People with mental illness are overrepresented throughout the criminal justice system. In Italy, an ongoing process of deinstitutionalization has been enacted: the Judicial Psychiatric Hospitals are now on the edge of their closure in favor of small-scale therapeutic facilities (Residenze per l’Esecuzione delle Misure di Sicurezza - REMS). Law 81/2014 prescribes that a patient cannot stay in a REMS for a period longer than a prison sentence for the same index offense. Therefore, when patients end their duty for criminal behaviors, their clinical management moves back to outpatient psychiatric centers. Elevated risks of violent behavior are not equally shared across the spectrum of psychiatric disorders. In the past several years, multiple studies in the field of forensic psychiatry confirmed a close relationship between violent offenders and comorbid substance abuse.

In order to broaden the research in this area, we analyzed sociodemographic, clinical and forensic variables of a group of psychiatric patients with a history of criminal behaviors, attending an outpatient psychiatric service in Milan, with a focus on substance abuse.

This is a cross-sectional single center study, conducted in 2020. Seventy-six subjects with a history of criminal behaviors aged 18 years or more and attending an outpatient psychiatric service were included. Demographic and clinical variables collected during clinical interviews with patients were retrospectively retrieved from patients’ medical records. Appropriate statistical analyses for categorical and continuous variables were conducted.

Data were available for 76 patients, 51,3% of them had lifetime substance abuse. Lifetime substance abuse was significantly more common in patients with long-acting injectable antipsychotics therapy, >3 psychiatric hospitalizations, history of previous crimes and economic crime (Table 1). Additionally, this last potential correlation was confirmed by logistic regression.Table 1.

Data emerging from this survey provide new information about offenders in an Italian mental health service with a focus on lifetime substance abuse in these patients. Our preliminary results should be confirmed in larger sample sizes.

None Declared

Mental Illness Stigma is a barrier in access to healthcare. Stigma also influences population health outcomes by worsening, undermining adequate processes. The healthcare professionals show several stigmatising behavirous and cognitions, which may impair the adequate provision of care of this population with mental illness.

We aimed to measure mental health stigma in healthcare professionals at a portuguese hospital center.

A cross-sectional study of health profissionals was performed using a survey that included socio-economic and job related questions, personal and familiar questions regarding mental health, and Attribution Questionnaire 27 (AQ-27), a translated and validated stigma questionnaire with nine stigma sub-scales (Responsability, Pity, Anger, Dangerousness, Fear, Help, Coercion, Segregation and Avoidance).

The sample included a total of 388 participants. The majority of the respondants were female (82,5%). The age ranged from 22 to 69 (mean = 40,05). According to the job place distribution, we found statistically significant differences in various stigma subscales among several healthcare settings within our center. The inpatient unit professionals showed lesser stigmatising attitudes in anger, coercion, segregation and avoidance domains; and higher stigmatising attitudes in pity and help domains. However, professionals who work at surgery room showed higher stigmatising attitudes in danger and fear, but lesser levels of help domains. We also found differences in five stigma subscales among various health professions. The study didn’t show differences in stigma domains regarding personal or professional contact with mental illness, neither academic studies in mental health.

Our findings suggest that workplace environment and profession may impact mental ilness stigma levels in healthcare professionals. We propose that future studies could be done to investigate methods to mitigate mental illness stigma, tailored to address different stigma domains in different workplace settings.

None Declared

Like many under-resourced settings, there is a large gap between burden of mental illness and availability of services in South Africa. Because South Africa also bears a high burden of adverse childhood events (ACEs) and adult trauma, mental illness is often preceded in individuals by either or both. While studies within South Africa have examined the association between ACEs and distress in adulthood and adult trauma and adult mental distress, there is less knowledge of how these preceding factors interact to affect mental distress together, particularly in clinical populations.

Using path analysis, this study seeks to ascertain the impact that ACEs and adult trauma have on mental illness in urban South Africa. Understanding the perceptions and experiences of people living with mental illness is key not only to expanding biomedical services and ensuring appropriate and effective mental health treatment, but can also help identify ways to prevent mental illness in the future.

This study uses data collected from 309 psychiatric out-patients at two public psychiatric hospitals in Johannesburg. Ethics approval was received and data were collected in-person between January and June of 2022. Patients 18 years and above, of African descent, and willing to provide informed consent were invited to participate. The survey included questions about demographics COVID-19, adverse childhood events, adult traumatic events, depression, anxiety, and stress. Participants were also invited to take part in a brief, semi-structured interview. Data were analyzed via path analysis, using the lavaan package in R, version 4.1.1.

Incidences of both ACEs and adult trauma were significantly associated with three mental illness outcomes – depression, anxiety, and stress. An aggregated adult trauma score was found to partially mediate the association between total ACEs and depression, anxiety, and stress. When analyzed separately, total adult trauma partially mediated the association between ACEs including childhood verbal abuse, sexual abuse, emotional neglect, and mental illness in the household and depression, anxiety, and stress. Total adult trauma also partially mediated the association between childhood physical abuse and depression and anxiety, but not stress.

This study highlights the importance of dis-aggregating adverse childhood events when exploring their effects, while also reinforcing previous findings that ACEs increase the likelihood of experiencing adult trauma and mental illness. Future studies should attempt to pinpoint which ACEs are most impactful, and target those in particular for prevention in childhood and intervention in adulthood, to mitigate their deleterious impacts.

None Declared

In Morocco, the only legal setting for sexuality is marriage, which presumes automatic consent between the couple, as much so that Islam has authorized any sexual practice between spouses except for anal sex .

In our socio-cultural context, it is difficult to determine the extent of the phenomenon, the subject being taboo with a jurisprudence that refuses to recognize the reality of rape between spouses.

The objective of this work is to emphasize this phenomenon of marital rape, its psychological repercussions, its legal and religious framework in order to debanalize this phenomenon and act in favor of women’s mental health.

Our study is conducted on 3 patients seen in liaison psychiatry admitted to the surgical departments for organic complications of medium to severe severity, secondary to rape in the marital context where our expertise was requested in front of the great psychic distress of the latter.

We collected information by taking notes after our psychiatric examination.

Our three patients were victims of rape and violence by their husbands on several occasions, prior to this hospitalization but never reported such an incident. Our patients presented a wide spectrum of psychiatric pathologies: post-traumatic stress disorder, depression, generalized anxiety, suicidal ideas. One of them has acted out on the latter . In addition to these psychological repercussions, two patients had presented complications of a gyneco-obstetrical nature (a miscarriage and a premature delivery). It should be mentioned that these acts of rape in our three patients were always accompanied by physical violence.

In our Moroccan context, rape within a married couple is not yet recognized by our society, which admits that a woman does not have the right to refuse sexual relations to her husband.

Much remains to be done to familiarize and sensitize society to the reality of marital rape and to ensure that women victims obtain adequate support and care.

None Declared

The COVID-19 pandemic had a considerable psychosocial impact on healthcare workers (HCWs) who were constantly requested during this era with an increased risk of infection. This implies behavioural changes, especially in smoking behaviour.

To study smoking behaviour in HCWs with COVID-19.

A cross-sectional descriptive study conducted in the department of occupational pathology of Charles Nicolle Hospital in Tunis involving the smoking HCWs affected by COVID-19 during the period from September 1, 2020, to February 28, 2021. The data collection was carried out by a telephone call using a standardized questionnaire.

During the study period, 61 smoking HCWs were identified. Thirty-two patients agreed to answer the questionnaire, with a response rate of 52%. The mean age was 41±10 years. The sex ratio (M/F) was 1.46. Half of the participants had comorbidities. The most represented occupational categories were blue-collar workers (n=11) followed by nurses (n=10) and physicians (n=7). The median professional seniority was 13 [3.5; 20] years. The mean age of smoking initiation was 20±5 years. The most common mode of smoking was cigarettes (93%) with an average consumption of 19 cigarettes per day. Water pipe smoking was noted in 3 patients. All patients started smoking before the COVID-19 infection. Strong tobacco dependence was noted in 25% of patients. Twenty-one per cent of the population had moderate dependence. Half of the participants maintained the same level of smoking as before the COVID-19 infection. An increase in smoking was noted in 34% of patients. A decrease in the level of smoking was reported by 15% of respondents. Four participants stopped smoking after COVID-19 infection. The reasons for smoking cessation were COVID-19 damage (n=3) and confinement with family (n=1).

The change in smoking behaviour during the COVID-19 pandemic is notable, particularly in HCWs who are exposed to a high physical and mental load. The presumed association of smoking with severe forms of COVID-19 infection makes tobacco control in HCWs an obligation in order to preserve the continuity of care.

None Declared

Neuropsychiatric manifestations in human immunodeficiency virus (HIV) infection are uncommon but salient once they emerge to the surface. These symptoms can be the result of direct or indirect effects of the virus on the central nervous system (CNS). In particular, HIV related mania can complicate any stage of the infection but increases its frequency with the progression of HIV infection to the final stage.

The objective of this case report is to rase awareness about secondary mania due to HIV infection and the importance of etiological treatment in mental disorders.

We herein report the case of a 27-year-old, male patient, who was admitted to our Psychiatric Clinic I Cluj-Napoca, with a 3-week history of typical manic symptoms such as: elated mood, alternating with episodes of irritability, talking too much, familiarity, multiple future plans, hypersexuality, social disinhibition and decreased need for sleep. Throughout the hospitalization, the course of the manic symptomatology did not improve, additionally the patient started to exhibit neurological symptoms accompanied by complex visual hallucinations. Prior to this episode he reported depressive symptoms, predominantly anhedonia, apathy, and social withdrawal but without meeting the clinical severity threshold. The patient had no family history of a mental disorder. A psychopharmacological treatment was initiated (atypical antipsychotic Quetiapine XR 300 mg/day initially, and then switched to Olanzapine 10 mg/day, mood stabilizer Valproic Acid 1,5 g/day), but he developed significant extrapyramidal side effects.

Blood tests revealed: leukopenia, lymphopenia, thrombocytopenia, subsequently hepatic cytolysis, and high CRP. Psychometric evaluation revealed: Young Mania Rating Scale (YMRS) score 33/60 – moderate mania, Positive and Negative Syndrome Scale (PANSS)- total score 51 (16/49 Positive; 7/49 Negative; 28/112 General Psychopathology). MRI: T2 and FLAIR hyperintense extended areas in the bilateral periventricular white matter and in the internal capsule. The anamnesis, heteroanamnesis, paraclinical investigations led us to a diagnosis of secondary mania related to HIV infection. The patient was transferred to the Infectious Diseases Clinical Hospital for a targeted antiretroviral therapy (Raltegravir 800 mg/day, Emtricitabine/Tenofovir disoproxil 200mg/245 mg).

Recognizing and controlling HIV secondary mania should be of high importance given its association with heightened sexual behavior and substance abuse which can result in an elevated risk of transmitting the infection to other people.

None Declared

The entity of ‘pseudoneurotic schizophrenia’ was coined in 1949 by Hoch and Polatin to define emerging psychotic symptoms, namely formal thought disorder and emotional dysregulation, in patients previously presenting with neurotic functioning. Although currently considered to be outdated, the term paved way for the concept of ‘borderline disorders’, known for their difficult assessment.

To highlight the obstacles in diagnosing clinical presentations of overlapping psychotic and neurotic symptomatology.

We report a case of an adolescent admitted for presumed psychosis, later to display fast clinical improvement and significant neurotic personality traits.

A 17-year-old male with no previous psychiatric follow-up, except for brief psychotherapeutic intervention at the age of 11, following the death of his grandfather.

He presented with a sudden change in behavior and sleep since the week before, coincident with acknowledging the loss of his best friend in a car accident. Upon evaluation, he presented with unstable gait. He seemed fatigued but displayed inappropriate restricted affect. He reported perceiving bizarre, meaningful signs everywhere concerning his own death since the event. Additionally, he detailed feelings of lethargy and unexplained sadness, relying on the nihilistic delusional beliefs that he had been in deep sleep and he would die soon. At admission, he was prescribed with aripriprazol 5mg id.

Throughout his stay in the hospital, he maintained consistently adequate, calm behavior. During inpatient clinical interviews, he showed clear insight into the aforementioned behavior. He provided clear, logical information referring to his past grief process and remaining trauma, reporting coping mechanisms based on spiritual beliefs

Prescription medication was interrupted soon after admission, with no noticeable changes. At dismissal, despite remaining sad concerning the death of his friend, there was no signs of psychotic symptoms or other significant mental distress.

In this report, we emphasize the hazards of differential diagnosis between psychosis and emotional dysregulation with underlying neurotic traits. There is conflicting evidence on the concept of ‘pseudoneurotic’ presentations, specifically ‘pseudoneurotic schizophrenia’. Available information on distinguishing between overlapping psychotic and neurotic features in adolescents is even more scarce. To perform extended, multidisciplinary evaluations might be key in accurately assessing these patients.

None Declared

The Food and Drug Administration (FDA) recently issued new warnings about the possible effects of the repeated or prolonged use of general anaesthesia and sedatives on the brain development of children under 4 years old during surgeries or paediatric procedures.

To evaluate the possible long-term neurotoxic impact the exposure to general anaesthesia has on the paediatric population from 0 to 4 years, which is the period during which the brain develops.

Initially, a search for observational studies that described the risk of neurotoxicity and alterations in the long-term cognitive development of children exposed to general anaesthesia before 4 years of age, was performed in PubMed between 2016 and 2020.

Finally, 5 retrospective cohort studies comparing children exposed and not exposed to general anaesthesia were included in this study. None of these showed significant differences in their main study variables. However, three of this studies found significant differences in some of the secondary variables such as speed of processing, motor skills, internalization of behaviour and learning, and attention deficit hyperactivity disorder (ADHD).

In vitro and in vivo studies of anesthetics have shown serious neurotoxic effects in the developing brain. However, the clinical relevance of these findings for children undergoing anesthesia remains unclear.

Most of these studies suggest a strong relationship between exposure to anesthesia in children aged 0 to 4 years, this being greater after multiple exposures. Despite these results, many of these articles conclude that further research is needed on this topic.

None Declared

Coercion in psychiatric wards may improve the safety of patients and surroundings, on the other hand, its use affects compliance and satisfaction with treatment. In Poland the coercive measures are strictly regulated by The Mental Health Act (1994). Most of published studies refers to the coercion only during hospitalisation.

Assessment of the extent of coercive measures in psychiatric emergency room and evaluation of the relationships between the use of direct coercion and selected demographic-clinical factors.

This study was conducted at the Bielanski Hospital in Warsaw on all the patients admitted to the psychiatric ward over one year. The extent of coercion in the psychiatric emergency room, demographic and clinical data were collected. Patients were assessed in Brief Psychiatric Rating Scale (BPRS) prior to admission. Patients’ sociodemographic and clinical factors were tested in a multivariate logistic regression model.

In the study 318 patients were included. Coercion of some form in the psychiatric emergency room was used in 29% of cases: admission without consent in 22% of cases and direct coercion (holding, forced medication, mechanical restraint) in 7%. Use of direct coercion in the psychiatric emergency room was associated with BPRS scoring: positively with severity of disorientation symptoms and negatively with severity of depression symptoms. Suicide attempts in the past were discovered to reduce the risk of being a subject of coercive measures. We found no demographic data associated in any way with coercion use.

Coercion in psychiatric emergency room was related to patients’ mental state and their past medical history. There is no evidence of coercive measures misuse towards any demographic group.

None Declared

Despite the well-established anti-suicidal effect of electroconvulsive therapy (ECT), patients receiving ECT remain at high risk of dying from suicide.

In the present study, we aimed to quantify this risk and identify risk factors for suicide among patients receiving ECT.

We used nationwide Danish registers to identify all patients that initiated ECT between 2006 and 2016. These patients were matched on sex and age to 10 reference individuals from the general Danish population. First, we compared 2-year suicide risk between patients initiating ECT and the matched reference individuals. Second, we investigated if any patient characteristics were associated with suicide following ECT via Cox proportional-hazards regression.

A total of 11,780 patients receiving ECT and 117,800 reference individuals were included in the analyses. Among the patients receiving ECT, 161 (1.4%) died from suicide within two years. Compared to the reference individuals, patients receiving ECT had a substantially elevated suicide rate (Hazard rate ratio (HRR)=44.5, 95%CI=31.1-63.6). Among those receiving ECT, we identified the following risk factors for suicide: Male sex (HRR=2.3, 95%CI=1.7-3.1), age 60-70 years (HRR=1.6, 95%CI=1.0-2.6), Medium-term higher education (HRR=1.5, 95%CI=1.0-2.2); Long-term higher education (HRR=1.9, 95%CI=1.1-3.1), history of substance use disorder (HRR=2.0, 95%CI=1.4-2.8) and history of intentional self-harm/suicide attempt (HRR=4.0, 95%CI=2.8-5.8).

Among patients receiving ECT, those who are male, aged 60-70 years, have mediumterm to long-term higher education, or have a history of substance use disorder or intentional self-harm/suicide attempt, are at particularly elevated risk of suicide. These findings may guide initiatives to reduce the risk of suicide.

None Declared

There has been an exponential rise in SSRI prescribing, between 2021 and 2022 there was a 5% increase. The majority of SSRI prescription initiation takes place in primary care. This is a national trend and mirrored internationally.

The study was undertaken to understand barriers to deprescribing both prescribing clinicians and patients and the potential of dependence caused by continued prescribing of SSRI and SNRI. We wanted to understand deprescribing challenges and both clinical anxiety and difficulty experienced and see if there is a correlation with the Drug use screening tool (DUST) tool.

Those patients who were stable on SSRI were offered lowering of dose and deprescribing as part of routine medication reviews. During medication reviews patients were asked about willingness to embark on a deprescribing schedule. Patients were screened during medication reviews on the DUST to see if this can be used to predict difficulty with deprescribing. We designed a deprescribing difficult questionnaire to assess the difficulty experienced by clinicians during a deprescribing consultation. We were able to study the is a correlation with DUST scores and Clinician experience of difficulty and challenge in deprescribing of the SSRI and SNRI.

Current alcohol drinkers and smokers were less likely to deprescribe from their antidepressants. Clinicals should do a risk assessment using the DUST screening tool checking for risk of dependence. There is an R value of 0.1586 (P-value is 0.018848) between the correlation of patients increased length time and increased DUST score causing an increased risk of dependence. The average R-score across the three practices between patient’s length of time being on medications and their DUST score is R= 0.18705 (P value of 0.01)

Inability to access IAPT therapies, shortened length of CBT sessions and lack of post IAPT support caused poor patient experience and contributed to reluctance to re-engage with IAPT services. Both cascade and incremental prescribing following lower doses without documentation of the limitations of medication results in unrealistic expectations generated from the prescribing. There is positive correlation between length of SSRI and SNRI prescribed, DUST scores, and Clinical challenge scores with patients’ unwillingness to be deprescribed. Patients should have a DUST score review prior to having been put onto any antidepressant as there is a potential link between increased DUST score and lower chances of willingness to deprescribe. Clinicians need to counsel patient of risk of dependence. The likelihood is these are drugs of dependence and clinicians should counsel patients of these risks and given review dates and offered deprescribing.

None Declared

The ASD Day Therapeutic Unit of the HUMT is an interdisciplinary reference center specialized in ASD, for the care of children and adolescents with this pathology, that offers care by programs with the aim of achieving functionality altered.

The main objective of this study is to know the clinical characteristics of the patients admitted to our center and to offer preliminary data on the functional improvement achieved in a pilot program that works by processes.

This is a prospective clinical study of patients with ASD, treated at the ASD Day Therapeutic Unit of the Hospital Universitario Mutua Terrassa (HUMT), since februay 2022 till nowadays. We compare the clinical improvement and functionality acquired through the evaluation through various scales: Conners scale, SRS, BRIEF and CBCL.

Our sample is made up of 19 patients with ASD who are admitted to the HUMT ASD Day Hospital. 13 belonged to the intensive care program, 5 to recovery of low-functioning functionality, and 1 to the differential diagnosis program. 84.21% (n=16) have preserved cognitive capacity. The median age is 13.1 years. 73.7% of the sample are men.

We observed that 89% of patients admitted to our unit presented comorbid symptoms with ADHD. more than 78.9% present isolation, anxiety/depression, altered thinking and attention difficulties. 13/19 present a SEVERE RANGE of affectation upon admission, in social area. Facing discharge, the CBCL shows us a general improvement in behavior and comorbidity in the total scale. The SRS shows us an improvement in social awareness, social communication, social motivation, repetitive behavior and stereotypes and in the total score.

Specific interventions in social skills, autonomy, social understanding, daily routines, and sensory integration in patients with ASD improve core symptoms, as well as associated behavior.

Specific interventions and working on social relationships during admission improve comorbidity derived from ASD.

More studies are needed to specify the most efficient interventions to improve the quality of life in children and teenagers with ASD.

None Declared

Paraphrenia is a chronic psychosis that has generally lost its status as an independent nosological entity, not being included in DSM-5. From the perspective of the particular psychopathological picture and the impact of the disease on the patient’s functioning in roles, paraphrenia remains a challenge for the clinician in terms of nosological classification and the correct therapeutic approach.

We take into account a patient who presents the classic diagnostic criteria of paraphrenia with a clinical and evolutionary picture followed for 15 years, with the aim of bringing the paraphrenic phenomenology back to the fore.

The case presentation will focus on the richness and absurdity of the delusional ideas that are in great contrast with the good insertion into reality of the subject and the preservation of the core of the personality. We will also describe the main landmarks of positive and differential diagnosis.

We believe that paraphrenia deserves to be differentiated from other psychotic disorders through the particular variant of insight that also explains the significant capacities of dissimulation and as a result of insertion into the roles of life. This attribute also explains the increased potential for danger and unpredictability of the paraphrenic patient.

Our approach is an argument for the psychopathological understanding of paraphrenic psychotic phenomenology independent of different nosographic classification systems. We are trying to contribute to increasing the quality of differential diagnosis in psychoses.

psychosis, paraphrenia, differential diagnosis

None Declared

Schizophrenia (SZ) is a severe and frequent mental disorder that has multifactorial origins (genetic but also environmental vulnerability, gene environment interactions). Our team has shown that in France smoking is common among these patients and often begins before the onset of symptoms. This calls into question the hypothesis of self-medication of psychotic symptoms and cognitive disorders by tobacco consumption, and raises the question of specific interactions between nicotine consumption and the genes of the dopaminergic and cholinergic nicotinic systems, in particular with regard to adolescence, period of neurodevelopmental vulnerability.

to study (i) the interactions between the DA system and exogenous nicotine in a pre-clinical mouse model (transgenic for DAT) (ii) the impact of smoking on the psychotic and clinical phenotype in a national cohort of SZ patients (iii) interactions between tobacco consumption and several genetic polymorphisms of the dopaminergic and nicotinic system in SZ population. Hypothesis: Disruption of the balance between DA and nicotine systems by nicotine consumption in adolescence may be a key neurobiological mechanism for the emergence of SZ disorders.

The characterization of the model is behavioral (anxiety, memory, social interactions, locomotion, motor coordination) but also biochemical. For the clinical approach, we exploit the clinical / cognitive / genetic data of a national cohort (Fondamental foundation) and another smaller and local cohort.

We demonstrate, for the clinical study, that some clinical and cognitive characteristics are associated with tobacco use in schizophrenia patients, with more cognitive distubrances in smokers, against the self medication hypothesis. Genes envionment interactions also demonstrate associations with genes involved in dopaminergic system. Regarding the preclinical study, we show a gene environment interaction, as heterozygote mice for the DAT gene exposed to Nicotine durig a critical neurodevelopmental window ( adolescence) show a loss of familiarity in the social memory test and a loss of cognitive flexibility at the set shifting test, similar to what is found in schizophrenia.

TBetter characterization of patients with schizophrenia is necessary to better understand the physiopathology of this disease and explore new personalized preventive and therapeutical targets. We show that tobacco is associated with cognitive disturbances in schizophrenia patients, against selfmedication hypothesis; and in our animal model, that nicotine exposition during the adolescence combined to a moderate cortical and limbic hyperdopaminergia, is associated with persistent cognitive and social deficits, in favor of a gene environment interaction.

None Declared

Insomnia is a robust risk factor for depression. Treating insomnia with digital CBT-I (dCBT-I) has been shown to prevent future episodes of depression; however, remission rate of insomnia following dCBT-I is lower compared to face-to-face CBT-I (fCBT-I), which may reduce the effect on depression prevention. A stepped-care model can optimize care by starting with a least resource intensive intervention (step 1: dCBT-I) and stepping-up non-remitters to specialized treatment (step 2: face-to-face CBT-I).

This study examined the efficacy of a stepped-care approach to prevent depression.

1018 individuals with DSM-5 insomnia and no depression were randomized into two conditions at step 1: dCBT-I (n=613), or an online sleep education control (n=624). Participants in the dCBT-I condition who did not show remission for insomnia (ISI>9) were further randomized to either face-to-face CBT-I (n=103) or sleep education (n=104). Rates of clinically significant depression (moderate severity and above) was assessed at one-year follow-up.

Insomnia remission rates were higher in the dCBT-I group (40%) compared to the control group (22%). Those who did not remit following step-1 dCBT-I showed step-2 insomnia remission rates of 75% following fCBT-I compared to 38% following the step 2 control.

At one year follow-up, the incident rate of clinically significant depression was 2.4 times higher in those who received control (13.2%) compared to fCBT-I (5.5%) at step 2. Depression rate was 10.1% in those who did not receive dCBT-I at step-1.

Preliminary evidence from this study provide supported that a stepped-care approach may produce greater protection against incident depression than dCBT-I alone.

None Declared

The clinical presentation and the course and outcome in Early-Onset Bipolar Disorder (EOBD) patients are found to be atypical compared to adult bipolar patients. Lithium and valproate are among the first-line maintenance treatments for bipolar disorder. Because of atypical features, in many patients, valproate is preferred over lithium. However, recent studies have shown that valproate results in more neurocognitive deficits than lithium. There have been very few Indian studies that assessed the prophylactic response to mood stabilizers in patients with early-onset bipolar disorder. BDNF has an important role in neurodevelopment, and it is shown that peripheral levels of BDNF are reduced in early-onset bipolar disorder.

To compare the effectiveness of lithium and valproate in attenuating manic, depressive, and mixed episodes in early-onset bipolar disorder.

This study was an observational (cross-sectional analytical) study conducted in the Affective Disorder clinic of a tertiary care hospital. We have recruited a total of 50 adult patients with a history of early-onset, i.e., onset at <18 years of age and in remission. Patients were divided into two groups based on the mood stabilizer drug they were receiving. There were 25 patients each in the lithium and valproate group. Montreal Cognitive Assessment (MoCA) scale was applied to assess cognitive functions.

The overall functioning was found to be significantly better in the patients receiving lithium than valproate, which was found by higher scores on the Global Assessment of Functioning (GAF) scale.We have found a statistically significant negative correlation between the number of episodes before starting a mood stabilizer and the time to recurrence after starting a mood stabilizer. However, the former cannot predict the latter. The age, educational status of the patient, total duration of illness and number of episodes before starting mood stabilizer correlated significantly with the MoCA score. Of all, the educational status could also predict the patient’s performance on the MoCA scale.

There were no significant differences between lithium and valproate in attenuating further episodes, the frequency of neurocognitive deficits and other adverse effects. Both drugs were equally effective and tolerable. The severity of illness was more in valproate-treated patients, and overall functioning was better in lithium-treated patients. BDNF levels did not correlate with neurocognitive deficits significantly. Future studies comprehensively assessing neurocognitive measures with a larger sample size in the early-onset bipolar disorder population would shed more light on the role of biomarkers in cognition in subjects with early-onset bipolar disorder.

None Declared

Depression, anxiety and lack of impulse control are common neuropsychiatric symptoms in neurocognitive disorders and have been strongly associated with suicidality.

The aim of this study was to explore suicide rates in three major neuropsychiatric conditions including various degenerative neurocognitive disorders (DND), alcohol related neurocognitive disorders (ARND), and traumatic brain injuries (TBI).

The register cohort data of 231 817 patients with a diagnosis of degenerative dementias, ARND, or TBI, and their mortality data were collected from Finnish nationwide registers between 1998 and 2018. We calculated incidences of suicides, types of suicides, and suicide rates compared with the age- and sex matched general population (Standardized Mortality Ratio, SMR).

In fifteen years since diagnosis, 0.3% (95% CI: 0.2 to 0.5) of patients with DND, 1.1% (0.7 to 1.8) of patients with ARND, and 1.0% (0.7 to 1.3) of patients with TBI died from suicide (Figure). Men died from suicide more often than women [58.9 (51.3 to 67.4) vs. 9.8 (7.5 to 12.5) per 100 000 person-years]. Of all three groups of patients, the highest number of suicides per 100 000 was in ARND (98.8; 65.1 to 143.8), then in TBI (82.0; 62.4 to 105.8), and then in DND (21.2; 18.3 to 24.5). The most common cause of death per 100 000 person-years was self-inflicted injury by hanging, strangulation or suffocation and drowning (12.4, 10.3 to 14.8), the second highest incidence self-inflicted poisoning (5.7, 4.3 to 7.4), and then self-inflicted injury by firearms, explosives, smoke, fire, flames, steam, hot vapours or hot objects (4.7, 3.4 to 6.2). The SMRs (95% CI) in the DND group were 1.31 (1.13 to 1.51) for the whole group, 1.21 (0.90-1.62) for women, and 1.34 (1.14-1.58) for men. The SMRs in the ARND group were 3.69 (2.53-5.38), 5.05 (1.90 to 13.46), and 3.52 (2.34 to 5.30), and in the TBI group 2.99 (2.31 to 3.86), 5.68 (3.22 to 10.00), and 2.66 (2.00 to 3.55), respectively.

Image:

Suicide rates were higher in all three patient groups compared with the same-aged general population. Risk for death from suicide remained elevated for more than ten years after the initial diagnosis. Men committed more suicides than women, but there was no difference between sexes in comparison with the age-matched general population. The suicide methods were mostly violent.

T. Talaslahti Grant / Research support from: Helsinki University Hospital, grant no 212 9003, M. Ginters: None Declared, H. Kautiainen: None Declared, R. Vataja: None Declared, A. Palm: None Declared, H. Elonheimo: None Declared, J. Suvisaari: None Declared, H. Koponen: None Declared, N. Lindberg: None Declared

European researchers are collaborating in the EU Horizon 2020-funded project “RESPOND” to address the psychological and psychosocial effects of the Covid 19 pandemic in order to prepare health systems for future crises. In the Co-RESPOND subproject, several longitudinal cohorts are contributing to an individual participant data (IPD) meta-analysis.

Co-RESPOND aims to assess trajectories of mental health and resilience, and to identify relevant moderators using a meta-analysis of individual participant data (“IPD”) approach. Moreover, a research network of European cohorts is being established alongside a sustainable shared IT infrastructure. Co-RESPOND aims to publish the results of the collaboration in a findable, accessible, interoperable and reusable way according to the “FAIR publication” principles.

To achieve these aims, a federated network for remote data analysis is being built. In this talk we describe the steps necessary to join existing cohorts into one network, and which challenges need to be met: First, existing data sets need to be harmonized retrospectively, second, data sharing and processing needs to be done in accordance with the GDPR requirements, and third, a technical solution needs to be found to facilitate joint analyses and publication of the network and its products.

We identified the Maelstroem guidelines for retrospective data harmonisation of epidemiologic studies as appropriate guidance to carry out and document the transformation of individual data sets. The OBiBa software suite is used to build the IT infrastructure of the project by connecting local data servers of the study sites and making them available for remote analyses by other partners. As of autumn 2022, data transformation is finalized and data sets uploaded on the local servers. A platform on the internet is created where the main characteristics of all participating cohorts (“meta-data”) are catalogued to help them gain visibility and make them findable for future joint projects. The Co-RESPOND network will be open for more partner cohorts to join.

The Covid pandemic has stimulated lots of international remote collaborations, and federated networks for data analyses are increasingly used as a means of enhancing the value of existing data sets. User-friendly and cost-free software solutions are already available (e.g., OBiBa) to facilitate such endeavours. However, researchers intiating cohort studies should be aware of such technology and methods and consider the use of their data in overarching collaborations from the start. We conclude with concrete recommendations how to optimize the design of epidemiologic data collections to enhance their interoperability with other cohorts, e.g., by using international coding standards.

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We research new neurological viewpoints of psychiatric syndromes in social cohesion regarding, especially the problematic of lymbic system and amygdala in adults. Nowadays, the number of the problematic use of internet is higher than before the COVID-19 pandemic. The development of the digital techniques is impulsive, which can be the main reason of most neurological dysfunctions and the change of the social communication.

In this presentation, we review studies investigating the relationship among the new digital techniques, limbic system and development of psychiatric syndromes. We attempt to provide a summary of new theories and the areas currently being researched around the topic. Another aim of our research is to present the change of the social communication and emotion regulation, which are risk factors of problematic use of internet and behavioral addictive disorders. These appear in different ways in rehabilitation and social inclusion in Europe.

In order to learn about recent international results, we conducted a literature search in 4 databases ( PubMed , Medline , Web of Science, Google Scolar) using keywords (amygdala, psychiatric syndromes, adults, emotion regulation, problematic use of internet, social cohesion) over the past 5 years. From the obtained results, the English empirical journal articles were used to prepare the literature review.

The frequency of co-occurrence of amygdala dysfunction, problematic use of internet and behavioral addictive disorders are correlated. The studies examined the presence of symptoms of impulsivity and dopamine level of the brain primarily through cross-sectional studies. The social cohesion and inclusion regarding types are different in the regions of Europe.

The dysfunctions of lymbic system regulation cause maladaptive emotion regulation and are risk factors and make the person vulnerable to the development of psychiatric symptoms, problematic use of internet and behavioral addictive disorders. The differents of regions and areas in Europe with the new neurological viewpoints in psychiatric disorders can help with rehabilitation in the social cohesion regarding. These changes are particularly pronounced during adolescence, when the demand for self regulation across a variety of emotional and social situations may be the greatest.

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Autoimmune diseases play a role in the etiology of a range of psychotic disorders which has attracted increasing interest in recent decades. This hypothesis is supported by genetic findings linking markers related to the immune system and mental disorders, and by clinical studies revealing increased levels of inflammatory markers in patients with mental disorders

The objective of our work is to discuss the involvement of autoimmune diseases in the development of mental disorders in children and adolescents.

We conducted our study through the analysis of three clinical observations.

These were three patients followed in the child psychiatry department for a characterized depressive disorder, an ASD and an acute psychotic attack, and in whom an autoimmune disease was revealed either in the history or on paraclinical explorations.

It appears legitimate to evoke and search for these autoimmune pathologies among the other organic etiologies, in front of any child or adolescent presenting acute and atypical psychiatric symptoms, tables of cognitive regression and resistances to the usual treatments. Biological immunological examinations, even invasive ones, should be repeated, if necessary.

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