Negative symptoms, such as avolition, blunted affect, or alogia, contribute to functional disability and reduced quality of life in schizophrenia. Patients with predominant negative symptoms and minimal positive symptoms represent a distinct subgroup requiring tailored therapeutic strategies. Sleep disturbances, particularly reduced sleep efficiency, are commonly reported in this population and may exacerbate the severity of negative symptoms. Understanding the differential impact of specific negative symptoms on sleep efficiency could inform individualized approaches for improving otucomes.

To explore associations between distinct dimensions of negative symptoms and sleep efficiency in schizophrenia patients with predominant negative symptoms and low positive symptoms.

This analysis used baseline data from a randomized, sham-controlled trial on the efficacy of transcranial magnetic stimulation in schizophrenia, conducted between 2000 and 2023. The study included patients with PANSS negative subscale score > 24 and PANSS positive subscale score < 20. The outcome variable was the sleep efficiency subscale of the Pittsburgh Sleep Quality Index. Independent variables were the five SANS dimensions: blunted affect, alogia, avolition(/apathy, anhedonia/asociality, and attention impairment. Quantile regression was used to assess associations, and robust standard errors were applied.

We included 76 patients (median age 36 years, 33% women). Alogia was positively associated with sleep efficiency (β = 4.41, p = 0.040), while avolition (β = -3.61, p = 0.014) and attention impairment (β = -4.12, p = 0.041) were negatively associated. Blunted affect and anhedonia/asociality were not significantly associated with sleep efficiency.

Distinct negative symptom dimensions show differential associations with sleep efficiency in schizophrenia patients with predominant negative symptoms. Alogia’s association with better sleep efficiency may reflect reduced mental arousal and fewer ruminative thoughts before sleep. Conversely, avolition and impaired attention may worsen sleep through increased inactivity and fragmented sleep patterns. These findings suggest that targeted therapeutic interventions may be necessary to optimize sleep and overall clinical management in this subgroup of patients. Further studies are needed to explore underlying mechanisms and clinical implications of the presented associations.

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Caregivers of patients with first psychotic episode (FPE) are under considerable stress. The onset of schizophrenia results in significant limitations for the relatives, and resulting maladaptive behavior. It is crucial to provide psychoeducation to those caring for a patient with FPE.

To assess the impact of psychoeducation on the psychological state of caregivers of patients with FPE.

A total of 48 caregivers of patients with FPE (40 women and 8 men) were assessed before and after psychoeducation. Psychometric and statistical methods were used.

Analysis of functioning in interpersonal roles of relatives of FPE patients using the SAS-SR scale before the intervention showed significant distress in various domains (above 66 T-scores). 32.9% of relatives had impaired social interactions (withdrawal, conflicts, sensitivity to criticism). 25.4% of caregivers had strained family relationships (conflicts, guilt), and 12.4% reported difficulties in intimate relationships. 10.8% of relatives experienced problems in their relationship with the patient (overprotection combined with emotional coldness, distancing). After psychoeducation distress decreased in most areas, but some relatives still had problems of social functioning and deterioration in marital relationships. According to the SCL-90 questionnaire, distress decreased after the intervention. GSI (General Symptomatical Index) dropped from 0.69 to 0.38 (with a norm of 0.31). Anxiety and hostility also approached normal levels (from 0.68 to 0.33 and from 0.59 to 0.28, with a norm of 0.30, respectively). However, scores for paranoia (from 0.72 to 0.40, with a norm of 0.34) and depression (from 0.79 to 0.43, with a norm of 0.36) remained elevated, reflecting ongoing stress. PSDI (Positive Distress Symptomatical Index) dropped from 1.53 to 1.44. PST (Positive Symptomatical Index) dropped from 37.06 to 23.56.

After psychoeducation caregivers members’ stress coping strategies improved. Confrontation decreased (from 9 to 8 points), while social support-seeking increased (from 13 to 14 points). Avoidance behavior and distancing also decreased. Medication adherence improved: before psychoeducation 63% of caregivers had moderate adherence and 35% had low adherence. After the intervention 90% of relatives showed moderate adherence and 2% showed high adherence, and none denied the necessity of treatment.

Psychoeducation for caregivers of patients with FPE helps them develop stress management skills, constructive communication with the patient and problem-solving strategies. The intervention reduces anxiety, stigma and improves medication adherence. The study demonstrates that psychoeducation is effective intervention that reduces the risk of relapse during the early years, contributes to the patient’s recovery.

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The use of antipsychotic medications in individuals with epilepsy has been studied extensively. Starting neuroleptic therapy in patients with epilepsy is complicated due to the potential for these drugs to lower the seizure threshold. Consequently, both psychiatrists and neurologists must collaborate to develop personalized treatment plans for these patients.

To evaluate various therapeutic options for patients experiencing both psychotic symptoms and seizures, aiming to select the most appropriate treatment for each individual.

This case report describes a 47-year-old male patient who is presented with a diagnosis of symptomatic focal epilepsy in the left temporoparietal malacic area post traumatic brain injury. Following a traffic accident at the age of 14, after which he suffered a temporoparietal hematoma, the patient has presented numerous epileptic seizures. Initially, he abandoned treatment and follow-up with neurology, which he resumed in 2021. Additionally, the patient was referred to psychiatry after verbalizing delusional ideation of persecution with affective repercussions (tendency towards irritability) and behavioral repercussions (tendency towards social isolation and difficulties in the work environment) as well as auditory hallucinations with derogatory content. Neurology initiated treatment with eslicarbazepine 800mg, with cessation of epileptic seizures. After considering different treatment options and taking into account interactions with antiepileptic treatment, risperidone 1mg was initiated.

Following the initiation of risperidone, the patient experienced a reduction in irritability and has not presented further epileptic seizures. Due to potential drug interactions, the risperidone dose was gradually titrated upwards, resulting in a decrease in delusional ideation and improved overall functioning.

Patients with epilepsy and comorbid psychotic symptoms require a multidisciplinary approach, including individualized treatment. Neuroleptic medications can significantly improve quality of life in these patients. Therefore, it is essential to carefully select the appropriate antipsychotic, starting at low doses and gradually titrating upwards, with close monitoring to ensure patient safety and drug efficacy.

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People exposed to more unfavourable social circumstances are more vulnerable to poor mental health over their life course, in ways that are often determined by structural factors which generate and perpetuate intergenerational cycles of disadvantage and poor health. Addressing these challenges has become an imperative matter of social justice. In this paper we provide a roadmap to address the social determinants that cause mental ill health. Relying as far as possible on high-quality evidence, we first map out the literature that supports a causal link between social determinants and later mental health outcomes. Given the breadth of this topic, we focus on the most pervasive social determinants across the life course, and those that are common across major mental disorders. We draw primarily on the available evidence from the Global North, acknowledging that other global contexts will face both similar and unique sets of social determinants that will require equitable attention. Much of our evidence focuses on mental health in groups who are marginalized, and thus often exposed to a multitude of intersecting social risk factors. These groups include refugees, asylum seekers and displaced persons, as well as ethnoracial minoritized groups; lesbian, gay, bisexual, transgender and queer (LGBTQ+) groups; and those living in poverty. We then introduce a preventive framework for conceptualizing the link between social determinants and mental health and disorder, which can guide much needed primary prevention strategies capable of reducing inequalities and improving population mental health. Following this, we provide a review of the evidence that has tested candidate preventive strategies to intervene on social determinants of mental health. These interventions fall broadly within the scope of universal, selected and indicated primary prevention strategies, but we also briefly review important secondary and tertiary strategies to promote recovery in those with existing mental disorders. Finally, we provide seven key recommendations, framed around social justice, which constitute a roadmap for action in research, policy and public health. Adoption of these recommendations would provide an opportunity to advance efforts to intervene on modifiable social determinants that affect population mental health.

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COVID-19 wreaked havoc across the world killing millions along its path. All attempts were made to lower and eventually control the death toll from the pandemic. The “trace, test and treat” approach had its limits since the latter were not developed fast enough. Vaccines were seen as the best hope to protect individuals from the coronavirus and COVID-19. Thus, vaccination was encouraged and promoted widely. Aside from vaccines, interventions emphasised non-pharmaceutical self-protective behaviours to protect against coronavirus infection. Subsequently, there were various levels of compliance and observance of self-protection within nations. Yet studies have not attempted to explore the research implications of compliance patterns.

The present study’s aim was to (i) identify latent classes of individuals’ varying levels of compliance with COVID-19 self-protective behaviours; and (ii) explore the capacity of the latent classes to separate individuals according to their levels of Perceived Infectability, Germ Aversion and Fear of COVID-19.

Data for the current study was extracted from a cross-district COVID-19 study conducted among high school level learners (N = 1609; girls = 59%; rural areas = 43%) in South Africa. Latent classes were derived based on the scores obtained by learners on a self-developed index of non-pharmaceutical self-protective behaviours. Three classes were identified, and they were compared against their obtained Perceived Infectability, Germ Aversion and Fear of COVID-19 scores.

Scores of all three knowledge groups did not differ on Perceived Infectability (p > .05), but the highest scorers, the “knowledgeable group”, scored higher than the “moderately knowledgeable group” and the “relatively low knowledge group” on Germ Aversion and Fear of COVID-19. The scores of the “moderately knowledgeable group” and the “relatively low knowledge group” did not differ on the Fear of COVID-19.

The study supports an approach where learners are classified according to their knowledge of COVID-19 self-protective behaviours, and their motivation for self-protection established according to the classification.

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Medical students face high demands in college, which may cause significant psychological stress and mental health problems, such as depression and anxiety. Several studies worldwide have shown that such individuals are more likely to experience anxiety. However, few studies have examined how generational status and being a first-generation medical student lead to mental health issues.

In this study, we aimed to estimate the prevalence of depression and anxiety in first-generation medical students (FGMS) compared with non-FGMS and to determine the correlation between socioeconomic factors and other variables with depression and anxiety in FGMS.

This cross-sectional study was conducted among medical students at the College of Medicine. A self-administered questionnaire was distributed to the students using convenience sampling. The questionnaire comprised socio-demographic information (e.g. age, gender, marital status), a General Anxiety Disorder (GAD-7) scale to assess anxiety, and a Patient Health Questionnaire (PHQ-9) to assess depression among medical students.

Among the 309 medical students who completed the questionnaire, 65.4% were female and 75.7% were FGMS. The prevalence of anxiety and depression among medical students was 36.2% and 39.5%, respectively, and was higher among FGMS, but not significantly different (p<0.05). Independent risk factors for anxiety and depression among FGMS included a previous history of mental disorders and lack of social and emotional support, while fair sleep quality was identified as a significant independent preventive factor for anxiety and depression. The prevalence rates of anxiety and depression among patients with FGMS were 39.3% and 41.9%, respectively. A previous diagnosis of mental disorder was a significant risk factor for anxiety and depression, whereas fair sleep quality was a significant protective factor. Further research is needed to identify the factors that influence anxiety and depression among FGMS in our region.

Anxiety and depression are common among first-generation medical students. FGMS with a history of mental disorders tended to exhibit symptoms of both anxiety and depression compared to the rest of the FGMS. However, satisfactory sleep quality could result in better mental condition in FGMS. Institutional measures should be adopted to help students improve their living conditions. Furthermore, institutional leaders should spearhead the destigmatisation of psychological disorders and advocate help-seeking behaviours when students need mental help, particularly when they are anxious or depressed.

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Based on potential risk of torsade de pointes (TdeP; a rare arrhythmia), regulatory agencies have issue warning for two specific antidepressants. This has translated in clinic as a class effect in that every antidepressant monography or guideline warns against this side effect. Current data suggest that excessive caution in the face of this undesirable effect could have a deleterious effect on mortality. Most research on antidepressant/antipsychotic drugs and TdeP is based on its intermediate marker, the corrected QT interval (QTc) on the electrocardiogram, or case reports.

Our objective is to measure the contribution of psychotropic drugs (antidepressants and antipsychotics) to the arrhythmia itself, and measure its weight among all other risk factors.

We completed a retrospective case-control study at the Montreal Heart Institute, with a 1:3 ratio (n=440). We performed hierarchical logistic regression for TdeP (cases vs controls), and included the following independent variables: sex, age, hypokalemia, acute myocardial infarction, left ventricular dysfunction, hepatic failure and/or renal failure, other QTc-prolonging drugs, and psychotropic drugs. We then calculated population attributable risks (PAR).

In our final model which adjust risk factors for one another, women, acute myocardial infarction, hypokalemia, left ventricular dysfunction, QTc-prolonging drugs, and use of ≥2 antidepressants were significantly associated with TdeP. Age, hepatic and/or renal failure and antidepressants/antipsychotic drug monotherapy were not. The PAR for use of ≥2 antidepressants was 6.3%, while those of other QTc-prolonging drugs, female sex, and left ventricular dysfunction were 55.1%, 41.8%, and 25.6%, respectively.

When adjusting for concomitant risk factors, monotherapy with antidepressant or antipsychotic drugs is not associated with TdeP. On its side, the use of ≥2 antidepressants is associated with TdeP, with a PAR of lesser magnitude than sex, left ventricular dysfunction, and other QTc-prolonging drugs. This research provides a more nuanced perspective on the relationship between psychotropic drugs and the occurrence of this arrhythmia.

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Autism Spectrum Disorder (ASD) is a complex neuropsychiatric disorder characterized by deficits in social interaction, anxiety and the presence of repetitive-ritualistic behaviours. Recent studies suggest that epigenetic mechanisms, such as histone methylation, play a crucial role in the etiology of ASD by regulating gene expression linked to neuronal differentiation and proliferation. The enzyme, G9a is responsible for histone H3K9 methylation, and its inhibition has shown promise in altering epigenetic pathways associated with ASD onset and progression. Similarly, histamine H3 receptor (H3R) has long been recognized as a potential therapeutic target for ASD treatment

This study aimed to investigate the dual action of A-366, a potent G9a inhibitor with high and selective H3R antagonistic affinity, on the ASD-like behaviours and neuroinflammation of male BTBR T+tf/J mice model.

Male BTBR T+tf/J mice were housed under standard conditions and treated chronically with A-366 (0.5-2 mg/kg, i.p.) for 21 days. ASD-like behaviors were assessed using the Marble Burying Test, Nestlet Shredding Test, Self-Grooming Test, Spontaneous Alteration Test, Elevated Plus Maze, Light Dark Box, and Three-Chamber Test. Following behavioral testing, cerebellar and hippocampal brain tissues were analyzed using ELISA to quantify pro-inflammatory markers (TNF-α, TNF-β, IL-6, IL-1β, TGF-β) and immunohistochemistry for Iba-1 expression to evaluate neuroinflammation.

A dose dependent decrease of repetitive and anxiety-like behaviours as well as amelioration in social deficits was observed in response to the chronic systemic treatment of A-366 (0.5-2 mg/kg, i.p.). Moreover, A-366 decreased neuroinflammation in cerebellar and hippocampal brain tissues of treated BTBR mice, as evidenced by the reduction in proinflammatory markers TNF-α, TNF-β, IL-6, IL-1β and TGF-β, as well as the decrease in Iba-1 expression.

This in vivo study demonstrates the potential therapeutic value of A-366 as a dual-targeting agent for G9a and H3Rs, with modulatory role on epigenetic, neuroinflammation, and brain histaminergic neurotransmission. Therefore, A-366 is expected to provide a lead template for future design and synthesis of a novel, potent and selective class of drugs to target ASD features.

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The progressive acquisition of autonomy, balanced with adequate supervision, is essential during psychiatry residency. However, the adequacy of supervision and the smooth transition to autonomy remains a concern among residents. This study evaluates psychiatry residents’ perceptions of the current process of acquiring autonomy from the first to fourth year of training.

To assess the perceptions of psychiatry residents in Spain regarding the process of progressively acquiring autonomy and how supervision is managed throughout their residency.

A qualitative analysis was conducted on responses to the survey question: “What should be improved in the progressive acquisition of autonomy and supervision from R1 to R4?” Data from free-text responses were coded thematically, with common themes identified and quantified.

Responses from 109 residents were analyzed. Thematic analysis revealed that 35% of residents emphasized the need for clearer and more structured feedback from supervisors, while 30% suggested more direct supervision during critical learning periods, particularly in the first two years. Additionally, 20% highlighted the inconsistency of supervision across different units, with some units providing much less oversight than others. Other suggestions included better scheduling of supervisory sessions (10%) and more frequent formal evaluations of their autonomy progression (5%).

Residents identified several key areas for improvement in the process of acquiring autonomy, with a particular focus on the need for more structured feedback and increased supervision during the early years of training. Addressing these concerns may improve the overall quality of psychiatric education and resident preparedness.

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Parkinson’s disease (PD) is characterized by basal ganglia dopamine depletion, leading to motor symptoms. Psychiatric symptoms, like psychosis, are associated with dopamine overactivity in the mesolimbic and mesocortical system. PD patients sometimes require both motor and psychiatric treatment. However, the pharmacologic treatments for each have opposing dopaminergic effects. Understanding the balance between dopamine antagonists to treat psychosis while increasing dopamine agonists (DAs) to treat PD is a difficult clinical task.

We aim to explore how dopamine agonists and antagonists affect the responsiveness of dopamine receptors in various brain regions.

We conducted a comprehensive literature review on pharmacological management of patients with PD and concurrent psychiatric symptoms. Special attention was given to balancing dopamine agonists (e.g., Carbidopa-Levodopa) for PD and dopamine antagonists (e.g., Quetiapine) for psychiatric symptoms.

While dopamine agonists and antagonists appear counterintuitive when used concurrently, their efficacy is contingent on target brain regions. DAs (Carbidopa-Levodopa) are most beneficial for increasing dopamine deficits in the striatum and nigrostriatal pathway, where voluntary movement is controlled. In PD, this pathway is primarily affected, and DAs are used to target the striatum’s high concentration of D1 and D2 sub-receptors. Gold-standard DAs mainly target D1 and D2 receptors.

Dopamine antagonists mitigate excess dopamine activity in the mesolimbic and mesocortical systems, which affect reward, memory, and executive functioning. These systems possess a high concentration of D3 and D4 sub-receptors. Typical antipsychotics have strong D2 receptor affinity, making them counterintuitive to DA motor treatment. Atypical antipsychotics have partial D2 affinity, but also readily bind D3 and D4. Some atypicals minimize D1/D2 affinity to allow DAs to be more effective. Quetiapine is currently used for psychosis in PD, but the drug’s MOA is not fully understood. Cariprazine binds D3 well but does cause extrapyramidal effects with its D2 affinity. Clozapine strongly binds D4 but can have severe adverse effects. Additionally, pramipexole and ropinirole have strong D3 and D4 affinity. Ultimately, the key lies in symptom control: achieving optimal motor function while controlling psychiatric manifestations.

PD management with concurrent psychiatric disease requires diligent pharmacologic balance of countering dopamine treatments. Dopamine agonists and dopamine antagonists do have opposed pharmacodynamics, but clinicians must understand that certain pharmacologic agents do not all target the same brain area nor dopamine sub-receptor. Clinicians must use this pharmacologic knowledge to carefully balance these therapies by adapting to the individual patient’s symptomatology and treatment response.

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Depression is increasingly linked to immunological processes. Therefore, immune-based therapies, e.g., celecoxib, are being tested as augmenting treatment strategies. Many physiological processes during life are also linked to immunological changes. We tested the hypothesis that age affects treatment efficacy in a randomized controlled sample treated with the anti-inflammatory agent Celecoxib.

We test the combined role of age and an anti-inflammatory augmentation treatment for treatment response in depression. For a more in depth understanding we investigated the role of six methylation-based cell-types in these immunological processes in a second step.

113 individuals with a diagnosis of major depressive disorder were included in our analyses (Mage=44, 56% women, MMADRS= 27.7). All patients were treated with Vortioxetine and recruited stratified by high sensitive C-Reactive Protein (hsCRP; <= 3 vs. > 3 mg/L)> 3mg/L). Based on a randomized controlled design, augmentation with Celecoxib was administered to 55 patients. A second assessment was performed after 6 weeks of treatment (MMADRS 6W= 20.2). Cell type compositions of neutrophils, monocytes, B-cells, CD4+ and CD8+ Lymphocytes, and natural killer cells (NK), were estimated based on epigenome-wide DNA methylation markers (Illumina Infinium MethylationEPIC 850k BeadChip) using the Houseman method. Analyses were performed with linear regression models with MADRS6W as outcome. Our hypothesis was tested in the full sample. The additional analyses were performed stratified by age. All models were corrected for sex, hsCRP, and depression severity at baseline.

Our analysis showed a statistically significant interaction between age and treatment condition on depression outcome (p=0.040), with significant main effects for both variables in the model (intervention: p=0.045, age: p=0.022). Sex and hsCRP were no statistically significant contributors. The intersection was identified at 45.5 years. Younger individuals treated with celecoxib showed a more pronounced reduction in MADRS (Mreduction=-9.6), than older individuals treated with the same condition (Mreduction=-5.5). The stratified individuals younger than 45 years, showed that neutrophils were associated with better treatment outcome (p=0.028), whereas for individuals older than 45 years this was the case for B-cells and NK cells (p=0.011, and p<0.001, respectively).

Our results indicate that immunological profiles in depression and in relation to treatment may be age-dependent, which can have major consequences for treatment success with anti-inflammatory augmenting strategies. Replication in an independent sample is needed to confirm the role of age in immune-focused treatment strategies for depression.

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Electroconvulsive therapy (ECT) is a treatment received by approximately 1.4 million people worldwide annually, depressive disorder being the most prevalent indication. Retrograde autobiographical amnesia (RAA) refers to difficulties in retrieving memories of past events. Despite being the most commonly reported side effect of ECT, its nature, duration and impact on patients’ lives remains uncertain.

(1) Assessing RAA severity in patients treated with ECT for depression compared with other treatment methods. (2) Assessing RAA severity in patients treated with right unilateral (RUL) vs bilateral (BL) ECT for depression. (3) Assessing overall RAA severity (pre-post effect) following an acute course of ECT. (4) Summarising patients’ lived experiences of RAA following ECT for depression.

This systematic review was registered prospectively with PROSPERO (CRD42024445105). Seven databases were searched for eligible articles. Quantitative and qualitative studies assessing RAA in patients treated with ECT for depression published since 1985 were included. Abstract, full-text screening and data extraction were done in duplicates and independently. Quantitative data were meta-analysed using random effects model and qualitative data were analysed using thematic meta-synthesis.

Of initial 6126 records, 22 quantitaive and 20 qualitative studies were included. ECT caused significantly greater RAA compared with other treatments (SMD -0.73, 95% CI -1.31; -0.15, I2=54%, Figure 1). BL treatment caused significantly greater RAA than RUL (SMD -0.29, 95% CI -0.57; -0.01, I2=32%, Figure 2). The pre-post effects were big for RUL (SMD -0.77, 95% CI -1.15; -0.38, I2=93%, Figure 3) and BL ECT (SMD -1.16, 95% CI -1.79; -0.52, I2=93%). The main effect moderator was RAA assessment tool. Few studies reported delayed effects of ECT on RAA. Four analytical themes were identified from qualitative data: (1) Uncertainty regarding the cause, nature and severity of memory loss may cause distress for patients, undermine the quality of information provision and post-ECT care. (2) Ambiguous testimonies – perception of memory loss often shaped by ECT effectiveness. (3) Returning to ‘normal’ daily life may be a challenging, frustrating and lonely process, which requires developing adaptive coping strategies. (4) Some memories may not come back for years; re-leaning facts about oneself and reshaping own identity may be important steps on the journey to recovery.

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ECT causes more severe (sometimes long-lasting) RAA than other forms of treatment with BL being more harmful than RUL. RAA measurement is not unified hindering identifying technical aspects of ECT, which may impact memory loss. Information provision and post-ECT care could be improved by reducing uncertainty around the nature and severity of RAA.

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Psychiatric diagnosis plays a key rol in the mental health care. One of the critical factors that influence the diagnostic process is inter-rater reliability, the degree to which different raters agree on the diagnosis when assessing the same patient. Despite the availability of standardized diagnostic manuals, variability in psychiatric diagnoses persists. The assessment of inter-rater reliability involves calculating statistical measures which quantify the level of agreement between raters beyond what would be expected by chance. Improving inter-rater reliability in psychiatric diagnoses is necessary for optimizing both patient care and research quality in mental health.

Assess inter-rater reliability across main psychiatric disorders and identify the sources of variability.

This study was performed according to the PRISMA guidelines and a total of ninety-three studies were included. Regarding inclusion criteria, (1) the articles had to focus on inter-rater reliability, (2) study participants had to have an average age greater than 18 years, and (3) the reported diagnoses had to refer to a diagnostic manual. Quality scores were assessed for all included studies (Armijo-Olivo S et al. J Eval Clin Pract. 2012; 18 12-8). Seven different meta-analysis were conducted, one for each psychiatric diagnosis detected. The heterogeneity between studies was quantified using Cochran’s Q and I2. Funnel plots was analyzed to assess the possible influence of publication and location biases (Higgins&Green. BMJ. 2011;343). To account for publication bias, the Eggers’ test and the Fail-Safe Number31 was applied.

Psychotic disorder: (k=0.70; 95% CI: 0.66-0.75) (I²=97%).

Anxiety Disorders: (k=0.65; 95% CI: 0.60-0.70) (I²=91%).

Obsessive-Compulsive Disorder (OCD): (k=0.73; 95% CI: 0.64-0.82) (I²=76%)

PTSD: (k=0.60; 95% CI: 0.52-0.66) (I² =84%).

DCA: (k=0.73; 95% CI: 0.67-0.79) (I² =76%).

two different meta-analysis were conducted because many studies used Intraclass Correlation Coefficient (ICC) as a value to express inter-rater agreement. [k=0.65 (95% CI: 0.59, 0.7)] (I2= 96%) (ICC=0.85; 95% CI: 0.82-0.87) (I² = 66%).

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The lower Kappa for schizoaffective disorder (Kappa < 0.7) compared to other psychiatric disorders underscores the diagnostic challenges posed by this category, given its overlapping symptoms with both mood and psychotic disorders. As regards personality disorder, antisocial and borderline PD showed highest agreement potentially due to its well-defined diagnostic criteria. The lowest agreement (k=0.60) of PTSD emphasizes the variability of his clinical presentation. In conclusion, studies show variability across disorders, highlighting the need for further research to improve diagnostic accurac (Regier et al. Am J Psychiatry. 2009;166 645-50) thereby enhancing clinical and research outcomes.

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A frequent developmental problem known as attention deficit hyperactivity disorder causes inattention, which may or may not be accompanied by hyperactivity.

Having trouble focusing, engaging in excessive activity, and acting in ways that are inappropriate for one’s age are all signs of ADHD.In the United States, research on the use of EEG to diagnose ADHD is still underway. The FDA has authorized the use of EEG to assess the illness’s morbidity alone.According to a different study, the EEG theta/beta ratio cannot definitively distinguish between people who have ADHD and those who do not.

the purpose of this study was to determine whether children with ADHD had altered EEGs.

study was carried out from January to June 2024 on sixty non-epileptic children with ADHD (8–18 years old) at Al Hussian university hospital, Egypt.

This study was authorized by the Al-Azhar Faculty of Medicine’s Ethical Committee. Following an explanation of the purpose of the study and the acquisition of verbal agreement, all children underwent semi-structured clinical interviews and were excluded from any other neuropsychiatric or medical disorders. All study children have been diagnosed with ADHD according to the DSM IV criteria SCID, Conner’s scale for ADHD was applied for all the study’s children. EEG was obtained for all the children in the study. SPSS version 20.0 was employed. Numbers and percentages were used to characterize the qualitative data, and the significance of the outcomes was assessed at the 5% level.

The research involved 60 children with ADHD diagnoses, of whom 70% were younger than 8 years old, 71.7% of whom were male, 28.3% of whom were female, and 53.3% of whom were in rural settings.Based on study statistics, the mixed form of ADHD was the preponderance kind, with 56.7% of participants having ADHD. Oppositional defiant disorder (ODD) was a co-morbid disorder. the study indicates a strong statistical correlation (P value<0.001) between the combined type of ADHD and the individuals’ educational attainment.Accompanied conditions and male ADHD children were shown to have a high statistical significance (P<0.005), as was age less than 8 years old (P=0.026)

Only 10% of the non-epileptic ADHD children in the study had aberrant EEG readings, and there was no statistical correlation between them. there is a significant correlation (P<0.007) between co-morbid conditions and ADHD children, irrespective of their kind.

Attention deficit Hyperactivity, EEG and accompanied disorder

The diagnosis of ADHD in children was not strongly correlated with changes in EEG.

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Discrimination against foreign healthcare professionals is an underexplored issue. Like many other countries, Denmark is experiencing an increasing influx of non-European Union (EU) physicians. These physicians face higher levels of requirements to obtain authorization to practice and be included in the Danish healthcare sector compared with their European peers, which can lead to an experience of perceived discrimination. Considering importance of physicians’ mental health, addressing this perceived discrimination is crucial.

This study aims to evaluate the perceived daily discrimination among non-EU physicians residing in Denmark. We focus on those who have immigrated within the past 10 years to shed light on the challenges faced during their integration into the Danish healthcare system.

62 non-EU physicians who immigrated to Denmark within the last decade participated in the online survey during January 2024. The survey consisted of demographic information and Perceived Discrimination Scale (PDS). PDS was used to assess daily discrimination. Participants were grouped based on their duration of stay in Denmark and employment status. A Kruskal-Wallis H Test was conducted to compare the median daily discrimination scores across the different groups, using SPSS version 29.

The study revealed that 74% of the participants who had lived in Denmark for less than four years were unemployed (p-value=0.001), suggesting significant challenges in finding employment. Furthermore, participants living in Denmark for over four years reported significantly higher levels of perceived daily discrimination compared to newcomers (p-value=0.016), indicating difficulties in integration. Similarly, employed physicians, reported higher discrimination levels than their unemployed peers (p=0.053), suggesting discrimination experiences at work.

This study reveals that non-EU physicians in Denmark face significant challenges to secure employment, especially in their first years of residence. Additionally, perceived discrimination for the physicians may be influenced by both employment status and duration of stay. High unemployment rates among recent arrivals and increased discrimination for those residing longer suggest that extended integration into the Danish healthcare system can intensify feelings of bias.

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Conduct problems (CP) in adolescents are associated not only with long-term personality and social development challenges, but also impose significant burdens on families, schools, and communities.

While numerous risk factors for CP have been identified in prior research, a comprehensive understanding of the underlying deficit mechanisms remains incomplete.

Utilizing data from the Adolescent Brain Cognitive Development (ABCD) study (N = 11,875), the largest longitudinal investigation of brain development and child health in the United States, we conducted a systematic analysis of the neural, cognitive, and environmental features linked to CP. The findings were further tested for generalizability across diverse cross-cultural datasets.

Our results propose a novel framework that accounts for cognitive deficits associated with CP, while also highlighting the interactions between biological and environmental factors in the development and potential remission of CP in adolescents.

These insights provide valuable directions for future research and intervention strategies targeting adolescent conduct problems.

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The use of antidepressants is becoming more prevalent among athletes due to the growing awareness of mental health issues in sports. However, the impact of these medications, especially selective serotonin reuptake inhibitors (SSRIs), on physical performance remains uncertain. Studies on psychotropic drugs’ effects on athletic capabilities raises concerns about their use in sports, particularly under anti-doping regulations.

This review aims to assess the impact of antidepressants on physical exercise performance and muscle metabolism, in order to clarify how they influence physical capabilities.

A literature search was conducted on PubMed in September 2024 using search terms such as “sports” AND “antidepressants,” “physical activity” AND “antidepressants,” “exercise” AND “selective serotonin reuptake inhibitors,” among others. Only systematic reviews and meta-analyses were included, without restrictions on language or year. Three articles met the scope of this work.

The effects of antidepressants on athletes are inconsistent, with some studies indicating no significant change in performance, while others report reduced endurance. Paroxetine and fluoxetine, commonly prescribed SSRIs, may impair endurance due to increased serotonin levels, which can exacerbate fatigue, known as central fatigue hypothesis. It is also emphasized that SSRIs may reduce athletic performance, especially under thermal stress, by affecting thermoregulation, alongside its interference in serotonin pathways. Potential metabolic impact of these drugs was found, as chronic exposure to SSRIs showed modulation of glucose uptake, mitochondrial respiration, and muscle mass. Furthermore, SSRIs also induced changes in electrical muscle activity.

The evidence on the effects of antidepressants, particularly SSRIs, on physical performance and muscle function remains inconclusive. Athletes and healthcare providers must weigh these risks carefully, considering both the clinical and ethical implications of psychotropic drug use in competitive sports. Therefore, future research should focus on more consistent study protocols and explore the long-term metabolic consequences of SSRIs in physically active populations.

None Declared

This is a 26-year-old male patient, diagnosed with bipolar disorder, admitted to a medium-stay unit for two months due to lack of awareness of the disease, after several admissions to the acute unit for manic decompensation with psychotic symptoms after abandoning psychopharmacological treatment and cannabis use.

The patient, who was stable since the beginning of the medium-stay admission after being referred directly from an acute unit, began to show strange behavior that became more pronounced over the days.

To study the relationship between energy drinks and the development of psychotic symptoms in the existing literature, based on a clinical case.

Description of the clinical case.

Bibliographic review related to the topic.

The difficulty in this case was to find out the cause of the psychotic symptoms that the patient was presenting, since he was taking the psychopharmacological treatment well and the urine tests that were carried out every time he returned from the street were negative. He had not had any stressful events either. On one of the outings that he made, an assistant saw that he was drinking a can of Monster. When asked, the patient commented that he usually drank between one and two cans a day. Olanzapine 10 mg (0-0-1) and clonazepam 2 mg (1-0-1) were added to the patient that he was taking. In addition, his outing permits will be withdrawn until clinical stabilization is achieved.

In the acute appearance of psychotic symptoms in patients with a previous history, possible causes must always be investigated, the most frequent being the following: abandonment of psychopharmacological treatment, consumption of toxic substances and stressful events. Although it is true that there are not many studies that support this, cases have been reported in which energy drinks, due to their high caffeine content, could also be one of the triggers.

None Declared

While depression trajectories have been extensively studied in recent decades, research has predominantly focused on younger and middle-aged individuals, often overlooking vulnerable older patients. Classifying patients based on treatment trajectories may enhance personalized care efforts and long-term treatment management for older adults.

This study investigates the varying patterns of depression treatment trajectories and examines the influence of social factors on these trajectories in older adults initiating first-time depression treatment over a three-year period.

We conducted a nationwide cohort study using Danish registers, including all adults aged 65 and older who filled their first-time antidepressant prescriptions between 2006 and 2015 (with no prescriptions in the previous decade). Depression treatment patterns were assessed through antidepressant prescription redemptions and psychiatric hospital contacts for depression. Latent class growth modeling identified distinct treatment trajectories over the three years, while multinomial logistic regression analyzed the association between social factors and trajectory group membership.

Among the 66,540 older adults included in the study (55.2% female, mean age: 77.3 years), three unique depression treatment trajectories emerged: ‘brief treatment’ (33.7%), where treatment ended within six months; ‘gradual withdrawal’ (26.5%), where treatment tapered off over two years; and ‘persistent treatment’ (39.8%), where treatment continued throughout the three years. Association analyses showed that female sex, living alone, and residing in less-urbanized regions were associated with higher odds of membership in the persistent treatment group. In contrast, older individuals, those who were widowed or separated, and individuals of non-Danish ethnicity were associated with lower odds of membership in the persistent treatment group.

This study identifies three distinct depression treatment trajectories in older adults. Social factors such as sex, household composition, place of residence, and ethnicity were associated with treatment duration and trajectories. Tailored interventions based on patient characteristics may enhance depression care for older adults, ensuring more personalized and effective treatment strategies.

K. Ishtiak-Ahmed: None Declared, C. Rohde Grant / Research support from: CR received the 2020 Lundbeck Foundation Talent Prize, O. Köhler-Forsberg Speakers bureau of: OKF reported honoraria for lectures for Lundbeck Pharma A/S and consultant fees for WCG Clinical, all unrelated to the present work., K. Christensen : None Declared, C. Gasse: None Declared

Reproduction in mammals relies on complex interactions involving the genital and olfactory systems, which can be influenced by environmental factors, such as manganese (Mn). Although essential for survival, Mn is potentially toxic over long periods, potentially affecting sexual and reproductive behaviors.

This study aims to assess the long-term effects of Mn exposure on sexual and reproductive functions in male Wistar rats, focusing on Mn-induced neuroaffective and olfactory dysfunctions.

Male Wistar rats received intraperitoneal injections of Mn at doses of 6 mg/kg, 25 mg/kg, and 30 mg/kg for 12 weeks. Each experimental group consisted of one Mn-intoxicated male and four non-intoxicated females. After six days of cohabitation, the females were isolated to evaluate fertility outcomes. The study also monitored weight changes and conducted behavioral assessments for anxiety, depression, and olfactory functions in males.

Higher Mn doses (25 mg/kg and 30 mg/kg) resulted in significant behavioral changes in males, including anxiety, depression, and olfactory dysfunctions, which were associated with decreased reproductive success. Specifically, pregnancy rates were 33% (4 out of 12) at 25 mg/kg and zero at 30 mg/kg. In contrast, males treated with 6 mg/kg Mn exhibited no significant neuroaffective or olfactory impairments, maintaining fertility rates comparable to those of the control groups.

Chronic Mn exposure adversely affects sexual behavior and reproductive success in male Wistar rats, probably due to olfactory and neuroaffective disruptions. Further research is recommended to elucidate the mechanisms underlying these effects.

None Declared