Decedents without known mental disorders constitute 5%-40% of suicides and epidemiologic studies show that 20% of those with a history of suicidal behavior (SB) may be free of psychiatric disorders. This implies that suicide ideation (SI) may occur in the psychiatrically healthy volunteers (HVs), providing an opportunity for preventing suicide and SB. Yet, studies of HVs have not focused on the occurrence of SI, nor has SI in HVs been characterized, especially in relation to the occurrence of stress. If SI is not rare in HVs, current approaches to managing suicide risk in medical settings may be too limited to identify psychiatrically healthy individuals at risk for suicide.

We recruited HVs and major depressive disorder (MDD) patients to test two hypotheses: (1) some HVs, screened to exclude those meeting lifetime criteria for Axis I or II disorders and with no personal or family history of SB, would endorse SI on Ecological Momentary Assessment (EMA); and (2) HVs’ SI scores would be lower than those of MDD patients. In addition, we investigated whether HV and MDD groups had different responses to stressors in terms of SI.

HVs and MDD patients were recruited through advertisements: some patients were recruited in the emergency department. Participants provided 7 days of ecological momentary assessment (EMA) data about SI and stressors. EMA data was collected in six 2-hour epochs during a 12-hour period selected to match participant wake hours. Longitudinal mixed effects logistic regression models compared HV and patient SI scores and frequency of stressors. Mixed effects linear regression models compared HVs’ and patients’ SI score change from the previous epoch’s SI score when each stressor occurred.

HVs (n=42) reported less frequent (p<0.001) and less intense SI (p<0.003) than patients (n=80). HVs did endorse SI and/or SI-related items in 44% of EMA epochs, endorsing actual SI items, as opposed to SI related items (lack of wish to live) in 25% of epochs with non-zero SI scores. For 7 of 8 stressors, patients reported stressors more often than HVs (all p<0.001) and responded to them with greater SI (0.0001<p<0.0472). HVs reported statistically significant SI increases only in response to neglect (p<0.0147), indicating HVs were relatively resilient to other stressors.

The occurrence of SI and SB among psychiatrically healthy individuals has been relatively neglected. However, SI does occur in this population. Although HVs demonstrated more modest SI increases than patients in response to stressors, the reports of SI in 44% of epochs by HVs suggest that focusing solely on individuals with mental disorders when screening for suicide risk may be too narrow an approach.

M. Oquendo, MD, PhD earned royalties from: Research Foundation for Mental Hygiene, Inc. - Columbia Suicide Scale, Conflict with: Honoraria - Alkermes - Grant Reviews, Honorarium.

Improving media adherence to World Health Organization (WHO) guidelines is crucial for preventing suicidal behaviors in the general population. However, there is currently no valid, rapid, and effective method to evaluate the adherence to these guidelines.

This comparative effectiveness study (January–August 2024) evaluated the ability of two artificial intelligence (AI) models (Claude Opus 3 and GPT-4O) to assess the adherence of media reports to WHO suicide-reporting guidelines. A total of 120 suicide-related articles (40 in English, 40 in Hebrew, and 40 in French) published within the past 5 years were sourced from prominent newspapers. Six trained human raters (two per language) independently evaluated articles based on a WHO guideline-based questionnaire addressing aspects, such as prominence, sensationalism, and prevention. The same articles were also processed using AI models. Intraclass correlation coefficients (ICCs) and Spearman correlations were calculated to assess agreement between human raters and AI models.

Overall adherence to WHO guidelines was ~50% across all languages. Both AI models demonstrated strong agreement with human raters, with GPT-4O showing the highest agreement (ICC = 0.793 [0.702; 0.855]). The combined evaluations of GPT-4O and Claude Opus 3 yielded the highest reliability (ICC = 0.812 [0.731; 0.869]).

AI models can replicate human judgment in evaluating media adherence to WHO guidelines. However, they have limitations and should be used alongside human oversight. These findings may suggest that AI tools have the potential to enhance and promote responsible reporting practices among journalists and, thus, may support suicide prevention efforts globally.

Psychotic disorders are frequently preceded by depressive disorders, and it has been hypothesized that treatment of depression in youth may reduce risk for later psychosis. Using quasi-experimental methods, we estimated the causal relationship between the treatment of adolescent depression with selective serotonin reuptake inhibitors (SSRIs) and the risk of later psychosis.

We used data linkage from multiple national Finnish registries for all individuals (n = 697,289) born between 1987 and 1997 to identify depression diagnosed before age 18, cumulative SSRI treatment within three years of diagnosis, and diagnoses of non-affective psychotic disorders by end of follow-up (age 20–29). We used instrumental variable analyses, exploiting variability in prescribing across hospital districts to estimate causal effects. Analyses were conducted using two-stage least squares modelling. Sensitivity analyses examined effects stratified by confounders and effects of specific SSRIs.

Our final sample included 22,666 individuals diagnosed with depression in adolescence, of whom 60.2% (n = 13,650) had used SSRIs. 10.7% of adolescents with depression went on to be diagnosed with a non-affective psychotic disorder. SSRI treatment for adolescent depression was not associated with a reduced risk of developing a psychotic disorder (one-year β = 0.04,CI:−0.01 to 0.09; two-years β = 0.02,CI:−0.06 to 0.09; three-years β = −0.02,CI:−0.08 to 0.05).

Our quasi-experimental investigation does not support the hypothesis that treatment of adolescent depression reduces the subsequent risk of psychosis. Our findings question the assumption that treatment of common mental health disorders in youth may impact the risk of developing severe mental illnesses in adulthood.

Digital studies based on the continuous monitoring of patients in their natural environment help to refine the suicidal phenotypes. Studies using ecological momentary assessment revealed the existence of different patterns of suicidal ideation (SI) based on both their severity and variability. Specifically, variable SI may be a frequent pattern of suicidal ideation that appears to be related to some clinical features (social withdrawal, impulsive aggression, suicide attempts), rooted in childhood trauma and serotonergic dysfunction and associated with the reactivity to stressful life events. Some individuals, in response to stress could experience both psychological pain and decision-making impairment in social contexts, leading to suicide risk. Then, the description of the suicidal pattern may help to define clinically and biologically homogeneous groups of at-risk patients.

In this sense, experimental studies where patients are submitted to a social stress task reported that patients who were more sensitive to a social stress, as measured with a higher salivary cortisol response, were less depressed, more impulsive, and made suicide attempts with a higher intent. Investigating the regulation of the immune inflammatory response to the social stress task, we recently reported that suicide attempters and ideators showed less dynamic inflammatory stress responses in comparison to psychiatric controls, and that platelet activation responses to stress were blunted in individuals with suicidal ideation. Last, we will present new data of cardiovascular and emotional responses to the virtual Trier Social Stress Test in women with a history of depression and with or without a history of suicide attempt. Combining digital and experimental studies could help to refine the suicidal phenotypes and reduce the heterogeneity of suicidal behaviors that are led by different processes, in order to develop specific therapeutic approaches for a better suicide prevention.

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The focus of suicide research changes from traditional risk factors to acute warning signs. Patient self-reported suicidal ideation (SI) is not a reliable measure of acute suicide risk. Presuicidal syndromes such as suicide crisis syndrome (SCS) attempt to describe measurable syndromes based on warning signs other than SI.

Seven hundred and ten acutely admitted patients were included in the study. Identification of symptoms describing the five components of SCS was done by performing a retrospective text analysis of the patient records (electronic medical records). Patients were grouped according to high or low level of SCS symptoms. We performed statistical tests for group differences in demographics, traditional risk factors, and clinical variables, including agitation assessed by the Positive and Negative Symptom Scale-Excited Component (PANSS-EC).

Seventy-two patients had high levels of SCS symptoms. They reported less SI the last month before admission; suicidality was less relevant for referral, the intake suicide assessment more often concluded with high suicide risk, they were more often referred and admitted involuntarily, and they had higher total scores on PANSS-EC.

The individual SCS symptoms may provide useful information in the evaluation of acute suicide risk at intake. A high level of SCS symptoms suggests more severe conditions. The lower reports among high-level than low-level SCS patients of self-reported SI last month before admission, shows the limitation of using SI as a warning sign. The association between the level of SCS symptoms and PANSS-EC total score suggests that agitation could give valuable additional information for suicide risk assessments.

Worldwide, suicidal ideation in youth varies between 14% and 23 %. Between 5% and 16% have made a suicidal attempt. The prevalence has increased recently. However, we measure a decrease in suicide deaths (Van Meter et al., 2021). Suicide is the second cause of death after accidents. Most psychiatric disorders appear during or before adolescence (Solmi et al., 2022), which makes it a critical period to begin treatment. Development induces peculiarities like more dependence on the environment, insight difficulties, and impulsivity.

Risk factors should be assessed like previous suicidal attempt history, active suicidal ideation, trauma, alcohol misuse, and drug misuse (Pernau et al., 2024).

The management of these situations stresses several challenges. Several interventions were designed but did not show specificities on subsequent suicide prevention. However, they decreased immediate psychiatric hospitalisations, increased mental health service use, and showed mild improvement in subsequent depressive symptoms (Pitt et al., 2024).

Studies in non-specific factors and therapeutic alliance operationalized in motivational interviewing open perspectives like the importance of reflective listening, open questions, semi-directivity and shared objectives (Miller & Moyers, 2021).

Understanding of depression enlightens specific simple approaches like behavioral activation (Richard et al., 2016; Kanter et al., 2010) and problem-solving therapy (Bell & D’Zurilla, 2009).

Specific tools like joint crisis plans (Jong et al., 2016) are useful and ethical on paper or in apps (Stanley et al., 2018)

Organization of care is of paramount importance like phone and letters contact like the program Vigilans (Plancke et al., 2020).

Bibliotherapy and internet CBT tools (Linardon et al, 2024 ; Hedman-Lagerlöf, et al., 2023 ; Lewis et al., 2012) could be useful to improve mental health care accessibility with a small cost.

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Difficult-to-treat depression (DTD) is a common clinical challenge for major depressive disorder and bipolar disorders. Electro convulsive therapy (ECT) has proven to be one of the most effective treatments for this condition. Although several studies have investigated individually the clinical factors associated with the DTD response, the role of their interplay in the clinical response to ECT remains unknown. In the present study, we aimed to characterize the network of symptoms in DTD, evaluate the effects of ECT on the interrelationship of depressive symptoms, and identify the network characteristics that could predict the clinical response.

A network analysis of clinical and demographic data from 154 patients with DTD was performed to compare longitudinally the patterns of relationships among depressive symptoms after ECT treatment. Furthermore, we estimated the network structure at baseline associated with a greater clinical improvement (≥80% reduction at Montgomery–Åsberg Depression Rating Scale total score).

ECT modulated the network of depressive symptoms, with increased strength of the global network (p = 0.03, Cohen’s d = −0.98, 95% confidence interval = [−1.07, −0.88]). The strength of the edges between somatic symptoms (appetite and sleep) and cognitive-emotional symptoms (tension, lassitude, and pessimistic thoughts) was also increased. A stronger negative relationship between insomnia and pessimistic thoughts was associated with a greater improvement after ECT. Concentration difficulties and apparent sadness showed the greatest centrality.

In conclusion, ECT treatment may affect not only the severity of the symptoms but also their relationship; this may contribute to the response in DTD.

Humanitarian crises result from various events threatening many individuals’ health, safety, and well-being. The frequency of public health crises has increased within the last decades, posing significant risks to health, particularly for people in low- and middle-income countries. Social determinants such as discrimination, poverty, and violence are risk factors for mental health conditions. People living through humanitarian crises might experience mental distress, with challenging circumstances that lead to vulnerability to developing mental disorders, including depression, anxiety disorders, and post-traumatic stress disorder.

Psychotherapy in humanitarian settings mainly refers to providing psychological support and treatment to individuals affected by wars and armed conflicts, famine, and natural disasters such as earthquakes, hurricanes, or floods. Humanitarian settings pose unique challenges to the delivery of mental health services due to disrupted infrastructure, cultural differences, and the complex needs of affected individuals. Therefore, psychotherapeutic interventions in humanitarian settings should recognize the psychological and social aspects of mental well-being for prevention and treatment. The psychological components of such interventions are related to the mental and emotional state of the person. Social components include efforts to strengthen social support and interpersonal skills, promoting positive aspects of mental health.

In humanitarian settings, mental health care is often integrated with other services, such as education and social services. This holistic approach ensures that mental health is addressed with basic needs like food, shelter, and safety. Another critical aspect is ensuring the safety and mental well-being of therapists at risk in conflict zones. Although limited evidence shows their effects on better mental health outcomes, several therapeutic modalities are frequently used in humanitarian settings, adapted to unique circumstances. Those include cognitive-behavioral therapy, group therapy, trauma-focused psychotherapy, mindfulness and stress reduction, narrative therapy, and interpersonal psychotherapy.

In conclusion, psychotherapy in humanitarian settings plays a crucial role in addressing the mental health needs of individuals affected by crises. It requires flexibility, cultural sensitivity, and a multidisciplinary approach to overcome the challenges posed by these environments. Digital platforms and web-based services might offer accessible and resourceful therapy options. However, further research is needed to evaluate the effectiveness of psychosocial interventions in such settings. Efforts to expand real-world solutions in mental health services, build local capacities, and integrate psychosocial support into broader humanitarian assistance in low-resourced settings are essential to fostering recovery and resilience in affected populations.

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Slow and inadequate implementation causes greater inequity and reduced quality in emergency psychiatric services. This symposium is based on five recommendations to improve health intervention research and implementation, presented by Professor Emma Mcginty (PhD), the leader of the Lancet Psychiatry Commission to transform implementation in mental health. This presentation will introduce each of these recommendations: I) integrate research into clinical practice to ease implementation II) embed equity in mental health intervention research III) use complexity science and bottom-up approaches to improve relevance of science and implementation IV) base implementation less additional methods beyond traditional RCT-based research V) use a transdisciplinary approach in development and implementation of research on new interventions.

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Individuals who die by suicide tend to share more characteristics with those who attempt suicide using violent methods than with those who employ nonviolent means. To date, limited research has been published on the demographic characteristics of individuals who engage in violent suicide attempts.

This study aimed to examine trends in the characteristics of violent suicidal behavior in comparison to nonviolent suicidal behavior.

Patients included in the study were consecutively admitted between 2016 and 2021 to the Dr. Manninger Jenő National Trauma Center and the Psychiatric and Toxicology Wards of Péterfy Sándor Hospital in Budapest, Hungary, for medical treatment following violent or nonviolent suicide attempts. Differences in demographic characteristics, risk factors associated with violent suicidal behavior, and methods of attempt were analyzed using Chi-square tests and logistic regression models.

A total of 298 inpatients (46.1% male, 53.9% female), aged between 18 and 65 – representing the economically active population – were included in the study. The sample comprised 145 individuals who attempted suicide using nonviolent methods (73% female, 27% male) and 153 who used violent methods (64.7% male, 35.3% female). Of the total sample, 22 individuals (12.1%) died during treatment due to severe medical complications. Among male attempters, the highest proportion fell within the economically active age range of 18–55 years, whereas among female attempters, the 18–35 age group represented the highest proportion. The most common violent methods, in descending order of frequency, were stabbing (49.7%), jumping from a height (29.8%), and jumping in front of a train (7.7%). The most frequently diagnosed psychiatric disorders among the sample were major depressive disorder (42.2%), anxiety disorders (44.9%), and bipolar disorder (12%). The leading reported motives for violent suicide attempts, in decreasing order of frequency, were marital conflict (32.4%), divorce/separation/break-up (30.2%), and severe or chronic somatic illnesses (12%). When comparing the two subgroups, the strongest risk factors associated with violent suicide methods included male gender, older age, and residence in the capital city.

Previous studies suggest that risk factors are largely indistinguishable between individuals who engage in violent versus nonviolent suicide attempts. However, individuals who attempted suicide using violent methods exhibited characteristics more closely aligned with those who died by suicide than with the remainder of the sample. The majority of data in this study were collected during the COVID-19 pandemic – a period marked by multiple overlapping crises – which may have played a disproportionately large role in the emergence of suicide risk.

Childhood maltreatment (CM) is a risk factor for mental and physical health problems in adulthood, potentially mediated by long-term autonomic nervous system (ANS) dysregulation. To explore this link, the association between CM and vagal-sensitive heart rate variability (HRV) metrics in adults was examined, accounting for biopsychosocial factors.

Data from 4,420 participants in the Study of Health in Pomerania were analyzed, with CM assessed using the Childhood Trauma Questionnaire. HRV was derived from 10-second electrocardiograms and 5-minute pre-sleep polysomnographic recordings. Post hoc analyses examined abuse and neglect.

CM was associated with reduced HRV (logRMSSD: β = −0.20 [95%-CI: −0.28, −0.12], p = 1.2e−06), driven by neglect (β = −0.27 [−0.35, −0.18], p = 1.9e−09) rather than abuse (β = 0.01 [−0.12, 0.14], p = 1). Adjustments for age, sex, and medication attenuated these effects, which remained robust after additionally controlling for socioeconomic, lifestyle, body mass index, and depressive symptoms (fully adjusted model: CM β = −0.08 [−0.15, −0.001], p = .047; neglect β = −0.11 [−0.19, −0.03], p = .009; abuse β = −0.08 [−0.20, −0.04], p = .174). Age-related differences were found, with reduced HRV in both young and older participants but not in middle-aged participants (fully adjusted: F(2,743) = 6.75, p = .001).

This study highlights long-term ANS dysregulation following CM, particularly neglect, indicated by altered vagal-sensitive HRV metrics. Although small in magnitude, the effect on the ANS was independent of adult biopsychosocial factors. This long-term dysregulation may contribute to an increased risk of adverse health outcomes in adulthood.

Coercive practices in mental health care can infringe upon human rights, necessitating urgent global action to eliminate them. However, inconsistencies in clinical practice, fragmented research on effectiveness, and limited understanding of barriers and facilitators hinder the real-world transformation of services. As part of the COST Action FOSTREN (Fostering and Strengthening Approaches to Reducing Coercion in European Mental Health Services), Working Group 4 Implementation Science conducted a systematic review to examine the models, theories and frameworks employed by studies in implementing programs aimed at reducing coercion in mental health settings and the reported implementation outcomes. A comprehensive search was conducted across multiple databases, resulting in the inclusion of eight studies (nine papers). The identified coercion reduction programs utilized holistic approaches, risk assessment methods, staff training, and sensory modulation interventions. All of them were conducted in inpatient settings. Eight different implementation tools were identified, but none of the studies reported all sought implementation outcomes. The most frequently reported outcomes were acceptability and adaptation, while no studies provided data on implementation costs. Overall, the quality of the studies assessed was relatively low. The review highlights the underutilization of systematic implementation models, theories and frameworks when embedding coercion reduction interventions in routine mental health care, especially in emergency psychiatry settings. Further research, incorporating the perspectives of service users and carers, is needed to address this gap and determine the costs and resources required for implementing complex interventions with implementation models, theories and frameworks guidance.

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Violence and suicidality are common in forensic inpatients, most commonly with schizophrenia (SZ), personality disorder (PD), or comorbid SZ and PD (dual diagnosis, DD). There are no biological markers used in risk assessment tools. Lipids may provide a useful biomarker to aid violence prediction, but the roles of diagnosis and sex remain unclear. We therefore investigated lipids in adult forensic inpatients in association with the risk of violence and suicidality by primary diagnosis and sex.

Anonymized data were obtained for all eligible inpatients [n = 230; 114 SZ (75 males), 77 PD (40 males), 39 DD (20 males)] who had been admitted (2002–2021) to Elysium Healthcare (UK-wide) medium/low-secure facilities on lipids, age, sex, diagnosis, medication, risk of violence and suicidality, as well as days in seclusion and on high observations due to violence.

Mean total cholesterol (TC) in the patient sample (4.57, s.d. = 1.09) was lower, relative to the age- and sex-corrected UK population norm (4.91 mmol/l). PD (4.46 ± 1.08 mmol/l) and DD (4.24 ± 0.82 mmol/l), compared to SZ patients (4.77 ± 1.14 mmol/l), had significantly lower TC (not explained by statin use; no effect or interaction involving sex). Lower TC had significant though small associations with more days in seclusion or high observation levels due to violence across all patients, and marginally with suicidality in females.

A low TC-violence (towards others) link exists not only for SZ but also for PD and DD and for males and females, encouraging further enquiry into lipids as a biomarker to aid violence prediction in secure care.

Open-door policy is a WHO-recommended framework to maximise safety, prevent coercion, and enhance recovery-based practices during admission to mental health wards. This talk will describe the open-door policy intervention, present results from our 1-year RCT and preliminary 5-year results from the Lovisenberg Open Acute Door Study (LOADS). LOADS is a 5-year in-clinic dual RCT study of open-door policy co-created with user representative and staff in our inner-city acute mental health wards in Oslo, Norway. By combining random allocation, effectiveness outcomes and implementation research, LOADS aims to address the need for faster development of clinically relevant knowledge in mental health.

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Alcohol is a major risk factor for mortality and morbidity worldwide (Agabio et al., 2017). Women are affected by specific alcohol-related consequences, including a dose-dependent increased risk of breast cancer from relatively low levels of alcohol consumption, of which many women remain unaware (Agabio et al., 2022), and risk of foetal alcohol syndrome, in their offspring, if alcohol is consumed during pregnancy (Minozzi et al., 2024). Alcohol use disorder (AUD) is a severe and frequent mental disorder with devasting consequences (Agabio et al., 2017). In US, approximately one out of 4 women suffer for this disorder during their lifetime (MacKillop et al. 2022). Although effective treatments are available (Agabio et al., 2024), AUD is undertreated, with stigma being one of the main reasons for not seeking medical treatment (MacKillop et al. 2022) Women usually experience more severe barriers to AUD treatment than men, with pregnant women experiencing more severe barriers than non-pregnant women (Agabio et al., 2017). Another reason of the scarce use of medical treatment is constituted by the widespread belief that available medications are not effective, or rather, are not effective for all people with AUD. Although sex and gender differences have been described in the response to medications, AUD medications have been studied almost exclusively in men (Agabio et al., 2016). In addition, the number of women with AUD is increasing and services for treatment of AUD should (a) consider women’s specific needs, and (b) realize effective policies to reduce latency prior to accessing medical treatment for both men and women with AUD (Agabio et al., 2021). Nevertheless, recent studies show that only a small number of services have adopted a gender medicine approach in AUD treatment (Vignoli et al., 2024).

Agabio et al. Efficacy of Medications Approved for the Treatment of Alcohol Dependence and Alcohol Withdrawal Syndrome in Female Patients: A Descriptive Review. Eur Addict Res. 2016.

Agabio et al. Sex Differences in Alcohol Use Disorder. Curr Med Chem. 2017.

Agabio et al. Gender Differences among Sardinians with Alcohol Use Disorder. J Clin Med. 2021.

Agabio et al. Alcohol Consumption Is a Modifiable Risk Factor for Breast Cancer: Are Women Aware of This Relationship? Alcohol Alcohol. 2022.

Agabio et al. Efficacy of medications for the treatment of alcohol use disorder (AUD): A systematic review and meta-analysis considering baseline AUD severity. Pharmacol Res. 2024.

MacKillop et al. Hazardous drinking and alcohol use disorders. Nat Rev Dis Primers. 2022.

Minozzi et al. Psychosocial and medication interventions to stop or reduce alcohol consumption during pregnancy. Cochrane Database Syst Rev. 2024.

Vignoli et al. Needs of female outpatients with alcohol use disorder: data from an Italian study. Alcohol Alcohol. 2024.

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Psychotherapy plays a crucial role in mental healthcare. Integrating evidence-based practices into treatment guidelines highlights the need for basic psychotherapy competence in psychiatry training. While programs set minimum requirements for psychotherapy training in line with the recommendations of the World Psychiatric Association or accreditation bodies like the European Union of Medical Specialists, implementation is often inconsistent, and resources are limited. This systematic review explores early career psychiatrists’ (ECPs) views, interests, and available opportunities for psychotherapy training worldwide.

We systematically searched MEDLINE, Scopus, and PubPsych for survey-based studies on ECPs’ perspectives on psychotherapy training, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Of 31,281 studies screened, 48 articles were included. Quality assessment was conducted using the Quality Assessment Checklist for Survey Studies on Psychology, and the findings were summarized through narrative synthesis.

Included studies were from Europe (24, 50%), United States (12, 25%), Western Pacific (6, 12.5%), South-East Asia (4, 8.3%), Eastern Mediterranean (1, 2%), and Africa (1, 2%), with a total of 7,196 participants. Thirty-one studies on ECPs’ interest in psychotherapy training found that 57–80% were interested in psychotherapy, 67–92% viewed being a psychotherapist as part of their psychiatrist identity, and 88–97.7% supported its inclusion in psychiatry training. Training opportunities varied by country and institution, with cognitive behavioral therapy and psychodynamic psychotherapy being primary modalities.

Improving psychiatrists’ access to evidence-based, culturally adapted psychotherapy training is essential. Educational activities offered by training institutions and professional organizations can play a key role in supporting ongoing professional development.

Dual diagnosis, the co-occurrence of substance use disorders (SUD) and mental health conditions, presents unique challenges influenced by gender-related factors. This narrative review explores the role of gender in the epidemiology, treatment access, environmental factors such as intimate partner violence, clinical features, and outcomes of dual diagnosis, highlighting structural and social determinants that exacerbate disparities. Women and gender minorities with dual diagnosis face heightened stigma, higher rates of trauma, and significant barriers to healthcare, often resulting in delayed treatment and poorer prognoses. Additionally, traditional gender roles and caregiving responsibilities influence coping mechanisms and treatment adherence. Despite increasing awareness, research on gender-responsive interventions remains limited. This review underscores the need for gender-sensitive approaches in dual diagnosis treatment, advocating for integrated, trauma-informed care that addresses the specific needs of diverse gender identities.

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Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that often persists into adulthood, significantly impacting daily functioning and quality of life. Sex differences influence ADHD presentation, with females experiencing delayed diagnosis and distinct patterns of severity and comorbidities. Exploring these differences is essential for improving diagnostic accuracy and developing tailored interventions. This study examines ADHD severity, psychiatric comorbidities, and functional impairment by ADHD subtype and sex.

This population-based study included 900 adults diagnosed with ADHD. ADHD severity, comorbidities, and functional outcomes were assessed using validated tools. Bivariate analyses and General Linear Models (GLMs) were applied to examine sex- and subtype-specific effects and their interactions.

Females exhibited greater ADHD severity (p < 0.001), higher levels of depression (p = 0.003) and anxiety (p < 0.001), lower substance use (p < 0.001), poorer functioning (p = 0.039), and greater disability (p = 0.001) than males. No significant sex differences were found in ADHD subtype distribution or age of symptom onset; however, females were diagnosed with ADHD later than males (p < 0.001). The combined ADHD subtype was associated with greater clinical severity, higher levels of depression, anxiety, and impulsive symptoms, increased substance use, and greater disability. A significant interaction between sex and subtype was observed only for disability, with females in the combined subtype exhibiting the most pronounced impairment.

ADHD presents differently across sexes and subtypes, with specific interactions influencing disability. These findings emphasize the importance of considering sex and ADHD subtype independently to enhance diagnostic accuracy and develop targeted treatment strategies.

Clinically derived approaches take the different psycho-social and biological conditions into regard and thus render more homogeneous groups, than the current diagnostic criteria, like ICD-11 or DSM 5. Precision medicine, moreover, shows that the amount of drinking, the reason for drinking and thereby also gender seems to be relevant for testing different anticraving drugs. Precision medicine indicates the necessity for more homogeneous subgroups, in order to find differences in the effects of anticraving substances. Many typologies in AUD render more homogeneous subgroups (Lesch et al, 2020). They could increasingly be used for testing anticraving drugs. After presenting these basics in anticraving research, the results of two trials will be presented. First, some genetic results could only be defined in Lesch type 3 female patients (Procopio et al, 2013). Second, in a treatment trial of ondansetron the genetic conditions lead to better sobriety rates only in the not very high drinking group (less than 10 drinks per day) but not in the very high drinking group (Addolorato et al, 2024). Summarizing these research results we see that for anticraving trials we need even more carefully defined subgroups of AUD patients. References: Lesch OM, Walter H, Wetschka Ch, Hesselbrock MN, Hesselbrock V, Pombo S: Alcohol and Tobacco. Medical and Sociological Aspects of Use, Abuse and Addiction. Springer Verlag, 2nd Edition, 2020. Addolorato G, Alho H, Bresciani M, DeAndrade P, Lesch OM, Liu L, Johnson B.: Safety and compliance of long-term low-dose ondansetron in alcohol use disorder treatment. Eur.J.Intern Med, Sept. 127: 43-49; 2024. Procopio DO, Saba LM, Walter H, Lesch O, Skala K, Schlaff G, Vanderlinden L, Clapp P, Hoffman PL, Tabakoff B. Genetic markers of comorbid depression and alcoholism in women. Alc Clin Exp Res. Jun. 37 (6): 896-904, 2013.

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