34-year-old patient with multiple sporadic and brief contacts with mental health services, which he unilaterally chooses to discontinue. He has a long history of parasuicidal behavior dating back to adolescence. The patient does not report any prior diagnoses and has no history of inpatient admissions. The patient describes experiencing social isolation, lacking contact with his family of origin, and having no significant peer relationships.

The primary goal is to improve the patient’s engagement with mental health services, particularly in a case experiencing chronic, unaddressed symptoms, by utilizing intensive and structured programs. An additional objective is to address the patient’s self-identification with suicidal ideation.

The patient’s first contact with mental health services in this region of Spain was through the emergency department following a suicidal episode. During this encounter, the clinician introduced an intensive program designed to address suicidal ideation through regular visits over a set period. The patient agreed to participate and was subsequently enrolled in the PRISURE program at HGUGM in Madrid, where he received multiple sessions each month (between 2 and 4) with both a psychiatrist and a nurse from March to June 2024.

At the beginning of the program, the patient was fixated on the idea of suicide from a romantic/nihilistic perspective, displaying a pervasive rejection of interpersonal contact and a narcissistic element in interactions. He expressed persistent suicidal ideation. Over the course of frequent visits, the patient gradually began to connect with the chronic nature of his behaviors and started to identify additional symptoms. Despite partial engagement in the program, in this case with some missing consultations, his attendance at consultations improved significantly compared to his prior behaviors. An inpatient stay was initially offered and declined by the patient; however, after further consideration, he later presented to the emergency room and agreed to inpatient treatment. During the admission, a diagnostic assessment was carried out and discussed with the patient, revealing challenges in identity, object relations, and moral functioning, which were positioned within the spectrum of personality disorders, particularly highlighting narcissistic and antisocial traits.

Initially focused on his suicidal ideation, the patient, through the PRISURE program, gradually explored underlying difficulties contributing to his suicidal behavior. This process allowed him to accept further support, ultimately leading to an inpatient stay. Potential diagnoses were discussed openly with the patient, helping him to gain a clearer understanding of his lifelong challenges and enabling him to articulate these difficulties within the therapeutic context.

None Declared

Inspired by discussions at the EPA Summer School 2024 on suicide prevention, this poster explores local strategies implemented across European nations. Emphasizing the importance of tailored approaches, the study analyses successful initiatives and community-based programs, and investigates how country-specific factors influence suicide rates. Key findings from research papers on innovative methodologies were also examined, offering insights to inform future practices in suicide prevention.

The poster aims to:

• - Present local strategies for suicide prevention across European countries, focusing on the contributions of clinicians who attended the EPA Summer School.

• - Highlight how knowledge of diverse strategies can impact clinical practice in mental health across Europe.

• - Categorization: European countries are grouped by suicide rates—high, medium, and low—using WHO and European CDC data.

• - Summarization: Local prevention strategies and programs in each group are summarized.

• - Analysis: Various socio-economic and cultural factors influencing suicide rates are discussed, including stigma, economic conditions, and access to healthcare.

• - Comparative Approach: Strategies are compared to identify common successful elements and contextual challenges.

None Declared

Suicide remains a leading cause of death worldwide, representing a significant public mental health challenge across all populations. Moreover, suicide rates are notably higher in patients following discharge from inpatient psychiatric care. Existing evidence regarding the specific risk factors for suicide in this population, however, remains contradictory. This study aims to systematically investigate those risk factors for post-discharge suicide death from a large psychiatric care facility.

To identify the risk factors associated with suicide following discharge from psychiatric care.

Data from a 15-year single-centre cohort study were linked with national death registry records. Competing risk models were employed to calculate cumulative incidence rates. Key variables analyzed included sex, age at admission, discharge diagnosis, year of admission and length of stay. Subdistribution hazard ratios for these factors were computed using Fine-Gray models.

In the sample of 18,425 discharges from 10,973 individual patients (57.03% female), a relative excess hazard to die by suicide of 1.4 additional suicides per 100,000 population the first year after discharge compared to the general population was found. That risk of suicide after discharge was significantly higher for males (SHR = 1.67; p = 0.037) as well as for patients diagnosed with affective disorders (SHR = 3.56; p = 0.017) and neurotic stress and somatoform disorders (SHR = 3.73; p = 0.024). The risk of suicide decreased significantly in more recent discharge periods (SHR = 0.93; p = 0.006). The length of hospital stay did not show a statistically significant association with suicide risk (SHR = 0.98; p = 0.834).

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Male sex and specific diagnoses, notably affective and neurotic stress and somatoform disorders, were associated with an increased risk of suicide following discharge from psychiatric care. The observed decrease in risk over time could potentially point to improvements in post-discharge patient management and or treatment. These findings underscore the necessity for enhanced risk assessment tools and targeted interventions to address suicide risk in discharged psychiatric patients.

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Research indicates that detailed and sensational media coverage of suicide can contribute to suicide mortality, known as the Werther Effect. Other research indicates that responsible reporting of suicide can promote hope and resilience, which can reduce suicidality, known as the Papageno effect. This has led to the development of responsible reporting of suicide guidelines. In Canada, these are contained in a booklet called Mindset, which was co-created by journalists and mental health experts. Mindset lists bullet-pointed recommendations for journalists, and has been widely disseminated to newsrooms, journalism schools and media professionals across the country, in tandem with educational activities aimed at journalists by suicide prevention experts.

The overall aim of this study is to assess fidelity to Mindset responsible reporting of suicide guidelines in the Canadian media over a multi-year period. A secondary objective is to assess whether fidelity to responsible reporting of suicide guidelines during the COVID-19 pandemic was significantly different to pre/post pandemic reporting of suicide.

We collected articles from 47 different Canadian national and regional news sources mentioning the word suicide on a daily basis from April 1st 2019 to March 31st 2023 (N=3,232). Each article was read and assessed for adherence to 12 key suicide reporting guidelines using a purposely-built coding sheet, derived from the Mindset guidelines. Trends in reporting were analyzed through time series analyses using a GLARMA model in R. software, including measuring for change during the COVID-19 pandemic.

Significant increases in putatively protective content were observed over the four years, including rises in the inclusion of help-seeking information and the quotation of experts. Similarly, there was a general decrease in content that is putatively harmful, for example significantly fewer articles in latter years gave a monocausal explanation of suicide, used sensational language or described in detail any suicide method. That said, fewer than one-third of articles in the final year included educational content about suicide, help-seeking information, or quotes from suicide experts. Reporting of suicide during the COVID-19 pandemic showed some positive improvements compared to pre-pandemic reporting, but these were not sustained post-pandemic.

Fidelity to responsible reporting of suicide guidelines improved over the four-year period, especially recommendations concerning putatively helpful content. However there remains room for improvement regarding inclusion of putatively protective content such as including help-seeking information and educating the public about suicide. As such, further educational outreach to journalists is needed to encourage greater inclusion of protective content, while avoiding harmful content.

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ChatGPT is a language model based on artificial intelligence (AI) that is designed to generate human-like text. It offers potential applications in automating and simplification of clinical documentation tasks, addressing the increasing administrative burden that contributes to high rates of burnout in psychiatry. As discharge summaries are typically structured and repetitive, the use of ChatGPT to automate this task could offer significant benefits, such as reducing clinical workload, improving summary quality, and preventing delays in patient discharges. However, concerns about reliability, accuracy, and ethical considerations persist.

Explore the feasibility and implications of using ChatGPT to assist in writing discharge summaries in psychiatric settings.

A narrative review was conducted by searching PubMed and Google Scholar with the keywords “ChatGPT”, “discharge” and “psychiatry”. Relevant articles, including empirical studies, case reports, reviews, and expert opinions were selected.

We found only one empirical study that evaluated psychiatric discharge summaries generated with ChatGPT-4: human-written discharge summaries were rated significantly higher in quality than those generated by ChatGPT; the ChatGPT summaries fell short, particularly in coherence and specificity of formulations, though they performed reasonably well in summarizing relevant case information. Most of the literature consisted of theoretical discussions and expert opinions related to the broader use of AI in psychiatry. Despite this, the potential benefits, such as improving the efficiency and consistency of documentation, were frequently highlighted. However, concerns related to accuracy, the need for clinician oversight, and ethical implications were consistently noted.

ChatGPT shows promise in assisting with the generation of psychiatric discharge summaries, potentially alleviating the documentation burden faced by clinicians. However, further refinement of the model, integration with electronic health records, and the establishment of clear ethical safeguards are necessary for its safe and effective use. The current lack of empirical evidence highlights the need for targeted research that should also address challenges related to data governance, patient acceptance, and error management. Additionally, studies should evaluate the direct impact on clinician workload and compare the quality of AI-generated summaries with those written by psychiatrists and residents. Such research will be essential to facilitate the broader integration of ChatGPT in real-world psychiatric practice.

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Public health and policy require effective health strategies for diverse contexts. Despite numerous studies, a gap exists in translating knowledge to real-world scenarios. The RESPOND study’s stepped-care intervention has shown efficacy in anxiety and depression among healthcare workers, recognized by the European Commission as a best practice. Conducting a pilot trial in Madrid, we aimed to address this research-to-practice gap.

After evaluating a previous randomized controlled trial, we adapted our intervention for a primary care center in Madrid, implementing it over 5-6 weeks in November-December 2023. We used two strategies: remote delivery via app or website with weekly calls, and hybrid, with group sessions instead of calls.

Gathering data included sociodemographic (age, gender, and type of job), clinical (Kessler Psychological Distress Scale, K-10), and qualitative insights through interviews, to explore implementation outcomes from Proctor’s model (Acceptability, Appropriateness, Feasibility, Fidelity, and some ideas for future large-scale implementation). We used mixed methods to analyse data. For the quantative data, we used descriptive statistics such as means, frequencies and percentages to describe the results. For qualitative data, interview transcriptions were analysed following thematic analysis guidelines.

We included 17 out of 39 healthcare workers (44%) working at the primary care center, the sample included 8 doctors, 5 medical residents, 3 nurses, and 1 social worker. Only 3 were male. Over half chose the hybrid option, with 2 dropouts. Regarding clinical information, 88% of participants initially reported psychological distress, but after the intervention, this dropped to 66%. Participants found the intervention timely and appropriate, with an average satisfaction rating of 8 out of 10.

Preliminary findings show the intervention was well-received, and both strategies were successful, reaching a broad audience. Thematic analysis of the interviews is still ongoing. Preliminary results suggest that these strategies are appropriate /feasible for the Madrilenian healthcare system.

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Digital wearable devices, such as smartphones and smartwatches, have shown potential for passively monitoring mental and physical health in individuals with Severe Mental Illness (SMI), such as schizophrenia and bipolar disorder. While research-grade devices are well studied, consumer-grade wearables could offer a more accessible alternative, though their utility in this specific context remains underexplored.

We conducted a systematic review to assess the utility of data from consumer-grade wearables in tracking and predicting changes in mental and physical health among adults with SMI. We focused on passively collected physiological data, such as sleep patterns, physical activity, and heart rate. We sought to a) identify relationships between data streams and both mental and physical health outcomes and b) recommendations for future digital phenotyping research.

A systematic review of multiple databases (Cochrane Central Register of Controlled Trials, APA PsycINFO, Embase, MEDLINE, and IEEE XPlore) was conducted in May 2024. Studies that collected passive physiological data for at least three days were included. Narrative methods were used to synthesise results across three key phenotypes: physical activity, sleep and circadian rhythms, and heart rate. Studies using invasive, or research-specific devices were excluded.

In total, 23 studies met the inclusion criteria, representing data from 12 distinct studies and more than 500 participants with SMI, mostly from high-income countries. The majority of studies used smartphones (N=15), with only eight utilizing smartwatches or other wrist-worn wearables. Eighteen studies focused on physical activity, 14 on sleep and/or circadian rhythms, and six on heart rate. We explore the findings of this study, focusing on practical recommendations for future research in the following areas: exploiting opportunities to promote physical health outcomes in SMI; greater standardization of reporting and methodologies; fine tuning longitudinal data collection and feature definition; and comparing alternative data analysis strategies.

Consumer-grade wearables hold significant promise for the passive monitoring of both mental and physical health in individuals with SMI, though current research focuses largely on psychiatric relapse prevention. The findings of this systematic review provide insights into research gaps and future research directions, including tackling physical comorbidities in this population.

L. Hassan: None Declared, C. Sawyer: None Declared, A. Milton: None Declared, J. Torous Grant / Research support from: Otsuka , Consultant of: Precision Mental Wellness, A. Casson: None Declared, A. Davies: None Declared, B. Ruiz-Yu: None Declared, J. Firth Consultant of: Atheneum, Informa, Bayer, HedoniaUSA, Strive Coaching, Angelini, ParachuteBH, and the Richmond Foundation.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that highly impacts children’s development, representing a significant challenge in pediatric healthcare. Parents of children with ASD are nowadays considered as real partners in their children’s care. Several parent-mediated interventions (PMIs) have proven to produce sustained improvements in autism symptomatology and social communication. However, widespread access to this type of intervention is still very limited mostly due to geographic and logistic constraints. The use of technology is therefore increasingly considered with the use of videoconferencing and online training modules. In this context, our team developed a novel parental coaching via E-learning (E-coaching) intended for parents of pre-school children with ASD.

The ongoing randomized controlled trial aims to evaluate the feasibility and preliminary efficacy of our E-Coaching program compared to a standard coaching and a control group with no PMI.

The present study is a monocentric randomized controlled trial with three arms (E-coaching, Standard coaching, Control) of 33 children (N=99). Feasibility was assessed across recruitment, acceptability and implementation using semi-structured interviews. The primary outcome will be the quality of parent-child interaction, measured using a range of behavioral observations and by monitoring parent and child gaze using two head-mounted eye-tracking systems during semi-structured standardized play sessions. Secondary outcomes will include child’s developmental level through neuropsychological testing, and parental wellbeing through several standardized parent-report questionnaires.

We present preliminary evidence supporting the feasibility and acceptability of the intervention, with participants reporting positive benefits on parent-child interaction. Preliminary observational data on the first families provided support for an improvement on parent-child interaction immediately after the end of the E-coaching intervention, as well as an increase of parental wellbeing.

We found initial feasibility for our E-coaching program, suggesting that parent-mediated E-learning interventions may be a promising format to implement with ASD families. Further evaluation to assess efficacy of the intervention is warranted and underway. If validated, E-coaching will enable us to reach a larger number of families and to have an early and meaningful impact on the developmental trajectory of these children, and on their quality of life.

None Declared

Previous resting-state fMRI studies have found hypoconnectivity between the areas underlying default mode and salience networks in OCD patients. A general dysconnectivity has been observed between the frontoparietal network and corticostriatal-thalamocortical loops in patients with OCD, We conducted a study to understand the neural correlates of OCD and its sub-types and compared them with healthy controls. As a part of the analysis of fMRI data, we also analyzed the resting state data for OCD patients and compared it to that of healthy controls.

To study the neural correlates of OCD using functional MRI by comparing the resting state functional connectivity in OCD patients with healthy controls.

We used the resting state functional MRI data of 8 OCD patients and compared it with 10 healthy controls. The healthy controls and patients were not age—and sex-matched. The resting state fMRI data was assessed using the CONN functional connectivity toolbox, version 15.d, in MATLAB. The Regions of interest (ROIs) were mapped using the MNI coordinate system. The functional connectivity (FC) was studied with ROI-to-ROI analysis and seed-to-voxel analysis.

1. In ROI to ROI analysis between resting state networks, only one significant result was found when FC between all the brain networks was compared. as shown in table 1 and image 1.Table 1.

2. Seed-to-voxel-based analysis revealed that at p-FWE <0.05 corrected, the left and right occipital pole and right intra-calcarine cortex were more active in OCD patients as shown in image 2.

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1. ROI TO ROI analysis: Attempts to gain control over automatic processes are taxing on the cognitive resources and effective control is lacking in OCD, which could explain higher functional connectivity in the areas linked to having selective attention for specific visual stimuli as found in our study. The lateral occipital cortex supports both visual perception and multisensory integration and visual cortices have been seen to contribute to impulsivity and disorders commonly associated with impulsivity. The rostral prefrontal area in the salience network is involved in sequence selection and evaluation and has a possible role in attention. DMN and corticostriatal networks were normal possibly due to the small sample size, patients on treatment, etc.

2. Seed to Voxel Analysis showed left as well as right occipital poles and right intra-calcarine cortex which process visual stimuli, were more active at rest in OCD patients. Some studies have highlighted deficits in visuospatial processing in OCD patients. The intra-calcarine cortex would require further research for a better understanding of its role in OCD patients.

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Fahr’s Syndrome is a rare disorder characterized by abnormal brain calcium deposits presenting as extrapyramidal signs, cognitive impairment, movement disorders, and psychiatric symptoms. Though well documented in association with hypoparathyroidism, its presentation secondary to pseudohypoparathyroidism (PHP) is exceptionally unusual.

To report a rare neuropsychiatric presentation of Fahr’s Syndrome secondary to PHP.

We report this rare case following the CARE Case Report guidelines.

A 25-year-old female was admitted to the neurology ward after a referral from the Psychiatry clinic for dysarthria, involuntary movements affecting gait and daily activities, worsening psychomotor slowing for five years & depressive symptoms for around a year. She had difficulty controlling anger for 2.5 years & 2 impulsive attempts at self-harm in the past 6 months with no suicidal intent in which she tried to slash her wrist & jump off the rooftop over verbal confrontations with family (Image1).

Neuroimaging revealed bilateral, symmetrical calcifications in basal ganglia, thalami, red nuclei, the gray matter of bilateral occipital and frontal lobes, and cerebellar hemispheres (Image 2). Image 3 shows MRI Brain (with contrast) axial section images: Altered hyperintense signals in bilateral basal ganglia & red nuclei of midbrain on T1WI, hypointense signals on T2/FLAIR, and Blooming artifacts on SWAN images.

She was diagnosed with PHP based on hypocalcemia, hyperphosphatemia, high intact parathormone (PTH), and normal Serum Vitamin D levels. The absence of Albright’s Hereditary Osteodystrophy (AHO) phenotype and normal thyroid profile suggested PHP-type 2/1B but we couldn’t perform the Ellsworth Howard test to distinguish due to the unavailability of synthetic PTH. She was treated with oral calcium supplements, oral active vitamin D (CALCITRIOL or 1, 25-DIHYDROXYCHOLECALCIFEROL), CALCIUM ACETATE, AMANTADINE, ALFACALCIDOL, and ESCITALOPRAM leading to significant improvement in depressive symptoms, and normocalcemia at one-year follow-up.

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The diagnosis and management of rare neuropsychiatric syndromes maybe challenging in low-resource settings and timely diagnosis and management necessitate looking beyond the mind-body dualism and ensuring a multidisciplinary approach. Our patient’s neurological features were overlooked at a specialist mental healthcare facility for 5 years which accentuates the significance of thorough neurological assessment during psychiatric evaluations and of incorporating neuropsychiatry and psycho-neuro-endocrinology into the training and practice of psychiatry and neurology in Pakistan. This case also provides insights into the economic barriers to the management of neuropsychiatric disorders in a lower middle-income country (LMIC), where high out-of-pocket expenditure on treatment may result in loss of follow-up.

None Declared

Schizophrenia (SCZ) is a mental disorder with as yet undefined aetiology and pathogenesis. It is currently considered as a neurodevelopmental disorder and one of the main causes of disability globally, with a prevalence of approximately 1%. About one in four individuals with SCZ is diagnosed with comorbid Cannabis Use Disorder (CUD). Aberrations in brain connectivity have been identified as contributing to the pathophysiology of SCZ.

To our knowledge, no resting-state functional magnetic resonance imaging (rs-fMRI) study has compared continued cannabis use in SCZ patients with CUD (SCZ-CUD+) vs. patients with SCZ without cannabis use (SCZ-CUD-). We hypothesised that continued cannabis use, could result in greater impairment of clinical and cognitive symptoms and in altered connectivity in the Salience Network (SaN), in striate/extended amygdala-cortical areas, and in those involved in planning and emotional control. Studying connectivity in patients with SCZ and CUD could elucidate the mechanisms underlying the development of psychotic symptoms and vulnerability to substance use relapse.

We included 14 SCZ-CUD+ and 20 SCZ-CUD- patients. All were assessed cross-sectionally through the Neurological Evaluation Scale, the Brief Assessment of Cognition in Schizophrenia, the Positive And Negative Syndrome Scale and the Clinical Global Impressions Scale-Severity, and underwent brain rs-fMRI with a 1.5 T scanner to explore functional connectivity (FC). Imaging protocol: All patients underwent a brain 1.5 T MRI scan (GE Signa Voyager) with 32-channel phased-array head coil. Beside the conventional morphological sequences, the functional MRI protocol included: 1) rs-fMRI obtained with a gradient-echo echo-planar imaging (EPI) sequence. Each scan session lasted for 6 min. 2) Structural imaging involved a sagittal three-dimensional sequence employing a magnetisation prepared rapid gradient echo (MPRAGE) over the whole brain.

CUD in SCZ patients was associated with higher impulsiveness and excitement, and lower negative symptoms and neurological soft signs (Fig.1). SCZ-CUD+ and SCZ-CUD- groups differed little on cognitive performance, except for Symbol Coding, where SCZ-CUD- outperformed SCZ-CUD+. Rs-fMRI, compared to SCZ-CUD-, showed reduced FC in patients with SCZ-CUD+ between regions of the salience network, including anterior cingulate and prefrontal cortices, and between right insula and dorsolateral prefrontal cortex and precuneus (Fig.2, Fig.3).

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Using rs-fMRI, we revealed differences in FC within the SaN between SCZ-CUD- and SCZ-CUD+. Continuous cannabis use reduces FC in cortical circuits, impacting connections already impaired in SCZ. In SCZ-CUD+ patients, altered self-relevance attribution and insular dysfunction may increase drug-related impulses and impair cognitive control.

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Despite extensive investigation, the neurophysiological underpinnings of ASD remain poorly understood; a predominant hypothesis relates to the activity of the brain’s mu-rhythm (defined as the frequency band ranging between 8–14 Hz topographically centered over the sensorimotor cortex) and the so-called “Mirror Neuron System” (MNS), considered as an execution-imagination-observation matching system. In particular, mirror neurons (MN) are bimodal neurons located in the ventral premotor cortex, discharging both when a goal-directed action is performed and when it is observed. Previous studies investigating mu-wave suppression in individuals with ASD were limited by having consistently employed video clips filmed with a fixed camera position, hence not including the potential movement of the observer towards the other person (a condition perceived as more ecological and close to reality).

Aim of this study was to investigate differences in mu-wave modulation in individuals with Autism Spectrum Disorder (ASD) without intellectual disabilities with respect to a group of neurotypical controls (NT).

Thirty individuals with ASD and thirty NT underwent an EEG recording while watching short videos depicting goal-oriented action filmed from a fixed position, zooming in on the scene, and approaching the scene by means of a steadycam. Afterwards, participants underwent a rating task to evaluate their subjective viewing experience.

Steadycam videos elicited enhanced event-related desynchronization (ERD), suggestive of an enhanced neural activity, in the NT group, and a reduced ERD in the ASD group, with respect to the other filming conditions. ASD participants also showed difficulties in returning to baseline mu-power levels after watching videos filmed from a fixed position. NT reported to feel more comfortable watching videos with movement, whereas participants with ASD did not exhibit differences between conditions.

The ecological nature of video recording (i.e., visual stimuli filmed with a steadycam) seems to have an opposite effect on the ASD an NT population, as it enhances mu-wave suppression in NT, and reduces it in individuals with ASD, bringing them to a level of desynchronization closer to the one of NT. Understanding these differences might help developing tailored interventions to support perceptual, cognitive, and social processes of people with ASD.

None Declared

Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is a hereditary cerebrovascular disorder caused by point mutations in the NOTCH3 gene located on chromosome 19. The condition is primarily characterized by three core MRI lesions: white matter hyperintensities (WMH), lacunar infarcts, and cerebral microbleeds. Unlike age-related MRI lesions, which can be attributed to multiple factors such as aging, hypertension, and diabetes, the lesions in CADASIL are linked to a single genetic cause, offering a more uniform model for studying the impact of lesion location.

This study focuses on CADASIL patients and aims to identify factors associated with dementia while examining the relationships between total WMH volume, WMH location, lacunar infarct count, cerebral microbleeds, and cognitive performance.

A total of 81 participants were included in the study. Each participant underwent both brain MRI and the CERAD neuropsychological battery. White matter hyperintensity (WMH) volume was assessed via MRI, and the WMHs were categorized by their proximity to the ventricular surface into three types: juxtaventricular (JVWMH), periventricular (PVWMH), and deep white matter hyperintensities (DWMH). DWMH included lesions located beyond 13 mm from the ventricular surface. Additionally, MRI was used to evaluate the number of lacunar infarcts and cerebral microbleeds (CMB) present.

The prevalence of dementia among CADASIL patients was 18.5%. Logistic regression analysis revealed an odds ratio of 1.078 (95% CI = 1.011–1.150) for WMH volume. Similarly, However, the number of lacunar infarcts and CMB did not demonstrate a significant relationship with dementia risk. Linear regression analysis indicated that total WMH volume was significantly linked to performance on several cognitive tests. When WMH volume was categorized by distance from the ventricular surface, JVWMH volume and PVWMH volume werr significantly associated with performance on various cognitve tests. Conversely, DWMH volume did not demonstrate a significant association with cognitive performance in CADASIL patients. The number of lacunar infarcts was correlated with performance on the trail-making test A, the Stroop word test, and the Stroop color test, while cerebral microbleeds did not show significant associations with cognitive performance.

Core MRI-detected lesions exhibit diverse impacts on cognitive function in CADASIL patients. Total WMH volume and JVWMH volume showed a significant correlation with dementia diagnosis. However, DWMH volume did not demonstrate a significant relationship with either dementia diagnosis or specific cognitive functions. The number of lacunar infarcts was notably associated with visual search speed, while CMB were not significantly connected to dementia diagnosis or any particular cognitive functions

None Declared

The detection of electrophysiological markers to differentiate patients with suicide attempts could support the efforts of clinicians to provide proper diagnosis and treatment for them, and finally reduce the suicide mortality rate.

The objective of the current study was to investigate and compare cortical functional networks from resting-state electroencephalogram in patients with suicide attempts and suicidal ideation using source-level weighted network analysis. We also examined the possibility of network features serving as biomarkers by differentiation between suicide attempts and suicidal ideation using machine learning techniques.

This study investigated source-level cortical functional networks using resting-state electroencephalography in drug-naïve depressed patients with suicide attempt and suicidal ideation. Electroencephalogram was recorded in 55 patients with suicide attempts and in 54 patients with suicidal ideation. Graph-theory-based source-level weighted functional networks were assessed using strength, clustering coefficient (CC), and path length (PL) in seven frequency bands. Finally, we applied machine learning to differentiate between the two groups using source-level network features.

There were significant differences in the three global level indices of the high alpha band. The strength and CC of the high alpha band were significantly lower in patients with suicide attempts than in those with suicide attempts ideation. In contrast, the PL of the high alpha band was significantly higher in patients with suicide attempts than in those with suicide ideation. No significant differences in the other frequency bands were between the two groups.

The nodal CCs of patients with suicide attempts were significantly lower than those of patients with suicide ideation in most regions, except for three of the 68 regions.

The best classification performance between suicide attempts and suicide ideation was an accuracy of 73.39%, a sensitivity of 76.36%, and a specificity of 70.37% with 17 features. Three of these features were global-level network indices (strength, CC, and PL) in the high alpha band; the other 14 features were high alpha band nodal level CCs in limbic, frontal, temporal, parietal,and occipital area.

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This is the first study to use electroencephalogram source level network measures, revealing that network indices for high alpha band could be potential biomarkers to distinguish betweensuicide attempts and suicide ideation in patients with depression. Moreover, our study evaluated the electroencephalogram signals immediately after fatal suicide attempts in a relatively large number of un-medicated patients.

None Declared

Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent mental disorders diagnosed in children and is characterized by complex, interacting symptoms. Although executive functioning systems are most frequently examined in functional magnetic resonance imaging (fMRI) activation studies of ADHD, atypical reward processing may also play a central role in ADHD and influence other symptoms, such as hyperactivity and impulsivity. This meta-analysis aims to advance our understanding of the neural basis of reward processing in ADHD, as measured by fMRI activation studies.

The present study aims to advance our understanding of the neural basis in reward processing in participants with ADHD by identifying aberrant functional activation in various brain regions compared with healthy controls.

We conducted a comprehensive literature search in PubMed for whole-brain, task-based fMRI activation studies comparing participants diagnosed with ADHD to healthy controls in accordance with PRISMA guidelines. We then used multilevel kernel density analysis (MKDA) with ensemble thresholding (α = .05–.0001; FWE-corrected) to explore neural activation patterns associated with ADHD across all tasks and during reward processing tasks.

We obtained 57 primary studies (N = 4,366) that met our inclusion criteria. We found that patients with ADHD (n = 1,591), relative to healthy controls (n = 2,775), exhibited statistically significant (p < .005; FWE-corrected) differential activation in multiple brain regions of the cerebral cortex and basal ganglia, including robust effects across various tasks and task-specific effects observed during reward processing.

These findings strengthen our understanding of the neural basis of reward processing in ADHD, which may inform new neurocognitive models of this heterogeneous disorder. Future studies should investigate disorder-specific and transdiagnostic neural features of ADHD and reward processing and explore clinical applications such as non-invasive brain stimulation and neurofeedback training.

None Declared

Apathy frequently occurs in older persons but its aetiology is not understood as of yet. One hypothesis, the vascular hypothesis of apathy, suggests a link between apathy and vascular factors such as cerebral small vessel disease (CSVD), that may cause lesions in the reward network of the brain. In previous studies, a cross sectional association was found between lower blood pressure (BP) and symptoms of apathy in older persons with more CSVD, potentially through reduced cerebral blood flow (CBF). However, longitudinal studies on associations between vascular factors and apathy are scarce.

We investigated whether in older persons, structural and dynamic vascular factors are associated with apathy symptoms over time. We hypothesized that a higher burden of CSVD, a lower BP and lower CBF, would be related to an increase in symptoms of apathy.

This study is a longitudinal cohort study involving community-dwelling older participants of the Discontinuation of Antihypertensive Treatment in the Elderly (DANTE) Study, all using antihypertensive treatment and with mild cognitive deficits. At baseline BP was measured and apathy was assessed with the Apathy Scale (AS, range 0-42) at baseline and after four years of follow-up (n=178). Additionally, a baseline MRI sub study (n=109) was conducted to measure CSVD and CBF. Univariate and multivariate linear regression analyses were performed using CSVD, BP and CBF as determinants and the change in Apathy Scale score over time as an outcome.

Mean age of the population was 80 years (SD 4) and 63% was female. In the MRI sub study, no significant association was found between the summary CSVD scores (β (95% CI)=0.018(-1.089-1.125), p=.975) or it’s separate features; WMH (β(95% CI)=0.012(-0.011-0.035), p=.318), CMB (β (95% CI)=-0.017(-0.605-0.572), p=.956), lacunar infarctions (β(95% CI)=-0.413(-1.266-0.440), p=.339), and a change in Apathy Scale score. Additionally, no significant association between the dynamic vascular factors; CBF (β(95% CI)=-0.029(-0.152-0.094), p=.640), systolic BP (β (95% CI)=-0.019 (-0.056-0.018), p=.310) and diastolic BP (β(95% CI)=-0.029(-0.099-0.042), p=.425), and change in Apathy Scale score was found. The multivariate linear regression model, which incorporated all the structural and dynamic vascular parameters, age, and gender, was not significant.

In older persons with mild cognitive deficits, structural and dynamic vascular factors were not associated with symptoms of apathy after four years of follow-up. Our findings thus do not support a ‘vascular apathy hypothesis’. Potentially, other factors such as life style factors confound the cross sectional association between vascular factors and apathy, or different apathy syndromes may have different aetiologies. Larger studies with less baseline vascular burden, are needed to confirm our results.

None Declared

Late-life depression (LLD) has been linked to increased likelihood of dementia, although mechanisms responsible for this association remain largely unknown. One feature frequently observed in both LLD and dementia is elevated levels of plasma inflammatory markers.

The present study aimed to compare the levels of 12 plasma inflammatory markers between older people with LLD and controls, and to explore whether these markers, along with clinical characteristics, can predict dementia in patients with LLD within 3 years of follow-up.

Using multiple linear regression with stepwise adjustment (for age, gender, smoking status, and physical comorbidities), we compared levels of plasma inflammatory markers (IL-1β, IL-1ra, IL-6, IL-10, IL-17a, IL-18, IL-33, TNFα, CD40L, IFN-γ, CCL-2 and CCL-4) between 136 older inpatients admitted to psychiatric units for LLD (PRODE cohort) and 103 cognitively healthy non-depressed controls (COGNORM cohort). In the PRODE cohort, follow-up data was available for 139 patients (of them 123 had data on baseline plasma inflammatory markers); 36 (25.9%) developed dementia by year 3. Using Cox proportional hazards regression, we explored whether inflammatory markers and clinical characteristics of LLD (age of onset, treatment response, number of episodes) predicted progression to dementia during follow-up.

Levels of IL-1ra, CCL-2, CCL-4, IFN-γ and IL-17a were significantly higher in LLD patients compared to controls in all models (See Fig 1); IL-33 was significantly elevated in most models. None of the baseline plasma inflammatory markers predicted progression from LLD to dementia. Among clinical features, only improvement in MADRS score at discharge (HR = 0.95, 95% CI 0.91-0.99) and treatment response (HR 0.45, 95%CI 0.21 – 0.98) were associated with lower chance of progression to dementia in fully adjusted models; age of onset and number of previous episodes were not significant predictors of dementia at follow-up.

Image 1:

This study demonstrated an increase in plasma inflammatory markers in LLD but did not find evidence they could predict dementia at follow-up.

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AMD is currently the main cause of deterioration in the quality of life, disability and blindness in people over the age of 50 in economically developed countries,the presence of symptoms of anxiety and/or depression may be a risk factor for the development and exacerbation of ophthalmological diseases, a risk factor for an unfavorable prognosis of the disease and one of the factors contributing to a decrease in the patient’s compliance and motivation for ophthalmological treatment

The aim was to study the prevalence of symptoms of anxiety and depression in patients with age–related macular degeneration and determine its impact on quality of life.

A continuous sampling method was used to examine 24 patients (9 men and 15 women, aged from 41 to 87 years, the average age in the group was 69.7 ± 10.8 years) with an established diagnosis of AMD, who were undergoing inpatient treatment at the Cheboksary branch of the FSAU NMIC MNTC Eye Microsurgery. Academician S.N. Fedorova” Ministry of Health of Russia, HADS, The Spielberger anxiety Questionnaire, SF-36,The results of the examination of the mental state were compared with the indicators of visual acuity

Clinically significant severity of depression symptoms was found in 4.2% of patients, mild manifestations of depression were found in 8.3%, 79.2% demonstrated moderate reactive anxiety; 12.5% of the subjects had a low level of reactive anxiety. 81.7 % of the respondents were subject to moderate and high personal anxiety. men were more prone to manifestations of both reactive (88.9% of men and 73.3% of women, respectively) and personal anxiety (100% of men and 86.7% of women, respectively), higher incidence of depression among women than among men. Patients with lower visual acuity tended to give a lower assessment of their physical health.

The results demonstrated a high prevalence of personality and reactive anxiety among patients with age-related macular degeneration. At the same time, persons with higher acuity vision was more prone to anxiety, which may probably be due to incomplete adaptation to pathology in the early stages of AMD development. A tendency was found to have a worse assessment of their physical well-being among older patients with lower visual acuity.

This study has a limitation due to the small sample of patients at the time of analysis, which dictates the need for further study of this issue.

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Historically, syphilis has been known as “the Great Imitator” due to its heterogeneous clinical manifestations. Though its incidence decreased with the widespread use of penicillin, recent data suggest a resurgence, particularly among those experiencing delays in treatment. This resurgence creates diagnostic challenges, especially when patients have coexisting psychiatric conditions like Borderline Personality Disorder (BPD).

This report explores the psychiatric and cognitive manifestations of neurosyphilis in patients with preexisting personality disorders. The primary objective is to highlight how neurosyphilis complicates psychiatric diagnosis and care and to emphasize the need for early detection and intervention.

A thorough literature review was conducted using PubMed database covering studies published from 2000 to 2023. Keywords included “neurosyphilis,” “borderline personality disorder,” “psychiatric symptoms,” “syphilis resurgence,” and “cognitive impairment.” Additionally, the case of a 35-year-old female with BPD who developed neurosyphilis is presented, demonstrating the complexities in distinguishing between overlapping psychiatric symptoms. The case also emphasizes the importance of comprehensive care.

The psychiatric symptoms of neurosyphilis, such as impulsivity, mood instability, and cognitive dysfunction, significantly overlap with those of BPD, complicating diagnosis and treatment. Literature indicates that neurosyphilis occurs in 0.5% to 2% of untreated syphilis cases. Common psychiatric manifestations of neurosyphilis—such as irritability, cognitive decline, and affective dysregulation—are often misattributed to underlying psychiatric disorders, leading to delays in proper treatment. In the case of the 35-year-old patient, her longstanding BPD symptoms, including emotional instability and impulsivity, worsened with the progression of neurosyphilis. Cognitive testing revealed mild impairment, which was consistent with the cognitive decline seen in neurosyphilis, further complicating the clinical picture.

This case underscores the critical need for timely syphilis screening, particularly for individuals with a history of untreated or inadequately treated infections. Early diagnosis and treatment of neurosyphilis can significantly improve cognitive and psychiatric outcomes while promoting overall wellness. Routine sexually transmitted disease screenings, especially in psychiatric populations, can prevent severe neuropsychiatric complications and support holistic well-being. Given the global resurgence of syphilis, a proactive approach to sexual health is essential in fostering both mental and physical health.

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Huntington’s disease (HD) is a hereditary neurodegenerative disorder marked by progressive declines in motor, cognitive, and psychiatric functions. This case report presents a 45-year-old female patient with HD who displayed significant manic symptoms, which later evolved into acute psychosis. Notably, her neuropsychiatric symptoms emerged months before motor deficits. This case aims to raise clinician awareness of the interplay between neuropsychiatric symptoms and HD.

Analyze early neuropsychiatric manifestations, particularly manic and psychotic symptoms; highlight the importance of recognizing these symptoms before the onset of motor dysfunction; and explore the neurobiological mechanisms underlying, including neurotransmitter dysregulation and structural brain changes.

A comprehensive clinical evaluation was conducted for the patient. Her psychiatric history was assessed using standardized tools, including the Young Mania Rating Scale (YMRS) and the Positive and Negative Syndrome Scale (PANSS).

Neuroimaging, including computed tomography (CT), assessed structural brain changes in regions related to mood regulation and psychosis, such as the striatum and prefrontal cortex. A literature review correlated these findings with existing research on neurobiological mechanisms in HD, focusing on neurotransmitter systems and brain morphology.

Initially, the patient exhibited manic symptoms such as elevated mood and irritability, with moderate severity noted on the YMRS. Within a month, her condition escalated to acute psychosis, featuring auditory hallucinations and paranoid delusions, as reflected by moderate PANSS scores. Neuroimaging revealed structural changes consistent with HD, including striatal atrophy and prefrontal cortex alterations. These findings supported the hypothesis of neurotransmitter dysregulation, particularly involving dopamine and serotonin.

The management plan included mood stabilizers and antipsychotics, such as valproic acid and risperidone, along with temporary benzodiazepines to manage agitation. This approach led to a significant reduction in both manic and psychotic symptoms, improving the patient’s overall quality of life through integrated psychiatric care.

This case underscores the importance of recognizing early neuropsychiatric symptoms, particularly manic and psychotic features, in HD patients. The emergence of these symptoms prior to motor dysfunction calls for heightened clinician awareness, as early identification can facilitate timely interventions and enhance patient outcomes. The observed structural brain changes and neurotransmitter dysregulation suggest underlying neurobiological mechanisms, warranting further research in the broader HD population. A multidisciplinary approach is essential for effectively managing the interplay of neuropsychiatric symptoms.

None Declared