Andrea Fiorillo

Background: This study aimed to investigate the relationship between orthorexic tendencies, autistic traits (ATs), and eating disorder (ED) psychopathology in patients with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), compared to healthy controls (HCs). Methods: A total of 125 participants were assessed using the Adult Autism Subthreshold Spectrum (AdAS Spectrum), ORTO-15, and Eating Disorder Inventory-2 (EDI-2). Results: ED patients exhibited significantly greater orthorexic tendencies and higher AdAS Spectrum and EDI-2 scores than HCs. ORTO-15 scores were significantly associated with both AdAS Spectrum and EDI-2 total scores and with most of their respective domains. In the multivariable regression model, AdAS Spectrum total score was significantly associated with orthorexic tendencies, whereas EDI-2 total score did not reach statistical significance. However, within the EDI-2 domains, Drive for Thinness and Maturity Fears were significantly associated with greater orthorexic tendencies. Among the AdAS Spectrum domains, Non-Verbal Communication was significantly associated with greater orthorexic tendencies. Conclusions: Orthorexic tendencies were elevated among ED patients and were associated with ATs and ED symptomatology itself. Our findings highlight the potential relevance of AT in understanding orthorexic tendencies in patients with ED and warrant confirmation in larger studies using psychometrically refined measures of orthorexia.

Background: The European Psychiatric Association (EPA) undertook a study to investigate treatment preferences of European psychiatrists towards Bipolar Disorder (BD), as part of the Ambassador programme series of surveys. Methods: We conducted a cross-sectional online survey among psychiatrists and psychiatry trainees from 40 European countries. The questionnaire contained clinical vignettes of different phases of BD including manic, rapid cycling, mixed, hypomanic, and depressive episodes, for both initial and subsequent treatment strategies. Results: The final sample consisted of 654 participants, from Central and Eastern Europe (CEE), Southern Europe (SE), Northern Europe (NE), and Western Europe (WE). The majority preferred pharmacotherapy, most commonly as a combination of two or three drugs to treat all phases of the BD, with lithium being the most preferred option in all phases. Among antipsychotics, olanzapine and quetiapine were the most commonly chosen. Antidepressants were applied in almost 20% of responses for the depressive phase. Psychosocial interventions were not systematically implemented, particularly during manic and mixed episodes, but when recommended, the most common approaches included psychoeducation, cognitive behavioural therapy (CBT) in up to 40% in depressive phase, and lifestyle recommendations. However, latent class analysis identified four different classes of prescribers. Conclusions: Psychiatrists showed broadly similar pharmacological treatment preferences for BD, with frequent use of lithium-based combination therapies and limited implementation of psychosocial interventions, although latent class analysis revealed distinct prescribing profiles. These findings support the need for enhanced dissemination of evidence-based guidelines and greater integration of psychosocial approaches in BD care.

Despite the existence of effective public mental health (PMH) interventions, only a minority across the European region receive treatment for mental health conditions (MHCs). Even fewer receive interventions to prevent MHC-associated impacts, with negligible coverage of interventions to prevent MHCs, or promote mental well-being and resilience. Various reasons account for implementation failure which breaches the right to health and results in population scale preventable suffering, broad impacts and associated economic costs. Public mental health involves a population approach to improve coverage, outcomes and coordination of PMH interventions. Required actions to scale up PMH implementation include effectively making the case through assessment of PMH need, highlighting economic impacts of PMH implementation failure and improved coverage, and coordinated advocacy and leadership. Public mental health practice involves the use of PMH needs assessment to inform choice of interventions, policy development, and required coverage and resources for effective PMH intervention delivery by different sectors. This is supported by the collection of PMH-relevant data. Further actions to scale up PMH implementation include adopting human rights-based approaches and legislation, PMH training to different sectors and improved population PMH literacy, maximizing existing resources, settings-based and integrated approaches, use of digital technology, prioritizing interventions with large population impact, and implementation-focused research. Scaled up PMH implementation results in broad population impacts, achievement of a range of policy objectives, sustainable reduction in impacts of MHCs and promotion of mental well-being across the population of the European region. Associated economic savings also make PMH practice an essential part of sustainable economic development.

Transforming mental health care in a changing Europe - Volume 69 Issue 1

Neurology and psychiatry have operated as separate disciplines for over a century, yet this division reflects historical and institutional developments rather than the underlying biology of the brain. Contemporary neuroscience shows that brain and mental health disorders share genetic susceptibilities, inflammatory and metabolic pathways, environmental and social risk factors, and clinical features that cross diagnostic boundaries. Cognitive, emotional, sensory, and motor symptoms regularly appear across both neurological and psychiatric populations, and conditions such as seizures, psychosis, mood disorders, cognitive disorders, and sleep disorders are common to both. A brain health framework addresses this reality by treating the brain as a single biological organ whose function emerges from the interplay between genome and exposome – including stress, trauma, social context, existential meaning, pollution, and physical health – and which underlies perception, behaviour, cognition, emotion, resilience, and vulnerability. Translating this perspective into practice requires coordinated action across domains. Clinically, collaborative models such as joint neurology–psychiatry consultations and shared outpatient pathways can be implemented within existing resources to improve diagnostic clarity and continuity of care. In training, a more harmonised curriculum with shared foundations in neurobiology, joint seminars, and cross-rotations would equip clinicians with a common language while preserving specialist depth, and support the emerging fields of preventive neurology and preventive psychiatry. In research, organising studies around shared mechanisms and symptom dimensions, and launching joint funding calls, would enhance translational relevance and reduce duplication. To realise this vision, sustained leadership from European professional bodies is essential to establish collaboration as a shared professional standard.

Mental disorders represent a major and growing public health challenge in Europe and worldwide, characterised by marked clinical, biological, and functional heterogeneity, that limits the effectiveness of current diagnostic and therapeutic approaches. In recent years, advances in precision medicine have initiated a paradigm shift in psychiatry, offering new opportunities to improve prevention, prediction, diagnosis, treatment selection, and long-term management by integrating biological, psychological, social, and environmental information. This EPA Guidance Paper provides an overview of the current state of precision medicine in mental health and outlines its potential clinical, scientific, and policy implications. We review key advances in genomics, epigenetics, neuroimaging, transcriptomics, digital technologies, and artificial intelligence, highlighting their relevance across the full clinical pathway, from risk prediction and early detection to treatment personalisation and monitoring. We also examine major barriers to implementation, including limited biomarker validation, insufficient representativeness of research populations, ethical and regulatory challenges, data protection concerns, and inequalities in access across healthcare systems. Based on the available evidence, we propose strategic recommendations to support the responsible and equitable integration of precision approaches into mental health care in Europe. These include strengthening translational research, promoting multidisciplinary collaboration, updating regulatory and ethical frameworks, enhancing professional training, and prioritising mental health within national and European research and health agendas. By addressing these challenges, precision psychiatry has the potential to contribute to more effective, person-centred, and sustainable mental health care, while supporting innovation, reducing stigma, and improving outcomes for patients and society.

Background: Eating disorders (EDs) frequently co-occur with trauma-related symptoms and elevated autistic traits (ATs), both of which contribute to clinical complexity. Social camouflaging, strategies used to mask or compensate for ATs, has been increasingly described in ED populations, yet its relationship with trauma-related symptoms remains poorly understood. This study aimed to examine the association between social camouflaging and post-traumatic stress symptoms in individuals with EDs and to evaluate whether trauma-related symptomatology is associated with camouflaging behaviors. Methods: A total of 67 ED patients were assessed using the Adult Autism Subthreshold Spectrum, the Trauma and Loss Spectrum—Self Report (TALS-SR), the Camouflaging Autistic Traits questionnaire (CAT-Q), and the Eating Disorder Inventory (EDI-2). Participants were divided into high-trauma-symptoms (HTS) (N = 36, 53.7%) and low-trauma-symptoms (LTS) (N = 31; 46.3%) groups based on TALS-SR criteria. Results: The sample was predominantly female (92.5%), and gender distribution differed between groups, which may represent a potential confounding factor and limits the generalizability of the findings. The HTS group reported significantly higher TALS-SR, EDI-2, CAT-Q, and AdAS Spectrum scores, although for the latter the p-value was barely significant (p = 0.046). No differences emerged in the distribution of ED diagnoses between groups. CAT-Q scores were significantly positively correlated with TALS-SR total scores and with domains related to reaction to losses, maladaptive coping, avoidance/numbing, and personal vulnerability. Regression analyses showed that overall trauma-related symptoms were significantly associated with greater camouflaging; however, the proportion of explained variance was modest, suggesting that trauma-related symptoms represent only one of multiple factors linked to camouflaging. Conclusions: Among individuals with EDs, higher trauma-related symptomatology is linked to greater use of social camouflaging strategies. These findings suggest that camouflaging may represent a transdiagnostic correlate connecting neurodevelopmental vulnerability and trauma responses within ED populations, underscoring the importance of integrated assessment and trauma-informed care.