Brain health impacts everyone, in Europe and beyond. Whether it is the continued quest for cures and treatment for those living with brain conditions or the protection and fostering of healthy brains for our future generations, the challenges are unprecedented. To elevate brain health on the national, EU, and international policy agendas while making the most of existing initiatives, the European Brain Council (EBC) kicked off the No Health Without Brain Health campaign in the European Parliament during the 2024 Brain Awareness Week ahead of the 2024 European Elections.

This campaign is structured around two priority policy asks: the creation of a European Parliament Intergroup on Brain Health and Research and increased support to the creation of EU and National Brain plans. One year after the official kick-off, the campaign demonstrated that, when united, the brain community can reach a significant number of policymakers and make its voice heard to drive tangible policy changes.

The presentation “No Health Without Brain Health: Prioritising Brain Health in the European Union to Leave No One Behind” in this joint workshop will showcase success stories, address challenges and share good practices in EU-wide brain health initiatives. It will highlight the importance of collaboration and breaking down silos in preparing for the brain-healthy transition of our societies. Additionally, it will address the burden of brain disorders, neurological and mental alike, in a comprehensive and collaborative manner.

None Declared

Sleep is essential for physical, brain (including mental) and societal health. Sleep-wake disorders are confirmed as independent risk factors and/or modulators of several neurological (such as stroke, dementia, and parkinsonism), psychiatric (depression) and other (arterial hypertension, diabetes, oncological) disorders. According to the Cost Of Illness in Neurology in Europe (COIN-EU) Study, 1.7 trillion euros cost is estimated for neurological disorders, of which 25.45% is dedicated for sleep disorders. In this talk both the socioeconomic burden of sleep disorders, and possible sleep-based interventions for improving brain and physical health, will be discussed.

None Declared

In this talk, Dr. Arnardottir will summarize the main findings of the SLEEP REVOLUTION, an EU Horizon 2020 Research and Innovation Programme no. 965417. The project is an inter-disciplinary and international research and development project with 39 partner institutions and companies in Europe and Australia. SLEEP REVOLUTION aims to introduce an approach based on machine learning to assess sleep apnea severity and treatment needs as well as the use of digital health technology to measure sleep and health (app, cognitive testing, consumer sleep technology and clinically validated sleep technology for home use). Through these technological solutions , the project brings together researchers, patients and healthcare professionals to provide beyond the current state-of-the-art diagnosis and optimal treatment for sleep disorders. The approach of this project can be used as a model for other disease assessment and follow-up.

E. Arnardóttir Consultant of: Medical Advisory Board for Philips (Feb 2022-Feb 2024) and Lille (Sept 2024), Speakers bureau of: Nox Medical, ResMed, Jazz Pharmaceuticals, Linde Healthcare, Apnimed, Wink Sleep, Vistor (NovoNordisk)

Living with major depressive disorder (MDD) reduces life expectancy, with respiratory disease being a significant threat. However, evidence on respiratory disease in this population has not yet been meta-analyzed.

This meta-analysis examines respiratory disease prevalence and odds ratio (OR) in patients with MDD and treatment resistant depression (TRD). A systematic literature search was conducted, with a snowball search of reference and citation lists. Inclusion criteria covered studies in MDD and TRD patients with confirmed diagnoses of respiratory diseases (asthma, chronic obstructive pulmonary disease [COPD], pneumonia, lung cancer, and tuberculosis), comparing with a control group when possible.

From 4,138 retrieved articles, 15 (including 476,927 individuals with MDD, 50,680 with TRD, and 1,108,979 control group) met the inclusion criteria. In MDD patients, COPD prevalence was 9.0% (95% CI: 3.8–19.6%), asthma 8.6% (95% CI: 5.7–12.8%), and pneumonia 2.5% (95% CI: 2.2–2.9%). In TRD patients, COPD prevalence was 9.9% (95% CI: 4.2–21.9%) and asthma 10.9% (95% CI: 10.7–11.2%), but meta-analysis limited to those diseases showed no significant relative risk differences. Compared to the general population, individuals with MDD had significantly higher rates of COPD (OR 1.79, 95% CI: 1.49–2.16), even higher in younger populations (1.85 [95% CI: 1.74–1.97]) and more prevalent in women.

This first meta-analysis on this topic shows that MDD is associated with an increased risk of respiratory illness compared to the general population. The prevalence of asthma doubles the mean described in the general population worldwide, and in COPD, women and younger people are at particular risk. Prevention policies are urgently needed.

Sleep is not something that occurs in isolation—it is embedded in a context. These contexts include biological, psychological and social factors, as well as a range of environmental considerations.

Throughout Europe psychologists engage in research and practice and collaborate with colleagues from allied professions such as psychiatry and those with lived experience on the topic of sleep.

Insights are gathered from throughout the network of the European Federation of Psychologists’ Associations (EFPA). Individual examples and emergent themes are identified from a wide range of contexts including:

The role of sleep in European policy

Sleep in times of crisis

Community-oriented approaches to supporting healthy sleep patterns

The role of sleep and rest in the workplace

How concern over topics like climate change affects sleep

Competency around sleep in practitioner training and standards

The implications of digitalisation on sleep

None Declared

Mood disorders (MD) have been consistently associated with alterations in the immune system. Evidence suggests a condition of systemic low-grade inflammation with abnormally decreased adaptive, increased innate immunity, and with higher levels of circulating cytokines, higher macrophage/monocyte inflammatory activation patterns, and higher neutrophils to lymphocyte counts. A dynamic pattern of premature immunosenescence and partial T cell defect starting early in adolescence, involving a reduction of naïve T cells and an expansion of memory and senescent T cells, parallels lifetime recurrence of illness episodes, worsening outcomes and fostering chronicity. Consistent systematic reviews and meta-analyses affirm that COVID-19 survivors show persistent psychopathology and neurocognitive impairment, with clinical significant depressive psychopathology being reported in around 31% of patients. Psychopathological features are the same observed in MD, along the same gradient of severity, and including a typically melancholic cognitive vulnerability. Neurocognitive impairment could possibly separate from depression in the long term, but not in the first year after infection, and it is largely overlapping with persistent cognitive deficits described in MD. We will discuss pathogenetic mechanisms shared by both, MD and post-COVID depression, with a specific emphasis on: (i) spread disruption of white matter microstructure, reduced grey matter volumes in anterior cingulate cortex, and abnormal functional connectivity in the cortico-limbic circuitries; (ii) abnormal cell trafficking across the blood brain barrier, essential for brain maintenance and repair in healthy conditions; (iii) altered immuno-inflammatory setpoints as observed in the peripheral blood, known to parallel white and grey matter abnormalities in the brain, and recently shown to disrupt neurovascular coupling and spontaneous neural activity. We suggest that post viral depression provides an invaluable model illness for the study of immune-inflammatory mechanisms involved in the pathogenesis of mood disorders, to identify new targets for treatment, with the aim of restoring mental health and brain homeostasis.

None Declared

Effective approaches exist to prevent and treat mental illness and to promote mental health but most people who could benefit from evidence-based interventions (policies, programmes, and individual-level practices or services) do not receive them. Too often, research produces interventions and implementation strategies that are difficult to scale owing to misalignment with the political, cultural, policy, system, community, provider, and individual realities of real-world settings. The Lancet Psychiatry Commission on Transforming Mental Health Implementation Research considers strategies for changing how research is done to produce more actionable evidence. It examines how to integrate research and real-world implementation; centre equity in mental health intervention and implementation research; apply a complexity science lens to mental health research; expand designs beyond the randomised clinical trial; and value transdisciplinarity across endeavours. Most mental health implementation research has been done in high-income countries but the Commission’s recommendations incorporate research from low-income and middle-income countries and call for strategies to expand mental health implementation research globally.

J. Marsh Employee of: Elsevier

Medication-induced dystonia (MID) is a movement disorder (MD), characterized by involuntary sustained or intermittent muscle contractions, causing abnormal, often repetitive, movements, postures, or both. Although MID is commonly associated with the use of antipsychotics, it also occurs with many other medications widely used in clinical practice.

A systematic literature search (from inception to November 2023), using the PubMed and Embase databases, was conducted without language restriction for articles reporting on MID in people without pre-existing MDs, and this for all potentially relevant non-antipsychotic medications. A narrative synthesis of the available evidence was undertaken.

MID is common (1 to 10%) with certain antiemetics. Selective serotonin reuptake inhibitors and the antiepileptics valproate, carbamazepine, and lamotrigine are rarely (0.01 to 0.1%) or very rarely (<0.01%) associated with MID. All other medications are very rarely (<0.01%) associated with MID or have a risk that cannot be precisely estimated. The actual rate of dystonic reactions with most non-antipsychotic agents remains unknown, owing to misdiagnosis and underreporting in the scientific literature. In general, MID seems to occur more often in children and adolescents, even with a single low dose, and with polymedication. In most cases, MID is acute in onset (occurring within hours to days) and involves the head and neck.

Although MID is most common with dopamine receptor-blocking antiemetics, many other medications may also produce dystonic reactions, particularly in children and adolescents. Although such incidents remain rare, there are indications that MID is underreported for many classes of medications.

Psychosocial interventions play a role in recovery and in the patient’s journey. Recovery is individual and so needs individual responses from the mental health services with individual goals set. Different interventions will be useful at different stages and, of course, they only “work” for some people. Three main strategies are often referred to – reducing symptoms, reducing barriers to recovery, and extending and maintaining recovery to achieve some stable and acceptable (to the patient) optimal level of functioning. Psychosocial intervention strategies are beneficial for each of these, and they are often thought of as independent, but they are inter-related with one type of therapy leading to reductions in the need for other therapies. Even though many of these strategies are included in guidelines, the process of considering which one to start with is a choice. We need to work out how that choice is made.

None Declared

There is increasing evidence that childhood Attention-Deficit Hyperactivity Disorder (ADHD) elevates the risk of later Bipolar Spectrum Disorder (BD). However, it remains unclear whether different trajectories of ADHD symptoms confer differential risk for BD.

Data from the Avon Longitudinal Study of Parents and Children were available from 7811 children at age 8 years, 7435 at 10, 6798 at 13, and 1217 at 21–23 years. ADHD symptoms were assessed at 8, 10, and 13 years with the Development and Well-Being Assessment. Clinically significant hypomanic symptoms (CSHS) at 21–23 years were assessed using the Hypomania Symptom Checklist (HCL-32). Group trajectories of ADHD and its subtypes were estimated using latent class growth analysis. The prospective associations between different ADHD trajectories and CSHS were tested using logistic regression analysis.

Persistently high, increasing, remitting, and persistently low ADHD symptom trajectories were identified for the three ADHD-related categories. Individuals with persistently high and increasing levels of ADHD symptoms had increased odds of CSHS compared to persistently low class. Sensitivity analyses validated these results. In separate analyses, persistently high levels of hyperactivity and inattentive, and increasing levels of inattentive symptoms were also independently associated with CSHS.

Young people with a longitudinal pattern of high and increasing ADHD symptoms are at higher risk for developing CSHS in young adulthood compared to individuals with low symptom patterns. These two trajectories in childhood and adolescence may represent distinct phenotypic risk profiles for subsequently developing BD and be clinically significant targets for prevention and treatment of BD.

I will present data from a range of Danish studies on both cannabis-induced psychosis and Danish epidemiological studies on the association between cannabis and psychotic disorders such as schizophrenia. A deeper understanding of these associations is important. If the consistent association that we have observed for many decades is indeed causal, then cannabis is perhaps the single most important preventable risk factor for schizophrenia that we have identified to date. The development over time of the population attributable risk fraction, gender differences, and other novel areas will be covered in the presentation.

None Declared

Introduction

Cannabis-induced psychosis (CIP) is often assumed to resolve with sustained abstinence, although recent studies report adverse long-term outcomes, such as a high risk of diagnostic transition to schizophrenia. Cannabis is also known to increase relapse rate in individuals with psychotic disorders in general, and there is a lack of knowledge on optimal treatment of this patient group.

In this presentation, data on incidence and mortality associated with CIP, and real-world effectiveness of antipsychotics in relapse prevention in persons with CIP will be presented.

Nationwide Scandinavian registers were utilized to identify persons with first-time CIP (ICD-10 F12.5) during the years 2000-2021. Incidence and mortality of CIP were investigated with Danish, Norwegian and Swedish register-based data, and antipsychotic use with Swedish data. Annual incidence rates of CIP per 100 000 persons were calculated. For mortality study, incident cases of CIP were matched by age- and gender with comparison persons without substance-induced psychosis and hazard ratios (HRs) were calculated for all-cause and cause-specific mortality. Association between use of specific antipsychotics (oral vs. long-acting injectable, LAI, forms) and risk of hospitalization due to any psychosis relapse was investigated in within-individual design where each person acted as his/her own control to minimize selection bias, analyzed with stratified Cox models.

The incidence rate of CIP increased in time in all Scandinavian countries and was the highest in Denmark throughout the study years (rate in 2016 5.6, vs. 3.0 in Norway and 2.7 in Sweden). CIP was associated with an increased risk of mortality, risk estimates (HRs) ranging from 6.6 in Denmark, to 7.6 in Sweden, and 9.0 in Norway, compared with general population controls. In within-individual models, antipsychotic use was associated with a decreased risk of hospitalization due to psychosis relapse, with an adjusted HR of 0.75 (95% Confidence Interval 0.67-0.84), compared with time periods when the same individuals did not use antipsychotics.

Incidence of cannabis-induced psychosis is increasing in Scandinavian countries, and it is associated with significant mortality risk. Antipsychotics are effective treatments in preventing psychosis relapses also in individuals with CIP.

H. Taipale Grant / Research support from: Janssen, Speakers bureau of: Gedeon Richter, Janssen, Lundbeck, Otsuka

Problematic cannabis use is prevalent among individuals with first-episode psychosis (FEP), with 35.6% meeting criteria for comorbid cannabis use disorder (CUD) (1). Cannabis use is associated with poorer FEP outcomes, including higher psychosis relapse risk (2). However, evidence on effective pharmacological treatments and long-term outcomes for FEP+CUD remains limited.

To evaluate outcomes of FEP with comorbid CUD and assess the real-world effectiveness of antipsychotic treatments in this population.

This study analyzed a Swedish nationwide cohort using longitudinal register data (2006–2021). The sample included 1,820 patients with FEP+CUD (84.7% male, mean age 26.8 years). Outcomes included hospitalizations for psychotic relapse, any psychiatric disorder, or substance use disorder (SUD). Associations between antipsychotic use and outcomes were assessed using within-individual Cox regression models. Mortality rates were compared across FEP+CUD (n=2,154, mean age 25.0 years), cannabis-induced psychosis (CIP, n=1,263, mean age 25.0), and FEP without SUD (n=17,589, mean age 27.4), adjusting for age, sex, education, other SUDs, and disability pension status.

Over a mean follow-up of 6.13 years, 76% of participants were hospitalized for psychiatric diagnoses, 63% for SUD, and 61% for psychotic relapse. Antipsychotic use was associated with a 33% reduction in psychotic relapse risk. Clozapine and long-acting injectable (LAI) formulations of risperidone, aripiprazole, and paliperidone showed the greatest efficacy in relapse prevention. Clozapine reduced SUD-related hospitalizations by 86%. Within 10 years, 7.8% of FEP+CUD and 5.2% of CIP patients died, compared to 3.4% of FEP without SUD (adjusted odds ratio [aOR] 2.61, 95% CI 2.19–3.13, and aOR 1.67, 95% CI 1.28–2.17). Suicide was the leading cause of death in all groups, with higher rates in FEP+CUD (aOR 1.94, 95% CI 1.49–2.52) and CIP (aOR 1.70, 95% CI 1.21–2.37) compared to FEP without SUD.

Clozapine and LAI formulations of second-generation antipsychotics (excluding olanzapine) or oral aripiprazole effectively prevent hospitalizations in FEP+CUD. Targeted efforts are needed to reduce premature mortality, particularly from suicide, in FEP patients with comorbid cannabis use disorder or cannabis-induced psychosis.

1. Hunt GE, et al. Prevalence of comorbid substance use in schizophrenia spectrum disorders in community and clinical settings, 1990–2017: Systematic review and meta-analysis. Drug Alcohol Depend. 2018;191:234–258.

2. Bowtell M, et al. Clinical and demographic predictors of continuing remission or relapse following discontinuation of antipsychotic medication after a first episode of psychosis: A systematic review. Schizophr Res. 2018;197:9–18.

S. Niemelä Consultant of: Recordati, Shire-Takeda, Speakers bureau of: Dne Pharma, Lundbeck, Recordati, Shire-Takeda