In this presentation I will show that mental health treatment for people with dual diagnosis is not very different from treatment of mental disorders without addiction problems. There are a few points that will be raised like interactions with the drug of choice for the patients and the problem arising from compliance.

The most important point that will be presented is the fact that too many people with dual disorders go untreated. There is a need to rise awareness of this problem within our profession.

The main aim of treatment is often to replace some of the effects that the patients experience using drugs like depression, irritability, fluctuating thoughts and sleep problems.

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The biopsychosocial model was first conceptualized by George L. Engel in 1977 in order to explain the contribution of biological, social and psychological factors in determining mental (and physical) illnesses. This model gained new attention in recent years: while many authors consider it as a complete framework, others highlight its clinical, scientific and theoretic vagueness. A revised biopsychosocial model is being proposed, including causal interactions within and between biological, social and psychological factors as the benchmarks of the complexity of mental disorders.

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Schizophrenia is a serious mental illness with positive, negative and cognitive dysfunctions and a significant deterioration in psychosocial functioning. Interactions between genetic predisposition and environmental stressors at the early stages of life, and subsequently a molecular level neurodegeneration process are important in the development of schizophrenia. Current approaches suggest that cytokines-induced neuroinflammation might have a role in the development of several psychiatric disorders, including schizophrenia.

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In this presentation, I will explore how the exposome paradigm can be leveraged to advance clinical practice in psychiatry. Specifically, I will highlight the potential of cumulative environmental risk scores to predict outcomes in severe mental disorders, such as the exposome score for schizophrenia (ES-SCZ).

Numerous socio-environmental factors have been linked to mental disorders, including childhood adversities, stressful life events, substance use, obstetric complications during pregnancy and childbirth, and urban living. Environmental factors do not exist in isolation; they form complex networks of interrelated and interactive elements. In this regard, the exposome represents the totality of an individual’s environmental exposures throughout their lifetime. The exposome framework introduces a holistic approach to embrace this complexity and a theoretical framework to investigate the poly-gene and poly-environment etiology of psychiatric disorders.

Guided by the exposome framework, we have recently estimated the ES-SCZ, a cumulative environmental exposure score for schizophrenia, including cannabis use, winter-birth, hearing impairment, bullying, and five domains of childhood adversities (emotional and physical neglect, along with emotional, sexual, and physical abuse). The ES-SCZ successfully differentiated individuals with schizophrenia, accounting for 28% of the variance in an independent case-control sample. Subsequently, we have tested the risk stratification properties and the predictive performance of the exposome score for schizophrenia in the general population. The ES-SCZ had strong discriminative performance for schizophrenia (AUC = 0.84) and was associated with the degree of psychosis risk in the general population. Finally, we tested the performance of ES-SCZ for dissecting the functional and symptomatic outcome heterogeneity in patients with psychosis in four different cohorts (EUGEI, GROUP, Athens FEP, and HAMLETT-OPHELIA). ES-SCZ was associated with poor overall functioning and cognitive impairment at baseline and follow-up visits. ES-SCZ was also temporally associated with poor symptomatic improvement from baseline to follow-up assessments, particularly the negative symptom dimension. Furthermore, models that included the polygenic risk score for schizophrenia and clinical features showed that the relationship between ES-SCZ and functional outcomes cannot be explained by genetic or clinical risk factors alone.

Overall, our findings demonstrate the potential benefits of the exposome score for schizophrenia, which can be integrated for early detection, outcome prognostication, clinical staging, and risk stratification in the future.

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Legalizing cannabis can yield significant benefits for public mental health by fostering harm reduction, promoting medical access, and mitigating societal stigma. While concerns about misuse exist, a well-regulated cannabis policy can outweigh these risks and provide a balanced approach to mental health promotion. 1. Harm Reduction through Regulation Prohibition often drives cannabis use into unregulated markets, where the lack of quality control increases risks of contamination with harmful substances. Legalization allows governments to regulate cannabis production, ensuring product safety and controlled potency. This can reduce incidents of adverse reactions, particularly those exacerbated by high-potency strains or toxic additives. A regulated market also discourages illicit activity, reducing exposure to dangerous drugs often sold alongside cannabis in black markets. 2. Promoting Medical Access and Mental Health Treatment Legalization enhances access to cannabis for therapeutic purposes, particularly for mental health conditions such as chronic pain and opens the door to explore the potential benefor for patents with anxiety and post-traumatic stress disorder (PTSD), and. Studies indicate that cannabinoids can alleviate symptoms of stress and anxiety when used responsibly and under medical supervision. By integrating cannabis into healthcare systems, individuals struggling with mental health disorders can benefit from a natural and potentially less addictive alternative to pharmaceuticals like opioids or benzodiazepines, which carry significant risks of dependency. 3. Addressing Stigma and Encouraging Open Dialogue Legalization reduces societal stigma associated with cannabis use, enabling more individuals to openly discuss their experiences and seek help for misuse if needed. Public health campaigns can then focus on education about responsible use, mental health implications, and support systems. Decriminalizing cannabis also reduces the disproportionate criminalization of marginalized groups, fostering a more inclusive and equitable approach to public health. 4. Potential to Reduce Alcohol and Opioid Use Research has suggested that legal cannabis availability is associated with reductions in alcohol and opioid consumption, substances that are more harmful to both physical and mental health. By providing a less harmful alternative for relaxation or pain management, cannabis legalization could mitigate the societal burden of these substances, including addiction and overdose crises. Conclusion While cannabis legalization requires careful regulation to mitigate risks like overuse or dependence, its potential benefits for public mental health are substantial. By reducing harm, enhancing medical access, and promoting a more informed and equitable societal approach, legalization represents a forward-thinking public health policy that prioritizes well-being over punitive enforcement.

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Cannabis legalisation has undergone a rapid global transformation, with varying policy approaches and public health implications across different geographic areas and social contexts.

Several arguments have been proposed to support cannabis legalisation, ranging from control of the quality and potency of the market products, harm reduction, addressing the black market activities, reducing crime, and economic benefit. However, cannabis use has been associated with public health concerns, and it has been established as the most preventable risk factor for psychotic disorders.

This work aims to dissect the key arguments supporting cannabis legalisation through the following objectives: 1) reviewing the relationship between cannabis legalisation and the incidence and prevalence of psychotic disorders in countries where cannabis has been legalised, as well as changes in incidence rates over time in those countries where legalization is currently under debate; 2) examining the relationship between cannabis use and psychopathological outcomes using a syndemic approach; and 3) presenting original data from the epidemiological branch of the EC-1 study, aiming to identify risk factors for psychopathology, violence, and aggression in South London.

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Artificial intelligence (AI) and -omics techniques (genomics, proteomics, metabolomics) represent two rapidly evolving fields that are increasingly intersecting to transform clinical research and healthcare.

AI, aiming to mimic human intelligence through computational modelling, possesses extraordinary capabilities for big data analysis. -Omics, offering quantifiable and dynamic readouts of the molecular state of the subject, can generate large databases covering hundreds to thousands of molecules with complex relationships.

Combining AI-driven insights with the wealth of data generated by genomics, transcriptomics, proteomics, and metabolomics can help uncovering complex biological networks, with the potential to revolutionize our understanding of disease mechanisms, improve patient stratification, and optimize therapeutic interventions.

In this presentation, the concepts of AI and -omics and their combined application to clinical research will be discussed, summarizing the strengths and limitations of these approaches. Studies leveraging AI across various -omics domains will be presented. Key advances, ongoing challenges, and future perspectives in this rapidly evolving field will be debated.

While still in the early stages, the synergistic partnership between metabolomics and AI represents an exciting frontier that holds great promises for groundbreaking advancements in clinical research and human health, paving the way toward a new era of precision medicine.

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Bipolar disorder (BD) is characterized by mood and cognitive fluctuations that manifest in speech patterns. Current assessments rely on subjective clinical evaluation, but advances in natural language processing (NLP) offer new opportunities for objective monitoring. This study analyzes speech from BD patients across different mood states—euthymia, mania, and depression—using structured tasks, spontaneous speech, and standardized text reading. Key acoustic, linguistic, and emotional features are extracted and correlated with clinical scales. Machine learning models are being developed to predict symptom severity and mood phase. This approach could provide reliable digital biomarkers, enhancing diagnosis, monitoring, and early relapse detection in BD. Standardized speech protocols may pave the way for international collaboration and large-scale validation.

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Burnout and mental health issues have become increasingly prevalent among psychiatry trainees and early career psychiatrists, posing significant challenges to their well-being. This presentation explores the multifaceted relationship between psychiatry training environment and the occurrence of burnout, characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment. Factors contributing to the severe burnout in psychiatry trainees include long working hours, lack of supervision, and not having regular time to rest (Jovanović N. et al., 2016). Other potential factors described include the high demands of clinical responsibilities, emotional strain from patient interactions, and inadequate support systems. Encountering possible suicidal patients and coping with patients’ violence are other factors that can have a strong influence on psychiatry trainees and early career psychiatrists’ clinical activity, especially in the absence of appropriate training in the field and supervision (Chumakov E. et al., 2022; Longo G. et al., 2023). Studies indicate that a significant proportion of psychiatry residents experience symptoms of mental distress (Pitanupong J. et al., 2024; Toni F. et al., 2024) with depression being an important source of impaired mental well-being. Furthermore, the stigma surrounding mental health within the medical community often discourages trainees from seeking help, exacerbating feelings of isolation and distress. There’s no question that poor mental health can affect not only psychiatry trainees and early career psychiatrists’ personal health but also their professional development and patient outcomes. In this presentation the implications of these issues for the psychiatry field will be discussed. There’s a growing demand for advocacy for comprehensive training programs that integrate wellness strategies, enhance supervision, and promote open conversations about mental health. By fostering a supportive environment and prioritizing self-care, the psychiatry community can mitigate the risks of burnout and mental disorders among peers, ultimately leading to a more resilient workforce and improved patient care. This presentation underscores the need to support the mental health of future psychiatrists and ensure the integrity of mental health services.

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Burnout is a set of experiences and symptoms which occurred in the context of stress and high ideals in the helping professions who feel drained, exhausted, tired, listless and unable to cope. Burnout leads to disengagement, blunted emotions, helplessness and hopelessness with feeling trapped causing detachment and depression. Prevention of burnout is important and includes interventions at policy, institutional and personal levels. These resources must include financial and human resources where appropriate; prompt and culturally acceptable help is available and easily accessible. Institutions must allocate sufficient funds for well-being of its staff. Various steps can be taken but perhaps most important is accessibility of services in a non-stigmatising manner. These services must be confidential, fit for purpose and widely advertised and accessible. Physical space to rest and access to affordable nutritious food are important. Access to occupational heath services or primary care are important.

Dinesh Bhugra

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The current post-covid situation and the increase of violent situations in the ward within another risk factors flourished within the last years. With this input is aimed, the change of culture into the active implementation of stress and therefore mental health prevention strategies in the workplace and in safe spaces after the shift. Coping Strategies have to be implemented to improve the resilience and the ability to act (empowerment) in the early career stages of trainees and early career psychiatrists, as they are at risk of life crises and suicidal behaviors.

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Burnout among mental health professionals poses a significant threat to personal wellbeing, patient care, and healthcare systems. Addressing this challenge aligns with the broader mission of the European Academy of Neurology (EAN) to promote brain health not only for patients but also for clinicians. This presentation highlights education, collaboration, and systemic interventions, integrating neurological and psychiatric perspectives.

This initiative stems from the EAN Task Force for Wellbeing (TFW), in collaboration with the European Psychiatric Association (EPA). A multipronged strategy was designed to enhance awareness, build resilience, and foster systemic reforms:

1. - Educational Media: A podcast series exploring burnout’s conceptualization, its neurobiological and psychological aspects, gender disparities, and practical solutions.

2. - Interactive Webinars: Interdisciplinary sessions combining insights from neurology and psychiatry, showcasing evidence-based strategies and technological innovations.

3. - Public Debates: Open forums to engage professionals across career stages, raising awareness and encouraging action to tackle burnout.

These initiatives were supplemented by systematic reviews, case studies, and suggestions of novel tools to monitor mental health and stress factors.

The combined educational and intervention efforts yielded significant outcomes:

1. - Advancing Brain Health for Clinicians: Awareness initiatives emphasized the vital link between clinician brain health and professional resilience

2. - Skill Development and Resilience: Practical strategies for time management, mentorship, and self-care were disseminated through case studies and interactive discussions.

3. - Collaborative Solutions: Webinars and public debates highlighted shared challenges and fostered interdisciplinary advocacy for systemic reform.

Burnout is not just an individual issue but a systemic challenge requiring collective action. By prioritizing clinician brain health as a mission, the EAN and EPA collaboration provides a unifying framework to tackle burnout. Educational initiatives bridged the gap between theory and practice, while public debates fostered community engagement and systemic advocacy. Interdisciplinary collaboration underscored the shared nature of burnout and the need for unified, brain-health-centric strategies.

Promoting wellbeing through education, collaboration, and innovative tools aligns with the broader goal of achieving brain health for clinicians. These initiatives provide a sustainable pathway to counteract burnout and foster a resilient and thriving workforce. Continued investment in education, public discourse, and systemic reform is essential to realizing this mission.

burnout, brain health, wellbeing, education, interdisciplinary collaboration, neurology, psychiatry, systemic reforms

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Perinatal psychiatry is a rapidly evolving subspecialty focused on diagnosing, recognising early, and treating mental disorders in pregnant and postpartum individuals, up to two years after childbirth (timeframes vary globally). The field has gained attention as governments around the world work to meet the United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (health and well-being) and SDG 5 (gender equality), aiming to improve maternal, infant, and child health outcomes.

In most countries, perinatal mental illness is managed by family doctors, midwives, and general adult psychiatrists, although some countries have developed specialist community and inpatient perinatal mental health services. The goal is effective treatment to improve pregnancy outcomes, parental mental health, social functioning, and child development. Studies show that infants of mothers with untreated perinatal depression and psychosis are at higher risk of long-term mental health disorders and poor social and educational outcomes. Early detection and efffective and acceptable interventions are key to breaking this cycle.

This presentation will address global advances and ongoing challenges. Significant progress includes increased awareness, emerging specialist services, novel pharmacological treatments with improved safety profiles, expanded evidence-based psychosocial interventions, and a focus on maternal suicide prevention, a key driver of maternal mortality. However, major challenges remain: perinatal suicide is a leading cause of maternal death, poor quality of evidence for prescribing in pregnancy and lactation, long-term morbidity due to untreated mental illness is often overlooked, and access to care is limited especially in low- and middle-income countries. Social stigma and structural barriers also prevent many from seeking help. Addressing these issues requires a global, multidisciplinary approach, integrating public health initiatives, policy changes, workforce training, and research innovations to ensure equitable access to high-quality perinatal mental health care worldwide.

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Pregnancy-related hormonal fluctuations, such as changes in estrogen and progesterone, can exacerbate ADHD symptoms, complicating the diagnostic process. Overlap with symptoms of pregnancy-related conditions, such as fatigue and mood instability, further obscures ADHD identification.

Non-pharmacological interventions, including cognitive-behavioral therapy (CBT) and psychoeducation, are first-line recommendations. For patients requiring pharmacological treatment, stimulant and non-stimulant medications must be considered cautiously, weighing risks such as low birth weight or preterm labor against the potential impact of untreated ADHD on maternal functioning. Emerging data suggest that atomoxetine and certain stimulants may be relatively safe under close monitoring.

Untreated ADHD in pregnant women is associated with higher risks of prenatal stress, inadequate prenatal care, and postpartum depression, highlighting the need for tailored management strategies.

ADHD, pregnancy, diagnosis, treatment, pharmacological safety, maternal mental health.

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Measuring medication levels in blood and/or milk of psychotropic-treated women during pregnancy and lactation provides significant benefits for optimizing maternal mental health while minimizing risks to the developing fetus or breastfeeding infant. This approach supports individualized treatment plans by addressing the unique pharmacokinetic and pharmacodynamic changes that occur during these physiological states. Among key benefits monitoring blood levels ensures that psychotropic medications remain within therapeutic ranges, thereby reducing the likelihood of relapse while avoiding toxicity. Moreover, measuring drug levels aids in balancing maternal benefits against fetal risks by enabling dose adjustments to minimize unnecessary fetal exposure while maintaining efficacy. It is particularly relevant for medications with narrow therapeutic indices or significant placental transfer. Additionally, pregnancy induces changes in drug absorption, distribution, metabolism, and excretion, which can lead to subtherapeutic levels. Monitoring essentially helps clinicians anticipate and adjust for these alterations, ensuring consistent drug efficacy. Further, postpartum, measuring drug levels in maternal blood and, when appropriate, in breastmilk provides data on infant exposure risks. This information is crucial for determining the safety of breastfeeding while continuing psychotropic therapy.

Last, drug level data allow clinicians to assess adherence, which is a major aspect during pregnancy and lactation.

Incorporating medication level assessments into risk management frameworks during pregnancy and lactation ensures that women receive evidence-based, safe, and effective psychotropic treatment while supporting fetal and neonatal well-being.

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There’s a lot of advice and written material available on research methods but much less on ‘how to be a researcher’. However, understanding this is as much a part of carrying out research as understanding a particular methodology. Having delivered countless teaching sessions on research design, I thought it would be interesting to consider (and attempt to write about) the origins of research principles, how these have developed over time, and what’s common across different fields. As well as this, there are the more mundane realities of attracting funding and publishing output, and the common challenges of achieving career progression and success in complicated political structures. There are great opportunities in research, and few careers that are as continuously interesting and engaging, but it’s wise to keep as clear a perspective as possible of the road behind and ahead.

R. Stewart Paid Instructor of: Oxford University Press

After the exploration of factors relevant to the conduct of collaborative research it is possible to formulate a set of rules which vastly increase the probability of success in the study conducted collaboratively.

A systematic exploration of the manners in which collaborative research has been organized and of the relation between the method or organization and the successful completion of the study.

The goal of this exploration was to formulate a set of rules which should be followed in conducting multicenter collaborative research to enhance the probability of its success.

The examination of the experience in the conduct of the studies organized and lead by the author it was possible to formulate certain rules which, when followed, not only led to a successful completion of the studies but also led to a number of additional benefits for the centres in which the study was conducted. The nine principal rules which were formulated in this way will be presented.

Collaborative research is more likely to have useful results if it is developed bearing certain rules in mind.

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ADHD in adulthood is still an orphan diagnosis in many countries in Europe. This is due to lack of knowledge in the education of psychiatrists in adult psychiatry about the research findings on adult ADHD of the past 30 years. Why is this important?

ADHD is prevalent in about 3-5% of adults in the general population, but in at least 20% of patients in psychiatry, whether anxiety, depression, bipolar disorder, substance abuse disorders and many more. In adults with borderline personality disorder, ADHD symptoms in childhood precede the development of this personality disorder later in life even in the majority of cases. Not recognising and treating ADHD in adulthood means that this condition impacts the treatment outcomes of any other psychiatric comorbidity due to impairing inattention, impulsivity and hyperactive behaviour. Psychotherapy for instance is hard to comply to when ADHD is not treated first. Also compliance to medication often fails in case of untreated ADHD, leading to high relapse rates. Also the treatment of physical diseases for instance for astma, obesity and diabetes may fail in case of untreated ADHD. In fact, not treating ADHD may lead to chronicity of any other comorbid condition; one of the reasons that ADHD can be found in chronic therapy-resistent patients.

ADHD is comorbid with 34 of 35 investigated disorders and diseases in a Swedish registry study, of which many have in part a genetic background. Allergies, astma, migraine, irritable bowel syndrome, hypermobility and weak connective tissue seem to play a role in many of these diseases. Psychiatric comorbidities are also broad: anxiety, depression, bipolar disorder, autism, sleep disorders, substance abuse disorders, personality disorders, severe hormonal moodchanges across the lifespan in women, and PSTD. This summary points to the systemic nature of ADHD across the lifespan, that urgently needs more research and understanding.

The good news is that ADHD is a well treatable condition in about 80% of patients using psycho-education, stimulant and other medication, CBT and other psychotherapies. Comorbid conditions must be diagnosed and treated as well, and often first. Treatment offers stability for patients who have never experienced this from childhood. As such, the diagnosis of ADHD in adults is often a game changer, enabling patients for the first time to persevere to a better lifestyle, to prevent further damage due to sleep loss, substance abuse and obesity.

Training about diagnostic assessment and treatment is available via books, (online) training and webinars.

In this presentation, all resources will be discussed followed by Q and A.

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We all have a personality, whether or not we also have a mental health disorder, and for some people parts of our personality lead to problems with others, or in getting on in our lives. Indeed the same might be said of neurodevelopmental conditions, autism, intellectual disability, ADHD, of which we understand there to be a spectrum of degree, and which in unfavourable circumstances produces difficulty and dysfunction. The combination of personality and neurodevelopmental pathology is common, so too is misdiagnosis between them. This talk will describe the key theories to understand the overlap, tackle diagnostic uncertainty, and outlines the ways in which support can be offered for the combination of the two.

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There are conflicting and inconclusive results regarding suicidality in patients with obsessive-compulsive disorder (OCD).

To describe the different psychopathological aspects of suicidality (suicidal ideation, suicide attempts, completed suicide, family history, etc.) in OCD.

In this case-control study we compared 114 patients with OCD and 127 controls (no OCD general hospital inpatients). The psychopathological aspects of suicidality were obtained through a 24 questions specific suicidality inventory (DETEC-S). Other instruments/data (Beck Depression and Anxiety Inventories, family history of psychiatric disorders, symptom severity scale, and psychiatric comorbidities) will be described in another study.

Patients with OCD reported: less will to live (p=0.005); greater will to die (p<0.001); more reasons to die (p=0.022); greater lifetime history of suicidal ideation (SI) (p<0.001); accept the idea of dying (p<0.001); admit death as an escape from problems (p<0.001); suicidal plan in the past (p=0.019); admit courage and ability to commit suicide (p=0.003); no organization for the afterlife (p=0.021); have already talked to other people about SI (p<0.001); access to a lethal method (p=0.047); higher rates of family members, close people or friends who have already attempted suicide (p=0.008). They did not differ from the controls: would save themselves in case of an accident; current intention to commit suicide; able to control suicidal desire; would not commit suicide because of family, friends or religion; absence of current suicidal plan; suicidal desire or plan in the near future; writing a suicide note; prevalence of lifetime suicide attemp (SA); when they had SA, there was no need for medical care; and suicide success rates of family members, close people or friends. There was no significant difference in the total DETECT-S score (p=0.086). There was a moderate and direct correlation of suicidality scores with: the current severity of OCD and (r=0.32; p=0.001), especially at the expense of the severity of compulsions (r=0.35; p<0.001); and with the severity of depressive symptoms (r=0.43; p<0.001); average rate of lifetime improvement of symptoms (r=0.36; p=0.007). We found a moderate and indirect correlation with total quality of life scores (r=-0.47; p<0.001), especially at the expense of aspects related to the physical (r=-0.47), psychological (-0.47) and environmental (r=-0.42) domains (all with p<0.001).

Suicidality appears to be markedly present in patients with OCD (of the 24 psychopathological aspects of the DETECT-S questionnaire, patients had higher scores in 13 items) even when compared to patients admitted to a general hospital. A detailed approach to suicidality in patients with OCD may help in therapeutic planning and reduce patient suffering.

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