Inpatient equivalent home treatment (IEHT), implemented in Germany since 2018, is a specific form of home treatment. Between 2021 and 2022, IEHT was compared to inpatient psychiatric treatment in a 12-months follow-up quasi-experimental study with two propensity score matched cohorts in 10 psychiatric centers in Germany. This article reports results on the treatment during the acute episode and focuses on involvement in decision-making, patient satisfaction, and drop-out rates.

A total of 200 service users receiving IEHT were compared with 200 matched statistical “twins” in standard inpatient treatment. Premature termination of treatment as well as reasons for this was assessed using routine data and a questionnaire. In addition, we measured patient satisfaction with care with a specific scale. For the evaluation of patient involvement in treatment decisions, we used the 9-item Shared Decision Making Questionnaire (SDM-Q-9).

Patients were comparable in both groups with regard to sociodemographic and clinical characteristics. Mean length-of-stay was 37 days for IEHT and 28 days for inpatient treatment. In both groups, a similar proportion of participants stopped treatment prematurely. At the end of the acute episode, patient involvement in decision-making (SDM-Q-9) as well as treatment satisfaction scores were significantly higher for IEHT patients compared to inpatients.

Compared to inpatient care, IEHT treatment for acute psychiatric episodes was associated with higher treatment satisfaction and more involvement in clinical decisions.

Cognitive (dys)function after ECT is often considered as a homogeneous phenomenon across patients. However, there are important inter-individual differences, with some patients experiencing residual invalidating cognitive deficits. We present the results of a study combining both group-level and individual-level analyses of cognitive function using an extensive cognitive test battery that was assessed in 73 patients at 5 time points during their ECT care pathway. Furthermore, we explored the presence of distinct subgroups of patients with a similar cognitive trajectory over time after treatment with ECT using Latent Class Growth Analysis.

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In the 20 years since a review by McCarthy (2001) on the presentation of Post-traumatic stress disorder (PTSD) in people with intellectual disability (ID), the understanding of trauma disorder has increased.

Diagnostic criteria for ID will be presented to set the context. A brief summary of the key literature over the past twenty years will be discussed focusing on the presentation of PTSD in people with ID including the use of ICD-11 criteria. Evaluated tools available to assess the impact of life events and trauma for use in people with ID will be outlined including treatment options. The presentation of trauma disorder will be illustrated through a case study.

Psychiatrists need to be aware that a history of trauma may be an underlying factor in the presentation of people with ID to psychiatric services.

McCarthy J (2001). Post-traumatic Stress Disorder in People with Learning Disability. Advances in Psychiatric Treatment; 7, pp. 163-169.

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The Werther effect is a phenomenon that has been demonstrated in the media. These media are being replaced by social media, the use of which has increased greatly over the decade especially among young people, allowing content to be streamed instantly and fostering connections around the world. At the same time, there is a deterioration in mental health among young people.

To know if there is a Werther effect on social networks, as well as to understand the relationship between this effect and social media. It was also wanted to know if the posts follow the guidelines for dealing with suicide if there are differences between types of social media and if this effect is observed after the death of celebrities.

A systematic review was performed with analysis, data extraction and synthesis of the structured results following the PRISMA criteria.

15 articles were included, 11 of which showed Werther effects on social media, while only 4 were unrelated. It was found that most publications did not follow the recommended guidelines. No differences were observed between social media, while a greater effect was observed when it was related to celebrity suicide.

Social media can act as a suicide support network, as it is a space where there is a risk of infection by normalizing suicide and treating it insecurely. However, it has also been shown that it can act as an agent of change and protection, as many public individuals on social media seek help and express their concerns. More studies are needed to know the magnitude of the Werther effect on social media and to know the potential benefits of talking about suicide if it is done safely.

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How far have we progressed in the field of treating cognitive side effects? Six months after the last ECT treatment, about 15% of patients still have such symptoms, limiting daily life. So far, studies in the field of cognitive training for ECT-related cognitive side effects show few positive effects. Nevertheless, these patients seem to help well. Because they have no structural damage to their brain, training with long-term effectiveness may be available for them. Amsterdam University Medical Centers started the CONNECT clinic (Cognitive and Neuropsychological Aftercare ECT) in early 2022 for diagnosis and treatment of patients with long-term cognitive complaints (longer than six months) that hamper their daily functioning. After the intake and neuropsychological diagnostics, treatment starts if there is an indication. Patients are then offered ’cognitive strategy training’ in an individual course. Developed in the field of neuropsychological rehabilitation, these help to get a grip on cognitive complaints by improving memory or executive functioning with learning strategies. Our initial experiences with patients show that patients master these strategies very well and quickly. We present a pilot project from the Amsterdam UMC where an individualized treatment-programme for long-term cognitive complaints after ECT is being implemented and evaluated.

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Violence occurs frequently in the life of forensic psychiatric patients, both as active aggression and in the form of victimization. Undoubtedly, these incidents shape personality, behavior, and affect the ability to interact adequately socially. Thus, such experiences may influence criminal recidivism and serve as forensic psychiatric/psychological predictors upon hospital discharge.

Hence, this study aimed at characterizing two distinct female forensic psychiatric patient populations (nonsubstance use mental disorders [n = 110] versus substance use disorder [n = 415]) regarding their active and passive violent experiences as well as contextualizing these with their individual crime recidivism rates. The analysis followed a record-based, retrospective approach.

While both groups experienced aggression throughout childhood and youth equally often, substance use disorder patients were significantly more often exposed to violence during adulthood. On the other hand, severely mentally ill patients tended to react more often with violence during their hospital confinement. However, regarding their violent recidivism rate, no intergroup effects were observed. Finally, within the addicted group, a violent index crime as well as physical aggression during hospital confinement increased the odds for violent reoffending by approximately 2.4-fold (95% confidence interval 1.3–4.5) and 2.5-fold (95% confidence interval 1.1–5.9), respectively.

In summary, these findings underline the importance of active aggression rather than victimization as an influencing factor on resocialization especially in a substance use disorder patient population.

Diagnostic criteria are not always useful to discriminate major depression with anxious distress (ADS-D; Diagnostic and Statistical Manual for Mental Disorders, version-5 [DSM-5] criteria) from mixed depression (Koukopoulos’ criteria; KMX-D). So, clinicians need alternative tools to improve their diagnostic ability and to choose the most appropriate treatment. The aim of the present study is to identify socio-demographic and clinical features that discriminate patients with ADS-D from those with KMX-D.

Two hundred and forty-one consecutive outpatients with unipolar (51%) and bipolar (49%) disorder, fulfilling DSM-5 criteria for a current major depressive episode (MDE) and with a 21-item Hamilton Depression Rating Scale score ≥ 14, were recruited and treated in a prospective observational study.

Ten percent of patients met criteria for KMX-D, 22% ADS-D, and 37% for both. Irritable premorbid temperament, mixed depression polarity at onset, mixed depression recurrence, and a high number of mania symptoms at intake were typical features of patients with KMX-D. Depressive polarity at onset, a low number of mania symptoms at intake, and generalized anxiety disorder comorbidity were typical features of patients with ADS-D. Multinomial logistic regression confirmed that higher rate of irritable temperament and higher Young Mania Rating Scale total score differentiated patients with KMX-D from patients with pure MDE.

Our findings suggest some clinical features that could help differentiate between ADS-D and KMX-D in patients meeting both conditions and to select the appropriate treatment. However, the small sample size may have limited the power to detect differences between the groups. Further research is needed to confirm the results of present study.

Data from literature show that people with Autism Spectrum Disorders (ASD) are more likely to develop a psychosis than the general population. They also have a higher chance of developing schizophrenia than neurotypical controls. In order to diagnose comorbid psychosis in ASD in an adult, first a full psychiatric examination is necessary to decide on the directions of possible further diagnostics and, if necessary, to recommend appropriate additional tests, e.g. psychological tests using professional scales and questionnaires for adults. In the case of diagnostic doubts, there are indications to refer the patient to more specialized centers. Although the two conditions are different, they share some common features, such as social withdrawal and communication disorders. This can lead to problems in the diagnosis of psychosis in people with autism. The basic symptoms of the mentioned diseases usually differ between the two disorders. For this reason, it’s important to try to get regular screenings and get care from the right professionals. A case report is presented of a patient, who received a diagnosis of ASD in the childhood, and later as an adult developed psychotic symptoms, which led to a change of diagnosis to schizophrenia.

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Cannabis and cannabinoids have been marketed and sold for a variety of different psychiatric conditions like e.g., anxiety, sleep problems, ADHD, PTSD, and even psychosis. Some of these indications may be reasonable, but for some a more conservative approach should be upheld. There are quite a few open studies and case reports on effects, while larger blinded RCTs either fail to find these effects or are lacking. The lecture aims at presenting the most recent evidence for the use of cannabis and cannabinoids for psychiatric indications, alongside a presentation of adverse effects.

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Many autistic children experience difficulties in their communication and language skills development, with consequences for social development into adulthood, often resulting in challenges over the life-course and high economic impacts for individuals, families, and society. The Preschool Autism Communication Trial (PACT) intervention is effective in terms of improved social communication and some secondary outcomes. A previously published within-trial economic analysis found that results at 13 months did not support its cost-effectiveness. We modeled cost-effectiveness over 6 years and across four European countries.

Using simulation modeling, we built on economic analyses in the original trial, exploring longer-term cost-effectiveness at 6 years (in England). We adapted our model to undertake an economic analysis of PACT in Ireland, Italy, and Spain. Data on resource use were taken from the original trial and a more recent Irish observational study.

PACT is cost-saving over time from a societal perspective, even though we confirmed that, at 13 months post-delivery, PACT is more expensive than usual treatment (across all countries) when given to preschool autistic children. After 6 years, we found that PACT has lower costs than usual treatment in terms of unpaid care provided by parents (in all countries). Also, if we consider only out-of-pocket expenses from an Irish study, PACT costs less than usual treatment.

PACT may be recommended as a cost-saving early intervention for families with an autistic child.

Previously considered a rare condition, OCD is now recognized as a common psychiatric disorder, with lifetime prevalence estimates ranging between 2% to 5%. Rates of resistance to first-line OCD treatments have been reported to be as high as 60%. Several clinical, biological and genetic factors have been investigated as treatment response moderators in OCD. These have included age at OCD onset, symptom subtypes, comorbidity patterns, gender and pharmacogenomics. This presentation will explore the definitions of treatment resistance in OCD as well as what is known about the epidemiology and clinical correlates associated with treatment resistance.

B. Dell’osso Grant / Research support from: LivaNova, Inc., Angelini, and Lundbeck

Adverse childhood experiences (ACEs), social–emotional impairments (SEIs), and neurodevelopmental disorders (NDs) are frequent in psychiatric disorders, including substance-use disorders. We aimed to determine the prevalence of ACE, SEI, or ND in individuals with cannabis-use disorder (CUD). We compared individuals with preCUD-onset ACE, SEI, or ND to those without.

We crosssectionally studied 323 inpatients or outpatients with a history of past or current CUD, aged 12–35 years (mean age 22.94 ± 4.79), 64.5% of whom were male. The sample was divided into two groups: the non-premorbid (N = 52) and the premorbid ACE/SEI/ND group (N = 271). Within the premorbid group, further subgroups were based on ACEs, SEI, and NDs. We also analyzed other substance use and psychiatric symptoms/diagnoses based on the non-premorbid-premorbid dichotomy in the CUD sample.

Pre-CUD ACE-SEI-ND had higher prevalence of bipolar, schizoaffective, borderline personality, and attention-deficit/hyperactivity disorders, and a history of agitation, hallucinations, and self-injury. The ACE group had higher rates of agitation, depression, delusions, hallucinations, eating disorders, and use of cocaine, amphetamines, and hallucinogens than the SEI or ND. Patients in the premorbid group initiated cannabis use at an earlier age, experienced the first comorbid psychiatric episode earlier, and were hospitalized earlier than those in the non- premorbid ACE-SEI-ND group.

PreCUD-onset ACE, SEI, or ND conditions in individuals with CUDare linked to earlier onset of comorbid mental illness. Furthermore, ACEs contribute to significant and potentially severe clinical symptoms, as well as the use of substances other than cannabis.

The United Nations Convention on the Rights of Persons with Disabilities as well as the new guidance on community mental health services recently published by the World Health Organization formulate clear goals for the future of psychiatry and psychosocial support. Innovative concepts of psychiatric care that focus on full participation, recovery-orientation and the prevention of coercion play an important role in achieving these goals. Implementing and scientifically evaluating the effects of such models in mental health services needs to be prioritized in national mental health planning and budgeting decisions.

In 2010, a new recovery-oriented treatment concept, the "Weddinger Modell", was developed and implemented at the Psychiatric University Clinic of the Charité in St. Hedwig Hospital (PUK-SHK). After 13 years of working with the Weddinger Model, there are, in addition to good practical experiences, numerous scientific findings that prove its effectiveness with regard to relationship promotion and reduction of coercive measures on various dimensions. These effects have encouraged many clinics, especially in German-speaking countries, to adopt principles of the "best-practice" model.

The "Weddinger Modell" shows that consistent adjustments of clinic structures and a recovery-oriented attitude of staff lead to a comprehensive improvement of treatment (Mahler et al. 2014; Mahler et al. 2019) and thus to a reduction of coercive measures to an absolute minimum (Czernin et al. 2020; Czernin 2021). Additionally, current studies found that coercive measures can be reduced almost exclusively to the first 24 hours of treatment (Cole et al. 2020). Working with the "Weddinger Modell" shows that coercion can be minimized "without evading responsibility for people with severe mental illness and without denying them responsibility for themselves" (Mahler et al. 2014).

In this lecture, the basic components of the "Weddinger Modell", the attitudes behind it, and the scientific data on effects of the model will be presented and discussed.

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Schizophrenia is a complex and heterogeneous syndrome with high clinical and biological stratification. Identifying distinctive subtypes can improve diagnostic accuracy and help precise therapy. A key challenge for schizophrenia subtyping is understanding the subtype-specific biological underpinnings of clinical heterogeneity. This study aimed to investigate if the machine learning (ML)-based neuroanatomical and symptomatic subtypes of schizophrenia are associated.

A total of 314 schizophrenia patients and 257 healthy controls from four sites were recruited. Gray matter volume (GMV) and Positive and Negative Syndrome Scale (PANSS) scores were employed to recognize schizophrenia neuroanatomical and symptomatic subtypes using K-means and hierarchical methods, respectively.

Patients with ML-based neuroanatomical subtype-1 had focally increased GMV, and subtype-2 had widespread reduced GMV than the healthy controls based on either K-means or Hierarchical methods. In contrast, patients with symptomatic subtype-1 had severe PANSS scores than subtype-2. No differences in PANSS scores were shown between the two neuroanatomical subtypes; similarly, no GMV differences were found between the two symptomatic subtypes. Cohen’s Kappa test further demonstrated an apparent dissociation between the ML-based neuroanatomical and symptomatic subtypes (P > 0.05). The dissociation patterns were validated in four independent sites with diverse disease progressions (chronic vs. first episodes) and ancestors (Chinese vs. Western).

These findings revealed a replicable dissociation between ML-based neuroanatomical and symptomatic subtypes of schizophrenia, which provides a new viewpoint toward understanding the heterogeneity of schizophrenia.

Although the rates of response to first-line pharmacological treatments (serotonin reuptake inhibitors – SRIs) are generally twice that of placebo, only 40-60% of patients respond sufficiently or are able to tolerate traditional first-line pharmacotherapy. Augmentation with dopamine antagonist medications is associated with the strongest evidence, yet dopamine antagonists benefit only a minority of those who try them and carry elevated risks of adverse effects. Based on evolving pathophysiologic models of OCD, a variety of agents targeting serotonin, dopamine, norepinephrine, glutamate, and anti-inflammatory pathways have been explored as alternative or adjunctive therapies for treatment-resistant OCD and have at least preliminary evidence of efficacy. Similarly, approximately 50% of patients do not respond optimally to first psychotherapeutic treatments including cognitive behavioural therapy (CBT) and exposure and response prevention (ERP), even when combined with pharmacotherapy. The psychotherapy outcome literature is heterogeneous and very few psychological strategies have been developed specifically to treat treatment resistant OCD. However, a recent systematic review concluded that CBT improved treatment response in individuals with pharmacotherapy resistance. This presentation will present an update on the pharmacological and psychotherapeutic treatment of refractory OCD including novel strategies such as the use of psychedelics.

M. Van Ameringen Grant / Research support from: Elvium, CIHR,Hamilton Academic Health Sciences Organization, Consultant of: Abbvie, Bausch Health, Boehringer Ingelheim, Elvium, Jazz, Vistagen, Speakers bureau of: Abbvie, Elvium (Purdue), Lundbeck, Otsuka, Sunovion, and Takeda

Childhood trauma (CT), depression, and psychological pain are known predictors of suicidal ideation. Recent literature additionally highlights the importance of the attachment system.

We aimed to predict suicidal ideation through CT, attachment, and psychological and social pain by using mediation models aiming to predict suicidal ideation through CT (predictor) and attachment (mediator). In the same models, we introduced psychological or social pain as a moderator of the relationship between attachment, CT, and suicidal ideation. We included 161 depressed patients and assessed depression, attachment, CT, suicidal ideation, psychological pain, and social pain.

We found (1) a complete mediating effect of anxious attachment (a2b2 = 0.0035, CI95% = [0.0010; 0.0069]) on the relationship between CT on suicidal ideation, and (2) a significant complete conditional mediating effect of anxious attachment and psychological pain (index of moderated mediation VAS: 0.0014; CI95% = [0.0002; 0.0032]) but not social pain on the relationship between CT and suicidal ideation. Both models were controlled for history of suicidal attempt, depression severity, and sex.

Our results suggest a developmental profile of suicidal ideation in mood disorder that is characterized by the presence of CT and insecure attachment, especially anxious attachment, that is sensitive to experiences of psychological pain. Nevertheless, we cannot conclude that avoidantly attached individuals do not present the same mechanism, as they may not disclose those ideas.

The menopause transition is a vulnerable period that can be associated with changes in mood and cognition. The present study aimed to investigate whether a symptomatic menopausal transition increases the risks of depression, anxiety, and sleep disorders.

This population-based, retrospective cohort study analysed data from five electronic health record databases in South Korea. Women aged 45–64 years with and without symptomatic menopausal transition were matched 1:1 using propensity-score matching. Subgroup analyses were conducted according to age and use of hormone replacement therapy (HRT). A primary analysis of 5-year follow-up data was conducted, and an intention-to-treat analysis was performed to identify different risk windows over 5 or 10 years. The primary outcome was first-time diagnosis of depression, anxiety, and sleep disorder. We used Cox proportional hazard models and a meta-analysis to calculate the summary hazard ratio (HR) estimates across the databases.

Propensity-score matching resulted in a sample of 17,098 women. Summary HRs for depression (2.10; 95% confidence interval [CI] 1.63–2.71), anxiety (1.64; 95% CI 1.01–2.66), and sleep disorders (1.47; 95% CI 1.16–1.88) were higher in the symptomatic menopausal transition group. In the subgroup analysis, the use of HRT was associated with an increased risk of depression (2.21; 95% CI 1.07–4.55) and sleep disorders (2.51; 95% CI 1.25–5.04) when compared with non-use of HRT.

Our findings suggest that women with symptomatic menopausal transition exhibit an increased risk of developing depression, anxiety, and sleep disorders. Therefore, women experiencing a symptomatic menopausal transition should be monitored closely so that interventions can be applied early.

Most patients with dementia are treated with irrational polypharmacy, which leads to higher mortality and other negative consequences (higher costs). Nearly 50% of elderly patients take one or more medications that are not medically necessary, which represents another important aspect of medication optimization. Research has established a strong relationship between irrational polypharmacy and its negative clinical consequences, including a negative impact on dementia, especially in patients with excessive polypharmacy (10 or more medications). These patients are underrepresented in the treatment guidelines and randomized controlled trials, although they represent a substantial patient population. The burden of irrational polypharmacy has also been associated with a greater risk of adverse drug events, drug-drug interactions, medication non-adherence and a higher risk of potentially inappropriate medication (PIM) use. Different treatment strategies have been available to reduce irrational polypharmacy in this population. The best intervention for irrational polypharmacy reduction in this population involves an inter-professional approach (collaborative care approach) that often includes special tools, a basic pharmacological approach and collaboration with a clinical pharmacist.

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