Cannabidiol (CBD) is a non-psychoactive cannabinoid with therapeutic potential in various fields, such as its effect on mental health or antiepileptogenic, among others. For this reason, the interest in research on the potential effects of this substance is booming and the sale and consumption by the general population is increasing.

To describe the observed effects of CBD use during treatment with electroconvulsive therapy (ECT).

To describe in detail the clinical case and to correlate the changes observed in the seizures and the electroencephalogram (EEG) of the ECT sessions when the patient performed concomitant consumption of CBD, in addition to the changes at the clinical level that he experienced during this period.

The subject is a 47-year-old man who required admission for a psychotic decompensation of his schizoaffective disorder bipolar subtype. In recent years, he had no adherence to psychopharmacological treatment or follow-up, and reported self-medicating with CBD cigarettes in varying amounts (he reported 5 to 15 units/day). During admission, pharmacological treatment was instituted with poor response and an acute course of ECT was performed due to a history of good response in a previous episode 10 years ago and the patient’s preference. He remained abstinent from CBD during hospitalization and it was agreed to remain non-consuming at discharge. He presented progressive improvement in the clinical signs from the 4th session, with remission in the 7th session. Upon discharge, it was agreed to perform consolidation ECT on an outpatient basis, initially with weekly sessions and then every two weeks.

From the 2nd outpatient session, a worsening of motor and electroencephalographic seizures was observed in the ECT sessions. A possible relapse into CBD use, which the patient denied, was explored. After the 3rd outpatient session, the patient recognizes relapse into CBD consumption with occasional consumption. During the following 2 sessions, the deterioration in the quality of the EEG pattern progresses and it is decided to interrupt ECT treatment due to the absence of seizures in EEG recording, coinciding with an increase in the daily amount of CBD consumed.

There is little literature on the management of the effects of CBD in ECT treatment. The observations in this clinical case provide valuable information about the combination of CBD and ECT that can be useful to other professionals with similar cases.

None Declared

Transcranial magnetic stimulation (TMS) has been consistently recommended in international guidelines as first-line for treatment-resistant depression, due to its superior efficacy over the next antidepressant, with minimal side effects. However, owing to its high cost, lack of insurance coverage, the need for daily time commitment over a period of 4 to 6 weeks and its relative novelty, TMS is still not being offered to many eligible patients with MDD including at our hospital, leading to an under-utilisation of the service.

We aim to determine the rate at which TMS is being offered to eligible patients with MDD at our hospital in Singapore, explore the root causes behind why it is not being offered and utilised more often, and implement new models of care to increase this rate by at least two-fold over 6 months.

All patients who registered at our outpatient clinics from June to November 2024 were screened for the eligibility criteria for TMS. Flow charts, affinity diagram and fishbone diagram were drawn. Multi-voting was conducted to arrive at the top root causes for the low rate at which TMS was being offered to eligible depressed patients, determined on a Pareto chart. 5 Plan, Do, Study, Act cycles were carried out. Key interventions included: (a) Adopting evidence-based, shorter TMS protocols that reduced time to remission from 6 weeks to 2-3 weeks, (b) initiating a novel, nurse-led TMS counselling service, (c) improving promotional materials, and (d) using simple yet effective strategies to improve familiarity with TMS and encourage psychiatrists to consider it more often.

The rate at which TMS was offered to eligible patients with MDD increased from 15% to 80% over June to November 2024. 31% of these eligible patients took up TMS, and 100% of those who started TMS eventually completed the course. Patients who completed the course had a 69% reduction in clinician-administered depression rating scales. Psychiatrists were more inclined to offer TMS via the TMS counselling service run separately by TMS nurses, as this otherwise often took up substantial time in busy clinic settings. The increased awareness of TMS through promotional materials empowered patients such that they were bringing up TMS during consultations before they were being offered. The evidence-based, shorter TMS protocols involved conducting multiple sessions a day with adequate intervals, without compromising on efficacy and safety. Patients enjoyed the option of having less interruptions from work or school, and the quicker times to remission. Direct cost savings were observed.

We observed better quality of clinical care, increased patient, staff and stakeholder satisfaction, cost and time savings to patients, and increased productivity in both patients and staff, through effective and sustainable interventions which can be replicated in TMS clinics elsewhere.

None Declared

Ehlers-Danlos Syndrome (EDS) is a group of hereditary connective tissue disorders that primarily involve skin hyperelasticity, hypermobility of joints and fragility of blood vessels.This syndrome shows heterogeneous features.Recent studies have shown that patients with EDS have a higher risk of psychiatric conditions such as depression, suicide and schizophrenia.The existing literature on safe administration of ECT defines several case reports which incorporates connective tissue disorders.

This case report aims to define a rare case of EDS related psychosis including the clinical presentation and management.Furthermore, to show the administration of ECT in patients suffer from this medical condition after their assessment.

Comprehensive presentation of patient’s case and review of systematic literature using database, in regards to connective tissue disorders and psychiatric conditions.

A 42-year-old female patient,diagnosed with anxiety disorder 7 years prior, who has shown no remission and has experienced multiple hospital admissions over the past year due to various psychotic and depressive episodes, presented to our hospital with complaints that a “sorcerer” had cast spells on her.She reported delusions of mystical and somatic nature, describing that as a result of these spells, supernatural entities had caused her teeth to shrink, her skull to shift, the brightness in her eyes to diminish, her internal organs to decay and her physical presence to fade away.Additionally, she expressed paranoid-persecutory delusions that these entities would ultimately lead to her death.Treatment history included multiple SSRIs, antipsychotics and 6 sessions of TMS therapy, all with limited response.Her family history revealed that her father had died by suicide and her siblings were also diagnosed with depression/anxiety disorders.

The patient was admitted with a preliminary diagnosis of psychotic depression.Physical examination findings included hyperflexibility and hyperlaxity, suggestive of EDS.As the patient was at increased theoretical risk for complications; several consultations were requested to assess fitness for treatment prior to ECT.Based on these evaluations, ECT was deemed safe to proceed.Bifrontal ECT was successfully administered, resulting in marked improvement in the patient’s psychotic symptoms.

Even delusions are remarkably indicative for psychosis, it is crucial to recognize the underlying medical conditions may contribute to its onset and/or exacerbation.Psychiatric evaluations should be performed during EDS patients’ routine follow-ups.Additionally, as is already shown in other case reports, administration of ECT in patients with EDS should be considered.However, further research is required to understand the eligibility of ECT on connective tissue disorders also to expand our repertoire in the treatment.

None Declared

Electroconvulsive therapy (ECT) is a widely recognized and effective treatment for severe psychiatric conditions, including major depressive disorder, treatment-resistant depression, and some psychotic disorders. Although ECT is highly effective, administering it to patients with cranial metal implants—such as plates, screws, clips, or electrodes—presents potential safety challenges. Metal implants, particularly those made of ferromagnetic materials, may interact with the electrical currents in ECT, which can lead to heating, shifting of the implant, or other adverse effects, thereby raising safety concerns.

To review the safety and clinical considerations of electroconvulsive therapy in patients with cranial metal implants. This literature search aims to identify evidence on risks, contraindications, and guidelines to support safe and effective treatment in this population.

We conducted a literature search on PubMed to investigate the application of ECT in patients with cranial metal implants. The search included keywords “electroconvulsive therapy” and “ECT” combined with the terms “cranial metal implants,” “head metal implants,” and “metallic skull plate” interchangeably. We included only case reports. We used this approach to gather relevant studies addressing the safety, efficacy, and considerations of electroconvulsive therapy in individuals with metal implants in or near the skull.

The literature search identified 11 case reports documenting the successful administration of ECT in patients with cranial metal implants. Across these cases, ECT was performed without adverse events related to the implants, and treatment outcomes were reported as effective in managing psychiatric symptoms. Most reports emphasized careful planning and individualized assessment to minimize risks, particularly regarding implant location and material composition. Safety measures included conducting pre-treatment imaging to evaluate implant positioning.

The connection between cranial metal implants and ECT necessitates careful consideration of safety protocols to prevent potentially hazardous interactions. While metals such as titanium are generally not problematic for this therapy, it is essential to consider the type of metal, its location, and its magnetic properties before applying this technique. Our clinical experience also shows positive outcomes in patients with cranial metal implants, demonstrating safe and effective administration with proper evaluation and precautions. Further research and establishing safety guidelines will be crucial for optimizing treatment and minimizing risks for patients with metal implants.

None Declared

Interpersonal Psychotherapy (IPT) has been recognized as an effective treatment for various eating disorders, particularly Binge Eating Disorder (BED) and Bulimia Nervosa (BN). IPT focuses on addressing interpersonal difficulties, such as role transitions, interpersonal disputes, and social deficits, which are common in individuals with eating disorders. While evidence supports its use for BED and BN, its effectiveness for Anorexia Nervosa (AN) remains limited. Group-based IPT has also shown promise by targeting interpersonal deficits that perpetuate disordered eating behaviors.

This literature review aims to evaluate the efficacy of IPT in treating eating disorders, with a focus on BED and BN. Additionally, it explores the role of interpersonal deficits as a central focus of IPT and compares the outcomes of individual and group-based IPT formats.

A review of peer-reviewed studies, clinical trials, and meta-analyses published between 2000 and 2024 was conducted. The review assessed the effectiveness of IPT in reducing disordered eating behaviors, improving interpersonal functioning, and maintaining long-term treatment gains. Studies on both individual and group IPT formats were included, with a focus on binge eating reduction, interpersonal relationship improvements, and relapse prevention.

The literature consistently shows that IPT is effective in reducing binge eating behaviors and improving interpersonal relationships in individuals with BED. Group IPT, in particular, has been shown to effectively address interpersonal deficits, providing social support and improving interpersonal skills, which contributes to sustained treatment outcomes. IPT has demonstrated comparable short-term efficacy to Cognitive Behavioral Therapy (CBT), with studies indicating superior long-term maintenance of treatment effects. However, evidence for IPT’s use in AN remains sparse.

IPT is a promising treatment for eating disorders, particularly for individuals with BED and BN who exhibit significant interpersonal deficits. Group IPT appears to be especially effective in addressing these interpersonal issues, providing long-term benefits. While CBT remains the most widely used therapy, IPT offers a valuable alternative, particularly for individuals who do not respond to CBT. Future research should focus on exploring IPT’s mechanisms and expanding its application to other eating disorders, including AN, where evidence is currently lacking.

None Declared

The relationship between childhood traumatic experiences and substance use disorders (SUD) has been the subject of considerable discussion in the literature. The development of efficacious therapeutic models for the treatment of these comorbidities remains an ongoing area of research. In particular, trauma-related disorders accompanied by dissociative changes and SUD may be effectively treated with ego-states therapy, which employs a combination of psychoanalytic and hypnoanalytic methods with other systemic approaches.

The objective of this presentation is to illustrate a case study from an interdisciplinary day clinic that employs an integrated approach to the treatment of substance use disorders (SUD) and other comorbidities. Furthermore, we will propose an innovative naturalistic method for addressing complex phenomenological manifestations of trauma-related disorders in individuals with SUD.

In this presentation, we will introduce a psychotherapeutic method from a day clinic in Lower Saxony, Germany, through a comprehensive case study.

Case:

A 40-year-old woman was referred to the day clinic following a period of ward treatment following the death of her father. This period led to an increase in her cannabis consumption and a concomitant increase in depressive symptoms. In her history, she revealed that her elder sister had committed suicide when the patient was in primary school. Consequently, she was tasked as a child with the responsibility of handling all bureaucratic matters with her parents, as she was the only member of her family who could speak German due to their migration background.

During the psychotherapeutic treatment, various ego states were identified and addressed through a combination of psychoanalytic, systemic-milieu therapeutic, and family therapeutic interventions. Particular attention was paid to those aspects that had been functional during childhood but were now manifesting in a destructive manner. The adult ego-states were activated to bring those processes into conscious awareness and promote psychological stabilization. By the end of the 6-week day clinic process, cannabis levels were no longer detected in the urine, and a significant reduction in depressive symptoms was observed.

Complex phenomenological presentations require multidisciplinary, holistic, and integrative therapeutic approaches. Further evidence-based evaluations are necessary to optimize treatment outcomes for such cases.

None Declared

In the general population, the lifetime prevalence rates for obsessive-compulsive disorder (OCD) range between 1.9% and 3.3%. In patients with schizophrenia, the prevalence rates of OCD range between 7.8% and 26%. Accurate diagnosis has prognostic and treatment implications.The empirical basis regarding the optimal treatment for comorbid OCD in patients with schizophrenia is almost nonexistent.

We report a successful treatment course of intensive CBT for a patient with OCD comorbid with schizophrenia and reflect on the difficulties in the management and treatment of these cases.

We describe a case report in which OCD emerged gradually after the remission of positive symptoms of schizophrenia. The CBT involved psychoeducation, case formulation, cognitive restructuring, and exposure and response prevention.

The case is a 24-year-old male, single, with no comorbid somatic diseases. He was admitted to our psychiatric ward for self-muttering activity and delusion of thought broadcasting from the past year. A diagnosis of schizophrenia was made. We started risperidone gradually titrated to 6 mg/day. During his follow-up period, he reported having repetitive and intrusive thoughts of blasphemous nature despite well-controlled psychotic symptoms. He acknowledged these thoughts as originating in his own mind but was unable to stop them on his own accord. He also reported obsessions related to contamination and disgust. This led to compulsive hand washing and avoidance behaviour of some objects, which was both distressing and time-consuming. The diagnosis was revised to comorbid schizophrenia and OCD. Antipsychotic was changed from risperidone to amisulpride 800 mg daily in combination with paroxetine up to 60 mg/d. Since paroxetine was already optimized, the next step taken was to substitute it. He was then medicated with amisulpride, and clomipramine slowly increased up to 225 mg/d. There was no significant clinical improvement, regardless of the dose. Cognitive behavioural therapy (CBT) was commenced later. Medication was kept stable during the baseline, treatment, and follow-up period. Fourteen 1-hour sessions of CBT, including exposure and response prevention, were delivered each week over a period of 14 weeks. At the end of the intensive treatment, he reported a significant reduction in obsessions and compulsions. His score on the Y-BOCS dropped from 34 to 8 (76%) before treatment to 4-month follow-up.He reported that the decrease in OCD symptoms was associated with a significantly higher quality of life.

CBT appears to offer a valuable opportunity to reduce symptom severity in patients with OCD comorbid with schizophrenia.Further research within this field and systematic clinical evaluations are highly desirable.

None Declared

Vicarious trauma (VT) was first described by Pearlman and McCann as the therapists’ internal experience that is “impacted as a result of empathic engagement with client’s traumatic material”. (JTS 1990. 3: 131–149). Furthermore, the authors used a constructivist framework to differentiate it from other forms of secondary trauma. In the context of mental illness, family elements of VT are be more subtle than primary trauma, but can remain identifiable across generations.

The primary focus of our study was to develop a theoretical framework for understanding severe mental illness (SMI) and its traumatic long-term consequences on the family. Our secondary aim was to explore the impact of SMI and of psychiatric stigma on 2nd and 3rd generation offsprings.

To begin with we conducted a narrative review of the scientific literature using Pubmed search engine. This was followed by a qualitative study with psychiatric patients who declared a family history of SMI in a first degree relative who received medical care in France. The methodology involved conducting 11 structured interviews, which were audio recorded, transcribed and thematically analyzed.

When family trauma develops, it is a complex phenomenon, seemingly infinite loop. It further impacts every aspect of the family’s communication and relational style, attachment and regulation.

On an individual level, the consequences can be viewed as a continuum from adverse childhood experiences and primary trauma to secondary traumatic responses. This study aims to advocate for identifying specific VT subtypes. Some specific complaints are often encountered in the initial presentation of psychiatric patients, even with adults as young as 18yo. Exploring family psychiatric history through the vicarious “trauma lens”, can allow us to have a better appreciation and understanding of the patient’s suffering: their system of meaning and beliefs regarding psychiatric diagnosis, treatment and case management are often disrupted, the nocebo effect is increased (by increased sensitization to all other trauma and by modified emotion control). When the sense of safety is disturbed on a family basis multi-generational level, the consequences could lead to extreme anti-psychiatry attitudes and predict negative mental health outcomes.

Current understanding of vicarious trauma is limited to specific job-related contexts. What has not been studied yet is the vulnerability of children to vicarious trauma due to perceived traumatizing treatment, or the way in which medical stories are recounted to children. Therefore, additional research is needed on this topic. For psychiatrists, the vicarious trauma approach can be one of the key entry points to building the therapeutic alliance, which further enhances patient adherence to the treatment.

None Declared

Medical school is known for high levels of anxiety, and mental health challenges. Psychological flexibility - the ability to accept difficult thoughts and emotions while acting in alignment with one’s values- can protect against these challenges. ACT has been shown to enhance psychological flexibility and reduce mental health symptoms in various populations. However, its impact on medical students has not been extensively explored.

This study aimed to assess whether a brief ACT intervention could improve psychological flexibility and related psychological outcomes in medical students.

Forty-two medical students from Istanbul Medeniyet University participated in a four-day ACT program. Inclusion criteria included active enrollment in a medical program and willingness to participate. Exclusion criteria were severe psychiatric disorders or ongoing psychiatric treatment.The intervention involved four days of ACT-based activities, including mindfulness, cognitive defusion, and value-based exercises. Each session lasted 90 minutes and was conducted in a group format. To assess the impact of the intervention, we measured psychological flexibility and related factors at baseline and after the program using the following tools: the Multidimensional Experiential Avoidance Questionnaire (MEAQ-30), AAQ-US, SF-25, Valuing Questionnaire (VQ) and the DASS-21. Paired t-tests were used to compare pre- and post-intervention scores, with statistical significance set at p < 0.05.

The ACT intervention led to significant improvements in psychological flexibility and related factors. The ACT intervention led to significant improvements in psychological flexibility and related factors. Specifically, Distress Aversion (MEAQ-30, subscale B) decreased significantly (p = 0.010), while Distress Endurance (MEAQ-30, subscale F) increased significantly (p = 0.008). Additionally, Anxiety (DASS-A) decreased significantly (p = 0.004), and Stress (DASS-S) also decreased significantly (p = 0.004). No significant changes were observed in other subscale scores, including those for SF-36, depression (DASS-D), and scores for AAQ-US and VQ. These results suggest that ACT may be particularly effective in reducing anxiety and stress while enhancing cognitive flexibility and acceptance.

This study suggests that even a brief, four-day ACT intervention can significantly improve psychological flexibility and reduce anxiety and stress in medical students. These findings highlight ACT’s potential as an effective tool for supporting mental health and resilience in medical students. Further research with larger sample sizes and longer follow-up periods is needed to explore the long-term impact of ACT interventions in academic settings.

None Declared

Clinically insight is a multifaceted phenomenon related to acceptance of one’s condition as being psychiatrically ill, recognition of symptoms as pathological, recognition of the social consequences of illness and treatment acceptance. The common features of psychotic disorders are symptoms classified through several dimensions: positive symptoms, negative symptoms, cognitive symptoms, affective symptoms and psychomotor symptoms. These symptoms often cause impaired reality testing and poor insight. Impaired insight is common during early stage of psychosis with its prevalence ranging from around 30-50% and may cause treatment delays, more severe symptoms, poorer treatment adherence, involuntary admissions, potentially aggressive behaviour, poorer social functioning and outcomes. Insight is directly related to the severity of psychotic symptoms and inversely related to depression score. Enviromental factors such as family beliefs and stigma can influence on insight level. Considering that the first symptoms of psychosis often appear in young adulthood while the affected still live with their parents, we believe that the role of parental insight is important in recognizing the signs and treating psychosis.

Aim of this study was to investigate level of patient’s and parent’s insight into early psychosis.

We performed a cross-sectional study on 105 diads parents - children suffering from early stage of the psychotic disorders, during disease < 5 years, diagnoses from the spectrum F20-F29, both sexes, aged 18-35 years who were hospitalized at “Sveti Ivan” Psychiatry Clinic. The purpose and objectives of the research were explained to all participants, and they signed informed consent. The instruments used: sociodemographic questionnaire, The Scale to Assess Unawareness of Mental Disorder - Abbreviated version (SUMD), The Positive and Negative Syndrome scale (PANSS) – The Five factor models, Clinical Global Impression-severity scale (CGI-s). The research was conducted in accordance with Helsinki declaration.

Among the patients, the male gender is slightly more represented, with a good level of education, mostly with the F23 diagnosis, while in the group of parents, mothers are significantly more represented. On the PANSS Five Factor scale, the patients showed significant improvement in all domains. The patients were more aware of their disorder than their parents. The fathers were more aware of their children’s disorders than mothers.

The research has contributed to clarifying the complexity of the issue of insight and complex relationships between parents and children, pointing to the necessity of family psychotherapy and psychosocial interventions in the treatment of patients in the early stages of psychotic disorders.

None Declared

Borderline Personality Disorder (BPD) is characterized by abandonment schemas, impairments in emotion regulation, and attachment issues. The literature shows significant evidence that psychotherapy is effective in the treatment of BPD in addition to pharmacotherapy. The therapeutic relationship established with the patient is a crucial component of psychotherapy processes and plays a vital role in the prognosis of the disorder. Working on the therapeutic relationship is essential to maintain an effective psychotherapy process in BPD treatment. The therapeutic alliance is at the core of the treatment’s success. When a therapist takes a break from the therapy process (due to reasons such as vacation, childbirth, or loss), ruptures may form in the therapeutic relationship with patients diagnosed with BPD.

This review compiles and synthesizes findings from empirical and case studies on the effects of breaks in psychotherapy treatment for BPD patients.

PsycArticles, Web of Science, PubMed, and Google Scholar were reviewed.

Immediately following a therapy break, BPD patients often experience intense feelings of anger, anxiety, and frustration. At the same time, in the long term, this can lead to distrust in the therapist and weaken the therapeutic relationship. Moreover, acting-out behaviors tend to increase during this period. For inpatient patients, this can be observed as non-compliance with clinic rules or using verbally inappropriate expressions.This break in the therapy process activates the abandonment schema, which is a core characteristic of BPD. Patients with borderline personality organization return to the dysfunctional coping strategies they had previously developed.

These results highlight several important areas of discussion for clinical practice and research. Firstly, BPD patients should be informed about upcoming therapy breaks and prepared for the absence, and expectations should be discussed openly. Secondly, after the break, working on the therapeutic relationship, mistrust, the activated abandonment schema, and negative emotions directed toward the therapist will contribute to the healing process. Thirdly, given the risk of suicide linked to impulsivity and acting out, the therapist should develop an action plan. Fourthly, maintaining the therapeutic framework is one of the most critical steps in the recovery of BPD patients, so it is crucial to preserve the framework even during therapy breaks. Lastly, due to the gap in the literature on this subject, there is a need for more empirical studies and research on how to repair potential ruptures in the therapist-patient relationship that occur during breaks.

None Declared

As part of our comprehensive early intervention program for psychotic disorders (RIPEPP), we have been conducting psychodynamic group psychotherapy for family members since 2005. This type of therapy intended for family members of patients that are motivated for psychological work and the correction of maladaptive forms of family interactions. The 90-minute sessions are held every two weeks under the guidance of a psychiatrist – group analyst.

At the beginning of this new experience, we applied group analytical principles in the group. Due to the large drop out and specific dynamics, we gradually changed the therapeutic technique and became more flexible and supportive.

During the years of therapy, with the strengthening of group cohesion, it was gradually possible to switch again from a more flexible and supportive method to the classic group analytical technique.

In this presentation, we will show vignettes from the therapeutic process.

An overview of the need to modify the group-analytic technique in the treatment of family members of individuals with psychotic disorders.

Following the protocol of group sessions.

Over the course of the therapeutic process, the group members become more ready for group analytical work, which is adapted and applied in sessions in which they openly talk about themselves, their feelings and partner relationships. The modification of the group analytic technique is still at work with a continuously present psychodynamic understanding.

A group-analytic approach is applied in the treatment of family members of individuals with psychotic disorders. The frequent occurrence of dropouts among group members highlighted the need to modify the group-analytic technique, with the potential to revert to the classical method by strengthening group cohesion and improving family dynamics.

None Declared

Numerous studies indicate that caregivers of patients with schizophrenia experience significant burden and exhibit depressive symptoms as measured by the CES-D scale. Specific psychoeducational programs like the multifamilal CBT based Profamille program may help alleviate these symptoms. However, it is yet to be established the extent to which these caregivers meet the criteria for clinical depression as defined by the DSM-5, as well as whether the interventions employed in this program can effectively reduce the prevalence of depressive disorder among caregivers.

Assess the prevalence of major depressive disorder among caregivers at the start and end of the Profamille psychoeducational multifamily program.

Caregivers were referred to the program by family organizations, welfare services or healthcare providers, or found out about the program through the local press.

A group consists of twelve caregivers of approximately ten patients, participating in 14 structured weekly sessions of Profamille program version V3.2, each lasting 4 hours. These sessions provide information about schizophrenia, develop coping strategies for caregivers, and employ behavioral and cognitive techniques to address depressive symptoms.

Mood was assessed using the PHQ-9, a self-report questionnaire consisting of nine items aligned with diagnostic criteria for major depressive disorder. Responses were analysed using an algorithm based on DSM-5 criteria to classify participants as having or not having major depressive disorder.

Given the paired nominal data, McNemar’s test was employed for analysis

A total of 507 caregivers were recruited, including 349 women. The average age of the participants was 58.0 years (SD = 9.0). At the beginning 14.6% of participants had a diagnosis of major depressive disorder. Fourteen sessions later this rate decreased to 5.7% (McNemar’s test, p-value < 0.00001)

The annual prevalence of depression in the general population is approximately 5%, indicating a threefold over-representation among caregivers participating in the program. This rate of over-representation is consistent with other studies utilizing the CES-D, which also captures subclinical depression. Given the implications of depression for participants’ physical health, this underscores the need for systematic investigations aimed at providing support. The Profamille program, which employed specific cognitive behavioral techniques in a group setting, resulted in a significant reduction in depression rates over 14 sessions, bringing the final rates more in line with those of the general population. These findings suggest that the program effectively normalized the prevalence of depression. However, the absence of a control group limits our ability to assess the natural progression of depressive symptoms without program participation

None Declared

Schizophrenia is a major cause of severe global functional disability with negative symptoms that greatly affect functional outcomes. These symptoms are divided into expressive (e.g., facial affect and voice tone) and experiential (e.g., amotivation and asociality) dimensions.

This study assessed the effectiveness of Cognitive Behavioral Social Skills Training (CBSST) in enhancing functioning in individuals with schizophrenia. It examined the link between defeatist performance attitudes and functional changes post-CBSST.

We conducted a comprehensive search of PubMed, Embase, and Cochrane databases up to September 2024 for studies comparing CBSST with standard treatments for schizophrenia. We calculated the mean or standardized mean differences (MDs and SMD) for continuous outcomes along with 95% confidence intervals (CIs). Heterogeneity was evaluated using the I² statistics.

Our review included 7 studies with 462 patients, of whom 219 (47.4%) received CBSST. There were no significant differences between the groups regarding positive symptoms (SMD 0.19, 95% CI -1.01 to 0.64, I² = 95; Figure 1A), negative symptoms (SMD -0.84, 95% CI -1.85 to 0.17, I² = 93; Figure 1B), Depression Scale scores (SMD 0.18, 95% CI -0.20 to 0.57, I² = 62; Figure 1C), or the Independent Living Skills Scale (MD 0.05, 95% CI 0.04 to 0.06, I² = 0; Figure 2). However, the independent living skills scores were significantly lower in the control group.

Image 1:

Image 2:

CBSST is effective in enhancing functioning in individuals with schizophrenia. Along with other supportive goal-oriented interventions, it can alleviate symptom distress, boost motivation and self-esteem, and enhance life satisfaction. Individuals with severe defeatist performance attitudes may experience the greatest benefit from cognitive-behavioral approaches that target functional improvements.

None Declared

Mood in puerperium is a subject of great interest since it can undergo variations in such a significant period of a woman’s life as motherhood. It is equally true that the presence of a partner with a secure attachment style can constitute a stable base for a woman to lean and to rely, while it is more likely to hypothesize cracks in mood in absence of effective support in the relational context.

The aim of this research is to analyse the trend of puerperal mood in women in the period immediately following the delibery and after a few months. The study also examines the attachment styles of the partners of these women and the relationship between mood in women and the attachment of their partners.

The study was conducted on a sample of women and their partners.

The women were administered 2 administrations of the Edinburgh Peripartum Depression Scale (EPDS): the first within 24 hours of delivery and the second four months after delivery.

The Relationship Questionnaire (RQ) was administered to the male partners immediately after the evnt of delivery.

The data were analyzed from a statistical point of view, with analysis of variance (ANOVA) and post hoc tests.

A 2-way ANOVA with repeated measures was performed using the different attachment styles as emerged from the RQ (secure attachment and insecure attachment) in the partner group as the independent variable and the EDPS scores in the 2 times (EPDS1, EPDS2) of the women themselves as the dependent variable. The ANOVA described the main effect of Time as significant (F (1, 14) = 5.79; p < .05). The post hoc (LSD - Least Significant Difference test) highlights how there is a significant decrease in the EPDS score of women in the before-after comparison (M = 8.71 vs M = 4.93; p = .005) considering, as an independent variable, the secure attachment group of partners. While this decrease is not significant in the group of partners with insecure attachment.

The initial data of this study suggest that security in the attachment style of the partner can favor an increase in the mood of the woman after a delivery. In particular, the research data tend to highlight a significant improvement in the mood of women 4 months after giving birth. The proximity of a partner with secure attachment therefore seems to favor a good mood in the woman in pueperium.

None Declared

Wisdom is a capacity which is needed to cope with difficult situations in life. Wisdom can be trained like other capacities. Wisdom psychotherapy has been developed as a method of cognitive behavior therapy to help patients who are stuck in negative life experiences, or confronted with unsolvabale dilemmas.

Test the efficacy of wisdom psychotherapy in patients with adjustment disorders.

patients with adjustment disorders (>18 on the ADNM8 scale) were randomly assigned to group wisdom therapy (WT: N=114), or group behavioral activation therapy (BA: N=109). Additionally a matched group of patients was build, which were not included in any study procedures but underwent routine treatment only (RT: N=114). Wisdom was measured with the Multidimensional Wisdom Competency Scale (MWC15).

There was an increase on the MWC15 of 5.3 in the wisdom group as compared to 0.4 in the activation group and 0,2 in the routine group. This is statically sigificant in the pre-post comparison and in the time/goup interaction (F4,42, p=0,13). The ADNM8 score, the SCL90 GSI, the BDI score decreased, with a trend for more side effects in the wisdom than the activity group.

The results confirm that wisdom psychotherapy can make a difference in the improvement of wisdom capacities. Wisdom therapy, different from other psychotherapies, does not aim at increasing hedonic or symptom free wellbeing but rather eudaimonic wellbeing in order to teach patients to live a decent and successful life.

None Declared

Some people with a diagnosis of psychosis wish to minimize or avoid medications. A literture exists that intensive psychosocial treatment can mitigate psychotic symptoms with lilttle or no medication being used.

We provided services to people who wishers to reduce or avoid medications within the context of a private psychiatric practice and wanted to assess their outcomes. We wondered what factors led to success.

We report on a series of 62 patients, age 18 years or older, who engaged in psychotherapy, medication, and lifestyle management over at least six months, aiming to minimize or eliminate medication. An additional 217 patients who consulted us did not continue for six months. An anonymous, matched comparison group of 62 patients of the same age, socioeconomic status, diagnosis, and severity of illness was generated from electronic health records at another clinic where LMM also worked. We used the Brief Psychiatric Rating Scale, the Positive and Negative Symptom Scale, the MADRS depression scales, and the Clinical Global Inventory. Narrative interviews generated qualitative data. We compared patients who met their goals to those who did not.

Forty-one people eliminated medication. Another 16 managed well on low-dose medications. Five patients had psychotic episodes that led them to return to higher levels of medication. This group functioned at higher levels than the comparison population with much lower doses of medications. The five readmissions to hospital were signnificantly lower than the number of readmissions in the comparison and the control groups. The cost for one year of care was higher for our people; the costs over subsequent years were less related to fewer hospitalizations, crises, and diminished suicidality.

The results suggest the need for individualized client-centered psychosocial approaches that build upon the person’s previous successes, enroll family and friends in a community effort, and collaborate with those communities to apply those approaches desired by the people themselves. In this dialogical approach to psychosis, lived experience is granted full ontological reality, which appears to facilitate recovery. Lifestyle management and embeddedness in a community facilitate recovery.

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It was demonstrated in the number of studies that patients with bipolar affective disorder (BD) at the initial stage of the disease are characterized by the high level of self-stigmatization (Latalova K., Kamaradova D., Prasko J., 2014; Solokhina T.A., Oshevsky D.S., Barkhatova A.N., et al., 2023). However, relationship of patients’ self-stigmatization with their psychopathological symptoms wasn’t analyzed, what determined the theoretical and practical significance of our study.

To reveal correlations between psychopathological symptoms and self-stigmatization of patients with BD at the initial stage of the disease and to work out the integrated approach to their psychosocial treatment.

Questionnaire for assessing the phenomenon of self-stigmatization of mentally ill people (Mikhailova et al., 2005), SCL-90-R were used. A group of 17 patients (12 women and 5 men) with diagnosis of bipolar affective disorder (BD, F31.xxx according to ICD-10) was examined. The average age of the patients was 25.52±4.55 years. The duration of the disorder varied within 0.5 -3 years.

Patients with BD demonstrated high overall level of self-stigmatization (1.22±0.73 points). This parameter was significantly higher than average values. As a result of correlation analysis, multiple dependable (p<0.01) moderate relationships between SCL-90-R indicators and parameters of several scales of the self-stigmatization questionnaire were established. So, perception of changes associated with the disease as irreversible, depriving opportunities in various spheres of life (scales «Overestimation of self-realization», «Overestimation of internal activity») leaded to somatization of patients and the formation of hypochondriac experiences (SOM, r=0.58 and r=0.54, respectively). In turn, this reduces self-esteem and causes an increase in the overall level of experienced distress (GSI, r=0.61 and r=0.53, respectively). Self-doubt, the expectation of a negative attitude towards oneself (the scale «De-identification from others in the social sphere») leads to increased anxiety (ANX, r=0.64), hostility (HOS, r=0.53), vulnerability in communication and restriction of social contacts (INT, r=0.51).

The obtained results permitted to work out proposals on psychosocial treatment of patients with BD at the initial stage of the disease. It is necessary to carry out psychoeducation programs as well as trainings aimed at forming a positive self-perception, activating personal resources, increasing communicative competence and maintaining social interaction.

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In Kyrgyzstan and other Central Asian countries, there has been a surge in advertisements for psychological services from underqualified practitioners. These individuals, often with only short-term training, market themselves as professionals while the cost of their services has risen dramatically. Vulnerable populations may be exploited financially without receiving effective care, leading to worsened outcomes.

This paper explores how the rise in underqualified practitioners and unchecked price increases for psychological services in Kyrgyzstan lead to harmful mental health outcomes. It also compares the regulatory frameworks in neighboring countries, highlighting Kazakhstan’s more structured approach.

This study utilizes a comparative analysis of the regulatory frameworks for psychological services in Kyrgyzstan, Tajikistan, Uzbekistan, and Kazakhstan. Data is sourced from governmental reports, academic studies, and analyses of online advertisements for psychological services. The focus is on licensing systems, training requirements, and the impact of rising consultation prices.

Kyrgyzstan, Tajikistan, and Uzbekistan lack adequate regulatory systems for licensing psychologists. The surge in online advertisements by underqualified practitioners has flooded the market, with many offering their services at increasingly inflated rates. These individuals often charge exorbitant prices while lacking the proper training, exacerbating mental health challenges for vulnerable populations. In contrast, Kazakhstan has introduced a structured National Qualifications Framework (SQF), which ensures that psychological services are provided by properly trained and certified professionals.

The unchecked rise of advertisements by unqualified therapists and the unlimited escalation of consultation fees in Kyrgyzstan and neighboring countries pose serious risks to public mental health. Without proper licensing and price regulation, individuals seeking help may face harmful consequences. Adopting a regulatory system similar to Kazakhstan’s, with strict licensing and certification requirements, would help ensure that psychological services are both safe and affordable. Such reforms are essential to protect the public from the exploitation and risks posed by untrained “therapists.”

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Supervision is recognized as having a vital role in the professional development of psychotherapists. The way it is implemented has a direct impact on the quality of the educator’s learning process, as well as on the quality of psychotherapy provided to clients. Supervision is a complex and dynamic practice, requiring supervisors to conceptualize the thoughts, feelings and behavior of their educators and the educator’s clients, as well as selective attention to the complexly layered interpersonal dynamics between clients, educators and themselves.

Emphasizing the possibility of the appearance of difficulties and their aspects and increasing awareness of these concepts can greatly help supervisors and educators in the formation of ways and approaches that can facilitate better communication and the formation of a more professional relationship as significantly influencing the main result of the quality of psychotherapy and the process of professional development.

During the training of mental health professionals, it is crucial to ensure that the supervision process is carried out according to a legal, ethical and competent approach, such as informed consent and a supervision contract, and it is necessary to take into account elements such as supervisor and educator competencies, awareness of the challenges of diversity and multiculturalism, personal and professional boundaries, multiple contexts of relationship between supervisor and educator, evaluation and feedback. Through the supervisor’s dilemmas, ambiguities in the perceptions of supervision educators, success is reflected through the analysis of personal contribution, of unconscious interpersonal and developmental dynamics, and access to one’s own limits.

The importance of clinical supervision is evidently recognized by almost all licensing boards and accrediting bodies for the mental health professions, requiring that educators receive psychotherapeutic, clinical supervision as part of their training, and ongoing supervision is often necessary to maintain professional licensure. An integrative approach of incorporating innovative research results, as well as consolidating them with already established factors, is key in leading psychotherapeutic training, research, supervision, as well as the client’s treatment itself towards increased effectiveness. A significant contribution to the literature would be enabled by future research dealing with issues of difficulties in supervision through the prism of educators.

This paper focuses on understanding the significance of the supervision process thorugh the theoretical perspective, approaching the concept of difficulties by the prism of supervisors and educators, and the practical implications of successful supervision.

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