Fibromyalgia and chronic fatigue syndrome are commonly associated with persistent somatic symptoms, significant functional impairment and limited response to pharmacological treatment. Complete remission of fibromyalgia-related pain is rarely described in clinical practice. Recent evidence highlights the interplay between psychosocial stressors, relational dynamics and somatic symptomatology, but reports of patients achieving a sense of “cure” remain exceptional.

To describe the clinical course of two female patients with fibromyalgia who experienced a remarkable remission of pain and fatigue symptoms, in temporal association with the exploration of relational conflicts and biographical narratives during psychiatric follow-up.

We present two case reports (aged 62 and 64) followed in outpatient psychiatric consultations. Both had long-standing fibromyalgia and depressive-anxious symptoms treated with duloxetine and adjunctive agents. During the last year, beyond pharmacological adjustments, psychotherapeutic interventions focused on linking relational patterns and life history to bodily symptoms, encouraging expression of emotions and establishing interpersonal boundaries.

Both patients reported progressive disappearance of diffuse fibromyalgia pain and fatigue, contrasting with the persistence of mechanical pain due to musculoskeletal disorders (arthrosis, spine pathology). They spontaneously differentiated this residual pain from their previous fibromyalgia pain (“plof”/diffuse body pain). They associated the improvement with being able to verbalize anger and frustration, set limits in family or marital contexts, and recognize the impact of unresolved relational conflicts on somatic expression. Although pharmacological regimens included antidepressants previously used with partial effect, patients emphasized the transformative role of emotional expression and relational change. At present, both report full functional recovery and describe themselves as “cured” of fibromyalgia.

These cases suggest that, in certain patients, remission of fibromyalgia symptoms may be facilitated by psychotherapeutic work addressing relational dynamics and biographical conflicts. Beyond pharmacological treatment, the ability to connect emotions with somatic experience, express conflict and set interpersonal boundaries may play a central role in the disappearance of chronic pain. Further research is needed to explore the mechanisms underlying these exceptional clinical evolutions.

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Multifamily group interventions are increasingly recognized as valuable complementary approaches for individuals with severe mental disorders. These groups provide a space where patients and their relatives can jointly explore relational dynamics and emotional experiences. However, systematic evaluations of psychodynamic and group-based multifamily interventions using standardized instruments remain scarce.

To describe the methodological design of a prospective evaluation of a psychodynamic multifamily therapy group in a public mental health service, and to present the baseline assessment plan prior to longitudinal follow-up.

The group includes patients with SMD—mainly psychotic and bipolar disorders—and their relatives, who typically present with neurotic structures and symptoms such as anxiety or depression. This heterogeneity allows exploration of contrasting subjective positions within the same therapeutic space. The intervention follows a psychodynamic group framework, integrating multifamily, group-analytic, and operative group perspectives, and is offered as a complement to standard psychiatric and pharmacological treatment. At the beginning of the therapeutic course (September 2025), participants completed: (a) a sociodemographic questionnaire; (b) the WHOQOL-BREF (quality of life); (c) the Reflective Functioning Questionnaire (RFQ-8); and (d) the short version of the Family Relations Scale (ERI). At the end of the course (June 2026), additional measures will include a Satisfaction Survey and Yalom’s Therapeutic Factors Questionnaire.

Data collection is ongoing. At the time of abstract submission, only baseline questionnaires have been distributed and responses are being gathered. Full descriptive results from the initial assessment will be presented at the congress poster session. Comparative pre–post analyses will be conducted after the completion of the therapeutic cycle in June 2026.

This project introduces a structured methodology to evaluate the impact of psychodynamic multifamily groups in routine psychiatric practice. The integration of validated psychometric tools with a group-based intervention highlights the feasibility of assessing both clinical and relational outcomes. Presenting baseline findings and methodological design at this stage contributes to the evidence base for multifamily interventions as meaningful complements to pharmacological treatment in SMD.

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Psychotherapy is a core skill in child and adolescent psychiatry practice. Psychotherapy remains an essential treatment modality for a child’s cognitive, emotional, behavioral, and relational problems. The knowledge and skills from psychotherapy contribute to other clinical activities such as diagnostic assessment, pharmacotherapy, and consultation to agencies, schools, and other physicians.

This study aimed to determine the patterns of psychotherapy among child and adolescent psychiatrists in the Philippines.

Using a cross-sectional descriptive study design, a self-reported questionnaire was sent via email to each participant along with the informed consent. Out of 56 actively practicing child and adolescent psychiatrists in the Philippines, 49 child and adolescent psychiatrists fulfilled the inclusion criteria and were included in the study from November 2024 until July 2025. Data on demographic profile, current workload and practice, psychosocial interventions, conceptual frameworks, psychotherapy practices, and obstacles faced in doing psychotherapy were analyzed using descriptive statistics.

Based on the results, majority of the child and adolescent psychiatrists actively practicing in the Philippines were female (89.8%), aged 31–40 years old (34.7%) and living in Luzon area (73.5%). Most of the respondents have been practicing for less than 10 years (44.9%) in both private and government settings (59.2%) with increased outpatient load. Commonly, psychotropic medications (59.2%) with psychosocial interventions specifically in counseling (57.1%), parenting advice and guidance (75.5%), and psychotherapy (53.1%) are being practiced. In doing case formulation and treatment planning, attachment theory (51.1%) and learning and cognitive theory (42.9%) were frequently used. Supportive psychotherapy (77.6%) and cognitive behavioral therapy (46.9%) were most utilized in their practice, particularly for patients with depressive (100%) and anxiety disorders (98%). The main hindrance in providing psychotherapy is attributed to the number of duties and responsibilities practitioners handle (59.2%).

In conclusion, it is of great importance that mental health workforce must be strengthened through (a) the increase of recruitment of trainees in child and adolescent psychiatry, (b) strengthen the capacity of general psychiatrists and non-psychiatrists such pediatricians/family practitioners to treat child and adolescent mental health problems, and (c) reinforce relationships with allied mental health professionals that can provide counseling and psychotherapy interventions such as guidance counselors and psychologists.

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As the number of treatment resistant patient in the psychiatric field has been growing over the last decades, there is a clear need for new therapeutic options. Over several years, the field of psychedelic assisted psychotherapy has been rapidly developing. In this scope ketamine assisted psychotherapy (KAP) has come into psychiatric use to treat depression resistant depression, generalized anxiety disorder, post-traumatic stress disorder as well as other psychiatric troubles.

The aim of this narrative review is to provide a better understanding of the KAP, its indications and the possibles changes during the course of the patient’s psychotherapy. In addition, this review studies the efficiency of the KAP and the possible associated risks.

Extended research has been made on the PubMed and Embase database, reviewing the articles written between 2015 and 2025 using the keys and mesh words psychotherapy and ketamine. Inclusions criteria were the following: use of psychotherapy, KAP session should be done is a relaxing setting and use a bolus dose inducing a psychedelic experience. Twenty for three articles have been finally selected using these inclusion criteria and additional exclusions criteria.

This study shows the clear efficiency of the KAP in the treatment for resistant depression, generalized anxiety disorder, post-traumatic stress disorder as well as other psychiatric troubles as addictions at a short term. These results could be partly related to the positive changes in the patient functioning in his psychotherapy after living a psychedelic experience.

Nevertheless, a large part of patient, varying from 30 to 50%, are not responding to the therapy.

This study has also shown a low risk associated to the KAP when properly conducted, which underlines the need for clearer guidelines and medical good practices.

KAP shows a good therapeutic potential and should yet carefully put into practice through clinical trials. Further studies are yet needed to better understand why some patients aren’t responding to the therapy and what could be done to improve the number of responding patients.

The long-term efficiency of KAP isn’t yet clear, which opens the door to new studies.

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Personality development is shaped by genetic predisposition and early caregiver relations. Through the interplay of temperament and early experiences, internalized representations of self and others are formed. The degree of integration of good and bad representations, along with self–object differentiation, leads to three levels of personality organization: neurotic (NO), borderline (BO), and psychotic (PO). These differ in defense mechanisms (mature vs. immature), identity coherence, and reality testing. PO and BO are marked by immature defenses (splitting, projection, projective identification), greater identity diffusion, and impaired reality testing (though preserved in BO). NO is defined by stable identity, mature defenses, and intact reality testing. In early psychosis (≤5 years), impaired insight is common and linked to delayed treatment, poor adherence, aggression, and worse long-term outcomes. Clinical insight is a multidimensional construct involving awareness of illness, consequences, treatment compliance, and recognizing symptoms as pathological.

Aim of this study was to investigate level of patient’s and parent’s personality

organization with clinical insight into early psychosis.

We conducted a cross-sectional study on 105 parent–child dyads with early-stage psychotic disorders (≤5 years; ICD-10 F20–F29), including patients aged 18–35 years of both sexes, hospitalized at Sveti Ivan Psychiatry Clinic. All participants gave informed consent. Instruments included a sociodemographic questionnaire, the abbreviated SUMD, PANSS (five-factor model), CGI-S, and Kernberg IPO. The study followed the Helsinki Declaration.

Patients were predominantly male, well educated, and most often diagnosed with F23; among parents, mothers were more represented. On the PANSS Five-Factor scale, patients improved across all domains. Patients showed greater illness awareness than parents, with fathers more aware than mothers. Compared to patients, parents demonstrated more mature defenses, less identity diffusion, and better reality testing. In parents, identity diffusion was linked to lower illness awareness and reduced recognition of social consequences, but not to insight into medication needs.

Insight is a complex, dynamic phenomenon that can only be meaningfully assessed in those with lived experience of psychosis. This study highlights the intricate parent–child dynamics and underscores the need for family psychotherapy and psychosocial interventions in early psychosis treatment.

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Ketamine-assisted therapy shows rapid benefit in treatment-resistant depression, anxiety, and PTSD (Walsh et al. BJPsych Open 2022;8:e19). The Roots to Thrive Ketamine assisted Therapy (RTT-KaT) program is a unique 12-week program that combines 12 Community of Practice (group therapy) sessions and three ketamine medicine sessions (Tsang et al. Ther Adv Psychopharmacol 2023;13:1–14). Predictors of treatment responses within this model are unclear.

1. (1) Evaluate pre–post changes in PHQ-9, GAD-7, PCL-5, and B-IPF;

2. (2) Assess whether baseline severity predicts improvement;

3. (3) Examine effects of concurrent pharmacotherapy or prior psychotherapy;

4. (4) Test whether Adverse Childhood Experiences (ACEs) predict treatment outcomes.

We conducted a retrospective cohort analysis of 305 participants enrolled in the 12-week RTT-KAT program (2018–2023), using validated scales (PHQ-9, GAD-7, PCL-5, BIPF) administered at baseline and post-program (Figure 1). Paired t-tests with 95% CI and Cohen’s d. Linear regressions assessed whether baseline severity predicted improvement, while ANCOVA of post-scores adjusted for baseline and pharmacotherapy/psychotherapy status. ACEs were evaluated using Pearson correlation and Welch’s t-tests (ACE ≥4 vs <4). Multiple analyses accounted for multiple comparisons with α=0.05.

Significant reductions were observed for PHQ-9, GAD-7, PCL-5 (all p<0.001, d>0.8) and moderate improvement for B-IPF (d=0.5; Figure 1). Higher baseline severity predicted greater absolute improvement across scales (negative β, p<0.001; Figure 2). After adjusting for baseline severity, concurrent pharmacotherapy and prior psychotherapy showed no effect on depression or anxiety. Pharmacotherapy predicted higher adjusted PTSD post-scores (β=4.48, 95% CI 0.72–8.24, p=0.020) and a non-significant trend toward poorer functioning (p=0.064). ACEs showed no significant correlation with treatment response (|r|<0.08, all p>0.20). Threshold comparisons (ACE ≥4 vs <4) also showed no group differences (all p>0.13). All confidence intervals included zero, indicating no evidence of either linear or threshold associations. Substance-use history was unrelated to outcomes (all p>0.20). Similarly, current alcohol, cannabis, or tobacco use did not significantly affect post-treatment outcomes once baseline severity was controlled.Image 1:

RTT-KAT was associated with significant reductions in depression, anxiety, and PTSD. Improvement was greatest among those with higher baseline severity. Neither ACEs, prior psychotherapy, pharmacotherapy nor substance-use history predicted outcomes. Overall, baseline severity emerged as the most consistent predictor of clinical improvement, underscoring the potential of group-based KAT as a broadly effective and accessible intervention for individuals with high symptom burden.

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Behçet’s disease is a chronic multisystem inflammatory disorder that may present in childhood with recurrent oral ulcers, uveitis, and skin lesions (ITR-ICBD, 2014; Koné-Paut, 2016). A 9-year-old boy receiving intramuscular methotrexate for Behçet’s disease developed anticipatory nausea and vomiting triggered by injection cues. This case describes how a single session of cognitive behavioral therapy (CBT) rapidly reduced these conditioned symptoms and restored treatment adherence.

A 9-year-old boy with Behçet’s disease was referred to the child and adolescent psychiatry clinic due to recurrent nausea and vomiting associated with intramuscular methotrexate injections. He had been diagnosed three years earlier after recurrent uveitis episodes. Following several oral treatments, intramuscular methotrexate 20 mg weekly was initiated, along with colchicine 0.5 mg twice daily, achieving reasonable disease control.

Initially, he tolerated the injections without difficulty. About ten months before referral, mild nausea began to appear before injections and gradually worsened. In recent weeks, nausea started as soon as his mother took the medication box in her hand and escalated to severe vomiting during the injection itself. Symptoms subsided immediately afterward, suggesting a conditioned anticipatory response rather than a direct pharmacologic reaction.

A single 45-minute CBT session was conducted. In this session, the injection was not performed; instead, the medication box was shown to elicit anticipatory cues safely. When nausea and discomfort intensified, the therapist applied breathing, relaxation, and short running exercises to demonstrate that these sensations were temporary and controllable. The patient enjoyed running, which was integrated as a behavioral activation technique to strengthen his sense of control. He remained cooperative and practiced the learned strategies effectively.

During the next injection, he delayed vomiting for several seconds; one week later, he was able to control the urge completely. Marked symptom reduction was achieved after a single CBT session, and follow-up sessions were recommended to reinforce coping and prevent relapse.

This case illustrates that anticipatory nausea and vomiting related to intramuscular medication can occur in children with chronic illnesses. Cognitive behavioral therapy was associated with rapid symptom reduction after a single session and helped the patient regain control of the conditioned response. Early recognition and prompt behavioral intervention may prevent escalation of procedural anxiety and reduce distress during medical treatments.

None Declared

Emotions are integral to everyday functioning, with positive self-related emotions—such as pride—playing a protective role across various domains of life. These emotions contribute to the development of enduring personal resources, which may be leveraged in psychotherapeutic contexts.

This pilot study aimed to validate a novel experimental design for inducing the self-conscious emotion of pride using randomly assigned positive and neutral feedback during repeated cognitive tasks, with the goal to establish a protocol suitable for EEG-based research.

Twelve healthy adult participants completed repeated cognitive tasks— the Stroop Test and the Eriksen Flanker Task—each paired with 10 neutral and 10 positive feedback trials. Emotional responses were assessed using the Self-Assessment Manikin (SAM) for valence, intensity, and arousal; the Authentic and Hubristic Pride Scale (AHPS) to differentiate pride subtypes; and the Qualitative Assessment of Emotions (QAE) to evaluate a range of emotional states. EEG data were recorded from 11 participants using a 64-channel system during task performance, followed by microstate analysis to explore neural correlates of induced emotional states.

According to SAM, no statistically significant differences were found between positive and neutral feedback conditions in emotional valence (W = 7.00, p = 0.071, r = –0.611; Mdn_pos = 6.60, Mdn_neu = 6.21), intensity (W = 14.50, p = 0.372, r = –0.356; Mdn_pos = 5.00, Mdn_neu = 5.00), or arousal (W = 16.00, p = 0.834, r = –0.111; Mdn_pos = 6.30, Mdn_neu = 6.00). However, authentic pride (Mdn = 3.00) was significantly more induced than hubristic pride (Mdn = 1.14; W = 66.0, p = 0.004). According to the QAE, positive emotions were experienced with significantly greater intensity than negative emotions (W = 77.0, p = 0.003). EEG microstate analysis revealed no significant differences between feedback conditions.

This pilot study demonstrates that the experimental design is feasible for EEG-based investigations of self-conscious emotions. While positive feedback showed a trend toward enhancing emotional valence, the effect did not reach statistical significance. The paradigm successfully elicited authentic pride more than hubristic pride, and positive emotions were experienced more intensely than negative ones. No EEG microstate differences were observed. Given the small sample size, further research is needed.

None Declared

Sleep paralysis as a form of parasomnia is associated with poor sleep habits and perceived poor sleep quality (Duarte et al., 2023). Its prevalence in medical students ranges from 16% (Penn et al., 1981) up to 41% (Duarte et al., 2023) with 70% of females reporting experiencing sleep paralysis (Muzammil et al., 2023). Although this disorder does not necessarily testify to the presence of the disease, it requires an effective help.

In this case report, we present a case of sleep paralysis that appeared and developed in a young healthy student, who is studying in a medical university, and who is changing his attitude to this phenomenon due to rational psychotherapy and practice of poetry writing as self-therapy.

We describe a 24-year-old male medical student, who has been under the observation of a psychotherapist because of periodic episodes of sleep paralysis.

Sleep disorders with the feeling of forcible retention when waking up and emergence of frightening visual images and death anxiety have been torturing the young man with different frequency since he was 18. At such moments he could not speak, shout, or move, his heart rate increased, and he was gripped by feelings of suffocation. Such state continued for 2-3 minutes. Those episodes appeared during intensive emotional stress associated with a high level of responsibility. Frequent disturbance of a sleep and rest regime provoked further bouts. We directed our diagnostic search at the exclusion of epilepsy and other paroxysmal states. The results of polysomnography did not show any specific changes. After the student heard from his psychiatrist that such states are not dangerous for health, the level of his anxiety lowered. He started analyzing his own experience of controlling and dealing with such states, worked at the techniques of discontinuing episodes of sleep paralysis. He began writing poems, in which he dissociated the problem from himself, which allowed him to avoid it and assure himself of his ability to cope with the problem, and to accept his actual state and his own fears.

In this case, a medical student and his psychotherapist jointly tried out effective stress controlling strategies. Poetry writing, as self-therapy, helped him to adapt by acknowledging what is happening to him and to actively deal with stress even at critical moments. Knowledge of medicine helped him to form and accept an adequate attitude to impossibility of absolute control over his physical state.

None Declared

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder with a prevalence of 2.5% in the adult population. Multimodal and combined interventions (pharmacological and psychological treatment) are the treatment of choice for ADHD in adults.

To develop a group psychological treatment protocol for adult patients diagnosed with ADHD. The aim is to reduce the core symptoms of the disorder and consequently improve overall functioning.

This protocol is applied in a group format (between 12 and 16 participants) and follows a psychoeducational approach. It consists of 12 weekly sessions, each lasting 90 minutes. The treatment content is structured into four modules: organization and planning, distractibility, procrastination and impulsivity, and adaptive thinking. Two scales are administered before and after the intervention to assess its effectiveness in symptom reduction and its impact on disorder-related dysfunction: the Attention Deficit/Hyperactivity Disorder-Rating Scale (ADHD-RS) and the Weiss Functional Impairment Rating Scale-Self-Report (WFIRS-S). Inclusion criteria: patients over 18 years old with ADHD, evaluated by clinical psychologists or psychiatrists at Hospital Clínic de Barcelona. Exclusion criteria: unstable psychopathological comorbidity.

To date, the intervention has been conducted with two patient groups. A reduction in the interference of ADHD symptoms is expected as a result of acquiring compensatory adaptive strategies worked on during treatment.

This protocol has been developed based on a review of the recommendations from Clinical Practice Guidelines and the adaptation of other evidence-supported non-pharmacological protocols and treatments. It is grounded in the principles of Cognitive Behavioral Therapy, which has shown strong evidence among psychological treatments for ADHD. Furthermore, the group format allows for an efficient and structured response to the needs of the population, while maintaining the depth and coherence of the therapeutic model. Additionally, it promotes the normalization of suffering, shared learning, and patient empowerment, thereby reducing unnecessary medicalization.

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Medical students applying for psychiatry residencies generally express strong interest in psychotherapy, seeing it as integral to their future roles. Surveys and systematic reviews consistently show that the majority of psychiatry residency applicants (and trainees) support the inclusion of psychotherapy in training, with 67–92% viewing being a psychotherapist as key to their psychiatric identity and around 88–98% supporting psychotherapy as an essential part of residency curricula. Despite strong initial interest, many residents report dissatisfaction with the quality of psychotherapy training they receive. Common concerns include inadequate supervision, limited clinical time, resource shortages, and financial constraints. These obstacles often lead to declining interest in psychotherapy over the course of residency, with senior residents less likely than juniors to plan to practice psychotherapy extensively.

We wanted to track changes in attitudes toward psychotherapy across the course of training.

We interviewed 76 medical students applying for psychiatry residency and again during their residency, asking about attitudes toward psychotherapy and about their comfort with doing psychotherapy.

Consistent with prior findings, 84% of medical students expressed an interest in doing psychotherapy. However, only 52% of applicants could identify a form of psychotherapy that interested them. Pursuing further questions in humanities, only 18% could identify a philosopher whom they enjoyed. Forty-five percent could provide a definition of psychotherapy. During residency, the trainees reported on average being able to do 1.4 hours per week of psychotherapy during years 2 -4. Eighty-four percent felt uncomfortable with psychotherapy and preferred prescribing medications, an activity for which they felt they had expertise. In examining job prospects, of 49 available postings, none provided the opportunity to do psychotherapy.

While an interest in psychotherapy is common among medical students, their understanding of the field is limited, and it diminishes quickly during training. Job opportunities that include psychotherapy are non-existent. In the United States, we speculate that economic forces are at work. Prescribing medications generates more income than doing psychotherapy alongside prescribing medications. Impetus exists to consider within the field of psychiatry, the role of prescribing alone versus prescribing and doing psychotherapy together.

None Declared

Creative arts therapies, particularly drama therapy techniques, are useful in psychotherapy

We aim to show how the creative arts can be used in the treatment of psychosis and in training people about the experience of psychosis.

The techniques can be used in one-on-one appointments or in groups. Useful approaches include the client’s making figures to represent their voices or visions. With the help of the therapist, they interact with the figure to reduce its fearfulness and to aid them to gain mastery over the voice or vision. Drawings are also useful. In a group context, each voice can be represented by a mask (sometimes including a costume) and the voices and their interactions with the person who has them can be enacted by the group. Trainees who participate in these enactments gain first-hand experience of the experience of psychosis. Voices can be put to puppets, to stuffed animals, and to other objects to help people manage their voices better. Student participation in this process leads to an improved understanding of the psychotic experience, and improved conceptualization for how to be helpful therapeutically to people diagnosed with psychosis. In a case series of 12 clients, working with creative arts methods in one-on-one appointments was associated with substantial improvement in their psychotic symptoms. In a case series of six groups, these methods were used. We present students’ and patients’ observations on their participation in these therapies.

Similarities observed included initial reluctance from clients to engage in this process. Some coaching is required which is therapeutic in itself. Reasons for reluctance included the belief that the voice/being could harm them or take control of them and make them commit acts against their will. Narrative therapy techniques exist for challenging these beliefs and demonstrating the lack of power of voices/beings. Once a safe space was created, in one-on-one sessions, the therapist played the being, but behind a mask or a figure to form a clear boundary between the voice and the therapist. Interactions with the voice/being were rehearsed until the client was no longer afraid of the voice. A story was created about the origins of the voice/being and where it could go when it left the client. Group therapies included enactment of ineraction with the voice/being using all group members. All clients who were willing to work with this process for at least 8 sessions reported improvement and, over the course of 6 months, significantly reduced their dose of antipsychotic medication.

We observe that enactment with objects in the physical world seems to bind the terror and anxiety often associated with psychosis in such a way as to reduce it to levels that can be managed in psychotherapy.

None Declared

The boundaries between complex post-traumatic stress disorder (cPTSD) and personality disorders, particularly borderline personality disorder (BPD), remain diagnostically and clinically ambiguous. While ICD-11 has introduced cPTSD as a distinct diagnosis, many patients continue to present with overlapping features, challenging rigid categorical distinctions. Psychoanalytic theory offers tools to understand underlying psychic structures — particularly in relation to symbolisation, internal object relations, and the role of enactments.

This presentation explores cPTSD and BPD as occupying a transitional diagnostic area. Through psychoanalytic and trauma-theoretical lenses, it seeks to clarify structural, developmental, and transference-based differences between the two, and examine the implications for treatment planning and therapeutic stance.

Drawing on clinical case material, diagnostic formulation tools, and psychoanalytic conceptual frameworks (Klein, Winnicott, Bion, Kernberg, Joseph, Fonagy), this paper examines:

• • The role and failure of symbolisation

• • Conflict-based versus deficit-based psychopathology

• • Transference and countertransference dynamics

• • Distinguishing trauma-related adaptations from primary personality pathology

Visual models are used to illustrate the diagnostic spectrum, symbolisation capacities, and key features of differing personality organisations.

The investigation supports the view that Kernberg’s concept of borderline personality organisation and Bion’s theory of symbolisation are essential in understanding the different needs of these patient groups. The patient’s capacity to symbolise experience — and its presence or absence in the transference — can serve as a key marker in differentiating cPTSD from borderline-level organisation. Assessing the depth of internal object relations, mentalisation, and the patient’s relation to meaning enables a more dynamic understanding of pathology. A spectrum model integrating conflict & deficit axes, alongside levels of symbolisation, offers a more nuanced and clinically useful formulation than traditional diagnostic categories.

Rather than treating complex PTSD and personality disorders as fixed or mutually exclusive categories, this presentation highlights the value of formulation-based, psychoanalytically informed assessment. By attending to levels of symbolisation and personality organisation in the transference, clinicians can better understand what psychic tasks the patient is struggling with — whether mourning, containment, or the construction of meaning. Kernberg’s structural approach and Bion’s insights into mental processing offer powerful tools for identifying the patient’s core difficulties and therapeutic needs. Ultimately, this approach enables us to move beyond classification, toward a clinical stance that honours complexity, supports psychic integration, and promotes development of symbolic capacity.

None Declared

Maladaptive Daydreaming (MD) is a relatively new and still under-recognized phenomenon. It is characterized by prolonged and emotionally engaging immersion in highly structured fantasies. Unlike normal daydreaming, MD involves narrative scenarios with complex characters and plots that may extend into real life. Individuals often spend hours per day in such fantasies, typically triggered by music, films, or solitude. While MD may serve as a means of affect regulation or escape from reality, it often leads to emotional distress and impairment in daily functioning. Despite growing scientific interest, MD is not included in DSM-5 or ICD-11, which complicates recognition and treatment.

To present a clinical case of MD in a young adult and to discuss its phenomenology, differential diagnosis, and psychodynamic implications.

We report a clinical case of maladaptive daydreaming and perform a non-systematic review of the literature.

A female university student in her early twenties was referred for outpatient psychotherapy due to emotional overwhelm. Since childhood, she had developed an ongoing imaginary narrative centered on a fictional partner. Over time, the story grew increasingly complex and included emotionally charged episodes. What stood out was the profound emotional involvement. The patient experienced these imagined events with striking intensity, as though they had truly occurred. Despite being academically successful and fulfilling her obligations, she spent several hours daily voluntarily immersing herself in these fantasies. Insight was preserved, and no psychotic symptoms were present. Differential diagnosis included obsessive–compulsive disorder, dissociative disorders, attention-deficit/hyperactivity disorder, and schizotypal personality disorder. Fantasies were voluntary, reality testing intact, and no intrusive obsessions were present, which all pointed to MD rather than psychosis or OCD. Epidemiological data suggest a prevalence of about 2.5% in the general population, more common in younger adults, and often associated with anxiety or depression. In this case, no major comorbidity was observed, yet the emotional intensity of fantasies pointed to clinical relevance.

The case illustrates the core features of MD, such as a richly elaborated, voluntary fantasy life with significant emotional involvement that can affect real-life feelings. Psychodynamically, MD may function as a defense and affect regulation strategy that offers temporary relief and reinforces unmet relational needs. Recognition of MD is essential to avoid misdiagnosis and to guide psychotherapeutic interventions. Given the absence of official diagnostic criteria, detailed case reports remain crucial for clarifying MD’s nosological boundaries and supporting its potential inclusion in future diagnostic systems.

None Declared

ApartaMENTE Terapêutico Gaia is a social innovation project that aims to promote adolescents’ mental health, through a transdisciplinary work. The community project is based in Vila Nova de Gaia, Porto, Portugal.

This project is funded by the Portugal Social Innovation initiative, with the support of other social investors, notably the Municipality of Vila Nova de Gaia.

• - Test and implement a new social innovation response in mental health.

• - Reduce negative behaviours associated with the illness in at least 70 young people.

• - Improve the subjective well-being of at least 50% of the young people involved in the intervention.

• - Validate an intervention methodology through results.

• - Use of a transdisciplinary team composed of a child and adolescent psychiatrist, a psychologist, and a social worker.

• - Use of Morenian psychodrama in groups and individually.

• - Use of cognitive-behavioural techniques in counselling.

• - Use of observation grids and psychometric instruments (EBEPG - General Psychological Well-being Scale (Dupuy, 1984), calibrated for the Portuguese population).

Over the course of nine months, it was possible to take action on 70 young people, 78.6% of whom saw an improvement in their interpersonal well-being ((EBEPG - General Psychological Well-being Scale (Dupuy, 1984)) and 50% register a reduction in negative behaviours resulting from their mental desease.

Public mental health policies for children and adolescents in Portugal are insufficient to provide a adjusted response. Therefore, the emergence of innovative responses supported by public and private funds in the community with validated results are an important tool to scourge of mental illness at earlier ages.

None Declared

Throughout their lives, transgender and gender-diverse (TGD) people are exposed to multiple challenges such as human rights violations, restricted access to healthcare, hostile narratives in society, and rejection from their families. Such continuous exposure to stigma, discrimination, and violence increases minority stress, negatively affecting both mental and physical health (Frost & Meyer, 2023). When family support is absent, the risks intensify, leading to higher rates of depression, anxiety, self-harm, and suicidality (Malpas, Pellicane & Glaeser, 2022). Research and clinical practice with families of TGD youth confirm that family acceptance and support are key to psychosocial wellbeing, mental health, and quality of life (McGregor et al., 2024; Başar et al., 2016; Campbell et al., 2024). Family therapy is standard practice in countries where gender-affirming healthcare is available, and the WPATH Standards of Care (Version 8) recommend involving parents in processes that strengthen children’s psychological safety and support.

The aim is to introduce different modalities of therapeutic work with families of TGD people, including counseling, family therapy, and multi-family therapy. These interventions are provided both within the public healthcare system through the BOJE Mental Health Support Programme for LGBTQIA+ people at the University Psychiatric Hospital Sveti Ivan, and in collaboration with civil society organizations.

Building on insights from previous research, the Mental Health Support Programme BOJE (Colours) was launched to offer comprehensive support tailored to the needs of LGBTQIA+ individuals within the Croatian public mental healthcare system. The programme consists of a counseling center, an outpatient clinic, a three-month structured group cycle (combining psychoeducation, group psychotherapy, and art therapy), ongoing support groups, and psychotherapeutic work with families, implemented in partnership with civil society organizations.

In family therapy, working with a transgender member opens a safe space for constructive dialogue, identity exploration, and adapting to shifts in family dynamics. Our expirience shows that these interventions lead to improved communication, greater openness, and reduced feelings of isolation.

The BOJE programme demonstrates how structured interventions can buffer the impact of minority stress. In particular, therapeutic work with families highlights the critical role of acceptance in promoting wellbeing. Our experience shows that these interventions nurture mutual understanding, acceptance, and hope — demonstrating that positive change is possible and support attainable.

None Declared

Music Breathing (MB) is a receptive music therapy (MT) method by psychiatrist Dag Körlin, for stressor-related and anxiety disorders, linked to autonomic nervous system (ANS) dysregulation and hypo-/ hyperarousal symptoms. It aims to expand the window of tolerance (WoT) and restore the sympathetic/ parasympathetic nervous system balance through music listening in expanded state of awareness and mindful breathing. Clients focus on the form of the breath, like shape and frequency, and the content of the experience, like memories and emotions, express them in a (mandala) drawing, and process the experience for integration. (Körlin D. In: Grocke D, ed. Guided Imagery and Music: The Bonny Method and Beyond. 2nd ed. Barcelona Publishers 2019; 531-560)

The objective is to present a case on managing stress-related symptoms through MB sessions.

The client is a 26-year-old female, experiencing hyperarousal symptoms, including intrusive thoughts, anxiety and anger bursts, restlessness, sleep disorders, headaches, and analgesic overuse. Having received MT before, we tried an innovative approach through MB: 10 hourly sessions over a 5-month period, combined with home practice. We started with a Discovery Breathing session (DB), observing normal breathing in silence, followed by Silent Breathing sessions, encouraging diaphragmatic breathing. Subsequent sessions integrated breathing modulation with music - initially with grounding qualities, in MB for Grounding (MBG), and later, in MB for Modulation - Working (MBW), more challenging music was used.

In the DB session (Fig. 1 – title: “Buzz”), stressful thoughts and discomfort emerged, which she portrayed as a gray film. The yellow–green butterfly was a hopeful figure. In the 4th (MBG) session, a childhood memory emerged (Fig. 2 – title: “Child memories”), bringing positive feelings of nostalgia and childlikeness. In the 8th (MBW) session, stressful imagery reappeared, represented as gray rocks (Fig. 3 – title: “Where there is darkness, there is light”). She focused on the anchor - representing her diaphragmatic breath in that moment - which helped her process the experience without ANS dysregulation symptoms. She explained that the session title reflected her awareness that, although stress was still present in her daily life, the stress-related symptoms had remitted, and she was coping more effectively.Image 1:Image 2:Image 3:

The MB method seems to be a promising intervention for the management of stress-related symptoms, rebalancing the ANS and expanding the WoT, thus improving the coping mechanisms against stress. Stressful experiences and thoughts can be revealed and discussed, promoting more creative stress management, and supporting the process of salutogenesis. As a new and emerging method, broader use in psychology and psychiatry could encourage further research into its role in stress and anxiety management and uncover additional applications.

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Endometriosis is a chronic, systemic, estrogen-dependent gynecological disorder affecting approximately 10% of women of reproductive age. Beyond the hallmark physical symptoms, the condition is associated with significant psychological burden. The disease not only generates local inflammation but also affects central pain modulation and gene expression in brain regions responsible for emotional regulation.

Our current study aims to evaluate the feasibility, applicability, and effectiveness of an 8-session mindfulness-based cognitive behavioral group intervention for women diagnosed with endometriosis. The primary focus is to examine changes in psychological functioning, mental wellbeing, sexual function, perceived pain, and health-related quality of life, as well as to identify psychological predictors of therapeutic response, with particular attention to affective temperament profiles.

The intervention will be delivered in a non-randomized, waitlist-controlled design (N = 80–100). Participants will be recruited through gynecological outpatient services, following a verified diagnosis of endometriosis by board certified gynecologists. The group therapy combines mindfulness practices (e.g., body scan, loving-kindness, breath-focused awareness) with classical cognitive behavioral techniques (e.g., cognitive restructuring, thought monitoring) and psychoeducational content. Psychological assessments will be conducted pre-intervention, post-intervention, and at 3- and 6-month follow-up visits. Instruments include the Patient Health Questionnaire-9 (PHQ-9), State-Trait Anxiety Inventory (STAI), Short Form Health Survey (SF-36), Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS-A), Schema Mode Inventory (SMI), a numerical pain rating scale, and the Female Sexual Function Index (FSFI).

We hypothesize significant improvements in psychological and functional outcomes in the intervention group compared to controls, including reductions in depression and anxiety scores (p < .05), decreased perceived pain, and enhanced quality of life and sexual functioning. Furthermore, we expect that specific temperament traits, along with demographic and baseline clinical factors, may predict the degree of therapeutic benefit.

The findings are expected to provide strong preliminary evidence for the integration of structured psychological interventions into the multidisciplinary care of endometriosis. Given the current lack of such programs in Hungary, this study may contribute to developing a sustainable, patient-centered treatment model that addresses both physical and psychological dimensions of the disease.

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Healthcare institutions need to improve care integration and coordination, especially in response to economic and technological changes. Good teamwork and clear communication, supported by a strong ethical environment, help improve the quality and continuity of care. Work organization and a shared sense of purpose directly influence team performance.

The aim of this study is to evaluate the quality of interactions among healthcare professionals’ and to highlight factors influencing the continuity and effectiveness of patient care.

This descriptive cross-sectional qualitative study was conducted from January to March 2025 among healthcare professionals working in the emergency and intensive care units of three university hospitals in Tunisia, using a self-administered questionnaire.

The majority of respondents were female (78.4%) with a sex ratio of 0.28, with over half being under the age of 30 (56.8%). Most held the position of nurse (75.2%), among whom 70.2% were senior nurses. Nearly two-thirds had less than five years of professional experience (64.0%) and mainly worked morning shifts (56.8%). A large majority had obtained their degrees after 2006 (86.4%) and worked in intensive care units (57.6%). Most respondents reported working six hours per day (91.2%), and over half were single (55.2%). Regarding work organization, 73.6% considered it acceptable, and 70.4% rated teamwork collaboration as satisfactory. Interpersonal communication in the workplace was rated as average (46.4%) or good (39.2%) by most respondents. The most frequently reported barriers were stress and fatigue (74.4%). Additionally, 67.2% believed that staffing levels were moderately insufficient. Verbal communication was the most commonly used channel (85.6%), while communication interruptions were perceived as frequent (45.6%) or occasional (24.8%).

Interpersonal communication is influenced by work organization and management. Workload pressure, stress, and understaffing can lead to misunderstandings, particularly in the continuity of care. These findings highlight the need for increased attention to communication dynamics and staffing levels within healthcare institutions.

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Interprofessional collaboration represents a fundamental component of organizational effectiveness across all sectors. In the context of healthcare, particularly within hospital settings, it is of a greater importance, as the complexity of care delivery requires increasingly sophisticated coordination and communication among diverse healthcare professionals.

The aim of this study is to asses the impact of communication among healthcare professionals on care’s quality and to propose strategic interventions.

This descriptive cross-sectional qualitative study was conducted from January to March 2025 among healthcare professionals working in the emergency and intensive care units of three university hospitals in Tunisia, using a self-administered questionnaire.

The majority of respondents were female (78.4%) with a sex ratio of 0.28, with over half being under the age of 30 (56.8%). Most held the position of nurse (75.2%), among whom 70.2% were senior nurses. Nearly two-thirds had less than five years of professional experience (64.0%) and mainly worked morning shifts (56.8%). A large majority had obtained their degrees after 2006 (86.4%) and worked in intensive care units (57.6%). Most respondents reported working six hours per day (91.2%), and over half were single (55.2%). A majority of respondents (92%) believe that interpersonal communication reduces patient anxiety. Similarly, 80.8% agree that effective communication promotes treatment adherence, while 89.6% think it enhances patient satisfaction. Additionally, 88.8% consider that communication can help reduce conflicts. Over half (59.2%) reported observing improved clinical outcomes as a result of good interpersonal relationships. The most frequently suggested tools to improve communication were interpersonal communication training (59.2%) and fostering a culture of respect and active listening (56.8%). Interestingly, 77.6% of respondents did not believe that regular meetings or debriefings would improve care coordination and continuity. Among those who answered “yes,” the majority (53.6%) felt that holding one meeting per week would be beneficial.

These findings highlight the perceived importance of interpersonal communication in improving various aspects of patient care, including anxiety reduction, treatment adherence, patient satisfaction, and conflict prevention. Strategic efforts should prioritize enhancing interpersonal skills and fostering respectful team dynamics to strengthen communication among healthcare professionals.

None Declared