Various psychotherapeutic approaches could be used for the assessment, formulation, and treatment of the same case. It is of great importance to include cultural evaluation and empathetic reformulation in psychotherapy applications. This case presentation illustrates a female patient in her thirties who was consulted at the psychiatric outpatient clinic with depressive symptomatology, which presented after a psychosocially stressful life event. Following a detailed clinical evaluation, psychotherapeutic treatment was planned with the diagnosis of major depressive disorder. In this case presentation and subsequent discussion, the case-specific advantages, along with standard and differing aspects of different psychotherapeutic methods and treatments, will be evaluated.

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The prevalence of mental health disorders has significantly increased in recent years, posing substantial challenges to healthcare systems worldwide, particularly primary care (PC) settings. This study examines trends in mental health diagnoses in PC settings in Catalonia from 2010 to 2019 and identifies associated sociodemographic, clinical characteristics, psychopharmacological treatments, and resource utilization patterns.

Data from 947,698 individuals without prior severe mental illness, derived from the Data Analytics Program for Health Research and Innovation (PADRIS), were analyzed for this study. Sociodemographic data, diagnoses, and resource utilization were extracted from electronic health records. Descriptive statistics, chi-square tests, Mann–Whitney tests, and a multivariate binary logistic regression were employed to analyze the data.

Over the study period, 172,112 individuals (18.2%) received at least one mental health diagnosis in PC, with unspecified anxiety disorder (40.5%), insomnia (15.7%) and unspecified depressive disorder (10.2%) being the most prevalent. The prevalence of these diagnoses increased steadily until 2015 and stabilized thereafter. Significant associations were found between mental health diagnoses, female sex, lower socioeconomic status, higher BMI, and smoking status in a multivariate binary logistic regression.

This study highlights a growing burden of stress-related mental health diagnoses in PC in Catalonia, driven by demographic and socioeconomic factors. These findings may be indicative of broader trends across Europe and globally. Addressing this rising prevalence requires innovative approaches and collaborative strategies that extend beyond traditional healthcare resources. Engaging stakeholders is essential for implementing effective, sustainable solutions that promote mental health in Catalonia and potentially inform similar initiatives worldwide.

The first psychotic episode is often a moment of utmost importance for the patients and their families, as well as for the treating professionals who need to address several dilemmas. Findings suggest that Self-Disorders (SD) specifically aggregate within schizophrenia spectrum disorders, pointing to the possibility that they could be a central phenotypic marker of schizophrenia spectrum disorders across the different severity of their clinical manifestations. We will present and discuss a case report involving a patient’s first admission, where diagnostic uncertainties exist. The goal is to enhance our comprehension of the significance of contemporary clinical and phenomenological psychopathology, with a specific focus on SD, in order to achieve a more accurate and precise assessment of incipient schizophrenia.

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Substance use may be associated with the onset of psychotic symptoms, necessitating treatment for individuals with comorbid mental health and substance use disorders (MHD/SUD). COVID-19 significantly impacted individuals with MHD/SUD, reducing access to appropriate care and treatment. Changes in drug availability and prices during the pandemic may have influenced drug consumption. This study aimed to determine the frequency of substance-induced psychosis (SIP) during COVID-19 among individuals with MHD/SUD and to explore substance fidelity by following patterns of SIP over time.

In this retrospective cohort study, we analyzed data from all individuals with MHD/SUD registered in 2019–2021 in the Norwegian Patient Register. We used graphical approaches, descriptives, and Poisson regression to study occurrence and risk of SIP episodes in the three-year observation period. Sankey diagrams were used to examine trajectories of psychotic episodes induced by various substances.

Despite a decrease in individuals diagnosed with SIP during COVID-19, SIP episodes increased overall. We observed a decline in cannabis-induced psychosis, but a rise in SIP episodes involving amphetamines and multiple substances. Among individuals with recurrent SIP episodes, the psychosis was more often induced by different substances during COVID-19 (2020: RR, 1.50 [95% CI, 1.34–1.67]; 2021: RR, 1.30 [95% CI, 1.16–1.46]) than in 2019.

During COVID-19, fewer individuals were hospitalized with SIP, but those patients experienced more episodes. There were fewer cannabis-induced psychotic episodes, but more SIP hospitalizations caused by central stimulants and more SIP diagnoses caused by different substances, possibly reflecting changes in drug availability and pricing.

Cognitive impairment is a core feature of psychosis, which adversely affects global functioning and quality of life and has been consistently reported from the early stages of illness. Patients with first-episode psychosis (FEP) exhibit deficits in processing speed, short-term memory, attention, working memory, and executive functioning, which respond poorly to psychotropic drugs. Among non-pharmacological approaches, physical activity has shown promise in improving cognitive functioning in schizophrenia spectrum disorders. However, current evidence lacks specific data on individuals with FEP. In this review, we aim to explore the potential role of physical activity-based interventions in ameliorating the cognitive functions of people with FEP.

The literature search was conducted on PubMed, PsycINFO, and Web of Science in March 2024, identifying 127 de-duplicated records. One additional article was identified by screening the reference lists of the included studies. A total of six studies fulfilled the inclusion criteria and were reviewed. They all analyzed the effect of structured physical activity interventions on the cognitive functioning of patients with FEP.

Preliminary findings suggest that physical activity interventions enhance memory, attention, and executive functions of patients with FEP but not social cognition and motor function.

Study differences in sample characteristics, design, and intervention protocols prevent firm conclusions about the cognitive-boosting effects of the interventions in FEP. Further studies using more rigorous methodologies are needed to understand the durability of these effects and the underlying mechanisms.

A case of misdiagnosis and mismanagement in forensic psychiatry Speaker: Farzaneh Saeedzadeh Sardahaee, MD, PhD, Consultant Psychiatrist, Trondheim, Norway

Timely diagnosis and treatment for psychiatric illnesses in first time offenders in forensic psychiatry remains a challenge. Presenting a young male first-time offender with recent onset psychosis, ADHD and anxiety disorder, the speaker reflects upon the complexities around making the right diagnosis in a prison with very limited resources for clinical observation. Minting the term “Psychosis Incognito”, the speaker goes on to explore a complex multiagency follow up process faced by this offender and his treating team, as well as many medical complications including malnutrition and Korsakoff syndrome.

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Geographical differences of the offender-patient pathways across Europe

In this part of the workshop,I will make an approach of of how will be treated an forensic psychiatric complex case from Spain point of view, and diffenneces with another countries.  . Differents pathways from detention to be admitedd in a psychiatric facility will be described . Also the approach from standard care to a more complex medical situacion ( from clinical, social and psychological viewa ) in a penitentiary (forensic) resources, including  rehablitaation. And finally, the follow-up / after care of a mentally ill offender, when discharge to the commnuity.

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Emerging evidence suggests a potential association between “leaky gut syndrome” and low-grade systemic inflammation in individuals with psychiatric disorders, such as schizophrenia. Gut dysbiosis could increase intestinal permeability, allowing the passage of toxins and bacteria into the systemic circulation, subsequently triggering immune-reactive responses. This study delves into understanding the relationship between plasma markers of intestinal permeability and symptom severity in schizophrenia. Furthermore, the influence of lifestyle habits on these intestinal permeability markers was determined.

Biomarkers of intestinal permeability, namely lipopolysaccharide-binding protein (LBP), lipopolysaccharides (LPS), and intestinal fatty acid binding protein (I-FABP), were analyzed in 242 adult schizophrenia patients enrolled in an observational, cross-sectional, multicenter study from four centers in Spain (PI17/00246). Sociodemographic and clinical data were collected, including psychoactive drug use, lifestyle habits, the Positive and Negative Syndrome Scale to evaluate schizophrenia symptom severity, and the Screen for Cognitive Impairment in Psychiatry to assess cognitive performance.

Results revealed elevated levels of LBP and LPS in a significant proportion of patients with schizophrenia (62% and 25.6%, respectively). However, no statistically significant correlation was observed between these biomarkers and the overall clinical severity of psychotic symptoms or cognitive performance, once confounding variables were controlled for. Interestingly, adherence to a Mediterranean diet was negatively correlated with I-FABP levels (beta = −0.186, t = −2.325, p = 0.021), suggesting a potential positive influence on intestinal barrier function.

These findings underscore the importance of addressing dietary habits and promoting a healthy lifestyle in individuals with schizophrenia, with potential implications for both physical and psychopathological aspects of the disorder.

Telepsychiatry has emerged as a transformative force in the field of mental health care, addressing disparities in service delivery and increasing access to care. This exploration focuses on the role of telepsychiatry in achieving equitable mental health care for individuals with intellectual disabilities (ID). Intellectual disabilities affect millions globally, posing significant public health challenges. This vulnerable population encounters numerous barriers in accessing quality mental health care, including geographical isolation, limited transportation options, and a shortage of specialized providers. Telepsychiatry offers a promising solution, leveraging technology to overcome these challenges. The presentation reviews the current landscape of mental health care for individuals with intellectual disabilities and the specific barriers they encounter. It highlights the potential benefits of telepsychiatry, including increased availability of specialized care, reduced geographical barriers, and enhanced caregiver support. Ethical considerations and best practices associated with implementing telepsychiatry in the context of intellectual disabilities are discussed. Case studies and success stories illustrate how telepsychiatry positively impacts individuals with intellectual disabilities and their families. In conclusion, telepsychiatry plays a promising role in promoting equitable mental health care for individuals with intellectual disabilities. Embracing technology and adopting best practices pave the way for a more inclusive and accessible mental health care system, leaving no one behind.

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Depressive symptoms remaining after antidepressant treatment increase the risk of relapse and recurrence. We aimed to analyze the distribution and main drivers of remaining symptoms in patients with a major depressive episode.

Two independent samples of 8,229 and 5,926 patients from two large naturalistic studies were retrospectively analyzed. DSM-IV criteria for major depressive episodes were assessed during two face-to-face visits with clinicians: before the prescription of a new antidepressant, and after 6 weeks of treatment. The Hospital Anxiety and Depression Scale (HADS) was used to assess baseline severity of anxiety and depression.

In both samples, two clusters of remaining symptoms were observed. The first cluster encompassed symptoms related to a negative emotional and cognitive bias and was specifically driven by the baseline severity of depression. The second cluster encompassed neurovegetative symptoms and was specifically driven by the baseline severity of anxiety.

The baseline anxiety-depressive balance of patients could be considered to adapt the treatment, focusing on emotional and cognitive symptoms with patients with high baseline severity of depression, and neurovegetative symptoms with patients with high baseline anxiety severity.

After the introduction of all the speakers, the main aim of this workshop will be mentioned, which consists of identifying and highlighting those clinical, sociodemographic, environmental and other factors than might predict an increased risk of overall, depressive, manic or mixed relapses in bipolar disorder, which is crucial for the identification of high-risk individuals. Dr. Pacchiarotti will present main results from a systematic review performed recently by the work group aimed at collecting the available evidence regarding different factors that increase rates of mood recurrences or relapses for different polarities in bipolar disorder.

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Electroconvulsive therapy (ECT) is a safe and effective treatment for several major psychiatric conditions, including treatment-resistant depression, mania, and schizophrenia; nevertheless, its use remains controversial. Despite its availability in some European countries, ECT is still rarely used in others. This study aims to investigate the experiences and attitudes of early career psychiatrists (ECPs) across Europe towards ECT and to examine how their exposure to ECT influences their perceptions.

In Europe, a cross-sectional survey was conducted among ECPs, including psychiatric trainees and recently fully qualified psychiatrists.

A total of 573 participants from 30 European countries were included in the study, of whom more than half (N = 312; 54.5%) received ECT training. Overall, ECPs had a positive attitude towards ECT, with the vast majority agreeing or strongly agreeing that ECT is an effective (N = 509; 88.8%) and safe (N = 464; 81.0%) treatment and disagreeing or strongly disagreeing that ECT was used as a form of control or punishment (N = 545; 95.1%). Those who had received ECT training during their psychiatry training were more likely to recommend ECT to their patients (p < 0.001, r = 0.34), and held more positive views on its safety (p < 0.001, r = 0.31) and effectiveness (p < 0.001, r = 0.33). Interest in further education about ECT was moderately high (modal rating on Likert scale: 4, agree), irrespective of prior training exposure.

ECT training is associated with more favorable perceptions of its safety and effectiveness among ECPs. There is a general willingness among ECPs to expand their knowledge and training on ECT, which could enhance patients’ access to this treatment.

In this section, the speaker will present the results from a recent longitudinal study performed by the work group, in which a cohort of 265 patients admitted with a manic episode were followed up during three years after hospital discharge to identify acute readmissions due to affective relapses. The study of different sociodemographic and clinical variables potentially implicated in a higher risk of readmission over three years is presented, including adherence to treatment, substance use, number of previous episodes, family history, predominant polarity, treatments used and number of visits to the Emergency Department.

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Functional impairment is a major concern among those presenting to youth mental health services and can have a profound impact on long-term outcomes. Early recognition and prevention for those at risk of functional impairment is essential to guide effective youth mental health care. Yet, identifying those at risk is challenging and impacts the appropriate allocation of indicated prevention and early intervention strategies.

We developed a prognostic model to predict a young person’s social and occupational functional impairment trajectory over 3 months. The sample included 718 young people (12–25 years) engaged in youth mental health care. A Bayesian random effects model was designed using demographic and clinical factors and model performance was evaluated on held-out test data via 5-fold cross-validation.

Eight factors were identified as the optimal set for prediction: employment, education, or training status; self-harm; psychotic-like experiences; physical health comorbidity; childhood-onset syndrome; illness type; clinical stage; and circadian disturbances. The model had an acceptable area under the curve (AUC) of 0.70 (95% CI, 0.56–0.81) overall, indicating its utility for predicting functional impairment over 3 months. For those with good baseline functioning, it showed excellent performance (AUC = 0.80, 0.67–0.79) for identifying individuals at risk of deterioration.

We developed and validated a prognostic model for youth mental health services to predict functional impairment trajectories over a 3-month period. This model serves as a foundation for further tool development and demonstrates its potential to guide indicated prevention and early intervention for enhancing functional outcomes or preventing functional decline.

Based on the available literature and the studies presented by the previous speakers, Dr. Andreu will provide a summary of predictive and protective factors associated with mood relapse or recurrence in bipolar disorder, with a special focus on the distinction between modifiable and non-modifiable factors and on the identification of specific phenotypes at higher risk of relapse. The speaker will also mention the role of psychotherapeutic and pharmacological treatments, and will summarize the available evidence regarding lithium response.

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While omega-3 polyunsaturated fatty acids (PUFAs) have shown promise as an adjunctive treatment for schizophrenia and other psychotic disorders, the overall consensus about their efficacy across studies is still lacking and findings to date are inconclusive. No clinical trials or systematic reviews have yet examined if omega-3 PUFAs are associated with differential levels of efficacy at various stages of psychosis.

A systematic bibliographic search of randomized double-blind placebo-controlled trials (RCTs) examining the effect of omega-3 PUFAs as a monotherapy or adjunctive therapy versus a control group in adults and children at ultra-high risk (UHR) for psychosis, experiencing a first-episode psychosis (FEP), or diagnosed with an established psychotic disorder was conducted. Participants’ clinical symptoms were evaluated using total and subscale scores on validated psychometric scales.

No beneficial effect of omega-3 PUFAs treatment was found in comparison with that of placebo (G = −0.26, 95% CI −0.55 to 0.03, p = 0.08). Treatment of omega-3 PUFAs did not prove any significant improvement in psychopathology in UHR (G = −0.09, 95% CI −0.45 to 0.27, p = 0.63), FEP (G = −1.20, 95% CI −5.63 to 3.22, p = 0.59), or schizophrenia patients (G = −0.17, 95% CI −0.38 to −0.03, p = 0.10).

These findings confirm previous evidence that disputes the original reported findings of the beneficial effect of omega-3 PUFAs in schizophrenia. Furthermore, accumulative evidence of the use of omega-3 as a preventive treatment option in UHR is not supported, suggesting that the need for future studies in this line of research should not be promoted.

This section will be destinated to the presentation of specific cases of patients with bipolar disorder admitted to our acute psychiatric ward. For each case, sociodemographic, clinical and environmental characteristics will be described and pharmacological treatment discussed. In addition, predictive and protective factors for mood relapses will be identified, and then, prospective information regarding their clinical prognosis will be provided in order to discuss with the attendees the impact of the mentioned factors on clinical outcomes.

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Postpartum anxiety (PPA) symptoms have harmful effects on child development and mother–infant interactions. Accordingly, in-depth knowledge of associated risk factors is crucial for prevention policies. This study aimed to estimate PPA symptom prevalence at 2 months and to identify associated risk factors in a representative sample of all women who gave birth in France in 2021, and in two subgroups: women with no postpartum depression (PPD) symptoms, and those with no history of mental health care.

Among the 12,723 women included in the representative French national perinatal survey 2021ENP, 7,133 completed the Edinburgh Postnatal Depression Scale (EPDS) self-administered questionnaire – including three anxiety-specific items (EPDS-3A) – at 2 months postpartum. We estimated the adjusted prevalence ratios (aPR) of PPA symptoms using Poisson regression models with robust variance.

PPA symptom prevalence at 2 months was 27.6% (95% CI [26.5–28.8]). Associated risk factors were: age ≤ 34 years (maximum aPR = 1.38 [1.22–1.58] obtained for persons aged 25–29 years vs. 35–39 years), poorer health literacy (1.15 [1.07–1.23]), a history of medical termination of pregnancy (1.32 [1.05–1.68]), psychological (1.31 [1.17–1.47]) or psychiatric (1.42 [1.24–1.63]) care history since adolescence, nulliparity (1.23 [1.12–1.35]), no weight gain or loss (1.29 [1.03–1.61] vs. 9–15 kg gain) or gain ≥23 kg (1.20 [1.00–1.43]) during pregnancy, ≥3 pregnancy-related emergency consultations (1.16 [1.03–1.31] vs. none), poor/good support during pregnancy, (1.16 [1.00–1.34] and 1.15 [1.05–1.26], respectively, vs. very good), sadness (1.52 [1.36–1.69]), anhedonia (1.48 [1.27–1.72]), or both (1.99 [1.79–2.21]) during pregnancy, not at all/not very satisfied with pain management during childbirth (1.16 [1.01–1.32] vs. quite/very satisfied). Similar risk factors were found in the ‘no PPD symptoms’ and ‘no history of mental health care’ subgroups.

Estimated PPA symptom prevalence at 2 months in our study sample was 27.6%. The risk factors we identified may guide future prevention policies.

Physician assisted dying is not new, neither historically, nor globally. What has changed in the UK however, is the perspective of society. In the UK, the British Medical Association is both a union and a professional organisation representing doctors and liaising with governments departments in matters of healthcare. As with various specialties within medicine, there are those in favour of change and those against. There are matters on which there is common ground, and a consensus of experts has identified principles, which, if legislation is to change, would be sensible to follow. A profession has united around the idea that if change is coming, it is better to inform the debate proactively and ensure that the interest of patients and doctors are promoted.  This session will look at how potential change in the UK has been approached and hopefully well managed.’

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