Several studies have called atention to the mental health disorders associated with chemsex -the intentional use of drugs before or during sexual intercourse GBMSM (gay, bisexual and men who have sex with men) population-. Sexualized intravenous drug use is also known as slam or slamsex. There are few studies that analyze the mental health differences between intravenous drug users compared to non-intravenous drug users in chemsex context.

We aim to analyze the relationship between the practice of slamsex and the development of drug-induced psychosis.

A cross-sectional descriptive analysis of a sample of users attended by the non-governmental organization Apoyo Positivo in the program “Sex, Drugs and You” between 2016-2019 was performed.

We included 217 participants. Drug-induced psychosis was found in 80 participants. Drug-induced psychosis was significantly higher in the intravenous drug use group compared to the non-intravenous drug use group (p<0.05).

Previous studies have reported that MSM who practiced chemsex were more likely to experience from different mental health disorders, being psychosis one of the most frequent psychiatric diagnoses. In our study, drug-induced psychosis was higher in participants who engaged in intravenous drug use. Further studies analyzing the relationship between slamsex and drug-induced psychosis are needed.

None Declared

Several studies have called atention to the mental health disorders associated with chemsex --the intentional use of drugs before or during sexual intercourse GBMSM (gay, bisexual and men who have sex with men) population-. Sexualized intravenous drug use is also known as slam or slamsex. There are few studies that analyze the mental health differences between intravenous drug users compared to non-intravenous drug users in chemsex context.

To describe the suicidal behaviour in a sample of users with sexualized drug use (chemsex) attended by the non-governmental organization Apoyo Positivo in the program “Sex, Drugs and You” and to compare the suicidal behaviour between intravenous drug users compared to non-intravenous drug users.

A cross-sectional descriptive analysis of a sample of users attended by the non-governmental organization Apoyo Positivo in the program “Sex, Drugs and You” between 2016-2019 was performed.

We included 217 participants. 37 had attempted suicide at least once. The percentage of chemsex users who have attempted suicide were significantly higher in the intravenous drug use group compared to the non-intravenous drug use group (p<0.05).

Possible risk factors for suicidal behaviour among chemsex users include slamsex. Other possible risk factors previously described in other studies include adversities experienced due to one’s sexual orientation and an increased risk for HIV and other STI infections. Further studies analyzing the relationship between chemsex, slamsex and suicidal behaviour are needed.

None Declared

Several studies have called atention to the mental health disorders associated with chemsex -the intentional use of drugs before or during sexual intercourse GBMSM (gay, bisexual and men who have sex with men) population-. Sexualized intravenous drug use is also known as slam or slamsex. There are few studies that analyze the mental health differences between intravenous drug users compared to non-intravenous drug users in chemsex context.

We aim to describe the mental health outcomes including current and past anxiety disorders diagnosis in a sample of users with sexualized drug use (chemsex) attended by the non-governmental organization Apoyo Positivo in the program “Sex, Drugs and You” and to compare the differences of current and previous diagnosis of anxiety disorders between intravenous drug users compared to non-intravenous drug users.

A cross-sectional descriptive analysis of a sample of users attended by the non-governmental organization Apoyo Positivo in the program “Sex, Drugs and You” between 2016-2019 was performed.

We included 217 participants. Current or past diagnosis of anxiety disorders was found in 142 participants. Anxiety disorders were significantly higher in the intravenous drug use group compared to the non-intravenous drug use group (p<0.05).

Previous studies have reported that MSM who practiced chemsex were more likely to experience from anxiety. In our study, anxiety disorders where higher in participantes who engaged in intravenous drug use. A multidisciplinary team is necessary to address chemsex and provide care and treatment for mental health problems such as anxiety, depression, suicidal behaviour or drug-induced psychosis.

None Declared

Several studies have called atention to the mental health disorders associated with chemsex -the intentional use of drugs before or during sexual intercourse GBMSM (gay, bisexual and men who have sex with men) population-. Sexualized intravenous drug use is also known as slam or slamsex. There are few studies that analyze the mental health differences between intravenous drug users compared to non-intravenous drug users in chemsex context.

We aim to describe the mental health outcomes including current and past depressive disorders diagnosis in a sample of users with sexualized drug use (chemsex) attended by the non-governmental organization Apoyo Positivo in the program “Sex, Drugs and You” and to compare the differences of current and previous diagnosis of depressive disorders between intravenous drug users compared to non-intravenous drug users.

A cross-sectional descriptive analysis of a sample of users attended by the non-govenrmental organization Apoyo Positivo in the program “Sex, Drugs and You” between 2016-2019 was performed.

We included 217 participants. Current or past diagnosis of depression was found in 137 participants. Depressive disorders were significantly higher in the intravenous drug use group compared to the non-intravenous drug use group (p<0.05).

Our study reports high levels of depression in chemsex users. The participants in our sample who engaged in intravenous drug use presented a higher frequency of depressive disorders than non intravenous drug use participants. Further studies analyzing the relationship between chemsex, slamsex and depresssion are needed. A multidisciplinary team is necessary to address chemsex and provide care and mental health treatment to chemsex users.

None Declared

The intentional use of drugs before or during sexual intercourse (chemsex) is a phenomenon of special importance in the MSM (men who have sex with men) population due to its impact on mental, physical and sexual health. Group therapy has been included in several programs for chemsex users.

To describe and to compare the different group therapy treatments for problematic chemsex users in NGOs community treatment settings in Spain.

We conducted several interviews with key informants from 5 NGO in Spain. A qualitative analysis of the different group therapy treatments for problematic chemsex was performed.

Different models of groups were described including: psychoeducational, support, interpersonal process, harm reduction and mindfulness-based cognitive groups. Most of the group interventions developed were support and psychoeducational based. There were fewer interpersonal group and relapse prevention group therapy. The different models of group intervention were considered useful and necessary for deliver information in a culturally sensitive context and for reducing drug use, social isolation and loneliness.

Chemsex is a phenomenon that needs a multidisciplinary approach, including individual and group therapy. Group therapy for problematic chemsex has several advantages over individual model treatments, including the reduction of sense of isolation, loneliness, information and feedback from peers. More research is needed to analyze the implementation and efficacy of group therapy for chemsex users in different contexts.

None Declared

New technologies have been steadily impacting and redefining the health care landscape over the last decades, a process recently enhanced by the covid-19 pandemics . VR is an advanced media that can simulate highly realistic virtual environments, providing a high sense of immersion (the feeling of “being really there”). VR has expanded its healthcare application over the last years. Surprisingly, the acute psychiatry ward has been, so far, systematically left out of the VR application field. Psychiatric wards are complex environments. Patients are frequently admitted against their will and many wards have a locked doors policy, with subsequent feelings of seclusion experienced by patients. Therefore the question emerges: could VR help psychiatry inpatients have a better experience during their hospitalization?

This is a pilot study where psychiatry inpatients are offered a single session with the Oculus Quest 2, where they are immersed in a computer generate scenario provided by a commercially available software (“Nature Treks”). The scenario is a nature-based immersive 360° walk. Patients are allowed to freely explore the scenario with no time restraints.

The STAI (State-Trait Anxiety Inventory), and the PANAS (Positive and Negative Affect Schedule) questionnaires are completed by patients before and after the VR exposure. After exposure, patients are also asked to complete the SUS (System Usability Scale) questionnaire, the IQ-presence questionnaire and the SSQ (Simulator Sickness Questionnaire). Electrophysiological recordings are gathered with the Empatica E4.

Up to date, 4 patients have been recruited. The sessions have lasted around 10 minutes. Reductions in the STAI and the PANAS have been reported by 3 patients (with no statistical significance so far). Usability has been extremely high as reported by the SUS. Minimal adverse reactions to VR use have been reported in the SSQ, mainly dizziness and nausea.

VR has a high potential to ameliorate the conditions of psychiatry inpatients admitted to a close-doors ward. As with many technological novelties, implementation and sustainability will be key. The small evidence provided by this pilot study points out to an initial good acceptability and potential efficacy in some patient-related outcomes.

None Declared

The coronavirus infectious disease 2019 (COVID-19) pandemic has had a deleterious impact in many areas. Given this, efforts have focused on developing effective vaccines and vaccination campaigns have been carried out prioritizing population at risk. This should include mental health patients since they are at higher risk of developing complications or ending up in a critical status. Since it may be sometimes difficult for these patients to access vaccination, hospitalization may be a window of opportunity to evaluate and offer vaccination.

This study aims to retrospectively assess vaccination status and offer during admission of psychiatry inpatients at Hospital Clínic of Barcelona during a 6-month period, in order to determine if there are differences regarding vaccination rates compared to general population and between main diagnostic categories.

We retrospectively evaluated all admitted patients to the acute psychiatry ward. The main collected variables included age, gender, main psychiatric diagnosis, presence of organic comorbidities, vaccination status at admission and vaccination offer during admission. We used descriptive statistics to extract most of the information. A binary logistic regression was also conducted to evaluate whether the main diagnosis, age and gender had some influence upon vaccination status at admission.

Between January 1st and June 30th of 2022, 216 patients were admitted to the psychiatry ward. A total of 42% were female, with a mean age for the whole sample of 42.8 years (SD 14.7). More than half were current smokers (55%), and 46% of the patients had at least one significant organic comorbidity. The percentages of main diagnosis were as follows: addiction 21.3%; bipolar disorder 18.5%; schizophrenia 18.1%; non-specified psychosis 14.4%; depression 7.4%; cognitive impairment 0.9%; personality disorders 6.9%.

Vaccination status was available for 187 patients (86.6%). Of these, 78 patients were fully vaccinated, 68 had an incomplete vaccination status and 41 patients had not received any dose. No differences on the vaccination status were seen based on the psychiatric diagnosis. Among patients with incomplete or no vaccination, 19 patients (17.4%) were offered a vaccination dose. A total of 11 patients accepted and received it (57.9%). In the logistic regression model, the only significant variable predicting an increase in the likelihood of being fully vaccinated was age, with every year of age increasing the probability of full vaccination by 6%.

Our data suggest that routine screening of vaccination status during psychiatric admission and improved strategies for vaccination offer and acceptance should become a priority in psychiatric wards. Given the impact of the pandemics, and the likelihood of new waves or even new pandemics, more research on vaccination strategies among mental health patients is warranted.

None Declared

The aim of this study was to investigate the psychometric properties of the Spanish version of the Stigma of Occupational Stress Scale for Doctors (SOSS-D) and the factors associated with Physician Burnout in Paraguay.

Participants included 747 Paraguayan healthcare workers, aged 24–77 years old, of both sexes. SOSS-D was translated into Spanish and validated through an exploratory and confirmatory factor analysis. Participants were also scored with the Oldenburg Burnout Inventory (OLBI), the CAGE questionnaire, and the stigma subscale of the Perceived Barriers to Psychological Treatment (PBPT) measure.

Three factors had a raw eigenvalue greater than 1, and explained 61.7% of total variance. The confirmatory analysis confirmed that the scale is three-dimensional. The model adjustment was good, according to all fit indices. OLBI results indicate clinically significant disengagement in 85.9% and clinically significant exhaustion in 91.6% of participants. Of the 747 participants, 57.6% reported alcoholic beverage consumption and among those, 19.3% had problematic alcohol consumption according to the CAGE questionnaire. The correlation between SOSS-D and the stigma subscale of the PBPT was statistically significant (r = 0.245, p < 0.001).

The Spanish version of the SOSS-D was found to have good psychometric properties and adequately reproduces the three-dimensional model of the original English version.

Lurasidone is an atypical antipsychotic agent with potential antidepressant effects through its antagonist activity at the 5-HT7 receptor. Although treatment-emergent affective switch (TEAS) induced by second-generation antipsychotics are not frequent, several cases have been reported. To our knowledge, there is no evidence of lurasidone-induced TEAS.

To describe a case of lurasidone-induced mania.

We describe a clinical case of a patient admitted to our psychiatric outpatient unit who developed a manic episode, presumably induced by the introduction of lurasidone. We also conduct a review of the literature on this subject.

A 37-year-old man diagnosed with obsessive-compulsive disorder (OCD) and an alcohol use disorder was hospitalized due to OCD decompensation with depressive symptomatology and suicidal thoughts, and for alcohol detoxification process. Since he had a previous history of clomipramine-induced TEAS, he was started on lurasidone up to 111mg to avoid the use of antidepressants, showing a progressive improvement of depressive symptoms. Thus, the patient was discharged when alcohol detoxification process was completed. Eight days after discharge, the patient began to show manic symptoms, so he had to be readmitted. Lurasidone was discontinued and valproic acid up to 1000mg/day as mood stabilizer was added, presenting a positive remission of manic symptoms.

According to our experience, lurasidone may have induced an affective switch in this patient. Based on our findings, patients and psychiatrists should monitor possible lurasidone-induced mood switching. However, further research is needed in order to back-up this one case report findings.

No significant relationships.

The COVID-19 pandemic entailed several changes in health and medical assistance, economy, and lifestyle. In the Acute Psychiatric Ward of the Hospital Clínic of Barcelona, the implementation of restrictive measures was necessary in order to ensure patients’ safety.

To compare clinical profiles and course of hospitalization of patients admitted before and during the COVID-19 lockdown in our Acute Psychiatric Ward.

All patients admitted from January 7th to February 25th and from March 19th to May 7th of 2020 in the Acute Psychiatric Hospitalization Unit of Hospital Clínic of Barcelona, Spain, were retrospectively included for analysis and divided into two groups according to the period when they were admitted. Statistical analyses were performed using SPSS, 23.0 version.

A total of 117 inpatients were included (73 admitted before lockdown and 44 during lockdown), being 50.4% male, with a mean age of 42.4 (SD 15.73). Patients from the first group presented a significantly higher proportion of antidepressants prescription at discharge (p<0.05) and more substance use disorders (p<0.05). Regarding the lockdown group, 51% of patients manifested COVID-19-related stress. Time of hospitalization was significantly lower in the lockdown group (p<0.05), even though a significantly higher proportion of patients were discharged at home (p<0.05) compared with the first group.

The situation of lockdown led to a series of changes in our unit and also in the profile of patients admitted, having shorter admissions, lower prescription of antidepressants, and often COVID-related stress. These differences should be considered in future situations in which restrictive measures may be necessary.

No significant relationships.

Bipolar Disorder (BD) is a severe recurrent disorder with a complex biogenetic and psychosocial etiology. The immune system cytokines in interaction with the CNS play a role in the pathophysiology.

To compare inflammatory cytokines between BD patients and controls during the manic episode; additionally, compare these cytokines with psychiatric symptoms and cognitive performance during follow-up.

We recruited 25 BD patients in mania with paired controls. We measured baseline IL-2, IL-4, IL-8, IL-10, GM-CSG, TNF- α, and TNF- γ in plasma. We used U-Mann-Whitney for group comparison and Spearman correlation between sub-group follow-up assessments and cytokines.

We found a significant difference in IL-6 between subjects and controls (figure 1). During the follow-up, we found a correlation with psychiatric symptoms, cognition, and cytokines during manic episodes (Table 1). Table 1. Follow-up Correlation with cytokines during a manic episode.

(+): positive correlation; (-): negative correlation. WMT: working-memory test, PST: Processing-speed test.

IL-6 was significantly different in patients with BD during a manic episode regardless of the treatment they were taking. IL-10 at manic episode was negatively correlated to general psychiatric symptoms, IL-4 positive correlated to depressive symptoms, and cognitive performance was positively correlated to TNF- α and TNF- γ at follow-up.

No significant relationships.

The aim of this study is to test the psychometric properties of the Spanish validation of the Fear of COVID-19 Scale (FCV-19S) in a Paraguayan population.

Participants were recruited through an Internet-based survey. All participants whose scores in the Hospital Anxiety and Depression Scale (HADS) and The Fear Questionnaire (FQ) were greater than zero were included. 1245 subjects responded voluntarily: 1077 subjects, scoring >0, were considered.

To establish construct validity of the FCV-19S, an exploratory factor analysis was performed using the KMO test, which was adequate, and the Bartlett sphericity test, which was significant (p <.0001). The CFI, NFI, GFI, TLI and RMSEA indices were used to evaluate the model and showed good adjustment. Cronbach’s α showed valid internal consistency (α = 0.86). This validation was supported by significant correlation (p <.001) with the HADS scale for anxiety and depression and with the FQ scale for specific phobia.

The Spanish version of the FCV-19S is a 7-item scale with two dimensions, psychological symptoms and physiological symptoms, which demonstrated robust psychometric properties in a Paraguayan population.

We conducted a naturalistic, multicenter, 24-hour, nonrandomized, observational study describing for the first time the effectiveness and safety of intramuscular (IM) olanzapine to control agitation and aggression in “real world” patients with psychosis. The data thus obtained was compared with that reported from randomized double-blind clinical trials.

92 patients attending psychiatric emergency settings were enrolled. The study subjects were 44 male and 48 female patients with a mean age of 36.5 ± 12 years and DSM-IV-TR diagnoses of schizophrenia (48.9%), psychotic disorder not specified (23.9%) or bipolar disorder (27.2%). 10 mg IM olanzapine was administered to all patients. An optional second injection was permitted ≥ 2 hours later in line with hospital policy. Evaluations (PANSS-EC and CGI-S) were performed at baseline and 2 and 24 hours following the IM injection.

Two hours after IM olanzapine was administered, a mean decrease of –9.6 in the PANSS-EC from a baseline score of 26.5 was recorded. At the 24-hour endpoint a statistically and clinically significant reduction in the PANSS-EC scores (11.6 ± 5.3) was observed as compared with values at study entry (26.5 ± 5.9) and at 2 hours endpoint (16.9 ± 9.3), which represent a mean decrease of –14.9 and –5.3, respectively.

The present naturalistic study provides naturalistic data on the effectiveness of IM olanzapine in the treatment of acute agitation in patients with schizophrenia or bipolar mania that is in line the data obtained in randomized double-blind clinical trials.

Psychedelic drugs were used extensively in psychotherapy in the 1950s to lower psychological defences and facilitate emotional insight. Thousands of research participants were administered hallucinogens in the context of basic clinical research or therapeutic clinical research, resulting in hundreds of publications. Results across studies were ultimately inconclusive due to such variations in methods and a lack of modern controls and experimental rigour. The growing controversy and sensationalism resulted in increasing restrictions on access to hallucinogens throughout the 1960s (ultimately resulting in the placement of the most popular hallucinogens into Schedule I of the 1970 Controlled Substances Act in the United States).

Renewed human administration research began in the 1990s. Recent clinical studies have administered hallucinogens to evaluate their safety and efficacy in the treatment of psychiatric disorders: specifically, anxiety related to advanced-stage cancer (Grob, 2005), obsessive-compulsive disorder (Moreno, et al., 2006), heroin dependence (Krupitsky, et al., 2007), personal meaning and spiritual significance (Griffiths, et al., 2008), and a meta-analysis of randomized controlled trials of LSD for alcoholism (Krebs,et al., 2012).

Psychedelic-assisted psychotherapy utilizes the acute psychological effects of psychedelic drugs to enhance the normal mechanisms of psychotherapy. The effects of psychedelic psychotherapy are often very pronounced within several days or weeks after a treatment session, but then these effects quickly decline. This phenomenon was termed a “psychedelic afterglow”.

Fhurther research, blinded, randomized, placebo-controlled, methodology should explore the efficacy of hallucinogens.

It is well known the relationship of manic episode with the consumption of different drugs organic diseases, and psychiatric drugs, such as mood stabilizers and antidepressants. There are several commonly used substances, mainly psychostimulant, potentially inducing psychiatric pathology.

To study other possible causes of substance-induced manic episode.

We report a case of manic episode with psychotic symptoms without previous psychiatric background, after consumption of Korean Ginseng.

It is necessary to scrutinize other possible substances, not usually described in the literature related to the onset of psychiatric illness, being necessary to ask about this use during the clinical interview.

Parkinson's disease (PD) is classified primarily as a movement disorder. Psychiatric complications, however, are common during the progression of the disease. Psychosis is rare in untreated patients with PD, but the prevalence rises to 40% during dopaminergic treatment.

We report the clinical course of a ropinirole induced psychosis in a 57-year-old female with PD.

The patient was treated with different antiparkinsonians (rasagiline, ropinirole and levodopa), and after a dosage increase of ropinirole, psychotic symptoms appeared (auditory hallucinations and paranoid delusion). Antipsychotic treatment started with quetiapine and a gradual dose reduction of antiparkisonians. Nevertheless, psychotic symptoms required a hospital admission.

Rasagiline was suspended at admission, the dose of ropinirole was decreased until withdrawal, and the dose of levodopa was reduced. The dose of quetiapine was increased to control psychotic symptoms.

The pathogenesis of psychosis in PD is poorly understood. It has been related with the presence of dementia and concomitant treatment with dopaminergic agonists (DA). According to the literature, pergolide is associated with a significantly increased risk for the development of psychosis, followed by ropinirole, pramipexole and cabergoline, whereas levodopa has the lowest associated risk. Treatment includes, in the first place, suspending anticholinergics and selegiline, and then, amantadine, DA, and entacapone. Finally, levodopa may also be reduced. These patients frequently require antipsychotic treatment that may worsen extrapyramidal symptoms.

Psychosis should be considered in PD, especially in patients treated with DA. Treatment begins with reducing antiparkinsonians and then adding antipsychotics. Clozapine and quetiapine are a good choice.

Previous studies suggest a relationship between decreased serum cholesterollevels and impulsive/aggressive behaviors [1]; howeverwe found just one study in the literature based in eating disorder [2].

To investigate the potentialrelationship between lipid profile (cholesterol, HDL, LDL, triglycerides) andmeasures of impulsivity, aggression or suicidal behavior in a sample of nevertreated patient whit Eating disorder and healthy controls.

The first episode of eatingdisorders group consisted of 199 (age range 14-60) subjects included in DETECTAprogram of Cantabria, Spain, from 2011 to 2013. Other group of 199healthy controls were initially recruited from the community and matched by ageand gender. Socio-demographic information was collected for each subject. Clinicalcharacteristics were ascertained either from clinical charts or by directquestioning the study participants. Lifetime diagnosis of impulse control wasassessed with questionnaires developed ad hoc. Impulsivity was evaluated using self-administered questionnaires, EatingDisorder Inventory and Cloninger's Temperament and Character Inventory.

Differences found betweensubgroups did not differ from those shown in the literature, with higher levelsof impulsivity in the group of Bulimia. However in the partial correlation we did not find a relationship betweencholesterol levels and Impulsivity. We neither found this relationshipbetween suicide attempts, pathological gambling, compulsive buying disorder, self-harm or kleptomania.

Although the biological mechanism between plasma hypocholesterolemia andimpulsive behavior has not been fully elucidated this relationship has beenestablished in others pathologies [3], howeverin eating disorders so far, this theory has not been proved.

Description of a manic episode with psychotic symptoms in a patient by consumption of energy drinks.

Literature review of the relationship between energy drink consumption and the possibility of suffering a manic episode and description of a clinical case.

This case report describes a patient with no history of psychiatric interest suffers a manic episode with psychotic symptoms after consuming high amounts of energy drinks.

To my knowledge, this is one of the few cases that describe a manic episode in relation to the consumption of energy drinks, given this possibility, clinicians should consider asking about the consumption of energy drinks to young people without previous psychiatric history presenting a manic episode.

Gender dysphoria is incoherence between the sex a person feels or expresses and the biological.

Revise the inclusion criteria for hormone therapy and sex reassignment surgery in gender dysphoria. Expose the multidisciplinary approach. Make differential diagnosis with other psychological disorders.

A 45 years old male patient (biological female), who was sent from Endocrinology Unit for a psychiatric evaluation before restart a hormonal treatment. Since his childhood, he has presented dissatisfaction with his sexual characteristics; he has had fantasies and dreams, in which he belonged to the other sex. He has always chosen male activities and male stereotypes companies. He has presented preference for cross-dressing from 9 years. Always felt the sexual attraction for women. He first consulted for this reason in 1995.

It reported favorably to start hormone treatment after completing the eligibility criteria: > 18 years old; knowledge of the effects of hormones; and more 3 months documented real-life experience. The hormone therapy caused the growth of microprolactinoma, which was treated with dopamine agonists until it disappeared and the cessation of galactorrhea. Testosterone treatment is restarted. Laboratory tests are done every 3 months during the first year and then, every 6 months.

Is the gender disphoria a pathology? The EU recommends a reclassification as no pathological disorders in ICD-11. The treatment of gender dysphoria is necessary, and there is no reason to postpone it. The main difficulty is the differential diagnosis; there may be comorbidity with others mental disorders which are not exclusive (psychotic disorder, OCD, personality disorders and other disorders of gender identity).

The authors have not supplied their declaration of competing interest.