Extremely preterm newborns - EPTN (born ≤28 weeks gestational age) are at increased risk of developing autism spectrum disorders (ASD). Demographic and perinatal risk factors associated with ASD risk in EPTN are understudied.

(i) In EPTN and born at full-term healthy controls (HC), to characterize the emergence of ASD traits and autistic symptom load at age 18 months; (ii) in EPTN, to identify the influence of perinatal characteristics such as sex and gestational age on autistic symptom load at corrected-age 18 months.

Observational, longitudinal, prospective, 18-month follow-up study. We recruited a cohort of n=113 EPTN and n=47 HC (the PremTEA cohort); n=57 EPTN and n=42 HC successfully completed the 18-month follow-up visit. We assessed autistic symptom load & risk at 18 months using the M-CHAT-R/F questionnaire. For all EPTN and HC, we collected demographic and perinatal data. Using GLMs, we assessed, in EPTN, the association between demographic/perinatal variables and 18-month autistic symptom levels.

At 18 months, EPTN children showed higher autistic symptom levels than HC (M-CHAT-R/F score, mean (SD) [range] = 2.21 (3.23) [0-12] in EPTN vs. 0.33 (0.57) [0-2] in HC; d=.873, p=.001. In EPTN, we identified differences by gestational age and sex in autistic symptom levels at 18 months (aR2=0.517, p=.006). In particular, female EPTNs born with lower gestational age showed higher autistic symptom load at age 18 months.

Our findings support the need for early screening of ASD symptomatology in EPTN infants, particularly in higher-risk subgroups, such as female patients born with lower gestational ages.

None Declared

The COVID-19 pandemic has stressed global healthcare systems, with Taiwan’s National Health Insurance (NHI) playing a crucial role in prevention and treatment. Like other countries, Taiwan grappled with managing the virus alongside regular healthcare services, resulting in notable financial strain on hospitals after COVID-19 pandemic.

This study explores the financial implications of the psychiatric department at a medical center in Taiwan, highlighting the changing dynamics of healthcare costs and revenue during this period.

Data were collected monthly between January 2020 and September 2022, including the number of outpatient visits, inpatient patient-days, medical revenue, medical costs, and gross medical profit. Multivariate linear regression analysis confirmed the assumptions of the model and validated the findings.

Regression analysis revealed a significant correlation between the number of patients and financial indicators (USD1). Medical revenue (Table. 1), grew by 82 USD for each outpatient visit(p<0.001, 95% CI:41–122), and grew by 70 USD for each inpatient-days(p=0.001, 95% CI:31–108). Medical costs (Table. 2), increased by 59 USD for every inpatient-days (p=0.01, 95% CI:15–102). Finally, the gross medical profits (Table. 3) increased by 72 USD for each outpatient visit (p=0.003, 95% CI:27–117).Table 1.

Multiple linear regression analysis of the impact of medical service on medical revenue.

During the COVID-19 outbreak, healthcare systems, including those in Taiwan, were tested for unparalleled service challenges. This study found that while outpatient services boosted profits, rising inpatient admissions strained finances, given their higher costs and staffing needs. After the pandemic, psychiatric departments should reconsider resource allocation to balance expenses and revenues. Effective management is crucial for patient outcomes, emphasizing the need for quality care and fiscal control. Future research must focus on fortifying healthcare resilience.

None Declared

While technology continues to evolve and the prevalence of screen-based activities is rising, limited studies have investigated the effect of various types of screen time on youth behavioural problems. Further, the influence of mindfulness intervention programs on behavioural problems beyond hyperactivity is largely understudied.

This study aims to address a research gap by examining the associations between four types of screen time and hyperactivity and conduct problems among community youth during the pandemic. The current study also aimed to investigate the efficacy of a mindfulness-based intervention in reducing hyperactivity and conduct problems.

Community youth aged 12-25 from Ontario, Canada, were recruited between April 2021 and April 2022 (n=117, mean age=16.82, male=22%, non-White=21%). The Mindfulness Ambassador Program, a structured, 12-week, evidence-based intervention program, was offered live, online and led by two MAP-certified facilitators. We conducted linear regression analyses using pre-intervention data to examine the unique association between the four types of screen time and behavioural problems (hyperactivity and conduct problems). The efficacy of the MAP on adolescent hyperactivity and conduct problems was examined considering the three survey time points (pre-, post-, and follow-up) using a series of linear regression models utilizing the Generalized Least Squares (GLS) Maximum Likelihood (ML), unstructured model.

The average score for conduct problems was classified within the normal range, while the average score for hyperactivity was considered borderline at baseline. More than 5 hours of playing video games were significantly associated with increased conduct problems [β= -1.75, 95% CI=-0.20 – 3.30, p=0.03]. Accounting for age, sex, baseline mental health status, and screen time, the mindfulness intervention program significantly contributed to decreased hyperactivity at post-intervention compared to the baseline [β=-0.49, 95% CI=-0.91 to -0.08, p=0.02]. It was maintained at follow-up [β=-0.64, 95% CI=-1.26 to -0.03, p=0.04].

Our findings suggest an adverse impact of excessive video gaming on behavioural problems among community youth and confirm that the trend remains the same. Considering the simplicity, brevity, non-invasive nature and other mental health benefits of the mindfulness intervention, we argue that the results are promising and worthy of further study and larger-scale implementation. Clinicians, parents, and educators should work collaboratively to provide developmentally appropriate strategies to moderate screen time spent on video games among youth.

None Declared

Globally, mental disorders account for almost 20% of disease burden and there is growing evidence that mental disorders are associated with various social determinants. Tackling the United Nations Sustainable Development Goals (UN SDGs), which address known social determinants of mental disorders, may be an effective way to reduce the global burden of mental disorders.

To examine the evidence base for interventions that seek to improve mental health through targeting the social determinants of mental disorders.

We conducted a systematic review of reviews, using a five-domain conceptual framework which aligns with the UN SDGs (PROSPERO registration: CRD42022361534). PubMed, PsycInfo, and Scopus were searched from 01 January 2012 until 05 October 2022. Citation follow-up and expert consultation were used to identify additional studies. Systematic reviews including interventions seeking to change or improve a social determinant of mental disorders were eligible for inclusion. Study screening, selection, data extraction, and quality appraisal were conducted in accordance with PRISMA guidelines. The AMSTAR-2 was used to assess included reviews and results were narratively synthesised.

Over 20,000 records were screened, and 101 eligible reviews were included. Most reviews were of low, or critically low, quality. Reviews included interventions which targeted sociocultural (n = 31), economic (n = 24), environmental (n = 19), demographic (n = 15), and neighbourhood (n = 8) determinants of mental disorders. Interventions demonstrating the greatest promise for improved mental health from high and moderate quality reviews (n = 37) included: digital and brief advocacy interventions for female survivors of intimate partner violence; cash transfers for people in low-middle-income countries; improved work schedules, parenting programs, and job clubs in the work environment; psychosocial support programs for vulnerable individuals following environmental events; and social and emotional learning programs for school students. Few effective neighbourhood-level interventions were identified.

This review presents interventions with the strongest evidence base for the prevention of mental disorders and highlights synergies where addressing the UN SDGs can be beneficial for mental health. A range of issues across the literature were identified, including barriers to conducting randomised controlled trials and lack of follow-up limiting the ability to measure long-term mental health outcomes. Interdisciplinary and novel approaches to intervention design, implementation, and evaluation are required to improve the social circumstances and mental health experienced by individuals, communities, and populations.

None Declared

The development of the methodology for the psychiatric care quality managing is associated with the implementation of criteria and standards, systematic evaluation and the continuous improvement of the care quality. Important role in assessing the care quality belongs to the specialists of the psychiatric services, who are both “providers” and “internal consumers” of care. At the same time, it is especially significant to take into consideration the opinion of nurses, as the largest group of specialists working in psychiatric institutions and directly providing treatment and care for patients.

To assess the quality of care by nurses of psychiatric institutions and to develop evaluation criteria and measures to improve the quality of care.

Questionnaire «Assessing the satisfaction with quality of care by medical staff of psychiatric institution», including 78 questions about the quality of the structure, process and results of activities (Solokhina et al., 2014); adapted questionnaire «Assessment of the burden of psychiatric staff working in psychiatric institution», including 52 questions (WHO, 1994). The study involved 35 nurses of inpatient and outpatient services of Moscow psychiatric hospital № 4 named after P.B. Gannushkin.

It was found that 76,5% of respondents were satisfied with the quality of proved care in general and 78,2% of them were satisfied professional level of medical staff. The lower satisfaction was obtained when the other aspects were assessed. For example, only 58,6% of respondents were satisfied by relations with colleagues, 55,9% – by support from administration correspondingly. Dissatisfaction of nurses was related with working conditions, salary, excessive control by administration, insufficient professional training and lack of participation in the assessment of the institution’s activities.

It was revealed that the integral index of professional burden of nurses was at the average level (1,47±0,26). Inverse correlations between burden of staff and satisfaction with quality of care and institution’s activities were established. This allows to consider the professional burden as criterion in assessing the quality of care. Using obtained results, a training aimed at improving the communicative competence of medical personnel was developed and implemented in practice (Trushkina, Solokhina, 2019). For today more the 60 nurses have taken part in this training. The results demonstrate the professional growth of the participants and their communication patterns expansion.

Nurses’ satisfaction and indicators of professional burden both can be used as criteria of assessment of the psychiatric care quality. It is also necessary to introduce in psychiatric institutions training aimed at continuous professional skills improving.

None Declared

Cannabis use poses a significant risk to the psychological wellbeing of youth, affecting academic performance and potentially triggering the onset of mental health issues. Providing young people with comprehensive information about patterns of cannabis use and specific factors that increase an individual’s health risks is crucial. The ability to critically assimilate this information is known as health literacy (HL).

To design a psychoeducational intervention to increase HL on risky cannabis use among students aged 16-25, and to assess its usability and feasibility.

We designed a psychoeducational intervention based on the outcomes of a 3-hour co-creation session involving healthcare professionals and students. 29 university students and 25 high-school students completed this intervention and assessed its usability and feasibility with the SUS (System Usability Scale), PSSUQ (Post-Study System Usability Questionnaire) and additional open questions regarding the most and less-liked aspects of the intervention.

The design phase resulted in an informative website (http://www.cahlyclinic.cat/) and a 1-hour structured onsite educator-facilitated session, comprising 3 group activities (completed on paper or online) addressing three dimensions of cannabis HL: searching for, interpreting and applying reliable information. Usability of the intervention was rated as excellent (SUS mean score>80). PSSUQ results indicate that students were satisfied with the intervention; found the HL information clear, relevant, and adequate for their needs; found the interface of the digital version pleasant and usable without support; and would recommend it to other students.

We propose an innovative structured and usable intervention, designed using a participatory approach, which aims to disseminate information on risky cannabis use to a key target population, namely young people.

None Declared

Rejection-sensitivity is a prevalent yet understudied emotional symptom often associated with adult ADHD. While ADHD research typically focuses on behavioral and cognitive facets, emerging evidence highlights the significance of emotional symptoms. Emotional dysregulation in ADHD impacts psychological well-being and mental health. Our study examines how ADHD symptoms relate to rejection sensitivity, considering factors like resiliency, self-regulation, and overall well-being.

Our study seeks to establish a direct connection between ADHD scores and rejection sensitivity among college students. We also investigate the mediating role of well-being, creative executive efficiency, self-regulation, and resilience, while exploring the moderating role of savoring capacity.

Between February and May of 2023, we conducted a cross-sectional study using an online questionnaire, gathering data from 304 Hungarian higher education students aged 18 to 35. The majority, 78.0%, were female, and 71.4% were full-time students. Most participants were pursuing a bachelor’s degree (56.6%), followed by undivided master’s (21.7%), doctoral studies (13.8%), and traditional master’s degrees (6.9%). We administered the Adult ADHD Self-Report Scale (ASRS-v.1.1), The Mental Health Test (MHT), and the Rejection Sensitivity Questionnaire (A-RSQ) for our research.

First, the ADHD scores were significantly associated with each mediator (well-being: β = -.343, p < .001; creative and executive efficiency: β = -.183, p < .01; self-regulation (β = -.230, p < .001; and resilience: β = -.321, p < .001). There was a direct effect of ADHD scores on rejection sensitivity scores (β = .466, p < .001). Finally, we also detected the indirect effects of ADHD scores on rejection sensitivity scores through the four mediators (β = .227, p < .001). Savoring capacity significantly moderated the relationship between ADHD and rejection sensitivity scores (β = -.244, p < .001).

ADHD scores in our study population significantly correlate with well-being, creative and executive efficiency, self-regulation, and resilience. Furthermore, these scores directly influence rejection sensitivity, suggesting a heightened vulnerability to perceived rejection among those with higher ADHD scores. The indirect effects emphasize that the relationship between ADHD and rejection sensitivity is mediated by the aforementioned positive psychological constructs. This underscores the need for holistic interventions in ADHD populations, addressing not just core ADHD symptoms but also enhancing well-being, cognitive efficiency, self-regulation, and resilience to potentially mitigate rejection sensitivity.

V. Müller Grant / Research support from: This project received funding from the New National Excellence Program under the Ministry for Culture and Innovation, sourced from the National Research, Development, and Innovation Fund, reference #ÚNKP-23-3-SZTE-66., B. Pikó: None Declared

Heightened affective responses to daily life stressors, referred to as elevated affective reactivity to stress (or ‘stress sensitivity’), have been proposed as a putative mechanism of schizophrenia. Previous studies on stress sensitivity mainly used a case-control design; given that schizophrenia is heterogeneous its relationship with specific symptoms (e.g. paranoia) is yet to be addressed. In view of the continuum approach of understanding psychotic symptoms, the relationship between stress sensitivity (especially ‘social stress sensitivity’) and paranoia in the general population is important. Supported by emerging evidence of the relationship between hostile attribution bias (i.e. a tendency to interpret others’ actions as hostile and intentional) and paranoia, we hypothesized that social stress sensitivity mediates the relationship between hostile attribution bias and momentary experiences of paranoia.

Using experience sampling method, this study aimed to examine the association between social stress sensitivity, hostile attribution bias and momentary paranoia in non-clinical young adults. We also tested the role of social stress sensitivity as mediator of the relationship between hostile attribution bias and momentary paranoia.

Consented participants free from any past and current psychiatric diagnoses (confirmed with the Structured Clinical Interview for DSM-IV Disorders) completed the measure of hostile attribution bias (i.e. abbreviated Ambiguous Intentions Hostility Questionnaire). Participants then filled in an ESM questionnaire measuring momentary levels of paranoia, social stress (i.e. pleasantness of and preference for being alone or with others) and negative affect on a mobile phone app repeatedly, ten times per day over six days. Social stress reactivity was calculated as the within-moment correlation between social stress and negative affect. The associations between social stress sensitivity, hostile attribution bias and momentary paranoia, and the mediating role of social stress sensitivity, were tested with multilevel modelling.

The final sample consisted of 131 participants (57.3% female, mean age= 20.36 (SD= 2.93)). The mean compliance rate was 71.9% (SD= 0.16). Social stress sensitivity was positively associated with momentary paranoia (B= 0.03, p= .002). Hostile attribution bias was associated with momentary paranoia (B= 0.41, p< .001), as well as social stress reactivity (B= 0.10, p= .003). The mediating effect from hostile attribution bias to momentary paranoia via social stress sensitivity was significant (ab= 0.05, 95% CI [0.03-0.07]).

Social stress sensitivity was related to momentary paranoia, as well as hostile attribution bias. Our finding suggests social stress reactivity as a potential mechanism underlying the relationship between hostile attribution bias and paranoia.

None Declared

Schizophrenia is a chronic mental disorder and clozapine is an atypical antipsychotic that can be used in treatment-resistant schizophrenia patients. However, treatment-resistant schizophrenia may also include patients with an inadequate response to clozapine.

In our study, we retrospectively analysed the sociodemographic and clinical characteristics of patients receiving clozapine monotherapy and patients receiving clozapine in combination with different antipsychotics. In this way, we aimed to evaluate the factors that influence the response to clozapine.

Clozapine monotherapy and clozapine in combination with different antipsychotics were identified by retrospective chart review of patients followed up at the Schizophrenia and Other Psychotic Disorders Outpatient Clinic, Department of Psychiatry, Faculty of Medicine, Selçuk University. Sociodemographic and clinical characteristics were recorded and subjected to statistical analysis. The study was approved by the Ethics Committee of Selçuk University.

Of the 143 patients whose data were analysed, 60 (42%) were female. The mean age of the patients was 40.2±12.0 years and the mean duration of training was 10.4±4.3 years. 62 patients (43.4%) used long-acting antipsychotics. 90 patients (62.9%) were using clozapine, 52 (36.4%) were using clozapine as monotherapy, 5 (3.5%) were using clozapine together with another oral antipsychotics drug, and 33 (23.1%) were using clozapine together with a long-acting antipsychotic. No statistically significant difference was found when comparing mean age, age at first antipsychotic initiation, age at clozapine initiation and mean clozapine dose between patients using clozapine monotherapy (n=52) and patients using different antipsychotics in combination with clozapine (n=38). When the two groups were compared, a significant difference was found in the mean number of antipsychotics used before starting clozapine and the mean number of hospitalisations, with a lower number in the monotherapy group (3.1±1.4 vs 4.1±2.0, p=0.01 and 2.8±2.2 vs 4.5±3.2, p=0.006, respectively).

It is important to assess the concept of treatment resistance appropriately in the treatment of schizophrenia patients. The results of our study suggest that starting clozapine treatment promptly in treatment-resistant patients may increase the likelihood that patients will benefit from clozapine and reduce the need for additional treatments. Although our data and criteria for evaluating response to treatment are limited, it is important to draw attention to the clinical results of proceeding in accordance with the guidelines in the treatment of schizophrenia. Evaluating the response to clozapine treatment needs studies with stronger data and larger sample sizes.

None Declared

There are many theoretical reasons to implement gender-specific care for schizophrenia. For all these reasons, the Mutua Terrassa-Functional Unit for Women with Schizophrenia was inaugurated in January 2023 in the context of a community mental health service.

Our aim today is to describe the health care model applied in this newly initiated unit.

We created a healthcare model in our new unit consisting of A)Five observatories of Health (somatic morbi-mortality, hyperprolactinemia-HPRL, substance use disorders, social exclusion/discrimination, and drug safety); B)Monitoring stations or vigilance teams (reflecting the 5 observatories); and C)resulting actions (specific interventions). The observatory teams each meet monthly. In this presentation, according to the healthcare model we implemented, we first describe data about the original patient recruitment and then focus on the observatories of somatic morbi-mortality and hyperprolactinemia.

From 265 potentially eligible women, 42 were included in the 5 observatories. (A) of the 11 women in the observatory of somatic morbi-mortality, 10 women had died within the last 24 months. Causes of Death: (1)respiratory tract disease (n=5,45.4%), (2)cancer (n=3;27.3%): lung cancer (n=1), pancreatic cancer (n=1), kidney cancer (n=1), (3)ischemic colitis (n=1;9%), (4)Alzheimer disease (n=1;9%). 2) Morbidity. One woman had an ongoing glioblastoma. (B)Observatory of HPRL. Eight women with moderate/severe HPRL were included. Strategies for lowering prolactin levels were discussed with neuroendocrinologists. Interventions:adjunctive aripiprazole (n=3), switch to aripiprazole (n=2), lowering antipsychotic doses (n=2), and adjunctive cabergoline (n=1).

Designating special teams to focus on specific problems of women with schizophrenia will reduce morbidity and improve outcomes in this vulnerable population.

None Declared

The development of oxidative stress in patients with schizophrenia is associated with changes in the level of activity of antioxidant enzymes. It is likely that catalytically active antibodies (abzymes) can take on these functions. Abzymes are antibodies with enzymatic activity. Catalase and SOD activity of abzymes was previously detected in patients with schizophrenia. But NADPH-dependent peroxidase activity has not been studied. The present work discusses the protective role of abzymes against reactive oxygen species within the pathogenesis of schizophrenia.

The aim of the study was to investigate the NADPH-dependent peroxidase activity of IgG in patients with paranoid schizophrenia in the exacerbation phase and in the remission phase.

A total of 124 patients were examined during the work. Of them, 82 patients with paranoid schizophrenia (F20.0) had a mean age of 33.6±5.12 years (52 males, 30 females), disease duration averaged 8.9± 4.62 years. Patients with schizophrenia included 42 patients with acute schizophrenia and 40 patients with schizophrenia in therapeutic remission. The control group included 42 sex- and age-matched patients. IgG was purified by affinity chromatography on columns with proteinsepharose on an AKTA purifier chromatograph (GE). The homogeneity of isolated IgG preparations was checked by Lemilly electrophoresis in a gradient of 4-18% PAAG. Gel filtration under pH-shock conditions was performed on a Superdex-200 HR 10/30 column. NADPH-dependent peroxidase activity of IgG was determined on a SPECORD M-40 spectrophotometer (Carl Zeiss) at 340 nm by NADPH oxidation in the conjugated glutathione reductase reaction of tertiary butyl hydroperoxide reduction. Statistical processing of data was performed in Statistica 12.0 program.

It was proved that IgG from patients with schizophrenia had NADPH-dependent peroxidase activity, and this activity is an intrinsic property of the investigated antibodies. The NADPH-dependent peroxidase activity in IgG patients in the exacerbation stage was increased 3-fold (p=0.0001) compared to the studied activity in the group of healthy individuals, and it was increased 2-fold (p=0.017) in the group of patients in therapeutic remission compared to the activity in healthy individuals. Also NADPH-dependent IgG peroxidase activity in patients in remission was 1.7 times lower than in patients during the exacerbation period (p=0.012).

It was established for the first time that abzymes from patients with schizophrenia and healthy individuals have NADPH-dependent peroxidase activity and can decompose lipo and hydroperoxides. We hypothesize that these abzymes help cope with generalized oxidative stress. Under the influence of neuroleptic therapy in patients in remission, the level of oxidative stress and NADPH-dependent peroxidase activity of abzymes decrease.

None Declared

Psychiatric patients have a higher risk of premature mortality primarily due to cardiovascular diseases (CVD). One significant contributing factor is the presence of dyslipidemias . Current studies are shifting focus towards lipoprotein ratios, believed to better reflect cardiovascular risk. These studies have demonstrated that ratios associated with high-density lipoprotein (HDL) are stronger predictors for CVD compared to traditional lipid parameters. One of these ratios is the logarithmic transformation of the triglyceride (TG) to HDL ratio, known as the plasma atherogenic index (PAI).

Our study aimed to compare the PAI between patients diagnosed with psychotic disorders who presented to our outpatient clinic and healthy control groups.

Fifty patients diagnosed with psychotic disorders, including 50 residing in a nursing home and 50 outpatient in such facilities, presented to our psychiatric outpatient clinic and were included in our study. Additionally, a healthy control group consisting of 49 individuals was recruited. A socio-demographic data form was administered to all groups. Peripheral blood levels of HDL, Triglycerides (TG), and LDL were recorded for each participant included in the study. Ethical approval for the study was obtained from the local ethics committee.

The patient groups were compared in terms of age and gender. While there was no statistically significant difference in gender between the groups, a significant difference was observed in terms of age (p=0.099, p=0.004). When examining the age distribution of the groups, it was observed that the care facility group was older compared to the other groups. The age and gender distributions of the groups are shown in Table 1 and Table 2.

Psychotic patients in the outpatient group and the nursing home group were compared in terms of age and atherogenic index. Age was statistically significant, indicating that thenursing home group was significantly older (p=0.001, p=0.478). In the comparison of the control group with psychotic patients, there was no statistical difference in age, but a significant difference was found in terms of the atherogenic index (p=0.510, p=0.001). The statistical analysis and data between psychotic patients and the control group are presented in Table 3.

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This study, examining the comparison of Plasma Atherogenic Index (PAI) in patients diagnosed with psychosis with healthy controls, represents a significant step in understanding the cardiovascular health profile of this population and developing appropriate treatment strategies. Future research will further contribute to a deeper understanding of the impact of psychiatric disorders on cardiovascular health and aid in the development of effective interventions to minimize these effects.

Disclosure of Interest: None Declared.

None Declared

Hospital readmissions in psychosis are a critical concern, with medication choice playing a vital role. Oral antipsychotics, though common, rely on patient adherence and can lead to relapses if not followed. Long-acting injectable atypical antipsychotics (LAIAs) provide an alternative, ensuring consistent medication release and reducing relapse risk due to missed doses. Studies indicate that LAIAs result in fewer readmissions due to improved adherence. Tailoring treatment to individual needs is essential. Medication choice significantly influences hospital readmission prevention in psychosis. LAIAs, which could offer greater adherence to treatment and symptom control, present a promising option. Individualized treatment decisions are a priority for long-term recovery.

This study aimed to compare the hospital readmission rates within two years post-discharge among two groups of patients diagnosed with schizophrenia and other psychotic disorders who received either oral antipsychotic treatment or LAIAs.

We collected sociodemographic and hospitalization data from 155 patients, 90 receiving oral antipsychotics and 65 receiving LAIAs, following their discharge from a psychiatric unit.

There were 90 patients in the oral treatment group, and 65 in the LAIA group, with 67.6% receiving paliperidone and 26.1% receiving aripiprazole. There were no significant differences in age or gender between the two groups. However, patients in the LAIA group had longer stays in the hospital (M=14.7; SD=10.2 vs M=11.1; SD=6.4; t(153)=2.67; p<.01) and a higher number of prior admissions (M=3.2; SD=3.7 vs M=1.3; SD=3.5; t(153)=2.41; p<.01) compared to the oral antipsychotic group. Additionally, a higher percentage of patients in the LAIA group were diagnosed with schizophrenia (60%) compared to the oral antipsychotic group (24%) (X2 (1, N = 155)= 20.4, p<.01). After two years, readmission rates were 66.6% for the oral antipsychotic group and 61.5% for the LAIA group (X2 (1, N = 155)= 8.5, p > .05). However, the time to readmission was shorter for patients on oral antipsychotics (M=172.4; SD=162.0) compared to those on LAIAs (M=326.2; SD=211.4; t(153)=3.05; p<.01). Notably, 86.6% of patients on oral antipsychotics were readmitted within the first year, while only 52% of those on LAIAs experienced readmission during the same period (X2 (1, N = 155)= 8.5, p = .001).

Long-acting injectable antipsychotics (LAIAs) appear to reduce hospital readmissions, with a more pronounced effect in the first few months post-discharge. However, after two years, the readmission rates between LAIAs and oral antipsychotics become comparable. This data suggests that while LAIAs may reduce early readmissions, their long-term effectiveness is on par with oral antipsychotics.

None Declared

In recent years, there has been increasing interest in the potential use of retinal imaging as a non-invasive and easily accessible tool for investigating the neurobiological underpinnings of schizophrenia. Studies have suggested that patients with schizophrenia spectrum disorders (SSD) have structural abnormalities in the retina, including changes in retinal thickness and the ratio of the retinal cup-to-disk ratio.

To investigate the relationship between retinal cup-to-disk ratio and cognitive performance in patients with SSD using a high-definition retinal imaging device – optical coherence tomography (OCT) scanner.

The sample was comprised of twenty patients with SSD (F20-F29 according to ICD-10 criteria). All diagnoses were confirmed by a researcher using the Mini International Psychiatric Interview. All patients underwent complete ophthalmological examination, excluding any ocular pathology. Retinal thickness was measured in both eyes of all patients with a high-definition spectral-domain OCT device. Examined retinal parameters were: total retinal nerve fiber layer thickness (RNFL); RNFL thickness in all eye quadrants (nasal, temporal, superior, inferior); RNFL symmetry; average macular volume (MV); average macular thickness (MT); ganglion cell layer thickness (GC); average retinal cup-to-disk (C/D) ratio, vertical C/D ratio. Cognitive performance of all patients was tested using the Intra/Extradimensional Set Shift Task (IED). IED is a component of a state-of-the-art computerized battery for cognitive assessment – Cambridge Neuropsychological Automated Test Battery. IED is a measure of maintenance, shifting and flexibility of attention. Associations between retinal variables and IED measures were determined with Pearson correlation analyses.

Mean age of patients was 33 ± 7.5 years. Fifty five percent of the sample was male, illness duration was 6.2 ± 3.9 years. Daily dosage of chlorpromazine was 225.7 ± 108.8 mg. Retinal C/D ratio in the right eye was positively associated with IED total errors (r=0.50; p=0.02) and negatively with IED stage progression (r=-0.52, p=0.18). Likewise, vertical C/D ratio was positively associated with IED total errors (r=0.49; p=0.02) and negatively with IED stage progression (r=-0.52, p=0.18).

Previous analyses of retinal parameters in patients with schizophrenia point towards enlargement of retinal cup-to-disk ratio, irrespective of any underlying somatic comorbidities. Our data shows worsening of attention flexibility in association with the increase of cup-to-disk ratio in patients with schizophrenia spectrum disorders. The significance of cup-to-disk retinal disturbance in schizophrenia spectrum disorders and its connection with cognitive performance should be further evaluated and supplemented with measurements of functional adaptation in these patients.

None Declared

In some clinical scenarios obsessive and delusive symptoms exhibit several similarities, making it challenging to differentiate between schizophrenia spectrum disorder (SSD) and obsessive-compulsive disorder (OCD). There are numerous reports of patients suffering from those disorders and manifesting both psychotic and obsession-like features, which makes accurate distinction even more complicated. We found several conflicting theories attempting to elucidate this overlap, one being the existence of the separate clinical entity - schizo-obsessive disorder.

The aim of this study is to consolidate current knowledge, synthesize existing theories and explore diagnostic implications.

We conducted a systematic literature review following the PRISMA protocol, we scrutinized studies addressing obsession-like symptoms in SSD, psychotic symptoms in OCD, and comorbidity of those disorders. We included peer-reviewed non-interventional studies published in English and Polish from 2013 onwards. The search was performed in the following medical databases: PubMed, Science Direct, Scopus, and Web of Science. Synthesis utilized a narrative approach due to diverse study designs, outcomes and observational nature of the collected data.

We identified several dozen articles, which revealed a range of diverse findings, often inconclusive, and occasionally conflicting, Although, the collected data indicate the schizo-obsessive spectrum exhibits clinical relevance.

The ambiguity in results emphasizes the necessity for further investigations into pathomechanism of schizophrenia and OCD. Future research, particularly involving children and adolescents, should strive for a comprehensive understanding of the nuanced manifestations of obsessive-like and psychotic symptoms in both disorders, aiding in refining diagnostic criteria and developing effective intervention strategies.

None Declared

Psychosis resulting from traumatic brain injury (TBI) is a relatively uncommon but potentially severe and disabling outcome. The complex relationship between TBI and the onset of psychosis is marked by significant scientific uncertainty and differing opinions.

To investigate the occurrence of psychosis following traumatic brain injury (TBI) and explore the intricate relationship between TBI and the development of psychosis.

A comprehensive case report was conducted on a 38-year-old patient who, after a severe TBI at the age of 23, exhibited signs of psychosis. Developmental history, family background, clinical assessments, magnetic resonance imaging (MRI), and electroencephalogram (EEG) results were analyzed.

The patient, at the time of writing aged 38, was born at full term with a regular presentation and uneventful delivery, with no indications of perinatal or obstetric complications. Developmentally, he reached all milestones within the expected range, and there were no significant premorbid characteristics. There was no family history of schizophrenia in a first- or second-degree relative; a paternal cousin had had psychosis-like symptoms, but reportedly remained well without any medication.

At the age of 23, the patient was knocked from his motorcycle by a car and sustained a severe traumatic brain injury (TBI), with initial loss of consciousness and was in a coma state for approximatively a month, with later sequelae of cerebellar syndrome and predominant right-sided pyramidal syndrome.

Magnetic resonance imaging (MRI) a year following the TBI showed sequelae of bifrontal and temporal contusion lesions.

An EEG did not indicate any evidence of epilepsy, and a repeat EEG 14 years later revealed no diagnostic abnormality.

A year after the accident, his surroundings have noticed social withdrawal, a turning inward with a religious fervor, and persecutory remarks focused on his brother. At the age of 26, he presented to a psychiatric service having auditory hallucinations. He was deluded, believing himself to be a prophesied redeemer figure who is expected to appear and bring justice and righteousness to the world. He had an inappropriate affect. A diagnosis of schizophrenia was made, and neuroleptics prescribed. His auditory hallucinations faded, but the subsequent course was of repeated episodes of florid psychosis requiring maintenance neuroleptic treatment, eventually haloperidol decanoate (150mg monthly).

Psychosis following TBI is an uncommon yet potentially severe consequence, carrying the risk of significant debilitation. The relationship between TBI and psychosis is complex, but notable distinctions exist in clinical, epidemiological, and neurobiological aspects when compared to primary psychotic disorders.

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Psychosis is a complex mental health condition that can have a significant impact on individuals and their families. Family-based intervention programs have been developed to provide support and education to both individuals with psychosis and their families. These programs aim to improve clinical and family outcomes, reduce relapse rates, and enhance the overall well-being of individuals and their families . This study examined the effect of family-based intervention programs used in psychosis on the disease by synthesizing evidence from a systematic review of relevant studies.Family interventions have shown promising results in improving clinical and family outcomes in long-standing psychosis (Sadath et al., 2015). These interventions focus on improving relationships through problem-solving and enhancing the understanding of the illness and its treatment (Kuipers et al., 2010).

The aim of this study was to evaluate the effect of intervention programs implemented for the families of individuals diagnosed with psychosis on the course of the disease.

The study was conducted between August and September 2023 in 3 databases (PubMed, Cochrane Library, Science Direct) using the keywords “psychosis”, “family interventions”, “family in psychosis”. These databases were preferred because they contain a significant amount of evidence-based literature in the field of biomedical sciences and psychology. Studies conducted between 2013 and 2023, whose full texts were accessed and written in Turkish and English were included in the study.

As of September 2023, 16 national and international research articles on the subject have been reached and the literature review continues. When the literature review is finalized, all study results will be presented together.

This review provides an overview of the effects of intervention programs implemented for the families of individuals diagnosed with psychosis on the course of the disease and solution suggestions. Family-based intervention programs have shown promise in improving clinical and family outcomes in psychosis. These programs focus on enhancing relationships, providing education, and reducing relapse rates. However, the implementation of family interventions in routine clinical services can be challenging due to various barriers. Peer support programs have emerged as a valuable addition to family interventions, providing a supportive environment for families to share their experiences and support one another. Future research should focus on addressing barriers to implementation and further exploring the benefits of peer-driven family support services in early intervention programs for psychosis.

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Schizophrenia patients have demonstrated a high prevalence of suicidal behavior. There isn’t yet a definitive explanation of the neurobiological mechanisms of suicidal behavior (SB) in psychotic patients. While subthreshold indices of dyslipidemia were observed in schizophrenia patients, it has shown that there is a relationship between dyslipidemia and suicidal behavior.

The study aimed to investigate possible associations between SB and lipid profile including cardiovascular biomarkers in first-episode psychosis (FEP) as compared with healthy controls (HC).

The study sample consisted of 173 subjects (111 male, 62 female). The sample included 31 drug- naïve FEP patients with current SB (FEP+S), 66 drug-naïve FEP patients without SB (FEP-S), and 76 mentally and medically HC subjects. Blood samples were collected from all participants to determine total cholesterol (TC), low- and high-density lipoproteins (LDL and HDL), and triglycerides (TG). Castelli Risk Index-I, Castelli Risk Index-II, and atherogenic index were calculated. Symptoms were assessed by using the Positive and Negative Syndrome Scale. Nonparametric Kruskal-Wallis and Mann-Whitney tests were used for pairwise comparisons of account of lipid parameters in three groups. A binomial logistic regression analysis was performed to examine the predictive power of lipid profile in the presence of SB in FEP.

The results of Kruskal-Wallis test revealed that a statistical difference was found in TC and TG between groups. Despite statistical significance was observed in TG between all patient groups (FEP+S and FEP-S) and controls, as well as in TC between FEP-S and controls, there was no significant difference between FEP-S and FEP+S for any lipid parameters or cardiovascular biomarkers. No significant correlation was identified between lipid profile and symptom severity. No significant relationships were able to predict the presence of SB in FEP.

In this study, plasma levels of lipid parameters and biomarkers of cardiovascular risk in all patient groups (FEP+S and FEP-S) and HC were compared. Current results show no linkage between SB and lipid profile, but significantly lower levels of cholesterol in FEP. Therefore, cholesterol might have a protective role in terms of psychosis while CI1, CI2, and AI were not increased in psychosis. Thus, increased cholesterol levels or cardiovascular risk in schizophrenia patients, that several studies found, may ensue after antipsychotic use. Overall, present findings suggest that lipid profile abnormalities are specifically associated with FEP rather than SB. Controversy of results may reveal that research on SB requires an understanding of whether the patient had concomitant psychosis.

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Relapse is defined as the return of psychotic symptoms after a period of improvement/stability. Relapse is often associated with the disruptive re-hospitalization of patients. Importantly, relapse history is a strong predictor of subsequent relapses and poorer outcomes. Therefore, relapse prevention in the beginning of the disorder is especially important. Cariprazine, a novel D3-D2 partial agonist, has been effective in preventing relapse compared to placebo in stabilized patients with schizophrenia.

To present the efficacy of cariprazine in preventing relapse in patients with early-stage schizophrenia.

Post-hoc analysis of data from a ˜96 weeks, multicentre, randomized, double-blind, placebo-controlled, parallel-group study in adults with schizophrenia. The study was composed of two parts: a 20-week open-label treatment phase and a double-blind treatment phase up to 72 weeks. During the open-label phase, patients were stabilized with cariprazine 3.0-9.0 mg/day. Then, they were randomized to continue cariprazine (fixed dosing: 3.0, 6.0, or 9.0 mg/day) or receive placebo. Relapse was defined as a deterioration of symptom scores as measured by the Positive Negative Syndrome Scale (PANSS), admission to a psychiatric hospital, exhibiting aggressive behaviour, or risk of suicide. In the present analysis, patients with a schizophrenia diagnosis history of 0-5 years were defined as early-stage patients. Baseline characteristics, and risk ratios (after the double-blind phase) with number-needed-to-treat (NNT) were calculated.

Of 200 patients, 71 (35.5%) met the early-stage criteria: 32 patients in the cariprazine (CAR) and 39 in the placebo (PBO) arm. The mean age was 31.6 years in both groups with an average illness duration of 2.51+/-1.03 years in the CAR and 2.75+/-1.24 years in the PBO arm. 47% of patients in the CAR arm and 77% in the PBO arm were men. The average number of previous hospitalisations was comparable in the two groups (CAR: 2.3; PBO: 2.6), as was the severity of illness: mean PANSS Total score: 89.2 (CAR), 90.4 (PBO). Patients in both groups were highly compliant (pill-count: CAR: 98.2%; PBO: 99.5%). The main reported adverse effects were headache (CAR: 11.3%, PBO: 7.0%), insomnia (CAR: 5.6%, PBO: 4.2%), and increased triglycerides (CAR: 5.6%, PBO: 1.4%), discontinuation due to adverse event was 3.1% in the CAR and 2.6% in the PBO group. Altogether, 9.4% of patients relapsed in the cariprazine group compared to 48.7% on placebo (risk ratio=0.19 (95% confidence interval (CI): 6.3-59.2%, p=0.0041;NNT: 2.5 (95%CI: 1.7-5.1).

In this post-hoc analysis of patients within the first five years of schizophrenia, the relative risk of relapse was 81% reduced with cariprazine with prevention of one additional relapse after each third patient exposed to cariprazine vs placebo. Cariprazine seems to be a good treatment option for early-stage patients for preventing relapse.

C. Correll Consultant of: AbbVie, Acadia, Alkermes, Allergan, Angelini, Aristo, Biogen, Boehringer-Ingelheim, Cardio Diagnostics, Cerevel, CNX Therapeutics, Compass Pathways, Darnitsa, Denovo, Gedeon Richter, Hikma, Holmusk, IntraCellularTherapies, Jamjoom Pharma, Janssen/J&J, Karuna, LB Pharma, Lundbeck, MedAvante-ProPhase, MedInCell, Merck, Mindpax, Mitsubishi Tanabe Pharma, Mylan, Neurocrine, Neurelis, Newron, Noven, Novo Nordisk, Otsuka, Pharmabrain, PPD Biotech, Recordati, Relmada, Reviva, Rovi, Sage, Seqirus, SK Life Science, Sumitomo Pharma America, Sunovion, Sun Pharma, Supernus, Takeda, Teva, Tolmar, Vertex, and Viatris., Z. Dombi Employee of: Gedeon Richter Plc., P. Herman Employee of: Gedeon Richter Plc., Á. Barabássy Employee of: Gedeon Richter Plc.

Neighborhood socioeconomic status seems to be related to functioning in patients with first episode of psychosis

(FEP).

The present study aimed to assess if neighborhood vulnerability and risk of social exclusion could predict functional outcomes in people with FEP after controlling for other key variables identified in previous literature.

A total of 137 patients with FEP (DSM-IV-TR criteria) and 90 controls comprised the study sample from February 2013 to May 2019. Functioning was assessed with the WHO Disability Assessment Schedule. Neighborhood vulnerability was measured using a multidimensional socioeconomic deprivation index; data for the index were collected by the Madrid City Council and based on the participant’s home address. Multilevel mixed-effects regression analyses were conducted to estimate the effects of neighborhood vulnerability on functioning.

Our results show that FEP patients could be more vulnerable to the effects of neighborhood-level characteristics than healthy controls (B = 1,570.173; z = 3.91; Pc .001). In addition, our findings suggest that higher neighborhood vulnerability is related to greater functional disability in people with FEP, after controlling for other relevant confounders (B = 1,230.332; 2=2.59; P=.010). based on the participant’s home address. Multilevel mixed-effects regression analyses were conducted to estimate the effects of neighborhood vulnerability on functioning.

Our results show that FEP patients could be more vulnerable to the effects of neighborhood-level characteristics than healthy controls (B = 1,570.173; z = 3.91; Pc 001). In addition, our findings suggest that higher neighborhood vulnerability is related to greater functional disability in people with FEP, after controlling for other relevant confounders (B = 1,280.332; z=2.59; P= 010).

These results highlight the importance of incorporating contextual factors into assessment of patients with FEP, since psychosocial difficulties observed In these patients could be partially related to the quality of neighborhood social-related resources.

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