Cognitive distortion is a central feature of depression, encompassing dysfunctional personality styles and attitudes, and negative thinking. One of the cognitive schemas characteristics of depressed individuals is the tendency to overestimate causal responsibility for negative events, but not for positive ones. Total sleep deprivation (TSD) has been shown to cause rapid and sustained antidepressant effects in depressed patients and to revert the biased self description present in these patients.

The aim of the study was to investigate if TSD treatment would change cognitive distortion in a sample of patients diagnosed with major depressive disorder (MDD).

Seven patients with MDD (all females), completed the Cognition Questionnaire (CQ) to assess cognitive distortions and were assessed before and after TSD treatment. TSD protocol involved three cycle of sleep deprivation, each one lasted 36 hours and was followed by a night of recovery sleep. Light therapy was administered for 30 minutes at 3 am during waking nights and in the morning after the recovery sleep.

A significant reduction of the depressive symptomatology was observed at both objective (Hamilton depression rating scale -HDRS F=9.85, p=0.008) and subjective (Beck depression Inventory – BDI F=54.73, p<0.001) measures. Investigating the 5 dimensions assessed through the CQ, we observed that the reduction of the dimension “attribution of causality” ( r=-7707, p=0.043) and the total CQ score (r=-.8865, p=0.008) after TSD were significantly associated with the reduction of depressive symptomatology as measured by the BDI.

This is a preliminary study on the effect of TSD treatment on cognitive distortion in MDD. TSD treatment improved not only clinical symptoms but also cognitive distortion. Our preliminary findings suggest that TSD could be added to antidepressant treatment to rapidly improve the depressive symptomatology and cognitive distortion which may hamper the compliance with pharmacologic treatments and consequently the reduce the possibilities of a favouble outcome of pharmachologic interventions.

None Declared

Body dysmorphic disorder is a diagnostic entity within the somatoform disorders of the obsessive-compulsive spectrum according to the DSM-V. Its prevalence is between 0.7% and 2.5%, being more frequent in men and usually beginning in adolescence or early adulthood. Its central symptom is cognitive distortions regarding appearance, with concern about imaginary physical defects, slight or even invisible to others and in some cases close to a delusional condition.

To delve deeper into the clinical aspects and nosological conditions through the description of a clinical case.

This is a 16-year-old patient who was admitted three times to the Acute Psychiatric Unit of the Puerta de Hierro Hospital due to behavioral disorders in the context of dysmorphophobia with intense concern about the shape of his nose. The patient gradually abandoned his daily routines, stopped attending classes at school and isolated himself from his social circle.

He is the youngest of two sisters. He lives with his parents and sister. He had good academic results until the time of diagnosis.

The patient’s concern about his nose began at about age 15, coinciding with the diagnosis of leukemia of his mother, who was undergoing chemotherapy treatment. The patient reports that the symptoms have increased until causing significant functional limitation.

He says that his nose is very large and he doesn’t allow anyone to see it. He leaves the house wearing a mask, performs rituals of checking it for hours in front of the mirror and has even manipulated his nose with objects to try to deform it. He appears to have a delusional component with significant emotional and behavioural repercussions.

Several pharmacological treatments were started, including SSRIs (sertraline) and various antipsychotics (risperidone, pimozide and olanzapine), with little response in all cases. Psychotherapeutic treatment was carried out in a day hospital for adolescents, but this was also unsuccessful. Finally, he was involuntarily transferred to a Medium Stay Unit given the significant impact of the symptoms on his life, showing progressive improvement after several months of treatment.

The nosology of TDC has evolved: the DSM IV specified a delusional variant within the psychotic spectrum and a non-delusional one within the somatoform spectrum. The DSM V integrates it within the obsessive-compulsive spectrum. In order to assess a correct treatment, a continuum could be established between TDC and eating disorders. Both present similar symptoms: dissatisfaction and distortion with body image, need for continuous checking and concern about imperfections in perceived appearance. Given the chronicity of TDC and the tendency to abandon treatment in the first months, long-term follow-up by a multidisciplinary team is necessary, as well as psychoeducation and the establishment of a solid therapeutic alliance.

None Declared

Post-traumatic stress disorder (PTSD) is an anxiety disorder that develops when a person is exposed to death, perceives a threat to their safety, or witnesses a traumatic event, either personally or vicariously. It is a condition that affects over 70% of adults who have experienced trauma at least once in their lives. What happens in the case of individuals who have attempted suicide? Do they also frequently develop PTSD?

To determine if individuals who have attempted suicide are at risk of developing PTSD as a result of their suicide attempt. If such a connection is proven, what therapeutic measures could be proposed to prevent the onset of this disorder?

This is a descriptive study using a survey of patients at the Department of Psychiatry D at RAZI Hospital, who have made one or more suicide attempts during the year 2023.

20 patients (80%) exhibited a moderate to severe depressive episode at the time of their suicide attempt. The average number of suicide attempts was 1.53. The methods used for the suicide attempts included medication ingestion, observed in 15 patients (60%), phlebotomy in 4 (16%), jumping from a height in 2 (8%), hanging in 2 (8%), and ingestion of toxins in 2 (8%). 14 patients (56%) required hospitalization in a medical unit following the suicide attempt. 9 out of 25 patients (36%) developed PTSD according to DSM-5 criteria.

A significant proportion of suicide attempt survivors may develop PTSD related to the suicide attempt. PTSD related to a suicide attempt could serve as a viable target for assessment and intervention to improve quality of life and reduce the risk of future suicide among individuals who have attempted suicide. However, more studies are needed to evaluate the risk of PTSD in this population.

None Declared

The development of artificial intelligence (AI) has led to significant advancements in various fields, including mental health applications. As AI technologies like ChatGPT continue to evolve, questions have arisen about whether AI can eventually develop a true personality, and what implications this might have for fields such as psychology and psychiatry. Isaac Asimov’s ideas about AI and the Turing test have gained renewed attention, yet these frameworks do not address the core psychological components such as empathy, emotion, and personal interaction—key elements in therapeutic settings.

This article explores whether AI could develop a personality and replace human therapists in psychological counseling and psychiatry. Specifically, it aims to evaluate AI’s current capabilities in providing emotional and psychological support and to address whether AI can evolve to meet therapeutic practice’s deeper, human-centered requirements.

The analysis is based on reviewing current AI applications in mental health, such as AI-based therapy platforms for post-traumatic stress disorder (PTSD), which provide symptom management tools and promote adaptive coping strategies. These applications were compared to the human therapist’s role, focusing on emotional interaction, empathy, and the therapeutic relationship. Additionally, the philosophical and psychiatric aspects of personality formation in both humans and AI were examined.

AI systems have made progress in simulating therapeutic techniques, providing guidance, and mimicking emotional responses. They can support symptom relief and enhance coping strategies, especially in areas where human therapists are scarce. However, AI’s ability to engage with deeper aspects of the therapeutic process, such as emotional empathy and personal connection, remains limited. AI lacks subjective experience, emotional depth, and self-awareness—essential factors for forming a genuine personality.

While AI has the potential to augment clinical practice, it cannot replace the human element in therapy. The development of AI-based tools is valuable for symptom management, but psychotherapy is inherently rooted in human connection, intuition, and emotional engagement—qualities AI does not possess. For AI to truly replace human therapists or develop a personality, significant advancements in consciousness and emotional cognition would be required, which remain speculative at this stage. Thus, AI will likely continue to serve as a supportive tool rather than a replacement for human therapists in the foreseeable future.

None Declared

Personality disorders are defined as maladaptive traits of personality and behavior causing severe harm to an individual or people around them. Personality development is closely related to identity development. Higher prevalence on personality disorder diagnoses has been found to be associated with gender dysphoria. However, previous research on this topic has been scarce and methodically varying (Table 1, Image 1&2).

The object of this research was to determine the prevalence of personality disorder diagnoses in individuals requesting medical gender reassignment.

A register-based follow-up study of individuals who contacted the nationally centralized gender identity services in Finland in the period 1996-2019 (n=3,665) and 8:1 age and sex-matched population controls (n=29,292). All their specialist-level psychiatric treatment contacts in 1994-2022 were identified in the National Care Register for Health Care. ICD-10 diagnoses and dates of the contacts were extracted.

Among the gender dysphoria group, 15.0% (551 out of 3,665) had received a diagnosis in the personality disorder group (F60-69 excluding F64.x) in specialized psychiatric health care, while among the control subjects, 2.1% (625 out of 29,292) had received such a diagnosis (Table 2). The most common personality disorder among the gender dysphoria group was borderline personality disorder.

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Personality disorders are overrepresented among those seeking medical gender reassignment. Further research is needed to explore the factors contributing to the higher prevalence of personality disorders among individuals with gender dysphoria.

None Declared

The COVID-19 pandemic significantly impacted the population in Russia, particularly students, who were forced to radically restructure their daily lives rhythm due to the introduction of distance learning, more homework, increasing the share of self-education. These factors could provoke the emergence of a particular psychopathological syndrome — asthenia, which is characterised by general and mental weakness, increased exhaustion, irritability, decreased productivity of cognitive processes, decreased motivation, sleep disorders and other psychosomatic disorders. These symptoms, in turn, could be associated with changes in the student’s quality of life.

The study aimed to assess the level of asthenia among students in humanities programs and to examine the relationship between asthenia indicators and quality of life.

Data collection was conducted from January to April 2021 through a specially developed Google form. Thirty-five students at the universities of the Russian Federation took part in the study. We used MFI-20 to assess the level of asthenia, and WHOQOL-BREF to study the life quality. Both questionnaires were adapted for Russian-speaking respondents.

We found that 31% of respondents had symptoms of general asthenia, 29% had symptoms of decreased activity, 26% had symptoms of decreased motivation, 71% had symptoms of physical asthenia, and 26% had symptoms of mental asthenia. No statistically significant correlations were found between asthenia manifestations and life quality indicators. However, significant direct correlations were obtained between all quality-of-life domains, except for “microsocial support” and “social well-being”.

In the conditions of the COVID-19 second wave, most students in Russia demonstrated physical asthenia symptoms. Asthenia manifestations were not related to the student’s life quality. Students in the pandemic conditions should observe the sleep, rest regime and optimal physical activity. Among students in Russia, the microsocial aspect of life quality (relations with partners, sexual life, relations with friends) are fairly detached from the broader social context (e.g. everyday life safety, healthy physical environment, and so on).

None Declared

This study examines the intersection of mental health services and gender-based violence (GBV) in Moldova, identifying knowledge gaps and assessing service capacity through a mixed-methods approach, including focus groups and a national KAP survey. The findings highlight the urgent need for specialized training and evidence-based interventions to improve mental health outcomes and GBV responses.

The study aimed to develop targeted interventions and training programs to enhance the capacity of mental health professionals in Moldova to address mental health challenges and gender-based violence (GBV) by identifying knowledge gaps, assessing practices, and providing actionable insights for improved service delivery and outcomes.

The study used a mixed-methods design, combining quantitative surveys and qualitative focus groups to assess knowledge gaps and training needs among mental health professionals in Moldova. A cross-sectional survey gathered quantitative data on perceptions of knowledge gaps, confidence, and training needs from a representative sample of professionals, including CCSM coordinators. Focus group discussions, held on the same day, provided qualitative insights into their challenges and suggestions for service improvement. This approach offered both breadth and depth, leading to evidence-based recommendations for addressing the identified gaps in knowledge and training.

The study uncovered major knowledge gaps among mental health professionals in Moldova, particularly in psychopharmacology, child and geriatric psychiatry, and gender-based violence (GBV) management. These gaps, identified via surveys and focus groups, reflected a lack of confidence in applying modern protocols and navigating legal aspects. There was a strong call for continuous professional development, especially through structured training in underserved regions. Inadequate training negatively affected the quality of care, particularly in GBV cases, though professionals were eager to improve their skills despite regional disparities in resources. The findings underscore the need for targeted training and better resource allocation.

The study concluded that mental health professionals in Moldova face significant knowledge gaps, particularly in psychopharmacology, child and geriatric psychiatry, and managing gender-based violence (GBV). These gaps, along with insufficient training, negatively impact care quality, especially for GBV cases. Despite motivation to improve, professionals face challenges like limited access to updated training and regional disparities in resources, highlighting the need for structured, continuous training and equitable resource distribution to improve mental health services nationwide.

None Declared

Communicating bad news is a common occurrence in the healthcare sector, especially in emergency services. However, it is also recognized as one of the most stressful, uncomfortable and difficult moments. Clinicians may appear cold, exhibiting depersonalized communication, or feel detached and overwhelmed due to a lack of training in communicating bad news. Therefore, it is crucial to develop their skills in communicating bad news to improve their proficiency in these challenging situations.

The purpose of this study is to comprehend the specific needs of clinicians when delivering bad news to emergency patients, and to identify effective strategies for tailoring educational programs to the demands of emergency healthcare. Additionally, the study aims to identify differences and similarities across two geographic and cultural settings.

A group of emergency health professionals working in Portugal and Brazil were invited to participate in the study. We will collected sociodemographic data and performed a professional characterization. Participants will describe their experience and training in delivering bad news in emergency settings and preferences regarding methods and design of communication skills training. The evaluation included clinicians self-evaluate their knowledge, skills, and application of seven relevant skills (adapted from Breaking Bad News, Servotte et al 2019).

We expect clinicians from emergency health units in Portugal and Brazil to identify specific strategies applied when delivering bad news, and how theoretical knowledge and previous training imbed their sense of capability. Sociodemographic and professional characteristics are probable factors influencing clinicians’ self-perception of communicating bad news to emergency patients and families.

Breaking bad news can be challenging for clinicians due to the complexity of communication and the emotional intensity involved. This highlights the need for tailored training programs that are culturally adapted and focused on clinicians’ needs and preferences. Albeit speaking the same language differences in the healthcare setting (Portugal vs. Brazil) must be considered when designing educational interventions.

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Participatory research can enhance the relevance, quality, and impact of studies, increase recruitment, and optimize research methods. It can also help to secure third-party funding,. The participatory inclusion of forensic psychiatric patients in research has so far primarily been implemented in the UK. With the establishment of the PART advisory board, founded in December 2023, this gap is intended to be closed in Germany by creating sustainable, previously lacking structures for the involvement of forensic psychiatric patients. The acronym PART refers to participation/ participatory. In the PART advisory board, people with lived experience and researchers actively cooperate in projects in the field of forensic psychiatry. In preparation for their role, people with lived experience received training where they were provided with knowledge and skills for their work. The board has now advised several research projects and issued recommendations.

The purpose of this presentation is to critically reflect on the first experiences and consider how to incorporate these insights to improve the structure and working methods of the advisory board: What experiences have researchers, people with lived experience and those presenting their research projects made? How were participants involved? What impact did the advisory board have on specific research projects? What challenges arose, and how were they addressed? What are the lessons learned so far?

To answer these questions, various evaluation tools were used. These include feedback questionnaires from participants assessing each advisory board meeting and project presentation, interviews with participants at least two times throughout the project, statements from the advisory board to project presenters, and responses from the presenters on how the board’s recommendations were implemented. Additionally, the perspectives of involved project staff were considered.

By the time interim results are presented at the EPA Congress 2025, the PART Forensic Advisory Board will have met at least 12 times and at least five research projects will have been presented to the board and received its recommendations. It has already become clear that involving participants, especially in forensic psychiatric settings, requires specific framework conditions. These address overarching structural aspects, disease specific patient relevant needs, as well as knowledge- and method-based issues relevant to participants.

Even at this stage, the advisory board can be considered successfully implemented. Participatory research with people with lived experience in forensic psychiatric settings is possible, feasible, and above all, meaningful.

None Declared

The term “quality of life” is widely used in the world community, has an interdisciplinary concept that characterizes the effectiveness of all aspects of human life. But it should be understood that its main component is the psychological and psychiatric part, which is based on self-perception. And in this regard, it is obvious that the degree of quality of life of patients with pituitary tumors, manifested by a complex clinical picture, sometimes a multi-component treatment strategy, is important for understanding, diagnostics and correction.

to assess and compare the degree of quality of life in patients with pituitary tumors.

120 patients (18-79 years old) after surgery for diencephalic tumor, 2019-2022. The following scales were proposed: 1) assessment of the severity of cognitive impairment and social maladjustment - the Global Deterioration Rating (GDR) scale (stages 1 to 7, where 1 is no impairment/deficit); 2) assessment of the general condition of cancer patients - the Karnofsky index (from 0% to 100%, where 100% is normal condition, no complaints); 3) a short version of the quality of life assessment (SF-12, 2000). All patients were examined dynamically by a psychiatrist.

The quality of life was assessed during treatment, when the degree: improves, remains unchanged, worsens. Different dynamics were noted with different tumor morphology, volumes of surgical intervention, and course of recovery after surgery. Thus, after surgery, the number of patients with severe disorders in large and giant tumors, especially with spread to the third ventricle (according to the Karnofsky and GDR scales), increased, respectively, they were found to have a low degree of “quality of life”. The use of questionnaires (SF-12) showed the inappropriateness of their use, since 33-78% of patients (with different tumor morphology) showed personality changes, they were not fully aware of their condition. Assessment by scales revealed the following features: 1) A large sample, no universal; 2) Mostly self-questionnaires, which is questionable due to the high percentage of patients with lack of criticality, inadequate assessment of the situation and themselves; 3) Conducted by different specialists; 4) To interpret the results, an assessment by a psychiatrist is necessary. Patients with pituitary tumors were divided into: 1) with pronounced health problems - sufficient quality of life; 2) with minimal symptoms - deeply “unhealthy”.

In assessing the “quality of life”, the primary factors are not the symptoms of the disease and their manifestations, but the perception of oneself and the ability to feel “happiness”. In the case of pituitary tumors, non-specific scales and self-questionnaires should be used with reservations; for the adequacy of the interpretation of the results, it is worth comparing the data with the psychiatric report.

None Declared

Problematic cannabis use is prevalent among individuals with first-episode psychosis (FEP), with 35.6% meeting criteria for comorbid cannabis use disorder (CUD) (1). Cannabis use is associated with poorer FEP outcomes, including higher psychosis relapse risk (2). However, evidence on effective pharmacological treatments and long-term outcomes for FEP+CUD remains limited.

To evaluate outcomes of FEP with comorbid CUD and assess the real-world effectiveness of antipsychotic treatments in this population.

This study analyzed a Swedish nationwide cohort using longitudinal register data (2006–2021). The sample included 1,820 patients with FEP+CUD (84.7% male, mean age 26.8 years). Outcomes included hospitalizations for psychotic relapse, any psychiatric disorder, or substance use disorder (SUD). Associations between antipsychotic use and outcomes were assessed using within-individual Cox regression models. Mortality rates were compared across FEP+CUD (n=2,154, mean age 25.0 years), cannabis-induced psychosis (CIP, n=1,263, mean age 25.0), and FEP without SUD (n=17,589, mean age 27.4), adjusting for age, sex, education, other SUDs, and disability pension status.

Over a mean follow-up of 6.13 years, 76% of participants were hospitalized for psychiatric diagnoses, 63% for SUD, and 61% for psychotic relapse. Antipsychotic use was associated with a 33% reduction in psychotic relapse risk. Clozapine and long-acting injectable (LAI) formulations of risperidone, aripiprazole, and paliperidone showed the greatest efficacy in relapse prevention. Clozapine reduced SUD-related hospitalizations by 86%. Within 10 years, 7.8% of FEP+CUD and 5.2% of CIP patients died, compared to 3.4% of FEP without SUD (adjusted odds ratio [aOR] 2.61, 95% CI 2.19–3.13, and aOR 1.67, 95% CI 1.28–2.17). Suicide was the leading cause of death in all groups, with higher rates in FEP+CUD (aOR 1.94, 95% CI 1.49–2.52) and CIP (aOR 1.70, 95% CI 1.21–2.37) compared to FEP without SUD.

Clozapine and LAI formulations of second-generation antipsychotics (excluding olanzapine) or oral aripiprazole effectively prevent hospitalizations in FEP+CUD. Targeted efforts are needed to reduce premature mortality, particularly from suicide, in FEP patients with comorbid cannabis use disorder or cannabis-induced psychosis.

1. Hunt GE, et al. Prevalence of comorbid substance use in schizophrenia spectrum disorders in community and clinical settings, 1990–2017: Systematic review and meta-analysis. Drug Alcohol Depend. 2018;191:234–258.

2. Bowtell M, et al. Clinical and demographic predictors of continuing remission or relapse following discontinuation of antipsychotic medication after a first episode of psychosis: A systematic review. Schizophr Res. 2018;197:9–18.

S. Niemelä Consultant of: Recordati, Shire-Takeda, Speakers bureau of: Dne Pharma, Lundbeck, Recordati, Shire-Takeda

Suicide is a worldwide leading cause of mortality in youth, estimated to be the second leading cause of death for 10 to 24-year-olds. Increasing suicidality rates prompted worldwide national efforts to implement extensive suicide prevention plans. Those include crisis helplines, brief interventions such as safety planning and lethal means counseling, along with gatekeeper training and social prescribing.

This rapid review aimed to highlight the focus on suicide prevention-related research and review various preventive strategies reported throughout 2024.

Participants from the European Psychiatric Association 2022 Summer School on “Focus on Suicide Behaviours - One Step Beyond” gathered and conducted a rapid, selective review of original research and review articles on the PubMed database using the search term “suicide prevention” with a time restriction to January-September 2024. Of 1529 results, 14 were selectively included depending on their specific discussion topics, such as suicide prevention in the perinatal period, social prescribing, social support system, and social network interventions, and crisis helplines. The main findings of the articles were summarized in specific brief sections.

Suicide being one of the leading causes of maternal mortality, the need for appropriate interventions for preventing maternal suicide was indicated (Gelabert et al. Matern Child Health 2024; 28(9) 1443-1453). Another topic of interest regarding the suicide rates among individuals without a mental disorder diagnosis being as high as one in five suicide attempters emphasized the scarcity of identifying this population’s risk factors (Oquendo et al. JAMA Psychiat 2024; 81(6) 572). A focus on crisis helplines as promising tools with a potential supportive impact on suicide prevention was obtained. Social prescribing, social support systems, and social network interventions were also identified as promising intervention strategies, particularly in adolescents (Dash et al. Front Public Health 2024; 12 1396614, Zheng et al. Prev Med Rep 2024; 39 102654). Gatekeeper training that aims to train community members to identify high-risk individuals and facilitate timely referrals and adequate support were found to have positive effects on gatekeeper behaviours (Spafford et al. Prev Sci 2024).

Recent research in suicide prevention includes an emphasis on adolescent and perinatal suicidality. The evaluated interventions involve crisis helplines, social network interventions, and gatekeeper training. Meanwhile, this review was focused on specific aspects of suicide prevention; thus, its results are limited. Considering particular methodological and ethical challenges in studying the efficacy of suicide prevention interventions, further research encapsulating new approaches is needed.

None Declared

Cannabinoid Hyperemesis Syndrome (CHS) is a condition associated with long-term cannabis use, marked by recurrent episodes of nausea, vomiting and abdominal pain, typically relieved by hot showers—a nearly pathognomonic feature. It often develops after years of heavy cannabis use, with symptoms recurring cyclically every few weeks to months while the individual continues to use cannabis. Symptom resolution is generally observed after cessation. Though cannabis is commonly used to relieve nausea (as in chemotherapy-induced vomiting), in susceptible individuals, prolonged use paradoxically induces these symptoms, presenting a diagnostic and therapeutic challenge. Recognizing CHS is increasingly important as global cannabis consumption rises.

The aim of this study is to review the clinical presentation of CHS, highlighting key diagnostic features, current management strategies and treatment.

A comprehensive case report of a 27-year-old female with a history of heavy cannabis use was conducted. She presented with severe nausea and vomiting for two weeks following reported cannabis cessation. A thorough clinical evaluation was undertaken to better understand the clinical presentation of CHS. Additionally, a literature review was performed using PubMed to gather relevant clinical articles on CHS.

The patient exhibited hallmark features of CHS, including a prolonged history of cannabis use beginning in adolescence, recurrent episodes of severe nausea, vomiting, abdominal pain, the typical compulsive use of hot showers for symptom relief and lack of response to conventional antiemetic treatments. These features, combined with the patient’s lack of motivation to discontinue cannabis despite symptom recurrence, strongly support the diagnosis of CHS. Although she had a history of an eating disorder and presented with the Russell sign and dental damage consistent with chronic vomiting, no psychiatric comorbidities or body image disturbances were identified.

CHS remains an under-recognized condition that poses diagnostic challenges. This case reinforces the need to inquire about cannabis use in patients presenting with cyclic vomiting, abdominal pain and weight loss. CHS symptoms and pathophysiological mechanisms can mimic other important diseases, such as eating disorders or gastrointestinal pathologies. Challenges in managing CHS include patient skepticism regarding the role of cannabis as a cause of symptoms, perceived benefits of cannabis and a lack of other effective therapies. Management of CHS involves both acute symptomatic treatment and long-term cessation of cannabis use. Acute interventions may include fluid resuscitation, haloperidol administration, and topical capsaicin application. However, the only definitive treatment is complete abstinence from cannabis, which leads to symptom resolution in the vast majority of cases.

None Declared

This Quality Improvement (QI) programme aimed to integrate co-production principles into rehabilitation psychiatry to enhance patient-centred care and facilitate positive step-down discharges. The initiative was developed in response to suboptimal audit results, revealing low patient attendance and limited positive discharges within an in-patient psychiatric unit. Recognising the critical role of rehabilitation psychiatry in supporting recovery and reintegration, the programme sought to transform patient engagement through equitable partnerships between patients and healthcare professionals.

The programme’s primary objectives were to:

1. 1. Implement and evaluate co-production within the Care Programme Approach (CPA).

2. 2. Increase patient attendance at CPA meetings and improve positive step-down discharges.

3. 3. Enhance engagement, communication, and shared decision-making to achieve better patient outcomes, including reduced anxiety.

A phased approach was employed, encompassing diagnostic, problem-solving, and evaluation stages. Root cause analyses were conducted using fishbone cause-and-effect diagrams and the 5-Why Technique. The Model of Improvement guided the programme, with change ideas developed and refined through Plan-Do-Study-Act (PDSA) cycles. Interventions included distributing patient information leaflets, staff training sessions, and introducing a structured CPA agenda template. Quantitative analysis using paired t-tests evaluated changes in attendance, discharge rates, and Hamilton Anxiety Rating Scale (HAM-A) scores. Qualitative data were gathered from a co-produced CPA questionnaire, with emerging themes integrated into the project’s evolution through narrative synthesis.

The implementation of co-production yielded significant improvements in patient engagement and discharge outcomes, resulting in a 50% increase in CPA meeting attendance and a 70% positive step-down discharge rate. Interventions were associated with reduced anxiety levels, evidenced by improvements in HAM-A scores. Qualitative analysis highlighted key themes, including challenges during community transitions, empowerment through shared decision-making, and enhanced communication with healthcare professionals. The structured CPA agenda template further improved patient-centred communication and care experiences.

The integration of co-production within rehabilitation psychiatry fosters transformative partnerships that enhance patient engagement and clinical outcomes. This QI programme demonstrates the efficacy of patient-centred interventions, supported by structured communication tools, in empowering individuals, reducing anxiety, and improving transitions to community care. Co-production provides a robust framework for advancing rehabilitation psychiatry and optimising patient care pathways.

None Declared

Tele-rehabilitation (Tele-TR) has emerged as a promising alternative to traditional, in-person cardiac rehabilitation (Conventional-CR), offering accessible and convenient rehabilitation options for patients who may face logistical or health-related barriers to attending conventional programs. Advances in digital health technologies, coupled with the increasing demand for remote healthcare solutions, have led to the widespread adoption of Tele-TR, particularly for patients recovering from cardiac events or undergoing surgery. However, there is a need for a comprehensive evaluation of the comparative effectiveness of Tele-TR versus Conventional-CR, especially in terms of clinical outcomes. Given the rise in mental health concerns among patients undergoing cardiac rehabilitation, the impact of these rehabilitation modalities on psychological well-being, particularly depressive symptoms, has become an important area of focus.

This meta-analysis aims to evaluate the efficacy of Tele-TR in comparison to Conventional-CR, specifically assessing their effects on depressive symptoms. The primary objective is to determine the mean differences in health assessment scores, such as the PHQ-9, across studies that compare Tele-TR and Conventional-CR. By synthesizing the findings from multiple randomized controlled trials (RCTs), this analysis will provide insights into the relative effectiveness of these two rehabilitation approaches, with a particular emphasis on mental health outcomes and their implications for patient recovery and quality of life.

Three studies were included, comparing Tele-TR with Conventional-CR. Outcomes were assessed based on mean differences (MDs) and 95% confidence intervals (CIs) for continuous data. Heterogeneity among studies was quantified using Tau² and I² statistics, and a random-effects model was employed to account for variability across studies.

The analysis of post-treatment improvement in PHQ-9 scores across included studies demonstrated an overall mean difference of -1.94 (95% CI [-4.02; 0.15]), suggesting a trend favoring Tele-TR over Conventional-CR. However, this improvement did not reach statistical significance (Z = -1.82, P = 0.07). High heterogeneity was noted (Tau² = 3.36, I² = 100%, P < 0.01), indicating substantial variability in treatment effects among studies.

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While Tele-TR showed a trend toward improvement over Conventional-CR, the findings did not achieve statistical significance. High heterogeneity suggests differences in study design and patient populations, warranting further research to clarify the potential benefits of Tele-TR and identify the contexts where it may offer the most significant advantages.

None Declared

Medical assistance in dying is an increasingly available option for people suffering (solely) from psychiatric disorders. Initially promoted to alleviate the suffering of terminally ill people, a growing number of jurisdictions are adopting it for any cause of intractable and severe suffering, including mental disorders. Today, the BENELUX countries, along with Spain and Switzerland, explicitly authorise it or allow it de facto. Other countries, such as Canada, are considering implementing it. Although in jurisdictions where it is permitted it is argued that it is discriminatory not to consider mental suffering as sufficient cause, there are reasons for concern. The procedure is likely to be used as an alternative to care, that is, as a gentler form of suicide, more commonly used by women. The long-term impact of this practice must be considered, as it sends the message that mental illnesses may not be curable, and that it is not worth the effort to treat them, or to demand the necessary care. Furthermore, all of these factors must be considered in the context of highly stigmatized disorders to which clearly scarce resources are allocated.

None Declared

Systemic lupus erythematosus (SLE) is a chronic, multisystemic disease that can significantly impact the quality of life (QoL) and self-esteem of lupus patients.

To study the quality of life of female patients with SLE and its relationship with self-esteem.

A descriptive and analytical cross-sectional study was conducted on 50 female patients with SLE followed at the Department of Internal Medicine at Hédi Chaker Hospital, Sfax, Tunisia, from September to November 2023. We used:

• - A socio-demographic and clinical data sheet and the Lupus QoL questionnaire to assess the quality of life of lupus patients

• - The Rosenberg Self-Esteem Scale

• - The mean age of patients was 43.46 ± 11 years. 56% had a medical or surgical history.

• - The mean age of SLE diagnosis was 33.54 years with a mean number of flares of 2.94 years ± 2.473

• - According to the Lupus QoL questionnaire: the mean global score was 59.76± 23.496 [8.8-91.98]. The mean scores in the different domains were: physical health = 58.35 ± 32.571 [0-97], pain = 53.013 ± 33.896 [0-100], planning= 69.33 ± 32.741 [0-100], feeling of being a burden = 71.36 ± 32.694 [0-100], emotional health = 57.71 ± 26.67 [0-95.83], body image = 72.9 ± 24.6 [10-100], fatigue = 40.93 ± 24.462 [0-87.5].

• - According to the Rosenberg Scale: a mean global score of 28.28 ± 8.572 [2-40]. Very low to low self-esteem was found in 50% of patients.

• - Statistically significant correlations between low scores in the domains of quality of life and low to very low self-esteem were found:

  • - Physical health: P = 0.000

  • - Planning: P = 0.042

  • - Pain: P = 0.002

  • - Emotional health: P = 0.004

  • - Fatigue: P = 0.017

  • - Body image: P = 0.007

  • - Global Lupus QoL: P = 0.001

Our results indicate that SLE can impair the QoL of lupus patients in various domains. The same is true for self-esteem. The positive relationship between the two parameters encourages a better understanding of the factors associated with each and highlights the importance of a global approach to improve the management of female lupus patients.

None Declared

The ASD (Autism Spectrum Disorder) Day Therapeutic Unit is a third-level care unit. It consists of 20 beds for the evaluation and treatment of children and adolescents with ASD. In recent years, there has been a significant increase in suicidal thoughts, self-harm and completed suicide in these patients. At the ASD Day Hospital, we offer multidisciplinary and intensive treatment to these patients, but we also want to delve into the causes of this situation: real prevalence, existing psychiatric comorbidities, gender differences, etc. with the aim of being able to improve our clinical and care dedication

The objective is to know the clinical and sociodemographic characteristics of patients with thoughts of death, self-harm and completed suicide, in our autism day hospital.

A review of the clinical history of patients included in the ASD Day Hospital from 2021 to 2023 (both complete) is carried out. The psychiatric comorbidity, age of the patients, gender, multidisciplinary treatment received and average stay are analyzed.

During the years 2021, 2022 and 2023, a total of 255 children (92 women and 163 men) were treated in HD for ASD, with an average age of 11.64 years for women and 11.44 for men. It was found that 40 (15 + 22) of them had suicidal thoughts, where (9 + 16) were women, (6 + 6) men. One patient committed suicide (woman), and 25 presented self-harming behaviors (16 women and 9 men). The most frequently found comorbidities were: anxiety, depression, ADHD and conduct disorders. And the most frequently prescribed drug was fluoxetine, followed by aripiprazole.

Patients with ASD have a high comorbidity with anxiety, depression and behavioural disorders, probably as a consequence of the ongoing socio-family requirements they present. This situation leads to an increase in the prevalence of harmful behaviours and thoughts of death in underage patients, occasionally leading to suicide.

Work on social skills, as well as multidisciplinary intervention, improves the clinical situation of these patients, which should be considered an economic and moral investment for future generations.

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Huntington’s disease (HD) is a hereditary neurodegenerative disorder marked by progressive declines in motor, cognitive, and psychiatric functions. This case report presents a 45-year-old female patient with HD who displayed significant manic symptoms, which later evolved into acute psychosis. Notably, her neuropsychiatric symptoms emerged months before motor deficits. This case aims to raise clinician awareness of the interplay between neuropsychiatric symptoms and HD.

Analyze early neuropsychiatric manifestations, particularly manic and psychotic symptoms; highlight the importance of recognizing these symptoms before the onset of motor dysfunction; and explore the neurobiological mechanisms underlying, including neurotransmitter dysregulation and structural brain changes.

A comprehensive clinical evaluation was conducted for the patient. Her psychiatric history was assessed using standardized tools, including the Young Mania Rating Scale (YMRS) and the Positive and Negative Syndrome Scale (PANSS).

Neuroimaging, including computed tomography (CT), assessed structural brain changes in regions related to mood regulation and psychosis, such as the striatum and prefrontal cortex. A literature review correlated these findings with existing research on neurobiological mechanisms in HD, focusing on neurotransmitter systems and brain morphology.

Initially, the patient exhibited manic symptoms such as elevated mood and irritability, with moderate severity noted on the YMRS. Within a month, her condition escalated to acute psychosis, featuring auditory hallucinations and paranoid delusions, as reflected by moderate PANSS scores. Neuroimaging revealed structural changes consistent with HD, including striatal atrophy and prefrontal cortex alterations. These findings supported the hypothesis of neurotransmitter dysregulation, particularly involving dopamine and serotonin.

The management plan included mood stabilizers and antipsychotics, such as valproic acid and risperidone, along with temporary benzodiazepines to manage agitation. This approach led to a significant reduction in both manic and psychotic symptoms, improving the patient’s overall quality of life through integrated psychiatric care.

This case underscores the importance of recognizing early neuropsychiatric symptoms, particularly manic and psychotic features, in HD patients. The emergence of these symptoms prior to motor dysfunction calls for heightened clinician awareness, as early identification can facilitate timely interventions and enhance patient outcomes. The observed structural brain changes and neurotransmitter dysregulation suggest underlying neurobiological mechanisms, warranting further research in the broader HD population. A multidisciplinary approach is essential for effectively managing the interplay of neuropsychiatric symptoms.

None Declared