Preventing psychiatric admissions holds benefits for patients as well as healthcare systems. The Clinical Global Impression-Severity (CGI-S) scale is a 7-point measurement of symptom severity, independent of diagnosis, which has shown capability of predicting risk of hospitalisation in schizophrenia. Due to its routine use in clinical practice and ease of administration, it may have potential as a transdiagnostic predictor of hospitalisation.

To investigate whether early trajectories of CGI-S scores predict risk of hospitalisation over a 6 month-follow-up period.

A retrospective cohort study was conducted, analysing Electronic Health Record (EHR) data from the NeuroBlu Database (Patel et al. BMJ Open 2022;12:e057227). Patients were included if they had a psychiatric diagnosis and at least 5 recorded CGI-S scores within a 2-month period, defined as the ‘index’ period. The relationship between early CGI-S trajectories and risk of hospitalisation was investigated using Cox regression. The analysis was adjusted for age, gender, race, number of years in education, and psychiatric diagnosis. Early CGI-S trajectories were estimated as clinical severity (defined as the mean CGI-S score during the index period) and clinical instability (defined as a generalised Root Mean Squared Subsequent Differences of all CGI-S scores recorded during the index period). The primary outcome was time to psychiatric hospitalisation up to 6 months following the index period. Patients who had been hospitalised before or within the index period were excluded.

A total of 36,914 patients were included (mean [SD] age: 29.7 [17.5] years; 57.3% female). Clinical instability (hazard ratio: 1.09, 95% CI 1.07-1.10, p<0.001) and severity (hazard ratio: 1.11, 95% CI 1.09-1.12, p<0.001) independently predicted risk of hospitalisation. These associations were consistent across all psychiatric diagnoses. Patients in the top 50% of severity and/or instability were at a 45% increased risk of hospitalisation compared to those in the bottom 50% (Figure 1).

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Early CGI-S trajectories reflecting clinical severity and instability independently predict risk of hospitalisation across diagnoses. This risk was compounded when instability and severity were present together. These results have translation potential in predicting individuals who are at high risk of hospitalisation and could benefit from preventative strategies to mitigate this risk.

E. Palmer Employee of: Holmusk, M. Taquet Consultant of: Holmusk, K. Griffiths Employee of: Holmusk, S. Ker Employee of: Holmusk, C. Liman Employee of: Holmusk, S. N. Wee Employee of: Holmusk, S. Kollins Employee of: Holmusk, R. Patel Grant / Research support from: National Institute of Health Research (NIHR301690); Medical Research Council (MR/S003118/1); Academy of Medical Sciences (SGL015/1020); Janssen, Employee of: Holmusk

When we were children we all remember hearing expressions like: “Do not be afraid.”, “What are you afraid of?”, “You are strong, you are not afraid!”. This primary emotion is introduced in our development associated, most of the time, with a negative connotation. However, we know that fear, as a normal response to a real or imagined threat, is an integral part of human development (Sequeira, 2011).

The existence of research on fears is relevant for the definition of developmental patterns, characteristics such as frequency and intensity, but also for the identification of risk factors that may be at the genesis of the development of anxiety disorders (Ollendick, King & Murris, 2002).

In Portugal, studies on fears are scarce, contrary to what happens in other countries (Sequeira, 2011).

The study sample consists of 121 students from the 1st cycle of basic education, 65 (53.7%) attending the 3rd year of schooling and 56 (46.3%) attending the 4th year of schooling, 66 ( 54.5%) were female and 55 (45.5%) were male, aged between 7 and 10 years old (M=8.5; SD=0.61).

For each child, an adult, parents or parental figures also participated in the study, most of which were the mother (89.3%) and the remaining participants were the father (7.4%), father and mother (1.7%), grandmother (0.8% ) and brother (0.8%).

Fears are more frequent in females than males.

In general, anxiety disorders tend to be more prevalent in girls than in boys (Ollendick, King & Murris, 2002).

None Declared

Ironically, the correlation between systemic pathologies and caries/ periodontal diseases is commonly accepted by the scientific and medical community, but the fact that severe mental illnesses may affect one’s physical health, and thus lead to poor oral health is less well-known.

This clinical case report’s aim is to raise awareness among medical staff about the relevance of appropriate management of patients with severe mental illnesses in terms of dental care.

Illustration of integrative management through the description of the oral rehabilitation of a 63-year-old female whose bipolar disorder had been diagnosed 20 years ago. This patient came in May 2020 to the Cliniques Universitaires Saint-Luc (Brussels, Belgium) for painless mobility of the lower central incisors. Her diagnosis later revealed more than 20 advanced carious lesions as well as chronic severe periodontitis. Since then, despite numerous dental treatments and regular follow-up appointments, an important degradation of her oral health could be noted over time, characterized by a recurrent carious phenomenon (called “rampant” caries) and a failure in the stabilization of her periodontitis.

The literature review revealed that bipolarity was a major risk factor leading to tooth decay and aggravation of periodontal disease; when bipolar disorders’ inherent symptoms are coupled with medication’s side effects, they work in synergy towards a deterioration of oral health. Following the results obtained after this etiological research, the management of this patient was pursued in accordance with specific recommendations proposed in the literature. A stabilization of her oral condition was then observed at the 3-6-9-12 month check-ups, without the appearance of any new lesion.

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The positive effect obtained on this patient’s oral health following the implementation of bipolar disorders specific measures opens the discussion on the relevance of integrating individual strategies within the therapeutic management of patients with severe mental illnesses.

None Declared

Up to 50% of patients with brain tumors experience psychiatric symptoms, and rates up to 80% have been reported in malignant neoplasms such as glioblastoma multiforme (GBM). Still, clinical presentation as mania-like syndromes is a rare phenomenon, mainly occurring when frontal structures are compromised.

We present the case of a 42-year-old woman who was admitted to our hospital due to manic symptoms coinciding with a recurrence of a bifrontal GBM, for which she underwent surgery 5 months prior.

1) To describe the clinical particularities of this case, focusing on the differential diagnosis.

2) To review the association between manic symptoms and frontal dysfunction caused by brain tumors, with special interest on GBM.

A review of the patient’s clinical history and complementary tests performed was carried out. Likewise, we reviewed the available literature in relation to manic symptoms related to brain tumors.

The patient’s GBM recurrence presented with late onset symptoms of mania, including euphoric mood, increased spending, ideas of grandiosity and hyper-religiosity. She had no previous psychiatric history but, interestingly, she had an extensive affective burden in her family, with 4 consummated suicides. However, she also presented other clinical signs, such as disorientation, perseveration, mild memory impairment and stereotyped motor behaviors, that pointed to relevant frontal lobe dysfunction, suggesting Moria as a possible contribution for the symptoms described.

Manic symptoms in the context of brain tumors appear in 7-15% of patients with psychiatric symptoms, usually associated with right frontal dysfunction (75% of cases). Bifrontal affectation, such as this patient, is only described in 6% of cases. Although fast growing, malignant tumors have been associated with higher rates of psychiatric symptoms, no correlation has been described between these and brain tumor histology.

- The presence of atypical manic symptoms, such as those presented in this case, should raise clinical concern for secondary mania.

- Moria shares similarities with mania, including mood elevation, tendency to hilarity or hyper-sexuality, that may hinder diagnosis of patients with frontal dysfunction.

- This case outlines the difficulties in making a differential diagnosis in patient with both manic and neurological signs, and highlights the implication of frontal structures in the development of manic symptoms.

None Declared

There is growing evidence to suggest that delusions in schizophrenia-spectrum disorders are associated with altered brain connectivity. Disruptions in long association fibers, such as the superior longitudinal fasciculus, are among the most consistent findings in psychosis. However, functional connectivity (FC) correlates of such structural alterations and their implications in delusional symptoms remains unclear.

The study used a hypothesis-driven approach and aimed at exploring structural connectivity (SC) disruptions of the left superior longitudinal fasciculus (part with parietal terminations, SLFP) and their FC correlates in a group of psychotic patients with persistent delusions across diagnostic categories within the schizophrenia-spectrum.

Sixteen right-handed patients (23.1-53.8 years, mean age 39.6±8.5, 44% females) with delusional disorder (DD, n=10) and schizophrenia (SCZ, n=6), presenting with persistent delusions, and 16 matched healthy controls (23.0-56.4 years, mean age 38.9±11.1, 44%females) underwent diffusion-weighted 3T MRI (DW-MRI), while patients additionally underwent resting-state 3T fMRI (rsfMRI). DW-MRI data were processed via FreeSurfer6.0 and TRACULA to derive axial (AD), radial (RD) diffusivities and fractional anisotropy (FA) for left SLFP. rsfMRI data were processed with SPM12 and Conn v19c to calculate ROI-to-ROI FC between lateral prefrontal and inferior parietal components of the frontoparietal network (FPCN) according to Yeo atlas (Yeo et al. J Neurophysiol. 2011; 106(3) 1125-65), which is sought to represent cortical projections of the SLFP (Image). Partial rank-based correlation analysis (with age and sex as covariates, ppcor v1.1, R v4.2.1) was used to explore the associations between SC and FC measures involving the SLFP, PANSS and BABS scores.

Compared to healthy controls, patients showed decreased AD in left SLFP [F(1, 28)=14.9, p=0.0006; Cohen’s d = −1.3, 95% CI: −2.1 to −0.5]. No RD or FA alterations were found. We revealed a correlation between AD in left SLFP and fronto-parietal FC within the FPN (r = 0.58, p = 0.031) in patients. Correlation between FC and PANSS total score (r = −0.54, p = 0.045) did not survived correction for multiple comparisons. No other correlations between SC or FC, chlorpromazine equivalents and clinical scores were revealed.

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The findings suggest that the structural connectivity disruptions of the SLFP may mediate FC strength within the FPN in patients with persistent delusions. However the limited sample size and the lack of correlations between connectivity measures and clinical scores do not allow to conclude definitely whether the revealed structural-functional connectivity pattern underlies delusional symptoms, which should be elucidated via further research.

This study was supported by RFBR grant 21-515-12007

None Declared

In individuals with first episode psychosis (FEP) and cannabis use disorder (CUD), reducing cannabis use is associated with improved clinical outcomes. Access to evidence-based psychological interventions to decrease cannabis use in FEP clinics is highly variable; E-mental health interventions may help to address this gap. Development of E-interventions for CUD in individuals with FEP is in its incipient phases.

To assess preferences for online psychological interventions aiming at decreasing or stopping cannabis use in young adults with psychosis and CUD.

Individuals aged 18 to 35 years old with psychosis and CUD were recruited from seven FEP intervention programs in Canada and responded to an electronic survey between January 2020-July 2022. We used the Case 2 Best Worst Scaling methodology that is grounded in the trade-off utility concept to collect and analyse data. Participants selected the best or worst option for each of the nine questions corresponding to three distinct domains. For each domain we used conditional logistic regression and marginal models (i.e., three models in total) to estimate preferences for attributes (e.g., duration, frequency of online intervention sessions) and attribute levels (e.g., 15 minutes, every day).

Participants (N=104) showed higher preferences for the following attributes: duration of online sessions; mode of receiving the intervention; method of feedback delivery and the frequency of feedback from clinicians (Table 1). Attribute-level analyses showed higher preferences for participating once a week in short (15 minutes) online interventions (Figure 1). Participants valued the autonomy offered by online interventions which aligns with their preference for completing the intervention outside the clinic and only require assistance once a week (Figure 2). Participants’ preferences were higher for receiving feedback related to cannabis consumption both from the application and clinicians at a frequency of once a week from clinicians (Figure 3).Table 1.Preferences for Attributes. Results of conditional logistic regression

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Using advanced methodologies to assess preferences, our results can inform the development of highly acceptable E-Mental health interventions for decreasing cannabis use in individuals with CUD and FEP.

None Declared

The effect of self-esteem in eating disorders has been investigated in several studies, but it’s still not extensively investigated in orthorexia nervosa.

To study the prevalence and factors associated with orthorexic eating behaviors in medical students and it’s relation with self-esteem.

A cross-sectional study was conducted through an online survey among medical students of the faculty of medicine of Sfax (Tunisia). Participants completed an anonymous self-administered questionnaire. We collected their sociodemographic and clinical data. Orthorexia nervosa (ON) was assessed using the self-reported scale, ORTO-15. We used the Rosenberg’s self-esteem scale to assess self-esteem.

Ninety five medical students completed the survey. The mean age was 25.8±3.4 years and the sex ratio (F/M) was 3.75. The average body mass index was 23.64±3.53 kg /m2.

Fifty-eight percent of the students (58%) reported that they were dissatisfied with their eating habits, and 27.4% tried to control their weight. Several methods of weight control were used, the most frequent (65.4%) were diet and physical exercise, none resorted to laxatives and 8.4% consulted a nutritionist.

Self-esteem was very low in 27.1% and low in 34.7% of the students.

Overall, the prevalence of orthorexia among our participants was 52.6%. The mean score of the ORTO-15 was 39.19±4.48.

Orthorexia was significantly correlated with the use of weight control measures (p=0.035) and physical activity (p=0.042).

Students with low self-esteem had higher tendency for orthorexia but with no significant correlation.

Our study supports a non-negligible frequency of orthorexic behaviors in medical students but future studies are needed to assess the direct effect of self-esteem on orthorexia.

None Declared

Major Depressive Disorder (MDD) and Bipolar Disorder Depression (BDD) are common psychiatric illnesses characterized by structural and functional brain alterations and signs of neuroinflammation. In line with the neuroinflammatory pathogenesis of depressive syndromes (Mechawar N, Savitz J. Neuropathology of mood disorders: do we see the stigmata of inflammation? Transl Psychiatry. 2016;6(11):e946), recent studies have demonstrated how white matter (WM) microstructural impairments detected by Diffusion Tensor Imaging (DTI) are correlated to peripheral immunomarkers in depressed patients.

In this context, the aim of our review is to report an updated overview of the evidence on the correlation between the blood immuno-markers changes and the brain WM disruptions in MDD and BDD patients.

Based on PRISMA 2020 guidelines (Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021;372), we performed a systematic search on original DTI studies exploring the association between WM integrity, neuroimmune alterations and inflammation in patients affected by MDD or BDD.

Concerning MDD, most of the reviewed studies provided evidence of a link between systemic immune dysregulation, detected through the elevation of peripheral markers (IL-1β and TNF-alfa) or an altered ratio between proinflammatory and counterregulatory cytokines (IL-8/IL-10), and DTI alterations in specific WM tracts, such as the genu of corpus callosum and the IFOF. As for the BDD, we detected an increase of pro-inflammatory molecules (such as TNF-alfa, IL-8, IFN-γ etc.) that correlated with DTI changes in different cerebral areas such as cingulum, forceps, corona radiata, corpus callosum, longitudinal fasciculus and internal capsule. Furthermore, other molecules seem to play a specific role in BDD pathogenesis, including counter-regulatory cytokines, kynurenine and specific lymphocyte classes, such as Th1 and Th17.

Taken together, these pathogenetic insights could outline an integrated clinical perspective to affective disorders, helping psychiatrists to develop novel biotype-to-phenotype models of depression and opening the way to tailored approaches in treatments.

None Declared

Auditory Hallucination(AH) is a core & one of the most common symptom seen in schizophrenia. A prevalence study found that 1yr prevalence of AHs is 70% among patients of schizophrenia. Most theories of AHs discuss biological & psychological factors in phenomenology of voices. There definitely is a role of biological & neuroanatomical basis for occurrence of psychotic phenomenon & AHs, however environment & sociocultural background play important role in their genesis. It has been observed that theme of AHs is usually same, repetitive & associated with past life experiences of patients. The Negative Life Experience(NLE) though not always have significant impact on patient’s psyche, may manifest sooner or later in mental illness. Although AHs may be comforting, helping to cope up with unacceptable unconscious conflict, most patients report them to be negative, distressing & affecting socio-occupational functioning, thus making it important to understand & treat them effectively. Often, AHs stays as a residual symptom with which patient has to deal throughout life. This study is an effort to bridge existing gaps for better understanding of AHs & hence, Schizophrenia. It aims to understand effect of NLE on AHs, & thereby contribute to aetiology & therapeutic services to reduce distress of patients.

This study aims to find presence of history of past NLE in patients with schizophrenia having AHs, find a correlation between NLE & the content of AHs & hence to establish the role of sociocultural factors in phenomenology of AH in patients with schizophrenia.

A longitudinal study of 30 patients diagnosed with Schizophrenia as per DSM-5 having AHs visiting Psychiatry Department of Government Hospital was carried out over a period of 2yrs. A quantitative study to find correlation between presence of NLE & AH in patients and a qualitative study by in-depth interview of 10 patients with help of semi-structured questionnaire to understand phenomenology by procedures of interpretative phenomenological analysis was carried out.

A positive statistically significant correlation between NLE & content of AH was found. Majority of patients experienced AHs based on NLE in past & heard voices related to it. Various themes such as Guilt, Fear, Inadequacy, Anger, Frustration surfaced during the qualitative study.

This study thus strengthens the holistic model where sociocultural factors with biological & psychological factors play a role in pathogenesis of AHs. Treatment weighing on addressing NLE & emotions attached to it may help in foreshortening recovery & deal with residual AHs. This can help in therapeutic management of distress in patients, relieve internal conflict within their psyche, where they would feel more understood and learn to live with persistent AHs.

None Declared

Despite the significant scientific progress in the study of the mechanisms underlying mental disorders, stable biomarkers facilitating their diagnosis and differential diagnosis are lacking. Therefore, we attempted to explore possible functional connectivity (FC) differences across some of the more prevalent mental disorders, namely mood disorders.

The current study aimed at investigating the alterations of the functional connectivity of major seeds of the Salience Network (SN) (the Anterior Cingulate Cortex (ACC), and Anterior Insula (AI) in patients with unipolar (Major Depressive Disorder-MDD) or bipolar (Bipolar Disorder-BD) depression as compared to healthy controls (HC).

For this study 103 adult subjects underwent resting-state Magnetic Resonance Imaging of whom 60 were patients with a depressive episode (MDD: n=35; BD: n=25), and 43 were healthy controls (HC). The individuals in both groups were matched for age and gender. Each participant has provided written informed consent (Ethics Committee: P186/22.01.2021). Seed-to-voxel analysis was performed via the CONN toolbox running on MATLAB. Random Field Theory parametric statistics was used with a cluster-level FWE correction p<0.05.

Both the ACC and the right AI demonstrated a statistically significant increase in the FC to the somatosensory cortex and the motor cortex in patients as opposed to HC. In addition, there was hyperconnectivity between ACC and the right Superior Frontal Gyrus, Precuneus, and the Superior Parietal Lobule bilaterally in patients as well. A reduced FC between the ACC and the hippocampus and parahippocampus was observed in depression in comparison to HC. The analysis of the left AI seed yielded no statistically significant between-group differences.

Our results demonstrate aberrant connectivity between nodes of the SN, the Default Mode Network, and the Limbic Network which might provide clarification on the mechanisms of impaired balance between internally and externally oriented attention, affective and cognitive control in depression. In addition, the alterations of the FC between SN and the somatosensory and motor cortices may be suggested as a possible explanation of the disturbances in the psychomotor activity in mood disorders.

A. Todeva-Radneva Grant / Research support from: This work has been funded by the Bulgarian National Program “European Scientific Networks” - Project DIP Neuroscience, R. Paunova Grant / Research support from: This work has been funded by the Bulgarian National Program “European Scientific Networks” - Project DIP Neuroscience, D. Stoyanov Grant / Research support from: This work has been funded by the Bulgarian National Program “European Scientific Networks” - Project DIP Neuroscience, T. Zdravkova Grant / Research support from: This work has been funded by the Bulgarian National Program “European Scientific Networks” - Project DIP Neuroscience, S. Kandilarova Grant / Research support from: This work has been funded by the Bulgarian National Program “European Scientific Networks” - Project DIP Neuroscience

In recent years much focus has been put on the role of immune/inflammatory alterations in affecting Major Depression (MDD) development and antidepressant efficacy. Neutrophil-to-lymphocyte ratio (NLR) is an inexpensive inflammatory marker shown to be elevated in depressed patients, with large population studies reporting this effect only in women. However, its relation to treatment response is much less clear. Reduced hippocampal volumes (HV) are among the few consistent brain structural predictors of poor treatment response, and they have been shown to be influenced by inflammatory status.

To investigate the effect of NLR on treatment response in MDD patients, testing a possible moderating role of sex. To investigate the effect of NLR on HV and test a possible mediating role of the latter in the relation between NLR and treatment response.

Our study was performed on a sample of 120 MDD inpatients suffering from a non psychotic depressive episode (F=78; M=42). Depression severity was assessed via the Hamilton Depression Rating Scale (HDRS), both at admission and discharge; as a measure of treatment response, delta HDRS was calculated subtracting the two scores. NLR was calculated for each subject. Patients underwent 3T MRI acquisition and bilateral HV were estimated.

We found a significant moderating effect of sex on the relationship between NLR and Delta HDRS (p < 0.001): a negative relation was found in women (p < 0.001) and a positive one in men (p = 0.042). NLR was found to negatively affect left HV in the whole sample (p = 0.027) and in women (p = 0.038). A positive effect on Delta HDRS was found for both left (p = 0.038) and right (p = 0.027) HV. Finally, we found a significant indirect effect of NLR values on Delta HDRS through left HV in women (95% BCa CI [- 0.948, -0.017]); the direct effect of NLR on Delta HDRS also remained significant (p = 0.002).

Sex was found to moderate the relation between NLR and treatment response. The detrimental effect in women is in line with previous reports linking inflammation to hampered antidepressant effect; the positive one in men is more surprising: however, the only studies to date on the effect of NLR on antidepressant efficacy report a positive effect in patients with psychotic depression. In women we found NLR to affect treatment response partially through its effect on left HV, providing a possible, albeit incomplete, mechanistic explanation of the effect of inflammatory status on antidepressant efficacy.

None Declared

Stigma is a complex process and a universal phenomenon that is part of all social groups and that is maintained by its functions related to the establishment of one’s own identity and the facilitation of socialization processes. The stigma of the patient is important to evaluate since it is a subjective experience that can have negative correlations in relation to self-esteem, empowerment and recovery orientation of the patient with mental illness. Hospitalization in mental health takes place at times of mental illness decompensation and is an intervention closely related to the stigma towards mental illness.

The objective of the study is to evaluate the stigma perceived by patients with mental illness hospitalized in an acute mental health unit.

Observational study with 53 patients hospitalized in an acute mental health unit.

Variables collected: Sociodemographic variables (age, sex), clinical diagnosis and stigma is evaluated with the Illness Self-stigma Scale (ISMI).

Sample of 53 patients, 55% women and 44% men, the most frequent diagnoses among those admitted are psychosis spectrum 26.42%, depressive disorders 24.53%, personality disorders 22.64% and bipolar disorders 11.33%. The average age is 41.96 years, between 18 and 72 years. The self-stigma according to the scale (ISMI) we obtain as a total score the patient with the highest stigma scores 100 points and the one with the least scores 44 points. Regarding diagnoses, depressive disorders score 33-72 points, while psychotic disorders score 36-85 points. The highest scores in self-stigma in our study are in personality disorders 49-100 and borderline personality disorder stands out (100 points). In the 5 subscales such as alienation, self-stigma, perceived discrimination, social isolation and resistance to stigma. Higher scores in alienation stand out in all patients.

Patients with personality disorders, especially borderline personality disorder, followed by psychotic disorders, present greater perceived self-stigma in our study than the rest of the patients; it is a very important factor that can affect the evolution of the clinical picture. This factor is important to establish the therapeutic plan and the different interventions, it would be recommended to assess the stigma together with the measures to reduce symptoms.

None Declared

Conventional healthcare records are generally inaccessible to service-users. ‘Beth’ is a digital tool in South London and Maudsley NHS Foundation Trust which allows service-users to self-monitor symptoms, set therapeutic goals, access aspects of clinical records and communicate with care teams.

To explore service-user and clinician perspectives of Beth, and to understand how Beth might impact clinical care.

Service-user and clinician users completed an online questionnaire. Likert-scale and free-text response questions covered user experience, impact on clinical care and suggested improvements. N=26 service-users and 43 clinicians completed the questionnaire. Quantitative and qualitative analyses are presented.

Service-users reported the most useful features were tracking sleep and mood, messaging their care team, logging coping strategies and viewing care plans, goals and upcoming appointments. A majority reported Beth improved clinical assessments and they would recommend it to others. Barriers to using Beth included navigational difficulties, lack of access to internet or hardware, needing to register for an account and forgetting to use it. Clinicians reported booking appointments, messaging service-users, sharing care plans and accessing mood diaries were the most useful features. However, many clinicians did not use Beth regularly. Barriers included difficulties using Beth, finding it time-consuming and reportedly poor service-user adherence.

Our findings highlight potential benefits of digital tools in mental health care, alongside numerous barriers and suggested improvements. Limitations include a small sample size and lack of objective user data. Future work may involve qualitative interviews, analysis of objective usage data and trialing improvements in service design.

None Declared

Most substance use disorders (SUDs) emerge in adolescence and young adulthood. Early interventions in young people may reduce the risk and severity of SUD and other mental disorders. However, we are not able to reach our young people early enough for prevention and treatment, and when we do, they often already show a high concentration of comorbid mental disorders and signs of a chronic intermittent course of SUD. Hence, we must reach our addicted young patients at an earlier stage, when symptoms are still mild or transient, or perhaps even before that – when they only show precursors of possible dysfunction.

One of the most prominent precursors of dysfunction is our ability – or lack thereof – to control or "self-regulate" our behaviors, cognitions, and emotions. Many scientists argue that poor self-regulation is perhaps the core determinant of the development of mental health disorders, including addiction. Several prospective general population studies have shown that poor childhood self-control early in life is a strong predictor of many negative outcomes later in life, up to 20 to 30 years later in adulthood. Although correlational in nature, these findings suggest that early childhood interventions that are deliberately aimed at improving self-regulation may be effective in preventing these negative life outcomes, and that early prevention and intervention targeted at improving self-control may reduce the risk of a broad array of psychiatric and social problems, including addiction. Indeed, several recent large-scale systematic reviews have suggested that self-regulation skills are malleable and can be learned through instruction and practice, and perhaps most so in the early years, roughly around 3 to 6 years, when there is a steep increase in learning curve, when the plasticity of the brain is still high, and when self-regulation skills are still very much in development.

This presentation provides an overview of the rationale and study findings of early prevention of substance use disorders and other mental health disorders. In terms of broad prevention, much can be gained by widespread, consistent implementation and normalization of early prevention at the pre- and elementary school level.

None Declared

There are no conclusive findings about the possible protective role of religion on students’ mental health during the COVID-19 pandemic. Therefore, more research is needed.

The purpose of this study was to assess the relationship between the level of emotional distress and religiosity among students from 7 different countries during the COVID-19 pandemic.

Data were collected by an online cross-sectional survey that was distributed amongst Polish (N = 1196), Bengali (N = 1537), Indian (N = 483), Mexican (N = 231), Egyptian (N = 565), Philippine (N = 2062), and Pakistani (N = 506) students (N = 6642) from 12th April to 1st June 2021. The respondents were asked several questions regarding their religiosity which was measured by The Duke University Religion Index (DUREL), the emotional distress was measured by the Depression, Anxiety, and Stress Scale-21 (DASS-21).

Egypt with Islam as the dominant religion showed the greatest temple attendance (organizational religious activity: M=5.27±1.36) and spirituality (intrinsic religiosity: M=5.27±1.36), p<0.0001. On another hand, Egyptian students had the lowest emotional distress measured in all categories DASS-21 (depression: M=4.87±10.17, anxiety: M=4.78±10.13, stress: M=20.76±11.46). Two countries with the dominant Christian religion achieved the highest score for private religious activities (non-organizational religious activity; Mexico: M=3.94±0.94, Poland: M=3.63±1.20; p<0.0001) and experienced a moderate level of depressive symptoms, anxiety, and stress. Students from Mexico presented the lowest attendance to church (M=2.46±1,39) and spirituality (M=6.68± 3.41) and had the second highest level of depressive symptoms (M=19.13±13.03) and stress (M=20.27±1.98). Philippines students had the highest DASS-21 score (depression: M=22.77±12.58, anxiety: M=16.07±10.77, stress: M=4.87±10.08) and their level of religiosity reached average values in the whole group. The performed regression analysis confirmed the importance of the 3 dimensions (organizational religious activity, non-organizational religious activity, intrinsic religiosity) of religiosity for the well-being of students, except for the relationship between anxiety and private religious activities. The result was as presented for depression: R2=0.0398, F(3.664)=91.764, p<0.0001, SE of E: 12.88; anxiety: R2=0.0124, F(3.664)=27.683, p<0.0001, SE of E: 10,62; stress: R2= 0.0350, F(3.664)=80.363, p<0.0001, SE of E: 12.30.

The higher commitment to organizational religious activity, non-organizational religious activity, and intrinsic religiositywas correlated with the lower level of depressive symptoms, stress, and anxiety among students during the COVID-19 pandemic, but taking into account factors related to religiosity explains the level of emotional well-being to a small extent.

None Declared

Home Treatment (HT) teams are among the better-studied options to reduce admission at the hospital, having been described as an alternative to hospitalization in patients with schizophrenia. There may be certain risk factors which has already been described such as living alone (Dean and Gadd, BMJ, 1990; 301, 1021–1023; Schnyder et al., Acta Psychiatr. Scand. 1999; 99, 179–187), lack of awareness of the illness, uncooperativeness (Cotton et al., BMC Psychiatry, 2007; 7, 52) and fewer visits carried out (Morgan et al., Aust. New Zeal. J. Psychiatry,2006; 40, 683–690) which together can negatively influence the possibility of conducting intensive home follow-up and, therefore, increase the likelihood of hospitalization.

To describe de relative contribution of several risk factors to patient hospitalization related to the possibility of conducting intensive home follow-up of patients diagnosed with Schizophrenia following home treatment. Second, to determine de risk of hospitalization related to the possibility of conducting intensive home follow-up according to the presence of one or more risk factors of patients diagnosed with Schizophrenia following home treatment.

All patients with schizophrenia who were visited by a home treatment team in Barcelona between January 2017 and December 2021 were included in the study. To assess whether there was an increased risk of hospitalization associated with factors such as living alone, uncooperativeness (PANSS G8 item >= 4) and ≤1 home visit, two bivariate logistic regression analyses were conducted. We studied these factors as independent variables to assess the relative contribution to the risk of hospitalization, and we studied if the presence of 1, 2, 3 or 4 of these risk factors as independent variables worsened the risk of hospitalization.

Uncooperativeness shows the highest contribution to the risk of hospitalization, followed by ≤ 1 home visit, lack of insight and living alone, all results reaching significance (p=0.000).

There is an increase in the risk of hospitalization depending of the presence of 1,2,3 or 4 of these risk factors (1 risk factor (Odds Ratio = 1.21), 2 risk factors (Odds Ratio = 5.28), 3 risk factors (Odds ratio = 13.53), 4 risk factors (Odds ratio = 29.18).

There are a number of factors directly related to the possibility of conducting intensive follow-up that appear relevant in the case of psychotic patients in acute crisis treated at home. This set of variables are the lack of awareness of the illness, lack of collaboration, living alone and the number of visits that have been made, all with statistically significant differences in our study. These factors together also greatly increase the risk of hospitalization, becoming almost 30 times more likely when these 4 factors are present.

None Declared

Mental health problems are common in children and young people (CYP) in England, yet evidence suggests high levels of unmet need in this group. Understanding of the determinants of mental health-related service contact is needed to identify gaps in service provision and areas for targeted intervention to improve access.

To determine the relationship between CYP characteristics and mental health-related support and service contact in England.

A secondary analysis of the 2017 NHS Digital Mental Health of Children and Young People (MHCYP-2017) cross-sectional survey dataset was performed. MHCYP-2017 was a national survey investigating the mental health of CYP using a stratified multistage random probability sampling approach, providing the official national statistics for England. Multi-informant data were collected through a combination of questionnaires and interviews. Expert clinical rating took place to formally identify the presence of mental disorders, according to established diagnostic criteria. This secondary analysis describes mental health-related support and service contact amongst 6681 participants aged 5-16 recruited to the MHCYP-2017 study. A range of socio-demographic and clinical characteristics were analysed as explanatory variables and their relationships with different types of support/service contact were examined through multivariable multinomial logistic regression. Analyses were stratified by age group: 5-10- and 11-16-year-olds.

Overall, around 25% of parents reported CYP mental health-related contact with one or more types of support/service in the past 12 months due to concerns regarding CYP “emotions, behaviour, concentration or difficulties in getting along with people”. Age stratified multivariable analyses revealed several statistically significant associations between participant socio-demographic/clinical characteristics and mental health-related support and service contact, independent of CYP mental health status and parental perception of difficulties. These associations were not necessarily consistent across mental health support categories, suggesting that several of the measured characteristics have differential relationships with different types of support and service contact. Whilst there were some differences between the 5-10 and 11-16 age groups, similar associations were seen for many of the explanatory variables. Socioeconomically disadvantaged and black and minority ethnic CYP were less likely to have had professional contact for mental health problems.

There may be higher levels of unmet need in socioeconomically disadvantaged and black and minority ethnic CYP, warranting further investigation and efforts to address inequalities. Further longitudinal studies are needed to elucidate causal associations and mechanisms underlying these observations.

None Declared

The fundamental principle of medical ethics is based on the principle of autonomy, of which consent is part, in addition to the right to information and the free choice of caregiver by the patient. In the psychiatric emergency department, the psychiatrist is confronted in his daily practice with the decisions of outpatient or hospital care, sometimes without the consent of the patients, in particular when the disorders hinder their capacities for self-assessment and judgment or when he there is a vital prognosis involved.

It is therefore important to know certain basic legal rules in order to better manage these emergency situations.

Literature review

Patients requiring care in the emergency department present particular challenges to ensuring valid consent. Patients often present in a crisis situation and their abilities may be altered by, for example, psychoactive substances or impaired judgment. These patients are cared for by clinicians who may have to make urgent decisions based on incomplete information. The emergency department can be a disorienting and frightening environment for patients. The following aspects of consent: autonomy and capacity, are particularly relevant to care in emergency departments.

The interplay between emergent need, presumed incompetence, implied consent, and societal interest, as well as the individual details of each case, are all important in making the right ethical and legal decision in an emergency situation. given, because the emergency situation does not allow any delay in the decision-making process.

None Declared

Burnout in the medical profession has garnered a lot of attention over the recent years. While it is reported across all specialties and all stages of medical education; resident physicians in particular are at high risk for burnout throughout their years of training.

This study aimed at evaluating the prevalence and correlates of burnout among resident physicians in Alberta.

Through a descriptive cross-sectional study design, a self-administered questionnaire was used to gather data from resident physicians at two medical schools in Alberta, Canada. Maslach Burnout Inventory was used as an assessment tool. Chi-squared and multivariate binary logistic regression analyses were used.

Overall burnout prevalence among residents was 58.2%. Working more than 80 hours/week (OR= 16.437; 95% CI: 2.059 – 131.225), being dissatisfied (OR= 22.28; 95% CI: 1.75– 283.278) or being neither satisfied nor dissatisfied with a career in medicine [(OR= 23.81; 95% CI: 4.89 – 115.86) were significantly associated with high depersonalization. Dissatisfaction with efficiency and resources (OR= 10.83; CI: 1.66- 70.32) or being neither satisfied nor dissatisfied with a career in medicine (OR= 5.14; CI: 1.33- 19.94)] were significantly associated with high emotional exhaustion. Working more than 80 hours/week (OR= 5.36; CI: 1.08- 26.42) and feeling that the residency program is somewhat having enough strategies aimed at resident well-being in place (OR= 3.70; CI: 1.10- 12.46) were significantly associated with high work exhaustion and interpersonal disengagement. Young age of the residents (≤ 30 years) (OR= 0.044; CI: 0.004- 0.445) was significantly associated with low professional fulfillment.

Burnout is a serious occupational phenomenon that can degenerate to other conditions or disrupts one’s professional performance. Significant correlates were associated with high rates of burnout. Leaders of medical schools and policy makers need to acknowledge, design, and implement various strategies capable of providing continuous effective mental health support to improve the psychological health of the medical resident across Canada.

None Declared

Complex regional pain syndrome (CRPS) is a rare condition associated with chronic pain. It is an inflammatory and neuropathic disorder principally characterized by involvement of the autonomic nervous system. The etiology of the syndrome is not clear and the known treatment modality is also very complicated.

Extant literature has shown the relationship between CRPS and suicidal behaviours in adults but less data are available in adolescents. This literature review aims to synthesize and evaluate the existing studies assessing suicidality in CRPS adolescents.

A narrative review of the literature focusing on CRPS and chronic pain in adolescents and their associations with suicidal behavior including suicidal ideations, suicide attempts and death by suicide.

The studies of suicidality factors in adolescents evaluated chronic pain in general. Those who studied CRPS specifically did not look for its association with suicide risk. In fact, adolescents who suffer from chronic pain present increased risk for suicide ideations and suicidal attempts. Furthermore, no available data have demonstrated the association between chronic pain and suicide. Additionally, among adolescents with CRPS, the risks of somatization, anxiety, and depression are higher. The duration of pain, depression and eating disorders has been shown to be associated with increased suicidality.

Our findings suggest that CRPS is associated with higher risks for suicidal ideation, suicidal attempts compared to the general population. The risk factors underlying suicidal behavior in CRPS patients are not studied enough and require further investigation.

None Declared