Lithium remains the most effective prophylactic agent for bipolar disorder (BD), yet reports suggest that clinical practice diverges from guideline recommendations. Understanding the prescribing practices is critical to inform treatment policy.

We aimed to characterise prescribing patterns for BD in Greece, focusing on drug category prevalence, adherence, polypharmacy, and diagnostic coding practices.

We analysed nationwide prescription records for 59,035 BD patients (ICD-10 F30.x, F31.x) covering >1.2 million prescriptions over one year (2020) n the e-Government Center for Social Security (IDIKA) database. The analyses included drug prevalence, medication possession ratio (MPR) to proxy adherence, and a range of subgroup and sensitivity analyses for major psychiatric comorbidities. The derived polypharmacy and MPR phenotypes were statistically modelled with fixed- and mixed-effects models to identify predicting variables.

Sex and age distributions diverged: BD was four times more likely in boys than girls, but prevalence in adults skewed female, peaking at ages 50–59. Lithium was prescribed to 7.6% of BD patients but showed one of the highest adherence scores (median MPR 0.67). Antipsychotics dominated, with 61% of the cohort receiving olanzapine or quetiapine at least once. Polypharmacy occurred in 22% of patients, was as rule short-term, and was strongly predicted by specialist involvement and unspecified severity codes. Mixed-effects modelling showed a substantial influence of unaccounted individual-level factors (R2 61% vs R2 4% in the fixed effects model). In the sensitivity analyses, diagnostic volatility was marked, with 64.4% of patients coded under general F31/31.9, and 37% showing comorbid BD+MDD diagnoses.

In this nationwide cohort study, an underuse of lithium is apparent despite high adherence, and antipsychotics dominate. Polypharmacy may reflect specialist involvement in diagnostically uncertain cases. Previous epidemiological findings of BD sex dimorphism are validated and this is more obvious in older ages, possibly due to more accurate diagnostic processes. This misalignment of guidelines and practice suggests that prescriber habits are partly shaping BD management.

None Declared

Antidepressants (ADs) are widely prescribed for a variety of depressive disorders, but may precipitate manic episodes (antidepressant-associated mania or hypomania, AAMH). Identifying predictors and rates of AAMH in real-world settings is crucial to stratify clinical risk, especially in the absence of prophylactic mood stabilizers.

We aim to identify AD that carry the highest risk of AAMH via a triangulation of evidence framework that combines nationwide prescription datasets, large pharmacovigilance databases and genetics-informed pharmacodynamic data.

We analyzed the Electronic Governance of Social Security (IDIKA) database encompassing patients with diagnoses of unipolar and manic episodes/bipolar depression. Incident AD users were identified based on a minimum of six observed months with no recorded AD prescriptions. Patients with prior manic or bipolar diagnoses were excluded. AAMH was defined as a new manic diagnosis within a maximum of 180 days post-AD initiation. Cox proportional hazards models stratified by AD were used to evaluate predictors of switch. The FDA Adverse Event Reporting System database was used for the extraction of manic or hypomanic episodes that follow an AD prescription. To further substantiate mechanistically any observed differences in those two sources, publicly available pharmacodynamic data on the affinities of each drug were used and corresponding variants were assessed for their strength of association with various mood-related phenotypes.

Among incident AD users without prior recorded mania (n=134,353, mean (SD) age: 64 (17) years, 66% female), a small proportion experienced manic switch during follow-up (992 events, switch rate = 0.7%). Adjusted logistic and survival models revealed heterogeneity in risk between ADs. Venlafaxine (adjusted hazard ratio (aHR) 1.74, 95% CI: 1.37–2.22, p<10⁻⁶) and mirtazapine (1.65, 95% CI: 1.28–2.12, p=9×10⁻⁵) had the highest rates, whereas citalopram (1.04, 95% CI: 0.78–1.40, p=0.69) and escitalopram (baseline switch rate 0.58%) had the lowest. Moclobemide, although rarely prescribed, was a notable outlier (aHR 21.1, 95% CI: 6.7–66.3, p<10⁻⁶). Age and female gender were modest predictors, with higher risk in younger female patients. The FAERS database showed largely concordant results, with vortioxetine ranking first and citalopram last. Few differences were observed with respect to mapping of the drug target genes to mood-related phenotypes.

There are important differences in the AAMH risk profile of ADs. While overall switch rates were low, notable differences emerged by drug class, with monoamine oxidase inhibitors, SNRIs, and mirtazapine showing high rates. The largest predictor was prior BD history. Although absolute risks were lower than prior evidence suggests, clinicians should be cautious of prescribing higher-risk ADs in individuals with latent bipolarity.

None Declared

Treatment-resistant depression (TRD) is highly prevalent and can affect one in three patients with unipolar depressive disorders. Lithium is an established option in the treatment of TRD. However, real-world data on how this recommendation is perceived by prescribers, as well as psychopharmacological and diagnostic correlates, remain scarce.

To investigate the frequency, diagnostic predictors, and prescribing patterns of lithium in patients diagnosed with unipolar depressive disorders in Greece, with a focus on polypharmacy and potential drug interactions.

We analysed a large Greek nationwide prescription database covering all ICD-10 unipolar depression codes for one calendar year. Logistic regression models were used to identify diagnostic predictors of lithium prescription, adjusting for age, sex, and psychiatrist involvement. We examined co-prescription patterns and potentially interacting drugs. Sensitivity analyses were conducted to exclude patients with coexisting psychiatric disorders during the observation period.

A total of 9,218,025 prescriptions were retrieved for 753,142 patients who received at least one unipolar depressive disorder diagnosis. Of these, 1,314 patients (0.174%) were prescribed lithium (people prescribed lithium, PPL). PPL were younger, with males overrepresented, and were more likely to have been treated by a psychiatrist. Disorder severity markers such as psychotic symptoms (adjusted odds ratio (aOR) 6.05 (5.21, 6.81)) and mixed presentations (aOR 7.12 (5.11, 9.08)) were predictive of lithium prescription. The most commonly prescribed primary agent was venlafaxine (38% of PPL), while atypical antipsychotics were the most frequently co-prescribed drug class (51%). The historically first described effective combination of lithium + tricyclic antidepressant was prescribed to 7% of PPL.

One in thirteen PPL received a potentially interacting drug, predominantly in the class of antihypertensives.

In sensitivity analyses, the proportion of PPL among those that consistently received only a unipolar depression was even lower (0.08%).

Lithium prescription in unipolar depressive disorders remains unpopular and is predominantly given in those with severe depression. Newer antidepressants are favoured against the classical combinations of lithium and tricyclic antidepressants. Despite proven efficacy and a sustained positioning in the treatment algorithms for treatment-resistant depression, other alternatives are preferred.

None Declared

Psychopharmacological epidemiological data regarding Major Depressive Disorder (MDD) are based on small-scale representative studies.

Our study aims to determine the one-year prevalence of major depressive disorder under antidepressant treatment, identify the severity of MDD, and describe patterns of antidepressant prescription for MDD in Greece.

The electronic prescription database of the e-Government Centre for Social Security was used to describe the characteristics, the diagnoses and the prescription patterns in patients that received at least two prescriptions of antidepressants, with an ICD-10 code relevant to unipolar depression, during the 1-year period between 1st of February 2019 and 31st January 2020. All the beneficiaries of the National Organization for Health Care Services Provision were covered.

The study population (n=369,860) indicates a 1-year prevalence of antidepressant-prescribed unipolar depression of 3.5%, with clear predominance of females (females: 72.5%), and mean sample age 65.1 years (standard deviation: 15.3). Concerning the severity of the diagnoses, 52.0% of the sample was characterized as “mild-moderate” severity, 6.6% was characterized as “severe” severity, and 56.2% was characterized as “unspecified” severity. 86.2% of the patients received one antidepressant, 12.1% of the patients received two antidepressants, and 1.7% of the patients received at least three antidepressants. The most commonly prescribed category of antidepressants was “SSRIs”, (78.3% ), followed by “SNRIs” (17.1%).

The prevalence of antidepressant-prescribed MDD was estimated at 3.5%. Identifying the prescription patterns of antidepressant treatment for MDD is of paramount importance in formulating policies for a cost-effective and quality-acceptable management of the disorder.

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Decision-making is a complex process, and little is known about the various elements that comprise it. Recent literature on neurocognitive deficits in patients with a history of suicidality has highlighted that impaired (non-adaptive) decision-making is one of the most consistent deficits in individuals with a history of suicidality.

This study aims to systematically review the available evidence on decision- making capacity in depressed patients with a history of suicide attempts.

A systematic search was conducted in PubMed, Psycnet, Elsevier and Scopus with additional searching through bibliographic references. This search was performed until the 31st of August 2022 and provided information on decision-making capacity in relation to suicidality and depression.

The literature review provided 377 references, the titles and abstracts of which were reviewed for relevance to this study and the entry criteria set. The review of the title and abstract of these studies resulted in 50 articles that were potentially relevant to the study topic and a further review was then conducted to re-examine the selected studies and articles, which resulted in the final selection of 20 studies. The outcome measure used by the majority of studies as a measure of decision-making ability was the IOWA Gambling Task (IGT), in which the performance of patients with a history of depression and self-harm in most studies was significantly worse than that of healthy controls. Some methodological characteristics of the studies included in this review complicated the interpretation of the results, such as the sample size and characteristics of each study.

Decision-making ability shows alterations in patients with a history of suicidality and depression, confirming the findings of previous studies. Furthermore, an impaired or dysfunctional decision-making ability may potentially be a predictor of suicidal behaviour in patients with depression, a possibility that could be a reason for further research in this field, both in the context of investigating predictors and in developing appropriate treatments for these patients.

None Declared

Resilience is defined as the process and outcome of successfully adapting to difficult or challenging life experiences, and adjustment to external and internal demands, including challenges in family or relationship dynamics, serious health concerns, financial pressure or work-related stress. Employees’ creative self-sufficiency, work environment, as well as the interpersonal relationships developing in the workplace which constitute basic parameters of professional satisfaction can potentially affect both psychosomatic resilience of the employees as well as their performance at work. Exploring the available bibliography, it was revealed that the mental health professionals’ community has not been sufficiently examined in terms of emotional resilience.

To examine the dimensions of psychological resilience among mental health professionals.

In the context of a postdoctoral research which is conducted on a sample of the Greek population- personnel working in mental health hospital and community-based settings -a review of 35 articles from 1985 to 2023 on PubMed and Google Scholar was proceeded regarding psychological resilience among mental health professionals.

Creative self-sufficiency and professional satisfaction were found to be positively correlated with resilience among mental health professionals. Additional factors have been found to influence mental resilience among mental health professionals, such as individual personality traits, coping style, perceived social support, a sense of security, and organizational support.

This review contributes to the evolving understanding of resilience, particularly regarding mental health prοviders. The positive correlation between creative self-sufficiency and professional satisfaction highlights the importance of fostering these dimensions to enhance mental resilience through implementing emotional capacity-building practices, social skills counseling, as well as mindfulness-based interventions.

None Declared

Knowledge of sex differences in risk factors for posttraumatic stress disorder (PTSD) can contribute to the development of refined preventive interventions. Therefore, the aim of this study was to examine if women and men differ in their vulnerability to risk factors for PTSD.

As part of the longitudinal AURORA study, 2924 patients seeking emergency department (ED) treatment in the acute aftermath of trauma provided self-report assessments of pre- peri- and post-traumatic risk factors, as well as 3-month PTSD severity. We systematically examined sex-dependent effects of 16 risk factors that have previously been hypothesized to show different associations with PTSD severity in women and men.

Women reported higher PTSD severity at 3-months post-trauma. Z-score comparisons indicated that for five of the 16 examined risk factors the association with 3-month PTSD severity was stronger in men than in women. In multivariable models, interaction effects with sex were observed for pre-traumatic anxiety symptoms, and acute dissociative symptoms; both showed stronger associations with PTSD in men than in women. Subgroup analyses suggested trauma type-conditional effects.

Our findings indicate mechanisms to which men might be particularly vulnerable, demonstrating that known PTSD risk factors might behave differently in women and men. Analyses did not identify any risk factors to which women were more vulnerable than men, pointing toward further mechanisms to explain women's higher PTSD risk. Our study illustrates the need for a more systematic examination of sex differences in contributors to PTSD severity after trauma, which may inform refined preventive interventions.

Binge eating behaviors are associated with psychological, social, and biological factors, while it is suggested that they may be triggered by negative emotions, including depression and anxiety, and provide relief from them, which in turn may lead to reinforcement of such behaviors.

This study aimed to examine the eating habits and in particular the binge eating behaviors of a sample of adults during the COVID-19 pandemic, an unprecedented challenge for public health and communities worldwide with multi-level consequences on people’s lives.

The sample consisted of 196 individuals residing in Greece aged 18 to 64 years (76.5% women), who completed an anonymous questionnaire from June to July 2021. This included the following psychometric instruments: Fear of COVID-19 Scale to assess the fear related to COVID-19, Rosenberg Self-esteem Scale to assess self-esteem, Depression Anxiety Stress Scale-21 to assess anxiety, depression and stress, Binge Eating Scale to assess binge eating behaviors, UCLA Loneliness Scale for the evaluation of the perceived feeling of loneliness and Reflective Functioning Questionnaire for the assessment of reflective functioning (i.e., the ability to understand human behavior in terms of underlying mental states).

The majority of participants (86.7%) reported that during the pandemic their diet was less healthy than before the pandemic onset, while almost half (46.4%) of the participants stated that they had experiences an episode of binge eating during the past 6 months, and 36.2% that they had used self-induced vomiting in order to control their weight. Of note, the results of a multiple regression analysis revealed that higher levels of fear of the pandemic as well as of depression were independently associated with higher binge eating, with women presenting higher mean scores in the Binge Eating Scale than men. Conversely, higher self-esteem appeared to be independently associated with lower binge eating levels, thus acting as a protective factor, whereas the remaining psychometric factors were not found statistically significantly related.

In conclusion, the findings of the present study highlight the importance of identifying dysfunctional eating behaviors and related psychological factors that may potentially act as risk or protective factors, especially during the pandemic.

None Declared

Racial and ethnic groups in the USA differ in the prevalence of posttraumatic stress disorder (PTSD). Recent research however has not observed consistent racial/ethnic differences in posttraumatic stress in the early aftermath of trauma, suggesting that such differences in chronic PTSD rates may be related to differences in recovery over time.

As part of the multisite, longitudinal AURORA study, we investigated racial/ethnic differences in PTSD and related outcomes within 3 months after trauma. Participants (n = 930) were recruited from emergency departments across the USA and provided periodic (2 weeks, 8 weeks, and 3 months after trauma) self-report assessments of PTSD, depression, dissociation, anxiety, and resilience. Linear models were completed to investigate racial/ethnic differences in posttraumatic dysfunction with subsequent follow-up models assessing potential effects of prior life stressors.

Racial/ethnic groups did not differ in symptoms over time; however, Black participants showed reduced posttraumatic depression and anxiety symptoms overall compared to Hispanic participants and White participants. Racial/ethnic differences were not attenuated after accounting for differences in sociodemographic factors. However, racial/ethnic differences in depression and anxiety were no longer significant after accounting for greater prior trauma exposure and childhood emotional abuse in White participants.

The present findings suggest prior differences in previous trauma exposure partially mediate the observed racial/ethnic differences in posttraumatic depression and anxiety symptoms following a recent trauma. Our findings further demonstrate that racial/ethnic groups show similar rates of symptom recovery over time. Future work utilizing longer time-scale data is needed to elucidate potential racial/ethnic differences in long-term symptom trajectories.

Suicide is the second most common cause of adolescent mortality worldwide.

To study the characteristics of a sample of adolescents (<18years of age) who died by suicide in Greece.

We investigated all suicides that took place within the area of the Piraeus Department of Forensic Medicine (population covered ~700,000) for the period 1992-2016, based on the victims’ forensic records.

During the 25-year period, 16 adolescents (and 1162 adults) died by suicide. They were mostly males (11/68.75%) and of Greek Nationality (14/87.5%). The mean age was 15.56 years (range: 12-17, standard deviation: 1.46). Two (12.5%) were under psychiatric medication (an antipsychotic and an antidepressant, respectively); none was receiving a benzodiazepine or a mood-stabilizing antiepileptic. None had used amphetamine, cannabis, cocaine or heroin. Two (12.5%) -one girl one boy- had consumed alcohol. The suicides took place primarily at home (12/75%), followed by outdoors (3/18.75%); one (6.25%) took place in a correctional facility. Hanging was the most prevalent method (6/37.5), followed by jumping (5/31.25%), shooting by a firearm (2/12.5%), drowning (1/6.25%), medication overdose (1/6.25% -amitriptyline poisoning) and a case of suffocating death (1/6.25%). Most suicides happened in September (5/31.25%) and April (3/18.75%). No significant differences were noted with the adult sample.

The methods chosen by the adolescents who died by suicide in our sample differ strikingly from those of usual suicide attempts at that age (medication overdose/self-cutting). The periods when the suicides took place may imply a role for school stress. Our study was retrospective and focused primarily on a large urban area.

We recently demonstrated that patients with major depression (MDD) with and without electroconvulsive therapy referral (ECTs vs. NECTs) qualitatively differ in neuropsychological profile. ECTs presented severe executive but minor visuospatial memory deficits, suggesting mainly frontostriatal involvement; NECTs presented the opposite pattern, compatible with temporohippocampal involvement. Here we follow up on ECT treatment effects on both cognitive domains.

15 ECTs were assessed with Hamilton Depression (HAMD-24), Hamilton Anxiety (HAMA) and Mini-Mental State Examination (MMSE) scales and 5 tests of the Cambridge Neuropsychological Test Automated Battery (CANTAB) at hospitalisation (PRE-ECT), immediately after ECT (POST-ECT) and 2 months later (FOLLOW-UP). ECTs at FOLLOW-UP were also compared to 15 matched non-psychiatric CONTROLS who underwent neuropsychological testing once.

There was significant clinical improvement (reflected by reduced HAMD-24 and HAMA scores: p < 0.001) between PRE-ECT and FOLLOW-UP. After a minor decline POST-ECT, MMSE scores showed significant increase at FOLLOW-UP (p < 0.02). At FOLLOW-UP, Paired Associates Learning (PAL) showed significant improvement (p < 0.001). Stockings of Cambridge (SOC) performance also improved (decrease in early abandonments, p < 0.04) POST-ECT and at FOLLOW-UP. However, clinical improvement did not result in improvement in Intra / Extradimensional Shift (IED): at FOLLOW-UP, ECT patients were indistinguishable from CONTROLS in all neuropsychological measures except IED (p < 0.04).

Clinically successful ECT treatment was accompanied by improved global cognitive functioning, visuospatial memory and spatial planning, but offered no benefit in attentional flexibility. This residual deficit suggests ‘trait’ frontostriatal involvement in this patient group.

The pretreatment neuropsychological profile of drug-resistant patients with major depressive disorder (MDD) referred for electroconvulsive therapy (ECT) may differ from that of their drug-respondent MDD counterparts. Such differences could help in identifying distinct MDD subtypes, thus offering insights into the neuropathology underlying differential treatment responses.

Depressed patients with ECT referral (ECTs), depressed patients with no ECT referral (NECTs) and nonpsychiatric Controls (matched groups, n = 15) were assessed with memory and executive function tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB).

ECTs scored significantly lower than NECTs in the Mini-Mental State Examination (MMSE; p = 0.01). NECTs performed worse than Controls in the Paired Associates Learning (PAL) task (p < 0.03 ; Control/NECT p < 0.01) and the Spatial Recognition Memory (SRM) task (p < 0.05 ; Controls/NECTs p < 0.05) ; ECTs performed between Controls and NECTs, not differing from either. In the Intra/Extradimensional (IED) set-shifting task, ECTs performed worse that Controls and NECTS (IED: p < 0.01 ; Controls/ECTs p < 0.01), particularly in the shift phases, which suggests reduced attentional flexibility. In Stockings of Cambridge (SOC), ECTs abandoned the test early more often than Controls and NECTs (H = 11, p < 0.01) but ECTs who completed SOC performed comparably to the other two groups.

A double dissociation emerged from the comparison of cognitive profiles of ECT and NECT patients. ECTs showed executive deficits, particularly in attentional flexibility, but mild deficits in tests of visuospatial memory. NECTs presented the opposite pattern. This suggests predominantly frontostriatal involvement in ECT versus temporal involvement in NECT dépressives.

The pretreatment neuropsychological profile of drug-resistant patients with major depressive disorder (MDD) referred for electroconvulsive therapy (ECT) may differ from that of their drug-respondent MDD counterparts. Such differences could help in identifying distinct MDD subtypes, thus offering insights into the neuropathology underlying differential treatment responses.

Depressed patients with ECT referral (ECTs), depressed patients with no ECT referral (NECTs) and non-psychiatric Controls (matched groups, n=15) were assessed with memory and executive function tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB).

ECTs scored significantly lower than NECTs in the Mini-Mental State Examination (MMSE; p=0.01). NECTs performed worse than Controls in the Paired Associates Learning (PAL) task (p<0.03; Control/NECT p<0.01) and the Spatial Recognition Memory (SRM) task (p<0.05; Controls/NECTs p<0.05); ECTs performed between Controls and NECTs, not differing from either. In the Intra/Extradimensional (IED) set-shifting task, ECTs performed worse that Controls and NECTS (IED: p<0.01; Controls/ECTs p<0.01), particularly in the shift phases, which suggests reduced attentional flexibility. In Stockings of Cambridge (SOC), ECTs abandoned the test early more often than Controls and NECTs (H=11, p<0.01) but ECTs who completed SOC performed comparably to the other two groups.

A double dissociation emerged from the comparison of cognitive profiles of ECT and NECT patients. ECTs showed executive deficits, particularly in attentional flexibility, but mild deficits in tests of visuospatial memory. NECTs presented the opposite pattern. This suggests predominantly frontostriatal involvement in ECT versus temporal involvement in NECT depressives.