Treatment-resistant schizophrenia can be of primay or secondary etiology. Systematic and thorough differential diagnostics is essential to exclude organic causes for treatment-resistant schizophrenia .Colloid cysts are congenital benign tumor accounting for 15-20 % of intraventricular mass but only about 1% of intracranial ones.They frequently cause psychiatric disturbances. The pathology behind these psychiatric symptoms remains unclear.

Through a case report and a review of the literature, we hypothesize that a colloid cyst in the third brain ventricle is the cause of resistance in a patient with treatment-resistant schizophrenia.

Starting from a case report, we conducted a literature review on “PubMed”, using key words “colloid cyst and psychosis”, “colloid cyst and treatment-resistant schizophrenia”,

We present a 48-year-old male who has a family history of malignant neoplasm.There was no history of physical illness. His past psychiatric history revealed a diagnosis of schizophrenia, having been admitted several times in different inpatient psychiatric wards.In the psychiatric examination, the presence of auditory hallucinations, dissociated thinking, and predominantly negative symptoms was observed.Recently, he has been diagnosed with treatment-resistant schizophrenia owing to the inadequate response to two sequential antipsychotic trials (with adequate dose, duration, and adherence). After a 2-month hospitalization, the severity of the psychotic symptoms had decreased but did not show remission. With no prodromes or triggering factors, our patient presented a drop attack without loss of consciousness and with instantaneous recovery to baseline status. He did not have any of the same experience previously.The physical and neurological examination did not reveal any positive findings. All biochemistry parameters were reported as normal range. Following the evaluation process, an urgent head CT scan showed a colloidal cyst at the anterior end of the third ventricle with dilatation of the lateral ventricles. A cerebral MRI was performed in order to get a more detailed image; it confirmed the diagnosis of a third ventricle colloid cyst immediately adjacent to the foramen of Monro with obstructive hydrocephalus. The patient was referred to the neurosurgical department for further evaluation. This neurological tumor didn’t require neurosurgery.

Our case implies the importance of neuroimaging in patients with treatment-resistant schizophrenia to rule out any underlying organic cause.It also emphasises the importance of considering an organic cause like any space occupying lesion in the brain (colloid cyst in the third brain ventricle in our case) for induction of psychopathological symptoms, even those of treatment-resistant schizophrenia.

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Managing lithium levels in patients with coexisting medical conditions can present several challenges. Here, we report a case of a bipolar disorder (BD) patient on lithium therapy who underwent apheresis in the hematology department for autologous stem cell transplantation preparation.

Bipolar disorder and multiple myeloma are both challenging conditions to manage individually, but their combination presents unique difficulties. This report details the case of a patient with both conditions, emphasizing the impact of a major medical intervention on psychiatric health.

Presentation of a patient’s case regarding the impact of apheresis on lithium levels.

A 52-year-old woman presented in January 2024 with bilateral hip pain, and MRI revealed lesions on the T12 vertebra, which were identified as multiple myeloma on a PET scan. She underwent neurosurgical intervention for the spinal lesions and was planned for autologous stem cell transplantation by the hematology team, involving apheresis and filgrastim administration. The patient has a 20-year history of BD and and has never been hospitalized in a psychiatric facility. Her condition has remained stable with lithium and quetiapine, especially when lithium levels were maintained between 0.8-0.9 mEq/L. During acute episodes, increasing the quetiapine dosage and adding clonazepam have proven effective. It was noted that her most recent hypomanic episode occured in January 2024, due to the interruption of her medications during her admission to the neurosurgery ward. When the patient was admitted to the hematology ward for apheresis, she was taking 1200 mg/day of lithium and 600 mg/day of quetiapine, with a blood lithium level of 0.56 mmol/L. Since her blood lithium levels were considered low, the dosage was increased to 1500 mg/day. One week later, the patient developed complaints of increased amount of speech, overspending and irritability. She was evaluated in consultation and hypomania was considered as a result of psychiatric examination. Her blood lithium level had decreased to 0.46 mmol/L at that time. Clonazepam 0.5 mg/daily was added to her treatment. The apheresis treatment was completed after 10 days. Four days after the completion of the apheresis therapy, her lithium level increased to 0.81 mmol/L and her hypomanic symptoms have improved.

Although lithium is well-documented to be effectively removed via hemodialysis and peritoneal dialysis, its removal through apheresis is not documented. Managing BD in patients undergoing apheresis presents challenges due to its impact on plasma lithium levels. This case underscores the importance of individualized treatment strategies, including frequent monitoring of serum lithium levels and timely dose adjustments. Clinicians must remain cautious in patients undergoing plasma exchange to maintain mood stability and adjust treatments as necessary.

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Fibromyalgia (FM) is a chronic condition characterized by widespread muscle pain,with an unclear etiology. Pain-related behaviors are often closely tied to the individual’s mental state. This has made FM a significant area of psychiatric research, highlighting the need to understand the psychological factors that influence disease progression.

We aim to explore differences in psychological resilience between FM patients and healthy controls and its relationship with depression,anxiety,and fibromyalgia symptoms. Specifically,we seek to understand how resilience may influence disease development and progression. By examining these factors, the study aims to clarify the underlying causes of fibromyalgia,is closely linked to psychiatric factors and remains poorly understood in terms of etiology.

The study included FM patients treated at the Department of Physical Medicine and Rehabilitation at Çanakkale 18 Mart University and a control group of healthy volunteers matched for demographic factors. Pain intensity was measured using the Visual Analog Scale(VAS) and functional disability was assessed with the Fibromyalgia Impact Questionnaire(FIQ). Participants completed sociodemographic forms, the Beck Anxiety Inventory(BAI), the Beck Depression Inventory(BDI), and the Psychological Resilience Scale(PRS).

The study involved 40 female patients with FM and 35 healthy controls. No significant differences were found between the two groups in terms of demographic factors. The FM group showed significantly higher scores for BDI,BAI and PRS compared to controls (p<0.001 for BDI and BAI; p =0.04 for PRS). Correlation analysis revealed significant negative correlations between pain intensity and both PRS total and PRS dedication scores (r=-0.34, p=0.02; r =-0.35, p =0.02). Additionally,FIQ scores were negatively correlated with PRS dedication scores(r=-0.37, p=0.01). (Table 1).

Table 1: Psychological Status and Performance Scales (BDI, BAI, PRS, etc.)

BMI: Body Mass Index, BDI: Beck Depression Inventory, BAI: Beck Anxiety Inventory, PRS: Psychological Resilience Scale

This study highlights the complex interplay between psychological resilience,depression,anxiety and pain in FM patients. Psychological resilience was not significantly lower in FM patients compared to healthy individuals,but higher levels of depression and anxiety were inversely related to resilience.These findings underscore the need for treatment approaches that not only address physical symptoms but also aim to enhance psychological resilience in order to improve the overall quality of life in FM patients.

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Although complex post-traumatic stress disorder (CPTSD) is closely associated with dissociative symptoms, and although dissociation is often conceptualized as a response to trauma, less is known about the co-occurrence of dissociation and (C)PTSD.

This study examined the co-occurrence of CPTSD and dissociation and their relationship with depressive symptoms and functional impairments.

We analyzed baseline data from a clinical trial that evaluated a web-based trauma program. This study included 220 treatment seekers from Hong Kong (Mage = 35.3; SD = 7.9; 82.3% female). Participants completed measures of CPTSD, dissociation, depression and functional impairment, which were assessed with the International Trauma Questionnaire (ITQ), the Dissociative Experiences Scale-Taxon (DES-T), the Patient Health Questionnaire-9, and the Work and Social Adjustment Scale, respectively.

In this sample, 34.1% screened positive for CPTSD only, 10.0% for dissociative symptoms only (DES-T ≥ 25), and 25.0% for both conditions. For participants with CPTSD (n = 130), 42.3% had dissociative symptoms. For participants with dissociative symptoms (n = 77), 7.8% had PTSD, and 71.4% had CPTSD. Hierarchical multiple regression analyses showed that, after controlling for age, gender, education level, and trauma exposure, PTSD (β = .127, p = .033), disturbances in self-organization (DSO) (β = .524, p < .001), and dissociative (β = .169, p = .002) symptoms were all associated with depressive symptoms. Yet, only DSO symptoms were associated with functional impairments (β = .519, p < .001).

This study provides updated data regarding the co-occurrence of CPTSD/PTSD and dissociation. About half of people with CPTSD have considerable dissociative symptoms, while most dissociative individuals may be suffering from CPTSD/PTSD. Moreover, this study found that, among different trauma-related symptoms, DSO symptoms are the strongest predictor of depressive symptoms and functional impairments, highlighting the importance of providing skills training for trauma survivors to address these difficulties in clinical settings.

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Humanitarian love, a concept grounded in compassion, emotional support, and empathy, plays a pivotal role in mental health care, where patients often confront profound emotional and psychological challenges. This compassionate approach strengthens patient-centered care by fostering deeper therapeutic relationships between mental health professionals and patients. However, balancing this emotional engagement with professional responsibilities can give rise to complex ethical dilemmas.

This literature review aims to: a) examine how humanitarian love influences mental health practice, and b) explore the ethical tensions between respecting patient autonomy and ensuring beneficence.

A literature review of scientific articles was conducted using databases such as PubMed, Scopus, and Cochrane, with a focus on recent research exploring the role of humanitarian love in mental health care.

The findings suggest that humanitarian love enhances the quality of mental health care by promoting empathy, trust, and greater patient engagement. However, significant challenges arise when mental health professionals must navigate the balance between compassion and their ethical and legal obligations. The assessment of a patient’s decision-making capacity is inherently subjective, which can potentially lead to bias or burnout among mental health professionals. Furthermore, cultural factors often add complexity to mental health care, particularly in global or cross-cultural contexts. In such situations, well-intentioned humanitarian interventions may inadvertently conflict with local traditions and human values.

While humanitarian love is essential in mental health care, it frequently comes into conflict with the ethical principles of autonomy and beneficence. The subjective nature of assessing a patient’s decision-making capacity, combined with cultural influences, requires mental health professionals to adopt a sensitive and nuanced approach to ensure balanced and high-quality healthcare services.

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In schizophrenia, cognitive symptoms emerge in the early period and are among the core symptoms. This study aimed to investigate the long-term effect of electroconvulsive therapy on the cognitive functions of schizophrenia patients.

In schizophrenia, cognitive symptoms emerge in the early period and are among the core symptoms. This study aimed to investigate the long-term effect of electroconvulsive therapy on the cognitive functions of schizophrenia patients.

In this study, 25 patients diagnosed with schizophrenia according to DSM-5 criteria and treated with only pharmacotherapy (FT), 25 patients treated with pharmacotherapy plus electroconvulsive therapy (ECT) those who are inpatients in the psychiatry clinics of Istanbul Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital 28 healthy controls were included. Patients were evaluated clinically with tests during the acute exacerbation period and 3 months later.

During the acute exacerbation period, schizophrenia patients were identified to present poor cognitive performance compared to healthy controls. After three months of treatment, significant clinical improvement was observed in both patient groups. MoCA total scores increased for both groups after treatment. After treatment, TMT-A and TMT-B performance improved in the pharmacotherapy group and TMT-A performance improved in the pharmacotherapy + ECT group. With treatment, there was a significant positive change in the number of categories completed in the WCST in the pharmacotherapy group. In the Stroop Test, the pharmacotherapy group showed significant positive changes in the duration values of all cards and in the interference effect, while the pharmacotherapy + ECT group showed significant changes in the duration values of Stroop 1, 2, 4 and 5 and in the interference effect. In the pharmacotherapy + ECT group, there was a statistically significant positive correlation between the change in PANNS negative subscale scores and the duration of TMT-B and the number of completed categories, perseverative responses and perseverative errors in WCST.

It was observed that treatment modalities are not superior to each other on cognitive functioning in the long term. The improvement in cognitive areas with treatment may be due to a decrease in symptom severity and increased patient compliance with treatment. In this field, prospective, multicenter studies with larger sample sizes, including different drug groups and different ECT modalities are needed.

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The SARS-CoV-2 virus, responsible for COVID-19, has been shown to affect the central nervous system (CNS), leading to a wide range of acute and long-term neuropsychiatric symptoms. These symptoms can profoundly impair cognitive and emotional functioning, highlighting the need for a deeper understanding of their underlying mechanisms and clinical manifestations. Addressing these sequelae is critical for developing effective management strategies and improving patient outcomes. Long COVID has been associated with conditions such as brain fog, depression, anxiety, and fatigue, which can further exacerbate pre-existing mental health conditions and impair quality of life.

This review aims to examine the neuropsychiatric manifestations associated with COVID-19, focusing on both acute and long-term (long COVID) effects, and to explore potential pathophysiological mechanisms, including neuroinflammation and immune dysregulation.

A systematic review of literature was conducted by searching databases such as PubMed and Scopus, using terms like ‘COVID-19’, ‘neuropsychiatric symptoms’, ‘long COVID’, ‘inflammation’, and ‘CNS involvement’. Only peer-reviewed articles published between 2020 and 2023 were included, with an emphasis on studies reporting acute neuropsychiatric symptoms and post-acute sequelae of COVID-19.

COVID-19, neuropsychiatric symptoms, long COVID, neuroinflammation, interleukin-6, CNS involvement

Acute neuropsychiatric manifestations of COVID-19 include encephalopathy, delirium, seizures, and mood disturbances. Approximately 22.5% of COVID-19 patients present with neuropsychiatric symptoms during the acute phase, including anxiety, depression, and cognitive impairment. In long COVID, persistent symptoms such as fatigue, depression, anxiety, sleep disorders, and cognitive dysfunction have been reported, with neuroinflammation and elevated interleukin-6 (IL-6) levels proposed as key mechanisms. Neuropsychiatric symptoms are observed in both hospitalized and non-hospitalized individuals, with risk factors including severe infection, female sex, and pre-existing mental health conditions.

COVID-19 is associated with a broad spectrum of neuropsychiatric symptoms that persist beyond the acute phase. The underlying pathophysiology likely involves immune dysregulation, cytokine-mediated neuroinflammation, and direct viral invasion of the CNS. Early recognition and targeted interventions are essential to mitigate long-term neuropsychiatric complications.

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Circular economy is a model of production and consumption entailing both environmental and social aspects. The collaborative dimension of this model is evident in the reuse of waste that can constitute a resource for other productive processes, encouraging cooperation and exchange. Also, the regeneration of disused spaces, in both urban and rural contexts, can stimulate social participation, cohesion and community development, thus becoming a resource for community-oriented interventions in the field of mental healthcare.

In 2024 a horticultural activity has been developed on the fields surrounding the facility, to grow edible species (mainly herbs and small fruits). The activity involved people hosted in the TC, local farmers, students of one agricultural high school and one catering school, to develop processes of agricultural products’ cultivation, exchange and transformation, as well as mutual learning. In particular, the project entails the reuse of TC’s organic waste (to produce compost), the cultivation of culinary plants and fruits, the production of derivatives (e.g. juices and jams) in the cooperation with the abovementioned schools, local producers, and consumers. The exchange of both products and skills aims to constitute (also metaphorically) fertile ground for the germination of new opportunities, supporting care in a broad sense and cultivating new individual and group identities. The original meaning of the acronym – “dreams” – points to the dreamlike dimension of a project that – within the controlled, safe perimeter of a pilot intervention – introduces innovative (sometimes bizarre) practices and unprecedented relationships between heterogeneous social actors, inviting the latter to “suspend every judgment”. Hopefully, configurations experienced during the pilot project and evidence supporting their therapeutic potential will be translated into the waking life, providing the basis for improved practice that intersects mental health, sustainability, and social cohesion.

observational work and data collection conducted by healthcare professionals and an ethnographer.

The performance of practical tasks and the prolonged time of the activity throughout months provided each person with the time needed to gradually explore new relational spaces. The aim of growing food, a necessary step in this circular and collective enterprise, supported motivation as well as the development of a social identity of the group, who felt part of the wider community and actively involved in its development.

Preliminary findings suggest further investigation and encourage collaboration between different social actors to develop inclusive, effective, and community-based interventions in the field of mental health and recovery.

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Antipsychotic drugs are known as the major cause of non-neoplastic hyperprolactinemia.

This study aimed to investigate the levels of serum prolactin elevation depending on the use of antipsychotic drugs in patients through the Clinical Data Warehouse.(CDW)

We conducted a cohort search in the CDW application with the following condition. The subjects who aged more than 18 years old and visited from March 1, 2017, to May 31, 2022 at the Department of St. Vincent’s Hospital, The Catholic University of Korea. The subjects were diagnosed according to ICD-10 for schizophrenia, schizotypal and delusional disorders, manic episodes, and bipolar affective disorders. And the subjects who was taking one of risperidone, blonanserin, amisulpride, and olanzapine. The subjects also conducted serum prolactin level tests. After that, we reviewed the medical data.

Among the 117 subjects included in the analysis, the mean serum prolactin level was 64.654.6ng/ml. Serum prolactin levels were significantly higher in subjects taking risperidone or amisulpride compared to blonanserin and olanzapine. The female subjects who took blonanserin, olanzapine, and risperidone had significantly higher prolactin levels, but there was no difference in serum prolactin levels between the sex in the subjects who took amisulpride.

This study suggests the need for regular monitoring of serum prolactin levels in patients who are taking antipsychotics, especially in female patients. And we showed that there is a possibility to conduct more effective and simpler big data research using the CDW. Further studies on the subjects with controlled confounding variables and larger sample groups are needed.

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Sleep deprivation (SD) is a global health concern that impairs cognitive and psychomotor functions (PF). While it can temporarily improve mood, its effects on mood and connection to depressive symptoms (DS) remain unclear. These impacts may involve circadian rhythm gene regulation, though distinct evidence from human studies is lacking.

To assess the impact of SD on the expression of circadian rhythm regulation genes and its associations with the alleviation of DS. Additionally, to explore the relationship between changes in gene expression and PF following SD.

Participants (n = 72) underwent a baseline sleep assesment by polysomnography (PSG), later being subjected to SD. In total, evaluation of mood And cognitive functions (Bimanual Eye-Hand Coordination Test - BEHCT) was conducted four times, pre/post PSG and SD. Moreover, circadian rhythm regulation genes expression: Circadian Locomotor Output Cycles Kaput (CLOCK), Brain and muscle Arnt-like protein-1 (BMAL1), Period Circadian Regulator 1 (PER1), Cryptochrome Circadian Regulator 1 (CRY1), Nuclear Receptor Subfamily 1 Group D Member 1 (NR1D1) and Neuronal PAS Domain Protein 2 (NPAS2) was evaluated. Participants were divided into respondents (RE, n = 49) and non-respondents (NR, n = 23) depending on changes in DS under the influence of SD by the Montgomery–Åsberg Depression Rating Scale evalluation.

No relationship was found between BEHCT parameters and the studied genes in the entire study group. NRs exhibited a negative correlation in number of motor function errors in relation to all examined genes of CLOCK (r=-0.52, p=0.02), BMAL1(r=-0.55, p=0.007), CRY1(r=-0.45, p=0.048), PER1(r=-0.6, p=0.023), and NR1D1 (r=-0.19, p=0.523) is except for NPAS2. Additionally, In NRs, the BEHCT error time negatively correlated with the PER1 and NR1D1 (r=-0.6, p=0.006; r=-0.52, p=0.045; respectively). In contrast, within the RE group, only NPAS2 expression showed a positive correlation with the number of errors (r= 0.35, p=0.049).

Reduced expression of CLOCK, BMAL1, CRY1, PER1, and NR1D1 is associated with impaired PF, only in individuals with worsening DS after SD. Increased NPAS2 expression appears to be an orgin of reduced PF results in the RE group. These genes, integral to the circadian system’s feedback loop, may mediate the complex effects of SD on mood and cognitive function, warranting further investigation.

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Patients admitted to psychiatric services present with several acute and long-term somatic health problems. Psychiatrists have limited time and expertise to manage those conditions. Nevertheless, general practitioner (GP) hospitalists rarely exist in psychiatric facilities.

To examine the effects of a novel hospitalist service we describe performance of GP hospitalists.

HUS Helsinki University Hospital Psychiatry has 12 hospital campuses (550 beds in total) and over 30 outpatient clinics in Southern Finland. During February-May 2024 the organization had three part-time GP hospitalists covering 11 acute adult psychiatric wards (307 beds), six forensic psychiatric wards (120 beds), and two out-patient clinics. Hospitalist assessments at hospital wards and outpatient clinics included structured health checks and consultations from psychiatrists and registered nurses. The hospitalists collected characteristics from consecutive assessments by filling in an online survey. Somatic health conditions assessed in consultations, and those needing attention in health checks were coded according to ICD-10 classification.

The hospitalists provided 245 assessments: 223 consultations and 22 health checks. The majority (n=146,60%) of the assessments lasted for 30-90 minutes, one third (n=82,33%) lasted less than 30 minutes, while some (n=17,7%) took over 90 minutes. Of the assessments 49% (n=120) were hospitalist’s appointments, 12% (n=29) were provided by a phone call, 1% (n=3) were video appointments and 38% (n=93) were solved based on patient records. The most common conditions in the consultations were endocrine and cardiovascular related (Image 1). The hospitalists estimated that eight referrals to emergency departments and 22 to somatic specialists were avoided with the help of the consultations. In turn, hospitalists themselves referred 18 patients to somatic specialists. In the health checks the hospitalists identified 56 somatic conditions needing attention: cardiovascular, endocrine, gastrointestinal, dermatological and vision related problems were the most prevalent (Image 2).

Image 1:

Image 2:

The variety and amount of untreated chronic common diseases and specific somatic conditions related to psychiatric diseases/medications was substantial, and even for the GP hospitalists, time-consuming to handle. Cardiometabolic problems were the most prevalent of health concerns. GP hospitalists are one of the real-world solutions in improving the overall health of patients with severe mental illnesses, and in alleviating the heavy workload of treating psychiatrists.

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Major depressive disorder is a common, disabling mental disorder characterized by extensive etiological and phenotypic heterogeneity. This heterogeneity makes treatment approaches imprecise and often ineffective. Insight into the underlying biological mechanisms underpinning depression and its subtypes may enable more personalized treatments.

A review of the literature as well as data analyses from 2981 individuals from the Netherlands Study of Depression and Anxiety (NESDA), of whom ˜1900 persons have or lifetime or current Major Depressive Disorder and 650 were healthy controls.

Significant immuno-metabolic dysregulations are present in about 20-30% of people with depression. Such immuno-metabolic depression is characterized by the clustering of 1) atypical, energy-related depressive symptoms such as hypersomnia, fatigue, hyperphagia, and possibly anhedonia, 2) systemic low-grade inflammation with elevated levels of e.g. C-reactive protein, cytokines and glycoprotein acetyls, and 3) metabolic abnormalities involving e.g. obesity, dyslipidaemia, insulin and leptin resistance. Evidence for such clustering is confirmed in large-scale proteomic, metabolomic, gene expression as well as genome-wide data analyses. Persons with immuno-metabolic depression are at a higher risk for cardiometabolic diseases and – from pooled analyses of 4 RCTs in over 1000 individuals - seem to respond less well to standard antidepressant treatment.

Interventions targeting inflammation, metabolism or lifestyle may be more effective treatment options for individuals with immuno-metabolic depression, in line with principles of precision psychiatry.

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Effective seizure induction with minimal adverse effects in Electroconvulsive Therapy (ECT) are influenced by administered electrical pulse frequency. Optimized pulse frequency is key to ensure therapeutic efficacy and reduce side effects.

This study examines electrical pulse frequency impact on neuronal excitability and seizure quality in ECT, guided by chronaxie and refractory periods.

A comprehensive literature review was conducted to assess neurophysiological properties affected by ECT and how different frequencies influence treatment outcomes.

Neurons fire action potentials when membrane potentials reach a -55 mV threshold. Lower frequencies (20-32 Hz) balance depolarization and repolarization to trigger seizures without excessive neuronal firing. The neuronal absolute refractory period is 1-2 msec, and the relative refractory period is 2-4 msec. Lower frequencies optimize repolarization recovery.

ECT is clinically administered at 20-70 Hz. Studies show 20-32 Hz is effective at triggering seizures with optimal treatment outcomes. Lower Hz also minimizes tissue damage from reduced power. The total charge delivered is affected by current amplitude, pulse width, frequency, and train duration. Shorter pulse widths (0.3 ms) reduce total energy and minimize tissue heating.

The neuronal soma is sensitive to electrical stimulation. Chronaxie is the minimum time that an electric current is applied to stimulate a neuron. Chronaxie is 0.2-0.3 msec. Aligning pulse frequencies with these values ensures stimulation with reduced adverse effects. The soma exhibits a lower spike threshold and shorter refractory period when facing prolonged steady depolarization, making it highly sensitive to pulse frequencies that align with its chronaxie values.

In contrast, axons have a higher density of voltage-gated Na+ channels that allow quicker recovery and shorter refractory periods. This high density enables axons to rapidly transmit action potentials, facilitating efficient neuronal signal propagation. Shorter axonal refractory period means they handle higher frequencies more effectively, but optimizing the overall frequency for ECT must balance the excitability of both the soma and axons.

Studies indicate that frequencies around 20-32 Hz are effective in initiating convulsive activity, aligning well with the end of the stimulus train. Frequencies over 50 Hz may suppress ictal activity and be inefficient in seizure induction due to “stimulus crowding,” with neurons stimulated during their absolute refractory period.

Optimizing ECT pulse frequency is vital to balance therapeutic efficacy and safety. Fine-tuning ECT’s electrical parameters enhances patient outcomes. Lower frequencies (20-32 Hz) are more effective to induce seizures and minimize adverse effects. 20-70 Hz in ECT is most clinically used, and lower end Hz could optimize results. Further frequency range research could lead to improved ECT protocols.

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Access to timely mental health care in the Netherlands has become increasingly challenging, with waiting times steadily increasing in recent years. Extended waiting times for treatment in mental health care can be harmful due to increased severity of symptoms, poorer treatment outcomes and a reduced quality of life. There is growing interest in the potential of unguided e-health interventions to provide support during these waiting periods without overburdening healthcare professionals

The main objective of this study is to test the clinical effectiveness and cost-effectiveness of a personalized unguided e-health intervention during the waiting list period.

A Randomized Controlled Trial (RCT) with two trial arms will be conducted: the intervention condition and the treatment as usual waiting list condition. Adult outpatients awaiting an intake at a several specialized mental health care institutions will be included in the study. Both trial arms will include repeated measures during the waiting period. The intervention arm will receive online access to a selection of existing e-health modules. Personalization will be achieved by employing both innovative and traditional methods to identify symptoms that are most influential for each individual participant. A Dynamic Time Warping analysis based on a three-week ecological momentary assessment (EMA) will be used to determine which specific symptoms are most responsible for maintaining the patient’s overall complaints (4). This analysis will be used to provide tailored recommendations of e-health modules. The study’s outcomes will focus on symptom severity, cost-effectiveness, quality of life, digital phenotyping and patient satisfaction during the waiting period.

At this stage, no results are available yet as the study is still being conducted.

No conclusions can be drawn as the study is still being conducted.

None Declared

Subjective well-being (SWB), defined as the way people think and feel about their lives, is often used to evaluate happiness. Separated into three components—positive affect, negative affect, and life satisfaction—SWB has been indirectly related to psychiatric symptoms and disorders. However, the relationship between SWB and obsessive-compulsive disorder (OCD) remains relatively unknown.

To determine whether SWB components correlate with the clinical features of OCD.

This was a cross-sectional study evaluating 68 individuals with OCD. Sociodemographic data were collected, treatment histories were taken, and validated instruments were applied (Y-BOCS, Dimensional Y-BOCS, USP-Sensory Phenomena Scale, BDI-II, BAI, Positive and Negative Affect Schedule (PANAS), and Satisfaction with Life Scale (SWLS)).

All three SWB components showed inverse correlations with the severity of depressive/anxiety symptoms and total OCD symptom scores. Life satisfaction and positive affect showed inverse correlations with suicidality. Life satisfaction and negative affect showed inverse correlations with the hoarding and contamination/cleaning OCD dimensions, respectively. No SWB aspect correlated with any other OCD dimension.

Some OCD-specific factors appear to correlate with SWB. However, it seems that the effect size is greatest for depressive symptoms, which suggests that depression mediates the relationship between OCD and SWB. Studies with larger samples and control groups are needed to confirm our findings.

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Sleep problems, particularly insomnia and sleep deprivation, are common among adolescents, and may increase their risk for poor psychosocial and metabolic health. Traditional classroom-based education programmes showed inconsistent results in promoting sleep behavioural changes. In contrast, enhancing training programme with experiential activities alongside classroom learning may be considered as a more sustainable means to promote healthy sleep in adolescents.

The present study evaluated the impact of a four-week enhanced sleep education programme on adolescents’ sleep quality, knowledge and behaviour, and their experience of participation.

Adolescent participants took part in the Youth Sleep Ambassadors Programme, which was designed to equip them with evidence-based information on sleep and circadian health through active learning and community outreach activities. A mixed-methods design was adopted to evaluate the programme. Participants completed self-administered questionnaires, including a sleep knowledge quiz, the Pittsburgh Sleep Quality Index (PSQI) to assess subjective sleep quality, and the Sleep Hygiene Index (SHI) to evaluate healthy sleep behaviour, before and after the programme. Additionally, two focus groups were conducted to understand participants’ experiences with the programme.

Thirteen participants, aged 15 to 17, participated in the progamme and rated the programme’s effectiveness at 4.38 out of 5. At post-programme, there were significant increases in total sleep time (baseline: 6.12hr, post: 7.31hr, p=.006) and time in bed (baseline: 6.83hr, post: 7.98hr, p=.046), in addition to a reduction in PSQI score (baseline: 5.92±1.98, post: 3.92±1.50, p=.031). There was a noticeable trend of improved sleep knowledge with a 13.5% increase in correct rate and healthy sleep behaviour (SHI: baseline: 24.4±6.76, post: 20.6±5.33). Focus groups revealed increased awareness and confidence to advocate for better sleep and mental health among peers. Participants praised the programme as professional and well-organised but expressed a preference for more experiential and research activity over classroom learning, underscoring the limitations of classroom-based sleep education.

The findings provided preliminary support for this enhanced sleep education programme as a viable strategy to engage adolescents in understanding and awareness of sleep and circadian health. Beyond traditional classroom education, self-discovery and knowledge application with experiential tasks can better develop their perspectives and advocate in their community.

None Declared

Gender incongruence (GI) and gender dysphoria (GD) represent a health condition in which the individual’s gender identity does not correspond to their assigned gender at birth, when dysphoria is present it means there is significant distress. This population needs specific healthcare from a multidisciplinary team involving psychiatry, psychology, endocrinology, urology and/or gynecology, otorhinolaryngology and plastic surgery. In Santo Antonio Hospital, currently, Unidade Local de Saúde de Santo António (ULSSA), there is a sex and gender unit (USEG – Unidade de Sexo e Género), with the previous described specialties, that evaluates and follows transgender individuals through their transition process. A mental health assessment is a major part of this process since, in Portugal, it is required an evaluation, from a mental health professional with clinical experience in this field, to have hormonal treatment, and two to have surgical procedures done.

Characterization of a population of transgender individuals in Portugal, framing the results in the current Portuguese panorama of transgender health care.

Retrospective study of individuals that attended sexology/psychiatry consultation from USEG. Age, type of treatments they have made so far and expectations, type of transition – male to female (MtF) or female to male (FtM) or non-binary (NB), occupation and education, relationship status, city of origin and comorbidities were analyzed.

143 people were assessed and/or followed for gender incongruence and/or dysphoria, with a minimum age of 17 and a maximum of 61 at the time of their first consultation, mean age of 24,4 years. Of these 49,65% had FtM GI/GD, 38,46 % MtF and 11,89% identified as NB. Several individuals had concomitant medical conditions, and there were high rates of psychiatric comorbidity like anxiety and depression but also neurodevelopmental disorders. The majority of the individuals intended to start hormonal treatment with many expressing fear and anxiety related to the surgical procedures but with a still high proportion looking forward to them in the future. Many of our patients lived in places far from our hospital.

We found a higher prevalence of FtM than MtF, which is in contrast with most studies in the field but similar to another Portuguese study. The high percentage of medical, specifically psychiatric comorbidities, enhances the importance of a mental health assessment and follow up in this population. A significant percentage of our patients came from cities far away reflecting the scarcity of specialized trans health care in our country. GD and GI diagnosis is increasing worldwide and the transition process is long and highly complex requiring a multidisciplinary team that can collaborate on a unique individual’s care in a coordinated and safe way.

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The scientific literature recognizes the Gut-brain axis (GBA) as a crucial connection between gastrointestinal health and mental well-being. Patients with inflammatory bowel disease (IBD) are at a disproportionately higher risk of developing psychiatric disorders due to factors including gut dysbiosis and chronic inflammatory changes. Recent developments in artificial intelligence (AI) and machine learning, provide novel opportunities to predict the comorbid psychiatric outcomes in patients with IBD by analyzing complex datasets including but not limited to the gut microbiome and neuroimaging data.

This systematic review discusses the current evidence for AI-driven models to aid in the prediction of psychiatric disorders in IBD patients, with a focus on their performance and potential challenges around their clinical implementation.

A systematic search on PubMed, EMBASE, Scopus, and Cochrane databases, identified 28 studies utilizing AI-based models to examine gut microbiota and neuroimaging data in patients with IBD. Data extraction illuminated the following artifacts: classification thresholds (i.e. predictive), relevant supervised learning or deep learning modeling (e.g. random forest classifiers, convolutional neural networks, and unsupervised models like attention-based learning), sensitivity, specificity, accuracy, and both accuracy measures and AUC-ROC curve values.

A pooled analysis of the included studies demonstrated an estimated sensitivity of 81% (95% CI: 77-85%) and specificity of 78% (95% CI: 73-82%) to predict psychiatric disorders in patients with IBD with the highest predictive accuracy elicited by studies based on microbiome and neuroimaging data. Yun et al. (2024), for instance, demonstrated a predictive accuracy of 86% using microbiome profiles and structural brain imaging data while Fil et al. (2024) elucidated the positive correlation between gut dysbiosis and psychiatric symptoms based on microbial signature models. Additionally, the variability noted in the predictive performance of the models was found to be based on the patient population, quality of data, and machine learning strategy.

AI models present promising evidence in predicting psychiatric disorders in IBD patients by leveraging microbiome and neuroimaging datasets. Overall, the meta-analysis reports strong predictive strength with high sensitivity and specificity. Future work in this field should focus on the validation of these prediction models in various clinical populations, improving their generalizability and standardization to enable widespread use and integration in the field of personalized psychiatry, especially in patients with IBD.

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Suicidal ideations are severe and serious symptoms in the clinical presentation of schizophrenia, as well as adverse reactions such as oculogyric crises. In certain situations, they may be associated with specific pharmacogenetic factors, such as gene variations for the serotonin transporter (SERT) and the CYP2D6 enzyme.

A 37-year-old patient with treatment-resistant schizophrenia, characterized by frequent suicidal ideations, is regularly treated with clozapine (100 mg/day). Additionally, during disease exacerbations, the patient is given haloperidol (10 mg/day) as supplemental therapy, resulting in the development of oculogyric crises.

Due to the lack of therapeutic response and a predisposition to side effects, a pharmacogenetic analysis revealed CYP2D6 genotype *4/*9 and 5-HTTLPR genotype SA/SA. This indicates CYP2D6 intermediate enzyme activity and SERT low activity. Due to these findings, haloperidol was discontinued, and paliperidone palmitate was introduced at a dose of 75 mg monthly, after which the oculogyric crises no longer occurred. The pharmacogenetic results showed reduced SERT activity, which may be associated with the decreased therapeutic response to clozapine and the persistence of suicidal ideations.

Haloperidol is metabolized via CYP2D6, and its intermediate activity can lead to higher plasma concentration, resulting in extrapyramidal side effects such as oculogyric crises. Paliperidone is a metabolite of risperidone, and the activity of CYP450 enzymes has a minimal impact on its therapeutic response and potential for adverse reactions. HTTLPR regulates the transcriptional activity of the 5-HTT gene, so genotypes with low expressions, such as S’/S’ or S’/L’, may exhibit a weaker response to clozapine, which may include the persistence of suicidal ideations.

The personalized antipsychotic treatment according to an individual’s pharmacogenetic profile may prevent adverse reactions and potentially explain therapeutic resistance in such cases where clozapine is otherwise indicated. Effective modern psychopharmacological treatment requires understanding pharmacogenetic factors and their influence on therapeutic response and the development of adverse reactions.

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This case highlights the interdisciplinary management of a 28-year-old Filipino female with recurrent depressive disorder and multiple medical comorbidities, including HIV, tuberculosis, and sexually transmitted infections. Managing depression in patients with complex medical conditions is especially challenging in resource-limited settings like the Philippines, where drug-to-drug interactions and access to high-quality care must be carefully navigated.

The objective of this case report is to illustrate the importance of personalized treatment decisions, the rationale for choosing Venlafaxine over SSRIs, and the value of psychodynamic psychotherapy in addressing underlying emotional conflicts in the context of maternal health challenges.

The patient was referred to the Psychiatry service due to suicidal ideations. She has a history of depressive episodes linked to family stressors and initial flashbacks and nightmares related to her physical abuse from her previous partner. Her extensive comorbidities made the usual first-line antidepressants (SSRIs) unsuitable due to drug interactions. Venlafaxine 75 mg/day was selected, and psychodynamic psychotherapy, trauma-informed psychotherapy, and psychoeducation were integrated into her treatment. Coordination with infectious disease, obstetrics, and internal medicine specialists ensured comprehensive care.

Venlafaxine was effective in improving mood, sleep, and appetite, with no significant side effects. Regular follow-ups confirmed adherence to the medication, and psychodynamic psychotherapy helped her address deep-seated emotional conflicts, particularly surrounding her history of trauma. Ongoing psychiatric care, along with monitoring her medical conditions, provided a supportive framework for her continued improvement. Despite financial constraints, the patient adhered to her treatment regimen, showing improved mental health and commitment to her care.

This case underscores the complexity of treating depression in patients with multiple comorbidities, particularly in resource-limited settings. The selection of Venlafaxine was crucial due to the potential interactions of SSRIs with the patient’s medical regimen. Psychodynamic and trauma-informed psychotherapy, combined with interdisciplinary collaboration, were key to the successful management of this case. This highlights the need for an integrated approach to mental health care, especially in low-resource environments, where interdisciplinary coordination is vital.

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