Cognitive dysfunctions are considered as core features of schizophrenia and significantly affect functional outcomes. Physical exercise has emerged as a promising non-pharmacological strategy to enhance cognitive functioning in schizophrenia patients.Aerobic exercise has consistently demonstrated positive effects on domains such as attention,memory, and executive functions (Shimada et al. Psychiatry Res 2022; 314:114656). While the benefits of regular aerobic exercise are well-established, recent meta-analyses indicate that even a single session of moderate-intensity aerobic exercise can acutely enhance cognitive performance(Chang et al. Brain Res 2012; 1453:87–101).

This study aims to investigate the effects of a single session of moderate-intensity aerobic exercise on cognitive performance in individuals with schizophrenia and healthy controls,to determine whether the effects differ between groups and to better understand the underlying mechanisms.

The study included 58 participants:29 individuals with schizophrenia and 29 healthy controls.It was conducted in two sessions.All participants first performed a cardiopulmonary exercise test (CPET) on a cycle ergometer to assess aerobic capacity.Target intensity for the acute exercise session was calculated using the VO₂ reserve method.Later, participants completed a second session to evaluate the acute effects of exercise on cognitive function.Cognitive tests were administered before and after the exercise and included the Trail Making Test(TMT), Digit Span Tests(DST), Auditory Verbal Learning Test(AVLT), Verbal Fluency Test(VFT), and Stroop Test(ST). A 2×2 mixed design repeated-measures ANOVA was used to examine changes in cognitive performance as well as the group effect.

Acute aerobic exercise significantly improved performance on ST(p=<.001). No significant group-by-time interaction or group effect was observed.TMT Part A and B completion times were reduced post-exercise(p<.001, both), with significant main effects of group in both (p<.001, both) but no interaction effects.VFT improved significantly after exercise (p=.026); the schizophrenia group showed lower overall performance(p=.003), with no significant interaction effect. In DST forward and backward performances, only exercise had significant effects (p<.001;p<.003). AVLT learning scores showed a significant group-by-time interaction (p=.027) and group effect(p=.002), with no exercise effect. Spontaneous recall showed only a significant group effect (p=.004).

A single session of aerobic exercise improved cognitive performance of both individuals with schizophrenia and healthy controls, particularly attention and processing speed.Although patients showed lower performance, the magnitude of improvement was comparable across groups. These findings suggest that acute aerobic exercise may offer a simple, non-pharmacological strategy to enhance cognition in schizophrenia.

None Declared

Schizophrenia (SZ) is a neurodevelopmental disorder with an evolutionary trade-off for human-specific cognitive abilities. Cortical sulcal patterns, tightly linked to evolution and neurodevelopment, represent potential SZ markers prenatally shaped by sulcal pits, the deepest points of cortical sulci. Human Accelerated Regions (HARs), evolutionary genomic elements, may link evolutionary and developmental factors in SZ, through the influence of their prenatal expression on cortical morphology.

i) To test the divergence of SZ sulcal pit patterns relative to healthy controls (HC) across lobes and hemispheres; ii) to evaluate the influence of HARs-related gene expression on this divergence.

The sample included 426 adults (237 SZ/189 HC) with T1-weighted MRIs (1.5 T). Sulcal pits were extracted from FreeSurfer-derived white matter surfaces. Graphs were created for each lobe and hemisphere and compared between SZ and HC using sulcal pit position (SP-Position), depth (SP-Depth), basin surface area (SP-SAbasin), topology (SP-Topology), and combined features (SP-Combined). Transcriptomic data (BrainSpan) included 179 HARs-related genes across 13, 21, and 37 post-conception weeks. Covariation between transcriptomic data and the differences in sulcal pits patterns was tested by Partial Least Squares Regression models.

SZ patients exhibited reduced pit similarity to HC in: i) the left frontal lobe (SP-Combined) in males, ii) in the right parietal lobe (SP-Topology) in females. HARs gene expression during prenatal stages covariated with group differences in a sex-specific manner.

Sulcal pits emerge as sex-specific early neurodevelopmental markers in SZ. These findings provide the first evidence of HARs-driven transcriptional influence on sulcal pits patterns, supporting the neurodevelopmental and evolutionary component of the disorder.

ISCIII: PI20/01002, FI21/00093-NH, CP20/00072-MFV, MV23/00059-NH, co-funded by ERDF/ESF; AGAUR: 2021SGR01475.

None Declared

Sex differences in schizophrenia (SZ) are well-documented in terms of age of onset, symptoms, and treatment response. However, sex is often treated as a covariate rather than a primary variable of interest. Continuous “sex-scores” have been proposed to quantify the “maleness/femaleness” of multiple traits, as a complement to biological sex.

We aimed: i) to compute brain sex-scores in healthy individuals (HC) and SZ patients and; ii) to examine the association of brain sex-scores with SZ symptoms.

In Sample A (215 males, 211 females HC), sex effect coefficients were obtained for 34 cortical regions (Desikan-Killiany atlas) through linear regressions of cortical thickness (CT) and surface area (SA). In Sample B (237 SZ patients), individual-level CT and SA values were summed and weighted by the sex effect coefficients obtained from Sample A to compute sex-scores ranging from 0 (maximum maleness) to 1 (maximum femaleness). We assessed correlations between sex-scores and Positive and Negative Syndrome Scale (PANSS) in SZ patients, separately for males and females.

CT sex-scores showed significant correlations with PANSS-Negative symptoms in females (r2 =-0.4; pFDR=0.017). In males, CT sex-scores were associated with PANSS-Positive symptoms (r2=-0.18; pFDR=0.033) and general psychopathology (r2=-0.24; pFDR=0.009).

Our data suggest that lower CT sex-scores (associated with greater maleness) are related to more severe symptoms, highlighting the importance of considering sex-related variability in a quantitative manner. Then, sex-scores emerge as a useful tool to study sex- and gender-related variability in the neurobiology and clinical expression of schizophrenia.

ISCIII project-PI20/01002, grant-FI21/00093-NH, grant-CP20/00072-MFV co-funded by ERDF/ESF; AGAUR-2021SGR01475; Beca Santander-Estades formatives Espanya i estranger 2024 doctorands UB-NH; Beca de Recerca Bàsica de l’Acadèmia 2025.

None Declared

Schizophrenia is a severe neuropsychiatric disorder with emerging evidence implicating neuroinflammation and immune dysregulation in its pathophysiology. Resolvin D1 (RvD1), a specialized pro-resolving lipid mediator derived from omega-3 fatty acids, exhibits potent anti-inflammatory, anti-apoptotic, and neuroprotective properties. This study explores the role of RvD1 in schizophrenia, focusing on its potential as a trait marker.

This study aimed to compare serum RvD1 levels between patients diagnosed with schizophrenia using the Structured Clinical Interview for DSM-5 (SCID-5) and healthy controls, and to evaluate its suitability as a trait marker for the disorder.

A total of 81 participants (55 patients with schizophrenia, 26 healthy controls) were included. Serum RvD1 levels were measured. Non-normal data distribution (Shapiro-Wilk test, p<0.05) led to the use of a Mann-Whitney U test for group comparison. Effect size was calculated using Cohen’s d.

Serum RvD1 levels were significantly elevated in schizophrenia patients compared to controls (p = 0.00119). The median RvD1 level was markedly higher in the schizophrenia group (457.54 pg/ml; IQR: 374.71–561.33) compared to the control group (373.52 pg/ml; IQR: 364.61–399.66). The effect size was moderate (Cohen’s d ≈ 0.49), indicating a clinically relevant difference.

This study demonstrates significantly higher serum RvD1 levels in schizophrenia patients, suggesting a compensatory anti-inflammatory response to underlying neuroinflammation. These findings position RvD1 as a promising trait marker for schizophrenia. Further validation in larger cohorts and investigation into its mechanistic pathways are recommended to confirm its diagnostic and therapeutic potential.

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There is a clear gap between international guidelines, which recommend replacing coercive aggression management methods with alternative interventions, and their inconsistent and unsystematic implementation in clinical practice. This situation underscores the need for evidence-based aggression management strategies. The care bundle approach, designed to standardize care and improve outcomes, is a promising solution.

This study aimed to develop a care bundle for the management of aggression in patients diagnosed with schizophrenia and receiving inpatient treatment and to evaluate its clinical outcomes.

The study was conducted in two phases. 1) the aggression management care bundle was developed by conducting a systematic literature review according to the Bundle Design Guidelines. 2) the six-element care bundle was implemented in a male psychiatric ward of a regional hospital using a sequential randomized controlled trial design, and the outcomes were evaluated (Figure 1). The study was conducted with 24 patients (12 in the experimental group and 12 in the control group). Data were collected using the Patient Information Form, Buss-Perry Aggression Scale, Brøset Violence Checklist, Overt Aggression Scale, and Care Bundle Compliance Follow-up Schedule. Data were analyzed using Pearson’s chi-square test, independent samples t-test, Mann-Whitney U test, paired samples t-test, two-way ANOVA for multifactor analyses, and linear mixed model analyses for mixed models.

Findings indicated a significant reduction in the experimental group’s total Buss-Perry Aggression Scale score and all subdimensions following care bundle implementation (p=0,001). The control group also exhibited decreases in total aggression (p=0,007), physical aggression (p=0,001), and anger scores (p=0,001). Intergroup pre-test–post-test differences were statistically significant in favor of the experimental group (p<0,001). Although Brøset Violence Checklist scores declined over time in both groups, no significant intergroup difference was observed (p>0,05). It was found that the BVC total score, irritability, boisterous, physical threat, and attack on objects sub-dimensions were affected by daily/momentary changes, while the confusion and verbal threat sub-dimensions were affected by the patient’s standard/permanent characteristics. According to the Overt Aggression Scale, aggressive incidents (control: 9, experimental: 6) and interventions applied did not differ significantly between groups (p>0,05). The care bundle demonstrated high clinical utility, with a 90,15% compliance rate.Image 1:

The aggression management care bundle was found to be an effective and applicable for male patients with schizophrenia. It is recommended that the care bundle be applied to larger samples, individuals with different psychiatric diagnoses, and female patients.

This registration was supported by the Scientific and Technological Research Council of Turkey (TUBITAK) under the Grant Number 1919B022509487. The authors thank TUBITAK for their support.

None Declared

We present a conversational-AI platform for simulation-based psychiatric training. The platform includes 100 clinically grounded use cases across three communication-difficulty tiers (cooperative, resistant, and non-cooperative), enabling practice in adaptive questioning and de-escalation. During each interview, the system renders a time-ordered series of simple avatar images. When a medication is mentioned, students can open the integrated drug module to view the package leaflet.

We aim to extend our conversational-AI virtual-patient platform into a comprehensive, clinically curated set of 100 psychiatry use cases, and to examine how graded communication difficulty shapes learners’ questioning strategies. To support presence and engagement, we added simple avatar visuals that depict only the patient’s physical appearance. When medications arise in dialogue, an integrated drug module reveals the package leaflet enabling context-aware medication education.

Users interview a virtual patient via text or voice; a large language model (LLM) pipeline maps utterances to intents and generates guarded, diagnosis-consistent replies. The library now comprises 100 clinician-curated patient profiles derived from real cases, de-identified records, and carefully synthesised data, spanning diverse diagnostic scenarios (Fig. 1). During interviews, the system renders a simple avatar sequence to visualise the patient’s physical appearance (not mental-status change). Built-in tools let learners inspect relevant physiological/clinical examinations (Fig. 2), while an embedded assessment engine evaluates adherence to ethical and methodological standards and verifies diagnostic accuracy (Fig. 3).

Building on our prior pilot, where psychiatrists rated dialogue realism highly and students reported improved confidence with an average diagnostic score of ~71%, the expanded platform functioned reliably at scale with 100 curated cases. System latency remained low; trainees engaged smoothly with three communication tiers, and interaction logs showed expected shifts toward more targeted, clarifying questions in “so-so” and non-cooperative scenarios. The avatar visuals were well-received for anchoring patient identity without implying clinical state. When medications were mentioned, learners successfully used the integrated drug module.Image 1:

A conversational-AI psychiatry simulator with graded communication difficulty, simple avatar visuals, and an in-context drug module is feasible and well-accepted, supporting medication-safety reasoning. Interaction analytics indicate more targeted questioning as difficulty increases, while learners efficiently retrieve drug information in context. The platform is ready for curriculum integration with automated feedback and educator dashboards; comparative outcomes will be reported.

None Declared

Quality of life in oncology is a multidimensional construct encompassing physical, psychological, and social domains, particularly in advanced stages of disease. Cancer patients often experience pain, fatigue, and prolonged exhaustion, limiting daily functioning. Coping with the trauma of diagnosis, side effects of treatment, and maintaining psychosocial stability are crucial challenges. Supportive medical, psychological, rehabilitative, and palliative care, along with family and professional support, play a key role in improving wellbeing during chemotherapy.

The primary objective was to assess the quality of life of cancer patients undergoing chemotherapy and to identify sociodemographic and clinical factors influencing its different domains.

A cross-sectional study was conducted among 226 oncology patients undergoing chemotherapy in the West Pomeranian Voivodeship, Poland. Data were collected using a diagnostic survey method, which included an original questionnaire and standardized Polish versions of validated research tools: the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the Functional Assessment of Cancer Therapy–General (FACT-G), and the Depression, Anxiety, and Stress Scale (DASS-21).

Most patients received intravenous chemotherapy (83.09%), usually for less than five years and up to 20 cycles. Quality of life scores varied significantly by age, education, marital status, and residence. The patients treated for less than one year reported better physical and functional wellbeing compared to those treated for 1–5 years or more than 10 years. Higher numbers of chemotherapy cycles correlated with better social functioning but also increased dyspnea. The respondents with colorectal and breast cancer achieved higher social and functional wellbeing compared to those with bladder, cervical, or renal cancers. Commonly reported symptoms negatively affecting quality of life included pain, fatigue, irritability, and helplessness. A significant negative correlation was observed between depression, anxiety, and stress and functional/social wellbeing.

The chemotherapy patients reported reduced quality of life, mainly due to insomnia, fatigue, and appetite loss. Shorter treatment duration and oral regimens were linked to better outcomes, while comorbidities and long-term therapy worsened them. Depression, anxiety, and stress strongly correlated with lower physical, emotional, and social functioning, with colorectal and breast cancer patients showing relatively higher wellbeing.

None Declared

Coronary artery bypass grafting (CABG) is among the most frequently performed interventions globally for the treatment of coronary artery disease (CAD). Anxiety and depression are common among patients undergoing coronary artery bypass graft (CABG) surgery and are associated with poorer recovery and quality of life.

Psychosocial interventions are increasingly used to address mental health needs in cardiac populations, but evidence regarding their effectiveness in CABG patients remains limited and inconsistent. This study sought to clarify their impact through systematic review and meta-analysis.

A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines and registered in PROSPERO database (No: CRD420251022254). Randomized controlled trials (RCTs) published within the last 10 years were retrieved from nine databases. Eligible studies evaluated psychosocial interventions targeting anxiety and/or depression in CABG patients. Risk of bias was assessed using the Cochrane RoB 2 tool. A random-effects model was used to calculate pooled effect sizes (Hedges’ g).

Seven RCTs (n = 1,371) were included. Interventions comprised psychoeducation, web-based support, and relaxation-based methods. Meta-analysis showed a significant reduction in anxiety symptoms (Hedges’ g = –0.51, p = .004; I² = 72.9%), indicating a moderate effect. For depression, the pooled effect was not statistically significant (Hedges’ g = –0.38, p = .059; I² = 51.4%), although some studies reported delayed or subgroup-specific improvements.

Psychosocial interventions appear effective in reducing anxiety in CABG patients, while their impact on depression is less clear and may depend on longer-term or tailored approaches. The evidence supports a paradigm shift toward integrated, multidisciplinary care for CABG patients, where psychosocial health is addressed as a core component of recovery alongside physical rehabilitation.Further rigorous trials are needed to establish their role in routine post-CABG care.

None Declared

Mindfulness can be defined as intentional, non-judgmental awareness of the present moment, including inner states and external environment. It is both a trainable skill and a personality trait, associated with stress reduction, enhanced well-being, and emotion regulation. Compassion refers to the emotional response of caring for another who is suffering, combined with a motivation to help. While mindfulness and compassion have been linked to reduced prejudice and intergroup bias, their role in addressing stigma toward people with mental illness remains understudied. This is particularly relevant in healthcare, where stigma can negatively affect treatment, recovery, and quality of life.

The aim of this study was to examine the associations between mindfulness, self-compassion, compassion, and stigma toward people with mental illness among medical and nursing students.

This cross-sectional study was conducted among students of a medical faculty (n=240). Data were collected online. Validated Czech versions of the Self-Compassion Scale (SCS), Santa Clara Brief Compassion Scale (SCBCS), Five Facet Mindfulness Questionnaire (FFMQ), Perceived Stress Scale (PSS), and the Opening Minds Scale for Health Care Providers (OMS-HC) were administered. Multiple linear regression analyses were performed with OMS-HC total scores as the dependent variable, and FFMQ, SCS, SCBCS, and PSS as predictors, adjusting for gender, grade, field of study, mindfulness practice, and experience with mental illness.

The average OMS-HC total score was 31.5, with subscale means of 13.3 for attitudes, 7.8 for disclosure, and 10.4 for social distance, suggesting overall low levels of stigma. Regression analyses showed that experiencing mental illness (B=–0.202, p=.002) and greater compassion (B=–0.224, p=.001) were significantly associated with lower stigma. In contrast, higher mindfulness scores were unexpectedly associated with greater stigma (B=0.202, p=.002). Self-compassion and perceived stress were not significant predictors. The overall model explained 15.6% of the variance in stigma.

This study highlights the destigmatizing potential of compassion and lived experience with mental health problems. Surprisingly, mindfulness was associated with higher stigma, which raises questions about the differential role of specific mindfulness facets. These findings suggest that not all forms of mindfulness function uniformly, and that general attentional awareness (trait mindfulness) may differ in its effects from compassion-oriented mindfulness practices. These findings underscore the relevance of integrating compassion-based approaches into medical education to promote more inclusive attitudes toward people with mental illness.

None Declared

Healthcare professionals are frequently exposed to high levels of stress, emotional strain, and demanding work conditions, which may lead to psychological distress and burnout. Emotional intelligence (EI), defined as the ability to recognize, regulate, and use emotions effectively, is considered a protective factor that enhances resilience, reduces stress, and improves quality of life (QoL). Understanding the interplay between EI, psychological distress, and QoL is crucial for safeguarding the well-being and professional effectiveness of healthcare workers.

This study aimed to investigate the relationships between emotional intelligence, psychological distress, and quality of life among healthcare professionals. Specifically, it examined: (1) the effect of EI on stress management and resilience; (2) the role of EI as a protective factor against psychological distress; and (3) the extent to which EI contributes to improved quality of life.

A cross-sectional study was conducted with a random sample of 250 healthcare professionals from hospital settings (82.8% women, mean age = 41.9 years, SD = 10.5). Participants represented various specialties, including physicians, nurses, therapists, and administrative staff. Data were collected using standardized questionnaires: the NHS Emotional Intelligence Questionnaire (five EI subscales), the Kessler K10 Scale (psychological distress), and the ProQOL Scale (quality of professional life).

The mean EI subscale scores indicated relatively high levels of self-awareness (M = 38.9) and empathy (M = 36.7), but lower emotion regulation (M = 33.2). Psychological distress scores averaged 30.2, reflecting moderate risk levels. Professional quality of life showed high compassion satisfaction (M = 37.8), low burnout (M = 24.4), and moderate secondary traumatic stress (M = 30.6). Strong positive correlations were found among EI dimensions (r = 0.79–0.84, p < 0.01), while EI was negatively correlated with psychological distress (r = -0.52, p < 0.01) and burnout (r = -0.49, p < 0.01). EI was positively associated with overall QoL (r = 0.58, p < 0.01). Marital status, however, was associated with higher self-awareness and lower distress (p < 0.05).

This study highlights the critical role of emotional intelligence in mitigating psychological distress and enhancing quality of life among healthcare professionals. Higher EI, particularly in self-awareness, empathy, and self-motivation, was associated with reduced stress, lower burnout, and greater professional satisfaction. Interventions that cultivate EI—through training, supervision, and supportive workplace cultures—may strengthen resilience, reduce the risk of compassion fatigue, and improve the overall well-being of healthcare staff. Future research should explore longitudinal effects and intervention strategies to sustain mental health in healthcare settings.

None Declared

Extremely preterm infants (≤28 weeks GA) are at high risk for neurodevelopmental disorders, including ASD and ADHD. Early detection of atypical neurodevelopmental trajectories remains limited. The Preverbal Visual Assessment (PreViAs) questionnaire evaluates early visual behaviors across four domains: Visual Attention (VA), Visual Communication (VC), Visuomotor Coordination (VMC), and Visual Processing (VP).

1. Compare PreViAs scores between extremely preterm infants (EPI) and full-term newborns (FTN) at 12 and 24 months.

2. Examine associations between atypical PreViAs profiles and perinatal clinical variables.

3. Assess its potential as an early dimensional marker for neurodevelopmental risk.

We conducted a prospective longitudinal cohort study including 58 EPI (GA <28 weeks) and 46 FTN recruited in the PremTEA study. PreViAs was administered at 12 and 24 months (corrected age for EPI). Clinical variables included intraventricular hemorrhage (IVH ≥ grade 3), periventricular leukomalacia (PVL), retinopathy of prematurity (ROP), and birth weight. Statistical analyses comprised Mann–Whitney U, Chi-square tests, and logistic regression models.

Global PreViAs scores were significantly lower in EPI than FTN at both 12 and 24 months (p<0.05). Notably, at 12 months, EPI showed deficits in VC, VMC, and VP domains; at 24 months, deficits persisted in VMC and VP. Furthermore, IVH ≥ grade 3 and cystic PVL were consistently associated with poorer outcomes across all domains (p<0.01). Longitudinal analysis revealed limited improvement in EPI, with persistent deficits in VMC (p=0.027) and VP (p=0.045).

PreViAs enables early identification of atypical visual neurodevelopmental trajectories in high-risk infants. Detecting early visual dysfunction may support timely interventions aimed at improving neurodevelopmental outcomes in extremely preterm populations.

None Declared

Stigma toward people with mental disorders remains a global challenge, negatively affecting healthcare quality and discouraging psychiatry as a career choice. Evidence suggests that well-designed educational experiences can reduce prejudice and foster greater interest in psychiatry.

To evaluate the impact of innovative educational strategies in mental health, developed through a partnership between the UNIFENAS-BH medical school and the Psychosocial Care Network (PCN) of Belo Horizonte, on medical students’ stigma toward people with mental disorders.

A quasi-experimental pre–post design was applied, including 156 medical students from different stages of training (1st, 4th and 6th year). Three curricular strategies were assessed: Community Medical Practice (CMP), Neuropsychiatry Discipline (ND), and Internship in Mental Health Emergencies (IMHE). Stigma was measured with the Brazilian version of the Attribution Questionnaire (AQ-26B). In addition, a six-year longitudinal cohort of 76 students was analyzed.

A significant reduction in stigma was found across all curricular interventions combined (p < 0.001). The CMP showed the strongest impact, with significant decreases in Segregation (p = 0.004), Withdrawal (p < 0.001), Fear (p = 0.010) and Coercion to treatment (p = 0.004). The IMHE also produced positive effects, especially reducing Fear (p = 0.001). In contrast, the ND showed limited effect and a slight increase in Coercion (p = 0.006).Longitudinal analysis confirmed a significant inversion in stigma levels: of 24 students who changed scores, 22 reduced their stigma degree between 2013 and 2019 (p < 0.05).Graduate evaluations indicated progressive improvement in mental health training after curricular reforms.

The integration of community-based mental health services into medical education and the adoption of active learning methodologies, centered on direct interaction with service users, effectively reduced stigma among medical students. These findings highlight the importance of longitudinal, practical, and human-centered curricular strategies to strengthen medical training in mental health.

None Declared

Major Depressive Disorder (MDD) is a severe psychiatric disorder characterised by persistent low mood, anhedonia, cognitive impairment, and social cognition (S-Cog) deficits, which reduce quality of life and hinder recovery. Notably, up to 50% of patients develop Treatment-Resistant Depression (TRD), with limited therapeutic options. Transcranial magnetic stimulation has emerged as a promising treatment for TRD, with intermittent theta-burst stimulation (iTBS) showing advantages in promoting neuroplasticity while requiring shorter sessions. This study will apply this innovative medical technology to evaluate the efficacy of an iTBS protocol in improving depressive symptoms and S-Cog deficits in patients with TRD.

Forty patients with TRD will be recruited and randomised to receive either active iTBS to the lDLPFC or sham stimulation (20 sessions in 4 weeks). The iTBS protocol will be in line with the FDA guidelines. Patients will undergo extensive socio-demographic, clinical, neurocognitive/social cognitive, and functioning evaluation at baseline (T0), post-treatment (T1), and 4 weeks post-treatment (T2). Standardised questionnaires and batteries will be used for this purpose, including HDRS-21 and BDI-II (depression); SCL-90 (psychopathology); WHODAS 2.0 (functioning); SF-36 (quality of life); BAC-A (neurocognition); Reading the Mind in the Eyes test; Ekman Test, Faux Pas Test (S-Cog). Forty healthy controls (HC) will also be recruited and undergo only the clinical and cognitive/social-cognitive evaluation at T0. Data collected from HC will serve as a benchmark for interpreting the effects of active-iTBS and sham-iTBS on patients.

Data will be analysed using mixed-effect models for repeated measures (T0, T1, T2); Intra-group effect sizes (Cohen’s d) will be calculated using performance change scores (mean score T1 – mean score T0) and standard deviations to quantify treatment impact within each group.

The primary expected outcome is an improvement of ≥50% in depressive symptoms and 30% in S-Cog, calculated as the percentage change between the mean scores at T1 and T0 on measures of depression and S-Cog. Secondary are - i) maintenance of the improvements at T2; ii) changes in pre-to-post measures of functioning, quality of life, and other cognitive measures;

The project will start in November 2025 and very preliminary findings will be presented at the upcoming conference.

None Declared

Depression and headaches are among the most common global health burdens, often co-occurring and significantly impairing individuals’ quality of life. Emerging evidence suggests a bidirectional relationship between mood disorders and chronic pain syndromes, particularly tension-type headaches (TTH) and migraines. Understanding the interrelationship between depression and headache characteristics may inform more effective, integrated treatment approaches.

To investigate the association between depression and headache frequency, intensity, and type in adult populations, and to explore shared pathophysiological mechanisms contributing to comorbidity.

A cross-sectional observational study was conducted with 250 adults aged 18–65, recruited from primary care and neurology clinics. Participants completed the Beck Depression Inventory-II (BDI-II) and the Headache Impact Test-6 (HIT-6). Depression diagnoses were confirmed using DSM-5 criteria, and headache types were classified per the International Classification of Headache Disorders (ICHD-3). Statistical analysis included Pearson correlation and multiple regression using SPSS version 26.0.

Depression severity was significantly positively correlated with both headache intensity and frequency (r = 0.62, p < 0.01). Participants with moderate to severe depression showed a higher prevalence of migraines and experienced diminished response to conventional headache treatments. Comorbid individuals reported higher HIT-6 scores, reflecting greater headache-related disability.

The findings highlight a strong association between depression and chronic headache parameters, suggesting overlapping neurobiological mechanisms, such as serotonin dysregulation and HPA axis dysfunction. Routine screening for depressive symptoms in headache patients—and vice versa—is recommended to improve diagnosis and treatment outcomes. Integrated, multidisciplinary management strategies may yield better clinical results. Further longitudinal research is warranted to examine causality and therapeutic interventions targeting both disorders.

None Declared

Major Depressive Disorder (MDD) is among the most prevalent psychiatric conditions worldwide. Cognitive impairment is a core feature, often persisting after remission and worsening with relapses. Cognitive Remediation (CR) is a structured psychosocial intervention targeting cognition and psychosocial functioning. This study reports the 3-month follow-up (T2) results of a previously conducted RCT, which assessed outcomes at baseline (T0) and post-treatment (T1).

To evaluate the sustained effects at 3 months (T2) of computerized CR versus an active control (computer games, CG) in adults with MDD experiencing a Major Depressive Episode (MDE), focusing on cognitive performance, depressive symptoms, and functioning.

This single-blind, multicenter RCT randomized patients to either CR, delivered by trained therapists, or CG. Outcomes were measured with validated instruments by blind assessors at T0, T1, and T2. Mixed models for repeated measures (MMRM) with an intent-to-treat analysis were applied. Inclusion criteria required ≥8 years of education; exclusions included neurological disorders, severe head injury, or intellectual disability. Drop-out was defined as>5 days interruption of antidepressant therapy or ≥2 consecutive missed sessions with declared discontinuation.

Of 142 screened patients, 101 were randomized (CR n = 52, CG n = 49), and 81 completed the study through T2 (CR n = 45, CG n = 36). At the 3-month follow-up, CR showed superior outcomes in self-reported depression (BDI, Figure 1, p = 0.003), subjective cognitive impairment (PDQ-5, p = 0.007), executive function (TMT-B, p = 0.032), and processing speed (DSST, Figure 2, p = 0.009), with significantly greater improvements compared to CG. No significant between-group differences were observed for clinician-rated depression (MADRS, p = 0.112) or verbal memory (CVLT, p = 0.083), although CR patients showed greater within-group improvements. While no statistically significant effects were found for TMT-A (p = 0.349) or Clinical Global Impression (CGI-S, p = 0.458), CR patients exhibited trends toward improved processing speed (TMT-A, p = 0.055) and a more pronounced reduction in clinical severity (CGI-S), suggesting potential non-specific benefits of the intervention.Image 1:

This multicenter study demonstrates that CR yields sustained improvements in self-reported depression, subjective cognitive impairment, executive function, and processing speed at 3-month follow-up. Although some outcomes showed non-significant trends favoring CR, these findings support its potential as an adjunctive intervention for MDD, warranting further investigation in real-world settings.

None Declared

Intranasal esketamine has emerged as an innovative treatment for TRD due to its rapid antidepressant effects. However, the clinical response is heterogeneous, and growing evidence suggests that comorbid personality disorders (PDs) may significantly shape treatment outcomes. Although PDs are frequently diagnosed in TRD patients, little is known about their differential influence on esketamine efficacy and response timelines.

This study aimed to explore distinct response trajectories across personality profiles and offer both neurobiological and psychodynamic interpretations.

We conducted a prospective naturalistic observational study on 60 TRD patients treated with esketamine (56-84mg twice weekly for 4 weeks, then weekly thereafter). Patients were recruited from two specialized clinical centers in Northern Italy. All participants met DSM5 criteria for a PD assessed with the SCID-5-PD and were categorized into 4 subgroups: borderline (n = 15), obsessive-compulsive (n = 15), dependent (n = 15), and avoidant (n = 15). Depressive severity was assessed weekly using the MADRS from baseline (T0) to week 6.

Distinct patterns of clinical response emerged. Patients with:

• - dependent PD showed rapid improvement from the 1st week, likely supported by the structured therapeutic setting and their externalized emotional regulation style.

• - borderline PD demonstrated a pronounced early response (weeks 1–2) followed by relapse or affective instability around week 4–5, potentially reflecting idealization-devaluation dynamics towards treatment and the therapeutic team.

• - obsessive-compulsive PD exhibited a slower but progressive improvement starting at week 3, possibly related to initial cognitive control and skepticism toward the treatment.

• - avoidant PD had a moderate and steady response, likely influenced by ambivalence toward intimacy and fear of judgment within the therapeutic setting.

Statistical analysis revealed a significant time-group interaction (p < 0.001): the borderline group had the fastest early response and the obsessive-compulsive group showed the most stable improvements by week 3. Between-group effect size at week 4 was large (Cohen’s d = 1.52).

These findings suggest that personality structure meaningfully influences esketamine treatment response – not only from a neurobiological perspective but also through relational and psychological processes. Dependent patients may benefit more rapidly due to the emotionally supportive context; obsessive-compulsive patients need time to relinquish cognitive control; and borderline patients, while initially reactive, may relapse due to unstable attachment dynamics. Integrating personality assessment and psychotherapeutic containment into esketamine protocols may improve efficacy and emotional safety, representing a key step towards genuinely personalized psychiatry.

None Declared

Esketamine-induced dissociation is a transient, pharmacologically mediated alteration in consciousness, often distinct from pathological dissociation. While not required for clinical improvement, these states may engage neural circuits implicated in therapeutic change.

This study explores patients’ lived experiences of dissociation as potentially meaningful transitional states rather than adverse effects.

We conducted a qualitative, narrative-based study on 36 patients with treatment-resistant depression (TRD) treated with intranasal esketamine in Northern Italy (2022–2024). Patients provided detailed accounts of dissociative episodes during treatment. Narratives were anonymized and thematically analyzed, focusing on phenomenological dimensions: sensory alterations, temporal distortion, body–space reconfiguration, and emotional detachment from suffering.

Four thematic domains emerged:

1. Sensory Intensification: Enhanced colors, synesthetic experiences, and altered auditory landscapes.

2. Temporal Distortion: Time dilation, loops, and present-centered awareness.

3. Body–Space Alteration: Weightlessness, out-of-body perspectives, and merging with surroundings.

4. Psychic Distance from Suffering: Temporary suspension of depressive thoughts and emotional pain.

Most participants described neutral-to-positive experiences, interpreting dissociation as peaceful, transformative, or offering a “pause” from suffering. A minority reported transient fear or disorientation, often mitigated by anticipatory guidance and post-session integration.Image 1:

In TRD patients, esketamine-induced dissociation can function as a liminal mental state that temporarily interrupts maladaptive self-processing. When framed within a supportive therapeutic context, these states may foster relief, insight, and psychological reorganization. Clinical protocols should incorporate psychoeducation and post-treatment reflection to optimize meaning-making and reduce distress.

None Declared

Approximately 60% of people living with mental health problems reside with their families. With the progressive shift to community-based psychiatric care, the closure of asylums, and the establishment of territorial services, families have become increasingly central in the management of severe mental disorders. While family involvement in major depressive disorder (MDD) is essential for patient recovery, the caregiving role itself critically affects the caregivers’ quality of life (QoL) and levels of stress. Family members of patients with schizophrenia or bipolar disorder often exhibit emotional overinvolvement, report high levels of subjective and objective burden, restrictions in social life, increased risk of depression/anxiety, financial difficulties, and reduced QoL. Furthermore, caregivers frequently experience powerlessness, hopelessness, and a sense of inability to change the situation.

The present study aims to identify both patient- and family-related factors influencing subjective and objective burden among relatives of patients with MDD. Moreover, we aim at identifying predictors for caregivers’ coping strategies and QoL.

41 family units were recruited across 23 Italian centers. Each unit consisted of one patient with MDD and one or more relatives. Participants completed a set of questionnaires assessing socio-demographic and clinical characteristics, psychopathological conditions, and caregivers’ burden, coping strategies, and QoL. Regression analyses were performed by selecting independent variables significantly correlated with each dependent variable, adjusting for fixed factors.

Regression analyses highlighted several significant predictors of caregiver burden. In particular, objective family burden was associated with caregiver age (β = 0.17, p < 0.001), longer daily cohabitation with the patient (β = 0.17, p < 0.001), lower positive attitudes (β =−0.26, p < 0.001), criticism (β = 0.16, p < 0.01), and higher tolerance and expectation (β = 0.13, p < 0.01); patient-related predictors included the patient’s own objective burden (β = 0.22, p<0.001). Furthermore, caregiver’s gender (β = 0.17, p < 0.001), age (β = 0.19, p < 0.001), overinvolvement (β = 0.16, p < 0.001), criticism (β = 0.18, p<0.001) and lower positive attitudes (β = −0.163, p<0.001) was associated with increased caregiver subjective burden as well as patient-related variables such as subjective burden (β = 0.23, p < 0.001), criticism (β = 0.1, p < 0.05), sexual abuse (β = 0.1, p < 0.05) and CGI (β = 0.1, p < 0.05).

The identification of specific determinants of higher family burden should serve as a warning for clinicians and highlight the importance of setting clear targets for family-oriented interventions. Psychoeducational strategies, in particular, may represent effective tools to support both families and patients, ultimately improving overall clinical and functional outcomes.

None Declared

Major depressive disorder (MDD) is a prevalent mental health condition, affecting around 10% of the population worldwide. Conventional treatments include psychotherapy, pharmacotherapy, and neuromodulation. Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation technique that has shown promise in alleviating depressive symptoms. Given evidence that tDCS enhances cognitive control and emotional regulation, it has been hypothesised that combining tDCS with cognitive behavioural therapy (CBT) may yield synergistic therapeutic benefits.

To evaluate the efficacy of tDCS combined with CBT in reducing depressive symptoms in patients with MDD, compared with sham tDCS combined with CBT.

A systematic search of PubMed, Embase, and Cochrane Library databases was conducted in accordance with PRISMA guidelines. The primary outcome was change in depressive symptom severity from pre- to post-intervention. Secondary outcomes included remission and response rates. Data were analysed using Review Manager 5.1.7 (Cochrane Collaboration). Standardised mean differences (SMDs) and risk ratios (RRs) were calculated using random-effects models, with heterogeneity assessed via the I² statistic. Statistical significance was set at p < 0.05.

Five RCTs comprising 173 patients were included; 91 (52.6%) received active tDCS plus CBT. Active tDCS plus CBT did not show a significant advantage over sham tDCS plus CBT for depressive symptom reduction (SMD = –0.14; 95% CI –0.68 to 0.39; p > 0.05; I² = 5%). Likewise, no significant differences were found for remission (RR = 1.49; 95% CI 0.61 to 3.64; p > 0.05; I² = 0%) or response rates (RR = 1.16; 95% CI 0.52 to 2.59; p > 0.05; I² = 4%). The forest plots for the outcomes of reduction in depressive symptoms and response rates can be seen, respectively, in Figures 1 and 2:Image 1:

This meta-analysis suggests that combining tDCS with CBT does not confer additional benefit over sham tDCS with CBT for reducing depressive symptoms or improving remission and response rates in MDD. To our knowledge, this is the first meta-analysis addressing this question. Larger, rigorously designed RCTs are warranted to determine whether tDCS has an adjunctive role alongside psychotherapy.

None Declared

Major depressive disorder affects 280 million people globally and is a major cause of disability (OMS 2023). Treatment-resistant depression (TRD) is associated with poorer quality of life, greater functional impairment, reduced work performance, and higher healthcare use (Jaffe et al. BMC Psych 2019;19:11). Intranasal esketamine (IN-ESK) has demonstrated efficacy and safety in TRD (Papakostas et al. J Clin Psych 2020;81:19r12889). Functional recovery and work reintegration are increasingly recognized as essential treatment goals.

To assess clinical and functional outcomes of INK-ESK in patients with TRD treated in routine clinical practice.

Retrospective, observational, multicenter study in 17 Spanish hospitals, approved by the local ethics committee. Subjects: patients ≥18 years, meeting DSM-5 criteria for MDD and TRD, treated with IN-ESK by their psychiatrist. Data: baseline sociodemographic and clinical characteristics, 12-month follow-up. Assessments: depressive severity (Montgomery-Åsberg-Depression-Rating-Scale-MADRS). Outcomes: clinical response (≥50% reduction in baseline MADRS), clinical remission (MADRS<7), and work reintegration. Time points: 4 weeks, 6 months, 12 months. Analysis: means, frequencies, chi-squared comparisons.

356 patients were included (mean age 52 years, 63% women, 38% on sick leave). Mean episode duration was 19 months; 49% lasted >1 year. Patients had failed a mean of four antidepressants (range 2–15); 35% remained non-responsive after five or more. Remission was achieved in 40% (27% ≤4 weeks) and response in 36%. Remission was higher in episodes <2 years (45% vs 25%, p=0.003) and tended to be higher in patients <30 years (53% vs 40%). Among 142 patients on sick leave, 49% achieved remission vs 35% not on leave (p=0.006), especially if leave ≤6 months (63% vs 42%, p=0.02). Return to work was 18% at 6 months and 22% at 12 months; early return more frequent with leave ≤6 months (36% vs 14%, p=0.002). Patients <30 years also returned to work more often than older patients (38% vs 19% at 6 months; 71% vs 27% at 12 months, ns).

IN-ESK led to 40% remission and 36% response rates in TDR patients. Shorter episode duration and earlier treatment initiation were associated with higher remission and functional recovery. Patients on sick leave showed higher remission rates, particularly when leave was brief. Work reintegration was modest but more likely with shorter sick leave. Younger age may predict better outcome. Further studies are needed to confirm these results.

A. De Santiago-Diaz Grant / Research support from: Johnson&Johnson: grant for 34th EPA congress and funding for clinical studies., Speakers bureau of: Johnson& Johnson, M. Madrazo-Maza Speakers bureau of: Johnson&Johnson, C. Pavón-Navajas: None Declared, A. Pérez-Poza: None Declared, J. Mesones-Peral Speakers bureau of: Johnson&Johnson, E. Sáez-Fuentes Speakers bureau of: Johnson&Johnson, F. Mora-Mínguez Speakers bureau of: Johnson&Johnson, M. Arrojo-Romero Speakers bureau of: Johnson&Johnson, A. Miranda-Sivelo : None Declared, F. Rodríguez-Batista: None Declared, V. Roselló-Molina Speakers bureau of: Johnson&Johnson, L. Gutiérrez-Rojas Speakers bureau of: Johnson&Johnson, V. Tordera-Tordera: None Declared, I. Domingos-Chaves: None Declared, D. Núñez-Arias Speakers bureau of: Johnson&Johnson, L. Montes Reula: None Declared, S. Arostegui-Uranga Speakers bureau of: Johnson&Johnson