After judgment of the Constitutional Tribunal of 22.10.2020, there are two premises for abortion: when pregnancy was caused by rape or pregnancy is the threat for health and life of a mother. Then some people indicated that the latter should be interpreted more broadly. So far, jurisprudence has interpreted health threats only in relation to physical health, currently – cases classified as mental health threats are included.

The aim of this paper is first to analyze different aspects of this phenomenon: clinical, philosophical, including ethical and legal. The second goal is to point out the best actions for psychiatrists.

The methodology of this paper corresponds to the pastoral paradigm: diagnosis, reflection, action. At first, the arguments of opponents and proponents of the concept of psychiatric premises for abortion were extracted. Then they were assessed from a logical and essential point of view. Finally, some conclusions and guides were included to enable psychiatrists to act appropriately, including ethical, clinical and legal aspects.

Statements and letters from various institutions and societies were analyzed, including the Presidium of the Supreme Medical Council, Polish Pediatrics Society, the Expert Team on Bioethics of the Polish Bishops’ Conference, the Bioethics Committee of the Polish Academy of Sciences, Patient’s Rights Ombudsman, Commissioner for Human Rights. The key arguments for psychiatric premises are presented in the Table 1.Table 1.

According to opponents, using the premise of mental health risks to terminate a pregnancy would be an example of the psychiatrization of life and the abuse of psychiatry for political purposes. There would be a danger of associating psychiatry as a tool for performing abortions, which would perpetuate the phenomenon of stigmatization – of both doctors and patients. Each of the arguments for this has been negated.

This problem illustrates an attempt to replace the paradigm of traditional personalistic ethics with utilitarianism. The concept of psychiatric premises for abortion is contrary to the principles of double effect and proportionality. It is also against the Polish Code of Medical Ethics: art. 39 and art. 54.

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In recent years, overweight and obesity have reached an alarmingly high incidence and prevalence worldwide; they have also been steadily increasing in military populations. Military personnel as an occupational group are often exposed to stressful and harmful environments that represent a risk factor for disordered eating with major repercussions on both physical and mental health.

This study aims to explore the effectiveness of weight loss interventions and to assess the significance of current obesity treatments for military populations.

Three online databases (PubMed, PsycInfo, and Web of Science) were screened to identify randomized controlled trials (RCTs) aiming to treat obesity in active-duty military personnel and veterans. Random-effects meta-analyses were conducted for body weight (BW) and body mass index (BMI) values, both longitudinally comparing treatment group from pre-to-post intervention, and cross-sectionally comparing the treatment group to controls at the end of the intervention.

A total of 21 studies were included: 16 cross-sectional (BW: n=15; BMI: n=12) and 16 longitudinal (BW: n=15; BMI: n=12) were meta-analyzed, and 5 studies were narratively synthesized. A significant small overall BW and BMI reduction from baseline to post-intervention was observed (BW: g = -0.10; p = 0.015; BMI: g = -0.32; p < 0.001), together with a decreased BMI (g = -0.16; p = 0.001) and nominally lower BW (g = -0.08; p = 0.178) in the intervention group compared to controls at post-intervention time-point. When conducting additional meta-analyses dividing by sample type, a significant decrease in both BMI (g= -0.35; p< 0.001) and BW (g= -0.12; p= 0.041) from pre-to-post intervention was observed in active-duty military personnel but not for veterans.Recommendations for clinical practice have been outlined from the findings of this study and summarized in Figure 1.

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Despite limitations, such as the heterogeneity across the included interventions and the follow-up duration, our findings highlight how current weight loss interventions are effective in term of BW and BMI reductions in military populations, and how a comprehensive approach with multiple therapeutic goals should be taken during the intervention.

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Menstrual psychosis has an acute onset and is characterised by confusion, stupor and mutism, delusions, hallucinations, or a manic syndrome lasting for a brief duration, with full recovery. These symptoms maintain periodicity in rhythm with the menstrual cycle. The symptoms may appear in the premenstrual phase or may begin with the onset of menstrual flow (catamenial psychoses). Usually, menstrual psychosis has a polymorphism of both psychotic and affective symptoms (Brockington I. Menstrual psychosis. World Psychiatry. 2005;4(1):9-17.). In this article we present a case of menstrual psychosis with premenstrual onset.

A 26 years old, nulliparous single female with one mentally ill relative on her mother’s side (her grandmother) presented with an episodic illness characterized by mood swings, irrelevant speech, irritability, suspiciousness and thought disorder related to her menstrual cycles. She had earlier suffered prolonged attacks of mania, developed a recurrent episodic illness which returned every month for five years. Her menses began at 15. She presented with the history of a few episodes of manic illness starting five days before and ending suddenly with the onset of the menses.

On mental status evaluation during the index episode, the patient was agitated, had labile affect, grandiose and referential delusions and erotomania. A detailed physical examination, routine biochemistry, and gonadal hormonal assay were unremarkable.

She was started on olanzapine 10 mg/day, lithium 1200 mg/day and low-dose clonazepam. Although the severity of the psychotic and affective symptoms gradually reduced during the future menstrual cycles, they did not completely resolve.

The pathophysiology of menstrual psychosis is not exactly understood, but it has been postulated that fluctuation of the sex hormones occurring during the menstrual cycle is responsible. Previous studies have reported the association of psychosis with estrogen withdrawal (Mahé V, Dumaine A. Oestrogen withdrawal associated psychoses. Acta Psychiatr Scand. 2001;104(5):323-331.). Treatment strategies for menstrual psychosis include the use of oral contraceptive pills for the regulation of hormones during the menstrual cycle, in our case patient did not want to use oral contraceptive pills.

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The Personality Inventory for DSM-5 (PID-5) is an instrument that aims to assess pathological personality traits according to the alternative model proposed by the DSM-5. To validate the comparison of an instrument’s scores between different groups, it is necessary that the measure’s invariance be attested, in order to guarantee that the same underlying constructions are being evaluated between the groups. Differences between sex in relation to the predominance of adaptive personality traits were portrayed in previous studies, a fact that seems to be related to culture.

This study aims to assess whether the PID-5 presents structural equivalence between sex (sex measuremet invariance) and whether there are differences between pathological personality traits in Brazilian men and women.

A community sample of 1110 subjects was assessed (71.2% women, mean age 34.6 (±15.8) years, 68.8% higher education). They were recruited through advertisements in different media and by the “snowball” method. Participants responded to the PID-5 in person. The cross-culturally adapted version into Brazilian Portuguese was used

The PID-5 showed that its structure was invariant for sex at the configural level (CFI= 1.000; TLI=1.007; RMSEA<0.001), metric (ΔCFI=0.01; ΔTLI= 0.02; ΔRMSEA=0.02) and scalar (ΔCFI=0.006) ; ΔTLI= 0.006; ΔRMSEA=0.004), allowing comparisons. Regarding the domains evaluated by the PID-5, men showed more traits of Distancing, Antagonism, Disinhibition and Psychoticism (p<0.002), while for Negative Affectivity there were no differences between genders (p=0.06). In terms of facets, women showed higher indicators of lability, anxiety and impulsivity (p<0.01), while men showed perseverance, withdrawal, restricted affectivity, manipulation, dishonesty, grandiosity, attention seeking, insensitivity, irresponsibility, exposure to risks, unusual beliefs and eccentricity (p<0.04).

The findings reinforce the validity evidence of the DSM-5 trait model, which, through the PID-5, similarly evaluates such aspects between sex. Differences between genders were observed in relation to pathological personality traits, which bear similarities with differences observed in terms of adaptive personality traits. Specificities are observed at the cultural level, when, for example, the findings are compared with a Japanese university sample, reinforcing the role of culture at this level

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(Abstract for the accepted case-based workshop by the NDAL section at EPA)

Women with ADHD are underdiagnosed in mental health care, and although ADHD starts in early childhood, the symptoms and impairment of women with ADHD may only be recognised for the first time during (peri)menopause.

The relationship between decreasing levels of estrogen and the interaction with dopamine function in the brain in women with ADHD will be discussed and illustrated by a clinical case vignet of Mary, age 54.

Mary presents with a history of repeated burnout episodes, mood swings, lifetime difficulty concentrating, planning and organising daily life, restlessness, sleep problems, and cardiac complaints.Mary has been working hard her whole life to overcome all difficulties, but her problem is she can never stop, leading to getting burnout several times. This time she is exhausted and can no longer cope; she is visiting the cardiologist for palpitations, hypertension and a recent myocardial infarction.

After a positive screening for ADHD, based on her lifetime symptoms of inattention, restlessness and impulsivity, as well as mood swings, she is referred to a psychiatrist for assessment of ADHD, mood and sleep problems. The pathophysiology behind this cluster of disorders during (peri)menopause, as well as the treatment options will be discussed based on Mary’s case.

Both ADHD in women, (peri)menopausal mood disorders as well as the heart complaints in women during menopause are underrecognised and undertreated, leading to unneccesary suffering and cardiac death in women. It is time for psychiatry to join forces with cardiology and gynaecology for better recognition, sharing knowledge and multidisciplinary treatment of women with mental disorders such as ADHD during menopausal transition (see www.h3-netwerk.nl).

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Sleep quality depends on several factors such as smoking, physical activity, diet, and certain pathologies, namely obstructive sleep apnoea syndrome. Indeed, following their vaccination against COVID19, several medical trainees complained about a deterioration of their sleep quality.

To evaluate the quality of sleep of medical trainees who work at Charles Nicolle Hospital and who were vaccinated against SARS-COV2.

We conducted a descriptive cross-sectional study among medical trainees at Charles Nicolle Hospital who were vaccinated against COVID-19 during the period from March 2020 to August 2022. Sleep quality was evaluated by the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Trainees were contacted during the period August 2022 to September 2022.

Sixty-nine medical trainees, vaccinated against Covid19 joined our study. Forty-nine of them had a significant sleep disturbance: Pittsburgh Sleep Quality Index (PSQI) greater than five. The average age was 29.39±3.04 years with a female majority (73.5%). No psychiatric history was found. The most affected category of trainees were residents (71.4%). Forty-three of them were inoculated with the messenger RNA vaccine and 4 with inactivated vaccine. Twenty-one patients vaccinated with the messenger RNA vaccine received two doses, seventeen received three doses and only one received a single dose. Sleep latency was high in 20,4% of cases. A sleep duration of less than five hours per night was found in 18,4% of the cases. Six participants reported using a sleep aid three to four times a week.

Our study revealed a significant sleep disturbance in medical trainees at Charles Nicolle Hospital. This could be due to the SARS-COV2 vaccination but can also be explained by the night shifts and the stress to which they are exposed, especially during this pandemic period.

None Declared

Philosophy of mind grapples with fundamental questions concerning the Consciousness, the Mind-body problem, the Identity, and Free will (as opposed to Determinism). In the context of psychiatry, this philosophical groundwork provides a conceptual framework for comprehending the intricate workings of the human psyche.

We aim to discuss how the philosophical investigation of the mind influence and enhance psychiatrists understanding of psychiatric disorders and patient-centered care.

Review of the literature.

Philosophy of mind explores what it means to be conscious and the nature of subjective experience. This includes questions about the “hard problem” of consciousness, that refers to the difficulty of explaining why and how physical processes in the brain give rise to subjective, first-person experiences (or qualia). The “hard problem” posits that even if we knew everything about the brain’s physical processes and how they relate to cognitive functions, we would still lack an explanation for why these processes give rise to subjective consciousness. Psychiatry often deals with individuals who experience disturbances in their subjective conscious experiences, so the “hard problem” perspective allows psychiatrists to appreciate the diversity of conscious experiences and to empathize with their patients’ unique mental worlds.

Related with the previous topic is the mind-body problem. The elucidation of this problem highlights the challenge of reconciling mental phenomena with neurobiological processes. Integrating philosophical notions of dualism, materialism, and emergentism into psychiatric practice is essential for addressing the holistic nature of mental health.

Concerning to philosophical perspectives on personal identity, questions about the continuity of identity, selfhood, and the role of narrative in shaping one’s sense of self contribute to a deeper understanding of disorders like dissociative identity disorder, borderline personality disorder and even psychosis.

Furthermore, philosophical discussions on free will and determinism are pertinent to psychiatric ethics and the treatment of individuals with behavioral disorders, informing the ethical considerations surrounding involuntary psychiatric hospitalization, medication administration, and the delicate balance between autonomy and paternalism in psychiatric care.

Philosophy of mind provides psychiatry with a rich conceptual landscape, offering insights into the nature of mental phenomena. As our understanding of the brain and consciousness continues to evolve, the philosophy of mind remains an evolving area of philosophical inquiry.

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In recent years, there has been renewed interest in lithium therapy due to emerging evidence of the protective effects of lithium against neuronal death caused by a wide range of neurotoxic effects. Oxidative stress is a common pathway that is involved in various pathologies. In this regard, the development and study of new lithium compounds with combined antioxidant effects becomes relevant. Pyruvate has many potential benefits due to its positive effects on cellular metabolism.

The purpose of this study was to study lithium pyruvate on blood cells of healthy donors under conditions of induced oxidative stress.

The study used blood from 20 healthy control group volunteers, aged 25 to 54 years. Venous blood was taken at baseline and then used for PBMCs extraction. After that cells were incubated during 24 hours in RPMI 1640 medium at 37°С and 5% carbon dioxide concentration. For oxidative stress induction hydroperoxide of trisubstituted butyl (HTB) was used in concentration of 50 μM. Cells were also incubated with lithium pyruvate in final concentration of lithium ions of 1.2 mM with or without HTB. Level of oxidative stress in culture was assessed by flow cytometer «Muse Cell Analyzer» (Merck Millipore, Germany) using «Oxidative stress» reagents kit (Merck Millipore, Germany). Statistical analysis was performed using the SPSS software, release 20.0 for Windows.

Percentage of cells with reactive oxygen species (ROS) cultivated with HTB (65,33 (41,95-79,30) %) was statistically significant higher compared to intact cells (11,03 (7,93-15,53) %) (p=0.001). After addition of lithium pyruvate in culture statistically significant antioxidant effects were observed. In PBMCs incubated with HTB and lithium pyruvate statistically significant decreased percentage of cells with ROS (42,70 (16,73-58,70) %) (p=0.001)

A pronounced antioxidant effect of lithium pyruvate under induced oxidative stress on human peripheral blood mononuclear cells has been established. Lithium pyruvate can be considered as a promising psychotropic antioxidant for further experiments.

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The mortality rate among individuals experiencing homelessness tends to be premature and is linked to mental disorders and chronic diseases. In Spain, there is a significant gap in the study of mortality among individuals in situations of residential exclusion with real clinical data.

This study aims to analyze mortality among individuals experiencing homelessness and its relationship with mental disorders and chronic diseases.

An observational and prospective longitudinal study was conducted on a cohort of 855 homeless individuals in the province of Girona over a 15-year period. Sociodemographic variables, mental health conditions, chronic diseases, and infections were analyzed, employing descriptive and inferential analyses. A binary logistic regression model was created to establish explanatory relationships between mortality and associated variables.

Among the participants, 87.7% were males with an average age of 53.03 years. A majority of 62.8% were foreign-born, mainly from Africa and Europe. It was identified that 40.8% had mental disorders, with substance dependencies (41.3%) and other disorders (36.4%) being the most prevalent. A total of 30.6% presented chronic diseases, notably hypertension (12.8%) and type 2 diabetes (10.9%). Furthermore, 22.3% had infections, with hepatitis C virus (8.7%) and HIV (4.7%) being the most common. During the follow-up period, 81 individuals (16.4%) passed away, with causes such as cancer (25%), suicide (21.7%), and heart conditions (11.7%).

The regression analysis demonstrated that age (OR = 0.915; 95% CI 0.884-0.947), alcohol addiction (OR = 2.354; 95% CI 1.486-3.731), and being born in Spain (OR = 2.906; 95% CI 1.594-5.299) were significantly associated with mortality in the homeless population.

This study highlights the high prevalence of mental disorders, chronic diseases, and infections among individuals experiencing homelessness. Mortality was associated with factors such as age, alcohol addiction, and place of birth. These findings underscore the importance of developing interventions aimed at enhancing the health and care of individuals experiencing homelessness, particularly within the immigrant population.

None Declared

Mental health problems have increased following the pandemic and are associated with considerable health, economic and societal outcomes, particularly affecting youth. In co-creation with young people several European prevention and early intervention strategies to promote mental wellbeing of youth are currently being developed. The development and implementation of easy-access youth mental services across Europe will be presented and discussed. In addition pilot data of online, hybrid treatment platforms and self-management ecological momentary intervention apps will be presented. Ultimately the aim is: 1) to develop clinical guidelines, best practices, and policy recommendations to mitigate the youth mental health challenges and 2) improve (cost-) effectiveness of early intervention strategies for promotion and prevention in mental health, including enhancing mental health literacy, resilience and self-management, while 3) actively involving young people in the process of these innovative developments. To amplify the reach, campaigns designed in co-creation with young people, to increase awareness, literacy, wellbeing and help-seeking among young people, targeting schools, further-education colleges, universities and other specific settings will need to be developed, specifically paying attention to high-risk groups within this young population, including children of parents with mental disorders, migrants, young people growing up in poverty, those in/leaving care, and the LGBTQ+ community, with coordination across domains: schools, general practitioners, and specialized mental healthcare facilities.

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Ketamine, originally an anesthetic, has emerged as a potent tool in the fight against treatment-resistant depression and suicide. Clinical trials have demonstrated its ability to induce remission of severe depressive symptoms, with effects that can extend over several weeks.Furthermore, research highlights Ketamine’s potential to rapidly reduce suicidal ideation. This suggests Ketamine’s role as an intervention in suicide prevention, especially when conventional treatments prove ineffective. While isolated cases report severe respiratory depression, primarily when combined with other medications, most incidents involve temporary apneic episodes following high-dose intravenous administration. Understanding Ketamine’s safety profile is vital for its clinical optimization and ensuring patient well-being during use

This presentation serves to describe, and evaluate our clinic’s safety protocol implemented for intravenous (IV) Ketamine infusions at the General Hospital of Corfu. Our primary goal is to rigorously assess the safety and tolerability of IV Ketamine in a clinical setting

Patients must meet stringent criteria:

• - Exclude those over 70.

• - MMSE score above 25.

• - Controlled blood pressure.

• - No cardiac insufficiency, myocardial ischemia, or high intraocular/intracranial pressure.

• - Absence of thyrotoxicosis, psychosis, or seizures.

Pre-infusion comprehensive evaluation:

• - Includes ECG, blood biochemistry studies, and frequent blood pressure checks.

• - Requires a 2-hour fast.

Ketamine infusion:

• - IV Ketamine administered at 0.5mg/kg in 100ml N/S.

• - Continuous monitoring of oxygen saturation (PO2) and cardiac rhythm.

• - Blood pressure checks every 15 minutes.

Treatment typically involves 7 sessions over a span of a month, with an initial test dose of 0.25 mg/kg.

Ketamine infusions were administered to a total of 208 patients. The majority of participants experienced a slight increase in blood pressure, while there were no significant changes in cardiac rhythm. Additionally, almost all patients reported experiencing dizziness or headaches during the infusion. Notably, nearly half of the patients reported an alteration in taste perception as a side effect. It’s important to highlight that all observed side effects, spontaneously resolved within an hour after the conclusion of the infusion. However, in a small subset of cases (six instances), the side effects were severe enough to necessitate the premature termination of the ketamine infusion

Although ketamine demonstrates a favorable safety profile with minimal major side effects when administered following our established safety protocol. However, we want to underscore the critical importance of vigilant patient monitoring during ketamine administration and the prompt addressing of any adverse effects. This proactive approach is paramount to ensure the safety and overall well-being of patients receiving ketamine treatment

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Autobiographical memory is known to be disturbed in schizophrenia. In addition, a leading theory of auditory hallucinations (AVH) is that they are intrusive – typically negative – autobiographical memories that are misinterpreted as perceptions.

The aim of this study was to examine the brain functional correlates of recall of negatively emotionally valanced autobiographical memories in patients with schizophrenia, with a longer term aim of comparing patients with and without AVH.

11 patients meeting DSM-5 criteria for schizophrenia or schizoaffective disorder and 10 age, sex and estimated premorbid IQ-matched healthy controls have so far taken part.

Participants underwent functional MRI in a 3T scanner while performing a task requiring them to recall autobiographical memories in response to individually tailored pairs of cue words. The cue words were based on autobiographical memories previously elicited in an interview with each patient and were designed to evoke the same memory. The cue words were presented in 10 20-second blocks interspersed with blocks where the subjects viewed cue words that did not evoke autobiographical memories. Brain activations were examined in three contrasts of interest: memory evoking words vs baseline, neutral words vs baseline and memory evoking vs neutral words.

Pre-processing and analysis were carried out with the FEAT module included in the FSL software. Statistical analysis was performed by means of a General Linear Model (GLM) approach.

In the memory evoking vs baseline contrast the patients showed hypoactivation in the medial frontal cortex compared to the healthy controls (Figure 1). There were no differences in activation between the patients and the controls comparing the memory evoking and neutral cues.

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The finding of hypoactivation in the medial frontal cortex compared to low level baseline in patients with schizophrenia suggests dysfunction in the default mode network, which is known to activate during recall of autobiographical memories.

These preliminary results suggest that recall of negative autobiographical memories in patients with schizophrenia is associated with reduced activity in the default mode network. A planned larger sample of patients and controls will be used to examine activations in patients with and without AVH.

None Declared

The bidirectional relationship between the effects of sleep and exercise is often underappreciated. We aim to explore the bidirectional relationship of sleep and exercise. We further discuss the prominence of poor sleep in both the athletic and general population and understand the underlying mechanisms of interdependencies between the two. The goal is to illuminate practical implications to improve both areas and optimize physical and mental health.

• - To explore the bidirectional relationship between sleep and exercise

• - To understand how exercise can counterbalance the adverse metabolic consequences of sleep deprivation.

We conducted a systemic literature review from Pubmed, Scopus, and PsychINFO using the search terms: “(exercise) and (sleep),” “(exercise performance) and (sleep),” “(sleep quality) and (exercise).” We included original studies in English conducted on age groups 18 years and older.

Data from 31 studies shows that a significant number of athletes experience poor sleep quality and daytime sleepiness. 68.5% of Qatar Stars League soccer players and 61% of collegiate athletes in NCAA institutions report daytime fatigue several times a week. Most common causes include overtraining, hectic travel schedules, and sleeping in unfamiliar settings. Studies confirm athletes often sleep less before intense training or competitions. Sleep deficiency may lead to reduced muscular strength and endurance, mood changes, increased perceived effort, impaired cognitive processing, and diminished motor skills. Athletes averaging less than 8 hours of sleep nightly were 1.7 times more prone to injuries. Physiologically, sleep loss alters ventilation, plasma lactate concentration, hormone secretion, and inflammatory responses, hinders muscle glycogen restoration. Extended sleep restriction decreases testosterone levels, which influence muscle mass, energy, bone strength, and more. On the contrary, exercise may counter adverse metabolic impacts of sleep deprivation. High-intensity interval exercise (HIIE) has shown to nullify negative metabolic effects of sleep deprivation, suggesting exercise’s protective potential.

Sleep and exercise are fundamental to maintaining physical, mental, emotional, and spiritual health. The bidirectional, interdependent relationship can be best utilized by the providers to optimize overall well being. The critical impact of adequate sleep, particularly among athletes, is frequently underestimated. Poor sleep can detrimentally affect performance, amplify injury risks, and disrupt physiological functions, yet contemporary lifestyles often downplay its significance. It is important for healthcare professionals to emphasize a balanced approach to optimize these vital aspects. Continued research can offer strategies that benefit athletes and the broader populace, aiming to uplift daily life functionality.

None Declared

World Health Organization estimates that climate changes are expected to cause an additional 250 000 deaths worldwide per year between 2030 and 2050 (1). We do not know, in what extense, population mental health will deteriorate due to climate change. Unfortunately, not all European countries, including Poland collect the evidence-based information about current and possible future risks for mental health.

(1)World Health Organization. Climate change and health; 2018. Available from who.int/news-room/ fact-sheets/detail/climate-change-and-health [cited 20 October 2020]

The aims of present study are: (1) summarize the available literature through a current review and (2) make recommendations for future actions/ prevention strategy for Poland.

Medline database (through PubMed) and Polish authorities documents was searched for records published in 2010–2024. Mental health-related descriptors (i.e. „mental health” OR “mental disorders”) and „climate change” and “Poland/ Polish” and “Europe” term were used in particular searches. The results of the screening were included in the final selection list. References of screened full-text articles and raports were manually searched for further literature. Additionally, European and worldwide publications and reports prepared by mental health and/ or climate change organizations were taken into account.

Mental health risks of climate change can stem from climate-related natural disasters (e.g., extreme weather events), slower moving events (e.g., drought), or concern about the phenomenon of climate change itself. Primary mental health impact is related mostly to disasters itself and its consequences: environment of disruption, trauma and grief. Direct consequences include increased rates of high-risk behaviours. Secondary effects of climate change are due to various processes of environmental changes and ecological disruptions. They consist of damages to physical and social infrastructure, physical health effects, food and water shortages, conflict, and displacement. Long-term droughts affect food and water supplies and can subsequently affect the economic and mental wellbeing not only the land-based workers.

A focus on climate change impact on mental health can help enhance the understanding of factors that strengthening psychosocial resilience and adaptation. The future mental health challenges of climate change in Poland cover:

• - developing scientific knowledge regarding adaptation process and resilience,

• - focusing on high-risk groups (i.e. children, rural workers),

• - strengthened community engagement,

• - developing available locally strategies for mental health improving.

None Declared

The treatment of dual disorders, the co-occurrence of a major psychiatric disorder and a substance use disorder, represents a great challenge. Recent articles recommend antipsychotics with a dopamine partial agonism as first line treatment for these patients. Studies also postulate that drugs targeting the dopamine D3 receptors specifically might have an advantage, as these receptors are involved in drug-related reward, drug-seeking, and drug-intake behaviour. One compound that has both, partial agonist- and D3- activity is cariprazine.

To evaluate the real-world evidence of the effectiveness of cariprazine in patients with dual disorders.

We performed a systematic literature search on PubMed, looking for English language articles published between January 2017 - September 2023 with the following search terms: (cariprazine) AND (psychosis OR schizophrenia OR schizoaffective OR bipolar depression OR bipolar mania OR bipolar disorder OR major depressive disorder) AND (“substance use disorder” OR cocaine OR alcohol OR cannabis OR heroin OR “double diagnosis” OR “dual diagnosis”) NOT (animal OR rat OR mouse) NOT (review or meta-analysis). An additional targeted hand search of congress reports, posters, and case reports was also conducted.

The search yielded 8 articles with 11 case reports. Mental health disorders included psychosis, schizophrenia, schizoaffective disorder, PTSD, and bipolar disorder while the abused substances were methamphetamine, cannabis, alcohol, and cocaine. All case reports described an improvement in both the symptoms of mental and substance use disorder with reduced craving and drug use and in some cases even ceasing drug use all together.

In summary, evidence suggests that cariprazine seem to be a potential candidate for dual disorders as it improves symptoms of both mental and substance use disorders.

Á. Barabássy Employee of: Gedeon Richter Plc., Z. Dombi Employee of: Gedeon Richter Plc., R. Csehi Employee of: Gedeon Richter Plc., D. Djuric Employee of: Gedeon Richter Plc., G. Németh Employee of: Gedeon Richter Plc.

Hyperprolactinemia (HPL) is a condition associated with disturbing consequences. Antipsychotic medications are one of the main causes of nontumoral hyperprolactinemia. Prolactin release in the hypothalamic tuberoinfundibular tract is increased through dopaminergic inhibition, which occurs more frequently with high- potency typical antipsychotics (40%–90%). Less commonly than typical antipsychotics, atypical antipsychotics can also result in hyperprolactinemia. In the presence of symptoms, clinicians frequently struggle with the decision of whether to stop using the suspected offending agent, lower the dosage, switch to another medication, or even add a full or partial dopamine agonist to the patient's current treatment. The issue is exacerbated by the fact that finding a suitable agent for each patient is sometimes a challenging task.

Due to the partial D2 receptor agonistic activity of aripiprazole, there is enough dopaminergic tone to continue the inhibition of prolactin release. Aripiprazole has been recommended in literature either as an adjunctive treatment in low doses or as a switch in therapy.

In the Psychiatric clinic of the General Hospital of Corfu, a low-dose (5mg/day) of aripiprazole is being used as adjunctive therapy in patients with antipsychotic-induced hyperprolactinemia. More specifically in total 42 subjects, 19 male and 22 female, with a mean prolactin level of 862ng/ml, were introduced to the prior therapy. We whereupon conducted prolactin measurements to evaluate the response at the first, the third, and the sixth month of treatment.

Of the 42 subjects, 38 responded with an average reduction of prolactin to the level of 530ng/ml (mean reduction 38,5%).

Having noticed the beneficial effect of low-dose Aripiprazole in patients with antipsychotic-induced hyperprolactinemia, we consider it appropriate that the literature recommendations concerning this additional use of aripiprazole should not be overlooked in clinical practice.

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There is a growing interest in understanding the impact of duty hours and resting times on training outcomes and the well-being of resident physicians. Psychiatry resident’s duty hours in Spain comprise a regular working schedule of 37.5h per week and a minimum of 4 mandatory on-call shifts. The most recent duty hours regulations in Spain were transposed from the European Working Time Directive (EWTD). According to Spanish Law, doctors cannot work for more than 48h per week and need to have resting times per day (at least 12h), per week (at least 36h) as well as annual leave (at least a month). However, there is practically no data on this situation in psychiatry resident physicians.

Our aim is firstly, to describe the number of shifts performed by psychiatry resident physicians in Spain. Secondly, to describe compliance with the daily and weekly rests compared to those set in national and European law. Finally, to analyse the difference by demographic variables (gender and year of residency), in both the number of on-call duty shifts and compliance with rests.

A descriptive cross-sectional study was designed through an online survey adapted from the existing literature. The target population were Spanish psychiatry resident physicians undergoing PGT who started their specialist training during the years 2018–2021. The survey was disseminated through the Spanish regional medical councils to all active psychiatry resident physicians by mail as well as through informal communication channels. The study was authorised by the Spanish Medical Organization’s General Assembly which is the highest ethical and deontological body of physicians in Spain.

55 responses were obtained, of which 61.82% identified as females. The mean number of on-call shifts in the last 3 months was 14.05. This mean was highest in women 14,32 and in the cohort of 2020 15.46 (first year of residency). Among the resident physicians surveyed, 66.07% exceeded the 48h per week limit set by the EWTD and 7% of them did not rest after a 24-h on-call shift. Furthermore, 22% of respondents did not have a day-off after a Saturday on-call shift. The mean working hours when not resting after an on-call-shift were 7 hours. The comparison by gender and year of residency of the main variables can be seen in figures 1 and 2 respectively.

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Image 2:

Psychiatry resident physicians in Spain greatly exceed the established 48 h/week EWTD limit. Likewise, non-compliance with labour regulations regarding mandatory rest after on-call duty and minimum weekly rest periods are observed. Differences can be seen by gender and year of residency. The situation described could potentially create a high-risk situation for the health and psychosocial well-being of resident physicians, hinder learning outcomes and could lead to suboptimal patient care.

None Declared

Mental healthcare services that address a variety of primary complaints which are highly related to maladaptive personality traits among the general population are important to prevent developing psychiatric disorders.

This study aimed to examine the effectiveness of a digital mental health service (named “Mindling”) that focuses on maladaptive personality traits in the general population.

Participants were recruited through a South Korean community website and screened for adults between the ages of 18 and 60 in terms of personality traits such as perfectionism, low self-esteem, social isolation, or anxiety. Participants were allocated to four intervention programs (Riggy, Pleaser, Shelly, and Jumpy) based on their screening results and were randomly assigned to digital treatment and waitlist groups. Each intervention program was conducted online for 10 weeks. The primary outcomes were all measured by self-report questionnaires; in addition to stress levels, each program included measures of perfectionism (Riggy), low self-esteem (Pleaser), loneliness (Shelly), and anxiety (Jumpy). The secondary outcomes included self-efficacy, depression, and other psychological states. All participants completed pre-treatment (baseline), intervention (week 5), and post-treatment (week 10) assessments, and the treatment group completed a separate follow-up assessment (week 14).

In the treatment group, 70.05% of the participants completed the full course of the digital intervention. The mean scores for each primary outcome measure and some secondary outcome measures were significantly different between baseline and post-treatment in the treatment group for the Total, Riggy, Pleaser, Shelly, and Jumpy programs, but these differences were not observed in the waitlist group. In addition, mean differences between the treatment and waitlist groups at post-treatment assessment were significant for all primary outcome measures and some secondary outcome measures. Specifically, the levels of stress (Total program), perfectionism (Riggy), loneliness (Shelly), and anxiety (Jumpy) were significantly lower in the treatment group, while self-esteem (Pleaser) was higher. In addition, the mean differences between post-treatment and follow-up assessment data were not statistically significant for all primary outcome measures and nearly all secondary outcome measures.

This study validated the effectiveness of the digital intervention program targeting maladaptive personality traits and suggested its sustainable effects.

None Declared

The studies about developmental bases of attachment in healthy children with high intellectual potential (HIP) are rare.Moreover, the literature underline socio-emotional disorders in HIP and difficulties with behavioral adjustment of parents.

We aimed to explore the developmental trajectory of attachment in HIP children without psychological or learning disorders.

The french version of the Adolescent-Unresolved-Attachment-Questionnaire (QANRA: internal consistency=0.74-0.82; test-retest =0.58-0.83) was analyzed in 80 healthy children (50 HIP with IQ>130 vs. 30 non-HIP), aged 7-to-13-years-old (mean 10y; SD 1.8). All children were recruited in private and public schools in Paris.

There was no significant difference between the groups. However, when we looked at the developmental trajectory by distinguishing the period of adolescence [7-10 years (56% in the HIP group vs. 53% in the non-HIP); 11-13 years (44% in the HIP group vs. 47% in the non-HIP)], we have noted a significantly early integration of resolved attachment in the HIP children that seems to remain stable in adolescence.

Our findings highlight the early onset of attachment with a harmony of intellectual/psycho-affective development in HIP children without skipping stages, but more quickly and effectively. This could potentially be explained by their cognitive abilities, particularly the theory of mind and the executive functions, known to be significantly more efficient in HIP children without neurodevelopmental disorders.

None Declared

Increasing volumes of information are being collected via electronic health records and there is growing multi-site expertise in utlising these for research. This emerging field of healthcare data science is not only concerned with the technical challenges associated with complex data, but also with the need for effective security and governance in the use of sensitive information with robust structures for stakeholder input and guidance. To date, most of the focus has been on supporting observational cohort studies nested within clinical records data - particularly investigating research questions around treatment response and course/prognosis. It is likely that electronic health records will become increasingly integrated with clinical trials, providing opportunities for pre-study feasibility scoping, targeted recruitment, and enhanced and extended follow-up. In addition, there is interest in emulated trials using routine data. For mental health data science, key challenges lie in the quality and quantity of data made accessible, with a particular need for natural language processing to derive structured data from extensive clinical text. Many of the challenges have been addressed for observational research, creating exciting prospects for a transformed trials landscape.

R. Stewart Grant / Research support from: Janssen, GSK, Takeda