“MRI-defined vascular depression” suggests that vascular lesions and small vessels disease induce depression by disruption of frontal–subcortical–limbic networks.Vascular depression is associated with disruption or cortico-striato-pallido-thalamo-cortical pathways or their modulating systems.

Based on clinical correlates and structural MRI findings we aim to evaluate causal relationship between specific brain changes and its related lesions in localization and number, through visual rating scales semi-automated and fully automated volumetric methods of specific software packages as part of deep machine learning.

We have included 50 T2/FLAIR MRI brain scanned images, 30 patients (both genders) with late-onset vascular depression and 20 controls. In all subjects, T2/fluid-attenuated inversion recovery (FLAIR) sequences of the brain were collected during a single session using a 3 Tesla scanner (Siemens Skyra Medical Systems). FLAIR-white matter hyperintense lesions were identified and quantified using a local thresholding segmentation technique using specific software. FLAIR lesion volume and number was reported for the whole brain and for each hemisphere separately, without distinction between deep and periventricular.

There is statistical significance in total number and total regional volume of interest in brains of patients with late-onset vascular depression compared to controls (p<0.05). Median number of white matter hyperintensities was 14 per patient, and white matter hyperintensities median volume was 721 mm3. No difference was found between right and left hemisphere in terms of number (p>0.05) and volume (p>0.05) of white matter hyperintensities. Statistical significance was faound in volume and localisation of lesions in the brain (p<0.05).

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Higher burden of white matter hyperintensities in patients with vascular depression could be associated with progression of clinical depressive symptomatology as well as with severity of brain damage.

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The pathogenesis of Parkinson’s disease (PD) is associated with simultaneous damage to the nervous, endocrine and immune systems. Therefore, drugs that have a regulatory effect on all of these systems should be used to treat PD. Similar properties are possessed by the synthetic analogue of fragment 41–46 Human Leukemia Differentiation Factor (Thr-Gly-Glu-Hse-His-Arg-NH2, HLDF-6-H)

To study the effects of HLDF-6-H in an experimental model of PD and its impact on the severity of motor and non-motor symptoms in patients with PD

The study used a preclinical PD model based on the administration of moderate doses of MPTP toxin (18 mg/kg) and chronic intranasal administration of HLDF-6-H peptide (300 μg/kg) to C57Bl/6 mice. Mice behaviour was assessed in the Grid test and the Forced Swim (FS) test. After 3 weeks of peptide administration, mRNA of neurotropic factors (BDNF and NGF) and key cytokines (IL-1β, IL-6, IL-10, gamma interferon, tumour necrosis factor α and transforming growth factor β1) was analyzed in five brain regions (striatum, hippocampus, hypothalamus, pituitary gland, cortex). Serum levels of 10 steroids, including testosterone, estradiol, progesterone, and corticosterone, were determined using MS analysis. The activity of inflammatory markers leukocyte elastase (LE) and α1-proteinase inhibitor (α1-PI) was determined using kinetic methods. Patients (24 people) with a disease duration from 1 to 16 years received HLDF-6-H intranasally as part of the balm “Rinohealing” (9-31 μg/kg per day, up to 6 months) in addition to standard pharmacotherapy for PD. The effectiveness of therapy was assessed based on the patients’ subjective assessment of their condition according to the MDS-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS)

HLDF-6-H blocked motor disorders (Grid test) and depressive-like syndrome (FS test) caused by MPTP in mice, restored the level of neurotropic factors and cytokines in the brain of animals (p<0.05). In the model used, a decrease in the level of estradiol and cortisol in the blood was reversible by the peptide (p<0.05). The development of the inflammatory process under MPTP action is indicated by an increase in the activity of α1-PI, the anti-inflammatory effect of HLDF-6-H is expressed in a decrease in the serum activity of LE and α1-PI (p < 0.05). A decrease in the severity of a number of motor (rigidity, tremor, movement and balance disorders) and non-motor (anxiety-depressive state, impairment of memory, cognitive functions, sleep, etc.) pathological symptoms of PD was noted with chronic use of “Rinohealing” as an additional therapy.

HLDF-6-H peptide has antidepressant, neuroprotective and anti-inflammatory activity. This has been demonstrated both in the experimental model of PD and when used as an additional therapy for PD. The obtained results indicate the prospects for further studies of HLDF-6-H for the treatment of PD.

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

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

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

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

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

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The Locus Coeruleus (LC), the first brain region affected by TAU aggregates in Alzheimer’s disease (AD), is the primary source of noradrenaline (NA). Given the importance of NA in cognitive functions, noradrenergic interventions may benefit patients with AD pathology.

This study aims (i) to examine memory delay and related fMRI activations in brainstem and midbrain regions in healthy aging and amnestic mild cognitive impairment (aMCI); and (ii) to explore the impact of atomoxetine on memory delay and inhibitory control in aMCI.

For aim (i), event-related fMRI was used. Fifty-three subjects (28 healthy older adults and 25 with aMCI) completed an incidental recognition memory task with emotional and neutral images. Memory tests were administered four hours later, brain BOLD fMRI activations for remembered versus not remembered images were assessed. For aim (ii), seven participants attended the lab over four days. On visit 1, they received either a placebo or atomoxetine, followed by a stop signal task and an incidental memory task. On visit 2, they completed a recognition memory task. Visits 3 and 4 repeated this protocol. T-tests were used to compare results between groups and visits.

For aim (i), a greater activation in the left caudate nucleus was observed in older adults compared to aMCI when contrasting remembered items with not remembered ones (SVC, cluster-level pFWE-corr = 0.08). A significant increase in activation was also found in the locus coeruleus (SVC, cluster-level pFWE-corr = 0.018). However, after adjusting for LC integrity and global grey matter volume (GMV), these differences were no longer significant, suggesting structural changes contribute to LC activation differences between healthy controls and MCI participants. For aim (ii), inhibitory control improved slightly but was not statistically significant, while delayed memory decreased during the atomoxetine visit compared to the placebo visit (p<.05).

Our findings highlight the caudate nucleus’s role in memory encoding in healthy older adults versus those with aMCI, linking LC dysfunction in aMCI to reduced LC integrity. The lack of improvement in executive functions and decreased memory during the atomoxetine visit may stem from individual differences in aMCI. Studies suggest atomoxetine is more effective in patients with high apathy and reduced LC integrity. In future analyses we will stratify participants by apathy and LC integrity to explore atomoxetine’s potential benefits. This study contributes to understanding neural mechanisms in aging and aMCI and informs personalized interventions for cognitive decline in AD.

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The Preoperative Psychological Assessment of Bariatric Surgery and Metabolic (PP-BSM) aims to detect psychopathologies before the procedure, facilitating interventions and lifestyle changes.

Describing and analyzing the psychological aspects and tools used for pre-bariatric surgery psychological evaluation in the Brazilian Public Health System.

Descriptive cross-sectional study. The convenience sample was composed by psychologists of the bariatric surgery and metabolic teams in the public health system in a region in the South of Brazil. Data were collected through an electronic questionnaire administered via telephone survey, focusing on PP-BSM.

There was consensus regarding the areas to be assessed: cognition, emotion, social support, and psychiatric comorbidities. Variation was found in the protocols and instruments used for PP-BSM, with each hospital using its own protocol. Semi-structured clinical interviews, along with self-reported scales and questionnaires, were used by most psychologists.

Although the psychological aspects assessed are aligned with current Brazilian guidelines, there is a lack of either standardized protocols among services or specific instruments for bariatric surgery candidates. Providing adequate tools and training professionals in their use may contribute to increasing safety and long-term positive surgical outcomes.

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Psychosis includes positive (e.g., hallucinations) and negative symptoms (e.g., anhedonia), with tools like the PANSS traditionally used for evaluation. Although clinician-administered scales are considered the gold standard, patient self-reports provide critical insights into subjective experiences.

This study explores the discrepancies between patient-reported and clinician-assessed symptoms, aiming to improve psychosis diagnosis and treatment.

Part of the BSNIP project, this study analyzed data from 159 participants (primarily male, average age 34.33) at the Boston site. Diagnoses were based on SCID, with most participants having schizophrenia, schizoaffective disorder, or bipolar disorder with psychotic features. The DSM-5 Level 1 Cross-Cutting Symptom Measure assessed psychiatric domains, including depression, anxiety, suicidal ideation, and psychosis, and was compared with clinician-reported assessments of the same symptoms.

Clinicians generally reported higher anxiety levels than patients with SZ (Z = -2.462, p = 0.014), while no significant differences were observed for the bipolar disorder (BP) and schizoaffective disorder (SAD) groups. Regarding suicidal ideation, patients typically reported higher levels than clinicians, particularly in the SZ group (Z = -3.507, p < 0.001) and the SAD group (Z = -2.007, p = 0.045). Similarly, patients in the BP (Z = -2.822, p = 0.005) and SAD (Z = -2.145, p = 0.032) groups reported more hallucinations compared to clinician assessments, while clinicians reported higher levels of hallucinations in the SZ group (Z = -3.451, p = 0.001). In terms of delusions, clinicians generally reported higher levels than patients in the SZ group (Z = -2.925, p = 0.003). Additionally, neither insight (PANSS_G12) nor cognitive function (BACS Composite) significantly impacted the discrepancies between patient and clinician reports of suicidal ideation, hallucinations, or delusions.

The study highlights significant discrepancies in the reporting of anxiety, suicidal ideation, hallucinations, and delusions, especially in schizophrenia, where patients tend to underreport anxiety and psychotic symptoms but report higher suicidal ideation. Our findings point to the value of obtaining both patient and clinician assessments when evaluating psychosis.

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Negative symptoms, such as avolition, blunted affect, or alogia, contribute to functional disability and reduced quality of life in schizophrenia. Patients with predominant negative symptoms and minimal positive symptoms represent a distinct subgroup requiring tailored therapeutic strategies. Sleep disturbances, particularly reduced sleep efficiency, are commonly reported in this population and may exacerbate the severity of negative symptoms. Understanding the differential impact of specific negative symptoms on sleep efficiency could inform individualized approaches for improving otucomes.

To explore associations between distinct dimensions of negative symptoms and sleep efficiency in schizophrenia patients with predominant negative symptoms and low positive symptoms.

This analysis used baseline data from a randomized, sham-controlled trial on the efficacy of transcranial magnetic stimulation in schizophrenia, conducted between 2000 and 2023. The study included patients with PANSS negative subscale score > 24 and PANSS positive subscale score < 20. The outcome variable was the sleep efficiency subscale of the Pittsburgh Sleep Quality Index. Independent variables were the five SANS dimensions: blunted affect, alogia, avolition(/apathy, anhedonia/asociality, and attention impairment. Quantile regression was used to assess associations, and robust standard errors were applied.

We included 76 patients (median age 36 years, 33% women). Alogia was positively associated with sleep efficiency (β = 4.41, p = 0.040), while avolition (β = -3.61, p = 0.014) and attention impairment (β = -4.12, p = 0.041) were negatively associated. Blunted affect and anhedonia/asociality were not significantly associated with sleep efficiency.

Distinct negative symptom dimensions show differential associations with sleep efficiency in schizophrenia patients with predominant negative symptoms. Alogia’s association with better sleep efficiency may reflect reduced mental arousal and fewer ruminative thoughts before sleep. Conversely, avolition and impaired attention may worsen sleep through increased inactivity and fragmented sleep patterns. These findings suggest that targeted therapeutic interventions may be necessary to optimize sleep and overall clinical management in this subgroup of patients. Further studies are needed to explore underlying mechanisms and clinical implications of the presented associations.

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Caregivers of patients with first psychotic episode (FPE) are under considerable stress. The onset of schizophrenia results in significant limitations for the relatives, and resulting maladaptive behavior. It is crucial to provide psychoeducation to those caring for a patient with FPE.

To assess the impact of psychoeducation on the psychological state of caregivers of patients with FPE.

A total of 48 caregivers of patients with FPE (40 women and 8 men) were assessed before and after psychoeducation. Psychometric and statistical methods were used.

Analysis of functioning in interpersonal roles of relatives of FPE patients using the SAS-SR scale before the intervention showed significant distress in various domains (above 66 T-scores). 32.9% of relatives had impaired social interactions (withdrawal, conflicts, sensitivity to criticism). 25.4% of caregivers had strained family relationships (conflicts, guilt), and 12.4% reported difficulties in intimate relationships. 10.8% of relatives experienced problems in their relationship with the patient (overprotection combined with emotional coldness, distancing). After psychoeducation distress decreased in most areas, but some relatives still had problems of social functioning and deterioration in marital relationships. According to the SCL-90 questionnaire, distress decreased after the intervention. GSI (General Symptomatical Index) dropped from 0.69 to 0.38 (with a norm of 0.31). Anxiety and hostility also approached normal levels (from 0.68 to 0.33 and from 0.59 to 0.28, with a norm of 0.30, respectively). However, scores for paranoia (from 0.72 to 0.40, with a norm of 0.34) and depression (from 0.79 to 0.43, with a norm of 0.36) remained elevated, reflecting ongoing stress. PSDI (Positive Distress Symptomatical Index) dropped from 1.53 to 1.44. PST (Positive Symptomatical Index) dropped from 37.06 to 23.56.

After psychoeducation caregivers members’ stress coping strategies improved. Confrontation decreased (from 9 to 8 points), while social support-seeking increased (from 13 to 14 points). Avoidance behavior and distancing also decreased. Medication adherence improved: before psychoeducation 63% of caregivers had moderate adherence and 35% had low adherence. After the intervention 90% of relatives showed moderate adherence and 2% showed high adherence, and none denied the necessity of treatment.

Psychoeducation for caregivers of patients with FPE helps them develop stress management skills, constructive communication with the patient and problem-solving strategies. The intervention reduces anxiety, stigma and improves medication adherence. The study demonstrates that psychoeducation is effective intervention that reduces the risk of relapse during the early years, contributes to the patient’s recovery.

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The use of antipsychotic medications in individuals with epilepsy has been studied extensively. Starting neuroleptic therapy in patients with epilepsy is complicated due to the potential for these drugs to lower the seizure threshold. Consequently, both psychiatrists and neurologists must collaborate to develop personalized treatment plans for these patients.

To evaluate various therapeutic options for patients experiencing both psychotic symptoms and seizures, aiming to select the most appropriate treatment for each individual.

This case report describes a 47-year-old male patient who is presented with a diagnosis of symptomatic focal epilepsy in the left temporoparietal malacic area post traumatic brain injury. Following a traffic accident at the age of 14, after which he suffered a temporoparietal hematoma, the patient has presented numerous epileptic seizures. Initially, he abandoned treatment and follow-up with neurology, which he resumed in 2021. Additionally, the patient was referred to psychiatry after verbalizing delusional ideation of persecution with affective repercussions (tendency towards irritability) and behavioral repercussions (tendency towards social isolation and difficulties in the work environment) as well as auditory hallucinations with derogatory content. Neurology initiated treatment with eslicarbazepine 800mg, with cessation of epileptic seizures. After considering different treatment options and taking into account interactions with antiepileptic treatment, risperidone 1mg was initiated.

Following the initiation of risperidone, the patient experienced a reduction in irritability and has not presented further epileptic seizures. Due to potential drug interactions, the risperidone dose was gradually titrated upwards, resulting in a decrease in delusional ideation and improved overall functioning.

Patients with epilepsy and comorbid psychotic symptoms require a multidisciplinary approach, including individualized treatment. Neuroleptic medications can significantly improve quality of life in these patients. Therefore, it is essential to carefully select the appropriate antipsychotic, starting at low doses and gradually titrating upwards, with close monitoring to ensure patient safety and drug efficacy.

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

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COVID-19 wreaked havoc across the world killing millions along its path. All attempts were made to lower and eventually control the death toll from the pandemic. The “trace, test and treat” approach had its limits since the latter were not developed fast enough. Vaccines were seen as the best hope to protect individuals from the coronavirus and COVID-19. Thus, vaccination was encouraged and promoted widely. Aside from vaccines, interventions emphasised non-pharmaceutical self-protective behaviours to protect against coronavirus infection. Subsequently, there were various levels of compliance and observance of self-protection within nations. Yet studies have not attempted to explore the research implications of compliance patterns.

The present study’s aim was to (i) identify latent classes of individuals’ varying levels of compliance with COVID-19 self-protective behaviours; and (ii) explore the capacity of the latent classes to separate individuals according to their levels of Perceived Infectability, Germ Aversion and Fear of COVID-19.

Data for the current study was extracted from a cross-district COVID-19 study conducted among high school level learners (N = 1609; girls = 59%; rural areas = 43%) in South Africa. Latent classes were derived based on the scores obtained by learners on a self-developed index of non-pharmaceutical self-protective behaviours. Three classes were identified, and they were compared against their obtained Perceived Infectability, Germ Aversion and Fear of COVID-19 scores.

Scores of all three knowledge groups did not differ on Perceived Infectability (p > .05), but the highest scorers, the “knowledgeable group”, scored higher than the “moderately knowledgeable group” and the “relatively low knowledge group” on Germ Aversion and Fear of COVID-19. The scores of the “moderately knowledgeable group” and the “relatively low knowledge group” did not differ on the Fear of COVID-19.

The study supports an approach where learners are classified according to their knowledge of COVID-19 self-protective behaviours, and their motivation for self-protection established according to the classification.

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Medical students face high demands in college, which may cause significant psychological stress and mental health problems, such as depression and anxiety. Several studies worldwide have shown that such individuals are more likely to experience anxiety. However, few studies have examined how generational status and being a first-generation medical student lead to mental health issues.

In this study, we aimed to estimate the prevalence of depression and anxiety in first-generation medical students (FGMS) compared with non-FGMS and to determine the correlation between socioeconomic factors and other variables with depression and anxiety in FGMS.

This cross-sectional study was conducted among medical students at the College of Medicine. A self-administered questionnaire was distributed to the students using convenience sampling. The questionnaire comprised socio-demographic information (e.g. age, gender, marital status), a General Anxiety Disorder (GAD-7) scale to assess anxiety, and a Patient Health Questionnaire (PHQ-9) to assess depression among medical students.

Among the 309 medical students who completed the questionnaire, 65.4% were female and 75.7% were FGMS. The prevalence of anxiety and depression among medical students was 36.2% and 39.5%, respectively, and was higher among FGMS, but not significantly different (p<0.05). Independent risk factors for anxiety and depression among FGMS included a previous history of mental disorders and lack of social and emotional support, while fair sleep quality was identified as a significant independent preventive factor for anxiety and depression. The prevalence rates of anxiety and depression among patients with FGMS were 39.3% and 41.9%, respectively. A previous diagnosis of mental disorder was a significant risk factor for anxiety and depression, whereas fair sleep quality was a significant protective factor. Further research is needed to identify the factors that influence anxiety and depression among FGMS in our region.

Anxiety and depression are common among first-generation medical students. FGMS with a history of mental disorders tended to exhibit symptoms of both anxiety and depression compared to the rest of the FGMS. However, satisfactory sleep quality could result in better mental condition in FGMS. Institutional measures should be adopted to help students improve their living conditions. Furthermore, institutional leaders should spearhead the destigmatisation of psychological disorders and advocate help-seeking behaviours when students need mental help, particularly when they are anxious or depressed.

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Based on potential risk of torsade de pointes (TdeP; a rare arrhythmia), regulatory agencies have issue warning for two specific antidepressants. This has translated in clinic as a class effect in that every antidepressant monography or guideline warns against this side effect. Current data suggest that excessive caution in the face of this undesirable effect could have a deleterious effect on mortality. Most research on antidepressant/antipsychotic drugs and TdeP is based on its intermediate marker, the corrected QT interval (QTc) on the electrocardiogram, or case reports.

Our objective is to measure the contribution of psychotropic drugs (antidepressants and antipsychotics) to the arrhythmia itself, and measure its weight among all other risk factors.

We completed a retrospective case-control study at the Montreal Heart Institute, with a 1:3 ratio (n=440). We performed hierarchical logistic regression for TdeP (cases vs controls), and included the following independent variables: sex, age, hypokalemia, acute myocardial infarction, left ventricular dysfunction, hepatic failure and/or renal failure, other QTc-prolonging drugs, and psychotropic drugs. We then calculated population attributable risks (PAR).

In our final model which adjust risk factors for one another, women, acute myocardial infarction, hypokalemia, left ventricular dysfunction, QTc-prolonging drugs, and use of ≥2 antidepressants were significantly associated with TdeP. Age, hepatic and/or renal failure and antidepressants/antipsychotic drug monotherapy were not. The PAR for use of ≥2 antidepressants was 6.3%, while those of other QTc-prolonging drugs, female sex, and left ventricular dysfunction were 55.1%, 41.8%, and 25.6%, respectively.

When adjusting for concomitant risk factors, monotherapy with antidepressant or antipsychotic drugs is not associated with TdeP. On its side, the use of ≥2 antidepressants is associated with TdeP, with a PAR of lesser magnitude than sex, left ventricular dysfunction, and other QTc-prolonging drugs. This research provides a more nuanced perspective on the relationship between psychotropic drugs and the occurrence of this arrhythmia.

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Autism Spectrum Disorder (ASD) is a complex neuropsychiatric disorder characterized by deficits in social interaction, anxiety and the presence of repetitive-ritualistic behaviours. Recent studies suggest that epigenetic mechanisms, such as histone methylation, play a crucial role in the etiology of ASD by regulating gene expression linked to neuronal differentiation and proliferation. The enzyme, G9a is responsible for histone H3K9 methylation, and its inhibition has shown promise in altering epigenetic pathways associated with ASD onset and progression. Similarly, histamine H3 receptor (H3R) has long been recognized as a potential therapeutic target for ASD treatment

This study aimed to investigate the dual action of A-366, a potent G9a inhibitor with high and selective H3R antagonistic affinity, on the ASD-like behaviours and neuroinflammation of male BTBR T+tf/J mice model.

Male BTBR T+tf/J mice were housed under standard conditions and treated chronically with A-366 (0.5-2 mg/kg, i.p.) for 21 days. ASD-like behaviors were assessed using the Marble Burying Test, Nestlet Shredding Test, Self-Grooming Test, Spontaneous Alteration Test, Elevated Plus Maze, Light Dark Box, and Three-Chamber Test. Following behavioral testing, cerebellar and hippocampal brain tissues were analyzed using ELISA to quantify pro-inflammatory markers (TNF-α, TNF-β, IL-6, IL-1β, TGF-β) and immunohistochemistry for Iba-1 expression to evaluate neuroinflammation.

A dose dependent decrease of repetitive and anxiety-like behaviours as well as amelioration in social deficits was observed in response to the chronic systemic treatment of A-366 (0.5-2 mg/kg, i.p.). Moreover, A-366 decreased neuroinflammation in cerebellar and hippocampal brain tissues of treated BTBR mice, as evidenced by the reduction in proinflammatory markers TNF-α, TNF-β, IL-6, IL-1β and TGF-β, as well as the decrease in Iba-1 expression.

This in vivo study demonstrates the potential therapeutic value of A-366 as a dual-targeting agent for G9a and H3Rs, with modulatory role on epigenetic, neuroinflammation, and brain histaminergic neurotransmission. Therefore, A-366 is expected to provide a lead template for future design and synthesis of a novel, potent and selective class of drugs to target ASD features.

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The progressive acquisition of autonomy, balanced with adequate supervision, is essential during psychiatry residency. However, the adequacy of supervision and the smooth transition to autonomy remains a concern among residents. This study evaluates psychiatry residents’ perceptions of the current process of acquiring autonomy from the first to fourth year of training.

To assess the perceptions of psychiatry residents in Spain regarding the process of progressively acquiring autonomy and how supervision is managed throughout their residency.

A qualitative analysis was conducted on responses to the survey question: “What should be improved in the progressive acquisition of autonomy and supervision from R1 to R4?” Data from free-text responses were coded thematically, with common themes identified and quantified.

Responses from 109 residents were analyzed. Thematic analysis revealed that 35% of residents emphasized the need for clearer and more structured feedback from supervisors, while 30% suggested more direct supervision during critical learning periods, particularly in the first two years. Additionally, 20% highlighted the inconsistency of supervision across different units, with some units providing much less oversight than others. Other suggestions included better scheduling of supervisory sessions (10%) and more frequent formal evaluations of their autonomy progression (5%).

Residents identified several key areas for improvement in the process of acquiring autonomy, with a particular focus on the need for more structured feedback and increased supervision during the early years of training. Addressing these concerns may improve the overall quality of psychiatric education and resident preparedness.

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Parkinson’s disease (PD) is characterized by basal ganglia dopamine depletion, leading to motor symptoms. Psychiatric symptoms, like psychosis, are associated with dopamine overactivity in the mesolimbic and mesocortical system. PD patients sometimes require both motor and psychiatric treatment. However, the pharmacologic treatments for each have opposing dopaminergic effects. Understanding the balance between dopamine antagonists to treat psychosis while increasing dopamine agonists (DAs) to treat PD is a difficult clinical task.

We aim to explore how dopamine agonists and antagonists affect the responsiveness of dopamine receptors in various brain regions.

We conducted a comprehensive literature review on pharmacological management of patients with PD and concurrent psychiatric symptoms. Special attention was given to balancing dopamine agonists (e.g., Carbidopa-Levodopa) for PD and dopamine antagonists (e.g., Quetiapine) for psychiatric symptoms.

While dopamine agonists and antagonists appear counterintuitive when used concurrently, their efficacy is contingent on target brain regions. DAs (Carbidopa-Levodopa) are most beneficial for increasing dopamine deficits in the striatum and nigrostriatal pathway, where voluntary movement is controlled. In PD, this pathway is primarily affected, and DAs are used to target the striatum’s high concentration of D1 and D2 sub-receptors. Gold-standard DAs mainly target D1 and D2 receptors.

Dopamine antagonists mitigate excess dopamine activity in the mesolimbic and mesocortical systems, which affect reward, memory, and executive functioning. These systems possess a high concentration of D3 and D4 sub-receptors. Typical antipsychotics have strong D2 receptor affinity, making them counterintuitive to DA motor treatment. Atypical antipsychotics have partial D2 affinity, but also readily bind D3 and D4. Some atypicals minimize D1/D2 affinity to allow DAs to be more effective. Quetiapine is currently used for psychosis in PD, but the drug’s MOA is not fully understood. Cariprazine binds D3 well but does cause extrapyramidal effects with its D2 affinity. Clozapine strongly binds D4 but can have severe adverse effects. Additionally, pramipexole and ropinirole have strong D3 and D4 affinity. Ultimately, the key lies in symptom control: achieving optimal motor function while controlling psychiatric manifestations.

PD management with concurrent psychiatric disease requires diligent pharmacologic balance of countering dopamine treatments. Dopamine agonists and dopamine antagonists do have opposed pharmacodynamics, but clinicians must understand that certain pharmacologic agents do not all target the same brain area nor dopamine sub-receptor. Clinicians must use this pharmacologic knowledge to carefully balance these therapies by adapting to the individual patient’s symptomatology and treatment response.

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Depression is increasingly linked to immunological processes. Therefore, immune-based therapies, e.g., celecoxib, are being tested as augmenting treatment strategies. Many physiological processes during life are also linked to immunological changes. We tested the hypothesis that age affects treatment efficacy in a randomized controlled sample treated with the anti-inflammatory agent Celecoxib.

We test the combined role of age and an anti-inflammatory augmentation treatment for treatment response in depression. For a more in depth understanding we investigated the role of six methylation-based cell-types in these immunological processes in a second step.

113 individuals with a diagnosis of major depressive disorder were included in our analyses (Mage=44, 56% women, MMADRS= 27.7). All patients were treated with Vortioxetine and recruited stratified by high sensitive C-Reactive Protein (hsCRP; <= 3 vs. > 3 mg/L)> 3mg/L). Based on a randomized controlled design, augmentation with Celecoxib was administered to 55 patients. A second assessment was performed after 6 weeks of treatment (MMADRS 6W= 20.2). Cell type compositions of neutrophils, monocytes, B-cells, CD4+ and CD8+ Lymphocytes, and natural killer cells (NK), were estimated based on epigenome-wide DNA methylation markers (Illumina Infinium MethylationEPIC 850k BeadChip) using the Houseman method. Analyses were performed with linear regression models with MADRS6W as outcome. Our hypothesis was tested in the full sample. The additional analyses were performed stratified by age. All models were corrected for sex, hsCRP, and depression severity at baseline.

Our analysis showed a statistically significant interaction between age and treatment condition on depression outcome (p=0.040), with significant main effects for both variables in the model (intervention: p=0.045, age: p=0.022). Sex and hsCRP were no statistically significant contributors. The intersection was identified at 45.5 years. Younger individuals treated with celecoxib showed a more pronounced reduction in MADRS (Mreduction=-9.6), than older individuals treated with the same condition (Mreduction=-5.5). The stratified individuals younger than 45 years, showed that neutrophils were associated with better treatment outcome (p=0.028), whereas for individuals older than 45 years this was the case for B-cells and NK cells (p=0.011, and p<0.001, respectively).

Our results indicate that immunological profiles in depression and in relation to treatment may be age-dependent, which can have major consequences for treatment success with anti-inflammatory augmenting strategies. Replication in an independent sample is needed to confirm the role of age in immune-focused treatment strategies for depression.

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Since 2001, the world has encountered an increase in terrorist attacks on civilian targets, during which conventional as well as unconventional modalities are being used. Terrorist attacks put immediate strains on health care systems, whilst they may also directly threaten the safety of first responders, health care workers, and health care facilities.

This scoping review aimed to systematically map the existing research on terrorist attacks targeting health care facilities, health care workers, and first responders, and to identify opportunities to improve future research and health care response to terrorist attacks.

A scoping review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. A systematic search for relevant literature was conducted through electronic databases including PubMed, Cochrane, and Embase. Inclusion and exclusion criteria were applied to check eligibility. Extracted data from the articles included the title, first author, year of publication, journal, study design, number of attacks, number of injured, number of fatalities, target type, and weapon modalities. Furthermore, methodological quality assessment was performed.

The initial search within three major databases yielded 4,656 articles, including 2,777, 1,843, and 36 articles from PubMed, Embase, and Cochrane Library, respectively. Finally, 11 studies were included, which were all database reviews.

This scoping review included 11 studies focusing on terrorist attacks against health care facilities, health care workers, and first responders. Nearly all studies were exclusively based on the Global Terrorism Database (GTD). An increase of attacks on health care-related targets was consistently reported by all studies in this review, but there were significant discrepancies in reported outcomes. In order to improve counter-terrorism preparedness and the future protection of health care workers, counter-terrorism medicine (CTM) research may benefit from a more standardized and transparent approach to document and analyze terrorist attacks, as well as the inclusion of additional databases other than the GTD.

Electroconvulsive therapy (ECT) is a treatment received by approximately 1.4 million people worldwide annually, depressive disorder being the most prevalent indication. Retrograde autobiographical amnesia (RAA) refers to difficulties in retrieving memories of past events. Despite being the most commonly reported side effect of ECT, its nature, duration and impact on patients’ lives remains uncertain.

(1) Assessing RAA severity in patients treated with ECT for depression compared with other treatment methods. (2) Assessing RAA severity in patients treated with right unilateral (RUL) vs bilateral (BL) ECT for depression. (3) Assessing overall RAA severity (pre-post effect) following an acute course of ECT. (4) Summarising patients’ lived experiences of RAA following ECT for depression.

This systematic review was registered prospectively with PROSPERO (CRD42024445105). Seven databases were searched for eligible articles. Quantitative and qualitative studies assessing RAA in patients treated with ECT for depression published since 1985 were included. Abstract, full-text screening and data extraction were done in duplicates and independently. Quantitative data were meta-analysed using random effects model and qualitative data were analysed using thematic meta-synthesis.

Of initial 6126 records, 22 quantitaive and 20 qualitative studies were included. ECT caused significantly greater RAA compared with other treatments (SMD -0.73, 95% CI -1.31; -0.15, I2=54%, Figure 1). BL treatment caused significantly greater RAA than RUL (SMD -0.29, 95% CI -0.57; -0.01, I2=32%, Figure 2). The pre-post effects were big for RUL (SMD -0.77, 95% CI -1.15; -0.38, I2=93%, Figure 3) and BL ECT (SMD -1.16, 95% CI -1.79; -0.52, I2=93%). The main effect moderator was RAA assessment tool. Few studies reported delayed effects of ECT on RAA. Four analytical themes were identified from qualitative data: (1) Uncertainty regarding the cause, nature and severity of memory loss may cause distress for patients, undermine the quality of information provision and post-ECT care. (2) Ambiguous testimonies – perception of memory loss often shaped by ECT effectiveness. (3) Returning to ‘normal’ daily life may be a challenging, frustrating and lonely process, which requires developing adaptive coping strategies. (4) Some memories may not come back for years; re-leaning facts about oneself and reshaping own identity may be important steps on the journey to recovery.

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ECT causes more severe (sometimes long-lasting) RAA than other forms of treatment with BL being more harmful than RUL. RAA measurement is not unified hindering identifying technical aspects of ECT, which may impact memory loss. Information provision and post-ECT care could be improved by reducing uncertainty around the nature and severity of RAA.

None Declared

Psychiatric diagnosis plays a key rol in the mental health care. One of the critical factors that influence the diagnostic process is inter-rater reliability, the degree to which different raters agree on the diagnosis when assessing the same patient. Despite the availability of standardized diagnostic manuals, variability in psychiatric diagnoses persists. The assessment of inter-rater reliability involves calculating statistical measures which quantify the level of agreement between raters beyond what would be expected by chance. Improving inter-rater reliability in psychiatric diagnoses is necessary for optimizing both patient care and research quality in mental health.

Assess inter-rater reliability across main psychiatric disorders and identify the sources of variability.

This study was performed according to the PRISMA guidelines and a total of ninety-three studies were included. Regarding inclusion criteria, (1) the articles had to focus on inter-rater reliability, (2) study participants had to have an average age greater than 18 years, and (3) the reported diagnoses had to refer to a diagnostic manual. Quality scores were assessed for all included studies (Armijo-Olivo S et al. J Eval Clin Pract. 2012; 18 12-8). Seven different meta-analysis were conducted, one for each psychiatric diagnosis detected. The heterogeneity between studies was quantified using Cochran’s Q and I2. Funnel plots was analyzed to assess the possible influence of publication and location biases (Higgins&Green. BMJ. 2011;343). To account for publication bias, the Eggers’ test and the Fail-Safe Number31 was applied.

Psychotic disorder: (k=0.70; 95% CI: 0.66-0.75) (I²=97%).

Anxiety Disorders: (k=0.65; 95% CI: 0.60-0.70) (I²=91%).

Obsessive-Compulsive Disorder (OCD): (k=0.73; 95% CI: 0.64-0.82) (I²=76%)

PTSD: (k=0.60; 95% CI: 0.52-0.66) (I² =84%).

DCA: (k=0.73; 95% CI: 0.67-0.79) (I² =76%).

two different meta-analysis were conducted because many studies used Intraclass Correlation Coefficient (ICC) as a value to express inter-rater agreement. [k=0.65 (95% CI: 0.59, 0.7)] (I2= 96%) (ICC=0.85; 95% CI: 0.82-0.87) (I² = 66%).

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The lower Kappa for schizoaffective disorder (Kappa < 0.7) compared to other psychiatric disorders underscores the diagnostic challenges posed by this category, given its overlapping symptoms with both mood and psychotic disorders. As regards personality disorder, antisocial and borderline PD showed highest agreement potentially due to its well-defined diagnostic criteria. The lowest agreement (k=0.60) of PTSD emphasizes the variability of his clinical presentation. In conclusion, studies show variability across disorders, highlighting the need for further research to improve diagnostic accurac (Regier et al. Am J Psychiatry. 2009;166 645-50) thereby enhancing clinical and research outcomes.

None Declared