controls (n=17, mean age 72.3±7.2 years, 14 females) underwent structural 3T MRI at baseline. MRI images were processed via FreeSurfer 6.0 to quantify gray matter thickness for 68 cortical areas according to Desikan atlas. Cognitive status was assessed using the Montreal Cognitive Assessment (MoCA) scale, and the severity of mild behavioral impairment was assessed using the MBI-C (Mild Behavioral Impairment Checklist) at baseline.

Cortical thickness in the left inferior parietal lobe (IPL) and left middle temporal gyrus (MTG) were decreased in converters compared to both non-converters (IPL: F(1,30)=12.8, p=0.0012, Cohen’s d=−1.30; MTG: F(1,30)=12.8, p=0.0012; Cohen’s d=−1.30) and healthy controls (IPL: F(1,24)=11.4, p=0.0025, Cohen’s d=−1.33; MTG: F(1,24)=8.3, p=0.008; Cohen’s d=−1.15) (Image 1A,B).

Converters also showed larger baseline MBI-C scores compared to non-converters (13.8±12.0 vs 7.8±6.6; GML t=2.1, p=0.045) and no difference in baseline MoCA (21.8±4.0 vs 23.2±2.8; GML t=−1.4, p=0.19).

Baseline MBI-C scores in the whole aMCI group correlated negatively with cortical thickness both in the left IPL (R=−0.53, p=0.0011) and left MTG (R=−0.48, p=0.004) (Image 1C). No correlations between MoCA scores and cortical thickness were observed.

Image 1. A: Clusters of decreased cortical thickness according to atlas of Desikan et al. (2006) in converters compared to non-converters and healthy controls. B: Box-plots of cortical thickness in the left inferior parietal lobe and left middle temporal gyrus. C: Scatter plots of MBI-C scores and gray matter thickness in the left inferior parietal lobe and left middle temporal gyrus in the whole aMCI group (n = 35).

Image 1:

The findings suggest that the decreased baseline cortical thickness in the left inferior parietal lobe and middle temporal gyrus with associated greater severity of mild behavioral impairment could be potential marker of increased risk of conversion to AD in aMCI patients.

The study was supported by RSF grant 24-15-00220

None Declared

Relapse refers to the recurrence of psychotic symptoms following a phase of improvement or stability. It often leads to the disruptive re-hospitalization of patients. Notably, a history of relapse is a strong indicator of future relapses and poorer outcomes. According to the literature, relapse rates might be higher in men compared to women due to better response to medication in women. Cariprazine (CAR), a D3-D2 partial agonist, has shown effectiveness in preventing relapse compared to a placebo in stabilized schizophrenia patients

We aimed to investigate whether there is a difference in the efficacy of CAR in preventing relapse by sex.

A post-hoc analysis was conducted on data from a multicentre, randomized, double-blind, placebo-controlled, parallel-group study lasting approximately 96 weeks in adults with schizophrenia. The study included two phases: a 20-week open-label treatment phase and a double-blind treatment phase lasting up to 72 weeks. During the open-label phase, patients were stabilized on CAR at doses of 3.0-9.0 mg/day. Subsequently, they were randomized to either continue CAR (at fixed doses of 3.0, 6.0, or 9.0 mg/day) or switch to a placebo (PBO). Relapse was defined by a worsening of symptom scores on the Positive and Negative Syndrome Scale (PANSS), psychiatric hospital admission, aggressive behaviour, or suicide risk. In this analysis, patients were separately analysed based on their sex. Baseline characteristics, hazard ratios by sex during the double-blind phase were calculated.

Of 200 patients, 132 (66%) were male (M) and 68 (34%) were female (F). In the female group, 57% were receiving CAR treatment, while in the male group 47% were on CAR. The mean age of the patients was between 36-41 years. The open-label baseline PANSS scores were comparable. The adherence of patients during the double-label phase was similar in all four groups (98-99%).

More relapses were documented in the placebo groups (M: 47%, F: 48%) than in the CAR groups (M: 27%, F: 21%). In females, those who received CAR during the double-blind phase had 66% less risk for relapse (HR=0.34, 95%CI= 0.14-0.82) than those who were on placebo. Similarly, male patients on cariprazine had 49% less risk for relapse (HR=0.51, 95%CI= 0.28-0.91) than those receiving placebo. The Cox regression analysis between groups showed that sex of patients did not affect the risk of relapse significantly.

In summary, sex does not seem to significantly influence risk of relapse. CAR decreases the risk of relapse compared to placebo in both males and females.

C. Correll: None Declared, Z. Dombi Employee of: I am an employee of Gedeon Richter Plc., originator of cariprazine., P. Herman Employee of: I am an employee of Gedeon Richter Plc., originator of cariprazine., Á. Barabássy Employee of: I am an employee of Gedeon Richter Plc., originator of cariprazine.

Second-generation antipsychotics (SGAs) have been increasingly used as off-label treatments for non-psychotic illnesses, there is a lack of updated data to describe its prescription among psychiatric populations.

This study aims to describe the most recent ten-year trend of SGA prescriptions and to identify the probable psychiatric diagnoses associated with the prescription among adult psychiatric patients in Hong Kong.

All patients aged 18 or older who had a psychiatric diagnosis and were initiated on an SGA based on the population-based electronic health record from the Clinical Data Analysis and Reporting System (CDARS) in Hong Kong between 2014 and 2023 were included. The probable psychiatric indication was defined as the diagnosis recorded within 6 months from the date of SGA initiation and was classified into four groups according to the ICD-9-CM categorization of Mental Disorders (290-319). Trends were examined using joinpoint analyses. The prescription trend was re-analyzed using an alternative classification into groups of Schizophrenia (SCZ), Non-schizophrenia serious mental illness (non-SCZ SMI), and Non-SMI.

A total of 79,681 patients (Female 57.9%, Age 56.8±22.5years) were included. There is significant increase in SGA prescriptions in patients with a probable indication within the ICD-9-CM category of ‘Non-psychotic Mental Disorders’ and ‘Organic Psychotic Conditions’, with an average annual percent change (AAPC) of 1.9% (p<0.01) and 1.7% (p<0.01), respectively; while the probable indications under ‘Other Psychoses’ decreased with an AAPC of -2.2% (p<0.01) (Figure 1). Importantly, the prescriptions among patients with probable diagnostic indications under the group of SCZ and non-SCZ SMI decreased with an AAPC of -6.9% (p<0.01) and -0.8% (p=0.03), respectively, while the non-SMI indications rose from 60.3% to 70.0% from 2014-2023 (AAPC=1.7%, p<0.01) (Figure 2).

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Our study provided important data demonstrating a trend of increasing proportions of SGA prescriptions for non-psychotic and non-SMI indications.

S. Pan: None Declared, B. Or: None Declared, T. Li: None Declared, N. Y. Chan: None Declared, T. Yip: None Declared, V. Wong Shareolder of: Stock: Co-founder of Illuminatio Medical Technology , Grant / Research support from: Research grants: Gilead Sciences, Consultant of: Consultancy: AbbVie, AstraZeneca, Boehringer Ingelheim, Echosens, Gilead Sciences, Intercept, Inventiva, Merck, Novo Nordisk, Pfizer, Sagimet Biosciences, TARGET PharmaSolutions, Visirna , Speakers bureau of: Lectures: Abbott, AbbVie, Echosens, Gilead Sciences, Novo Nordisk, Unilab, Y. K. Wing Consultant of: YKW received consultation fee from Eisai Co., Ltd., honorarium from Eisai Hong Kong for lecture, travel support from Lundbeck HK limited for overseas conference., J. Chan Speakers bureau of: JWYC received personal fee from Eisai Co., Ltd and travel support from Lundbeck HK limited for overseas conference.

Numerous studies have revealed the association between deficit hyperactivity disorder (ADHD) and brain inflammation due to immune system response to congenital or perinatal human cytomegalovirus (CMV) infection.

The aim of study was to examine the impact of neuroinflammation caused by CMV infection on the development of ADHD in prematurely born children.

The medical records of 126 prematurely born children aged 7-11 were retrospectively analyzed. Participants were divided into two groups, the observed population of 56 children with ADHD and the control group without ADHD. Three parameters were observed, C-reactive protein (CRP) as an indicator of inflammation, IgM antibodies to CMV for etiological diagnosis of CMV infection and cranial ultrasound findings for the confirmation of structural changes in the brain.

Statistical analysis of our data showed the association between the onset of ADHD and the presence of congenital/perinatal CMV infection in prematurely born children (p<0.01). Nevertheless, these two variables had a very low positive correlation (phi coefficient 0.07173). The results did not show the association between elevated levels of CRP and presence of ADHD in prematurely born children (p>0.01), which confirmed that not every inflammation, regardless of the cause, was associated with ADHD. The analysis also confirmed the positive correlation between the variables listed in pairs: elevated levels of CRP and positive IgM on CMV, elevated levels of CRP and altered ultrasound neuroimaging findings, as well as positive IgM on CMV and altered ultrasound neuroimaging findings. All of these correlations speak in favor of the CMV caused neuroinflammation as etiopathogenetic basis in ADHD.

In our sample CMV-induced neuroinflammation was associated with the development of ADHD in prematurely born children.

None Declared

Acute generalised exanthematous pustulosis (AGEP) is a rare but severe cutaneous reaction often triggered by medications like antibiotics, calcium channel blockers, and antipsychotics. It is characterised by the rapid onset of non-follicular sterile pustules, fever, and leukocytosis with neutrophilia and eosinophilia. The European SCAR study reports an incidence of 1–5 cases per million annually, with a mortality rate of up to 5% in severe cases (Szatkowski et al. JCM 2022; 11:397). While AGEP is well-documented with various drugs, AGEP induced by low-dose olanzapine is particularly noteworthy due to its rarity and the lack of substantial evidence in existing literature.

The aim of this report is to highlight the potential for AGEP to develop even at low doses of olanzapine and to review similar cases from the literature.

We present the case of a 19-year-old male treated with low-dose olanzapine (2.5 mg) for severe insomnia who developed AGEP. A literature review was conducted to identify other instances of AGEP related to olanzapine. The review utilised PubMed and Google Scholar databases, focussing on cases with detailed patient information including age, gender, dosage, and time to symptom onset (Table 1).

A 19-year-old male with a one-year history of severe sleep deprivation, reporting only one hour of sleep per day in the past week, was prescribed olanzapine 2.5 mg after failed attempts with melatonin, hydroxyzine, and mirtazapine. Two days later, he developed a pruritic rash on the neck, spreading to the trunk and limbs, along with a fever of 38.5°C. Blood tests revealed leukocytosis (12,000/μL), neutrophilia, and eosinophilia but normal liver and kidney function. Dermatological evaluation confirmed AGEP. Olanzapine was discontinued, and cetirizine, an H1 antagonist, was administered. Symptoms improved within 24 hours, and the rash resolved within a week.

Table 1: Summary of Olanzapine-Induced AGEP Cases

This case underscores the need to recognize rare hypersensitivity reactions like AGEP, even at low doses of olanzapine. Early detection and discontinuation of the drug are essential to avoid complications. Literature shows AGEP can occur across various dosages, with symptom onset typically within days. Clinicians should be cautious when prescribing olanzapine, regardless of dose, and closely monitor patients for signs of AGEP to prevent severe outcomes.

None Declared

Depressive disorders and anxiety disorders are typical comorbidities in autism spectrum disorder (ASD), with a reported prevalence of 20% and 9%, respectively (Lai, 2019). Autistic subjects are more at risk for suicidal thoughts and behaviors compared to typically developing peers; moreover, depressive symptoms are often resistant to both pharmacological and psychotherapeutic treatments. In 2019 intranasal esketamine was approved in Italy for treatment-resistent depression (TRD). We observed two young outpatients affected by autism (diagnosis made by “Lab-Aut”, a specialized mental health service in Pavia) treated with esketamine in our ambulatory for TRD. Clinical information and personal details were summarized in Image 1.

To evaluate the clinical response to intranasal esketamine in subjects with major depression in ASD and to compare the outcome with neurotypical patients.

Autism diagnosis wase made according to ADOS-2 and ADI-R scores, confirmed by a clinical judgment of senior psychiatrist. Our follow-up protocol during esketamine treatment consists in the following scales: MADRS, C-SSRS, DES-II, Psychace Scale, Reading the Mind in the Eyes Test, HAM-A, HAM-D, BDI, PANSS. Psychometric evaluation was performed at T0 (before esketamine), T1 (one week of pharmacotherapy), T2 (one month), T3 (2 months) T4 (3 months) and T5 (6 months). We collected results from neurotypical patients (n=12) and autistic patients (n=2) between 2022 and 2024.

Both in autistic patients and in neurotypical ones we noticed a premature decrease in depressive symptoms and a reduction of suicidal thoughts. This improvement was testified by a reduction from T0 to T1 in MADRS total score and in C-SSRS sub-score focused on intensity of suicidal ideation. The reduction was maintained during the observation period (Image 2). Due to the small sample size of autistic patients, we couldn’t reach the statistical significance threshold for this population. Considering the entire sample (n=14) we obtained significant results (T0-T1: MADRS decrease p=0,00006, C-SSRS decrease p=0,00009. T0-T5 MADRS and C-SSRS variations p<0,00001). Comparing our sub-samples, it’s possible to notice a similar trend in follow-up between autistic and neurotypical patients. (Image 3).

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Our preliminary data coming from clinical experience suggest the efficacy of intranasal esketamine in depressive episodes occurring in autistic patients. A larger sample size of autistic patients will be necessary to set a comparative study and to give significance to these results. Esketamine could represent an important therapeutic option in depressed patients with ASD comorbidity.

None Declared

Hemispheric imbalance might underlie the genesis of psychosis. In patients with schizophrenia left eye dominance was higher than in control subjects. The aim of the study is to investigate sexual differences in left eye dominance as a biological marker of neuronal dysontogenesis in schizophrenic patients and control subjects. This study is part of a larger investigation project on the intriguing relations between six groups of markers of neuronal dysontogenesis - left-handedness, left-footedness, left-eyedness, minor physical anomalies, digit ratio, and cognitive (attention and memory) deficit.

Altered cerebral lateralization is a key trait found in many neurological and psychiatric disorders. This study investigates the gender difference in eye dominance between patients with schizophrenia and controls.

The study was conducted in the Clinic of Psychiatry at the University Hospital in Sofia and the State Psychiatric Hospital in Radnevo. The sample included 98 (56 men, 42 women) consecutively admitted schizophrenic inpatients with a mean age 34.45 years for men and 42.20 years for women and 82 control subjects (30 men, 52 women) with a mean age 34.70 for men and 44.50 years for women. Three tests for eye dominance were administered as performance tasks- Looking through a monocle, Hole test and Porta test.

The non-parametric Mann-Whitney test was used to analyse the data.

The mean left-eyedness is significantly higher in schizophrenic patients than in control subjects in the three eye tests: Looking through a hole - .81 vs. .39, p<.001, over two times increase; Looking through a monocle - .78 vs. .39, p<.002, two times increase; Porta test - .86 vs. .41, p<.002, over two times increase.

In male subjects the difference between schizophrenia and controls reaches statistical significance for Looking through monocle (p=.037), but does not reach statistical significance for Hole test (p=.196) and Porta test (p=.077). In contrast, all female intra-gender comparisons between schizophrenia and controls reach statistical significance- Looking through monocle (p=.013) and Porta test (p=.015) reach statistical significance at p<.05, while Hole test at p=.001.

The patients with schizophrenia have significantly higher mean left-eyedness than the controls in both sexes, but this difference is much more pronounced in women than in men for all three eye tests. Altered eye dominance in patients with schizophrenia is related to a prenatal maldevelopment and exhibits clear gender difference.

None Declared