Self-esteem, defined as an individual’s overall sense of self-worth and confidence, plays a crucial role in shaping how people interact with their environment. It has been strongly linked in the literature to both mental health and resilience. Tunisian women, known for their achievements despite numerous challenges, provide a compelling population for exploring the dynamics between self-esteem and resilience.

To assess the impact of self-esteem on resilience among Tunisian women.

This cross-sectional study surveyed Tunisian women aged 18 and above, between June and August 2024, using an online questionnaire. General health information was gathered through a structured survey. Self-esteem levels were evaluated using the Rosenberg Self-Esteem Scale, while resilience was measured with the 25-item Connor-Davidson Resilience Scale (CD-RISC 25).

Data were collected from 695 Tunisian women, with participants having a mean age of 36.72 ± 12.23 years. Of the respondents, 22.3% reported using psychoactive substances: 20.4% smoked, 9.4% consumed alcohol, and 2.5% used cannabis. Additionally, 22.2% had somatic conditions, 24.5% reported a personal psychiatric illness, 28.2% had a family psychiatric history, 39.3% had seen a psychiatrist at least once, and 15% were using psychotropic medications. The average resilience score was 68.26 ± 14.09, with 26.3% of participants displaying low resilience. The mean self-esteem score was 29.38 ± 5.64, with 55.8% of participants exhibiting low self-esteem. No significant correlation was found between resilience and substance use. However, resilience was significantly associated with personal psychiatric illness (p < 10⁻³), family psychiatric history (p < 10⁻³), psychotropic medication use (p < 10⁻³), and psychiatrist visits (p < 10⁻³). In contrast, there was no correlation between resilience and somatic conditions. A strong association was found between resilience and self-esteem: only 6.8% of participants with normal to high self-esteem exhibited low resilience, compared to 41.8% of those with low self-esteem showing low resilience.

This study demonstrates a significant relationship between self-esteem and resilience among Tunisian women, indicating that higher self-esteem is linked to greater resilience. These findings suggest that interventions aimed at enhancing self-esteem could improve resilience, particularly for women facing psychological difficulties. Future research could explore targeted strategies to boost self-esteem as a pathway to strengthen resilience and overall mental well-being in this population.

None Declared

Treatment-resistant depression (TRD) is a severe condition with substantial economic and social impacts, defined by a lack of response to two or more adequate antidepressant treatments. Esketamine, an NMDA receptor antagonist, acts as an antidepressant by modulating glutamatergic transmission. Some studies suggest that dopaminergic system activation is crucial for the antidepressant effect of (S)-Ketamine (Jelen LA et al. J Psychopharmacol. 2021 Feb;35(2):109-123). Recently, nasal spray esketamine (ESK-NS) has been approved for TRD by the EMA and FDA, showing high response rates in some studies (Martinotti ed al. 2022 J. Affect. Disord. 319, 646–654). However, while the efficacy of ESK-NS varies among patients, studies on predictive factors of response, especially clinical ones, are limited, and no research has yet examined personality traits as predictors of ESK-NS response.

In this multicenter study we aim to investigate correlations between personality traits and response to ESK-NS in a real-world sample of subjects with TRD.

Eighteen patients with TRD were enrolled in two different centers in Genoa. Sociodemographic and clinical data were collected through semi-structured interviews. The Temperament and Character Inventory (TCI) was administered before therapy (T0) to assess personality traits, while the Hamilton Depression Scale (HAM-D) was used at T0 and three months (T3) to evaluate depression severity and treatment response.

The mean age of patients was 56 years with SD 11,3 years. 66,6 % of patients (n=12) were female. The enrolled patients were divided into two groups (responders 55,6% and non-responders 44,4%) as determined by a reduction of at least 50% in the HAM-D score from T0 to T3. In a multivariate analysis with TCI as the dependent variable and HAM-D severity at T0 as a covariate, a statistically significant difference (p=0.018) was found between the responders and non-responders groups in the TCI Reward Dependence (RD) subscale with higher values in responders compared to non-responders.

Previous studies have examined the link between personality traits and antidepressant response, but this correlation with ESK-NS hasn’t been previously investigated. This study, for the first time, demonstrates the correlation between Esketamine responders and RD traits, even when accounting for depressive severity (HAM-D). This may be because individuals with high RD are more sensitive to positive reinforcement. If ESK-NS improves mood and rewarding experiences, these patients might benefit more quickly. Additionally, RD is linked to dopamine, and since ESK-NS influences dopaminergic pathways, those with high RD may respond better to the treatment. This finding supports earlier research that anhedonic features predict better responses in TRD patients (Pettorruso et al. Psychiatry Res. 2023 Sep;327:115378).

M. Marino: None Declared, E. Briasco: None Declared, R. Guglielmo: None Declared, E. Cavanna: None Declared, F. Schiavon: None Declared, G. Giacomini: None Declared, D. Malagamba: None Declared, G. Martinotti Grant / Research support from: Janssen-Cilag, Consultant of: Janssen-Cilag, Speakers bureau of: Janssen-Cilag, M. Amore: None Declared, G. Serafini: None Declared

People exposed to more unfavourable social circumstances are more vulnerable to poor mental health over their life course, in ways that are often determined by structural factors which generate and perpetuate intergenerational cycles of disadvantage and poor health. Addressing these challenges has become an imperative matter of social justice. In this paper we provide a roadmap to address the social determinants that cause mental ill health. Relying as far as possible on high-quality evidence, we first map out the literature that supports a causal link between social determinants and later mental health outcomes. Given the breadth of this topic, we focus on the most pervasive social determinants across the life course, and those that are common across major mental disorders. We draw primarily on the available evidence from the Global North, acknowledging that other global contexts will face both similar and unique sets of social determinants that will require equitable attention. Much of our evidence focuses on mental health in groups who are marginalized, and thus often exposed to a multitude of intersecting social risk factors. These groups include refugees, asylum seekers and displaced persons, as well as ethnoracial minoritized groups; lesbian, gay, bisexual, transgender and queer (LGBTQ+) groups; and those living in poverty. We then introduce a preventive framework for conceptualizing the link between social determinants and mental health and disorder, which can guide much needed primary prevention strategies capable of reducing inequalities and improving population mental health. Following this, we provide a review of the evidence that has tested candidate preventive strategies to intervene on social determinants of mental health. These interventions fall broadly within the scope of universal, selected and indicated primary prevention strategies, but we also briefly review important secondary and tertiary strategies to promote recovery in those with existing mental disorders. Finally, we provide seven key recommendations, framed around social justice, which constitute a roadmap for action in research, policy and public health. Adoption of these recommendations would provide an opportunity to advance efforts to intervene on modifiable social determinants that affect population mental health.

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Suicidal behavior is a public health problem in which the entire society must commit to implementing all available strategies to prevent it (Tighe et al., 2018), as more than 800,000 people die worldwide each year (Pedrola-Pons et al., 2024).

The objective is to determine the efficacy of ACT in reducing suicidal behaviors through a systematic review.

A systematic review was conducted following the PRISMA 2020 methodology, searching the Cochrane, EMBASE, PubMed, PubPsych, and MEDLINE databases for scientific literature published between 2013 and March 31, 2024, using the keywords: “suicidal behavior” and “acceptance and commitment therapy” in Spanish and English. After applying inclusion and exclusion criteria, 7 studies were finally included in the systematic review.

After conducting the search, 7 studies were included, among which were 1 meta-analysis of randomized controlled trials, a systematic review and meta-analysis, two randomized clinical trials, a systematic review of 5 studies, a program analysis, and an effectiveness study. The review showed a significant reduction in suicidal behavior in patients who received ACT (Calati et al., 2024).

A relationship was observed between increased psychological flexibility and decreased suicidal ideation (Macri et al., 2024). The efficacy of ACT was comparable or superior to other interventions in some of the studies included in the review (Kumpula et al., 2019).

ACT shows promising results in reducing suicidal behaviors. However, more studies with long-term follow-up are needed to confirm its efficacy.

More studies with larger sample sizes and longer participant follow-up are needed to establish the long-term efficacy of ACT in reducing suicidal behavior.

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Although there is good empirical data on factors that predict harmful outcomes, and standardised approaches to risk assessment have been developed, there remains a disconnect between the academic study of risk and routine clinical practice. This is exemplified by (i) the outstanding uncertainty about how to use predictive models for everyday clinical decision-making, and (ii) the use of predictive methodology to test tools that eschew prediction. The disconnect is, in part, a consequence of the varied use of the notion of ‘risk’ within and between academia and clinical practice.

To derive a more nuanced understanding of the meaning of ‘risk’ in clinical practice.

After reading clinical vignettes, participants (all practising clinicians, n=18) took part in semi-structured interviews regarding clinical decision-making. The interview transcripts were subject to thematic analysis using a novel approach to the analysis of ideas in expressed language (in this case the idea of ‘risk’) which draws on philosophical and intellectual history methodologies (derived from the work of Wittgenstein, and Skinner respectively).

The use of risk by participants varied according to the extent and type of its spatial location (figure 1).

In many cases, ‘risk’ was used in a disembodied (i.e., dislocated) way (e.g., ‘what is the risk,’ ‘risk will increase’).

When locatable, it was evident that participants located risk in:

1. a) the patient (e.g., ‘the patient’s risk’) which was sometimes qualified by the type of harm envisaged (e.g., ‘his risk involved hurting staff’);

2. b) clinical activity (e.g., risk assessment, positive risk-taking, risk management);

3. c) the clinician (e.g., risk tolerances and thresholds); and

4. d) the system (e.g., ‘our system is… quite risk averse,’ ‘who holds the risk’).

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This study demonstrates the varied use of ‘risk’ in practice. By empirically delineating the different expressed forms ‘risk’ takes in clinicians’ language (and thinking), the findings of this study can inform (i) the development of risk study methodologies that are more applicable to practice, and (ii) improvements in clinical practice by clarifying how risk can be understood and spoken about.

None Declared

Mood disorders with mixed features, characterized by the concurrent presence of manic and depressive symptoms, represent a complex and significant area in psychiatric research. Historically, the recognition of such mixed states traces back to ancient Greek scholars, with evolving understanding through the 19th century. This evolution reflects substantial contributions from early thinkers to modern psychiatric frameworks.

1. 1. To trace the historical development of the concept of mixed mood states from ancient Greece to the 19th century.

2. 2. To analyze the contributions of key figures such as Areteo of Cappadocia, Wilhelm Griesinger, Jean-Pierre Falret, Emil Kraepelin, and Wilhelm Weygandt in shaping the understanding of mixed states.

3. 3. To evaluate the impact of Kraepelin’s and Weygandt’s work on contemporary classifications of mood disorders.

A historical review of primary and secondary sources, including classical texts and psychiatric literature, was conducted. The analysis focused on the contributions of significant historical figures, examining their theories and classifications of mood disorders. Key publications, such as Kraepelin’s treatises and Weygandt’s monographs, were scrutinized to assess their influence on modern psychiatric nomenclature.

The study highlights the foundational observations of mixed mood states by ancient Greek scholars, particularly Areteo, who first proposed that mania and melancholia were facets of the same condition. The 19th-century revival of interest in these states saw important contributions from Griesinger and Falret, with Kraepelin’s systematic framework in his 1899 treatise integrating mixed states into a unified concept of manic-depressive insanity. Weygandt’s 1899 monograph further refined the understanding of mixed states, reflecting a collaborative intellectual effort with Kraepelin.

The historical evolution of mixed mood states demonstrates a significant advancement in psychiatric theory. Kraepelin’s comprehensive framework, supported by Weygandt’s detailed analysis, laid the groundwork for contemporary classifications of mood disorders. Recognizing the collaborative nature of these developments underscores the importance of shared intellectual contributions in the advancement of psychiatric science.

None Declared

Psychotic depression is a severe mental disorder that can cause severe suffering and dysfunctionality in the patient. It is characterised by the presence of major affective symptoms together with the presence of psychotic symptoms in the form of delusions and/or sensory-perceptual alterations. Psychotic depression is particularly severe when it becomes resistant to pharmacological treatment, often requiring the combination of antipsychotics with antidepressants and even the use of electroconvulsive therapy. Lifetime prevalence of psychotic depression ranges from 0.35% to 1%, being more frequent in the elderly. Previous studies have shown positive experience with intravenous ketamine in the treatment of psychotic depression, improving psychotic symptomatology and showing a good safety and tolerability profile. The present study shows the response in a series of cases with psychotic depression treated with inhaled esketamine, showing their evolution through the Montgomery-Asberg Depression Rating Scale (MADRS) as well as their safety and tolerability profile.

The main objective of this study is to describe the use of inhaled esketamine in patients with psychotic depression in real clinical practice, using the MADRS as main outcomes to show the evolution.

Retrospective descriptive study with a sample selected by non-probabilistic consecutive sampling, retrospective type, in a time interval of 2 years. The patients selected were those who completed treatment with inhaled esketamine and had a diagnosis of psychotic depression at Hospital Universitario Infanta Elena. A descriptive analysis was performed. Mean and standard deviation were calculated for quantitative variables and N and percentage for categorical variables.

A total of 5 patients with a diagnosis of psychotic depression (n: 5) all treated with inhaled esketamine were included in the study. The efficacy of inhaled esketamine was very high in the treatment of patients with psychotic depression, achieving a 100% response rate (MADRS<10). All 5 patients showed a rapid improvement in psychotic symptomatology, with cessation of psychotic symptoms in the initial phases of treatment, showing a rapid response. No worsening of psychotic symptoms was observed at any time with the administration of inhaled esketamine. Tolerability was excellent, with no serious adverse effects occurring during treatment administration.

The present study shows a high efficacy of esketamine in the treatment of psychotic depression, with a high response rate and an excellent tolerability profile. Inhaled esketamine could be a useful tool in the treatment of psychotic depression, helping to rapidly restore patients’ functionality. Longitudinal studies must be carried out to confirm this hypothesis.

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Familiarity with, social distance from people with mental illness and socio - demographic characteristics has been linked to conditions that lead to weaker prejudiced beliefs and a more positive opinion about mental illness.

The relation of the attitudes and perceptions of the citizens of Larissa city towards mental illness and their desire for social distance from the mentally ill people, in relation to their familiarity with mental illness and their demographic characteristics.

A convenience sampling survey was conducted in Greece, Larissa City (n=220). The research tools which were used were: a) Familiarity was assessed using the Level of Contact Report, b) The Social Distance Scale, to measure the desire for social distance from people with mental illness c) Attitudes about mental illness were assessed using The Opinions About Mental Illness (OMI) Questionnaire and finally d) a questionnaire for the socio - demographic information.

Univariate and multivariate analysis was applied for the statistical analysis of the data, which showed that: Desire for social distance from people with mental illness is positively related with the familiarity (with mental illness) but on the other hand is negatively related to the opinions / attitudes about mental illness.

The results from this study highlight and emphasize the important role of familiarity (with mental illness) and the desire for social distance (from people with mental illness) in the formation of positive/negative (prejudiced) attitudes and perceptions about mental illness.

None Declared

Transgender and Gender Non-Conforming (TGNC) individuals are at increased risk of diagnosis with mental disorders, including suicidality and suicidal gestures (Anderson & Ford. Nursing Inquiry 2022; 29). Patients’ psychological distress may be secondary to gender dysphoria; however, the evidence may be unclear.

The goal of this review was to compile current evidence to assess a relationship between gender dysphoria and suicidal ideation, suicidal attempt, and self-harming behavior.

A literature review on PubMed databases was conducted using the search terms “transgender,” “gender non-conforming “suicidality,” “self-harm,” “suicidal gestures,” “child,” “adolescent,” and “youth” in various permutations to assess recent evidence on suicidality and suicidal gestures among TGNC children and adolescents. We also reviewed relationships between gender-dysphoria, social support as a protective factor, and suicidality and/or suicidal gestures among TGNC youths.

A study conducted across 19 states in the United States and large urban school districts found that within the last year, 43.9% of transgender students reported they have seriously considered attempting suicide compared to 20.3% in cis-females and 11.0% cis-males, 39.3% of transgender students reported having a suicide plan compared to <16.0% of cisgender students, and 16.5% of transgender students reported having a suicide attempt requiring medical treatment compared to <2.5% of cisgender students (Garthe et al. Transgend Health 2022; 7 416-422). Another study conducted across three different US cities found higher levels of suicidal ideation and behavior among TGNC youths, compared to their cisgender counterparts (Johns et al. MMWR 2019; 68, 67–71). Also, chosen name use was associated with less suicidal ideation, behavior, and depressive symptoms (Russel et al, J Adolesc Health 2018; 63 503–505). Additionally, a surveillance analysis concluded that TGNC youths reported experiencing higher levels of emotional distress, bullying victimization, risk behaviors (substance use and sexual behavior), and lower levels of protective factors such as internal assets, family connectedness, and feeling safe in their community (Eisenberg et al. J Adolesc Health 2017;61 521–526)

Further research needs to be conducted regarding the relationship between gender dysphoria and suicidality, and the presence of suicidal gestures. However, the current data suggests decreased depressive symptoms, as well as suicidal ideation and behavior associated with increased chosen name usage.

None Declared

Rates of mental health disorders in resettled refugees surpass those of the host population (Hameed et al, KJM 2018;11 20-23). However, most studies suggest heterogenicity between populations, suggesting a need for a non-generalized approach to resettled-refugee mental health (Silove et al, World Psychiatry 2017;16 130-139). Since the Taliban assumed control in August 2021, the United States has taken in about 90,000 Afghan refugees (Green, Wilson Center 2023), 15,000 have settled in Houston, Texas (Schneider, Texas Standard 2023).

This study investigates factors that may predict higher rates of distress and symptoms of PTSD and depression within an Afghan refugee community resettled in Houston, Texas.

Seventy-four Afghan refugees located in Houston, Texas were surveyed for demographic information and physical or emotional symptoms as directed by the Refugee Health Screener-15 (RHS-15). An average score of ≥ 12 on the RHS-15 or a self-reported distress score ≥5 indicated a positive result on the screening tool. Mann-Whitney and Fisher’s exact tests were used to compare differences in patient baseline characteristics and responses stratified by a positive RHS-15 or distress screen. Spearman’s Rank Correlation Coefficient was used to assess the correlation between selected response variables and outcomes as well as between the RHS-15 and distress scores.

40% of subjects scored ≥12 on the RHS-15 and 35% indicated a distress score ≥ 5. Income differed significantly between the RHS <12 group and the RHS ≥12 group (p=.02). The RHS <12 group had a higher proportion of individuals in the lowest income bracket, < $10,000, and a greater proportion in the $20,000-$30,000 bracket. Meanwhile, the RHS ≥12 group had a higher proportion in the $10,000-20,000 income bracket. There was a negative correlation between self-reported health scores with both RHS-15 score (ρ=-.508, p<.001) and distress score (ρ=-.423, p=.001) as well as between neighborhood support levels and distress scores(ρ=-.314, p=.018).

This Afghan refugee cohort shows theoretical rates of PTSD and MDD higher than the average American (40.3% RHS-15 score vs. 3.6% PTSD and 8.3% MDD) (NIH 2023). The increased risk of mental disorder may be attributed to lower perceived community support, poor physical health, and low socioeconomic status. If income growth is a function of increased time spent in the United States, the unique pattern in income between the two RHS groups may reflect a “honeymoon period” that has previously been demonstrated in studies on migrants and culture shock (Maillet et al, APMH 2023; 50 563–575). Following this honeymoon period, however, lower income may predict worsened mental health in resettled refugees. These results support multi-factorial initiatives to support resettled refugees especially in areas of community interconnectedness, health and economic support.

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Persons with schizophrenia are currently excluded from psychedelic-assisted therapy due to concerns about psychedelic-induced acute or persistent psychotic symptoms. However, meta-analytic evidence of the precise risk for psychedelic-induced de novo and exacerbation of psychosis in people with pre-existing psychotic disorders is lacking.

We conducted an overview of reviews, systematic review, and meta-analysis to examine the incidence of psychedelic-induced psychosis and the exacerbation of psychotic symptoms in schizophrenia.

Our pre-registered protocol (CRD42023399591) covered: LSD, psilocybin, mescaline, DMT, and MDMA. Embase, PubMed, PsyARTICLES, PsyINFO, and trial registries were searched from inception until 11/2023.

The incidence of psychedelic-induced psychosis was computed using a random-effects model, and standardized assessments of study quality was performed. We retained 131 publications: 14 systematic reviews, 20 reviews, 35 randomized-controlled trials (RCTs), 10 case-control studies, 30 uncontrolled trials (UCT), and 22 cohort studies with overall low study quality. The meta-analysis included nine studies. Incidence of psychedelic-induced psychosis was 0.002% (95%CI 0-0.006, I2=0%, N=123,800; n=2) in population studies; 0.2% (95%CI 0.1-0.3, I2=0%, N=6,535; n=6) in UCT, and 0.6% (95%CI 0.2-1.8, I2=0%, N=563; n=3) in RCTs excluding individuals with a history of psychotic symptoms. In UCT including patients with schizophrenia, 3.8% (95%CI 1.6-8.9, I2=0%, N=133; n=2) developed long-lasting psychotic symptoms. In cohort studies, 13.1% (95%CI 9.4-17.9, I2=24%, N=353; n=3) of those with psychedelic-induced psychosis developed schizophrenia. Sensitivity analyses confirmed the main findings. The incidence for psychedelic-induced psychosis is low but slightly higher in studies including patients with schizophrenia. The risk of transition to schizophrenia after psychedelic-induced psychosis is considerable.

In summary, the reviewed evidence suggests that schizophrenia might not be a definite exclusion criterion for clinical trials exploring safety and efficacy of psychedelics for treatment-resistant depression and negative symptoms. However, given the low quality and limited number of studies, more high-quality research is needed, and a conservative approach is recommended until further data is available.

None Declared

The World Health Organization defines non-adherence to treatment as “a situation where an individual’s medication-taking behavior diverges from the agreed recommendations of healthcare professionals”. Individuals with psychiatric disorders frequently encounter challenges in adhering to their prescribed treatments, which is due amon other factors to a lack of insight. The non-adherence can lead to increased relapse rates, diminished treatment efficacy over time, and adverse effects on both the individual and the broader community.

This study’s objectives were towfold : (1) to investigate medication adherence among patients with schizophrenia and bipolar disorders under antipsychotics, and (2) to identify various factors associated with non-adherence to antipsychotic treatments.

A cross-sectional study was conducted at Razi Hospital, Tunisia, between December 2023 and January 2024. Were included patients who attended the outpatient clinic during the study period, who were in remission for at least one month and who were receiving antipsychotic medication. The Brief Adherence Rating Scale, the Positive and Negative Syndrome Scale and the Glasgow Antipsychotic Side-effects Scale were administered to all patients.

The study included 35 male patients with a mean age of 39 years ± 11 years. Schizophrenia was diagnosed in 86% (N=30) of the participants. Of these, 49% were prescribed first-generation antipsychotics (N=17), while 51% (N=18) were prescribed second-generation antipsychotics. More than half of the patients (63%) demonstrated non-adherence to their treatment regimen. Among these, 65% exhibited moderate to severe lack of insight into their illness, and 66% had not received psychoeducation about their condition. A significant association was found between non-adherence and moderate to severe lack of insight (p=0.000, OR=4, 95% CI [1.4-10]), lack of psychoeducation for the patient (p=0.02, OR=2, 95% CI [1-4.3]), and lack of psychoeducation for the caregiver (p=0.05, OR=1.7, 95% CI [0.9-3.2]). Binary logistic regression analysis indicated that lack of insight (p=0.01, OR=3.6) remained a significant risk factor for non-adherence.

This study underscores significant association between lack of insight and non-adherence to antipsychotic medications. Enhancing insight through early psychoeducational interventions could potentially improve medication adherence and positively influence long-term clinical and functional outcomes for patients.

None Declared

The United Nations Children’s Fund defines mistreatment as any act that causes harm to the health, dignity or development of an individual. The aim of this study was to quantitatively analyze the effect of speech therapy stimulation on the development and quality of social skills in adolescents victims of childhood mistreatment. The hypothesis is that after the intervention program the subjects will show improvement in relation to the performance of these skills.

To quantitatively and qualitatively analyze the effect of speech therapy stimulation on the development and quality of social skills in adolescents victims of childhood mistreatment. The hypothesis is that after the intervention program the subjects will show improvement in relation to the performance of these skills.

10 adolescents, between 12 and 16 years old, have participated in the research. The following inclusion criteria were used: 1) being between 7 and 17 years old; 2) having experienced mistreatment in childhood; 3) be treated in a highly complex health service. The intervention programs consisted of 12 follow-up sessions, carried out in person. The main focus was on stimulating communicative and pragmatic skills, also covering theory of mind skills, personal problem solving and paralinguistic skills. After the 12 sessions, patients underwent reevaluation and the results were tabulated and analyzed by the researcher.

Participants had considerable difficulties with social skills before speech therapy intervention, the initial difficulties was mainly in self-control and assertiveness skills. After the 12 intervention sessions, a significant improvement in the social skills was observed, especially in empathy and assertiveness.

The participants progressed after the intervention in all areas evaluated, with more significant improvements in empathy and assertiveness. These results demonstrate the positive impact of speech-language therapy intervention for the stimulation of social communication and pragmatic skills.

It is important to emphasize that this population has many specificities, making it difficult to work with isolated variables. Therefore, more studies involving speech-language therapy, particularly speech-language therapy intervention, with adolescent victims of abuse are needed.

None Declared

Introduction

Cannabis-induced psychosis (CIP) is often assumed to resolve with sustained abstinence, although recent studies report adverse long-term outcomes, such as a high risk of diagnostic transition to schizophrenia. Cannabis is also known to increase relapse rate in individuals with psychotic disorders in general, and there is a lack of knowledge on optimal treatment of this patient group.

In this presentation, data on incidence and mortality associated with CIP, and real-world effectiveness of antipsychotics in relapse prevention in persons with CIP will be presented.

Nationwide Scandinavian registers were utilized to identify persons with first-time CIP (ICD-10 F12.5) during the years 2000-2021. Incidence and mortality of CIP were investigated with Danish, Norwegian and Swedish register-based data, and antipsychotic use with Swedish data. Annual incidence rates of CIP per 100 000 persons were calculated. For mortality study, incident cases of CIP were matched by age- and gender with comparison persons without substance-induced psychosis and hazard ratios (HRs) were calculated for all-cause and cause-specific mortality. Association between use of specific antipsychotics (oral vs. long-acting injectable, LAI, forms) and risk of hospitalization due to any psychosis relapse was investigated in within-individual design where each person acted as his/her own control to minimize selection bias, analyzed with stratified Cox models.

The incidence rate of CIP increased in time in all Scandinavian countries and was the highest in Denmark throughout the study years (rate in 2016 5.6, vs. 3.0 in Norway and 2.7 in Sweden). CIP was associated with an increased risk of mortality, risk estimates (HRs) ranging from 6.6 in Denmark, to 7.6 in Sweden, and 9.0 in Norway, compared with general population controls. In within-individual models, antipsychotic use was associated with a decreased risk of hospitalization due to psychosis relapse, with an adjusted HR of 0.75 (95% Confidence Interval 0.67-0.84), compared with time periods when the same individuals did not use antipsychotics.

Incidence of cannabis-induced psychosis is increasing in Scandinavian countries, and it is associated with significant mortality risk. Antipsychotics are effective treatments in preventing psychosis relapses also in individuals with CIP.

H. Taipale Grant / Research support from: Janssen, Speakers bureau of: Gedeon Richter, Janssen, Lundbeck, Otsuka

Adverse Childhood Experiences, referring to potentially traumatic events such as sexual abuse, rejection, and family dysfunction, are strongly associated with the development of psychiatric disorders, including anxiety, depression, and substance misuse. Peer victimization related to sexual orientation and gender identity or expression has been linked to higher rates of depressive symptoms, disrupted educational paths, trauma, and increased use of substances such as alcohol and drugs. Gender-diverse youth are particularly vulnerable to substance misuse, especially in environments with limited support and prevalent discrimination.

To emphasize the complex interactions between substance use, early trauma, and gender identity struggles, while highlighting the importance of a multidisciplinary therapeutic approach.

This case report was developed through detailed psychiatric interviews and assessments conducted during the patient’s follow-up in an outpatient addiction treatment unit. The case description is supported by a focused literature review on PubMed using the keywords “Adverse Childhood Experiences”, “Substance Use Disorder” and “Gender Identity”.

The patient is a young adult with a history of polysubstance use, starting in adolescence. His substance use was closely associated to early trauma, including childhood sexual abuse and rejection by family and peers after disclosing his sexual orientation. These events led to dropping out of school, running away from home, and experiencing homelessness. As a result, he developed long-standing anxiety, depressive symptoms, and emotional instability. Internal struggles with gender identity, alongside ongoing familial conflict and unstable romantic relationships, further worsened his psychopathology. After a multidisciplinary intervention involving psychiatry, psychology, and social services, he showed significant improvements in emotional regulation, anxiety management and has remained abstinent since starting treatment.

Personal experiences, especially during childhood and adolescence, profoundly influence mental health and behaviors in adulthood. This case underscores the interaction between adverse childhood experiences, substance misuse, and discrimination related to sexual orientation, illustrating how these factors collectively impact psychiatric health. The patient’s journey through addiction, identity struggles, and mental health challenges reflects the deep influence of both personal trauma and systemic issues. This case highlights the need for multifaceted therapeutic approaches that address the psychological, social, and familial factors underlying the patient’s condition.

None Declared

Sweden has a long history as a host country for refugees. In recent years there has been a shift from being one of the most generous host countries in Europe to one of the most restrictive. In Sweden, refugees with a residence permit have a full right to care, but asylum seekers and undocumented migrants only have a right to care that cannot be deferred. Despite relatively good formal access to mental health care, and so far, the availability of free language interpreters, refugees face barriers to and within mental health care.

To give a brief overview of the current challenges for mental health care in Sweden and the work on solutions for people on the move.

Ongoing research and clinical development are summarised in parallel with the identification of challenges.

A complex picture of the development and challenges of mental health care for people on the move in a situation of increasing social pressure on refugees is described.

There is a need for equal treatment of people on the move without discrimination and exclusion.

None Declared

Sexual minority individuals face unique challenges in mental and sexual health, emotion regulation, and well-being. Although understanding the complex dynamics among these variables in the context of diverse sexual orientations and gender identities is crucial to supporting and tailoring comprehensive interventions, limited research has investigated their overlapping relationships and intersections.

The current study aims to examine the connections between mental health, sexual health, emotion regulation, and well-being among sexual minority and heterosexual individuals in Israel. The main purpose was to provide a comprehensive understanding of the unique challenges sexual minority individuals face.

The study included 465 participants, 324 (70%) were identified as heterosexual individuals and 119 (26%) as sexual minority individuals. Various variables were assessed using an online anonymous questionnaire, including mental health (anxiety, depression, suicide ideation, substance use disorder), sexual health (sex-related distress, problematic pornography use, compulsive sexual behavior disorder), emotion-regulation, and well-being. Between-group differences were analyzed using Mann-Whitney U tests. Network analysis was conducted to examine the centrality and edges of relationships between variables within each group.

Significant differences were found between the heterosexual and sexual minority groups across the measured variables. Sexual minority individuals reported higher levels of psychopathology, lower sexual health, as well as lower levels of emotion regulation and well-being compared to heterosexual individuals. Network analysis revealed that the number of diagnosed psychopathologies and depression were central nodes in the sexual minority group, while sexual functioning played a central role in the heterosexual group. The sexual minority group’s network showed less stability, suggesting distinct subpopulations within this group.

This study contributes to understanding the unique mental and sexual challenges sexual minority individuals face and the intersections between mental health, sexual health, emotion regulation, and well-being. These findings highlight the importance for mental health professionals to acknowledge and address these connections, emphasizing the need for tailored psychosocial interventions that integrate sexual health.

None Declared

Selenium seems to have the ability to alleviate inflammatory signaling path-ways. Obesity is associated with chronic low-grade inflammation. Depression is also defined as an inflammatory disorder. PPAR-γ has been shown to have antidepressant-like effects The levels of inflammatory cytokines that are parameters associated with obesity―are also related to the severity of depression. Studies confirm an increased risk of depressive symptoms in middle-aged women. Therefore, it seems reasonable to consider the influence of selenium, PPAR-γ, and selected proinflammatory cytokines in the context of obesity and depression among middle-aged women.

The aim of this study was to evaluate the effect of serum selenium on PPAR-γ and selected proinflammatory cytokines (IL-1β, IL-6, TNF-α) in relation to depressive symptoms and obesity in middle-aged women.

The study sample included 443 middle-aged women living in north-western Poland. The research procedure: a survey performed using the authors’ questionnaire and the BDI, anthropometric measurements, and analysis of blood for the levels of selenium, cytokines, and genetic analysis of the PPAR-γ polymorphism.

It has been found that BMI increases along with the concentration of IL-6. No moderating effect of selenium was observed, although cut-off values for “p” were established for IL-β*Se (p=0.068) and IL-6*Se (p=0.068), so there is a potential association with these two markers. At high selenium levels, the effect of higher IL-β levels on a decrease in BMI was stronger. So was the effect of an increase in IL-6 levels on an increase in BMI.

No effect of selenium on PPAR-γ has been found in relation to depressive symptoms and obesity. 2. Higher selenium levels may have a beneficial effect on BMI even at high IL-β concentrations, however, at high IL-6 concentrations, this effect was not observed. 3. Selenium levels had no impact on depressive symptoms.

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Two seemingly different paradigms for psychotherapy appear to have converged in narrative psychotherapy and psychoanalysis.

We wanted to explore the philosophical perspectives of some of their practitioners to understand this seemingly emergent paradigm.

We interviewed narrative psychotherapists and practitioners identifying as narrative psychoanalysts about their philosophical foundations in order to explore this apparent convergence. We used constructivist grounded theory to produce common themes. We also put the interviews through an AI program -- Perplexity to explore how well it correlated with our non-AI analysis.

Both groups of practitioners believed that that we construct stories to give us identity and meaning in our lives. The practitioners who came from a psychoanalytic perspective described their coming to understand that psychoanalysis is embedded in stories that ciients and therapists tell. Patients and analysts bring, create, and modify stories in analytic work. Both types of practitioners described the importance of cultivating an active listening attitude on the part of the clinician. Jacques Lacan was often quoted as saying that the greatest gift we can give our clients is to listen without judgment or interpretation. Narrative therapists were more inclined to mention Hermans’ dialogical self-theory while psychoanalytically trained therapists spoke of object relations theory with both supporting a philosophy of making meaning together. Both groups of practioners mentioned the importance of meaning being constructed within a particular context. Both groups mentioned the importance of reflective practices, Buddhism, and Indigenous philosophies to support the introspective elements of this technique along with therapy being grounded in our relationships with others. Both groups emphasized the importance of showing how creating new life narratives over time transforms our sense of self, relationship, and meaning.

Qualitative analysis of these two groups of practitioners’ philosophies of psychotherapy supports the idea of a convergence between narrative psychotherapy and psychoanalysis which may promise to enrich both groups.

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Clozapine is the reference treatment for resistant schizophrenia. Its pharmacokinetic characteristics (metabolism by cytochromes CYP1A2, CYP2C19, and CYP3A4, among others) as well as its pharmacodynamic properties are the source of numerous high-risk drug interactions. According to the French marketing authorization, clozapine is contraindicated with bone marrow depressants, and associations with benzodiazepines, omeprazole, fluvoxamine, and lithium require specific precautions.

Collaboration between a national multi-professional network operating in various public or private mental health hospitals (the PIC network) and a regional psychiatric research federation (FERREPSY Occitanie) enabled the implementation of a study describing the prevalence of high-risk drug associations in a large panel of French psychiatric hospitals

An observational cross-sectional study was conducted in December 2023 across 30 centers that are members of the PIC network and/or FERREPSY.

The medical records of 795 patients were analyzed by hospital pharmacists from the participating centers. Several high-risk associations with clozapine were identified. In 1.5% of cases, clozapine was associated with carbamazepine, in 1.1% of cases with omeprazole, and in 3% of cases with fluvoxamine. More frequently, associations with lithium salts were found in 15.6% of patients and with benzodiazepines in 68.3% of patients.

This study provided an overview of high-risk co-prescriptions with clozapine in French psychiatric institutions. It highlights a high prevalence of certain high-risk associations, which underscore the discrepancy between clinical practices and health agency recommendations.

None Declared