Psychiatrist working with ADHD-patients since 2007.

I have diagnosed and treated more than a 1000 patients with ADHD. I have always, when it has been possible, given one medication at a time to be able to evaluate how it works, and what gives side effects.

When stimulants suddenly don’t work anymore, I have searched for physical and psychological problems that could explain it. By solving these problems, the stimulants work again.

By working this way, we have noticed that patients have a high compliance, and there are a lot less cases of relapse with ADHD symptoms.

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The aim of this study is to determine the prevalence and type of mental disorders associated with pathological gambling/gambling disorder (GD) in the general population.

Systematic review and meta-analysis of adult population-based studies reporting on psychiatric comorbidity of GD according to International Classification of Diseases (ICD-10/ICD-11), Diagnostic and Statistical Manual of Mental Disorders (DSM-IV/DSM-5) criteria, or widely used assessment instruments. PubMed, Scopus, and Web of Science databases were searched for relevant studies in English. The study’s protocol was preregistered in PROSPERO (CRD42024574210).

Of 454 articles published between 1993 and 2024, 12 met the inclusion criteria. Most studies used DSM-IV or DSM-5 criteria (only two ICD-10 criteria), and were evenly distributed across Europe, North America, and Southeast Asia. The weighted average prevalence of any mental disorder in individuals with GD was 82.2%. High comorbidity rates were found for substance use disorders (SUDs) (34.2%), mood disorders (30.9%), and anxiety disorders (29.9%), followed by personality (14.3%) and psychotic (5.9%) disorders. Meta-analysis indicates that individuals with GD are 10.7 (95% confidence interval [CI]: 5.7;20.1) times more likely to develop any mental disorder than the general population. The odds ratio for mental disorders associated with GD were 5–12 times higher for nicotine dependence, drug use disorder, alcohol use disorder, and SUD, and 3–4 times higher for anxiety and mood disorders.

These findings add weight to the view that GD is associated with a significantly increased risk for addictive behaviors, mood, and anxiety disorders.

A better mechanistic understanding of schizophrenia spectrum disorders is crucial to developing efficient treatment approaches. Therefore, this study investigated longitudinal interrelations between clinical outcomes, brain structure, and somatic health in post-acute individuals from the schizophrenia spectrum.

A sample of 63 post-acute patients from two independent physical exercise studies was included in the final analyses. Demographic, clinical, cognitive, and somatic data were acquired at baseline and follow-up, as were structural magnetic resonance imaging scans. Multivariate cross-lagged panel modeling including mediators was used to study the mutual interrelations over time between the clinical, neural, and somatic levels.

A higher baseline global gray matter volume and larger regional gray matter volumes of the hippocampal formation, precuneus, and posterior cingulate predicted improved clinical outcomes, such as daily-life functioning, negative symptoms, and cognition. Increases in white matter volume from baseline to follow-up resulted in significantly reduced positive symptoms and higher daily-life functioning.

Our findings suggest that stimulating neuroplasticity, especially in the hippocampal formation, precuneus, and posterior cingulate gyrus, may represent a promising treatment target in post-acute schizophrenia spectrum disorders. Physical exercise therapies and other lifestyle interventions, and brain stimulation approaches reflect potential treatment candidates. Given the exploratory character of the statistical analysis performed, these findings need to be replicated in independent longitudinal imaging cohorts of patients with schizophrenia spectrum disorders.

The management of elderly patients receiving polypharmacy presents significant clinical challenges due to age-related physiological changes, the prevalence of chronic conditions, and the potential for drug-drug interactions and adverse drug reactions (ADRs). Blood level assessments of medications provide a critical tool for optimizing pharmacotherapy in this population. Here we present the benefits of therapeutic drug monitoring (TDM) and pharmacokinetic assessments in the personalized management of elderly patients with polypharmacy. Regular monitoring of blood drug concentrations can identify drug-drug interactions, related toxicity risks, and adherence issues, thereby informing dosage adjustments to achieve optimal therapeutic outcomes.

G. Schoretsanitis Consultant of: Dexcel, Saladax, HLS Therapeutics, Speakers bureau of: Saladax, HLS Therapeutics, Lundbeck, Thermo Fisher.

The pharmacological effect is the result of both pharmacokinetic (e.g., how the body affects the medication) and pharmacodynamic (e.g., how the medication affects the body) processes occurring simultaneously. Pharmacokinetics includes the processes of liberation, absorption, distribution, metabolism, and elimination (LADME). These processes govern the steady-state plasma concentration (Css). Therapeutic drug monitoring (TDM) is a pharmacological tool used to select and adjust medications. TDM enables Css measurements and dose adjustment calculations. In this presentation, the presenter will cover the main pharmacokinetic issues related to TDM in this clinical case, including Css determination, therapeutic range, dose adjustment, and pharmacokinetic calculations. Participants will learn the fundamental pharmacokinetic aspects necessary for understanding the case.

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Psychosocial interventions are vital in treating severe mental illness, yet their use remains limited, and patients often lack adequate information about them. Patient-focused versions of clinical guidelines are designed to enhance mental health literacy and inform patients about available treatments, but these resources are underutilized. This study evaluated the impact of implementing a patient-focused psychosocial intervention guideline on empowerment, knowledge, and use of psychosocial interventions among individuals with severe mental illness.

Multicentre, cluster-randomised trial. The study population comprised adult patients with a severe mental disorder. The intervention group received a multimodal, structured, and protocol-led patient-focused guideline implementation, whereas the control group received treatment as usual. Data were analysed using hierarchical linear models. The primary outcome was the change in patients’ empowerment.

There was no significant intervention effect on empowerment (effect size=0.13, p=0.605), which increased slightly in both groups. The number of psychosocial interventions familiar to patients increased significantly more in the intervention group. Exploratory analyses suggest that patient empowerment could have been influenced by COVID-19-related stress, patient age, the severity of functional impairment, and migration background. The improvement in the utilisation of psychosocial interventions did not differ significantly between the intervention group (M=1.1, SD=2.5) and the control group (M=1.3, SD=2.4).

The implementation of a patient-focused psychosocial intervention guideline failed to enhance empowerment among service users. However, our analyses indicate that the intervention led to an improvement in patient knowledge with respect to guideline content. The availability of psychosocial interventions may have been significantly constrained by the COVID-19 pandemic.

Despite the high prevalence of mental disorders, knowledge about mental health, its promotion, prevention, and pathways to care in the general population remain limited. Mental Health First Aid (MHFA) seeks to increase mental health literacy in the general population and enable individuals to support others with mental health problems until professional help is available. This study aimed to investigate the feasibility and initial effects of MHFA training on (i) mental health literacy, (ii) stigmatizing attitudes toward individuals with mental health problems, (iii) social distance, (iv) trainees’ mental health, and (v) quality of life.

In an uncontrolled pilot study, individuals aged 18–75 years who participated in MHFA courses in Germany were recruited. Outcomes were assessed at baseline, post-training, and 6-month follow-up.

In total, 362 participants (mean age 43 years, 78% female) enrolled in the study at baseline. Retention was about 50% for post-training and 60% for follow-up assessment. At post-training, mental health literacy was increased (adjΒ = 6.77, 95% CI = 5.69 to 7.84) and social distance (adjΒ = −2.30, 95% CI = −2.73 to −1.87) and stigmatizing attitudes (adjΒ = −2.61, 95% CI = −3.25 to −1.97) were reduced. These effects were also evident at 6-month follow-up. There were no effects on trainees’ mental health. At the 6-month follow-up, 89% of trainees had talked to someone with mental health problems at least once, and 65% of trainees were quite or very confident in offering help.

Our findings suggest initial beneficial effects of MHFA training as implemented in Germany. A randomized controlled trial of MHFA in Germany is now warranted.

Although still somewhat reluctantly used (and thus underutilized) by many clinicians, it is the well-evidenced fact that clozapine is an effective drug for treatment-resistant schizophrenia. In order to optimize its therapeutic potential and to minimize side effects, therapeutic drug monitoring (TDM) of plasma clozapine and N-desmethylclozapine is an essential clinical tool. TDM can also help to reveal insufficient adherence or individual differences in the rates of metabolism. Moreover, clozapine plasma levels can be affected by other factor, such as smoking or concomitant medication (fluvoxamine). In our study sample, we were able to demonstrate the relationship between the dosage and clozapine plasma levels and their impact on clinical efficacy and safety.

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Lived experience – how individuals perceive and interact with their environment – plays a central role in understanding mental health. Yet, insights into this first-person perspective, including subjective thoughts, emotions, and socio-contextual influences, remain limited in current research approaches.

To address this gap, we developed StreetMind, a scalable, secure, and user-friendly digital citizen science platform grounded in a psycho-sociogeographic framework. The platform collects self-reported data on individuals’ activity spaces through a mobile app and web interface, capturing location visits, travel routes, and daily experiences. These subjective reports are combined with objective real-time health, environmental, and sociocultural data to generate integrated community “footprints.”

Initial usage data (N = 1,010 for location and route entries; N = 509 for daily experiential data) demonstrate the platform’s structural robustness and functional feasibility. StreetMind enables classification of daily experiences by linking personal perceptions with contextual environmental data. This integration facilitates the identification and quantification of key environmental and psychosocial factors associated with mental well-being.

StreetMind offers a novel, data-rich mapping of health–environment interactions by merging individual lived experience with environmental metrics. This approach supports the creation of dynamic “health–environment spaces” and holds promise for informing public health strategies and advancing precision mental health care.

Therapeutic Drug Monitoring (TDM) plays a crucial role in optimizing treatment for patients with psychiatric disorders and comorbid medical conditions, particularly in the elderly. This talk will focus on the practical application of TDM in managing polypharmacy and drug-drug interactions in a geriatric patient with mood disorders. Using a case-based approach, the discussion will highlight how TDM can guide dose adjustments, improve treatment efficacy, and minimize adverse effects in patients with multiple comorbidities.

Emphasizing real-world clinical challenges, this session will provide practical insights into integrating TDM into psychiatric practice, ensuring safer and more effective pharmacotherapy. Audience interaction will be encouraged through live voting and discussion to enhance learning and application in daily clinical settings.

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The presentation gives a narrative account of a case of ethnopsychiatry and criminology from the standpoint of the care network, with personal details supplied by the patient himself. The person involved, Mosè Barabba, was born in Sierra Leone where he was kidnapped and forced to become a child soldier at a very early age. He was brainwashed, brutalized and taught to admire and practice violence. He arrived in Italy at 16 years of age after a traumatic journey through North Africa, homeless and alone. At 19 years old, he was hospitalized for drug abuse, and then cared for by various associations (NAGA, CPS, SPDC). The presentation outlines his descent into substance abuse-induced violence and the first encounter with the law when he was twenty-five years old, followed by a return to a criminal environment after a first experience in a community. He was diagnosed with PSTD, NOS psychosis, behavioral issues related to substance abuse and chronic multifactorial hepatopathy. By the time he was 28 his violence had spiraled out of control and he was hospitalized by TSO, where the violence continued. He was committed to a two-year period in a REMS 1 , for psychopharmacological therapy with mood stabilizers. On his release from the REMS, he was placed in a rehabilitation program in AS.FRA 2 where positive results were obtained: his pathology was stabilized, with support he was able to abstain from substances and alcohol and he was receptive to therapy and rehabilitation. In 2021, then 31 years old, Mosé was considered to be well integrated into the community and was transferred to a CPA (a high protection residence for patients with psychiatric diagnosis).

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Little is known about the interrelationships among adverse childhood experiences (ACEs), post-traumatic stress disorder (PTSD), dissociative disorders, depression, and dementia risk. We sought to investigate associations of ACEs, PTSD, dissociative disorders, and depression with incident dementia and explore whether these associations may be interrelated through mediation.

This prospective cohort study used population-based UK Biobank data, including 502 355 participants recruited at 22 assessment centres who completed questionnaires, an interview, and physical assessments at baseline (2006–2010). Data are linked to participants’ electronic health records from primary care, hospital admissions, and death registers through November 30, 2022, and to the results of the UK Biobank online mental health survey (2016–2017). Cox regression and g-formula-based mediation analyses were used to examine associations between self-reported ACEs, self-reported PTSD symptoms, diagnosed PTSD, dissociative disorders, depression, and dementia.

In the final sample (n = 434 215, mean (SD) age 56.58 (8.07) years), ACEs (hazard ratio (HR)1point: 1.10; 95% CI 1.02–1.20), diagnosed PTSD (HR: 2.09; 95% CI 1.38–3.18), dissociative disorders (HR: 3.96; 95% CI 2.55–6.15), depression (HR: 2.17; 95% CI 2.05–2.30), and self-reported PTSD symptoms (HR1point: 1.09; 95% CI 1.06–1.11) were associated with increased dementia risk, after adjusting for sociodemographic characteristics. Self-reported PTSD symptoms explained 75.26% (P < .001) of the excess dementia risk associated with ACEs. Depression explained 4.51% (P = .02) of the ACEs-dementia link, 8.42% (P < .001) of the diagnosed PTSD-dementia link, and 10.29% (P < .001) of the dissociative disorders-dementia link.

Individuals with ACEs, PTSD, dissociative disorders, or depression appear to be at increased risk of dementia, potentially through both shared and unique associations. However, these findings should be interpreted with caution due to potential limitations in statistical power.

Exposure to Adverse Childhood Experiences (ACEs) represents a significant, dose-dependent risk factor for the development of numerous psychiatric and physical disorders (including diabetes, myocardial infarction, obesity, alcoholism, drug addiction, etc.), as well as for poorer social outcomes (dropping out of school, unemployment, economic decline, unwanted pregnancies) and violent behaviour.

A history of maltreatment is found in 80–90% of young offenders, and about one quarter of individuals with a history of severe maltreatment receive criminal convictions. Among the forensic psychiatric patients admitted to the REMS (Residential Facilities for the Enforcement of Security Measures), we have likewise observed a high prevalence of maltreatment, abuse, neglect, and other traumatic events, including those related to war and migratory pathways.

We have treated some patients showing psychotic-spectrum symptoms (delusions, hallucinations) that did not respond to pharmacological treatment (including clozapine and clozapine–first-generation antipsychotic combinations). Their condition improved only when trauma-oriented psychotherapy, such as EMDR or Narrative Exposure Therapy for Forensic Offender Rehabilitation (FORNET), was added to antipsychotic treatment.

This observation raises critical questions about the overlap between psychotic and post-traumatic symptoms in offending patients with severe early victimization histories, and hence about the link between schizophrenia spectrum disorders and complex post-traumatic stress disorder. In light of ongoing conflicts, rising geopolitical tensions, and their impact on migration, the early diagnosis and effective treatment of these conditions are of paramount importance from both a public health perspective and from the standpoint of security and the prevention of violent offenses

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Adverse childhood experiences (ACEs) can cause morphological brain alterations across the lifespan, contributing to increased vulnerability to mental and physical disorders. Despite extensive research on ACEs-related brain alterations, the protective or augmenting role of modifiable lifestyle factors such as physical activity has been largely underexplored, representing a key gap in our understanding of trauma-related neuroplasticity. To close this gap, we aimed to investigate how lifetime physical activity (LPA) influences the relationship between ACEs and morphological brain alterations.

Moderation analyses using Hayes’ PROCESS macro examined the interaction between ACEs and LPA on the volume of limbic system-related regions – hippocampus, amygdala, anterior cingulate cortex (n = 81).

While LPA showed no moderating effect on hippocampal or anterior cingulate volume, the model concerning the volume of the amygdala was significant. This model explained 8.1% of the variance in amygdala volume (p = 0.002) and the interaction of LPA and ACEs contributed 7.9% of this variance, with a significant effect (β = −0.221 p ≤ 0.001). That indicated LPA moderates ACEs-related structural changes in the amygdala, a key component of the central circuitry of emotion and stress sensitization. Notably, only in individuals with low physical activity were ACEs associated with increased volume of amygdala.

Our findings underscore the behavioral dependency of the structural adaptations of the amygdala following childhood adversities. These results emphasize the therapeutic potential of incorporating physical activity into interventions for trauma-exposed individuals, offering a behavioral approach to mitigating stress-related neurobiological changes.

it is indisputable that against the backdrop of the popularity of various addictions among patients with schizophrenia, a joint study of the clinical and pathomorphological deformation of two nosologically phenomena of paranoid schizophrenia and, depending on modern drugs that are gaining popularity, synthetic cannabinoids in various ethnoterritorial groups is relevant.

to study the ethnoterritorial features of paranoid schizophrenia, comorbid with the abuse of synthetic cannabinoids, clinical dynamics, behaviour, and adaptation.

follow-up, clinical-psychopathological methods (PANS, SANS, CGI, MMPI, CGI, STAI, LSI, TPA, ICD-10), statistical (Python 3.11.0).

of the examination of 193 patients (aged from 18 to 35 years): 142 – patients with paranoid schizophrenia dependent on synthetic cannabinoids F20.xx+F12.2xx and 51 – F20.xx without drug addiction. The study took place from 2018 to 2024 in the database of psychiatric institutions in Russia - Tomsk region, St. Petersburg, Noyabrsk and Nizhnevartovsk.

The leading position among patients with schizophrenia who use synthetic cannabinoids in the temperate continental climate zone of Russia was occupied by such ethnic groups as the hierarchy: Russians, Tatars; Uzbeks; Germans; Azerbaijanis, and Armenians.

The phenomenon of abuse of synthetic cannabinoids leads to the development of diseases. Persistent exogenous visual and delirious disorders are included in the complex of symptoms of exacerbation of schizophrenia; A new symptom of pseudohallucinoids appears - thought disorders of an associative (fantasy) disease that arose against the background of long-term exogenous (toxic) effects of the drug on the subject type, usually against the background of a primary endogenous schizophrenic process

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Sleep disorders are closely linked to the onset, progression and severity of psychiatric disorders, yet large-scale data from real-world inpatient settings remain limited. Evaluating the impact of chronic sleep disorders (CSD) in this context is essential for improving care.

We conducted an analysis of adult inpatients hospitalized from January 1, 2021, to December 31, 2023, using data from the Paris Psychiatry Hospital Group’s health data warehouse. Sleep disorders were identified via ICD-10 codes, hypnotic prescriptions, or mentions in medical record. CSD was defined using an Index of Length of Stays with Disorders (ILSD) >0.5, and no sleep disorders (NSD) with an ILSD of zero.

Among 13,913 psychiatric inpatients, 81% were classified as having CSD. Compared to NSD patients, those with CSD had a higher number of hospitalizations (1.84 vs 1.33, p<0.001) and increased use of seclusion (17.6% vs 13.3%, p<0.001) and physical restraint (6.6% vs 5.3%, p=0.003). Individuals with CSD were more frequently hospitalized than the NSD group for depressive disorders (15.6% vs13.1%, p<0.001), bipolar disorders (11.4% vs5.6%, p<0.001), personality disorders (5.3% vs4.3%, p=0.009), alcohol abuse (3.3% vs2.4%, p=0.005), other substance use disorders (2.9% vs2.2%, p=0.018), manic episode (2.0% vs0.9%, p<0.001), and anxiety disorders (1.4% vs0.9%, p=0.012). Hypnotics were prescribed in 50.5% of SD-related stays. The CSD group had more psychiatric and non-psychiatric comorbidities.

CSD are highly prevalent in psychiatric inpatients and associated with more severe clinical profiles, greater hospitalization burden, and increased restraint use. Targeted sleep management strategies may help improve outcomes and care.

Violence is commonly conceptualized as a behavioural act, yet its phenomenological underpinnings reveal significant distinctions between its manifestations in psychopathological conditions and in the general population. This presentation explores how violent behaviour, when emerging as a symptom of psychiatric disorders, differs in its affective structure, intentionality, and embodiment from other forms of aggression. Drawing from phenomenological theories of emotions, we will examine how emotions such as anger, rage, resentment, and hatred manifest differently in psychopathology, particularly in psychotic states, mood disorders, and personality disorders. Emotions are not merely internal states but are lived experiences embedded in bodily spatiality, affecting contraction, expansion, and relationality. In psychopathological contexts, these emotions frequently exhibit disturbances in their anchoring point (what triggers them) and condensation area (where they settle), often leading to dysregulated, disproportionate, or delusionally overdetermined expressions of violence. By contrasting normative anger—typically goal-directed, normatively regulated, and socially embedded—with its pathological counterparts, we uncover crucial distinctions. In conditions such as paranoid psychosis, anger is fused with persecutory delusions, altering its structure from a transient reaction to an entrenched, self-perpetuating stance. Similarly, borderline personality disorder presents dysregulated anger as a core feature, where affective instability fosters reactive aggression that lacks modulation. In psychotic disorders, violent outbursts may emerge in a dissociative or hallucinatory framework, leading to actions detached from conventional interpersonal dynamics. Through a phenomenological analysis, we emphasize how aggressive emotions in psychopathology lack the typical integration of selfhood and social intelligibility, contributing to a distinct kind of violence—one that challenges legal and ethical frameworks regarding responsibility, intentionality, and treatment. By refining our understanding of these differences, we improve both clinical assessment and therapeutic interventions for patients at risk of violent behaviour.

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There is limited evidence on the association between psychiatric morbidity and COVID-19 mortality.

We used deidentified electronic health records from the Catalan public health system to evaluate the association between number of mental disorders and COVID-19 mortality. Adults diagnosed with a mental disorder in Catalonia’s mental health services (from to 2017–2019) were compared to a matched (1:1) control group by sex, age, and area of residence. COVID-19 mortality risk was evaluated from February to December 2020. Odds ratios (OR) with 95% confidence intervals (CI) were estimated for the association between the number of mental disorders and COVID-19 mortality. To examine if different patterns of psychiatric comorbidity were related to COVID-19 death, we performed K-means cluster analysis on individuals with ≥2 disorders, stratified by COVID-19 death.

The final sample included 785,378 adults (392,689 with ≥1 mental disorder). Mortality risk increased with the number of mental disorders: OR 1.23 (95% CI: 1.11–1.35) for one mental disorder, up to 5.21 (95% CI: 1.34–20.27) for four or more. Cluster analysis (n=84,207) identified seven psychiatric comorbidity profiles among those who did not die of COVID-19, and six profiles among those who died, with substantial comparability between cohorts.

An increasing number of psychiatric diagnoses was associated with greater COVID-19 mortality, while specific comorbidity patterns showed limited differential influence. This suggests that it is not the specific combination of mental disorders that influences COVID-19 death outcomes, but rather the overall burden of multiple diagnoses.

Schizophrenia is associated with impaired mentalizing abilities, often conceptualized through Theory of Mind (ToM) paradigms, which highlight deficits in understanding cognitive and affective mental states. Empirical findings suggest that affective ToM impairments reduce the likelihood of violence, while deficits in cognitive ToM may increase its propensity. However, phenomenological approaches challenge the primacy of ToM, suggesting that schizophrenia’s core disturbance lies in the embodied self, specifically in the domain of interaffectivity—the pre-reflective, affective resonance between self and others.

Interaffectivity, rooted in early embodied interactions, forms the foundation of social and emotional connectedness. In schizophrenia, disruptions in this fundamental capacity result in a disconnection from the social environment and a breakdown in shared affective states. This disturbance may contribute to violence by impairing empathic resonance and fostering misinterpretations of social cues.

Phenomenological approaches offer a critical lens for understanding these disturbances, emphasizing the embodied and relational aspects of schizophrenia. By shifting the focus from purely cognitive deficits to fundamental disruptions of interaffectivity, these approaches may provide a roadmap for developing interventions that address the precursors of violence, fostering a multifaceted understanding and management of schizophrenia.

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