The high prevalence of mental health disorders makes investigating their etiology a fundamental activity. Factors influencing their physiology include genetic predisposition, substance use, environmental factors, etc. Among these, weather and atmospheric pollutants are two of the least studied. The biologically active agents in the atmosphere interact with living beings, disrupting their homeostasis and leading to alterations in both physical and mental health. This interaction was already noted in the Corpus Hippocraticum in the 4th century BC.

The objective is to analyze the impact of various environmental factors and atmospheric pollutants on daily emergency hospital admissions for mental disorders in the healthcare area of the province of León from 2011 to 2022.

An observational, retrospective, ecological, longitudinal, and time series study is conducted. Admission data is sourced from the coding office at the Complejo Asistencial Universitario de León, meteorological data from the Agencia Estatal de Meteorología, and pollutant data from the Junta de Castilla y León. A combined database in Excel is created for statistical analysis, both descriptive and analytical (Poisson regression), using the SPSS statistical package.

It was observed that hospital admissions for mental disorders are significantly related to sunlight hours, ozone, precipitation, average wind speed, CO, NO2, maximum atmospheric pressure, NO, and PM10.

The findings of this study show that meteorological factors and atmospheric pollutants are related to hospital admissions for mental disorders. Applying this information in psychiatric emergencies could improve forecasting and resource management during periods of higher demand.

None Declared

Sexual harassment (SH) is defined as any form of pressure aimed at obtaining a sexual act, for the benefit of the perpetrator or a third party. Despite movements aimed at combating sexual harassment, it remains a complex and concerning reality, particularly in the workplace. Unfortunately, the hospital environment is not spared from this issue. Medical residents and interns seem to be the population most affected by the SH.

To estimate the prevalence of SH among medical residents and interns.

To describe the profile of SH’s victims and examine their perceptions regarding sexual education.

We conducted a cross-sectional and descriptive study involving medical residents and interns working in hospitals in Sfax. Data were collected using an anonymous self-questionnaire. This questionnaire was published on social media during January and February 2024. It included sociodemographic characteristics, psychiatric and medical history, psychoactive substance use, professional data, information related to sexual life and experiences related SH.

We received 141 responses, of which 19.9% declined to participate in this study. Ultimately, 113 participants, with an average age of 27.92 years, were included in the final analysis. The sex ratio (M/F) was equal to 0.54. In our population, 20.4% were interns. Among the participants, 68.1% were single, 91.2% were from urban origine and 12.4% had psychiatric follow history for anxiety disorders, depression, obsessive-compulsive disorder, and bipolar disorder (n= 8, 2, 2, and 1, respectively).

Among the participants, 41.6% reported experiencing sexual harassment during their practice at the hospitals in Sfax. The most common form reported as harassment was verbal harassment (43,3%). The majority of SH perpetrators were male (87.2%), and 27.6% were senior physicians. According to our study, 8.5% of the SH perpetrators were sanctioned for their actions, and 80.5% of SH victims believed that the perpetrators had continued to exhibit such behavior.

Regarding sexual education, 80.5% of participants thought that it was necessary in school curriculums, with thirty-seven participants believing they had received adequate sexual education.

This study highlighted the high prevalence of sexual harassment among medical trainees in Sfax. These results serve as an urgent call to the development of effective strategies to prevent sexual harassment in hospital environments and highlight the importance of raising awareness among staff about available legal protections.

None Declared

Although electroconvulsive therapy (ECT) is one of the most important treatments for major mental disorders, many patients are concerned about the risk of developing cognitive impairment or cardio-cerebrovascular disease after ECT.

This study aimed to compare the incidence of cognitive disorders and cardio-cerebrovascular diseases in the ECT group and the control group at a university hospital.

The subjects of this study were the ECT group (n = 173 people) who received ECT in patients with major affective or psychotic disorders, and the control group (n = 11,444 people) who did not receive ECT. The ECT and control groups were matched for demographic and clinical characteristics in a 1:5 ratio. This study investigated the incidence of cognitive disorders and cardio-cerebrovascular diseases through retrospective follow-up for up to 5 years after ECT. Statistical analysis used a multivariate Cox proportional hazards model to obtain the hazard ratio (HR) and 95% confidence interval (CI).

The incidence rates per 1,000 patient-years in the ECT vs. control groups were 17.56 vs. 6.25 for cognitive disorders, 4.41 vs. 4.35 for cardiovascular diseases, and 2.28 vs. 2.48 for cerebrovascular diseases. The ECT group tended to have a higher incidence of cognitive disorders compared to the control group, but this was not statistically significant (HR, 2.46; 95% CI, 0.89–6.36; p=0.07). There was no significant difference in the risk of cardiovascular disease (HR, 1.50; 95% CI, 0.21–7.09; p=0.65) or cerebrovascular disease (HR, 0.96; 95% CI, 0.05–6.56; p=0.97) between the two groups.

This study showed that there were no significant differences in the incidence of cognitive disorders and cardio-cerebrovascular diseases between patients with major affective or psychotic disorders who received ECT and those who did not. This study suggests that ECT is a safe treatment, but further prospective multicenter collaborative follow-up studies are required to confirm this.

None Declared

Correlation between cannabis decriminalization and some psychotic disorders, specifically Acute and transient psychotic disorders (ATPD), Schizophrenia, and Psychotic disorder with delusions due to known physiological condition. It will cover overview of these disorders, challenges in differential diagnoses and the effects of drug abuse on mental health.

Impact of cannabis decriminalization on selected psychotic disorders: Acute and transient psychotic disorders (ATPD), Schizophrenia, and Psychotic disorder with delusions due to known physiological condition.

• - Quantitative, Retrospective Analysis: Analysis of archived medical records from 2013 to 2023 at “Center for Mental Health and Prevention of Addiction” in Tbilisi.

• - Examination of Prevalence Changes: Focus on ATPD, Schizophrenia, and Psychotic Disorder with Delusions due to Known Physiological Condition.

• - Statistical Comparisons: Comparison between pre-decriminalization (2013-2018) and post-decriminalization (2019-2023) periods.

• - Analysis of Drug User Patient Cases: Assessment of the increase in drug user cases within the mentioned diagnoses.

• - ATPD Cases: Increased significantly by threefold (from 195 to 594).

• - Schizophrenia Cases: Decreased slightly by 21% (from 2068 to 1627).

• - Psychotic Disorder with Delusions due to Known Physiological Condition: Remained relatively stable with a 14% decrease (from 473 to 408).

• - Drug User Patients: Increased dramatically by about 3.5 times following cannabis decriminalization.

• - The findings suggest a potential link between increased substance use, including cannabis, and the rise in ATPD cases.

• - Decriminalization may have indirectly influenced accessibility and use of various narcotics.

• - The lack of public education about the potential mental health risks of narcotic use could be a contributing factor.

• - The observed decrease in Schizophrenia and Psychotic Disorder with Delusions due to Known Physiological Condition cases might be due to other factors requiring further investigation.

• - These findings highlight the need for comprehensive research on the long-term consequences of cannabis decriminalization on mental health.

• - Targeted public health interventions and mental health support services are crucial to address the challenges of rising narcotic use in Georgia.

None Declared

Although mental health problems are common in the workplace, discrimination against mental health is still prominent. Characteristics of one’s own occupation can influence aspects of stigma and attitudes to mental health problems in the workplace context, but there are limited studies examining differences in them between occupational groups.

We investigated occupational differences in mental health stigma, and attitudes to both mental and physical health in the workplace.

Data from the British Social Attitudes 2015 survey were used. Logistic regression models were conducted to investigate associations between occupational categories and stigma as measured by desire for social distance, as well as attitudes towards mental and physical health in the workplace. Occupational categories were based on the National Statistics Socio-economic Classification. Measures for attitudes to mental and physical health in the workplace include whether paid work is good for mental and physical health, how soon one should return to work following depression, whether work can help speed recovery from depression, whether one’s medical history should affect their promotion, including depression, schizophrenia and diabetes. Desire for social distance from people with depression and schizophrenia was measures using unlabelled vignettes.

We found occupational differences in attitudes towards mental and physical health in the workplace, but not in levels of stigma. People in lower supervisory and technical (group 4), semi-routine and routine (group 5) occupations were more likely to have negative attitudes towards mental and physical health in the workplace compared to managerial and professional occupations (group 1). Both occupation groups were less likely than group 1 to believe that paid work is good for mental health (group 4: odds ratio (OR) = 0.38, 95% confidence interval (CI) = 0.24-0.61; group 5: OR = 0.34, 95% CI = 0.24-0.49). They were also less likely to believe that people with depression should return to work when they can do some or most of the job (group 4: OR = 0.67, 95% CI = 0.48-0.94; group 5: OR = 0.52, 95% CI = 0.41-0.66). People in group 5 were less likely to believe that paid work is good for physical health (OR = 0.69, 95% CI = 0.53 to 0.89) and that having schizophrenia should not affect promotion at work (OR = 0.78, 95% CI = 0.62-0.97) than group 1.

Our study reinforced the importance of job characteristics on attitudes to mental health in the workplace. First, employers need to invest more in improving their employees’ well-being. Second, governments should provide more support and resources for small companies to help them develop mental health policies and practices. Third, modifications need to be made to improve job control for employees and to ensure enough reasonable adjustments can be made.

G. Cheung: None Declared, A. Ronaldson: None Declared, C. Henderson Consultant of: C.H. has received consulting fees from Lundbeck and educational speaker fees from Janssen.

The Epidemiological Study of Cognitive Impairment in Schizophrenia (EPICOG-SCH) is a brief battery to screen for cognitive impact of schizophrenia in outpatient settings. The EPICOG-SCH includes well-known subtests available worldwide that cover key cognitive domains demonstrated to be related to a variety of functional outcomes. Novel composite scores are modelled to predict patient’s functionality in daily life at short, mid and long term.

We want to progress in the elaboration of specific algorithms first episodes of schizophrenia at different follow up periods by modelling cognitive performance to predict short, mid and long term functionality.

Data for the present investigation were obtained from an the epidemiological and three-year longitudinal intervention program of first-episode psychosis (PAFIP) conducted at the outpatient clinic and the inpatient unit at the University Hospital Marques de Valdecilla, Spain. The cohort is composed by 167 patients with a diagnose of Schizophrenia and 160 healthy controls recruited between February 2001 to February 2014. For all analyses, a subset of measures was selected corresponding to the EPICOG-SCH domains with the Rey Auditory Verbal Learning Test (RAVLT) task ifor Logical Memory. Functional outcomes were measured by the Disability Assessment Scale (DAS) and the General Assessment for Function (GAF) scales. Functional measurements were conducted regarding premorbid, baseline set at clinical stabilization and 1, 3 year follow-up, and cognitive assessments where conducted at baseline and 1, 3 years of follow up.

A cohort of 122 patients and 114 Controls completed the study with a 3-year follow up were included in the analysis. Changes across evaluations is tested in patients and controls. A regression analysis including the different EPICOG-SCH subtests at baseline as predictors of functionality at the different time points to explore the best predictive algorithms at 1 and 3 years of patient’s functionality in daily life following a first-episode.

The EPICOG-SCH brief battery is modelled to be a useful first to screen for the cognitive impact of schizophrenia in daily functionality daily life. This research work will validate the composite scores for a context of use of first-episodes schizophrenia and follow up. To date it has not been described an efficient and straightforward way for clinicians working with schizophrenia to transfer quantitative information about patient cognitive profile into real life. The EPICOG-SCH global composite score provides valuable information to clinicians which can facilitate disease management, drawing a roadmap for cognitive rehabilitation, and planning of supportive resources from the community and health care system.

None Declared

Depression is a leading cause of disability globally, and while conventional treatments, such as antidepressants and psychological therapy, benefit many patients, a significant proportion fail to achieve symptom relief. Ketamine has demonstrated both rapid and sustained efficacy in treating depression, especially in treatment-resistant cases. However, concerns regarding the addictive potential of ketamine during long-term depression treatment persist among clinicians.

The review aimed to assess the prevalence of addiction phenomena associated with ketamine treatment of depression in adult populations.

The review followed PRISMA guidelines and was pre-registered on PROSPERO (CD42023435468). A comprehensive search was conducted in Medline, Embase, PsycInfo and Global Health databases, with additional relevant studies identified through reference lists. Data extraction and study selection were performed by two independent reviewers. Risk of bias was assessed using appropriate tools based on study design.

Sixteen studies were included, comprising six randomised controlled trials, three single-arm open-label studies, one retrospective study, three case series and three case reports, for a total of 2174 patients. The studies employed various routes of administration, including intravenous, intramuscular, intranasal, oral and sublingual. Ketamine was administered in the racemic form, except for the studies that utilised intranasal esketamine. Four patients were reported to exhibit clear signs of tolerance to the antidepressant effects of ketamine or dependence on the drug, while the majority did not. Additionally, papers discussing addiction phenomena in studies that did not meet the inclusion criteria are also reviewed.

Despite the heterogeneity in study designs and outcome assessment methods, the review underscores the relative safety of ketamine treatment for adult patients with depression, emphasising the importance of medically supervised administration, vigilant monitoring and judicious dosing. Future long-term studies employing quantitative scales to assess dependence phenomena could contribute to strengthen the evidence for a safe and effective use of ketamine in the treatment of depression.

None Declared

Severe personality disorders are characterized by deeply ingrained patterns of thought, behavior, and emotional functioning, along with impaired mental functioning in the areas of self-stability and identity formation. The challenges in interpersonal relationships and overall functioning result in a significant reduction in the capacity to adapt to social roles.

In this context, the present study aims to explore the severity of symptoms (SPrDP) in correlation with alexithymia (TAS-20) and dissociation (DES II) in individuals under the care of the Department of Mental Health of Forlì-Cesena.

The sample was selected using the SCID PD (Structured Clinical Interview for DSM-5), followed by the administration of the following scales: SPrDP (Parma’s Scale), TAS-20 (Toronto Alexithymia Scale), and DES II (Dissociative Experiences Scale). Multivariate analyses were applied, including non-parametric correlations (Spearman’s Rho) between variables using SPSS software.

The sample consists of 55 individuals (F=38; M=17), of whom 42 have borderline personality disorder (BPD), 3 have narcissistic personality disorder (NPD), 6 have histrionic personality disorder (HPD), 3 have obsessive-compulsive personality disorder (OCPD), and 1 has dependent personality disorder (DPD). The analysis did not reveal a significant correlation between SPrDP and the TAS-20 and DES II scales, although a trend was observed that could correspond to more compromised personality functioning in the presence of high scores on these scales. Furthermore, a statistically significant correlation was found between TAS-20 and DES II. Higher marginal means for TAS-20 were observed in individuals with OCPD. For DES II, the highest estimated marginal means were found in individuals with OCPD and BPD.

The symptom severity measured by SPrDP was not statistically significant in relation to TAS-20 and DES II. However, the presence of a trend between the scales suggests the possibility of further investigation with a larger sample. Additionally, the statistically significant correlation between alexithymia and dissociation may indicate that difficulties in identifying and managing intense emotions lead to the use of dissociative defense mechanisms. The higher average alexithymia scores in individuals with OCPD suggest a possible emotional rigidity with a tendency to control or suppress emotions. The frequency of dissociative symptoms observed in individuals with BPD and OCPD may indicate the centrality of alexithymia and dissociation in the impairment of emotional and relational functioning in severe personality disorders. Further studies are necessary.

None Declared

Functional neurological disorders (FND), also referred to as conversion disorder or psychogenic neurological disorders, are one of the most common and disabling conditions in the neurology practice field, with very limited treatment options. FNDs present with sensory and/or motor symptoms that can mimic other neurological conditions, but appear to be related to recognizable psychological factors and are thought to occur via mechanisms other than those related to identifiable structural neuropathology. This condition has very limited treatment options, but there is preliminary evidence that psychedelic-assisted therapy (PAT) might be effective in a growing number of psychiatric disorders, including FNDs.

We aim to review the current literature regarding the role of psychedelic-assisted therapy in the treatment of functional neurological disorders.

We search PubMed with the following keywords: psychedelics, functional neurological disorder and conversion disorder.

Only nine studies were published, between 1954 and 1967, reporting the use of psychedelics in the treatment of FNDs, with a total of 22 patients, of which 69% (n = 18) were found to have made at least some recovery, though the included studies were of low quality, often lacking control groups and valid outcome measures.

There is a lack of evidence for the efficacy of PTA on the treatment of FNDs. Nevertheless, the discussion remains, as several abnormalities of the default mode network activity (DMN) have been reported in patients with FND and many of the proposed therapeutic benefits of psychedelics have been theorized to relate to their action on the DMN.

None Declared

The rapid increase in smartphone usage among minors raises significant concerns about problematic smartphone use in children and adolescents. As the first generations immersed in high-tech media, today’s youth may be more vulnerable to its negative effects compared to older age groups. Understanding these impacts is essential as smartphones become integral to daily life.

This study seeks to assess the prevalence of problematic smartphone usage among a group of children, explore its impact on social, emotional, and academic outcomes, identify associated risk factors, and above all evaluate parental awareness and intervention strategies.

An online questionnaire was administered to parents of children aged from 1 to 18 years. It included sociodemographic information, the Smartphone Addiction Proneness Scale (SAPS) and additional questions designed to explore various aspects of smartphone use.

In total, 100 parents participated in the study. The preliminary results revealed that 60% of children started using smartphones before the age of 6 years and displayed signs of problematic smartphone use, with a notable negative correlation between high usage and academic performance. Additionally, half of parents expressed concerns about their children’s social skills, reporting that excessive smartphone use often diminished social interactions, communication and attention. Withdrawal symptoms were common, with 30% of parents indicating that their children experienced anxiety or restlessness when separated from their devices. Finally, 86% of parents expressed interest in receiving expert advice on healthy and balanced smartphone use for their children.

The results indicate a troubling trend of smartphone addiction among children.This highlights the urgent need for greater parental awareness and active strategies to manage smartphone use. Future research should focus on developing and evaluating intervention programs aimed at fostering healthier technology habits in children.

None Declared

Chronic painful conditions in alcohol use disorder (AUD) are often seen and represent a significant problem in their therapy. Its incidence is higher than in the general population and is often associated with AUD relapse. Often, they are very manipulative.

The aim of our study was the intersection of the state of therapy and therapeutic response in patients with chronic pain and AUD.

This cross-sectional study includes 25 patients treated at the Department for male alcoholism in the SPH “Slavoljub Bakalovic” in Vršac during their hospitalization. The covered period was from April 1st to August 31st 2024.

During our research, 48 male patients with AUD were treated at our department, and 25 (52.01%) had horonic pain. The average age of the patients was 52 years (24-80), and the duration of symptoms was from 7 months to 20 years (average 8 years and 4 months). Localization was mainly in the area of the lower back (10), lumboischialgia (9) and only in the extremities (6). According to the type of pain, the majority (23) had predominantly neuropathic pain. The average value of pain intensity on the VAS scale was 4 (4.2). All patients were treated with non-steroidal analgesics and benzodiazepines. Along with the mentioned therapy, 9 (36%) patients received a coanalgetic from the group of anticonvulsants and 12 (48%) from the group of antidepressants. Few patients (7) used before and during the hospitalizations supplement based on Mg and vitamin B complex. A good therapeutic response was achieved in 17 patients (reduction of pain on the VAS scale by 2 or more points), partial in 6 patients (reduction of pain on the VAS scale by 1 point). In 2 patients, the prescribed therapy did not reduce pain.

Chronic pain syndromes in AUD is more frequent than in general population, and early detection and good therapy protocol is very important to reduce symptoms. Pain treatment protocol for AUD patients must be made individually for each patient in order to achieve an adequate therapeutic response and avoid interaction with other drugs in the therapy of AUD. With a well-balanced therapy, a good therapeutic response in pain reduction can be achieved.

None Declared

If stress, insomnia, anxiety, and depression persist for a long time and occur more than normal, it can become a serious illness. Based on the data from 263 mountain work reports submitted to the Department of Mining, Production, and Technology and the Coal Research Department of the Mineral Oil Department in 2018, a human resource survey of the industry was conducted. There are 56,635 registered workers in the mining sector, 96% of whom are Mongolian and 4% are foreign experts. 90% of all employees working in the mining industry are men, and 10% are women. In our country, there is a lack of research on the psychological health of mine workers and the factors affecting it, so this study is the reason for conducting this research.

To identify the anxiety of mine workers and to study some correlations and effects.

The survey was conducted from March 26, 2024, to April 5, 2024, by the employees of “TiTiGiViSiOu LLC,” located in Tsogtsetsii Sum, Umnugobi Province, according to GAD7, SRQ20, issued by WHO for doctors of primary health care institutions. Survey data were collected from mining workers using the PHQ9, 18 sleep disturbance questionnaires, and 10 general information questionnaires. IBM SPSS-26 software was used to analyze the research.

66.0% of the study participants had no anxiety, 23.3% had mild anxiety, 6.8% had moderate anxiety, and 3.9% had severe anxiety. Also, 70.9% work in the night shift, while 24.3% do not work in the night shift. However, 4.8% answered that they sometimes work the night shift. The majority of night shift workers are male workers. 66.0% of the respondents had no anxiety, 23.3% had mild anxiety, 6.8% had moderate anxiety, and 3.9% had severe anxiety. Anxiety has a strong direct correlation with stress (r = 0.7**, p = 0.00), depression (r = 0.87**, p = 0.00), and sleep disturbance (r = 0.58**, p = 0.00). degree was directly related. In univariate regression analysis, a one-point increase in stress score was associated with a 71% increase in anxiety. The depression score increased by 80% per unit increase, and the sleep disturbance score increased by 87% per unit increase. Multivariate linear regression analysis revealed that anxiety increased by 18.6% when the stress score increased by one and depression increased by 66.2% when the depression score increased by one.

Anxiety is strongly associated with stress, depression and sleep disturbances. An increase in stress, depression, and sleep disturbance scores leads to an increase in anxiety. Multivariate linear regression analysis reveals these relationships.

None Declared

Compared to the general population, mood disorders (MD) patients show an increased risk of developing type II diabetes and obesity, which are associated with changes in brain correlates and a worse clinical outcome[1]. According to the literature, MD patients with a dysregulated metabolic system are characterized by a reduction in white matter (WM) integrity, lower global functioning, and suicidal behaviors (SB) [2],[3],[4]. However, little is known about the impact of early stages of metabolic dysregulation, namely insulin resistance (IR), in relation to the clinical course of MD[1].

Therefore, the present study aims to investigate the effect of IR on WM integrity in MD patients with suicidal behaviors (s-BP, s-UP) compared to those without suicidal behaviors (ns-BP, ns-UP). Finally, we have hypothesized that obesity may be linked to SB through a biological pathway involving inflammatory and IR markers.

Our sample was composed of 184 depressed patients (92 BP, 92 UP) who were assessed for SB via the Beck Suicidal Scale (BSS). Patients underwent 3T Magnetic Resonance imaging, and blood samples were collected to determine levels of insulin and glucose and blood cell counts. The Homeostatic Model Assessment for Insulin Resistance (HOMA) and systemic-immune-inflammation index (SII) were then computed. To investigate the effect of HOMA and SII on WM microstructure, we performed voxelwise DTI analyses: first, we tested whether the relation between HOMA, SII, and DTI measures differed between s-BP and ns-BP patients; then, post-hoc analyses were performed for analyzing the effect of HOMA, and SII separately in 40 s-BP and 52 ns-BP. The same analyses were replicated on 43 s-UP and 49 ns-UP. Moderated mediation analyses were performed with the macro PROCESS for SPSS.

The relationship between BMI and suicidal behaviors was fully serial mediated by SII and HOMA only in BP (b=0,031, 95% BCa CI [0.003, 0.088]). Specifically, we found that higher BMI was sequentially associated with increased SII and HOMA levels, ultimately leading to higher BSS scores. A significant interaction between s-BP and ns-BP was identified for the effect of (1) HOMA on mean diffusivity (MD), axial (AD), and radial diffusivity (RD). However, no significant interaction was found for the effect of IR and SII markers in UP. Performing the analyses separately in the two groups, s-BP showed (1) a negative widespread association between HOMA and FA, and a positive effect between HOMA and RD, AD, and MD. In ns-BP, no significant results were found.

These findings may suggest that IR may play a key role in the biological pathway underlying suicidal behaviors in BP but not in UP. Therefore, metabolic system dysregulation should be taken into consideration during the treatment.

None Declared

Mental and behavioral disorders resulting from alcohol use are a significant public health issue. As the nation’s most populous state, São Paulo encounters distinct challenges in this domain. According to the 2022 Census, the most recent national demographic survey, the state of São Paulo’s population is estimated at 44,411,238, representing approximately 21.9% of Brazil’s total population of 203,080,756. Understanding the epidemiological profile of these disorders is crucial to better assess their impact on the healthcare system and to guide effective resource allocation and management strategies.

The present study aims to analyze statistical data related to hospitalizations due to mental and behavioral disorders caused by alcohol use in the state of São Paulo in 2023.

A cross-sectional, descriptive, retrospective, and quantitative study was conducted, focusing on hospitalizations of individuals diagnosed with mental and behavioral disorders due to alcohol use in the state of São Paulo during 2023. Data were collected from the Department of Health Informatics of the Brazilian Unified Health System (DATASUS) within the “Hospital Information System of SUS” section, examining variables such as age range, gender, ethnicity, and length of hospital stay.

In 2023, São Paulo recorded 5,898 hospitalizations for alcohol-related mental and behavioral disorders, with total expenditures amounting to R$ 9,215,994.94. The average length of stay was 22.9 days, and the overall mortality rate was 0.64%, with 38 deaths. The highest number of hospitalizations occurred in the 35-39 years (12.1%), 40-44 years (14.7%), and 45-49 years (15.5%) age groups, which together accounted for 42.3% of all cases. Men represented 86.1% of hospitalizations, with an average length of stay of 23.4 days compared to 19.9 days for women. The ethnic distribution showed that 52.9% of hospitalizations were among White individuals, 8.3% were Black, 37.5% were Multiracial, and 0.7% were Asian. The longest average stays were among White individuals (25.1 days), followed by Black (22.2 days) and Multiracial (20.2 days). The overall mortality rate was 0.64%, with a slightly higher rate in men (0.65%) compared to women (0.61%). Black individuals had the highest mortality rate (1.23%), particularly among men (1.25%).

This study underscores the public health impact of alcohol-related mental and behavioral disorders in the state of São Paulo, particularly among middle-aged men. Ethnic disparities in hospitalization duration and mortality suggest the need for targeted healthcare strategies to meet diverse demographic needs. These findings highlight the importance of tailored interventions and strategic resource allocation to reduce the burden of alcohol-related disorders and enhance health equity.

None Declared

Clozapine remains one of the most effective antipsychotic medications for treatment-resistant schizophrenia. However, its use is limited by significant metabolic and rare neurological side effects. The variability in patients’ susceptibility to these adverse effects suggests an unidentified genetic predisposition, which is critical to personalizing treatment.

This review aims to systematically investigate the genetic variants involved in the development of metabolic and neurological side effects in patients treated with clozapine. Specifically, it seeks to elucidate the pathways participating in the occurrence of these adverse reactions and identify genetic markers for personalized therapeutic approaches.

A literature search was conducted across multiple databases for studies published in recent years. Data were extracted from cohort studies and case-control studies based on predefined criteria, using keywords such as “clozapine”, “metabolic side effects”, “neurological side effects”, “pharmacogenetics”.

Preliminary results identified that variants in the FTO gene, known for its role in adipogenesis and energy homeostasis, were linked to enhanced adiposity and altered leptin signaling, contributing to the metabolic syndrome. Similarly, APOE gene was strongly correlated with increased risk of severe weight gain, dyslipidemia, and insulin resistance due to association with impaired lipid transport and metabolism.

In the context of neurological side effects, SNPs within the DRD2 Taq1A polymorphism, which affects dopamine receptor density and signaling, were associated with a higher incidence of extrapyramidal symptoms and tardive dyskinesia in patients on clozapine. The COMT Val158Met polymorphism, known to modulate prefrontal catecholamine degradation, was linked to cognitive impairments and clozapine-induced sedation.

Next-generation sequencing (NGS) enlightens rare SNPs, copy number variations (CNVs) and novel variants in genes related to drug metabolism, such as CYP1A2 and CYP2D6, allowing for the identification of complex genetic interactions. Furthermore, patients with high polygenic risk scores (PRS) exhibited a markedly increased likelihood of developing severe metabolic and neurological side effects, underscoring the utility of PRS in stratifying patient risk.

In summary, our findings demonstrate that genetic factors are key contributors to the development of clozapine-induced metabolic and neurological side effects. Variations in genes related to drug metabolism, neurotransmitter regulation, and metabolic pathways significantly influence individual susceptibility to these adverse effects. A deeper understanding of pharmacogenetic approaches could offer the potential for more personalized and precise treatment strategies, reducing adverse effects and improving drug tolerance.

None Declared

Substance Use Disorders (SUDs) are highly prevalent and substantially contribute to the global burden of disease, negatively impacting individuals’ health, well-being, and social functioning. While SUD treatments have demonstrated effectiveness in reducing substance use and related behaviors, there has been a growing emphasis on including subjective outcome measures, recognizing the importance of patients’ perspectives on their well-being. This shift has driven the development of Patient-Reported Outcome Measures (PROMs), which are progressively being integrated in healthcare to enhance patient-centered care, patient-provider communication and shared decision-making.

This study aims to develop a PROMs Digital Health Intervention (PROMs-DHI) with the potential to improve the quality and effectiveness of outpatient addiction treatment services.

PROMs-DHI includes the electronic adaptation of ICHOM’s standardized set for addictions using REDCap software and feedback created by Tableau on individual PROMs scores for patients and clinicians. PROMs-DHI will be assessed through mixed methods following a patient-centered design. Quantitative data will be collected using the System Usability Scale (Brooke, 1986), while qualitative data will be gathered through 5 focus groups with patients and 5 with healthcare professionals from collaborating addiction treatment centers. This strategy will yield valuable insights into the experiences and perspectives of both groups in utilizing the PROMs-DHI, offering a deeper understanding of their interactions and outcomes.

It is expected that patients will perceive a positive effect of the usage of the PROMs-DHI, gaining insights into their progress, reinforcing communication with clinicians, and enhancing self-management. Clinicians are expected to find the PROMs-DHI beneficial for managing patient care, profiting from the ability to monitor patient outcomes in real-time, receive notifications when values exceed critical thresholds, and access detailed reporting tools to inform their treatment decisions. This would enable them to provide more targeted and effective care, ultimately leading to improved patient outcomes.

Implementing the PROMs-DHI in addiction care could facilitate outcome comparisons, guide service improvement, and ultimately increase the effectiveness and quality of interventions, contributing to a stronger and more sustained recovery for patients undergoing treatment. Providing patients with regular feedback on their outcomes may also have a therapeutic effect in itself, promoting self-awareness, motivation and empowerment to manage their recovery. Furthermore, PROMs can support healthcare professionals in making well-informed treatment decisions that are tailored to each patient’s needs, thereby strengthening the impact and sustainability of addiction interventions.

None Declared

There is a call to consider sex differences in mental health research [Galbally et al. CNS Drugs 2024; 38(7):559-570; Ercis et al. J Affect Disord. 2024; 352:171-192]. Sex-related differences in risperidone efficacy have been reported to be limited [Galbally et al. CNS Drugs 2024; 38(7):559-570]. Risperidone ISM (Risp-ISM) is a monthly long-acting injectable (LAI) formulation of risperidone, recently authorised in Europe, USA and some other countries.

To investigate potential sex-related differences in the short-term efficacy of Risp-ISM LAI in adults with schizophrenia [Correll et al. NPJ Schizophr. 2020; 6(1):37].

Post-hoc analysis of a double-blind (DB), randomised, placebo-controlled, 12-week study conducted in participants with acutely exacerbated schizophrenia (NCT03160521). Data from the Positive and Negative Syndrome Scale (PANSS) were analysed by sex to reveal potential differences in efficacy versus placebo. The data were analysed within three separate study groups: 75 mg Risp-ISM, 100 mg Risp-ISM and placebo using a mixed effect with repeated measures model (MMRM). Herein, PANSS total scores changes from baseline (the primary efficacy endpoint) are shown.

In the double-blind phase, 437 eligible participants were randomly assigned 1:1:1 to receive Risp-ISM 75 mg, 100 mg or placebo every 28 days. 144 (33%) were female and 293 (67%) male. Analysis showed no sex-related differences on PANSS total scores. After 12 weeks of treatment, the scores in PANSS Total as well in the Positive, Negative and General Psychopathology subscales were statistically significant lower for Risp-ISM 100 mg and 75 mg versus Placebo in both male and female subgroups. Specifically, decreases from baseline were significantly greater versus placebo at Day 8 (after first injection) and beyond in both sex subgroups at the 100 mg Risp-ISM dose versus Placebo; likewise, at Day 15 and beyond for the 75 mg Risp-ISM dose (Figures 1 and 2).

Image 1:

Image 2:

There were no statistically significant differences in efficacy, measured as PANSS score change from baseline, for male or female participants versus placebo regardless of Risp-ISM dose. Risp-ISM LAI provided significant improvement of the symptomatology as early as 8 days after first injection in acutely exacerbated patients with schizophrenia regardless of their sex.

C. Sherifi Employee of: ROVI Biotech Ltd., J. Martínez González Employee of: Laboratorios Farmaceuticos ROVI S.A., L. Anta Carabias Employee of: Laboratorios Farmaceuticos ROVI S.A., M. Almendros Gimenez Employee of: Laboratorios Farmaceuticos ROVI S.A., C. Salazar García Employee of: Laboratorios Farmaceuticos ROVI S.A., C. Correll Shareolder of: Cardio Diagnostics, Kuleon Biosciences, LB Pharma, Mindpax, and Quantic., Grant / Research support from: Janssen and Takeda., Consultant of: AbbVie, Acadia, Alkermes, Allergan, Angelini, Aristo, Biogen, Boehringer-Ingelheim, Cardio Diagnostics, Cerevel, CNX Therapeutics, Compass Pathways, Darnitsa, Denovo, Gedeon Richter, Hikma, Holmusk, IntraCellular Therapies, Jamjoom Pharma, Janssen/J&J, Karuna, LB Pharma, Lundbeck, MedAvante-ProPhase, MedInCell, Merck, Mindpax, Mitsubishi Tanabe Pharma, Mylan, Neurocrine, Neurelis, Newron, Noven, Novo Nordisk, Otsuka, Pharmabrain, PPD Biotech, Recordati, Relmada, Reviva, Rovi, Sage, Seqirus, SK Life Science, Sumitomo Pharma America, Sunovion, Sun Pharma, Supernus, Takeda, Teva, Tolmar, Vertex, and Viatris.

Managing agitated or aggressive patients prior to psychiatric admission is a critical challenge in clinical practice. When verbal de-escalation fails, effective pharmacological interventions, including benzodiazepines and neuroleptics, are necessary, either orally or via injectable forms. In some cases, physical restraint is inevitable, which is challenging and distressing for both patients and staff members Midazolam, a short-acting benzodiazepine, is well-known for its rapid sedative effects and potential to minimize the need for physical restraint in such patients.

To evaluate the efficacy of oral midazolam in providing rapid sedation in agitated patients, facilitating their pre-admission management to psychiatric units.

A review of clinical practices and relevant studies was conducted to assess the use of midazolam for sedation in patients displaying aggression or agitation prior their admission to a psychiatric unit. The evaluation focused on the drug’s pharmacological profile, including its onset of action, duration, and impact on patient care and staff workflow.

Oral midazolam, due to its rapid onset and short duration of action, effectively provides sedation in acutely agitated patients. Its use significantly reduces the need for physical restraints or other invasive interventions, improving patient comfort and making the admission process smoother for the healthcare staff.

Midazolam presents a promising pharmacological option for pre-admission sedation of agitated or aggressive patients in psychiatric settings. Its rapid sedative effect, combined with its short duration, enhances patient management and minimizes the need for physical restraints, ultimately helping both patients and staff. Further research is needed to standardize its use in psychiatric emergencies.

Midazolam, sedation, agitation, psychiatric admission, aggression, pre-admission management.

None Declared

Autism spectrum disorder is a complex pathology that can occur very frequently with other disorders. It is known to co-occur with ADHD (attention deficit hyperactivity disorder), anxiety disorders or depression. Comorbidity with obsessive-compulsive disorder (OCD) can be difficult to detect since rigid and obsessive thinking, which in many cases is similar to the obsessions and compulsions of the OCD patient, is part of the core symptomatology of autism spectrum disorder.

To present two cases of patients atteded in the Adolescent Hospitalization Unit with Autism Spectrum Disorder comorbid with OCD

Two clinical cases are presented, with review of literature.

First case

This is a 16-year-old male, diagnosed with autism spectrum disorder at age 4. He begins with intense preoccupation for hygiene, developing cleaning rituals. He begins to develop the idea that his cells are released from his body and that they are sensitive to external stimuli in the same way that he is. He claims that in order for them to be eliminated and “not to suffer” he has to wash them and make flapping movements and avoid their accumulation.

He begins to treat with sertraline up to 200 mg with partial response, adding fluvoxamine 100 mg with important improvement of the symptomatology.

Second case

17-year-old male admitted to the inpatient unit for isolation and cleaning rituals and fear of contamination. The patient had no past psychiatric history. He had been out of school for 4 months. The patient began to develop a fear of pathogen contamination. He maintained cleaning and checking rituals. He ate only packaged food and spent hours, and slept, in the same corner of the bed.

Medication with sertraline up to 150 mg was started with progressive improvement. During the admission a history of evolutionary development was taken, observing a difficulty in the mentalization of other people’s emotions. Very adult and literal speech with difficulty in abstract thinking. He revealed presence of restricted interests throughout his history such as rare languages. Finally, the diagnosis of Autism Spectrum Disorder and comorbid obsessive compulsive disorder was made.

The comorbidity between autism spectrum disorder and OCD occurs between 37%. This comorbidity can make it difficult to perform psychotherapeutic interventions. This work shows on the one hand an already diagnosed autistic patient who develops an OCD, and on the other hand, how the initial diagnosis is an OCD on which an autism spectrum disorder is detected. This highlights the importance of knowing the comorbidity in order to detect both diagnoses.

None Declared

Aphasia, a language disorder resulting from brain damage, presents significant challenges in assessment and treatment. Traditional evaluation methods often lack precision and efficiency. This study introduces a novel framework for feature extraction in aphasia speech data, leveraging the power of state-of-the-art Large Language Models (LLMs) to enhance assessment, classification, and treatment planning. We used the AphasiaBank database (https://aphasia.talkbank.org/) to test our methods.

Our primary objectives were to:

1. 1. Develop a comprehensive set of LLM-based feature extractors for aphasia speech analysis.

2. 2. Evaluate the effectiveness of these features in assessing aphasia types and severity.

3. 3. Explore the potential of AI-assisted speech analysis in clinical settings for aphasia management.

We developed a novel framework focusing on content analysis of transcribed aphasia speech. Our approach utilizes the embedded knowledge of language usage in LLMs to evaluate speech disfluencies. The advanced set of features derived from LLMs includes, but is not limited to: 1) Lemma similarities for vocabulary diversity assessment, 2) Syntactic structure analysis, 3) Use of linkers and connectors, 4) Degree of abstraction in word usage, 5) CEFR framework-based word complexity analysis, 6) Maze type identification, 7) Semantic field variability, 8) False start analysis.

This content-focused feature set is designed to complement existing phonetic features derived from audio files and other potential data sources, such as MRI.

Our evaluation demonstrates that current SOTA LLMs show significant potential in aphasia assessment and group differentiation. The novel feature set provides detailed insights into various aspects of language use affected by aphasia, offering a more comprehensive evaluation than traditional methods.

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This study presents an advancement in applying AI to aphasia assessment and treatment. Our novel LLM-based framework offers a more nuanced and efficient approach to analyzing aphasia speech, potentially leading to more accurate diagnoses and personalized treatment plans. The findings lay the groundwork for integrating AI-assisted tools into clinical workflows, complementing rather than replacing human expertise. Future research could explore combining this framework with immersive technologies for enhanced language rehabilitation. This work contributes to a future where AI augments the quality and accessibility of care for individuals with aphasia, while maintaining the central role of human clinicians in the therapeutic process.

None Declared