Around the world, people living in objectively difficult circumstances who experience symptoms of generalized anxiety disorder (GAD) do not qualify for a diagnosis because their worry is not ‘excessive’ relative to the context. We carried out the first large-scale, cross-national study to explore the implications of removing this excessiveness requirement.

Data come from the World Health Organization World Mental Health Survey Initiative. A total of 133 614 adults from 12 surveys in Low- or Middle-Income Countries (LMICs) and 16 surveys in High-Income Countries (HICs) were assessed with the Composite International Diagnostic Interview. Non-excessive worriers meeting all other DSM-5 criteria for GAD were compared to respondents meeting all criteria for GAD, and to respondents without GAD, on clinically-relevant correlates.

Removing the excessiveness requirement increases the global lifetime prevalence of GAD from 2.6% to 4.0%, with larger increases in LMICs than HICs. Non-excessive and excessive GAD cases worry about many of the same things, although non-excessive cases worry more about health/welfare of loved ones, and less about personal or non-specific concerns, than excessive cases. Non-excessive cases closely resemble excessive cases in socio-demographic characteristics, family history of GAD, and risk of temporally secondary comorbidity and suicidality. Although non-excessive cases are less severe on average, they report impairment comparable to excessive cases and often seek treatment for GAD symptoms.

Individuals with non-excessive worry who meet all other DSM-5 criteria for GAD are clinically significant cases. Eliminating the excessiveness requirement would lead to a more defensible GAD diagnosis.

There are numerous structured group psychological treatments (GPT), especially in the cognitive behavioral paradigm, which have proven effective. In these TPG, strategies, guidelines, knowledge, etc. are worked and, in many cases, homework is prescribed as an integral part of the treatment. A group context is also generated where people relate, generally with a similar culture, ages, mental health states and life problems

Elucidate which group therapeutic factors (GTF) are valued as most important by patients in their psychological improvement process. Know what our patients consider has helped them most in their GPT, whether the GTF or the content of the therapy (CT), conceptualized as the set of guidelines, knowledge, strategies, exercises and learning carried out with the therapists intrasession and with the material provided intersessions

A total of 36 patients(mean age=51.04 (9.21)); 69.44% women (n=25); with main diagnoses (77.77%, n=28) of adaptive disorder, 6 patients of major depression (16.66%) and 2 unspecified anxiety disorders (5.55%) are included in GPT based on acceptance and commitment therapy (ACT) of Hayes’s (2012) for primary care patients, and on a treatment protocol developed in our clinical health psychology section (Segú et al. PaP 2023; 25 6-18) in long covid patients

Patients are recruited and cared for in the collaboration program with the primary care centers (CPPC), n=22(61.11%), and 12 patients (38.89%) diagnosed with long covid in the specialized post-covid unit of internal medicine, and treated in the clinical health psychology section on the Hospital Clínic of Barcelona (HCB)

Post-treatment evaluation is carried out using the GTF questionnaire, based on Yalom’s Q-short(1985), validated with 11 items, adapted to Spanish (Ribé et al. RAEN 2018; 38(134) 473-89). Patients rate from 1 to 10 how much they consider each FTG has helped them in their improvement process

The relevance of the GTF are: Altruism(8.16), catharsis(7.61), cohesiveness(7.94), corrective recapitulation(6.15); socialization techniques (6.41); self-awareness of reality(6.65); imitative behavior(6.43); participated information(6.69), instill hope(6.39); interpersonal learning (7.07), universality(8.27).

Regarding the other objective, 44.44%(n=16) consider the GTF more important than the content of the therapy in their improvement; 36.11%(n=13) equal importance; 13.88%(n=5) plus the CT and 2 consider that none of it has helped them (5.55%). Total importance CT(7.18/10) and GTF(7.44/10). The perceived help in their improvement process in the GPT(CT + GTF)=7.61/10.

In two structured group treatments, based on ACT, a greater percentage of patients value that the GTFs have helped them more in their improvement process than the CT. The GTFs considered most relevant were universality, altruism, cohesiveness and catharsis.

None Declared

Physical activity is recognised as an important intervention in patients with CHD. However, more data on the actual magnitude of physical training impact on functional capacity in this group of patients are still warranted. We aim to assess effort tolerance in a contemporary cohort of patients with congenital heart disease, regularly following a training programme, in comparison with a matched control group.

Patients with CHD followed at the sports medicine department, who had undergone cardiopulmonary exercise test between 2011 and 2019, were included. Variables recorded were maximum workload, absolute and indexed maximum oxygen consumption, maximum heart rate, absolute and indexed maximum O2 pulse, ventilatory equivalent of CO2 and oxygen consumption/Work. Trend of cardiopulmonary parameters was analysed over time. Maximal workload, maximum oxygen consumption and ventilatory equivalent of CO2 were compared with a control group of patients with a more sedentary lifestyle, matched for diagnosis, gender, age, and body mass index.

Among one hundred and eleven patients, 73 males (66%) were analysed. Median age was 14 (12–17) years. Twenty-nine patients (27%) were practising sports at competitive level. Maximum oxygen consumption and oxygen consumption % of maximum predicted were not significantly different at follow-up as compared with baseline. Follow-up of maximum oxygen consumption was 38.2 ± 9 ml/kg/min versus 38.6 ± 9.2 ml/kg/min (p = NS) and follow-up of %oxygen consumption was 88 ± 20 versus 87 ± 15 (p = NS). Ventilatory equivalent of CO2 significantly improved in the last test as compared with the baseline: 30 ± 4 versus 33 ± 5 (p = 0.002). As compared with the control group, trained patients displayed a significantly higher maximum workload and oxygen consumption, while ventilatory equivalent of CO2 was not significantly different.

In our cohort, patients following a regular training programme displayed a significantly higher functional capacity as compared with not trained control group, irrespective of NYHA class. Objective functional capacity was stable over a median follow-up of 3 years.

To better understand the process of hospital acquisition of innovative medical devices (MDs) and the hospital-based health technology assessment (HB-HTA) pathways in France, an in-depth study based on a quantitative approach is needed. The aim of the present study was to assess through a national survey how HB-HTA is currently implemented in French hospitals and to identify its level of formalization.

A quantitative online survey was conducted among hospitals performing HB-HTA in France, with a focus on the acquisition of innovative MDs for individual use. The survey, conducted between March and June 2022, was developed by a scientific board composed of members of the French-speaking Society for HB-HTA.

Sixty-seven out of 131 surveyed hospitals with HB-HTA activities responded, including 29 university hospitals, 24 nonprofit private hospitals, and 14 local hospitals. Sixty-one respondents (91 percent) reported the existence of a process dedicated to evaluating innovative MDs; of these, 16 declared that their hospitals had a formalized unit with HB-HTA activity. These units were more frequently found in larger hospitals with more than 500 inpatient beds (n = 16, p = 0.0160) and in university hospitals (n = 12, p = 0.0158). No hospital reported any collaboration with HAS, the French national HTA agency.

A diverse range of HB-HTA organizations with different structural levels exist in France for MD procurement linked to the category of hospitals. The study highlights the need for recognition of HB-HTA activity at the regulatory level in France and for direct collaboration between HTA activities performed at local and national levels.

Despite their documented efficacy, substantial proportions of patients discontinue antidepressant medication (ADM) without a doctor's recommendation. The current report integrates data on patient-reported reasons into an investigation of patterns and predictors of ADM discontinuation.

Face-to-face interviews with community samples from 13 countries (n = 30 697) in the World Mental Health (WMH) Surveys included n = 1890 respondents who used ADMs within the past 12 months.

10.9% of 12-month ADM users reported discontinuation-based on recommendation of the prescriber while 15.7% discontinued in the absence of prescriber recommendation. The main patient-reported reason for discontinuation was feeling better (46.6%), which was reported by a higher proportion of patients who discontinued within the first 2 weeks of treatment than later. Perceived ineffectiveness (18.5%), predisposing factors (e.g. fear of dependence) (20.0%), and enabling factors (e.g. inability to afford treatment cost) (5.0%) were much less commonly reported reasons. Discontinuation in the absence of prescriber recommendation was associated with low country income level, being employed, and having above average personal income. Age, prior history of psychotropic medication use, and being prescribed treatment from a psychiatrist rather than from a general medical practitioner, in comparison, were associated with a lower probability of this type of discontinuation. However, these predictors varied substantially depending on patient-reported reasons for discontinuation.

Dropping out early is not necessarily negative with almost half of individuals noting they felt better. The study underscores the diverse reasons given for dropping out and the need to evaluate how and whether dropping out influences short- or long-term functioning.

Bipolar disorder (BD) is a chronic mental disorder characterized by mood instability1. BD is further related to neurocognitive and functional disruptions that remain remarkably stable even when patients are euthymic, leading to poor well-being and quality of life. Mindfulness means paying attention on purpose, in the present moment, and involves different facets such as observing, describing, acting with awareness, non-judging and non-reacting of inner experience. It remains unclear whether mindfulness and its specific facets are differentially associated with different aspects of attention and trait impulsivity in individuals with BD.

To examine associations between different mindfulness facets, and different aspects of attention and trait impulsivity in BD.

This study was approved by the Hospital Clínic Ethics and Research Board (HCB/2017/0432). After informed consent, 94 outpatients, M age = 45.57, SD = 9.8, range 19-61 years, 41.5% Male, 63.8% BD-I according to DSM-5 criteria, in partial or total remission based on Young Mania Rating Scale (YMRS; M = 1.81, SD = 2.11) and Hamilton Depression Rating Scale (HDRS; M = 5.46, SD = 3.71) were enrolled in this study. Participants were evaluated using the Five Facet Mindfulness Questionnaire (FFMQ) to assess Mindfulness, the Trail Making Test (TMT-A) and the Conner’s Continuous Performance test (CPT-II) to assess Attention, and the Barratt Impulsiveness Scale (BIS-11) to assess Impulsivity. Pearson correlations were performed, and statistical significance was evaluated two-sided at the 5% threshold.

Mindfulness-Describing was negatively associated with Cognitive and Non-Planning Impulsivity (r = -.43 and -.28, p < .001), Mindfulness-Acting with Awareness was negatively associated with Cognitive, Motor and Non-Planning Impulsivity (r = -.27 to -.45, p < .001), Mindfulness Non-Judging (r = -.33 and -.34, p < .001) and Non-Reacting (r = -.30 and -.46, p < .001) of inner experience were negatively associated with Cognitive and Motor Impulsivity. No associations were found between neither Mindfulness nor Impulsivity with any aspects of Attention.

Preliminary findings suggest that better performance in specific facets of mindfulness (describing, acting with awareness, non-judging or reacting of inner experience) may be related to a decrease in different aspects of trait impulsivity. Further longitudinal and interventional research is needed on underlying mechanisms. Nonetheless, our study suggests the need for including mindfulness-based approaches to improve behavioral and functional outcomes for those with BD.

This work was supported by the European Union Horizon 2020 research and innovation program (EU.3.1.3. Treating and managing disease: Grant 945151), CIBERSAM, FIS PI17/00941 ISCIII, European Regional Development Fund.

1. Carvalho AF, Firth J, Vieta E. Bipolar Disorder. N Engl J Med. 2020;383(1):58-66. doi:10.1056/NEJMra1906193

None Declared

Bipolar disorder (BD) is a chronic and recurrent mental condition characterized by mood fluctuations between hypomania or mania and depression, with high level of burden and mortality rates (Hayes et al., 2015). Subsyndromal mood symptoms, including residual depression, mania and/or anxiety, are major risk factors for episodic relapses after mood stabilisation (Samalin et al., 2016). A psychological protective mechanism against the occurrence of these maladaptative mood symptoms is dispositional mindfulness (DM). DM refers to paying purposeful attention to present moment experiences with a curious, non-judgmental and accepting attitude (Radford et al., 2014). DM has been barely assessed in BD and there is very little evidence on the relationship between DM, residual mood symptoms and quality of life

To explore associations between DM, residual mood symptoms and quality of life in individuals with BD

After informed consent, a total of 94 adults (Mean age= 45.57 years, 41.50% Male) with diagnosis of BD according to DSM-5 criteria, in full or partial remission,were recruited from the Bipolar and Depressive Disorders Unit at the Hospital Clinic of Barcelona. The ethical committee approved this study. Dispositional mindfulness was assessed using the Mindfulness Attention Awareness Scale (MAAS).The presence of residual depressive symptoms was assessed with the Hamilton Depression Rating Scale (HDRS), residual mania symptoms were assessed with the Young Mania Rating Scale(YMRS), and anxiety symptoms were assessed with the Hamilton Anxiety Rating Scale (HAM-A). The subjective quality of life was assessed with the Quality of Life in Bipolar Disorder Questionnaire (QoL-BD). Pearson correlations were carried out and the level of significance was set at p<0.05

DM was negatively related to residual depressive symptoms (r= -0.283; p=0.009) and to anxiety symptoms (r=-0.345; p<0.001), and positively related to quality of life (r=0.433; p<0.001), but not related to residual manic symptoms in BD

Our preliminary data suggest that BD patients with higher levels of DM may experience less depressive and anxiety subsyndromal symptoms and perceived higher quality of life. No associations were detected regarding mania symptoms. These findings support the use of mindfulness training as an adjunct therapy to pharmacotherapy to reduce residual mood symptoms and improve quality of life in patients with BD

None Declared

Bipolar disorder is a serious mental disorder. Although bipolar disorder I (BDI) might seem to have a more complex evolution and severe prognosis than bipolar disorder II (BDII) because of cross-sectional symptom severity, BDII has a high episode frequency, high rates of psychiatric comorbidities and recurrent suicidal behaviours that impair functioning and quality of life.

To explore whether there are differences between patients with BDI and BDII concerning sociodemographic and clinical variables of interest.

A sample of 407 euthymic patients with bipolar disorder (307 BDI and 100 BDII) being age 18 or older was recruited from the Bipolar and Depressive Disorders Unit of the Hospital Clinic of Barcelona. Sociodemographic and clinical variables were collected through the administration of semi-structured interview and clinical scales. Differences between groups in these variables were analysed using the Mann-Whitney U and Chi-square tests, as appropriate. The level of significance was set at p <0.05.

We found statistically significant differences between both groups. Patients with BD II were older (p<0.001), presented a longer illness duration (p=0,001) and a greater subsyndromal depressive symptomatology (p=0,010). Patients with BDI had a higher number of previous hospitalizations (p<0,001) and higher rates of psychotic symptoms (p<0,001) even during the first episode (p<0,001).

Our data suggests that clinical differences exist between both bipolar subtypes. The episodes may be more serious, with a greater presence of a history of psychosis, and require more hospitalizations in BDI patients. In the BDII group, persistent subsyndromal symptoms may predominate, especially of the depressive pole.

No significant relationships.

Bipolar Disorder (BD) is a severe mental disorder with a high genetic load, in which is relevant to identify potential differences in affective temperaments between both diagnostic subtypes.

To find differences between BDI and BDII patients in affective temperaments evaluated by Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego TEMPS-A.

A sample of 407 euthymic patients with diagnosis of bipolar disorder type I (BDI= 307) or type II (BDII= 100) according to DSM-IV-TR criteria being age 18 or older was recruited from the Bipolar and Depressive Disorders Unit of the Hospital Clinic of Barcelona. Five affective temperaments were evaluated using the TEMPS-A. It was initially verified that the scores of these temperaments do not fulfil the assumption of normality by means of tests. Differences in means were estimated using Mann-Whitney U and Chi square tests (p <0.05) as appropriate, and ANCOVA controlling the effect of confounding variables.

Data revealed that patients with BD II had significantly higher scores in four affective temperaments: dysthymic, cyclothymic, irritable and anxious compared to BDI. After controlling the most relevant moderating variables, BDII patients continued to show higher scores in irritable temperament .

BDII patients present a more irritable temperament than BDI (p=0,037), which can affect the course and management of the disease. It could be suggested that presenting higher scores of these temperaments could be associated with BDII and further studies are needed to replicate this finding since it might help the clinicians in early phases to guide in the diagnostic process.

No significant relationships.

Major depressive disorder (MDD) is characterised by a recurrent course and high comorbidity rates. A lifespan perspective may therefore provide important information regarding health outcomes. The aim of the present study is to examine mental disorders that preceded 12-month MDD diagnosis and the impact of these disorders on depression outcomes.

Data came from 29 cross-sectional community epidemiological surveys of adults in 27 countries (n = 80 190). The Composite International Diagnostic Interview (CIDI) was used to assess 12-month MDD and lifetime DSM-IV disorders with onset prior to the respondent's age at interview. Disorders were grouped into depressive distress disorders, non-depressivedistress disorders, fear disorders and externalising disorders. Depression outcomes included 12-month suicidality, days out of role and impairment in role functioning.

Among respondents with 12-month MDD, 94.9% (s.e. = 0.4) had at least one prior disorder (including previous MDD), and 64.6% (s.e. = 0.9) had at least one prior, non-MDD disorder. Previous non-depressive distress, fear and externalising disorders, but not depressive distress disorders, predicted higher impairment (OR = 1.4–1.6) and suicidality (OR = 1.5–2.5), after adjustment for sociodemographic variables. Further adjustment for MDD characteristics weakened, but did not eliminate, these associations. Associations were largely driven by current comorbidities, but both remitted and current externalising disorders predicted suicidality among respondents with 12-month MDD.

These results illustrate the importance of careful psychiatric history taking regarding current anxiety disorders and lifetime externalising disorders in individuals with MDD.

To report an extremely rare case of malleoincudal osteoma that led to conductive hearing loss despite an unusually normal otomicroscopic appearance, and to highlight the usefulness of costal cartilage for ossicular chain reconstruction after tumour removal.

A 37-year-old woman presented with a 2-year history of progressive, right-sided hearing loss. Physical examination revealed a normal tympanic membrane. Pure tone audiometry showed a right-sided conductive hearing loss. High-resolution computed tomography revealed a right-sided epitympanic mass arising from the malleus head and contiguous with the incus. The patient underwent a closed mastoido-epitympanectomy. The malleus head and the incus with associated malleoincudal osteoma were removed. Ossicular chain reconstruction using costal cartilage was performed at the time of tumour removal.

The possibility of a middle-ear osteoma must be considered in cases of unilateral and progressive conductive hearing loss with a normal otomicroscopic appearance in patients with no history of ear infection, trauma or prior surgery, and with no family history of hearing loss. Surgical treatment is indicated in cases of significant conductive hearing loss. To our knowledge, this is the first case report of malleoincudal osteoma in which the ossicular chain was reconstructed using costal cartilage.