Psychological and behavioural symptoms are an inherent part of neurodegenerative diseases such as Alzheimer’s disease and other dementias or Parkinson’s disease. Despite the growing research on the subject, there are still large gaps in knowledge about their origin, pathophysiology, diagnosis and treatment. In recent years, various initiatives have been carried out in Spain to improve knowledge, especially on the most controversial issues, of various aspects such as Alzheimer’s disease from the point of view of Psychiatry, the use of antipsychotic drugs or depression in neurodegenerative diseases. The presentation will include data on these national initiatives and will address in more detail two studies using Delphi methodology referring to depression in neurodegenerative diseases. The first one addressed depression in the context of Alzheimer’s disease and other dementias in 53 controversial items regarding risk factors, signs and symptoms, diagnosis and treatment. The second one addresses depression in Parkinson’s disease in 49 controversial issues about the aetiopathological mechanisms, clinical features and connections with motor and non-motor symptoms, diagnostic criteria, and therapeutic options. In both cases, in addition to trying to shed light on etiological and clinical aspects, specific advice is provided on the choice of antidepressant treatment and the particularities linked to its prescription.

None Declared

Autoimmune encephalitis (AE) is a neuroinflammatory condition that often presents with psychiatric symptoms, such as psychosis, mood disturbances, and cognitive impairment, mimicking psychiatric disorders like schizophrenia or bipolar disorder. These symptoms frequently appear before neurological signs, complicating diagnosis and delaying treatment. Early recognition of this condition is fundamental to improve patients outcomes.

This review examines the psychiatric manifestations of AE, highlights challenges in differentiating AE from primary psychiatric disorders, and emphasizes the importance of interdisciplinary collaboration.

A nonsystematic review of literature focusing on the psychiatric presentation of AE.

AE often presents with psychiatric symptoms like hallucinations, delusions, agitation, and mood disturbances, frequently leading to misdiagnoses such as schizophrenia or bipolar disorder. In particular, anti-NMDA receptor encephalitis is associated with severe psychiatric manifestations like psychosis. Diagnosis is based on recognizing the rapid progression of psychiatric symptoms, along with seizures or other neurological signs, and confirming the autoimmune cause through specific autoantibody tests. Early treatment is essential to reverse these psychiatric symptoms. However, delayed diagnosis can result in persistent cognitive and psychiatric difficulties even after treatment. Diagnosing the psychiatric manifestations of AE is challenging due to their overlap with primary psychiatric disorders. However, the rapid onset and progression of symptoms, combined with neurological signs, should prompt clinicians to consider an autoimmune origin. Autoantibodies, particularly those against NMDA receptors, disrupt neurotransmitter systems, explaining the psychiatric features of AE. While psychotropic medications may provide temporary symptom relief, they do not target the underlying immune dysfunction. Timely immunotherapy significantly improves outcomes, and multidisciplinary collaboration between psychiatrists and neurologists is crucial for comprehensive patient care.

AE should be considered in cases of acute psychosis, mood disturbances, or cognitive impairment. Early diagnosis and treatment are key to preventing long-term psychiatric and neurological issues. Greater awareness of AE’s psychiatric presentations aids in distinguishing it from primary psychiatric disorders and facilitates timely treatment. Further research is needed to explore the neuroimmune mechanisms behind AE and optimize treatment. Collaborative efforts between psychiatry and neurology are essential for successful patient outcomes.

None Declared

Since the outbreak of Coronavirus Disease 2019 (COVID-19) pandemic, sleep and mental health of the population have been disrupted worldwide. Predisposing, precipitating, and perpetuating factors of insomnia may signify shared mechanisms that relate insomnia symptoms to psychiatric disorders during stressful periods like pandemic. However, long term repercussions of COVID-19 pandemic on sleep features such as insomnia, and psychological health remains poorly elucidated even after the alleviation of the pandemic measures.

The current study aims to identify the longitudinal trajectory of insomnia, in terms of prevalence and associated risk factors, during and post COVID-19 pandemic era among the general population of Singapore.

Current study consists of longitudinal online and in person surveys involving two-point assessments-Phase1 (during pandemic) from May 2020-June 2021 and Phase2 (post pandemic) from October 2023-August 2024. Singapore residents aged 21 years and above, fluent in English, Chinese or Malay language participated in the study. Participants answered an interviewer-administered questionnaire across both timepoints, including Socio-Demographic information, Insomnia Severity Index, Generalised Anxiety Disorder-7, Physical Health Questionnaire, Depression Anxiety Stress Scales and Covid-19 related stressors-Exposure to Covid-19, current and future perceived risk of infection.

597 participants completed both assessments at phase1 and phase2. The prevalence of insomnia increased from 8.83% in phase2 as compared to 8.24% in phase1 (p<0.00). Those aged 50 years and above (vs 21-34 years) (p<0.02), highest educational attainment of primary school (vs University) (p<0.05), being economically inactive (vs employed) (p< 0.01), having mild levels of anxiety (p<0.007) and having severe levels of depression, anxiety or, stress (p<0.005) was seen to be significantly associated with insomnia.

Insomnia prevalence rose from 8.24% in phase1 to 8.83% in phase2 and was significantly associated with anxiety disorder, psychological distress, and perceived stress among Singapore residents in both phases. These findings could be ascribed to the failure in re-establishment of pre-COVID-19 pandemic norms, social situations and working dynamics that might have led to sleep curtailment and insomnia. Study findings can be utilised to design effective targeted interventions like cognitive behavioural therapy, therapist assisted relaxation and meditation programs to improve sleep and reduce psychological distress. Mentioned interventions can be delivered via smartphone applications enabling easy access, monitoring, delivery, and utilization by the vulnerable groups.

None Declared

Previous studies have shown that unwanted pregnancy and abortion, particularly in adolescents, are associated with a higher risk of suicidal thoughts and behaviors. Moreover, women with a history of abortion faced a significantly higher risk of various mental health problems, including suicidal behaviors, compared to those who did not undergo abortion. This is often due to a combination of psychological and social pressures. Factors such as the feeling of shame, social isolation, and a sense of being a burden can exacerbate the mental distress that pregnant women or adolescents experience, especially when the pregnancy is unplanned. Additionally, women who attempted suicide often report high levels of stress related to social expectations, family conflict, and lack of support during pregnancy. In some cases, individuals who were born from unwanted pregnancies or whose mother attempted abortions have also shown a higher risk of suicidal behavior later in life. However, our understanding of the risk and protective factors is uncomplete.

In our study the connection between unwanted pregnancy, abortion and suicide attempts were analysed and identify their role as potential suicide risk factors.

: Structural clinical interview was used to explore trauma history of induced abortion and unwanted pregnancy. 324 subjects were involved in the analysis. 134 of them with history of suicide, 135 clinical sample without suicide history 55 non-clinical sample. We assessed the moderator effect of the attachment style and childhood trauma using the Adult Attachment Scale (AAS) and the Childhood Trauma Questionnaire (CTQ).

We found no significant effects regarding whether the individual was born from unwanted pregnancies (β = -1.509, p = 0.110, OR = 0.221), and whether they lost their child (β = 0.247, p = 0.892, OR = 0.981). However, whether their mother attempted abortion when pregnant with them have shown a higher risk of suicidal behavior later in life (β = 6.939, p = 0.007, OR = 1031.427). The participants who undergone abortion were also more likely to attempt suicide (β = 2.397, p = 0.011, OR = 10.988). In both cases, childhood trauma was a mediator variable on a significant level (in case of mother’s abortion: β = -0.130, p = 0.005, OR = -2.804) or as a trend (in case of participant’s abortion: β = -0.034, p = 0.050, OR = 0.966).

The perinatal period, particularly for those experiencing unwanted pregnancies, is a critical time for mental health interventions to prevent suicide attempts.

None Declared

Objectives: Tele-mental health services can play an important role in overcoming barriers in mental health services in the Eastern Mediterranean Region. However, despite its potential, tele-mental health has not been widely adopted in Oman.

This study is an exploratory investigation into the experiences of therapists and their clients in utilizing video-based tele-mental health care during the COVID-19 pandemic.

A total of 19 semistructured qualitative interviews were individually conducted, it included 13 adult clients with mental health conditions who received video-based tele-mental health care and six clinical psychologists who provided video-based tele-mental health care during the COVID-19 pandemic.

The clients reported favorable experiences using tele-mental health, with the primary benefits being convenience, easy accessibility to subspecialized care, reduced absenteeism from work with commuting costs, and alleviated mental health stigma. The therapists also expressed experiencing benefits from tele-mental health, such as reduced risk of intrahospital infection, reduced healthcare costs, and the achievement of work-life balance. Primary concerns were related to the lack of public tele-mental health services, lack of specified tele-mental health guidelines, shortage of trained therapists, limited access to high-speed Internet, electronic devices, privacy, and concerns toward the security of telehealth systems in general.

Clients and therapists report that tele-mental health offers new opportunities to improve the quality of mental healthcare services in Oman, and that the challenges could be resolved by establishing governmental tele-mental health services along with developing tele-mental health guidelines and implementing local postgraduate clinical psychology programs in universities in Oman.

None Declared

Cohort studies in first-episode psychosis (FEP) provide crucial insights into the diverse trajectories of clinical and functional recovery. These studies are invaluable for evaluating the effectiveness of new intervention models and informing resource allocation and policy development.

To synthesize quantitative and qualitative findings on mortality and clinical outcomes and to explore their interrelations in a multi-modal investigation of long-term outcomes in FEP. Specific objectives include appraising how this study’s findings have influenced the development of new models of care.

Data were drawn from the iHOPE-20 study, comprising cohort analyses and qualitative interviews with 171 FEP participants diagnosed between 1995–1999 in Dublin, Ireland. Participants with lived experience contributed to the design of the 20-year follow up assessments. Mortality rates were calculated; symptoms, functionality and quality of life trajectories were analyzed using mixed models; and personal recovery themes were derived through thematic analysis. Ongoing analyses are addressing predictors of the number, timing and sequencing of relapses/readmissions among baseline variables as foci for service development.

The study revealed substantial variation in long-term outcomes among individuals with FEP. Shorter DUP was consistently associated with better outcomes across all of the follow-up points. Mortality rates highlighted the importance of interventions to address physical health morbidity. Diagnostic instability over time underscored the dynamic nature of psychosis management. Employment status at follow-up highlighted the importance of strategies to support a return to education or employment after a first presentation.

Findings emphasize the enduring impact of DUP and the need for tailored interventions. Data from this cohort highlight the value of longitudinal insights as a benchmark for comparing the effectiveness of new intervention models. In such studies, addressing ethical and data protection challenges, incorporating the expertise of those with lived experience and harmonising outcome measures remain vital to advance recovery-oriented care models.

None Declared

The assessment of competence for medical decision-making is a critical aspect in the care of patients with mental health disorders. Since patient autonomy is a fundamental pillar of medical ethics, evaluating their capacity to make informed decisions ensures respect for their rights while safeguarding their well-being. An accurate assessment of competence not only facilitates safer and more appropriate decisions for the patient, but also allows physicians to act ethically and legally. Understanding the tools and criteria for such assessments is essential to balance patient autonomy with the protection of their health.

Identify factors that may influence a patient’s competence for specific decisions.

Familiarize with validated scales for assessing patient competence.

Identify strategies to improve competence in cases where necessary.

We present the case of a 65-year-old female patient without significant medical or psychiatric history, who was evaluated in the emergency department for cardiac tamponade, requiring urgent intervention via pericardiocentesis. At the time of the procedure, the patient refused the intervention due to severe pain, requesting voluntary discharge without undergoing further tests. Psychiatry was consulted to assess the patient’s decision-making capacity. An interview was conducted using the MacCAT-T (MacArthur Competence Assessment Tool for Treatment) scale.

A joint interview was conducted between the emergency medicine, intensive care, and psychiatry departments. The results indicated partial competence of the patient for this medical decision (understanding of the procedure and its impact on daily life, but high risk associated with the decision). The patient’s family was involved in the decision-making process, and it was decided to extend the emergency department stay for two additional days to promote better patient competence. No psychopathology was found that impaired the patient’s competence. Ultimately, it was determined that the patient had the necessary competence for this specific decision, and she was discharged home.

Interviews assisted by validated competence assessment scales, such as the MacCAT-T, can be a useful tool in challenging decision-making contexts in emergency situations, providing a more objective and ethical evaluation of patient competence.

None Declared

Cancer is a disease with a high mortality rate and requires care. The identification of cancer with death may cause patients and caregivers not to talk about illness and death. However, communication is one of the most important elements of this disease process. In addition to the inability to talk, the increased responsibilities of caregivers cause physical, economic, social and psychological burdens on caregivers. This can lead to high levels of stress, mental fatigue and depression in caregivers. Poor communication between patients and caregivers is an important factor related to depressive symptoms in caregivers during the caregiving process. Open communication between caregivers and the patient is a factor that can positively affect the disease process. With this study, it can be found that being open communication can reduce depression, anxiety and stress levels in caregivers and support studies to reduce the burden of care of caregivers. Thus, it can be ensured that patients and their caregivers experience the disease process more positively and spend it more positively.

Existing measures of mortality communication may not capture much of the nuance in that cancer caregiver report to be particularly upsetting, so we thought it would be important to examine reliability and validity of the Caregiver’s Communication with the Patient about Illness and Death (CCID) Scale for measuring the extent to which caregivers of cancer patients discuss illness and death with the patientin Turkey.

The methodological study will be conducted to establish the validity and reliability of the Caregiver’s Communication with the Patient about Illness and Death (CCID) Scaleto Turkish Culture and to determine the level of mortality communication, expected grief, care burden and mental health problems among cancer caregiver in Eastern Turkey. The sample of the study will consist of cancer caregivers and who agree to participate in the study. The data will be subjected to appropriate methods for statistical analysis and will be used to understand the relationships between mortality communication and grief, depression, anxiety, stress and caregiver burden at caregivers of cancer patients.

Data extraction is still on going in detailed style by principal authors. Description of studies and the key findings will be presented.

It is predicted that not discussing illness and death causes an increase in depression, anxiety and stress levels in caregivers. In this study, it is aimed to evaluate depression, anxiety and stress in caregivers of cancer patients who will be evaluated with the scale and to evaluate their relationship with care burden.

None Declared

Epilepsy is the most common chronic neurological disease in the general population. The role of the psychiatrist in this pathology is to consider the epileptic diagnosis within the diagnostic possibilities, its psychosocial consequences and the psychological and cognitive effects of common antiepileptics. It has been reported that 30% to 50% of all individuals with epilepsy present, at some point in their lives, psychiatric difficulties. An epileptic seizure is a transient paroxysmal pathophysiological alteration of brain function caused by spontaneous excessive neuronal discharge. Symptoms will depend fundamentally on the cerebral origin of the seizure and the spread of activity in the brain. Finally, to better understand the clinical case that will be presented, it is important to differentiate between partial epileptic seizures, which involve epileptiform activity in localized brain regions, and generalized seizures, which affect the entire brain.

The main objective of this work is to review the current scientific evidence on psychiatric symptons in epilepsy.

The case of a 75-year-old man with a neurological history and abrupt appearance of atypical psychiatric symptoms is presented. A detailed search was performed on UpToDate with the search terms “Epilepsy” and “psychiatric pathology.”

This is a 75-year-old man with an organic history of repeated cerebral strokes and vascular epilepsy who attended the Emergency Department due to the onset of autolytic ideation abruptly and without a biographical trigger. After the express request by psychiatry for a neurological study, an EEG was performed, where epileptiform activity was observed in the frontal lobe and a diagnosis of right frontal focal status epilepticus secondary to a chronic cerebrovascular lesion was diagnosed. Preictal events in complex partial epilepsy include autonomic sensations (gastric repletion, flushing and changes in breathing), cognitive sensations (déjà vu, jamais vu, forced thoughts), affective states (fear, panic, depression, euphoria) and automatisms.

Status epilepticus constitutes one of the main neurological emergencies. Convulsive status epilepticus is a life-threatening situation that requires immediate pharmacological treatment and life support measures, as well as recognition and treatment of a possible triggering cause. It is a prolonged epileptic seizure or one that repeats itself in time intervals that are short enough so that the patient does not regain consciousness between episodes. Among the possible symptoms in epilepsy with a focus on the frontal lobe, atypical behavioral alterations are included that can go unnoticed and be referred to psychiatry.

In conclusion, this case shows the need for organic screening in those patients with atypical symptoms that do not fit into the major neuropsychiatric syndromes.

None Declared

Schizophrenia frequently coexists with substance use disorders, especially cannabis use disorder (CUD). Importantly, cannabis use is known to further exacerbate symptoms, leading to more frequent and severe psychotic episodes, longer hospital stays and poorer overall treatment outcomes. The lifetime risk of relapse is around 60%. Therefore, the treatment of patients with multiple episodes is even more challenging

To evaluate the effectiveness of cariprazine in schizophrenia patients with multiple episodes and comorbid cannabis use disorder.

This was a 6-month, multi-centre, observational study conducted at six institutions in Spain. The study included adult outpatients aged 18 to 65 years, diagnosed with schizophrenia and cannabis use disorder according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, who were receiving cariprazine treatment based on medical judgment. Exclusion criteria included pregnant or breastfeeding women and patients with co-existing medical conditions that could potentially skew the study results.

The study evaluated changes in schizophrenia symptoms using the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression-Schizophrenia (CGI-SCH), as well as changes in CUD symptoms based on the Cannabis Abuse Screening Test (CAST) and the Severity of Dependence Scale (SDS). This post-hoc analysis focused on patients with multiple episodes. Patient characteristics were summarized using descriptive statistics. Least squares (LS) means were calculated for the change from treatment start to treatment end for PANSS, CGI-SCH, CAST, SDS using a mixed model for repeated measures. All analyses were conducted using SAS.

From the cohort, 38 (65%) patients had multiple episodes. The mean age of these patients was 36.5 and 65.8% of them was male. Most patients received 4.5 mg/day cariprazine at baseline (60.5%). Half of the patients also took concomitant antidepressants and/or antipsychotics. Throughout the 6-month observational period significant improvement was detected in both schizophrenia (LS mean change in PANSS Total score: -46.2, p<0.001, CGI-SCH Total score: -8.0, p<0.001) and CUD symptomatology (LS mean change in CAST Total score: -6.6, p<0.001, SDS Total score: -8.0, p<0.001).

Cariprazine seem to be an effective treatment option for schizophrenia patients with multiple episodes and comorbid CUD.

N. Szerman : None Declared, Z. Dombi Employee of: I am an employee of Gedeon Richter Plc., originator of cariprazine., P. Vega: None Declared, C. Roncero: None Declared, L. Peris: None Declared, L. Grau-López: None Declared, I. Basurte-Villamor: None Declared

Alexithymia is characterized by difficulty in verbally expressing emotions, a trait commonly observed in patients with psychosomatic symptoms, such as those with asthma. These individuals struggle to identify their emotions and are more prone to developing somatic health issues.

• - To study the prevalence of alexithymia, anxiety and depression in asthma patients

• - To identify the relationship between these aspects.

It was a cross-sectional, case-control, descriptive and analytical study, conducted in the pulmonology department at Hedi Chaker University Hospital in Sfax. The study involved 50 asthma patients and a control group consisting of 50 healthy nurses. Data collection was based on a sociodemographic and clinical questionnaire, as well as two psychometric scales: the Toronto Alexithymia Scale 20 (TAS-20) and the Hospital Anxiety and Depression Scale (HADS).

The mean age of the patients was 44.08 ± 12.78 years and the male-to-female ratio (M/F) was 0.92.

More than half of the patients (62%) had experienced an acute severe asthma requiring hospitalization. The disease was controlled in 70% of the cases.

The prevalence of alexithymia was 40% in the asthma patients and 36% in the control group, with no significant difference between the two groups (p = 0.68).

The prevalence of anxiety was 38% in patients and 34% in the control group with a significant difference between the two groups (p = 0.012).

The prevalence of depression was 38% in patients and 28% in the control group with a significant difference between the two groups (p = 0.002).

Alexithymic patients were significantly more anxious (p = 0.01) and more depressed (p = 0.01) than non-alexithymic patients.

Patients with ashtma present high rates of anxiety, depression and alexithymia. This latter does not appear to be a determining factor in asthma. However, it seems to be associated with the emotional distress caused by anxiety and depression. Timely screening for emotional distress and its early management is essential in this population.

None Declared

Huntington’s disease (HD) is a progressive neurodegenerative disorder characterized by motor dysfunction, cognitive decline, and psychiatric symptoms. Among these psychiatric manifestations, psychosis occurs in a subset of patients, presenting significant challenges for both diagnosis and treatment. While pharmacological interventions, such as antipsychotics, are commonly used to manage psychosis in HD, they often come with limited efficacy and a high risk of adverse effects. Electroconvulsive therapy (ECT), traditionally employed in the treatment of severe mood disorders and treatment-resistant psychosis, has garnered minimal attention as a therapeutic option for psychosis associated with HD. This is proven by the absence of literature focusing specifically on the use of ECT for treatment of Huntington’s Psychosis. This underexplored avenue holds potential, given ECT’s neuroplastic and neurochemical effects, which may counteract the neurodegenerative processes seen in HD. Exploring the efficacy of ECT in HD-associated psychosis could not only provide symptom relief but also offer insights into the broader neuropsychiatric management of the disease.

This review aims to highlight the therapeutic potential of ECT as a novel intervention in Huntington’s psychosis, addressing the current gap in clinical research and therapeutic strategies.

A non-systematic review of the published literature using the PubMed/MEDLINE database with the MESH terms “huntington,” “psychosis” and “ECT” was made. The articles were selected according to relevance.

There were found 14 relevant publications that adress the use of ECT in HD. 11 of them were case reports and 3 were case series. Most of the studies show good results from the use of ECT in HD. There was improvement in several areas of the patient’s mental state, namely depressive symptoms, irritability, psychotic symptoms and psychomotor agitation.

Few case studies reported worsening of the clinical picture, namely aggravation of the catatonic symptoms or cognitive impairment.

The limited but promising evidence from case reports and case series suggests that ECT may be an effective therapeutic intervention for addressing psychiatric symptoms, including psychosis, in patients with Huntington’s disease. The majority of studies demonstrate positive outcomes. However, the findings are not universally positive, with a few reports noting potential worsening some symptoms. Given the complexity of managing psychiatric symptoms in HD, ECT presents itself as a valuable treatment option, particularly when pharmacological approaches prove ineffective or poorly tolerated. Nonetheless, the absence of larger, controlled studies on ECT for HD psychosis underscores the need for further research to validate its safety and efficacy.

None Declared

Schizophrenia is a complex neuropsychiatric disorder, which affects 1% of people in the world. It presents marked heterogeneity in terms of clinical presentation, course and prognosis, although patient with schizophrenia may have diseases of other physical causes, in which pain has a protective role for the individual and diagnostic importance. Studies on pain in schizophrenia are rare and predominantly experimental. The cause of decreased sensitivity or lack of sensitivity to pain in patients with schizophrenia is unknown. Among the hypothesis are lesions in the thalamus and psychotic symptoms that would decrease the patient’s concentration or divert his attention from the pain.

The aim of this research was to study the presence/absence and intensity of pain compatible with the cause in 753 men that we have been treating for schizophrenia for 20 years.

We asked all our patients with schizophrenia at their first consultation in 2002 whether they would be willing to be clinically investigated for the presence/absence and intensity of pain compatible with any cause.

We divided our patients into 3 groups:

Group 1: 51 patients aged 17 – 25 years

First episode currently symptomatic-negative symptoms.

Group 2: 325 patients aged 27-31 years

Multiple episodes currently symptomatic, 25 negative symptoms, 300 positive symptoms.

Group 3: 377 patients aged 40-45 years

Continuous currently – 7 negative symptoms, 370 positive symptoms.

These patients were examined every 3 months by clinicians and dentists for 20 years.

Treatment

Patients with:

• - Positive symptoms (delusional beliefs, hallucinatory perception, and disorganization of thinking and behavior) associated with excessive dopamine release, who respond adequately to (FL-APM) First Line dopamine antagonist medication.

• - Positive symptoms which does not respond adequately to FL-APM, who respond adequately to chlozapine.

• - Refractory schizophrenia treated with electroconvulsive therapy.

100 patients quit of the survey

653 had (at least once in these 20 years) headache, toothache or earache.

51 did not complain of pain with trigeminal neuralgia.

30 patients did not complain of pain when they had herpes zoster.

Patients with negative schizophrenic symptoms and resistance to treatments showed an absence of pain (pertinent to their physical illness)

The causes of reduced or absent pain sensation in patients with schizophrenia are unknown. Proposed explanations include thalamic damage and psychotic symptoms that render the patient unable to perceive pain. Our patients did not have thalamic damage but had severe negative psychotic symptoms and resistance to treatments.

None Declared

Patients of depression and psychotic disorders are often troubled by unsatisfactory interpersonal relationships. While an inability to maintain a stable sense of self restricts one’s understanding another’s emotional state, whether disrupted self-versus-other referential processing is a transdiagnostic predictor of increased emotion misreading across diagnostic groups has not been explicated.

We tested whether weakened differential learning between self and other may account for impoversihed emotion recognition accross mood and psychotic disorders.

Inpatients admitted for major depressive disorder (MDD), bipolar disorder (BD), and schizophrenia (SCZ; ns = 59, 32, and 43) and 40 healthy controls were recruited. Aside from ratings of depressive and schizophrenic symptoms by psychiatrists, participants were assessed on self- versus other- referential learning, emotion recognition, emotion sharing.

Regression analysis indicates lower effectiveness of self-other tagging to be a predictor independent from symptom severity for increased emotion misrecognition across MDD, BD and SCZ (F(8, 160) = 8.52, p < 0.001). Clinical groups showed lower accuracy for other-referential recall and emotion recognition, but comparable emotion sharing and self-prioritization to healthy controls.

Image:

Heightened emotion misrecognition in MDD, CD, and SCZ patients can be traced back to the weakened ability in coordinating self- and other-representations according to task-demands. Future examinations on whether interventions on brain regions pertaining to self-versus-other learning might enhance emotion recognition in different patient groups would be clinically relevant.

None Declared

Electroconvulsive therapy (ECT) is an effective treatment for major depressive disorder (MDD). Only few studies have measured CSF in patients undergoing ECT; thus far, no prognostic candidate biomarkers for treatment response have been found (Kranaster et al. Neuropsychobiology. 2019;77(1):13-22). Neurofilament light chain (NfL) is a protein found in the axons of neurons. If elevated in blood or cerebrospinal fluid (CSF), it is an indicator of neuroaxonal damage. A recent study including 15 patients with MDD who underwent ECT found no significant change in serum NfL concentrations after completion of treatment (Besse et al. Eur Arch Psychiatry Clin Neurosci 2024; 274(5):1187-95). The astrocyte marker glial fibrillary acidic protein (GFAP) is elevated in MDD and neuroinflammatory diseases. Serum GFAP levels in 40 MDD patients decreased after ECT compared to baseline (Xu et al. Psychiatry Clin Neurosci. 2023; 77(12):653-64). No studies measuring CSF levels of both markers have been performed.

In this prospective study we aimed to measure changes in CSF of NfL and GFAP in patients undergoing an ECT series.

In a sample of 9 MDD patients undergoing bilateral ECT, CSF was analyzed before and after the 8th ECT session. Patients took antidepressant medication in a steady state over the course of ECT. A mixed-effects linear regression analysis was done using the log-transformed NfL and GFAP levels as outcome variables. The timepoint (pre-ECT, post-ECT) were entered as fixed effects, patient ID was included as a random effect to account for individual variability. We corrected for multiple testing and defined alpha = 0.05/2 = 0.025. Statistical analyses were performed using R version R-4.3.2.

The mean age ± SD was 34 ± 11 years, 6 out of 9 patients (67%) were women. Mean elevations of NfL by 19,9 pg/ml (95% CI: -120.3 to 160.0) and GFAP by 445.8 pg/ml (95% CI: -1279.6 to 2171.4), there was no significant change in NfL (p = 0.213) or GFAP (p = 0.362) levels after ECT. Figure 1 shows concentrations of both NfL and GFAP pre and post ECT.

Image:

This study found no significant changes of NfL or GFAP levels in CSF after an ECT series, suggesting no evidence of neuroaxonal damage or brain damage through astrocyte activation related to ECT. However, the small sample size may have obscured potential effects. Future research with larger sample sizes is therefore essential.

S. Riessland Grant / Research support from: This study was sponsored by the Austrian Science Fund (project number KLI 1098, principal investigator P. Baldinger-Melich) and the 2021 NARSAD Young Investigator grant (grant number 29950, principal investigator P. Baldinger-Melich). S. Rießland is partially funded by the Austrian Science fund and the NARSAD Young Investigator Grant., M. Ponleitner: None Declared, V. Millischer: None Declared, S. Macher: None Declared, R. Lanzenberger: None Declared, P. Rommer: None Declared, R. Frey: None Declared, D. Rujescu: None Declared, P. Baldinger-Melich Grant / Research support from: This study was sponsored by the Austrian Science Fund (project number KLI 1098, principal investigator P. Baldinger-Melich) and the 2021 NARSAD Young Investigator grant (grant number 29950, principal investigator P. Baldinger-Melich). The other authors have no conflict of interest related to this study to declare.

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS) typically describe the sudden onset of neuropsychiatric symptoms, such as Obsessive-Compulsive Disorder (OCD), following streptococcal infections. However, cases that present with comorbid motor abnormalities, such as myoclonic jerks, are rare and pose diagnostic challenges. We report the case of a child who developed severe OCD accompanied by myoclonic movements after a streptococcal pharyngitis infection, representing a rare neuropsychiatric syndrome with an atypical clinical course.

To present a rare case of post-streptococcal OCD in a child with comorbid motor myoclonus, highlighting the unusual presentation and the multidisciplinary therapeutic approach.

An 11-year-old male presented to the emergency department with sudden-onset severe compulsive behaviors, including repetitive prayers and ritualistic actions. These symptoms were accompanied by involuntary, rapid, jerky movements in both upper and lower limbs, consistent with myoclonus. Two weeks prior, the patient had been treated for streptococcal pharyngitis. A comprehensive evaluation was performed, including throat culture, elevated antistreptolysin O (ASO) titers, and electroencephalogram (EEG) to rule out seizures. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used for assessing OCD severity.

The patient was managed with a multidisciplinary approach involving pediatricians, neurologists, and psychiatrists. A combination of antibiotics, selective serotonin reuptake inhibitors (SSRIs), and clonazepam for myoclonus was prescribed, alongside Cognitive-Behavioral Therapy (CBT).

ASO titers were elevated, indicating recent streptococcal infection, and the EEG showed no epileptiform activity. The initial Y-BOCS score was 32, reflecting severe OCD. After four weeks of antibiotic therapy, CBT, and pharmacological treatment, the Y-BOCS score decreased to 18. Myoclonic movements also reduced by 70% with clonazepam. Symptomatic improvement continued over the next three months, with residual mild OCD symptoms and no recurrence of myoclonus.

This case illustrates a rare and complex presentation of PANDAS, where post-streptococcal OCD is accompanied by myoclonic movements. The integration of antibiotics, SSRIs, clonazepam, and CBT significantly improved both OCD and motor symptoms. This highlights the importance of recognizing and treating atypical neuropsychiatric manifestations following streptococcal infections in pediatric populations.

None Declared

NAVIGATE, is a comprehensive manual based intervention developed in the US for young people experiencing a first episode psychosis (FEP). The intervention is based on four main service components: Individual Resilience Training (IRT), supported employment and education (SEE), family psychoeducation (FEP) and medication management.

To describe the process of implementing NAVIGATE in Israel with an emphasis on cultural adaptation, fidelity, patterns of use and their relation to outcomes.

Between 2017-2021 demographic and diagnostic, service utilization data and ratings of functioning and symptoms were collected from clinical registries of 142 NAVIGATE participants.

Most participants were males (70%), aged 23.5 (SD 5.5, Range 16-43). On average, participated in the program over a year. IRT was the most utilized intervention (M=23, SD 11.51). Overall, three clusters of program usage were found. Number of sessions and their frequency were highly correlated. Number of family psychoeducation meetings showed the highest correlation with improvement overtime in functioning and symptoms severity. Program Fidelity rates ranged from 2.8 to 3.3 (range 0-4).

The NAVIGATE program in Israel demonstrated significant clinical and functional outcomes across all service use patterns. NAVIGATE was formally offered for two years and included four components, in reality, service users attended less than what was offered. It is possible that when an effective comprehensive team-based intervention is offered flexibly to meet the often rapid changes needs of young people with FEP, the actual use is less than one might expect, which has important implications for policy and practice.

None Declared

Globally, the number of international migrants has been rising, with Europe seeing a significantly higher increase compared to other regions. Migration has been frequently identified in the literature as a risk factor for various mental health issues (Schouler-Ocak et al. Indian J Psychiatry 2020; 62 242-6). Despite this, migrant populations often encounter significant challenges in accessing mental health care services, primarily due to language and communication barriers and cultural differences (Forray et al. BMC Public Health 2024; 24 1593). To improve mental health treatment for migrant populations, it is essential to not only provide cultural competence training for healthcare professionals and ensure access to professional interpreters but also to establish and maintain multicultural treatment teams (Machleidt W. Der Nervenarzt 2022; 73 1208-12). Addressing these needs, we have been operating a multicultural treatment team at our day clinic in Hamburg for the past year, providing care to Turkish-speaking migrants and native-born patients together.

To describe our efforts in developing a cross-cultural center and facilitating effective communication between migrant patients and native-born patients.

A descriptive overview of our efforts to establish a day clinic model adapted to the cultural and linguistic needs of the migrant (Turkish) population in Germany with a brief review of the relevant literature.

At our day hospital, we provide care for patients with psychiatric disorders who do not require inpatient treatment but for whom outpatient care is insufficient. Our multicultural treatment team is composed of healthcare professionals whose native languages are German and/or Turkish.In our day hospital, patients with a migration background receive psychotherapy and medical consultations in their native language, ensuring they can access the treatment they need without language barriers. Additionally, we aim to improve cultural understanding through collaborative activities. This approach facilitates the development of cross-cultural communication among patients and healthcare professionals from different backgrounds, while also contributing to equal opportunities in psychiatric treatment. The program addresses linguistic, cultural, and religious communication difficulties, aiming to build and sustain meaningful relationships.

The migrant population in Europe continues to grow each day, and mental health care services must adapt to this heterogeneous population and their diverse treatment needs. We advocate for the establishment of treatment centers where migrant populations and native-born patients are considered together, as such centers can play a role in bridging the intercultural communication gap.

None Declared

In Ireland, 1 in 5 young adults (aged 18-25) experience moderate to severe levels of depression and anxiety. To meet the growing need for mental health supports, Jigsaw – The National Centre for Youth Mental Health – provides accessible, early intervention services throughout Ireland. Building on its reputation for championing youth voices and inspired by examples set by other international integrated youth mental health services, one such strategy Jigsaw is exploring is youth peer support.Peer support offers social, emotional, and practical assistance from young people with personal experience of mental health challenges. Evidence suggests that peer support can positively impact young people by promoting a recovery-based approach to mental health. However, despite the recognized benefits, peer support is underutilized in Irish youth mental health services, and there is limited guidance available for its development.

This research adopts a collaborative approach to intervention development, aiming to create an evidence-informed framework to guide the introduction of peer support in Jigsaw services.

This PhD project adheres to the Medical Research Council’s Guidance for Developing and Evaluating Complex Interventions. The first stage of this project comprised a published scoping review of peer support in integrated youth mental health services and educational settings. The second stage of the project aimed to understand the benefits and challenges of peer support using semi-structured interviews with mental health professionals. The final stage of the project will take a participatory approach to intervention design, utilizing co-design workshops with stakeholders to identify potential intervention functions.

The scoping review identified common types of peer support programs (peer-delivered one-to-one support, self-help groups, and internet support groups) and target problems addressed (depression, anxiety, and psychological distress). Interviews with fifteen professionals revealed insights into the benefits of peer support for young people, such as increased connection and empowerment, and for services, such as reduced power imbalances and increased accessibility. Challenges for implementation were also identified, including boundary management, funding, and resource allocation. The ongoing final stage focuses on developing a program theory underpinning a potential peer support intervention in Jigsaw. Key stakeholders, including Jigsaw’s senior management and youth advisory panel (YAP), will be consulted to identify intervention components.

Recommendations regarding key components of peer support, as well as barriers and facilitators to its implementation, will be shared to support other organizations in enhancing their understanding and application of peer support for youth mental health.

None Declared