Clozapine is a second-generation atypical antipsychotic medication used in patients with treatment-refractory schizophrenia. Its use is limited due to its associated adverse effects, including myocarditis. These adverse effects may have variable presentations, such as myocarditis transient or persistent, and a generalized inflammatory process. Thus, clinical monitoring to inform accurate diagnosis is essential to avoid unnecessary discontinuation of clozapine, leading to psychiatric decompensation.

To review clinical features of clozapine induced Myocarditis and accurately identify signs and symptoms attributed to be most specific for myocarditis and determine at what stage clozapine should be discontinued.

We conducted a literature review on PubMed, MeSH, google scholar and Mount Sinai’s Levy Library using keywords, clozapine, drug related side effects, adverse reaction, myocarditis, treatment resistant schizophrenia. Review of two cases series was done.

A review of 15 articles that addressed the cardiac complications of clozapine was performed. This review provides a base on variable clinical characteristics and outcomes of clozapine –induced Myocarditis. It showed patients who had myocarditis ruled out, demonstrated high prevalence of systemic signs of inflammation such as fever, malaise, tachycardia and elevated c-reactive protein. However, despite clozapine maintenance in most, this systemic response subsided without any intervention. A nonspecific inflammatory response is common when initiating clozapine, this inflammatory “clozapine storm’ occurs within the first month of initiation and is not necessarily predictive of myocarditis. These patients were monitored closely. Those confirmed with clozapine- induced myocarditis using echocardiography and cardiac magnetic resonance imaging were managed with dose reduction, laboratory monitoring, vital signs check, with early initiation of beta-blockers without discontinuation of clozapine, with improvement in their laboratory results and vital signs. Those with progressive clinical signs of myocarditis required immediate cessation of clozapine.

We are proposing a critical need for a multidisciplinary team of psychiatrists, cardiologists and pharmacists collaborating to prevent premature termination of clozapine in cases of treatment-refractory schizophrenia. Our cases showed middle aged patients with treatment - refractory schizophrenia, presenting with symptoms suggestive of clozapine induced- myocarditis, few weeks after initiation. Clozapine was continued with close monitoring, as symptoms resolved. Though clozapine is associated with myocarditis, with proper knowledge on guidelines for monitoring patients, it can mitigate unnecessary discontinuation of clozapine in those patients.

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Studies of differences in the incidence and severity of physical and social anhedonia between women and men diagnosed with schizophrenia spectrum disorder (SSD) are often inconsistent, and gender differences in treatment response have not been well studied. Hormonal factors, such as those related to the menstrual cycle, pregnancy or menopause, as well as social and cultural patterns and roles, may influence treatment response. The incidence of affective or stress-related psychiatric comorbidities may be gender-specific, which could also complicate the treatment of anhedonia and other negative symptoms of SSD. Finally, there is no evidence of sufficient quality on gender differences in the effects of rTMS, but the results are intriguing and point to the need for further research.

To investigate gender differences in the effect of rTMS with the H7-coil on physical and social anhedonia in patients diagnosed with SSD with dominant negative symptoms.

We conducted a randomized, sham-controlled trial during 2000-2023 in the population of patients diagnosed with SSD with primary negative symptoms defined as PANSS negative symptoms subscale score > 24, and PANSS positive symptoms subscale score < 20. The intervention was HF rTMS H7 coil (Brainsway Ltd. Jerusalem, Israel) once daily for 20 days applied to the prefrontal cortex (mPFC and ACC) at 100% motor threshold with a frequency of 18 Hz, and total of 39600 pulses. The outcomes were Physical and Social Anhedonia Scales (PAS, and SAS). We controlled for the large number of relevant covariates.

We randomized 49 men and 29 women of similar age. The effect on physical anhedonia was statistically significant in women (b = 9.04; p = 0.016), but not in men (b = 2.87; p = 0.272). The effect on social anhedonia was similar, but the difference was smaller (for men b = 3.71; p = 0.082; for women b = 5.42; p = 0.043). However, the Wald test showed no statistically significant differences between the beta coefficients for women and men.

Based on this study, it is not possible to make valid and reliable conclusions about the existence of gender differences in the effects of rTMS treatment of anhedonia with the H7 coil. However, it is possible to claim that the treatment of anhedonia with this protocol is effective in women.

None Declared

Maintenance electroconvulsive therapy (ECT) can be effective and necessary in the long-term for patients with severe and recurrent mood or psychotic disorders that are not amenable to any other forms of treatment. Patients with such treatment resistance affecting their ability to maintain minimal daily activities may eventually fall within the palliative psychiatric care domain in which advanced medical directives become an important beacon to direct care. There are Psychiatric Advance Directives which allow people with severe mental health conditions to consent to or refuse to consent to hospital admission and psychiatric treatment in the event they lose decision-making capacity and this can be especially important for a potentially controversial treatment such as ECT. However, the focus tends to be on enforcing involuntary treatment and less about a comprehensive long-term care plan. To our knowledge, there is no available framework to structure maintenance ECT as a patient-centred care plan.

Our aim is to share the process of development of a patient-centred care plan for patients requiring maintenance ECT. Our objectives are:

1. 1. Constant engagement with patients and family or caregivers

2. 2. Regular reviews of clinical and consent aspects of treatment

3. 3. Advocating for the welfare of patients and respect of values

4. 4. Focus on dignity especially for patients who require treatment well into old age

5. 5. Being prepared for termination of treatment if necessary

We reviewed our management of previous and existing patients on maintenance ECT and incorporated diligent consent-taking practices. Adopting good practices from known palliative approaches and involving the patient voice helped to form a framework for a patient-centred care plan.

Our patient-centred care plan features half-yearly discussions about the risks and benefits of treatment, as well as an assessment of the patient’s cognition and ability to consent which may change over time. Opportunities for them to share their values and expectations of care and engagement with their caregivers about their quality of life guide the continued treatment. A framework for discussing the disruption or eventual termination of ECT prepares for scenarios where older-aged patients may develop frailty or present with acute, prolonged or devastating medical concerns. This end-of-life care approach manages anticipated psychiatric-specific behavioural concerns and prepares for the possibility of death following the planned termination of ECT for patients who required long-term treatment throughout their life. Lastly, issues of grief amongst caregivers and ethical concerns from medical staff are addressed.

We hope that our patient-centred care plan provides a well-considered conversation and structure for the initiation, continuation and termination of maintenance ECT in the long-term.

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Electroconvulsive Therapy (ECT) is one of safest and most effective treatments for severe mental illnesses. The ECT Unit of Centro Hospitalar Universitário de Santo António – Magalhães Lemos Hospital (CHUSA-HML) is a reference center for this treatment modality, providing support to the northern region of Portugal.

This study aims to characterize patients undergoing ECT treatment from April to June 2023, at the ECT Unit of CHUSA-HML.

Retrospective study from April to June/2023. Social, demographic, epidemiological and clinical data were evaluated.

Among the 55 patients who were treated there was a predominance in male sex (56%), the average age was 53 years old and only 9 completed higher education. Half of them were in a long-term relationship. Around 67% of patients are retired, predominantly (62%) due to psychiatric disability.

Most patients (78%) were referred through psychiatric consultation and the remainder came from psychiatric hospitalization (only 3 were never hospitalized). 41 patients were under maintenance treatment and 14 under acute treatment. Concerning the type of treatment 30 were submitted to bilateral ECT. For 33% it wasn’t the first ECT treatment. Almost all patients improved their symptoms, only one patient had complications related to the procedure (tooth loss).

According to the international classification of disease (ICD11) the most frequent primary diagnosis was Schizophrenia or Other Primary Psychotic Disorders (58%). Neurodevelopmental disorders and substance use disorders were the most frequently comorbid diagnoses.

The results presented are preliminary, and other data that may be relevant are being collected and processed.

Severe mental illnesses profoundly impact patients, often imposing substantial limitations and suffering. These findings support the safety and effectiveness of ECT as treatment for severe mental disorders. Founding more specialized centers represents an important step toward enhancing mental health treatments. Access to controlled studies is crucial, fostering a deeper understanding of the ECT technique and long-term benefits.

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Despite the importance of electroconvulsive therapy (ECT) as treatment, it remains one of the most controversial and misunderstood treatments. Negative media representations, primitive practice in the past and fear for electricity results in fear that extends beyond other therapies. Research on the perspective and role of informal caregivers (IC) in the process of ECT is limited. Most research focuses on relatives’ attitude or knowledge of ECT measured with questionnaires. However, profound understanding of their perspective can facilitate the role of physicians (or psychiatrists) in guiding patients and their IC through the decision-making process of ECT.

The aim of this study was to describe the perspective of informal caregivers in the decision-making process in ECT treatment.

A qualitative phenomenological study was set up. Semi-structured interviews were held with IC of patients who are treated with ECT. Purposive sampling was based on maximum variation. All interviews were fully transcribed and thematic analyses took place. Trustworthiness was guaranteed by e.g. researcher triangulation

In nine interviews were held with partners, children and parents of patients. The interviews had a mean duration of 102 minutes and interviewing proceeded until saturation of the most important themes was reached. During the interviews it became clear that the decision-making process of ECT is strongly influenced by the illness-trajectory and context of living with the mental health problems of the patient. IC describe their life and that of the patient as ‘trying to survive’. The proposal of ECT is seen as a way out of this unendurable situation. The perceived responsibility of the IC in the informed consent process to ECT adds to this burden. The IC worry, feel uncertain and fear to do wrong. Nonetheless ECT seems to be a beacon of hope. Trust in the psychiatrist as a competent professional who wants the best for the patient seems more important than having an answer to all of their questions. After the ECT has been started, IC establish a framework to evaluate the side-effects and effectiveness of ECT. This framework is based on how they experience the patient in daily life and on what they define as ‘the patient becoming a bit more himself again’. IC weigh the effects and side-effects to support the continuation of ECT. However, if patients clearly express that they experience side-effects that are too hindering, IC follow the patient if he or she wants to stop ECT.

Our study gives an insight in the perspective of the IC of patients undergoing ECT. It could be helpful for IC if the psychiatric team repeats information stepwise and takes the burden of responsibility perceived by the IC into account. The framework used by IC to evaluate the effects of ECT could be a valuable addition to the clinical evaluation of the ECT treatment.

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Metabolic syndrome (MetS) is of primary clinical interest because of its harmful impact on the general health and quality of life of patients with psychotic disorders. Paradoxically, MetS is associated with impaired cognitive functions in patients receiving antipsychotics primarily shown to improve cognition (e.g., clozapine and olanzapine).

In this study, we aimed to investigate the relationship between MetS, cognitive functions, and peripheral inflammation.

The participants were 154 patients with schizophrenia. Fifty-seven patients met the criteria of MetS. We evaluated cognitive functions with the Repeated Battery for the Assessment of Neuropsychological Status (RBANS). The Positive and Negative Syndrome Scale (PANSS) quantified the clinical symptoms. We also measured the plasma levels of IL-6 and C-reactive protein (CRP). In addition to conventional statistics, we also calculated Cohen’s effect size (d) and Bayes Factors (BF10).

Results revealed that patients with MetS exhibited worse cognitive function relative to patients without Mets in attention (d = 0.19, BF10 = 2.3) and delayed memory (d = 0.25, BF10 = 5.7). No significant between-group differences existed in immediate memory, visuospatial functions, and language. The MetS and non-MetS groups did not differ in positive, negative, or general symptoms. Higher IL-6 levels were associated with worse delayed memory (r=-0.56, BF10=34.6).

Our results suggest that MetS-associated cognitive dysfunctions are less severe than reported in the literature: it was confined to two cognitive domains, the effect size was small, and the Bayesian evidence level was weak. Peripheral inflammation may mediate the association between MetS and long-term memory dysfunctions.

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Schizophrenia is a complex psychiatric disorder that changes the patient’s life by influencing how they think, behave, express emotions, percept reality and their interpersonal relationships.

The aim of this study was to evaluate sociodemographic and therapeutic factors that act as risk and protective factors in the clinical outcomes of patients diagnosed with schizophrenia.

This was an observational retrospective study including patients diagnosed with schizophrenia, treated at the “Xhavit Gjata” Psychiatric Hospital, Tirane, Albania, who were discharged between May 1- October 30, 2022. The follow-up period was six months. Data on further hospitalizations during the follow-up were obtained from the Department of Statistics, QSUT, and confirmed by family members for hospitalizations in other psychiatric hospitals in the country. Univariate and multivariate analyses were conducted to identify potential factors associated with emergency room stays, length of stay, and time until the next admission.

A total of 158 patients were included in the study, 63 women and 95 men (p=0.03). The average age of the patients was 42.9 years, with women averaging 45.3 years and men 40.6 years (p=0.01). 43.7% of them had elementary education. The average age of disorder onset was 24.7 years. Haloperidol was the ambulatory therapy used in 54.3% of patients, while atypical antipsychotics were used in 75.1% of patients. The most commonly used atypical antipsychotic was Risperidone in 34.1% of patients, followed by Olanzapine in 17% of cases. Depo antipsychotics were used in 35.1% of patients. Clozapine was administered to 29.3% of patients, where 12.8% for the first time. 54.2% of patients starting Clozapine for the first time had three or more admissions. Clozapine was more frequently used in men, showing a significant difference from women (p=0.05). In 44.7% of cases, monotherapy was prescribed. The average hospital stay was 21.9 days, ranging from 2-68 days. Living with a family member, male gender, and being “married” helped reduce the length of hospital stay. In the 6-month follow-up period, 31.4% were re-hospitalized. Significant factors affecting the reduction of time spent outside the hospital until the next hospitalization were social problems, the number of previous hospitalizations, civil status “not married,” living arrangements, negative symptoms, and alcohol use (nearly significant). Protective factors included Clozapine, which reduced the prevalence of hospitalization by 57% compared to patients not taking it. Additionally, the use of Clozapine and Haloperidol increased the time spent outside the hospital.

Social and family support, positive compliance, and antipsychotic therapy such as Clozapine serve as protective factors for patients diagnosed with schizophrenia.

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The Clinical High Risk (CHR) group for transition to psychotic disorders (PD) is usually defined by the severity of positive symptoms, help-seeking and impairment in level of functioning. However, the CHR concept has a limited transition risk to PD. Recent studies have shown that some of the risks might be attributable to other symptoms.

This study investigates the association between affective and negative symptoms and the risk of transition to PD in a community-based population of 2185 participants in Turkey.

At baseline, psychotic and affective symptomatology were assessed. The same participants were contacted again 6-years later. The initial analysis aimed to assess the link between affective and negative symptoms, and the progression to PD. The independent variable, baseline symptomatology, was categorized into five groups: no Psychotic Experiences (PE)(reference), subclinical PE, subclinical PE accompanied by affective/negative symptoms, clinical PE, and clinical PE with affective/negative symptoms. In the subsequent analysis, the association between affective and negative symptoms at baseline and the onset of PE and PD at follow-up was evaluated. For this analysis, the baseline symptomatology was restructured into two categories: neither PE nor affective/negative symptoms (reference), and the presence of affective/negative symptoms without PE.

The findings from the initial analysis indicated that being part of the ‘subclinical PE only’ group at baseline was not associated with an increased risk of developing PD at follow-up. Being part of the ‘subclinical PE+affective/negative symptoms’ group was not significantly associated with PD at follow-up, although a trend was observed (OR: 3.22; z=1.90; p=0.057). Moreover, being classified as having ‘clinical PE only’ (OR: 6.23; z=2.57; p=0.010) and ‘clinical PE+affective/negative symptoms’ (OR: 8.48; z=4.17; p=0.001) at baseline was associated with an increased risk of developing PD at follow-up. Results from the subsequent analysis showed that being in the ‘affective/negative symptoms’ group at baseline was associated with an increased risk of new subclinical PE (RR: 1.98; z=3.20; p=0.001), new clinical PE (RR: 3.14; z=4.84; p=0.001), and new PD (RR: 4.21; z=2.17; p=0.030) at follow-up, compared to the ‘neither PE nor affective/negative symptoms’ group.

The results confirm that baseline severity of positive symptoms is significant in predicting transition to PD. In addition, the findings imply that not only positive symptoms but also affective and negative symptoms might contribute to the risk of transition to PD as well as incident psychotic symptoms. Defining CHR groups based on a combination of positive, affective and negative symptoms instead of focusing only on positive symptoms likely will help more accurately predict the transition to psychosis.

None Declared

Auditory verbal hallucinations (AVHs) in schizophrenia have been suggested to arise from failure of corollary discharge mechanisms to correctly predict and suppress self-initiated inner speech. However, it is unclear whether such dysfunction is related to motor preparation of inner speech during which sensorimotor predictions are formed. The contingent negative variation (CNV) is a slow-going negative event-related potential that occurs prior to executing an action. A recent meta-analysis has revealed a large effect for CNV blunting in schizophrenia. Given that inner speech, similar to overt speech, has been shown to be preceded by a CNV, the present study tested the notion that AVHs are associated with inner speech-specific motor preparation deficits.

The present study aimed to provide a useful framework for directly testing the long-held idea that AVHs may be related to inner speech-specific CNV blunting in patients with schizophrenia. This may hold promise for a reliable biomarker of AVHs.

Hallucinating (n=52) and non-hallucinating (n=45) patients with schizophrenia, along with matched healthy controls (n=42), participated in a novel electroencephalographic (EEG) paradigm. In the Active condition, they were asked to imagine a single phoneme at a cue moment while, precisely at the same time, being presented with an auditory probe. In the Passive condition, they were asked to passively listen to the auditory probes. The amplitude of the CNV preceding the production of inner speech was examined.

Healthy controls showed a larger CNV amplitude (p = .002, d = .50) in the Active compared to the Passive condition, replicating previous results of a CNV preceding inner speech. However, both patient groups did not show a difference between the two conditions (p > .05). Importantly, a repeated measure ANOVA revealed a significant interaction effect (p = .007, ηp2 = .05). Follow-up contrasts showed that healthy controls exhibited a larger CNV amplitude in the Active condition than both the hallucinating (p = .013, d = .52) and non-hallucinating patients (p < .001, d = .88). No difference was found between the two patient groups (p = .320, d = .20).

The results indicated that motor preparation of inner speech in schizophrenia was disrupted. While the production of inner speech resulted in a larger CNV than passive listening in healthy controls, which was indicative of the involvement of motor planning, patients exhibited markedly blunted motor preparatory activity to inner speech. This may reflect dysfunction in the formation of corollary discharges. Interestingly, the deficits did not differ between hallucinating and non-hallucinating patients. Future work is needed to elucidate the specificity of inner speech-specific motor preparation deficits with AVHs. Overall, this study provides evidence in support of atypical inner speech monitoring in schizophrenia.

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Introduction: Affective patients, especially depressive, have an increased risk of suicidal behavior. Identifying individuals at increased risk remains a challenge. Among the correlates that may be crucial, the impact of personality is emphasized. Attention is paid to impulsivity, measured by subjective or objective tests.

Objectives: Comparative analyses were carried out to capture the differences and relationship between personality dimensions, impulsivity, and the decision-making style and coping with stress strategies in suicide attempters and non-attempters in the course of an affective disorder.

Methods: Data were obtained from 276 individuals diagnosed with unipolar and bipolar affective disorder, both sexes. The study group was disaggregated into a subgroup of patients with (N=95) and without (N=181) suicide attempts in an individual’s history. The Temperament and Character Inventory (TCI) was used to assess personality dimensions. The Barratt Impulsiveness Scale version 11 (BIS-11) was used to measure impulsivity subjectively, and the Simple Reaction Time (SRT) test and the Continuous Performance Test (CPT) were objective assessment methods. The Coping Orientation to Problems Experienced (COPE) and Iowa Gambling Task (IGT) were applied to investigate coping and decision-making styles. Statistical analyses were performed in Statistica 13.3 StatSoft, Krakow, Poland.

Results: In TCI, significant differences between suicide attempters and non-attempters concerned the following dimensions: harm avoidance (HA) (p=<0.0000), self-directedness (SD) (p=0.0001), and cooperativeness (C) (p=0.0186). In the CPT test, significant differences concerned correctly responded trials (p=0.0179) and Bias response (p=0.0230). In IGT, significant differences occurred in IGT block1_sum (p=0.0496) only (Table 1). We did not observe any significant differences in other tests applied. In the Spearman rank correlation analysis in the group of suicide attempters, the following correlations (p>0.05) with at least moderate strength rs>0.4 were revealed: Novelty seeking (NS), SD, and C correlated with several CPT parameters; Persistence (P) correlated with SRT variables; NS, HA and SD with BIS-11 variables.

Conclusions: Objective computerized tests (SRT; CPT; IGT) did not differentiate suicide attempters and non-attempters more clearly than self-reporting personality inventory TCI. Personality traits correlated with SRT and CPT variables. BIS-11 and COPE parameters did not enable to distinguish suicide attempters and non-attempters in the investigated group. This suggests that tests used complement each other, and using a single tool may be insufficient to indicate patients at increased risk of suicidal behavior.

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Police-officers are in a strategic position of providing the first immediate response to a crisis as mental health frontliners.

In this nation-wide cross-sectional study, we explored knowledge and attitudes towards suicide in the local police force, a crucial first step in the design and implementation of effective suicide prevention programmes.

An online, anonymous questionnaire was distributed to all local police-officers (n=2600). It contained questions about their demographics and their experience with suicide while on duty, along with 34 statements from the validated tool Attitudes Towards Suicide (ATTS) (Renberg & Jacobsson. Suicide Life Threat Behav. 2003; 33 52-64), scored on a 5-point Likert Scale (1 = Strongly Disagree, 5 = Strongly Agree).

The sub-scale “Suicide as a right” was positively correlated with “Tabooing” (r (201) = .25, p=<.001), “Normal-common” (r (201) = .29, p=<.001), and “Resignation” (r (201) = .47, p=<.001), but negatively correlated with “Incomprehensibility” (r (201) = -.26, p=<.001), and “Preparedness to Prevent” (r (201) = -.19, p=<.001), meaning such individuals had a more permissive attitude towards suicide. On the other hand, the subscale Preventability was found to be positively correlated with Incomprehensibility (r (201) = .21, p=<.001) and Preparedness to Prevent (r (201) = .30, p=<.001).

Females scored higher in the sub-scale Non-communication (M=3.40, 95% CI [3.29, 3.51]) while males scored higher in Preventability (M=3.35, 95% CI [3.27, 3.44]). The higher the educational status of police-officers, the more they adopt a pro-prevention attitude to suicide (M=3.67, 95% CI [3.44, 3.89]) and the more likely they are to appreciate that suicidal thoughts and behaviour can be common (M=3.40, 95% CI [3.20, 3.60]). Participants with a mixed/different composition at home (M=4.05, 95% CI [3.86, 4.24]) and/or have experienced only between 0 to 2 situations related to suicide in the past one year alone (M=4.05, 95% CI [3.94, 4.16]), were the most likely to feel prepared to prevent suicide.

This study brings out different attitudes police-officers hold towards different aspects of suicide, influenced by their gender, educational background, personal life at home and total exposure to suicide during their career. Training programmes can help improve their knowledge and attitudes towards suicide, leading to a more positive behavioural response to individuals in crisis and create a safer environment. Malta, through an EU-funded programme, is currently investing its resources on drafting a national suicide prevention strategy, and such educational opportunities for our frontliners will ensure we have the right tools in screening, identifying, treating, and saving more lives.

Abbreviations: M: Mean score; CI: Confidence Interval

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Suicidality and depression awareness still remains a concern in Hungary. This programme, based on the principles of the European Union Against Depression, implemented its five steps, such as: 1. improving family doctors’ readiness to diagnose and treat depression, 2. increasing public awareness, 3. training stakeholders and community facilitators, 4. offering special help for risk groups, 5. facilitating self-help by the online tool “ifightdepression” in five of seven districts of Heves county from November 2014 until May 2016.

We aimed to look at some clinical outcome measures of the programme, like diagnosis density of depression in primary care before and after the intervention; diagnosis density of depression in outpatient services; suicide attempts in specialised care; and completed suicide rates.

We extracted patient turnover data from the joint database of the National Healthcare Fund and the National Directorate-General for Hospitals. Raw patient turnover data were divided by the total patient turnover in order to obtain diagnosis density. For the diagnosis of depression, we used the sum of the ICD-10 diagnoses of F32 (depressive episode) to F33 (recurrent depression) plus F4120 (mixed anxiety-depressive disorder), as family doctors tend to use these diagnoses interchangeably. For suicide attempts, we used the diagnoses X60 to X84, plus Y8700. For completed suicides we used the same diagnoses with the “deceased” flag. Diagnosis densities were compared with concurrent national data and were standardised to the long-term average. In the case of outpatient services, we only could retrieve monthly data, which we smoothed out with threemonthly moving averages.

Baseline diagnosis density of depression in primary care was already 44% above the national average when the program started and after the kickoff, it shortly went up to 53,3% and remained over the baseline for as long as until 2019. Also, the recognition rates of depression with no comorbidities in primary care increased by 6%, and steadily remained over the national average until 2019. For outpatient psychiatry, there was an 8% increase in depression turnover throughout the duration of the programme. As regards to suicide attempts treated in hospital, the rates went 20% below the national averages for the duration of the programme, and mostly remained there until 2020. Fatal suicidal events accounted for five to seven deaths a year per county, therefore, simple statistical methods could not uncover significant differences.

These early results indicate that the programme may have been effective in terms of reinforcing the diagnostic and treatment capacities of primary care for recognising a treating depression adequately, thereby eliminating suicide risk. Further statistical exploration of the data is still needed to confirm the magnitude and the validity of these results.

None Declared

Competency and skill-based education and assessment have become increasingly significant in mental health professional training. The conventional approach of acquiring knowledge is now being supplemented by emphasizing practical skills and implementing best practices that prove effective in the field. This emphasis on competencies is particularly apparent in the instruction regarding suicide risk evaluation and management. Cramer and colleagues have identified ten core competencies essential for working with patients at risk of suicide and developed a training material (Cramer et al. 2013, Train. Educ. Prof. Psychol; 1 1-11).

We aim to tailor Cramer et al.’s training program to the Hungarian setting and assess its efficacy among mental health experts, including psychiatrists, clinical psychologists, and social workers. Additionally, we aim to validate the Suicide Prevention and Assessment - Competency Assessment Form (SCAF-R), which comprises a ten-item survey to measure the ten core competencies’ levels with Likert scales and textual ratings by observers. Through this training program, we aim to offer mental health professionals an educational framework to enhance their skills in evaluating and managing suicide risk. Our goal is to provide a comprehensive approach to suicide risk assessment and better equip professionals to handle this emotionally difficult clinical task.

We have created a Hungarian version of the core competencies training material tailored to the culture. We are assessing changes in attitudes towards suicide behavior and prevention by administering pre- and post-training psychometric measures, such as Willingness to Intervene against Suicide (WISE), Suicide Behavior Attitude Questionnaire (SBAQ), Attitudes Toward Suicide Prevention Scale (ASP), and Suicide Competency Assessment Form - Revised (SCAF-R). A quantitative analysis will be performed on the responses. The research was approved by Péterfy Hospital’s Institutional Review Board (IRB): approval number 07-2023.

The questionnaires’ results will be summarized with standard statistical methods.

Improving mental health education in healthcare with up-to-date knowledge of evidence-based best practices is a top priority. Enhancing skills and knowledge can lower clinicians’ anxiety in this emotionally challenging and burdensome task. There is a high demand for mental health workshop training among healthcare workers in both undergraduate and post-graduate education. We expect positive changes in attitude and self-perceived competencies in participants.

None Declared

Basic beliefs can be defined as a person’s implicit, global, stable ideas about the world and about himself. The psychological features of people with suicidal ideas can be considered as characteristics of the value sphere of a person who is ready to choose a destructive way of solving problems.

The relationship of basic beliefs regarding the general «Benevolence of the surrounding world», its «Meaningfulness» and «Worthiness of the Self» with the presence of suicidal ideas was investigated.

The study involved 140 people, (117 women). The Janoff-Buhlman World Assumptions Scale (WAS), the short Epstein Rational-Experiential Inventory (REI)), Simptom Check List-90-Revised (SCL-90R), moral dilemmas (proposed by J.D.Green), as well as separate questions about the suicidal ideation, risk tendency were used.

For analysis, the subjects were divided into two subgroups: 98 people without thoughts of suicide; and 42 people answered that they had thoughts of suicide of varying severity. The subgroups did not differ by gender; in the group with suicidal ideation, the average age of the subjects was lower.

In the subgroup with suicidal ideas, almost all indicators of basic assumptions, such as “Benevolence of the World” (average values of 16.10 ± 3.28 and 12.13 ± 4.80 for the control subgroup and the subgroup with suicidal ideas), were lower: “Benevolence of the People “ (15.35±3.07 and 12.42±4.97), “justice” (12.46±3.30 and 10.46±3.60), “value of one’s own self” (16 .21±3.93 and 11.83±5.15), etc., with the exception of the “Self-controllability”, which does not differ between subgroups. Also, in the subgroup with suicidal ideas, the indicators of “randomness” were increased (15.67±3.64 and 18.67±3.96). Indicators on the clinical scale “Hostility” of the SCL-90R questionnaire are also significantly higher in the group with suicidal ideation (average values 0.53±0.5 and 1.29±0.8). In the group with suicidal ideation, there is a higher tendency to take risks. At the level of a statistical trend, the rational method of decision-making in the “Rational - Intuitive” questionnaire is lower (average values 14.3 and 13.0; significance level of differences 0.05). In the “Moral Dilemmas” test, in the subgroup with suicidal ideas, the ratio of choices in personal and impersonal dilemmas is statistically higher (0.67 and 0.93).

It was shown that the presence of suicidal ideas is associated with a reduced indicator of the Worthiness of the Self, the meaningfulness of the world and its benevolence, and with an increased sense of randomness as a principle for distributing ongoing events, which can manifest itself in a propensity for risk, impulsive decisions, devaluation of human life.

None Declared

The purpose of this study is to investigate the potential relationship between stressful events experienced in childhood and subsequent toxic substance consumption among university students majoring in Social Education at a Spanish university during the academic year 2022-2023.

The primary objective is to analyze whether an association exists between stressful life events in childhood and patterns of substance consumption among university students.

A cross-sectional, observational, and analytical design was employed. The target population encompassed 258 students enrolled in the Social Education program in 2023. The final sample consisted of 161 students. A questionnaire incorporating the Childhood Trauma Questionnaire - Short Form (CTQ-SF) and the Severity of Dependence Scale (SDS) was administered to assess trauma history and substance consumption.

A high percentage (95.03%) of students reported having consumed toxic substances at some point in their lives. The most common substances were alcohol (95.03%) and cannabis (52.8%). A statistically significant correlation was observed between childhood emotional abuse and increased alcohol consumption currently (p = 0.015). Furthermore, a significant relationship was identified between childhood sexual abuse and heightened alcohol consumption (p = 0.015). Moreover, positive correlations were found between sexual abuse and the consumption of specific drugs, such as cocaine and psychopharmaceuticals (p < 0.05).

No statistically significant differences were observed in drug consumption with regard to other forms of childhood maltreatment, such as emotional or physical neglect.

The results underscore the connection between childhood stress experiences and substance consumption among university students. Emotional and sexual abuse in childhood are linked to higher alcohol consumption and, in some cases, specific drugs like cocaine and psychopharmaceuticals. These findings emphasize the importance of considering traumatic experiences when addressing prevention and treatment strategies for substance consumption among young student populations.

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Schizophrenia, a chronic and complex psychiatric pathology, can be isolated. However, it can be associated with other comorbidities and thus be accompanied by addictive behaviors that complicate their management.

The objectives of our study were to estimate the prevalence and identify the characteristics of addictive behaviors in patients with schizophrenia.

A retrospective study of 151 patients with schizophrenia hospitalized in the psychiatry department of Taher Sfar University Hospital in Mahdia from January 2017 to December 2021.

The mean age of the patients was 39.8 ± 11.23 years, with a predominance of the 36-45 age group (38.4%). All patients were male. Three quarters of the patients (75.5%) were users of psychoactive substances (PAS): nearly three quarters (72.8%) were addicted to tobacco, more than one third (39.7%) were addicted to alcohol, more than one quarter (29.1%) were addicted to cannabis and nearly one quarter (26.5%) were addicted to other PAS. In more than half of the cases (54.4%), the age of onset of substance use was between 16 and 25 years. The use of PAS preceded the onset of schizophrenia in 62.3% of cases. The relationship with the entourage was marked by hetero-aggressiveness in 77.5% of patients, withdrawal from the entourage in 16.6% of patients and conflict in 5.3% of patients. The impact on the relationship with oneself was marked by self-aggressiveness in 18.5% of patients. Concerning the professional impact, three quarters of the patients (76.1%) had to stop working. The majority of patients (84.1%) continued their usual treatment, while 15.2% of patients stopped it. Only one patient required an increase in dose.

Subjects suffering from schizophrenia are particularly vulnerable to addictions, mainly to tobacco and alcohol. They are thus a group more at risk of the deleterious effects of psychoactive substances and of the aggravation of the clinical and psychosocial evolution of their psychiatric disorders. Measures for early detection and treatment of their addictive behaviors even before the onset of schizophrenia should be proposed.

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Substance use disorders (SUDs) are associated with high rates of comorbid depression. Finding effective treatments for many of the substances of abuse is still an area of developing research. Repetitive transcranial magnetic stimulation (rTMS) is an established treatment for depression, but its effects in SUDs are less conclusive.

Therefore, we aimed to investigate the effect of rTMS in patients with SUDs and comorbid major depressive disorder (MDD).

We conducted a retrospective observational study of 55 patients with SUDs and comorbid MDD who were eligible for rTMS. Craving was measured using the Brief Substance Craving Scale (BSCS). Severity of MDD was measured using the Clinical Global Impression-Severity (CGI-S) scale.

We found a statistically significant difference between baseline and posttreatment scores in patients receiving rTMS on both CGI-S scores and BSCS scores. The number of rTMS sessions significantly predicted increased days of abstinence in the community, even after controlling for confounders.

Patients with SUDs and MDD who received rTMS significantly improved in the areas of severity of depression and craving. The number of rTMS sessions significantly predicted increased abstinence.

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Use of psychoactive substances is a risk factor for mental health. Studying the peculiarities of using psychoactive substances by university students is extremely important for organizing preventive health care

To specify the frequency of smoking and alcohol drinking, as well as the peculiarities of the correlational interconnections, in domestic and foreign university students

The survey covered 546 undergraduate domestic and foreign university students of both genders and different religious backgrounds. As a tool, we used the Sociocultural Health Questionnaire (E. Nikolaev)

It has been revealed that domestic students smoke cigarettes and hookahs surely more often (p=.01) than foreign students (30.49% vs 19.08%). It is obvious that they also more often (p=.01) use electronic cigarettes or vaping drugs (25.24% vs 12.86%) and alcohol (54.42% vs 9.96%). Students in both groups denied using other psychoactive substances. Foreign students reveal positive correlational interconnections between smoking and alcohol drinking (r=.44), while there is no evidence of such interconnections in domestic students. Both groups show valid interconnections between the frequency of smoking and the level of stress (r=.15 и r=.17 correspondingly), the frequency of smoking and monthly financial expenses (r=.21 и r=.22 correspondingly). With domestic students, vaping negatively correlates with exercising in gyms (r=-.12), with foreign students it directly correlates with bodybuilding supplements consumption (r=.15). Those foreign students who drink alcohol more often point to the necessity of having a psychologist in the university (r=.13).

The revealed general and specific factors associated with domestic and foreign students’ use of psychoactive substances call for the necessity of developing culturally differentiated preventive programs

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Social networks (SN) addiction is a serious problem among young adults that requires increased attention.

The aim of the study was to assess the relationships between internet addiction and selected psychological characteristics of university students.

This is a descriptive and analytical study, conducted over the period from November 2022 to January 2023, among students in various fields. SN addiction was measured using the Social Media Addiction Scale-Student Form (SMAS-SF). The Rosenberg scale was used to assess global self-esteem and the Social Self-Esteem Inventory was used to assess social self-esteem. The Big Five Personality-10 (BFI 10) scale was used to assess the 5 personality dimensions.

A total of 116 students, with an average age of 25.49, took part in the study. Most students (91.4%) were over 20 years old. They were female in 78.4% of cases. They enrolled in postgraduate studies in 55.2% of cases. The majority of students (59,5%) studied medicine. According to the SMAS-SF scale, the average score was 75.87. The mean score for social self-esteem score was 122.03. Sixty-four participants (55.2%) had low and very low self-esteem. The dominant personality dimensions were extraversion and neuroticism in 15.5% each. Addiction to SN was significantly associated with very low global self-esteem (p=0.028) and a lower social self-esteem score (p=0.011). Low conscientiousness and neuroticism were significantly associated with increased SN use (p=0.007, p=0.004 respectively).

This study provides a better understanding of the phenomenon of addiction to SN, and enables us to tailor prevention and care more effectively. The psychological factors associated with this behavior need to be more explored in future research.

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Buprenorphine/Naloxone (B/N) is a safe and effective treatment for the long-term stabilization of individuals with opioid use disorder (OUD). Patients undergoing opioid maintenance treatment experience reduced mortality rates, decreased substance use, and an overall improvement in their quality of life. Premature discontinuation of maintenance treatment increases the risk of relapse.

Our primary objective was to assess patient compliance with maintenance treatment and to identify potential factors associated with treatment discontinuation and relapse.

The study involved 206 patients with OUD who initially enrolled in a 28-day abstinence-based inpatient program at our hospital. Following their inpatient treatment, they were subsequently admitted as outpatients for B/N maintenance treatment at the Alcohol and Substance Addiction Treatment Center in Trakya University School of Medicine (Edirne, Türkiye). The addiction profiles of patients were assessed using the Addiction Profile Index (API) Clinical Form during the baseline evaluation. Sociodemographic and clinical data were collected from the patients’ records.

After 3 months, 114 patients (55.3%) remained in treatment, and 52 patients (25.2%) were still in treatment at the end of 1 year. Factors associated with a higher likelihood of remaining in treatment for one year included older age (z=-2.257, p=0.024), longer length of education (z=-2.270, p=0.023), later onset of smoking (z=-2.704, p=0.007), later onset of substance use (z=-3.597, p<0.001), and a higher rate of completing the inpatient treatment program (χ²=4.016, p=0.045). Patients in the 1-year retention group had lower scores on the API anxiety (z=2.767, p=0.009), anger management problems (z=2.754, p=0.011), and novelty-seeking behavior (z=2.634, p=0.043) subscales. They also had a lower rate of having a criminal history (χ²=5.349, p=0.021). The duration of treatment retention was positively correlated with age (r=0.160, p=0.021), length of education (r=0.158, p=0.023), age of onset of smoking (r=0.228, p=0.001), and age of onset of substance use (r=0.268, p<0.001). It was negatively correlated with the duration of substance use (r=-0.138, p=0.048), the number of inpatient treatments (r=-0.142, p=0.042), and scores on the API anxiety (r=-0.167, p=0.040), anger management problems (r=-0.173, p=0.033), and novelty-seeking behavior (r=-0.209, p=0.010) subscales.

Identifying the specific factors associated with treatment retention and dropout/relapse can be valuable in developing more effective and personalized treatment plans for individuals with OUD.

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