Stigma on mental health struggles and psychiatric practices are important components of difficulty in accessing mental healthcare, in addition to their contribution to the burden experienced with health challenges. These kinds of stigma are rooted in a wide range of factors including structural inequities and centuries old myths. Still, some elements of the mainstream discourse and some practices of the mental healthcare practitioners can play reproducing and enhancing roles in the stigmatizing attitudes. Stigmatizing attitudes about the professional identity, role, and practices may also lead to difficulties in the professional life of the practitioners. Therefore, the widespread presentation of the professional identity of a psychiatrist and clinical psychiatric practices may be influential. Professional organizations are often considered the representatives of these facets of the profession, especially in the messages they share with the community. They can act as reliable sources of information for both the lay community, other healthcare professionals, and the administrators. The associations have to work on the means they can reach to wider audience in their messages, but also in the way their discourse could modify the common stigmatizing attitude. Often information alone is not sufficient to change the general attitude, the association has to be open on the critic of the practices that have been associated with violation of rights, and the management of the members of the profession who fail to stick to the core features of the professional identity and ethical principles. For all these work, it is essential that a kind of collaboration could be constituted with people with lived experience. This kind of collaborations not only increase the impact of the work, but also work as models of nonstigmatizing behavior.

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Negative symptoms (NS) represent an important unmet need in schizophrenia (SZ) assessment and management. Despite NS are strongly associated with poorer functioning and quality of life, they are frequently underrecognized, inconsistently evaluated, and show limited response to current treatments. Although specific assessment tools and European Psychiatric Association (EPA) guidance on NS have been developed, their impact on routine clinical practice appears limited. This study aimed to investigate the competence and confidence of European Early Career Psychiatrists (ECPs) in NS evaluation and management.

The CARE project was a cross-sectional online survey directed towards ECPs from European countries.

828 ECPs’ responses were collected from 19 countries. The majority of ECPs were trainees (65.8%), reported theoretical training in negative symptoms (NS) and placements in schizophrenia-specialized settings (67.9% and 70.3%), while about half reported extracurricular NS training (51.1%) and involvement in clinical research (46.1%). Only 11% correctly identified NS domains, despite 65.7% felt well-trained in NS assessment tools. Just 15.9% correctly answered questions based on the EPA guidance papers. 46.7% and 25.9% ECPs reported feeling competent in NS evaluation and management, respectively. Gender (men) specialist status, research involvement, theoretical NS training, and placements in specialized SZ services predicted perceived competence. However, in-depth NS knowledge was predicted only by specialist status, engagement in clinical research, and extracurricular NS training.

Despite reported exposure to NS training, ECPs demonstrated limited knowledge of NS. Actions need to be taken to ensure that ECPs receive the highest standard of training in NS.

Attitudes toward people with mental disorders in Ukraine reflect a complex interplay of historical, cultural, and social factors. For decades, psychiatric care remained predominantly institutional: patients were placed in specialised hospitals, which reinforced their isolation and contributed to persistent stigma. This model entrenched the perception of individuals with mental illness as a group incapable of social integration.

Recent healthcare reforms aim to transform this system. The national concept for the development of psychiatric care until 2030 envisions a shift from institutional care to community-based services, as well as the expansion of outpatient centers and mobile teams. Nevertheless, public prejudice remains widespread, manifesting in discrimination in employment, limited access to education, and insufficient social support.

The ongoing war has significantly altered the context of mental health. Widespread traumatic experiences, forced displacement, and the loss of loved ones have led to an increase in cases of post-traumatic stress disorder, anxiety, and depressive conditions. Under these circumstances, societal attitudes toward people with mental illness become not only a matter of human rights but also a factor of national resilience.

Despite persistent challenges, positive trends can be observed: the role of psychologists and social workers is strengthening, attention to patients’ rights is increasing, and mental health is increasingly recognised as an essential component of overall well-being. Ukraine is currently undergoing a transition from the legacy of an institutional model to a modern approach focused on integration and respect for human dignity.

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Existing research on post-traumatic stress disorder (PTSD) development over time covers brief periods predominantly among military personnel, rather than civilians, and baseline measurements from before traumatic experiences are rarely available. This longitudinal study examined PTSD trajectories among Israeli civilians before and after the October 7, 2023, terror attack, exploring their associations with current and previous trauma.

Data included 1,231 Israeli Jewish adults from a quasi-representative sample surveyed at four time points: January 2018, April 2022, December 2023, and March 2024. Participants completed self-report measures, including the PTSD Checklist for DSM-5 (PCL-5), exposure to the October 7 attack and subsequent war, and trauma in childhood and adulthood. Latent growth mixture modeling identified PTSD trajectories.

Four trajectories were identified: resilience (70.4%), trauma recovery (9.4%), trauma vulnerability (16.8%), and chronic PTSD (3.5%). The chronic PTSD group exhibited persistently high symptoms, associated with greater childhood trauma and war-related exposure. The trauma vulnerability group showed low-medium pre-attack PTSD levels that escalated post-attack, associated with higher war-related stressors. The trauma recovery group had high pre-attack PTSD severity related to high trauma exposure, but showed significant symptom reduction post-attack.

This study, the first to examine PTSD trajectories in civilians after large-scale trauma, highlights diverse impacts. Most participants demonstrated resilience, while some exhibited chronic symptoms. Two trajectories – trauma vulnerability and trauma recovery – were event-responsive, suggesting that collective trauma can both exacerbate and paradoxically alleviate symptoms. Findings emphasize the need for targeted interventions and suggest future research using machine learning to refine PTSD trajectory prediction.

Pharmacological factors and challenges across Cultures

Cultures are important factors in defining what is normal and what is abnormal. These abnormal behaviours determine where help is sought from. Cultures influence explanatory models and also how individuals express and deal with distress – whether it is physical or emotional. Culturally influenced are accepted by healthcare workers if they are from same culture. Cultures and society dictate health resources as well as encourage individuals to follow certain pathways into care and how they accept or reject health care. Cultural variations in presentation of various psychiatric disorders have been studied, but not treatment responses as widely.

In addition to pharmacokinetics and pharmacogenetics, otherfactors such as body weight, dietary habits and simultaneous use of alternative and complementary medicines will affect how the role of medication is perceived and accepted which then affect and pharmacodynamics. All these factors play a major role in acceptance or rejection of pharmaceutical agents due to potential side effects and resulting treatment outcomes across cultures.

In various cultural settings, patients and their carers have varying expectations and responses to medication. This talk will explore various factors which affect acceptance of psychiatric medications across different cultural groups.

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Psychiatric treatment of patients with migration background can pose multiple challenges, including pharmacokinetic and pharmacodynamic factors influencing treatment response and occurrence of side effects, as well as differences in attitude towards psychiatric treatment options, cultural differences in symptom presentation, language barriers and stigmatization of mental disorders. The interplay of these factors can be complex and has to date only been partially understood. In this presentation, recent data regarding clinical, sociodemographic and biological factors that need to be considered in treatment of patients with migration background will be highlighted.

E. Döring-Brandl Speakers bureau of: Speaker fees from Medice.

The population with a serious mental illness (SMI) shows a high risk of premature mortality. Overexposed to multiple health risks throughout life, their main threat is physical illness, which starts earlier and is not diagnosed in time. Developing preventive actions is a public health priority.

This longitudinal prospective study evaluated the predictive value of lung function on all-cause mortality in patients with schizophrenia (SCHIZ) or bipolar disorder. Patients aged 40–70 years, active smokers, and without preexisting respiratory disease underwent spirometry following American Thoracic Society/European Respiratory Society 2021 standards. Mortality data were collected through December 2022. Cox proportional hazards models and Kaplan–Meier survival curves analyzed the association between lung function, specifically forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and mortality, adjusting for relevant confounders (age, gender, abdominal circumference, and comorbidities).

Of 107 participants (mean age 49.3 years, 63.3% male) with SMI (72% SCHIZ) and active smokers, 8 (7.5%) died during the 6-year follow-up (5 cardiovascular and 3 cancer). Mean z-scores were −1.41 (SD = 1.22) for FEV1 and −0.99 (SD = 1.16) for FVC. Lower FEV1 and FVC z-scores were significantly associated with increased mortality risk (p = 0.002 and p = 0.009, respectively). Kaplan–Meier analysis confirmed this association for FEV1 (p = 0.039) and FVC (p = 0.007) but not for gender, comorbidities (hypertension, diabetes, and dyslipidemia), or FEV1/FVC. A multivariate Cox regression model, adjusting for age and abdominal circumference, confirmed the independent predictive value of lower FEV1 z-score for mortality (hazard regression = 0.473, 95% confidence interval: 0.220–0.979, p = 0.044).

Poorer lung function, especially lower FEV1, was independently associated with all-cause mortality in SMI. Spirometry, an easily implementable technique, could help to detect at-risk individuals and favor prevention initiatives.

Childhood maltreatment (CM) has been widely acknowledged as a risk factor for Eating Disorders (EDs). Although research has predominantly emphasized the role of sexual and physical abuse, literature has recently outlined the profound impact of childhood emotional abuse and neglect. However, the psychological and biological mechanisms underlying the associations between CM and EDs have not yet been clearly elucidated.

The objective of this presentation is summarizing findings that support the existence of a maltreated echo-phenotype of EDs.

Data from our research group and from studies reported in the literature will be summerized and discussed.

Individuals with EDs and a history of CM show a more severe clinical presentation than those without CM. Findings regarding treatment response are mixed. Among the biological signatures characterizing individuals with EDs and CM, the main evidence suggests the presence of neuroanatomical alterations (namely, reduced integrity of gray and white matter and decreased cortical thickness) as well as abnormalities in the basal and acute functioning of the endogenous stress response system, as indicated by impaired cortisol and alpha-amylase patterns.

The present findings suggest that, in addition to specific clinical features, CM is associated with distinct biological correlates in individuals with EDs, including neuroanatomical modifications, alterations in the endogenous stress response system, and changes in inflammation markers. This evidence supports the identification of a maltreated eco-phenotype of EDs, suggesting that CM acts as an etiological factor contributing to a distinct phenotypic expression of EDs that warrants specific attention to improve treatment outcomes.

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More than 75 years after the breakthrough in identifying lithium salts as having antimanic and prophylactic activity, modern research continues to confirm lithium’s position at the forefront of the treatment of bipolar disorder. Undoubtedly, lithium is an essential medication for patients with mood disorders and represents the most valuable treatment option in the long-term management of bipolar disorder. When used correctly, lithium unquestionably produces the most dramatic benefits of any medication in psychopharmacology. Since its introduction to modern psychiatry in 1949, basic and clinical research has uncovered many new aspects of its use in psychiatry, including antisuicidal and antidepressant properties. Lithium is considered the first-line “gold standard” medication for the maintenance treatment of bipolar disorder with serum lithium levels ideally in the range of 0.6-0.8 mmol/L. Over the past three decades, there has been increasing recognition of lithium’s efficacy in conferring long-lasting mood stability, a perception of its capabilities that is reflected in clinical practice guidelines worldwide. Recent independently published meta-analyses included all available placebo randomized controlled trials (RCTs) and reached similar conclusions: lithium was statistically significantly superior to placebo for the prevention of affective episodes of any polarity, manic episodes, and, depending on the methodology used, depressive episodes. Although RCTs are fundamental for demonstrating the efficacy and safety of medications, their results do not reflect the entire population of patients with bipolar disorder seen in clinical practice. Given the limitations and uncertainties of RCTs, it is important to compare evidence from RCTs with evidence from observational studies of patients treated in so-called real-world clinical settings, e.g. using a naturalistic design and typically including a wide range of patients. A systematic review of nonrandomized controlled observational studies by a task force of the International Society for Bipolar Disorders (ISBD) found that in eight of nine studies identified, with a total of more than 14 000 patients, maintenance lithium therapy was associated with improved outcomes compared with another mood stabilizer in monotherapy.

M. Bauer Consultant of: In the past 3 years, MB has served as an advisor to Alfred E. Tiefenbacher GmbH Co. KG, COMPASS Pathfinder Ltd., GH Research, MedEd-Link Inc., Janssen Global Services, LLC, Livanova, Mindforce Game Lab AB, and Lilly.

Bipolar disorder (BD) is associated with impairments in facial emotion recognition (FER), affecting social functioning and quality of life. Understanding FER deficits in BD is crucial for tailoring interventions and improving treatment outcomes. This systematic review and meta-analysis aims to evaluate FER differences among individuals with BD, unaffected first-degree relatives (FDRs), and healthy controls (HCs), exploring predictors related to patient and study characteristics.

We systematically searched PubMed/MEDLINE, Scopus, EMBASE, and PsycINFO databases from inception to March 28, 2024. Random-effects meta-analyses were conducted to explore differences in accuracy and reaction time during FER identification and discrimination tasks.

A total of 100 studies were included, comprising 4920 individuals with BD (females = 56%, mean age = 34.1 ± 9.1), 676 FDRs (females = 55%, mean age = 36.1 ± 12), and 4909 HCs (females = 53.2%, mean age = 32.5 ± 9.5). Compared to HCs, adults with BD exhibited significantly lower accuracy (SMD = −0.47; 95% CIs = −0.56, −0.38) and higher reaction time (SMD = 0.57; 95%CIs = 0.33, 0.81) during facial emotion identification tasks. During facial emotion discrimination tasks, adults with BD had significantly lower accuracy than HCs (SMD = −0.59; 95%CIs = −0.78, −0.4), but similar speed. No significant differences were observed between BD and FDRs. Meta-regressions identified several predictors of FER performance, including manic symptom severity, stimulus duration, and presence of practice before task.

FER deficits appear to be a core feature of BD and require specialized, systematic assessment. Identifying these deficits may help guide interventions aimed at improving affective cognition and social outcomes in individuals with BD.

Lithium (Li) remains the gold standard for long-term bipolar disorder management, significantly reducing relapse, hospitalisation, suicidal behaviour, and all-cause mortality (Cipriani et al., 2013; Geddes et al., 2004; Pompili et al., 2025). However, only one-third of patients achieve an excellent response, while others experience partial or no benefit (Alda, 2015). The identification of markers predicting Li treatment response is crucial to optimise benefit-risk ratios, guide personalised treatment strategies and avoid empirical lengthy trials.

We present innovative longitudinal study designs and breakthroughs in -omics and neuroimaging, with a focus on the preliminary results of EU Horizon 2020-funded R-LiNK study. Our final goal is to translate these findings into clinical practice, reducing trial-and-error prescribing and improving patient outcomes.

The R-LiNK consortium conducted a landmark multinational, multicentre study to identify biomarkers of lithium response and tolerability (Scott et al., 2019). A total of 169 patients initiating lithium were followed for 24 months, with biomarker assessments at baseline and 3 months. Response was evaluated monthly using the Alda scale and expert consensus.

• - Study design and challenges: Overview of R-LiNK’s approach, addressing methodological hurdles in defining lithium response and tolerability in real-world settings.

• - Preliminary results include (i) significant reduction of suicide risk 3 months after Li initiation, (ii) baseline Gray Matter (GM) in hippocampus and amygdala associated with Li response, (iii) global GM volume increase between baseline and Month 3, (iv) GM volume increase between baseline and Month 3 in hippocampus and amygdala, (v) using Li-MRI, lower Li signal in several brain regions associated with good response and (vi) Li-induced molecular signature in blood was different in males and females.

• - Neuroimaging innovations: Harmonised MRI (structural, diffusion-weighted, proton spectroscopy) and pioneering multinuclear 7Li-MRI—implemented in six centres—to map lithium’s brain distribution. Findings from individual modalities and plans for multimodal data fusion will be discussed.

• - A comprehensive update on research efforts aiming at the identification of Li response biomarkers and their clinical implication.

• - Practical implications of integrating advanced technologies into psychiatric care in the future.

Alda, M. (2015). Molecular Psychiatry, 20(6), 661-670. Cipriani, A., et al. (2013). BMJ, 346, f3646. Geddes, J. R., et al. (2004). American Journal of Psychiatry, 161(2), 217-222. Pompili, M., et al. (2025). Acta Psychiatrica Scandinavica, 152(4), 290-298. Scott, J., et al. (2019). International Journal of Bipolar Disorders, 7(1), 20.

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Major depressive disorder is a prevalent and debilitating mental health condition contributing to a growing global burden. Late-life depression (LLD), affecting individuals over 60 years of age, is further associated with elevated risks for cardiovascular diseases, cognitive decline, and dementia. Treatment responses vary widely, potentially due to underlying neurodegeneration and cellular senescence. We aimed to explore blood-based biomarkers related to Alzheimer’s disease and senescence-associated secretory phenotype (SASP) proteins, seeking to identify biological underpinnings of LLD and their association with response to psychotherapy.

We performed a secondary analysis of the Cognitive Behavioral Therapy for Late-Life Depression (CBTlate) trial in 228 participants aged 60 years and older with a diagnosis of LLD. Depression trajectories were compared using clustering. In participants with available plasma samples, biomarker data were generated post hoc. We assessed associations between biomarkers and depression trajectories, biomarker dynamics, and their ability to predict treatment response.

Two depression trajectories were identified: persistently high stable Geriatric Depression Scale (GDS) scores (hsGDS) and decreasing scores over time (dGDS). The hsGDS group had more severe baseline depression (p = 2.88 × 10−6), anxiety (p = 4.39 × 10−4), and sleep disorders (p = 1.09 × 10−3), and was more likely to have a history of major depression (p = 0.01) and mild cognitive impairment (p = 0.01). Biomarker analysis revealed elevated baseline plasma neurofilament light chain (NfL, p = 2.51 × 10−2) and reduced C-X-C Motif Chemokine Ligand 5 (CXCL5, p = 2.83 × 10−2) in the hsGDS group. Including CXCL5 in predictive models improved trajectory differentiation (p = 3.94 × 10−3).

Cellular aging biomarkers like CXCL5 may improve understanding of LLD and guide personalized therapeutic interventions.

Lithium is considered the first-line treatment for bipolar disorder but its use has been declining worldwide. This is apparently attributable to its side effects and to the fact that lithium is inexpensive, meaning that pharmacological companies have no incentive for marketing.

To give an overview on the real-world evidence on the effectiveness of lithium of bipolar disorder and unipolar depression.

Literature review in PubMed.

All large real-world studies indicate that lithium is highly beneficial treatment compared with other options for bipolar disorder, concerning relapses, suicidality, working ability, and somatic well-being of the patients. It was observed also to be useful in the augmentation of treatment for unipolar depression.

The results suggest the use of lithium as the mainstay of treatment in bipolar disorder.

J. Tiihonen Grant / Research support from: EU/Forte, State Research Funding, Jane and Aatos Erkko Foundation; Research collaboration with Janssen and Lecture fees from Janssen, Lundbeck, Orion Pharma, Otsuka, and Teva, Consultant of: Healthcare Global Village, Janssen, Lundbeck, Orion Pharma, and Teva; Expert testimony for Janssen; Advisory Board member Teva.

This presentation is based on a recent nationwide Danish cohort study examining cardiometabolic risk following antipsychotic initiation across age groups. We will use the study as a framework to illustrate why age at treatment initiation matters clinically. The presentation will show that although absolute cardiometabolic event rates are higher in adults, the excess risk attributable to antipsychotics is greatest when treatment is initiated in childhood and adolescence, particularly before age 12. We will discuss the implications for prescribing thresholds, treatment duration, and metabolic monitoring in younger patients.

M. Højlund Consultant of: Lundbeck, Orion, and Otsuka, Paid Instructor of: Lundbeck, Orion, and Otsuka.

Substance use has consistently been linked with cognitive impairments. However, most previous studies have focused on highly selective samples of individuals with chronic substance use disorders and have typically relied solely on self-reports. The associations between recreational use patterns of single or multiple substances and cognitive functioning in representative samples remain unclear.

We measured over 100 substances and their metabolites over the past 3 months in 850 young adults (48.6% female, Mage = 24.4) from a community-based cohort, using quantitative hair analysis. We assessed sustained attention, working memory, declarative memory, and a total cognitive performance index using the Cambridge Neuropsychological Test Automated Battery. We regressed cognition on hair substance concentrations, adjusting for sex, household socioeconomic status, migration background, education, gaming experience, and self-reported daily tobacco and alcohol use.

In their hair samples, 386 (45.5%) participants tested positive for at least one psychotropic substance other than alcohol and nicotine. Higher hair concentrations of Δ9-tetrahydrocannabinol (Cohen’s d = 0.40) and codeine (d = 0.22) were associated with lower sustained attention; higher concentrations of ketamine (d = 0.59) with worse declarative memory. Higher hair concentrations of cocaine and a higher polysubstance use severity index (PSUSI) were associated with both reduced attention (cocaine: d = 0.21; PSUSI: d = 0.30) and declarative memory (cocaine: d = 0.20; PSUSI: d = 0.29).

In this community sample of young adults, substance use was highly prevalent and associated with reduced cognitive performance, with small-to-moderate effect sizes. Cognitive consequences of recreational substance use may have been previously underestimated.

Although Intensive Home Treatment (IHT) is intended to prevent hospital admissions, little is known about its effects in a specific population of patients who are already in outpatient treatment (Flexible Assertive Community Treatment; FACT) before the were referred to IHT.

To study the effects of psychiatric crisis-care using IHT versus psychiatric crisis-care in Flexible Assertive Treatment (FACT) Teams.

We used a quasi experimental design to study the effects after 6 months on admissions and Length of Hospital Stay (LOS) of crisis-care in IHT versus FACT. Patients in a crisis situation, who were treated in FACT, were either admitted to IHT or stayed in FACT, based on the treatment availability in IHT.

463 patients in a psychiatric crisis situation were referred to IHT, and 59 patients in a psychiatric crisis situation could not be referred to IHT. After 6-month follow-up 27.2% vs. 33.9% patients were voluntary admitted (a difference of 6,7%; 95% CI: -6.6% to 20.0%), 7.1% vs. 8,5% patients were involuntary admitted (a difference of 1.4%; CI: -6.4% - 9.2), and the median LOS (days) was 31.0 vs. 61.5 in patients who were initially referred to IHT versus those who remained in FACT and could not be referred to IHT.

IHT may thus reduce involuntary admissions as well as hospital-bed days for patients in a psychiatric crisis situation, and referred by outpatient mental health services. The effect on voluntary admissions did not reach statistical significance.

None Declared