In the last decennium there is an explosion of medical devices to help patients in their fight against their psychiatric disorder and if possible to take more control and responsibilities over their own lives. In our research on measurement instruments it was doubted that patients were able to use computers and apps. Happell, 2009, addressed that psychiatric patients were very interested in using apps and also were positive being partners in the development of apps that could enhance their quality of life. Their attitude towards apps in clinical practice was more positive than their clinicians who were afraid of being judged on their performance and are more hesitant (Buwalda, et al., 2015). 10-15 years later millions of patients and clinicians are using applications and other medical devices to enlighten their lives.

But what about the most vulnerable citizens, our patients, in the cities in the context of urbanisation. In Amsterdam the public mental health services developed the self-sufficiency matrix (SSM) to gain insight in the peoples individual possibilities. A measure that insights the adaptation to the complex city life and how they can take care of themselves in this ever changing world. How do they feel about using apps or their professionals in daily clinical practice?

This presentation is about the history of the development of a mental health app for psychiatric patients in the city to be used by the professionals. Through a small pilot the presenter will a show the process of development of the SSM-app that gives insight in the wellbeing of the most vulnerable and their needs. We will also discuss the challenges and user-friendliness of the SSM- app in our PMH to make our work more digital proof.

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Heterogeneous symptoms in major depression contribute to unsuccessful antidepressant treatment, termed treatment-resistant depression (TRD). Psychometric network modeling conceptualizes depression as interplay of symptoms with potential benefits for treatment; however, a knowledge gap exists regarding networks in TRD.

Symptoms from 1,385 depressed patients, assessed by the Montgomery-Åsberg-depression rating scale (MADRS) as part of the “TRD-III” cohort of the multinational research consortium “Group for the Studies of Resistant Depression,” were used for Gaussian graphical network modeling. Networks were estimated for two timepoints, pretreatment and posttreatment, after the establishment of outcomes response, non-response, and TRD. Applying the network-comparison test, edge weights, and symptom centrality was assessed by bootstrapping. Applying the network-comparison test, outcome groups were compared cross-sectionally and longitudinally regarding the networks’ global strength, invariance, and centrality.

Pretreatment networks did not differ in global strength, but outcome groups showed distinct symptom connections. For both response and TRD, global strength was reduced posttreatment, leading to significant differences between each pair of networks posttreatment. Sadness, lassitude, inability-to-feel, and pessimistic thoughts ranked most centrally in unfavorable outcomes, while reduced-appetite and suicidal thoughts were more densely connected in response. Connections between central symptoms increased in strength following unsuccessful treatment, particularly regarding links involving pessimistic thoughts in TRD.

Treatment reduced global network strength across outcome groups. However, distinct symptom networks were found in patients showing response to treatment, non-response, and TRD. More easily targetable symptoms such as reduced-appetite were central to networks in patients with response, while pessimistic thoughts may be a key symptom upholding disease burden in TRD.

COVID-19-related conspiracy theories (CTs) have been observed among healthcare workers (HCWs). There exists, however, a lack of research investigating the extent, nature, and determinants of CTs among HCWs worldwide.

A systematic literature search of Medline, EMBASE, Web of Science, Scopus, and CINAHL electronic databases (from inception to October 2023) was conducted for studies examining the prevalence and nature of COVID-19-related CTs among HCWs and health students and/or factors driving HCWs into believing these CTs.

Prevalence rates of COVID-19-related CTs among HCWs varied widely across studies, ranging from 0.89% to 75.6%. These prevalence rates mainly concern vaccine-hesitant HCWs (although a minority of vaccinated HCWs also endorse CTs). Higher prevalence rates of CTs were found in the Arab world, Ethiopia, and Nigeria, compared to other African and Western countries. While in European countries and Northern America, an increased belief of HCWs in the “destabilization and power gain” narrative was found, African HCWs particularly endorsed the “population reduction” and “liberty restriction” narratives. Limited and heterogeneous data prevented conclusive findings on the relationship between CTs and sociodemographic factors, ethnicity, and psychological traits among HCWs. However, a consistent observation emerged regarding the level of education, indicating HCWs with higher educational attainment (e.g., physicians) tend to endorse CTs less frequently.

Although COVID-19-related CTs may be highly prevalent among vaccine-hesitant HCWs, gaps in understanding the drivers of CTs among HCWs remain. Given HCWs’ critical role in public health, especially during pandemics, further research is therefore essential.

It is important to address the prevention and early detection of opioid addiction with a comprehensive approach. The collaboration and early attention are essential to mitigate the risks associated with opioid misuse. In this session we will review the myths associated with high risk of opioid addiction and how to address when it has been developed.

Some key strategies could be: Provide accurate and understandable information about the risks associated with opioid use, as well as the early signs of addiction. Consider alternative options for pain management, such as physical therapies, exercise, and medications non-opioids, before prescribing opioids. It is important balance pain relief with control of possible addiction risks. The appropriate and controlled indication of opioids is of vital importance to prevent and detect inappropriate use. Prescribe the lowest dose and duration shortest possible. It is important to visit frequent monitoring to detect signs of misuse and/or addiction.

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Opioid use disorder (OUD) is a devastating condition with frequent suicidality, contributing to overdose deaths. Theta burst stimulation (TBS) to the dorsolateral prefrontal cortex (DLPFC) is used to treat major depressive disorder (MDD) and is effective in treating suicidal ideation. We piloted a randomized, double-blind, sham-controlled trial of bilateral rTMS for patients with OUD and MDD experiencing suicidality.

Sequential bilateral TBS was delivered guided by structural neuroimaging: continuous TBS to the right then intermittent TBS to the left DLPFC, daily (20 treatments). The primary objective was to determine the feasibility of this population. The primary clinical outcome was the scale for suicidal ideation (SSI), secondary outcomes included depressive symptoms and opioid cue-induced craving. ClinicalTrials.gov: NCT04785456.

Eighty-seven individuals were pre-screened. The most common reasons for ineligibility included being unreachable by the study team, difficulty with scheduling/travel requirements, and medical/psychiatric instability. Six participants (5:1 M:F) were enrolled (3/arm), four had a fentanyl use history; two completed per protocol (1/arm). Of the participants with follow-up data, SSI scores decreased in 2/3 in the sham arm and 2/2 in the active arm; depression and opioid craving scores decreased in all participants.

We present the first data piloting a structural neuroimaging-guided, multi-session rTMS treatment course in outpatients with suicidality and OUD in the current North American context. Recruitment and retention were the main challenges given the highly unstable medical and psychosocial context of this patient population. Future trials should consider a suitable environment to improve the feasibility of delivering this treatment.

Opioid use disorder in patients with chronic pain poses a specific clincal challenge. Tapering opioids can initially increase pain, while continuing opioids is associated with tolerance and opioid induced hyperalgesia, resulting in inadequate analgesia. In the long run tapering of opioids or rotation to long-acting alternatives, such as buprenoprphine or methadone, have been associated with less pain and better qualtity of life. In this presentation, evidence for various tapering and rotation strategies will be presented, as well as the possiblities for integrated pain management and addiction care. After this session you will know how to prepare your patient with presciroption opioid use disorder and chronic pain for tapering of opioids, how to support your patient with tapering, including the pace of tapering and the use of supproting pharmacological and non-pharmacoligcal interventions. Finally, it will be discussed who is more likely to benefit from rotation to long-acting opioids, and why some patients might be better of without opioid tapering.

A. Schellekens Grant / Research support from: PI in several studies, funded by national governmental funding agencies.

The diagnosis of ADHD in adults is on the rise. Applying the ADHD diagnosis, which originally was described in children, to adults has involved a “subjectivization” of some of the diagnostic criteria, i.e., some behavioral features (signs) in children have become experiences (symptoms) in adults. These issues raise the question of how ADHD is best diagnosed in adults? Thus, we examined how ADHD is diagnosed in adults in research.

A review of how ADHD is diagnosed in adults in randomized controlled studies (RCTs).

We include 292 RCTs. We found substantial variation and no consensus about the diagnostic method. More than half of the studies did not seem to include an assessment of general psychopathology, and only in 35% of studies was the ADHD diagnosis allocated by psychiatrists or psychologist. More than half of the studies included patients with psychiatric comorbidity.

These findings raise concerns about the validity of the ADHD diagnosis in many of the included RCTs. It is worrying that securing a reasonably accurate diagnosis is not prioritized in more than half of the studies. If neither clinicians nor researchers can rely on the basic fact the patients in scientific studies diagnostically resemble the patients they are facing, scientific studies risk losing their clinical relevance. Since RCTs can lead to changes in clinical practice, they must be conducted carefully. To advance research on adult ADHD, the quality of the diagnostic assessment must be prioritized, requiring comprehensive differential diagnosis by a skilled psychiatrist or psychologist.

Introduction This presentation will provide an up-to-date cross-national comparison of the individual, environmental and socioeconomic determinants of the European population mental health (MH). Methods The European House & Ambrosetti-funded 2023 Headway Mental Health Index 3.0 initiative collected data on 19 Key Performance Indicators (KPIs) in individual (e.g., smoking), environmental (e.g., air pollution) and socioeconomic (e.g., poor housing conditions) determinants of MH for the European Union 27 countries and the UK. KPIs scores were standardised in a 1-10 Likert Scale (1: worst performance; 10: best performance), thus allowing between-country comparisons of the relative performance. Unadjusted bivariate correlations between KPIs scores were run. Results Finland (8.0), Sweden and Estonia (7.5) had the lowest MH risk, while France (3.1) and Romania (2.8) had the highest MH risk. Smoking (r=-0.43, p=.021), alcohol use (r=0.57, p=.002), daylight hours (r=0.74, p<.001), ecoanxiety (r=-0.51, p=.005), air pollution (r=-0.46, p=.015), commuting time (r=0.42, p=.026) and Fragile State Index (r=-0.44, p=.018) correlated with overall MH status, thus emerging as common determinants of MH across the board. Conclusions The determinants of MH varied across European countries, although the correlation between determinants-based MH risk and MH status was relatively weak, including ‘low-risk, poor MH status’ and ‘high-risk, good MH status’ countries. Further non-tested determinants of MH and/or between-country differences in their responsiveness to the population MH needs may explain this discrepancy. These results may inform future evidence-based public MH policymaking and universal preventive strategies in Europe.

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Due to limited inpatient care resources and high healthcare expenditures, understanding factors that affect lengths of stay (LOS) is highly relevant. We aimed to investigate associations between metabolic disturbances and LOS in a psychiatric hospital and to identify other clinical and sociodemographic LOS predictors.

Patients admitted to one of the units of the general psychiatric or psychogeriatric departments between January 1, 2007 and December 31, 2020, were included. Metabolic disturbances (i.e., the metabolic syndrome and its five components) were defined using the International Diabetes Federation definition. Cox frailty regression models with time-varying coefficients were used to investigate the association between metabolic disturbances and LOS. Hazard ratios (HR) >1 and HR < 1 indicated the relative likelihood of shorter and extended LOS, respectively.

A total of 7,771 patients for 16,959 hospital stays throughout 14 years of follow-up were included. Central obesity (HR = 0.82; 95% confidence interval [CI] = [0.76–0.89]), hyperglycemia (HR = 0.83; 95% CI = [0.78–0.89]), hypertriglyceridemia (HR = 0.87; 95% CI = [0.80–0.92]), and the metabolic syndrome (HR = 0.76; 95% CI = [0.70–0.82]) were associated with an increased risk of extended LOS in the psychiatric hospital, while underweight (HR = 1.30, 95% CI = [1.09–1.56]) and HDL hypocholesterolemia (HR = 1.10, 95% CI = [1.03–1.18]) were associated with a higher likelihood of shorter LOS. In first-episode psychosis patients, hypertriglyceridemia (HR = 0.82; 95% CI = [0.67–0.99]) and hypertension (HR = 0.76, 95% CI = [0.58–0.99]) were associated with extended LOS when considering all stays, while no association was found when considering the first stay per patient.

Future studies should determine whether better metabolic monitoring and treatment of metabolic disturbances can contribute to reducing LOS.

The mental health of incarcerated individuals is a widely recognized public health issue, but little is known about the mental health status of the incarcerated individuals upon release. This study aimed to measure the prevalence of psychiatric disorders and substance use disorders (SUDs) among incarcerated men scheduled to be released from jail soon.

We conducted a cross-sectional national survey from September 2020 to September 2022 across 26 jails (selected at random) in France. Each participant was interviewed within 30 days prior to their release via a structured questionnaire, including the Mini International Neuropsychiatric Interview.

A total of 579 individuals were included in the analysis (participation rate: 66.2%). The prevalence of mood disorders, anxiety disorders, post-traumatic stress disorder, and psychotic episodes were 30.7% (95% confidence interval [CI]: 27.1%–34.6%), 28.7% (95% CI: 25.1%–32.5%), 11.1% (95% CI: 8.8%–13.9%), and 10.5% (95% CI: 8.3%–13.3%), respectively. Additionally, almost half of the individuals had an SUD, and dual disorders were identified in 21.9% (95% CI: 18.8%–25.5%) of the cases. The analysis of mental health care pathways raised questions about access to certain types of care, such as full-time psychiatric hospitalization while in prison, as well as questions about the continuity of care upon release.

This study shows that the mental health of incarcerated men who are scheduled to be released soon is precarious. Complex mental health problems, particularly dual disorders, are common and require better coordination between mental health care systems in prisons and the community.

This study evaluated European countries’ responsiveness to mental health (MH) needs by analyzing key performance indicators (KPIs) across healthcare, workplaces, schools, and society. Data from the 2023 Headway Initiative included 15 KPIs related to healthcare responsiveness—such as workforce availability, facilities, quality of care, and MH expenditure—and 14 KPIs assessing responsiveness in workplaces, schools, and society. KPI scores were standardized on a 1-10 Likert scale, with higher scores indicating better performance. Bivariate correlations examined associations between responsiveness and overall MH status. Sweden (10.0), Denmark (8.8), and Finland (8.3) demonstrated the highest responsiveness in healthcare, whereas Romania (1.0), Slovakia (1.1), and Latvia (1.2) ranked lowest. In non-healthcare domains, Germany (10.0), France (9.1), and Denmark (9.1) were the most responsive, while Greece and Slovakia (1.0) exhibited the poorest performance. These findings highlight significant disparities in MH support across Europe and emphasize the need for policies that address inequalities and bridge treatment gaps. Future efforts should focus on balancing MH status improvements with sustained investment in MH responsiveness.

C. Arango Speakers bureau of: Dr. Arango has been a consultant to or has received honoraria or grants from Abbot, Acadia, Ambrosetti, Angelini, Biogen, BMS, Boehringer, Carnot, Gedeon Richter, Janssen Cilag, Lundbeck, Medscape, Menarini, Minerva, Otsuka, Pfizer, Roche, Sage, Servier, Shire, Schering Plough, Sumitomo Dainippon Pharma, Sunovion, Takeda and Teva.

The EPA Action Plan 2025-2027 aims to optimize mental health care in Europe, by focusing on several unmet needs still experienced by patients. New ways for treatment delivery and new settings of care, tailored diagnostic approaches, research on brain and on mental health, reduction of multimorbidity and mortality gap, promotion of prevention strategies in mental health and more attention on minorities’ mental health represent some of the milestones on which a roadmap for mental health in Europe may be based.

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The COVID-19 pandemic increased the incidence and burden of eating disorders (EDs) globally. First Episode Rapid Early Intervention for EDs (FREED) is a nationally implemented early intervention service model for young people (16–25 years) with EDs in England. This study evaluates the longer-term impact of the pandemic on presentations and service provision in FREED.

Data from January 2019 to September 2024 were analyzed, including three services with pre-, pandemic, and post-pandemic data (Sample 1), and 62 services with post-pandemic data (Sample 2), 32 of which also contributed data during the pandemic. Linear mixed models examined referral numbers, duration of untreated ED, diagnostic mix, average body mass index for anorexia nervosa, and wait times.

In the three services with pre-, pandemic, and post-pandemic data, referrals remained significantly higher post-pandemic compared to the pre-pandemic period. Across all services, post-pandemic referrals declined compared to the pandemic period. Consistently, anorexia nervosa diagnoses decreased, and the duration of untreated ED at presentation increased post-pandemic.

The COVID-19 pandemic has had lasting impacts on ED service provision in England. Sustained investment and national support are essential to ensure FREED services continue to meet the needs of young people with recent-onset EDs and to reduce the duration of untreated ED.

Depression is characterized by disturbed emotion processing, with aberrant neural and physiological responses to emotional stimuli. Here, we applied an emotion anticipation and processing paradigm to investigate brain neural and electrodermal reactivities in patients with depression compared with healthy controls.

The study included 42 patients (27 females) and 44 healthy controls (21 females). Subjects underwent functional magnetic resonance imaging with simultaneous measurement of electrodermal activity. During scanning, red or green color cues were presented, followed by pictures of negative or positive valence, respectively. Behavioral valence and arousal ratings of the picture stimuli were conducted after scanning. Anhedonia was assessed through a semi-structured interview in both subject groups.

Patients perceived positive pictures as less positive than controls did. Positive anticipation (i.e., green color cues) elicited stronger activations in the anterior cingulate cortex and the right insula in patients than in healthy controls, indicating salience network disturbances. An exploratory analysis of all regions in the Automated Anatomical Labeling Atlas 2 found significant differences in activity to positive anticipation between groups in several brain regions involved in cognition and emotion processing. Positive and negative anticipation elicited stronger electrodermal responses in healthy controls. However, electrodermal reactivity to negative pictures was higher in patients than in controls.

Ongoing depression affects emotion anticipation and processing at the behavioral, neural, and physiological levels. These findings contribute to increased understanding of the disorder.

Attention-deficit/hyperactivity disorder (ADHD) in adults often presents with nonspecific symptoms that can be obscured by years of compensatory mechanisms and comorbid conditions. Traditional diagnostic approaches may fall short in capturing the nuanced presentation of ADHD in previously undiagnosed adults, leading to potential misdiagnosis or delayed treatment. This talk presents a comprehensive clinical framework for evaluating adult ADHD that integrates structured assessment protocols with thorough clinical investigation.

Our diagnostic model employs a multi-stage evaluation process that includes: (1) comprehensive pre-interview rating scales, (2) in-depth clinical interviews focusing on lifetime symptom presentation and functional impact, (3) systematic gathering of collateral information, and (4) administration of validated assessment instruments with embedded validity scales. The evaluation protocol emphasizes the assessment of executive function, emotional regulation, and adaptive behaviors developed throughout adulthood.

This approach represents a significant advancement in adult ADHD diagnosis by incorporating validated assessment tools with thorough clinical investigation. The model’s emphasis on lifetime symptom patterns, adaptive behaviors, and compensatory mechanisms provides crucial insights into how ADHD manifests in adults who have developed various coping strategies throughout their lives. Furthermore, the integration of multiple data sources with patient insights facilitates better treatment engagement and outcomes.

The proposed comprehensive evaluation framework offers a more sophisticated and nuanced approach to diagnosing ADHD in previously undiagnosed adults. By combining validated assessment instruments with thorough clinical investigation and collateral information, this model enhances diagnostic accuracy and treatment planning. Our findings suggest that this approach not only improves diagnostic precision but also provides valuable insights into the developmental trajectory of ADHD, leading to more personalized and effective treatment strategies.

Adult ADHD, clinical evaluation, executive function, compensatory mechanisms, diagnostic precision

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Although Autism Spectrum Disorder (ASD) is frequently reported as a comorbidity in adults with Attention Deficit Hyperactivity Disorder (ADHD), diagnosing this additional condition in clinical practice remains challenging. Missing this diagnosis can significantly impact treatment and reduce the quality of life for these adults. In child and adolescent psychiatry, attention is also given to the source(s) that influence the symptoms and complaints of ASD and ADHD, both in diagnosis and treatment.

This lecture highlights the importance of identifying the source(s) of symptoms and complaints in adult patients, with or without ADHD, in an outpatient urban setting. Better mapping of these source(s) helps distinguish the symptoms of ASD from those of ADHD, refining both diagnosis and treatment. Unsurprisingly, ASD is often not even considered a potential comorbid condition in adults. In this lecture, we share practical experiences with adult outpatients and discuss the source(s) that frequently emerge, which aid in differentiating ASD symptoms from those of ADHD.

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Clinical high risk for psychosis (CHR) is often managed with antipsychotic medications, but their effects on neurocognitive performance and clinical outcomes remain insufficiently explored. This study investigates the association between aripiprazole and olanzapine use and cognitive and clinical outcomes in CHR individuals, compared to those receiving no antipsychotic treatment.

A retrospective analysis was conducted on 127 participants from the Shanghai At Risk for Psychosis (SHARP) cohort, categorized into three groups: aripiprazole, olanzapine, and no antipsychotic treatment. Neurocognitive performance was evaluated using the MATRICS Consensus Cognitive Battery (MCCB), while clinical symptoms were assessed through the Structured Interview for Prodromal Syndromes (SIPS) at baseline, 8 weeks, and one year.

The non-medicated group demonstrated greater improvements in cognitive performance, clinical symptoms, and functional outcomes compared to the medicated groups. Among the antipsychotic groups, aripiprazole was associated with better visual learning outcomes than olanzapine. Improvements in neurocognition correlated significantly with clinical symptom relief and overall functional gains at follow-up assessments.

These findings suggest potential associations between antipsychotic use and cognitive outcomes in CHR populations while recognizing that observed differences may reflect baseline illness severity rather than medication effects alone. Aripiprazole may offer specific advantages over olanzapine, underscoring the importance of individualized risk-benefit evaluations in treatment planning. Randomized controlled trials are needed to establish causality.

Cognitive dysfunction is well documented in patients with schizophrenia and bipolar disorder, including impairments in attention, memory, executive function and social cognition. These impairments are associated with poor social functioning and reduced activities of daily living.

Various therapeutic interventions have targeted cognitive impairment in both schizophrenic and bipolar patients. Several trials and meta-analyses are currently available. In addition to psychopharmacology, cognitive remediation programmes are available and have been shown to be applicable in clinical practice.

In conclusion, as we move towards more integrative and personalised treatment strategies for schizophrenic and bipolar patients, new assessments and therapies are available to target cognitive dysfunction. Not least because there are currently no cognitive enhancers on the market, it is hoped that new pharmacological adjunctive strategies can improve cognition in schizophrenia and bipolar disorder.

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Maternal alcohol consumption can adversely affect children’s development, but the impact of paternal drinking is less understood. We aimed to investigate whether maternal or paternal alcohol consumption during pregnancy affected children’s mental health and behavior.

A total of 2,013 parent–child triads from the European Longitudinal Study of Pregnancy and Childhood cohort were used. Data on alcohol consumption was obtained from questionnaires during pregnancy and after the child’s birth. Mental health and behavior of children were assessed with Strength and Difficulties Questionnaire (SDQ). The associations were tested using linear regression, adjusting for socio-demographic and psychosocial covariates.

Increased maternal alcohol consumption was associated with higher total SDQ scores at ages 7, 11, and 18 years old when the outcomes were reported by mothers, but only at 11 years when reported by children. We did not observe any dose–response relationship, and the effect size did not change during the follow-up. The effects were observed across various domains of SDQ: in the emotional symptoms subscale at age 11, in the conduct problems subscale at ages 7 and 11, and in the hyperactivity/inattention subscale at age 18. Paternal alcohol consumption was not associated with SDQ.

Maternal alcohol consumption during pregnancy is associated with long-term effects on children’s mental health and behavior, particularly when reported by mothers. No association was found between paternal alcohol consumption, suggesting that the results may stem from biological effects of alcohol or other factors beyond the direct exposure, potentially encompassing broader maternal psychosocial or behavioral characteristics.