People living with schizophrenia (PLWS) face one of the most significant health equality gaps in Europe. Their life expectancy is 15–20 years shorter than that of the general population, mainly because they are affected at an earlier age by preventable physical illnesses, but encounter barriers in accessing adequate care. PLWS did not benefit from prevention campaigns for cardiovascular, oncologic, or metabolic risk. Antipsychotics might add to the cardiometabolic risk and represent a further reason for monitoring and treating emergent conditions. Notwithstanding international guidance papers or national guidelines, PLWS do not receive adequate screening and treatment.

This presentation will summarize national and international efforts to reduce this health equality gap, illustrating the minimum screening procedures and several interventions that can be integrated into schizophrenia treatment to improve health outcomes of PLWS.

A. Mucci Consultant of: Angelini, Gedeon. Richter Bulgaria, Janssen Pharmaceuticals, Lundbeck, Otsuka Pharmaceutical, Pfizer, Pierre Fabre, Rovi. Pharma and Boehringer Ingelheim

Epigenetic mechanisms might play a role in modulating susceptibility to bipolar disorder (BD) and response to lithium, the mainstay treatment for BD. Additionally, individuals with BD experience accelerated biological aging.

We compared blood DNA methylation profiles measured with EPIC v.2.0 arrays between patients with BD (33 lithium responders and 31 nonresponders) and nonpsychiatric controls (n = 32), as well as based on long-term lithium response. In addition, we compared cellular aging between these groups using epigenetic age, pace of aging, and, for the first time, transcriptional age acceleration based on bulk RNA sequencing in 93 patients and 56 controls.

We identified 191 differentially methylated positions (DMPs) and 8 differentially methylated regions between patients with BD and controls, located in genes enriched for “Postsynaptic Density” (odds ratio = 6.81, p = 0.001). No DMP was significantly associated with lithium response after multiple testing correction. Patients showed a significantly higher biological age acceleration than controls based on two epigenetic clocks (GrimAge, Mann–Whitney U = 551, p = 0.0009; GrimAge2: U = 477, p = 9.0E-05) and pace of aging (DunedinPACE, t = 3.01, p = 0.003), but not on transcriptional age. While we observed no significant difference in epigenetic aging based on lithium response, lithium responders showed lower epigenetic acceleration using all clocks, with a trend observed using the PhenoAge clock (t = 1.97, p = 0.053).

Our findings point to methylation patterns characterizing BD and support the hypothesis of accelerated cellular aging in BD.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked genetic enzymopathy that impacts 4.9% of the population, with greater prevalence among Mediterranean, East Asian, and African populations. G6PD deficiency results in levels of nicotinamide-adenine dinucleotide phosphate (NADPH) and glutathione (GSH) that are insufficient for maintaining the balance of oxidation-reduction in the body. This results in elevated production of reactive oxygen species (ROS), oxidative stress on proteins and lipids, damage to DNA, and potential activation of chemokine and cytokine pathways by astrocytes and microglia. We propose that these direct and indirect effects of G6PD deficiency are associated with development of ADHD.

This study investigated the association between G6PD deficiency and Attention Deficit/Hyperactivity Disorder (ADHD).

The study involved 7,473 G6PD-deficient patients and 29,892 matched case-controls (selected at a 1:4 ratio) from a cohort of 1,031,354 within the Leumit Health Services database. Clinical characteristics were analyzed using Fisher’s Exact Tests for categorical variables and Mann-Whitney U tests for continuous variables.

The average age of patients was 29.2 ± 22.3 years, with 68.7% being male. The mean follow-up duration was 14.3 ± 6.2 years. Individuals with G6PD deficiency showed a significant 16% higher risk of being diagnosed with ADHD (Odds Ratio (OR) = 1.16 [95% CI, 1.08-1.25], p < 0.001) on follow up. Furthermore, G6PD deficiency was associated with a 30% greater likelihood of seeking care from adult neurologists (OR = 1.30 [95% CI, 1.22-1.38], p < 0.001) and a 12% higher probability of consulting adult psychiatrists (OR = 1.12 [95% CI, 1.01-1.24], p = 0.048). The use of stimulant medications among G6PD deficient individuals was 17% higher for methylphenidate class drugs (OR = 1.17 [95% CI, 1.08, 1.27], p < 0.001), and use of amphetamines elevated by 16% (OR = 1.16 [95% CI, 1.03, 1.37], p = 0.047).

This study establishes a significant association between G6PD deficiency and an increased risk of ADHD diagnoses. These findings suggest potential opportunities for the development of culturally sensitive interventions.

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International migration is a complex phenomenon of global and historical relevance. It includes voluntary, forced, and workforce migration, shaped by diverse determinants. Push factors comprise war, persecution, and political instability, while pull factors include stability, economic opportunities, education, and favorable living conditions. Forced migration is frequently associated with displacement and a disproportionate burden of mental health disorders, which are urgent yet difficult to address due to structural, cultural, and legal barriers.

Evidence demonstrates that restricted health care access exacerbates psychiatric disorders, while treatment delays contribute to poorer outcomes. Barriers include administrative limitations, linguistic and cultural differences, stigma, and resource shortages. This policy paper was developed by the Committee on Ethics and the Task Force on Migration and Mental Health of the European Psychiatric Association (EPA). Relevant literature was reviewed and combined with the professional expertise of committee members. The draft was subsequently evaluated by the Publication Committee and the EPA Board, and revised accordingly.

Ethical principles in refugee care are insufficiently implemented in many European countries. Core principles of medical ethics – beneficence, respect for autonomy, non-maleficence, and justice – as well as the obligation to advance psychiatric standards and apply psychiatric expertise for societal benefit, are inconsistently upheld.

The primary duty of physicians is to promote health and well-being through competent, timely, and compassionate care. The EPA therefore advocates coordinated strategies to mitigate the mental health consequences of war, displacement, and trauma, and to secure equitable access to psychiatric services for migrants and refugees.

Jonathan will present the impacts of smoking on physical and mental health, the impact of smoking cessation on mental health and the need to reduce doses of some psychotropic medications after cessation in order to prevent toxicity. He will set out the low population coverage of evidence-based interventions for smoking cessation and prevention uptake particularly for people with mental health conditions, and the reasons for this. He will then outline implementable opportunities to scale up coordinated coverage of interventions by different sectors

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Schizophrenia is a chronic severe mental illness affecting 24-million people globally, associated with a life expectancy 15 years shorter than the general population. Approximately 70% of people with schizophrenia experience auditory verbal hallucinations (AVHs), i.e. ‘hearing voices’. Current treatment approaches remain unsuccessful in up to 30% of cases.

This systematic review and meta-analysis evaluated randomised controlled trials (RCTs) of non-pharmacological treatments for AVHs in schizophrenia spectrum disorders, assessing emerging treatment effectiveness and identifying research gaps.

A literature search was performed between 2013-2024 across five databases: PubMed, Embase, PsycINFO, Medline, and Web of Science. The meta-analysis included 45 studies based on predefined criteria and bias assessment. Effect sizes (Hedge’s g) were calculated using a random effects model with 95% confidence intervals. The study followed PRISMA guidelines and was pre-registered (PROSPERO ID: CRD42024598615).

Our sample included 2,314 patients and fourteen interventions. The overall mean effect size was -0.298 (95% CI, [-0.470, -0.126]), representing a medium, statistically significant effect. Subgroup analyses revealed medium, statistically significant effects for both AVATAR therapy and cognitive behavioural therapy (CBT). Conversely, repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) showed small, non-significant effects.

AVATAR therapy has the strongest evidence for treating AVHs, highlighting the need for large-scale RCTs and integration into treatment guidelines. CBT requires methodological standardisation. Acceptance and commitment therapy shows promise but needs further high-quality RCTs. Non-invasive brain stimulation techniques require additional trials before clinical implementation.

Jonathan will begin by outlining the impact of mental disorder and wellbeing. He will summarise effective public mental health interventions to treat mental disorder, prevent associated impacts, prevent mental disorder, and promote mental wellbeing and resilience. He will outline the scale of implementation failure of such interventions and the reasons for this. He will then set out required actions and real-world solutions to support scale implementation of public mental health interventions leading to sustainable reduction of the impact of mental disorder and the promotion of mental wellbeing.

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Clinical response and remission may not fully reflect patient priorities in treatment-resistant depression (TRD). Health-related quality-of-life (HRQoL) outcomes should be assessed to comprehensively capture treatment benefits.

ESCAPE-TRD (NCT04338321) was a 32-week randomized, phase IIIb trial comparing esketamine nasal spray (NS) versus quetiapine extended release (XR), both alongside an ongoing selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitor, in patients with TRD. Symptom and HRQoL improvements were assessed using the Patient Health Questionnaire-9 (PHQ-9), 36-Item Short Form Survey (SF-36), Quality of Life in Depression Scale (QLDS), and EuroQoL 5-Dimension 5-Level (EQ-5D-5L) measures.

Esketamine NS-treated patients (N=336) reached PHQ-9 remission (score ≤4) quicker than quetiapine XR-treated patients (N=340), and more had remission by Week 32 (34.5% vs. 18.2%; odds ratio [OR]: 2.39 [1.67, 3.41], p<0.0001). “Role Emotional”, “Mental Health”, and “Social Functioning” SF-36 domains showed significantly greater improvements in esketamine NS-treated patients compared with quetiapine XR-treated patients at Week 32 (p<0.05), returning to levels close to general population norms. More esketamine NS-treated patients had a meaningful improvement in their QLDS score by Week 32 (60.7% vs. 41.8%; OR: 2.16 [1.59, 2.94], p<0.0001), and reached this improvement quicker than quetiapine XR-treated patients. Proportions of patients reporting an EQ-5D-5L score of 1 (no problems) were significantly higher across all domains with esketamine NS versus quetiapine XR at Week 32 (p<0.05).

Esketamine NS produced superior improvements in HRQoL compared with quetiapine XR, indicating positive impacts on aspects of patients’ lives that matter to them, alongside clinical symptoms of TRD.

Esketamine has been shown to produce a major antidepressant response in patients with treatment-resistant depression (TRD). We evaluated the factors associated with achieving remission in these individuals.

The study was carried out across four psychiatry departments in Madrid, Spain. Patients aged over 18 years were included if they received esketamine as an augmentation treatment for TRD. Standard esketamine protocol included an induction phase (4 weeks) and a maintenance phase (5 to 8 weeks). Subsequent treatment continuation was proposed. Clinical data and scores at the Clinical Global Impression scales were measured following each esketamine administration.

Sixty-five patients initiated the treatment, and 45 patients (69.2%) completed the standard protocol. The median number of esketamine administrations was 19. The mean age was 53.09 and 52.3% of the patients were females. Out of the whole sample, 36 (55%) of the patients achieved remission over the follow-up. Remission rates elevated to 67% in those who completed the standard protocol, and to 70% in those having received more than 19 esketamine administrations. Achieving remission over the follow-up was associated with the absence of dissociative symptoms, and with completing the standard esketamine protocol (OR = 0.229, p = 0.045; and OR = 4.538, p = 0.025, respectively). Receiving more than 19 esketamine administrations was associated with remission over the follow-up (OR = 6.513, p = 0.006).

Our results suggest that extending the numbers of esketamine administration may increase the chances to obtain remission. Adverse effects did not impact the treatment course.

Emerging research reveals a striking overlap between ADHD, hypermobility syndromes, immune dysfunction, and autonomic dysregulation. Studies suggest that approximately half of individuals with ADHD are hypermobile, while ADHD is significantly over-represented in those with hypermobility syndromes, such as Hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorder (HSD). Unlike benign joint hypermobility, these syndromes involve multisystem pathology, often accompanied by dysautonomia (e.g., postural orthostatic tachycardia syndrome, POTS), mast cell activation disease (MCAD), and autoimmune conditions.

This ‘somatic super-syndrome’ encompasses many of ADHD’s under-recognised somatic comorbidities, including hypermobility, allergy and autoimmunity, POTS, fatigue and pain syndromes (Chronic Fatigue Syndrome and Fibromyalgia Syndrome), and sensory processing issues, amongst others. A small but growing body of evidence suggests that mast cells - ‘first responder’ immune cells involved in allergic and inflammatory responses - play a critical role in neurocognitive function and that their excessive activation has been associated with a range of neurological and psychiatric/neurodevelopmental conditions. Could a similar issue with aberrant mast cell activation be contributing to the pathophysiology of ADHD.

Dr. James Kustow, consultant psychiatrist and adult ADHD specialist, will present the latest insights into this complex interplay between connective tissue dysfunction, chronic low-level inflammation, and autonomic dysregulation. He will explore how these factors may, in some, drive an ADHD-like syndrome and discuss emerging research on neuroimmune mechanisms linking ADHD with inflammatory disorders such as infections, asthma, rhinitis, and food allergies.

By illuminating these connections and reviewing the available evidence, this presentation will encourage a broader, integrative approach to understanding and managing ADHD. It will also consider how future research might inform novel therapeutic strategies targeting immune dysregulation and autonomic dysfunction in ADHD.

J. Kustow Consultant of: I have done some consultancy work for a couple of pharmaceutical companies but not for over 3 years, Speakers bureau of: I have previously spoken at and chaired events organised by pharmaceutical companies (but I dont speak on the subject of ADHD medication).

Artificial Intelligence (AI) is revolutionizing the field of psychotherapy by introducing innovative, accessible, and efficient methods for mental health care. AI-based psychotherapy practices leverage machine learning algorithms, natural language processing (NLP), and predictive analytics to provide personalized therapeutic interventions, support mental health practitioners, and enhance patient outcomes. These systems, including virtual therapists and chatbot platforms, are designed to simulate human empathy, analyze user inputs, and deliver evidence-based therapeutic techniques such as cognitive-behavioral therapy (CBT).

Moreover, AI systems assist clinicians by offering diagnostic support, monitoring patient progress through behavioral data analysis, and optimizing treatment plans. The integration of AI into psychotherapy practices has shown promise in addressing barriers such as stigma, geographic limitations, and therapist shortages. However, ethical challenges related to data privacy, algorithmic bias, and the therapeutic efficacy of AI-driven interactions remain significant concerns. This abstract explores the potential, applications, and limitations of AI-based psychotherapy, emphasizing the need for rigorous research and ethical considerations to ensure its effective and responsible integration into mental health care.

None Declared

This presentation explores the intersection of psychotherapy interventions and AI, focusing on how AI can be leveraged to augment traditional therapeutic methods. AI-powered tools such as chatbots, virtual therapists, and predictive analytics will be covered. Additionally, the talk will address the ethical implications, challenges, and opportunities posed by the use of AI in mental health care, emphasizing the importance of maintaining the human element in therapy. Drawing on current research and case studies, possible opportunities of AI assisted therapists in identifying patterns in patient behavior, improving treatment efficacy, and reducing barriers to mental health care, especially in underserved populations will be explored. The presentation will conclude with a forward-looking perspective on how AI and psychotherapy can collaboratively evolve to shape the future of mental health care.

Artificial Intelligence, Psychotherapy, Mental Health, Chatbots, Virtual Therapy, Ethical Considerations, Personalized Treatment.

None Declared

Artificial intelligence (AI) tools have gained attention for their potential to transform mental health care. However, in the context of psychotherapy, these tools reveal fundamental limitations that warrant critical analysis.

Psychotherapy is deeply rooted in relational dynamics, cultural sensitivity, and the ability to engage with the complex emotional landscapes of individuals. Current AI-based tools often struggle to address these dimensions adequately. While language models can generate coherent and seemingly empathetic responses, their inability to genuinely understand and respond to nuanced human emotions and interpersonal subtleties presents a significant barrier (Floridi & Chiriatti, 2020).

Ethical concerns also pose considerable challenges. The use of AI in psychotherapy raises questions about data privacy, algorithmic transparency, and the potential perpetuation of biases within AI systems. Such issues not only risk undermining the therapeutic process but may also erode trust in these technologies.

The therapeutic alliance—a critical factor in psychotherapy—represents another area of concern. Effective therapy relies heavily on building trust, mutual understanding, and a genuine connection, all of which are difficult to replicate with AI-based tools. Current research suggests that while AI can support certain therapeutic tasks, its capacity to maintain and enhance the therapeutic alliance remains unproven (Linardon et al., 2019).

This presentation will critically examine these limitations through case-based discussions and clinical reflections. By highlighting the inherent challenges of integrating AI into psychotherapy, it aims to encourage thoughtful and cautious exploration of its applications, emphasizing the importance of preserving the relational and ethical foundations of psychotherapeutic practice.

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Starting medication for attention deficit and hyperactivity disorder (ADHD) in adults begins with a thorough evaluation. Diagnostic evaluation should involve a careful investigation of the psychiatric and medical comorbidities and an interview with the patient and family members or partners. The next step is to assess the severity of ADHD symptoms, comorbidities and their impact on functioning. This will help guide the order in which targeted treatments are introduced. When selecting the medication, considerations such as the presentation of ADHD symptoms, the patient’s medical history, previous responses to ADHD treatments, and preferences about the effect onset are crucial. This choice typically lies between stimulant and non-stimulant options. The initial dose prescribed should be low enough to mitigate potential side effects while still effectively alleviating symptoms and gradually improving functioning. Treating comorbid psychiatric disorders, such as depression, anxiety, and substance use disorders, is equally important alongside ADHD treatment. The dosage should be slowly adjusted based on the patient’s response and any side effects that arise. Regular follow-up appointments are essential during this phase to monitor the medication’s effectiveness, identify side effects, and make necessary dosage adjustments. Dr Ozge Kilic will discuss key tips related to assessment, medication selection, titration, adjusting dosages, and managing side effects through clinical case vignettes.

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

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

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

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

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

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Psychiatrist working with ADHD-patients since 2007.

I have diagnosed and treated more than a 1000 patients with ADHD. I have always, when it has been possible, given one medication at a time to be able to evaluate how it works, and what gives side effects.

When stimulants suddenly don’t work anymore, I have searched for physical and psychological problems that could explain it. By solving these problems, the stimulants work again.

By working this way, we have noticed that patients have a high compliance, and there are a lot less cases of relapse with ADHD symptoms.

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The management of elderly patients receiving polypharmacy presents significant clinical challenges due to age-related physiological changes, the prevalence of chronic conditions, and the potential for drug-drug interactions and adverse drug reactions (ADRs). Blood level assessments of medications provide a critical tool for optimizing pharmacotherapy in this population. Here we present the benefits of therapeutic drug monitoring (TDM) and pharmacokinetic assessments in the personalized management of elderly patients with polypharmacy. Regular monitoring of blood drug concentrations can identify drug-drug interactions, related toxicity risks, and adherence issues, thereby informing dosage adjustments to achieve optimal therapeutic outcomes.

G. Schoretsanitis Consultant of: Dexcel, Saladax, HLS Therapeutics, Speakers bureau of: Saladax, HLS Therapeutics, Lundbeck, Thermo Fisher.

The pharmacological effect is the result of both pharmacokinetic (e.g., how the body affects the medication) and pharmacodynamic (e.g., how the medication affects the body) processes occurring simultaneously. Pharmacokinetics includes the processes of liberation, absorption, distribution, metabolism, and elimination (LADME). These processes govern the steady-state plasma concentration (Css). Therapeutic drug monitoring (TDM) is a pharmacological tool used to select and adjust medications. TDM enables Css measurements and dose adjustment calculations. In this presentation, the presenter will cover the main pharmacokinetic issues related to TDM in this clinical case, including Css determination, therapeutic range, dose adjustment, and pharmacokinetic calculations. Participants will learn the fundamental pharmacokinetic aspects necessary for understanding the case.

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Although still somewhat reluctantly used (and thus underutilized) by many clinicians, it is the well-evidenced fact that clozapine is an effective drug for treatment-resistant schizophrenia. In order to optimize its therapeutic potential and to minimize side effects, therapeutic drug monitoring (TDM) of plasma clozapine and N-desmethylclozapine is an essential clinical tool. TDM can also help to reveal insufficient adherence or individual differences in the rates of metabolism. Moreover, clozapine plasma levels can be affected by other factor, such as smoking or concomitant medication (fluvoxamine). In our study sample, we were able to demonstrate the relationship between the dosage and clozapine plasma levels and their impact on clinical efficacy and safety.

None Declared

Therapeutic Drug Monitoring (TDM) plays a crucial role in optimizing treatment for patients with psychiatric disorders and comorbid medical conditions, particularly in the elderly. This talk will focus on the practical application of TDM in managing polypharmacy and drug-drug interactions in a geriatric patient with mood disorders. Using a case-based approach, the discussion will highlight how TDM can guide dose adjustments, improve treatment efficacy, and minimize adverse effects in patients with multiple comorbidities.

Emphasizing real-world clinical challenges, this session will provide practical insights into integrating TDM into psychiatric practice, ensuring safer and more effective pharmacotherapy. Audience interaction will be encouraged through live voting and discussion to enhance learning and application in daily clinical settings.

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