Transcranial Magnetic Stimulation (TMS) is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain. It is primarily used to treat depression and other mental health conditions. When it comes to the safety of TMS during pregnancy, the current evidence is limited but generally suggests that it may be a safer alternative to medications that could potentially harm the fetus. Several small studies and case reports have indicated that TMS does not appear to pose significant risks to the pregnant woman or the fetus. However, the data is not extensive, and more research is needed to fully understand the implications. The procedure is typically avoided in the first trimester unless absolutely necessary, as this is a critical period for fetal development. In summary, while TMS is considered relatively safe during pregnancy, especially compared to some pharmacological treatments, it should only be used when the potential benefits outweigh the risks, and under the close supervision of a healthcare provider. Pregnant women considering TMS should discuss their specific situation with their doctor to make an informed decision.

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The turn of the century was an important era for the field of psychiatry. Influential physicians such as Sigmund Freud (1856-1939) or Eugen Bleuler (1857-1939) made headlines and new theories on the pathogenesis of psychological disorders emerged with the psychoanalytic approach – the whole field seemed in a state of transition. But did this modern image correspond to how two of psychiatry’s most famous conditions – psychoses and delusions – where framed in the mass media of film? Surprisingly, there are no systematic works on these question, neither by medical nor film historians. This lecture tries to close this gap and, for the first time in international research, provides a systematic overview of the representation of the theme in silent cinema. With the aim of sketching a representative image, 36 works portraying psychoses and / or delusions were identified and, among other things, historically classified, analyzed and evaluated for medical correctness. In summary, it is shown that the early film depicts the condition in a highly ambivalent way, from dangerous and untreatable Insanity to curable illness, thereby reflecting one of the most significant transitions in the history of the understanding delusional symptoms. The presented therapy methods – e. g. psychoanalysis, hypnotherapy, electrotherapy, water therapy and even music therapy –, thus rarely utilized, appear highly modern, while the depiction of the patients seems more influenced by the shadows of the past. Accompanied by scenes from representative works such as The Other (1913), Wolf Blood (1925), Shadows (1923) or the German classic The Cabinet of Dr. Caligari (1920), the presentation aims to illustrate all these characteristics of the early ‘psychosis und delusion film’ and explores the important role of cinema as a source of medical history.

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Under the rubric of cinema therapy, or movie therapy, research has been undertaken for some time to test the effect of films in different therapeutic settings and with different patient groups. Taking a closer look at the history of film therapy, it becomes apparent that at the time of the silent film, there was already a medical discourse on the effect of films in a therapeutic context. In this lecture, principal philosophical-therapeutic elements of consideration regarding cinema therapy are presented along with historical and current discourses; the most important publications are indicated; and the author’s own cinema-therapeutic models, experiences and reflections are reported. In addition, selected case studies show how films can be utilized in a clinical context and which effects and unwanted side effects result from film therapy. The final focus of the lecture is on films that depict psychotherapy, love films, and films that address the phenomena of intoxication, ecstasy, and addiction, and how these have been applied by the author in the inpatient treatment of addicts.

Martin Poltrum (2025) Cinema Therapy––The Film as a Medicine. From the Silent Film Era to the Present Day. In: Martin Poltrum et al. (eds.) The Oxford Handbook of Mental Health and Contemporary Western Aesthetics, Oxford: Oxford University Press.

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The presentation juxtaposes the practice of psychiatry with the creative processes involved in filmmaking. It proposes a correlation between the representation of reality in film, and the processing of visual information. It is informed by autobiographical case study films written and directed by individuals with experience of psychosis. In-depth analysis of film conventions employed by filmmakers with experience of psychosis indicate the potential benefits of further research into collaboration with, and contributions from, those filmmakers.

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Although cognitive impairment is a core symptom of schizophrenia related to poor outcome in different functional domains, it still remains a major therapeutic challenge. To date, cognition is still poorly assessed in both research and clinical settings and no comprehensive treatment guidelines for assessment and treatment of cognitive impairment in schizophrenia are implemented.

The aim of the European Psychiatric Association (EPA) guidance paper was to provide a comprehensive meta-review of the current available evidence for the assessment of cognitive functions in schizophrenia both in research settings and in real-world clinical practice and for treatment of cognitive impairment, structured into three sections: pharmacological treatment, psychosocial interventions, and somatic treatments.

Based on the reviewed evidence, the EPA guidance recommends a comprehensive and systematic assessment of neurocognitive and social cognitive domains in schizophrenia, in all phases of the disorder, as well as in subjects at risk to develop psychosis. It is recommended not only the use of observer reports, but also of self-reports and interview-based cognitive assessment tools. As for treatment, the EPA guidance recommends an appropriate pharmacological management as a fundamental starting point in the treatment of cognitive symptoms in schizophrenia. Among psychosocial interventions, cognitive remediation and physical exercise, and some variables have been confirmed as core elements for cognitive remediation effectiveness.

The dissemination of the EPA guidance papers may promote the development of shared guidelines concerning the assessment and treatment of cognitive functions in schizophrenia, with the purpose to improve the quality of care and to achieve clinical recovery in this population.

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The presentation will summarize recent findings on the role of the two domains of negative symptoms (motivational impairment and expressive impairment) and social cognition as mediators of the impact of neurocognitive impairment on functional outcomes in people living with schizophrenia (PLWS).

One hundred and fifty subjects from 8 different European centers were recruited. Our data showed that the expressive impairment predicted global functioning and together with motivational impairment fully mediated the effects of neurocognition on the same outcome. Motivational impairment was a predictor of personal and social functioning and fully mediated neurocognitive impairment effects on the same outcome. Both motivational and neurocognitive impairments predicted socially useful activities, and the emotion recognition domain of social cognition partially mediated the impact of neurocognitive deficits on this outcome.

Our results indicate that pathways to functional outcomes are specific for different domains of real-life functioning and that negative symptoms and social cognition mediate the impact of neurocognitive impairment on different domains of functioning. Our results suggest that psychosocial interventions should target both negative symptoms and social cognition to enhance the functional impact of cognitive remediation.

A. Mucci Consultant of: Angelini, Gedeon Richter Bulgaria, Janssen Pharmaceuticals, Lundbeck, Otsuka Pharmaceutical, Pfizer, Pierre Fabre, Rovi Pharma and Boehringer Ingelheim.

Cognitive impairment associated with schizophrenia (CIAS) is a relevant problem and can be well assessed in different ways, as described in an EPA guidance paper (1). In routine clinical practice, the clinician usually relies on targeted questions to elicit psychopathological findings, as described in the AMDP system (2), for example. If there is a need for a more precise assessment of cognitive dysfunction, also in a transdiagnostic way, the Screen for Cognitive Impairment in Psychiatry (SCIP) (3) has recently been used by several working groups.

In a recent pilot study (4), we used the German version of the SCIP (SCIP-G) (5,6) to assess cognitive impairment in acute psychiatric inpatients diagnosed with psychotic disorders, bipolar disorder and depression.

(1) Vita A, Gaebel W, Mucci A, Sachs G, Erfurth A, Barlati S, Zanca F, Giordano GM, Birkedal Glenthøj L, Nordentoft M, Galderisi S. European Psychiatric Association guidance on assessment of cognitive impairment in schizophrenia. Eur Psychiatry. 2022 Sep 5;65(1):e58. doi: 10.1192/j.eurpsy.2022.2316.

(2) The AMDP System: Manual for Assessment and Documentation of Psychopathology in Psychiatry, 9th edition. 2017. Ed.: Broome MR, Bottlender R, Rösler M, Michael; Stieglitz RD. Hogrefe Publishing GmbH. ISBN: 978-0-88-937542-0

(3) Purdon SE. The Screen for Cognitive Impairment in Psychiatry (SCIP): Instructions and three alternate forms. 2005. PNL Inc, Edmonton, Alberta

(4) Maihofer EIJ, Sachs G, Erfurth A. Cognitive Function in Patients with Psychotic and Affective Disorders: Effects of Combining Pharmacotherapy with Cognitive Remediation. J Clin Med. 2024 Aug 16;13(16):4843. doi: 10.3390/jcm13164843.

(5) Sachs G, Lasser I, Purdon SE, Erfurth A. Screening for cognitive impairment in schizophrenia: Psychometric properties of the German version of the Screen for Cognitive Impairment in Psychiatry (SCIP-G). Schizophr Res Cogn. 2021 May 12;25:100197. doi: 10.1016/j.scog.2021.100197.

(6) Sachs G, Bannick G, Maihofer EIJ, Voracek M, Purdon SE, Erfurth A. Dimensionality analysis of the German version of the Screen for Cognitive Impairment in Psychiatry (SCIP-G). Schizophr Res Cogn. 2022 Jun 6;29:100259. doi: 10.1016/j.scog.2022.100259.

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Cognitive impairments are present from the first manifestations of the disorder, including social cognition in individuals at ultra-high risk for psychosis (UHR). While advances in psychopharmacology in recent decades have significantly altered the course of the illness, antipsychotic therapy is more effective in treating positive symptoms than negative symptoms, comorbid depression, and cognitive and social cognitive dysfunction. Again, cognitive impairment has a significant impact on functional outcome, more so than symptom severity.

Due to the particular significance of cognitive deficits, it is very important to identify them accurately at an early stage. Strategies for identifying cognitive deficits are presented in an EPA guidance paper.

To improve cognition in patients with schizophrenia, it has been suggested to combine pharmacotherapy with neuropsychological training. A meta-analysis showed the positive effect of cognitive remediation programmes in schizophrenia. While the strategies available today for the treatment of cognitive dysfunction are useful and should be implemented, it is hoped that pharmacological add-on strategies will come onto the market to have a greater effect on cognitive impairments.

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An experienced practitioner describes the fundamentals of crisis support and Psychological First Aid – the knowledge base for the ongoing work in Västra Götalandsregionen, Sweden, using VR to practice crisis support. How is crisis support defined and what is the difference between crisis support and psychological treatment? What is the aim of crisis support? The presentation includes current knowledge about how humans react in a crisis, in the acute phase as well is in the longer term. What are the guidelines for providing Psychological First Aid and how can we implement them in practice?

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This presentation will explore the development and implementation of the Crisis Support VR project, funded by the VGR Innovation Fund and involving five hospitals and primary care. In today’s society, the need for crisis support is more pressing than ever. However, we identified a significant gap in opportunities to practice Psychological First Aid. To address this, Region Västra Götaland collaborated with VirtualSpeech to create a system that has been tested by hospital staff, emergency services, and crisis support teams. This presentation will detail the project’s journey from its inception to its current state, highlighting the challenges and successes encountered along the way.

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This presentation will provide an overview of existing research on crisis-support training in virtual reality, highlighting both the opportunities and challenges of utilizing this training method. It will review current research trends in the field, identify gaps in knowledge, and propose directions for future research initiatives. Studies on crisis-support training that utilize a virtual reality training approach for professionals working with children and adolescents will also be presented.

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While generative AI (genAI) has made significant advances, millions of people are facing humanitarian crises, resulting in the denial of their basic human rights. One humanitarian response to addressing humanitarian crises is crisis support teams with knowledge of psychological first aid (PFA). In humanitarian crises, skilled practice in PFA by crisis support teams can strengthen the mental health of affected individuals, which can be crucial to ensuring societal well-being. At the same time, there are major challenges in training crisis support teams in PFA. With advancements in genAI, there are opportunities to develop virtual patient systems to enhance PFA training for crisis support teams. This presentation will share preliminary data collected through the genAI-agents survey, which explores technological openness, attitudes and learning through genAI and genAI-based virtual patient systems in healthcare education as well as specifically targeted questions to the genAI-based VP system Crisis Support-VR. This survey is a part of a larger project focusing a central research question Does Crisis Support-VR enhance the skills and ability of crisis support teams to deliver effective PFA, thereby strengthening the mental health of individuals affected by humanitarian crises with two interconnected sub-goals; • to empirically explore health and medical staff within children, youth and adult services learning in Crisis Support-VR, • to develop an educational module for training and practice opportunities in PFA to support and help national and international organizations train crisis support teams in applying PFA to children, youths an adults affected by humanitarian crises.

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Psychological First Aid is (thankfully) not something most people use daily – yet it’s crucial for responders to be trained, confident and fully prepared for unexpected emergencies. So how can we ensure this readiness? The answer is AI avatars in virtual reality! At VirtualSpeech, in partnership with Region Västra Götaland, we’ve developed AI roleplay simulations that enable crisis and emergency teams to not only practice their psychological support skills but also receive personalized feedback on their performance and tips for improvement.

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In recent years, developments in Generative artificial intelligence (genAI) have opened new possibilities for continuous education that were recently only science fiction. However, genAI introduces several ethical considerations and ethical issues continue to appear. These include privacy, ownership, accuracy, bias, psychological impact, and environmental impact. In this workshop we will consider where these ethical issues might specifically intersect with the development and implementation of genAI in training professional conversational skills in the context of professional mental health support. Understanding these ethical issues is important for ensuring positive and sustainable impact on society and individual health. As a part of this workshop, we consider theoretical issues, but we will also look at methods to ensure the development of ethical and trustworthy genAI systems, including transparency and human-in-the-loop methods, along with quality and risk management systems. Moreover, when considering worker health, it is will be important that future work empowers workers to continue to develop in their field, without introducing additional harms such as accessibility problems or exposure to harmful imagery or interactions.

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Introduction. Previous evidence showed significant discrepancies in psychiatric services utilization between migrants and reference populations in Europe. An important barrier for migrants to Europe is the lack of adequate legal entitlements. Sometimes these barriers are mistakenly attributed to cultural differences and misunderstandings because the term ‘culture’ may be used as a putative politically correct expression reifying social differences and neglecting discrimination. Our study aims were to evaluate incidence and characteristics of psychiatric hospitalizations of migrant patients compared with reference populations and to assess how the COVID-19 pandemic affected admissions. Methods. All patients admitted to the psychiatric ward “SPDC-Malpighi” of the Bologna Mental Health Department, Italy, from 01/01/2018 to 31/12/2020 were included. Differences in sociodemographic and clinical characteristics were tested by migrant status. Incidence rate ratios of hospital admissions by migrant status were estimated via Poisson regression considering population-at-risk, gender, and age-group. Results. Migrants had higher hospitalization rates due to any psychiatric disorder (IRR=1.16). The risk was especially pronounced among women (IRR=1.25) and within the youngest age-group (IRR=3.24). Young migrants had also a greater risk of compulsory admission (IRR=3.77). Regarding admissions due to a specific diagnosis, we found relevant differences in hospitalization rates for psychosis, mood disorders, and personality disorders. Finally, migrants were more likely to be admitted via the Emergency Department and less likely to be referred from a specialist. Discussion. During the year of pandemic (2020) we observed an increase in the proportion of migrants admitted voluntarily or compulsorily. Migrants, especially those from the youngest age-group, had higher hospitalization rates for any disorder. Younger migrants were also at higher risk of compulsory treatment. The distribution of psychiatric admissions during the pandemic period seemed to have further increased discrepancies in mental healthcare needs and provision between migrants and the reference population. Tailored interventions and policies are urgently needed to address this issue. Keywords Psychiatric admissions · Migrants · Pandemic · Compulsory treatments References: Tarricone I, D’Andrea G, Galatolo M, Carloni AL, Descovich C, Muratori R; Bo-East Psychiatric Admissions Study Group. Psychiatric Admission Among Migrants Before and During Pandemic: a Retrospective Study in Acute Psychiatric Ward in Bologna, Italy. J Immigr Minor Health. 2023 Jun;25(3):507-521. doi: 10.1007/s10903-023-01464-7. Epub 2023 Mar 23. PMID: 36952152; PMCID: PMC10034892.

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Chronic (non-cancer) pain is a rising problem within Western population. Importantly, people with mental illness have disproportionally high levels of (chronic) pain. Prescription opioid medications are frequently initiated for the treatment of chronic pain. This, despite the growing evidence showing a lack of effectivity and an increased risk of complications such as the development of substance use disorders. Specifically, people with MH problems appear to be more vulnerable to lose control and develop opioid use disorders.

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Individuals with neurodevelopmental disorders, such as ADHD and autism spectrum disorder, often experience higher rates of chronic pain compared to the general population. Potential shared mechanisms could be central sensitization, muscular dysregulation and altered pain experiences. Individuals with ADHD and chronic pain frequently have a lower health-related quality of life, including higher pain interference and depressed symptoms. Psychological inflexibility, insomnia and hypermobility are identified as mediators in the relationship between neurodevelopmental symptoms and chronic pain. Understanding these connections can aid in developing targeted interventions to improve the quality of life for individuals with neurodevelopmental disorders experiencing chronic pain.

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Fibromyalgia is not a primarily psychogenic disorder, however due to high levels of comorbidity with psychiatric disorders and shared therapeutic targets, psychiatrists can play an important role in the diagnosis and treatment of fibromyalgia.

Fibromyalgia is a chronic pain syndrome affecting around 2-5% of the general population. Fibromyalgia’s core symptom is the persistent generalized pain, its other symptoms include fatigue, stiffness, depressed mood, anxiety and sleep disturbance. Although some psychiatric symptoms are an integral part of fibromyalgia clinical presentation, in a significant part of patients their severity warrants a specific psychiatric diagnosis and management. Available data shows high rates of psychiatric comorbidity in fibromyalgia, with lifetime prevalence reaching 9-33% for anxiety disorders, 16% for post traumatic stress disorder, 63% for depression, 26% for bipolar disorders. Psychiatric comorbidity in fibromyalgia is associated with the severity of fibromyalgia, its impact on patients functioning, quality of life and socioeconomic status. Moreover, the works of our team have also shown that some psychopathological symptoms such as depression, anxiety, anhedonia, chronobiological preferences and circadian rhythm disruptions as well as some psychological traits are linked to lack of response to pharmacological treatment in fibromyalgia.

The current knowledge on fibromyalgia etiopathogenesis is incomplete and does not warrant a comprehensive description. There are no biomarkers or objective tests, which would verify the fibromyalgia diagnosis, which is therefore based primarily on the physician’s history-taking and fulfillment of criteria. In effect, the group of patients diagnosed with fibromyalgia is most likely heterogeneous, regarding the biological basis of its symptoms, clinical presentation and susceptibility to treatment. This also means treatment is symptomatic and characterized by limited effects.

Fibromyalgia management requires a multidisciplinary approach, with emphasis on non-pharmacological interventions such as physical activity, cognitive–behavioral/mindfulness psychotherapy, physical therapies. For a large number of fibromyalgia patients these interventions are not sufficiently effective and there is a need for pharmacotherapy. The use of selective serotonin and noradrenaline reuptake inhibitors (SNRI) and pregabalin, which are commonly used to manage depression and anxiety, is supported by best scientific evidence. Also other drugs used for psychiatric disorders such as amitriptyline, gabapentin, quetiapine or naltrexone (in low doses) were proven useful in fibromyalgia management.

This presentation will sum up current knowledge on psychiatric comorbidity in fibromyalgia and treatments which psychiatrists can offer to fibromyalgia patients.

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In recent years, artificial intelligence has increasingly demonstrated its potential to transform healthcare, particularly in the domain of psychopharmacotherapy. This workshop explores the integration of language models into the personalization of treatment strategies for special populations, including those with complex comorbidities or unique pharmacokinetic profiles. By educating language models with domain-specific data, we can enhance their capacity to support clinicians in decision-making processes, optimize treatment outcomes, and reduce the risk of adverse drug reactions. Attendees will gain insights into the methodologies for training AI models on tailored datasets, addressing challenges in bias mitigation and ethical considerations, and leveraging these tools for real-world clinical applications. This session aims to foster a deeper understanding of how cutting-edge AI can reshape psychopharmacological practices and empower clinicians with data-driven insights.

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Mental disorders in the elderly occur much more often than in young adults, and their prevalence increases significantly with age and in the case of people receiving institutional care. Psychopharmacotherapy in an elderly patient is much more challenging and requires more restrictive safety strategies than in younger patients. The significantly increased risk of interactions, side effects and complications resulting from: comorbidities, systemic changes due to aging and, as well as their pharmacotherapy, are a serious problem in the treatment of elderly patients. It should be emphasized that the safety profile may be different in the elderly compared to the young adults - some complications that are rare in younger patients, e.g. bleeding complications, fractures and bone loss, cataract progression, hyponatremia, falls, QT prolongation, stroke, pneumonia and others, are a much more common problem among seniors and their risk should be considered at the initial stage of pharmacotherapy selection. In the case of some drugs (e.g. antipsychotics), the accumulation of serious complications may significantly increase the risk of premature mortality, if they are used incorrectly. Moreover, it should be remembered that certain side effects, e.g. orthostatic hypotension, may occur with drugs for which these side effects are unlikely in younger patients. During the treatment process, it is also necessary to monitor the presence and severity of side effects, such as: constipation, dry mouth, tremors, urination problems, excessive sleepiness or cognitive impairment, which may reduce the quality of life, particularly in an elderly patient. This presentation will provide a brief and practical clinical guide to safe and effective pharmacotherapy in the elderly patients.

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