Electroconvulsive therapy (ECT) is a psychiatric intervention that has proven effectiveness and safety in various psychiatric conditions, such as major depressive disorder, prolonged or severe manic episodes and catatonia. Despite positive scientific evidence, ECT was always seen as controversial by patients, caregivers, and even some psychiatrists, which lead to a decrease in its use over the years.

To investigate the way young psychiatrists view the place of ECT in modern psychiatry by assessing their knowledge, attitude and access to training opportunities in ECT.

An anonymous survey was disseminated online among early career psychiatrists and psychiatric trainees. The questionnaire consisted of 36 multiple-choice and Likert scale questions.

Most of our respondents consider ECT both an effective and a safe treatment option and would recommend ECT to their patients when indicated. Early career psychiatrists who had access to ECT training are more knowledgeable about the indications, precautions and side effects of this method, but more than half of the participants mentioned ECT training was unavailable during their residency programme. Almost all respondents stated that they are interested in enhancing their theoretical and practical competencies in ECT.

Early career psychiatrists have a positive attitude towards ECT but express the need of targeted education aimed at improving levels of knowledge about ECT.

None Declared

With a history of several decades, electroconvulsive therapy (ECT) has been carefully investigated and data supports its use as a safe and effective treatment for patients with severe depression, prolonged or severe manic episodes and catatonia. However, ECT is still regarded with reluctance by patients and caregivers, and its acceptance and use seem to be controversial even for psychiatrists.

To investigate the access to opportunities of training in ECT among early career psychiatrists and their views regarding the place of ECT in modern psychiatry.

A cross-sectional study was conducted between July and December 2022 utilizing an anonymous online survey consisting of 36 multiple-choice and Likert scale questions.

These preliminary findings show a great discrepancy regarding the availability of ECT training in European countries, as access to specialized ECT centers is unavailable in some areas. Early career psychiatrists who had access to ECT training are more knowledgeable about the indications, precautions and side effects of this method. Most of our respondents consider ECT both an effective and a safe treatment option and have expressed their wish to improve their theoretical and practical competencies in ECT.

ECT is a standard treatment and a therapeutic mainstay in psychiatry but is being less performed in some countries. Early career psychiatrists lack experience with ECT but are interested in training opportunities. Future actions are needed for the improvement of education and training in ECT.

None Declared

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.

The 2021 Research Summer School took place virtually, and 7 psychiatric trainees or early career psychiatrists (ECPs) from 7 different European countries participated in a working group on how to conduct a cross-sectional survey study.

To provide an overview of the process of developing an internationally collaborative protocol during the EPA Virtual Research Summer School.

All participants were asked by the Faculty mentor chairing this working group to write a research question that could be investigated through a cross-sectional survey. After a brainstorming discussion, it was decided to investigate the experiences, knowledge, and attitudes of psychiatric trainees and ECPs about electroconvulsive therapy (ECT) in Europe, an effective yet controversial procedure.

The process of developing a protocol entailed different phases. First, a literature search was conducted, which supported the need to explore more the attitudes towards ECT among ECPs. Through group discussion the study’s objectives were decided, as well as the most appropriate methodology (including data collection and questionnaire use). At the end of the course, the core of the research plan was presented to all participants at the Research Summer School, preceding its implementation.

Participating in the EPA Research Summer School is a unique experience, a great learning opportunity, and can also lead to fruitful collaborations. It enabled the learning of the key aspects of designing and conducting a survey. In a short period of time, it was possible to design a study protocol for a future international cross-sectional survey on ECT.

No significant relationships.

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome refers to a cluster of clinical symptoms/signs related to drug hypersensitivity. The main clinical features include fever, skin rash, eosinophilia, enlarged lymph nodes, atypical lymphocytosis, and involvement of at least one internal organ. Clozapine-related DRESS syndrome has been rarely reported, but this may be due to a different clinical presentation pattern compared to DRESS for other culprit drugs.

We aimed to assess clusters of main clinical features of clozapine-related DRESS.

We ran a network analysis for clinical manifestations in the pooled sample of all previous published cases of clozapine-related DRESS.

We observed a triad of core symptoms (i.e., organ implication, fever, and eosinophilia) among DRESS criteria co-occurring in 59.3% (n=16) of 27 patients. The organs most likely to be involved in clozapine-related DRESS included lungs, liver, heart, and kidneys. Fever was also present in almost all cases (n=25 patients), while eosinophilia was observed in two thirds of the sample (n=18 patients).

Regarding clinical manifestations clozapine-related DRESS may differ from DRESS for other culprit drugs as skin reaction is not very typical; thus, clinicians need to consider DRESS as a potential diagnosis even in absence of a skin reaction. When managing clozapine-treated patients with the core triad of organ implication, fever, and eosinophilia clinicians should consider guidelines for DRESS treatment.

No significant relationships.

This work represents the continuation of the studies presented in two e-posters during the EPA 2021 conference (De Filippi et al., 2021; Rignanese et al., 2021), which addressed the physical pain-suicidality association (k=44 studies).

The aim of this meta-analysis is to provide an update of those studies, integrating data relating to adolescents, adults, and olders.

We started with the analysis of three papers, in particular a meta-analysis (Calati et al., 2015) and two systematic reviews (Hinze et al., 2019; Santos et al., 2019). After searching on Pubmed (until September 2020), data were extracted from articles comparing the rates of current and lifetime suicidal thoughts and behaviours (death wish, suicidal ideation, suicidal planning, suicide attempt and suicide death: DW, SI, SP, SA, and SD) in adolescents, adults, and olders with any type of physical pain and in individuals who did not report this condition. Data were analysed using Comprehensive Meta-Analysis Software (CMA) version 2.

67 studies were included, of which 16 on adolescents, 29 on adults, 16 on olders, and 6 on mixed ages. Although quite high between-study heterogeneity was detected in most analyses, results suggested that individuals with physical pain are more likely to report any form of suicidal outcome if compared to those not affected by pain.

Collected data are therefore in line with previous literature on this topic, which considered physical pain an extremely predictive risk factor for suicidal thoughts and behaviours. However, further research on this topic would be extremely useful.

No significant relationships.

Suicide is the third leading cause of death in adolescents (15-19 years). Physical pain is an important risk factor for suicidal thoughts and behaviors, especially in a delicate phase as adolescence.

Several studies investigated this association and the aim of this meta-analysis was to synthesize data in literature about this topic in adolescents (11-20 years).

We started from a systematic review published by Hinze and colleagues in 2019 and we searched on PubMed (January 2019-June 2020) studies comparing rates of suicidal outcomes (Suicidal Ideation, Suicide Plan, Attempt, Self-Harm: SI, SP, SA, SH) in individuals with any type of physical pain (head, back, neck, chest, stomach, abdomen, muscle, joint, arthritis) vs. those without it. Data were analyzed with Comprehensive Meta-Analysis software (CMA, version 3).

Of the 16 included studies, eleven focused on SI (68.8%), six (37.5%) on SA, four (25%) on SH and two (12.5%) on SP. Adolescents with physical pain were more likely to report SI (p < .001), SH (p < .001), SA (p = .004) and SP (p = .006). In all analyses, the between study heterogeneity was high. The presence of publication bias has been detected in SI (k≥10).

Results are in line with previous literature on this topic. Future research should investigate the specific impact of: acute vs. chronic pain; different types and intensities of pain; planned vs. impulsive action and therefore suicidal intent; role of psychological factors (in particular sensitivity and tolerance to physical pain).

Multiple epidemiologic and clinical studies have explored the relationship between physical pain and suicidal thoughts and behaviours.

The aim of this meta-analysis was to provide an update of the data already present in literature about this specific association in adults.

Starting from a meta-analysis published by Calati and colleagues in 2015, 28 studies were included in this work. After searching on Pubmed (until March 2020), data were extracted from articles comparing the rates of current and lifetime suicidal thoughts and behaviours (death wish, suicidal ideation, suicidal planning, suicide attempt and suicide death: DW, SI, SP, SA, and SD) in adults with any type of physical pain and in individuals who did not report this condition. Data were analysed using Cochrane Collaboration Review Manager software (RevMan, version 5.4).

Although high between-study heterogeneity was detected in most analyses, results suggested that adults with physical pain are more likely to report any form of suicidal outcome, except for death by suicide, compared to individuals not affected by pain. No evidence of publication bias was reported in the main analysis (lifetime SA).

Collected data are therefore in line with previous literature on this topic, which considered physical pain an extremely relevant risk factor for suicidal thoughts and behaviours. Future studies should specifically focus on alternative types of physical pain (such as medically unexplained pain or psychogenic pain) or explore the different impact of acute versus chronic pain in terms of increased suicide risk.

Topiramate (up to 300 mg per day) is more efficacious than placebo as an adjunct to standardised medication compliance management in treatment of alcohol dependence. However, adverse events can limit its use in different clinical situation. In this randomised, double-blind, placebo controlled trial we aimed to investigate the efficacy of low-dosage topiramate on alcohol drinking indices. Craving and psychiatric symptoms improvements were the secondary endpoints.

Forty alcohol dependent subjects where detoxified and subsequently randomised into two groups, respectively receiving topiramate (100mg/die) or Placebo. The level of craving for alcohol was evaluated by a 10-cm Visual Analogue Scale (VAS) and the Italian -version of the Obsessive and Compulsive Drinking Scale (OCDS). Psychiatric symptomatology was evaluated by the Symptom Check List 90 Revised (SCL-90 R).

The improvement of alcohol drinking indices and craving scores was higher in the topiramate group than placebo. The survival function showed that patients treated with topiramate remained abstinent from any alcohol amount for a longer time with respect to placebo (Z= -2.197; P< 0.05). The SCL-90-R general index of “Positive Symptom Total” significantly reduced in the topiramate group (F= 3.41, p< 0.05). The number of patients dropped-out from the study for adverse events was not different between groups.

To our knowledge, this is the first randomised, parallel group trial to evaluate the efficacy of topiramate at low dosage for alcohol dependence. The use of topiramate at low dosage could increase the number of subjects in treatment, given the reduced possibility of adverse events.

Most of brief instruments of evaluation of substance related disorders focuses on the dependence physical indexes and/or on compulsion, evaluating only incidentally the dependence-related social and psychological factors. Our aim is to create and validate a short questionnaire, easy to be distributed, exploring the dependence social and psychological indexes and to be used to evaluate the effectiveness of the therapeutic and rehabilitation treatments whose aim is to change lifestyle as well as abstinence.

The S.A.I.D. is an auto-evaluation questionnaire of 39 items that explore emotions, thoughts and behaviours in addictive subjects, thus providing patient's diagnostic profile in two areas: social area, divided into 4 scales (work/study, relationships, social interaction, cure/physical health); psychological area, divided into 5 scales (depression, hostility, lack of attention, anxiety, alexithymia).446 subjects have been examined: 256 with alcohol dependence diagnosis by using DSM-IV-TR, 70 with cocaine dependence diagnosis by using DSM-IV-TR, 120 not clinical subjects representing the control sample, that are not under psychiatric treatments.

The statistical analysis by Student's t test has showed that the instrument is able to discriminate between alcoholics, cocaine addicts and healthy control subjects; Cronbach's Alpha analysis has noticed a good internal validation in two main areas of the questionnaire, but a substantial unhomogeneity about single subscales.

These results indicate that the instrument is useful for the overall evaluation of social and psychological impairment in addictions, but also suggest the need for a revision of the instrument aiming to a better internal consistency of subscales.

In this multicenter, randomised, single-blind, parellel group, comparison trial we aimed to investigate the efficacy of lorazepam, tiapride and pregabalin in alcohol withdrawal. Craving and psychiatric symptoms improvements were the secondary endpoints.

One-hundred-nine alcohol dependent subjects (DSM-IV) were detoxified and subsequently randomised into three groups, respectively receiving 200-400 mg of tiapride (TIA; mean dosage 300 mg), 2-5 mg of lorazepam (LOR; mean dosage 3 mg) and 150-450 mg of pregabalin (PRE; mean dosage 280 mg). Withdrawal symptomatology was determined by the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar), whereas the level of craving for alcohol was evaluated by a 10-cm Visual Analogue Scale (VAS) and the Italian -version of the Obsessive and Compulsive Drinking Scale (OCDS). Psychiatric symptomatology was evaluated by the Symptom Check List 90 Revised (SCL-90 R).

All the three medications have shown efficacy on reducing alcohol drinking indices, craving scores and withdrawal symptomatology. The reduction observed in the PRE group was significantly higher than those in the LOR and TIA groups. In terms of safety and tolerability, all the compounds were generally well-tolerated. Only one patient has reported an epileptic episode during the treatment with tiapride.

Results from this study globally place the three medications at the same range of efficacy, with the PRE group reporting an higher reduction of withdrawal symptoms. Another point in favour of the employment of pregabalin was represented by a better outcome in those patients reporting a comorbid psychiatric disorder.

Affective temperament is a phenotype underpinned by a constitutional substrate.

It represents signs related to certain mood stability and attitudes to react to environmental stimuli.

Temperament has been related to predisposition to bipolar disorder.

Bipolar disorder is highly related to Substance Abuse Disorders but it is less clear which affective temperaments are more involved in this relation and if they can influence substance abuse patterns.

The aim of this study was to investigate temperamental traits, according to the Akiskal and Mallya formulation, in patients with bipolar I disorder associated with comorbid substance abuse disorders.

Data from 120 patients with Bipolar Disorders and Comorbid substance abuse disorders, were assessed in inpatient unit.

The brief TEMPS- M self-questionnaire was used to assess the temperamental distribution. The temperamental scores on various outcomes were investigated using Sperman rank (Rho), Principal Component Analysis (PCA), Cluster Ananlysis (CA).

Chyclothymia was positively correlated to Opiate Addiction (ρ 0.18 p< 0.001).

Irritability was positive correlated with Alchol Abuse and Cannabis Abuse (ρ 0.26 and 0.27 p< 0.001).

The PCA and CA did not show statistically significant results although showed a trend to link irritability with alchool abuse.

Our results suggest that bipolar patients with comorbid substance abuse disorders exhibit a prevalent temperament of irritable and cyclothymic related to alcohol and cannabis abuse and opiate dependence respectively. Further studies are needed to explore this relationship.

to date, studies on the relationship between Theory of Mind (ToM) and eating disorders (ED) have never considered binge eating disorder (BED).

Aims a) to assess ToM abilities in a sample of patients suffering from BED comparing them with healthy controls; b) to evaluate the influence of several variables (demographic, clinical and neuropsychological dimensions, attachment styles, traumatic events, comorbid Axis I and II disorders) on ToM abilities.

we assessed ToM in a sample of 20 BED patients and 22 women from the general population using the Reading the Mind in the Eyes Test (RMET) and the Faux Pas Test (FPT).

regarding the first aim, the comparison between groups showed that the clinical group scored significantly lower than the control group on the RMET as well as on FPT. Regarding the second aim, two different multiple regression models were performed: one for the RMET and one for the FPT. Both of them led to significant results. When modeling RMET score, it emerged that age and Binge Eating Scale significantly reduce the score, while vocabulary and drive for thinness have a positive effect (r2 = 0.62). When modeling FPT score, we found that central coherence and binge eating significantly reduce the total score (r2 = 0.33).

our study begins to shed light on the relationship between ToM and BED; in particular, it suggests that BED patients have lower mentalization skills than healthy controls and ToM abilities are partially influenced by clinical variables related to eating pathology.

The authors have not supplied their declaration of competing interest.

The aim of this analysis was to evaluate the economic consequences of a new treatment approach in the treatment of schizophrenia in the Italian setting. In terms of direct costs, in Italy was estimated that the main driver were represented by hospitalization and residential cost (71% of total direct cost per patient), followed by semi-residential services (13%), anti-psychotic and other drugs (8%) and ambulatory services (8).

A probabilistic cost consequence model was developed to estimate the potential cost reductions derived from an early treatment with atypical long-acting injectable anti-psychotics (aLAIs) drugs. A systematic literature review was carried out to identify direct and indirect costs associated to the management of schizophrenic patients in Italy. The model projects a scenario analysis in order to estimate potential cost reductions applying a new model management (MoMa) based on patient recovery and early aLAIs treatment.

Overall, the total economic burden associated with schizophrenia was estimated at €2.7 billion per year. A total of 50.5% of the economic burden was related to indirect costs and 49.5% to direct costs. Drug costs correspond to 10% of the total expenditure in terms of direct costs, while hospitalization and residential costs accounts for 81%. Scenario analysis demonstrate a potential cost reduction between 200 million and 300 million based on the effects of MoMa over the reduction of hospitalization and residential costs.

This analysis was the first attempt to translate clinical management aspects in economic consequences and will be a useful instruments for decision maker.

The authors have not supplied their declaration of competing interest.