Previous research has implicated herpes simplex virus 1 (HSV1) and cytomegalovirus (CMV) in severe mental illness (SMI) with conflicting results. Both pathogens have high universal seroprevalence, are neurotropic and after the primary infection typically establish a persistent latent infection with periodic reactivations. Increased immunoglobin G (IgG) concentrations are considered to be attributable to an increased infection severity with more frequent reactivations or host immune system alterations.

We assessed the HSV1 and CMV IgG concentrations in previously infected (seropositive) patients with SMI and healthy controls (HC). We hypothesized that seropositive patients would show higher IgG concentrations than seropositive HC.

We included 765 patients, 515 with schizophrenia (SZ) and 250 with bipolar disorder (BP), and 541 HC. HSV1 and CMV IgG seropositivity and concentrations were measured with immunoassays. 355 patients, mean age 33 years, 45% females, and 238 HC, mean age 35 years, 44% females, were HSV1 seropositive (HSV1+) while 447 patients, mean age 33 years, 50% females, and 296 HC, mean age 34 years, 47% females, were CMV seropositive (CMV+). In our main analysis among seropositive participants, we investigated the main effect of patient/control status on HSV1 and CMV IgG concentrations.

There were no significant differences in CMV or HSV1 seropositivity frequencies between patients with SZ, patients with BP and HC. Among seropositive participants, patients had higher HSV1 (p<0.001) and CMV (p=0.018) IgG concentrations than HC; stratifying by diagnosis, both patients with SZ (p=0.001) and patients with BP (p=0.001) had higher HSV1 IgG concentrations than HC, while patients with SZ, but not BP, had higher CMV (p=0.045) IgG concentrations than HC (Image). For HSV1, higher IgG concentrations were associated with higher general (p=0.017), negative (p=0.041) and positive (p=0.028) psychotic symptom scores.

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Seropositive patients with SMI showed higher HSV1 and CMV IgG concentrations than seropositive HC suggesting that patients suffer a more severe infection or exhibit an altered immune response when contracting the pathogens. For HSV1, higher IgG concentrations were linked to more psychotic symptoms.

D. Andreou: None Declared, N. E. Steen: None Declared, K. N. Jørgensen: None Declared, T. Ueland: None Declared, L. Wortinger: None Declared, L. Mørch-Johnsen: None Declared, R. Yolken: None Declared, O. Andreassen Consultant of: Consultant to HealthLytix, Speakers bureau of: Received speaker’s honorarium from Lundbeck and Sunovion, I. Agartz Speakers bureau of: Received speaker’s honorarium from Lundbeck

Complementary and alternative therapy, especially yoga, is emerging as an important treatment modality for various complex disorders. Yoga therapy has reportedly been demonstrated to exhibit clinical benefits in schizophrenia. However, the modulatory effects of yoga therapy on the pathobiological pathways of schizophrenia are inadequately explored. Immune dysregulation is a widely recognized etiopathological construct of schizophrenia. It is not precisely known whether yoga therapy can modulate the expression of immune molecules by regulating gene expression and epigenetic processes in schizophrenia.

To understand the impact of 12-weeks add-on yoga therapy on the immune-inflammatory pathway in schizophrenia by examining plasma levels and gene expression levels of cytokines and complement proteins as well as by profiling promoter DNA methylation pattern of genes coding for cytokines and complement proteins.

Fifty-seven schizophrenia patients fulfilling DSM-V criteria were recruited into the study and randomized into Yoga therapy (n=28) and waitlist control (n=29) groups. Plasma levels of IL-1β, IL-6, IL-10, IL-17, C1q, C2, C3, C4, C5, C5a, Factor B and Factor H by Multiplex Suspension Assay, quantification of gene expression of Il1b, Il6, Il10, IL17, C3, C4 and C5 genes by quantitative PCR and promoter DNA methylation of Il1b, Il6, Il10, Il17, C3, C4 and C5 genes by pyrosequencing were carried out in all the study participants.

Plasma levels of IL-1β (Z score= 2.42, p=0.02) dropped significantly and C2 (Z score= 2.24, p=0.03) levels increased after 12-weeks of yoga therapy. The expression of Il1b (Z score=2.45, p=0.01) and Il6 (Z score=2.07, p=0.04) genes were significantly downregulated, while the levels of C4 (Z score=2.23, p=0.03) gene was upregulated in schizophrenia patients of yoga therapy group. Two CpG sites in the promoter region of Il1b (all p≤0.05) and Il6 (all p≤0.05) genes and three CpG sites in the promoter region of C4 (all p<0.05) gene were hypermethylated, while two CpG sites in the gene body of Il6 (all p≤0.05) gene and two CpG sites in the promoter region of Il10 (all p ≤0.05) gene were hypomethylated after 12-weeks of yoga therapy in schizophrenia patients.

Our findings provide important insights into the mode of action of yoga therapy in schizophrenia. This study for the first time reports the epigenetic effects of yoga therapy on immune-inflammatory pathway in schizophrenia.

None Declared

Exploring the positive psychological and behavioural dimensions of people living with mental disorders can establish a firm ground in a therapeutic alliance for setting up positive life goals.

The present study aimed to explored whether the strength of the mental health capacities and the severity of mental disorder symptoms and the interaction of the two differ in the strength of their associations with several dimensions of well-being on Hungarian adult psychiatric and non-clinical community samples.

The psychiatric sample (129 patients (44 male, 85 female)) was collected in four Hungarian healthcare facilities using a cross-sectional design. The non-clinical community sample (253 adults (43 male, 210 female)) was collected online using a cross-sectional design. All the respondents completed the Mental Health Test, six well-being and mental health measures, and the Symptom Checklist-90-Revised.

Including both the mental health competencies and mental disorder symptoms variables in one regression model in both samples can predict patients’ well-being even more accurately. Mental health competencies related positively; mental disorder symptoms connected negatively to subjective well-being. In all models and both samples, mental health competencies were found to be a stronger determinant of well-being than the mental disorder symptoms. The interaction of mental health functioning and mental disorders is no more predictive of well-being in either psychiatric or non-clinical samples than when the effects of each are considered separately.

The assessment of mental health competencies has an important predictive value for well-being in the presence of psychopathological symptoms and/or mental disorders.

None Declared

Autism Spectrum Disorder (ASD) is characterized by impairments in social interaction and restricted interests. It has been reported that oxytocin may improve processing of social cues and emotions in adults with ASD.

The aim of this study was to evaluate the therapeutic effects and safety of intranasal oxytocin in this population.

Thirty-nine patients with ASD were randomly assigned to two groups: one group received intranasal oxytocin and the other group received a placebo, with 24 units administered every 12 hours for 8 weeks. The patients were evaluated using the Autism Quotient (AQ), Ritvo Autism Asperger Diagnostic Scale – Revised (RAADS-R), Social Responsiveness Scale (SRS), Clinical Global Impression (CGI), and World Health Organization Quality of Life-BREF (WHOQL-BREF) questionnaires at weeks 0, 4, and 8.

The intervention group showed clinical improvements in RAADS-R (P=0.010), social communication subscale of SRS (P=0.002), CGI (P=0.000), physical (P=0.004), psychological (P=0.006), and social relationships (P=0.046) domains of WHOQL-BREF. Improvements reached their maximum at week 4 and were maintained until week 8 (Table 1).Table 1.

Effect of group, time time-group interaction and the effect size

The findings of this study suggest that nasal oxytocin therapy can significantly improve social skills and quality of life in individuals with ASD. Further research is needed to determine the timing and scope of oxytocin’s effects across the lifespan.

None Declared

Sexuality, although an essential component of human health, remains a controversial topic shrouded in stigma, particularly in the context of neurodiversity, which includes autism spectrum disorder (ASD), where the expression of sexuality presents unique challenges. Autism and sexuality is a complex and multifaceted topic that involves understanding the unique ways in which individuals on the autism spectrum experience and express their sexuality.

The purpose of this work is to address the complexity of the biopsychosocial sexuality components of people with autism, promoting a shift in the medical perspective, societal attitudes, and supporting greater inclusion of these individuals in current discussions regarding this area of human behavior and experience.

Evidence-based review, through research conducted on PubMed and selection of the most relevant studies on this topic, published in the last decade.

Sexuality in autism is now recognized as a normative and integral aspect of development and functioning. Existing research suggests that most individuals with ASD display a clear interest in sexuality and relationships, with a study reviling that 96% of the ASD sample expressed an interest in sexuality. Individuals with high autistic traits tended to identify themselves more times as bisexual or presented a sexuality not definable within the categories of heterosexual. The relationship between autism and gender dysphoria is an area of ongoing research and discussion. Studies have suggested a higher prevalence of gender diverse identities and experiences within the autism community compared to the general population. Various hypotheses have been proposed to explain the increased gender and sexual diversity among individuals with autism. People with ASD may face unique challenges when it comes to their sexuality. The impairments in social skills and communication central to ASD potentially impact an autistic individual’s expression and experience of sexuality by affecting their abilities to understand and interpret social cues, emotions, and nonverbal behaviors of others. Importantly, such individuals may be more vulnerable, as they may have different or even limited understanding of boundaries and consent. To address these challenges, it is important to acknowledge and respect the diversity of sexual experiences and desires among individuals with neuro(bio)logical differences. This can be done by providing accurate and inclusive sex education, creating safe spaces for such individuals to explore and express their sexuality, and working to address discrimination and abuse in intimate contexts.

Recognizing and respecting this diversity and fostering inclusive and accepting environments, we can help individuals with neurological differences to fully express and explore their sexuality and have satisfying sexual lives.

None Declared

In the last decades, growing evidence suggests, that young adults and even adolescents consume more and more pornographic content, which might lead to behavioural addictions. Excessive pornography use was found to be associated with higher rates of sexual dysfunctions, such as genital dysfunction or disorders related to desire, arousal, orgasm and pain. The role of attachment style on sexual function has still rarely been investigated.

To examine associations between sexual dysfunction, problematic pornography use and attachment styles in a Spanish-Hungarian sample.

A cross-sectional comparative study was carried out in 2023 which included a Hungarian (N=447; 63% female; age: 30,5±9,8) and a Spanish sample (N=201; 72% female; age: 40,7±14) from the general population. In the online survey, we used the Arizona Sexual Experiences Scale (ASEX) to measure sexual dysfunction, the Problematic Pornography Use Scale (PPCS) to assess pornographic content consumption within the theoretical framework of addiction and the Relationships Questionnaire to explore the attachment styles of the subjects.

13% of the Hungarian sample and 19% of the Spanish sample reported severe sexual dysfunction (ASEXTotal >19). The Hungarian sample reported more problems related to orgasm (climax and satisfaction). Overall, 7% of the Hungarian sample and 1% of the Spanish sample reported very severe problems (PPCSTotal >76) with pornography use. We found significant differences in every subscale and the Hungarian sample reportedly showed more difficulties in every aspect, especially in salience and mood change. Regarding attachment styles, the samples also showed significant differences (Hungarian: 31% secure, 26% anxious-ambivalent, 20% avoidant, 23% disorganized; Spanish: 53% secure, 11% anxious-ambivalent, 23% avoidant, 13% disorganized). In the combined sample, secure attachment style was associated with the least difficulties in sexual functioning, whereas subjects with anxious-ambivalent style reported more problems in sexual drive, arousal and erection. Disorganized attachment style was associated with the most severe dysfunction in orgasm (climax and satisfaction). The association between problematic pornography use and attachment styles was more consistent. Secure attachment style showed the least of problems, whereas subjects with anxious-ambivalent and disorganized attachment styles reported the most, especially in salience and mood change.

Our findings showed significant intercultural differences between the two samples and highlighted the potential role of attachment styles in sexual functioning and problematic pornography use. A more profound understanding of the relationship between attachment and sexual functioning could facilitate potential treatment of sexual dysfunctions by addressing attachment issues in psychotherapy.

None Declared

Headache is a very common health problem worldwide and in our country due to the increasing environmental damage and daily stress. The proportion of patients with headache in general practice is 4-5%, in neurology up to 30%. Chronic headache as a persistent stressor exhausts the body through central sensitisation, which can lead to the consolidation of maladaptive coping strategies such as avoidance, feelings of loss of control, catastrophising pain. This can lead to a deterioration in quality of life and depression also. The effectiveness of pharmacotherapy in coping with chronic pain is limited, so attention should be paid to modifying maladaptive pain behaviour, as recommended by the NICE guidelines. The international literature shows that mindfulness-based cognitive therapy (MBCT) has been shown to be effective in the management of chronic headache, primarily in improving quality of life, increasing self-efficacy and reducing pain catastrophisation and depression (Hunt et al., 2022).

Our first objective was to introduce mindfulness-based cognitive therapy in Hungary to patients suffering from chronic headache. Secondly, we wanted to measure the impact of the method on quality of life, coping with pain and depression.

N=28 patients, suffering from chronic headaches (tension headache and migraine) participated in the study at the Department of Clinical Psychology, Semmelweis University (BNO: G430, G431, G442). Selection criteria were: referral from a neurologist, age 18-65. The intervention was an 8-session mindfulness-based cognitive therapy for pain (Day, 2017) led by an MBCT teacher and a clinical psychology resident. Before the intervention, all patients had an individual first interview and filled in the questonnaires. Measures: Beck Depression Questionnaire, Pain Catastrophizing Scale, Comprehensive Headache-related Quality of life Questionnaire, Five Facet Mindfulness Questionnaire, Cognitive Emotion Regulation Questionnaire.

After the intervention, there was a significant reduction in the negative impact of pain on quality of life (p<0.05, Cohen’s d=0.6), pain catastrophization (p<0.01, Cohen’s d=0.74), and depression (p<0.001, Cohen’s d=0.84). In addition, several sub-factors of mindfulness increased, including non-reactivity and being non-judgemental (p<0.05, Cohen’s d=0.57), as well as adaptive cognitive emotion regulation strategies (p<0.05, Cohen’s d=0.49).

We can conclude, that in line with international findings, MBCT has been shown to be effective in reducing the negative impact of depressive symptoms, pain catastrophisation and headache on quality of life, and in helping people to cope with pain more adaptively, primarily through the acquisition of mindfulness skills.

None Declared

Generalized anxiety disorder (GAD) is one of the most common mental disorders in adults. Psychotherapies are among the most recommended treatment choices for GAD, but which should be considered as first-line treatment still needs to be clarified.

To examine the most effective and accepted psychotherapy for GAD both in the short and long-term, via a network meta-analysis.

We searched MEDLINE, Embase, PsycINFO, and the Cochrane Register of Controlled Trials – CENTRAL, from database inception to January 1st, 2023, to find randomized controlled trials (RCTs) of psychotherapies for GAD. Eight psychotherapies (behaviour therapy, cognitive-behaviour therapy, cognitive restructuring, psychoeducation, psychodynamic therapy, relaxation therapy, supportive psychotherapy, and third-wave CBTs) were compared with each other and two control conditions (treatment as usual, waiting list). We followed Cochrane standards when extracting data and assessing data quality and used PRISMA guidelines for the reporting. We conducted random-effects model pairwise and network meta-analyses. We assessed risk of bias of individual studies through the second version of the Cochrane’s Risk of Bias tool and used the Confidence in Network Meta-Analysis (CINeMA) to rate certainty of evidence for meta-analytical results. Severity of GAD symptoms and acceptability of the psychotherapies were our outcomes of interest.

We analysed data from 66 RCTs. Effect size estimates on data from 5,597 participants suggest third wave cognitive-behavioural therapies (standardized mean differences [SMDs] =-0.78; 95%CI=-1.19 to -0.37; certainty=moderate), cognitive-behavioural therapy (CBT) (SMD=-0.68; 95%CI=-1.05 to -0.32 certainty=moderate), and relaxation therapy (SMD=-0.54; 95%CI=-1.04 to -0.05; certainty=low) reduced generalized anxiety symptoms more than treatment as usual (TAU). Relative risks for all-cause discontinuation signalled no differences compared with TAU for all psychotherapies. When excluding studies at high risk of bias, relaxation therapy lost its superiority over TAU. When considering anxiety severity at three to twelve months after completion of the intervention only CBT remained significantly more efficacious than TAU (SMD=-0.58; 95%CI=-0.93 to -0.23).

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Given the evidence for both acute and long-term efficacy, CBT may represent the reasonable first-line psychological treatment for GAD. Third-wave CBT and relaxation therapy have short-term efficacy and may also be offered. Results from this investigation should inform patients, clinicians, and guidelines. This project is funded by the European Union’s HORIZON EUROPE research programme under grant agreement No 101061648.

None Declared

A complex, Nature-, and Adventure Therapy - integrated Schema Therapeutic program (N-ABST) and a related efficacy study was launched in 2022 April at the Psychotherapy Department, at Semmelweis University. The participants had the opportunity of having outdoor, experience based group processes – seven full days in a month - in addition to the classic Schema Therapy (ST) sessions. According to the study design, 4-week long traditional thematic ST programs and 4-week long N-ABST programs were taken place alternately.

Our aim was to compare the efficacy in a randomized, controlled design, short and medium terms. The participants of the programs and thus the target group of the research were adults, diagnosed mainly with Borderline Personality Disorder, inpatients in psychiatry.

This methodological innovation also meant the integration of two therapeutic teams in practice. When establishing the collaboration, we put emphasis on finding common points and understanding how N-AT contributes to schema therapy goals. During our joint work, it became clear that the elemental need for contact with nature enriched the schema therapy approach with a new basic need that was not included in it before. Measurements were taken before the start of the entire program and at the end of the 4-week cycle. Preliminary results are presented based on the Personality Inventory for DSM-5 - Hungarian Short Form (PID-5-HSF), and the Derogatis Symptom Checklist (SCL90).

In the N-ABST group (n=23) the PID5 “Dysinhibition” scale (p < .01, Cohen’s d = .636), and the “Negative Affectivity” scale (p < .05, Cohen’s d = .388) showed significantly lower scores after therapy. In the case of the “Detachment” we have found a tendency to decrease after the therapy. Regarding the comparison of the effectiveness of N-ABST and classical Schema Therapy - with the current state of analysis - there was a significant difference in the PID5 values for “Suspiciousness” and “Manipulativeness”. The former characteristic was reduced to a greater extent by the schema therapy, and the latter by the N-ABST therapy. Based on the SCL90, the N-ABST program resulted in a significant symptom reduction measured by the following subscales: somatization, obsessive compulsive, interpersonal sensitivity, depression, phobia. Global symptom severity also decreased significantly (p < .05, Cohen’s d = .588).

According to our results, Nature- Adventure Therapy enhanced Schema Therapy seems to be an innovative and efficient method in the psychotherapy of personality disorders. Besides the effectiveness, there is a great challenge to design programs that are sustainable and therefore serves therapy long term as well.

This study was supported by the National Research, Development and Innovation Office grant K 129195.

None Declared

Irvin D. Yalom defines existential psychotherapy as a dynamic therapeutic approach that focuses on concerns rooted in existence with the four ultimate concerns being death, isolation, meaning in life, and freedom. Patients in advanced stages of cancer often experience elevated levels of psychological distress, encompassing conditions such as depression, anxiety, and a sense of spiritual hopelessness. Recently, interest in spiritual well-being has prompted a new wave of interventions that directly target this population, namely logotherapy and other existential interventions based on existential principles.

In this review, the primary focus was to comprehend the current evidence on the application of existential psychotherapy for individuals coping with advanced cancer and give an overview of the therapy approaches used.

Narrative review of scientific literature using Pubmed search engine.

Terao and Satoh identified nine types of existential psychotherapies which were investigated using randomized controlled trials for patients with advanced cancer or in terminal care: Meaning-Centered Group Psychotherapy (MCGP), Individual Meaning-Centered Psychotherapy (IMCP), Meaning-Making intervention (MMi), Meaning of Life Intervention, Managing Cancer and Living Meaningfully (CALM), Hope Intervention, Cognitive and Existential Intervention, Dignity Therapy, and Life-Review Interviews. All deal with the issues pointed by Yalom. Existential or spiritual well-being improvements were validated in MCGP, IMCP, Meaning of Life intervention, and Life-Review intervention.

Current evidence is still based on a very limited number of studies. Additional research is needed to delve into the impact of existential psychotherapy on individuals facing advanced cancer.

None Declared

Mentalization-based therapy (MBT) and dialectical behavior therapy (DBT) are two treatments known to be effective for borderline personality disorder (BPD). However, head-to-head comparisons between those two treatments are scarce and their effectiveness in naturalistic clinical services, where BPD is often comorbid with other cluster B personality disorders (PD), needs to be further explored.

The study’s goal was to answer the following question: Is there a difference in emergency department visits, hospitalizations and dropout rates after one year of treatment in MBT compared to DBT for a clinical adult population with cluster B PD?

We compared the effectiveness of MBT and DBT in 288 patients between 2015 and 2019 with at least one cluster B PD by measuring their emergency services use and hospitalizations one year before and one year after beginning therapy. Drop-out rates for those two treatment modalities are also compared. Image 1 illustrates the patient distribution for the study.

In terms of reducing emergency room use, patients in each treatment group experienced a significant decrease with medium effect sizes (p < .001 for both, d=.768 for MBT and d=.640 for DBT).

In terms of reducing hospitalizations, the MBT group had a significant decrease (p < .05) with a medium effect size (d=.568) whereas the DBT group had a non-significant decrease (p = .595) with a negligible effect size (d=.140).

When we compare both therapies, no significant differences were found between them in terms of reductions in emergency room use (p = .358) and hospitalizations (p =.195), as well as dropout rates (p = .743). Image 2 further illustrates the dropout trends in the first year of treatment for both groups in intervals of 3 months.

Hospitalizations were rare in our population, which may hinder the validity of results containing this variable. In absolute numbers, total emergency room visits decreased from 119 to 37, whereas hospitalizations were reduced from 24 to 12. Drop-out rates before entering treatment were high (20.6%), as it was during treatment for both therapies (around 30% in the first year of treatment).

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This study emphasizes that both DBT and MBT are linked to a reduction in service use over time. Dropout rates in both treatments are also similar to other studies. Therefore, future research should investigate the factors that can help clinicians guide individuals with PDs towards the type of therapy that is most suitable for them.

None Declared

Patients with severe mental disorders have a significantly reduced life expectancy than the general population, often resulting from the increased prevalence of cardiovascular and metabolic diseases. Reasons include unhealthy lifestyle behaviours, reduced access to screening programs and adverse effects of many psychotropic drugs.

Our goal is to assess the efficacy of a psychosocial group intervention promoting healthy lifestyle behaviors compared to a brief psychoeducational group intervention in terms of improvement of severity of psychiatric symptoms and perceived quality of life, and a series of anthropometric and hematological parameters.

This is a multicenter randomized controlled trial. Patients between 18 and 35 years of age with a diagnosis of schizophrenia and other primary psychotic disorders, unipolar depression and bipolar disorder were recruited. Exclusion criteria were inability to perform moderate physical activity, pregnancy and breastfeeding and impaired cognitive functions.

401 patients were recruited and randomly assigned to receive the experimental intervention (LIFESTYLE) or a behavioural control intervention. About 57% of the sample were female, with a mean age of 45.8±11.8, and BMI of 32.5±5.5. All of them were receiving almost one psychotropic drug. At one year, we observed a reduction in HOMA-IR index (from 4.3 ± 5.5 to 3.1 ± 2.9, p<0.01) and triglycerides (from 162.5 ± 78.1 mg/dL to 131.4 ± 76.0 mg/dL, p<0.001), as well as an increase in HDL (from 46.2± 14.6 mg/dL to 50.9±26.7 mg/dL, p<0.05). Moreover, a reduction in the values of BPRS “Affectivity” (from 8.7±3.0 to 7.2±2.5, p<0.001), “Activity” (from 4.7±1.9 to 4.2±1.3, p<0.01) and “Negative Symptoms” subscale (from 7.7±3.1 to 7.0±2.7, p<0.001) was also observed, along with an improvement in perceived quality of life (MANSA total score from 4.0 ± 1.0 to 5.3 ± 0.8, p<0.01).

The results support the evidence that the LIFESTYLE intervention has long-lasting positive effects on physical and mental health of people with mental disorders. More efforts need to be done in order to increase the availability of these treatments in routine clinical settings.

None Declared

The European Alliance for Sport and Mental Health (EASMH) is a partnership of scientific institutions, charity associations and sport organizations, funded by EU-Erasmus+. It aimed at developing good clinical practice in psychiatric rehabilitation through sport-based interventions as an integration of pharmacological and psychological therapies. Within the framework of the EASMH projects, several actions have been promoted including an assessment of the dissemination of sport-based interventions, a training course for specialized coaches and the implementation of pilot actions in four European Countries.

To briefly describe EASMH pilot actions performed in Finland, Italy, Romania and United Kingdom, where trained coaches delivered sport-based interventions to patients with severe mental disorders.

After completing pilot actions, charity associations and sport organizations belonging to EASMH network described general and specific aims, sport activities, composition of staff, timing and tools for assessing the outcomes.

In Italy, “Crazy for Rugby”, including adolescents and young patients, and “Not only headshots”, a football project for adults with severe mental disorders were performed. In UK, a football-based activity called “Imagine Your Goal” and a walking-football program for participants aged more than 40 were delivered. In Romania, two courses including gymnastics, yoga and pilates called “Get fit!” were provided. Different team sport-based activities were implemented in Finland, where “Multiple Sport Group” and “Rehabilitating Sports” aimed at increasing patients’ autonomy. Assessment of psychopathological, social, cognitive and sport/fitness outcomes confirmed the overall beneficial effects of sport on mental health.

Pilot actions represent the final step of EASMH project, which showed improvement of mental health outcomes by also delivering sport-based rehabilitation to patients with severe mental disorders. Institutions and stakeholders are now called to promote the implementation of such initiatives on a broader scale.

None Declared

Compulsory mental health care remains a controversial practice. The many difficulties in performing Randomised Controlled Trials (RCT) on the topic means there is limited evidence to support its effectiveness. For ethical and legal reasons, compulsory mental health care should only be used when necessary. Yet, geographical variations, which can indicate both overuse and underuse, have been observed. In the funded research project “Controversies in Psychiatry” we intend to use this variation as a source of knowledge production. We propose that this naturally occurring variation mimics randomisation, and can therefore permit causal inference from registry data.

We will estimate the causal effect of compulsory inpatient mental health care on a range of outcomes, including injuries, self-harm, and all-cause mortality; violent crime; employment vs benefit allowance; rehospitalisation and outpatient commitment.

Observed variation in register data on all episodes of compulsory inpatient mental health care in Norway between 2015-2016 (N ≈ 300 000), will serve as a source of as-random variation. Provider-preference for compulsion usage will be used as an instrumental variable (IV).

Outcomes will be observed from 2017-2025. If assumptions underlying IV-analysis do not hold, the project will still provide important and complete descriptive data on long-term outcomes for a whole population.

Geographical variation is a cause for concern if people are treated differently depending on area of residence. But it also presents an opportunity to use differences in service provider’s preference for using compulsory care as an instrumental variable to estimate the causal effect of compulsory care on multiple short and long-term outcomes. This approach can help resolve controversies that are difficult or even impossible to investigate through RCTs. After presenting the project plan we invite to a discussion of the feasibility of using an instrument variable approach to explore if relatively low versus high rates of compulsory care produce favorable outcomes for patients.

None Declared

Implementing research projects on community-based health care interventions in low-ressource settings is feasible with specific methods and applications. In order to critically understand all ins and outs of influencing factors involved in health care pathways for children and their mothers, we must consider to implement more than one research in the same context.

The objective of this presentation is to showcase the continuum of research projects starting from the assessment of the effectiveness of a combined nutrition and psychosocial intervention and its economic evaluation, and how that led to exploring social representations of malnutrition in order to better understand the link with health care seeking behaviours.

The FUSAM cluster randomized control trial included 427 were severe acutely malnourished (SAM) children and their mothers. They were divided in two groups receiving the standard nutrition treatment while the intervention group benefited from five psychosocial sessions. A battery of tests for child development and maternal mental health was administered pre and post intervention. For the economic evaluation, a data collection was conducted with 98 community members and District Public Health Office personnel in Saptari and 17 Action contre la Faim and government personnel in Kathmandu. Finally, a mixed-method study comparing social representations of malnutrition included 376 adults in Saptari and Nuwakot district. Data analysis was performed according to the study design: a multivariate model analysis for the CRCT, a micro-costing methodology to cost data collection and analysis was favored. For the mixed-method analysis, descriptive and inductive analysis were performed.

Regarding the child development, children in the intervention group showed higher scores than children in the control group at all time points. And the economic evaluation showed that the costs of adding psychosocial counselling to an existing CMAM program was approximately EUR 28,788 for 6 centers per year. However, referrals of children through the community-based screening were not optimal. The findings related to health seeking behaviors showed that different meaning categories were simultaneously resorted to by community members leading to different representations of SAM children and that relevant health advises were neither systematically nor uniquely associated to medical categories but are linked to different meaning categories depending on the cultural context.

Multiplying research projects is crucial to mitigate the limitations of the studies often facing numerous contextual challenges and ultimately to leverage further opportunities.

None Declared

Fat plays an important role in brain function; 60% of the brain’s dry weight is fat. Among fats, omega-3 fatty acids, which are long-chain fatty acids, have been reported to reduce depressive symptoms. On the other hand, there are few studies on short-chain fatty acids (SCFAs), and those that do exist are mostly animal studies, with only a few human studies (about 100 cases). This is the first study to examine the association between fecal short-chain fatty acids and depressive symptoms on a large scale in the general population.

We examined the association of fecal SCFAs with depressive symptoms. In addition, we analyzed the associations stratified by age and examined differences in the associations.

This study was conducted using data from the Dynamics of Lifestyle and Neighborhood Community on Health Study (DOSANCO Health Study). The target population was all residents of the city of Suttu, Hokkaido, Japan, excluding residents of special nursing homes (n=2638). 579 individuals (22% of the target population) aged 18 years and older who were able to measure fecal SCFA participated in this study with written informed consent. Approval was obtained from the Ethics Committee of Hokkaido University School of Medicine (15-002 and 15-045). Fecal SCFA was measured by high-performance liquid chromatography. We examined the association of fecal concentrations of SCFA subtypes (i.e., acetate, butyrate, and propionate) and total SCFA concentrations (mg/g wet weight as a continuous variable) with total Patient Health Questionnaire-9 (PHQ-9) scores using multiple regression analysis. We adjusted for age, sex, habitual exercise, total energy intake, and total dietary fiber intake. We performed additional multiple regression analyses with stratification by age group (18-59 years and 60 years or older). Two-tailed tests were used for all analyses with a significance level of P < 0.05.

The mean age (standard deviation) of the study participants (n=534) was 58.3 (16.0) years. Among them, 48% were 18-59 years old and 54% were female. Fecal propionate concentration was significantly associated with total PHQ-9 score (beta=0.62, p<0.01). Other SCFAs and total SCFA were not significantly associated with total PHQ-9 score. In addition, using stratification analyses by age group, the associations between fecal propionate concentration and total PHQ-9 score showed a different trend by age group (beta=0.18, p=0.62 for 18-59 years; beta=0.80, p<0.01 for 60 years or older).

The study showed an association between higher concentrations of fecal propionic acid and higher levels of depressive symptoms. The association was particularly pronounced in older people, those aged 60 years and older. The results suggest that improving dietary habits to reduce fecal propionic acid may be effective in preventing depression in the elderly.

R. Okubo Shareolder of: None, Grant / Research support from: A Grant-in-Aid for Scientific Research from Japan Society for the Promotion of Science (No. 22K17844), Consultant of: None, Employee of: None, Paid Instructor of: None, Speakers bureau of: Speakers bureau from Takeda Pharmaceutical Company Limited, R. Yamamura: None Declared, S. Ishikawa: None Declared, T. Kimura: None Declared, S. Ukawa: None Declared, K. Nakamura: None Declared, A. Tamakoshi: None Declared

Cardiovascular disease (CVD) is a leading cause of excess mortality in people with severe mental illness (SMI). Physical activity (PA) is widely acknowledged with multiple health benefits, but associations of PA with incident CVD, all-cause and CVD mortality in people with SMI remain unclear.

To determine dose-response and intensity-specific associations of PA with incident CVD, all-cause and CVD mortality in people with SMI.

This prospective cohort study was conducted on 6313 SMI participants with accelerometry data from UK Biobank (mean age 61.05 years) from February 2013 to November 2021 (median 7-year follow-up). Moderate-to-vigorous PA (MVPA) was categorized by meeting the guideline level or not, while total PA and light-intensity PA (LPA) were grouped by tertiles. Incident CVD, all-cause and CVD mortality ascertained by hospital and death registries were main outcomes.

PA was inversely associated with the risk for incident CVD (Poverall < 0.05 for total PA and MVPA, Pnonlinearity > 0.05 for all PA), all-cause mortality (Poverall < 0.05 for all PA, Pnonlinearity < 0.05 for total PA and LPA), and CVD mortality (Poverall < 0.001 for total PA and LPA, Pnonlinearity < 0.05 for all PA). Performing guideline-recommended volume of MVPA was associated with a reduced risk of 19% for incident CVD (95% CI, 0.67-0.98), 42% for all-cause mortality (95% CI, 0.43-0.79), and 50% for CVD mortality (95% CI, 0.31-0.82). A combination of recommended MVPA and a moderate volume of LPA was associated with the lowest risk, mitigating 21% risk for incident CVD, 59% for all-cause mortality, and 78% for CVD mortality.

Primary engagement of guideline-recommended MVPA, supplemented with moderate amount of LPA, was associated with lower risks for incident CVD, all-cause and CVD mortality among people with SMI.

This research has been conducted using the UK Biobank Resource under Application Number 58082.

This work was supported by the National Natural Science Foundation of China (grant number 32100880), Guangzhou Municipal Key Discipline in Medicine (2021-2023), Guangzhou High-level Clinical Key Specialty, and Guangzhou Research-oriented Hospital. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

None Declared

Stigma towards mental health has been described as a major obstacle to seek help and access to mental health services. This could result in a worsened Quality of Life (QoL). There is a little evidence of stigma in Mental Health Professionals and its consequences, especially in Early Career ones (ECMPH), who can be a more vulnerable group. There is even more lack of studies with multicultural approaches. Exploring stigma, support systems and access to these, and the link of these factors with QoL is essential to develop effective strategies to support ECMHP, for both their own mental health and providing care to patients.

This study aims to explore the association between ECMHP’s stigma towards mental health and their QoL, and to identify predictors of QoL among this population.

In this cross-sectional study, we designed an online survey to collect data among ECMHP, identified as having completed training since less than 7 years. QoL was assessed using the WHO-QoL. Stigma towards mental health was measured with the Opening Minds Stigma Scale for Health Care Providers (OMS-HC). Other general sociodemographic data were also collected. Descriptive results are resumed in absolute and relative frequencies for categorical variables. Student’s t-test and ANOVA were used to analyse scores in WHO-QoL and OMS-HC according to categorical variables. Pearson’s correlation coefficient was used to assess the association between WHO-QoL and OMS-HC. Simple and multiple linear regression were used to study the effect of stigma on QoL, taking into account potential confounders.

We collected data from 277 ECMHP from Europe (54.15%) and Asia (45.85%). Only 20% of our sample knew that their workplace has staff dedicated for mental health practitioners support, and among those, only 44% had visited it. OMS-HC total scores were significantly higher (p<0,05) in nurses and practitioners without a sufficient support system and without a mental disorder. WHO-QoL total scores were significantly higher in participants with sufficient support systems, and without a mental or physical illness. There was a negative correlation between OMS-HC and WHO-QoL total scores. Univariate analysis showed that OMS-HC total scores predicted WHO-QoL total scores. In the multivariate analysis, OMS-HC total scores, having a mental illness and having sufficient support, independently predicted WHO-QoL total scores, even when adjusted for sociodemographic variables.

Stigma towards mental health is related to QoL in ECMHP. Also, having sufficient support in the workplace improves QoL in this population. More studies are needed to help clarify the relationship between stigma and QoL using a longitudinal design.

None Declared

Psychotic disorders present a significant lifetime risk for suicide. Past estimates suggest that up to 25-50% of individuals with schizophrenia (SCZ) may attempt suicide during their lifetime. A growing body of literature indicates that the level of cognitive performances may be associated with a differing level of lifetime suicide attempts, albeit inconsistently depending on the diagnostic category and study setting. However, the vast majority of the literature in the field is composed of cross-sectional studies, limiting the overall interpretation of the available evidence.

In the present study, we probed the possible association of BDNF plasma levels, cognitive functions assessed through the Brief Assessment of Cognition in Schizophrenia (BACS) and lifetime suicide ideation and/or attempts (LSI+LSA). More specifically, we tested whether such association would persist during the 2 years follow-up divided in 5 different timepoints at 6-month intervals, if present.

The present study represents a secondary analysis of a previously described cohort (Manchia et al. Brain Sci. 2022 Dec 4;12(12):1666). The sample comprised 105 subjects with SZC or schizoaffective disorder. We employed the 1) Wilcoxon test for non-parametric data 2) linear modelling to test the possible association of BACS-defined cognitive task performances with LSI+LSA. We also investigated if either BDNF plasma levels or four tested BDNF SNP genes would mediate this association.

From a total of 105 subjects, data relevant to the analysis were available for 89 subjects. We observed a significant association between BACS-Letter fluency task (BACS-LF) with LSI+LSA, persisting even when adjusting for gender, duration of untreated psychosis, total Positive and Negative Syndrome Scale score, age, chlorpromazine equivalents of antipsychotic therapy and for the effect of time. The association remained significant even when adjusting with the Bonferroni-Holms method for multiple comparisons (p=0.002). No association was found either for BDNF plasma levels or the tested BDNF genes for the tested outcomes.

In our sample, higher BACS-LF performances appeared to be associated with a higher lifetime risk of LSI+LSA. This report adds to the previous literature suggesting that different cognitive performance levels may represent one of the many chronic risk factors associated with LSI+LSA, and that may ultimately complexly interact with more proximal ones.

None Declared

Suicide is one of the leading causes of preventable deaths worldwide. The psychiatric disorder that is most strongly associated with suicide is depression. It is crucial to develop clinical tools that can provide objective data to assess suicide risk in clinical settings. Depression and high suicide risk may lead to physiological changes that can affect the speech pattern. Prior research has indicated that the acoustic and prosodic characteristics of speech may hold potential clues for assessing suicide risk. Additionally, specific speech parameters may serve as discriminators for identifying individuals at risk. In recent years, deep learning-based models have yielded successful results in identifying such alterations in speech signals.

The aim of our study was to examine specific voice analysis parameters between control, depressive and high suicide risk groups. We also aimed to investigate the effect of voice-related variables in predicting suicidal behavior in patients with depression using an artificial intelligence model. The results of voice analysis are intended to serve as a starting point for the development of future artificial intelligence algorithms.

The study sample consisted of 30 near-term suicidal patients, 30 patients with major depression and 30 healthy controls. The participants were presented with a pre-determined text and a voice recording was carried out. Feature extraction and model training for three tasks, namely depression or not, suicide or not, and depression or suicide were carried out. Mel-Frequency Cepstral Coefficients (MFCCs), deep learning-based (VGGish), formant and prosodic features were extracted to analyze the sound characteristics of the participants. The Support Vector Machine was used as the machine learning algorithm for classification and the three models were trained for each task. A 10-fold cross-validation was carried out and presented by metrics including accuracy, precision, sensitivity and specificity.

Among the metrics examined, MFCCs for the “Suicide or not” task were found to be more successful with rates of 0.90, 0.88, 0.93 and 0.86 for accuracy, precision, sensitivity, and specificity, respectively. MFCCs were also more successful for the “Depression or suicide” task with rates of 0.68, 0.66, 0.76, and 0.60 for accuracy, precision, sensitivity, and specificity, respectively. Among the metrics examined for the “Depressed or not” task, VGGish was more successful with rates of 0.73, 0.81, 0.70, and 0.76 for accuracy, precision, sensitivity, and specificity, respectively.

To the best of our knowledge, our study is the first to compare the VGGish and other features of speech (MFCCs, prosodic, formant features) between high suicide risk, depression and control groups. Classification parameters developed using the VGGish and MFCCs features of speech could be useful in predicting suicide risk in future studies.

None Declared