The association between cannabis and psychosis is established, but the role of underlying genetics is unclear. We used data from the EU-GEI case-control study and UK Biobank to examine the independent and combined effect of heavy cannabis use and schizophrenia polygenic risk score (PRS) on risk for psychosis.

Genome-wide association study summary statistics from the Psychiatric Genomics Consortium and the Genomic Psychiatry Cohort were used to calculate schizophrenia and cannabis use disorder (CUD) PRS for 1098 participants from the EU-GEI study and 143600 from the UK Biobank. Both datasets had information on cannabis use.

In both samples, schizophrenia PRS and cannabis use independently increased risk of psychosis. Schizophrenia PRS was not associated with patterns of cannabis use in the EU-GEI cases or controls or UK Biobank cases. It was associated with lifetime and daily cannabis use among UK Biobank participants without psychosis, but the effect was substantially reduced when CUD PRS was included in the model. In the EU-GEI sample, regular users of high-potency cannabis had the highest odds of being a case independently of schizophrenia PRS (OR daily use high-potency cannabis adjusted for PRS = 5.09, 95% CI 3.08–8.43, p = 3.21 × 10−10). We found no evidence of interaction between schizophrenia PRS and patterns of cannabis use.

Regular use of high-potency cannabis remains a strong predictor of psychotic disorder independently of schizophrenia PRS, which does not seem to be associated with heavy cannabis use. These are important findings at a time of increasing use and potency of cannabis worldwide.

Cannabis use and familial vulnerability to psychosis have been associated with social cognition deficits. This study examined the potential relationship between cannabis use and cognitive biases underlying social cognition and functioning in patients with first episode psychosis (FEP), their siblings, and controls.

We analyzed a sample of 543 participants with FEP, 203 siblings, and 1168 controls from the EU-GEI study using a correlational design. We used logistic regression analyses to examine the influence of clinical group, lifetime cannabis use frequency, and potency of cannabis use on cognitive biases, accounting for demographic and cognitive variables.

FEP patients showed increased odds of facial recognition processing (FRP) deficits (OR = 1.642, CI 1.123–2.402) relative to controls but not of speech illusions (SI) or jumping to conclusions (JTC) bias, with no statistically significant differences relative to siblings. Daily and occasional lifetime cannabis use were associated with decreased odds of SI (OR = 0.605, CI 0.368–0.997 and OR = 0.646, CI 0.457–0.913 respectively) and JTC bias (OR = 0.625, CI 0.422–0.925 and OR = 0.602, CI 0.460–0.787 respectively) compared with lifetime abstinence, but not with FRP deficits, in the whole sample. Within the cannabis user group, low-potency cannabis use was associated with increased odds of SI (OR = 1.829, CI 1.297–2.578, FRP deficits (OR = 1.393, CI 1.031–1.882, and JTC (OR = 1.661, CI 1.271–2.171) relative to high-potency cannabis use, with comparable effects in the three clinical groups.

Our findings suggest increased odds of cognitive biases in FEP patients who have never used cannabis and in low-potency users. Future studies should elucidate this association and its potential implications.

Artificial intelligence (AI)-based health technologies (AIHTs) have already been applied in clinical practice. However, there is currently no standardized framework for evaluating them based on the principles of health technology assessment (HTA).

A two-round Delphi survey was distributed to a panel of experts to determine the significance of incorporating topics outlined in the EUnetHTA Core Model and twenty additional ones identified through literature reviews. Each panelist assigned scores to each topic. Topics were categorized as critical to include (scores 7–9), important but not critical (scores 4–6), and not important (scores 1–3). A 70 percent cutoff was used to determine high agreement.

Our panel of 46 experts indicated that 48 out of the 65 proposed topics are critical and should be included in an HTA framework for AIHTs. Among the ten most crucial topics, the following emerged: accuracy of the AI model (97.78 percent), patient safety (95.65 percent), benefit–harm balance evaluated from an ethical standpoint (95.56 percent), and bias in data (91.30 percent). Importantly, our findings highlight that the Core Model is insufficient in capturing all relevant topics for AI-based technologies, as 14 out of the additional 20 topics were identified as crucial.

It is imperative to determine the level of agreement on AI-relevant HTA topics to establish a robust assessment framework. This framework will play a foundational role in evaluating AI tools for the early diagnosis of dementia, which is the focus of the European project AI-Mind currently being developed.

Lack of adherence to pharmacological treatment is considered a multifactorial phenomenon, remarkably frequent in clinical practice. Non-adherence is associated with increased number of relapses, poor clinical and functional outcomes, and worsening of patient health status, with a resulting increase in healthcare costs, particularly in people with severe mental disorders (SMD). Treatment adherence rates remain extremely low, highlighting the need to develop innovative and integrated strategies; one of these is represented by the promotion of healthy lifestyle behaviours, including regular physical activity.

The aim of this study is to assess how the rates of treatment adherence vary in patients with SMD after receiving a psychosocial intervention, focusing on the positive relationship between treatment adherence and physical activity.

LIFESTYLE is a randomized controlled trial comparing the efficacy of a structured psychosocial lifestyle intervention involving moderate physical activity exercises over a brief psychoeducational intervention. Levels of physical activity was assessed thorough the IPAQ scale, while treatment adherence was evaluated by the Morisky Medication Adherence Scale (MMAS).

The sample includes 401 patients, with a mean duration of illness was 16.3 (±17.8) years. All patients were receiving a pharmacological drug treatment; in particular, 59.6% (N=239) were treated with a second-generation antipsychotic and 54.9% (N=220) with a mood stabilizer. Our results show that moderate physical activity improves rates of treatment adherence. After 6 months, adherence to treatment increased from 35.8% at baseline to 47.6% at baseline in the experimental group, along with improvement in clinical health parameters (reduction in BMI, weight, and metabolic parameters). Another significant inverse correlation was found between adherence and quality of life (Rho di Person: -.140, p<.005). Furthermore, this study indicates that having a diagnosis of major depression, a better cognitive functioning, a shorter duration of illness and contact time with the local mental health centre are factors that positively influence treatment adherence. Remarkably, treatment adherence was not influenced by symptom severity and type of pharmacological treatment.

Moderate physical activity can represent a valid strategy to increase treatment adherence in patients with SMD. Therefore, promoting physical activity exercises in our clinical practice may be associated with better outcomes. However, further studies that evaluate patients with acute mental disorders are needed.

None Declared

The comorbidity between depression and anxiety is a common occurrence. The DSM-5 introduced the “anxious distress” (AD) specifier that can be applied to any depressive episode – both in major depressive disorder (MDD) and bipolar disorder (BD) – when symptoms such as feelings of tension, restlessness, difficulty concentrating, and fear that something awful may happen or to lose control are present. Longitudinal data showed that the AD specifier may be an effective predictor of chronicity, time to remission, and functional disability in depressive disorders. In addition, evidence on AD proved its association with increased depressive symptom severity.

Available literature seems to suggest that AD occurs in a specific subgroup of patients, thus enabling a peculiar clinical profile to be outlined. To expand knowledge in this field, we performed a cross-sectional study aimed at identifying clinical correlates of AD in people with major depressive episodes.

Adult people admitted to two psychiatric inpatient units in the northern area of the Metropolitan City of Milan from May 2020 to December 2022 were screened for a major depressive episode and relevant specifiers using the Structured Clinical Interview for DSM-5 (SCID-5). Data on socio-demographic and clinical variables were collected. The severity of depressive and manic symptoms was assessed using the Montgomery–Åsberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS), respectively. Univariate comparisons between participants with and without AD were conducted, and two multiple logistic regression models were arranged to investigate the association between AD and candidate explanatory variables.

We included 206 inpatients with a major depressive episode (mean age =48.4 ± 18.6 years; males = 38.8%), of whom 155 diagnosed with MDD and 51 with BD. AD was present in 137 participants (66.5%). Mixed features (p=0.049), higher YMRS scores (p=0.004), psychotic features (p<0.05), and a diagnosis of MDD (p<0.05) were found to be associated with AD in the multiple logistic regression analysis.

Notwithstanding some limitations, such as the cross-sectional design and the inclusion of inpatient only, our study highlights the association of AD with mixed and psychotic features, as well as with MDD. Clinical implications of these results include the possible contribution in delineating a specific symptom profile in people with AD during a major depressive episode.

None Declared

The prognostic prediction of outcomes in individuals at clinical high-risk for psychosis (CHR-P) is still a significant clinical challenge. Among multiple baseline variables of risk calculator models, the role of ongoing pharmacological medications has been partially neglected, despite meta-analytical evidence of higher risk of psychosis transition associated with baseline prescription exposure to antipsychotics (AP) in CHR-P individuals. In particular, baseline AP exposure in CHR-P individuals may be considered as a functional equivalent of the psychometric transition to psychosis, as already postulated in the original ‘Ultra High-Risk’ model.

The main aim of the current study was to test the hypothesis that ongoing AP need at baseline indexes a subgroup of CHR-P individuals with more severe psychopathology and worse prognostic trajectories along a 1-year follow-up period.

This research was settled within the ‘Parma At-Risk Mental States’ program. Baseline and 1-year follow-up assessment included the Positive And Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF). CHR-P individuals who were taking AP medications at entry were included in the CHR-P-AP+ subgroup. The remaining participants were grouped as CHR-P-AP-. The acquisition of drug and outcome information was collected both at baseline and across the follow-up period. Finally, logistic regression analyses with dichotomized 1-year outcome parameters (previously showing statistically significant differences in inter-group comparisons) as dependent measures and sociodemographic and clinical characteristics as independent variables were also performed.

Hundred and seventy-eight CHR-P individuals (aged 12–25 years) were enrolled (91 CHR-P-AP+, 87 CHR-P-AP-). Compared to CHR-P AP-, CHR-P AP+ individuals had older age, greater baseline PANSS ‘Positive Symptoms’ and ‘Negative Symptoms’ factor subscores and a lower GAF score. At the end of our follow-up, CHR-P-AP+ subjects showed higher rates of psychosis transition, new hospitalizations and urgent/non-planned visits compared to CHRP- AP- individuals.

The current study suggests that AP need is a significant prognostic variable in cohorts of CHR-P individuals and should be included in the current risk calculators. In particular, the results of this study conducted in a realworld clinical setting indicate that the rate of CHR-P individuals who were already exposed to AP at the time of CHR-P status ascription was higher than those reported in recent meta-analyses on this topic. Moreover, our findings confirm that baseline AP prescription appears to increase psychotic transition risk.

None Declared

An alteration of inflammatory indices has been reported in several major mental disorders. This alteration seems to be related to disease severity and treatment resistance, but its pathophysiological meaning remains to be established. Patients with severe mental disorders tend to have increased levels of circulating cytokines and increased microglial activity in the central nervous system, suggesting that inflammation may contribute to the onset, or chronicity, of mental disorders. Detecting inflammation‐relevant symptom clusters across mental disorders may represent an important step towards precision medicine in psychiatry.

The SMInflam project is a longitudinal, observational, real-world study which aims to: assess a set of inflammatory indices at baseline in a sample of patients with the diagnosis of a major mental disorder; identify inflammatory profiles of these patients using a latent class analysis approach; assess the response to pharmacological treatments of patients with different inflammatory profiles; re-assess the inflammatory indices and profiles at several times during follow-up and test their correlation with the evolution of psychopathology.

The sample will consist of 50 patients with a diagnosis of a major mental disorders consecutively enrolled at the outpatient unit of the Department of Psychiatry of University of Campania. All enrolled patients will be administered a set of reliable and validated psychopathological assessment tools. We will perform a complete physical evaluation, and a battery of laboratory tests. Peripheral markers of chronic inflammation will be assessed. Clinical and biological assessments will be performed at baseline (T0) and after 3 and 6 months (respectively, T1 and T2).

Expected results include the evaluation of the levels of inflammatory indices in a varied sample of patients with severe mental disorders. According to the pre-post design, these aspects will be evaluated before the start and at the follow-up. We will also take into consideration the role of confounding factors such as age and gender, which represent a critical biological variable influencing such inflammatory pathways.

Collected data will be used for having a more informative, reliable and valid characterization of psychopathology in a vast sample of patients with severe mental disorders. Our study may represent the first of a new wave of methodologically-sound studies on the role of inflammation and psychopathology in patients with severe mental disorders.

None Declared

Neurofilmology is a young and evolving research field, at the intersection between neuroscience and movie experiences, that explores how the brain processes and responds to visual storytelling. It involves examining the cognitive and emotional effects of movies on viewers, including social cognition and perspective-taking aspects. However, up to date, these studies have focused only on the neurotypical population, hence constituting a considerable gap in the literature with respect to individuals with neuroatypical functioning.

Aim of this study was to investigate the experience of film viewing and its correlates in individuals with a diagnosis of Autism Spectrum Disorders (ASD).

30 neurotypical individuals and 30 individuals with ASD without intellectual disabilities were asked to observe 12 short video clips of 3 seconds length, showing an agent grasping an object from a table, and filmed with three different camera techniques: Still, Steadycam, Zoom; for each clip, they were asked to respond to six question on a Visual Analogue Scale (0-100) designed to investigate participants’ potential feeling of involvement with the observed scene, their comfort with the different filming conditions, and their estimation of the ecological plausibility of the different types of camera movements.

Participants felt more involved watching videos filmed with a Steadycam, with respect to the Zoom and Still condition. Within the neurotypical group participants felt more comfortable when the camera was in motion (both Steadycam and Zoom condition) compared to the Still condition; no differences were found between conditions in the ASD group, as if they felt equally comfortable in every condition administered, regardless the filming technique.

First, our results reinforce prior findings regarding the influence of different camera techniques on neurotypical individuals. Second, they add to the existing literature suggesting that individuals with ASD may exhibit differences in their subjective experiences related to empathizing with characters and immersing themselves as actors when the camera replicates naturalistic movements, resulting in a diminished overall fulfillment in the movie-watching process.

None Declared

Patients with severe mental disorders have a significantly reduced life expectancy than the general population, often resulting from the increased prevalence of cardiovascular and metabolic diseases. Reasons include unhealthy lifestyle behaviours, reduced access to screening programs and adverse effects of many psychotropic drugs.

Our goal is to assess the efficacy of a psychosocial group intervention promoting healthy lifestyle behaviors compared to a brief psychoeducational group intervention in terms of improvement of severity of psychiatric symptoms and perceived quality of life, and a series of anthropometric and hematological parameters.

This is a multicenter randomized controlled trial. Patients between 18 and 35 years of age with a diagnosis of schizophrenia and other primary psychotic disorders, unipolar depression and bipolar disorder were recruited. Exclusion criteria were inability to perform moderate physical activity, pregnancy and breastfeeding and impaired cognitive functions.

401 patients were recruited and randomly assigned to receive the experimental intervention (LIFESTYLE) or a behavioural control intervention. About 57% of the sample were female, with a mean age of 45.8±11.8, and BMI of 32.5±5.5. All of them were receiving almost one psychotropic drug. At one year, we observed a reduction in HOMA-IR index (from 4.3 ± 5.5 to 3.1 ± 2.9, p<0.01) and triglycerides (from 162.5 ± 78.1 mg/dL to 131.4 ± 76.0 mg/dL, p<0.001), as well as an increase in HDL (from 46.2± 14.6 mg/dL to 50.9±26.7 mg/dL, p<0.05). Moreover, a reduction in the values of BPRS “Affectivity” (from 8.7±3.0 to 7.2±2.5, p<0.001), “Activity” (from 4.7±1.9 to 4.2±1.3, p<0.01) and “Negative Symptoms” subscale (from 7.7±3.1 to 7.0±2.7, p<0.001) was also observed, along with an improvement in perceived quality of life (MANSA total score from 4.0 ± 1.0 to 5.3 ± 0.8, p<0.01).

The results support the evidence that the LIFESTYLE intervention has long-lasting positive effects on physical and mental health of people with mental disorders. More efforts need to be done in order to increase the availability of these treatments in routine clinical settings.

None Declared

We examined whether cannabis use contributes to the increased risk of psychotic disorder for non-western minorities in Europe.

We used data from the EU-GEI study (collected at sites in Spain, Italy, France, the United Kingdom, and the Netherlands) on 825 first-episode patients and 1026 controls. We estimated the odds ratio (OR) of psychotic disorder for several groups of migrants compared with the local reference population, without and with adjustment for measures of cannabis use.

The OR of psychotic disorder for non-western minorities, adjusted for age, sex, and recruitment area, was 1.80 (95% CI 1.39–2.33). Further adjustment of this OR for frequency of cannabis use had a minimal effect: OR = 1.81 (95% CI 1.38–2.37). The same applied to adjustment for frequency of use of high-potency cannabis. Likewise, adjustments of ORs for most sub-groups of non-western countries had a minimal effect. There were two exceptions. For the Black Caribbean group in London, after adjustment for frequency of use of high-potency cannabis the OR decreased from 2.45 (95% CI 1.25–4.79) to 1.61 (95% CI 0.74–3.51). Similarly, the OR for Surinamese and Dutch Antillean individuals in Amsterdam decreased after adjustment for daily use: from 2.57 (95% CI 1.07–6.15) to 1.67 (95% CI 0.62–4.53).

The contribution of cannabis use to the excess risk of psychotic disorder for non-western minorities was small. However, some evidence of an effect was found for people of Black Caribbean heritage in London and for those of Surinamese and Dutch Antillean heritage in Amsterdam.

The COVID-19 pandemic represents an unprecedented in health events that has had a negative impact on the mental health of the population in general as well as on specific categories, including patients with mental and physical disorders, and healthcare professionals. In particular, COVID-19 pandemic has produced extraordinary stress in healthcare workers, especially frontline physicians, nurses and healthcare professionals.

In the present study we aimed to evaluate levels of burnout, a clinical condition characterized by emotional, psychological and physical exhaustion, in a sample of health workers from the Campania region, Italy, during the first phase of the COVID-19 pandemic. Secondary objectives of the study include the assessment, in the same group, of levels of anxiety-depressive symptoms, insomnia, suicidal ideation and symptoms on the post-traumatic spectrum.

An online survey was released through the official website of the University of Campania “L. Vanvitelli” and social media. The Maslach Burnout Inventory was used to assess burnout in the healthcare professionals; Depression Anxiety Stress Scale-21 Short Version to measure levels of anxiety, depression and stress; the Insomnia Severity Index was used to identify insomnia-related symptoms; the Suicidal Ideation Attributes Scale was adopted to select individuals based on the presence of suicidal thoughts while the Impact of Event Scale-Revised was administered to evaluate trauma-related dimensions.

A total of 389 health workers was recruited. They were predominantly female, with an average age of 39.06 (± 11.85) years, working mainly in the second line hospitals during the COVID-19 emergency. During the pandemic, first- or second-line health workers reporting significant levels of emotional exhaustion are on average 23,89 (±4.22), those reporting feelings of depersonalization are on average 7.58 (±2.73), while those who report a good level of professional efficiency are on average 21.12 (±3.48).

Predictors of increased levels of depersonalization are being a first-line worker and the presence of traumatic event avoidance symptoms. Furthermore, levels of professional fulfillment are negatively affected by age, the presence of intrusive symptoms, the presence of sleep disorders, and being a frontline worker.

The impact of the COVID-19 pandemic on the mental health of healthcare professionals involved in the first and/or second line COVID hospitals is indisputable. Although burnout syndrome is not a new clinical condition, the COVID-19 pandemic may further worsen the magnitude of the problem. However, our results could be a starting point to promote a change in the way we perceive the mental health of healthcare professionals.

None Declared

Bipolar Disorder (BD) is a frequent psychiatric disorder, which can be associated with high disability. Psychotic symptoms occur in more than half of bipolar patients and are associated with an unfavorable course of the disorder (Chakrabarti et al. World J Psychiatry 2022; 12(9) 1204-1232).

The aim of this study is therefore to identify clinical and biological markers able to discriminate between BD patients with (BD-PS) and without lifetime psychotic symptoms (BD-NPS) to facilitate early diagnosis and to implement a target clinical management of these patients.

We recruited 665 patients consecutively hospitalized for BD at Fondazione IRCCS Policlinico (Milan) and at San Gerardo Hospital (Monza). Data were obtained through a screening of the clinical charts and blood analyses conducted during the hospitalization. Patients were assessed by psychometric scales. The two groups (BD-PS and BD-NPS) were compared by t tests for quantitative variables and χ2 tests for qualitative ones. Variables that resulted to be significant in univariate analyses were inserted in binary logistic models with the presence of psychotic symptoms as dependent variable.

Among the total sample, 64.5% of patients were affected by BD-PS while 35.5% by BD-NPS. The final binary logistic regression model showed that, compared to patients with BD-NPS, those with BD-PS had a longer duration of hospitalization (p=0.007) and were more frequently hospitalized for a manic episode (p=0.001). In addition, subjects with BD-PS had a lower score on the current Global Assessment of Functioning (GAF) (t = 3.157; p = 0.002) and were more frequently males (χ² = 4.061; p = 0.044; OR = 1.399). With regard to biological variables, patients with BD-PS, compared to the counterpart, had a higher Neutrophile to Lymphocyte Ratio (NLR) (t = 2.776; p = 0.006), lower levels of Gamma-Glutamyl Transferase (γGT) (t = 2.249; p = 0.026), higher total bilirubin (t = 2.348; p = 0.019) and creatine phosphokinase (CPK) (t=2.807; p = 0.005), lower total cholesterol (t = 2.369; p = 0.018) and triglycerides (t = 2.554; p = 0.013).

Our data appear to be in line with the literature, especially with respect to the occurrence of psychotic symptoms mainly in manic episodes and their association with greater clinical severity, longer hospitalization and worse outcome (Altamura et al. Aust N Z J Psychiatry 2019; 53(8) 772-781). From a biological point of view, it seems important to emphasize that patients with lifetime psychotic symptoms presented a higher NLR, revealing more prominent low-grade inflammation in these patients than the counterpart. These data confirm the possibility of using NLR as biomarker of severity in bipolar patients, as proposed previously by other authors (Kulacaoglu et al. Nord J Psychiatry 2022). Future multi-center study have to confirm the results of the present study.

None Declared