Clozapine is the reference treatment for resistant schizophrenia. Its pharmacokinetic characteristics (metabolism by cytochromes CYP1A2, CYP2C19, and CYP3A4, among others) as well as its pharmacodynamic properties are the source of numerous high-risk drug interactions. According to the French marketing authorization, clozapine is contraindicated with bone marrow depressants, and associations with benzodiazepines, omeprazole, fluvoxamine, and lithium require specific precautions.

Collaboration between a national multi-professional network operating in various public or private mental health hospitals (the PIC network) and a regional psychiatric research federation (FERREPSY Occitanie) enabled the implementation of a study describing the prevalence of high-risk drug associations in a large panel of French psychiatric hospitals

An observational cross-sectional study was conducted in December 2023 across 30 centers that are members of the PIC network and/or FERREPSY.

The medical records of 795 patients were analyzed by hospital pharmacists from the participating centers. Several high-risk associations with clozapine were identified. In 1.5% of cases, clozapine was associated with carbamazepine, in 1.1% of cases with omeprazole, and in 3% of cases with fluvoxamine. More frequently, associations with lithium salts were found in 15.6% of patients and with benzodiazepines in 68.3% of patients.

This study provided an overview of high-risk co-prescriptions with clozapine in French psychiatric institutions. It highlights a high prevalence of certain high-risk associations, which underscore the discrepancy between clinical practices and health agency recommendations.

None Declared

Cognitive impairments represent core features in schizophrenia, impact the functional capacity of patients, and are highly predictive of poor functional outcomes. There is a huge unmet need for improvement of these impairments, and the development of new therapies is conditioned by understanding underlying pathophysiology that is not clear enough. Kynurenic acid (KYNA) is the major matabolite of kynurenine (KYN) pathway (KP) of tryptophan (TRP) degradation, which acts as the inhibitor of NMDA and α7-nicotinic receptors that are crucial for cognitive functioning. Excessive antagonism of these receptors by KYNA is hypothesized to contribute to cognitive deficits while data indicate that proinflammatory cytokyines activate this TRP catabolic cascade.

The objective of this study was to assess correlation between blood levels of TRP, KYNA, KYN, KYN/TRP ratio, IL-8, IFN-γ, IL-1β and cognitive functioning in clinically stable schizophrenia patients.

We measured plasma concentrations of TRP, KYNA, KYN, IL-8, IFN-γ, IL-1β and conducted assessment of cognitive functioning in domains of verbal memory, working memory, attention and processing speed, motor speed, verbal fluency, and executive functions using Brief Assessment of Cognition in Schizophrenia Scale (BACS) in 64 clinically stable schizophrenia (SCZ) patients. Patients were matched by age, sex and body mass index and exclusion criteria included obesity class 2 or higher, any concomitant organic mental or neurological disorder, acute or chronic inflammatory disease, and use of immunomodulatory drugs or psychoactive substances.

A significant positive correlation was observed between BACS verbal fluency subtest score and kynurenine levels (p<0.05), along with a significant negative correlation with IL-β levels (p<0.05). There were no other significant correlations of blood levels of TRP, KYNA, KYN, KYN/TRP ratio, IL-8, and IFN-γ, and cognitive impairments in domains of verbal memory, working memory, attention and processing speed, motor speed, and executive functions.

While the relationship between KP metabolites and cognitive functioning in schizophrenia in domains of verbal and working memory is more reported, specific correlation between KYN levels and verbal fluency observed in our study is less studied and understood. Furthermore, negative correlation between IL-1β levels and verbal memory performance is a valuable finding and can be further explored in the context of suggested detrimental role of IL-1β on hippocampal neurogenesis. Our findings should be interpreted cautiously and corroborated in larger studies with parallel measurement of preferal and central levels of analyzed parameters since there are data that suggest that peripheral concentrations of TRP, KYNA, KYN, IL-8, IFN-γ, IL-1β do not mirror those in the central nervous system.

None Declared

Long-acting injectable antipsychotic treatments (LAIA) have marked a significant therapeutic advancement. For certain patients, clinical necessity may dictate that the most suitable treatment option is to initiate a 6-monthly LAIA earlier than standard protocols recommend. This can involve transitioning directly from an oral antipsychotic regimen or accelerating the switch from a monthly LAIA, a process known as alternative initiation.

The objective of this study is to describe our experience with alternative initiation protocols for 6-monthly paliperidone palmitate (PP3M) in psychotic patients, as implemented at Torrevieja University Hospital.

This retrospective descriptive study utilized a sample selected through non-probabilistic consecutive sampling over a 27-month period (n=43). The study included patients who initiated 6-monthly paliperidone palmitate treatment through an alternative approach between May 2022 and August 2024 at Torrevieja University Hospital. All alternative initiations were performed in acute patients, who were decompensated at the time of initiating PP6M treatment, with very low therapeutic adherence. A descriptive analysis was conducted, with mean and standard deviation calculated for quantitative variables, and frequencies (N) and percentages calculated for categorical variables.

Over the 27-month duration of this study, PP6M was administered to 43 patients (n=43). The average age was 41 years (SD ± 14.07). 53.49% (n=23) were male and 46.51% (n=20) female. The mean duration of disease progression was 6.67 years (SD ± 7.16). 20.9 % (n=9) of the patients were using substances with abuse potential. The diagnoses were distributed as follows: schizophrenia (32.56%), unspecified psychosis (30.23%), bipolar disorder (11.63%), delusional disorder (11.63%), borderline personality disorder (9.30%), and schizoaffective disorder (4.65%).

A total of 24 alternative initiations were made from oral antipsychotics, 15 from monthly paliperidone palmitate (PP1M), and 4 from aripiprazole LAIA 400 mg/month. During the 27-month study period, there were 4 hospital admissions and 7 visits to the emergency department.

Treatment adherence after the alternative initiation of PP3M was 72 %, with patients completing all administrations on the scheduled dates. 74% of the patients are in outpatient follow-up. One patient experienced extrapyramidal symptoms as a side effect..

The present study indicates that there is a subset of patients who may benefit from an alternative initiation with PP6M, potentially enhancing adherence due to the simplified administration regimen. Initiating PP6M as an alternative, whether transitioning from oral antipsychotics, from PP1M or from another LAIA, could be an effective approach for managing decompensated patients with very low therapeutic adherence, demonstrating excellent tolerability and improved adherence.

None Declared

Attention-Deficit/Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder and accurate diagnosis is essential but remains challenging due to the potential for malingering. Additionally, the increasing demands of a fast-paced society place, prompting quick solutions, may lead to simulated presentations or feigning. This paper examines the complexities of distinguishing genuine ADHD cases from malingering, emphasizing the need for refined diagnostic protocols. Malingering, in fact, involves deliberately fabricating symptoms to achieve a desired result, such as:

• - Academic Advantages

• - Access to Medications

• - Avoiding Responsibilities

Given all these challenges, we explored how current scientific literature addresses this issue. Inspired by the work of many colleagues, we aimed to summarize their efforts in this systematic review to propose a possible solution for collaborative improvement.

We analyzed over 296 papers from major scientific databases focusing on “malingering and ADHD” to create a comprehensive overview of this increasingly widespread problem.

The main results, after a thorough analysis of all parameters, emphasize the need for:

1. Advanced Assessment and Objective Measures: dynamic assessment techniques, combined with psychophysiological measures and parental input.

2. Enhanced Diagnostic Protocols and Tools Integration: ADHD rating scales and Symptom Validity Tests (SVTs) like TOMM (Test of Memory Malingering) and WMT (Word Memory Test) to minimize diagnostic errors, make the criteria more robust.

The following table summarizes the criteria analyzed in the 37 articles selected after a thorough review.

Traditional ADHD assessments, based heavily on self-reported symptoms, are becoming less reliable, especially with the growing trend of self-diagnosis and malingering. To address this, adding performance-based tests like TOMM and WMT is key for spotting malingering and improving diagnosis accuracy. Our study aims to elucidate this issue, which has subtle but profound implications for the quality of life of thousands of patients, who may receive a superficial diagnosis that could affect them for a lifetime, even pharmacologically.

None Declared

Hemispheric imbalance might underlie the genesis of psychosis. In patients with schizophrenia left eye dominance was higher than in control subjects. The aim of the study is to investigate sexual differences in left eye dominance as a biological marker of neuronal dysontogenesis in schizophrenic patients and control subjects. This study is part of a larger investigation project on the intriguing relations between six groups of markers of neuronal dysontogenesis - left-handedness, left-footedness, left-eyedness, minor physical anomalies, digit ratio, and cognitive (attention and memory) deficit.

Altered cerebral lateralization is a key trait found in many neurological and psychiatric disorders. This study investigates the gender difference in eye dominance between patients with schizophrenia and controls.

The study was conducted in the Clinic of Psychiatry at the University Hospital in Sofia and the State Psychiatric Hospital in Radnevo. The sample included 98 (56 men, 42 women) consecutively admitted schizophrenic inpatients with a mean age 34.45 years for men and 42.20 years for women and 82 control subjects (30 men, 52 women) with a mean age 34.70 for men and 44.50 years for women. Three tests for eye dominance were administered as performance tasks- Looking through a monocle, Hole test and Porta test.

The non-parametric Mann-Whitney test was used to analyse the data.

The mean left-eyedness is significantly higher in schizophrenic patients than in control subjects in the three eye tests: Looking through a hole - .81 vs. .39, p<.001, over two times increase; Looking through a monocle - .78 vs. .39, p<.002, two times increase; Porta test - .86 vs. .41, p<.002, over two times increase.

In male subjects the difference between schizophrenia and controls reaches statistical significance for Looking through monocle (p=.037), but does not reach statistical significance for Hole test (p=.196) and Porta test (p=.077). In contrast, all female intra-gender comparisons between schizophrenia and controls reach statistical significance- Looking through monocle (p=.013) and Porta test (p=.015) reach statistical significance at p<.05, while Hole test at p=.001.

The patients with schizophrenia have significantly higher mean left-eyedness than the controls in both sexes, but this difference is much more pronounced in women than in men for all three eye tests. Altered eye dominance in patients with schizophrenia is related to a prenatal maldevelopment and exhibits clear gender difference.

None Declared

Motor abnormalities in schizophrenia are important as they are measurable objective parameters. Neurological soft signs (NSS), which are one of the primary motor abnormalities, are minor motor and sensory abnormalities that cannot be localised to a specific brain region, reflect the areas of sensory integration, motor coordination and motor sequencing. Instrumental measures of motor abnormalities have the potential to improve detection, early intervention and treatment strategies in psychotic disorders.

Our aim in this cross-sectional study was to compare NSS in patients with treatment-resistant schizophrenia (TRS) and treatment responsive schizophrenia (non-TRS) and healthy controls (HC), and to examine the relationship of NSS with sociodemographic and clinical variables, premorbid adjustment, functioning, negative and cognitive symptoms.

30 TRS patients, 30 non-TRS patients and 30 HC were included in the study between November 2021 and November 2022. The inclusion criteria for the TRS group were to meet the criteria for resistance to antipsychotic treatment. Neurological Evaluation Scale (NES) was applied to all participants to evaluate NSS. The scale assesses impairment in four different functional areas: “sensory integration”, “motor coordination”, motor sequencing” and “other signs”. Brief Psychiatric Rating Scale (BPRS), Brief Negative Symptom Scale, General Assessment of Functioning (GAF), Clinical Global Impression-Severity Scale (CGI-S), Premorbid Adjustment Scale-Childhood (PAS), and a cognitive battery were applied to patients with schizophrenia. The authors declare that all methods used in this study adhere to the ethical guidelines of the corresponding national and institutional review boards for human research and are in alignment with the 1975 Helsinki Declaration, as updated in 2008. All participants provided written informed consent to participate in this study.

We found significant differences in the NES-Total score and all subscale scores between patients with schizophrenia and HC (all comparisons p<0,001). NSS in patients with schizophrenia were found to be higher than in HC. TRS had higher NES-Total (p=0,002), NES-Sensory Integration (p=0,001), and NES-Other Signs (p<0,001) scores than non-TRS. NES-Total score was negatively correlated with GAF score and positively correlated with BPRS, CGI-S and PAS-childhood scores. Poor performance on cognitive tests was associated with more NSS. Only the sensory integration deficits were found to be associated with negative symptoms.

Our findings suggest that NSS examination in patients with schizophrenia may indicate treatment resistance or response. NSS are associated with severity of illness, lower functioning, poor premorbid adjustment, and poor cognitive performance. Longitudinal studies involving larger samples are needed to understand the course of NSS at different stages of the illness.

None Declared

Schizophrenia frequently coexists with substance use disorders, especially cannabis use disorder (CUD). Importantly, cannabis use is known to further exacerbate symptoms, leading to more frequent and severe psychotic episodes, longer hospital stays and poorer overall treatment outcomes. The lifetime risk of relapse is around 60%. Therefore, the treatment of patients with multiple episodes is even more challenging

To evaluate the effectiveness of cariprazine in schizophrenia patients with multiple episodes and comorbid cannabis use disorder.

This was a 6-month, multi-centre, observational study conducted at six institutions in Spain. The study included adult outpatients aged 18 to 65 years, diagnosed with schizophrenia and cannabis use disorder according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, who were receiving cariprazine treatment based on medical judgment. Exclusion criteria included pregnant or breastfeeding women and patients with co-existing medical conditions that could potentially skew the study results.

The study evaluated changes in schizophrenia symptoms using the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression-Schizophrenia (CGI-SCH), as well as changes in CUD symptoms based on the Cannabis Abuse Screening Test (CAST) and the Severity of Dependence Scale (SDS). This post-hoc analysis focused on patients with multiple episodes. Patient characteristics were summarized using descriptive statistics. Least squares (LS) means were calculated for the change from treatment start to treatment end for PANSS, CGI-SCH, CAST, SDS using a mixed model for repeated measures. All analyses were conducted using SAS.

From the cohort, 38 (65%) patients had multiple episodes. The mean age of these patients was 36.5 and 65.8% of them was male. Most patients received 4.5 mg/day cariprazine at baseline (60.5%). Half of the patients also took concomitant antidepressants and/or antipsychotics. Throughout the 6-month observational period significant improvement was detected in both schizophrenia (LS mean change in PANSS Total score: -46.2, p<0.001, CGI-SCH Total score: -8.0, p<0.001) and CUD symptomatology (LS mean change in CAST Total score: -6.6, p<0.001, SDS Total score: -8.0, p<0.001).

Cariprazine seem to be an effective treatment option for schizophrenia patients with multiple episodes and comorbid CUD.

N. Szerman : None Declared, Z. Dombi Employee of: I am an employee of Gedeon Richter Plc., originator of cariprazine., P. Vega: None Declared, C. Roncero: None Declared, L. Peris: None Declared, L. Grau-López: None Declared, I. Basurte-Villamor: None Declared

Social cognition impairments are well-recognized in both Schizophrenia Spectrum Disorders (SSDs) and Autism Spectrum Disorder (ASD), significantly impacting interpersonal relationships and overall quality of life. While some studies have suggested differences in social cognition between these two disorders, recent research has shown that these differences may be non-significant when controlling for factors such as age and symptom severity(Pinkham et al. Psychol Med 2019; 1-9). Given the overlap in symptoms and the potential for autistic traits to influence social cognitive functioning in SSD, it’s crucial to investigate how these traits can impact social cognition in individuals with SSD.

The aim of this study is to evaluate autistic traits in SSD and its relation with social cognition and clinical variables.

73 participants with SSD (56 patients (mean age 37.80 ± 11.519) with schizophrenia and 17 patients (mean age 36.47± 10.909) with schizoaffective disorder) participated in the study. All participants were interviewed using the Structured Clinical Interview for DSM-IV. Current psychotic, negative and positive symptoms of all patients were evaluated using the Scale for the Assessment of Positive Symptoms and the Brief Negative Symptom Scale (BNSS). The Screen for Cognitive Impairment in Psychiatry(SCIP) was used for measuring cognitive function. Autistic traits are evaluated with the Comprehensive Autism Trait Inventory (CATI). In the assessment of social cognition, facial emotion recognition was evaluated with Penn Emotion Recognition Test (PERT), theory of mind was assessed Reading Mind in The Eyes (RMET) task.

Total CATI scores weren’t correlated with RMET and PERT scores. Communication and social camouflage subscores of CATI were negatively correlated with total RMET score (r=-0.289, p=0.013; r=-0.265, p=0.024). CATI total/subscale scores didn’t have a relationship with age, education years, BNSS and SCIP scores. SCIP score was correlated with RMET(r=0.358, p<0.01) and PERT (r=0.259, p=0.027). Age had a negative relationship with RMET(r=-0.27, p=021) and PERT (r=-0.397, p<0.01) scores while education was positively correlated with RMET even though the the strength was low (r=0.246, p=0.036).

Contrary to expectations, the results did not show a relationship between higher autistic traits in SSD and social cognitive performance. The social subscales of CATI revealed a negative correlation between higher autistic traits and theory of mind performance, but no correlation with emotion recognition. In accordance with literature, aging shows a relationship with lower social cognition scores. Future research should further investigate how autistic traits impact theory of mind deficits in SSD. Interventions regarding social cognitive deficits with age should be evaluated.

None Declared

The 10th edition of the International Classification of Diseases (ICD-10) categorizes acute and transient psychotic disorders (ATPD) as a composite group that merges traditional acute psychosis definitions, characterized by acute onset (≤15 days) and rapid resolution (1-3 months), often linked to stress (WHO, 1992). The incidence of ATPD ranges from 4-10 per 100,000, with a prevalence between 5.8% and 19% (Marneros et al. Cambridge University Press 2004; Queirazza et al. BJPsych 2014; 204:299-305), predominantly affecting middle-aged to older individuals and females. Diagnostic stability for ATPD varies, with reported values between 35.9% and 56% (Aadamsoo et al. Nord. J. Psychiatry 2011; 65:381-8; Poon et al. Nord. J. Psychiatry; 2017; 71:139-44), influenced by factors such as age of onset, gender, comorbid substance use and symptom overlap (Taş et al. Noro Psikiyatr Ars 2019; 56:47-51). Studies indicate that the highest diagnostic consistency is linked to schizophrenia diagnoses (Queirazza et al. BJPsych 2014; 204:299-305).

This study retrospectively investigates the temporal stability of first-episode ATPD over a three-year follow-up period. Furthermore, it aims to explore whether initial clinical presentations and sociodemographic factors may serve as prognostic indicators for diagnostic transitions to schizophrenia or other psychotic disorders.

Patients diagnosed with ATPD and followed over 3 years were evaluated retrospectively. Socio-demographic and clinical variables potentially associated with diagnostic transitions were investigated. The study was approved by the Gazi University School of Medicine Ethics Committee (2023-889).

106 patients (57 males, 49 females) with a mean age of 29.90 ± 10.33 years were included. The diagnostic stability of ATPD was found to be 17.8%. Additionally, 62.3% of the subjects received a diagnosis of schizophrenia or other psychotic disorders. Significant differences were observed between diagnostic groups with regard to education level (χ² = 9.776, p = 0.008) and hospitalization rates (χ² = 8.083, p = 0.018). Multivariate logistic regression analysis indicated that younger age at onset (OR = 0.951, 95% CI 0.90−0.96; p = 0.032) and lower educational attainment (OR = 0.219, 95% CI 0.08−0.54; p = 0.001) were significantly associated with a diagnostic shift to schizophrenia or other psychotic disorders.

In Turkey, the diagnostic stability of ATPD is notably low, with the most common diagnostic shift being towards schizophrenia-related disorders. To our knowledge, no comprehensive studies have been conducted in Turkey that evaluate patients diagnosed with ATPD. Therefore, our study aims to contribute to the existing literature. Further research involving larger sample sizes is needed to assess the influence of clinician attitudes and stigma on diagnostic changes.

None Declared

Complex post-traumatic stress disorder (cPTSD) is a recently recognized condition characterized by the combination of core PTSD symptoms—re-experiencing, avoidance, and hyperarousal—alongside disturbances in self-organization (DSO), which include affective dysregulation, negative self-concept, and interpersonal difficulties. Emerging evidence suggests that these complex symptom domains not only lead to greater functional impairment compared to PTSD but are also closely associated with the onset of psychotic-like experiences (PLEs). PLEs, which encompass subthreshold cognitive and perceptual anomalies such as hallucinations and delusional thinking, are increasingly viewed as critical indicators of vulnerability to more severe psychopathological outcomes. Given the developmental vulnerability during adolescence, the intersection of cPTSD and PLEs during this period is of significant concern, particularly as it may signal the emergence of broader psychopathological trajectories.

The primary aim is to identify the key cPTSD symptoms driving the comorbidity with PLEs in adolescents using two different network analysis approaches. We indeed seek to clarify what symptoms explain are modt central in the relatioship between PTSD/cPTSD and PLEs and elucidate the directionality of these symptom relationships. We finally aim to also explore whether gender moderates these associations within the network structures. We hypothesize that cPTSD symptoms are central in understanding the relationship between trauma and PLEs.

A group of 1,010 late adolescents was assessed for post-traumatic symptoms and PLEs. The study involved estimating the Gaussian Graphical network structure for PTSD/cPTSD symptoms and PLEs, examining their bridge centrality indices. Subsequently, a Bayesian network analysis was conducted to create a directed acyclic graph (DAG). Gender was considered a moderator in both the Gaussian and Bayesian models.

Findings revealed that affect dysregulation, a domain of cPTSD, had the strongest connection with the PLEs cluster. The Bayesian network analysis showed a pathway linking cPTSD symptoms of worthlessness and interpersonal difficulties to PLEs symptoms like paranoia and social anxiety. Additionally, gender differences were observed in both network models.

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The study emphasizes the pivotal role of affect dysregulation and a negative self-concept in associating cPTSD with PLEs, highlighting gender-specific differences. These results point to the importance of gender-sensitive strategies in preventing and treating PLEs in adolescents, stressing the need for early intervention and customized treatment plans.

None Declared

This research explores the intricate relationship between coping strategies, perceived stress levels, and life satisfaction among female medical professionals. The medical field is known for its rigorous demands, and understanding how lady doctors manage stress and its impact on their overall life satisfaction is crucial. While previous studies have shed light on stress-related issues in medical undergraduates, there is a significant gap in research focused on the well-being of practicing female doctors.

The objectives of this study are to investigate the relationship between coping behaviors and stress levels among lady doctors, assess the role of coping behaviors in shaping life satisfaction, explore the connections between coping behaviors, life satisfaction, and stress, and analyze the influence of demographic factors such as age and marital status on coping life satisfaction, and stress perception.

This study utilizes a quantitative research design and a purposive sample of lady doctors from government hospitals in Pakistan. Key measures include the COPE Inventory to assess coping behaviors, the Satisfaction with Life Scale to gauge life satisfaction, and the Perceived Stress Scale to measure stress levels. These tools allow for a comprehensive examination of the intricate interplay between these variables. SPSS 21 was used to analyze the data.

Results indicated that Coping is negatively correlated with Stress (r = -.29, n = 100, p = 0.05) meaning that higher coping strategies are associated with lower stress levels. Similarly, Coping is positively correlated with Life Satisfaction (r = .36, n = 100, p = 0.05) indicating that higher coping strategies are associated with higher life satisfaction. Likewise, Stress is negatively correlated with Life Satisfaction (r = -.22, n = 100, p = 0.05), suggesting that higher stress levels are associated with lower life satisfaction. Also, there is a statistically significant difference in coping between Single and Married individuals (t = 2.2, df = 36.6, p = 0.03), with Single individuals showing higher coping scores.

The findings of this study provide valuable insights into the psychological well-being of female medical professionals in Pakistan. This research contributes to the broader discourse on the well-being of healthcare professionals, shedding light on the unique experiences of female doctors in a challenging healthcare environment. Ultimately, it aims to inform policies and practices that support the psychological resilience and job satisfaction of female doctors, ensuring they can continue providing high-quality healthcare services to their communities.

None Declared

Previous studies show contradictory results about the relationship between the age of menarche and the intensity of anxiety symptoms. Some studies found that anxiety symptoms were significantly higher in patients with earlier age of onset of menarche. Recent studies show that early puberty and menarche are associated with greater rates of morbidity of anxiety and other psychiatric illnesses than relatively late menarche. It is presumed that girls who achieve menarche earlier are less prepared for puberty and tend to have more negative emotions associated with menstruation.

The purpose of this research was to determine the correlation between onset of menarche and intensity symptoms of anxiety in female patient with affective and anxiety disorders.

The research is prospective and includes female patients with established diagnoses of depressive disorder, anxiety-depressive disorder, bipolar disorder (depressive episode) aged 18-65. The patients had their laboratory parameters determined, including sex hormones (estrogen, progesterone, testosterone, FSH, LH and prolactin), filled out a demographic questionnaire and questionnaires: The Suicide Behaviors Questionnaire-Revised (SBQ-R), Generalised Anxiety Disorder Assessment (GAD-7), Patient Health Questionnaire (PHQ-9), Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI), Matthey Generic Mood Question. Montgomery-Asberg Depression Rating Scale (MADRS), Hamilton Anxiety Rating Scale (HAMA) i Hamilton Depression Rating Scale (HAMD).

The preliminary data of the prospective study showed that there was a statistically significant proportion of patients in whom a correlation was found between the age of onset of menarche and the intensity of anxiety.

Age of menarche could be an influence on intensity of anxiety symptoms in female patients.

None Declared

Recent research suggests that psychological and personality factors, specifically affective temperaments, may influence adherence to prescribed pharmacotherapeutic interventions. However, this relationship has not yet been investigated in the context of infertility treatments.

Our prospective longitudinal study aimed to assess the impact of affective temperaments on medication adherence during infertility treatments.

Among women presenting for infertility treatment at the Semmelweis University Assisted Reproduction Centre, we administered the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego (TEMPS-A) questionnaire before treatment to assess their affective temperament and the Morisky Medication Adherence Scale (MMAS) questionnaire six months after treatment initiation to measure their medication adherence during treatment. The effect of affective temperaments on medication adherence was analyzed using linear regression models. All statistical analyses were performed using R statistical software version v4.4.1.

In this paper, we present preliminary partial results. In our cohort of 121 women undergoing infertility treatment, higher hyperthymic affective temperament score predicted significantly higher adherence to pharmacotherapy recommendations (β = 0.11, p = 0. 042), while the other four dominant affective temperaments predicted significantly poorer medication adherence (cyclothymic: β =-0.15, p<0.001, depressive: β = -0.21, p=0.001, irritable: β =-0.14, p=0.004, anxious: β =-0.09, p=0.011).

The results suggest that affective temperaments may affect adherence to prescribed pharmacotherapeutic interventions among women undergoing infertility treatment, which may thereby influence the outcome of infertility treatment administered. By screening for affective temperament profiles, it would be possible to identify patient groups at high risk of drug non-adherence and then to aid adherence by applying patient-tailored treatment, including psychological interventions, which could increase the chances of successful pregnancy among women undergoing in vitro fertilization treatment.

None Declared

Thyroid and sex hormones play pivotal roles in the regulation of various physiological processes, including brain function. Dysregulation of these hormones has been increasingly associated with a range of neuropsychiatric disorders, including depression, anxiety, cognitive impairment, and mood disorders.

This review aims to systematically examine the correlation between thyroid and sex hormones disorders and the spectrum of emerging neuropsychiatric manifestations, enlightening the pathophysiological mechanisms.

A literature search was performed in many databases including PubMed, Web of Science, and Google Scholar for studies published in recent years. Eligible randomized controlled trials, observational studies, and systematic reviews examining neuropsychiatric outcomes in patients with thyroid or sex hormone disorders were included. Findings were synthesized both quantitatively, with meta-analyses where possible, and qualitatively, with thematic analysis for heterogeneous data.

The review identified a strong association between thyroid dysfunctions and neuropsychiatric disorders such as depression, anxiety, and cognitive decline. Hypothyroidism was consistently linked with depressive symptoms likely due to impaired serotonergic and dopaminergic neurotransmission, along with decreased hippocampal neurogenesis. Conversely, hyperthyroidism, characterized by elevated thyroid hormone levels, was associated with heightened anxiety, irritability, and emotional lability, possibly through dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and increased sympathetic nervous system activity.

In the context of sex hormone disorders, estrogen deficiency during menopause was correlated with a significant increase in behavioral and cognitive impairments, potentially mediated by reduced modulation of serotonin receptors, diminished synaptic plasticity, and increased neuroinflammatory responses. Similarly, testosterone decline in aging men was linked to mood and cognitive disorders, with evidence pointing to disruptions in androgen receptor signaling and alterations in γ-aminobutyric acid (GABA)ergic and glutamatergic pathways.

This review underscores the significant link between thyroid dysfunctions, particularly hypothyroidism and hyperthyroidism and mood disorders such as depression and anxiety, while also indicates that estrogen deficiency and testosterone decline contribute to cognitive impairments and emotional disturbances. These findings help the healthcare providers to recognize neuropsychiatric symptoms as potential indicators of underlying endocrine disorders.

None Declared

Hypoactive sexual desire disorder (HSDD) is an underdiagnosed and poorly treated condition that is highly prevalent among women. Characterised by a persistent or recurrent deficiency of sexual desire, HSDD leads to significant personal distress and interpersonal difficulties, and can adversely affect emotional well-being and intimate relationships.

The aim of this review is to discuss the aetiology, diagnosis, and treatment of HSDD.

A comprehensive literature search was conducted using the electronic database PubMed. The keywords used for the search included “Hypoactive Sexual Desire Disorder”, “treatment”, and “aetiology and diagnosis”.

The search yielded a total of five systematic reviews. These studies concluded that the aetiology of HSDD involves a complex interaction of biological, psychological, and sociocultural factors. The diagnosis of this disorder should include a comprehensive sexual and medical history to rule out other causes. Treatment options for HSDD are multifaceted, incorporating both pharmacological and non-pharmacological approaches.

HSDD may be caused by biological factors such as a reduction in sexual excitation signals, an increase in sexual inhibition signals, or a combination of both. Testosterone plays a crucial role in initiating sexual activity, desire, and behaviour, through its influence on vaginal lubrication, sensation, and clitoral engorgement. Low oestrogen levels are associated with dyspareunia and changes in the vulvovaginal mucosa. Progesterone, serotonin, dopamine, and noradrenaline also play a role in the physiology of sexual desire. Psychological factors, particularly a lack of emotional intimacy, communication difficulties, negative body image perceptions and low self-esteem, can also reduce sexual desire. Depressive and anxiety disorders can significantly affect sexual desire. Sociocultural factors, such as religious beliefs and traditional values, can have a negative impact on sexuality. The diagnosis is made through a detailed clinical history, which may be supported by a screening tool, the Decreased Sexual Desire Screener (DSDS), as well as laboratory and imaging investigations. Identified modifiable factors, such as illicit substance abuse, sleep problems, medication use, and various medical and psychological factors, should be addressed first. For women without remaining modifiable factors who need psychological support, sex therapy, cognitive-behavioural therapy, and couples therapy are recommended. In premenopausal women, pharmacological treatment with flibanserin or bremelanotide may be considered. In postmenopausal women, hormonal therapy with testosterone may be considered off-label. The combination of psychological and pharmacological interventions is the most effective approach for HSDD. However, further studies are needed to better understand the pathological mechanisms of HSDD and to develop new therapeutic options.

None Declared

Gambling disorder, previously known as pathological gambling, is a behavior that significantly impairs functioning in personal, social, and occupational domains. Currently, there is no pharmacological treatment for gambling disorder, emphasizing the need for innovative treatment modalities. Imaging studies have identified a connection between prefrontal circuit dysfunction and behavioral disinhibition, supporting the potential use of non-invasive brain stimulation in treating gambling disorder.

The purpose of this study is to investigate the effect of theta-burst stimulation (TBS) on gambling disorder.

The study duration is 2 weeks, with 10 sessions of TBS intervention. The intervention group will receive 1800 pulses of intermittent TBS at the left dorsolateral prefrontal cortex and 1200 pulses of continuous TBS at the pre-supplementary motor area during each session, while the control group will receive sham stimulation. Primary outcomes, including the Gambling Symptom Assessment Scale (G-SAS) and the Visual Analogue Scale (VAS) for craving, were administered at weeks 0, 2, 4, and 8, and the changes between the two groups were compared using generalized estimating equations. Secondary outcomes, including Beck Anxiety Inventory and Beck Depression Inventory, and serum brain-derived neurotrophic factor (BDNF), cortisol, and hsCRP, were measured at weeks 0, 4, and the changes between the two groups were compared using repeated measures ANOVA.

A total of 33 patients with gambling disorder were randomly assigned in a 2:1 ratio to the intervention group (21 patients) and the control group (12 patients) on a double-blind basis. They were included in the preliminary analysis on an intention-to-treat basis. The VAS scores of the active group decreased more than those of the sham group (active group: 53.3 to 17.9, sham group: 37.5 to 15.3), but the difference did not reach statistical significance (p = 0.13). Compared to the sham group, the active group showed a decreasing trend in hsCRP (p = 0.54) and an increasing trend in free BDNF (p = 0.34), but neither reached a statistically significant difference.

Drawing definitive conclusions is limited by small sample size. Nevertheless, the initial results from this study suggest that the alterations in levels of gambling craving, hsCRP, and serum BDNF align with our hypothesis.

None Declared

The chronic relapsing nature of alcohol use disorder (AUD) makes treatment and recovery especially difficult. One of the most prevalent factors contributing to relapse is craving, which is a strong urge to drink alcohol. Moreover, alcohol withdrawal symptoms experienced during abstinence can trigger the urge to drink alcohol. Furthermore, stress and anxiety can also elicit craving and increase the motivation to drink alcohol.

Further understanding the risk of relapse would be crucial for the treatment of AUD. Thus, the aim of this study was to identify clusters within a sample of patients with AUD based on the different factors of relapse risk, and to compare these clusters based on the severity of alcohol use disorder, craving and anxiety.

The sample consisted of 114 patients diagnosed with AUD at the Department of Psychiatry, University of Szeged, Hungary between November 2022 and January 2024. The level of AUD was measured with the Alcohol Use Disorders Identification Test (AUDIT) (subscales: consumption, dependence, harmful consequences of alcohol use) and the Severity of Alcohol Dependence Questionnaire (SAD-Q) (subscales: physical withdrawal signs, affective withdrawal signs, withdrawal relief drinking, quantity and frequency of alcohol consumption, rapidity of reinstatement of withdrawal symptoms following abstinence). State and trait anxiety were measured with the State-Trait Anxiety Inventory (STAI-S, STAI-T). Craving was measured with the Multidimensional Alcohol Craving Scale (MACS). The risk of relapse was measured with the Alcohol Relapse Risk Scale (ARRS) (subscales: stimulus-induced vulnerability (SV), emotionality problems (EP), compulsivity for alcohol (CA), negative expectancy for alcohol (NE), positive expectancy for alcohol (PE), insight into mental condition (IM)).

Two-step cluster analysis was performed with the six subscales of the ARRS as predictor variables. A two-cluster solution was found, in which SV proved to be the most important predictor. Independent sample t-tests for the two clusters revealed significant between-cluster differences on all subscales except for ‘lack of negative expectancy for alcohol’ (p ≥ 0.001). Independent sample t-tests and Chi-square tests were performed to compare the two clusters on the basis of age, sex, the severity of AUD, craving and anxiety. Significant differences were found in almost all factors except for age, sex and the ‘rapidity of reinstatement of withdrawal symptoms following abstinence’ subscale of the SAD-Q (p ≥ 0.01).

The first cluster with more defined signs for the risk of relapse was characterised by more severe AUD, craving, state and trait anxiety compared to the second cluster with milder signs for the risk of relapse. These results suggest that the risk of relapse is a complex phenomenon, which can be identified through the evaluation of several different factors, which may influence treatment choices.

None Declared

Alcohol withdrawal syndrome (AWS) is not a common medical condition in general population however it affects patients with alcohol use disorder (AUD) and causes severe complications when diagnosed late or left untreated. Diazepam is a benzodiazepine, which is used to treat various diseases such as insomnia, anxiety, muscle spasm, pain and AWS. Compared to other benzodiazepines, diazepam is more efficient to prevent delirium and decrease withdrawal due to its long half-life. Diazepam is metabolised to its main metabolite nordiazepam with the enzymes expressed by CYP2C19 and CYP3A4 genes. It has been reported that metabolic activity of the enzymes encoded by CYP2C19 gene may be varied due to genetic polymorphisms leading a change in the efficiency of treatment via effecting the plasma level of drugs metabolised by CYP2C19.

The aim of this study is to investigate whether CYP2C19*17 gene polymorphism has an impact on plasma levels of diazepam and nordiazepam in the Turkish patients with AWS and under oral diazepam treatment.

The study included 50 male patients who were in withdrawal state and taking diazepam therapy. CYP2C19*17 polymorphism was determined by PCR-RFLP method. Plasma levels of diazepam (DZP) and nordiazepam (NDZP) were detected by HPLC.

Genotype frequencies were calculated as 66% for CC, 30% for CT and 4% for TT. Dose-normalized DZP and dose-normalized NDZP values were 0.049 μg/ml per mg/day and 0,056 μg/ml per mg/day, respectively. No statistical significance was observed in the levels of normalized DZP and NDZP when CC and CT+TT genotypes were compared (p= 0.073 and p=0.282, respectively).

The effect of CYP2C19*17 polymorphism on the plasma levels of DZP and NDZP following long term oral diazepam to treat patients with AWS was determined for the first time. With the help of current study, first data on Turkish population was obtained and may be useful for personalized therapy in the future.

This study was supported by Scientific and Technological Research Council of Turkey (TUBITAK) under the Grant Number 121C441. The authors thank to TUBITAK for their supports.

None Declared

The consumption of alcohol, cannabis, cocaine, or heroin causes alterations in the central nervous system, affecting mood, perception, and behaviour. Despite the harmful effects of these substances, they remain widely used. Younger individuals tend to consume cannabis and cocaine, while older adults more commonly use alcohol and prescription medications. Ageing brings changes in consumption patterns and has both physical and mental health consequences

This study aims to analyze how age influences the clinical characteristics of patients with Substance Use Disorder (SUD), comparing differences between older and younger users.

A total of 297 SUD patients participated in this study. They were divided into two groups: those aged 55 and older (G1) n= 88, and those younger than 55 (G2) n= 209. The SF-36 questionnaire was used to assess quality of life, the BIS-11 for impulsivity, the ASRS v1.1 for ADHD, the STAI-R for anxiety, and the AQ for autistic traits. All participants provided informed consent, and the study adhered to ethical guidelines.

G1 showed better social functioning (SF-36) but a significant physical decline compared to G2. G1 also demonstrated lower levels of impulsivity (BIS-11), aggression, anxiety (STAI-R), and ADHD symptoms (ASRS), though higher autistic traits (AQ) were observed in G1.

Ageing reduces impulsivity, aggression, anxiety, and ADHD symptoms in individuals with SUD, but worsens physical health and may increase social isolation and autistic traits. These findings underscore the need to adapt SUD treatments according to age, addressing both physical and psychosocial challenges specific to each group.

None Declared

Substance use disorders are among the leading causes of morbidity and mortality worldwide. SUDs are highly comorbid with other mental health disorders. Given this comorbidity, a transdiagnostic view on treatment, seems appropriate. Within such a transdiagnostic perspective, treatment outcome can be described as a decrease in comorbid clinical symptomatology and not merely in terms of abstinence/relapse in substance use. A promising transdiagnostic factor within the RDoC framework is temperament, more specifically reactive and regulative temperament. According to the dual pathways model, psychopathology arises from an imbalance between two complementary neurobiological systems: the bottom-up reactivity system in terms of behavioral inhibition (BIS) and behavioral activation (BAS) (reactive temperament) and the top-down regulation in terms of Effortful Control (EC) (regulative temperament).

We want to investigate whether reactive (BIS/BAS) and regulative temperament (EC) are associated with treatment outcome in terms of a decrease in clinical symptomatology in a sample of adult inpatients with a SUD. When these temperamental factors turn out to be significant predictors of clinical symptomatology, treatment interventions targeting reactivity (high BAS or BIS level) or aiming at strengthening EC could possibly result in better treatment outcomes for patients with SUDs and comorbid disorders.

The sample consisted of 612 inpatients with a SUD ((76,5% males, mean age 42,9 years) admitted at a specialized treatment unit for addiction. At the start of the treatment (pre) self-report questionnaires were administered to assess the reactive temperament dimensions (the Behavioral Inhibition/Behavioral Activation System Scales), the regulative temperament dimension (the Effortful Control Scale from the Adult Temperament Questionnaire) and clinical symptomatology (Symptom-Checklist-90-Revised, SCL-90-R). At discharge, the SCL-90-R was administered again to assess treatment effectiveness (post).

Paired sample t-test showed significant decreases between pre- and posttreatment symptom scores indicating that treatment was effective in decreasing symptomatology. A hierarchical regression analysis showed that higher levels of EC were associated with a stronger decrease in levels of psychological symptoms and that higher levels of BIS were associated with a lower decrease. There was however no moderating role of EC in the relation between reactive temperamental dimensions and treatment outcome.

We found that reactive and regulative temperament could predict psychological symptomatology after a residential treatment period of 8 weeks in a specialized addiction unit. These results point out that interventions aiming at either strengthening EC or lowering anxiety (BIS) could possibly result in better treatment outcomes for patients with SUDs their comorbid disorders.

None Declared