A number of studies have demonstrated that hyperthyroidism increases the prevalence of psychiatric disorders and the likelihood of depressive symptoms, anxiety and hipomania. Apathetic hyperthyroidism is a syndrome, which presents with symptoms of depression, apathy, somnolence or pseudodementia in the absence of the usual symptoms and signs of hyperthyroidism. This condition is more common in the elderly although it has also been described in young adults and adolescents.

In the majority of cases, treatment of hyperthyroidism results in an improvement in neuropsychiatric manifestations in parallel with an improvement of psychical (somatic?) symptoms and psychotropic medication is deemed unnecessary.

Approximately one-third of patients with Graves’ hyperthyroidism are prescribed psychotropic drugs. Sometimes to treat mental symptoms like psychosis or severe agitation, sometimes to treat mental symptoms remaining after amelioration of hyperthyroidism, and sometimes when the diagnosis of Graves’ hyperthyroidism has been missed and the patient is treated as having a primary psychiatric disorder.

To present a case of a patient with neuropsychiatric symptoms caused by thyroid dysfunction.

Case presentation and non-systematic review of existing literature on Pubmed using the following keywords: hyperthyroidism, psychiatric disorders, psychiatric symptoms, depression, psychosis.

We report the case of a 21-year-old female without history of psychiatric illness who presented to the emergency department with somnolence, apathy, cognitive impairment (answering “I don’t know” to most questions), poverty of speech, abulia, perplexity and delusional belief of ruin, in addition to physical symptoms namely alopecia and weight loss. According to her father, she was very active and dynamic person until two days prior, when he started noticing growing apathy, leading to job absenteeism. Urine analysis for elicit drugs was negative.

Investigation for organic disease was undertaken and the blood analysis revealed overt hyperthyroidism.

She was initially treated with aripiprazol. After thyroid dysfunction was identified, she was evaluated by an endocrinologist and started treatment with tiamazol and propanolol, presenting gradual remission of the psychiatric changes. Aripiprazole was discontinued and she was reevaluated in psychiatry consultation after about a month, with complete remission of psychiatric manifestations and normalized thyroid function.

Neuropsychiatric manifestations of thyroid dysfunction are often misdiagnosed as a primary psychiatric disorder. It is necessary to optimize the medical management of these patients in whom the psychiatric symptoms masks a curable organic cause.

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Individual patient safety processes (such as reporting, investigating, learning and improving patient outcomes) activated following serious adverse incidents (e.g. patient suicide) are not distinct or standalone. Rather, they are embedded within a complex system of multiple interdependent processes enacted by individuals who are subject to an array of implicit and explicit influences (Nathan et al. BJPsych Advances 2022; 1-11). Although some specific elements of the response to adverse incidents have been examined, no previous empirical research has set out to study the complex interacting system within which these elements are situated.

This study’s aim was to characterise a complex patient safety system and to identify types of processes across that system that have an impact on the goal of improving patient safety.

Recorded 1:1 semi-structured interviews were undertaken with staff in a range of patient safety roles across a mental health care system to elicit accounts of the system response to serious adverse incidents. These interviews were transcribed, and the transcriptions were subject to thematic analysis using the Framework Method for qualitative research in health care settings (Gale et al. BMC Med. Res. Methodol. 2013; 13.1; 1-8).This preliminary study relates to the analysis of 8 interviews.

The following six main types of influences on the effectiveness of patient safety system responses to adverse incidents were identified:

1. 1. Differing functions/expectations of investigations into serious incidents (due to differing demands of different parties, such as the health provider, the family, the coroner, etc);

2. 2. Differing methodologies used to investigate serious adverse incidents (although system-based generally preferred, there was a noted risk that this approach may fail to identify occasional examples of poor practice);

3. 3. Relationship between incident investigation processes and patient safety processes (with a particular potential for the latter to dominate the system at the expense of the former);

4. 4. System complexity (multiple interacting processes/processors at multiple levels within the health provider and wider health system);

5. 5. Operationalising recommendations from investigations (with the potential for adverse unintended patient safety consequences)

6. 6. Influence of national directives

As well as paying attention to individual components of the safety system (e.g. investigation methodology and organisational culture), the development of an effective patient safety system is dependent on an understanding of the complex interacting processes across the system. This study sheds empirical light on key influences that act across a mental health provider system. Both researchers of patient safety and providers intending to improve their approach to patient safety should take account of such systemic influences on effectiveness.

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Introduction: LGBTQ (lesbian, gay, bisexual, transgender, queer) people often do not seek health care and do not identify as LGBTQ people because of fear of judgment, stereotyping, and discrimination by health professionals. All of this is a particularly worrying phenomenon, because various mental difficulties, risky behaviors, and certain types of somatic and psychosomatic diseases may appear in a higher proportion among them.

Attitudes related to LGBTQ people were examined in several areas in Hungary. Most of our data comes from psychologists, however, a comprehensive examination of health professionals’ attitudes towards LGBTQ people has not yet been carried out.

In a cross-sectional online survey, we ask healthcare professionals (medical doctors, nurses, other graduate healthcare professionals and medical university students) to fill out our questionnaire. The participants complete the Modern Homonegativity Scale and the Lesbian, Gay, Bisexual and Transgender Clinical Skills Development Scale.

We assume that the majority of Hungarian healthcare professionals have a neutral or positive attitude towards LGBTQ people, but they struggle with a significant lack of affirmative skills. We will present our results in detail in the presentation of the symposium.

There is an urgent need to provide the appropriate affirmative knowledge material to Hungarian healthcare workers.

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Erotomania, was described in 1942, is more common in women than in men, although the incidence is unknown. This syndrome is usually characterized by a young woman with the illusion that a man whom she considers to be of a higher social or professional position is in love with her. Developing an elaborate delusional process about this man, his love, his pursuit and total commitment to the idea. Two forms, pure or secondary, are described. As well as fixed or recurring

52-year-old female patient in outpatient follow-up with a diagnosis of schizophrenia with long-term follow-up, start of follow-up by a new therapist, in this context intensive follow-up is carried out in the event of the appearance of pharmacological secondary effects, pharmacological readjustment is carried out with good results.

During the joint follow-up with nursing, the cessation of secondaryisms is confirmed and we are informed of the gradual appearance of overvalued ideas in relation to the new therapist, which are gradually structured in the form of erotomanic delirium that coincides with the cessation of follow-up by said therapist. Consultations in the emergency room occur on a couple of occasions due to mild behavioral alterations secondary to messages and communications that he reports receiving where said love is confirmed. Despite readjustments, there continues to be an increase in clinical symptoms due to abandonment of medication, finally producing serious alterations aimed at the search for said therapist, finally culminating in admission to the acute care unit for containment of said condition.

The objetives is the diferencial diagnosis, in this case symptoms could be classified as positive symptoms of schizophrenia, although it is its own nosological entity.

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This patient represents a classic example of De Clerambault syndrome and is a faithful expression of the recurrent syndrome associated with delusions of grandeur, eroticism and jealousy. There have also been ideas of reference and agitated behavior associated with his delusional process.

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A new approach of social therapy for criminal offenders was applied in Penalty Facility in Niš, Serbia. It is based on three month peer-training focusing on recognizing of triggers for anger, understanding emotional manifestation and learning socially acceptable ways of anger expression.

To estimate how the impact of pear-based training influences the level of agression of criminal offenders in prison settings.

One hander and six prisoners were randomly assigned to program. The six previously educated inmates trained the participants through 12 work-shops. An independent professional evaluated change in aggression levels after training using Buss&Perry Aggression Scale. We compared subgroups with shorter versus longer sentences pre and post training using Student’s t test. And univariate logistic regression analysis for impacts of sociodemographic variables on aggression scores.

We found a significant higher scores of anger (6.6 ± 4.7 & 11.8 ± 4.2, p=0,043) hostility (15.5 ± 8 & 20.1 ± 6.5, p=0,029) and total aggression (32 ± 14 & 48 ± 21, p=0,023 in subgroup with longer sentences at baseline. After training anger (12.4 ± 4.8 & 15.5 ± 5.6, p= 0,0167), physical aggression (14.6 ± 51. & 17.2 ± 5.6 ,p=0,024) and total aggression score (55.5 ± 14.1 & 68.2 ± 18, p=0,0152) remained higher in the group with sentences more than five years. Lower education level is associated with undesirable outcome-higher level of aggression after training.

Three months training was not sufficient for adopting skills for better control of aggressive behavior in criminal offenders never the less the length of the sentences.

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Recently, the new therapeutic approach based on genome editing using the CRISPR/Cas9 system has been applied to treat cancer and other monogenetic disorders. CRISPR/Cas9 allows specific correction of the altered gene without affecting the rest of the genome.

The aim of this study was to report the current CRISPR/Cas9 genome editing clinical trials in neurodevelopmental and mental disorders.

We conducted a search via the ClinicalTrials platform to describe clinical trials that have been conducted using the CRISPR/Cas9 genome-editing tool in neurodevelopmental disorders.

Our research revealed three clinical trials that used the CRISPR/Cas9 tool for diagnostic and therapeutic purposes. The first study aimed to investigate the pathological role of KMT2D mutations in 40 Kabuki syndrome patients in order to facilitate the identification and characterization of therapeutic strategies to improve symptoms, to identify the consequences of KMT2D mutations on epigenetic marker changes and cellular structural changes and to finally attempt gene correction by CRISPR/Cas9. The therapeutic approach was an epigenome editing approach aimed at increasing the expression of the wild-type KMT2D allele to restore the functional activity of a histone H3-lysine 4 (H3K4)-methyltransferase (MLL4) in treated mesenchymal stem cells. The second clinical trial aimed to validate gene editing based on CRISPR/Cas9 technology combined with AAV delivery for the correction of the most common MECP2 mutations in Rett syndrome both in vitro and in vivo. The third GENEPI clinical trial aimed to identify acetylation profiles as epigenetic markers to assess the causality of CREBBP and EP300 variants in Rubinstein-Taybi syndrome, which is considered as a genetic model of neurodevelopmental abnormality with an epigenetic component.

CRISPR/Cas9 clinical trials in polygenic conditions, such as psychiatric disorders, could be envisaged at the level of the epigenetic component of these pathologies. This therapy could be applied ex vivo to perform tissue-specific gene editing.

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Orthorexia nervosa is defined as an unhealthy obsession with eating healthy food. Recent studies currently demonstrated that students in health-oriented academic programs, highly focused on nutrition and physical exercise, are more prone to develop orthorexia nervosa than students in other educational areas.

Determine the prevalence of orthorexia nervosa in medical students and identify associated factors.

We conducted a cross-sectional, descriptive, and analytical study in the faculty of medicine of Sfax in Tunisia, between February and April 2023. We used ORTO-15 for the assessment of orthorexia.

The research has enrolled 220 students. Their mean age was 21.40±1.68 years, with female predominance (70%). The mean Body mass index (BMI) was 22.46±4.15 kg/m2. The prevalence of overweight (BMI≥25 kg/m2) and obesity (BMI≥30 kg/m2) were respectively 19.5% and 3.6%. Over a third of students (34.1%) were using means of weight control, of which the diet represented 62.66% of cases. The participants had consulted a nutritionist in 11.4% of cases. The ORTO-15 mean total score was 36.88±6.76, with a mean score of 12.95±2.69 for cognitive dimension, 13.31±2.70 for clinical dimension, and 10.61±2.52 for emotional dimension. A total of 60% of participants had a score under the threshold.

Orthorexia was significantly associated with female gender (p<10-3), overweight or obesity (p=0.037), the use of weight control methods (p<10-3), following a diet (p<10-3), and consulting a nutritionist (p=0.009).

In our study, orthorexia seems to be quite widespread among medical students, particularly females, who are overweight or obese, and who use weight control methods.

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It is still being discussed whether treatment-resistant schizophrenia (TRS) is a biological subtype which differs from non-treatment-resistant schizophrenia or is it a more severe condition that affects brain worse than non-treatment-resistant schizophrenia. However, there are few and heterogeneous studies and the etiology of TRS remains quite unclear.

This study aimed to explore cortical and subcortical morphometric characteristics in TRS patients and its associations with the clinical features. The pilot stage comprises the comparison to the mentally healthy subjects.

21 right-handed male patients (mean age 28.99 ± 8.08 years) fulfilling TRS criteria and 21 matched healthy controls (mean age 29.35 ± 7.41 years) underwent T1-weighted structural MRI at 3T Philips scanner and clinical examination. Images were processed using FreeSurfer 7.1.1. Cortical thickness and area, volumes of subcortical structures and separately volumes of the amygdala nuclei and hippocampal subregions were compared between groups. The morphometry data, PANSS (Positive and Negative Syndrome Scale), CDSS (Calgary Depression Scale for Schizophrenia) and daily chlorpromazine equivalent doses of antipsychotics were included in correlational analysis. Results were considered significant if they retained significance after correction for multiple comparisons.

Compared to healthy controls, TRS patients showed decreased gray matter thickness in frontal, temporal, parietal, occipital, cingulate and insular regions (Figure 1). The temporal lobe showed the most prominent thinning of the cortex. The volumes of the amygdala, hippocampus (Figure 2) and nucleus accumbens, a number of amygdala nuclei and hippocampal subregions bilaterally were also decreased in TRS patients. The volume of the right globus pallidus, on the contrary, was increased (Figure 2). No correlations between altered cortical thickness, PANSS (positive, negative, general psychopathology scales and total score), CDSS and chlorpromazine equivalent doses of antipsychotics were found.

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The widespread gray matter cortical and subcortical loss in TRS finds confirmation in the literature. The increased globus pallidus volume is an unexpected and intriguing result. Other studies demonstrated conflicting results on that point. Some studies reported possible therapy influence, others suggested possible associations with symptoms. We did not find any correlations with psychometric or therapy characteristics. It is possible that there are non-linear relationships or relationships that exist only at a certain stage of the disease. As for therapy, patients took individual medication, consisting of various antipsychotics and drugs from other pharmacological groups, and such heterogeneity could affect the results of the study. Further research is going to be carried out.

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The clinical high-risk state for psychosis (CHR) is associated with alterations in grey matter volume (GMV) in various regions such as the hippocampus (Vissink et al. BP:GOS 2022; 2(2) 147-152). Within the scope of the North American Prodrome Longitudinal Study (NAPLS-2; Cannon et al. AM J Psychiatry 2016; 173(10), 980-988), a publicly available risk calculator based on clinical variables was developed to assess the likelihood of individuals to transition to psychosis within a 2-year period.

In the current study, we aim to examine the association between GMV and NAPLS-2 risk scores calculated for individuals with CHR and recent-onset depression (ROD), taking a transdiagnostic approach on the transition to psychosis.

The sample consisted of 315 CHR (M = 23.85, SD = ± 5.64; female: 164) and 295 ROD (M = 25.11, SD = ± 6.21; female: 144) patients from the multi-site Personalised Prognostic Tools for Early Psychosis Management (PRONIA) Study (Koutsouleris et al. JAMA Psychiatry 2018; 57(11), 1156-1172). Risk scores were calculated using the six clinical and neurocognitive variables included in the NAPLS-2 risk calculator that were significant for predicting psychosis. Further, we derived smoothed GMV maps from T1-weighted structural magnetic resonance imaging using a full width at half maximum kernel size of 8 mm. We employed a multiple regression design in SPM12 to examine associations between risk scores and GMV. On the whole-brain level, we calculated permutation-based threshold-free cluster enhancement (TFCE) contrasts using the TFCE toolbox. Additionally, we calculated t-contrasts within a region-of-interest (ROI) analysis encompassing the hippocampus. All results were thresholded at p < 0.05 with family wise error correction to address multiple comparisons.

Our analysis revealed that linear GMV increases in the right middle and superior frontal gyrus (kE= 2726 voxels) were significantly associated with higher risk for psychosis transition within two years (see figure 1, highlighted in blue). In the ROI analysis, we found a significant negative linear association between GMV decreases in the left hippocampus (kE = 353 voxels) and higher risk for psychosis transition (see figure 1, highlighted in red).

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GMV reductions in the hippocampus have frequently been observed in CHR and psychosis patients (Vissink et al. BP:GOS 2022; 2(2) 147-152), therefore our results further highlight the crucial role of this region in the progression of the disease. There is limited evidence on GMV increases in CHR patients. However, the GMV increase we found in the frontal pole may reflect compensatory mechanisms of the brain in the development of psychosis. In addition, we were able to provide biological validation of the NAPLS-2 risk calculator and its assessment of risk for transition to psychosis.

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Many mental health conditions, including anxiety, mood disorders, and depression, can be effectively treated at a relatively low cost. Exercise interventions can be a therapeutic strategy, but even though exercise has consistently been shown to improve physical health, cognitive function, and psychological well-being, as well as reduce depression and anxiety symptoms, this intervention is often neglected in mental health care services.

The study aims to assess the feasibility of incorporating an Exercise Intervention Program (EIP) as a therapeutic pathway within the Mental Health and Addictions Program (MHAP) in Nova Scotia, as well as to evaluate the effectiveness of the program on mental health outcomes and incremental costs, and the patient acceptability and satisfaction with the program.

This proof-of-concept study has a pragmatic, prospective, controlled observational design with an embedded one-phase qualitative component. Patients with a primary diagnosis of depression or anxiety attending the Rapid Assessment and Stabilization Program (RASP, Halifax, Nova Scotia, Canada) will be offered to receive 60-minute exercise sessions three times per week, per 12 weeks. Patients with similar mental health conditions that have opted to wait for Cognitive Behavioral Therapy (CBT) with the community provider and declined from the EIP will be part of the control group. A certified recreational therapist will conduct the EIP. Participants of both groups (EIP and control condition) will be assessed at baseline and then weekly for four weeks, six weeks and then at 12 weeks post-enrollment. Primary outcomes include differences in the mean change in functional (well-being, resilience, and recovery) and symptom variables (depression, anxiety, and suicidal risk), which will be assessed through online validated scales/questionnaires. Service variables (patient acceptance and satisfaction) and health care utilization (crisis calls, emergency department visits, hospital admissions and readmissions, length of stay for each admission) will comprise the secondary outcomes.

The results of the study will provide information about the effectiveness of EIP in the treatment of anxiety and depression compared to those only wait-listed to receive CBT or counselling from a CMHA provider. The study will also inform about the acceptability and satisfaction of the EIP, as well as the incremental cost-effectiveness of the intervention compared to the control condition.

This proof-of-concept study will demonstrate the effectiveness of EIP as an adjunctive or alternative therapeutic option for the treatment of anxiety and depression in patients seeking mental health support from the MHAP in Nova Scotia.

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Therapy of adolescent depression is accompanied by a number of difficulties associated with the influence of the age factor, which include the following aspects: social - with the possibility of forming a fear of stigmatization, biological – with low tolerance of psychopharmacological agents due to the immaturity of the functional systems of the body, psychological – with a combination of oppositional behavior of adolescents and their desire to “be like everyone else”. All these factors may lead to a decrease in patients’ compliance in the treatment of adolescent depression and premature refusal to continue treatment, which may provoke a relapse of the disorder.

To assess the adherence of adolescent patients with a first depressive episode regarding the continuation of therapy after discharge from the hospital.

124 patients (average age – 19.4) were examined after discharge from the hospital where they were treated for a depressive episode (according to ICD-10: F32.1, F32.2, F32.38, F32.8). The severity of depression during hospitalization and at discharge was assessed according to the HDRS scale. During hospitalization, 45.9% of patients (n=57) were diagnosed with severe depression (HDRS score of more than 24), 54.1% (n=67) were diagnosed with moderate depression (HDRS score of 17-23) (Zimmerman M. et al. JAD 2013; 150(2):384-8). At discharge, 35.5% of patients (n=44) had moderate depression, 38.7% of patients (n=48) had mild depression (HDRS score of more than 7-16) and only 25.8% of patients (n=32) had no depression (HDRS score of less than 7 points). This indicated the need to continue therapy after discharge. The degree of adherence to therapy and the main reasons for its refusal were analyzed using the Medication Compliance Scale (Lutova N. NIPNI, 2007; 26).

The average duration of treatment continuation in patients with adolescent depression was 7.4±9.6 months. At the same time, 42 patients (33.9%) refused to continue therapy within 30 days after discharge from the hospital. 15 patients (12.1%) turned out to be fully compliant, following the doctor’s prescriptions. The main reasons for refusing therapy were: negative attitude to the fact of receiving therapy and visiting a psychiatrist (n=50, 40.3%), the development of side effects of therapy (n=46, 37.1%), negative attitude of relatives to the continuation of therapy (n=11, 8.9%), and negative attitude to the attending psychiatrist (n=2, 1.6%). In general, formally, the average duration of continuation of therapy coincides with the recommended 6-12 months (Sim K. et al. IGN 2015;19(2) pyv076), however, it is noteworthy that some patients tend to self-cancel therapy without the approval of the attending physician.

The results indicate a low level of adherence to therapy in patients with adolescent depression and require additional measures to improve it.

The work was carried out with the financial support of the RSF grant 22-15-00437.

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Many COVID-19 survivors who were attacked and suffered severe symptoms of the virus have suffered from post-traumatic stress disorder (PTSD) which persists for long periods. These people need treatment to alleviate the severity of these disorders. Metacognitive therapy (MCT) is one of the modern therapeutic trends in psychological counseling, which focuses on the nature of the thought rather than on identifying and changing the thought as in other cognitive therapies. It is also concerned with whether people possess an aspect of reflective awareness and aims for a broader understanding of the way the mind works. Working on the process of metacognition, that is, the individual’s thinking about what he knows, being aware of his thoughts, and constantly monitoring and organizing them, helps reduce anxiety disorders and mood swings, and this will reduce psychotic disorders.

The current study aims to identify the effect of a virtual reality (VR) counseling program based on MCT in reducing the severity of PTSD among survivors of Covid-19. It also examines the continuity of the effectiveness of this program in reducing these disorders.

The quasi-experimental method (two group design) with experimental and control groups with a pre-posttest and a follow-up test was adopted. The sample for the current study consisted of 60 COVID-19 survivors suffering from PTSD. The PTSD scale was applied online to a group of people recovering from Covid-19 from the Arab Republic of Egypt. Then those who had high scores were selected, contacted and their consent was obtained to apply a virtual reality counseling program to them. The counseling program was implemented via virtual reality technology, and consisted of 20 counseling sessions, each session lasted between 60-90 minutes. The program continued for two months, with two sessions per week.

The results of the current research revealed a significant improvement in the experimental group through a significant reduction in their post-traumatic stress disorders. The results also showed the effectiveness of the counseling program based on metacognitive therapy in reducing the manifestations of post-traumatic stress disorders in those recovering from Covid-19. The results confirmed the continuing effect of the program after the follow-up period.

Using metacognitive therapy has an effective effect in reducing post-traumatic stress disorder, and it can be used with many psychologically disturbed people.

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Nonsuicidal self-injury (NSSI) is a self-damaging behavior with typical onset in early adolescence, and shows greater prevalence in females. NSSI is defined by recurrent episodes of intentional self-inflicted damage to body tissue, without suicidal intent. These recurring self-inflicted injuries are done by the indivuduel to relief oneself from negative feelings, to resolve interpersonal difficulties, or to induce positive feelings.

NSSI in DSM-5. has been included among the conditions in need of further study.

NSSI can be interpreted as a maladaptive coping mechanism that can be regarded as an emotional dysregulation. Adverse childhood experiences including physical abuse, neglect or sexual abuse are the strongest predictors of the NSSI. Research has repetitively found strong associations between NSSI and identity diffusion and/or distorted personality traits.

The aim of our study was to assess the association between childhood traumatization, personality characteristics including stages of identity development, and self-injurious behavior among female adolescents that experience difficulties with emotional regulation.

We compared our results to a Hungarian normative sample. The sample consisted of inpatients adolescents, age between 14 and 18, with a diagnosis consisting of „Emotional disorders with onset specific for childhood” or „Mixed disorders of conduct and emotions” with chronic nonsuicidal self-injurious behavior.

Childhood traumatization was measured with the short version of Childhood Trauma Questionnaire (H-CTQ-SF). Identity development and identity diffusion were measured with the Assessment of Identity Development in Adolescence Questionnaire (AIDA). Temperament and character factors were measured with the Junior Temperament and Character Inventory (JTCI).

Adolescent patients with NSSI reported severe and multiplex childhood traumatization. These patients scored higher on novelty seeking and harm avoidance and scored lower on the persistence, self-directedness, and cooperativeness factors in the JTCI. These results were compared with the Hungarien normative sample. Adolescents scored higher on the Discontinuity and Incoherence scales of the AIDA.

Our preliminary results suggest that childhood traumatization predicts self-injurious behavior in adolescent females. Additionally, we have found associations between signs indicative of personality disorder, including lower level of self-cohesion, self-integration and self-directedness.

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The burden of mental illness in Europe: High individual and societal burden, but only 2% spent on mental health. The tradition of European Psychiatry needs to be strengthened in care, research and teaching.Within the long-term Strategic Mental Health Plan of the EPA the improvement of clinical care research, the “mapping excellence” and “developing core treatment guidelines” require further action. Researching the influence of environmental stressors on the development and maintenance of mental illness and fostering stepped care approaches to improve resilience are none the less important. Furthermore, to improve the reliability and especially validity of diagnoses of mental disorders by introducing (bio)markers and defining dimensions of mental illnesses using big data and predictive sciences are just as important as an enforced research on reducing stigma and discrimination of mental disorders.

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UK healthcare is undergoing significant challenges in facing borderline personality disorder (BPD) and accommodating the increased demand to allocate sufficient care and carers to deal with BPD’s growing number and emotional and suicidal crises.

To generate forecasting models and preventive policies to deal with BPD crises and improve the effectiveness of the UK National Healthcare Service in suicide prevention (NHS).

The underlying analysis framework is stochastic forecasting. We used current knowledge and data to complete systematic future predictions extracted from recent trends. A logical-mathematical model generated the required expressions. The software for logic prediction and annotation was Wolfram Alpha (Wolframalpha.com).

Persons with BPD become suicidal because the team cannot comprehend and address the cycle of dysthymia, rumination and suicide. The BPD crises start from Stage 1 (α), assessing the comorbidity between BPD with dysthymia, cyclothymia, autism and ADHD. Teams shall avoid overmedication as ineffective. Stage 2 (β) is introspection and rumination, which do not respond to pharmacotherapy. The health carers establish if rumination is present and suggest distraction techniques. Stage 3 (γ) is when constant rumination with catastrophising leads to hopelessness. Stage 4 (δ) is when BPD starts feeling more anxious, depressed and unable to stop rumination. We suggest thought-stopping techniques and discourage social isolation, which triggers rumination. As BPDs use external locus of control and aim for higher dosages of antidepressants and anxiolytics with minimal effect, we explain that medication is not the only solution. Stage 5 (ε) is a crisis and panic attack because constant rumination brings back traumatic thoughts focused on the past, present and future. This is when BPDs self-refer to the hospital, attempt suicide, and feel that hospital admission is the only solution. The stages combined generated Model I. The Model II forecast Δ from this study is that we will observe a higher frequency (Δ) of hospital occupancy (Δbo = A), suicidal attempts (Δsa = B), and heavy service use (Δsu = C) by BPDs.

The predictive model algorithm has thus extracted (1) Model I (Analysis): [α → (β → (γ → (δ → ε)))] = Z; The truth density for Model I and its strength of prediction for stage progression is 96.87% in the dysthymia-rumination-suicide cycle; and (2) Model II (Prediction): Z implies (A And B And C), Z→A ∩ B ∩ C; the truth density for the Model II is 56.25% for predicting a national shortage of healthcare resources. The combined models predict a truth of 73.81% in the outcomes of BPD crises in the UK NHS due to the dysthymia-suicide cycle.

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Promoting high quality mental health (MS) services is an obligation of many social agents due to the impact of these diseases on the population. Making care increasingly evidence-based does not depend exclusively on technical training, but also on gradual and functional changes in the structure of an institution. Improving the quality of services in MH is a predominantly social intervention, in which it is necessary to group and interpret complex data. They represent real-time interventions in a real world by teams delivering health services.

Describe the context where the MH service (iNC) is inserted, its main characteristics and purposes.

Mixed study identifying the location, socio-demographic data, characteristics and fundamentals of an organization providing services in MH that proposes to act based on evidence.

iNC is a private secondary care institution located in the city of Blumenau, Vale do Itajaí, state of Santa Catarina, Brazil (FIG 1). Vale do Itajaí is a mesoregion with approximately 1.5 million inhabitants composed of small regions: Blumenau, Itajaí Ituporanga and Rio do Sul. Most of the population is of German and Italian descent. Blumenau has 361,261 inhabitants, an average monthly income of 2.9 minimum wages, 97% of schooling between 6-14 years old and the number of deaths of 6.48 (1000 live births). iNC is located in the center of the city (3-story building) with a clinical staff idealized for 3 psychiatrists, 16 psychologists, 4 nutritionists, 1 nurse, 1 nursing technician and 1 physical educator in face-to-face and online, individual and in-person sessions group. Performs care for adult patients between 18-70 years. Its missions are: to promote MS care from an interdisciplinary perspective, to provide health interventions supported by the best individualized scientific evidence and to encourage teaching and research in the field of MH. Its guiding principles are: psychopathology and nosology (DSM-5 and CID-11), neuroscience and psychopharmacology, mood, anxiety, sleep, eating and obesity disorders (FIG 2), psychological treatments and psychoeducation, assessment instruments in MH and neuropsychology, evidence-based medicine, health promotion and disease prevention.

Identifying, measuring and quantifying a local assistance service in MH can help in its development and allow comparisons over time. The improvement of services depends on multiple factors and is necessary for their development, both for researchers, implementers, health professionals and patients.

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Bipolar disorder (BD) is a chronic and severe psychiatric disorder, characterized by the alternance of episodes of (hypo)-mania and major depression. Lithium (Li) is the first-line treatment for BD but unfortunately response to Li is highly variable: after at least two consecutive years of treatment, only a fraction of patients receiving Li will display significant improvement in the frequency and/or severity of mood recurrences. This interindividual variability of treatment response is difficult to predict, in the bipolar disorder context. This could be determined by genetic factors still misidentified by available genetic studies. In addition, no clinical or biological markers are available to reliably define eligibility criteria for a lithium treatment in bipolar disorder. A consequence is a long process of therapeutic trials (18-24 months) to phenotype Li response, delaying the stabilization.

To identify objective biomarkers of the prophylactic response to lithium in order to improve patient care and propose therapeutic alternatives to patients who do not respond to lithium.

Using a genome-wide methylomic approach, and then logistic regressions incorporating as covariates the different types of treatments, we were able to identify differentially methylated regions (DMRs) whose methylation difference between responders and non-responders was not impacted by co-prescribed treatments. Then, we used Methylation Specific High-Resolution Melting (MS-HRM), a PCR based method than can be implemented in any medical laboratory at low cost and with minimal equipment, to estimate methylation proportion of 9 DMRs in 61 samples of bipolar patients.

In the sample of 61 individuals with BD, the 9 MS-HRM-measured DMRs combined with clinical variables (age, sex, cigarette smoking status, lifetime number of hospitalizations, age at onset of BD, polarity at onset, psychotic symptoms at onset, family history of BD, lifetime alcohol/cannabis misuse, panic disorders, Li prescribed as the first mood stabilizer (vs 2nd or 3rd choice)) correctly classified 83,6% of individuals as good or non-responders (n=61, prophylactic response phenotype defined using the “Alda” scale). Excluding the partial responders, the percentage of correctly classified individuals is as high as 100% (n=43, 18 non responders and 25 responders). The AUC are respectively AUC=0.913 and AUC=1.0.

The MS-HMR method allow to identify the response status of individuals with BD with 9 DMR. These DMRs discriminate good from non-responders and can be used in combination with clinical variables.

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Contrary to classical belief, people affected by this disease are at greater risk of developing organic pathologies.This risk has a very complex origin: a greater exposure to risk factors and specific socioeconomic conditions, a high prevalence of risk behaviors, the use of antipsychotics, and a potential common genetic background. (Reynolds et al.Int. J.Neuropsychopharmacol.2021; 24 854–855, Suvisaari J et al. Curr Diab Rep. 2016 16). Multiple studies demonstrate that Schizophrenia confers a high endogenous risk of Diabetes. Before patients diagnosed with Schizophrenia start taking antipsychotics (Andreassen OA et al. Am J Psychiatry. 2017;174 616-617), they have an approximately 3 times higher risk of developing Diabetes compared to the general population. The risk increases 3.6 times after the initiation of antipsychotic treatment compared to drug naive patients(Annamalai A et al World J Diabetes. 2017 390-396)

To study the association between Schizophrenia or other Psychotic Disorders and Diabetes Mellitus in a sample of patients diagnosed with Schizophrenia or other Psychotic Disorders.

This is a Descriptive and Cross-sectional Observational Study. Clinical Histories were reviewed and a personal or telephone interview was established to expand data related to the objectives of the study. The patients were recruited among the patients seen in the specific Severe Mental Disorder consultation who had a diagnosis of schizophrenia or other Psychotic Disorders, according to DSM 5-TR criteria.

From a sample of 93 patients, 24 had Diabetes. The Prevalence of Diabetes in patients with Schizophrenia or other Psychotic Disorders was 25.8%. Of the patients without a diagnosis of Diabetes, 15 of them had values of Glycosylated Hemoglobin (HbA1c) for Prediabetes. Using the Chi-Square Test, statistically significant differences were found between the variable Main Psychiatric Medication and Diabetes. Patients treated with Clozapine, Aripiprazole and Olanzapine had a Prevalence of Diabetes of 40.9%, 33.3% and 28.5%, respectively.

Prevalence of Diabetes in our sample was 3.4 times higher than the 7.51% of the general population in Spain. This presumes a significant importance and impact on the health of these patients. The diabetic patients in our sample were diagnosed with Diabetes years after the diagnosis of the mental illness, which seems to indicate that the causes have to do with lifestyle, dietary habits, weight, and exposure to chronic antipsychotics. Premature death in schizophrenia has several explanations, being of special importance the development of cardiovascular disorders and Diabetes This can be due to many reasons, but it is worth highlighting the metabolic side effects of some antipsychotics and lifestyle. In this sense, it is essential to carefully monitor this group of patients.

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Individuals experiencing psychotic symptoms often lack insight into their conditions, especially in first psychotic episodes. According to the Portuguese Mental Health Law, involuntary hospitalization may be necessary in cases of severe mental disorder, involving a threat to the patient or his/her legal assets, when there is a refusal of the necessary treatment.

The aim of our study was to characterize patients admitted involuntarily for first psychotic episode and to compare them with the patients undergoing inpatient voluntary treatment.

Out of a total of 87 patients diagnosed with first psychotic episode, hospitalized between 2020 and 2022 in our service, at Hospital Magalhães Lemos, 65 were included in the study. Exclusion criteria included patients from other residential areas. 40 patients were admitted under involuntary treatment, whereas 25 were hospitalized voluntarily. For both groups, we calculated the duration of untreated psychosis, the prevalence of psychoactive substance abuse, the type of treatment provided and the number of re-hospitalizations.

Patients in involuntary treatment had longer duration of untreated psychosis (71 vs 38 weeks). Among these patients, 53% had comorbid psychoactive substance abuse, in contrast with only 36% of voluntarily treated patients. Upon discharge, 58% of patients in involuntary treatment were prescribed depot antipsychotic medication, whereas only 12% of the ones in voluntary treatment. Out of 40 patients admitted involuntarily, 11 were re-hospitalized, but only 4 of the 25 patients in voluntary treatment (28 vs 16%).

Patients in involuntary treatment probably suffered from more severe disease, as seen for the higher duration of untreated psychosis and frequent comorbid substance abuse. Injectable medication was the preferred choice at the time of discharge for this group. Additionally, they experienced higher rates of re-hospitalizations. Recent changes in Portuguese Mental Health Law, that aims to safeguard the rights and responsibilities of individuals with mental health care needs, motivated this study.

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Psychotic disorders present a significant lifetime risk for suicide. Past estimates suggest that up to 25-50% of individuals with schizophrenia (SCZ) may attempt suicide during their lifetime. A growing body of literature indicates that the level of cognitive performances may be associated with a differing level of lifetime suicide attempts, albeit inconsistently depending on the diagnostic category and study setting. However, the vast majority of the literature in the field is composed of cross-sectional studies, limiting the overall interpretation of the available evidence.

In the present study, we probed the possible association of BDNF plasma levels, cognitive functions assessed through the Brief Assessment of Cognition in Schizophrenia (BACS) and lifetime suicide ideation and/or attempts (LSI+LSA). More specifically, we tested whether such association would persist during the 2 years follow-up divided in 5 different timepoints at 6-month intervals, if present.

The present study represents a secondary analysis of a previously described cohort (Manchia et al. Brain Sci. 2022 Dec 4;12(12):1666). The sample comprised 105 subjects with SZC or schizoaffective disorder. We employed the 1) Wilcoxon test for non-parametric data 2) linear modelling to test the possible association of BACS-defined cognitive task performances with LSI+LSA. We also investigated if either BDNF plasma levels or four tested BDNF SNP genes would mediate this association.

From a total of 105 subjects, data relevant to the analysis were available for 89 subjects. We observed a significant association between BACS-Letter fluency task (BACS-LF) with LSI+LSA, persisting even when adjusting for gender, duration of untreated psychosis, total Positive and Negative Syndrome Scale score, age, chlorpromazine equivalents of antipsychotic therapy and for the effect of time. The association remained significant even when adjusting with the Bonferroni-Holms method for multiple comparisons (p=0.002). No association was found either for BDNF plasma levels or the tested BDNF genes for the tested outcomes.

In our sample, higher BACS-LF performances appeared to be associated with a higher lifetime risk of LSI+LSA. This report adds to the previous literature suggesting that different cognitive performance levels may represent one of the many chronic risk factors associated with LSI+LSA, and that may ultimately complexly interact with more proximal ones.

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