Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for major depressive disorder (MDD), but initial outcomes can be modest.

To compare SSRI dose optimisation with four alternative second-line strategies in MDD patients unresponsive to an SSRI.

Of 257 participants, 51 were randomised to SSRI dose optimisation (SSRI-Opt), 46 to lithium augmentation (SSRI+Li), 48 to nortriptyline combination (SSRI+NTP), 55 to switch to venlafaxine (VEN) and 57 to problem-solving therapy (SSRI+PST). Primary outcomes were week-6 response/remission rates, assessed by blinded evaluators using the 17-item Hamilton Depression Rating Scale (HDRS-17). Changes in HDRS-17 scores, global improvement and safety outcomes were also explored. EudraCT No. 2007-002130-11.

Alternative second-line strategies led to higher response (28.2% v. 14.3%, odds ratio = 2.36 [95% CI 1.0–5.6], p = 0.05) and remission (16.9% v. 12.2%, odds ratio = 1.46, [95% CI 0.57–3.71], p = 0.27) rates, with greater HDRS-17 score reductions (−2.6 [95% CI −4.9 to −0.4], p = 0.021]) than SSRI-Opt. Significant/marginally significant effects were only observed in both response rates and HDRS-17 decreases for VEN (odds ratio = 2.53 [95% CI 0.94–6.80], p = 0.067; HDRS-17 difference: −2.7 [95% CI −5.5 to 0.0], p = 0.054) and for SSRI+PST (odds ratio = 2.46 [95% CI 0.92 to 6.62], p = 0.074; HDRS-17 difference: −3.1 [95% CI −5.8 to −0.3], p = 0.032). The SSRI+PST group reported the fewest adverse effects, while SSRI+NTP experienced the most (28.1% v. 75%; p < 0.01), largely mild.

Patients with MDD and insufficient response to SSRIs would benefit from any other second-line strategy aside from dose optimisation. With limited statistical power, switching to venlafaxine and adding psychotherapy yielded the most consistent results in the DEPRE'5 study.

The neurobiological basis of suicidal behaviour remains poorly understood. However, emerging evidence suggests that inflammation and vascular homeostasis factors may play a role in its pathophysiology. Childhood trauma, through immune system dysfunction and increased risk of suicidal behaviours, might influence these associations. This study examined the relationships between immune-inflammatory and vascular homeostasis-related markers and their interaction with childhood trauma in relation to a history of suicide attempts in individuals with depression.

A total of 328 patients with major depression were recruited: 166 with a history of suicide attempts and 162 without. Using multivariate binary logistic regression models adjusted for cofounders, we examined the associations between childhood trauma, levels of platelet-related immune markers (serotonin, MCP-1, TSP-1, TSP-2, PDGF-AB, PDGF-BB), and suicide attempt history. Independent associations between PDGF-BB, childhood trauma, and suicide attempts were further assessed using interaction models. Stratified sensitivity analyses based on childhood trauma history were also conducted.

Childhood trauma consistently emerged as associated with suicide attempts across all models. Among the measured biomarkers, higher TSP-2 levels were associated with a suicide attempt history, independent of childhood trauma. Meanwhile, while PDGF-BB alone was not directly linked to suicide attempt history, the interaction analysis revealed that individuals with lower PDGF-BB levels and more severe childhood trauma were more likely to have attempted suicide.

TSP-2 and PDGF-BB are potential biomarkers linked to suicide attempts, with distinct roles in the interplay between biological processes and early-life adversity. These insights can inform the biomarker-informed development of tailored prevention and treatment strategies.

The European Resuscitation Council (ERC) establishes guidelines for cardiopulmonary resuscitation (CPR) under standard conditions and special circumstances but without specific instructions for nighttime situations with reduced visibility. The aim of this study was to evaluate the feasibility of performing CPR at night under two different conditions, in darkness with ambient light and with the additional illumination of a headlamp, as well as to determine the quality of the maneuver.

A crossover, randomized pilot study involving nineteen lifeguards was conducted, with each participant performing two five-minute CPR tests: complete darkness with headlamp and natural night environment at the beach without additional lighting. Both tests were conducted with a 30:2 ratio of chest compression (CC) to ventilations using mouth-to-pocket mask technique in the darkness of the night with a 30-minute break between them. Outcome measures included quality of CPR, number of CCs, mean depth of CCs, mean rate of CCs, and number of effective ventilations. Results were reported as the mean or median difference (MD) between the two groups with 95% confidence interval (CI) using techniques for paired data.

There were no statistically significant differences between the two lighting conditions for the outcomes of CPR quality, mean depth of CCs, or number of effective ventilations. The number of CCs was lower when performed without the headlamp (MD: -8; 95%CI, -15 to 0). In addition, the mean rate of CCs was lower when performed without the headlamp (MD: -3; 95%CI, -5 to -1).

The rescuers performed CPR at night with good quality, both in darkness and with the illumination of a headlamp. The use of additional lighting with a headlamp does not appear to be essential for conducting resuscitation.

Integrating scientific research across multiple disciplines to advance breakthroughs is at the heart of clinical-translational science (CTS); among competencies that have been identified as essential for progress, skillful communication is critical. Few tools are available to address the social dynamics of the multidimensional diversity characteristics of CTS. We created the “Building a Diverse Biomedical Workforce Through Communication Across Difference (CAD)” workshop intervention. Based on principles of intercultural communication, CAD taught novel situationally-based communication skills to dyads of near-peer mentors and their undergraduate mentees. This study reports on the effectiveness of the operative mechanisms employed in CAD workshops for helping participants navigate highly diverse research environments.

Participant data were collected from multiple sources, including workshop artifacts as well as focus groups conducted post-workshop. Data were organized, individually coded, and then iteratively and collectively into pre-defined and emergent themes.

Responses indicated that the content and activities resonated strongly with participants and illuminated their understanding of challenges (both their own and others’) related to belonging, confidence, and connectedness to the research environment; several participants shared that they planned to use or had successfully used the skills. Focus group comments revealed that participants recognized the potential of the skills to include significant opportunities for non-instrumental interaction, contributing to a psychologically healthier workplace.

A brief intervention to develop communication skills across a variety of differences characteristic of clinical-translational settings improves communication between mentors and mentees and with peers and increases sense of belonging in the workplace, with potential benefits to wellbeing.

Preadoption assessments are the most frequent type of evaluation conducted by the Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS). RedETS aimed to develop a framework to utilize real-world data (RWD) to better adjust its assessments to the Spanish population’s context and provide live assessments throughout the lifecycle of health technologies.

A working group within RedETS was set up, which held several meetings to define the primary uses of RWD in the short term. Next, a manual review was conducted on national and international initiatives that provided guidance on the use of RWD in HTA. Common pathways for utilizing RWD in HTA were identified. The working group agreed to outline and explain the key overarching steps and provide general guidelines for working with RWD, developing as illustration a use case for an interventional technology. The Big Data project of Aragon (BIGAN) was chosen as the data source for the use case.

We formulated a case for leveraging RWD in the assessment of implantable cardiac defibrillators (ICDs) for the prevention of sudden cardiac death (SCD). Based on this scenario, we developed a methodological framework outlining a workflow consistent with RedETS practices. RWD complemented the usual process of systematic review of a technology. Crucial steps comprised the definition of data requirements through a data model specification, an exploratory data analysis, and the construction of a decision model. We presented solutions for dealing with unavailable data on essential variables and unstructured records. We discussed the main limitations to account for when working with RWD.

The task ahead holds great hope but requires overcoming some challenges to fully deploy RWD-driven methods. This entails fostering collaboration with health authorities and designated data holders to address data access challenges. In the short term, it is essential to include data scientists in assessment teams and provide appropriate capacity-building to encompass RWD tools and modeling techniques.

Cannabis use and familial vulnerability to psychosis have been associated with social cognition deficits. This study examined the potential relationship between cannabis use and cognitive biases underlying social cognition and functioning in patients with first episode psychosis (FEP), their siblings, and controls.

We analyzed a sample of 543 participants with FEP, 203 siblings, and 1168 controls from the EU-GEI study using a correlational design. We used logistic regression analyses to examine the influence of clinical group, lifetime cannabis use frequency, and potency of cannabis use on cognitive biases, accounting for demographic and cognitive variables.

FEP patients showed increased odds of facial recognition processing (FRP) deficits (OR = 1.642, CI 1.123–2.402) relative to controls but not of speech illusions (SI) or jumping to conclusions (JTC) bias, with no statistically significant differences relative to siblings. Daily and occasional lifetime cannabis use were associated with decreased odds of SI (OR = 0.605, CI 0.368–0.997 and OR = 0.646, CI 0.457–0.913 respectively) and JTC bias (OR = 0.625, CI 0.422–0.925 and OR = 0.602, CI 0.460–0.787 respectively) compared with lifetime abstinence, but not with FRP deficits, in the whole sample. Within the cannabis user group, low-potency cannabis use was associated with increased odds of SI (OR = 1.829, CI 1.297–2.578, FRP deficits (OR = 1.393, CI 1.031–1.882, and JTC (OR = 1.661, CI 1.271–2.171) relative to high-potency cannabis use, with comparable effects in the three clinical groups.

Our findings suggest increased odds of cognitive biases in FEP patients who have never used cannabis and in low-potency users. Future studies should elucidate this association and its potential implications.

The Positive and Negative Syndrome Scale (PANSS) has been used as a universal instrument for clinical assessment of psychopathology in schizophrenia. Different studies have analyzed the factorial structure of this scale and have suggested a five-factor model: positive, negative, excited, depressive, and cognitive/disorganized factors. Two of the most used models are the Marder´s solution and the Wallwork´s one.

The aim of this work was to study the correlations of the two cognitive factors (Marder and Wallwork) with a cognitive assessment performed with a standard cognitive battery, in a sample of patients with first psychotic episode of schizophrenia.

Seventy four patients with first psychotic episode of schizophrenia (26.9, SD:7.8 years old; 70.3% male) were included. The cognitive assessment was performed with the MATRICS Consensus Cognitive Battery (MCCB). The MCCB present seven cognitive domains: Speed of processing, Working memory, Attention/Vigilance, Verbal Learning, Visual Learning, Reasoning and Problem Solving, and Social cognition). Pearson correlations were performed between MCCB scores and Marder´s PANSS cognitive factor (P2, N5, G5, G10, G11, G13, G15) and Wallwork´s one (P2, N5, G11).

Correlation between MCCB scores and cognitive factors of Marder and Wallwork can be seen in the table.

Both PANSS cognition factors show a moderate correlations with Speed of processing, Working memory, Attention/Vigilance and Verbal Learning assessed by MCCB. More discrete correlations were found with Visual Learning, Reasoning and Problem Solving, and with Social cognition (in fact, non-significant correlation with Wallwork´s cognitive factor was found).

Acknowledgements. This study has been funded by Instituto de Salud Carlos III (ISCIII) through the project PI19/00766 and co-funded by the European Union.

None Declared

An increased risk of suicide has been reported by psychiatric patients, including schizophrenia1. Numerous evidence suggests alterations in the grade of pro-inflammatory impact on suicidal behavior2, and this relation has been shown in patients with mood or anxious disorders3,4. However, the grade of inflammation impact suicidal behavior in patients with schizophrenia has hardly been investigated.

Identify peripheral blood biomarkers of suicidal behavior in patients with schizophrenia, including inflammatory and lipid profile parameters.

Secondary analysis of a cross-sectional study. Sample: 254 patients with schizophrenia, aged 18-72. Assessments: ad-hoc demographic and clinical questionnaire, PANSS, CDS, CAINS, PSP. Inflammatory and lipid parameters: C-reactive protein (PCR), interleukin 6 (IL-6); high-density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglyceridaemia (TG). Statistical analysis: Correlations, T Student, U Mann-Withney and lineal regression.

Mean age: 40.49 (13.10). Men: 64.2%.

No statistically significant differences were found between patients with suicide attempts and those without in any of the inflammatory or lipid parameters (p>0.05). However, differences were found in terms of suicide attempts (yes/no) in the PANSS negative (T=-2.217; p=0.028) and PANSS general psychopathy (T=-4.224; p< 0.001), in depressive symptoms (T =-6.967; p< 0.001), and the MAP subscale of the CAINS (T= -3.741; p<0.001).

Among patients with suicide attempts (n=42; 16.52% of the sample) (mean=1.90; sd=1.73; Range:1-7), statistically significant correlations were found with PCR (r=0.309; p=0.046), but not with cytokines and lipid parameters. On the other hand, no correlations were found with age, sex, length of illness, and any of the clinical scales.

A multiple linear regression was performed considering the number of suicide attempts as the dependent variable and as independent variables, age, sex, and those that were significant in the bivariate analysis (PCR).

A predictive model was found that explains 9.60% of the variance of number of suicide attempts (F = 4.224; p < 0.001). The variable that entered the model was PCR (β= 0.309; p=0.046).

The increase in inflammation (manifested by the elevation of PCR) is related to an increase in the number of suicides. On the contrary, no correlations were found with lipid parameters or interleukins.

None Declared

Short-chain fatty acids (SCFA) are bacterial metabolites that, within microbiome-gut-brain axis, make a promising research line on etiopathology of mental diseases like schizophrenia (SZ) and major depression disorder. Besides, depressive symptoms are frequent clinical features of SZ.

• - Describe fecal SCFA concentrations in SZ patients.

• - Analyze differences in SCFA depending on:

• - Depression.

• - Clinical severity, antipsychotics and antidepressants, comorbidities (pro-inflammatory state/obesity/metabolic syndrome [MetS]), lifestyle.

Cross-sectional study of 67 outpatients [mean age=43.52±12.42, range=22-67; males=40 (59.7%)] with diagnosis (DSM-5) of SZ recruited from their mental health clinics in Oviedo (Spain).

• - Assessment:

• - Fecal SCFA (gas chromatography;μg/mL).

• - Plasmatic C-reactive protein (CPR;mg/dL).

• - PANSS, Calgary Depression (CDS), International Physical Activity (IPAQ), Mediterranean Diet Adherence (MEDAS).

• - Toxic habits (alcohol use/smoking/cannabis).

• - Chlorpromazine equivalent doses (CPZ-ED), use of antidepressants.

• - MetS (ATP-III), body mass index (BMI; kg/cm2).

• - Statistics: Spearman correlation, U Mann-Whitney, ANCOVA.

14 patients showed clinical depression (CDS≥5). There were no differences in age or sex between groups. 36 patients (53.7%) showed systemic low-grade inflammation (CPR≥0.3mg/dL) and 32 (30.8%) MetS.Table 1 shows fecal SCFA levels by depressive state. Means (SD) are ahown.Table 1

Correlations were found in Age with Butyrate (r=-0.248,p=0.043) and weekly alcohol units with Propanoate (r=0.250,p=0.041) plus trend to significance with Butyrate (r=0.232,p=0.059). It also showed a trend towards statistical relation for CPZ-ED with Propanoate (r=-0.253,p=0.039) and Total SCFA (r=-0.253,p=0.039). We found no correlation in SCFA with MetS, CGI, PANSS-N, BMI, IPAQ, MEDAS and other toxic habits.

ANCOVA was performed to Acetate and Total SCFA using depression state as independent variable and Age and CPZ-ED as covariates. There was a trend towards statistical significance for Acetate (F=3.937,p=0.052,η2=0.059) whereas Total SCFA showed no difference (F=1.350,p=2.250,η2=0.021).

There seems to be lower levels of fecal Acetate in SZ patients with depressive symptoms, considering age and antipsychotic intake. In our sample there was no relation between SFCA and clinical severity, lifestyle, comorbidities or antidepressant use.

None Declared

An increase in suicidal behavior among the adolescent population is reflected in the literature and in clinical practice. According to a study of suicidal behavior and mental health by the Spanish ANAR Foundation, the number of cases with suicidal behavior has experienced an accentuated growth in the period 2012-2022 (1,921.3%), highlighting the increase produced in the post-COVID-19 period, between 2020 and 2022 (128%)

To analyze the reasons for admission to the short hospitalization unit. To describe the sociodemographic characteristics of hospitalized adolescents.

Descriptive observational study of the sample of adolescents admitted to the inpatient psychiatric unit of the Hospital Universitario Puerta de Hierro between January 1, 2023 and June 30, 2023. It is carried out through the information obtained in the clinical history of the patients.

During this period of time 113 adolescents were admitted, 80.2% were female. The mean age was 15.16 years. The main reason for admission was autolytic ideation, occurring in 33.3% of the patients. The second most frequent reason for admission was suicide attempt (29.7%) and behavioral disturbance (17.1%) was the third most frequent. Of the methods used in suicide attempts, drug overeating stands out among the methods used in suicide attempts. (75.8%), followed by attempted hanging (12.1%) or cutting (12.1%).

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The results corroborate what is reported in the scientific literature, where self-harm and self-injury attempts have increased and are the most frequent reasons for admission. This shows that suicide is a public health problem of the first order, where prevention and early intervention programs are necessary.

None Declared

Suicide attempts (SA) leading to highly lethal consequences have been associated with heightened suicide planning (Barker et al., 2022), along with deficits in social cognition (Levi-Belz et al., 2022). Hypomentalizing, characterized by excessive uncertainty regarding mental states, may contribute to heightened social withdrawal and an increased risk of SA (Nestor & Sutherland, 2022). Although certain studies have identified a connection between hypomentalizing profiles and self-harm (Badoud et al., 2015), research into the lethality of SA remains limited.

This study aimed to explore the association between hypomentalizing and SA lethality.

Our study encompassed a cohort of 1,371 patients who committed a SA. We conducted assessments of mentalizing using the RFQ-8 instrument, and evaluations of suicidal ideation and behavior employing the CSRSS questionnaire. Demographic and clinical characteristics were compared using the T-student and Chi-square tests. To investigate the relationship between hypomentalizing and the SA lethality, we employed logistic regression models.

Descriptive date are presented in Table 1. Our results show that hypomentalizing do not predict a higher SA lethality. Additionally, hypomentalizing increased the risk of SA planning (p≤0.001, B=-0.182), and SA planning predicted a higher SA lethality (see Table 2).Table 1.

Means Comparison for low and high lethality (N=1371)

While the association between hypomentalizing and high SA lethality was not significant, a discernible trend toward such relationship can be noted. Further studies examining the moderating effects of planning in the association between hypomentalizing and SA lethality are required.

None Declared

Psychotic patients are a vulnerable population from a social and health point of view. The SARS Cov-2 pandemic affected millions of people around the world, however, its effects on psychotic patients in Avilés Spain, have not been analized.

The objective of this study was to determine and compare the mortality of patients with psychosis due to SARS Cov-2 in Avilés, Spain with others regions and countries in the European Union. Determine the influence of social condition and antipsychotic treatment on the condition of these patients.

This is a descriptive, observational study, in which patients diagnosed with psychosis in the period 2020-2021 who contracted SARS Cov-2 infection in Avilés, Spain, were studied to determine those who died from this cause. The influence of social status and antipsychotic medication, as well as sociodemographic factors (age, sex, marital status) were analyzed and compared with other regions and countries of the European Union.

Despite the high mortality rate in patients with psychosis, during the years of the pandemic SARS Cov-2 played an important role given the vulnerability of these patients.

The negative effects and deaths during the COVID-19 pandemic were at the time a major problem for public health worldwide. This study concluded that the morbidity and mortality of psychotic patients who contracted COVID-19 was lower than the rest of the population.

None Declared