To evaluate the efficacy of the Abbott ID NOW system in detecting COVID-19 using different specimen collection methods, emphasizing diagnostic accuracy and patient comfort.

Three cohorts were analyzed, including two using the nasopharyngeal (NP) swab technique and one utilizing the swish-and-gargle (SG) method. Positive percent agreement (PPA), negative percent agreement (NPA), and cycle threshold (Ct) values were assessed to determine the system’s performance.

The PPA for the NP swab cohorts averaged around 70%, while the SG cohort exhibited a higher PPA of 80%. All cohorts maintained high NPAs, close to 100%. The SG method significantly reduced false negatives, especially at lower Ct values, indicative of elevated levels of viral RNA. Additionally, the NP swab method, often uncomfortable, posed challenges in repeated testing scenarios, particularly among healthcare workers.

While the Abbott ID NOW system demonstrates reliable COVID-19 detection, the SG method emerges as a superior collection technique to NP swabs, offering enhanced diagnostic accuracy and improved comfort for test takers. This study underscores the importance of selecting appropriate collection methods to ensure accurate and efficient COVID-19 testing.

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

Forensic psychiatry transcends legal and cultural boundaries across Europe, but specialization and training remain inconsistent. With freedom of movement in most European countries, psychiatrists accredited in one country can practice in others if they meet language requirements. Therefore, harmonizing psychiatric education and practice is crucial and aligns with the European Federation of Psychiatry Trainees (EFPT)’s goals.

This study aims to map the current state of forensic psychiatry education across Europe, focusing on its recognition as a specialty on its own or subspecialty, training structure, and financial implications. It also assesses whether general adult psychiatry (GAP) and child and adolescent psychiatry (CAP) trainees receive adequate forensic psychiatry education, identifying gaps and variations across countries.

Data was collected via an online survey distributed to European National Trainee Association (NTA) representatives in the EFPT through Google Forms in August 2024. Responses from non-European countries and incomplete entries were excluded. The final dataset was analyzed using SPSS 24.

A total of 29 participants, including 24 GAP trainees (82.8%), 2 CAP trainees (6.9%), and 3 specialists (10.3%), from 20 European countries responded to the survey. Forensic psychiatry was recognized either as a specialty or subspecialty in 13 counctries (65%) with 20 (69%) of participants confirming its recognition. 38% reported forensic training lasts less than 1 year or lacks a formal program. Financial support varied as well, with some countries offering full subsidies, while others required trainees to cover costs. Forensic psychiatry was included in the training of 66.7% of GAP trainee and 50% of CAP trainees, though the depth of exposure differed. Notable gaps were found particularly in risk assessment, expert witness training, and competency evaluations.

This study reveals significant variation in the recognition, structure, and delivery of forensic psychiatry training across Europe. While some countries offer well-defined programs, discrepancies in accessibility and comprehensiveness persist. These findings highlight the need for standardized curricula to ensure consistent training. Enhancing forensic psychiatry education is crucial for preparing future psychiatrists and ensuring high-quality psychiatric contributions in legal contexts and harmonization of forensic training across Europe.

None Declared

Psychotic disorders, particularly schizophrenia, are severe mental illnesses associated with high rates of disability and functional impairment, causing significant individual burden and incurring high societal costs. Typical onset of schizophrenia is in late adolescence or early adulthood and the complex management requires often life-long pharmacological and non-pharmacological treatment. Early symptom recognition and timely intervention can improve the course of illness and result in better outcome and prognosis, effective management leads to a functional recovery. However, recent reports have identified significant gaps in access to timely assessment and shared decision-making interventions, with inadequate care pathways. In the face of an unprecedented demand for mental healthcare for young people, it can be challenging for health services to deliver high-quality mental healthcare which, according to the World Health Organization, should be timely, effective and evidence-based, safe and person-centered. The project covers nine countries in Europe.

Building on the European Brain Council Rethinking Schizophrenia Beyond The Voices Policy Report (2024), the survey and literature review aim to: (1) evaluate the effectiveness of integrated models of youth mental healthcare on a broader range of outcomes, including both mental health outcomes, such as clinical symptoms, functioning and quality of life and health service outcomes, including access and satisfaction with care in young people; and (2) identify the common components of integrated care pathways for young people with first episode psychosis.

Using the care pathway as a tool at the first step of the research, a cross-country survey was co-designed with the Board of experts and anonymously launched earlier this year. By complementing the survey, the literature review on the care pathway will address quality and continuity of care from the first onset of psychosis and schizophrenia to long-term care in the selected countries including existing guidelines and overview country health situation assessments.

Patients and mental health professionals’ insights will be collected. Obtained data will also be analysed by the stakeholders and used to formulate recommendations for policy makers, care payers, mental health professionals, patients and their families (both country specific and at the EU level).

A policy report, based on the consensus, will be released at the Brain Awareness Week 2025 with results and recommendations which will provide valuable insight into understanding the needs of patients with first-episode psychosis and defining the optimal care pathways to engage with them. In order to show that there is a progress in the field of care for schizophrenia patients, the utilization of new technologies is included.

None Declared

Treatment-resistant schizophrenia patients have the worst clinical outcomes and poor quality of life, despite the administration of clozapine. Currently, the definition of resistance is based on treatment response, but evidence differentiating resistance remains unclear. The dysconnectivity theory suggests that disrupted brain interactions contribute to schizophrenia pathology. Advances in functional and structural neuroimaging allow exploration of connectivity patterns that may characterize treatment-resistant schizophrenia.

This study aimed to describe functional and structural connectivity patterns in schizophrenia patients on clozapine.

Patients taking clozapine (CLZ) or other antipsychotic (nCLZ) were recruited from the Hospital of the Medical School of Ribeirão Preto. Healthy controls (HC) were recruited from the Hospital database. Seventy-seven participants were selected: CLZ = 35, nCLZ = 27, and HC = 27. Functional connectivity (FC) was assessed via resting-state functional magnetic resonance imaging (rs-fMRI) and ROI-to-ROI analysis using the CONN toolbox. Structural connectivity was analyzed with diffusion tensor imaging and tractography using TRACULA toolbox. ANOVA and Tukey test were used for three-group comparisons, and the t-tests for two-group comparisons. Functional analysis was performed with a significance threshold of p < 0.05 and false discovery rate (FDR) set to p < 0.01.

Reduced frontotemporal FC and increased FC in the frontal-occipital were common in CLZ and nCLZ compared to HC. An increased FC between sensorimotor and the cerebellum was notable in CLZ compared to HC. Structural findings included increased axial diffusivity (AD) and mean diffusivity (MD) in 8 of 10 tracts in CLZ compared to HC. The corticospinal tract and inferior longitudinal fasciculus exhibited increased AD and MD in CLZ compared to nCLZ. The cingulum angular bundle showed significantly altered diffusion measures in nCLZ: increased AD, MD, and radial diffusivity (RD), and reduced fractional anisotropy (FA).

This study described a widespread functional and structural dysconnectivity in CLZ, characterized by reduced frontotemporal FC and increased frontal-occipital and sensorimotor–cerebellum FC. Altered AD and MD measures in the corticospinal tract and inferior longitudinal fasciculus were observed in the CLZ. Alterations in AD, MD, RD, and FA measures in the cingulum angular bundle, particularly noted in nCLZ, may be associated with antipsychotic administration. Further studies are necessary to establish whether these dysconnectivity patterns consistently characterize these patient groups.

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

Since 2017, the reform of mental health services implemented in Portugal has included the establishment of a national network of long-term mental health care (MH-LTC) to promote the psychosocial rehabilitation of people with mental illness. Different facilities are available according to the degree of psychosocial disability, functionality and family and social support network. Thus, residential structures, home support teams, and socio-occupational units are available to reintegrate these users into society and their families.

To assess discharge destinations according to the MH-LTC typology (home care teams, residential structures and socio-occupational units).

We conducted a national retrospective observational study to analyse the MH-LTC discharge destinations using secondary data publicly available. The following discharge destination categories were considered in the analysis: home (with or without support), social facilities, nursing home, other typologies from the long-term care network (LTC), and others. The analysis included the discharge destinations between May 2018 and March 2024.

A total of 119 discharges were recorded, with 50 patients (42.0 %) going home, four (3.3%) to social facilities, 46 (38.7%) to other LTC typologies and 19 (16.0%) to unspecified destinations. Regarding discharge to home, 27 (54.0%) came from home care teams, 14 (28.0%) from socio-occupational units and 9 (18.0%) from residential facilities. The remaining discharge destinations included 34 (49.3%) from home care teams, 13 (18.8%) from socio-occupational units and 22 (31.9%) from residential facilities.

Although these results do not allow us to gauge the level of disability before and after joining the MH-LTC, they raise some questions. Firstly, the number of discharges is small considering the span of more than five years. In addition, non-residential facilities have the highest number of discharges compared to residential facilities. On the other hand, less than half of the discharge destinations are to the patient’s homes, which may lead us to question whether the MH-LTC fulfils its purpose of psychosocial rehabilitation or whether it is a transitional structure aimed at responding to social issues.

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

Huntington’s disease (HD) is a progressive neurodegenerative disorder characterized by motor dysfunction, cognitive decline, and psychiatric symptoms. Among these psychiatric manifestations, psychosis occurs in a subset of patients, presenting significant challenges for both diagnosis and treatment. While pharmacological interventions, such as antipsychotics, are commonly used to manage psychosis in HD, they often come with limited efficacy and a high risk of adverse effects. Electroconvulsive therapy (ECT), traditionally employed in the treatment of severe mood disorders and treatment-resistant psychosis, has garnered minimal attention as a therapeutic option for psychosis associated with HD. This is proven by the absence of literature focusing specifically on the use of ECT for treatment of Huntington’s Psychosis. This underexplored avenue holds potential, given ECT’s neuroplastic and neurochemical effects, which may counteract the neurodegenerative processes seen in HD. Exploring the efficacy of ECT in HD-associated psychosis could not only provide symptom relief but also offer insights into the broader neuropsychiatric management of the disease.

This review aims to highlight the therapeutic potential of ECT as a novel intervention in Huntington’s psychosis, addressing the current gap in clinical research and therapeutic strategies.

A non-systematic review of the published literature using the PubMed/MEDLINE database with the MESH terms “huntington,” “psychosis” and “ECT” was made. The articles were selected according to relevance.

There were found 14 relevant publications that adress the use of ECT in HD. 11 of them were case reports and 3 were case series. Most of the studies show good results from the use of ECT in HD. There was improvement in several areas of the patient’s mental state, namely depressive symptoms, irritability, psychotic symptoms and psychomotor agitation.

Few case studies reported worsening of the clinical picture, namely aggravation of the catatonic symptoms or cognitive impairment.

The limited but promising evidence from case reports and case series suggests that ECT may be an effective therapeutic intervention for addressing psychiatric symptoms, including psychosis, in patients with Huntington’s disease. The majority of studies demonstrate positive outcomes. However, the findings are not universally positive, with a few reports noting potential worsening some symptoms. Given the complexity of managing psychiatric symptoms in HD, ECT presents itself as a valuable treatment option, particularly when pharmacological approaches prove ineffective or poorly tolerated. Nonetheless, the absence of larger, controlled studies on ECT for HD psychosis underscores the need for further research to validate its safety and efficacy.

None Declared

Effective suicide risk assessment remains a significant challenge in psychiatric care, particularly when dealing with patients undergoing acute crises. This case study highlights the limitations of current assessment practices and underscores the need for a more nuanced understanding of suicide risk, particularly through the lens of personal narrative crisis and Suicide Crisis Syndrome (SCS).

The objective of this study is to describe a clinical case involving a patient with Suicide Crisis Syndrome (SCS), which emerged from a fundamental alteration in his personal life narrative. Additionally, this study reflects on the existing clinical gap due to the lack of consensual or homogeneous approaches for detecting suicide risk in psychiatric patients experiencing a crisis.

Methodology: A detailed review of the clinical process and hetero-anamnesis was conducted. The case explores the concept of SCS—an acute mental state that precedes a genuine suicide attempt.

The patient, a 45-year-old single male with no children, had a biographical history marked by traumatic events during military service and the loss of a child in combat at age 30. For years, he exhibited symptoms consistent with Post-Traumatic Stress Disorder (PTSD), which he managed effectively through meditation and martial arts, resulting in total symptom remission for over a decade. However, following complex cardiac surgery two years ago, he experienced a significant loss of functionality and autonomy, leading to the abandonment of his martial arts practice and lifelong profession as a rehabilitation therapist. This change had profound emotional, behavioral, and socio-economic impacts, resulting in depressive symptoms. During psychiatric evaluation, the patient exhibited affective dysregulation, marked hopelessness, a sense of loss of meaning, feelings of non-belonging, social defeat, and difficulty adjusting unrealistic goals to his current situation. Although he denied active suicidal ideation, he reported intrusive thoughts of death.

Conclusion and Implications: The assessment of self-reported suicidal ideation is often unreliable. There is an urgent need to adopt more comprehensive approaches that focus on the personal narrative crisis and SCS, as current evidence suggests that SCS is a strong predictor of actual suicidal behavior within 1-2 months after discharge.

None Declared

Research into early interventions following a first episode of psychosis (FEP) has enabled a focused approach on prognostic-modifying factors. Among these, poor medication adherence contributes to relapse, as well as cognitive and functional deterioration. Several studies report discontinuation rates of oral antipsychotics (OAPs) after FEP at 70%, regardless of the prescribed OAP. The early introduction of long-acting injectable antipsychotics (LAIAs) could present an alternative.

This study aims to review the efficacy of LAIAs in the early stages of psychosis and compare the most relevant international guidelines on this topic.

Methodology: A non-systematic literature review using the keywords “long-acting injectable” and “first episode psychosis,” limited to articles published in English and Portuguese in the last 10 years from the PubMed®/MEDLINE® database, and clinical practice guidelines on psychosis, schizophrenia, and FEP from NICE, APA, and RANZCP.

Despite frequent selection biases (such as reserving LAIAs for patients with worse prognostic factors), significant benefits of LAIAs over OAPs in preventing hospitalization and relapse during the early phases of psychosis are consistently reported. LAIAs reduce non-adherence due to forgetfulness or reduced insight, while their different pharmacokinetics minimize withdrawal symptoms, drug interactions, and fluctuations in plasma concentration, enhancing tolerability. No second-generation LAIA was found to be clearly superior in terms of efficacy. Various guidelines recommend offering this treatment option early, favoring an informed and collaborative decision-making process. However, despite documented benefits in robust studies, they do not consider LAIAs as a first-line treatment.

Discussion/Conclusions: Significant variations in the proportion of patients on LAIAs across countries suggest that factors other than efficacy may influence its use. Greater understanding of these factors could help identify potential barriers to optimal implementation. New evidence may prompt a review of the guidelines.

None Declared

Depressive disorder is a common mental disorder, with an estimated 3.8% of the population experiencing it. Despite the advent of new antidepressant medication, many patients presenting with Major Depressive Disorder (MDD) do not recover after multiple trials. Although the prevalence of treatment-resistant depression (TRD) is not clear due to the lack of a standard definition, its prevalence ranges from approximately 30 to 70 percent.

Considering the high prevalence of treatment-resistant depression, this work aims to evaluate the effectiveness of alternative treatments, namely Noninvasive Neuromodulation Therapies in the treatment of MDD.

Non-systematic literature review, using Pubmed as database, with the keywords “depression treatment”, “neuromodulation” and “noninvasive neuromodulation”.

We can divide non-invasive neuromodulation into convulsive therapies (CV) and therapies that do not involve inducing a seizure. Additionally, we can also divide them into clinically available therapies and others only available in investigational settings.

Regarding clinically available CV, we have Electroconvulsive Therapy (ECT), the oldest neurostimulation procedure. Being heavily studied, ECT is superior to pharmacotherapy for MDD based upon meta-analyses of randomized trials and is generally considered the most efficacious treatment for depression, albeit recurrence following remission is common.

Other CV, but still in investigational stages, are Magnetic seizure therapy (MST) and Focal electrically administered seizure therapy (FEAST) both showing positive results in prospective studies and MST in a small head-to-head randomized trials with ECT, that showed a similar efficacy between these two therapies.

Other clinically available, but not convulsive therapies, are Repetitive Transcranial Magnetic Stimulation (rTMS) and Cranial Electrical Stimulation (CES). Meta-analyses of randomized trials indicate that rTMS is beneficial for treating TRD, being also approved by the FDA. In its turn, multiple reviews indicate that no high-quality studies have demonstrated that CES is efficacious for MDD or TRD.

Additional non-convulsive therapies, available in investigational settings, include Transcranial Direct Current Stimulation, Transcranial Low Voltage Pulsed Electromagnetic Fields, Trigeminal Nerve Stimulation, Low Field Magnetic Stimulation and Transcutaneous Vagus Nerve Stimulation, with all of them showing positive effects in the treatment of MDD or TRD, except for Low field magnetic stimulation.

With this review, we were able to verify that clinically available non-invasive neurodomulation therapies, such as ECT and rTMS, present robust results in the treatment of MDD and TRD, however, resistance to these therapies also exists.

Considering the positive results of multiple novelty therapies, these could be the solution to this scourge.

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.

The Bible offers various insights into human struggles, including what can be interpreted today as mental illness. Although ancient texts do not explicitly refer to mental health using modern terminology, there are many accounts of emotional distress, depression, anxiety, and other psychological challenges. Throughout Scripture, several figures are portrayed grappling with deep sorrow, fear, and mental turmoil. These narratives provide spiritual reflections on suffering, healing, and divine intervention, shedding light on how biblical teachings have historically addressed human fragility.

To raises questions about how we can relate ancient wisdom to contemporary mental health issues, offering opportunities for spiritual growth, empathy, and care in our own lives.

A non-systematic review of the published literature was conducted using the Google Scholar database with the search terms “Bible” and “mental illness.” Articles were selected based on their relevance, and further information was obtained through direct consultation of biblical texts.

The prophet Elijah exhibits signs of reactive depression, triggered by stress after confronting the prophets of Baal and receiving a death threat from Jezebel (1 Kings 18:20-40). His symptoms—loss of appetite, isolation, low self-esteem, and hopelessness—are well-documented (1 Kings 19:3). God’s response (1 Kings 19:11-14) provides an example of care for depression, with affection, understanding, and patience.

James 5:15-18 references Elijah to highlight that depression can affect Christians, suggesting that illness, whether physical or spiritual, requires dialogue and support. James emphasizes God’s forgiveness, even if illness stems from sin, viewing depression as an organic condition in line with the holistic Jewish understanding. He advocates for confession and prayer as therapeutic (James 5:16), stressing that mercy triumphs over judgment.

Psalm 6:6-7 captures the deep despair of depression, showing the importance of seeking God amid mental anguish, which is often invisible to others.

The accounts of figures like Elijah and the reflections in Psalms demonstrate that conditions resembling modern definitions of depression and anxiety have long been acknowledged, albeit through the lens of ancient cultural and religious contexts. The compassionate care that God extends to Elijah, coupled with the guidance found in the New Testament, particularly in the book of James, underscores the importance of community and support in addressing mental health challenges.

By examining these stories, we gain a broader understanding of how faith communities have interpreted and coped with the complexities of mental illness - in light of their relationship with God.

These accounts present a holistic biblical view of depression, underscoring the need for empathy, spiritual care, and community support in mental health.

None Declared

Postcoital dysphoria (PCD) refers to feelings of sadness, anxiety, or irritability following sexual intercourse, even when it is consensual and satisfying. These emotions can last from minutes to hours and affect both genders.

Historically, sex was mainly viewed as a means of reproduction, with pleasure often regarded as secondary. However, during the sexual revolution of the 1960s and 70s, perceptions shifted, recognizing sex as a source of pleasure and emotional connection. Today, despite a focus on mutual satisfaction, some individuals still experience post-sexual distress, highlighting the complexity of human sexuality. As a source of important distress, PCD calls for exploration of therapeutical agents.

To examine the prevalence of postcoital dysphoria (PCD) and explore potential therapeutic agents.

A non-systematic literature review using the keywords “postcoital”, “dysphoria” and “tristesse” limited to articles published in English from the PubMed®/MEDLINE® database.

Seven relevant studies were identified regarding postcoital dysphoria (PCD). In a study of 1,208 males, 40% reported experiencing PCT at least once, with 20% experiencing symptoms in the past month, and 3–4% regularly. PCT was linked to psychological distress, childhood sexual abuse, and sexual dysfunctions.

Among women, a UK survey of female twins found that 3.7% reported recent PCT symptoms, while 7.7% had long-term symptoms. Another study indicated that nearly 50% of female university students experienced PCT at least once, with no correlation found between PCT and relationship intimacy.

In the LGBTQIA+ population, a survey of 172 adults revealed PCD prevalence of 42% among men attracted to men and 81% among bisexual/fluid individuals. Significant correlations were observed between sex life satisfaction and PCD in this group. Regarding treatment, one single case report described a patient without psychiatric comorbidities treated successfully with escitalopram (10 mg), with symptomatic relief.

The reviewed studies highlight the prevalence and factors contributing to postcoital dysphoria (PCD) across diverse populations. Among men, up to 40% experience PCD at least once, with contributing psychosocial factors. In women, PCT prevalence varies, with no clear link to relationship intimacy. In the LGBTQIA+ community, PCD is notably high, affecting 42% of MSM and 81% of bisexual/fluid individuals, with sexual dissatisfaction and perceived discrimination as key correlates. Treatment options remain unexplored, with only one case report showing positive results using escitalopram. These findings suggest PCD is a complex conditions influenced by psychological, sexual, and societal factors. More research is needed to understand the underlying mechanisms and explore effective treatments, particularly for minority populations and those without psychiatric comorbidities.

None Declared

Psychoactive substance use among pregnant women has reached alarmingly high rates and is considered a public health problem. Pregnancy is a period in which women become more sensitive and concerned about their well-being, in view of how that will affect their baby. Therefore, pregnancy becomes a favorable period for therapeutic intervention, especially with regard to drug use. Despite this, there is still a small number of studies that address the issue of female drug users in Brazil, especially due to stigma and prejudice.

Our main aim was to characterize the clinical and psychiatric profile of pregnant crack users in Brazil, with a focus on comorbidities, the severity of crack use, and the use of other substances.

This was a cross-sectional study of 24 pregnant crack users admitted to a referral hospital for psychiatric disorders in pregnant women, in Porto Alegre, Brazil, over three years. Most women tend to remain hospitalized for a long time, often months, until giving birth. This scenario directly influenced the sample size of this study. The following instruments were applied: a clinical-obstetric questionnaire; the condensed version of the Addiction Severity Index; a diagnostic interview for psychoactive substance use based on DSM-5; the Mini International Neuropsychiatric Interview for DSM-IV; and the Semi-Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II).

Most patients had severe crack dependence and used other substances, such as tobacco, cannabis, and alcohol. The median duration of crack use was three years, ranging between three and 12 years. Most women subsisted from illegal or informal activities; a fifth had previously been arrested and often had relationship problems. Twenty percent had HIV (n = 5), and 37.5% (n = 9) had syphilis. Borderline personality disorder was the most prevalent mental condition (62.5%), followed by suicidal tendencies (45.8%), hypomanic episodes due to substance use (37.5%), and past major depressive episodes (33.3%).

This is one of the few studies exploring and characterizing social, economic and health aspects of pregnant crack users in Brazil. An alarmingly high prevalence of consumption of other drugs, psychiatric disorders, and difficult-to-treat personality disorders was observed in our study. Investigating the psychiatric profile of women who use substances is essential to minimize the impacts on the mother and child, optimize therapeutic approaches to comorbidities, and enable more effective relapse prevention.

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

Herpes Simplex Encephalitis (HSE) and anti-NMDA receptor autoimmune encephalitis (ANMDARE) are severe neurological conditions that can lead to significant psychiatric symptoms. While these conditions commonly cause cognitive and behavioral disturbances, mania with psychotic symptoms is an uncommon manifestation. Understanding this rare presentation is crucial for accurate diagnosis and management.

To describe a case of mania with psychotic symptoms in a 33-year-old woman approximately one month after Herpes Simplex Encephalitis (HSE), further complicated by anti-NMDA receptor autoimmune encephalitis.

We conducted a detailed review of the clinical process and heteroanamnesis from family reports. A non-systematic literature review was performed using the terms “encephalitis,” “mania,” “psychosis,” “herpes simplex,” and “anti-NMDA” in the PubMed®/MEDLINE® database.

A 33-year-old woman, seven months postpartum with no prior psychiatric history, presented with psychomotor agitation, distractibility, elevated mood, verbose speech, tachypsychia, impulsivity, verbal perseveration, insomnia, and mystical and persecutory delusions, including auditory-verbal hallucinations, starting 15 days after discharge from hospitalization for HSE. Her subsequent hospitalization revealed severe and fluctuating behavioral changes, significant memory deficits, and spatial-temporal disorientation. Neuroimaging showed atrophy of the left temporal lobe, ipsilateral insula, and notable involvement of the left hippocampus. Cerebrospinal fluid analysis detected anti-NMDA receptor antibodies, leading to treatment with corticosteroids and immunoglobulins. The patient was stabilized on clozapine 150 mg/day, valproate 1000 mg/day, clonazepam 1 mg/day, and monthly injectable risperidone 100 mg.

HSE is a major cause of death in sporadic encephalitis cases, with a 12% relapse rate linked to viral reactivation and the development of anti-NMDA receptor encephalitis. ANMDARE, caused by anti-NMDA receptor IgG antibodies targeting the NR1 subunit, affects about 25% of HSE patients within three months. Psychiatric affective syndromes have been described both as possible initial symptoms of HSE and as long-term sequelae, but the underlying mechanisms remain not fully understood.

None Declared

Mental health disorders are a leading cause of disability in European Union countries. Previous evidence highlighted the role of socioeconomic inequalities on unmet mental health care needs, varying by income or education. Being both reducing inequalities’ gaps and mental health promotion current goals of European Union (EU), it is essential to understand the differences between EU countries and the role of socioeconomic factors on this.

The study aims to assess the socioeconomic inequalities on unmet needs for mental health care in EU countries in 2019.

This was a cross-sectional study using data from the 2019 European Health Interview Survey across 26 EU countries. The main outcome considered was the proportion of self-reported unmet needs for mental health care due to financial reasons. Inequalities for income, education and degree of urbanization were assessed by calculating the rural-city, primary-tertiary education and lowest-highest income quintiles, respectively.

The proportion of self-reported unmet need for mental health care in 2019 ranged between 1.1% (Romania) and 27.8% (Portugal), with a median of 3.6%. Regarding income inequality, all countries except Hungary (ratio=0.88) showed highest share of unmet need among inhabitants with the lowest income quintile. The country with the highest inequality was Greece with a ratio of 23.8. Regarding education inequality, 15 out of 26 countries showed that less educated inhabitants had highest unmet needs of mental health care, with values ranging from 0.5 in the Netherlands and 7.2 in Bulgaria. As for degree of urbanization, rurality showed lowest unmet needs for 21 out of 26 countries, with the highest ratio being 2 in Romania.

The study highlights significant and wide socioeconomic (income, education, and urbanization) inequalities in unmet mental health care needs across EU countries.

While income inequality plays a similar role across EU countries with the poorer quintile showing higher unmet needs due to financial reasons, EU is divided on the role that education plays. On the opposite side, there is also a tendency across the EU for rural areas showing lower unmet needs for mental health care. Policymakers should prioritize strategies to ensure financial access to mental health services, as well as promoting mental health literacy and improve service availability for vulnerable populations.

J. V. Santos Conflict with: This article was supported by National Funds through FCT - Fundação para a Ciência e a Tecnologia, I.P., within CINTESIS, R&D Unit (reference UIDB/4255/2020), V. Pinheiro: None Declared