Avoidant/Restrictive Food Intake Disorder (ARFID) was introduced as a diagnostic category in DSM-5 to describe individuals with restrictive eating behaviors without fear of weight gain, differentiating it from Anorexia Nervosa (American Psychiatric Association, DSM-5, 2013). Although prevalent in children with Autism Spectrum Disorder (ASD), ARFID’s co-occurrence with ASD and its prevalence in parents of children with ASD, particularly regarding the Broad Autism Phenotype (BAP), remains underexplored. This study investigates the prevalence of ARFID in both children diagnosed with ASD and their parents, focusing on BAP features in parents and their relationship with ARFID symptoms.

1. 1. To determine the prevalence of ARFID in parents of children diagnosed with ASD.

2. 2. To explore the relationship between ARFID symptoms and ASD symptoms in both parents and children, examining the role of BAP in parents.

A cross-sectional study was conducted at Başkent University Psychiatry Clinic. The sample consisted of 69 children aged 2-18 diagnosed with ASD and 115 parents. ARFID diagnosis was determined using structured clinical interviews and the Nine-Item ARFID Screen (NIAS), while autism symptoms were assessed using the Childhood Autism Rating Scale (CARS) for children and the Autism Spectrum Quotient (AQ) for parents. Psychosocial, anthropometric, and clinical assessments were performed, including body mass index (BMI), nutritional status, and vitamin deficiencies. Statistical analysis included t-tests, chi-square tests, and correlation analyses (SPSS 24).

The study found that 34.8% of children with ASD (n=24) and 13% of parents (n=15) were diagnosed with ARFID, significantly higher than general population estimates (3.5%, p<0.001) (Thomas et al. Curr Psychiatry Rep 2017; 19: 54). Children with ARFID scored higher on the CARS (mean=38.58, SD=7.92) compared to non-ARFID children (mean=33.73, SD=5.59), with a statistically significant difference (t=-2.878, p=0.005). Furthermore, positive correlations were found between ARFID symptoms and autism-related features in both children and parents, particularly in the AQ imagination subscale (r=0.358, p<0.01).

This study highlights a significantly higher prevalence of ARFID in children with ASD and their parents compared to the general population. The strong correlation between ARFID and ASD symptoms, particularly BAP features in parents, suggests shared neurodevelopmental pathways. These findings underscore the need for increased clinical awareness of ARFID in both ASD children and their families, as well as the importance of incorporating ARFID assessments into ASD treatment plans. Future research should focus on the genetic and developmental mechanisms linking ARFID and ASD.

None Declared

Transformation images, widely circulated on social media, depict a contrast between an ‘unideal’ body state and an ‘ideal’ one, often categorized under ‘thinspiration’ or ‘fitspiration’. Unlike ‘ideal’ images shown individually, transformation images not only showcase an ‘ideal’ physique but also suggest its attainability. Although research has found that exposure to ‘ideal’ images is linked to risk factors for eating disorders, scant research has focused on the effects of transformation images.

This study aims to investigate the impact of viewing transformation images on body dissatisfaction, weight management intentions, and emotions in adult young women.

137 Chinese adult women (mean age 21.7±3.0 years) were randomly assigned to one of four image conditions: side-by-side thinness transformation images, side-by-side fitness transformation images, thinness images shown individually, and fitness images shown individually. After baseline assessment of Body Dissatisfaction, Body Mass Index, Internalization of Thinness/Muscularity, participants underwent a 7-day Ecological Momentary Assessment. Prompts were delivered four times per day at 3 to 4-hour intervals. Each prompt included the display of an image for 5 seconds, followed by a survey assessing body dissatisfaction, weight management intentions (intentions to diet, binge eating, and work out), and emotions (positive and negative emotions). Linear mixed models were used to analyze the data, controlling for baseline assessments, autocorrelation, and within-person variability.

Fitness transformation images significantly increased intentions to diet (p < 0.05), binge eating (p < 0.01), and work out (p < 0.05) compared to fitness images shown individually (Table 1). However, this impact was not observed with thinness transformation images (Table 2). Neither thinness nor fitness transformation images had a significant impact on body dissatisfaction or emotions.

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Image 2:

Our study demonstrates that fitness transformation images have a stronger impact on weight management intentions than fitness images presented individually. This finding aligns with the cultural shift in the ideal of physical attractiveness, which now emphasizes ‘fitness’ and a ‘healthy lifestyle’ over ‘thinness’ in women. It is essential to focus on the exposure fitness transformation images on social media and to develop strategies for mitigating potential negative effects in the future.

S. Pan: None Declared, X. Zeng: None Declared, Y. Huang: None Declared, Q. Sun: None Declared, J. He Grant / Research support from: This research was partially supported by the Presidential Fund of the Chinese University of Hong Kong, Shenzhen, to Jinbo He (Grant Number: PF.01.001428)

In high-income countries, Coordinated Specialized Care for First Psychotic Episode (FEP) programs have been shown to be effective in reducing symptoms and disability. Chile guarantees universal access to these services through a national policy, but previous research indicates that evidence-based approaches are not used. Our team adapted the OnTrackNY (OTNY) program to the Chilean context, called OnTrackChile (OTCH), to evaluate its effectiveness and implementation. This summary presents preliminary results on model fidelity, one of the primary outcomes of the study.

To evaluate the fidelity of the implementation of the OTCH program in comparison with usual care services for FEP, analyzing its compliance in 18 key domains of care and its alignment with the National Mental Health Plan.

A fidelity scale was designed to guide data collection on OTCH implementation. The scale included the name and definition of each domain, along with a set of expectations. The scale assessed 18 key domains, such as staffing, team integration, communication, burden of care, service flexibility, crisis, treatment planning, prescribing, care management, working with families, and education and employment support, among others. The scale was applied in the 5 OTCH intervention sites and 8 control sites that maintained usual care included in the cluster-randomized controlled clinical trial.

OTCH sites met more than 80% of the criteria for the domains assessed in the fidelity scale, which is more than twice the compliance observed in the control sites. In domains related to the usual functioning of the centers coincident with those established in the National Mental Health Plan, OTCH intervention sites exceeded compliance standards to control sites (p<0.001). In situations where the frequency of problems was similar between both types of centers, such as suicidal risk and risky substance use, OTCH centers showed significantly better performance (p<0.001) compared to control centers.

The implementation of the OTCH model has not only allowed the introduction of specific aspects of the program, but has also improved the overall performance of the centers in key areas defined by the National Mental Health Plan. This suggests that the implementation of OTCH in the Chilean context is not only feasible, but can also improve the quality of community mental health care.

OnTrack Chile is funded by the U.S. National Institute of Mental Health (R01MH115502).

None Declared

Capturing the complex and heterogeneous clinical phenotypes across Schizophrenia Spectrum Disorders (SSD) is still challenging and Artificial Intelligence is a promising tool. In the past years, machine learning (ML) models have been developed for diagnostic classification, highlighting both neuroimaging and language measures as relevant predictors (Zucchetti et al. It J of Psy (2024). Fewer studies focused on predicting symptom severity or quality of life, based on clinical variables, but with relatively low performance (Beaudoin, et al. Schizophrenia (2022); 8.1 29; Podichetty et al. Clin and Transl Sc (2021), 14(5), 1864-1874). However, to the best of our knowledge, no previous studies have applied ML regression tasks using neurophysiological features, nor combining them with language ones.

The aim is to combine neurophysiological and language features via ML to predict symptoms severity in schizophrenia.

Forty-one individuals with a diagnosis of schizophrenia were enrolled and assessed for psychopathology, communicative-pragmatic abilities and underwent a 5-minute resting state EEG recordings.

A Least Absolute Shrinkage and Selection Operator (LASSO) regression was employed to identify significant EEG and language features, extracted through Natural Language Processing to predict symptoms severity. After feature selection, two LASSO models were built and compared: Model 1 (M1) included the most important EEG features, while Model 2 (M2) included both the most important EEG and language features.

Feature selection led to the identification of main predictors, including EEG microstates and aperiodic activity, lexical-semantic features and imageability of words.

Both models reached an acceptable performance (MSE=0.590, adj. R2= 0.344; MSE= 0.334, adj. R2 =0.582), but the Diebold-Mariano test and BIC highlighted a significant difference between M1 and M2, indicating an improved performance in predicting symptoms, when adding language features. See Fig.1 for more details

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These preliminary results identify relevant features, confirming the role of EEG and language measures as potential biomarkers for SSD. Innovatively, data also show that EEG variables alone, can reliably but only partially predict psychopathology, while the inclusion of linguistic variables further improves the model. Overall, EEG and language measures, obtained quickly through simple tasks, appear as relevant features that may discriminate clinical outcomes within SSD and implementation of ML tools mat help to guide diagnosis and refine treatments.

None Declared

This study explores whether high-dose treatment with SGA LAIs may benefit patients with schizophrenia who are inadequately controlled on a standard dose

The objectives of this study have been to evaluate the retention, effectiveness and tolerability of high doses of second-generation antipsychotic long-acting injectable formulations (SGA LAI) in the treatment of patients with severe resistant schizophrenia.

A 72-month observational, mirror-image study of patients with severe (CGI-S ≥ 5) resistant schizophrenia receiving treatment with ≥75 mg of risperidone long-acting injectable (RLAI) (N = 60), ≥175 mg of monthly paliperidone palmitate (PP) (N = 60), and ≥600 mg of aripiprazole once-monthly (AOM) (N = 30). All of the patients were previously treated with at least two different APs, with poor outcomes. Patients were eligible if deemed likely to benefit from treatment with SGA LAIs: at risk of medication non-compliance, with a lack of effectiveness, or adverse effects with previous APs. The assessment included the CGI-S, the WHO-DAS, the Medication Adherence Rating Scale (MARS), laboratory tests, weight, adverse effects, reasons for treatment discontinuation, hospital admissions and suicide attempts.

The average antipsychotic doses were: RLAI = 111.2 (9.1 SD) mg/14 days; PP = 231.2 (12.3 SD) mg eq./28 days; and AM = 780 (120 SD) mg/28 days.

Tolerability was good for all LAIs, reducing the side effects reported and the changes in biological parameters compared to previous treatments, especially in the AOM group. Weight and prolactin levels decreased in all LAI treatments; the reduction was statistically significant only among patients treated with AOM (p < 0.05). Two patients discontinued treatment due to side effects with AOM, five with PP and nine with RLAI .

There were four discontinuations with RLAI, two with PP, and one with AOM due to a lack of effectiveness. After three years, the scores decreased in CGI-S (p < 0.01) and in WHO-DAS in the four areas with all injectables. MARS increased with all LAIs (p < 0.01), especially with PP and AOM.

We report a statistically significant decrease in both hospital admissions (p <0.001) and suicide attempts (p < 0.001) at the end of 36-month treatments, compared to the previous three years, without any difference across the three LAIs. In the previous three years, 60 patients discontinued their AP treatment, and 11 during the three-year follow-up (p < 0.0001

Our study indicates the good effectiveness and tolerability of RLAI, PP and AM at high doses. These SGA LAI treatments improved treatment adherence and outcomes of the patients, with good tolerability, helping them to achieve clinical stabilization and better functioning. Therefore, we suggest that, in some illness-critical conditions, high doses of SGA LAIs could represent an alternative to clozapine.

None Declared

Psychosis is characterized by hallucinatory and delusional experiences. Although, it was mostly considered to be present among clinical populations, there is strong evidence it can also be found in the general population. Limited reviews currently exist on the quality of the assessment methods designed to evaluate psychotic-like experiences in the general population. None of them assessed whether the existing instruments measure the same construct and, consequently, neglected problems associated with the “jingle-jangle fallacy” (Weidman et al., 2017; Flake and Fried, 2020). This fallacy might account for contradictions in the literature, as well as, issues with generalizability of the results.

The goal of our study is to better understand the agreement between various instruments used to assess hallucinations and paranoia-like experiences.

We conducted a systematic search of the scales assessing hallucinations and paranoia-like experiences among the general population. Labels for the content analysis were created based on their definition in literature by the first authors and revised by another researcher. Three researchers coded each item independently of each other. We then estimated to which extent any item overlaps with any item from the other scale included in the analysis. We used Jaccard index to assess similarities between sets (from 0 with no overlap among scales) to 1 (complete overlap). The analysis was done in R and Excel.

For 263 items from 11 hallucination scales, we estimated 38 labels with a mean overlap of 0.19 (very weak). CAPS demonstrated the highest mean overlap of 0.26. The highest overlaps were observed between MUSEQ and CAPS (0.5), MUSEQ and SPQ (0.4), and between LSHS-R and RHS (0.4). For the paranoia scales, the analysis of 183 items drawn from 12 scales resulted in 18 labels. The mean overlap across these labels was 0.30 - a weak association. The PIQ exhibited the highest mean overlap at 0.42, whereas the PSQ displayed the weakest overlap with a value of 0.17.

The overlap between hallucination scales was very weak. This disparity may be due to different instruments adopt varying interpretations of the hallucination continuum (Laroi, 2012). The weak overlap in paranoia scales may be less problematic, as theoretical models and empirical data suggest a more clear continuum of suspiciousness within the general population (Freeman et al., 2005) that maps our results. It is necessary to establish certain common grounds regarding what experiences represent which sides of the continuum, both in their variability, and severity in the field.

None Declared

The human body hosts a vast array of commensal microbes known as the gut microbiota, which plays a crucial role in various physiological functions, including immune system maturation, digestion, and central nervous system development. Recent studies suggest a significant link between gut microbiota and psychiatric disorders, particularly schizophrenia. Imbalances in gut microbiota composition have been associated with symptom severity and treatment response in schizophrenia patients.

This study aims to synthesize current knowledge on the role of gut microbiota in the severity of symptoms and the prediction of treatment response in schizophrenia, highlighting its potential as a biomarker for therapeutic strategies.

We conducted a systematic literature review following PRISMA guidelines, focusing on articles published between 2014 and 2024. Using databases like PubMed and Google Scholar, we searched for keywords related to gut microbiota, schizophrenia, first episode psychosis, treatment response, and symptoms severity.

Our review included eight studies that utilized 16S rRNA sequencing to analyze fecal microbiota. The findings revealed significant correlations between specific gut microbiota profiles and the severity of psychiatric symptoms. Notably, families such as Lachnospiraceae and Bacteroidocacae were linked to increased symptom severity, while others, including Flavobacteriaceae, Enterococcaceae and Flintibacter butyricus , correlated with symptom remission. Additionally, variations in gut microbiota composition were predictive of treatment outcomes, suggesting its role as a potential biomarker for response to antipsychotic treatments.

The gut microbiota presents a promising avenue for understanding the complex interplay between microbial communities and psychiatric health. By identifying specific microbiota profiles associated with symptoms and treatment responses in schizophrenia, we can pave the way for novel personalized therapeutic approaches.

None Declared

Psychotic disorders, particularly schizophrenia, are severe mental illnesses associated with high rates of disability and functional impairment, causing significant individual burden and incurring high societal costs. Typical onset of schizophrenia is in late adolescence or early adulthood and the complex management requires often life-long pharmacological and non-pharmacological treatment. Early symptom recognition and timely intervention can improve the course of illness and result in better outcome and prognosis, effective management leads to a functional recovery. However, recent reports have identified significant gaps in access to timely assessment and shared decision-making interventions, with inadequate care pathways. In the face of an unprecedented demand for mental healthcare for young people, it can be challenging for health services to deliver high-quality mental healthcare which, according to the World Health Organization, should be timely, effective and evidence-based, safe and person-centered. The project covers nine countries in Europe.

Building on the European Brain Council Rethinking Schizophrenia Beyond The Voices Policy Report (2024), the survey and literature review aim to: (1) evaluate the effectiveness of integrated models of youth mental healthcare on a broader range of outcomes, including both mental health outcomes, such as clinical symptoms, functioning and quality of life and health service outcomes, including access and satisfaction with care in young people; and (2) identify the common components of integrated care pathways for young people with first episode psychosis.

Using the care pathway as a tool at the first step of the research, a cross-country survey was co-designed with the Board of experts and anonymously launched earlier this year. By complementing the survey, the literature review on the care pathway will address quality and continuity of care from the first onset of psychosis and schizophrenia to long-term care in the selected countries including existing guidelines and overview country health situation assessments.

Patients and mental health professionals’ insights will be collected. Obtained data will also be analysed by the stakeholders and used to formulate recommendations for policy makers, care payers, mental health professionals, patients and their families (both country specific and at the EU level).

A policy report, based on the consensus, will be released at the Brain Awareness Week 2025 with results and recommendations which will provide valuable insight into understanding the needs of patients with first-episode psychosis and defining the optimal care pathways to engage with them. In order to show that there is a progress in the field of care for schizophrenia patients, the utilization of new technologies is included.

None Declared

New treatments for negative symptoms (NS) in schizophrenia spectrum disorders (SSD) are urgently needed. NS are believed to stem from disruptions between the mesocorticolimbic dopamine system and networks for socioemotional processes. Oxytocin (OXT) enhances connectivity between the neural networks, improving social cognition and NS. Lower plasma OXT levels are linked to greater NS severity and social cognition deficits in SSD. While OXT increases social cognition in healthy individuals, its effects in SSD are inconsistent. The social salience hypothesis suggests OXT’s effect varies with social context. Our pilot study showed reduced NS with OXT administration in a positive social setting using mindfulness-based group therapy (MBGT).

This trial aims to assess the effects of combining OXT with MBGT on each of the five NS in individuals with SSD. We hypothesize that OXT nasal spray administered before MBGT will significantly reduce NS compared to placebo. The primary outcome is the change in NS, measured by the Positive and Negative Syndrome Scale (T1 - T0 score difference) after 4 weeks and as secondary outcome on the Brief Negative Symptom Scale (BNSS) as well as changes of stress and affect.

The research design is a triple-blinded, randomized, placebo-controlled study comparing OXT to placebo. Manual-based MBGT sessions, led by experienced psychotherapists, occur weekly for four weeks with groups of up to six patients. Participants receive intranasal OXT (24 I.U.) or placebo 30 minutes before sessions, aligning with the peak effect window (30-80 min) for optimal social behavior reinforcement. Plasma oxytocin levels are measured by radioimmunoassay. Recruitment will be at the Department of Psychiatry, Charité, Berlin, including both genders in mixed-sex groups, controlling for contraceptive use and menstrual cycle phase. Nasal sprays are indistinguishable. The primary outcome will be analyzed using ANCOVA, with treatment condition and training group as covariates. Based on pilot and previous study effects, a conservative effect size of f = 0.25 is assumed. With 1:1 randomization, 80% power, a 5% two-sided significance level, and a 10% drop-out rate, 140 subjects will be recruited.

This project explores how OXT augmentation enhances the positive effects of MBGT. It is expected that combining OXT with MBGT will significantly improve NS, stress, and affect in SSD patients. Preliminary results already show a significant reduction in social withdrawal and blunted affect in the OXT group compared to placebo.

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Current treatments for NS in SSD are insufficient, highlighting the urgent need for new or combined strategies. Evidence supports the benefits of augmented psychotherapy. This project could pave the way for innovative, personalized psychiatric treatment for SSD.

None Declared

Identifying early-life risk factors for chronic depression symptomology in young people, is essential to informing early targeted interventions. One highly prevalent symptom (and potential risk factor) in depression is sleep problems, such as insomnia or hypersomnia. However, most studies have measured sleep disturbances and depression symptoms at only one time point, and the prospective relationship between persistent shorter or longer sleep duration in childhood and chronic depression symptoms in adolescence through to adulthood has not been explored.

To identify whether longitudinal trajectories of persistent shorter sleep and persistent longer sleep duration between 6 months to 7 years of age, are associated with increased risk of developing chronic depression symptoms between 13-22 years of age.

Prospective associations were explored using the Avon Longitudinal Study of Parents and Children (ALSPAC), in the UK. Childhood night-time sleep duration was parent-reported at 6, 18, and 30 months and at 3.5, 4 to 5, 5 to 6, and 6 to 7 years. Depression symptoms were self-reported via the Short Mood and Feelings Questionnaire (SMFQ) at, 12.5, 13.5, 16, 17.5, 18, 21 and 22 years of age. Latent Growth Curve Analysis was used to identify longitudinal trajectories of night-time sleep duration from 6 months to 7 years of age (i.e. longer (63%), shorter (2%), average-shorter sleep (22%) and average-longer sleep (13%)) and depression symptoms (i.e. chronic (5%), non-chronic (95%)) from 13 to 22 years. Logistic regressions were conducted to identify the prospective association between persistent shorter and persistent longer sleep trajectories and chronic depression symptoms.

Preliminary results revealed that persistent shorter sleep duration across childhood was associated with increased likelihood of presenting with chronic depression symptoms, even after adjusting for the effects of sex, birthweight, maternal age, child ethnicity, family adversity and maternal socioeconomic status (OR = 1.94, 95% CIs, 1.01, 3.73 p =. 046). Persistent longer sleep however did not show significant associations.

A persistent pattern of shorter sleep duration across childhood is associated with chronic depression symptoms in adolescence through to adulthood. Sleep is a modifiable risk factor and targeted interventions for those presenting a sustained pattern of shorter sleep duration across childhood is suggested to prevent future mental health problems, such as depression.

None Declared

Targeting insomnia may have a therapeutic value for mental disturbances. Indeed, insomnia chronic nature may necessitate switching between various insomnia approaches and medications. Daridorexant is a new pharmacological option for insomnia treatment, which is a dual orexin receptor antagonist (DORA).

The aim of the present study was to treat consecutive patients with insomnia disorder with and without mental co-morbidities with this new therapeutic option and during the deprescripion of previous hypnotic medications which have failed in insomnia treatment.

Ninety consecutive patients with insomnia disorder according to the DSM-5-TR criteria (sleep condition indicator SCI<16) were treated with daridorexant 50 mg. Baseline, 1 month, and 3 month evaluations were performed. Demographic and clinical data were incorporated. Insomnia severity (Insomnia Severity Index-ISI), mood and anxiety symptoms (Beck Depression Inventory II-BDI-II, Young Mania Rating Scale-YMRS, Self Reported Anxiety Scale-SAS), and pre sleep arousal(Pre Sleep arousal Scale-PSAS) were evaluated. The evaluation of psychiatric diagnosis was conducted in accordance with the DSM-5-TR criteria (SCID-5) and the concurrent use of pharmacological therapy was taken into account. For previous insomnia treatment discontinuation, cross-tapered programs were developed following the 25% per week rule while inserting daridorexant.

The final sample included 80 patients (N° 40, 50.0% females, mean age 60 ± 13.2). Most of them (75.5%) suffered from insomnia comorbid with unipolar/bipolar depression, anxiety disorders and sedative-hypnotics use disorders. Repeated Anova analyses showed that ISI and PSAS total score decreased across time (respectively F=63.42, p<0.001, F=61.44, p<0.001). Similarly mood symptoms, anxiety symptoms significantly improved over time and after 3 months of treatment (respectively F=62.45, p<0.001, F=31.48, p<0.001, F=41.14, p<0.001, F=21.44, p<0.001). Analyses conducted on a subsample of patients with comorbid sedative-hypnotics use disorders (50%) revealed a beneficial effect on insomnia, arousal and anxiety symptoms. Multiple regression models demonstrated that the clinical improvement of anxiety symptoms was most best predicted by the improvement in emotion regulation -PSAS score at T1 and T2, and the improvement in insomnia symptoms at T1and T2.

The treatment of chronic insomnia with daridorexant improved insomnia symptoms in patients with and without mental comorbidities across time. It was particularly effective in patients with sedative-hypnotics use disorders, where we deprescribed previous sedative hypnotics including neuroleptics and sedative antodepressants. These data are in line with the data showing that sleep is involved in the regulation of the reward system.

L. Anastasio: None Declared, G. Alfi: None Declared, G. Aquino: None Declared, E. Annuzzi: None Declared, G. Cerofolini: None Declared, A. Coccoglioniti: None Declared, M. Gambini: None Declared, M. Pioltino: None Declared, G. Perugi: None Declared, A. Gemignani: None Declared, L. Palagini Consultant of: Consultancy for Laura Palagini, Bruno, Idorsia, Fidia, Pfizer, Sanofi

Daridorexant is a dual orexin receptor antagonist approved for the treatment of chronic insomnia. Phase 3 studies have demonstrated that consistent nightly use of daridorexant 50 mg significantly improved both subjective total sleep time (sTST) and daytime functioning (Insomnia Symptoms and Impacts Questionnaire [IDSIQ] sleepiness domain) at Months 1 and 3 in patients with insomnia disorder versus placebo (Mignot et al. Lancet Neurol 2022; 21 125-39).

This exploratory analysis evaluated how the effect of daridorexant on both sleep and daytime functioning are perceived by patients with insomnia over time (i.e. week by week), as compared to placebo.

In this multi-centre, double-blind trial (NCT03545191), adult (18–64y) and elderly (≥65y) patients with insomnia disorder were randomized (1:1:1) to receive daridorexant 25mg, 50mg or placebo every evening for 3 months. Patients completed daily eDiary entries throughout the study, and weekly mean changes from baseline in sTST and IDSIQ-sleepiness domain were used to assess patients’ perceived duration of sleep and daytime functioning, respectively.

Weekly mean changes from baseline of both the sTST (Figure 1) and IDSIQ-sleepiness domain (Figure 2) from Week 1 to Week 12 of treatment improved over time in all treatment groups. At each week, the observed improvements from baseline were numerically larger for daridorexant 25 and 50 mg than placebo, with the 50 mg group demonstrating the greatest response. For sTST, treatment differences versus placebo were seen from Week 1 of treatment (mean increases from baseline for 25 mg, 50 mg vs placebo of +23.83, +32.63 vs 10.07, respectively), and were maintained throughout the study. For IDSIQ-sleepiness domain scores, treatment differences vs placebo were seen from Week 1 (mean reductions from baseline for 25 mg, 50 mg vs placebo of –1.56, –1.90 vs –0.92, respectively), with further separation from placebo until Week 4.

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Image 2:

The benefits of daridorexant treatment on total time asleep and daytime functioning start to be perceived from Week 1. With consistent nightly use, efficacy on sleep and daytime functioning continued to build over the course of the 3-month treatment period, with the greatest effect being observed with daridorexant 50 mg.

T. Bakker Employee of: Idorsia Pharmaceuticals, O. Briasoulis Employee of: Idorsia Pharmaceuticals, A. Olivieri Employee of: Idorsia Pharmaceuticals, S. Pain Employee of: Idorsia Pharmaceuticals, L. Palagini Consultant of: Bruno, Fidia, Idorsia Pharmaceuticals, Pfizer, Sanofi, Pharmanutra, Neopharmed Gentili, D. Kunz Consultant of: Austrian Association of Skiing (ÖSV), Idorsia Pharmaceuticals, Speakers bureau of: AbbVie, Idorsia Pharmaceuticals, German Ministry for Economy (BMWi), Austrian Association of Skiing (ÖSV), P.-A. Geoffroy Consultant of: Apneal, Arrow, Biocodex, Dayvia, Di&Care, Idorsia Pharmaceuticals, Janssen-Cilag, Jazz pharmaceuticals, Myndblue, Mysommeil, Posos, ResilEyes, Withings, Speakers bureau of: Biocodex, Bioprojet, Ibsa, Idorsia Pharmaceuticals, Janssen-Cilag, Isis Medical, Jazz pharmaceuticals, Lundbeck, MySommeil, Withings

Sleep problems, particularly insomnia and sleep deprivation, are common among adolescents, and may increase their risk for poor psychosocial and metabolic health. Traditional classroom-based education programmes showed inconsistent results in promoting sleep behavioural changes. In contrast, enhancing training programme with experiential activities alongside classroom learning may be considered as a more sustainable means to promote healthy sleep in adolescents.

The present study evaluated the impact of a four-week enhanced sleep education programme on adolescents’ sleep quality, knowledge and behaviour, and their experience of participation.

Adolescent participants took part in the Youth Sleep Ambassadors Programme, which was designed to equip them with evidence-based information on sleep and circadian health through active learning and community outreach activities. A mixed-methods design was adopted to evaluate the programme. Participants completed self-administered questionnaires, including a sleep knowledge quiz, the Pittsburgh Sleep Quality Index (PSQI) to assess subjective sleep quality, and the Sleep Hygiene Index (SHI) to evaluate healthy sleep behaviour, before and after the programme. Additionally, two focus groups were conducted to understand participants’ experiences with the programme.

Thirteen participants, aged 15 to 17, participated in the progamme and rated the programme’s effectiveness at 4.38 out of 5. At post-programme, there were significant increases in total sleep time (baseline: 6.12hr, post: 7.31hr, p=.006) and time in bed (baseline: 6.83hr, post: 7.98hr, p=.046), in addition to a reduction in PSQI score (baseline: 5.92±1.98, post: 3.92±1.50, p=.031). There was a noticeable trend of improved sleep knowledge with a 13.5% increase in correct rate and healthy sleep behaviour (SHI: baseline: 24.4±6.76, post: 20.6±5.33). Focus groups revealed increased awareness and confidence to advocate for better sleep and mental health among peers. Participants praised the programme as professional and well-organised but expressed a preference for more experiential and research activity over classroom learning, underscoring the limitations of classroom-based sleep education.

The findings provided preliminary support for this enhanced sleep education programme as a viable strategy to engage adolescents in understanding and awareness of sleep and circadian health. Beyond traditional classroom education, self-discovery and knowledge application with experiential tasks can better develop their perspectives and advocate in their community.

None Declared

Complex post-traumatic stress disorder (cPTSD) is a clinical entity characterized not only by the typical symptoms of hyperarousal, avoidance, and flashbacks but also by disturbances in self-organization. Given the well-known association between trauma and cognitive deficits, it is common to observe a significant prevalence of such alterations among patients with cPTSD.

The aim of this study is therefore to assess cognitive functioning in response to treatment using Eye Movement Desensitization and Reprocessing (EMDR).

Fifty-eight patients were recruited and divided into two groups (28 PTSD; 23 cPTSD), to whom scales for post-traumatic symptomatology (Impact of Event Scale – revised – IES-R; Clinician-Administered PTSD Scale – CAPS), along with cognitive tests (MATRICS Consensus Cognitive Battery - MCCB), were administered. The patients were evaluated at baseline (T0) and 6 months after the completion of the last EMDR session (T6).

EMDR was effective in the treatment of post-traumatic symptomatology (IES-R; CAPS - p<0.001). The PTSD group showed improvement in the domains of verbal learning (RAVLT), visual attention (TMT-A), and working memory (CBTT) (p<0.05). The cPTSD group reported improvement in the verbal learning domain (p<0.05).

In addition to clinical symptomatology, EMDR has been shown to be effective in treating cognitive deficits in patients with PTSD and cPTSD. However, further studies are needed to confirm the results and identify the underlying mechanisms of this effect.

None Declared

Nightmares have been linked to childhood trauma and an increased risk for mental health problems, such as depression. Meanwhile, there is a high comrobdity of nightmares and insomnia. Yet relatively few studies have compared the clinical presentations of nightmares in different clinical groups. Additionally, considering the close association between childhood trauma, insomnia, and depression, there might exist potential unique interactions between childhood trauma and clinical diagnoses on nightmare experience.

This case-control study aimed to compare nightmare-related parameters (i.e., frequency, distress, severity, and impairment), and childhood trauma among adolescents with depression only (DG), insomnia only (IG), and healthy control (HG) groups. We explored the interaction between diagnosis and childhood trauma on nightmare parameters.

Participants completed a clinical interview to ascertain their eligibility. Data on demographic and clinical information, childhood trauma as assessed by the childhood trauma Questionnaire (CTQ) , and nightmare-related parameters, including nightmare frequency, nightmare distress, nightmare severity, and nightmare impairment, were analysed in the current study. Analysis of variance (ANOVA) and multivariate analysis of variance (MANOVA) were used to examine the group differences, and regression analysis was used to examine the interaction effect on study variables.

Adolescents with insomnia (N = 31; age 16.84 ± 1.88 years; female: 54.8%), female: 55.2%), depression (N = 22; age 17.50 ± 2.18 years; female: 54.5%) and healthy controls (N = 31; age 16.84 ± 1.88 years; female: 54.8%) were recruited. Compared to the HG, the IG and DG had greater nightmare distress (IG: p = .024; DG: p =.005) and nightmare impairment (IG: p = .007; DG: p = .031), but not nightmare frequency. However, only DG showed significantly higher nightmare severity (p = .038). No other significant differences were found in nightmare parameters between IG and DG (all p > .05). For childhood trauma, only DG showed significantly higher scores in emotional abuse (p =.013), emotional neglect (p = .021), and physical neglect (p = .012). No interaction effect of childhood trauma and clinical diagnosis was found on nightmare-related parameters (all p > .05).

This study showed that adolescents with insomnia or depression exhibited greater nightmare-related distress and impairment. Higher nightmare severity may be a unique characteristic in adolescents with depression but not for insomnia. Despite the depression group reporting significantly more childhood traumatic experiences, the potential interaction effect between diagnosis and childhood trauma was not observed on nightmare-related parameters. Future research may examine the relationship between the relevant variables in a larger sample size using a longitudinal design.

Y. Li: None Declared, H. F. Sit: None Declared, Y. L. Wong: None Declared, S. X. Li Grant / Research support from: This work was funded by Seed Fund for Basic Research, The University of Hong Kong and General Research Fund (Ref. 17613820), Research Grants Council, University Grants Committee, Hong Kong SAR, China.

The evaluation of trauma-related disorders is becoming increasingly significant in psychiatric assessments. According to the DSM-5, these disorders are categorized as Post-Traumatic Stress Disorder (PTSD), Acute Stress Disorder, Adjustment Disorders, Prolonged Grief Disorder, Reactive Attachment Disorder, and other specified trauma- and stressor-related disorders. International guidelines on post-traumatic symptoms report positive outcomes with trauma-focused cognitive-behavioral therapy and EMDR, as well as non-trauma-focused therapies, such as relaxation techniques. Acupuncture and acupressure techniques can be used not only for treating symptoms but also for addressing associated sleep disorders, headaches and affective disorders. These methods are clinically applied to patients with traumatic events, primarily as ear acupuncture using the NADA protocol, along with ‘Battlefield Acupuncture,’ which has been established among American soldiers. In our clinical work, we use a unique protocol called Acupuncture-Based Exposition (ABE) (Schottdorf & Musil, 2017).

The assessment of the effectiveness of the newly developed method of Acupuncture-Based Exposure (ABE).

The ABE (Acupuncture-Based Exposition) method was developed by Dr. Schottdorf and investigated by Dr. Musil and has already been clinically applied in their practice and clinic to a variety of patients. It has also been invetigated in an initial pilot study focusing on Type I trauma-related disorders, post-embitterment disorder as well as postpartum depression, and pain disorders. During ABE sessions, after a basic acupuncture treatment, patients are guided to visualize images of their traumatic experiences. The resulting physical sensations and emotions are addressed through corresponding acupuncture points until their intensity decreases. Finally, the imagined images are faded out using points on the head. Patients subsequently report a significant reduction in the burden of intrusive memories.

In an initial case series involving 24 patients with trauma-related symptoms, an average reduction in trauma-specific symptoms was observed after just 3.95 sessions, as measured by the Impact of Events Scale-Revised (IES-R), from 55.6 ± 23.0 to 16.2 ± 21.1 (Wilcoxon test: p < 0.002). Additionally, a decrease in depressive symptoms was noted, measured by the Beck Depression Inventory, from 38.3 ± 8.0 to 25.6 ± 8.0 (Wilcoxon test: p < 0.001) (Schottdorf, 2018). So far, there have been no investigations into the mechanisms of action of ABE beyond clinical experience and initial data from clinical pilot projects.

Particularly, integrating acupuncture as an adjunct to conventional treatments for mental disorders appears to offer promising results. Further clinical research in the field of acupuncture and the ABE method is necessary.

None Declared

Daridorexant, a dual orexin receptor antagonist [DORA] which works by selectively reducing the orexin-induced wake signalling, has been shown to induce a dose-dependent reduction in wake time after sleep onset [WASO] in patients with insomnia disorder (Dauvilliers et al. Ann Neurol 2020; 87 347–356).

This exploratory analysis examined the efficacy of daridorexant in reducing the duration of awakenings in each quarter of the night, when compared to placebo and to the GABA-receptor agonist zolpidem, which induces sleep through widespread CNS sedation.

This was a multi-centre, double-blind trial (NCT02839200), including adult (18–64y) patients with insomnia randomized (1:1:1:1:1:1) to placebo, daridorexant (5, 10, 25, or 50mg), or zolpidem (10mg) for 30 days. Polysomnography [PSG]-determined WASO was evaluated using descriptive statistics by quarter of the night (Q1–Q4) i.e. every 2 hours over 8 hours at Days 1 & 2, 15 & 16, and 28 & 29. Baseline was defined as the mean of the two PSG nights during the run-in period and Days 1&2 as the mean of the first two PSG treatment nights; Days 15&16 and 28&29 were defined similarly.

Dose-dependent decreases in mean change from baseline in Q1–Q4 WASO were observed with daridorexant (5–50mg) at Days 1 & 2 (Figure 1). Whereas the approved doses of daridorexant (25mg and 50mg) provided similar response to zolpidem 10mg in the first half of the night, mean reductions from baseline in WASO were numerically greater with daridorexant 50mg versus zolpidem 10mg during the second half of the night – with the difference most pronounced in the fourth quarter (mean WASO change from baseline Q3: –13.49 min versus –9.73 min; Q4: –17.51 min versus –7.81 min). Similar effects were seen at Days 15 & 16, and Days 28 & 29.

Image 1:

In patients with insomnia disorder, daridorexant reduces the duration of awakenings throughout the entire night, including the last two quarters.

B. Steiniger-Brach Employee of: Idorsia Pharmaceuticals, O. Briasoulis Employee of: Idorsia Pharmaceuticals, A. Olivieri Employee of: Idorsia Pharmaceuticals, S. Pain Employee of: Idorsia Pharmaceuticals, L. Palagini Consultant of: Bruno, Fidia, Idorsia Pharmaceuticals, Pfizer, Sanofi, Pharmanutra, Neopharmed Gentili, D. Kunz Consultant of: Austrian Association of Skiing (ÖSV), Idorsia Pharmaceuticals, Speakers bureau of: AbbVie, Idorsia Pharmaceuticals, German Ministry for Economy (BMWi), Austrian Association of Skiing (ÖSV), P.-A. Geoffroy Consultant of: Apneal, Arrow, Biocodex, Dayvia, Di&Care, Idorsia Pharmaceuticals, Janssen-Cilag, Jazz pharmaceuticals, Myndblue, Mysommeil, Posos, ResilEyes, Withings, Speakers bureau of: Biocodex, Bioprojet, Ibsa, Idorsia Pharmaceuticals, Janssen-Cilag, Isis Medical, Jazz pharmaceuticals, Lundbeck, MySommeil, Withings.

Major depressive disorder (MDD) is the single most important risk factor for suicide. Interestingly, even with a high prevalence of suicidality, not all MDD patients develop suicidal thoughts or complete suicide. Thus, it is critical to examine the risk factors that can distinguish suicidality among MDD patients.

It has been hypothesized that epigenetic marks, such as DNA methylation, can be influenced by the environment, which may play a critical role in developing depression and suicidal behavior. The present study examined genome-wide DNA methylation in the prefrontal cortex of depressed suicide (DS), depressed non-suicide (DNS), and nonpsychiatric control subjects.

Genome-wide DNA methylation was examined in the prefrontal cortex of age- and sex-matched depressed suicide, depressed non-suicide, and nonpsychiatric control subjects using 850K Infinium Methylation EPIC BeadChip. The methylation β values were generated based on normalized signal intensities and background subtraction using negative control probes and were derived as the ratio of methylation probe intensity to the overall intensity. The hyper and hypo-methylated sites were also mapped across 22 autosomes using PhenoGram Plot. The significantly differentially methylated gene lists were used to determine the functional enrichment of genes for ontological clustering and pathway analysis.

The chromosome-wise methylation sites and mapping of methylated sites based on the number of CpG content and their relative distribution from specific landmark regions of genes identified 32958 methylation sites 12574 genes in NC vs. all MDD subjects, 30852 methylation sites across 12019 genes in NC vs. DNS, 41648 methylation sites across 13941 genes in NC vs. DS, and 49848 methylation sites across 15015 genes in DNS vs. DS groups. A comparison of methylation sites showed 33129 unique methylation sites and 5451 genes in the DNS group compared to the DS group. Functional analysis suggested Oxytocin, GABA, VGFA, TNFA, and MTOR pathways associated with suicide in the MDD group.

Our data show a discrete pattern of DNA methylation, the genomic distribution of differentially methylated sites, gene enrichment, and pathways in MDD subjects who died by suicide compared to non-suicide MDD subjects and suggest that epigenetic DNA modifications could be used to distinguish suicidality in MDD patients.

None Declared

Psychiatric disorders are risk factors for suicidality, but it is also considered a multifactorial phenomenon. Genome-wide association studies may provide an insight into the etiological background of distinct phenomena along the suicidal continuum, and may also help disentangle their overlapping genetic architecture with psychiatric disorders.

Our aim was to carried out a GWAS for suicidal ideation in a well-phenotyped sample.

We conducted a genome-wide association study (GWAS) in the NewMood (New Molecules in Mood Disorders, Manchester and Budapest) database, 1820 subjects were involved (533 males, 1287 females), the suicidal ideation and behaviour were investigated with a suicide-focused item of the Brief Symptom Inventory (BSI). SNP-level association was assessed employing linear regression models, assuming additive genetic effects, using PLINK2.0, with gender, age and the first ten principal components (PCs) of the genetic data as covariates. Bonferroni-corrected significance threshold on SNP-level was p ≤ 5.0 × 10-8, and the suggestive significance threshold was p ≤ 1.0 × 10-5. GWAS results including the identified significant results were interpreted using FUMA v1.5.2.

9 SNPs were identified, 2 with genome-wide significance and 7 with suggestive significance. The most significant SNP, rs79912020 (β=, P=3.21x10-10, Chr4) was located in the MANBA gene and the other genome-wide significant variant, rs10236520 (β=, P= 1.706x10-8, Chr7) is located near the gene LOC124901613. Furthermore, we have found more important variants with suggestive significance, rs117677616 (β= , P=1.199x10-6, Chr20) is identified in PTPRT gene, rs34475 (β= , P=1.981x10-6, Chr12) is located in CFAP54, rs711180 (β= , P= 2.934x10-6, Chr12) is near the gene VWA1 and the variant rs2655484 (β= , P=5.717x10-6, Chr12) is located near the GRIP1. No genes were identified in gene-level analysis with genome-wide significance.

We identified 9 SNPs with genome-wide or suggestive significance in association with suicidal ideation, with several lines of converging evidence supporting their involvement in the development of suicide risk. MANBA gene has role in the development of unipolar depression, PTPRT is associated with appearance of major depressive disorder, and the GRIP1 gene may be considered also as a potential biomarker for suicide, as it has been previously associated with psychiatric phenotypes indirectly linked to suicidal behaviour and in patients with increasing suicidal ideation during antidepressant treatment. The prevention of the suicides is a prominent aim in mental healthcare and these new variants may be helpful in establishing novel, focused and more filters for this vulnerability.

Funding: NAP2022-I-4/2022, K143391, 2019-2.1.7-ERA-NET-2020-00005, TKP2021-EGA-25

None Declared

Suicide is a global health issue. Clinicians still have difficulties to differentiate patients who will or not commit suicide. This process is influenced by emotional and rational factors. Emotional responses (also known as countertransference) refers to what emotions clinicians experience. When working with suicidal patients, clinicians frequently experience negative emotions, such as fear, guilt and hopelessness. Clinicians’ negative emotions responses contribute to their assessment of risk. Possible factors that influence emotional responses are myths and beliefs around suicide, contributing to stigma.

This study aims to investigate the relationship between emotional responses, knowledge and stigma about suicide when providing care to suicidal patients.

An anonymous web-based survey was implemented through the software REDCap. Data were collected by snowball sampling. Participation was voluntary and participants had the ability to opt out at any time. The study was approved by the University Ethics Committee. The survey consisted of the Informed Consent Form (ICF), Sociodemographic Questionnaire, Scale of Myths, Beliefs and Attitudes About Suicide (SMBAS) - which evaluates stigma about suicide trough true or false questions. We also included the Rating Scale for Countertransference (RSCT) which evaluates the main emotional responses towards suicidal patients, divided in approach, indifference or rejection. Other questionnaires were included for future research, beyond the scope of this study.

From 210 respondents, 179 (85.2%) completed the questionnaire. Sociodemographics: 108 (60.3%) were female; 166 (92.7%) were self-declared white-colored skin; The mean age was 37.22 (SD = 12.33), with 6 (0 to 48) median years of professional life [65(36.3%) were medical residents; 112(62.6%) were already specialists, 54(48.2%) of those declared to be psychiatrists]. Psychiatrists had highest rate of correct answers (M = 28,96, SD = 1,84) in SMBAS when compared with non-psychiatrists (M = 27,86, SD = 2,39 , p = 0,008); Psychiatrists presented more emotional responses of interest (M = 2,58, SD 0,68, p < 0,001), solidarity (M = 2,81, SD 0,45, p < 0,001) and desire to help (M = 2,83, SD 0,38, p = 0,010). Non-psychiatrists presented more emotional responses of hostility (M = 0,06, SD 0,25, p = 0,040) and distance (M = 0,32, SD 0,56, p = 0,002). Psychiatrists presented more approach (p=0,03) and non-psychiatrist indifference (p=0,03).

We find preliminary evidence that psychiatrist present higher knowledge around suicide theme, having lower stigma around suicide. Psychiatrists also present more countertransference of approach and less of indifference.

None Declared