According to the UN Refugee Agency, around 100 million individuals were estimated to be forcibly displaced worldwide in 2022 due to violence, war or other human rights violations. This represents a doubling in the global population of forcibly displaced individuals during the last decade. War migrants are frequently exposed to multiple traumas, including direct or indirect exposure to violence, as well as extended periods of insecurities in access to housing, clothes, food, education and health care. As a corollary, war migrants face extensive health risks, including elevated risks of psychiatric disorders with potential implications for the development of other conditions, e.g. autoimmune and cardiovascular diseases. The most recent evidence of the health risks of war migrants will be reviewed along with possible mitigating factors of such adverse sequalae.

None Declared

Patients with severe psychotic disorders exhibit a severely reduced quality of life (QoL) at all stages of the disease. Integrated care often led to an improvement in QoL. However, the specific mediators of QoL change are not yet well understood.

The ACCESS II study is a prospective, long-term study investigating the effectiveness of an integrated care program for people with severe psychotic disorders (IC-TACT) that includes Therapeutic Assertive Community Treatment within a care network of in- and outpatient services at the University Medical Center Hamburg-Eppendorf, Germany. We examined longitudinal associations between QoL and the hypothesized mediators of change (i.e., negative symptoms, depression, and anxiety), using cross-lagged panel models.

The sample includes 418 severely ill patients treated in IC-TACT for at least 1 year. QoL increased, whereas symptom severity decreased significantly from baseline to 6-month follow-up (p-values ≤ 0.001), and remained stable until 12-month follow-up. QoL and symptom severity demonstrated significant auto-correlated effects and significant cross-lagged effects from QoL at baseline to negative symptoms (6 months, β = −0.20, p < 0.001) to QoL (12 months, β = −0.19, p < 0.01) resulting in a significant indirect, mediated effect. Additionally, negative symptoms after 6 months had a significant effect on the severity of depression after 12 months (β = 0.13, p < 0.05).

Negative symptoms appear to represent an important mechanism of change in IC-TACT indicating that improvement of QoL could potentially be achieved through optimized intervention on negative symptoms. Moreover, this may lead to a reduction in the severity of depression after 12 months.

The PTSD diagnosis was in 1980 largely facilitated by consequences of the Vietnam War. Since then, there have been hundreds of other war-related conflicts in the world. My presentation will distinguish between war-related trauma effects on military personnel (where most research has been done) and on civilians, distinguishing effects on children/adolescents, adults and older people. I will answer the question, how do war-related trauma sequelae differ from other man-made or accidental traumas? Further, I will address the issue of whether “moral injury” research in military personnel after wartime operations is also relevant to similar phenomena in civilian populations traumatised by war? Which of the brain-related research approaches (localisation, network connectivity, altered RDoC functions) are particularly relevant in this context? Finally, emerging research priorities related to the current war of invasion against Ukraine will be addressed.

None Declared

Mortality among people with mental disorders is higher in comparison with the general population. There is a scarcity of studies on mortality in the abovementioned group of people in Central and Eastern European countries.

The study aimed to assess all-cause mortality in people with mental disorders in Poland. We conducted a nationwide, register-based cohort study utilizing data from two nationwide registries in Poland: the registry of healthcare services reported to the National Health Fund (2009–2018) and the all-cause death registry from Statistics Poland (2019). We identified individuals who were consulted or hospitalized in public mental healthcare facilities and received at least one diagnosis of mental disorders (International Statistical Classification of Diseases and Health Problems [ICD-10]) from 2009 to 2018. Standardized mortality ratios (SMRs) were compared between people with a history of mental disorder and the general population.

The study comprised 4,038,517 people. The SMR for individuals with any mental disorder compared with the general population was 1.54. SMRs varied across diagnostic groups, with the highest values for substance use disorders (3.04; 95% CI 3.00–3.09), schizophrenia, schizotypal and delusional disorders (2.12; 95% CI 2.06–2.18), and pervasive and specific developmental disorders (1.68; 95% CI 1.08–2.29). When only inpatients were considered, all-cause mortality risk was almost threefold higher than in the general population (SMR 2.90; 95% CI 2.86–2.94).

In Poland, mortality in people with mental disorders is significantly higher than in the general population. The results provide a reference point for future longitudinal studies on mortality in Poland.

Gambling disorder was reclassified as a first behavioral addiction in the DSM-5 in 2013. In 2018, gaming disorder was included in the ICD-11. In this presentation, research findings regarding the psychological and neurobiological mechanisms in gambling disorder and other behavioral addictions are highlighted. Specifically, neural and behavioral responses regarding reward expectation, reward outcomes, and the role of specific mechanisms in gambling like near wins, and in gaming, like lootboxes are highlighted. Besides the recognition of gambling disorder, the broader perspective of gambling harms is highlighted and related to psychosocial, financial, and health consequences. The perspective of interaction between human design factors (e.g. psychological and neurobiological mechanisms, such as decision making, reward processing) and gambling design factors (e.g. near wins, multiline betting) is reviewed. Evidence with regard to psychological and pharmacological interventions are discussed and future directions for research perspectives are discussed.

A. Goudriaan Grant / Research support from: Anna Goudriaan received grants from the Dutch Foundation for Scientific Research (NWO and ZonMw) and from VCVGZ Foundation

Studies reporting that highly intelligent individuals have more mental health disorders often have sampling bias, no or inadequate control groups, or insufficient sample size. We addressed these caveats by examining the difference in the prevalence of mental health disorders between individuals with high and average general intelligence (g-factor) in the UK Biobank.

Participants with g-factor scores standardized relative to the same-age UK population, were divided into two groups: a high g-factor group (g-factor 2 SD above the UK mean; N = 16,137) and an average g-factor group (g-factor within 2 SD of the UK mean; N = 236,273). Using self-report questionnaires and medical diagnoses, we examined group differences in the prevalence of 32 phenotypes, including mental health disorders, trauma, allergies, and other traits.

High and average g-factor groups differed across 15/32 phenotypes and did not depend on sex and/or age. Individuals with high g-factors had less general anxiety (odds ratio [OR] = 0.69, 95% CI [0.64;0.74]) and post-traumatic stress disorder (PTSD; OR = 0.67, 95 %CI [0.61;0.74]), were less neurotic (β = −0.12, 95% CI [−0.15;−0.10]), less socially isolated (OR = 0.85, 95% CI [0.80;0.90]), and were less likely to have experienced childhood stressors and abuse, adulthood stressors, or catastrophic trauma (OR = 0.69–0.90). However, they generally had more allergies (e.g., eczema; OR = 1.13–1.33).

The present study provides robust evidence that highly intelligent individuals do not have more mental health disorders than the average population. High intelligence even appears as a protective factor for general anxiety and PTSD.

Digital interventions for common mental disorders are coming of age. The uptake of evidence-based self-guided and guided (a-synchronic in time) cognitive behavioural digital interventions for depression and anxiety in routine care is however low. Blended treatment formats appear an attractive alternative for routine care settings as these combine face-to-face sessions with digital ones in integrated treatment protocols. Yet little is known about the clinical and cost-effectiveness of blended CBT (bCBT). In this presentation I will touch upon the current state of the art of digital interventions for depression and anxiety disorders, including blended formats in routine care and I will go beyond that state by addressing new developments. I will illustrate these new developments by virtue of several studies (RCT’s) we conducted on the clinical and cost-effectiveness of blended CBT interventions (and their implementation) in routine care settings. A specific focus will be put on blending digital phenotyping in CBT treatment which includes mobile ecological momentary assessment tools and AI algorithms.

While digital mental health for depression and anxiety in routine care was boosted through the Covid-19 pandemic, the question remains whether the current knowledge base will leveraging digital mental health research and services to the next level. Implications for future research on blended treatments and clinical applications in routine care will be discussed.

None Declared

We retrospectively evaluated the effectiveness of trauma-focused psychotherapy (TF-P) versus stabilization and waiting in a civilian cohort of patients with an 11th version of the international classification of disease (ICD-11) diagnosis of complex post-traumatic stress disorder (CPTSD).

We identified patients with CPTSD treated at a specialist trauma service over a 3-year period by triangulating evidence from self-report questionnaires, file review, and expert-clinician opinion. Patients completed a phase-based treatment: stabilization consisting of symptom management and establishing safety, followed by waiting for treatment (phase 1); individual TF-P in the form of trauma-focused cognitive behavioral therapy (TF-CBT), or eye movement desensitization and reprocessing (EMDR) or TF-CBT plus EMDR (phase 2). Our primary outcome was PTSD symptoms during phase 2 versus phase 1. Secondary outcomes included depressive symptoms, functional impairment, and a proxy CPTSD measure. Exploratory analysis compared outcomes between treatments. Adverse outcomes were recorded.

Fifty-nine patients were included. Compared to receiving only phase 1, patients completing TF-P showed statistically significant reductions in PTSD [t(58) = −3.99, p < 0.001], depressive symptoms [t(58) = −4.41, p < 0.001], functional impairment [t(58) = −2.26, p = 0.028], and proxy scores for CPTSD [t(58) = 4.69, p < 0.001]. There were no significant differences in outcomes between different treatments offered during phase 2. Baseline depressive symptoms were associated with higher PTSD symptoms and functional impairment.

This study suggests that TF-P effectively improves symptoms of CPTSD. However, prospective research with validated measurements is necessary to evaluate current and new treatments and identify personal markers of treatment effectiveness for CPTSD.

It remains unclear whether all physical activity (PA) domains (e.g., occupation-related PA [OPA], transportation-related PA [TPA], and leisure-time PA [LTPA]) have equivalent beneficial relationships. We aimed to investigate the associations of OPA, TPA, and LTPA with depressive symptoms in adults.

We included and analyzed 31,221 participants (aged ≥18 years) from the cross-sectional 2007–2018 U.S. National Health and Nutrition Examination Survey (NHANES). The PA domains were assessed by a self-report questionnaire and categorized based on the PA guidelines. Depressive symptoms were measured by the nine-item Patient Health Questionnaire.

Participants achieving PA guidelines (≥150 min/week) were 26% (odds ratio [OR] 0.74, 95% confidence interval [CI] 0.68–0.80) and 43% (OR 0.57, 95% CI 0.51–0.62) less likely to have depressive symptoms depending on total PA and LTPA, respectively, while OPA or TPA did not demonstrate lower risks of depressive symptoms. LTPA at levels of 1–149, 150–299, and ≥300 min/week was associated with 31% (OR 0.69, 95% CI 0.60–0.78), 43% (OR 0.57, 95% CI 0.49–0.67), and 51% (OR 0.49, 95% CI 0.43–0.55) lower odds of depressive symptoms, respectively.

LTPA, but not OPA or TPA, was associated with a lower risk of depressive symptoms at any amount, suggesting that significant mental health would benefit from increased PA, even at levels below the recommendation.

Mental health problems have a substantial economic impact across the world. Those who have their problems detected may receive therapies (usually medication or psychological) or who packages of care (for example, early intervention or residential support). Some problems are transient while others will remain across the life course. Costs are closely associated with care received and it may be that costs need to rise in order to provide adequate support. Economic costs also occur due to lost opportunities such as work and leisure. This talk will summarise recent estimates of the cost of mental health problems in a number of countries.

Establishing total costs does not tell us how to use limited resources. This requires the use of economic evaluation methods such as cost-effectiveness and cost-utility analyses. There is a growing evidence base from such evaluations for many psychological and pharmacological interventions and recent key findings will be discussed. The need for long-term, life course approaches to economic evaluation of mental health interventions will be proposed.

None Declared

Over a 5-year program-project, focusing on 4 of the most disabling disorders (i.e. Bipolar Disorder, Major Depressive Disorders, Schizophrenia, and Autism Spectrum Disorders), PROPSY’s ambition is to bring solutions for precision medicine in psychiatry. This ambition requires overcoming multiple challenges: (i) to discover prognostic and stratification biomarkers, (ii) to better understand underlying causes and mechanisms, (iii) to develop targeted therapeutic strategies (iii) to reduce stigma and false representation, (iv) to reduce the direct and indirect economic costs. To tackle these challenges, PROPSY is an inclusive program project composed of 5 operational work packages. PROPSY will also implement this knowledge into clinical practice, in a truly learning healthcare system, and increase awareness with Patients’ Associations to reach out to civil society. This research effort in precision psychiatry aims to strengthen the coordination of the French workforce along with international collaborations in connection with users and policymakers

None Declared

Cost-effectiveness analysis needs to be considered when introducing new tools and treatments to clinical services. The number of new assessment tools in mental health has rapidly expanded, including suicide risk assessment. Such suicide-based assessments, when linked to preventative interventions, are integral to high-quality mental health care for people with severe mental illness (SMI). We examined the cost implications of implementing Oxford Mental Illness and Suicide (OxMIS), an evidence-based, scalable suicide risk assessment tool that provides probabilistic estimates of suicide risk over 12 months for people with SMI in England.

We developed a decision analytic model using secondary data to estimate the potential cost-effectiveness of incorporating OxMIS into clinical decision-making in secondary care as compared to usual care. Cost-effectiveness was measured in terms of costs per quality-adjusted life years (QALYs) gained. Uncertainty was addressed with deterministic and probabilistic sensitivity analysis.

Conducting suicide risk assessment with OxMIS was potentially cheaper than clinical risk assessment alone by £250 (95% confidence interval, −786;31) to £599 (−1,321;−156) (in 2020–2021 prices) per person with SMI and associated with a small increase in quality of life (0.01 [−0.03;0.05] to 0.01 QALY, [−0.04;0.07]). The estimated incremental cost-effectiveness ratio of implementing OxMIS was cost saving. Using probabilistic sensitivity analysis, 99.96% of 10,000 simulations remained cost saving.

Cost-effectiveness analysis can be conducted on risk prediction models. Implementing one such model that focuses on suicide risk in a high-risk population can lead to cost savings and improved health outcomes, especially if explicitly linked to preventative treatments.

Women with triple X syndrome (TXS) have an extra X chromosome. TXS appeared to be associated with psychiatric disorders in biased or underpowered studies.

This study aims to describe the prevalence of psychiatric disorders in adults with TXS in a relatively large and less biased group of participants.

In this cross-sectional study, data were collected from 34 women with TXS (mean age = 32.9; s.d. = 13.1) and 31 controls (mean age = 34.9; s.d. = 13.7). Psychiatric disorders were assessed using the MINI International Neuropsychiatric Interview (MINI) and the adult behavior checklist (ABCL). Trait and state anxiety were assessed using the State–Trait Anxiety Inventory.

In the TXS group, MINI results showed a higher prevalence of major depressive episodes (43.3%), psychotic disorders (29.4%), and suicidality (23.5%). Only 50% of the TXS group earned a normal score for the total syndrome score using the ABCL. In addition, levels of trait anxiety were higher in the TXS group. Only three women in each group received psychotropic medication. Impaired social functioning appeared to represent a major risk factor in TXS as regards psychotic, affective disorders, trait anxiety, and low self-esteem.

Women with TXS are vulnerable to developing psychiatric disorders, and women with both TXS and impaired social functioning are even more vulnerable.

After a short review of the state of the art of clinical staging in schizophrenia, I will present a recently developed empirical staging model.

Two hundred twelve stable outpatients with schizophrenia from Oviedo (Spain) were assessed with: an ad hoc questionnaire (demographic, clinical information); psychopathology: PANSS, CDS, OSQ, CGI-S; functioning: PSP; cognition: MATRICS; lab tests: C-Reactive Protein, IL-1RA, IL-6, Platelet/Lymphocyte (PLR), Neutrophil/Lymphocyte (NLR), and Monocyte/Lymphocyte (MLR) ratios.

An ad hoc genetic algorithm (GA) was developed to select those variables showing the best performance for patients’ CGI classification. The objective function of the GA maximizes the individual’s correct classification of a support vector machines (SVM) model that employs as input variables those given by the GA. Models’ performance was assessed with the help of 3-fold cross-validation, and this process was repeated 10,000 times for each one of the models evaluated. Once developed, we used the ANOVA test (Duncan’s post-hoc) for all the variables included in the model to demonstrate its construct validity.

Our model included the following variables: positive, negative, depressive, and general psychopathological symptoms, processing speed, visual learning, social cognition, and real-world functioning. Its classification accuracy is 64.54% (SD=4.83%) with a specificity and sensitivity of 0.85 and 0.63. The external validity of the new model is being tested using a French sample from the FACE-SZ (FondaMental Advanced Centers of Expertise-Schizophrenia) cohort.

We developed an SVM model including psychopathological, cognitive, and functional variables.

Our model demonstrated good construct validity since all the variables included behaved as expected. That is, they score significantly worse as the patients’ severity increases. Besides, it showed good accuracy, specificity, and sensitivity classification properties.

Using staging models in daily clinical practice will help clinicians to better.

None Declared

In many fields of heath, precision medicine has been integrated in clinical practise, for instance in oncology. In the case of psychiatry, and in particular bipolar disorder, we are in a prior step for the moment. Different proposal of stratification will be described during the talk for instance the classification of staging. Moreover some proposal of precision psychiatry in bipolar disorder will be put forward.

None Declared

Ghrelin, a stomach-derived hunger and appetite signal, drives behaviors that ensure we seek out and consume foods, not only in situations of energy deficit but also when anticipating palatable foods. Key target pathways for ghrelin include the orexigenic agouti-related peptide (AgRP) neurones in the hypothalamic arcuate nucleus (Arc), that appear to confer the unpleasant feelings of hunger. They also include dopamine neurones in the ventral tegmental area, where ghrelin heightens motivation for food rewards. Recently, we have employed a variety of neural circuit mapping techniques in rodents to help clarify the function of populations of ghrelin-responsive targets. We found that 1) chemogenetic activation of ghrelin-responsive cells in the Arc is sufficient to drive a feeding response and to induce food-motivated behaviour and 2) that dopamine neurones in the VTA are activated when mice are exposed to cues that predict a food reward than to its retrieval, as revealed by fiber photometry recordings from these cells. Further studies aim to determine the role of ghrelin-responsive cells in the parabrachial nucleus of the brainstem. Overall, the brain ghrelin signalling system is well positioned to integrate the response to hunger, enhanced by both intrinsic and external cues and in ways that are relevant to curb over-eating in obesity.

None Declared

If people with episodic mental-health conditions lose their job due to an episode of their mental illness, they often experience personal negative consequences. Therefore, reintegration after sick leave is critical to avoid unfavorable courses of disease, longer inability to work, long payment of sickness benefits, and unemployment. Existing return-to-work (RTW) programs have mainly focused on “common mental disorders” and often used very elaborate and costly interventions without yielding convincing effects. It was the aim of the RETURN study to evaluate an easy-to-implement RTW intervention specifically addressing persons with mental illnesses being so severe that they require inpatient treatment.

The RETURN study was a multi-center, cluster-randomized controlled trial in acute psychiatric wards addressing inpatients suffering from a psychiatric disorder. In intervention wards, case managers (RTW experts) were introduced who supported patients in their RTW process, while in control wards treatment, as usual, was continued.

A total of 268 patients were recruited for the trial. Patients in the intervention group had more often returned to their workplace at 6 and 12 months, which was also mirrored in more days at work. These group differences were statistically significant at 6 months. However, for the main outcome (days at work at 12 months), differences were no longer statistically significant (p = 0.14). Intervention patients returned to their workplace earlier than patients in the control group (p = 0.040).

The RETURN intervention has shown the potential of case-management interventions when addressing RTW. Further analyses, especially the qualitative ones, may help to better understand limitations and potential areas for improvement.

The last decade has seen an enormous expansion on our knowledge of the human gut microbiome and its importance for human physiology. The gastrointestinal inhabitants have taken centre stage as regulators of the bidirectional gut to brain communication. The gut microbiota is not only critical for metabolism, glucose homeostasis and body composition, but increasing evidence is demonstrating the significant effects of the gut microbiota on mood and mental wellbeing and its role in the development of affective disorders, such as anxiety and depression, and other neuropsychiatric conditions. Studies in the field of nutritional neuroscience and nutritional psychiatry are now increasingly including the gut microbiota as a key factor mediating the impact of diet on central nervous system function. Accumulating evidence from cell-based in vitro studies, animal models and preclinical intervention studies are linking the gut microbiota to the effects of diet on brain function, but the precise mechanism are still not fully understood and studies have had limited translation to human intervention studies. Overall, the increase in our understanding of interconnectedness of the gastrointestinal microbiota of human health and disease, has led to a strong focus on the development of microbiota-targeted strategies to influence all host physiological responses, including those that can modulate central nervous system function. In this talk, I will provide an overview of the most recent advances in the nutritional psychiatry–microbiome field, highlighting significant opportunities for future research.

None Declared

Deficits in social cognition (SC) are significantly related to community functioning in schizophrenia (SZ). Few studies investigated longitudinal changes in SC and its impact on recovery. In the present study, we aimed: (a) to estimate the magnitude and clinical significance of SC change in outpatients with stable SZ who were assessed at baseline and after 4 years, (b) to identify predictors of reliable and clinically significant change (RCSC), and (c) to determine whether changes in SC over 4 years predicted patient recovery at follow-up.

The reliable change index was used to estimate the proportion of true change in SC, not attributable to measurement error. Stepwise multiple logistic regression models were used to identify the predictors of RCSC in a SC domain (The Awareness of Social Inference Test [TASIT]) and the effect of change in TASIT on recovery at follow-up.

In 548 participants, statistically significant improvements were found for the simple and paradoxical sarcasm of TASIT scale, and for the total score of section 2. The reliable change index was 9.8. A cut-off of 45 identified patients showing clinically significant change. Reliable change was achieved by 12.6% and RCSC by 8% of participants. Lower baseline TASIT sect. 2 score predicted reliable improvement on TASIT sect. 2. Improvement in TASIT sect. 2 scores predicted functional recovery, with a 10-point change predicting 40% increase in the probability of recovery.

The RCSC index provides a conservative way to assess the improvement in the ability to grasp sarcasm in SZ, and is associated with recovery.