Therapeutic activities are essential in mental health rehabilitation, supporting recovery through social inclusion, physical wellbeing, creativity, and cognitive stimulation. While the UK’s QN Rehab recommends ~25 hours of structured activity weekly, no universal standard exists; locally, 3–5 hours per day (~15–25 hours/week) is used. Despite this, many patients attend infrequently, often due to lack of awareness, anxiety, or low confidence. This audit aimed to assess satisfaction and engagement, identify barriers, and incorporate patient feedback into programme development.

This aims to evaluate patient attendance and engagement in current activities, assess satisfaction with their variety, timing, and accessibility, and examine perceived benefits for mental health, social connection, and recovery. It also seeks to identify barriers to participation, such as anxiety, stigma, or lack of information, while gathering patient suggestions and preferences to inform the development of programmes that better meet their needs.

Design: Cross-sectional audit (first cycle).

Participants: Inpatients with ≥2 weeks’ stay.

Tools:

• • Patient Satisfaction Survey (attendance, preferences, perceived benefits, barriers).

• • Staff Attendance Logs (objective participation data, engagement levels).

• • Qualitative Feedback (free-text comments, optional interviews).

• • Analysis: Combination of quantitative measures (attendance, satisfaction rates, benefit ratings) and qualitative themes (barriers, suggestions).

• • Duration: Data collected over 3 months.

Many patients did not attend activities due to anxiety, low confidence, or lack of information, yet they suggested new options such as theatre games, karaoke, and opportunities to lead groups. Sporting activities, particularly team sports, were valued for enjoyment and social connection, while creative outlets like art and photography attracted strong interest, with some preparing for a community art festival. Yoga and meditation were consistently rated highly for relaxation and recovery, though some patients questioned the need for rehabilitation, underscoring the importance of addressing stigma and clearly communicating the benefits of participation.

The first audit cycle identified gaps in patient engagement, often related to anxiety, stigma, and limited awareness of available activities. Patients expressed strong interest in expanding and diversifying programmes, particularly through creative, sporting, and patient-led initiatives.

Next steps involve introducing a short film to showcase the activity programme, developing patient-led groups to build confidence, expanding options such as sports, theatre, karaoke, and art, and integrating patients’ hobbies and interests into rehabilitation. A second audit cycle will be conducted in 3–6 months to assess whether these changes enhance satisfaction and engagement.

None Declared

A comprehensive observation of the mental development of preschool children with intellectual disabilities at a medical center revealed numerous variations in mental developmental difficulties. The path to correcting mental disorders was determined by the child’s individual support program and depended on the family’s request for the type of support provided by the medical center’s specialists.

to study mental disorders in preschool children with mental retardation in the context of individual training and comprehensive support by specialists of the medical center.

The sample consisted of 104 children with intellectual disabilities (ages 3 to 5) attending the Medical Center. Of these, 74 children were assigned to the experimental group (EG), which was trained using the center’s integrated solutions algorithm, and 34 children were assigned to the control group (CG), which was trained by an individual specialist at the family’s request.

parental survey, observation, pedagogical and psychiatric testing, comparative analysis.

Children in the EG showed uniform positive dynamics in mental development in the main areas: 58% of children showed positive dynamics in social-communicative development, cognitive-speech development with persistent mild difficulties in cognitive development; 32% showed positive dynamics in social-communicative and cognitive development with persistent moderate difficulties in cognitive development; 10% showed positive dynamics in social-communicative development and pronounced difficulties in cognitive development and the emotional-volitional sphere.

In the children of the control group, there was an unexpressed dynamics in cognitive development, and only those areas that were identified at the request of parents (speech and communication) were indicative: 38% - with positive dynamics in social and communicative development with persistent difficulties in cognitive development; 35% - with positive dynamics in speech development and persistent mild difficulties in cognitive development and the emotional-volitional sphere; 27% - with unexpressed dynamics in cognitive and social development, and persistent difficulties in the emotional-volitional sphere.

Variability in the mental development dynamics of children with intellectual disabilities in the experimental and control groups determines the most effective approach to correcting mental developmental deviations through comprehensive medical, psychological, and pedagogical support, compared to implementing individual parental requests for support from a specific specialist. Our study aims to further develop and test an action plan for center specialists to address the problem of comprehensive support for children with intellectual disabilities.

None Declared

Being non-verbal has a vast influence on child development and requires thorough rehabilitation process using significant tools and accuracy. It is similar to a non-mobile condition, but has more cognitive and emotional consequences. In this research we examine an advanced phase in helping a completely non-verbal child, 7 years old, to over come an obstacle on the way to spoken language. This child was able to acquire all syllables and hundreds of words under imitation in 3 years since he was 4 years old. However, the production time is very slow and requires many efforts. The research is examining techniques to reduce the reaction and execution time of words and syllables.

The objective was to test VML techniues for the improvement of reaction time in speech treatment for a child with developmental delay and apraxia of speech.

Prospective Single case study design. We tested most single syllables in Dutch and a few word structures for typical execution time, reaction time, execution time, ratio between RT and expected RT, and ratio between CAS execution and typical one. Intervention based on VML method is designed for three months, afterwards a final test will take place.

RT was found elongated, about 5 times more then expected, and was growing with the length of structure usually. Execution time was found elongated, 4 times more for the CV and lower ratio for the words. The reason is probably elongated words production by the examiner which wasn’t typical.

The elongated time for processing and execution damage the ability to use spoken language even when all sounds exist under imitation. The influence of this situation on daily life and rehabilitation into typical environment is significant and life changing.

At presentation we will present the full process and results, including sound samples.

None Declared

As per the MMBS course, we are required to partake in an external elective in the fourth year, lasting four weeks. I chose to do my elective under the guidance of a consultant psychiatrist with the goal of participating in research.

Primary Objectives:

1. 1. One published article as first author

2. 2. One published article as an additional author

Secondary Objectives

Assist the consultant in progression of his projects, aiming towards a mutually beneficial elective

1. Enhance my own skillset for my future aspirations as a researcher

The plan involved writing a poster abstract for a journal, satisfying a first author publication. The other objective would be achieved by working in tandem with the consultant on either finalising a write-up for his concluded project, or by writing up a research protocol.

In addition to this, there were opportunistic experiences during the placement, such as the ability to peer-review two studies awaiting journal publication, and critically appraising two published articles.

2 Journal reviews

2 Critical appraisals

Contributed to finalising a paper for publication

Co-wrote a research protocol

Submitted a poster abstract

The elective offered several experiences and opportunities for me to be involved in a variety of projects, in different aspects of the research process, from forming an idea and writing up a protocol, to reviewing finalised research projects. I believe this experience has enhanced my skillset, offered me unique insight into the world of research and provided a solid foundation to start my research career. This experience has also anecdotally shown me the importance of mentorship in supporting personal growth and development of the skills involved in research.

None Declared

Cost-effectiveness (CE) models are an important decision-making aid when making re-imbursement decisions within resource constrained health systems. However, unlike the results of clinical trials, the findings from cost-effectiveness are highly context dependent. They may depend on choice of comparators, local cost estimates, and current estimates of effectiveness and patient utilities.

The objective of this project was to investigate whether a fully working model adaptable to a local context could be developed using an LLM based on a published manuscript.

We attempted to develop a working version of the CE model of venlafaxine treatment described by Sobocki et al. (Sobocki et al. Int J Clin Pract, April 2008, 62, 4, 623–632) in the R statistical language using ChatGPT 5.0 based on simple prompts and a PDF copy of the manuscript.

The prompt “please develop R code for the model described in this paper” produced functioning R code that did not require modification. However, the published results were not replicated. The prompt “which parameters are not explicitly stated in the paper” identified the placebo relapse rate, background mortality, and venlafaxine acquisition cost as not fully reported and identified those were most influential. In addition, ChatGPT identified the key parameters offered to ‘back-fit’ plausible values for these parameters. Using these estimates the model results matched published results. The model was then validated by code inspection and independent replication in R.

ChatGPT 5 successfully replicated the model based on simple prompts and minimal iteration. It was also able to identify inadequately specified model parameters and, significantly, able to conduct a calibration exercise to estimate these. The ability of ChatGPT 5 to replicate published cost-effectiveness models is much improved on previous versions only requiring simply prompts and, in this case, producing code that ran ‘first time’. This model can be used to estimate the cost effectiveness of venlafaxine based on current costs and local contexts that may enable clinicians to make more informed clinical decisions. Will ChatGPT 5 ‘democratise’ cost-effectiveness analysis?

N. Hawkins: None Declared, R. Thompson Employee of: Viatris, K. Subramaniam Employee of: Viatris, P. Purushottamahanti Employee of: Viatris

Positive solitude appears to have a positive impact on mental health, social relations, greater life satisfaction, and creativity. Contrastingly, loneliness and social isolation often seem to be associated with depressive symptoms, and an increased risk of cardiovascular disease, stroke, cognitive decline or suicide. The “Motivations for Solitude Scale - short form” (MSS-SF) asks the question of “why” individuals seek solitude, such as self-discovery, social disinterest or autonomy, as it distinguishes between self-determined and non-self-determined solitude.

The purpose of this study was to validate the MSS-SF questionnaire in Czech adults and to assess its psychometric properties. As the instrument was originally validated in adolescents and emerging adults, we compared the analyses between the adult (26 to 64 years old) and the emerging adult (18 to 25) subgroups. We also tested for convergent validity with relevant measures.

The final sample consisted of 1274 adults between 18 and 64 years old (M = 37.4, SD = 12.1). The measures used in the study were MSS-SF, Positive Solitude Scale, the UCLA Loneliness Scale and DeJong Gierveld Loneliness Scale. Reliability was assessed using Cronbach’s alpha. To test the validity, we computed an inter-item correlation as well as correlations with the other questionnaires. For factorial validity, we run a confirmatory factor analysis. To compare the MSS-SF in emerging adults vs. adults, we used a multigroup factor analysis and independent samples t-tests.

The two-factor model of the MSS-SF demonstrated a good fit to the data with all indices within the acceptability range. The correlation of the items supported the two subscales design of the questionnaire. The subscales correlated with other instruments suggesting a good concurrent validity. Both self-determined solitude and non-self-determined solitude differed significantly between the groups. A multigroup analysis showed that the two-factor model provided a good fit to the data in both groups, with significant loadings for all items.

The Czech version of the MSS-SF is a valid instrument to measure motivation for solitude in adults as well as emerging adults. The two-subscale solution fit the data and correlated with other measures of loneliness and solitude. In comparison with adults, emerging adults scored lower on self-determined solitude and showed similar results across the loneliness instruments.

None Declared

Maternal burnout is a widely recognized condition seriously affecting the life of a mother, her child and those around them. The importance of its timely identification, as well as increasing general awareness of the characteristics of this phenomenon, may not be overestimated. As a result, there exists a need for modern instruments for the assessment of the condition in Russian language, which meet up-to-date validity requirements.

Our research objective was to create a tool for studying the condition of maternal burnout based on a recent and internationally recognized burnout questionnaire, so that maternal burnout may then be suitably assessed, and potentially compared to work-related burnout in the future.

A maternal burnout questionnaire in Russian (the Maternal Burnout Assessment Tool, MBAT) has been prepared on the basis of the work-related Burnout Assessment Tool (BAT) questionnaire by replacing the references to work with references to childcare and making other minor adjustments, as required, to appropriately adapt the work-related BAT wording. The surveys were conducted between September 2023 and January 2025. The samples consisted of up to 792 mothers with children up to seven years of age. Additionally, to measure optimism, depressive tendencies and anxiety, LOT-R, BDI and State-Trait Anxiety Inventory by C. Spielberger in their respective Russian adaptations were used.

We have achieved the replication of the original BAT-23 four-factor structure (as supported by confirmatory factor analysis), with the exception of question 13, which has been dropped as not duly fitting the factor structure based on the relevant statistical checks. The resulting model fit indices are as follows (N=792):Table 1.

The internal consistency of the MBAT has been supported by the following Cronbach’s alpha coefficients: the composite 0.94 for the total burnout score, 0.90 for the exhaustion subscale, 0.83 for the mental distance subscale, 0.89 for the cognitive impairment subscale and 0.87 for the emotional impairment subscale.

As to the convergent and discriminant validity, it is confirmed by the associations of the total burnout score with, among others, such indicators as: optimism (N=469, r=-0.52, p <0,001), depressive tendencies (N=392, r=0.62, p <0,001), state anxiety (N=356, r=0.61, p <0,001) and trait anxiety (N=356, r=0.57, p <0,001) (in each case using Spearman’s rank correlation coefficient).

In view of the above, the MBAT, being an instrument created on the basis of the BAT model and wording, is a valid and reliable tool for assessing maternal burnout and may be used for research purposes. For the use of this questionnaire in assessing paternal burnout, further research on an adequate sample of fathers needs to be conducted.

None Declared

Late-onset schizophrenia (≥ 50 years) is a clinical entity that remains relatively under-studied. It has drawn the attention of many researchers who have attempted to clarify its definition and characteristics. While most authors agree on defining it as a clinical presentation beginning after the age of 40, there is still disagreement regarding its specific clinical features and progression.(Yasuda M et al.Late-onset schizophrenia; 2013 Apr; 71(4):707-11)

To describe the clinical, therapeutic, and evolutionary characteristics of elderly patients hospitalized for late-onset schizophrenia.

This is a descriptive retrospective study involving 30 patients aged 60 and over, hospitalized in the psychiatry department of Ibn Nafis Hospital – University Hospital Center Mohammed VI in Marrakech, between January 2024 and July 2025, with a diagnosis of schizophrenia whose first symptoms appeared after the age of 50. Clinical, sociodemographic, therapeutic, and outcome- related data were collected from medical records.

The average age of the patients was 62 years, with a female predominance (59%). The onset was insidious in 48.7% of cases. Persecutory delusions were the most frequently reported themes (74.3%), while auditory hallucinations were the most common delusional mechanism (81.2% of cases). Negative symptoms were observed in only 13% of patients. The majority of patients (86%) showed a good response to antipsychotic treatment, with a preference for atypical antipsychotics. Risperidone was prescribed in 48.3% of cases. Adverse effects were noted in 23.7% of cases.

Late-onset schizophrenia is characterized by specific clinical features and often follows a more stable course than early-onset forms. Better recognition of this entity is essential to avoid diagnostic delays and to tailor therapeutic strategies to the aging population.(Wynn Owen PA et al. Late-onset schizophrenia: epidemiology, diagnosis, management and outcomes. Drugs Aging. 1999 Aug;15(2):81-9).

None Declared

This study is conducted to observe negative symptoms details in correlation with multiple factors. 90 patients(n=90) diagnosed with schizophrenia were interviewed and observed in the outpatient clinic during there follow-up appointments.

• - First question: Are there any correlations between severity of negative symptoms and factors such as age, duration and educational level ?

• - Second question: What is the relationship between compliance to medications and severity of negative symptoms?

• - Third question: What are the differences between the specific negative symptoms developed between male and female patients as measured by PANSS?

90 patients with schizophrenia were observed and interviewed in the outpatient clinic during their follow up appointments, and patients’ informed consent was obtained. Pearson and Spearman’s Rho correlation tests, Kruska-Wallis test, independent t-test and PANSS, (Positive and Negative Syndrome Scale of Schizophrenia), were used for this study.

Table 1.

Pearson and Spearman’s Rho correlation tests results between age, and duration of the illness, and educational level with the negative symptoms

Table 1 analysis: age and duration of the illness are positively correlated to negative symptoms. Where we can notice that time is almost always related to more severe negative symptoms and patients who are educated, will have less severe negative symptoms. Table 2 analysis : patients who take their medications by force are the most compliant, although they represent a small number of the sample (n=3). Table number 3: there are no differences between either gender regarding the type of negative symptoms the patients develop.

None Declared

Neurocysticercosis (NCC) is an infection of the central nervous system (CNS) caused by the larval stage of Taenia solium. It is the most common parasitic disease of the CNS (Del Brutto OH. Scientific World Journal 2012; 159821). Although more prevalent in developing countries, the progressive increase in migration and international travel has raised its prevalence in developed countries. NCC predominantly presents with neurological symptoms but may also be associated with psychiatric manifestations, including psychosis.

To characterise the main features of a psychotic episode secondary to NCC, including its most frequent clinical manifestations and the most appropriate treatment approaches.

Relevant and recent scientific articles were selected from PubMed®. The theoretical evidence derived from this review was contextualised with a clinical case of an 86-year-old woman with no previous psychiatric history, who developed a psychotic episode secondary to NCC.

Psychosis is a rare manifestation of NCC, occurring in up to 5% of cases (Mahajan et al. J Assoc Physicians India 2004; 52 663-5). Psychiatric symptoms in NCC are associated with increased cerebrospinal fluid pressure and inflammatory lesions of the brain parenchyma caused by cystic formations (Anjana et al. Arch Ment Health 2020; 21 55-58). In this context, psychotic episodes present with delusional ideation, disorganised speech, psychomotor agitation with aggressive behaviour, and visual hallucinations (El-Kady et al. Neuropsychiatr Dis Treat 2021; 17 1599-1610). Although not exclusive to psychosis, the most striking neuropsychiatric manifestations of NCC have been reported when cysts lodge in the prefrontal and occipital lobes (Goyal et al. Neurol India 2023; 71 228-232). Treatment should combine the use of antipsychotics and, in acute NCC, antiparasitic drugs and corticosteroids.

As described in the literature, the patient presented with a psychotic episode characterised by auditory and olfactory hallucinations, paranoid and persecutory delusional ideation, disorganised speech, and psychomotor agitation. Brain MRI revealed cystic lesions in the bilateral frontal lobes and in the right caudate nucleus. Treatment with the antipsychotic paliperidone (6 mg/day) led to complete remission of hallucinatory activity and partial remission of delusional ideation, now encapsulated.

None Declared

Medication non-adherence and social stigma remain major barriers to relapse prevention in severe mental disorders. In low-resource settings, additional structural obstacles—such as cost and access to care—further compromise treatment continuity. Exploring these factors within the Tunisian context may provide insights into improving relapse prevention strategies.

To evaluate how medication adherence, insight, internalized stigma, and structural barriers to care affect psychiatric relapses in Tunisian patients with severe mental disorders

Eighty-seven hospitalized patients (43 BD, 44 SCZ) were assessed using the Drug Attitude Inventory (DAI-10) for adherence, Birchwood Insight Scale (BIS) for insight, Internalized Stigma of Mental Illness scale (ISMI), and a questionnaire on access-to-care barriers (transport, availability, cost). Outcomes included number of relapses in the previous year. Analyses used Chi-square tests and Spearman correlations.

Non-adherence was observed in 78% of patients (BD: 81%, SCZ: 75%; p=0.47). Insight (BIS mean 35/60) did not correlate with relapse (r=–0.12, p=0.24) or adherence (r=0.09, p=0.38). Internalized stigma (ISMI mean 2.8/4) correlated positively with relapse (r=0.32, p=0.005) and negatively with adherence (r=–0.28, p=0.012). Significant access-to-care barriers associated with relapse included medication shortages (52%; p=0.037) and transport difficulties (22%; p=0.027), particularly in rural areas.

Medication adherence, internalized stigma, and structural barriers significantly influence psychiatric relapses, while insight alone is not predictive. Interventions should combine psychoeducation, anti-stigma programs, family involvement, and improved rural access to care.

None Declared

Despite decades of research, the pathophysiology of schizophrenia remains incompletely understood. Oxidative stress—resulting from an imbalance between reactive oxygen species and antioxidant defenses—contributes to neuronal damage, neuroinflammation, mitochondrial dysfunction, and impaired dopaminergic and glutamatergic transmission. Antipsychotic treatment may further exacerbate oxidative stress. Catalytic antibodies with superoxide dismutase-like (SOD), catalase-like, and peroxidase-like activity, identified in our laboratory, presumably complement the work of canonical antioxidant systems. Their role in schizophrenia is emerging.

To assess SOD-like, catalase-like, and NADPH-dependent peroxidase activities of IgG in schizophrenia patients versus healthy controls, and evaluate their association with disease phase.

Eighty participants were enrolled: 30 healthy controls and 50 schizophrenia patients (28 acute phase, 22 remission). IgG was purified by affinity chromatography on Protein G‑Sepharose using an ÄKTA pure (GE). Purity was confirmed by Laemmli electrophoresis (4–18% gradient PAGE) and gel filtration (Superdex 200 HR 10/30, pH-shock). Catalase activity was measured at 240 nm (H₂O₂ consumption); SOD activity via inhibition of nitroblue tetrazolium reduction at 560 nm; NADPH-dependent peroxidase activity at 340 nm through NADPH oxidation coupled to glutathione reductase and tert-butyl hydroperoxide. Group comparisons used Mann–Whitney U test (p < 0.05, Statistica 10.0).

SOD-like IgG activity was elevated in remission (p = 0.001). Catalase-like activity IgG was lower in remission versus controls (p = 0.0004) and acute patients (p = 0.002). NADPH-dependent peroxidase activity was increased in both acute (p = 0.0001) and remission (p = 0.017) phases, with highest levels during acute exacerbation.

These results may reflect specific aspects of oxidative stress regulation in schizophrenia. Specifically, we likely observe compensatory activation of IgG peroxidase activity against a background of decreased catalase-like activity. Thus, IgG oxidoreductase activity appears to depend on the course of schizophrenia and may reflect systemic changes in redox processes in patients, although these mechanisms remain poorly understood.

None Declared

Treatment-resistant schizophrenia (TRS) is associated with high risk for morbidity, mortality and hospitalization, as available antipsychotics (APs) are ineffective in treating these patients (Siskind et al, BrJPsychiatry 2022). Clozapine is the only approved treatment for TRS worldwide, but its usage is limited to 5% in US and 15% in EU (Warnez et al, BMC Psychiatry 2014) due to safety concerns and blood monitoring requirements. Emerging evidence implicates excessive glutamatergic rather than dopaminergic activity in patients with TRS (Demjaha et al, BiolPsychiatry 2014), explaining the poor response to first- and second-generation APs (FGA/SGA) and pointing to the need for novel drugs targeting the glutamate system.

Evenamide has proved to reduce aberrant hippocampal glutamatergic activity and hyperdopaminergic firing. Clinical benefits of evenamide as an add-on to SGA were observed in a long-term uncontrolled study in TRS patients (Anand et al, IJNP 2025) and replicated in a short-term placebo-controlled study in inadequate responders (Anand et al, Neuropharm 2025). ENIGMA-TRS 1 (EveNamIde’s Glutamate Modulation Ameliorates TRS) is a phase 3, international, 1-year, randomized, double-blind, placebo-controlled trial with the primary efficacy endpoint at 12 weeks and long-term efficacy endpoints at 26 and 52 weeks. It evaluates efficacy, tolerability and safety of 15 and 30 mg BID of evenamide as add-on in TRS patients on SGA (including clozapine).

To present considerations and challenges faced in the design of ENIGMA-TRS 1 trial.

The study is conducted at >80 centers in 20 countries across Europe, Asia, Latin and North America. This implies high heterogeneity in healthcare systems, languages, evaluation of patients’ illness through subjective measures (PANSS/CGI). Moreover, it requires approval from numerous regulatory authorities. Other challenges relate to the patient population, e.g. adoption of appropriate criteria for TRS diagnosis, assessment of compliance with current AP, need for caregiver.

For the design of the study, multiple discussions with regulatory authorities and advisory boards with international experts were conducted to ensure regulatory requirements are fulfilled. A rater training program has been developed and implemented to standardize rating practices across centers. Patients with TRS are selected according to TRRIP consensus criteria, severity of illness is critically evaluated, and an independent committee ensures high standards in enrollment. Compliance with current AP is assessed through plasma level blood monitoring to confirm that patients are truly resistant rather than noncompliant.

Despite many challenges, several strategies have been undertaken to guarantee global high standards by relying on internationally accepted criteria, ensure homogeneity in patients’ evaluation, and provide reliable data.

R. Anand Consultant of: Newron Pharmaceuticals SpA, A. Turolla Employee of: Newron Pharmaceuticals SpA, G. Chinellato Employee of: Newron Pharmaceuticals SpA, F. Sansi Employee of: Newron Pharmaceuticals SpA, R. Hartman Consultant of: Newron Pharmaceuticals SpA

Currently available antipsychotics (APs) that modulate dopamine/serotonin have demonstrated benefit on positive symptoms; however, improvement of negative symptoms, that are mediated by hippocampal mechanisms, remains elusive. Recently published effects of evenamide in the MAM neurodevelopmental model indicated that evenamide normalizes excessive glutamatergic activity in the hippocampus, the site of dysfunction in schizophrenia, and downregulates hyperdopaminergic activity in the ventral tegmental area (VTA), thereby reversing schizophrenia-associated cognitive and social dysfunctions (Uliana et al, NPP 2025). Evenamide has already demonstrated benefits on positive symptoms and disease severity in patients with treatment-resistant schizophrenia (TRS) and inadequate response (Anand et al, IJNP 2025; Anand et al, Neuropharm 2025). These findings led to an analysis to determine whether glutamate modulation by evenamide improves negative symptoms including socialization.

To present post-hoc analyses of data from Study 014/015 and 008A, to demonstrate the clinically meaningful benefits of evenamide add-on treatment in patients with schizophrenia.

Study 008A, a phase 2/3, 4-week, international, randomized, double-blind, placebo-controlled trial, evaluated the efficacy and safety of evenamide 30 mg bid as add-on in patients with inadequately controlled schizophrenia (PANSS 70-85; CGI-S 4-6) despite stable treatment with an atypical AP (including clozapine) at a therapeutic dose for an adequate period (compliance confirmed through plasma levels before randomization). Study 014/015, a phase 2, 1-year, randomized, open-label, rater-blinded, international study, assessed the long-term efficacy and safety of three fixed doses of evenamide (7.5/15/30 mg bid) as add-on to an AP (excluding clozapine) in patients with TRS (PANSS 70-90; CGI-S 4-6).

Post-hoc analyses demonstrated that evenamide was associated with an increasing improvement in social functioning and life engagement. This effect was noted both in a long-term observational study in patients with TRS and in a placebo-controlled study in patients with inadequate response to SGAs in which the improvement was significantly greater compared to standard of care. These benefits together with the previously demonstrated improvement in the PANSS total score, responder rate, CGI-S/C, indicate that glutamate modulation is a powerful mechanism that can produce clinically significant benefits across positive and negative symptoms that appear to increase over time.

Evenamide, by modulating aberrant glutamatergic activity, uniquely produces clinically meaningful benefits and provides a new therapeutic opportunity for patients with TRS and inadequate response to existing treatments.

R. Anand Consultant of: Newron Pharmaceuticals SpA, A. Turolla Employee of: Newron Pharmaceuticals SpA, G. Chinellato Employee of: Newron Pharmaceuticals SpA, F. Sansi Employee of: Newron Pharmaceuticals SpA, R. Hartman Consultant of: Newron Pharmaceuticals SpA

The hippocampus is regarded as the primary site of dysfunction in schizophrenia and offers a promising target for therapeutic intervention (Lodge and Grace, TIPS 2011). Hippocampal hyperexcitability is thought to play a key role in the pathophysiology of schizophrenia. As none of the currently available antipsychotics (APs) affect hippocampal activity, they are unlikely to alleviate cognitive dysfunctions or negative symptoms, as these are controlled by nuclei above the basal ganglia.

Evenamide, a voltage-gated sodium channels modulator, attenuated stimulated release of glutamate in an in vivo microdialysis rat model; due to its higher affinity for the inactivated state of the channels, it reduces neuronal hyperexcitability. Recently, evenamide was investigated by Uliana et al (NPP 2025) in the MAM (methylazoxymethanol acetate, a DNA alkylating agent) neurodevelopmental animal model of schizophrenia which revealed that evenamide exerts its action in the hippocampus.

To provide new insights into evenamide’s mechanism of action

To interpret clinical findings from phase 2/3 trials in light of the results obtained with MAM model

Electrophysiological recordings in the MAM model assessed the effects of evenamide on neuronal activity in the hippocampus and ventral tegmental area (VTA). Behavioral outcomes were evaluated using the novel object recognition (cognitive function) and social approach (negative symptoms) tests.

MAM-treated pups as adults show features consistent with schizophrenia: loss of hippocampal parvalbumin neurons, hippocampal hyperactivity, hyperdopaminergic state, impaired cognitive function and social deficits (Lodge and Grace, TIPS 2011). Evenamide normalized hippocampal pyramidal neurons hyperactivity and reduced dopaminergic (DA) activity in the VTA of MAM rats; interestingly, effects persisted long after administration of evenamide despite its rapid pharmacokinetic profile. Additionally, evenamide restored impaired recognition memory and improved social interaction.

These results are in line with data from clinical trials, in which evenamide add-on treatment was associated with significant improvement of positive and also negative symptoms (PANSS subscales) in patients with inadequate response to APs (Anand et al, Neuropharm 2025). Moreover, persistence of effects is consistent with long-lasting benefits observed in a 1-year open-label trial in patients with TRS (Anand et al, IJNP 2025); long-term efficacy of evenamide compared to standard of care will be confirmed in the ongoing phase 3, 1-year, double-blind ENIGMA-TRS 1 trial.

Evenamide’s distinct mechanism of action targeting the hippocampus differentiates it from all available APs. By modulating upstream glutamatergic dysregulation, evenamide may provide broader and more durable efficacy across various schizophrenia symptom domains.

R. Anand Consultant of: Newron Pharmaceuticals SpA, A. Turolla Employee of: Newron Pharmaceuticals SpA, G. Chinellato Employee of: Newron Pharmaceuticals SpA, F. Sansi Employee of: Newron Pharmaceuticals SpA, R. Hartman Consultant of: Newron Pharmaceuticals SpA

Treated induced paranoid disorder is rare, therefore, there is insufficient information about the frequency of delusional ideas occurring in family members living with the inducers, as well as about prognosis of the illness. The underlying etiology is primarily attributed to maladaptive family and interpersonal dynamics, as well as psychiatric comorbidities. Four types of shared psychotic disorder were described: imposed, simultaneous, communicated and induced psychosis.

We present a case of imposed psychosis in a mother–son dyad, emphasizing clinical features, treatment, and risk factors.

A 68-year-old woman and her 38-year-old son were admitted with shared somatic delusions and refusal of eating solid food leading to weight loss. They lived in close emotional and physical symbiosis in rural isolation. The mother, a retired seamstress, had a psychiatric history beginning in 2005 with mixed anxiety–depressive disorder, and was later hospitalized for psychotic depression and poor treatment adherence. Brain imaging showed cortical atrophy and microvascular lesions. On current admission, she showed psychomotor retardation, selective mutism, catatonia, and somatic and hypochondriacal delusions. She developed urinary retention and waxy flexibility. Bush–Francis Catatonia Rating Scale indicated marked catatonia (screening 7, severity 24). Neuropsychological testing suggested severe cognitive decline, likely secondary to vascular dementia. She received olanzapine, vortioxetine, and clonazepam. Psychotic symptoms improved significantly (PANSS 6-item: P1 7→2, P2 4→3, P3 1→1, N1 7→5, N4 7→5, N6 7→5). The son had mild lifelong intellectual disability and a history of schizophrenia with multiple hospitalizations and poor adherence. On admission, he was selectively mutistic, withdrawn, and exhibited autistic traits. Treatment with haloperidol and clonazepam led to rapid improvement once separated from his mother; he resumed eating solid food and delusional ideas subsided within days.

After six weeks, both were discharged simultaneously. Socioeconomic hardship necessitated their return to the same environment post-discharge. Local social services were engaged, and institutionalization was advised to minimize relapse risk and ensure supervision.

This case represents a classic form of imposed psychosis, where prolonged cohabitation, emotional dependence, and social isolation enabled the transmission of delusional beliefs from mother to son. Shortly after separation, the induced recovered, and the inducers’ recovery was slower. The inducer’s vascular cognitive impairment and the induced’s pre-existing schizophrenia and intellectual disability likely increased vulnerability. Shared psychotic disorder can emerge in isolated, codependent dyads with pre-existing psychopathology. Early recognition, treatment, separation, and social support are essential for recovery and prevention of recurrence.

None Declared

The coexistence of endocrine and psychiatric disorders poses significant diagnostic and therapeutic challenges. Thyrotoxicosis, particularly due to Graves’ disease, may exacerbate or precipitate psychotic symptoms, especially in patients with schizophrenia. This case illustrates how endocrine dysregulation contributed to psychotic relapse in a patient with chronic schizophrenia and poor treatment adherence.

To describe the clinical presentation, diagnostic complexity, and multidisciplinary management of a psychotic decompensation associated with untreated Graves’ disease in a patient with schizophrenia.

A 51-year-old man with paranoid schizophrenia and type 2 diabetes was admitted involuntarily after family members reported severe behavioral disturbances at home. He had a long history of poor adherence to psychiatric follow-up and antipsychotic treatment. On admission, he presented with marked disorganization, paranoid and bizarre delusions, lack of insight and psychomotor agitation. Laboratory tests revealed thyrotoxicosis (TSH <0.01 μU/ml; free T4: 6.73→2.59 ng/dl; free T3: >20→10.4 pg/ml; TSI >40 U/L). Cardiac monitoring showed sinus tachycardia and a previously unknown left bundle branch block.

Antipsychotic therapy with oral paliperidone (up to 12 mg/day) and olanzapine (up to 15 mg/day, later reduced to 10 mg/day due to daytime sedation) led to progressive improvement in thought organization and behavior. Endocrinology restarted methimazole and propranolol, achieving a gradual decline in thyroid hormone levels. As endocrine parameters improved, psychotic symptoms diminished, suggesting a close temporal relationship.

Because of persistent non-adherence, severe behavioral disturbances at home, and with the family’s consent, a 6-month long-acting injectable formulation of paliperidone was initiated, despite being off-label. The patient tolerated it well, with no extrapyramidal symptoms or adverse events. Social work evaluation confirmed social vulnerability and poor support, prompting judicial notification and recommendations for protective measures. During hospitalization, the patient progressively regained collaboration, re-established contact with relatives, and showed stable behavior at discharge.

This case highlights the bidirectional relationship between thyrotoxicosis and psychosis. Thyroid hyperactivity can exacerbate psychiatric symptoms and hinder stabilization in schizophrenia. Systematic endocrine monitoring and close collaboration between psychiatry and endocrinology are essential for optimal management in such complex cases. In cases of severe behavioral dysregulation and poor adherence, long-acting injectable antipsychotics—even off-label—may represent a safe and effective strategy when supported by family involvement and multidisciplinary consensus.

None Declared

Clozapine is under-utilised due to social and organisational barriers that delay initiation and compromise retention. A social-work “navigator” may address practical frictions, improve monitoring adherence and support continuity of care.

Determine whether a navigator shortens time from confirmed eligibility to clozapine initiation. Secondary: 3- and 6-month treatment retention, adherence to absolute neutrophil count (ANC) monitoring, motor adverse effects and health-related quality of life (QoL). and unplanned emergency utilisation and equity of access.

Single-centre, before–after service evaluation in a specialised severe mental illness clinic. Adults with treatment-resistant schizophrenia-spectrum disorders meeting guideline criteria were included. The navigator delivered shared decision-making/psychoeducation; coordinated baseline work-up (CBC/ANC, ECG, metabolic panel, CRP and high-sensitivity troponin during titration per local protocol); arranged reminder/recall for ANC; provided benefits/housing/employment/transport support; and liaised with prescribers and primary care. Consecutive pre-implementation usual-care cases served as comparator. Outcomes: time-to-initiation (days); retention (on treatment at 3/6 months); ANC adherence (on-schedule draws, % per current EMA label/local policy); motor adverse effects (Simpson–Angus Scale; Abnormal Involuntary Movement Scale); QoL (EQ-5D-5L index/VAS); emergency department (ED) visits/bed-days. Analysis: Kaplan–Meier and Cox models for time-to-initiation; logistic regression for retention and ANC adherence; Poisson/negative binomial for utilisation; interrupted time-series sensitivity analyses with prespecified covariates.

Data from n=148 (pre=74, post=74). Median time-to-initiation decreased from 90 to 58 days; Cox HR 1.47 (95% CI 1.09–2.00, p=0.01). Three-month retention increased from 60% (44/74) to 78% (58/74) (adjusted OR 2.25, 95% CI 1.20–4.25, p=0.011); six-month retention 52% to 70% (adjusted OR 2.15, 95% CI 1.13–4.08, p=0.019). On-schedule ANC monitoring improved from 70% to 88% (adjusted OR 2.95, 95% CI 1.70–5.20, p<0.001). Motor adverse-effect changes were small (SAS Δ −0.2, 95% CI −0.6 to 0.2; AIMS Δ +0.1, −0.2 to 0.4). QoL improved (EQ-5D-5L index +0.06, 95% CI 0.01–0.10, p=0.02). ED visits fell from 1.0 to 0.7 per 100 patient-months (IRR 0.72, 95% CI 0.55–0.95, p=0.02). Sensitivity analyses were consistent.

A social-work–led navigator is a pragmatic, scalable strategy to activate clozapine pathways. In this service, initiation was faster, monitoring adherence and short-term retention improved, and unscheduled utilisation decreased without a signal for increased motor adverse effects. Findings support scale-up and multisite evaluation with formal cost-effectiveness analysis.

None Declared

Patients with schizophrenia are particularly susceptible to stress, including dental trauma, under the influence of which there is a risk of both exacerbation of mental illness and the occurrence of adverse reactions caused by dental procedures, including refusal of treatment. According to literary sources, the issues of premedication in mentally ill patients before dental treatment have not been sufficiently developed.

In this regard, the aim of the work was to develop methods for assessing the effectiveness of psychotherapeutic and psychopharmacological preparation of patients with schizophrenia for dental procedures, the choice of methods of psychocorrection and premedication in accordance with the mental status of the patient.

The work used clinical-psychopathological, clinical-anamnestic methods. For express assessment of psychoemotional state of patients with schizophrenia before dental procedures before and after premedication, the Clinical Dental Scale (CDS, 1983, A.F. Bizyaev, S.Yu. Ivanov) was used.

Based on the conducted studies, it was found that without a psychoprophylactic conversation, only 5% of patients with schizophrenia underwent adequate dental procedures; after a psychotherapeutic conversation, instances of successful interventions increased 3 times. For premedication, in accordance with the instructions of the attending psychiatrist, drugs from the group of tranquilizers or neuroleptics were prescribed.

The conducted studies indicate that the method of express assessment of the psychoemotional state of patients with schizophrenia before dental procedures allows identifying patients with moderate and severe psychoemotional stress and choosing the most effective premedication method.

None Declared

Valproic acid (VPA) is a widely preferred and frequently prescribed antiepileptic drug used in the treatment of both generalized and focal epilepsies worldwide. Due to its broad-spectrum efficacy and generally good tolerability, it holds an important place among standard treatment options. However, although rare, serious adverse effects may occur in some patients, including hemorrhagic pancreatitis, coagulation disorders, bone marrow suppression, VPA-induced hepatotoxicity, and encephalopathy. Additionally, very rare but clinically significant neurological adverse effects have been reported, such as VPA’s so-called paradoxical effect, characterized by increased seizure frequency without VPA-induced encephalopathy, and brain pseudoatrophy. The incidence and mechanisms underlying these specific adverse effects remain unclear in the literature. Moreover, treatment outcomes and definitive indications regarding VPA use have not yet been fully established.

To evaluate the dissociative symptoms and paranoid psychotic features that emerged during and/or after long-term VPA treatment discontinuation, and to discuss the potential effects of VPA on these psychiatric manifestations.

A retrospective case report. Medical records, psychiatric assessments, MRI, and EEG findings were reviewed.

A 48-year-old female was started on VPA 1000 mg/day at 13 after an epileptic seizure and continued for 25 years. At 39, epilepsy was ruled out, and VPA discontinued. About a year later, after an emotional stressor, she developed depressive mood, paranoid delusions, and psychotic features. Partial improvement occurred with lithium and risperidone, but she discontinued them due to side effects. Untreated periods worsened psychotic symptoms, including persecutory delusions and surveillance thoughts. Trials of amisulpride and aripiprazole caused akathisia and parkinsonian symptoms, leading to non-adherence. During the drug-free period, delusions severely impaired functionality, and lithium and risperidone were given. Tardive dyskinesia emerged, for which bornaprine was started. While on bornaprine, lithium, and risperidone, she developed dissociative symptoms, prompting a switch to lithium, valproic acid, clozapine, fluvoxamine, and bornaprine. After reintroducing VPA, marked improvement in psychotic and dissociative symptoms occurred.

This case suggests that VPA may exert a stabilizing and possibly protective effect on mood and psychotic symptoms in vulnerable individuals. Discontinuation of long-term VPA treatment may contribute to the emergence or worsening of paranoid psychosis. Psychiatric monitoring is advised after VPA withdrawal, especially in patients with affective dysregulation or psychotic predisposition. Further studies are required to clarify whether VPA functions as a protective factor against psychosis.

None Declared