Autism spectrum disorders (ASD) are developmental deviations that cause social, communication and behavioral problems. Valproic acid (VPA) works as an inhibitor of histone deacetylases. One of the presumed causes of ASD development is neuroinflammation. A low-grade inflammatory process in nervous tissue can cause serious disorders, leading to the death of neurons, impaired myelination and anatomical and biochemical changes in brain structures. Currently, there are known inflammatory markers that are detected in the blood and used to assess the level of inflammation in the brain, for example, leukocyte elastase.

To investigate the effect of postnatal administration of VPA on the behavioral manifestations of ASD and the activity of leukocyte elastase in blood serum in male white rats.

The study was performed on male rat pups. The conditions for keeping animals and the experimental procedures used were approved by the Bioethics Commission of Moscow State University (registration No. 12.3 of 17.11.2022). The animals were administrated intraperitoneally with water (H2O) or VPA at a dose of 150 mg/kg from the 6th to the 12th day of life. The study used standard behavioral tests: weight monitoring from 6-12 days of life, “Social behavior” in the sibling/stranger modification on 55 day. The animals were decapitated on the 57th day. Blood was collected into tubes with serum separating gel (BD Vacutainer® SST™II Advance), centrifuged at 2000 g, serum was frozen -78°C. The activity of leukocyte elastase in blood serum was measured spectrophotometrically by the rate of hydrolysis of the substrate BOC-Ala- ONp (Biomedical, Inc.).

An important physiological indicator for ASD in the model used is a slowdown in weight gain. As a result of the study, it was revealed that the weight of males after 6 days of VPA administration was lower compared to control individuals (p = 0.003). In the “Social Behavior” test, in males who received VPA, the latent period for leaving the starting compartment was significantly longer than in the control (p = 0.019); also, experienced males later approached a stranger as if they were a stranger (p = 0.037), compared to controls. In this study, the activity of leukocyte elastase in the rat’s blood serum receiving VPA was significantly higher than in control individuals (p = 0.04). Similar deviations are observed in patients with ASD.

These results allow us to conclude that the administration of valproic acid to rats in the early postnatal period causes changes in physiological and behavioral characteristic typical for ASD. This confirms the validity of the created experimental model. The increase of leukocyte elastase activity in the rat receiving VPA indicate the role of inflammation in pathogenesis of ASD.

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Perinatal mental illness refers to all psychiatric disorders that occur during pregnancy and up to one year after childbirth. For a long time, pregnancy was believed to be a protective factor for women, representing a period of emotional well-being. However, research has shown that pregnancy does not shield women from the onset or persistence of psychiatric disorders. Instead, it poses a risk factor. The mother’s mental state directly influences the cognitive, emotional, behavioral, and physical development of the child. Mothers experiencing mental health issues during this critical period may struggle with bonding with the baby, and these difficulties might persist even after the resolution of the triggering mental disorder. Hence, early diagnosis and treatment are crucial.

The objective of this study is to review the available evidence on mental disorders in the peripartum period, focusing on the most common ones (postpartum blues, postpartum depression, and postpartum psychosis). Additionally, we will discuss data regarding the most severe consequences, such as maternal suicide and filicide.

A systematic literature review was conducted, analyzing documents published in various scientific journals with online publications.

The prevalence is high; depending on the studies, between 15-20% of women experience some form of treatable pathology during pregnancy and postpartum. We will discuss postpartum blues, postpartum depression, and postpartum psychosis. Postpartum blues are characterized by transient mood disturbances (spontaneous relief within 2-3 weeks) occurring between the first day and the third week postpartum. Symptoms include emotional lability, episodes of crying, sadness, anxiety, irritability, fatigue, and mild depressive mood. Postpartum depression is a clinical syndrome characterized by moderate to severe depressive symptoms lasting longer than postpartum blues and significantly impacting family life. It begins within the first 4 weeks after childbirth, although some studies date it between 6-7 weeks postpartum. Prevalence ranges from 5-15%. The term postpartum psychosis refers to an acute psychotic episode starting between 4-6 weeks after childbirth. Its prevalence in the general population is 0.1-0.2%, rising to 20-25% in individuals with personal or family history of affective disorders.

Perinatal mental disorders are a public health problem with high prevalence, associated with complications in maternal health, pregnancy, neonatal outcomes, mother-infant bonding, and neonatal neurodevelopment. The perinatal period increases the risk of relapses in women with severe mental disorders and the onset of mental disorders.

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Non-suicidal self-injury (NSSI) refers to the deliberate act physical harm without intent of suicide. Common forms of NSSI include cutting, burning, and hitting oneself. The prevalence of NSSI among college students have been estimated to be between 15% to 25%.and higher than in the general population. Investigating patterns associated neurobiological and personality traits may provide a more comprehensive understanding of NSSI.

We aim to identify latent trajectory classes for NSSI behavior among college students. We expect that baseline personality and the behavioral inhibition/activation scales (BIS/BAS) will predict NSSI trajectory.

A total of 704 first-year university students at University of Victoria, Canada, were recruited in the beginning of the first semester over two consecutive academic years. Participants attended a baseline testing session completing self-report measures including the Ten Item Personality Inventory, BIS/BAS and NSSI instruments. There were monthly follow-up sessions from October to April. Longitudinal data will be analysed with latent growth curve modeling and group-based trajectory modeling, and baseline predictors will be analysed with multivariate logistic regression.

Latent class growth analysis found three distinct classes of NSSI during the follow-up period. A small percentage (2.4%) of the participants had a high degree of self-injury throughout the follow-up period. A second class of 13.4% of the participants had a moderate degree of self-injury at baseline, which fell throughout the follow-up period. Lastly, a third class of the majority of the participants (84.3%) had minor or none self-injury both at baseline and in the follow-up period. Concerning baseline predictors, higher openness and BAS drive were associated with lower NSSI at baseline.

In line with previous studies, we identified three distinct trajectories of NSSI behavior among college students. Notably, low openness and low BAS drive were associated with a degree of NSSI at baseline. These findings suggest that openness and drive may play a protective role in NSSI, providing valuable insights for future prevention and intervention efforts. The project is part of the Collaborative Research Program at the International Society for the Study of Self-Injury.

None Declared

Bipolar disorder (BD) is commonly comorbid with other psychiatric conditions, such as obsessive-compulsive disorder (OCD). Despite increasing interest in this comorbidity, quantitative data on its clinical characteristics remain limited. This systematic review and meta-analysis aimed to evaluate the clinical impact of OCD comorbidity in BD by comparing individuals with BD and OCD (BD-OCD) to those with BD without OCD.

We systematically searched the PubMed/MEDLINE, Scopus, PsycINFO, and Web of Science databases up to April 15, 2024. Meta-analyses were conducted to compare BD-OCD and BD without OCD groups across multiple clinical domains.

From 11,959 initial records screened, 26 studies were included in the qualitative synthesis, with 22 eligible for meta-analysis. Individuals with BD-OCD showed higher odds of experiencing chronic mood episodes (OR = 9.42; 95%CI = 2.23, 39.9), rapid cycling (OR = 1.92; 95%CI = 1.04, 3.53), comorbid eating disorders (OR = 3.37; 95%CI = 1.99, 5.7), panic disorder (OR = 3.3; 95%CI = 2.11, 5.2), substance use disorders (OR = 1.39; 95%CI = 1.02, 1.89), and lifetime suicide attempts (OR = 1.85; 95%CI = 1.21, 2.84). Additionally, they presented earlier onset of BD (SMD = -0.27; 95%CI = -0.52, −0.01) and reduced functioning (SMD = -0.42; 95%CI = -0.59, −0.24). Most data were derived from adult populations, limiting the evidence available for children and adolescents.

BD-OCD presents a more severe and complex clinical profile, requiring specialized assessment and integrated treatment approaches. Identifying these features may support earlier recognition and inform personalized interventions for this population.

One of the quality statements for the treatment of psychosis in adults refers to the provision of education programmes for carers (NICE QS 80 2015). Our Early Intervention in Psychosis Service (EIS) in South London offered individual support for carers, but there was a need for a structured psychoeducational group for carers.

1. 1. The development of a psychoeducational and support programme for carers. 2. A reduction on carers’ experience of burden, as measured by a reduction on the Brief Experience of Caregiving Inventory (BECI). 3. An improvement on the carers’ wellbeing, as measured by an increase on the Warwick-Edinburgh Mental Well-being Scale (WEMWBS).

The team used the materials created by the University of Lancaster in REACT (Lobban et al. BJPsych; 2013 203 366-72), and further amended them to reflect the local services, and expand peer support discussions. Sessions were further co-produced with input from team members, and following feedback from participants. Quantitative feedback was obtained before the group and in the end. Qualitative feedback about the group’s experience was elicited at each session.

The group was attended by 7.1 participants on average, with a drop out of 3 participants after the first session. For those participants that completed the group, it was elicited an improvement on the experience of burden associated to caregiving and on wellbeing; please see Table 1 for details. The improvement on BECI included its four subscales: Stigma/Effects on Family, Positive Personal Experiences, Problems with Services and Difficult Behaviours. Qualitative feedback elicited that the participants felt listened to, their knowledge about psychosis and management had increased, and they felt less lonely.

Table 1

A psychoeducational group for carers was well received by participants, and on average they experienced an improvement on the burden associated to caregiving and their wellbeing. Analysis of results was limited due to drop outs, but their feedback included that they did not feel the need anymore for this intervention. Further feedback from participants has contributed to change the sessions’ content based on co-production, and the time of the group to enable attendance.

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Heterogeneity in both the etiology and the phenotypic presentation of autism spectrum disorder (ASD) poses a major challenge to clinical and translational research. Attempts to stratify individuals with ASD have been primarily based on behavioral criteria, but clinical subtyping is blind to the underlying neurobiological mechanisms and has limited predictive value of the forthcoming developmental path. Yet, it is still unclear whether and how atypical brain functional connectivity can account for individual differences across ASD-related symptomatology and behaviors.

The goal of the study was to identify clinically meaningful subgroups of young children with ASD based on distinctive patterns of brain functional connectivity, to better understand the neural substrates underlying ASD heterogeneity.

We combined resting-state EEG data from 4 independent datasets on 541 children with ASD aged 2-12 years to estimate and stratify brain functional connectivity measures. We performed an unsupervised clustering analysis of the cortical network properties, using data-driven similarity network fusion and source-based spectral analysis. We then compared the clinical profile of the identified clusters to define symptom-linked connectivity dimensions.

We identified four subgroups of ASD children with distinct cortical network properties, mainly mapped in the fronto-parietal and precentral cortices for the alpha band, and in the middle temporal cortex for beta band. These four clustered dimensions of functional connectivity were associated to distinctive different clinical symptom profiles, specially with respect to cognitive level, adaptive behavior and motricity.

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Our findings shed light on atypical brain network topology conferring risk for specific phenotypic manifestations of ASD, which may implicate unique underlying neurobiological mechanisms. Cross-validation stability hints at a solid stratification model to challenge ASD heterogeneity. Collectively, the stratification of well-defined neural signatures that give rise to the clinical heterogeneity of ASD has the potential to provide more accurate prognosis and help to select the optimal strategy for therapeutic intervention.

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Prader-Willi syndrome (PWS) is a rare neurodevelopmental and multisystemic disorder. This syndrome is most often caused by paternal deletion or a maternal disomy of chromosome 15. PWS is characterized by hypotonia, hypogonadism, and hyperphagia. Intellectual disability, impaired social skills, emotional regulation, sleep disorders and behavioral problems (tantrums, temper outbursts, obsessive–compulsive symptoms, skin picking) are also present. Autism spectrum disorder, mood disorders, anxiety, and psychosis are common in these individuals. (Bos-Roubos et al. Frontiers in psychiatry 2022; 13 897138).

The aim of the case is providing a review of psychiartric and behavioral problems in PWS.

Clinical case description and literature review on the subject.

We report a clinical case of a 23 year old man who was diagnosed with PWS. Clinical features includes intellectual disability, obesity, scoliosis bracing, probable hypoventilation-obesity syndrome [using non-invasive ventilation], hypercholesterolemia and hypogonadism. He took 3 doses of testosterone in 2017, which had to be suspended due to serious changes in behavior. Behavioral sporadic problems, reactive to the environment, are also present such as impulsiveness, stubbornness, aggressive outbursts, oppositional behavior, self-injuring behavior (placement of foreign bodies in the ear canal), card obsession and suspicious posture. This clinical condition has an impact on PWS relatives and at social level. He was medicated with Paliperidone 9mg; Topiramate 50mg; Clozapine 25mg; Escitalopram 10mg; and Haloperidol 2mg/ml (SOS). Currently, the patient is stable, with little weight gain and sporadic episodes of greater impulsivity without clinical relevance. He has participating in integrated activities at the institution.

The main limitations in adolescence/adulthood are psychiatric and behavioral comorbidities, in association with hyperphagia and intellectual disability, which become more prominent with age. However, these symptoms are highly variable among individuals of different ages. Antipsychotics have been used for management of psychiatric and/or behavioral comorbidities. Other medications have also been used such as antidepressants (SSRI), antiepileptics, mood stabilizers and the response may vary depending on the individual. Weight gain, due to atypical antipsychotics, can be mitigated when food has controlled access. PWS has a major impact on the individual’s social and family environment, which requires an appropriate multidisciplinary strategy. A safe and constant environment as well as behavioral management programs must be ensured. (Butler et al. Current pediatric reviews 2019; 15 207-244).

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Spinal occupational injuries constitute an important health problem affecting workers in their most productive years. The outcomes of these injuries may influence the quality of life of those victims.

Assessing the quality of life among victims of spinal occupational injuries and identifiying the associated factors to physical and mental health.

A cross-sectional analysis was conducted during 9 months (from October 2020) among workers victims of occupational injuries consulting for an Impairment Rating Evaluation. Only those with spinal injuries were included. Socio-professional data and the accident’ outcomes were collected. The assessment of perceived mental health (Mental Component Summary: MCS) and physical health (Physical Component Summary: PCM) by each employee was obtained by the 12-item Short Form Health Survey. Social support was evaluated by the Social Support Scale. The pain was evaluated by a Visual Analogue Scale. Unsuccessful return to work comprises all situations other than a satisfactory return to the same position held before the accident.

A total of 73 injured workers were included, 75.3% were male. The mean age was 42.78± 8.46 years. The mean job seniority was 14.44±7.86 years and the average number of working hours per week was 46.93±5.61 hours. Among the participants, 43.8% had an unsuccessful return to work, 28.1% of them had a low social support. The mean scores for MCS and PCS were 41.17± 11.89 and 29.57± 5.31 respectively.

Factors assocoiated with MCS were : the duration of absence (p=0.008), the rate of Permanent Partial Disability (p=0.025), lhe low social support (p=0.000), working in confection sector (p=0.016) and unsuccessful return to work (p=0.023).

Factors associated with PCS were : The pain score (p=0.002), the duration of immobilisation (p=0.007) and being a laborer (p=0.002). No association was found with age, job seniority, the presence of disc diseases and hospitalisation duration.

Victims of spinal occupational injuries are vulnerable to unfavorable outcomes from work accidents, and hence the need for special efforts to reintegrate them into professional life.

None Declared

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.

None Declared

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.

None Declared

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.

None Declared

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.

None Declared

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.

None Declared

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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