A variety of treatment options for people with alcohol use disorder (AUD) exist. Surveys estimate that 1 in 10 people with AUD utilise treatment, but real-world treatment pathways remain covert. This data-linkage study seeks to characterise treatment utilisation patterns to identify gaps in treatment access and delivery in Germany.

Linking individual-level data from three sources (statutory health insurance, pension funds, outpatient addiction care services) identified seven alcohol-related treatment types delivered in outpatient (brief psychiatric consultation; formal psychotherapy; pharmacotherapy; low-threshold counselling), inpatient (standard, somatic inpatient treatment; intensive inpatient treatment with somatic and psychosocial care), or either of the two settings (long-term rehabilitation treatment) during 2016–2021. For patients with a new AUD diagnosis (ICD-10: F10.1–9), treatment utilisation over 24 months was recorded and patterns were identified using latent class analyses.

Of n = 9,491 patients with a new AUD diagnosis, 30% utilised at least one alcohol-related treatment type. Treatment utilisation was associated with younger age, female sex, unemployment, German nationality, and lower physical comorbidity. Among treatment entrants, nearly half received only brief psychiatric consultation. A similar share of patients utilised standard or intensive inpatient treatment; the latter occasionally followed by rehabilitation treatment. Formal psychotherapy, low-threshold counselling, and pharmacotherapy were rarely utilised and were mostly used in conjunction with other treatments.

The real-world utilisation of alcohol-related treatments contrasts with existing guidelines, as most patients with diagnosed AUD do not receive adequate care. Structural and social barriers should be minimised to ensure healthcare provision for those affected.

Measuring biology is considered the cornerstone of diagnosis in medicine. For example, we have blood tests to diagnose auto-immune diseases, such as rheumatoid arthritis or lupus. Also, cancer patients with, for example, colon cancer, will receive personalized treatments following biomarker diagnostics of their tumor. In contrast, current classification methodologies for mental disorders are based on signs and symptoms. These classification systems provide a uniform language to assess psychiatric and neurological disorders across the globe. Clinicians use these diagnoses to communicate with their patients and with other clinicians, and to request, when applicable, reimbursement from payers. Unfortunately, currently available psychotherapies and pharmacotherapies work only in a small proportion of patients within these diagnostic categories. This clinical heterogeneity in treatment response within diagnostic categories is likely explained by biological variation between patients that is not being accounted for in the current classification system for mental disorders. In addition, there is transdiagnostic overlap allowing for novel opportunities to develop innovative quantitative biological endpoints and treatments beyond the current diagnostic framework. The European College of Neuropsychopharmacology (ECNP) New Frontiers meeting 2024 addressed these issues, and indicated a high need for a biology-informed framework to establish more precise diagnosis and treatment for mental disorders. The ECNP, following the 2024 New Frontiers Meeting, is coordinating a global initiative to design and implement a Precision Psychiatry Roadmap. By mobilizing resources and harmonizing translational methodologies and datasets, the aim is to discuss, design, and implement an iterative framework that incorporates biology-informed evidence into symptom-based syndromes, allowing for more discovery and implementation of mechanism-based effective treatments for mental disorders.

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The U.S. National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC) offers a framework to facilitate clinical research for psychopathology. Unique features include an emphasis on transdiagnostic dimensions spanning normal and abnormal ranges of function, novel independent variables (mechanisms, not diagnoses), and the integration of different kinds of observations (neural, psychological, self-report). In this talk, principles and pragmatics of RDoC approach are illustrated with examples from RDoC-framed clinical research, and the clinical significance is discussed.

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Treatment-resistant depression (TRD) affects 10–30% of patients with major depressive disorder, leading to increased comorbidities, higher mortality, and significant economic and social burdens. This study aimed to compare the efficacy and safety of bupropion and aripiprazole as augmentation therapies for TRD.

This population-based, retrospective cohort study included adults aged ≥18 years with a diagnosis of depressive disorder who met the criteria for TRD. Data were collected from a nationwide claims database in South Korea. Patients prescribed bupropion were matched 1:1 with those prescribed aripiprazole. Subgroup analyses were performed according to age. An as-treated analysis was performed as the primary analysis, and an intention-to-treat analysis was performed to identify different risk windows. The primary outcome was depression-related hospitalization, and the secondary outcomes were first-time diagnoses of movement disorder and seizure.

A total of 5,619 patients (bupropion: n = 1,568; aripiprazole: n = 4,051) were included in this study. Bupropion was associated with lower risks of hospitalization (hazard ratio [HR]: 0.51; 95% confidence interval [CI] 0.29–0.86) and movement disorders (HR: 0.56; 95% CI 0.36–0.85) than aripiprazole. No significant difference in seizure risk (HR: 0.65; 95% CI 0.30–1.31) was observed between the two treatments. The subgroup analysis of participants aged ≥60 years revealed no significant differences in the three outcomes between the two medications.

Bupropion augmentation is associated with a significantly lower risk of depression-related re-hospitalization and movement disorders in patients with TRD. Therefore, bupropion augmentation can be a comprehensive treatment strategy for TRD.

Suicide and self-harming behaviors represent significant public health challenges across Europe, with profound implications for individuals, families, and communities. This presentation aims to explore current trends in suicide and self-harm, highlighting variations across different European countries and demographic groups. Recent data indicate a concerning rise in self-harming behaviors, particularly among adolescents and young adults, often linked to factors such as mental health disorders, social isolation, and the impact of the COVID-19 pandemic. Furthermore, the stigma surrounding mental health issues continues to hinder open discussions and access to care, exacerbating the problem.Looking ahead, this presentation will propose future directions for research and practice, advocating for a multidisciplinary approach that integrates psychological, social, and medical perspectives. By fostering collaboration among healthcare providers, policymakers, and community organizations, we can enhance our understanding of suicide and self-harm, ultimately leading to more effective prevention and intervention strategies. This session aims to stimulate dialogue and inspire innovative solutions to address these pressing issues in Europe, promoting mental well-being and reducing the incidence of suicide and self-harming behaviors.

P. Saiz Grant / Research support from: “laCaixa” Foundation, Government of the Principality of Asturias, Instituto de Salud Carlos III, Consultant of: Angelini Pharma, Ethypharm Digital Therapy, Johnson & Johnson, Rovi, and Viatris España.

Many psychiatric and somatic comorbidities increase the risk of suicidal behavior, but the effect of co-existing comorbidities is sparsely elucidated. We described co-existence of psychiatric and somatic comorbidities and the influence of the combined comorbidity burden on the risk of suicidal behavior.

We defined two case populations above 10 years in the Danish health registries: those who 1) died by suicide (2010–2020) and 2) had an incident suicide attempt (2010–2021). Co-existing somatic and psychiatric comorbidities and relative odds of suicidal behavior at increasing comorbidity burden were assessed.

Among 5.9 million Danish citizens (2021), 6,257 individuals died by suicide whereas 30,570 had an incident suicide attempt. More than half had ≥2 co-existing psychiatric and/or somatic comorbidities. Of those who died by suicide, 18% had co-existing mood disorders and stress disorders, while 5% had both mood disorders and cancer. An 88-fold increase of odds for attempting suicide and a 35-fold increase of odds for suicide were observed among those with the highest combined burden of somatic and psychiatric comorbidities relative to those without. The presence of somatic comorbidities seemed to protect against suicide in older individuals.

Psychiatric and somatic comorbidities commonly co-exist in individuals with suicidal behavior. Higher combined burden of psychiatric and somatic comorbidities increased the odds of suicidal behavior, though the presence of somatic diseases had a potential protective effect on the risk of suicide in older individuals. This warrants collaboration and enhanced awareness of suicidal behavior risks across somatic and psychiatric departments.

Youth mental health is under significant strain, with long-lasting impacts on European citizens and societies. Alleviating this burden requires a preventive approach. We will review current preventive strategies for youth mental health, including school-based universal, selective, and indicated primary prevention interventions. Additionally, we will discuss novel care systems for youth mental health currently available across Europe and their potential for implementation in various settings.

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Childhood maltreatment (CM) significantly increases the risk of developing post-traumatic stress disorder (PTSD) for which the prevalence in Europe is higher than initially assumed. While the high economic burden of PTSD is well-documented, little is known about the health care cost differences between individuals with PTSD-CM and those without PTSD in Germany. This study aimed to determine the excess health care and absenteeism costs associated with PTSD-CM in Germany.

Baseline data from a multi-center randomized controlled trial on individuals with PTSD-CM (n = 361) were combined with data from individuals without PTSD (n = 4760). Entropy balancing was used to balance the data sets with regard to sociodemographic characteristics. Six-month excess health care costs from a societal perspective were calculated for 2022, using two-part models with logit specification for the first part and a generalized linear model for the second part.

The total six-month excess costs associated with PTSD-CM were €8864 (95% CI: €6855 to €10,873) per person. Of this, the excess health care costs accounted for €4647 (95% CI €3296 to €5997) and the excess costs of absenteeism for €4217 (95% CI: €3121 to €5314). Individuals with mild to moderate PTSD symptoms incurred total excess costs of €6038 (95% CI: €3879 to €8197), while those with severe to extreme symptoms faced €11,433 (95% CI: €8220 to €14,646).

Excess health care and absenteeism costs associated with PTSD-CM were substantial, with absenteeism accounting for roughly half of the total excess costs.

Substance use is an onging public health burden. As a result all psychiatrists encounter patients with substance use and addictive disorders, either as primary mental health issue, or as co-occurring with other mental health issues. In this presentation, first trends in substance use across Europe will be presented, based on findings from the European Union Drugs Agency (EUDA). Next, findings on co-occurring other mental health issues will be discussed, with a focus on co-occurring Attention Deficit Hyperactivy Disorder (ADHD). Recent findings from the International Colaboration on ADHD and Substance Abuse (ICASA) will be shared. ICASA’s most recent work was the longitudinal International Naturalistic Cohort Study of ADHD and Substance Use Disorders (SUD). Nearly 600 patients with both ADHD and SUD in treatment were followed for nine months. About two thirds of participants received some kind of ADHD treatment, with half receiving pharmacologic treatment, one third receiving psychological treatment, and only one-fifth receiving combined pharmacologic and psychological treatment. Higher ADHD symptom severity and sobriety at intake were associated with receiving ADHD treatment. These findings suggest that treatment of SUD and ADHD is suboptimal. The implementation of ICASA’s consensus statements on diagnosis and treatment of co-occurring ADHD and SUD could help improve quality of care for these individuals.

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Psychiatry faces numerous challenges that significantly affect mental health of people in Europe, from climate change, wars, migration, pandemics, to rapid advance of artificial intelligence. Among the most pressing issues are deteriorating mental health of children and adolescents and the lack of trained professionals. At the same time, progress in neuroscientific research contributes to the development of new effective treatments, e.g., monoclonal antibodies for Alzheimer’s disease; repurposing of drugs for psychiatric disorders, such as GLP-1 agonists, showed potential in treatment of alcohol addiction. There is also a renewed interest in psychedelics, recent studies verified their therapeutic efficacy in treatment of several mental disorders. Neurostimulation methods (rTMS, tDSC) are recognized non-pharmacological interventions; utilization of new technologies (AI, virtual reality, mobile apps, etc.) can help us in treatment and prevention of mental disorders.

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The development of guidelines is time-consuming and cost-intensive. The heterogeneity of clinical practice, evidence, and patients’ needs is an issue across Europe. An European core guidance for a specific psychiatric disorder may help to overcome this issue. Here, we present a progress report on the European Psychiatric Association (EPA) proof-of-concept approach to develop a European consensus guidance on the pharmacological treatment of schizophrenia.

All national psychiatric associations in Europe were contacted to provide their schizophrenia guidelines. Six guidelines were rated by three experts, experienced in the development of national and international guidelines, from three different countries (Italy, Hungary, and Germany), and the German schizophrenia guideline published in 2019 was found to have the highest quality. For this proof-of-concept approach, 45 recommendations on the pharmacological treatment of schizophrenia from the German guideline were evaluated in a two-step Delphi process to determine their acceptability throughout the European continent.

44 experts participated in the first round and 40 experts in the second round of the Delphi process. Agreement among the involved experts was reached for 75% of the presented recommendations from the German schizophrenia guidelines. 11 out of 45 recommendations (24.4%) did not reach this level of agreement.

This progress report highlights the possibility of developing a pan-European core guidance on the pharmacological treatment of schizophrenia by adapting national guidelines and reconciling their recommendations. However, several barriers in this adaptation process, such as non-agreement in recommendations with strong scientific evidence in the reconciling process, were identified and must be considered when developing the final guidance.

Peripheral inflammatory markers, including serum interleukin 6 (IL-6), are associated with depression, but less is known about how these markers associate with depression at different stages of the life course.

We examined the associations between serum IL-6 levels at baseline and subsequent depression symptom trajectories in two longitudinal cohorts: ALSPAC (age 10–28 years; N = 4,835) and UK Biobank (39–86 years; N = 39,613) using multilevel growth curve modeling. Models were adjusted for sex, BMI, and socioeconomic factors. Depressive symptoms were measured using the Short Moods and Feelings Questionnaire in ALSPAC (max time points = 11) and the Patient Health Questionnaire-2 in UK Biobank (max time points = 8).

Higher baseline IL-6 was associated with worse depression symptom trajectories in both cohorts (largest effect size: 0.046 [ALSPAC, age 16 years]). These associations were stronger in the younger ALSPAC cohort, where additionally higher IL-6 levels at age 9 years was associated with worse depression symptoms trajectories in females compared to males. Weaker sex differences were observed in the older cohort, UK Biobank. However, statistically significant associations (pFDR <0.05) were of smaller effect sizes, typical of large cohort studies.

These findings suggest that systemic inflammation may influence the severity and course of depressive symptoms across the life course, which is apparent regardless of age and differences in measures and number of time points between these large, population-based cohorts.

Background and relevance

Addictive behaviours have for the first time been included within the addiction spectrum. The transition to ICD-11 is a critical step in advancing mental health and addiction medicine.

The implementation of ICD-11 is expected to improve Health Records, facilitate Better Treatment, reduce Stigma, and enhance Public Health Surveillance.Testing the practical implications of these changes is key to ensure preparedness and smooth and effective implementation.

We conducted a comprehensive evaluation to assess the practical implications of these changes in Switzerland, determining the ease of implementation in clinical and public health settings.

Assessment consisted in:

Gathering Feedback through collecting insights from health professionals to identify potential challenges and areas for improvement.

Informing Training Needs by identifying the training requirements for health professionals to effectively use the new system.

The field testing involved multiple components: online survey, focus groups, expert reviews, key informant interviews, and a consensus conference.

The testinginvolved 64 health professionals and covered diverse professional backgrounds and geographical locations). Respondents had a median of 15.25 years of experience in addiction medicine, 75% of them were Clinicians and 25% were Public Health Professionals.

Key findings of the diffrernt survey components included: High approval rates for the utility (89%), feasibility (92%) and ease of use (86%) of the ICD-11.

Strong support (90%) for the inclusion of Addictive behaviors, particularly Gaming disorder and Gambling disorder, In contrast, the broader clinical spectrum of Gaming disorder (hazardous gaming and harmful gaming) received limited support (5%).

The national consensus conference concluded that ICD-11 is mainly perceived to have a positive impact on Swiss health records, to enable better documentation of emerging health conditions, and to reduce stigma. Divergent views were represented and expressed their acceptance or reluctance towards including addictive behaviours.

Careful transition and preparedness at the national level, training health professionals along with effective communication to public audience, were reported to be essential to mitigate risks of stigma and over-pathologizing addictive behaviours.

The implementation of ICD-11 in Switzerland is anticipated to enhance the understanding of the societal and economic impacts of new categories such as Gaming disorder. The field-testing data collected from a wide variety of experts and care professionals underscores the need for investment in training, communication, and preparedness to ensure a smooth transition and maximize the benefits of the new classification system.

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In the ICD-11 the number of drug categories as “headers” for the substance related morbidity chapters has doubled. Furthermore, the ICD-11 has rationalized the number of criteria for substance dependence from six to three, but in the process in fact the threshold for receiving a diagnosis of substance dependence has been reduced substantially. Lastly, the ICD-11 has increased substantially the number of drug induced comorbidities. The former “substance induced psychosis” has now been joined by substance induced depression, anxiety disorder and even OCD for some drugs. This talk will raise some questions regarding the functionality of these changes.

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Despite uncertain benefits, antidepressants are used in the management of personality disorders (PDs). We investigated the association between antidepressants and two adverse outcomes - suicidal behaviour and violent crimes - in individuals with PDs.

We used nationwide Danish healthcare registries to identify all individuals with a diagnosed PD aged 18–64 years from 2007 to 2016. Antidepressant use was identified using dispensed prescriptions. Individuals were followed up for healthcare presentations of suicidal behaviour and separately for police-recorded charges of violent crimes. We applied a within-individual design comparing rates of suicidal behaviour and violent crimes during time periods of antidepressant treatment with periods without treatment. Subgroup analyses were performed according to PD clusters, individual antidepressants, specific PDs, psychiatric comorbidities, and history of suicidal behaviour and violent crime.

The cohort included 167,319 individuals with a diagnosed PD, 19,519 (12%) of whom were prescribed antidepressants and presented at least one outcome event during follow-up, making them eligible for within-individual analyses. Overall, we found an association with lower rates of suicidal behavior during periods of antidepressant treatment, compared with periods when individuals were not on antidepressants (incidence rate ratio 0.86, 95% CI 0.84–0.89). However, this association was modified by specific PDs, individual antidepressants, comorbidities, and past history. For violent crimes, we did not observe consistent associations in any direction.

Antidepressants were associated with lower rates of suicidal behaviour, but less clearly in violent crimes. Types of PDs, individual antidepressants, and comorbidities modified these associations.

The latest revision of the International Classification of Diseases, ICD-11, was first issued by the World Health Organization in 2022 and a comprehensive account of mental and behavioural disorders, the Clinical Descriptions and Diagnostic Requirements (CDDR) was published in 2024. Within mental disorders is a new section “Disorders due to Substance Use and Addictive Behaviours”, which sets out the diagnostic requirements for, and distinctions between, the accepted range of conditions related to psychoactive substance use and behaviours such as gambling and online (video-) gaming.

Considerable changes have been made to ICD-11 compared with its predecessor ICD-10, originally published in 1992. The process leading to ICD-11 began in 2005 and a work group for substance disorders was convened in 2010, and for addictive behaviours in 2014. Certain key considerations guided the development of the new section, which had to serve both public health and preventive and clinical diagnostic needs. These were:

1. - the importance for reporting a wide range of psychoactive substances for monitoring and prevention, which led to the expansion to 14 categories;

2. - the need on public health and also clinical grounds for having a spectrum of severity of substance use, which could be defined precisely in line with the evidence base;

3. - the recognition of the high-level psychometric performance of key diagnoses in ICD-10 including substance dependence; and:

4. - compatibility with the available data on the neurobiology and cognitive processes underlying addictive disorders.

Four central substance use diagnoses feature in ICD-11. They are, in order of severity, (i) hazardous substance use, (ii) episode of harmful use, (iii) harmful (pattern of) substance use, and (iv) substance dependence. When there is any form of unhealthy use, one of these four conditions should be diagnosed. In addition, there are many substance-induced disorders, including intoxication, withdrawal, substance-induced delirium, substance-induced mental disorders, and substance-induced neurocognitive disorders. In separate sections are the physical disorders related to substance use. There are currently two diagnoses available for specific behavioural conditions, namely gambling disorder and gaming disorder, together with the health risk factors of hazardous gambling and hazardous gaming. The presentation will include some of the empirical data that support the election of these diagnoses which form the basis for monitoring and healthcare provision in WHO (UN) member countries.

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Mental health is an integral and essential component of health. An important implication of this definition is that mental health is more than just the absence of mental disorders or disabilities. Brain health can be defined as a life-long dynamic state of cognitive, emotional and motor domains underpinned by physiological processes. Exercise is a good model, since training the body improves Brain and Mental Health. Pathophysiological research and biomarkers are required.

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Current knowledge on psychiatric illness following periods of social distancing during the COVID-19 pandemic is mostly limited to smaller studies in selected populations. This nationwide study of all 4.6 million Danish adults examined if periods of social distancing were associated with changes in surrogate measures of mental health.

All Danish adults (≥18 years) were included and rates of collection of antidepressant prescriptions, psychiatric hospital admissions, and suicide or suicide attempts for the periods March 12, 2020–May 20, 2020 (lockdown period 1), and December 21, 2020–March 1, 2021 (lockdown period 2), were compared to corresponding periods 1 year prior. Individuals were censored due to death or SARS-CoV-2 infection.

Antidepressant consumption increased for both period 1 and period 2, with an incidence rate ratio (IRR) of 1.02 (95% CI: 1.01–1.02, p < 0.001) and IRR 1.08 (95% CI: 1.08–1.09, p < 0.001) respectively, compared to the control periods. Psychiatric hospitalization rates decreased significantly, with an IRR of 0.65 (95% CI: 0.63–0.66, p < 0.001) for period 1, and IRR 0.86 (95% CI: 0.84–0.88, p < 0.001) for period 2. The risk of suicide did not increase in period 1, IRR 0.96 (95% CI: 0.82–1.13, p = 0.64), but seemed increased during period 2, IRR 1.19 (95% CI: 1.02–1.38, p = 0.03).

Periods of social distancing during the COVID-19 pandemic were associated with an increase of antidepressant consumption, but decreased rates of psychiatric hospitalization. Suicide risk seemed increased during the second lockdown period.