The 3-dimensional (3D) marker-less motion capturing (MoCap) systems are an emerging technique in movement analysis. Recent studies have shown that such MoCap assessment have great potential for accurate and objective assessment of motor alterations in psychiatric patients. Gait as a fundamental gross motor function is the final motor outputs of a complex network integrating sensorimotor systems, cognitive and affective stimuli. Understanding gait alterations in catatonia patients can provide insights into their sensorimotor dysfunction and help in diagnosis and treatment in future.

The primary objective of this study is identifying gait alterations using a 3D optical marker-less MoCap system in catatonia patients (CAT) compared to non-catatonia controls (Non-CAT). We hypothesize that there will be significant reduction in the spatiotemporal parameters of gait, such as speed, stride width, stride length, step length, and cadence as well as increased gait instability in CAT group. Moreover, these alterations will be correlated with general psychomotor slowing.

In this cross-sectional study, we examined a total of 61 patients with and without catatonia diagnosis (CAT; n=22, Non-CAT; n=39) according to ICD-11. Participants were assessed with the Positive and Negative Syndrome Scale (PANSS), Northoff Catatonia Rating Scale (NCRS), the Brief Psychiatric Rating Scale (BPRS), Global Assessment of Functioning (GAF). We conducted clinical psychomotor examination with the Heidelberger Neurological Soft Sign Scale (NSS), Salpêtrière Retardation Rating Scale (SRRS) and Unified Parkinson Disease Rating Scale (UPDRS). Gait analysis were performed using a marker-less MoCap system with 8 cameras (Qualisys, Goeteborg, Sweden). Participants walked on a marked path (18 m) with a self-selected tempo during the experiment. The spatiotemporal parameters (STP) of gait were obtained automatically through Theia Software.

The two groups did not differ in age, sex, or BMI. The CAT group showed higher scores in PANNS, BPRS, NCRS and GAF (p< 0,05). We found a statistically significant difference in clinical psychomotor parameters in NSS, SAS and UPDRS between the two groups (p <0,05) and more specifically in gait subdomain of each scale. No differences were found in any of STP of gait or gait instability measurements after controlling for covariates (age, sex, BMI and medication).

Image 1:

This study exhibit a significant difference between the results of clinical psychomotor assessments and objective gait analysis through marker-less MoCap. This discrepancy suggests a potential overestimation of gait alterations in clinical evaluations. The findings underscore the importance of integrating advanced 3D MoCap technologies into the psychiatric assessment to enhance our understanding of gait alterations in mental disorders.

None Declared

Given the increasing rates of antipsychotic use in multiple psychiatric conditions, greater attention to the assessment, monitoring and documentation of their side effects is warranted. While significant attention has been provided to metabolic side effect monitoring, comparatively little is known about how clinicians screen for, document and monitor their motor side effects (i.e. parkinsonism, akathisia, dystonia and tardive dyskinesia (TD), collectively “extrapyramidal symptoms” or EPS).

This review aims to systematically assess the literature for insights into current trends in EPS monitoring practices within various mental health settings globally.

In line with our preregistered protocol (PROSPERO: CRD42023482372), we systematically searched the OVID Medline, PubMed, Embase, CINAHL and PsycINFO databases for studies published from 1998 to present day. Figure 1 shows a detailed flowchart of the selection process. Included studies were assessed for quality using a modified version of the Quality Improvement Minimum Criteria Set (QI-MQCS) and findings summarized using narrative synthesis. All stages of the review process are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.

A total of 22 studies met our inclusion criteria. Studies occurred in varied settings and employed a range of study designs. The APA and NICE guidelines were most commonly used to guide practice. Baseline monitoring rates in adult settings ranged from 0 to 54%, and 3.7 to 100% in child & adolescent settings. In studies reassessing EPS monitoring rates following practice improvement initiatives, virtually all demonstrated benefits. Screening processes and instruments varied, ranging from standardized rating scales (such as the AIMS for TD screening) to locally developed tools. In some studies, no structured tool was identified. Monitoring rates were higher when structured processes and tools were used.

Image 1:

This review demonstrates significant heterogeneity in clinical practice for the screening, documentation, and monitoring of EPS in patients prescribed antipsychotic medication in mental health settings globally. Adherence to existing guidelines was found to be poor in most settings, with practice improvements observed in virtually all settings where quality improvement initiatives were implemented. The best improvements were seen to occur after services introduced structured EPS screening tools with regular education on their use.

R. Aubry: None Declared, T. Hastings: None Declared, M. Morgan: None Declared, J. Hastings: None Declared, M. Bolton: None Declared, M. Grummell: None Declared, R. Shorr: None Declared, S. Killeen: None Declared, C. Coyne: None Declared, M. Solmi Consultant of: MS has received honoraria/has been a consultant for AbbVie, Angelini, Lundbeck, Otsuka.

Psychiatric patients, especially those with psychotic disorders, face an increased metabolic and cardiovascular risk, which ultimately leads to higher mortality from cardiovascular disease and reduced life expectancy. This is due to a multitude of risk factors, including those related to the course of the mental illness, lifestyle, socioeconomic and cultural circumstances, and the use of certain medications, such as atypical antipsychotics. This underscores the need for structured interventions during hospitalization to identify and manage these risks. Non-pharmacological interventions, such as physical activity and dietary education, have shown to be beneficial in managing weight and improving cardiovascular health. Pharmacological treatments, particularly the use of metformin and aripiprazol, have demonstrated efficacy in reducing metabolic disturbances such as weight gain, dyslipidemia, and hyperglycemia. The implementation of structured protocols to mitigate metabolic risk in psychiatric inpatients is recommended.

The main goal of the protocol is to guide the assessment, diagnosis, and therapeutic management of metabolic and cardiovascular risk factors in psychiatric inpatients. It also aims to guide the follow-up of these patients after discharge and coordination with other medical specialties.

The protocol was developed in an interdisciplinary manner, involving the specialties of Psychiatry, Endocrinology, and Internal Medicine, and is based on recent guidelines and recommendations from other countries on this matter. The protocol was also adapted to the current conditions of the psychiatric inpatient setting.

The protocol involves a thorough clinical evaluation, including medical history, physical examination, and extensive laboratory analysis to identify comorbidities. Cardiovascular risk is calculated using the SCORE2, PRIMROSE and QRISK3 models. Non-pharmacological interventions include physical activity programs and nutritional counseling, while pharmacological interventions involve adjusting antipsychotic medications, selecting antipsychotics with more favourable metabolic profiles, and the adjuvant use of medications like metformin, aripiprazol, and topiramate. These evaluations are conducted at regular intervals, including post-discharge, to assess the efficacy of these interventions.

Psychiatric inpatients, especially those on atypical antipsychotics, face significant metabolic and cardiovascular risks. A comprehensive assessment of risk factors and early intervention during hospitalization, combining lifestyle modifications and pharmacological treatments, can significantly reduce these risks and improve patient outcomes. Continued monitoring and coordination with outpatient services post-discharge are essential for sustained management of these health risks.

None Declared

Psychiatric diagnosis plays a key rol in the mental health care. One of the critical factors that influence the diagnostic process is inter-rater reliability, the degree to which different raters agree on the diagnosis when assessing the same patient. Despite the availability of standardized diagnostic manuals, variability in psychiatric diagnoses persists. The assessment of inter-rater reliability involves calculating statistical measures which quantify the level of agreement between raters beyond what would be expected by chance. Improving inter-rater reliability in psychiatric diagnoses is necessary for optimizing both patient care and research quality in mental health.

Assess inter-rater reliability across main psychiatric disorders and identify the sources of variability.

This study was performed according to the PRISMA guidelines and a total of ninety-three studies were included. Regarding inclusion criteria, (1) the articles had to focus on inter-rater reliability, (2) study participants had to have an average age greater than 18 years, and (3) the reported diagnoses had to refer to a diagnostic manual. Quality scores were assessed for all included studies (Armijo-Olivo S et al. J Eval Clin Pract. 2012; 18 12-8). Seven different meta-analysis were conducted, one for each psychiatric diagnosis detected. The heterogeneity between studies was quantified using Cochran’s Q and I2. Funnel plots was analyzed to assess the possible influence of publication and location biases (Higgins&Green. BMJ. 2011;343). To account for publication bias, the Eggers’ test and the Fail-Safe Number31 was applied.

Psychotic disorder: (k=0.70; 95% CI: 0.66-0.75) (I²=97%).

Anxiety Disorders: (k=0.65; 95% CI: 0.60-0.70) (I²=91%).

Obsessive-Compulsive Disorder (OCD): (k=0.73; 95% CI: 0.64-0.82) (I²=76%)

PTSD: (k=0.60; 95% CI: 0.52-0.66) (I² =84%).

DCA: (k=0.73; 95% CI: 0.67-0.79) (I² =76%).

two different meta-analysis were conducted because many studies used Intraclass Correlation Coefficient (ICC) as a value to express inter-rater agreement. [k=0.65 (95% CI: 0.59, 0.7)] (I2= 96%) (ICC=0.85; 95% CI: 0.82-0.87) (I² = 66%).

Image 1:

The lower Kappa for schizoaffective disorder (Kappa < 0.7) compared to other psychiatric disorders underscores the diagnostic challenges posed by this category, given its overlapping symptoms with both mood and psychotic disorders. As regards personality disorder, antisocial and borderline PD showed highest agreement potentially due to its well-defined diagnostic criteria. The lowest agreement (k=0.60) of PTSD emphasizes the variability of his clinical presentation. In conclusion, studies show variability across disorders, highlighting the need for further research to improve diagnostic accurac (Regier et al. Am J Psychiatry. 2009;166 645-50) thereby enhancing clinical and research outcomes.

None Declared

Euthanasia is an ancient theme that, especially since individual autonomy became the health paradigm in contemporary societies, has sparked profound reflections and declared dissensions between different socio-ideological quadrants. The experience of the countries where it is decriminalised shows a tendency to broaden the clinical, age and legal assumptions for its access. Older adults with psychiatric disease, a clinically and socially idiosyncratic group, where physiological weaknesses and social losses accumulate, and the chronological proximity to death becomes progressively more self-aware, are a group of particular concern.

Our research aimed to reflect on the Constitutional feasibility of Euthanasia in Portugal, make available a validated psychometric instrument to assess attitudes towards euthanasia and do a multidimensional study of the attitudes towards euthanasia of older adult patients with mixed anxiety-depressive disorder.

The field research study applied a paper questionnaire composed of a sociodemographic section and a battery of scales (to assess depression, anxiety, cognitive performance, suicide risk, therapeutic adhesion, functionality, loneliness, attitude towards euthanasia, decision pattern, personality, empathy and health status) in the Psychogeriatric Unity of Senhora da Oliveira Hospital in Portugal. The sample was collected by convenience. The multidimensional study included 114 patients and 25 controls of the same age. Six months later, a reassessment was conducted. Patients and controls were compared using descriptive statistics and a multiple-regression model.

The Constitution of the Portuguese Republic does not prohibit medically assisted death. The results support the validated scale’s usefulness and validity. Eighty-one point six per cent of patients had four or fewer years of schooling. Contrary to controls, they presented mild depressive and anxiety symptoms, loneliness feelings, worse cognitive performance, a more fragile personality, higher personal distress and a poorer health state. No statistically significant differences were found between controls and patients regarding their attitudes towards euthanasia. Patients more favourable to euthanasia had higher empathic concern, conscientiousness and fantasy and lower personal distress.

When addressing euthanasia in older adult patients with mixed anxiety and depressive disorder, it is crucial to ensure they are fully self-determinate and that all the necessary treatment and support are available. It may not be the case when the educational level is low and mild disease persists, significantly affecting their well-being and cognitive performance.

None Declared

In research, recruitment challenges are common and lead to delays and reduce sample size and power. People with schizophrenia are often described as hard to reach and retain in research, and in particular, studies targeting people with chronic comorbidities such as diabetes, meet difficulties related to recruitment.

This study aims to describe challenges and strategies to recruitment of Danish adults with schizophrenia and type 2 diabetes to a cross-sectional survey study about psychosocial health and support.

The recruitment process was tracked in a register where all relevant information was synthesized systematically. This included information on how eligible participants were identified and invited for the study and reasons for declining. Two recruitment strategies were applied for recruiting participants to complete a questionnaire: 1) Through mental health professionals in psychiatric outpatient clinics in Region Zealand, Denmark, and 2) Through phone calls to eligible participants. Descriptive analyses of the recruitment data were conducted.

Three types of challenges were found and described: 1) Identifying eligible participants, 2) Challenges with having mental health professionals to recruit, and 3) Participants’ lack of ability to complete a questionnaire. The challenges were met by several practical approaches: 1) Identifying eligible participants though electronic health records and medication types, 2) Inviting participants through phone calls, and 3) Letting participants receiving help for completing the questionnaire from a care coordinator, family/friend or researcher when needed. Approximately 15% of all eligible participants declined to take part, which indicate high willingness to participate.

Exploring different types of challenges was important for understanding the actual difficulties in recruitment, for using approaches to meet the challenges, and for detecting the high willingness to take part.

None Declared

Since October 2004, antidepressants have had a black-box warning indicating that they are associated with an increased risk of suicidal thinking, feeling, and behavior in children and adolescents. On 2nd May 2007, the United States Food and Drug Administration ordered that all antidepressant medications carry an expanded black-box warning stating an increased risk of suicidal symptoms in young adults aged 18 – 24.

The initiation of antidepressants in the young adult population present unique patient safety considerations and medicolegal risks for physicians. Unlike the triadic doctor-parent-patient relationship in a child or adolescent patient, the doctor-patient realtionship in a young adult is a dyadic one. Hence, enlisting the help of a trusted adult to supervise the young person who has been newly initiated on antidepressants is more challenging.

In this poster, we explore the unique ethical considerations in initiating antidepressants in the young adult population and the steps clinicians may take to mitigate their medicolegal risk in treating this population. The ethical considerations of autonomy, beneficence and non-maleficence are analysed. The measures an individual clinician may take in clinical decision-making and follow-up to mitigate medicolegal risk are also discussed.

A literature search was conducted to determine the clinical considerations and prescription patterns in prescribing antidepressants to young adults. The legislation surrounding medication prescription in major jurisdictions were explored. Current literature on medicolegal risk management was studied to come up with recommendations on mitigating medicolegal risk when initiating antidepresants in young adults.

Initiating antidepressants in a young adult is a collaboratively undertaken medical decision. A thorough evaluation is required to determine if antidepressant initiation is warranted. Young adults initiated on antidepressants must be closely monitored for increased suicidality. The clinician should offer to psychoeducate a member of the young adult’s support network on his diagnosis and treatment, and apprise this person of the black box warning. . If there are imminent grave risks to the young person or others, confidentiality may have to be broken. Clear detailed documentation of the clinical considerations and discussion with the young person is essential.

Initiating antidepressants in young adults presents clinicians with unique patient safety and medicoleagl risk concerns. Steps in clinical decision-making and follow-up may be undertaken by clinicians to mitigate this risk.

None Declared

Mainstream literature classifies SARS-CoV-2 positive-sensed single-stranded RNA (ssRNA), and only a few literature mentioned the method being Reverse Transcription–Polymerase Chain Reaction -- one limited to ssRNA studies without method improvement of RNA interference (Wang et al. BMC Bio 2018; 18). Studies found the 3’-to-5’ exoribonuclease activity within CoV nonstructural protein 14 (NSP14) critical for CoV high-fidelity replication (Smith & Denison, PLoS Pathog 2013; 9 e1003760), and NSP15 a distinctive endoribonuclease able to cleave both ss- and double-stranded RNA (dsRNA) effectively (Frazier et al. NA Res 2022; 50 8290-8301). While MERS-CoV inhibit oligoadenylate synthetase–ribonuclease L, protein kinase R, and interferon (IFN), CoV-2 activates the former two and induces minimal levels of IFN (Li et al. PNAS 2021; 118 e2022643118), corroborating with S2 protein’s homogeneity with HIV gp41 (Zhang & Yap JMS: THEOCHEM 2004; 677 73-76) with differentiated impacts on macrophage activities via interleukin 6 (Ascierto et al. JIC 2021; 9). Image 1 indicates the post-vaccination pericarditis is caused by negative charge interference during depolarization in NCT05711810.

Primary objective of advancing treatment designs followed the fixed effect metaanalysis model and gathered relevant data (Nikolakopoulou et al. EBMH 2014; 17 64). Secondary objective is to compare effects between presynaptic and postsynaptic treatment efficacies in order to determine infection depth for post-COVID-19-vaccination neuropathic pain to appear, and adverse events (AEs) are collected for random effects metaanalysis. Tertiary objective is to weigh the evidences whether COVID-19 is ssRNA or dsRNA.

With the framework and paradigm of sebaceous immunobiology, the pathway bypassing blood-brain barrier is found with steroidogenesis (Pachankis JP 2023; 26 615; Pachankis GJMR 2023; 23C 5-11). NCT05839236 and NCT06357104 trials’ metaanalysis are illustrated in image 2 with the observational protocol NCT06107348 in image 3.

Sebaceous (purpura and ecchymoses) AEs appeared with postsynaptic treatments with valproate, and comparatively, presynaptic treatments with gabapentin afterwards attenuated them. Presynaptic treatments of gabapentin shows superiority by the equivalence tests on neuropathic pains’ attenuation in duration and intensities. The considerations of Ca2+ channel inhibition by the adoption of gabapentin in the proton-coupled electron transport chain are consistent with the electrocardiogram indications of negative charge interference on cardiac activities.

Image 1:

Image 2:

Image 3:

Migraine AEs in NCT05711810 trial is the neuropathic pain resulted from immune activation with initial treatment. Infection depth of neuropathic pains from COVID-19 post-vaccination symptoms is extendable to the presynaptic vesicles with impacts to macrophage activities. Indirect evidences support that SARS-CoV-2 is negative-sensed dsRNA (Pachankis JCMI 2023; 6 1-4).

None Declared

Conspiracy thinking refers to the tendency to accept explanations about reality that are different from those that are most rational or best proven. This trend became a significant threat during the COVID-19 pandemic, as belief in false information about COVID-19 was an important factor inhibiting preventive actions. The tendency to think conspiratorially has also been associated with the severity of some psychopathological symptoms, such as anxiety and depressive symptoms.

The aim of the study was to assess the differences in general and COVID-19 conspiracy thinking between Polish and Spanish respondents, as well as the relationship between conspiracy thinking and the severity of anxiety and depression symptoms.

192 Polish citizens (average age of 39.7 ± 8.61 years; women: 151, men: 41) and 190 Spanish citizens (average age of 48.3 ± 10.03 years; women: 139, men: 51) were recruted. The GCBS (Brotheron, et al.), the COVID-19 CBS (Dębski, et al.) and the HADS (Zigmond & Snaith) tools were used. The Shapiro-Wilk test, the Mann-Whitney U test and Spearman’s correlation coefficient were implemented.

In Spain, the highest average score in terms of conspiracy thinking about COVID-19 was obtained by the statement: “Governments deliberately spread false information about COVID-19 in order to conceal the actual state of the pandemic” (mean = 2.784), while in Poland this statement was: “SARS-CoV-2 tests are unreliable, they may be positive in the case of infection with another virus” (mean = 2.912). Spanish citizens obtained significantly higher scores than Poles on the Malevolent global conspiracies scale (median 9 vs 8, p=0.024), as well as in two false beliefs about COVID-19: “Wearing face masks causes oxygen deficiency…” (median 3 vs 2, p=0.000) and “There is a drug that can effectively cure COVID-19 patients, but information about it is confidential…” (median 3 vs 1.5, p =0.026). Among Polish citizens, the belief: “Health workers receive financial benefits for diagnosing COVID-19…” was higher (median 2 vs. 1, p=0.000). In the Spanish group, most of the GCBS subscales correlated positively with the anxiety and depression symptoms. COVID-19 CBS also correlated with anxiety. In the Polish group positive correlations were noted between two GCBS scales and the severity of depression symptoms. There were no significant associations between GCBS and COVID-19 CBS with the anxiety symptoms in that group.

The group studied in Spain showed a significantly higher intensity of conspiracy beliefs in more issues than the group studied in Poland. At the same time, conspiracy thinking in the Spanish group showed more pronounced relationships with the severity of anxiety and depression symptoms than in the Polish group.

None Declared

Remote interaction offers new opportunities for medical-psychological rehabilitation, providing access when in-person consultations are limited. The proactive model of psychosomatic medicine, focusing on prevention and can to enable continuous monitoring and active patient engagement, crucial for those affected by post-COVID syndrome and war.

Analyze the effectiveness of a medical-psychological rehabilitation program for anxiety and depressive post-COVID disorders, as well as post-traumatic symptoms resulting from war, in the context of remote interaction.

The study sample consisted of 240 individuals with anxiety and depressive post-COVID disorders. The tools used in the study included the PHQ-9, GAD-7, and PCL-5.

By day 63, according to the PHQ-9, depression in the study group decreased to 6.942±5.073, while in the control group it remained at 15.567±6.540 (p < 0.001; t = 11.437). According to the GAD-7, anxiety reduced to 3.991±3.589 in the study group, whereas in the control group it remained higher at 12.966±3.980 (p < 0.001; t = 18.355). According to the PCL-5, PTSD symptoms decreased to 13.295±8.727 in the study group, while in the control group they remained high at 29.177±13.541 (p < 0.001; t = 10.836).

The study results indicate that the medical-psychological rehabilitation program, delivered through remote interaction, effectively reduces symptoms of depression, anxiety, and post-traumatic stress in individuals with post-COVID disorders amid wartime conditions.

None Declared

Since the outbreak of Coronavirus Disease 2019 (COVID-19) pandemic, sleep and mental health of the population have been disrupted worldwide. Predisposing, precipitating, and perpetuating factors of insomnia may signify shared mechanisms that relate insomnia symptoms to psychiatric disorders during stressful periods like pandemic. However, long term repercussions of COVID-19 pandemic on sleep features such as insomnia, and psychological health remains poorly elucidated even after the alleviation of the pandemic measures.

The current study aims to identify the longitudinal trajectory of insomnia, in terms of prevalence and associated risk factors, during and post COVID-19 pandemic era among the general population of Singapore.

Current study consists of longitudinal online and in person surveys involving two-point assessments-Phase1 (during pandemic) from May 2020-June 2021 and Phase2 (post pandemic) from October 2023-August 2024. Singapore residents aged 21 years and above, fluent in English, Chinese or Malay language participated in the study. Participants answered an interviewer-administered questionnaire across both timepoints, including Socio-Demographic information, Insomnia Severity Index, Generalised Anxiety Disorder-7, Physical Health Questionnaire, Depression Anxiety Stress Scales and Covid-19 related stressors-Exposure to Covid-19, current and future perceived risk of infection.

597 participants completed both assessments at phase1 and phase2. The prevalence of insomnia increased from 8.83% in phase2 as compared to 8.24% in phase1 (p<0.00). Those aged 50 years and above (vs 21-34 years) (p<0.02), highest educational attainment of primary school (vs University) (p<0.05), being economically inactive (vs employed) (p< 0.01), having mild levels of anxiety (p<0.007) and having severe levels of depression, anxiety or, stress (p<0.005) was seen to be significantly associated with insomnia.

Insomnia prevalence rose from 8.24% in phase1 to 8.83% in phase2 and was significantly associated with anxiety disorder, psychological distress, and perceived stress among Singapore residents in both phases. These findings could be ascribed to the failure in re-establishment of pre-COVID-19 pandemic norms, social situations and working dynamics that might have led to sleep curtailment and insomnia. Study findings can be utilised to design effective targeted interventions like cognitive behavioural therapy, therapist assisted relaxation and meditation programs to improve sleep and reduce psychological distress. Mentioned interventions can be delivered via smartphone applications enabling easy access, monitoring, delivery, and utilization by the vulnerable groups.

None Declared

Major depressive disorder (MDD) is a severe psychiatric condition with a high risk of suicide. Research on MDD and suicidality has identified structural and functional abnormalities in the cortico-limbic network as candidate biomarkers, but little is known about the temporal dynamics of these brain regions. Recently, abnormal amygdala habituation to emotional stimuli has been highlighted as a reliable fMRI phenotype linked to emotional dysregulation and increased suicide risk.

Our study aimed to assess amygdala habituation to emotional stimuli in MDD and explore differences between suicide attempters (SA) and non-attempters (nSA). Additionally, we examined the relationship between amygdala habituation and depressive symptoms.

414 MDD patients (239 SA, 175 nSA) selected from the UK Biobank underwent fMRI during a block-designed emotion processing task, including faces and shapes conditions. We obtained bilateral amygdala activation for each block using FSL. Habituation was quantified using two methods: the regression approach (REG) and First minus Last block (FmL). One sample T-tests were used to investigate whether habituation rates significantly differed from zero. Group differences were analysed using Mann-Whitney U-tests. Generalized linear models (GLM) were applied to examine relationships between habituation and depression severity, controlling for age, sex, group (SA vs. nSA), and handedness.

In both MDD and SA groups, no significant habituation was observed for either emotional or non-emotional stimuli (pFDR>.05). However, the nSA group showed significantly positive habituation rates for left amygdala in both conditions and for right amygdala in faces condition using REG (pFDR<.05), suggesting a possible sensitization process. Moreover, nSA showed significantly higher habituation rates than SA in all conditions with REG (pFDR<.01). GLM analyses revealed no significant associations with depression severity.

Our results suggest that MDD is characterized by a lack of amygdala habituation to emotional stimuli, potentially offering new insights into its pathophysiology. This biomarker may help in developing novel therapeutic strategies targeting the amygdala and its regulation within the cortico-limbic system.

The current study was supported by the Italian Ministry of Health, GR-2019-12370616.

None Declared

Depression is a leading cause of disability globally, and while conventional treatments, such as antidepressants and psychological therapy, benefit many patients, a significant proportion fail to achieve symptom relief. Ketamine has demonstrated both rapid and sustained efficacy in treating depression, especially in treatment-resistant cases. However, concerns regarding the addictive potential of ketamine during long-term depression treatment persist among clinicians.

The review aimed to assess the prevalence of addiction phenomena associated with ketamine treatment of depression in adult populations.

The review followed PRISMA guidelines and was pre-registered on PROSPERO (CD42023435468). A comprehensive search was conducted in Medline, Embase, PsycInfo and Global Health databases, with additional relevant studies identified through reference lists. Data extraction and study selection were performed by two independent reviewers. Risk of bias was assessed using appropriate tools based on study design.

Sixteen studies were included, comprising six randomised controlled trials, three single-arm open-label studies, one retrospective study, three case series and three case reports, for a total of 2174 patients. The studies employed various routes of administration, including intravenous, intramuscular, intranasal, oral and sublingual. Ketamine was administered in the racemic form, except for the studies that utilised intranasal esketamine. Four patients were reported to exhibit clear signs of tolerance to the antidepressant effects of ketamine or dependence on the drug, while the majority did not. Additionally, papers discussing addiction phenomena in studies that did not meet the inclusion criteria are also reviewed.

Despite the heterogeneity in study designs and outcome assessment methods, the review underscores the relative safety of ketamine treatment for adult patients with depression, emphasising the importance of medically supervised administration, vigilant monitoring and judicious dosing. Future long-term studies employing quantitative scales to assess dependence phenomena could contribute to strengthen the evidence for a safe and effective use of ketamine in the treatment of depression.

None Declared

While depression trajectories have been extensively studied in recent decades, research has predominantly focused on younger and middle-aged individuals, often overlooking vulnerable older patients. Classifying patients based on treatment trajectories may enhance personalized care efforts and long-term treatment management for older adults.

This study investigates the varying patterns of depression treatment trajectories and examines the influence of social factors on these trajectories in older adults initiating first-time depression treatment over a three-year period.

We conducted a nationwide cohort study using Danish registers, including all adults aged 65 and older who filled their first-time antidepressant prescriptions between 2006 and 2015 (with no prescriptions in the previous decade). Depression treatment patterns were assessed through antidepressant prescription redemptions and psychiatric hospital contacts for depression. Latent class growth modeling identified distinct treatment trajectories over the three years, while multinomial logistic regression analyzed the association between social factors and trajectory group membership.

Among the 66,540 older adults included in the study (55.2% female, mean age: 77.3 years), three unique depression treatment trajectories emerged: ‘brief treatment’ (33.7%), where treatment ended within six months; ‘gradual withdrawal’ (26.5%), where treatment tapered off over two years; and ‘persistent treatment’ (39.8%), where treatment continued throughout the three years. Association analyses showed that female sex, living alone, and residing in less-urbanized regions were associated with higher odds of membership in the persistent treatment group. In contrast, older individuals, those who were widowed or separated, and individuals of non-Danish ethnicity were associated with lower odds of membership in the persistent treatment group.

This study identifies three distinct depression treatment trajectories in older adults. Social factors such as sex, household composition, place of residence, and ethnicity were associated with treatment duration and trajectories. Tailored interventions based on patient characteristics may enhance depression care for older adults, ensuring more personalized and effective treatment strategies.

K. Ishtiak-Ahmed: None Declared, C. Rohde Grant / Research support from: CR received the 2020 Lundbeck Foundation Talent Prize, O. Köhler-Forsberg Speakers bureau of: OKF reported honoraria for lectures for Lundbeck Pharma A/S and consultant fees for WCG Clinical, all unrelated to the present work., K. Christensen : None Declared, C. Gasse: None Declared

Financial capability, which encompasses both financial competence and financial performance, is a key requirement for an autonomous and independent life. However, individuals with psychiatric disorders often report difficulties with financial capability and financial stress.

The current study aims to disclose the impact of affective disorders (AD) on financial performance using prospective data from wave 8 and wave 9 of the Survey of Health, Retirement and Ageing in Europe (SHARE).

The SHARE project includes individuals born on or before 1971 or households with at least one member meeting this age criterion. During each wave, participants reported whether they received one of 17 diagnoses, including “affective or emotional disorders, including anxiety, nervous or psychiatric problems”. Furthermore, monthly household net income and whether participants experienced difficulties in managing money, challenges in making ends meet, and their debt situation were recorded. The differences between the AD and a control group (i.e., participants without affective or neurological conditions) on monthly household net income and the three financial performances were examined for both waves. Logistic regression analyses were performed to analyze whether an AD diagnosis predicted financial performances in wave 8 and wave 9.

2,645 individuals reported an AD diagnosis in wave 8, and 47,068 were classified as controls. In wave 9, 3,574 individuals indicated having an AD diagnosis and 60,902 were classified as controls. In both waves, individuals with AD received a lower monthly household net income and reported more difficulties across all three financial performances relative to controls. Furthermore, in both waves, AD individuals reported having more debts on cars and other vehicles, debt on credit/store cards, loans, debts to relatives or friends, overdue bills, and other types of debts than controls. In wave 8, the odds of experiencing difficulties in managing money, making ends meet, and having debts were 3.61, 1.45, and 1.73 times higher, respectively, in AD individuals than in controls. A diagnosis of AD increased the likelihood of future (i.e., during wave 9) financial difficulties: 2.67, 1.38 and 1.68 times for managing money, making ends meet, and having debt, respectively.

Individuals with AD are more prone to experiencing impairments with both current and future financial performance and might face financial difficulties. The present study emphasizes the importance of recognizing financial difficulties in individuals with AD and offering financial assistance when necessary, especially since financial difficulties might exacerbate affective symptoms.

None Declared

A number of medicinal plants have produced noticeable results in depression treatment including, Rhodiola rosea and Crocus Sativus (saffron).

To evaluate the efficacy and safety of a combination of rhodiola and saffron in patients with moderate depression.

Adults with moderate depression (International Classification of Diseases [ICD-10]) of moderate intensity (Hamilton Depression Score [HAM-D] ≥ 17 and ≤ 23) were recruited (n=126; 64 students, 62 non students). Patients took 2 tablets of the supplement (i.e. 308 mg rhodiola and 30 mg saffron) or a placebo daily for 6 weeks. Main criterion was the evolution of HAM-D score between Day (D) 0 and D42. Other criteria were evolution of HAM-D, Hospital Anxiety and Depression Scale (HADS)-anxiety and HADS-depression, Patient’s Global Impression of Change (PGIC), Clinical Global Impression of severity and improvement (CGI-S and -I) at D0, D21 and D42, tolerability and compliance.

A significant 10-point decrease in HAM-D score was observed only in the supplemented non-student population between D0 and D21 (from 18.9±1.7 to 8.6±3.4 in Supplement group versus 18.5±1.8 to 11.2±4.2 in Placebo group, p=0.005). At D42, a 12-point decrease was observed in the Supplement group; the difference between the two groups being marginally significant (from 18.9±1.7 to 7.1±5.0 in Supplement group versus from 18.5±1.8 to 8.8±4.2 in Placebo group, p=0.087). The percentage of patients with a HAM-D score reduction >75% was higher in the Supplement group (p<0.05). The HAM-D score decrease was particularly marked in patients with HADS-anxiety ≥11 at D21. The distribution of patients by severity HAM-D classes (no, mild, moderate depression) was significantly different between the two groups (p<0.05 at D21 and D42), with a greater number of patients with no or mild symptoms in the Supplement group. The remission rate (HAM-D ≤ 7) was higher in this group (p<0.05 at D21 and D42). These results by classes were also found with HADS-depression scale. Results for CGI-S and CGI-I were in favor of the Supplement group (p<0.05 at D21). These results were not observed in students. Compliance and tolerability were good.

As expected, the rhodiola plus saffron combination improved psychological well-being of non-student patients with moderate depression. The poor results observed in students suggest that health professionals should ascertain the real depressive state of students confronted with stressful and/or anxiety-provoking situations linked to exams, professional future or precarity. When prescribing, clinicians should not only rely on quantitative scales, but above all on their clinical feelings.

None Declared

Major depressive disorder (MDD) is a chronic condition with recurrence rates ranging between 50-90%. MDD is also one of the leading causes of functional impairment (Moriarty AS et al. Br J Gen Pract. 2020 Jan 30;70(691):54-55). Therefore, clinical practice guidelines (CPGs) recommend continuing antidepressant treatment of MDD (6-24 months) beyond achieving clinical remission to prevent relapse. Sertraline, a selective serotonin reuptake inhibitor, is recommend as a first line agent by most CPGs in the management of MDD (Lam RW et al. Can J Psychiatry. 2024 Sep;69(9):641-687, NICE guideline Jun 2022).

To evaluate the effectiveness of sertraline in the long-term management of MDD in a real-world clinical practice setting.

A retrospective, observational study of real-world data assessed the clinical course in patients with MDD with or without comorbid anxiety disorders (N=713, female=526), who were prescribed sertraline. Data from >25 mental health centers in the USA from Holmusk’s NeuroBlu database were used to estimate the effectiveness of sertraline in patients with moderate to severe MDD (CGI-S ≥ 4, n=556, female=414). Changes in CGI-S from baseline to months 2, 3, 6, 9 and 12 following sertraline initiation were analyzed. One point or more reduction in CGI-S was regarded as improvement, one point or more CGI-S increase was by denoted as worsening. Stability was assumed where no CGI-S change was observed.

In comparison to baseline, patients showed a general trend for improvement, regardless of the available follow-up duration (Fig 1). In total, 32.7% to 41.9% patients with moderate to severe MDD showed clinically meaningful improvement across any of the time points (Fig 2).

Image 1:

Image 2:

The results from this retrospective analysis of health records suggest that sertraline is an effective treatment in the management of MDD in real-world clinical practice, even in the long-term.

First, this study only assessed patients who had CGI-S recorded at baseline and at least one additional recorded at any of the pre-defined follow-up points. As a result, patients who did not have a follow-up CGI-S value or had the value recorded outside of the pre-defined follow-up points were excluded from the study. The study also did not assess detailed MDD symptom ratings. Finally, information was lacking whether patients were treated previously in other clinical setting.

P. Purushottamahanti Employee of: Viatris, C. Correll Shareolder of: Cardio Diagnostics, Kuleon Biosciences, LB Pharma, MedLink, Mindpax, Quantic, and Terran., Grant / Research support from: Bendheim Research Foundation, Boehringer-Ingelheim, German Ministry for Education and Research; German Research Foundation; Janssen, National Institute of Mental Health (NIMH), Patient Centered Outcomes Research Institute (PCORI), Takeda, Thrasher Foundation, Speakers bureau of: AbbVie, Acadia, Adock Ingram, Alkermes, Allergan, Angelini, Aristo, Biogen, Boehringer-Ingelheim, Bristol-Meyers Squibb, Cardio Diagnostics, Cerevel, CNX Therapeutics, Compass Pathways, Darnitsa, Delpor, Denovo, Gedeon Richter, Hikma, Holmusk, IntraCellular Therapies, Jamjoom Pharma, Janssen/J&J, Karuna, LB Pharma, Lundbeck, MedInCell, Merck, Mindpax, Mitsubishi Tanabe Pharma, Maplight, Mylan, Neumora Therapeutics, Neurocrine, Neurelis, Newron, Noven, Novo Nordisk, Otsuka, PPD Biotech, Recordati, Relmada, Reviva, Rovi, Sage, Saladax, Seqirus, SK Life Science, Sumitomo Pharma America, Sunovion, Sun Pharma, Supernus, Tabuk, Takeda, Teva, Tolmar, Vertex, Viatris and Xenon Pharmaceuticals., K. Subramaniam Employee of: Viatris, B. Bayan Employee of: Viatris, N. Lipunova Employee of: Holmusk Inc., E. Palmer Employee of: Holmusk Inc., J. Yeow Employee of: Holmusk Inc., J. Wong Employee of: Holmusk Inc.

Current ketamine-based therapies for treatment-resistant depression (TRD) can induce dissociative symptoms. A novel oral prolonged-release ketamine formulation (KET01) results in a lower and delayed peak concentration of ketamine, and a higher concentration of the metabolites norketamine and hydroxynorketamine than after intravenous administration. KET01 has limited dissociative properties, compared to other ketamine formulations.

To explore the relation between dissociative and antidepressant effects of KET01.

KET01-02 (EudraCT 2021-004927-34) was a randomized, double-blind phase 2 trial in outpatients with TRD comparing adjunct 120 mg (n=42) or 240 mg (n=40) oral KET01 once-daily for 3 weeks to placebo (PBO, n=40). The primary endpoint was change from baseline on the Montgomery-Åsberg Depression Rating Scale (MADRS) total score on day 21. Dissociation was assessed using the Clinician-Administered Dissociative States Scale (CADSS).

The association between CADSS scores at 7 hours after first dosing and MADRS scores on day 4 was investigated with a statistical mediation analysis. The 7-hour timepoint was selected since it coincides with the average Tmax (time-to-peak) when the highest dissociation is expected. Depression scores at the first subsequent visit (on day 4) were selected for the analysis. It was also the time point where change in MADRS score from baseline differentiated the most between KET01 and placebo with a difference of 4.32 (p=0.006) to the benefit of KET01 – based on the model used in the mediation analysis.

The antidepressant effect of KET01 that was mediated through dissociation was estimated to the negligible -1.28% (CI: (-28%) – (+11%)).

The antidepressant effect of KET01 was achieved with minimal to no dissociation and with no significant mediation through dissociation. Our findings challenge the commonly held clinical view that some degree of dissociation is necessary to guarantee ketamine’s antidepressant effect. Instead, it appears that dissociative symptoms are merely adverse events associated with certain formulations of ketamine.

L. Arvastson Consultant of: HMNC Brain Health, E. Papanastasiou Employee of: HMNC Brain Health, K. Schmid Employee of: Develco Pharma, A. Damyanova Employee of: HMNC Brain Health, A. Glas Employee of: HMNC Brain Health, C. Strote Employee of: HMNC Brain Health, C. Eulenburg Consultant of: HMNC Brain Health, D. Gehrlach Employee of: HMNC Brain Health, K. Maiboe Consultant of: HMNC Brain Health, H. Eriksson Employee of: HMNC Brain Health

Women who experience childhood trauma may be at a greater risk of developing postpartum depression (PPD), which can result in significant harm to both mothers and their children. Few studies have longitudinally evaluated the effect of childhood trauma on PPD.

This study aimed to evaluate the impact of childhood trauma on PPD among Brazilian postpartum women.

This prospective longitudinal study was conducted with 153 women evaluated at two time points: T1 (immediate postpartum) and T2 (three months postpartum). PPD symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) and childhood trauma was assessed using the Childhood Trauma Questionnaire (CTQ). To verify the differences in PPD scores in the periods assessed and in relation to childhood trauma, generalized estimating equations (GEE) were used. EPDS scores were categorized with values ≥10 defined as the presence of PPD. Multinomial logistic regression analyses were performed to evaluate the influence of trauma on PPD risk subgroups as follows: early PPD (risk of depression at T1), late PPD (risk of depression at T2), and chronic PPD (risk of depression at T1 and T2).

The results demonstrated that women who suffered trauma in childhood had significantly higher EPDS scores at both time points evaluated when compared to women who did not suffer from trauma. However, there was no significant difference in EPDS scores over time or in the interaction between time and childhood trauma, indicating that PPD scores and the impact of childhood trauma on PPD remained constant over time. All types of childhood trauma were significantly associated with late or chronic PPD. Emotional abuse, physical abuse, and emotional neglect are significantly associated with early PPD.

The present study demonstrated that women who experienced childhood trauma had significantly greater symptoms of PPD. However, PPD symptoms did not vary between the two assessments and remained stable. Mental health screening and interventions must be adopted during pregnancy monitoring and in the postpartum period.

None Declared

Previous research suggests that sexual dysfunction (SD) can both contribute to and result from depression. Additionally, evidence indicates that antidepressants may cause SD as a side-effect. However, knowledge of SD patterns in depressed individuals at the population level remains limited.

To describe and compare the prevalence and incidence of SD during a three-year period before and after a diagnosis of depression.

Nationwide health registers in Sweden were used to identify patients diagnosed with a new-onset depressive episode (ICD-10: F32 and F33) in specialized healthcare between 2006 and 2014. SD was defined as having an SD diagnosis (ICD-10: F52.0-52.3) or a filled prescription of a drug aimed against SD (phosphodiesterase 5 inhibitor) for women and men separately. First, the prevalence of SD was calculated for the three-year period before and after the depression diagnosis. Second, annual incidence rates of SD were calculated by only including the first-ever SD event for each year during the same periods. Finally, in men, the annual incidence rates of SD were stratified by age groups (18–29, 30–49, and 50–65 years).

We identified 110,725 women (mean age 38 years) and 73,566 men (mean age 39 years) with newly diagnosed depression. Among the women, 117 had SD in the three years before the depression diagnosis, corresponding to a three-year prevalence of 0.12% (95% CI 0.10%–0.14%), whereas 192 had SD in the 3 years after the depression diagnosis, corresponding to a 3-year prevalence of 0.19%, 95% CI 0.17%–0.22%). The annual incidence of SD ranged from 0.03%–0.09% with the highest incidence in the first year after depression. Among the men, 4,299 had SD in the 3 years before the depression diagnosis, corresponding to a 3-year prevalence of 6.4% (95% CI 6.2%–6.6%), whereas 5,716 had SD in the 3 years after the depression diagnosis, corresponding to a 3-year prevalence of 8.6% (95% CI 8.4%–8.8%). The annual incidence of SD ranged from 1.4%-2.2%, with the highest incidence in the first year after depression. When stratified by age, the annual incidence of SD in men was lowest in the youngest group (18-29 years: 0.2%–0.8%) compared to the older age groups (30-49 years: 1.4%–2.6%; 50-65 years: 2.2%–3.3%).

In this study of patients with specialist treated depression, SD was significantly more commonly diagnosed and/or treated in the three-year period after the depression diagnosis than before in both women and men. Furthermore, the incidence of SD was highest in the first year after the depression diagnosis. As expected, SD was more common among men, where it also increased with age.

J. Isung Grant / Research support from: Affiliated with/employed at the center for Pharmacoepidemiology, Karolinska Institutet, which receives grants from several entities (pharmaceutical companies, regulatory authorities, contract research organizations) for the performance of drug safety and drug utilization studies., P. Karlsson Grant / Research support from: Affiliated with/employed at the center for Pharmacoepidemiology, Karolinska Institutet, which receives grants from several entities (pharmaceutical companies, regulatory authorities, contract research organizations) for the performance of drug safety and drug utilization studies., M. Schuier Employee of: Employee of J&J Innovation. The work on this study was part of the employment., V. Johansson Grant / Research support from: Affiliated with/employed at the center for Pharmacoepidemiology, Karolinska Institutet, which receives grants from several entities (pharmaceutical companies, regulatory authorities, contract research organizations) for the performance of drug safety and drug utilization studies., K. Gembert Grant / Research support from: Affiliated with/employed at the center for Pharmacoepidemiology, Karolinska Institutet, which receives grants from several entities (pharmaceutical companies, regulatory authorities, contract research organizations) for the performance of drug safety and drug utilization studies., J. Reutfors Grant / Research support from: Affiliated with/employed at the center for Pharmacoepidemiology, Karolinska Institutet, which receives grants from several entities (pharmaceutical companies, regulatory authorities, contract research organizations) for the performance of drug safety and drug utilization studies.