Attention-Deficit/Hyperactivity Disorder (ADHD) is characterised by cognitive and behavioural tendencies that extend beyond clinical symptoms and can shape social and economic participation. Polygenic scores (PGS) increasingly enable the study of genetic predispositions in population-based settings, offering insight into how inherited liability—regardless of clinical manifestation—may influence life-course outcomes.

This study examined how genetic liability to ADHD relates to a range of economic outcomes in the general population.

We analysed six Finnish population-based cohorts collected between 1992 and 2017 (N ≈ 20,000; ages 25–64), linking registry, survey and genetic data. PGS for ADHD was derived from large-scale genome-wide association studies (Demontis et al. Nature Genetics 2019; 51 63–75) and applied in regression models of educational and labour market outcomes. Models adjusted for demographic and genetic ancestry covariates.

Higher PGS for ADHD were associated with less favourable outcomes across multiple domains of economic performance. Individuals with elevated genetic liability were disadvantaged in both educational attainment and labour market participation. Additional economic disadvantages were largely attributable to earlier sorting into educational and occupational pathways. Moreover, the study offers novel evidence that higher ADHD-PGS is linked not only to objective markers of economic status but also to subjective economic wellbeing.

Genetic predisposition to ADHD is linked to economic disadvantage through multiple pathways across the life course. These findings highlight that ADHD-related genetic liability relates to socio-economic inequality beyond the clinically diagnosed population.

A. Hazak: None Declared, J. Liuhanen: None Declared, K. Kantojärvi: None Declared, S. Sulkava: None Declared, T. Jääskeläinen: None Declared, V. Salomaa: None Declared, S. Koskinen: None Declared, M. Perola: None Declared, T. Paunio Consultant of: Idorsia Pharmaceuticals and Biogen (unrelated to the present work)

Work-family conflict is a widespread issue in modern workforces. However, longitudinal evidence on its mental health impacts remains mixed and inconclusive. While research on non-Western populations is growing, significant gaps remain, especially regarding anxiety and factors that influence the conflict’s effects on mental health.

To examine the short- and long-term contributions of work-to-family conflict (WFC) to mental health and identify factors that may modify the effects of WFC on mental health.

The study was built on the FAMILY Cohort, a large, population-based cohort study in Hong Kong. Two household visits were completed in 2009-11 (Wave 1) and 2011-14 (Wave 2) and a telephone survey was completed in 2023-24 (Wave 3). Mental health outcomes included depressive symptoms (score ≥5) and probable depression (score ≥10), assessed using the Patient Health Questionnaire-9, as well as anxiety symptoms (score ≥5) and probable anxiety (score ≥10), assessed using the Generalized Anxiety Disorder Scale. We also analysed PHQ-9 and GAD-7 scores as continuous outcomes. Moderators included sex, socioeconomic status (SES), family structure, social support from various sources (e.g., domestic helper, supervisor, co-worker, organisational level), and work-family benefits.

The analytic samples comprised 6,056 participants for the short-term (Wave 1 to Wave 2) and 1,061 participants for the long-term (Wave 1 to Wave 3) mental health consequences. Higher baseline WFC scores were associated with short-term depressive symptom scores (incident rate ratio (IRR): 1.04, 95% CI: 1.01-1.07) and long-term anxiety symptom scores (IRR: 1.10, 1.03-1.17) in the fully adjusted models. No significant associations were identified for binary outcomes in the overall sample. Further analyses revealed that these associations were significant among men, specifically, for short-term depressive symptoms (odds ratio (OR): 1.16, 1.05-1.28) and long-term probable anxiety (OR: 1.44, 1.10-1.88), but not among women. The association with long-term anxiety symptoms was strongest among unmarried parents with children aged <10 (IRR: 1.33, 1.14-1.54). Access to childcare support from a domestic helper and the availability and utilisation of work-family policies appeared to buffer the long-term negative effects of WFC on anxiety outcomes.

Our findings provide compelling evidence of the mental health consequences of WFC, revealing gender-specific patterns and emphasising the vital role of domestic helper and work-family policies in balancing work and family demands and promoting mental health in working adults in Hong Kong. The relevance of our findings extends to other Chinese and Asian cities with similar socio-cultural contexts, as well as rapidly developing and high-income cities globally, where WFC is an escalating challenge.

None Declared

Schizophrenia is marked by major impairments in psychosocial functioning. Disability arises from intertwined processes, notably impairments in cognition, motivation, social interactions, and metacognition. The Evaluation of Cognitive Processes involved in Disability in Schizophrenia (ECPDS) is a 13-item scale completed by relatives, focusing on these four processes in daily life. Network analysis provides a framework to examine their interconnections, identify central nodes as potential intervention targets and explore links with external factors.

We tested whether clustering from a network analysis of the ECPDS provides insights beyond its established four-factor structure, identifies items associated with neurocognition, global functioning, quality of life and anticholinergic burden, in order to define intervention targets to guide innovative approaches for psychosocial disability in schizophrenia.

Data came from the FondaMental FACE-SZ cohort, including patients with schizophrenia spectrum disorders; after exclusions, analyses focused on 429. Networks were estimated as regularized partial correlation networks (EBICglasso), with edge and centrality stability assessed via bootstrapping. External variables were a global neurocognition score, the Personal and Social Performance scale (PSP, a clinician-rated measure of overall psychosocial functioning in domains conceptually distinct from the ECPDS, which captures relatives’ perspectives on underlying cognitive and motivational processes), the Subjective Quality of Life scale (SQOL), and the Salahudeen anticholinergic burden scale.

Three clusters emerged in the ECPDS network (image 1): (1) Cognitive Impairments, (2) Avolition, (3) Socio-Metacognitive Deficits. Strongest ECPDS nodes were “Routine organization”, “Adaptation”, “Curiosity”, and “Perspective-taking”. Neurocognition was linked with “Routine organization”, “Non-routine organization”, and “Learning”. PSP connected with “Initiative”, “Project”, and “Use of time” (image 2). For SQOL, only “Use of time” showed a reliable association(image 3). Salahudeen scale related to “Organization”, “Adaptation”, “Learning”, and “Attention”. Bootstrap analyses confirmed stability of centrality estimates.Image 1:

Relatives’ assessments with the ECPDS provide specific insights into psychosocial disability. Difficulties in “organization” and “learning”, when reported by relatives, may help detect patients needing extended neuropsychological assessment. ECPDS scores may also reflect treatment effects, improving with adequate dosing but impaired by anticholinergic burden. Neurocognition, psychosocial functioning and quality of life each captured different aspects, underlining the composite nature of the ECPDS and its potential to guide targeted interventions, with consequences for cognition, functioning, and quality of life.

None Declared

Beyond cognitive and behavioral difficulties, Attention-Deficit/Hyperactivity Disorder (ADHD) is often accompanied by stigma, including negative public attitudes, self-stigmatization, and poor mental health literacy. Such factors may compromise well-being during adolescence and young adulthood, a critical period for identity formation.

This study investigated the associations between ADHD-related traits, stigma, and well-being in Hungarian adolescents and young adults, focusing on how inattention and hyperactivity/impulsivity traits relate to emotional, social, and psychological well-being, and whether stigma components act as mediators.

A cross-sectional community sample (N = 1295, age 14-25) completed validated measures: SWAN (Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Scale), MHC-SF (Mental Health Continuum - Short Form), ASQ (ADHD Stigma Questionnaire), RIBS (Reported and Intended Behaviour Scale), and MAKS (Mental Health Knowledge Schedule). Correlations, linear regressions, and mediation analyses were performed.

Inattention traits were negatively associated with all well-being domains (r = 0.27-0.41, p < 0.001), while hyperactivity/impulsivity showed weaker but significant associations (r = 0.18-0.23, p < 0.001). In multiple regression models, inattention (β = -0.32, p < 0.001) and mental health knowledge (β = 0.12, p < 0.001) emerged as significant predictors of psychological well-being, with internalized stigma (ASQ negative self-image; β = -0.13, p < 0.001) exerting an additional negative effect. Emotional and social well-being were significantly predicted by inattention (β = -0.09 to -0.27, p < 0.01) and mental health knowledge (β = 0.09-0.27, p < 0.01). The final model predicting psychological well-being explained 17.5% of the variance (Adj. R² = 0.175, F(3,694) = 50.124, p < 0.001). Mediation analyses revealed limited but significant indirect effects of inattention on emotional well-being through stigma and knowledge.Image 1:

ADHD-related inattention traits and mental health literacy are key determinants of youth well-being, while internalized ADHD-related stigma directly undermines eudaimonic well-being, which is closely related to good functioning and self-realization. Findings underscore the importance of psychoeducation and stigma-reduction efforts, even in non-clinical populations with elevated ADHD traits.

None Declared

The UK population is ageing rapidly, with a large cohort currently aged 55–65 soon to enter the 65+ age band, increasing demand for old age psychiatry services. Older adults have elevated rates of psychiatric comorbidity, particularly in the context of frailty and dementia (Age UK, 2023). Recent national surveys also indicate rising prevalence of common mental health conditions in younger and middle-aged adults (NHS Digital, 2023), suggesting that future cohorts entering older age may have higher psychiatric morbidity.

This project, commissioned by the Royal College of Psychiatrists’ Faculty of Old Age, aims to guide psychiatrist workforce planning by assessing current service capacity and forecasting future needs, thereby informing College and national policy.

The work comprises three strands: (1) mapping the distribution of the old age psychiatry workforce across the UK, including consultant full-time equivalents (FTEs), regional variation, and training numbers; (2) correlating workforce supply with demographic and epidemiological trends to identify misalignment between need and provision; and (3) modelling future workforce supply and demand, taking into account training patterns, projected retirements, and service use models. Regular supervision is provided by the Faculty Chair and Vice Chair, with stakeholder engagement ensuring applicability to service planning.

Preliminary analyses suggest that demand for old age psychiatry will outpace consultant growth, exacerbating existing regional disparities. Consultant provision in old age psychiatry is insufficient: current estimates indicate approximately one consultant per 23,000 adults aged 65+, projected to deteriorate markedly over the next 10 years without corrective action. This work commenced in August 2025 and is ongoing; full analyses across the three workstreams will be completed by March 2026, with comprehensive results available for presentation at the EPA Congress.

Urgent workforce planning is required to expand training capacity, enhance retention, and align resources with projected demographic and morbidity trends. The findings will be disseminated through publication and national conference presentation, contributing to evidence-based workforce policy for the specialty.

None Declared

The transition to higher education often involves moving away from home and navigating a new social environment. For college students, maintaining pre-existing interpersonal relationships while establishing new social networks presents notable challenges. Successfully fostering social connection has been linked to improved health outcomes, including reduced vulnerability to risky substance use behavior. Nevertheless, substantial variability in the conceptualization of social connection hampers clear insights into its association with substance use behavior and limits the development of targeted prevention and intervention strategies.

This study aims to (1) establish a clear conceptualization of social connection among college students, and to. (2) examine the association between social connection and substance use behavior.

We analyzed data from a representative sample of Flemish college students (n = 21,313; R-indicators of 94%) who participated in the Flemish College Surveys, an online survey conducted between 2022 and 2023. The survey was based on the Composite International Diagnostic Interview Screening Scales (CIDI-SC) which included items on social network characteristics, positive and negative aspects of interpersonal relationships, and substance use behavior. Exploratory (EFA) and confirmatory factor analyses (CFA) were performed to identify the underlying structure of social connection. Subsequently, we examined the unique associations between each factor and substance use behavior.

Through EFA we identified a five factor structure. The factors could be labeled as (1) online network, (2) offline network, (3) social support, (4) social strain, and (5) loneliness. Our analyses indicate that these factors are related to substance use, with substance use being related to denser online and offline networks, lower social support, higher social strain, and higher loneliness.

Given the observed associations between social connection and substance use, targeting specific aspects of social connection may enhance the effectiveness of prevention and intervention programs aimed at reducing substance use among college students.

None Declared

Belgium’s prisons face overcrowding, with many mentally ill offenders (internees) held while awaiting placement in forensic psychiatric hospitals. Long waits and strict criteria delay care for months or years. Some are reincarcerated due to non-compliance or substance use. Psychiatric care in prison is minimal, making prolonged detention harmful. Forensic psychiatric care is mainly residential; community-based services are underdeveloped. Yet, such care can reduce hospital stays, reincarceration, and allow direct prison admissions. Other countries, like the U.S., have advanced models such as Forensic Assertive Community Treatment (FACT), backed by research. Belgium could benefit from implementing FACT alongside residential services to build a full care continuum, shorten wait times, and improve outcomes.

This study explores FACT as a community-based addition to Belgium’s residential forensic psychiatric care.

The research involved four steps: We defined FACT by combining ACT elements linked to positive outcomes with forensic rehabilitation models (RNR and GLM). We then studied a FACT team in Leuven over 33 months (n=70) using a cross-sectional, controlled, retrospective design. We then focussed on substance use disorders due to their impact on outcomes, and reviewing related literature. We then designed a pilot project to reduce the impact of substance use on community tenure. In a prospective study, 24 patients were followed for one year using START (risk) and MATE (substance use). A 5-day intensive cognitive behavioural treatment was offered as an alternative to admission during relapse.

Six ACT elements were linked to positive outcomes: home-based treatment, embedded psychiatrist, integrated substance use and vocational therapy, small caseloads, and 24/7 service. Two forensic elements were added: hybrid professional stance and good judicial communication. FACT patients were over 6 times less likely to be rearrested and 14 times less likely to be reincarcerated, with higher community tenure. However, short admissions were frequent, mostly due to substance use. Substance use disorders were key in deciding whether patients could enter FACT directly from prison or via residential care. In the pilot, patients using the 5-day alternative postponed admission and maintained good community tenure. Risk assessments decreased, and MATE scores remained stable except for increased physical complaints.

FACT is a safe and effective way to add community-based care to Belgium’s residential forensic psychiatric system. Its integration could reduce prison time and prevent reincarceration. Substance use disorders are critical in determining the best entry point into the care continuum to ensure safety and effective treatment.

None Declared

The DSM-5 Cultural Formulation Interview (CFI) is a tool meant to strengthen mental health assessments’ sociocultural sensitivity. While a growing number of studies have demonstrated the value of conducting CFI with adult patients, there is limited knowledge as to the value of using the tool in child mental health assessments.

In this study, we evaluated the standard child mental assessment in primary care when complemented with parental interviews with the CFI.

We used both quantitative and qualitative methods. The effect of the CFI was aimed to be investigated in a quasi-experimental trial including children who had sought care at four primary care based mental health services in Region Stockholm, Sweden. We compared standard assessment to standard assessment enhanced with the CFI. Web questionnaires completed by parents were used to assess treatment credibility, working alliance, mental problems and health-related quality of life. Of the 248 participants required, only 57 had been recruited within 18 months, which led to a premature termination of the study. Qualitative in-depth interviews were conducted with ten parents and five clinicians about their experience of the CFI.

Findings showed no differences in treatment credibility and working alliance between groups but suggested that children allocated to standard assessment enhanced with CFI had significantly lower level of anxiety and depressive symptoms, and higher levels of health-related quality of life. These results should be treated with caution, due to the limited number of children included, and limited pre-treatment assessment. In the qualitative interviews, parents described having been able to share their story, and that the questions during the assessment with the CFI were relevant. However, parents emphasized the importance for the CFI to be used flexibly. Clinicians described an improved understanding of parents’ perspective and of the child’s sociocultural context. However, the CFI questions on cultural identity were described as challenging to ask, and some clinicians found the information produced from the CFI to be too extensive for the primary care context.

While indicating the value of using the CFI in child mental health assessments, our findings highlight the need for a flexible, contextualized use of the tool, and for further refinement of the questions in the CFI.

None Declared

Disgust is a multifaceted aversive emotion. Triggers for disgust reactions extend beyond pathogen-related elicitors, encompassing a wide range of stimuli. Anxiety disorders, obsessive-compulsive disorder, and posttraumatic stress disorder can change the perception of disgust. However, despite growing interest in the different types of disgust and the role of disgust for psychiatric disorders, research of its relevance in eating disorders (EDs) remains limited.

Three studies conducted in the UK between 2022 and 2025 aimed to examine: 1) differences in disgust conditioning between individuals with EDs and healthy controls, 2) relevance of food disgust to attentional and behavioural patterns and ED symptom severity in people with anorexia nervosa (AN), and 3) differences in characteristics of autobiographical memory and future thinking in response to moral disgust-related cues in individuals with EDs and healthy controls.

A multi-method approach was applied across three studies: (1) a pilot study adapted an app-based fear learning paradigm to remotely deliver a Pavlovian disgust conditioning task; (2) a virtual reality (VR) study randomly assigned individuals with AN to one of three virtual kitchen scenarios: (a) virtual kitchen only, (b) virtual kitchen + pet, or (c) virtual kitchen + avatar. Food-specific trait disgust was assessed before VR exposure, and food-specific state disgust was assessed afterward. Food interactions, including eye gaze and touching of virtual food items, were also recorded during VR exposure; and (3) a cross-sectional study examined whether the proportion and vividness of specific autobiographical memories or future events in response to moral disgust-related cues (versus neutral cues) differed between individuals with EDs and healthy controls.

The data provided some support for alterations in disgust experiences and their relevance to the psychopathology of EDs. Individuals with EDs reported higher levels of food disgust and self-disgust compared to healthy controls. Altered disgust extinction may be a mechanism underlying ED psychopathology. Despite non-significant differences in the specificity or vividness of memories and future events, individuals with EDs who reported higher levels of childhood teasing and betrayal sensitivity generated more vivid memories and future events in response to disgust-related cue words—a pattern not observed in healthy controls.

Targeted interventions aimed at assessing and mitigating maladaptive disgust responses may be beneficial for individuals with EDs. Findings also inform potential directions for future research, highlighting how refined methodologies across paradigms could further clarify the mechanistic role of disgust in the onset and maintenance of eating disorders.

None Declared

Whereas childhood adversity is a well-recognised risk factor in the development of psychiatric disorders, there is a lack of descriptive data in clinical population, especially in Eating Disorders (ED).

ED are characterized by difficulties in social communication, and most studies on emotion regulation have revealed disparities in ED samples. The sources of this heterogeneity remain to be explored, and adversity could play a role in determining distinct traumatic pathways, as it is the case for borderline personality disorders, a frequent comorbidity of ED.

Few studies described emotion regulation in adolescents, while delineating emotions perception profiles at this age could allow a better understanding of psychopathology and possibly orientate prevention and treatment.

This communication summarises the literature data on childhood adversity and on emotion regulation in ED. It then presents data from three original studies conducted on adversity and its links to emotional regulation in ED. The aim is to map psychopathological pathways between adversity factors and ED symptoms, to promote tailored therapeutic perspectives.

In the FAMILY & CARE study, maltreatment and at-risk family interactions were measured in 425 hospitalized adolescents among psychiatric main disorders, including a subgroup of 92 adolescents with ED.

In the EURNET-BPD study, adolescents with borderline personality disorders (n = 85) were compared to healthy controls (n = 84), to measure emotional regulation characteristics (alexithymia, level of emotional awareness, facial affect recognition through a morphing paradigm, and empathy). An Eating Disorders sub-group (n = 47) was analysed as a comorbidity of borderline personality disorder.

In the RELADO study, 21 adolescents with ED were compared to 26 control patients and to 42 healthy adolescents. Experimental emotional and body perceptions were measured and correlated to adversity (abuse and neglect): alexithymia, interoceptive awareness, heart beat detection task.

Our results revealed that history of patients with ED was characterized by 39.6% of emotional abuse, 16.5% of physical abuse, 27.5% of sexual abuse and 74.7% of neglect. These patients were more accurate at detecting facial emotions than control patients, and showed higher emotional awareness of others. Their accuracy at detecting body signals (heartbeats) was higher than healthy controls, while self-emotional and interoceptive awareness was lower and correlated to body mass index, and to parental neglect.

These results were used to develop a trauma-informed therapeutic and preventive programme, Artemis, based on the physical and emotional perceptions in adolescents with ED.

Our research confirms the importance of establishing links between adversity and emotional regulation in ED, in order to develop approaches that specifically target these psychopathological pathways.

None Declared

Cognitive impulsivity is referred as the increased preference for an immediate rather than a delayed reward, evaluated in a delay discounting task (DDT) in both humans and rodents. Patients with anorexia nervosa (AN) exhibit an increased sensitivity for delayed reward particularly in acute stages of the disorder (Schuman et al. Sci. Rep. 2025;). Recent findings suggest that the ghrelin/LEAP2 (Liver-Expressed Antimicrobial Peptide 2) ratio impacts the dynamics of reward sensitivity (Andreoli et al. Diab Obes. & Metab 2024), and that LEAP2 could potentially serve as a biomarker of remission in patients with AN (Tezenas du Montcel et al. iScience 2023). We hypothesized that the ghrelin/LEAP2 balance was involved in impulsive food choices during refeeding processes following prolonged food restriction.

We investigated how changes in cognitive impulsivity correlate with the ghrelin/LEAP-2 balance during food restriction and following weight restoration through a translational study in mice and patients with AN.

Impulse control and plasma ghrelin and LEAP2 concentrations were evaluated in a longitudinal study of 30 female patients with AN in the acute stage of the disorder, after weight restoration and 6-months following hospital discharge. Cognitive impulsivity was also assessed in young C57Bl6/J female mice at baseline, after a 15-day 50% quantitative food restriction and following a 10-day refeeding (n=8-12/group). The DDT task was performed in operant conditioning chambers as the choice for a small-immediate or a large-delayed delayed delivered with increasing delays (0 to 40 seconds). We collected blood for ghrelin and LEAP2 measurement and brain areas involved in metabolic response or reward and cognitive control.

Ghrelin/LEAP2 ratio was negatively correlated with impulse control in patients after weight restoration only in patients maintaining weight gain after discharge (n=14) but not in patients with unstable remission (n=16). In mice, food restriction increased cognitive impulsivity and refeeding only partially restored this phenotype compared to control conditions. Cognitive impulsivity was also positively correlated with plasma LEAP2 levels but not with gene expression of main hypothalamic neuropeptides or dopamine D1/D2 receptors in mesocorticolimbic structures.

Our results suggest that the interaction between LEAP2 and cognitive impulsivity is affected by changes in nutritional status in patients and female mice. A prolonged episode of food restriction enhances cognitive impulsivity even after weight regain, which is correlated with plasma LEAP2 concentrations. Metabolic and cognitive consequences of food restriction could be implicated in how food choices are being modified in patients and be associated with a greater likelihood of achieving stable remission in AN.

C. Tezenas Du Montcel: None Declared, H. Hamelin: None Declared, N. Lebrun: None Declared, N. Ramoz: None Declared, P. Duriez: None Declared, P. Gorwood Consultant of: P. G. received during the last 5 years fees for presentations at congresses or participation in scientific boards from Angelini, Biogen, Janssen, Lundbeck, Merk, Newron, Otsuka, Richter and Viatris, O. Viltart: None Declared, V. Tolle: None Declared

Adverse childhood experiences (ACEs) are widely recognized as risk factors for the development of several psychiatric disorders. Among them, neglect is the least studied form of childhood maltreatment. Even less is known about its association with bipolar disorder (BD), a condition characterized by strong biological underpinnings and high familial loading. To date, no meta-analytic work has specifically addressed this relationship.

Primary aim was to evaluate the association between BD and the three main types of childhood neglect, including unspecified (Ne), physical (PN), and emotional (EN), by estimating the Odds Ratios (ORs). Secondary aim was to explore potential moderators of these associations using meta-regression.

A systematic search of PubMed, Scopus, and Web of Science was conducted in September 2024, in accordance with PRISMA guidelines. Studies were eligible if they included adult populations with BD and documented exposure to childhood neglect assessed with validated instruments. ORs were pooled using random-effects models; heterogeneity was assessed with the Cochran’s Q and I² statistic, and multiple meta-regression analyses were performed to explore moderating factors.

Eleven studies met inclusion criteria. Childhood neglect was significantly associated with BD across different subtypes: Ne (OR = 5.89, 95% CI [1.24, 27.90]; I² = 49.2%, p = 0.139), EN (OR = 3.68, 95% CI [1.44,9 .41]; I² = 85.0%, p < 0.001), and PN (OR = 2.80, 95% CI [1.21, 6.46]; I² = 86.3%, p < 0.001) all showed strong associations. High heterogeneity was observed for EN and PN, indicating substantial between-study variability.

The literature increasingly recognizes the role of childhood neglect as a factor that worsens the clinical trajectory of BD, contributing to earlier onset and higher psychiatric comorbidity. Our findings confirm a strong association between neglect and BD, suggesting that neglect amplifies the inherent biological vulnerability of the disorder and leads to a more severe and complex clinical course. Routine assessment of neglect may help guide preventive strategies and tailored interventions for individuals with BD.

None Declared

Immune-inflammatory dysregulation has gained increasing attention among the possible causal frameworks of bipolar disorder (BD) and its relapsing-remitting course. In particular, inflammatory indices derived from the complete blood count (CBC) – including the neutrophil-to-lymphocyte ratio (NLR), the monocyte-to-lymphocyte ratio (MLR), and the platelet-to-lymphocyte ratio (PLR) – have been studied as a proxy for immune-inflammatory processes.

The aim of this systematic review and meta-analysis is to provide a better understanding of the role of inflammation in BD and to identify accessible markers that could inform clinical management.

This work was conducted in accordance with the Meta-analyses Of Observational Studies in Epidemiology (MOOSE) Reporting Guidelines. A protocol was registered in Open Science Framework (OSF) Registries on June 23, 2025 [doi: 10.17605/OSF.IO/NPCX6].

After a full-text review, 51 studies, based on 49 independent samples, met eligibility criteria and were included. Subjects with BD showed higher NLR (k=35; SMD=0.44, 95%CI: 0.30 to 0.59, p<0.001; I2=92.2%) and MLR (k=20; SMD=0.28, 95%CI: 0.14 to 0.42, p<0.001; I2=88.1%) than healthy controls (HCs), while no significant differences in PLR were observed (k=29; SMD=0.05, 95%CI: –0.06 to 0.16, p=0.373; I2=85.5%). In subjects with a manic episode, NLR (k=24; SMD=0.62, 95%CI: 0.41 to 0.83, p<0.001; I2=93.7%), MLR (k=14; SMD=0.51, 95%CI: 0.37 to 0.65, p<0.001; I2=78.3%), and PLR (k=21; SMD=0.18, 95%CI: 0.04 to 0.33, p=0.014; I2=85.8%) were higher than in HCs. In subjects with a depressive episode, PLR was significantly lower than in HCs (k=10; SMD=–0.14, 95%CI: –0.22 to –0.06, p<0.001; I2=27.2%), and no significant differences emerged for NLR (k=12; SMD=0.19, 95%CI: –0.03 to 0.42, p=0.091; I2=91.2%) and MLR (k=8; SMD=0.11, 95%CI: –0.11 to 0.32, p=0.342; I2=88.5%). In euthymic individuals, NLR was higher than in HCs (k=15; SMD=0.37, 95%CI: 0.14 to 0.61, p=0.002; I2=86.8%), while no significant differences were found in MLR (k=8; SMD=0.11, 95%CI: –0.19 to 0.42, p=0.459; I2=85.9%) and PLR (k=13; SMD=–0.03, 95%CI: –0.23 to 0.16, p=0.756; I2=77.3%).

Despite generally high statistical heterogeneity, this work strengthens the case for higher inflammation in people with BD compared to HCs. In particular, mania bears the most marked inflammatory profile. The presence of residual, trait-like inflammation in euthymia was also observed. Taken together, our findings support the role of NLR, MLR, and PLR as accessible trait and state markers of BD.

None Declared

Bipolar disorder (BD) presents with heterogeneous longitudinal cycling patterns: manic-depressive (MD), depressive-manic (DM), and irregular (IRR). Although cycle type has long been considered a central feature, studies systematically examining its impact on clinical course remain limited.

To investigate associations between cycle type (MD, DM, IRR) and clinical-demographic features in a large, well-characterised sample of BD-I and BD-II patients, with focus on onset polarity, hospitalisations, suicidality, seasonality, predominant polarity, and diagnostic subtype.

A total of 378 outpatients with DSM-5 BD-I/BD-II were assessed using life charts to classify cycle type. Clinical and demographic variables were collected via structured interviews and records. Group differences were tested with chi-square and ANOVA/Kruskal–Wallis; multivariate logistic regressions assessed independent associations.

Among 378 patients, 140 (37.0%) showed MD, 92 (24.3%) DM, and 146 (38.6%) IRR cycles. MD patients were more likely to present manic/hypomanic onset, manic predominant polarity, BD-I diagnosis, and higher hospitalisation rates. DM cycles strongly associated with depressive onset and depressive predominant polarity. Both MD and DM showed higher seasonality than IRR. BD-II was more frequent in DM and IRR. Suicidal ideation did not differ; suicide attempts were more frequent in IRR.Table 1.

Key clinical characteristics by cycle type

Cycle type represents a clinically meaningful longitudinal specifier in BD. Early recognition may inform prognosis and guide personalised preventive and therapeutic interventions. Systematic adoption of cycle pattern classification could enhance precision psychiatry in bipolar disorder.

None Declared

Eating disorders (EDs) and substance use disorders (SUDs) often coexist, leading to significant clinical challenges and poorer treatment outcomes. This comorbidity is characterised by a complex interplay of biological, psychological, and social factors, which complicate both diagnosis and treatment. However, there is a notable gap in research populations, where cultural, social, and economic factors can influence the manifestation and progression of these disorders. The stigma associated with both eating disorders and substance abuse further complicates the clinical landscape. Patients may be reluctant to seek help due to societal judgement and lack of awareness, leading to underdiagnosis and inadequate treatment.

• - To determine the rate of eating disorders among female patients with methamphetamine substance use disorders.

• - To identify the demographic, psychological, and social correlates associated with the co-occurrence of these disorders.

• - Type of Study: It is a cross-sectional observational study.

Age range: 18-45 years old.

Egyptian nationality

• - study tools:

• - MINI: The Mini-International Neuropsychiatric Interview

• - Addiction severity index (ASI)

Eating Attitudes Test-26 (EAT-26)

• - Dysmorphic Concern Questionnaire (DCQ)

This study found that many female adolescents who use methamphetamine also have body dysmorphia (BDD), with 35% of those with BDD also having an eating disorder. These include anorexia nervosa (15%), bulimia nervosa (9%), and other eating disorders (22%). Methamphetamine use, often linked to body image improvement and self-esteem, was reported by 25% of women with bulimia and 6% with anorexia. The use of methamphetamine to suppress appetite and enhance body image often worsened disordered eating behaviours. Additionally, 60% of women with eating disorders had a substance use disorder, and 45% of those with a substance use disorder had an eating disorder. This combination of disorders significantly increased the risk of medical and psychiatric complications, including mood disorders and psychosis.

The co-occurrence of methamphetamine use and eating disorders in female adolescents represents a major clinical challenge. Integrated treatment approaches that address both conditions simultaneously are essential for improving outcomes. Clinicians should be aware of the heightened risks and the importance of a comprehensive, trauma-informed treatment plan. The findings highlight the need for further research to refine these approaches and ensure effective, long-term recovery for this vulnerable population.

None Declared

The stigma literature shows that negative attitudes and discriminatory interactions lead to poorer health experiences and reduced life expectancy.Stigma is ubiquitous and healthcare providers are not immune from the outward internal and systematic manifestations of stigma in their practices. The way health care providers view patients can determine the quality of care that is provided and impact the overall treatment outcomes. There is a dearth of research which synthesizes the experiences of stigma of persons living with personality disorders (PD). No known systematic reviews have focused on the experiences of stigma for persons living with a PD.

To synthesize existing qualitative research exploring experiences of stigma for people with PDs and to identify gaps and areas of saturation in the existing current literature.

We deployed a systematic search of seven academic databases: Medline, PsychINFO, EMBASE, SCOPUS, Nursing and Allied Health Abstracts, Social Work Abstracts, and Sociological Abstracts. We followed the methodology described by the Joanna Briggs Institute (JBI) to complete a systematic review of experience and meta-aggregation. Consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a title/ abstract screening of every article identified in the search, a full text review, and data extraction followed by a meta-aggregation of the findings of the included studies.

After de-duplication, 6,079 records remained. In total, 48 studies were included in the final review (Figure 1). Half of the included studies (n=24; 50%) represented participants in Europe. Across 47 of these studies, 1,157 participants living with a PD were included. Samples focused primarily on Cluster B PDs, mainly borderline personality disorder (BPD) and antisocial personality disorder (n=1,069), with the remaining participants (n=89) described as general PDs. No studies capturing the distinct experiences of people with other PD diagnoses (e.g., schizoid) were identified. The meta-aggregation yielded 98 extracted themes which were organized into four synthesized findings: 1) the cost of labelling personality: clarity and confusion; 2) (‘ill’) legitimacy, burden, and powerlessness; 3) stigma in health-care settings and its influence on treatment; and 4) resistance to stigma and pathways to recognition: reframing and connecting.Image 1:

In this research, we identified a range of gaps and areas of saturation in research exploring the experiences of stigma for individuals living with PDs. Future research should explore the experiences of stigma faced by people with other PDs beyond BPD. We recommend that practitioners increase their awareness of the high degrees of stigma described by individuals living with PDs in the context of healthcare encounters, and revise their practice in ways that mitigate this stigma.

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Cancer diagnosis frequently leads to psychosocial distress, including anxiety, depression, and reduced quality of life. Although psychosocial support is essential, access barriers limit timely care. Artificial intelligence (AI) has emerged as a scalable and accessible means of delivering psychosocial interventions.

This study systematically reviewed randomized controlled trials (RCTs) evaluating AI-based interventions addressing psychosocial needs in cancer patients, focusing on intervention types, effectiveness, and implications for supportive care.

Following PRISMA guidelines, a systematic review was conducted (PROSPERO: CRD420251134621). Database searches identified 996 records; 143 full texts were assessed, and 7 RCTs met inclusion criteria, encompassing 913 cancer patients. Eligible studies tested AI-based interventions designed to address unmet psychosocial needs. Risk of bias was assessed using the Cochrane RoB 2 tool.

Interventions included chatbots, mobile apps, digital counseling, and app-based therapeutics. Most demonstrated positive psychosocial effects, with significant reductions in anxiety, depression, and distress, particularly in younger patients and those receiving chatbot or app support. Additional benefits included improved self-efficacy, social support, knowledge, and empowerment. Some studies also reported reductions in fatigue and improved attitudes toward AI. While certain trials showed no significant effects on distress or quality of life, feasibility, acceptability, and patient satisfaction were consistently high. Secondary benefits included reduced pain, fewer pain-related hospitalizations, and better symptom management (Image 1).Image 1:

RCT evidence indicates that AI-based interventions can effectively reduce psychosocial distress and related symptoms in cancer patients, while enhancing empowerment and self-management. Despite mixed effects on quality of life, consistent psychological and symptomatic benefits highlight their potential as valuable adjuncts to oncology care. Further large-scale, culturally diverse, and long-term trials are needed to confirm generalizability and sustainability.

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Network analysis provides a methodological alternative to traditional latent variable approaches by conceptualizing psychiatric disorders as systems of interacting symptoms. While cross-sectional network studies map comorbidity at a single point in time, repeated measures are needed to understand how these structures evolve. Longitudinal and repeated cross-sectional designs offer distinct strategies: the former tracks intra-individual symptom dynamics, while the latter captures population-level changes across independent samples. Methodological guidance on how to apply network analysis to comorbidity over time remains scarce, despite increasing demand to study the impact of contextual factors such as pandemics or socioeconomic stressors.

Demonstrate methodological strategies for applying network analysis to the study of comorbidities across time, and to illustrate their application with a repeated cross-sectional analysis of depressive symptoms and alcohol use disorder.

We outline a stepwise framework for temporal network studies of comorbidity. Key stages include: (1) design selection (cross-sectional, repeated cross-sectional, longitudinal), (2) consistent measurement of symptom sets across time, (3) network estimation using regularized models, (4) evaluation of central and bridge symptoms with indices tailored to cross-disorder connectivity, (5) assessment of accuracy and stability via bootstrapping, and (6) network comparison across time points with formal tests of structural invariance. As an applied example, we employed a repeated cross-sectional study using Peruvian survey data on depressive symptoms and alcohol use disorder between 2018 and 2023, with more than 30,000 cases in each year.

he framework enabled detection of stable within-disorder symptom clusters and identification of bridge nodes linking depression and alcohol use. In Peru, worthlessness and guilt consistently emerged as central depressive connectors, while withdrawal acted as a key alcohol-related bridge. Cross-disorder associations intensified in 2020 during the COVID-19 pandemic, illustrating how external stressors can reshape comorbidity structures. Formal comparison confirmed overall invariance across years, highlighting both the sensitivity of the approach and the boundaries of repeated cross-sectional designs.Image 1:

The methodological guide demonstrates how temporal network analysis supports identification of core and bridge symptoms in comorbidity. Repeated cross-sectional designs capture population-level responses to contextual stressors, while maintaining feasibility at scale. This approach equips researchers with a practical roadmap to design, estimate, and interpret comorbidity networks across time, offering actionable insights for clinical and public health interventions.

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Depression is prevalent among patients with chronic heart failure (CHF) and is associated with increased morbidity, hospitalization, and reduced quality of life. Inflammation and neurohormonal dysregulation are hypothesized to underlie this association. However, few studies have evaluated depressive symptoms in CHF patients in relation to proinflammatory cytokines, natriuretic peptides, and functional status.

To assess the relationship between depressive symptoms and levels of TNF-α, NT-proBNP, and clinical variables including anxiety and quality of life among patients with CHF.

A total of 120 patients diagnosed with CHF (NYHA II–III) were recruited. Depression was assessed using the Beck Depression Inventory (BDI), and anxiety with the Generalized Anxiety Disorder scale (GAD-7). Quality of life was evaluated using EQ-5D. Serum levels of TNF-α and NT-proBNP were measured by ELISA method. Echocardiographic parameters, demographic variables (age, sex), and lipid profiles were recorded. Correlation and subgroup analyses were conducted to assess associations between biomarker levels and psychological/clinical outcomes.

Depressive symptoms (BDI ≥14) were present in 66.7% of patients. Higher depression scores correlated significantly with elevated TNF-α (r = 0.48, p < 0.01), NT-proBNP (r = 0.42, p < 0.01), and anxiety levels (GAD-7, r = 0.61, p < 0.001). Patients with depression also reported significantly lower EQ-5D index scores (mean 0.56 vs. 0.74, p < 0.001). Women reported higher depressive and anxiety scores than men (p < 0.05), while older patients (>65) showed stronger correlations between NT-proBNP and emotional distress. No significant correlation was observed between lipid levels and depressive symptoms.

Depression in CHF patients is significantly associated with elevated inflammatory and neurohormonal markers, as well as anxiety and reduced quality of life. These findings underscore the importance of psychosomatic assessment in CHF management. Future research should explore integrated treatment strategies targeting both physiological and psychological domains.

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Substance use disorder (SUD) is highly prevalent in individuals with schizophrenia, with a lifetime prevalence of around 40%, and is consistently associated with poor outcomes. However, prior studies have yielded inconsistent results regarding its associations with negative symptoms, cognition, and functioning. The present study adopted a multivariate approach to delineate the clinical and functional profile of patients with schizophrenia and comorbid SUD.

We aimed to identify sociodemographic, clinical, premorbid, cognitive, functional, and coping dimensions associated with SUD in schizophrenia, using data from a large multicenter cohort.

This cross-sectional study included 922 clinically stable patients with DSM-5 schizophrenia consecutively recruited within the Italian Network for Research on Psychoses. SUD diagnosis was established with the MINI. Assessments included PANSS, BNSS, PAS, SLOF, MCCB, MSCEIT, and Brief COPE. Group comparisons were followed by multivariate logistic regression and causal mediation analysis.

Of 922 participants, 240 (26.0%) had comorbid SUD. Compared to non-SUD, they were more often male (80.8% vs 65.5%), younger (38.4 vs 40.8 years), with earlier onset (22.5 vs 24.6 years) and more hospitalizations (5.1 vs 3.2). In the SUD group, PAS showed poorer academic functioning (p < .00001) with relatively better social functioning (p < .00001) across childhood and adolescence. BNSS scores were lower for both MAP (11.5 vs 13.3, p = .003) and EXP domains (19.5 vs 21.1, p = .033). No group differences emerged for PANSS positive, disorganization, cognition, or social cognition. Regression indicated higher odds of SUD with maladaptive coping (COPE substance use OR 1.44, p < .001; self-distraction OR 1.21, p < .001), poorer PAS academic functioning in early adolescence (OR 1.44, p = .003), and better SLOF physical functioning (OR 1.18, p = .030). Protective effects were observed for PAS social functioning (OR 0.55, p < .001), higher BNSS EXP scores (OR 0.79, p = .011), and better SLOF work skills (OR 0.96, p = .016). Mediation analysis showed that the protective effect of premorbid social functioning was largely direct, with only about 10% mediated by lower severity of EXP symptoms, suggesting that reduced expressive deficits may indirectly increase opportunities for substance exposure.

In our study, comorbid SUD in schizophrenia emerged as a distinct clinical profile, characterized by early academic difficulties, preserved premorbid social functioning, lower severity of negative symptoms, and maladaptive coping strategies. These findings suggest that SUD may reflect a different trajectory of illness, rather than its greater severity. Preventive school-based initiatives, together with structured psychosocial interventions, could play a crucial role in reducing vulnerability in this subgroup.

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