To understand healthcare workers’ (HCWs) beliefs and practices toward blood culture (BCx) use.

Cross-sectional electronic survey and semi-structured interviews.

Academic hospitals in the United States.

HCWs involved in BCx ordering and collection in adult intensive care units (ICU) and wards.

We administered an anonymous electronic survey to HCWs and conducted semi-structured interviews with unit staff and quality improvement (QI) leaders in these institutions to understand their perspectives regarding BCx stewardship between February and November 2023.

Of 314 HCWs who responded to the survey, most (67.4%) were physicians and were involved in BCx ordering (82.3%). Most survey respondents reported that clinicians had a low threshold to culture patients for fever (84.4%) and agreed they could safely reduce the number of BCx obtained in their units (65%). However, only half of them believed BCx was overused. Although most made BCx decisions as a team (74.1%), a minority reported these team discussions occurred daily (42.4%). A third of respondents reported not usually collecting the correct volume per BCx bottle, half were unaware of the improved sensitivity of 2 BCx sets, and most were unsure of the nationally recommended BCx contamination threshold (87.5%). Knowledge regarding the utility of BCx for common infections was limited.

HCWs’ understanding of best collection practices and yield of BCx was limited.

Both childhood adversity (CA) and first-episode psychosis (FEP) have been linked to alterations in cortical thickness (CT). The interactive effects between different types of CAs and FEP on CT remain understudied.

One-hundred sixteen individuals with FEP (mean age = 23.8 ± 6.9 years, 34% females, 80.2% non-affective FEP) and 98 healthy controls (HCs) (mean age = 24.4 ± 6.2 years, 43% females) reported the presence/absence of CA <17 years using an adapted version of the Childhood Experience of Care and Abuse (CECA.Q) and the Retrospective Bullying Questionnaire (RBQ) and underwent magnetic resonance imaging (MRI) scans. Correlation analyses were used to assess associations between brain maps of CA and FEP effects. General linear models (GLMs) were performed to assess the interaction effects of CA and FEP on CT.

Eighty-three individuals with FEP and 83 HCs reported exposure to at least one CA. CT alterations in FEP were similar to those found in participants exposed to separation from parents, bullying, parental discord, household poverty, and sexual abuse (r = 0.50 to 0.25). Exposure to neglect (β = −0.24, 95% CI [−0.37 to −0.12], p = 0.016) and overall maltreatment (β = −0.13, 95% CI [−0.20 to −0.06], p = 0.043) were associated with cortical thinning in the right medial orbitofrontal region.

Cortical alterations in individuals with FEP are similar to those observed in the context of socio-environmental adversity. Neglect and maltreatment may contribute to CT reductions in FEP. Our findings provide new insights into the specific neurobiological effects of CA in early psychosis.

The association between cannabis and psychosis is established, but the role of underlying genetics is unclear. We used data from the EU-GEI case-control study and UK Biobank to examine the independent and combined effect of heavy cannabis use and schizophrenia polygenic risk score (PRS) on risk for psychosis.

Genome-wide association study summary statistics from the Psychiatric Genomics Consortium and the Genomic Psychiatry Cohort were used to calculate schizophrenia and cannabis use disorder (CUD) PRS for 1098 participants from the EU-GEI study and 143600 from the UK Biobank. Both datasets had information on cannabis use.

In both samples, schizophrenia PRS and cannabis use independently increased risk of psychosis. Schizophrenia PRS was not associated with patterns of cannabis use in the EU-GEI cases or controls or UK Biobank cases. It was associated with lifetime and daily cannabis use among UK Biobank participants without psychosis, but the effect was substantially reduced when CUD PRS was included in the model. In the EU-GEI sample, regular users of high-potency cannabis had the highest odds of being a case independently of schizophrenia PRS (OR daily use high-potency cannabis adjusted for PRS = 5.09, 95% CI 3.08–8.43, p = 3.21 × 10−10). We found no evidence of interaction between schizophrenia PRS and patterns of cannabis use.

Regular use of high-potency cannabis remains a strong predictor of psychotic disorder independently of schizophrenia PRS, which does not seem to be associated with heavy cannabis use. These are important findings at a time of increasing use and potency of cannabis worldwide.

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.

Community-Engaged Research (CEnR) and Community-Based Participatory Research (CBPR) require validated measures and metrics for evaluating research partnerships and outcomes. There is a need to adapt and translate existing measures for practical use with diverse and non-English-speaking communities. This paper describes the Spanish translation and adaptation of Engage for Equity’s Community Engagement Survey (E2 CES), a nationally validated and empirically-supported CEnR evaluation tool, into the full-length “Encuesta Comunitaria,” and a pragmatic shorter version “Fortaleciendo y Uniendo EsfueRzos Transdisciplinarios para Equidad de Salud” (FUERTES).

Community and academic partners from the mainland US, Puerto Rico, and Nicaragua participated in translating and adapting E2 CES, preserving content validity, psychometric properties, and importance to stakeholders of items, scales, and CBPR constructs (contexts, partnership processes, intervention and research actions, and outcomes). Internal consistency was assessed using Cronbach’s alpha and convergent validity was assessed via a correlation matrix among scales.

Encuesta Comunitaria respondents (N = 57) self-identified as primarily Latinos/as/x (97%), female (74%), and academics (61%). Cronbach’s alpha values ranged from 0.72 to 0.88 for items in the context domain to 0.90–0.92 for items in the intervention/research domain. Correlations were found as expected among subscales, with the strongest relationships found for subscales within the same CBPR domain. Results informed the creation of FUERTES.

Encuenta Comunitaria and FUERTES offer CEnR/CBPR practitioners two validated instruments for assessing their research partnering practices, and outcomes. Moreover, FUERTES meets the need for shorter pragmatic tools. These measures can further strengthen CEnR/CBPR involving Latino/a/x communities within the US, Latin America, and globally.

Extremely preterm newborns - EPTN (born ≤28 weeks gestational age) are at increased risk of developing autism spectrum disorders (ASD). Demographic and perinatal risk factors associated with ASD risk in EPTN are understudied.

(i) In EPTN and born at full-term healthy controls (HC), to characterize the emergence of ASD traits and autistic symptom load at age 18 months; (ii) in EPTN, to identify the influence of perinatal characteristics such as sex and gestational age on autistic symptom load at corrected-age 18 months.

Observational, longitudinal, prospective, 18-month follow-up study. We recruited a cohort of n=113 EPTN and n=47 HC (the PremTEA cohort); n=57 EPTN and n=42 HC successfully completed the 18-month follow-up visit. We assessed autistic symptom load & risk at 18 months using the M-CHAT-R/F questionnaire. For all EPTN and HC, we collected demographic and perinatal data. Using GLMs, we assessed, in EPTN, the association between demographic/perinatal variables and 18-month autistic symptom levels.

At 18 months, EPTN children showed higher autistic symptom levels than HC (M-CHAT-R/F score, mean (SD) [range] = 2.21 (3.23) [0-12] in EPTN vs. 0.33 (0.57) [0-2] in HC; d=.873, p=.001. In EPTN, we identified differences by gestational age and sex in autistic symptom levels at 18 months (aR2=0.517, p=.006). In particular, female EPTNs born with lower gestational age showed higher autistic symptom load at age 18 months.

Our findings support the need for early screening of ASD symptomatology in EPTN infants, particularly in higher-risk subgroups, such as female patients born with lower gestational ages.

None Declared

Delirium is common in hospital settings, with approximately 3% to 45% of older patients in hospitals developing delirium during their stay. Among the elderly and those with severe or advanced medical conditions, the reported percentage of patients with delirium is over 56%. The three motor subtypes of delirium are hyperactive, hypoactive, and mixed. Another way to characterize delirium is based on whether it is reversible, irreversible, or terminal.

Identifying appropriate pharmacological treatment options among antipsychotics and their correlation with various precipitating and predisposing factors in the in-hospital context

This was a retrospective, cross-sectional, observational study that utilized a database created by the psychiatry department at the National Medical Center 20 de Noviembre, with data collected from April 2021 to April 2022. The database contains anonymized administrative and clinical data of patients who were seen in the psychiatry department for the diagnosis of any type of delirium, using the CAM scale for classification. The database includes records and data of hospitalized patients, encompassing all specialties at this medical center

A total of 139 patients were included in the study, of which 39% were female and 61% were male, with a mean age of 67 and a median age of 68 years. It was observed that the average duration of delirium symptoms, from receiving the consultation to remission, was approximately 6 days (p <0.005) (OR 5.12-6.62), and the average length of hospital stay was approximately 20 days (OR 17.3-22.09). Among the patients, 50.39% were overweight, 63% had hypertension (HTA), 29% had chronic kidney injury, 24% had a history of delirium, and 73% had recent surgical interventions. Patients with diabetes mellitus had a 3.1 times higher risk, those with HTA had a 2.8 times higher risk, and those with kidney injury had a 3.8 times higher risk of having a positive CAM result. It was observed that haloperidol, used in 84% of the patients, showed the highest percentage reduction in CAM scores

Image:

Image 2:

The results of this study emphasize the importance of identifying risk factors associated with delirium and implementing effective treatment for this condition. It was observed that the average duration of delirium symptoms was approximately 6 days, which is relevant for understanding the course and management of this illness. Furthermore, it was found that the average hospital stay was 20 days, underscoring the burden that delirium can place on healthcare systems.

In conclusion, this study highlights the importance of identifying risk factors and providing appropriate treatment, such as the use of haloperidol, to improve outcomes in patients with delirium.

None Declared

Hydroxychloroquine, an antimalarial drug, is an important therapeutic tool in the management of rheumatic diseases such as Systemic Lupus Erythematosus (SLE) due to its anti-inflammatory action. SLE is a chronic autoimmune inflammatory disease that affects the connective tissue of multiple organs. Neuropsychiatric disturbances in SLE are common; however, lupus psychosis is rare, occurring in 2 to 11% of patients. The literature has described the emergence of neuropsychiatric symptoms as an adverse effect of hydroxychloroquine use, with some patients experiencing clinical depression, anxiety, suicidal ideation, and psychotic symptoms.

The aim of this work is to review the available evidence regarding neuropsychiatric symptoms secondary to the use of hydroxychloroquine.

The case of a 50-year-old woman diagnosed with SLE, with no other relevant medical history, has been evaluated. She was brought to the emergency department due to paranoid and persecutory ideas, as well as self-referentiality, coinciding with the introduction of hydroxychloroquine in her treatment. She was admitted to the University Hospital of Gran Canaria Doctor Negrín with a diagnostic orientation of a first psychotic episode.

The presence of neuropsychiatric symptoms in patients diagnosed with SLE is so common that they constitute a diagnostic criterion for the disease. On the other hand, the medications used for therapeutic management of this disease can lead to the emergence of new neuropsychiatric symptoms or exacerbate preexisting neuropsychiatric clinical manifestations.

The study of this case highlights the challenges in establishing a differential diagnosis between primary SLE symptoms that require an increase in hydroxychloroquine and those caused by its own treatment. It underscores the need for further studies to explore the risk of psychiatric symptoms associated with the use of hydroxychloroquine, as well as its impact on the course of underlying mental disorders.

None Declared

Artificial intelligence (AI) and virtual reality (VR) are useful tools that can improve precision medicine and can prove useful in the clinical care of patients with psychosis.

Our aim was to determine whether AI and VR have been applied to the prediction of clinical response in women with schizophrenia.

A systematic review was carried out in PubMed and Scopus from inception to September 2023 by using the PRISMA guidelines. Search terms: (“artificial intelligence” OR “intelligent support” OR “machine intelligence” OR “machine learning” OR “virtual reality” OR “intelligent agent” OR “neural networks” OR “virtual reality” OR “digital twins”) AND (“schizophrenia” OR “psychosis”) AND (“women” OR gender”). Inclusion criteria: 1)English, French, German or Spanish language, 2) reporting treatment response in schizophrenia (as long as information in women was included), and 3) including AI and VR techniques.

From a total of 320 abstracts initially screened (PubMed:182, Scopus:138), we selected 6 studies that met criteria.

• - Prediction of treatment response. (1) Clinical information, genetic risk score and proxy methylation score have been shown to improve prediction models. (2) Graph-theory-based measures have been combined with machine learning.

• - Therapeutic drug monitoring. (1) A machine learning model has been useful in predicting quetiapine blood concentrations.

• - Pharmacovigilance. (1) Machine learning has connected prolactin levels and response in olanzapine-treated patients. (Zhu et al., 2022).

• - Treatment-resistant schizophrenia (TRS). (1) Women with TRS have been found to receive clozapine less frequently than men (adjusted for sociodemographic, biological and clinical factors). (2) Statistical learning approach: Women have been found to respond better to clozapine than men.

AI, including machine learning, show promising results in the prediction of treatment response in women with schizophrenia. As of yet, digital twins have not been investigated to test specific interventions or to personalize treatment in women with schizophrenia.

None Declared

Treatment Resistant Depression is a challenging condition with a poor outcome and limited therapeutic options. Esketamine is the enantiomer of Ketamine and has recently been approved and marketed for treating depression. Questions remain about its short- and long-term benefit, as well as its usefulness in suicide risk. Hopelessness is one of the symptoms most closely associated with suicide risk.

The aim of this paper is to evaluate the effect of this drug on hopelessness after one month of treatment with Esketamine.

The Beck Hopelessness Scale (BHS) was administered to patients receiving Esketamine at the Doctor Negrín University Hospital of Gran Canaria, who provided informed consent and exhibited suicidal ideations and depressive symptoms at the beginning of treatment. This scale was administered before the intranasal administration of Esketamine and after one month of treatment.

Participants (n=5) had an average age of 54,4 years (median 56). We observed variability in the results among the evaluated patients, although the overall trend was a decrease in scores. On average, the patients’ scores decreased from 14,6 to 7,4 points (with a median change from 14 to 8 points).

Hopelessness improved in the BHS after one month of treatment with Esketamine. These results could be of clinical significance. Hopelessness is associated with suicide risk, so we hypothesize that the improvement could have an impact on it. Nevertheless, we must exercise caution with these results: the sample size is small, patients were taking different medications, and they have diverse medical histories.

None Declared

Interest in the co-occurrence of gender dysphoria and autism spectrum disorder has gained prominence in recent years. Gender dysphoria refers to the distress experienced when there is an incongruence between gender identity and sex assigned at birth. On the other hand, autism spectrum disorder is characterized by difficulties in communication and social interaction, as well as restrictive and repetitive patterns of behavior.

The aim of this paper is to review the current available literature in order to expand our knowledge about gender identity and dysphoria in the population with autism spectrum disorder.

A qualitative review was conducted over the last 20 years, using the Medline database through PubMed. Combinations of MeSH terms related to gender identity and people with autism spectrum disorder were used, selecting those studies in English, French or Spanish that met the objectives of the review, excluding references in other languages. The scientific evidence obtained was analyzed and synthesized.

The development of gender identity of people with autism spectrum disorder can be a complex process. Comparing the general population with the population with autism spectrum disorder, a higher prevalence of gender dysphoria has been evidenced in the population with autism spectrum disorder, and within this group when segmented by gender, greater in women than in men.

This review highlights the importance of increasing knowledge about sexuality and gender dysphoria in people with autism spectrum disorder in order to facilitate the development, understanding and acceptance of their gender identity and sexual orientation of these people.

None Declared

Sexual unwellness (SU) has been linked to a lack of sexual satisfaction and to an incapacity to maintain sexual relations.

The objective of this cross-cultural study is to shed light on older adults’ perspectives on SU across cultures.

Eighty-three older participants (65 to 98 years of age) took part in this qualitative study. Participants lived in the community and were of two different nationalities (Portuguese and Mexican). Semi-structured interviews were conducted, and content analysis was then carried out.

SU emerged in the findings of the content analysis through six themes: Dissatisfying Sexual Experiences; Feelings of Isolation; Spirituality; Medication; Unattractiveness and Pain. The most common theme among older Portuguese participants was ‘Dissatisfying Sexual Experiences’ (25.5%). ‘Feelings of Isolation’ was most common among older Mexican participants (13.7%).

A diversity of experiences of older adults in relation to SU was highlighted in this study. Moreover, cross-cultural research on the construct of SU is essential for understanding the cultural differences in the conceptualization of the construct and how these themes may influence the quality of sexual life in old age.

None Declared

There are many theoretical reasons to implement gender-specific care for schizophrenia. For all these reasons, the Mutua Terrassa-Functional Unit for Women with Schizophrenia was inaugurated in January 2023 in the context of a community mental health service.

Our aim today is to describe the health care model applied in this newly initiated unit.

We created a healthcare model in our new unit consisting of A)Five observatories of Health (somatic morbi-mortality, hyperprolactinemia-HPRL, substance use disorders, social exclusion/discrimination, and drug safety); B)Monitoring stations or vigilance teams (reflecting the 5 observatories); and C)resulting actions (specific interventions). The observatory teams each meet monthly. In this presentation, according to the healthcare model we implemented, we first describe data about the original patient recruitment and then focus on the observatories of somatic morbi-mortality and hyperprolactinemia.

From 265 potentially eligible women, 42 were included in the 5 observatories. (A) of the 11 women in the observatory of somatic morbi-mortality, 10 women had died within the last 24 months. Causes of Death: (1)respiratory tract disease (n=5,45.4%), (2)cancer (n=3;27.3%): lung cancer (n=1), pancreatic cancer (n=1), kidney cancer (n=1), (3)ischemic colitis (n=1;9%), (4)Alzheimer disease (n=1;9%). 2) Morbidity. One woman had an ongoing glioblastoma. (B)Observatory of HPRL. Eight women with moderate/severe HPRL were included. Strategies for lowering prolactin levels were discussed with neuroendocrinologists. Interventions:adjunctive aripiprazole (n=3), switch to aripiprazole (n=2), lowering antipsychotic doses (n=2), and adjunctive cabergoline (n=1).

Designating special teams to focus on specific problems of women with schizophrenia will reduce morbidity and improve outcomes in this vulnerable population.

None Declared

The relationship between Borderline Personality Disorder and Attention Deficit Hyperactivity Disorder has been highlighted in different studies over the last few years, with an estimated prevalence of around 15-35% of ADHD in adult patients diagnosed with BPD and a 7.4 times higher risk of developing BPD in patients diagnosed with ADHD.

To conduct a pragmatic review of the recent literature on the relationship between ADHD and BPD, so that it serves as a starting point for an in-depth study of the sociodemographic, clinical and cross-sectional dimensional factors of both disorders.

A bibliographic review of scientific articles published in recent years, in English and Spanish, extracted from the MEDLINE database, which delve into the relationship between BPD and ADHD, will be carried out. In addition, the common psychopathological dimensions, such as impulsivity or emotional dysregulation, as well as the weight of other dimensional factors related to both disorders, will be studied.

The results of the selected articles will be grouped, for a better understanding, in the following sections:

• - Clinical factors and shared comorbidities.

• - Psychopathological dimensions: impulsivity and emotional dysregulation.

• - Other common dimensional factors.

There are common symptoms and etiological or perpetuating factors, as well as comorbidities shared in both conditions, which in many cases make the correct diagnosis and, therefore, the appropriate therapeutic approach to these patients, quite difficult. Taking into account the differential characteristics of BPD and ADHD, it is possible to create different profiles that allow a precise approach to both disorders in those cases in which they coexist in the same patient.

None Declared

New drugs in the treatment of dual psychosis: use of cariprazine in schizophrenia, other psychotic disorders and use of cocaine. A case series in a specific outpatient psychiatric clinic for substance use disorders.

The main objective of this case series is to observe and describe the tolerability and clinical response to different doses of cariprazine in a series of patients with dual psychosis, especifically cocaine users; with a special attention upon psychotic symptoms, disruptive behaviour, affective symptoms and cocaine use pattern.

This series consists of an observation of a total of 20 patients treated on an outpatient basis. All of them had a either a diagnosis of Schizophrenia or Other Non Specified Psychotic Disorder meeting the DSM-5 criteria, as well as a Cocaine Use Related Disorder meeting the DSM-5 criteria. All of them received treatment with cariprazine in different doses from 1,5mg to 6mg per day, as a solo treatment or as an adjuvant to another previous antipsychotic treatment when antipsychotic augmentation was justified. We observed patients that had started cariprazine in the past three months and that had active drug use or had had one in the past three months.

We monitored the tolerance to the treatment, the clinical response in terms of positive and negative symptoms of schizophrenia, affective symptoms, disruptive behavior, and the response in terms of substance use; for a period of six months of follow-up, with psychiatric consultation at least every month and nurse consultation every two weeks in our clinic.

95% of the patients did not present any side effect related to cariprazine. In one patient (5%) the treatment had to be stopped due to akathisia that did not disappear after two weeks and symptomatic treatment with benzodiacepines. 60% of patients either stopped using (50%) or reduced their use frequency (50%). 70% of the patients presented an improvement in positive symptoms and behavior. Also, one third of them presented a slight improvement in negative symptoms. 20% of patients referred a significant improve in depressive symptoms.

The main conclusion of this case series is that cariprazine at any dosis between 3mg and 6mg per day has a positive outcome, both in the psychotic domain and the substance use disorder. We hope this case series will help our colleagues treat their patients suffering from these pathologies in an optimal way. This could also set a basis to encourage a proper clinical trial to assess if new antipsychotics such as cariprazine could be a new standard for the treatment of Dual Disorders.

None Declared