Nearly two-thirds of individuals with a mental disorder start experiencing symptoms during adolescence or early adulthood, and the onset of a mental disorder during this critical life stage strongly predicts adverse socioeconomic and health outcomes. Subthreshold manifestations of autism spectrum disorders (ASDs), also called autistic traits (ATs), are known to be associated with a higher vulnerability to the development of other psychiatric disorders. This study aimed to assess the presence of ATs in a population of young adults seeking specialist assistance and to evaluate the study population across various psychopathological domains in order to determine their links with ATs.

We recruited a sample of 263 adolescents and young adults referring to a specialized outpatient clinic, and we administered them several self-report questionnaires for the evaluation of various psychopathological domains. We conducted a cluster analysis based on the prevalence of ATs, empathy, and sensory sensitivity scores.

The cluster analysis identified three distinct groups in the sample: an AT cluster (22.43%), an intermediate cluster (45.25%), and a no-AT cluster (32.32%). Moreover, subjects with higher ATs exhibited greater symptomatology across multiple domains, including mood, anxiety, eating disorder severity, psychotic symptoms, and personality traits such as detachment and vulnerable narcissism.

This study highlights the importance of identifying ATs in young individuals struggling with mental health concerns. Additionally, our findings underscore the necessity of adopting a dimensional approach to psychopathology to better understand the complex interplay of symptoms and facilitate tailored interventions.

Eating disorders (EDs) have long been thought to be conditions that only or mainly affect women, especially young, affluent, skinny girls and women in Western cultures. Mostly over the last decade, we have come to realize that EDs may affect individuals of all genders, ages, sexual orientations, ethnic, and socio-economic backgrounds. This, in turn, has implications for ED presentation and assessment, and the necessity for adjustments in the provided care according to diverse treatment needs. Here, we present and discuss current advances in ED-related research in underrepresented groups as well as the need to further incorporate diversity aspects in clinical care and research within the ED realm.

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Clinical decision support systems (CDSS) based on machine-learning (ML) models are emerging within psychiatry. If patients do not trust this technology, its implementation may disrupt the patient-clinician relationship. Therefore, the aim was to examine whether receiving basic information about ML-based CDSS increased trust in them.

We conducted an online randomized survey experiment in the Psychiatric Services of the Central Denmark Region. The participating patients were randomized into one of three arms: Intervention = information on clinical decision-making supported by an ML model; Active control = information on a standard clinical decision process, and Blank control = no information. The participants were unaware of the experiment. Subsequently, participants were asked about different aspects of trust and distrust regarding ML-based CDSS. The effect of the intervention was assessed by comparing scores of trust and distrust between the allocation arms.

Out of 5800 invitees, 992 completed the survey experiment. The intervention increased trust in ML-based CDSS when compared to the active control (mean increase in trust: 5% [95% CI: 1%; 9%], p = 0.0096) and the blank control arm (mean increase in trust: 4% [1%; 8%], p = 0.015). Similarly, the intervention reduced distrust in ML-based CDSS when compared to the active control (mean decrease in distrust: −3%[−1%; −5%], p = 0.021) and the blank control arm (mean decrease in distrust: −4% [−1%; −8%], p = 0.022). No statistically significant differences were observed between the active and the blank control arms.

Receiving basic information on ML-based CDSS in hospital psychiatry may increase patient trust in such systems.

Depression is a complex and highly heterogeneous disorder with an omnigenic and multifactorial background. This diversity is obvious not only in its symptomatic manifestation but also in its neurobiological underpinnings which is one potential factor contributing to the high observed rate of treatment resistance. Thus, subtyping depressions, understanding their distinct neurobiological and genetic background, and potentially developing biomarkers aiding their differential diagnosis may bring us one step closer to more effective treatment. The present talk will overview the different etiological factors contributing to the emergence of depression along an endogenous-reactive continuum, the contributory roles of different types of stress, different genes involved in distinct processes, and the potential consequences of conceptualising, diagnosing and treating depressions developing in the context or independently of current stress.

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Suicidal behavior constitutes a multi-cause phenomenon that may also be present in people without a mental disorder. This study aims to analyze suicidal behavior outcomes in a sample of attempters, from a symptom-based approach.

The sample comprised 673 patients (72% female; M = 40.9 years) who attended a hospital emergency department due to a suicide attempt. A wide range of clinical factors (e.g., psychopathology symptoms, psychiatric diagnoses, impulsivity, acquired capability), was administered within 15 days after the index attempt. Nine psychopathology domains were explored to identify the profile of symptoms, using latent profile analysis. The relationship between the profile membership and suicide outcome (i.e., intensity of suicidal ideation, number of suicide behaviors, and medical injury derived from index attempt) was also studied, using linear and logistic regression.

Three psychopathology profiles were identified: high-symptom profile (45.02% of participants), moderate-symptom profile (42.50%), and low-symptom profile (12.48%). High-symptom profile members were more likely to show higher risk of non-suicidal self-injury, acquired capability for suicide, and more severe suicide behavior and ideation. On the other hand, a more severe physical injury was associated with low-symptom profile membership in comparison to membership from the other profiles (OR < 0.45, p < .05).

A symptom-based approach may be useful to monitor patients and determine the risk of attempt repetition in the future and potential medical injury, and to optimize prevention and intervention strategies.

Is bipolar mixed depression associated with a good response to psychotropic augmentation? Zoltán Rihmer Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest and at the National Institute of Mental Helath, Neurology and Neurosurgery, Budapest, Hungary.

Suboptimal response to antidepressant pharmacotherapy (nonresponse or partial response but no remisson) is the most challenging issue in the treatment of depressive disorders. Open and controlled clinical studies show that augmentation of the given antidepressant with lithium, atypical antipsychotics, antiepileptics and thyroid hormones are effective in 30-40% in such cases.

To explore the possiblity wether bipolar mixed depression is the ideal subject of good response to psychotroic augmentation.

Literature review.

Studies consistently indicate that in contrast to unipolar MDE (=MDD) the rate of antidepressant-resistant depression is higher not only in bipolar I and II depression but also in MDE with subthreshold bipolarity (bipolar mixed depression). However, lithium, atypical antipsychotic and antiepileptic (but not thyroid) augmentation works much better in bipolar depression and in unipolar MDE with subthreshold bipolarity (mixed depression) tjan in unipolar MDE without subthreshold bipolar features. In addition to this, almost all clinical predictors of good response to lithium/atypical antipsychotics/antiepileptics are classical bipolar markers (familial bipolarity, eraly onset, intradepressive hypomanic symptoms, agitation, cyclothymic tempermanent, shorter episodes, more than three depressive episodes, and suicidality).

Considering that lithium, atyipcal antipsychotics and antiepileptics, but not thyroid stimulating drugs have more and less antimanic effect, these results suggst that tretating intradecpressive hypomanic symptoms in bipolar mixed depression is a new (if not the only) explanation among the several previously proposed mechanisms of action of successful psychotropic augmentation of antidepressants in patients with MDE.

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The “suicidal transition” from ideation to an act has become a specific topic of research. However, rates in the general population, variations across time and risk factors are unclear.

Data were collected from the phone survey Baromètre Santé among 18–75-year-olds in France. Seven independent samples interviewed between 2000 and 2021 (total N = 133,827 people; 51.3% females) were questioned about suicidal ideation and attempts over the previous 12 months. Transition was calculated as the weighted ratio of attempt on ideation 12-month rates.

Mean 12-month rates of suicidal ideation, attempts and transition were 4.7% (95% Confidence Interval (CI) (4.6–4.8)), 0.5% (95% CI (0.4–0.5)) and 7.7% (95% CI (6.8–8.6)), respectively. Transition rates varied between 4.5 and 11.9% across surveys. In multivariable analyses, higher transitions rates were associated with a previous suicide attempt (adjusted Odds Ratio (aOR) = 11.1 95% CI (7.9–15.6)); 18–25 vs 26–55-year-olds (1.8 95% CI (1.2–2.8)); lower vs higher income (1.7 95% CI (1.0–2.7); and lower vs higher professional categories (aOR around 1.9). No significant association was found with gender, education level, employment status, living alone, urbanicity, current major depression, daily smoking, weekly heavy drinking, cannabis use, and body mass index.

Most people with suicidal ideation do not attempt suicide. These findings emphasize the need to avoid generic terms such as “suicidality”, and to increase research on suicidal transition to improve prevention and prediction. They may also inform the organization of suicide prevention in the general population.

Introduction. Military conflicts are ubiquitous. There are many combat veterans around the world. The combat environment is characterized by violence, physical strains, separation from loved ones, and other hardships. Mood disorders and suicidality in combat veterans are a large and important issue.

To discuss the pathophysiology and prevention of suicidal behavior in combat veterans with mood disorders

A review of the literature on suicidal behavior in combat veterans with mood disorders including own publications.

Combat deployment may lead to multiple emotional, cognitive, psychosomatic symptoms, mood disorders, suicidal ideation and behavior. Pre-deployment, deployment and post-deployment adversities may increase risk of mood disorders and suicide in combat veterans. The act of killing in combat is a stressor which may raise suicide risk. Combat-related injuries are associated with significantly increased depression and suicide risk. Post-deployment difficulties of reintegrating into civilian life may lead to depression and suicidality. Studies suggest that suicidal behavior in combat veterans may have a neurobiological basis. Prevention of mood disorders and suicide among combat veterans should include pre-deployment screening to exclude individuals with psychiatric disorders; psychological support and prevention of harassment and/or abuse during deployment; psychosocial support after deployment; diagnosing and treating psychiatric and medical disorders including neurological disorders; frequent depression and suicide screening; education of mental and non-mental health clinicians, war veterans, their families and friends regarding signs/symptoms of mood disorders and suicidality; and restriction of access to lethal means.

Combat veterans are a unique population. They are frequently exposed to psychological, physical, and biological factors which are unusual for civilians or non-combat military veterans. We need to study the specific psychobiology of combat veterans to understand how to develop effective depression and suicide prevention interventions for this population.

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Theoretical and empirical contributions have identified insula as key in addiction. However, anatomical modifications of the insula in addictive states, and their variations across substance use disorders (SUDs), remain to be specifically explored. We therefore explored the specificities and commonalities of insula gray matter (GM) alterations in severe alcohol use disorder (sAUD) and severe cocaine use disorder (sCUD).

We explored insula GM volume through a refined parcellation in 12 subregions (six bilateral): anterior inferior cortex (AIC), anterior short gyrus, middle short gyrus, posterior short gyrus, anterior long gyrus (ALG), and posterior long gyrus (PLG). Using a linear mixed model analysis, we explored the insula volume profiles of 50 patients with sAUD, 61 patients with sCUD, and 36 healthy controls (HCs).

In both sAUD and sCUD, we showed overall insular lower volume with a right-sided lateralization effect, and a major volume deficit in bilateral ALG. Moreover, differences emerged across groups, with higher left AIC and PLG volume deficits in sCUD compared to sAUD and HC.

We offered the first joint exploration of GM insular volumes in two SUD through refined parcellation, thus unveiling the similarities and dissimilarities in volume deficit profiles. Our results bring evidence complementing prior ones suggesting the core role of the right and posterior insula in craving and interoception, two crucial processes in addiction. Left AIC and PLG group differences also show that, while insula is a region of interest in SUD, sCUD and sAUD generate distinct insular profiles, which might parallel clinical differences across SUD.

Antipsychotics are among the substances that are very frequently used for elderly people and dementia patients in particular. This is known from studies both in outpatient care and in nursing homes. They are often part of a polypharmacy. This group of substances is discussed in the context of the increased risk of falls, increased mortality and also - as here - in the context of the development of delirium.

On the other hand, antipsychotics are drugs for the treatment of delirium, whereby the question of their significance in modern delirium treatment is being asked anew. In the past, butyrophenones in particular have played a role here, partly because of their variable form of administration and also because of their low cardiac impact.

In the context of delirium prevention, the aim is to reduce the number of drugs on the one hand and the anticholinergic load of the drugs on the other. Algorithms and recommendations exist for this.

In the treatment of delirium, the focus is rightly placed primarily on non-pharmacological management. The use of antipsychotics should be reserved for severe states of agitation or agitation in the context of delirium. In other cases, careful judgement is required.

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Inflammatory biomarkers are reportedly increased in depressed patients. Several studies have been conducted using neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and monocyte/lymphocyte ratio (MLR). The objective of this systematic review was to study the relationship between these peripheral biomarkers and suicidality in depressed patients with/without suicidal behavior, including suicide attempts and ideation, and healthy controls.

We searched the following relevant terms in the PubMed, Web of Science, and Scopus databases published in the last 5 years. We assessed the methodological quality of included studies using the Oxford criteria and reviewed the evidence following PRISMA guidelines.

Eleven studies were retained for the data synthesis, with a total sample of 1,701 participants, of which the majority (819) were patients with depression and suicidal behavior, 494 were depressed patients without suicidal behavior, and only 388 were healthy participants. Our results reinforce the idea that NLR could be an attractive, convenient, and cost-effective trait marker of suicidal vulnerability in patients with major depressive disorder (MDD).

Future large-scale replication studies are needed to examine the apparently understudied role of PLR and MLR in depressed patients in greater depth.

Elderly patients treated with antipsychotics are often prescribed multiple medications simultaneously (polypharmacy), leading to an increased risk of various medication-related problems, including irrational polypharmacy, drug-drug interactions, and potentially inappropriate medications (PIMs). Polypharmacy may be rational with clear indications and benefits, but it becomes irrational when better alternatives are available. This irrational polypharmacy is associated with poorer clinical and economic outcomes, including a higher mortality rate. Antipsychotic polypharmacy in elderly patients with schizophrenia is not well-studied and, therefore, is not generally recommended. Long-term antipsychotic use in patients with dementia has also been linked to a higher mortality rate. PIMs, representing a greater risk than benefit, are prevalent in mental health institutions at all healthcare levels, with a prevalence ranging from 40% to 60%. Antipsychotics, along with benzodiazepines, are among the most commonly included in PIMs and polypharmacy in these institutions. Moreover, antipsychotics are frequently implicated in potential severe drug-drug interactions in elderly patients with mental disorders, particularly with antibiotics and antiarrhythmics.

Unfortunately, the existing treatment guidelines and meta-analyses mostly do not cover these aspects, which represent a gap between the ‘real clinical’ pharmacology and treatment guidelines. The speaker will summarize the medication-related problems in this population and present practical recommendations for daily clinical practice.

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Intellectual disability (according to the DSM-5) or intellectual developmental disorder (according to the ICD-11) is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social and practical domains. The term learning disability (LD) is also used, although this term shows more specifically deficits in the domain of learning. The term learning difficulties is often used for specific or generalized intellectual impairment that does not meet all of the criteria of LD.

The prevalence of learning disability in prisoners is about 10%. Up to 60% of male prisoners have learning difficulties. Prevalence rates for offending behaviour in patients with LD is higher than in the general population and show a large range, from 2-40%.

The main explanatory factor underlying the link between intelligence and offending is the lack of ability to manipulate abstract concepts. Poor academic performance, common in persons with LD, is also linked to offending.

With regard to sexual offending, some persons with LD may not have learnt the rules that define acceptable and unacceptable behaviour. Sexual offences may amount to inappropriate, impulsive expressions of emotion rather than premediated violent acts. Violent behaviour in the LD population may be due to frustration, impulsivity or poor problem solving skills. There is no significant difference in the frequency of violent or property offences between individuals with LD and those without. However, sex offences and fire-setting are frequently seen in individuals with LD.

Persons with LD are vulnerable suspects and may also be disadvantaged by the criminal justice system because of a lack of appropriate support and legal representation from early stages in the process.

In this introductory paper these themes will be addressed.

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A large increase in the rate of hospitalizations for adolescents and children with anorexia nervosa (AN) was observed during the coronavirus disease (COVID-19) pandemic. It is still not clear whether this was a temporary effect or whether the increased admission rates persist.

Data were retrieved from the largest health insurance in Germany comprising 2.5 million children between 9 and 19 y. All patients of this age group with a discharge diagnosis of typical (AN) and atypical AN (AAN) according to the International Classification of Diseases, Tenth Revision (ICD-10), were included. Admission rates per 10,000 person-years were computed separately by sex, age and type of AN for entire years from 2019 to 2022 and the first half of 2023 in relation to the entire number of insured persons of the same sex and age per year.

Two years after the final lockdown admission rates were still significantly higher in adolescent and childhood AN than in the pre-COVID-19 time. While admission rates declined for adolescents in 2023, those for children remained high, with an increase for girls of more than 40% compared with the rate before the pandemic (1.42 (CI 1.26, 1.60); p < 0.0001). The highest admission risk for AAN relative to the pre-COVID-19 period was observed in adolescents in the first half of 2023 (1.6; CI 1.34; 1.90; p < 0.0001).

Children appear to be especially vulnerable to the pandemic-associated disruptions. Clinicians should try to determine the ongoing effects of the pandemic and support early detection and treatment of AN to prevent its often lifelong consequences.

Since its introduction in the diagnostic manuals DSM-5 and ICD-11, the construct of personality functioning has gained increasing attention. However, it remains unclear which factors might predict improvement in personality functioning.

We examined a sample of 648 completed psychodynamic psychotherapies conducted by 172 therapists at the Heidelberg Institute for Psychotherapy. A machine learning approach was used to filter for variables that are relevant for the prediction of the improvement of personality functioning from a broad data set of variables collected at the beginning of each psychodynamic psychotherapy.

On average, we found an improvement of 0.24 (SD = 0.48) in the OPD-SQ. This corresponds to a medium effect in the improvement of personality functioning. Patients with initially high impairment experienced particularly large improvements. Overall, we found a large number of variables that proved to be predictive for the improvement of personality functioning. Limitations in social activity due to physical and emotional problems proved to be one of the most important predictors of improvement. Most of the effect sizes were small.

Overall, the improvement in personality functioning during psychotherapy is determined more by the sum of a large number of small effects than by individual variables. In particular, variables that capture social areas of life proved to be robust predictors.

The very brief presentation will describe the initial approach to the psychiatric assessment of the case presented including the issue of fitness to participate in court proceedings. The use of screening tools at court to identify people with intellectual disabilities will be highlighted along with what support can be provided for vulnerable offenders in attending court. The potential disposal options for the court such as prison or hospital or community will be outlined. Variation in practice across Eurpean countries needs further discussion to ensure the rights of defendants with intellectual disabilities are safeguarded during their participation in court proceedings

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Quality of life is decreased in bipolar disorders (BD) and contributes to poor prognosis. However, little is known about the causal pathways that may affect it. This study aimed to explore health-related QoL (HRQoL) in BD and investigate its relationship with cognition and psychosocial functioning.

This multicenter cross-sectional study used a neuropsychological battery to assess five cognition domains. Functioning was evaluated using global and domain-based tools, and health-related HRQoL was assessed using the EQ-5D-3L. Structural equation modeling was used to test whether the association between cognition and HRQoL would be mediated by functioning in BD while controlling for covariates such as residual depression, anxiety, antipsychotic medication, and psychotic features.

We included 1 190 adults with euthymic BD. The model provided a good fit for the data. In this model, the direct effect of cognition on HRQoL was not significant (β = − 0.03, z = −0.78, p = 0.433). The total effect of cognition on HRQoL was weak, albeit significant (β = 0.05, z = 3.6, p < 0.001), thus suggesting that cognition affected HRQoL only indirectly through functioning. Anxiety was associated with decreased functioning (β = −0.27, z = −7.4, p < 0.001) and QoL (β = −0.39, z = −11.8, p < 0.001).

These findings suggest that improving cognition may not directly lead to a higher HRQoL. Cognitive remediation is expected to improve HRQoL only through functioning enhancement. They also reveal the potential importance of functional remediation and reduction of comorbid anxiety symptoms in improving HRQoL in BD.

Legal frameworks and the challenges for treatment and rehabilitation of offenders with intellectual disabilities Speaker: Farzaneh Saeedzadeh Sardahaee, MD, PhD, Consultant psychiatrist St. Olav University Hospital, Trondheim, Norway

Lack of timely diagnostic and treatment for mild intellectual disability amongst offenders presents special challenges to clinicians and prison system alike. On the one hand, appropriate treatment for their psychiatric symptoms may not be implemented as they can be mislabeled primarily as behavioral issues. Different approaches to such perceived behavioral issues within judiciary (or prison) system and health care system is a potential conflict area. On the other hand, treatment and rehabilitation of offenders with intellectual disability require both resources and expertise that may not be readily available in prison systems, pre- or past sentencing. Furthermore, the scope of such challenges varies greatly based on different legal frameworks for sentencing offenders with intellectual disability within Europe.

In the first section an overview of Norwegian legal framework for offenders with intellectual disability is briefly presented. Then using the example of a young female offender with mild intellectual disability, drug dependence and multiple psychiatric morbidities, the speaker examines complexities of dual diagnoses, inter-disciplinary and multiagency cooperation follow-up and challenges faced in the recovery process. A brief introduction to the current Norwegian follow-up system for offenders with intellectual disability is discussed before examining recent changes in legal framework for sentencing offenders with intellectual disability in Norway, and its ramifications, as well as potential benefits for treatment and future rehabilitation of offenders. Finally, the speaker reflects on points for further improvement, especially considering the multi-agency nature of treatment and rehabilitation of offenders with intellectual disability.

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Hector, 44 years, with mild Intellectual Disability and impulse control disorder, committed serious sexual offences against two children of his partner. Considered “socially dangerous”, he was put in prison, then with a deferment of the enforcement of the prison sentence in the forms of home detention he was hospitalized in a psychiatric facility due to his depressive condition. Upon entering the Community, he presented a deflected mood as a reaction to the discomfort from the custodial experience, which was not cognitively integrated. Both psychotropic and rehabilitation treatments started. He has been involved in a gardening activity, too. After a first period of high degree of denial of the facts and a defensive mode marked by stolidity and fatuity, revealing his poor cognitive resources, during the psychiatric sessions he became even more conscious of his crime and the suffering of the victims. Services/pathways available for offenders with ID and psychiatric disorders will be presented.

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