The search for biomarkers to diagnose depression is an endeavor being pursued in psychiatric research since the 1980s, but hasn’t resulted in clinical application. This remains challenging since the symptomatology of depression is very heterogeneous and because there is no diagnostic gold standard that focuses on an underlying biological mechanism. Despite knowing about the metabolic, endocrine, inflammatory as well as autonomous dysregulation that has been observed in depressed patients, none of these are broadly used to stratify patients. A novel area of research involves the insulin-like growth factor (IGF) system, which plays a vital role in brain development, neurogenesis, and neuroprotection. The insulin-like growth factor (IGF) system, encompassing IGF-I, IGF-II, IGFBPs (1-6), and their receptors, is critical for brain development, neurogenesis, neuroplasticity, and neuroprotection. Insulin-like growth factor binding protein-2 (IGFBP-2), the predominant IGFBP in the central nervous system, regulates IGF-I and IGF-II bioavailability, half-life, localization, and receptor interactions. Serum levels of IGFBP-2 inversely correlate with DTI-derived myelin integrity measures, especially in anterior brain regions.

In a data-driven clustering analysis of a depressed cohort, elevated IGFBP-2 levels delineated a healthier subgroup within a hospitalized cohort of patients with unipolar depression. Additionally we discovered, that patients with higher IGFBP2 levels at inclusion were more likely to remit faster concerning their depressive symptoms, in contrast to an inflammatory marker-defined subgroup. These findings suggest IGFBP-2 as a biomarker for stratifying patients and tailoring interventions in depression. Future research should explore IGFBP-2 and inflammatory markers to better stratify patients and develop targeted therapies, advancing precision medicine for depression and related disorders.

J. Eder: None Declared, P. Falkai Consultant of: Peter Falkai is on the advisory boards of Janssen, Lundbeck, Otsuka, Servier, and Richter, Speakers bureau of: Peter Falkai receives speaker fees from Janssen, Lundbeck, Otsuka, Servier, and Richter

Non-adherence to prescribed medications in schizophrenia is a primary factor leading to relapse and repeated hospitalizations, posing a significant challenge in psychiatric care. Understanding and enhancing medication adherence is crucial for improving outcomes in schizophrenia treatment.

This study aimed to estimate the prevalence of medication non-adherence among schizophrenia patients and to explore the impact of depression and other sociodemographic factors on adherence levels. Recognizing these influences is essential for developing targeted interventions to improve patient outcomes.

A cross-sectional analysis was conducted involving 350 individuals with schizophrenia, encompassing both outpatients and inpatients. A comprehensive questionnaire was employed to collect data on sociodemographic characteristics, clinical history, and therapeutic interventions.

To assess medication adherence and depressive symptoms, the study utilized the Medication Adherence Rating Scale (MARS) and the Calgary Depression Scale for Schizophrenia (CDSS), both of which are validated tools designed for psychiatric evaluations.

Data analysis revealed that 21.3% of the participants exhibited poor medication adherence as measured by MARS. Further statistical testing using a logistic regression model identified employment status and level of depression as significant predictors of non-adherence.

Patients who were unemployed and those exhibiting higher scores on the CDSS indicating more severe depressive symptoms were more likely to be non-compliant with their medication regimen (p=0,001). This highlights the intricate relationship between mental health symptoms and treatment adherence.

The results of this study illuminate the importance of considering depression and employment status when addressing medication adherence in individuals with schizophrenia. These factors play a pivotal role in the adherence behavior and overall treatment outcomes of patients.

Emphasizing comprehensive care that includes management of depression alongside routine antipsychotic treatment could enhance adherence and improve the prognosis for individuals living with schizophrenia. Ongoing research is needed to further elucidate the pathways that influence medication adherence and to develop strategies that effectively address these challenges.

None Declared

Attention Deficit Hyperactivity Disorder (ADHD) varies in presentation and associated comorbidity conditions. Diagnosis and treatment is often challenging, highlighting the need for individualized approaches in managing ADHD. Optimal therapy includes a combination of different methods such as psychological interventions and pharmacotherapy. Pharmacogenetics allows for a more personalized and effective treatment plan, which can reduce empirical prescribing of medication, meaning less side effects, faster treatment response and achieving remission. Altogether, this leads to improved compliance and outcomes.

In our opinion this is an interesting case study which explores the challenging presentation, medical management, and treatment of a patient with ADHD and its comorbidity.

We present a male subject, age 14, who met DSM- V criteria for ADHD at the age of 8. The treatment effects of conventional approaches with psychosocial interventions and individual psychotherapy as well as child and parental psychoeducation had not proven sufficient, so pharmacotherapy was added to the treatment strategy. He was initially introduced to methylphenidate therapy and developed side effects in the form of depressive symptoms and motor tics. Regression of side effects occurred when the drug was discontinued. Impulsive and aggressive behaviors became severe so antipsychotics were prescribed, which resulted in improvement of behaviour. Attention and concentration disturbances remained, however. During this period, the subject experienced a growth spurt, gained in body weight and his laboratory findings showed high liver enzymes. We conducted a multidisciplinary approach that included a complete examination by a geneticist, an endocrinologist, and a cardiologist. EEG and psychological testing were performed. Due to a lack of progress in socio-emotional functioning, genotyping analyses of CYP2D6, CYP1A2, CYP2C9, CYP2C19, CYP3A4, CYP3A5, ABCB1, ABCG2, 5-HTTLPR, DAT1 VNTR was performed.

The pharmacogenetic findings suggested a higher activity of the CYP2D6 enzyme than normal. Significantly reduced and weak transport function of protein ABCB1 was observed. Atomoxetine is not a substrate for ABCB1, so the introduction of atomoxetine is planned after the stabilization of liver enzymes.

Various treatment strategies can help ameliorate ADHD symptoms. Finding an effective medication and dosage for a given child with ADHD can be a complex process. Although pharmacogenetic testing is not a standard procedure in child and adolescent psychiatry, it can have an impact on the management of treatment-resistant symptoms and medication-related side effects. The potential for pharmacogenetics to enhance treatment precision remains a promising area for future research in psychiatry.

None Declared

Humor is widely recognized for its potential to improve psychosomatic health, enhancing both physical and mental well-being.

To investigate the correlation between humor styles and psychosomatic health in older adults.

A cross-sectional study was conducted with 83 older adults (41 females, 42 males), aged 65 to 94 years (mean age: 74.1, SD = 8.1). Participants completed a sociodemographic questionnaire, the 32-item Humor Styles Questionnaire, and the 36-Item Short Form Survey (SF-36). Linear regression analysis was used to examine the relationship between humor styles and psychosomatic health outcomes.

Self-Enhancing Humor. For Aggressive Humor, the mean was 22.7 (SD = 7.95), and for Self-Defeating Humor, 26.3 (SD = 8.70). The mean scores for Physical Health and Mental Health were 277 (SD = 84.5) and 272 (SD = 70.6), respectively. Self-Enhancing Humor had a significant positive effect on Mental Health (B = 3.458, SE = 0.893, p < 0.001), RF (B = 0.7659, SE = 0.375, p = 0.044), GH (B = 0.7113, SE = 0.234, p = 0.003), MH (B = 0.9711, SE = 0.228, p < 0.001), and SF (B = 0.7165, SE = 0.329, p = 0.033). Additionally, Self-Defeating Humor showed a significant negative effect on RE (B = -1.093, SE = 0.474, p = 0.024).

The findings suggest that positive humor styles, particularly Self-Enhancing Humor, are strongly associated with better psychosomatic health in older adults. Incorporating humor-based interventions could be a valuable approach to enhancing psychosomatic health in this population.

None Declared

The term self-disorder investigated in this study refers to a disorder of the minimal self. It is a disturbance at the basic pre-reflective level typical in schizophrenia spectrum disorder, These disturbances are often present in the prodromal face of schizophrenia.

In 2003 Sass and Parnas proposed the ipseity-disturbance model (ipseity also sometimes termed minimal self, basic self, experimental self, and for-meness). Since 2003 Parnas and colleagues have published EASE (Examination of anomalous Self-experience): a semi-structured interview guide to allow for a systematic, qualitative and quantitative assessment of self-disorders.

The EASE-scale consist of a checklist of 57 items divided into 5 domains: 1) Cognition and Stream of Consciousness, 2) Self-Awareness and Presence, 3) Bodily Experiences, 4) Demarcation/Transitivism and 5) Existential Reorientation. The domains serve to structure the interview and to aid the interviewer to navigate and cover all 57 items during the interview.

In the last 20 years, several studies using EASE have supported self-disorders to be a central psychopathological feature of schizophrenia. A systematic review from 2021 showed that self-disorders hyper- aggregate in schizophrenia spectrum disorders but not in other mental disorders. However, self-disorder aggregation and distribution in between schizophrenia spectrum disorders have not been investigated before.

The purpose of this study is to compare overall EASE-sums in types of schizophrenia spectrum disorders including subtypes of schizophrenia (ICD10).

We hypothesize that there will not be a significant difference in overall EASE-score, reflecting self-disorder to be a core disturbance in schizophrenia spectrum disorders.

Furthermore, we plan to perform explorative statistical analysis on item-level of the EASE-scale, to investigate whether self-disorders presents differently and characteristically in-between schizophrenia spectrum disorders.

Data is pooled from 6 different studies, totaling 236 patients.

All patients were examined using the EASE-guide by a professional clinicians who were trained in the semi-structed EASE-interview. The patients were furthermore assessed thoroughly for psychopathology and diagnosed according to ICD10 and DSM-IV or V.

Ongoing

Ongoing

None Declared

Communicating bad news (CBN) in emergency medicine is a crucial and challenging aspect of clinical care. Emergency Health Care (EHC) operates in high-pressure, time-sensitive environments, where life-altering information must be communicated rapidly, leaving little time for careful preparation or consideration. The emotional, ethical, and psychological complexities of CBN in such settings necessitate effective communication strategies to mitigate the distress of patients, families, and healthcare providers. This literature review aimed to examine the key challenges and best practices associated with delivering bad news in emergency medicine.

This review aims to synthesize the literature with the main objectives of 1. identifying the challenges faced by emergency medical professionals in delivering bad news and 2. collect the best practices, general guidelines, specific protocols and communication models used in emergency settings.

A systematic review of the literature was conducted, focusing on peer-reviewed articles published between 2000 and 2023, using the keywords “comunicating bad news,” “emergency health care,” “communication in emergencies,” and “best practices for CBN.”. Articles were screened for relevance and rigor, and key findings were synthesized thematically.

The literature highlights several challenges: time constraints in EHC, lack of formal communication training, and emotional toll on both providers and recipients of the news. Emergency physicians often struggle to deliver bad news in a compassionate yet efficient manner, especially in the context of sudden or unexpected death. The best practices identified include the use of structured communication frameworks, such as the SPIKES protocol, which helps guide healthcare providers through the process. Multidisciplinary support, including involving social workers and counselors, was also emphasized as essential to alleviating the burden on both the physician and the patient. Furthermore, studies have revealed that when formal DBN training is implemented during residency, physician confidence and patient satisfaction improve significantly.

The review underscores the complexity of delivering bad news in emergency medicine. Incorporating structured communication protocols and formal training into medical education and emergency department practices is essential for improving patient outcomes and physician well-being. Future research should focus on evaluating the effectiveness of tailored CBN protocols and programs as well as interdisciplinary collaboration.

None Declared

In Spain, involuntary admission due to mental disorder requires judicial authorization, which can be prior or, in cases of urgency, immediately subsequent. The courts routinely request an independent medical expert opinion in these cases.

Our aim was to determine the current results of these evaluations and the characteristics of the patients assessed.

Retrospective study from January 1 to June 30, 2023 in the city of Barcelona. The source of information were the case records at the Institute of Legal Medicine and Forensic Sciences of Catalonia. The inclusion criteria were: psychiatric involuntary admission, urgent, and assessment by the forensic doctor assigned to the courts. Sociodemographic, clinical and forensic data were collected.

In the 181 days between January 1 and June 30, 2023, 1,151 forensic medical assessments of urgent hospitalizations were recorded in Barcelona (on average 6.4 per day). Of these, 849 (73.8%) were included. In all of them, the forensic medical report concluded that hospitalization was rightly indicated. The admissions were carried out in 14 different health centers. The psychiatric acute inpatient wards of the city’s main general hospitals received the vast majority of cases. The patients were mostly men (n=483; 56.9%). The average age was 38.2 years (s.d. 16.99), with no differences between sexes. 13.5% (n=115) were minors, with female predominance (n=79; 68.7%). 6.9% (n=59) were 65 years of age or older, also with a female predominance (n=39; 66.1%). In minors, affective disorders (n=37; 32.7%) or eating behavior disorders (n=32; 28.3%) stood out, while in the group from 18 to 65 years of age the main diagnostic group were psychotic disorders (n =491; 73.1%). The latter were also the majority after 65 years of age (n=35; 59.3%), followed by affective disorders (n=16; 27.1%). Globally, psychotic disorders were the most frequent diagnostic group for both men (n=346; 71,9%) and women (n=188; 51,8%). Affective or eating behaviour disorders accounted for 35,8% of women (n=130) and 18,3% of men (n=88).

The forensic assessment of the medical indication of urgent involuntary psychiatric hospitalizations coincides with the clinical assessment. Patients with this measure show differential characteristics according to age in terms of gender and diagnosis. More men are involuntarily admitted than women for most of the adult stage, while the reverse is true at both extremes of the lifespan. Also, involuntarily admitted women show a higher frequency of mood or eating behaviour disorders than men.

None Declared

Sleep disorders are commonly reported among patients diagnosed with multiple sclerosis (MS), particularly in the period following the disclosure of the diagnosis. The combination of psychological stress and the chronic nature of the disease contributes to significant sleep disturbances. Understanding the prevalence, causes, and implications of these disorders is crucial for improving patient care.

The aim of this study is to evaluate the prevalence and characteristics of sleep disorders in MS patients following the announcement of the diagnosis and to explore the contributing factors, including psychological and physical symptoms.

A descriptive and analytical cross-sectional study was conducted from March 1, 2023, to January 30, 2024, involving patients diagnosed with multiple sclerosis (MS)who were observed in the neurology department at Habib Bourguiba University Hospital in Sfax. We evaluated sleep disorders using the insomnia severity index scale which included 7 items to investigate sleep disturbance.

A total of 100 patients, with a mean age of 38 years ± 10 years, were included, with a strong majority of women (73%). No psychiatric history was noted. The median disease duration was 7.38 years (3-10.75). Among our patients, 64(64%) had attained a university level of education. In addition, 40(40%) were married, and 60 (60%) were single, divorced, or widowed.

The median Insomnia Severity Index was 5 (1-10.75). More than half of our patients (62%) did not suffer from insomnia. However, 9% had a mild subclinical form of insomnia, 10% had moderate clinical insomnia, and 19% suffered from severe clinical insomnia.

Primary education level was correlated significantly with mild sleep disorders n=33.3 (33.3%), (p=0.044). On the other hand, those with a higher education level showed a lower prevalence of mild sleep disorders n=22.2(22.2%) (p=0.01). However, a lower prevalence of severe sleep disorders was noted among married individuals (10.5% p=0.004), while a higher frequency was observed in divorced individuals (15.8%, p=0.). Only refusal of the diagnosis upon its initial announcement was significantly associated with severe sleep disorders (63.2%, p=0.012).

Addressing sleep disorders in MS patients requires a holistic approach that incorporates both psychological and symptom management strategies. Early interventions targeting anxiety, depression, and physical discomfort are essential for improving sleep quality and overall well-being in this patient population. Further research is needed to develop tailored therapeutic approaches that address the unique challenges faced by MS patient’s post-diagnosis.

None Declared

Childhood sexual abuse, a serious issue for all societies, is a complex experience that requires many legal and professional initiatives(Odacı et al. Psikiyatride Güncel Yaklaşımlar,2023).It is a widespread, multidimensional problem worldwide, with physical, mental, social, moral, cultural, and legal aspects(İşeri et al. Çocuk ve Ergen Psikiyatrisi Temel Kitabı,2008).

This study aimed to evaluate risk factors and medicolegal assessment results in children who were sexually abused.

The records of children who were victims of sexual abuse retrospectively reviewed at Dokuz Eylül University Faculty of Medicine, Department of Child and Adolescent Psychiatry, between January 2010 and December 2023.Sociodemographic, clinical, psychometric, and medicolegal evaluation data were analyzed.

Of the 537 cases that underwent medicolegal evaluation, 80.3% were male and 19.7% were female.The mean age at the time of sexual abuse incident was significantly higher in females(12.5±3.4) than in males(9.8±3.4).Before the incident, 63.0% of cases had at least one psychiatric diagnosis(most commonly Mental Retardation or Developmental Delay(57.5%), MDD(5%), and Conduct Disorder(4.7%)).The period after the incident, 77.1% had at least one psychiatric diagnosis(most commonly PTSD(57.9%) and MDD(49.7%)), most of which occurred after the incident.22.7% of the cases were victims of incest, 77.3% were victims of extra-familial abuse.The most common abuser was the father in incest(7.1%) and a familiar person(neighbor, etc.) in extra-familial abuse(22.4%).51.4% of cases experienced simple sexual abuse, while 48.6% faced sexual penetration.In 42.7% of the cases, sexual abuse was first disclosed to family members. In incest victims, compared to cases of extra-familial sexual abuse; the rates of being female(86.9%-78.3%), having successful-average academic success(55.2%-43.3%), having normal-borderline intelligence(77.7%-67.7%), having an unemployed father(25.5%-16.2%), being subjected to simple sexual abuse(63.1%-48.0%), being subjected to sexual abuse by a single perpetrator(90.2%-81.2%), being subjected to repeated sexual abuse(69.7%-45.8%), living in a broken family(66.7%-38.9%), not having a psychiatric diagnosis before the incident(50.8%-34.2%), and withdrawing the abuse allegation/complaint(18.9%-6%) were statistically significantly higher.The age at the date of the incident was significantly younger(median:11-13), and the time taken to apply to judicial authorities (months) was significantly longer(median:18.5-12).Predictive variables of incest have also been evaluated using logistic regression analysis.

In this study, the findings found in cases that underwent medicolegal evaluation support the literature findings regarding risk factors for sexual abuse and the negative effects of sexual abuse on children and adolescents.

None Declared

Mental disorders in the elderly occur much more often than in young adults, and their prevalence increases significantly with age and in the case of people receiving institutional care. Psychopharmacotherapy in an elderly patient is much more challenging and requires more restrictive safety strategies than in younger patients. The significantly increased risk of interactions, side effects and complications resulting from: comorbidities, systemic changes due to aging and, as well as their pharmacotherapy, are a serious problem in the treatment of elderly patients. It should be emphasized that the safety profile may be different in the elderly compared to the young adults - some complications that are rare in younger patients, e.g. bleeding complications, fractures and bone loss, cataract progression, hyponatremia, falls, QT prolongation, stroke, pneumonia and others, are a much more common problem among seniors and their risk should be considered at the initial stage of pharmacotherapy selection. In the case of some drugs (e.g. antipsychotics), the accumulation of serious complications may significantly increase the risk of premature mortality, if they are used incorrectly. Moreover, it should be remembered that certain side effects, e.g. orthostatic hypotension, may occur with drugs for which these side effects are unlikely in younger patients. During the treatment process, it is also necessary to monitor the presence and severity of side effects, such as: constipation, dry mouth, tremors, urination problems, excessive sleepiness or cognitive impairment, which may reduce the quality of life, particularly in an elderly patient. This presentation will provide a brief and practical clinical guide to safe and effective pharmacotherapy in the elderly patients.

None Declared

Medical students face a demanding academic journey, where stress can significantly impact their well-being and performance. Both personal and environmental factors contribute to this burden, yet research on academic stress in Italian medical schools remains limited.

We investigated the impact of various factors on perceived academic stress among third-year medical students during the pre-clinical phase of their studies.

A cross-sectional, anonymous, self-reported online survey was distributed to third-year medical students at Humanitas University (Milan, Italy) over a 10-day period in April 2024. The survey included various questions on sociodemographic factors, lifestyle behaviors (e.g., sports activity, diet, smoking, alcohol binge drinking), satisfaction with sleep and sexual activities, smartphone and video game use, significant life events, and objective academic performance. Additionally, several validated questionnaires were included to assess academic stress, personality traits, psychological dispositions (e.g., proneness to boredom, procrastination, impulsivity, perfectionism, intolerance of uncertainty, worry), coping strategies, resilience, attentional control, feelings of loneliness, and perceived social support. Data were analyzed using hierarchical multiple linear regression, with a significance level at 0.05.

Seventy-six students (70.4%) out of 108 who provided their informed consent completed the survey; 58 (76.3%) were female and 18 (23.7%) were male, with 53 (69.7%) being Italian and 23 (30.3%) from other countries. Higher academic stress was significantly associated with the female gender, a higher burden of negative life events, and greater propensity for impulsivity and worry. In contrast, passing more exams and experiencing positive life events were associated with lower academic stress. No other statistically significant associations were found. The independent variables collectively explained about 60% of the variation in academic stress (adjusted R², p<0.001).

Our preliminary findings provide insights into the factors influencing the multifaceted nature of academic stress. These results may help educators, administrators, and policymakers create a more supportive learning environment and offer psychological support to reduce academic stress in vulnerable students. Enhancing the psychological well-being of medical students could help prevent potential mental health conditions in this population. Further studies with larger samples and a prospective design are warranted.

None Declared

Loneliness and social isolation are frequently associated with mental health problems. In Spain, the term ‘unwanted loneliness’ has gained particular importance in recent years, referring to an involuntary insufficiency in social relationships. According to recent studies, this affects an estimated 13.4% of the Spanish population (Jiménez Rodríguez. Rev Esp Salud Publica 2024; 98).

To conduct a review of the studies that address loneliness and social isolation

We searched in PubMed using the following terms: ‘((unwanted loneliness[Title/Abstract]) OR (loneliness[Title/Abstract]) OR (social isolation[Title/Abstract])) AND (mental health[Title/Abstract])’, limiting the search to the last 30 years.

We found 5,472 articles on the subject, of which 4,373 were published in recent years, confirming the growing interest in this issue. The countries with the most publications on this topic were England (1,733 results), the United States (1,561 results), and Switzerland (894 results). Although we did not focus on this aspect, it is worth noting that the most frequently used keyword was ‘COVID-19,’ appearing a total of 1,229 times, which may partially explain the increase in publications over the last year.

Upon reviewing the content of the articles, we observed that many focus on demographic factors. For example, living with a romantic or sexual partner has been consistently identified as a protective factor against loneliness (Currin et al. Curr Psychol 2022; Online publication), and we also found significant associations between loneliness and being single, separated, or divorced (Ibáñez-Del Valle et al. Int J Environ Res Public Health 2022; 19:16622).

The association of this issue with social inequalities has also been highlighted (Martín Roncero et al. Gac Sanit 2021; 35:432-437). We observed a potential gender bias, with findings indicating a higher risk in women for the perception of loneliness and the evaluation of social relationships (Pavlidis et al. Aging Ment Health 2023; 27:1313-1321). Other studies have found that higher population density reduces social isolation in areas with a high proportion of people of the same race or ethnicity but increases it in areas with fewer people of the same ethnicity (You et al. Inquiry 2024; 61:469580241273127). Sexual orientation-related factors also appear to be significant: internalized homonegativity has been associated with loneliness, where it is noted that accepting and integrating a gay or lesbian identity seems particularly important for younger, non-gay-identified individuals (Berg et al. J Gay Lesbian Ment Health 2015; 19:285-302).

Unwanted loneliness is a complex and highly significant phenomenon, with a demonstrated association with poorer overall and mental health (Martín Roncero et al. Gac Sanit 2021; 35:432-437). This issue should be studied not only from the lens of mental health but also from a sociological perspective.

None Declared

Obsessive-compulsive symptoms (OCS) are frequently observed in both obsessive-compulsive disorder (OCD) and schizophrenia-spectrum disorders (SSD), creating significant diagnostic challenges. Historically, Karl Jaspers defined “true obsessions” as a struggle against intrusive ideas that appear nonsensical and “alien” to the personality, demarcating this concept from delusions and overvalued ideas, in which cases the person would be convinced of the relevance of the content. However, since the 1980s, the concepts of insight and resistance in OCD have been deemphasized in diagnostic criteria, broadening the definition of OCD to include cases with poor or absent insight. The broadening of these criteria has blurred the distinction between OCD and SSD and has narrowed the diagnosis of schizophrenia to primarily delusional and hallucinatory conditions, overlooking obsessive phenomena in this disorder.

The primary goal of this review is to differentiate the phenomenological features of OCS in OCD from those in SSD, focusing on the connection between obsessive-compulsive phenomena and disturbances in the basic self in SSD.

A literature review was conducted using the keywords “obsessive-compulsive symptoms”; “schizophrenia”; “obsessive-compulsive disorder”; “phenomenology” in the Pubmed and Google Scholar databases.

The findings suggest that the underlying nature and subjective experience of OCS may differ substantially between OCD and SSD. An essential component of this differentiation is the exploration of basic self-disturbances, which refer to profound disruptions in an individual’s sense of ownership of experience and agency of action - elements often impacted in SSD but less so in OCD. Patients with SSD often experience OCS in a more alien and automatic manner, with intrusive thoughts and compulsions lacking a clear sense of personal ownership or agency. These obsessions are more likely to blend with delusional thinking and other psychotic features, reflecting broader disturbances in the basic self. The lack of insight and the feeling that obsessive thoughts are externally imposed or intruding from outside the self is a hallmark in these cases. As for compulsions, these may serve as maladaptive strategies to manage or compensate for self-disturbances, rather than purely to neutralize distress as seen in OCD.

Accurate differentiation of OCS in SSD from those in OCD requires clinicians to focus on the quality of self-experience, particularly in terms of insight, ownership and agency. Recognizing how certain obsessive phenomena in SSD reflect disturbances in the basic self is crucial for improving diagnostic accuracy and ensuring appropriate treatment.

None Declared

Psychopharmacological treatment of anxiety and depression in patients with liver and/or kidney disease is complex, primarily due to the differences in pharmacokinetics compared to healthy individuals. Most medications are excreted via the kidney and/or liver, so dose adjustments are often necessary in these patients. Drug-drug interactions are also a significant clinical concern in liver and/or kidney disease, making regular monitoring essential. These factors may contribute to treatment relapse and severe adverse drug reactions associated with psychotropic medications and comedications.

Medication selection is, therefore, based on these considerations. Clinicians must regularly monitor kidney and liver function, although there are no clear global recommendations. A summary of product characteristics is the primary guideline for dose adjustments related to kidney and liver function, though it has limitations and is updated slowly. The most important monitoring parameters for these patients are liver enzymes and serum creatinine levels.

Patients with liver and/or kidney disease are often excluded from randomized controlled trials, meta-analyses, and clinical guidelines, resulting in a lack of data specific to this population. This issue is even more relevant in elderly patients treated with polypharmacy, as many somatic medications can worsen liver and/or kidney function in patients with anxiety and depression. In this context, some medications, such as vortioxetine, trazodone, agomelatine, quetiapine, and sertraline, are less affected by kidney disease in terms of pharmacokinetics.

Several tools are available for prudent medication selection and monitoring in these patients, including medication lists (e.g., Beers, Priscus), therapeutic drug monitoring (TDM), and collaboration with clinical pharmacists and/or pharmacologists. In this presentation, the presenter will discuss this topic from both pharmacological and clinical perspectives. Participants will learn the fundamental pharmacokinetic aspects necessary for medication selection in these patients, which are valuable for daily practice.

None Declared

Dementia is a progressive neurodegenerative disorder characterized by a gradual decline in cognitive functions, such as memory, reasoning, and communication, which places a significant burden on caregivers. Dementia caregiving presents unique challenges that contribute to elevated stress levels. Caregivers of dementia patients often face increased psychological and physical strain, exacerbated by the disease’s progressive nature and complex caregiving demands. This systematic review explores the perceived stress among dementia caregivers, highlighting the impact of caregiving responsibilities and identifying potential coping mechanisms. Our review seeks to offer evidence-based recommendations to support caregivers and improve their quality of life, thereby addressing a crucial gap in dementia care.

This systematic review aims to assess the extent of perceived stress among dementia caregivers, identify associated factors, and evaluate coping mechanisms. The goal is to highlight critical stressors and propose evidence-based strategies for improving caregiver support.

We systematically reviewed eighteen studies from PubMed using the terms “Perceived Stress Scale” and “Caregivers of Dementia Patients.” Our analysis included data from 3,385 caregivers, focusing on stress levels, cortisol measurements, and psychological impacts.

The review consistently identified high levels of perceived stress among dementia caregivers. Cortisol levels, assessed in three studies, were significantly elevated in caregivers compared to non-caregivers (Williams et al., 2021; Kim & Park, 2022; Nguyen et al., 2023). Perceived stress showed a significant correlation with cognitive decline and sundowning behaviors. Additionally, caregivers reported elevated depressive symptoms, with stress levels showing a direct association with these symptoms (Jones et al., 2021). The review also identified that higher education was associated with reduced anxiety and depression, while female caregivers reported higher stress levels compared to males (Miller et al., 2022). Effective coping strategies included seeking information, participating in culturally adapted interventions, and enhancing social support networks (Patel & Singh, 2023).

Dementia caregiving imposes considerable stress due to the demanding nature of the role and the complexities of patients’ conditions. Interventions should prioritize culturally sensitive support programs, expand educational opportunities for caregivers, and strengthen social support systems to alleviate caregiver stress. Future research should further investigate the influence of gender, social isolation, and healthcare access on caregiver stress, particularly in low- and middle-income countries (LMICs) and during global crises such as the COVID-19 pandemic. Addressing these factors will be crucial in developing comprehensive strategies to support dementia caregivers effectively.

None Declared

Liraglutide, a glucagon-like peptide-1 (GLP-1) agonist, is an interesting candidate for improving metabolic syndrome and cognition in psychiatric disorders.

We investigated the effects of liraglutide on a depression-like phenotype in mice exposed to chronic unpredictable stress (CUS).

Learning and memory were also assessed using the Morris water maze (MWM) test. Liraglutide (0.3 mg/kg/day for 21 days) was administered to mice with or without exposure to CUS. After 21 days of CUS, the forced swim test (FST) was performed to assess its antidepressant effect. To evaluate cognitive function, liraglutide was administered to mice under stress-free conditions for 21 days, and then the MWM test was performed on 6 consecutive days.

Chronic liraglutide treatment reduced FST immobility in mice with and without CUS. In the probe trial of the Morris water maze test, the search error rate was reduced and the time spent and path length in the target quadrant and the number of platform crossings were increased.

Additional animal model experiments and molecular level studies are needed to support the results obtained in this study. Liraglutide appears to exert antidepressant effects and could improve cognitive function. Based on these results, GLP-1 agonists could have potential as novel antidepressants. It may also help with metabolic syndrome, cognitive dysfunction, and depressive symptoms.

None Declared

Electroconvulsive therapy (ECT) is a recognized treatment for various psychiatric conditions (Bernardo et al., 2018). However, there is a lack of recent studies describing the clinical characteristics of patients undergoing ECT (Peltzman et al., 2020).

To provide an updated evaluation of the clinical characteristics, treatment parameters, and outcomes of patients receiving ECT at Clinica Universidad de Navarra (CUN), focusing on its effectiveness and evolution over recent years.

This cross-sectional descriptive study examines patients who underwent electroconvulsive therapy (ECT) at CUN’s Psychiatric Hospitalization Unit from January 2019 to August 2023. It focuses on those who received bifrontotemporal ECT, with stimulation power quantified using the DGx program on the Thymatron® machine. Collected data include age, sex, prior psychotropic medication use, ECT indication, comorbidities, Stimulus potency (%DGx), seizure duration (seconds on the electroencephalogram), and anesthetic induction type. Hamilton Anxiety and Depression Scales were recorded before and after treatment when clinically indicated.

ECT was administered in 80 cases, constituting 8.62% of admitted patients, with 33.75% being male. Among these, 33% had psychiatric comorbidities, most commonly being pathological personality traits (16%) and generalized anxiety disorder (5.3%) (Image 1). Non-psychiatric comorbidities included endocrine-metabolic conditions 49% and cardiac conditions 34% (Image 2.)

Pre-ECT, the most common psychotropic medications included benzodiazepines (87.5%), atypical antipsychotics (76.5%), and dual antidepressants (47.5%). Propofol was used for initial anesthetic induction in 86.25% of cases, with 30.43% requiring a switch to thiopental due to the reduced efficacy. The average number of ECT sessions per patient was 8.9 (range: 3-13), with a mean seizure duration of 30.5 seconds. The primary indications for ECT were depressive disorders (85%) and psychotic disorders (11%) (Image 3).

Before ECT, the average Hamilton Depression Scale score was 25.3, decreasing to 5.3 post-treatment. Similarly, the Hamilton Anxiety Scale score average was 23.72 before ECT and 4.6 after.

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Our sample revealed that the primary indications for ECT were affective and psychotic disorders, with a predominant impact on adult women. This supports its role as a key intervention for treatment-resistant conditions, a finding consistent with existing literature (Leiknes et al., 2012). These preliminary results represent an initial evaluation in a broader study aimed at exploring additional aspects of clinical response and comparing ECT with other treatment modalities.

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Previous resting-state fMRI studies have found hypoconnectivity between the areas underlying default mode and salience networks in OCD patients. A general dysconnectivity has been observed between the frontoparietal network and corticostriatal-thalamocortical loops in patients with OCD, We conducted a study to understand the neural correlates of OCD and its sub-types and compared them with healthy controls. As a part of the analysis of fMRI data, we also analyzed the resting state data for OCD patients and compared it to that of healthy controls.

To study the neural correlates of OCD using functional MRI by comparing the resting state functional connectivity in OCD patients with healthy controls.

We used the resting state functional MRI data of 8 OCD patients and compared it with 10 healthy controls. The healthy controls and patients were not age—and sex-matched. The resting state fMRI data was assessed using the CONN functional connectivity toolbox, version 15.d, in MATLAB. The Regions of interest (ROIs) were mapped using the MNI coordinate system. The functional connectivity (FC) was studied with ROI-to-ROI analysis and seed-to-voxel analysis.

1. In ROI to ROI analysis between resting state networks, only one significant result was found when FC between all the brain networks was compared. as shown in table 1 and image 1.Table 1.

2. Seed-to-voxel-based analysis revealed that at p-FWE <0.05 corrected, the left and right occipital pole and right intra-calcarine cortex were more active in OCD patients as shown in image 2.

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1. ROI TO ROI analysis: Attempts to gain control over automatic processes are taxing on the cognitive resources and effective control is lacking in OCD, which could explain higher functional connectivity in the areas linked to having selective attention for specific visual stimuli as found in our study. The lateral occipital cortex supports both visual perception and multisensory integration and visual cortices have been seen to contribute to impulsivity and disorders commonly associated with impulsivity. The rostral prefrontal area in the salience network is involved in sequence selection and evaluation and has a possible role in attention. DMN and corticostriatal networks were normal possibly due to the small sample size, patients on treatment, etc.

2. Seed to Voxel Analysis showed left as well as right occipital poles and right intra-calcarine cortex which process visual stimuli, were more active at rest in OCD patients. Some studies have highlighted deficits in visuospatial processing in OCD patients. The intra-calcarine cortex would require further research for a better understanding of its role in OCD patients.

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The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines pica as the ingestion of non-nutritive and non-food substances. For a diagnosis to be made, the behavior must persist for at least one month, not be consistent with the child’s developmental stage, and not be a socially normative or culturally accepted practice. The etiology of pica is not well understood. Additionally, knowledge about its overall prevalence is limited.

We present the case of a 61-year-old female patient diagnosed with histrionic personality disorder and generalized anxiety disorder, who began to frequently visit the hospital emergency department due to the ingestion of various objects, such as screws, paper clips… (Image 1). It was decided to admit her to the psychiatric ward with two main objectives:To halt the progression of disruptive behaviors and to determine the underlying cause of the pica behaviors.

During hospitalization, no clear affective disturbances toward any polarity were observed. Additionally, the patient was unable to coherently justify her behaviors, merely describing them as “spontaneous and irresistible impulses.” However, significant cognitive impairment was evident during the admission. Furthermore, the presence of balance disturbances with lower limb incoordination and urinary incontinence was confirmed. The described triad—gait disturbances, urinary incontinence, and cognitive deterioration—is characteristic of adult chronic hydrocephalus (ACH). Given this suspicion, a cranial computed tomography (CT) scan, was requested.

The Evans’ index (EI) was calculated. An EI greater than 0.30 is indicative of ventricular dilation, and the patient’s EI was 0.39 (Image 2). The high clinical suspicion, insidious onset, and the ventricular dilation observed made the diagnosis of ACH highly probable. Consequently, the patient was referred to the neurosurgery department to evaluate the potential placement of a cerebrospinal fluid shunt.

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Although pica behaviors can be associated with various psychiatric disorders, there is often an underlying organic substrate. In this patient, the initial diagnosis of personality disorders and generalized anxiety, coupled with the repetitive pica behaviors, might have initially pointed exclusively toward a psychiatric approach. The identification of a broader symptomatic pattern, led to the suspicion of adult chronic hydrocephalus (ACH). The triad of symptoms in ACH, though classic, may not always be evident, and neuropsychiatric manifestations such as pica could be indirect signs of brain involvement.

This case underscores the need to consider organic differential diagnoses in patients presenting with atypical or unexplained behaviors from a purely psychiatric standpoint.

None Declared