There are multifactorial pathologies in the development of addictive disorders, such as psychosocial factors, genetic and biological factors, as well as their interaction. In line with this, psychological research focuses on the abusive environment and its impact, where the developmental psychopathological analysis of addictive disorders is of paramount importance, since it examines the causes of the disease with the involvement of several disciplines.

In our research, we studied the risk factors leading to the development of addictive disorders through the lifetime histories of those who recovered from this disorder. Our goal was to point to the common factors that emerged in the interview narratives in the development of addictions. Furthermore, we revealed risk factors that affected the psychological processes influencing both personal and social functioning.

We processed semi-structured interview materials from 12 adult patients who were previously treated for addictive disorder but were substance-free for more than 4 years. Distinguishable phenomena with guided questions emerged: peak experiences, lows, turning points, and first psychoactive substance use. The interviews distinguished childhood, adolescence and adulthood, as well as the best and worst substance use experiences.

Emotion regulation difficulties and low self-esteem emerged as dysfunctionality in most of the interviews. Without exception, the good effects of substance use appeared in the life stories, and led to the development of addictive disorder. In retrospective narratives, it is decisive and points toward recovery from the bad effects of the drug decisive presence. The narratives showed a change in the overall pattern, when self-control, performance, empowerment appeared. The road to recovery in the narratives led from illness to the pursuit of good emotion regulation and the strengthening of self-esteem.

A common narrative thread mostly showed a V-shape, which, unlike previous models, is a dynamic model. This new finding sheds light on the possibility of a recovery-centered model in adult population with addictive disorder.

Disturbances in emotion regulation and low self-esteem could be experienced as early as in adolescence, correctly recognizing the risk factors of addiction. Therefore, prevention can be applied. In addition to the qualitative studies, it is also necessary to measure the risk factors by quantitative method, which can confirm the results.

We need to be mindful of the different characteristics of disease- and recovery-oriented narratives, which may differ due to various life history experiences.

None Declared

According to the United Nations World Drug Report 2019, there are an estimated 53 million opioid users[1]. Health problems, social problems associated with this abuse are the result of a complex interaction between psychoactive substances, the patient and the environment. There are two main approaches in the treatment - aimed at complete abstinence from the use of a psychoactive substance and substitution maintenance therapy using methadone and buprenorphine [2]. This is due to the pharmacological effects of narcotic substances, the dynamics of physiological processes and the general state of health with the systematic use of psychoactive substances.

The problem of the use of narcotic substances must be considered not only as a physiological problem, but also as a problem of a person resorting to drugs in a specific social situation. In this case, curative and rehabilitation work acquires new content and new opportunities. The emergence of addiction depends on two main reasons: on the one hand, these are certain specific personality traits of a person, formed primarily by the family, and on the other hand, external factors such as the influence of friends, curiosity, life difficulties experienced and other personal problems. The greatest danger of the formation of drug addiction occurs in the case of simultaneous exposure to both groups of causes.

The study interviewed 123 patients aged 23 to 45 years (109 men and 14 women) diagnosed with opioid addiction. Of these, 17 patients with a period of abuse of up to three years and 105 - longer than three years, respectively. Personality disorders were assessed using the 16-factor Cattell Personality Questionnaire for the study of personality traits [3], the multi-aspect MMPI methodology (mini-mult) [4], and the Luscher color choice method [5].

14 drug addicts (82%) with a period of abuse of less than 3 years were characterized by impulsivity, reduced stress resistance, risk appetite; in 83 drug addicts (79%) with a period of abuse longer than 3 years, persistent psychosocial maladjustment, communication difficulties, conflicts were detected, social norms were disregarded, increased readiness for open manifestation of aggression; 14 women (100%) had features of mental rigidity, disregard for social norms, conflict, impulsiveness; 88 men (81%) had emotional instability, excitability, hostility.

The formation of opioid dependence is influenced by both the psychophysiological characteristics and the pathopsychological changes that occurred during the use of a psychoactive substance.

Addiction therapy should include a psychological analysis of risk factors.

Selection of psychological options for social adaptation that contribute to the maximum possible realization of the individual’s potential, will increase the effectiveness of substitution therapy and accelerate the resocialization of drug addicts.

None Declared

Patients with an alcohol use disorder frequently relapse after various efforts to quit. Admission to hospital units is a possible start to stop drinking alcohol and reach abstinence. Among the pharmacological strategies to quit this addiction are specific drugs, such as disulfiram or namelfen, which are widely studied. Hospitalized patients frequently initiate these medications to control addiction, but little is known about their efficacy after discharge in this group.

The aim is to determine whether the initiation of treatment with specific drugs for alcohol use disorder could help to maintain alcohol abstinence after admission to a General Hospital Psychiatric Ward. In addition, we want to check those factors associated with a higher rate of relapse in consumption.

We conducted a retrospective cross-sectional study of a group of patients admitted in 2018 to a psychiatric hospitalization ward due to alcohol use disorder and who expressed their desire to stop drinking. At the time of admission, we recorded sociodemographic data, consumption of other substances and alcohol family history. Patients initialized specific treatments to reduce and control alcohol consumption if they wanted. Twenty-four months after discharge, we acquired the number of relapses through new admissions, emergency room visits or outpatient follow-up data.

A sample of 36 patients (28 men) admitted to a psychiatric hospitalization ward was analyzed. At discharge, 17 accepted specific pharmacological treatments to reduce alcohol consumption. After a follow-up period of 24 months, 70.8% relapsed compared to 94.7% who did not accept treatment (χ2=4.001, DF=1, p=0.045, OR=0.13). There were no differences between the two groups in age, gender, amount of alcohol consumed, follow-up modality at discharge or if it was their first detoxification attempt. However, those who did not accept the specific pharmacological treatment consumed other drugs (41.1% vs 5.8%, χ2= 5.888, DF=1, p=0.015), had other history of mental disorder (64.7% vs 23.5%, χ2= 5.845, FD=1, p=0.015) and a higher proportion of relatives with alcohol consumption (81.8% vs 42.8%, χ2= 3.896, FD=1, p=0.048) more frequently. The time (in days) to relapse was faster in this group of patients (200.8 vs 402.7 , Z=-2.5413, p=0.005).

Accepting drug-specific treatment for alcohol use can be helpful for many patients who want to achieve alcohol abstinence. Among the factors that prevent the acceptance of this treatment is the consumption of other substances, comorbidity with another mental pathology and family history, which may involve genetic factors that favour addiction. This group of patients could benefit from a specific pharmacological treatment, although other psychosocial factors may also help.

None Declared

Since gambling opportunities expanded over the last four decades, gambling, including pathological and problem gambling, has received increased attention from clinicians and researchers worldwide.

Prevalence of gambling disorders varies according to the screening instruments, measurement used as well as accessibility of gambling opportunities but it is believed that gambling disorders affect 0.2–5.3% of adults worldwide. In addition, considering that the gambling disorders are highly comorbid with other substance use and mental health disorders, for both the causes and treatment implications of this disorder a further understanding is needed.

This research has been conducted at the Addiction and Psychotrauma Department of the Insula County Hospital over a period of two months on a sample of 150 people using a questionnaire that was distributed to patients whose primary diagnosis was substance use disorder but did not have a diagnosed gambling addiction with the aim of early detection of it.

Substance abuse may include minimizing one’s use, hiding other comorbid addictions including gambling, and an underestimation of the effect one’s use has on life areas as well as family members.

This article highlights the prevalence of comorbid unrecognised pathological gambling in substance use disorders, but also reviews definition, clinical similarities and differences and treatment approaches.

None Declared

Pathological gambling is an addictive disorder and a current important issue with substantial social and personal costs. It is associated with impaired functioning, criminal record, bankruptcy and mental health problems. There is a significant comorbidity between gambling disorder, mood disorders and other addictive behaviors like alcohol use. Suicidality is common, impulsivity being a major risk factor for suicidal acts.

Case presentation of gambling disorder associated with a suicide attempt

Review of the clinical file of a patient diagnosed with gambling disorder and non-systematic review on the topic on PubMed

A 35 old male patient is brought to our psychiatrical emergency unit by means of ambulance as he attempted to commit suicide by inflicting multiple deep cuts on his forearms. He has a positive history of gambling disorder, no prior suicide attempt, or criminal record. He has a precarious economic status, the trigger for his acts being the loss of a substantial financial amount. The risk factors in his case were a positive familial history of addictive disorders (his father was diagnosed with alcohol use disorder), aversive childhood events, comorbid depression, alcohol misuse and low income. The patient resumed his gambling behavior 7 months prior to admission, after a 5 year abstinence, motivated by the desire to rapidly pay a loan he recently took. The addictive behavior worsened after his wife experienced a miscarriage. He started borrowing money, engaging in antisocial acts like stealing money from his wife’s bank account, neglecting his job and ending up in financial debt. He experienced feelings of alienation and isolation from his social network and family, unable to verbalize his burden. He also feared a divorce. Psychological coping strategies such as thought and emotional suppression were present and also an important tendency to minimize the severity of the events. Cluster B traits were present but not clinically significant. The suicide attempt is described by the pacient as being impulsive, with no prior planning, as a mean of problem solving for his desperate situation of high financial and social burden.

In the hospital setting, pharmacological treatment with SSRI Escitalopram and opiate antagonist Naltrexone was initiated. The patient was referred to psychological counseling during hospitalisation and to CBT after he left the hospital. He had excellent social support.

Although suicide is initially seen as an impulsive act, in fact it includes a constellation of thoughts, emotions and behaviors which lead to the hopelessness and desperation preceding the suicidal attempt. Gambling disorder tends to have a chronic evolution, impacting many important life domains, complex management such as pharmacotherapy, psychological interventions and social support being necessary for a favorable outcome.

None Declared

Treatment resistant depression (TRD) is common with substance use disorder (SUD) and few studies demonstrated the effectiveness of medication-psychotherapy treatments in this population

To compare the effeictiveness of ECT in the treatment resistant depression patients vs TRD with SUD patients.

14 TRD patients with 14 TRD-SUD patients compared in terms of ECT treatment response rates at baseline, thhree months and six months of the follow up periond. Pateints completed Hamilton anxiety, Hamilton depression-21 items, Barrat 11 impulsivity and visual analog scales each follow up visit.

Both groups completed ECT treatment between 2011-2018 with follow up of 12.3+4.1 months following the ECT procedure. Patients received average 11.7+2.6 bilateral ECT treatments per series. Both groups responded well to ECT treatment in terms of response rates and side effects however there were higher rates of relapse at intermediate to long term follow up period at TRD-SUD group.

ECT seems to be an effective treatment for patiens of TRD-SUD. Moreover the response rates are equal to treatment reisstant depression cases without substance use disorder.

None Declared

Substance dependence affects an individual as well as the family and is considered as a complex biopsychosocial phenomenon. Family members can act as a social and emotional support in the treatment engagement and recovery of the patient with substance use disorder. Caregiving is a multidimensional construct. Caregiving process to an individual with substance use disorder can help in either positive or negative outcome and is often challenging. Positive aspects of caregiving has gathered some attention in mental health literature in recent past, data for the same is limited across substance use disorder.

To determine whether substance use status is associated with differences in positive aspects of caregiving and burden among the caregivers of patients with opioid use disorders.

A cross-sectional observational study with purposive sampling was used to recruit 199 caregivers of patients with opioid use disorders. The sample was divided based upon the current substance use status of the patients. Scale for Positive Aspects of Caregiving Experience (SPACE) and Family Burden Interview Schedule (FBIS) were used to assess positive aspects of caregiving and family burden respectively

The study included 199 caregivers of patients with opioid use disorder. Table 1 describes the socio-demographic profile of the patients and caregivers. Of 199 caregivers recruited, 135 (67.8%) reported that the patient was using opioids, while 64 (32.2%) reported that the patient was abstinent on treatment. The mean SPACE domain score of caregivers abstinent on treatment was highest for motivation for caregiving role (2.73 versus 1.76) followed by self-esteem and social aspect of caring (2.42 versus 1.87), caregiver satisfaction (2.41 versus 1.29) and caregiving personal gains (2.40 versus 1.45). Details of SPACE domain score and FBIS are depicted in table 2. It was seen that caregivers of patients currently abstinent on treatment experienced greater positive aspects of caregiving (SPACE mean score 128.3 versus 80.1, t = 9.383, p <0.001), and lesser burden (FBIS mean score 13.4 versus 29.3, t = 10.419, p <0.001). Overall the mean SPACE domain score had a negative correlation with FBIS (r = -0.57, p<0.001).

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In our study it was found that caregivers of patients who are currently abstinent on treatment experience lower burden of care, and also experience greater positive aspects of caregiving. Clinicians should be aware of the caregiver experiences as well as they engage both patients and caregivers in the treatment process.

Keywords: Positive Aspects of Caregiving Experience; Family Burden; Caregivers; Opioid; Substance.

None Declared

Opioid-related deaths continue to rise in the U.S. A clinical decision support (CDS) system to help primary care clinicians (PCCs) identify and treat patients with opioid use disorder (OUD) could help address this crisis.

To implement and test an OUD-CDS system in three health systems for the diagnosis and treatment of OUD in 90 primary care clinics.

In this cluster-randomized trial, primary care clinics in three healthcare systems were randomized to receive or not receive access to an OUD-CDS system. The OUD-CDS system alerts PCCs and patients to elevated risk of OUD and supports OUD screening and treatment. It includes guidance on OUD screening and diagnosis, treatment selection, starting and maintaining patients on buprenorphine for waivered clinicians, and screening for common comorbid conditions. The primary study outcome is, of patients at high risk for OUD, the percentage receiving an OUD diagnosis within 30 days of index visit. Additional outcomes are, of patients at high risk for or with a diagnosis of OUD, (a) the percentage receiving a naloxone prescription, or (b) the percentage receiving a medication for OUD (MOUD) prescription or referral to specialty care within 30 days of an index visit, and (c) total days covered by a MOUD prescription within 90 days of an index visit.

The intervention started in April 2021 and continues through December 2023, with successful implementatio and uptake. PCCs and patients in 90 clinics are included; study results are expected in 2024.

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If effective, this OUD-CDS intervention could improve screening of at-risk patients and rates of OUD treatment for people with OUD, a significant step in decreasing the morbidity and mortality associated with OUD.

None Declared

Cannabis (aka marijuana) is the most frequently consumed illicit substance worldwide, and a subset of frequent cannabis smokers (up to 30%) develop dependence. A less well-known consequence of cannabis dependence is withdrawal syndrome, characterized by a time-dependent constellation of symptoms (Lafaye et al. Dialogues Clin Neurosci 2017;19(3), 309-316).

This study aims to prospectively assess the course of cannabis withdrawal symptoms within a controlled inpatient detoxification setting and to correlate the severity of withdrawal symptoms with the serum levels of neurotransmitters (NT).

N=45 treatment-seeking chronic cannabis dependents (assessed by ICD-10) were enrolled, and their withdrawal symptoms were assessed prospectively from admission (Day-0) to 28 days using Marijuana withdrawal checklist (MWC). Sociodemographic characteristics and self-reported drug use histories were reported. Serum levels of dopamine, serotonin, norepinephrine, epinephrine, and cortisol were measured. Cannabis abstinence symptoms were assessed daily using MWC for 4 weeks, and serum neurotransmitter levels were analyzed at admission (Day 0), 7, 14, 21, and 28. Comparison between groups was done using Friedman’s test. Correlation between NT level and MWC scores was performed using linear regression spearman correlation analysis

The follow-up NT levels from Day 0 to 28 showed a significant (p<0.05) decrease in serotonin and dopamine, whereas epinephrine levels showed a significant increase (Fig 1) with the course of withdrawal. Withdrawal symptoms like decreased appetite, sweating, and craving were significantly and positively correlated with serotonin, dopamine, and epinephrine NT levels (Fig 2).

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Findings support the presence of clinically significant cannabis withdrawal symptoms with NT levels in subjects with cannabis dependence seeking substance abuse treatment. The data of this study determine the relationship between observed withdrawal symptoms and changes in brain chemistry and evaluate its possible utility as a predictor of relapse.

None Declared

Studies consistently show that patients with prescription opioid use disorder (OUD) respond to buprenorphine treatment. Few studies have followed these patients in the long-term. Our longitudinal research has shown opioid abstinence to be associated most strongly with opioid agonist/partial agonist treatment. We also found that many patients used agonist treatment inconsistently; questions remain about the benefits of intermittent opioid agonist treatment.

We examined patients during the 3.5 years following their entry into a 3-month trial of treatment for prescription OUD. The current analysis compared opioid use outcomes among patients who reported receipt of agonist treatment consistently, inconsistently, or never.

This secondary analysis (N=309) of a U.S. multi-site randomized controlled trial of treatment for prescription OUD assessed variability in receiving opioid agonist treatment during the 3.5-year follow-up period, and the association between agonist treatment and opioid abstinence. Assessments were collected at months 18, 30, and 42 following treatment entry; patients were asked if they were currently taking agonist treatment and whether they had used other opioids in the previous month. Patients with only one follow-up assessment (n=29) were excluded from this analysis.

Most patients reported current opioid abstinence on at least one follow-up visit: 38% were always abstinent, 41% sometimes, and 21% never. Twenty-three percent always reported currently using agonist treatment, 26% sometimes, and 51% never. Patients consistently reporting agonist use were most likely to always be opioid-abstinent in the past month (69%), with 25% sometimes and 6% never abstinent. Patients who never reported agonist use were equally likely to be abstinent never (32%), sometimes (35%), and always (32%). Patients who sometimes reported receiving agonists were most likely to report abstinence sometimes (65%); 14% never reported abstinence, and 21% always did.

Those consistently receiving agonist treatment were more likely to always be opioid-abstinent (69%) than those sometimes (21%) or never (32%) receiving agonists. Those never receiving agonist treatment were more likely to never report opioid abstinence (32%) than were those sometimes (14%) or always (6%) receiving agonists. Interestingly, those who sometimes received agonists were more likely to be abstinent than those who never received agonists: those who sometimes received agonists were more likely to be abstinent sometimes than those who never received agonists (65% vs. 35%) and less likely to never be abstinent than were those who never received agonists (14% vs. 32%).

Receiving opioid agonist treatment has been shown to be associated with opioid abstinence during long-term follow-up. This study shows that even those who only inconsistently receive agonists are also likely to benefit.

R. Weiss Consultant of: Alkermes, M. Griffin: None Declared

The treatment of the person with alcohol dependence allows the possibility of a self-determined alcoholic abstinence and reducing the consequences associated with alcohol-related problems at a personal, family, work and social level.

It is important to develop therapeutic strategies that complement the different approaches in the treatment of people with alcohol dependence, enabling them to use effective coping strategies that facilitate the maintenance of their self-determined alcohol abstinence.

In recent years, scientific evidence has emerged that justifies the adoption of mindfulness-based protocols as a complement to various treatments, both for the prevention of relapses and as a treatment enhancer.

To train people with alcohol dependence to use Mindfulness;

To promote psychological well-being and positive emotions;

To reduce anxiety;

To evaluate the effectiveness of a Mindfulness-based intervention program.

The Mindfulness-based intervention program was developed with 2 groups of people hospitalized for the treatment of alcohol dependence (the institution’s treatment protocol is comprehensive and based on self-determined alcohol abstinence). The 1st G (pilot) - 6 people; 2nd G - 5 people), total of 11 participants; 4 sessions (each group), duration 45-60 minutes.

The selection criteria of the participants were evaluated in an interview and defined as follows: being in the first week of the treatment program; self and allo psychic orientation; reduced to moderate anxiety (Zung Self-Assessment Anxiety Scale - EAAZ); existence of motivation for change.

Participants gave informed consent.

In the global assessment used instruments: Psychological General Well-being Scale for the Portuguese population (BEP); Short Version of the Portuguese Scale of Positive and Negative Affect (PANAS-VRP) in the first session (before intervention). In the last session (after the intervention), in addition to the BEP and the PANAS-VRP, the EAAZ was also used.

At the end of each session, an evaluation was carried out using a grid built for this purpose.

As for the general psychological well-being, the BEP, only one participant (pilot group) had a final score lower than the initial one.

With regard to PANAS-VRP, in both groups, there was an increase in positive affection and a reduction in negative affection at the end of program implementation.

With regard to the EAAZ, 7 participants showed a decrease in anxiety after the intervention.

The evaluation grid of each session revealed good participation, good adhesion and positive evaluation.

It is concluded that after the implementation of the Mindfulness-based intervention program there was: an increase in well-being (the higher the score, the greater the state of well-being); increase in positive affection (which remained or increased); decrease in negative affection and decrease in the level of anxiety.

None Declared

Multiple Sclerosis (MS) is an autoimmune inflammatory disease that affects 1 in 1000 people. Given the association of MS to many affective disorders and specifically with Bipolar Disorder (BD), it is possible that a manic episode and an acute episode of MS may appear together. In these cases, it is difficult to decide whether it is necessary to start a corticosteroid regimen as treatment for the acute episode of MS, since it may worsen manic symptoms.

The aim is to carry out a review of the existing information in relation to the comorbidity prevalence of MS and TB as well as the joint treatment of both illnesses, and to expose the details of a clinical case, regarding the treatment that was used in the acute psychiatry unit.

First, a search was done in PubMed database reviewing recent cases of steroid induced psychosis using the words (Multiple Sclerosis) AND (Bipolar Disorder). Subsequently, we describe the case of a 41-year-old patient who was admitted to the acute care unit from the emergency department presenting manic symptoms (megalomania, sensation of increased capacities and ideas of mystical content) associated to episodes of muscle weakness and gait disturbances. A screening Magnetic Resonance was performed in which lesions with inflammatory-demyelinating characteristics were detected, and was therefore catalogued as MS debut.

After carrying out a bibliographical review, we can conclude that studies recommend the inclusion of MS within the differential diagnosis of a first manic episode (1), performing neurological examinations, complete anamnesis and imaging tests, given that there is a high prevalence ratio of the comorbidity (2.95%) (2). It has been described that the use of lithium has a calming and neuroprotective agent that may be useful (3).

We consider it of interest to describe the therapeutic approach to the case. After the introduction of Aripiprazole and Lithium, a short regimen of methylprednisolone in high doses was administered to treat the MS episode. When the treatment started, the patient presented a progressive improvement of the manic episode and motor symptoms. We observed that corticosteroid therapy did not worsen the manic symptoms or the patient’s evolution in this case. We intend to contribute by providing information on the joint management of these pathologies and we consider that it is necessary to continue studying this matter to be able to manage these cases in the most appropriate way.

None Declared

Emotion regulation (ER) is the ability to assess, monitor, or modify emotional reactions to achieve a goal (Gross. Psychological inquiry 2015; 26 1-26). When ER strategies are rigidly or maladaptively applied, emotional dysregulation (ED) can occur (Thompson. Development and psychopathology 2019; 31 805-815). ED is common in people diagnosed with bipolar disorder (BD), but it can also be described in other clinical populations given its transdiagnostic nature. Numerous aspects of ED have been described in BD (De Prisco et al. Neuroscience & Biobehavioral Reviews 2022; 104914), but it is unclear whether these manifest similarly in other conditions such as major depressive disorder (MDD) or borderline personality disorder (BPD), or whether they are specific to BD.

The objective of this systematic review and meta-analysis is to examine the literature comparing BD with other psychiatric disorders in terms of ED, focusing on those studies using validated clinical tools.

A systematic search from inception to April 28th, 2022, was conducted exploring the PubMed/MEDLINE,EMBASE, Scopus, and PsycINFO databases. Those studies providing quantitative data on ED in people diagnosed with BD and compared with clinical groups were eligible for inclusion. No restriction about age, sample size, or language were applied. Random effect meta-analyses were conducted, and effect sizes were calculated as standardized mean differences (SMD).

A total of 3,239 records was identified and, after duplicate removal and title/abstract evaluation, 112 were explored at the full text. Twenty-nine studies were finally included, and it was possible to perform a meta-analysis with twenty-two (145 comparisons) of them. Only studies comparing BD with MDD, and BPD provided sufficient data to perform a meta-analysis. People with BD did not differ from people with MDD in most of the comparisons considered. However, BD patients presented higher positive rumination (two comparisons: SMD=0.46; CI=0.27, 0.64; p=8.5e-07; I2=0%; and SMD=0.34; CI=0.15, 0.52; p=2.7e-04; I2=0%) and risk-taking behaviors (SMD=0.48; CI=0.27, 0.69; p=8.11e-06; I2=0%). In contrast, people with BPD displayed an overall higher degree of ED (SMD=-1.22; CI=-1.94, -0.5; p=9.1e-04; I2= 90.7) and used fewer adaptive ER strategies. Additionally, higher levels of self-blaming (SMD=-0.80; CI=-1.11, -0.50; p=2.68e-07; I2=0) and impulsive behavior (SMD=-0.76; CI=-0.89, -0.63; p=5.4e-29; I2=0) were observed.

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ED is a trans-diagnostic construct that spans a continuum of different psychiatric disorders. Outlining the specific clinical features of one disorder versus another may help future research to increase our knowledge of these issues and develop new treatment strategies to reduce the clinical burden of these patients.

M. De Prisco: None Declared, V. Oliva: None Declared, G. Fico Grant / Research support from: “La Caixa” Foundation (ID 100010434 - fellowship code LCF/BQ/DR21/11880019), Consultant of: Angelini, Janssen-Cilag and Lundbeck, J. Radua Grant / Research support from: Spanish Ministry of Science and Innovation (PI19/00394, CPII19/00009) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdirección General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER) and the Instituto de Salud Carlos III, I. Grande Grant / Research support from: Spanish Ministry of Science and Innovation (MCIN) (PI19/00954) integrated into the Plan Nacional de I+D+I and cofinanced by the ISCIII-Subdirección General de Evaluación y el Fondos Europeos de la Unión Europea (FEDER, FSE, Next Generation EU/Plan de Recuperación Transformación y Resiliencia_PRTR ); the Instituto de Salud Carlos III; the CIBER of Mental Health (CIBERSAM); and the the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2017 SGR 1365), CERCA Programme / Generalitat de Catalunya as well as the Fundació Clínic per la Recerca Biomèdica (Pons Bartran 2022-FRCB_PB1_2022), Consultant of: ADAMED, Angelini, Casen Recordati, Ferrer, Janssen Cilag, and Lundbeck, Lundbeck-Otsuka, Luye, SEI Healthcare, N. Roberto: None Declared, G. Anmella Grant / Research support from: Rio Hortega 2021 grant (CM21/00017) from the Spanish Ministry of Health financed by the Instituto de Salud Carlos III (ISCIII) and co-financed by the Fondo Social Europeo Plus (FSE+), Consultant of: Janssen-Cilag, Lundbeck, Lundbeck/Otsuka, and Angelini, D. Hidalgo-Mazzei Grant / Research support from: Juan Rodés JR18/00021 granted by the Instituto de Salud Carlos III (ISCIII), M. Fornaro: None Declared, A. de Bartolomeis Consultant of: Janssen, Lundbeck, and Otsuka and lecture fees for educational meeting from Chiesi, Lundbeck, Roche, Sunovion, Vitria, Recordati, Angelini and Takeda; he has served on advisory boards for Eli Lilly, Jansen, Lundbeck, Otsuka, Roche, and Takeda, Chiesi, Recordati, Angelini, Vitria, A. Serretti Consultant of: Abbott, Abbvie, Angelini, AstraZeneca, Clinical Data, Boehringer, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Innovapharma, Italfarmaco, Janssen, Lundbeck, Naurex, Pfizer, Polifarma, Sanofi, Servier, and Taliaz, E. Vieta Grant / Research support from: Spanish Ministry of Science and Innovation (PI18/00805, PI21/00787) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdirección General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER); the Instituto de Salud Carlos III; the CIBER of Mental Health (CIBERSAM); the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2017 SGR 1365), the CERCA Programme, and the Departament de Salut de la Generalitat de Catalunya for the PERIS grant SLT006/17/00357. Thanks the support of the European Union Horizon 2020 research and innovation program (EU.3.1.1. Understanding health, wellbeing and disease: Grant No 754907 and EU.3.1.3. Treating and managing disease: Grant No 945151), Consultant of: AB-Biotics, AbbVie, Angelini, Biogen, Boehringer-Ingelheim, Celon Pharma, Dainippon Sumitomo Pharma, Ethypharm, Ferrer, Gedeon Richter, GH Research, Glaxo-Smith Kline, Janssen, Lundbeck, Medincell, Novartis, Orion Corporation, Organon, Otsuka, Rovi, Sage, Sanofi-Aventis, Sunovion, Takeda, and Viatris, A. Murru Grant / Research support from: Spanish Ministry of Science and Innovation (PI19/00672) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdirección General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER), Consultant of: Angelini, Idorsia, Lundbeck, Pfizer, Takeda

Bipolar disorder (BD) is a severe mental disorder associated with functional impairment, high disability and premature mortality. Modifications of editing in mRNA of serotonin receptor subtype 2C (5-HTR2c) was reported by us in depressed suicide decedents. We have also identified a panel of RNA editing-based blood biomarkers for the diagnosis of BD, which also allowed to discriminate unipolar depression from BD with high sensivity and specificity.

Herein, aiming to confirm the diagnostic value of this panel, a new cohort of BD patients was recruited in Brazil.

This study is based on the analysis of 47 control patients (CTRL) compared to 40 patients with bipolar disorder (BD). BD patients (BP) were classified into 4 subgroups: euthymic (BP_EUT, n = 17), depressive (BP_DEP, n = 11), manic/hypomanic (BP_HM, n = 7) and mixed (BP_MIX, n = 5). The diagnostic value of a panel of RNA editing-based blood biomarkers for the diagnosis of BD, which includes a set of eight genes, namely PDE8A, CAMK1D (calcium/calmodulin-dependent protein kinase type 1D); GAB2 (growth factor receptor bound protein 2-associated protein 2); IFNAR1 (interferon alpha/beta receptor 1); KCNJ15 (ATP-sensitive inward rectifier potassium channel 15); LYN (tyrosine-protein kinase Lyn); MDM2 (E3 ubiquitin-protein ligase Mdm2); PRKCB (protein kinase C beta type), which was able to discriminate unipolar depression from BD with high sensivity and specificity, was confirmed here by testing an independent cohort of patients suffering from BD recruited in a well-known genetic admixed ancestry population, which is typical in South America, more specifically in Brazil.

We identified new combinations allowing a clear discrimination of euthymic versus depressed bipolar patients, and euthymic versus healthy controls, confirming that RNA editing is a key mechanism in the physiopathology of mental disorders, in particular in BD.

In conclusion of this study, we confirm that RNA editing is a key mechanism in the physiopathology of mental disorders in general, and in BD in particular, and that measuring changes in this mechanism at the peripheral level allowed us to stratify BD patients not only with respect to their symptomatology, but also with respect to the pathophysiology, thus paving the way for personalised medicine in psychiatry.

None Declared

The gut microbiome is one of our most prominent surfaces interacting with the outside world through the food we eat. It is influenced in terms of composition and diversity by our diets and life style habits and, in turn, affects us through the ‘gut-brain axis’. Cardiovascular risk, which is one of the main causes of death in Bipolar Disorder (BD), is affected by diet. The association between diet and microbiome in BD patients has not been studied.

We aimed to assess whether [1] dietary quality is associated with the microbiome’s diversity, and [2] what changes and interactions occur during in both the dietary quality and microbiome diversity during the subsequent year of onset BD.

39 recently diagnosed patients with BD of the ‘Bipolair Nederlands Cohort’ (BINCO) (mean age 36 years, 61.5% female) were included. Food Frequency Questionnaires (FFQ) and corresponding Dutch Healthy index (DHD-15) were analyzed at baseline and one year follow-up. Feces samples corresponding to the FFQ were analyzed using 16S rDNA gene amplicon sequencing to attain the Shannon Diversity index and the Chao1 diversity index. Multivariate regression analyses were performed.

The Shannon diversity index significantly correlated to the DHD-15 total score after adjusting for sex and age (beta = 0.451; P = 0.004). The Chao1 index showed the same trend, but did not reach significance (beta = 0.264; P = 0.11). These positive correlations seemed to be driven by the positive effect of fish, beans, coffee, fruits and nuts. There was neither a significant change in DHD-15 index nor in the diversity measures after one year.

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Diversity of the microbiome is positively associated with a healthy and varied diet in BD patients, which could have consequences on mood episodes and cardiovascular risk.

None Declared

Mixed states in bipolar disorder (BD) are characterized by the simultaneous occurrence of both manic and depressive features. Growing evidence suggests that they are associated with longer duration of illness, increased relapse risk, and higher prevalence of comorbidities. Suicide risk among BD patients is up to 20–30 times greater than in the general population, although there is not a univocal consensus in whether mixed states should be considered as a high-risk state for suicide.

The objective of this study was to identify whether depressive and hypo/manic episodes with mixed features, are associated with more frequent suicidal behavior or ideation when compared to pure hypo/manic and depressive ones. We hypothesized that suicidal ideation or behavior would be more common in those experiencing mixed symptoms. We subsequently also tested whether gender or bipolar subtype moderated the relation between mood and suicidality.

In a naturalistic study, 903 adult BD outpatients participating in the Stanley Foundation Bipolar Network were followed longitudinally across 14,213 visits for 7 years. The scores at the Inventory of Depressive Symptomatology–Clinician-Rated Version (IDS-C) and at the Young Mania Rating Scale (YMRS), administered at each visit, were used to define the mood episode. Given partial overlap of items between these scales, analyses were also conducted by removing overlapping items. The presence of suicidality was evaluated through the 18th item of the IDS-C (Suicidal Ideation).

During the observation period, up to 60.7% of subjects had at least one visit with suicidal ideation or behavior, broadly defined as a score ≥ 1 at the 18th item of the IDS-C. The distribution of suicidality among visits in different mood states is reported in Figure 1 (N° of visits in which suicidality was detected by mood state at the time of visit). Depressive symptoms were associated with suicidal ideation and behavior either during mixed depression and hypo/mania (p < 0.0001). Hypomanic or manic symptoms appeared to be related to suicidality only during hypo/mania, either pure or mixed (p 0.007). When overlapping items between the two psychometric scales were removed results seemed to confirm these hypotheses. Moreover, male gender appeared to have a protective role against suicidal ideation when hypo/manic (p 0.002).

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The primary role of depressive symptoms in predicting suicidal risk was confirmed by our results, which however suggest that mixed symptoms relate to suicidal ideation and behavior more intensely than pure hypo/manic symptoms. More importantly, hypo/manic symptoms did not appear to have a protective role during mixed episodes. Future studies considering also deaths by suicide are required in order to better clarify the role of mixity on suicidality.

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Bipolar disorder is a chronic psychiatric illness of an episodic and recurrent nature with marked mood and behavioural dysfunction and causes substantial psychosocial morbidity, as it frequently affects independent living, vocational, and social activities. But there is a relative dearth of Indian research about the factors associated with risk of recurrence in patients with BPAD receiving treatment according to contemporary practice guidelines.

The study was under taken to assess the association of psycho-social and treatment factors with frequency of episodes in BPAD

A cross-sectional study consisted of first 120 subjects with bipolar disorder who availed psychiatry services in a general hospital setting in central Kerala from January 2014 to July 2014. Diagnosis was made by DCR-10 criteria. Data for 114 subjects with BPAD were analyzed. Episode frequency was estimated as the number of episodes of depression, mania, and hypomania and mixed per year of illness. Stressful life events were assessed by Presumptive Stressful Life Event scale and treatment adherence by Drug Attitude Inventory. Modified Camberwell Family Interview were used for assessing expressed emotions and Kuppuswamy’s Socio Economic Scale for assessing SES

Episode frequency was significantly associated with young age group, female sex, low educational status, unemployment, lower socio-economic class, marital status, number of children, earlier age at onset, family history of BPAD, high stressful life events, high expressed emotions and poor treatment adherence. The association of co-morbid general medical condition and psychiatric condition with episode frequency were not significant. The influence of religion, family type and co-morbid substance use on episode frequency could not be commented

Episode frequency was significantly associated psycho-social and treatment factors. Hence specific interventions are required to change the modifiable risk factors to reduce the recurrence in BPAD

M. Mundottu Kandy Consultant of: NIL

Childhood maltreatment (CM) is recognized to be a non-specific risk factor for the development of psychiatric disorders in adulthood. It has been consistently demonstrated that exposure to CM increases the risk of developing bipolar disorder (BD). In addition, CM has been associated with worse clinical presentation and course of BD. CM has been also linked to poorer responses to psychotropic drug treatments in different psychiatric disorders.

The aim of the current study was to explore retrospectively the impact of CM on the response to prophylactic treatment with lithium or anticonvulsants in a cohort of adult BD patients. Based on the reported literature, we hypothesized that BD patients with a history of CM would present a poorer response to both lithium and anticonvulsant treatments.

Participants were recruited from patients consecutively attending the outpatient facilities of the Psychiatric Unit of the University of Salerno. The following inclusion criteria were adopted: (1) diagnosis of BD type 1 or type 2 according to DSM‐5 criteria; (2) age ≥ 18 years; (3) willingness to participate in the study, expressed by written informed consent; (4) stable adequate treatments with mood stabilizers (at least 1‐year duration and, in the case of lithium, at therapeutic blood levels); (5) being clinically euthymic at the time of inclusion. Retrospective treatment response was evaluated by using the Alda scale. CM history was assessed by means of the short form of the Childhood Trauma Questionnaire (CTQ).

Thirty‐seven patients (24 with a history of CM and 13 without CM) were on stable lithium treatment while sixty (35 with a history of CM and 25 without CM) were on stable anticonvulsant treatment. Clinical response to drug treatment did not differ between BD with CM and those without CM in the whole sample as well as in the anticonvulsant‐treated subgroup. In the lithium‐treated subgroup, a significant negative correlation emerged between physical abuse and treatment response (ρ = −0.38; p = 0.03) and patients with CM showed a significantly reduced Alda score (p = 0.04).

In patients with BD, CM did not influence the clinical response of anticonvulsants, whereas it was associated with a poorer response to lithium with childhood physical abuse playing a major role in this effect.

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The longitudinal course of bipolar disorder (BD) is related to an active process of neuroprogression, associated with brain changes and functional impairment (Berk et al., Bipolar Disord 2014; 16(5):471-7). Several clinical factors may influence illness trajectories, including the number of episodes and hospitalizations, the presence of comorbidities, stressful life events and familiarity for psychiatric disorders (Post. Braz J Psychiatry 2020;42(5):552-557). Trying to better define such progression, several authors conceptualized different staging models for BD, each one emphasizing different aspects of illness.

In the present study, we focused on the Kupka & Hilleghers staging model, owing to its favorable ratio between the number of classes and transitions (Kupka & Hilleghers. Tijdschr Psychiatr 2012; 54(11):949-956). The aim was to investigate the transition of a sample of 100 BD patients through the different stages of illness across 10 years of observation, analyzing the potential role of clinical variables on the risk of illness progression.

Clinical stages of 100 BD patients (53 BDI and 47 BDII) were retrospectively assessed according to the model proposed by Kupka & Hilleghers at four time points: T0 (2010), T1 (2015), T2 (2018) and T3 (2020, at inclusion). Multistate Model using the mstate package in R and Markov model with stratified hazards were used for statistical analysis, to assess transition intensities across illness stages and the potential role of clinical variables on the risk of progression.

A significant stage progression emerged during the observation period (Figure 1). More in detail, high hazard of transition from stage 2 to stage 3 was observed (Figure 2). A significant effect on the transition rate from 3 to 4 was found for higher number of affective episodes lifetime (> 3 episodes) (p=0.03) and for elevated predominant polarity (p=0.01). Overall, the average time subjects spent in stage 0 was 30.8 years and for stage 1 was 0.78 years. After BD onset, patients spent an average of 0.78 years in stage 2, 6.21 years in stage 3 and 2.23 in stage 4.

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Present preliminary results confirm the progressive nature of the disorder. An increased risk of transition across stages emerged for patients with higher number of episodes lifetime and with elevated predominant polarity, confirming the need of improving timing and accuracy of diagnosis and therapeutic interventions. Further studies are warranted with the aim of define a universal staging model for BD.

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Patients with bipolar disorder have a hig risk of becoming overweight and obese, associated with an increased risk of somatic diseases and premature mortality. The Austrian BIPFAT/BIPLONG study aims at investigating lipid metabolism, psychosocial functioning, and cognitive parameters in bipolar disorder (BD).

The aim was to investigate to what extent overweight, obesity and metabolic syndrome (MetS) are associated with clinical symptoms (e.g. suicidality, depressive symptoms) and cognitive factors (attention, memory, executive function) in BD.

In addition to anamnestic interview and psychological tests, all participants were tested with a neuropsychological test battery including the Trail Making Test A/B, the Stroop Color and Word Interference Test, the d2 Test of Attention Revised, Digit Span, Digit-Symbol-Test, and the California Verbal Learning Test. Additionally, body mass index (BMI) and variables defining MetS including waist circumference, serum triglycerides, high-density lipoprotein, blood pressure, and fasting glucose levels have been collected in DSM-5 diagnosed patients with BD and healthy controls.

In our Austrian bipolar cohort (n=290), the median BMI was 27.9 (SD=5.9), 30.5 % of the patients were overweight (BMI = 25.5-29.9) and 24.6% of the patients were obese (BMI ≥ 30.0). In the control group (n=183), the median BMI was 24.5 (SD=4.8), 15.2% were overweight and 8.0% were obese. A sub-analysis in 215 patients showed that compared to overweight patients, normal weight patients showed more suicidal ideation in psychiatric history (χ2(2)=7.97, p=.019). In addition, there was a significant association between suicidal ideation and glucose (r=.15, p=.043) and cholesterol (r=−.17, p=.028). In another sub-analysis with 148 euthymic bipolar patients, we found a high prevalence of MetS in patients with BD (30.4% versus 15.4% in healthy controls) associated with impaired executive function compared to patients without MetS or healthy controls with and without MetS (p=.020). Clinical variables (illness duration, suicidality, number of affective episodes, medication, age of onset, and history of psychosis) did not relate to MetS in BD (p > .05). A longitudinal analysis in 52 patients (35 without MetS and 17 with MetS) did not find an association of MetS on the one-year trajectory of cognitive decline in BD. In contrast, high baseline BMI predicted a decrease in the patient’s performance in working memory in the 12-months observation period.

The BIPFAT/BIPLONG study demonstrated a high prevalence of overweight, obesity and MetS in bipolar patients with adverse effects on cognitive function. Clinical variables such as suicidality were not related to the presence of obesity or MetS. Clinical impact and further (unpublished) results will be presented.

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