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

None Declared

6-monthly paliperidone palmitate features an initiation regimen through 1-monthly paliperidone palmitate or 3-monthly paliperidone palmitate. Some patients do not have sufficient adherence to treatment and it is necessary at the clinical level to start directly with 6-monthly paliperidone palmitate. There is little clinical experience with these alternative initiations and through this work those that have been carried out for 12 months at the Hospital Universitario Infanta Elena are exposed.

The main objective of the study is to describe the alternative initiations performed with 6-monthly paliperidone palmitate in routine clinical practice, having opted for a regimen different from the standard for clinical reasons.

A retrospective selection of patients will be made through non-probabilistic consecutive sampling, including all patients who have been administered 6-monthly paliperidone palmitate with a start different from the standard during the last 4 months. To do this, the electronic medical record will be used, first selecting the patients who have started 6-monthly paliperidone palmitate through the anonymized digital records and, later, including in the study only those who have followed an alternative initiation pattern. The variables studied will be the following: age, sex, diagnosis, dose of paliperidone palmitate, initiation regimen, consumption of toxic substances, absenteeism from 6-monthly paliperidone palmitate, and visits to the emergency room and admissions.

The study included a total of 20 patients (n: 20). 80% of the patients were male and 20% were female. The mean age was 39.7 years. 75% of the patients had an associated substance use disorder. The following alternate starting schedules were performed with biannual paliperidone palmitate: monthly paliperidone palmitate on days 1 and 8, and 6-monthly paliperidone palmitate on day 38 (n: 11); monthly paliperidone palmitate 150 mg together with semi-annual paliperidone palmitate both on day 1 (n: 5); biannual paliperidone palmitate on day 1 supplemented with oral paliperidone for 45 days (n:4). A total of 0 visits to the emergency department and 0 admissions were observed after the 6-monthly paliperidone palmitate regimen.

Alternative initiations with 6-monthly paliperidone palmitate may be a useful and safe clinical alternative in patients with very low adherence who, due to clinical needs, require starting 6-monthly paliperidone palmitate earlier in order to guarantee adherence.

None Declared

The VML (Verbal Motor Learning) method (Vashdi, 2013, Vashdi, 2014, 2017) is an organized, structured method which includes unique evaluation, algorithmic analysis, manual techniques, motor learning principles and unique treatment principles. The VML method targets the Apraxia of speech syndrome deficits, while teaching the learner how the plan the speech movements and time the speech systems for an accurate pronunciation.

Being a multidimensional entity in nature, as a speech therapy tool developed by a physical therapist, the VML method crosses disciplinary boundaries of agreement and proposing new policies for treatment. The speech tool serves other professions then speech therapists and is also given to parents for practice and learning. The parent’s role in the therapeutic team is controversial, however, we have found that parent’s intervention in some cases can be very effective, contributing to treatment process.

The purpose of this retrospective study is to answer two major questions; What is the efficacy of the professional and non-professional VML treatment.

A retrospective study was conducted analyzing 900 evaluations of which 136 longitudinal treatment processes of children diagnosed with CAS or suspected CAS, were extracted. The participants contacted the early age intervention clinic for VML speech evaluation on their own will, and were examined by a VML expert. The data was collected over the years 2006-2018 based on children evaluated at the clinic in Israel. A set of variables based on the VML method assessment (Vashdi, 2013; Vashdi, 2014) was established for the retrospective data collection

136 speech treatment processes passed the inclusion criteria and were examined (59 professional treatment and 77 non-professional treatment

There were no differences between the professional and non-professional group’s baseline data. The entry syllables score for all participants was 16.32%. The average improvement in syllables for all participants was significant (33.18% , p<0.05, paired t-test). It was also found significant for the professional and non-professional treatment groups ( 45.49% and 23.75% respectively, p<0.001, t-test). Single syllables improvement was found higher for professional group (P=0.02).

Both groups demonstrated significant improvement in the single syllables production skill, while the professional group was found significantly more effective than the home-based treatment. The findings regarding the professional group are not surprising, however support the efficacy of the VML intervention for children with severe CAS, even with one session per week of intervention. The non-professional home based treatment results were surprising and promosing for future practice.

None Declared

Fahr’s disease (FD) is a rare disorder consisting of bilateral and symmetrical calcium deposits in basal ganglia and cerebral cortex. These lesions are associated with neurological and psychiatric symptoms such as a rigid hypokinetic syndrome, mood disorders and memory and concentration abnormalities. It can be idiopathic or secondary to endocrine disorders, infectious diseases or mitochondrial myopathies.

To highlight the importance of considering organic causes when evaluating patients presenting atypical psychiatric symptoms and claim the role of neuroimaging.

Case report and non-systematic review of literature: sources obtained from Pubmed database.

A 69-year-old man, native of Syracuse (Italy), was admitted to the Psychiatry Unit in February 2022 presenting behavioural disturbances and irritability. In July 2021 he presented the same symptoms, being mistakenly diagnosed with Bipolar Disease type I. He has no previous psychiatric history. He started with changes in his personality, short-term memory loss, aggressiveness and disorganized behaviour at the age of 66. At admission he was talkative and hyperfamiliar, presenting delusions of grandiosity, exalted affectivity and insomnia. Neurological examination showed short-term memory problems, signs of frontal disinhibition and abnormal glabellar tap sign. Blood tests, CT brain and MRI were performed to rule out organic underlying causes. Neuro-imaging found bilateral and symmetric calcifications in globus pallidus, thalamus and corpus striatum, in favour of FD. Secondary causes (abnormalities in the PTH, vitamin disorders and infectious diseases such as HIV, brucellosis or neurosyphilis) where discarded, allowing us to conclude it was probably a primary case of FD. Valproate was started as a mood stabilizer and anticonvulsant. Genetic tests were indicated.

FD should be considered as a differential diagnosis in the evaluation of psychiatric symptoms, especially when atypical and/or presented with neurological symptoms. The role of neuro-imaging is essential.

None Declared

Mental illnesses affect one in eight people in the world according to the WHO in 2019. They are a leading cause of morbidity and a major public health problem. Stigma harms the quality of life of people with mental illness.

Our study aimed to evaluate the association of mental illness stigma with socio-demographic characteristics in Tunisian students.

This is a cross-sectional study conducted on Tunisian students who anonymously completed a form circulated online through the groups and social network pages related to each academic institution. The form was containing an Arabic validated version of the “Mental Health Knowledge Schedule” (MAKS) and the “Reported and Intended Behaviour Scale” (RIBS) along with a sociodemographic questionnaire.

We have included 2501 Tunisian students with a sex-ratio Male/Female of 0.37. The mean age was 21.57 (±2.55) ranging from 17 to 42 years. Participants’ fields of study were: Science and Technology (58.7%), Literature (17,4%), Economics and management (15.8%), and Arts (4.8%). Among them, 17.1% had a history of family psychiatric disorders and 17.6% had a psychiatric disorder. Besides, 20.9% of the students were using tobacco and 75.6% of them were religious. We also found that 26.7% of participants had previously attended an awareness session. Several determinants had a statistically significant association with the stigma of mental illness in our study population. We noted that females had higher mental health knowledge scores (p=0.001), while males had higher behavior scores (p=0.002). Moreover, students in the scientific and literary fields had higher scores on both MAKS (p<10-3) and RIBS (p<10-3). In addition, we found greater knowledge of mental illness and less discrimination among participants with a psychiatric history (p=0.013 and p<10-3 respectively) and among those who had previously attended a stigma awareness session (p=0.020 and p=0.002 respectively). We also noted higher behaviour scores among people with substance use (p<10-3) and lower scores among people with religious beliefs (p=0.009).

Our results show a multiplicity of factors related to mental illness stigma that we can target in anti-stigma strategies. Addressing stigma is a long-term effort; small and large-scale interventions should be considered and evaluated on an ongoing basis to strive for a better future.

None Declared

A popular genre of television shows is medical dramas. Although the primary objective of watching these shows is entertainment, acquiring medical knowledge is a passive by-product. Surgical procedures constitute a large part of the storyline of these shows. This could either serve as a source of medical knowledge or provide false information, the effect being especially important in individuals with no prior medical exposure.

This study aims to assess the impact medical TV shows can have on the surgical knowledge of non-healthcare students and the difference in knowledge between different demographic groups (among those with relatives in the medical community and those without).

A cross-sectional study was conducted among the non-healthcare students of Lahore, Pakistan. A self-administered questionnaire was used containing socio-demographic factors (age, gender, educational discipline), history, and hours of medical TV shows watched. It also contained ten questions each with a score of 1 to assess surgical knowledge. Data was analyzed using SPSS v.26.

Among the 1097 respondents, 450 (41%) had a history of watching medical TV shows. The majority, 319 (29.1%), had seen these shows for < 24 hours. The mean score of all respondents was 5.79 out of a maximum score of 10. Respondents with a history of watching medical TV shows were more knowledgeable than those who did not (p < 0.001). Similarly, respondents with a history of watching more hours of medical TV shows were more knowledgeable than those who watched for a lesser number of hours (p < 0.001). Respondents with relatives in the healthcare profession were also more knowledgeable than those without (p = 0.049).

If properly developed, while maintaining their primary entertainment value, medical TV shows can also be used as efficient learning tools. Quality controls must also be applied to minimize the risk of false information.

None Declared

Maintaining remission, preventing from future episodes, better treatment adherence and improving the quality of life are main aims of long-term treatment in bipolar disorders (BD). In recent years, new generation long-acting injectable (LAI) antipsychotics have been frequently used in maintenance treatment for bipolar disorders.

We aimed to review socio-demographic and clinical characteristics of bipolar patients taking LAI treatment for maintenance treatment.

Clinical records of 56 bipolar patients who are on LAI treatment and followed in Mazhar Osman Mood Clinic (MOMC) of Selcuk University Medical Faculty were evaluated. Descriptive statistical analysis was performed with Statistical Package for the Social Sciences (SPSS).

Nearly half of the patients were male (n:29, 52%). 49,1% of the patients were married. The mean age was 37.1±12.2 years and the mean duration of education was 11.1±4.2 years. All of the patients were diagnosed with bipolar 1 disorder. Most of the patients (64,7%) was on aripiprazole LAI while remaining was receiving paliperidone LAI for maintenance treatment. We found a significant reduction in the number of manic episodes after long-acting treatment (p<0.001), but we could not find any difference for depression. Ten of the patients discontinued the treatment due to the side effects, extrapyramidal side effects were the most common side effects. Eight of the patients were switched from paliperidone treatment to aripiprazole treatment due to side effects, especially hyperprolactinemia. Relapse was observed in 46,4% of the patients and there was no difference between aripiprazole and paliperidone in terms of relapse rate.

LAI new generation antipsychotics are taking place in long-term treatment of bipolar disorder via improving treatment adherence. Side effect profile of aripiprazole and paliperidone are different. However, we could not find any difference between two drugs in terms of side effects and relapse rates. Small sample size and shorter duration of follow-up should be considered as limitations.

None Declared

Prevention of Post-traumatic stress disorder (PTSD) is a major public health interestand one of the concerns of any emergency physician.

The purpose of this study was to evaluate the efficacy and safety of a herbal supplement in preventing the occurrence of PTSD in high-risk patients.

: It is a randomized, double-blind, prospective, interventional study including patients exposed to a traumatic event meeting DSM-V Criterion A and having a Peri-traumatic Distress Inventory score and/or Peri-traumatic Dissociative Experience Questionnaire (PDEQ) and/or immediate stress score (L.Crocq score) higher than the thresholds between day 1 and day 3. A total of two hundred patients were included and they were randomly assigned into two groups: Aleozen group and placebo group. Patients included in the aleozen group received Aleozen® for 10 days while patients in the placebo group received a Placebo. A CAPS-5 assessment was performed for all patients at different moments. The main objective was to assess the efficacy of Aleozen® after day 90 of exposure to traumatic events according to PTSD. The secondary objectives were to evaluate the safety of Aleozen® at 10 and 30 days after its administration and to assess PTSD in the involved population after one year.

No statistical differences were noted between the two groups in terms of baseline characteristics, including age, sex, and ISS score. After day 90 of follow-up, and according to the CAPS-5 scale, 85 patients (42.5%) had PTSD. Concerning the primary endpoint, less PTSD was observed in the intervention group compared to the placebo group (38.8% versus 61.2%, respectively; p<0.001). No adverse events were noted during the study

The results of this study suggest the potential preventive effects of an herbal supplement on PTSD for traumatic patients in the emergency department. Further confirmatory studies are required

None Declared

Eating Disorders are common. They onset in adolescence and affect individuals of all ages. Women are more affected than men. I will present evidence on the epidemiology of eating disorders across the lifespan. I will also review risk factors focusing in particular on biological risk factors that might explain onset of these disorders in critical periods of a woman’s life. I will also cover pyschosocial risk factors across life stages. I will present results from a series of cohort studies. I will then summarise the evidence from our own and other existing studies.

None Declared

One of the factors influencing the symptoms of schizophrenia, which may indicate changes in the cognitive functioning of patients, is the fluctuating level of inflammatory cytokines.

The aim of the review was to analyze the available literature on the importance of selected inflammatory factors [interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), of tumor necrosis α (TNF-α)] in schizophrenia and the assessment of the impact of changes in cytokine levels on the occurrence of schizophrenia symptoms.

For this purpose, available scientific publications from following databases: PubMed, Scopus, Google Scholar were used to prove that the levels of selected inflammatory parameters changed in people suffering from schizophrenia. Moreover, fluctuations in cytokine concentrations influenced the occurrence of negative symptoms of schizophrenia, including cognitive disorders, as well as psychotic symptoms.

An increase in the concentration of IL-1β in the cerebrospinal fluid of patients with the first episode of schizophrenia has been described, which may indicate the involvement of the cytokine in the inflammatory process involving the CNS. The increased level of IL-6 is associated with the occurrence of psychotic disorders, it is also noted in stressful conditions. IL-6 is qualified as an indicator of exacerbation of schizophrenia, which normalizes after antipsychotic treatment. In the blood of patients with paranoid schizophrenia, elevated levels of IL-8 and IL-6 were detected compared to healthy individuals, which indicates the development of an inflammatory process in schizophrenia. The relationship between the level of IL-8 in women in the second trimester of pregnancy and the risk of developing schizophrenia spectrum disorder in children has been proven. Untreated patients with acute psychotic symptoms showed an increase in the level of TNF-α in the blood serum (compared to healthy subjects). An increase in the level of TNF-α in the blood serum of patients with an acute relapse of schizophrenia or the first episode of psychosis was also demonstrated. In conclusion, the relationship of IL-6 and TNF-α with the occurrence of psychotic disorders, the relationship of IL-1β with the appearance of changes in mood, behavior, including cognitive dysfunction, the relationship of IL-8 with the risk of developing schizophrenia spectrum disorder in children, the relationship of reduced concentrations of IL-10 with the intensification of negative symptoms, including cognitive deficits.

In conclusion, the analysis showed that patients with schizophrenia fluctuate in the concentration of inflammatory cytokines, which affects the occurrence of clinical symptoms.

None Declared

Treatment Resistant Depression (TRD) occurs in up to 30% of patients with Major Depressive Disorder (MDD). New treatments are clearly needed and there is a burgeoning interest in novel agents including ketamine. While ketamine in various formulations has been demonstrated to have a robust antidepressant effect there is a lack of evidence-based psychotherapies specifically designed for combination use.

We hypothesize that the combination of “Almond TherapyTM” with intranasal ketamine will result in a statistically significantly better outcome as demonstrated by a greater reduction in MADRS scores and/or response rates and/or remission rates in TRD patients compared with those who receive esketamine plus TAU. Secondary outcome measures include PHQ-9, GAD-7, PCL-5, Asssessment of Quality of Life - 8D (AQOL-8D), and Rosenberg Self-Esteem Scale.

We have developed a research protocol combining a unique and specifically-designed, multi-modal psychotherapy program, “Almond TherapyTM”, with intranasal esketamine in a randomized, controlled, single-blind 28-day study. The therapy utilizes an individualized, evidence-informed approach for each participant consisting of a number of modules selected using a shared decision-making process determined at the first study visit. This uniquely tailored approach ensures that the chosen modules are personally meaningful to the participant, and thus, promotes therapeutic adherence. The proprietary therapy combines elements of cognitive behavioral therapy (CBT), trauma focused-CBT, Dialectical Behavioral Therapy (DBT), and mindfulness, together with biofeedback. In addition to in-clinic sessions, participants also receive standardized remote therapy sessions by trained therapists.

Patient recruitment and enrolment has begun. Interim results are anticipated.

This study is the first examination of the potential additional clinical benefit of adding a specific therapy program to existing intranasal esketamine treatment. If demonstrated to be of clinical benefit then further studies may potentially provide comparison to other therapy programs and in conjunction with other agents.

P. Chue Shareolder of: Zylorion, P. Silverstone Shareolder of: Zylorion, Employee of: Zylorion, T. Hillier Shareolder of: Zylorion, Employee of: Zylorion, S. Rizvi: None Declared, S. Phillips Shareolder of: Zylorion, Employee of: Zylorion, L.-A. Langkaas Employee of: Zylorion, K. Davidson Employee of: Zylorion, M. Brown: None Declared, J. Chue: None Declared

Numerous authors have proposed “responder” criteria for patients with schizophrenia treated with antipsychotic monotherapy (Leucht, S et al 2009; 438 7-14; Suzuki T et al, 2012; 197 1-6; Kane J et al 1988; 45 789-96). These suggest reductions greater than 30% on the PANSS total score, improvements of 1 category or more on the CGI-S, or CGI-C ratings of very much, much or minimally improved, as well as various permutations and combinations of the above. No study has met the responder definition of Kane et al in the last 30 years in monotherapy studies in TRS patients. However, a widely accepted definition of response in patients with TRS treated with a putative antipsychotic added to their background antipsychotic monotherapy, is not currently available, and more work is needed on this highly relevant topic (Suzuki, T et al 2011; 133 1-3).

Combining PANSS (30-item anchored scale), CGI-C and CGI-S (both 7-point Likert scales), three of the most accepted scales to evaluate patients with schizophrenia worldwide, we propose two different definitions of response in TRS population

Study 014 was designed to evaluate the safety and preliminary evidence of efficacy of evenamide, a NCE added to an antipsychotic monotherapy, given orally at 3 fixed doses (7.5, 15 and 30 mg bid) in patients with TRS not adequately responding to a therapeutic dose of an AP. Assessment of efficacy was based on changes of the PANSS and CGI-S/C. We reviewed the efficacy data of the first 100 patients at various timepoints up to 30 weeks.

We assessed multiple definitions involving all the three measures (PANSS, CGI-S, and CGI-C) to determine one that would define a “responder” by categories that may be clinically meaningful. Review of the data indicated two definitions of responders based on the different combinations of the individual measures. “Full responder” was defined as PANSS total score improvement ≥ 20%; CGI-C at least much improved (i.e. 1,2); CGI-S at least one point improvement and reaching at least mildly ill (i.e. a score of at least 3 or less). “Partial responder” was defined as PANSS total score improvement ≥ 15%; CGI-C rated as any improvement (i.e. 1,2,3); CGI-S at least one point improvement. These two categories are alternatively true and patients not fulfilling the criteria for the above categories are considered as “non-responders”. Further descriptive analysis will be presented.

These definitions may change the selection of compounds used as add-on therapy for TRS patients as well as the study designs to evaluate them.

None Declared

For most countries it is currently unknown to what degree concentrations of psychotropic drugs in surface water exceed environmental threshold concentrations (ETCs) [MOU1] for ecosystems and what risk mitigation could be applied. ETCs are defined as per-compound threshold concentrations above which detrimental effects on reproduction, growth, and mortality of aquatic organisms cannot be exclude

To quantify levels of antidepressants, antipsychotics, mood stabilizers, and benzodiazepines in surface water, investigate their sources and assess whether these levels exceed ETCs.

Cross-sectional analysis of measured and modeled data. Environmental levels were compared to ETCs to evaluate their risks for the aquatic environment. Finally, sources of psychotropic drugs were investigated.

All available Dutch water monitoring data from all regional and national monitoring campaigns of 2019, the last year before the COVID-19 pandemic.

Concentrations of aripiprazole, carbamazepine and its metabolites, clozapine, diazepam, (es)citalopram, fluoxetine, haloperidol, nortriptyline, olanzapine, oxazepam, temazepam, quetiapine, sertraline, valproic acid, and venlafaxine.

The main outcomes were measured and modeled concentrations of the aforementioned agents in surface water. As a secondary outcome, where possible, average risk quotients (RQs) were calculated by dividing the measured or modeled concentrations by the ETC. An RQ > 1 was interpreted as a risk to the environment.

Psychotropic drug samples (n=1201; 14-520 measurements per drug) showed the highest average concentrations for oxazepam (0.91 μg/L; RQ = 1.89) and carbamazepine (0.74 μg/L; RQ = 1.48), with individual measurements exceeding ETCs. For other drugs, measured concentrations did not reach the detection limit (amisulpride, (es)citalopram, quetiapine, and venlafaxine) or did not exceed the ETC (fluoxetine). Furthermore, households contributed most to psychotropics in surface water. Finally, psychotropics were cleared less efficiently from a wastewater treatment plant than other medications.

Psychotropic drugs are present in surface water, are primarily emitted by households, and may put organisms at risk. We signal a need to reduce concentrations of several psychotropic agents in the environment. Our findings set the stage for policies and research aimed at curtailing emissions of psychotropic drugs into the environment and highlight a need for responsible prescribing and waste measures.

None Declared

Clozapine has been well established as the most efficacious medication for treatment refractory schizophrenia. Optimising the benefit during clozapine trial is an important clinical consideration. Therapeutic drug monitoring of clozapine plasma or serum levels has formed a critical part of this. Though there is no agreed standardised therapeutic range, advice traditionally recommends a clozapine level of >350ng/mL in order to effect best response. Most studies analysing the relationship between treatment response and clozapine level are older, have small sample sizes, and do not consider whether additional factors might assist in determining optimal clozapine level for response.

We conducted a systematic review of PubMed, PsycInfo and Embase for studies that provided individual participant level data on clozapine levels and response.

This data was analysed using Receiver Operating Characteristic (ROC) curves to determine the prediction performance of serum clozapine levels for treatment response.

We were able to include data on 294 individual participants. ROC analysis yielded an area under the curve (AUC) of 0.612. The clozapine level at the optimal Youden index was 372ng/mL, and at this level there was response sensitivity of 57.3%, and specificity of 65.7%. The interquartile range for treatment response was 223ng/mL – 558ng/mL. There was no improvement in ROC performance with mixed models including patient sex, age or length of trial.

Clozapine dose should be optimised based on clozapine therapeutic levels. We found that a range between 250 – 550ng/mL could be recommended, while noting that a level of >350ng/mL is most optimal for response.

None Declared

Antipsychotics (AP) are the primary pharmacological treatment for schizophrenia but increase the risk for diabetes, with recent meta-analyses indicating important differences between specific APs. However, these findings are based on randomized clinical trials, which only include 20% of patients seen in everyday clinical settings, and are hence prone to selection bias.

We aim to investigate 1) the actual risk of developing diabetes in patients treated with APs using real-world data and 2) whether there are risk differences between specific APs.

We conducted a retrospective cohort study using Danish nationwide healthcare registers. We identified all individuals receiving a schizophrenia diagnosis from January 1, 1999, to January 1, 2019 and an age- and sex-matched reference population from the general population. The primary outcome was diabetes, identified via hospital discharge diagnoses and redeemed prescriptions for glucose-lowering drugs. First, we compared the risk of developing diabetes between patients with schizophrenia and the age- and sex-matched reference population. Second, among the patients with schizophrenia, the association between AP drug treatment and the risk of diabetes were analyzed. Third, risk differences for developing diabetes between specific AP drugs were investigated. We used cox regression for all analyses, the latter adjusted for age, sex, year of schizophrenia diagnosis, Charlson Comorbidity Index (CCI), occupational status, marital status, education and schizophrenia severity (use of antipsychotics, antidepressants, anxiolytics/hypnotics/sedatives, mood stabilizers and number of psychiatric admissions in the year preceding the diagnosis of schizophrenia).

We identified 31,856 patients with schizophrenia and 159,280 reference individuals. Patients with schizophrenia had an increased risk of developing diabetes compared with the reference individuals (unadjusted HRR: 3.12, 95%CI: 2.98-3.28). Treatment with AP in patients with schizophrenia, compared to periods with no AP use, was associated with an increased risk of developing diabetes (adjusted HRR: 2.04, 95%CI: 1.75-2.38). This risk was particularly increased among individuals treated with lurasidone (HRR: 2.66, 95%CI: 1.10-6.42), sertindole (HRR: 2.10, 95%CI 1.51-2.93), paliperidone (HRR: 1.84, 95%CI 1.47-2.31), clozapine (HRR: 1.74, 95%CI 1.49-2.03) and aripiprazole (HRR: 1.54, 95%CI 1.35-1.75), whereas treatment with zuclopenthixol (HRR: 1.00, 95%CI 0.82-1.23), flupentixol (HRR: 0.71, 95%CI 0.40-1.25) and pimozide (HRR: 0.74, 95%CI 0.31-1.78) were not associated with an increased risk of diabetes.

This real-world study indicates differences in the risk of developing diabetes between specific AP compounds. Further analyses will be presented at the conference.

None Declared

Childhood trauma has been linked to adult psychosocial outcomes including social exclusion, loneliness, and psychological distress.

To explore the associations between childhood trauma and social exclusion in adulthood with consideration of loneliness and symptoms of anxiety and depression in the UKBiobank database.

Hierarchical multiple regression analysis of 87,545 participants (mean age=55.68[7.78], 55.0% female, 97.4% white) enrolled in the UK Biobank. The main predictor variable was occurrences of traumatic childhood experiences. Current loneliness and symptoms of anxiety (GAD-7) and depression (PHQ-9) were included as secondary predictors. The outcome variables were ‘limited social participation’, ‘area deprivation’, ‘individual deprivation’ and (combined) ‘social exclusion’ .

We found small associations between childhood trauma and social exclusion, explaining between 1.5% and 5.0% of the variance. Associations remained significant when loneliness, anxiety, and depression were entered in the models. These findings support a relationship between early-life adversity and socioeconomic deprivation including heightened risks of homelessness, antisocial behaviour and lower social mobility in adulthood.

Loneliness was the strongest predictor of ‘limited social participation.’

Depression was the strongest predictor of ‘individual deprivation,’ ‘area deprivation’ and ‘social exclusion,’ closely followed by childhood trauma.

Anxiety symptoms protected against ‘individual deprivation’ and ‘social exclusion’ in adulthood. Given the composition of the ‘individual deprivation’ dimension (i.e. employment, education, income) this may tentatively suggest that low levels of anxiety could have a positive impact on individuals’ pursuit of education and employment, potentially in line with the theory that the Yerks and Dodson law (i.e., there is an inverted U-shaped relationship between arousal and cognitive performance; Yerkes & Dodson, 1908) may apply to anxiety symptoms. In other words, higher vigilance may help seeking a way out of childhood adversity and increase cognitive performance if anxiety is low level, thus possibly playing a role in resilience. This may particularly be the case given that average levels of anxiety were low in the current sample (only 5% had a clinically significant GAD-7 score of above 10).

Trauma and neglect in childhood are associated with an increase of social exclusion in adulthood.

Loneliness and depression make this association stronger.

Anxiety symptoms may lead to better performance in education and employment and hence play a protective role against individual level social deprivation - higher vigilance and cognitive performance can occur in low level anxiety and may increase resilience in adulthood.

None Declared

Post-traumatic stress disorder is common and the risk of developing it after a trauma is high. Its global management is long and complex.

The general practitioner, as a primary care provider, has a fundamental role in detecting it. They may have to take care of these patients both physically and psychologically, and may find themselves at a loss when faced with repercussions such as Post-Traumatic Stress Disorder (PTSD).

In some countries, the role of the general practitioner is different. More involved and better trained, they are actors in the pre-hospital system in case of psychotrauma.

By means of a survey conducted among general practitioners in Morocco, we will first try to determine their place in the screening and management of psychotrauma, and then to evaluate their knowledge of EMDR therapy.

For this purpose, a questionnaire was developed and used as a basis for the study.

It included practical questions relating to the physicians’ activity, their practice in emergency consultations, their training, their management of physical and psychological trauma, and finally their knowledge of EMDR therapy,

Finally, we will attempt to propose concrete avenues for more effective, safer, and non-harmful management of psychotrauma in the basic health care system.

the general practitioner was the first professional to receive a patient who was a victim of a physical or psychological trauma (road accident, rape, physical or verbal aggression), but the degree of knowledge and training for this type of care was low among our doctors.

Training sessions should be scheduled for general practitioners in order to optimize the management and prevention of post-traumatic stress disorder.

None Declared

Fort McMurray, a city in northern Alberta, Canada, has experienced multiple traumatic events in the last five years, including the 2016 wildfire, the 2020 floods, and the COVID-19 pandemic. Traumatic events often lead to increased mental health burdens in affected communities.

To assess if the number of traumatic events experienced by residents of Fort McMurray correlates with the prevalence and severity of mental health issues experienced.

A cross-sectional study using an online survey questionnaire was used to gather demographic, trauma (wildfire, flooding, and COVID-19), and clinical information from the resident of Fort McMurray between April 24 to June 2 2021. Likely Generalized Anxiety Disorder (GAD), Major Depressive Disorder (MDD), Post-Traumatic Stress Disorder (PTSD) and low resilience were measured using standardized rating scales. Data were analyzed with SPSS version 26 using Chi-Square tests and multivariate regression analysis.

Respondents who experienced COVID-19 and either flood or wildfire traumas (N = 101) were eleven times more likely to have GAD symptoms (OR: 11.39; 95% CI: 1.43-91.04), four times more likely to have likely MDD, (OR: 3.85; 95% CI: .995-14.90), ten times more likely to have likely PTSD (OR: 10.47; 95% CI: 1.28-85.67), and low resilience (OR: 10.56; 95% CI: 1.21-92.17). Respondents who experienced COVID-19, flooding, and wildfire traumas (N = 47) were eighteen times more likely to express GAD symptoms (OR: 18.30; 95% CI: 2.20-152.45) and more than eleven times likely to have likely PTSD (OR: 11.41; 95% CI: 1.34-97.37) in comparison to the respondents who experienced COVID-19 only trauma (N = 19).

Measures to reduce climate change and associated natural disasters could reduce the impact of cumulative trauma and associated mental health burden in vulnerable populations. It is essential that more mental health resources are mobilized to support communities impacted by multiple natural disasters.

None Declared

Repeated self-harm represents the single strongest risk factor for suicide. Worldwide, suicide is the second leading cause of death in young people aged 15-29 year, and the leading cause of death in many Asian countries.

This qualitative study was nested in a multi-center effectiveness trial of a Youth Culturally-adapted Manual Assisted Problem-solving intervention (Y-CMAP) for prevention of self-harm in Pakistan and aimed to explore young people’s perspective on the intervention.

One-to-one in-depth qualitative interviews were conducted with 20 participants from 5 cities across Pakistan, using a semi-structured topic guide to explore their views about self-harm, Y-CMAP intervention content, perceived effectiveness and challenges. Interviews were conducted in Urdu language, digitally recorded, transcribed verbatim and translated into English. Thematic analysis was conducted by the trained qualitative researchers.

Interpersonal conflicts including relationship difficulties, financial problems, and lack of social support were highlighted as precipitating factors of self-harm. Participants reported that Y-CMAP intervention is structured and easy to understand. They acknowledged the role of distraction techniques, cost-benefit analysis, discussion on thinking pattern, problem-solving and anger management in improving their mental health and wellbeing and reduce self-harm. Participants also shared their initial fears regarding the intervention, such as fear of disclosure of information to media. School and job timings were described as potential challenges for participation in the intervention.

Exploring the perspectives of young people about culturally-appropriate intervention is imperative in their journey towards preventing suicide, which is a preventable cause of premature death. Findings are particularly relevant for Pakistan, one of the youngest nations in the world with limited resources for suicide prevention.

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Instagram, one of the most widely used social media by population was changed the way individuals communicate around the world. It can be used to increase individual self popularity or increase self-esteem.

To determine the relationship between the instagram addiction and self-esteem in a population of tunisian doctors.

A cross-sectional study was conducted online using the Google Forms platform, with a sample of tunisian doctors in september and october 2022. We used :

• - Instagram Addiction Scale (IAS) : to assess Instagram addiction levels. A score above 37 indicates addiction to instagram.

• - Rosenberg Self-Esteem Scale : to measure the level of self-esteem. Higher scores indicate higher levels of self-esteem.

The sample comprised 106 doctors.

• - IAS : The mean score was 31.18 (SD=11.64). Less than half (42.5%) presented an addiction to instagram and 36.8% were mildly addicted.

• - The mean self-esteem score was 29.70 (SD=3.57). Less than half (44%) had low to very low self-esteem.

• - The instagram addiction score was negatively correlated with the self-esteem score (r=-0.543 ; p=0.0001).

It was found that these scores were significantly lower in the addicts (p=0.0001) indicating lower self-esteem. Among addicts, 80% had low to very low self-esteem. Among non addicts, 18% had low to very low self-esteem.

It was found that the higher the intensity of using instagram the lower the self esteem.

Further research is expected to be carried out with a wider population to verify the present findings and to study other factors related to instagram addiction such as loneliness and life satisfaction.

None Declared