This systematic review and meta-analysis evaluates the prevalence of disruptive mood dysregulation disorders (DMDD) in community-based and clinical populations.

PubMed and PsychINFO databases were searched, using terms specific to DMDD, for studies of prevalence and comorbidity rates conducted in youths below 18.

Fourteen studies reporting data from 2013 to 2023 were included. The prevalence of DMDD in the community-based samples was 3.3% (95% confidence interval [CI], 1.4–6.0) and 21.9% (95% CI, 15.5–29.0) in the clinical population. The differences in the identification strategy of DMDD were associated with significant heterogeneity between studies in the community-based samples, with a prevalence of 0.82% (95% CI, 0.11–2.13) when all diagnosis criteria were considered. Anxiety, depressive disorders, and ADHD were the most frequent comorbidity present with DMDD. The association with other neurodevelopmental disorders remained poorly investigated.

Caution is required when interpreting these findings, considering the quality of the reviewed data and the level of unexplained heterogeneity among studies. This review stresses the importance of considering a strict adhesion to DMDD criteria when exploring its clinical correlates.

The expansion of institutional long-term psychiatric care, while well-intentioned, repeats the historical failures of the 19th century answer to severe mental illness: asylums—facilities often marred by neglect, abuse, and the marginalization of individuals with mental illness. Many of the handicaps of persons living in these asylums were not the consequence of the mental health disorder but were iatrogenic damage done by living in these asylums. Though modern psychiatric institutions are more regulated, institutionalization inherently limits autonomy and reinforces stigma, undermining recovery-oriented models of care. Instead of diverting resources to rebuild large-scale facilities, investment should focus on strengthening community-based services, supportive housing, individual placement and support and integrated care models that empower individuals with serious mental illness to live fulfilling lives within society. Evidencebased outpatient programs, Flexible Assertive Community Treatment teams, peer support networks, recovery colleges, mobile crisis teams, peer farms, respite houses offer more humane, cost-effective, and person-centered alternatives. Addressing systemic challenges—such as poverty, lack of housing, lack of social connectedness and fragmented healthcare systems—can better serve this population without reverting to institutional confinement. Long-term solutions must prioritize dignity, autonomy, and inclusion rather than a return to segregated care.

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Bach et al (2024) investigated in a study published in Biological Psychiatry the effects of psychosocial stress on brain activation in individuals with alcohol use disorder (AUD), finding that stress heightened alcohol cue-induced activation in the left anterior insula, a region associated with salience attribution and goal-directed behavior. The activation correlated with alcohol craving and subsequent alcohol use, suggesting a neurobiological mechanism linking stress, cue reactivity, and relapse. Hassen et al (2024) performed a multi-center study examining cocaine use across Europe, revealing prevalence rates with a general upward trend, particularly among youth, marginalized groups, and opiate-dependent individuals. The study was published in European Addiction Research. Leonhardt et al (2024) investigated individuals with co-occurring substance use disorder and mental illness during the COVID-19 pandemic in Norway and found dramatically higher all-cause mortality rates, despite no increased risk of SARS-CoV-2 infection. This excess mortality highlights the vulnerability of this population and suggests that factors beyond the virus itself contributed to their elevated death rates. The study of Qeadan et al (2024) published in Addiction was one of many studies indicating that GIP/GLP-1 receptor agonist were effective against alcohol and other abuse. This study found lower rates of opioid overdose and alcohol intoxication. The findings support the use of these drugs at least in AUD.

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Cardiovascular disease (CVD) is twice as prevalent among individuals with mental illness compared to the general population. Prevention strategies exist but require accurate risk prediction. This study aimed to develop and validate a machine learning model for predicting incident CVD among patients with mental illness using routine clinical data from electronic health records.

A cohort study was conducted using data from 74,880 patients with 1.6 million psychiatric service contacts in the Central Denmark Region from 2013 to 2021. Two machine learning models (XGBoost and regularised logistic regression) were trained on 85% of the data from six hospitals using 234 potential predictors. The best-performing model was externally validated on the remaining 15% of patients from another three hospitals. CVD was defined as myocardial infarction, stroke, or peripheral arterial disease.

The best-performing model (hyperparameter-tuned XGBoost) demonstrated acceptable discrimination, with an area under the receiver operating characteristic curve of 0.84 on the training set and 0.74 on the validation set. It identified high-risk individuals 2.5 years before CVD events. For the psychiatric service contacts in the top 5% of predicted risk, the positive predictive value was 5%, and the negative predictive value was 99%. The model issued at least one positive prediction for 39% of patients who developed CVD.

A machine learning model can accurately predict CVD risk among patients with mental illness using routinely collected electronic health record data. A decision support system building on this approach may aid primary CVD prevention in this high-risk population.

Public mental health (PMH) involves a population-based approach to improve coverage, outcomes and coordination of PMH interventions to treat mental health conditions, to prevent associated burden, to prevent mental health conditions from arising, and promote mental well‐being and resilience. Collaborative care models involve population-based care teams sharing a defined group of patients tracked in a registry to ensure no one falls through the cracks. Practices track and reach out to patients who are not improving or who do not seek help (yet).

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Beyond psychosis prediction, clinical high-risk (CHR-P) symptoms show clinical relevance by their association with functional impairments and psychopathology, including personality pathology. Impaired personality functioning is prioritized in recent dimensional personality disorder models (DSM-5, ICD-11), yet underexplored in CHR-P, as are associations with cognitive biases, which early studies indicate as possibly linking CHR-P-symptoms and personality pathology.

A community sample (N = 444, 17–60 years, 61.8% female) was assessed via clinical telephone interview and online questionnaires. Using zero-inflated Poisson models, we explored associations of personality functioning, cognitive biases, current psychopathology, and psychosocial functioning with likelihood and severity of overall CHR-P, as well as perceptive (per-) and non-perceptive (nonper-)CHR-P-symptoms distinctly.

Higher nonper-CHR-P-symptom likelihood was associated with more impaired personality functioning and psychosocial functioning, while more severe cognitive biases were associated with higher CHR-P- and per-CHR-P-symptom likelihood, alongside higher CHR-P- and nonper-CHR-P-symptom severity. Further, more axis-I diagnoses were linked to higher CHR-P-, per-CHR-P-, and nonper-CHR-P-symptom likelihood, and younger age to higher CHR-P- and per-CHR-P-symptom severity, with CHR-P-symptom severity appearing higher in females. In an exploratory analysis, personality functioning elements identity and self-direction, and cognitive biases dichotomous thinking, emotional reasoning, and catastrophizing, respectively, showed multifaceted associations with nonper-CHR-P-symptom likelihood and overall CHR-P-symptom expression.

Our study supports the association of CHR-P-symptoms with multiple mental health factors. Findings suggest intricate associations between personality functioning impairments and cognitive biases with CHR-P-symptom expression in non-help-seeking populations, possibly contributing to different per-CHR-P- and nonper-CHR-P-symptom expression patterns. Therefore, they should be targeted in future longitudinal studies, aiming at better understanding CHR-P-manifestations to inform preventive intervention.

This Symposium will consider the process of collaboration from the family persective.

EUFAMI is of the view that the involvement of families in the process of care and recovery is accepted in theory but is not sufficiently practiced. concerned and involved family members are often excluded from important decisions that affect their loved ones and ultimately affect the quality of care and recvovery.

There will be a brief introduction from a representative of EUFAMI followed by a presentarion from a family member. Issues such as involvement in earlt indentivication and assessment,diagnosis, planning of interventions and supporting the recovery process will be considered.Issues such as the rights of famililies, concerns abour relapss, patiient confidentiality and the sharing of infromaton will all be considered in the context of the delivery of mentsl helth care services in the community

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Transcranial direct current stimulation (tDCS) is a promising treatment for major depressive disorder (MDD). This study evaluated its antidepressant and cognitive effects as a safe, effective, home-based therapy for MDD.

This double-blind, sham-controlled, randomized trial divided participants into low-intensity (1 mA, n = 47), high-intensity (2 mA, n = 49), and sham (n = 45) groups, receiving 42 daily tDCS sessions, including weekends and holidays, targeting the dorsolateral prefrontal cortex for 30 minutes. Assessments were conducted at baseline and weeks 2, 4, and 6. The primary outcome was cognitive improvement assessed by changes in total accuracy on the 2-back test from baseline to week 6. Secondary outcomes included changes in depressive symptoms (HAM-D), anxiety (HAM-A), and quality of life (QLES). Adverse events were monitored. This trial was registered with ClinicalTrials.gov (NCT04709952).

In the tDCS study, of 141 participants (102 [72.3%] women; mean age 35.7 years, standard deviation 12.7), 95 completed the trial. Mean changes in the total accuracy scores from baseline to week 6 were compared across the three groups using an F-test. Linear mixed-effects models examined the interaction of group and time. Results showed no significant differences among groups in cognitive or depressive outcomes at week 6. Active groups experienced more mild adverse events compared to sham but had similar rates of severe adverse events and dropout.

Home-based tDCS for MDD demonstrated no evidence of effectiveness but was safe and well-tolerated. Further research is needed to address the technical limitations, evaluate broader cognitive functions, and extend durations to evaluate its therapeutic potential.

The so called “silver tsunami” i.e. the unprecedented increase in the number of older patients often affected by multimorbidity is a serious health and socioeconomic concern for modern societies and the interconnected challenges of huge workload, premature burnout, and the shortage of primary care personnel represent a pressing issue for the near future. Addressing the complexity of this issue requires a comprehensive approach due to the scarcity of healthcare professionals in European primary care. The health and well-being of both the primary care workforce and the communities they serve are intrinsically intertwined. Enhancing working conditions is a priority: addressing issues like long hours, heavy workloads, bureaucratic demands, and burnout can enhance the appeal of rural primary care practice, attracting and retaining more professionals. Wonca Europe is actively involved in addressing this issue: in June 2023 at the WONCA Europe 2023 Conference in Brussels with the statement Shortage of European Primary Health Care Workforce and in October 2023 at the 73rd Session of the WHO Regional Committee for Europe, Astana, Kazakhstan. Policymakers, healthcare organizations and professional associations need to collaborate to develop tailored solutions that address the unique challenges faced in each region. By addressing the workload of primary care doctors and other professionals, we can enhance their professional satisfaction, improve patient outcomes, and strengthen primary care as a whole.

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Estimating the risk of developing bipolar disorder (BD) in children and adolescents (C&A) with depressive disorders is important to optimize prevention and early intervention efforts. We aimed to quantitatively examine the risk of developing BD from depressive disorders and identify factors which moderate this development.

In this systematic review and meta-analysis (PROSPERO:CRD42023431301), PubMed and Web-of-Science databases were searched for longitudinal studies reporting the percentage of C&A with ICD/DSM-defined depressive disorders who developed BD during follow-up. Data extraction, random-effects meta-analysis, between-study heterogeneity analysis, quality assessment, sub-group analyses, and meta-regressions were conducted.

Thirty-nine studies were included, including 72,371 individuals (mean age=13.9 years, 57.1% females); 14.7% of C&A with a depressive disorder developed BD after 20.4–288 months: 9.5% developed BD-I (95% CI=4.7 to 18.1); 7.7% developed BD-II (95% CI=3.2% to 17.3%); 19.8% (95% CI=9.9% to 35.6%) of C&A admitted into the hospital with a depressive disorder developed BD. Studies using the DSM (21.6%, 95% CI=20.2% to 23.1%) and studies evaluating C&A with a major depressive disorder only (19.8%, 95% CI=16.8% to 23.1%) found higher rates of development of BD. Younger age at baseline, a history of hospitalization and recruitment from specialized clinics were associated with an increased risk of developing BD at follow-up. Quality of included studies was good in 76.9% of studies.

There is a substantial risk of developing BD in C&A with depressive disorders. This is particularly the case for C&A with MDD, DSM-diagnosed depressive disorders, and C&A admitted into the hospital. Research exploring additional predictors and preventive interventions is crucial.

On its 40th anniversary, the European Psychiatric Association (EPA) held a ceremony at the EU Parliament on December 6, 2023, and published the Manifesto for the EU Elections in preparation for the upcoming EU elections in June 2024.

This manifesto outlines the key goals and priorities for advancing mental health in the EU, emphasizing the vital role of psychiatrists in shaping policies and initiatives. The presentation will focus on five main topics, highlighting the involvement of psychiatrists at the European level. These include the harmonization of mental health care delivery, the improvement of working conditions and addressing the shortage of the Mental health workforce, the promotion and harmonization of ethical standards, developing new answers to an evolving World, and promotion of research and implementation of public mental health and prevention measures.

Beyond these overarching European priorities, psychiatrists are actively engaged in national policy forums, addressing a range of issues—from developing comprehensive mental health strategies to tackling specific concerns related to vulnerable populations, children, legal aspects of treatment, and more. Achieving synergy between national and international policy efforts is crucial for the successful implementation of these initiatives, which remains the core objective of this work.

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

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Recent stressful life events (SLEs) are an established risk factor for a range of psychiatric disorders. Animal studies have shown evidence of gray matter (GM) reductions associated with stress, and previous work has found similar associations in humans. However longitudinal studies investigating the association between stress and changes in brain structure are limited.

The current study uses longitudinal data from the UK Biobank and comprises 4,543 participants with structural neuroimaging and recent SLE data (mean age = 61.5 years). We analyzed the association between recent SLEs and changes in brain structure, determined using the longitudinal FreeSurfer pipeline, focusing on total GM volume and five a priori brain regions: the hippocampus, amygdala, anterior cingulate cortex, orbitofrontal cortex, and insula. We also examined if depression and childhood adversity moderated the relationship between SLEs and brain structure.

Individuals who had experienced recent SLEs exhibited a slower rate of hippocampal decrease over time compared to individuals who did not report any SLEs. Individuals with depression exhibited smaller GM volumes when exposed to recent SLEs. There was no effect of childhood adversity on the relationship between SLEs and brain structure.

Our findings suggest recent SLEs are not directly associated with an accelerated decline in brain volumes in a population sample of older adults, but instead may alter brain structure via affective disorder psychopathology. Further work is needed to investigate the effects of stress in younger populations who may be more vulnerable to stress-induced changes, and may yet pinpoint brain regions linked to stress-related disorders.

Several years ago, the first studies were conducted in which the effects of psychedelics in low doses were tested in healthy participants. These studies focused mainly on the acute effects of LSD. Questions that remained unanswered were whether low doses have lasting effects, as well as whether they can reduce symptoms of ADHD. To answer these questions, we conducted two studies, administering LSD (15 mcg) repeatedly over 2 weeks to healthy participants and administering LSD (20 mcg) repeatedly over 6 weeks to participants with ADHD. The latter study was a multicenter trial conducted by Universitatsspital (Basel) and Maastricht University. Based on the findings of both studies, we have now planned a follow-up study in 100 individuals with ADHD who also have problems with emotion regulation and/or sleep, to get closer to an “average” ADHD population. This study, which will start later this year, aims to find markers of treatment response. Lastly, plans for a study investigating high-ventilation breathwork as a novel intervention for individuals with social anxiety symptoms will be presented. High-ventilation breathwork has the potential to induce altered states of consciousness similar to those elicited by psychedelics. This research aims to explore its therapeutic potential as a non-pharmacological alternative to psychedelics in psychiatric treatment.

K. Kuypers Grant / Research support from: Part of the work that is presented is funded by Mindmed Inc (LSD, ADHD), the Beckley Foundation (LSD, healthy volunteers), and grants from the Dutch research organisation (LSD, ADHD, biomarkers) and the Tiny Blue Dot Foundation (Breathwork, Social Anxiety).

The EPA acknowledges both the therapeutic potential of psychedelic substances and the challenges for both research and clinical implementation. Steps need to be taken towards a well-balanced policy based upon sound scientific evidence and research, aiming at safe, ethical responsible integration of psychedelic therapy available for all patients who can potentially benefit. In the EPA policy paper the importance of the psychosocial components of the treatment as well as the ethical and professional aspects playing a role in real-world implementation, are highlighted. Four recommendations are formulated for further research and clinical implementation.

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Acute health and social services for children and adolescents often struggle with youth aggression and violence. Early identification of violence risk during institutional stay can help prevent violent incidents. As such, this study assessed the predictive accuracy of the Violence Risk Assessment Checklist for Youth (V-RISK-Y) aged 12–18 in two different juvenile settings providing 24-hour services for youth. Institutions were included from child and adolescent inpatient psychiatry and residential youth care under child protective services.

A prospective, naturalistic observational study design was employed. V-RISK-Y was administered for youth admitted to four acute inpatient psychiatric units and four acute residential youth care institutions. Incidents of violence and threats during the youth’s stay were registered by institutional staff. In total, 517 youth were included in analyses, 59 of whom were registered with at least one incident of violence or threats during their stay. Area under curve (AUC) and logistic regression analyses were used to assess predictive accuracy and validity of V-RISK-Y.

For the overall sample, V-RISK-Y had good predictive accuracy, and the sum score of V-RISK-Y significantly predicted registered violent incidents. Stratified analyses indicated good predictive accuracy of V-RISK-Y for the inpatient units, but not for the residential youth care institutions.

Findings imply that V-RISK-Y is accurate in identifying violence risk for youth admitted to inpatient psychiatric units but has limited predictive accuracy in residential youth care institutions. Future research should explore approaches to correctly identify violence risk in residential care settings.

Understanding the complex relationships between brain structure, function, and behavior is a central challenge in neuroscience. This presentation aims to showcase the transformative potential of neuroimaging and bioinformatics in bridging the gap between neural mechanisms and behavior, ultimately advancing our understanding of the human brain and informing precision medicine. Recent advancements in neuroimaging and bioinformatics enable researchers to explore these relationships with unprecedented precision and scale. This presentation will provide an overview of how neuroimaging modalities can be integrated with advanced bioinformatics tools, including machine learning to uncover novel brain-behavior associations. We will discuss key applications of these methods for neuropsychiatric disorders and specific examples will be used to highlight how combining neuroimaging data with bioinformatics pipelines enhances our ability to measure brain organization at the level of a single individual. Additionally, challenges such as data complexity, standardization, and interpretability will be addressed, alongside strategies to overcome them.

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Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely used due to their profound efficacy in glycemic control and weight management. Real-world observations have revealed potential neuropsychiatric adverse events (AEs) associated with GLP-1RAs. This study aimed to comprehensively investigate and characterize these neuropsychiatric AEs with GLP-1RAs.

We analyzed GLP-1RA adverse reaction reports using the FDA Adverse Event Reporting System database. Disproportionality analysis using reporting odds ratio (ROR) identified eight categories of neuropsychiatric AEs associated with GLP-1RAs. We conducted descriptive and time-to-onset (TTO) analyses and explored neuropsychiatric AE signals among individual GLP-1RAs for weight loss and diabetes mellitus (DM) indications.

We identified 25,110 cases of GLP-1RA-related neuropsychiatric AEs. GLP-1RAs showed an association with headache (ROR 1.74, 95% confidence interval [CI] 1.65–1.84), migraine (ROR 1.28, 95%CI 1.06–1.55), and olfactory and sensory nerve abnormalities (ROR 2.44, 95%CI 1.83–3.25; ROR 1.69, 95%CI 1.54–1.85). Semaglutide showed a moderate suicide-related AEs signal in the weight loss population (ROR 2.55, 95%CI 1.97–3.31). The median TTO was 16 days (interquartile range: 3–66 days).

In this study, we identified eight potential neuropsychiatric adverse events (AEs) associated with GLP-1RAs and, for the first time, detected positive signals for migraine, olfactory abnormalities, and sensory abnormalities. We also observed positive suicide-related signals of semaglutide, in weight loss population. This study provides a reliable basis for further investigation of GLP-1RA-related neuropsychiatric AEs. However, as an exploratory study, our findings require confirmation through large-scale prospective studies.