In recent years, there has been growing recognition of the importance of affirmative interventions for neurodiverse individuals. However, empirical evidence regarding such interventions in ADHD remains limited, particularly within conservative-religious cultures. The present study examined the effectiveness of a culturally sensitive, online psychosocial intervention for parents and children. The intervention is grounded in a salutogenic existential approach (SEA), an integrative framework that conceptualizes ADHD as a tension between a tendency toward freedom and reality demands (necessity), and aims to enhance sense of coherence (SOC), autonomous motivation, and support for neurodivergent identity while integrating the medical model with the neurodiversity framework. The study included 427 participants from the Ultra-Orthodox Jewish (UOJ) community in Israel: 311 in the intervention group and 116 in the control group. The intervention group participated in a 12-session online program that combined weekly lectures and practice for parents, along with audio story episodes and a workbook for children. Assessments were conducted before and after the intervention or waiting period using parent-report questionnaires: ADHD symptoms and comorbid difficulties (VADPRS), child functioning (WFIRS-P), and parental self-efficacy (TOPSE). The intervention group demonstrated a significant reduction in ADHD symptoms, behavioral problems, and anxiety/depression, as well as significant improvements in child functioning and parental self-efficacy. In the control group, only a minimal reduction in ADHD symptoms was observed, with no changes in the other domains. Between-group differences remained significant after controlling for background variables. The findings indicate the potential of an SEA-based intervention to improve parent and child functioning among individuals with ADHD symptoms in the UOJ community, and highlight the contribution of SEA as an integrative model for addressing ADHD.

BACKGROUND:Although scientific advancements highlight the involvement of inflammatory processes in psychiatric disorders, few studies have explored how these processes relate to treatment outcomes. This study aimed to examine whether inflammation is associated with reduced treatment outcomes in inpatient psychiatric care, and whether oxytocin (OT) - a neuropeptide known for its anti-inflammatory properties - may buffer these effects. METHODS:Patients (N = 72, 76% females) who received intranasal OT or placebo twice daily for four weeks adjacent to standard inpatient care were examined for their pre-treatment inflammation, using the neutrophil-to-lymphocyte ratio (NLR). Baseline Depressive symptoms, anxiety, suicidal ideation, and distress were assessed using self-report measures at pre and post-treatment. Multilevel models were utilized to test the predictive effects of baseline NLR on treatment outcomes and its interaction with OT administration. RESULTS:Higher pre-treatment NLR was associated with reduced improvement in trait anxiety (p = .02). A significant NLR × OT interaction emerged for depression (p = .005), indicating that OT administration did not significantly improve depression outcomes for patients with high baseline NLR (p = .35), but was associated with greater improvement among patients with low baseline NLR compared to placebo (p = .001). CONCLUSIONS:Inflammation is a potential biological factor shaping treatment outcome, however, OT administration benefits mostly those with low inflammation. Additional studies are needed to assess whether other anti-inflammatory agents may buffer its effects.

Nonadherence to pharmacological treatment for attention-deficit/hyperactivity disorder (ADHD) is common among children and adolescents. Despite well-documented clinical and contextual barriers, to the best of our knowledge no dedicated tool exists to quantify parental challenges in supporting adherence. This study aimed to develop and evaluate the My Experience with ADHD Pharmacotherapy – Parent Report (ME WAPH-P) questionnaire. The ME WAPH-P was developed based on existing instruments, clinical experience, expert input, and literature on nonadherence. The initial 30-item questionnaire assessed adherence-related challenges across six subscales. Parents of children aged 4–18 years who had received ADHD medication were recruited via social media and a commercial survey platform. The final sample included 351 parents. Psychometric evaluation included internal consistency, item discrimination, subscale intercorrelations, and exploratory factor analysis (oblique rotation). After removing one item, the 29-item scale demonstrated excellent internal consistency (Cronbach’s α = 0.90). Subscale reliability demonstrated moderate-to-high intercorrelations. Parallel analysis supported a three-factor structure explaining 44.7

IntroductionOxytocin (OT) has been previously found to facilitate therapeutic outcomes when administered to patients. Recent evidence suggests that therapist’s OT levels similarly influence clinicians’ ability to respond to patients in an empathic and responsive manner. However, no study previously assessed the impact of OT administration to clinicians treating patients in acute settings. This preliminary feasibility study investigated the applicability and trends of effects of OT administration to clinicians performing triage assessment in a public psychiatric emergency room, while focusing on perceived empathy and quality of the therapeutic encounter.MethodsThree clinicians were double-blindingly administered with intranasal OT at one day, and saline placebo (PLC) at a different day. The patients they met (N = 16) provided self-reports on the clinician’s empathy (BLRI), the quality of the session (SEQ), and their level of psychological distress (HSCL-11). The Wilcoxon signed-rank test was used to compare ratings across the two conditions.ResultsPatients reported significantly deeper and more valuable meeting with the clinicians following OT administration to clinicians (S = 32.0, p = 0.0398) as well as significantly lower levels of distress (S = 70.5, p = 0.0343). Clinicians perceived empathy was higher after OT administration compared to PLC, however, this difference did not reach statistical significance (S= 38, p = 0.1675).ConclusionAlthough these results should be interpreted with caution due to the preliminary nature of the study, they highlight the potential contribution of clinician’s OT in facilitation the therapeutic process in acute settings, and call for further investigation in larger, controlled trials.

Attention Deficit/Hyperactivity Disorder (ADHD) is associated with impairments in social cognition and theory of mind (ToM), potentially mediated by alterations in dopaminergic and oxytocinergic pathways. This pilot, proof-of-concept, randomized controlled trial examined the effects of intranasal oxytocin (IN-OT) on ToM and social cognition in children with ADHD. Eight participants (6 males, 2 females), all diagnosed with ADHD, were randomly assigned to receive a single dose of IN-OT or placebo in a double-blind, crossover design. Participants completed assessments of ToM, social cognition, and executive function at baseline and post-treatment. In the second phase, IN-OT was administered alongside prescribed stimulant medication. Statistical analysis was conducted by calculating the Reliable Change Index (RCI > 1.96) and assessing whether participants returned to a functional distribution (SD < 2.0). Results demonstrated improvements in mean reaction time and response consistency in tasks assessing ToM and emotion recognition following OT administration. No adverse effects were reported. While preliminary, this study suggests a possible role of IN-OT in enhancing social cognition and ToM in children with ADHD. Given the study's small sample size, larger trials are needed to confirm these effects and explore IN-OT as a potential adjunctive therapy for ADHD-related social deficits.

Background: Fibromyalgia Syndrome (FMS) is a highly prevalent condition, that causes chronic pain and severe reduction in quality of life and productivity, as well as social isolation. Despite the significant morbidity and economic burden of FMS, current treatments are scarce. Objective: To investigate whether stimulation of ACC -mPFC activity by dTMS enhances a pain-directed psychotherapeutic intervention. Methods: 19 FMS patients were randomised to receive either 20 sessions of dTMS or sham stimulation, each followed by a pain-directed psychotherapeutic intervention. With the H7 HAC coil or sham stimulation, we targeted the ACC -mPFC; specific brain areas that play a central role in pain processing. Clinical response to treatment was assessed with the McGill Pain Questionnaire Short Form (SF-MPQ), the Visual Analogue Fibromyalgia Impact Questionnaire, the Brief Pain Inventory questionnaire, and the Hamilton Depression Rating Scale. Results: DTMS treatment was safe and well tolerated by FMS patients. A significant decrease in the combined sensory and affective pain dimensions was specifically demonstrated in the dTMS cohort, as measured by the SF-MPQ (Significant group x time interaction [F(2, 32) = 3.51, p < .05,eta(2)(p) = 0.18]; No significant changes were found in depressive symptoms in both the dTMS and sham groups. Conclusion: Our results suggest that a course of dTMS combined with a pain-directed psychotherapeutic intervention can alleviate pain symptoms in FMS patients. Beyond clinical possibilities, future studies are needed to substantiate the innovative hypothesis that it is not dTMS alone, but rather dTMS-induced plasticity of pain-related networks, that enables the efficacy of pain-directed psychotherapeutic interventions.

Individuals with severe mental illness (SMI) have been found to suffer a greater decline in psychological well-being compared to the general population in times of stress. The present study aimed to examine clinical and endocrine resilience factors of psychological well-being in SMI patients during the Covid-19 pandemic. METHODS:After Covid-19 crisis outburst in Israel 112 participants, 69 outpatients, and 43 inpatients and day treatment patients were recruited. Outpatients signed an online informed consent and filled in questionnaires regarding their level of mental health symptoms (OQ-45), fear of Covid-19 (FCV), and psychological well-being (PWB). Inpatients answered the same questionnaires and in addition, went through a positive social interaction paradigm while providing three saliva samples to measure their s-IgA and oxytocin (OT) levels. RESULTS:A strong negative correlation was found in the whole sample between reported mental health symptoms, fear of Covid-19, and well-being. Hierarchical regression did not find additional contribution of the fear of the pandemic in predicting well-being beyond the impact of symptomatology. For inpatients (N = 39) only, hierarchical regression found that oxytocin, but not s-IgA could explain 5% of the variance of well-being (R2 = 0.05) in individuals with SMI regardless of their mental health symptoms (R2 = 0.46) and their marital status (R2 = 0.21). CONCLUSIONS:OT is suggested as a possible independent biological resilience factor of well-being in times of major stress among SMI patients. It is still unknown whether OT is a mediator that contributes to well-being or a biological marker that indicates the degree of beneficial social interactions.

Introduction: In recent years, several studies were conducted to explore the potential augmenting effect of oxytocin for the treatment of individuals with severe mental illness. Nonetheless, studies exploring its effects in routine inpatient settings using high-quality randomized controlled trials are scarce. The current study assessed the effect of oxytocin administration on treatment process and outcome among psychiatric inpatients, while employing a rigorous experimental methodology. Methods: A double-blind, placebo-controlled, randomized trial was conducted at a public psychiatric hospital in Israel. Patients (N = 87, 71.3% female participants) were administered intranasal oxytocin/placebo twice daily for 4 weeks, as add-on to usual care. Patients were assessed for severity of anxiety and depression symptoms and their working alliance with their therapist after each therapy session, and treatment outcome was assessed weekly. Multilevel modeling was performed to assess the linear change from pre- to post-treatment. Results: Patients receiving OT demonstrated significantly larger symptomatic improvements (B = −0.01, t [437] = −2.36, p = 0.01). Larger gains were also observed for depression (B = −0.14, p < 0.001 in the OT group, B = −0.06, p = 0.02 in the placebo group) and general distress (B = −0.57, p < 0.001 in the OT group, B = −0.29, p = 0.02 in the placebo group). No significant effect was observed for anxiety, the working alliance, or attachment. Discussion: Oxytocin has the potential to improve treatment outcome among inpatients. Nonetheless, additional controlled research is needed to further assess its effects on therapy process, as well as to account for therapeutic, pharmacological, and neuronal intervening factors.

•An increased initial evaluation of pain intensity was found in unipolar depression compared to bipolar depression.•Anxiety levels may mediate differences in initial evaluation of pain between unipolar and bipolar depression.•Unique patterns of pain perception have been described in unipolar depression but not in bipolar depression.•Unipolar and bipolar depressed patients report excessive pain symptoms compared with healthy controls.

Introduction NMDA-Receptor antagonists have rapid antidepressant and antisuicidal properties. However, the antidepressant effect is short lasting raising the question of best maintenance strategy, which is unanswered so far. Invasive vagus nerve stimulation (VNS) as a treatment option for refractory and chronic major depression was shown to reduce the need of maintenance treatment sessions in electroconvulsive therapy (ECT) patients. Objectives There are no published data on the combination of VNS and esketamine. To determine the impact of the combination of VNS and esketamine in DTD. Methods In this naturalistic observational study, we investigated the short- and long-term impact of combination of VNS and esketamine in n=8 patients with difficult-to-treat depression (DTD). Follow-up evaluations were scheduled prospectively pre-surgery at baseline and every 3 months after VNS-implantation (follow-up period 12-24 months, mean 17). Results The mean age of patients was 50,8 years. 50 % of patients (n=4) were female. All patients suffered from severe DTD (mean MADRS at baseline 30,9). Mean number of hospitalizations per months decreased from 0.17 to 0.11 after VNS implantation. 6 of 8 patients were offered maintenance esketamine treatment. Mean MADRS at 12-months was 19 (38.5 % MADRS reduction). The need of mean esketamine treatment sessions decreased from 2.3 at 6-months visit (V6) to 1.37 at V9 and 0.96 at V12 respectively. Termination of maintenance esketamine was possible in 4 cases after a mean of 11.5 months. Conclusions Combination of esketamine and VNS is a safe and effective treatment option in severely ill DTD patients to relieve disease severity and reduce hospitalizations. Need of esketamine treatment sessions decreases 6 months after VNS implantation. Disclosure of Interest None Declared

Introduction Fibromyalgia Syndrome (FMS) is a highly prevalent condition, causing chronic pain and severe reduction in quality of life and productivity, as well as social isolation (Birtane et al. Clinical Rheumatology 2007; 26(5), pp. 679–684; Arnold et al. Psychosomatics. England 2010; 51(6), pp. 489–497; Lacasse, Bourgault and Choinière. BMC Musculoskeletal Disorders 2016; 17(1), pp. 1–9). Despite significant morbidity and economic burden caused by FMS, current treatments are scarce (Busch et al. The Journal of rheumatology. Canada 2008; 35(6), pp. 1130–1144; Bernardy et al. Journal of Rheumatology 2010; 37(10), pp. 1991–2005; Jackson et al. American journal of hematology 2016; 91(5), pp. 476–80). Objectives To examine whether stimulation of the dorsal Anterior-Cingulate-Cortex and the medial Prefrontal-Cortex (ACC-mPFC) activity by deep Transcranial Magnetic Stimulation (dTMS) enhances a pain-directed psychotherapeutic intervention. Methods Nineteen FMS patients were randomized to either 20 sessions of dTMS or sham stimulation, each followed by a pain-directed psychotherapeutic intervention. Using H7 HAC-coil or sham stimulation, we targeted the ACC-mPFC; specific brain areas that have a central role in pain processing (Fomberstein, Qadri and Ramani. Current Opinion in Anaesthesiology 2013; 26(5), pp. 588–593; Tendler, A. et al. Expert Review of Medical Devices 2016; 13(10), pp. 987–1000). Clinical response to treatment was evaluated using the McGill Pain Questionnaire (MPQ), Visual Analogue Fibromyalgia Impact Questionnaire (VAS-FIQ), Brief Pain Inventory questionnaire (BPI), and the Hamilton Depression Rating Scale (HDRS). Results DTMS treatment was safe and well tolerated by FMS patients. A significant decrease in the sensory and affective pain dimensions was demonstrated specifically in the dTMS cohort, as measured by the MPQ using paired-sample t-tests with Bonferroni correction for multiple comparisons on three-time points (Significant group x time interaction [F(2, 34) = 3.79, p < .05, η2 = 0.183]. No significant changes were found in the cognitive functions, psychophysical measurements of pain, or depressive symptoms in both dTMS and sham groups and between groups. Conclusions Our findings suggest that a course of dTMS combined with a pain-directed psychotherapeutic intervention can alleviate pain symptoms in FMS patients. Beyond the clinical possibilities, future studies are needed to substantiate the innovative hypothesis that it is not the dTMS alone, but rather dTMS driven plasticity of pain-related networks, that enables the efficacy of pain-directed psychotherapeutic interventions. Disclosure of Interest None Declared

Background: Worldwide national surveys show a rising mental health burden among children and adolescents (C&A) during COVID-19. The objective of the current study is to verify the expected rise in visits to psychiatric outpatient clinics of C&A, especially of new patients. Methods: a cross-sectional study focusing on visits as recorded in electronic medical records of eight heterogeneous C&A psychiatric outpatient clinics. The assessment was based on visits held from March to December of 2019 (before the pandemic) in comparison to visits held in 2020 (during the pandemic). Results: The number of visits was similar for both periods. However, in 2020, 17% of the visits used telepsychiatry (N = 9885). Excluding telepsychiatry reveals a monthly decrease in traditional in-person activities between 2020 and 2019 (691.6 ± 370.8 in 2020 vs. 809.1 ± 422.8 in 2019, mean difference = −117.5, t (69) = −4.07, p = 0.0002, Cohen’s d = −0.30). Acceptation of new patients declined during 2020, compared to 2019 (50.0 ± 38.2 in 2020 vs. 62.8 ± 42.9 in 2019; Z = −3.12, p = 0.002, r = 0.44). Telepsychiatry was not used for new patients. Conclusions: The activity of C&A psychiatric outpatient clinics did not rise but was guarded due to the use of telepsychiatry. The decline in visits of new patients was explained by the lack of use of telepsychiatry for these patients. This calls for expanding the use of telepsychiatry, especially for new patients.

BACKGROUND:Recovery-promoting and occupation-oriented interventions for people with schizophrenia who receive in-patient services are scarcely investigated, limiting our understanding of the factors affecting intervention effectiveness and hindering occupational inclusion. AIMS:To investigate the impact of contextual factors on the effectiveness of 'Occupational Connections' (OC) - occupational intervention for in-patient psychiatric settings. MATERIALS AND METHODS:Quasi-experimental, single-blind study compared between inpatients with schizophrenia participating in OC (N = 14) and those receiving treatment as usual only (N = 16) on primary outcomes of participation dimensions and recovery-orientation of the service, and on secondary outcomes of cognition, symptom severity, and functional capacity. RESULTS:Participation in OC in a new context appears to contribute to improvement in cognitive fluency and flexibility, schizophrenia symptoms, and functional capacity (-2.8 0.05) or reduction (-2.25

During the COVID-19 pandemic there have been numerous reports of increases in psychiatric morbidity and a deterioration of status among existing patients. There is little information about how this increase has affected youth and rates of adolescent psychiatric hospitalization. Our study was aimed at examining trends in youth psychiatric hospitalization during the first year of the COVID-19 pandemic. Method: We used medical records to compare trends in hospitalization rates from 2019 to 2020, among psychiatric youth wards from five different centers in Israel. Results: The number of patients that were hospitalized in youth psychiatric wards decreased significantly from 2019 (Mean ± SD=52.2 ± 28.6 per month) to 2020 (M ± SD = 40.8 ± 22.0; unstandardized B = −11.4, 95% CI = −14.4 to −8.3, p < 0.0001). There was a significant decrease in the number of patients that were hospitalized due to internalizing disorders from 2019 (M ± SD = 22.3 ± 9.3 per month) to 2020 (M ± SD = 16.8 ± 7.7; B = −5.5, 95% CI = −8.0 to −3.0, p = 0.0002) and a marginally significant increase in the number of restraints per month (2019: M ± SD = 2.8 ± 6.8, 2020: M ± SD = 9.0 ± 14.5; Z = −1.96, Rosenthal’s r = 0.36, p = 0.07). Conclusions: There was a significant decline in psychiatric hospitalizations during the pandemic, specifically among patients suffering from internalizing disorders. The reasons for this decline, and the future impact these changes had on hospitalizations during the pandemic demand further research. Study limitations: This is a retrospective multicenter study from five medical centers in Israel, therefore generalizability of our findings is limited.

Objectives: Studies assessing the effect of the COVID-19 pandemic on psychiatric patients have mostly focused on cross-sectional evaluations of differences in levels of distress. In this study, we aimed to assess changes in distress and well-being following the COVID-19 pandemic outbreak as compared with pre-pandemic levels, as well as potential predictors of symptomatic deterioration, among psychiatric outpatients treated in a public mental health hospital in Israel. Methods: Patients evaluated for distress and well-being before the pandemic (n = 55) were re-evaluated at the end of the first lockdown in Israel. Results: Analyses revealed a significant decrease in the patients’ sense of personal growth. Increases in distress were significantly associated with fear of COVID-19 beyond patient characteristics. Conclusion: These results suggest that the pandemic has a short-term effect on patients’ well-being, and that fear of the pandemic is associated with elevations in distress.

Introduction: The COVID-19 pandemic affected the wellbeing of children and adolescents. The psychiatric emergency room (ER) is the hub of psychiatric emergencies and reflects clinically significant mental problems. Previous studies compared 2019 and 2020 and observed a decline in ER referrals. The current study focused on the continuous trend of referrals from 2010 to the end of 2021. Method: In our observational retrospective study, we procured data from 9156 child and adolescent referrals to our psychiatric ER. The comparison was made based on similar months of each year. Results: There was a significant positive trend in monthly referrals between 2010 and 2021, representing a similar increase in referrals per month in comparison to that month in the preceding year (unstandardized β = 4.21, 95% CI = 3.44 to 4.98, p < 0.0001). Between March 2020 and February 2021 (monthly visits = 72.5 + 16.6 [median = 79.5], annual referrals = 870), we observed no additive effect beyond this general trend after controlling for population growth. Conversely, between March and December 2021 (monthly referrals = 106.1 + 31.8 [median = 105.5], overall referrals = 1061) we observed a significant additive effect beyond the projected incline, as predicted by previous years (β = 21.61, 95% CI = 12.12 to 31.06, p < 0.0001). Conclusions: The first year of the COVID-19 pandemic was no different from the continuous decade long rise of referrals to the children and adolescents’ psychiatric ER. Conversely, the second year showed an additional incline beyond the general trend. The complexity in this rising need demands the awareness of clinicians and policy makers alike.

Background& aimes Psychiatric admissions during the covid-19 pandemic were limited, overlooking their possible benefit. This study focused on assessing the effect of the fear of covid on the mental health and well-being of inpatients as opposed to outpatients. Methods During the first lockdown, forty-four inpatients and day care patients (inpatient group) and 74 outpatients (outpatient group) were recruited after an informed consent procedure. Fear of the infection was assessed using the Fear of COVID-19 (FCV-19S); severity of mental health symptomatology was evaluated with the outcome questionnaire-45 (OQ-45); wellbeing was assessed with the Psychological well-being scale (PWB). Outcomes There was no difference between the inpatient group and outpatient group in their fear of COVID-19 levels. FCV-19 predicted changes in the outpatient OQ total score (B = 2.21, p < 0.001), OQ interpersonal relation subscale (B = 0.34, p = 0.01), PWB total score (B = -0.05, p < 0.001), PWB environmental mastery subscale (B = -0.07, p < 0.001) and PWB positive relation subscale (B = -0.05, p < 0.001), but not in the inpatient group. Conclusions Mental health and wellbeing of the outpatient group, which had less therapeutic contact than the inpatient group, correlated with the fear of covid, supporting the hypothesis that intensive psychiatric therapy had a protective effect on the mental health consequences of "fear of covid".

The COVID-19 (SARS-CoV-2) pandemic has been a major stressor for the mental health and well-being of children and adolescents. Surveys and reports from hotlines indicate a significant rise in mental health problems. As the psychiatric emergency room (ER) is a first-line free-of-charge facility for psychiatric emergencies, we expected to see a significant increase in visits, specifically of new patients suffering from anxiety, depression, or stress-related disorders. Data from two psychiatric hospital ERs and one general hospital were included. All visits of children and adolescents from the computerized files between March and December of 2019 were analyzed anonymously and compared to the same months in 2020, using multilevel linear modeling. There was a significant decline in the total number of visits (p = .017), specifically among those diagnosed as suffering from stress-related, anxiety, and mood disorder groups (p = .017), and an incline in the proportion of visits of severe mental disorders (p = .029). The limited use of child and adolescent psychiatric emergency facilities during the pandemic highlights the importance of tele-psychiatry as part of emergency services. It also suggests the importance of the timeline of the emergence of clinically relevant new psychiatric diagnoses related to the pandemic. Future studies are needed to establish the long-term effects of the pandemic and the expeditious use of tele-psychiatry.

The worldwide effort to recover from the COVID-19 crisis is now at its pinnacle with the putative vaccine against SARS-CoV-2. To reach herd immunity, it has become an urgent global need to understand the emotional factors that drive people's choice to get vaccinated. Therefore, this exploratory study examined emotional motivations as predictors of the decision to receive the vaccine. The sample (N = 627) included adult (18+) participants in Israel who were recruited by a snowball sampling. The participants filled out an online survey when the vaccines have become widely available in Israel. Within the entire sample, as well as among people who did not receive the vaccine yet, hope was the only factor that was associated with their willingness to be vaccinated; higher levels of hope were related to willingness to be vaccinated. The results of the study indicate that hope is an important factor related to motivation to receive the SARS-CoV-2 vaccine.