The European Psychiatric Association (EPA) Summer School allows psychiatric trainees and early career psychiatrists (ECPs) from all over Europe to meet, network, and learn together. After the 2020 edition being cancelled due to COVID-19, the 10th edition in 2021 focused for the first time on research and was conducted remotely.

To provide an overview and feedback about the first Virtual EPA Research Summer School as a new way to encourage international networking during COVID-19.

The School was organized by the EPA Secretary for Education, and 4 Faculty members. It started with a “breaking the ice session” one week before and then a two-days meeting on 23-24 September 2021 using an online video-platform. This was preceded by all the 21 participants (from 18 different countries) recording a short 4-minute video presentation, which was uploaded and shared with other participants and Faculty.

Participants were divided on a voluntary basis into three working groups: 1) “Drug repurposing: overcoming challenges in pharmacoepidemiology” 2) “Psychopathological research in psychiatry”; 3) “How to conduct a cross-sectional survey?”. The Summer School program was composed of plenary sessions with lectures by the Faculty members, discussion sessions, and working groups time. At the end, each group presented a summary of the work done to the rest of the participants.

Although the remote format limits social interactions during the Summer School, overall participants’ high satisfaction and productivity indicate that not only online formats, but also the topic of research might be covered in future editions.

No significant relationships.

Clinical intervention in early stages of psychotic disorders is crucial for the prevention of severe symptomatology trajectories and poor outcomes. Genetic variability is studied as a promising modulator of prognosis, thus novel approaches considering the polygenic nature of these complex phenotypes are required to unravel the mechanisms underlying the early progression of the disorder.

The sample comprised of 233 first-episode psychosis (FEP) subjects with clinical and cognitive data assessed periodically for a 2-year period and 150 matched controls. Polygenic risk scores (PRSs) for schizophrenia, bipolar disorder, depression, education attainment and cognitive performance were used to assess the genetic risk of FEP and to characterize their association with premorbid, baseline and progression of clinical and cognitive status.

Schizophrenia, bipolar disorder and cognitive performance PRSs were associated with an increased risk of FEP [false discovery rate (FDR) ⩽ 0.027]. In FEP patients, increased cognitive PRSs were found for FEP patients with more cognitive reserve (FDR ⩽ 0.037). PRSs reflecting a genetic liability for improved cognition were associated with a better course of symptoms, functionality and working memory (FDR ⩽ 0.039). Moreover, the PRS of depression was associated with a worse trajectory of the executive function and the general cognitive status (FDR ⩽ 0.001).

Our study provides novel evidence of the polygenic bases of psychosis and its clinical manifestation in its first stage. The consistent effect of cognitive PRSs on the early clinical progression suggests that the mechanisms underlying the psychotic episode and its severity could be partially independent.

Longitudinal data on the mental health impact of the coronavirus disease 2019 (Covid-19) pandemic in healthcare workers is limited. We estimated prevalence, incidence and persistence of probable mental disorders in a cohort of Spanish healthcare workers (Covid-19 waves 1 and 2) -and identified associated risk factors.

8996 healthcare workers evaluated on 5 May–7 September 2020 (baseline) were invited to a second web-based survey (October–December 2020). Major depressive disorder (PHQ-8 ≥ 10), generalised anxiety disorder (GAD-7 ≥ 10), panic attacks, post-traumatic stress disorder (PCL-5 ≥ 7), and alcohol use disorder (CAGE-AID ≥ 2) were assessed. Distal (pre-pandemic) and proximal (pandemic) risk factors were included. We estimated the incidence of probable mental disorders (among those without disorders at baseline) and persistence (among those with disorders at baseline). Logistic regression of individual-level [odds ratios (OR)] and population-level (population attributable risk proportions) associations were estimated, adjusting by all distal risk factors, health care centre and time of baseline interview.

4809 healthcare workers participated at four months follow-up (cooperation rate = 65.7%; mean = 120 days s.d. = 22 days from baseline assessment). Follow-up prevalence of any disorder was 41.5%, (v. 45.4% at baseline, p < 0.001); incidence, 19.7% (s.e. = 1.6) and persistence, 67.7% (s.e. = 2.3). Proximal factors showing significant bivariate-adjusted associations with incidence included: work-related factors [prioritising Covid-19 patients (OR = 1.62)], stress factors [personal health-related stress (OR = 1.61)], interpersonal stress (OR = 1.53) and financial factors [significant income loss (OR = 1.37)]. Risk factors associated with persistence were largely similar.

Our study indicates that the prevalence of probable mental disorders among Spanish healthcare workers during the second wave of the Covid-19 pandemic was similarly high to that after the first wave. This was in good part due to the persistence of mental disorders detected at the baseline, but with a relevant incidence of about 1 in 5 of HCWs without mental disorders during the first wave of the Covid-19 pandemic. Health-related factors, work-related factors and interpersonal stress are important risks of persistence of mental disorders and of incidence of mental disorders. Adequately addressing these factors might have prevented a considerable amount of mental health impact of the pandemic among this vulnerable population. Addressing health-related stress, work-related factors and interpersonal stress might reduce the prevalence of these disorders substantially. Study registration number: NCT04556565

Parents who receive a diagnosis of a severe, life-threatening CHD for their foetus or neonate face a complex and stressful decision between termination, palliative care, or surgery. Understanding how parents make this initial treatment decision is critical for developing interventions to improve counselling for these families.

We conducted focus groups in four academic medical centres across the United States of America with a purposive sample of parents who chose termination, palliative care, or surgery for their foetus or neonate diagnosed with severe CHD.

Ten focus groups were conducted with 56 parents (Mage = 34 years; 80% female; 89% White). Results were constructed around three domains: decision-making approaches; values and beliefs; and decision-making challenges. Parents discussed varying approaches to making the decision, ranging from relying on their “gut feeling” to desiring statistics and probabilities. Religious and spiritual beliefs often guided the decision to not terminate the pregnancy. Quality of life was an important consideration, including how each option would impact the child (e.g., pain or discomfort, cognitive and physical abilities) and their family (e.g., care for other children, marriage, and career). Parents reported inconsistent communication of options by clinicians and challenges related to time constraints for making a decision and difficulty in processing information when distressed.

This study offers important insights that can be used to design interventions to improve decision support and family-centred care in clinical practice.

Oxidative stress suposses an imbalance between oxidants and antioxidants molecules. Negative and positive family environment have been related with worse and better outcomes respectively in schizophrenic patients.

Our objetive is to determine antioxidant defense in healthy controls and unaffected relatives of early onset psychosis patients and to asses its relationship with familiar environment.

We included 82 healthy controls (HC) and 14 healthy controls with second degree family history of psychosis (HCWFHP), aged between 9 to 17.

Total antioxidant status and lipid peroxidation test were determined in plasma and antioxidant enzime activities and glutathione levels were determined in erytrocytes.

We used the Global Assesment Functioning scale (GAF) and the Family Environment Scale (FES). The FES is made up of ten subscales: cohesion, expressiveness, conflict, independence, achievement, intellectual-cultural, social, moral, organization and control.

The analyses showed a significant decrease in total antioxidant level in HCWFHP compared with the HC (U Mann Withney = 281.00, p=0.009, effect size= -0.78).

HC and HCWFHP did not differ in the GAF scale, nevertheless the scores of HCWFHP were significantly higher in cohesion and intellectual-cultural dimensions of the FES (p=0.007, p=0.025).

Adjusting by this two FES dimensions, antioxidant status remained significantly different between groups: OR= 10.86, p=0.009.

Although we cannot induce causative relations, we can state that family environment is not playing a role in inducing oxidative stress in these subjects. It could be hypothesized that families with affected relatives protect themselves with positive envionmental factors such as cohesion and intellectual-cultural activities.

Allelic variation in the promoter region of the serotonin transporter (5-HTTpro) contributes for the risk of alcohol dependence (AD). The short allele (S) of this polymorphism has been associated with co-occurring clinical features in severe AD such as depression, early onset or impulsivity. We studied the putative link between this allele and relapse in AD.

60 male alcohol dependent patients were followed for 3 months after withdrawal. Persistent abnormalities in lab tests (GGT and CDT) or failure to show up at scheduled interviews were considered as relapse. PCR amplifying the 5-HTTpro polymorphism from genomic DNA were performed. The impact of the S allele on relapse was assessed by a non-parametric Pearson χ2 test.

67.27 % of the patients relapsed during follow-up. The S allele of the 5-HTTpro was significantly associated with relapse (χ2 = 7.66 ; p < .006) while no other factor influenced relapse.

Responsible for a 5-HT hypo-functioning, the S allele of the 5-HTTpro may be associated with relapse in abstinent alcohol dependent patients, possibly through intermediate phenotypes such as personality features or lack of behavioral inhibition.

Patients with schizophrenia and bipolar disorder appear to have more difficulties with smoking cessation than the general population. Moreover, gender and unsuccessful smoking cessation are associated with depression and negative emotional experience. Less attention has been given to the association of cigarette smoking in women and the use of other substances.

To determine the influence of gender and substance abuse on smoking cessation in a long-term follow up after a first psychotic episode.

Patients were evaluated at years 1, 3, and 5 obtaining information about functional outcome, positive and negative symptoms and substance use. At 8th year, functional outcome and use of substance were recorded. Patients were classified in two groups: those who stopped smoking during follow-up, and those who did not stop.

At baseline, rates of tobacco smoking were high with no differences between genders. Difficulty with smoking cessation was associated with female (p = 0.017) and typical antipsychotics (p = 0.032). Those who used alcohol continuously were less likely to stop smoking (p = 0.050) controlling for typical antipsychotics. The interaction with gender was not significant. Continuous cannabis use was not associated with smoking cessation, but women who use cannabis continuously were less able to stop smoking than men (adjusted p = 0.036).

Women are less prone to quit smoking than men during long-term follow-up after the development of psychosis. Different treatments should be considered for men and women in relation to tobacco dependence in patients with psychotic disorder. Treatment for women smokers should probably be more supportive and intensive.

Cloninger's type II is a severe, early-onset, male-limited, genetically influenced, impulsive form of alcoholism. We assessed the association of two gene polymorphisms (TaqI A DRD2 and 5-HTTpro) with Cloninger's typology, as defined by age at onset of alcohol-related problems, and family history of alcohol abuse, which is thought to be more frequent in type II alcoholics.

58 male alcohol dependent patients were discriminated according to age at onset of alcohol-related problems and interviewed about family history of alcoholism. Genomic DNA was extracted and PCR amplifying the studied polymorphisms were performed. The associations between DRD2 (A1 or A2 alleles), 5-HTTpro (L and S alleles), family history and typology were assessed by Pearson chi2 analyses.

While typology was not influenced by any of the studied polymorphisms, a higher rate of general family history of alcohol abuse was still observed in type II patients (χ2= 4.53; p = 0.033). Furthermore, the A1 allele of the DRD2 was significantly associated with paternal history of alcoholism (χ2= 4.66; p = 0.031) and male, first-degree, collateral history of alcoholism (χ2= 4.40; p = 0.036).

Age at onset as main discriminator between type I and type II does not seem to be influenced by TaqI A DRD2 and 5-5HTTpro polymorphisms. However, the A1 allele of the DRD2 may be a marker of male familial alcoholism, which is in line with previous studies showing association between TaqI A DRD2 with some clinical features of type II alcoholism.

The management of treatment-resistant depression remains a major public health problem. Several acute depression trials suggest that only 45% of the patients achieve remission state with antidepressant monotherapy. An increasing body of evidence is emerging suggesting that multi-action antidepressants might be more effective in treatment-resistant depressed patients than single-action agents. In this context, the purpose of the study was to assess the effectiveness of duloxetine in treatment-resistant major depressed outpatients.

We performed a prospective study assessing the efficacy of duloxetine in major depressed outpatients who did not achieve full symptom remission (CGI-S (severity) ≥ 3) after treatment of adequate dose and duration (more than 8 weeks) with at least either one SSRI or the SNRI venlafaxine. We excluded patients with a severe medical illness and a personality disorder. CGI-S was used as a measure of symptom severity and administered before the administration of duloxetine and 6 weeks later. Five patients had been treated with venlafaxine and the others with a SSRI (Fluoxetine, Paroxetine, Citalopram).

The sample included 10 patients (3 M, 7 F). We observed a very significant decrease in CGI-S scores (5 ± 0.45 to 1.2 ± 0.63, p < 0.0001) after treatment with duloxetine (dose between 20 and 60 mg). Remission was achieved in 90% of the patients. The tolerance was excellent.

This study suggests the potential interest of duloxetine in treatment-resistant depressed patients.

Resilience enables people to develop and regain mental health in the face of adversity, and is related to recovery. There are no current measures of resilience for Bipolar Disorder (BD).

To develop and validate a BD specific resilience measure, and examine relationships between resilience and recovery-related variables.

(1) Describe the development and psychometric evaluation of the Spanish 23-item Resilience to Bipolar Disorder (RBD) questionnaire. (2) Test relationships between RBD scores and recovery-related variables in BD.

The 41-item RBD questionnaire (developed based on prior qualitative research) was completed by 113 participants with BD, along with measures related to quality of life, functioning and recovery. Exploratory Factor Analysis (EFA) using Principal Axis Factoring with promax rotation was conducted to identify redundant items and underlying factors. Reliability and Confirmatory Factor Analysis (CFA) for the resulting factorial structure were assessed.

EFA identified 23RBD items suitable for retention, structured within five factors. Cronbach αs were all satisfactory (all αs ≥ .76) at both subscale and total score level. Convergent validity was supported through positive correlations between RBDand the Resilience Scale-25. Additionally, the RBD correlated significantlywith quality of life, well-being, personal recovery, functional impairment and symptoms. CFA fit indexes supported the five factor structure of the RBD scale.

TheRBD is a reliable and valid measure of resilience in BD, being associated with measures related to quality of life, functioning and recovery, which is consistent with previous research in resilience and mental health in other psychiatric populations.

Two common approaches to identify subgroups of patients with bipolar disorder are clustering methodology (mixture analysis) based on the age of onset, and a birth cohort analysis. This study investigates if a birth cohort effect will influence the results of clustering on the age of onset, using a large, international database.

The database includes 4037 patients with a diagnosis of bipolar I disorder, previously collected at 36 collection sites in 23 countries. Generalized estimating equations (GEE) were used to adjust the data for country median age, and in some models, birth cohort. Model-based clustering (mixture analysis) was then performed on the age of onset data using the residuals. Clinical variables in subgroups were compared.

There was a strong birth cohort effect. Without adjusting for the birth cohort, three subgroups were found by clustering. After adjusting for the birth cohort or when considering only those born after 1959, two subgroups were found. With results of either two or three subgroups, the youngest subgroup was more likely to have a family history of mood disorders and a first episode with depressed polarity. However, without adjusting for birth cohort (three subgroups), family history and polarity of the first episode could not be distinguished between the middle and oldest subgroups.

These results using international data confirm prior findings using single country data, that there are subgroups of bipolar I disorder based on the age of onset, and that there is a birth cohort effect. Including the birth cohort adjustment altered the number and characteristics of subgroups detected when clustering by age of onset. Further investigation is needed to determine if combining both approaches will identify subgroups that are more useful for research.

Migration of mental health professionals is an important phenomenon influencing mental health services of host and donor countries. Data on medical migration in Europe is very limited, particularly in the field of young doctors and psychiatry. To research this hot topic, the European Federation of Psychiatric Trainees (EFPT) conducted the EFPT Brain Drain Survey.

To identify the impact of previous short-term mobility on international migration and to understand characteristics, patterns and reasons of migration.

In this cross-sectional European multicentre study, data were collected from 2281 psychiatric trainees across 33 countries. All participants answered to the EFPT Brain Drain Survey reporting their attitudes and experiences on migration.

Two-thirds of the trainees had not had a short-mobility experience in their lifetime, but those that went abroad were satisfied with their experiences, reporting that these influenced their attitude towards migration positively. However, the majority of the trainees had not had a migratory experience of more than 1 year. Flows showed that Switzerland and United Kingdom have the greatest number of immigrant trainees, whereas Germany and Greece have the greatest number of trainees leaving. ‘'Pull factors'’ were mostly academic and personal reasons, whereas ‘'push factors'’ were mainly: academic and financial reasons. Trainees that wanted to leave the country were significantly more dissatisfied with their income.

The majority of the trainees has considered leaving the country they currently lived in, but a lower percentage has taken steps towards migration.

A functional polymorphism of the brain-derived neurotrophic factor gene (BDNF) Val66Met has been associated with cognitive function and symptom severity in patients with schizophrenia. It has been suggested that the Val66Met polymorphism has a role as a modulator in a range of clinical features of the illness, including symptoms severity, therapeutic responsiveness, age of onset, brain morphology and cognitive function. However, little work has been done in first-episode schizophrenia (FES) spectrum disorders. The objective of this study is to investigate the association of the BDNF Val66Met polymorphism on cognitive function and clinical symptomatology in FES patients.

Using a cross-sectional design in a cohort of 204 patients with FES or a schizophrenia spectrum disorder and 204 healthy matched controls, we performed BDNF Val66Met genotyping and tested its relationship with cognitive testing (attention, working memory, learning/verbal memory and reasoning/problem-solving) and assessment of clinical symptom severity.

There was no significant influence of the BDNF allele frequency on cognitive factor scores in either patients or controls. An augmented severity of negative symptoms was found in FES patients that carried the Met allele.

The results of this study suggest that in patients with a first-episode of schizophrenia or a schizophrenia spectrum disorder, the BDNF Val66Met polymorphism does not exert an influence on cognitive functioning, but is associated with negative symptoms severity. BDNF may serve as suitable marker of negative symptomatology severity in FES patients within the schizophrenia spectrum.

The authors have not supplied their declaration of competing interest.