The young adult can experience psychological difficulties related to the delicate phase of life he/she is going through. Many of them show psychological difficulties but only a small portion receive the needed care. In this regard, internet-based interventions represent an important resource.

MindBlooming is a seven-week intervention delivered through a mobile application for university students with mild to moderate psychological difficulties. The application is the result of the interdisciplinary work between the Department of Psychology and the Department of Informatics, Systems and Communication of the University of Milan-Bicocca.

The intervention focused on symptoms of depression, anxiety, sleep problems, self-destructive thoughts, job- and study-related stress and burnout, and chronic pain. It is based on different approaches (multi-approach), primarily psychoeducation, Cognitive-Behavioral Treatment (CBT), and third-wave CBT. During the first pilot study, the intervention consisted of a 7-week treatment on two problematic areas according to each students’ personal needs, identified through an initial assessment. The achieved results are promising especially in terms of interest shown by students. However, we encountered technical problems that hampered the pilot study. A second pilot will be performed to further test the application.

The MindBlooming project will be discussed in light of the need for further multidisciplinary research that confirms how biomarkers can be sensitive to non-pharmacological internet-based interventions.

cognitive-behavioral treatment; internet-based intervention; university students.

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The Childhood Mental Disorders Research Group of ELTE began helping displaced children and their families immediately after the outbreak of war in Ukraine in March 2022. This work is still being carried out on a voluntary basis. According to the current needs, they organize "playgroup" for children and their families several times a week both at a fixed location at the ELTE and at external locations in shelters where they work with many children and their families at the same time. The main focus of the groups is the prevention of mental illness.

In this presentation, the work of the Research group will be presented, which has been done in a shelter that accommodates mainly families with Roma ethnic backgrounds from the Transcarpathia region fleeing the Russian-Ukraine war.

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The war in Ukraine caused many people to flee within Ukraine and across Europe. Trauma, separation from family and prolonged uncertainty increase the risk of posttraumatic stress disorder and depression among Ukrainians. The element of time is a critical aspect of intervention in stress-related disorders as an identical intervention may be beneficial or harmful if given at different times, focussing on primary, secondary or tertiary prevention. Recent studies showing the importance of timing of intervention in prevention of PTSD lend further support to the concept of the “golden hours” or “window of opportunity”. Dr. Iryna Frankova will present lessons learned from implementation of this psychological first aid digital intervention of low intensity during the ’golden hours’ following escalation of the war in Ukraine. During the talk she will provide guidance on what should and should not be done for the end users, as well as strengths and limitations of the chatbot intervention.

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Research investigating interventions for problematic usage of the Internet (PUI) remains at an early stage but is steadily developing. In terms of therapies assessed through randomized clinical trials, literature suggests that cognitive behavioral therapy may be the most effective intervention but definitive statements as to its benefits need more testing. In relation to pharmacological treatments for PUI, studies have largely examined the efficacy of agents such as antidepressants and stimulants with a potential therapeutic effect of escitalopram, bupropion, methylphenidate, and atomoxetine. Another emerging form of potentially useful treatment involves non-invasive neurostimulation techniques such as transcranial magnetic stimulation and transcranial direct current stimulation. These interventions are thought to mediate their effect in PUI via stimulation of cortical brain cells and modification of their related functions. In summary, although the limited available treatment evidence includes some promising findings, there is a need for higher-quality research to develop best practice guidelines and determine cost-effective options in PUI treatment. The presentation will provide a state-of the-art overview in the field of therapeutics for PUI.

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

Bipolar disorder (BD) has been consistently associated with alterations in the immune system. Evidence suggests a condition of systemic low-grade inflammation due to decreased adaptive, increased innate immunity, with higher levels of circulating cytokines, higher macrophage/monocyte inflammatory activation patterns, and higher neutrophils to lymphocyte counts; and with a dynamic pattern of premature immunosenescence and partial T cell defect starting early in adolescence, involving a reduction of naïve T cells and an expansion of memory and senescent T cells. Quantitative analysis of circulating inflammatory markers suggested persistent low-grade inflammation.

A growing literature suggests that the immune system plays a core role in maintaining brain homeostasis, with both adaptive and innate immune support, ensured by cell trafficking across the blood brain barrier, being essential for brain maintenance and repair in healthy conditions, and disrupted in brain disorders including BD. Measured in peripheral blood, these markers of altered immuno-inflammatory setpoints parallel activation of microglia and disruption of white matter (WM) integrity in the brain.

Studies in the field are in its infancy, but findings by our group showed that: circulating Th17 cells correlated with higher FA, while regulatory FOXP3+ cells correlated with higher RD and MD, and with lower fMRI neural responses in the right dorsolateral prefrontal cortex; higher circulating cytokine-producing NK cells were fostered by ongoing lithium treatment and directly correlated with better FA, and inversely with RD and MD, also partially mediating the known benefits from lithium on WM; and activation status and expression of killer proteins by cytotoxic CD8+ T cells negatively associated with WM microstructure, thus suggesting that CD8+ T cells can leave the blood stream to migrate into the brain and induce an immune-related WM damage in BD.

Implications of these findings for neuroprogression, clinical outcomes, and new treatment strategies of the disorder will be discussed.

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Most substance use disorders (SUDs) emerge in adolescence and young adulthood. Early interventions in young people may reduce the risk and severity of SUD and other mental disorders. However, we are not able to reach our young people early enough for prevention and treatment, and when we do, they often already show a high concentration of comorbid mental disorders and signs of a chronic intermittent course of SUD. Hence, we must reach our addicted young patients at an earlier stage, when symptoms are still mild or transient, or perhaps even before that – when they only show precursors of possible dysfunction.

One of the most prominent precursors of dysfunction is our ability – or lack thereof – to control or "self-regulate" our behaviors, cognitions, and emotions. Many scientists argue that poor self-regulation is perhaps the core determinant of the development of mental health disorders, including addiction. Several prospective general population studies have shown that poor childhood self-control early in life is a strong predictor of many negative outcomes later in life, up to 20 to 30 years later in adulthood. Although correlational in nature, these findings suggest that early childhood interventions that are deliberately aimed at improving self-regulation may be effective in preventing these negative life outcomes, and that early prevention and intervention targeted at improving self-control may reduce the risk of a broad array of psychiatric and social problems, including addiction. Indeed, several recent large-scale systematic reviews have suggested that self-regulation skills are malleable and can be learned through instruction and practice, and perhaps most so in the early years, roughly around 3 to 6 years, when there is a steep increase in learning curve, when the plasticity of the brain is still high, and when self-regulation skills are still very much in development.

This presentation provides an overview of the rationale and study findings of early prevention of substance use disorders and other mental health disorders. In terms of broad prevention, much can be gained by widespread, consistent implementation and normalization of early prevention at the pre- and elementary school level.

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Elevated peripheral inflammation is common in psychosis. Impairments in general cognition were linked to elevated C-reactive protein (CRP) and other inflammatory markers in patients with psychotic disorders. Whether there is a subgroup of persons with elevated peripheral inflammation demonstrating deficits in specific cognitive domains remains unclear. While molecular underpinnings of altered inflammation in psychosis are hypothesized, genetic contributions to relationships of psychosis, inflammation, and cognition have not been clarified. Thirteen peripheral inflammatory markers and 17 neurobehavioral tasks were quantified in a subset of participants (129 psychosis, 55 healthy controls-HCs) from the Bipolar-Schizophrenia Network on Intermediate Phenotypes (B-SNIP) consortium. Principal component analysis resulted in 5 inflammation factors across inflammatory markers. Three latent cognitive domains (Visual Sensorimotor, General Cognitive Ability, and Inhibitory Control) were characterized based on the neurobehavioral battery. Hierarchical clustering identified a psychosis subgroup with elevated inflammation and worse cognitive performance. Genetic predispositions to schizophrenia and cognition were explored in relation to inflammation. Among persons with psychosis, higher inflammation indices were associated with impairments of Inhibitory Control and Visual Sensorimotor function. Greater deficits in Inhibitory Control were observed in a high inflammation patient subgroup. Consistent with previous studies, global genetic correlations of schizophrenia, CRP, and cognition were observed. Significant bivariate local genetic correlations of CRP with schizophrenia or cognition across 22 loci with several genes in 1 locus on chromosome 3 suggested pleiotropic mechanisms for inflammatory relationships with cognition and psychosis. Specific neurobehavioral domains may be more sensitive to inflammation dysregulation in psychosis as compared to general cognitive function, particularly performance on tasks requiring ongoing behavioral monitoring and control. These, along with evidence of genetic correlations of CRP, psychosis, and cognition, provide further supporting evidence that inflammation dysregulation is an important underlying mechanistic contributor to the disruption of cognition in psychosis. Targeting this dysregulation may be an avenue for novel therapeutics to improve cognitive outcomes in these patients.

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Bullying constitutes a major public health concern, on account of its high prevalence rates and its association with a wide range of adverse health outcomes across the lifespan, including increased incidence of mental disorders such as depression, anxiety, and psychotic disorders. Previous research suggests effectiveness of school-based programmes in reducing bullying prevalence and improving mental health outcomes in children and adolescents. Despite the fact that some subpopulations such as young people with special educational needs are at increased risk for both bullying victimisation and mental health difficulties, there is little information on the effectiveness of universal school-based programmes in these high-risk populations. We will review available evidence of the effectiveness of school-based anti-bullying interventions as a tool to improve youth mental health, including results from a cluster-randomised clinical trial conducted in 20 publicly funded schools in Madrid to test the effectiveness of a 12-week web-enabled, user-friendly, school-based, preventive programme incorporating universal and targeted components (LINKlusive; ISRCTN15719015) and discuss the potential implications, challenges, and unmet needs of such approaches.

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Psychosis onset is a transdiagnostic event that leads to a range of psychiatric disorders, which are currently diagnosed through clinical observation. Since several years, the role of immune system in the pathophysiology of psychosis has been well-recognized, showing differences from the onset to chronic phases. In this lecture, I will show the results of our recent study that tested the hypothesis of the existence of subgroups of first-episode psychosis (FEP) patients identified by distinct peripheral immunomarkers’ profiles, possibly underpinning a subgroup-specific immunopathogenesis. More in detail, I will show the results obtained by the unsupervised machine learning model that we applied to the set of 12 peripheral blood immune gene transcripts, which we recently demonstrated to classify with high accuracy a cohort of FEP patients and HC. Also, I will report the results obtained by performing post-hoc univariate analyses using selective clinical, cognitive, and brain structural phenotypes of FEP patients and HC belonging to each subgroup identified by the computational model. I will extensively discuss two key clusters identified and validated by our model: 1) a FEP cluster characterized by the high expression of inflammatory and immune-activating genes; 2) a cluster consisting of an equal number of FEP and HC subjects, which did not show a relative over or under expression of any immune marker (balanced subgroup). Therefore, in this lecture I will emphasize that our study has been the first to demonstrate the existence of a psychosis onset subgroup identified by a peculiar multivariate pattern of immunomarkers, independently of clinical features or categorical diagnosis. This is paramount as if validated in independent samples, our clustering model could enable the sample selection in clinical trials aiming to test the efficacy of novel immunomodulant or anti-inflammatory therapies tailored to the specific inflammatory subgroup of psychotic patients.

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Prof. dr. sc. Slađana Štrkalj Ivezić, psychiatrist, University psychiatric hospital Vrapče, Croatia

The aim is to present the importance of educating psychiatrists to acquire competencies relate to knowledge, attitudes and behavior in holistic understanding of patients, implementation of principles of recovery and respect for human rights and use of alternative interventions to coercion in order to eliminate or reduce coercive practice such as involuntary hospitalizations and coercive measures. All the necessary competences such as clinical assessment, skills to form therapeutical relationship and application of evidence base interventions that can prevent or significantly reduce the use of coercive measures: de-escalation; availability of a comfort room with sensory modulation; a trained response team; joint crisis intervention, advance directives and successful multimodal strategies will be presented including the elimination of potential environmental triggers of aggression in the hospital setting. The training and education of psychiatrists on human rights, recovery and alternatives to coercive practice can abolish or significantly reduce coercion.

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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.

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The code of ethics of the EPA intends to guide the ethical practice of psychiatry by offering a comprehensive approach to the ethical challenges in the field. It highlights universal ethical principles and considers their application to the specific practice of psychiatry. Ethical questions in psychiatric practice are manifold: tensions between respect for autonomy versus care and protection from harm, problems with coercive therapy and capacity for judgement etc. To receive more information, the Committee on Ethical Issues conducted a survey on “Ethics in psychiatric practice” to collect information from inpatient treatment settings of individual wards in psychiatric hospitals Europe-wide on following topics:

• - Experiences and practices addressing ethical conflicts and malpractice from the personal perspective of health care workers in these settings

• - Identification and engagement with violence

• - Measures for the reduction of restraints and coercion (violation of the autonomy of patients)

In this talk, the preliminary results of this survey will be presented and discussed.

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Dr. Pereira-Sanchez, Founder and Executive Director of the World Network of Psychiatric Trainees (WNPT) and responsible for the WNPT Human Rights Curriculum Initiative, will present an overview of the same, which aims at understanding the current state of human rights education for psychiatric trainees across the world and at partnering with relevant organizations to develop international standards on the topic. The talk will highlight pilot results and achievments of the initiative and invite feedback, discussion, and further collaboration.

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In the recent past, the standardized suicide mortality rate (SMR) in Lithuania was more than double the global SMR and nearly one and a half higher than in the EU. Herewith Lithuania has high male-to-female SMR ratios e.g., at 7.1 in 2016. Autopsy studies in Lithuania revealed that approximately two thirds of men and one third of women who died by suicide had a blood alcohol con-centration level above 0.04 g/dL. Although suicide is a complex phenomenon, heavy alcohol use has been considered as it’s important risk factor though the relationship was never systematically studied before in Lithuania. Experts have suggested that gender differences in excessive alcohol consumption can explain the gender disparity in suicide mortality and linked tackling the harmful use of alcohol as an opportunity for suicide prevention. Alcohol control policies may cause immediate effect on excessive alcohol consumption at both the population and individual-level and may be capable of impacting suicide mortality rates by altering alcohol use patterns at both domains. Implementation of alcohol taxation policy in Lithuania provided an opportunity to evaluate it‘s impact on suicide mortality in a country comparable to other high income countries with a comparable health care and medical education systems.

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Over the past twenty years a large number of new psychoactive substances (NPS) have entered and modified the recreational drug scene. Their intake has been associated with health-related risks, especially so for vulnerable populations such as people with severe mental illness, who might be at higher risk of suicidality or self-injurious behavior. The consumption and frequent poly-consumption of NPS result in death, suicide, serious self-injury behaviours as well as adverse effects on medical and mental health. Hence, the talk will deal with current data on suicidality and self-injury behaviours due to the use of NPS, particularly considering the suicide and self-injury risk due to the NPS intake among vulnerable people with preexisting severe mental illness.

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Worldwide, suicidal patients are treated in residential care. The used interventions and support systems during inpatient care are important in suicide prevention. Nurses are asking for guidelines on how to provide care for suicidal depressed patients. The aim of this study is to explore useful processes during the nursing care for suicidal patients. These processes are identified by exploring the suicidal patient’s experiences with nursing care. We have developed a category system of helpful processes and interventions that are observed in nursing care for suicidal patients. The category system contains four core themes; nurse behavioral interventions, nurse attitudes, and nurse conversational intervention and environment.

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Alcohol plays a part in suicide risk in two ways. Alcohol intoxication is often a preceding factor in the acute suicidal phase. But also, chronic overuse or Alcohol Use Disorder (AUD) is a risk factor for suicide attempts and suicides over time. At least 1 in 4 AUD patients have serious lifetime suicide attempts. Standardized mortality rates (SMR) for suicide in AUD lie around 15-25. Gender differences in suicide risk and suicide attempts are influenced by at least 2 phenomena. Firstly, suicide attempts are more common and competed suicide is less common among females in the general population. Secondly, female AUD is rarer and female AUD patients tend to be sicker and have more mental health co-morbidities than male AUD patients. This leads to SMRs for suicide in female AUD patients being higher than in male AUD patients, even if suicides are more common in male AUD patients. Also, for suicide attempts, these are more common in female AUD patients. Suicide attempts seem to be more related to AUD severity in male AUD patients, but more related to mental heath co-morbidities in female AUD patients.

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In the treatment of persons with schizophrenia the goal has gradually shifted from the reduction of symptoms and prevention of relapse to recovery. However, this goal is achieved for a minority of persons with schizophrenia, while for most of them the disorder still is a major cause of disability, poor quality of life and premature death, and presents considerable social and economic costs.

Studies aimed at identifying variables with a significant impact on schizophrenia outcome indicate that early intervention, shared decision making, treatment continuity, physical comorbidities, negative symptoms, deficits in cognitive functions and functional capacity account for most of the functional impairment of patients but are often neglected in current clinical practice.

In this presentation, I will illustrate the role of these variables and the need for an in-depth clinical characterization of persons with primary psychoses to implement personalized treatment plans and improve the care of people with schizophrenia.

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tDCS is a low-cost and well-tolerated neuromodulation treatment of depression. It seems to be a good and effective option to start the treatment of depression along or instead of medication in mild or moderate depression. tDCS can be used as an add-on treatment with psychotherapy or medication. Home based tDCS is easy to conduct. However, tDCS should be used with qualified protocols like any other neuromodulation treatment. When the tools in psychiatry are diversifying the precise diagnostics, careful defining of the clinical picture and effective early and individually planned management of depression are key elements gaining better outcomes and preventing treatment resistant depression.

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Depression is one of the most common psychiatric disorders causing considerable economic burden. However, the current treatment as usual, pharmacotherapy and psychotherapy, provides unsatisfactory treatment outcome for majority of the patients and in most cases fails to prevent treatment resistance and chronicity. tDCS, has emerged as a new neuromodulation treatment and has shown efficacy in depressed patients. To provide important insight to the payers, the cost-utility of tDCS in comparison to treatment as usual, should be clarified.

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