Eating disorders affect almost one million people in France. More than half of them have not been screened for the disorder, and are still unable to access treatment!

To shed light on the clinical characteristics and management of patients with eating disorders

We report on a series of clinical situations involving patients presenting with binge eating disorder at the adolescent unit of the Gonesse hospital.

Our sample included 5 patients, all female, aged between 13 and 16 years. They presented with anorexia nervosa with or without hyperphagia. Comorbidities included depression, anxiety disorders, chronic illness and suicidality.

In some cases, treatment is based on re-feeding via a nasogastric tube. In others, behavioral treatment was sufficient. Pharmacological treatment for comorbidities was prescribed.

Untreated eating disorders can be a source of deterioration in patients’ quality of life and high mortality. Early detection and diagnosis is essential for better patient management.

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Depression, particularly in early adulthood, presents a significant mental health challenge with far-reaching implications. Innovative approaches to address and alleviate depressive symptoms are of paramount importance in this context. One such approach involves the utilization of technology, specifically chatbot-based programs, to target specific cognitive biases associated with depression.

The central objective is to empirically examine whether this program can effectively influence depressive mood and negative cognition in individuals grappling with depressive symptoms.

To ascertain the program’s efficacy, participants were divided into two groups: the CBM-I group (n=20), which underwent interpretation bias modification training, and the Mood Check group(n=20), which served as a control and engaged in a simple mood-checking exercise. A battery of psychological measures was employed, including assessments of depression, interpretation bias, suicidal ideation, resilience, and attention control.

Analysis results showed that the CBM-I group had a significant reduction in depression (PHQ-9, CES-D) compared to the Mood Check group in the post-measurement. Moreover, resilience (CD-RISC) and attention control (ACQ) significantly improved in the CBM-I group.

This research serves as a stepping stone towards a deeper understanding of how chatbot-based interventions can contribute to the management of early adulthood depression, offering new perspectives and possibilities in the realm of mental health support and treatment.

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Neuropsychiatric disorders can develop following a group A β-hemolytic streptococcal infection, through autoimmune inflammation of the nervous system. Sydenham’s chorea and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection) are the two most well-known syndromes, primarily affecting children but rarely observed in adults.

Our aims are to contribute to the scientific understanding of adult PANDAS-like syndrome and provide a comprehensive literature review on the subject.

Case report using clinical records and a non-systematic literature review.

A 24-year-old female presented to the emergency department with profound emotional distress triggered by intrusive thoughts of existential dread, accompanied by compulsive praying. She reported that these symptoms had commenced five days earlier. Two days prior to the onset of her obsessions, she had experienced a high fever, odynophagia, cough, and chills and received an empirical diagnosis of tonsillitis following a physical examination. She was prescribed antibiotics with good response. She revealed that she had experienced two prior episodes of similar anxiety and obsessions when she was approximately seven years old.

She developed acute obsessive thoughts, including doubts about the meaning of her life, and engaged in compulsive prayer and seeking reassurance from relatives. Notably, there were no signs of affective, dissociative, or psychotic disorders during her admission to the ED or in the preceding months. She reported suffering from anxiety, insomnia, and loss of appetite in the past five days but did not express any suicidal ideation.

Physical examination indicated mild laryngeal erythema, and laboratory tests showed non-specific signs of infection with no further significant findings. Symptoms were alleviated within a week, aided by treatment with benzodiazepines (lorazepam 1 mg/8h), and she did not require further psychiatric counselling.

It is worth noting that adult patients can experience a PANDAS-like reaction after a streptococcal infection and may also undergo symptom relapse following new immunological challenges upon reinfection. The existence of a PANDAS spectrum has been postulated, encompassing various manifestations. Thus, when presented with acute obsessive symptoms, healthcare providers should consider this diagnosis, inquire about previous episodes, and conduct a comprehensive medical history and etiological assessment.

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Patients suffering from mental disorders tend to be less adherent to the recommended therapies. Moreover, the COVID-19 pandemic had a global impact on physical and social well-being, which turned out stronger in the most fragile patients, like those with a mental condition.

To assess whether the COVID-19 pandemic influenced the physical healthcare gap between patients with and without severe mental illness (SMI) treated for chronic conditions.

Data were retrieved from Healthcare Utilization Databases of Lombardy region (Italy). Prevalent users of antihypertensive drugs, statins or antidiabetic drugs, receiving healthcare in Lombardy during 2020, were identified. Among them, those with a previous diagnosis of schizophrenic or bipolar disorder were selected and matched with up to 3 patients without any sign of mental disorder by sex, age and number of contacts with the NHS during the previous year. 3 cohorts (not necessarily independent) were formed.

High adherence to specific recommended drug therapies and discontinuation during 2020 were evaluated.

Association between presence of SMI and high adherence was evaluated by using a log-binomial model (risk ratios, RR with 95% CI); a Cox model (hazard ratios, HR) was used for discontinuation.

As comparison, same analyses were performed to the cohorts of prevalent users in 2019, to evaluate the impact of the COVID-19 pandemic. Results were stratified according to the type of mental disorder.

36'436, 14'136 and 12'597 prevalent users of antihypertensives, statins or antidiabetics respectively were identified, of which 25% with SMI (9'109, 3'536 and 3'152 respectively).

During the pandemic period, for all the three cohorts, patients with mental illness had 10% lower probability of being adherent to the recommended drug therapies.

The association between SMI and discontinuation was significant and varied among the three cohorts, with HR (95% CI): 1.27 (1.21; 1.33) for antihypertensives users, 1.16 (1.07; 1.26) for antidiabetics users and 1.08 (1.01; 1.16) for statins users.

Compared with 2019 the gap remained similar, except for discontinuation of antidiabetics, where the gap diminished from 34% in 2019 to 16% in 2020.

No differences between the two mental disorders were found.

Results show that suffering from a mental disorder in people with chronic physical conditions affects their adherence to recommended drug therapies. During the pandemic period, the restrictive measures adopted may have led to a better care by family members, counteracting any increase in the gap.

The healthcare gap in patients suffering from mental illness remains an unsolved problem of primary importance for public health.

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In psychosocial rehabilitation (PSR), rank scales are widely used to assess the severity of functional disorders in patients. The main problem of evaluating the effectiveness of PSR is related to the methods of processing data obtained using psychometric scales used to evaluate the effectiveness of interventions within PSR. J. Pfanzagl (1968) obtained the proof of the non-numerical nature of ranks. Incorrect processing of rank information obtained in the framework of psychosocial research leads to contradictions in the assessment of the patient’s condition. Consequently, rank processing does not allow classical mathematical operations (summation, average), which makes it impossible to correctly estimate the effectiveness of PSR numerically.

Development of algorithms for numerical evaluation of PSR efficiency based on rank information processing using the analytic hierarchy process (AHP) [1].

Clinical, psychometric, AHP algorithms.

The analysis of the problems of assessing the patient’s conditions on the basis of categorical and psychometric (rank) scales and subscales shows that these problems can be presented in the form of appropriate hierarchies [2], the structure of which must be taken into account when processing the initial information.

According to the results of the analysis of the data of preliminary studies, the main areas of impaired functioning of patients affecting the evaluation of the effectiveness of PSR have been identified. Rank estimates of changes in the relevant areas of the patient’s dysfunction after the PSR program compared to the initial level are the basis for the conclusion about the effectiveness of the PSR components. Algorithms of the AHP normative approach were used to translate rank information into numerical information [2]. The weight of the areas of the patient’s functioning disorders was used in the formation of integral estimates of the effectiveness of PSR.

The fundamental difference between AHP-based assessments and rank assessments is due to the fact that numerical estimates of the weight of the criteria and the corresponding changes in the patient’s condition are obtained, which depend on the qualifications of specialists, the characteristics of the scales used to measure violations in the relevant areas and the procedures of the PSR.

Obtaining the results of processing rank information in a numerical scale allows to obtain the correct integration of the patient’s personal characteristics when considering PSR procedures and to obtain correct models of the patient’s state. 1. Saaty T. European Journal of Operational Research.1990; 48(1):9-26. https://doi.org/10.1016/0377-2217(90)90057-I 2. Mitikhin V.G., Solokhina T.A. et al. Psychiatry, 2022; 20(2): 51-59. DOI: 10.30629/2618-6667-2022-20-2-51-59

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Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most common neuropsychiatric conditions, maintaining its presence well into adolescence and adulthood, resulting in impaired functioning. Evaluating ADHD symptoms through self-reporting plays a crucial role in assessing individuals within these age groups. The novel self-report version of the Strengths and Weaknesses of ADHD and Normal Behaviors (SWAN) scale offers a comprehensive assessment of behaviour, extending beyond just focusing on the typical signs and symptoms of ADHD, thus providing a more holistic perspective.

Our goal was to assess the factorial validity of the Hungarian version of the SWAN self-report by comparing a two-factor model with bifactor models with a general and 1) two specific factors (inattention, hyperactivity/impulsivity), 2) three specific factors (inattention, motor hyperactivity/impulsivity, verbal hyperactivity/impulsivity) in a community sample.

Data from 717 adolescents and young adults (mean age = 20.0 years, SD = 3.10, range: 14 - 25 years, female: N = 664, 92.6%) were analysed. Participants completed an online questionnaire including the SWAN scale after giving informed consent. Confirmatory factor analyses were conducted based on the maximum likelihood estimator (ML).

The bifactor model with a general and three specific factors demonstrated the best fit to our data (CFI = .933, RMSEA = .064 [90% CI: .058 – .071], SRMR = .038). While the overall composite reliability was excellent (ω = .91), the reliability of the specific verbal hyperactivity/impulsivity factor fell below acceptable (ωh = .40).

In line with previous studies, the fit indices of the bifactor models were superior to the non-hierarchical two-factor model. Our results support the existence of a strong general factor but suggest uncertainty in the capacity of the specific factors to consistently explain the distinct variance in observed variables, particularly when compared to the overarching influence of the general factor.

This work was supported by the ÚNKP-22-2 New National Excellence Program of the Ministry for Culture and Innovation from the source of the National Research, Development and Innovation Fund (grant number ÚNKP-22-2-I-ELTE-854).

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Schizophrenia is a mental disorder characterized by negative symptoms, such as cognitive impairment. Recent reports indicate the importance of the immune system in the pathophysiology of schizophrenia. The development of inflammation affects cognitive functioning.

The aim of the study was to analyze the association between the level of lymphocytes in venous blood and selected cognitive functions in patients with schizophrenia.

Lymphocyte levels were determined in the venous blood of patients suffering from schizophrenia and the control group. Additionally, a verbal fluency test (VFT) and a Stroop test were conducted on the same day. The VFT evaluates the ability to express words, and the Stroop test assesses verbal working memory. The inclusion criteria were age up to fifty years, and for the study group – diagnosis of schizophrenia and treatment with neuroleptics. Exclusion criteria included organic brain diseases, electroconvulsive therapy, and use of benzodiazepines within 48 hours before the study. Currently, six patients and six healthy people have been studied.

Patients diagnosed with schizophrenia have an increased lymphocyte concentration in the blood compared to healthy individuals constituting the control group. There are discrepancies in the results of the phonemic fluency test, no significant differences were found between schizophrenics and the control group. Healthy men and women achieved higher results in the semantic fluency test compared to men and women with schizophrenia. Women constituting the control group achieved higher results in the Stroop test compared to women suffering from schizophrenia. Table 1 illustrates the concentration of lymphocytes in venous blood and the number of points in the phonemic fluency test, semantic fluency test, and in the Stroop test of the study and the control groups.

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Patients with schizophrenia are characterized by higher levels of immune system parameters and worse results in terms of semantic fluency. Men with schizophrenia showed no verbal working memory deficits. In turn, women with schizophrenia obtained worse results in the verbal working memory test. In conclusion, there is evidence of immune system activation in schizophrenia, which affects the cognitive functioning of patients.

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Generalized anxiety disorder (GAD) is characterized by excessive and uncontrollable worry and anxiety about several activities or events. Although some cognitive symptoms are common in GAD patients, there are still controversial results from their linkage. Some studies indicate intact cognitive functions in GAD patients, while others suggest that anxiety and its cognitive aspect, worry, are associated with reduced performance in several cognitive domains.

To assess the linkage and contribution of cognitive impairment to the maintenance and severity of GAD; to determine which specific domains of cognitive function are impaired in patients with GAD; and to examine age differences regarding cognitive impairment in GAD patients

A systematic literature search was executed using the PubMed and Google Scholar databases from 1960 to 2023 and the keywords “generalized anxiety disorder”, “anxiety disorder” “cognitive function”, “cognitive dysfunction”, “cognitive impairment”, “late-life”, “young”, “adult”, and their combination.

Anxiety and worry, as main characteristics of GAD, were shown to be linked and manifested by deficient attentional control, a main function of working memory. Attentional control functions are biased toward threats, which, in turn, hinders cognitive processing efficiency. Moreover, several structural and electrophysiological impairments could be linked to cognitive dysfunction in people with GAD. For example, patients with GAD showed reductions in gray matter volumes, especially in the regions of the hip, midbrain, thalamus, insula and superior temporal gyrus. The hippocampus, middle cingulate gyrus, putamen and head of the caudate nucleus also showed lower activity in response to the neutral words. Also, GAD patients have better inhibitory control, which may be associated with more severe symptomatology. These results are consistent with attentional control theory, which posits that worry might negatively impinge on inhibition and set-shifting. In terms of age differences, we observed that GAD in elderly patients is associated with impairment of short-term and delayed memory. In young adults, GAD is associated with various cognitive impairments, particularly in selective attention, working memory, cognitive flexibility, planning ability or efficiency, and other executive functions (EF).

To sum up, we observed that GAD is associated with worse cognitive functioning in several domains. Further research into cognitive dysfunction in GAD is needed to better understand the impact on daily living and to allow more tailored treatment strategies including medication, therapy and interventions targeted to improve specific cognitive domains.

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Accordingly, the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) working committee, composed of domestic experts, developed Korea’s first KMAP-BP in 2002 and later in 2006, 2010, and 2010. A revised version of KMAP-BP was announced every four years four times in 2014 and 2018.6-10). The treatment strategy considering the safety and tolerability of KMAP-BP 2022 was developed by collecting opinions from domestic bipolar disorder experts.

Safety and tolerability of drugs are very important factors in the treatment of bipolar disorder. An expert opinion survey was conducted on treatment strategies in various special clinical situations, such as significant weight gain, characteristic drug side effects, low drug adherence, pregnant and reproductive women, and genetic counseling.

A written survey about treatment strategies related to safety and tolerability was prepared and focused on significant weight gain, characteristic drug side effects, low drug adherence, pregnant and reproductive women, and genetic counseling. Ninety-three experts of the review committee completed the survey.

In the case of weight gain occurring during drug treatment, it was preferred to replace it with a drug that caused less weight gain, such as lamotrigine, aripiprazole, or ziprasidone. If there was a significant weight gain due to the treatment drug, it was preferred to intervene as soon as possible. In the case of hyperprolactinemia, it was selected to change the medication and discontinue it for benign rash caused by lamotrigine. In improving drug adherence, the preference for long-acting injections increased. Antipsychotics can be used with great caution in pregnant or reproductive women.

Treatment strategies in various clinical situations related to safety and tolerability in drug treatment for bipolar disorder were described. It is hoped that it will be useful in practical clinical situations.

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Exercise and other lifestyles are key treatment strategies to improve diabetes outcome, prevent cardiovascular risk and may also result in further results in quality if life and emotional symptoms.

To evaluate the effectiveness of an exercise intervention program for people with diabetes or cardiovascular risk.

To evaluate the influence of previous metal health and quality of life status in the results.

61 people with a type 2 diabetes or cardiovascular risk factors were recruited from health primary health centers in Ponferrada (EL Bierzo), including patients from the mental health association. After informed consent they were included in a 20 week, twice a week supervised walking training program to improve exercise and other lifestyles. A poster used for advertisement of the adtivity (“the way/walk to change diabetes”) is displayed in image 1). Baseline and after 20 weeks BMI and Waist perimeter were assessed, quality of life was evaluated with EQ-5D-5L and WHO-5 scales and the weekly steps walked were recorded previously and after the intervention with the subject usual mobile device.

Differences in the variables were compared with Paired Ts and repeated ANCOVAs measures adjusted by gender, age and initial steps.

46 subjects (75.4%) completed more than 90% of the sessions and 3 more 70-90%. The 19.7% that did not complete had worse scores in SF-12 Role Physical (t 2.261, p=0.041) and Role Emotional (t:2.048, p=0.045) and Mental Component Summary (t:2,313; p=0,036) and WHO5 Total Score (t:2.101; p=0,040) at Baseline. Main reasons for dropout (Image 2) were health related problems (50%) and adherence to exercise and motivation problems (31.25%).

Those who completed the training improve number of weekly steps (baseline: 42022,92 +- 18836,35, final: 66448.06 +-28914,58; t:5.038; p<0.001), BMI (29.45 +-4.66 to 28.25 +-4.09 kg/m2; t:5.629; p<0.001), waist (from 107,34 + 9.98 to 102,88 +9,79 cm; t:6,840; p<0.001) and the EoQ-5D-EL VAS (form 72.88 to 82.42; t:6.122; p<0.001, image 3). The increase in the steps correlated directly with the improvement in the EoQ VAS (r:0.308; p=0.033).

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Exercise and lifestyle supervised intervention programs appear to be useful to improve physical health, wellbeing, emotional symptoms and quality of life in people with diabetes and cardiovascular risk.

Factors associated to higher dropout rates were previous limited quality of life scores and mental health worse status. These could be related with limited motivation and adherence to the program and may be of interest to develop specific strategies for these high-risk groups.

Studies focused on the long-term effect of the program are warranted.

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Suicide is one of the leading causes of unnatural death worldwide. There might be meaningful differences between those individuals that attempt suicide once in their lifespan and those who make multiple attempts in terms of sociodemographic and clinical characteristics. There are no previous meta-analysis addressing this topic in the adult population.

We aimed to examine the factors that differentiate single and multiple suicide attempters in adult population.

We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to conduct this review and meta-analysis. The review protocol was registered in PROSPERO. We carried out a systematic literature search in three databases to identify original studies that explored the differences between single and multiple suicide attempters among adult population. A total of 75 studies were included in the review and 69 were included in the meta-analysis.

Multiple attempters were more likely to present certain disorders such as mood and psychotic disorders, as well as personality or substance use disorders. Higher suicide ideation and suicide intent scores also characterized this group. Childhood trauma experiences, stressful life events, and higher rates of hopelessness were statistically significant in multiple attempters.

Identifying the factors predicting multiple suicide attempts helps to delineate a high-risk suicidal profile that should be taken into account in the clinical and suicide prevention scenario.

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Psychiatryai.com was launched in 2021 and initial findings were published at EPA 2023. The portal is an advanced computing science project in Applied Data Science and Evidence-Based Healthcare for my MSc studies at the University of Oxford (Kellogg College). Artificial Intelligence (AI) and Data Science (DS) technology are utilised to analyse live Real-World Evidence (RWE) in Psychiatry and Mental Health from PubMed to provide CPD/CME online. A two-year review of the site and its performance will be presented to EPA 2024.

To develop and study an experimental real-time AI and DS platform in Global Mental Health and Psychiatry, to provide the latest RWE from PubMed for online education and training, and to report findings to EPA 2024 for peer review in Budapest. AI and misinformation are newly identified risks in healthcare (AI Safety Summit 2023). The site also aims to raise awareness about “Aiatrogenesis” to address this problem, with RWE and CPD/CME utilising AI and DS technology for the categorisation and meta-analysis of evidence, rather than the production of possibly misleading or false Generative AI evidence (Monteith et al. BJP 2023; 1-3).

As reported to EPA 2023 in Paris, a free open-code WordPress site was launched on the 22nd of November 2021 (Psychiatryai.com). The portal has been further developed and now features over 90k pages comprising 7GB of data with Cloudflare security and speed. Live evidence is collected into an open database and research articles are categorised into evidence nodes with AI. The results are presented in a real-time Evidence Matrix and Blueprint, creating 15-minute CPD/CME reflection modules. Data analytics from Psychiatryai.com with Google Analytics (G4A) along with platform insights from two years of development and research will be presented to EPA 2024. The site is conceptualised and designed to be viewed in an interactive VR headset.

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Psychiatryai.com has successfully developed a novel AI and DS platform that incorporates the latest research in mental health and psychiatry, providing real-world evidence (RWE) for psychiatrists and healthcare professionals worldwide, along with CPD/CME online. This enhances hypothesis testing in research by presenting a related Evidence Matrix and Blueprint (from the last 365 days) for each evidence node on the site (RAISR 4D). These matrices provide a real-time visual table (8 x 8 / 64) of global research related to the evidence node in the preceding year. The site is VR-ready and has a special focus on AI and Psychiatry, Disaster and Traumatology Sciences, and Youth Mental Health. This project is dedicated to the memory of Dr Denis O’Leary and Dr Navin Venkatraman.

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Intellectual disability (according to the DSM-5) or intellectual developmental disorder (according to the ICD-11) is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social and practical domains. The term learning disability (LD) is also used, although this term shows more specifically deficits in the domain of learning. The term learning difficulties is often used for specific or generalized intellectual impairment that does not meet all of the criteria of LD.

The prevalence of learning disability in prisoners is about 10%. Up to 60% of male prisoners have learning difficulties. Prevalence rates for offending behaviour in patients with LD is higher than in the general population and show a large range, from 2-40%.

The main explanatory factor underlying the link between intelligence and offending is the lack of ability to manipulate abstract concepts. Poor academic performance, common in persons with LD, is also linked to offending.

With regard to sexual offending, some persons with LD may not have learnt the rules that define acceptable and unacceptable behaviour. Sexual offences may amount to inappropriate, impulsive expressions of emotion rather than premediated violent acts. Violent behaviour in the LD population may be due to frustration, impulsivity or poor problem solving skills. There is no significant difference in the frequency of violent or property offences between individuals with LD and those without. However, sex offences and fire-setting are frequently seen in individuals with LD.

Persons with LD are vulnerable suspects and may also be disadvantaged by the criminal justice system because of a lack of appropriate support and legal representation from early stages in the process.

In this introductory paper these themes will be addressed.

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Alterations in motor activity are an extremely important characteristic and one of the leading symptoms of major functional psychiatric disorders. These pattern disturbances can be observed in schizophrenia. Actigraphy is a non-invasive method that can be used to monitor these changes, and recent studies emphasize its significance in the early identification of disorders like schizophrenia.

This study uniquely focuses on distinguishing latent liabilities for schizotypy from manifested schizophrenia using specific actigraphy features.

Actigraphy data were collected using specialized devices from the University of Szeged and Haukeland University Hospital datasets (Berle et al., 2010). At Haukeland University Hospital patients with chronic schizophrenia (N=23) (so-called: manifested group) were collected, separately, at the University of Szeged, healthy university students were recruited and screened for latent tendencies towards shizotypic pathological development. In the latter study, two main groups were formed based on their scores: a positive schizotypy factor group (so-called: latent group) (N=22) and a control group (N=25), with actigraphy data.

Utilizing the pyActigraphy library (Hammad et al., 2021) and wavelet analysis, features such as activity mean, interdaily stability and sleep movement characteristics were derived. Feature selection employed machine learning algorithms, notably Logistic Regression, Random Forest, ANN, and AHFS aided by Shapley values and Click Forming Feature Selection for insight into the most influential features.

The three models exhibited similar performance with a 60% accuracy threshold. In the latent group, sleep-related movements have a substantial impact, while in the manifested group, in addition to sleep characteristics, features like RA, IV, ADAT, M10, the mean activity level (all of which decreased), and the ratio of zero values also play a significant role. In the latent group, features related to the length of small amplitude movements were dominant, particularly the increased values, along with a decrease in the density of large movements.

Our study indicates that in the latent phase of schizophrenia, actigraphy features related to sleep are most significant, but as the disease progresses, both sleep and daytime activity patterns are crucial. Sleep disturbances may signal early susceptibility, with nighttime movements offering clearer insights. These variations might be influenced by medication effects in the manifested group, reflecting the broader challenges in schizophrenia research where the drug-free study of patients remains elusive. Further studies should explore these features in the Clinical High Risk and prodromal groups to refine our understanding of the development of the disorder.

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Severe schizophrenia is often closely related to delinquency resulting in relative overrepresentation of these manifestations of disease in forensic institutions.

The aim of the present work is to report the therapeutic challenges in a case of severe schizophrenia in a forensic institution from a clinical viewpoint as a basis for discussion.

The case report is based on the available clinical documentation, exploratory interviews as well as a structured clinical interview (PANSS).

Presenting a case of a 41-year-old, male Caucasian inpatient suffering from a catatonic schizophrenia, we report the challenges in treatment of chronic, major schizophrenic disease resistant to antipsychotic medication. Without any previous criminal convictions, he has been instutionalized in a forensic psychiatry after a bodily harm to a random stranger about three years ago. Regarding medical history, information is limited to a few inpatient admissions prior to detention documenting intravenous opioid and cocaine abuse. Initially, the patient presented sexual disinhibition and ongoing endangerment of others with frequent assaults to other patients and prison guards. From a psychopathological viewpoint several phenomenona such as delusional intuition, acoustic, tactile and coenaesthetic hallucinations, echolalia, mannerisms and thought diffusions reflect the severe course of the disease (PANSS: P 34/49, N 38/49, G 73/112; total 145/210). Therapeutic attempts with an antipsychotic combination of risperidone, olanzapine and quetiapine as well as valproic acid resulted in insufficient recovery with persistent physical assaults and florid psychosis. In reaction to that zuclopenthixol for impulse control was added. As from the beginning of this year a switch of medication by gradually replacing risperidone and zuclopenthixol with haloperidol and clozapine showed modest success. Under the current medication and therapeutic drug levels the patient does not pose endangerment to others. However, regular tonic-eye fits require supplementary treatment with biperiden, and the patient still presents frequent periods of self-harm punching himself, verbal lack of impulse control and the psychopathological phenomenona described before. In addition to pharmacological treatment the patient receives psychotherapeutic one-on-one conversations. Despite approaching all limits of the available antipsychotic repertoire, psychopathology is only insufficiently controlled leading considerations to electroconvulsive therapy as a treatment of last resort.

Certainly, the present case is exemplary for a severely ill population of patients reaching – after a long and untreated course of disease - a chronic stage that does not sufficiently respond to a multitude of treatment attempts despite proper compliance raising the urgent need for further treatment options.

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Patients with severe mental illnesses (SMI) are often exposed to polymedication. Additionally, the risk of somatic diseases is twice as high in patients with SMI as in individuals without a psychiatric disorder. Furthermore, drug–drug interactions (DDI) between psychiatric drugs and somatic medications are a well-known cause of adverse drug reactions (ADR).

The aim of this study was to analyse whether already known DDI related to psychiatric drugs and somatic medication still occur in everyday clinical practice.

Therefore we identified all spontaneous ADR reports contained in the European ADR database EudraVigilance from Germany received between 01/2017 and 12/2021 reported for patients older than 17 years in which antidepressants, antipsychotics and mood stabilizers were reported as suspected/interacting (n= 9,665). ADR reports referring to intentional overdoses and suicide attempts were excluded (n= 9,276 left). We used the ABDATA drug information system in order to identify all potential DDI (pDDI). The identified reports with pDDI were then assessed individually to determine whether the respective DDI occurred.

1,271 reports with 728 potentially interacting drugs pairs related to psychiatric drugs and somatic medications with 2,655 pDDI were found. Restricted to potentially interacting drug pairs with more than 10 reports, (i) hyponatremias related to antidepressants and diuretics (n= 362, 32.6%), (ii) bleeding events related to selective serotonin reuptake inhibitors (SSRI) and platelet aggregation inhibitors, anticoagulants or non-steroidal antiinflammatory drugs (NSAID) (n= 295, 17.5%), and (iii) increased beta-blocker effects related to SSRIs and beta-blockers (n= 126, 11.3%) were the most frequently identified pDDI. After individual case assessment, in 33.3% (14/42), 23.7% (45/190) and 17.4% (8/46) of the reports bleeding events related to SSRIs and anticoagulants, SSRIs and platelet aggregation inhibitors and SSRIs and NSAIDs were reported. Hyponatremia was reported in 7.6% (22/289) of the reports related to antidepressants and diuretics and increased beta-blocker effects in 6.9% (8/116) of the reports related to SSRIs and beta-blockers.

According to our analysis, well-known DDI still occur in the treatment of psychiatric patients with psychiatric drugs and somatic medication. Whenever possible, alternative drug combinations with a lower potential of DDIs may be considered or appropriate monitoring measures should be conducted.

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We present the case of a 70-year-old man who, after presenting atypical depressive symptoms, was diagnosed with incipient frontotemporal dementia.

Through the presentation of the case, a brief review is made of the affective prodromes of frontotemporal dementia

The patient, who had no personal history of interest, suddenly began to present depressive symptoms consisting of marked irritability, dysphoric mood, anxious semiology with a subjective feeling of anguish, maintenance insomnia and a feeling of lack of self-control, with a tendency towards verbal heteroaggressiveness. The patient reported all these symptoms with great suffering.

After one year of treatment with venlafaxine 300g DMD and quetiapine 400g DMD, with one admission to the short-stay inpatient unit for self-harm threats, the patient had not experienced any improvement. In addition, during this year, the patient’s family began to observe small memory lapses that affected his daily functioning, making the patient progressively more dependent.

In view of this clinical picture, it was decided to request an MRI and a brain PET scan, where deficits in the frontal and temporal regions were observed, and a diagnosis of incipient frontotemporal dementia was made.

Frontotemporal dementia is the third most common dementia in people over 65 years of age. About half of the patients debut with psychiatric symptoms, one of them being depressive symptoms. Treatment is focused on the use of psychotropic drugs with the aim of symptom management. Olanzapine or aripiprazole are effective for psychotic symptoms or acute agitation. For more subacute conditions, SSRIs or trazodone are recommended. The iACOs are not recommended, because they are ineffective and worsen neuropsychiatric symptoms.

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In this talk I will present new findings from EarlyCause, a European consortium which aims to better understand the link between early life stress and the development of psycho-cardiometabolic (PCM) comorbidity across the lifespan, leveraging data from large-scale pediatric and adult population studies. I will discuss findings regarding the effect of (prenatal and postnatal) early life stress on PCM health outcomes and their comorbidity, potential moderating and mediating factors, as well as evidence for causality.

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Several research already proved the role of certain immunological factors (neutrophil-lymphocyte (NLR), monocyte-lymphocyte (MLR) and platelet-lymphocyte (PLR) ratio, and C-reactive protein (CRP)) in the background of suicidal behaviour.

The aim of this research was to study the association between routinely measurable low-grade inflammation parameters and suicidal behaviour among patients in the acute psychiatric care setting.

The study population included psychiatric in-patients (N=100) consecutively treated with depressive disorders and/or suicidal behaviour in a University Clinic between December 1, 2020 and December 31, 2021. Three different patient-groups were generated based on their suicidal behaviour: suicide attempters (N=55) including recent attempters(N=36) and past attempters (N=19) and non-suicidal patients (N=45), who never had a suicide attempt. Basic socio-demographic data, the severity of depression and immunological parameters (white blood cell count: lymphocytes, monocytes, neutrophil, eosinophil, basophil granulocytes; thrombocytes; C-reactive protein) were recorded.Descriptive analyses and multivariate regression model were performed with RStudio version 4.2.3.

CRP was significantly higher (2.00 vs. 1.00; p=0.007) in suicidal patients (N=55), however other immunological parameters did not differ significantly between the suicidal and the non-suicidal groups (NLR: 2.02 vs. 2.19; MLR: 0.22 vs. 0.11; PLR: 118 vs. 130). NLR and MLR showed significantly higher values (NLR: 2.83 vs. 1.93, p=0.021; MLR: 0.28 vs. 0.11, p=0.01) for those who currently attempted suicide (N=36) compared to the patients with no or past suicide attempt (N=64). In the regression analysis, the NLR and MLR showed significantly higher values in current suicide attempters even when gender, age, suicidal risk and severity of depression were included in the model. However, no significant differences were found when comparing current and past suicide attempters with the non-suicidal patients.

Despite the small number of cases in the samples, our results confirmed the association of certain immunological parameters (NLR, MLR) and acute suicidal behaviour. This relationship was found to be independent of depression and its severity. Our data suggest that, unlike the NLR and MLR parameters, the higher CRP value may not be related to acute suicide attempt, but rather to suicidal vulnerability, as a trait-marker. Markers of chronic systemic inflammation may help in the prediction of suicidal behaviour and in the development of new therapeutic options, however, further prospective studies are needed to identify the specific role of immunological factors in suicidal behaviour more precisely.

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