Alcohol use disorder (AUD) has a significant impact on the individuals affected, their relatives, and the society at large. Given the limited efficacy of currently available treatments, there is a pressing need for a more comprehensive mechanistic understanding. In particular, consideration must be given to the dynamical and real-world aspects. The objective of this study was to investigate the association of dynamic variations across menstrual cycle phases (indicative of progesterone-to-estradiol ratios) in women with AUD and progesterone-to-estradiol ratios in men with AUD with real-world problem drinking. To this end, longitudinal data from the German TRR265 cohort (comprising smartphone entries on alcohol consumption, craving, and loss of control, self-reports on menstrual cycle phases, and blood progesterone-to-estradiol ratios) were subjected to analysis. In women with AUD, the lowest levels of problem drinking, craving, and loss of control were observed during the late luteal phase, when the progesterone-to-estradiol ratios reached their peak. Similarly, in men with AUD, higher progesterone-to-estradiol ratios were associated with lower problem drinking, craving, and loss of control. Some of these effects were moderated by the severity of the AUD. The results highlight the progesterone-to-estradiol ratio as a promising future treatment target and point to the necessity of cycle phase-tailored treatments for women with AUD.

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Decisional capacity is an important requirement for assisted suicide, which has been legalized in an increasing number of countries. While several instruments have been developed over the past few decades to assess the capacity to consent to treatment, little is known about their applicability to assessing capacity in the context of requests for assisted suicide.

Systematic review of instruments assessing decisional capacity published up to March 2024. Data concerning criteria for determining decisional capacity, psychometric properties, and other aspects were extracted from all instruments included. Selected instruments were analyzed regarding their applicability to requests for assisted suicide.

We identified 23 instruments assessing the capacity to consent to treatment. There is considerable heterogeneity regarding the criteria utilized for assessing decisional capacity and their operationalization. Next to more cognitive abilities, some instruments directly incorporated emotions and values. Five instruments were assessed for applicability to requests for assisted suicide. The framing of decisional capacity within the context of disease and treatment options frequently limits the application of instruments to assess decisional capacity in the context of requests for assisted suicide.

No instrument could be identified that could be applied to assessing decisional capacity in the context of requests for assisted suicide without any limitations or without necessitating adjustments. Further normative and empirical work is required for developing an instrument that could be applicable in this context.

Mental health issues among children and adolescents have risen, particularly following the COVID-19 pandemic. Despite increased awareness, less than half receive necessary care, leading to long-term consequences. The World Health Organization advocates for integrated, preventive community interventions to address this gap. This paper presents the Mental Health Clinical Liaison Programme for Schools in the Community of Madrid, Spain, which provides school-based activities led by multidisciplinary mental health teams. The programme focuses on early detection, intervention, and prevention strategies for children and adolescents. We describe its implementation, review supporting evidence, provide preliminary data, and discuss its scope and challenges. Between 2023 and 2025, the programme has reached over 100 primary and secondary schools, identifying more than 1,700 cases, evaluating over 500 students, and referring 232 to specialized services. It has also supported interventions for more than 400 students already in mental healthcare and facilitated 45 reintegrations following psychiatric hospitalization. Additionally, anti-stigma workshops have engaged approximately 2,500 students. Ongoing research aims to assess the programme’s effectiveness and cost-effectiveness to ensure continuous improvement in mental health services for young people.

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Previous studies have shown that repetitive transcranial magnetic stimulation (rTMS) can treat suicidal symptoms; however, the effects of rTMS on suicidal ideation (SI) in late-life depression (LLD) have not been well-characterized, particularly with theta burst stimulation (TBS).

Data were analyzed from 84 older adults with depression from the FOUR-D trial (ClinicalTrials.gov identifier: NCT02998580), who received either bilateral standard rTMS or bilateral TBS targeting the dorsolateral prefrontal cortex. The primary outcome was change in the Beck Scale for Suicide Ideation (SSI). The secondary outcome was remission of SI. Demographic, cognitive, and clinical characteristics that may moderate the effects of rTMS or TBS on SI were explored.

There was a statistically significant change in the total SSI score over time [χ2(7) = 136.018, p < 0.001], with no difference between the two treatment groups. Remission of SI was 55.8% in the standard rTMS group and 53.7% in the TBS group. In the standard rTMS group, there was no difference in remission of SI between males and females, whereas remission was higher in females in the TBS group (χ2(1) =6.87, p = 0.009). There was a significant correlation between time to remission of SI and RCI z-score for D-KEFS inhibition/switching [rs = −0.389, p = 0.012].

Both bilateral rTMS and bilateral TBS were effective in reducing SI in LLD. There may be sex differences in response to TBS, with females having more favorable response in reducing SI. There may be an association between improvement in cognitive flexibility and inhibition and reduction of SI.

Rates of youth anxiety, depression, and self-harm have increased substantially in recent years. Expansion of clinical service capacity is constrained by workforce shortages and system fragmentation, and even substantial investment may not achieve the scale of growth required to address unmet need. Preventive strategies – such as strengthening social cohesion – are therefore essential to alleviate mounting pressures on the mental health system, yet their potential to compensate for these constraints remains unquantified.

This study employed a system dynamics model to explore the interplay between service capacity and social cohesion on youth mental health outcomes. The model was developed for a population catchment characterized by a mix of urban, suburban, and rural communities. Primary outcomes were prevalence of psychological distress and mental disorders, and incidence of mental health-related emergency department (ED) presentations among young people aged 15–24 years, projected over a 10-year time horizon. Two-way sensitivity analyses of services capacity and social cohesion were conducted.

Changes to specialized mental health services capacity growth had the greatest projected impact on youth mental health outcomes. Heatmaps revealed thresholds where improvements in social cohesion could offset negative impacts of constrained service capacity. For example, if services capacity growth was sustained at only 80% of baseline, improving social cohesion could still reduce years lived with symptomatic disorder by 6.3%. To achieve a similar scale of improvement without improvements in social cohesion, the current growth rate in services capacity would need to be more than double. Combining a doubling of service capacity growth with reversing the decline in social cohesion could reduce ED presentations by 25.6% and years with symptomatic mental disorder by 19.2%. A doubling of specialized, headspace, and GP services capacity growth could prevent 24,060 years lived with symptomatic mental disorder among youth aged 15–24.

This study provides a quantitative framework for understanding how social cohesion improvements can help mitigate workforce constraints in mental health systems, demonstrating the value of integrating service expansion with social cohesion enhancement strategies.

Children in special education schools are particularly susceptible to developing mental health issues. Specifically, it is estimated that 40% of individuals with intellectual disabilities have a comorbid mental disorder diagnosis (1). However, access to mental health services for patients with intellectual disabilities remains far below expectations. Numerous barriers impede this access, including a lack of coordination between professionals and service providers responsible for their care (2).

Therefore, interventions within special education schools, promoting early detection and intervention for psychopathology and facilitating coordination between educational and healthcare services, are critically important.

We present an innovative mental health care resource designed for special education schools in the Community of Madrid, Spain. This initiative combines multi-disciplinary expertise with flexible, hybrid care delivery to ensure accessibility for students across 14 public schools. The team consists of a psychiatrist, a clinical psychologist, and a mental health nurse who provide both in-person and remote assistance, addressing the psychopathology exhibited by their students.

Preliminary results suggest that this intervention has the potential to improve early detection rates of mental health issues and foster better coordination between education and healthcare systems. This model could serve as a blueprint for similar programs worldwide, addressing significant gaps in mental health care for children with intellectual disabilities.

(1) Cooper, S. A., Smiley, E., Morrison, J., Williamson, A., & Allan, L. (2007). Mental ill-health in adults with intellectual disabilities: prevalence and associated factors. The British Journal of Psychiatry, 190, 27–35. https://doi.org/10.1192/bjp.bp.106.022483

(2) Whittle, E. L., Fisher, K. R., Reppermund, S., Lenroot, R., & Trollor, J. (2017). Barriers and enablers to accessing mental health services for people with intellectual disability: A scoping review. Journal of Mental Health Research in Intellectual Disabilities, 11(1), 69–102. https://doi.org/10.1080/19315864.2017.1408724

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Children and young people spend much time in school and therefore the school setting provides an important setting in which to intervene to promote, protect and enhance mental health. This presentation will provide an overview of the importance of making an economic case for action within schools. A scoping review has been undertaken to map the types of interventions that have been subject to cost-effectiveness evaluation. Aspects of the strengths and weakness of the existing evidence are presented. Implementation and sustainability challenges are also discussed, given the need for collaboration between the health and education sectors.

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Loneliness is a global public health concern. Investigating loneliness in the general population offers a greater generalizability across various levels of health-related impairments, the identification of at-risk individuals, the detection of different loneliness severity levels, and broader insights into social determinants. Previous studies have shown that loneliness might be a transient or chronic experience, depending on how consistently it is reported across at least two timepoints. This study aimed to assess differential associations of chronic and transient with various domains of psychopathology.

Participants were enrolled from the general population and assessed at two timepoints spanning 6–7 months. Depressive symptoms, generalized anxiety, social anxiety, and paranoid thoughts were measured using self-reports. The data were analyzed using binary logistic regressions.

Altogether, 3,275 participants completed both assessments with a retention rate of 64.2%. Chronic loneliness was associated with higher baseline and follow-up scores across all symptom domains. The strongest association was observed for social anxiety. Transient loneliness was not robustly associated with symptom scores. It was not significantly associated with depressive symptoms (at either of timepoints) and paranoid ideation (at baseline). The strongest association was observed for generalized anxiety. Chronic loneliness, compared to transient loneliness, was associated with significantly higher odds of social anxiety, depressive symptoms, and paranoid ideation, but not generalized anxiety.

Both transient and chronic loneliness are associated with mental health outcomes, with the latter one showing generally stronger associations. Risk stratification and early intervention among individuals experiencing loneliness might be needed to prevent the development of more severe psychopathology.

Cognitive deficits and immune system dysregulation are core features of psychotic disorders. Among inflammatory markers, interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α) have been linked to both psychosis pathophysiology and related cognitive impairments.

We investigated associations among IL-6, TNF-α, and neurocognitive performance in 107 participants: individuals at clinical high risk for psychosis (CHR-P, n = 35), first-episode psychosis (FEP, n = 39), and healthy controls (HC, n = 33). Assessments included memory, processing speed, executive function, and social cognition. Cytokines were measured from fasting serum samples. Analyses included ANOVA, correlations, and multivariate regressions controlling for age, sex, IQ, group, and symptom severity.

TNF-α levels were significantly elevated in FEP compared to CHR-P (p = 0.0251); IL-6 differences were non-significant. FEP showed poorer performance in multiple cognitive domains, especially social cognition. CHR-P individuals exhibited intermediate profiles between FEP and HC in cognition. In adjusted regression models, IL-6 was significantly associated with undermentalization on the MASC task (β = 0.28, p = 0.0337) and showed a trend-level association with slower processing speed (β = 0.98, p = 0.075). TNF-α levels predicted poorer facial emotion recognition (β = −1.37, p = 0.0022). IQ and group were significant covariates in most models.

Our findings suggest that peripheral inflammation, particularly IL-6 and TNF-α, may selectively impact social cognitive functioning in early psychosis. Though modest, these associations highlight potential inflammatory contributions to functional impairment and support further investigation of immunological targets in early intervention.

In this talk I will discuss current findings related to therapeutically informed (e.g., Mindfulness and CBT based) universal school-based interventions for mental health. For example, I will highlight the evidence showing that many of these interventions often lead to null or unstained positive effects, have the potential to elicit negative effects and are not well liked by young people themselves. I will end by suggesting the field moves away from these universal interventions, towards more effective alternatives such as targeted, indirect and 1:1 interventions

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The large-scale Russian invasion of Ukraine in early 2022 resulted in a humanitarian crisis with hundreds of thousands of children exposed to traumatic events. To date, trauma-focused evidence-based treatments (EBTs) for children and youth have not been systematically evaluated and implemented in Ukraine. This study aims at evaluating 1) the feasibility of a training program for Ukrainian therapists on Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) and 2) the feasibility and effectiveness of the treatment for children, youth, and their families in and from Ukraine during the ongoing war.

The project “TF-CBT Ukraine” was implemented between March 2022 and May 2024, in close collaboration with local and international partners. Therapists completed questionnaires before/after the training, and patients were asked to complete a measure on PTSD before and after treatment.

Altogether 138 therapists started the training program and 44.9% were certified as TF-CBT therapists. The program completers reported overall high satisfaction with the training program, a positive change in their attitude towards EBTs and trauma-related knowledge gain. The patients (age 3–21, 37% male) reported significant improvement in symptoms of PTSD at the end of treatment with large pre-post effect sizes for DSM-5 PTSD (dselfreport = 2.36; dcaregiverreport = 2.27), ICD-11 PTSD (dselfreport = 1.97; dcaregiverreport = 1.77), ICD-11 CPTSD (dselfreport = 2.04; dcaregiverreport = 1.99), and DSM-5 pre-school PTSD (dcaregiverreport = 3.14).

The results of this study are promising in regard to the general implementation of trauma-focused EBTs in active conflict areas. Future studies need to replicate these findings in a randomized controlled study design.

A growing body of literature report, that vulnerable groups eg refugee, asylum seeker and forcibly displaced groups across Europe face social and psychological challenges linked to their minority status, often involving discrimination and racism. Moreover, they have to overcome many other barriers to accessing healthcare and preventive interventions. There is increasing evidence that a large proportion of refugees or forcibly displaced persons suffer from the consequences of traumatic events and exhibit psychological problems or develop mental disorders, including post-traumatic stress disorder, depressive and anxiety disorders, and relapses in psychotic episodes. European countries are aware that psychosocial and health services face major challenges and need to develop or expand strategies to overcome them. The direct and indirect consequences of humanitarian catastrophes cannot be estimated at present. In this presentation, strategies to improve the access of forcibly displaced people to mental health care services will be presented and discussed.

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Cohort studies in first-episode psychosis (FEP) provide crucial insights into the diverse trajectories of clinical and functional recovery. These studies are invaluable for evaluating the effectiveness of new intervention models and informing resource allocation and policy development.

To synthesize quantitative and qualitative findings on mortality and clinical outcomes and to explore their interrelations in a multi-modal investigation of long-term outcomes in FEP. Specific objectives include appraising how this study’s findings have influenced the development of new models of care.

Data were drawn from the iHOPE-20 study, comprising cohort analyses and qualitative interviews with 171 FEP participants diagnosed between 1995–1999 in Dublin, Ireland. Participants with lived experience contributed to the design of the 20-year follow up assessments. Mortality rates were calculated; symptoms, functionality and quality of life trajectories were analyzed using mixed models; and personal recovery themes were derived through thematic analysis. Ongoing analyses are addressing predictors of the number, timing and sequencing of relapses/readmissions among baseline variables as foci for service development.

The study revealed substantial variation in long-term outcomes among individuals with FEP. Shorter DUP was consistently associated with better outcomes across all of the follow-up points. Mortality rates highlighted the importance of interventions to address physical health morbidity. Diagnostic instability over time underscored the dynamic nature of psychosis management. Employment status at follow-up highlighted the importance of strategies to support a return to education or employment after a first presentation.

Findings emphasize the enduring impact of DUP and the need for tailored interventions. Data from this cohort highlight the value of longitudinal insights as a benchmark for comparing the effectiveness of new intervention models. In such studies, addressing ethical and data protection challenges, incorporating the expertise of those with lived experience and harmonising outcome measures remain vital to advance recovery-oriented care models.

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Patients with posttraumatic stress disorder (PTSD) exhibit smaller regional brain volumes in commonly reported regions including the amygdala and hippocampus, regions associated with fear and memory processing. In the current study, we have conducted a voxel-based morphometry (VBM) meta-analysis using whole-brain statistical maps with neuroimaging data from the ENIGMA-PGC PTSD working group.

T1-weighted structural neuroimaging scans from 36 cohorts (PTSD n = 1309; controls n = 2198) were processed using a standardized VBM pipeline (ENIGMA-VBM tool). We meta-analyzed the resulting statistical maps for voxel-wise differences in gray matter (GM) and white matter (WM) volumes between PTSD patients and controls, performed subgroup analyses considering the trauma exposure of the controls, and examined associations between regional brain volumes and clinical variables including PTSD (CAPS-4/5, PCL-5) and depression severity (BDI-II, PHQ-9).

PTSD patients exhibited smaller GM volumes across the frontal and temporal lobes, and cerebellum, with the most significant effect in the left cerebellum (Hedges’ g = 0.22, pcorrected = .001), and smaller cerebellar WM volume (peak Hedges’ g = 0.14, pcorrected = .008). We observed similar regional differences when comparing patients to trauma-exposed controls, suggesting these structural abnormalities may be specific to PTSD. Regression analyses revealed PTSD severity was negatively associated with GM volumes within the cerebellum (pcorrected = .003), while depression severity was negatively associated with GM volumes within the cerebellum and superior frontal gyrus in patients (pcorrected = .001).

PTSD patients exhibited widespread, regional differences in brain volumes where greater regional deficits appeared to reflect more severe symptoms. Our findings add to the growing literature implicating the cerebellum in PTSD psychopathology.

People with psychosis present a significantly higher premature death, leading to a reduction of life expectancy of up to 15-20 years.

To a high extent, this premature mortality is due to a higher incidence of common physical conditions, appearing earlier than in the general population. Traditionally, the focus has been put on the cardiovascular diseases. However, more recently, there ir mounting evidence of the contribution of other conditions to this premature mortality, such as repiratory (e.g.: chronic obstructive pulmonary disease) and liver (MAFLD) conditions.

We are presenting results from PAFIP and ITPCan early intervention programs (Cantabria, Spain), regarding the early impact of psychosis on physical health, observing early alterations at the organic level (e.g.: liver, lung), which precede the development of chronic organic pathology causing premature mortality in the general population.

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The Danish OPUS trial was originally a randomized controlled trial testing Early Intervention Services among individuals diagnosed with schizophrenia spectrum disorders between the years 1998-2002. Today, the OPUS trial includes a unique cohort of individuals (n=578) longitudinally followed and clinically assessed for more than two decades after a first diagnosis within the schizophrenia spectrum. Using longitudinal Danish register data and clinical data from the Danish OPUS cohort, we explored the effects of early intervention services including symptom remission, use of antipsychotics, hospitalization, global functioning and other aspects of life including social relations, parenthood, and mortality.

Investigating modern-era treatment facilities in 20 years of follow-up of the OPUS trial, we found no evidence for long-term disease-modifying effects from two years of Early Intervention Services compared to Treatment as Usual. While a majority of participants experienced a reduction and stabilization of psychotic symptoms over time it seems half of all the participants experienced no significant improvements in negative symptoms. Still, 17% were in clinical recovery, and 40% were in symptom remission. Combining clinical data from the Danish OPUS cohort with the Danish registers, we found that 29% (n=120) of individuals were in current treatment with antipsychotic medication after 20 years of follow-up. A total of 36% (n=51) of the clinical sample were in remission of psychotic symptoms and off antipsychotics with better clinical outcomes compared to individuals in non-remission off/on medication. Additionally, a substantial proportion of 38% (219 out of 578) of individuals in the OPUS cohort had become parents over two decades, and on average, they had better functional and clinical outcomes than their counterparts without children. A mortality rate of 14.2 was found. Suicide was the single most common cause of death, but death due to natural causes and death due to unnatural causes made of roughly half of all deaths each.

While many patients may achieve remission of psychotic symptoms, our findings suggest negative symptoms are of a much more chronic nature. Investigating the use of antipsychotics over 20 years a substantial proportion were in remission and off medication. Since an observational study design cannot differentiate between cause and effect, these individuals still set a benchmark for good outcomes in schizophrenia. Also, 38% of individuals had become parents over two decades, and cross-sectionally, they had better illness prognosis and lifetime course than their counterparts without children. Finally, one in seven of the participants in the OPUS trial had died during follow-up. Suicide is a vital problem even many years after diagnosis and suicide-preventive measures are needed in the later course of illness.

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Psychotic disorders, including schizophrenia (SZ), schizoaffective disorder (SZA), bipolar disorder (BD), psychotic depression (PD), and other nonaffective psychoses (ONAP), are associated with increased risk of suicidal acts. Few studies have compared suicidal act prevalence across psychotic disorders using both self-report and register data. The impact of hospitalization duration on subsequent suicidal acts is unclear.

We used data from the SUPER-Finland study, involving 7067 participants with register-based ICD-10 diagnoses of psychotic disorders (SZ, SZA, BD, PD, ONAP). Lifetime suicidal acts were identified through self-report and register-based records of intentional self-harm events requiring medical treatment. Associations between diagnostic categories and suicidal acts were assessed using logistic regression, adjusted for sex, duration of illness, socioeconomic status, childhood abuse, and substance use. Survival analysis was used to examine the impact of hospital stay length on postdischarge self-harm.

Lifetime suicide attempts (39.1%) and register self-harm (19.3%) were prevalent. of those with self-reported suicide attempts, 40.5% also had register-based self-harm. Self-harm and suicide attempts were significantly more prevalent in SZA, BD, and PD compared to schizophrenia, with large differences between groups (24.1–46.4% for suicide attempts, 11.1–23.9% for self-harm). Adjusted odds of self-harm were higher for disorders with a mood component. Shorter hospitalizations were associated with an elevated hazard ratio for subsequent self-harm.

Prevalence of register-based self-harm and self-reported suicide attempts differ markedly. Suicidal acts are common in psychotic disorders, particularly in those with a mood component. Very short inpatient stays may not be adequate in these disorders.

The macro-social and environmental conditions in which people live, such as the level of a country’s development or inequality, are associated with brain-related disorders. However, the relationship between these systemic environmental factors and the brain remains unclear. We aimed to determine the association between the level of development and inequality of a country and the brain structure of healthy adults.

We conducted a cross-sectional study pooling brain imaging (T1-based) data from 145 magnetic resonance imaging (MRI) studies in 7,962 healthy adults (4,110 women) in 29 different countries. We used a meta-regression approach to relate the brain structure to the country’s level of development and inequality.

Higher human development was consistently associated with larger hippocampi and more expanded global cortical surface area, particularly in frontal areas. Increased inequality was most consistently associated with smaller hippocampal volume and thinner cortical thickness across the brain.

Our results suggest that the macro-economic conditions of a country are reflected in its inhabitants’ brains and may explain the different incidence of brain disorders across the world. The observed variability of brain structure in health across countries should be considered when developing tools in the field of personalized or precision medicine that are intended to be used across the world.

Comparing long-term outcomes in psychosis can be challenging due to widely differing definitions, measures, and populations. The remission working group led by Andreasen et al. suggested remission criteria based on positive symptoms and duration. However, there is no internationally agreed definition of functional recovery. The TIPS study is one of very few with very long-term follow-up, and this presents a unique opportunity both to investigate outcomes as well as use findings to develop valid definitions for the future.

In this longitudinal study, we explore remission patterns and functional status with regards to social contacts, living situation and employment status over 20 years.

A representative sample originally consisting of 201 first episode psychosis patients from two Norwegian well defined catchment areas in the Scandinavian TIPS study have been followed for more than 20 years with symptom and functional measures. Assessments have taken place at inclusion, one, two, five, ten and twenty years. At the 20-year follow-up, 43% of living participants were retained; 15% had died.

Data analysis is in progress, and symptoms and function results will be presented.

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