Effective diagnostic and treatment pathways for ADHD are needed in prison settings due to the high prevalence of ADHD and comorbidities in the prison population.

In this presentation, we will describe two studies conducted in seperate London prisons in England. In the first study, the aim was to identify prisoners with ADHD with a focus on describing comorbidity. In the second study, using QI (quality improvement) methodology, the aim was to measure the practicability and effectiveness of a specialist ADHD diagnostic and treatment pathway for prisoners.

Two studies were carried out in two separate prisons in London. Firstly, data were collected to understand the prevalence of ADHD and the comorbidities. The second study used quality improvement (QI) methodology to assess the impact of a diagnostic and treatment pathway for prisoners with ADHD.

Of the prisoners, 22.5% met the diagnostic criteria for ADHD. Nearly half of them were screened positive for autistic traits, with a higher prevalence of mental disorders among prisoners with ADHD compared to those without. The QI project led to a significant increase in the number of prisoners identified as requiring ADHD assessment but a modest increase in the number of prisoners diagnosed or treated for ADHD.

Despite various challenges, an ADHD diagnostic and treatment pathway was set up in a prison using adapted QI methodology. Further research is needed to explore the feasibility of routine screening for ADHD in prison and examine at a national level the effectiveness of current ADHD prison pathways.

No significant relationships.

Magnocellular deficit in visual perception and impaired emotion recognition are core features of schizophrenia, however their relationship and the neurobiological underpinnings are still unclear.

The aim of our research was to investigate the oscillatory background of perception and emotion recognition in schizophrenia and to examine the relationship between these processes.

Thirty-nine subjects with schizophrenia and forty healthy controls subjects were enrolled in the study; the two study groups did not differ in age, gender and education. In the visual paradigm the participants viewed magnocellular biased low-spatial frequency (LSF) and parvocellular biased high-spatial frequency (HSF) Gabor-patches and in the second paradigm happy, sad and neutral faces were presented, while 128-channel EEG was recorded.

Significantly weaker theta (4-7 Hz) event related synchronisation (ERS) was observed in patients compared to controls in the LSF condition, whereas in the HSF condition there was no difference between the two groups. Event related changes in theta amplitude were also found to be significantly weaker in patients compared to healthy controls in the emotion recognition task, which difference was disappeared after correction for ERS to LSF condition. In the correlational analysis theta activity in the magnocellular biased stimuli correlated significantly with theta activity in the emotion recognition task, while theta to parvocellular biased stimuli showed no similar correlation with emotion recognition.

In schizophrenia, emotion recognition impairments are closely related to the dysfunction of the magnocellular system, which supports the bottom-up model of schizophrenia.

No significant relationships.

Existing research has seldom examined patient safety problems experienced by service users accessing community mental healthcare, with the growing evidence base focusing largely on safety in psychiatric inpatient settings. Accordingly, there is poor understanding of safety issues in community-based mental health services as perceived by service users, carers, and healthcare professionals.

This study aims to explore safety problems in adult community-based mental health services, their causation, and priority areas for improving the safety of care provided in these services.

In-depth, semi-structured interviews and focus groups were conducted with users of community-based mental health services, carers, and healthcare professionals employed within these settings. Interview topic guides were designed jointly with stakeholders from these groups (N=7) and piloted (N=3). Interviews and focus groups will be transcribed, coded, and analysed using an inductive thematic analysis approach. Illustrative quotes will be extracted and used to describe the key themes that emerge from the analysis and their inter-relationships.

This presentation will provide an outline of patient safety as understood and experienced by key stakeholder groups. Study findings will explicate safety issues, healthcare system factors underpinning their causation, as well as practices which could improve safety in this context.

This research will help to advance understanding of the nature of patient safety problems in community-based mental healthcare services for adults, based on the experiences of service users, carers, and healthcare professionals within these services. The research will address key evidence gaps and represents an important step towards identifying areas which warrant intervention to improve patient safety.

NS is the director of London Safety and Training Solutions Ltd, which offers training in patient safety, implementation solutions and human factors to healthcare organisations and the pharmaceutical industry. The other authors have no competing interests.

Area-level residential instability (ARI), an index of social fragmentation, has been shown to explain the association between urbanicity and psychosis. Urban upbringing has been shown to be associated with decreased gray matter volumes (GMV)s of brain regions corresponding to the right caudal middle frontal gyrus (CMFG) and rostral anterior cingulate cortex (rACC).

We hypothesize that greater ARI will be associated with reduced right posterior CMFG and rACC GMVs.

Data were collected at baseline as part of the North American Prodrome Longitudinal Study. Counties where participants resided during childhood were geographically coded using the US Censuses to area-level factors. ARI was defined as the percentage of residents living in a different house five years ago. Generalized linear mixed models tested associations between ARI and GMVs.

This study included 29 HC and 64 CHR-P individuals who were aged 12 to 24 years, had remained in their baseline residential area, and had magnetic resonance imaging scans. ARI was associated with reduced right CMFG (adjusted β = -0.258; 95% CI = -0.502 – -0.015) and right rACC volumes (adjusted β = -0.318; 95% CI = -0.612 – -0.023). The interaction terms (ARI X diagnostic group) in the prediction of both brain regions were not significant, indicating that the relationships between ARI and regional brain volumes held for both CHR-P and HCs.

Like urban upbringing, ARI may be an important social environmental characteristic that adversely impacts brain regions related to schizophrenia.

No significant relationships.

Hearing music inside our heads is frequent, however some hear it more vividly, constantly and involuntarily. Musical Hallucinations (MH), first described by Baillarger in 1846, are a complex type of auditory hallucination characterized by perception of melodies, music, or songs.

This work aims to review the literature considering MH.

Pubmed and Google Scholar search using MeSH term “musical hallucinations”

MH occurs in 0.16% of the population. They´re usually perceived as frightening or annoying. Proposed mechanisms include spontaneous activity triggered by sensory deprivation from hearing impairment, like in visual hallucinations in Charles Bonnet syndrome, and some authors even include MH as a subtype of this syndrome. Indeed, 60% of all patients with MH have hearing impairment or deafness. Other less frequent causes include focal brain lesions involving the auditory pathway and cortex, temporal epilepsy, metabolic or drug intoxication. Psychiatric conditions are uncommon but not impossible, especially in affective disorders. MH most frequently consist in familiar tunes, sometimes of personal significance, religious songs (especially in older patients), childhood songs, folk and popular songs from the radio - suggesting that musical perception is never unlearned but represents a “parasitic memory”, an unchangeable memory feature which can be experienced by relevant neuronal circuit stimulation. Most patients with MH were reported to have no extraordinary musical skills.

MH are rare and strongly associated with hearing loss, though investigation of other causes should be sought. Treating the underlying cause is important but remission is not guaranteed.

No significant relationships.

Social anxiety disorder (SAD) can accompany emotional symptoms as well as physical reactions. The assessment and real-time measurement of SAD is difficult in real-world.

This study aims to predict the severity of specific anxiety states and virtual reality (VR) sickness in SAD patients by a machine learning model based on only quantitative measuring of autonomic physiologic signals during VR therapy sessions.

In total, 32 individuals with SAD symptoms were enrolled in VR participatory sessions. We assessed patients’ specific anxiety symptoms through Internalized Shame Scale (ISS) and Post-Event Rumination Scale (PERS), and VR sickness through Simulator Sickness Questionnaire (SSQ). Specific anxiety symptoms and VR sickness were divided into severe and non-severe states based on the total score of each scale by K-means clustering. Logistic regression, Random Forest, Naïve Bayes classifier, and Support Vector Machine were used based on the physiological signal data to predict the severity group in subdomains of ISS, PERS, and SSQ.

Prediction performance (F1 score) for the severity of the ISS mistake anxiety subdomain was higher than other scales with 0.8421. For VR sickness, prediction performance for the severity of the physical subdomain was higher than the non-physical subdomain with 0.7692.

The study findings present that mistake anxiety and physical sickness could be predicted more accurately by only autonomic physiological signals, suggesting these features are probably associated with autonomic responses. Based on the present study results, we could provide the evidence for predicting the severity of specific anxiety or VR adverse effects only based on in-situ physiological signals.

No significant relationships.

Hungarian Family Planning Service’s mission is decreasing the negative outcomes of pregnancy, including perinatal depression.

Childbirth as a great irreversible life event is a normative crisis of the life, thus pregnancy and post-partum period are times of high risk for psychiatric symptoms. Stress in pre- and post-natal period has short and long-term effect on offspring. Women participating in family planning program should be evaluated for the high risk and specific preventive program are provided for them.

Between 2015-2018, 446 women were participating in family planning service. They were screened for premenstrual syndrome by using the shortened form of PAF questionnaire. We compared healthy and PMS affected patients’ data in according to the prevalence of PPD, spontaneous abortion and period needed for conception.

Prevalence of PMS in our sample was 51.4%. Overage duration between wished and realized conception was 6.1 months in healthy group vs 9.2 months in PMS group. Post-natal depression was screened by Edinburgh Post-natal Scale and it showed about 4-times higher prevalence between affected women by PMS. Surprising the rate of spontaneous abortion was 2-times higher, although the absolute number is rather low for statistical validation.

Women affected by PMS can be considered as high risk for perinatal mood disorders and negative outcomes of pregnancy. PMS can be useful as a presymptomatic marker of perinatal depression and may be increased risk for spontaneous abortion. Psychological aspect should be included into the periconceptional care. Family planning may be an optimal solution to prevent perinatal depression and its complication.

No significant relationships.

Higher thalamic volume has been found in children with obsessive-compulsive disorder (OCD) and children with clinical-level symptoms within the general population (Boedhoe et al. 2017, Weeland et al. 2021a). Functionally distinct thalamic nuclei are an integral part of OCD-relevant brain circuitry.

We aimed to study the thalamic nuclei volume in relation to subclinical and clinical OCD across different age ranges. Understanding the role of thalamic nuclei and their associated circuits in pediatric OCD could lead towards treatment strategies specifically targeting these circuits.

We studied the relationship between thalamic nuclei and obsessive-compulsive symptoms (OCS) in a large sample of school-aged children from the Generation R Study (N = 2500) (Weeland et al. 2021b). Using the data from the ENIGMA-OCD working group we conducted mega-analyses to study thalamic subregional volume in OCD across the lifespan in 2,649 OCD patients and 2,774 healthy controls across 29 sites (Weeland et al. 2021c). Thalamic nuclei were grouped into five subregions: anterior, ventral, intralaminar/medial, lateral and pulvinar (Figure 1).

Both children with subclinical and clinical OCD compared with controls show increased volume across multiple thalamic subregions. Adult OCD patients have decreased volume across all subregions (Figure 2), which was mostly driven by medicated and adult-onset patients.

Our results suggests that OCD-related thalamic volume differences are global and not driven by particular subregions and that the direction of effects are driven by both age and medication status.

No significant relationships.

New insights into the pathophysiology of mental disorders and innovations in psychiatric care depend on the availability of representative, longitudinal and multidimensional datasets across diverse, transdiagnostic populations. Biobanks usually attempt to collect such data in parallel to clinical routine, which is resource-intensive, puts additional burden on health-care providers, and may reduce the generalizability of the results. Despite containing rich phenotypic and biological information, data generated in routine clinical care is seldomly used for research purposes, because it is usually unstructured and locked in data silos. To truly link clinical practice and research, solutions that optimize the generation and scientific utilization of real-world clinical data are needed.

Evaluation of a new digital infrastructure which warrants the efficient, automatized, and structured collection of real-world data in psychiatric care, and integrates the generated data into existing biobanking efforts.

We have developed a new documentation system which augments the existing IT-structures, enables the collection of routine clinical data in a structured format and involves patients in the data generation process. In an implementation science approach, to replicate and extend the findings of Blitz et al. (JMIR Ment Health 2021), we are investigating the acceptance, efficacy, and safety of the system in our outpatient clinic for affective disorders.

First results describing the technical safety, usage metrics, and acceptance of the system, and the quality of the collected data will be presented.

Challenges of collecting real-world data for biobanking and research purposes and perspectives on future digital solutions will be discussed.

No significant relationships.

No significant relationships.

No significant relationships.

In December 2019, infection with the novel coronavirus (SARS-CoV-2) was first reported in the city of Wuhan, China. Although generally recognized for its often fatal respiratory problems, other neuropsychiatric complications are receiving increasing attention.

We will try through a clinical case to explain the psychiatric disorders in the context of this infection, and to highlight the two main explanatory theories of psychiatric disorders, in relation with the SARS-Cov-2 infection.

We report here a case of SARS-CoV-2 infection in a 54-year-old female patient with no specific pathological history, including psychiatric, who presented a fever, anosmia, and asthenia in the absence of any respiratory signs. Her PCR came back positive and her chest CT scan was normal.The patient was treated with paracetamol with vitamin C,with good clinical improvement. She came 15 days later to the psychiatric emergency room with psychomotor excitement. The patient was motorically unstable, could not hold still, her mimicry was hypermobile, contact with her was familiar, she was logorrheic with flight of ideas,she verbalized multiple projects, her mood was euphoric and her sleep was disturbed. Her blood tests were unremarkable.

The diagnosis of manic episode was retained, and the patient was put on Olanzapine 10 mg, sodium Valproate 1g and Lorazepam 2.5 mg in degression with good clinical improvement.

Although the data in the literature remain scarce concerning the impact of this virus on mental health, we will try through this clinical case to explain the psychiatric disorders in the context of this viral epidemic, due to stress and inflammation.

No significant relationships.

Infertility is a major problem in life and affects the lives of infertile couples in every way

Infertility is associated with several negative reactions and emotional problems. Review of effective interventions for improving emotional risk factors In infertile and infertile patients undergoing treatment

A comprehensive narrative review of the studies was conducted. Databases such as Web of Science, Science Direct, Cochrane Library, Scopus, PubMed/Medline, Clinical Key, and MAGIRAN were retrieved from May 10 to August 8, 2021, with no time limit. After reviewing the abstract and the full text of the articles, 32 articles were selected for writing. The methodological quality of the article was assessed based on the Cochrane Risk of Bias

Interventions were divided into two subgroups of mind-body, and web-based CBT. Mind-body interventions generally show the anxiety, stress and depression reduction and Possible improvement in pregnancy rate, but most of these programs require extensive financial resources.The results of web-based,showed that using online CBT approach can greatly reduce stress and anxiety,due to increased use of the internet, non-collaborative, cheap and private treatment of web-based interventions, this method can be used as a way along with other treatments to reduce these negative reactions.

According to the present study CBT methods, application and Internet-based interventions can be used as appropriate counseling methods in reducing stress, anxiety and improving pregnancy outcomes in infertile patients. This information can be used as a proper source to select appropriate counseling methods for health care providers, midwives, and treatment staff involved in infertility patients.

No significant relationships.

Infodemic is a new term which refers to rapidly spreading information from both reliable and unreliable sources in the form of news and publications regarding the COVID-19 pandemic, which requires proper management strategies on its own to prevent the spread of fake news. This is especially relevant in a global state of alert where the fear of contagion is a common denominator and is reflected upon people’s behaviors within a crisis context. Van Bavel et al (2020) affirm “Emerging research is using social science to understand and counter the spread of fake news”, and furtherly emphasize on the limitations of Fact Checking as the main approach to hinder such spread

Test the association between sociomoral cognition, religiousness and political identity, and belief in COVID-19 Fake News.

Online-based survey applied through opportunity sampling. Demographic variables political and religious orientation, RMET and B-IRI, and two dimensional utilitarian dilemmas were used and independent variables, and a selection of true and fake news in order to measure participants’ belief in the latter as a dependent variable.

Morality (R2 = 0.08, p < 0.001), social cognition (R2 = 0.05, p < 0.05), and political and religious orientation (R2 = 0.1, p < 0.000001) predicted belief in COVID-19 fake news. On the other hand, no variables were found to predict belief in fake news unrelated to the pandemic.

Higher impartial beneficence and more years of formal education point toward an evidence-based reasoning, while religiousness and affinity with right-wing ideals has been associated with intuition-based reasoning, thus affecting judgement accuracy.

No significant relationships.

An established body of literature has identified that PTSD and dissociation are comorbid. Furthermore, the DSM introduced a dissociative subtype of PTSD into their most recent update; DSM-5.

The current study aimed to examine symptom-level associations between PTSD and dissociation using network analysis among UK Armed Forces veterans resident in Northern Ireland (NI) to identify if there are certain symptoms that may act as bridges between the two constructs.

A large scale cross sectional survey was conducted examining the physical and mental wellbeing of UK Armed Forces Veterans living in NI. The total eligible sample size was 619 (89.8% male), with a mean age of 55.38 years (SD = 10.41). Two networks were estimated, (1) a network consisting of 20 DSM-5 PTSD items and (2) a network consisting of 20 PTSD items and four dissociative items. Expected influence bridge centrality was calculated to examine symptoms with the most/strongest cross-domain associations (i.e. between PTSD and dissociation). The presence of meaningful clustering among symptoms was also explored.

The PTSD symptoms ‘concentration problems’, ‘flashbacks’ and ‘negative emotional state’ had the highest relative bridge expected influence centrality. Of the four dissociative items, ‘gaps in awareness’ had the highest relative bridge expected influence centrality, followed by ‘cognitive-behavioural re-experiencing’. A community structure of five clusters was detected. Four clusters reflected each subscale of the PCL-5 PTSD items and the final cluster reflected the dissociation items.

This study extends our understanding of PTSD and disociation comorbidity by investigating symptom level relationships; potentially informing future treatments and interventions.

No significant relationships.

The only available genome-wide study (Minelli et al., 2018) indicated an association between the neglect CT and MED22, a transcriptional factor gene.

To verify how the dysregulation of MED22 could be affected by environmental and genetic factors, we carried out an analysis on these components and a longitudinal study concerning the effect of trauma-focused psychotherapy in MDD patients that experienced CT.

On a large mRNA sequencing dataset including 368 MDD patients we computed the genetic (GReX) and the environmental (EReX) components affecting gene expression in relation to CT. Furthermore, we measured the expression of MED22 in 22 MDD patients treated with trauma-focused psychotherapy.

The dissection of MED22 expression profiles revealed an association of neglect with environmental and genetic components (p=6x10-3 p=2.6x10-4). Furthermore, in an independent cohort of 177 controls, we also observed a significant association between cis-eSNPs of MED22 and higher neuroticism scores (best p-value: 0.00848) that are usually associated with a decreased amount of resilience to stress events. Finally, the results of psychotherapy revealed a reduction of depressive symptomatology (p<0.001) and 73% of patients resulted responders at the follow-up visit. MED22 expression during psychotherapy showed a change trend (p=0.057) with an interaction effect with response (p=0.035). Responder and non-responder patients showed MED22 expression differences at different trauma-focused psychotherapy timepoints (p=0.15; p=0.012) and at the follow-up (p=0.021).

Our results provide insights suggesting that some biological and clinical consequences of CT depend on genetic background and environmental factors that could induce vulnerability or resilience to stressful life events.

No significant relationships.

The covid pandemic has become a unique phenomenon in world history with great impact on mental health.

A great growth of anxious depressive pathology in relation to the Covid situation has appeared with the need to increase the psychiatric approach in the general population

A 58-year-old woman with no personal medical story of interest is referred to the high-resolution Covid program due to severe depressive symptoms: intense apathy, abulia, anhedonia, weight loss, insomnia and important social distancing after the beginning of the confinement due to the Covid Pandemic. 4 psychotherapy sessions are performed, with a maximum duration of 45 minutes. It is necessary to add antidepressant medication with sertraline up to 100mg to improve psychotherapeutic work.

A complete recovery of symptoms is achieved even their severity with normalization of daily life.

Small psychotherapeutic interventions have been shown, even with critically ill patients, to be very effective in helping patients regain their baseline status.

No significant relationships.

Ireland has been one of the worst affected countries affected by COVID-19 in Europe. Many primary studies from Ireland have documented prevalence of anxiety and depressive disorders during the pandemic and their correlates.

To study the prevalence range of anxiety and depression in Ireland, and their correlates during the pandemic.

We systematically searched Pubmed, PsycInfo and the WHO COVID-19 global research database using key words ( January 2020 - September 2021). We removed duplicates and extracted data into an excel database and carried out a narrative synthesis of the extracted data.

From a total 127 studies, we included 22 studies that met our criteria in our narrative review. Depending on the tool used and the type of population studied, the prevalence of general anxiety disorders varied between 20% and 49.5% while prevalence of depressive disorders ranged between 20.4% and 53.8%. Younger people, health care workers, those who had to give up physical activity, people who had lost income, those who lived alone, infected by COVID-19, or had a higher perceived risk of the disease had a higher prevalence of both anxiety and depression disorders during the pandemic. There was conflicting evidence on prevalence levels among men and women and on whether they had children or not.

COVID-19 has had a profound effect on the mental health of the Irish population. Some population groups are more affected than the others. Addressing mental health concerns of Irish population during and post pandemic should remain as one of the top public health priorities.

No significant relationships.

There is evidence that metabolic syndrome (MetS) is common in chronic psychosis but also exists in the early stages.

To study the prevalence and course of MetS over a period of 2 year after a first episode psychosis. To determine whether there may be differences in its prevalence according to the type of antipsychotic used over two years.

A sample of 300 patients participate in the PEPsNa Early Intervention Programme. SMet was determined at baseline and at 6, 12, 18 and 24 months. The type of antipsychotic used at each assessment moment is collected (none, aripiprazole, paliperidone, others). Adult Treatment Panel III (ATP III) criteria were used to define MetS.

The prevalence of MetS at baseline is 4.44% and increases to 7.96% at 6 months, 10.1% at 12 months, 8.62% at 18 months and 9.01% at 24 months. The prevalence of MetS increases at 6 (p<0.021) and 12 months (p<0.003) compared to baseline and then remains stable. Only at 6 months assessment there are significant differences (F-Ficher p<0.022) in the presence of MetS (15.8%) in the paliperidone group treatment (oral or LAI).

Metabolic syndrome (MetS) exists from the early stages of psychosis and increases in the first 6-12 months and remains stable thereafter. The type of antipsychotic treatment only seems to have an influence at 6 months, with no differences at other follow-up times.

No significant relationships.

Psychiatric emergencies in Major Depressive Disorder (MDD) are characterised by multiple types of symptoms including risk of self-harm and suicidal ideation. S-ketamine intranasally (Spravato) has recently been shown to help alleviate symptoms during depressive emergencies. In this case-series, we detail the clinical effects and usability of S-ketamine applied intranasally in a psychiatric emergency setting.

To describe the effects of S-Ketamine on depressive crises associated with suicidality and self-harm in a psychiatric emergency setting.

Patients with MDD in a psychiatric emergency were provided with intranasal S-Ketamine according to clinical indication in routine clinical care in a University inpatient setting. Clinical characteristics were assessed in a standardised manner and symptom measures were applied pre-and posttreatment. Experience with 10 patients is systematically described in this case-series.

Patients had a primary diagnosis of MDD accompanied by a variety of secondary psychiatric comorbidity. Among these 10 patients, the majority were female (70 %) and the mean age was 49.5 yrs (range 26-66). All cases were considered treatment resistant and suffered severe acute suicidal ideation. Across all cases, pre-treatment MADRS was 37 on average (range 20-47) indicating a severe form of MDD. High severity was confirmed in elevated BDI scores (pre-treatment 39). Post-treatment, MADRS scores were reduced to 18 on average, alongside BDI scores (mean 24). S-ketamine administration was well-tolerated and side effects such as dissociation were of short-lived duration.

S-Ketamine intranasally can be safely and effectively administered in an acute psychiatric setting to treat psychiatric emergencies.

BTB received honoraria for consultancy and presentations from AstraZeneca, Bristol-Myers Squibb, Lundbeck, Pfizer, Servier, Wyeth, LivaNova, Janssen, Novartis, Otsuka, Angelini.