Rates of high expressed emotion (EE) towards patients with schizophrenia have only indirectly been compared between families and community residential facilities, since studies including patients in both settings are unfortunately lacking. High EE rates in staff-patient studies are typically lower than in families, with negligible rates of high emotional overinvolvement (EOI). However, indirect comparisons can suffer from many biases.

This study directly compared patients with schizophrenia living in halfway houses or with their families on the EE of their caregivers, adjusting for patient- and caregiver-related confounders.

We included 40 inpatients with schizophrenia living in halfway houses and 40 outpatients living with their families and recorded the EE of the caring staff (N=22 nurses) or parents (N=56), respectively, through Five Minutes Speech Sample interviews. Each nurse rated 1-12 inpatients and each inpatient was rated by 2-5 nurses, totaling 155 nurse ratings. Each outpatient was rated by one or both parents. Due to the multilevel structure of EE ratings, generalized linear mixed models were fitted. We first adjusted only for differences in patient-related confounders between groups and then added basic caregiver-related demographics.

Compared to outpatients, inpatients were older (p=0.001), less well educated (p=0.002), had a longer disease duration (p=0.047), more hospitalizations (p=0.012), lower severity of psychotic (p=0.027) and, specifically, negative symptoms (p=0.015), and lower perceived criticism (p=0.001). Nurses were younger (p<0.001) and better educated (p=0.001) than parents. After adjusting for patient-related confounders only, EOI was significantly higher in parents (p=0.027) while criticism did not significantly differ between groups. However, after also adjusting for caregiver demographics (age, gender and education), criticism was significantly higher in nurses (p=0.027) while differences in EOI became non-significant.

Differences in EE, when directly compared between parents and professional caregivers, may be explained by differences in patient-related characteristics, caregiver demographics as well as other caregiver characteristics to be investigated in future studies.

None Declared

The Positive and Negative Syndrome Scale (PANSS) has been used as a universal instrument for clinical assessment of psychopathology in schizophrenia. Different studies have analyzed the factorial structure of this scale and have suggested a five-factor model: positive, negative, excited, depressive, and cognitive/disorganized factors. Two of the most used models are the Marder´s solution and the Wallwork´s one.

The aim of this work was to study the correlations of the two cognitive factors (Marder and Wallwork) with a cognitive assessment performed with a standard cognitive battery, in a sample of patients with first psychotic episode of schizophrenia.

Seventy four patients with first psychotic episode of schizophrenia (26.9, SD:7.8 years old; 70.3% male) were included. The cognitive assessment was performed with the MATRICS Consensus Cognitive Battery (MCCB). The MCCB present seven cognitive domains: Speed of processing, Working memory, Attention/Vigilance, Verbal Learning, Visual Learning, Reasoning and Problem Solving, and Social cognition). Pearson correlations were performed between MCCB scores and Marder´s PANSS cognitive factor (P2, N5, G5, G10, G11, G13, G15) and Wallwork´s one (P2, N5, G11).

Correlation between MCCB scores and cognitive factors of Marder and Wallwork can be seen in the table.

Both PANSS cognition factors show a moderate correlations with Speed of processing, Working memory, Attention/Vigilance and Verbal Learning assessed by MCCB. More discrete correlations were found with Visual Learning, Reasoning and Problem Solving, and with Social cognition (in fact, non-significant correlation with Wallwork´s cognitive factor was found).

Acknowledgements. This study has been funded by Instituto de Salud Carlos III (ISCIII) through the project PI19/00766 and co-funded by the European Union.

None Declared

Negative symptoms (NS) are an important clinical characteristic of schizophrenia. In recent years, clinical research on NS has focused on their clinical heterogeneity. Based on two-factor analysis, it has been proposed to divide NS into abulia-apathy (AA) and expressive deficit (ED) domains. A number of studies have shown that these domains have different effects on the clinical features of schizophrenia, which suggests different pathophysiological mechanisms of their development. Neurobiological differences between AA and DE have been identified in neuroimaging and immunological studies but there is less research on the genetic background of NS.

To search for an association between the rs1344706 polymorphism of the zinc finger protein gene (ZNF804A) and the AA and ED subdomains. The rs1344706 polymorphism is one of the best-supported risk variants for schizophrenia. The risk genotype AA has been shown to be associated with clinical presentations of the disease.

The study included 1116 (741 (66.3% women) patients with schizophrenia. The diagnosis was made according to ICD-10 criteria (item F20). The average age of the patients was 38.4 (13.6) years, age at disease onset was 26.1 (10.6) years. NS were assessed with the PANSS. The PANSS-derived AA domain consisted of Emotional withdrawal (PANSS item N2), Apathetic social withdrawal (N4), Active social avoidance (G16). The DE domain included Blunted affect (N1), Poor rapport (N3), Lack of spontaneity (N6), Mannerism and posturing (G5), Motor retardation (G7), Disturbance of volition (G13). Genotyping of the ZNF804A rs1344706 polymorphism was carried out using HRM-PCR. ANOVA with genotype and sex as independent variables, and age at the time of disease manifestation and its duration as covariates was used. Post hoc tests were performed using Bonferroni correction.

A significant effect of the rs1344706 polymorphism on the severity of symptoms in the AA domain was revealed (F=5.88, df=2, p=0.002). In carriers of the CC genotype, the severity of symptoms was significantly lower than in carriers of the AA genotype and the AC genotype (8.4(3.5), 9.4(7.4) and 8.8(3.5) points, respectively). This effect was independent of sex and was not mediated by age at onset or duration of disease. There was no effect of the rs1344706 polymorphism on the severity of symptoms in the ED domain.

The association of the ZNF804A rs1344706 (A/C) polymorphism with NS of schizophrenia has not been reported so far though some studies have found the effect of this polymorphism on  PANSS positive symptoms and PANSS total score. The finding of the association with NS can be explained by the fact that the NS heterogeneity was taken into account in the present study.

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Understanding the relations between genetic (G) and environmental (E) factors in the development of schizophrenia is important for psychosis prevention. These relations may vary from G x E correlations to G x E interactions and independent additive effects of genetic load and environment. The G x E interactions mean that genetic variants associated with schizophrenia make an individual vulnerable to specific environmental exposures thus enhancing the risk of disease manifestation in those who possess such genetic variants. In the case of independent effects, environmental exposure might serve as the main cause or an additional to genetic load external trigger which is needed for the illness development. Thus, the rate of independent environmental risk factors is expected to be higher in patients with a lower genetic liability to schizophrenia.

The study aimed to confirm this hypothesis by comparing schizophrenia patients with higher and lower polygenic risk scores for schizophrenia (SZ-PRS) on the rate of urbanicity, winter birth and obstetric complications (OC), as previous data suggested their independence from the genetic burden of the disease.

SZ-PRS were calculated for 861 patients with schizophrenia spectrum diagnoses (ICD-10, F2), predominantly of Slavic decent, based on the latest GWAS. For patients comprising the highest and lowest SZ-PRS deciles, information on the environmental risk factors was extracted from medical records. Each environmental factor was coded as present/absent. The presence were defined as being born in the most urban environment (a city’s population > 5 million), in winter months and having at least one OC from a predefined list (Alfimova et al. Int J Mol Sci 2022; 23: 12629). In addition, hypoxia/asphyxia, and low birth weight were analyzed separately. Polyenvirommental risk scores (PERS) aggregating the three factors were calculated using natural logarithms of the odds ratios (OR) from an umbrella review (Radua et al. World Psychiatry 2018; 17: 49-66). Logistic regression adjusted for ancestry-related principal components, demographic, and technical variables was applied to compare the SZ-PRS deciles on each factor and PERS.

None of the factors alone or PERS predicted SZ-PRS decile membership.

The results did not support the hypothesis. Future research needs reliable data on the frequency of the studied factors in the general population where the patients come from.The study was supported by the Russian Science Foundation, grant no. 21-15-00124.

None Declared

First episode psychosis (FEP) is the first manifestation of psychotic disorders lasting at least one week, but not longer than 2 years, causing personal suffering and decreased functional outcome of patients. The early intervention in FEP is crucial. Published results on early intervention programmes indicate that during the first 5-10 years relapse prevention and functional outcomes can be improved and mental health care costs can be reduced, compared to treatment as usual.

Our objective was to examine FEP patients at the Department of Psychiatry and Psychotherapy. Our aim was to create a homogeneous sample and identify factors that can help in early differential diagnosis and therapy. Our goal was to compare the neuropsychological performance and MRI results of patients and healthy controls.

Male and female inpatients hospitalized at our department due to a first psychotic episode and consenting to participate were included, since 2019 October. Cases with drug induced psychosis and organic background in the etiology of the psychotic episode were excluded. Male and female healthy controls were matched by age and education. Including healthy controls is still in progress. The duration of the project is 36 months, 24 months for recruiting patients and healthy controls, 12 month for analyzing data. The investigation includes detailed clinical, neuropsychological examination (baseline, 6th, 12th, 18th, 24th month) and MRI (baseline and in the 24th month).

Forty patients and sixteen healthy controls were included. 60% of the patients were rehospitalized due to relapses. Neuropsychological tests (RBANS, faux pas, Baron-Cohen eyes test) indicate cognitive dysfunction compared to healthy subjects. Using resting state fMRI second level analysis we found alterations in thalamo-cortical connectivity. We found significant differences in the connectivity of the thalamus and frontal lobe, postcentral gyrus, insula and cerebellum.

Our FEP research, although limited by the COVID-19 pandemic, shows promising results that can help in better understanding of the underlying factors of psychotic disorders.

None Declared

New drugs in the treatment of dual psychosis: use of cariprazine in schizophrenia, other psychotic disorders and use of cocaine. A case series in a specific outpatient psychiatric clinic for substance use disorders.

The main objective of this case series is to observe and describe the tolerability and clinical response to different doses of cariprazine in a series of patients with dual psychosis, especifically cocaine users; with a special attention upon psychotic symptoms, disruptive behaviour, affective symptoms and cocaine use pattern.

This series consists of an observation of a total of 20 patients treated on an outpatient basis. All of them had a either a diagnosis of Schizophrenia or Other Non Specified Psychotic Disorder meeting the DSM-5 criteria, as well as a Cocaine Use Related Disorder meeting the DSM-5 criteria. All of them received treatment with cariprazine in different doses from 1,5mg to 6mg per day, as a solo treatment or as an adjuvant to another previous antipsychotic treatment when antipsychotic augmentation was justified. We observed patients that had started cariprazine in the past three months and that had active drug use or had had one in the past three months.

We monitored the tolerance to the treatment, the clinical response in terms of positive and negative symptoms of schizophrenia, affective symptoms, disruptive behavior, and the response in terms of substance use; for a period of six months of follow-up, with psychiatric consultation at least every month and nurse consultation every two weeks in our clinic.

95% of the patients did not present any side effect related to cariprazine. In one patient (5%) the treatment had to be stopped due to akathisia that did not disappear after two weeks and symptomatic treatment with benzodiacepines. 60% of patients either stopped using (50%) or reduced their use frequency (50%). 70% of the patients presented an improvement in positive symptoms and behavior. Also, one third of them presented a slight improvement in negative symptoms. 20% of patients referred a significant improve in depressive symptoms.

The main conclusion of this case series is that cariprazine at any dosis between 3mg and 6mg per day has a positive outcome, both in the psychotic domain and the substance use disorder. We hope this case series will help our colleagues treat their patients suffering from these pathologies in an optimal way. This could also set a basis to encourage a proper clinical trial to assess if new antipsychotics such as cariprazine could be a new standard for the treatment of Dual Disorders.

None Declared

Eating disorders and sports addiction are becoming increasingly common among athletes.It’s important to be aware of these disorders in order to improve their overall prevention.

The aim of our study was to determine the links between exercise addiction (EA) and eating disorders in Tunisian students at the Institute of Physical Education and to examine the factors associated with these disorders.

An anonymous self-administered questionnaire was distributed to students in the Sfax and Gafsa sports sections during March 2023. The Exercise Addiction Inventory (EAI) was used to study exercise addiction. It is a scale whose purpose is to separate individuals into 3 groups: those at risk of exercise addiction (score ≥ 24), those non-addicts with symptoms (score 13 to 23) and those non-addicts without symptoms (score 0 to 12).

Eating disorders were assessed using the SCOFF-F questionnaire ( Sick, Control, One stone, Fat, Food), with a score of 2 or more indicating possible eating disorders.

We collected 240 participants. The mean SCOFF-F and EAI scores were 1.7±1.3 and 16.6 ± 4.1 respectively. Among the participants, 52.9% of students were at risk of developing eating disorders and 2.5% of students were at risk of exercise addiction. In our study, 82.5% of students took part in regular physical activity in a gym. The main reasons for going to the gym were muscle strengthening (57.9%) and preparation for a sporting competition (37%).

Among students exercising outside the institute, the mean SCOFF score was significantly higher for those doing so to prepare for a sports competition (p=0.001), for professional obligations (p=0.005) or for weight loss (p=0.001). Participants at risk of exercise addiction had a higher mean SCOFF score, but the difference was not significant (p=0.051).

Our study shows that eating disorders were widespread among Tunisian athlete students, and were higher among students at risk of exercise addiction.

None Declared

Several studies have called atention to the mental health disorders associated with chemsex --the intentional use of drugs before or during sexual intercourse GBMSM (gay, bisexual and men who have sex with men) population-. Sexualized intravenous drug use is also known as slam or slamsex. There are few studies that analyze the mental health differences between intravenous drug users compared to non-intravenous drug users in chemsex context.

To describe the suicidal behaviour in a sample of users with sexualized drug use (chemsex) attended by the non-governmental organization Apoyo Positivo in the program “Sex, Drugs and You” and to compare the suicidal behaviour between intravenous drug users compared to non-intravenous drug users.

A cross-sectional descriptive analysis of a sample of users attended by the non-governmental organization Apoyo Positivo in the program “Sex, Drugs and You” between 2016-2019 was performed.

We included 217 participants. 37 had attempted suicide at least once. The percentage of chemsex users who have attempted suicide were significantly higher in the intravenous drug use group compared to the non-intravenous drug use group (p<0.05).

Possible risk factors for suicidal behaviour among chemsex users include slamsex. Other possible risk factors previously described in other studies include adversities experienced due to one’s sexual orientation and an increased risk for HIV and other STI infections. Further studies analyzing the relationship between chemsex, slamsex and suicidal behaviour are needed.

None Declared

Behavioral addictions (BAs) are intensely explored during the last decades due to their impact on the quality of life, functionality, socio-economical negative consequences, and high risk of mental health negative consequences. BAs are new challenges for clinicians and researchers due to a lack of well-defined diagnostic criteria, very few available epidemiological data, and scarce information about efficient therapeutic interventions. Cell phone addiction (CPA) has been raising a significant interest for mental health specialists because of its increasing prevalence and potential long-term physical and mental complications. Therefore, an analysis of the available data about the main characteristics of this pathology seems granted.

The main objective of this review was represented by the need to find relevant reports about the epidemiological, clinical, and therapeutic interventions in CPA.

A narrative review focused on the available treatments for food addiction was performed through a search in four electronic databases (PubMed, Cochrane, EMBASE, and Web of Science/Clarivate) using the paradigm “cell phone addiction” or “smartphone dependence” and “treatment” or “epidemiology” or “diagnostic criteria” or “risk factors.” No inferior time limit for published papers was established, and the superior limit was July 2023.

A relatively large number of papers regarding this topic were found (n=772), but after applying the inclusion and exclusion criteria, only 29 articles remained. Female gender and adolescents, but also high anxiety levels, insomnia, excessive Internet use, less physical activity, and a higher level of dependence have been correlated with CPA. Six validated scales have been identified as possible instruments for monitoring the CPA evolution. Different diagnostic criteria have been suggested, but they still lack clinical validation. Cognitive-behavioral therapy could be helpful, and smartphone applications that limit online time could also be efficient. Treatment of previously mentioned vulnerability factors is also recommended to obtain long-term favorable effects.

CPA is an increasingly explored BA, but validated diagnostic criteria are still missing. The treatment is also based on extrapolations from other addictions. Therefore large sample-based therapy trials are needed.

None Declared

Inflammatory processes may play a role in the pathophysiology of substance use disorders. Chronic opiate use may lead to inflammation, and elevated inflammation markers have been observed in individuals with opioid use disorder (OUD). The Neutrophil-Lymphocyte Ratio (NLR) serves as an indicator of systemic inflammation. NLR can be employed in both diagnosis and treatment monitoring as an inflammatory marker to gauge the severity of OUD.

Our aim was to assess the utility of NLR as a marker of chronic inflammation in diagnosing and monitoring treatment in individuals with OUD.

A total of 200 patients with OUD and 78 healthy control subjects were enrolled in the study. Patients were initially admitted to a 28-day abstinence-based inpatient program and subsequently transitioned to outpatient buprenorphine/naloxone (B/N) maintenance treatment after hospitalization at the Alcohol and Substance Addiction Treatment Center in Trakya University School of Medicine (Edirne, Türkiye). NLR was employed as a measure of systemic inflammation. Blood samples were collected the morning following admission for detoxification. Patients were categorized into two groups: the treatment retention group and the dropout/relapse group based on their 3-month and 12-month follow-up results. Clinical data were obtained from patient records.

At the 3-month follow-up, the median NLR with interquartile range was 1.34 (1.05-1.99) in the treatment retention group (n=112) and 1.72 (1.11-2.46) in the dropout/relapse group (n=88). At the 12-month follow-up, the median NLR with interquartile range was 1.28 (0.88-1.85) in the treatment retention group (n=52) and 1.56 (1.07-2.33) in the dropout/relapse group (n=148). The median NLR in the control group (n=78) was 1.36 (1.12-1.74). According to the 3-month and 12-month follow-up data, the difference between the groups concerning NLR was statistically significant (χ2=9.072, p=0.011; χ2=11.165, p=0.004; respectively). Pairwise comparisons indicated that patients in the dropout/relapse group had significantly higher baseline NLR values than those in the treatment retention group and healthy controls according to the 3-month (p=0.038 and p=0.019, respectively) and 12-month follow-up data (p=0.012 and p=0.040, respectively). NLR did not differ significantly between the treatment retention and control groups in both follow-ups (p>0.05).

Our findings suggest that elevated baseline NLR is associated with dropout/relapse in OUD, indicating its potential as a marker for treatment follow-up in these patients.

None Declared

Interoception encompasses processes that involve receiving, processing, and integrating bodily signals with external stimuli, ultimately influencing ongoing motivated behaviors. Disruptions in these interoceptive processes are believed to contribute to the development and progression of alcohol use disorder (AUD). Interoceptive accuracy (IAc), the objective dimension of interoception, has been shown to be decreased in patients with AUD. Traits linked to substance use vulnerability, such as personality dimensions and alexithymia, may be associated with decreased IAc.

Our objective was to compare the heartbeat perception (HBP) scores, as a measure of IAc, between abstinent inpatients with AUD and healthy controls. Additionally, we aimed to investigate potential associations between IAc and variables such as alcohol craving, personality dimensions, and alexithymia.

The study comprised 48 abstinent inpatients with AUD and 68 healthy control subjects. All participants completed a heart rate tracking task, serving as an objective physiological measure of IAc. In addition to the IAc task, several assessments were administered to the patient group, including the Alcohol Use Disorders Identification Test (AUDIT), the Penn Alcohol Craving Scale (PACS), the Temperament and Character Inventory (TCI), and the Toronto Alexithymia Scale (TAS-20). Patients were recruited for a 28-day abstinence-based inpatient treatment program, and all assessments were conducted during the final week of hospitalization at the Alcohol and Substance Addiction Treatment Center in Trakya University School of Medicine (Edirne, Türkiye).

Patients’ HBP scores (mean ± standard deviation: 0.59±0.21) were significantly lower than those of healthy control subjects (0.74±0.15) (t=-4.469, p<0.001). The patients’ HBP scores showed significant negative correlations with AUDIT (r=-0.312, p=0.035), PACS (r=-0.361, p=0.019), and TAS-20 scores (r=-0.406, p=0.004). Additionally, there was a significant positive correlation between patients’ HBP scores and TCI self-directedness scores (r=0.371, p=0.009), and a near-significant correlation with TCI persistence scores (r=0.282, p=0.052). TCI novelty seeking, harm avoidance, reward dependence, cooperativeness, and self-transcendence scores did not significantly correlate with patients’ HBP scores (p>0.05).

Our findings may support the hypothesis that interoceptive processes play a role in AUD, and that certain traits linked to vulnerability to alcohol use are associated with decreased IAc.

None Declared

Bipolar Disorder (BD) is a complex psychiatric condition that typically manifests during late adolescence and early adulthood. Over the past two decades, international studies have reported that BD often goes unrecognized and untreated for several years, which can lead to negative clinical and functional outcomes. However, the components of delay in the diagnosis and treatment of BD in adolescents and young adults and various factors influencing those components have not been systematically explored.

To determine the known factors that contribute to delays in the treatment of BD in adolescents and young adults and identify current knowledge gaps.

A conceptual framework based on the Model of Pathways to Treatment by Scott and colleagues was used as a foundation for our search and extraction strategy to ensure all components of delay and potential factors influencing each component are explored. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline (PRISMA-ScR) to systematically search the electronic databases of MEDLINE (OVID), EMBASE, PsycINFO and CINAHL for peer-reviewed original research articles published from January 01, 2000 through March 29, 2023. Inclusion was restricted to studies with quantitative or qualitative data on individuals diagnosed with bipolar spectrum disorders with symptomatic onset or study participation between the ages of 13-24. Grey literature and studies not published in English were excluded due to resource limitations. Two independent reviewers screened the references retrieved by the literature search based on our inclusion criteria. The findings of included studies were summarized in a narrative and tabular form according to component of delay.

Our search yielded 5180 unique citations, of which 44 articles met our inclusion criteria. We present findings on the patient, illness, and healthcare provider/mental health system factors contributing to the delays in illness appraisal, help-seeking, diagnosis, and treatment.

To the best of our knowledge, this is the first systematic scoping review to explore the potential factors that influence delays in the treatment of BD in adolescents and young adults. Findings from this review will inform clinical practice and policy. We also demonstrate the utility of a systematic approach to identifying the components of delay, from symptom recognition through treatment, as a methodology to help identify knowledge gaps to inform future research.

None Declared

Insufficient knowledge about the pathophysiological processes in bipolar disorder (BD) leads to difficulties in differentiating this disorder from other affective disorders. Quantitative analysis of serum protein profiles in BD expands our understanding of the pathophysiology of the disease and may aid in subsequent diagnosis. As a result of a previously conducted comparative mass spectrometric study of serum proteins in patients with depression, bipolar disorder and healthy donors, increased expression of Heat Shock 70kDa Protein1A (HSPA1A) and transthyretin was identified.

Determination of HSPA1A and transthyretin concentrations in the blood serum of patients with mental disorders.

Blood serum of 28 patients with bipolar disorder aged 49 years [33;52], 30 patients with recurrent depressive disorder aged 40 years [31; 51] and 130 patients with schizophrenia aged 38 years [31;49], as well as 20 mentally and somatically healthy individuals aged 35 years [31;40] was studied. The amount of Heat shock protein 1A (HSPA1A) and Transthyretin (thyroxine and retinol transport protein) was determined using a Enzyme-linked Immunosorbent Assay Kit from Homo sapiens (Cloud-Clone Corp). Statistical data processing was carried out in the Statistica 12.0 program.

A statistically significant (p = 0.016) increase in the level of HSPA1A was found in patients with BD (0.84 [0.59; 1.09] ng/ml), compared with healthy individuals (0.61 [0.51; 0.77] ng/ml). HSPA1A plays a pivotal role in the protein quality control system, ensuring the correct folding of proteins. It is known that this protein is involved in the embryonic development of the central nervous system, as well as in neuroprotection by preventing the death of neurons due to its anti-apoptotic properties. A statistically significant (p = 0.047) increase in the level of transthyretin was found in patients with BD 21.8 рg/ml, compared with healthy individuals 19.4 pg/ml. Transthyretin plays an important role in ensuring the normal state of the central nervous system and is involved in cognitive processes.

Thus, the HSPA1A and transthyretin are probably involved in the pathogenesis of BD and can be proposed as be proposed as an additional paraclinical criterion for differential diagnosis.

Support by RSF №23-75-00023.

None Declared

During the past 2 decades there has been intense interest in the clinical significance of the concurrence of manic symptoms in depressed patients. DSM-5 introduced a mixed features specifier for both bipolar depression and major depressive disorder. Studies of the DSM-5 mixed features specifier have generally found a low prevalence of mixed depression. One approach towards increasing the sensitivity of the DSM-5 mixed features criteria is to lower the classification threshold.

In the present study we examine the impact of lowering the DSM-5 diagnostic threshold from 3 to 2 criteria on the prevalence and validity of the DSM-5 mixed features specifier for depression.

Four hundred fifty-nine psychiatric patients in a depressive episode were interviewed by a trained diagnostic rater who administered semi-structured interviews including the DSM-5 Mixed Features Specifier Interview. The patients were rated on clinician rating scales of depression, anxiety and irritability, and measures of psychosocial functioning, suicidality, and family history of bipolar disorder.

If the DSM-5 diagnostic threshold is lowered from 3 to 2 symptoms, then the prevalence of mixed features based on the DSM-5 majority of episode time frame tripled from 3.9% to 13.1% (n=60). Based on a past week time frame prevalence more than doubled from 9.4% to 22.9% (n=105) going from the 2 and 3 symptom threshold, respectively. There was no difference between the patients with 2 mixed features and patients with 0 or 1 mixed features on family history of bipolar disorder, psychosocial impairment, presence of comorbid disorders, age of onset, history of suicide attempts or psychiatric hospitalization.

The results of the present study do not support lowering the DSM-5-TR diagnostic threshold for the mixed features specifier in depressed patients from 3 to 2.

None Declared

Lithium treatment is a proven method for bipolar disorder management, but its narrow therapeutic range and the risk of severe side effects, including lithium intoxication, pose significant clinical hurdles. Lithium intoxication, a potentially life-threatening complication, can occur during treatment, raising ongoing questions about its clinical factors, risk elements, and best practices for management.

Our objective is a comparative analysis between patients who have experienced lithium intoxication and those who have not, aiming to identify influencing factors and enhance clinical care.

We collected demographic data, age at lithium treatment initiation, treatment duration, therapeutic adherence, Mental Health consultations, and lithium level monitoring from 14 individuals requiring clinical attention due to lithium intoxication and 14 patients with similar gender, age, and diagnosis with lithium treatment but without intoxication during four years of follow-up.

Regarding the results, the age of onset of lithium treatment in patients with lithium intoxication was 30.2 years (SD=8), and the duration of lithium treatment averaged 11.1 years (SD=8.8), which did not significantly differ from the control group with ages of onset at 38.1 years (SD=15.1) and treatment duration of 9.27 years (SD=8.8), respectively. Lithium intoxication patients developed severe complications, including hospitalizations in medical-surgical units, the necessity for dialysis, and death, one fatal case. Although therapeutic adherence to lithium, measured through pharmaceutical dispensation, exceeded 90% and was comparable in both groups, patients affected by lithium intoxication exhibited a significantly higher treatment discontinuation rate (OR 32.5; 95% CI, 3.1 to 337.8) during the follow-up period. Patients who experienced lithium intoxication had an average of psychiatric consultations every 11.2 months (SD=13.4), with 35.7% not attending at least once a year, while the control group had an appointment every 5.31 months (SD=2.7) (p > 0.05). Lastly, despite both groups having a similar frequency of plasma lithium level monitoring, occurring approximately every 5.5 months (SD=2.6) and 7.8 months (SD=4.8), respectively, in 28.5% of those who suffered from lithium intoxication did not undergo any monitoring for periods exceeding 18 months (p < 0.05).

Our research highlights the significance of delivering thorough clinical care and continuous monitoring to patients receiving lithium treatment for bipolar disorder. Ensuring effectiveness therapeutic adherence and maintaining strict monitoring of lithium levels are critical factors that significantly enhance treatment safety. Appropriate management has the potential to improve the quality and safety of care for people with bipolar disorder who are dependent on lithium therapy.

None Declared

The ASD Therapeutic Day Unit is a tertiary care unit that consists of 20 beds, designed to facilitate the evaluation and treatment of children and adolescents with ASD who present high psychiatric comorbidity with behavioral problems, communication/language problems, sensory, and/or in the management of their repetitive and restricted interests. In addition to diagnosis and genetic counseling and clinical care, we offer the possibility of performing an individualized pharmacogenetic study in order to offer appropriate pharmacological treatment to patients with ASD and comorbidities.

The objective is to promote pharmacological tolerability, avoid unwanted side effects, as well as avoid the use of polypharmacy, in children with a tendency to poor drug metabolism.

A review of the medical history of the patients included in the Blood Extraction Program of the ASD Day Therapeutic Unit is carried out during the year 2022. The existing medications at admission, the results of the pharmacogenetic analyzes carried out, and the pertinent changes in the pharmacological treatment of these children.

37 children were included in the program during 2022. The genes CYP1A2, CYP2C19, CYP2D6, CYP3A4 and 5-HTT were analyzed. The variant studied is described, as well as the observed genotype and the expected phenotype.

Of the 37 patients, 11 maintained the same pharmacological treatment as at the beginning of admission, 5 were not taking pharmacological treatment and 25 underwent a treatment modification.

The most frequently modified treatment was risperidone with aripiprazole (n=10), secondly risperidone with guanfacine (n=5), and thirdly fluoxetine with aripiprazole (n=2).

Furthermore, the degree of pharmacological polytreatment was reduced. 18 patients switched to a single drug, instead of 14. 11 patients 2 drugs (instead of 14), 3 patients 3 drugs instead of 4 and 5 patients remained without drug treatment.

Patients with ASD have worse tolerability to pharmacological treatments than other patients with severe mental disorders.

The use of pharmacogenetics allows improving the cost/effectiveness of medical prescription, avoiding undesirable side effects or lack of effectiveness in the treatment of patients with ASD.

Promoting the implementation of pharmacogenetics in patients with ASD (among others) would improve the clinical situation of these patients more effectively and would improve the economic expenditure derived from erroneous prescription and/or excessive polypharmacy.

None Declared

Attention-Deficit/Hyperactivity Disorder (ADHD), once considered a predominantly childhood condition, has increasingly gained recognition as a prevalent and clinically significant concern among adult women. They often display a distinctive symptom profile characterized by high levels of inattention, emotional dysregulation, and difficulties in executive functioning. Diagnosis of female adult ADHD is frequently complicated by gender bias in traditional diagnostic criteria, which may fail to account for the unique ways in which women manifest the disorder.

This comprehensive literature review aims to characterize the unique symptomatology of female adult ADHD, including variations in inattention, hyperactivity, and impulsivity, as well as the presence of emotional dysregulation. It also seeks to explore the diagnostic challenges stemming from gender bias in diagnostic criteria and the role of comorbidity in diagnostic complexity. Additionally, the review assesses the broad spectrum of functional impairments experienced by adult women with ADHD, spanning academic, occupational, interpersonal, and emotional domains.

This literature review comprises a systematic examination of published research articles, clinical studies, and relevant academic literature addressing female adult ADHD. A comprehensive search strategy involving electronic databases, including PubMed, PsycINFO, and Google Scholar, was employed to identify peer-reviewed articles published between 2000 and 2023. The selected studies underwent critical appraisal for quality and relevance to the review’s objectives.

The synthesis of existing literature reveals that female adult ADHD presents a distinctive clinical picture characterized by a higher prevalence of inattention, emotional dysregulation, and comorbid conditions such as mood and anxiety disorders. Diagnostic challenges arise from gender bias in diagnostic criteria and the absence of overt hyperactivity, often leading to delayed diagnosis or misdiagnosis. Functional impairments extend to academic, occupational, interpersonal, and emotional domains, affecting the overall quality of life for affected individuals. Gender-specific factors, including societal expectations and biases in healthcare evaluation, contribute to diagnostic disparities and hinder timely access to appropriate interventions.

The literature review underscores the critical need for enhanced recognition, understanding, and tailored support for female adults with ADHD. The distinct symptomatology, diagnostic complexities, functional impairments, and gender-specific factors contribute to a multifaceted clinical landscape. Advancing gender-sensitive diagnostic criteria, increasing awareness among healthcare professionals, and developing interventions that address the unique needs of this population are essential steps toward improving the quality of life and outcomes for female adults with ADHD.

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Borderline personality disorder (BPD) in youth has the greatest spectrum of psychopathology and is strictly associated with nonsuicidal self-injury (NSSI) and suicidal behaviour [Guile et al. Adolesc Health Med Ther 2018; 9 199-210; Paris Med. 2019; 55(6):223]. The formation of autoaggressive behaviour and suicidal activity is due to the psychopathological features of BPD, which include affective instability, impulsivity and impaired self-identity.

The aim of the study was to investigate the psychopathological features of suicidal behaviour in BPD in youth.

Clinical and psychopathological examination with assessment of suicidal behaviour at the time of, 6 and 12 months later. For additional psychometric examination of patients we used: SCID-II questionnaires, Barratt Impulsiveness Scale (BIS-11), Toronto Alexithymic Scale (TAS), Columbia Suicide Severity Rating Scale (C-SSRS). Sample: N=62 male and female youth males and females in two equal groups of 31, respectively, with an established diagnosis of BPD and the presence of suicidal behaviour. The mean age of first referral in both groups was 19.1±2.2 years.

This study defined 2 variants of suicidal behaviour in patients with BPD in youth: 1) Expansive - with predominance of impulsiveness (BIS-11 70±3), affective instability, associated with psychosocial factors as a trigger of suicidal activity. Suicidal attempts were made at the height of psychoemotional stress. These patients were characterised by moderately high scores of the C-SSRS scale 2±1, in which patients noted the absence of a plan and specific intentions before the attempt, and a lower incidence of repeated attempts after 6 ((N=6 (19.4%) and 12 months N=10 (32.2%). 2) Rationalistic variant of suicidal behaviour was found in patients with predominance of self-identification disorders, dissociative disorders and high level of alexithymia TAS 81±4.2 in the clinical picture. Suicidal ideation was revealed in all patients, often throughout the entire youth period, and attempts were characterised by thoughtfulness and led to severe consequences, including fatal outcome. Patients with rationalistic variant of suicidal activity had higher C-SSRS scale scores of 4±1, with the presence of suicidal intentions and high frequency of attempt recurrence after 6 (N=11 (35.5%) and 12 months (N=17 (54.8%)).

The variant of suicidal behaviour depended on the degree of severity and correlation of the psychopathological structure of BPD in youth. Less favourable prognosis was characteristic of the rationalistic variant due to the high frequency of repeated attempts. The results obtained require further analysis and contribute to the development of differentiated therapeutic strategies.

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In ESCAPE-TRD, esketamine nasal spray (ESK-NS) significantly increased the probability of remission at Week (Wk)8 and being relapse‑free through Wk32 after remission at Wk8 versus (vs) quetiapine extended-release (QTP-XR), in patients (pts) with treatment resistant depression (TRD). Safety data were consistent with established profiles of each treatment, with no new safety signals identified (Reif et al. DGPPN 2022; P-01-04).

To explore weight changes and their impact on treatment discontinuation in ESCAPE-TRD.

ESCAPE‑TRD (NCT04338321) was a randomised, open-label, rater-blinded, phase IIIb trial comparing efficacy and safety of ESK-NS vs QTP-XR in pts with TRD. Safety analyses were conducted on pts who received ≥1 dose of study treatment. Treatment-emergent adverse events (TEAEs) were defined as occurring at or after the first dose of study treatment and within 14 days/30 days (non-serious/serious) of the last dose. A ≥7% increase/decrease in weight from screening was considered for evaluation as a TEAE. Weights were measured and are reported as observed, with no missing data imputation.

336 and 340 pts were randomised to ESK-NS and QTP-XR; 334 and 336 were included in the safety population. Over the 32-week study, a TEAE of weight increase was reported in fewer pts treated with ESK-NS than QTP-XR (9 [2.7%] vs 42 [12.5%]), leading to treatment discontinuation in 0 vs 6 (1.8%) pts, respectively. Incidences of weight increase TEAEs were balanced across pts categorised as normal, overweight or obsese by baseline body mass index (BMI; Figure). A weight decrease TEAE was reported in 7 pts (2.1%) in the ESK-NS arm vs 0 pts in the QTP-XR arm. Mean (standard deviation [SD]) weight at baseline was 76.4 (16.2) kg (ESK-NS; n=334) vs 79.1 (16.9) kg (QTP-XR; n=336). At Wk32, mean weight was maintained (76.5 [16.3] kg) in ESK-NS treated pts (n=249; mean [SD] change from baseline: 0.1 [4.0] kg) and increased (80.7 [15.6] kg) in QTP-XR treated pts (n=203; mean [SD] change from baseline: 2.5 [5.1] kg).

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Increase in weight was uncommon with ESK-NS; weight increases were more common with QTP-XR and resulted in more treatment discontinuations. Weight increase was independent from baseline BMI.

We thank the patients who participated. Funding: Janssen, medical writing: Costello Medical, UK

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Health science students in post-secondary institutions experience high levels of depression and anxiety due to increased stress levels, workload, low socioeconomic status, and history of family mental illness, among other factors. Given the significant negative impact that depression and anxiety can have on undergraduate health science students, it is essential to understand the prevalence and correlation of these conditions in this population.

This scoping review aims to identify, document and analyze the literature on the prevalence and determinants of anxiety and depression among undergraduate health sciences students and identify gaps in knowledge for future research.

The scoping review was planned and executed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for the Scoping Reviews statement. A comprehensive and systematic search was carried out for five databases, namely MEDLINE, Scopus, EMBASE, CINAHL and PubMed.

From the literature identified by our search strategy, the lowest prevalence for anxiety was 5.8%, and the highest was 82.6%, with a median of 44.25%. The prevalence of depression ranged from a high of 88.8% to a low of 2.1%, with a median value of 34.8%. Our analysis revealed that correlates of anxiety and depression among health science students include sociodemographic factors such as age, sex, gender, relationships, ethnicity and family history, personal health conditions, and academic and socioeconomic issues.

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With the high incidence of anxiety and depression among health science students, there is an increasing need to find practical remedies to support these students. It is also essential for policymakers and university authorities to implement interventions such as supportive text messages and other strategies geared toward providing support and improving the psychological well-being of health science students.

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