Traumatic brain injury (TBI) is a rare, yet possible cause of psychosis (Fujii D et al. Psychiatr Clin North Am. 2014; 37(1):113-24), with one of the main challenges being distinguishing between Psychosis secondary to traumatic brain injury (PSTBI) and schizophrenia (SZ).

To discuss the diagnostic challenges in patients with psychosis and history of TBI.

In addition to describing a case report of a male with psychotic symptoms presenting after a severe traumatic brain injury, research was undertaken in PubMed and other databases using the keywords “traumatic brain injury”, “psychosis” and “schizophrenia”.

Our patient is a 36 year-old male who suffered a severe TBI at age 22, with consequent frontal and temporal encephalomalacia. Initially he presented with persecutory delusions, delusional perceptions associated with colors, social isolation and decline in academic performance, which were attributed to Post-Concussion Syndrome. However, these symptoms would remain for years to come, leading to the new diagnosis of SZ, at age 25. This way, he started intramuscular antipsychotic medication, which reduced psychotic symptoms and improved his academic performance. This amelioration, at age 30, led to the belief in another diagnosis: Brief Psychotic Episode (after brain trauma). Consequently a reduction in antipsychotic dosage was tried but a resurgence of psychotic symptoms was observed at age 33, which led to the reintroduction of antipsychotic medication, and the reconsideration of the diagnosis of SZ. When we examined him, at age 36, he presented similar symptoms to those observed after the brain injury, intensified by years without antipsychotics. We also found that he had regular use of cannabinoids since age 16 and that his brother was diagnosed with Schizoaffective disorder.

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PSTBI usually occurs after a TBI with frontal and temporal lesions, and psychotic symptoms like persecutory delusions, with the frontal lesions being a possible explanation for the decline in cognitive function by causing deficits in attention, executive functions and memory (Fujii D et al. Journal of Neuropsychiatry Clinics in Neuroscience 2002;14:130-140). SZ can similarly explain many of the findings presented, like psychotic symptoms, social isolation and decline in cognitive function due to negative symptoms, specially considering the use of cannabinoids and genetic vulnerability present in this patient and the fact that TBI is also a risk factor for the development of SZ. This case highlights the difficulty in the differential diagnosis between PSTBI and SZ, given that it presents aspects that can point in both directions.

None Declared

Social support can significantly influence mental health help-seeking (Rickwood et al., 2005). At MHWS, many patients are older and receiving late diagnoses for ADHD, often after experiencing lifelong difficulties. Research shows that women’s mental health issues are frequently overlooked due to gender biases in healthcare (Kuehner, 2017), with men often underestimating the severity of their partners’ mental health challenges (O’Neil, 2008; Cummings & Davies, 2002). This study explores whether similar patterns of underrepresentation occur in ADHD diagnoses, particularly in relation to observer gender and relationship to the patient.

The study aimed to explore differences in ADHD assessment scores between patients and their observers based on the observer’s gender and relationship to the patient. Additionally, it sought to determine whether the underrepresentation of ADHD symptoms differs based on these variables.

A cross-sectional comparative study was conducted involving 196 patients (123 females, 73 males) and their observers (135 females, 61 males) using the Conners’ Adult ADHD Rating Scales (CAARS). The DSM-IV ADHD Symptoms Total was analyzed by comparing scores between patients and observers. The significance level was set at 0.10 for exploratory purposes. Statistical analyses included the Mann-Whitney U test and Kruskal-Wallis test to explore the effects of observer gender and relationship on the discrepancy in ADHD symptom reporting.

1. 1. Gender of the patient did not influence self-reported ADHD scores (U = 5057.500, p = 0.705), but observer gender significantly impacted their rating of the patient’s symptoms (U = 5312.500, p = 0.032).

2. 2. Female patients’ ADHD symptoms were underrepresented more than male patients’ (U = 3941.500, p = 0.019).

3. 3. Male observers underreported symptoms more than female observers (U = 4772.500, p = 0.075).

4. 4. Observer relationship to the patient did not significantly affect ADHD symptom score discrepancies (H(3) = 4.928, p = 0.177).

5. 5. Female partners were less likely to underrepresent ADHD symptoms compared to female parents, female and male family members, and male partners (p = 0.028, 0.002, <0.001).

Female patients were more likely to have their ADHD symptoms underrepresented, particularly by male observers and male partners, indicating potential gender biases in perception. The findings suggest that clinicians should be cautious of possible underreporting of ADHD symptoms by male observers and particularly male partners. Future research should explore whether hyperactivity or inattentiveness is more frequently underrepresented and further validate these exploratory findings.

None Declared

Based on previous studies, we already know that very preterm birth constitutes an important risk factor for neurodevelopmental disorders and psychopathology.

The present study aims to identify those variables that might impact the neurodevelopment of children born below 32 weeks gestation and 1.5 kg of weight, and their parents, in a three-year follow up.

This is a prospective observational study implemented at Donostia University Hospital between January 2018 and December 2021. Inclusion criteria: newborns with gestational age < 32 weeks and/or birth weight < 1.5 kg, and their parents. Participants were 113 newborns, 87 mothers and 77 fathers. Children’s neurodevelopment was evaluated through the Bayley Scale of Infant and Toddler Development- Third Edition (Bayley-III) at their first, second and third years of life. Parents’ predictive variables, evaluated during the period of time in which their children were hospitalized in the Neonatal Intensive Care Unit (NICU), were parents’ mental health (postpartum depression, anxiety and general symptoms), postnatal bonding, and obstetric variables. To analyze the study’s dependent variables, step linear regression models (cognition, receptive and expressive language, fine and gross motor skills) at first, second and third year were employed.

Parents’ mental health, especially phobic anxiety in fathers and paranoid ideation in mothers, as well as postnatal maternal bonding, significantly predicted neurodevelopmental difficulties in children during their first three years of life. Children’s gestational age at birth and fathers’ obsessive-compulsive symptoms predicted neurodevelopmental difficulties in several models, although not as expected, in a counterintuitive manner. In terms of cognition and fine motor skills, the model’s predictors were not significant at age three.

According to our results, we consider an early mental health intervention for parents of newborns in need of hospitalization at the NICU to be of major importance. This intervention should be implemented during the hospitalization period, focusing on both parents (father included) and addressing bonding issues from a preventive perspective.

None Declared

Evidence regarding metabolic alterations associated with maternal antenatal depression (AD) is limited, and their role as potential biomarkers improving the prediction of AD and adverse child birth, neurodevelopmental, and mental health outcomes remains unexplored.

To identify metabolic measures associated with AD.

To test whether the metabolic measures associated with AD increased the amount of variance explained in AD over its risk factors.

To test whether the identified metabolic measures increased the amount of variance explained in child gestational age and weight at birth, developmental milestones at ages 2.3-5.7 years and any mental or behavioral disorder by the ages of 13.1-16.8 years over AD, sex, and age.

To replicate the findings in an independent cohort.

In a cohort of 331 mother-child dyads, we applied elastic net regression to study associations between AD (history of medical register diagnoses and/or Center of Epidemiological Studies Depression Scale score during pregnancy≥20) and 95 metabolic measures analyzed three times during pregnancy. Child birth and mental health outcomes were extracted from national registers and child neurodevelopmental outcomes were mother-reported.

Elastic net regression identified 15 metabolic measures that collectively explained 25% (p<0.0001) of variance in AD, including amino and fatty acids, glucose, inflammation, and lipids. These metabolic measures increased the variance explained in AD over its risk factors (32.3%,p<0.0001 vs. 12.6%,p=0.004), and in child gestational age (9.0%,p<0.0001 vs. 0.7%, p=0.34), birth weight(9.0%,p=0.03 vs. 0.7%, p=0.33), developmental milestones at the age of 2.3-5.7 years(21.0%,p=0.002 vs. 11.6%,p<0.001) and any mental or behavioral disorder by the age of 13.1-16.8 years(25.2%,p=0.03 vs. 5.0%,p=0.11) over AD, child sex and age. These findings replicated in the independent cohort.

AD is associated with alterations in 15 metabolic measures, which collectively improve the prediction of AD over its risk factors, and birth, neurodevelopmental and mental health outcomes of the child over AD. These metabolic measures may become biomarkers identifying at-risk mothers and children for personalized interventions.

None Declared

Electroconvulsive Therapy (ECT) is a proven treatment for treatment-resistant depression (TRD), especially in elderly patients. Managing depression in this population is challenging due to comorbidities and medication intolerance. Research suggests that factors like melancholic features and early symptom improvement predict a positive response to ECT. ECT offers rapid and sustained antidepressant effects.

To present the case of a 74-year-old woman with TRD who successfully underwent ECT after failing multiple medications.

A literature review was conducted on ECT for TRD in elderly patients. The clinical case is detailed, focusing on treatment, ECT application, and outcomes.

The patient had a history of severe depressive episodes. Previous hospitalizations were managed with tricyclic antidepressants, lithium, and olanzapine. However, lithium was discontinued after discharge due to subclinical hypothyroidism and renal function impairment. Although the patient remained stable for a time, her mood progressively worsened, leading to a marked decline in daily functioning and eventual admission to the psychiatric unit. Upon admission, the patient presented with severe depression, including loss of functionality, self-neglect, and passive suicidal ideation, hyporeactive state, significant vegetative symptoms, and moderate-to-severe anxiety. Given the lack of response to a comprehensive pharmacological regimen, ECT was initiated. The patient underwent six sessions of ECT, with initial improvements observed after the first session. By the third session, she showed marked improvements in mood, energy, and anxiety levels. By the end of the ECT course, she had regained full functionality and emotional stability.

This case underscores the effectiveness of ECT in managing psychotic depression in elderly patients when pharmacological treatments are ineffective or poorly tolerated. The patient’s rapid response aligns with previous findings suggesting that early symptom improvement predicts favorable ECT outcomes. Additionally, the presence of melancholic features may have contributed to the success of ECT, as described in the literature. Given the patient’s history of lithium intolerance and multiple pharmacological failures, ECT emerged as the most viable treatment option. ECT also demonstrated long-term benefits.

This case also highlights the importance of considering ECT earlier in the treatment process for elderly patients and demonstrates the crucial role of ECT in achieving rapid and sustained recovery in elderly patients with psychotic depression resistant to pharmacological treatments. Early intervention with ECT was essential for the patient’s full functional recovery, reinforcing its value as a therapeutic option in severe, treatment-resistant cases.

None Declared

It is well known that alcohol has a variety of pathologic effects on hematopoiesis. Long term alcohol abuse result in a significant suppression of both the production of blood cells and structural changes in precursors, namely the suppression of their maturation, up to pancytopenia. We first demonstrated the immunomodulatory properties of a synthetic GABAA-R ligand, meta-chlorobenzhydrylurea (m-CBU). We also showed that splenic lymphocytes modulated in vitro by m-CBU after intravenous administration to syngeneic long-term alcoholized recipients have a positive effect, manifested in the editing of behavior characteristic of alcoholism against the background of stimulation neuroplasticity and reduction of neuroinflammation.

The purpose of this work was to study bone marrow hematopoiesis and peripheral blood parameters in long-term alcoholized recipients after transplantation of syngeneic lymphocytes modulated in vitro by m-CBU.

Male (CBAxC57Bl/6)F1 mice with 6-month 10% ethanol exposure were undergoing the transplantation of syngeneic long-term alcoholized mice lymphocytes, pretreated in vitro with m-CBU. The number of bone marrow hematopoietic progenitors and cellular composition of the blood were assessed in the recipients.

Long-term alcoholization in mice led to a decrease in the colony-forming activity of hematopoietic precursors, mainly erythroid; in the peripheral blood of mice, a significant decrease in the number of erythrocytes, leukocytes, lymphocytes and platelets was recorded, while the population of segmented neutrophils significantly increased. Lymphocytes, precultured with m-CBU, in syngeneic long-term alcoholized recipients had a corrective effect on a number of hematopoietic parameters (colony-forming activity of erythroid precursors in the bone marrow, the number of erythrocytes, segmented neutrophils and lymphocytes in the peripheral blood) to indicators comparable to those in intact mice of the corresponding with tendency to increase the number of platelets in the peripheral blood.

The data obtained may indicate the effectiveness of m-CBU -modulated lymphocytes transplantation in correcting a number of changes in hematopoiesis provoked by long-term alcohol abuse.

None Declared

Several challenges exist rendering people with mental disorders particularly vulnerable to wrongful assisted suicide. Their desire to die may be a symptom of the mental illness rather than an autonomous choice; their decision-making competence may be compromised by the illness and hence more troublesome to determine; the severity of suffering may be more challenging to assess from an external perspective; the very wish to die may be variable over time; and prognostic uncertainty in mental illness may impede determining of whether severe suffering is, in fact, resistant to treatment. An ethically sound argument for excluding people with mental disorders from assisted suicide is their potential inability to make a free, autonomous decision. A person’s request for assisted suicide should be considered in the context of an assessment of their capacity to make a well-informed and deliberated decision. Opponents of legalising euthanasia and assisted suicide agree that the suffering caused by mental illness can be just as severe and agonising as in cases of somatic conditions. However, one cannot with all certainty assume that the illness is incurable and that the suffering cannot be minimised to such an extent that the patient experiences relief. The task of psychiatry is to prevent suicide. What follows is that diseases such as depression should be treated, while the patients should be supported and not facilitated to part with their lives. Considering their potentially illness-affected request for suicide, it seems better to prolong their suffering than let them die. One cannot grant the right to die to all those who have the competence to make decisions. Furthermore, legalising euthanasia and assisted suicide also in the case of patients with mental illnesses risks distorting the doctor-patient relationship. Euthanasia is not a balance between the interest of the state and the benefit of the individual in terms of choosing the time and manner of their death. What happens if the interest of the state is not to protect the lives of citizens, especially the most vulnerable and defenceless, including the mentally ill? Once values are rejected, only practical ‘benefits’ remain, such as financial savings on psychiatric care and treatment. And this is extremely risky. Drawing a clear line in the light of the above considerations seems to be impossible. In the current situation, where many people are exposed to mental suffering, e.g. in the form of depression, the priorities are suicide prevention policies and funding programmes for psychiatric treatment. The debate will take into account arguments for and against euthanasia in patients with mental disorders.

None Declared

Detailed knowledge on prognostic predictors and illness trajectories of many mental disorders, especially schizophrenia spectrum disorders, is needed towards implementation of more personalized treatment.

A potential candidate to predict prognosis and illness trajectories is self-disorders. Self-disorders are non-psychotic symptoms that seem to be present years prior to illness onset and to persist after remission from psychotic episodes. Self-disorders describe a fundamental disturbance of consciousness and can be assessed with the Examination of Anomalous Self-Experiences (EASE) scale.

We know from previous studies that self-disorders are non-psychotic symptoms central to schizophrenia spectrum disorders.

The purpose of this study is to examine if self-disorders are related to clinical and functional outcome as well as illness trajectories and life courses.

We will test if high levels of self-disorders at baseline predict worse outcome in terms of psychopathology, social function, recovery, more malign illness trajectories and life courses for the individual patient.

Additionally, we will examine if self-disorders remain stable over a period of 25 years.

This ongoing study is a 25-year follow-up study of a cohort of 151 first-admission patients, comprising 51 patients with schizophrenia, 50 patients with schizotypal disorder, and 50 patients with other mental disorders (including bipolar disorder, major depression, anxiety, and personality disorder).

This cohort is the oldest and largest sample in the world that has been assessed for self-disorders. By combining psychosocial and psychopathological history as well as psycho-diagnostic assessments and tests at follow-up examination, with information from the Danish registers, we will obtain as complete a picture as possible of the patients and their illness trajectories and life courses. This will not only be at the point in time of the follow-up, but throughout the last 25 years and gain further knowledge about self-disorders over time. For assessments of psychopathology we will use semi-structured interview using EASE as well using OPCRIT, PANSS, GAF-S and parts of the Bonn Scale for psycho-diagnostic. Social functioning will be measured using the Personal and Social Performance scale (PSP) and GAF-F.

Ongoing study, results are pending.

Ongoing study.

None Declared

Schizophrenia is a complex, chronic psychiatric disorder marked by disruptions in thought processes, perception, social interactions, and emotional regulation. Despite various therapeutic options, 20–34% of patients develop treatment-resistant schizophrenia (TRS)¹, a condition associated with a poor prognosis and significant challenges in clinical management. Early identification of predictive factors for treatment resistance may enable more targeted interventions, ultimately improving patient outcomes by allowing for tailored treatment approaches.

This study aims to identify early predictive factors for the progression to TRS, differentiate modifiable from non-modifiable factors, and determine prognostic indicators for schizophrenia. The goal is to facilitate early intervention for high-risk cases and prevent TRS by targeting modifiable factors.

This is a descriptive and an analytical retrospective study including patients diagnosed with TRS according to NICE criteria, treated with Clozapine, and hospitalized at the Ar-Razi Psychiatric Hospital in Salé between 2022 and 2024. Included cases meet specific criteria, such as complete clinical records and the need for Clozapine treatment, with no age restrictions. Sociodemographic, clinical, evolutionary, and therapeutic data are collected using Excel and analyzed using SPSS 20 software.

Among the 126 TRS cases included, several risk factors were identified. Non-modifiable factors include age, family history, and the presence of negative symptoms, while modifiable factors include the duration of untreated illness and certain comorbidities.

The results of this study provide valuable insights into risk factors associated with TRS and guide specific management and prevention strategies for this subgroup of schizophrenia patients.

None Declared

Despite the number of medications considered as effective in the treatment of bipolar disorder (BD), incomplete response to treatment is very prevalent (Perlis et al. Am J Psychiatry 2006;163(2):217-24). Existing evidence supports the effectiveness of clozapine for treatment-resistant BD (TRBD) with clinical guidelines recommending clozapine as a third-line treatment (Yatham et al. Bipolar Disord. 2018;20(2):97-170). There is evidence to support that a shorter delay before clozapine initiation is associated with a better response to this treatment (Griffiths et al. Psychol. Med. 2021;51(3):376-86).

This study aimed to identify clinical and sociodemographic characteristics at the time of the first bipolar diagnosis associated with future clozapine treatment.

We performed a population-based cohort study using nationwide data from Danish registries to investigate factors associated with initiation of clozapine treatment in incident BD. Cox proportional hazard regression analyses were used to investigate associations between patients’ characteristics at the time of the diagnosis of BD and a subsequent redemption of a prescription for clozapine, yielding hazard rate ratios (HRRs).

We identified a total of 29,696 patients registered with their first (incident) ICD-10 diagnosis of BD between 1999 and 2019, of whom 102 (0.3%) received clozapine treatment during follow-up. The median age at the first prescription of clozapine was 48.6 years (25-75 percentile: 37.7-59.9).  The multivariable Cox proportional hazards regression model showed that a prior diagnosis of psychotic disorder (other than schizophrenia or schizoaffective disorder) (HR: 2.10; CI: 1.13-3.93), having had three (HRR: 2.91; CI: 1.23-6.87), four (HRR: 2.89; CI: 1.15-7.24) or five or more (HRR: 3.17; CI: 1.19-8.44) previous psychopharmacological treatments prior to the diagnosis of BD, and being outside the labour force (HRR: 2.58; CI: 1.42-4.66) were positively associated with clozapine treatment after controlling for the remaining variables.

The results of this study suggest that there are clinical characteristics associated with subsequent clozapine treatment already at the time of diagnosis of BD. These findings may guide targeted interventions, such as an earlier initiation of clozapine treatment.

E. Salagre: None Declared, C. Rohde: None Declared, S. Østergaard Shareolder of: Dr. Østergaard reports ownership of units of mutual funds from companies with the stock tickers DKIGI, IAIMWC, SPIC25KL, and WEKAFKI; ownership/past ownership of units of exchange-traded funds with the stock tickers BATE, TRET, QDV5, QDVH, QDVE, SADM, IQQH, USPY, EXH2, 2B76, IS4S, OM3X, and EUNL during the conduct of the study, Grant / Research support from: Dr. Østergaard reported receiving the 2020 Lundbeck Foundation Young Investigator Prize; and grants from the Novo Nordisk Foundation (NNF20SA0062874), Lundbeck Foundation (R358-2020-2341 and R344-2020-1073), Danish Cancer Society (R283-A16461), Central Denmark Region Fund for Strengthening of Health Science (1-36-72-4-20), Danish Agency for Digitisation Investment Fund for New Technologies (2020-6720), and Independent Research Fund Denmark (7016-00048B and 2096-00055A) outside the submitted work

Gambling disorder (GD) can be defined as the maintenance of gambling behavior despite its negative impact both on the health, social, work and financial aspects of one’s life, with growing importance over other interests, loss of control over this behavior and an intense need of maintaining it. In the last decades, the prevalence of GD has been increasing, while it remains an underdiagnosed and undertreated disorder. Regarding scratch tickets (ST), Portugal is the European country with the biggest per capita spending, more than doubling the European average, with 150€ spent annually.

We report the case of a woman with GD and aim to briefly discuss the most recent evidence on this subject.

Description of clinical case and brief review of the literature on the subject.

G. is a caucasian 66-year-old woman without past psychiatric history. Her first contact with ST happened in 2016, when she started working at a kiosk and spent around 1€/day. In 2017, after going through a divorce, her gambling habits worsened, spending around 70€/day. She spent most of her income on gambling and started developing depressive symptoms. By the end of 2020, she is put in a medical leave of absence and starts seeing a therapist. To better control her spendings, her daughter is appointed as her bank account holder, but the patient relapses a week after returning to work, having contracted a loan to keep up with her addiction. She maintains this behavior until 2023 when she is referenced to a Psychiatry appointment and starts treatment, including individual psychotherapy sessions and weekly Gambling Anonymous meetings. In January 2024, G. joins an in-hospital patient group for gambling addicts and decides to retire, to distance herself from the environment that potentiates her addiction. She is now in remission and has been abstinent from gambling for over a year. She still has occasional thoughts about gambling as well as craving to gamble, but all other psychiatric symptoms have resolved, and she has been discharged from Psychiatry appointments.

The average ST gambler is middle aged, plays weekly and earns less than minimum wage, with the chance of gambling decreasing drastically if monthly wage is >1500€. Additionally, service workers are 55% more likely to gamble ST when compared to their counterparts. With the lack of regulation, growth in publicity and the possibility of anonymity, the prevalence of GD is growing, becoming essential that we detect this disorder promptly so that a multidisciplinary treatment can be implemented.

None Declared

Recent events in Tunisia have highlighted the severe challenges faced by young doctors, including high stress levels, burnout, and mental health issues.

This study aims to shed light on the often-invisible realities of the medical profession in Tunisia by exploring the impact of working conditions and health policies on the mental health of young doctors.

This multicentric cross-sectional study collected data from 385 interns and residents working in four main university hospitals in Tunisia. The questionnaire included sections on sociodemographic characteristics, satisfaction with working conditions, burnout symptomatology (MBI), and anxiety and depressive symptomatology (HADS).

Most respondents (82.6%) were aged 25-29, with 73% being women. Most participants (83.1%) were residents. The study \revealed widespread dissatisfaction with working conditions, including remuneration (82% dissatisfied), days off and rest periods (73% dissatisfied), and overall working conditions (78% dissatisfied).

The average emotional exhaustion score was 31.883 (SD=10.2), indicating a high degree of burnout. Depersonalization scores averaged 10.176 (SD=6.3), and personal accomplishment scores averaged 23.838 (SD=8.7). The mean anxiety score was 8.776 (SD=4.2), and the mean depression score was 7.774 (SD=3.9), indicating moderate levels of anxiety and depressive symptoms.

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The results paint a concerning picture of the mental health status of young doctors in Tunisia, with high levels of burnout, anxiety, and depression strongly correlated with poor working conditions and work-life imbalance. These findings highlight the urgent need for comprehensive reforms in the Tunisian healthcare system, including policy changes, organizational support, and improved medical education. Limitations include the cross-sectional nature of the study and potential self-reporting bias. Future longitudinal studies are needed to understand the long-term impacts of poor working conditions on physician mental health and career trajectories.

None Declared

Previous research has demonstrated a relationship between work-related stigma during the COVID-19 pandemic and posttraumatic stress disorder (PTSD). Whilst it is possible that shared social characteristics explain the link between stigma and PTSD, this article hypothesizes that work-related stigma is itself associated with symptoms of PTSD.

This study examined whether work-related stigma was associated with PTSD symptoms one year after the onset of the COVID-19 pandemic in a sample of French healthcare workers (HCWs).

Data were based on an online survey that recruited HCWs working during the first wave of the COVID-19 pandemic. The presence of PTSD symptoms was assessed using the Posttraumatic Stress Disorder Checklist (PCL-5) with a cut-off score of ≥33. Work-related stigma was defined as the perception of having been treated differently and unfairly because of one’s profession.The relationship between work-related stigma and PTSD symptoms was tested using propensity scores including all relevant confounding factors: financial and social support, and work-related,or pandemic-related factors.

Among the 655 respondents, 71.6% were physicians, 11.1% were nurses, and 17.3% had other occupations. A total of 53 participants (8.7%) presented symptoms of PTSD. We found an association between work-related stigma and PTSD symptoms (OR 2.13, 95% CI [1.04;4.35]) one year after the onset of the COVID-19 pandemic adjusted for propensity scores including relevant confounding factors.

Our findings suggest that work-related stigma is associated with PTSD symptoms among HCWs. This association was independent of social characteristics known to influence both stigma and PTSD. Work-related stigma may be a propitious occupational risk factor to target in order to improve HCWs work conditions and mental health.

None Declared

Stress is one of the biggest problems facing teachers today. The increasingly demanding nature of their job has also increased pressure levels dramatically. Research shows that teachers are now facing greater day-to-day problems with occupational stress than most other employees.

Determine the prevalence and the caracteristics of the occupational stress among teachers.

This is an exhaustive cross-sectional study carried out among the teachers of a private teaching group in the city of Sousse in Tunisia between October and December 2022. The data were collected using an anonymous questionnaire in electronic format ‘Microsoft Forms’ distributed by e-mail. The questionnaire included socio-professional and medical data. Ocuupational stress was assessed using the Karasek questionnaire.

A total of 241 questionnaires were included, representing a response rate of 90.14%. The mean age of the teachers in this study was 39.98 ± 9.14 years, with a predominance of females (56.8%) and a sex ratio (M/F) of 0.75. In this private teaching group, there were 181 higer education teachers (75.1%) and 60 school teachers (24.9%).The average seniorty in this educational group was 3.49 ± 2.95 years. Participants worked an average of 4.88 ± 1.49 hours per day and 16.92 ± 7.39 hours per week. The majority of respondents had no medical (82.6%) or surgical (71.8%) co-morbidities. Only 10 (4.1%) teachers were anaemic, 6 (2.5%) were hypertensive and 4 (1.7%) were diabetic. More than half (55.6%) of the teachers had a BMI above the normal range: 102 participants were overweight (42.3%) and 32 (13.3%) were obese. As for lifestyle habits, 12.9% of teachers were smokers, 9.5% drank alcohol and 34.4% practised a sporting activity. Referring to Karasek’s two-dimensional model, 59 (24.5%) of the 241 teachers were classified in a situation of <<Jobstrain>>associating: low latitude and high professional demands. By completing this model with the third dimension of social support at work, 35 (14.5%) of the 241 teachers were classified in a situation of <<Isostrain>> combining low latitude, high professional demands and low social support.

Action to improve work organisation and support for teachers would be necessary to prevent the occupational stress.

None Declared

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

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

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

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

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

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

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

None Declared

Previous studies have shown that neuroinflammation can play a significant role in the pathogenesis of schizophrenia. The search for inflammatory markers in late-onset schizophrenia are very important for diagnostics.

Determination of inflammatory markers in the peripheral blood plasma of patients with late-onset schizophrenia in relation to the clinical characteristics of patients.

The study included 46 patients with schizophrenia aged 61 [56; 69] years (2 men and 44 women); the age of disease onset was 51 [45; 60] years. The severity of mental disorders was assessed using the PANSS scale, and cognitive impairment was assessed using the MMSE and MoCA scales. The control group consisted of 77 people comparable in age with the patients (p=0.16). A spectrophotometric method was used to determine inflammatory markers (enzymatic activity of leukocyte elastase (LE), functional activity of α1-proteinase inhibitor (α1-PI)). The protease inhibitory index (PII) was calculated - the ratio of LE and α1-PI activity, indicating the direction of the inflammatory process. Comparative data analysis was performed using the Statistica 10.

The 1st cluster (22 patients (47.8%)) was characterized by a significantly increased α1-PI activity (p=0.000), decreased LE activity (p=0.000) compared to the control values, and, accordingly, a low PII value (p=0.000), which is an unfavorable prognostic factor for further development of the disease and response to therapy. A 28-day course of therapy with 1st and 2nd generation neuroleptics didn’t change the immunological parameters in patients of this cluster. In this cluster, a positive correlation was found between LE activity and scores on the MMSE (r=0.512, p<0.05) and MoCA (r=507, p<0.05) scales at the start of treatment, i.e. the lower score on the cognitive functioning scales and the more severe the disease correlate with lower the LE activity.

The 2nd cluster (24 patients (52.2%)) was characterized by a significant increase in inflammatory markers, LE and α1-PI activity (p=0.000, p=0.000, respectively) in relation to the control parameters, while the PII value didn’t differ from the control. In this group, paranoid and schizotypal personality were significantly less common in the premorbid period (41.6% of cases), and formal thinking disorders were expressed to a lesser extent. No clinical and immunological relationships were revealed. A 28-day course of therapy influenced the change in immunological parameters towards their relative normalization.

The obtained results confirm the involvement of the inflammatory link in the development of late-onset schizophrenia, as well as the heterogeneity of the patient group in terms of clinical and immunological parameters. Evaluation of the spectrum of inflammatory markers allows us to identify patients with an unfavorable course of the disease and resistance to therapy.

None Declared

Systemic lupus erythematosus (SLE) is an autoimmune disorder characterized by a wide range of symptoms, including neurological and psychiatric symptomatology. Between 37 and 95% of SLE patients present psychiatric symptoms, which can appear at any point in the disease and may present in various forms, ranging from more common conditions like depression and anxiety to rarer manifestations such as psychosis and catatonia (Carrión-Barberà et al. Autoimmunity Reviews 2021;20:102780).

To describe the case of a patient who presented a SLE debut with catatonic symptoms and to review neuropsychiatric and specifically catatonic symptoms in SLE patients.

We present the case of a 32-year-old woman with no previous psychiatric history who was brought to our psychiatry emergency department (PED) for difficulties in language emission, only being able to babble for the last days. Approximately two weeks ago she had started to present anxiety, insomnia and catastrophic thoughts, so she consulted a psychiatrist who recommended starting escitalopram up to 15mg/d. In the next days she started to present difficulties of speech which worsened. Upon arrival, several diagnostic tests were performed including blood tests, CT scan, lumbar punction and electroencephalogram, showing no abnormalities. However, since the symptoms did not improve she was hospitalized for diagnostic affiliation.

During her hospitalization, more diagnostic tests were performed, including brain MRI and more exhaustive blood tests with autoimmunity profile, although the results were not available until several days later. Although the diagnosis was not yet clear and there were doubts among psychosis, neurologic functional disorder and organic mental disorder, several drugs were started including corticotherapy and olanzapine 15mg/d, venlafaxine up to 150mg/d and clonazepam 2.5mg/d with partial improvement of the symptoms, still showing motor retardation, blocking, perplexed gaze and mutism. In parallel, blood tests results emerged, showing high titre ANA antibodies, positive anti-double-stranded DNA and anti-Sm antibodies and decreased complement C3 component. With these findings, the diagnosis orientation was systemic lupus erythematosus (SLE).

Catatonia is a rare psychomotor syndrome that can be associated with SLE. Given its rarity, there still no standardized treatment for it in SLE patients, although some options have been proposed including, as in any other SLE manifestations, flare immunosuppressive at high doses and in these patients, the usual psychiatric management (Boeke et al. Psychosomatics 2018;59:523-530; Sundaram et al. Rheumatology Journal 2021;42:1461-1476) Clinicians should keep this in mind to correctly diagnose and treat these patients, since early identification of this syndrome and prompt treatment leads to a more favorable outcome.

None Declared

The general population’s views on marrying individuals with bipolar disorder are shaped by a combination of personal experiences, cultural beliefs and media portrayals, and this emphasize the challenges for successful, supportive relationships among them.

To explore these perceptions we performed a qualitative analysis of public attitudes toward marriage in individuals with bipolar disorder.

A cross-sectional study was carried out using a convenience sampling approach among the general population. The survey was distributed through social media platforms and, in addition to collecting socio-demographic and clinical data, it provided a detailed account of the symptoms and outcomes associated with bipolar disorder. It also included open-ended questions aimed to evaluate perceptions of the potential advantages and disadvantages of being in a relationship with someone who has bipolar disorder. The responses were analyzed, and common themes reflecting public opinion were identified.

A total of 304 participants, mostly aged between 20 and 30, were included, with women making up 80.9% of the group. The majority held a university degree. A family history of psychiatric conditions was reported by 35.6% of the participants, and 23.35% mentioned living with someone who has a psychiatric disorder. Additionally, around 87% of the participants acknowledged having consulted a psychiatrist at least once in their lifetime.

Responses regarding potential disbenefits of being married to a patient with bipolar disorder included 9 themes. The most representative ones were 1) the fear of dealing with mood swings and recurrent mood episodes (10.2%); 2) the impossibility of having a stable relationship (7.2%), 3) the risk of physical and/or verbal violence (6.4%); 4) the elevated risk of separation (4.6%); and 5) the risk of suicide (3.9%). Other themes included concerns about 6) transmitting the pathology to their descendants; 7) dealing with a partner who refuses treatments; 8) having an irresponsible companion; and 9) facing financial problems.

About 8.9% of the participants stated that they were willing to get married with a patient with bipolar disorder in order to help him survive his illness; 6.2% of them qualified him as intelligent and affectionate; and 5.2% considered manic episodes as an opportunity to alter routine.

Public perceptions of marriage with individuals with bipolar disorder are shaped by a complex interplay of stigma, fear, and misinformation. While negative stereotypes are prevalent, there is also a recognition that with the right support, successful marriages are possible. Addressing the knowledge gaps and promoting empathy are crucial steps in reducing stigma and supporting individuals with bipolar disorder in their personal and marital lives.

None Declared

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

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

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

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

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

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