Children and adolescents with ASD are more likely to have eating problems compared to the general population of the same age, one of the disorders whose prevalence is increased in people with ASD is avoidant/restrictive eating disorder Food (ARFID) ARFID is characterized by a lack of interest in eating or avoidance of food intake, which in the case of people with ASD is usually related to impaired sensory processing and cognitive rigidity. For this reason, the Autism Day Hospital carries out a specific food intervention program.

To retrospectively evaluate the results of the Food Program of the Autism Day Hospital during the year 2022.

A retrospective analysis of the cases of patients admitted to the Food Program of the Autism Day Hospital during the year 2022 is carried out. Results of the sensory pattern and presence of genetic alterations of each one of the patients are compared. And the results of the intervention are evaluated by quantifying the new foods introduced into the diet at the end of the admission.

The sample is made up of a total of 5 children (4 boys and 1 girl) aged between 7 and 12 years. All of them meet diagnostic criteria for Autism Spectrum Disorder and present comorbidity with ARFID. Of the total sample, 1 of the patients presented in the genetic study a microdeletion S. in 15q13.3, duplication in 2q13 and duplication in 5p12-p11, with the genetic studies in the rest of the patients in the sample being normal. Regarding the results of the sensory pattern (Infant/Toddler Sensory profile test), all the patients presented differences in relation to other children of their age in the oral sensory pattern, this difference being definitive in 3 of the 5 patients in the sample. All the patients included in the program presented a satisfactory evolution, introducing at least 15-20 new foods into their usual diet, including different textures and consistencies.

The therapeutic approach to ARFID in children with ASD carried out from a multidisciplinary perspective; sensory integration, behavioral approach and, if necessary, psychopharmacological, has shown, based on the results obtained from the food program of the ASD Day Hospital, a favorable evolution of the eating disorder. For this reason, we consider the detection of this typical comorbidity of ASD and its referral to specific therapeutic programs to be of special importance.

None Declared

The ASD Therapeutic Day Unit is a tertiary care unit that consists of 20 beds, designed to facilitate the evaluation and treatment of children and adolescents with ASD who present high psychiatric comorbidity with behavioral problems, communication/language problems, sensory, and/or in the management of their repetitive and restricted interests. In addition to diagnosis and genetic counseling and clinical care, we offer the possibility of performing an individualized pharmacogenetic study in order to offer appropriate pharmacological treatment to patients with ASD and comorbidities.

The objective is to promote pharmacological tolerability, avoid unwanted side effects, as well as avoid the use of polypharmacy, in children with a tendency to poor drug metabolism.

A review of the medical history of the patients included in the Blood Extraction Program of the ASD Day Therapeutic Unit is carried out during the year 2022. The existing medications at admission, the results of the pharmacogenetic analyzes carried out, and the pertinent changes in the pharmacological treatment of these children.

37 children were included in the program during 2022. The genes CYP1A2, CYP2C19, CYP2D6, CYP3A4 and 5-HTT were analyzed. The variant studied is described, as well as the observed genotype and the expected phenotype.

Of the 37 patients, 11 maintained the same pharmacological treatment as at the beginning of admission, 5 were not taking pharmacological treatment and 25 underwent a treatment modification.

The most frequently modified treatment was risperidone with aripiprazole (n=10), secondly risperidone with guanfacine (n=5), and thirdly fluoxetine with aripiprazole (n=2).

Furthermore, the degree of pharmacological polytreatment was reduced. 18 patients switched to a single drug, instead of 14. 11 patients 2 drugs (instead of 14), 3 patients 3 drugs instead of 4 and 5 patients remained without drug treatment.

Patients with ASD have worse tolerability to pharmacological treatments than other patients with severe mental disorders.

The use of pharmacogenetics allows improving the cost/effectiveness of medical prescription, avoiding undesirable side effects or lack of effectiveness in the treatment of patients with ASD.

Promoting the implementation of pharmacogenetics in patients with ASD (among others) would improve the clinical situation of these patients more effectively and would improve the economic expenditure derived from erroneous prescription and/or excessive polypharmacy.

None Declared

The ASD Day Therapeutic Unit of the HUMT is an interdisciplinary reference center specialized in ASD, for the care of children and adolescents with this pathology, that offers care by programs with the aim of achieving functionality altered.

The main objective of this study is to know the clinical characteristics of the patients admitted to our center and to offer preliminary data on the functional improvement achieved in a pilot program that works by processes.

This is a prospective clinical study of patients with ASD, treated at the ASD Day Therapeutic Unit of the Hospital Universitario Mutua Terrassa (HUMT), since februay 2022 till nowadays. We compare the clinical improvement and functionality acquired through the evaluation through various scales: Conners scale, SRS, BRIEF and CBCL.

Our sample is made up of 19 patients with ASD who are admitted to the HUMT ASD Day Hospital. 13 belonged to the intensive care program, 5 to recovery of low-functioning functionality, and 1 to the differential diagnosis program. 84.21% (n=16) have preserved cognitive capacity. The median age is 13.1 years. 73.7% of the sample are men.

We observed that 89% of patients admitted to our unit presented comorbid symptoms with ADHD. more than 78.9% present isolation, anxiety/depression, altered thinking and attention difficulties. 13/19 present a SEVERE RANGE of affectation upon admission, in social area. Facing discharge, the CBCL shows us a general improvement in behavior and comorbidity in the total scale. The SRS shows us an improvement in social awareness, social communication, social motivation, repetitive behavior and stereotypes and in the total score.

Specific interventions in social skills, autonomy, social understanding, daily routines, and sensory integration in patients with ASD improve core symptoms, as well as associated behavior.

Specific interventions and working on social relationships during admission improve comorbidity derived from ASD.

More studies are needed to specify the most efficient interventions to improve the quality of life in children and teenagers with ASD.

None Declared

While it is well known that there is an interaction between sleep disorders and substance abuse, it is certainly more complex than was previously thought. The effects on sleep depend on the substance used, but it has been shown that both during use and in withdrawal periods consumers have various sleep problems, and basically more fragmented sleep. We know that sleep problems must be taken into account to prevent addiction relapses.

To explain the different sleep disorders caused by substances such as alcohol and cannabis

As an example of this, two cases are introduced: the first one, a 17-year-old boy, who is diagnosed with ADHD with daily cannabis use since the age of 14. As a result of reducing consumption, he presents an episode of sleep paralysis that he had not previously had. The second one is a 50-year-old man diagnosed with a personality disorder and with dependence on cannabis and alcohol for years. He currently has abstinence from alcohol for months and maintains daily cannabis use. However, he has long-standing sleep pattern disturbances and frequent depersonalization phenomena at night.

Alcohol at low doses has no clear effects on sleep architecture. At higher doses it decreases sleep latency, as well as awakenings. In chronic alcoholic patients, a decrease in deep slow sleep, and more fragmented sleep have been found. Cannabis withdrawal reduces sleep quality, increases latency, and produces strange dreams.

There is a positive relationship both between having a substance use disorder and suffering from a sleep disorder.

No significant relationships.

Attention deficit hyperactivity disorder (ADHD) is a neurobehavioral disorder, characterized by developmentally inappropriate levels of overactivity, inattention and impulsivity. Measuring inattention is a controversial question in ADHD diagnosis. Eye movement could provide a method to assess distractibility. Several studies have related visual attention and perceptual dominance in binocular rivalry.

To assess visual attention through the measurement of fixations in a binocular rivalry task in ADHD children and control groups.

We proposed a task for the assessment of distractibility and to enhance the diagnosis of attention disorders.

Forty children, 20 with ADHD-combined type and 20 controls, matched by gender, age and intelligence, were tested with a binocular rivalry task (i.e. an anaglyph image) with an exogenous distractor appearing regularly. The stimulus was divided in four Areas of Interest (AOI). Measurements of duration of the periods of exclusive dominance, perceptual alternations in dominance / suppression and fixations were taken by an eye tracker and a response box. Analysis of Variance was used to test differences between ADHD and control groups.

Significant differences between ADHD and control groups were found in dwells at the main AOI. Also, significant differences between groups in “Fixation over alternations ratio” were found.

ADHD participants looked at the relevant region (AOI_1) for a shorter time than the control group; they also looked at the no demanded regions (AOI_2, AOI_3, AOI_4) longer than the control group. Moreover, the ratio fixations/alternations were greater for the control group than the ADHD group.

Psychotic spectrum diseases are one of the most expensive illnesses in our society. Being able to recover as much social and laboral activity as possible has to be the goal. Trying to achieve this objective, we face different problems, as for example therapeutic adherence.

Show the importance of an adequate treatment and adherence in order to keep the patient as much integrated in the society as possible, and in order to reduce the economic and social cost of the psychotic spectrum diseases.

Case report and bibliography review.

The patient of this case is a 34 year old woman with a schizophrenia diagnosis given after 4 hospitalizations in psychiatry units. She had 4 years of stabilization taking an injectable antipsychotic, in which she was able to study and keep adequate familiar and sentimental relationships. After being badly recommended to retire her medication for some who identified himself as member of the “new psychiatry”, she began with new delusions and hallucinations which had to be treated at the Hospital Psychiatry Unit. She was close to get a statal job related to her architecture studies, but she was not able to go to the exam due to the exacerbation of her illness. In the review we see that the average economic cost per schizophrenic patient in developed European countries such as Germany is, at least, 14000€ per patient.

Adequate treatment adherence is highly important to keep an adequate control of the illness in order to sustain the better social live and job function.

The authors have not supplied their declaration of competing interest.

Alcoholic hallucinosis is a rare complication of chronic alcohol abuse, characterized by acoustic verbal hallucinations and delusions, mainly of a menacing content, arising in clear consciousness, that appear during or shortly after a period of heavy alcohol consumption.

To outline the key clinical features of alcoholic hallucinosis in order to improve differential diagnosis with other entities.

We studied the evolution of an outpatient followed in a Mental Health Centre of Valladolid and compared it with present data about the condition, found in a bibliographic search of articles no older than 10 years about the topic.

Partial insight about the experience, along with clear consciousness, was key to discard other psychiatric diagnosis that also present acoustic hallucinations. Neuroimagining and functional tests in our patient showed moderate cognitive impairment and cortical atrophy, which contradicts other studies which claim that an acceptable level of cognition must be present in order to gain the necessary insight to meet the diagnostic criteria.

Alcoholic hallucinosis is a rare form of subacute encephalopathy, secondary to an abrupt stop in a previously chronic and heavy alcohol consumption. Its diagnosis is mainly clinical, and neuroleptics are the most used drug, being abstinence essential for an adequate evolution. The course is usually benign, although the acoustic phenomena may not disappear completely.

The authors have not supplied their declaration of competing interest.

Alcohol consumption represents a significant factor for mortality in the world: 6.3% in men and 1.1% in women. Alcohol use disorder is also very common: 5.4% in men and 1.5% in women. Despite its high frequency and the seriousness of this disorder, only 8% of all alcohol-dependents are ever treated. One potentially interesting treatment option is oriented toward reducing alcohol intake.

To describe one case who has improved his alcohol consumption after starting treatment with nalmefene, an opioid receptor antagonist related to naltrexone.

A 35-year-old male with alcohol use disorder since 2001 came to our consult in November 2015. He was in trouble with his family and he had a liver failure. We offer a new treatment option with nalmefene 18 mg to reduce alcohol consumption.

Before to start nalmefene he drank 21 drinks/week. Six-month later, he decreased alcohol intake until 5 drinks/week with better family relationship and liver function. After starting nalmefene he complained of nausea, so we recommend to take the middle of the pill for next 7 days. After this time he returned to take one pill with good tolerance and no more side effects or withdrawal syndrome.

Nalmefene appears to be effective and safe in reducing heavy drinking and in preventing alcohol withdrawal syndrome due to its opioid receptor antagonism. This case suggests nalmefene is a potential option to help patients, who do not want or cannot get the abstinence, in reducing their alcohol consumption.

The authors have not supplied their declaration of competing interest.

CADASIL (Cerebral Autosomal-Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy), the most common form of hereditary stroke disorder, is characterized by headaches, transient ischemic attacks and psychiatric symptoms which include mood changes, behaviour disorders and variable levels of dementia.

To emphasize the necessity of discarding somatic and neurological processes before a psychiatric diagnosis is reached.

We present a case initially followed in psychiatry and derived to neurology, and compare it with articles no older than ten years, found in a bibliographic search in Medline (PubMed), fitting the next keywords: CADASIL, autosomal dominant encephalopathy, psychiatric symptoms.

The most frequent manifestation of CADASIL is the early age onset of cerebrovascular ischemic attacks, nonetheless, a fair percentage of patients debut with insidious psychiatric symptoms, especially mood changes, behavioural disorders and even mutism. Independently of the age of onset, these symptoms are present at some point of the illness in most cases.

Psychiatric symptoms can be found in a vast number of somatic and neurological disorders, even being the first manifestation of such processes. This challenges diagnosis, and given than the line between brain and mind is blurred and not always clear, cooperation among different specialities is of utmost importance in order to correctly treat the illness as a whole, and not just the sum of the parts.

The authors have not supplied their declaration of competing interest.

Paraphrenia is a poorly defined process whose uncertain origins date back to the German psychiatry mid-nineteenth century. Paraphrenia would be a subtype of schizophrenia characterized by a more benign clinical course in terms of volitional and emotional involvement. Certain types of serious sensoperceptive distortions and paranoid symptoms are characteristics of this clinical variant. Despite its diverse presentation, its chronic development and its presence in the daily lives of the patient, the overall functionality is not deeply affected.

To discuss the validity of this and other clinical processes based on classical clinical descriptions for diagnostic approach of our current patients, in contrast to the common use simplified concept (forgetting in ICD-10 or disappeared in American manuals).

Clinical case a middle-aged woman diagnosed with longstanding paranoid schizophrenia who suffered from a highly systemized delusional and hallucinatory syndrome with chronic evolution after a first relapse due to abandonment of treatment, but keeping high functional performance even during phases of partial remission.

Schizophrenia presents multiple symptomatic and prognostic paths. Classical authors named these different subtypes. Revisiting these subtypes could be useful as a complementary tool for predicting clinical outcome based on their descriptions, especially in the absence of reliable material instruments.

The authors have not supplied their declaration of competing interest.

The main feature of body dysmorphic disorder (BDD) is impairing preoccupation with a physical defect that appears slight to others. Previously, its delusional and nondelusional variants were sorted in two separate categories, but owing to new data suggesting that there are more similitudes than differences between them, DSM-5 now classifies both as levels of insight of the same disorder.

To enunciate the similarities and differences between the two variants of BDD.

To better understand the features and comorbidity of BDD, so as to improve its management and treatment.

Taking DSM-5 and DSM-IV-TR as a reference, we have made a bibliographic search in MEDLINE (PubMed), reviewing articles no older than 5 years that fit into the following keywords: body dysmorphic disorder, delusions, comorbidity, DSM-IV, DSM-5.

Both the delusional and nondelusional form presented many similarities in different validators, which include family and personal history, pathophysiology, core symptoms, comorbidity, course and response to pharmacotherapy.

The new classification of delusional and nondelusional forms of BDD as levels of insight of the same disorder, which places them closer to the obsessive-compulsive spectrum than to the psychotic one, not only improves treatment options, but also reinforces the theory that delusions are not exclusive of psychotic disorders, setting a precedent for the understanding and classification of other disorders with delusional/nondelusional symptoms.

The authors have not supplied their declaration of competing interest.

Adoption constitutes a discontinuity in child care trajectory, that falls into a separation and a lost of reference figures, and therefore, the need to set up new attachment figures into a suitable familiar atmosphere.

This case is a review of how a child adoption process, that can be something positive at first, can also produce many problems in the future, added to dificulties in order to regulate stressing situations and also solving problems.

The clinical case consists in a 25-year-old woman, who suffers from anxiety and self-injure behaviour. She has a diagnosis of non-specified personality disorder with limit characteristics. The patient was adopted a few months after her birth. At the moment she's living with her adoptive father, her adoptive mother passed away when she was 4. At the age of 21, the patient meets her biological mother and since that moment she spends most of the weekends with her. After a few medical appointments, she admits that she has allowed sexual relationships with her biological mother since six months ago.

It's important to appreciate the value of familiar atmosphere, and in addition, the attachment between child and his parental figures. The quality of the attachment is going to have influence in emotional regulation.

Children who have suffered neglect from their biological parents and have been adopted develop attachment behaviours characterized by negative experiences. In spite of being in a good familiar environment, they feel vulnerable and insecure. Early and appropriate attachment experiences can improve relationships between children and their new family.

The authors have not supplied their declaration of competing interest.