During the pandemic, health professionals had the unprecedented experience of dealing with a newdisease with high contagiousness and mortality. The workload, but also the fear of disease management, caused significant levels of stress. Each employee managed stress in his own way. This study detects the level of stress experienced by health workers during the pandemic and the coping strategies they selected accordingly.

The aim of this study was to investigate the coping strategies used by health professionals during the pandemic of coronavirus.

The sample comprised 180 health professionals that were working in a public hospital. The data collection tool was an anonymous questionnaire consisting of socio-demographic questions, the Toulouse Scale for coping , and a sub questionnaire to explore health professionals’ views on the pandemic.

Women (73.9%), young individuals (50.6% are up to 35 years old) and TEI graduates (53.9%) predominate in the sample. The sample consisted mainly of nurses (68.3%) and the great majority were contract workers (67%).

The most frequently used dimensions were “Active focus” (Average 3.91/5.00), “Acceptance” (3.86), “Cognitive Control and Planning” (3.61) and “Social Information Support” (3.60).

Also, health workers used more often the strategies of “Social support” (3.45), “Control” (3.33) and “Focus” (3.23), while they use the “Withdrawal” strategy less often (2.25). Finally, respondents used “Positive strategies” more often (3.54) than negative ones.

The health professionals in the present study preferred to ask for information and use cognitive and informative strategies more often and, to a lesser extent, they were overwhelmed by their emotions. The strategies of social support, control and focus were used more often, while the strategy of withdrawal was selected less often. Furthermore, positive strategies were used to a greater extent.

None Declared

Pandemics affect the mental health of individuals as they cause specific reactions throughout society due to the measures taken to contain them, which lead individuals to change their behaviour and habits and generally change their daily routine and lifestyle. In addition, the real or perceived threat of the virus and what it may cause exacerbates the anxiety and stress experienced by individuals.

To assess the psychological distress experienced by the Greek population due to COVID-19 and to investigate the possible determinants that contributed to negative psychological experience.

Methodology: A synchronic study was conducted involving 200 participants from different regions of Greece. Data collection took place from October to December 2021. The mean age of the participants was 33.5 years. 76% of the participants had a family and/or friend who had COVID-19, while 27.5% of the participants had a family and/or friend who was hospitalized in the ICU due to coronavirus. The Impact of Event Scale-Revised (IES-R-Gr) questionnaire, adapted for COVID-19, was used to assess mental disorders

40% of participants had no symptoms of PTSD. 14.5% of participants had symptoms of PTSD and 45.5% of participants had a probable diagnosis of PTSD. Women, participants with worse self-assessed health status and participants who had a relative and/or friend hospitalized in ICU due to COVID-19 experienced worse health outcomes due to the pandemic (p<0.001). In addition, women and participants, who had a family and/or friend who was hospitalized in ICU due to COVID-19, were more worried about the pandemic, while participants with worse health status assessment had more nervousness due to the pandemic.

Pandemic is an unprecedented situation experienced by people and has an impact not only on the physical but also on the mental health of the population. Therefore, special attention should be paid to the impact of COVID-19 on the mental health of the population and measures should be taken to protect the mental health of individuals.

None Declared

The COVID-19 pandemic is a healthcare crisis, with unprecedented impact on healthcare services, notable morbidity and mortality of the public and healthcare workers, economic impact and significant psychosocial impact. Besides, this pandemic has had a profound negative effect on the mental health of people worldwide, particularly among those who are faced with combating the virus.

The aim of this research was to examine the impact of the COVID-19 pandemic on healthcare workers’ mental health (HCWs), as they are on the front line of the pandemic.

An internet-based questionnaire was created including the following scales: (1)Posttraumatic Stress Disorder Checklist (PCL-5), (2) Secondary Traumatic Stress Scale (STSS) (3) Quality of Professional Life (ProQOL) (4) Post-Traumatic Growth Inventory, (PTGI), (5) Brief Resilience Scale (BRS), (6) Brief Orientation to Problems Experienced Inventory (Brief Cope)], (7) Self-Compassion Scale (SCS-SF). It was distributed to 120 Greek health professionals, including nurses, doctors, midwives and physiotherapists.

Most of the participants were female with an average age of 46 years. HCWs had low levels of both primary and secondary traumatic stress . They presented post-traumatic growth in the dimension of relationship with others. They used predominantly the coping strategies of positive reframing, acceptance of the situation, venting, and instrumental support.

Females had statistically significant higher levels of post-traumatic growth, better quality of life, and used more positive coping strategies compared to males. Humor and acceptance were coping strategies used mainly by physicians. Nurses and midwives had worse quality of professional life potentially due to increased workload. HCWs with more functional ways of coping were more resilient and seemed to have better quality of life, such as higher compassion, satisfaction, lower burnout, and lower post-traumatic stress.

The experience of the COVID-19 pandemic highlights the need to implement some strategies to protect health care workers’ mental health and to take extensive prevention measures in highly stressful situations.Further research is needed to clarify the long-term negative and positive psychological effects of the pandemic on healthcare personnel’s mental health.

None Declared

Research findings show that during the COVID-19 pandemic, healthcare workers (HCWs) have been subject to increased workload while also exposed to many psychosocial stressors.

The aim of this study was to investigate Covid’s impact on healthcare professionals’ mental health and their coping strategies

The study population consisted of 144 health professionals from health care facilities in Patras. An internet based questionnaire was distributed,which included demographic survey questions and the following three scales: (1) The Psychological Consequences Questionnaire (PCQ) scale, (2) The Kessler Psychological Distress scale (k6) and (3) Toulouse’s scale for coping strategies (E.T.C.).

144 health care workers participated in the survey, who were basically women (72.2%) and nurses (60%) In terms of psychological consequences, participants felt pressured, stressed (3.12), and sad/depressed (2.78). The most frequently used coping strategies were acceptance (3.44), active focus (3.38), cognitive focus (3.31), cognitive control and planning (3.30), emotional control (3.17), social informational support (3.16) and cooperation (3.15). In contrast, the strategies used to a lesser extent are substance addiction (1.91), emotional focus ( 2.13), denial (2.27) and alexithymia (2.49). Generally, positive strategies (3.11) were chosen to a greater extent than negative ones ( 2.38).

It is very important for hospital administrations to design specific psychological support programs and encourage health professionals to participate in them in order to manage their fear, anxiety and stress experienced.

None Declared

The COVID-19 pandemic represents an unprecedented in health events that has had a negative impact on the mental health of the population in general as well as on specific categories, including patients with mental and physical disorders, and healthcare professionals. In particular, COVID-19 pandemic has produced extraordinary stress in healthcare workers, especially frontline physicians, nurses and healthcare professionals.

In the present study we aimed to evaluate levels of burnout, a clinical condition characterized by emotional, psychological and physical exhaustion, in a sample of health workers from the Campania region, Italy, during the first phase of the COVID-19 pandemic. Secondary objectives of the study include the assessment, in the same group, of levels of anxiety-depressive symptoms, insomnia, suicidal ideation and symptoms on the post-traumatic spectrum.

An online survey was released through the official website of the University of Campania “L. Vanvitelli” and social media. The Maslach Burnout Inventory was used to assess burnout in the healthcare professionals; Depression Anxiety Stress Scale-21 Short Version to measure levels of anxiety, depression and stress; the Insomnia Severity Index was used to identify insomnia-related symptoms; the Suicidal Ideation Attributes Scale was adopted to select individuals based on the presence of suicidal thoughts while the Impact of Event Scale-Revised was administered to evaluate trauma-related dimensions.

A total of 389 health workers was recruited. They were predominantly female, with an average age of 39.06 (± 11.85) years, working mainly in the second line hospitals during the COVID-19 emergency. During the pandemic, first- or second-line health workers reporting significant levels of emotional exhaustion are on average 23,89 (±4.22), those reporting feelings of depersonalization are on average 7.58 (±2.73), while those who report a good level of professional efficiency are on average 21.12 (±3.48).

Predictors of increased levels of depersonalization are being a first-line worker and the presence of traumatic event avoidance symptoms. Furthermore, levels of professional fulfillment are negatively affected by age, the presence of intrusive symptoms, the presence of sleep disorders, and being a frontline worker.

The impact of the COVID-19 pandemic on the mental health of healthcare professionals involved in the first and/or second line COVID hospitals is indisputable. Although burnout syndrome is not a new clinical condition, the COVID-19 pandemic may further worsen the magnitude of the problem. However, our results could be a starting point to promote a change in the way we perceive the mental health of healthcare professionals.

None Declared

Early neurodevelopmental deviations, such as abnormal cortical folding patterns, are a candidate biomarker for major depressive disorder (MDD). Previous studies on patterns of abnormal cortical gyrification in MDD have provided valuable insights; however, the findings on cortical folding are controversial.

We aimed to investigate the association of MDD with the local gyrification index (LGI) in each cortical region at the whole-brain level and the association of the LGI with clinical characteristics of MDD, including recurrence, remission status, illness duration, severity of depression, and medication status of patients with MDD.

We obtained T1-weighted images of 234 patients with MDD and 215 healthy controls (HCs). LGI values were automatically calculated using the FreeSurfer software according to the Desikan–Killiany atlas. LGI values from 66 cortical regions in the bilateral hemispheres were analyzed. We compared the LGI values between the MDD and HC groups using the analysis of covariance, including patients’ age, sex, and years of education as covariates. The association between clinical characteristics and LGI values was investigated in the MDD group.

Compared with HCs, patients with MDD showed significantly decreased LGI values in the cortical regions, including the bilateral ventrolateral and dorsolateral prefrontal cortices, medial and lateral orbitofrontal cortices, insula, right rostral anterior cingulate cortex, and several temporal and parietal regions, with the highest effect size in the left pars triangularis (Cohen’s f = 0.361; P = 1.78 × 10-13). As for the association of clinical characteristics with LGIs within the MDD group, recurrence and longer illness duration of MDD were associated with increased gyrification in several occipital and temporal regions, which showed no significant difference in LGIs between MDD and HC groups.

Considering that the aforementioned cortical regions are involved in emotion regulation, abnormal cortical folding patterns in such regions may be associated with the dysfunction of emotion regulation-related neural circuits, which may lead to MDD. These findings suggest that LGI may be a relatively stable neuroimaging marker associated with the trait of MDD predisposition.

None Declared

Sleep deprivation (SD) is being examined in the treatment of depression and other affective disorders for years. However, studies’ outcomes remain ambiguous, with varying levels of clinical improvement and its ephemeral character. Thus, it is necessary to find new factors accounting for the variability of results to develop new therapeutic protocols.

The study aimed to assess the influence of physical activity on mood and reaction speed following SD.

The study group consisted of 71 participants. SD lasted about 24 hours, beginning in the morning hours of the SD day to the morning hours of the following day. Physical activity (PA) was controlled using actigraphy (actigraph GENEActive Original, ActivInsights Ltd.) given to each participant. Participants underwent the reaction speed test (Response Time Test Apparatus, AT Smart Systems, Poland) and filled out a questionnaire assessing depression symptoms- Beck Depression Inventory (BDI), in the evening of the SD day, and the following morning. Based on the percentage of sedentary time (gravity-subtracted sum of vector magnitudes<386, DOI 10.1111/sms.13488) participants were classified as inactive (≥70% of SD duration spent sedentary, n= 43) or active (n= 28).

There were no significant differences between the active and the inactive participants regarding pre/post SD BDI score, reaction speed, and demographic data (age, sex, BMI) (all p>0.05). The inactive group had a significantly lower BDI score following SD in comparison with their baseline parameters (5, IQR 1-12 vs. 3, IQR 0-12, p=0.024) than the active group (3, IQR 1-6 vs. 3, IQR 0-7, p=0.408). Reaction speed after SD was impaired in both active (0.216, IQR 0.206-0.226 vs. 0.231, IQR 0.222-0.46, p<0.001) and inactive group (0.224, IQR 0.216-0.235 vs. 0.238, IQR 0.220-0.251, p<0.001). However, the difference between pre/post SD response time was slightly higher in the active individuals (0.015, IQR 0.011-0.028 vs. 0.012, IQR 0.003-0.022, p=0.047).

This study shows, that a sedentary behavior during SD might improve mood and slightly less impair the response time to auditory or visual stimuli than a higher activity level. Thus, PA could be an important modulator of clinical outcomes observed in individuals with affective disorders subjected to SD. PA should be accounted for in the SD protocols designed for future studies.

None Declared

The COVID-19 pandemic impelled a transition from in-person to telehealth psychiatric treatment. The COVID-19 pandemic has been depressogenic. Major disruptions in lifestyle due to social isolation, job loss, financial strain, and deaths of neighbors, family and friends are potential contributors to the increased levels of depression due to the pandemic. As one of the core elements of psychotherapeutic approaches towards treating depression is behavioral activation and increased social contact the psychosocial limitations imposed by COVID-19 might make it more difficult to treat depression during the pandemic.

There are no studies of partial hospital telehealth treatment for major depressive disorder (MDD). In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compared the effectiveness of partial hospital care of patients with MDD treated virtually versus in-person.

Outcome was compared in 294 patients who were treated virtually from May, 2020 to December, 2021 to 542 patients who were treated in the in-person partial program in the 2 years prior to the pandemic. Patients completed self-administered measures of patient satisfaction, symptoms, coping ability, functioning, and general well-being.

In both the in-person and telehealth groups patients with MDD were highly satisfied with treatment and reported a significant reduction in symptoms from admission to discharge. Both groups also reported a significant improvement in positive mental health, general well-being, coping ability, and functioning. A large effect size of treatment was found in both treatment groups. Contrary to our hypothesis, the small differences in outcome favored the telehealth-treated patients. The length of stay and the likelihood of staying in treatment until completion were significantly greater in the virtually treated patients.

In an intensive acute care setting, delivering treatment to patients with MDD using a virtual, telehealth platform was as effective as treating patients in-person.

None Declared

The emphasis on symptom resolution in depression treatment research is at variance with the recommendations of official treatment guidelines and the results of surveys of depressed patients’ views of the most important treatment goals.

In the present study, we examined the interrelationship between response rates on various outcome domains and whether response on each domain was associated with patients’ global rating of improvement (PGI) reported upon treatment completion. We also examined whether the PGI was associated with the number of domains on which the patients had achieved responder status and which domains were independent predictors of PGI response.

Eight hundred and forty-four patients with major depressive disorder completed the Remission from Depression Questionnaire (RDQ), a self-report measure that assesses 6 constructs considered by patients to be relevant to assessing treatment outcome. The patients completed the RDQ at admission and discharge from the treatment program. For each domain, response was defined as a 50% or greater reduction in scores. At discharge, the patients rated the PGI.

The patients significantly improved from admission to discharge on each of the 6 domains assessed on the RDQ. The responders on each domain reported significantly greater improvement on the global rating of improvement at discharge. Responder status in one domain mostly co-occurred with responder status in another domain. In a logistic regression analysis, responses on all domains, except nondepressive symptoms, were independently associated with PGI response.

The results of the present study are consistent with multiple surveys which have suggested that focusing on symptom reduction is too narrow of an approach when measuring outcome in the treatment of depression. Expanding the assessment of outcome beyond symptoms and viewing nonsymptomatic outcome domains as critical composites of primary endpoints would be more consistent with a patient-centered approach towards the treatment of depression.

None Declared

Depression is a severe mental disorder with an estimated 3.8% of the population affected, representing a leading cause of disability worldwide. Being linked to reduced quality of life and individual functioning, medical morbidity and mortality, depression has a huge social and economic impact. A wide range of potentially modifiable factors for depression has been identified. Among these, social factors (e.g. support/engagement) appear to play a major role in the emergence and severity of depression.

We aimed at providing a quantitative synthesis of the consistency and magnitude of the association between measures of social connection and depression. Social connection included both quantitative (i.e. existence/absence of social relationships) and functional (i.e. support provided) measures of social relationships, as well as measures focusing on social inequalities related to participation in community spaces/activities (i.e. social discrimination).

We searched PubMed, PsycINFO, Cochrane Library and EMBASE. The strength of the association between exposure factors (social measures) and depression was extracted and equivalent odds ratios were computed to compare the strength of the effect sizes among meta-analyses. The quality of each review was assessed using AMSTAR-2.

As a result of the selection process 47 studies were included in the umbrella review. Social support was found to have a protective role on depression, with an observed moderate/strong effect in peripartum population and a weaker effect in clinical populations (e.g. AIDS/HIV patients). A moderate association between stigma/discrimination and depression emerged in clinical populations (e.g. epilepsy, mental illness, post-stroke), while a weaker effect was found in (ethnic) minorities. There are still few studies quantitatively investigating the link between depression and other social measures (e.g. community connectedness).

Our findings align with the literature on social connection and mental health, confirming the role of social determinants in the emergence and severity of depression, particularly in the case of vulnerable populations. Social factors emerge as important modifiable targets in the context of depression prevention. Efforts to counteract disconnection at the societal and individual levels and to reduce stigma should be central to an effective depression prevention agenda.

None Declared

Treatment-resistant depression (TRD) is considered one of the major clinical challenges in the field of psychiatry. At least 15% of all patients with MDD remain refractory to any treatment intervention. Repetitive transcranial magnetic stimulation (rTMS) is considered a treatment option for patients with TRD. Additionally, iCBT is an evidence-based psychotherapy for the management of TRD.

This study aims to evaluate the clinical effectiveness of adding iCBT to rTMS treatment as an innovative combined intervention, exploring the short and long-term outcomes on patients with TRD

This study is a randomized controlled trial. Participants diagnosed with TRD were randomized to one of two interventions: rTMS alone and rTMS+iCBT. Each group completed evaluation measures at baseline, discharge (6 weeks), and one & three months after discharge. The primary outcome measure was the mean change in the Hamilton depression rating scale (HAMD-17) from baseline to three months.

Preliminary results for the early outcome of the study showed that after adjusting for the baseline scores, there was no significant difference in the mean score of HAMD-17 from baseline to six weeks between the participants of the two groups, (F (1, 53) = 0.15, p = 0.70, partial eta square = 0.003). The result of the long-term effectiveness is underway, forecasting the potential synergism of the two interventions.

This study found the combined treatment of rTMS + iCBT not to be superior to treatment with rTMS alone, in the short term. We hope the long-term results would thoroughly address the effectiveness of the combined therapy in this randomized controlled trial.

None Declared

Despite emerging evidence suggesting the efficacy of psilocybin in the treatment of mood disorders such as depression, the exact mechanisms by which psilocybin is able to elicit these antidepressant effects remains unknown.

As the use of psilocybin as a treatment modality for depression has garnered increasing interest, this study aims to summarize the existing evidence of the mechanism of action with which psilocybin alleviates depressive symptoms, focusing specifically on the neurobiological effects of psilocybin in human subjects.

Four databases (Ovid MEDLINE, EMBASE, psychINFO, and Web of Science) were searched using a combination of MeSH terms and free text keywords in September 2021. The original search included both human and animal studies and must have included testing of the mechanism of action of psilocybin. Only antidepressant effects were considered, with no other mood disorders or psychiatric diagnoses included. Two independent researchers screened at every stage of the review, with a third researcher resolving any conflicts. Though a full systematic review outlining the current literature on the complete mechanisms of action of psilocybin on depression was conducted, this abstract will focus specifically on the nine papers that included human subjects, disregarding the five animal models. PROSPERO registration number: 282710.

After removing duplicates, the search identified 2193 papers and forty-nine were selected for full text review. Out of nine papers outlining the mechanisms of action of psilocybin use in human subjects, three papers investigated psilocybin’s effect on serotonin or glutamate receptor activity, two found an increase in synaptogenesis in regions such as the medial frontal cortex and hippocampus. Four found variation in blood flow to the amygdala, two found altered blood flow to the prefrontal cortex, and one found a reduction in delta power during sleep. Four papers found changes in functional connectivity or neurotransmission, most commonly in the hippocampus or prefrontal cortex.

Overall, the exact mechanism of psilocybin’s potential antidepressant effect remains unclear. Multiple pathways may be involved, including alterations in serotonin and glutamate receptor activity, as well as shifts in amygdala activity, neurogenesis, and functional connectivity in various brain regions. The relative lack of studies, and the variety of neurobiological modalities and endpoints used challenged the consolidation of data into consensus findings. Further studies are needed to better characterize psilocybin’s mechanism of action and to better understand the clinical effects of the use of psilocybin in the treatment of depression.

None Declared

Pharmaceutical slogans presuming a particular antidepressant molecule being the best solely based on a core concept could be proved “not accurate” especially following patients’ actual exposure to the antidepressant for longer than the usual six or twelve weeks’ trials

Reviewing the current situations of SSRI induced anhedonia recognition and its management. Distinguishing anhedonia as a core symptoms of depression from SSRI induced anhedonia and the combination of both.

Review of literatures including theses related to the same topic

Research suggests that, SSRIs might be more effective at treating some symptoms than others. More specifically, it has been suggested that, SSRIs might be more effective at improving symptoms such as low mood and anxiety but not anhedonia (Argyropoulos et al. psych.pharmaology, 2013; 27(10), 869-877). It has been proposed that, catecholaminergic antidepressants might be more effective treatments for anhedonia and emotional blunting in MDD than SSRIs (McCabe et al. Biological psychiatry, 2010; 67(5), 439–445. The primary effect of SSRIs is reduced processing of negative stimuli rather than increased positive stimuli. Emotional blunting is related to SSRI dose and possibly serotonergic effects on the frontal lobes and/or serotonergic modulation of midbrain dopaminergic systems projecting to the prefrontal cortex (PFC). By enhancing serotonergic transmission, SSRIs can activate the inhibitory Gamma Aminobutyric Acid (GABA) interneurons, thereby dampening the noradrenergic and dopaminergic input ( Blier. Int J Neuropsychopharmacol., 2014; 17:997–1008).

Management of SSRI induced anhedonia includes lowering the current SSRI dose. Adding non SSRI antidepressant to the current SSRI dose or to a lowered SSRI dose. Gradual discontinuation of the SSRI and switching to another antidepressant with a different profile (SNRI) that might improve the patient’s emotional response (Koenigs. Behav Brain Res., 2009;201:239–43).

Bupropion is an antidepressant with less possibility to give rise to emotional blunting. (Tomoko et al. Neuroscience Letters., 2021; 749, 135716. agomelatine(Thome et al. Journal of neural transmission., 2015; 122(1), 3-7.Vortioxetine and others (Bing et al. frontiers in psychiatry., Jan, 2019; 10-17. are of inrerest in this regard.

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The most selective SSRI concept assumes that most selective means less affinity to other receptors or secondary binding sites which might suggest less side effects and perhaps being the most efficacious. Not only serotonin but multiple neurotransmitters are in action at the downstream part of a cascade of events underpinning the etiology of MDD. MDD has heterogeneous etiology and this explains why patients respond differently. SSRI induced anhedonia could be tackled and we need to explore how many patients would benefit from that now and have not yet.

None Declared

Depression is a highly prevalent disorder associated with reduced social functioning, impaired quality of life, and increased mortality. This disease is one of the most common reasons for the use of complementary and alternative therapies. Music therapy is a therapeutic approach that uses musical interaction as a means of communication and expression.

To assess, through a systematic review, the effectiveness of music therapy in patients with depression disorder, and to design a research protocol for a randomised controlled trial of group music therapy for depressed patients in a Psychiatry Department.

We conducted a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA).We systematically searched 3 databases (Pubmed, Google Scholar and SciElo) and reviewed randomized controlled trials. The evaluation of the trials was made using the CONsolidated Standards of Reporting Trials (CONSORT) guidelines.The review included studies of 16-to-80-year-old impatients and outpatients of both genders with clinical depression using any diagnostic criteria such as ICD 10 (WHO 1992) or DSM 5 Research Diagnostic Criteria. Change in depressive symptoms was measured with various scales. An experimental protocol was then designed to conduct a randomized controlled trial for depressed patients in the Psychiatry Department at the University Hospital of Mahdia, seeking to supplement scientific knowledge in the field of music therapy that has not yet been explored.

A total of 13 articles were included in the study: The analysis of these articles highlighted a predominance of Anglo-Saxon papers and an increasing rate of publication over time.The duration of treatment varied between 2 weeks and 10 weeks and the number of music therapy sessions varied between 4 sessions and 20 sessions.Two major music therapy approach were identified, active method where patients are the ones making music and receptive or passive methods where patients will receive the music.12 researches included in our review reached the conclusion that music therapy had a significant positive effect on patients as the score scales were significantly lower after the end of the therapy. Only one included research found no significant difference between music therapy group and treatment as usual.In addition the results of all studies came on the conclusion that music therapy improved symptoms of anxiety and scores were significantly lower.

This systematic review and meta-analysis suggests that music therapy has an effect on reducing depressive symptoms to some extent. However, high-quality trials evaluating the effects of music therapy on depression are required. Thus,the aim of our study protocol is to contribute to the development of this therapy

None Declared

Cognitive models of depression highlight the role of inhibitory control - the cognitive control ability which supports our goal directed behavior – as key and even causal feature of the disorder. According to these models, deficits in inhibitory control prevent the exclusion of irrelevant negative information, leading to rumination and sustained negative mood which result in depressive episodes. However, the scientific evidence linking deficits in inhibitory control to depression is thus far mixed. Moreover, although one’s inhibitory control ability may fluctuate, it is often assessed using a single-time measurement in the lab.

Here we aimed to assess the association between intra-individual fluctuations in inhibitory control measured in ecological settings, daily mood states, and depressive symptoms.

N=106 participants (Mean age: 38 ± 10 years; range: 19-62 years; 68% female) reported their depressive symptoms (using the PHQ-9 scale) and completed a mobile version of the Go-NoGo inhibition task at baseline. They then completed a 5-day ecological-momentary-assessment (EMA) protocol, in which they reported their current mood (using the IMS-12 scale) and performed a shortened version of the Go-NoGo task twice/day using a mobile application. Depressive symptoms were assessed again following the 5-day EMA. Hierarchical-linear-modeling (HLM) was applied to examine the association between momentary IC and mood, with post-EMA depressive symptoms as a moderator. Inhibitory control was included as a time-varying predictor for mood in the 1st step, and depressive symptoms post-EMA and their interaction with inhibition were included in the 2nd step.

At baseline, there were no correlations between depressive symptoms and inhibitory control (rp = .035, n.s). However, individuals with elevated depressive symptoms demonstrated worse and more variable inhibition performance over time (rp = .29, p = .002), as captured in the EMA measures. In addition, participants with more variable inhibitory control performance over time also reported more depressive symptoms at the end of the 5-day period (rp = .27, p = .006). Finally, post-EMA depressive symptoms moderated the association between momentary inhibitory control and daily mood, such that reduced inhibition was associated with more negative mood only for those with lower, but not with higher, depressive symptoms (Figure 1).

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Variable, rather than mere reduced inhibitory control is related to depressive symptoms. Moreover, the role of inhibition in modulating mood differs in non-depressed vs. depressed individuals. These findings contribute to our understanding of inhibition and mood in real life and help account for some of the discrepant findings related to cognitive control models of depression. Future investigations should examine the validity of these outcomes in other, clinical samples.

None Declared

Depression is a psychiatric disorder characterized by low mood and anhedonia. The diagnosis of depression and the initiation of treatment is important for improving quality of life and avoiding disability. Machine learning (ML), can be used for solving classification and regression problems.In this study, scores of multiple psychiatric scales were used to detect depression and different ML algorithms were used to study if they can help for diagnosing depression accurately.

The purpose of the study is to detect with high accuracy whether people are depressed or not by using widely used ML algorithms. It is also aimed to compare the algorithms used to predict depression with each other.

Data were collected from 96 university students. Beck Depression Inventory (BDI), Beck Anxiety Inventory, Neo Personality Inventory, Chronic Stress Scale (CSS), Perceived Stress Scale (PSS), Childhood Trauma Questionnaire, Post-Traumatic Stress Disorder Checklist (PTSD), SHAPS, Relationship Scales Questionnaire and Dissociative Events Scale were applied. 14 points from the BDI was accepted as the cut-off value as depressed. Total scores of each scale was used as the dependent variable in the Xgboost (XGB) to classify the depression. By XGB, the most important 4 of these surveys and scales were selected to use in the Non-Linear (NL) models such as XGB, Decision Trees (DT), Support Vector Machines (SVM), K-Nearest Neighbor (KNN). Lastly, a linear model as a Logistic Regression (LR) model was also used to compare with the NL algorithms. The success of the models was measured with the Cross Validation method, which is the gold standard in ML.

In the model in which all measurements are used as Independent Variables (IV), the XGB highlighted 4 scale scores: these are CSS, PSS, SHAPS and PTSD. All scale scores were used as IV, both XGB and DT classified depression with a success of 87.5%, while this score increased to 89.6% in both models when 4 prominent scales’ scores were used as IV. In the KNN, the classification made with prominent scales increased the success from 83% to 86%. The variance explanation rate of the LR model using 4 prominent scales remained at 58%.

With ML’s ability to solve NL relationships and dimensional reduction ability, models in which a large number of variables are input and there is no high correlation between dependent variables and IV can be classified with high success. Also, the success of the models was increased by choosing the most importants of the many IV and the variables that contributed negatively to the model could be excluded. The use of ML can yield promising results in fields such as psychiatry where linear relationships cannot be observed much.

None Declared

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

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

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

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

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

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

Major depressive disorder (MDD) is characterized by both clinical symptoms and cognitive deficits. Prior studies have typically examined either symptoms or cognition correlated with brain measures, thus causing a notable paucity of stable brain markers that capture the full characteristics of MDD. Brain controllability derived from newly proposed brain model integrating both metabolism (energy cost) and dynamics from a control perspective has been considered as a sensitive biomarker for characterizing brain function. Thus, identifying such a biomarker of controllability related to both symptoms and cognition may provide a promising state monitor of MDD.

To assess the associations between two multi-dimensional clinical (symptoms and cognition) and brain controllability data of MDD in an integrative model.

Sparse canonical correlation analysis (sCCA) was used to investigate the association between brain controllability at a network level and both clinical symptoms and cognition in 99 first-episode medication-naïve patients with MDD. The potential mediation effect of cognition on relationship between controllability and symptoms was also tested.

Average controllability was significantly correlated with both symptoms and cognition (rmean=0.54, PBonferroni=0.03). Average controllability of dorsal attention network (DAN) (r=0.46) and visual network (r=0.29) had the highest correlation with both symptoms and cognition. Among clinical variables, depressed mood (r=-0.23) , suicide(r=-0.25), work and activities(r=-0.27), gastrointestinal symptoms (r=-0.25) were significantly negatively associated with average controllability, while cognitive flexibility (r=0.29) was most strongly positively correlated with average controllability. Additionally, cognitive flexibility fully mediated the association between average controllability of DAN and depressed mood (indirect effect=-0.11, 95% CI [-0.18, -0.04], P=0.001) in MDD.

Brain average controllability was correlated with both clinical symptoms and cognition in first-episode medication-naïve patients with MDD. The results suggest that average controllability of DAN and visual network reached high associations with clinical variates in MDD, thus these brain features may serve as stable biomarkers to control the brain functional states transitions to be relevant to cognitions deficits and clinical symptoms of MDD. Additionally, altered average controllability of DAN in patients could induce impairment of cognitive flexibility, and thus cause severe depressed mood, indicating that controllability of DAN may be a potential intervention target for alleviating depressed mood through improving cognitive flexibility in MDD.

None Declared

Anorexia nervosa (AN) is associated with several medical complications. The cardiac changes represent the most severe complications and are associated with higher mortality. For this reason, periodic evaluation is necessary, by ECG and echocardiography. Moreover, there is not a protocol that defines the timelines or how to select higher risk patients that must be evaluated more frequently.

This single-center, retrospective, observational and epidemiological study aims to analyze the prevalence of cardiac changes and their correlation with disease severity, in patients admitted to the Child and Adolescent Psychiatry Unit, AOU Meyer, Florence.

The study population consisted of 123 children between the ages of 7 and 18 years old admitted to inpatient or intensive day hospital, with a diagnosis of AN, between January 1, 2019, to March 31, 2022. Data were collected by retrospectively consulting clinical reports. The correlation between BMI, percentage of weight loss since the onset of symptoms and HR, QTc interval values and pericardial effusion was evaluated. Furthermore, the correlation between cardiac changes and the intake of antidepressant and antipsychotic medications was analyzed.

The overall prevalence of cardiac changes was 57.7%. In our analysis BMI showed a significant positive correlation whit HR. QTc prolongation was significantly related only to psychotropic drug intake. Pericardial effusion was evidenced exclusively in patients diagnosed with severe or extreme AN. After six months from the hospitalization and the beginning of treatment the prevalence of cardiovascular complications was reduced.

The present study identifies criteria able to select patients with AN at higher risk of developing cardiac changes and underlines the importance of performing more frequent and targeted cardiologic evaluations in this subgroup of patients. This suggests the importance of establishing a common protocol for all clinicians.

None Declared

NES is characterized by daytime anorexia, sleep difficulties with nocturnal food intake, resulting in obesity (Stunkard et al. Am J of Med. 1955; 19 78-86). Alexithymia refers to the impairment in recognizing and describing feelings. The impairment in distinguishing emotions from body sensations may lead patients to confuse emotional arousal with physical hunger (Sifneos et al. Mod. trends psychosom. med. 1976; 3 430-439). This mechanism could lead to nocturnal food intake. Alexithymia was firstly described in BED and was related to BED severity.

To our knowledge no studies have investigated the relationship between alexithymia and NES. The aim of the present study was to assess alexithymia in patients with NES, to improve surgical and nutritional outcomes.

110 patients with clinical diagnosis of NES admitted to the Eating Disorder Unit, between 2013 and 2022 underwent psychiatric assessment for bariatric surgery. Clinical assessment consisted of clinical interview and the following psychometric rating scales: 20-item Toronto Alexithymia Scale; Eating Disorder Inventory 2, specifically the Interoceptive Awareness subscale; Barratt Impulsiveness Scale; Binge Eating Scale.

The mean BES score was 24.14(SD 8.23), computed on 107 patients, of which 16 (14.5%) had no or minimal binge eating problems and 91 (82.7%) had moderate-severe binge eating problems. The mean TAS total score was 55.11(12.92), computed on 103 patients. 42 patients had a TAS-20 total score ≤50 and were categorized as non-alexithymic, and 61 had a TAS-20 total score >50 and were categorized as alexithymic. Simple linear regression was used to test if TAS-20 total score significantly predicted EDI-IA in the whole sample (97 patients). The overall regression was statistically significant (R2=0.27, F(1,96)=35.46, p< .001) and TAS total score significantly predicted EDI-IA score (β=0.519, p<.001). In the alexithymic group, the regression was statistically significant (R2=0.305, F(1,57)=25.07, p< .001) and TAS total score significantly predicted EDI-IA score (β=0.553, p<.001).

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In patients with NES, alexithymia significantly predicts poor interoceptive awareness, thus explaining excessive nocturnal food intake.

None Declared