Immunological study of late stages of schizophrenia manifesting in young adult age is of considerable interest for clarification of pathogenetic patterns of the disease and optimization of further treatment of patients.

To evaluate the relationship between the spectrum of inflammatory markers and psychopathological symptoms in patients with juvenile schizophrenia in a long-term follow-up study.

34 patients with schizophrenia (F20) first manifested at the age of 16-25 years were followed-up for 20-25 years. The mean age of the patients at the time of follow-up study was 46.7±3.2 years. PANSS and PSP scales were used to quantify the severity of psychopathological symptoms. The control group consisted of 20 healthy people. Plasma immune parameters included leukocyte elastase (LE) and α1-proteinase inhibitor (α1-PI) activity, and antibodies to S100B and myelin basic protein.

Three types of juvenile schizophrenia follow-up outcomes were identified. The immunological heterogeneity of the types allowed us to distinguish groups of patients differing in the level of inflammatory activation. There were a significant increase in LE and α1-PI in patients of the first type (with a predominance of personality dynamics), a significant increase in α1-PI in patients of the second type (with actual negative disorders) compared to controls, and no significant differences with controls in LE and α1-PI in patients of the third type (with relevant positive and negative disorders).

Residual psychopathological symptoms observed in the late stages of juvenile schizophrenia may be due to both low/moderate inflammation and genetic mechanisms.

None Declared

Elevated levels of lipopolysaccharide (LPS) in circulation support chronic inflammation, which is involved in the pathological process in the brain and may be a contributing factor to treatment resistance in schizophrenia.

To compare inflammatory markers and indicators of systemic endotoxemia (SE) in patients with treatment-resistant schizophrenia and in those with a good response to treatment.

The study involved 34 patients with schizophrenia (27±7,5 years) (F20) in an acute psychotic state: 15 patients with TRS (non-responders), 19 patients responded to treatment with reduced symptoms (responders). The markers of systemic inflammation (leukocyte elastase (LE) and a1-proteinase inhibitor (α1-PI) activity, CRP concentration, antibodies (Abs) to S100B and myelin basic protein) and the indicators of SE (LPS level and Abs to LPS) were determined in the blood of patients.

The responders showed a significant increase in LE and α1-P1 activity (p<0.001), CRP concentration (p<0.05), and Abs to neuroantigens (p<0.05) compared to controls. LPS levels did not differ from control values. In non-responders, a moderate increase in LE and α1-PI activities (p<0.05) and a significant increase in CRP concentration (p=0.01) were accompanied by no significant differences in Abs to neuroantigens. These patients had elevated LPS level and Abs to LPS deficiency compared with both responders (p<0.01) and controls (p<0.05).

The identified spectra of systemic inflammation markers, elevated LPS level, and insufficient anti-endotoxin immunity in patients with treatment-resistant schizophrenia may be related to endotoxin tolerance. Further research in this field can help develop new approaches to overcoming resistance to therapy in patients with schizophrenia.

None Declared

Transcranial direct current stimulation (tDCS) is a form of neuromodulation most commonly used in depression. tDCS aims to modulate cortical activity by the application of a weak electrical current to the brain via electrodes placed on the scalp. Several studies have identified the potential of tDCS for managing behavioural and psychological symptoms in a range of dementias, including Alzheimer’s disease, vascular dementia, dementia with Lewy bodies and frontotemporal dementia. Although the preliminary data on efficacy is promising, the safety of repeatedly neuromodulating the brain of a person with dementia, by tDCS, has not been extensively reported.

Our aim was to review the current literature on how safe it is to repeatedly neuromodulate a brain with dementia.

Advanced literature searches of PubMed and the Web of Science Core Collection were conducted to identify relevant publications. The search terms deployed were: “tDCS” or “transcranial direct current stimulation” and “frontotemporal dementia” or “vascular dementia” or “Lewy body” or “Alzheimer’s disease”. The following inclusion criteria were applied to the search: (1) publications which focused on the use of tDCS in patients with either frontotemporal dementia, vascular dementia, dementia with Lewy bodies or Alzheimer’s disease, (2) studies involving human participants and, (3) publications written in, or readily translated to English.

216 articles were returned in the initial search. Following the removal of 54 duplicate articles, the remaining 162 underwent eligibility screening using the titles and abstracts. 31 articles were then selected for a full text reading and following this, 12 studies were selected to be included in the review. Across all 12 studies, 3590 sessions of active tDCS were performed with no severe adverse effects being reported. The most commonly occurring adverse effect was a tingling/burning sensation underneath the electrodes, followed by headache and skin changes. These reported effects tended to be mild and short lived.

Overall, the results of the reviewed papers suggest that repeated neuromodulation by tDCS can be safely performed in dementia patients. More and larger studies should aim to perform a greater number of sessions of tDCS, across a longer time period. Few studies assessed for potential brain damage as a result of tDCS and future studies should consider using MRI or monitoring biomarkers to further investigate this.

None Declared

Status Epilepticus is defined as a condition that can have long-term outcomes involving neuronal death and injury due to the failure of the mechanisms responsible for seizure termination or from the initiation of mechanisms that lead to abnormally prolonged seizures. Electroconvulsive therapy (ECT) is a highly effective treatment option for psychiatric disorders. Although it rarely occurs in the treatment, non-convulsive status epilepticus can be seen as a complication after ECT. Due to its rarity, this complication is not yet well understood, is challenging to diagnose, and information about treatment options is limited.

By sharing this case report, we aim to emphasize the importance of being careful in terms of the risk of status epilepticus in patients receiving electroconvulsive therapy.

Here in we present a 29-year-old patient with no previous neurological disease and who had a history of schizophrenia. Electroconvulsive therapy was planned because the patient was resistant to antipsychotic treatment. EEG was planned for the patient who had urinary incontinence during the ninth session of ECT. Generalized slow wave activity and intermittent rhythmic delta activity were observed in the EEG, therefore it was found suspicious for NCSE, and the patient was planned to perform an EEG again by administering diazepam to confirm the diagnosis. After diazepam, the patient whose EEG tracing was clearly improved was admitted to the neurology intensive care unit. He was followed up for 48 hours with continuous 4 mg/hour/day midazolam and continuous bedside EEG in the neurology intensive care unit. Concomitant lamotrigine was started at 100 mg/day. Significant improvement in EEG, sinusoidal alpha, and beta waves with the eye open was observed at the 48th hour, and the patient was transferred back to the psychiatry service. Lamotrigine treatment was increased up to 200 mg/day and clozapine treatment was adjusted to 350 mg/day in the psychiatry service. In the patient whose EEG was requested again before discharge.

The diagnosis of NCSE post-ECT can be laborious; the symptoms may not be characteristic and clear, and usually not distinguish from symptoms of confusion, delirium, or psychiatric illness, hence the follow-up psychiatrist should be careful. In suspicious cases, EEG should be taken, especially in patients at risk for seizures. These risky conditions include previous seizure history, and lithium or clozapine use.

The diagnosis of NCSE after ECT is a demanding condition. Particular attention should be paid to factors that will lower the seizure threshold. In cases with ECT treatment with clozapine, intermittent clozapine blood levels can be quantified and medication interactions and smoking can be considered. When the cases are examined, the common aspect of most of them is that the treatments have good results.

None Declared

Fibromyalgia Syndrome (FMS) is a highly prevalent condition, causing chronic pain and severe reduction in quality of life and productivity, as well as social isolation (Birtane et al. Clinical Rheumatology 2007; 26(5), pp. 679–684; Arnold et al. Psychosomatics. England 2010; 51(6), pp. 489–497; Lacasse, Bourgault and Choinière. BMC Musculoskeletal Disorders 2016; 17(1), pp. 1–9). Despite significant morbidity and economic burden caused by FMS, current treatments are scarce (Busch et al. The Journal of rheumatology. Canada 2008; 35(6), pp. 1130–1144; Bernardy et al. Journal of Rheumatology 2010; 37(10), pp. 1991–2005; Jackson et al. American journal of hematology 2016; 91(5), pp. 476–80).

To examine whether stimulation of the dorsal Anterior-Cingulate-Cortex and the medial Prefrontal-Cortex (ACC-mPFC) activity by deep Transcranial Magnetic Stimulation (dTMS) enhances a pain-directed psychotherapeutic intervention.

Nineteen FMS patients were randomized to either 20 sessions of dTMS or sham stimulation, each followed by a pain-directed psychotherapeutic intervention. Using H7 HAC-coil or sham stimulation, we targeted the ACC-mPFC; specific brain areas that have a central role in pain processing (Fomberstein, Qadri and Ramani. Current Opinion in Anaesthesiology 2013; 26(5), pp. 588–593; Tendler, A. et al. Expert Review of Medical Devices 2016; 13(10), pp. 987–1000). Clinical response to treatment was evaluated using the McGill Pain Questionnaire (MPQ), Visual Analogue Fibromyalgia Impact Questionnaire (VAS-FIQ), Brief Pain Inventory questionnaire (BPI), and the Hamilton Depression Rating Scale (HDRS).

DTMS treatment was safe and well tolerated by FMS patients. A significant decrease in the sensory and affective pain dimensions was demonstrated specifically in the dTMS cohort, as measured by the MPQ using paired-sample t-tests with Bonferroni correction for multiple comparisons on three-time points (Significant group x time interaction [F(2, 34) = 3.79, p < .05, η2 = 0.183]. No significant changes were found in the cognitive functions, psychophysical measurements of pain, or depressive symptoms in both dTMS and sham groups and between groups.

Our findings suggest that a course of dTMS combined with a pain-directed psychotherapeutic intervention can alleviate pain symptoms in FMS patients. Beyond the clinical possibilities, future studies are needed to substantiate the innovative hypothesis that it is not the dTMS alone, but rather dTMS driven plasticity of pain-related networks, that enables the efficacy of pain-directed psychotherapeutic interventions.

None Declared

NMDA-Receptor antagonists have rapid antidepressant and antisuicidal properties. However, the antidepressant effect is short lasting raising the question of best maintenance strategy, which is unanswered so far. Invasive vagus nerve stimulation (VNS) as a treatment option for refractory and chronic major depression was shown to reduce the need of maintenance treatment sessions in electroconvulsive therapy (ECT) patients.

There are no published data on the combination of VNS and esketamine. To determine the impact of the combination of VNS and esketamine in DTD.

In this naturalistic observational study, we investigated the short- and long-term impact of combination of VNS and esketamine in n=8 patients with difficult-to-treat depression (DTD). Follow-up evaluations were scheduled prospectively pre-surgery at baseline and every 3 months after VNS-implantation (follow-up period 12-24 months, mean 17).

The mean age of patients was 50,8 years. 50 % of patients (n=4) were female. All patients suffered from severe DTD (mean MADRS at baseline 30,9). Mean number of hospitalizations per months decreased from 0.17 to 0.11 after VNS implantation. 6 of 8 patients were offered maintenance esketamine treatment. Mean MADRS at 12-months was 19 (38.5 % MADRS reduction). The need of mean esketamine treatment sessions decreased from 2.3 at 6-months visit (V6) to 1.37 at V9 and 0.96 at V12 respectively. Termination of maintenance esketamine was possible in 4 cases after a mean of 11.5 months.

Combination of esketamine and VNS is a safe and effective treatment option in severely ill DTD patients to relieve disease severity and reduce hospitalizations. Need of esketamine treatment sessions decreases 6 months after VNS implantation.

None Declared

We previously demonstrated that the difference between 11 PM and 8 AM TSH response to protirelin (TRH) tests on the same day (∆∆TSH test) is an improved measure in detecting hypothalamic-pituitary-thyroid (HPT) axis dysregulation in depression. This chronobiological index is normalized after successful antidepressant treatment.

The present study aimed at assessing the effects of repetitive transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex (DLPFC) on the HPT axis activity in treatment resistant depressed inpatients (TRDs) (defined as having at least 2 treatment failures).

The ∆∆TSH test was performed in 13 TRDs and 14 healthy hospitalized control subjects (HCs). To be enrolled in this study, patients had to show reduced ∆∆TSH values (i.e., < 2.5 mU/L) at baseline (BL). After 20 sessions of rTMS (using daily theta-burst stimulation; 100% resting motor threshold; number of pulses/session: 900), the ∆∆TSH test was repeated in all inpatients. The 17-item Hamilton depression rating scale (HAM-D) was used to assess the severity of depression. Remission was defined by a final HAM-D score ≤ 8.

Compared to BL, HAM-D scores decreased and ∆∆ TSH values increased after 20 sessions of rTMS (both p< 0.05 by T-test). There was a relationship between the reduction in HAM-D scores from BL to endpoint and the increase in ∆∆TSH values (rho = - 0.64; n = 13; p = 0.018). At endpoint, 7 patients showed ∆∆TSH normalization (among them 6 were remitters), while 6 patients did not normalize their ∆∆TSH (all were non-remitters) (p < 0.005 by Fisher Exact test).

Our results suggest that after 20 sessions of rTMS, chronobiological restoration of the HPT axis activity is associated with clinical remission. Further investigation of the specific effects of rTMS on the HPT axis activity in TRDs is warranted.

None Declared

Non-invasive brain stimulation protocols are effective treatments for depressive episodes. Although the cognitive adverse effects of electroconvulsive therapy (ECT) are well documented, evidence regarding the cognitive effects of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) is mixed.

The aim of this study was to synthesize research on the cognitive effects of non-invasive brain stimulation protocols and to differentiate between studies of major depressive disorder (MDD), bipolar depression and mixed populations.

Following a systematic literature search of multiple electronic databases, a series of meta-analyses were conducted to estimate standardized mean differences (SMD) between pre- and post-treatment cognitive functioning across nine cognitive domains. Where possible, SMDs were estimated separately for MDD, bipolar depression and mixed populations. In studies that included both patients with MDD and bipolar depression, the percentage of patients with a diagnosis of bipolar depression was tested as a potential moderator.

More than 150 treatment arms were included in the analyses. For ECT, we observed a small decline in language functioning and a decrease in autobiographical memory scores. There was no evidence of pre-post differences across other cognitive domains. For rTMS and tDCS, small to moderate cognitive improvements were observed for several cognitive domains, for example for executive functioning. Across most analyses, between-study heterogeneity was high and could not be accounted for by differences between MDD, bipolar depression or mixed populations.

There was limited evidence that differentiation between studies of MDD, bipolar depression and mixed populations accounted for between-study heterogeneity in analyses of pre-post differences in cognitive functioning. Given that most studies included both patients with MDD and bipolar depression, this finding should be treated as preliminary. Across all the treatment protocols examined, more data are needed to investigate the cognitive effects of non-invasive brain stimulation in patients with bipolar depression.

None Declared

Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive treatment method and the only been approved for medication refractory depression by US Food and Drug Administration (FDA). However, comprehensive knowledge about rTMS is not yet widespread among psychiatrists. The aims of this study were to assess psychiatrists’ knowledge of and attitudes toward rTMS and to determine the contributing factors on knowledge of rTMS in Oman.

A quantitative observational cross-sectional study will be conducted using an online survey. Demographic information, knowledge of and attitudes towards rTMS measures were collected. Both univariate analysis, multiple linear regression was performed to identify the risk factors associated with knowledge levels.

A quantitative observational cross-sectional study will be conducted using an online survey. Demographic information, knowledge of and attitudes towards rTMS measures were collected. Both univariate analysis, multiple linear regression was performed to identify the risk factors associated with knowledge levels.

A total of 50 psychiatrists participated in this study (response rate = 83%). The average age of the participants is 32.7±4.3 years [26.0-41.0], more than half of them were females (n=28, 56.0%), and resident (Junior/Senior) (n=25, 50.0%). The majority of the samples are Omani (n=45, 90.0%), working in the tertiary hospital (n=38, 76.0%). The average scores on knowledge of and attitudes towards rTMS in this sample were 14.5±3.8 and 22.5±6.3, respectively. Linear model showed that senior residents and above had a higher knowledge level than junior residents (ß=4.65, p<.001). Those samples with the rTMS device in their work-place had a higher knowledge level than don’t have (ß=1.88, p=0.027).

Three factors have a directional effect on the level of knowledge among psychiatrists toward rTMS, namely, higher educational level, presence of rTMS device at the workplace and availability of standardized training in Rtms.

None Declared

Electroconvulsive therapy (ECT) is one of the few non-pharmacological stimulation treatment which is cost effective, effecious and lifesaving in various psychiatric disorders. Although myths and misconceptions prevailed in a society undermine the usefulness of such treatment.

Attitude towards Electroconvulsive therapy (ECT) among psychiatric patients.

It was a descriptive cross-sectional study conducted at the Department of Psychiatry and Behavioural sciences, Jinnah Postgraduate Medical Centre (JPMC), Karachi from 22-Oct-2019 to 21-April-2020 and a total of 250 psychiatric patients were enrolled.

Methode; Attitudes toward ECT were assessed using ECT attitude questionnaire6 (Annexure III). A 15 items questionnaire, each item has three alternatives based on which responses were categorized into positive, negative, or ambivalent attitudes. Mean score was calculated for each.

Patients who were given 8 positive answers out of 15 were labeled as having a positive attitude. Patients who were given 8 negative answers out of 15 were labeled as having a negative attitude. Patients who were given 8 I don’t know answers out of 15 were labeled as having ambivalent attitude.

Age 18-65 years

Either gender

Psychiatric patients, having awareness regarding their nature of illness and could give consent for study.

Patients with duration of illness >3 months.

Psychiatry patients who have no awareness regarding their illness.

Patients with impaired cognitive

Forty-four (45.83%) patients had positive attitude, 36 (37.50%) had negative attitude and 16 (16.67%) had ambient attitude.

Further stratification was also performed on the basis of educational status, occupational status, duration of illness, psychiatric diagnosis, and previous experience of ECT. There was no significant association was found of these variables with attitude regarding ECT.

Mean age was 39.58±12.48 years included in this study. There were 55 (57.29%) female and 41 (41.71%) male patients. There were 72 (75.00%) patients were household workers, 04 (4.17%) students, 06 (5.25%) unskilled labour, 3 (3.13%) skilled labour, 10 (10.42%) professionals and just 01 (1.04%) were law enforcement worker. 19 (19.79%) patients were diagnosed with schizophrenia, 62 (64.58%) were diagnosed with unipolar depression and 15 (15.63%) were diagnosed with bipolar disorder. Source of ECT information was 11 (11.46%) electronic media, 09 (9.38%) print media, 19 (19.79%) social media and 57 (59.38%) was from health professionals. Forty-four (45.83%) patients had positive attitude, 36 (37.50%) had negative attitude and 16 (16.67%) had ambient attitude.

Knowledge regarding electroconvulsive therapy (ECT) was low in psychiatric patients in Pakistan. Only 45.83% patients showed positive attitude towards ECT.

Carney S, Geddes J. Electroconvulsive therapy. Br Med J. 2003;326:1343-4

Gangadhar BN., Kapur RL., Kalyanasundaram S. Comparison of electroconvulsive therapy with imipramine in endogenous depression: a double blind study. Br J Psychiatry.1982;141:367–71.

Kellner CH., Fink M., Knapp R., Petrides G., Husain M., Rummans T., et al. Relief of expressed suicidal intent by ECT: a consortium for research in ECT study. Am J Psychiatry. 2005;162:977–82.

Baghai T C, Moller HJ. Electroconvulsive therapy and its different indications. Dialogues Clin Neurosci. 2008 Mar; 10(1): 105–17.

Weiner RD., Coffey CE., Folk J., Fochtmann LJ., Greenberg RM., et al. American psychiatric association committee on electroconvulsive therapy, The practice of electroconvulsive therapy. 2nd ed. Washington, DC: American Psychiatric Association; 2001

None Declared

Schizophrenia is a severe and disabling psychiatric disorder probably based on complex pathophysiological mechanisms of reduced inhibition, impaired connectivity and reduced plasticity in neural networks. Beside clinical symptomatology, a core feature of schizophrenia is a global cognitive and social disability, which strongly affect patients’ lives and their quality of life. The cognitive impairment involves memory, attention, executive functions, language, facial emotion recognition and theory of mind abilities. Cognitive remediation strategies, in addition to pharmacological and psychological treatments, has received increasing attention in recent years, as well as the use of non-invasive brain stimulation techniques such as TMS, which have demonstrated promising therapeutic potential.

The present study aimed to evaluate the efficacy of TMS to induce improvements in cognitive functioning in schizophrenia. It also aimed to test the effects of a combined approach to rehabilitation, using both TMS and cognitive remediation strategies.

16 patients were submitted to effective or sham iTBS over the left dorsolateral prefrontal cortex during 3 consecutive weeks. In half of patients the neuromodulation was combined with daily cognitive remediation training (Cogpack software), administered immediately after the application of TMS. Clinical, cognitive and social functioning were tested at baseline and at different timepoints after conclusion of the rehabilitation protocol (immediately after the 3 weeks protocol, and after 1, 3 and 6 months).

The preliminary results indicate that the proposed TMS protocol induced significant improvements in global cognition. In addition, patients submitted to TMS, even without combined cognitive rehabilitation training, showed major benefits after 1 month from brain stimulation.

These preliminary data suggest that TMS can induce long-lasting plastic changes in the prefrontal cortex of schizophrenic patients, improving their cognitive perfomances. TMS could be therefore considered in the treatment of schizophrenia to reduce cognitive impairments.

None Declared

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

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

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

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

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

None Declared

Schizophrenia is a chronic, frequent, and disabling psychiatric condition. The prognosis is more severe in the absence of treatment.

The aims of our study were to evaluate the quality of treatment adherence and the quality of insight of patients with schizophrenia and to assess the implication of these factors as predictors of poor adherence.

We conducted a cross-sectional and analytical study. We recruited 150 patients with schizophrenia treated at Razi Hospital of Manouba, divided into 113 patients with good adherence compared to 37 patients with poor adherence. We used the Medical Adherence Report Scale (MARS) to assess the quality of therapeutic adherence and the Birchwood Insight Scale for Insight Assessment.

Poor treatment adherence in patients with schizophrenia was significantly associated with poor insight (p=0.001). Good adherence was associated with positive perception of treatment effectiveness (p<0.001). The predictive factor for poor adherence to therapy in multivariate analysis, after adjusting for the confounding variables was the negative perception of side effects (p=0.02). The predictive factor for good adherence was the presence of insight into the need for treatment (p=0.002).

To prevent poor treatment adherence, a systematic screening for predictive factors and adequate management of schizophrenia would be imperative.

A. Rami Shareolder of: no, Grant / Research support from: no, Consultant of: no, Employee of: no, Paid Instructor of: no, Speakers bureau of: no, E. Sana Shareolder of: no, Grant / Research support from: no, Consultant of: no, Employee of: no, Paid Instructor of: no, Speakers bureau of: no, C. Mejda Shareolder of: no, Grant / Research support from: no, Consultant of: no, Employee of: no, Paid Instructor of: no, Speakers bureau of: no, D. Rahma Shareolder of: no, Grant / Research support from: no, Consultant of: no, Employee of: no, Paid Instructor of: no, Speakers bureau of: no

The accurate examination of attributional patterns and cognitive biases in delusional patients is relevant to explain the externalizing tendency in paranoid schizophrenia patients. In subjects with delusional disorder (DD), attributional styles and other cognitive bias have been poorly investigated.

Our main goal was to review the tendency to use external-internal attributions for negative events and the presence/absence of other cognitive biases in patients suffering from DD.

A systematic review was conducted in PubMed and ClinicalTrials.gov databases/registers up to September 2022 according to the PRISMA Guidelines. The following key-words were searched in the title and abstracts: (attributions OR attributional OR “cognitive” OR “cognition” OR “social cognition”) AND (“delusional disorder”). Additionally, references of included studies were manually examined to identify further studies.

A total of 144 records were identified (Pubmed, n=125; ClinicalTrials.gov, n=16; other sources, n=13), five studies met our inclusion criteria, reporting attributional styles (n=5) and other cognitive biases (n=2) in DD. (A)Attributional style in DD. Mainly excessive external attributions implying the ascribing of negative experiences to another person’s behavior or action. Other authors describe attributions of negative events to internal causes (n=2). (B)Cognitive biases: Jumping to conclusions bias or judgments made on inadequate evidence have been described in DD (n=2).

Findings in attributional patterns in DD are mixed. Several authors report external and stable attributions in DD, whereas others described internal attributes for negative events, suggesting that depressive vs. “pure” paranoid core dimensions may appear in DD.

None Declared

Antidepressants are often used by persons with schizophrenia. These medications are used for a variety of symptoms, such as negative or depressive ones. Effectiveness of antidepressant use in persons with schizophrenia has rarely been studied in the real-world setting.

The aim of this study was to investigate the risk of hospitalization due to psychosis related to antidepressant use in persons with schizophrenia.

This cohort study utilized data combined from Finnish nationwide registers. The study cohort included all 61 889 persons treated in inpatient care due to schizophrenia (defined as International Classification of Diseases, ICD, version 10 codes F20-F25 during 1972–2014 in Finland). National Prescription register data was utilized to obtain drug purchase data, and modelled into drug use periods with PRE2DUP (From Prescriptions to Drug Use Periods) method, developed by our research group. The follow-up covered the years from 1996 to 2017. Antidepressants (Anatomic Therapeutic Chemical classification system, ATC code N06A) were categorized by mechanism of action (non-selective monoamine reuptake inhibitors, TCAs, ATC-codes N06AA, selective serotonin reuptake inhibitors, SSRIs, N06AB and serotonin-norepinephrine reuptake inhibitors, SNRIs, including venlafaxine, milnacipran and duloxetine), and also on drug-substance level. Main outcome was hospitalization due to psychosis (ICD-10 diagnoses F20-F29) as the main diagnosis. We used within-individual design to compare the risk of outcome between the time periods of antidepressant use and non-use within the same person to minimize selection bias. Stratified Cox regression analyses were utilized to calculate adjusted hazard ratios (aHR) with 95% confidence intervals (CIs). These analyses were then adjusted for sequential order of treatments, time since cohort entry, use of antipsychotics, mood stabilizers, benzodiazepines, and Z-drugs.

The mean age of the study cohort was 46.2 (SD 16.0) years at cohort entry, and 50.3% of were males. Altogether 49.3% (N=30 508) of the study cohort used antidepressants during the follow-up (median 14.8 years, IQR 7.5-22.0), with citalopram and mirtazapine being the most commonly used antidepressants. The risk of psychosis hospitalization was lower during antidepressant use as compared to non-use (aHR 0.93, 95% CI 0.92-0.95). Use of SSRIs was associated with similar risk (aHR 0.91, 95% CI 0.89-0.93), followed by SNRIs (aHR 0.92, 95% CI 0.88-0.97) and TCAs (aHR 0.93, 95% CI 0.89-0.98). Considering individual drug substances, lowest risk were obserwed with use of sertraline (aHR 0.87, 95% CI 0.83-0.91), fluoxetine (aHR 0.88, 95% CI 0.83-0.91) and citalopram (aHR 0.92, 95% CI 0.90-0.95).

Use of antidepressants was associated with a 7% lowered risk of hospitalization due to psychosis, and AD subgroups did not differ in their real-world effectiveness.

A. Puranen: None Declared, M. Koponen: None Declared, M. Lähteenvuo Shareolder of: Genomi Solutions ltd, Nursie Health ltd, Springflux ltd, Grant / Research support from: Finnish Medical Foundation, Emila Aaltonen Foundation, Speakers bureau of: Sunovion, Lundbeck, Otsuka Pharma, Orion Pharma, Recordati, Janssen, Janssen-Cilag, A. Tanskanen Grant / Research support from: Janssen-Cilag, Eli Lilly, , J. Tiihonen Grant / Research support from: Janssen-Cilag, Eli Lilly, Consultant of: HLS Therapeutics, Orion, and WebMed Global, Speakers bureau of: Eli Lilly, Evidera, Janssen-Cilag, Lundbeck, Mediuutiset, Otsuka, Sidera, and Sunovion, H. Taipale Grant / Research support from: Janssen-Cilag, Eli Lilly, Academy of Finland, Speakers bureau of: Janssen-Cilag, Otsuka

Although the immune system is thought to contribute to the etiology of schizophrenia, the mechanism has not been clearly elucidated. Clarifying the relationship between them is important in terms of diagnosis, treatment, and prevention approaches.

In this study, it is aimed to determine whether there is any difference in serum levels of neutrophil gelatinase-associated lipocalin (NGAL) and tumor necrosis factor-alpha (TNF-α) in the group of patients with schizophrenia and healthy volunteers, whether these values are changed by medical treatment, whether there is any relation between these values and the severity of the symptoms of patients with schizophrenia, and whether NGAL can be used as a biomarker in the diagnosis and the follow-up of the schizophrenia.

A total of 64 patients who were hospitalized in the Psychiatry Clinic of Xxxxxx and diagnosed with schizophrenia and 55 healthy volunteers were included in the study. A sociodemographic information form was given to all participants and TNF-α and NGAL values were measured. Positive and Negative Symptoms Rating Scale (PANSS) were applied to the schizophrenia group on admission and follow-up. TNF-α and NGAL levels were re-measured in the 4th week after the start of antipsychotic treatment.

As a result of the present study, it was found that NGAL levels decreased significantly after antipsychotic treatment of schizophrenia patients hospitalized with exacerbation (Figure 1). There was no significant correlation between NGAL and TNF-α levels among schizophrenia and the control group.

Image:

In psychiatric diseases, especially schizophrenia, there may be differences in immune and inflammatory markers compared to the healthy population. After treatment, the NGAL levels of the patients at follow-up were reduced in comparison with the levels at their admission. It can be thought that NGAL may be related to psychopathology in schizophrenia and antipsychotic treatment. This is the first followup study for NGAL levels in schizophrenia.

A. Gül Çakıl Grant / Research support from: This study funded by the Turkish Republic SBU Scientific Research Projects Coordinatorship. (Project no: 2020/013), H. Kaya: None Declared, A. Sakallı Nural: None Declared, I. Çakmak: None Declared, I. Okay: None Declared, E. Göka: None Declared

The vulnerability-stress-inflammation model is a well-known psychopathological model in patients with psychosis. It implies an imbalance of the microglia activation (M1/M2 pathways’ homeostasis) leading to an over-expression of pro-inflammatory cytokines. However, despite a higher prevalence of cannabis (THC) consumption in patients with psychosis, few studies have investigated the impact of this use on inflammatory markers.

The objective of this study was to investigate the impact of cannabis use and its withdrawal on inflammatory markers in patients with psychosis and to explore the link between these inflammatory markers and clinical symptoms.

A retrospective study was performed including 102 patients with psychosis. White blood cell, hsCRP and fibrinogen levels were measured at baseline and after 4 weeks of cannabis cessation. Urinary THC was also measured at baseline and after 4 weeks of cannabis cessation. Comparisons, adjusted on age, gender, body mass index, smoking status and diagnosis, were performed between cannabis users (THC+) and cannabis nonusers (THC-). To assess the association between inflammatory markers and sociodemographic or PANSS scores, Spearman or Pearson correlations were computed.

After cannabis cessation, a greater increase of leucocyte levels (p < 0.01), monocyte levels (p = 0.05) and a statistical trend to a higher increase of lymphocyte levels (p = 0.06) were found in the consumer group compared to the nonuser group. After 4 weeks of cannabis cessation, higher leucocyte (p = 0.03), lymphocyte (p = 0.04) and monocyte (p < 0.01) counts were found in the THC+ group whereas at baseline no difference was found. A positive correlation was found between monocyte count at 4 weeks and baseline PANSS negative subscore (p = 0.045) and between the variation of monocyte count between baseline and 4 weeks and the PANSS total score at 4 weeks (p = 0.05).

This study shows that cannabis cessation is associated with an increased inflammation depicted by an elevation of white blood cell, lymphocyte, and monocyte levels, which correlates with symptomatology of patients with psychosis. Studying the link between cannabis and inflammation could lead to a better understanding of the pathophysiology of psychosis.

B. Romeo: None Declared, V. Lestra: None Declared, C. Martelli: None Declared, A. Amirouche: None Declared, A. Benyamina Consultant of: Lundbeck, Mylan, Merck-Serono and Bristol-Myers Squibb , Speakers bureau of: member of board Indivior, N. Hamdani: None Declared

Gene-environment interactions increase psychosis risk (Gayer-Anderson et al. Soc Psychiatry Psychiatr Epidemiol 2020; 55(5):645-657). However, identifying the genetic variants involved and how they interact with environmental risk factors underlying psychosis remains challenging.

To investigate whether there are gene-environment interactions in the relationships of childhood trauma, lifetime cannabis use, and single nucleotide variants (SNVs) of dopamine D2 receptor (D2R: DRD2), N-methyl-d-aspartate receptor (NMDAR: GRIN1, GRIN2A and GRIN2B) and cannabinoid receptor type 1 (CB1R: CNR1) with psychosis.

In a population-based case-control study nested in an incident study (STREAM, Brazil) (Del-Ben et al. Br J of Psychiatry 2019; 215(6):726-729), part of the EU-GEI consortium (Gayer-Anderson et al. Soc Psychiatry Psychiatr Epidemiol 2020; 55(5):645-657), 143 first-episode psychosis patients and 286 community-based controls of both sexes aged between 16 and 64 years were included over a period of 3 years. Twenty-three SNVs of D2R (rs1799978, rs7131056, rs6275), NMDAR (GRIN1: rs4880213, rs11146020; GRIN2A: rs1420040, rs11866328; GRIN2B: rs890, rs2098469, rs7298664), and CB1R genes (CNR1: rs806380, rs806379, rs1049353, rs6454674, rs1535255, rs2023239, rs12720071, rs6928499, rs806374, rs7766029, rs806378, rs10485170, rs9450898), were genotyped from peripheral blood DNA using a custom Illumina HumanCoreExome-24 BeadChip. Environmental adversities were evaluated using the Cannabis Experience Questionnaire (Di Forti et al. The Lancet Psychiatry 2009; 6(5):427–436) and the Childhood Trauma Questionnaire (Grassi-Oliveira et al. Rev Saude Publica 2006; 40(2):249-55). Associations between SNVs and environmental risk factors were performed using the nonparametric multifactor dimensionality reduction software (version 3.0.2).

Single locus analysis showed no association among the 23 SNVs with psychosis; however, gene-environment analysis was significant for the polymorphic loci rs12720071 and rs7766029 in CNR1. The best association models were the two-factor representing by the combination of CNR1 rs12720071 with lifetime cannabis use (p<0.001), and CNR1 rs12720071 with childhood trauma (p<0.05), both suggesting an increased risk of psychosis. Additionally, when considering the interaction of both environmental factors in the same model, we found CNR1 rs7766029 to be associated with psychosis (p<0.001).

Our study supports the hypothesis of gene-environment interactions for psychosis involving the T allele carriers of CNR1 SNVs (rs12720071 and rs7766029), childhood trauma and lifetime cannabis use in psychosis.

None Declared

The eye is considered as a part of the central nervous system and a window of the brain. The eye and the brain, also their microvascular system, share many common features in terms of anatomy and pathophysiology. Choroid and retina related abnormalities have been reported in psychotic disorders, especially in schizophrenia. Choroidal vascularity index (CVI) is a useful tool to assess choroidal structural alterations and CVI is defined as the proportion of luminal area (LA) to the total choroidal area (TCA).

This is the first study to investigate choroidal vascularity index in first-episode psychosis (FEP) using optical coherence tomography (OCT).

31 patients with FEP and 30 age and gender-matched healthy controls (HC) included in this study. All participants underwent psychiatric and ophthalmological clinical assessments. Imaging of the choroid was performed using enhanced deep imaging (EDI) protocol - spectral domain OCT. Central choroidal thickness (CCT) with EDI-OCT was measured manually from the inner border of the sclera to the outer border of the RPE vertically using the calipers of the Heidelberg reader subfoveally. The choroidal vascularity index was assessed using the EDI-OCT images.

There were no statistically significant differences between FEP and HC in terms of CCT (p=0.33), TCA (p=0.809) and LCA (p=0.710). The CVIs were 66.66±2.98% and 62.32±3.32% in FEP and HC, respectively and it was significantly different between groups (p<0.001, effect size d=1.38).

These results suggest that first episode psychosis is characterized by choroidal vascular abnormalities. in vivo ophthalmological imaging with OCT, a non-invasive, fast, and safe technological tool, can be a promising biomarker to quantitatively evaluate microvasculature abnormalities in patients with psychosis.

None Declared

Individuals with schizophrenia exhibit severe speech and Theory of Mind (ToM) deficits creating substantial handicaps for them on the level of communication and interpersonal skills. Consequently, these individuals cannot adequately take part in social life, and are exposed to marginalization in all aspects of life. Hence, communication impairments associated with schizophrenia are a central issue to investigate in order to optimize their quality of life and functioning in society. The study being part of an interdisciplinary research is based on guided interviews related to a short story by Hemingway. The analysis of person deictic expressions related to social emotions and social interactions combined with the most frequently used mental state terms (e.g. ‘I don’t know’, ‘I think’) identified in the corpus may not only describe the severity of linguistic disturbances indicating ToM deficits but can also help understand patients’ social dysfunction and difficulties in the context of social cohesion.

The primary task of the functional linguistic research is to identify and classify the occurrence of linguistic disturbances during mentalizing processes expressed via mental state terms. The study particularly focuses on interpersonal relations expressed with person deictic forms that may indicate the difficulties of this patient group with social cohesion.

The corpus involves 40 guided interviews including 20 individuals with schizophrenia treated at the Department of Psychiatry of the University of Pécs and 20 controls. The interviews were conducted by a PhD student of Psychology in Hungarian and centred around Hemingway’s short story entitled The End of Something. The interviews were digitally recorded and transcribed in Hungarian. The qualitative analysis was performed with Sketch Engine corpus analysis tool, which assisted in the identification and classification of collocations associated with the interviewees’ mental processes directed at interpersonal relations expressed by person deictic forms.

Pragmatic processes including the communicative aspect showed severe deficiencies. The most commonly used mental state term ‘I don’t know’ combined with person deictic expressions revealed that individuals with schizophrenia have difficulty attributing mental states to a specific linguistic utterance during a social situation (e.g. ‘I don’t know why somebody said that’). These examples show that their communicative and interpersonal skills are substantially impaired.

The findings can offer some possible indications for psychotherapists how to detect pragmatic impairments in schizophrenic speech and interpret mental state terms with reference to social interaction, thereby contributing significantly to therapeutic success enhancing the social reintegration of individuals with schizophrenia.

None Declared