Gene x environment (G×E) interactions, i.e. genetic modulation of the sensitivity to environmental factors and/or environmental control of the gene expression, have not been reliably established regarding aetiology of psychotic disorders. Moreover, recent studies have shown associations between the polygenic risk scores for schizophrenia (PRS-SZ) and some risk factors of psychotic disorders, challenging the traditional gene v. environment dichotomy. In the present article, we studied the role of GxE interaction between psychosocial stressors (childhood trauma, stressful life-events, self-reported discrimination experiences and low social capital) and the PRS-SZ on subclinical psychosis in a population-based sample.

Data were drawn from the EUropean network of national schizophrenia networks studying Gene-Environment Interactions (EU-GEI) study, in which subjects without psychotic disorders were included in six countries. The sample was restricted to European descendant subjects (n = 706). Subclinical dimensions of psychosis (positive, negative, and depressive) were measured by the Community Assessment of Psychic Experiences (CAPE) scale. Associations between the PRS-SZ and the psychosocial stressors were tested. For each dimension, the interactions between genes and environment were assessed using linear models and comparing explained variances of ‘Genetic’ models (solely fitted with PRS-SZ), ‘Environmental’ models (solely fitted with each environmental stressor), ‘Independent’ models (with PRS-SZ and each environmental factor), and ‘Interaction’ models (Independent models plus an interaction term between the PRS-SZ and each environmental factor). Likelihood ration tests (LRT) compared the fit of the different models.

There were no genes-environment associations. PRS-SZ was associated with positive dimensions (β = 0.092, R2 = 7.50%), and most psychosocial stressors were associated with all three subclinical psychotic dimensions (except social capital and positive dimension). Concerning the positive dimension, Independent models fitted better than Environmental and Genetic models. No significant GxE interaction was observed for any dimension.

This study in subjects without psychotic disorders suggests that (i) the aetiological continuum hypothesis could concern particularly the positive dimension of subclinical psychosis, (ii) genetic and environmental factors have independent effects on the level of this positive dimension, (iii) and that interactions between genetic and individual environmental factors could not be identified in this sample.

The COVID-19 pandemic represents a new form of trauma, which is impacting on the mental health of the general population. However, the effects of this new trauma are variable, being mediated by individual factors such as the levels of resilience and the coping strategies.

The aims of the present study are: 1) describe the levels of resilience and the type of coping strategies adopted by the Italian general adult population during the first wave of the pandemic; 2) evaluate the protective role of coping strategies and resilience on the levels of depressive, anxiety and stress symptoms.

An online survey has been developed, which includes several validated self-reported questionnaires for the evaluation of participants’ mental health condition, coping strategies and levels of resilience. The main outcome measure is the Depression Anxiety and Stress Scale-21 (DASS-21).

The finale sample consists of 20,720 participants, more than half reported low levels of resilience, which were not associated with age or gender. The levels of resilience did not differ among the general population, patients with pre-existing mental disorders and those infected by COVID-19. People with low levels of resilience rarely used adaptive coping strategies. The levels of resilience did not have any influence on stress, depressive or anxiety symptoms.

The presence of low levels of resilience in the general population may be the missing link between the pandemic and increasing concerns on mental health problems. This could be important for the development of ad-hoc supportive and preventive psychosocial interventions.

No significant relationships.

Bipolar disorder (BD) is associated to high personal and social burden, impaired social functioning and high levels of disability. Recent studies have showed that relapse rates are significantly reduced in those patients whose families receive psychoeducational interventions. Even though most of available evidences are related to the short-term efficacy of psychoeducational family interventions (PFI). No evidence is available on medium and long-term efficacy.

This study aims to assess the efficacy after one and five years of PFI in BD in terms of: 1) improvement of patients’ symptoms and global functioning; 2) improvement of relatives’ objective and subjective burden and coping strategies.

A multicenter, controlled, outpatient trial has been conducted in BD patients and their key relatives, recruited in 11 Italian mental health centers. Patient’s clinical status, social and personal functioning, burden of illness, and relative’s burden and coping strategies were assessed with specific instruments at baseline, after 1 year and after 5 years.

137 families were recruited, 70 allocated to the experimental intervention. After one year, an increasing positive effect on patients’ clinical status, global functioning and objective and subjective burden was found. Moreover, were observed a reduced number of relapses and of hospitalizations after five years, compared to the control group. A reduction in the levels of family burden and an improvement of their coping strategies were also observed.

Positive effects of the experimental intervention persist over the mid and long-term period. PFI should be provided in mental health centres to patients with BD and their relatives.

No significant relationships.

The sudden changes in daily routine due to the containment measures adopted for facing the COVID-19 pandemic have had an impact on the mental health of the general population. In particular, young adults are exposed to a higher risk compared to the general population to suffer from the consequences of the pandemic, in terms of anger and irritability, depressive symptoms and somatic complaints, insomnia, lack of motivation and loneliness. In particular, loneliness can be particularly pronounced during young adulthood.

This study aimed to describe the levels of loneliness in a sample of Italian young people during the national lockdown in 2020, evaluating clinical and socio-demographic differences and the role of coping strategies and levels of resilience.

A sub-analysis of a sample of adults aged 18-34 years has been drawn on a larger cross-sectional observational national trial (COMET, 2020) in which, among other psychopathological dimensions, the levels of loneliness have been assessed by the UCLA scale short version.

Levels of loneliness were particularly severe in a third of cases (risk factors: unemployment, low income and vulnerability in mental health), in association with depression, anxiety, stress, OCD symptoms, higher rates of suicidal ideation, sleep disturbance and excessive use of Internet. Levels of loneliness tended to increase over time.

Overall, during the Italian COVID-19 lockdown young people have experienced quite high levels of loneliness: this dimension could represent a useful domain to assess in routine clinical practice.

No significant relationships.

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

Response to lithium in patients with bipolar disorder is associated with clinical and transdiagnostic genetic factors. The predictive combination of these variables might help clinicians better predict which patients will respond to lithium treatment.

To use a combination of transdiagnostic genetic and clinical factors to predict lithium response in patients with bipolar disorder.

This study utilised genetic and clinical data (n = 1034) collected as part of the International Consortium on Lithium Genetics (ConLi+Gen) project. Polygenic risk scores (PRS) were computed for schizophrenia and major depressive disorder, and then combined with clinical variables using a cross-validated machine-learning regression approach. Unimodal, multimodal and genetically stratified models were trained and validated using ridge, elastic net and random forest regression on 692 patients with bipolar disorder from ten study sites using leave-site-out cross-validation. All models were then tested on an independent test set of 342 patients. The best performing models were then tested in a classification framework.

The best performing linear model explained 5.1% (P = 0.0001) of variance in lithium response and was composed of clinical variables, PRS variables and interaction terms between them. The best performing non-linear model used only clinical variables and explained 8.1% (P = 0.0001) of variance in lithium response. A priori genomic stratification improved non-linear model performance to 13.7% (P = 0.0001) and improved the binary classification of lithium response. This model stratified patients based on their meta-polygenic loadings for major depressive disorder and schizophrenia and was then trained using clinical data.

Using PRS to first stratify patients genetically and then train machine-learning models with clinical predictors led to large improvements in lithium response prediction. When used with other PRS and biological markers in the future this approach may help inform which patients are most likely to respond to lithium treatment.

Studying phenotypic and genetic characteristics of age at onset (AAO) and polarity at onset (PAO) in bipolar disorder can provide new insights into disease pathology and facilitate the development of screening tools.

To examine the genetic architecture of AAO and PAO and their association with bipolar disorder disease characteristics.

Genome-wide association studies (GWASs) and polygenic score (PGS) analyses of AAO (n = 12 977) and PAO (n = 6773) were conducted in patients with bipolar disorder from 34 cohorts and a replication sample (n = 2237). The association of onset with disease characteristics was investigated in two of these cohorts.

Earlier AAO was associated with a higher probability of psychotic symptoms, suicidality, lower educational attainment, not living together and fewer episodes. Depressive onset correlated with suicidality and manic onset correlated with delusions and manic episodes. Systematic differences in AAO between cohorts and continents of origin were observed. This was also reflected in single-nucleotide variant-based heritability estimates, with higher heritabilities for stricter onset definitions. Increased PGS for autism spectrum disorder (β = −0.34 years, s.e. = 0.08), major depression (β = −0.34 years, s.e. = 0.08), schizophrenia (β = −0.39 years, s.e. = 0.08), and educational attainment (β = −0.31 years, s.e. = 0.08) were associated with an earlier AAO. The AAO GWAS identified one significant locus, but this finding did not replicate. Neither GWAS nor PGS analyses yielded significant associations with PAO.

AAO and PAO are associated with indicators of bipolar disorder severity. Individuals with an earlier onset show an increased polygenic liability for a broad spectrum of psychiatric traits. Systematic differences in AAO across cohorts, continents and phenotype definitions introduce significant heterogeneity, affecting analyses.

It is not known with certainty how different phenotypes are transmitted in groups of families divided into three generations.

Having meticulously searched for terms of psychopathogic lexicon that best translated the sterile categorical diagnosis, we obtained three dimensional groups for all six families in the three generations.

We calculated the frequencies and percentages of the three dimensional groups for the three generations of families based on sex.

The chi-square TEST attests a p-value = 0.049, statistically significant for the dimensional group “A”. (Tab. 3)

The genetics, and above all the epigenetics, of the phenotypes are periodically transmitted in group “A” and group “C” in the female and male sex. (Graphs 2.1.1 and 2.3.1) Different phenotypes indicate that the complexity of the interactions of the regulatory mechanisms of genes with the environment is extremely significant for the group with the most severe psychiatric pathology.

Severe mental disorders (SMD) are associated with higher morbidity rates and poorer health outcomes compared to the general population. They are more likely to be overweight, to be affected by cardiovascular diseases, and to have higher risk factors for chronic diseases.

To assess physical health in a sample of patients with SMD and to investigate which mental health-related factors and other psychosocial outcomes could be considered predictors of poor physical health.

Patients referring to the psychiatric outpatients unit of the University of Campania “L. Vanvitelli” were recruited, and were assessed through validated assessment instruments exploring psychopathological status, global functioning and stigma. Physical health was assessed with an ad-hoc anthropometric schedule. A blood sample has been collected to assess levels of cholesterol, blood glucose, triglycerides, and blood insulin.

75 patients have been recruited, with a mean age of 45.63±11.84 years. 30% of the sample had a diagnosis of psychosis, 27% of depression and 43% of bipolar disorder. A higher BMI is predicted by higher number of hospitalizations, a reduced score at MANSA (p<.000), and PSP (p<.05), and higher score at ISMI and BPRS (p<.05). A higher cardiovascular risk is predicted by a reduced MANSA score (p<.000), a higher ISMI score and a poorer adherence to pharmacological treatments (p<.05). Higher ISMI score (p<.0001) and number of hospitalizations (p<.05) are predictors of insulin-resistance.

Our study shows that psychosocial domains negatively influence physical health outcome. It is necessary to disseminate an integrated psychosocial intervention in order to improve patients’ physical health.

No significant relationships.

Antidepressants in older people have experienced their increase in medical prescriptions in recent decades whit comorbidity with other pathologies and drug polytherapies. With the use of antidepressants, can be observed side and unwanted effects (e.g. emotional blunting). Vortioxetine is a new antidepressant agent which promises fewer side effects.

To evaluate the clinical efficacy, safety, side effects (e.g emotional blunting) and cognitive profile

45 elderly patients affected by MDD (DSM-5) were recruited in our observational study. All patients were treated with vortioxetine for 12 months. Physiological and pathological parameters were collected at baseline (T0), after 3 months (T1), 6 months (T2); 12 months (T3). All patients were administered the following scales: GDS; MMSE; QLi; ODQ. The statistical data were processed with EZAnalyze.

33.33% of patients had a score in the “unlikely depression” GDS group. The ANOVA ODQ “Total” results indicate that at least two of the repeated measures differ significantly. Data of the “antidepressant as cause” dimension are interesting [T0 vs T3 (P-Unadjusted .000; P-Bonferroni .000; T-value 5.687. MMSE scores are indicative of one small but not significant difference. Mean QLIndex scores did not show statistically significant changes, but are indicative of positive changes from the baseline score

Vortioxetine resulted in partial reduction of depression. There was a moderate non-statistically significant increase in body weight, glycidic and lipid profiles. Overall data highlight the importance and role that vortioxetine can have in the management of depressive symptoms in elderly subjects. The handling, effectiveness and reduced side effects of the molecule are emphasized.

Panic disorder is among the most prevalent anxiety diseases. Although psychotherapy is recommended as first-line treatment for panic disorder, little is known about the relative efficacy of different types of psychotherapies.

To evaluate the effectiveness and acceptability of different types of psychotherapies for adults suffering from panic disorder, with or without agoraphobia.

We are conducting a systematic network meta-analysis of randomized controlled trials examining panic disorder. A comprehensive search was performed to identify relevant studies. The primary efficacy outcome is anxiety symptoms at study endpoint. The primary acceptability outcome is all-cause trial discontinuation at endpoint. Pairwise and network meta-analysis will be conducted. We are considering any kind of psychotherapy delivered by any therapist, as long as they were trained to deliver the therapy, or as self-help.

To date we have identified 126 panic disorder and agoraphobia trials. The publication time span ranges from 1968 to 2020. We are now extracting data to provide an overview of the included study characteristics. The statistical analysis will be conducted between December 2020 and January 2021, and its results presented for the first time at the forthcoming 2021 EPA congress.

126 trials on psychotherapy for panic disorders in adults are available. Because of this huge body of knowledge, it is important that the results of these studies are summarized using network meta-analytic techniques. The findings of this study will guide future research as knowledge gaps will be easily identified. Moreover, policymakers will have the opportunity to use this summarized knowledge to inform evidence-based decision making.

No significant relationships.

Eating Disorders are a frequent pathology, particularly among teenagers, a group characterized by its vulnerability and body dissatisfaction. Social networks (SN) can be a gateway to ED, mainly with Pro-Ana and Pro-Mia resources. Despite the aforementioned, SN can also be helpful for professionals, either as a tool of approach to vulnerable groups or as a way of interaction in patients already diagnosed.

To study the relationship between ED and SN, using the open access evidence available in Pubmed over the last 5 years.

A single-phase computerised search was carried out in Pubmed. The search terms were: (“Anorexia Nervosa”[Mesh] OR “Bulimia Nervosa”[Mesh] OR “Feeding and Eating Disorders”[Mesh] OR “Eating Disorders”[Tiab] OR “Eating Disorder”[Tiab] OR “Disorder, Eating”[Tiab] OR “Disorders, Eating”[Tiab] OR “Anorexia”[Tiab] OR “Bulimia”[Tiab]) AND (“blogging”[Mesh] OR “social media”[Mesh]). The filters applied were: “free Full Text” and publications for the last 5 years.

36.84% studied SN as a positive tool for ED. 47.37% revealed negative influence, only 44.44% focused on Pro-Ana and Pro-Mia. 15.79% provided both positive and negative arguments. The most studied SN were Twitter and Facebook.

Despite the known negative effect that SN can have on ED, they can also be used as a supportive recovery framework. They can be used to identify dangerous behaviours and intervene or as a prevention tool.

No significant relationships.

Bipolar disorder (BD) is one of the most burdensome psychiatric illnesses, being associated with a negative long-term outcome and high suicide rate. Although affective temperaments are considered possible mediators of outcome, their role on the course and outcome of BD remains poorly studied.

The aims of the present study are to describe the clinical characteristics of patients with BD more frequently associated with the different affective temperaments and to verify which affective temperaments are associated with a more severe clinical picture in a sample of patients with BD.

All patients with BD referring to the outpatient units of two Italian university sites have been recruited. Patients’ psychiatric symptoms, affective temperaments, and quality of life were investigated through validated assessment instruments.

199 patients were recruited. 54.8% of patients had a diagnosis of bipolar I disorder. 56.8% of the sample reported at least one episode of aggressive behaviours and 30.2% of suicidal attempt. Predominant cyclothymic and irritable temperaments predicted more frequent relapses, a poorer quality of life (p<;0.05), more aggressive behaviours and suicide attempts (p<;0.01). The predominant hyperthymic disposition was a protective factor for several outcome measures, including relapses and suicidality (p<;0.01), and was correlated with a less severity of psychiatric symptoms and later age at onset (p<;0.05).

Early identification of affective temperaments in BD patients can help clinicians to identify those who could show a worse prognosis. A screening of affective temperaments can be useful to develop early targeted integrated pharmacological and psychosocial interventions.

No significant relationships.

Suicide is one of the major public health concerns worldwide, currently listed as the 15th most common cause of death. Mental illness stigma may contribute to suicidality and is associated with social isolation and low self-esteem among people with affective disorders.

The aim of the present study is to assess, in a sample of people with affective disorders, whether high levels of internalized stigma are associated to suicidal thoughts and behaviours.

60 outpatients diagnosed with depression or bipolar disorder according to DSM-5 have been recruited. Suicidal behaviours and ideation were assessed through the Columbia Suicide Severity Rating Scale (C-SSRS); internalized stigma through the Internalized Stigma of Mental Illness (ISMI) scale. Socio-demographic characteristics have been collected through an ad hoc schedule.

62.9% of the sample was female, with a mean age of 45.7 (±14) years. About half of the sample had a diagnosis of major depression (54.8%). Patients with suicidal ideation reported higher score at ISMI “alienation” subscale (p<0,05), compared to those without suicidal ideation. Patients with a previous history suicide attempts reported higher score at “alienation” and “social withdrawal” ISMI subscales (p<0,05). Moreover, “alienation” ISMI subscale significantly correlated with suicidal ideation and behaviours (p<0,01).

These results are in line with the available literature, highlighting that stigma and suicidality are strongly correlated. This underline the importance of interventions at addressing internalizing stigma, in particular to those with previous suicidal attempts and with an active suicidal ideation.

No significant relationships.

INTRODUCTION TikTok is a social network (SN) that allows users to share short videos about different issues. Since the COVID-19 lockdown, there has been an increase in Pro-Ana and Pro-Mia videos in this specific SN.

OBJECTIVES To know the main characteristics about Pro-Ana and Pro-Mia contents among TikTok users.

METHODS A search was carried out using uncontrolled language with the term “TCA” (ED in English). The study included only Pro-Ana and Pro-Mia resources in Spanish. Resources under the category “recovery” were excluded. A random sample of 16 TikTok was used, since it is enough to estimate, with a confidence of 95% and an accuracy of +/- 20 percentage units, a population percentage that is expected to be around 20%. The studied variables were images, type of resources, “challenges” and misspelled words.

RESULTS In the sample, 68.75% of the profiles were created upon confinement, 56.25% had more than 500 followers and 68.75% had more than 3000 “likes”. 43.75% included more than 30% of ED advocacy content, 18.75% promoted challenges and 37.5% used misspelled words to avoid SN censorship.

CONCLUSIONS There has been a remarkable increase in ED-related content as a result of lockdown. In turn, the increasing number of users who are part of TikTok reveals that this is a SN that can be associated with ED advocacy.

No significant relationships.