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

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

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

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

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

None Declared

Although the research on behavioral addictions (BAs) is continuously developing, the awareness about this category of disorders and their important negative consequences still remains a problem for many physicians. This phenomenon is associated with delayed diagnosis and treatment initiation, lack of valid epidemiological data about these pathologies, and overall lower quality of life in these patients.

The main objective of this study was to explore the awareness of GPs on the general diagnosis criteria of BAs.

An online questionnaire addressed to general practitioners (GPs) investigated the level of their knowledge regarding the main criteria for diagnosis in five more commonly reported BAs, i.e., gambling disorder, problematic Internet use, cell phone addiction, food addiction, and shopping addiction. The questionnaire included 50 items and required 20-25 minutes to complete. The answers were anonymized.

Answers from 12 GPs were analyzed, with an 80% completion rate. Gambling disorder was the only diagnosis recognized by all the respondents, followed by shopping addiction (50%) and abusive Internet use (33.3%). Lack of time to screen for these disorders was the most frequently invoked reason for not including instruments dedicated to BAs in the regular visits to the GPs. The Internet was admitted by all the respondents as their source of information about BAs.

There is an acute need to improve the knowledge of GPs about the existence and consequences of BAs in order to increase the probability of early detection and treatment initiation for these patients. It is expected that Internet-based campaigns for increasing GPs will benefit BAs patients in the long term.

None Declared

An important aspect in providing effective psychiatric care and treatment is the formation of an adequate perception of their mental disorder in patients and awareness of the need for treatment, especially at the initial stages of the disease. Patients’ misunderstanding of their own psychopathological manifestations can act as a serious obstacle to their compliance and lead to an increase in the frequency of exacerbations and repeated hospitalizations.

To assess the attitude to the disease and treatment in patients with various mental disorders at the initial stages of the disease.

Clinical and psychopathological, psychological, statistical. The following scales were used: Drug Attitude Inventory (DAI, Hogan T.P. et al., 1983); Insight Scale for Psychosis (ISP, Birchwood M., 1994); Questionnaire “Style of self-regulation of behavior” (SSPM, V.I. Morosanova, 1988) and others. 17 patients with a diagnosis of bipolar disorder (BD, F31.xxx, ICD-10) were examined, the average age of patients was 25.52±4.55 years and 39 patients with a diagnosis of schizophrenia (F20.1xx and F23.1xx, ICD-10), the average age of patients was 29.29±9.71. The duration of the disorder in both groups of patients was 0.5-3 years.

A comparative analysis of the average scores of the scale of attitude to the disease revealed significant differences in the groups (p≤0.01). Patients with schizophrenia had a lower awareness of their disease (2.31±0.91 points) than patients with bipolar disorder (3.59±0.76 points). Correlation analysis revealed reliable connections (p≤0.01) between the scales of attitude to the disease and drugs and the self-regulation questionnaire. In patients with schizophrenia, deeper violations were found in the links of self-regulation, such as programming and planning when assessing the presence of a mental disorder and deterioration of their condition due to discontinuation of medication (r=0.38 and r=0.36, respectively). The low level of self-regulation in general and the rigidity of negative attitudes in awareness of the disease and the need for treatment also have a negative impact on compliance with the medication regimen. No such correlations were found in patients with bipolar disorder: they were more aware of the presence of a mental disorder and the need for treatment, but the degree of compliance with the medication regimen was not high enough.

The treatment of patients with mental disorders requires an integrated approach with the mandatory inclusion of a psychoeducational component in order to form an adequate model of their disease and an understanding of the expected risks when therapy is discontinued. Psychoeducation is especially relevant in the early stages of the disease, both for patients with schizophrenia and with BD.

None Declared

Suicidal behaviors are frequently observed among patients with substance use disorder, including suicidal ideation (SI) (1). Alcohol use disorder (AUD) is one of the most prevalent addictions and may be related to suicidal behaviors (2,3). However, the association between AUD and SI requires a deeper analysis which includes several clinical features observed among AUD patients.

To analyze the clinical characteristics and features associated with lifetime SI among patients who had AUD.

This is a cross-sectional study performed in an outpatient center for addiction treatment in patients seeking treatment who met the criteria for AUD between 01/01/2010 and 12/31/2021. Patients were evaluated with an ad-hoc questionnaire and the European addiction severity index (EuropASI). SI was evaluated by using the item for SI in EuropASI.

From a potential sample of n=3729 patients, only n=1082 (73.8% males; mean age 42.82±12.51) met inclusion criteria and had data for the current analysis. Lifetime SI was present in 50.9% of the AUD patients. Several clinical features were related to SI, including: sex differences, any type of lifetime abuse, polyconsumption, benzodiazepine use disorder, any psychiatric diagnosis aside of SUD, and higher addiction severity according to the EuropASI (See table)

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SI among AUD patients is related to several clinical features which indicate a higher addiction severity, more polyconsumption, and a higher prevalence of psychiatric comorbidities. These findings may contribute to the understanding of suicidal behaviors in AUD patients but it is required further investigations, including longitudinal studies.

REFERENCES

1. Rodríguez-Cintas L, et al. Factors associated with lifetime suicidal ideation and suicide attempts in outpatients with substance use disorders. Psychiatry Res. 2018;262:440-445. doi:10.1016/j.psychres.2017.09.02

2. MacKillop J, et al. Hazardous drinking and alcohol use disorders. Nat Rev Dis Primers. 2022;8(1):80. doi:10.1038/s41572-022-00406-1 3. Darvishi N, et al. Alcohol-related risk of suicidal ideation, suicide attempt, and completed suicide: a meta-analysis [published correction appears in PLoS One. 2020;15(10):e0241874]. PLoS One. 2015;10(5):e0126870. doi:10.1371/journal.pone.0126870

R. Palma-Alvarez Speakers bureau of: RFPA has received speaker honorariums from Angelini, Cassen Recordati, Exeltis, Lundbeck, MSD, Rubió, Servier, and Takeda., A. Rios-Landeo: None Declared, G. Ortega-Hernandez Speakers bureau of: GOH has received speaker honorariums from Rubió., E. Ros-Cucurull Speakers bureau of: ERC has received speaker honorariums from Janssen-Cilag, Lundbeck, Otsuka, Pfizer, Lilly, Servier, Rovi, Juste., C. Daigre: None Declared, M. Perea-Ortueta: None Declared, L. Grau-Lopez Speakers bureau of: LGL has received fees to give talks for Janssen-Cilag, Lundbeck, Servier, Otsuka, and Pfizer., J. Ramos-Quiroga Speakers bureau of: JARQ has been on the speakers’ bureau and/or acted as consultant for Janssen-Cilag, Novartis, Shire, Takeda, Bial, Shionogi, Sincrolab, Novartis, BMS, Medice, Rubió, Uriach and Raffo.

Serotonin syndrome is a potentially life-threatening condition that is precipitated by the use of serotonergic medications, Selective Serotonin Reuptake Inhibitors (SSRIs) and Monoamine Oxidase Inhibitors (MAOIs). It usually occurs when high doses of serotonergic drugs are prescribed. It is a medical emergency that requires prompt recognition, cessation of offending drugs and supportive therapy.

We present a case of serotonin syndrome that occurred in a patient who was prescribed a low dose of sertraline, and aim to highlight the importance of early detection of this severe condition.

Details of the case were described. Information was gathered based on medical records.

Patient M was a 29-year-old Malay male with a history of major depressive disorder, who was previously trialed on fluvoxamine 100mg every night but subsequently switched to and maintained on sertraline 75mg every night in 2020. He then defaulted follow up appointments. In 2023, he presented to the emergency services for a suicide attempt and was diagnosed with major depressive disorder with psychotic features. He was restarted on sertraline 50mg every night and risperidone 0.5mg every night was newly started. Two days later, sertraline was increased to 100mg every night. Two days following this increase, he was noted to have altered mental state, fever of 39.3-degree celcius, tachycardia of 120 beats per minute, ocular clonus and generalized hyperreflexia. Sertraline and risperidone were immediately stopped. Blood tests including creatine kinase, lumbar puncture and magnetic resonance imaging (MRI) of the brain did not show any abnormalities. After stopping of the medications, the patient’s symptoms resolved within 24 hours. Based on clinical symptoms and a normal creatine kinase level, neuroleptic malignant syndrome (NMS) was ruled out. Subsequently, he was restarted on risperidone 0.5mg and mirtazapine 7.5mg every night. He developed symptoms of serotonin syndrome with a low dose of sertraline. Symptoms resolved after the discontinuation of the SSRI.

In this case, differential diagnoses of serotonin syndrome were also considered, such as NMS, encephalitis, meningitis and thyroid storm. NMS was less likely due to the rapid onset of onset and resolution of symptoms. Encephalitis and meningitis were unlikely in view of normal MRI brain and lumbar puncture findings.

There have been case reports of serotonin syndrome developing with lower doses of an SSRI in the pediatric population. There is, however, a lack of literature describing serotonin syndrome with low doses of SSRI in the adult population. To avoid a missed diagnosis, clinicians should monitor closely for SSRI toxicity, including serotonin syndrome, even when low doses of serotonergic drugs are used.

None Declared

Recent studies have emphasized the importance of clinical manifestations, such as insomnia and sleepiness, in defining phenotypes of obstructive sleep apnea (OSA), shifting from a focus on OSA severity and sleep structure.

The study aimed to characterize insomnia and sleepiness associated with OSA phenotypes and assess their involvement in depression symptoms (DS) in OSA.

A total of 181 participants undergoing polysomnography (PSG) were asked to fill out questionnaires, including Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and Back Depression Index (BDI). They were categorized into phenotypes: insomnia-sleepiness (I+S; ESS≥11; ISI≥15; n=20), sleepiness (S; ESS≥11; ISI<15; n=22), insomnia (I; ESS<11; ISI≥15) and asymptomatic (A; ESS<11; ISI<15; n=55).

A linear regression model for BDI score (R2=0.357, p<0.001) included ISI score and subjective to objective sleep latency ratio. ISI score was a predictive factor for mild and moderate DS (OR=1.226, p<0.001 and OR=1.392, p=0.002, respectively). I and I+S phenotypes are characterized by higher BDI scores (p<0.001 and p=0.015), longer subjective sleep latency (p=0.008 and p=0.041), and shorter subjective total sleep time (TST; p=0.049 and p=0.006), compared to A. Furthermore, the I and I+S groups had shorter subjective TST than S (p=0.028 and p=0.047). I and I+S had higher BDI scores than A (p<0.001 and p=0.015, respectively) and S (p<0.001 and p=0.017, respectively). I phenotype was associated with the risk of mild and moderate DS (OR=5.614, p<0.001 and OR=9.550, p=0.008 respectively). Moreover, the I+S phenotype presented an even greater risk for mild DS (OR=10.286, p<0.001).

The study suggests that using clinical features for OSA phenotyping holds promise for finding OSA individuals with increased risk for the occurrence of DS.

None Declared

Exercise can be considered a feasible and efficient add-on treatment in schizophrenia. However, there remain two major challenges with regard to feasibility and efficiency: First, drop-out rates during exercise programs appear to be relatively high, ranging between 30 to 80 percent. Second, only between 30 and 50 percent of patients clinically respond to exercise interventions. Hence, we aimed to identify factors that predict adherence and response to exercise programs in people with schizophrenia. Based on data from 180 patients with schizophrenia enrolled in the Enhancing Schizophrenia Prevention and Recovery through Innovative Treatments (ESPRIT) C3 study, we examined clinical baseline characteristics that may predict study completion and number of attended trainings (adherence), as well es clinically relevant improvements in symptomatology and functioning (response). We found that only levels of functioning at baseline, but not symptom severity, cognitive functioning, or physical health, predicted adherence. Further, we provide preliminary evidence suggesting that patients with higher cognitive abilities and higher education who performed regular exercise already prior to the study participation were more likely to respond. To conclude, our findings indicate that exercise is particularly helpful for a subgroup of patients characterized by higher levels of functioning, higher cognitive abilities and education, and more pronounced affinity to exercise. Future studies should additionally include environmental, genetic, and neural data to predict adherence and response to exercise.

None Declared

Delusional parasitosis, also known as delusional infestation or Ekbom’s syndrome, is a rare psychotic disorder characterized by the false belief that a parasitic skin infestation exists, despite the absence of any medical evidence to support this claim. These patients often see many physicians, so a multidisciplinary approach among clinicians is important. Many patients refuse any treatment due to their firm belief that they suffer from an infestation, not a psychiatric condition, so it is crucial to gain the trust of these patients.

The comprehensive review of this clinical case aims to investigate Ekbom syndrome, from a historical, clinical and therapeutic perspective.

Literature review based on delusional parasitosis.

A 65-year-old woman comes to the psychiatry consultation referred by her primary care physician concerned about being infested by insects that she perceives through scales on her skin for the last three months. She recognizes important impact on her functionality. She is also convinced that her family is being infected too. As psychiatric history she recognizes alcohol abuse in the past (no current consumption) and an episode of persecutory characteristics with a neighbor, more than ten years ago. On psychopathological examination, she shows delusional ideation of parasitosis, with high behavioral repercussions, cenesthetic and cotariform hallucinations, as well as feelings of helplessness and anger. Treatment with Pimozide was started and the patient was referred to dermatology for evaluation, a plan she accepted. Her primary care physician and dermatology specialist were informed about the case and the treatment plan. In the recent reviews, the patient is calmer, however, despite the corroboration of dermatology and in the absence of organic lesions in cranial CT, she is still unsatisfied with the results, remaining firm in her conviction of infestation. It was decided to start treatment with atypical neuroleptics (Aripiprazole), with progressive recovery of her previous functionality.

Despite the increase in the number of studies in recent years, there are still few studies on this type of delirium. The female:male ratio varies in the bibiliography (between 2:1 and 3:1). The onset is usually insidious, generally appearing as a patient who comes to his primary care physician convinced of having parasites in different skin locations. It is usual to observe scratching lesions or even wounds in search of the parasite. In the past, the most used and studied treatment was Pimozide. Currently the treatment of choice is atypical neuroleptics due to their lower side effects. The latest reviews on the prognosis of this disorder show data with percentages of complete recovery between 51% and 70%, and partial responses between 16.5% and 20%. Finally, for a good diagnosis and therapeutic management, it is important to achieve a multidisciplinary approach.

None Declared

Addiction to video games, cybersex, internet gambling, social media, texting and emailing, and online auctions can be as addictive as substances. These technological addictions have real-world ramifications and lead to the loss of jobs, money, and loved ones. As technology becomes integrated into many facets of modern life, the appreciation of such addictions has become increasingly challenging. This session will explore the addictive potential of technology and discuss the legitimacy of technological addictions as psychiatric conditions worthy of medical assessment, diagnosis, and treatment.

1. 1. List five forms of Technological Addictions as they appear in the scientific literature of 2023.

2. 2. Describe the psychology and culture surrounding Internet Gaming addiction.

3. 3. Distinguish between normal use and addiction.

Lecture and discussion

1. 1. Research on the phenomenology and nosology of these illnesses helps us further elucidate the distinction between problematic and nonproblematic use of technology, especially in children and young adults.

2. 2. Another area of new research involves emerging technologies. By the time clinicians get a firmer grasp of today’s ailments, the technology of tomorrow—such as virtual reality and smart devices powered by artificial intelligence—will be commonplace enough to bring about a host of new problems.

Though data on the prevalence of technological addictions are sparse, most people use computers, tablets, and smartphones regularly with great benefits and no serious adverse consequences. We will need to be ready to guide our patients, our colleagues, and the general public on how to best handle technology with an eye on maximizing its enormous potential for fulfillment, gratification, and happiness while minimizing its significant risks for dissatisfaction, misery, and despair.

None Declared

In recents years, the number of social exclusion patients who go to the emergency room for psychiatric evaluation, has increased significantly. This fact may be due to the circumstances associated with migration: economic problems, house searching, moving away from the family origin,… These situations can cause stress before, during and after adaptation, which is a risk factor for presenting psychotic symptoms.

The objective of this study is present another alternative treatment for adults with social exclusion with psychotic symptoms or Psychotic Disorder. Presenting through a case of Acute Inpatient Mental Health Unit.

A 25 year old men was referred to the emergency deparment due to an episode of agitation. As relevant psychiatric history, a previous admission to psychiatry’s hospitalitation with a diagnosis of Schizophrenia. Upon discharge, the patient has not been followed up in Mental Health, although he has gone to the emergency room on several ocassions where ir is reflected that no psychotic decompensation has been observed. He emigrated to Spain two years ago, since then he has been homeless, working intermittenly in agriculture.

At our assessment, after having ruled out consumption of toxic substances, the patient presented a neglected and cachetic appearance. He says that he is worried because some people can not see him and others can.

We admit the patient for study and treatment. Involuntary admission.

During the hospitalitation, a join approach was carried out with Social Work and it was decided to start depot treatment in order to promote therapeutic adherence. In this case, it was decided to apply paliperidone depot every sin month. For this, an induction regimen was followed: fisrt, monthly paliperdione 100mg depot was administered, 4 days later, monthly paliperidone 150mg depot and 4 days later, the biannual injection.

Other depot treatment alternatives would have been aripripazole or risperidone. However, the duration of the depot treatment is shorter than in the case of paliperidone, since today the presentation formulas are monthly and quarterly, respectively.

Long-acting antipsychotics are an effective alternative for the treatment of patients with Schizophrenia, especially for those in whom we can not ensure good therapeutic adherence. In addition, the induction regimen allows treatment to be administered more quickly than that carried out in Mental Health outpatient programs, thus reducing the average hospital stay.

In recent years, great advances have been made in the treatment of psychotic symptoms thanks to depot drugs, which allows for numerous effective alternatives for the treatment of these patients. The figure of the Social Worker for the evaluation of the patient and subsequent follow-up is essential in this case.

None Declared

Autism spectrum disorder (ASD) is a childhood onset neurodevelopmental condition, that leads to permanent disability in a high proportion of cases. ASD is associated with a heterogeneous symptom presentation, which - besides social interaction and communication difficulties - encompasses altered sensory reactivity, including excessive hyper-sensitivity to stimuli, especially in the visual domain. Meta-analyses of fMRI studies revealed increased reactivity in visual task conditions in the temporal and occipital brain regions. Neural oscillations in the EEG gamma band are viewed as a candidate neurobiological marker for higher order sensory and perceptual processes, and social interactions.

We investigated changes in gamma activity in the EEG in the eyes open (EO) vs. eyes closed (EC) condition in order to identify the neurobiological underpinning of the enhanced sensitivity to visual input in ASD as compared to typically developing (TD) subjects.

EEGs were obtained in EC and EO condition in ASD (N=23) and TD subjects (N=24) in an ongoing study. For EEG recording we used a high-density 128-channel BioSemi system, with 0.5 Hz frequency resolution. The spectral power in the gamma band (30-100Hz) was quantified by the power spectral density. To investigate whether changes in the gamma band were linked to changes in arousal instead of enhanced visual processing, we also examined alterations in the alpha band (8-13Hz) in the EO condition. Spectral power changes were determined for each EEG channel by computing the difference between the EC and EO conditions (EO-EC).

Spectral power in the gamma band showed changes in the opposite direction in the two study groups: ASD subjects manifested significant (p<0.05) increase, while TD subjects had a decrease in the EO vs. EC condition in the temporal and occipital brain regions. By contrast, the changes in the alpha band were similar, with both groups exhibiting a spectral power decrease in the EO compared to the EC condition.

In ASD, an enhancement of gamma activity is present in the EO as compared to the EC condition in the posterior brain areas. These brain areas are involved in the processing of visual information, and gamma activity is considered as a measure of perceptual processes. Thus, the gamma alterations in the EO vs. EC condition may underlie the hyper-sensitivity symptoms to visual stimuli in ASD, and EEG can offer a simple to use tool to delineate the neurobiological foundation of the symptom presentation.

Funding statement: Hungarian Brain Research program,#NAP2022-I-4/2022

None Declared

Schizophrenia is a chronic mental illness that has a lifetime prevalence worldwide of about 1% regardless of culture, social class and race. This implies that it affects a large number of families. Family therapy has been used for years as a promising approach to intervene with people suffering from such pathology. It has been shown that families with a high level of hostility, critical comments and over-involvement are related to a higher number of relapses in the family member diagnosed with schizophrenia.

The objectives are to examine whether systemic interventions could help to decrease the emotion expressed in these family members and thus decrease the number of relapses of patients as an alternative to pharmacological treatment.

A case report and a literature review on the impact of family therapy in patients with a diagnosis of schizophrenia. The search strategy included keywords such as “family intervention”, “schizophrenia” and “systemic therapy”. Selection criteria included randomized controlled trials (RCTs) and meta-analyses published between 2010 and 2021. Studies focused on the impact of family intervention on symptom management, relapse prevention and general functioning were included.

The findings consistently demonstrated the effectiveness of family intervention in improving outcomes for people with schizophrenia. These interventions generally involved psychoeducation, communication skills training, problem-solving techniques, and emotional support for family members. Results showed significant reductions in symptom severity, decreased relapse rates, improved adherence to pharmacological treatment, and better overall functioning among people who received family intervention compared with those who received only standard care. In addition, family intervention was associated with reduced caregiver burden, improved family communication, as well as increased knowledge about schizophrenia and its management.

Family intervention has become a valuable adjunctive treatment for people with schizophrenia. The findings of this review highlight its positive impact on symptom management, relapse prevention, and overall functioning. Family intervention offers a holistic approach that recognizes the importance of involving and supporting the family system in the treatment process. This intervention provides families with the tools and resources necessary to effectively cope with the challenges associated with schizophrenia and promotes a supportive and nurturing environment for the individual. Future research should focus on long-term outcomes and implementation of the family intervention in routine clinical practice.

None Declared

Depressive symptoms are a common occurrence in people suffering from schizophrenia spectrum disorders (SSDs), representing a separate domain that interacts in peculiar ways with positive and negative symptoms. Nonetheless, available evidence on the relationship between depression and key clinical dimensions of SSDs is limited.

To increase the knowledge regarding depression in SSDs, we performed a cross-sectional study aimed to investigate the association of depressive symptoms with overall, general psychopathology, positive, and negative symptoms in individuals with SSDs.

Adult people with SSDs were recruited from two psychiatric inpatient units in the northern area of the Metropolitan City of Milan from May 2020 to March 2023. Study participants with a Calgary Depression Scale for Schizophrenia score >6 were rated as depressed. Symptom severity was assessed by using the Positive and Negative Syndrome Scale (PANSS). Variables associated with depression at the univariate level were included into two multiple logistic regression models to analyse the association between depression and PANSS overall score as well as General Psychopathology, Positive, and Negative sub-scores.

A total of 231 subjects with SSDs were included. Among them, approximately one third (N=78; 33.8%) reported depressive symptoms. Multiple logistic regression models suggested that depression in individiuals with SSDs was associated with higher overall (p<0.001) and General Psychopathology (p<0.001) PANSS scores. Conversely, an inverse relationship between depression and positive symptoms was found (p=0.002). Negative symptoms were not associated with depression (p=0.210).

Our findings suggest that people affected by comorbid SSDs and depression have more severe overall and General Psychopathology symptoms according to PANSS scores, as well as lower levels of positive symptoms. Further investigations are needed to evaluate the generalisability of these findings and to improve the clinical management of people with SSDs and depression.

None Declared

Rheumatoid arthritis (RA) is a chronic inflammatory disease that significantly impacts patients’ quality of life (QOL), affecting both physical and mental well-being. QOL is predictive of morbidity and mortality, making its consideration increasingly important in treatment decisions.

This study aims to assess the Quality of Life in Female Rheumatoid Arthritis patients.

The study included 87 female patients with confirmed RA, diagnosed by an experienced rheumatologist based on the ACR 1987 or ACR/EULAR 2010 criteria. Quality of life was assessed using the World Health Organization Quality of Life assessment, short form (WHOQOL-BREF scale). The scoring ranged from 0 to 100 for each domain. Disease activity was assessed using the Disease Activity Score (DAS28), and functional disability was evaluated using the Health Assessment Questionnaire (HAQ).

The study included 87 patients with a mean age of 54.7 ± 12.2 years and a mean disease duration of 12 ± 9.1 years. The majority of patients had a medium socioeconomic level (81.6%), and a low cultural level with 31% being illiterate, 6% attending university, and 76.9% unemployed. Regarding marital status, 74.7% were married. RA was erosive in 77% of patients, deforming in 68%, and 40% were seropositive (FR and/or anti-CCP). Extra-articular manifestations were present in 34.5% of patients. Sixty-seven patients (77%) were on disease-modifying antirheumatic drugs (DMARDs), with 67.8% on methotrexate. Eighteen percent were treated with biological agents. Corticosteroids were used by 47.1% of patients, while 12.6% used non-steroidal anti-inflammatory drugs, and 6.9% used both. Disease activity varied, with 9.2% having low activity, 43.7% moderate activity, and 24.1% high activity based on DAS28. The mean HAQ index was 1.1 ± 0.8, indicating moderate to severe disability for more than 60% of patients. The mean WHOQOL scores were substantially reduced in the physical health (43 ± 16.2), psychological health (50.3 ± 14.4), social relationships (51.5 ± 18.6), and environment domains (46.8 ± 15). There was a significant inverse correlation between HAQ and the physical health (r = −0.52, p < 0.001), psychological (r = −0.57, p < 0.001), social relationships (r = −0.37, p = 0.001), and environmental domains (r = −0.45, p < 0.001) of QOL. There was no correlation between any domain of QOL and DAS28.

Patients with RA experience reduced QOL across multiple domains, including physical function, mental health, and social relationships. Functional disability, as reflected by HAQ, is the most significant factor affecting QOL in RA. The WHOQOL-BREF should be considered a valid outcome measure for interventions aimed at improving the quality of life for people with rheumatoid arthritis.

None Declared

Suicide is one of the leading causes of death worldwide being the fourth major cause of death among young people 15-29 years old. The reduction of suicide mortality is prioritized by the World Health Organization (WHO, 2019). There is a number of internal and external factors associated with suicidality (Soto-Sanz V et al., 2019; Farbstein et al., 2022.). Special attention is paid to the influence of the social media on suicidality (Cheng A. T. A. et al., 2007; Niederkrotenthaler T. et al., 2020; Sedgwick R. et al., 2019). In the Russian Federation, anime, an animation genre and a media cultural phenomenon, is increasingly popular among young people. Characters who are lonely and lost their meaning of life are common in anime. Romanticization and idealization of such characters may lead to increased attractiveness of death and thus have a negative effect on the mental health of adolescents and young adults due to their incomplete identity development (Liu Y. et al., 2022; Backer, H. A., 2023).

We aimed to study the influence of the anime on the presence of suicidality and depression in adolescents and young adults in the Russian Federation.

We interviewed 304 people living in the Russian Federation and watching anime on the regular basis (244 women, mean age 20.9 ± 3.8 years, range 13-36 years). We collected sociodemographic data and age when a person had started watching anime. We performed Reasons for Living Inventory, RFL (M. Linehan et al., 1983), Beck Depression Inventory, BDI (Aaron Beck, 1961). We divided all participants into three groups according to their age: adolescents (13-19 years), young people (20-24 years), adults (25-36 years). In each group, we compared BDI: level of depressive symptoms, cognitive-affective subscale, subscale of somatic manifestations of depression; RFL scales: Survival coping beliefs, responsibility to family, child related concerns, fear of suicide, fear of social disapproval, moral objections between three subgroups based on the age of the anime watching start (<12 years old, 12-15 years old, ≥16 years old) using Kruskall-Wallis test and post hoc Mann-Whitney U-test for pair comparisons with Bonferroni correction for multiple comparisons. Level of significance p<0.05.

In the adolescents (n=130), we did not find any differences between the three subgroups. In the young people (n=127), participants who had started watching anime in childhood (<12 years old) had higher level of depression (p= 0,014) and higher level of cognitive-affective symptoms (p= 0,006). In the adults (n=47), participants who had started watching anime in childhood had decreased moral attitudes contrary to suicide (p= 0,004). Other scales not found to differ significantly.

Start of the anime watching in childhood (<12 years old) was associated with increased suicidal risk factors and decreased anti-suicidal factors in the young adults.

None Declared

In large cities around the world, many sources of noise including traffic, domestic, construction, and industrial activities, contribute to urban noise pollution, which is now, a major concern in public health as declared by the WHO, for more than a decade (in 2011).

The aim of this study was to try to find potential recommendations and references in terms of urban planning, particularly with the emergence of smart cities, to combat the problem of noise pollution and related mental health hazards.

We conducted a comprehensive review of the scientific literature using the following keywords: cities, smart cities, noise, pollution and mental health.

Our research found that the continuous exposure to high noise levels could lead to psychological and physiological problems, such as hearing disorders, high blood pressure, heart disease, inconvenience and sleep disorders. While recent evidence indicates that road traffic noise has a negative impact on mental health and that aircraft noise significantly increases the risk of depression, there are not enough studies to date to properly assess the relationship between urban noise pollution and mental health hazards such as anxiety, mood disorders, sexual disturbance, cognitive impairment, learning disabilities, dementia, etc. In the field of urban planning, there is also a lack of reliable data on individual exposure to environmental noise in space and time, and on its effects on mental health.

Various noise mitigation strategies in urban renewal plans are proposed, such as the implementation of noise mapping to provide the detailed spatial distribution of noise levels in urban areas, their sources and time intervals, noise barriers along traffic arteries, vegetation and landscaping. New infrastructure projects involving new expressways and high-speed trains as well as the widening of major roads in their central areas are also suggested.

None Declared

Since its first publication in 1977, the World Health Organization’s (WHO) Model List of Essential Medicines (EML) has guided the national procurement of medicines deemed essential to inform public health policy worldwide. Aiming to include the most effective, safe, and cost-effective medicines for priority conditions, WHO updates the EML every two years. However, over the past 45 years, updates to the mental health section of the EML have been infrequent, mostly involving the addition of individual medicines. A comprehensive revision of the entire section was never attempted.

The aim of this project was to update the mental health section of the EML to identify the most effective and safest medicines for mental disorders in the light of the most up-to-date evidence base.

A series of nine evidence-based applications were submitted to the WHO Expert Committee on the Selection and Use of Essential Medicines in December 2022, recommending a substantial revision of the entire mental health section.

All of our applications were accepted by the WHO Expert Committee. For psychotic disorders, aripiprazole, olanzapine, paliperidone, and quetiapine were added as therapeutic alternatives to risperidone; short-acting intramuscular chlorpromazine was replaced by short-acting intramuscular olanzapine; first-generation antipsychotics were limited to oral haloperidol and chlorpromazine. For bipolar disorder, the list now includes second-generation antipsychotics such as quetiapine, aripiprazole, olanzapine, and paliperidone. Tricyclic antidepressants for depressive disorders were limited to amitriptyline alone. Treatment options for anxiety and obsessive-compulsive disorder are now expanded to include SSRIs. For anxiety disorders, diazepam and lorazepam became the only benzodiazepines recommended, with the specific caveat that they should only be used for short-term emergency treatment of acute and severe anxiety symptoms. Finally, chlorpromazine and haloperidol are no longer considered essential medications for psychotic disorders in children under 13 years of age.

The WHO released the 23rd EML in July 2023. After decades of minimal and inconsistent updates, groundbreaking changes have been made to its mental health section. The updated mental health section provides a compelling opportunity to improve the quality of medicine selection at the country level, with the goal of increasing the availability of the safest and most effective psychotropic medicines worldwide.

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It has been several years since the World Health Organization (WHO) advocated for shared decision-making(SDM) models when developing treatment plans for individuals with mental illnesses. It is emphasizing the importance of actively involving patients in expressing their opinions and sharing treatment-related information. However, few clinicians accept patients’ subjective views in clinical practice. Given that patients’ subjective beliefs about their symptoms significantly impact treatment satisfaction, prognosis, and adherence, it is essential to assess these perceptions. However, few studies have been conducted to assess patients’ subjective beliefs, their mental representation, of their disease. Therefore, this study aims to develop Interview that enable the utilization of patients’ cognitive representations of their mental illnesses in clinical practice.

The primary objective of this study is to develop a semi-structured interview and a self-report scale to evaluate patients’ mental representations of their illnesses. Subsequently, validate the reliability and validity of these tools as psychological assessments.

An initial structure for both the semi-structured interview and self-report scale was established through a literature review of existing disease representation measurements. Subsequently, expert panel discussions and further literature reviews were conducted to refine the structure and content of both tools. Content validity for both the interview and self-report scale was assessed by a panel of nine experts and a group of ten students. Following this, the developed interview tool was subjected to a validity analysis with clinical patients using Missick’s six validity criteria(Content, Substantive, Structural, Generalizability, External, Consequential).

Content validity index (CVI) values for the overall structure indicated that all subdomains scored above 0.8, demonstrating the appropriateness of the interview tool’s five subdomains: symptoms, causes, temporal aspects, impact, and treatment and control. Content validity assessment for individual items revealed that some items within the “causes of the disease” subdomain, specifically stress-related factors, scored below 0.6, prompting necessary item modifications. All other factors achieved CVI scores of 0.6 or higher. Facial validity assessment yielded favorable results for all items in the self-report scale. All validity was demonstrated to be satisfactory.

This study has provided evidence that the developed tools are reliable and valid instruments for measuring patients’ perceptions of their illnesses, offering a trustworthy means to assess these vital cognitive representations in clinical practice.

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Verbal fluency, a cognitive function that reflects executive functions and the rapid retrieval of pertinent information from memory, has yielded inconsistent findings in previous research on autism spectrum disorder (ASD), however in schizophrenia (SCH) semantic fluency exhibits a more pronounced impairment compared to letter fluency.

In this study we aim to comprehensively investigate verbal fluency in ASD, SCH, and neurotypical healthy control individuals (NTP). The primary objective is to investigate disparities in novel response generation, specifically between the ASD, SCH and NTP groups, using phonemic and semantic fluency tasks. Three central inquiries guide our research: (1) whether differences between groups (ASD, SCH, and NTP) can be identified in word productivity, clustering, errors, and perseverations; (2) whether participants with ASD and SCH exhibit different word production with elevated imageability and concreteness values; and (3) if individuals with ASD and schizophrenia demonstrate reduced productivity during the earlier phases of fluency tasks.

Forty participants with ASD (12 female, 24 male, 4 other, mean age: 30.5), 39 with SCH (10 female, 28 male, 1 other, mean age: 34.7) and 41 NTP (13 female, 28 male, mean age: 31.0) were recruited from the outpatient units of the Department of Psychiatry and Psychotherapy, Semmelweis University. Participants were requested to list as many words as they could on two phonemic and two semantic category conditions. Audio recordings were later transcribed. To assess concreteness and imageability, we employed a seven-point scale and recruited independent external raters to evaluate a total of 1481 words.

Preliminary results indicate that the three study groups did not differ significantly in phonemic fluency (F(2, 119)= 0.983, p=0.377), during either time period. However, a significant difference was observed in semantic fluency (F(2, 119)= 6.531, p=0.002). Post-hoc tests (Tukey corrected) revealed that this difference stemmed from impaired performance in the SCH group. Participants with schizophrenia (SCH) exhibited reduced semantic word productivity compared to both neurotypical (NTP) individuals and participants with ASD (Figure 1). However, there were no significant differences between participants with ASD and NTP individuals.

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In conclusion, our study investigated the characteristics of verbal fluency in a transdiagnostic approach. While phonemic fluency did not reveal significant differences among the three groups, our analysis of semantic fluency unveiled a distinction. Specifically, individuals with schizophrenia exhibited impaired semantic word productivity. Our study highlights the complex nature of verbal fluency impairments in different conditions and the importance of considering more nuanced methods when assessing cognitive functions.

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Digital interventions have been found to be successful in preventing occupational mental health concerns, however, they seem to be affected by attrition bias through high attrition rates and differential attrition. Differential attrition arises when the rates of participant dropouts differ across different treatment conditions and is considered a significant challenge to internal validity.

We aimed at systematically review and meta-analyse differential attrition of digital mental health interventions in the workplace setting.

On January 2, 2022, we performed a search in the following electronic databases: PubMed, Scopus, and Web of Science Core. We utilized a combination of terms from five distinct areas, namely mental health, intervention, workplace, implementation, and study design. The study encompassed adult employees who took part in a randomized control trial aimed at preventing mental health issues in the workplace through an online intervention. A team of six reviewers collaborated on the study selection process, while two independent researchers conducted the data extraction for the selected studies. We performed a meta-analysis of the log-transformed relative attrition rates of the included studies using a random-effects model with limited maximum-likelihood (REML) estimation to account for the degree of heterogeneity.

A total of 19 studies were included in the meta-analysis. For baseline to post-intervention, the average total attrition was 26.27% (SD = 21.16%, range = 0 – 66.3%) and the random effects model revealed a higher attrition rate in the intervention group compared to the control group, with a pooled risk ratio of 1.05 (95% CI: 1.01 - 1.10, p = .014). For baseline to follow-up measurement the average total attrition was 27.71% (SD = 20.80%, range = 0 – 67.78%), however, in this case the random effects model did not indicate a higher attrition in the intervention group when compared to the control group (pooled risk ratio = 1.05, 95% CI: 0.98 – 1.12, p = .183).

There is an indication of higher attrition in the intervention group as compared to the control group in occupational e-mental health interventions from baseline to post-intervention, however this does not seem to be the case for baseline to follow-up attrition. These results should be taken into account in the design process of studies and statistical analyses should be adapted to counteract the bias that could result from differential attrition.

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