Mental Health Literacy (MHL) includes four distinct but interrelated components: maintenance of positive mental health (MH), recognition of mental disorders (R), mental illness stigma attitudes (S), and help-seeking efficacy (E). A fifth component, help-seeking attitude (A) was included in a MHL model because it is a strong predictor of help-seeking behaviors. The five-factor model of MHL has been validated previously. In the study of multiple mediation model of MHL, it demonstrated the mediation role of help-seeking efficacy between recognition of mental disorders and help-seeking attitude (R-E-A path), but the roles of mental illness stigma attitudes or maintenance of positive mental health remain unknown.

The present study aimed to examine the theory-based multifaceted MHL model by utilizing a meta-analytic structural equation modeling analyses (MASEM) method.

Systematic search of articles from electronic databases, including APA PsycArticles, ERIC, MEDLINE, Psychology and Behavioral Sciences Collection, Pubmed, and Airiti Library (Chinese), from inception up to July 31, 2022, was conducted by raters independently assessed study eligibility, and extracted 127 empirical, quantitative, non-interventional studies with properly reported effect sizes (k=192). MASEM analyses were conducted via a two-stage approach. First, a pooled correlation matrix was obtained for each mediation model by applying a multivariate random-effects model using Comprehensive Meta-Analysis Version 3.3. Second, a structural equation model was fitted on the pooled correlation matrices to test for mediation effects (i.e., indirect effects) using IBM SPSS Amos.

In the single-mediator model analysis, there was a significant partial mediation effect of help-seeking efficacy and Mental illness stigma attitudes on the relationship between recognition of mental disorders and help-seeking attitude (R-E-A path & R-S-A path, p <.05). The multiple-mediator model has showed adequate fit (RMSEA = 0.09, SRMR = 0.04, CFI = 0.93, GFI = .99). It confirmed the help-seeking efficacy served as a mediator. A sequential mediation of maintenance of positive mental health and mental illness stigma attitudes was found (p <.05) between recognition of mental disorders and help-seeking attitude (R-MH-S-A path).

There is a robust mediation effect of Help-seeking efficacy on the relationship between recognition of mental disorders and help-seeking attitude either in the single mediation model or the multiple mediation model. Furthermore, increased recognition of mental disorder was related to increased maintenance of positive mental health, therefore decreased mental illness stigma attitude, and eventually increased help-seeking attitude. Future research directions regarding pathways in the MHL models were discussed.

None Declared

Early intervention on a first psychotic episode is fundamental for a more favorable prognosis, and it usually combines pharmacological treatment, which mainly affects positive psychotic symptoms, with interventions that can improve the rest of the symptoms and associated problems such as deterioration in social functioning (Harvey & Penn, 2010; Fusar-Poli, McGorry & Kane, 2017). While Mindfulness is gaining more and more prominence in the field of psychotherapy (Chan et al., 2019; Cillesen et al., 2019), social cognition and social functioning are being researched as key targets on which to intervene after a first psychotic episode (Green, Horan & Lee, 2015).

SocialMIND® is a mindfulness-based social cognition training tailor-made to improve social functioning in people who have suffered a first psychotic episode within the last five years. It is currently being compared with a group Psychoeducational Multicomponent Intervention (PMI) in a Randomized Controlled Trial (RCT) (Mediavilla et al., 2019). Both group psychotherapies include 17 sessions delivered over a 9 month period: 8 weekly sessions, 4 biweekly sessions and 5 monthly sessions.

The results of SocialMIND® at 8 weeks showed improvements in social cognition and social functioning, specifically on affective social cognition and self-care (Mediavilla et al., 2021).

To evaluate the efficacy of SocialMIND® in improving social functioning, measured by the Personal and Social Functioning (PSP) scale 16 weeks after starting the intervention, in people who have suffered a first psychotic episode in the last 5 years.

Randomized, controlled pilot trial (use of a psychoeducational multicomponent intervention or PMI as active comparator) of two parallel groups (SocialMIND® and PMI) with a 1:1 ratio using a blind evaluator.

No statistically significant differences were found in the social functioning variable between the two treatment arms. Intragroup differences are observed in other secondary variables studied (social cognition) 16 weeks after starting the interventions.

SocialMIND® has not been shown to be more effective than a PMI in improving social functioning at 16 weeks after starting the intervention in people who have suffered a first psychotic episode in the five years prior to being included in the study.

None Declared

We report here our experience of treating hallucinations (auditory, visual, sensorial) using Cognitive Behavioural Therapy (CBT), along with medications. Our experience goes towards the conclusion that diagnosis is usually made prior to medical treatment of symptoms with high doses of neuroleptic drugs.

Our aim was to make a clear difference between hallucinations which need high doses of neuroleptics for cure and hallucinations that could respond to lesser drug treatment associated with CBT.

Our method was based on individual sessions of CBT.

Our behavioural-cognitive method yielded high success rates as evidenced by thorough investigation into patients’ medical record including past medical history, prior drug use and life-threatening events.

This work is preliminary to a follow-up with the rigorous method for evaluation.

Further, we aim to promote out-patient follow-ups in our unit after a very short inpatient assessment and treatment.

Our therapeutic approach is now approved by our team and new patients are currently being included.

None Declared

Depression is a leading cause of disability, annually affecting up to 300 million people worldwide, yet fewer than one third of patients receive care. Cognitive behavioural therapy (CBT) is an effective treatment for depression, but there are barriers to access therapy. Electronic CBT (e-CBT) can address these barriers, but the digital format may reduce personalization and patient compliance. A balanced, hybrid model (i.e., combination of e-CBT & supervised care) could make therapy scalable and effective through a stepped-care model: a care model that begins treatment with the least resource intensive, yet effective, method while slowly ‘stepping up’ to intensive care based on patients’ needs.

-To examine the efficacy of a stepped-care e-CBT model for depression through reduction in depressive symptoms.

-To develop a decision-making process that can effectively allocate the appropriate level of care for each patient.

This is a single-blinded randomized controlled trial (RCT). Participants were randomized to either the e-CBT group (n = 53) or the e-CBT with stepped care group (n = 26). Both groups received a 12/13-weeks e-CBT program tailored to depression. The e-CBT program was provided through a secure online mental health clinic called the Online Psychotherapy Tool (OPTT). Participants read through the sessions and completed assignments related to each session. Each participant was designated a care provider who was a trained research assistant. Participants in the experimental group received extra interventions based on their standard questionnaire scores, and textual data.

Figure 1: The average PHQ-9 (A), QLESQ (B), and QIDS (C) scores pre-, mid-, and post- treatment for the e-CBT only (n = 53) and stepped care groups (n = 26).

* Depressive symptoms: PHQ-9 (Patient Health Questionnaire-9) & QIDS (Quick Inventory of Depressive Symptomatology)

* Quality of Life Measure: QLESQ (Quality of Life Enjoyment and Satisfaction Questionnaire – Short Form)

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Stepped care model can be reliable and effective method of delivering targeted care to future patients. Using this approach, the amount of care each patient receives is tailored to their needs, allowing for more efficient usage of scarce resources. This would also lower the general cost of care for each patient. By understanding the therapeutic needs of each patient, we can use these results to develop objective interventions and efficient algorithms to triage individuals. This technique could scale up care capacity without sacrificing the quality of care for each patient.

N. Alavi Shareolder of: OPTT inc, M. Omrani Shareolder of: OPTT inc, J. Jagayat: None Declared, A. Shirazi: None Declared, A. Kumar: None Declared, A. Pannu: None Declared, Y. Shao: None Declared

Psychophysical diseases can be cured without medical intervention, and this is the so-called self-healing. Self-healing is the process of recovery from emotional ill-health, but self-healing can also include accompanying physical health issues. Cognitive-behavioral therapy is one of the effective methods that help the individual to activate their role in self-healing and controlling thoughts and lifestyle. Being therapeutically effective in previous literature and less expensive than medication, CBT can be utilized by psychiatry practitioners.

The current study aimed at investigating the effects of a cognitive behavioral therapy-based program to promote self-healing of patients with irritable bowel syndrome (IBS). Additionally, it explores the continuity of the proposed program effectiveness throughout six months.

The quasi-experimental method (one group design) was adopted Participants were 4 patients (ages between 29-34 years) were purposively selected since they were suffering from irritable bowel syndrome (IBS) for (4-11) years based on the diagnosis conducted by Gastroenterology Clinic specialists at Sultan Qaboos Hospital in Salalah. The fifteen sessions of the therapeutic intervention lasted for five weeks. No medications were taken during the intervention and the follow-up period.

Results indicated the effectiveness of the intervention in promoting self-healing of the irritable bowel syndrome (IBS) and a decrease in the symptoms of the irritable bowel in the medical examination after intervention as shown in the significant differences between time 1 and time 2 assessment while no significant difference was detected between time 2 and time 3 assessment (follow-up). A significant decrease in the medical symptoms of IBS (85% improvement rate).

Non-pharmacological psychotherapy is beneficial with patients with psychosomatic disorders as it can be used effectively to improve self-healing.

None Declared

Oncological and palliative care patients face unique stressors which increase their risk of developing depression and anxiety. Cognitive behavioural therapy (CBT) and mindfulness has established success in improving this population’s mental health. Traditional face-to-face psychotherapy is costly, has long wait lists, often lacks accessibility, and has strict scheduling, each of which can make attending psychotherapy physically, mentally, and financially out of reach for oncological and palliative patients. Web-based CBT (e-CBT) is a promising alternative that has shown efficacy in this and other patient populations.

To quantify the efficacy of online CBT and mindfulness therapy in oncological and palliative patients experiencing depression and anxiety symptoms.

Participants with depression or anxiety related to their diagnosis were recruited from care settings in Kingston, Ontario, and randomly assigned to 8 weekly e-CBT/mindfulness modules (N= 25) or treatment as usual (TAU; N=24). Modules consisted of CBT concepts, problem-solving, mindfulness, homework, and personalised feedback from their therapist through a secure platform (Online Psychotherapy Tool- OPTT) Participants completed PHQ-9 and GAD-7 in weeks 1, 4, and 8. (NCT04664270: REB# 6031471).

Significant decreases in PHQ-9 and GAD-7 scores within individuals support the hypothesis of efficacy. At this time, 10 e-CBT/mindfulness and 12 TAU have completed the study. Decreases in PHQ-9 and GAD-7 scores within e-CBT group support the hypothesis of efficacy. Specifically, PHQ-9 scores decreased over the 3 repeated measures (ANOVA, 2 groups, 3 repeated measures and the decrease in GAD-7 scores was similarly large)

As hypothesized, the results suggest that e-CBT/mindfulness therapy is an affordable, accessible, and efficacious mental health treatment for this population. The virtual, asynchronous delivery format is particularly appropriate given the unique barriers.

N. Alavi Shareolder of: OPTT inc, Grant / Research support from: department psychiatry Queen’s University, M. Omrani Shareolder of: OPTT inc, A. Shirazi: None Declared, G. Layzell: None Declared, J. Eadie: None Declared, J. Jagayat: None Declared, C. Stephenson: None Declared, D. Kain: None Declared, C. Soares: None Declared, M. Yang: None Declared

Psychotic disorders are associated with a degree of disability that is much more considerable if the duration of untreated psychosis is prolonged. This fact highlights the importance of early intervention strategies among individuals at ultra-high risk (UHR) for psychosis, often struggle with depressive symptoms.

The objective of this work was to evaluate the effectiveness of cognitive-behavioral and emotional therapy on depressive symptoms in a patient at high risk of psychosis.

This is a detailed case report of a young adult at UHR for psychosis who was referred to psychiatry department “A” at Razi Hospital for treatment of depression symptoms.

The patient had benefited from 15 sessions of cognitive-behavioral and emotional psychotherapy, over eight months, from July 2021 to February 2022, at the rate of one 45-minute session per two weeks. The main psychotherapeutic techniques used were: behavioral activation, cognitive restructuring and relaxation.

An initial and final assessment was performed by the Hamilton Depression Scale and by the comprehensive assessment of mental states at risk.

The clinical case illustrated concerns a 21-year-old female with a state of high risk of psychosis, suffering from depression symptoms that had been worsen since two years.

As the therapy progressed, an improvement in depressive symptoms and functioning has been noticed, by a decrease in the score of the Hamilton scale, from 28 to 11, with a response estimated at 61% and a score for social functioning and professional, initially estimated between 21 and 30, to became between 41 and 50 after therapy.

The active participation of the patient, and her assiduity were important factors in this success.

Cognitive-behavioral and emotional therapies for depressive symptoms could constitute an effective intervention approach for subjects at high risk of psychosis, allowing the improvement of the prognosis of psychotic disorders.

None Declared

ASD are heterogeneous pathological conditions characterized by difficulties in establishing social contacts and the manifestation of repetitive behavior. An atypical trajectory of brain maturation, impaired neurogenesis, synaptogenesis, and an imbalance in the excitatory and inhibitory systems of the CNS form the morphofunctional basis of the ASD.

To understand the functioning of this complexly organized system in time and space, a three-dimensional model is needed. The closest in vitro model of the human brain from early embryonic stages to aging is brain organoids. Human brain organoids are self-organizing three-dimensional cell aggregates derived from pluripotent stem cells (hiPSCs)

Organelles generalize neurogenesis, gliogenesis, synaptogenesis, cell migration and cell differentiation, gyrification of the cerebral cortex, and reflect the connections of brain regions.

The use of telencephalon organelles in the RAS model revealed a deficit in neuronal migration, acceleration and disruption of cell cycle synchronization, aberrant cell proliferation, abundant synaptogenesis, temporary deviations in the development of the cortex, increased branching of neurons, unbalanced inhibitory differentiation of neurons, high activity of ion channels is a consequence of a violation of FOXG1 activity. Organelles generalize neurogenesis, gliogenesis, synaptogenesis, cell migration and cell differentiation, gyrification of the cerebral cortex, and reflect the connections of brain regions.The use of telencephalon organelles in the RAS model revealed a deficit in neuronal migration, acceleration and disruption of cell cycle synchronization, aberrant cell proliferation, abundant synaptogenesis, temporary deviations in the development of the cortex, increased branching of neurons, unbalanced inhibitory differentiation of neurons, high activity of ion channels is a consequence of a violation of FOXG1 activity .

hiPSCs can provide insight into the cellular mechanisms underlying ASD as a neuropsychiatric disorder, providing access to the development of platforms for in vitro drug screening and individualized patient therapy.

None Declared

Alzheimer’s disease (AD) is a neurodegenerative pathology that develops mainly in elderly and senile people.

The aim of the study was a comparative analysis of the results of neuropsychological tests with the indicators of the study of oral fluid and buccal epithelium cytograms in patients with Alzheimer’s disease.

In the main group of 12 patients with Alzheimer’s disease, m=76.25±4.89. There were 12 cognitively healthy people in the control group. The average MMSE score among the observations of the main group was 13.42±3.63. The ADAS-COG scale was used to detail the impaired cognitive functions. The concomitant pathology is compensated. The content of BDNF, TNF-α, IL1RA, IL-6, and IL-8 was determined in the oral fluid and in the blood serum. The concentration of salivary and serum biomarkers was determined by multiparametric fluorescence analysis with magnetic microspheres. Micronuclei, karyopycnosis, karyorexis, and karyolysis were determined in the cellular structures of the buccal epithelium. The material for cytological examination was collected from the inner surface of the cheek.

When analyzing buccal cytograms, attention was drawn to a pronounced increase in the number of cells with micronuclei in patients with AD to 1.8%; in the control group, the median was 0.1% (p<0.05). A direct correlation was established between the number of binuclear cells and the level of BDNF in the blood serum (r=0.646; p=0.03) in patients with AD. It is also important to note that the level of serum BDNF had a significant direct correlation with immediate memory, and the concentration of salivary BDNF correlates with the parameter of naming objects.

Correlations between amnesia, speech disorders, praxis, gnosis and pathology of the oral fluid and buccal epithelium, especially with the severity of karyopycnosis and karyorexis, have been established, indicating a direct correlation between the neurodegenerative process pathogenetically associated with Alzheimer’s disease and the processes of systemic inflammation and degeneration of the buccal epithelium.

None Declared

Large proportion of patients with ADHD experience sleep problems. Well conducted, good quality clinical research could identify non-pharmacological sleep improvement interventions that would benefit patients with ADHD and would inform evidence based guidelines for sleep management in ADHD.

To conduct a novel meta-research assessment of available clinical trials in the field of light therapy and non‑pharmacological sleep improvement interventions for people with ADHD.

Peer-reviewed publications of clinical trials were analysed. An advanced literature search strategy was performed in major medical databases, including EMBASE, MEDLINE, the Cochrane Central Register of Controlled Trials and PsycINFO. Available data at WHO-approved clinical trial registries were searched and linked to the published literature. Detailed methodological assessment of results was conducted using the Cochrane Risk of Bias Tool version 2.0 (ROB2), conflict of interest, spin and favourability of findings. Reduction in ADHD symptom severity and improvement of sleep quality served as primary outcomes for the efficacy analysis. Any adverse events were recorded. Statistical analysis of the primary outcomes was conducted by calculating standardised mean difference and transformed as necessary. Publication bias was evaluated with contour enhanced funnel plots and the trim-and-fill procedure, and by summarising unpublished trials.

Analysed clinical trials often had a high risk of bias (evaluated by the ROB2). The primary outcome interpretation and overall trial conclusions frequently favoured the trial intervention. Clinical trials showed an association between primary outcome effect size and interpretation, and risk of bias. Clinical research in this field faces many of the same challenges identified for complex interventions in mental health, such as small sample size, lack of funding and difficulties with blinding.

Clinical research regarding light therapy and non‑pharmacological sleep improvement interventions for ADHD patients indicates safety and effectiveness but studies often lack methodological rigour.

None Declared

Sunshine increases placebo effect in major depressive disorder (MDD) patients (Gailledreau et al., 2015). Kokras et al. (2014) showed that sunshine induces different responses in female than male mice in preclinical models of depression.

To determine if the sunshine induced placebo effect exhibits gender differences in human

Data from 9 double-blind, randomized, placebo-controlled studies of antidepressants conducted by the French GICIPI network were reviewed. MADRS (5) or HAM-D 17 (4) were used as the main efficacy tool. For each patient, variation of scores (Delta MADRS/Delta HAM-D) between two consecutive visits were correlated with the average sunshine index observed at noon between these visits. Sunshine indexes were provided by Météo-France. Correlations were computed with Microsoft Excel.

Sunshine increases placebo effect: however analysis of both genders (n=52) demonstrates no statistically significant (NS) correlation (r²=0.0064). Analysis of the males (n=8) demonstrates NS correlation in cloudy (< 1000 Joules/cm²), variable (1000-2000 Joules/cm²) or sunny (> 2000 Joules/cm²) weather. Although analysis of the females (n=44) demonstrates NS correlation as well for cloudy or variable weather (r²=0.0016), there is a strong correlation between sunshine index and Delta MADRS/Delta HAMD for females exposed to sunny weather: r²=0,315, n=20, p<0.01. This correlation is even stronger in the subpopulation of females aged less than 50 years: r²=0.6398, n=12, p<0.001.

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Sunshine increases placebo effect in female patients aged less than 50. This insufficiently known effect may be responsible for failure of a number of double-blind, randomized, studies of antidepressant compounds.

None Declared

In recent years, new concepts have been proposed to discriminate between healthy (adaptive) and unhealthy (nonadaptive) self-esteem. Among them, Yamasaki et al. (2017) proposed the concepts of “autonomous” and “heteronomous” self-esteem. As they underscored that autonomous self-esteem needs to be nonconsciously assessed, several nonconscious assessment methods have been developed using implicit association tests (IATs). However, any IAT has not been developed for younger children, even though it is necessary to measure autonomous self-esteem in early childhood because it is largely formed in early developmental stages.

The aim was to develop an IAT to measure autonomous and heteronomous self-esteem for 1st-grade elementary school children. In order to standardize it, the validity and reliability were examined.

Participants were 1st-grade children in a public elementary school in Japan. The final sample included 55 children (35 boys and 20 girls). Their two home-room teachers participated to evaluate the children. The IAT was administered twice, around four weeks apart. The original paper-and-pencil version of the IAT was developed based on the IAT by Yokoshima et al. (2021). In this test, the implicit association between two kinds of stimuli, category (e.g., “myself”) and attribute (face pictograms expressing high and low self-esteem), is measured in terms of accuracy and speed. The evaluation by teachers was conducted using 7-point Likert scales (“not true at all” to “very true”). The evaluation items were “this child proactively does what he or she wants to do alone or with friends for autonomous self-esteem and “this child is competitive and concerned with the consequences of other children” for heteronomous self-esteem.

The test-retest reliability was calculated using correlational analyses of the two measurements. The correlation was significantly positive, r = .70, p < .01. To examine the validity, the children were divided into high and low groups based on the cut-off scores (over 1 SD above the mean and under 1 SD below the mean). Statistical analyses showed that the evaluated scores were significantly higher in Group High than in Group Low regarding the characteristic of autonomous self-esteem, t (19) = 3.87, p < .01, d = 1.62, and that they were significantly higher in Group High than in Group Low for the characteristic of heteronomous self-esteem, t (19) = 3.14, p < .01, d = 1.32.

This study showed that the newly developed IAT for lower-grade children includes high reliability and validity. Hereafter, this test can be utilized at schools to assess autonomous and heteronomous self-esteem. As schools are interested in enhancing healthy and adaptive self-esteem, this tool will be an effective assessment method to ascertain how autonomous self-esteem is cultivated.

None Declared

The 1978 Italian reform of psychiatric services initiated the closure of psychiatric hospitals encouraging the development of community mental health. However, there is wide variability across regions in the amount of resources devoted to community-based psychiatric care, and the range of services provided still is cause of concern.

To evaluate the quality of mental health care delivered to patients with schizophrenia and related disorders taken-in-care by mental health services in four Italian regions (Lombardy, Emilia-Romagna, Lazio, Sicily).

Thirty-one clinical indicators concerning accessibility, appropriateness, continuity, and safety were defined and estimated using healthcare utilization (HCU) databases, containing data on mental health treatments, hospital admissions, outpatient interventions, lab tests and drug prescriptions.

A total of 70,586 prevalent patients with schizophrenia treated in 2015 were identified, of whom 1,752 were newly taken-in-care. For most patients community care was accessible and moderately intensive. However, care pathways were not implemented based on a structured assessment and only half of the patients received psychosocial treatments. One patient out of ten had access to psychological interventions and psychoeducation. Activities specifically addressed to families involved a third of prevalent patients and less than half of new patients. One patient out of six was admitted to a community residential facility, and one out of ten to a general hospital psychiatric ward (GHPW); higher values were identified in new cases. In general hospitals, one-fifth of the admissions were followed by readmission within 30 days of discharge. For two- thirds of patients continuity of community care was met, and six times out of ten a discharge from a GHPW was followed by an outpatient contact within two weeks. For cases newly taken-in-care the continuity of community care was uncommon, while the readiness of outpatient contacts after discharge was slightly more frequent. Most of the patients received antipsychotic medication, but their adherence to long-term treatment was low. Antipsychotic polytherapy was frequent and the control of metabolic side effects was poor. The variability between regions was high and consistent.

The Italian mental health system could be improved by increasing the accessibility to psychosocial interventions, improving the quality of care for newly taken-in-care patients, focusing on somatic health and mortality, and reducing regional variability. Clinical indicators demonstrate the strengths and weaknesses of the mental health system in these regions, and, as HCU databases, they could be useful tools in the routine assessment of mental healthcare quality at regional and national levels.

None Declared

Selective serotonin reuptake inhibitors (SSRI group antidepressant drugs) are not significantly different from tricyclic antidepressants and other antidepressants in terms of efficacy, but provide significant advantages in terms of side effects and toxicity. One of the most important side effects of antidepressant drugs is weight gain. However, there is not yet enough study on weight gain mechanism.

Nutrition and hunger-satiety circle are occured under the control of neuropeptids and hormones that are synthesized and secreted from the hypothalamic arcuate nucleus (ARC), adipose tissue and the pancreas.

In this study, we examined how escitalopram affects the body weight, the body mass index, the serum lipid profile, the liver function tests, the underlying molecular mechanisms of weight change, the relationships these mechanizms and the hypotalamic nutrition regulatory neuropeptides such as POMC, NPY, leptin, CCK and insülin that is a pancreatic hormone.

In order to understand the relationship between antidepressants and metabolic risk factors such as diabetes and obesity and to understand the underlying mechanisms, body weight, waist and hip circumference, POMC and NPY levels from hypothalamic nutrition regulating neuropeptides, CCK from peripheral neuropeptides, a pancreatic hormone insulin, and the effects of escitalopram use on these parameters were investigated.

In this prospective study, 30 patients, who were decided to have escitalopram treatment and who met the inclusion criteria and continued the treatment for 12 weeks, were included in the study.

Weight, waist circumference increase and waist-hip ratio decreased significantly after 12 weeks. The decrease in neuropeptide level in POMC was significant.

In our study, according to the insignificant change in lipid parameters it was thought that the use of escitalopram does not cause a metabolic change that would increase the risk in terms of metabolic syndrome and cardiovascular disease, despite the short study period. The decrease in POMC levels due to escitalopram use; It was thought that it may lead to weight gain by modulating eating behavior modulation.

None Declared

Paliperidone Palmitate 3-month formulation (PP3M) has shown a significantly longer time to relapse compared to placebo, with similar efficacy and safety to Paliperidone Palmitate 1-month (PP1M) (Carpiniello et al. Drug Des. Devel. Ther. 2016; 10 1731–1742).

The main objective of this study was to determine the effectiveness of PP3M in preventing hospital admissions and emergency room visits, in people with non-acute schizophrenia in a naturalistic psychiatric outpatient setting

Sample: 30 people with diagnosis of schizophrenia (DSM 5 criteria), who had started treatment with PP3M, after being stabilized with PP1M (the dose was not modified in the four months prior to inclusion in the study)

Quarterly basis, the following evaluations were performed during a follow-up period of 66 months:

The Clinical Global Impression-Schizophrenia scale (CGI-SCH)

Treatment adherence, concomitant medication and the number of hospitalizations and emergency visits

Efficacy values: Percentage of patients who remained free of admissions at the end of 66 months of follow-up.

Other evaluation criteria: Percentage of patients who never visited the emergency department at the end of 66 months of follow-up. Average change from baseline visit to the final evaluation as assessed by score obtained on the following scale: GSI-SCH, percentage of patients on antipsychotic monotherapy and treatment adherence rate.

The mean dose of PP3M was 401. 55 mg

The percentage of patients who remained free of admissions at the end of the 66 months was 83.25% and the percentage of patients who never visited the emergency department at the end of 66 months was 79.92%

Mean variations from baseline scores at 66 months were: (-0.36 ±0-37) on the GCI-SCH.

The percentage of patients on antipsychotic monotherapy at the end of the 66 months was 76.56%

The rate of adherence was 86.58%

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In our study, we found that paliperidone palmitate 3-month formulation was effective in reducing the number of admissions and visits to the emergency department, under conditions of daily clinical practice.

None Declared

It has been previously identified that levels of peripheral inflammatory proteins, such as cytokines, are altered in people with schizophrenia spectrum disorders (SSD).

As there is considerable inconsistency in the literature with respect to how inflammatory profiles differ between acute and chronic stages of SSD, a systematic review and network meta-analysis was performed.

Records from CINAHL, the Cochrane Central Register of Controlled Trials, EMBASE, PubMed, and PsycINFO were systematically searched from inception until 31 March 2022 for published studies that had measured levels of inflammatory proteins in cases of SSD and healthy controls. Pairwise and network meta-analyses were performed to determine whether there were significant differences in mean peripheral protein concentrations between acute SSD, chronic SSD, and healthy controls.

After application of the screening process, 215 articles were included for data-analysis. One group of markers were consistently elevated (p<0·05) in both acute and chronic SSD, relative to healthy controls; this group comprised interleukin (IL)-1β, IL-1 receptor antagonist (IL-1RA), soluble interleukin-2 receptor (sIL-2R), IL-6, IL-8, IL-10, tumor necrosis factor (TNF)-α, and high sensitivity C-reactive protein (hsCRP). A second group of markers were inconsistently altered between illness stages: IL-2 and interferon (IFN)-γ were significantly elevated (p<0·05) in acute SSD, whilst IL-4, IL-12 and IFN-γ were significantly decreased (p<0·05) in chronic SSD.

These results indicate that a baseline level of inflammatory protein alteration occurs in SSD throughout the course of illness. This was evident from the group of markers that were consistently elevated in acute and chronic SSD (e.g., IL-6), representing possible trait markers. Moreover, superimposed immune activity may occur in acute SSD, given the group of possible state markers that were increased only in acute illness (e.g., IFN-γ). Further research is required to elucidate whether these peripheral changes are reflected within the central nervous system.

None Declared

Long-acting injectable antipsychotics (LAIA) have provided a significant improvement in the treatment of schizophrenia. Although there is already significant clinical experience with paliperidone palmitate, it is important to evaluate the clinical response of patients to this new 6-monthly presentation, so descriptive studies based on real clinical evidence can be very useful for this purpose.

The main objective of the study is to describe the use of 6-monthly paliperidone palmitate in routine clinical practice, providing variables that objectify the evolution such as the number of admissions and visits to the emergency room.

Retrospective descriptive study with a sample selected by non-probabilistic consecutive sampling, retrospective type, in a time interval of 12 months (n=40). The patients selected were all those who received 6-monthly paliperidone palmitate treatment, with a diagnosis of schizophrenia, in 12 months of use at Hospital Universitario Infanta Elena. A descriptive analysis was performed. Mean and standard deviation were calculated for quantitative variables and N and percentage for categorical variables.

A total of 40 administrations of 6-monthly paliperidone palmitate were performed in the study. None of the patients presented adverse reactions related to the administration of the drug, not reporting local pain or inflammation of the puncture area, except for the characteristic discomfort of an intramuscular puncture. Regarding the efficacy of 6-monthly paliperidone palmitate, none of the patients presented a psychotic decompensation after its administration, maintaining psychopathological stability after the change. The switch to 6-monthly paliperidone palmitate was made from both 1-monthly paliperidone palmitate and 3-monthly paliperidone palmitate, both showing the same efficacy. Regarding tolerability, all the patients who were administered 6-monthly paliperidone palmitate were previously treated with the monthly and quarterly presentation of the same molecule, having presented good tolerability to it, maintaining said tolerability after treatment. change to 6-monthly paliperidone palmitate, with no adverse reaction being recorded after the change. The adherence presented by the patients was very good, performing 100% of the administrations of 6-monthly paliperidone palmitate

6-monthly paliperidone palmitate may be an effective and well-tolerated treatment for the treatment of schizophrenia. In the present study, the use of said LAIA in a group of 40 patients is objectified, showing excellent efficacy and tolerability. All study patients were already stable with the 1-monthly and 3-monthly paliperidone palmitate formulations, maintaining said psychopathological stability when switching to the 6-monthly paliperidone palmitate formulation, with excellent adherence and adverse effect profile .

None Declared

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

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

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

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

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

None Declared

Long-acting injectable antipsychotics (LAIA) are used in diagnoses other than schizophrenia. Over the last two decades, LAIAs have been developed with less administration frequency, going from 2-weekly presentations to 6-monthly presentations. The 6-monthly paliperidone palmitate has recently been released, allowing a reduction in the frequency of administration compared to the 1-monthly presentation and the 3-monthly presentation. Descriptive studies based on real clinical evidence can be very useful to assess clinical outcomes.

The main objective of the study is to describe the use of 6-monthly paliperidone palmitate in patients with schzophrenia, providing variables that objectify the evolution such as the number of psychotic decompensations.

Retrospective descriptive study with a sample selected by non-probabilistic consecutive sampling, retrospective type, in a time interval of 10 month (n=80). The patients selected were all those who received 6-monthly paliperidone palmitate treatment from after 10 months of use at Hospital Universitario Infanta Elena. A descriptive analysis was performed. Mean and standard deviation were calculated for quantitative variables and N and percentage for categorical variables.

A total of 80 administrations of 6-monthly paliperidone palmitate were performed in the study. None of the patients presented adverse reactions related to the administration of the drug, not reporting local pain or inflammation of the puncture area, except for the characteristic discomfort of an intramuscular puncture. Regarding the efficacy of 6-monthly paliperidone palmitate, none of the patients presented a psychotic decompensation after its administration, maintaining psychopathological stability after the change. The switch to 6-monthly paliperidone palmitate was made from both 1-monthly paliperidone palmitate and 3-monthly paliperidone palmitate, both showing the same efficacy. Regarding tolerability, all the patients who were administered 6-monthly paliperidone palmitate were previously treated with the monthly and quarterly presentation of the same molecule, having presented good tolerability to it, maintaining said tolerability after treatment. change to 6-monthly paliperidone palmitate, with no adverse reaction being recorded after the change. The adherence presented by the patients was very good, performing 100% of the administrations.

6-monthly paliperidone palmitate may be an effective and well-tolerated treatment for the treatment of schizophrenia and other diagnoses such as bipolar disorder or borderline personality disorder. According to objective data, 6-monthly paliperidone palmitate could be an effective and well-tolerated treatment as an alternative to monthly and quarterly presentations of the same molecule. Longitudinal studies must be carried out to confirm this hypothesis.

None Declared

Paliperidone 3-monthly (PP3M) is a long-acting injectable antipsychotic (LAI) which has been shown to be an equally effective and more convenient alternative to Paliperidone 1-monthly (PP1M) (Hope et al. Australas Psychiatry 2018;26(2):206-209). A prerequisite for PP3M use is stability on a consistent dosing of PP1M ≥4 months, though, few studies have so far explored patients’ experiences with switching.

The aim of the study was to assess satisfaction and perspectives following the change to PP3M. A safety question with regards to the Covid-19 was also included.

This cross-sectional survey was performed within a large, urban mental health setting between May-June 2021 while the UK was still under Covid-19 restrictions. Two psychiatrists obtained verbal consent before administering the survey. Questions 1 and 2 focused on satisfaction and safety with respondents rating to what extent they agreed or disagreed using a 5-point Likert scale. Questions 3 and 4 focused on advantages and disadvantages of the medication change; suggested answers were supplied but there was also an option to provide additional responses. Additional demographic and clinical information were collected from the electronic records.

Of the 61 patients who were receiving PP3M at the time of the survey 46 (31 male and 15 female) agreed to participate. One declined to participate, while 14 were not contactable, making the response rate 98% (46/47).

89.5% of respondents strongly agreed or agreed that they were satisfied after switching, 6.5% neither agreed nor disagreed and 4% disagreed. The bulk of the respondents (93.5%) strongly agreed or agreed that they felt safer having their injection every 3 months during the Covid-19 pandemic. 6.5% neither agreed nor disagreed but no one disagreed with this statement.

Questions on whether patients experienced any advantages or disadvantages as a result of the switch allowed for multiple answers. Convenience (93.5%), was the most popular positive reply, followed by improved quality of life (59%), decreased stigma (39%), better adherence (28%) and improved tolerability (21.7%). While 6.5% did not experience any advantages, 93.5% did not encounter any disadvantages, with 4.3% reporting worsening or new side effects and 2.2% a relapse of symptoms.

The overall experience of switching to PP3M was positive. Similar to two previous studies (Pungor et al. BMC Psychiatry. 2021; 21, 300; Rise et al. Nord. J. Psychiatry 2021;75(4): 257-265) the majority of patients favoured the change quoting convenience, quality of life and reduced stigma as potential benefits. The importance of enhanced safety with less frequent medication administration under pandemic conditions was also highlighted. Shared and supported decision making should further inform clinical practice (Pappa et al. Community Ment Health J. 2021;57(8):1566–1578).

None Declared