Autism is a neurodevelopmental condition affecting 1 in 36 people worldwide. Approximately one third of autistic individuals report a diagnosed mental health condition. Autistic people constitute 20% of referrals to outpatient psychiatry clinics. Limited knowledge and awareness of autism is the main barrier to receiving appropriate diagnostic and therapeutic support. Autistic individuals’ increased mental health needs coupled with greater barriers to accessing healthcare necessitate that both primary care physicians as well as specialised services are well versed in working with these patients.

This study aimed to evaluate knowledge of autism and self-reported confidence in caring for autistic patients amongst psychiatrists and general practitioners (GPs) in Malta. This will facilitate identification of lacunae in doctors’ knowledge and advocating for greater training and awareness.

A online, anonymous questionnaire was distributed amongst psychiatrists and general practitioners in Malta as well as psychiatry and GP trainees. The questionnaire consisted of demographic questions, a 22-item modified Knowledge of Autism Scale as well as a 14-item Self-efficacy Scale targeting confidence in working with autistic patients. Data was analysed using SPSS and scores were adjusted for chance responses. Scores of the psychiatry group and the GP group were compared.

The questionnaire was answered by 98 participants of which 60% (n=59) were female. The mean score on the knowledge of autism scale was 89.2% (SD=7.7) for psychiatry and 83.1% (SD=8.5) for GP. Mann Whitney U test revealed that psychiatrists fared better than GPs with an effect size of 0.35 (p=0.0003). The mean self-efficacy score was 6.7 (SD=0.4) for psychiatry and 5.7 (SD=0.8) for GP. Independent sample t-test revealed that psychiatrists scored better than GP (p=0.0003, 95% CI [0.509,1.49]). In both groups, there was no significant correlation between knowledge of autism scales and self-efficacy scales (psychiatry p = 0.26; GP p = 0.14).

General practitioners, psychiatrists and their trainees overall have good knowledge about autism, and feel moderately confident in working with autistic patients. As expected, psychiatrists scored better than GPs for both knowledge and self-reported efficacy. The scores obtained are comparable to studies done on a similar population in the United Kingdom. Unfortunately, Malta stilll lacks autism diagnostic services in the public sector. Nonetheless, undergraduate medical education and postgraduate training must strive to prepare doctors for working with this common cohort of patients. This will ensure a high standard of care and avoidance of adverse health outcomes or iatrogenic harm.

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International Medical Graduates add up to nearly one-third (23-28%) of the total physician workforce in the US, the UK, Australia, and Canada, of which around 40%-75% are from low-income countries. Pakistan is one of the three leading source countries following India and the Philippines. As per 2002 statistics by the Bureau of Emigration and Foreign Employment, only 10-15% of emigrated Pakistani physicians repatriate. No official data on the exact number of repatriated Pakistani physicians are available. This is the first original study that assessed satisfaction with life in physicians repatriating to a lower-middle-income country.

To assess satisfaction with life (SWL) and its correlation with psychological well-being in foreign-trained, repatriated Pakistani physicians.

We conducted this cross-sectional study from April’22 to Nov’23, through purposive sampling among foreign-trained Pakistani physicians who repatriated at least three months before participating. We used the Scale of Positive and Negative Emotions (SPANE), Flourishing Scale, and Satisfaction with Life (SWL) scale. After transforming data to normality in SPSS 25 through the Distribution Fraction method, the independent sample t-test, and one-way ANOVA were applied. We assessed the correlation between affect balance, flourishing, and SWL through Pearson’s correlation and ascertained the predictors of SWL through binary logistic regression (α=0.05).

Of 109 respondents, the majority (70.6%) were males, from Punjab (83.5%), trained in USA/Canada (68.8%), and from the private sector (69.7%), with a Mean±SD age of 47.31±7.9. The total Mean ± SD SWL scores were 27.48± 5.03. 99 (90.8%) were satisfied with life while only 9.2% weren’t. The currently married respondents (27.8±4.9 vs 24.6±5.4, p=0.04) while those from Sindh and KPK provinces had lower scores. We found a positive moderate correlation between SWL and flourishing (r=0.488), positive emotions (r=0.391), and affect balance (r=0.327) all at p=<0.001. We found good fitness of the final model with SWL as the outcome variable and Flourishing and Overall Affect Balance as predictors: Omnibus Tests of Model Coefficients (p=0.001) and Hosmer and Lemeshow tests (p=0.322). Only flourishing predicted SWL and with higher perceived flourishing, there were 1.3x higher odds of SWL.

This is the pioneer study to have addressed SWL and its correlation with psychological well-being in repatriated physicians, who using their skill sets and expertise, may help strengthen the healthcare system of the lower-middle income countries of origin, hence it’s imperative to identify factors linked to their psychological well-being. We recommend further research on this particularly qualitative exploration.

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Topiramate is a widely prescribed anticonvulsant and migraine prophylactic agent, recognized for its efficacy in treating epilepsy and preventing migraines. While its use is generally well-tolerated, it is known to cause a range of side effects. However, olfactory hallucinations, also referred to as phantosmia, represent a rare and poorly documented adverse effect of Topiramate. Phantosmia involves the perception of smells in the absence of an external odor source. This case report presents the case of a woman who developed olfactory hallucinations following the re-initiation of Topiramate for epilepsy. The hallucinations resolved completely upon discontinuation of the drug. This report highlights the need for clinicians to be aware of this potential side effect.

Topiramate is a well-established treatment for epilepsy and migraine prevention, but it can cause neurological and cognitive side effects like paresthesia, dizziness, memory issues and confusion. However, olfactory hallucinations are rare and underreported. This case report aims to contribute to the limited literature by documenting a case of reversible phantosmia related to Topiramate.

A woman presented with complaints of persistent olfactory hallucinations, perceiving unpleasant odors in the absence of any external source. Her medical history was unremarkable, apart from a diagnosis of epilepsy. After other treatments had limited success, she was started on Topiramate a couple of weeks before the manifestation of the olfactory hallucinations. Weeks after starting Topiramate, the patient began experiencing olfactory hallucinations which interfered with her daily life. The patient had no prior history of olfactory disorders, nasal pathology or psychiatric conditions and her physical examination was unremarkable. Upon investigation, no structural abnormalities were found.

The patient’s medication history revealed that the onset of olfactory hallucinations coincided with the initiation of Topiramate.After discussing the side effect profile of the drug, it was decided to discontinue Topiramate. Within two weeks of discontinuation, the patient reported a complete cessation of the olfactory hallucinations. A follow-up evaluation showed no recurrence of the symptoms after switching to an alternative therapy. Given the temporal relationship between the onset of olfactory hallucinations and Topiramate use, alongside the resolution of symptoms upon drug discontinuation, a diagnosis of Topiramate-induced phantosmia was made.

This case highlights a rare but significant adverse effect of Topiramate, olfactory hallucinations. Given the reversibility of this side effect upon discontinuation of the drug, physicians should be vigilant in monitoring for sensory disturbances in patients administered with Topiramate. Awareness of phantosmia as a potential adverse effect will allow for appropriate management, potentially preventing patient distress.

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The high prevalence of anxiety and depression among patients with cancer has an impact on a decrease in quality of life. there are practically no studies among people with lymphoproliferative diseases, which determines the relevance of our study.

Purpose: to assess the prevalence of anxiety-affective spectrum disorders and their impact on the quality of life and adaptability in patients with non-Hodgkin lymphoma (NHL), Hodgkin lymphoma (HL) and a group, including malignant neoplasm of the body of the stomach and T- and B- cellular lymphoma.

95 patients (women - 52, men - 44) diagnosed with NHL, HL, others were examined using a continuous sampling method.

Clinical interviews; the author’s questionnaire; HADS, EQ-5D, EQ-VAS, PSM-25. STATTECH were used to process the data.

The average age was 52.8±8.3 years (18 to 86). 3 groups: 1-non–Hodgkin’s lymphoma, 2-Hodgkin’s lymphoma, 3- malignant neoplasm of the stomach body and T- and B-cell lymphoma. In gr-s 1 and 2 (90% and 85%), no symptoms of anxiety were detected. In gr 3, clinically pronounced anxiety levels were uniformly detected in 50%. Depressive symptoms a predominantly absence in all groups (1 - 95%; 2 - 86% and 3 - 75%) p>0.05. The assessment of quality of life: in gr 1 and 2, most of the patients noted that they experience some difficulties in the final indicator (55% and 61%), pronounced problems prevail in gr 3 (50%). The mobility of the majority in all groups does not suffer or suffers to a minor extent, 80% of all noted the absence of difficulties in self-care. “daily activity” were a statistically significant - 64% maintained it at a high level (p=0.006); Pain/discomfort is experienced by more than half of the respondents to a moderate degree 55% (p=0.003). In gr 1 and 3, the average of EQ-VAS determined at a level of more than 70 (the arithmetic mean 78 and 73), which indicates a more favorable sense of self. In gr 2 the average was determined at 68, also characterizes a high level of assessment of their general condition, in all patients with CLL, according to PSM 25, the stress level was determined to be low, indicates a state of psychological adaptation to workloads in 100%. In the gr 1, 12 people (17%) were identified with an average level of stress and reduced adaptation and need the rest for this contingent.

our pilot study showed that patients with lymphoproliferative diseases are characterized by a slight decrease in their quality of life, a high level of life satisfaction, good stress resistance to workloads. The main symptoms (reliably expressed in 55%), are moderate severity of pain and discomfort. The obtained data make it possible to emphasize the heterogeneity of the prevalence and severity of anxiety-affective symptoms in patients with various types of oncological diseases.

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Individuals at high familial or genetic risk of cancer face unique psychological challenges that can lead to significant distress, including worry, fear, and uncertainty about their future health and family members’ risk. This study assessed mental health challenges, including anxiety and depression, in this population and explored their preferred forms of psychological support.

To examine the prevalence of psychological distress in individuals at high hereditary cancer risk, the relationship between their current perceived support and distress, and preferred psychological support forms to inform the development of tailored mental health services.

Participants (N = 152; 95% female, 3% male, 2% non-binary; mean age = 42.6 ± 8.3) were cancer-free residents of the Republic of Ireland identified as high-risk for hereditary cancer through high-risk clinic attendance or self-reported genetic screening or family history. They completed a cross-sectional survey using standardised mental health assessments, including Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9), and self-reported adequacy of psychological support and preferences. Descriptive statistics and post-hoc tests were used to analyse psychological distress, support adequacy, and preferences.

Moderate to severe anxiety (GAD-7 ≥10) was reported by 23%, and moderate to severe depression (PHQ-9 ≥10) by 18%. Participants reporting inadequate support had significantly higher anxiety (M = 8.1 ± 6.2) and depression (M = 6.4 ± 5.7) scores than those with adequate support (GAD-7: M = 4.2 ± 3.9; PHQ-9: M = 3.6 ± 3.9). ANOVA indicated significant differences in anxiety (F (2,132) = 7.04, p = .001) and depression (F (2,130) = 4.68, p = .011) scores across support levels. Post-hoc Tukey tests showed poorer mental health for those without support (p < .001 for anxiety; p = .013 for depression). Mental health professionals (psychologists and counsellors) were the top preferences for support, chosen by 74.8% of participants, with 47.5% selecting a psychologist and 27.3% a counsellor. An additional 12.2% preferred a healthcare professional (e.g., General Practitioner or nurse).

This study provides important insights into the mental health challenges faced by individuals at high hereditary cancer risk, particularly those lacking adequate psychological support. Participants reporting inadequate support experienced significantly higher levels of anxiety and depression. These findings highlight the importance of ensuring adequate psychological support services for this population and their strong preference for professional psychological care. Integrating this care into routine genetic counselling and oncology services could help to address the unmet mental health needs of this underserved population.

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When an adolescent or young adult is diagnosed with cancer, they’re frequently accompanied by their caregiver. Literature shows that caregivers of adolescents and young adult cancer survivors (AYACS) frequently experience high anxiety and depressive symptoms. Being these caregivers an important source of support to AYACS during this challenging journey, one question emerges: does caregivers’ mental health impact AYACS’ quality of life (QoL)?

Considering this, this study examined the associations between caregivers’ mental health and AYACS’ QoL.

Forty-eight dyads were recruited in four hospitals and one association in Portugal. AYACS were mostly women (62.5%) and off-treatment (62.5%). They were, on average, diagnosed at 18.9 years (range: 15-25) and currently 21.98 (range: 15-38). Their caregivers were mostly women (77.1%) and, on average, 47.02 years (range: 19-76). Parent-child dyads were the most frequent. The Quality of Life Questionnaire Core-30 assessed the AYACS’ QoL. Caregivers’ mental health, the Hospital Anxiety and Depression Scale, and the FCR7 scale assessed caregivers’ anxiety and depressive symptoms and fear of cancer recurrence, respectively.

Preliminary results show that among AYACS’ QoL, only low social functioning was significantly related to high anxiety and depression in caregivers. Treatment status was also significantly positively related to AYAs’ social functioning and negatively to caregivers’ anxiety and depression. AYAs and caregivers’ ages at recruitment were also negatively correlated with caregivers’ anxiety. Age of AYACS at diagnosis, living with caregiver, and type of caregiver were not related to AYACS social functioning nor caregiver anxiety and depression. A model was tested, showing that caregivers’ anxiety and depression predict AYAs’ social functioning, having treatment status as covariable.

Caregivers’ mental health and treatment status were shown to be important for AYACS’ QoL, especially social functioning. This supports the need to assess how caregivers are adapting to this new stage of life and provide specialized support when needed. This could indirectly have a positive impact on the QoL of AYACS. It’s important that the support provided considers the diverse challenges these caregivers face, which can differ from other caregiver groups.

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A growing body of literature focuses on psychosocial interventions that include positive outcomes such as resilience, posttraumatic growth, and meaning in cancer survivors. A research synthesis is needed to provide a comprehensive understanding of this field.

This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to determine the effectiveness of psychosocial interventions on resilience, posttraumatic growth, and meaning in cancer survivors.

CINAHL Plus with Full Text (EBSCOhost), CENTRAL, Pubmed, and WOS Core Collection databases were searched with no publication date or language restrictions. In addition, backward and forward citation searching was conducted in the Scopus database. The risk of bias of included studies was performed using the Revised Cochrane risk-of-bias tool for randomized trials (ROB2). The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used for rating the certainty of evidence assessment. Analyses were carried out using IBM SPSS Statistics 28, trial version.

The review included 14 RCTs with 1801 participants, published between 2005 and 2022. 10 of 14 RCTs reporting posttraumatic growth and/or meaning outcomes were involved in quantitative analysis. The overall risk of bias was judged as “some concerns” or “high” for all but one study. The pooled results suggested a small, beneficial effect in favor of psychosocial interventions on meaning “from pre-to immediately post-intervention,” compared with routine care (Cohen’s d = -0,298, 95% CI: -0,518 to -0,077; p = 0.008; I2 = 0%; 319 participants; low-certainty evidence), but no sustained effects “from pre-intervention to the longest follow-up” period (Cohen’s d = -0,172, 95% CI: -0,361 to 0,018; p = 0.075; I2 = 0%; 433 participants; low-certainty evidence). No significant differences were found for posttraumatic growth between the effects of psychosocial interventions and routine care “from pre-to immediately post-intervention” (Cohen’s d = -2.310, 95% CI: -5.735 to 1.115; p = 0.186; I2 = 99.6%; 498 participants; very low-certainty evidence) and “from pre-intervention to the longest follow-up” (Cohen’s d = -1.612, 95% CI: -3.847 to 0.623; p = 0.157; I2 = 99.6%; 947 participants; very low-certainty evidence) periods. The effects of psychosocial interventions on resilience could not be pooled since only two studies existed.

The effectiveness of psychosocial interventions on all study outcomes is uncertain, and additional evidence are needed. Future RCTs of high methodological quality are warranted to meet the robust effects of psychosocial interventions in cancer survivors.

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Auditory hallucinations (AH) are frequently considered a hallmark of psychotic disorders. Even in the absence of any other features, persistent AH will fall under the DSM-5 label of Other Specified Schizophrenia Spectrum and Other Psychotic Disorder. However, AH are not exclusive to psychosis and can occur across various psychiatric and neurological conditions. Furthermore, AH have been reported in the general population, with prevalence estimates ranging from 4% to 21%. While typically transient and sporadic, a minority may experience recurrent and persistent AH. These experiences, spanning from subclinical to pathological, have been lately understood within the framework of the “extended psychosis phenotype”.

This study aims to challenge the conventional view of AH as definitive indicators of psychotic disorders by examining their occurrence in different contexts and exploring the relevance of the “extended psychosis phenotype” in understanding these symptoms.

A literature review was conducted using the keywords “auditory hallucinations”, “extended psychosis phenotype” and “phenomenology” in the PubMed and Google Scholar databases.

Psychotic experiences seem to run in families, suggesting a transdiagnostic psychosis trait that may be passed down independently of emotional or thought regulation processes. As a result, psychosis - and AH in particular - can be expressed across multiple disorders, including schizophrenia, bipolar disorder, major depressive disorder, anxiety disorders, autism spectrum disorders, post-traumatic stress disorder (PTSD), and certain personality disorders, such as borderline personality disorder (BPD). Phenomenological differences of AH across these conditions remain unclear. Notably, evidence challenges the concept of ‘pseudohallucinations’ in BPD, showing that AH can be as severe and persistent as those in schizophrenia. Neurobiologically, AH are not always linked to abnormal dopamine activity, which calls into question the routine use of antipsychotics for all psychotic-like symptoms. Environmental and psychological factors, such as trauma, also play a role in AH, especially in BPD and PTSD. In such cases, psychosocial interventions, such as cognitive-behavioral therapy and trauma-focused therapies, are often more effective than pharmacological treatments. Finally, AH can occur in isolation, with a generally low risk of progressing into a full psychotic disorder unless accompanied by other psychotic symptoms or functional impairments.

The diagnostic approach to AH should be reconsidered to avoid automatic narrowing of differential diagnosis to psychotic disorders. AH can emerge from various mechanisms, including non-dopaminergic pathways. Recognizing the extended psychosis phenotype and transdiagnostic psychosis trait is crucial for understanding the continuum of psychotic experiences and improving treatment approaches.

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Dysfunctions in mental imagery are linked to various psychopathologies, including intrusive memories from trauma, distorted perceptions of reality, and mood disorders. Therapeutic approaches, such as Imagery Rescripting (ImRs), address emotional dysfunctions by modifying mental images. ImRs is a cognitive-behavioral process requiring substantial visuospatial working memory, where distressing memories are recalled and actively altered to reduce their emotional impact. Neuroimaging studies suggest that ImRs engages mechanisms related to sensory perception and autobiographical memory recall.

The objective of this paper is to review recent functional neuroimaging evidence on the effects of ImRs on emotional regulation. Specifically, it seeks to explore the neurological mechanisms of ImRs, focusing on its interaction with visuospatial working memory and sensory-perceptual processes to influence emotional outcomes.

An integrative review of neuroimaging studies on ImRs was conducted using databases like PubMed and Google Scholar, with keywords such as “ImRs” and “functional MRI (fMRI).” The review focused on studies from the last 10 years. Brain areas involved in emotional regulation, such as the visual cortex, amygdala, prefrontal cortex, and hippocampus, were emphasized. Both experimental and clinical studies were included to provide a comprehensive understanding of ImRs’ neurobiological mechanisms.

ImRs improves emotional regulation by activating brain systems involved in visuospatial working memory and emotional responses. Neuroimaging studies reveal that ImRs stimulates the visual cortex and other regions, depending on the type of mental imagery. Emotional systems responsible for primary responses like fear and reward are influenced through these sensory-perceptual processes. Since these emotional systems develop before language, ImRs effectively modifies emotional responses tied to distressing memories by altering the brain’s sensory processing. The findings suggest that ImRs reshapes neural pathways related to visuospatial memory and emotional processing, with significant activation of the visual cortex, amygdala, and prefrontal cortex during rescripting. This highlights its potential as a therapeutic tool for emotional dysfunctions, such as trauma and mood disorders. However, gaps remain in fully understanding its long-term neurological effects and the complete range of brain regions affected by ImRs.

This review highlights the potential of ImRs in regulating emotions by influencing key brain regions. While ImRs shows promise in modifying emotional responses and neural pathways, there are still gaps in understanding its long-term effects. Future research should focus on these gaps, using advanced neuroimaging techniques and examining its effects across diverse clinical populations to fully elucidate its neurobiological mechanisms and optimize therapeutic applications.

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Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are two common neurodevelopmental conditions, whose prevalence in the general population has significantly increased in the last decade (2.2% and 2.5%, respectively). The co-occurring prevalence of ASD and ADHD is estimated at approximately 28% (Lai et al. 2019), and the differential diagnosis between these two conditions has become increasingly challenging, especially in adulthood. For instance, both individuals diagnosed with either ASD or ADHD might present social difficulties, despite the underlying causes are notably different: individuals with ASD struggle with social approach and communication, while individuals with ADHD might show distractibility and rapid loss of interest in social activities, or even exhibit behaviors perceived as annoying or rude, such as interrupting and intruding conversations (Antshel & Russo, 2019). Most importantly, in both ASD and ADHD (and especially in women) copying strategies such as the well-known “camouflaging” were observed, to mask autistic- or ADHD-related traits, to try to fit into a society mainly structured by and for neurotypical individuals (Lai & Baron-Cohen, 2015), but ultimately affecting their physical and mental health.

Aim of this study was to estimate the prevalence of ADHD traits and diagnosis in a sample of adult individuals with ASD without intellectual disabilities, examine sex differences in ADHD features, and explore the association between impulsivity and autistic traits.

146 adults with ASD completed assessments for autistic-, ADHD-traits, and impulsivity. Those above the ADHD-traits cut-off underwent the Diagnostic Interview for ADHD in adults (DIVA-5).

42 subjects (28.8%) were diagnosed with ADHD comorbid with ASD (26 combined type, 16 inattentive, 0 impulsive). Most diagnosed subjects (71.4%) were females, but males scored higher on inattentive and hyperactive-impulsive symptoms. Autistic traits were positively correlated with attentive impulsiveness.

Adults with ASD without intellectual disabilities show a significant prevalence of comorbid ADHD, particularly with inattentive symptoms. Attention difficulties are common in both disorders. Further studies and tailored diagnostic processes are needed to assess sub-threshold symptoms in ASD, ADHD, and other neurodevelopmental conditions.

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Despite differences in the onset and symptomatology, Autism Spectrum Disorder (ASD) and Schizophrenia (SCH) are neurodevelopmental conditions with evolving conceptual links in modern psychiatry. This stems from increasing evidence suggesting overlap in social cognition, attachment and the conceptualization as disorders of the self. A transdiagnostic approach, in which network analysis can play an important role, offers valuable insights into the complex interrelationships between symptoms and key constructs in the psychopathology of them. It may reveal underlying similarities and differences, contributing to more targeted interventions.

Our study aims to investigate the symptom structures of ASD, SCH, and neurotypical individuals (NTP) using network analysis. By comparing them, our explorative goal was to identify key constructs and their connections, providing potential intervention targets. We hypothesize that both ASD and SCH networks will significantly differ from the NTP network, and that mentalization and disorganized schizotypy would be the most central nodes in the networks of ASD and SCH.

In a cross-sectional study, 1694 participants were involved in the analysis (NNTP=1477, NASD=155, NSCH=62). Participants completed self-report questionnaires. Based on theoretical and methodological considerations we included psychological inflexibility, mentalization, insecure attachment, perceived social support, minimal and narrative self, negative and disorganized schizotypy, autistic traits, anxiety in the analysis. Gaussian Graphical Models were used to estimate relationships between constructs, with LASSO regularization, focusing on network centrality and predictability measures. Network Comparison Test was applied to unveil local and global differences.

A comparative representation with node scaling for predictability values are shown in image 1 and image 2. Minimal self was the most predictable node in each case. Central nodes in the ASD network were psychological inflexibility and minimal self, in the SCH network narrative self and insecure attachment, in the NTP network psychological inflexibility and minimal self. Significant differences in global strength were observed between ASD and NTP networks. Details of a relevant pattern are shown on image 3.

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Our study highlights distinct symptom networks in ASD and SCH, with distinct centralities emerging. Results suggest interventions targeting psychological inflexibility and self-concept may be effective for ASD, while in SCH, narrative self experience and attachment insecurity may be beneficial. Results show that focusing on isolated constructs may overlook the importance of other constructs. By focusing to the strongest edges and relevant patterns, clinicians may benefit from interventions that simultaneously target the dimensions of the relationships, also considering the most central nodes in the network.

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Many grieving individuals report sensory and phenomenological experiences involving deceased loved ones, such as visual, auditory, or sensed presences. These experiences are common across cultures, with 40-70% of bereaved spouses reporting them. They can provide comfort or cause distress, and can last from brief moments to several years. Despite their prevalence, there is limited empirical research on these occurrences, leaving mental health professionals often unprepared to address them.

This study aims to explore the phenomenology of sensory experiences with the deceased, the factors associated with these experiences, and their impact on grieving individuals.

A bibliographic review was conducted using PubMed, using terms like “Bereavement,” “Hallucinations,” “Phenomenology,” and “Sensory Experiences.”

The review indicates that sensory experiences involving deceased loved ones should not automatically be viewed as pathological. Rather, these experiences may function as adaptive responses that help maintain emotional bonds with the deceased, facilitating the grieving process. Research highlights that “sensing a presence” is the most frequently reported phenomenon, followed by visual and auditory encounters. Key factors influencing these experiences include sensory deficits, cognitive difficulties and poor sleep.These phenomena are particularly common among older adults, with women more likely than men to report them. Strong emotional ties, marital satisfaction, and having children with the deceased correlate positively with these sensory experiences. High levels of avoidant coping are significant predictors of experiencing these phenomena, while a more detached coping style appears to help in accepting the finality of the loss. Studies suggest that those who have these experiences often report greater levels of prolonged grief, PTSD, depression, and feelings of emotional loneliness compared to those who do not. However, these experiences do not necessarily result in better or worse clinical outcomes. Mental health professionals must create a supportive environment where individuals can discuss these experiences without fear of judgment or being labeled as mentally ill. Understanding these phenomena as psychologically meaningful and significant to the bereaved can promote healing.

This review emphasizes the need for a nuanced understanding of sensory experiences involving the deceased, moving beyond simplistic interpretations as signs of mental illness. Instead, these experiences should be seen as contextually meaningful and part of the bereaved’s relationship with the deceased. For those distressed by these experiences, therapeutic interventions could focus on reshaping their relationship with the deceased or modifying their responses.

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Personality disorders are defined as maladaptive traits of personality and behavior causing severe harm to an individual or people around them. Personality development is closely related to identity development. Higher prevalence on personality disorder diagnoses has been found to be associated with gender dysphoria. However, previous research on this topic has been scarce and methodically varying (Table 1, Image 1&2).

The object of this research was to determine the prevalence of personality disorder diagnoses in individuals requesting medical gender reassignment.

A register-based follow-up study of individuals who contacted the nationally centralized gender identity services in Finland in the period 1996-2019 (n=3,665) and 8:1 age and sex-matched population controls (n=29,292). All their specialist-level psychiatric treatment contacts in 1994-2022 were identified in the National Care Register for Health Care. ICD-10 diagnoses and dates of the contacts were extracted.

Among the gender dysphoria group, 15.0% (551 out of 3,665) had received a diagnosis in the personality disorder group (F60-69 excluding F64.x) in specialized psychiatric health care, while among the control subjects, 2.1% (625 out of 29,292) had received such a diagnosis (Table 2). The most common personality disorder among the gender dysphoria group was borderline personality disorder.

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Personality disorders are overrepresented among those seeking medical gender reassignment. Further research is needed to explore the factors contributing to the higher prevalence of personality disorders among individuals with gender dysphoria.

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Attention Deficit and Hyperactivity Disorder (ADHD) is a neurodevelopmental condition characterized by persistent patterns of inattention, hyperactivity, and impulsivity. Beyond these core symptoms, ADHD seems to present complex associations with certain personality traits and to share several clinical features with personality disorders (PDs), particularly those within Cluster B. This overlap of symptomatology may lead to diagnostic challenges and potential misdiagnoses. This paper reviews the literature on the relationship between ADHD and personality traits, highlighting overlaps with personality disorders and exploring their clinical and diagnostic implications.

The primary objective of this review is to understand the potential associations between ADHD and specific personality traits, focusing on the extent to which these traits overlap with clinical features of personality disorders.

A non-systematic literature review was conducted using major databases such as PubMed, Wiley and ScienceDirect targeting peer-reviewed studies published over the last two decades. The search terms included “ADHD,” “personality traits,” “personality disorders,” and “diagnostic overlap.” Relevant studies were selected based on their focus on adult ADHD and its association with personality traits and personality disorders. Review articles and cross-sectional studies were included.

The currently available literature reveals significant associations in the clinical presentation of ADHD and specific personality traits (changing accordingly to different models of personality assessment), as well as a relevant diagnostic overlap with Cluster B personality disorders, particularly Borderline Personality Disorder (BPD) and Antisocial Personality Disorder (ASPD). Shared features include impulsivity, emotional dysregulation, and difficulty in maintaining relationships. The presence of ADHD seems to increase the likelihood of personality pathology, with some studies suggesting a high co-occurrence of ADHD with traits of increased neuroticism and novelty-seeking, and decreased conscientious inhibition.

ADHD and personality disorders share multiple overlapping clinical features, making accurate diagnosis challenging and potentially delaying adequate treatment. Thus, as suggested in some of the articles reviewed, an integrative and dimensional approach to such clinical pictures may be more adequate, so to ensure a profound understanding of the difficulties presented by patients, aiming at providing accurate and tailored treatment. Further research is needed to refine diagnostic criteria and strengthen a standardized dimensional thinking to address this diagnostic ambiguity.

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Evidence has shown that perfectionism is linked with increased perceived stress, whereas self-compassion might mitigate poor outcomes related to stress. However, how these traits influence stress responses in a naturalistic setting is unclear.

The study aims to test the associations of perfectionism and self-compassion traits with stress-related biomarkers, namely C-reactive protein (CRP), alpha-amylase, and cortisol, in medical students exposed to pre-exam stress.

61 second-year medical students were enrolled in this study. At baseline, perfectionism and self-compassion were self-rated using the Self-Compassion Scale and the Short-Revised Almost Perfect Scale, respectively. Morning saliva samples were collected at baseline and one week before the exam. The levels of salivary CRP, alpha-amylase, and cortisol were quantified as biomarkers for inflammation, sympathetic activity, and hypothalamus-pituitary-adrenal axis, respectively, using enzyme-linked immunosorbent assay. Multiple linear regression analysis was performed to test the associations between the two traits with pre-exam salivary biomarkers, adjusted for baseline salivary biomarkers, age, sex, and body mass index (BMI). Other potential confounding variables, including acute illness, underlying mood disorder, and lifestyle factors, were also added to the model as sensitivity analyses.

Adjusted for the baseline level of biomarker, age, sex, and BMI, perfectionism traits significantly predicted pre-exam salivary alpha-amylase (B = 0.04, 95% CI 0.01 to 0.07, p = .007), but not CRP (B = -0.03, 95% CI -0.07 to 0.01, p = .177) or cortisol (B = 0.004, 95% CI -0.005 to 0.012, p = .424). No significant associations were found between self-compassion traits and the pre-exam levels of all three salivary biomarkers. The sensitivity analysis, additionally adjusted for other potential confounding factors, confirmed the significant positive association between perfectionism traits and pre-exam salivary alpha-amylase (B = 0.04, 95% CI 0.01 to 0.07, p = .006).

Perfectionism traits could positively predict the level of morning salivary alpha-amylase in naturalistic stress exposure, suggesting a heightened sympathetic activity among those with high perfectionism in response to stress. Replication studies in a larger sample with more diverse populations are warranted.

None Declared

The interaction between grapefruit juice and certain psychiatric medications can lead to significant clinical implications due to the inhibition of the cytochrome P450 3A4 (CYP3A4) enzyme (Fuhr et al. CPT 2023, 114(2), 266-275; Guttman et al. Phytother. Res 2020, 34(5), 1168-1176; Paine et al. Drug Metab. Dispos 2004, 32(10), 1146-1153; Paine et al. J. Pharmacol. Exp. Ther 2005, 312(3), 1151-1160; Schmiedlin-Ren et al. Pharmacol. Ther 1997, 66(2), 234-241). Grapefruit juice contains furanocoumarins, specifically bergamottin and 6’,7’-dihydroxybergamottin (DHB), which irreversibly inhibit CYP3A4, potentially increasing drug plasma concentrations and the risk of adverse effects (Bailey et al. CPT 1998, 64(3) 248-256; de Castro et al. J. Agric. Food Chem 2006, 54(7) 2498-2503; Row et al. J. Med. Chem 2005, 49(20), 6139-6146).

This review aims to quantify the impact of grapefruit juice on the plasma concentrations of buspirone, carbamazepine, and diazepam and to understand the duration of these effects to better manage patient safety.

A comprehensive review of existing pharmacokinetic studies (Furukori et al. BJCP 2003, 55(3), 307-311; Lane et al. Psychopharm 2001, 155(3), 356-359; Tanaka et al. Clin. Pharm 2013, 52(5), 397-420; Wang et al. CPT 1993, 65(3), 314-321; Yasui et al. Psychopharm, 145(1), 84-87) was conducted to gather data on the effects of grapefruit juice on CYP3A4 substrate psychiatric medications. Quantitative increases in plasma concentration metrics (AUC and Cmax) were extracted, and the duration of the inhibition effect was analyzed.

Buspirone plasma concentrations increased by 4.3-fold, with effects lasting 24 hours. Carbamazepine showed a 1.4-fold increase in AUC and a 1.2-fold increase in Cmax, with effects persisting up to 24 hours. Diazepam concentrations increased by 3-fold in AUC and 2-fold in Cmax, with an effect duration of 24 hours. No significant interaction was observed for clozapine and haloperidol.

Grapefruit juice significantly increases the plasma concentrations of buspirone, carbamazepine, and diazepam by inhibiting CYP3A4, with effects lasting up to 24 hours. Clinicians should educate patients on avoiding grapefruit consumption while on these medications and monitor for potential toxicity. Further research is needed to develop guidelines for managing these interactions and to explore genetic variations in response to grapefruit consumption.

None Declared

Major depressive disorder (MDD) is a severe mental disorder with a prevalence rate of 10%. Approximately 30-40% of patients suffering from MDD show higher levels of proinflammatory cytokines, associated to low response to pharmacotherapy. Thus, modulation of immune system might have a key role in the management of MDD.

This study is aimed to: 1) assess the interrelation between immune hyperactivation and neuronal plasticity; 2) assess how non-pharmacological treatments impact on the immune hyperactivity in patients suffering from MDD; 3) identify biological makers able to predict the course of MDD and the effectiveness of treatments.

Immune4Plasticity is a longitudinal, multisite trial funded by Italian Ministry of Health. Preclinical analyses aimed at investigating the interrelation between immune hyperactivation and neuroplasticity as well as the identification of biological markers of MDD will be carried out at National Institute of Health in Rome. Clinical part of the study will be performed at the Department of Psychiatry of University of Campania, Naples, and at the Vita-Salute San Raffaele University, Milan. Seventy patients aging 18-65, with a diagnosis of MDD according to the DMS-5 criteria without psychotic symptoms, scoring more than 14 at the 17-item Hamilton Depression Rating Scale and able to release informed consent will be included. Thirty-five participants will attend a lifestyle psychosocial intervention in Naples; thirty-five will undergo light-therapy sessions in Milan. Assessments of both groups will be performed at recruitment (T0), after 3 months (T1) and after 6 months (T2), by using standardized psychometric tools and blood samples. The project will be carried out for 24 months.

This multidisciplinary, translational study will shed more light on the complex interrelationship between MDD, immune system and neuroplasticity by investigating the role of psychosocial intervention and light therapy as ‘modulators’. This will make it possible to develop innovative therapeutic strategies by integrating non-pharmacological approaches with anti-inflammatory drugs and to identify new peripheral markers to assess the response to treatment of patients with MDD.

MDD is a complex mental disorder associated with higher expression of inflammation. Sometimes, it is not adequately responsive to pharmacotherapy. Understanding the effect of non-pharmacological treatments as “modulators” of the inflammatory pattern of MDD may be an important strategy to optimize clinical management of this disorder.

None Declared

Pro-inflammatory mediators inhibit drug metabolism and transport. Detailed knowledge is lacking on the mechanism and extent of alterations in olanzapine pharmacokinetics during acute inflammatory states accompanying infections.

To quantify the extent of systemic and brain exposure to olanzapine in a murine model of endotoxemia compared to a non-endotoxemia model.

Acute endotoxemia model was established in C57BL/6N mice intraperitonealy injected with 5 mg/kg Escherichia coli lipopolysaccharide (LPS). On Day 2 following LPS administration, LPS-injected mice and saline-treated controls were given single doses of olanzapine orally (p.o.) or intravenously (i.v.) or desmethylolanzapine (DMO) i.v. Concentrations and unbound fractions of olanzapine and DMO were measured in plasma samples and brain homogenates. Moreover, plasma biochemistry parameters and mRNA expression patterns were evaluated of pro-inflammatory cytokines, selected phase I and II drug-metabolizing enzymes and transporters in the liver, ileum and brain.

Following p.o. olanzapine, the areas under the concentration-time curve (AUC) for olanzapine and DMO in the plasma were increased 3.8-fold and 2.6-fold (P<0.05) in LPS-injected mice vs. controls. The AUC for olanzapine in the brain homogenate was 5.2-fold higher (P<0.05). Brain DMO was hardly detectable in both groups. The penetration ratios (Kp,brain) of 8.5 and 6.3 confirmed that LPS increased the passage of olanzapine into the brain. Expression of mRNAs was decreased in the liver of CYP1A2 and UGT1a1/1a5 enzymes and Abcb1a, Bsep and Ntcp transporters and of ileal Abcb1a, whereas Abcb1a and Abcb1b in the brain and inflammatory cytokines and chemokines mRNAs in the liver were upregulated.

Investigation of olanzapine pharmacokinetics in endotoxemia mice clearly indicates a considerable increase in systemic and brain concentrations of the drug after oral administration. Further studies should clarify whether or not the inflammation-induced inhibition of metabolism and efflux transport results in brain overexposure to the drug and adverse effects in accutely infected patients treated with oral olanzapine.

None Declared

Accumulating research has suggested a possible role of the immune/inflammatory response system in the pathophysiology of suicidal behavior, more specifically of specifically high-lethality suicide attempts (SA). To count with reliable and affordable biological markers of high-lethality SA to complement clinical assessment for early detection of individuals at a high risk of committing suicide is thus mandatory.

To assess if immune/inflammatory parameters may differ between suicide attempters with and without SA, taking into account the type of suicide method. The odds of repeating a high-lethality SA in the future will also be explored.

In this retrospective observational single center study, medical records of suicide attempters admitted to the Emergency Department at Vall d’Hebron University Hospital (Barcelona, Spain) between 2017-2021, will be reviewed. The following immune/inflammatory parameters (i.e., total and differential white blood cell count, platelet counts, C-reactive protein levels) will be extracted for comparisons between subjects without a history of previous suicide attempt (SA), and those with a history of previous SA. Additionally, the following ratios/indexes will be calculated as a proxy of subject’s inflammatory status: neutrophil-to-lymphocyte ratio (NLR), basophil-to-lymphocyte-ratio (BLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic inflammatory response index (SIRI). Analyses will be controlled for clinical and sociodemographic variables, such as age, gender and/or primary psychiatric diagnosis. Analyses will be also stratified according to the attempt method. Moreover, the capability of the previously mentioned parameters to predict a high lethality SA or to commit suicide in the coming two years will also be evaluated.

Results from the interim analysis will be presented at the congress.

Peripheral immune/inflammatory parameters may allow us to discriminate subjects at risk of committing suicide. In case of positive findings, immune/inflammatory parameters could be incorporated in the comprehensive evaluation of high-lethality SA in individuals admitted to the emergency setting, contributing to improve early detection of suicide risk.

L. Martorell Mensua Shareolder of: First authorship, W. Vidal Cachay Shareolder of: First authorship, M. Quesada Franco: None Declared, A. Beneria Gonzalez: None Declared, J. Ramos Quiroga: None Declared, A. Motger Albertí: None Declared, G. Arteaga-Henriquez Shareolder of: Last authorship, D. Braquehais Conesa Shareolder of: Last authorship.

Effective seizure induction with minimal adverse effects in Electroconvulsive Therapy (ECT) are influenced by administered electrical pulse frequency. Optimized pulse frequency is key to ensure therapeutic efficacy and reduce side effects.

This study examines electrical pulse frequency impact on neuronal excitability and seizure quality in ECT, guided by chronaxie and refractory periods.

A comprehensive literature review was conducted to assess neurophysiological properties affected by ECT and how different frequencies influence treatment outcomes.

Neurons fire action potentials when membrane potentials reach a -55 mV threshold. Lower frequencies (20-32 Hz) balance depolarization and repolarization to trigger seizures without excessive neuronal firing. The neuronal absolute refractory period is 1-2 msec, and the relative refractory period is 2-4 msec. Lower frequencies optimize repolarization recovery.

ECT is clinically administered at 20-70 Hz. Studies show 20-32 Hz is effective at triggering seizures with optimal treatment outcomes. Lower Hz also minimizes tissue damage from reduced power. The total charge delivered is affected by current amplitude, pulse width, frequency, and train duration. Shorter pulse widths (0.3 ms) reduce total energy and minimize tissue heating.

The neuronal soma is sensitive to electrical stimulation. Chronaxie is the minimum time that an electric current is applied to stimulate a neuron. Chronaxie is 0.2-0.3 msec. Aligning pulse frequencies with these values ensures stimulation with reduced adverse effects. The soma exhibits a lower spike threshold and shorter refractory period when facing prolonged steady depolarization, making it highly sensitive to pulse frequencies that align with its chronaxie values.

In contrast, axons have a higher density of voltage-gated Na+ channels that allow quicker recovery and shorter refractory periods. This high density enables axons to rapidly transmit action potentials, facilitating efficient neuronal signal propagation. Shorter axonal refractory period means they handle higher frequencies more effectively, but optimizing the overall frequency for ECT must balance the excitability of both the soma and axons.

Studies indicate that frequencies around 20-32 Hz are effective in initiating convulsive activity, aligning well with the end of the stimulus train. Frequencies over 50 Hz may suppress ictal activity and be inefficient in seizure induction due to “stimulus crowding,” with neurons stimulated during their absolute refractory period.

Optimizing ECT pulse frequency is vital to balance therapeutic efficacy and safety. Fine-tuning ECT’s electrical parameters enhances patient outcomes. Lower frequencies (20-32 Hz) are more effective to induce seizures and minimize adverse effects. 20-70 Hz in ECT is most clinically used, and lower end Hz could optimize results. Further frequency range research could lead to improved ECT protocols.

None Declared