Loneliness, social isolation, and living alone are emerging as significant risk factors for mortality, especially in older adults.

Loneliness, social isolation, and living alone are recognized as significant risk factors for mortality in older adults. This study aimed to quantify their associations with all-cause and cause-specific mortality, extending the scope of previous research by considering a broader range of social factors.

A systematic search was conducted in PubMed, APA PsycINFO, and CINAHL databases up to December 31,2023, adhering to PRISMA 2020 and MOOSE guidelines. Inclusion criteria comprised prospective cohort or longitudinal studies examining the relationship between loneliness, social isolation, living alone, and mortality. Quality assessment was performed using the Newcastle-Ottawa Scale. Meta-analyses utilized random-effects models with the Restricted Maximum Likelihood method, while subgroup and meta-regression analyses explored further relationships.

Out of 11,964 studies screened, 86 met the inclusion criteria. Loneliness was associated with a 14% increase in all-cause mortality risk, social isolation with a 35% increase, and living alone with a 21% increase. However, substantial heterogeneity was observed across studies, influenced by various factors including gender, age, geographical region, chronic diseases, and study quality. Meta-regression analysis identified predictors such as longer follow-up periods, female sex, validated social network indices, cognitive function adjustments, and study quality.

Loneliness, social isolation, and living alone significantly increase mortality risk in older adults, emphasizing the urgency of public health interventions targeting these factors to enhance health outcomes among the aging population. However, due to study variations, further research is needed to understand their cumulative effect on mortality risks and inform tailored interventions.

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Healthcare workers (HCW) face a growing crisis marked by high burnout levels (40-60%) and a rising intent to leave the profession. Current interventions focus mainly on individual resilience but have limited collective impact. Emerging evidence suggests that “Moral Injury” (MI)—a deep discord between HCW values and their practice, often worsened by organizational and economic constraints—may play a key role in this crisis.

The primary aim of this study was to describe the manifestations of MI among HCW in France, with a healthcare system characterized by universal health coverage. Secondary objectives included the psychometric validation of the Moral Injury Inventory (MII) for HCW, analysis of organizational determinants of MI, and modeling of the underlying mechanisms of this phenomenon.

This cross-sectional, observational study was conducted nationally via an online survey. Measures included the MII, the Moral Injury Events Scale (MIES), the PHQ-9 for depression, the GAD-7 for anxiety, the Maslach Burnout Inventory (MBI), and the EuroQol 5-Dimensions (EQ-5D) for quality of life. Item Response Theory (IRT) was used to test the MII, including assessments of construct validity, and reliability. Structural equation modeling (SEM) was used to explore complex interactions between MI and other variables, including burnout, depression, and anxiety.

Nearly 3,000 HCW participated in the survey. Psychometric analysis confirmed that the MII met IRT model assumptions, including unidimensionality, local independence, and monotonicity, with fit indices indicating adequate model fit (RMSEA ≤ 0.08, CFI, TLI ≥ 0.95, and infit mean square statistic ranging between 0.7 and 1.0). Differential Item Functioning analysis revealed no item biases. Over 50% of HCW reported experiencing MI, with notable variability across structural/organizational characteristics. MI and burnout emerged as distinct yet frequently associated constructs, with moderate to strong correlations observed between them. Their combined presence had a cumulative negative impact on health outcomes, with affected HCW showing higher levels of depression, anxiety.

This study highlights the high prevalence of MI among HCW in France, even within a robust healthcare system with universal coverage, and confirms that MI is distinct from burnout. These findings underscore the need for systemic interventions that address organizational factors, beyond the current individual-focused approaches used for burnout. Such a shift in focus would also help move away from the current tendency to over-burden and even blame HCW for systemic issues beyond their control. Given the global nature of the healthcare crisis, an international study is essential to identify systemic factors across healthcare settings, paving the way for a holistic, worldwide approach to supporting the healthcare workforce.

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Hospitalization in psychiatry often marks a critical point in the management of mental health disorders. For elderly patients, this can be a first-time experience and is often associated with complex psychological, social, or medical factors. Due to the age, psychiatric symptoms may become more pronounced because of comorbidities, cognitive decline and social challenges. Understanding the profile, medical history, presenting complaints, and associated conditions of elderly patients admitted for the first time to psychiatric care is essential to improve the comprehensive care.

The objective of this study is to analyze the profile of elderly patients hospitalized for the first time in the psychiatric department, focusing on their medical history, presenting complaints, diagnoses, and comorbidities.

It’s a retrospective study. We reviewed the files of all patients aged over 65 years old who were hospitalized in the Avicenne Psychiatric Department at Razi Hospital between September 2022 and September 2024.

We identified 22 patients with 16 men and 6 women. The average age of our patients was 68 years (ranging from 64 to 80 years). The majority had a secondary school education (47%), came from an urban background (81%) , were retired (54%), with a high socioeconomic status (42%), married (61%), parent of an average of 2 children and with a family history of mental disease (52%). A history of somatic illness was found in 61% of the patients. The reason for hospitalization was behavioral disorder in 73%, suicidal thoughts in 18.2% and refusal to eat in 8.8%. A history of psychiatric consultation without the need for hospitalization was found in 59% of the cases around the age of 51 years. In 18% of the cases, the onset of the disorder was acute, while it was progressive in the rest. Concerning the diagnosis, we observed mental confusion caused by an organic pathology in 9%, a purely neurological cause of the disorder in 14% ( dementia in 10% and Parkinson’s disease in 4%), a depressive episode in 31%, a manic episode within the context of bipolar disorder in 37%, and schizophrenia in 9%. Comorbidity with paranoid personality disorder was observed in 4 patients, all of them were females. For patients with a psychiatric diagnosis, a neurological comorbidity was found in 31.25% (25% dementia, 6.25% Parkinson’s disease).

This study shows that elderly patients in their first psychiatric hospitalization have complex profiles affected by age-related factors and comorbidities. Diagnosis varied from mood to psychotic disorders, often with neurological issues. The frequent history of psychiatric consultations without hospitalization suggests that early intervention could help prevent more severe admissions. Understanding these profiles is crucial for improving care and treatment for elderly patients.

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With both the Russian invasion of Eastern Ukraine and Crimea in 2014, and the war that began in February 2022, Ukraine has faced extensive damage, numerous casualties, widespread displacement of people, and significant psychological trauma. These events have strained health care and, particularly, mental health care systems that were ill-equipped to handle such stresses.

The Commission was created in February 2023, coincident with the first anniversary of the Russian attacks. Prof. Irina Pinchuk was invited to lead The Lancet Psychiatry Commission on Mental Health in Ukraine, with Prof. Norbert Skokauskas and Prof. Bennett Leventhal as Co-chairs. The Commission brought together 40 experts in mental health, economics, law, and science from 12 countries, formed into five workgroups (Clinical Services, Clinical Training, Research, Forensics and Legal Advocacy, and Finance).

The Commission recommends a stepped-care model in which low-intensity services are provided by non-specialist personnel, with proper training, integrated in primary care, augmented by digital tools, all directed to moving individuals from institutional to community-based services; Developing a multidisciplinary mental health research infrastructure that is adequately funded and initially focused on relevant issues such as PTSD, the war’s impact on Ukrainians, and innovative service models for Ukraine; Policy and legislative changes; Increase in Ukraine’s mental health spending, to 4.5% of total healthcare expenditures.

The Lancet Commission supports Ukraine’s goals to end the war, provide evidence-based services for its citizens and to join the global community with improved resources clinical education, research, legal structures, funding, and care.

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Jumping to conclusions (JTC) is a cognitive bias strongly involved in the genesis of psychotic symptoms. Accurate evaluation of JTC is crucial for early intervention and treatment planning. However, traditional assessment methods are time-consuming and subject to human error. This study leverages state-of-the-art Large Language Models (LLMs) to evaluate JTC in a unique Spanish population database collected through the DISCOURSE protocol at the Instituto de Investigación Marqués de Valdecilla (IDIVAL).

Our primary objectives were to:

1. Assess the efficacy of LLMs in evaluating JTC bias from transcribed speech.

2. Compare different LLM models and prompting techniques for optimal performance.

3. Explore the potential of AI-assisted cognitive bias evaluation in clinical settings.

We utilized a database of approximately 170 participants, including patients, controls, and relatives, collected through the DISCOURSE protocol. This protocol is particularly valuable as it includes tasks designed to elicit JTC behaviors, such as ambiguous picture interpretation. Audio recordings were automatically transcribed using two speech-to-text algorithms and manually revised for accuracy.

We investigated various LLM models (“gpt4o”, “claude-sonnet-3.5”, “llama3”, “gemini pro”) and experimented with different prompting techniques, including instruction combinations and reasoning scratchpads (Chain of Thoughts).

Our evaluation has provided valuable insights into the potential of LLMs for assessing Jumping to Conclusions (JTC) bias. We observed varying degrees of effectiveness across different LLM models in identifying JTC behaviors from transcribed speech, with some showing promise in capturing subtle linguistic cues. Prompting techniques, particularly Chain of Thought reasoning, demonstrated potential in enhancing the models’ analytical capabilities. Given our Spanish-language database, we gained important insights into LLM performance in non-English contexts. Error analysis identified common limitations, informing future refinements. Preliminary findings suggested performance variations across demographic subgroups, highlighting areas for further investigation.

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This study represents a step towards integrating AI and automation into clinical workflows for psychosis evaluation and treatment. The understanding of the ability of LLMs to assess JTC from speech samples could significantly enhance the objectivity of cognitive bias evaluations. These findings lay the groundwork for future research exploring the integration of AI in psychosocial interventions for psychosis, including potential applications in cognitive remediation, metacognitive training, and personalized treatment planning.

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Electrodermal activity (EDA) measures the skin’s electrical properties. It varies according to the sweat gland’s activity which responds to the sympathetic nervous system (Boucsein W. Electrodermal Activity. Berlin: Plenum Press; 2012). Previous literature has reported lower EDA during bipolar and unipolar depressive episodes (Sarchiapone M, et al. BMC Psychiatry 2018; 18: 22 & Valenzuela-Pascual C, et al. Acta Psychiatr Scand 2024). Historically, heightened anxiety has been correlated with increased EDA, although findings in this area have been inconsistent (Naveteur J, et al. Int J Psychophysiol 2005; 56(3): 261–269).

This study aimed to determine whether significant differences in EDA exist among depressed patients based on their levels of anxiety.

We analysed EDA recordings from an E4 wearable device utilised by 29 depressed patients with bipolar disorder. They wore the device for a period of 48 hours without altering their daily routines. The tonic mean and phasic peaks parameters of EDA were extracted and analysed via a mixed-effects model for repeated measures, incorporating sleep state and anxiety level as variables. Anxiety levels were assessed based on the scores from item 10 on the Hamilton Rating Scale for depression, which reflects psychic anxiety.

The results indicated that anxiety levels did not significantly influence any of the models examined. However, in the phasic peaks model, there is a noteworthy interaction between anxiety level and sleep status (p < 0.01). Both models demonstrated a tendency towards increased EDA values in the high anxiety group although these findings did not reach statistical significance. This trend was consistent across both sleep states for the tonic mean model (Image 1). In contrast, the high anxiety group exhibited higher phasic peaks values (M [SD] = 2.33 [0.80-3.86]) compared to the low anxiety group (M [SD] = 2.33 [0.80-3.86]) only during wakefulness, although this difference was not statistically significant (p > 0.05) (Image 2).

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These findings should be interpreted with caution due to the small sample size and the imbalance in the distribution of low (17%) versus high anxiety (83%) participants. Furthermore, anxiety is a multifaceted symptom that should be evaluated using a more comprehensive assessment tool. To validate these preliminary observations, it is essential to increase the sample size and use a more precise measure of anxiety.

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Bipolar disorders (BD) are highly recurrent, necessitating effective long-term treatment to prevent negative outcomes. Current guidelines recommend maintenance treatment with mood stabilizers (MS) and/or antipsychotics (AP), emphasizing monotherapy after successful acute treatment. Despite limited evidence supporting polypharmacy, real-world prescribing often involves the use of multiple psychotropic drugs when monotherapy fails to adequately manage symptoms. The use of benzodiazepines (BDZ) in BD remains controversial due to potential for misuse and the exacerbation of existing substance use disorders, which are common in this population. Moreover, BDZ use may be linked to an increased risk of mood episode recurrence and could indicate a more severe course of BD.

To examine real-world prescribing patterns in BD outpatients, with a specific focus on BDZ use.

This cross-sectional study included BD outpatients treated at the outpatient department and day hospital at the Institute of mental health in Belgrade during a one-month index period (November 2021). Besides the diagnosis, inclusion criteria were: age 18-65 years, regularly managed medical record established at least three months prior, and a consistent prescription pattern for at least one month. Basic socio-demographic and clinical data, along with information on regularly prescribed medications (MS, AP, antidepressants (AD) and BDZ), were extracted from medical records.

Data from 107 clinically stable BD outpatients (75.7% female, age 44.8±11.7 years) were analyzed. Monotherapy was prescribed to 8.4% of patients, with six receiving only MS and three only AP. The majority (91.6%) were prescribed multiple psychotropic medications, predominantly the combination of MS (87.9%) and AP (80.4%). AD, mainly SSRI, were prescribed to 50.5% of the sample. Additionally, 54.2% were prescribed BDZ daily as part of their maintenance therapy, with a mean daily dose of 3.4 mg lorazepam equivalents (SD=2.5, range 0.5-12.0 mg). Patients prescribed with BDZ, compared to the those without, were significantly older (p=0.002, r=0.300), had a longer psychiatric history (p=0.042, r=0.197), and were less likely to have a comorbid personality disorder (p=0.021, Cramer’s V=0.223).

This study illustrates prescribing practices in a university psychiatric clinic in the Western Balkans, an under-researched region. Our findings, similar to those from other regions, indicate that real-world prescribing for BD maintenance often deviates from guidelines, with most patients receiveing polypharmacy, including BDZ in over half of the cases. These results underscore the need for further research into the role of GABAergic mechanisms in the pathophysiology of BD and for randomized studies to assess the efficacy and safety of adjunctive BDZ use in BD management.

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In forensic psychiatry, the most common diagnoses among the affected population are mood and psychotic disorders, personality disorders, or other conditions including intellectual disabilities. These individuals are either offenders or victims in criminal cases. Moreover, the tendency towards criminal behavior, disinhibition, agitation and aggression may also be associated with a neurocognitive disorder. Criminal behavior has been detected in 37.4% of frontotemporal dementia, 7.7% of Alzheimer’s disease, and 20% of Huntington’s disease patients.

Raising awareness on the potential presentations of disinhibited behaviors through three case reports and on the importance of detailed clinical evaluation to differentially diagnose and appropriately manage forensic referrals.

Each case was evaluated based on a predefined procedure comprising the anamnesis, mental status examination, review of previous medical and forensic records, neurological consultation including neuropsychiatric battery, social investigation and any other relevant information. Informed consent was obtained from all patients before presentation.

Case 1

A 63-year-old male, presented with a legal request of determining the need for a legal representative. The patient, who previously showed no similar behavior, repeatedly took loans under his own name, sold his assets at undervalued prices, experienced difficulties managing money, and was easily deceived. The patient was determined to exhibit frontal-type memory impairment, consistent with behavioral variant FTD (bvFTD), and it was deemed appropriate to appoint him a legal representative.

Case 2

A 52-year-old male, presented to assess his criminal responsibility regarding a theft offense. Anamnesis revealed forgetfulness, difficulties in managing money, tendency to take items from stores without paying, and repetitive behavior of cooking. Detailed examination and tests conducted led to a diagnosis of anxiety disorder, with a conclusion indicating full criminal responsibility.

Case 3

A 72-year-old male was hospitalized regarding an insult towards legal authorities. During the observation period in the inpatient ward, he exhibited similar behaviors. However, the final diagnosis was consistent with no significant psychopathology, and the patient was deemed criminally fully responsible for this act.

In cases where behavioral disturbances predominate, the possibility of frontal lobe dysfunction should be considered. Nevertheless, temporality relationships in symptomatology and the course of the disease, as well as where, when, and how the criminal act happened should also be taken into account. Cases which have similar initial presentations may finally lead to unrelated diagnoses. Systematic evaluations are necessary to accurately guide the legal authorities as well as planning treatment.

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Charles Bonnet Syndrome (CBS) is characterized by complex hallucinations in patients with sensory impairment. The World Health Organization in 2018 outlined the diagnostic criteria for CBS as follows: complex visual hallucinations; partial or complete vision loss; and absence of mental disorders (Dhooge Patty et al. AES 2022;7:12). Notably, auditory hallucinations are excluded from this definition, and recent reviews argue that CBS should not encompass sensory or auditory hallucinations (Rojas LC, Gurnani B. StatPearls 2024). Although their frequent association with psychotic disorders, a broad differential diagnosis is crucial given the diverse etiologies. Recently, there has been growing literature of cases of auditory hallucinations which were only explained as a CBS.

The work aims to explore and discuss the auditory variant of Charles Bonnet Syndrome (CBSa).

Based on two clinical cases, we conducted a literature review on this topic using PubMed database.

We describe two patients with severe sensorineural hearing loss and auditory hallucinations. The first patient, a 95-year-old independent in daily activities, presented with sudden-onset external voices. The second, an 81-year-old institutionalized woman, exhibited musical auditory hallucinations that developed over several months. Both patients maintained insight into the unreality of their hallucinations.

Comprehensive evaluations ruled out other potential causes, including neurological, psychiatric, pharmacological, and toxic-metabolic origins. Given the symptoms and and the exclusion of alternative diagnoses, CBSa was determined as the underlying cause.

The course of CBSa is known to be variable; hallucinations may diminish or resolve spontaneously or when the hearing deficit is ameliorated. Therefore, management is directed toward addressing the primary cause. No standardized treatment exists; however, medications such as antipsychotics, antidepressants, or antiepileptics may alleviate symptoms (Perez PA et al. Open Neurol J 2017 Feb 28;11:11-14). In our cases, both patients were treated with risperidone at 1 mg/24h, resulting in good tolerance and complete resolution of symptoms.

Despite the absence of definitive diagnostic criteria for CBS, it is predominantly associated with visual hallucinations without concomitant neurological or psychiatric pathology, excluding auditory manifestations. However, if patients experience hallucinations in non-visual sensory modalities while retaining insight into their unreality, they should not be excluded from a CBS diagnosis. Recent case studies support the existence of such variants.

This paper advocates for the refinement of CBS diagnostic criteria to encompass these additional manifestations. Expanding these criteria could enhance psychiatric epidemiology by addressing the current underestimation of CBS prevalence and improving the recognition and management of this condition.

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Sleep is essential for physical, brain (including mental) and societal health. Sleep-wake disorders are confirmed as independent risk factors and/or modulators of several neurological (such as stroke, dementia, and parkinsonism), psychiatric (depression) and other (arterial hypertension, diabetes, oncological) disorders. According to the Cost Of Illness in Neurology in Europe (COIN-EU) Study, 1.7 trillion euros cost is estimated for neurological disorders, of which 25.45% is dedicated for sleep disorders. In this talk both the socioeconomic burden of sleep disorders, and possible sleep-based interventions for improving brain and physical health, will be discussed.

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Autism spectrum disorders (ASD) are a group of neurodevelopmental conditions characterized by impairments in social interaction, communication (both verbal and non-verbal), and repetitive behaviors. The global prevalence of ASD has increased significantly, with an estimated 28.3 million cases worldwide. Although many individuals with ASD have normal cognitive and language skills, difficulties with social interactions and understanding nonverbal cues can interfere with their ability to form romantic and sexual relationships, potentially leading to inappropriate behaviors and a distorted experience of sexuality.

This paper aims to review the literature on sexuality in individuals with ASD, focusing on typical sexual behaviors, sexual preferences, as well as hypersexuality and paraphilic fantasies and behaviors within this population.

A non-systematic literature review was conducted, with article selection from PubMed using the keywords: “autism spectrum disorders”, “sexuality”, “hypersexuality” and “paraphilia”.

Studies have shown that adolescents with ASD experience higher rates of inappropriate sexual behaviors and gender dysphoria compared to neurotypical peers. Variants in sexual orientation, including homosexuality, asexuality, and bisexuality, are more prevalent in this population. Recent research indicates that sexual experiences, both alone and with others, are common among individuals with high-functioning ASD, with one study revealing that 47% expressed interest in having a romantic partner. Despite this, adults with ASD, especially men, are generally less likely to be in romantic relationships. They also exhibit more hypersexual and paraphilic fantasies and behaviors than neurotypical individuals. Hypersexual behaviors are predominantly observed among male ASD individuals, while paraphilias, such as voyeurism and fetishism, are frequently reported among both ASD men and women. Sadistic and masochistic fantasies and behaviors are also common in this group.

The results indicate that individuals with ASD have a higher prevalence of sexual orientation variants and inappropriate behaviors compared to their peers. Although they have sexual interests and desires for relationships, their ability to express sexuality in a healthy way is hindered by communication deficits, social interaction challenges, and an unsupportive environment, exacerbated by inadequate sexual education. These challenges prevent many from fully embracing their sexuality. Specialized, evidence-based sexual education addressing the unique needs of individuals with ASD is essential for promoting healthier sexual behaviors and improving psychosocial well-being.

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Binge-eating disorder (BED) is a significant global health challenge associated with obesity and psychological issues. The combination of Naltrexone-Bupropion (NB) has emerged as a promising pharmacological approach for managing eating behaviors.

This meta-analysis aims to evaluate the efficacy and safety of Naltrexone-Bupropion compared to placebo in managing eating behaviors, focusing on weight loss, binge-eating frequency, eating disorder psychopathology, quality of life, and adverse effects.

PubMed, Embase and Cochrane databases were searched for randomized controlled trials (RCT) comparing NB versus placebo for BED. Primary endpoints were weight loss and binge-eating frequency. Secondary endpoints included eating disorder psychopathology, depression, quality of life, food cravings, and adverse effects.The mean differences (MD) were applied with their 95% confidence intervals (95%CIs) for continuous outcomes, using a random-effects model. We used RevMan 5.4.1 for statistical analyses. Heterogeneity was assessed using the I² statistic.

Five RCTs with 2,466 adult participants (mean age 46.5 years, BMI 21.5-50 kg/m²) were included. NB was associated with a statistically significant reduction in weight loss percentage compared to placebo (MD -3.67%, 95% CI [-4.30; -3.03], I²=98%; Figure 1). However, no significant differences were found between NB and placebo in reducing binge-eating episodes(SMD 0.02, 95% CI [-0.30; 0.34], I2 =0%, Figure 2) , improving eating disorder psychopathology, alleviating depression, or decreasing food cravings. Although NB showed some benefits in improving the quality of life, the results were not statistically significant. NB was associated with a higher risk of adverse effects, including nausea, headache, constipation, dizziness, vomiting, insomnia, and dry mouth. The certainty of the evidences is in the Summary of findings (SOF) of GRADE evaluation (Figure 3). After leave-one-out sensitivity analysis, no single study was found to influence the effect estimate or drive heterogeneity excessively.

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NB demonstrated efficacy for weight loss in individuals with eating behavior issues but showed no significant benefits for core eating disorder symptoms. The higher risk of adverse effects necessitates careful consideration in clinical decision-making. Further research is needed to determine optimal patient populations, treatment duration, and strategies to mitigate adverse effects.

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Major Depressive Disorder (MDD) is the leading cause of disability worldwide, affecting individuals’ functioning in various life areas. Prolonged residual functional impairment is one of the risk factors for recurrence. Moreover, symptoms severity and accompanying functional disabilities negatively impact quality of life (QoL) and personal well-being, affecting the recovery process of people with MDD and their reintegration into daily life. Therefore, restoring functional abilities is no less important than reducing symptoms.

Recent changes in mental health policy have led to an expansion of client-oriented community-based services, focusing on preventing health problems and promoting QoL and well-being. A significant change can also be seen in depression evaluation and treatment, moving from traditional face-to-face therapy to hybrid care settings that incorporate remote or home-based treatments and assessments of everyday life.

While traditional assessments of symptoms and behavior often rely on questionnaires and interviews, they frequently miss the dynamic changes in daily functioning experienced by people with MDD. Clinicians primarily rely on patients’ retrospective reports regarding mood, affective state, thoughts, and behavior. However, understanding and gaining insight into day-to-day experiences requires addressing dynamic processes and changes that occur over time, rather than in a single time point. Hence, ecological momentary assessment (EMA) is a powerful and effective technique for assessing moment-to-moment function patterns in daily life.

Advancements in technology have enabled the use of computer-assisted methodology and real-time monitoring EMAs. The methodological advantages, including the circumvention of retrospective bias and increased longitudinal and ecological validity, have facilitated the widespread use of EMA in mood disorder clinical practice. Nevertheless, addressing everyday functioning using EMA remains limited in clinical research and practice.

Utilizing EMA can enhance our understanding of human experience, leading to human-centered research, design practice, and mental health care. It has the potential to reveal real everyday functioning and reflect the activities and contexts chosen and experienced by people with MDD. Addressing each patient’s unique functional profile can facilitate personalized interventions, supporting the recovery process and improving QoL.

This presentation will review the benefits of EMA in the field of mood traits, and especially EMA monitoring for daily function. Additionally, it will present recent studies using EMA and discuss advancements and clinical applications.

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Young general practitioners allocated in the rural area sustain the community healthcare frontline and endure the limited medical resources and social supports. Physician mental health could affect the quality of healthcare.

We examined the association of work-related experience with mental health in young public health physicians in the rural area.

Study promotional document was posted on the Korean Association of Public Health Doctors (PHD) website (http://kaphd.org) on July 2023. Three-hundred PHD (among the total 1,256 PHD) completed a web-based self-reported questionnaire on demographics, working experiences, and mental health on a first-come, first-served basis. Adjusted odds ratios(aOR) of depression, anxiety, lower self-esteem, and distress for working experiences in PHD were calculated in the multivariable logistic regression model with the best fit combinations of significant explanatory variables (P<0.05) in univariate logistic regression.

Distress, depression, anxiety, and lower self-esteem were reported by 39.7%, 25.3%, 11.3%, and 8.7% of the PHDs, respectively. Higher odds of worse mental health in PHD were associated with patient-physician conflicts at workplace, isolated residence from local facilities, and higher workload. Conversely, perceived expertise utilization and social connections with peers were related to the lower odds of worse mental health in PHD.

This study highlights the needs of governmental policy targeting the young general practitioners in rural area to enhance the expertise utilization and social connectedness, and to reduce the patient-physician conflict.

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34-year-old patient with multiple sporadic and brief contacts with mental health services, which he unilaterally chooses to discontinue. He has a long history of parasuicidal behavior dating back to adolescence. The patient does not report any prior diagnoses and has no history of inpatient admissions. The patient describes experiencing social isolation, lacking contact with his family of origin, and having no significant peer relationships.

The primary goal is to improve the patient’s engagement with mental health services, particularly in a case experiencing chronic, unaddressed symptoms, by utilizing intensive and structured programs. An additional objective is to address the patient’s self-identification with suicidal ideation.

The patient’s first contact with mental health services in this region of Spain was through the emergency department following a suicidal episode. During this encounter, the clinician introduced an intensive program designed to address suicidal ideation through regular visits over a set period. The patient agreed to participate and was subsequently enrolled in the PRISURE program at HGUGM in Madrid, where he received multiple sessions each month (between 2 and 4) with both a psychiatrist and a nurse from March to June 2024.

At the beginning of the program, the patient was fixated on the idea of suicide from a romantic/nihilistic perspective, displaying a pervasive rejection of interpersonal contact and a narcissistic element in interactions. He expressed persistent suicidal ideation. Over the course of frequent visits, the patient gradually began to connect with the chronic nature of his behaviors and started to identify additional symptoms. Despite partial engagement in the program, in this case with some missing consultations, his attendance at consultations improved significantly compared to his prior behaviors. An inpatient stay was initially offered and declined by the patient; however, after further consideration, he later presented to the emergency room and agreed to inpatient treatment. During the admission, a diagnostic assessment was carried out and discussed with the patient, revealing challenges in identity, object relations, and moral functioning, which were positioned within the spectrum of personality disorders, particularly highlighting narcissistic and antisocial traits.

Initially focused on his suicidal ideation, the patient, through the PRISURE program, gradually explored underlying difficulties contributing to his suicidal behavior. This process allowed him to accept further support, ultimately leading to an inpatient stay. Potential diagnoses were discussed openly with the patient, helping him to gain a clearer understanding of his lifelong challenges and enabling him to articulate these difficulties within the therapeutic context.

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One of the mechanisms underlying the pathogenesis of mental disorders, including endogenous depression, is systemic inflammation. It is of interest to study the immunological aspects of the early stages of endogenous disorders and identify subgroups of patients with immunotypes that characterize a high risk of developing the first psychotic episode.

Comparative analysis of the spectrum of inflammatory markers in patients with a juvenile depression with high and low risk of developing psychosis.

The study involved 98 women 16 to 25 years (20.9 ± 5.14 years) with depression within the framework of various nosologies (F31.3-4; F33.0-1; F60.0-9; F21.3-4; F20.01-2; F25.1). Two groups of patients without a history of psychosis were identified: group 1 (n = 47) - without symptoms of psychosis risk, group 2 (n = 51) - with depression associated with psychopathological symptoms of psychosis risk. The control group consisted of 42 healthy women of the corresponding age. The severity of depressive symptoms was assessed using the HDRS-21, the severity of negative and positive symptoms was determined using the SANS and SAPS. In group 2, the severity of attenuated positive symptoms was determined using the SOPS. The activity of the leukocyte elastase (LE) and α1-proteinase inhibitor (α1-PI), as well as the level of autoantibodies (AB) to S100B and MBP, were determined in plasma.

The groups were characterized by a statistically significant increase in both LE and α1-PI (p<0.05), and the level of AB compared to the control (p<0.05), but no significant differences were found. In group 1, clinical and biological correlations were found between LE activity and the total score on the SANS (r=0,44, p=0.002). In group 2, a negative correlation was found between LE activity and the age of onset of the disease (r=-0.3, p=0.046).

The clustering of patients by LE activity and their distribution by immunological groups showed that 29.4% and 27.5% of patients in groups 1 and 2, respectively, were characterized by a high level of inflammatory markers and the absence of an autoimmune component to neuroantigens, which is a sign of a more favorable course of the pathological process. On the contrary, 70.6% and 72.5% of patients in groups 1 and 2, respectively, were characterized by the type of inflammatory response associated with an increase in the level of AB and varying degrees of insufficiency of the functional activity of neutrophils, which is considered an unfavorable factor that aggravates the course of the disease.

Comparison of the spectrum of inflammatory markers in juvenile depression with different risk of developing psychosis indicate their significant immunological heterogeneity. The immunotype characterized by a high level of AB and insufficient LE activity can presumably be considered as a predictor of the risk of developing psychosis.

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The MAPS-T is a screening instrument currently under development in Brazil, designed for patients over 50 years of age and administered in a computerized format, either online or with assistance. Its purpose is to assess memory binding abilities, which involve integrating complex elements into unified representations, crucial for both short- and long-term memory. Conjunctive binding in short-term memory is responsible for the temporary retention of associations or combinations of features, such as color and shape. Screening instruments like the MAPS-T aim to be low-cost, quick, and non-invasive tools that provide indicators of potential clinical conditions.

To investigate the relationship between performance on memory tasks involving binding and the variables age and educational level.

A total of 33 individuals aged between 50 and 78 years (M=62.09; SD=6.67) with 6 to 35 years of education (M=19.88; SD=5.63) were evaluated. Participants with reported neurological/psychiatric conditions or uncorrected sensory impairments were excluded. Data collection was conducted on a computer by a trained administrator in sessions lasting 15 minutes. The memory binding task required the recognition of a nameable figure and the color and geometric shape surrounding it. Data were analyzed using Spearman’s correlation.

Spearman’s correlation coefficients indicated that age did not show a significant correlation with total recognition, binding score, or dichotomous score (p > 0.05), suggesting that this variable does not have a relevant association with performance in these scores. In contrast, education demonstrated a moderate and significant correlation with total recognition, binding score, and dichotomous score (p < 0.05), suggesting that more years of education are associated with better performance in these areas.

Descriptive Statistics

Education showed a positive and consistent association with performance across all test measures (total recognition, binding score, and dichotomous score). Age, in turn, did not show a significant correlation with these variables, indicating that, in this sample, education is a more important factor than age in explaining performance on the MAPS-T scores, particularly in the binding stage.

None Declared

Affective disorders are in constant rise and they are a serious medical and social problem. All the latest studies suggest that the incidence of affective disorders is about 14%, which makes them one of the most common psychiatric disorders. Because of that, there is a need for alternative forms of treatment of affective disorders.

The main goal of this study is to evaluate the effectiveness of the combined treatment of pharmacotherapy together with the Neurofeedback method in the treatment of affective disorders in adult individuals.

A prospective randomized study including a total of 100 outpatients from University Clinic of Psychiatry in Skopje. The subjects were randomly divided into 2 groups of 50 patients, of which the patients in the study group were treated with a combined treatment that includes the neurofeedback method as an augmentation to antidepressant therapy, while the control group with monotherapy with antidepressant medications. Subjects were examined for 2 months, with evaluation of despressive symptoms 2 weeks after the start of treatment, and then after 1 month, using the following psychodiagnostic instruments: psychiatric interview; short non-standardized socio-demographic questionnaire, CGI, HAMD, HAMA and Beck depression scale.

Patients in the study group, treated with a combined approach of antidepressant therapy and the neurofeedback method, showed a significantly greater reduction in symptoms of depression and anxiety compared to patients in the control group treated with antidepressants as monotherapy. According to the HAMA anxiety scale, the mean score in the study group (SG) decreased by 2.86 points (p<0.0001), compared to a decrease of 0.84 points in the control group (CG) (p=0.0017). On the Beck Depression Scale, the mean score in the decreased by 2.08 points (p<0.0001), compared to a decrease of 0.44 points in the CG (p=0.022). On the HAMD depression scale, the average score in the study group (SG) decreased by 2.42 points (p<0.0001), while in the control group (CG) the decrease was 0.12 points (p=0.63), the CGI scale showed a significant reduction in global symptoms in (SG) (p=0.0035), which further confirms the positive effects of the combined treatment.

The research shows that neurofeedback treatment in addition to pharamcological therapy leads to significant improvement in depressive and anxiety symptoms.

None Declared

Hypertriglyceridaemia as a side effect of antidepressants including venlafaxine and mirtazepine has been described in the literature. A relatively new SSRI, vortioxetine has never been reported to contribute to hypertriglyeridaemia and it is not mentioned in the prescribing information for this agent. Dyslipidaemia is an important risk factor for morbidity in people who suffer with mental illness, most often observed in patients who are prescribed antipsychotic medications. Evidence to date with antidepressant medication is mixed but may represent a clinically relevant additional cardiovascular risk.

This case report explores the possible relationship between Vortioxetine and worsening hypertriglyceridaemia in a patient with depressive illness.

Clinical case report and brief literature review

A 58 year old female, with a history of Recurrent Depressive Disorder was admitted to an acute psychiatric inpatient unit with a relapse in depressive illness with anxious distress and suicidality. Prior to admission, her medications included Mirtazepine 60mg, Duloxetine 120mg and Olanzapine 7.5mg. She had a family history of dyslipidaemia. A blood panel was taken which revealed mildly deranged lipid profile - Total Cholesterol of 7.72mmol/L (Upper limit of Normal - 5.0mmol/L); HDL 1.02mmol/L (ULN - 2.0mmol/L); LDL 5.44mmol/L (ULN - 3.0mmol/L); Triglycerides 2.78mmol/L (ULN - 2.0mmol/L).

The patient’s Duloxetine was switched to Venlafaxine and repeat lipid levels one week later revealed a dramatic rise in triglycerides to 12.16 mmol/L, and then 14.07 mmol/L 2 days later again. Venlafaxine was discontinued in view of these findings with a reduction in serum triglycerides to 11.43mmol/L within 24h.

Vortioxetine 10mg was commenced and the patient’s lipid profile was again repeated with an upswing in triglyceride levels to a peak of 15.4mmol/L within 48h of commencement. Vortioxetine was discontinued and fenofibrate was commenced to treat the patient’s dyslipidaemia due to a risk of acute pancreatitis and atherosclerotic disease. Serum triglycerides reduced to near-normal levels within days.

This case report highlights the risk of dyslipidaemia associated with antidepressant prescribing and identifies vortioxetine as an agent which may contribute to this. This patient had a number of risk factors for developing hyperlipidaemia including co-prescription with olanzapine and mirtazepine which have known metabolic effects, as well as a family history for hyperlipidaemia and a post-menopausal state. However, it was notable that her significant hypertriglyceridaemia was cause by venlafaxine, and exacerbated further by vortioxetine. Cardiovascular risk profiles must always be considered in the psychiatric patient population and we feel that this case report may add to the literature around commonly prescribed antidepressant medications and their contribution to this risk.

None Declared