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IntroductionIndividuals with schizophrenia exhibit severe speech and Theory of Mind (ToM) deficits creating substantial handicaps for them on the level of communication and interpersonal skills. Consequently, these individuals cannot adequately take part in social life, and are exposed to marginalization in all aspects of life. Hence, communication impairments associated with schizophrenia are a central issue to investigate in order to optimize their quality of life and functioning in society. The study being part of an interdisciplinary research is based on guided interviews related to a short story by Hemingway. The analysis of person deictic expressions related to social emotions and social interactions combined with the most frequently used mental state terms (e.g. ‘I don’t know’, ‘I think’) identified in the corpus may not only describe the severity of linguistic disturbances indicating ToM deficits but can also help understand patients’ social dysfunction and difficulties in the context of social cohesion.ObjectivesThe primary task of the functional linguistic research is to identify and classify the occurrence of linguistic disturbances during mentalizing processes expressed via mental state terms. The study particularly focuses on interpersonal relations expressed with person deictic forms that may indicate the difficulties of this patient group with social cohesion.MethodsThe corpus involves 40 guided interviews including 20 individuals with schizophrenia treated at the Department of Psychiatry of the University of Pécs and 20 controls. The interviews were conducted by a PhD student of Psychology in Hungarian and centred around Hemingway’s short story entitled The End of Something. The interviews were digitally recorded and transcribed in Hungarian. The qualitative analysis was performed with Sketch Engine corpus analysis tool, which assisted in the identification and classification of collocations associated with the interviewees’ mental processes directed at interpersonal relations expressed by person deictic forms.ResultsPragmatic processes including the communicative aspect showed severe deficiencies. The most commonly used mental state term ‘I don’t know’ combined with person deictic expressions revealed that individuals with schizophrenia have difficulty attributing mental states to a specific linguistic utterance during a social situation (e.g. ‘I don’t know why somebody said that’). These examples show that their communicative and interpersonal skills are substantially impaired.ConclusionsThe findings can offer some possible indications for psychotherapists how to detect pragmatic impairments in schizophrenic speech and interpret mental state terms with reference to social interaction, thereby contributing significantly to therapeutic success enhancing the social reintegration of individuals with schizophrenia.Disclosure of InterestNone Declared

IntroductionEveryday social interactions are based on Theory of Mind (ToM) or mentalizing, whose complex processes are involved in understanding, representing one’s own and other people’s mental states. ToM is supposed to have two systems. The implicit ToM seems to be a fast, automatic, non-verbal processing. The explicit ToM is characterized by a slower, but more flexible processing, which is mostly verbal, interpretative. Several studies have described explicit ToM deficit in schizophrenic patients. Less research has investigated implicit ToM in patients, however recently, there has been a growing number of articles examining implicit ToM of patients with schizophrenia.ObjectivesThe aim of our systematic review and meta-analysis is to summarize the results of the implicit ToM in schizophrenia.MethodsA systematic search was performed in four major databases. We included 11 publications. 7 studies; and 5 studies were included the quantitative synthesis and the qualitative synthesis, respectively.ResultsWe found significant differences in accuracy, reaction time and brain activation patterns during implicit ToM between schizophrenic patients and controls. The systematic review revealed further alterations in visual scanning, cue fixation, face looking time, and difficulties in perspective taking.ConclusionsBased on our results implicit ToM is affected in schizophrenia in addition to explicit ToM deficit. However, based on these results we cannot exclude the possibility, that implicit ToM or at least some elements of it might be relatively unaffected (e.g. detection of intentionality), however its effectiveness is limited by non-mentalizing deficits (e.g. certain neurocognitive impairments). Our results may have important implications for the remediation of mentalizing skills.DisclosureThe research is supported by the Hungarian National Excellence Centrum Grant (FIKP II) and Hungarian Brain Research Program (KTIA-13-NAP-A-II/12).

IntroductionMentalizing helps us to understand the behaviour of others in our everyday social interactions. Spontaneous mentalizing without explicit instructions refers to representing mental state attribution. Several studies have described social cognitive deficit in schizophrenia, which largely determines the functional outcome of the disease.ObjectivesTo better understand the involvement of spontaneous mentalizing in schizophrenia, we consider it important to summarize the results of studies that used indirect instruction to measure spontaneous mentalizing performance in schizophrenia.MethodsIn our meta-analysis, we conducted a systematic search of four large databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials [CENTRAL], Web of Science). A total of 14 articles were involved.ResultsBased on our findings, the performance of patients with schizophrenia is significantly weaker than in the average population for both scripts with mentalizing interactions (MD: -0.63; 95%CI (-0.90, -0.35); p=0.0021), and with goal-directed movements (SMD: -0.55; 95%CI (-0.97, -0.13); p=0.02). The intentionality of expressions used by patients with schizophrenia is significantly lower compared to the average population (for both animations with complex social interactions: MD: -0.99; 95% CI (-1.39, -0.59); p=0.0003; and with goal-directed movements: MD: -0.31; 95% CI (-0.53, -0.08); p=0.0218). We have found no significant difference neither in appropriateness nor in intentionality of verbal terms between the two goups in the case of animations with random movements.ConclusionsBased on the meta-analysis, we found poorer performance in schizophrenia in spontaneous mentalizing. We also found poorer performance in tasks with goal-directed movements used as control tasks, suggesting a more pervasive impairment of mentalizing in schizophrenia. These deficits may affect the functional outcome of the disease and could potentially have therapeutic implications.Disclosure of InterestNone Declared

IntroductionSuicide is the most severe consequence of major depressive disorder (MDD). The most novel researches assume the role of immunological dysregulation in the background – several studies have reported alterations of inflammatory cells related to both MDD and suicidal behaviour (SB).ObjectivesChanges in the number of certain immune cells and their ratios have been proposed as potential biomarkers of suicide risk (SR). The aim of our research was to investigate alterations of these values related not only to MDD as an assumed inflammatory state, but also to an increased risk of SB.MethodsIn our restrospective cohort study carried out between January 2015 and January 2020, we investigated laboratory parameters of psychiatric patients diagnosed with MDD (n=101). Individuals with recent (≤48 hours prior) suicide attempt (SA) (n=22) and with past SA (>48 hours prior) (n=19) represented the high SR group. MDD patients with no history of SA (n=60) composed the intermediate SR group. We compared the number of neutrophil granulocytes, monocytes, lymphocytes, platelets, leukocytes, neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), platelet-to-lymphocyte ratio (PLR), red blood cell distribution width (RDW) and erythrocyte sedimentation rate (ESR). Furthermore, we evaluated alterations of these parameters related to antidepressant (AD) treatment, which has been proved to have anti-inflammatory effects. Statistical analyses were carried out using GraphPad 9.5.0 and MedCalc 16.8 programmes.ResultsWe found a significant increase in neutrophil granulocyte count (p=0.016), NLR (p=0.031, Fig. 1), monocyte count (p≤0.0001), MLR (p=0.005, Fig. 2), leukocyte count (p=0.048) and ESR (p=0.037) in patients with recent SA compared to patients with no history of SA. Moreover, there was a significant elevation in monocyte count (p≤0.0001), MLR (p=0.020, Fig. 3), ESR (p=0.041) and RDW (p=0.037) in patients with high SR compared to patients with intermediate SR. AD treatment resulted in a significant decrease in neutrophil granulocyte count (p=0.0163) and NLR (p=0.016), however, it did not affect the rest of the parameters.Image:Image 2:Image 3:ConclusionsAssuming immunological mechanisms in the background of MDD and SB, our findings support the role of NLR as a biomarker of acute SR, though its alterations may be masked by AD therapy in the long term. However, MLR – remaining unaffected by AD treatment – may be a possible indicator of both acute and long term suicidal vulnerability. In order to further specify the diagnostic value of these parameters, future prospective research is needed.The study was supported by the FIKP-IV and the TNIL projects.Disclosure of InterestNone Declared

Background Reliable assessment of retinal nonperfusion is critical in managing vascular retinopathies. While ultrawide-field fluorescein angiography (UWF-FA) is the clinical standard, it is invasive and dye-dependent. Previous wide-field optical coherence tomography angiography (WF-OCTA) systems have been limited by insufficient peripheral coverage. To the best of our knowledge, this is the first quantitative comparison of DREAM WF-OCTA with UWF-FA. The study leverages the device’s increased field of view (≈130° single scan, > 200° montage) and demonstrates that the previously published, semi-automated VMseg approach can also be applied to DREAM data. Methods 24 eyes from 13 patients with diabetic retinopathy or retinal vein occlusion underwent both UWF-FA (Optos Silverstone, 200°) and WF-OCTA and were analyzed. The ischemic index (ISI) was calculated for each modality using previously developed semi-automated segmentation (VMseg) for WF-OCTA and manual annotation for UWF-FA. Agreement was assessed using correlation, linear regression, and Bland-Altman analyses. Results ISI values from WF-OCTA showed strong correlations with UWF-FA ( r  = 0.92 for central, r  = 0.96 for montage). Central WF-OCTA showed good absolute agreement with UWF-FA in mild ischemia, montage WF-OCTA with extended coverage in mild to moderate and partly severe ischemia. However, Bland-Altman analysis revealed proportional bias with increasing underestimation at higher nonperfusion levels, indicating that field of view limitations persist despite technological advances. Conclusions This study demonstrates that the DREAM OCT™ system with improved peripheral coverage enables reliable non-invasive assessment of retinal ischemia in mild to moderate cases. However, WF-OCTA should be considered complementary to UWF-FA, particularly in severe peripheral ischemia. Semi-automated segmentation enhances reproducibility and supports broader clinical adoption of OCTA in ischemia monitoring. Trial registration Ethics approval was granted by the Institutional Review Board of the Faculty of Medicine at LMU Munich (study ID: 24–0571), and the study was conducted following the principles of the Declaration of Helsinki. All participants provided written informed consent before inclusion in the study.

IntroductionTheory of Mind is the ability to attribute mental states to others. Investigations have distinguished implicit and explicit forms of ToM. It is known, that patients with schizoprenia have deficits in their explicit ToM, and they also show altered brain activations during examining explicit ToM.ObjectivesIn this study our aim was to investigate the underlying neural substrates of implicit ToM in patients with schizophrenia with fMRI.MethodsSeven healthy subjects and two patients with first episode schizophrenia were involved. We used: false belief condition and control condition. All movies consisted of a belief formation phase and an outcome phase. The belief formation phase started with an agent placing a ball on a table in front of an occluder. Then the ball rolled behind the occluder. The movies could continue in different ways leading to a true or false belief. At the end of each movie, the agent reentered the scene and the occluder was lowered. In the outcome phase the ball was either present or absent behind the occluder. The control conditions started with a ball rolled behind the occluder on a table ended up with two different ways as the ball was either present or absent behind the occluder. There was no agent in the control movies.ResultsWe found that healthy subjects activated significantly stronger the left lingual gyrus as well as the right temporoparietal junction.ConclusionsOur findings suggest deficits in implicit ToM in schizophrenia and our findings also might help to clarify the underlying neural substrates of implicit ToM.DisclosureThis research project was supported by the KTIA-13-NAP-A-II/12 (2018–2022) and the Hungarian National Excellence Centrum Grant 2018–2019.

IntroductionFollowing the mentalization of interpersonal relations can be improved through reading for which the influence of literary fiction can also serve as a model. Schizophrenia is characterized by extensive deficits in mentalization, and the amelioration of these impairments is a major focus in psychosocial treatment research. Reading literature can be a potential tool in improving mentalizing skills.ObjectivesWe aimed to examine and compare healthy participants with patients living with schizophrenia, focusing on measuring mentalizing skills and the impact of reading literary fiction on their mentalization skills.Methods47 persons with schizophrenia in remission and 48 healthy controls were assessed and compared with Short Story Task (SST) a new measurement of ToM. SST proved to be a sensitive tool, to individual differences. After reading the short story “The End of Something” (Hemingway) a structured interview was done with 14 questions.ResultsWe found that patients with schizophrenia performed significantly worse in their ToM scores compared to healthy controls (ANOVA test, p<0,05 ). Previous reading experiences correlated significantly with mentalizing scores not just in healthy controls (Independent Samples T-test, p<0,05) but also in patients with schizophrenia. ToM scores were twice as high among those who had prior reading experiences in the schizophrenia group ((MS= 3,91, SD=3,166, M=8,08, SD=4,542; p<0,05, t=-3,509).ConclusionsWe found that mentalization skills could be improved by regular reading. Our results could also be influenced by several other factors such as empathy skills, identification with the characters etc. Our results and conclusions are in line with the results of international research on this topic.DisclosureNo significant relationships.

IntroductionInflammation and immune dysregulation could contribute to the pathogenesis of schizophrenia. Osteopontin (OPN) is a key cytokine-like molecule in cellular immune response and it can directly modulate the cytokine expression and survival of microglia. Furthermore, its mRNA expression is elevated in first episode psychosis. Imbalance of T-helper subtypes could also represent a vulnerability factor for schizophrenia.ObjectivesThe aim of this study was to evaluate the relevance of T-helper subtype associated cytokines, OPN and NLR in the assessment of the severity of schizophrenia.Methods22 patients with schizophrenia were assessed for the intensity of their symptoms by PANSS and CGI scores. Serum OPN, IFNy, IL-10 and IL-8 concentrations were measured by ELISA kits and NLR was calculated from blood count. Statistical evaluation was performed using Mann-Whitney U test, Student’s t test and Spearman correlation.ResultsWe found significant correlation between the level of OPN and PANSS-total, PANSS-general scores. IFNy level and NLR showed significant correlation with PANSS-total, PANSS-positive, PANSS-general and CGI score. Antipsychotic therapy only had significant effects on NLR and OPN levels, both of which were significantly reduced after long-term antipsychotic treatment.ConclusionsOur results indicate that elevated OPN and IFNy concentrations, and increased NLR are associated with severe symptoms in schizophrenia and suggest the importance of Th1 subtype in patients with high PANSS-positive and PANSS-general score. Antipsychotic treatment had significant effects on the level of OPN and NLR, but not on the level of IFNy. Overall our results strengthen the inflammation hypothesis of schizophrenia.DisclosureNo significant relationships.

Non-response to intravitreal ranibizumab represents a frequent problem in pachychoroid neovasculopathy (PNV). To investigate the effectivity of switching to aflibercept, the database of the Ludwig Maximilians University, Munich, was screened for patients fulfilling the following inclusion criteria: (i) diagnosis of PNV; (ii) inadequate response to ≥ 3 ranibizumab injections, in spite of monthly dosing, defined as persistence of subretinal-fluid four weeks after the last ranibizumab injection; (iii) resulting switch to aflibercept administered as three monthly injections. Primary outcome measure was percentage of eyes with a dry macula four weeks after the third aflibercept injection. Secondary outcome measures included changes in maximum subretinal fluid (SRF), central subfield thickness (CST) and subfoveal choroidal thickness (SFCT). In total, 14 eyes of 14 patients were included. Mean age was 64.1 ± 7.5 (range: 51–78) years. Switching to aflibercept was performed after mean 8.4 ± 4.1 (3–15) ranibizumab injections. While no eye (0%) achieved a dry macula status during ranibizumab treatment, switching to aflibercept achieved a dry macula status in eight eyes (57.1%) after three injections. While both ranibizumab and aflibercept showed an effect on CST (p = 0.027, p = 0.003), only aflibercept showed a significant effect on SRF (p = 0.0009) and SFCT (p = 0.044). In cases of PNV not responding to intravitreal ranibizumab, switching treatment to aflibercept induces a favorable short-term response resolving persistent fluid and achieving a dry macula. Further studies with longer follow-up are warranted.

Background The pathogenesis of central serous chorioretinopathy (CSC) is still poorly understood. An animal model of CSC proved that the mineralocorticoid receptor [ 1 ] of the choroid also plays a role in CSC. Since there is still no evidence-based therapy for non-self-limiting CSC, this case series evaluates the effect of oral spironolactone in CSC patients. Methods In this interventional, uncontrolled, prospective case series, we present 18 consecutive CSC patients. Patients were treated with spironolactone 25 mg twice daily (Spironolacton AL® 50 mg, ALIUD PHARMA) for up to 12 weeks. Follow–up examinations with BCVA, OCT, and EDI-OCT were performed at 1, 2, and 3 months after starting the treatment. Main outcome measure was a change of subretinal fluid (SRF) (in micrometers) measured by optical coherence tomography. Secondary outcome was a change in central retinal thickness (CRT) (in micrometers) measured by OCT and a change in BCVA. Results The subretinal fluid (SRF; mean) decreased from 219 μm (baseline) to 100 μm (visit 3) (difference 119 μm). Total central retinal thickness (CRT; mean) decreased from 405 μm before treatment (baseline) to 287 μm after treatment (difference 118 μm). The BCVA (in logMAR; mean) increased from 0.32 at baseline to 0.20 at visit 3. Conclusion Our case series could confirm a positive influence of spironolactone on the course CSC. Longer follow-up with a larger number of cases could provide more data about the long-term efficiency, recurrences, and safety of this well-tolerated and non-invasive treatment option of CSC.