Sexuality in the elderly has become an increasingly important topic in healthcare as the global population continues to age, raising new challenges and considerations related to the quality of life and well-being of older adults.

This work aims to explore the barriers faced by the elderly regarding sexuality and propose strategies for promoting healthy and fulfilling sexuality at this stage of life.

A narrative review was employed on the topic, aiming to broadly and exploratorily understand the main aspects related to sexuality in the elderly population.

Recent studies suggest that sexual activity can remain an important part of life for older individuals, positively influencing both mental and physical health. The main obstacles to healthy sexuality in old age can be broadly categorized into physiological, psychological, and sociocultural factors. Physiological changes include a natural decline in hormone levels, such as estrogen in women and testosterone in men, leading to reduced libido, vaginal dryness, and erectile dysfunction. Chronic illnesses like cardiovascular disease, diabetes, and arthritis, along with medications for these conditions, can further impact sexual function. Psychological factors, such as anxiety, depression, and reduced self-esteem due to aging-related body changes, also play a significant role in diminishing sexual desire and activity. Sociocultural factors include long-standing societal taboos around older adults and sexuality, which can lead to embarrassment, reluctance to discuss sexual health issues, and feelings of shame. Healthcare professionals can adopt several strategies to improve sexuality in aging such as open communication. Regular sexual health assessments should be integrated into routine care, including questions about sexual function, relationship satisfaction, and any challenges faced. Medical interventions, such as hormone replacement therapy or treatments for erectile dysfunction can address physiological barriers. Psychosocial support can improve communication, body image issues, and mental health factors like anxiety or depression that often accompany aging.

The approach to sexuality in the elderly should be multifaceted, integrating biopsychosocial perspectives, with an emphasis on promoting sexual education and providing appropriate treatments that address individual challenges. Healthcare professionals shouldadopt a welcoming and open attitude, encouraging dialogue on this topic to improve the quality of life of older adults.

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Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that often persists into adulthood, significantly impacting daily functioning and quality of life. Studying sex differences in ADHD is crucial as females are frequently underdiagnosed or misdiagnosed, which can delay treatment and worsen outcomes. ADHD presents in three main subtypes: inattentive, hyperactive-impulsive, and combined. The combined subtype tends to cause more significant impairments, particularly in academic and social contexts. Males are more likely to be diagnosed with hyperactive-impulsive or combined types, while females often present with the inattentive subtype. A subtype-specific approach is essential, as it guides targeted interventions to address distinct behavioral and cognitive challenges, enhancing treatment efficacy and outcomes.

This study aims to analyze differences in ADHD severity, comorbidity with other conditions, and socio-functional impact by ADHD subtype and sex, as well as to evaluate interactions between these variables.

This population-based study included 900 adults diagnosed with ADHD from a specialized ADHD clinic. Participants were classified by ADHD subtype and sex. Diagnostic and severity assessments were conducted using validated tools, including the CAADID-I, DIVA-5, ADHD Rating Scale (ADHD-RS), Wender Utah Rating Scale (WURS), and Clinical Global Impression Severity Scale (CGI-S). Comorbid psychiatric conditions and psychosocial functioning were evaluated using the BDI-II, STAI, BIS-11, PSQI, FAST, and WHODAS scales. Statistical analyses included bivariate, multivariate, and General Linear Model (GLM) methods.

Females were diagnosed with ADHD later than males (p=0.001) and exhibited greater severity (ADHD-RS, p<0.001) and higher levels of depression and anxiety. No significant sex differences were observed in impulsivity or sleep quality. The combined ADHD subtype was associated with greater clinical severity and functional impairment. An interaction effect was found between sex and ADHD subtype only for WHODAS scores, with females in the combined subtype showing greater impairment.

ADHD presents differently across sexes and subtypes, with specific interactions observed in functional impairment. These findings emphasize the importance of considering sex and ADHD subtype independently to enhance diagnostic accuracy and inform targeted treatment strategies.

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Artificial Intelligence (AI) is revolutionizing the field of psychotherapy by introducing innovative, accessible, and efficient methods for mental health care. AI-based psychotherapy practices leverage machine learning algorithms, natural language processing (NLP), and predictive analytics to provide personalized therapeutic interventions, support mental health practitioners, and enhance patient outcomes. These systems, including virtual therapists and chatbot platforms, are designed to simulate human empathy, analyze user inputs, and deliver evidence-based therapeutic techniques such as cognitive-behavioral therapy (CBT).

Moreover, AI systems assist clinicians by offering diagnostic support, monitoring patient progress through behavioral data analysis, and optimizing treatment plans. The integration of AI into psychotherapy practices has shown promise in addressing barriers such as stigma, geographic limitations, and therapist shortages. However, ethical challenges related to data privacy, algorithmic bias, and the therapeutic efficacy of AI-driven interactions remain significant concerns. This abstract explores the potential, applications, and limitations of AI-based psychotherapy, emphasizing the need for rigorous research and ethical considerations to ensure its effective and responsible integration into mental health care.

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Parent-focused interventions are an important part of the treatment plan for children with Attention-deficit/hyperactivity disorder (ADHD). Minority families tend to be less involved in psychosocial treatments and are more likely to discontinue the intervention. The Haredi community in Israel is a cultural-religious minority of 1.2 million people

We aimed to assess the feasibility and potential efficacy of culturally adapted psychosocial programs for attention-deficit/hyperactivity disorder (ADHD) within the Haredi community in Israel.

This was an open-label non-randomized study conducted within the Haredi community in Israel between 2018 and 2021. The participants (N=265) were parents of children aged 8-12 years who had been diagnosed with ADHD or exhibited ADHD symptoms. Three culturally adapted programs were compared: 1. A program involving only the parents (N=46), 2. A program involving both children and parents (N=155) and 3. Only recorded video lectures with no interaction (N=38). Parents completed questionnaires to assess their self-efficacy using the Parenting Self-Efficacy tool (TOPSE) and their child’s ADHD symptom severity, using the Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS) both before and after the intervention.

The programs demonstrated high feasibility. Of 335 referrals, 265 parents were recruited. Participation rates differed significantly between the video lectures program (60%) and the two interactive programs (80%, p<0.001). A significant interaction was found between time and program type for both parental efficacy (F(2,213)=5.65, p=0.004) and for ADHD symptomatology (F(2, 213)=5.65, p=0.004). Post hoc analysis revealed that the video lectures program showed no benefit, whereas both interactive programs (parents-only and parent-child) exhibited improvement in parental self-efficacy and reduction in reported ADHD symptom severity.

Despite certain limitations, this study suggests that culturally adapted psychosocial programs for ADHD in the Haredi community are feasible and that including an interactive component is crucial for effectiveness.

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The potential of psychedelic substances to treat mental illness is of significant clinical and societal interest, leading to academic and industry-based research to test their effects. Partly, such research was conducted to fulfil requirements of government agencies such as the European Medicines Agency (EMA) and the Food and Drug Administration (FDA), that have started defining requirements and pathways to regulate psychedelic treatments. It is expected that such requirements will involve elements related to psychotherapeutic components of such treatments, which will require standardized reporting of such methods. Here, I will present the results of a systematic review summarising the quality of reporting on psychological interventions in original studies on psychedelic-assisted psychotherapy. We reviewed 45 studies assessing psilocybin, 3,4-methylenedioxymethamphetamine (MDMA), lysergic acid diethylamide (known as LSD), or ayahuasca, for the treatment of mental disorders. Our findings support that psychological interventions were done heterogeneously across studies, and completeness of information reported about these interventions was mostly low, according to an adaptation of the Template for Intervention Description and Replication checklist. In studies including MDMA, psychotherapy was more homogeneous and more procedural details were provided. We thus propose that improved reporting on psychological interventions of psychedelic treatments are necessary to support replicability, generalisability, and accurate interpretation of research. Furthermore, improved reporting practices are expected to enhance feasibility and safety of future clinical research and real-world implementation of treatments.

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The Council of Europe’s Model Mental Health Act places emphasis on the need for a ‘debriefing’ discussion with patients after incidents of restrictive practices to arrive at a common understanding concerning what happened and to consider future prevention strategies. For the patient, issues may arise that may be subjectively reinforcing or subjectively aversive and staff may feel that the incident has, or does not have, alienating consequences.

The aim of this study was to evaluate the consequences for the patient and for staff of incidents and use of subsequent restrictive practices, as a basis for future understanding of what debriefing might usefully include.

A prospective cohort study was completed whereby incidents were rated using the Dynamic Assessment of Situational Aggression (DASA) and DRILL tool ‘consequences’ scales in the Central Mental Hospital (CMH). The DRILL consequences scale consists of three ladders, ‘re-enforcing’, ‘aversive’ (both rated from the point of view of the patient) and ‘alienating’ (rated from the point of view of ward based staff). Data were gathered as part of the Dundrum Forensic Redevelopment Evaluation Study (D-FOREST). An omnibus General Estimating Equations model (GEE) was tested with the DRILL ‘consequences’ as dependent prior to dismantling studies.

In this study, the 384 patient-days were in scope, 411 lines of data including 326 patient-days, 85 harmful incidents and 63 incidents of seclusion. In an omnibus GEE with the three-item DRILL consequences scale as dependent variable, DASA on the day before Wald X2=3065.9, p<0.001; DRILL behaviours scale Wald X2=970.7, p<0.001; DRILL interventions Wald X2=140,159.1, p<0.001; DUNDRUM-1 Wald X2=1638.9, p<0.001. The three items of the DRILL consequences scale were individually tested as dependent variables in GEE models with DASA the day before, DRILL behaviour scale, DUNDRUM-1 and each of the eight items of the DRILL interventions scale. Only increasing observation levels were not re-enforcing, with searches and seclusion strongly re-enforcing.

We have shown that consequences of harmful behaviours and preventive, restrictive interventions are measurable and proportionate for patients and for staff. Short-term risk on the day prior to an incident was able to predict the re-enforcing and aversive consequences for the patient, but not the alienating consequences – or lack of them – for staff. Future research will examine the way in which the baseline need for security mediates or moderates the relationship between incidents and patients and staff views of the consequences of incidents and restrictive practices.

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In recent years, dopamine D3 receptor (DRD3) has gained extensive attention in substance use disorders (SUDs) in terms of their anatomical localization and role in drug-related processes. Animal studies have shown that DRD3 agonists modulate addictive behaviour. In addition, cariprazine (CAR), a novel antipsychotic with a partial agonist effect on DRD3, may be a treatment option for patients diagnosed with schizophrenia (SCZ) with comorbid SUD.

Therefore, the main goal of the present work was to summarize literature data about DRD3 and CAR in SUDs.

A systematic review was conducted in August 2024. The full-text search was performed without filtering from four databases (PubMed, ScienceDirect, Web of Science, Cochrane Registry). In the first search “dopamine receptor D3” AND “substance use” OR “addiction” OR “dependence” OR “misuse” were used as the key search terms, and in the second search “cariprazine” AND “substance use” OR “addiction” OR “dependence” OR “misuse” were used. Duplicated studies, non-relevant articles, review articles, and animal and cell studies were excluded.

In the first search, 40 articles were identified; however, 15 were excluded. In the second search, 21 articles were identified; however, 12 were excluded. Findings based on the 25 included articles show that DRD3 modulators, which are mostly agonists of the receptors, may have a positive effect on both psychotic symptoms and substance use frequency- and drug-seeking behavioral reduction. Our findings based 9 included articles demonstrate that CAR is a more effective and safe medication for SCZ with comorbid SUD than other atypical antipsychotics. It could also be suggested that in other psychiatric conditions where substance abuse is occurring CAR is also a good treatment option.

Based on past and current research, it’s crucial to systematically evaluate the role of DRD3 for developing new therapeutic perspectives in SUDs, though more research is needed to confirm the efficacy and safety of DRD3 modulators and CAR as medications for SUDs. Furthermore, the present review suggests that CAR may be the optimal antipsychotic for treating SCZ with comorbid SUDs.

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People with bipolar disorder (BD) have an increased risk of premature mortality, and the respiratory mortality rate is higher than those of the general population. However, the evidence on respiratory disease in this population has not been meta-analyzed.

To systematically review and meta-analyze the frequency of respiratory diseases in patients with BD and to compare prevalence and Odds Ratio (OR) with the general population.

A systematic literature search was conducted in Pubmed, PsycINFO, Scielo and Scopus from inception to June 2, 2023, and a snowball search of reference and citation lists was conducted. Inclusion criteria were studies reporting diagnoses of respiratory diseases (asthma, chronic obstructive pulmonary disease (COPD), pneumonia, lung cancer and tuberculosis) in people with BD according to operationalized criteria and where possible, control group. This study followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and MOOSE reporting guidelines. A pair of reviewers independently extracted data using a predefined data extraction form and a senior co-author was consulted in cases of disagreement. The risk of bias and methodological quality was assessed using the adapted Newcastle-Ottawa scale.

Of the 2,158 articles screened, 20 including 962,352 people with BD and 37,340,405 control group, met the inclusion criteria (see Figure 1). Prevalence and OR of respiratory disease in people with BD was the main outcome as percentage point estimates with corresponding 95% CIs. In people with BD, the prevalence of COPD was 9.14% (95%CI: 6.61%-12.5%), asthma 6.4% (95%CI: 4.56%-8.91%), pneumonia 2.78% (95%CI: 2.51%-3.08%) and lung cancer 0.44% (95%CI:0.23%-0.84%) (see Figure 2). Compared to the general population (see Figure 3), people with BD had significantly higher rates of COPD (OR: 1.73; 95% CI: 1.40-2.14), showing an increased rate in younger and female patients; asthma (OR: 1.91, 95% CI: 1.25-2.94), with a greater rate in younger patients; and pneumonia (OR: 2.82, 95% CI: 1.33-5.99).

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In the first meta-analysis on the topic, BD was associated with an increased risk of respiratory illness versus the general population. In COPD and asthma, young people and women are at particular risk. Prevention programs are urgently needed.

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Psychopathology in adolescents is influenced by genetic factors, hormonal changes, individual vulnerabilities, and coping skills. Telepsychiatry has proven effective in improving access to mental health services.

To implement a Remote Primary Care and Psychiatry Model (MAP/PSI) to facilitate early diagnosis and timely treatment of depressive symptoms in youths from the Municipality of Ciudad Fernández, San Luis Potosí, Mexico, using an implementation science approach

A prospective study was conducted with 38 patients evaluated in child psychiatry, using the PHQ-9 (Patient Health Questionnaire) and GAD-7 (Generalized Anxiety Disorder) scales. Non-parametric statistical tests were applied

The sample included patients aged 15 to 25. Diagnoses included 8 (20%) with generalized anxiety, 8 (20%) with mild depression, 15 (35%) with moderate depression, and 9 (25%) with severe depression, who were referred to the general hospital due to suicidal ideation. 60% of patients were female and 40% male. The mean age was 20 years ±3, with mean scores on the PHQ-9 of 16 ±7 and on the GAD-7 of 13 ±6, reduced in the final consultation to 8 ±6 and 7 ±6, respectively. Increased symptom frequency was observed in females (p < 0.044) and older age correlated with higher initial PHQ-9 scores (p < 0.034), with no correlation to generalized anxiety (p < 0.021). No relationship was found between the duration of symptoms and improvement

The MAP-PSI model facilitated early detection and treatment of depressive and anxiety symptoms in youths, preventing progression to severe depression and its complications.

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Obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD) often co-occur, creating complex symptom profiles and requiring multifaceted treatment approaches. OCD can lead to intense self-monitoring and distressing obsessive-compulsive behaviours, while BDD contributes to a distorted self-image, exacerbating feelings of inadequacy and shame. This case study explores the use of a metacognitive approach using Dramatised Socratic Dialogue (DSD) in the treatment of a patient with severe OCD and BDD, focusing on relational challenges, pervasive shame and self-criticism.

To evaluate the effectiveness of dramatised Socratic dialogue and exposure with response prevention (E/RP) in the treatment of a complex case of OCD and BDD. Specifically, to address intrusive self-criticism, enhance the therapeutic alliance, and reduce shame-related behaviours.

A 33-year-old man with a long history of OCD and BDD symptoms, including excessive mirror checking and social avoidance, was assessed using the MMPI-2, PID-5, MADRS, STAY-1 and 2, and Y-BOCS, confirming OCD, BDD, and major depressive disorder. Treatment included establishing a strong therapeutic alliance, psicoeducation, E/RP and DSD targeting persistent self-criticism. After an initial phase, interventions focused on reducing compulsive behaviours and promoting self-acceptance.

Initial E/RP led to symptom improvement but maintained a sense of control that limited full therapeutic progress. DSD successfully reduced self-critical dialogue and addressed shame and self-perceived social unacceptability, although it temporarily disrupted the therapeutic alliance. Subsequent reintegration of E/RP alongside DSD facilitated substantial reductions in OCD and BDD symptoms, with the patient reporting increased mood stability and reduced social avoidance.

This case highlights the benefits of integrating dramatised Socratic dialogue with traditional CBT methods such as E/RP to address OCD and BDD symptoms where shame and self-criticism are significant. DSD proved effective in reframing negative self-talk, breaking cycles of self-criticism and supporting long-term symptom reduction. This approach shows promise for treating complex cases involving intense feelings of inadequacy and shame.

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Evidence for efficacy of various modalities of psychotherapies is growing and such therapies are increasingly recommended in international guidelines for the treatment of psychiatric disorders. Psychiatrists with strong psychotherapy skills are better positioned to provide individualized and multidisciplinary care. Training in psychotherapy also fosters the development of reflective practice, empathy, and cultural competence, all of which are vital in addressing the diverse needs of patients. Accessibility of psychotherapeutic treatment for the patients can be improved through integrating psychotherapy training in psychiatric training, together with continuous medial education activities. European and other international organisations have published guidelines requiring programs to promote psychotherapeutic competences among psychiatry trainees. However, psychotherapy education and supervision can often become a luxury rather than being a mandatory component of training; and resources are heterogenous. In this presentation, psychotherapy training availabilities and limitations in Turkey will be discussed, with a focus on the psychotherapy courses of Psychiatric Association of Turkey among other initiatives.

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Epilepsy, one of the most common neurological disorders, affects around 50 million people worldwide. It is unpredictable, intrusive illness that impacts not only the patients but also those who care for them. Caregivers are vulnerable to great burden; depressive and psychosomatic symptoms, as well as physical, emotional, and economic pressures.

To explore the psychiatric comorbidities, attributes related to caregiver burden and psychosocial intervetions available to allivate the burden in Caregivers of patients with Epilepsy.

A narrative review of the relevant studies focusing on psychiatric comorbidities and psychosocial interventions for reducing the caregiver burden in caregivers of patient with epilepsy was comducted.

Caregivers of patient with epilpsy have poor quality of life and are at risk of developing psychiatric illnesses. Caregiving was reported to negatively impact one’s physical and mental health, overall family functioning, and financial status. Psychological interventions such as psychoeducation, individual, group or family counselling, Interpersonal and social support networks, relaxation therapy and cognitive behaviour therapy have been used to treat caregiver burden associated with epilepsy caregiving.

Caring for patients with epilepsy is challenging and it is associated with enormous burden. It can lead to mental health problems which ultimately affects the compliance to treatment and overall prognosis. Psychosocial interventions can prepare caregivers for a better role of caregiver and better management of the care process. There is increased need to focus on this unexplored area through research and to provide effective interventions as a part of clinical services.

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Despite the identification of several risk factors, an understanding of the role of specific psychopathological profiles in predicting adolescent suicidal behaviours remains a key challenge in public health research.

The current study aimed to identify psychopathological profiles in suicidal adolescents and to analyse their association with suicide-related outcomes.

A total of 285 adolescents aged 12 to 17 years [mean age (SD)=14.98 (1.51); females: 249 (87.40%)] were recruited from different hospitals in Spain. Latent profile analysis was performed to classify subgroups with similar patterns based on self-report Strengths and Difficulties Questionnaire. Logistic regression and generalised linear modelling were applied to examine the relationship between profile membership and suicidal behaviours.

Three psychopathological profiles were identified: internalizing symptom profile (52.63%), externalizing symptom profile (24.21%), and low symptom profile (25.58%). The predominantly female internalizing symptom profile members were more likely to report higher levels of psychopathological symptoms, including number of psychiatric diagnoses, depressive symptoms, and trauma (except sexual abuse). Additionally, they had more non-suicidal self-injury (NSSI) and suicidal thoughts and behaviours. Likewise, greater ideation intensity was associated with the internalizing symptom profile compared to other groups, while greater number of previous suicide attempts correlated with an increase in suicidal behaviours. Finally, higher levels of motor impulsivity were associated with a lower probability of suicidal behaviours.

Identifying symptom profiles among adolescents who have attempted suicide allows us to establish reliable predictors for suicide prevention as well as personalised interventions, indicating the domains where these interventions are needed.

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Recent research highlights the importance of technological solutions in delaying cognitive decline and improving life quality for at-risk individuals, emphasizing the need for innovative, tech-based approaches in dementia prevention (Johnson et al.,2023; Smith et al.,2023). Exercogs® is an innovative tool designed to tackle the global challenge of dementia by addressing modifiable risk factors (Livingston et al.,2020). Developed through a clinic-academia partnership, it integrates physical exercise, cognitive skills, and social interaction into a single activity for dementia prevention programs.

This scientific study aims to: 1) Creating and validating 4 Exercogs® (using gamification) for an augmented reality platform; 2) Validating a dementia prevention program that generates health benefits using Exercogs®.

1. 1. Research and Planning: assessment of seniors’ needs; survey of market solutions;

2. 2. Ideation and Concept Development: definition of therapeutic objectives; selection of stimulus types; idealization of game scenarios, cognitive, and motor areas;

3. 3. Design and Prototyping: programming video games; implementation of gamification techniques;

4. 4. Testing and Evaluation: testing the prototypes and interaction mechanics with a group of users; usability testing.;

5. 5. Scientific Validation: experimental study with pre and post-test assessment, with a sample of 204 subjects aged ≥ 65 years old.

6. 6. Maintenance and Improvement: the solution is being used in pilot studies in different institutions in Portugal for evaluation and continuous improvement.

Exercogs® consists of 4 games that target key areas of healthy and pathological ageing, focusing on cognitive (attention, memory, executive functions), physical (mobility, coordination, balance) and social (general social skills) domains. Each game adapts to users’ abilities with different difficulty levels and is designed for group play to enhance social interaction, crucial for mental health. Utilizing gamification and augmented reality for engagement, scientific validation showed significant improvements in cognitive, affective, social, functional domains, and quality of life, with marked statistical significance in all areas assessed.

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Notable health benefits were observed among users, particularly in cognitive function and quality of life. These findings indicate the potential effectiveness of Exercogs® in dementia prevention programs. The alliance between the clinic and academia is crucial for solving the challenges of longevity and creating technological solutions that respond to new health needs. The use of technologies in health intervention generates high levels of adherence and motivation among older adults, as well as among health professionals. Exercogs® are a promising technological solution that uses gamification with clinical support to prevent dementia!

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Schizotypal personality disorder is characterized by social and interpersonal deficits, eccentric behaviour, unusual beliefs, magical thinking and blunted affect, and it may represent a predisposition for psychosis. Hoarding disorder, which has recently been recognised in ICD-11, is defined by accumulation and persistent difficulty in discarding ordinary possessions, leading to interfering levels of clutter that compromise the use or safety of living spaces. Hoarding behaviour can occur in a variety of neuropsychiatric disorders, including psychotic disorders. Research suggests an association between schizotypal traits and hoarding symptoms including cognitive deficits, emotional dysregulation or impaired insight, which are also characteristic of psychosis.

We aim to present a case of hoarding disorder in a woman with schizotypal personality traits which presented with a first psychotic episode at her fifties.

We describe a case report and a non-systematic review on the subject.

A 55-years-old woman was admitted to psychiatric emergency department with behaviour changes, marked by significant neglect in self and health-care in addition to social and emotional isolation. She also exhibited somatic, persecutory and autoreferential delusions, as well as auditory hallucinations. She believed that her body had no production of saliva and her meals mostly consisted of chocolate pudding, since she was convinced this was the only food her organism could tolerate. As a consequence, her nutrition was fairly neglected and severe potassium deficits were observed with electrocardiogram changes and fainting episode. Beyond these symptoms, a severe hoarding pattern was found which had worsened over the last years. Supported by family meetings and psychological personality assessment, dysfunctional personality traits stood out, with a difficulty in interpersonal relationships and adaptation to external reality. During hospitalization, we found that psychotic symptoms had months of evolution. Antipsychotic medication was initiated (Paliperidone) with significant improvement of symptomatology, but not full remission.

Upon a comprehensive assessment, we concluded that the patient’s dysfunctionality was mainly due to schizotypal personality disorder rather than the acute psychotic episode. This case also suggests the importance of assessing personality traits, in particular schizotypal, in patients with hoarding symptoms. An overlap between hoarding symptoms and schizotypy has previously been reported in literature. Therefore, we highlight that distinction among schizotypal personality traits, psychotic and hoarding symptoms can be challenging among clinical practice. In overall, a broad assessment of symptoms is warranted in order to better understand what is in the basis of patient’s dysfunctionality and ensure and effective treatment.

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Substance use is an onging public health burden. As a result all psychiatrists encounter patients with substance use and addictive disorders, either as primary mental health issue, or as co-occurring with other mental health issues. In this presentation, first trends in substance use across Europe will be presented, based on findings from the European Union Drugs Agency (EUDA). Next, findings on co-occurring other mental health issues will be discussed, with a focus on co-occurring Attention Deficit Hyperactivy Disorder (ADHD). Recent findings from the International Colaboration on ADHD and Substance Abuse (ICASA) will be shared. ICASA’s most recent work was the longitudinal International Naturalistic Cohort Study of ADHD and Substance Use Disorders (SUD). Nearly 600 patients with both ADHD and SUD in treatment were followed for nine months. About two thirds of participants received some kind of ADHD treatment, with half receiving pharmacologic treatment, one third receiving psychological treatment, and only one-fifth receiving combined pharmacologic and psychological treatment. Higher ADHD symptom severity and sobriety at intake were associated with receiving ADHD treatment. These findings suggest that treatment of SUD and ADHD is suboptimal. The implementation of ICASA’s consensus statements on diagnosis and treatment of co-occurring ADHD and SUD could help improve quality of care for these individuals.

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Perinatal depression (PND) is a debilitating mood disorder that occurs during or following pregnancy. Information regarding characteristics associated with PND can aid in better understanding the disease.

Examine patient characteristics and comorbidities of PND patients and matched non-PND controls in a UK electronic health record (EHR) database.

Women aged 12-55y with a delivery record (livebirth, stillbirth, mixed birth) during Jan 2017-Dec 2021 were selected from the Clinical Practice Research Datalink (CPRD) GOLD primary care database via a pregnancy algorithm. PND was ascertained using read codes during pregnancy or one year after the end of pregnancy date (EPD). Two ways to define PND were explored: 1) restricted definition (PND-r) where only PND codes were included; 2) broad definition (PND-b) including both PND and 34 other depression codes. For each PND case, two controls were matched on key patient variables such as age, depression history, and pregnancy outcome. Patients were required to have at least 12 months (mo) of continuous enrollment prior to and post EPD. Patient characteristics and select psychiatric and pregnancy-related comorbidities were compared, and prevalence rate ratios (PRR) and 95% Wald confidence intervals (CI) were calculated comparing cases and controls.

The study included 2,214 cases of PND-r and 4,718 cases of PND-b, and their respective non-PND matched controls. PND-r and PND-b cases differed in timing of diagnosis. Of the PND-r cases, 6% were diagnosed during pregnancy and 47% in the first 3mo following delivery; whereas the distribution in the PND-b was, respectively, 18% and 30%. The mean age of the PND-r and PND-b cohorts was consistent (29y, SD=6). A prior recorded history of depression was present in 36% of PND-r cases and 43% of PND-b cases. Approximately 55% of PND-r cases and 65% of PND-b cases had a history of antidepressant use prior to last menstrual period.

During the 12mo pre-EPD, PND-r cases had higher prevalence of hyperemesis gravidarum (PRR=1.5, 95% CI 1.3-1.8), gestational diabetes (PRR=1.4, 95% CI 1.1-1.7), and anxiety/panic disorders (PRR=1.8, 95% CI 1.3-2.3) compared to controls. During the 12mo post-EPD, PND-r cases had higher prevalence of comorbid anxiety/panic disorders (PRR=3.8, 95% CI 3.0-4.9) as well as post-traumatic stress disorder (PRR=3.1, 95% CI 1.5-6.1) compared to controls. Results were similar in the PPD-b analyses, but with higher PRR of anxiety/panic disorders (post-EPD PRR: 11.2, 95% CI 9.7-12.9).

80% of PND-r and 71% of PND-b cases were diagnosed during pregnancy or in the first 6mo following EPD. Cases had higher prevalence of certain pregnancy and psychiatric conditions compared to controls, with comorbid anxiety/panic disorder estimates higher using the PND-b definition. Future research should consider comparing results using both broad and restricted definitions of PND in EHRs.

C. Gillis Shareolder of: Biogen, Employee of: Biogen, S. Chen Shareolder of: Biogen, Employee of: Biogen, C. Mak Shareolder of: Biogen, Employee of: Biogen, E. Tworkoski Shareolder of: Biogen, Employee of: Biogen, L. Li Shareolder of: Biogen, Employee of: Biogen, S. Eaton Shareolder of: Biogen, Employee of: Biogen, C. Green Shareolder of: Biogen, Employee of: Biogen, N. Maserejian Shareolder of: Biogen, Employee of: Biogen, M. Koch Shareolder of: Biogen, Employee of: Biogen.

The Autonomous Region of the Azores faced considerable challenges in providing comprehensive, efficient, and integrated mental health care services, exacerbated by geographical isolation, resource constraints, and the absence of a cohesive system for referrals and quality assessment in mental health care.

Despite the recognized need, the integration of mental health services into primary health care (PHC) and the broader health system in the Azores was fragmented. Key issues included lengthy waiting lists, inadequate referral systems between primary care and specialized psychiatric services, and a lack of standardized quality assessment and performance indicators for mental health care. Additionally, there was a significant need for community mental health teams, emergency management of agitated patients, and comprehensive training for health professionals in psychiatric care.

Through collaborative efforts, the region achieved notable advancements, including the creation of referral criteria from PHC to psychiatry services, structuring inter-service referrals, reactivation of Community Mental Health Teams, and establishment of a “Physician’s Bank.” Noteworthy was the elimination of a waiting list of over 1,000 patients and the development of quality assessment and performance indicators. The construction of a courtyard for involuntarily hospitalized patients and the creation of an emergency room on Faial Island further exemplified the tangible improvements in patient care and system efficiency. Training programs were extensively implemented across various professional groups, enhancing the capacity for mental health care delivery at all levels.

The integration efforts underscored the value of cross-sector collaboration, stakeholder engagement, and the adaptation of models like the SURE framework and COM-B theory to address the multifaceted barriers to mental health care integration. Key facilitators included the development of guidelines, training, and clinical supervision, alongside innovative approaches to public health interventions.

The transformative work in the Azores exemplifies how integrated care models, supported by strategic collaborations and policy reforms, can significantly enhance mental health service delivery in geographically isolated regions. It underscores the importance of systemic approaches to training, infrastructure development, and stakeholder engagement in achieving sustainable improvements in mental health care.

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