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

Mental and behavioral disorders resulting from alcohol use are a significant public health issue. As the nation’s most populous state, São Paulo encounters distinct challenges in this domain. According to the 2022 Census, the most recent national demographic survey, the state of São Paulo’s population is estimated at 44,411,238, representing approximately 21.9% of Brazil’s total population of 203,080,756. Understanding the epidemiological profile of these disorders is crucial to better assess their impact on the healthcare system and to guide effective resource allocation and management strategies.

The present study aims to analyze statistical data related to hospitalizations due to mental and behavioral disorders caused by alcohol use in the state of São Paulo in 2023.

A cross-sectional, descriptive, retrospective, and quantitative study was conducted, focusing on hospitalizations of individuals diagnosed with mental and behavioral disorders due to alcohol use in the state of São Paulo during 2023. Data were collected from the Department of Health Informatics of the Brazilian Unified Health System (DATASUS) within the “Hospital Information System of SUS” section, examining variables such as age range, gender, ethnicity, and length of hospital stay.

In 2023, São Paulo recorded 5,898 hospitalizations for alcohol-related mental and behavioral disorders, with total expenditures amounting to R$ 9,215,994.94. The average length of stay was 22.9 days, and the overall mortality rate was 0.64%, with 38 deaths. The highest number of hospitalizations occurred in the 35-39 years (12.1%), 40-44 years (14.7%), and 45-49 years (15.5%) age groups, which together accounted for 42.3% of all cases. Men represented 86.1% of hospitalizations, with an average length of stay of 23.4 days compared to 19.9 days for women. The ethnic distribution showed that 52.9% of hospitalizations were among White individuals, 8.3% were Black, 37.5% were Multiracial, and 0.7% were Asian. The longest average stays were among White individuals (25.1 days), followed by Black (22.2 days) and Multiracial (20.2 days). The overall mortality rate was 0.64%, with a slightly higher rate in men (0.65%) compared to women (0.61%). Black individuals had the highest mortality rate (1.23%), particularly among men (1.25%).

This study underscores the public health impact of alcohol-related mental and behavioral disorders in the state of São Paulo, particularly among middle-aged men. Ethnic disparities in hospitalization duration and mortality suggest the need for targeted healthcare strategies to meet diverse demographic needs. These findings highlight the importance of tailored interventions and strategic resource allocation to reduce the burden of alcohol-related disorders and enhance health equity.

None Declared

Children and adolescents frequently encounter a range of adverse childhood experiences (ACEs), which encompass various forms of adversity such as abuse, neglect, and household dysfunction. These experiences can have profound and lasting effects on an individual’s health and well-being. Alarmingly, nearly three out of four children—approximately 300 million aged 2 to 4 years—are subjected to physical punishment and/or psychological violence by parents and caregivers. Moreover, statistics indicate that one in five women and one in thirteen men were sexually abused during their childhood (ages 0-17). Despite the widespread prevalence of these experiences, trauma in children often goes unrecognized. The nature of trauma can make it challenging for both the child and caregivers to identify and articulate trauma-related symptoms. Children may struggle to understand or express their experiences, and caregivers might misinterpret or overlook these signs, leading to underreporting and a lack of timely intervention.

Experiencing adverse events during childhood or adolescence is particularly concerning because it can significantly disrupt normal developmental trajectories, affecting physical, emotional, and cognitive growth. During these formative years, the brain is highly plastic and sensitive to environmental influences, making it especially vulnerable to the effects of trauma and stress. Such exposure can result in long-term consequences, including a heightened risk of developing mental health disorders, behavioral issues, and challenges in academic and social settings.

In this context, early identification of children and adolescents who have faced adverse experiences is crucial. By providing appropriate support and resources early on, it is possible to foster resilience and promote more positive growth despite the challenges posed by early adversity.

Using tools like the Child PTSD Symptom Scale (CPSS), a widely recognized self-report instrument designed to assess the severity of post-traumatic stress disorder (PTSD) symptoms in children and adolescents aged 8 to 18, can be especially effective for identifying and evaluating the impact of trauma exposure in young individuals and facilitating early intervention.

Research published by the National Institute of Mental Health (NIMH) indicates that early identification through screening can lead to timely interventions, significantly reducing the psychological harm associated with trauma exposure.

Research strongly supports the effectiveness of screening for trauma symptoms in children and adolescents, emphasizing its critical role in early detection, timely intervention, and the prevention of long-term negative outcomes. This proactive approach not only addresses the immediate psychological impact of trauma but also contributes to improved long-term well-being and quality of life for those affected.

None Declared

There are limited data to guide treatment continuation decisions for clinicians caring for patients with treatment resistant depression (TRD). Identifying the magnitude of early improvement (at Weeks 4 and 8) as a predictor of long-term outcomes for TRD can guide treatment continuation decisions.

To evaluate the probability of achieving response or remission by Week 32 in patients with TRD after 4 or 8 weeks of esketamine nasal spray (ESK-NS) treatment, flexibly dosed in combination with an ongoing selective serotonin/serotonin-norepinephrine reuptake inhibitor (SSRI/SNRI).

ESCAPE‑TRD was a randomised phase IIIb trial comparing the efficacy of ESK-NS versus quetiapine extended release, both in combination with an ongoing SSRI/SNRI, in patients with TRD (Reif et al. NEJM 2023; 389 1298–309). Remission was defined as a Montgomery-Åsberg Depression Rating Scale (MADRS) total score ≤10, and partial response and response as ≥25% and ≥50% improvements, respectively, in total MADRS score (or remission). Long-term outcomes were based on the best outcome on-treatment across 32 weeks (≥1 instance of response or remission) from earliest outcome endpoint onwards. Non-responder imputation (NRI) was applied after treatment discontinuations.

336 patients were randomised to ESK-NS; 334 received ≥1 dose. Table 1 shows long-term outcomes following at least partial response, response or no partial response at Weeks 4 and 8. For example, among those who had at least a partial response at Week 4, 94.1% and 79.8% had response and remission by Week 32, respectively.

Image 1:

This analysis demonstrated a relationship between short- and long-term outcomes. Presence of at least partial response at Week 4 led to more favourable outcomes by Week 32. Moreover, most patients with response by Week 4 achieved remission by Week 32. Continued symptom improvements were observed beyond the induction phase even in some patients with no partial response at Week 4.

None Declared

34-year-old patient with multiple sporadic and brief contacts with mental health services, which he unilaterally chooses to discontinue. He has a long history of parasuicidal behavior dating back to adolescence. The patient does not report any prior diagnoses and has no history of inpatient admissions. The patient describes experiencing social isolation, lacking contact with his family of origin, and having no significant peer relationships.

The primary goal is to improve the patient’s engagement with mental health services, particularly in a case experiencing chronic, unaddressed symptoms, by utilizing intensive and structured programs. An additional objective is to address the patient’s self-identification with suicidal ideation.

The patient’s first contact with mental health services in this region of Spain was through the emergency department following a suicidal episode. During this encounter, the clinician introduced an intensive program designed to address suicidal ideation through regular visits over a set period. The patient agreed to participate and was subsequently enrolled in the PRISURE program at HGUGM in Madrid, where he received multiple sessions each month (between 2 and 4) with both a psychiatrist and a nurse from March to June 2024.

At the beginning of the program, the patient was fixated on the idea of suicide from a romantic/nihilistic perspective, displaying a pervasive rejection of interpersonal contact and a narcissistic element in interactions. He expressed persistent suicidal ideation. Over the course of frequent visits, the patient gradually began to connect with the chronic nature of his behaviors and started to identify additional symptoms. Despite partial engagement in the program, in this case with some missing consultations, his attendance at consultations improved significantly compared to his prior behaviors. An inpatient stay was initially offered and declined by the patient; however, after further consideration, he later presented to the emergency room and agreed to inpatient treatment. During the admission, a diagnostic assessment was carried out and discussed with the patient, revealing challenges in identity, object relations, and moral functioning, which were positioned within the spectrum of personality disorders, particularly highlighting narcissistic and antisocial traits.

Initially focused on his suicidal ideation, the patient, through the PRISURE program, gradually explored underlying difficulties contributing to his suicidal behavior. This process allowed him to accept further support, ultimately leading to an inpatient stay. Potential diagnoses were discussed openly with the patient, helping him to gain a clearer understanding of his lifelong challenges and enabling him to articulate these difficulties within the therapeutic context.

None Declared

Autoimmune encephalitis (AE) is a neuroinflammatory condition that often presents with psychiatric symptoms, such as psychosis, mood disturbances, and cognitive impairment, mimicking psychiatric disorders like schizophrenia or bipolar disorder. These symptoms frequently appear before neurological signs, complicating diagnosis and delaying treatment. Early recognition of this condition is fundamental to improve patients outcomes.

This review examines the psychiatric manifestations of AE, highlights challenges in differentiating AE from primary psychiatric disorders, and emphasizes the importance of interdisciplinary collaboration.

A nonsystematic review of literature focusing on the psychiatric presentation of AE.

AE often presents with psychiatric symptoms like hallucinations, delusions, agitation, and mood disturbances, frequently leading to misdiagnoses such as schizophrenia or bipolar disorder. In particular, anti-NMDA receptor encephalitis is associated with severe psychiatric manifestations like psychosis. Diagnosis is based on recognizing the rapid progression of psychiatric symptoms, along with seizures or other neurological signs, and confirming the autoimmune cause through specific autoantibody tests. Early treatment is essential to reverse these psychiatric symptoms. However, delayed diagnosis can result in persistent cognitive and psychiatric difficulties even after treatment. Diagnosing the psychiatric manifestations of AE is challenging due to their overlap with primary psychiatric disorders. However, the rapid onset and progression of symptoms, combined with neurological signs, should prompt clinicians to consider an autoimmune origin. Autoantibodies, particularly those against NMDA receptors, disrupt neurotransmitter systems, explaining the psychiatric features of AE. While psychotropic medications may provide temporary symptom relief, they do not target the underlying immune dysfunction. Timely immunotherapy significantly improves outcomes, and multidisciplinary collaboration between psychiatrists and neurologists is crucial for comprehensive patient care.

AE should be considered in cases of acute psychosis, mood disturbances, or cognitive impairment. Early diagnosis and treatment are key to preventing long-term psychiatric and neurological issues. Greater awareness of AE’s psychiatric presentations aids in distinguishing it from primary psychiatric disorders and facilitates timely treatment. Further research is needed to explore the neuroimmune mechanisms behind AE and optimize treatment. Collaborative efforts between psychiatry and neurology are essential for successful patient outcomes.

None Declared

Autism Spectrum Disorder (ASD) affects approximately 3% of children and adolescents in the U.S. This condition is increasingly prevalent worldwide and presents significant treatment challenges. Preliminary evidence suggests that cannabidiol (CBD) cannabis extracts may help manage ASD symptoms, but their efficacy and potential harms have not yet been systematically investigated.

To systematically review and meta-analyze the evidence from clinical trials investigating the efficacy and safety of CBD cannabis extracts in alleviating symptoms of ASD in children and adolescents.

We conducted a comprehensive search in MEDLINE, Embase, PsycINFO, and the Cochrane Central Register of Controlled Trials using MeSH terms including “Autism Spectrum Disorder,” “Cannabidiol,” “Cannabis,” “Child,” and “Adolescents.” No language or publication date restrictions were applied. The search was last updated on September 8, 2024. We included randomized, placebo-controlled trials on the efficacy or safety of CBD cannabis extracts in children and adolescents with ASD. For outcomes with limited study data, we used a fixed-effects model. The risk of bias in the included studies was evaluated using the Risk of Bias 2 tool.

Three studies met our criteria, comprising 276 participants (78.3% male; mean age 10.5 years, range 5 to 21). Interventions included orally administered CBD cannabis extracts, with tetrahydrocannabinol (THC) present in minimal amounts or in ratios of 9:1 to 20:1 CBD to THC. Dosages of CBD started at 1 mg/kg per day and were titrated up to 10 mg/kg per day. CBD cannabis extracts significantly enhanced social responsiveness (SMD = -0.75 [-1.08, -0.43], p < 0.01, I² = 17%), reduced disruptive behavior (SMD = -0.36 [-0.67, -0.06], p = 0.02, I² = 0%), and alleviated anxiety (SMD = -0.33 [-0.63, -0.03], p = 0.03, I² = 59%). CBD cannabis extracts also improved sleep quality, without reaching statistical significance (SMD = -0.19 [-0.49, 0.11], p = 0.21, I² = 0%). There was no significant difference in adverse effects between interventions and placebo (odds ratio = 2.11 [1.00, 4.46], p = 0.05, I² = 38%).

CBD cannabis extracts appear to provide meaningful benefits for children and adolescents with ASD, showing moderate improvements in social responsiveness and small yet notable reductions in disruptive behaviors and anxiety. They do not seem to significantly increase adverse effects compared to placebo, suggesting a favorable safety profile. These findings support the potential consideration of CBD cannabis extracts in ASD treatment plans. However, the review’s limitations include a small number of studies, limited sample sizes, and significant heterogeneity. Future research with larger, robust trials is needed to clarify the efficacy and safety of CBD cannabis extracts in managing ASD.

None Declared

Treatment for bipolar disorder (BD) predominantly focuses on psychopharmacology, including lithium, antipsychotics, and anticonvulsants. Electroconvulsive therapy (ECT) is highly effective for managing manic or depressive episodes, yet studies on the effects of anticonvulsant therapy as a modifying factor of clinical outcome during ECT are scarce.

To evaluate how concurrent anticonvulsant use affects seizure parameters and clinical outcomes of ECT in BD patients.

A comprehensive search of multiple databases (MEDLINE, Embase, Web of Science, PsycINFO, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov) was conducted on October 2, 2024, without language or publication date restrictions. Eligible studies included clinical trials and retrospective analyses comparing BD patients undergoing ECT with and without anticonvulsant use. Random-effects models were applied for a sufficient number of studies, while fixed-effects models were used for fewer studies. Subgroup and sensitivity analyses were conducted.

Six studies met the criteria, involving 359 participants (mean age: 29.7 years; 31.2% female). Five studies focused on the effect of concomitant treatment with valproate during a manic episode, and only one study included subjects in treatment with other anticonvulsants during different mood episodes of BD. Anticonvulsant users required significantly higher minimal electrical dosages to achieve adequate seizures (SMD = 0.71, 95% CI [0.46 to 0.95], p < 0.0001), as indicated by higher seizure thresholds and stimulus doses. Additionally, anticonvulsant use was associated with a significantly shorter seizure duration (SMD = -0.75, 95% CI [-1.10 to -0.41], p < 0.0001). However, no significant differences in symptomatic improvement were found between those using and not using anticonvulsants (SMD = 0.03, 95% CI [-0.19 to 0.25], p = 0.78).

Concurrent anticonvulsant use in BD patients undergoing ECT is associated with higher seizure thresholds and shorter seizure durations, but this does not affect clinical outcomes regarding disease severity. Based on these findings, discontinuation of anticonvulsants during ECT may not be necessary. This review was limited by the small number of studies, small sample sizes, and considerable heterogeneity. Additionally, the majority of the studies analyzed only included patients in the manic state of the illness. Further research is needed to explore whether variations in seizure parameters are linked to individual clinical outcomes in BD patients, the impact of different anticonvulsants on these parameters and the outcome for depressive and mixed episodes of bipolar disorder.

I. Borja De Oliveira: None Declared, E. Tolotti Leite: None Declared, I. Santos Raposo Andrade: None Declared, M. Geremias: None Declared, A. Stephany: None Declared, A. de Vasconcelos: None Declared, D. Xavier: None Declared, F. Wagner: None Declared, G. A. M. Alves: None Declared, M. O. Pozzolo Pedro: None Declared, D. Soler Lopes: None Declared, A. Balduino de Souza: 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.

Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) are prevalent conditions that significantly affect quality of life. Many patients with MDD and GAD do not respond adequately to conventional therapies, such as psychotherapy and antidepressants, highlighting the need for alternative treatments. In this context, electrostimulation, particularly Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (tDCS), has shown promise by modulating brain activity to relieve symptoms.

To assess the efficacy of TMS and tDCS in treating MDD and GAD.

This systematic literature review was conducted in SciELO, PubMed, covering the period from 2014 to 2024. After an initial selection of 15 articles, six studies were chosen based on relevance and reliability. The analysis focused on outcomes from controlled and randomized studies as well as systematic reviews and meta-analyses, involving TMS and tDCS.

The reviewed studies demonstrated that TMS and tDCS significantly reduce symptoms in MDD and GAD compared to placebo. One study evaluated the combined effect of tDCS with antidepressants, indicating a more pronounced clinical response and suggesting potential synergy between neuromodulation and pharmacotherapy in cortico-limbic circuits. However, larger sample sizes are needed to achieve robust statistical validation, clarifying the isolated impact of each modality and their combination.

Both TMS and tDCS represent effective therapeutic alternatives for patients with MDD and GAD, especially those refractory to conventional approaches. Although promising, implementing these techniques faces challenges, including high costs, the need for specialized professionals, and stronger scientific validation to enable widespread use. Expanding clinical knowledge and disseminating evidence-based guidelines can promote safe access to and usage of these therapies.

None Declared

Motherhood represents a challenge for all women, but it’s even more complex for those suffering from serious psychiatric illnesses such as Bipolar Disorder, Schizophrenia and Schizoaffective Disorder. The treatment of these women requires special care during the preconception, prenatal and postnatal phases, taking into account the risk of decompensation, the psychosocial factors involved and the difficult balance between the potential harm to the foetus and/or infant and the risks associated with not treating the mother. With the scarcity of randomised clinical trials and limited evidence, clinical practice guidelines become essential to determine the best therapeutic approaches to adopt.

To systematise the best evidence of care for pregnant and/or postpartum women with a history of psychotic illness.

Systematic literature review.

Mental health management in women with severe psychiatric illness who want to become pregnant should involve shared decision-making and multidisciplinary counselling. In women of childbearing age who are diagnosed with such conditions, adequate awareness of the illness and the need for family planning is the first step towards effective and safe long-term treatment. In the prenatal period, it’s essential to monitor early signs of relapse, to psychoeducate about the need to stop comorbid consumption and to carry out additional foetal ultrasounds at specific times to rule out malformations in foetuses exposed to antipsychotics and lithium. In the postnatal period, the risk of relapse is especially high. Careful monitoring in the first month after birth and regular review thereafter are essential. When necessary, hospitalisation in mother-baby units is the gold standard treatment. Pharmacological treatment of pregnant and breastfeeding women should weigh up the risks associated with non-intervention and the potential adverse effects on the foetus and lactating infant. The choice of psychotropic drugs should taking into account the varying safety profiles; for example, typical antipsychotics can cause extrapyramidal symptoms or withdrawal syndrome in the newborn and atypical antipsychotics metabolic syndrome. Nevertheless, despite the quality of the evidence, antipsychotics appear to be generally safe in pregnancy and breastfeeding.

The management of mental health care for this subpopulation must ensure that decisions are shared, follow-up is multidisciplinary, pre- and post-natal monitoring is individualised and pharmacological treatment is chosen based on the best balance between the needs of the mother and the safety of the foetus/infant.

None Declared

Major Depressive Disorder (MDD) affects up to 20 million people worldwide over their lifetime. 30% will not attain lasting symptom relief even after multiple treatment attempts. Mindfulness-based interventions (MBIs) have recently been added as adjunctive therapy for MDD. However, their efficacy as adjunctive therapy for difficult-to-treat depression (DTD) remains unclear.

This systematic review and meta-analysis sought to evaluate the efficacy of MBIs in treating DTD.

We conducted a search of MEDLINE, Embase, Web of Science, PsycINFO, Cochrane Central Register of Controlled Trials, the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. No restrictions on language or publication date were enforced. We included randomized controlled trials that compared MBIs with usual care or other treatments for unipolar DTD. In this context, DTD refers to the inability to achieve full remission of depressive symptoms despite receiving an adequate course of antidepressant medication. When a sufficient number of studies were available for the outcome analysis, we employed a random-effects model to address the variability between interventions. For outcomes based on a smaller number of studies, we used a fixed-effects model. Additionally, we performed influential and subgroup analyses to investigate the data further. To assess the risk of bias, we utilized the Risk of Bias 2 tool.

Eight studies met our inclusion criteria, comprising 449 participants (mean age = 42.6, predominantly female). The MBIs evaluated included mindfulness-based cognitive therapy, breathing-based meditation, and dialectical behavior therapy with mindfulness components. We found that adjunctive MBIs significantly reduced depressive symptom severity, with an effect size of g = -0.80 (95% CI [-1.32, -0.27], p = 0.0004). Additionally, MBIs caused significant improvements in anxiety (g = -0.57, 95% CI [-0.94, -0.20], p = 0.002) in four studies (n = 126), mindfulness (g = 0.32, 95% CI [0.06, 0.57], p = 0.02) in three studies (n = 243), and psychological well-being (g = 0.66, 95% CI [0.25, 1.07], p = 0.002) in three studies (n = 97).

MBIs demonstrate a substantial benefit for patients with DTD, with a large effect size in reducing depressive symptoms, a medium effect size in improving anxiety and psychological well-being, and a smaller effect size in enhancing mindfulness. Their ability to significantly alleviate depressive symptoms and improve overall mental health supports their integration into treatment plans for DTD. However, this review was limited by the small number of eligible studies, small sample sizes, and high heterogeneity between studies. To better understand the effectiveness of MBIs for DTD, larger clinical studies are needed.

I. Borja De Oliveira: None Declared, L. Robles Rafael: None Declared, M. Kraide Piedade de Abreu: None Declared, A. Stephany: None Declared, D. Soler Lopes: None Declared, M. Geremias: None Declared, F. Wagner: None Declared, A. de Vasconcelos: 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

Studies indicate that approximately 50% to 70% of children will experience at least one adverse childhood event, such as abuse, neglect, household dysfunction, community violence, or natural disasters.

Yet, accutely traumatized children are rarely seen in outpatient clinics until months or even years later, often presenting with chronic symptoms or maladaptive behaviors. Exposure to adverse childhood experiences (ACEs) has been linked to a wide range of psychiatric disorders, including mood disorders, personality disorders, and substance abuse. Beyond mental health, ACEs have been correlated with higher rates of chronic medical conditions such as heart disease, metabolic disorders, and autoimmune diseases, as well as a reduced life expectancy. Furthermore, children who are abused are more likely to perpetuate abuse in adulthood, leading to a cycle of violence that spans generations. Given its widespread and long-lasting effects, childhood trauma is indeed a public health pandemic.

Enhancing our response to and prevention ACEs requires a multisectoral approach.

One key approach is a collaborative response with law enforcement. Police officers have unique access to children at risk, but they often lack the specialized training to respond effectively. With appropriate training, law enforcement can serve as a critical bridge to mental health assessments for children and their families.The Child Development-Community Policing Program exemplifies such collaboration. This initiative, a partnership between the New Haven Department of Police Services and the Yale University Child Study Center, brings together police officers and mental health professionals for joint training, consultation, and support. This partnership enables them to provide direct, interdisciplinary intervention to children and families who are victims, witnesses, or perpetrators of violent crimes. Law enforcement can refer cases to the Child and Family Traumatic Stress Intervention (CFTSI), designed for the peritraumatic period.

CFTSI focuses on enhancing the caregiver’s understanding and response to both their own and their child’s traumatic reactions. It also aims to improve the child’s comprehension of their emotional responses. The intervention includes establishing strategies to address trauma responses and assessing pre-existing vulnerabilities to determine the need for long-term treatment. Studies have shown that CFTSI is effective in reducing post-traumatic stress symptoms in children and adolescents. A randomized controlled trial (RCT) published in Child Abuse & Neglect found that children who received CFTSI had significantly fewer post-traumatic stress symptoms compared to those who received standard care.

Early intervention like this can make a significant difference in the lives of affected children, helping to mitigate the long-term impact of trauma and promote healing and resilience.

None Declared

The Porto Municipal Health Plan for 2022-2024 prioritized initiatives targeting addictions within the community. Built in the collaboration between the Public Health Unit, the Faculty of Psychology (FPCEUP), and the Drug Addiction Intervention and Reduction Division (DICAD), Porto aimed to comprehensively address addiction-related challenges. This includes developing monitoring tools, identifying areas lacking intervention, and promoting innovative social programs.

To define and implement a plan from prevention to treatment of addictive behaviors and addiction within the Porto Municipal Health Plan.

After defining priorities within this scope, tasks were defined together with the different institutions of the Municipality, including disseminating information on tobacco and alcohol legislation and improving community literacy on health-conscious environments. Additionally, integrated projects focus on evaluating existing interventions, identifying best practices, and fostering collaboration among entities to address addiction effectively were listed as main steps.

By aligning with strategic objectives outlined in the Porto Municipal Health Plan, such as building citizen and professionals’ capacity, improving prevention strategies, and facilitating access to resources, Porto is addressing addictive behaviors comprehensively. Initiatives include capacity building, implementing intervention strategies, and promoting harm reduction approaches in recreational settings.

Porto’s efforts to combat addiction highlight its commitment to public health. Through targeted communication, integrated projects, and resource optimization, Porto aims to mitigate the impact of addictive behaviors and promote a healthier community, aligning with the Municipal Health Plan.

None Declared

The collaboration between nursing, psychology, and psychiatry is essential for delivering comprehensive and effective mental health care. A multidisciplinary approach ensures that patients receive holistic support where everyone is aligned on the patient’s needs, treatment progress, and level of risk, and drawing on the unique skills and expertise of each discipline. Without proper coordination, there is a higher risk of gaps in care, conflicting interventions, or misunderstandings that could negatively impact the patient’s safety and well-being.

To highlight the importance of collaborative work between nursing, psychology, and psychiatry within the context of an acute, short-term, intensive outpatient program for suicidal ideation, such as PRISURE, is essential. For patients at high risk of suicide, particularly those experiencing acute symptoms, a combined multidisciplinary approach is critical to providing effective and timely care.

The program distinguishes between two types of interventions: an intensive program and a regular program, both offering a couple months long intervention but differing in the frequency of visits. The entire team meets weekly to assess new cases and discuss patients within the intensive program. An additional meeting is held to coordinate care for patients in the regular program between nursing and psychiatry. Regular multidisciplinary meetings are key to ensuring a coherent and unified approach across both programs. Appointment schedules are carefully coordinated to minimize the time between consultations, ensuring continuous and consistent follow-up for patients. The program also coordinates with regular mental health out-patient clinics within the public health system, to garantee a good transition of care.

During these collaborative meetings, each specialist shared their assessments and observations on the patient’s progress, enabling the team to develop a unified therapeutic plan. Any changes in symptoms or new events are promptly communicated among all treating professionals, allowing for a rapid and coordinated multidisciplinary response. The diverse perspectives of each team member contribute to a more nuanced and comprehensive understanding of the patient’s needs and treatment.

In summary, the collaboration between nursing, psicology and psychiatry creates a synergistic approach that is essential for delivering high-quality, patient-centered mental health care, particularly for those experiencing suicidal ideation.

None Declared

The treatment of Borderline Personality Disorder (BPD) presents a clinical challenge in many ways, as the current recommended psychotherapies are often insufficient or unavailable. As of today, no pharmacological treatment has been approved by regulatory agencies for the treatment of BPD, even though up to 96% of these patients receive at least one psychotropic medication. Some professional societies cautiously recommend the off-label and symptom-targeted use of psychotropic agents as part of a multimodal approach, whereas others recommend its use only in the event of an acute crisis.

Conduct a non systematic review of literature regarding the efficacy of mood stabilizers (MS) and antipsychotics (AP) in the treatment of patients with BPD.

A search in the PubMed database was performed with the terms borderline, behaviour and mood stabilizer or antipsychotic or pharmacological, filtered for reviews, systematic reviews and meta-analysis over the last 20 years.

The efficacy of pharmacotherapies for the treatment of BPD is limited to improvement of individual symptoms but not of global functioning nor the severity of the condition overall, although the evidence is of very low certainty. For affective dysregulation and impulsive-behavioural dyscontrol, the highest efficacy emerged for MS, as AP shows a lower yet significant effect size. Both drug classes seem to improve symptoms of anger, with evidence suggesting a much larger (and significant) effect-size for aripiprazole compared to other AP. For cognitive-perceptual symptoms, only AP proved to be effective, showing higher effect-size in longer trials, which suggests their slowly progressive efficacy on this symptom dimension. Although many studies suggest a superior anti-suicide effect of clozapine in schizophrenia, the evidence is very uncertain about the effect of any medication compared with placebo on self-harm and suicide-related outcomes in patients with BPD, indicating little to no effect. There appears to be no significant difference between pharmacotherapy and placebo in terms of dropout rates, but there is insufficient data regarding drug tolerability in these patients.

In congruence with some clinical practice guidelines, pharmacotherapy can be used to target specific core-symptoms on BPD, even though evidence on its efficacy is of very low certainty and limited to the improvement of individual symptoms but not the overall condition. Mood stabilizers and antipsychotics can have a positive effect on affective dysregulation, anger and impulsive-behavioural dyscontrol, and antipsychotics proved to be effective for cognitive-perceptual symptoms.

None Declared

Major depressive episodes (MDEs) occur in mood disorders such as major depressive disorder (MDD) and bipolar disorder (BD), affecting nearly one in four U.S. adults over their lifetime. The neurotrophic hypothesis suggests that disruptions in growth factor signaling contribute to MDEs. While brain-derived neurotrophic factor (BDNF) is well-studied, vascular endothelial growth factor (VEGF) may also play a crucial role, though evidence of its association with MDEs is inconsistent. Understanding VEGF is important for identifying predictors of treatment outcomes, such as those related to electroconvulsive therapy (ECT). This study explores the relationship between VEGF and MDEs, focusing on implications for ECT effects.

To consolidate evidence from studies evaluating the association between VEGF and ECT outcomes in patients experiencing an MDE.

A systematic search for published clinical trials and cohort studies was conducted on August 13, 2024, using keywords including ECT, VEGF, MDE, and mood disorders, with no language or publication date restrictions. We selected studies enrolling patients in a current MDE related to MDD or BD, excluding those focused on manic episodes. A fixed-effects or random-effects model was applied. Subgroup analyses were performed to investigate the data further.

Seven studies involving 621 participants (61.9% female; mean age: 50.2 years) were preselected. Six studies measured plasma VEGF levels; one assessed cerebrospinal fluid (CSF) levels. Plasma VEGF levels did not differ significantly between healthy controls and MDE patients, either before (SMD = 0.02 [−0.17; 0.21], p = 0.84, I² = 0%) or after ECT (SMD = 0.11 [−0.21; 0.44], p = 0.50, I² = 0%). Of the five studies reporting post-ECT VEGF levels, three found a significant increase from baseline. A significant correlation was observed between baseline plasma VEGF levels and depression response to ECT (r = 0.34, Z = 4.92, p < 0.0001, I² = 0%). Of the five studies examining increased VEGF levels after ECT and symptom reduction, only one found a significant association. A sensitivity analysis indicated substantial heterogeneity when including the CSF study.

Plasma VEGF levels were not significantly different in MDE patients compared to healthy controls, either before or after ECT. Baseline plasma VEGF levels positively correlated with ECT treatment response, suggesting they may provide neurotrophic support and predict outcomes. Despite robust findings and minimal heterogeneity, this analysis was limited by the low number of studies and small sample sizes. Further research is needed to explore the association between MDEs and VEGF, especially in the CSF, and to clarify the role of baseline VEGF in ECT treatment response.

I. Borja De Oliveira: None Declared, G. A. M. Alves: None Declared, D. Soler Lopes: None Declared, A. de Vasconcelos: None Declared, A. Stephany: None Declared, F. Reis Soares: None Declared, M. Kraide Piedade de Abreu: 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

Pharmacogenomic testing is a cutting-edge precision medicine tool that analyzes genetic variations influencing drug metabolism. By assessing an individual’s unique genetic profile, this testing enables the personalization of treatment strategies, improving therapeutic outcomes, and enhancing patient care. Integrating pharmacogenomic testing into clinical practice holds great promise for improving the efficiency and effectiveness of mental health care delivery. In this case, a 17-year-old patient presented with a severe case of obsessive-compulsive disorder showed no response to treatment with sertraline (250mg). Sertraline is metabolized into N-desmethylsertraline through multiple pathways, including CYP3A4, CYP2C19, CYP2B6, and other CYP enzymes, with pharmacokinetic studies identifying CYP2C19 as the primary metabolic pathway.

The patient had a poor response to pharmacological treatments previosly used, our aim was to determine the possible involvement of patient specific responses to treatments based on his pharmacogenetic proffile.

A blood sample was submitted for pharmacogenetic testing. This analysis includes genes involved in the metabolism of sertraline (CYP2C19, CYP3A4, and, to a lesser extent, CYP2B6 and CYP2D6) as well as other pharmacogenes associated with the metabolism and response to psychiatric medications, including HTR2A, OPRM1, COMT, and DRD2.

Gene | Genotype | Inferred Phenotype

• - CYP2C19 | *1/*1 | Normal Metabolizer

• - CYP2B6 | *1/*1 | Normal Metabolizer

• - CYP2D6 | *3/*4 | Poor Metabolizer

• - CYP3A4 | *1/*1 | Normal Metabolizer

• - OPRM1 | AA | Normal Genotype

• - HTR2A (rs7997012 A>G) | GG | Normal Genotype

• - HTR2A (rs6311 G>A) | GA | Heterozygous

• - DRD2A (rs1799732 G>-) | GG | Normal Genotype

• - DRD2A (rs1799978 A>G) | TT | Normal Genotype

The patient did not exhibit clinically significant alterations in the metabolism of sertraline (CYP2C19, CYP3A4 and CYP2B6). However, the lack of response to treatment should be further investigated, factors such as potential drug interactions, and other variables including age, renal function, and liver function should be considered. In contrast, the patient has notable alterations in CYP2D6 and HTR2A, which could be important for guiding future treatment decisions. Variants in HTR2A can significantly influence a patient’s response to antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), specific polymorphisms in HTR2A, such as rs7997012 and rs6311 have been associated with differences in treatment outcomes, side effects, and remission rates. Has a CYP2D6 poor metabolizer, this patient may be at risk for higher drug levels and increased side effects when taking medications such as venlafaxine, fluoxetine, paroxetine (SSRIs), haloperidol, and risperidone.

None Declared

Although carotid endarterectomy (CEA) or carotid artery stenting (CAS) is recommended for symptomatic extracranial carotid stenosis of 50–99%, the COVID-19 pandemic significantly impacted resources. CAS therefore offered potential advantages as access to the angiosuite was seemingly easier than access to operating rooms. The primary objective was to determine the frequency of serious and non-serious complications following CAS before and during the COVID-19 pandemic.

We performed a retrospective cohort study of consecutive patients who received CAS at the Ottawa Hospital, Canada, from June 2019 to May 2021. We reviewed baseline demographics, imaging, as well as intraprocedural and postprocedural complications based on chart review. We performed multivariable logistic regression to determine associations between clinical and safety outcomes.

We included 47 patients in the pre-pandemic period and 93 patients in the pandemic period (mean age = 70.4 years; 54% female; P = 0.287 for age and P = 0.962 for sex, respectively). The combined rate of intraprocedural and postprocedural serious complications (ischemic stroke, intracerebral hemorrhage, myocardial infarction or death) was 7.1%. Eight strokes occurred, and one patient with a postprocedural ischemic stroke died 11 days after stenting. Complication rates were similar before and during the pandemic (aOR 1.040, 95% CI 0.466–2.321). The number of referrals for CEA during the pandemic period decreased by 50%.

In this cohort of consecutive patients undergoing CAS at a Canadian comprehensive stroke center before and during the COVID-19 pandemic, the rates of stroke and death were similar to pre-pandemic conditions and were generally consistent with the published literature.