People with severe mental illness (SMI) view employment as central to their recovery process, principally when work task is experienced as meaningful, manageable, and comprehensible. However, unemployment rates remain extremely high among people with SMI, especially those diagnosed with schizophrenia. The costs are high: significant numbers of people are at risk of loss of life’s purpose, social isolation, poverty, and even suicide. Internationally, there is a knowledge gap of lived experience of receiving IPS in a job development and working phase. We need to know more about those who do not get or stay in a job. Correspondingly, in a national context more knowledge is needed about mainstream ESs’ practices from an IPS client’s perspective.

Thus, the aim of this study was to explore clients’ experiences of receiving job support from employment specialists (ESs) working with individual placement and support (IPS) in Norway. IPS is developed to help people with severe mental illness (SMI) into competitive employment as an integral component of mental health services.

Using a hermeneutic phenomenological methodology, this study comprises individual semi-structured interviews with ten participants engaged in IPS at two districts psychiatric centers. Data analysis was conducted according to systematic text condensation.

Three themes emerged: (1) ES—a door opener? (2) Striving to sidestep a “spider web” of triggers at and away from work; and (3) Calling for a safer route.

This study highlights the importance of ESs offering IPS clients’ opportunities to try out diverse jobs and focusing more on assessing the work environment in the jobs they place people into. Our findings imply that ESs should spend more time on building a good working alliance with both clients and employers, and pay more attention on understanding individuals’ vocational capacities and support needs at the worksite. The ES training should focus not simply on the technical processes of job development and placement, but more directly on empowering clients to stay focused on their vocational ambitions and prospects. The salutogenic model of health can help ESs to analyze whether clients experience workplaces as meaningful, manageable, and comprehensible.

None Declared

Patients with postpartum depression may have an increased risk of developing schizophrenia or bipolar affective psychosis. Conversely, women with schizophrenia may have a higher risk of developing depression during the perinatal period, which could be screened using the EPDS. The presence of cutoff effects complicates the statistical analysis of the Edinburgh Postnatal Depression Scale (EPDS). Sensitivity and specificity, two key parameters, cannot be treated as independent variables in such cases. To improve the precision of EPDS evaluations across different populations, versions with multiple cutoff points are preferable. While linear regression correlations may produce statistically significant results, they can be misleading when nonlinear relationships are present. In these instances, alternative statistical methods are recommended, such as hierarchical (Bayesian) models, bivariate (random effects) models assuming normal distribution, and joint modeling of sensitivity and specificity. Additionally, models with multiple cutoff values for sensitivity and specificity are particularly useful.

This study aims to review the literature and assess the validity of the EPDS in its various language versions and across different psychotic states.

The literature data on the EPDS, across different language versions and psychotic states, was statistically analyzed, focusing on specificity, sensitivity, and the influence of cutoff thresholds.

The analysis of 42 pairs of sensitivity and specificity data using linear regression showed a statistically significant moderate negative correlation (Pearson’s r =−0.4342, p = 0.0018). Visual aids such as the histogram and Q-Q plot indicated the absence of normal distribution, confirmed by formal normality tests. The normality test results were as follows: Kolmogorov-Smirnov: D(84) = 0.135, p<0.001; Shapiro-Wilk: W = 0.817, p<0.001.

The Kruskal–Wallis one-way ANOVA test revealed statistically significant differences among the three variables (sensitivity, specificity, and cutoff threshold), with a test statistic of H(2) = 79.647, p<0.001. The Receiver Operating Characteristic (ROC) curve is widely regarded as the most reliable tool for representing the relationship between sensitivity, specificity, and cutoff thresholds across different language versions of the EPDS. These variations account for cultural and national characteristics, which play a significant role in the scale’s overall validity.

None Declared

Virtual reality (VR) has the potential to enhance current psychotherapies for psychotic symptoms by simulating virtual environments that evoke responses reflective of real-world scenarios.

This study aimed to evaluate the effectiveness of VR-based psychotherapeutic interventions through findings from two large-scale randomized clinical trials—CHALLENGE and Face Your Fears—that targeted auditory hallucinations (AH) and paranoia, respectively, in individuals with schizophrenia spectrum disorders (SSD).

The CHALLENGE and Face Your Fears trials were randomized, assessor-blinded, parallel-group superiority trials that enrolled 270 and 254 patients with SSD, respectively. In the CHALLENGE trial, participants were randomized to 7 sessions of Challenge-VR therapy (Challenge-VRT) or treatment-as-usual (TAU). In Face Your Fears, participants received either 10 sessions of VR-CBT or standard CBT.

Linear mixed-model analyses on primary and secondary outcomes in both trials revealed that in the CHALLENGE Trial, Challenge-VRT significantly reduced AH symptom severity, as measured by the Psychotic Symptoms Rating Scales (PSYRATS-AH total, adjusted mean difference: -2.26, 95% CI: -4.26 to -0.25, p = 0.03) and frequency (PSYRATS-Frequency, adjusted mean difference: -0.84, 95% CI: -1.53 to -0.14, p = 0.02) at treatment cessation. Face Your Fears Trial: No significant differences were observed between groups on the primary outcome at endpoint (adjusted mean difference: 1.12, 95% CI: -1.75 to 3.99; Cohen’s d = 0.10; p = 0.44). However, both groups demonstrated large within-group improvements (VR-CBT: Cohen’s d = 0.88; standard CBT: Cohen’s d = 0.87). Standard CBT demonstrated superiority over VR-CBT on the secondary outcome measure emotion recognition latency overall at treatment cessation (adjusted mean difference -348.3, 95%CI: -696-6 to -0.04; Cohen’s d = 0.25, p= 0.05), and on emotion recognition accuracy, sadness at 9 months follow-up (adjusted mean difference 0.85, 95% CI: 0.06 to 1.63; Cohen’s d = 0.27, p= 0.03). No serious adverse events were reported in either trial.

Challenge-VRT appears to be a promising treatment for reducing the severity of AH in SSD, though further research is required to optimize and extend its efficacy across broader aspects of schizophrenia. In contrast, VR-CBT did not demonstrate superiority over standard CBT for paranoia, suggesting that both treatments may offer comparable benefits. Future research should explore mediators and moderators of treatment efficacy, as well as patient preferences, to tailor interventions for maximum impact.

L. Birkedal Glenthøj Consultant of: Consultancy for Khora-VR., M. Nordentoft: None Declared

Fragile X Syndrome (FXS) is a hereditary disease, linked to the X chromosome. FXS is the most common form of inherited intellectual disability and monogenic cause of Autism Spectrum Disorder (Protic et al. Developmental medicine and child neurology 2024; 66,7 863-871). Other clinical features includes speech and language delay, deficits in executive functioning, attention deficit hyperactivity disorder, sensory hyperarousal, social anxiety and aggressive behaviour. Cardiac abnormalities, musculoskeletal and gastrointestinal symptoms are also present.

The aim of the case is providing a review of multidisciplinar strategy in Fragil X Syndrome.

Clinical case description and literature review on the subject.

We report a clinical case of a 25 year old man was diagnosed with autism spectrum disorder, moderate intellectual disability, associated with Fragile X Syndrome. The patient is followed up in a Psychiatry (neurodevelopment) consultation. The present clinical condition causes multiple difficulties in managing his daily life, requiring supervision to carry out most of the tasks assigned to him, resulting in dependence on a third person. Furthermore, the patient has permanent total incapacity for any employment activity. Despite the diagnosis presented, as a result of investment on the part of the clinical, school, social action teams and especially his parents, the patient does not present behavioral changes that justify, at the moment, the use of any psychotropic drug. However, it is important to have access to all non-pharmacological therapies, otherwise the patient will lose the benefits achieved to date. The patient is currently stable, taking a course to become an administrative assistant at an institution. He participates in dance groups, speech therapy and hydrotherapy.

The best approach involves a targeted intervention to control symptoms and improving the quality of life. The management includes non-pharmacological strategies, such as individualized educational support, applied behavior analysis, physical, occupation and speech-language therapy. A pharmacologic strategies that includes, for exemple, SSRIs and/or antipsychotics is often helpful. FXS has a major impact on the individual’s social and family environment, which requires an appropriate multidisciplinary strategy that includes occupational, physical therapists, teachers, psychologists and psychiatrists. (Protic et al. International journal of molecular sciences 2022; 23 1935).

None Declared

Schizophrenia is a chronic disorder with a massive impact on quality of life. The prevalence of treatment resistance has been estimated around 30%. Treatment resistance is typically defined as non-response to 2 antipsychotics of adequate dose and duration. However, clinical reality often shows that the definition at an individual level is more complex and a personalised approach is needed.

We present a literature review discussing clinical, neurobiological and pharmacogenetic aspects relevant to treatment resistance.

Our overview highlights the need for indiviudalised assessement of patient needs. We discuss pharmacogenetic aspects related to treatment respons and tolerability, including Clozapine. We focus on indicators for stratification and treatment optimization in the context of personalised medicine. In addition, we present evidence for other augmenting treatment modalities in the context of treatment resistance for schizophrenia, such as neuromodulation (e.g., rTMS for acoustic hallucinations).

This talk focuses on the challenges of treatment resistance in schizophrenia and discuesses new insights in the existing treatments and pharmacogenetics, as well as opportunities for treatment augmentation that arise from emerging technologies.

None Declared

Research on temperament in individuals with familial high risk for psychosis (FHR-P) and bipolar disorder (FHR-BD) suggests that specific temperament patterns may mirror characteristics of the associated disorders. Terms such as schizotaxia and cyclotaxia describe these patterns: schizotaxia is linked to traits such as cognitive disorganization and social withdrawal seen in those at risk for psychosis, while cyclotaxia involves emotional instability and reactivity associated with bipolar disorder.

This study aims to investigate the relationship between temperament traits associated with psychosis and bipolar disorder as suggested in the concept of schizotaxia and cyclotaxia.

We recruited a total of 94 participants, comprising 29 people at familial high risk for psychosis (FHR-P), 41 people at familial high risk for bipolar disorder (FHR-BD), and 24 controls (HC). Participants from familial high-risk groups were identified through patient records or outpatient settings at Dokuz Eylül University. Several self-report measures are selected to investigate the temperament traits of schizotypy and cyclothymia. Those measures listed as; the Schizotypal Personality Questionnaire (SPQ), Behavioral Inhibition System/Behavioral Activation System (BIS/BAS) Scale, Temperament Evaluation of Memphis, Pisa, Paris and San Diego-auto questionnaire version (TEMPS-A), Pittsburgh Sleep Quality Index (PSQI), Barratt Impulsiveness Scale (BIS). One-way ANOVA is used to analyze the data using Jamovi Version 2.6.2.0.

FHR-P individuals, but not FHR-BD, had significantly higher scores of depressive(p<.001), cyclothymic (p=.005) and anxious(p=.002) temperament than HC in TEMPS-A subscales. Both familial groups had significantly higher scores in activation(p=.001) but not in inhibition in BIS/BAS. Moreover, they had worse sleep quality indicated by significantly higher PSQI (p=.014) scores. BIS scores and SPQ total scores do not significantly differ across groups however, FHR-P had significantly higher scores in negative subscores(p=.032) of SPQ than HC.

Our findings show significant differences in the FHR-P group across most temperament scores, indicating a greater vulnerability to schizotypal and cyclothymic traits. This may result from various factors, such as participants being recruited from outpatient psychiatric settings. Both familial groups also demonstrated lower educational levels and premorbid IQ scores on the WAIS, with more pronounced differences in the FHR-P group compared to the FHR-BD group. Additionally, the unequal sample sizes among the groups could affect the results. Therefore, further research is needed to account for the influence of common psychiatric conditions associated with participants’ help-seeking behaviour and to ensure better educational matching with healthy controls.

None Declared

A 44-year-old woman with a history of migraine, ulcerative colitis, obesity, and hypertension. She experienced a depressive episode that resolved completely in 2013. Hospitalized in 2020 and 2021 for psychotic symptoms (auditory pseudo-hallucinations) resistant to treatment, requiring bilateral ECT (LOW05, dose titration up to 45% - 227 mC-) and initiation of clozapine. In October 2021, she was enrolled in a monthly ECT maintenance program, maintaining a period of euthymia without psychotic symptoms until September 2022. At that point, she began to present anxiety secondary to auditory perseveration: after an auditory stimulus, the patient verbalizes an echo of that sound outside her head, which lasts for hours or even days.

Perform a differential diagnosis between schizoaffective disorder (given the persistence of psychotic symptoms despite euthymia) and palinacusia. Additionally, monitor the patient’s progress and address the described psychopathology according to current scientific evidence.

Systematic review of the existing literature on the etiology, pathophysiology, and therapeutic approach to palinacusia. Clinical follow-up of the patient’s progression.

Various complementary tests are performed: normal blood tests (complete blood count, biochemistry, serologies, autoimmune markers, thyroid function). Clozapine levels: 315 ng/ml; norclozapine 189 ng/ml; ratio 1.6 (all within normal range). EEG: overload of slow activity over bilateral temporal regions. No postictal activity. MRI: slight cortico-subtemporal atrophic changes with a temporal predominance. No mesial sclerosis foci observed.

Since October 2023, different antiepileptic drugs have been trialed (topiramate, eslicarbazepine, and valproic acid). Additionally, the patient continues in a monthly maintenance ECT program (bilateral, LOW05, reaching a dose of 90%). As a result, the patient shows slow progress, with no remission of the described symptoms, although there is a temporary reduction in intensity (February 2024).

The term “palinacusia” was described by Jacobs in 1971 as auditory perseveration (following a trigger and with neutral content). It is associated with various etiologies, primarily convulsive phenomena, and it remains debated whether it is ictal or postictal. The temporal lobe’s GTS is typically affected. To date, it has been described in 43 patients, and only in two patients with psychosis. The case described began after treatment with ECT, which raises the possibility of its pathophysiological involvement (difficulty in postictal suppression capacity). Currently, after discontinuing ECT treatment in March 2024 due to the possibility that it was exacerbating the palinacusia, and after trialing the aforementioned antiepileptic drugs, no remission of symptoms has been achieved.

R. Ramallo Castillo Employee of: Internal medicine resident in the Andalusian Health System, M. Pérez Sosa Employee of: Specialist doctor in the Andalusian Health System, M. Vázquez Delgado Employee of: Specialist doctor in the Andalusian Health System, C. Sánchez Martínez Employee of: Internal medicine resident in the Andalusian Health System, J. M. Duro Garrido Employee of: Internal medicine resident in the Andalusian Health System

Borderline personality disorder (BPD) is common in incarcerated persons. Psychiatric medications are prescribed in prisons for the treatment of psychiatric illnesses, but also for the reductions of symptomes triggered by the specific conditions and environment. The use of psychotropic medications in incarcerated persons is beneficial in terms of prevention of aggression and violent outbursts. Clozapine, as the most effective antipsychotic for aggressive and violent behavior could be very useful in forensic population, but is avoided due to adverse effects and the need for regular monitoring (Cekerinac et al. IJOPH 2024).

The objective of this reserch is to analyze the use of clozapine among incarcerated persons with BPD, and to evaluate the incidence of adverse effects.

A cross-sectional, epidemiological survey was used to measure the prevalence of antipsychotic prescribing among adult prisoners in Sremska Mitrovica Prison (Serbia) in 2020.

Of 1280 incarerated persons, (all men, average age 36.3 years), 80 (6.25%) were prescribed an antipsychotic. More than a half (N=44) were prescribed clozapine, but in doses lower than recommended for approved indications. None of them had an approved indication for clozapine, so this can be defined as off-label use. The average dose of clozapine was 51.14 mg/day, while the recommended maintenance dose is 300–450 mg/day. The other commonly used antipsychotic in this population was olanzapine (N=30). No cases of elevated white blood cells count were noted during regular monitoring. For the broader purpose of the study, metabolic parameters were assessed for the users of both antipsychotics, BMI, plasma glucose levels, plasma cholesterol levels and plasma triglyceride levels. Only the mean values of the levels of glucose and triglycerides in the plasma were slghtly elevated compared to the referent values of the Prison Hospital (Table 1.).

Table 1. Metabolic parameters in inmates prescribed olanzapine and clozapine vs. inmates who were prescribed metabolically inert antipsychotics

We justify the off-label use of clozapine in prison settings due its benefits in reducing violence and aggression; however, further research would be necessary to clarify does the use of clozapine in incarcerated persons cause behavioral improvements that could reduce recidivism and improve post-imprisonment outcomes. The prevalence of adverse effects is rare; however, that is possibly due to low doses of the prescribed antipsychotics and specific prison settings in terms of dietary options and physical activity, as well as the average young age of the inmates.

None Declared

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder characterized by significant sex differences in symptomatology, prevalence rates, and associated developmental challenges. Research indicates that these disparities are not merely superficial but are rooted in complex biological, psychological, and social factors. Despite the growing recognition of these differences, the underlying etiological mechanisms remain inadequately explored.

This study aims to propose a framework addressing hormonal fluctuations in females with ADHD, emphasizing the cyclical nature of ovarian hormones and their impact on executive functioning and behavioral regulation. We hypothesize that hormonal changes exacerbate ADHD symptoms during specific menstrual cycle phases, ultimately enhancing our understanding of sex differences in ADHD and informing future research and treatment strategies.

We conducted a literature review to synthesize studies on estrogen levels, executive function, and ADHD symptoms. Our focus was on the role of estradiol (E2) in cognitive functions, particularly in the prefrontal cortex, and the effects of cyclical hormonal changes on behavior and cognition in females with ADHD during adolescence and the menstrual cycle.

Evidence suggests that estrogen is crucial for cognitive control, with fluctuations in hormone levels impacting mental performance in women. Notably, ADHD symptoms are more likely to manifest during periods of rapid estrogen decline, particularly within the menstrual cycle. These hormonal decreases correlate with reduced executive function and self-regulation at two critical phases: increased risk-taking behaviors during the mid-cycle (periovulatory phase) and heightened avoidance and negative emotions in the perimenstrual phase. Research indicates that drops in estradiol (E2) can lead to significant increases in inattention and hyperactivity-impulsivity symptoms, especially in young adult women with high impulsivity traits. Additionally, the organizational effects of puberty may interact with hormonal changes, particularly in females with advanced limbic system development, increasing the risk of emotional dysregulation and impulsive behavior. Changes in the limbic system, essential for emotional processing and memory, further underscore the importance of considering individual sensitivity to hormonal variations.

This framework emphasizes the importance of hormonal influences in diagnosing and treating ADHD in females. By recognizing the relationship between hormonal fluctuations and ADHD symptoms, particularly via the Multiple Hormone Sensitivity Theory, we advocate for a tailored treatment approach. Future research should focus on longitudinal studies to deepen understanding and develop targeted interventions, thereby improving ADHD management and quality of life for females.

None Declared

Previous studies investigating the association between pubertal timing and depression in girls primarily use self-reported age at menarche (AAM). This study examines a range of pubertal timing indicators, including anthropometric and self-reported measures.

Compare associations of multiple indicators of pubertal timing with depressive symptoms and depression in girls and explore whether these associations persist into early adulthood.

The sample comprised 4607 girls from UK-based Avon Longitudinal Study of Parents and Children. Seven measures of pubertal timing were assessed between ages 7 and 17 (age at: peak height velocity (aPHV); peak weight velocity; peak bone mineral content velocity; Tanner pubic hair and breast development stage 3; axillary hair; and AAM). Depressive symptoms were measured at 14, 17, 18 and 24 years using the Short Mood and Feelings Questionnaire. Depression was assessed at 15, 18 and 24 years using the Development and Well-Being Assessment and Clinical Interview Schedule-Revised. Multivariable logistic regression models were adjusted for socioeconomic status and pre-pubertal body mass index.

Later pubertal timing was associated with lower odds of depressive symptoms at age 14 across six measures, including aPHV (adjusted odds ratio (AOR): 0.82; 95% CI 0.72, 0.95) and AAM (AOR: 0.84; 95% CI 0.76, 0.92). Later AAM and Tanner breast stage 3 were associated with lower odds of depression at age 18 (AOR: 0.85; 95% CI 0.75, 0.97 and AOR: 0.83; 95% CI 0.72, 0.95, respectively). Associations attenuated by age 24.

Later pubertal timing was associated with reduced odds of depressive symptoms during mid-adolescence, with associations attenuating by adulthood.

Major depressive disorder (MDD) is associated with high rates of incomplete response during treatment, with only one-third of the patients reaching remission after the first trial of antidepressants, according to the STAR*D trial. Based on the results of the same study, only 67% of the patients with MDD obtained remission after four trials of antidepressants, including a monoamine oxidase inhibitor, i.e., tranylcypromine, and various augmenting strategies. However, in STAR*D, no atypical antipsychotics (AAPs) were used, which is an important shortcoming of this trial. Exploring the efficacy of AAPs as add-on agents to antidepressants in the case of MDD with partial responsiveness may improve the prognosis of patients who did not remit during either antidepressant monotherapy or antidepressant therapy augmented with other psychotropic agents.

To assess the available data on the efficacy and tolerability of atypical antipsychotic augmentation in patients with MDD who obtained only partial response to antidepressants.

This review included three databases (Google Scholar, PubMed, and EMBASE) that were searched from their inception until June 2024 for papers published in English corresponding to the keywords “major depressive disorder,” and “partial response” and “atypical antipsychotics”. Both primary and secondary reports were included.

Systematic reviews dedicated to this topic reported significantly superior responses to placebo for ziprasidone, risperidone, aripiprazole, brexpiprazole, cariprazine, and quetiapine when added to antidepressants. The tolerability of these augmenting agents was low, with high rates of early treatment discontinuation reported. Only risperidone was reported in a systematic review as similar to placebo in terms of tolerability for this population. Network meta-analyses showed positive results for quetiapine, olanzapine, aripiprazole and brexpiprazole in terms of efficacy, but in terms of acceptability, no difference between these four antipsychotics and between each of them and placebo were found; tolerability was low for all antipsychotics vs. placebo, but the certainty of most evidence was evaluated as low and very low. Aripiprazole, quetiapine, olanzapine, brexpiprazole and cariprazine are approved by the FDA for the adjunctive treatment of MDD that does not respond to antidepressant monotherapy.

AAPs are an efficient option for augmenting antidepressants when MDD is only partially responsive to antidepressants, but careful monitoring of this strategy’s tolerability is needed, and high rates of treatment discontinuation are reported.

None Declared

Suicide risk correlates with the nature of psychotraumatic factors that act directly during military service, their severity, duration of exposure, and individual adaptive capacities of military personnel. The development of suicidal behavior occurs against the background of anxiety and depressive syndromes in military patients and is aggravated by concomitant addictive behavior.

To investigate the relationship between the mechanisms of development of suicidal behavior in the military and psychopathological status that potentiate suicidal activity.

The following diagnostic scales were used: Suicide Risk Scale of the Los Angeles Suicide Center, Sad People Scale (W.M. Patterson, H.H. Dohn, J. Bird), Spielberger-Hanin Scale of Reactive (Situational) and Personal Anxiety (STAI), Hospital Anxiety and Depression Scale (HADS), Hamilton Rating Scale for Depression, Impact of Event Scale (IES-R). Review of existing literature on suicidal behavior among military personnel.

38 patients with a suicide attempt (within the diagnostic criteria F 43, F 32, F 31, F07 according to ICD-10) were examined during 6 weeks of inpatient care. It was established that the psychopathological presuicidal period in the examined patients was formed against the background of high levels of anxiety (38% of patients), anhedonia (26% of patients), feelings of sadness and hopelessness (19% of patients), addictive behavior (13% of patients), feelings of anger and irritability (4% of patients). In 43% of cases, the formation of suicidal behavior in military personnel was observed against the background of violations of interpersonal relationships: self-isolation behavior (22%), conflict (13%), and antisocial actions (8%). The duration of the pre-suicidal period are several minutes (23% of patients), several days (44% of patients), a month or more (33% of patients). The dominant methods of suicide attempts among the observed military personnel are self-inflicted wounds (61%), poisoning (18%), gunshot wounds (11%), hanging attempts (8%) and self-arson (2%). The reaction of suicidal people to an unsuccessful suicide attempt depends on the current mental state of the military personnel, often with a critical assessment, less often - suicidal-fixed.

In most cases, the development of suicidal behavior in military personnel occurs against the background of anxiety, depressive symptoms, post-concussion disorders, anhedonia, and concomitant addictions. Prevention of suicide among military personnel should include early detection of the main psychopathological symptoms and timely crisis therapy.

None Declared

people with alcohol- and substance use disorders have disproportionally high levels of tobacco use compared with the general populations. This concerns not only the prevalence of nicotine dependence but also the intensity of their smoking behaviour. Importantly, regarding the negative consequences the combined effects of alcohol and smoking are exponentially. Efforts to include smoking cessation treatment within the treatment programs for AUD and other SUD patients need to be intensified.

None Declared

The first place to intervene in individuals who have attempted suicide is often the emergency department. These individuals may then be referred to intensive care units for close monitoring of physical findings and treatment, depending on the results of the suicide attempt. The attitudes and stigmatisation of nurses in the emergency department and intensive care unit toward suicide affect the quality of care provided. It is important to determine the attitudes and stigmatisation of nurses.

This study aims to determine the attitudes and stigma levels of nurses working in intensive care and emergency services towards suicidal behaviour and to examine the related factors.

The research is descriptive, cross-sectional and correlational. The research was conducted with 82 volunteer nurses working in the emergency room and intensive care unit of a hospital in Turkey between January and March 2023, with approval from the ethics committee and the institution. Nurses filled out the Personal Information Form, Attitude Towards Suicide Attempt Scale and Stigma of Suicide Scale. In data analysis; Independent samples t-test, One-way ANOVA, and Welch test were used in cases where variances were not homogeneously distributed. Bonferroni and Games-Howell methods were preferred among post hoc multiple comparison tests. Pearson correlation was used for the relationship between continuous variables, and Spearman correlation analysis was used for categorical variables.

The mean score of the nurses’ Attitudes Towards Suicide Attempt Scale was 98.78±9.16. The mean scores of the Stigma of Suicide Scale; Stigma, Isolation\Depression, Sublimation\Normalization sub-dimensions were 71.95±18.09, 57.68±10.94, 27.11±6.86, respectively. The mean score of the Sublimation\Normalization sub-dimension of the Stigma of Suicide Scale of those who had attempted suicide in their close circle was higher than those who had not, and the results were significant (p<0.05). In the same sub-dimension, the mean scores of those who gave care to patients who attempted suicide were lower than those who did not, and the results were significant (p<0.05). The total score of the Attitude Towards Suicide Attempt Scale had a positive and statistically significant effect on the Stigma of Suicide Scale (β=0.562, t=6.071, p<0.001).

These results indicate that nurses have high levels of negative attitudes towards suicidal behaviour, stigmatize it, associate suicide with depression and isolation, consider suicide normal, or glorify people who commit suicide. The presence of those who have attempted suicide in the immediate environment and providing care to individuals who have attempted suicide was associated with nurses’ attitudes and stigmatisation towards suicidal behaviour. It was found that nurses’ negative attitudes towards suicide had an increasing effect on their stigmatisation.

None Declared

Sports psychiatry is a developing subdiscipline, which emphasises the need for adequate treatment and prevention schemes to uphold the mental wellbeing of athletes. Previous studies indicate that elite-level male cyclists face distinctive socioenvironmental risk factors, including external pressures from teams, particularly in relation to weight management concerns. However, there has been little attention to the mental health support available within teams and the awareness of relevant stakeholders to psychiatric issues.

This study sought to gain perspectives on the level of mental health awareness from stakeholders in elite-level cycling teams (i.e., sporting directors, coaches, and medical staff).

An anonymous online survey has been compiled containing quantitative and qualitative questions for sporting directors, coaches, or medical staff about their own mental health awareness and literacy. This was distributed to cycling teams and through a national-level federation. The survey link will be available online from the beginning of October 2024 to the end of February 2025. An ethical application was made to the Ethics Committee in the Canton of Bern, who determined that the research fell outside the scope of the Swiss Human Research Act and therefore did not require formal approval.

Preliminary results will be ready in March 2025 in time for the poster display at the European Congress of Psychiatry in April 2025. The findings will provide insights into mental health awareness amongst team stakeholders in men’s elite-level cycling. The quantitative data will be studied with descriptive statistics and the qualitative results will be evaluated using thematic content analysis to identify key themes.

Based on prior literature, our hypotheses are that there is limited mental health awareness about the mental health of elite-level riders amongst cycling team stakeholders and scarce knowledge about how to manage these issues should they arise. These findings would underline a need for more attention to this topic within the sport, potentially necessitating the involvement of national federations and regulators.

A. Smith: None Declared, J. Grana: None Declared, J. Colangelo: None Declared, A. Buadze: None Declared, M. Liebrenz Consultant of: In cooperation with Swiss Cycling, Michael Liebrenz provides mental health support to elite-level riders involved with the Swiss national team.

Charles Bonnet syndrome (CBS) is a condition in which patients with a free psychiatric history manifest visual hallucinations on the basis of a diagnosed ophthalmic disease (brain disease or optic nerve damage), which causes severe vision loss (partial or total).

Hypothesis testing: “Administration of low doses of typical and atypical antipsychotics is the more effective pharmacological treatment for visual hallucinations of CBS”.

Patients underwent pathological, psychiatric and ophthalmological assessment, resulting in a complete study-appropriate medical history.

The sample consisted of ten female patients and eight male patients. The median age of the sample was 84 years. None of the patients was diagnosed with major psychopathology and in no clinical case was an individual medical history of dependence on alcohol or other psychotropic substances recorded. A common cause of the dysfunctional vision of the entire sample of patients was the visual deficit due to a diagnosed cataract condition. During the examination of each patient, it was found that a significant number of predisposing factors for CBS, as described in the literature, were detected. Increased stress levels, depressed mood, cognitive deficits, damage at the level of brain tissue, living conditions of the patient in environments with insufficient light intensity, social withdrawal or poor interaction with others contributed to the vulnerability of visual hallucinations. The administration of broad-spectrum medicines of Internal Medicine was also recorded as a covariate for the triggering of visual hallucinations. As demonstrated by the majority of patients, the administration of a low dose of a typical antipsychotic led to effective treatment of the syndrome.

Based on the present study, in patients of both sexes (men and women), aged 73-98 years, haloperidol and risperidone in low doses of 1-2 mg and olanzapine in low doses of 2.5-5 mg appear to be more effective options in treating with optical hallucinations in CBS.

None Declared

Migraine is one of the leading neurological causes of disability worldwide with a significant impact on all aspects of life, despite the high prevalence and debilitating effects migraine remains underestimated in Sudan. This study aims to measure the prevalence of migraine among medical students at a Sudanese University.

This study aims to measure the prevalence of migraine among medical students from the University of Science and Technology Faculty of Medicine, Omdurman, Sudan.

This descriptive cross-sectional study was carried out between June and August 2024 involving 283 medical students enrolled in the University of Science and Technology, data was collected online and ID-Migraine was used to screen for migraine and R programming language for statistical computation and graphics was used to analyze the data.

The prevalence of migraine was 41% and females were more affected than males. The most reported trigger factor was irregular sleep 84%, with rest being the most used method for relief 43% and the majority of migraine-positive students 46% mentioned their academic performance was moderately affected.

This study found a high prevalence of migraine among medical students enrolled in the University of Science and Technology, with female students being more affected and significant impact on academic performance.

None Declared

We present the case of a 58-year-old male patient with a history of bipolar disorder, schizoaffective disorder, renal insufficiency and diabetes insipidus who developed malignant catatonia (MC), possibly related to the administration of ciprofloxacin. In a first admission to our care facility, the patient presented a neuroleptic malignant syndrome (NMS) due to antipsychotic medication, with partial remission following the discontinuation of these drugs and introduction of benzodiazepine (BZD) and dantrolene treatment. However, after this first hospital discharge, the patient required a second hospitalization due to a worsening of his general condition, apparently related to a urinary tract infection (UTI). During this last admission, antibiotic therapy with ciprofloxacin was administered, resulting in the worsening of his neuropsychiatric condition and developing clinical symptoms compatible with catatonia. The clinical presentation of his condition eventually requires treatment with BZD and electroconvulsive therapy (ECT).

The aim of this work is to describe the course and therapeutic approach of a case of MC possibly induced by ciprofloxacin, clarifying the differential diagnosis between NMS and MC.

A thorough review of the patient’s clinical history was performed from the onset of symptoms in the care facility through his ICU and inpatient hospitalizations. Pharmacological changes were documented, including antipsychotic interruption and BZD administration. Treatment with ECT was initiated after an insufficient response to BZD. Finally, a literature review was conducted to explore the relationship between MC and ciprofloxacin.

Initially, the patient showed a partial remission of the catatonic symptoms with BZD and dantrolene after discontinuing antipsychotics, achieving a temporary stabilization. However, after the introduction of ciprofloxacin, he developed a severe catatonic symptoms characterized by central fever, extreme rigidity, mutism, and withdrawal from the environment. Despite BZD treatment, the catatonic symptoms persisted, leading to the decision to initiate ECT. After multiple sessions, the patient experienced a significant improvement on autonomic, motor and cognitive symptoms of catatonia, as well as a more robust clinical stabilization.

This case suggests a possible association between the administration of ciprofloxacin and the onset of MC in a chronic psychiatric patient with a history of NMS. The favorable response to ECT highlights the utility of this therapeutic option in the management of severe catatonia when other treatments are not fully effective. The chronology on this case suggests a neurotoxic effect of ciprofloxacin, emphasizing the importance of considering interactions between antibiotics and psychiatric pathologies in vulnerable patients.

None Declared

Heart Rate Variability assesses the autonomic system function. We have previously reported increased sympathetic activation (i.e. increased proarrhythmic risk) and asymptomatic left ventricular myocardial dysfunction in a group of drug-naïve, First Episode Patients with psychosis. We performed the same cardiological evaluation in a subgroup of these patients one year after the initiation of antipsychotic treatment.

To find out the impact of antipsychotic medications in cardiac function.

Thirty three consecutive patients diagnosed with first psychotic episode were included in the current analysis. None of the patients had a previous history of cardiovascular diseases. All patients were assessed by 24-hour Holter ECG monitoring (including QT analysis and heart rate variability indices) and a thorough echocardiographic study (including myocardial strain analysis – global longitudinal strain GLS) at baseline (shortly after stabilization) and 1 year after treatment.

The mean age of our population was 29±7 years, 75% were males and their body surface area was 1.87±0.21 m2. At baseline 1) the mean value of QTc was normal in all subjects although the greatest QTc value measured was above 500msec in 35% of patients, 2) SDNNI<50 msec was observed in 50% of the patients, all patients had an abnormal HRV index, low RMSSD <20 msec was observed in 35% of patients, no patient had abnormally low PNN50 values. No patient had evidence of overt structural heart disease and the value of left ventricular ejection fraction was within normal range (57.5±5.1 %). GLS was decreased (i.e. < -16%) in 25% of patients. At follow-up maximum QTc value (517±52 vs 485±69, p=0.014) and PNN50 (14.1±12.1 vs 9.8±10.5, p=0.05) were increased while left atrial volume index (20.1±6.3 vs 23.3±6.4, p=0.031) and GLS (-18.6±2.5 vs -17.5±2.5, p=0.007) were decreased compared to baseline. No other significant changes were observed at follow-up. At follow-up, abnormal GLS, QTc max, SDNNI, HRV index, RMSSD and PNN50 values were observed in 16%, 60%, 38%, 96%, 15% and 0% respectively of included patients.

Normal values

SDNNI >100 (especially <50)

HRV INDEX >60

RMSSD 13-48 MS

Pnn50 -3 – 43%

In patients with a first psychotic episode without a previous history of cardiovascular disease or risk factors, a significant proportion showed abnormal autonomous system function and subclinical myocardial dysfunction of the left ventricle. After 1 year of treatment, improvement was observed in left ventricular function and parasympathetic system activity with a concomitant increase QTc interval. Optimal management of psychotic episodes may lead to an amelioration of the risk of future myocardial impairment without affecting the risk for arrhythmias and sudden death.

None Declared