Addiction to social media and video games in children and adolescents is associated with negative mental health outcomes, such as depression, anxiety, ADHD, social isolation, and suicidal risk.

This research project has two main aims. First, to develop an artificial intelligence (AI)-based tool, grounded in language models, to automate key stages of a systematic review and meta-analysis (search, article selection, and data extraction). Second, to conduct a systematic review and meta-analysis on the prevalence of use, the impact on mental health, and the effectiveness of interventions for social media and video game addiction in child and adolescent populations. The analysis will be carried out through two approaches: the conventional procedure and the AI-based tool, enabling methodological comparison and assessment of the potential of artificial intelligence in the synthesis of scientific evidence.

Study Selection

Traditional: Two researchers will screen articles in three phases: (a) titles and abstracts according to inclusion criteria; (b) full-text review with assessment of mental health outcomes and sufficient data; (c) exclusion of overlapping studies.

AI-based: A large language model (LLM) will process data in Excel (phase 1) and full texts in Markdown format (phase 2), generating outputs in JSON. The model will detect overlapping studies for exclusion (phase 3).

Data Extraction

Traditional: Two researchers will extract data on publication characteristics, demographics, type of addiction, comorbidities, interventions, and outcomes.

AI-based: The LLM will analyze PDFs converted to Markdown, extracting the same variables into JSON format.

A three-level meta-analysis will be conducted following Cochrane guidelines, using literature from PubMed, Scopus, MEDLINE, and the Cochrane Library, with direct comparison between both methods.

The AI-based tool is expected to automate the processes of search, selection, and data extraction for systematic reviews, reducing the required time and improving methodological efficiency. Furthermore, the systematic review and meta-analysis are anticipated to reveal significant associations between problematic use of social media and video games and various mental health indicators in children and adolescents, such as symptoms of anxiety, depression, ADHD, and suicidal behaviors. The comparison between the conventional approach and the AI-assisted approach will allow for the evaluation of the potential of these technologies in the synthesis of scientific evidence and their future applicability in clinical and academic settings.

This study is pioneering in applying generative AI to systematic reviews. It also addresses an urgent child and adolescent mental health issue related to behavioral addictions.

None Declared

Delays in accessing treatment for psychosis and other severe mental disorders can reach 8–10 years. Inspired by McGorry’s Australian model, the Transition to Adulthood Program in Toledo applies a targeted and cost-effective screening strategy based on two risk markers: age (16–20 years) and substance use.

• - To describe the program design and clinical framework.

• - To evaluate its ability to detect severe psychopathology at early stages.

• - To analyze its impact on reducing treatment delays and improving service organization.

Open-access program (2015–2025) including 1,300 patients. Inclusion criteria: adolescents/young adults (16–20 years) and/or substance or behavioral addictions. Multidisciplinary intervention (psychiatrists, psychologists, mental health nurses, social workers). Combined individual, group, and family psychotherapy, with daily open consultation slots.

• - Two-thirds presented substance use; one-third met only age criteria.

• - Mean age: 16.8 years; 60% female.

• - 40% reported complex trauma history.

• - 15% showed psychotic symptoms at intake; ~50% progressed to schizophrenia or bipolar disorder.

• - ~400 patients treated annually; mean treatment duration: 18 months; 30% early dropout rate.

The program achieved cost-effective early detection in high-risk populations, reduced time-to-treatment, and provided flexible, accessible care. This model demonstrates both clinical and organizational utility and can be adapted to other public mental health contexts.

None Declared

Despite strong evidence for group psychotherapy, its implementation in adolescent mental health services remains limited. Barriers include lack of professional training, insufficient supervision, and rigid adherence to specific theoretical schools.

• - To identify barriers in the training and implementation of adolescent group therapy.

• - To present insights from the Toledo Transition Program on overcoming these barriers.

• - To propose recommendations for professional development and service design.

Qualitative descriptive study based on clinical experience. Observation of group sessions, supervision dynamics, and training needs of psychiatry residents and staff were analyzed.

• - Residents were often relegated to observer roles in groups, limiting active learning.

• - Lack of supervision spaces hindered skill acquisition and confidence.

• - Rigid theoretical frameworks discouraged flexible, integrative approaches.

• - Program experience showed that transdisciplinary teamwork and integrative use of dynamic, systemic, and cognitive tools improved training outcomes.

Expanding group therapy training requires supervision, active participation, and theoretical flexibility. Addressing these gaps can strengthen workforce capacity and facilitate the integration of group interventions as a standard tool in adolescent psychiatry.

None Declared

Depression and anxiety are prevalent among first-time mothers. Evidence suggests that culturally adapted psychoeducational interventions can effectively prevent perinatal emotional disorders when integrated into local health care systems.

This study aimed to culturally adapt What Were We Thinking (WWWT, Fisher et al., BMC Public Health 2010;10:1), an Australian gender-informed psychoeducational program for couples with newborns, to the Catalan primary health care context, and to assess the feasibility of the adapted intervention.

Cultural adaptation followed a structured model, including literature review, stakeholder consultations, translation, expert review, and pilot testing guided by the Ecological Validity Model (Bernal et al., Prof Psychol 2009;40:361–8). A qualitative pilot study (n=13) explored acceptability, usefulness, and comprehensibility. A quantitative feasibility analysis was then conducted within a randomized controlled trial involving 60 participants who received the intervention, assessing recruitment, adherence, retention, and participants’ perceptions of comprehensibility, acceptability, and relevance.

Adaptations improved cultural relevance, language clarity, and contextual fit. The pilot study indicated that the program was understandable, meaningful, and relevant. Preliminary quantitative analysis of the RCT sample suggested satisfactory recruitment, high session attendance, low attrition, and positive perceptions of comprehensibility, acceptability, and relevance, supporting feasibility in the Catalan primary care context.

The Catalan and Spanish versions of WWWT represent culturally sensitive adaptations of the original program. Qualitative and quantitative findings provide preliminary evidence of feasibility and acceptability, supporting the rationale for a larger-scale trial to evaluate effectiveness.

This study was supported by funding from the Fundació La Marató.

E. Gelabert Grant / Research support from: Fundació la Marató: 193/C/2022, N. Fernández-Jarabo: None Declared, A. Torres-Gimenez: None Declared, S. Andrés-Perpiñá: None Declared, C. Martínez-Bueno: None Declared, L. Garcia-Esteve: None Declared, S. Subirà: None Declared, A. Roca-Lecumberri Grant / Research support from: Fundació la Marató: 193/C/2022

Mental health is a major public health concern. Over one in three people reported mental problems in 2023, and suicide is the second leading external cause of death. Manual coding of psychiatric diagnoses from free text into ICD-10 slows clinical workflows, introduces errors, and hinders research. Automating this process with natural language processing (NLP) and machine learning (ML) can improve consistency, reduce administrative burden, and assist clinicians in improving diagnostic accuracy and treatment planning.

1) to clean and normalize an anonymous corpus of 79,048 Spanish psychiatric notes; 2) to evaluate semantic representations and identify the most suitable Spanish biomedical embeddings; 3) to develop and compare multilabel classification models, including XGBoost, random forests, neural networks, hierarchical models, and large language models (LLMs) fine-tuned with QLoRA; 4) to measure performance and computational cost.

The dataset from a Spanish hospital was used for model training. It contained more than 150,000 diagnostic labels referring to 83 ICD-10 codes and was preprocessed to correct errors, normalize codes, and replace abbreviations. Several embedding models were tested, with multilingual e5-large selected as the most effective. This representation was used as input to classical classifiers, neural networks, hierarchical models grouped by diagnostic families, and LLMs. Training and evaluation followed a stratified split, using F1, precision, and recall as metrics. All experiments were executed on a single NVIDIA RTX 4090 GPU.

The best balance between accuracy and cost was achieved with multilingual e5-large embeddings and multilabel XGBoost, reaching F1 = 0.72 with four minutes of training (Figure 1). A neural network on top of the encoder increased F1 to 0.76, at 37× higher cost. The hierarchical family-based approach lowered combined performance to F1 = 0.667 due to error propagation, with overall results ranging from 0.37 (Disorders of adult personality and behaviour) to 0.78 (Mood disorder) across models. Llama-3 LLMs fine-tuned with QLoRA improved from near-zero performance to F1 = 0.62, showing potential but still underperforming compared to embedding-based models. All approaches were computationally feasible within limited resources.Image 1:

Automatic mapping of psychiatric notes to ICD-10 codes is feasible and clinically valuable. The embedding + XGBoost pipeline offers the most practical trade-off for immediate deployment, while fine-tuned encoders provide higher accuracy when computational budgets allow. Fine-tuned LLMs represent a promising medium-term option if larger corpora and hardware are available. Limitations include short note length, class imbalance, and labelling variability. Future work will explore active learning with experts, synthetic data generation, and adaptation to ICD-11.

None Declared

Paliperidone palmitate 6-month (PP6M), 3-month (PP3M), and 1-month (PP1M) formulations have demonstrated efficacy in improving clinical outcomes and reducing risk of relapse in patients with schizophrenia. Real-world studies have shown that longer dosing intervals are associated with improved clinical outcomes, however, there is minimal evidence comparing the outcomes of these three formulations in clinical practice.

This study evaluated the effectiveness of PP6M vs PP3M and PP1M in delaying and preventing relapse among patients with schizophrenia and compared healthcare providers’ treatment satisfaction and healthcare utilization with longer dosing formulations.

Patient data (n=125) were collected using the MeMind digital ecosystem, covering the period from July 2014 to July 2024 across multiple hospitals in Madrid. Memind registry is representative of the population with schizophrenia that is attended in the participating hospitals. Given the fact that all-registered patients meeting eligibility criteria will be included, sample size estimation is not needed. The number of patients in treatment with PP6M is around 300.Two retrospective treatment phases were considered: one year of prior treatment with PP1M, PP3M, or a combination of both before initiating PP6M, and one year following the initiation of PP6M (1 year mirror image analysis). A Shapiro-Wilk test was performed to assess the normality of the distribution of differences. If the distributions were normal, paired t-tests were conducted to compare the matched cohorts (PP1M vs. PP6M and PP3M vs. PP6M). If the distributions were not normal, a Wilcoxon signed-rank test (nonparametric) was used.

The relapse rate during the PP1M–PP3M period was 9.6% (95% CI: 5.49–16.2), which was almost than double that observed during the PP6M period (4.8%; 95% CI: 1.05–8.55). The hazard ratio for relapse during the PP1M–PP3M period, compared to the PP6M period, was 2.07 (95% CI: 0.78–5.53). 34% of the patients were in monotherapy with PP1M, 49% with PP3M, and 53% with PP6M. The average satisfaction of psychiatrists with paliperidone palmitate long acting injectables was higher than 7.7 out of 10. Fewer visits to psychiatrists were required with PP6M treatment compared to PP1M and PP3M (p<0.001); attendance rates were almost 100%, and visits to mental health nurses’ offices also improved.

Paliperidone palmitate long-acting injectable formulations have shown low relapse rates in real-world settings, with PP6M demonstrating the lowest relapse rate. Combined with high treatment satisfaction and more efficient resource utilization, PP6M may enhance mental health service delivery for patients with schizophrenia.

E. Baca-Garcia Grant / Research support from: Janssen, Consultant of: Janssen, A. SERRA SEGURA Employee of: Johnson &Johnson, P. LOPEZ RENGEL Employee of: Johnson &Johnson, J. MEHAWEJ Employee of: Johnson &Johnson, J. ANTUNES Employee of: Johnson &Johnson Innovative Medicine, L. KILLION Employee of: Johnson &Johnson Innovative Medicine.

Treatment resistant depression (TRD) is related to more severe disease burden, including poorer health, quality of life, and productivity, exacerbated by the lack of effective treatments. Delayed appropriate treatment is associated with mediocre clinical outcomes, longer time to remission, and poorer functional outcomes. Potential for functional improvement decreases with symptom chronicity and treatment failure. Esketamine nasal spray (ESK NS), with its promising results, offers potential to improve TRD patient outcomes. HOIPOCRAT-ESK is a real-world study designed to assess functional remission rates in TRD patients under ESK NS treatment at different TRD stages, evaluating if early intervention relates to more beneficial functional and clinical outcomes in Spanish clinical practice.

To report the initial functional results of HIPOCRAT-ESK, the first real-world, prospective study evaluating functional remission of TRD patients treated with ESK NS based in Spanish clinical practice.

HIPOCRAT-ESK is a cohort, non-interventional, prospective, real-world study evaluating functions remission as a primary endpoint in TRD patients treated with ESK NS as per the Spanish clinical practice including a total sample of 300 TRD patients with 12 months prospective follow-up. Functional evolution diuring treatment is evaluated with SDS scale. Functional remission was defined as total SDS score of ≤6.

83 patients were included in the intention to treat analysis. Patient’s basal functioning was severely impacted (total SDS basal score = 23.48 points). In this hard-to-treat population, ESK NS achieved positive functional results (Figure 1), with sustained improvement in functioning during induction pahse (mean SDS decrease of 3.96 and 6.04 points by day 15 and 28 of treatment, respectively). 10% of patients achieved functional remission status by the end of the induction phase (higher funtional remission rates were obserd in early TRD patients compared to chronic TRD ones). Highlighting the key importance of early treatment optimization.Table 1.

SDS Total score evolution:

Preliminary functional short-term analysis from HIPOCRAT-ESK stuyd show promising functional improvements results, observed as soon as second administration session, and sustained over the induction phase. The positive results were more marked in early TRD profiles vs chronic TRD patients.

T. Caraballo Lopez Employee of: Full time J&J employee, M. García Dorado Employee of: Johnson & Johnson Full-time employee, L. Gutiérrez - Rojas Grant / Research support from: Has recieved research support from Johnson & Johnson, Consultant of: Has participated as consultant for Johnson & Johnson, J. M. Olivares Grant / Research support from: Has recieved research support from Johnson & Johnson, Consultant of: Has participated as consultant for Johnson & Johnson, N. Cardoner Álvarez Grant / Research support from: Has recieved Research support from Johnson & Johnson, Consultant of: Has participated as consultant for Johnson & Johnson, Á. Ibáñez Cuadrado Grant / Research support from: Has recieved research support from Johnson & Johnson, Consultant of: Has participated as consultant fro Johnson & Johnson

An increasing number of adolescents present to mental health services with anxiety, depression, or self-harming behaviors. In a significant subset, these symptoms conceal undiagnosed neurodevelopmental conditions—such as borderline intellectual functioning (BIF), mild intellectual disability (ID), or autism spectrum disorder (ASD)—that were not identified during childhood. Many of these youths advanced academically and socially despite substantial effort, which delayed recognition by pediatricians and schools. Without acknowledging these hidden developmental profiles, clinicians risk applying symptom-focused therapies that are ill-suited to the adolescent’s cognitive and adaptive capacities.

(1) To highlight the impact of missed childhood diagnosis of BIF, mild ID, or ASD in adolescents presenting with emotional or behavioral symptoms. (2) To demonstrate how undetected neurodevelopmental conditions undermine standard psychotherapeutic approaches. (3)To propose systematic neurodevelopmental screening prior to intervention initiation in adolescent mental health care.

We conducted a narrative review (2023–2025) of recent meta-analyses on adapted psychotherapy in ASD and ID, conceptual reviews of BIF, and major international guidelines (NICE, NHS England). We analyzed recommendations on neurodevelopmental screening and psychotherapeutic adaptations for adolescents.

1. (1) Missed in childhood: Many adolescents with low IQ or autistic traits escaped earlier detection, progressing academically at the cost of hidden distress.

2. (2) Secondary presentations: In adolescence, they present with anxiety, depression, or self-harm, symptoms that overshadow the underlying condition.

3. (3) Therapy works—when adapted: Evidence supports the efficacy of adapted psychotherapies (simplified CBT, visual supports, structured pacing, family involvement) when neurodevelopmental conditions are recognized.

4. (4) Guideline gap: Although guidelines recommend adaptations, they rarely require clinicians to systematically rule out neurodevelopmental conditions prior to starting standard therapy.

The failure to detect neurodevelopmental disorders early partly explains why many adolescents show poor response to conventional, symptom-focused treatments. Unless mental health services incorporate routine cognitive and adaptive screening before pychotherapy or pharmacotherapy, treatments risk addressing symptoms while ignoring root causes. This raises a necessary debate: should adolescent mental health care continue to apply one-size-fits-all protocols, or move toward precision psychotherapy tailored to each individual’s neurodevelopmental profile?

None Declared

Post-traumatic stress disorder (PTSD) and complex PTSD (C-PTSD) are debilitating conditions that can develop after experiencing trauma and are characterized by intrusive symptoms, dissociation, hypervigilance, avoidance behaviors and persistent negative emotional states. C-PTSD is often the result of prolonged, repeated trauma and includes difficulties with emotional regulation, a negative self-image, and relationship problems.

Trauma-Sensitive Yoga (TSY) is a specialized practice designed for individuals who have experienced trauma. Unlike traditional yoga, TSY prioritizes safety, personal autonomy, interoception and nervous system regulation, while avoiding potential traumatic triggers, which allows participants to rebuild a sense of trust with their bodies. Research has demonstrated that yoga, and specifically TSY, can be a valuable tool for those suffering from PTSD. Studies have shown that it can significantly reduce symptoms such as hypervigilance, anxiety, and dissociation, while also improving emotional regulation.

To describe a pilot project that aims to implement a 10-session TSY in a small group of patients with PTSD/complex PTSD and to explore feasibility, acceptability, and preliminary changes in PTSD symptomatology.

The participants are patients from a psychiatric outpatient service with a diagnosis of PTSD/C-PTSD or significant traumatic history with anxiety, depressive or dissociative symptoms. Exclusion criteria include severe symptoms preventing group participation, active substance use that interferes with the process, active suicidal ideation/risk and relevant medical conditions contraindicating physical exercise.

The intervention consists of weekly 60-minute TSY sessions over 10 weeks, co-facilitated by a psychiatrist trained in TYS and a psychologist. Each session addresses core components: safety, choice, present-moment awareness, interoceptive/proprioceptive awareness, autonomic regulation, and compassion. Sessions are followed by brief group reflection.

Participants will complete the Posttraumatic Stress Disorder Symptom Severity Scale-Revised (EGS-R) and the PTSD Checklist for DSM-5 (PCL-5) pre- and post-intervention. Clinical interviews are conducted to identify individual goals and evaluate subjective experiences.

At the time of submission, the intervention and data collection is ongoing. Descriptive feasibility outcomes (recruitment, attendance, adherence) and preliminary symptom changes will be presented.

This pilot project will help us understand the feasibility and clinical value of TSY in a psychiatric setting. We hypothesize that TSY may represent a valuable complementary practice for patients with PTSD, supporting both symptom reduction and overall well-being.

None Declared

Severe forms of autism spectrum disorder (ASD) may present with extremely intense behavioral disturbances that are resistant to treatment, with significant clinical and social consequences. The limited efficacy of psychopharmacological interventions, together with pharmacogenetic restrictions, often results in only partial symptom control. These situations generate an extraordinary burden on primary caregivers.

To present a case of severe ASD with extreme behavioral disturbances and poor response to multiple treatments, highlighting the profound family impact and the limitations associated with pharmacogenetics.

This work is based on the detailed analysis of a clinical case admitted to the acute psychiatric unit of the University Hospital of Salamanca, complemented with a review of the relevant literature.

Case description: A 21-year-old male with severe ASD and multiple prior psychiatric hospitalizations was admitted due to episodes of extreme agitation, self-injury, and aggression. The severity of the symptoms required exceptional protective measures, including the use of a boxing helmet to prevent cranial trauma and boxing gloves to reduce injury from striking.

Despite these precautions, the patient developed a stress fracture of the metatarsal. Pharmacological management was further complicated by a deficient metabolic profile, with limited response to several drugs and the need for continuous adjustments. The family, as the main source of support, became overwhelmed, experiencing significant emotional and physical exhaustion. Following treatment adjustments with risperidone and topiramate, partial improvement was achieved, and the patient was referred to a specialized regional unit for further care.

This case illustrates the complexity of managing severe behavioral disturbances in ASD. Treatment resistance and pharmacogenetic limitations compromise therapeutic effectiveness. The impact on the family is devastating, with exposure to risk, emotional exhaustion, feelings of helplessness in the face of violence, and continuous physical and psychological strain. Clinical management should not only focus on the patient but also actively include support and guidance for caregivers, whose role is essential yet extremely vulnerable.

• - Severe behavioral disturbances in ASD can reach extreme intensity, with high risk of self-injury and aggression.

• - Pharmacogenetic limitations further restrict therapeutic options.

• - The family impact is profound, leading to emotional, physical, and social overload that exceeds typical caregiving capacities.

• - Strengthening caregiver support and designing comprehensive strategies that acknowledge their fundamental role is imperative.

None Declared

The interaction between psychiatric disorders and orthopedic injuries is clinically relevant but often underestimated. Self-harming behaviors, impulsivity, and impaired judgment in psychiatric patients may result in traumatic injuries requiring specialized medical care. These cases demand close collaboration between psychiatry and traumatology to optimize outcomes.

To present a clinical case illustrating the overlap between psychiatric symptoms and traumatic injury.

To emphasize the importance of an integrated, multidisciplinary approach.

To discuss diagnostic and therapeutic challenges.

We report the case of an adolescent patient admitted to the emergency department following a fracture sustained during an impulsive act related to psychiatric symptomatology. Data were collected from emergency records, psychiatric evaluations, and follow-up in both services.

The patient, with a history of mood instability and self-harm, presented with a distal radius fracture following an episode of agitation and impulsivity.

• • Traumatology: Urgent orthopedic stabilization was performed, followed by routine postoperative care.

• • Psychiatry: Comprehensive assessment revealed underlying depressive symptoms and emotional dysregulation. Psychotherapy and pharmacological treatment with SSRIs were initiated.

• • Multidisciplinary care: Joint follow-up visits allowed coordination of physical rehabilitation and psychiatric stabilization.

  After several months, fracture healing was achieved, and the patient showed significant improvement in mood regulation and reduction of self-harming behaviors.

This case highlights the critical intersection of psychiatry and traumatology. Traumatic injuries in psychiatric patients are not merely physical events but markers of psychological vulnerability. A collaborative, multidisciplinary approach ensures both physical recovery and mental health stabilization, ultimately improving prognosis.

None Declared

Schizophrenia is a heterogeneous mental disorder with diverse clinical and biological profiles. Current diagnostic systems relying solely on symptoms may overlook the full diversity of patients’ presentations, so developing neurobiological subtypes has been of great interest in recent research (Clementz et al. Schizophr Bull 2022; 48 56-68).

Biomarkers such as inflammatory markers (Lalousis et al. Brain Behav Immun 2023; 113 166-175), features of metabolic syndrome (Saccaro et al. Front Psychiatry 2024; 15 1225693), and gut-brain axis indicators (González-Blanco et al. Eur Psychiatry 2024; 67(1) e84) provide insights into pathophysiology and could enhance precision psychiatry approaches.

To stratify schizophrenia patients into subgroups based on inflammatory, metabolic, and gut-brain biomarkers. To investigate associations of such profiles with clinical outcomes, including symptom severity and cognitive performance.

Data from 199 patients diagnosed with schizophrenia (DSM-5) (mean age 40.9 years, 60.3% male), enrolled in an observational, cross-sectional, multicentre study from four centres in Spain (PI17/00246) were analysed.

Assessment:

Biomarkers:

Inflammatory: C-reactive protein (CRP; mg/L).

Metabolic: Abdominal circumference (cm)

Gut-brain axis: Lipopolysaccharide-binding protein (LBP; μg/mL).

Psychometrics: CGI-SCH, Screen for Cognitive Impairment in Psychiatry (SCIP), Positive and Negative Syndrome Scale (PANSS) for Schizophrenia.

Statistics:

Models based on latent profile analysis (LPA) with 1 to 6 profiles were estimated and compared using AIC, BIC, entropy, and the bootstrap likelihood ratio test (BLRT).

Differences in cognitive tests (SCIP) and symptom severity (PANSS, CGI-SCH) were assessed by ANCOVA (controlled by age). Analyses were conducted in R.4.5.1 (package: tidyLPA)

A two-profile solution (AIC = 1555, BIC = 1588, entropy = 0.930, BLRT < 0.01) was selected as optimal for balancing fit, parsimony, and clinical interpretability. Two distinct biomarker profiles emerged: a normative profile (91.5% of participants) with typical biomarker levels, and a high-risk profile (8.5%) with elevated inflammatory and metabolic markers (see profiles’ representation in image 1).

The high-risk group showed significant impairments in working memory and verbal fluency compared to the normative group (see comparison in figure 2); no significant differences were found in PANSS or CGI-SCH scores.Image 1:

Integrating inflammatory, metabolic, and gut-brain biomarkers via LPA identifies distinct schizophrenia patient subgroups. The high-risk profile is associated with cognitive deficits despite comparable symptom severity. These findings support biomarker-informed precision psychiatry for targeted treatment approaches.

None Declared

Treatment-resistant depression (TRD) is highly burdensome. Intranasal esketamine is effective, yet hospital-centric delivery adds travel and continuity barriers that may hinder adherence and outcomes. We hypothesize that community outpatient, patient-proximal delivery—often with the patient’s usual psychiatrist—improves effectiveness, engagement and acceptability, consistent with Spanish implementation experience and expert consensus (Molero et al. XLI Congr Nac Enferm Salud Ment 2024; — —; Ramos-Quiroga et al. Eur J Psychiatry 2025; 39(3) 100313; Young et al. Neurosci Appl 2024; 3 105240).

Primary: evaluate the effectiveness of intranasal esketamine for TRD in community outpatient clinics.

Secondary: trajectories of functioning, suicidality, well-being and treatment satisfaction; engagement/continuity and tolerability; exploratory association between proximity/continuity and outcomes.

Multicentre, prospective, pragmatic cohort across urban and rural public community mental-health clinics; consecutive recruitment. Adults with TRD (≥2 adequate antidepressant failures) initiated esketamine per routine care. Assessments: baseline; weeks 2, 4, 8, 16, 24; program discharge; and 3/6-month post-discharge. Outcomes: MADRS (primary; response ≥50%; remission ≤10), SDS, C-SSRS, SHS, SWLS, TSQM-9; engagement (retention, attendance, continuity with the same psychiatrist); safety/tolerability. Planned analyses: mixed-effects models and time-to-event.

Preliminary subset (n = 7, single site); median age 55 years. MADRS means: 44.1 (baseline) → 35.1 (wk-2) → 32.3 (wk-4) → 26.4 (wk-8) → 24.4 (wk-12); last-observation mean 19.0; mean absolute change −25.1 (≈−56.6%). Response 4/7 (57.1%); remission 2/7 (28.6%). SDS mean: 28.1 (baseline) → 16.0 (last); mean change −12.1. C-SSRS median: 4 (baseline) → 0 (last). Mean exposure 4.9 months; at cut-off: 5/7 in treatment, 1/7 suspended for lack of efficacy, 1/7 discharged with 4-month post-discharge stability. No discontinuations for safety recorded; adverse-event monitoring ongoing.

Early real-world signals indicate that near-patient outpatient delivery yields rapid, clinically meaningful improvements in symptoms, functioning and suicidality with good feasibility and retention. Findings support the hypothesis that proximity and relational continuity act as outcome amplifiers in TRD, aligning with Spanish implementation experience and expert recommendations on practical delivery and adequate duration (Molero et al. XLI Congr Nac Enferm Salud Ment 2024; — —; Ramos-Quiroga et al. Eur J Psychiatry 2025; 39(3) 100313; Young et al. Neurosci Appl 2024; 3 105240).

None Declared

Adolescent substance use is recognized as an early marker of vulnerability to severe mental illness, regardless of frequency or intensity. Detecting and addressing initial consumption provides a gateway for cost-effective preventive programs, avoiding the limitations of broad population screening.

• - To assess substance use as an entry point to early intervention.

• - To describe the Toledo program’s experience with adolescents presenting early substance use.

• - To analyze the role of brief group psychotherapy in improving outcomes.

Cohort of adolescents with cannabis, alcohol, polysubstance use, or behavioral addictions (mobile phones, video games, internet). Weekly brief group interventions based on Yalom’s Here and Now and Badaracco’s Healthy Virtuality, integrated with individual and family sessions.

• - Cannabis was the primary reason for referral.

• - Growing demand related to behavioral addictions (e.g., smartphones, gaming).

• - Over 70% had received prior, often fragmented, treatments.

• - Groups facilitated symbolization processes and improved adherence in resistant populations.

• - High prevalence of complex trauma and homo/heterotypic relapses (>70%).

Early substance use is a strong clinical and epidemiological marker for indicated prevention. Integrating group-based brief psychotherapies enables effective intervention, enhances adherence, and fosters early detection of psychosis, reducing long-term risk of chronic trajectories.

None Declared

Depressive disorders disproportionately affect women, who experience distinct biological and sociocultural risk factors that contribute to differential symptom profiles and disparities in treatment access and outcomes. Current interventions often lack gender sensitivity and personalization.

This study aims to evaluate the efficacy of the 3D Program, a human-supported, internet-based cognitive behavioral therapy (iCBT) intervention tailored for women with mild to moderate depressive symptoms, and to explore metabolic biomarkers associated with treatment response.

In a single-blind, randomized controlled trial, 120 women aged 18 to 45 years will be allocated to either the 10-week 3D Program or psychoeducational video condition. Both groups will continue treatment as usual. The 3D Program combines personalized therapist support, self-guided digital modules, and a moderated online peer-support group, with materials co-designed by women with lived experience of depressive symptoms. The primary outcome is the change in depressive symptom severity, measured by the 17-item Hamilton Depression Rating Scale at 12- and 26-weeks post-baseline. Secondary outcomes include functioning, quality of life, perceived stress, and menstruation-related distress. Additionally, biological samples (plasma, saliva, urine, hair, and fingernails) will be analyzed to assess metabolic markers of tryptophan metabolism and adrenal steroid pathways. Data will be analyzed using linear mixed-effects models and multivariate techniques to examine treatment effects and biomarker associations. The trial is registered at ClinicalTrials.gov (NCT07060690) and received ethical approval from the Drug Research Ethical Committee of the Hospital del Mar Research Institute (2023/11236/I).

The intervention is hypothesized to reduce depressive symptoms more effectively than psychoeducation alone. Analysis of metabolic markers may further help identify biological correlates of treatment response, contributing to the development of personalized interventions.

This trial seeks to advance gender-responsive and biomarker-informed mental health care. If effective, the 3D Program could offer a scalable, accessible adjunct to standard care in public health systems, improving outcomes for women with depressive symptoms and informing future precision-psychiatry approaches.

None Declared

Suicide is a leading global public health problem, accounting for over 700,000 deaths each year. Beyond its lethality, suicidal thoughts and behaviours carry a significant morbidity burden. Social connectedness has been identified as a key protective factor for suicide, yet most studies rely on static, cross-sectional assessments. Ecological Momentary Assessment (EMA) allows for the capture of real-time fluctuations in risk factors and the protective nature of social connectedness.

This study aims to advance the field by examining the prospective association between EMA-measured social connectedness and suicidal outcomes (both EMA-based and EHR outcomes), over a 12-month EMA follow-up period.

We conducted a 12-month prospective EMA study involving 550 psychiatric outpatients from four Spanish hospitals who had experienced recent suicidal thoughts or attempts. Participants received a daily survey containing 2–4 randomly selected items from a pool of 34. These items included measures of social connectedness, active and passive suicidal ideation, and non-suicidal self-injury (NSSI). Information on suicide attempts was extracted from electronic medical records. Multilevel mixed-effects models were used to distinguish between-person (average levels) and within-person (daily deviations) associations, adjusting for age, sex, time, and missingness.

Across 81,023 completed assessments, higher average connectedness was significantly associated with lower active suicidal ideation (b = −0.18, p = .014) and NSSI (b = −0.28, p = .003). Within-person increases in connectedness also predicted reductions in active suicidal ideation (b = −0.12, p < .001), but not NSSI or passive ideation. Lastly, the only significant predictor of suicide attempts was the missingness of active suicidal ideation EMA in the 7 days prior.Table 1.

Descriptive and variability statistics for suicide outcomes and social connectedness

Social connectedness predicts active suicidal ideation at both the between- and within-person levels. Lower connectedness is also associated with a greater risk of NSSI. Long-term EMA offers valuable insights suggesting that connectedness should be incorporated into suicide monitoring and intervention strategies.

None Declared

Extreme prematurity (<28 weeks) exposes parents to high stress levels in the Neonatal Intensive Care Unit (NICU), increasing risks of anxiety, depression, and impaired bonding. The interplay between family structure, cultural background, and parental mental health trajectories remains insufficiently studied.

To examine longitudinal changes in anxiety, depression, and bonding among parents of extremely preterm infants (EPTI) versus term infants (TI), assessing the impact of family size, race/ethnicity, and social support on parental mental health outcomes.

We conducted a prospective observational study including 150 EPTI and 50 TI. Parental anxiety (State-Trait Anxiety Inventory, STAI), depression (Beck Depression Inventory-II, BDI-II), NICU stress (PSS:NICU), bonding (Postpartum Bonding Questionnaire), and perceived social support were assessed at birth and at 40 postmenstrual weeks (PMW). Analyses included Kruskal–Wallis tests, Spearman correlations, hierarchical clustering, and mixed-effects regression models.

Anxiety and depression scores decreased significantly from birth to 40 PMW across most family structures (STAI: β = −19 to −25, p < 0.001; BDI-II: β = −3.5 to −8.1, p ≤ 0.043). Families with 2–3 cohabitants showed the greatest symptom reduction, while larger households (>5) exhibited persistently higher scores. Non-Caucasian ethnicity and lower maternal education were associated with elevated distress and weaker bonding. Heatmaps and clustering revealed distinct psychosocial profiles linked to family size and cultural background. Longitudinal models confirmed time as a significant predictor of symptom reduction in most subgroups.

Parental mental health trajectories after extreme prematurity are shaped by family structure, cultural background, and social support. Culturally sensitive, family-focused interventions in NICUs may mitigate long-term psychological burden and improve bonding outcomes.

None Declared

The widespread recognition of Attention-Deficit/Hyperactivity Disorder (ADHD) has led to a simplified, predominantly symptomatic approach, often initiated by non-specialized mental health staff (e.g., educators, primary care physicians). However, recent research highlights the need for a more refined perspective, emphasizing neurobiological underpinnings—executive dysfunction, arousal dysregulation, delayed reward processing—and the differentiation between primary ADHD and secondary ADHD-like presentations stemming from complex trauma, attachment disturbances, or emotional dysregulation.

To analyze the main neurobiological hypotheses underlying ADHD (executive dysfunction, arousal regulation deficits, intolerance to reward delay), to explore the clinical overlap with trauma- and attachment-related disorders during childhood and adolescence, and to examine longitudinal outcomes and differential pharmacological responses in primary versus secondary ADHD.

A narrative synthesis of recent neurobiological and clinical findings was conducted, focusing on: (1) competing neurobiological models (fronto-striatal dysfunction, aberrant arousal regulation, and reward delay intolerance); (2) symptom overlap with trauma-related and attachment disorders in children and adolescents; (3) longitudinal outcomes across developmental stages; and (4) differential response to stimulant medication in primary versus secondary ADHD.

Evidence supports the heterogeneity of ADHD trajectories. Neurobiologically, individuals with impaired arousal regulation or delayed reward processing show distinct profiles compared to those with inhibitory deficits, suggesting that uniform pharmacological approaches may be insufficient. Longitudinal studies show that about one-third of girls and one-fourth of boys no longer meet ADHD criteria by adolescence without intervention, highlighting the role of maturational processes. Moreover, children diagnosed with ADHD often evolve into divergent adult diagnoses (e.g., mood, anxiety, substance use disorders), underscoring the nonspecificity of early symptoms. Importantly, stimulant response differs: primary ADHD typically shows robust benefit, whereas secondary ADHD-like presentations linked to trauma or relational disturbances present attenuated or paradoxical responses.Image 1:

Complex trauma in early development induces neuroadaptive changes in arousal and reward systems that may mimic ADHD phenotypes. Treating these cases solely with stimulants risks chronicity and progression to comorbidities such as addictions, mood, or anxiety disorders in adolescence. Therefore, a comprehensive assessment distinguishing between primary neurodevelopmental ADHD and secondary ADHD-like syndromes is crucial. Integrating trauma- and attachment-focused interventions alongside or instead of stimulants offers a more tailored, prognostically favorable approach.

None Declared

Few studies have examined attitudes toward collaborative work among medical residents.

We evaluated collaborative attitudes and examined their relationships with empathy, personality traits, covert narcissism, and affective–cognitive dysregulation, among medical residents.

All medical residents at a public tertiary care teaching hospital were invited to participate in the survey; 213 completed the anonymous online questionnaire (77% response rate). Spearman correlation coefficients were calculated between scores on the Jefferson Scale of Physician Empathy for Physicians and Health Professionals, the Hypersensitive Narcissism Scale, the Zuckerman–Kuhlman Personality Questionnaire, the Affective–Cognitive Dysregulation Scale, and the Jefferson Scale of Attitudes Toward Interprofessional Collaboration (JeffSATIC).

The mean overall collaborative attitude score was 118.8 ± 15.4 (range: 20 -140). Empathy was positively correlated with working relationships (ρ = 0.408) and accountability (ρ = 0.372). In contrast, aggression–hostility (ρ = –0.156 and –0.177, respectively) and affective–cognitive dysregulation (ρ = –0.244 and –0.259, respectively) were negatively correlated with these outcomes. Covert narcissism, impulsive sensation seeking, and neuroticism–anxiety were negatively associated with accountability but showed no relationship with working relationships.

Some factors were associated with both JeffSATIC dimensions —working relationships and accountability —while others were linked only to one. The findings suggest that teamwork is not a single construct and that enhancing accountability may require addressing specific personality traits.

None Declared

A 74-year-old male with chronic anxiety and a previous brief depressive episode presents with persistent major depression, severe anxiety, and cognitive complaints including memory and attention difficulties worsened by benzodiazepine use. He reports insomnia, anhedonia, and difficulty managing daily activities. Despite treatment with high-dose SSRIs and benzodiazepines, symptoms and functional impairment persist. No clear psychosocial triggers are identified. Family reports sedation, confusion, and a recent fall linked to benzodiazepines. The patient remains independent in basic activities of daily living.

His medical history includes controlled hypertension, dyslipidemia, anticoagulated atrial fibrillation, and knee osteoarthritis. He denies substance use and has no known drug allergies or family psychiatric history. Comprehensive workup including labs, hormonal profile, urine toxicology, and brain CT is unremarkable.

To evaluate the discontinuation of benzodiazepines and the initiation of alternative pharmacological strategies with a more favorable safety and tolerability profile in the elderly population, such as tianeptine.

The patient was alert, oriented, and cooperative, exhibiting sad, blunted affect and psychomotor retardation. Speech was coherent, monotone, and slowed. He demonstrated depressed, apathetic mood with anhedonia, hopelessness, and severe mixed anxiety. Attention and concentration were impaired; memory and orientation intact. No suicidal ideation. Insomnia, adequate oral intake, and social withdrawal were present. Intellectual function and judgment remained intact.

The clinical diagnosis was moderate depressive episode (ICD-10 F32.1) with severe anxiety and cognitive impairment secondary to benzodiazepine use; due to age and comorbidities, tianeptine 12.5 mg twice daily was initiated, benzodiazepines were gradually discontinued, the SSRI was stopped, a non-benzodiazepine hypnotic was prescribed nocturnally, and supportive psychotherapy with cognitive remediation was implemented.

After four weeks, the patient showed improved mood, less anxiety, better sleep, and enhanced attention and memory. These improvements continued at six weeks. The family reported reduced anxiety without side effects like drowsiness or confusion seen with previous benzodiazepines. By two and a half months, the patient resumed social activities such as golf and socializing, with no major side effects or cognitive decline. The patient continues both medication and psychological therapy.

Tianeptine is an effective treatment for elderly patients with comorbid depression and anxiety, especially when benzodiazepines are poorly tolerated. It provides strong anxiolytic effects without sedation or cognitive impairment. Its glutamatergic action improves mood, anxiety, and cognition with minimal side effects. Tianeptine can be a first-line option in this population.

None Declared