Under the Universal Health Care Act of the Philippines, all health technologies should undergo health technology assessment. This manuscript details the process of the development of the Philippine guidance document for the use of real-world evidence (RWE) in the clinical evaluation of health technologies.

This study consisted of two phases. Phase 1 was a comprehensive, systematic review of all available HTA methods guides and literature related to the use of RWE in the clinical evaluation of health technologies. Based on the results of the review, a draft HTA methods guide on the use of RWE was created. Phase 2 was a validation study by expert consultation through key informant interviews (KIIs), and pilot assessment of the methods guide.

Seventy-nine articles and nine guidance papers were included, with pertinent information extracted and organized into sections. The first draft covered definitions of RWE, guidance for RWE utilization, scoping and selecting RWE, critical appraisal, data extraction, and synthesis and analysis of RWE. Changes were made to this draft based on the KIIs and pilot assessment results to produce the final output of the methods guide.

This document describes the process of creating a Philippine guidance document that covers the definition of RWE and the appropriate methods for conducting systematic search, screening, critical appraisal, data extraction, data analysis, and synthesis of RWE.

Early life adversity (ELA) such as physical and emotional abuse has been recognized as an important risk factor for depression in adults. Past research has shown that ELA was associated with alteration in the hippocampus, a key region involved in stress sensitivity, emotional learning and memory. However, relatively little is known about the role of the hippocampus in the relationship between ELA and depression in adolescents.

This study aimed to investigate whether the hippocampal volume and hippocampus resting-state functional connectivity (RSFC) moderated the relationship between ELA and depressive symptom severity in adolescents with major depressive disorder (MDD).

This study included 73 adolescents with MDD (age M (SD) = 15.0 (1.5) years, 51 girls). The participants completed the Early Trauma Inventory and Children’s Depression Rating Scale to assess ELA and depressive symptom severity, respectively. Resting–state functional and structural T1 images were collected using a Siemens 3T MR scanner and preprocessed using AFNI and FreeSurfer routines. The average BOLD time-series was extracted from our regions-of-interest (ROIs), the bilateral hippocampus and dorsolateral prefrontal cortex (DLPFC). An ROI-to-ROI RSFC analysis was conducted to calculate Pearson correlation coefficients between the hippocampus and DLPFC ROIs. The correlation coefficients were transformed to Fisher’s z. We performed correlation and moderation analyses to test our moderation model (Figure 1) after controlling for age and sex.

Emotional abuse, one form of ELA, was significantly correlated with depressive symptoms in adolescents with MDD (r = 0.25, p < .05). Bilateral hippocampus – left DLPFC RSFCs moderated the association between emotional abuse and depressive symptoms in adolescents with MDD (ps < .01). The association between emotional abuse and depressive symptoms was stronger when bilateral hippocampus – left DLPFC RSFCs were lower (left hippocampus – left DLPFC RSFC, -1D: b = 3.72, SE = 1.06, p < .001; right hippocampus – left DLPFC RSFC, -1D: b = 4.15, SE = 1.04, p < .001) than when they were greater (left hippocampus – left DLPFC RSFC, +1D: b = -0.09, SE = 1.05, p = .93; right hippocampus – left DLPFC RSFC, +1D: b = -0.10, SE = 0.98, p = .69) (Figure 2). Hippocampal volumes also moderated the relationship between emotional abuse and depressive symptoms, but the results did not remain significant after correcting for multiple comparisons.

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Our findings suggest the important role of hippocampus RSFC with the DLPFC in the relationship between emotional abuse and depressive symptoms in adolescents with MDD.

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Pathological anxiety in social anxiety disorder (SAD) is characterized by dysregulated arousal and altered cardiac autonomic responses, with lower heart rate variability (HRV) potentially indicating emotional dysregulation.

This study aimed to explore the relationship between peripheral and central autonomic nervous system activity during emotional processing in patients with SAD.

Thirty-two patients with SAD and 41 healthy controls participated in a passive viewing task that alternated between neutral and angry faces. We analyzed correlations between brain activation during emotional processing and root mean square of successive differences (RMSSD) in HRV during both resting state and task conditions.

Unlike the controls, the SAD group showed a trend toward significant correlations between baseline RMSSD and left anterior insula activity during neutral face processing (R2 = 0.118, β = -0.003, F= 3.886, p = .058) and significant correlations with both left anterior insula and right amygdala activities during angry face processing (R2 = 0.157, β = -0.003, F= 5.415, p = .027 and R2 = 0.135, β = -0.002, F= 4.360, p = .046, respectively). In the control group, task RMSSD was significantly correlated with right amygdala and right dorsomedial prefrontal cortex activities during neutral face processing (R2 = 0.160, β = -0.003, F=6.284, p = .017 and R2 = 0.222, β = -0.009, F=9.443, p = .004, respectively), while in the SAD group, correlations were found with the right parahippocampal gyrus (R2 = 0.148, β = -0.002, F=4.5, p = .044). Additionally, only in the control group, RMSSD during neutral face trials was significantly correlated with neural activation during angry faces processing (R² = 0.132, β = -0.002, F=4.856, p = .035).

This study identifies distinct patterns of autonomic and neural responses to emotional stimuli in SAD patients, highlighting heightened autonomic readiness and reduced flexibility when processing social threats.

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Breast cancer is one of the most common cancers in women. Depression and anxiety affect not only health behaviors and treatment adherence but also cancer recurrence. Several studies have demonstrated that psychosocial interventions improve both mood symptoms and survival in breast cancer patients.

Psychodynamics plays a significant role in psychological distress and maladaptive behaviors. Therefore, psychoeducation focusing on patient dynamics can offer more individualized and tailored intervention. This study investigated the impact of psychodynamic-oriented psychoeducation for early-stage breast cancer patients on both psychological distress and disease trajectory, compared to those receiving standard cancer treatment only.

Psychodynamic-oriented psychoeducation aims to provide guidance on managing psychological distress during cancer treatment, based on clinical and psychodynamic assessments of patients. A trained psychiatrist delivered this 60-minute intervention at least once within one-week post-mastectomy. The study included early-stage breast cancer patients (AJCC stages 0-IIIA) who underwent mastectomy at Kyungpook National University Hospital (KNUH) and Kyungpook National University Chilgok Hospital (KNUCH) between 2008 and 2015, excluding those with prior cancer history. Participants were divided into two groups: control (standard treatment) and treatment (standard treatment plus psychodynamic-oriented psychoeducation). Outcomes measured included breast cancer recurrence, disease-free survival, and psychological assessments using the Hospital Anxiety and Depression Scale (HADS) and Experiences in Close Relationships-Modified 36 (ECR-M36) at baseline and 12 months post-intervention in the treatment group. Propensity score matching was used to control for recurrence-related factors.

The median follow-up was 72.6 months. Recurrence rates were comparable between control and treatment groups (control vs. treatment: 9.0% vs. 8.3%, p=0.763). In a subanalysis of recurrent cases, the treatment group showed longer disease-free survival (51.3 vs. 32.5 months, p=0.038). (Table 1 and Figure 1) HADS scores showed no significant difference at 12 months, while ECR-M36 showed significant decreases in total and anxiety subscale scores at 12 months (p<0.05). (Table 2)

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This study, unique in integrating psychodynamic principles into psychoeducation, showed improvements in attachment-related anxiety and longer disease-free survival, specifically among recurrent cases, suggesting the potential benefits of this approach for certain breast cancer patients. Further research is needed to identify which patients might benefit most from this intervention.

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There is an increasing demand for alternative evaluation tools capable of providing objective assessments or highlighting differences. Functional near-infrared spectroscopy (fNIRS) and heart rate variability (HRV) are frequently employed as biomarkers for assessing emotional status.

This study hypothesizes that emotional expressions, particularly unpleasant emotions and their variations in adolescents, are associated with changes in heart rate variability and frontal lobe activity.

A total of 55 adolescents participated in this study. Following the completion of clinical scales, assessments of both HRV and fNIRS in a resting state were conducted for all participants for 200 seconds. After a 10-second rest, HRV and fNIRS assessments were performed during a positive emotional perception test for 192 seconds. Following a 30-second rest, the same procedures were repeated during a negative emotional perception test.

The correction rate of unpleasant emotional perception negatively correlated with HRV measures (unpleasant-HF, unpleasant-SDNN) and positively with pleasant-RMSSD. Additionally, it positively correlated with the ΔaccHBO2 within the left dorsolateral prefrontal cortex (DLPFC). Conversely, the correction rate of pleasant emotional perception negatively correlated with increases in ΔaccHBO2 within the left DLPFC. Both unpleasant-SDNN and unpleasant-HF negatively correlated with ΔaccHBO2 within the left DLPFC.

The perception of negative emotions in adolescents is associated with individual levels of depression and anxiety. Furthermore, the perception of negative emotions significantly correlates with changes in HRV and activity within the left DLPFC. There is also evidence suggesting a link between changes in HRV and brain activity in response to the perception of negative emotions.

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Physical activity has been associated with improved sleep health, yet the specific impact on individuals with depressive disorders remains underexplored. This study aims to investigate the relationship between regular physical exercise and sleep duration in individuals diagnosed with a depressive disorder, utilizing data from the Behavioral Risk Factor Surveillance System (BRFSS). Understanding this relationship could inform integrative approaches to managing depressive symptoms and improving overall sleep health in this population.

• - To analyze the impact of regular physical exercise on sleep duration among individuals with a depressive disorder.

• - To assess the potential role of physical exercise in mitigating inadequate and prolonged sleep patterns within this population.

Data from the BRFSS for the years 2013, 2014, 2016, 2018, 2020, and 2022 were analyzed to explore the relationship between physical exercise and sleep duration in individuals with depressive disorders. The study included 518,214 participants who reported having a depressive disorder. Of these, 342,276 (weighted 68.5%) reported engaging in physical exercise within the past 30 days. Sleep duration was categorized, and regression analysis was used to assess the association between recent physical exercise and sleep duration.

The analysis indicated that individuals with a depressive disorder who engaged in physical exercise in the past 30 days were less likely to experience inadequate sleep (6-7 hours, Odds Ratio [OR] = 0.83, p < 0.05) and more likely to achieve adequate sleep (7-9 hours, OR = 1.18, p < 0.001) compared to those who did not exercise. They were slightly less likely to have prolonged sleep (9-12 hours, OR = 0.9, p < 0.05). No significant associations were found for very inadequate sleep (<6 hours, OR = 1.34) and very prolonged sleep (>12 hours, OR = 0.6) with physical exercise (p > 0.05).

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Regular physical exercise appears to be associated with better sleep outcomes in individuals with depressive disorders, particularly in promoting adequate sleep duration (7-9 hours). Exercise was linked to a reduced likelihood of inadequate sleep (6-7 hours) and a slight decrease in prolonged sleep (9-12 hours). However, no significant associations were found for very short (<6 hours) or very prolonged (>12 hours) sleep durations. These findings highlight the potential role of physical exercise in managing sleep health within this population. Incorporating regular physical activity into treatment plans for depression may improve sleep quality and contribute to better overall health outcomes. Further research is needed to understand the mechanisms and long-term effects of exercise on sleep patterns in those with depressive disorders.

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Older adults with treatment-resistant depression (TRD) can be treated with augmentation or switched to a different drug.

We aimed to identify factors that moderate the effectiveness of these strategies on treatment outcomes to guide the selection of the optimal strategy for each patient.

We analyzed data from 742 older adults with TRD in the Outcomes of Treatment-Resistant Depression in Older Adults (OPTIMUM) clinical trial. All participants were randomized to one of two treatment strategies, which were augmentation with aripiprazole, bupropion, or lithium; or switching to bupropion or nortriptyline. Treatment outcomes were change in MADRS scores and remission after 10 weeks. Age, burden of comorbid physical illness, number of adequate previous antidepressant trials, presence of executive cognitive impairment, and clinically relevant comorbid anxiety were examined as potential moderators of the effect of the two treatment strategies (augmentation vs. switching) on treatment outcomes.

Overall, augmentation produced more improvement in MADRS scores and produced a higher rate of remission than switching. For change in MADRS scores after 10 weeks of treatment, the number of adequate previous antidepressant trials was the only significant moderator of the superiority of augmentation over switching (b = -1.6, t = -2.1, p = 0.033, 95%CI [-3.0,-0.1]). There were no significant moderators for remission.

Older patients with TRD with less than three previous antidepressant trials benefit more from augmentation than from switching. Future studies validating this finding with different drugs in more diverse samples can facilitate their application in real world settings.

H. Kim Grant / Research support from: Dr. Kim reports grant support from the PSI foundation (R23-21). She is supported by the Canadian Institutes of Health Research (CIHR) and the Temerty Faculty of Medicine (Chisholm Memorial Fellowship)., J. Karp: None Declared, H. Lavretsky Grant / Research support from: Dr. Lavretsky received support from grants (K24 AT009198, R01 AT008383, and R01 MH114981) from the NIH., D. Blumberger Grant / Research support from: Dr. Blumberger reports grants from Canadian Institutes of Health Research (CIHR) and the Temerty family through the Centre for Addiction and Mental Health (CAMH) Foundation during the conduct of the study; nonfinancial support from Magventure (in-kind equipment support for investigator-initiated research); grants from Brainsway (principal investigator of an investigator-initiated study and site principal investigator for sponsored clinical trials), National Institutes of Health (NIH), Brain Canada Foundation, Campbell Family Research Institute, and Patient-Centered Outcomes Research Institute outside the submitted work; received medication supplies for an investigator-initiated trial from Indivior; and has participated in advisory boards for Janssen and Welcony., P. Brown Grant / Research support from: Dr. Brown received additional support from the National Institute of Mental Health OPTIMUM NEURO grant (5R01MH114980)., A. Flint Grant / Research support from: Dr. Flint has received grant support from the US National Institutes of Health, the Patient-Centered Outcomes Research Institute, the Canadian Institutes of Health Research, Brain Canada, the Ontario Brain Institute, and Alzheimer’s Association., E. Lenard: None Declared, P. Miller: None Declared, C. Reynolds Shareolder of: Dr. Reynolds receives payment from the American Association of Geriatric Psychiatry as Editor-in-Chief of the American Journal of Geriatric Psychiatry and royalty income for intellectual property as co-inventor of the Pittsburgh Sleep Quality Index., S. Roose: None Declared, E. Lenze Grant / Research support from: Dr. Lenze received additional support from the Taylor Family Institute for Innovative Psychiatric Research at Washington University School of Medicine, as well as the Washington University Institute of Clinical and Translational Sciences grant (UL1TR002345) from the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH)., B. Mulsant Grant / Research support from: Dr. Mulsant received additional support from the Labatt Family Chair in Biology of Depression in Late-Life Adults at the University of Toronto. He holds and receives support from the Labatt Family Chair in Biology of Depression in Late-Life Adults at the University of Toronto. He currently receives or has received during the past three years research support from Brain Canada, the CAMH Foundation, the Canadian Institutes of Health Research, and the US National Institutes of Health (NIH); Capital Solution Design LLC (software used in a study funded by CAMH Foundation), and HAPPYneuron (software used in a study funded by Brain Canada).

Recently, CBT-based digital therapy has been developed and used for the treatment of various psychiatric disorders, including insomnia, depression, anxiety and panic disorders, and alcohol/drug addiction. In the United States, the first game-based digital therapy for ADHD has also received FDA approval and is being used for the treatment of children and adolescents with ADHD.

We conducted a randomized controlled study to examine the effectiveness of a digital therapeutic (model named ‘ADAM-101’) for children with ADHD in Korea, which was developed by Dragonfly GF Co., Ltd.”

Participants are 18 children with ADHD, aged 7 to 13 years, who are visiting the Department of Child and Adolescent Psychiatry at Seoul National University Children’s Hospital in Seoul, Korea. ADHD children with an IQ of 70 or above, who are currently taking stimulants and do not have other pediatric psychiatric disorders such as depression, anxiety disorders, tic disorders, ASD, were included in the study. They were randomly assigned to either the combined treatment group (medication + digital therapy, n = 9) or the medication-only group (n = 9). The digital therapy program was conducted using a tablet PC for 25 minutes a day, 5 days a week, for 4 weeks. Before starting the study, permission was obtained from the Institutional Review Board of Seoul National University Hospital. As a primary outcome measure, the Korean version of the Continuous Performance Test (KAT) was administered individually to the ADHD children by child clinical psychologists to assess inattention, impulsivity, and processing speed, after obtaining written agreement to participate in the study. Additionally, the Korean version f the ADHD Rating Scale-5 (K-ARS-5) was administered to the parents of the ADHD children.

We have not yet completed the study. Currently, out of the 18 ADHD children, 8 have completed the training and both pre- and post-assessments. All training and evaluations are expected to be completed by early October, and an analysis to verify the effectiveness of the digital therapeutic will be conducted in mid-October. Since this was not a double-blind study, we observed that, based on some children’s CPT and K-ARS-5 results, children in the combined treatment group tended to show a reduction in omission and commission errors on the CPT compared to those in the medication-only group. Additionally, there was a trend towards a reduction in inattention and hyperactivity-impulsivity scores on the K-ARS-5 in the combined treatment group.

Despite being conducted with a small sample, these results suggest the potential efficacy of the digital therapeutic (model named ‘ADAM-101’) for Korean ADHD children, indicating its potential clinical usefulness as an adjunctive treatment tool for ADHD children

None Declared

We present the case of a 61-year-old retired woman with hypothyroidism and rheumatoid arthritis who was diagnosed with bipolar disorder in 2006 after a manic episode. Her initial treatment included venlafaxine, valproic acid, quetiapine, zolpidem, and lormetazepam. She had several manic episodes over the years, some requiring hospitalization. In 2017, venlafaxine was replaced with vortioxetine, which she now introduces when detecting depressive phases, under psychiatric supervision but with some autonomy. She has remained stable, with occasional manic or hypomanic episodes triggered by stress, but none requiring hospitalization.

Figures 1 and 2 illustrate the patient’s self-perception changes with vortioxetine treatment. Figure 1 shows her as unhappy during the depressive phase (top) and happy after recovery (bottom). Figure 2 depicts her self-image during the depressive phase (left) and after recovery (right).

• - To assess the effectiveness, safety and risk of mood swings of vortioxetine in a patient with bipolar disorder during depressive phases.

• - To determine if effective psychoeducation allows patients to manage some of their medications safely under specialist supervision.

The patient mantains treatment with vortioxetine 20 mg daily, valproic acid 500 mg every 12 hours, quetiapine extended release 400 mg at dinner, zolpidem 15 mg, and lormetazepam 2 mg at bedtime during depressive phases. In manic episodes, quetiapine 300 mg is added, vortioxetine is discontinued, and the dosage of hypnotics is doubled. Intensive psychological support has improved her disease awareness and treatment adherence, allowing her to adjust vortioxetine (but not other medications) as needed under medical supervision. She has not reported any adverse effects from vortioxetine.

Vortioxetine 20 mg could effectively treat depressive phases without causing mania. Though research on its use in bipolar disorder is limited, it shows potential when combined with a mood stabilizer, with a response time of about nine weeks and a low risk of hypomania/mania. It may also help with cognitive decline and brain inflammation related to bipolar disorder, improving cognitive performance and reducing inflammatory markers. Vortioxetine is noted for its effectiveness, tolerability, and low dropout rate.

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Vortioxetine 20 mg may be effective for treating depressive phases in bipolar disorder with a lower risk of manic episodes compared to other antidepressants. Its procognitive and potentially anti-inflammatory effects could also support stability in non-psychiatric comorbidities. For this patient, good psychoeducation has facilitated a degree of independence in managing the medication, which is aided by vortioxetine’s safety and ease of use for both professionals and patients.

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This study explores sleep health disparities among adults with depressive episodes, focusing specifically on sexual and gender minorities (SGM). Given the high prevalence of sleep disturbances in this population, we aim to understand the influence of sexual orientation, alongside sociodemographic factors, on sleep health.

• - To determine the prevalence of sleep difficulties among sexual minorities with depressive episodes.

• - To assess how sociodemographic factors, including education and ethnicity, relate to sleep health in this population.

Using data from the 2020-2021 National Survey on Drug Use and Health (NSDUH), we analyzed a sample of 15,244 individuals who experienced depressive episodes. The study employed weighted estimates to accommodate the survey’s multistage sampling design. Descriptive statistics were used to assess the prevalence of various factors, including tobacco and nicotine use, age, gender, ethnicity, income, marital status, and education. To evaluate the relationships between these factors and sleep difficulties, we utilized generalized linear models with Poisson distribution and log-link function to estimate adjusted prevalence ratios for each covariate.

The study identified notable disparities in sleep health among individuals with depressive episodes based on sexual orientation and sociodemographic factors. Gay/lesbian individuals and bisexual individuals were both found to have a higher likelihood of reporting sleep difficulties compared to heterosexuals, with an increased prevalence of 1.06 times (p = 0.038 for gay/lesbian and p = 0.009 for bisexual). Educational attainment appeared to play a significant protective role; those with a college degree or higher were 0.89 times less likely to report sleep difficulties than individuals without a high school diploma (p < 0.001). Additionally, ethnicity influenced sleep health, with Hispanic individuals being 1.05 times more likely to report sleep issues than non-Hispanic Whites (p = 0.015).

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The findings emphasize the presence of sleep health disparities among sexual and gender minorities experiencing depressive episodes. Gay/lesbian and bisexual individuals face a higher risk of sleep difficulties, highlighting the need for mental health interventions that are sensitive to sexual orientation. The protective effect of higher educational attainment suggests that enhancing access to education and related resources may improve sleep health outcomes. The increased prevalence of sleep difficulties among Hispanic individuals points to the need for culturally tailored approaches in mental health care. Addressing these disparities through individualized and culturally sensitive therapeutic strategies can contribute to better sleep health and overall well-being for these populations, underlining the importance of integrated, comprehensive care in managing depressive disorders.

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Attention Deficit Hyperactivity Disorder (ADHD) is a complex neurodevelopmental disorder that presents challenges in achieving accurate and timely diagnosis.

This study investigates the effectiveness of using electroencephalogram (EEG) data combined with machine learning techniques to enhance the prediction accuracy for ADHD diagnosis.

A total of 168 subjects were evaluated using the Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version Korean Version (K-SADS-PL-K), categorizing them into two groups: ADHD (n=107) and Neurotypical (NT, n=61). We analyzed quantitative EEG (qEEG) data across 19 channels, focusing on frequency ranges including delta (1–4 Hz), theta (4–8 Hz), alpha (8–12 Hz), beta (12–25 Hz), high beta (25–30 Hz), and gamma (30–80 Hz). To classify ADHD versus NT groups, the Extreme Gradient Boosting (XGBoost) classifier was utilized, with Leave-One-Subject-Out (LOSO) cross-validation employed to assess model performance.

To address the issue of limited data, we segmented each subject’s EEG data into 30-second intervals, resulting in 2434 segments for the ADHD group and 1060 segments for the NT group (figure 1). These segments were used to train the machine learning model. The XGBoost algorithm, combined with the LOSO cross-validation strategy, achieved a test accuracy of 90.81% and an F1 score of 0.9347, demonstrating robust performance in distinguishing between ADHD and NT subjects (figure 2). Feature importance analysis using SHAP values highlighted that EEG features from specific frequency bands, particularly the middle beta/theta ratio and relative gamma of O1 electrode sites, played a crucial role in the classification (figure 3).

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Our findings suggest that EEG-based machine learning models hold significant potential as non-invasive tools for assisting in the diagnosis of ADHD. Further research with larger datasets and additional validation is necessary to confirm these results and explore their clinical applicability.

None Declared

Recently, there has been growing interest in leveraging large language models (LLMs) in psychiatry and counseling. Specifically, there is a need to develop LLM-based programs that generate psychodynamic assessments, helping individuals gain self-insight and evaluate the quality of such services. However, research in this area remains limited.

This pilot study aims to evaluate quality, risk of hallucination, and client satisfaction with psychodynamic psychological reports generated by GPT-4.

The reports consisted of five components: psychodynamic formulation, psychopathology, parental influence, defense mechanisms, and client strengths. Participants experiencing distress from recurring interpersonal issues were recruited for the study, which followed three stages: 1) GPT-4 generated tailored questions for participants to infer psychodynamic formulations, then used the responses to create psychological reports. 2) Seven psychiatry professors from various university hospitals assessed the reports for quality and hallucination risk, comparing GPT-4-generated reports with expert-inferred reports. 3) Participants evaluated their satisfaction with the psychological reports. All assessments were conducted using self-report questionnaires based on a Likert scale developed for this study.

Ten participants were recruited for the study, with an average age of 32 years. The median response indicated that the quality across all five components of the psychological report aligned closely with expert evaluations. The risk of hallucination was assessed to be minimal, ranging from unlikely to minor. In the satisfaction evaluation, over 90% of participants agreed or strongly agreed that the report was clear, insightful, credible, useful, satisfying, and recommendable.

These findings suggest that artificial intelligence may have the potential to provide expert-level psychodynamic interpretations with minimum face-to-face interaction.

None Declared

Obstructive Sleep Apnea (OSA) significantly complicates psychiatric conditions, yet its systematic screening within psychiatric settings is not common. We present a unique collaborative initiative within a tertiary care psychiatric hospital in South Bronx, USA, with approximately 3000 outpatients. We aim to bridge this gap by implementing a comprehensive OSA screening and referral process to improve patient outcomes.

• - Implement a standardized Obstructive Sleep Apnea screening in psychiatric outpatient care.

• - Enhance collaboration between psychiatry and sleep medicine for integrated care.

• - Address compliance barriers by offering at-home sleep diagnostic options.

Starting in April 2024, patients in the Adult Outpatient Psychiatry Department are being screened for Obstructive Sleep Apnea using the STOP-Bang questionnaire, with this process ending in October 2024. High-risk patients identified through screening will receive WatchPAT Home Sleep Apnea Testing devices, with distribution and testing to be completed by December 2024. Data collected will include the number of patients screened, proportion identified as high-risk, HSAT completion rates, diagnostic outcomes, and subsequent referrals to sleep medicine services.

The STOP-Bang questionnaire has been successfully integrated into routine clinical assessments for psychiatric outpatients, and the screening phase will conclude in October 2024. Preliminary data shows that a substantial number of patients were identified as high risk for Obstructive Sleep Apnea. The distribution of WatchPAT Home Sleep Apnea Testing devices to these high-risk individuals is underway and will be completed by December 2024. Initial results indicate effective triaging of patients and a high rate of compliance with at-home sleep testing. Detailed findings, including the exact number of patients screened, high-risk identification rates, HSAT completion rates, and diagnostic outcomes, will be presented upon project completion.

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Early findings from this Quality Improvement project suggest that integrating Obstructive Sleep Apnea screening into psychiatric outpatient care is feasible and beneficial. By identifying at-risk patients and providing accessible, at-home diagnostic tools, we aim to enhance patient care and address the underdiagnosed issue of sleep disturbances in psychiatric populations. The project demonstrates the potential for a streamlined, interdisciplinary approach to improve outcomes and set a scalable model for comprehensive patient management in similar settings. Further analysis will focus on the impact of this intervention on psychiatric care and overall patient health outcomes.

None Declared

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by difficulties in social communication and interaction, as well as restrictive and repetitive stereotyped behaviors, with considerable variation in cognitive and adaptive functioning. Accordingly, behavioral symptoms observed in daily life are likely to vary across individuals.

The present study aimed to explore the heterogeneity in intellectual abilities and behavioral issues among individuals with ASD using Latent Profile Analysis (LPA). This study was conducted between 2020 and 2021, with approval from the Institutional Review Board (IRB) of SNUH.

A cross-sectional analysis was conducted on 66 children (ages 6-18) diagnosed with ASD. The following psychometric instruments were used: Autism Diagnostic Observation Schedule-2 (ADOS-2), Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV), Child Behavior Checklist 6-18 (CBCL 6-18), Social Responsiveness Scale (SRS).

As the 3-profile solution returned a significant BLRT value and model entropy was estimated to be 0.93, the LPA of the WISC-IV indices and ADOS-2 comparison scores revealed three profiles that were clinically meaningful and balanced in group sizes: Profile 1 (“Higher ASD score with intellectual disability”; ADOS = 6.25, VCI = 55.16, PRI = 52.34, WMI = 53.47, PSI = 50.31), Profile 2 (“Higher ASD score with borderline intelligence”; ADOS = 5.76, VCI = 78.59, PRI = 80.65, WMI = 80.82, PSI = 67.12), and Profile 3 (“Lower ASD score with above-average intelligence”; ADOS = 4.41, VCI = 105.53, PRI = 108.41, WMI = 106.35, PSI = 89.41). On the SRS subscales, Profile 3 showed significantly lower scores in Social Cognition, Social Communication, and Social Motivation compared to Profile 1 (F(2, 63) = 10.45, p <.001; F(2, 63) = 5.24, p < .01; F(2, 63) = 8.75, p < .001). Additionally, on the CBCL syndrome subscales, Profile 3 showed significantly lower problem behaviors in Withdrawal/Depression, Social Immaturity, and Attention Problems (F(2, 63) = 4.57, p <.05; F(2, 63) = 5.07, p < .01; F(2, 63) = 4.19, p < .01).

In the present study, Latent Profile Analysis (LPA) using IQ and ADOS scores identified three distinct profiles within children with ASD. The findings suggest that while high-functioning ASD has traditionally been defined by an IQ threshold of 70–75, further distinction between borderline and above-average intelligence ASD groups may be warranted. Furthermore, targeted interventions addressing negative emotions, such as depression, may be indicated for the ASD group with intellectual disability.

Y. K. Lim Financial Support for Research from:, Financial Support for Research from: This research was supported by the National Research Foundation (NRF) funded by the Korean Government (MSIT) (RS-2024-00397737), and co-funded by the National IT Industry Promotion Agency(NIPA), an agency under the MSIT and with the support of the Daegu Digital Innovation Promotion Agency (DIP), the organization under the Daegu Metropolitan Government., E. Chung: None Declared, B. N. Kim: None Declared