Over the past half-decade, many surveys conducted in high-demand healthcare settings across Europe and globally have highlighted the psychological toll on healthcare workers (HCWs). Meta-analytic estimates suggest that approximately one-third of HCWs report symptoms consistent with depression and/or anxiety disorders. This persistent challenge underscores the need for scalable, evidence-based interventions that can be implemented across individual, organisational, and policy levels. The European Commission’s Best Practices Portal highlights a stepped-care programme of digital interventions designed to support mental health. This programme includes two interventions developed by the World Health Organization: Doing What Matters in Times of Stress (DWM) and Problem Management Plus (PM+).

We will (1) present the results of the adaptation process of DWM and PM+, (2) analyse their effectiveness in a sample of distressed healthcare workers in Spain, (3) describe the implementation process, and (4) evaluate the DWM’s implementation under real-world conditions.

We will synthesize evidence from three complementary studies: a qualitative study identifying key problems and needs among HCWs in routine clinical practice, a multi-centre randomised controlled trial testing the effectiveness and implementation of DWM and PM+, and a pilot study that examined implementation outcomes of two versions of DWM under real world conditions.

The qualitative study showed that doctors’ and nurses’ narratives could inform the adaptation of the two eHealth interventions, with narratives from nearly 100 stakeholders shaping the final version of the programme. The randomized control trial showed that DWM and PM+ were more effective than enhanced care as usual in reducing anxiety and depressive symptoms when delivered in a stepped-care format. A mixed-methods process evaluation also showed favourable implementation outcomes. The pilot implementation study revealed high participation rates and high acceptance rates, appropriateness, and feasibility, among healthcare workers in a primary care centre in Madrid, Spain.

These findings show that this stepped-care programme of scalable psychological interventions can be effectively implemented within routine healthcare services, with potential relevance for Spain, and other European countries with similar healthcare systems. The results highlight the continued relevance of evidence.based, digitally delivered stepped/care models and support their broader adoption by policy makers and health systems, reinforcing the value of the European Commission’s Best Practices protocol as a guide for sustainable strategies to support HCW’s mental health.

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Improving quality of life (QoL) is a primary objective in the treatment of schizophrenia. The current analysis aimed to evaluate the impact of antipsychotic administration routes on QoL in early-phase schizophrenia (SZ) patients randomized to treatment with either long-acting injectable (LAI) or oral aripiprazole or paliperidone as part of the “European Long-acting Antipsychotics in Schizophrenia Trial” (EULAST).

A total of 492 patients were followed for up to 19 months. QoL was assessed using the EQ-5D-5L. In the primary analysis, the relationships between oral versus LAI treatment and between treatment with paliperidone versus aripiprazole were investigated by fitting generalized estimating equation models. In secondary analyses, we examined the individual dimensions of the EQ-5D-5L, including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. In subgroup analyses, we estimated the treatment effect on the EQ-5D-5L across clinically relevant subgroups, including sex, age, symptomatology, and side effects.

Overall, EQ-5D-5L scores improved over the course of the study, with no significant differences between patients treated with LAI versus oral antipsychotics (p = 0.662) or between those treated with aripiprazole versus paliperidone (p = 0.266). Subgroup analyses based on sex, age, medication side effects, and psychopathology also did not reveal any significant differences in EQ-5D-5L outcomes between LAI and oral antipsychotic treatment.

These findings indicate comparable QoL in SZ patients starting LAI or oral antipsychotic treatment with aripiprazole or paliperidone. Further research with extended follow-up periods is required to gain deeper insights into potential subgroup-specific benefits and the long-term effects of different antipsychotic administration routes on QoL.

Cohort studies of individuals with a suicide attempt are crucial for identifying risk and protective factors to prevent recurrence. The SURVIVE prospective cohort study aims to investigate the demographic and clinical profiles of individuals presenting with suicidal behaviour.

A total of 1,741 individuals (289 adolescents aged 12–17 and 1,443 adults aged 18 and older) were recruited from emergency departments at eight hospitals across five Spanish regions following a suicide attempt. Baseline data were collected using structured clinical interviews and validated self-report instruments. Sociodemographic and psychiatric variables were analysed.

Most participants were female, and approximately 20% were migrants. Religious affiliation was reported by 35.6% of adolescents and 48.4% of adults. Depression and anxiety were the most prevalent psychiatric diagnoses, while trauma-related and eating disorders were more frequent in adolescents, and substance use disorders in adults. Non-suicidal self-injury was reported by 76.6% of adolescents and 40.1% of adults. The most common method of attempt was self-poisoning in both groups. Psychotropic medication use was widespread, with both groups receiving a similar number of prescriptions.

The SURVIVE study provides a detailed characterization of suicide attempters in Spain, highlighting age-specific clinical patterns and contextual risk factors such as migration and religion. These findings underscore the need for tailored prevention strategies that consider developmental stage, psychiatric comorbidity, and social vulnerability.

Over time, identifying a specific personality type that confers increased vulnerability to cardiac disease has proven challenging. Moreover, specific personality traits may also predispose individuals to major psychiatric disorders, exerting cumulative effects that increase the risk of psychosomatic conditions. In this context, coronary heart disease can be regarded as a prototypical model of these underlying psychobiological mechanisms. The concept of Type D personality was introduced to characterize enduring psychological traits observed in individuals with coronary heart disease who have a highly persistent tendency to experience negative emotions throughout life. Individuals with Type D personality exhibit heightened sensitivity of the hypothalamic–pituitary–adrenal (HPA) axis, leading to overreacting neuroendocrine responses, systemic immune activation, and chronic inflammation. This inflammatory state contributes to endothelial dysfunction and promotes the transformation of circulating immune cells into lipid-laden foam cells, thereby accelerating atherosclerotic processes within the coronary arteries. Over time, sustained neuroinflammation leads to reduced levels of monoamines and neurotrophic factors in the brain, as well as increased excitotoxicity. Altogether, these mechanisms may account for the higher prevalence of cardiac comorbidity and poorer cardiovascular outcomes observed in individuals with Type D personality compared with their non–Type D counterparts.

type D personality, inflammatory mechanisms, coronary heart disease

1. Kupper N, Denollet J. Type D Personality as a Risk Factor in Coronary Heart Disease: a Review of Current Evidence. Curr Cardiol Rep. 2018 Sep 12;20(11):104.

2. Libby P. Inflammation and cardiovascular disease mechanisms. Am J Clin Nutr. 2006 Feb;83(2):456S-460S.

3. Simats A, Sager HB, Liesz A. Heart-brain axis in health and disease: role of innate and adaptive immunity. Cardiovasc Res. 2025 Apr 8;120(18):2325-2335.

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Patients presenting with cardiac symptoms such as chest pain, palpitations, dyspnea, or syncope frequently exhibit underlying psychiatric conditions that may mimic or exacerbate cardiovascular disease. Anxiety disorders, depressive disorders, and somatic symptom disorders are highly prevalent in cardiology and emergency settings, yet remain underdiagnosed, contributing to repeated investigations, increased healthcare utilization, and poorer clinical outcomes. Consultation-liaison (C-L) psychiatry plays a pivotal role in the differential diagnosis and management of these complex presentations.

This presentation aims to review recent evidence on the prevalence, diagnostic challenges, and clinical impact of psychiatric disorders in patients with cardiac symptoms, and to highlight the contribution of C-L psychiatry to improving diagnostic accuracy and patient care.

A narrative review of recent literature (last 3–5 years) indexed in PubMed was conducted, focusing on systematic reviews, meta-analyses, and large cohort studies examining psychiatric comorbidity in cardiac populations and the effectiveness of psychiatric assessment in cardiology and emergency contexts.

Recent studies indicate that up to 30–50% of patients presenting with non-cardiac chest pain meet criteria for an anxiety or depressive disorder, with panic disorder being particularly prevalent. Symptom overlap between cardiac and psychiatric conditions frequently leads to diagnostic uncertainty and delayed psychiatric referral. Evidence supports the use of structured screening instruments (e.g., GAD-7, PHQ-9) and early psychiatric consultation to enhance diagnostic clarity. C-L psychiatry interventions have been associated with reduced unnecessary cardiac testing, improved symptom management, and better patient-reported outcomes.

Integrating C-L psychiatry into cardiology and emergency services is essential for the timely identification of psychiatric disorders in patients with cardiac symptoms. Early, structured psychiatric assessment represents a best-practice approach to reduce misdiagnosis, optimize treatment strategies, and improve both mental and cardiovascular health outcomes. Future research should focus on standardized clinical pathways and longitudinal outcomes of integrated care models.

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Schizophrenia-spectrum disorders (SSD) are characterized by structural and functional brain abnormalities, including disrupted functional connectivity within networks such as the salience network. The anterior cingulate cortex (ACC), a core hub of this network, has shown alterations in the major neurotransmitter systems comprising glutamate (Glu) and γ-aminobutyric acid (GABA). While dysfunctional glutamatergic signaling has been proposed as a key mechanism in SSDs, the relationship between anterior cingulate cortex (ACC) functional connectivity, glutamatergic neurotransmission, and clinical symptomatology remains poorly understood.

Here, we combined resting-state functional MRI to measure functional brain connectivity with proton magnetic resonance spectroscopy to measure Glu and GABA levels in the dorsal ACC of 26 patients with schizophrenia spectrum disorders and 38 healthy controls.

Patients showed reduced connectivity within the salience network compared to controls. Across the whole sample, a dorsal ACC-seed showed glutamate-dependent connectivity to several clusters, including right insula, thalamus, and cerebellum. In patients, the averaged connectivity of these clusters was associated with positive symptom severity.

These findings suggest that disrupted glutamatergic modulation of large-scale brain networks may underlie core clinical features in schizophrenia spectrum disorders.

Depression is common in patients with chronic heart failure (CHF) and is associated with poorer functional outcomes, reduced quality of life, and increased morbidity. Growing evidence indicates that inflammatory pathways may represent a shared mechanism linking depressive symptoms and cardiovascular disease progression. This presentation summarises clinical and translational findings on the role of antidepressant treatment as a potential modulator of inflammation in patients with comorbid depression and CHF. Focusing on multimodal antidepressants, I will discuss observed changes in biomarkers relevant to psychocardiology—including soluble ST2 and fibronectin—and their relationship with symptom severity and clinical status. The talk will address practical implications for consultation-liaison psychiatry, including psychopharmacological decision-making in cardiac patients, the potential value of biomarker-informed monitoring, and interdisciplinary collaboration with cardiology. By connecting inflammatory mechanisms with clinical outcomes, the presentation supports a more integrated, mechanism-informed approach to treating depression in CHF, aiming to improve both emotional well-being and cardiovascular care.

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Cognitive impairment associated with schizophrenia (CIAS) is a prevalent, meaningful feature of schizophrenia with limited real-world data on its recognition and care setting impact. The LUCIA initiative is an international multi-stakeholder study that explored awareness, assessment practices, and the burden of CIAS to inform future care pathways.

A three phase, Delphi-informed design was applied, comprising expert interviews to frame the enquiry, qualitative interviews with health and social care professionals (HCPs; n = 74) and caregiver advocates (n = 11), two waves of a Delphi survey among HCPs (n=449 and 343, respectively) and one round among 61 patients and 112 caregivers across 15 countries (n = 964).

The results showed poor awareness of CIAS across stakeholders. Structured cognitive assessment was infrequent, and clinicians largely relied on the dementia oriented Mini-Mental State Examination (MMSE) rather than schizophrenia specific tools, citing time, training, and unclear actionability as key barriers. CIAS imposed broad humanistic, clinical, societal, and economic burden – poorer quality of life, social isolation, higher comorbidities, increased hospital days and health care costs, and heavy informal care. Consensus actions prioritized the development of brief, validated screening instruments, improved psychoeducation, and accelerated research into effective pharmacological and non pharmacological interventions.

These results provide additional evidence for the under-recognition of CIAS worldwide, despite its substantial multidimensional societal burden. The use of dementia-oriented cognitive tests carries significant risks of misclassification and inappropriate management. Therefore, improving awareness, implementing assessment guidelines, and accelerating therapeutic innovation is critical to improve the quality of life of CIAS patients and the wider community.

Ethical dilemmas are a central and everyday challenge in psychiatric practice, particularly where questions of equity and human rights are concerned. Psychiatry operates in a unique space between care, social control, and legal authority, which makes ethical tensions especially visible and, at times, unavoidable. This talk examines key ethical dilemmas in psychiatry through the lens of equity and human rights, focusing on issues such as involuntary treatment, coercive practices, decision-making capacity, stigma, and unequal access to mental health care. It highlights how social and structural inequalities—related to socioeconomic status, ethnicity, gender, migration status, disability, and other forms of marginalization—shape both mental health outcomes and patients’ experiences within psychiatric systems. Drawing on international human rights frameworks, including the United Nations Convention on the Rights of Persons with Disabilities, the presentation explores tensions between autonomy, beneficence, non-maleficence, and justice in everyday clinical practice. By integrating ethical reflection with real-world clinical challenges, the talk aims to stimulate discussion on how rights-based, person-centered approaches can help reduce harm, enhance dignity, and promote more equitable and humane psychiatric care.

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Thought disorder (TD) is a core feature of severe mental illnesses such as schizophrenia, characterized by disruptions in speech, language, and communication. People with TD face unique barriers that hinder their involvement in research, both as participants and as partners. Their systematic underrepresentation in psychiatric research is driven by pervasive assumptions about their decisional capacity, willingness to participate, and ability to engage in research. This perpetuates a biased evidence base, likely hindering the therapeutic progress toward addressing this core problem.

This review, informed by professional (clinical and research) and lived (bottom-up and phenomenological) experience of TD, examines how flawed assumptions regarding capacity, engagement, and participatory abilities serve as active barriers to inclusion.

We argue for a shift toward supported inclusion through tailored capacity assessments, enhanced informed consent procedures, targeted training of research personnel, and systemic institutional practices. Incorporating lived experiences of those with TD as research partners is integral to this approach, fostering co-production of research that is more valid, inclusive, and applicable.

Without these inclusion-focused changes, the development of treatments for TD is likely to have very slow progress and a critical segment of the severely unwell population will continue to be underrepresented from the scientific process, undermining both the utility and generalizability of psychiatric research.

The global movement away from institutional models of care toward inclusive, community-based support for persons with disabilities represents one of the most significant transformations in contemporary social and mental health policy. This shift is grounded in international human rights standards, particularly the United Nations Convention on the Rights of Persons with Disabilities (CRPD), which emphasizes inherent dignity, individual autonomy, non-discrimination, equality of opportunity, and full participation in society. The CRPD challenges long-standing practices of segregation and substitute decision-making, calling instead for systems that enable independent living and meaningful inclusion in the community.

The abstract examines how these principles are translated into practice across mental health and social care systems worldwide. Drawing on assessments conducted using the World Health Organization’s QualityRights Toolkit, it identifies recurring structural and systemic barriers, including limited recognition of legal capacity, continued reliance on institutional care, inadequate access to community-based services, and insufficient individualized support for daily living and social participation. These challenges highlight the gap between formal policy commitments and lived experiences of persons with disabilities.

At the same time, the analysis presents evidence-based strategies and policy approaches that have demonstrated success in advancing deinstitutionalization and rights-based care. These include the development of supported decision-making frameworks, investment in community mental health services, cross-sector collaboration, and the active involvement of persons with disabilities in service design, monitoring, and evaluation. Particular attention is given to the role of legislative reform, workforce training, and cultural change in sustaining long-term transformation.

Through international case studies and comparative perspectives, the abstract offers practical insights for policymakers, clinicians, service providers, and advocates. It underscores the necessity of aligning mental health and disability services with human rights standards, not only as a legal obligation but as a foundation for ethical, effective, and person-centered care.

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The European Working Time Directive (EWTD) mandates a maximum average of 48-hour working week, yet compliance across European healthcare systems remains inconsistent. Despite widespread transposition into national legislation, enforcement is inadequate, and junior doctors routinely work 60–70+ hours weekly due to opt-out clauses, weak monitoring, and misaligned institutional incentives. This presentation examines EWTD implementation through an Equity, Diversity, and Inclusion (EDI) lens, drawing on European Junior Doctors (EJD) survey data to demonstrate how working time violations intersect with demographic factors including gender, age, and training stage. In this talk, systemic barriers - inflexible training structures, inadequate rest provisions, and differential exposure to workplace violence and harassment -are analyzed, showing how they disproportionately impact women and marginalized groups, exacerbating work–life imbalance, burnout, and workforce attrition. The discussion integrates EJD’s own gender equality policy with WHO data on physician wellbeing, highlighting elevated rates of burnout and psychological distress among European doctors. This presentation contextualizes these workforce challenges within the specific demands of psychiatry training, where extended hours compound emotional labour and occupational stress. The presentation concludes with evidence-based recommendations for policymakers and training bodies: strengthening enforcement mechanisms for working time regulations, implementing targeted protections for vulnerable trainee cohorts, and embedding EDI principles into workforce planning and postgraduate curricula. These strategies aim to create sustainable training environments that promote the principles of equitable, high-quality psychiatric education across Europe.

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Multiple observational studies have reported associations between age at menarche (AAM) and mental health problems, yet their shared genetic architecture remains poorly characterized.

We leveraged genome-wide association study summary statistics for AAM and 15 mental health-related phenotypes. We conducted a multi-method integrative analysis encompassing linkage disequilibrium score regression, pleiotropic analysis under the composite null hypothesis, functional mapping and annotation, multi-marker analysis of genomic annotation, pathway enrichment, and bidirectional two-sample Mendelian randomization (MR) to explore shared genetic architecture and potential causal relationships.

Our study identified significant genetic correlations between AAM and eight mental health-related phenotypes (miserableness, fed-up feelings, nervous feelings, ever thought that life is not worth living, ever self-harmed, depression, ever smoker, and age started smoking in former smokers). A total of 155 pleiotropic loci, 18 colocalized loci (e.g., 6q16.3), and 203 pleiotropic genes (e.g., LIN28B) were identified. These genes are expressed in multiple regions, including the cerebral cortex and hypothalamus, and are involved in various biological processes and signaling pathways. Additionally, MR analysis revealed causal associations between AAM and 5 mental health-related phenotypes (mood swings, miserableness, fed-up feelings, and age at which smokers started smoking in former/current smokers).

Our study revealed extensive genetic associations between AAM and mental health-related phenotypes, and further explored the potential causal relationships between them. These findings enhance our understanding of the relationship from a genetic perspective and establish a foundation for future research to explore the biological pathways and environmental interactions contributing to these associations.

Cognitive reserve (CR) is considered a positive factor in the onset, progression, and prognosis of diseases. It may also help explain the clinical heterogeneity observed in schizophrenia (SZ).

This cross-sectional study included 70 patients with SZ and 64 healthy controls. Participants were assessed on CR, symptoms, cognition, and functional outcomes. Following PRISMA guidelines, we also searched PubMed, Scopus, Web of Science, Embase, the Cochrane Library, and PsycINFO for studies published up to September 25, 2025. Study quality was evaluated using the Newcastle-Ottawa Scale (NOS).

Patients with higher CR showed less severe negative and general psychopathological symptoms, along with better functional outcomes. Meta-analysis confirmed this relationship and further revealed positive correlations between CR and multiple cognitive domains, including speed of processing, working memory, verbal learning, visual learning, and reasoning and problem solving.

This study demonstrates a positive association between CR and symptoms severity, cognitive performance, and functional outcomes in SZ.

Negative symptoms of schizophrenia represent a major determinant of long-term functional impairment and quality of life, yet they remain insufficiently recognized and inadequately managed in routine clinical practice. Although appropriate brief assessment instruments and international guidance papers have been developed over the past two decades, their effective integration into psychiatric training and everyday care has not yet been verified. This study aimed to evaluate the level of knowledge and self-perceived competence in evaluating and managing of negative symptoms among early career psychiatrists (ECPs) in Europe.

The CARE project was a cross-sectional online survey conducted between January and June 2025 and distributed through European psychiatric networks. A total of 828 ECPs from 19 European countries were included in the analysis. The survey assessed demographic and training-related characteristics, knowledge and familiarity with guideline-based recommendations, and self-reported competence in evaluation and treatment of negative symptoms.

Despite high self-reported exposure to theoretical courses about negative symptoms and clinical placements in schizophrenia care wards/clinics (67.9% and 70.3%) and 65.7% of ECPs reporting feeling well-trained to administer negative symptom assessment tools, the objective knowledge of negative symptoms was limited. Only 11% of participants correctly identified all core negative symptom domains while 15.9% provided correct answers to European Psychiatric Association guidance-based questions. In contrast, a considerably larger percentage of 46.7% and 25.9% respondents reported feeling competent in the evaluation and management of negative symptoms, indicating a striking discrepancy between perceived competence and actual knowledge about negative symptoms. Higher knowledge levels were associated with specialist status, engagement in clinical research, and participation in extracurricular training in negative symptoms, but not with the standard components of specialist curricula (theoretical courses and placements in wards/clinics specialized in schizophrenia care). Almost 90% of ECPs agreed that there should be more emphasis on negative symptoms in the specialist training curricula.

These findings highlight substantial educational gaps in the field of negative symptoms among European ECPs and suggest that current training programs need to be updated and refined to foster guideline-concordant expertise. Integrating evidence-based recommendations into mandatory curricula and providing ECPs with skills-oriented training may be the essential steps toward raising the recognition and management of negative symptoms and eventually improving the functioning and quality of life of people living with schizophrenia.

None Declared

Childhood maltreatment (CM) is related to structural alterations in adult limbic regions. However, the change in limbic structures remains unclear in adolescents from the general population since most reports stem from clinical samples. Additionally, large longitudinal neuroimaging studies in community adolescents reporting CM are scarce. Hence, we aimed to investigate the cross-sectional and longitudinal associations between CM and the structure and function of the extended limbic and reward systems throughout adolescence.

We analysed data of 634 community adolescents from the IMAGEN cohort at age 14, followed up at age 18. CM was inferred from the Childhood Trauma Questionnaire completed at age 18, yielding subgroups with CM (N = 105) or without CM (N = 529). Using 3-Tesla T1 MRI, we performed between-group voxel-wise analyses at ages 14 and 18 to investigate grey matter volumes (GMV). In addition, GMV were investigated longitudinally between ages 14 and 18. Finally, using functional MRI and the Monetary Incentive Delay task, we measured reward anticipation and feedback sensitivity between groups at ages 14 and 18.

Both at ages 14 and 18, adolescents reporting CM had lower GMV in the right insula, left orbitofrontal cortex, putamen, superior medial frontal gyrus, paracentral lobule, and other paralimbic regions, but no significant differences in reward response. Longitudinal analyses revealed no GMV difference between age groups.

CM was associated with GMV alterations persisting from early to late adolescence in the limbic regions in community individuals. Therefore, these findings further support the need for research on targeted preventive interventions for adolescents who have experienced CM.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurobehavioral disorders, and it afflicts about 7% of young people. Its prevalence in adult women is 3.2% in the US. As a consequence, many young women might be pregnant while taking medication for ADHD, but data about safety have not yet been strictly examined. To mend such gap, a serch throug Electronic databases (PubMed,Embase,andPsycINFO) were conducted through December 31, 2023. It resulted in a meta analysis of ten studies involving 16621481 pregnant women, 30830 of them affected by ADHD. Congenital anomalies or miscarriages were not more frequent in offspring of mothers receiving treatment with methylphenidate or atomoxetine during pregnancy compared with unexposed offspring (OR, 1.14; 95% CI, 0.83-1.55; P = .41; I2 = 8% for congenital anomalies; OR, 1.15; 95% CI, 0.82-1.62, P = .67; I2 = 0% for miscarriages) or compared with the general population (OR, 1.19; 95% CI, 0.93-1.53; P = .16; I2 = 74% for congenital anomalies; OR, 0.98; 95% CI, 0.77-1.25; P = .40; I2 = 0% for miscarriage). In conclusion, evidence suggests the maintenance of methylphenidate or atomoxetine during pregnancy is safe, sincecongenital anomalies and miscarriages did not appear to significantly increase. Further studies are highlyrecommended to support and confirm these findings.

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Forensic psychiatric services are expanding in many countries, and discharging patients from secure hospitals relies on accurate estimates of risk of adverse outcomes. Novel evidence-based tools for estimating one key risk, violent reoffending, have been developed in recent years. We aimed to externally validate one new tool, FoVOx, in forensic psychiatric patients sentenced to treatment and to develop an updated model (FoVOx2), incorporating additional clinical predictors.

Using Swedish national registers, we conducted a temporal external validation of FoVOx by examining 767 patients discharged between 2014 and 2023. For the FoVOx2 cohort, 906 patients discharged between 2008 and 2023 were followed up, and additional predictors tested. The outcome was violent reconviction within 12 or 24 months. Model performance was evaluated using Harrell’s C-index, area under the receiver operating characteristics curves (AUCs), calibration, and classification metrics at predefined thresholds.

In temporal validation, FoVOx showed moderate discrimination (AUCs 0.69 and 0.71; C-index = 0.69) and acceptable overall accuracy (Brier <0.11). Calibration was generally good, with mild overestimation at the highest predicted risks (>20%) at 12 months and slight underprediction at 24 months. The updated FoVOx2 model incorporated novel predictors, including clozapine treatment and additional diagnostic categories. It was associated with improved performance (AUCs 0.77; optimism-corrected C-index = 0.72; Brier 0.06 and 0.09) and demonstrated good calibration (intercept ≈ 0; slopes 1.03 and 1.05).

Updating risk assessment tools with additional clinical factors can lead to incremental improvement in model performance. Implementing tools should consider clinical utility and impact as next steps.

While it is well known that the perinatal period is a time of risk for women’s mental health, the vast majority of episodes are mild to moderate in intensity. However, there are also episodes of severe decompensation that may be accompanied by auto- or hetero-aggressive behavioral disorders, which raises the question of appropriate care.The aim of this presentation is to describe the semiological contexts of these severe decompensations, as well as the therapeutic strategies involving medication and care pathways that can be proposed, with a focus on preventive care.

None Declared