Gambling disorder (GD) and bulimic spectrum eating disorders (BSDs) not only share numerous psychopathological, neurobiological, and comorbidity features but also are distinguished by the presence of inappropriate behaviours related to impulsivity and compulsivity. This study aimed to emphasise the differences and similarities in the main impulsivity and compulsivity features between GD and BSD patients, and to analyse the potential influence of sex in these domains.

Using self-reported and neurocognitive measures, we assessed different impulsive–compulsive components in a sample of 218 female and male patients (59 with BSD and 159 with GD) and 150 healthy controls.

We observed that GD and BSDs exhibited elevated levels of impulsivity and compulsivity in all the dimensions compared to healthy controls. Moreover, these disorders showed differences in several personality traits, such as high novelty seeking in GD, and low persistence and high harm avoidance in BSDs. In addition, patients with BSDs also displayed a trend towards greater impulsive choice than GD patients. Regarding sex effects, GD women presented higher overall impulsivity and compulsivity than GD men. Nevertheless, no sex differences were found in BSDs.

Clinical interventions should consider these deficits to enhance their effectiveness, including adjunctive treatment to target these difficulties. Our findings also provide support to the relevance of sex in GD, which should also be considered in clinical interventions.

Impairments in social and non-social cognition are common in psychosis and may be sparsely present even before the onset of the disorder. Genetic and environmental influences have been linked to cognitive dysfunctions, which, in turn, may significantly impact the real-world functioning of people with psychosis. The role of gender in determining the interplay between cognitive skills, risk factors, and outcomes has been relatively unexplored. Nevertheless, identifying putative gender differences in cognitive functions and their correlates may favor the identification of individualized prevention and treatment strategies.

None Declared

A negative impact on mental health of Ukrainian people who will survive the war is very likely.

Those who leave are exposed to the trauma of leaving behind home, relatives, friends, job, habits, i.e., most of what they had built in their life, and to the unpleasant feeling of knowing nothing of what they will go through.

Mutual support and nurture problem-solving strategies, including favoring family reunion, restoring people dignity and control over the environment, help children recover a more positive social reality, are major protective factors in buffering the impact of war, displacement and related trauma.

By November 2022, Italy had hosted more than 170.000 Ukrainian refugees. The National Service intervention, coordinated by the Civil Protection Department, has developed a Plan for the reception and assistance of the population from Ukraine to uniform the response to the emergency on the national territory. The plan has focused on two aspects: humanitarian assistance and reception. The network for reception is composed of the CAS - Extraordinary Reception Centers and the SAI - Integration Reception System. The Plan also provides measures related to health care and education to ensure mandatory vaccination requirements and the access to the school system for unaccompanied foreign minors. As to plans aimed to address mental health issues, the right to care is guaranteed, but several issues can be identified that limit the impact of the national policies on the needs of this population.

None Declared

The duration of untreated psychosis (DUP) continues to be a global priority. Early intervention services were established to reduce treatment delays but have had limited impact. This systematic review examines barriers and facilitators to seeking access to these services, to identify targets for service level change.

We conducted a systematic review of relevant databases (PsychINFO, MEDLINE, CINAHL, and PsychARTICLES) using pre-defined search terms for psychosis, early intervention, and barriers and facilitators. Given the majority of qualitative studies, a thematic synthesis rather than meta-analysis was indicated.

The search yielded 10 studies. Mental health stigma and discrimination predict DUP, compounded by structural barriers which limit the impact of early intervention services on timely access to recommended treatments. Synthesis of the qualitative studies generated three themes: knowledge, relationships, and stigma. Lack of knowledge, absence of supportive relationships (social and professional), and self-stigma constitute significant barriers to seeking access to early intervention services.

This is the first review of the barriers and facilitators to seeking access to early intervention services. The findings highlight public health and secondary care service targets to expedite access to recommended treatments and thereby reduce the DUP.

The number of people seeking gender reassignment (GR) has increased everywhere and these increases particularly concern adolescents and emerging adults with female sex. It is not known whether the psychiatric needs of this population have changed alongside the demographic changes.

A register-based follow-up study of individuals who contacted the nationally centralized gender identity services (GIS) in Finland in 1996–2019 (gender dysphoria [GD] group, n = 3665), and 8:1 age and sex-matched population controls (n = 29,292). The year of contacting the GIS was categorized to 5-year intervals (index periods). Psychiatric needs were assessed by specialist-level psychiatric treatment contacts in the Finnish Care Register for Hospital Care in 1994–2019.

The GD group had received many times more specialist-level psychiatric treatment both before and after contacting specialized GIS than had their matched controls. A marked increase over time in psychiatric needs was observed. Among the GD group, relative risk for psychiatric needs after contacting GIS increased from 3.3 among those with the first appointment in GIS during 1996–2000 to 4.6 when the first appointment in GIS was in 2016–2019. When index period and psychiatric treatment before contacting GIS were accounted for, GR patients who had and who had not proceeded to medical GR had an equal risk compared to controls of needing subsequent psychiatric treatment.

Contacting specialized GIS is on the increase and occurs at ever younger ages and with more psychiatric needs. Manifold psychiatric needs persist regardless of medical GR.

Today, the indicated prevention of psychosis prior to its first episode is mainly based on clinical high-risk of psychosis (CHR) criteria, namely ultra-high risk criteria and basic symptom criteria. These are associated with conversion-to-psychosis rates of about 30% within three years. Thus, many patients meeting CHR criteria will not progress to psychosis over a medium-term period, and the cost-benefit evaluation of CHR states is always complicated by the largely unknown individual psychosis risk of CHR patients. In consequence, for the lesser risk of adverse events, treatment recommendations commonly favour non-pharmacological strategies, in particular cognitive-behavioural psychotherapy. Yet, individual risk estimation in identified CHR patients is increasingly done with help of machine learning algorithms, which might help to identify CHR patients who would greatly benefit from an additional pharmacological intervention with low-dose antipsychotics. The presentation will discuss the evidence-base of such a multistep, machine learning informed prevention strategy.

None Declared

Over the past decades the role of sex in the antipsychotic treatment type and dose selection has been virtually overseen. In fact, medication approval trials barely stratify for sex differences. Emerging hints from different types of data highlight the need for antipsychotic treatment personalization within the context of sex differences. Varying bioavaibility patterns of the prescribed antipsychotics between female and male patients may be easy to capture measuring plasma or serum levels of the antipsychotics ultimately guiding dose selection in clinical routine. Here we will discuss pitfalls and current evidence regarding sex affecting dose selection to enhance safety and effectiveness outcomes of antipsychotic treatment.

G. Schoretsanitis Consultant of: HLS Therapeutics and ThermoFisher

The European Psychiatric Association (EPA) is an organization that speaks on behalf of its individual members and members of National Psychiatric Associations (NPAs). The aim of this study to identify and investigate current contents of ethical codes and practices in the countries belonging to EPA.

The study is an expert survey sent out to 44 representatives of 30 NPAs covering the following topics: the existence of national bodies dealing with ethical issues in psychiatry, the availability of documents relevant to ethical issues, the types of ethical issues addressed at the national level, and the current and envisaged ethical debates.

Out of 44 experts invited to participate in the study, 31 NPAs from 30 countries responded (response rate 70.45%). In the majority of countries, the general mission statement serves as the main document covering ethical issues in psychiatry. Most frequently, internal documents were reported to address medical malpractice, workplace bullying, plagiarism, academic fraud, sexual abuse, and discrimination/racism. Furthermore, internal documents cover the ethical assessment of potentially controversial procedures, including psychosurgery, euthanasia, and pregnancy termination. The most important topics for debate at the level of NPAs/EPA were associated with violations of clinical practice standards and human rights.

NPAs are active in the field of professional ethics, defining ethical standards related to interactions among professionals and services provided by mental health care professionals. Future collaboration of NPAs, under the umbrella of the EPA, could allow to develop a database of local ethical documents that would be translated into English and accessible to all EPA members.

By the decision of the Polish Government, all persons arriving in the territory of the Republic of Poland after the commencement of the Russian aggression against Ukraine have free access to public psychiatric assistance, including reimbursement of pharmacological treatment on the same terms as Polish citizens. According to the UHNR data over 4 million displaced people, refugees, came to Poland so far and some of them benefited from such help.

Displaced individuals suffer from the consequences of traumatic events, exhibit psychological problems or develop mental disorders, including post-traumatic stress disorder, depressive and anxiety disorders or relapses of psychotic episodes.

The lecture will present data from the Interdisciplinary War in Ukraine Research Laboratory by pointing out the most important problems faced by Ukrainian refugees in Poland, why they chose Poland when escaping the war, how they evaluate Polish help, what their integration in Poland looks like. The survey also measured the level of war trauma (RHS-15). The results of the analysis show that most refugees present post-traumatic stress disorder symptoms (76 %), while only 0.15% of this population was treated in public psychiatric facilities.

Mental healthcare services are suddenly faced with major challenges and need to develop or expand strategies to address them. The Polish Ministry of Health prepared and started implementation of a reform of the mental health care system for adult as well as children and adolescent psychiatry. This fundamental reform should comprise three main actions, i.e. integration of mental health services into primary healthcare; establishment of community psychiatric services together with the provision of inpatient services in general hospitals; and limitation of the role of mental hospitals to specific tasks only (long-term or specialist treatment).

None Declared

Psychiatry has changed a lot during the last decades and lot of effort has been made to ensure that treatment of schizophrenia spectrum disorders is in line with modern science of medicine. Therefore, in everyday practice the psychiatrist is in a constant process of decision making when to start pharmacological treatment of early psychosis and with what dosage. The lecture will include evidence-based treatment options, the aspects of clinical practice and the power of shared decision-making in psychiatry.

None Declared

Lifestyle interventions are important to improve the mental and physical health outcomes of people with mental illness. However, referring patients to lifestyle interventions is still not a common practice for mental healthcare professionals (MHCPs) and their own lifestyle habits may impact this. The aim of this study was to investigate MHCPs’ personal lifestyle habits, their lifestyle history and referral practices, and if these are associated with their lifestyle habits, gender, and profession.

In this cross-sectional study, an online questionnaire was distributed across relevant MHCP’s in The Netherlands. Ordinal regression analyses on lifestyle habits, gender, profession, and lifestyle history and referral practices were conducted.

A total of the 1,607 included MHCPs, 87.6% finds that lifestyle should be part of every psychiatric treatment, but depending on which lifestyle factor, 55.1–84.0% take a lifestyle history, 29.7–41.1% refer to interventions, and less than half (44.2%) of smoking patients are advised to quit. MHCPs who find their lifestyle important, who are physically more active, females, and MHCPs with a nursing background take more lifestyle histories and refer more often. Compared to current smokers, MHCPs who never or formerly smoked have higher odds (2.64 and 3.40, respectively, p < 0.001) to advice patients to quit smoking.

This study indicates that MHCPs’ personal lifestyle habits, gender, and profession affect their clinical lifestyle practices, and thereby the translation of compelling evidence on lifestyle psychiatry to improved healthcare for patients.

There are a lot of studies investigating gender differences in the side effects of first and second-generation antipsychotic drugs. Even though some side effects are seen at higher rates in women, it is not determined yet the influence of gender on the efficacy and side effects of antipsychotic agents is still not well clear. In this review, we give a brief overview of antipsychotic side effects leading probably to distinguished clinical outcomes in both sexes.

None Declared

Different components of the endocannabinoid (eCB) system such as their most well-known endogenous ligands, anandamide (AEA) and 2-arachidonoylglycerol (2-AG), have been implicated in brain reward pathways. While shared neurobiological substrates have been described among addiction-related disorders, information regarding the role of this system in behavioral addictions such as gambling disorder (GD) is scarce.

Fasting plasma concentrations of AEA and 2-AG were analyzed in individuals with GD at baseline, compared with healthy control subjects (HC). Through structural equation modeling, we evaluated associations between endocannabinoids and GD severity, exploring the potentially mediating role of clinical and neuropsychological variables.

The sample included 166 adult outpatients with GD (95.8% male, mean age 39 years old) and 41 HC. Peripheral blood samples were collected after overnight fasting to assess AEA and 2-AG concentrations (ng/ml). Clinical (i.e., general psychopathology, emotion regulation, impulsivity, personality) and neuropsychological variables were evaluated through a semi-structured clinical interview and psychometric assessments.

Plasma AEA concentrations were higher in patients with GD compared with HC (p = .002), without differences in 2-AG. AEA and 2-AG concentrations were related to GD severity, with novelty-seeking mediating relationships.

This study points to differences in fasting plasma concentrations of endocannabinoids between individuals with GD and HC. In the clinical group, the pathway defined by the association between the concentrations of endocannabinoids and novelty-seeking predicted GD severity. Although exploratory, these results could contribute to the identification of potential endophenotypic features that help optimize personalized approaches to prevent and treat GD.

Psychiatric problems occur in people’s normal daily life, in a dynamic interaction with the context people are in. Yet, we have very few techniques to assess this dynamical nature of symptoms, nor do we have good insights in how people actually function in their ordinary life. Ambulatory assessment techniques such as Experience Sampling Methodology (ESM) or Ecological Momentary Assessment (EMA) have been proposed as a potential clinical tool to bridge this gap. Yet, very few of these techniques have actually made it to the clinic. In my talk, I will discuss the strengths and limitations of using these digital diary techniques to open up someone’s real life in clinical practice. I will discuss qualitative research identifying barriers and facilitators, identified by patients and clinicians. I also will discuss what is needed in terms of technology and data security, by demonstrating the MoMent app and MoMent Dashboard, that has been developed within the H2020 IMMERSE project. Finally, I will discuss how these digital mental health tools could help in developing a much more fine-grained understanding of how psychopathology emerges in the realm of ordinary life, making patients active partners in the clinical process.

None Declared

Severe mental disorders – such as schizophrenia, bipolar disorder, and substance use disorders – exert a negative impact not only on affected people but also on their carers. To support carers of people with severe mental disorders, several psychosocial interventions have been developed.

This systematic review and meta-analysis aimed to assess whether psychosocial interventions for carers of persons with schizophrenia, bipolar disorder, or substance use disorders produce benefit/harm with respect to a series of outcomes – including subjective and objective burden, depressive symptoms, well-being/quality of life, sleep, skills/knowledge, self-efficacy, physical health – as compared to standard support/support as usual or other control conditions.

In carers of persons with schizophrenia, psychoeducational interventions were associated with significant improvement in personal burden, well-being, and knowledge about the illness; and a supportive-educational intervention with an improvement in personal burden. In carers of persons with bipolar disorder, psychoeducational interventions were associated with significant improvement in personal burden and depressive symptoms; family-led supportive interventions with an improvement in family burden; family-focused intervention and online “mi.spot” intervention with a significant reduction in depressive symptoms. Psychosocial interventions used for carers of persons with substance use disorders were found to be overall effective on the level of well-being, but the low number of trials did not allow detection of differences between the various psychosocial interventions.

The quality of the evidence ranged from very low to moderate, suggesting the need for further better-quality research.

Recent reports of individuals experiencing suicidal and/or self-injurious behaviors while using liraglutide and semaglutide have heightened the concerns regarding neuropsychiatric safety of Glucagon-like peptide-1 agonists (GLP-1RAs). As real-world evidence is very limited, we explored the association between GLP-1RA and suicide/self-injury by mining the FDA Adverse Event Reporting System (FAERS) database.

The FAERS database was queried from 2005 Q2 to 2023 Q2. The Reporting Odds Ratio (ROR) and Empirical Bayes Geometric Mean (EBGM) were used to conduct the disproportionality analysis.

A total of 534 GLP-1RA-associated suicide/self-injury cases were reported in the FAERS during the study period. GLP-1RA did not cause a disproportionate increase in overall suicidal and self-injurious cases (ROR: 0.16, 95%CI 0.15-0.18, P < 0.001; EBGM05: 0.15). Stratified analyses found no safety signal of suicide/injury for GLP-1RA in both females and males. The ROR for suicide/self-injury with GLP-1RA was slightly elevated (ROR: 2.50, 95%CI 1.02-6.13, P = 0.05) in children, while the EBGM05 was < 2 in this population. No significant signal value was observed in other age groups. No over-reporting of suicide/self-injury was identified for GLP-1RA before or after the COVID-19 pandemic outbreak.

The cases of suicide or self-injury reported to FAERS do not indicate any overall safety signal attributable to GLP-1RA at this time. Subgroup analysis revealed a marginal elevation of ROR for suicide and self-injury with GLP-1RA in children, but no safety signal was detected by EBGM05 in this population. Further large-scale prospective investigations are still warranted to further confirm this finding.

Although cognitive impairment is a core symptom of schizophrenia related to poore outcome in different functional domains, it still remains a major therapeutic challenge. To date, no comprehensive treatment guidelines for cognitive impairment in schizophrenia are implemented.

The aim of the European Psychiatric Association (EPA) guidance paper was to provide a comprehensive meta-review of the current available evidence-based treatments for cognitive impairment in schizophrenia, structured into three sections: pharmacological treatment, psychosocial interventions, and somatic treatments.

Based on the reviewed evidence, the EPA guidance recommends an appropriate pharmacological management as a fundamental starting point in the treatment of cognitive symptoms in schizophrenia. Among psychosocial interventions, cognitive remediation and physical exercise are recommended for the treatment of cognitive impairment in schizophrenia. As for cognitive remediation, some variables have been confirmed as core elements for treatment effectiveness.

The dissemination of the EPA guidance paper may promote the development of shared guidelines concerning the treatment of cognitive functions in schizophrenia, with the purpose to improve the quality of care and to achieve clinical recovery in this population.

None Declared

Epidemiological studies indicate an alarming narrowing in the gender gap of alcohol and tobacco use especially in adolescents, which may reflect changes in sociocultural patterns in women. Moreover, women use more often alcohol to cope with stress and negative feelings. Pharmacokinetics and pharmacodynamics differences, reward process specificities, and female hormones play a major role in gender differences. Women’s consumption of alcohol may be associated with serious birth and developmental consequences in newborns.Thibaut F et al. WFSBP and IAWMH Guidelines for the treatment of alcohol use disorders in pregnant women. The World Journal of Biological Psychiatry 2019 20(1):17-50

None Declared

Loneliness has become a big issue in the time of the COVID pandemic. The attention to the topic also has to do with the increase in people living alone in Europe, although this also has to do with prosperity. Living alone does not yet mean being lonely. In the scientific discussion and especially in the measures, a differentiation must be made between loneliness, solitude and social disintegration. Poor social integration is easily measurable and has a lot to do with the physical health (mobility, vision and hearing) of the people concerned. However, the extent to which participation in social and cultural opportunities is possible, for example through the expansion of public transport, also plays an important role.

Loneliness, on the other hand, is by definition subjective and strongly linked to mental health. It describes the subjective suffering of missing or unsatisfactory social relationships, lack of integration and security. Loneliness is often found in two peaks, among the young and the old. Political and public health campaigns often focus on social integration measures. However, measures to combat loneliness mean first and foremost recognising mental illness in old age, especially depression. But they also mean providing help to people with long-term mental illness in old age.

None Declared