Obsessive-compulsive disorder (OCD) frequently co-occurs with various psychiatric conditions and may impact as many as one-fifth of individuals diagnosed with bipolar disorder (BD). Despite the expanding body of literature on the coexistence of OCD and BD, there is a notable lack of comprehensive data pertaining to the distinct features of obsessive-compulsive symptoms that define this comorbidity. To bridge this knowledge gap, we conducted a systematic search of PubMed/MEDLINE, Scopus, EMBASE, and PsycINFO until August 7th, 2023. We performed random-effects meta-analyses to compare individuals with both OCD and BD to those with OCD in terms of OCD symptomatology as well as the specific categories of obsessions and compulsions. Out of the 10,393 records initially screened, 17 studies were ultimately incorporated into the qualitative assessment, with 15 of them being included in the quantitative analysis. Individuals with OCD and BD experienced fewer lifetime contamination obsessions (OR=0.71; 95 %CI=0.53, 0.95; p = 0.021) and more sexual obsessions (OR=1.77; 95 %CI=1.03, 3.04; p = 0.04) compared to individuals with OCD without BD. No significant difference was observed for other types of obsessions or compulsions or for the severity of OCD symptoms, although BD type may play a role according to meta-regression analyses. The detection of the presence of sexual or contamination obsessions through a detailed interview may be the focus of clinical attention when assessing OCD in the context of comorbid BD. Sub-phenotyping complex clinical presentation of comorbid psychiatric disorders can aid in making more informed decisions when choosing an appropriate treatment approach.

Background: Electroconvulsive therapy (ECT) is a safe and effective treatment for several major psychiatric conditions, including treatment-resistant depression, mania, and schizophrenia; nevertheless, its use remains controversial. Despite its availability in some European countries, ECT is still rarely used in others. This study aims to investigate the experiences and attitudes of early career psychiatrists (ECPs) across Europe towards ECT and to examine how their exposure to ECT influences their perceptions. Methods: In Europe, a cross-sectional survey was conducted among ECPs, including psychiatric trainees and recently fully qualified psychiatrists. Results: A total of 573 participants from 30 European countries were included in the study, of whom more than half (N = 312; 54.5%) received ECT training. Overall, ECPs had a positive attitude towards ECT, with the vast majority agreeing or strongly agreeing that ECT is an effective (N = 509; 88.8%) and safe (N = 464; 81.0%) treatment and disagreeing or strongly disagreeing that ECT was used as a form of control or punishment (N = 545; 95.1%). Those who had received ECT training during their psychiatry training were more likely to recommend ECT to their patients (p < 0.001, r = 0.34), and held more positive views on its safety (p < 0.001, r = 0.31) and effectiveness (p < 0.001, r = 0.33). Interest in further education about ECT was moderately high (modal rating on Likert scale: 4, agree), irrespective of prior training exposure. Conclusions: ECT training is associated with more favorable perceptions of its safety and effectiveness among ECPs. There is a general willingness among ECPs to expand their knowledge and training on ECT, which could enhance patients’ access to this treatment.

Background: Bipolar disorder (BD) is commonly comorbid with other psychiatric conditions, such as obsessive-compulsive disorder (OCD). Despite increasing interest in this comorbidity, quantitative data on its clinical characteristics remain limited. This systematic review and meta-analysis aimed to evaluate the clinical impact of OCD comorbidity in BD by comparing individuals with BD and OCD (BD-OCD) to those with BD without OCD. Methods: We systematically searched the PubMed/MEDLINE, Scopus, PsycINFO, and Web of Science databases up to April 15, 2024. Meta-analyses were conducted to compare BD-OCD and BD without OCD groups across multiple clinical domains. Results: From 11,959 initial records screened, 26 studies were included in the qualitative synthesis, with 22 eligible for meta-analysis. Individuals with BD-OCD showed higher odds of experiencing chronic mood episodes (OR = 9.42; 95%CI = 2.23, 39.9), rapid cycling (OR = 1.92; 95%CI = 1.04, 3.53), comorbid eating disorders (OR = 3.37; 95%CI = 1.99, 5.7), panic disorder (OR = 3.3; 95%CI = 2.11, 5.2), substance use disorders (OR = 1.39; 95%CI = 1.02, 1.89), and lifetime suicide attempts (OR = 1.85; 95%CI = 1.21, 2.84). Additionally, they presented earlier onset of BD (SMD = -0.27; 95%CI = -0.52, −0.01) and reduced functioning (SMD = -0.42; 95%CI = -0.59, −0.24). Most data were derived from adult populations, limiting the evidence available for children and adolescents. Conclusions: BD-OCD presents a more severe and complex clinical profile, requiring specialized assessment and integrated treatment approaches. Identifying these features may support earlier recognition and inform personalized interventions for this population.

Background: Substance Use Disorder (SUD) is more prevalent among individuals with psychotic disorders than in the general population and is associated with poorer functioning, treatment adherence, and outcomes. Understanding motives for substance use in this group is essential for targeted interventions. Methods: Motives were assessed using the 26-item Reasons for Substance Use Questionnaire in 118 male patients admitted for a psychotic episode between October 2024 and September 2025. Results: In total, 20.3% of the participants were first-admission patients. Enhancement motives were most frequently endorsed, followed by coping and social motives; conformity and relief were least endorsed. In exploratory unadjusted analyses, patients with multiple hospital admissions reported greater relief related motives, including alleviating positive symptoms and medication side effects. Motives varied by primary substance used. Conclusions: Mood enhancement and coping were predominant motives; relief motives appeared to be stronger in patients with multiple admissions. Further research is needed to improve treatment strategies.

Background: Negative symptoms (NS) represent an important unmet need in schizophrenia (SZ) assessment and management. Despite NS are strongly associated with poorer functioning and quality of life, they are frequently underrecognized, inconsistently evaluated, and show limited response to current treatments. Although specific assessment tools and European Psychiatric Association (EPA) guidance on NS have been developed, their impact on routine clinical practice appears limited. This study aimed to investigate the competence and confidence of European Early Career Psychiatrists (ECPs) in NS evaluation and management. Methods: The CARE project was a cross-sectional online survey directed towards ECPs from European countries. Results: 828 ECPs’ responses were collected from 19 countries. The majority of ECPs were trainees (65.8%), reported theoretical training in negative symptoms (NS) and placements in schizophrenia-specialized settings (67.9% and 70.3%), while about half reported extracurricular NS training (51.1%) and involvement in clinical research (46.1%). Only 11% correctly identified NS domains, despite 65.7% felt well-trained in NS assessment tools. Just 15.9% correctly answered questions based on the EPA guidance papers. 46.7% and 25.9% ECPs reported feeling competent in NS evaluation and management, respectively. Gender (men) specialist status, research involvement, theoretical NS training, and placements in specialized SZ services predicted perceived competence. However, in-depth NS knowledge was predicted only by specialist status, engagement in clinical research, and extracurricular NS training. Conclusions: Despite reported exposure to NS training, ECPs demonstrated limited knowledge of NS. Actions need to be taken to ensure that ECPs receive the highest standard of training in NS.