Occupational stress is a major challenge in psychiatric settings due to high patient demands and frequent exposure to aggression. Identifying coping strategies is essential to promote staff resilience and well-being.

To investigate the coping strategies used by psychiatric nurses in response to occupational stress.

A cross-sectional, descriptive study was conducted among 100 nurses working in psychiatric services. Data collection included a self-administered questionnaire and the Ways of Coping Checklist (WCC). Statistical analysis was performed using SPSS v21.

Work in psychiatric services was reported as exhausting by 36% and burdensome by 40% of participants. The main obstacles identified were staff shortages (61%) and work overload (36%). Stress levels were moderate in 46%, high in 33%, very high in 12%, and low in 9% of respondents. Aggressive or violent patient behaviors were cited as the leading stressor (58%), followed by lack of resources (36%) and excessive workload (6%). Regarding coping, 23% reported using a single strategy, 30% two strategies, 37% three strategies, while 10% used none.

Psychiatric healthcare workers experience significant occupational stress, largely linked to patient aggression and organizational constraints. Targeted training in stress management and psychological coping techniques may enhance resilience and improve care delivery in psychiatric settings.

None Declared

The Mental Health Bill 2024 introduces a landmark change in Irish mental health law, making advance directives legally binding except through High Court intervention.1 While enhancing patient autonomy, the Bill raises important ethical and clinical challenges, particularly in balancing individual choice with psychiatrists’ duty to safeguard wellbeing.1,2

To explore psychiatrists’ perspectives on familiarity with the Bill, overall attitudes, anticipated impact on clinical practice, workload implications, and support for its implementation.

We conducted a cross-sectional observational survey of psychiatrists across multiple regions in Ireland. Participation was anonymous and voluntary, with implied informed consent. No identifiable data were collected, ensuring strict confidentiality and adherence to ethical standards. Structured multiple-choice questions were used to capture a broad range of professional perspectives.

Thirty clinicians completed the survey. Most were psychiatrists (56.7%), with 30.0% at Senior House Officer/Intern level and 13.3% at Registrar/Specialist Registrar level. Experience ranged from <3 years (23.3%) to >15 years (23.3%), with 26.7% each having 3–7 or 8–15 years.

Familiarity with the Bill was moderate: 33.3% were very familiar, 53.3% somewhat familiar, and 13.3% not familiar (Figure 1). Overall views were negative in 50.0%, neutral in 43.3%, and positive in 6.7% (Figure 2).

Regarding clinical impact, 66.7% felt the Bill would not improve practice, 20.0% expected no change, and 13.3% anticipated improvement (Figure 3). On patient rights, 46.7% felt protections were partial, 33.3% inadequate, and 20.0% adequate. For staff workload, 80.0% reported no benefit, 16.7% some benefit, and 3.3% clear benefit.

Support for implementation in its current form was limited: 46.7% opposed, 46.7% favoured partial adoption with amendments, and 6.7% supported full adoption.Image 1:Image 2:Image 3:

The findings highlight professional caution and ethical tension between autonomy and safety. While the Bill strengthens patient rights, psychiatrists foresee practical and operational challenges, limited clinical benefit, and conditional support for implementation. These results emphasize the need for structured guidance, robust ethical frameworks, and clinician engagement to navigate complex decision-making, reconcile patient-centred care with operational realities, and ensure reforms are implemented responsibly. The Bill presents an opportunity to advance Irish psychiatric practice, but success will require careful, ethically informed, and collaborative implementation.

1. 1. Kelly BD. Ir J Med Sci. 2020;189:1127-34.

2. 2. Kelly BD. Ir J Med Sci. 2024;193:2897-2914.

None Declared

Ensuring security in a psychiatric hospital remains a complex and multifaceted challenge, involving architectural, operational and digital dimensions. In recent years, the integration of Artificial Intelligence (AI) into digital modeling tools such as Building Information Modeling (BIM) and City Information Modeling (CIM) has emerged as a promising avenue to improve safety, responsiveness and inclusivity in mental health institutions.

This review of the literature aims to examine the role of AI in improving safety in a psychiatric hospital setting. It focuses on AI-based applications within BIM /CIM systems that contribute to risk prevention, environmental adaptation and the protection of neurodiverse and vulnerable populations.

A systematic literature review was conducted using the main academic databases. Key words included: Artificial intelligence, psychiatric hospital, BIM, CIM, hospital security.

Our review reveals a growing number of evidence supporting the role of artificial intelligence in improving safety in psychiatric hospital environments. AI technologies, when integrated into BIM and CIM systems, allow the proactive identification of architectural hazards, such as ligation points-through automated spatial analysis. In addition, AI supports trauma-informed design by guiding the incorporation of natural light, biophilic characteristics and acoustic modulation to reduce sensory overload, especially for neurodivergent individuals. AI-powered simulations further optimize patient and staff circulation, improving operational efficiency and responsiveness to emergencies. At the infrastructure level, AI-activated sensor networks facilitate predictive maintenance and continuous monitoring of the environment, thus preventing system failures that could compromise safety. In addition, AI contributes to cybersecurity by detecting anomalies and protecting sensitive patient data in increasingly digitized healthcare environments. Finally, by analyzing behavioral patterns and the various needs of users, AI supports the creation of flexible and inclusive architectural solutions adapted to the cognitive and emotional profiles of psychiatric populations. Together, these applications illustrate how AI is transforming psychiatric institutions into safer, more adaptive and human-centered spaces.

The integration of AI into BIM and CIM frameworks represents a paradigm shift in the design and management of psychiatric healthcare environments. Beyond technical optimization, these tools allow a more proactive, adaptive and ethical approach to safety and inclusivity. However, the literature also highlights the need to continue empirical studies and ethical frameworks to guide the responsible deployment of AI in architectural design of facilities for mental health and psychiatric care.

None Declared

Central and Eastern European (CEE) mental health systems share a legacy of hospital-centrism, fragmented governance, and low investment (~3.2% of health spending, largely to psychiatric hospitals). COVID-19-era telepsychiatry, nongovernmental organization (NGO) innovations, and war-related pressures catalysed activity, however, implementation and evaluation remain uneven.

To position Hungary’s mental healthcare within a unified CEE framework using a multi-country scoping review aligned with the WHO Mental Health Care Pyramid.

Narrative policy/systems review (2017–2024) of national statistics and reports, OECD/WHO documents, programme evaluations, workforce registers, and inputs from professional bodies and NGOs.

Economic burden of mental health was ~3.1% of GDP (2018). Unmet need for mental healthcare rose from 3.8% (2021) to 8.4% (2024). Suicide declined from 46.1/100,000 (1984) to 15.7 (2019) but increased to 16.8 (2024), with persistently higher male mortality. Governance is highly centralised (Ministry of Interior/OKFŐ). Recent reforms include large salary increases (physicians ~120%, nurses ~70–80%), nationwide e-health records, and EU-funded infrastructure upgrades. Care is free at the point of use; the state covers ~87.4% of psychotropic costs. Workforce shortages mirror CEE patterns: only ~4,201 of ~8,200 registered mental-health professionals are active, with pronounced urban–rural inequities; child and adolescent services remain under-resourced. Hospital-orientation persists in Hungary. Telepsychiatry expanded during COVID-19, however, the availability, and the intra-sectoral and cross-sectoral integration of community services is widely variable. Complex NGO-led initiatives show promise yet lack national embedding. Prevention and promotion (e.g., iFightDepression; school- and work-based activities; primary-care involvement; mental-health promotion centres; labor market developments), are promising yet fragmented and insufficiently prioritized. Perinatal care assets—health-visitor network and a specialised maternity mental-health unit—are under-leveraged. Several reforms remain pilots, sustainability plans are limited, and performance monitoring favours administrative over patient-centred outcomes, echoing regional gaps.

Hungary’s trajectory partially typifies the CEE region: key enablers (central governance, salary reform, digitalisation, infrastructure, employment) have advanced; however, hospital-centrism, workforce constraints, and cross-sector fragmentation persist. Priorities are a comprehensive national mental-health strategy; sustained, prevention-oriented financing for community services; systematic health–social–education integration; transparent, outcome-focused monitoring and evaluation; and meaningful service-user involvement to improve quality and equity.

R. Wernigg Employee of: a back-office institute of the Hungarian Ministry of Interior., D. Őri: None Declared, T. Bulyáki: None Declared, A. Slezák: None Declared, J. Harangozó: None Declared, I. Gallai: None Declared, Z. Guerrero: None Declared, A. Kagstrom: None Declared, P. Winkler: None Declared

Minority stress remains a central factor in the mental health of sexual and gender minorities often resulting in elevated distress, anxiety, depression, suicidality, and substance misuse (Moorhead, B., Lewis, H.K. & Arnull, L. LGBT sexuality and gender minority experiences of minority stress: a comparison of models and theories. Qual Quant 58, 3973–4001 (2024)). Building on insights from previous research, the Mental Health Support Programme BOJE (Colours) was launched to offer comprehensive support tailored to the needs of LGBTQIA+ individuals within the Croatian public mental healthcare system.

The aim is to present our two year experinece with the BOJE - Mental Health Support Programme that aims to address minority stress to offer specialized support tailored to the unique needs of LGBTIQ+ individuals, fostering resilience and well-being.

In October 2023, a multidisciplinary team at the University Psychiatric Hospital Sveti Ivan in Zagreb, Croatia, formed a Mental Health Protection Programme BOJE which consists of a counseling center, an outpatient clinic and a three-month therapeutic and educational cycle for LGBTQIA+ users. Over time, the programme has expanded to include support group, psychotherapeutic with families and a platform was provided for training healthcare professionals in LGBTQIA+ affirmative practice.

To date, we have carried out more than 1,200 interventions — including counseling, psychiatric consultations, reviews, and psychotherapy. Four cycles of closed-group workshops have been completed with a very low dropout rate, and a fifth cycle is currently underway. The support group now brings together participants from all previous cycles. n the evaluation of the work so far, we see that the input data show a high level of distress, while the preliminary output data shows improvement. Across both group formats, we observed rapid development of cohesion, stronger interpersonal support, greater participation, improved outcomes, and consistently low dropout rates.

The BOJE programme represents the first structured mental health intervention for LGBTQIA+ people within the Croatian healthcare system. It shows that affirmative, structured interventions can effectively address the impact of minority stress and improve the mental health of LGBTQIA+ people. Our experience highlights the rapid development of group cohesion, the protective role of family acceptance, and the value of safe therapeutic spaces for identity exploration and resilience. Together, these outcomes demonstrate that inclusive mental health care not only fosters wellbeing but also strengthens belonging, community support, and hope.

None Declared

Healthcare professionals experience high levels of occupational stress, which can adversely impact their physical and psychological well-being. Physical activity is known to contribute positively to health, stress reduction, and quality of life, yet limited research has examined these associations within the Greek healthcare workforce. Despite this evidence, the degree to which physical activity is practiced by healthcare professionals themselves and its potential association with their quality of life has not been sufficiently investigated in Greece. This issue is particularly relevant, as healthcare workers are simultaneously caregivers and individuals whose well-being is central to the effectiveness of healthcare systems.

This study aimed to assess the level of physical activity among healthcare professionals in the 6th Regional Health Authority of Greece and to explore its relationship with perceived quality of life.

A cross-sectional study was conducted with 77 healthcare professionals using an online questionnaire. Data collection instruments included a demographic survey, the International Physical Activity Questionnaire (IPAQ), and the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF). Statistical analysis was performed with IBM SPSS 27, employing descriptive statistics, correlation analyses (Pearson and Spearman), and non-parametric tests (Kruskal–Wallis), with significance set at p < 0.05.

Participants were predominantly women (90.9%) with a mean age of 39.6 years, and nurses constituted the majority (63.6%). IPAQ findings indicated low engagement in vigorous activity (mean 1.6 days/week, ~45 minutes), while moderate activity (2 days/week, ~82 minutes) and walking (4.6 days/week, ~55 minutes) were more common. Sedentary behavior averaged 338 minutes daily. WHOQOL-BREF scores revealed generally satisfactory physical, psychological, and environmental quality of life. No significant correlations emerged between physical activity and quality of life dimensions. However, education level significantly influenced quality of life, with higher education linked to better quality of life outcomes.

This study provides insight into the physical activity behaviors and quality of life perceptions of healthcare professionals in the 6th Regional Health Authority of Greece. Although physical activity is recognized as beneficial for both physical and mental health, the present findings did not identify a direct statistical relationship between activity levels and quality of life within this sample. Instead, education appeared to play a more decisive role, suggesting that higher levels of academic training and ongoing professional development may enhance overall well-being. These results highlight the importance of supporting healthcare staff through continuing education programs and workplace interventions that foster both professional growth and personal health.

None Declared

Mental disorders can evolve unpredictably, sometimes progressing to acute states that pose significant risks to the patient. Such acute episodes due to a somato-psychic neurovegetative process require urgent intervention, intensive monitoring, and multidisciplinary therapeutic approaches, given their potential for rapid deterioration of the patient’s general condition. Admission to intensive care units (ICUs), although relatively rare, signals major decompensation, reflecting the complexity and severity of the pathological process.

This study will investigate the acute somato-psychiatric profile requiring transfer to the ICU from psychiatric wards, with the aim of identifying factors of severe decompensation, underlining the complexity of the clinical evolution and highlighting the challenges of multidisciplinary interventions in psychiatric emergencies.

The study was conducted retrospectively based on clinical observation records of patients admitted to psychiatric wards and subsequently transferred to the ICU between 2022 and 2025. Demographic data (age, gender), main psychiatric diagnoses, somatic comorbidities, and discharge status were collected and analyzed. Diagnoses were classified according to ICD-10 criteria, and data were stratified by age group (<18 years, 19–44 years, 45–64 years, and ≥65 years) to highlight distribution and clinical characteristics.

The patient cohort included individuals aged between 14 and 79 years, of whom 4.0% were <18 years,19-44 years (26.0%), 45-64 years (45.0%), and 25.0% ≥65 years. The gender distribution showed a male predominance (60.0%) compared to females (40.0%). In patients <18 years of age, autism spectrum disorders, acute psychotic episodes, and severe depressive disorders with psychotic elements predominated, frequently associated with malnutrition, gastroesophageal reflux with esophagitis, and iron deficiency anemia, with no cases of death. Whereas in those aged ≥18 years, the dominant psychiatric diagnosis was paranoid schizophrenia (≈48%), followed by catatonic schizophrenia (≈11%), organic and behavioral disorders (≈10%), dementias (≈9%) and acute psychotic disorders with symptoms of schizophrenia (≈7%), associated with ischemic cardiomyopathy, congestive heart failure, multiple organ failure, pulmonary tuberculosis, chronic hepatitis, respiratory infections (including SARS-CoV-2), diabetes mellitus, and nutritional disorders. Mortality in the ICU was ≈10%.

The admission of patients with psychiatric disorders to ICU wards is due to both severe mental decompensation and the complexity of associated somatic comorbidities. Early identification of risk factors, continuous monitoring, and interdisciplinary collaboration are essential elements for optimizing outcomes and implementing individualized management strategies for this category of patients.

None Declared

Research suggests that men are less likely than women to seek psychological treatment. Identifying barriers to mental health treatment seeking among men may help identify intervention targets.

The present study aimed to examine demographic, clinical, and stigma-related variables associated with treatment seeking, identify those that differ between genders, and explore whether these variables statistically account for the relationship between gender and treatment seeking.

Participants (N = 345; 62% female; Mage = 46.37) were recruited from primary care offices across Hungary and completed a survey assessing demographics, lifetime treatment seeking, self and public stigma, anxiety, depression, and experiential avoidance. Independent samples t-tests were used to examine gender differences in study variables. Binary logistic regression was conducted to identify predictors of lifetime treatment seeking, and indirect effects were tested using mediation models with bootstrapped confidence intervals.

As expected, gender significantly predicted lifetime treatment seeking, B = 0.82, SE = 0.34, Wald = 5.88, p = .015, OR = 2.26, 95% CI [1.17, 4.37], with women more likely to have sought treatment. Additionally, attitudes toward seeking help were positively associated with lifetime treatment seeking, B = 0.12, SE = 0.03, Wald = 10.07, p = .002, OR = 1.13 95% CI [1.05, 1.22], such that more positive attitudes were linked to a higher likelihood of having sought treatment. Independent samples t-test revealed that men and women did not significantly differ in age, public stigma, depression, or experiential avoidance, ps = .156–.535. However, men had significantly greater self-stigma, less positive attitudes toward seeking help, higher income, and lower anxiety relative to women, ps = .003-.019. Analyses of indirect effects revealed that both attitudes toward help-seeking and anxiety partially mediated the association between gender and treatment seeking. Specifically, men’s less positive attitudes toward help-seeking were associated with lower odds of treatment seeking (indirect effect = 0.14, boot SE = 0.06, 95% CI [0.03, 0.29]), and women’s higher anxiety scores were associated with greater odds of treatment seeking (indirect effect = 0.20, boot SE = 0.09, 95% CI [0.04, 0.39]). In both cases, the direct effect of gender on treatment seeking remained significant, indicating partial mediation.

Findings indicate that men were less likely than women to report lifetime treatment seeking. Mediation analyses suggested this association was accounted for, in part, by differences in anxiety and attitudes toward seeking help. Improving treatment seeking attitudes in men may be a relevant intervention target. This may be especially important given that men did not differ from women in other relevant clinical variables, including depression and experiential avoidance.

None Declared

Breast cancer is the most common malignancy among women worldwide. Mastectomy, while often life-saving, significantly affects physical, emotional, and social functioning. Acceptance of illness is recognized as a key psychological resource that may facilitate adaptation, reduce symptom burden, and improve health-related quality of life (HRQoL).

To assess the relationship between the level of disease acceptance and quality of life in women after mastectomy, with consideration of sociodemographic determinants of acceptance.

A cross-sectional, descriptive study was conducted in 2024 among 125 women after mastectomy at the West Pomeranian Oncology Center and the Amazon Association “AGATA” in Szczecin, Poland. Data were collected using a sociodemographic questionnaire, the Acceptance of Illness Scale (AIS), and the EORTC QLQ-C30 and QLQ-BR23 questionnaires. Statistical analyses included descriptive statistics, Mann–Whitney U, Kruskal–Wallis tests, and Spearman’s correlations, with significance set at p<0.05.

The mean AIS score was 28.8 (SD=7.05). Higher acceptance was significantly associated with better global quality of life and improved physical, emotional, cognitive, and social functioning (all p<0.001). It was negatively correlated with fatigue, pain, insomnia, appetite loss, constipation, and financial difficulties. In the breast cancer-specific module, greater acceptance was linked to a more positive body image, higher sexual enjoyment, and a better future perspective, and negatively correlated with systemic therapy side effects, breast and arm symptoms, and distress related to hair loss. Sociodemographic determinants of higher acceptance included higher education (p=0.002), better financial status (p=0.019), and being professionally active or retired compared with pensioners (p=0.024). Age, marital status, and living arrangement showed no significant associations.

Acceptance of illness significantly improves the quality of life in women after mastectomy, enhancing multiple domains of functioning while reducing the severity of treatment-related symptoms. Its level is influenced by sociodemographic factors such as education, financial situation, and employment status.These findings highlight important practical implications: interventions aimed at strengthening disease acceptance and addressing social determinants should be integrated into psycho-oncological care and rehabilitation to support adaptation, reduce symptom burden, and improve long-term well-being in breast cancer survivors.

None Declared

Collegiate students are increasingly utilizing mental health services. University counseling centers have implemented multiple models to deliver care and expanded services. A novel model recently employed involves embedding university counseling services directly in campus academic departments in addition to the existing site of the university central counseling center. In 2020, a large public university expanded mental health services to include counseling services embedded in three academic departments.

The study’s aim is to describe changes in service utilization after embedded counseling services were initiated. We hypothesized that the availability of embedded counselors in academic departments would increase students’ access to, and subsequent utilization of, mental health services.

The current study was based on two cohorts of students from a U.S. public university who used the university’s Counseling and Psychological Services (CAPS). The two cohorts included students enrolled in three schools 1) Architecture, 2) Commerce and 3) Leadership and Public Policy, between July 1, 2016 and June 30th, 2019 (when there were no embedded services), and July 1, 2021 and June 30th, 2024 (after embedded services were initiated). Data was extracted from the Student Health Research Database, an IRB-approved database connecting student data from different datasets. The study compared overall mental health utilization before and after embedded counseling was available using Generalized Estimating Equations (GEE) and robust Poisson regression models with the natural logarithm of student enrollment as offset. Rate ratios (RR) with 95% confidence intervals (CI) were computed. Data analysis was performed using R 4.4.2

During the 2016-2019 study period, a total of 3,378 visits to CAPS were reported. During the 2021-2024 study period, central visits accounted for 4,564 visits while embedded counseling accounted for 3,919 visits. The rates of mental health visits more than doubled (RR=2.2; 95%CI 1.9-2.6) following the initiation of embedded counseling services within the School of Architecture and within the School of Leadership and Public Policy (RR= 2.6; 95%CI 1.5-3.4), while it increased by 60% within the School of Commerce (RR=1.6, 95% CI 1.3-2.0). The rate of utilization by unique students increased 48% within the School of Architecture (RR=1.48; 95%CI 1.5-3.4).

As the need for mental health services increases among the collegiate population, diversifying service access increases student utilization. Embedded services in addition to central services can decrease barriers and increase utilization of university mental health services.

None Declared

Obesity is a chronic, multifactorial disease and a major public health challenge, characterized by excessive body fat accumulation leading to metabolic disturbances and comorbidities. Contemporary obesity management includes lifestyle modification, pharmacotherapy, and, in severe cases, bariatric surgery. Psychological factors, including body image perception, self-efficacy, self-esteem, and depressive symptoms, play a crucial role in treatment decisions and outcomes.

The study aimed to identify and analyze factors influencing body image perception among patients with obesity undergoing bariatric surgery.

The study was conducted among 125 participants. Data were collected using a diagnostic survey that comprised a self-designed questionnaire alongside standardized instruments, including the Body Esteem Scale (BES), the General Self-Efficacy Scale (GSES), the Rosenberg Self-Esteem Scale (RSES), and the Beck Depression Inventory (BDI).

Motivations for bariatric surgery varied, with the majority aiming to improve overall wellbeing (49.6%) and achieve sustained weight loss (25.6%). Sociodemographic variables such as age, marital status, education, residence, and employment significantly influenced self-perception and psychological measures. Older age was associated with lower self-esteem, while individuals in informal relationships reported higher SES scores. Higher depressive symptoms were observed among married patients and those with a family history of obesity. Strong correlations were found between body image, self-efficacy, and self-esteem―higher self-efficacy and self-esteem were associated with better physical attractiveness, weight control, and physical fitness. Lower self-esteem and self-efficacy were linked to higher depression scores. In women, higher self-efficacy and self-esteem correlated with improved physical attractiveness and fitness perception; in men, higher self-esteem was associated with higher ratings of attractiveness, strength, and fitness.

The patients undergoing bariatric surgery exhibited substantial body dissatisfaction, low self-efficacy, and low self-esteem, which were closely related to depressive symptoms. Sociodemographic and psychological factors significantly influenced body perception and treatment-related decisions. Family history of obesity increased the risk of depressive symptoms. These findings highlight the importance of integrating psychological assessment and support in bariatric surgery planning.

None Declared

Medical education is a highly demanding and stressful program, often leading to elevated stress, depression, and anxiety among students. Personality traits influence coping strategies, which in turn affect mental health outcomes. Understanding these relationships can help in designing the interventions to promote psychological well-being.

This study examines the impact of personality traits on coping styles and mental health among Pakistani medical students, identifies the coping strategies most frequently used, and assesses the relationship between adaptive and maladaptive coping strategies and psychological well-being. It also aims to help students understand how personality profiles impact stress management, facilitating the development of targeted support programs.

Using a correlational cross-sectional design, data were collected from MBBS students at the Public Sector Medical College in Lahore, Pakistan, through purposive sampling. Participants completed the Big Five Personality Test, the Brief COPE Inventory, and the General Health Questionnaire-12. Data were analyzed using SPSS with Pearson correlation and regression analysis.

A Pearson correlation revealed a significant positive association between Neuroticism and avoidant coping, r(77) = .28, p = .015, indicating that students higher in Neuroticism tended to engage more in avoidant coping. Extraversion was positively associated with problem-focused coping, r(77) = .35, p = .002, suggesting that students higher in Extraversion were more likely to use problem-focused strategies. Openness to Experience was also positively correlated with problem-focused coping, r(77) = .29, p = .009, showing that students with higher openness scores engaged more in problem-focused coping. A multiple regression examined which Big Five traits predicted better general mental health. Results indicated that only Agreeableness was a significant predictor, β = .39, t(71) = 3.31, p = .001, such that higher Agreeableness was associated with better general health.

Findings highlight the significant role personality traits play in shaping coping and mental health among Pakistani medical students. These results underscore the need for interventions in medical education that address stress management training while considering personality profiles. Effective coping strategies are crucial for managing challenges, achieving academic success, and maintaining emotional well-being. By fostering adaptive coping tailored to individual traits, medical institutions can better support the well-being of future healthcare professionals.

None Declared

While double-blinded, randomized controlled trials are considered the gold standard for assessing therapies, they are not always practical when therapies last for years with complicated patients for whom controls would be difficult to find. A rationale exists for looking at the effects of real-world practice where RCTs are impractical and too expensive.

We have been working in the field of Inegrative Psychiatry since 1990, providing long-term management of bipolar disorder with a goal to eliminate or reduce medications. We wanted to present the results we have accumulated over a 35 year period to show what is possible.

The setting was a private practice which provided free or reduced fee care for Indigenous people. Our approach falls into three arms: full integrative management, multi-nutrients and nutrition alone with or without psychotherapy, and conventional care with medication minimization, also with or without psychotherapy. No patient was turned away. We used the clinical global impressions (CGI) scale with all patients along with the Young Mania Scale (YMS) and the Montgomery-Asburg Depression Scale (MADRS).

To date we have seen 307 patients for an average of 18.7 months. Seventy-two people engaged in full integrated care consisting of psychotherapy, mindfulness meditation, acupuncture, osteopathy, yoga, nutritional modifications and micronutrients, and physical exercise for an average of 26.4 months. Sixty-nine of those patients were able to eliminate conventional medications. Fifty-nine patients participated in micronutrient supplementation alongside conventional medication for 15.3 months. Fifty four of those patients were able to reduce or eliminate conventional medication. Two hundred seventy two patients participated in conventional care with an aim to reduce medications. Twenty seven were able to eliminate medication and 120 were able to reduce medications. The remainder maintained (20) or increased (55) their use of medications over time. This group stayed for an average of 161.5 months. Successful strategies are multi-modal, supported by family and community members with feedback at early signs of mania or returning depression, and required continued, diligent application of practices. Unsuccessful approaches tended to involve only one or two modalities, tended to lack family or community support,and lacked early warning systems, Patients appeared equally severe at intake based on number of prior hospitalizations, number of prior suicide attempts, medication equivalencies, and similar scores on the CGI, MADRS, and the YMS. Statistically significant improvement occurred on the CGI, YMS, and MADRS for all patients.

Integrative psychiatric treatment over time can help people function without psychiatric medications but commitment is required at a level not all patients can reach or afford. New research paradigms are needed that address long-term treatments for complex problems.

None Declared

Hypermobility (HM) is a heritable connective tissue difference found in 20% of adults, disproportionately females (70%). The 2017 nosology distinguishes Generalised joint HM (GJH), HM Spectrum disorder (HSD) and HM Ehlers Danlos (hEDS). Emerging evidence suggests up to half of HM are also neurodivergent (ND), yet the intersection between HM and ND is rarely explored. This comorbidity likely confounds population-based studies over all age groups on anxiety, depression, stress, quality of life and levels of PA and Sedentary Behaviour (SB).

We examined (1) levels of anxiety, stress, depression and quality of life in people with HM. (2) objectively measured PA in relation to WHO guidelines and SB; (3) differences across HM classification, presence of ND and diagnostic status.

Mixed methods: 2 phases: Phase 1 online questionnaire (n =110; age 18-59 (M =35.8 years) including DASS8, QLES-SF with extended qualitative response, Phase 2 accelerometers n= 19 for PA and SB.

Mental Health: 70% diagnosed/self-diagnosed ND; 62.7% with long-term conditions. ND hypermobile (NDH) report greater moderate to severe levels of Depression (U=939, p=.029), Anxiety (U=910, p = 0.018), Stress (U = 683.5, p = < .001). ND status associated with higher risk of pain severity, psychiatric comorbidity, and multiple medications (U=795.5 p=<.0019).

Quality of Life: hEDS participants reported significantly lower QoL compared to GJH (adj. p=.0119) and HSD (adj. p=.030). Thematic analysis identified five key themes: (1) inextricable body–brain connection, (2) unpredictability and disruption, (3) invisibility and invalidation, (4) uncertain future, and (5) resilience despite adversity.

PA: 84.2% (16/19) met 150 min/week MPA guideline; only 36.8% (7/19) met the extended 300 min/week recommendation relative to sedentary time. Self-reported PA significantly underestimated objectively measured PA (t(11)=4.47, p<.001, r=.819). Qualitative comments revealed perceived limits of participation (“I want to do more but cannot increase this without long periods of pain and recovery”).

We provide novel evidence of the high comorbidity of HM and ND and its significant impact on mental health, pain, and medication burden. While objective PA levels suggest most participants meet minimum WHO guidelines, elevated SB and underreporting of PA highlight unique barriers and negative self-concept in hypermobile women. QoL lowest in hEDS, explained partly by the unpredictable and invisible nature of symptoms. These findings suggest PA alone may not protect mental health in this group, and that diagnostic and neurodivergent status are important moderators of wellbeing outcomes. Recognition of HM–ND comorbidity is critical for developing targeted interventions and improving clinical support.

None Declared

Shared Decision Making (SDM) focuses on patient–clinician interactions regarding treatment decisions, aiming to improve health outcomes through personally tailored care. SDM aligns with recovery-oriented care, emphasizing self-determination, choice, and autonomy and therefore is increasingly used in community-based mental health services worldwide, supported by ethical, clinical, and empirical evidence. Yet, SDM is not systematically implemented and investigated during psychiatric hospitalization. Barriers to inpatient SDM include concerns about inpatients’ limited decision-making capacity and cognitive impairments, which may be especially prominent for women due to gender and cultural factors.

This study aimed to examine, for the first time, association between SDM and cognition, participation in daily life, and health indices among women hospitalized in an inpatient psychiatric setting.

This cross-sectional study included 38 women (Mdn = 33 years, IQR = 25–42) hospitalized in a psychiatric acute facility. Psychotic disorders were the most common diagnosis (N = 28, 73.7%), with a median illness onset at 22.5 years (IQR = 18–26.5). Most participants were voluntarily hospitalized (N = 24, 63.2%) and were candidates for discharge at the time of data collection (N = 23, 60.5%). All the participants completed the following assessments: Shared Decision Making Questionnaire-9-Psy (SDM-Q-9-Psy) to evaluate experience of involvement in the decision-making process; Montreal Cognitive Assessment for cognitive evaluation; the Kohlman Evaluation of Living Skills (KELS) for functional capacity; the Engagement in Meaningful Activities Survey (EMAS) for meaningful participation; and the Patient Health Questionnaire-9 (PHQ-9) for self-evaluation of health. In addition, the Brief Psychiatric Rating Scale (BPRS) was completed by a clinician for each participant to evaluate the severity of psychiatric symptoms.

SDM-Q-9-Psy scores were relatively low (Mdn = 28.5, IQR = 16–41.5). At average, the participants experienced moderate psychiatric symptoms (BPRS: M=46.5, SD 14) and slight cognitive impairments (MoCA: M=23.4; SD=3.8), however, functionally could be independent (KELS: Mdn=2.5, IQR: 1-4.5). Lower SDM-Q-9-Psy score was associated with longer hospitalization (r = –0.367, p < .05) and higher BPRS scores (r =–.334, p<.05). No significant correlations were found between SDM-Q-9-Psy and cognitive functioning, functional capacity, participation, or self-rated health (–0.3<r<0.16, p>.05).

Among women in acute psychiatric wards, SDM was compromised and associated with illness-related variables―symptom severity and hospitalization length― regardless of personal capacities or self-rated health. These findings raise concern about personally tailored practice and SDM implementation in acute psychiatric care.

None Declared

Dispositional mindfulness has been associated with better mental health and well-being, yet its pathways in community samples remain under-specified.

To examine (i) age/sex differences in mindfulness, psychopathology, and well-being; (ii) correlations among dispositional mindfulness, symptom severity, and subjective well-being; and (iii) whether mindfulness mediates links between psychopathology and well-being.

Cross-sectional online survey with a non-probabilistic snowball sample of Portuguese adults (N = 400; 18–78 years). Measures: Mindfulness Attention Awareness Scale (MAAS), Brief Symptom Inventory-18 (global severity index and subscales), Positive and Negative Affect Schedule (PANAS), and Satisfaction With Life Scale (SWLS). Analyses included t-tests/ANOVA, Pearson correlations, and mediation models with MAAS as mediator.

Younger adults showed higher psychopathology and negative affect, whereas adults aged 60–69 reported higher mindfulness and life satisfaction (declining ≥70 years). Men scored higher on mindfulness; women reported higher negative affect.

Mindfulness correlated positively with life satisfaction and positive affect, and negatively with symptom severity (IGG; somatization, depression, anxiety), stress, and negative affect.

In mediation analyses, psychopathology had a direct negative effect on life satisfaction and a direct positive effect on negative affect; the direct path to positive affect was not significant. Total effects were negative for life satisfaction and positive for negative affect. Models specified MAAS as mediator between psychopathology and well-being indicators.

Findings indicate that higher dispositional mindfulness is linked to lower symptom burden and better subjective well-being, partially accounting for the association between psychopathology and well-being. Results support integrating mindfulness-based strategies in mental-health promotion for adults. Limitations include cross-sectional design, online snowball sampling, over-representation of women/younger adults, and reliance on self-report.

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Collaboration in mental health care is crucial for executing a model focused on the psychosocial rehabilitation of individuals through multidimensional interventions that include various stakeholders and sectors of society to address their needs. Notwithstanding the advantages indicated by scientific data, numerous obstacles to collaborative care persist, and practitioners continue to grapple with adjusting their practices. The present circumstances necessitate organization and the formulation of sound action plans to address issues, which in turn requires a comprehensive understanding of collaborative practices in mental health care (CPMHC) and their conceptual limits.

A conceptual analysis study was conducted to establish a working definition of CPMHC.

This study employed the Walker and Avant concept analysis methodology. This encompasses the identification of defining conceptual attributes, antecedents, consequences, and empirical referents. A literature search was conducted from November 2024 to February 2025 across three databases (Medline, CINAHL, and LILACS), focusing on papers published from 2010 to 2024.

Thirty 30 papers were examined. The essential attributes included effective communication, relationship development, shared responsibility for care, hierarchical adaptability, coordination among services, providers, and the community, oversight and assessment of care processes, and consideration of diverse sociocultural contexts.

This concept analysis aids in directing future research and policy formulation about collaborative approaches in mental health, taking into account individual, relational, institutional, and social dimensions. More research is needed to enhance the comprehension of collaborative practices in mental health, considering the intricacies of social relations and systemic injustices.

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Workforce instability in child protection threatens service quality and staff mental health (burnout, moral distress). Profile-based evidence is scarce in Central and Eastern Europe, despite international concern about retention (Burns & Christie Child Youth Serv Rev 2013; 34:1115–22; Cook et al. CRCF Briefing 2022; European Social Network. Protecting Children. 2024).

To identify psychosocial profiles of child protection professionals based on identity, support, and meaning, and to examine their relation to exit risk, enriched by qualitative narratives.

Survey of Hungarian residential child protection staff (N = 90). Measures: MGIS – solidarity subscale (used exploratorily in Hungary; α = 0.98), MSPSS (α = 0.85), and PERMA-Profiler subscales ‘meaning’ and ‘relationships’ (α = 0.89). Exit intention was assessed with items on career plans and active job search. Analyses included descriptive statistics, Mann–Whitney U, Spearman correlations, and Ward + k-means cluster analysis. Additionally, 15 semi-structured interviews were analysed thematically (Braun & Clarke. Qual Res Psychol 2006;3:77–101).

Three clusters emerged:

1) Embedded but strained (n = 56; 62.2%) – strong solidarity and meaning, but only moderate external support.

2) Isolated strugglers (n = 29; 32.2%) – lowest support and meaning, identity under strain, highest exit risk.

3) Supported outsiders (n = 5; 5.6%) – weak professional identity and meaning, but strong family/friend support.

Solidarity was significantly lower among those at exit risk (U = 742.5, p < 0.001). Interviews illustrated these profiles: “Nobody listens to us, and nobody cares” (struggler); “My colleagues keep me in the profession; without them I would have quit” (embedded); “I don’t stay because of the workplace, I stay because of my family” (outsider).

Exit risk reflects identity–support–meaning profiles rather than stress alone. These findings align with European evidence on workforce instability and highlight intervention points beyond individual stress management. Strategies that strengthen solidarity, reinforce work meaning, and leverage external support may prevent burnout and turnover, stabilising child-facing mental-health services.

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Since the beginning of this century, Belgium has been going through important shifts and reforms regarding the organization of mental healthcare. One of the most important shifts lays in the de-institutionalization of care to a more community-based mental healthcare. These reforms are embedded in a public health approach. Building on these changes, Belgium established in 2019 a system of reimbursed primary psychological care (PCP), providing low-intensity and low-threshold interventions, both individually or in groups.

This study aims at identifying which patients make use of PCP (1) and the effect of the intervention on clinical outcomes on the patient-level (2).

A longitudinal study was performed. N=2,745 patients treated with PCP were included at baseline and followed-up at 3, 6 and 12 months. The instrument includes questions on socio-demographics, mental disorders and related problems, quality of life, previous treatment use and treatment barriers.

Over 70% of the patients met criteria for a DSM-5 mental disorder, both for lifetime and 12 months prevalence, with anxiety and depression as the most frequently identified disorders. Suicidal ideation and behaviors within the last 12 months were reported by more than one-third of patients. 43.9% had never engaged with mental health services prior to PCP treatment. The median duration between symptom onset and initial treatment contact was 4 years. Patients improved positively on symptomatology, quality of life and resilience. A commonly cited barrier to seeking professional help was the belief that the issue could be managed independently.

Up to 2025, more than 500 000 patients made use of PCP. The intervention covered a large number of patients with varying pathologies and severity. Most importantly this intervention was able to shorten the delay of seeking treatment to 4 years compared to 10 years in the Belgian general population. Furthermore, patients treated with PCP showed improvement on several clinical outcomes, further underpinning it’s positive societal and economic impact. Next to a continuous longitudinal clinical and epidemiological study, future research will focus on the nature of the interventions proposed in PCP and a thorough socio-economic analysis.

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The initiative to implement the community model in the Adult Psychiatric Clinic of Mytilene was driven by the goal of establishing Social Psychiatry on the island of Lesvos. The objective was to develop the necessary institutions and structures to operate the Psychiatric Sector as a model of Community Psychiatric Care, promoting holistic, patient-centered mental health services.

Significant resistance was encountered, particularly from nursing and paramedical staff, who were hesitant to join therapeutic teams and shift from traditional hierarchical approaches to cooperative work with patients. Hospital staff, also expressed discomfort and fear about the presence of psychiatric patients moving freely within the hospital grounds, even with professional accompaniment.

A multi-layered approach was adopted, focusing on both systemic reform and individual therapeutic engagement: 1) assignment of a Referral Person to each patient, 2) Therapeutic and Support Groups (weekly special staff group, monthly general staff group, weekly inpatient community group, weekly outpatient group, biweekly supervision group. 3) integration of patients into individual, group, and family therapy programs, 4) establishment of a Day Center to support daily structure and rehabilitation, 5) creation of a Mobile Mental Health Unit for community outreach, 6) implementation of mental health promotion activities in the broader community.

The implementation led to transformative changes in care delivery and outcomes. As a result, we observed significant improvement in the following areas: 1) active patient participation in the therapeutic process, 2) enhanced collaboration between staff and patients, 3) creative employment as a therapeutic tool, 4) promotion of personal responsibility in patients, 5) encouragement of initiative from both staff and patients, 6) development of a sense of community within the clinic, 7) significant reduction in involuntary hospitalizations, 8) use of minimal necessary medication, 9) decreased use of restraint methods, 10) improved patient functionality and faster, more complete social rehabilitation, 11) notable reduction in stigma, both within the institution and the community.

Over the past three years, the community psychiatric model implemented at the Adult Psychiatric Clinic of Mytilene has demonstrated that even within a biologically-oriented clinical setting, the need for coercive practices can be significantly reduced. This model fosters a holistic, participatory therapeutic environment, where patients are treated as equal members of the therapeutic relationship and are supported in reclaiming their roles and responsibilities within their families and communities. It represents a practical and effective step toward realizing the principles of Social Psychiatry and community-based care.

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