Behavioral (externalizing) and emotional (internalizing) problems were showed to be associated with the prenatal environment. Changes in placental DNA methylation was identified as a relevant potential mechanism of such association.

We aimed to explore the associations between placental DNA methylation and child behavior in order to explore pathways that could link prenatal exposures to child behavior.

Data including 441 children of 3 years of age from the EDEN mother-child cohort. Child behavior assessed using the Strengths and Difficulties Questionnaire (SDQ). Both hypotheses-driven and exploratory analyses (including epigenome-wide association studies (EWAS) and differentially methylated regions (DMR) analyses) were conducted. The analyses were adjusted for confounding and technical factors and estimated placental cell composition. All the p-values were corrected using a false discovery rate (FDR) procedure for multiple tests.

In the hypothesis-driven analysis, cg26703534 (AHRR), was significantly associated with emotional problems (pFDR = 0.03). In the exploratory analyses, cg09126090 (pFDR = 0.04) and cg10305789 (PPP1R16B; pFDR < 0.01) were significantly associated with peer-relationship problems and 33 DMRs were significantly associated with at least one of the SDQ subscales. Placental DNA methylation showed more associations with internalizing than externalizing symptoms, especially among girls. DMRs tented to include highly methylated CpGs.

This study investigated for the first time the associations between placental DNA methylation and internalizing and externalizing symptoms in preschoolers. Further analyses, such as consortium meta-analyses would be necessary to confirm and extend our results.

None Declared

Childhood trauma has been linked to adult psychosocial outcomes including social exclusion, loneliness, and psychological distress.

To explore the associations between childhood trauma and social exclusion in adulthood with consideration of loneliness and symptoms of anxiety and depression in the UKBiobank database.

Hierarchical multiple regression analysis of 87,545 participants (mean age=55.68[7.78], 55.0% female, 97.4% white) enrolled in the UK Biobank. The main predictor variable was occurrences of traumatic childhood experiences. Current loneliness and symptoms of anxiety (GAD-7) and depression (PHQ-9) were included as secondary predictors. The outcome variables were ‘limited social participation’, ‘area deprivation’, ‘individual deprivation’ and (combined) ‘social exclusion’ .

We found small associations between childhood trauma and social exclusion, explaining between 1.5% and 5.0% of the variance. Associations remained significant when loneliness, anxiety, and depression were entered in the models. These findings support a relationship between early-life adversity and socioeconomic deprivation including heightened risks of homelessness, antisocial behaviour and lower social mobility in adulthood.

Loneliness was the strongest predictor of ‘limited social participation.’

Depression was the strongest predictor of ‘individual deprivation,’ ‘area deprivation’ and ‘social exclusion,’ closely followed by childhood trauma.

Anxiety symptoms protected against ‘individual deprivation’ and ‘social exclusion’ in adulthood. Given the composition of the ‘individual deprivation’ dimension (i.e. employment, education, income) this may tentatively suggest that low levels of anxiety could have a positive impact on individuals’ pursuit of education and employment, potentially in line with the theory that the Yerks and Dodson law (i.e., there is an inverted U-shaped relationship between arousal and cognitive performance; Yerkes & Dodson, 1908) may apply to anxiety symptoms. In other words, higher vigilance may help seeking a way out of childhood adversity and increase cognitive performance if anxiety is low level, thus possibly playing a role in resilience. This may particularly be the case given that average levels of anxiety were low in the current sample (only 5% had a clinically significant GAD-7 score of above 10).

Trauma and neglect in childhood are associated with an increase of social exclusion in adulthood.

Loneliness and depression make this association stronger.

Anxiety symptoms may lead to better performance in education and employment and hence play a protective role against individual level social deprivation - higher vigilance and cognitive performance can occur in low level anxiety and may increase resilience in adulthood.

None Declared

Psychotropic drugs are the first-line medications in the treatment of psychosis, bipolar, anxiety and depressive disorders. Some of these psychoactive agents are suspected to be linked to rare, but lethal, ventricular arrhythmias, known as Torsade de Pointes (TdP). Most of the studies found an association between these classes of psychiatric agents and a prolongation of the corrected QT interval. However, QTc prolongation remains an imperfect, though well-established marker of risk for TdP and little is known about the relation between psychotropic drugs and TdP. Some physicians hence refrain from prescribing psychotropic medications to their patients for fear of cardiac adverse events, which can severely undermine the management of underlying psychiatric conditions. It is thus crucial to evaluate the relation between psychotropic medication use and the occurrence of TdP.

The primary objective of this study is to assess the relative contribution of psychotropic medications (antidepressants, antipsychotics) among all TdP risk factors (e.g. sex, hypokalemia, antiarrhythmic drug use). We hypothesize that psychotropic drug use will indeed be associated to TdP, but that this association is negligeable compared to other TdP risk factors.

A retrospective case-control study (1 :3 ratio) of patients hospitalized at the Montreal Heart Institute was carried out (n=444).

Antidepressant and antipsychotic medication use proportions among the cases are 27% and 12% respectively, compared to 17% and 5% in controls (p= .018407 and p= .016326). In our study, patients who take antidepressants [OR=1.83; 95% CI 1.10-3.04] or antipsychotics [OR=2.47; 95% CI 1.16-5.26] are more likely to experience TdP. Patients with a psychotropic polypharmacy are also more prone to TdP [OR=5.67; 95% CI 2.58-12.42]. However, cases are also significantly more likely (p=.000281) to take concomitant medications associated with QTc prolongation (based on CredibleMeds, July 2022 list). Female sex [OR=2.40; 95% CI 1.55-3.71], hypokalemia [OR=3.46; 95% CI 1.65-7.26], kidney failure [OR=1.61; 95% CI 1.05-2.48], a QTc interval greater or equal to 500 ms [OR=5.89; 95% CI 3.59-9.65] are also associated with TdP.

In this study, psychotropic drug use is indeed associated to TdP. Further analyses, i.e. multivariate logistic regressions, will determine psychotropic drugs’ relative contribution among the identified risk factors for TdP.

None Declared

The Institute of Forensic Psychiatry is an institution which, with the orders of the courts, evaluates the mental state of persons who have committed criminal offenses of all kinds.

From 2019, with the entry into force of the new penal code in Kosovo, even domestic violence is a criminale offense punishable by law up to three years in prison.

With the beginning of the pandemic and the measures that have been put into place by the government, which also meant the complete closure of many institutions and businesses with the aim of preventing the spread of the disease, restrictions on movement, and the presentation of many other problems such as the economy, the purchasing power, the loss of jobs that led to an increase in requests made by the courts to the Forensic Psychiatric Institute for the evaluation of the mental state of many perpetrators of domestic violence.

Data were collected retrospectively from March 2019 to March 2020 in the time before the pandemic. March 2020 to March 2021 during the Lock Down, and March 2021 to March 2022, the time after the pandemic when we did not have these measures. These data have been provided by the archive of the Forensic Psychiatric Institute by collecting all the cases - the orders of the courts where the persons have been accused of the crime of domestic violence under Article 248 of the Criminal Code of the Republic of Kosovo.

During the Lock Down, there was an increase in cases of domestic violence. The number of requests from the Courts in the Forensic Psychiatric Institute increased from 494 before the pandemic to 648 orders during the pandemic and a slight decrease to 562 orders after the pandemic. The criminal offense with which they were accused most often was domestic violence from 119-23.68% of cases before the pandemic, in 202-3.17% of cases during the lockdown and a slight decrease after the pandemic in 156-27.75% of cases.

An increase in domestic violence caused by the female gender was also observed from 19 cases - 16.23% of all cases referred before the pandemic 61 cases - 30.19% of cases during the pandemic and a slight decrease in the time after repentance in 29 cases - 19.86%.

During the pandemic, domestic violence experienced a significant increase that was a consequence of the government’s lock down measures to prevent the spread of the disease.

The number of cases of reoccurrence of violence in the family also increased among people who have had problems with mental health before.

There has also been a significant increase in domestic violence caused by the female gender, which was unexpected for our culture.

None Declared

Patients admitted into Forensic Clinics for Dependency Diseases (FCDD) in Germany are diagnosed with at least one substance use disorder. Opioid use disorders is common in this clinical population. Surprisingly, data on the availability and practice of opioid substitution treatment (OST) options in German FCDD according to Sect. 64 of the German Criminal Code (StGB) is scarce. Additionally, important data on the prevalence of adverse incidents such as violent behavior, relapse or escape from the clinic are missing for this highly specific treatment setting.

Our aim ewas to describe the clinical practice regarding opioid substitution therapy in forensic psychiatry in Germany and to identify the prevalence of relevant adverse incidents during the therapy process.

We conducted a observational study including all FCDD units in Germany via a questionnaire. We assessed the clinical practice and total number of patients that received an OST, clinical reasons for beginning and ending the OST, number of treatments terminated without success, number of successful treatments and relevant adverse incidents such as violent behavior, relapse, escape and reoffending. The data was analyzed descriptively.

15 of the existing 46 FCDD participated in our study (33%). In total, 2483 patients were treated in the participating FCDD, 18% of the patients were relocated into prison due to treatment termination and 15% were discharged successfully. 275 adverse incidents were reported: violence against a patient (4%), violence against staff (1,6%), escape (4,7%) and reoffending (0,5%). Merely in seven FCDD treating 1153 patients, an OST was availabe. Available options included buprenorphine/naloxone, buprenorphine, methadone and levomethadone. Regarding adverse incidents and successful discharge, no differences were detected in the clinics with or without an OST. In the clinics that offered an OST, we found a significantly higher rate for treatment termination without success (p<0.007) in comparison to clinics without this program. 99 patients received an OAT and this treatment was ended due to illegal drug abuse (57%), refusal to give an urine drug sample (71%) and in cases were the OAT was given away to other patients (85%).

Surprisingly, opioid substitution therapy is only accessible in a part of the FCDD in Germany. Reasons for this are unclear. Critical incidents such as violent behavior against staff/patients and escape are not uncommon in this forensic psychiatric treatment setting. Further studies are needed to enhance the understanding of the limited OST practice and the risks for patients and staff in this specific forensic treatment setting.

None Declared

Aggressive behavior can be understood as a compelx and social phenomenon. A number of studies have shown that the risk of aggressive behavior is increased for patients with severe mental disorders such as schizophrenia. Although specialized forensic institutions exist in many countries, most offenders with mental disorders are still found in prison settings what corresponds to international literature suggesting an increased prevalence of mental disorders in prison inmates. Still, data on the specific characteristics of patients demonstrating aggressive behavior in medical and mental health settings is limited, especially for prison environments.

The aim of our study was to identify patient characteristics that are potentially associated with aggressive incidents in a prison psychiatric setting.

In routine documentation in German prisons, specific incidents, as e.g. aggressive behavior are reported through an official reporting system. Analyzing these official reports, we collected all aggressive incidents concerning at the Department of Psychiatry of the Berlin prison hospital between 1997 and 2019. In addition, for each patient acting aggressively, we collected data on an equal number of patients who did not demonstrate this behavior during their hospital stay. For those patients with more than one inpatient treatment period, only the first stay in the prison hospital was included. Furthermore, patients were excluded based on age (younger than 16 or older than 70) or death during treatment. The statistical data was analyzed descriptively.

In total, 225 treatment episodes were included of which in 118 cases violent behavior were documented. The items older age, German citizenship, previous violent crimes (OR = 0,40, 95 % KI: 0,35 – 1,17) and antipsychotic (OR = 0,28, 95 % KI: 0,14 – 0,55) or antidepressant (OR = 0,35, 95 % KI: 0,13 – 0,88) treatment within six months prior to admission had a rather protective effect on the occurrence of aggressive behavior during inpatient treatment. Alcohol (OR = 1,21, 95 % KI: 0,64 – 2,27) and drug use disorders (OR = 2.18, 95 % KI: 1,09 – 4,44) tended to be risk factors for aggressive behavior. Thus, the results in this prison psychiatric population correspond to the risk factors described in the literature.

The reported results point in the direction that optimising the availability of psychopharmacological treatment options and offering specialized treatment for patients with comorbid substance use disorder may lead to the prevention of aggressive behavior in patients with a schizophrenia diagnosis.

None Declared

The personality construct of psychopathy consists of severe deficits in behavior, emotion and cognition, often categorized in the two dimensions affective-interpersonal and antisocial-lifestyle. Research indicates that a lack of anxiety and fear play an important role in psychopathic personalities. Understanding the interplay of psychopathic traits, fear and threat processing and reactive behavior is important due to its implications for risky and potentially antisocial behavior.

We conducted a mixed reality study using the elevated plus-maze in a non-clinical sample to test anxiety-related behavior in correlation to psychopathic personality traits. Our hypothesis was that higher psychopathy would lead to higher expression of risky behavior and, thus, to longer time on open arms, higher number of entries to open arms and reduced latency for a first visit on open arms and for open arm endexploration.

Healthy volunteers were recruited (N=170) and completed the Sensation Seeking Scale V (SSSV), the Acrophobia Questionnaire (AQ), and the Brief Questionnaire of Psychopathic Personality Traits. The included subjects were tested on the human elevated plus-maze, which consists of a physical life-sized wooden platform and its representation in a virtual environment. Data recording was performed via the virtual reality tracking system (HTC Vive Base Station®, Seattle, USA) and custom soft-ware (A+ cross®) using the following parameters: total time spent on open arms (time on open arms), number of entries to open arms, latency for the first entry of an open arm (latency 1st visit) and time until subjects reach the end of an open arm (latency endexploration).

Statistical analyses were carried out using IBM SPSS Statistics 23.0 (IBM Corp., Armonk, NY, USA) and R software (R version 4.0.2). Pearson correlation was performed to assess associations between psychopathic traits and measures of anxiety-related constructs.

Reduced levels of anxiety were associated with higher psychopathic traits. This was reflected in a correlation between the PPT sum score and all measures of anxiety-like behavior on the EPM (time on open arms: R = .29, p < 0.001; number of entries to open arms: R = .32, p < 0.001; latency 1st visit: R = -.29, p < 0.001; latency endexploration: R = -.30, p < 0.001). Psychopathic traits were also negatively correlated with subjective levels of anxiety on the EPM (R = -.23, p = 0.004). Sensation seeking (SSSV) (R =.33, p < 0.001) but not general levels of acrophobia (ACQ) (R = -.13, p = 0.11) were moreover associated with psychopathic personality traits.

In light of the ongoing discussion, our results demonstrate a correlation between psychopathic personality traits and anxiety-related behavior in a non-clinical sample. This supports the theory of a lack of fear in psychopathy and may influence risky and potentially harmful behavior in this population.

None Declared

The question of violence and dangerousness is a central subject in psychiatry, since it is a source of stigmatization for many patients and represents a major element of medical, legal and social care. Violence being defined as: "the deliberate use or threat of deliberate use of physical force or power against oneself, against another person or against a group or community, which results in or is very likely to lead to trauma, death, moral damage, maldevelopment or deficiency”. The violent character of the mentally ill was among the precursors to the discussion around the first therapeutic measures for the mentally ill. A better knowledge of the risk factors for the passage to a violent act in mental disorders is therefore necessary for the development of therapeutic and preventive strategies.

The objective of our work is to determine the socio-demographic, clinical and criminological characteristics of forensic patients and to seek the predictive factors of violence in these patients.

This is a retrospective study spread over 10 years on a series of forensic patients who were hospitalized at the Ar-razi psychiatric hospital in Salé (Morocco). The collection of data was carried out from clinical observations, psychiatric expertise and an exploitation sheet.

Numerous studies have defined subgroups of patients at risk. Factors such as positive symptoms, poor treatment compliance, and comorbidities such as substance use disorders or antisocial personality traits have been described as predictive of violence.

The prevention of medico-legal acts must take into consideration these associated factors, in particular early management of the disorders, improvement of therapeutic observance and family care.

None Declared

People with mental illness are overrepresented throughout the criminal justice system. In Italy, an ongoing process of deinstitutionalization has been enacted: the Judicial Psychiatric Hospitals are now on the edge of their closure in favor of small-scale therapeutic facilities (Residenze per l’Esecuzione delle Misure di Sicurezza - REMS). Law 81/2014 prescribes that a patient cannot stay in a REMS for a period longer than a prison sentence for the same index offense. Therefore, when patients end their duty for criminal behaviors, their clinical management moves back to outpatient psychiatric centers. Elevated risks of violent behavior are not equally shared across the spectrum of psychiatric disorders. In the past several years, multiple studies in the field of forensic psychiatry confirmed a close relationship between violent offenders and comorbid substance abuse.

In order to broaden the research in this area, we analyzed sociodemographic, clinical and forensic variables of a group of psychiatric patients with a history of criminal behaviors, attending an outpatient psychiatric service in Milan, with a focus on substance abuse.

This is a cross-sectional single center study, conducted in 2020. Seventy-six subjects with a history of criminal behaviors aged 18 years or more and attending an outpatient psychiatric service were included. Demographic and clinical variables collected during clinical interviews with patients were retrospectively retrieved from patients’ medical records. Appropriate statistical analyses for categorical and continuous variables were conducted.

Data were available for 76 patients, 51,3% of them had lifetime substance abuse. Lifetime substance abuse was significantly more common in patients with long-acting injectable antipsychotics therapy, >3 psychiatric hospitalizations, history of previous crimes and economic crime (Table 1). Additionally, this last potential correlation was confirmed by logistic regression.Table 1.

Data emerging from this survey provide new information about offenders in an Italian mental health service with a focus on lifetime substance abuse in these patients. Our preliminary results should be confirmed in larger sample sizes.

None Declared

The use of antipsychotics in the treatment of the mentally ill represents a complex modality, especially in specialized institutions such as the Institute of Forensic Psychiatry of Kosovo. Current best practices are summarized in clinical guidelines, which nevertheless recognize the importance of individualizing treatment. In literature there is the scarcity of knowledge on the effectiveness of pharmacological treatment within a forensic psychiatric population.

To understand the features of the use of antipsychotics in IPFK as a prerequisite for increasing the quality and adequate treatment in psychiatric institutions in Kosovo.

It is a retrospective study. The files of 100 patients admitted to IPFK for evaluation and treatment in 2021 were analysed. The age ranged from 18 to 71 years (Mage=36.33; SD=12.66). General demographic data, types of antipsychotics, their doses, their combinations were looked at. Data analysis was processed with SPSS 26 and Microsoft Excel 2016.

43% of patients were not prescribed any antipsychotic drugs. 38% used one antipsychotic, 16% used 2 antipsychotics at the same time and 3% used three types of antipsychotics. 12% of patients used four types of psychotropic drugs (antipsychotic, anxiolytic and mood stabilizer), 12% were on three types of psychotropic drugs, 42% did not use any type of medication. No side effects were noted. Only one case of refusal of therapy was recorded. The doses of the drugs used are within the recommended therapeutic limits. Most of the antipsychotics used were of the second generation. In 44% of cases they received Risperidone, in 17% of cases Haloperidol, in 14% of cases Olanzapine, in 5% of cases Clozapine and in only 1% Aripiprazole.

Antipsychotic medication is the main method of treatment in IPFK, based on the specifics of the cases. The impression of overuse of several antipsychotics at the same time requires deeper professional consideration in order to avoid chemical restraint as a management method.

None Declared

REMSs (Residenze per l’Esecuzione delle Misure di Sicurezza, which roughly translates into Facilities for the execution of security measures) are psychiatric residential facilities introduced in Italy following the discontinuation of Forensic Psychiatric Hospitals, a process started between 2012 and 2014 and concluded in 2017. REMSs are forensic psychiatric communities, focusing on treatment and rehabilitation, managed exclusively by the italian NHS. They host psychiatric patients, who have committed crimes, but are not sended into the ordinary jail circuits because judged as mentally impaired and socially dangerous, with the aim that of stabilizing and treating psychiatric symptoms and that of their gradual social re-insertment. After the closure of psychiatric hospitals in 1978, the overcoming of forensic psychiatric hospitals is the big new thing happening in Italy when it comes to mental health. The introduction of REMSs has spotlighted how much is needed a care program used as a prevention tool, putting the mentally impaired with a social danger profile back into their dignity as human beings. Notwithstanding, after 10 years from its greenlight, some remarkable issues about REMSs system are at hand, starting from long waiting lists, which triggers the double risk of illegal jail detention of the mentally impaired; or leaving free without containment socially dangerous subjects.

Purpose of the present study is to offer an overview of the italian REMSs system, focusing on its critical issues such as waiting lists to be admitted and treading prospects for improvement.

Our work involves a research review on litterature on REMSs, forensic psychiatric services and admitting procedures.

There are 33 REMSs in Italy. As of 31st December 2021, 573 in-patients are hosted in REMSs. The most frequent diagnosis is schizophrenia (33%), followed by personality disorders (32%) and substance abuse (21.4%). 80% of the crimes committed involve violence towards human beings. As of 25th March 2022, the REMSs waiting lists include 605 individuals, 42 of whom were already imprisoned and 561 released. The average waiting time for admittance is about 10 months. Positioning on the waiting list follows the exclusive chronological criterion (date of sentence) and is not related to any clinical risk criteria whatsoever. It is estimated that one third of waiting patients remain without adequate care.

Rethinking the admittance criteria to REMSs is crucial. The use of alternative safety measures, the improvement of community mental health services and a real integration between both legal and heatlh systems in terms of management of the offending psychiatric patient are among ways suggested to avoid breaking the dream of deinstitutionalisation.

None Declared

Hyperprolactinemia is a commonly encountered adverse effect of antipsychotic medication. Short and long-term repercussions of high prolactin, such as amenorrhea, sexual dysfunction, osteopenia and increased cardiovascular risk carry significant burden and may compromise therapeutic adherence. Despite its serious practical implications, hyperprolactinemia is still underscreened and its management neglected.

To review current clinical guidelines regarding the management of hyperprolactinemia associated with the use of antipsychotics, reflecting upon the importance and need to share the management of this risk with an endocrinology expert.

We performed a literature review to identify clinical guidelines containing specific recommendations for antipsychotic-induced hyperprolactinemia (British Association of Psychopharmacology [BAP], NICE, Maudsley Prescribing Guidelines, Royal Australian and New Zealand College of Psychiatrists), published over the last ten years, with a particular focus on its physical risks.

Most guidelines do not recommend routine monitoring of prolactin levels in asymptomatic patients. NICE and BAP guidelines have suggested measuring the baseline prolactin level, but have not specified follow-up monitoring, while Maudsley guidelines have. Management strategies depend on factors such as sex, age, as well as the clinical manifestations that ensue. Different treatment strategies have been described, such as decreasing the dose of the antipsychotic, switching antipsychotics, adding aripiprazole or adding dopaminergic agonists. Referral to an endocrinology specialist should be made if the aetiology is unclear, prolactin levels continue to rise despite some intervention, the hyperprolactinaemia is severe (>3000 mIU/L) or there is suspected/confirmed pituitary adenoma. Further physical implications of having hyperprolactin are to be dressed by the endocrinology expert, namely those on bone metabolism, gonodal function and cancer risk.

Given the widespread use of antipsychotics and the need to have psychotic patients stabilized (sometimes with a lack of effective alternative), early detection and shared management of hyperprolactinemia are instrumental towards assisting both clinician’s and patients’ decision-making, be it towards lowering prolactin levels or managing its risk without compromising the antipsychotic’s efficacy.

None Declared

Power calculations are widely used in the conduct of clinical trials and are often required in funding applications and approvals. There is a recent debate on the role of power calculations in observational studies on existing data with (Hernán J Clin Epidemiol 2022; 144 203-205) and (Moris and Smeden J Clin Epidemiol 2022; 142 261-263) emphasizing the need for planning for all study types without risking discarding imprecise but otherwise relevant studies. In the current study, we construct a graph useful in the planning of a wide range of studies with survival data. We map the minimal detectable effect (MDE) for any possible number of events with a dichotome exposure varying the proportion assigned to the exposure groups.

To provide a visual tool relating the sample size, more precisely the number of events, and the MDE for survival data in unbalanced designs.

The visualization is based on the formulas used by Stata’s power logrank function by (Schoenfeld Biometrics 1983; 39 499-503) and (Freedman Statistics in medicine 1982; 1 121-129), and the MDE is mapped as a function of the number of events. Furthermore, we apply this to an ongoing project on data from the Danish national registers, comparing the risk of developing polycystic ovary syndrome (PCOS) associated with treatment with valproic acid in a population with bipolar disorder or epilepsy.

Preliminary results (Fig. 1) show, as expected, that a larger sample size is required to obtain an MDE close to one. Also, the MDE increases when the assignment among groups is skewed. Moreover, we find a relevant minimal detectable HRR of 1.78 for developing PCOS in a population of 13,839 patients with bipolar disorder or epilepsy, exposed to valproic acid versus those not exposed to valproic acid, with a total of 203 cases of PCOS.

Fig. 1 shows the minimal detectable effect size as a function of the number of events, with α = 0.05 and a power of 1 - β = 0.8, for various assignment ratios φ = PT/PC, where PT and PC are the proportions of patients assigned to the treatment group and the control group, respectively.

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The current visualization and corresponding calculation can be used to guide decisions in the design phase of both observational studies as well as in clinical trials. For observational studies, the sample size, or equivalently, the number of events, could well be fixed, and the MDE may help assess the clinical relevance of conducting the study as in the example with PCOS data. The curves can also provide insight into which efforts might lower the MDE, e.g., whether a small increase in sample size or a different assignment proportion would be most beneficial based on a given sample size.

None Declared

A humanitarian crisis is defined as a singular event or a series of events that are threatening in terms of health, safety or wellbeing of a community or group of individuals, and require action that is usually urgent and often non-routine. Examples of such crisis are wars, natural disasters, epidemics and forced immigration. There is an urgent need of an international commitment to planning for humanitarian emergencies that include individual and community psychosocial support for older adults with mental health conditions. The current lack of inclusion for these older adults in humanitarian response is dramatic and constitute a clear violation of their Human Rights.

The World Psychiatric Association Section of Old Age Psychiatry and the International Psychogeriatric Association are working together since 2020 to promote the older adults’ Human Rights. Articles, position statements, seminars, sympsoia and congress were produced. The ultimate common goal is to support the adoption of an UN Convention on the Human Rights of the Older Persons that include the promotion and protection of the mental health of these persons.

Input to the Independ Expert on Older Adults at the OHCHR who prepared official repports presented during the UN General Assembly in 2022.

Publication of articles, organization of seminars, symposia and congress

The main documents pulblished will be presented as well the template of the next Position statement on Older Adult’s mental health during Humanitarian Crisis

Humanitarian actors must provide assistance in accordance with the principles of humanity, neutrality and impartiality. Promoting and ensuring compliance with these principles are essential elements of effective humanitarian coordination, in respect of the Human Rights principles, in particular when vulnerable people such older adults with mental health conditions are involved.

None Declared

: Occupational justice (OJ) regards the human right to be engaged in meaningful life occupations (work, leisure, learning, house management etc.). It highlights the idea that all society members should be able to actively participate in all occupations as equals. Yet, people with mental health problems remain at the margins of society and struggle to fully participate in life activities. At the same time, such participation has been shown to lead to better functional abilities, higher quality of life, and better illness management among this population. It provides routine, connectedness, belonging, purpose, and identity. Moreover, impaired occupational participation due to mental health problems has resulted in functional impairment, symptomatic deterioration, loss of social roles, and a reduced sense of competence. Despite the importance of such participation, it is unclear in many mental health rehabilitation service organizations how to design policies that will achieve better occupational participation for their consumers.

To better understand the OJ concept and to create a conceptual model pertaining to the challenges and solutions, which may serve policy makers as a theoretical basis for enhancing OJ based policies.

We conducted a qualitative phenomenological study that included in-depth interviews with mental health rehabilitation consumers, to identify their experiences and perceptions in relation to OJ and focus groups with rehabilitation employees and managers. Data analysis was a multi-staged process using a systematic and inductive procedure.

Based on our analysis, the three key themes clarifying the interviewees’ experiences with the OJ concept were a) the importance of and barriers for achieving meaningful participation, b) the required resources for implementing OJ, and c) principles for practice. These elements comprise a holistic OJ construct, affording a practical understanding of what a service that implements OJ means. Such a service would use the resources and practices discussed in this study and address meaningful participation as the desired outcome to achieve.

Unlike other forms of justice, OJ emphasizes the need for flexible and tailor-made services that address the consumer’s changing needs and circumstances. It considers the consumers’ role as active rather than passive service recipients. Recently, the fields of health and rehabilitation have increasingly acknowledged the importance and applications of involving consumers. Their genuine involvement would enhance OJ and provide a basis for more accurate assessments and customized interventions.

None Declared

The reform of mental health care is a key health policy target. Mental health care provision in Spain is designed with national and regional strategies that stablish the objectives to develop. The Castilla y Leon regional strategy 2022-2026 aim to stabilsh the priorities for objectives and actions with stakeholders from th eregional society.

To evaluate priorities in the implementation of a Mental Health strategy with the consensus of professionals and society.

An initial consensus was achieved with the regional health goverment and local mental health representatives, considering the 2022-2026 national strategy and other mental health plans from nearby regions. Lines in the strategy included transversal lines (part of all the mental health scope) and action lines (priorities focused in one relevant field)

Priorities were stablished by different representatives from mental health and other healthcare professionals, social and educational stakeholders, scientific societies, people with mental health disorders and families. After agreeing to participate in the process, they had to answer an online survey. For each line, they have to score from 0 to 10.

500 subjects participated (44% Healthcare workers, 5.8% education or social services, 3.8% Justice, 8,6% workers for associations, 14% Mental Health Care users). All the lines were highly appreciated (mean score >7). Within the transversal lines, the highest score was for the Humanization line (8.81±1.43) and the lowest for the Digitalization line (7.18±1.92). In the Action Lines, the highest score was for Suicide (9.03±11.5) and the lowest for Elder people (8.04±1.94).

Prevention line had higher scores by Education, Justice, Associations and Healthcare professionals and the lowest was for users (F: 2.754; p=0.012). In the Digitalization line the higher scores were in the health professionals and scientific societies and the lowest in the users (F:4.665; p<0.001). In the research, innovation and Training line, the higher scores were for professionals, societies and users and the lowest in the education and justice groups. The only differences found in the Action lines was for the Addiction line, with higher scores for societies, social services, professionals and users and lower in Associations and Justice (F:2.219; p=0,040)

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Highest transversal priority for the MH Strategy was Humanization of Mental Health Services, and the most critical action was Suicide prevention. Professionals, Scientific societies and Users considered more important research, innovation and training compared with other society groups, whereas the less important areas for the users were digitalization and prevention users. These priorities will help to design the implementation and schedule for the lines of the Mental Health Strategy in Castilla y León.

None Declared

A well-established principle is that informed consent is an obligatory requirement for any medical intervention; a patient’s decision-making capacity to consent is a requirement for legally valid consent. Some individuals may be unable to give valid informed consent due to their limited mental capacity. In such cases, laws permit substitute decision-making and involvement of the patient as far as possible (Art.6, Oviedo Convention). National laws of European countries allow persons with mental health problems to be deprived of their liberty and undergo involuntary treatment, namely treatment without a patient’s informed consent, in certain circumstances. Procedural safeguards must be secured, and a court must review its lawfulness (FRA, 2012). The legality of involuntary treatment is highly debated by various audiences (CRPD committee, CoE bodies). In Latvia and other countries, the requirement to assess a person’s decision-making capacity in the application of involuntary treatment is not required.

This study was conducted to reveal the role of a person’s decision-making capacity to consent to the treatment of mental disorders in cases where involuntary treatment was approved by courts.

A retrospective case law study method was applied. Anonymised decisions of Latvian courts at www.manas.tiesas.lv in cases of involuntary treatment in Latvian adult psychiatric hospitals since 2010 were collected and analysed. The content of decisions concerning persons’ decision-making capacity and applicable legal regulations were studied.

The case law revealed that the decision-making capacity had not been addressed regularly and in detail. Latvian law does not require an assessment of capacity, and as a result, the courts do also not require any data. Some elements of decision-making abilities, such as the limited ability to comprehend or process information, are mentioned in the decisions of courts.

There is a need to address the significance of decision-making capacity in the application of patients’ rights law in clinical and legal settings when involuntary treatment is suggested or applied. There is a need to amend the laws justifying the limitations of patients’ rights, particularly concerning involuntary treatment.

This paper has been prepared within the research project “Towards a human rights approach for mental health patients with a limited capacity: A legal, ethical and clinical perspective”, No. lzp-2020/1-0397 and the project “Strengthening of the capacity of doctoral studies at the University of Latvia within the framework of the new doctoral model, identification No.8.2.2.0/20/I/006”

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Smoking is highly prevalent in patients with mental health disorders and although most literature describes the physical health impact of smoking, there is little which addresses the poverty and social consequences associated with nicotine addiction. In 2022, Ireland’s HSE (Health Service Executive) published clinical guidelines, regarding smoking cessation in healthcare settings, with special attention to mental health settings.

The aim of this study was to assess the current prevalence of smoking among inpatients in a psychiatric unit with a “Tobacco Free Campus” policy in place, and the associated patient factors. We also assess the efficacy at which mental health professionals are addressing smoking in this setting.

We performed a cross-sectional analysis of all patients admitted to the inpatient psychiatric unit on a single date. All inpatients were interviewed using a standardised format to ascertain smoking history and employment status. Case records were examined to record diagnoses and assess the patient’s inpatient care plan, nursing admission proforma and medical admission proforma. Medication charts were examined to ascertain whether Nicotine Replacement Therapy (NRT) was prescribed to those identified as smokers. Using Microsoft Excel, we analysed the smoking behaviours data gathered, and the identification of smokers and their orientation to the Tobacco Free Campus policy, on admission.

Of the 51 inpatients, 78% (n=40) had an Axis 1 diagnosis according to the DSM-4, 72% (n=37) were unemployed and 67% (n=34) were receiving Social Welfare. 57% (n=29) of inpatients were current smokers. 63% (n=25) of smokers had an Axis 1 diagnosis, 51% (n=19) were unemployed and 53% (n=18) were receiving Social Welfare. Since admission, 52% (n=15) of smokers have been smoking more, and 48% (n=14) have been spending more money on tobacco. 7% of smokers (n=2) started smoking on the unit. 50% (n=9) of smokers receiving Social Welfare were smoking more, with the majority in receipt of long-term disability allowance (n=7). Only 10% (n=3) of smokers were prescribed NRT, with only 1 patient taking NRT. 90% (n=26) of smokers did not have smoking addressed in their care plan. 38% (n=11) had a fully completed smoking history in the nursing admission, while only 14% (n=4) had one in the medical admission.

Despite a Tobacco Free Campus policy, smoking continues to be highly prevalent in an inpatient psychiatric setting. Smoking was particularly prevalent in patients with Axis 1 diagnoses, and in the unemployed. A large proportion increased their smoking on admission, and their expenditure on tobacco. More can be done to identify smokers on admission so as to promote quitting, and in turn, reduce the social consequences related.

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Multiple definitions for “difficult to treat” patients (DTP) were given throughout the years. While most authors focus on diagnoses, others focus on clinical, social and demographic factors, which should be regarded as factors of bad prognosis and elevated costs for the healthcare systems.

To identify and haracterize DTP patients admitted in acute ward, based on practical criteria.

Through the hospital’s IT services, all acute inpatient episodes at Centro Hospitalar Psiquiátrico de Lisboa were collected, since 2017. Cluster analysis was performed, regarding number of previous admissions (PA) and days of admission. Descriptive and comparative statistics (with multiple comparisons) for the different clusters, regarding age, gender, diagnosis at discharge (according to ICD10), and, to the DTP, previous medical following, compliance to medication, and substance use at admission.

Three clusters were identified: (C1, n=5861) a larger, uncharacteristic one; (C2, n=1168) with a higher number of PA (average of 8, versus less than 2 on the others); and (C3, n=1462) with higher number of days of admissions (58 versus less than 16). Statistical significance was found regarding age (higher in C3), gender (more men in C2), nationality (C1 with more foreigners). Regarding diagnosis at discharge, statistical difference was found between the 3 groups: C1 has significantly less patients with Schizophrenia (11% versus 30% in the others), but more depressive (21% versus 6% in C2 and 12% in C3) and neurotic disorders. C2 presented less dementias (0,5% versus 3% in C1 and 10% in C3) and delusional disorders, but more bipolar disorders (24% versus 15% in C1 and C3); C3 represented less episodes due to substance abuse (alcohol or others) and personality disorders. In both C2 and C3, no psychiatric consultation happened in the 3 months prior admission to around 40% of episodes, and 50% had stopped medication. The majority had only oral medication. Almost 24% of C2 tested positive for cannabinoids, with no differences regarding other substances.

These findings allow the definition of 2 kinds of DTP, which present unique characteristics but some common features (namely poor adherence to consultations and are in therapeutic compliance). An assertive multidisciplinary approach, focused on current treatment and relapse prevention (including social structures, more frequent clinical follow-up, and rehabilitation centers), will be the key to their treatment.

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With the increasing push to legalize cannabis in Western nations, there is a need to gauge the potential impact of this policy change on vulnerable populations, such as those with mental illness, including schizophrenia, mood and anxiety disorders.

Understand the effects of cannabis in people with mental illness and the impact of policies legalizing cannabis in societies.

Literature review performed on PubMed and Google Scholar databases, using the keywords “cannabis”, “mental health”, “psychiatry”.

Cannabis use is a modifiable risk factor for the development and exacerbation of mental illness. The strongest evidence of risk is for the development of a psychotic disorder, associated with early and consistent use in youth and young adults. Cannabis-related mental health adverse events precipitating Emergency Department (ED) or Emergency Medical Services presentations can include anxiety, suicidal thoughts, psychotic or attenuated psychotic symptoms, and can account for 25–30% of cannabis-related ED visits. Up to 50% of patients with cannabis-related psychotic symptoms presenting to the ED requiring hospitalization will go on to develop schizophrenia. With the legalization of cannabis in various jurisdiction and the subsequent emerging focus of research in this area, our understanding of who (e.g., age groups and risk factors) are presenting with cannabis-related adverse mental health events in an emergency situation is starting to become clearer.

There’s a need to provide a reconciliation of the addiction vulnerability and allostatic hypotheses to explain addiction comorbidity in mentally ill cannabis users, as well as to further aid in developing a rational framework for assessment and treatment of problematic cannabis use in these patients.

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