Older adults with treatment-resistant depression (TRD) can be treated with augmentation or switched to a different drug.

We aimed to identify factors that moderate the effectiveness of these strategies on treatment outcomes to guide the selection of the optimal strategy for each patient.

We analyzed data from 742 older adults with TRD in the Outcomes of Treatment-Resistant Depression in Older Adults (OPTIMUM) clinical trial. All participants were randomized to one of two treatment strategies, which were augmentation with aripiprazole, bupropion, or lithium; or switching to bupropion or nortriptyline. Treatment outcomes were change in MADRS scores and remission after 10 weeks. Age, burden of comorbid physical illness, number of adequate previous antidepressant trials, presence of executive cognitive impairment, and clinically relevant comorbid anxiety were examined as potential moderators of the effect of the two treatment strategies (augmentation vs. switching) on treatment outcomes.

Overall, augmentation produced more improvement in MADRS scores and produced a higher rate of remission than switching. For change in MADRS scores after 10 weeks of treatment, the number of adequate previous antidepressant trials was the only significant moderator of the superiority of augmentation over switching (b = -1.6, t = -2.1, p = 0.033, 95%CI [-3.0,-0.1]). There were no significant moderators for remission.

Older patients with TRD with less than three previous antidepressant trials benefit more from augmentation than from switching. Future studies validating this finding with different drugs in more diverse samples can facilitate their application in real world settings.

H. Kim Grant / Research support from: Dr. Kim reports grant support from the PSI foundation (R23-21). She is supported by the Canadian Institutes of Health Research (CIHR) and the Temerty Faculty of Medicine (Chisholm Memorial Fellowship)., J. Karp: None Declared, H. Lavretsky Grant / Research support from: Dr. Lavretsky received support from grants (K24 AT009198, R01 AT008383, and R01 MH114981) from the NIH., D. Blumberger Grant / Research support from: Dr. Blumberger reports grants from Canadian Institutes of Health Research (CIHR) and the Temerty family through the Centre for Addiction and Mental Health (CAMH) Foundation during the conduct of the study; nonfinancial support from Magventure (in-kind equipment support for investigator-initiated research); grants from Brainsway (principal investigator of an investigator-initiated study and site principal investigator for sponsored clinical trials), National Institutes of Health (NIH), Brain Canada Foundation, Campbell Family Research Institute, and Patient-Centered Outcomes Research Institute outside the submitted work; received medication supplies for an investigator-initiated trial from Indivior; and has participated in advisory boards for Janssen and Welcony., P. Brown Grant / Research support from: Dr. Brown received additional support from the National Institute of Mental Health OPTIMUM NEURO grant (5R01MH114980)., A. Flint Grant / Research support from: Dr. Flint has received grant support from the US National Institutes of Health, the Patient-Centered Outcomes Research Institute, the Canadian Institutes of Health Research, Brain Canada, the Ontario Brain Institute, and Alzheimer’s Association., E. Lenard: None Declared, P. Miller: None Declared, C. Reynolds Shareolder of: Dr. Reynolds receives payment from the American Association of Geriatric Psychiatry as Editor-in-Chief of the American Journal of Geriatric Psychiatry and royalty income for intellectual property as co-inventor of the Pittsburgh Sleep Quality Index., S. Roose: None Declared, E. Lenze Grant / Research support from: Dr. Lenze received additional support from the Taylor Family Institute for Innovative Psychiatric Research at Washington University School of Medicine, as well as the Washington University Institute of Clinical and Translational Sciences grant (UL1TR002345) from the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH)., B. Mulsant Grant / Research support from: Dr. Mulsant received additional support from the Labatt Family Chair in Biology of Depression in Late-Life Adults at the University of Toronto. He holds and receives support from the Labatt Family Chair in Biology of Depression in Late-Life Adults at the University of Toronto. He currently receives or has received during the past three years research support from Brain Canada, the CAMH Foundation, the Canadian Institutes of Health Research, and the US National Institutes of Health (NIH); Capital Solution Design LLC (software used in a study funded by CAMH Foundation), and HAPPYneuron (software used in a study funded by Brain Canada).

Children with mild intellectual disability (MID) face specific challenges threatening their development, particular their mental health. They face a heightened risk of psychopathology (Buckley et al. ANZJP 2020; 54 970–984). This heightened susceptibility is theorized to be shaped by a complex interplay of diverse socio-demographic factors experienced by these children, collectively known as social determinants of mental health (SDOMH), include ethnicity, socioeconomic status, household conditions, family dynamics, and neighborhood deprivation (Allen et al. IJP 2014; 26 392–407).

This study examined the collective and unique role of diverse social determinants of mental health (SDOMH) associated with mental health problems (MHP) for children with MID, compared to peers with and without MHP.

Combining microdata from Statistics Netherlands, municipality data from The Hague and mental health care records, this population-based case-control study included four groups aged 0-17 years (Mage = 10.6, 35.6% female). Two groups of children receiving outpatient mental health care for MHP with MID (n=505) and without MID (n=2,767), each with a matched control group from the general population (n=2,525 and n=13,835, respectively), were studied. Through multivariate logistic regression analyses, both MHP groups were compared to their control group and each other to examine the likelihood of a particular SDOMH associated with receiving mental health care for MHP in children with and without MID.

Children with MID receiving mental health care showed significant differences in multiple domains compared to their control group and to children receiving mental health care without MID. In the multivariate model, they were less likely to have European-born mothers, more likely to have parents with moderate or low education levels, and tended to live in smaller, single-parent, lower-income households. Similar, though less deviant, patterns were observed for children without MID receiving mental health care compared to the general population, except for parental education. Additionally, children without MID were more likely than their controls to reside in densely populated areas with lower neighborhood education levels.

Our study highlights that diverse SDOMH are associated with the likelihood of receiving care for MHP in children. Moreover, children with MID face disproportionate disadvantages, particularly regarding low parental education and household income. Thus, interventions should not only target the child but also their family and environmental context.

None Declared

The field of psychiatry encompasses a range of approaches that guide both clinical practice and training.

This study aims to explore residents’ views on these diverse approaches, identifying trends and preferences that could inform the development of psychiatric education and clinical practice in the region.

The objective of this study is to assess the perspectives of psychiatry and child psychiatry residents in Tunisia on different approaches to mental health care and to identify their preferences and attitudes towards evidence-based psychiatry.

A cross-sectional survey was conducted among 31 psychiatry and child psychiatry residents in Tunisia through an online survey.

The survey utilized a combination of yes/no questions and gradual questions to gather data on residents’ perspectives regarding various psychiatric approaches.

Data collection was carried out throughout the month of july 2024.

This study included 31 participants with an average age of 28.1 years.

Less than half of the participants (45.2%) reported that they believe the brain is the sole source of mental disorders, with a notable proportion identifying as non-theist.

A majority of residents (80.5%) agreed that medicine should be grounded in the scientific method. However, only 14 participants agreed that “Evidence-based approaches should be the only approaches in psychiatry,” and 15 participants agreed that “The biological approach should be the primary focus in psychiatry.”

Most residents considered most approaches to be evidence-based. In contrast, the psychodynamic approach was less frequently viewed as evidence-based.

Nearly all residents (n=27) believed that an integrative approach is beneficial in psychiatric practice.

More than half of the participants (54.8%) rated their training in Evidence-Based Psychiatry as limited. Despite this, 24 participants reported that they often try to adhere to evidence-based guidelines when treating patients.

The main barriers to implementing Evidence-Based Psychiatry were identified as a lack of resources in psychiatric departments or hospitals (41.9%) and insufficient training (38.7%).

The results indicate that while there is strong support for evidence-based medicine and the integration of multiple theoretical models, there are differing views on the predominance of specific approaches in clinical practice.

The majority of residents acknowledge the importance of grounding psychiatric practice in empirical evidence, yet there is less consensus on making evidence-based approaches the exclusive or primary focus.

Despite recognizing the benefits of integrating diverse approaches, many residents perceive limitations in their training and resources, which affect their ability to adhere fully to evidence-based practices.

The findings underscore the need for enhanced training in Evidence-Based Psychiatry and improved resources within psychiatric departments and hospitals.

None Declared

Historically, syphilis has been known as “the Great Imitator” due to its heterogeneous clinical manifestations. Though its incidence decreased with the widespread use of penicillin, recent data suggest a resurgence, particularly among those experiencing delays in treatment. This resurgence creates diagnostic challenges, especially when patients have coexisting psychiatric conditions like Borderline Personality Disorder (BPD).

This report explores the psychiatric and cognitive manifestations of neurosyphilis in patients with preexisting personality disorders. The primary objective is to highlight how neurosyphilis complicates psychiatric diagnosis and care and to emphasize the need for early detection and intervention.

A thorough literature review was conducted using PubMed database covering studies published from 2000 to 2023. Keywords included “neurosyphilis,” “borderline personality disorder,” “psychiatric symptoms,” “syphilis resurgence,” and “cognitive impairment.” Additionally, the case of a 35-year-old female with BPD who developed neurosyphilis is presented, demonstrating the complexities in distinguishing between overlapping psychiatric symptoms. The case also emphasizes the importance of comprehensive care.

The psychiatric symptoms of neurosyphilis, such as impulsivity, mood instability, and cognitive dysfunction, significantly overlap with those of BPD, complicating diagnosis and treatment. Literature indicates that neurosyphilis occurs in 0.5% to 2% of untreated syphilis cases. Common psychiatric manifestations of neurosyphilis—such as irritability, cognitive decline, and affective dysregulation—are often misattributed to underlying psychiatric disorders, leading to delays in proper treatment. In the case of the 35-year-old patient, her longstanding BPD symptoms, including emotional instability and impulsivity, worsened with the progression of neurosyphilis. Cognitive testing revealed mild impairment, which was consistent with the cognitive decline seen in neurosyphilis, further complicating the clinical picture.

This case underscores the critical need for timely syphilis screening, particularly for individuals with a history of untreated or inadequately treated infections. Early diagnosis and treatment of neurosyphilis can significantly improve cognitive and psychiatric outcomes while promoting overall wellness. Routine sexually transmitted disease screenings, especially in psychiatric populations, can prevent severe neuropsychiatric complications and support holistic well-being. Given the global resurgence of syphilis, a proactive approach to sexual health is essential in fostering both mental and physical health.

None Declared

Cannabis is the most widely used psychoactive substance among youth, and its use has been increasingly linked to psychiatric disorders, particularly psychosis. THC, the psychoactive component of cannabis, has the potential to trigger or worsen schizophrenia. Cannabis use is associated with an earlier onset of schizophrenia and is more prevalent among males with first-episode psychosis, which may contribute to an earlier onset of schizophrenia observed in men. With increasing cannabis legalization, understanding gender differences in cannabis use in schizophrenia patients is essential for personalized treatment approaches.

To examine the gender-specific impact of cannabis use on schizophrenia or other psychotic disorders, focusing on pre-onset use and discontinuation following antipsychotic (AP) treatment.

A retrospective study was conducted including personal interviews and medical history reviews of inpatients and outpatients. Inclusion criteria were age between 18 and 65 years, diagnosis of schizophrenia or schizoaffective disorder, and use of AP therapy, both for at least 5 years. Statistical analysis was performed using the Jamovi statistical analysis software.

136 patients being treated at University Medical Centre Maribor’s Department of Psychiatry were included in the study. 38.2% of patients were females and 61.1% were males. The mean age of all participants was 49.2±11.8 years. The mean age at the time of diagnosis was statistically significantly higher in females compared to males (30.4±8.9 versus 26.0±7.9 years; Mann Whitney U test: p<0.001). Before the onset of psychosis, 23.1% females and 56.0% males used cannabis, while 76.9% females and 44.0% males did not (Image 1). A chi-squared test showed a significant gender difference in cannabis use (p<0.001), indicating higher prevalence among males. After introduction of the AP treatment 58.3% females and 57.4% males discontinued cannabis use (Image 2). A chi-squared test indicated no significant association between sex and cannabis discontinuation (p=0.956), with similar rates for both genders.

Image 1:

Image 2:

Our study reveals significant gender differences in cannabis use before psychosis onset, with males showing higher prevalence and potentially earlier diagnosis. However, cannabis discontinuation rates after AP treatment were similar across genders, suggesting comparable responses to treatment. As cannabis legalization increases, the need for customized interventions that consider gender-specific factors in managing psychotic disorders is emphasized. Further research is necessary to investigate the long-term effects of cannabis use on treatment outcomes in both males and females.

None Declared

The treatment of severe mental disorders benefits significantly from a multidisciplinary approach that integrates, among others, psychopharmacology and psychotherapy. The intervention with multifamily groups (MFG) shows multiple benefits for this patient profile. Its positive effects include reducing relapse rates, increasing treatment adherence, improving socio-occupational and family functioning, and reducing stress and family burden. When implemented optimally, it can be an effective tool that complements other treatment options, such as psychopharmacology and other psychosocial interventions.

To describe a clinical case of severe mental disorder, emphasizing the special relevance of a comprehensive approach.

The case of a 46-year-old woman, with no prior mental health history, is described. She began follow-up after experiencing several psychotic episodes induced by substance use (cannabis). It was agreed with the patient to start psychopharmacological treatment and a psychotherapeutic approach by incorporating her into the center’s Multifamily Group (MFG). Initially, she received treatment with olanzapine 15 mg maximum daily dose (MDD), but it was discontinued due to the metabolic syndrome that appeared as a side effect. Treatment with lurasidone 74 mg MDD was then started, but it was also eventually discontinued due to intense akathisia. During the three years of follow-up, the patient remained abstinent from cannabis, without psychopharmacological treatment, and received intensive therapy in the MFG. Over time, her delusional ideation of persecution and self-referential clinical symptoms progressively subsided until resolution.

During a session of the MFG, in the context of several stressful situations (her son moving out of the family home, personal experience with the stigma of mental illness after a reading in the MFG, and frequent arguments with her husband), the patient reported delusional ideation and self-referentiality again, predominantly affecting her emotional state. In agreement with the patient and considering the side effects previously experienced with other antipsychotics, it was decided to initiate treatment with Brexpiprazole at progressively increasing doses until reaching 4 mg MDD, with good tolerability and clinical efficacy.

This case highlights the particular importance of adopting a multimodal approach for the effective management of severe mental disorders, which can optimize clinical outcomes, promote more sustainable recovery, and improve the quality of life for patients.

None Declared

Caregiving to individuals with schizophrenia is intensive, complex, and long lasting. In developing countries, the primary caregivers are family members who rarely receive adequate preparation for their role. The diversity and intensity of caregiving roles also may result in caregiver strain and burden. Interaction with nature even in form of hearing sounds have been found to reduce stress markers. Immersive Virtual Environments (IVEs) can result in restorative effects such as increased positive affect, decreased negative affect, and decreased stress.

To assess and compare the effect of combined use of nature-based VR and nature-based sounds to nature-based sounds only on physiological parameters (heart rate, respiratory rate, oxygen saturation, systolic and diastolic blood pressure) in caregivers of individuals having schizophrenia.

Sixty caregivers (aged more than 18 years) of inpatients with schizophrenia as per Diagnostic & Statistical Manual (DSM-5) will be recruited with consecutive sampling. Caregivers should have been staying with patient for at least previous 1 year and have been staying in the ward for previous 7 days for at least 12 hours/day. Individuals with hearing or visual deficits, history of having received treatment for mental illness/epilepsy, or taking sleeping pills/sedatives/hypnotics/cough syrup currently would be excluded. Paid caregiver and those not willing to provide written informed consent would be excluded from the study. Data collection tools will include a semi-structured proforma for mentioning the socio demographic details, checklist for observing physiological parameters (Heart Rate, Respiratory Rate, Oxygen Saturation, and Blood Pressure), Perceived Stress Scale (PSS), Pittsburg Sleep Quality Index (PSQI), Satisfaction with Life Scale (SwLS), Subjective stress on Visual analogue scale (VAS), User Satisfaction Evaluation Questionnaire (USEQ) and VR Experience Questionnaire (VEQ). Participants would be divided randomly into two groups with group 1 (n=30) individuals receiving only nature-based sounds intervention and those in group 2 (n=30) would receive combined nature-based VR and nature-based sounds intervention.

Primary outcome will be change in physiological parameters using repeated measures ANOVA. Additional outcomes like acceptability and feasibility of the intervention will also be reported as descriptive data. Pearson’s correlation will be done between scale scores and change in physiological parameters in different groups based upon nature of intervention, illness based or gender based.

The study provides insight into the utility of upcoming VR interventions to cater the needs of caregivers to individuals with schizophrenia in moderating the stress levels.

None Declared

Postpartum depression (PPD) is one of the most prevalent mental disorders, with the potential to precipitate complications in childbearing. The estimated prevalence of PPD ranges from 7% to 13% in developed countries and exceeds 20% in underdeveloped countries. Near 20% of women presenting with symptoms of PPD experience suicidal ideation. Prompt detection and management of this patient group is of particular importance. The use of esketamine has shown to reduce the incidence of PPD in previous studies, but its widespread use has been hampered by its side effects and the need for hospitalisation.

We aimed to review the available literature on the efficacy and safety of peripartum esketamine use.

A narrative literature review was carried out in the PubMed, Cochrane and Embase databases, selecting only the articles published in the last 10 years, using the following keywords: pregnancy, esketamine, postpartum depression.

After childbirth 6 week is a high-risk period for PPD, specially the first week. The incidence of PPD is higher in C/S than in normal births. Compared with pregnant women who underwent C/S without the use of esketamine, those who used esketamine in the perioperative period had a 48% reduced risk of developing postpartum depression and a 1.43 point reduction in the Edinburgh Postnatal Depression Scale (EPDS). The optimal dose of esketamine for PPD is unknown; most studies consider high doses above 0.5 mg/kg and low doses inferior. These favourable effects were observed at both short and long-term follow-up and in low and high doses. Compared to intranasal esketamine, intravenous esketamine has a higher bioavailability and is more convenient to dose control. Route of administration and dose of esketamine did not affect the prophylactic effect of esketamine on PPD, but they differ in their adverse effect profiles. The incidence of immediate adverse reactions to intraoperative pumped esketamine is extremely high, particularly during the intraoperative period when more patients receiving esketamine developed neurological or psychiatric symptoms (97.7%). Other common immediate intraoperative maternal adverse events were nausea and vomiting, dizziness and hallucinations, but had no significant effect on postoperative adverse. Adverse reactions to esketamine are usually transient and are more common when single intravenous injection is used (continuous infusion is preferable), with faster and higher doses.

PPD has potentially serious consequences for mothers and their children, and there is an urgent need for safe, effective and accessible treatments. As the use of esketamine has progressed, concerns have arisen about adverse effects, particularly long-term efficacy, addiction and suicide risk. Current evidence suggests that although it may have a good preventive effect, a long research trail is needed to prove and confirm the efficacy and safety of esketamine.

None Declared

The term “climate change distress” has been proposed to capture the broad range of negative emotional reactions associated with Climate Change/CC. Although it can be an adaptive reaction that motivates climate action to mitigate a real threat, for a growing number of people climate distress impairs subjective well-being and daily functioning, causing significant suffering to such an extent it often necessitates psychological support.

Hepp et al. (2023) developed the Climate Change Distress and Impairment Scale/CC-DIS, comprising 23 items to distinguish CCDistress (spanning eco-anxiety, -anger, -sadness) and CCImpairment that may indicate a need for intervention.

To analyse the psychometric properties of the Portuguese version of the CC-DIS.

Participants were 590 adults, recruited through social media (64.6% women; Mean age=34.40±16.18; range: 18-75) completed an online survey including: preliminary Portuguese versions of CC-DIS; Pro-Environmental Behavior Scale/PEBS (Pereira et al. 2024); and Depression Anxiety and Stress Scales-21/DASS-21 (Pais-Ribeiro et al., 2004). Total sample was randomly divided into two sub-samples: one (n=290) for exploratory factor analysis/EFA and the other (n=300) for confirmatory factor analysis/CFA

RESULTS and DISCUSSION: EFA and parallel analysis resulted in two factors (explained variance= 58.60%). CFA of this two-factor model resulted in “acceptable” fit indices (χ2/df=2.772; CFI=.892; TLI=.872; GFI=.846; RMSEA=.0796; p<.001), with standardized factor loadings ranging from .490 to .844. Cronbach’s alpha coefficients were .90 for CCDistress and 0.85 for CCImpairment.

CCImpairment, but not CCDistress, correlated significantly and moderately (r=.25) with DASS-21, suggesting that these last two may be relatively independent phenomena.

With PEBS, the correlation coefficients were both significant (p<.001): .43 for CC-Distress, .22 for CC-Impairment. Both CCDistress and CCImpairment were significant predictors of collective (R2=17.5%; b) and political (R2=17.2%; b) pro-environmental actions, but only CCDistress predicted personal actions (R2=22.9%, p<.001; ), which suggests the more maladaptive nature of CCImpairment.

Such as reported by Hepp et al. (2023), CCDistress mean scores were moderate to high (3.71±0.63); CCImpairment were low to moderate (2.13±0.72) and only the former significantly differ by gender (higher in women). This suggests that individual factors, other than gender (e.g., personality traits), may be more relevant to understand psychopathological reactions to CC.

The Portuguese CCDIS presented good validity (construct, convergent and discriminant) and reliability. It can be used to better understand and improve CC adaptation in our country, which, like Spain, is located in Southern Europe, the area of the globe projected to to be at the highest risk for CC negative impacts.

None Declared

Individuals with autism spectrum disorder (ASD) show notable intellectual impairment compared to other neurodevelopmental disorders, as seen in intelligence and neuropsychological tests, including attention assessments. Given the strong link between intellectual and neuropsychological performance, it is essential to determine if low neuropsychological scores stem from general intellectual limitations or specific domain vulnerabilities.

To assess specific neuropsychological vulnerabilities in ASD, we will administer intelligence and neuropsychological tests to both ASD and Tic disorder groups, examining group differences after controlling for FIQ. Within the ASD group, we will further analyze performance variations by symptom severity and explore links between test results and specific ASD symptoms.

We recruited children aged 5-16 with no comorbidities into Tic (n=75) and ASD (n=97) groups, administering the Wechsler Intelligence Scale and neuropsychological tests (ATA, CCTT, WCST, Stroop). Using SPSS 29, we performed an ANCOVA with FIQ as a covariate to examine group differences. In the ASD group, ADOS-2 scores further distinguished autism spectrum and autism groups, and correlations were analyzed between neuropsychological scores and ADOS-2 Social, RRB, and Total scores.

The ASD group had a significantly lower FIQ than the Tic group (t(66) = 2.54, p = .013) and showed poorer WCST performance with fewer correct responses and more errors, even after controlling for FIQ. In the ATA, the ASD group’s response time was significantly faster, with higher false alarms, indicating hasty judgments. The Stroop color-word task showed poorer ASD performance, while the CCTT interA_rate was higher in the Tic group. No significant differences were found between the autism spectrum and autism groups on neuropsychological tests, except intelligence. ATA scores correlated significantly with ADOS-2 social, RBB, and total scores, whereas WCST scores correlated only with RBB.

This study’s WCST, ATA, and Stroop test results indicate that the ASD group has deficits in cognitive flexibility and inhibitory control, independent of FIQ. The absence of significant differences between autism and spectrum groups suggests these traits are inherent to the autism spectrum, regardless of symptom severity. Unexpectedly, the CCTT interA_rate was high, likely due to a floor effect given the ASD group’s longer CCTT 1 completion time. ATA scores correlated with overall autism symptoms, while WCST scores correlated only with RBB, linking social interaction difficulties to attentional control and repetitive behaviors to cognitive rigidity and insistence on sameness.

S. Lee Conflict with: Financial Support for Research from: This research was supported by the National IT Industry Promotion Agency (NIPA), an agency under the MSIT and with the support of the Daegu Digital Innovation Promotion Agency (DIP), the organization under the Daegu Metropolitan Government, and co-funded by the National Research Foundation (NRF) funded by the Korean Government (MSIT) (RS-2024-00397737)., S. Y. Lee: None Declared, B.-N. Kim: None Declared

A growing body of literature report, that vulnerable groups eg refugee, asylum seeker and forcibly displaced groups across Europe face social and psychological challenges linked to their minority status, often involving discrimination and racism. Moreover, they have to overcome many other barriers to accessing healthcare and preventive interventions. There is increasing evidence that a large proportion of refugees or forcibly displaced persons suffer from the consequences of traumatic events and exhibit psychological problems or develop mental disorders, including post-traumatic stress disorder, depressive and anxiety disorders, and relapses in psychotic episodes. European countries are aware that psychosocial and health services face major challenges and need to develop or expand strategies to overcome them. The direct and indirect consequences of humanitarian catastrophes cannot be estimated at present. In this presentation, strategies to improve the access of forcibly displaced people to mental health care services will be presented and discussed.

None Declared

As of January 1, 2020, the new Dutch Mental Health Compulsory Care Act (WVGGZ) came into effect, replacing the Special Admissions to Psychiatric Hospitals Act (Wet BOPZ).

One of the expectations of the WVGGZ was that earlier (medication-based) involuntary intervention in outpatient settings would lead to fewer or shorter hospital admissions. The most important change was the outpatient use of involuntary medication, which was not allowed before the law.

Data from the Argus rating scale (Noorthoorn et al, 2016) and its successor, the compulsory care registration were combined with background data on admissions and wards. For this study, patients with a court order (RM) in 2016 and 2017 and a cumpulsory care authorization (ZM) in 2022 and 2023 were selected.

In 2016 and 2017, 549 patients received an RM, and 958 RM’s were issued. In 2022 and 2023, there were 405 patients, and 546 ZM’s were implemented. The total number of admission days for these patients before the law was 78,183 compared to 76,099 after the law. The average length of stay increased from 81 days per patient to 140 days per patient (t=-8.93, p<0.001). Seclusion decreased from 45,893 hours to 2,985 hours (t=4.93, p<0.001). Intramuscular (IM) medication was administered 137 times before the law and 369 times in clinical settings after the law (2022-2023) (chi-square= 325.10, p<0.001). IM medication was administered 777 times in outpatient settings.

Contrary to expectations, the legislative change did not result in shorter admissions for patients with a ZM. The data indicate significant differences in involuntary treatment for patients before and after the legal change. The presentation will explore possible factors influencing these figures.

None Declared

Spine simulators offer learners risk-free environments to develop psychomotor skills for pedicle screw insertions. The virtual reality TSYM simulator deconstructs and simulates pedicle screw insertions. This case series study investigates face, content, construct, and convergent validity of an L4–L5 bilateral pedicle screw insertion on the TSYM simulator.

Neurosurgical-orthopedic residents, fellows, and spine surgeons performed an L4–L5 bilateral pedicle screw insertion on the TSYM simulator. Participants were classified a priori into skilled (postgraduate year (PGY) 5–6, fellows, and consultant neurosurgeons or orthopedic surgeons) or less skilled (PGY 1–4) groups. Face and content validity were assessed utilizing a 7-point Likert scale. Construct validity was determined by investigating group differences in simulation-derived performance metrics and the Objective Structured Assessment of Technical Skills (OSATS) ratings. Convergent validity was examined by correlating simulation-derived performance metrics and OSATS ratings.

Thirteen skilled and 14 less skilled participants were included in this study. Eight of nine face and content validity statements were rated a median ≥ 4. Significant differences between the groups were found for four simulation-derived performance metrics (P < 0.05) and all OSATS categories (P < 0.001). Three simulation-derived performance metrics (maximum force and tool contact using the simulated screwdriver and three-dimensional velocity using the tap) significantly correlated with OSATS ratings.

The L4–L5 bilateral pedicle screw insertion simulation on the TSYM platform demonstrated mixed and variable evidence for face, content, construct and convergent validity, supporting its educational potential for spine surgery training, but improvements are needed to optimize learning.

We report the case of an 18-year-old male patient diagnosed with autism spectrum disorder at age of 12. Between the age of 12 and 18 he developed anxiety and substance use disorders.

He was acutely admitted to the Department of Psychiatry and Psychotherapy at Semmelweis University due to a severe manic episode with psychotic symptoms at the age of 18. He provided a multidisciplinary treatment, including medication, support group, individual addiction consultation and rehabilitation. He became stable, currently abstinent for six months and planning to graduate.

Our case report has practical implications for physicians by raising their awareness of comorbid mental disorders in the autism spectrum and also the difficulties in the transition between adolescence to adulthood.

autism spectrum, comorbidity, transient psychiatry

None Declared

Psychotic disorders typically have their onset in adolescence, a formative age that comes with many developmental challenges. The onset of mental illness in this phase of life can be very disruptive. Literacy on the nature and potential impact of psychosis can promote recovery, while family interventions have the potential to prevent relapse. Moreover, many patients and family members report a need for tools that provide guidelines to improve their communication and stimulate mutual understanding. However, an integrated psyche-education module for both adolescents with lived experience and their relatives was lacking until now.

The development of a new integrated psycho-education module and the content of this module will be presented,

Stakeholders (people with lived experience and family members) were interviewed on their preferences for the content, form and timing of psycho-education individually (n=15) and in focus groups (n=7). This information was used by a task force of experts composed of people with lived experience with psychosis, family members and mental health professionals. Subsequently, the intervention was piloted in two mental health care organizations.

Adolescents with lived experience preferred psycho-education on communications skills and wanted to learn how to communicate with their relatives during and after the psychotic episode, adjusted to their specific situation. They prefer psycho-education together with their relatives, not separately. They also noted that the content of psycho-education may differ depending on the relationship they have with their relatives. Relatives and people with lived experience both reported they needed basic knowledge about psychosis, training in communication and problem solving skills, content with respect to self-care and content about online information. With regards to the timing of psycho-education, relatives preferred basic information as soon as possible and communication skills later on.

Both groups felt an integrated psycho-education could be beneficial. The final integrated module is composed of themes related to different dimensions of recovery, e.g. societal and social impact and spirituality. Results of the pilot were used to refine the module.

This new integrated psycho-education module was based on stakeholders preferences and needs and was found to be helpful to increase mental health literacy and communication between adolescents with lived experience with psychosis and their relatives.

None Declared

This presentation will explore the development and implementation of the Crisis Support VR project, funded by the VGR Innovation Fund and involving five hospitals and primary care. In today’s society, the need for crisis support is more pressing than ever. However, we identified a significant gap in opportunities to practice Psychological First Aid. To address this, Region Västra Götaland collaborated with VirtualSpeech to create a system that has been tested by hospital staff, emergency services, and crisis support teams. This presentation will detail the project’s journey from its inception to its current state, highlighting the challenges and successes encountered along the way.

None Declared

Violent, abusive, and harmful behavior enacted by older adults upon their caregivers represents a distressing and frequently disregarded facet within the domain of caregiving.

This qualitative study aims to 1) explore family caregivers’ experiences of violent, abusive, and harmful behavior by the older person and 2) explore how violent, abusive, and harmful behavior by the older person affects family caregivers’ mental health.

This qualitative study encompassed 307 participants, with a diverse age range spanning from 65 to 87 years. All the interviews went through the process of content analysis.

For the first objective, findings indicated six emerging themes: Persistent and intense verbal abuse (79.1%); Subjugation and manipulation by older adults (72.5%); Unexpected illicit activities initiated by older adults (62.1%); Financial exploitation by older adults (39.8%); Physical abuse (31.5.%); and Sexual abuse (30.7%). The second objective highlighted four themes: High levels of anxiety and depression (87.9%), Intense rage (79.4%), Feelings of moral isolation (77.4%), and Intense explosions (63.6%). Brazilian participants mainly experienced persistent and intense verbal abuse (64.1%). Moreover, higher levels of depression and anxiety were mainly verbalized by English participants (81.8%).

These findings underscore the significant toll that older individuals’ violent, abusive, and harmful behavior can have on the mental well-being of family caregivers. This study sheds light on the complex experiences faced by family caregivers and emphasizes the urgent need for targeted interventions to foster healthier caregiving environments.

Keywords: Carers; family caregivers; mental health; older adults; violent, abusive and harmful behavior.

None Declared

The pharmacological treatment strategies for bipolar disorders include both acute and maintenance treatments. However, a substantial number of patients do not respond sufficiently to pharmacotherapy. Thus far, there has been no standardized definition for treatment resistance in bipolar disorder. Studies have been using different definitions, possibly due to the clinical complexity including the episodic nature of bipolar disorder and various subtypes. The talk will discuss the definitions, neurobiological, and genetic aspects as well as ongoing initiatives to identify markers for treatment resistance in bipolar disorder.

None Declared

Artificial intelligence (AI) has enriched the everyday lives of many people and is used in a variety of ways, i.e. as a resource of medical information. One of the most popular AI functions is the generation of images of real-world settings. Recent research (Mei et al. ACM FAcct 2023; 1699-1710) has shown, that AI could reinforce prejudice and can be biased in its answers leading to stigmatization in the online world as well. This has dramatic consequences as stigma is known to affect mental health negatively (Pérez-Garín et al. Psychiatry Res. 2015; 228 325-331). Little is known, however, if and to what extend AI generated images reveal bias towards people with mental illness or corresponding institutions such as psychiatric clinics.

The aim of this exploratory study is to investigate whether AI-generated images of psychiatric institutions, scenes, and severe mental illnesses are perceived as stigmatizing compared to other hospital scenes and severe illnesses from patients, mental health experts, and the general population in Germany.

Two researchers prompted three different AIs to generate various realistic medical scenes (prompts: person suffering from a severe mental illness, person suffering from a severe illness, mental health institution, hospital, psychiatric ward, hospital ward, incident in a mental health institution, incident in a hospital, electroconvulsive therapy session, cardiopulmonary resuscitation session). For each chatbot, one image per prompt was selected randomly for the following online survey. In a mixed subject design, participants were randomly assigned to one of three groups displaying the generated images of one AI. Then, they were asked to rate the images on SAM rating scales, adjective scales, to provide a title for the image, and to decide whether the image stigmatizes specific groups. The survey starts on November 2024 and a total sample size of 100 subjects is aimed for.

Preliminary results will be presented at the congress.

This study examines the effects of AI-generated images on patients, experts and the general population. It attempts to find out whether and to what extent AI-generated images stigmatize people with severe mental illnesses and to what extent psychiatric institutions are portrayed realistically compared to general medical institutions and severe illnesses.

J. Grimmer: None Declared, N. Khorikian-Ghazari: None Declared, L. Schoch: None Declared, N. Hartmann: None Declared, A. Hasan Consultant of: Rovi, Recordati, Otsuka, Lundbeck, AbbVie, Teva and Janssen-Cilag, Speakers bureau of: Janssen-Cilag, Otsuka, Recordati, Rovi, Boerhinger-Ingelheim and Lundbeck, I. Papazova: None Declared