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.

Cognitive behavioural therapy for psychosis as an adjuvant to pharmacological treatment has been been shown to be one of the most effective interventions for schizophrenia with benefits noted in even treatment resistant schizophrenia. Benefits have been mostly registered in the positive symptoms domain of schizophrenia. Acceptance and commitment therapy is a third generation Cognitive-Behavioural Therapy, empirically supported for a range of symptoms and conditions, including psychosis, with quickly increasing data. It targets experiential avoidance, which seems to be closely related with psychopathology. Its ability to also target affective symptoms can be an important advantage in the adjuvant treatment of psychosis.

To critically review the evidence of acceptance and commitment therapy in psychosis.

Non-systematic review of the literature with selection of scientific articles published in the past 10 years; by searching Pubmed and Medscape databases using the combination of MeSH descriptors. The following MeSH terms were used: “schizophrenia”, “acceptance and commitment therapy”.

Very few studies have been published on ACT and psychosis, with even less controlled trials and systematic reviews. So far there is convincing evidence for ACT reducing the frequency of hallucinations, increasing the outcomes of traumatic events associated with psychosis and having measurable effects on anxiety and help seeking behaviour.

As Acceptance and Commitment therapy evolves and more evidence arises a new kind of therapy with possible effects on both affective and positive symptoms in schizophrenia can emerge, allowing us to know what works for patients with psychosis and through what mechanisms and permitting the improvement of treatment strategies.

No significant relationships.

Nowadays we know that autism spectrum disorders (ASD) and Schizophrenic spectrum (SS) are different types of disorders in their etiology, symptoms and prognosis, but the clinical distinction is often difficult to make due to comorbidity and similar symptoms.

With this project, the authors intend to explore the differential diagnosis between ASD and SS specially when we talk about critical ages of onset.

An analysis of articles searched on Pubmed (articles between 2010-2020) with the key words “adult autism”, “childhood onset schizophrenia”, “childhood psychosis”.

Early-onset schizophrenia (EOS) is defined as occurring before age 18 years. The condition share key diagnostic symptoms with adult-onset schizophrenia (AOS) but his prognoses and comorbidities differ. Autism spectrum disorder (ASD) is a common neurodevelopmental disorder characterized by difficulties since early childhood across reciprocal social communication and restricted interests and behaviors. ASD is a lifelong neurodevelopmental disorder, however there is a lack of answers and research for adults with ASD. There are shared aspects of odd thinking, rigid behaviors and impaired socialization in schizophrenia and ASD and COS seems to have a strong relationship with ASD, being comorbid in up to 50% of cases.

Usually the evaluation of the developmental history of the person, prodrome and onset, its course and the presence of positive symptoms of schizophrenia is enough to help us find a diagnosis. Unfortunately, in some ages the conclusion is not so easy to find. However is essential to determine whether the clinical manifestations belong to the autistic spectrum, the schizophrenic or result from comorbidity.

The study objective is to propose bioelectrical impedance vector analysis (BIVA) ellipses for the population and investigate its use to assess nutritional status through the BMI/age ratio and the cardiovascular risk through waist circumference (WC).

Age, weight, height and WC were recorded, along with the values of resistance (R), reactance (Xc) and phase angle (PA) by impedance. Student’s t test and ANOVA were applied to ascertain the significance between means and a specific programme was applied to investigate the significance between ellipses.

Fortaleza, Brazil.

A total of 467 students from public schools participated in the study: 120 children and 347 adolescents were evaluated, with respective means of age, weight and height of 8·2 years, 27·6 kg and 1·29 m and 12·7 years, 48·6 kg and 1·53 m, respectively.

The mean values of R/H, Xc/H and PA were 569·0 and 424·7 Ohm/m, 59·1 and 50·4 Ohm/m, and 5·9º and 6·8º for children and adolescents, respectively. The mean vectors for R/H and Xc/H show significant differences between for both age ranges and are inversely proportional to the BMI/A. As for WC, individuals without cardiovascular risk had higher R/H and lower Xc/H, but Xc and R in participants without cardiovascular risk were greater than with cardiovascular risk.

It was possible to propose confidence and tolerance BIVA ellipses for children and adolescent’s clinical evaluation. The method was also suitable to identify cardiovascular risk ellipses in these age groups, but it was not possible to draw nutritional classifications ellipses by BMI/age data.

Tympanostomy is one of the most commonly performed surgical procedures in otolaryngology, and its complexity is challenging for trainee surgeons. Investing in medical education is a cornerstone of good patient safety practices. For trainees, use of simulators before operating on actual patients helps mitigate risks. This study aimed to develop a three-dimensional printed model simulator for myringotomy, tympanostomy and ventilation tube placement.

An articulated model with a detachable portion, base and plastic bag to simulate the external auditory canal, middle ear and tympanic membrane, respectively, was modelled and printed.

The final simulator was made from acrylonitrile butadiene styrene polymer and measured 4 × 4 × 12 cm. It was designed to mimic the angulation of patient anatomy in the myringotomy position and simulate the texture and colour of the tissues of interest. The cost was low, and testing with an operating microscope and endoscope yielded satisfactory results. The advent of three-dimensional printing technology has made surgical simulation more accessible and less expensive, providing several advantages for medical education.

The proposed model fulfilled expectations as a safe, inexpensive, reproducible, user-friendly and accessible surgical education tool that can be improved and reassessed for further research.

Childhood trauma (CT) increases the risk of adult depression. Buffering effects require an understanding of the underlying persistent risk pathways. This study examined whether daily psychological stress processes – how an individual interprets and affectively responds to minor everyday events – mediate the effect of CT on adult depressive symptoms.

Middle-aged women (N = 183) reported CT at baseline and completed daily diaries of threat appraisals and negative evening affect for 7 days at baseline, 9, and 18 months. Depressive symptoms were measured across the 1.5-year period. Mediation was examined using multilevel structural equation modeling.

Reported CT predicted greater depressive symptoms over the 1.5-year time period (estimate = 0.27, s.e. = 0.07, 95% CI 0.15–0.38, p < 0.001). Daily threat appraisals and negative affect mediated the effect of reported CT on depressive symptoms (estimate = 0.34, s.e. = 0.08, 95% CI 0.22–0.46, p < 0.001). Daily threat appraisals explained more than half of this effect (estimate = 0.19, s.e. = 0.07, 95% CI 0.08–0.30, p = 0.004). Post hoc analyses in individuals who reported at least moderate severity of CT showed that lower threat appraisals buffered depressive symptoms. A similar pattern was found in individuals who reported no/low severity of CT.

A reported history of CT acts as a latent vulnerability, exaggerating threat appraisals of everyday events, which trigger greater negative evening affect – processes that have important mental health consequences and may provide malleable intervention targets.

Both psychodynamic group therapy (PGT) and clonazepam are used as treatment strategies in reducing symptoms of generalized social anxiety disorder (GSAD). However, many individuals remain symptomatic after treatment with PGT or clonazepam.

Fifty-eight adult outpatients with a diagnosis of GSAD according to DSM-IV were randomized to 12 weeks PGT plus clonazepam or clonazepam. The Clinical Global Impression-Improvement (CGI-I) Scale was the primary efficacy measure. Secondary efficacy measures included the Liebowitz Social Anxiety Scale (LSAS) total score, the World Health Organization Instrument to Assess Quality of Life—Brief (WHOQOL-Bref) Scale and the Beck Depression Inventory (BDI).

CGI-I data from 57 patients (intent-to-treat population) showed that patients who received PGT plus clonazepam presented significantly greater improvement than those who received clonazepam (P = 0.033). There were no significant differences between the two groups in the secondary efficacy measures.

Our study suggests that the combination of PGT with clonazepam may be a promising strategy for the treatment of GSAD, regarding gains in the global functioning. However the present study failed to detect more specific changes in social anxiety symptomatology between the two groups.

Addiction, depression, anxiety and antisocial personality disorder may share common biological mechanisms and changes in impulsivity may contribute to the characterization of different clinical phenotypes.

Our aim was to identify diagnostic profiles in a sample of inmates in a Portuguese prison.

We examined a sample recruited at Paços de Ferreira Penitentiary Centre (n=89). Diagnosis was performed using the International Neuropsychiatric Interview (MINI). Six Version of Addiction Severity Index – European version (EuropASI) and the Psychopathy Checklist –Revised (PCL-R) were used to assess the severity of drug addiction and the presence of psychopathy.

Drug misuse was found in 61.8% of the studied subjects according to MINI. A high prevalence of psychiatric comorbidity was detected, with antisocial personality disorder (70.9%), depression (30.9%), and anxiety (32.7%) being the most common disorders. The total PCL-R score was 24. 1 (SD 8.8), 36 prisoners presented a diagnosis of psychopathy (PCL-R>30). The presence of depression in addicted individuals is associated with a lower severity of dependence (p <0.05) and lower PCL-R scores (p <0.05). The presence of addiction and depression reduces the risk of violent crime, whereas the presence of psychopathy (PCL-R> 30) increases (OR = 3.87, p <0.05).

Psychiatric disorders and addiction were successfully evaluated. Depression is associated with a lower addiction severity. The different types of psychiatric diagnoses produce a modulation in the frequency of violent crimes. The prevalence of psychiatric comorbidity underscores the advantages of a structured psychiatric assessment in prison inmates in order to provide the best treatment.

Executive functions (EF) are associated to frontal lobes and cognitive decline (CD) with worse results on EF tests.

Analyze if the Frontal Assessment Battery/FAB assessing EF discriminates elders with CD (vs. with no CD; Montreal Cognitive Assessment/MoCA), and if the results obtained with the Rey Osterreith Complex Figure Test/ROCF (copy's quality, immediate, and delayed memory) are associated with the CD presence/absence. Moreover, we wanted to assess if copy's quality and 3 minutes memory test are associated with FAB results, since these two tests are supposedly associated with EF and with frontal lobes assessed by the FAB, contrarily to the 20 minutes memory (supposedly related to the temporal area).

556 institutionalized elders (age: M ± SD =80.2 ± 5.23; range=60-100) filled in voluntarily a sociodemographic questionnaire, ROCF, MoCA and FAB.

FAB and all ROCF tests were associated with the absence/presence of CD. Regarding variables stratified by age and education, FAB was associated with immediate memory but not with copy's quality nor with delayed memory. With no stratified ROCF and FAB, correlations confirmed the previous associations, but also between FAB and copy's quality.

Results follow the literature regarding the association between immediate memory and EF (associated to frontal lobes), in contrast to the long-term memory which is associated with the temporal area and that was not associated with FAB. Results concerning copy's quality (ROCF) are not consensual.

B-vitamin insufficiency is associated with depression but it is uncertain if treatment with these is effective in prevention or treatment.

1. 1. To determine if daily supplementation with B-vitamins enhances response to antidepressants.

2. 2. Systematic review and meta-analysis of randomised, placebo-controlled trials of B-vitamins for depressive symptoms in adults.

1. 1. The B-VITAGE trial is a 52 week randomised, double-blind, placebo-controlled trial of citalopram together with vitamin B12, B6 and folic acid in older adult participants with major depression.

2. 2. Systematic review of 13 eligible trials of B-vitamin supplementation for the reduction, remission and prevention of clinically significant depressive symptoms.

Remission was achieved by 78.1% and 79.4% of participants treated with placebo (n=76) and vitamins (n=77) by week 12 (p=0.328), and by 75.8% and 85.5% at week 52 (effect of intervention over 52 weeks: odds ratio, OR=2.49; 95% confidence interval, 95%CI=1.12,5.51). The risk of subsequent relapse among those who had achieved remission of symptoms at week 12 was lower in the vitamin group (OR=0.33, 95%CI=0.12,0.94).

Short-term use of vitamins did not improve depressive symptoms in adults with major depression treated with antidepressants (standardised mean difference=-0.12, 95% CI=-0.45,0.22), but more prolonged consumption decreased the risk of relapse (OR=0.33, 95%CI=0.12,0.94) and the onset of clinically significant symptoms in people at risk (risk ratio=0.65, 95%CI=0.43,0.98).

Short-term use of B-vitamins does not appear to benefit depressive symptoms although longer use may enhance and sustain antidepressant response and decrease the risk of relapse or onset of clinically significant depression.

The Nova Aurora Community Association psychosocial rehabilitation program was developed based in the most current values of Psychosocial Rehabilitation. Some nuclear assumptions were considered, such as a) suppressing the disease stigma, b) defocusing from the mental ill role, promoting empowerment and self-determination, c) developing personal competencies directly related to the individuals’ social integration specific context (readiness, cognitive, social, emotional stress management, employability).

To present the rational of this program and the outcomes of a pilot study designed to test if this psychiatric rehabilitation program effectively helps persons living with psychiatric disabilities become more successful and satisfied in living, learning, working, and social environments of their choice.

The program is being implemented for 13 months to 38 persons living with psychiatric disabilities and it is developed in 2 main levels: a) tranversal competencies (neurocognitive, stress and illness management, healthy lifestyle, self efficacy and anti-self-stigma); b) specific competencies directly related to the individuals’ social integration specific context (employability/housing, social cognition, etc). All users still frequent an empowerment center and develop sport and leisure activities. It is also available home support and family psicoeducation. The program effectiveness assessment integrated pre and post tests, evaluating all these different functional domains and life quality and program satisfaction.

Preliminary results point towards very positive outcomes, specifically regarding personal competencies development, satisfaction level with the program, reduction of relapse, and absence rates.

Although these results are promising, this research is an initial step in establishing the efficiency of this rehabilitation program.

When cognitive decline (CD) is present, attention is one of the impaired mental functions. CD is also associated with anxious/depressive symptoms and with some demographic variables, particularly, age.

Investigate the associations between selective attention (Stroop Test: Stroop_Word, Stroop_Color, Difference between Stroop_Word and Stroop_Color, Stroop Ratio_Word, Stroop Ratio_Color and Difference between Stroop Ratio_Word and Stroop Ratio_ Color) and CD (Montreal Cognitive Assessment/MoCA) in institutionalized elders; explore the predictive value of Stroop variables for CD, controlling anxious/depressive symptoms and sociodemographic variables.

140 institutionalized elders (mean age, M = 78.4, SD = 7.48, range = 60-97) voluntarily answered to sociodemographic questions, the MoCA, the Geriatric Anxiety Inventory/GAI, the Geriatric Depression Scale/GDS and Stroop test.

73 elders (52, 1%) had CD. Dichotomized MoCA was associated with Stroop_Word, Stroop_Color, Stroop Ratio_Word, Stroop Ratio_Color, GDS and the sociodemographic variable schooling × profession. Age and education were not tested, since MoCA was stratified according to those variables. GDS, Stroop Ratio_Word and Stroop Ratio_Color showed to predict CD.

There was an association between Stroop_Word, Stroop_Color, Stroop Ratio_Word and Stroop Ratio_Color and CD, confirming that selective attention is smaller when the elderly reveal CD. GDS and CD were, also, associated. However, there was no association between MoCA dichotomized and differences between the correct answers (Stroop_Word and Stroop_Color) and Ratios (Stroop Ratio_Word and Stroop Ratio_Color). Selective attention and depressive symptoms predicted CD. It would be important to intervene through cognitive rehabilitation with the elders to improve their attention.

Melancholic features of depression (MFD) seem to be a unidimensional group of signs and symptoms. However, little importance has been given to the evaluation of what features are related to a more severe disorder. That is, what are the MFD that appear only in the most depressed patients. We aim to demonstrate how each MFD is related to the severity of the major depressive disorder.

We evaluated both the Hamilton depression rating scale (HDRS-17) and its 6-item melancholic subscale (HAM-D6) in 291 depressed inpatients using Rasch analysis, which computes the severity of each MFD. Overall measures of model fit were mean ( ± SD) of items and persons residual = 0 (± 1); low χ2 value; P > 0.01.

For the HDRS–17 model fit, mean (± SD) of item residuals = 0.35 (± 1.4); mean (± SD) of person residuals = –0.15 (± 1.09); χ2 = 309.74; P < 0.00001. For the HAM-D6 model fit, mean (± SD) of item residuals = 0.5 (± 0.86); mean (± SD) of person residuals = 0.15 (± 0.91); χ2 = 56.13; P = 0.196. MFD ordered by crescent severity were depressed mood, work and activities, somatic symptoms, psychic anxiety, guilt feelings, and psychomotor retardation.

Depressed mood is less severe, while guilt feelings and psychomotor retardation are more severe MFD in a psychiatric hospitalization. Understanding depression, as a continuum of symptoms can improve the understanding of the disorder and may improve its perspective of treatment.

The authors have not supplied their declaration of competing interest.