The impacts of the coronavirus disease of 2019 (COVID-19) pandemic on mental health have been relatively severe.

This study examined the influence of the COVID-19 especially on depression and suicidal ideation in community-dwelling elderly in Korea.

Data were employed from a survey on elderly mental health in Jeollanam-do (southwest province in Korea). A total of 2,423 elderlies were recruited from 22 counties in Jeollanam-do between April and October 2021. We used self-reported questionnaires, including sociodemographic factors, COVID-19 related stress, suicidal ideation, Geriatric Depression Scale-Short Form Korean Version (GDS-SF). Logistic regression was performed to examine the factors on depression and suicidal ideation

Of the 2423 subjects, 622 (25.7%) reported depressive symptoms and 518 (21.4%) reported suicidal ideation. The multivariate logistic regression analysis revealed that living alone, poor perceived health status, the worry of COVID-19 infection and restriction of daily activity due to COVID-19 pandemic were significantly associated with depression. Male sex, poor perceived health status, disability in house chores and depressive symptom are risk factors for suicidal ideation.

Image:

Image 2:

Image 3:

These findings showed that increased risk factor for depression and suicidal ideation in community dwelling elderly during COVID-19 pandemic. We confirmed that feelings of isolation and negative perception of health were risk factors on depression in community dwelling elderly in the context of the COVID –19 pandemic. Also male, poor self-perceived health status, difficulty of independent living and worry and depression are increased the risk of suicidal ideation among the elderly.

None Declared

It is known that cognitive impairment is one of the main symptoms of schizophrenia, which determines the functional outcome. The question of the effect of antipsychotics on the cognitive functions of these patients is still unresolved. Cognitive impairment while taking antipsychotics is thought to be mostly related to extrapyramidal abnormalities. In practice, it is difficult to distinguish what causes a patient’s complaints of cognitive decline. Is it related to taking the medication? Or a worsening mental state? Age, lifestyle, etc.?

We analyzed the relationship of cognitive impairment with the severity of extrapyramidal symptoms, mental status gravity, age, and dose of antipsychotic and cholinergic medication at weeks 2 and 8 of treatment.

We examined 37 patients with schizophrenia on stable antipsychotic treatment at weeks 2 and 8 of therapy. Thirty patients received a 2nd-generation antipsychotic, and seven patients received a 1st-generation antipsychotic. The anticholinergic drug was trihexyphenidyl. The antipsychotic dose was estimated in olanzapine equivalent. Extrapyramidal symptoms were assessed by The Scale for Extrapyramidal Symptoms (SAS), severity of mental condition was rated by The Positive and Negative Syndrome Scale (PANSS), cognitive function was measured by The Brief Assessment of Cognition in Schizophrenia (BACS).

As previously described, patients with more severe extrapyramidal symptoms tended to have lower BACS composite scores (rxy = -0.318, p-value = 0.055) at week 8 of therapy. The total score on the SAS scale, as expected, only negatively correlated with scores on the Token Motor Task test (rxy = -0.412, p-value = 0.011) at the 8th week of therapy. There were also negative correlations between Token Motor Task scores and trihexyphenidyl dose (rxy = -0.496, p-value = 0.002). At both weeks 2 and 8, there was a negative relationship between age and Symbol Coding scores (rxy = -0.387, p-value = 0.018; rxy = -0.35, p-value = 0.034, respectively). Verbal Fluency scores were lower in patients with high scores on the PANSS excitement component and at week 2 (rxy = -0.42, p-value = 0.01), this trend continued at week 8 (rxy = -0.31, p-value=0.063) . Tower of London scores were negatively associated at week 8 with cognitive and positive PANSS scores (rxy = -0.46, p-value = 0.004; rxy = -0.336, p-value = 0.042, respectively).

Thus, we have demonstrated that cognitive impairment in patients with schizophrenia is associated with various factors, and not only antipsychotic treatment.

None Declared

One of the factors influencing the symptoms of schizophrenia, which may indicate changes in the cognitive functioning of patients, is the fluctuating level of inflammatory cytokines.

The aim of the review was to analyze the available literature on the importance of selected inflammatory factors [interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), of tumor necrosis α (TNF-α)] in schizophrenia and the assessment of the impact of changes in cytokine levels on the occurrence of schizophrenia symptoms.

For this purpose, available scientific publications from following databases: PubMed, Scopus, Google Scholar were used to prove that the levels of selected inflammatory parameters changed in people suffering from schizophrenia. Moreover, fluctuations in cytokine concentrations influenced the occurrence of negative symptoms of schizophrenia, including cognitive disorders, as well as psychotic symptoms.

An increase in the concentration of IL-1β in the cerebrospinal fluid of patients with the first episode of schizophrenia has been described, which may indicate the involvement of the cytokine in the inflammatory process involving the CNS. The increased level of IL-6 is associated with the occurrence of psychotic disorders, it is also noted in stressful conditions. IL-6 is qualified as an indicator of exacerbation of schizophrenia, which normalizes after antipsychotic treatment. In the blood of patients with paranoid schizophrenia, elevated levels of IL-8 and IL-6 were detected compared to healthy individuals, which indicates the development of an inflammatory process in schizophrenia. The relationship between the level of IL-8 in women in the second trimester of pregnancy and the risk of developing schizophrenia spectrum disorder in children has been proven. Untreated patients with acute psychotic symptoms showed an increase in the level of TNF-α in the blood serum (compared to healthy subjects). An increase in the level of TNF-α in the blood serum of patients with an acute relapse of schizophrenia or the first episode of psychosis was also demonstrated. In conclusion, the relationship of IL-6 and TNF-α with the occurrence of psychotic disorders, the relationship of IL-1β with the appearance of changes in mood, behavior, including cognitive dysfunction, the relationship of IL-8 with the risk of developing schizophrenia spectrum disorder in children, the relationship of reduced concentrations of IL-10 with the intensification of negative symptoms, including cognitive deficits.

In conclusion, the analysis showed that patients with schizophrenia fluctuate in the concentration of inflammatory cytokines, which affects the occurrence of clinical symptoms.

None Declared

VR-Assisted Therapy (VRT) for auditory verbal hallucinations has been demonstrated to have a significant impact on the symptoms, beliefs, and quality of life of patients with treatment-resistant schizophrenia. However, little is known about how these changes are implemented into their lives and on which aspects these improvements occur.

This study aimed to qualitatively explore changes in the quality of life of patients who underwent VRT in the context of an ongoing clinical trial.

Ten consecutive patients enrolled in an ongoing clinical trial were assessed using semi-guided interviews before as well as 3 months after VRT. These encounters have been recorded and transcribed. Then, the content of the participants’ discourse was thoroughly analyzed, leading to the generation of an extensive theme grid. Each utterance was then coded by at least two members of the research team, and each disagreement was then discussed in a group format until a consensus was reached. As the cases were analyzed, the grid was adapted in a back and forth manner. New participants were included until data saturation occurred.

The content analysis allowed the identification of nine main themes representing different aspects of the patients’ quality of life: psychiatric symptomatology, identity, occupations, wishes, interpersonal relationships, lifestyle, psychiatric follow-up, life events, and attitudes/behaviors during the interview. Each theme was then subdivided into more specific codes. By analyzing the evolution of the frequency of each subtheme, it was observed that, following therapy, patients presented with less psychotic symptoms, which were also perceived more positively, a better self-esteem, more hobbies and projects, as well as an overall improved lifestyle and mood.

Investigating how VRT impacts the patients’ quality of life allows for a deeper understanding of how people with treatment-resistant schizophrenia can achieve meaningful changes and move towards a certain recovery process.

None Declared

Auditory verbal hallucinations (AVH), which often present in individuals with schizophrenia, can cause great psychological distress. Although antipsychotic medication can reduce AVH, 30% of patients will be resistant. Treatment resistance could be associated with important consequences, and there are only few treatment alternatives. Unfortunately, more than 50% of patients will not respond favorably to the best available psychological therapy, cognitive-behavioral therapy (CBT). However, using virtual reality (VR), our research team has adapted a therapy whose goal is to recreate the faces and voices of the patients’ persecutory voices as avatars. By interacting with an external representation of their hallucinations, patients implement new strategies to control their voices and to regulate their emotions. A small clinical trial (proof of concept) has demonstrated the safety and validity of this therapy as well as its superiority compared to the usual treatment.

(1) To verify whether VR-Assisted Therapy (VRT) is superior to CBT for the treatment of AVH; and (2) to examine the effects of VRT and CBT on the symptomatology and quality of life.

For this single-blind randomized controlled clinical trial, 136 patients will by recruited (68/intervention) The effects on psychotic symptomatology as well as on quality of life is assessed using standardized questionnaires. Patients are included if they hear persecutory voices and have not responded to at least 2 trials of antipsychotics. Both groups are randomized from an external site and begin with an initial clinical assessment prior to randomization. Participants then receive 9 weekly one-hour therapy sessions (CBT or VRT), beginning the following week. A second clinical evaluation is carried out one week after the last session. A linear mixed effects model will be used to compare the effects of the 2 interventions.

Results from a pilot randomized comparative trial evaluating the short- and long-term efficacy of VRT over CBT for patients with treatment-resistant schizophrenia (N=37/group) showed that both interventions produced significant improvements in AVH severity and depressive symptoms. Although results did not show a statistically significant superiority of VRT over CBT for AVH, VRT did achieve larger effects particularly on overall AVH (d = 1.080 for VRT and d = 0.555 for CBT). The recruitment of the current clinical trial is in progress.

Image:

VRT, which is currently under clinical investigation, presents itself as an interesting complement to existing pharmacological treatments. Since VR technologies allow the recreation of scenarios that are nearly impossible to reproduce in real life, VR-assisted psychotherapy could eventually become an integral part of our clinical practices.

None Declared

Schizophrenia is a chronic severe mental disorder characterized by acute decompensation episodes that may lead to hospitalization. In Portugal a previous study found a total of 25,385 hospitalizations in an 8-year period, being one of the most burdensome serious mental disorders in Portugal.Rehospitalizations (hospitalization occurring after a previous discharge due to Schizophrenia) are one of the quality-of-care indicators of schizophrenia treatment.

This project aims to describe and quantify hospitalization readmission rates in patients with schizophrenia in Portuguese public hospitals

A descriptive study was designed according to the RECORD guidelines, using a nationwide hospitalization administrative database that contains all hospitalizations registered in Portuguese mainland public hospitals. All episodes with discharges occurring between 2008 and 2015 with a primary diagnosis of Schizophrenia were selected according to the International Classification of Diseases version 9, Clinical Modification (ICD-9-CM) codes of diagnosis 295.xx. Readmission rates were estimated using a methodological approach developed by the authors that identified patients who have been rehospitalized in <=5; <=30; <=90 and <=365 days from a previous hospitalization episode during the study period. Individual patients were identified (crosschecking three variables: birthdate; sex and place of residence). The time between discharges was calculated using the difference between an index hospitalization and the next registered hospitalization from the same patient.

A total of 14,279 patients were anonymously identified in order to calculate readmission rates per patient from a total of 25,385 hospitalization episodes. The mean hospitalization per patient ratio was 1.78. A total of 367 patients (2.6%) had a readmission in <=5 days after discharge. The readmission rate at <=30 days was 8.6% (n=1224); 14.1% (n=2013) at <= 90 days and 23.7% (n=3378) at <=365 days. Readmission rates were higher in male sex patients. Shorter periods of time between readmissions were increasingly frequent in male patients (3.1% vs. 1.6% of all male vs. all female patients in <=5days readmissions; 9.6% vs. 6.5% in <=30 days readmissions; 15.7% vs. 11.0% in <=90days readmissions and 25.3% vs. 20.4% in <=365days readmissions).

Rehospitalizations arise as one of the indicators of treatment failure and quality of care in patients with a diagnosis of schizophrenia. Our study is the first to measure and assess readmission rates in patients with Schizophrenia in Portuguese public hospitals at a nationwide level. Portugal presents lower 30-day readmission values when compared to other countries. The 30-day readmission rate in patients with Schizophrenia in Portuguese Public Hospitals is 8.6% and male patients have higher readmission rates when compared to female patients.

None Declared

Schizoaffective disorder is a mental health disorder frequently associated with somatic and addictive comorbidities. This association can be dangerous as it may change the expression of the disease and its prognosis and may even affect the quality of life (QOL) and the overall functioning of patients.

This study aimed to investigate the impact of somatic and addictive comorbidities on QOL and the overall functioning of patients with schizoaffective disorder.

This paper is a cross-sectional descriptive study conducted at the Department of Psychiatry within outpatient settings over six months. We evaluated the QOL using the SF-36 and Global Assessment of Functioning scale (GAF). We included all patients suffering from a schizoaffective disorder and excluded patients with associated mental impairment, those we could not assess because of another disability, and those with missing records.

Fifty-two patients with schizoaffective disorder met our inclusion criteria with an average age of 38. This study found somatic comorbidities in 30.8% of patients, where diabetes ranked first (13.5%), followed by high blood pressure (9.6%). We noted addictive comorbidities in 63.5% of patients, with tobacco, alcohol, and Cannabis being the most consumed substances, with respective rates of 57.7 %,28.8 %, and 13.5%.

The QOL assessment revealed an impaired QOL score in 80.8% of patients, whereas 65.4% had a GAF score lower than 70 indicating a deterioration of functioning level. Our results showed that dimension D1 (physical activity) of the SF-36 was strongly influenced by somatic comorbidities, according to an analytical investigation of the association between these two variables (p = 10-4). We also found that the deterioration in the patient’s global functioning was not significantly related to somatic comorbidities (p = 0.28). Furthermore, our studies showed no association between impaired quality of life and substance abuse.

Somatic comorbidities and substance abuse have a detrimental effect on patients with pre-existent schizoaffective disorder, and the goals of patient care with a schizoaffective illness go beyond the remission of clinical symptoms to the improvement of quality of life and socio-professional functioning.

None Declared

In the inherently noisy real world, we can rarely have full certainty about what we have just seen or heard. Thus, making a perceptual decision on sensory information, and simultaneously tracking our varying levels of certainty in these decisions (i.e., metacognitive abilities) are crucial components of everyday life.

Hallucinations, such as confidently reporting a human voice or face when none was present, are a hallmark of psychotic disorders but also occur among the normal population. Particularly in patients with psychotic disorders, these misperceptions are linked to confident beliefs in their actual existence. However, whether patients’ confidence is only increased during such erroneous perceptions and whether perceptual and metacognitive decisions arise from supramodal mechanisms across sensory modalities remains unknown.

In the laboratory, we tested perceptual and metacognitive decisions under varying levels of sensory certainty in healthy adults and patients with psychotic disorders admitted to a psychiatry ward (Ncon=32, Npat=12; age = 19-49; F2x.x diagnoses).

Specifically, participants had to detect human voices or faces against briefly presented noisy backdrops and subsequently rate their confidence in the accuracy of their perceptual decision (Fig 1A,B,C). We further hypothesised that probabilistic cues prior to blocks of trials can bias participants’ choices and hallucination probability (i.e., confident false alarms).

Patients exhibited higher perceptual sensitivity in the auditory than the visual task, alongside a generally stronger decision bias towards fewer ‘voice/face’ choices (Fig 2A,B). This bias was more pronounced in the visual domain. Decision performance was overall higher on the auditory task but lower for patients (predicted minimum > 55%; Fig 2C). Strong correlations between auditory accuracy and PANSS hallucination scores of patients and LSHS scores of healthy participants suggest an effect of these hallucinatory experiences on accurate perception.

Metacognitive abilities were reduced in patients across both modalities: They exhibited general overconfidence, which was stronger for incorrect trials (Fig 3A). Patients’ confidence ratings were inversely related to the probability of choosing ‘voice/face’. Combining both perceptual and confidence decisions, patients showed higher hallucinations probability in the auditory task, particularly in more difficult trials (i.e., with less informative sensory evidence; Fig 3B).

Image:

Image 2:

Image 3:

In sum, patients with psychotic disorders exhibit increased decision bias accompanied by increased confidence, and thus a reduced fidelity in their metacognitive abilities. The modality differences are in line with phenomenology and reported hallucination rates. These results suggest stronger priors in psychotic disorders resulting in worse perceptual acuity and assessment of this perception.

None Declared

Previous functional neuroimaging studies have demonstrated a brain network responsible of time discrimination (TD) processes, which may play a significant mediating role in other cognitive processes, such as change detection and cognitive control. The study of TD and its dysfunction in psychosis has become a matter of growing interest. We hypothesize that the impairment of the TD network is involved both in the mechanisms of psychosis and in the cognitive deficit presented by patients.

1. 1. To delimit the brain regions involved in TD.

2. 2. To examine the dysfunction in TD brain network in patients diagnosed with psychosis.

3. 3. To sudy the integrity of brain white matter pathways in psychosis.

4. 4. To verify whether the neuroimaging findings and TD test performance predict the neurocognitive profile of the patients.

Participants included 20 patients with psychosis (PSY group) and 13 healthy controls (HC group). PSY group participants met remission criteria for 6 months prior to the study. Participants were interviewed for sociodemographic information and clinical assessments. They underwent a detailed cognitive assesment using the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB). Neuroimaging study was performed on a 3 Tesla MRI scanner. We designed an experimental task including a test tool to assess TD and Oddbal detection (OD) paradigms with a cognitive control component. The task was conducted under functional magentic resonance imaging (fMRI). We used the general linear model analysis of the individual data of the fMRI images and the random effects model for group inference. Group differences in DTI were tested using tract-based spatial statistics (TBSS).

We find statistically significant differences (fMRI) in the activity related to TD (in HC), with greater activity in frontal cortical regions, the insular cortex and the cerebellum. In the PSY group, differences in the functionality and activation pattern of brain networks responsible for TD are observed, although voxel clustering does not reach the cluster significance limit when compared to HC. Compared to the HC, the PSY group has a significant deficit of fractional anisotropy (DTI) in the whole brain and in 21 specific brain regions. The PSY group has significantly lower scores in six of the seven cognitive domains than the control group, as well as in the overall composite. We correlated FA values in the groups of interest with MCCB scores.

Image:

Image 2:

Image 3:

We have defined the TD network, its relationship with other brain networks and cognitive processes of more complexity. The inclusion of participants with stable psychosis allowed us to analyze de TD disfunction in the PSY group. We compared the integrity of TD related brain pathways and correlated the findings with various clinical characteristics and the cognitive impairment present in psychotic patients.

None Declared

The treatment with long-acting injectable antipsychotics (LAIAs) is more and more frequent and it shows advantages regarding adherence, effectiveness and tolerance.

To describe and compare the profile of patients under treatment with LAIAs in a psychiatric hospital in Portugal.

An observational and retrospective study was carried out with the collection of data referring to patients hospitalized with a first psychotic episode between 01/01/2019 and 30/06/2022 in a psychiatric hospital in Portugal and the respective evaluation of sociodemographic and clinical data through the information recorded in the clinical files.

During the 42 months of the study, we selected 78 patients who presented psychotic symptoms on admission. Patients with a history of previous psychotic episodes and prescription of antipsychotic therapy prior to hospitalization were excluded.

Of 78 patients hospitalized with a first psychotic episode, 34 - which corresponds to approximately 44% - were discharged with LAIAs.

Patients receiving LAIAs had an average age of 39 years. The average number of days of hospitalization was 28 days; 41% were female (n=14) and 59 were male (n=20); 35% (n=12) consumed psychoactive substances previously on admission to hospital; 62% (n=21) were discharged under the compulsive treatment regimen. Regarding the diagnosis at discharge, based on the international classification of disease-11 (ICD-11), the most common were schizophrenia, psychotic disorder induced by psychoactive substances and acute and transient psychotic disorder.

From the statistical analysis carried out, no correlation was observed between the rate of readmissions and the administration of LAIAs, nor was there any correlation between the rate of readmissions and compulsive outpatient treatment.

Despite what is described in the literature, in the sample under study, the LAIAs were not superior in the variables studied, namely in reducing the readmission rate. Possible explanations for the results obtained may be justified by the size of the sample under study and the follow-up time of the cases.

None Declared

Schizophrenia is a chronic psychotic disorder characterized by a high prevalence of sexual dysfunctions (SD). SD can affect the quality of life (QOL) of patients, cause low self-esteem and self-stigma.

To evaluate the sexual functioning, the QOL, and the internalized stigma among outpatients with schizophrenia.

To determine the links between SD, the QOL, and the internalized stigma.

A cross-sectional, analytical study was conducted between Mars and September 2019. It included 53 outpatients with schizophrenia in clinical remission for at least two months.

We used the Arizona Sexual Experiences Scale (ASEX) to assess sexual functioning, the Internalized Stigma of Mental Illness scale (ISMI) to assess the subjective experience of stigma, and the 36-item Short-Form Health Survey (SF-36) to evaluate the QOL.

The average age of patients was 42.28 years old, and their sex ratio was 3.81. The average ASEX score was 19.77±5.99, and 67.9% of participants had at least one SD.

The mean ISMI score was 2.47±0,34. 60,4% of patients had a high level of internalized stigma. The QOL was impaired in 66% of the cases.

We found correlations between SD and a high level of internalized stigma (p=0.011) and its subscales «alienation » (p=0.013), «stereotype endorsement» (p=0.034) and « discrimination experience» (p =0.001).

SD correlated with impaired QOL (p<0.001), emotional limitation (0.050), and social functioning (0.031).

Our study highlights the importance of the impact of SD on the prognosis of schizophrenia through internalized stigma and altered QOL.

None Declared

Sexual dysfunctions (SD) are common in patients with schizophrenia. The link between schizophrenia and sexuality is complex. Studies have shown that SD can be linked to the side effects of antipsychotic medications, but also to symptoms of illness.

To identify the clinical and therapeutic factors associated with SD in outpatients with schizophrenia.

A cross-sectional and analytical study was conducted between Mars and September 2019. It included 53 outpatients with schizophrenia in clinical remission for at least two months.

We used the Positive and Negative Symptom Scale (PANSS) to assess clinical symptoms and the Arizona Sexual Experiences Scale (ASEX) to assess sexual functioning.

The average age was 42.28 ±10.49 years old. The sex ratio was 3.81. The mean age of onset was 27.09±5,46 years. The mean duration of illness was 18.11±9.29 years. First-generation antipsychotics were prescribed in 77.4% of cases, while second-generation antipsychotics were prescribed in 39.6% of cases.

The average ASEX score was 19.77±5.99, and 67.9% of participants had at least one SD. the analytical study revealed significantly higher average scores for the PANSS-negative subscale (p=0.006) and the PANSS total score (p=0.04) in patients with SD. SD correlated with first-generation antipsychotic treatments (p=0.02).

Our results show that SD are frequent in patients with schizophrenia and that they are related to the severity of the symptoms, in particular the negative symptoms of illness, and the prescription of first-generation antipsychotics.

None Declared

Antipsychotics (AP) are the primary pharmacological treatment for schizophrenia but increase the risk for diabetes, with recent meta-analyses indicating important differences between specific APs. However, these findings are based on randomized clinical trials, which only include 20% of patients seen in everyday clinical settings, and are hence prone to selection bias.

We aim to investigate 1) the actual risk of developing diabetes in patients treated with APs using real-world data and 2) whether there are risk differences between specific APs.

We conducted a retrospective cohort study using Danish nationwide healthcare registers. We identified all individuals receiving a schizophrenia diagnosis from January 1, 1999, to January 1, 2019 and an age- and sex-matched reference population from the general population. The primary outcome was diabetes, identified via hospital discharge diagnoses and redeemed prescriptions for glucose-lowering drugs. First, we compared the risk of developing diabetes between patients with schizophrenia and the age- and sex-matched reference population. Second, among the patients with schizophrenia, the association between AP drug treatment and the risk of diabetes were analyzed. Third, risk differences for developing diabetes between specific AP drugs were investigated. We used cox regression for all analyses, the latter adjusted for age, sex, year of schizophrenia diagnosis, Charlson Comorbidity Index (CCI), occupational status, marital status, education and schizophrenia severity (use of antipsychotics, antidepressants, anxiolytics/hypnotics/sedatives, mood stabilizers and number of psychiatric admissions in the year preceding the diagnosis of schizophrenia).

We identified 31,856 patients with schizophrenia and 159,280 reference individuals. Patients with schizophrenia had an increased risk of developing diabetes compared with the reference individuals (unadjusted HRR: 3.12, 95%CI: 2.98-3.28). Treatment with AP in patients with schizophrenia, compared to periods with no AP use, was associated with an increased risk of developing diabetes (adjusted HRR: 2.04, 95%CI: 1.75-2.38). This risk was particularly increased among individuals treated with lurasidone (HRR: 2.66, 95%CI: 1.10-6.42), sertindole (HRR: 2.10, 95%CI 1.51-2.93), paliperidone (HRR: 1.84, 95%CI 1.47-2.31), clozapine (HRR: 1.74, 95%CI 1.49-2.03) and aripiprazole (HRR: 1.54, 95%CI 1.35-1.75), whereas treatment with zuclopenthixol (HRR: 1.00, 95%CI 0.82-1.23), flupentixol (HRR: 0.71, 95%CI 0.40-1.25) and pimozide (HRR: 0.74, 95%CI 0.31-1.78) were not associated with an increased risk of diabetes.

This real-world study indicates differences in the risk of developing diabetes between specific AP compounds. Further analyses will be presented at the conference.

None Declared

Psychotic disorders are frequently linked to a public perception of dangerousness and propensity to engage in violent acts. Despite efforts to demystify these disorders, the evidence on the relationship between violence and psychotic disorders is mixed. Together with media coverage of violent crime associating violence with the occurrence of a mental disorder, such a situation has contributed to the social stigmatisation of people with severe mental disorders and the consequent discrimination that this scenario entails. Despite efforts to demystify such disorders, the association between violent behaviour and psychosis remains unclear.

This study aims to explore the incidence and main clinical characteristics associated to violent offences recorded in a cohort of patients presenting a First-Episode Psychosis (FEP).

Patients presenting with an affective or non-affective first psychotic episode were recruited from the First Episode Psychosis Intervention Program (CRUPEP) cohort between 2009 and 2016. The main clinical variables were collected, including medical-forensic records of patients registered at the Basque Institute of Forensic Medicine (BIFM), to retrieve any violent acts in which patients with FEP were involved, either as victims or as offenders.

Overall, 79.5% (n=182) of CRUPEP patients had no violent record of crime or offence recorded in the BIFM. Annual crime rates for the 2009–2016 period show a decreasing trend in both the general population (IRR=0.981 (95%CI=0.978–0.983) p<0.001) and in patients with FEPs (IRR=0.019 (95%CI=0.012–0.028) p<0.001); this pattern is more pronounced the FEP group. Victimisation accounted for the vast majority of reported incidents; nevertheless, patients who have committed violent offences were mostly involved in intrafamily violence

Patients with FEP were not involved in a higher number of crime rates than the general population. The types of violent acts committed by FEP patients were heterogeneous, with extreme violence being particularly uncommon.

None Declared

Even though the construct of Formal Thought Disorder (FTD) is an ambiguous and disputed one, it has endured as a fundamental psychopathological concept in the clinical coalface of Psychiatry. FTD can be summarized as a multidimensional concept, which reflects difficulties or idiosyncrasies in thought, language, and communication in general. It is usually subdivided into positive versus negative and objective versus subjective, and it can be a major challenge for both mental health professionals and patients themselves.

In this presentation, we aim to explore the latest neuroscientific findings regarding FTD and its putative neurobiological substrate, ranging from the synaptic and neurotransmitter level to the structural and functional one, briefly considering some of the linguistic and neuropsychological implications.

We conducted a thorough narrative review by researching the Pubmed database using the following search string: “formal thought disorder”[Title/Abstract] and selecting only those articles published after 2010. Afterwards, we summarized the main findings from the gathered information.

Some of the most consistent findings in current meta- and mega-analyses of structural MRI studies in patients with schizophrenia and FTD are volume reductions of regional grey matter in the frontal operculum and the language-related lateral temporal cortices, namely the left superior temporal gyrus and middle temporal gyrus. Another consistent finding is the so-called reversed lateralization of the temporal cortices. Regarding functional MRI studies of FTD, amongst the most common implicated regions are the bilateral superior and middle temporal gyri, the fusiform gyrus and the inferior frontal gyrus. Alterations in the glutamatergic, dopaminergic and serotoninergic neurotransmitter systems have also been linked to FTD.

Many areas of the brain have been implicated in the pathogenesis of FTD, though some more consistently than others. The superior temporal, middle temporal and inferior frontal gyri in particular have repeatedly revealed both structural and functional alterations in patients with FTD. A reversed lateralization has also been observed at both structural and functional levels. The different neurotransmitter systems have also been connected with FTD, with the glutamate system being the one more thoroughly explored. However, the direction of causality between changes in the brain and FTD, and the influence of potential mediators remain largely unknown.

None Declared

The ICD and DSM diagnostic categories do not represent entirely distinct entities because several cognitive impairments are shared across psychiatric disorders. Such shared cognitive impairments are hypothesized to be caused by common neurobiological substrates, one of which is transdiagnostic alterations in functional network connectivity (FNC).

To investigate and compare the within-network functional connectivity (WNFC) and between-network functional connectivity (BNFC) in alcohol use disorder (AUD), schizophrenia (SCZ), bipolar affective disorder (BPAD), obsessive-compulsive disorder (OCD) and healthy controls (HC) using resting-state fMRI employing a data-driven exploratory approach.

The current study was a secondary analysis of data from the ADBS project in India. After pre-processing of fMRI data, a spatially and temporally constrained group-independent component analysis in the GIFT toolbox was performed using the NeuroMark templates to generate 53 independent components (ICs). These components were divided into seven functional domains including subcortical (SC), auditory (AU), sensorimotor (SM), visual (VI), cognitive-control (CC), default-mode (DM), and cerebellar (CB). To investigate the FNC correlations associated with group status (patients or HC) univariate models were applied which were subjected to corrections for multiple comparisons at an alpha=0.05 significance level using the FDR.

The overall sample size was 249 [AUD=35, SCZ=44, BPAD=48, OCD=53, and HC=69]. Transdiagnostic WNFC alterations largely involved dysconnectivity in the CC, DM, and SC domains, resulting in ICs with both increased and decreased WNFC. Transdiagnostic BNFC alterations were primarily in the form of increased connectivity of the SC domain with various cortical domains whereas reduced connectivity was noted between AU, VI, SM, and CB domains. There was AUD-specific hyperconnectivity in the CC domain and SCZ-specific hyperconnectivity in the DM domain, and dysconnectivity in the SC domain. BPAD-specific hyperconnectivity was identified in DM and SC domains in addition to increased connectivity between CB and SM domains and decreased connectivity between CB and SC domains. All results were significant at p ≤ 0.05; [FDR] q= 0.05.

Our transdiagnostic WNFC alterations corresponded to the central executive network, default mode network, salience network, and CSTC loop, which provided transdiagnostic evidence for the triple network model of psychopathology and underlined the relevance of subcortical dysconnectivity in this model. Furthermore, our BNFC changes showed subcortical hyperconnectivity with many cortical networks, underscoring its relevance as a potential target for transdiagnostic therapeutic interventions.

None Declared

There is evidence that cerebral myelination is impaired in schizophrenia. The purpose of this study is to find the myelin content changes in the brain structures of patients with early-stage schizophrenia using the macromolecular proton fraction (MPF) method, and also to evaluate the differences in the myelination of these structures.

To measure MPF in the brain structures of schizophrenia patients

Forty-five subjects, 22 controls (10m+12f, 31.6±9.7 y.o.) and 23 schizophrenia patients (F20.0, 11m+12f, 31.5±5.1 y.o.). Philips Achieva dStream 3T MRI scanner, standard head coil. The magnetization transfer (TR=20 ms, TE=4.60 ms, FA=10°), T1-weighted (TR=20 ms, TE=4.60 ms, FA=20°) and PD-weighted (TR=20 ms, TE=4.60 ms, FA=4°) were acquired. The MPF maps were reconstructed using home-made software. In FSL, non-brain structures were removed and MPF maps were registered to a standard MNI152 1 mm atlas. Harvard Oxford Cortical and Subcortical atlases were used to select areas of interest. T-test was used in search for between-group differences.

A 3% decrease in myelination in schizophrenia was observed in whole cerebral cortex p = 0.03) and cerebral white matter (p=0.02). Trends to cortical demyelination were found: paracingular cortex (p=0.06), anterior (p=0.1) and posterior cingulate cortex (p=0.07). No myelination disorders were detected in the cerebellum.

Image:

Image 2:

Image 3:

To our knowledge, the absence of cerebellar myelination disorders in patients at an early-stage schizophrenia is reported for the first time, while the observed decrease in cerebrum myelination in schizophrenia is consistent with the previous findings. The difference in myelination between cerebellum and cerebrum may help to characterize the dynamics of the pathological process and provide additional information for understanding the biological mechanisms of the development of schizophrenia.

Grant RSF 20-15-00299 (partially).

None Declared

Recent longitudinal studies point towards the existence of a positive relationship between cannabis use and violence in people with severe mental disorders. However, the existence of a dose-response relationship between the frequency and/or the severity of cannabis use and violence has seldom been investigated.

This study aimed to determine if a dose-response relationship between cannabis use and violence exists in a psychiatric population.

This observational study was conducted at the Institut universitaire de santé mentale de Montréal (Montréal, Canada). A total of 98 outpatients (81 males and 17 females, all over 18 years of age) with severe mental disorders were included in the analyses. Clinical evaluations were conducted every 3 months for a year. Substance use, violent behaviors, and potential covariables were assessed through self-reported assessments, urinary testing, as well as clinical, criminal, and police records. Using generalized estimating equations, the association between cannabis use frequency (non-users, occasional, regular, and frequent users, assessed using the Time-Line Follow-Back and confirmed with urinary testing) and violence was investigated, as well as the association between the severity of cannabis use (measured using the Cannabis Use Problems Identification Test – CUPIT) and violent behaviors.

Cannabis use frequency and severity were significant predictors of violent behaviors. After adjustment for time, age, sex, ethnicity, psychiatric diagnoses, impulsivity and use of alcohol and stimulants, odds ratios were of 1.91 (p <0.001) between each frequency profile, and 1.040 (p <0.001) for each increase of one point of the severity of cannabis use score (0 to 79).

Image:

These findings have important implications for clinicians, demonstrating that cannabis use may have serious adverse consequences in a psychiatric population. Nevertheless, the mechanisms underlying this association remain unclear.

None Declared

Paliperidone palmitate 6-month (PP6M), administered twice-yearly, demonstrated non-inferiority to paliperidone palmitate 3-month (PP3M) in preventing relapse in patients with schizophrenia in a phase-3 randomized, double-blind (DB) global study.1 We report results of a 2-year single-arm, open-label extension (OLE) of this study (NCT04072575).

To assess long-term efficacy and safety of PP6M in patients with schizophrenia.

Patients who completed DB study without relapse were enrolled and followed up every 3 months for up to 2 years. Patients received 4 PP6M injections (700/1000 mg eq.) at baseline, 6-month, 12-month, and 18-month visits. Efficacy endpoints included relapse rate, Positive and Negative Syndrome Scale (PANSS) total score, Personal and Social Performance (PSP) score, and Clinical Global Impression-Severity (CGI-S) scale change from baseline. Safety was assessed by treatment-emergent adverse events (TEAEs), physical examinations and laboratory tests.

Of 178 patients, 154 (86.5%) completed the study; mean age: 40.4 years; 70.8% were men. Mean duration of PP6M exposure was 682.1 days. Overall, 7/178 (3.9%) patients relapsed between 20 to 703 days after enrolment. Mean (SD) change from baseline to endpoint: PANSS total score, 0.7 (8.22); CGI-S, 0.0 (0.51); PSP Scale, 0.5 (7.47). Overall, 111/178 patients (62.4%) reported ≥1 TEAE; most common (>10%) TEAEs were headache (13.5%) and blood prolactin increased (10.7%). Total, 7/24 patients withdrew due to TEAEs, and 8/178 (4.5%) patients experienced serious TEAEs; no deaths were reported.

Relapse rate with PP6M was very low (<4%). Clinical improvements in PANSS, CGI-S, and PSP scales demonstrated in DB study were maintained during this 2-year OLE study and no new safety concerns were identified.

1. D. Najarian et al. Int J Neuropsychopharmacol. 2022 Mar 17;25(3):238-251.

D. Najarian Shareolder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, I. Turkoz Shareolder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, S. Galderisi Consultant of: Janssen, Gedeon Richter-Recordati, Angelini, Speakers bureau of: Angelini, Gedeon Richter-Recordati, Janssen, Lundbeck, Sunovion, Recordati, H. Lamaison Grant / Research support from: Novartis, Eli Lilly, Lundbeck, Servier, AstraZeneca, Wyeth, Pfizer, Otsuka, Takeda, Sunovion, Roche, Janssen Pharmaceutical, Speakers bureau of: Servier, Abbot, Raymonds, Raffo, Temis Lostalo and Janssen Pharmaceutical, P. Zalitacz: None Declared, S. Aravind Shareolder of: Johnson & Johnson, Employee of: Advarra, Inc. USA, U. Richarz Shareolder of: Johnson & Johnson, Employee of: Janssen Research & Development-Cilag, Switzerland.

Nitrous oxide recreational use and abuse has significantly increased in recent years among youth. To our knowledge, no previous study investigated the frequency and characteristics of N2O use disorder.

To assess the frequency and the socio-demographic and clinical characteristics of nitrous oxide use disorder in a sample of health professions students.

An online survey was distributed to health professions students at Paris-Cité University, Paris-Sorbonne University, Paris-Saclay University, Lille University and Picardy University, France. The following data were collected: age, gender, frequency of nitrous oxid use, DSM-5 criteria for nitrous oxide use disorder, frequency (day/week/month/year/lifetime) of tobacco, alcohol, cannabis, cocaine, amphetamines, and hallucinogens use, Alcohol Use Disorders Identification Test scores (AUDIT), the Fagerström Tobacco Dependence Test scores, the Cannabis Abuse Screening Test scores, lifetime psychiatric or sleep disorders.

2067 participants (mean age 21.7±2.6 years, 75% female) completed the survey from September 2021 to May 2022. Among them, 38% (n=790) reported nitrous oxide lifetime use. Seven per cent of the subjects (n=137) fulfilled DSM-5 criteria for current nitrous oxide use disorder (114 mild use disorder, 16 moderate use disorder, 7 severe use disorder). In the group of patients with nitrous oxide use disorder, there were correlations between nitrous oxide use disorder and daily alcohol use (Chi2=24.2, p<0.0001), daily tobacco use (Chi2=25.3, p<0.0001), AUDIT scores >12 (Chi2=7.9, p<0.0001), lifetime depressive disorders (Chi2 =13.6, p=0.0001), anxiety disorders (Chi2 =13.2, p=0.02), or sleep disorders (Chi2 =14.4, p=0.006), compared to the group of subjects without nitrous oxide use or the group of subjects without nitrous oxide use disorders.

Nitrous oxide use and nitrous oxide use disorder were common among the health professions students included in the present study and correlated with daily alcohol or tobacco use.

None Declared