In recent years, dopamine D3 receptor (DRD3) has gained extensive attention in substance use disorders (SUDs) in terms of their anatomical localization and role in drug-related processes. Animal studies have shown that DRD3 agonists modulate addictive behaviour. In addition, cariprazine (CAR), a novel antipsychotic with a partial agonist effect on DRD3, may be a treatment option for patients diagnosed with schizophrenia (SCZ) with comorbid SUD.

Therefore, the main goal of the present work was to summarize literature data about DRD3 and CAR in SUDs.

A systematic review was conducted in August 2024. The full-text search was performed without filtering from four databases (PubMed, ScienceDirect, Web of Science, Cochrane Registry). In the first search “dopamine receptor D3” AND “substance use” OR “addiction” OR “dependence” OR “misuse” were used as the key search terms, and in the second search “cariprazine” AND “substance use” OR “addiction” OR “dependence” OR “misuse” were used. Duplicated studies, non-relevant articles, review articles, and animal and cell studies were excluded.

In the first search, 40 articles were identified; however, 15 were excluded. In the second search, 21 articles were identified; however, 12 were excluded. Findings based on the 25 included articles show that DRD3 modulators, which are mostly agonists of the receptors, may have a positive effect on both psychotic symptoms and substance use frequency- and drug-seeking behavioral reduction. Our findings based 9 included articles demonstrate that CAR is a more effective and safe medication for SCZ with comorbid SUD than other atypical antipsychotics. It could also be suggested that in other psychiatric conditions where substance abuse is occurring CAR is also a good treatment option.

Based on past and current research, it’s crucial to systematically evaluate the role of DRD3 for developing new therapeutic perspectives in SUDs, though more research is needed to confirm the efficacy and safety of DRD3 modulators and CAR as medications for SUDs. Furthermore, the present review suggests that CAR may be the optimal antipsychotic for treating SCZ with comorbid SUDs.

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People with bipolar disorder (BD) have an increased risk of premature mortality, and the respiratory mortality rate is higher than those of the general population. However, the evidence on respiratory disease in this population has not been meta-analyzed.

To systematically review and meta-analyze the frequency of respiratory diseases in patients with BD and to compare prevalence and Odds Ratio (OR) with the general population.

A systematic literature search was conducted in Pubmed, PsycINFO, Scielo and Scopus from inception to June 2, 2023, and a snowball search of reference and citation lists was conducted. Inclusion criteria were studies reporting diagnoses of respiratory diseases (asthma, chronic obstructive pulmonary disease (COPD), pneumonia, lung cancer and tuberculosis) in people with BD according to operationalized criteria and where possible, control group. This study followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and MOOSE reporting guidelines. A pair of reviewers independently extracted data using a predefined data extraction form and a senior co-author was consulted in cases of disagreement. The risk of bias and methodological quality was assessed using the adapted Newcastle-Ottawa scale.

Of the 2,158 articles screened, 20 including 962,352 people with BD and 37,340,405 control group, met the inclusion criteria (see Figure 1). Prevalence and OR of respiratory disease in people with BD was the main outcome as percentage point estimates with corresponding 95% CIs. In people with BD, the prevalence of COPD was 9.14% (95%CI: 6.61%-12.5%), asthma 6.4% (95%CI: 4.56%-8.91%), pneumonia 2.78% (95%CI: 2.51%-3.08%) and lung cancer 0.44% (95%CI:0.23%-0.84%) (see Figure 2). Compared to the general population (see Figure 3), people with BD had significantly higher rates of COPD (OR: 1.73; 95% CI: 1.40-2.14), showing an increased rate in younger and female patients; asthma (OR: 1.91, 95% CI: 1.25-2.94), with a greater rate in younger patients; and pneumonia (OR: 2.82, 95% CI: 1.33-5.99).

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In the first meta-analysis on the topic, BD was associated with an increased risk of respiratory illness versus the general population. In COPD and asthma, young people and women are at particular risk. Prevention programs are urgently needed.

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Psychopathology in adolescents is influenced by genetic factors, hormonal changes, individual vulnerabilities, and coping skills. Telepsychiatry has proven effective in improving access to mental health services.

To implement a Remote Primary Care and Psychiatry Model (MAP/PSI) to facilitate early diagnosis and timely treatment of depressive symptoms in youths from the Municipality of Ciudad Fernández, San Luis Potosí, Mexico, using an implementation science approach

A prospective study was conducted with 38 patients evaluated in child psychiatry, using the PHQ-9 (Patient Health Questionnaire) and GAD-7 (Generalized Anxiety Disorder) scales. Non-parametric statistical tests were applied

The sample included patients aged 15 to 25. Diagnoses included 8 (20%) with generalized anxiety, 8 (20%) with mild depression, 15 (35%) with moderate depression, and 9 (25%) with severe depression, who were referred to the general hospital due to suicidal ideation. 60% of patients were female and 40% male. The mean age was 20 years ±3, with mean scores on the PHQ-9 of 16 ±7 and on the GAD-7 of 13 ±6, reduced in the final consultation to 8 ±6 and 7 ±6, respectively. Increased symptom frequency was observed in females (p < 0.044) and older age correlated with higher initial PHQ-9 scores (p < 0.034), with no correlation to generalized anxiety (p < 0.021). No relationship was found between the duration of symptoms and improvement

The MAP-PSI model facilitated early detection and treatment of depressive and anxiety symptoms in youths, preventing progression to severe depression and its complications.

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Obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD) often co-occur, creating complex symptom profiles and requiring multifaceted treatment approaches. OCD can lead to intense self-monitoring and distressing obsessive-compulsive behaviours, while BDD contributes to a distorted self-image, exacerbating feelings of inadequacy and shame. This case study explores the use of a metacognitive approach using Dramatised Socratic Dialogue (DSD) in the treatment of a patient with severe OCD and BDD, focusing on relational challenges, pervasive shame and self-criticism.

To evaluate the effectiveness of dramatised Socratic dialogue and exposure with response prevention (E/RP) in the treatment of a complex case of OCD and BDD. Specifically, to address intrusive self-criticism, enhance the therapeutic alliance, and reduce shame-related behaviours.

A 33-year-old man with a long history of OCD and BDD symptoms, including excessive mirror checking and social avoidance, was assessed using the MMPI-2, PID-5, MADRS, STAY-1 and 2, and Y-BOCS, confirming OCD, BDD, and major depressive disorder. Treatment included establishing a strong therapeutic alliance, psicoeducation, E/RP and DSD targeting persistent self-criticism. After an initial phase, interventions focused on reducing compulsive behaviours and promoting self-acceptance.

Initial E/RP led to symptom improvement but maintained a sense of control that limited full therapeutic progress. DSD successfully reduced self-critical dialogue and addressed shame and self-perceived social unacceptability, although it temporarily disrupted the therapeutic alliance. Subsequent reintegration of E/RP alongside DSD facilitated substantial reductions in OCD and BDD symptoms, with the patient reporting increased mood stability and reduced social avoidance.

This case highlights the benefits of integrating dramatised Socratic dialogue with traditional CBT methods such as E/RP to address OCD and BDD symptoms where shame and self-criticism are significant. DSD proved effective in reframing negative self-talk, breaking cycles of self-criticism and supporting long-term symptom reduction. This approach shows promise for treating complex cases involving intense feelings of inadequacy and shame.

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Evidence for efficacy of various modalities of psychotherapies is growing and such therapies are increasingly recommended in international guidelines for the treatment of psychiatric disorders. Psychiatrists with strong psychotherapy skills are better positioned to provide individualized and multidisciplinary care. Training in psychotherapy also fosters the development of reflective practice, empathy, and cultural competence, all of which are vital in addressing the diverse needs of patients. Accessibility of psychotherapeutic treatment for the patients can be improved through integrating psychotherapy training in psychiatric training, together with continuous medial education activities. European and other international organisations have published guidelines requiring programs to promote psychotherapeutic competences among psychiatry trainees. However, psychotherapy education and supervision can often become a luxury rather than being a mandatory component of training; and resources are heterogenous. In this presentation, psychotherapy training availabilities and limitations in Turkey will be discussed, with a focus on the psychotherapy courses of Psychiatric Association of Turkey among other initiatives.

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Epilepsy, one of the most common neurological disorders, affects around 50 million people worldwide. It is unpredictable, intrusive illness that impacts not only the patients but also those who care for them. Caregivers are vulnerable to great burden; depressive and psychosomatic symptoms, as well as physical, emotional, and economic pressures.

To explore the psychiatric comorbidities, attributes related to caregiver burden and psychosocial intervetions available to allivate the burden in Caregivers of patients with Epilepsy.

A narrative review of the relevant studies focusing on psychiatric comorbidities and psychosocial interventions for reducing the caregiver burden in caregivers of patient with epilepsy was comducted.

Caregivers of patient with epilpsy have poor quality of life and are at risk of developing psychiatric illnesses. Caregiving was reported to negatively impact one’s physical and mental health, overall family functioning, and financial status. Psychological interventions such as psychoeducation, individual, group or family counselling, Interpersonal and social support networks, relaxation therapy and cognitive behaviour therapy have been used to treat caregiver burden associated with epilepsy caregiving.

Caring for patients with epilepsy is challenging and it is associated with enormous burden. It can lead to mental health problems which ultimately affects the compliance to treatment and overall prognosis. Psychosocial interventions can prepare caregivers for a better role of caregiver and better management of the care process. There is increased need to focus on this unexplored area through research and to provide effective interventions as a part of clinical services.

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Despite the identification of several risk factors, an understanding of the role of specific psychopathological profiles in predicting adolescent suicidal behaviours remains a key challenge in public health research.

The current study aimed to identify psychopathological profiles in suicidal adolescents and to analyse their association with suicide-related outcomes.

A total of 285 adolescents aged 12 to 17 years [mean age (SD)=14.98 (1.51); females: 249 (87.40%)] were recruited from different hospitals in Spain. Latent profile analysis was performed to classify subgroups with similar patterns based on self-report Strengths and Difficulties Questionnaire. Logistic regression and generalised linear modelling were applied to examine the relationship between profile membership and suicidal behaviours.

Three psychopathological profiles were identified: internalizing symptom profile (52.63%), externalizing symptom profile (24.21%), and low symptom profile (25.58%). The predominantly female internalizing symptom profile members were more likely to report higher levels of psychopathological symptoms, including number of psychiatric diagnoses, depressive symptoms, and trauma (except sexual abuse). Additionally, they had more non-suicidal self-injury (NSSI) and suicidal thoughts and behaviours. Likewise, greater ideation intensity was associated with the internalizing symptom profile compared to other groups, while greater number of previous suicide attempts correlated with an increase in suicidal behaviours. Finally, higher levels of motor impulsivity were associated with a lower probability of suicidal behaviours.

Identifying symptom profiles among adolescents who have attempted suicide allows us to establish reliable predictors for suicide prevention as well as personalised interventions, indicating the domains where these interventions are needed.

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Recent research highlights the importance of technological solutions in delaying cognitive decline and improving life quality for at-risk individuals, emphasizing the need for innovative, tech-based approaches in dementia prevention (Johnson et al.,2023; Smith et al.,2023). Exercogs® is an innovative tool designed to tackle the global challenge of dementia by addressing modifiable risk factors (Livingston et al.,2020). Developed through a clinic-academia partnership, it integrates physical exercise, cognitive skills, and social interaction into a single activity for dementia prevention programs.

This scientific study aims to: 1) Creating and validating 4 Exercogs® (using gamification) for an augmented reality platform; 2) Validating a dementia prevention program that generates health benefits using Exercogs®.

1. 1. Research and Planning: assessment of seniors’ needs; survey of market solutions;

2. 2. Ideation and Concept Development: definition of therapeutic objectives; selection of stimulus types; idealization of game scenarios, cognitive, and motor areas;

3. 3. Design and Prototyping: programming video games; implementation of gamification techniques;

4. 4. Testing and Evaluation: testing the prototypes and interaction mechanics with a group of users; usability testing.;

5. 5. Scientific Validation: experimental study with pre and post-test assessment, with a sample of 204 subjects aged ≥ 65 years old.

6. 6. Maintenance and Improvement: the solution is being used in pilot studies in different institutions in Portugal for evaluation and continuous improvement.

Exercogs® consists of 4 games that target key areas of healthy and pathological ageing, focusing on cognitive (attention, memory, executive functions), physical (mobility, coordination, balance) and social (general social skills) domains. Each game adapts to users’ abilities with different difficulty levels and is designed for group play to enhance social interaction, crucial for mental health. Utilizing gamification and augmented reality for engagement, scientific validation showed significant improvements in cognitive, affective, social, functional domains, and quality of life, with marked statistical significance in all areas assessed.

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Notable health benefits were observed among users, particularly in cognitive function and quality of life. These findings indicate the potential effectiveness of Exercogs® in dementia prevention programs. The alliance between the clinic and academia is crucial for solving the challenges of longevity and creating technological solutions that respond to new health needs. The use of technologies in health intervention generates high levels of adherence and motivation among older adults, as well as among health professionals. Exercogs® are a promising technological solution that uses gamification with clinical support to prevent dementia!

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Schizotypal personality disorder is characterized by social and interpersonal deficits, eccentric behaviour, unusual beliefs, magical thinking and blunted affect, and it may represent a predisposition for psychosis. Hoarding disorder, which has recently been recognised in ICD-11, is defined by accumulation and persistent difficulty in discarding ordinary possessions, leading to interfering levels of clutter that compromise the use or safety of living spaces. Hoarding behaviour can occur in a variety of neuropsychiatric disorders, including psychotic disorders. Research suggests an association between schizotypal traits and hoarding symptoms including cognitive deficits, emotional dysregulation or impaired insight, which are also characteristic of psychosis.

We aim to present a case of hoarding disorder in a woman with schizotypal personality traits which presented with a first psychotic episode at her fifties.

We describe a case report and a non-systematic review on the subject.

A 55-years-old woman was admitted to psychiatric emergency department with behaviour changes, marked by significant neglect in self and health-care in addition to social and emotional isolation. She also exhibited somatic, persecutory and autoreferential delusions, as well as auditory hallucinations. She believed that her body had no production of saliva and her meals mostly consisted of chocolate pudding, since she was convinced this was the only food her organism could tolerate. As a consequence, her nutrition was fairly neglected and severe potassium deficits were observed with electrocardiogram changes and fainting episode. Beyond these symptoms, a severe hoarding pattern was found which had worsened over the last years. Supported by family meetings and psychological personality assessment, dysfunctional personality traits stood out, with a difficulty in interpersonal relationships and adaptation to external reality. During hospitalization, we found that psychotic symptoms had months of evolution. Antipsychotic medication was initiated (Paliperidone) with significant improvement of symptomatology, but not full remission.

Upon a comprehensive assessment, we concluded that the patient’s dysfunctionality was mainly due to schizotypal personality disorder rather than the acute psychotic episode. This case also suggests the importance of assessing personality traits, in particular schizotypal, in patients with hoarding symptoms. An overlap between hoarding symptoms and schizotypy has previously been reported in literature. Therefore, we highlight that distinction among schizotypal personality traits, psychotic and hoarding symptoms can be challenging among clinical practice. In overall, a broad assessment of symptoms is warranted in order to better understand what is in the basis of patient’s dysfunctionality and ensure and effective treatment.

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Substance use is an onging public health burden. As a result all psychiatrists encounter patients with substance use and addictive disorders, either as primary mental health issue, or as co-occurring with other mental health issues. In this presentation, first trends in substance use across Europe will be presented, based on findings from the European Union Drugs Agency (EUDA). Next, findings on co-occurring other mental health issues will be discussed, with a focus on co-occurring Attention Deficit Hyperactivy Disorder (ADHD). Recent findings from the International Colaboration on ADHD and Substance Abuse (ICASA) will be shared. ICASA’s most recent work was the longitudinal International Naturalistic Cohort Study of ADHD and Substance Use Disorders (SUD). Nearly 600 patients with both ADHD and SUD in treatment were followed for nine months. About two thirds of participants received some kind of ADHD treatment, with half receiving pharmacologic treatment, one third receiving psychological treatment, and only one-fifth receiving combined pharmacologic and psychological treatment. Higher ADHD symptom severity and sobriety at intake were associated with receiving ADHD treatment. These findings suggest that treatment of SUD and ADHD is suboptimal. The implementation of ICASA’s consensus statements on diagnosis and treatment of co-occurring ADHD and SUD could help improve quality of care for these individuals.

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Perinatal depression (PND) is a debilitating mood disorder that occurs during or following pregnancy. Information regarding characteristics associated with PND can aid in better understanding the disease.

Examine patient characteristics and comorbidities of PND patients and matched non-PND controls in a UK electronic health record (EHR) database.

Women aged 12-55y with a delivery record (livebirth, stillbirth, mixed birth) during Jan 2017-Dec 2021 were selected from the Clinical Practice Research Datalink (CPRD) GOLD primary care database via a pregnancy algorithm. PND was ascertained using read codes during pregnancy or one year after the end of pregnancy date (EPD). Two ways to define PND were explored: 1) restricted definition (PND-r) where only PND codes were included; 2) broad definition (PND-b) including both PND and 34 other depression codes. For each PND case, two controls were matched on key patient variables such as age, depression history, and pregnancy outcome. Patients were required to have at least 12 months (mo) of continuous enrollment prior to and post EPD. Patient characteristics and select psychiatric and pregnancy-related comorbidities were compared, and prevalence rate ratios (PRR) and 95% Wald confidence intervals (CI) were calculated comparing cases and controls.

The study included 2,214 cases of PND-r and 4,718 cases of PND-b, and their respective non-PND matched controls. PND-r and PND-b cases differed in timing of diagnosis. Of the PND-r cases, 6% were diagnosed during pregnancy and 47% in the first 3mo following delivery; whereas the distribution in the PND-b was, respectively, 18% and 30%. The mean age of the PND-r and PND-b cohorts was consistent (29y, SD=6). A prior recorded history of depression was present in 36% of PND-r cases and 43% of PND-b cases. Approximately 55% of PND-r cases and 65% of PND-b cases had a history of antidepressant use prior to last menstrual period.

During the 12mo pre-EPD, PND-r cases had higher prevalence of hyperemesis gravidarum (PRR=1.5, 95% CI 1.3-1.8), gestational diabetes (PRR=1.4, 95% CI 1.1-1.7), and anxiety/panic disorders (PRR=1.8, 95% CI 1.3-2.3) compared to controls. During the 12mo post-EPD, PND-r cases had higher prevalence of comorbid anxiety/panic disorders (PRR=3.8, 95% CI 3.0-4.9) as well as post-traumatic stress disorder (PRR=3.1, 95% CI 1.5-6.1) compared to controls. Results were similar in the PPD-b analyses, but with higher PRR of anxiety/panic disorders (post-EPD PRR: 11.2, 95% CI 9.7-12.9).

80% of PND-r and 71% of PND-b cases were diagnosed during pregnancy or in the first 6mo following EPD. Cases had higher prevalence of certain pregnancy and psychiatric conditions compared to controls, with comorbid anxiety/panic disorder estimates higher using the PND-b definition. Future research should consider comparing results using both broad and restricted definitions of PND in EHRs.

C. Gillis Shareolder of: Biogen, Employee of: Biogen, S. Chen Shareolder of: Biogen, Employee of: Biogen, C. Mak Shareolder of: Biogen, Employee of: Biogen, E. Tworkoski Shareolder of: Biogen, Employee of: Biogen, L. Li Shareolder of: Biogen, Employee of: Biogen, S. Eaton Shareolder of: Biogen, Employee of: Biogen, C. Green Shareolder of: Biogen, Employee of: Biogen, N. Maserejian Shareolder of: Biogen, Employee of: Biogen, M. Koch Shareolder of: Biogen, Employee of: Biogen.

The Autonomous Region of the Azores faced considerable challenges in providing comprehensive, efficient, and integrated mental health care services, exacerbated by geographical isolation, resource constraints, and the absence of a cohesive system for referrals and quality assessment in mental health care.

Despite the recognized need, the integration of mental health services into primary health care (PHC) and the broader health system in the Azores was fragmented. Key issues included lengthy waiting lists, inadequate referral systems between primary care and specialized psychiatric services, and a lack of standardized quality assessment and performance indicators for mental health care. Additionally, there was a significant need for community mental health teams, emergency management of agitated patients, and comprehensive training for health professionals in psychiatric care.

Through collaborative efforts, the region achieved notable advancements, including the creation of referral criteria from PHC to psychiatry services, structuring inter-service referrals, reactivation of Community Mental Health Teams, and establishment of a “Physician’s Bank.” Noteworthy was the elimination of a waiting list of over 1,000 patients and the development of quality assessment and performance indicators. The construction of a courtyard for involuntarily hospitalized patients and the creation of an emergency room on Faial Island further exemplified the tangible improvements in patient care and system efficiency. Training programs were extensively implemented across various professional groups, enhancing the capacity for mental health care delivery at all levels.

The integration efforts underscored the value of cross-sector collaboration, stakeholder engagement, and the adaptation of models like the SURE framework and COM-B theory to address the multifaceted barriers to mental health care integration. Key facilitators included the development of guidelines, training, and clinical supervision, alongside innovative approaches to public health interventions.

The transformative work in the Azores exemplifies how integrated care models, supported by strategic collaborations and policy reforms, can significantly enhance mental health service delivery in geographically isolated regions. It underscores the importance of systemic approaches to training, infrastructure development, and stakeholder engagement in achieving sustainable improvements in mental health care.

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The prevalence of depressive symptoms and cognitive decline increases with age. Understanding the temporal dynamics of these symptoms could provide valuable insights into the early stages of cognitive decline, allowing for more timely and effective treatment and management.

Our objective was to explore how depressive symptoms, apathy, limitations in daily life activities, and cognitive impairment evolve and interact over time in older individuals. Specifically, we aimed to determine whether changes in these symptoms could help identify subsequent cognitive decline. We used Dynamic Time Warping analysis to model and characterize the progression of these symptoms, examining their relationships both at individual and group levels.

Participants from the Prevention of Dementia by Intensive Vascular Care (preDIVA) trial cohort with baseline and ≥3 follow-up measurements were included, with a median of 6.7 years of follow-up. Dynamic Time Warping analysis was used to model temporal dynamics of individual constituents of the Mini Mental State Exam (MMSE), activities of daily living (ADL) using the Amsterdam Linear Disability Scale (ALDS) and depressive symptoms using the 15-item Geriatric Depression Scale (GDS-15).

The 1537 participants had an average age of 74 years at baseline, 56.5% were female, and 19.9% had finished a higher education. The directed analyses revealed a nuanced temporal pattern, wherein certain depressive symptoms preceded cognitive decline indicators, and vice versa. The GDS-15 symptoms with the strongest outstrength, meaning changes in these symptoms preceded subsequent changes in other items, were the apathy symptoms ‘dropped activities/interests’, ‘energetic’ and ‘not doing new things’ (all p’s<.001). The MMSE constituents with the strongest instrength, meaning changes in these symptoms were preceded by changes in other items, were ‘immediate memory’, ‘verbal comprehension’ and ‘naming objects’. Decline in ADL function was a consistent predictor of worsening of depressive symptoms and cognitive decline (p<.001).

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An increase in apathy and a decline in ADL preceded mood-related symptoms and cognitive impairment in older people aged 70-78 years.

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Addiction treatments are complex, and their goals have changed over time. In the past, abstinence was the main objective. Nowadays, treatments focus on people and their recovery. They are developed to act in many areas of life, therefore appropriate measures are needed that really show the results achieved. One of the variables that has been shown to be appropriate for measuring the results of interventions is quality of life.

Our main objective was to evaluate the results of the intervention carried out on people who have been discharged, with an instrument that includes data on quality of life. Another objective was to standardize the measurement of results, establishing reliable criteria that include the diversity of people in treatment for addictions.

A computer-assisted telephone survey was conducted, with 575 people, between May 2023 and June 2024. They had been for 3 or 6 months on therapeutic or voluntary discharge.

Criteria for therapeutic discharge, voluntary discharge, and abandonment were established. They included results in different areas: substance use, health and self-care, mental health, social/family integration and educational/work.

The World Health Organization Quality of Life BREF (WHOQOL BREF) questionnaire was used. Psychosocial and drug use questions were added to the evaluation.

At discharge, around 75% of people considered that they were in better health than before starting treatment, 60% believed that their quality of life was good or very good, 72% considered that their life had a lot or some meaning and 75% maintained abstinence from the substance for which they were in treatment.

Regarding quality of life (WHOQOL BREF) in people with discharge from treatment, the domain with the lowest score was the one of personal relationships.

Opiate patients were the ones with the lowest scores, with physical health values being highlighted. In terms of gender, women scored worse than men, especially in psychological health.

The results obtained indicate that the biopsychosocial and interdisciplinary treatment of addictions at the Addictions Institute of Madrid City Council improves the overall quality of life and the perception of health. These changes are largely maintained over time, including abstinence.

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In 2002, the euthanasia law was voted in Belgian parliament, depenalising physician-assisted dying under certain conditions for irremediable physical or mental suffering caused by an incurable condition for which all therapeutic options have been exhausted. The euthanasia request needs to be repeated, well-considered and voluntary and the patient should be competent. If the patient is not in a terminal condition, there should be at least one month between the written request and the euthanasia and three independent physicians have to be involved in the evaluation.

Psychiatric suffering was not excluded in the law, but there is discussion whether the possibility of psychiatric euthanasia was intended by the legislator. In the first years after the euthanasia law, psychiatric euthanasia was limited to a few cases, but then rose to a mean of 25 cases per year. There was a peak in 2013 of 54 cases, but after 2013 there was no more increasing trend.

In 2017, the Flemish Association for Psychiatry issued an advice regarding due diligence in psychiatric euthanasia. Controversy regarding psychiatric euthanasia kept stirring the public debate, especially after one court case in which a psychiatrist and general physician were accused and acquitted after a psychiatric euthanasia.

Another prominent topic in the public debate in Belgium is broadening the euthanasia law for advanced dementia based on an advance directive. Now euthanasia is only possible in the earlier stages of neurodegenerative disease, when competence is still sufficiently intact.

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Perinatal psychopathology, encompassing a spectrum of psychiatric disorders such as perinatal depression, generalized anxiety disorder, post-stress traumatic disorder (PTSD), bipolar disorder, and postpartum psychosis, has been increasingly recognized for its potential to disrupt early mother-infant interactions. These disruptions may have profound consequences on the formation of secure attachment, which is crucial for healthy infant neurodevelopment. Attachment theory posits that early relational experiences shape the foundation of emotional regulation and social functioning, making it essential to understand how maternal psychopathology influences this critical developmental period.

This study aims to explore the impact of perinatal psychopathology on the development of attachment between mothers and their infants. Specifically, it seeks to identify how various mental health disorders affect maternal sensitivity and responsiveness, and how these alterations contribute to insecure or disorganized attachment styles in children.

A comprehensive review of the literature was conducted by searching major medical databases (e.g. PubMed and Google Scholar), giving preference to studies published between 2000 and 2024. Articles were selected based on relevance to perinatal psychopathology and attachment theory. This narrative review includes both quantitative and qualitative studies, clinical trials, and observational research that examine how maternal mental health conditions during pregnancy and the postpartum period affect attachment processes. Key themes and findings were extracted to provide a holistic view of the current state of knowledge on this subject.

The findings align with existing research on the impact of maternal mental health on early attachment, reinforcing the role of maternal sensitivity as a mediator between psychopathology and attachment security. Psychiatric conditions impair the mother’s ability to engage in synchronous interactions with her infant, disrupting the child’s ability to develop a secure base. Moreover, the presence of comorbid psychiatric conditions and chronicity of symptoms were identified as risk factors for more severe attachment disruptions. Pharmacological treatment and psychotherapy were shown to mitigate these effects, highlighting the need for integrated perinatal mental health services.

Perinatal depression, PTSD, and psychosis significantly compromise maternal-infant attachment, increasing the risk of insecure or disorganized attachment styles. Timely psychiatric interventions can enhance maternal mental health and promote healthier attachment outcomes. This review underscores the importance of integrating maternal mental health treatment into perinatal care to prevent long-term developmental issues in children and foster secure attachment relationships.

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Autism is a neurodevelopmental condition affecting 1 in 36 people worldwide. Approximately one third of autistic individuals report a diagnosed mental health condition. Autistic people constitute 20% of referrals to outpatient psychiatry clinics. Limited knowledge and awareness of autism is the main barrier to receiving appropriate diagnostic and therapeutic support. Autistic individuals’ increased mental health needs coupled with greater barriers to accessing healthcare necessitate that both primary care physicians as well as specialised services are well versed in working with these patients.

This study aimed to evaluate knowledge of autism and self-reported confidence in caring for autistic patients amongst psychiatrists and general practitioners (GPs) in Malta. This will facilitate identification of lacunae in doctors’ knowledge and advocating for greater training and awareness.

A online, anonymous questionnaire was distributed amongst psychiatrists and general practitioners in Malta as well as psychiatry and GP trainees. The questionnaire consisted of demographic questions, a 22-item modified Knowledge of Autism Scale as well as a 14-item Self-efficacy Scale targeting confidence in working with autistic patients. Data was analysed using SPSS and scores were adjusted for chance responses. Scores of the psychiatry group and the GP group were compared.

The questionnaire was answered by 98 participants of which 60% (n=59) were female. The mean score on the knowledge of autism scale was 89.2% (SD=7.7) for psychiatry and 83.1% (SD=8.5) for GP. Mann Whitney U test revealed that psychiatrists fared better than GPs with an effect size of 0.35 (p=0.0003). The mean self-efficacy score was 6.7 (SD=0.4) for psychiatry and 5.7 (SD=0.8) for GP. Independent sample t-test revealed that psychiatrists scored better than GP (p=0.0003, 95% CI [0.509,1.49]). In both groups, there was no significant correlation between knowledge of autism scales and self-efficacy scales (psychiatry p = 0.26; GP p = 0.14).

General practitioners, psychiatrists and their trainees overall have good knowledge about autism, and feel moderately confident in working with autistic patients. As expected, psychiatrists scored better than GPs for both knowledge and self-reported efficacy. The scores obtained are comparable to studies done on a similar population in the United Kingdom. Unfortunately, Malta stilll lacks autism diagnostic services in the public sector. Nonetheless, undergraduate medical education and postgraduate training must strive to prepare doctors for working with this common cohort of patients. This will ensure a high standard of care and avoidance of adverse health outcomes or iatrogenic harm.

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The relationship between psychosis and ayahuasca use is a topic of considerable interest and debate in the scientific and medical community. Ayahuasca is traditionally used in shamanic ceremonies in the Amazon, composed mainly of the Banisteriopsis caapi vine and the leaves of Psychotria viridis, which contain DMT (dimethyltryptamine), a powerful hallucinogen.

Ayahuasca induces altered states of consciousness, with experiences that can include visions, deep introspection, and changes in the perception of reality. The experience can be intense and emotionally overwhelming. In individuals with a history of psychosis or psychiatric disorders, ayahuasca may more easily trigger a psychotic episode. The interaction with neurotransmitters and the serotonergic system can influence their appearance.

We report a case of a patient who, after consuming ayahuasca, presented a psychotic episode that required hospitalization. After the initiation of treatment with antipsychotics, the condition had a favorable evolution towards the complete resolution of the symptoms.

Given the increasingly frequent use of ayahuasca in developed societies, the current case highlights the needs to understand, regulate and research the use of ayahuasca. Additionally, raising awareness of the potential risks of ayahuasca use through psychoeducation should be implemented.

Describe the case of a psychotic episode induced by ayahuasca: Clinical debut, symptoms and evolution after initiation of treatment.

Description of a clinical case as well as bibliographic review.

The relationship between hallucinogens and psychosis is a critical area of study due to the intense and potentially destabilizing effects that hallucinogens can have on people with this condition. Hallucinogens can trigger or aggravate psychotic symptoms, which may include hallucinations and delusions. We must keep in mind that hallucinogens can interact negatively with antipsychotics or other medications used to treat psychosis. These interactions may reduce the effectiveness of treatment or cause adverse side effects, as well as affect adherence to treatment, as it may lead to an alteration in the perception of the need for medication or the ability to follow the treatment regimen.

Ayahuasca use can have profound and potentially destabilizing effects, especially in people with a history of psychotic disorders. Although there is therapeutic potential, it is crucial to proceed with caution and under the supervision of trained professionals. Proper preparation and risk assessment are essential to minimize potential adverse effects.

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