Clozapine is the gold standard for treatment-resistant schizophrenia, but its use is constrained by the risk of severe neutropenia, thus requiring mandatory lifelong hematological monitoring in many jurisdictions. However, a significant evidence gap persists regarding the long-term comparative risk profiles of clozapine versus other second-generation antipsychotics (SGAs), complicating shared decision-making.

To compare the risk of neutropenia associated with clozapine versus non-clozapine SGAs, assess temporal risk evolution and identify high-risk subgroups to optimise monitoring.

This retrospective cohort study used Hong Kong’s electronic health records to identify patients initiating clozapine or non-clozapine SGAs (2003–2019), with follow-up until 2023. Outcomes included minor (absolute neutrophil count (ANC) 1.0–1.5 × 109/litre) and serious neutropenia (ANC <1.0 × 109/litre). Serious neutropenia leading to clozapine discontinuation within 6 weeks was considered clozapine-associated.

Among 4868 clozapine and 38 277 non-clozapine SGA users, clozapine users showed higher unadjusted incidences of minor (7.05 v. 3.74%) and serious neutropenia (2.53 v. 1.45%). However, adjusted rates of serious neutropenia were similar between groups (0.37 v. 0.36 per 100 person-years). Clozapine was associated with higher risks of minor (incidence rate ratio (IRR) 5.91; 95% CI 3.96–8.70) and serious neutropenia (IRR 3.48; 1.70–6.84) in the first 18 weeks. Bayesian change-point analysis showed sharply declining clozapine-associated risk after 26–29 weeks, converging with non-clozapine SGAs by 82–135 weeks (around 2 years). No significant early excess risk was found in patients younger than 45, while males experienced a transient risk of minor neutropenia.

The risk of clozapine-associated neutropenia is highest in the initial 18 weeks, declining to levels seen with non-clozapine SGAs by 2 years. Weekly monitoring for 18 weeks and monthly for up to 2 years is advisable, with potential for personalised schedules based on age and sex.

Non-suicidal self-injury (NSSI) and suicide attempts (SA) represent overlapping yet clinically distinct forms of self-harm. While both behaviors share common psychological underpinnings such as emotional dysregulation and interpersonal difficulties, their intent, lethality, and clinical implications differ substantially. Understanding these differences is particularly critical in emergency department (ED) settings, where clinicians must rapidly assess risk and determine appropriate interventions.

This study aimed to delineate their unique risk, rescue, and psychopathology profiles among patients presenting to the emergency department (ED).

We analyzed 356 ED patients with self-harm, categorizing them into NSSI (n = 61) and SA (n = 295) groups based on behavioral intent. Comprehensive comparisons were made across demographic, clinical, psychopathological, and situational (risk/rescue) variables.

The NSSI group was significantly younger, more often female, employed, and single (all p < 0.05). While both groups reported emotional distress, the SA group exhibited more severe depression, hopelessness, and comorbid medical illness (all p < 0.001), alongside higher prevalence of persistent suicidal ideation, planned acts, and use of high-lethality methods. In contrast, the NSSI group reported more frequent, impulsive episodes of self-injury—primarily by cutting—with minimal planning, no suicide notes, and low medical lethality (all p < 0.01). Interpersonal stress was the dominant precipitant for NSSI, whereas SA was more often associated with financial or interpersonal loss. Critically, the NSSI group demonstrated significantly lower suicide risk and medical severity (p < 0.001) but higher rescue potential, including more frequent overt help-seeking and better outcomes (all p < 0.01).

NSSI and SA in the ED setting have distinct risk, rescue, and psychopathology profiles. NSSI is characterized by younger, more socially connected individuals engaging in impulsive, low-lethality acts with higher rescue potential, while SA involves older patients with more severe psychopathology, planned high-lethality behaviors, and poorer outcomes. Recognizing these differences is essential for accurate risk assessment and tailored intervention in emergency and acute care settings.

None Declared

Clozapine has shown potential in treating severe aggression in individuals with neurodevelopmental disorders, a population for whom pharmacological options remain limited. We present a case of effective use of Clozapine for treatment of challenging behaviours in Autism Spectrum Disorder and Intellectual Disability.

We seek to illustrate the effective use of Clozapine in an individual with Autism Spectrum Disorder and Intellectual Disability who exhibited severe aggressive and self-injurious behaviours in the psychiatric inpatient setting, along with a discussion on the key considerations and risks of the treatment that were pertinent to the case.

Details of the case are described, with information gathered from past medical records.

The case is a 28-year-old male with a diagnosis of Autism Spectrum Disorder and Intellectual Disability. He had recurrent readmissions due to aggressive behaviour towards his mother and self-injurious behaviour (hitting his head on walls). Triggers for these episodes appeared to centre around his rigidity with demands and poor frustration tolerance.

He had been tried on multiple psychotropics in the past to manage his challenging behaviour, including Olanzapine, Trifluoperazine, Aripiprazole, Haloperidol, Chlorpromazine, Sertraline, Lithium and Carbamazepine, with limited efficacy.

He began to exhibit more severe behavioural disturbances during a prolonged hospital admission. Some of these concerning behaviours include aggression towards nursing staff and other patients, damaging of property and barging open electromagnetically-sealed doors to enter secured rooms to satisfy his demands of obtaining food or playing with electronics. There was limited efficacy with behaviour modification and alternative strategies such as providing him with activities to redirect and provide sufficient stimulation and regulation as these were limited by ward staffing resources.

The decision was made in consultation with the patient’s parents to initiate clozapine treatment in his best interests. Initial rate of up-titration of the clozapine dose was limited by side-effects of oversedation, mild tachycardia, hypersalivation and concerns for seizures given a history of generalized tonic-clonic seizures. Significant improvement in his behaviour was observed at a dose of Clozapine 250mg/day after a period of 3 months.

Clozapine may represent a safe and effective pharmacological option for managing challenging behaviour in individuals with neurodevelopmental disorders who are unresponsive to other treatments. Further research is needed to better understand its efficacy and safety in this population.

None Declared

Disorders of gut–brain interaction (DGBI), including irritable bowel syndrome (IBS), functional dyspepsia (FD), and functional constipation (FC), are prevalent conditions associated with psychological comorbidities. While psychosocial correlates of symptom burden have been widely reported, machine learning approaches to phenotype severity and predict risk based on psychological profiles remain limited.

This study aimed (1) to identify severity-based clinical phenotypes of DGBI patients using unsupervised clustering of gastrointestinal symptom indices, and (2) to evaluate the predictive value of psychological variables in differentiating severity groups using machine learning.

A total of 373 patients diagnosed with DGBI at a Brain-gut axis Clinic, Department of Psychiatry, Wonkwang university hospital from 2020 to 2023 completed validated gastrointestinal severity scales (IBS-SSS, NDI-K, PAC-SYM, GERD-Q) and psychological assessments (BDI, BAI, CTQ, MSPSS, CD-RISC, DS-14). K-means clustering (k=3) was applied to GI severity measures to define mild, moderate, and severe groups. Group comparisons of psychological measures were conducted using ANOVA/Welch’s ANOVA with Benjamini–Hochberg correction. Random Forest classifiers with nested 5-fold cross-validation and SMOTE oversampling were used to predict severity clusters. Feature importance was assessed by permutation analysis.

Clustering classified patients into mild (n=159), moderate (n=132), and severe (n=82) groups. Significant between-group differences were observed in CTQ subscales (physical, sexual, emotional abuse; all FDR-corrected p < 0.01) and BAI muscular/motoric symptoms (p = 0.0066). Machine learning models based on CTQ or BAI alone showed modest performance (accuracy ~52–57%). Combining CTQ+BAI improved accuracy to 60.6% (F1=58.4%). The model incorporating all psychological variables achieved the best performance (accuracy 65.4%, F1=64.1%). Permutation importance highlighted sexual and emotional abuse as top predictors.

Our findings indicate that early adverse experiences and anxiety-related symptoms strongly differentiate severity phenotypes in DGBI. Machine learning models integrating multiple psychological dimensions outperform single-scale approaches, supporting precision psychosomatic profiling for DGBI management.

None Declared

Movement abnormalities, including bradykinesia (slow movements) and dyskinesia (involuntary muscle contractions), consistently appear in different stages of psychosis continuum. Accumulating evidence supports the notion that movement abnormalities are a cardinal part of schizophrenia and not merely side effects of antipsychotics. Nevertheless, we still have an insufficient understanding of these movement issues in schizophrenia. For example, little research has focused on exploring whether movement abnormalities were significant correlates of quality of life and functions in patients with schizophrenia. Identifying these correlates paves the way for recognizing meaningful intervention targets and developing tailored intervention programs.

To examine association between quality of life and functions with bradykinesia and dyskinesia in patients with schizophrenia.

Currently, we have recruited 13 participants with schizophrenia and 5 healthy participants. Quality of life was assessed using the short version of the World Health Organization Quality of Life questionnaire. Daily living and work functions were assessed using Jebsen-Taylor Hand Function Test and total working hours in the past four weeks respectively. Bradykinesia was assessed using Box and Block Test (specifically assessing upper-limb gross motor speed), Purdue Pegboard Test (assessing upper-limb fine motor speed), and the hypokinesia domain of Extrapyramidal Symptom Rating Scale. Dyskinesia was assessed using Abnormal Involuntary Movement Scale. Spearman’s correlation coefficients were calculated.

For the total sample (N = 18), higher quality of life, a higher daily living function, and a higher work function were related to faster upper-limb gross motor (rho = 0.65, p = 0.004; rho = −0.77, p < 0.001; rho = 0.73, p = 0.001) and fine motor (rho = 0.56, p = 0.016; rho = −0.84, p < 0.001; rho = 0.68, p = 0.002) and less severe hypokinesia (rho = −0.60, p = 0.009; rho = 0.83, p<0.001; rho = −0.73, p = 0.001), but not related to dyskinesia (rho = −0.14, p = 0.587; rho = 0.35, p = 0.150; rho = −0.38, p = 0.120). For participants with schizophrenia (n = 13), a higher daily living function was related to faster upper-limb fine motor (rho = −0.68, p = 0.011) and less severe hypokinesia (rho = 0.56, p = 0.048). The other correlations were not significant.

Bradykinesia was a significant correlate of daily living functions in patients with schizophrenia. Healthcare practitioners should target bradykinesia to develop effective interventions for these patients, thus contributing to enhancing their independent living.

None Declared

Insomnia is one of the most prevalent sleep disorders among young adults, particularly university students, and is associated with impaired daily functioning, psychiatric comorbidities, and increased health risks. Despite the high burden, few studies have examined multidimensional risk factors in Korean college populations.

This study aimed to investigate sociodemographic, behavioral, and psychological correlates of insomnia among young college students in Korea.

A cross-sectional survey was conducted among 5,273 students aged 19–34 years from 14 universities in Jeollanam-do, Korea. Participants completed validated questionnaires including the Korean version of the Insomnia Severity Index (ISI-K), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Generalized Anxiety Disorder-7 (GAD-7). Sociodemographic and lifestyle characteristics such as gender, residential status, socioeconomic perception, smoking, alcohol, caffeine, and smartphone use were also assessed. Group comparisons and multivariate logistic regression were performed to identify independent predictors of insomnia risk, with statistical significance set at p < 0.05.

Overall, 31.1% of participants were classified as being at risk for insomnia (ISI-K ≥ 8). Females had a significantly higher prevalence compared with males (56.8% vs. 43.2%, p = 0.016). Living alone, low perceived socioeconomic status, and lack of close friendships were associated with elevated insomnia risk. Smoking (OR = 1.59, 95% CI: 1.37–1.86, p < 0.001) and alcohol use (OR = 1.23, 95% CI: 1.02–1.49, p = 0.030) emerged as significant behavioral factors. In contrast, caffeine consumption and smartphone use did not show significant associations. Psychological distress was the strongest predictor: depressive symptoms (CES-D ≥ 21) increased insomnia risk more than five-fold (OR = 5.26, 95% CI: 4.22–6.54), and anxiety symptoms (GAD-7 ≥ 10) tripled the risk (OR = 3.03, 95% CI: 2.14–4.29).

This study demonstrates that insomnia in university students is shaped by an interplay of demographic, psychosocial, and mental health factors rather than lifestyle behaviors alone. Depression and anxiety were the most powerful predictors, underscoring the need for early psychological screening and integrated mental health interventions. Public health strategies in Korea should incorporate structured sleep education, counseling services, and policies that strengthen social and economic support systems for young adults.

None Declared

The 34th European Congress of Psychiatry in 2026 emphasises improving care and expanding horizons through enhanced collaboration with multidisciplinary professionals, experts by experience, and carers. This focus provides an opportune context to share insights from Singapore’s experience in addressing communication challenges within mental health inpatient services. Patient’s experience surveys consistently identify communication gaps as a primary concern in psychiatric inpatient settings, with interaction and communication problems, inadequate understanding of care plans, and insufficient follow-up communication emerging as predominant issues.

A standardised inpatient communication process, which enhances multidisciplinary team’s (MDT) coordination and improves family engagement throughout the patient journey, was developed and implemented in the Institute of Mental Health. It is a comprehensive communication framework mapping four key touchpoints: admission orientation within 24 hours, initial clinical updates between 24-72 hours post-admission, ongoing interim updates during admission, and discharge planning communication. The process integrates with existing Care Coordination Model activities, establishing clear roles for clinicians, advanced practice nurses, staff nurses, care coordinators and case managers. Standardised message templates were created for various communication scenarios, utilising multiple channels including SMS, WhatsApp messages, and telephone contact.

The initiative was piloted across eight acute regional wards with planned adaptation for subspecialty units across the hospital. Change management strategies included pre-rollout engagement sessions with stakeholders, educational materials, publicity roadshows and post-rollout troubleshooting and feedback collection.

The standardised communication process aims to improve patient and family experience scores, reduce communication-related complaints, and enhance care coordination. Success will be measured through internal Patient-Reported Experience Measures and Ministry of Health’s Patient Experience Survey results, with particular focus on improving team-based care and communication metrics.

This systematic approach addresses critical gaps in mental health inpatient communication, potentially serving as a model for other psychiatric institutions seeking to enhance family engagement and patient experience. The integration of structured communication protocols with existing care coordination frameworks represents an innovative approach to enhancing family engagement and patient experience in mental health settings.

None Declared

Poor emotional expression and depression of patients with schizophrenia are difficult problems in clinical situation. The objective of this study was to investigate the effects of group arts therapy based on emotion management training on emotional expression, positive emotion and negative emotion, alexithymia, depression and quality of life in patients with schizophrenia

The objective of this study was to investigate the effects of group arts therapy based on emotion management training on emotional expression, positive and negative emotion, alexithymia, depression and quality of life patients with schizophrenia.

24 patients of 160 in-patients with schizophrenia from H Mental Health Care Facilities in G city were randomly assigned to either an experimental or control group. Each group were consist of 12 patients. Group arts therapy was conducted on the experimental group twice a week, 60 minutes per session, for a total of 16 sessions. The following scales were used for assessment: Berkeley Expressivity Questionnaire (BEQ), Positive Affect and Negative Affect Schedule (PANAS), Toronto Alexithymia Scale (TAS-20K), Depression Scale for Schizophrenia (K-CDSS), and Schizophrenia Quality of Life Scale (SQLS). Repeated measures ANOVA was conducted to confirm the differences for scores of each scales regarding groups, measuring timing, and also the interaction between groups and measuring timing.

Group arts therapy increased emotional expression (total score, expressivity and impulse strength subscale socre of BEQ) in experimental group compared to control group.(p<.001)

Group arts therapy increased positive emotion(p<.001) as well as decreased negative emotion(p<.05) in experimental group compared to the control group.

Group arts therapy increased score of difficulty identifying feelings of TAS-20(p<.01) in experimental group compared to the control group.

Group arts therapy decreased depression(p<.01) in experimental group compared to the control group.

Group arts therapy increased quality of life(p<.01) in experimental group compared to the control group.

The group arts therapy have significantly improved the emotional expression and positive emotion, and decreased negative emotion, Alexithymia and depression in patients with schizophrenia and also improved quality of life. These results suggest that group arts therapy based on emotion management training could be a useful intervention for emotional disturbance in patients with schizophrenia.

None Declared

Attention-deficit/hyperactivity disorder (ADHD) is associated with alterations in executive function and prefrontal cortical activity. Functional near-infrared spectroscopy (fNIRS) provides a non-invasive method to assess task-related hemodynamic changes, yet developmental differences in drug-naïve ADHD populations remain insufficiently understood.

This study aimed to investigate prefrontal activation patterns during executive function tasks in drug-naïve individuals with ADHD compared with healthy controls, and to explore age-related differences across childhood, adolescence, and adulthood.

We enrolled a total of 48 drug-naïve patients with ADHD (children, adolescents, and adults) and 50 healthy controls between March 2019 and February 2022. Participants were recruited from the outpatient clinic of the Child and Adolescent Psychiatry Department. All participants underwent standardized assessments, including IQ testing, ADHD symptom rating scales, and the Computerized Attention Test (CAT). Prefrontal cortical activation was measured using functional near-infrared spectroscopy (fNIRS) during the Trail Making Test A and B. Group comparisons were conducted between ADHD and control participants, as well as across age groups. The study was approved by the Ethical Committee (No. MJH 2010-08-025-001).

ADHD participants showed significantly higher symptom severity compared with controls (all p < 0.001), as well as lower performance on the Computerized Attention Test (CAT) (p = 0.009) and reduced working memory and processing speed indices of IQ (p < 0.01) (Fig 1). fNIRS analyses during the Trail Making Tests revealed distinct activation patterns across groups and age strata.(Fig 2) While overall group-level effects were limited, exploratory ROI-level analyses indicated a significant difference in oxygenated hemoglobin response at ROI4 under specific task conditions, suggesting localized prefrontal hypoactivation in ADHD (Fig 3).Image 1:

Drug-naïve individuals with ADHD demonstrated marked clinical and cognitive impairments compared with controls. Although global group differences in prefrontal activation were subtle, the presence of localized alterations such as ROI4 highlights the potential of fNIRS to capture specific neural dysfunctions in ADHD. These findings underscore the importance of developmental context and support the need for larger-scale studies to validate ROI-specific effects.

S. Lee: None Declared, W. S. Kang: None Declared, M. Hong Grant / Research support from: Supported by National Research Foundation of Korea

Medication nonadherence undermines treatment effectiveness in psychiatric care, yet objective, continuous measurement in routine practice is challenging. AI-enabled wearables may offer scalable monitoring but evidence from randomized evaluations remains limited.

the present study evaluated the effectiveness of an AI-based wearable and behavioral data algorithm for adherence monitoring in outpatient psychiatric patients, using a randomized design.

We conducted a single-center, prospective, randomized controlled trial of an AI-based, wrist-worn adherence monitoring system in outpatient psychiatric care. Participants (age ≥12 years) were randomized 1:1 to smartwatch intervention or usual care for 4 weeks. Algorithm-derived adherence was calculated as the proportion of detected medication events relative to scheduled doses over prespecified 28-day baseline and post-intervention windows. The primary endpoint was change in adherence (Δ = post − pre). Analyses used complete cases with linear regression (adjusting for baseline adherence, age, sex, and medication covariates) and HC3 standard errors; ANCOVA served as a confirmatory model. Prespecified responder thresholds were Δ ≥10 and ≥20 percentage points (pp). Sensitivity analyses excluded benzodiazepine users.

Seventy-eight participants were analyzed (control n=41; intervention n=37; mean age 18.8±6.7 years). Baseline adherence was similar (control 22.4%±16.5; intervention 20.4%±17.1). Follow-up adherence increased modestly in controls (25.5%±15.2) and substantially in the intervention group (39.9%±34.5). The mean change favored intervention (+19.5%±38.1 vs +3.1%±11.5). In adjusted models, intervention assignment was associated with greater improvement (β=14.28, 95% CI 1.80–26.77; p=0.025); ANCOVA results were consistent. Responder analyses showed higher odds at the ≥20 pp threshold (45.9% vs 4.9%; OR=16.58, 95% CI 3.48–78.97; p<0.001), but not at ≥10 pp (54.1% vs 39.0%; OR=1.84; p=0.185). Excluding benzodiazepine users yielded similar effects.

An AI-enabled smartwatch intervention improved short-term, algorithm-derived medication adherence compared with usual care in outpatient psychiatry. Larger, multi-center trials with longer follow-up and clinical endpoints are warranted.

None Declared

Sexual violence mediated through digital media, including videos, photographs, and online communication, poses unique and escalating risks for victims’ mental health. While depressive symptoms are common consequences, little is known about how these outcomes differ by age group and trauma-related factors in digital media–related cases.

This study aimed to investigate age group differences and trauma-related risk factors associated with depressive outcomes among sexual violence victims, focusing specifically on cases involving digital media.

We analyzed 84 victims of digital media–related sexual violence who visited a support center. Participants were categorized into two groups based on depressive symptom scores: low (n=55) and high (n=29). Sociodemographic variables, crime-related circumstances, perpetrator characteristics, and motives for visiting the center were compared using chi-square tests.

All participants were victims of sexual violence involving digital media. Significant differences emerged across several domains:

Age group: Adults were more likely to present with high depressive scores than adolescents (60.6% vs. 17.7%, p<.0001).

Crime circumstances: Within this digital media–related sample, cases involving alcohol use or loss of consciousness were strongly associated with higher depressive scores (83.3%), whereas videos/photography cases showed lower depressive scores by comparison (p=0.033).

Perpetrator age: Victims assaulted by perpetrators aged 20–30 years exhibited higher depressive scores (57.1%, p=0.021).

Help-seeking motives: Voluntary visitors more often reported high depressive scores than involuntary ones (53.9% vs. 25.9%, p=0.013).

Other factors, including sex, psychiatric history, number of perpetrators, and past victimization, were not significantly different.Image 1:

Among victims of digital media–related sexual violence, mental health outcomes varied according to age group, trauma circumstances, and perpetrator characteristics. Adolescents were more likely to report lower depressive scores, potentially reflecting delayed symptom expression, while adults exhibited greater immediate distress. Importantly, cases involving alcohol or impaired consciousness carried the highest depressive burden, whereas video/photography cases displayed a different pattern of symptom severity. These age-related differences underscore the need for distinct, age-sensitive intervention strategies: proactive monitoring and long-term follow-up for adolescents, and immediate intensive support for adults.

Acknowledgement: Preliminary findings from this dataset were presented at the APA Annual Meeting 2025; the present abstract reflects extended analyses with a focus on age group differences and trauma-related risk factors.

None Declared