Studies in different countries of defendants with mild to borderline intellectual disability found they have distinct characteristics from other defendants. The aim of this study was to examine several characteristics among defendants with intellectual disability comparing to those defendants without intellectual disability presenting to court services in London, England.

This was a retrospective data analysis of routine administrative data collected by the Liaison and Diversion services across five Magistrates courts in London, England. Data were analysed on defendants identified through screening to have an intellectual disability and compared to defendants without an intellectual disability.

9088 defendants were identified and of these 349 (4%) had an intellectual disability. Defendants with intellectual disability were over four times more likely to have comorbid attention deficit hyperactive disorder and over 14 times more likely to have autism spectrum disorder. There was an increased odds ratio of self-reported suicidal/self-harming behaviour for those defendants with intellectual disability compared to those without intellectual disability.

This study has highlighted the increased vulnerability of defendants with intellectual disability for other neurodevelopmental disorders.

J. McCarthy Grant / Research support from: Guy’s & St. Thomas’ Charity for £674,000, E. Chaplin Grant / Research support from: Guy’s & St. Thomas’ Charity for £674,000

Care and treatment of prisoners with intellectual disabilities I will describe what is the care, from different points of view when an offender with intelledtual disabilities entry in the penitentiary system. As a vulnerable population, people with intellectual disabilities have to be treated in a more specific manner, and both prison managers and clinciacal staff have to be aware of of that. This prisoners, sometimes, also belongs to another vulnerable population ( illegal inmigration, fenmales, ehtnic groups ,etc) that make this cases as a complex ones.  The care have to be as a comprehensive, with thr higest standards of care a nd avoid neglicence en treating this cases. We have to emphasize about rehablitation and a goodl coordnation with the intellectual disability community services to avoid relapse and recidivism

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A thorough pre-electroconvulsive therapy (ECT) assessment is a integral to ECT preparation. Usually, the assessment encompasses elements such as medical history, cognitive assessment, laboratory tests, imaging diagnostics, and consultation with an anesthesiologist. However, there is currently no universally standardized minimal or optimal pre-ECT evaluation at the international level. Recent results show a high variability of the pre-ECT evaluation practice across Europe. Establishing a standardized approach to pre-ECT evaluation would be of great interest for both patients and practitioners.

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The recent network perspective of depression conceptualizes depression as a dynamic network of causally related symptoms, this in contrast with the traditional view of depression as a discrete latent entity that causes all symptoms. Electroconvulsive therapy (ECT) is an effective treatment for severe depression, but little is known about the temporal trajectories of symptom improvement during a course of ECT. We will present the results of a study that investigates the temporal trajectories of individual symptoms during treatment with ECT.

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After numerous unsuccessful attempts to create a therapy that could alter the course of Alzheimer’s disease, first monoclonal antibodies targeting amyloid-β in the brain have finally shown consistent evidence of clinical effectiveness. These therapies not only slow the progression of the disease, but also show positive results in secondary clinical outcomes and reduced amyloid-β levels on PET scans. This presentation will examine the main features of the previous failed trials and explore possible reasons for their lack of success in developing a treatment for early-stage Alzheimer’s disease. It will also compare the safety profiles of various antibodies and point out precautions that should be taken when using them in regular clinical practice. Furthermore, it will be discussed how blood-based biomarkers can revolutionize the clinical care pathway, making it easier to adopt antibody treatments. A comprehensive model that integrates case-finding and treatment across various healthcare sectors will be proposed. In conclusion, we may have made a significant breakthrough by demonstrating that reducing amyloid-β levels leads to clinical benefits, not just changes in biomarkers. As the new generation of drugs becomes more commonly used, we will see whether their statistical effectiveness translates into meaningful clinical changes. This could mark the start of a new phase in the development of drugs for Alzheimer’s disease.

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Persistent negative symptoms of schizophrenia are generally considered difficult to treat or treatment resistant. A large number of investigational drugs developed and or tested for the treatment of persistent negative symptoms failed to show efficacy leading to pessimism in treatment and disinvestment in treatment research of negative symptoms.

1. To demonstrate, that available treatment methods – both pharmacological and non-pharmacological - are in fact effective for the treatment of negative symptoms of schizophrenia 2. To shortly summarize new drug research in this field.

Review of research data.

The overall estimate for the placebo effect had a medium effect size, with a Cohen’s d value of 0.6444 (SE = 0.091).1 The estimates for the placebo effect were similar in the add-on and monotherapy studies. Amisulprid was superior to placebo, cariprazine was superior to risperidone, and “direct comparisons of antipsychotics in patients with predominant negative symptoms indicated no significant difference between amisulpride and olanzapine and between asenapine and olanzapine…”2 . Various nonpharmacological interventions improved negative symptoms in randomized controlled trials relative to treatment as usual (e.g. social skills training, music therapy, non-invasive brain stimulation, mindfulness, and exercise-based interventions) 3 There is a progress in research with non-dopaminergic agents for the treatment of negative symptoms (e.g. pimavanserin, roluperidon, ulotaront).

For medication classes other than antipsychotics and antidepressants, we found no reliable support for evidence-based recommendations for using these agents in the treatment of negative symptoms in clinical practice. Effect sizes for psychosocial interventions range from small to moderate. The use of placebo has shown a clinically significant positive effect on negative symptoms, a finding that warrants further research and provides a sense of optimism regarding potential therapeutic benefits.

1. 1. Czobor, P., Kakuszi, B. and Bitter, I., 2022. Placebo response in trials of negative symptoms in schizophrenia: a critical reassessment of the evidence. Schizophrenia Bulletin, 48(6), pp.1228-1240. 2. Czobor, P., Bitter I. Pharmacologic treatment of negative symptoms: Focus on efficacy. In: Bitter I. (ed): Managing Negative Symptoms of Schizophrenia, Oxford University Press, 2020, p. 67

2. 2. Savill, M. Psychosocial/non-pharmacologic treatment of negative symptoms: focus on efficacy. In: Bitter I. (ed): Managing Negative Symptoms of Schizophrenia, Oxford University Press, 2020, p. 87

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Mortality from cardiovascular disease is increased in people with mental health disorders in general and schizophrenia in particular. The causes are multifactorial, but it is known that antipsychotic medication can cause cardiac side-effects beyond the traditional coronary risk factors. Schizophrenia itself is a contributor to an increased risk of cardiovascular mortality via cardiac autonomic dysfunction and a higher prevalence of metabolic syndrome, both contributing to a reduced life expectancy.

Overall, management of cardiovascular risk within this population group must be multifaceted and nuanced to allow the most effective treatment of serious mental illness to be conducted within acceptable parameters of cardiovascular risk; some practical measures are presented for the clinical cardiologist.

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Negative symptoms of schizophrenia are linked with poor functioning and quality of life. Therefore, appropriate measurement tools to assess negative symptoms are needed. The NIMH-MATRICS Consensus defined five domains for negative symptoms. We used the COSMIN guidelines for systematic reviews to evaluate the quality of psychometric data of negative symptom scales as Clinician-Rated Outcome Measure (ClinROM). COSMIN assesses risk of bias, so called updated criteria of measurement properties, a modified GRADE approach and a final judgement on the rating scale. In the lecture the process will be described using the Brief Negative Symptom Scale and the Clinical Assessment Interview for Negative Symptoms (CAINS) as examples.

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Affective disorders represent a category of psychiatric syndromes with high prevalence and associated disability. While effective, both pharmacological and psychosocial, treatments are available for depression and bipolar disorder, the many therapeutic needs of affected patients are far from being properly addressed under routine conditions. Along the past decade, several digital treatments, tools and approaches have been developed and tested in clinical settings, showing an highly promising potential to fill the treatment gap of affective psychopathology. In more detail, reviewed here will be telepsychiatry solutions for affective disorders, also encompassing the available officially approved digital therapies for major depression and bipolar disorder. Furthermore, the impact of artificial intelligence, serious gaming, social media and virtual/augmented reality in the treatment of mood disorders will be also discussed, in the light of the most recent research evidence on these topics.

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The final aim of the EXPERIENCE project is to enable individuals to record and share extended-personal realities in Virtual Reality (VR) - which entails the consideration of a person’s neurophysiological, psychological, and cognitive states. One prospective application is using this technology to aid in assessing symptoms of affective disorders.

The objective is to test the ability of a pre-designed VR environment to differentiate between individuals with depressive symptoms and healthy controls (HCs) via machine learning algorithms.

Conducted as a pilot study in Italy, we recruited 100 volunteers, comprising 50 HCs and 50 individuals with moderate depressive symptoms assessed via the PHQ-9. Through a 40–60-minute VR engagement, comprehensive data on cognitive (inc. cognitive flexibility, sustained attention, working memory, processing speed), behavioral (exploration, attentional bias), and physiological (heart-rate variability, skin conductance) variables was collected. Subsequently, an explainable artificial intelligence model (xAI) was trained on data from 80% of the sample and tested on the remaining 20% in terms of accuracy for between-group classification.

Following an iterative process that considered both the importance assigned to each variable in the different models and the theoretical relevance of these variables to depression the final model achieved an average accuracy of 71% (with individual trials ranging from 64.5% to 77.1%). Key predictors included exploratory behaviors and heart-rate variability during both exploration and cognitive tasks.

These results are comparable, however remain below the levels of accuracy achieved based on fMRI and DTI data alone (around 80%). Nonetheless, the EXPERIENCE system, slated for refinement beyond this pilot phase, shows potential in integrating multimodal data for evaluating affective disorder symptoms, aiming for a more objective screening and diagnostic approach at a lower cost.

The EXPERIENCE project is funded by the European Commission H2020 Framework Program, Grant No. 101017727.

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An increase in the prevalence of depressive symptoms can be seen in patients with severe somatic conditions, with a reduction in quality of life, an increase in sleep disturbances and an increased risk of suicide as some of the most serious consequences. However, few evidence-based interventions have been developed with the aim of reducing this comorbidity. The NEVERMIND system aims to address this issue by collecting psychometric and biomedical data via a smart shirt and a mobile app, which are used to predict patients’ depressive symptoms. Patients are then directed to personalised lifestyle behavioural advice, mindfulness-based therapy, and cognitive behavioural therapy.

The primary objective was to evaluate the effectiveness of the NEVERMIND system in reducing depressive symptoms in patients with somatic conditions compared to treatment as usual. Secondary objectives included the system’s effectiveness in preventing depressive symptoms, sustaining the effects at 24 weeks post-baseline, and reducing suicide ideation. Besides these, the usability, acceptability, and satisfaction of the system were examined in patients with breast or prostate cancer.

For this pragmatic randomised controlled trial, 425 patients diagnosed with myocardial infarction, breast or prostate cancer, kidney failure, or lower limb amputation were recruited from hospitals in Turin, Pisa and Lisbon. Data collection occurred at baseline, 12 weeks, and 24 weeks, with the primary outcome being depressive symptoms at week 12, measured by the Beck Depression Inventory II. Regarding the usability, acceptability and patient satisfaction, data from 288 patients was used.

The intervention group included 213 and the control group 212 patients, with the sample’s mean age being 59.41 (SD=10.70). Patients who used the system reported having statistically significant lower depressive symptoms at 12 weeks (mean difference=-3.05, p=0.004; 95%CI -5.12 to -0.99) compared to controls, with a clinically relevant effect size (Cohen’s d=0.41). Furthermore, significant reductions were found for suicide ideation (mean difference=-0.61, p=0.020; 95%CI -1.13 to -0.10) and incidence of depressive symptoms at week 12 (OR=0.43, p=0.019; 95%CI 0.22 to 0.87). The decrease in depressive symptoms was sustained at week 24 (mean difference=-1.34, p=0.015; 95%CI -2.41 to -0.26). The system was found to have good usability, with women rating the system more favourably than men and valuing its emotional support, while men used the system more frequently than women and valued the self-awareness that the system encouraged.

The NEVERMIND system was shown to be superior to standard care in reducing and preventing depressive symptoms among the studied sample. A new project will be launched in the near future to continue the examination of the system’s effectiveness.

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Schizophrenia, as one of the most common disorders from the psychotic spectrum is most commonly detected in the phase of first psychosis and may pose a diagnostic challenge, as commonly comprise a heterogeneous group of schizophrenias, with distinct clinical presentations. If it detected in its prodromal phase without clearly developed psychotic symptoms, the diagnosis is even more unreliable, as the transition to full blown psychosis in the next two years happens in 15-40% of more, depending probably on a variety of cumulative environmental risk factors (including childhood trauma, the use of high-potency cannabis, urbanicity, season of birth). Moreover, the first episode psychosis may underlie for example the first manic episode, brief intermittent psychotic symptoms in persons with borderline personality disorders, acute reaction to trauma, the use of cannabis and psychostimulants and different organics causes, such as endocrinologic disorders and autoimmune encephalitis. Therefore, in everyday clinical practice, the diagnosis of first episode psychosis always requires an assessment of possible causes of psychosis, and also factors that may influence prognosis and treatment. Usual assessment include detailed anamnestic and heteroanamnestic data, physical examination, standard blood laboratory findings, drugs in urine/ blood, EEG and CT/MR scan. The absence of typical risk factors for schizophrenia, as well as the absence of premorbid symptoms and developmental course typical for schizophrenia, abrupt course of psychotic symptoms, symptoms such as disorientation, catatonia, speech disturbances, alteration of consciousness, neurologic signs, autonomic dysfunction and laboratory aberrations may be especially indicative for organic cause and possibly encephalitis and require further confirmation with the analysis of cerebrospinal liquor with antineuronal antibodies.

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Childhood trauma is a severe form of stress that has been strongly related to both the appearance of a psychotic disorder and the existance of social cognition disturbances. We hereby hypothesize childhood trauma might be a transdiagnostic marker of social cognition disturbances across the psychosis spectrum, regardless of the main diagnosis.

To investigate the effect of different forms of childhood trauma in social cognition impairments in first-episode psychosis, at-risk mental states for psychosis and healthy controls.

Using cross-sectional data, we will examine the relationship between different kinds of chidlhood trauma (measured with the Childhood Trauma Questionnaire, CTQ) and several social cognition domains, including facial emotion recognition, theory of mind (assessed using the Movie Assessment for Social Cognition, MASC, The Hinting Task, and the Faux-Pas Questionnaire). Intra and inter-group differences be studied for three study groups, including patients with first-episode psychosis (n=60), subjects with at-risk mental states for psychosis (n=60), and healthy controls (n=60).

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Abstract: This presentation seeks to explore the interplay between various types of psychological traumas and their potential correlation with the development of distinct types and severities of eating disorders. Emphasis will be placed on elucidating the underlying biological underpinnings and psychological and developmental factors that contribute to the manifestation of diverse eating disorder phenotypes in individuals who have experienced childhood maltreatment.

Drawing upon existing research and novel insights, I will present some data from studies investigating the notion that the observed variations in eating disorder presentations may be linked especially to environmental influences. Contrary to the conventional focus on genetic determinants, our findings suggest that the differential ecophenotypic expression of eating disorders may not solely be attributed to DNA variants but rather to the complex interplay between genetic predispositions and environmental contexts.

In particular, I will expose the concept of an ecophenotype characteristic of eating disorders associated with childhood maltreatment, positing that the unique ecological context in which an individual is raised significantly influences the trajectory and severity of their eating disorder. This exploration extends beyond a mere examination of genetic markers, shedding light on the environmental and ecosystemic factors that shape the development of an individual’s relationship with food and body image.

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Traumatic exposure is a common global problem across nations. It is currently well established that childhood trauma is associated with increased risk for psychopathology transdiagnostically, with children having experienced trauma being twice as likely to develop a mental health condition compared to those who have never experienced trauma. According to population-based studies, this heightened risk for the emergence of mental health disorders persists throughout adolescence and adulthood. The risk for psychopathology seems to be most marked in children exposed to interpersonal violence (child emotional and physical abuse, neglect, sexual violence). In this presentation, we will summarize the results of an increasing number of published studies that have examined the mechanisms underlying vulnerability to psychopathology following childhood trauma and protective factors that buffer this risk. Specifically, we will highlight the role of emotion dysregulation and interpersonal difficulties, related to disrupted threat processing following trauma exposure, in mediating the impact of trauma on internalizing and externalizing symptoms. Research studies have also identified protective factors accross the lifespan that might mitigate these outcomes, including social support and emotional skills building. Based on this review, we will suggest a conceptual transdiagnostic and biopsychosocial model of risk and resilience, which can provide opportunities and targets for early interventions and treatment, at the primary and secondary healthcare levels, as well as the social, public health and community levels. Our model is based on a socioecological and multisystemic paradigm of risk and resilience, where resilience is conceptualized as an interaction between individuals and resourceful environments and communities.

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Increased psychosis risk has long been reported for some migrant and ethnic minority populations, a finding has been replicated in different parts of the world, with risk seeming to persist for further generations. Several explanations such as genetic liability or selective migration, higher cannabis-use or higher exposure to neurodevelopmental risk factors were considered unlikely explanations. Rather, exposure to adversity experiences found to be a determinant of psychotic disorders, such as parental separation, social and economic disadvantage, discrimination, social exclusion and marginalization. Additionally, migrants often live in cities, where high population density, low social cohesion and social fragmentation and deprivation, combined with lack of green space and urban stress increase the psychosis risk. Although previous research work has emphasized the quantitative exploration of social-environmental determinants of psychosis, qualitative studies allow for the generation of innovative, rich and nuanced understandings about a given phenomenon, being an ideal approach in face of complex social dynamics and contexts. Concretely, the associations are established, however, the underlying mechanisms and experiences remain largely unknown.

This study aims to address several research gaps identified in research on the issues of psychosis, socio-environmental determinants of mental health, migration and ethnicity, and inequalities by exploring the life narratives and experiences of service-users with first psychosis with distinct ethnic, racial and migrant backgrounds.

Participants aged between 18 and 35 years old, who have been diagnosed with a first psychosis are recruited in Montreal, Canada, and in the Netherlands. The aim is to recruit at least 20-25 individuals from each site, but recruitment is still ongoing. Qualitative interviews of about an hour are being held, and transcripts will be analyzed with Nvivo, software for qualitative data. Categories and clusters will be formed from the narratives, resulting in common themes that are important to the patients, in their understanding of the development of their psychosis, and the help they have received.

Preliminary data show that the patients have predominantly African or (Eastern)European background, moved around a lot, and experiences inequities. Help and care were not always available for them, not always beneficial. Participants experiences a lot of isolation and deplacement, together with socio-economic disadvantages. Common themes as to by which mechanisms these aspects play a role will further be explored.

These findings will be discussed in light of the quantitative data already existing. Implications for prevention and interventions will be discussed.

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According to the latest Intergovernmental Panel on Climate Change (IPCC) Report (2022), climate changes (e.g. rising sea levels and temperatures and) are noticeable and intensifying on the entire planet. Extreme weather events or ecological disasters are occurring with increased frequency and intensity. Anthropogenic climate change has been called “the defining issue of our time” (United Nations, 2022) and “the greatest threat to global health in the 21st century” (World Health Organization, 2015). Health impacts from climate change may include increased morbidity and mortality from worsening cardiopulmonary health, and greater risk of infectious diseases and mental illness. During this lecture, we will discuss environmental aspects that clearly have a negative impact on the mental well-being of the general population and, more specifically, the psychiatric population. The focus will primarily delve deeper into climate anxiety.

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Science, Ethics, Solidarity… These three words are mottos of Psychiatric Association of Türkiye (PAT), since its foundation in 1995. In accordance, PAT has Code of Ethics for more than 20 years. There are many developments and changes both in practicing psychiatry and in the community in the last couple of decades. As a result, many new ethical questions, dilemmas and approaches arise for psychiatry. PAT had decided to update the Code of Ethics about two years ago and the updating process is almost on the edge of finalization.

In this presentation, main points of the updated and newly written principles will be summarized with special references to recent developments in the world and updated or newly written international Code of Ethics such as, EPA, WPA, and several national associations’ documents.

One of the most important outcome and benefit of such an updating process is modelling the project on a participatory base, having wide feedback and inputs from experts (as many as possible, enriched by diverse interests of related disciplines) and reaching as many colleagues as possible from different working conditions. A six step project with this perspective was prepared and implemented, and will be summarized in the presentation for international exchange of experiences.

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Borderline personality disorder (BPD) is associated with excess suicide risk, natural-cause mortality, comorbid medical conditions, poor health habits and stress related epigenomic alterations. This presentation will report findings of BDNF and stress system associated epigenetic alterations in a group of severely impaired BPD and suicidal patients. Further, findings of GrimAge – a state-of-the-art epigenetic age (EA) estimator- in patients with BPD and attempted suicide patients will be presented. Genome-wide methylation patterns were measured using the Illumina Infinum Methylation Epic BeadChip in whole blood from well characterized 97 BPD patients, 88 suicide attempters and 32 healthy controls.

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Despite major advances in research into the neurobiological basis of mental illness, there have been hardly any new developments in new drug therapies. As there are approximately 30% of affected individuals that do not respond sufficiently to available treatments, there is a significant unmet medical need for new therapeutic approaches. About 90% of novel substances that have shown promise in animal studies are not effective in clinical trials. Recent research on human induced pluripotent stem cells (hiPSC) could lead to the use of more human-tailored models in this field. IPSC-derived cell models and organoids may be very attractive for preclinical screening and bridge the gap between in vitro and in vivo studies, reducing animal testing. However, the next steps must first demonstrate the validity and reproducibility of the initial functional results from the hIPSC models of mental illness. In our own studies on neuronal cell models of patients with attention-deficit/hyperactivity disorder (ADHD) with rare PARK2 gene variants, we were able to show evidence of mitochondrial dysfunction and impaired energy metabolism. Additionally, we have first hints at a oxidative dysbalance which could be as well targeted by medication. In a model of cortical development of ADHD patients with common variants in the ADGRL3 gene, we found first evidence for altered neuronal maturation as well as abnormalities in calcium metabolism and glutamatergic functionality compared to cells from healthy controls. In summary, these first results are promising that hIPSC models can contribute new insights into cellular pathomechanisms of mental and neurodevelopmental disorders and the development of new, individualised therapeutic approaches.

S. Kittel-Schneider Grant / Research support from: The studies are funded by IZKF Wuerzburg and BBRF fund (to SKS and RMcN). SKS received speaker’s honoraria from Takeda, Medice and Janssen.