Obsessive-compulsive symptoms (OCS) are a prevalent and under-recognized complication of clozapine treatment in schizophrenia, with significant implications for clinical practice and patient outcomes. This synthesis of four longitudinal studies explores the interplay between psychosis, clozapine dose, and OCS, emphasizing their phenomenology, prevalence, and impact.

OCS, particularly checking compulsions, affect up to 47% of clozapine-treated patients, with risk factors including psychosis severity, duration of clozapine therapy, and antiserotonergic properties of the drug. A two-phase model of OCS development is proposed: during active psychosis, compulsions emerge as goal-directed responses to hypervigilance, while post-remission, they persist as maladaptive habits mediated by clozapine’s serotonergic effects. While clozapine improves psychotic symptoms, its dose and plasma levels are positively correlated with OCS persistence after psychosis remission, suggesting a dose-dependent effect.

Notably, OCS significantly reduce subjective well-being independently of depressive and psychotic symptoms but do not impair general functioning, highlighting the ego-syntonic nature of compulsions. Screening for and addressing OCS in clinical practice is critical for optimizing therapeutic outcomes.

This integrated perspective advances our understanding of the nuanced relationship between schizophrenia, clozapine treatment, and OCS, with implications for personalized treatment strategies.

E. Fernández-Egea Grant / Research support from: Dr Fernandez-Egea is supported by the 2022 MRC/NIHR CARP award (MR/W029987/1) and this research was supported by the NIHR Cambridge Biomedical Research Centre (BRC-1215-20014). The views expressed are those of the author(s) and not necessarily of the NIHR or the Department of Health and Social Care. , Consultant of: EFE has received consultancy honoraria from Boehringer-Ingelheim (2022), Atheneum (2022) and Rovi (2022-24), speaker fees by Adamed (2022-24), Otsuka (2023) and Viatris (2024) and training and research material from Merz (2020) and editorial honoraria from Spanish Society of Psychiatry and Mental Health (2023-).

While risk factors for children’s internalizing and externalizing symptom trajectories have been widely studied, their association with parental depressive symptom trajectories has yet to be explored.

We used data from a prospective birth cohort of 2,542 Czech children and their parents. Children reported internalizing and externalizing symptoms at ages 11, 15, and 18 years. Parental depressive symptoms were assessed eight times from the prenatal period to the child’s age of 11 years. Latent Class Growth Mixture Modeling identified parallel trajectories of children’s symptoms. Five parental depressive symptom trajectories were adopted from previous research.

We identified four distinct classes of children’s symptom trajectories: (1) low internalizing and low externalizing (64%), (2) low internalizing and high externalizing (8%), (3) elevated internalizing and elevated externalizing (19%), and (4) high internalizing and elevated externalizing symptoms (9%). Children were more likely to experience any symptoms if their mothers had elevated depressive symptoms. High maternal and paternal depressive symptoms were associated with high internalizing and elevated externalizing symptoms in children. Constantly depressed mothers with elevated depressive symptoms in fathers had a high likelihood of any symptom trajectories in children. Other strong predictors of children’s symptom trajectories included parental relationship status (e.g., divorce), prior abortion, as well as children’s sex, urban versus rural residence, stressful life events, and self-esteem.

Parents’ and children’s mental health trajectories are interconnected. Given the strong influence of parental relationship dynamics on both parental and child mental health, interventions should prioritize mitigating relationship strains to support family well-being.

Cognitive impairment is central to psychosis and strongly linked to functional outcomes. The Brief Assessment of Cognition (BAC) app is a tablet-based, automated tool for assessing key cognitive domains but has not been validated in Spanish-speaking populations or across illness stages.

A total of 402 participants (117 with first-episode psychosis [FEP], 125 with schizophrenia, and 160 controls) completed the BAC app along with clinical and functional assessments. We evaluated internal consistency, group differences, convergent and discriminant validity, and the effects of sex, age, and education. Normative percentiles were derived from controls.

The BAC app showed good internal consistency across groups (α = 0.76–0.87) and effectively differentiated individuals with psychosis from controls (area under the curve [AUC] = 0.862), with performance declining from controls to FEP to schizophrenia. Discrimination between FEP and schizophrenia was limited (AUC = 0.649). BAC App correlated positively with estimated intelligence quotient and functional capacity, and negatively with symptom severity, particularly in FEP. Performance varied by age, sex, and education, supporting the need for stratified normative data.

The BAC app showed strong reliability and validity for cognitive assessment in Spanish-speaking individuals with psychosis. Its brevity, automated scoring, and normative data support its clinical and research applications for cognitive screening, monitoring, and treatment evaluation.

Cannabis use is highly prevalent among individuals at risk for psychosis, yet its role remains paradoxical—offering both temporary relief and potential harm. In this session, we present preliminary results from a study examining cannabis perception, use patterns, and motivations in cannabis users with and without psychosis. Findings reveal that cannabis users with psychosis consume over three times more THC but do not perceive significantly greater risks. They also exhibit a higher risk of cannabis addiction, which may influence their risk assessment and experience of cannabis effects. Both groups reported similar reasons for use and quitting, though individuals with psychosis were more likely to cite cost as a reason for quitting. These insights suggest that financial concerns could be a target for intervention. Understanding why individuals vulnerable to psychosis turn to substances is crucial for refining treatment strategies, as addressing these underlying motivations may enhance therapeutic outcomes.

None Declared

The significant heterogeneity among individuals who die by suicide complicates prevention, suggesting that a “one-size-fits-all” approach is insufficient. It is crucial to identify distinct subgroups for targeted strategies. This study aims to characterize suicide profiles based on trait impulsivity and related factors.

Data from the FRieNDS project (Factores de Riesgo en Defunciones por Suicidio – Risk Factors in Suicide Deaths), a psychological autopsy study of 408 suicide deaths, were used. After determining the optimal number of clusters via stability analysis through agglomerative nesting, a final cluster analysis was performed on 391 valid suicide deaths (defined as cases with no missing data on the variables used for clustering) using k-means on a lower-dimensional representation of the data encoded by an autoencoder. Key clustering variables included sex, impulsivity (Barratt Impulsivity Scale-11), aggression, intent to die, previous history of suicide attempts, history of substance abuse, psychotic and affective disorders, and the presence of a depressive episode at the time of death.

We identified three clusters: (1) Impulsive-aggressive (29.8%), characterized by high rates of Cluster B disorders, substance abuse, more stressful events, and low lethal intent; (2) depressive prior attempters (24.5%), which comprised mostly women and showed greater behavioural changes before death; and (3) non-impulsive/aggressive (45.7%), a group with no clear psychopathological profile, less healthcare contact, and minimal communicated intent to die, despite having few prior attempts.

Our study identified three suicide clusters with varying impulsivity levels, highlighting the need for tailored interventions and community-level research for better suicide prevention strategies.

Chronic pain (CP) and mental disorders often coexist, yet their relationship lacks comprehensive synthesis. This first hierarchical umbrella review examined systematic reviews and meta-analyses, also observational studies and randomized controlled trials (where reviews are currently lacking) to report CP prevalence, risk factors, and treatment across mental disorders.

We searched MEDLINE, PsycINFO, Embase, Web of Science, and CINAHL, identifying 20 studies on anxiety, depression, bipolar disorder, schizophrenia, ADHD, autism, or dementia, and CP. Quality was assessed using AMSTAR and Newcastle-Ottawa Scale.

Prevalence varied widely—23.7% (95% CI 13.1–36.3) in bipolar disorder to 96% in PTSD—consistently exceeding general population rates (20–25%). Risks were elevated, with bidirectional links in depression (OR = 1.26–1.88). Risk factors included female gender, symptom severity, and socioeconomic disadvantage, though data were limited beyond PTSD and depression. Treatment evidence was sparse: cognitive behavioral therapy showed small effects on pain (SMD = 0.27, 95% CI -0.08–0.61), acupuncture with medication improved pain (MD = -1.06, 95% CI -1.65–-0.47), and transcranial direct current stimulation reduced pain in dementia (d = 0.69–1.12). Methodological issues were evident, including heterogeneous designs and inconsistent pain definitions.

This review confirms CP as a significant comorbidity in mental disorders. Clinicians should prioritize routine pain screening and multimodal treatments. Researchers need longitudinal studies with standardized assessments to clarify causality and improve interventions. Taken together, this work highlights an urgent need for integrated psychiatric care approaches, emphasizing that addressing CP could enhance mental health outcomes and overall patient well-being.

Women face a greater incidence of mental health issues than men, stemming from societal expectations, gender stereotypes, organizational structures that prioritize male leadership, and the need to balance work responsibilities with home life. Research indicates that women are twice as likely to suffer from depression, generalized anxiety disorder, and post-traumatic stress disorder (PTSD) compared to men. They are also more likely to battle eating disorders.

The authors will review the current literature on this topic.

43% of female executives experience burnout, compared to 31% of their male counterparts (Mc Kinsey 2024). Research is definitely needed to better understand the pathophysiology and socioeconomic mechanisms that drive sex-specific risk factors of psychological disorders in women. There is also an urgent need for studies that addressed the specific needs of women including insights around: the biological, life stage, socioeconomic, political and cultural factors associated with being female that have a significant impact on women’s mental health.

A mental health reform is necessary to prevent mental illnesses in women, provide specific care to vulnerable women and increase the overall well-being of women living with existing mental health conditions.

None Declared

Traditionally, the discipline of Epidemiology, regardless of clinical specialty, has tended to focus on public health in community populations, although its study designs are widely applied in more clinically oriented research. The emergence and rapid accumulation of digital health records have resulted in data resources that are both large in sample size and granular in detail presenting unprecedented opportunities for understanding course and outcome in mental health.

Drawing on over 15 years of experience in building and achieving research output from electronic mental health records data in south London, this presentation will consider the role of Epidemiology as a discipline in this field.

There is no fundamental difference between studying disease incidence in community populations and using healthcare data to study disease course and outcome in clinical populations, and there are similar considerations of sample representativeness and cohort cohesion. Psychometrics principles are also strongly applicable to measurement issues in clinical data, although computer science collaborations particularly underpin the natural language processing and m-health advances required to improve information availability in routine data. Clinical Informatics and Epidemiology face common analytic challenges from data density and complexity, as well as in realising novel clinical trials opportunities.

Clinical Informatics does benefit from the public health focus that Epidemiology brings, as well as its methodological frameworks. However, multiple disciplines are key to setting up and maintaining data resources and achieving research output, so it is equally important to flatten hierarchies and enable a genuine cross-cutting team science approach.

R. Stewart Grant / Research support from: GSK, Takeda

Rates of common mental disorders (CMD), such as anxiety and depression, treated in primary care have increased among young adults in the UK. However, it remains unclear whether this increase reflects a greater tendency to seek help for CMD or a rise in CMD symptoms over time. Additionally, it is not clear if these increases are more pronounced in specific sociodemographic groups. This research examined the temporal trends of primary care-recorded CMD and self-reported CMD symptoms in young adults.

We included participants born between 1980 and 2003 in two datasets: UK primary care records from the Clinical Practice Research Datalink, and longitudinal cohort data from Understanding Society. We estimated the annual incidence of primary care-recorded CMD overall and by sex, age, birth cohort, ethnicity, country, region, and deprivation from 2009 to 2019, and explored changes over time using incidence rate ratios. We compared these trends to annual estimates of self-reported CMD symptoms from longitudinal cohort data between 2009-10 and 2019-20, calculating ratios to explore changes in CMD symptoms over time by sociodemographic group.

Between 2009 and 2019, the incidence of recorded CMD increased by 9·90% and CMD symptoms increased by 19·33%. The sharpest increases for both recorded CMD and CMD symptoms were observed in older adolescents (ages 16-19) and those born after 1995. Recorded CMD increased more in males (20·61%, increase) than in females (7·65%), despite similar increases in CMD symptoms. Recorded CMD increased the most in the least deprived areas of England (16·34%) compared to the most deprived areas (3·55%), despite similar increases in CMD symptoms across all levels of deprivation.

Both primary care-recorded CMD and self-reported CMD symptoms in young adults increased between 2009-19, suggesting that the rising rates of CMD treated in primary care may reflect heightened symptoms of CMD. However, differences in the patterns of recorded CMD and CMD symptoms across sociodemographic groups highlight potential misalignment between mental health care provision and underlying population need, suggesting that the groups with the highest burden of CMD symptoms may not be the groups most likely to receive care.

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While evidence-based clinical practice guidelines promote high-quality care, their absence may create unwarranted variation in disease management, leading to suboptimal outcomes. This study aimed to identify existing clinical practice guidelines for tardive dyskinesia (TD) in France, Germany, Italy, Spain, and the United Kingdom (EU4+UK), assessing the evidence for recommended TD treatments.

MEDLINE, PubMed, and other sources (e.g., government/public agencies, associations, patient/research organizations) were searched to identify clinical practice guidelines for TD published between January 2000 and February 2025 in EU4+UK. Mentions of TD treatments in identified documents were classified as “recommendations” or “descriptions.” Recommendations were ranked according to the Scottish Intercollegiate Guidelines Network grading system or received a “no-rank” label. Subanalyses on tetrabenazine and tiapride, were performed.

Of the 31 documents identified, only two were TD-specific, with the remainder primarily developed for schizophrenia, major depressive disorder, and bipolar disorder. Data extraction led to 112 mentions of TD treatments (40 recommendations, 72 descriptions). Most recommendations focused on antipsychotic regimen modification (75%) and had no rank (88%). Only five recommendations (no rank) proposed a pharmaceutical (add-on) treatment: three for tetrabenazine and one each for amantadine and buspirone. Neither of the TD-specific guidelines contained TD treatment recommendations.

No specific clinical practice guidelines for TD in EU4 + UK were found, although TD management was mentioned in guidelines for other disorders. Most recommendations were not supported by high-quality evidence. To improve quality of care for patients with TD in Europe, updated treatment recommendations are needed based on high-quality studies.

This analysis evaluated potential differences in subjective well-being (SW) among patients with early-phase schizophrenia (SZ) randomized to treatment with either long-acting injectable (LAI) or oral aripiprazole or paliperidone within the “European Long-acting Antipsychotics in Schizophrenia Trial” (EULAST).

A total of 478 patients were followed for up to 19 months. SW was measured using the Subjective Well-being under Neuroleptic Treatment scale (SWN). Linear mixed-effects models assessed treatment differences. Comprehensive analyses included age, sex, symptomatology (Positive and Negative Syndrome Scale [PANSS]), and side effects (Systematic Monitoring of Adverse Events Related to Treatments [SMARTS] and St. Hans rating scale [SHRS] for extrapyramidal syndromes) on SWN changes.

Overall, SW improved over the course of the study. No significant differences emerged between LAI and oral administration (p = 0.1533) or between aripiprazole and paliperidone (p = 0.2008). Similarly, age and sex were not relevant in this regard. In contrast, negative, positive, and affective symptoms (all p < 0.0001) as well as the overall side effect burden (SMARTS sum-score, p < 0.0001) showed significant inverse associations with SW. Certain SHRS subscales correlated with SW in partial models, but associations disappeared in the fully adjusted model.

Patients with SZ initiating LAI or oral treatment with aripiprazole or paliperidone reported comparable SW improvements. Findings emphasize that treatment choice should be guided less by formulation or substance and more by individual patient needs, prioritizing symptom control while minimizing adverse effects. A patient-centered approach remains essential to optimize both clinical outcomes and subjective well-being in early-phase SZ.

High-risk studies have shown significant parent-child transmission of bipolar disorders (BPD) and major depressive disorder (MDD), which was stronger when parents had a mood disorder with an early onset. However, less studies have focused on functional outcomes of these offspring across development and most studies have not adjusted for the effect of offspring psychopathology. Our goal was to assess 1) psychosocial functioning in offspring of parents with mood disorders, and 2) the role of emerging mood psychopathology in offspring on the association between the parental mood disorder and psychosocial functioning in offspring.

We have collected clinical information on 32 patients with early-onset BPD (prior to age 21), 54 with later-onset BPD, 23 with early-onset MDD, 51 with later-onset MDD, 74 controls and their 425 offspring assessed for a mean duration of 14.9 (s.d: 5.3) years. Current Global Assessment of Functioning (GAF) scores for offspring were rated by trained interviewers after administering diagnostic interviews. Multilevel models adjusting for intra-familial correlation (several offspring per family) assessed the impact of parental mood disorders on the last rated GAF scores for offspring, with and without adjustment for offspring mood disorders over the follow-up.

An initial model showed an association between early-onset BPD and a trend level association between early-onset MDD in parents with lower GAF scores in offspring. However, these associations disappeared after adjustment for emerging offspring mood disorders.

Our data suggest that the frequently reported lower psychosocial functioning in high-risk offspring is essentially mediated by emerging offspring mood psychopathology.

M. Preisig Grant / Research support from: This research was and is supported by five grants from the Swiss National Foundation (SNF: #3200-040677, #32003B-105969, #32003B-118326, #3200-049746 and #3200-061974), three grants for a National Centers of Competence in Research project “The Synaptic Bases of Mental Diseases” (#125759, #158776, and #51NF40 – 185897) financed by the Swiss National Foundation, one grant from the Swiss State Secretariat for Education, Research and Innovation (SERI #22.00170), one grant from the Foundation Campus Biotech Geneva, and one grant from GlaxoSmithKline Clinical Genetics. The funders had no involvement in any aspect of this study.

people with alcohol- and substance use disorders have disproportionally high levels of tobacco use compared with the general populations. This concerns not only the prevalence of nicotine dependence but also the intensity of their smoking behaviour. Importantly, regarding the negative consequences the combined effects of alcohol and smoking are exponentially. Efforts to include smoking cessation treatment within the treatment programs for AUD and other SUD patients need to be intensified.

None Declared

Suicidal behaviors (SB) in bipolar disorder (BD) are major adverse outcomes that may influence disease progression. While staging models exist for psychiatric disorders, none include suicide. This study aims to stratify suicidal risk in BD, propose a staging model for SB, and assess its clinical utility.

Participants from the FondaMental Advanced Centers of Expertise for Bipolar Disorder (FACE-BD) cohort were categorized into five stages (St) based on SB: St0 (no suicidal ideation [SI]), St1 (SI but no suicide attempt [SA]), St2a (non-severe/violent SA), St2b (severe /violent SA), and St3 (multiple SAs). Stages were analyzed based on demographic, clinical, cognitive, and biological characteristics using logistic regression.

Key differences emerged between stages. St1 showed longer untreated illness and higher lability and lower functioning than St0. St2a was linked to anxiety, substance use disorders, and longer disorder duration, while male gender and lithium bitherapy were protective. St2b exhibited shorter untreated illness and higher childhood trauma (CTQ) scores, with male gender and alcohol use as risk factors. St3 was associated with BD-II, alcohol use, longer disorder duration, and more depressive episodes, but less anxiety. No biochemical or cognitive differences were found across stages. The model was significantly associated with SA occurrence (LRT = 28.74, p < 0.0001).

This staging model for suicidality in BD provides a multifaceted approach to risk stratification and predictive insights, although further refinement is needed.

Smoking remains a significant cause of mortality and morbidity, with a higher prevalence among those with severe mental illness compared to the general population. Patients with psychotic disorders are the most frequent smokers, which contributes to increased somatic diseases and cardiovascular risk. Existing guidelines for smoking cessation are not well-suited for patients with mental disorders, and these patients often lack confidence in their ability to quit. An effective intervention must therefore be comprehensive and interdisciplinary to increase motivation. As part of the national, Norwegian multicenter project “Preventing Multimorbidity in Severe Mental Disorders with a Multidisciplinary Approach (CVD-MENT), the subproject User-Driven Smoking Cessation Group has been launched. The idea of users’ active participation as co-leaders of a smoking cessation group comes from patients and is based on their experiences with their own smoking cessation attempts.

To investigate whether a new, tailored treatment specifically targeted at patients with severe mental disorders affects smoking behaviour in a patient group known to have a very high risk of cardiovascular disease.

The program for the User-Driven Smoking Cessation Group is based on the existing template for smoking cessation groups described by the Norwegian Directorate of Health, but is adapted to the patient group. The study is conducted at three Norwegian hospitals. International recommendations for smoking cessation counselling describe the approach to unmotivated and ambivalent participants in five R’s, all of which are emphasized in the project:

1. - Relevance - Help the patient reflect on whether tobacco cessation might be relevant

2. - Risks - Discuss personally related health risks

3. - Rewards - Help the patient articulate potential benefits of quitting tobacco

4. - Roadblocks - Identify barriers preventing the patient from attempting to quit

5. - Repetition - Prepare the patient for discussing this again at the next meeting

The project has developed a program for open smoking cessation groups specifically tailored for individuals with severe mental disorders. Patients who have successfully quit smoking actively participate in leading the group alongside healthcare professionals. The content focuses on smoking cessation, but other factors known to impact cardiovascular risk are addressed in the semi-structured teaching over seven sessions. Training is provided for users who are co-leaders.

Experiences from a pilot study and preliminary experiences and results from the first groups will be presented and discussed.

None Declared

Measurement-based care (MBC) is widely recommended in psychiatry but remains underutilized in routine clinical settings. The Transdiagnostic Global Impression – Psychopathology (TGI-P) scale was developed to provide a brief yet comprehensive assessment of 10 core transdiagnostic symptom domains. To support more inclusive care and promote patient and caregiver engagement in treatment planning, two new versions of the TGI-P, that is, a patient-rated and a separate informant-rated, were developed, complementing the previously published clinician-rated version.

The patient and informant versions mirror the original clinician-rated TGI-P, assessing the identical 10 domains using a seven-point Likert severity scale, with results displayed via a personalized symptom map. A user satisfaction/feasibility study was conducted with 50 participants (25 patients and 25 caregivers) from the UK and US. After completing the scale, participants provided feedback on its clarity, usability, emotional impact, and comparative utility.

Most participants completed the scale in less than 5 min. Instructions were considered clear, and the format was rated easy to follow. Response options were deemed appropriate by 86% of participants, and the visual output was widely appreciated. While one-third reported mild emotional triggering, overall burden was described as manageable. Approximately, three-quarters of participants rated the TGI-P as equal to or better than other tools they had used.

TGI-P patient and informant versions were developed and, informed by the feasibility study, refined to offer brief, user-friendly tools that support multi-informant assessment as input to MBC. Both versions of the TGI-P, with their graphical output, may support shared understanding and collaborative decision making among clinicians, patients, and caregivers. A validation study of the TGI-P is underway.

While many evidence-based mental health prevention, promotion, and treatment interventions exist, they are poorly and inequitably scaled across populations. Too often, research produces interventions and implementation strategies that are difficult to scale due to misalignment with culture, policy, system, community, provider, and individual realities. This presentation will introduce the Lancet Psychiatry Commission on Transforming Mental Health Implementation Research, which makes five recommendations to transform the research enterprise to produce more actionable evidence and address the mental health implementation gap. These recommendations focus on strategies for integrating research and real-world implementation; centering health equity in mental health intervention and implementation research; using a complexity science lens to study strategies for scaling effective interventions; expanding research designs beyond the traditional randomized clinical trial; and using transdisciplinary approaches. The Commission also made cross-cutting recommendations related to elevating work on mental health systems and policy and the importance of strengthening mental health implementation research globally.

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Completed suicide (CS) is among the leading causes of death. Suicide attempts (SAs) are more frequent and are a significant contributor to overall morbidity. However, there is only few data on community-based suicide prevention using systemic approaches. We have implemented a communal suicide prevention program and tested whether it reduced the number of SA and CS.

“FraPPE” comprised measures proposed by previous studies: low-threshold outpatient services, a SA postvention, a hotline targeting individuals with suicidal intent, qualification of gatekeepers and general practitioners, and a campaign to refer SA cases to psychiatric services and antistigma campaigns. The intervention lasted for 25 months.

For CS, 7.7 cases per month were recorded during baseline, compared to 9 cases per month in the intervention phase. For SA, the numbers were 39.2 and 40.7, respectively. These numbers did not differ significantly. The most frequent diagnostic group was affective disorders, followed by substance use disorders. The average age was lower in the SA group. More males committed suicide (p < 0.001), whereas the sex ratio was balanced in SA.

The communal suicide prevention measures implemented in FraPPE did not reduce the number of suicides and SAs. This should be interpreted with caution, as a number of prevention measures were already executed in the region. Also, data were confounded by the COVID-19 pandemic. Our awareness campaign may also have reduced the dark field, leading to increased reporting. We thus propose to enact registries on suicidal behaviors, to obtain better data and develop new preventive measures.

Despite rigorous evidence of the benefits, costs and savings and mentions in treatment guidance, cognitive remediation access is still sparse. Providers are often confused by disagreements about the strength of the benefits evidence, some think it is a game not a treatment and others do not consider that cognition should be a treatment target. These are all issues that were present in the literature at least ten years ago.

To identify the steps to widespread implementation of this beneficial intervention

Drawing on the literature and data from a large UK adaptive randomised control trial, we describe three: (i) the barriers and facilitators for the implementation into first episode services, (ii) cost effectiveness and (iii) training rollout and competency.

(i) Clinicians need to understand the relevance of cognition and be aware of effective interventions, (ii) Despite evidence of efficacy a therapist seems important for engagement and leads to cost effective therapy and (iii) online therapy can improve competencies for delivering cognitive therapy and but commitment to completing therapy is related to management commitment.

All the implementation issues can be overcome but we still need to understand the non-specific effects of cognitive remediation as well as the specific if we are to provide a formulation-based approach. Clinicians need to know that cognitive remediation is not “brain training” but is a holistic therapy that involves an active therapist providing motivation support, and who helps to mitigate the impact of cognitive difficulties through metacognition to develop awareness of cognitive approaches to problems.

T. Wykes Grant / Research support from: NIHR grant 2.2m

Late-life depression (LLD) is prevalent in older adults and linked to increased disability, mortality, and suicide risk. Insomnia symptoms are considered common remaining symptoms of LLD following treatment. However, the multivariate relationship between insomnia and depressive symptoms and the impact of psychotherapy on their interrelationship is insufficiently assessed.

We conducted a secondary analysis of data from 185 patients with LLD, recruited from seven university hospitals in Germany as part of a larger original cohort study. Participants had undergone eight-week psychotherapy interventions (cognitive behavioral therapy or supportive unspecific intervention). Three regularized canonical correlation analyses (rCCA) assessed the multivariate association between insomnia and depressive symptoms at baseline, post-treatment, and six-month follow-up. rCCA was conducted within a machine learning framework with 100 repeated hold-out splits and permutation tests to ensure robust findings. Canonical loadings and cross-loading difference scores were calculated to examine symptom changes before/after psychotherapy (Holm-Bonferroni corrected p-value <0.05).

At baseline, a moderate association was observed between insomnia and depressive symptoms (r = 0.24). Interestingly, this association slightly increased after the eight-week treatment period (r = 0.42, pcorrected = 0.064) and remained significantly elevated at the follow-up session (r = 0.48, pcorrected = 0.018). At baseline, anxiety-related depressive symptoms were mainly associated with insomnia, while at post-treatment and follow-up sessions, somatic and negative affective symptoms showed the strongest correlation with insomnia symptoms. While the relative relationship of depressive symptoms with insomnia altered after psychotherapy, the pattern of insomnia symptoms remained stable.

The observed changes in the association between insomnia and depressive symptoms after psychotherapy highlight the necessity to consider targeting insomnia for effective LLD treatment.