According to the UN Refugee Agency, around 100 million individuals were estimated to be forcibly displaced worldwide in 2022 due to violence, war or other human rights violations. This represents a doubling in the global population of forcibly displaced individuals during the last decade. War migrants are frequently exposed to multiple traumas, including direct or indirect exposure to violence, as well as extended periods of insecurities in access to housing, clothes, food, education and health care. As a corollary, war migrants face extensive health risks, including elevated risks of psychiatric disorders with potential implications for the development of other conditions, e.g. autoimmune and cardiovascular diseases. The most recent evidence of the health risks of war migrants will be reviewed along with possible mitigating factors of such adverse sequalae.

None Declared

The PTSD diagnosis was in 1980 largely facilitated by consequences of the Vietnam War. Since then, there have been hundreds of other war-related conflicts in the world. My presentation will distinguish between war-related trauma effects on military personnel (where most research has been done) and on civilians, distinguishing effects on children/adolescents, adults and older people. I will answer the question, how do war-related trauma sequelae differ from other man-made or accidental traumas? Further, I will address the issue of whether “moral injury” research in military personnel after wartime operations is also relevant to similar phenomena in civilian populations traumatised by war? Which of the brain-related research approaches (localisation, network connectivity, altered RDoC functions) are particularly relevant in this context? Finally, emerging research priorities related to the current war of invasion against Ukraine will be addressed.

None Declared

Gambling disorder was reclassified as a first behavioral addiction in the DSM-5 in 2013. In 2018, gaming disorder was included in the ICD-11. In this presentation, research findings regarding the psychological and neurobiological mechanisms in gambling disorder and other behavioral addictions are highlighted. Specifically, neural and behavioral responses regarding reward expectation, reward outcomes, and the role of specific mechanisms in gambling like near wins, and in gaming, like lootboxes are highlighted. Besides the recognition of gambling disorder, the broader perspective of gambling harms is highlighted and related to psychosocial, financial, and health consequences. The perspective of interaction between human design factors (e.g. psychological and neurobiological mechanisms, such as decision making, reward processing) and gambling design factors (e.g. near wins, multiline betting) is reviewed. Evidence with regard to psychological and pharmacological interventions are discussed and future directions for research perspectives are discussed.

A. Goudriaan Grant / Research support from: Anna Goudriaan received grants from the Dutch Foundation for Scientific Research (NWO and ZonMw) and from VCVGZ Foundation

Digital interventions for common mental disorders are coming of age. The uptake of evidence-based self-guided and guided (a-synchronic in time) cognitive behavioural digital interventions for depression and anxiety in routine care is however low. Blended treatment formats appear an attractive alternative for routine care settings as these combine face-to-face sessions with digital ones in integrated treatment protocols. Yet little is known about the clinical and cost-effectiveness of blended CBT (bCBT). In this presentation I will touch upon the current state of the art of digital interventions for depression and anxiety disorders, including blended formats in routine care and I will go beyond that state by addressing new developments. I will illustrate these new developments by virtue of several studies (RCT’s) we conducted on the clinical and cost-effectiveness of blended CBT interventions (and their implementation) in routine care settings. A specific focus will be put on blending digital phenotyping in CBT treatment which includes mobile ecological momentary assessment tools and AI algorithms.

While digital mental health for depression and anxiety in routine care was boosted through the Covid-19 pandemic, the question remains whether the current knowledge base will leveraging digital mental health research and services to the next level. Implications for future research on blended treatments and clinical applications in routine care will be discussed.

None Declared

Mental health problems have a substantial economic impact across the world. Those who have their problems detected may receive therapies (usually medication or psychological) or who packages of care (for example, early intervention or residential support). Some problems are transient while others will remain across the life course. Costs are closely associated with care received and it may be that costs need to rise in order to provide adequate support. Economic costs also occur due to lost opportunities such as work and leisure. This talk will summarise recent estimates of the cost of mental health problems in a number of countries.

Establishing total costs does not tell us how to use limited resources. This requires the use of economic evaluation methods such as cost-effectiveness and cost-utility analyses. There is a growing evidence base from such evaluations for many psychological and pharmacological interventions and recent key findings will be discussed. The need for long-term, life course approaches to economic evaluation of mental health interventions will be proposed.

None Declared

Over a 5-year program-project, focusing on 4 of the most disabling disorders (i.e. Bipolar Disorder, Major Depressive Disorders, Schizophrenia, and Autism Spectrum Disorders), PROPSY’s ambition is to bring solutions for precision medicine in psychiatry. This ambition requires overcoming multiple challenges: (i) to discover prognostic and stratification biomarkers, (ii) to better understand underlying causes and mechanisms, (iii) to develop targeted therapeutic strategies (iii) to reduce stigma and false representation, (iv) to reduce the direct and indirect economic costs. To tackle these challenges, PROPSY is an inclusive program project composed of 5 operational work packages. PROPSY will also implement this knowledge into clinical practice, in a truly learning healthcare system, and increase awareness with Patients’ Associations to reach out to civil society. This research effort in precision psychiatry aims to strengthen the coordination of the French workforce along with international collaborations in connection with users and policymakers

None Declared

After a short review of the state of the art of clinical staging in schizophrenia, I will present a recently developed empirical staging model.

Two hundred twelve stable outpatients with schizophrenia from Oviedo (Spain) were assessed with: an ad hoc questionnaire (demographic, clinical information); psychopathology: PANSS, CDS, OSQ, CGI-S; functioning: PSP; cognition: MATRICS; lab tests: C-Reactive Protein, IL-1RA, IL-6, Platelet/Lymphocyte (PLR), Neutrophil/Lymphocyte (NLR), and Monocyte/Lymphocyte (MLR) ratios.

An ad hoc genetic algorithm (GA) was developed to select those variables showing the best performance for patients’ CGI classification. The objective function of the GA maximizes the individual’s correct classification of a support vector machines (SVM) model that employs as input variables those given by the GA. Models’ performance was assessed with the help of 3-fold cross-validation, and this process was repeated 10,000 times for each one of the models evaluated. Once developed, we used the ANOVA test (Duncan’s post-hoc) for all the variables included in the model to demonstrate its construct validity.

Our model included the following variables: positive, negative, depressive, and general psychopathological symptoms, processing speed, visual learning, social cognition, and real-world functioning. Its classification accuracy is 64.54% (SD=4.83%) with a specificity and sensitivity of 0.85 and 0.63. The external validity of the new model is being tested using a French sample from the FACE-SZ (FondaMental Advanced Centers of Expertise-Schizophrenia) cohort.

We developed an SVM model including psychopathological, cognitive, and functional variables.

Our model demonstrated good construct validity since all the variables included behaved as expected. That is, they score significantly worse as the patients’ severity increases. Besides, it showed good accuracy, specificity, and sensitivity classification properties.

Using staging models in daily clinical practice will help clinicians to better.

None Declared

In many fields of heath, precision medicine has been integrated in clinical practise, for instance in oncology. In the case of psychiatry, and in particular bipolar disorder, we are in a prior step for the moment. Different proposal of stratification will be described during the talk for instance the classification of staging. Moreover some proposal of precision psychiatry in bipolar disorder will be put forward.

None Declared

Ghrelin, a stomach-derived hunger and appetite signal, drives behaviors that ensure we seek out and consume foods, not only in situations of energy deficit but also when anticipating palatable foods. Key target pathways for ghrelin include the orexigenic agouti-related peptide (AgRP) neurones in the hypothalamic arcuate nucleus (Arc), that appear to confer the unpleasant feelings of hunger. They also include dopamine neurones in the ventral tegmental area, where ghrelin heightens motivation for food rewards. Recently, we have employed a variety of neural circuit mapping techniques in rodents to help clarify the function of populations of ghrelin-responsive targets. We found that 1) chemogenetic activation of ghrelin-responsive cells in the Arc is sufficient to drive a feeding response and to induce food-motivated behaviour and 2) that dopamine neurones in the VTA are activated when mice are exposed to cues that predict a food reward than to its retrieval, as revealed by fiber photometry recordings from these cells. Further studies aim to determine the role of ghrelin-responsive cells in the parabrachial nucleus of the brainstem. Overall, the brain ghrelin signalling system is well positioned to integrate the response to hunger, enhanced by both intrinsic and external cues and in ways that are relevant to curb over-eating in obesity.

None Declared

The last decade has seen an enormous expansion on our knowledge of the human gut microbiome and its importance for human physiology. The gastrointestinal inhabitants have taken centre stage as regulators of the bidirectional gut to brain communication. The gut microbiota is not only critical for metabolism, glucose homeostasis and body composition, but increasing evidence is demonstrating the significant effects of the gut microbiota on mood and mental wellbeing and its role in the development of affective disorders, such as anxiety and depression, and other neuropsychiatric conditions. Studies in the field of nutritional neuroscience and nutritional psychiatry are now increasingly including the gut microbiota as a key factor mediating the impact of diet on central nervous system function. Accumulating evidence from cell-based in vitro studies, animal models and preclinical intervention studies are linking the gut microbiota to the effects of diet on brain function, but the precise mechanism are still not fully understood and studies have had limited translation to human intervention studies. Overall, the increase in our understanding of interconnectedness of the gastrointestinal microbiota of human health and disease, has led to a strong focus on the development of microbiota-targeted strategies to influence all host physiological responses, including those that can modulate central nervous system function. In this talk, I will provide an overview of the most recent advances in the nutritional psychiatry–microbiome field, highlighting significant opportunities for future research.

None Declared

Striatal dysfunction is a key characteristic of addictive disorders, but neuroimaging studies have reported conflicting findings. An integrative model of addiction points to the presence or absence of addiction-related cues as an explanation for striatal hypo- or hyperactivations, respectively, but has never been directly tested. Here, we developed a novel paradigm to investigate striatal activation during monetary reward anticipation in the presence versus absence of addiction-related pictures using functional MRI. Across two studies, we compared 24 gambling disorder (GD) patients with 22 matched healthy controls and 46 alcohol use disorder (AUD) patients with 30 matched healthy controls. A behavioral interaction was seen where gambling cues made participants respond faster for bigger, but slower for smaller rewards. During monetary reward anticipation, hypoactivation of the reward system was seen in AUD individuals compared to HCs. However, no striatal differences were seen between the participants with GD or AUD and their matched controls. In sum, these findings suggest that striatal dysfunction is a key but heterogeneous mechanism within both AUD and GD and indicate an important but complex role for addiction-related cues in explaining striatal dysfunction in addiction.

None Declared

Neuroimaging studies of addiction seek to understand the brain mechanisms that predispose to and support the maintenance of addictive behaviors. Traditional studies are case-control cross-sectional studies, i.e. they conceptualized individuals suffering from addiction as a homogenous group, and report lab-based experiments conducted at one particular point in time. In this talk, I will argue that a refined understanding of addictive behaviors requires the use of dimensional longitudinal studies. Using dimensions will reveal the existence of heterogenous profiles within diagnostic groups, and allow researchers to incorporate individual variability in their models. In turn, using longitudinal follow-up measures should allow researchers to determine whether brain-related abnormalities are predictive of symptoms in real-life. I will illustrate these points using a few example studies from the literature.

None Declared

The field of treatment and understanding in psychosis is evolving at an unprecedented pace with advances in neuroscience. It takes time before research findings are translated to clinical practice. Daunting as it is, clinicians need to keep up with findings which change our practice straightaway (new medication), findings which suggest that changes are expected in future (new theories about how illness develops and can be predicted) and findings which remind us of continuing practice and the evidence behind them (long term follow-up studies which give no big surprises but consolidate existing knowledge).

In a snap shot, I bring to you a range of five papers published in 2022 which enrich our understanding of psychosis, its development and treatment.

None Declared

The COVID-19 pandemics brought numerus changes in the European mental health systems. One of the major, was the widespread introduction of digital psychiatry across the globe, as the only possible option to maintain the psychiatric care. On February 28th 2022, the European Psychiatric Association has started a network of solidarity for Ukraine to respond to the needs of people in Ukraine as verbalized by the Ukrainian mental health professionals, but also to the need of surrounding countries where people from Ukraine fled to. As verbalized by the colleagues from Ukraine and surrounding countries, one of the unmet educational needs was the education for first line helpers and volunteers from Ukraine and countries surrounding Ukraine where displaced persons fled to. This resulted in the series of webinars on the topics detected as unmet needs (what is normal response to trauma, how to triage dispaced persons in need of help, how to provide first psychological help, how to approach to children of different ages, how to take care of one-self and what is the role of supervision). The webinars were delivered by experienced clincians, trauma experts and experts with lived experince in the war zones, incliding the ones from Ukraine. These are available freely at the EPA website https://www.europsy.net/resource-page/, in several languages.

None Declared

Conventional antidepressants, such as SSRIs, are an effective treatment for many patients with depression. However, for a significant proportion of patients SSRIs either lack efficacy or are poorly tolerated. Even when SSRIs are effective in treating mood symptoms, there are often residual symptoms that are not well treated, including cognitive impairment and anhedonia. The development of novel treatment for depression is particularly challenging given the limited predictive validity of animal models. Human neurocognitive models of antidepressant action can help to bridge the translational gap and allow rapid investigation of novel compounds in healthy volunteers and people with depression. In this talk, using the 5-HT4 receptor as an example of a novel target of interest, I will outline how these objective neurocognitive models can be used as a translational tool to understand antidepressant treatment mechanisms, guide treatment selection and test novel putative antidepressants early in development.

S. Murphy Grant / Research support from: Zogenix, UCB, Janssen, Consultant of: Zogenix, Sumitomo Danippon, Janssen, UCB, Speakers bureau of: Zogenix

Conclusions about the efficacy of antidepressants, such as the selective serotonin reuptake inhibitors (SSRIs), in clinical trials have generally been based on analyses of total sum scores on psychometric rating scales, mainly the Hamilton Depression Rating Scale (HDRS). However, this rating scale has several drawbacks, such as multidimensionality and a tendency of several items to pick up side-effects. Therefore, analyses that only rely on global drug treatment effects on the HDRS and similar scales risk misrepresenting important properties of any drugs investigated.

This presentation concerns the findings of a research project investigating item-level effects of SSRIs in treating depression in a material encompassing 8262 patients having participated in pre- and post-marketing industry-sponsored studies concering paroxetine, sertraline or citalopram. This has been a fruitful endeavour, having resulted in numerous research papers. Though our main focus at the outset was to investigate if a comparatively low efficacy of SSRIs in clinical trials was an artefact related to the use of HDRS sum scores as the main outcome (which was indeed the case), we have also used this material to investigate a number of other important questions relating to the influence of SSRIs on the various symptoms experienced by patients with depression. Major findings discussed in the presentation include: i) confirmation of early (but not widely known) reports that SSRIs significantly reduce core depression symptoms already after a week of treatment ii) strong evidence for SSRIs being equally effective in treating core depressive symptoms in mild as well as severe depression, earlier reported differences apparently being explained by differences in terms of effects (and prevalence) of non-core symptoms iii) SSRIs do not seem to exacerbate suicidality as measured by the relevant item of the HDRS scale - indeed, both average scores as well as likelihood of worsening are significantly reduced already at week 1. The implications of these, and other, findings are discussed in relation to both the role of SSRIs in the clinic as well as pre-clinical research into e.g. the mode of action of these drugs.

None Declared

Interest in possible clinical uses for psychedelic drugs has grown steadily over the past decade. Although impressive findings from small studies stimulated considerable speculation and provided a strong justification for further study of psychedelic treatments, until very recently there was a dearth of high-quality evidence for their efficacy, mechanisms of action, and appropriate treatment models for clinical use. However, during the past 2-3 years, there have been dramatic advances in the field. This presentation will focus on 5 publications in the field of psychedelic medicine that exemplify three important aspects of the recent progress in psychedelic research. (1) There has been a rapid increase in the number and size of controlled clinical trials of various psychedelic treatments. (2) Conceptual models for studying and potentially understanding the therapeutic effect of psychedelics have increased in sophistication and comprehensiveness. And (3) progress has been made toward developing models of treatment that would facilitate access to safe and effective psychedelic treatments, if and when they are approved by regulatory bodies. Although progress has been rapid, the field of psychedelic medicine is still in its infancy. Much more work on these and many other fronts will be necessary to discover what the study of psychedelics can contribute to healthcare and neuroscience.

None Declared

This talk will focus on the pitfalls of using multidimensional rating scales to measure the severity of depression – with particular emphasis on the Hamilton Depression Rating Scale (HDRS-17). First, the history behind the development of the HDRS-17 will be briefly covered. Second, it will be argued that the HDRS-17 measures symptoms that overlap with common antidepressant side effects (gastrointestinal dysfunction, sexual dysfunction, somatic anxiety and sleep disturbances), making it possible that side effects of antidepressant treatment are erroneously rated as symptoms of depression.

The rest of the talk will focus on the results of a recent study (1) in which we used individual-level data from antidepressant treatment trials to assess whether side effect ratings co-vary with HDRS-17 ratings. Specifically, data from all HDRS-17-rated, industry-sponsored pre- and post-marketing trials (n = 4647) comparing the serotonin and noradrenaline reuptake inhibitor, duloxetine, to placebo and/or to a selective serotonin reuptake inhibitor were pooled. Severity was assessed for side effects related to sleep, somatic anxiety, gastrointestinal function, and sexual dysfunction. Analysis of covariance was used to assess the relation between these side effects and ratings of relevant HDRS-17-derived outcome parameters. Side effects related to sleep, somatic anxiety and sexual dysfunction significantly and exclusively associated with higher scores on HDRS-17 items measuring the corresponding domains. Side effects related to gastrointestinal function associated with higher HDRS-17 item scores on all assessed domains. Treatment outcome was significantly related to side effect severity when assessed using HDRS-17-sum (beta 0.32 (0.074), p < 0.001), but not when the HDRS-6-sum-score (beta 0.035 (0.043), p = 0.415) or the depressed mood item (beta 0.007 (0.012), p = .527) were used as effect parameters. That some HDRS-17 items co-vary with common antidepressant side effects likely leads to an underestimation of antidepressant efficacy. Finally, based on data from a recent study (2), it will be argued that the Montgomery-Åsberg Depression Rating Scale is biased in the same direction as the HDRS-17 (underestimates antidepressant efficacy), albeit to a lesser extent.

1. Hieronymus et al. Do side effects of antidepressants impact efficacy estimates based on the Hamilton Depression Rating Scale? A pooled patient-level analysis. Transl Psychiatry. 2021;11:249.

2. Hieronymus et al. The response pattern to SSRIs as assessed by the Montgomery-Åsberg Depression Rating Scale: a patient-level meta-analysis. World Psychiatry. 2022;21:472-473.

S. D. Østergaard Shareolder of: SDØ owns/has owned units of mutual funds with stock tickers DKIGI, IAIMWC, SPIC25KL and WEKAFKI, and has owned units of exchange traded funds with stock tickers BATE, TRET, QDV5, QDVH, QDVE, SADM, IQQH, USPY, EXH2, 2B76 and EUNL., Grant / Research support from: SDØ is supported by grants from the Novo Nordisk Foundation (grant number: NNF20SA0062874), the Lundbeck Foundation (grant numbers: R358-2020-2341 and R344-2020-1073), the Danish Cancer Society (grant number: R283-A16461), the Central Denmark Region Fund for Strengthening of Health Science (grant number: 1-36-72-4-20), the Danish Agency for Digitisation Investment Fund for New Technologies (grant number 2020-6720) and Independent Research Fund Denmark (grant numbers: 7016-00048B and 2096-00055A).

Digital technologies help to improve the work of psychiatric services through the use of modern approaches.

The use of telepsychiatry (TP) during war allows people with psychiatric disorders to receive quality treatment that would otherwise be unavailable.

TP and other digital technologies are an important resource for providing psychiatric care to internally and externally displaced persons affected by war.

As our experience shows, the conditions for effective use of TP are availability of legislative, technical and staff base. The services are implemented according to the protocol, which defines the methods of treatment’s effectiveness evaluation.

The presentation will provide methodological approaches to the use of TP and other digital tools.

None Declared

The value of pharmacological antidepressants have been contested since they were first introduced in the 1960s, but the points of contention have varied over time. This session will examine and critically discuss some of the concerns that are commonly voiced today, with particular emphasis on the evaluation of efficacy. The session will cover topics such as the utility of dichotomized outcome measures (e.g., response and remission) and whether the use of these measures risk inflating apparent efficacy, whether antidepressant effect sizes are too small to be clinically meaningful, and whether there is individual variability in the response to pharmacological antidepressants.

F. Hieronymus Speakers bureau of: I have received speaker’s fees from Janssen and H Lundbeck.