Autism and epilepsy often occur together. Epilepsy and other associated conditions have a substantial impact on the well-being of autistic people and their families, reduce quality of life, and increase premature mortality. Despite this, there is a lack of studies investigating the care pathway of autistic children with co-occurring epilepsy in Europe.

We analyzed the care pathway for autistic children with associated epilepsy in Italy, Spain, and the United Kingdom from the perspective of caregivers (using a survey aimed at caregivers of autistic children 0–18 years old), the autistic community, and professionals, in order to identify major barriers preventing caregivers and autistic children from receiving timely screening and treatment of possible co-occurring epilepsy.

Across all three countries, an analysis of the current care pathway showed a lack of systematic screening of epilepsy in all autistic children, lack of treatment of co-occurring epilepsy, and inappropriate use of antiepileptic drugs. A major challenge is the lack of evidence-based harmonized guidelines for autism with co-occurring epilepsy in these countries.

Our findings show both heterogeneity and major gaps in the care pathway for autism with associated epilepsy and the great efforts that caregivers must make for timely screening, diagnosis, and adequate management of epilepsy in autistic children. We call for policy harmonization in Europe in order to improve the experiences and quality of life of autistic people and their families.

Shared decision making (SDM) has found its way into mental health care to a limited extent only, and especially “challenging” patients do not benefit from this approach. In this lecture we will describe barriers to shared decision making among mental health professionals and among patients. Integrative approaches will be presented that meet the needs of patients and mental health staff when aiming at implementing SDM in acute mental health settings. Finally, best practice examples will illustrate that SDM actually can be implemented in the very acute settings/treatment phases and yields positive results.

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Recovery in mental health care comprises more than symptomatic improvement, but preliminary evidence suggests that only collaborative care may improve functioning of depressed older adults. This study therefore evaluates the effectiveness of behavioural activation (BA) on functional limitations in depressed older adults in primary care.

This study uses data from a multicentre cluster randomised controlled trial in which 59 primary care centres (PCCs) were randomised to BA and treatment as usual (TAU), and 161 consenting older (≥65 years) adults with clinically relevant symptoms of depression participated. Interventions were an eight-week individual BA programme by a mental health nurse (MHN) and unrestricted TAU. The outcome was self-reported functional limitations (WHODAS 2.0) at post-treatment (9 weeks) and at 12-month follow-up.

At the end of treatment, the BA participants reported significantly fewer functional limitations than TAU participants (WHODAS 2.0 difference −3.62, p = 0.01, between-group effect size = 0.39; 95% CI = 0.09–0.69). This medium effect size decreases during follow-up resulting in a small and non-significant effect at the 12-month follow-up (WHODAS 2.0 difference = −2.22, p = 0.14, between-group effect size = 0.24; 95% CI = -0.08–0.56). MoCA score moderated these results, indicating that the between-group differences were merely driven by those with no cognitive impairment.

Compared to TAU, BA leads to a faster improvement of functional limitations in depressed older adults with no signs of cognitive decline. Replication of these findings in confirmatory research is needed.

Eating Disorders are common. They onset in adolescence and affect individuals of all ages. Women are more affected than men. I will present evidence on the epidemiology of eating disorders across the lifespan. I will also review risk factors focusing in particular on biological risk factors that might explain onset of these disorders in critical periods of a woman’s life. I will also cover pyschosocial risk factors across life stages. I will present results from a series of cohort studies. I will then summarise the evidence from our own and other existing studies.

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It is not clear if there is an interaction between psychotherapy and pharmacotherapy. First, there may be no interaction at all, meaning that the effects of both are independent of each other. Second, antidepressants may reduce the effects of psychotherapy, and third, antidepressants may increase the effects of psychotherapy. We examined which of the three is correct.

We conducted random effects meta-analyses of randomized trials comparing psychotherapies for adult depression with control conditions. The proportion of users of antidepressants was used as a predictor of the effect size in a series of meta-regression analyses, while adjusting for relevant moderators, such as type of control group and baseline severity.

We included 300 randomized controlled trials (353 comparisons between treatment and control; 32,852 participants). The main effect size of psychotherapy was g = 0.71 (95% CI: 0.64; 0.79) with high heterogeneity (I2 = 82; 95% CI: 80; 84). We found no significant association between the proportion of antidepressants users and effect size (p = .07). We did find a significant association with some other predictors, including the type of control group and risk of bias. The use of antidepressants was associated with higher response rates within the control conditions, but not with the relative effects of the treatments compared to the control groups.

We found support for the independent effects of psychotherapy and pharmacotherapy, which is good news from a clinical perspective. Apparently, patients can start with psychotherapy and do not have to be afraid that this will reduce the effects of the therapy.

More than 100 million people are forcibly displaced including refugees, internally displaced persons and asylum seekers who have fled their homes to escape violence, conflict, and persecution. The vulnerable group of refugees and forcibly displaced people have a high burden of mental disorders, including post-traumatic stress disorder (PTSD), depression, idioms of distress, and prolonged-grief disorder, which are highly related to the load of traumatic circumstances surrounding refugees associated with human rights abuses, lack of human needs, and separation from others and many refugees are severely traumatized and suffer a variety of symptoms, and not all seek help. Their mental health problems are of emergency nature place a huge burden upon services which are difficult to deliver. This implies that mental health professionals and patients are more likely than ever to come from different cultural backgrounds. To have access to mental health care is often a challenge for them and most of them do not seek help. Unfortunately, these vulnerable groups are not treated equally according to ethical principles of mental health professionals. This presentation will focus on these dilemmas and discuss them.

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Cognitive (dys)function after ECT is often considered as a homogeneous phenomenon across patients. However, there are important inter-individual differences, with some patients experiencing residual invalidating cognitive deficits. We present the results of a study combining both group-level and individual-level analyses of cognitive function using an extensive cognitive test battery that was assessed in 73 patients at 5 time points during their ECT care pathway. Furthermore, we explored the presence of distinct subgroups of patients with a similar cognitive trajectory over time after treatment with ECT using Latent Class Growth Analysis.

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Against the background of missing culturally sensitive mental health care services for refugees, we developed a group intervention (Empowerment) for refugees at level 3 within the stratified Stepped and Collaborative Care Model of the project Mental Health in Refugees and Asylum Seekers (MEHIRA). We aim to evaluate the effectiveness of the Empowerment group intervention with its focus on psychoeducation, stress management, and emotion regulation strategies in a culturally sensitive context for refugees with affective disorders compared to treatment-as-usual (TAU).

At level 3 of the MEHIRA project, 149 refugees and asylum seekers with clinically relevant depressive symptoms were randomized to the Empowerment group intervention or TAU. Treatment comprised 16 therapy sessions conducted over 12 weeks. Effects were measured with the Patient Health Questionnaire-9 (PHQ-9) and the Montgomery–Åsberg Depression Rating Scale (MÅDRS). Further scales included assessed emotional distress, self-efficacy, resilience, and quality of life.

Intention-to-treat analyses show significant cross-level interactions on both self-rated depressive symptoms (PHQ-9; F(1,147) = 13.32, p < 0.001) and clinician-rated depressive symptoms (MÅDRS; F(1,147) = 6.91, p = 0.01), indicating an improvement in depressive symptoms from baseline to post-intervention in the treatment group compared to the control group. The effect sizes for both scales were moderate (d = 0.68, 95% CI 0.21–1.15 for PHQ-9 and d = 0.51, 95% CI 0.04–0.99 for MÅDRS).

In the MEHIRA project comparing an SCCM approach versus TAU, the Empowerment group intervention at level 3 showed effectiveness for refugees with moderately severe depressive symptoms.

The assumption by ICD-11 of Intellectual Disability (ID) as part of the Neurodevelopmental Disorders, named Intellectual Developmental Disorders (IDD), bring more attention of the psychiatric community to this population and the problems they face.

In the field of neurodevelopmental disorders, different diagnosis intersect, since they share symptoms, and some of those symptoms are difficult to define.

At the same time, the difficulty of people with ID to conceptualize and / or express is subjective experience creates another obstacle to clearly identify witch symptoms are present.

We will try to discuss these questions, and offer some references, in order to help mental health professionals to recognize the most common diagnosis in people with ID, and differentiate between them, namely Autism Spectrum Disorder, Attention-Deficit Hyperactivity Disorder, Mood Disorders, and Impulse Control Disorders.

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Evidence suggests that the media plays an important role in shaping public beliefs and attitudes towards mental illness and people with mental illness. On the one hand, holistic and balanced portrayals that focus on treatments and recovery can help reduce stigma and prejudice by increasing knowledge and understanding. On the other hand, sensational and one-dimensional portrayals can create and perpetuate stigmas and stereotypes, which can contribute to prejudice, fear and social exclusion.

Related research indicates that the media can also influence suicidal behaviour. On the one hand, research indicates an increase in suicide mortality following romanticized, sensational and detailed media coverage of a suicide (the Werther effect). On the other hand, emerging research indicates a decrease in suicidal mortality following media coverage focused on suicide prevention, available resources and hopeful narratives (the Papageno effect).

This presentation will discuss an ongoing national action-research project that has been continuously funded since 2010, which aims to decrease inaccurate and stigmatizing coverage, while increasing hopeful and recovery-oriented coverage, in relation to mental illness and suicide. This will include discussion of (i) longitudinal results from a media monitoring project, examining coverage of mental illness from 2010 to the present; (ii) various educational initiatives targeted at journalists and journalism schools during the project; and (iii) an innovative citizen journalism programme aiming to produce alternative positive portrayals.

This presentation will be highly-relevant to people wanting to learn more about media coverage of mental health and suicide, and especially pertinent to people interested in conducting similar research elsewhere.

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Patients with remitted psychosis wish to reduce antipsychotic doses yet facing increased risks of relapse. Examining dose-tapering processes may provide insights to re-evaluate the risk-to-benefit balance. We aimed to depict and subgroup tapering trajectories, and explore factors associated with different dose-reduction patterns.

A 2-year open-label randomized prospective comparative trial from August 2017 to September 2022 in Taiwan. Patients with a history of schizophrenia-related psychotic disorders under stable medications and symptoms were eligible, randomizing a proportion to conduct guided dose reduction. We depicted the trajectories of individual patients and named subgroups based on dose-tapering patterns. Predictors of baseline characteristics for designated subgroups were examined by logistic regression analysis; changes in outcomes were compared by paired t-test.

Fifty-one patients undergoing guided dose reduction, 18 (35.3%) reduced 4 steps consecutively (sequential reducers, SR), 14 (27.5%) reduced 1 to 3 steps (modest reducers, MR), 3 (5.9%) re-escalated to previous level (alert reducers, AR), 7 (13.7%) returned to baseline level (baseline returners, BR), 6 (11.7%) relapsed (failed reducers, FR) and 3 (5.9%) withdrew without relapse (early exits, EE). Patients with a history of relapse assumed a conservative dose-tapering pace; only the SR subgroup exhibited significant improvements in functioning and quality of life while failing to identify variables for predicting who would become SR or FR.

Guided dose reduction comprises dynamic processes with differences between individual trajectories. The proposed naming of dose-tapering patterns/subgroups provides a framework depicting patients undergoing dose-tapering. Longer-term observation and more flexible tapering approaches are anticipated to reveal favorable outcomes.

EPA 2023SP-1290

Objective

In medicine, women are still understudied because they are considered less reliable research subjects than men, due to hormonal changes during the lifespan. Women with ADHD have been even more understudied, while exactly their hormonal mood changes and increased severity of ADHD urgently need our research attention.

Methods

In a selfreport questionnaire study (Dorani 2021) among 209 women with ADHD, hormonal mood changes during the menstrual cycle, after childbirth and during menopausal transition were investigated, and compared with available data from women of the general population, using the same instruments.

Results

The data showed that in every episode of hormonal changes, women with ADHD suffered from a 2-3 fold increase in frequency and severity of mood changes.

Conclusions

This first study points to increased severity of mood changes and probably also ADHD symptoms during episodes of hormonal changes in women with ADHD during the lifespan. During this talk, the findings and their etiological background will be clarified, such as interaction between the sex hormones estrogen and progesteron with dopamine and other neurotransmitters in the brain. Treatment options will be discussed as well.

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Affective disturbances in schizophrenia and bipolar disorder may represent a transdiagnostic etiological process as well as a target of intervention. Hypotheses on similarities and differences in various parameters of affective dynamics (intensity, successive/acute changes, variability, and reactivity to stress) between the two disorders were tested.

Experience sampling method was used to assess dynamics of positive and negative affect, 10 times a day over 6 consecutive days. Patients with schizophrenia (n = 46) and patients with bipolar disorder (n = 46) were compared against age-matched healthy controls (n = 46).

Compared to controls, the schizophrenia group had significantly more intense momentary negative affect, a lower likelihood of acute changes in positive affect, and reduced within-person variability of positive affect. The bipolar disorder group was not significantly different from either the schizophrenia group or the healthy control group on any affect indexes. Within the schizophrenia group, level of depression was associated with weaker reactivity to stress for negative affect. Within the bipolar disorder group, level of depression was associated with lower positive affect.

Patients with schizophrenia endured a more stable and negative affective state than healthy individuals, and were less likely to be uplifted in response to happenings in daily life. There is little evidence that these affective constructs characterize the psychopathology of bipolar disorder; such investigation may have been limited by the heterogeneity within group. Our findings supported the clinical importance of assessing multiple facets of affective dynamics beyond the mean levels of intensity.

Autobiographical memory loss is a common complaint of patients treated with electroconvulsive therapy (ECT). However, reliable measurement of autobiographical memory loss after ECT is still a subject of debate. In the 1990s, the Colombia University Autobiographical Memory Interview (CUAMI) was developed specifically to monitor changes in autobiographical memory during a course of ECT. However, this instrument has been criticized due to the lack of psychometric data. In this talk, we will discuss the experiences of administrators and preliminary results of a study into the psychometric properties of the CUAMI. Is the CUAMI useful to test autobiographical memory after ECT or could it use an upgrade?

B. Isidoor Grant / Research support from: Isidoor Bergfeld works on a clinical trial of DBS for depression sponsored by Boston Scientific (in kind). He also received grants from ZonMw and Amsterdam Brain and Cognition for studies on DBS and ECT

The media portrayal of mental health is relevant in shaping the population’s attitudes towards mental disorders. However, there is little information about the representation of children and adolescent mental health in the Spanish press, especially in the context of the COVID-19 pandemic. The general objective of this study was to analyze the tone and content of Spanish newspaper articles about mental disorders in youth during the COVID-19 pandemic.

We collected media articles from 10 news sources, comprising the digital editions of five online news websites and five printed newspapers over a 6 month period (January 2021-June 2021). These articles were coded for content using a standardized codebook, followed by a qualitative thematic analysis. A total of 205 news items were evaluated.

Results showed that the majority of the news items had an overall positive tone (68.3%), only 5.4% were stigmatizing and only 7.3% were related to violence. However, few articles offered help seeking information (6%), adolescents were rarely quoted (14%) and children were never quoted. Substantial differences are described in terms of age, gender and disorder, with adolescents, males and patients with psychosis or behavioral disorders most associated with stigmatizing content or violence. The thematic analysis led to three emergent themes: (i) violence and victimization; (ii) the COVID-19 pandemic; and (iii) technology and social media. The number of articles that described young people with mental health problems as victims of violence was prominent.

The Spanish media generally does not stigmatize mental health problems in children and adolescents. Furthermore, the COVID-19 pandemic may have promoted more positive discussion about youth mental health. However, there remains some room for improvement, as patients are seldom quoted, very few articles offer help-seeking information, and a narrative of victimization without appropriate discussion of resilience regularly occurs.

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Understanding the neural mechanism underlying the transition from suicidal ideation to action is crucial but remains unclear. To explore this mechanism, we combined resting-state functional connectivity (rsFC) and computational modeling to investigate differences between those who attempted suicide(SA) and those who hold only high levels of suicidal ideation(HSI).

A total of 120 MDD patients were categorized into SA group (n=47) and HSI group (n=73). All participants completed a resting-state functional MRI scan, with three subregions of the insula and the dorsal anterior cingulate cortex (dACC) being chosen as the region of interest (ROI) in seed-to-voxel analyses. Additionally, 86 participants completed the balloon analogue risk task (BART), and a five-parameter Bayesian modeling of BART was estimated.

In the SA group, the FC between the ventral anterior insula (vAI) and the superior/middle frontal gyrus (vAI-SFG, vAI-MFG), as well as the FC between posterior insula (pI) and MFG (pI-MFG), were lower than those in HSI group. The correlation analysis showed a negative correlation between the FC of vAI-SFG and psychological pain avoidance in SA group, whereas a positive correlation in HSI group. Furthermore, the FC of vAI-MFG displayed a negative correlation with loss aversion in SA group, while a positive correlation was found with psychological pain avoidance in HSI group.

In current study, two distinct neural mechanisms were identified in the insula which involving in the progression from suicidal ideation to action. Dysfunction in vAI FCs may gradually stabilize as individuals experience heightened psychological pain, and a shift from positive to negative correlation patterns of vAI-MFC may indicate a transition from state to trait impairment. Additionally, the dysfunction in PI FC may lead to a lowered threshold for suicide by blunting the perception of physical harm.

People with severe mental illness (SMI) die prematurely, mostly due to preventable causes.

To examine multimorbidity and mortality in people living with SMI using linked administrative datasets.

Analysis of linked electronically captured routine hospital administrative data from Northern Ireland (2010–2021). We derived sex-specific age-standardised rates for seven chronic life-limiting physical conditions (chronic kidney disease, malignant neoplasms, diabetes mellitus, chronic obstructive pulmonary disease, chronic heart failure, myocardial infarction, and stroke) and used logistic regression to examine the relationship between SMI, socio-demographic indicators, and comorbid conditions; survival models quantified the relationship between all-cause mortality and SMI.

Analysis was based on 929,412 hospital patients aged 20 years and above, of whom 10,965 (1.3%) recorded a diagnosis of SMI. Higher likelihoods of an SMI diagnosis were associated with living in socially deprived circumstances, urbanicity. SMI patients were more likely to have more comorbid physical conditions than non-SMI patients, and younger at referral to hospital for each condition, than non-SMI patients. Finally, in fully adjusted models, SMI patients had a twofold excess all-cause mortality.

Multiple morbidities associated with SMI can drive excess mortality. While SMI patients are younger at referral to treatment for these life-limiting conditions, their relatively premature death suggests that these conditions are also quite advanced. There is a need for a more aggressive approach to improving the physical health of this population.

The UEMS (or European Union of Medical Specialists) is a non-governmental organisation representing 40 national associations of medical specialists and operating through 43 Specialist Sections. The Psychiatry Section’s purpose is to promote the highest standard of care for people who are affected by mental health problems in Europe through postgraduate training and continuing medical education of psychiatrists. It is responsible for developing the European Training Requirements (ETR) for the Specialty of Psychiatry through an iterative process that involved consulting national psychiatric associations, trainees, patient and carer organisations, EPA and WPA. Because medical education and the practice of psychiatry are continually evolving, it is intended that the ETR will be seen as a living document that will be periodically reviewed and amended.

In 2016, the Section approved an Annex to the competency framework covering learning outcomes of knowledge, skills and professionalism required for the care of refugees and asylum seekers. Last year, the Section undertook a major update and revision of the ETR and these learning outcomes have now been fully incorporated.

In this presentation, I am going to outline the specific requirements related to the care of refugees and asylum seekers. They relate to knowledge of traumatic stress, transcultural psychiatry and health promotion and social inclusion; intercultural communication skills, detailed history taking with reference to the impact of adverse events and psychoeducational skills; and professionalism, including awareness of own world view, respecting culture, ethnic and religious difference.

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