Antipsychotics are used to manage psychotic symptoms and reduce the risk of relapse. However, the side effects associated with antipsychotic treatment are seen to hinder societal recovery and happiness by antipsychotic users.

In this study, we investigate the association of side effects, antipsychotic dose and antipsychotic polypharmacy with societal recovery and happiness.

Data from a naturalistic longitudinal cohort was used (PHAMOUS, 2013-2021; n> 3000). Mixed effect linear regression models were used to investigate the association between subjective side effect burden, antipsychotic dose and antipsychotic polypharmacy with societal functioning and happiness. Moreover, the association of single antipsychotic side effects with societal recovery and happiness were investigated with mixed effect linear regression models.

The subjective antipsychotic side effect burden and total antipsychotic dose were both negatively associated with societal recovery and happiness. Polypharmacy was additionally negatively related to societal recovery. Cognition, mood and anticholinergic side effects were most strongly associated with societal functioning. Mood, sedation, cognitive, and sexual related side effect were most strongly associated with happiness.

The association between side effects and the antipsychotic dose and societal functioning and happiness in this population in long term care shows the importance of addressing overtreatment at an early stage. Future research should focus on whether addressing side effects, especially mood and cognition related side effects, is beneficial for societal recovery and happiness in the long-term.

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Attention Deficit Hyperactivity Disorder (ADHD) and Borderline Personality Disorder (BPD) are common psychiatric conditions, with comorbidity rates ranging from 18% to 34% in adults. Both disorders share symptoms such as impulsivity, emotional dysregulation, and interpersonal dysfunction, complicating differential diagnosis. Their frequent co-occurrence may suggest overlapping developmental and environmental risk factors as well as common underlying mechanisms. Particularly for BPD patients, recognizing the shared characteristics between ADHD and BPD may help reduce the stigma surrounding this disorder and eventually lead to a broader range of pharmacological treatment options.

This review aims to explore the links between ADHD and BPD, focusing on their symptomatology overlap, comorbid presentation, shared risk factors and treatment insights in adults.

A narrative literature review was conducted using the keywords “ADHD”, “borderline personality disorder”, “comorbidity” and “adults” in PubMed and Google Scholar databases.

Findings reveal that ADHD and BPD share several risk factors, including genetic predispositions and early-life adversities. Early-life adversity, particularly trauma, is a shared risk factor; however, the type and timing of adversity seem to play differential roles in developing ADHD and BPD symptoms. In terms of clinical presentation, ADHD is characterized by more severe impulsivity compared to non-comorbid BPD, whereas BPD features more severe difficulties in emotional regulation compared to non-comorbid ADHD. The comorbid ADHD+BPD presentation is marked by heightened severity in both impulsivity and emotional instability. The traditional view of ADHD as an early-onset disorder and BPD as a late-onset personality disorder is increasingly questioned, prompting calls for a dimensional diagnostic approach. Recent studies highlight the potential of ADHD medication, particularly stimulant compounds, in reducing suicidal behavior among BPD patients exhibiting ADHD symptoms. Such medications have been found to lower the risk of suicidal behavior in these patients, while other treatments (e.g., antidepressants, antipsychotics, mood stabilizers) did not show similar protective effects.

This review highlights the complex interplay between ADHD and BPD, emphasizing that both disorders should be considered within a dimensional framework rather than as separate categorical entities. Shared symptoms and risk factors underscore the need for integrated treatment approaches that address the combined symptomatology of ADHD and BPD. Future research should focus on understanding the developmental trajectories of these disorders, refining diagnostic criteria, and evaluating the effectiveness of combined treatment strategies.

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Pathological traits according to the dimensional diagnostic system for personality disorders include a certain set of emotional, cognitive and behavioral features. In different people, a certain trait manifests itself in a different behavioral form, while the same trait can manifest itself in several people similarly.

To analyze shoplifting in individuals with borderline personality disorder through pathological traits.

A non-systematized literature review was performed, with keywords: borderline personality disorder, shoplifting, and a case series was presented.

This is a series of three cases of people with borderline personality disorder, who were also assessed according to ICD 11 criteria with LPFS-BF 2.0, PSQ-11 and BPS. The first person is a female, 20 years old, a student, LPFS-BF 2.0 - 34, on PSQ-11 elevated values for all pathological traits, except for anankastia and BPS – 47. She is occasionally depressed and continuously abuses marijuana for a long period of time. The second person is the also female, age 21, student, LPFS-BF 2.0 - 31, on PSQ-11 elevated values for negative affectivity and disinhibition and BPS – 46. Occasionally has obsessive controlling and criticizing thoughts and several episodes of self-harm, incidental substance abuse. The third person is a 20-year-old male, unemployed, LPFS-BF 2.0 - 32, PSQ-11 elevated values for negative affectivity and disinhibition and BPS – 41. He is occasionally paranoid, has a history of self-harm and occasional excessive use of benzodiazepines. All three give information that they occasionally steal from markets and large stores, but they do not steal from people. As a reason for stealing, they cite a lack of funds at a given moment for a particular item they wanted, but also the need to steal, the inability to refrain and the excitement they feel at that moment.

Negative affectivity and disinhibition appear as common pathological traits in all three people. Disinhibition, characterized by impulsivity due to a rush of immediate emotions and thoughts, without thinking about the consequences and the need for immediate gratification, manifests itself in these individuals through shoplifting. Occasional shoplifting, without practice of other forms of stealing, is a disinhibitory phenomenon.

None Declared

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that begins in childhood and persists into adulthood in 35-50% of cases, resulting in a prevalence of 2-4% in the adult population. The core symptoms are inattention, hyperactivity, and impulsivity, while emotional dysregulation is considered an associated symptom. Several lines of evidence support structural and functional brain imaging alterations in ADHD. Decreased volume of the accumbens and amygdala persist from childhood into adulthood, and several resting-state and task-related functional alterations have also been reported.

To investigate differential brain activation patterns in adults diagnosed with ADHD as compared to healthy controls (HC) during an affective Go/NoGo task, to understand the neural background of selective inhibition in emotionally demanding situations.

Data of 61 subjects were analyzed: 34 adult ADHD patients meeting DSM-IV diagnostic criteria (17 women, 17 men, mean age 37.3 years) and 19 HCs (10 women, 9 men, mean age 30.2 years). HCs were screened using the 90-item Symptom Checklist to exclude current psychiatric comorbidity. Symptom severity was assessed using the Conners’ Adult ADHD Rating Scale (CAARS). During the MRI scan in a Philips Achieva 3.0T scanner, we used a block design delivering positive, negative and neutral stimuli from the IAPS System applying a Go/NoGo paradigm. The fMRI analysis focused on contrasts between task and rest, emotional and neutral, and Go and NoGo conditions (activation or deactivation). Contrast between activation and deactivation in the ADHD and HC groups were tested.

Based on the pooled data from both groups, we found significant contrasts between the task and rest conditions, including an activation of primary and secondary visual cortex, frontal areas, corresponding to the Visual Network (VN), the Dorsal- and Ventral- Attention Networks (DAN, VAN), and the Central Executive Network; and a deactivation of the anterior cingulate, precuneus and parietal areas, corresponding to the Default Mode Network (DMN). During emotional vs neutral conditions, we detected activation of the secondary visual cortex, while contrasts between NoGo vs Go conditions manifested as activation of ACC and insular regions. ADHD subjects showed increased BOLD activation in the DAN and VAN areas. In all conditions, DMN areas showed higher deactivation in the ADHD group.

Here, we report differences in VN, DAN and VAN brain regions and the DMN in adult ADHD patients suggestive of distinctive pattern of activation and deactivation during an emotional Go/NoGo task. The results have clinical implications for understanding ADHD patients under in emotionally demanding situations.

Funding: Hungarian Brain Research Program, grants 2017-1.2.1-NKP-2017-00001 ans #NAP2022-I-4/2022 to JMR and PC.

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Binge-eating behavior and anxiety disorders pose a significant public health issue worldwide, as it has severe implications for both the physical and mental health of the adolescent population. The present study evaluated the prevalence of binge-eating behavior, anxiety disorders, and associated factors among the northern Saudi adolescent population.

assessed the correlation between binge eating and anxiety.

The present population-based cross-sectional study was carried out among adolescents in the Aljouf region of Saudi Arabia from June 2023 to December 2023. A total of 384 eligible participants were selected using the convenience sampling method. The present study used a pretested Arabic version of the binge eating scale (BES) and Hamilton Anxiety Scale (HAM-A) to assess the binge-eating behavior and anxiety disorders among the target population. The Spearman correlation test determined the strength and direction of the correlation between BES and HAM-A scores. Furthermore, logistic regression analysis was applied to find the associated factors for binge-eating behavior among the study participants.

Of the 384 participants, moderate and severe binge-eating behaviors were found among 11.2% and 8.3% of the respondents, respectively. Regarding the severity of anxiety as assessed by the HAM-A scale, mild, moderate, and severe anxiety were shown among 12.8%, 9.6%, and 7.5% of the participants, respectively. Also, the study found a positive correlation between binge eating and anxiety scores, with a correlation coefficient of 0.26 and a p-value of 0.001. Furthermore, being female (p = 0.001), moderate (p = 0.004), and severe anxiety (P = 0.001) were significantly associated with binge-eating behavior.

The present research findings advocate for the implementation of targeted interventions and support services aimed at decreasing binge-eating behavior and anxiety, thereby promoting the overall well-being of adolescents and building stronger future generations. Moreover, it is recommended that optional courses about binge eating be incorporated into the curricula of schools and universities.

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Centropontine myelinolysis (CPM) is an acute demyelinating neurological disorder that primarily affects the central bridge and is frequently associated with rapid correction of hyponatremia. Common clinical manifestations of CPM include spastic quadriparesis, dysarthria, pseudobulbar palsy and encephalopathy of varying degrees. In addition, CPM could be accompanied by neuropsychiatric manifestations, such as personality changes, thymic symptoms, acute psychosis, paranoia, hallucinations or catatonia, usually associated with additional brain damage, described as extrapontine myelinolysis (EPM).

Study the nature of comorbidity between CPM and mood disorders, particularly depression.

We present the case of a patient hospitalized in the psychiatry department B of the Hedi Chaker hospital in Sfax in July 2024. He was been admitted at the request of a third party for behavioral disorders such as agitation and refusal of treatment.

This is Mr. S.BH aged 68, with a psychiatric family history of follow-up for unspecified psychiatric disorders in a niece. He has no psychiatric history, but has a somatic history, unmonitored high blood pressure as well as chronic constipation causing hyponatremia, which was quickly corrected 1 month ago. The latter was responsible for CPM objectified on the brain MRI requested by a free practice neurologist who consulted him for agitation. Our patient is married. He has been retired for a few months and previously worked as a farmer for 35 years. According to the family, the history of his illness dates back to March 2024, following professional stressors when he began to present multiple somatic complaints, with anorexia and weight loss as well as a tendency towards isolation. Since June 2024, following the CPM, he believed that the police wanted to harm him. As a result, he became anxious and agitated. At the interview: Slowed down on the psychomotor level, the contact was superficial, the mood was sad, his speech was provoked, poor and conveyed in a low voice verbalizing anhedonia, he presents congestive disorders and he refuses treatment and diet at the beginning. The patient obtained a score of 12 on < < the Geriatric Depression Scale GDS >> and a score of 12 on < <the mini-mental state examination MMSE >>.

This case demonstrates that depression might represent the main manifestation of CPM, especially in the early stages of the disease, which should be taken into consideration when evaluating patients with acute abnormalities of sodium metabolism.

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There is an ongoing need to explore new treatment options not just for depression, but also for its associated conditions. Depression often coexists with hematologic health issues, especially anemia, and both can be influenced by factors such as inflammation and imbalances in gut microbiota. Therefore, investigating interventions that target microbiota holds promise for developing safe and effective adjunctive therapies for both depression and its related disorders.

The main objective of this secondary analysis was to evaluate the impact of probiotic supplementation on parameters related to red blood cells in individuals suffering from depressive disorders. The secondary goal was to evaluate several potential pretreatment determinants of probiotic activity on RBC, such as dietary habits, inflammatory or metabolic condition, severity and dimensions of psychiatric symptoms, and taken medications. The third goal was to evaluate probiotics’ effects on RBC parameters in addition to their effectiveness in treating depression.

The parent study was a two-arm, 60-day, prospective, randomized, double-blind, controlled study involving eighty-nine participants. The probiotic formulation used in the trial included Lactobacillus helveticus Rosell®-52 and Bifidobacterium longum Rosell®-175. The current analysis assessed changes in red blood cells-related markers following the intervention using the Χ² test. Linear regression and two-way ANOVA analyses were performed to assess the effects of all major clinical variables on the changes (post- minus pre- intervention values) of RBC parameters.

Probiotic intake did not significantly alter the levels of red blood cell parameters, including red blood cell count, hematocrit, hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin concentration, and red cell distribution width, in comparison to placebo.

None of the linear regression, nor ANOVA models were statistically significant.

In the PLC group, increases in RBC counts and HCT levels were associated with a deterioration in self-assessed depressive and anxiety symptoms. Furthermore, this group also exhibited a positive correlation between MCH and MCHC changes and the differences in MADRS score.

Despite the potential benefits of probiotics in treating anemia, our study found limited evidence of significant changes in red blood cell parameters following probiotic supplementation. However, the precise details regarding the clinical sample characteristics, intervention duration, dosage, and specific probiotic strain used are not fully elucidated.

But, probiotic supplementation appeared to may help prevent some alterations in RBC and HCT levels, as well as in MCH and MCHC in depressed individuals.

ClinicalTrials.gov identifier: NCT04756544.

None Declared

In this presentation, I will explore how the exposome paradigm can be leveraged to advance clinical practice in psychiatry. Specifically, I will highlight the potential of cumulative environmental risk scores to predict outcomes in severe mental disorders, such as the exposome score for schizophrenia (ES-SCZ).

Numerous socio-environmental factors have been linked to mental disorders, including childhood adversities, stressful life events, substance use, obstetric complications during pregnancy and childbirth, and urban living. Environmental factors do not exist in isolation; they form complex networks of interrelated and interactive elements. In this regard, the exposome represents the totality of an individual’s environmental exposures throughout their lifetime. The exposome framework introduces a holistic approach to embrace this complexity and a theoretical framework to investigate the poly-gene and poly-environment etiology of psychiatric disorders.

Guided by the exposome framework, we have recently estimated the ES-SCZ, a cumulative environmental exposure score for schizophrenia, including cannabis use, winter-birth, hearing impairment, bullying, and five domains of childhood adversities (emotional and physical neglect, along with emotional, sexual, and physical abuse). The ES-SCZ successfully differentiated individuals with schizophrenia, accounting for 28% of the variance in an independent case-control sample. Subsequently, we have tested the risk stratification properties and the predictive performance of the exposome score for schizophrenia in the general population. The ES-SCZ had strong discriminative performance for schizophrenia (AUC = 0.84) and was associated with the degree of psychosis risk in the general population. Finally, we tested the performance of ES-SCZ for dissecting the functional and symptomatic outcome heterogeneity in patients with psychosis in four different cohorts (EUGEI, GROUP, Athens FEP, and HAMLETT-OPHELIA). ES-SCZ was associated with poor overall functioning and cognitive impairment at baseline and follow-up visits. ES-SCZ was also temporally associated with poor symptomatic improvement from baseline to follow-up assessments, particularly the negative symptom dimension. Furthermore, models that included the polygenic risk score for schizophrenia and clinical features showed that the relationship between ES-SCZ and functional outcomes cannot be explained by genetic or clinical risk factors alone.

Overall, our findings demonstrate the potential benefits of the exposome score for schizophrenia, which can be integrated for early detection, outcome prognostication, clinical staging, and risk stratification in the future.

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Upper limb occupational injuries constitute an important health problem affecting workers in their most productive years. The professional environment influences the outcomes of these injuries. The impact of social support among this vulnerable population may explain the difference in terms of outcomes of occupational injury.

Evaluating the impact of social support in upper limb occupational injuries’ outcomes.

A cross-sectional analysis was conducted during 9 months among workers victims of upper limb occupational injuries consulting for an Impairment Rating Evaluation. Socio-professional data and the accident’ outcomes were collected. Social support was evaluated by the Social Support Scale. The pain was evaluated by a Visual Analogue Scale. Anxiety and depression were evaluated by the Arabic version of Hospital Anxiety and Depression scale. Unsuccessful return to work comprises all situations other than a satisfactory return to the same position held before the accident.

Out of 90 injured workers, 78.9% were male. Hand and wrist injuries represented 63% of injured sites. The mean age was 43.10± 9.87 years. The mean pain scale was 5.75±2.78. The mean length of absence was 180.73±245.14 days. A proportion of 12.2 % had low social support. Unsuccessful return to work was found among 37.8% of participants. The prevalence of anxiety and depression were 31.1% and 20% respectively. Sleep disorders were mentionned by 56.7% of subjects. Low social support was associated with unsuccessful return to work (p=0.000), negative outlook of the professional future (p=0.000) and depression (p=0.002). No association was found with pain, length of absence and sleep disorders.

Social support may influence the outcomes of upper limbs occupational injuries. This finding highlights the need for further examination of social factors among this vulnerable population.

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Even mild forms of dementia have a detrimental effect on memory and activities of daily living, and cause distress to patients and their families. As the disease progresses, the impairment of patients and the burden on their carers increases over time. Thus, there is a need for effective, safe and well-tolerated treatments that can be initiated at the earliest stages.

A meta-analysis of pooled patient subgroup data from randomised clinical trials was conducted to assess the treatment effects of Ginkgo biloba extract EGb 761 in patients with mild dementia.

The studies included in this meta-analysis were selected from a previous systematic review (von Gunten et al. World J Biol Psychiatry 2016, 17(8),622-633). They enrolled patients with mild dementia (total score 9-15 on the SKT Short Cognitive Performance Test, SKT) (Lehfeld and Erzigkeit, Int Psychogeriatr 1997, 9(Suppl 1), 115-21) with probable Alzheimer’s disease, probable vascular dementia, or possible Alzheimer’s disease with cerebrovascular disease, respectively. Outcome measures were cognition, activities of daily living, global clinical assessment and quality of life.

From four eligible trials data of 782 patients with mild dementia were included in the meta-analysis. The analysis demonstrated that treatment with 240 mg EGb 761 daily was significantly superior to placebo in cognition (p=0.04), global assessment (p=0.01), activities of daily living (p=0.01) and quality of life (p=0.02) with medium to large standardised effects. Adverse events were similarly frequent in patients treated with EGb 761 and placebo (p=0.66).

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The meta-analysis shows that EGb 761 has beneficial effects on cognition, activities of daily living, global assessment and quality of life in patients with mild dementia.

M. Riepe Speakers bureau of: Dr. Willmar Schwabe GmbH & Co. KG, M. Burkart Employee of: Dr. Schwabe Holding SE & Co. KG

Understanding the complex interplay between cognitive and functional domains in schizophrenia is crucial for improving patient functional outcomes.

Metacognition has emerged as a critical factor in the functioning and rehabilitation of individuals with schizophrenia. Additionally, the role of disorganization and clinical insight in this complex disorder has been extensively studied due to their role in shaping in the trajectory and real-life functioning outcomes of the disorder.

This study aimed to assess the differences and relationships between disorganization, clinical insight, metacognition, and various functional domains in patients with short (< 5 years) and long (≥ 5 years) illness duration.

A network representation of the relationships between variables and the calculation of centrality and clustering indices were performed within each group. The two groups were compared with a network comparison test.

Eighty-nine patients with early and one hundred and six with late phase SZ were included. We found no significant differences in the overall network structure between the two groups despite patients with longer illness duration showing significant worsening across all examined domains. Interestingly, the relationships between the network variables remained stable regardless of disease duration.

One notable difference emerged in the correlation between interpersonal functioning and unawareness of symptoms, negatively correlated only in the group with longer illness duration. These results suggest that the link between social functioning and clinical insight may become more pronounced as the disorder progresses. Decentration was more central in the group with short disease duration, whose patients do not yet show marked impairment of metacognition, particularly in the ‘understanding other’s mind’ domain. Regarding clustering indices in the group with short illness duration, the misattribution of symptoms to the disorder is more clustering. On the other hand, metacognitive mastery, was highly clustering in both the short and long illness duration.

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The stability of the relationships between metacognitive variables, clinical insight, and functional outcomes, regardless of disease duration, suggests that interventions targeting metacognition may be beneficial for improving functioning in patients with schizophrenia. Additionally, the emerging negative correlation between interpersonal functioning and unawareness of symptoms in patients with longer illness duration highlights the importance of addressing both social skills and clinical insight as the disease progresses. These findings underscore the potential utility of integrated treatment approaches that address cognitive, social, and functional domains to optimize functional outcomes for individuals with schizophrenia across the course of the illness.

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Cognitive dysfunction has been identified as a key mediator of functional impairment in major depression and a contributing factor to antidepressant resistance. Theta burst stimulation (TBS) is a novel form of transcranial magnetic stimulation (TMS) that has shown greater efficacy and efficiency than conventional TMS in the treatment of treatment-resistant depression (TRD). However, its effects on cognitive symptoms in depression remain largely unstudied.

The objective of this study is to evaluate the impact of TBS on neurocognition in unipolar and bipolar TRD patients treated at a public hospital. Additionally, clinical, demographic, and treatment predictors of cognitive change were explored.

This is a follow-up study of n=64 patients with TRD (unipolar=48, bipolar=16) who received daily adjunctive TBS for 6 weeks. Cognitive performance was assessed before and after TBS using different versions of the Screening for Cognitive Impairment (SCIP-S), which measures immediate verbal learning, working memory, verbal fluency, delayed verbal learning, and processing speed. Cognitive performance in each domain was compared using paired t-tests. Global cognitive change was assessed by quantifying pathological domains at baseline and at the end of TBS. Differences in neurocognition between clinical responders (50% reduction on the HDRS) and non-responders to TBS were compared using ANOVA models. Additionally, possible predictors of cognitive change in each domain were explored using correlation analyses and multiple linear regressions, which included factors such as age, diagnosis, number of TBS sessions, treatment type, TBS modality (left unilateral vs. bilateral), clinical response, and baseline severity.

Patients treated with TBS achieved significant clinical response (68%) and cognitive improvement in the domains of immediate verbal learning, working memory, verbal fluency, and processing speed (mean differences of 2.16, 2.31, 1.30, and 1.05, respectively). Neurocognitive improvement was independent of clinical response. The percentage of improvement on the HDRS was only associated with improvement in the verbal fluency domain (p = .007). Left unilateral TBS and bipolar diagnosis predicted better global cognitive improvement in SCIP in regression models (p = .042, p = .037, respectively).

The results support the utility of TBS in treating cognitive dysfunction associated with TRD. Further larger studies are needed to clarify clinical and treatment predictors of cognitive improvement.

None Declared

Early-onset bipolar disorder (BD) and attention-deficit hyperactivity disorder (ADHD) have recently been the subject of a highly controversial debate, due to theories regarding the underlying pathophysiological processes and a clinical overlap of symptoms. Epidemiological data, clinical aspect, neuroimaging, neurochemical and genetic studies suggest that there may be a possible relationship between biological factors and clinical characteristics in the development of symptoms.

Investigation of the prevalence of ADHD symptoms in bipolar patients compared to the control group.Investigating differences in age of onset, clinical presentation, and course of affective illness between bipolar disorder patients with childhood ADHD symptoms compared to those without childhood ADHD symptoms.

The study included 20 patients with bipolar disorder, hospitalized in the Psychiatric Hospital accompanied by their parents/relatives and 30 healthy controls (matched age, sex, socio-economic status) recruited through avalanche sampling in the Directorate of QSU “Mother Tereza”. The Abbreviated International Neuropsychiatric Interview (MINI) was used to identify cases with bipolar disorder or possible psychiatric pathology. The Diagnostic Interview for ADHD Adults (DIVA 2.0) was used to explore the presence of symptoms of attention deficit hyperactivity disorder (ADHD) in childhood and at the current age.Descriptive analysis in SPSS was used for data analysis.

It resulted that 80% of bipolar patients had ADHD symptoms in childhood compared to 16.67% in the control group. The age of onset of bipolar disorder was 17.31 years earlier in the group of cases with history of ADHD in childhood compared to the age of 21.25 years in cases without ADHD in childhood. In cases with history of ADHD, 43.75% had longer duration of manic episodes/ hypomanic compared to 25% in the group of cases without childhood ADHD. The number of suicide attempts 1 or >1 was more frequent in patients with a history of ADHD (25% and 12.5 %) compared to cases without a history of ADHD (25 %). In psychotic symptoms during mania, it was found that in patients with a history of ADHD in childhood, the prevalence was higher (81.82%) compared to (50%) in those without a history of ADHD in childhood. The prevalence of adult ADHD in cases was 35% compared to controls 6.66%. Apparently, the number of cases with comorbid ADHD with impaired social/family functioning was higher compared with the group of controls with comorbid ADHD.

The associations of each clinical component of bipolar disorder with the presence or absence of ADHD in childhood were not statistically significant. However, it is worth noting that in complexity, the number of patients with more severe features of bipolar disorder is higher in cases with ADHD in childhood compared to cases without ADHD in childhood in our sample.

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Substance use disorders are among the leading causes of morbidity and mortality worldwide. SUDs are highly comorbid with other mental health disorders. Given this comorbidity, a transdiagnostic view on treatment, seems appropriate. Within such a transdiagnostic perspective, treatment outcome can be described as a decrease in comorbid clinical symptomatology and not merely in terms of abstinence/relapse in substance use. A promising transdiagnostic factor within the RDoC framework is temperament, more specifically reactive and regulative temperament. According to the dual pathways model, psychopathology arises from an imbalance between two complementary neurobiological systems: the bottom-up reactivity system in terms of behavioral inhibition (BIS) and behavioral activation (BAS) (reactive temperament) and the top-down regulation in terms of Effortful Control (EC) (regulative temperament).

We want to investigate whether reactive (BIS/BAS) and regulative temperament (EC) are associated with treatment outcome in terms of a decrease in clinical symptomatology in a sample of adult inpatients with a SUD. When these temperamental factors turn out to be significant predictors of clinical symptomatology, treatment interventions targeting reactivity (high BAS or BIS level) or aiming at strengthening EC could possibly result in better treatment outcomes for patients with SUDs and comorbid disorders.

The sample consisted of 612 inpatients with a SUD ((76,5% males, mean age 42,9 years) admitted at a specialized treatment unit for addiction. At the start of the treatment (pre) self-report questionnaires were administered to assess the reactive temperament dimensions (the Behavioral Inhibition/Behavioral Activation System Scales), the regulative temperament dimension (the Effortful Control Scale from the Adult Temperament Questionnaire) and clinical symptomatology (Symptom-Checklist-90-Revised, SCL-90-R). At discharge, the SCL-90-R was administered again to assess treatment effectiveness (post).

Paired sample t-test showed significant decreases between pre- and posttreatment symptom scores indicating that treatment was effective in decreasing symptomatology. A hierarchical regression analysis showed that higher levels of EC were associated with a stronger decrease in levels of psychological symptoms and that higher levels of BIS were associated with a lower decrease. There was however no moderating role of EC in the relation between reactive temperamental dimensions and treatment outcome.

We found that reactive and regulative temperament could predict psychological symptomatology after a residential treatment period of 8 weeks in a specialized addiction unit. These results point out that interventions aiming at either strengthening EC or lowering anxiety (BIS) could possibly result in better treatment outcomes for patients with SUDs their comorbid disorders.

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Metabolic syndrome (MetS) is notably prevalent among individuals with bipolar disorder (BD). Despite numerous studies indicating an increasing MetS prevalence in this group over time, comprehensive investigations of associated risk factors remain limited.

This study aims to assess the prevalence and 1-year changes in MetS among BD patients. It also seeks to identify baseline clinical features that could predict the development of MetS during follow-up.

The study included euthymic BD type 1 patients consecutively admitted between July 2023 and July 2024. MetS was diagnosed uaccording to NCEP ATP-III criteria at baseline and after one year. Patients without MetS at baseline were analyzed to evaluate the association between initial clinical characteristics and MetS presence at follow-up through logistic regression.

A total of 98 patients completed the baseline and follow-up assessments. The prevalence of MetS significantly increased from 29.6% to 51.0% over the 1-year naturalistic follow-up. Initially, there were no significant differences between the groups with and without MetS regarding demographics, illness characteristics, treatment types, comorbidities, and chlorpromazine equivalent dose. By the end of the follow-up period, 29 new MetS cases were diagnosed after excluding those initially identified. This group exhibited higher numbers of total episodes, more manic episodes, and greater hospitalization rates (p = 0.04,-2.067; p = 0.03, -2.193; p = 0.03, -3.207), with no significant differences in other demographic or clinical variables.In the logistic regression analysis, which controlled for age, gender, number of depressive episodes, and the use of lithium and valproate, the equivalent chlorpromazine dose (p = 0.04, OR: 1.003) emerged as a significant predictor of metabolic syndrome, while the number of manic or hypomanic episodes demonstrated a trend towards significance (p = 0.05).

In conclusion, this study shows that the prevalence of MetS in patients with BD type-1 in Turkey increased from 29.6% to 51.0% over one year. Increased numbers of manic episodes and higher chlorpromazine doses were linked to the development of MetS. This underscores the importance of monitoring metabolic health, especially in patients with frequent manic episodes or high antipsychotic doses.

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ADHD (Attention-Deficit/Hyperactivity Disorder) is a common treatable disorder that impairs daily functioning along the life span. Pharmacotherapy plays a central role in managing ADHD, but adherence rates can be low, impacting treatment effectiveness.

To compare the adherence to the specific medication used to treat ADHD on specific patient populations.

In this study, we used “Clalit Medical Services” anonymized data base and focused on the first year of treatment with the four available first-line pharmacotherapy products: Methylphenidate tablets, Methylphenidate Slow Release tablets, Methylphenidate Long Aacting capsules, and Oros Methylphenidate tablets. Analyzing data from 214,035 patients of all ages diagnosed with ADHD who initiated pharmacotherapy between 2000 and 2022, we used a Negative Binomial Regression to develop a model to predict the number of prescriptions purchased in the first year of treatment, serving as a proxy for adherence. Our main focus was on identifying medications that enable better adherence.

Oros Methylphenidatehad the highest number of predicted purchases (RR CI 95%: 5.85-5.96). After adjusting for calendar year effects, our results identified gender, age group, and socioeconomic status (SES) as significant predictors of adherence. A significant interaction effect revealed that the predicted number of purchases for a specific medication is influenced by the patient’s SES level, i.e., for the lower SES levels adherence with Methylphenidate was better than adherence with Oros Methylphenidate.

The choice of the specific medication available as first-line treatment for ADHD, has a significant effect on adherence. Oros Methylphenidatehas has better adherence than the other MPH formulas. This would guide physicians to prefer the use of Oros Methylphenidateas first line therapy. This is not true for the lower SES. Strengthening our assumptions that knowledge about medication adherence and patient characteristics are potential indicators for improving the treatment of ADHD.

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Up to 30-70% of patients with treatment-resistant schizophrenia (TRS) remain symptomatic despite gold standard treatment, clozapine. To date, commonly used antipsychotics have demonstrated little therapeutic benefit as augmenting agents in comparison to placebo. Emerging evidence suggests that novel D2-D3 partial agonist cariprazine is a promising augmentation strategy to clozapine for TRS.

This systematic review aims to collect the available real-world evidence of effectiveness and tolerability of cariprazine and clozapine combination treatment.

A systematic review was performed using PubMed, MEDLINE, EMBASE and Cochrane databases from January 2017 until September 2024 for cases where cariprazine was used as an augmentation strategy for clozapine with the following terms: (cariprazin*) AND (clozapin*) AND (‘case report*’ OR ‘case report’/de OR ‘case stud*’ OR ‘case study’/de OR ‘case seri*’ OR ‘add-on’ OR augmentation OR combin*).

After removal of duplicates, 108 studies were retrieved, of which 20 studies were included (one prospective pilot study and 19 case reports). Total cases comprised of 47 patients (30 male, 17 female), with diagnoses of schizophrenia (n=40), schizoaffective disorder (n=6) and emotionally unstable personality disorder (EUPD) and autism spectrum disorder (n=1). Patients were treated with clozapine (dose range 37.5-850 mg/day) and cariprazine (doses 1.5-6.0 mg/day) for a median of 122 days (range 18-456). Although a variety of subjective and objective outcome measures were employed, cariprazine was generally found to be a well-tolerated and effective adjunct to clozapine in a wide range of different symptom profiles; demonstrating efficacy across positive, negative and affective symptoms, quality of life and global functioning in the majority of cases. Additional benefits of weight loss and improving commonly experienced adverse side effects of clozapine were also frequently reported. In 3 cases cariprazine augmentation did not improve symptomatology, whereas in 6 cases the combination resulted in the exacerbation of different symptoms such as anxiety or restlessness.

By targeting different receptors, cariprazine and clozapine appear to act synergistically allowing for a well-tolerated and effective antipsychotic combination. Large-scale RCTs are warranted to further evaluate its effectiveness compared to placebo.

S. Pappa: None Declared, Z. Dombi Employee of: I am an employee of Gedeon Richter Plc., originator of cariprazine., E. Caldwell-Dunn: None Declared, R. Csehi Employee of: I am an employee of Gedeon Richter Plc., originator of cariprazine., Á. Barabássy Employee of: I am an employee of Gedeon Richter Plc., originator of cariprazine.

Cannabis use in young adulthood is common, yet few studies have explored how it predicts changes in psychopathology and functional well-being in community samples. We assessed these links using both self-reported frequency of cannabis use and hair THC concentrations.

Data came from a community sample of young adults (N = 863) who reported cannabis use (weekly-to-daily use: n = 150) and provided hair samples at age 20 (cannabis detected: n = 110). Liquid chromatography–tandem mass spectrometry quantified delta-9-tetrahydrocannabinol (THC) and cannabinol (CBN) concentrations in hair. At ages 20 and 24, participants reported psychopathology (psychotic-like experiences, problematic substance use, internalizing symptoms, and aggression) and functional wellbeing (general well-being, delinquency, and not being in employment, education, or training). Multiple linear and logit regression models tested associations between six different continuous and dichotomous operationalizations of self-reported and objective cannabis exposure at age 20 and psychological and functional well-being at age 24, adjusting for sex, sociodemographic characteristics, and the outcomes measured at age 20.

Both self-reported frequency of cannabis use and hair THC concentrations predicted increases in psychotic-like experiences and internalizing symptoms, increased aggression, decreased general well-being, higher odds of not being in employment, training, or education, and more problematic substance use from age 20 to 24, with small effect sizes. Composite exposure scores derived from self-reports and hair data were not more informative than either source alone.

Frequent cannabis use predicted adverse changes in psychopathological outcomes from ages 20 to 24, regardless of how it was assessed.