Resistant schizophrenia is a schizophrenia subtype characterized by a non-ability to respond to an appropriate antipsychotic treatment in dosage and duration by the patients. These patients show a lower prognostic and symptomatology. The unique drug which has shown efficacy for resistant schizophrenia treatment is clozapine, which is effective in suicide and aggressive behaviour prevention too. Whereas clozapine has numerous and serious adverse effects such as agranulocytosis risk. Because of this, and for guaranteeing an accurate diagnosis of resistant schizophrenia, distinguishing this from pseudo-resistance due to a poor tracing of schizophrenia, clozapine’s plasmatic levels monitoring is recommended in Spain by many clinical practise-guidelines.

This studio has the objective of determining if altered clozapine’s plasmatic levels have predictive potential of therapeutical response and answering what clinical and sociodemographic variables are associated to these anormal plasmatic levels.

In this work, a cross-sectional observational study was carried out in which clinical and sociodemographic data obtained by the Mental Health Unit of the Jerez de la Frontera University Hospital were collected within the research project entitled: "Role of social cognition as a factor psychosocial functioning of the schizophrenic patient” (ECOFUN), of all the participating patients (in total the sample was 141 patients, of which 40 are in treatment with clozapine).

The sample of patients has a mean age of 44 years and medium-high educational levels. The vast majority are men and do not currently consume substances of abuse, and when this consumption occurs, tobacco and alcohol are the most consumed substances. Their total scores on the PANSS and Markova Barrios scales are generally very disparate, but with average values of 55 and 16. It has been obtained as results that there is no significant statistical correlation between the plasma levels of clozapine and the values of the PANSS scale and its subscales in the patients. On the other hand, patients treated with clozapine would present clinical and sociodemographic characteristics practically identical to those of patients treated with other antipsychotics, especially their values on the PANSS scale. In addition, plasma levels of clozapine are correlated, although not significantly, with an improvement in the positive symptomatology of schizophrenia.

As a conclusion, unusually higher values of clozapine are correlated significantly with lower values in positive symptomatology in schizophrenia, but plasmatic levels are not correlated significantly with values of PANSS scale.

None Declared

The “Post-COVID Syndrome” affects approximately 10% of people who have been infected with Covid-19. These people have a physical and mental impact.

The objective of this study is to analyze factors related to poorer mental health in these patients from primary health care.

Cross-sectional study. The study population was post-COVID-19 patients aged 18 years or older and treated by Primary Health Care (PHC). The main variable was Affective state through the Hospital Anxiety and Depression Scale (HADS) questionnaire. The rest of the variables were: Socio-demographic variables, number of residual symptoms, cognitive using the Montreal Cognitive Assessment (MoCA), physical functioning variable will be measured by Sit to Stand Test and Sleep quality through the Insomnia Severity Index (ISI). A bivariate analysis and also a lineal multivariate model were developed. Ethics approval was granted by the Clinical Research Ethics Committee of Aragón (PI21/139 and PI21/454).

A total of 100 individuals participated, of whom, 80 were women and 20 were men. The median scores in HADS was 16 and the interquartile range was 12. Multilevel analysis shows that better physical functioning (sit to stand test) and worse sleep quality (Insomnia severity index) are predictors of worse affective state. The models explain 36.5% of the HADS variance.

It is relevant to take account these variables in the treatment of the affective state of patients with long covid.

None Declared

Long COVID patients have experienced a decline in their quality of life caused, in part but not wholly, by its negative emotional impact. Some of the most prevalent mental symptoms presented by Long COVID patients are anxiety, depression and sleep disorders.

The objective of this study is to increase understanding of the affective state of people diagnosed with Long COVID, the evolution and associated factors.

Longitudinal study of three months of duration. The study population was 100 post-COVID-19 patients aged 18 years or older (80 women and 20 men). The main variable was the affective state through the Hospital Anxiety and Depression Scale (HADS) questionnaire. The rest of the collected variables were: Socio-demographic variables, number of residual symptoms, cognitive functioning using the Montreal Cognitive Assessment (MoCA), physical functioning variable measured by Sit to Stand Test and Sleep quality through the Insomnia Severity Index (ISI). A statistical analysis comparing baseline and 3months follow up measures were performed, using a Student T for related samples statistical. A lineal regression analysing associated factors to a reduction in HADS score was also performed. Ethics approval was granted by the Clinical Research Ethics Committee of Aragón (PI21/139 and PI21/454).

At baseline the score in anxiety, depression and total score were 9,10 (SD: 4,67), 8,25 (SD: 4,51) and 17,35 (SD: 8,43) respectively, and 74% of the participants were considered cases. At three months, there is a slightly decrease but not significative in the score of HADS, both in anxiety, depression and total score (pvalue 0,465; 0,236; and 0,216 respectively). 64,4% of the participants had a positive diagnosis of depression/anxiety. About the rest of the variables there were also a slight decrease but without being significant There was not a predictive model that explained the decrease in the HADS score.

The evolution of the people suffering long covid is very slow along the time, and also the affective state.

None Declared

Andalusia is the most highly populated (7,849,799 hab.) region of the Spanish State. It has all the sanitary domains under its own Health Service (Consejería de Salud), and it has undertaken a deep reorganization of the psychiatric services, establishing a new model based on the mental health communitarian alternative that is already completely implanted. Rates of readmission are a method to assess the quality of care and an important tool in the planning of services of mental health.

The aim of this study is to establish if readmission rates are influenced by Human Resources in Psychiatric Community Devices.

Part of FIS Project PI05/90061 ‘Patterns of General Hospital Psychiatric Units Overuse’.

MBDS is a system of hospital register that gathers all the discharges produced in the andalusian hospitals. It is totally trustworthy from 1995, and we have processed data up to 2004.

Our Data Set register 101234 hospital admissions of psychiatric patients.

The number of admissions from patients who enter three times or more throughout the year has been: 22.66%(1995); 24.66% (1996); 31.01%(1997); 30.72%(1998); 34.07%(1999); 35.35%(2000); 36.92%(2001); 32.93%(2002); 31.20%(2003) and 29.36%(2004).

On the other hand, it has been an increase in Mental Health Human Resources Rates: 24.23-100.000 inhab-(1998); 24.19 (1999); 26.01(2000); 28.04(2001); 29.83(2002); 29.16(2003); 29.34(2004) and 29.90(2005).

Increasing human resources in psychiatric community devices do not change revolving-door rates in general hospital acute psychiatric units in a community mental health system.

Alcohol dependence belongs to one of the major risk factors to health worldwide. Alcohol consumption is a significant factor for mortality in the world: 6.3% in men and 1.1% in women. The alcohol use disorder is also very common: 5.4% in men, 1.5% in women. Despite its high frequency and severity of this disorder, only 8% of all alcohol dependents are treated once.

An interesting treatment option is geared toward reducing alcohol intake. Some patients in treatment for alcohol use disorder prefer an initial target of reducing consumption. Nalmefene, an antagonist naltrexone associated with opioid receptors, has been authorized in the European Union to help alcohol-dependent patients reduce their consumption. Antagonists’ opiate receptors are associated with reduced reward in relation to alcohol consumption, thus helping patients in reducing energy consumption.

A man of 39 years old, with a diagnosis of alcohol use disorder and depressive disorder and poor outcome despite different types of treatment (as aversive agents) was treated with nalmefene.

After a few months, nalmefene had a beneficial effect on the patient, with a significant reduction in the number of days of excessive alcohol consumption and total consumption in the sixth month. In addition, treatment was well tolerated, with no observed secondary effects.

Nalmefene appears to be effective and safe in reducing heavy drinking. Drugs such as nalmefene have demonstrated efficacy in association with a biopsychosocial approach to help patients achieve their personal objectives for this disorder.

The authors have not supplied their declaration of competing interest.

More than 60% of patients receiving intensive treatment with first generation antipsychotic manifest some type of clinically significant extrapyramidal side effects. Parkinsonian syndrome is the most common and is characterized by rigidity, tremors, akinesia and bradykinesia and usually improves with discontinuation of antipsychotic drug or anticholinergic association.

It is a 60-year-old man, married with two children. Initiates contact with mental health in 2013 with a diagnosis of adjustment disorder. In February 2014 he requires hospitalisation, establishing the diagnosis of delusional disorder and starting treatment with long-acting injectable paliperidone palmitate (100 mg/month) with remission of psychotic symptoms in a few days. When we receive the patient in our clinic, he presents parkinsonian extrapyramidal symptoms (UKU subscale: 18), with significant functional limitation. We decrease the dose to 75 mg/month and an anticholinergic was added without improvement of Parkinsonian clinic, so we decided to switch to long-acting injectable aripiprazole 400 mg/month, objectifying complete remission of extrapyramidal syndrome (UKU subscale: 0).

The mechanism of action of aripiprazole m LAI (partial agonist of D2 receptors in the brain) without decreases in the nigrostriatal dopamine pathway, of improving extrapyramidal effects associated one other antipsychotics.

The authors have not supplied their declaration of competing interest.

The major depression is associated with decreased cognitive functions in a range of areas, including attention, memory and executive functions. The cognitive symptoms of depression can have a profound effect on the ability of patients to keep out the tasks of daily living, and are significant factors that affect the ability to function both interpersonal and occupational level.

Vortioxetina have a multimodal action acting on various serotonin receptors in addition to inhibiting serotonin reuptake. Vortioxetina, is a new therapeutic tool seems to have shown efficacy in the treatment of cognitive symptoms of depression.

To evaluate this action we have evaluated the cognitive decline in patients with major depression before receiving treatment vortioxetina (whether state or not previously treated with other antidepressants) and at 2, 6 and 12 months after starting treatment with the drug. For that, we’ve used the Verbal Hearing Test King (RAVLT), which evaluates the auditory verbal short-term memory, the learning rate, the retention of information, and the differences between learning and recovery, and testing Digit substitution by symbols (DSST) that perform quick detection of brain dysfunctions by a conventional task.

The results of this study are still under analysis.

The authors have not supplied their declaration of competing interest.