The neurobiological basis of suicidal behaviour remains poorly understood. However, emerging evidence suggests that inflammation and vascular homeostasis factors may play a role in its pathophysiology. Childhood trauma, through immune system dysfunction and increased risk of suicidal behaviours, might influence these associations. This study examined the relationships between immune-inflammatory and vascular homeostasis-related markers and their interaction with childhood trauma in relation to a history of suicide attempts in individuals with depression.

A total of 328 patients with major depression were recruited: 166 with a history of suicide attempts and 162 without. Using multivariate binary logistic regression models adjusted for cofounders, we examined the associations between childhood trauma, levels of platelet-related immune markers (serotonin, MCP-1, TSP-1, TSP-2, PDGF-AB, PDGF-BB), and suicide attempt history. Independent associations between PDGF-BB, childhood trauma, and suicide attempts were further assessed using interaction models. Stratified sensitivity analyses based on childhood trauma history were also conducted.

Childhood trauma consistently emerged as associated with suicide attempts across all models. Among the measured biomarkers, higher TSP-2 levels were associated with a suicide attempt history, independent of childhood trauma. Meanwhile, while PDGF-BB alone was not directly linked to suicide attempt history, the interaction analysis revealed that individuals with lower PDGF-BB levels and more severe childhood trauma were more likely to have attempted suicide.

TSP-2 and PDGF-BB are potential biomarkers linked to suicide attempts, with distinct roles in the interplay between biological processes and early-life adversity. These insights can inform the biomarker-informed development of tailored prevention and treatment strategies.

Abnormal cerebellar functional connectivity (FC) has been independently implicated in the pathophysiology of schizophrenia (SCZ) and bipolar disorder (BD). However, the relationship between cerebellar dysconnectivity patterns in these two disorders and their association with cognitive functioning and clinical symptoms have not been fully clarified. In this study, we used the state-of-the-art functional atlas of the cerebellum to examine cerebellar FC changes in the SCZ–BD spectrum and their association with cognitive and clinical variables.

Resting-state functional magnetic resonance imaging (fMRI) data of 39 individuals with SCZ, 43 BD type I and 61 healthy controls were examined. The cerebellum was parcellated into ten functional systems and we calculated seed-based FC for each cerebellar system. Cognitive abilities were investigated with the Wechsler memory scale, the California Verbal Learning test, the Stroop test, the Attentional network task, the Continuous performance test, the Task Switch task and the Stop Signal task. Psychopathological evaluation was carried out using the Scale for the Assessment of Negative Symptoms and the Scale for the Assessment of Positive Symptoms. We used principal component analyses to reduce the dimensionality of the diagnosis-related FC and cognitive variables, respectively. Multiple regression analyses were conducted to assess the relationship between FC and cognitive and clinical data.

We observed lower cerebellar FC with the frontal, temporal, occipital and thalamic areas in SCZ, and a more widespread decrease in cerebellar FC in BD, involving the frontal, cingulate, parietal, temporal, occipital and thalamic regions. SCZ presented increased within-cerebellum and cerebellar-frontal FC compared to BD. Higher cortico-cerebellar FC was positively associated with memory (p-FWE=0.036) and verbal learning (p-FWE=0.043). Exploratory analyses showed a negative correlation between cortico-cerebellar FC and positive symptoms (p-FWE=0.051).

These findings suggest a role for shared and distinct patterns of corticocerebellar dysconnectivity in the SCZ–BD spectrum that can result in cognitive impairment and psychotic symptoms. In addition, they highlight the potential role of cerebellar stimulation as a promising intervention for individuals with SCZ and BD-I that present cognitive impairment.

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Alterations in cognition and social cognition in bipolar disorder and schizophrenia have been largely documented. However, to which extent these alterations overlap between the disorders and how they are relevant to early stages as well as to risk conditions remains unclear. To shed light on this topic, 59 patients with Bipolar Disorder (BD), 118 patients with schizophrenia (SCZ), two independent cohorts of Healthy Controls (HC1=95, HC2=195), as well as individuals at Clinical High Risk (CHR=35) and at First Episode of Psychosis (FEP=29) were characterized for a series of cognitive and socio-cognitive features, which were entered in a machine learning analysis as a cognitive, a socio-cognitive, and a combined cognitive and socio-cognitive (stacking) classifier. Such classifiers were probed to discriminate at the single subject level BD vs. HC1 and SCZ vs. HC2. Then, those with the greatest diagnostic power in categorizing BD vs. HC1 were challenged to predict discrimination between SCZ vs. HC2, and vice-versa. Thus, decision scores for such models were compared with those obtained when they were applied to FEP and CHR. Results indicated that stacking classifiers were the best in discriminating HC1 vs. BD (Balanced Accuracy - BAC = 80%) and HC2-SCZ (BAC = 84%). Furthermore, the HC1-BD staking classifier successfully discriminated HC2 from SCZ (BAC=77.4%), and vice-versa (BAC=83.1%). Decision scores for SCZ and BD overlapped with those obtained when stacking models were applied to FEP, identifying a “patient-like” pattern. Differently, when such combined signatures were applied to CHR individuals, they were classified neither as patients nor as HC. Findings suggest an overall overlap of cognitive and socio-cognitive anomalies classifying schizophrenia and bipolar disorder, which is also relevant to early stages of disease. In this general context, disease-specific core abnormalities characterize SCZ and BD. Personalized rehabilitative programs may be oriented to primarily manage disease-related cognitive and socio-cognitive “hub” alterations, but always within a broader assessment.

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Neurodevelopmental conditions are crucial risk factors for catatonia in pediatric and adult populations. Recent case reports and studies have identified an increasing number of genetic abnormalities likely contributing to catatonia. Catatonia associated with genetic abnormalities is challenging in terms of identification, chronicity, and resistance to treatment. In addition, understanding these genetic abnormalities through identifying rare single nucleotide and copy number variants may offer valuable insights into the underlying pathophysiology.

We conducted a systematic review of all genetic abnormalities reported with catatonia and performed a gene-set enrichment analysis. Our systematic literature search for relevant articles published through July 15, 2024, using combinations of “catatonia,” “catatonic syndrome,” “genetic,” and “genes” in PubMed, yielded 317 articles. Of these, 94 were included, covering 374 cases of catatonia and 78 distinct genetic abnormalities.

This review discusses the clinical presentation of catatonia for each genetic disorder, the treatment strategies, and the putative underlying mechanisms.

The review highlights that catatonia underpinned by genetic abnormalities presents specific clinical and treatment-response features. Therefore, we propose genetic testing guidelines for catatonia and advocate for systematically investigating catatonia in several genetic diseases. Regarding the pathophysiology of catatonia, the gene ontology of biological processes reveals significant enrichment of variants in synaptic and post-synaptic regulatory genes, particularly within GABAergic neurons, reinforcing the implication of the excitatory/inhibitory imbalance. Finally, genetic variants are enriched in microglial cells, highlighting the role of brain inflammation in triggering catatonia. This comprehensive insight could pave the way for more effective management strategies for this condition.

Major depressive disorder (MDD) is the most heterogeneous psychiatric disorder, as over 1400 combinations of symptoms can satisfy DSM diagnostic criteria, and understanding the underlying biological heterogeneity is fundamental in the perspective of precision psychiatry. Genetic variants are responsible for part of this heterogeneity and contribute to inter-individual differences in treatment effects. Therefore, pharmacogenetic studies can identify predictors of poor treatment response and treatment-resistant depression (TRD), aid the prescription and development of targeted treatments or the prescription of early intensive treatments in patients at risk of TRD. Previous genome-wide association studies (GWASs) had limited power to identify specific variants/genes involved in TRD, but polygenic overlap between poor antidepressant response/TRD and several other traits was demonstrated, e.g., schizophrenia, attention deficit hyperactivity disorder (ADHD), and cognitive traits. As suggested by the high clinical heterogeneity of MDD, considering specific symptom profiles can improve the power to identify genetic signals associated with TRD. Other promising strategies to identify the biological mechanisms involved in TRD include the study of large population cohorts, using proxies of TRD defined from electronic health records (EHRs), and the integration of biomarkers reflecting also environmental factors, such as proteomics. These strategies and ongoing studies will be discussed during this talk, with reference to Psych-STRATA, a project within the Horizon Europe research and innovation programme (101057454; https://psych-strata.eu).

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Physical activity is a known protective factor against depression but physical activity competes with other time-consuming behaviors that may increase depression risk. This study investigates the association between time spent in various movement-related activities and incident major depression, with a particular focus on the effects of replacing TV-watching time with other activities. Additionally, we explored whether the impact of substituting TV-watching differs across age groups.

A population-based cohort study (Lifelines) with four-year follow-up, including 65,454 non-depressed adults (18+). Participants self-reported time spent in active commuting, leisure, sports, household, work or school physical-related activities, TV-watching, and sleep. Major depressive disorder was assessed using the Mini International Neuropsychiatric Interview. Compositional isotemporal data analysis was performed to analyze the effect of reallocating time in TV-watching with other activities adjusting for potential confounders. Interactions with age groups were also examined.

The incidence of major depressive disorder was 2.4%. Reallocating TV-watching time to any other physical activity or sleep reduced this risk in middle-aged adults. In older adults, only substituting TV-watching time with sports reduced the probability of becoming depressed. No significant reduction in probabilities for incident depression was found in younger adults.

Replacing TV-watching time with other activities, including sleep, may serve as a preventive strategy against depressive disorder in middle-aged adults, while only the substitution with sports seems beneficial for older adults. Future research should aim to identify other activities, particularly in younger adults, that may prevent depression.

The pharmacological treatment strategies for bipolar disorders include both acute and maintenance treatments. However, a substantial number of patients do not respond sufficiently to pharmacotherapy. Thus far, there has been no standardized definition for treatment resistance in bipolar disorder. Studies have been using different definitions, possibly due to the clinical complexity including the episodic nature of bipolar disorder and various subtypes. The talk will discuss the definitions, neurobiological, and genetic aspects as well as ongoing initiatives to identify markers for treatment resistance in bipolar disorder.

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The coronavirus disease 2019 (COVID-19) pandemic has impacted global mental health, with individuals with severe mental illness (SMI) being particularly vulnerable. Research on changes in psychiatric symptoms during this pandemic has yielded inconsistent results, often due to individual heterogeneity and a limited focus on broader outcomes such as psychosocial functioning, societal and personal recovery, and quality of life (QoL). Furthermore, long-term effects remain underexplored. This longitudinal cohort study aimed to assess the COVID-19 pandemic’s impact on mental and psychosocial functioning, QoL, and recovery in individuals with SMI, and to explore individual and treatment characteristics associated with outcome changes.

Two cohorts were included, involving adults (≥18 years) diagnosed with DSM-5 disorders and experiencing long-term impairments. Participants received care between January 1, 2018 and December 31, 2023. Outcomes included the Health of the Nation Outcome Scales, the Manchester Short Assessment of Quality of Life, and the Individual Recovery Outcomes Counter. Changes were analyzed across five pandemic periods using linear mixed models.

Improvements in mental and psychosocial functioning, QoL, and recovery were observed over time, regardless of the COVID-19 pandemic period. However, progress was slower during the COVID-19 pandemic compared to pre-pandemic levels. No individual or treatment characteristics were significantly linked to changes in outcomes.

The findings suggest that the COVID-19 pandemic had a minimal negative impact on individuals with SMI. This may be due to the marginal negative effects of the pandemic on this population, or the mitigating role of stabilizing factors within the current Dutch care models.

Schizophrenia is a chronic disorder with a massive impact on quality of life. The prevalence of treatment resistance has been estimated around 30%. Treatment resistance is typically defined as non-response to 2 antipsychotics of adequate dose and duration. However, clinical reality often shows that the definition at an individual level is more complex and a personalised approach is needed.

We present a literature review discussing clinical, neurobiological and pharmacogenetic aspects relevant to treatment resistance.

Our overview highlights the need for indiviudalised assessement of patient needs. We discuss pharmacogenetic aspects related to treatment respons and tolerability, including Clozapine. We focus on indicators for stratification and treatment optimization in the context of personalised medicine. In addition, we present evidence for other augmenting treatment modalities in the context of treatment resistance for schizophrenia, such as neuromodulation (e.g., rTMS for acoustic hallucinations).

This talk focuses on the challenges of treatment resistance in schizophrenia and discuesses new insights in the existing treatments and pharmacogenetics, as well as opportunities for treatment augmentation that arise from emerging technologies.

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Nowadays, both researchers and clinicians alike have to deal with increasingly larger datasets, specifically also in the context of mental health data. Sophisticated tools for dataset visualization of information from various item-based instruments, such as questionnaire data or data from digital applications or clinical documentations, are still lacking, specifically for an integration at multiple levels and for use in both data organization and appropriate construction for its valid use in subsequent analyses.

Here, we introduce ItemComplex, a Python-based framework for ex-post visualization of large datasets. The method exploits the comprehensive recognition of instrument alignments and the identification of new content networks and graphs based on item similarities and shared versus differential conceptual bases within and across data and studies.

The ItemComplex framework was evaluated using four existing large datasets from four different cohort studies and demonstrated successful data visualization across multi-item instruments within and across studies. ItemComplex enables researchers and clinicians to navigate through big datasets reliably, informatively, and quickly. Moreover, it facilitates the extraction of new insights into construct representations and concept identifications within the data.

The ItemComplex app is an efficient tool in the field of big data management and analysis addressing the growing complexity of modern datasets to harness the potential hidden within these extensive collections of information. It is also easily adjustable for individual datasets and user preferences, both in the research and clinical field.

Schizophrenia (SCZ), bipolar (BD) and major depression disorder (MDD) are severe psychiatric disorders that are challenging to treat, often leading to treatment resistance (TR). It is crucial to develop effective methods to identify and treat patients at risk of TR at an early stage in a personalized manner, considering their biological basis, their clinical and psychosocial characteristics. Effective translation of theoretical knowledge into clinical practice is essential for achieving this goal. We describe the methodology of the PROMPT project that aims at the development of a precision medicine algorithm that would help early detection of non-responder patients, who might be more prone to later develop TRD. In addition, we demonstrate other ongoing comprehensive protocols in Precision Psychiatry, such as the Horizon Europe funded PsychSTRATA consortium. To address these objectives, the PROMPT project which is organized in 2 phases will involve 300 patients with MDD already recruited in phase 1, comprising 150 TRD and 150 responders. In phase 2, a new naturalistic cohort of 300 MDD patients will be recruited to assess, under real-world conditions, the capability of the algorithm to correctly predict the treatment outcomes. Moreover, in this phase a shared decision making (SDM) process in the context of pharmacogenetic testing is explored and various needs and perspectives of different stakeholders toward the use of predictive tools for MDD treatment to foster active participation and patients’ empowerment are evaluated. In addition to this effort, the Psych-STRATA consortium addresses a major research gap in Precision Psychiatry through a seven-step approach. First, transdiagnostic biosignatures of SCZ, BD and MDD are identified by GWAS and multi-modal omics signatures associated with treatment outcome and TR (steps 1 and 2). In a next step (step 3), a randomized controlled intervention study is conducted to test the efficacy and safety of an early intensified pharmacological treatment. Following this RCT, a combined clinical and omics-based algorithm will be developed to estimate the risk for TR. This algorithm-based tool will be designed for early detection and management of TR (step 4). This algorithm will then be implemented into a framework of shared treatment decision-making with a novel mental health board (step 5). The final focus of the project is based on patient empowerment, dissemination and education (step 6) as well as the development of a software for fast, effective and individualized treatment decisions (step 7). Both the PROMPT study and the PsychSTRATA project have the potential to change the current trial and error treatment approach towards an evidence-based individualized treatment setting that takes TR risk into account at an early stage.

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The use of coercive measures is an increasingly debated aspect of psychiatric treatment. Considering the multitude of negative effects, patients, clinicians, and ethicists alike have called for a more cautious application of coercion. It therefore remains important to investigate which organizational characteristics have the potential to facilitate efficient coercion reduction. The same holds true for the efficient reduction of symptom severity during inpatient treatment.

The current study compared 22 Swiss psychiatric clinics treating 45,095 cases regarding their relative efficiency in treating cases without coercion given their staff resources. To this end, we applied a Data Envelopment Analysis to clinical routine data. We focused specifically on inefficiencies attributable to management factors independent of the clinics’ total staff numbers. We further compared the clinics’ relative efficiencies regarding changes of self-reports and third-person reports of symptom severity during inpatient stays.

Efficiency scores suggest that on average, the clinics could improve the percentage of cases treated without coercion by 9% and the changes of symptom severity by 34% (for third-person ratings) or 18% (for self-reports) while keeping staff numbers constant. An analysis of specific coercion types revealed that the potential for efficiency improvements via management was highest for movement restrictions. We found no effect of clinic size on efficiency scores regarding any of the outcome measures.

Our results underline the importance of management factors beyond staff resources (e.g., staff trainings or changes in ward structure and treatment concepts) for the efficient reduction of coercion and psychiatric symptoms during inpatient stays.

We report the case of an 18-year-old male patient diagnosed with autism spectrum disorder at age of 12. Between the age of 12 and 18 he developed anxiety and substance use disorders.

He was acutely admitted to the Department of Psychiatry and Psychotherapy at Semmelweis University due to a severe manic episode with psychotic symptoms at the age of 18. He provided a multidisciplinary treatment, including medication, support group, individual addiction consultation and rehabilitation. He became stable, currently abstinent for six months and planning to graduate.

Our case report has practical implications for physicians by raising their awareness of comorbid mental disorders in the autism spectrum and also the difficulties in the transition between adolescence to adulthood.

autism spectrum, comorbidity, transient psychiatry

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The COVID-19 pandemic has impacted various aspects of daily life, leading to increased psychological symptoms and changes in alcohol use, yet little is known about their specific interactions, particularly early stages during the pandemic. We examined the relationship between psychological symptoms and alcohol-related behaviors associated with COVID-19, and determined whether associations shifted already early during the pandemic and whether changes in psychological symptoms from the pre- to during COVID-19 impacted changes in alcohol consumption.

Participants were young adults from a longitudinal cohort (N=435, age: 22–25) from two time points. We applied paired samples t-tests, correlation analyses, SHapley Additive exPlanations, and classification models to examine the multiple associations between psychological symptoms and alcohol use directly pre- and early during COVID-19.

We found significant associations between psychological symptoms and alcohol use pre- compared to during COVID-19. Anxiety was the strongest factor influencing alcohol use pre-pandemic, depression had the greatest impact during COVID-19. Changes in anxiety from pre- to during COVID-19 were the main factor associated with an increase in alcohol use, while changes in depression appeared to be most predictive for a decrease/persistence in alcohol use.

These findings suggest a shift in the association between psychological symptoms and alcohol use following COVID-19, as well as a differential impact of psychological symptoms, depending on their changes related to the pandemic. Changes in anxiety may contribute to riskier alcohol use behaviors following the pandemic, while depression appears to be one of the most critical factors influencing alcohol use during such crisis situations.

Transitional care refers to the coordination and continuity of care between different healthcare locations or levels of care within the same facility, regardless of the patient’s age. Transition planning and management is therefore a key element in the organization and delivery of health services. Unfortunately, for many young people with mental health problems, transition is poorly planned, lacks coordination, and results in discontinuity of care. This is particularly true for intellectual disability, Autism Spectrum Disorder, and ADHD: as neurodevelopmental conditions, care typically begins at a young age with attendance at Child and Adolescent Mental Health Services (CAMHS), and the transition to Community Mental Health Services (CMHS) encounters numerous challenges.

A narrative review of the literature was conducted on the topic of transition from inception to January 26th, 2025. The following search string was used through PubMed, Web of Science, Scopus, and PsychInfo: (“Transitional Care” OR “Transition to Adult Care”) AND (“Neurodevelopmental Disorders” OR “Intellectual Disability” OR “Autistic Disorder” OR “Autism Spectrum Disorder”) AND (“Child and Adolescent Mental Health Services” OR “CAMHS” OR “Community Mental Health Centers”).

A total of 202 references were identified and screened considering titles and abstracts. After excluding papers not relevant to the topic and those that were unretrievable, 31 papers were included in the review. A significant majority of the included papers were qualitative studies based on focus groups and interviews conducted with family members and caregivers.

Findings reveal a lack of clarity and consistency regarding service availability for the conditions studied, possibly due to different eligibility criteria between child and adult mental health services, with variable service provision for young people with neurodevelopmental conditions (specifically, ASD, ADHD and ID). While high workloads and staff shortages were perceived to influence service thresholds and eligibility criteria, the lack of perceived severity by the CMHS often led to loss of follow-up.

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Patients in forensic psychiatric care (FPC) are commonly treated with a wide range of psychotropic medications. There is, however, a lack of understanding regarding how pharmacological treatment and psychotropic polypharmacy are used throughout care.

This register-based cohort study included patients admitted to FPC in Sweden between 2009 and 2020. We estimated the prevalence of the use of major psychotropic medication, as well as psychotropic polypharmacy, at admission and discharge. We also examined the change in antipsychotic use after admission.

In total, 1962 patients were included. Antipsychotics were the most used psychotropic medication class, with 86.2% (95%CI: 84.5–87.8) of patients receiving at least one typical or atypical antipsychotic at admission. Changes in the antipsychotic regime were more common at the beginning of FPC, compared to later time points. Within the subgroup of patients discharged during the study period (n = 561), there was a reduction in the use of typical antipsychotics (admission: 34.9%; discharge: 26.6%) and hypnotics and sedatives (admission: 37.4%; discharge: 28.1%). Other major medication classes remained relatively stable. The prevalence of psychiatric polypharmacy at admission was 70.6% (95%CI: 68.5–72.7) and remained similar during care.

Our study documented a high prevalence of antipsychotic use and psychotropic polypharmacy through FPC. Further, a high level of off-label antipsychotic use and antipsychotic polypharmacy was observed. Stronger evidence regarding the effectiveness and safety of these treatment strategies is needed.

According to the American Academy of Child and Adolescent Psychiatry (AACAP), 50% of all lifetime cases of mental illness begin by age 14, and 75% by age 24 (1). Development is a life-long process, but adult development is generally more gradual and less critical than that of children and adolescents. That is why the role of development in child psychiatry is particularly important, contrary to the adult psychiatry, more focused on the categorical definition of the observed clinical situation.

Autism Spectrum Disorders (ASD) in particular, characterized by heterogeneity, may evolve to adulthood with an atypical presentation. Approximately a quarter of autistic adults reported being misdiagnosed with at least one psychiatric condition before receiving an autism diagnosis. Personality disorders, mood disorders, and anxiety disorders were most frequently perceived as misdiagnoses, according to Fusar-Poli et al (2).

The contact between adult psychiatry and child and adolescent psychiatry, may be organized in transition care settings (outpatient care, clinical discussions, …). These practices may have a major impact in adult psychiatry practice, emphasizing the importance of a developmental approach, at any given time and with each patient, going beyond the classical inquiry about clinical and personal backgrounds. It also helps adult’s psychiatrists to keep in mind diagnostic hypotheses of neurodevelopmental disorders, which are usually more focused on child and adolescent psychiatry.

A clinical case will be presented to illustrate our thesis.

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Common mental disorders (CMDs) are significant causes of work disability. Low socioeconomic status (SES) is a known risk factor for CMDs and work disability, one possible reason being poorer treatment adherence. We aimed to study the realization of pharmacological treatment and antidepressant adherence in patients with CMDs 3 years before and 3 years after being granted a disability pension (DP) and the role of SES in this. We also studied whether antidepressant adherence is associated with return to work (RTW) after a temporary DP.

Information on all persons granted a DP due to CMD between 2010 and 2012 in Finland (n = 12,388) was retrieved from national registers, which included medical, socioeconomic, and sociodemographic information of the subjects. We used the PRE2DUP method to estimate drug use periods and regression analyses to study associations between SES, taking medications, and RTW.

Prevalence of taking antidepressants increased towards the DP grant and decreased thereafter, but 14.6% of subjects did not take antidepressants or antipsychotics at all during the study period. Of SES factors, only income was positively associated with antidepressant adherence, lasting over a year. Antidepressant adherence was not associated with RTW.

An alarming result was the absence of recommended medication in fewer than every seventh patient estimated to be disabled due to pharmacologically treatable psychiatric disorders. Contrary to expectations, SES had only a minor predictive role in antidepressant adherence in this patient group. Contrary to taking antidepressants, rehabilitation was associated with RTW. The results adduced the importance of CMD treatment optimization regardless of SES.

Individuals with autism and intellectual disability encounter numerous challenges as they transition into adulthood. By analyzing case studies of students in both specialized and mainstream educational settings, I aim to highlight their perspectives and experiences.

These individuals grapple with a myriad of hurdles, from difficulties in communication and social interaction to challenges in academic and vocational pursuits. Through case studies, we witness the personal and societal barriers they encounter, highlighting the need for tailored interventions and support systems.

Early intervention and specialized education play crucial roles in empowering these individuals to thrive. By providing nurturing environments and equipping them with essential skills, we can foster independence and enhance their overall well-being. Additionally, community resources offer ongoing support beyond the school setting, further facilitating their transition into adulthood.

Central to our discussion is the importance of fostering an inclusive society that embraces neurodiversity. When individuals with autism and intellectual disability are valued for their unique perspectives and talents, they can contribute meaningfully to society. Through acceptance and understanding, we can pave the way for a more equitable future for all.

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Recent meta-analyses support the inclusion of cognitive behavioral therapy (CBT) in schizophrenia treatment. Metacognitive Training (MCT) for psychosis is a psychoeducational program derived from CBT, with most meta-analyses showing favorable results. Although meta-analyses are commonly used in clinical practice to guide evidence-based decision-making, the grading system provides complementary results by offering a structured approach for assessing the strength and reliability of evidence and deriving grades of recommendations accordingly.

Our research applies the guidelines from the World Federation of Societies of Biological Psychiatry (WFSBP) to propose grades of recommendation for MCT for psychosis, analyzing 38 randomized controlled trials (RCTs) (n = 1942) and 10 meta-analyses. The primary outcome was positive symptoms, with secondary measures including negative symptoms, general psychopathology, self-esteem, functioning, insight, and cognitive function.

Our findings are primarily based on the risks of bias attributed to RCTs (11 high, 19 moderate, 6 low) and, when necessary, on the overall confidence attributed to meta-analyses (3 low, 7 critically low). According to the WFSBP guidelines, strong recommendations should be made for using MCT for psychosis to improve post-treatment positive symptoms, delusions, and total psychotic symptoms (WFSBP-grade 1). Limited recommendations (WFSBP-grade 2) could be made for using MCT to improve post-treatment visuospatial abilities and to maintain benefits over time in psychopathology, functioning, self-esteem, episodic memory, and attention.

MCT for psychosis is an evidence-based program, especially for positive symptoms, with long-lasting clinical benefits. These recommendations should be interpreted with caution given potential residual biases and heterogeneity among studies.