Dear Sir or Madam,

I write with regard to the representation of topics in Child and Adolescent Psychiatry (CAP), as well as Nutritional Psychiatry at the 2025 WPA World Congress of Psychiatry held last October. A sizeable number of clinical and research topics within the field of CAP, accompanied by several Nutritional Psychiatry themes, was showcased.

From a perspective of Adverse Childhood Events (ACEs) impacting on mental and physical health, several concepts were explored, including early social-emotional and somatic health being impacted by childhood adversity. Findings presented from the FinnBrain Birth cohort study (Karlsson et al. Reference Karlsson, Tolvanen, Scheinin, Uusitupa, Korja, Ekholm, Tuulari, Pajulo, Huotilainen, Paunio and Karlsson2018) depicted not only that ACEs around the ages of 9–10 are associated with behavioral, neurodevelopmental and mental health problems, but also that maternal prenatal mental health predicts the accumulation of ACEs (Kataja et al. Reference Kataja, Tuulari, Karlsson, Sinisalo, Autere, Perasto, Juusola, Salama, Aatsinki and Karlsson2025). These led to a discussion around the need for early screening, identification and support, as well as resilience promotion. Additional findings relating to paternal early life stress and brain development of offspring were discussed, with male germline inheritance suggested as a contributory mechanism (Karlsson et al. Reference Karlsson, Merisaari, Karlsson, Scheinin, Parkkola, Saunavaara, Lähdesmäki, Lehtola, Keskinen, Pelto, Lewis and Tuulari2020). These support the idea of environmental factors influencing the epigenome of human spermatozoa, thereby impacting the mental health of offspring.

In terms of interventional approaches for ACEs in youngsters, researchers from the ATTUNE project developed a mobile videogame titled “Ace of Hearts.” It is hoped that this would provide young people affected by ACEs with space and privacy to think about what is happening in their lives, and be encouraged to seek other forms of support if needed. ATTUNE is a joint collaborative research effort between the University of Oxford, Falmouth University and the University of Kent, aimed at investigating how ACEs affect adolescents via arts-based approaches (ATTUNE Project website 2025). The “Ace of Hearts” encompasses themes around bereavement, narrative exposure therapy and dealing with gender dysphoria (ATTUNE All About Gaming 2025). Such digital interventions may have a beneficial impact on the mental health of younger people (Bhui et al. Reference Bhui, Shakoor, Mankee-Williams and Otis2022).

Our appreciation of the impact of childhood maltreatment on sleep disturbances later in life (Yu et al. Reference Yu, Liu, Yang, Chen and He2022) was consolidated by further findings supporting an association between physical neglect and indicators of sleep apnea (Spitzer et al. Reference Spitzer, Weihs, Ewert, Stubbe, Penzel, Fietze, Völzke and Grabe2024). Further work conducted by Jiang and colleagues examined the impact of childhood emotional abuse and depressive symptomatology on sleep macro-architecture and brain cortical thickness. Here, there appeared to be an increase in the proportion of slow-wave sleep (SWS) in emotionally abused but non-depressed participants (Jiang et al. Reference Jiang, Weihs, Frenzel, Klinger-König, Ewert, Stubbe, Berger, Penzel, Fietze, Bülow, Völzke and Grabe2025). Larger regional cortical thicknesses in these individuals suggest that increased SWS may be a protective mechanism from brain volume loss associated with emotional abuse and depression. Nonetheless, further research to explore sleep processes and circadian determinants needs to be conducted.

There were two salient presentations within the field of Nutritional Psychiatry. Regarding dietary interventions, Dr. Carlo Longhitano from the James Cook University, Australia, presented research investigating the effects of ketogenic metabolic therapy on both mental health and metabolic outcomes in patients with bipolar affective disorder (BPAD) and schizophrenia in a randomized controlled clinical trial (Longhitano et al. Reference Longhitano, Finlay, Peachey, Swift, Fayet-Moore, Bartle, Vos, Rudd, Shareef, Gordon, Azghadi, Campbell, Sethi, Palmer and Sarnyai2024). The concept of bioenergetic abnormality (Henkel et al. Reference Henkel, Wu, O’Donovan, Devine, Jiron, Rowland, Sarnyai, Ramsey, Wen, Hahn and McCullumsmith2022; Sarnyai and Ben-Shachar Reference Sarnyai and Ben-Shachar2024; Sullivan et al. Reference Sullivan, Koene, Hasselfeld, O’Donovan, Ramsey and McCullumsmith2019) for example, hyperglycolysis and glutaminolysis in BPAD (Campbell and Campbell Reference Campbell and Campbell2024) and insulin resistance in schizophrenia (Chouinard et al. Reference Chouinard, Henderson, Dalla Man, Valeri, Gray, Ryan, Cypess, Cobelli, Cohen and Öngür2019) and BPAD (Calkin et al. Reference Calkin, Ruzickova, Uher, Hajek, Slaney, Garnham, O’Donovan and Alda2015), was introduced. Their study involved comparing a twelve-week dietician-led medically supervised ketogenic diet to that of a controlled diet i.e. diet aligning with the Australian Guide to Healthy Eating (AGHE). Further details can be found in their protocol (Longhitano et al. Reference Longhitano, Finlay, Peachey, Swift, Fayet-Moore, Bartle, Vos, Rudd, Shareef, Gordon, Azghadi, Campbell, Sethi, Palmer and Sarnyai2024). Preliminary data indicated that participants receiving the ketogenic dietetic intervention experienced increased self-reported daily energy levels, decreased fasting glucose and improvements in blood pressure control in contrast to their AGHE-diet counterparts. Such findings and more will hopefully add to the mounting evidence that ketogenic diets may have adjunctive therapeutic potential in patients with schizophrenia, BPAD (Campbell et al. Reference Campbell, Needham, Grossi, Kamenska, Luz, Sheehan, Thompson, Thrippleton, Gibbs, Leitao, Moses, Burgess, Rigby, Simpson, McIntosh, Brown, Meadowcroft, Creasy, Mitchell-Grigorjeva, Norrie, McLellan, Fisher, Zielinski, Gaggioni, Campbell and Smith2025; Sethi et al. Reference Sethi, Wakeham, Ketter, Hooshmand, Bjornstad, Richards, Westman, Krauss and Saslow2024) and refractory mental illnesses (Danan et al. Reference Danan, Westman, Saslow and Ede2022).

The other interesting presentation focused on the impact of early life adversity (ELA) and dietary exposure to polyphenols on psychotic-like experiences (PLEs) in adolescents. Dr. Xuemei Ma, with the Institute of Psychiatry at King’s College London, explained the possible mental health benefits of polyphenols, which are abundantly found in plant-based foods. Though evidence suggests that polyphenols may improve mood, cognition and depression (Morris et al. Reference Morris, Gamage, Travica, Berk, Jacka, O’Neil, Puri, Carvalho, Bortolasci, Walder and Marx2021), there is limited research investigating their effects on psychotic symptoms. One study illustrates improved total and negative symptoms with consumption of curcumin in patients on antipsychotics, diagnosed with schizophrenia (Miodownik et al. Reference Miodownik, Lerner, Kudkaeva, Lerner, Pashinian, Bersudsky, Eliyahu, Kreinin and Bergman2019). Dr. Ma also explained the evidence-based association between ELAs and PLEs, noting that the former may indeed mediate to a poorer diet. Ma and colleagues’ longitudinal investigation (eBRAIN website 2025) followed 230 adolescents for ELAs and PLEs for approximately 3 years. Results at the time indicated that adolescents exposed to ELAs had a higher risk of experiencing PLEs in contrast to their counterparts. Additionally, females experienced more PLEs than males at baseline and there appeared to be a stronger effect of ELAs on PLEs in female adolescents. These gender differences could be explained by factors such as greater post-pubertal HPA axis reactivity to stress and stronger effects of ELA disruption of prefrontal-amygdala connectivity in females in contrast to males. Higher polyphenol intake in ELA-positive females was associated with fewer PLEs over adolescence. It was suggested that flavonoids and lignans may protect mental health via anti-inflammatory mechanisms. Future interventional studies are needed to confirm the protective role of polyphenols in adolescent mental health.

Overall, the World Congress of Psychiatry is an invaluable CME event which highlights many emerging mental disorders and sheds light on research which may help identify contributory factors not previously considered as part of a patient’s formulation. Future directions in terms of beneficial therapeutic adjuncts are provided. I highly recommend attendance by any trainee in psychiatry, including CAP trainees.

Yours sincerely,

D. Antoine Lachmansingh

Trainee Editor for IJPM.