Treatment resistant schizophrenia still represents a major clinical and pharmacological challenge.30% of patients diagnosed with schizophrenia is characterised by a poor response to at least two different antipsychotics administered for a proper period of time and at adequate doses. Clozapine still represents the gold standard for treatment resistant patients. Unfortunately, a significant percentage of these are only partial responders. Augmentation strategies must be set up and atypical antipsychotic drugs are used in clinical practice. Promising findings have been observed in patients treated with Lurasidone as an add-on therapy with Clozapine. This novel second-generation antipsychotic has a unique receptor profile, showing 5-HT1a partial agonism and 5HT7 antagonism. These properties could also explain its procognitive effect, as several preclinical studies in literature have demonstrated.

The aim of our study is to highlight the advantages of add on therapy with Lurasidone compared with treatment as usual (i.e. Clozapine + another atypical antipsychotic) in treatment resistant schizophrenia patients.

We conducted an observational study in a sample of 20 patients diagnosed with treatment resistant schizophrenia, based on DSM-5 diagnostic criteria and psychopharmacologic history. Treatment choices were taken independently by clinicians in charge of each patient. 10 subjects underwent Lurasidone augmentation of Clozapine, whereas the remaining 10 subjects were treated as usual with Clozapine and another atypical antipsychotic. PANSS and BPRS scales to assess general psychopathology and UKU side effects scale were administered both at baseline and at follow-up (T1= 1 month; T2=6 months).

All patients treated with Lurasidone augmentation strategy achieved a significant reduction of both positive and negative symptoms, with no significant adverse effects to be reported. In particular, Lurasidone showed no impact on metabolic parameters nor on ECG features, namely the QTc interval. The psychopathological improvement appeared higher in patients who received Lurasidone than in those treated as usual. This was particularly evident in cognitive domains.

Our observation suggests that augmentation strategy with Lurasidone to Clozapine can lead to clinically significant improvements in psychopathology when compared to Clozapine combined with another atypical antipsychotic, with a good tolerability profile. In future we will increase the number of our sample and the duration of follow-up time. In order to have more relevant statistical results, further research on this topic is needed.

None Declared

In this workshop we aim to discuss the ins and outs of publishing in psychiatry with practical guidance from both sides of the couch. The executive editors of the European Journal of Psychiatry (Dr Asilay Seker, Dr Mário J. Santos, and Dr Luís Afonso Fernandes) will talk about their experience of starting a journal from scratch with very limited resources and share practical tips with the participants about publishing for early career psychiatrists to early career psychiatrists.

None Declared

Reducing maternal and newborn mortality is apriority on the health agenda. Priority, integral, integrated and barrier-free care a attention to the population frames the spirit of the route. The Comprehensive Care Route in Perinatal Maternal Health (CRPMH) proposes “to promote health and the improvement of maternal and perinatal health outcomes, through comprehensive health care, including coordinated action FROM the state, THE society and the family on the social and environmental determinants of health inequities” (Minsalud).

To evaluate the implementation of the CRPMH in a group of maternal students from 0-12 months.

Qualitative, through semi-structured interview techniques and focused groups (FG) referenced from the CRPMH (table 1) in 11 undergraduate students in psychology over 18 years from 2 Colombian universities.

Qualitative analysis evaluates convergences/divergences by percentages of questionnaire responses and axial text analysis (FG). In preconception attention 100% of mothers do not report signs of health risk, however, caesarean section was performed in 83.3% of cases, this safer method is perceived for the mother and fetus, and is justified taking into account that the pain of childbirth is very strong (FG).

In gestational health they indicate prenatal control, medical appointments, formation in the condition of the fetus, guidelines on care, respectful upbringing and breastfeeding in 100%. In contrast, the focus group reports low empathy of doctors toward levels their fears, reduced time to address concerns, negative information about labor and satisfaction with medical procedures, considering caesarean section a humanized strategy.

Access to CRPMH is known by 50% of mothers, they do not know the preconceptional consultation. In the GF they conclude that the information on preparation for maternity and paternity is ineffective.

Psychological support is absent during childbirth and postpartum. There is a greater knowledge about breastfeeding 83.3%

The successful implementation of the route could reduce the risks of physical and psychological impact on perinatal maternal health by facilitating decisions about motherhood and its practice in the university educational environment. There was recognition of the clinical factors of the CRPMH and ignorance of the responsibility of the educational environment in its implementation.

Image:

The CCRPMH regulation is insufficient to guarantee its implementation. Risk factors include the quality of service provided by health-care providers and the lack of knowledge of regulations in university management.

None Declared

Decades ago, the classical psychedelics psilocybin and LSD entered the therapeutic setting and already then showed their therapeutic potential in the treatment of psychiatric disorders. For thousands of years another psychedelic, ayahuasca, is being used by tribes in western Amazonia for healing and divination, and in recent years its use has expanded worldwide.

Research into the therapeutic potential of these substances has re-emerged and (preliminary) findings are promising, showing that after one or two administrations remission is reached in depressed patients that were labeled as treatment-resistant. This is a remarkable finding as the therapeutic effects of treatment with conventional pharmacological agents like SSRIs take longer to lead to remission, with one-third of the patients failing to reach this stage.

The fast onset of positive therapeutic effects by psychedelics increases the interest to discover the mechanism of action behind this. There is a debate about the importance of the psychological experience caused by these agents in the therapeutic outcome, while science also tries to understand the neurobiological correlates. The latter will be addressed in my talk and I will link it to psychedelics’ therapeutic effects.

None Declared

One of the major challenges in clinical psychiatry remains the absence of well established objective measures of symptoms’ severity. Clinical insights are mainly provided through keen behavioral observation and subjective questionnaires and scales.

The aim of this paper is to predict depression severity through speech using the features extracted from the speech as provided by participants during a semi-structured dialogue with a virtual avatar.

We use data from a subset of the DAICWOZ dataset consisting in 142 dialogues between participants and a virtual avatar during which the avatar uses several prompts to maintain a conversation with the participant. The avatar uses prompts involving the topics of travel, dream jobs, and memorable experiences. From the speech generated from the dialogue, we extract participant utterances separated by prompt and extract features from the three sets of transcripts. We extract content features from the transcript and acoustic features from the excerpt corresponding to the speech from the participant for the prompt in question.We perform regression experiments on the PHQ8 items using the features extracted from each set of transcripts. Furthermore, we combine the features extracted from each set of transcripts and compute partial spearman correlations between them and the PHQ8 items using gender as a covariate.

With our best regression model we obtain an R2 of 0.1, explaining 10% of the variance in the PHQ total score. Additionally, we obtain a mean absolute error of 1.25, suggesting that the regressor can detect with more or less precision clinically meaningful differences in depression severity between participants. Partial correlations between the total score and the features show significant correlations between features dependent on the amount of speech generated by each participant, along with the complexity of syntactic structures used.

Automatic analysis of spontaneous speech could help with the detection and monitoring of signs of depression. By combining the use of this technology with timely intervention strategies for instance provided by a virtual agent it could contribute to timely prevention.

A. König: None Declared, M. Mina Employee of: ki:elements GmbH, S. Schäfer Employee of: ki:elements GmbH, N. Linz Shareolder of: ki:elements GmbH, Employee of: ki:elements GmbH, J. Tröger Shareolder of: ki:elements GmbH, Employee of: ki:elements GmbH

Accelerated biological ageing might contribute to the higher prevalence of age-related diseases and excess mortality amongst individuals with mental disorders. Recent advances in machine learning and the collection of high-dimensional molecular “omics” data allow for the quantification of biological age.

The aim of this study was to use machine learning methods to predict biological age from nuclear magnetic resonance spectroscopy metabolomics data and to identify psychiatric traits associated with accelerated biological ageing.

The UK Biobank is a multicentre community-based observational study that recruited >500,000 middle-aged and older adults. 168 metabolomic measures were quantified using the Nightingale Health platform. Phase 1 release of these data included a random subset of 118,462 UK Biobank participants. Metabolomic age delta (MetaboAgeΔ) was defined as the difference between predicted biological age and observed chronological age. We estimated group differences in MetaboAgeΔ between individuals with and without mental disorders and examined whether polygenic scores for mental disorders predicted MetaboAgeΔ.

Up to 110,780 participants with complete data on all metabolomic measures were included in the analysis. Individuals with a history of mental disorders had higher MetaboAgeΔ values than people without a mental illness. For example, MetaboAgeΔ suggested that the difference between predicted biological age and observed chronological age was about two-years greater amongst individuals with bipolar disorder than amongst people without mental illness. Polygenic scores for mental disorders were positively correlated with MetaboAgeΔ.

These findings suggest that individuals with a history of mental disorders or with higher polygenic scores for mental disorders were biologically older than their chronological age.

None Declared

As of September 2022, over 600 million COVID-19 cases have been reported worldwide. Implemented measures and novelty caused by the epidemic caused wellbeing complaints, including depression and anxiety. One particularly inflicted group are students, who were switched to online education. Many universities have decided to start with face-to-face lecturing again, but as the pandemic is still ongoing, the fear of potentially catching COVID and risking one’s wellbeing are still high.

The study’s aim is to explore the influence of COVID-19 anxiety on wellbeing among university students.

A total of 844 university students participated in a 5-minute paper-pen survey, completing self-report scales including a sociodemographic form assessing relevant information regarding COVID-19, The Covid-19 Anxiety Syndrome Scale (C-19ASS) and the Short Warwick-Edinburg Mental Wellbeing Scale (SWEMWBS). Bivariate correlation and multiple linear regression analyses were performed to assess the associations between the variables.

A negative moderate association was found between COVID-19 anxiety and wellbeing, indicating that presence of anxiety related to COVID-19 may predict a lack of wellbeing among university students.

As a negative association between COVID-19 anxiety and wellbeing was found, we can speculate that the existence of anxiety related to COVID-19 may predict student’s wellbeing. Knowing this, different psychological/wellbeing interventions, trainings and techniques, may be utilized to improve the wellbeing of the student population during and after these trying times, to try and minimize the negative effects of the pandemic on the student population.

None Declared

Mental disorders are among the most poorly treated illnesses in sub-Saharan Africa. It is estimated that 70-80% of South Africans consult Traditional Health Practitioners (THPs) for the treatment of psychological ailments. Few studies have examined the perceptions of THPs regarding causes of mental illness and whilst we know little about their practices, THPs maintain a strong role in assessing and treating patients with mental illness.

This research aims to be among the first studies to identify perceived causes and treatment modalities for mental illness among THPs in Johannesburg, South Africa.

Semi-structured in-depth interviews were conducted with 18 THPs in Johannesburg, South Africa between January and May, 2022. Interviews were transcribed and translated into English. Data was managed using NVivo 12 software and thematically analyzed.

THPs interviewed generally perceived mental illness to be of supernatural causation, either as a result of bewitchment, a calling for the patient to become a THP themselves, due to angry ancestors, or due to natural causes. THPs identified eight primary treatments that they use for treating mental illness. Among these were: throwing of bones (tinhlolo) to start communicating with ancestors, steaming (ukufutha) to start the cleansing process, sneezing (umbhemiso) to forcefully dispel the spirit causing the illness, vomiting (phalaza) and laxatives (mahlabekufeni) to remove the spirits poisoning the body as well as animal sacrifice to purge spirits and communicate with ancestors. This is all followed by cutting (ukucaba) which is the final part of treatment that ensures that the evil spirit cannot return.

This study is among the first to examine the perceived causes and treatments for mental illness used by THPs in Johannesburg, South Africa. As the vast majority of South Africans continue to seek help for mental illness via THPs, it is important to understand what forms of care healers are providing to patients. Future research should continue to document ways in which THPs approach healthcare as well as investigate interventions that can foster collaboration between THPs and biomedical professionals.

None Declared

With the increase of older adult population, late life depression is emerging as a major problem in many countries as it significantly deteriorates function and quality of life in older adults. Late life depression is a multidimensional disease that requires intervention in biopsychosocial perspective. Recent reduction in family size and rapid simplification of generations are making this decrease more dramatic. Thus, single older households are becoming general type of household in late life, emphasizing the importance of social engagement in late life depression

the purpose of this study is to assess the correlation between the frequency of face-to-face and non-face-to-face contact with non-cohabitating adult children and late life depression after the COVID-19 pandemic. Additionally, we hypothesized 10 possible moderators and evaluated the moderation effect of each moderator on the correlation. By identifying groups of older adults that are more affected by contact with their children, the understanding of the relationship between late life depression and family contact in older adults might provide insights to set intervention targets in the community.

Older adults who completed the Living Profiles of Older People Survey in Korea were included. In total, 7,573 participants were analyzed by measuring their contact frequency and depression symptoms. Regression analysis was done adjusting covariates. Process macro was used to verify the moderating effects of variables.

Multivariable logistic regression analysis showed that both infrequent face-to-face (OR=1.87, 95% CI=1.56-2.23) and non-face-to-face contact (OR=1.22, 95% CI=1.03-1.44) with non-cohabitating adult children group was associated with higher risk of late life depression compared to a frequent contact group. Further linear regression analysis, which viewed depressive symptoms as SGDS-K score, indicated consistent results in face-to-face and non-face-to-face contact (estimate=0.468, standard error [SE]=0.091, p<0.001 and estimate=0.262, standard error [SE]=0.079, p<0.001, respectively). Finally, using moderation analysis, association with late life depression and frequency of face-to-face contact was moderated by age, quartiles of household income, number of chronic diseases, frequency of physical activity, existence of spouse, and nutritional status (NSI) whether effect of frequency of non-face-to-face contact on late life depression was increased by participation in social activity, frequent physical activity, and good cognitive function (MMSE-DS score)(p for interaction<0.05).

Frequent contact of non-cohabitating children lowers the risk of later life depression. Several variables were found significant in moderating contact frequency-depression symptoms.

None Declared

Symmetrical Drug-Related Intertriginous and Flexural Exanthema (SDRIFE) is characterised by a distinctive pattern of erythematous and symmetrical rash over the gluteal and intertriginous regions after exposure to certain systemic medications. This is an uncommon condition which has been thought to be due to a Type IV delayed hypersensitivity reaction. Literature on clozapine-induced SDRIFE remains scarce, and reports of cross-reactivity among anti-psychotics are limited as well.

To present a clinical case of Clozapine-induced SDRIFE with cross-reactivity between Clozapine and Quetiapine.

We describe a case of a lady with Treatment Resistant Schizophrenia who developed erythematous lesions with desquamation over her skin fold regions and buttocks within two months of Clozapine initiation.

In our case, the lady was diagnosed with SDRIFE secondary to Clozapine. Clozapine was ceased, and the rashes resolved completely within a week. However, her psychiatric condition continued to worsened and she was trialed on Quetiapine. Unfortunately, she developed angioedema of the lips which necessitated a cessation of Quetiapine.

This case report illustrates the importance of recognising this rare condition, which can be readily treated by withdrawal of the culprit drug. Given that Clozapine and Quetiapine are structurally similar and fall under the class of Dibenzodiazepines, physicians should also be aware of the possibility of cross-reactivity among anti-psychotic medications leading to hypersensitive reactions.

None Declared

Well-being encompasses positive emotions and good physical health as well as, positive meaningful social relationships and connections or social well-being. Philosophies about the healing powers of nature, the value of spaces as a determinant of health and the impact of design of buildings on human health and wellbeing can be traced back for centuries. Bringing hospitality experience to inhospitable environments and humanizing’ healthcare environments according to a healthy architecture map and architecture health indices become currently an emergency to improve to improve the health of architectural environment and to promote the social and human wellbeing, in particular in healthcare environments.

Given the increase in mental and social health problems, We aim through this review of literature to identify as architect what is a healthy architecture map and what are the architecture health indices in healthcare environments, in particular in hospitals for mental disorders.

We comprehensively review the scientific literature using Pubmed database and Google scholar to state the presence of consensual healthy architecture maps and architecture health indices in mental healthcare environments.

Our bibliographic review revealed that, more than for other buildings, the construction of a hospital is extremely constrained involving highly complex program and multifaceted and interconnected factors with which the architect must deal. Medical and technological progress as well as the strong involvement of the healthcare personnel, who are requested, to turn towards the patient who must be at the heart of the medical and the space process make the program more complex. This lead all professionals, to have a deep reflection on the various and multi-layered challenges of the transformation of the hospital landscape especially when it is designed for patients with mental illnesses.

At this era of wellness revolution and precision medicine, despite some ambitious projects there are not yet a consensual healthy architecture map and precise architecture health indicators focusing on how the architectural composition of a mental health hospital may be planned.

None Declared

Treatment Resistant Depression (TRD) is a complex, heterogeneous and multifactorial clinical condition that affects patients’ quality of life, their psychosocial functioning as well as suicidal risk. Intranasal esketamine is a new add-on treatment specifically approved for TRD.

The aim of the study was to evaluate the efficacy and safety of intranasal esketamine treatment combined with intensive Cognitive Behavioral psychotherapy (CBT), together with treatment satisfaction, in two complex clinical cases of TRD with high suicidal risk in a 12 months follow-up.

Two male patients, 67 and 63 years old, with TRD, defined by at least two therapeutic failures with SSRI/SNRI and positive screening for high suicidal risk at the Columbia Suicide Severity Rating Scale, were selected for treatment with intranasal esketamine + CBT as an add-on to SSRI/SNRI antidepressant therapy. Psychopathological assessment were made by means of Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Columbia Suicide Severity Rating Scale (C-SSRS), Clinical Global Impression (CGI), Short Form Health Questionnaire (SF-36 items) at T0, every 7 days for the first 3 months, then every month. Treatment satisfaction was evaluated by means of the Client Satisfaction Questionnaire (CSQ-8), administered by trained nursing staff at 1, 3, 6 and 12 months. CBT specifically focused on depression was administered by a certified psychotherapist, weekly for the first 4 months, fortnightly for the next 3 months, monthly for the remaining 3 months.

After 2 administrations of esketamine the total HAM-D score was reduced by an average of 10 units and the suicidal risk was progressively reduced to zero according to C-SSRS. After 12 months one of the two patients reached and actually maintains clinical remission; the other one maintains a condition of mild depression; both without suicidal ideation and with a significant increase in perceived quality of life. Treatment was well tolerated, with mild and temporary adverse effects, self-limited to the administration sessions. CBT has contributed to increasing insight, cognitive resources, social interaction and self-esteem, and has made it possible to structure and carry on new life projects. The variation of the mean scores for CSQ-8 shows that esketamine + CBT treatment was considered as very satisfactory throughout the observation period.

Intranasal esketamine associated with intensive CBT sessions showed to be effective, safe and satisfactory in the real world clinical management of two complex cases of TRD with high suicidal risk, improving quality of life, social functioning and eliminating suicidal ideation within 12 months follow-up. Satisfaction with the treatment contributed to strengthening adherence and improving the operator-patient therapeutic relationship.

None Declared

Substance use disorders among individuals with psychotic disorders are a common. This is generally linked to more symptoms, worsened illness and high rates of treatment non-adherence. Long acting injections offer reliable drug delivery, reduce relapse risk and mortality (Khan et al 2016, Correll et al 2020) and can be used in individuals using illicit substances (Coles et al 2021, Erdogan et al 2021).

Aim was to look at literature comparing morbidity and mortality between oral versus long acting antipsychotics in patients with Schizophrenia and psychotic disorders who are currently using illicit drugs.

A literature search was conducted using keywords long acting antipsychotic injection / depot and substance use on databases EMBASE, Psychinfo, Medline and CINAHL.

A review of psychopharmacological properties of first and second generation LAI (Taylor 2009) noted that use is complicated by adverse effects and confusion over dose response relationships. Atypical antipsychotics may induce direct cardiovascular alterations, probably through apoptotic effect of dopamine receptor D2 (DRD2) blockade. A cross sectional study (Dehelan et al 2021) looked at cardiac ejection fraction (EF) in 123 patients with Schizophrenia or Schizoaffective disorder on Aripiprazole, Olanzapine, Paliperidone and Risperidone Long acting injections. A trend was observed indicating that patients treated with an antipsychotic associated with a lower affinity for the DRD2, such as Olanzapine, have higher EF values than patients treated with antipsychotics with a stronger binding to the DRD2, such as Paliperidone and Risperidone. Patients receiving Aripiprazole, which has the strongest affinity for the DRD2 from all four antipsychotics but is also a partial DRD2 agonist, display higher EF values than those on Paliperidone and Risperidone.

A critical systematic review and meta-analysis of randomised long term trials looking at oral vs depot antipsychotic drugs for Schizophrenia (Leucht, Claudia et al 2011) included 10 studies. Relapse was significantly reduced in patients on long acting injections. There was limited data on non-adherence, drop outs and adverse events. This data revealed no significant differences. There is concern with methodological issues in trials and possibility of bias.

Another systematic meta review of randomised controlled trials of long acting antipsychotic injections (Adams Clive et al 2001), found no difference in adverse effects in long acting injections vs oral medications but small benefit on global outcome measure (relapse).

Larger studies of populations of patients who are using illicit substances and are on long acting antipsychotic injections are required to discern differences in long term adverse effects in this population .

None Declared

Methanol intoxication is a public health problem in developing countries and can be ingested accidentally or with suicidal intent, leading to intoxication in isolated or collective forms. Methanol is used as a substitute for ethyl alcohol in several adulterated alcoholic beverages such as “eau de vie”, which is a drink distilled from dried fruits, such as dates, grapes and figs. Inside the body, it is metabolised into formic acid which, if left untreated, affects brain tissue, leads to blindness and can also cause death.

The objective of this retrospective study of a series of cases was to describe the epidemiological characteristics of methanol “eau de vie” poisoning cases collected by the Anti-Poison and Pharmacovigilance Centre of Morocco between 2013 and 2020 and to explain these results.

This is a descriptive and retrospective cross-sectional study over a period of 7 years from 1 January 2013 to 31 December 2020, which concerned 16 cases of intoxication by methanol “eau de vie” reported to the Anti-Poison and Pharmacovigilance Centre of Morocco, the study population concerned the entire Moroccan population throughout the territory of Morocco. The analysis concerned the frequency, the distribution in time, the distribution in space, the characteristics of the intoxicated, the type and circumstances of the intoxication and its evolution.

The CAPM recorded, during the study period, 16 cases of intoxication by methanol “Eau de vie” in Morocco. These cases were reported by telephone in 93.75% of the cases and collected by studies on hospital registers in 6.25% of the cases. Men were more affected than women. The most affected age group was adults, accounting for 50%. Adolescents accounted for 37% of cases and children for 13%. Drug addiction was the most frequent circumstance, followed by accidental intoxication and voluntary intoxication. The most frequently encountered signs were gastrointestinal signs followed by central and peripheral nervous system signs and heart rate and rhythm disorders. The outcome was favourable in 62% of cases, 6% with blindness after-effects and death occurred in 19% of cases.

Methanol poisoning can result from the consumption of illegal products containing methanol such as brandy, hence the importance of raising public awareness of this danger. It is also necessary to make health professionals aware of the clinical signs of methanol poisoning and what to do in the event of intoxication.

None Declared

Deep brain stimulation has become a last resource procedure for severe, chronic and refractory OCD. However, the procedure is highly invasive and its efficacy must be balanced against the risks it may entail. In addition, there are a number of procedure-related issues that may influence the efficacy of DBS, such as the target of stimulation, the stimulation parameters to be selected, the presence of comorbidities as exclusion criteria, or the efficacy in different OCD subtypes, among others. A comprehensive review of the knowledge and experience of DBS in OCD may be useful in helping to select appropriate candidates.

None Declared

The UN Convention on the rights of people with disabilities (UN CRPD) raised awareness of the need to find alternatives to coercion in the process of care for people with mental illness and/or mental impairment. In order to promote the application of the CRPD the World Psychiatric Association (WPA) has undertaken to produce a document listing possible alternatives to coercion and proposed to the General Assembly of the WPA to support the recommendations of that document by a WPA Position Statement on the matter.

The presentation will discuss the suggestions included in the Position Statement and in the review of options to reduce coercion in the WPA materials.

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

Major depressive disorder (MDD) is a mental health disorder characterised by persistently low mood; anhedonia; feelings of worthlessness and guilt; altered appetite, weight and sleep and suicidal ideation. About one-third of patients do not respond to available antidepressants (AD). Treatment-resistant depression (TRD) is a clinical term used to define a lack of response to two or more AD in patients with MDD that do not respond to other lines of treatment either. TRD is associated with an increased risk of relapse, hospitalisation and suicide. Esketamine is a non-competitive NMDAR antagonist that acts as an antidepressant by modulating glutamatergic neurotransmission, disturbed in MDD patients. It has recently been approved by the European Commission as a fast-acting nasal spray therapy for depression and suicidal ideation after showing effectiveness in TRD patients (Papakostas et al. JCP 2020; 81 4).

The aim of this study is to determine the effectiveness, safety and tolerability of intranasal esketamine in two TRD-diagnosed patients and to assess their clinical evolution.

A prospective study was conducted describing the evolution of two TRD patients treated with intranasal esketamine. We used The Hamilton Depression Rating Scale (HDRS) to quantify the severity of their symptoms and assess their recovery over time, analyzing the score change from baseline to endpoint as a primary outcome of the study. We also applied the Addensbrooke Cognitive Examination (ACE-III) as a tool to establish their cognitive condition before therapy and its evolution. Changes in dosage during treatment, adverse effects, time required for onset of action, clinical outcomes and other variables were also measured.

Intranasal esketamine was administered twice a week during the first 4-week induction phase and weekly during the following 6-month maintenance phase. Dosage of antidepressant was determined depending on each patient’s age and clinical evolution, being 56 mg the initial dose for case 1 (57 years old) and 28 mg for case 2 (71 years old). This antidepressant was effective in both patients in a fast-acting way, with the onset of action occuring within the first two weeks. During the course of treatment, the HDRS score significantly decreased, associated with improvement and remission of depressive symptoms. Cognitive performance got better in both cases. None of the patients discontinued treatment due to adverse effects or lack of efficacy.

Our data suggest that intranasal esketamine therapy is a good alternative in TRD patients, being effective, fast-acting and well-tolerated, with a manageable safety profile. Clinical stability was also observed in the medium-term follow-up after the end of treatment. This presents esketamine as a promising therapeutic and effective strategy in MDD patients who are either treatment-resistant or acutely suicidal.

None Declared

Globally, burns are responsible for around 11 million injuries and 180 000 burn-related deaths yearly. Unfortunately, 9 of 10 burn injuries and deaths happen in low-and-middle-income countries (LMICs) such as Pakistan. One in three people admitted to hospitals with burn injuries die within three weeks, and survivors face serious lifelong physical, emotional and psychosocial problems. This may result in anxiety, depression, post-traumatic stress disorder, increased mortality and social disintegration. This study aims to evaluate if implementation of a culturally adapted multidisciplinary rehabilitation programme for burn survivors is clinically and cost-effective, sustainable and scalable across Pakistan.

• - To understand lived experiences of burn survivors, families, and other stakeholders including the experience of care and impact of burns To work together with key stakeholders (such as burn survivors, family members) to adapt a culturally appropriate affordable burn rehabilitation programme

• - To undertake social media campaigns to promote burn prevention and risk assessment at communities, workplaces/industries/households; improve first aid; and address burn related stigma

• - To work with policy makers/parliamentarians to develop national guidelines for burns care and prevention in Pakistan

There are 6 work-packages (WPs). WP1 is to co-adapt a culturally appropriate burn care and rehabilitation programme. WP2 will develop and implement national burn registry on WHO’s initiative. WP3 is a cluster randomised controlled trial to determine clinical and cost-effectiveness in Pakistan. WP4 will evaluate social media campaigns for burn prevention and reduce stigma. WP5 involves working with key-stakeholders for burns-related care and policy and WP6 offers sustainable capacity and capability for burns treatment and rehabilitation.

A clinical and cost-effective burn care quality and rehabilitation programme may have a huge potential to save lives and contribute health and socio-economic benefits for patients, families, and the healthcare system in Pakistan. The nation-wide implementation and involvement of burn centres across all provinces offer an excellent opportunity to overcome the problem of burn care access experienced in LMICs.

To date, burns prevention, care and rehabilitation have not received sufficient attention in policy initiatives in Pakistan and other LMICs. This study is an excellent opportunity to evaluate culturally adapted burn care and rehabilitation programmes that can be implemented across LMICs. We will disseminate our findings widely, using a variety of approaches, supported by our stakeholder and patient advisory groups.

None Declared