The prevalence of extreme temperature is increasing largely due to the progression of climate change globally (LaSorte et al. Climate Change 2021; 166 1-2). Existing research indicates extreme temperatures have an impact on mental health, including its effect on mood disorders (Rony & Alamgir. Health Sci Rep 2023; 6 12). While there is evidence to suggest that mood disorders can be influenced by various environmental, biological, and social factors (Zhang et al. Environmental International 2020; 143), no study has synthesized findings on the relationship between extreme temperature and mood disorders in existing literature.

The study aims to: investigate the linkage between extreme temperature and mood disorders in terms of symptom severity, hospital admissions and adverse events; describe factors moderating the relationship between extreme temperature and mood disorders; outline study-defined interventions and make policy recommendations.

This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Major databases (Medline/PubMed, PsychINFO, Scopus, Web of Science) were searched for eligible reports using a search strategy developed for the study. This was supplemented by snowball searching for references in relevant studies. Title and abstract screening and data extraction were completed by at least two independent investigators and conflicts were resolved by discussion amongst investigators or consulting the senior author. All included studies will be assessed with the National Institutes of Health Study Quality Assessment Tools.

As seen in Image 1, 468 articles were identified from searching databases. Following screening and full-text review, 22 articles were selected for data extraction. Preliminary findings showed that the included studies were conducted in North America, Europe, Asia, and Oceania-Australia among others. The included studies were of different designs, including case-crossover, cohort and cross-sectional studies. Findings across studies indicate that extreme temperatures have a complex and significant impact on mood disorders. High temperatures were associated with increased hospital admissions, with adolescents, women, and the elderly especially vulnerable. Individuals with bipolar disorder and depression showed increased sensitivity to heat exposure. While some studies found increased emergency department visits for mood disorders during periods of extreme heat, others revealed insignificant correlations. Moreover, short-term exposure to humidity was also linked to elevated risk for mood disorders.

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This study underscores the impact of extreme temperatures on mood disorders and highlights the need for real-world solutions, like policy implementation, to reduce exposure to such conditions due to climate change.

None Declared

Delusions in schizophrenia have been theoretically linked to probabilistic reasoning bias (‘jumping to conclusions’, JTC), although experimental support has been mixed (Garety et al BJP 2013; 203 327-333). Ward and Garety (Schiz Res 2019; 203 80-87) recently proposed a reformulation of the theory in terms of Kahneman’s concepts of ‘fast’ and ‘slow’ thinking. This proposes that decision-making involves two cognitive processes: a fast, heuristic-based approach which is prone to errors, and a slow, deliberate process that carefully evaluates all the relevant evidence. According to this view, an overreliance on fast thinking and/or reduced engagement of slow thinking underlies the initial development of delusional interpretations of everyday events and also makes them harder to be corrected.

Our aim was to develop a novel task to investigate the fast and slow thinking hypothesis of delusions in patients with schizophrenia, for use in behavioural and functional imaging studies. As a preliminary step, we tested this task on healthy participants.

A battery of 137 experimental questions (where fast thinking leads to incorrect answers) was generated from multiple sources, including examples of the base rate and conjunction fallacies, the cognitive reflection test (CRT), trick questions, and syllogisms. Example questions included: If it takes 5 machines 5 minutes to make 5 widgets, how long would it take 100 machines to make 100 widgets? [Correct answer = 5 minutes; intuitive answer = 100 minutes; category: cognitive reflection] A farmer had 15 sheep and all but 8 died. How many are left? [intuitive answer: 7; correct answer: 8, category: trick question]. 137 control questions (where both fast and slow thinking give the correct answer) were adapted from the experimental questions. The questions were administered online to 176 healthy volunteers using PsychoPy software, with 15 experimental and 15 control questions randomly assigned to each participant.

The sample had a mean age of 40.3 years (range 17-77 years); 55.1% were female and 65.9% had a university education. Correct answers to experimental questions were markedly fewer than answers to control questions in all categories (overall p < 0.001). Response latency for the experimental questions was slightly higher than for the control questions, apart from in one category (CRT) (overall p = 0.004).

Results from a large sample of healthy participants indicate that a battery of questions can be feasibly developed to reliably detect fast thinking.

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Individuals with neurodevelopmental disorders, such as ADHD and autism spectrum disorder, often experience higher rates of chronic pain compared to the general population. Potential shared mechanisms could be central sensitization, muscular dysregulation and altered pain experiences. Individuals with ADHD and chronic pain frequently have a lower health-related quality of life, including higher pain interference and depressed symptoms. Psychological inflexibility, insomnia and hypermobility are identified as mediators in the relationship between neurodevelopmental symptoms and chronic pain. Understanding these connections can aid in developing targeted interventions to improve the quality of life for individuals with neurodevelopmental disorders experiencing chronic pain.

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While most individuals adhere to preventive measures during pandemics, a subset engages in behaviors that may intentionally spread COVID-19, presenting unique challenges to public health efforts.

This study explores the psychological, social, and environmental factors influencing deliberate virus-spreading behavior in the Saudi Arabian population during the initial phase of the COVID-19 pandemic.

A cross-sectional online survey was conducted between April 3 and May 5, 2020, with 1,817 participants. The survey collected demographic information and variables related to virus-spreading inclinations. Descriptive statistics and Pearson’s chi-squared tests were used to analyze associations between deliberate virus-spreading behavior and various characteristics, with statistical significance set at p < 0.05.

Individuals who intentionally spread the virus (2% of the sample) were younger (mean age 22.9 vs. 29.3 years, p < 0.001), predominantly female (81.1% vs. 65.6%, p = 0.033), and more likely to have a history of mental health issues (24.3% vs. 8.5%, p < 0.001) and conspiracy beliefs (45.9% vs. 26.2%, p = 0.003) compared to those who did not engage in virus-spreading behaviors. No significant differences were found regarding marital status, education level, or traumatic life events.

This study highlights key factors associated with intentional virus-spreading behaviors, such as younger age, mental health history, and conspiracy beliefs, underscoring the need for integrated mental health support and targeted misinformation interventions. Public health strategies should include age-appropriate messaging and digital outreach to mitigate the risks posed by intentional spread behaviors and enhance pandemic response efforts. Further research with larger, more diverse samples is recommended to expand understanding and improve intervention strategies

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Obsessive-Compulsive Disorder (OCD) and psychotic disorders are traditionally considered distinct entities; however, there is increasing evidence of a spectrum where these conditions overlap. In some cases, OCD presents with poor insight, leading to obsessive thoughts and behaviors that resemble psychotic features. These “schizo-obsessive” phenomena challenge standard diagnostic categories and suggest a continuum between OCD and psychosis, necessitating a more integrated approach to diagnosis and treatment.

We report the case of a 69-year-old male evaluated in the emergency department for severe obsessive symptoms, including intrusive images and compulsive behaviors, accompanied by low insight and depressive symptoms, such as suicidal ideation. Initial management with selective serotonin reuptake inhibitors (SSRIs) led to only partial improvement, highlighting the complexity of distinguishing obsessive from psychotic symptomatology and supporting the concept of a continuum between OCD and psychosis.

1. 1) To describe the clinical presentation and management of a patient with OCD and psychotic features.

2. 2) To review the evidence regarding the clinical characteristics and management of the schizo-obsessive spectrum.

A review of the patient’s clinical history, psychiatric assessments, and treatment responses was conducted. A literature review was also performed to provide an overview of OCD with low insight and schizo-obsessive phenomena.

The schizo-obsessive spectrum concept suggests an overlap between obsessive-compulsive symptoms and psychotic features, particularly when insight is impaired. In OCD with poor insight, obsessions can lose their typical egodystonic quality and appear more like delusions. This challenges traditional diagnostic boundaries and indicates a continuum between OCD and psychosis, where insight fluctuates and symptoms may shift from obsessive to delusional states. Clinical management is complex; combining SSRIs with antipsychotics can be effective, particularly in cases with minimal insight. In our case, the introduction of low-dose aripiprazole led to significant improvement, supporting a combined pharmacological strategy addressing both obsessional and psychotic dimensions and aligning with the schizo-obsessive spectrum framework.

1. 1. This case highlights the difficulty in distinguishing psychotic from obsessive symptoms when insight is poor, emphasizing the need for careful differential diagnosis.

2. 2. The overlap of obsessive and psychotic features in this patient indicates the need for further study of “schizo-obsessive” phenomena.

3. 3. The patient’s positive response to combined SSRIs and antipsychotics suggests this approach may be effective for similar cases with overlapping symptoms.

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Previous studies show the aggregation of major psychiatric disorders (MPDs; a combined category of schizophrenia, bipolar disorder, depression, and anxiety) among siblings. However, few studies have examined whether MPDs in childhood and early adulthood are associated with siblings’ future socioeconomic status (SES).

To assess subsequent SES outcomes among siblings of individuals with an MPD diagnosed at age 5–25.

This cohort study included 54,742 full siblings, 4,490 paternal, and 4,858 maternal half siblings of individuals born in Finland between 1975–1985 with MPDs diagnosed at ages 5–25 (affected probands). We defined the reference groups as identical types of siblings of individuals without any MPD diagnosis (matched unaffected probands). The siblings of both the affected and the unaffected probands were followed from the diagnosis date of affected probands until December 31, 2020. MPD diagnoses were obtained from the Finnish Care Register. SES was measured through employment status, annual disposable income (measured in EUR), and educational achievement derived from the FOLK module of Statistic Finland. Conditional logistic regression, median regression, and Generalized Estimating Equations (GEE) models were applied to estimate the adjusted associations.

The median age (interquartile range, IQR) at baseline was 20 years (16–24) for full siblings, 17 years (12–26) for maternal half-siblings, and 18 years (12–26) for paternal half-siblings of the affected and unaffected probands. Compared to siblings of the unaffected probands, the odds of unemployment were 50% higher (95% CI: 1.46-1.55) in full siblings of affected probands with any MPD; this association was particularly pronounced in full siblings of an affected proband diagnosed before age 15 (aOR: 1.68, 95% CI 1.49-1.90). Full siblings of the affected probands were more likely not to attain a university degree (aOR: 1.37, 95% CI 1.33-1.41). The median annual disposable income was 1,518.3 EUR lower (95% CI: -1647.4, -1389.3) in full siblings of affected probands. Similar but weaker associations were observed in maternal and paternal half-siblings. For example, compared with the half siblings of the unaffected probands, the odds of unemployment were 29% (95%CI 1.16-1.44) and 23% (95%CI 1.10-1.38) higher in maternal and paternal half-siblings of affected probands with any MPD, respectively.

Our findings suggest that the unfavorable socioeconomic consequences of MPDs might extend to siblings.

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Current ketamine-based therapies for treatment-resistant depression (TRD) can induce dissociative symptoms. A novel oral prolonged-release ketamine formulation (KET01) results in a lower and delayed peak concentration of ketamine, and a higher concentration of the metabolites norketamine and hydroxynorketamine than after intravenous administration. KET01 has limited dissociative properties, compared to other ketamine formulations.

To explore the relation between dissociative and antidepressant effects of KET01.

KET01-02 (EudraCT 2021-004927-34) was a randomized, double-blind phase 2 trial in outpatients with TRD comparing adjunct 120 mg (n=42) or 240 mg (n=40) oral KET01 once-daily for 3 weeks to placebo (PBO, n=40). The primary endpoint was change from baseline on the Montgomery-Åsberg Depression Rating Scale (MADRS) total score on day 21. Dissociation was assessed using the Clinician-Administered Dissociative States Scale (CADSS).

The association between CADSS scores at 7 hours after first dosing and MADRS scores on day 4 was investigated with a statistical mediation analysis. The 7-hour timepoint was selected since it coincides with the average Tmax (time-to-peak) when the highest dissociation is expected. Depression scores at the first subsequent visit (on day 4) were selected for the analysis. It was also the time point where change in MADRS score from baseline differentiated the most between KET01 and placebo with a difference of 4.32 (p=0.006) to the benefit of KET01 – based on the model used in the mediation analysis.

The antidepressant effect of KET01 that was mediated through dissociation was estimated to the negligible -1.28% (CI: (-28%) – (+11%)).

The antidepressant effect of KET01 was achieved with minimal to no dissociation and with no significant mediation through dissociation. Our findings challenge the commonly held clinical view that some degree of dissociation is necessary to guarantee ketamine’s antidepressant effect. Instead, it appears that dissociative symptoms are merely adverse events associated with certain formulations of ketamine.

L. Arvastson Consultant of: HMNC Brain Health, E. Papanastasiou Employee of: HMNC Brain Health, K. Schmid Employee of: Develco Pharma, A. Damyanova Employee of: HMNC Brain Health, A. Glas Employee of: HMNC Brain Health, C. Strote Employee of: HMNC Brain Health, C. Eulenburg Consultant of: HMNC Brain Health, D. Gehrlach Employee of: HMNC Brain Health, K. Maiboe Consultant of: HMNC Brain Health, H. Eriksson Employee of: HMNC Brain Health

In the ESCAPE-TRD study, esketamine nasal spray (ESK-NS) significantly increased chance of remission at Week 8 versus (vs) quetiapine extended release (Q-XR) in patients (pts) with treatment resistant depression (TRD; Reif et al. NEJM 2023; 389:1298–309). Changes in disability and functional impairment due to depressive symptoms assessed with the Sheehan Disability Scale (SDS) are reported.

To assess the effect of ESK-NS vs Q-XR on pts’ daily functioning using SDS, considering their symptom evolution.

ESCAPE‑TRD was a randomised phase IIIb trial comparing the efficacy of ESK-NS vs Q-XR, both alongside an ongoing selective serotonin/serotonin-norepinephrine reuptake inhibitor, in pts with TRD. Clinical response (CRes) was defined as ≥50% improvement in Montgomery-Åsberg Depression Rating Scale (MADRS) score from baseline or total score ≤10, clinical remission (CRem) was defined as total MADRS score of ≤10, and functional remission (FRem) was defined as SDS total score ≤6. The Kaplan-Meier method was used for time to event analyses, and hazard ratios (HRs) were estimated using Cox regression models. Time in each state was estimated by treatment arm and compared between arms using analysis of covariance.

336 and 340 pts were randomised to ESK-NS and Q-XR, respectively. Significantly more ESK-NS treated pts achieved CRes, CRem and FRem (HRs: 1.848, 1.711 and 1.819, respectively; all p<0.001), and achieved these faster, compared to Q-XR (Figure 1). In each arm and at each time point, more pts reached CRes than CRem, and more reached CRem than FRem, illustrating that FRem is more difficult to achieve (Figure 1). Total time in CRes was 5.4 weeks greater for ESK-NS compared with Q-XR; total time in CRem was 3.7 weeks greater and in FRem 2.0 weeks greater for ESK-NS vs Q-XR, respectively (Table 1).

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Image 2:

These data support a temporal cascade of events from CRes to CRem to FRem; ESK-NS improved time to, and in, each outcome vs Q-XR. Treatments that reduce clinical symptoms better and faster provide the best chance of improving functional impairment.

None Declared

Understanding patient attitudes toward psychoactive substances is essential for improving treatment outcomes in psychotic disorders. Substance use complicates these disorders, worsening symptoms and hindering recovery. Despite known risks, many individuals with psychotic disorders engage in substance use influenced by various factors. The debate over the legalization, decriminalization, and normalization of psychoactive substances, including marijuana and psychedelics, is growing. Legalization removes legal restrictions, decriminalization reduces penalties, and normalization involves societal acceptance of these substances. Alcohol, a culturally embedded substance, is also highly harmful despite its legal status. Recently, there has been increased interest in cannabis for therapeutic use, though its role in psychotic disorders remains contentious. While some evidence suggests the benefits of cannabidiol (CBD), excessive use of high-THC cannabis may elevate the risk of psychosis or exacerbate symptoms.

To examine the attitudes and perceptions of patients with psychotic disorders toward alcohol, marijuana, and psychedelics, and to assess the prevalence of psychoactive substance use among individuals with psychotic disorders.

For this descriptive study, data were collected from September 2023 to September 2024 through a questionnaire distributed to patients during their hospitalization at the University Hospital of Split in the Psychiatry Department. Inclusion criteria included adult patients with ICD diagnoses from F20-F29 who agreed to participate in the study; exclusion criteria included patients with F21 (unless they also have F23) and those who declined to participate.

This study examined the attitudes and behaviors of 62 patients with psychotic disorders regarding alcohol and psychoactive substance use. The sample consisted of 37 men (59.7%) and 25 women (40.3%). Alcohol consumption was reported by 34 respondents (54%) in socially acceptable quantities, while 7 respondents (11.3%) admitted to combining alcohol with medications. Additionally, 8 respondents (12.9%) reported using other psychoactive drugs. Regarding perceptions, 6 respondents (9.7%) believed that marijuana helps their health, and an equal number expressed a similar belief about psychedelics.

Despite therapeutic cooperation, many patients continue to consume alcohol due to its availability and social acceptance. Some patients use marijuana, believing that it improves their mental state, while others use psychedelics; however, fewer patients engage with these substances compared to alcohol. These findings reveal significant variability in substance use and perceptions among patients with psychotic disorders, highlighting the need for further investigation into the factors influencing these behaviors to develop effective treatment strategies and support systems tailored to this population.

None Declared

Obstructive Sleep Apnea (OSA) significantly complicates psychiatric conditions, yet its systematic screening within psychiatric settings is not common. We present a unique collaborative initiative within a tertiary care psychiatric hospital in South Bronx, USA, with approximately 3000 outpatients. We aim to bridge this gap by implementing a comprehensive OSA screening and referral process to improve patient outcomes.

• - Implement a standardized Obstructive Sleep Apnea screening in psychiatric outpatient care.

• - Enhance collaboration between psychiatry and sleep medicine for integrated care.

• - Address compliance barriers by offering at-home sleep diagnostic options.

Starting in April 2024, patients in the Adult Outpatient Psychiatry Department are being screened for Obstructive Sleep Apnea using the STOP-Bang questionnaire, with this process ending in October 2024. High-risk patients identified through screening will receive WatchPAT Home Sleep Apnea Testing devices, with distribution and testing to be completed by December 2024. Data collected will include the number of patients screened, proportion identified as high-risk, HSAT completion rates, diagnostic outcomes, and subsequent referrals to sleep medicine services.

The STOP-Bang questionnaire has been successfully integrated into routine clinical assessments for psychiatric outpatients, and the screening phase will conclude in October 2024. Preliminary data shows that a substantial number of patients were identified as high risk for Obstructive Sleep Apnea. The distribution of WatchPAT Home Sleep Apnea Testing devices to these high-risk individuals is underway and will be completed by December 2024. Initial results indicate effective triaging of patients and a high rate of compliance with at-home sleep testing. Detailed findings, including the exact number of patients screened, high-risk identification rates, HSAT completion rates, and diagnostic outcomes, will be presented upon project completion.

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Early findings from this Quality Improvement project suggest that integrating Obstructive Sleep Apnea screening into psychiatric outpatient care is feasible and beneficial. By identifying at-risk patients and providing accessible, at-home diagnostic tools, we aim to enhance patient care and address the underdiagnosed issue of sleep disturbances in psychiatric populations. The project demonstrates the potential for a streamlined, interdisciplinary approach to improve outcomes and set a scalable model for comprehensive patient management in similar settings. Further analysis will focus on the impact of this intervention on psychiatric care and overall patient health outcomes.

None Declared

Patients suffering from severe mental disorders have a reduced life expectancy of approximately 10-25 years compared to the general population. This mortality gap is mainly due to physical comorbidities among which metabolic disorders play a significant role.

In our study we used the Body Mass Index (BMI), an indicator of general health that can be easily calculated in daily clinical practice, to investigate how weight and the different psychopathological and psychosocial dimensions mutually influence each other in patients with mental disorders.

This naturalistic observational multicenter study was carried-out in 7 Italian university centers (Universities of Campania “L. Vanvitelli,” Catania, Magna Graecia of Catanzaro, Cattolica del Sacro Cuore of Rome, Padova, Sapienza University of Rome, and Tor Vergata of Rome). Patients were recruited if they: 1) had diagnosis of bipolar disorder (BD) or major depressive disorder (MDD) according to DSM-5 criteria; 2) had an age between 18 and 65 years; 4) were in a stable phase of the disease (total score < 9 on the Hamilton Rating Scale for Depression and a score of ≤11 on the Young Mania Rating Scale). Affective temperaments were assessed with the Munster Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego, impulsivity with the Barratt Impulsiveness Scale, and suicidal ideation with the Columbia Suicide Severity Rating Scale.

A total of 598 patients were recruited, of which 60.9% affected by DB and 39.1% by MDD. Univariate analyzes revealed an association between higher BMI and male gender (p<0.001), BD diagnosis (p<0.001), high levels of impulsivity (p<0.05), presence of psychotic symptoms during the acute phases of illness (p<0.05), greater number of hospitalizations (p<0.01), cigarette smoking (p<0.05) and depressive temperament (p<0.001). Furthermore, patients treated with lithium (p<0.05), antiepileptics (p<0.05) and first-generation antipsychotics (p<0.001) had a significantly higher BMI compared to those not taking the aforementioned pharmacological treatments.

The results of our study highlight a strong link between BMI and some clinical outcomes in patients with affective disorders. The routinary assessment of these outcomes would be useful for the early identification of potential metabolic comorbidities as well as to identify patients at higher risk to develop a worse outcome.

None Declared

Gambling disorder, previously known as pathological gambling, is a behavior that significantly impairs functioning in personal, social, and occupational domains. Currently, there is no pharmacological treatment for gambling disorder, emphasizing the need for innovative treatment modalities. Imaging studies have identified a connection between prefrontal circuit dysfunction and behavioral disinhibition, supporting the potential use of non-invasive brain stimulation in treating gambling disorder.

The purpose of this study is to investigate the effect of theta-burst stimulation (TBS) on gambling disorder.

The study duration is 2 weeks, with 10 sessions of TBS intervention. The intervention group will receive 1800 pulses of intermittent TBS at the left dorsolateral prefrontal cortex and 1200 pulses of continuous TBS at the pre-supplementary motor area during each session, while the control group will receive sham stimulation. Primary outcomes, including the Gambling Symptom Assessment Scale (G-SAS) and the Visual Analogue Scale (VAS) for craving, were administered at weeks 0, 2, 4, and 8, and the changes between the two groups were compared using generalized estimating equations. Secondary outcomes, including Beck Anxiety Inventory and Beck Depression Inventory, and serum brain-derived neurotrophic factor (BDNF), cortisol, and hsCRP, were measured at weeks 0, 4, and the changes between the two groups were compared using repeated measures ANOVA.

A total of 33 patients with gambling disorder were randomly assigned in a 2:1 ratio to the intervention group (21 patients) and the control group (12 patients) on a double-blind basis. They were included in the preliminary analysis on an intention-to-treat basis. The VAS scores of the active group decreased more than those of the sham group (active group: 53.3 to 17.9, sham group: 37.5 to 15.3), but the difference did not reach statistical significance (p = 0.13). Compared to the sham group, the active group showed a decreasing trend in hsCRP (p = 0.54) and an increasing trend in free BDNF (p = 0.34), but neither reached a statistically significant difference.

Drawing definitive conclusions is limited by small sample size. Nevertheless, the initial results from this study suggest that the alterations in levels of gambling craving, hsCRP, and serum BDNF align with our hypothesis.

None Declared

Auditory verbal hallucinations (AVH) are one of the primary symptoms of schizophrenia, but the biological mechanisms underlying them remain uncertain (1,2). Theoretical approaches have proposed that AVH are caused by abnormal activity in the auditory cortex; or that they represent misinterpreted cognitive activity such as inner speech. Recently, our group found, using a symptom capture task, that AVH did not trigger activity in the auditory cortex, but instead in language-related areas, thus shifting the focus towards cognitive theories of AVH (3). To date, cognitive approaches have only been preliminarily investigated, and mostly in psychological studies (1,2).

Our aim was to test the theory that a disturbance in inner speech processes underlie AVH. We used conjunction analysis to examine common activation patterns between the experience of AVH and phonological encoding.

Eleven patients meeting DSM-5 criteria for schizophrenia or schizoaffective disorder with near-continuous AVH underwent fMRI during symptom capture and during a phonological encoding task. In the symptom capture task, the patients were instructed to press their left index finger when they begin to hear an AVH, wait three minutes, mentally repeat what they heard, and then press their right index finger. The phonological encoding task required them to indicate, via button press, whether the names of two objects shown in line drawings rhymed.

Pre-processing and analyses were carried out with FSL software using linear models. Activation maps were thresholded at p<0.05, cluster-corrected for multiple comparisons. To find regions of common activation between the two tasks, the activation maps from the contrasts of interest were binarized and entered into a conjunction analysis. Regions showing significant activation in both tasks simultaneously were considered activated in the conjunction analysis.

The conjunction analysis showed common activation in several regions involved in phonological encoding, such as Broca’s area and its right homologue, supplementary motor area bilaterally, Wernicke’s area and cerebellum, in patients with AVH.

These results support a non-perceptual origin of AVH and link them to brain areas related to the phonological loop and working memory in schizophrenia.

None Declared

Chronic medical conditions are increasingly recognized as significant contributors to suicide risk, especially in patients without prior psychiatric diagnoses (Østergaard et al. JAMA Psychiatry 2024). This case examines the psychiatric impact in a 65-year-old male admitted to general surgery for abdominal pain, who subsequently underwent an ileocolectomy for suspected gastrointestinal malignancy.

To explore the psychiatric impact of medical morbidity on suicide risk, emphasizing recent findings suggesting heightened attention for patients without a psychiatric history.

The patient, with no prior psychiatric history, was observed by liaison psychiatry after verbalizing suicide ideation without intent or plan. The ideation was associated with worsening mood, particularly over the past week. Emotional distress escalated after perceived medical setbacks and was compounded by familial dynamics, particularly the wife’s expressed anxiety. A diagnosis of adjustment disorder with depressive symptoms was considered, with initial treatment involving mirtazapine and psychosocial support.

The case reflects evidence supporting the idea that suicide risk may follow a dose-response pattern based on the disability burden in patients without prior psychiatric history (Østergaard et al. JAMA Psychiatry 2024). This suggests clinicians may need to be particularly vigilant in medically ill patients without a psychiatric background, as their suicide risk may increase as disability burdens mount – contrary to the understandable and maybe more intuitive focus on those with established psychiatric diagnoses.

This case highlights the importance of thorough suicide risk evaluation in patients without psychiatric histories, particularly following a major medical diagnosis. While suicide risk remains high in psychiatric patients, clinicians must be equally or even more vigilant with medically ill patients without psychiatric histories. Psychiatric care should be integrated early, with attention to the timing of suicide risk, the disability burden, and psychosocial stressors. This highlights the need for careful monitoring and early intervention, particularly in the acute phase following medical complications, where risk evaluation may be more nuanced.

None Declared

Evidence links early adolescent cannabis use (CU) to long-term health risks, but most studies lack comprehensive early-life confounder data and rely on subjective health measures.

To assess the association between adolescent CU trajectories and healthcare use for physical and mental health problems (P&MHP) in young adulthood.

Data from the Québec Longitudinal Study of Child Development, a 23-year population-based birth cohort (N = 1,591), were linked to healthcare administrative records (hospitalizations, outpatient, and ER visits). CU trajectories (exposure) were derived from age of onset and frequency data (ages 12-17) using group-based trajectory modeling. Missing data on pre-exposure confounders were multiply imputed. Overlap-weighted logistic regression was used to assess the adjusted associations between these trajectories and healthcare use for P&MHP between ages 18-23.

Three CU trajectories were identified: non-users, late users, and early users (Figure 1). Early users had a higher risk of healthcare use for any mental disorder (OR 1.55, 95% CI 1.17-2.06), common mental disorders (OR 1.69, 95% CI 1.19-2.39), substance-related disorders (OR 2.25, 95% 1.24-4.10), and hospitalizations for physical diseases (OR 1.57, 95% CI 1.03-2.38) compared to non-users. No significant differences were found between late and non-users.

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These findings highlight the need for targeted interventions during adolescence to mitigate long-term health risks. Prevention efforts should prioritize early users, and be focused on integrated social, mental, and physical care.

None Declared

Feigning is defined as “to represent falsely; to imitate so as to deceive” (McDermott et al. Int J Law Psychiatry 2013; 36:287-92). Malingering and dissimulation are subtypes of feigning: malingering involves intentionally producing symptoms for incentives (World Health Organization. ICD-11 2022), while dissimulation involves concealing symptoms to appear mentally well (Caruso et al. J Am Acad Psychiatry Law 2003; 31:444-50). The prevalence of feigning illness remains uncertain, and varies with context and incentives. Within the legal context, 17.5% feign incompetence to stand trial and 64.5% to plead not guilty by reason of insanity. Malingering has been reported in up to 56% of general offender samples (McDermott et al. Int J Law Psychiatry 2013; 36:287-92). In the public setting, the malingering prevalence constituted 30% of disability evaluations, 29% of personal injury evaluations, 19% of criminal evaluations and 8% of medical cases (Mittenberg et al. J Clin Exp Neuropsychol). In 2006, malingering resulted in approximately $150 billion in annual expenses for the US insurance industry (Mason et al. Perspect Psychiatr Care 2014; 50: 51-7).

To explore the challenges in differentiating psychiatric illness from feigning.

This case involves analysing the patient’s history, collateral information, and diagnostic interviews to distinguish psychiatric pathology from feigned symptoms.

A 31-year-old male with a history of paranoid schizophrenia, whose recent psychiatric admission was prompted by psychosis and charges of serious assault, property damage, and possession of a weapon. The admission raised suspicions of symptom feigning and patient wariness of the psychiatric stigma. Despite four years of engagement with mental health services (MHS), the patient disclosed shortly after admission that he had been feigning his symptoms to obtain an insanity plea, but now hopes to return to prison seeking a more favourable environment and the certainty of a confirmed guilty sentence. Collateral information from the community MHS and family members suggested underlying psychiatric concerns and manipulative tendencies of the patient, complicating the diagnosis and raising the possibility of dissimulation.

The case highlights the challenges of distinguishing genuine psychiatric illness from deceptive behaviour, emphasizing the importance of thorough history-taking, understanding symptom pathology, using diverse interview techniques, gathering collateral information, and conducting psychological assessments. Clinicians must carefully distinguish feigning from true pathology to provide accurate diagnoses, ensure proper treatment, reduce costs, and safeguard public safety.

None Declared

Autism spectrum disorder (ASD) is characterized by communication challenges, particularly in non-verbal aspects such as facial expressions.Research in this area is limited due to the lack of accurate methodologies. Existing literature generally agrees that individuals with ASD often show a disconnect between verbal communication and emotional expression, with facial expressions being diminished or inappropriate. Most studies have relied on ratings by highly trained observers, which can reduce accuracy and introduce biases, such as confirmation bias.

Our goal was to create a model for capturing and analyzing facial expressions using computer algorithms and assess its effectiveness in identifying individuals with ASD.

The study involved 100 participants, divided into two groups based on ASD diagnosis. The ASD group included 73 individuals, 51 (69.8%) of whom were male, while the control group comprised 27 participants, with 16 (59.2%) being male. ASD diagnoses were made by a specialist child and adolescent psychiatrist using developmental history and mental state examinations, confirmed with the ADOS-2 protocol. In the control group, ASD was ruled out using the same protocol. A significant age difference was found between the ASD group (mean age: 14 years; 95% CI: 13.5-14.5) and the control group (mean age: 16.3 years; 95% CI: 15.2-17.5), according to the Mann-Whitney U test.

All participants completed three tasks: a semi-structured conversation, recognizing facial expressions displayed on a screen, and imitating these expressions. Throughout the tasks, participants’ faces were recorded using five cameras positioned around them. Faces were then detected in the images using a sliding window algorithm in a multi-resolution representation of the Gaussian pyramid utilizing a linear classifier based on the Support Vector Machine (SVM) with a classical Histogram of Oriented Gradients (HOG) descriptor. An Ensemble of Regression Trees was applied to these detected faces to model facial landmarks in each frame. Using these landmarks, anthropometric distances and proportions were calculated, which were then used to train the SVM classifier.

The obtained model was able to predict the diagnosis of ASD in the study population with almost 100% accuracy. The mean difference between the probability of the correct class and the probability of the incorrect class determined by the SVM on the test set was 56%.

This method of facial expression analysis using an SVM classifier shows potential as a tool for diagnosing ASD. The technique could be applied using smartphones. However, further research is needed to evaluate its clinical viability, particularly when using non-standard devices. These findings also support the hypothesis that individuals with ASD display facial expressions significantly differently from neurotypical individuals.

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It is well established that living, or growing up, in poverty has a negative impact on both physical and mental health. The area our service covers includes Great Yarmouth and Lowestoft, 2 of the most economically impoverished areas of the UK. The vast majority of our patient group will have grown up in relative poverty. While there are associations between poverty and impaired physical health and increased risk of some mental health conditions, the actual causal link is unclear.

To explore if there appears to be a link between growing up in poverty and developing a significant mental illness.

Data anlaysis from Consultant caseload list.

We do know that there are some factors associated with both poverty and increased risk of mental illness and these include;

• - Parental drug or alcohol abuse

• - Parental mental health problems (if these are not well managed)

• - Early/premature death of a parent

• - Exposure to domestic violence

• - Physical abuse

• - Going into the Care System

• - Early drug or alcohol use

• - Early separation or loss of a parent

Findings

Total number of patients = 122

Number who have a specific factor associated with poverty =56

This equates to 46% of my current caseload.

Gender =35 female (62.5), male 21 (37.5%)

Summary of Findings – “The poor bear the greatest burden of mental illness” (2)

This would certainly seem to be the case, from the findings of this service evaluation. Our findings show that a significant percentage of our patient group have mental health issues directly related to poverty.

It is worth noting that the vast majority of my patient case load grew up in poverty, due the demographics of the area we work in (a quick analysis suggests about 97% of my case load are from working class, impoverished backgrounds). We abandoned recording “parental unemployment” in this analysis, because for all but a few, this was the case. Unemployment is an entrenched issue in this area, with the demise of the shipping and offshore industries, currently standing at 5.4% in Yarmouth and 3.5% in Lowestoft (3) (National average 3.8%). For those that are employed, poverty is a significant issue with many in low paid jobs. I have also not included here factors associated with poverty, such as poor diet, smoking, malnutrition, poor dentition, and obesity, but we know these are the case for many patients seen here.

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