POTION is an EU funded project (No. 824153) within the Horizon2020 initiative that aims at understanding the nature of chemosignals in humans and their sphere of influence on social interaction. The emotional state of one person can be transmitted to another through volatile molecules contained, for example, in the sweat. These molecules, or chemosignals, are processed by the receiver who is not only able to identify the feelings of the sender but also to respond accordingly.

Whitin this project, we conducted a study with the aim of exploring the possible catalyst effects of body odour on social anxiety. We hypothesized that subjects exposed to human chemosignals, while undergoing mindfulness treatment, would show an enhanced reduction in anxiety symptoms in comparison to the control group (exposed to clean air).

To this aim, a study including 96 women aged between 18 and 35 years with symptoms of social anxiety was conducted. Ater recruitment, subjects were randomly allocated to one exposure group (happiness, fear or neutral human body odour or clean air) and followed a mindfulness intervention while being exposed to one of the odour or clean air. The same intervention was repeated twice, over two consecutive days. The main outcome was change in the State-Trait Anxiety Inventory (STAI) scores for which data was collected before and after treatment at each day. Mixed model analysis revealed significant changes in STAI scores in all groups during both days of trial. However, a greater decrease in anxiety symptoms was observed in subjects exposed to fear chemosignals during both days. A post-hoc comparison of the group exposed to clean air and the group exposed to fear chemosignals showed a trend level time x odour interaction during the second day of trial (F(1,45)=3.74, p=0.07).

In conclusion, our pilot study indicated a potential use of human body odours as a catalysts of social anxiety treatment. While the small sample size restricts the generalizability of our findings, the observed trends offer a promising foundation for future research.

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New data from the MRC funded project “Integrating psychological models with biological pathways in psychosis” will be presented. The overall objective of this project is to use both environmental and genetic data to understand the biological pathways in patients with schizophrenia and bipolar disorders. Specifically, to find out if polygenic risk and childhood adverse events increase the relative risk of mental illness above that of its individual case-control explained variance, and secondly, the effect of both polygenic risk and childhood adverse events on clinical characteristics and ageing processes. Both data from new unpublished systematic reviews and original data will be presented.

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In this talk I will present new findings from EarlyCause, a European consortium which aims to better understand the link between early life stress and the development of psycho-cardiometabolic (PCM) comorbidity across the lifespan, leveraging data from large-scale pediatric and adult population studies. I will discuss findings regarding the effect of (prenatal and postnatal) early life stress on PCM health outcomes and their comorbidity, potential moderating and mediating factors, as well as evidence for causality.

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Childhood trauma and depression are both associated with increased risk of metabolic disorders, but their joint effects and underlying mechanisms are not well understood. This talk will present recent findings from large-scale epidemiological and biobank studies that explore the metabolic signature of childhood trauma, depression, and their interplay. For example, using longitudinal data from the NESDA cohort, we investigated the association of childhood trauma with metabolic syndrome in ˜3000 adults, including patients with depression and/or anxiety and healthy controls, over 9 years of follow-up. The talk will also describe preliminary results from an individual patient data meta-analysis pooling >160,000 subjects from the Early Cause European Consortium. In this study, we examined the differences in markers of obesity and dyslipidemia across individuals with neither childhood trauma nor depression (controls), those with childhood maltreatment, those with depression, those reporting both of these conditions. The findings described in the talk shed light on the complex interplay between early life stress, mood disorders, and metabolic health.

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Gaming disorder is characterized by ICD 11 as persistent or recurrent gaming behavior manifested by impaired control over gaming, increasing priority given to gaming over other life interests and daily activities; and continuation or escalation of gaming despite the occurrence of negative consequences. IGD shares to a large extent neurobiological alterations seen in other addictions, such as activation in brain regions associated with reward, reduced activity in impulse control areas and impaired decision-making; and reduced functional connectivity in brain networks that are involved in cognitive control, executive function, motivation and reward. Moreover, there were structural changes, mainly reduction in gray matter volume and white matter density. Comorbidity studies indicate that executive control networks in ADHD may increase the susceptibility to develop IGD. Problematic SNS use has been associated with an increased rate of depression, anxiety, stress, obsessive-compulsive disorder (OCD), attention-deficit/hyperactivity disorder (ADHD), and propensity to excessive alcohol use. It may also lead to vulnerability to aggression, cyberbullying and fear of missing out (FOMO). There is little evidence for cognitive impairments, but there is some preliminary event-related potentials (ERPs) evidence for inefficiency in allocating and monitoring resources and inhibitory control. There is evidence for reduced sleep quality and quantity, longer sleeping latency and more sleep disturbance. Brain imaging studies showed impaired inhibitory-control mechanism, reduced gray matter volumes in the nucleus accumbens, amygdala, and the insula, suggesting rewarding effects of SNS use on the brain.

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Exercise can be considered a feasible and efficient add-on treatment in schizophrenia. However, there remain two major challenges with regard to feasibility and efficiency: First, drop-out rates during exercise programs appear to be relatively high, ranging between 30 to 80 percent. Second, only between 30 and 50 percent of patients clinically respond to exercise interventions. Hence, we aimed to identify factors that predict adherence and response to exercise programs in people with schizophrenia. Based on data from 180 patients with schizophrenia enrolled in the Enhancing Schizophrenia Prevention and Recovery through Innovative Treatments (ESPRIT) C3 study, we examined clinical baseline characteristics that may predict study completion and number of attended trainings (adherence), as well es clinically relevant improvements in symptomatology and functioning (response). We found that only levels of functioning at baseline, but not symptom severity, cognitive functioning, or physical health, predicted adherence. Further, we provide preliminary evidence suggesting that patients with higher cognitive abilities and higher education who performed regular exercise already prior to the study participation were more likely to respond. To conclude, our findings indicate that exercise is particularly helpful for a subgroup of patients characterized by higher levels of functioning, higher cognitive abilities and education, and more pronounced affinity to exercise. Future studies should additionally include environmental, genetic, and neural data to predict adherence and response to exercise.

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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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Persons with intellectual disability (PwID) and/or and autism spectrum disorder with high support needs (ASD-HSN) have resulted to be among the most vulnerable populations to COVID-19 and distress factors associated to the measures for containing its spread. Many health, rehabilitation, and assistance needs were managed through the use of telemedicine, specifically teleassistance (TA) and telerehabilitation (TR), with regard to the prevention and treatment of the epidemic illness as well as the continuity of care required for the condition of developmental disability and co-occurring physical or mental disorders. TA and TR can function either directly or indirectly with the PwID/ASD; in the latter case, a family member, a regular caregiver, or a technician provides local mediation. This paper examines the most common TA and TR activities, along with their requirements, applications, and goals. All of these activities should be in line with the overarching goal of each customized therapy and rehabilitation plan, which is to enhance and support the quality of life for people with intellectual and developmental disabilities.

Studies on TA and TR efficacy for PwID/ASD are limited, especially concerning adulthood. The scant research that is currently available demonstrates efficacy in maintaining or marginally enhancing cognitive, adaptive, and vocational skills. In addition to managing both routine and unusual activities as well as critical episodes, family members and other caregivers reported feeling more empowered about their educational and interpersonal abilities with the PwID/ASD. The primary benefits over traditional in-person services have been found to be greater accessibility and availability as well as a reduction in both physical and psychological distance. The primary limits include the absence of all elements of the therapeutic alliance pertaining to face-to-face communication, possible poor ability to use technology, accessibility of the technology itself, concerns regarding privacy, and variables that divert attention connected to the household setting.

Even while telemedicine has proven to be feasible and beneficial thus far, it is doubtful that traditional techniques will be able to be replaced, at least not anytime soon. Telemedicine could, nonetheless, serve as a useful addition, integration, or short-term substitute. Future studies should provide light on the indications, contextual deployment, efficacy evaluation, and operational stability over time of certain TA and TR activities in addition to the use of artificial intelligence, machine learning, and interactive avatars.

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Défigame is a training tool designed in collaboration with parents and specialists from the French Rare Diseases Network DéfiScience.

In this serious game, you take on the role of a general practitioner treating four young patients whose developmental trajectories raise questions. Interactively and with the help of concrete tools, you’ll learn about the recommendations for coordinating an appropriate course of prescription, care and support for a family, from the search for a diagnosis to early management of a Neurodevelopmental Disorder (NDD).

WHO IS DEFIGAME FOR?

1. – Any European doctor questioning the etiology of a neurodevelopmental disorder, prescribing genetic tests or wishing to update their knowledge in the field of NDD, particularly in relation to a rare disease.

2. – Any other healthcare professional concerned with etiological diagnosis or support for people with NDD and their families.

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Telemedicine is an emerging treatment option having been heaviliy used during covid lockdowns, in order to maintain traetment access including for ddictive disorders.

In the present talk, we first present data published on the challmenges met at ReConnecte the treatment facility for Addictive behaviors during pandemic.

We second, present results of a survey we conducted on preferences of telemedicine use in patients and doctors in our Geneva University Hospitals.

We finaly illustrate findings by clinical cases of patients suffering form addictive behaviors and their specific meeds and preferences in terms of telemedicine (phone or Visioconsultation).

Preferences and ehealth tools elicited depended of their psychosocial profiles, their specific needs and expected benefits from online sessions of psychotherapy.

One of the ingredients of successful psychotherapy for addictive behaviors, is teh purposeful use of telemedicine as an inztegarted treatment modality.

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To discuss novel approaches in the development early detection, response and interventions of drug overdoses.

There is an urgent need to research and develop novel strategies to rapidly and accurately detect, respond, and treat them with the ultimate goal of reducing drug deaths secondary to fatal drug overdose incidents. This should be additional to supporting communities and networks able to intervene utilizing novel public health approaches.

We will describe technologies and associated systems that are able to accelerate detection and result in a timely response to potential overdose with effective and timely intervention to these occurrences using digital technologies and therapeutics. This will be contextualised around novel public health approaches.

We will describe 11 protypes as part of a £5 million UK inititiative. The themes will include:

1. – Use of discrete digital technology for easy use by people who use drugs in clinical and non-clinical settings

2. – Simple alert / responder pathways that created effective responses to potentially fatal overdose events

3. – Enhance innovative therapeutics as antidotes to overdose episodes

4. – Novel public health approaches

The use of remote monitoring devices like wearables and smartphone applications, paired with artificial intelligence and innovative therapeutics is an emerging field of research. This needs to be balanced around novel public health approaches.

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In Sweden, four lives are lost to suicide each day. Hence, identifying relevant risk factors to inform effective prevention strategies is key. Such strategies can range from individual (‘micro’) -level prevention methods, to broader national suicide prevention policies.

Whilst a range of studies have explored individual-level risk factors, highlighting municipal, regional, or national-level predictors can be valuable to identify broader social and contextual determinants. This study will therefore aim to go beyond proximal predictors of suicide by looking through a wider national- and regional-level lens in Sweden.

This project will be conducted utilizing routinely collected and publicly available data and applying longitudinal modelling to investigate potential predictors of changes in suicide rates across time in Sweden. More specifically, the study will explore whether regional data on economic (e.g. proportion of state benefit recipients), socio-demographic (e.g. educational level) and healthcare related variables (e.g. trust in the healthcare system) are associated with suicide rates over time.

This is an ongoing project and results will be available and presented at the time of the conference.

Utilizing publicly available data to explore potential predictors of suicide rates is not only cost-effective, but adding such findings to existing knowledge of individual-level risk factors can also be important when targeting wider policy and ensuring effective coordination and implementation of regional suicide prevention strategies.

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Several changes to the classification of mental disorders have been made during the past half century to increase the reliability, clinical use and validity of the diagnostic classification. Despite the high expansion of knowledge about mental disorders, understanding of their components and processes still requires fine-tuning. This symposium identifies key issues on different classification systems with different purposes relevant to understanding and classifying mental disorders. We discuss how key issues such as ICD-11, RDoC or Biomarkers correspond or diverge because of their different purposes, and constituencies. Although these approaches have varying degrees of overlap and distinguishing features, they share the goal of reducing the burden of suffering due to mental disorder.

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Electroencephalography (EEG) serves as a non-invasive, cost-effective, and robust tool, directly measuring in-vivo neuronal mass activity with high temporal resolution. Using state-of-the-art machine learning techniques, EEG recordings have the potential to generate in silico biomarkers for severe mental disorders. In this study, we developed EEG-based classification models for schizophrenia and depression taking into account physiological and pathological aging processes.

From a cohort (N=735, 51.6% male) that is acquired in LMU Hospital, Department of Psychiatry and Psychotherapy, comprising healthy control individuals (HC, N=245) and patients with schizophrenia (SCZ, N=250) or major depressive disorder (MDD, N=240), we extracted power spectrum density and connectivity measures based on 60 second resting-state EEG recordings with 19 channels. The support vector machine models were trained to 1) classify patients with SCZ or MDD and HC individuals, and 2) predict age in HC individuals using ten-by-ten repeated nested-cross validation. The age-predicting model was applied to patient groups to calculate EphysAGE (Electrophysiological Age Gap Estimation) by subtracting chronological age from chronological age. The links between diagnosis, medication, and EphysAGE, i.e., accelerated aging, were then further explored with univariate analyses.

The EphysAGE Model had an explained variance of 46% (MAE=8.7 years, T=14.31, P1000<0.001). The patients with SCZ had a significantly higher EphysAGE (mean[SD]=0.61[10.32]) than the patients with MDD (mean[SD]=-1.10[10.49], p=0.04). The classification models discriminated SCZ from HC (Balanced Accuracy, BAC=72.7%, p<0.001), MDD from HC (BAC=67.0%, p<0.001), and SCZ from MDD individuals (BAC=63.2%, p<0.001). Higher EphysAGE was associated with an increased likelihood of being misclassified as SCZ in HC and MDD (ρHC=0.23, p<0.001; ρMDD=0.17, p=0.01) based on percentile rank scores from the SCZ Model. Moreover, in the Differential Diagnostic Model, higher EphysAGE is positively correlated with being misclassified as SCZ in patients with MDD (ρMDD=0.14, p=0.03).

Machine learning models can extract electrophysiological signatures of MDD and SCZ for potential clinical use. However, the impact of aging processes on diagnostic separability calls for timely application of such models, possibly in early recognition settings.

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Several meta-analyses demonstrated the efficacy of unilateral High-Frequency Left-sided (HFL) repetitive Transcranial Magnetic Stimulation (rTMS) for individuals with Major Depressive Disorder (MDD); however, results are contradictory due to heterogeneity of the included studies. Empirical evidence on the relative efficacy of rTMS treatment compared with standard pharmacotherapy in Treatment-Resistant Depression (TRD) is presented. Random effects models were used to assess the effects of rTMS on response and remission rates. In 19 randomized double-blinded sham-controlled studies were included for quantitative analysis for response (n = 854 patients) and 9 studies for remission (n = 551 patients), the risk ratio (RR) for response and remission are 2.25 and 2.78, respectively for patients after two treatment failures using rTMS as add-on treatment compared to standard pharmacotherapy. The presentation will conclude, that rTMS is significantly more effective than sham rTMS in TRD in response and remission outcomes and may be beneficial as an adjunctive treatment in patients with MDD after two treatment failures. This finding is consistent with previous meta-analyses; however, the effect size was smaller than in the formerly published literature.

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Schizophrenia has a heterogeneous range of possible outcomes. A portion of patients with schizophrenia significantly improves over the long term, with both clinical and functional remission. Recovery has been differently conceptualized by clinicians and service users, the former focusing on clinical and functional outcomes, the latter more underlying issues as the building a trail of personal meaning and subjective well-being. Besides the “clinical” and “personal” recovery, attention is now put on a wider perspective of “societal” recovery . The frequency of recovery achievement depends on which of these perspectives is considered. Many factors, demographic, clinical, contextual and treatment-related are involved in modulating the probability to meet these objectives. Both pharmacological and psychosocial interventions, and their integration, and attention to environmental and social circumstances could substantially improve the outcome of schizophrenia and achievement of specific recovery goals.

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Comprehensive care programs, which include individually planned pharmacotherapy are associated with higher rates of recovery1 and better long-term prognosis2. However, there are barriers to individually optimised antipsychotic treatment both from both the patients and treatment teams perspectives.

To summarize the potential contribution of adequate long-term antipsychotic treatment to recovery or better outcomes in schizophrenia.

Review of research data.

Results A shorter duration of untreated psychosis, a lower number of relapses, and the absence of a chronic course of psychosis are associated with higher rates of recovery and a better prognosis. The OPUS early intervention program was associated with better outcomes for up to 10 years, but not for more than 20 years3. Second generation antipsychotics are associated with lower mortality rates, including suicides in young people with schizophrenia.4

Higher doses of antipsychotics are associated with poorer outcomes and with potential structural brain changes, while adequate (lower) doses of antipsychotics are associated with lower side effect burden and better overall outcomes5. A significant proportion of patient may benefit from polypharmacy (combination of 2 antipsychotics)6. Antipsychotic treatment discontinuation strategies are associated with the development of treatment resistance.7

Adequate (low dose) antipsychotic treatment is part of the complex early intervention programs and long term treatment of schizophrenia, which are associated with higher rates of recovery and good outcomes. The role of polypharmacy (combination of 2 antipsychotics) may need a reconsideration in the treatment guidelines of schizophrenia.

1. 1. Kane JM et al. The Journal of clinical psychiatry. 2015 Mar 25;76(3):16590.

2. 2. Posselt CM et al. 2021. American Journal of Psychiatry, 2021, 178(10):941-951

3. 3. Hansen HG et al. 2023. JAMA Psychiatry, 2023, 80(4): 371-379.

4. 4. Correll CU et al. World Psychiatry. 2022 Jun;21(2):248-71.

5. 5. Andreasen NC et al. 2013 Jun;170(6):609-15.

6. 6. Katona L et al. 2014 Jan 1;152(1):246-54.

7. 7. Emsley R et al2013 Feb 1;33(1):80-3.

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Recovery in Schizophrenia: The Role of Psychosocial interventions Recovery is individual and so needs individual responses from the mental health services. Different interventions are useful at different stages and of course they only “work” for some people. The paper will describe some psychosocial interventions and the role they might pay in the patient’s journey to their expected recovery. Three main strategies are often referred to – reducing symptoms, reducing barriers to recovery, and extending and maintaining recovery to achieve some stable and acceptable (to the patient) optimal level of functioning. Psychosocial intervention strategies are beneficial for each of these often thought of as independent, but they are inter-related with one type of therapy leading to reductions in the need for other therapies. The process of considering which one to start with is a choice and this paper will describe some decision making to ensure that patients have the best options.

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The World Health Organization (WHO) has stated that in situations of armed conflict, “Around 10 percent of the people who experience traumatic events will have serious mental health problems, and another 10 percent will develop behavior that will hinder their ability to function effectively.” Problems include post-traumatic stress disorder, anxiety, depression, substance misuse, and possibly precipitation of psychosis. War has a catastrophic effect on the health and well being of nations. Studies have shown that conflict situations cause more mortality and disability than any major disease. Only through a greater understanding of conflicts and the myriad of mental health problems that arise from them, coherent and effective strategies for dealing with such problems can be developed.

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War represents one of the major traumatic events for humans and comes with enormous consequences for individuals and society over a long period of time. War causes acute psychological trauma, but also results in subacute, chronic psychiatric disorders for all those experiencing or witnessing direct war trauma and to those experiencing indirect war trauma resulting from losing the safety of home and financial income, to losing family members and close ones. Therefore, acute reaction to trauma may result in maladaptive disorders and PTSD within days of experiencing trauma and with chronic posttraumatic stress conditions even years after the traumatic experience. Chronic PTSD is associated with higher morbidity of somatic conditions, including hypertension, hyperlipidemia, metabolic syndrome, all resulting in cardiovascular and cerebrovascular disorders. Additionally, according to reports from World Health Organisation (WHO), it has been projected that in emergencies, on average, the percentage of people with a severe mental disorder increases by 1 per cent over and above an estimated baseline of 2–3 per cent. In addition, the percentage of people with mild or moderate mental disorders, including mood and anxiety disorders (including PTSD), may increase by 5–10 per cent above an estimated baseline of 10 per cent. Furthermore, research indicate the possibility of a transgenerational effect of trauma, via maternal psychosocial stress and socioeconomic disadvantage during pregnancy but also through adverse parenting practices, as parenting style may change when exposed to war traumas.

As war affects mental health of different population groups dramatically and long-term, establishment of long term and coordinated mental health care is necessary. In the presentation, examples of practices from Croatia will be discussed.

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