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Abstract Background The purpose of this exploratory study is to examine the role of sociodemographic, clinical, and cognitive – both objective and subjective – factors in overall and in specific domains of psychosocial functioning, in patients with depression at different clinical states of the disease (remitted and non-remitted). Methods A sample of 325 patients with major depressive disorder, 117 in remission and 208 in non-remission, were assessed with a semi-structured interview collecting sociodemographic, clinical, cognitive (with neuropsychological tests and the Perceived Deficit Questionnaire), and functional (Functioning Assessment Short Test) characteristics. Backward regression models were conducted to determine associations of global and specific areas of functioning with independent factors, for both clinical states. Results Residual depressive symptomatology and self-appraisal of executive competence were significantly associated with psychosocial functioning in remitted patients, in overall and some subdomains of functioning, particularly cognitive and interpersonal areas. While depressive symptoms, executive deficits and self-appraisal of executive function were significantly related to functional outcomes in non-remitted patients, both in overall functioning and in most of subdomains. Discussion This study evidences the strong association of one’s appraisal of executive competence with psychosocial functioning, together with depressive symptoms, both in remitted and non-remitted patients with depression. Therefore, to achieve full recovery, clinical management of patients should tackle not only the relief of core depressive symptoms, but also the cognitive ones, both those that are objectified with neuropsychological tests and those that are reported by the patients themselves.

Introduction: Many patients with schizophrenia are unable to achieve adequate levels of psychosocial functioning and quality of life despite of the remission of illness symptoms. According to previous reports, only one-third of patients with symptomatic remission reach functional remission. While current pharmacotherapy options seem to be relatively effective for different symptoms of schizophrenia (e.g. positive symptoms), more specific psychosocial interventions that could enable functional remission are yet to be developed. Objectives: Our objective is to investigate differences in psychopathology, quality of life, functioning, and achieving functional remission before and after specific group treatments developed in our clinic. Methods: We will conduct a prospective study including a consecutive cohort of female patients older than 18 years of age, which fulfilled the criteria for schizophrenia and schizoaffective disorder according to the International Classification of Disorders, 10th revision. Exclusion criteria are intellectual disabilities, mental disorders due to known physiological or neurological conditions, lactation or pregnancy, treatment with medications that can provoke psychosis, alcoholism, and other addictions. Patients will be recruited after finished hospital treatment or during individual outpatient controls. The Recovery Helm will be used at the beginning of the treatment, to make individual treatment plan and include patients in specific programs including day hospital treatment and/or outpatient group programs: psychoeducation, relaxation, metacognitive training, and social skills training. Besides collecting sociodemographic data, pre- and post-treatment assessment will include the Positive and Negative Syndrome Scale (PANSS), the Global Assessment of Functioning (GAF), the Quality of Life Scale (QLS), and the "Functional Remission of General Schizophrenia" (FROGS) scale. Results: We will analyze the changes in psychopathology levels, quality of life, functioning, and achieving functional remission between the two assessment points, taking into account different treatment possibilities. Conclusions: Evaluation of current available programs can help with recognition of specific needs of patients with schizophrenia and provide guidelines for further development of treatment programs that could be helpful in achieving functional remission. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Introduction: Avoidant Restrictive Food Intake Disorder is a disorder included among the eating disorders criteria group. Prevalence and incidence rates of ARFID in the general population remain largely unknown. Despite ongoing variability in the interpretation of diagnostic criteria in clinical practice, good progress has been made regarding recognition and assessment of ARFID. Different approaches to treatment are currently being explored, with reported outcomes for ARFID vary, consistent with the heterogeneity of the disorder. At present, there is insufficient evidence to determine the likely course and prognosis. Objectives: Review what avoidant restrictive food intake disorder consists of, the challenges it presents, as well as its prognosis and potential treatments. Methods: Presentation of a patient's case and review of existing literature, in regards to ARFID. Results: The patient in question is not clear he can be diagnosed of avoidant restrictive food intake disorder given his OCD symptoms, which are intertwined. That said, he does not have body dysmorphophobia and does check for all the ARFID criteria. Their prognosis is not good, having failed several psychological and pharmacological treatments. In literature, there is not much evidence around the disease because of its novelty, being recently included in the DSM 5 as a new class of eating disorders (EDs), not finding high quality studies (meta analysis, systematic review). ARFID is characterised by a lack of interest in eating or avoiding specific types of foods because of their sensory characteristics. This avoidance results in decreased nutritional intake, eventually causing nutritional deficiencies. In severe cases, ARFID can lead to dependence on oral nutritional suplemments, which interferes with psychosocial functioning. The prevalence of ARFID can be as high as 3% in the general population, and it is often associated with gastrointestinal symptom. Given the high prevalence of ARFID, a rapid and systematic nutrition survey should be conducted during every consultation. Its treatment should also be adapted depending on the severity of the nutritional problem and may involve hospitalisation with multidisciplinary care (paediatrician, nutritional therapist, dietitian, psychologists, and speech therapists). In regards to potential treatments, there is no evidence-based psychological treatment suitable for all forms of ARFID at this time. Several groups are currently evaluating the efficacy of new psychological treatments for ARFID, particularly, family-based and cognitive-behavioural approaches, but results have not yet been published. Conclusions: Future directions for research could be usefully informed by closer collaboration with other fields, including feeding disorders, emotion processing and regulation, neurodevelopment, and appetite. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Introduction: Craniofacial surgery is a specialized field that addresses congenital and acquired deformities of the head and face. While the physical outcomes of craniofacial surgery are well-documented, less attention has been given to the psychological well-being of adult patients. This abstract aims to explore self-esteem issues among adult patients treated at the Craniofacial Surgery Sector of HCPA (Hospital de Clínicas de Porto Alegre), where a substantial proportion of adult patients have reported self-esteem problems. Objectives: 1. To assess the prevalence of self-esteem issues among adult patients (≥18 years old) attending the HCPA Craniofacial Surgery Sector. 2. To examine potential contributing factors to self-esteem problems in this specific patient population. 3. To evaluate the impact of self-esteem on the mental health and psychosocial functioning of adult craniofacial surgery patients. 4. To propose recommendations for psychosocial support and intervention strategies tailored to the needs of adult patients in this context. Methods: This cross-sectional study involved 132 adult patients who had undergone or were scheduled for craniofacial surgery at HCPA. Participants reported self-esteem issues in their talk with the hospital's physicians, and their medical records were reviewed to collect demographic and clinical data. Additionally, participants provided information about their mental health status and psychosocial functioning. Results: Among the 39 adult patients included in the study, 37 (94.9%) reported experiencing self-esteem issues, such as lack of confidence or feeling unattractive. The most commonly reported contributing factors were visible facial differences, social interactions, and prior surgical experiences. Patients with lower self-esteem had a higher likelihood of reporting symptoms of depression and anxiety and reported lower overall psychosocial functioning compared to those with higher self-esteem. Conclusions: This reveals a strikingly high prevalence of self-esteem issues among adult patients attending the Craniofacial Surgery Sector at HCPA. These findings underscore the importance of recognizing and addressing the psychological well-being of adult craniofacial surgery patients. Comprehensive psychosocial support, including counseling, peer support, and interventions to enhance self-esteem, should be integrated into the care of these patients. By addressing self-esteem concerns, healthcare providers can improve the mental health and overall quality of life of adult craniofacial surgery patients. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Introduction: Natural disasters are a risk for significantly disrupting the quality of life as a result of changes in life circumstances they bring, such as endangering health, property, existential issues, and can lead to social exclusion. They can also affect mental health and increase the risk of developing psychiatric disorders. Objectives: To show the impact of natural disasters on the psychosocial functioning of people in the affected area and the importance of adequate preparedness of the social community, including mobile teams, with an emphasis on providing somatic, psychological, and social support. Methods: Data were collected from research on the consequences of major natural disasters and providing psychological, psychiatric and social support to the affected population. Results: After natural disasters, there are significant changes in social functioning with the possible development of mental health problems. It is especially evident in sudden and intense catastrophic events. Conclusions: In addition to the immediate provision of psychiatric and psychological assistance to victims, people who have experienced a catastrophic event need to be provided with immediate and continuous assistance and socioeconomic support, due to the need for better social inclusion and return to their role in the community. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Introduction: Cognitive reserve (CR) refers to the ability of the brain to cope with damage or pathology. In bipolar disorder (BD), it has been seen that the effects of the disease may potentially reduce CR, thus compromising cognitive outcomes. This concept takes on special relevance in late life in BD, due to the increased risk of cognitive decline because of the accumulative effects of the disease and the potential effects of aging. Therefore, we believe that CR may be a protective factor against cognitive decline in older adults with bipolar disorder (OABD). Objectives: The aim of this study was to study the CR in OABD compared with healthy controls (HC) and to analyze its association with psychosocial functioning and cognitive performance. Methods: A sample of euthymic OABD, defined as patients over 50 years old, and HC were included. CR was assessed using the CRASH scale. Differences in demographic, clinical, and cognitive variables between patients and HC were analyzed by t-test or X2 as appropriated. Lineal simple and multiple regressions analyses were used to study the association of CR and several clinical variables with functional and cognitive performance. Results: A total of 83 participants (42 OABD and 41 HC) were included. Compared to HC, OABD exhibited poorer cognitive performance (p<0.001), psychosocial functioning (p<0.001) and lower CR (p<0.001). Within the patient's group, the linear simple regression analysis revealed that CR was associated with psychosocial functioning (β=-2.16; p=0.037), attention (β= 3.03; p=0.005) and working memory (β = 2.98; p=0.005) while no clinical factors were associated. Age and CR were associated with processing speed and verbal memory, but after applying multiple regression model, only the effect of age remained significant (β =-2.26; p= 0.030, and β =-2.23; p= 0.032 respectively). CR, age, and number of episodes were related to visual memory, but the multiple regression showed that only age (β = -2.37; p= 0.023) and CR (β = 3.99; p<0.001) were associated. Regarding executive functions only the number of manic episodes were significant. CR and age at onset were associated with visuospatial ability, but multiple regression only showed association of CR (β =2.23; p=0.032). Other clinical factors such as number of depressive or hypomanic episodes, illness duration, admissions, type of BD, and psychotic symptoms were not associated. Conclusions: To the best of our knowledge, this is the first report that studies the CR in a sample of OABD. We demonstrated that OABD had lower CR than HC. Importantly, we observed that CR was associated with cognitive and psychosocial functioning in OABD, even more than disease-related factors. These results suggest the potential protector effect of CR against cognitive impairment, supporting that improving modifiable factors associated with the enhancement of CR can prevent cognitive decline. Disclosure of Interest: L. Montejo: None Declared, C. Torrent Grant / Research support from: Spanish Ministry of Science and Innovation (PI20/00344) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdireccion General de Evaluacio ́n and the Fondo Europeo de Desarrollo Regional (FEDER), S. Martín: None Declared, A. Ruiz: None Declared, M. Bort: None Declared, G. Fico Grant / Research support from: Fellowship from "La Caixa" Foundation (ID 100010434 - fellowship code LCF/BQ/DR21/11880019), V. Oliva: None Declared, M. De Prisco: None Declared, J. Sanchez-Moreno Grant / Research support from: Spanish Ministry of Science and Innovation (PI20/00060) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdireccion General de Evaluacio ́n and the Fondo Europeo de Desarrollo Regional (FEDER),, E. Jimenez Grant / Research support from: Spanish Ministry of Science and Innovation (PI20/00060)integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdireccion General de Evaluacio ́n and the Fondo Europeo de Desarrollo Regional (FEDER),, A. Martinez-Aran: None Declared, E. Vieta Grant / Research support from: Spanish Ministry of Science and Innovation (PI18/ 00805, PI21/00787) integrated into the Plan Nacional de I+D+I and cofinanced by the ISCIIISubdireccio ́n General de Evaluacio ́n and the Fondo Europeo de Desarrollo Regional (FEDER); the Instituto de Salud Carlos III; the CIBER of Mental Health (CIBERSAM); the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement (2017 SGR 1365), the CERCA Programme, and the Departament de Salut de la Generalitat de Catalunya for the PERIS grant SLT006/17/00357; the European Union Horizon 2020 research and innovation program (EU.3.1.1. Understanding health, wellbeing and disease: Grant No 754907 and EU.3.1.3. Treating and managing disease: Grant No 945151)., B. Sole: None Declared [ABSTRACT FROM AUTHOR]

Introduction: The concept of "life engagement" encompasses several aspects of one's life, including personal well-being, contentment, purpose, and engagement in meaningful activities. In 2006, the group led by Scheier designed a 6-item scale to measure this concept in the general population: the Life Engagement Test (LET), however, this tool was never validated in clinical populations (Scheier et al. 2006 J Clin Psychiatry 2006; 29 291-298). In subjects living with schizophrenia life engagement can be measured through the Positive and Negative Syndrome Scale-Life Engagement (PANSS-LE), derived by isolating 11 items (i.e., N01, N02, N03, N04, N05, N06, G06, G07, G13, G15, G16) from the PANSS (Correll et al. 2022 J Clin Psychiatry 2022; 83-4) (Correll et al. 2022 J Clin Psychiatry 2022; 83-5). Objectives: The aim of this study was to investigate the clinical and functional correlates of two different measures of life engagement in a cohort of individuals living with schizophrenia spectrum disorders (SSD). Methods: Ninety-five subjects living with SSD recruited from the ASST Spedali Civili of Brescia (Italy) were included in the preliminary ad-interim analysis of the present study: for each patient information regarding the clinical presentation were measured with the Clinical Global Impression (CGI) scale, the Health of the Nation Outcome Scales (HoNOS), the Brief Negative Symptoms Scale (BNSS) and the PANSS; additionally, information related to the psychosocial functioning were collected through the Global Assessment of Functioning (GAF) scale; finally, life engagement was evaluated through the LET and the PANSS-LE. Spearman's correlations were performed using SPSS v28 and p values < 0.05 were considered significant. Results: Both the LET and the PANSS-LE were correlated with the CGI (p=0.002 and p<0.001 respectively), but only the PANSS-LE was found to be correlated with the GAF (p<0.001), the BNSS (p<0.001) and the HoNOS (p<0.001). Conclusions: The concept of life engagement is of growing interest for healthcare professionals working in the mental health field, in line with the concept of reaching a full functional recovery and considering patient-reported outcomes. From our study it is evident that life engagement in individuals living with SSD is better characterized through the PANSS-LE rather than the LET, as the former is more specific to define the complexity of the SSD symptomatology. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Introduction Schizophrenia is characterized by impairments in motivation and coping and decrements in psychosocial functioning in major life areas. Objectives This study attempted to examine the links between treatment motivation, coping, and psychosocial functioning for persons with schizophrenia. Design: Cross-sectional survey. Methods One hundred thirty-eight participants were recruited at random from outpatient psychosocial rehabilitation programs in Moscow-based psychiatric hospitals. The measures of motivation were administered by testers blind to scores on other study variables; measures of coping (COPE, CERQ) and psychosocial functioning (PSP, EQ5D5L, SF36, Q-Les-Q-18) were administered. Data were analyzed using latent construct modeling to test for mediator and moderator effects. Results There were strong bivariate relationships between coping, motivation, and psychosocial functioning. The results demonstrated that coping strongly mediated the relationship between motivation and psychosocial functioning. This mediation was evidenced by: 1) the direct path from motivation to a functional outcome no longer being statistically significant after introducing coping into the model; 2) the statistical significance of the indirect path from motivation through coping to functional outcome. There was no support for the moderation hypotheses. Conclusions Motivation influences psychosocial functioning through its relationship with coping, and coping is a critical mechanism for explaining the relationship between motivation and psychosocial functioning. These results will be compared with work on motivation, neurocognition, and psychosocial functioning in schizophrenia (Nakagami et al. 2008), as well as with gender issues. Professionals working with schizophrenia patients should consider such variables as coping when designing and implementing gender-sensitive intervention programs. Disclosure No significant relationships.

Background. Impairment in a wide range of cognitive abilities has been consistently reported in individuals with schizophrenia. Both neurocognitive and social cognitive deficits are thought to underlie severe functional disabilities associated with schizophrenia. Despite the key role in schizophrenia outcome, cognition is still poorly assessed in both research and clinical settings. Methods. In this guidance paper, we provide a systematic review of the scientific literature and elaborate several recommendations for the assessment of cognitive functions in schizophrenia both in research settings and in real-world clinical practice. Results. Expert consensus and systematic reviews provided guidance for the optimal assessment of cognitive functions in schizophrenia. Based on the reviewed evidence, we recommend a comprehensive and systematic assessment of neurocognitive and social cognitive domains in schizophrenia, in all phases of the disorder, as well as in subjects at risk to develop psychosis. This European Psychiatric Association guidance recommends not only the use of observer reports but also self-reports and interview-based cognitive assessment tools. The guidance also provides a systematic review of the state of the art of assessment in the first episode of psychosis patients and in individuals at risk for psychosis. Conclusion. The comprehensive review of the evidence and the recommendations might contribute to advance the field, allowing a better cognitive assessment, and avoiding overlaps with other psychopathological dimensions. The dissemination of this guidance paper may promote the development of shared guidelines concerning the assessment of cognitive functions in schizophrenia, with the purpose to improve the quality of care and to obtain recovery. [ABSTRACT FROM AUTHOR]

Abstract Background Impairment in a wide range of cognitive abilities has been consistently reported in individuals with schizophrenia. Both neurocognitive and social cognitive deficits are thought to underlie severe functional disabilities associated with schizophrenia. Despite the key role in schizophrenia outcome, cognition is still poorly assessed in both research and clinical settings. Methods In this guidance paper, we provide a systematic review of the scientific literature and elaborate several recommendations for the assessment of cognitive functions in schizophrenia both in research settings and in real-world clinical practice. Results Expert consensus and systematic reviews provided guidance for the optimal assessment of cognitive functions in schizophrenia. Based on the reviewed evidence, we recommend a comprehensive and systematic assessment of neurocognitive and social cognitive domains in schizophrenia, in all phases of the disorder, as well as in subjects at risk to develop psychosis. This European Psychiatric Association guidance recommends not only the use of observer reports but also self-reports and interview-based cognitive assessment tools. The guidance also provides a systematic review of the state of the art of assessment in the first episode of psychosis patients and in individuals at risk for psychosis. Conclusion The comprehensive review of the evidence and the recommendations might contribute to advance the field, allowing a better cognitive assessment, and avoiding overlaps with other psychopathological dimensions. The dissemination of this guidance paper may promote the development of shared guidelines concerning the assessment of cognitive functions in schizophrenia, with the purpose to improve the quality of care and to obtain recovery.

Introduction: The sensitive delusion of reference represents a clinical entity described by Kretschmer in 1918, arising in people with sensitive personality. This personality type is mainly characterized by a tendency towards social isolation, introversion, low self-esteem and by a greater sensibility to interpersonal judgement. In this personality type, the presence of specific environmental triggers may provoke a reference delusion of persecutory content, feelings of guilty and injustice. Although eliminated from the current diagnostic classifications, the sensitive delusion of reference represents a key milestone in the history of psychopathology. Objectives: The goal of this report is to report on a clinical case of a patient diagnosed with Kretschmer´s sensitive delusion of reference. Methods: The present work consists on a descriptive report of a clinical case through consultation of the patient´s clinical file as well as a survey of relevant articles on Pubmed. Results: This is a 38 year old, married man with no children. He describes himself as a private, introverted individual, who has little interaction with his peers, and has been very sensitive to criticism ever since his adolescence. His first psychiatry appointment took place in April 2021, following the medical referral of his general practitioner as, according to the patient´s mother and wife, he had been, for quite some time, implying that his mobile phone had been under wire and that someone had been monitoring him. As stated by these relatives, these ideas surfaced after a workplace conflict. At the time, the patient was medicated with olanzapine 10mg and lorazepam 2.5mg before bedtime, exhibiting significant improvements with full remission of psychotic symptomatology. Succeeding the antipsychotic tapering attempt, the patient had begun to suffer from insomnia and recrudescence of psycotic symptomatology, namely, the delusion ideation of persecutory content and auditory hallucinations, as a result, the previous treatment regimen was resumed, which resulted in significant improvements of the clinical picture. Following new observation, in 2023, the patient mentions weight gain and drowsiness during the day, leading to the switch of olanzapine 10mg for aripiprazole 15mg. The current treatment plan consists of aripiprazole 15mg once a day and lorazepam 1mg 1/2 before bedtime, resulting in an improvement of the previous complaints and maintenance of the psychosocial functioning, unaccompanied by psychotic symptomatology. Conclusions: In conclusion, and relatively to the condition´s prognosis, Kretschmer observed that, although in some situations the episodes were brief and self-limiting, in others, the patients maintained psycothic symptomatology, during the following years. In the present clinical case we recognised the need to sustain the antipsycothic treatment regimen, as the respective dosage reduction lead to an aggravation in symptomatology. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Introduction: During the past 2 decades there has been intense interest in the clinical significance of the concurrence of manic symptoms in depressed patients. DSM-5 introduced a mixed features specifier for both bipolar depression and major depressive disorder. Studies of the DSM-5 mixed features specifier have generally found a low prevalence of mixed depression. One approach towards increasing the sensitivity of the DSM-5 mixed features criteria is to lower the classification threshold. Objectives: In the present study we examine the impact of lowering the DSM-5 diagnostic threshold from 3 to 2 criteria on the prevalence and validity of the DSM-5 mixed features specifier for depression. Methods: Four hundred fifty-nine psychiatric patients in a depressive episode were interviewed by a trained diagnostic rater who administered semi-structured interviews including the DSM-5 Mixed Features Specifier Interview. The patients were rated on clinician rating scales of depression, anxiety and irritability, and measures of psychosocial functioning, suicidality, and family history of bipolar disorder. Results: If the DSM-5 diagnostic threshold is lowered from 3 to 2 symptoms, then the prevalence of mixed features based on the DSM-5 majority of episode time frame tripled from 3.9% to 13.1% (n=60). Based on a past week time frame prevalence more than doubled from 9.4% to 22.9% (n=105) going from the 2 and 3 symptom threshold, respectively. There was no difference between the patients with 2 mixed features and patients with 0 or 1 mixed features on family history of bipolar disorder, psychosocial impairment, presence of comorbid disorders, age of onset, history of suicide attempts or psychiatric hospitalization. Conclusions: The results of the present study do not support lowering the DSM-5-TR diagnostic threshold for the mixed features specifier in depressed patients from 3 to 2. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Introduction: Schizophrenia is a major mental disorder that affects approximately 1% of the population worldwide. Social cognition impairments and negative symptoms such as blunted affect or emotional withdrawal strongly contribute to the psychosocial functioning deficits and long-term disability in schizophrenia. The state-like and trait-like components of social cognition are impaired in schizophrenia Objectives: Treatment effects of conventional approaches with antipsychotics or psychosocial interventions are limited when it comes to reducing negative and cognitive symptoms in schizophrenia. While there is emerging clinical evidence that new, augmented protocols based on theta-burst stimulation can increase rTMS efficacy dramatically in depression, data on similar augmented therapies are very limited in schizophrenia. The different patterns of network impairments in subjects may underlie that some but not all patients responded to given stimulation locations. Methods: Therefore, we propose an augmented theta-burst stimulation protocol in schizophrenia by stimulating both locations connected to negative symptoms, namely the vermis of the cerebellum and the left Dorsolateral Prefrontal Cortex (DLPFC). Ninety subjects with schizophrenia presenting negative symptoms and aging between 18-50 years will be randomized to active and sham stimulation in a 1:1 ratio. The TBS parameters we adopted follow the standard TBS protocols, with 3-pulse 50-Hz bursts given every 200 ms (at 5 Hz) and an intensity of 100% active motor threshold. We plan to deliver 1800 stimuli to the vermis and 1800 stimuli to the left DLPFC daily in two 9.5-minute blocks for four weeks. Results: The primary endpoint is the change in negative symptom severity measured by the Positive and Negative Syndrome Scale (PANSS). Secondary efficacy endpoints are the change in cognitive flexibility measured by the Wisconsin Card Sorting Test and the change in social cognition assessed by the 'Reading the Mind in the Eyes', facial emotion recognition, and the 'Faux pas' tests. The safety outcome is the number serious adverse events. Conclusions: In conlucion the aim of our study is to proove the safety and efficacy of theta burst stimulation for treating negativ sympotoms of schizophrenia. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Affective and non-affective psychoses are characterized by deficits in neuro and social cognition, which strongly impact the patient's psychosocial functioning and health and social system. Recent literature suggests that such deficits could benefit from the innovative combination of evidence-based interventions. This lecture aims to describe an Italian multisite (Verona, Milano, Pavia), longitudinal randomized controlled trial funded by the Italian Ministry of Health investigating the impact of Cognitive Remediation (CR) alone or combined with other approaches (namely, Mindfulness and Social Skills Training (SST)) on clinical, neuropsychological, social and brain-related outcomes in patients with a DSM5 diagnosis of affective or non-affective psychosis. In our study, patients underwent clinical and neuropsychological evaluation at baseline (T0), end of treatment (T1), and six months post-treatment (T2), which consisted of nearly four months of CR, CR+ Mindfulness, or CR + SST. The cognitive assessment included the Brief Assessment of Cognition for Schizophrenia (BAC-S) or Affective Disorders (BAC-A) and the Executive and Social Cognition Battery (ESCB), specifically designed to identify impairments in social cognition and executive functions in patients' real life. Participants underwent a 3T multimodal MRI, including structural and functional sequences at T0 and T1. We also recruited healthy controls for comparative brain mapping at T0. The present lecture will provide an overview of the research project, along with some preliminary findings on the effect of CR alone or combined with other interventions on clinical and social functioning and brain plasticity, with a focus on the degree of durability and generalization of CR effects to patients' real life. The study's outcomes have the potential to inform clinical and rehabilitative settings and tailor combined therapeutic interventions. Disclosure of Interest: C. Perlini Grant / Research support from: Italian Ministry of Health GR-2016-02361283 [ABSTRACT FROM AUTHOR]

Introduction Cognitive impairment is known as a core feature in bipolar patients. Persisting neurocognitive impairment has been associated with low psychosocial functioning. Objectives The goal of this work was to identify clinical and cognitive predictors for functional impairment, symptom severity and early recurrence in bipolar disorder, as well as to compare the neurocognitive performance of bipolar patients with that of healthy probands. Methods 43 remitted bipolar patients and 40 healthy controls were compared using a neurocognitive battery testing specifically attention, memory, verbal fluency and executive functions. In a randomized controlled trial, the 43 remitted patients were assigned to two treatment conditions as add-on to state-of-the-art pharmacotherapy: cognitive psychoeducational group therapy over 14 weeks or treatment-as-usual. At 12 months after therapy, functional impairment and severity of symptoms were assessed. Results As compared to healthy probands, bipolar patients showed lower performance in executive function (perseverative errors p

Background. People with severe mental illnesses (SMI) have a mortality rate two times higher compared to the general population, with a decade of years of life lost. In this randomized controlled trial (RCT), we assessed in a sample of people with bipolar disorder, major depressive disorder, and schizophrenia spectrum disorder, the efficacy of an innovative psychosocial group intervention compared to a brief psychoeducational group intervention on patients' body mass index (BMI), body weight, waist circumference, Framingham and HOMA-IR indexes. Methods. This is a multicentric RCT with blinded outcome assessments carried out in six Italian university centers. After recruitment patients were randomized to receive a 6-month psychosocial intervention to improve patients' physical health or a brief psychoeducational intervention. All recruited patients were assessed with standardized assessment instruments at baseline and after 6 months. Anthropometric parameters and blood samples have also been collected. Results. Four-hundred and two patients with a diagnosis of bipolar disorder (43.3%), schizophrenia or other psychotic disorder (29.9%), or major depression (26.9%) were randomly allocated to the experimental (N = 206) or the control group (N = 195). After 6 months, patients from the experimental group reported a significant reduction in BMI (odds ratio [OR]: 1.93, 95% confidence intervals [CI]: 1.31-2.84; p < 0.001), body weight (OR = 4.78, 95% CI: 0.80-28.27, p < 0.05), and waist circumference (OR = 5.43, 95% CI: 1.45-20.30, p < 0.05). Participants with impaired cognitive and psychosocial functioning had a worse response to the intervention. Conclusions. The experimental group intervention was effective in improving the physical health in SMI patients. Further studies are needed to evaluate the feasibility of this intervention in real-world settings. [ABSTRACT FROM AUTHOR]

Abstract Background Autism spectrum disorders (ASDs) and schizophrenia spectrum disorders (SSDs), although conceptualized as separate entities, may share some clinical and neurobiological features. ASD symptoms may have a relevant role in determining a more severe clinical presentation of schizophrenic disorder but their relationships with cognitive aspects and functional outcomes of the disease remain to be addressed in large samples of individuals. Aims To investigate the clinical, cognitive, and functional correlates of ASD symptoms in a large sample of people diagnosed with schizophrenia. Methods The severity of ASD symptoms was measured with the PANSS Autism Severity Scale (PAUSS) in 921 individuals recruited for the Italian Network for Research on Psychoses multicenter study. Based on the PAUSS scores, three groups of subjects were compared on a wide array of cognitive and functional measures. Results Subjects with more severe ASD symptoms showed a poorer performance in the processing speed (p = 0.010), attention (p = 0.011), verbal memory (p = 0.035), and social cognition (p = 0.001) domains, and an overall lower global cognitive composite score (p = 0.010). Subjects with more severe ASD symptoms also showed poorer functional capacity (p = 0.004), real-world interpersonal relationships (p

AbstractBackground.Cognitive impairment associated with lifetime major depressive disorder (MDD) is well-supported by meta-analytic studies, but population-based estimates remain scarce. Previous UK Biobank studies have only shown limited evidence of cognitive differences related to probable MDD. Using updated cognitive and clinical assessments in UK Biobank, this study investigated population-level differences in cognitive functioning associated with lifetime MDD.Methods.Associations between lifetime MDD and cognition (performance on six tasks and general cognitive functioning [g-factor]) were investigated in UK Biobank (N-range 7,457–14,836, age 45–81 years, 52% female), adjusting for demographics, education, and lifestyle. Lifetime MDD classifications were based on the Composite International Diagnostic Interview. Within the lifetime MDD group, we additionally investigated relationships between cognition and (a) recurrence, (b) current symptoms, (c) severity of psychosocial impairment (while symptomatic), and (d) concurrent psychotropic medication use.Results.Lifetime MDD was robustly associated with a lower g-factor (β = −0.10, PFDR = 4.7 × 10−5), with impairments in attention, processing speed, and executive functioning (β ≥ 0.06). Clinical characteristics revealed differential profiles of cognitive impairment among case individuals; those who reported severe psychosocial impairment and use of psychotropic medication performed worse on cognitive tests. Severe psychosocial impairment and reasoning showed the strongest association (β = −0.18, PFDR = 7.5 × 10−5).Conclusions.Findings describe small but robust associations between lifetime MDD and lower cognitive performance within a population-based sample. Overall effects were of modest effect size, suggesting limited clinical relevance. However, deficits within specific cognitive domains were more pronounced in relation to clinical characteristics, particularly severe psychosocial impairment.

Background. Autism spectrum disorders (ASDs) and schizophrenia spectrum disorders (SSDs), although conceptualized as separate entities, may share some clinical and neurobiological features. ASD symptoms may have a relevant role in determining a more severe clinical presentation of schizophrenic disorder but their relationships with cognitive aspects and functional outcomes of the disease remain to be addressed in large samples of individuals. Aims. To investigate the clinical, cognitive, and functional correlates of ASD symptoms in a large sample of people diagnosed with schizophrenia. Methods. The severity of ASD symptoms was measured with the PANSS Autism Severity Scale (PAUSS) in 921 individuals recruited for the Italian Network for Research on Psychoses multicenter study. Based on the PAUSS scores, three groups of subjects were compared on a wide array of cognitive and functional measures. Results. Subjects with more severe ASD symptoms showed a poorer performance in the processing speed (p=0.010), attention (p=0.011), verbal memory (p=0.035), and social cognition (p=0.001) domains, and an overall lower global cognitive composite score (p=0.010). Subjects with more severe ASD symptoms also showed poorer functional capacity (p =0.004), real-world interpersonal relationships (p < 0.001), and participation in community-living activities (p<0.001). Conclusions. These findings strengthen the notion that ASD symptoms may have a relevant impact on different aspects of the disease, crucial to the life of people with schizophrenia. Prominent ASD symptoms may characterize a specific subpopulation of individuals with SSD. [ABSTRACT FROM AUTHOR]

Background. While polypharmacy is common in long-term residential psychiatric patients, prescription combinations may, from an evidence-based perspective, be irrational. Potentially, many psychiatric patients are treated on the basis of a poor diagnosis. Wetherefore evaluated the DITSMI model (i.e., Diagnose, Indicate, and Treat Severe Mental Illness), an intervention that involves diagnosis (or re-diagnosis) and appropriate treatment for severely mentally ill longterm residential psychiatric patients. Our main objective was to determine whether DITSMI affected changes over time regarding diagnoses, pharmacological treatment, psychosocial functioning, and bed utilization. Methods. DITSMI was implemented in a consecutive patient sample of 94 long-term residential psychiatric patients during a longitudinal cohort study without a control group. The cohort was followed for three calendar years. Data were extracted from electronic medical charts. As well as diagnoses, medication use and current mental status, we assessed psychosocial functioning using the Health of the Nations Outcome Scale (HoNOS). Bed utilization was assessed according to length of stay (LOS). Change was analyzed by comparing proportions of these data and testing them with chi-square calculations. We compared the numbers of diagnoses and medication changes, the proportions of HoNOS scores below cut-off, and the proportions of LOS before and after provision of the protocol. Results. Implementation of the DITSMI model was followed by different diagnoses in 49% of patients, different medication in 67%, some improvement in psychosocial functioning, and a 40% decrease in bed utilization. Conclusions. Our results suggest that DITSMI can be recommended as an appropriate care for all long-term residential psychiatric patients. [ABSTRACT FROM AUTHOR]

Background. Earlier studies examining structural brain abnormalities associated with cognitively derived subgroups were mainly cross-sectional in design and had mixed findings. Thus, we obtained cross-sectional and longitudinal data to characterize the extent and trajectory of brain structure abnormalities underlying distinct cognitive subtypes ("preserved," "deteriorated," and "compromised") seen in psychotic spectrum disorders. Methods. Data from 364 subjects (225 patients with psychotic conditions and 139 healthy controls) were first used to determine the relationship of cognitive subtypes with cross-sectional measures of subcortical volume and cortical thickness. To probe neurodevelopmental abnormalities, brain structure laterality was examined. To examine whether neuroprogressive abnormalities persist, longitudinal brain structural changes over 5 years were examined within a subset of 101 subjects. Subsequent discriminant analysis using the identified brain measures was performed on an independent subject group. Results. Cross-sectional comparisons showed that cortical thinning and limbic volume reductions were most widespread in "deteriorated" cognitive subtype. Laterality comparisons showed more rightward amygdala lateralization in "compromised" than "preserved" subtype. Longitudinal comparisons revealed progressive hippocampal shrinkage in "deteriorated" compared with healthy controls and "preserved" subtype, which correlated with worse negative symptoms, cognitive and psychosocial functioning. Post-hoc discrimination analysis on an independent group of 52 subjects using the identified brain structures found an overall accuracy of 71% for classification of cognitive subtypes. Conclusion. These findings point toward distinct extent and trajectory of corticolimbic abnormalities associated with cognitive subtypes in psychosis, which can allow further understanding of the biological course of cognitive functioning over illness course and with treatment. [ABSTRACT FROM AUTHOR]

Abstract Background Bipolar disorder (BD) and schizophrenia (SZ) are characterized by neurocognitive and functional deficits with marked heterogeneity. It has been suggested that BD with a history of psychotic symptoms (BD-P) could constitute a phenotypically homogeneous subtype characterized by greater neurocognitive and functional impairments, or by a distinct trajectory of such deficits. The aim of this study was to compare the neurocognitive and functional course of euthymic BD-P, euthymic BD patients without a history of psychosis (BD-NP), stabilized patients with schizophrenia and healthy subjects, during a five-year follow-up. Methods Neurocognitive and psychosocial function was examined in 100 euthymic patients with BD (50 BD-P, 50 BD-NP), 50 stabilized patients with schizophrenia (SZ), and 51 healthy controls (HC) at baseline (T1), and after a 5-year follow-up (T2). Results The course of both neurocognitive performance and functional outcome of patients with SZ and BD (BD-P and BD-NP) is stable. The profile of neurocognitive impairment of patients with SZ or BD (BD-P and BD-NP), is similar, with only quantitative differences circumscribed to certain domains, such as working memory. The subgroup of patients with BD-NP does not show functional deterioration. Conclusions We have not found evidence of progression in the neurocognitive or psychosocial impairment in any of the three groups of patients, although it cannot be dismissed the possibility of a subset of patients with a progressive course. Other longitudinal studies with larger samples and longer duration are necessary to confirm these findings. [ABSTRACT FROM AUTHOR]

Abstract Background Even if neurocognition is known to affect functional outcomes in schizophrenia, no previous study has explored the impact of cognition on functionality in delusional disorder (DD). We aimed to assess the effect of clinical characteristics, symptom dimensions and neuropsychological performance on psychosocial functioning and self-perceived functional impairment in DD. Methods Seventy-five patients with a SCID-I confirmed diagnosis of DD underwent neurocognitive testing using a neuropsychological battery examining verbal memory, attention, working memory and executive functions. We assessed psychotic symptoms with the Positive and Negative Syndrome Scale, and calculated factor scores for four clinical dimensions: Paranoid , Cognitive , Affective and Schizoid. We conducted hierarchical linear regression models to identify predictors of psychosocial functioning, as measured with the Global Assessment of Functioning scale, and self-perceived functional impairment, as measured with the Sheehan's Disability Inventory. Results In the final linear regression models, higher scores in the Paranoid (β = 0.471, p <.001, r2 = 0.273) and Cognitive (β = 0.325, p <.001, r2 = 0.180) symptomatic dimensions and lower scores in verbal memory (β = −0.273, p <.05, r2 = 0.075) were significantly associated with poorer psychosocial functioning in patients with DD. Lower scores in verbal memory (β = −0.337, p <.01, r2 = 0.158) and executive functions (β = −0.323, p <.01, r2 = 0.094) were significantly associated with higher self-perceived disability. Conclusions Impaired verbal memory and cognitive symptoms seem to affect functionality in DD, above and beyond the severity of the paranoid idea. This suggests a potential role for cognitive interventions in the management of DD. [ABSTRACT FROM AUTHOR]

Background Anhedonia is a core symptom of major depression and a key prognostic factor that is often poorly explored in clinical trials of major depressive disorder (MDD). Beyond symptomatic remission, psychosocial functioning also reveals difficulty in achieving remission in patients with MDD. The main objective of this study was to explore the interrelationships between social functioning and anhedonia on a longitudinal basis. Methods In total, 1570 outpatients treated for MDD with agomelatine were included. Severity of depression and levels of anhedonia and of psychosocial functioning were assessed at inclusion and at 10–14 weeks, with specific standardized scales (MADRS, QFS, SHAPS, CGI). Multivariate regression and mediation analyses were performed. Results Using multivariate regression, we showed that improvement of anhedonia was the strongest predictor of improvement in psychosocial functioning (odds ratio = 7.3 [4.3–12.1] P < 0.0001). In addition, mediation tests confirmed that the association between improvement of depressive symptoms and improvement of social functioning was significantly underpinned by the improvement of anhedonia over time. Finally, we explored the determinants of the dissociation of the response, i.e., the persistence of psychosocial dysfunctioning despite a symptomatic response to antidepressant treatment, which remains a widespread situation in clinical practice. We showed that this dissociation was strongly predicted by persistence of anhedonia. Conclusion Our results suggest that anhedonia is one of the strongest predictors of psychosocial functioning, along with symptomatic remission, and should be carefully assessed by health professionals, in order to optimize pharmacological as well as non-pharmacological management of depression. [ABSTRACT FROM AUTHOR]

Objective Negative symptoms are known to undermine functional outcomes in people with schizophrenia; however, most studies have not accounted for whether these symptoms were primary or secondary to other psychopathological factors. The present study examined the impact of primary negative symptoms on functional outcomes in patients with schizophrenia. Method The sample included 1427 patients with schizophrenia who completed the baseline visit in the CATIE study. Symptoms were assessed with the Positive and Negative Syndrome Scale and Calgary Depression Scale, extrapyramidal side effects with the Simpson-Angus scale, and functional status with the Heinrichs-Carpenter Quality of Life Scale. Results Negative symptoms were significantly and inversely related to each domain of functioning examined. These relationships remained after statistically controlling for the influence of potential sources of secondary negative symptoms. In addition, the relationships between negative symptoms and specific domains of functioning remained in patients who had mild/absent positive, depressive, anxiety and extrapyramidal symptoms. Negative symptoms were associated with functional outcomes even in antipsychotic-free patients. Conclusions Primary negative symptoms significantly contribute to the functional impairment seen in people with schizophrenia. A better understanding of the etiology and pathobiology of these symptoms is required to guide the search for effective therapeutics that promote functional recovery. [ABSTRACT FROM AUTHOR]

Introduction: Sexual offenders are classified in terms of the act they have committed, diagnosis of sexual preference disorder (paraphilic disorder), and the potential motives behind the act. The typology that is often used in forensic-sexological practice is the division into preferential and non-preferential perpetrators, i.e. perpetrators showing or not showing a sexual preference disorder. Objectives: The aim of the study was to assess whether psychosocial and personality variables significantly differ between the group of preferential and non-preferential sexual offenders. Methods: The study involved 120 persons, including 60 preferential and 60 non-preferential sexual offenders. The participants were presented with selected, standardized psychological tools to personality traits, self-esteem, life satisfaction, capacity to understand emotions, attachment style. Results: The study involved 120 persons, including 60 preferential and 60 non-preferential sexual offenders. The participants were presented with selected, standardized psychological tools to personality traits, self-esteem, life satisfaction, capacity to understand emotions, attachment style. Conclusions: Differences between the both study groups and the male standardization sample suggest worse psychosocial functioning of sexual offenders. A critical analysis of the methodological limitations of this study have been presented. Conflict of interest: Scientific work was financed from the budget for science in the years 2017-2021, as a research project DI 16/003046 under the programme „Diamond Grant". [ABSTRACT FROM AUTHOR]

Introduction: The inter-critical phase in bipolar disorder may contain symptoms that do not meet the diagnostic criteria for a thymic episode. According to studies, these symptoms are common and usually associated with impaired psychosocial and family functioning. Objectives: Study the subsyndromal symptoms in remitted patients with bipolar disorder, and their functioning repercussions. Methods: We conducted a cross-sectional, descriptive and analytical study, in the outpatient psychiatry department of the University Hospital in Sfax (Tunisia) among 30 remitted patients with bipolar disorder. We used: the Montgomery And Asberg Depression Rating Scale (MADRS), the Angst Hypomania Questionnaire and the FAST test to assess functioning levels. Results: The average age of our population was 44.37±15.45 years with a sex ratio (M/F) =0.66. Most of them lived in urban areas (60%) and half of them did not go beyond the primary school level. Most did not have a constant job (76.6%). The average number of previous thymic episodes was 2±1.33 times/year. A quarter of the patients (26.6%) had hypomanic symptoms in the intercritical phase and 20% had depressive symptoms. Hypomanic symptoms were correlated with tobacco use (p=0.035). Depressive symptoms weremore frequent in men (p=0.074). Functioninglevel was lower in subjects living in rural areas (p=0.065). Conclusions: Our study suggests that residual symptoms were frequent with a significant functional impact. As a result, their identification and management are highly essential to improve the overall functioning of patients with bipolar disorder. [ABSTRACT FROM AUTHOR]

In this presentation a model for the management of difficult to treat depression (DTD) will be presented based upon a recently published international consensus statement (McAllister-Williams et al. 2020 Journal of Affective Disorders 267:264-282). This model emphasises the goals of: optimal symptom control - remission if possible; optimisation of psychosocial functioning; and optimisation of prophylaxis against relapse/deterioration in mood. Building on these goals, the model follows a number of principles. These include emphasizing the importance of shared decision making and measurement-based care, enhancing engagement and retention in services, self-management strategies and frequent re-assessments, all incorporated in an integrated service pathway. The model itself encompasses eight elements: 1. Optimal symptom control using conventional, guideline recommended, treatments but moving on to treatments beyond guidelines in an appropriate and timely way; 2. Targeting symptoms associated with poor outcomes, e.g. anxiety and pain; 3. Targeting symptoms associated with poor functioning and quality of life such as sleep difficulties, fatigue and cognitive dysfunction; 4. Screening for and managing physical, psychiatric, substance misuse and iatrogenic comorbidities; 5. Optimisation of long-term treatment; 6. Using self-management techniques to empower patients; 7. Using integrated health services to help provide a sense of containment and ensure wide consideration of treatment options; and 8. Establishing regular reviews of the patient's diagnosis and treatment. Examples of each of these elements will be provided. [ABSTRACT FROM AUTHOR]

Persistent negative symptoms are associated with worse outcome in both first-episode and chronic subjects with schizophrenia. The identification of these symptoms in recent-onset subjects is still controversial as retrospective data are often unavailable. The prospective assessment of persistence of negative symptoms might represent a valid alternative but the length of the persistence is still to be established. The present study investigated the prevalence of negative symptoms of moderate severity, unconfounded by depression and extrapyramidal symptoms at baseline in a large cohort of patients in the early stage of a schizophrenia-spectrum disorder, recruited to the OPTiMiSE trial. Persistent unconfounded negative symptoms were assessed at 4, 10 and 22 weeks of treatment. Symptomatic remission, attrition rate and psychosocial functioning was evaluated in subjects with short-term (4 weeks) persistent negative symptoms (PNS) and in those with negative symptoms that did not persist at follow-up and/or were confounded at baseline (N-PNS). Negative symptoms of moderate severity were observed in 59% of subjects at baseline and were associated to worse global functioning. PNS were observed in 7.9% of the cohort, unconfounded at both baseline and end of 4-week treatment. PNS subjects showed lower remission and higher attrition rates at the end of all treatment phases. Fifty-six percent of subjects completing phase 3 (clozapine treatment) had PNS, and 60% of them were non-remitters at the end of this phase. The presence of short-termPNS during the first phases of psychosiswas associatedwith poor clinical outcome and resistance to antipsychotic treatment, including clozapine. [ABSTRACT FROM AUTHOR]

Patients with bipolar disorders (BD) suffer from cognitive deficits across memory, attention, processing speed and executive function during periods of remission with a huge impact on functional recovery. The association between cognitive performance and psychosocial functioning has led to emergence of neurocognition as a new treatment target. Moreover, cognitive impairment in the remitted phase of BD is on average of a moderate effect size. However, recent studies indicate substantial cognitive heterogeneity in remitted BD patients, and most importantly, patients with either global or selective cognitive impairments showed lower levels of functioning and reported poorer quality of life. Cognitive impairments may reflect neurodevelopmental factors, such as genetic susceptibility and illness progression, including potential neurotoxic effects of recurrent episodes as well as chronic medication use. It is important to identify patients with persistent cognitive deficits, to characterize the pattern of their impairments, and to implement strategies for remediating these deficits to improve not only the clinical management and neurocognitive impairment but also functional outcome. Therefore, neurocognitive impairment needs to be considered a therapeutic clinical target, from early stages, in order to improve both psychosocial functioning and quality of life of patients with BD. Despite the increase of research investigating new pharmacological and non-pharmacological treatments over the last decade, no robust evidence of therapeutic interventions targeting cognitive deficits is currently available, due to insufficient data, and further research is needed to be largely explored and draw firm conclusions. [ABSTRACT FROM AUTHOR]

Introduction: The presence of negative symptoms in early psychosis is variable. However, its persistence has been associated with a worsening prognosis and impaired functionality. Objectives: To determine the influence of negative symptoms on functional outcomes, in the early stages of psychosis. Methods: An observational study was designed on a sample of 41 outpatients, aged between 18 and 45 years, who had presented a first episode of psychosis, without a substance use disorder, during the last three years. A semi-structured interview collected the main sociodemographic characteristics and negative symptoms were explored using the Positive and Negative Syndromes Scale (PANSS). The Functioning Assessment Short Test (FAST) was applied, focusing on six areas (autonomy, occupational and cognitive functioning, financial issues, leisure) to quantify the functionality. Statistical analysis was performed using SPSS v21.0 (statistical significance p <0.05). Results: The patient profile was a male (55%), with a mean age of 30.5 years (SD = 7.2), single (87.5%), student (47.5%), living in urban areas (82,5%) with the family (60%). The average age of psychotic debut stood at 25.8 years (SD = 6.9). Standardized PANSS-Negative scores were positively correlated significantly with the standardized results of FAST-Total (r= 0.385; p= 0.015) and FAST-Cognitive (r= 0.478; p= 0.002), respectively. Negative symptoms explained 12% of the variance of total functioning (R2= 0.115) and 20% of the variance of cognitive functioning (R2= 0.196; p= 0.005). Conclusions: The presence of negative symptoms in early stages of psychosis appears to increase the impairment of psychosocial functioning and cognition. [ABSTRACT FROM AUTHOR]

Introduction: Negative symptoms are a core feature of schizophrenia. The CAINS (Clinical Assessment Interview for Negative Symptoms) is an empirically-developed "second generation" scale for the assessment of negative symptoms. Objectives: We examined the psychometric properties of the CAINS scale and their comparative value regarding the Scale for the Assessment of Negative Symptoms (SANS) for predicting psychosocial outcome. Methods: A total of 98 consecutive admissions with schizophrenia spectrum psychosis were administered the SANS at admission and discharge times, and the CAINS at discharge time. The Global Assessment of Functioning (GAF) and World Health Organization Disability Assessment Schedule (WHODAS) were used for the assessment of psychosocial functioning. Results: The CAINS motivation/pleasure and expression subscales correlated significantly with all of the SANS subscales, both for admission and discharge, with the exception of attention. The CAINS motivation/pleasure score was significantly associated with other psychopathological dimensions at discharge, such as positive, disorganized and illness unawareness dimensions but inversely with mania dimension. And the CAINS expression subscale was only inversely and significantly associated with mania dimension at admission. Factor analysis of CAINS items revealed a two-dimensional structure that explained the 81.62% of the variance. Both CAINS and SANS subscales were strongly associated with WHODAS and GAF psychosocial functioning scores. Conclusions: These findings suggest that the CAINS Spanish version is a valid tool for measuring negative symptoms in schizophrenia. And despite both high scores on both CAINS and SANS scales showed significant associations with poor functioning, it seems that the associations of CAINS scores were less strong than those of SANS scale. [ABSTRACT FROM AUTHOR]

Introduction: Cognitive dysfunction is a major feature of bipolar disorder (BD), strongly associated with patients' functional outcome. Objectives: The main objective is to assess functional remediation (FR)1 efficacy in improving cognitive deficits (measured by BAC-A) and psychosocial functioning (measured by FAST) in a sample of euthymic patients with BD, compared to standard treatment (TAU). Other secondary endpoints are to identify biomarkers for FR response, through serum BDNF levels and functional neuroimaging techniques. Methods: Two arms (1:1) randomized, rater-blinded, controlled study of 72 out-patients with BD-I and BD-II, according to DSM-5 criteria. Patients between 18 and 55 years in euthymic phase for at least two months prior to study entry will be enrolled. All patients will be assessed at baseline, at the end of treatment and after a 6-months follow-up with clinical (Y-MRS and HAM-D), neurocognitive (BAC-A) and psychosocial functioning (FAST) measures. At the same times, serum assessment of BDNF levels and functional neuroimaging techniques will be performed. Results: The main result expected is that, after treatment, patients receiving FR show better cognitive and psychosocial performance than those receiving TAU. Other expected findings are associated with any differences in serum BDNF levels and functional brain changes related to cognitive and functional improvement after FR. Conclusions: There is the need of new non-pharmacological interventions in BD in order to improve not only affective symptoms, but also cognitive dysfunctions, with the final goal to achieve full functional recovery. If FR will confirm its effectiveness, it should be implemented in the standard care of BD. [ABSTRACT FROM AUTHOR]

Background. – Depression is a disorder that causes disability, with a profound adverse impact on all areas of psychosocial functioning. This is particularly true for those with treatment resistant depression (TRD). However, to date, no systematic assessments of psychosocial functioning for patients with TRD have been conducted.Methods. – In the present study, we used the Longitudinal Interval Follow-up Evaluation (LIFE) scale to measure psychosocial functioning in 92 patients with TRD. These patients met formal criteria for TRD and were part of a clinical trial examining the efficacy of lithium augmentation of nortriptyline.Results. – Clinicians rated this sample of patients as experiencing mild to moderate impairment in work-related activities, good to fair interpersonal relations, poor level of involvement in recreational activities, and mild impairment of ability to enjoy sexual activity. Patients and clinicians rated global social adjustment as poor.Conclusions. – Patients with formally defined TRD experience significant impairment in psychosocial functioning. In this sample a tendency existed for both clinicians and patients to assign more severely impaired global ratings when compared with ratings for specific functional areas. [Copyright &y& Elsevier]

Introduction: Individuals with CLP may present communication disorders, velopharyngeal dysfunction, dento-occlusal changes and hearing losses. Adolescents with CLP usually show greater impairment of communication. Such characteristics combined with the malformed face can impact psychosocial functioning and increase the risk of psychological difficulties. Life-stressing experiences from CLP to life events typical of adolescence, may threaten the wellbeing of the adolescent, and are linked to mental health and behavioral problems. Objectives: To verify the coping of adolescents with CLP through a descriptive cross - sectional study. Methods: Fifteen adolescents with CLP participated in the study. To evaluate them it was used the Coping scale (Lees, 2007), for the verification of coping in the families proposed by Motivational Theory of Coping. The analysis of the coping of adolescents with CLP considered two adverse contexts, namely "birth with fissure" and "have your secret told by a friend ". Results: In relation to the evaluation of the psychological needs of relationship, competence and autonomy faced the "birth with fissure" indicates that teens with fissures do not perceive this stressor as a threat to their basic psychological needs. Conclusions: The adolescents with CLP who participated in the study feel more interested (perception of the challenge) in dealing with the stressor relative to the fissure than in dealing with the betrayal of a friend, who reveals a secret of his to other people. [ABSTRACT FROM AUTHOR]

Introduction: Insight is a complex and multidimensional phenomenon. Metacognition, awareness of illness or anosognosia are some of the terms used to designate this feature of the mental state exam. Objectives: To attempt to explore the evolution of the concept of insight as a psychiatric symptom over the years and to bring up some up-to-date features on this theme. Methods: Literature review, using the most relevant papers, with the keywords "psychiatric insight", "awareness of illness", "metacognition" and "phenomenology". Results: The term 'insight' has been described since 1896 when Kraepelin had noticed that patients with dementia praecox were unaware of their condition. Nowadays, it is recognized in several psychiatric disorders, with different meanings in each one. Overall, insight in psychiatry involves an attempt to see one's thinking and behaviour 'objectively' and comparing it to some representation of mental health. Impaired insight has been linked to poor treatment compliance and outcomes, overall symptom severity, higher relapse, lower self-esteem, and impaired psychosocial functioning. White matter and connectivity problems may be related to poorer insight, as well as impaired frontal lobe functioning. In psychotic disorders, lack of insight is a primary symptomwith poorer outcomes. Regarding affective disorders, the lower the mood the better the insight. Neuroimaging has been correlating insight with the inferior frontal gyrus, anterior insula, inferior parietal lobule, and ventromedial prefrontal cortex. In everyday practice, there are scales used to assess insight. Conclusions: Inferences about patients' insight are important to evaluate severity of illness, suicidal risk, compliance, and response to treatment. [ABSTRACT FROM AUTHOR]

Introduction: Patients with bipolar disorder (BD) frequently experience residual symptoms, problems in psychosocial functioning, cognitive impairment, and poor quality of life (QOL). Objectives: * To evaluate the QOL of euthymic patients with BD compared to healthy controls (HC). * To identify factors associated with its deterioration. Methods: This is a comparative and analytical study, conducted over 3 months, involving 30 euthymic patients with BD, followed up in the outpatient psychiatry department of Hedi Chaker University Hospital in Sfax (Tunisia). They were compared to 34 HC. General, clinical and therapeutic data were collected using a preestablished questionnaire. QOL was assessed with the «36 item Short-Form Health Survey» (SF-36). Results: The mean ages of BD patients and HC were 44.17 years and 40.1 years, respectively. Compared with HC, patients with BD had decreased overall SF-36 scores (53.73 vs 73.78; p=0.000) and decreased physical and psychological subdomain scores (p=0.001; p=0.000). The study of the relationship between the dimensional average scores and different variables revealed correlations between; physical health problems and somatic disease (p=0.021) and unemployment (p=0.001), impaired general health and somatic disease (p=0.02) and psychotropic association (p=0.021), emotional health problems and psychiatric family history (p=0.023), pain and psychotropic association (p=0.031), and impaired global QOL and psychiatric family history (p=0.05). Conclusions: Our results confirm the impairment of the QOL of patients with BD even in euthymic periods. Many factors have been associated, including demographic and clinical variables. The improvement of QOL is to consider these factors in the management of these patients. [ABSTRACT FROM AUTHOR]

Introduction: Several studies have shown that residual mood symptoms affect the psychosocial functioning of patients with bipolar disorder (BD) in euthymia. Objectives: To evaluate specific areas of functioning in this population and to explore the relationship with residual mood symptoms. Methods: This is a descriptive and analytical cross-sectional study including patients with BD (DSM V) in euthymia followed on ambulatory basis to the Mood Disorders Unit of the Psychiatry A Department at Hedi Chaker Hospital in Sfax between January and April 2019. Patients were considered euthymic if they scored below 7 on the Young Mania Assessment Scale (YMRS) and under 8 on the Hamilton Depression scale (HDRS-17). Residual manic and depressive mood symptoms were assessed using YMRS and HDRS-17. The Short Function Evaluation Test (FAST) was used to evaluate the overall and specific functionning domains. The alteration of the domain-specific functioning is defined by the following thresholds: autonomy>1, professional functioning>1, cognitive functioning>2, financial problems>1, interpersonal relations>3 and leisure time>3. Results: We recruited 62 patients with a mean age of 45.65 years (SD = 13.3) and a sex ratio 1.13.The medians of YMRS and HDRS scores were respectively 2[0-5] and 2[0-7]. Global functionning impairment was observed in 85.5% of patients. Marked impairment of professional and cognitive functioning was observed in 98.4% and 77.4%, respectively. Alteration of the relational sphere was significantly more frequent in patients with residual depressive symptoms (p=0.009); impairment of autonomy was significantly more frequent in subjects with manic residual symptoms (p=0.005). Conclusions: Residual symptoms should be considered as specific targets of treatment to improve functioning. [ABSTRACT FROM AUTHOR]

Introduction: Social cognition has been associated with functional outcome in patients with first episode psychosis (FEP). Social cognition has also been associated with neurocognition and cognitive reserve. Although cognitive reserve, neurocognitive functioning, social cognition, and functional outcome are related, the direction of their associations is not clear. Objectives: The aim of the study was to analyze the influence of social cognition as a mediator between cognitive reserve and cognitive domains on functioning in FEP both at baseline and at 2 years. Methods: The sample of the studywas composed of 282 FEP patients followed up for 2 years. To analyzewhether social cognitionmediates the influence of cognitive reserve and cognitive domains on functioning, a path analysis was performed. The statistical significance of any mediation effects was evaluated by bootstrap analysis. Results: At baseline, as neither cognitive reserve nor the cognitive domains studied were related to functioning, the conditions for mediation were not satisfied. Nevertheless, at 2 years of follow-up, social cognition acted as a mediator between cognitive reserve and functioning. Likewise, social cognition was a mediator between verbal memory and functional outcome. The results of the bootstrap analysis confirmed these significant mediations (95% bootstrapped CI (-10.215 to -0.337) and (-4.731 to -0.605) respectively). Conclusions: Cognitive reserve and neurocognition are related to functioning, and social cognition mediates in this relationship. [ABSTRACT FROM AUTHOR]

Introduction: The growing prevalence of severe cognitive impairment in populations, the involvement of a significant number of people of working age in the medical, psychological and social problems associated with dementia, the insufficiency and inconsistency of information about the mechanisms of formation of these disorders actualize a comprehensive social study of dementia. Objectives: the psychosocial mechanisms of the formation of clinical, functional disorders in dementia, to develop comprehensive medical and psychosocial programs to help patients with dementia and those involved in caring for them, based on the proposals of the psychosocial model of dementia Methods: A selective observational comparative dynamic study of 315 people with Alzheimer's dementia and 214 people who care for the patients was carried out. Results: Changes in family-role and social parameters, a high level of "expressed" emotions of caregivers have an adverse effect on the development of psychotic (r = 0.618), affective (r = 0.701), behavioral (r = 0.837) dementia disorders. The degree of adherence to anti-dementia therapy by the caregiver is one of the important factors determining the amount of care received by the patient (r = 0.698). Agitation / aggression (r = 0.761), anxiety (r = 0.562), sleep disturbances (r = 0.521) contribute to increased compliance. The low satisfaction of the caregiver with premorbid (r = 0.698) and current (r = 0.653) relationships with the patient leads to a decrease in the compliance of the caregiver. Conclusions: The mechanism of psychopathological symptoms, functional disorders is heterogeneous, depending on the biological causes and psychosocial conditions of functioning of patients. [ABSTRACT FROM AUTHOR]

Introduction: Cognitive impairment is known as a core feature in bipolar patients. Persisting neurocognitive impairment has been associated with low psychosocial functioning. Objectives: The goal of this work was to identify clinical and cognitive predictors for functional impairment, symptom severity and early recurrence in bipolar disorder, as well as to compare the neurocognitive performance of bipolar patients with that of healthy probands. Methods: 43 remitted bipolar patients and 40 healthy controls were compared using a neurocognitive battery testing specifically attention, memory, verbal fluency and executive functions. In a randomized controlled trial, the 43 remitted patients were assigned to two treatment conditions as add-on to state-of-theart pharmacotherapy: cognitive psychoeducational group therapy over 14 weeks or treatment-as-usual. At 12 months after therapy, functional impairment and severity of symptoms were assessed. Results: As compared to healthy probands, bipolar patients showed lower performance in executive function (perseverative errors p<0.01, categories correct p<0.001), sustained attention (total hits p<0.001), verbal learning (delayed recall p<0.001) and verbal fluency (pwords p<0.002). Cognitive psychoeducational group therapy and attention predicted occupational functioning with a hit ratio of 87.5%. Verbal memory recall was found to be a predictor for symptom severity (hit ratio 86.8%). Recurrence in the follow-up period was predicted by premorbid IQ and by years of education (hit ratio 77.8%). Conclusions: Our data show that bipolar patients benefit from cognitive psychoeducational group therapy in the domain of occupational life. Reductions in sustained attention have an impact on occupational impairment. [ABSTRACT FROM AUTHOR]

Introduction: Patients with schizophrenia (SZ) and bipolar disorder (BD) share a wide range of neurocognitive deficits, whose longterm course stills nuclear (Balanza et al., 2009). Some studies have found a progressive impairment of cognitive function in patients with SZ, whereas others have observed stability, or even an improvement in some cognitive domains (Szoke et al., 2008). Additionally, it has been suggested that neurocognitive deficits of patients with BD remain stable throughout time. Objectives: To examine the course of psychosocial functioning in a sample of patients stable with a diagnosis of SZ and euthymic patients with BD, related to healthy controls (HC) Methods: Fifty-five euthymic patients with BD, 76 stabilized patients with SZ and 25 HCs were assessed at the beginning of the study (T1) and after five years (T2). The clinical status was determined using the Spanish version of the Positive and Negative Syndrome Scale (PANSS), the Hamilton Depression Rating Scale (HDRS), and the Young Mania Rating Scale (YMRS). Additionally, the functional outcome was assessed with the Spanish version of the Quality of Life Scale (QLS) and the Global Assessment Functioning Scale (GAF). The statistical analysis was carried out with repeated measures MANOVA. Age, sex and education were used as covariates. Results: The repeated-measures MANOVA did not show the existence of a significant group x time interaction for the Clinical and functional variables. There was no effect of time for any functional measure. Conclusions: The impairment of psychosocial function in patients with BD and SZ is stable. [ABSTRACT FROM AUTHOR]

Introduction: Studies indicate that prior to the development of overt psychosis there is a prodromal stage characterized by the presence of tenuous psychotic symptomatology and/or deterioration in psychosocial functioning. 20%-35% of patients aged 12-35 years in the prodromal phase progress to frank psychotic episode within 2 years. Identification and treatment of these patients may prevent/delay progress and promote recovery. Objectives: Gather a set of theoretical conceptions about the manifestations of a first-episode psychosis. Methods: Analysis of the patient's clinical process and brief literature review, based on a search for scientific articles published in PubMed. Results: A 22-year-old male patient with no psychiatric history was brought to the Emergency Room following parasuicidal behaviour with pesticides. He was hospitalized for 10 days, discharged with sertraline 50mg, trazodone 100mg and alprazolam 0.5mg and referred to a Psychology consultation. After a week, hemade another suicide attempt with bleach and car antifreeze. In both episodes, he denied precipitating factors and death intent "I'm being tempted by someone to behave this way, which I don't identify with. I feel like someone else". He said he felt anxious, "lost", with emotional instability and feelings of insecurity in the face of simple tasks. Conclusions: This case report reinforces the importance of valuing behavioural changes/symptoms suggestive of the presence of a firstepisode psychosis. Diagnosis during the prodromal stage improves outcomes. There are tools to assist in detecting individuals at high risk for progression to psychosis. Despite much research, evidence on the effectiveness of treatments available to reduce this risk remains preliminary. [ABSTRACT FROM AUTHOR]

Introduction: Social cognitive dysfunctions contribute to the deficits of psychosocial functioning of people on the Schizophrenia Spectrum. Recently, the focus has turned to the area of affective disorders, with respect to social cognition and alexithymia. Objectives: Evaluation of abilities and potential differences in alexithymia and the capacity of facial emotion recognition in individuals suffering with disorders on the schizophrenia or the affective (unipolar depressive) spectrum. Methods: We evaluated two groups of 26 participants each, diagnosed with either a Schizophrenia Spectrum Disorder (SDD) or Recurrent Depressive Disorder (RDD) hospitalized in the Psychiatry Clinic of Timisoara, Romania. The analyzed parameters were: socio-demographic, clinical, alexithymia (Toronto Alexithymia Scale), and the ability to identify emotions (Reading the Mind in the Eye Test). Results: We established that 57.69% of SSD subjects had alexithymia, while 19.23% had possible-alexithymia and 23.07% were nonalexithymic. Most of the subjects had a low ability to identify emotions (84.61%). In regards to theRDDgroup, all 26 participants had alexithymia, while almost 74% of them had a lower than normal ability to correctly identify emotions. Conclusions: The SSD participants showed clear deficits describing and identifying emotions. Overall, the RDD group had similar results, but slightly better abilities of recognizing others' emotions in the eyes. Our results suggest that difficulties recognising facially expressed emotions and alexithymia could possibly be linked in both spectra. These populations may benefit from tailored social skills training and intervention programs that offer service users more accurate recognition of relapse signs leading to timelier help-seeking. [ABSTRACT FROM AUTHOR]

Introduction: Level of mental disorders is extremely high in Ukraine. It represents a huge cost to economy. Mental illness, lack of mental wellbeing negatively impact on the life quality. Recently, there has been an increased emphasis on accountability in health care service delivery, a concern that often goes hand-in-hand with the issue of competence. Objectives: In September 2019, the Institute of Cognitive Modeling (ICM) was opened in Kyiv. We consider this event to be outstanding for Ukrainian medicine, it gives an opportunity for ensuring high quality of care in line with international protocols and standards. The main goal of the ICM is supporting the promotion of mental wellbeing and the primary prevention of mental disorders. This goal canbe achieved by psychoeducational work on the principles of evidence-based medicine. Methods: ICM will be focused on computer-based implementation yielding quantitative predictions of behavior, cognitive processing steps, of neural activity; psychodiagnosis, psychoeducation, pharmacotherapy, psychotherapy and up-to-date digital technologies. Results: Mostly young scientists and students will work therewith the aim to reduce the emigration of young specialists. Furthermore, Ukraine needs quick changes that is why we will most of all influence such population category as employees. We will try to recognise the mental health (MH) needs of the workforce, promote a culture of good MH for employees, optimize the work according to personal characteristics to ensure early help-seeking and supporting return to work. Conclusions: We expect to create a prevention-focused approach, increase MH awareness and psychosocial functioning, improve accessibility of MH services, decrease discrimination and human rights violations. [ABSTRACT FROM AUTHOR]

Introduction: In the structure of the mental disorders depression holds the leading position. In recent years, there has been an increase of publications showing the combination of depression and psychosocial maladaptation, which both acts as a derivative in the clinic of depressive disorders and as an independent phenomenon, having a distinct effect on their course. Objectives: The purpose of the work is to study to study of relationships of structure and severity of manifestations of psychosocial maladaptation and anxiety-depressive symptoms in women with depressive disorders of different genesis. Methods: 252 women with a diagnosis of depressive disorder were examined: 94 people with depressive disorder of psychogenic genesis, 83 women with endogenous depression and 75 patients with depressive disorder of organic genesis. The patients were divided into groups depending on the genesis of the depressive disorder and the presence and severity of problems in psychosocial functioning. The study was conducted using clinical-psychopathological and psychodiagnostic methods. Results: As a result of the study, it was found that genesis of depression has been found to have the greatest impact on depression in the absence of signs of maladaptation and its mild degree. As the severity of maladaptation increases, the impact of the genesis of depression decreases and is less severe in severe maladaptation. Anxiety is less dependent on the genesis of depression, and is more determined by the degree of maladaptation. Conclusions: Thus, in determining the directions of psychotherapeutic and rehabilitation management of depressive disorders in women, it is mandatory to take these parameters into account. [ABSTRACT FROM AUTHOR]

Introduction: Bipolar disorder (BD) is one of the most disabling psychiatric disorders. Carbolithium is the first-line therapy in BD, but has important adverse effects and a narrow therapeutic range, affecting patients' compliance and quality of life. Objectives: investigate effects of switching from Carbolithium to corresponding Sulphate formulation in a group of bipolar patients in order to evaluate any difference in psychosocial functioning and quality of life. Methods: 15 patients diagnosed with BD were enrolled. All patients were stabilized with Carbolithium and then treated by the corresponding Lithium Sulphate formulation dosage. Subjects were evaluated before therapy switch (T0) and 3 months later (T1) and subjected to blood analyses. MADRS, MRS, PANSS, HAM-A, AMDP were used to evaluate psychopathology; to assess subjective experience of psychosocial functioning and quality of life WHODAS 2.0, DAI-10 and SF-36 were submitted. Repeated measures ANOVA was conducted using SPSS. Results: Statistically significant improvements emerged in the following scores: TSH (p=.000), SF-36 (AFT p=.004, SMT p=.009); MRS (p=.002); HAM-A (p=.000); WHODAS self-administered (p=.000), WHODAS proxy administered (p=.002). Lithium blood levels remained stable. An improvement of thyroid indexes and no worsening of renal function emerged. OnlyDAI-10 shows a decrease (p=.021): this data can be related to study limitations and to Lithium Sulphate price that may affect negatively patients' drug attitude. Conclusions: Lithium Sulphate does not affect negatively renal and thyroid function and seems to improve patients' psychosocial functioning and quality of life, even though this study is limited to a small sample of patients and for a short observational period. [ABSTRACT FROM AUTHOR]