The National Institutes of Health (NIH) Executive Abilities: Measures and Instruments for Neurobehavioral Evaluation and Research (EXAMINER) is a validated laptop-based battery of executive functioning tests. A modified tablet version of the EXAMINER was developed on the UCSF Tablet-based Cognitive Assessment Tool (TabCAT-EXAMINER). Here we describe the battery and investigate the reliability and validity of a composite score.

A diagnostically heterogeneous sample of 2135 individuals (mean age = 65.58, SD = 16.07), including controls and participants with a variety of neurodegenerative syndromes, completed the TabCAT-EXAMINER. A composite score was developed using confirmatory factor analysis and item response theory. Validity was evaluated via linear regressions that tested associations with neuropsychological tests, demographics, clinical diagnosis, and disease severity. Replicability of cross-sectional results was tested in a separate sample of participants (n = 342) recruited from a frontotemporal dementia study. As this separate sample also collected longitudinal TabCAT-EXAMINER measures, we additionally assessed test-retest reliability and associations between baseline disease severity and changes in TabCAT-EXAMINER scores.

The TabCAT-EXAMINER score was normally distributed, demonstrated high test-retest reliability, and was associated in the expected directions with independent tests of executive functioning, demographics, disease severity, and diagnosis. Greater baseline disease severity was associated with more rapid longitudinal TabCAT-EXAMINER decline.

The TabCAT-EXAMINER is a tablet-based executive functioning battery developed for observational research and clinical trials. Performance can be summarized as a single composite score, and results of this study support its reliability and validity in cognitive aging and neurodegenerative disease cohorts.

Anxious depression (AxD) as an independent diagnostic has been controversial, with many suggesting it as a transient state and others highlighting evidence of a worse outcome, severity, and increased suicide risk. The International Classification of Diseases (ICD-11) lists a related concept under 6A73, Mixed depressive and anxiety disorder. Previous literature on ketamine’s efficacy has mainly focused on either anxiety or depression, with limited comparison of both groups. Given their high comorbidity and shared pathophysiology, we aimed to assess ketamine’s efficacy in these populations.

This meta-analysis aimed to consolidate evidence from clinical trials evaluating ketamine therapy in AxD and Non-Anxious Depression (NAxD).

A search for published clinical trials in indexed journals and databases was conducted on August 11, 2024. Keywords included ketamine, anxiety, comorbidity, and depression, with no restrictions on language or publication date. Studies on bipolar or psychotic depression were excluded. A random-effects model accounted for variability, and subgroup analyses were performed.

Eight studies involving 536 participants (mean age = 39.0 years) were preselected. Seven studies defined “anxious depression” as a score of 7 or higher on the HAMD-AS, with AxD mean of 8.74 (±0.56) and NAxD mean of 5.83 (±1.9). MADRS scores were 35.18 (±2.22) for AxD and 31.97 (±2.29) for NAxD. The effect size of improvement in depressive symptom severity (as assessed by the MADRS) was not significantly different between the groups either 13 days after treatment (SMD = -0.07[-0.69, 0.55], p = 0.82, I2 = 73%) or 26-28 days after treatment (SMD = -0.30[-0.64, 0.04], p = 0.09, I2 = 21%). The overall depression response also did not significantly differ between the groups (odds ratio = 0.84 [0.50, 1.41], p = 0.52, I² = 13%). Insufficient data were available for remission rates.

Ketamine shows comparable efficacy in reducing depressive symptoms and achieving response in both groups. The group classified as AxD parallels previous reports of increased severity when reviewing baseline scores MADRS and other available scores. Thus, ketamine should be considered a viable treatment for patients with AxD, as they may have lower response rates to traditional antidepressants. This analysis was limited by the small number of studies, small sample sizes, and moderate heterogeneity. Differences in baseline depressive symptom severity and varying definitions of MDD with anxiety also constrained our analysis. Given the severity of symptoms in this population, we recommend developing better classification instruments for AxD. Further research is needed to explore remission differences in AxD and refine treatment strategies.

I. Borja De Oliveira: None Declared, A. Stephany: None Declared, M. Geremias: None Declared, D. Xavier: None Declared, F. Wagner: None Declared, A. Balduino de Souza: None Declared, M. O. Pozzolo Pedro: None Declared, D. Soler Lopes: None Declared, M. Carbajal Tamez: None Declared, J. Quevedo Shareolder of: Instituto de Neurociencias Dr. Joao Quevedo, Grant / Research support from: LivaNova; and receives copyrights from Artmed Editora, Artmed Panamericana, and Elsevier/Academic Press, Consultant of: EMS, Libbs, and Eurofarma, Speakers bureau of: Myriad Neuroscience and AbbVie., M. Teranishi: None Declared

The Convalescence Unit provides semi-open inpatient care during the subacute phases of psychiatric illness, with the goal of restructuring and reorganizing the personality after a crisis or relapse.

The main objective is to observe the profile of patients admitted to the Convalescence Unit who could benefit from this type of resource.

A retrospective, observational study was conducted by collecting and analyzing data in 2019, which 61 patients were admitted in this resource. The profile of patients during the year 2019 was analyzed.

Of a total of 61 patients, 47 were referred from the Brief Hospitalization Unit (UHB), 11 from the Mental Health Team (ESM), and 3 from other facilities. By gender, there were 38 women and 23 men. The average age was 44.16 years. Regarding the type of admission, 29 were voluntary and 32 involuntary. Seventeen patients had been readmitted from previous years. The diagnoses were: 10 patients with bipolar disorder, 14 with schizophrenia, 6 with substance-induced psychosis, 2 with schizoaffective disorder, 10 with anxiety-depressive syndrome, 5 with dysthymia, 2 with obsessive-compulsive disorder, 7 with delusional disorder, and 6 with personality disorders. Of these patients, 58 received therapeutic discharge, 1 voluntary discharge, and 2 were transferred to other facilities. Regarding marital status, 43 were single, 7 married, 4 widowed, and 7 divorced. The average length of stay was 48.56 days.

As for the profile of patients admitted to the Convalescence Unit, it is not possible to determine a statistically significant pattern. However, we observed that most are women with severe mental health disorders. Notably, the majority are single, suggesting less family support, and a high percentage are admitted involuntarily, often from the UHB, to extend their stay for the management of subacute conditions in a more controlled environment. This helps ensure adherence to treatment, which is both difficult and crucial for a favorable outcome in these patients.

None Declared

Several medications in use in the psychiatry field, particularly in severe mental illness (SMI), are associated with weight gain and other cardio-metabolic side effects and are usually prescribed long-term. Extensive research has been conducted on the contribution of these effects to poorer physical health and a 10- to 20-year mortality gap in patients with SMI. Many factors have been reported, such as patients’ lifestyle behaviours, lower search for medical care, delayed diagnosis and treatment, diagnostic overshadowing by mental illness, and stigma towards this population. In this context, psychiatrists may have a role in monitoring medication’s side effects their role is still to be defined.

To access usual practices and barriers on cardio-metabolic monitoring of patients by psychiatrists.

We conducted a narrative review on general psychiatrists’ practices of cardio-metabolic monitoring. A search was conducted in Pubmed and PsycNet using the keywords “practice”, “assessment”, “weight gain”, “metabolic”, and “psychiatrist”. Further papers were included after references and citations review of relevant articles. Papers focused exclusively on guidelines or on border programs (such as first psychotic episode protocols) were excluded.

Most of the research dedicated to reporting psychiatrists’ practices regarding monitoring of cardio-metabolic side effects focused on patients treated with long-term antipsychotics. Despite knowledge and concern about these side effects being transversally reported, it doesn’t always translate into clinical practice, and practices are widely diverse. Many factors were appointed as explanations; the most commonly reported were training limitations, poorer physical examination skills, underestimation of side effects, overshadowing of co-occurring physical disease by mental symptoms, lack of scientific consensus amongst different specialties resulting in contradictory guidelines, fragmentation of care across different healthcare providers and specialties, and the still undetermined role of psychiatrists in diagnosing and treating cardio-metabolic complications.

Despite knowledge and awareness of cardio-metabolic side effects are almost transversal in psychiatrists’ practice and translated into the selection of treatments, management of these complications still needs to be put into action. Some strategies may be introduced, such as improving medical training and including this training in residency programs, developing consensual and multidisciplinary guidelines for the assessment and treatment of these side effects, defining the responsibility and improving the coordination of different health care providers in a community setting.

None Declared

Psychiatric hospitalization of adolescents can have biological, psychological and social impacts on these patients with psychiatric illness if not managed correctly. To achieve this, the aim is to keep the hospitalization time as short as possible and to have a clear goal of the intervention (i.e., to diagnose, monitor risks, and stabilize comorbidities). This care is important because the effectiveness of the hospitalization process and its articulations after discharge are related to the chances of these patients being readmitted.

To describe the general aspects related to the hospitalization of adolescents with psychiatric illnesses who require hospitalization in a general hospital in northeastern Brazil.

This is a longitudinal study carried out in a general hospital in the state of Pernambuco, in the northeastern region of Brazil Medical records of hospitalizations that occurred between January 2018 and January 2023 were analyzed. The medical records of patients aged 12 to 17 years and 11 months were included in the study. Sociodemographic and clinical data were collected from the medical records to be submitted to statistical analysis. This study was approved by the local ethics committee (number 6.880.316).

Five hundred and nineteen adolescents were admitted to the general hospital under study for mental reasons throughout that time. After evaluating the data for consistency, 484 medical records were included in this study. It was observed that approximately 53.7% of hospitalized patients were male. The median age was 16 years (IQR 14-17 years). Regarding the clinical profile of hospitalizations, 39 different diagnoses of psychiatric illnesses were listed throughout the period. Following the ICD-10 classification, the three main reasons for hospitalization are: F23 - acute and transient psychotic disorders (13%); F19 - mental and behavioral disorders due to multiple drug use and use of other psychoactive substances (12.4%), and F32 - depressive episodes (11.4%). Notably, during the study period, 63 individuals were hospitalized more than one time.

The primary mental health diagnoses of teenagers who were hospitalized to a northern Brazilian general hospital were described. From the standpoint of public health, the existence of patient readmissions highlights the deficiency of proper care provided to the adolescents after being discharged from the facility. Nevertheless, the examination of the variables associated with the hospitalization of adolescents was made difficult by the lack of uniformity and precision in medical records.

None Declared

Inspired by discussions at the EPA Summer School 2024 on suicide prevention, this poster explores local strategies implemented across European nations. Emphasizing the importance of tailored approaches, the study analyses successful initiatives and community-based programs, and investigates how country-specific factors influence suicide rates. Key findings from research papers on innovative methodologies were also examined, offering insights to inform future practices in suicide prevention.

The poster aims to:

• - Present local strategies for suicide prevention across European countries, focusing on the contributions of clinicians who attended the EPA Summer School.

• - Highlight how knowledge of diverse strategies can impact clinical practice in mental health across Europe.

• - Categorization: European countries are grouped by suicide rates—high, medium, and low—using WHO and European CDC data.

• - Summarization: Local prevention strategies and programs in each group are summarized.

• - Analysis: Various socio-economic and cultural factors influencing suicide rates are discussed, including stigma, economic conditions, and access to healthcare.

• - Comparative Approach: Strategies are compared to identify common successful elements and contextual challenges.

None Declared

Body dissatisfaction is becoming more common among adolescents and is a putative risk factor for adverse mental (e.g., eating disorder and depressive symptoms) and physical health outcomes (e.g., excessive weight gain), both of which have also been increasing. Targeting body dissatisfaction through preventative interventions might improve these outcomes, however robust evidence of causal associations is limited.

To investigate the association between body dissatisfaction at age 16 and eating disorder symptoms at age 21, as well as depressive symptoms and BMI at ages 21 and 26 using a co-twin control design.

We used data from the Twins Early Development Study (TEDS) and validated self-report measures. We fitted univariable and multivariable linear mixed effect models adjusting for a comprehensive list of confounding factors (Figure 1) to investigate the association between body dissatisfaction, eating disorder and depressive symptoms, and BMI in the full twin sample. We then repeated these analyses using a co-twin control design, which allows to fully and partially control for genetic confounding in monozygotic (MZ) and dizygotic (DZ) twins, respectively, and for any shared measured and unmeasured environmental factors. We conducted primary analyses in imputed datasets for participants with complete exposure data.

The analytical sample included 2,183 twins (60.2% females, 61.7% DZ twins). In the full twin sample, one unit increase in body dissatisfaction at age 16 was associated with: (i) a 1.80-point increase in eating disorder symptoms at age 21 (95%CI: 1.49 to 2.11), (ii) a 0.59-point increase in depressive symptoms (95%CI: 0.46 to 0.72), and (iii) a 0.20-point BMI increase (95%CI: 0.08 to 0.32) across age 21 and 26 years. In co-twin control analyses, the association between body dissatisfaction and eating disorder symptoms was larger in DZ twins (N=661; 1.72, 95%CI: 1.11 to 2.33) than in MZ twins (N=414, 0.96, 95%CI: 0.15 to 1.77), whereas effect sizes for depressive symptoms were comparable [DZ: (0.56, 95%CI: 0.33 to 0.78); MZ: (0.50, 95%CI: 0.15 to 0.85)]. Associations with BMI were smaller in DZ (0.20, 95%CI: 0.00 to 0.40), and null in MZ twins (0.07, 95%CI: -0.21 to 0.35).

Image 1:

Our findings suggest that greater body dissatisfaction might be a causal risk factor for eating disorders and depression in young people, as associations seen in the full sample persisted in co-twin control analyses. This indicates that body dissatisfaction could be a modifiable target to reduce the risk of these mental health problems in adolescents and young adults. Evidence of associations between body dissatisfaction and increased BMI was weaker in co-twin control analyses than in the full sample. This might be due to larger proportions of shared genetic risk and thus require larger sample sizes to detect.

None Declared

Borderline Personality Disorder (BPD) remains a challenging and complex disorder but it can be successfully treated.

In 2013, the first portuguese BPD specialized treatment programme was created in the Psychiatry Department at Local Health Unit of São João, becoming a very useful tool in the patients’ management.

We aim to study the influence of clinical characteristics on the duration of intervention and discharge from this BPD treatment programme.

Retrospective observational study of patients admitted to this programme until August 31st 2024. Descriptive analysis of the results was performed using the SPSS software, version 29.

A total of 157 BPD patients were admitted to this programme, 154 (98%) of which are female. These patients had a mean age of 24,6 years old, when they engaged in the programme. During the follow‑up 39% have abandoned the programme, and 27% have been discharged due psychotherapeutic stabilization.

We will also present results related to association between clinical factors (namely previous diagnoses and history of use of substances) and the duration of the intervention/discharge plan, in order to know if our results are consistente with the ones from another centers where comorbidity with eating disorders and cocaine use disorder were clinical variables predictors of shorter duration of the intervention.

Understanding the influence of clinical factors and their impact on intervention is essential to enhance this challenging programme to improve the treatment of BPD patients.

None Declared

When an adolescent or young adult is diagnosed with cancer, they’re frequently accompanied by their caregiver. Literature shows that caregivers of adolescents and young adult cancer survivors (AYACS) frequently experience high anxiety and depressive symptoms. Being these caregivers an important source of support to AYACS during this challenging journey, one question emerges: does caregivers’ mental health impact AYACS’ quality of life (QoL)?

Considering this, this study examined the associations between caregivers’ mental health and AYACS’ QoL.

Forty-eight dyads were recruited in four hospitals and one association in Portugal. AYACS were mostly women (62.5%) and off-treatment (62.5%). They were, on average, diagnosed at 18.9 years (range: 15-25) and currently 21.98 (range: 15-38). Their caregivers were mostly women (77.1%) and, on average, 47.02 years (range: 19-76). Parent-child dyads were the most frequent. The Quality of Life Questionnaire Core-30 assessed the AYACS’ QoL. Caregivers’ mental health, the Hospital Anxiety and Depression Scale, and the FCR7 scale assessed caregivers’ anxiety and depressive symptoms and fear of cancer recurrence, respectively.

Preliminary results show that among AYACS’ QoL, only low social functioning was significantly related to high anxiety and depression in caregivers. Treatment status was also significantly positively related to AYAs’ social functioning and negatively to caregivers’ anxiety and depression. AYAs and caregivers’ ages at recruitment were also negatively correlated with caregivers’ anxiety. Age of AYACS at diagnosis, living with caregiver, and type of caregiver were not related to AYACS social functioning nor caregiver anxiety and depression. A model was tested, showing that caregivers’ anxiety and depression predict AYAs’ social functioning, having treatment status as covariable.

Caregivers’ mental health and treatment status were shown to be important for AYACS’ QoL, especially social functioning. This supports the need to assess how caregivers are adapting to this new stage of life and provide specialized support when needed. This could indirectly have a positive impact on the QoL of AYACS. It’s important that the support provided considers the diverse challenges these caregivers face, which can differ from other caregiver groups.

None Declared

Electrodermal activity (EDA) measures the skin’s electrical properties. It varies according to the sweat gland’s activity which responds to the sympathetic nervous system (Boucsein W. Electrodermal Activity. Berlin: Plenum Press; 2012). Previous literature has reported lower EDA during bipolar and unipolar depressive episodes (Sarchiapone M, et al. BMC Psychiatry 2018; 18: 22 & Valenzuela-Pascual C, et al. Acta Psychiatr Scand 2024). Historically, heightened anxiety has been correlated with increased EDA, although findings in this area have been inconsistent (Naveteur J, et al. Int J Psychophysiol 2005; 56(3): 261–269).

This study aimed to determine whether significant differences in EDA exist among depressed patients based on their levels of anxiety.

We analysed EDA recordings from an E4 wearable device utilised by 29 depressed patients with bipolar disorder. They wore the device for a period of 48 hours without altering their daily routines. The tonic mean and phasic peaks parameters of EDA were extracted and analysed via a mixed-effects model for repeated measures, incorporating sleep state and anxiety level as variables. Anxiety levels were assessed based on the scores from item 10 on the Hamilton Rating Scale for depression, which reflects psychic anxiety.

The results indicated that anxiety levels did not significantly influence any of the models examined. However, in the phasic peaks model, there is a noteworthy interaction between anxiety level and sleep status (p < 0.01). Both models demonstrated a tendency towards increased EDA values in the high anxiety group although these findings did not reach statistical significance. This trend was consistent across both sleep states for the tonic mean model (Image 1). In contrast, the high anxiety group exhibited higher phasic peaks values (M [SD] = 2.33 [0.80-3.86]) compared to the low anxiety group (M [SD] = 2.33 [0.80-3.86]) only during wakefulness, although this difference was not statistically significant (p > 0.05) (Image 2).

Image 1:

Image 2:

These findings should be interpreted with caution due to the small sample size and the imbalance in the distribution of low (17%) versus high anxiety (83%) participants. Furthermore, anxiety is a multifaceted symptom that should be evaluated using a more comprehensive assessment tool. To validate these preliminary observations, it is essential to increase the sample size and use a more precise measure of anxiety.

None Declared

Binge-eating disorder (BED) is a significant global health challenge associated with obesity and psychological issues. The combination of Naltrexone-Bupropion (NB) has emerged as a promising pharmacological approach for managing eating behaviors.

This meta-analysis aims to evaluate the efficacy and safety of Naltrexone-Bupropion compared to placebo in managing eating behaviors, focusing on weight loss, binge-eating frequency, eating disorder psychopathology, quality of life, and adverse effects.

PubMed, Embase and Cochrane databases were searched for randomized controlled trials (RCT) comparing NB versus placebo for BED. Primary endpoints were weight loss and binge-eating frequency. Secondary endpoints included eating disorder psychopathology, depression, quality of life, food cravings, and adverse effects.The mean differences (MD) were applied with their 95% confidence intervals (95%CIs) for continuous outcomes, using a random-effects model. We used RevMan 5.4.1 for statistical analyses. Heterogeneity was assessed using the I² statistic.

Five RCTs with 2,466 adult participants (mean age 46.5 years, BMI 21.5-50 kg/m²) were included. NB was associated with a statistically significant reduction in weight loss percentage compared to placebo (MD -3.67%, 95% CI [-4.30; -3.03], I²=98%; Figure 1). However, no significant differences were found between NB and placebo in reducing binge-eating episodes(SMD 0.02, 95% CI [-0.30; 0.34], I2 =0%, Figure 2) , improving eating disorder psychopathology, alleviating depression, or decreasing food cravings. Although NB showed some benefits in improving the quality of life, the results were not statistically significant. NB was associated with a higher risk of adverse effects, including nausea, headache, constipation, dizziness, vomiting, insomnia, and dry mouth. The certainty of the evidences is in the Summary of findings (SOF) of GRADE evaluation (Figure 3). After leave-one-out sensitivity analysis, no single study was found to influence the effect estimate or drive heterogeneity excessively.

Image 1:

Image 2:

Image 3:

NB demonstrated efficacy for weight loss in individuals with eating behavior issues but showed no significant benefits for core eating disorder symptoms. The higher risk of adverse effects necessitates careful consideration in clinical decision-making. Further research is needed to determine optimal patient populations, treatment duration, and strategies to mitigate adverse effects.

None Declared

Difficulties in identifying and expressing one’s emotions, known as alexithymia, may influence the development of bipolar disorder. Attachment style reflects how a person forms and maintains interpersonal relationships

The aim of the study is to analyze the connection between alexithymia, attachment style and the clinical evolution of bipolar disorder.

The study was conducted on a sample of 31 subjects diagnosed with bipolar affective disorder, with a longitudinal evolution of at least 10 years. Sociodemographic parameters, alexithymia (Toronto Alexithymia Scale), and attachment style (Adult Attachment Scale) were evaluated. Data were collected and analyzed to identify potential correlations between levels of alexithymia and attachment styles, as well as their impact on the number of illness episodes.

There is no correlation between alexithymia and attachment style (r = -0.044, p > 0.05). A strong and significant correlation was observed between the level of alexithymia and the number of bipolar episodes (r= 0.907, p < 0.05). Attachment style did not have a significant influence on the course of illness. The educational level correlated inversely with alexithymia, but without being statistically significant (r=- 0.344, p > 0.05).

Alexithymia has an important role in the evolution of bipolar disorder, as it appears to be associated with an increased frequency in the number of illness episodes. The development of psychotherapy interventions to reduce alexithymia are essential to ensure a satisfactory quality of life for patients.

None Declared

The role of causality in reality has sparked a long and ongoing debate that began with Aristotle, but in its modern form, having reverberated to this day, found its origin in Hume. In psychiatry, causality gains additional layers since the domain of intelligibility does not extend as broadly as it does to the natural sciences, due to the nature of both its object and its method.

To explore proposals for understanding causality in psychiatry and mental illnesses.

A non-systematic literature review was conducted using the PubMed/MEDLINE and PhilPapers databases with the search terms “causality,” “psychiatry,” “interventionism,” and “causal grammar.” Reference bibliography was also consulted.

Causal interventionism is a way of understanding causality, where performing an intervention in groups allows the distinction between causality and mere correlation, utilizing counterfactuals that are verified in light of that intervention. The idea of causal grammar allows causal explanation to be thought of as a matter of finding a family of interventions in variables that make a difference to the outcome variable, governed by the causal grammar of that domain.

While each of the positions addresses certain issues—interventionism tackling various levels of explanation of causality in psychiatry, whether biological or psychodynamic, and causal grammar seemingly overcoming mechanismism—neither is fully satisfactory: in interventionism, the unfolding of causes, and in causal grammar, the pre-theoretical intuition seems challenged.

None Declared

The assessment of competence for medical decision-making is a critical aspect in the care of patients with mental health disorders. Since patient autonomy is a fundamental pillar of medical ethics, evaluating their capacity to make informed decisions ensures respect for their rights while safeguarding their well-being. An accurate assessment of competence not only facilitates safer and more appropriate decisions for the patient, but also allows physicians to act ethically and legally. Understanding the tools and criteria for such assessments is essential to balance patient autonomy with the protection of their health.

Identify factors that may influence a patient’s competence for specific decisions.

Familiarize with validated scales for assessing patient competence.

Identify strategies to improve competence in cases where necessary.

We present the case of a 65-year-old female patient without significant medical or psychiatric history, who was evaluated in the emergency department for cardiac tamponade, requiring urgent intervention via pericardiocentesis. At the time of the procedure, the patient refused the intervention due to severe pain, requesting voluntary discharge without undergoing further tests. Psychiatry was consulted to assess the patient’s decision-making capacity. An interview was conducted using the MacCAT-T (MacArthur Competence Assessment Tool for Treatment) scale.

A joint interview was conducted between the emergency medicine, intensive care, and psychiatry departments. The results indicated partial competence of the patient for this medical decision (understanding of the procedure and its impact on daily life, but high risk associated with the decision). The patient’s family was involved in the decision-making process, and it was decided to extend the emergency department stay for two additional days to promote better patient competence. No psychopathology was found that impaired the patient’s competence. Ultimately, it was determined that the patient had the necessary competence for this specific decision, and she was discharged home.

Interviews assisted by validated competence assessment scales, such as the MacCAT-T, can be a useful tool in challenging decision-making contexts in emergency situations, providing a more objective and ethical evaluation of patient competence.

None Declared